Objective: To investigate the current status and influencing factors of sleep disorders among pregnant women, so as to provide insights into health management during pregnancy. Methods: Pregnant women who underwent prenatal checkups at Hangzhou Obstetrics and Gynecology Hospital from January to October 2023 were selected as subjects, and general data including age, pregnancy period and exercise were collected through questionnaire surveys. Sleep quality, pregnancy stress, anxiety and depression were evaluated using Pittsburgh Sleep Quality Index, Pregnancy Stress Rating Scale, Pregnancy-related Anxiety Scale and Edinburgh Postnatal Depression Scale, respectively. Factors affecting sleep disorders among pregnant women were analyzed using a multivariable logistic regression model. Results: A total of 386 pregnant women was surveyed, with a mean age of (30.28±4.65) years, including 20.47% in the first trimester, 47.93% in the second trimester and 31.61% in the third trimester. Women with anxiety and depression accounted for 14.51% and 21.76%, respectively. Pregnancy stress was mainly moderate, accounting for 51.04%. There were 106 pregnant women with sleep disorders, accounting for 27.46%. Mutivariable logistic regression analysis showed that age (≥35 years, OR=1.656, 95%CI: 1.094-2.503), pregnancy period (third pregnancy, OR=2.097, 95%CI: 1.213-3.621), regular exercise in the past 6 months (OR=0.376, 95%CI: 0.210-0.670), anxiety (OR=2.794, 95%CI: 1.545-5.048), depression (OR=3.501, 95%CI: 1.877-6.529) and pregnancy stress (moderate, OR=1.355, 95%CI: 1.018-1.801; severe, OR=2.538, 95%CI: 1.417-4.540) were the factors affecting sleep disorders among pregnant women. Conclusions Sleep disorders of pregnant women is influenced by age, pregnancy period, pregnancy stress, anxiety, depression and exercise. It is necessary to identify high-risk individuals with sleep disorders early, and to provide psychological intervention and prenatal health guidance.

Objective To investigate the predictive value of metastatic lymph node ratio (MLNR) combined with preoperative serum carcinoembryonic antigen (CEA) in the detection of distant metastasis of stage Ⅱ-Ⅲ colon cancer after radical resection.Methods A retrospective study was performed on the clinical data of 325 patients with stage Ⅱ-Ⅲ colon cancer undergoing radical resection in the Second Hospital of Lanzhou University from Jan 2010 to Jan 2015.Results MLNR was correlated with the maximum diameter of tumors,the degree of differentiation of tumors,clinical TNM stage and distant metastasis (P ＜ 0.05),serum CEA was correlated with the maximum diameter of tumors,clinical TNM stage,nerve or vascular invasion and distant metastasis (P ＜ 0.05).Logistic regression analysis showed that low differentiation of tumor tissue,TNM Ⅲ stage,high MLNR and high serum CEA were independent risk factors for distant metastasis of colon cancer after radical operation.Conclusions The combined detection of MLNR and serum CEA has a good predictive value for distant metastasis with stage Ⅱ-Ⅲ colon cancer.

Objective:To summarize the evidence related to the guidance and management of breastfeeding in pregnant women with gestational diabetes mellitus.Methods:UpToDate, BMJ Best Practice, CINAHL, PubMed, Cochrane Library, Embase, Wanfang database, China National Knowledge Infrastructure, and other databases and professional websites were searched by computer for evidence on breastfeeding guidance and management for pregnant women with gestational diabetes mellitus, including clinical decisions, guidelines, evidence summaries, systematic reviews, expert consensus and randomized controlled trials. The search period was from database establishment to April 1, 2023. Two researchers independently conducted literature quality evaluation, evidence extraction, and integration.Results:A total of 23 articles were included, including 4 clinical decision-making articles, 4 guidelines, 4 evidence summaries, 6 systematic reviews, 1 expert consensus and 4 randomized controlled trials. A total of 21 best pieces of evidence were summarized from six aspects of support and education, knowledge and skills, safety issues, feeding issues, dietary care, and blood glucose monitoring.Conclusions:This study summarizes the best evidence on breastfeeding guidance and management for pregnant women with gestational diabetes and suggests that the medical staff should apply the proof according to the clinical situation and the patient's wish.

