In this paper the causes of deficiency of public welfare were analyzed in medical research,and some strategies were proposed to enhance the public welfare of public health care services according to the cardinal principles of new healthcare reform package in 2009.These were benefit to maintain the public welfare of public medical and health care services,and to reach the goal of medical research served as the clinic and the patients.

Objective To explore the anti‐cancer effects of physiological deep‐sea water(PDSW) combined with hyperther‐mia for hepatocellular carcinoma in vitro .Methods Deep‐sea water (DSW) from the south Chinese sea was processed ,and made in‐to PDSW ,detection of some elements .In vitro ,the cultured normal liver cells and human hepatoma QGY‐7703 cells were randomly divided into PDSW group and normal saline(NS) group ,the NS group received saline ,the PDSW group received different concentra‐tions of PDSW .Two groups were heated respectively to 6 h of 40 ℃ or 1 h of 43 ℃ ,24 ,48 ,72 h after the administration of PDSW or saline ,the normal liver cells and QGY‐7703 cells proliferation capacity and toxicity were investigated by MTT assay .At the same time testing PDSW and NS in 40 ℃ 6 h for 10 d state of human liver QGY‐7703 cell clone formation rate .Results The results of MTT assay showed that tumor inhibitory rate were time and concentration dependent in tow groups .Tumor inhibitory rate of PD‐SW group in different time was significantly higher than NS group (P<0 .05) .On the other hand ,the inhibitory of hepatocyte for PDSW group in different time were significantly lower than NS group .In addition ,the clone formation rate of PDSW group was lower than those of NS group(P<0 .05) .Conclusion PDSW can improve the heat tolerance of normal liver cells .When combine with heat ,it can obviously inhibit the growth of human liver cancer QGY‐7703 cells .

Objective To explore the non-HLA gene polymorphisms that influence CMV infection after hematopoietic stem cell transplantation (HSCT).Method Non-HLA gene (ACE,CD14,MPO,MBL) single nucleotide polymorphisms were determined by using sequence-specific primer polymerase chain reaction (PCR-SSP) and sequencing in 64 pairs of donors and recipients before HSCT and the differences of non-HLA gene were analysed in CMV positive and negative patients Results The distribution of ACE gene single nucleotide polymorphism was DD (14/128,10.9％),ID (72/128,56.3％),and Ⅱ (42/128,38.8％).The distribution of CD14-159 allele gene single nucleotide polymorphism was CC (18/128,14.1％),CT (81/128,63.3％),and TT (29/128,22.7％).The distribution of MPO-463 allele gene single nucleotide polyrnorphism was G (100)/128,78.1％),A (2/128,1.6％),and GA (26/128,20.3％).The distribution of MBL gene single nucleotide polymorphism was H (28/128,21.9％),HL (73/128,57.0％),L (27/128,21.1％),Y (87/128,68.0％),YX (38/128,29.7％),X (3/128,2.3％),A (94/128,73.4％),AB (32/ 128,25.0％),and B (2/128,1.6％).The allele frequency of ACE,CD14 and MPO shoed no significant differcence between CMV positive and negative patients The gene frequency of MBL-HL was increased in CMV positive group.Conclusion MBL gene single nucleotide polymorphisrns may influence CMV infection after HSCT.

Objective To explore the effects of physiological deep-sea water(PDSW) on hyperthermal tolerance of Kunming (KM ) mice in the 45 .0 ℃ environment .Methods Deep-sea water from the south Chinese sea was processed ,and the metallic ele-ments dissolved in the DSW were analysed .The mice were randomly divided into 2 groups :the control group received tap water ;the experimental group treated with PDSW for 15 d .And then the mice were fed in the 45 .0 ℃ conditions .The survival time and histo-morphometric analyses of the brain ,lung ,heart ,liver and kidney were investigated .Results The survival time in PDSW-fed group was significantly longer than that of the control group (P< 0 .05) .Moreover ,histomorphometric analyses showed that PDSW could protect the brain ,lung ,heart ,liver and kidney of KM mice from the 45 .0 ℃ conditions .The results of western blot revealed that ex-pression of HSP72 of liver tissues for PDSW-fed group substantially increased ,when compared with the control mice(P< 0 .05) . Conclusion PDSW could improve hyperthermal tolerance of KM mice ,which maybe in the relation with expression of HSP72 pro-moted by PDSW .

