Background The optimal technique for performing caesarean section with respect to minimising postoperative adhesions has not been determined.Objectives To evaluate adhesion formation for three common caesarean section techniques in women undergoing repeat caesarean section surgeries.Search strategy A database was constructed from Medline, EMBASE, Cochrane Library, National Science Digital Library, China Biological Medicine Database and through contact with experts in this field from January 1990 to May 2010.Selection criteria Studies were included if they examined adhesion formation in repeat caesarean sections as a primary objective, delineated a clear study design, specified an adhesion scoring system, and had sufficient patient exclusion criteria.Data collection and analysis We abstracted data regarding adhesion formation. The Mantel-Haenszel random-effects model was employed for all analyses using odds ratio or inverse variance, along with 95% CI.Main results Thirty-three qualified studies including 4423 women were analysed. There were 406 adhesions among 571 women and 238 adhesions among 596 women in the Stark's caesarean section (also known as Misgav-Ladach method) group and modified Stark's caesarean section group, respectively, with pooled OR 4.69 (95% CI 3.32-6.62; P < 0.01, 12 studies); 1173 adhesions among 1555 women and 1179 adhesions among 1625 women in Stark's caesarean section group and classic lowersegment caesarean section group, respectively, with pooled odds ratio 1.28 (95% CI 0.97-1.68; P = 0.08, 21 studies); and 29 adhesions from 102 women and 115 adhesions from 193 women in modified Stark's caesarean section group and classic lowersegment caesarean section group, respectively, with pooled odds ratio 0.28 (95% CI 0.10-0.82; P = 0.02, two studies).Authors' conclusions Closure of the peritoneum in modified Stark's caesarean section resulted in less adhesion formation and should be recommended.Keywords Adhesion, caesarean section, postoperative.

Objectives: The mortality rate of sepsis remains very high. Metabolomic techniques are playing increasingly important roles in diagnosis and treatment in critical care medicine. The purpose of our research was to use untargeted metabolomics to identify and analyze the common differential metabolites among patients with sepsis with differences in their 7-day prognosis and blood PD-1 expression and analyze their correlations with environmental factors.Methods: Plasma samples from 18 patients with sepsis were analyzed by untargeted LC-MS metabolomics. Based on the 7-day prognoses of the sepsis patients or their levels of PD-1 expression on the surface of CD4+ T cells in the blood, we divided the patients into two groups. We used a combination of multidimensional and monodimensional methods for statistical analysis. At the same time, the Spearman correlation analysis method was used to analyze the correlation between the differential metabolites and inflammatory factors.Results: In the positive and negative ionization modes, 16 and 8 differential metabolites were obtained between the 7-day death and survival groups, respectively; 5 and 8 differential metabolites were obtained between the high PD-1 and low PD-1 groups, respectively. We identified three common differential metabolites from the two groups, namely, PC (P-18:0/14:0), 2-ethyl-2-hydroxybutyric acid and glyceraldehyde. Then, we analyzed the correlations between environmental factors and the common differences in metabolites. Among the identified metabolites, 2-ethyl-2-hydroxybutyric acid was positively correlated with the levels of IL-2 and lactic acid (Lac) (P &lt; 0.01 and P &lt; 0.05, respectively).Conclusions: These three metabolites were identified as common differential metabolites between the 7-day prognosis groups and the PD-1 expression level groups of sepsis patients. They may be involved in regulating the expression of PD-1 on the surface of CD4+ T cells through the action of related environmental factors such as IL-2 or Lac, which in turn affects the 7-day prognosis of sepsis patients.

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