Objective To investigate the influencing factors of portal vein tumor thrombus in patients with primary liver cancer(PLC).Methods A total of 483 patients with PLC in the Second People's Hospital of Fuyang from January 2012 to December 2016 were included in this retrospective study.Univariate analysis and multi-variate logistic regression analysis were employed to analyze the association between portal vein tumor thrombus and routine clinical parameters.Results The univariate analysis showed that alanine aminotransferase,aspartate aminotransferase,total bilirubin,γ-glutamyltranspeptidase,alkaline phosphatase,alpha-fetoprotein,the size and the number of tumors,ascites and center location of cancer performed a close relationship with the formation of portal vein tumor thrombus in patients with PLC,and the differences were statistically significant(P values were 0.010,0.000,0.010,0.000,0.001,0.000,0.000,0.004 and 0.010).Multivariate logistic regression analysis showed that potential significant predictors of portal vein tumor thrombus in patients with PLC were alpha-fetoprotein and ascites,and the differences were statistically significant(P values were 0.000 and 0.040).Conclusion PLC patients with high level of alpha-fetoprotein and ascites are easier to induce the formation of portal vein tumor thrombus.

Objective:To investigate the efficacy and safety of high semi-decubitus position in the second stage of labor in epidural analgesic delivery of primipara.Methods:A total of 120 women who gave birth in Hang-zhou women's Hospital from May 1,2021 to July 30,2021 were randomly divided into experimental group(n=60)and control group(n=60)by random number table method.The control group adopted supine position in the sec-ond stage of labor,and the experimental group transferred to high semi-supine position after the supine position was used applied for 30 minutes when the fetal head was not exposed.To compare the effects of different postur-al positions on the duration of the second stage of labor,mode of delivery,postpartum injury,perineal tearing,la-bor force experience and labor control,and neonatal asphyxia.Results:The duration of uterine opening to fetal head exposure,the duration of uterine opening to fetal head crown and the duration of second stage of labor in experimental group were shorter than those in control group.The rate of natural delivery of experimental group was higher than that of control group.The episiotomy rate and the second degree perineal laceration rate were lower than that of control group.The amount of blood loss during delivery and 2h postpartum of experimental group was less than that of control group.The scores of birth experience and birth control of experimental group were higher than those of control group,and the differences were statistically significant(P＜0.05).There was no significant difference in 1-minute Agpar score and 5-minute Agpar score between the two groups(P＞0.05).Conclusions:The application of high semi-decubitus position under epidural labor analgesia promoted vaginal natural labor,shortened the time of second stage of labor,reduced episiotomy rate and perineal laceration de-gree,reduced postpartum hemorrhage,had positive labor force experience,and increased the sense of labor con-trol.

Objective To screen key genes for ferroptosis in atherosclerosis(AS)using bioinformatics methods and analyze the biological functions of key genes to gain an in-depth understanding of the pathogenesis of AS.Methods AS gene expression profile chip dataset GSE100927 was downloaded from the Gene Expression Omnibus(GEO)database.P＜0.05 and|logFC＞1|were used as the conditions to screen the differential genes of AS.These genes were intersected with ferroptosis gene dataset to screen out the genes related to AS ferroptosis.Gene ontology(GO)functional annotation and enrichment analysis of Kyoto Encyclopedia of Genes and Genomes(KEGG)were carried out.The STRING online analysis tool combined with Cytoscape visualization software was subsequently used to mine genes that play a key role in the biological process of AS,and the AS dataset GSE9874 was used as the verification set to verify the expression of key genes.Blood samples from 30 confirmed AS patients in the cardiovascular department of our hospital from January to March 2023 were collected as the experimental group,while blood samples from 20 healthy volunteers were collected as the control group.Sample RNA was extracted,and quantitative real time polymerase chain reaction(qRT-PCR)was used to verify the selected genes.Results A total of 10 differential genes related to ferroptosis were screened by bioinformatics method.GO functional enrichment analysis showed that differential genes were mainly involved in inflammation,apoptosis,oxidative stress and other biological processes,while KEGG pathway enrichment analysis showed that differential genes were mainly involved in ferroptosis,HIF-1 signaling pathway,and leukocyte migration pathway through endothelial cells.Seven key modules of gene construction were screened out through the protein interaction network,which were FTL,SLC40A1,CYBB,NCF2,HMOX1,DPP4 and ALOX5.GSE9874 was used for verification,and 5 key genes including ALOX5,DPP4,FTL,SLC40A1 and NCF2 were finally screened out.The expression detection of key genes in clinical samples by qRT-PCR showed that compared with the control group,the up-regulated genes in blood of AS group were DPP4(t=1.795,P=0.046),FTL(t=2.218,P=0.029)and SLC40A1(t=2.859,P=0.009),and the down-regulated genes were ALOX5(t=8.039,P＜0.001)and NCF2(t=11.867,P＜0.001),and the differences were significant.The experimental results were consistent with the results of bioinformatics analysis.Subgroup analysis showed that DPP4 expression in plaque group was higher than that in intima thickening group,and the difference was significant(t=2.843,P=0.036).Conclusion The key genes of ferroptosis screened by bioinformatics are AS,ALOX5,DPP4,FTL,SLC40A1 and NCF2,which may be potential targets for the diagnosis and treatment of AS,providing new ideas for the clinical diagnosis and treatment of AS.