To construct a recombinant plasmid Pet23a-M, the gene encoding severe acute respiratory syndrome (SARS) coronavirus membrane protein was amplified by RT-PCR and cloned into the expression plasmid Pet23a. Results of restriction endonuclease analysis, PCR detection and DNA sequencing analysis revealed that the cloned DNA sequence was the same as that reported. The recombinants were transformed into Escherichia coli (E. Coli) BL21 (DE3) and induced by Isopropyl-beta-D-thiogalactopyranoside (IPTG). The expression of 27 kD (1 kD=0.992 1 ku) protein was detected by SDS-PAGE and pured by metal chelated chromatography. Results of Western-blot showed that this expressed protein could react with antibodies in sera of SARS patients during convalescence. This provided the basis for the further study on SARS virus vaccine and diagnostic agents.
Cloning, Molecular ; Escherichia coli/genetics ; Escherichia coli/metabolism ; Membrane Proteins/*biosynthesis ; Membrane Proteins/genetics ; Membrane Proteins/isolation & purification ; Plasmids/biosynthesis ; Plasmids/genetics ; Recombinant Proteins/biosynthesis ; Recombinant Proteins/genetics ; Recombinant Proteins/isolation & purification ; Reverse Transcriptase Polymerase Chain Reaction ; SARS Virus/chemistry ; SARS Virus/*genetics ; Viral Vaccines/biosynthesis

To construct a recombinant plasmid Pet23a-M, the gene encoding severe acute respiratory syndrome (SARS) coronavirus membrane protein was amplified by RT-PCR and cloned into the expression plasmid Pet23a. Results of restriction endonuclease analysis, PCR detection and DNA sequencing analysis revealed that the cloned DNA sequence was the same as that reported. The recombinants were transformed into Escherichia coli (E. Coli) BL21 (DE3) and induced by Isopropyl-beta-D-thiogalactopyranoside (IPTG). The expression of 27 kD (1 kD=0.992 1 ku) protein was detected by SDS-PAGE and pured by metal chelated chromatography. Results of Western-blot showed that this expressed protein could react with antibodies in sera of SARS patients during convalescence. This provided the basis for the further study on SARS virus vaccine and diagnostic agents.
Cloning, Molecular ; Escherichia coli ; genetics ; metabolism ; Humans ; Membrane Proteins ; biosynthesis ; genetics ; isolation & purification ; Plasmids ; biosynthesis ; genetics ; Recombinant Proteins ; biosynthesis ; genetics ; isolation & purification ; Reverse Transcriptase Polymerase Chain Reaction ; SARS Virus ; chemistry ; genetics ; Viral Vaccines ; biosynthesis

Objective:To explore the clinical significance of cervical length (CL) measured by transabdominal ultrasound during fetal structural anomalies screeing at 20-24 +6 weeks of gestation. Methods:This was a retrospective nested case-control study based on a prospective longitudinal cohort of "Prediction and Prevention of Early-onset Preeclampsia", which recruited 4 995 singleton pregnant women at the gestational age of 11-13 +6 weeks in Nanjing Drum Tower Hospital from April 2019 to August 2022. All the subjects underwent second-trimester ultrasound screening for fetal structural anomalies in our hospital with image records. This study excluded the women who were lost to follow-up, underwent cervical cerclage, terminated the pregnancy due to personal or social factors, or had miscarriage before 20 weeks of gestation, and those with iatrogenic preterm births, intrauterine fetal death or no second-trimester cervical sonography images. Propensity score matching was used to match pregnant women with spontaneous preterm birth ( n=101) and those with full-term delivery ( n=101) in a 1∶1 ratio, with factors of maternal age, body mass index, preterm birth history, cesarean section history, and pregnancy interval ≥5 years. CL was measured based on the retained ultrasound images. Nonparametric test or Chi-square test were used for statistical analysis. Receiver operating characteristic (ROC) curve was used to evaluate the correlation between CL measured by transabdominal ultrasound in the second trimester and spontaneous preterm birth. Results:The CL measured by transabdominal ultrasound at 20-24 +6 weeks of gestation was significantly shorter in the spontaneous preterm birth group than that in the full-term group [2.8 cm (2.5-3.3 cm) vs. 3.4 cm (3.0-3.9 cm), Z=－5.85, P<0.001]. If CL<3.4 cm was used as the cut-off value for predicting spontaneous preterm birth (20-36 +6 weeks), the specificity and the sensitivity were 0.50 and 0.77, respectively, and the sensitivity reached 0.92 for predicting preterm birth before 32 weeks and 1.00 for predicting preterm birth before 28 weeks. If CL<3.7 cm was used as the cut-off value, the specificity and the sensitivity were 0.36 and 0.87, respectively, and the sensitivity was 1.00 for predicting preterm birth before 32 weeks. The efficacy of preterm birth screening at 28-36 +6 weeks of gestation was comparable to that at 20-36 +6 weeks, if CL<3.4 cm and CL<3.7 cm were used as the cut-off value, the sensitivity were 0.76 and 0.86, respectively. Conclusion:Transabdominal ultrasound measurement of CL in the second trimester can be a preliminary screening to determine whether further transvaginal ultrasound measurement of CL is needed for women without a history of preterm birth or late spontaneous abortion.

Objective:To construct the gestational‐age‐specific blood pressure curve and percentile blood pressure values of pregnant women in Jiangsu Province, and to explore the clinic significance of the blood pressure changes in women whose blood pressure was less than 140/90 mmHg (1 mmHg=0.133 kPa) in each trimester and eventually developed pregnancy induced hypertension (PIH) or pre-eclampsia (PE).Methods:A prospective longitudinal cohort during pregnancy was built. Singleton pregnant women in the first trimester (11-13 +6 weeks) were recruited from July 2017 to September 2020 in Nanjing Drum Tower Hospital, and were followed up in the second trimester (19-23 +6 weeks), the third trimester (30-33 +6 weeks) and approaching the expected date of delivery (35-38 +6 weeks). The Viewpoint 6.0 software was used to record pregnancy-related information. The blood pressure was measured by standard methods in our clinic. Least mean square (LMS) function was performed to fit the gestational-age-specific blood pressure curve and percentile blood pressure values were calculated at every follow‐up time point. Logistic regression was applied to calculate the OR for the groups with blood pressure ≥95th percentile ( P95). Results:There were 3 728 singleton pregnant women invited in this study, including 3 490 normal pregnant women (93.62%, 3 490/3 728), and 238 pregnant women with PIH or PE (6.38%, 238/3 728). Gestational-age-specific blood pressure curve showed that systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) decreased in the second trimester, compared with those in the first and the third trimester, however the fluctuation of blood pressure was low, but regardless of the gestational age, P95 of SBP, DBP and MAP increased by 14, 11 and 11 mmHg respectively, compared with 50th percentile ( P50). In the first trimester, the risk of developing PIH or PE finally in pregnant women with blood pressure ≥ P95 was 4.36-fold (95% CI: 2.99-6.35) for SBP than women with SBP< P95, 5.22-fold (95% CI: 3.65-7.46) for DBP and 5.14-fold (95% CI: 3.61-7.32) for MAP. When approaching the expected date of delivery, the corresponding risks of the women with blood pressure ≥ P95 were 16.76 times, 27.45 and 27.31 times respectively than those of the women with blood pressure < P95. In the first trimester, every 1 mmHg elevation of SBP the risk developing PIH or PE increased by 24% ( OR=1.24, 95% CI: 1.15-1.33), 44% ( OR=1.44, 95% CI: 1.31-1.59) for DBP and 47% ( OR=1.47, 95% CI: 1.33-1.61) for MAP, respectively. The risk in the second trimester was similar to that in the first trimester, and in the third trimester, the risk was further increased. When approaching the expected date of delivery, DBP or MAP increased by 1 mmHg, the risk developing PIH or PE was double; while SBP increased by 1 mmHg, the risk increased by 58%. The areas under the receiver operator characteristic curves of SBP, DBP and MAP were similar for predicting PIH or PE, and the predictive efficiency were all poor. Conclusions:Construction of percentile blood pressure values for pregnant women is helpful in identification of high-risk women of developing PIH or PE. The risk of PIH or PE in pregnant women with blood pressure ≥ P95 but <140/90 mmHg has significantly increased compared with women with blood pressure < P95.