Objective: To compare the tear related indexes of patients with type-2 diabetes and the healthy subjects, analyze the functions of tear film of these two groups and provide significant theoretical evidences for the causes of the increased prevalence of dry eye in patients with type-2 diabetes and their pathogenesis. Methods: A case-control study was designed.During the epidemiological investigation of dry eye in communities, 79 patients with diabetes and 74 normal healthy subjects were randomly selected as participants in this case-contol study.Dry eye tests including tear film break-up time (BUT), SchirmerⅠtest (SⅠt) and corneal fluorescein staining were performed.The tears were collected to detect mucoprotein-5AC (MUC-5AC), matrix metalloproteinase 9 (MMP-9), receptor of advanced glycation endproducts (RAGEs) and the content of insulin.The diagnosis standard referred to Experts Consensus on Clinical Diagnosis and Treatment of Dry Eye published in 2013.The study was followed the Declaration of Helsinki.This study protocol was approved by Medical Ethics Committee of the Shanghai General Hospital, Shanghai Jiaotong University(No.2016KY005), and written informed consent was obtained from all subjects. Results: There were significant differences between 79 diabetes patients and 74 normal healthy subjects in the value of BUT, SⅠt and corneal fluorescein staining (all at P<0.05). The value of BUT and SⅠt in patients with diabetes were lower than those in the control group, while the corneal fluorescein staining scores of patients were higher than those of normal healthy subjects, with significant differences (P<0.05). In addition, compared with normal healthy subjects, the diabetic patients were higher in the value of MMP-9 and RAGEs, but lower in the content of insulin and MUC-5AC, with significant differences (P<0.05). There were significant differences in gender, diabetes duration, MMP-9, and MUC-5AC between the dry and non-dry eyes in the diabetic group (P<0.05). Women were more likely to develop dry eyes with a significant difference (t=4.35, P=0.04). The duration of diabetes in dry eye group was higher than that in non-dry eye group, with a significant difference (t=2.56, P=0.01); the value of MMP-9 in dry eye group was (1 052.37±157.68)pg/ml, which was significantly higher than that in non-dry eye group ([459.11±258.67]pg/ml)(t=11.92, P<0.01); the value of MUC-5AC in dry eye group was (867.83±121.82)pg/ml, which was significantly lower than in non-dry eye group ([972.93±153.52] pg/ml)(t=-3.30, P<0.01). There was no statistical difference in age and insulin between the two groups.Pearson correlation analysis showed that MMP-9 was negatively correlated with BUT (r=-0.349, P<0.01), and positively correlated with corneal fluorescein staining (r=0.181, P=0.026). MUC-5AC was positively correlated with SⅠt (r=0.367, P<0.01). Conclusions Dry eye prevalence is significantly related with the decrease in MUC-5AC and the increase in MMP-9 in community-based diabetic patients.

Objective To observe the clinical efficacy of Jiangshabanxia nano-paste on nausea and vomiting in end-stage patients and its effect on the quality-of-life (QOL) in cancer patients. Methods 120 end-stage patients with nausea and vomiting symptoms above grade III were randomly divided into observation group and control group. They were treated with Jiangshabanxia nano-paste and placebo paste respectively. The paste patch was changed every 24 hours and used continuously for 7 days. The nausea and vomiting symptom score, the quality-of-life measurement score and KPS score of cancer patients in the two groups were observed to evaluate the curative effect. Results After 7 days of treatment, the symptom scores of nausea and vomiting in the observation group decreased significantly, the KPS score of the observation group increased, and the effective rate was higher than that in the control group. The score of QOL measurement showed that after treatment, the score of main symptom areas and other symptom areas (except external dyspnea, diarrhea and economic difficulties) in the observation group decreased, and the score of overall health area increased. After treatment, the score of main symptom areas and other symptom areas (except external dyspnea, diarrhea and economic difficulties) in the observation group was lower than that in the control group, and the scores of overall health area in the observation group were higher than those in the control group. Conclusion Jiangshabanxia nano-paste has a good clinical efficacy nausea and vomiting in end-stage patients, it also can improve the quality of life end-stage cancer patients.