Objective:To investigate the clinical characteristics of cases with different congenital pulmonary airway malformations (CPAM) volume ratios (CVR) and the effect of maternal glucocorticoid treatment during pregnancy on CPAM.Methods:A retrospective study was conducted on 56 singleton pregnant women with fetal CPAM diagnosed prenatally in the Department of Obstetrics and Gynecology at Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, from September 2020 to May 2023. Among these, three cases received maternal glucocorticoid treatment during pregnancy and clinical conditions were reported in detail. Statistical analyses were performed using independent sample t-tests, non-parametric tests, Chi-square tests, or Fisher's exact test. Results:(1) General information: The average age of the 56 pregnant women with CPAM fetuses was (32.0±0.7) years. All fetuses had unilateral lesions, with 25 cases (44.6%) on the left side. Types Ⅰ, Ⅱ, and Ⅲ CPAM accounted for 5.4% (3/56), 50.0% (28/56), and 44.6% (25/56), respectively. Fetal hydrops occurred in two cases, and the maximum CVR during the fetal period for the other 54 non-hydropic fetuses was 0.79±0.66. (2) The CVR threshold for the risk of fetal hydrops was set as the mean maximum CVR of non-hydropic CPAM fetuses plus 2 standard deviations (0.79+2×0.66=2.1). The subjects were divided into two groups based on the maximum CVR during the fetal period: CVR≤2.0 group ( n=50) and CVR>2.0 group ( n=6). Comparison between the CVR>2.0 group and CVR≤2.0 group: The CVR>2.0 group had significantly higher rates of fetal hydrops [2/6 vs. 0.0% (0/50), Fisher's exact test], mediastinal shift [5/6 vs. 32.0% (16/50), χ 2=4.03], polyhydramnios [6/6 vs. 4.0% (2/50), Fisher's exact test], and postnatal surgery [4/5 vs. 22.2% (10/45), continuity correction χ 2=4.86] (all P<0.05). None of the fetuses with CVR≤2.0 had hydrops or received intrauterine intervention. The overall live birth rate was 89.3% (50/56). (3) Maternal glucocorticoid treatment during pregnancy: three of six fetuses with CVR>2.0 were treated with maternal glucocorticoid during pregnancy, and all were delivered alive at term after the intervention with resolution of edema and/or reduction in mass size. Two of them were treated with postnatal thoracoscopic surgery and were followed up to 5 and 14 months of age, respectively, with no abnormalities in feeding and development; the other was not treated surgically until 3 months of age, with no respiratory-related symptoms and no abnormalities in feeding and development. Conclusions:Prenatal ultrasound indicating CVR>2.0 is associated with increased rates of fetal hydrops, mediastinal shift, and polyhydramnios. Maternal glucocorticoid treatment during pregnancy may lead to favorable pregnancy outcomes for these CPAM fetuses.

Objective:To investigate the effectiveness and prognosis of using improved domestic neonatal ureteral stents (referred to as improved double-J stents) for thoraco-amniotic shunting (TAS) in treating fetal chylothorax.Methods:A retrospective analysis was conducted on the clinical data of 21 cases of fetal chylothorax treated with TAS using improved double-J stents at Nanjing Drum Tower Hospital, Nanjing University Medical School from April 1, 2018, to September 30, 2023. Surgical complications and perinatal outcomes were summarized, and the development of surviving infants in five domains (communication, gross motor, fine motor, problem-solving, and personal-social) was assessed using the Ages and Stages Questionnaires-Third Edition (ASQ-3). Descriptive statistical analysis was used. Results:(1) The median gestational age at prenatal diagnosis was 28.7 weeks (27.3-30.4 weeks), with 85.7% (18/21) of cases complicated by fetal hydrops, 90.5% (19/21) by polyhydramnios, and 85.7% (18/21) by bilateral pleural effusion. (2) The median gestational age at the first TAS was 30.9 weeks (29.7-32.7 weeks). Of the 21 cases, 10 required repeat stent placement due to dislodgement or blockage, with a total of 49 stent placements. The dislodgement rate within 7 days was 24.5% (12/49), and the blockage rate was 16.3% (8/49). The rate of premature rupture of membranes within one week post-stent placement was 9.5% (2/21), with an overall preterm premature rupture of membranes rate of 28.6% (6/21). The median interval from the first TAS to delivery was 30.0 d (19.8-40.0 d). Of the 21 cases, three opted for selective termination of pregnancy; the remaining 18 cases resulted in live births, with a median gestational age at delivery of 35.6 weeks (34.1-37.1 weeks), and three neonatal deaths. The overall neonatal survival rate was 15/18. Surviving infants were followed up to a median age of 30 months (7-48 months), with 13 showing normal development and two scoring below the ASQ-3 threshold.Conclusion:The improved double-J stent can be used for TAS in the treatment of fetal chylothorax, with generally favorable outcomes.