Objective:To explore the feasibility of expectant management in pregnant women with preterm premature rupture of membranes (PPROM) before 28 weeks of gestation.Methods:A retrospective analysis was conducted on the clinical data of 92 pregnant women diagnosed with PPROM before 28 weeks and delivered in Peking University First Hospital from January 2015 to March 2023. These women were divided into the termination group or expectant management group, and the latter was further divided based on whether the rupture of membranes occurred before 24 weeks or after. Clinical data of the women and neonates between the two groups and the two subgroups were analyzed. Additionally, all the subjects were divided based on the presence or absence of severe neonatal complications and clinical data of the mothers and their neonates were also analyzed. Statistical analyses were performed using t-tests, Mann-Whitney U tests, Chi-square tests, or Fisher's exact tests. Results:(1) Among the 92 women with PPROM, 53 (57.6%) chose to terminate the pregnancy, while 39 (42.4%) chose expectant management including ten twins and 29 singletons. (2) Compared to the termination group, the expectant management group had a smaller percentage of multiparous women [7.7% (3/39) vs. 32.1% (17/53), Fisher's exact test, P=0.019], greater gestational age at membrane rupture [24 +6 weeks (18-27 +6) weeks vs.21 +3weeks (14 +2-27 weeks), Z=53.14, P=0.042], and a lower incidence of oligohydramnios after membrane rupture [46.2% (18/39) vs. 84.9% (45/53), χ2=6.56, P=0.031]. (3) All of the 39 women in the expectant group gave birth before 37 weeks with the mean gestational age at delivery of 28 +1weeks (25 +1-36 +1 weeks) and 49 live born babies, among which four neonates died giving the survival rate of 91.8%(45/49). There were no statistically significant differences in gestational age at delivery or neonatal outcomes between women with membrane rupture before 24 weeks and those ruptured between 24 and 27 weeks and 6 days of gestation (all P>0.05), but the expectant duration was significantly longer in the former group [55.0 d (20.0-96.0 d) vs. 9.0 d (0.5-52.0 d ), Z=－4.95, P<0.001]. (4) The 49 neonates were further divided into with ( n=9, including the death) or without ( n=40) severe complication subgroups. Those neonates in the non-severe complication subgroup had a significantly greater gestational age at birth compared to those in the other subgroup [30 +6 weeks (27 +5-36 +4 weeks) vs. 27 +5 weeks (25 +1-31 +5 weeks), Z=－3.42, P=0.001], a longer expectant duration [42.0 d (3.0-80.0 d) vs. 19.0 d (0.5-59.0 d), Z=－2.31, P=0.021], a higher birth weight [(1 630±544) g vs. (1 069±272) g, t=4.56, P=0.009], a lower incidence of neonatal asphyxia [2/9 vs. 70.0% (28/40), Fisher's exact test, P=0.012], a shorter hospital stay [37.5 d (3.0-54.0 d) vs. 67.0 d (60.0-105.0 d), Z=－3.01, P=0.003] and a higher proportion of pregnancies completing two courses of fetal lung maturation [5/9 vs. 17.5% (7/40), Fisher's exact test, P=0.029]. (5) Among the ten twin pregnancies, all the 20 babies developed severe complication resulting a higher proportion of twins in the severe complication group than in the non-severe complication group [50% (20/40) vs. 0/9, Fisher's exact test, P=0.005]. Conclusions:For pregnant women with PPROM before 28 weeks, under the premise of informed consent and thorough evaluation, expectant management can be considered if there are no indications for immediate termination of pregnancy, to achieve a higher neonatal survival rate. However, the incidence of severe complications related to preterm infants remains high in the short term, with most having a good prognosis after treatment in the neonatal intensive care unit. Twin pregnancies and lower gestational age at birth are risk factors for severe complications in preterm infants.

Chronic diabetic wound remains a critical challenge suffering from the complicated negative microenvironments, such as high-glucose, excessive reactive oxygen species (ROS), hypoxia and malnutrition. Unfortunately, few strategies have been developed to ameliorate the multiple microenvironments simultaneously. In this study, Chlorella sp. (Chlorella) hydrogels were prepared against diabetic wounds. In vitro experiments demonstrated that living Chlorella could produce dissolved oxygen by photosynthesis, actively consume glucose and deplete ROS with the inherent antioxidants, during the daytime. At night, Chlorella was inactivated in situ by chlorine dioxide with human-body harmless concentration to utilize its abundant contents. It was verified in vitro that the inactivated-Chlorella could supply nutrition, relieve inflammation and terminate the oxygen-consumption of Chlorella-respiration. The advantages of living Chlorella and its contents were integrated ingeniously. The abovementioned functions were proven to accelerate cell proliferation, migration and angiogenesis in vitro. Then, streptozotocin-induced diabetic mice were employed for further validation. The in vivo outcomes confirmed that Chlorella could ameliorate the undesirable microenvironments, including hypoxia, high-glucose, excessive-ROS and chronic inflammation, thereby synergistically promoting tissue regeneration. Given the results above, Chlorella is considered as a tailor-made therapeutic strategy for diabetic wound healing.

【Objective】 To analyze the hepatitis B virus (HBV) infection data of blood donors from 18 domestic blood stations, so as to investigate the HBV infection situation of blood donors. 【Methods】 The positive rate of HBV and its distribution characteristics of regions, the percentage of HBsAg+ ELISA in first-time vs repeated blood donors, and the percentage of HBsAg-/HBV DNA+ blood donors of 18 domestic blood stations during 2017 to 2020 were collected from the Working Platform for Practice Comparison of Blood Centers, and the HBV infection among blood donors were statistically analyzed. 【Results】 From 2017 to 2020, the positive rate of HBV in blood donors among 18 domestic blood stations was 13.48/10 000-144.02/10 000, with the average HBV positive rate in eastern, central and western region at 26.14/10 000, 51.98/10 000 and 41.00/10 000, respectively. The HBsAg+ rate by ELISA among first-time and repeated blood donors was 14.55/10 000-305.39/10 000 vs 1.04/10 000-87.43/10 000 The HBsAg-/HBV DNA+ yield was 1.80/10 000-35.31/10 000. 【Conclusion】 The distribution of HBV infection in blood donors has regional characteristics, and HBV prevalence was low in repeated blood donors. HBsAg ELISA combined with HBV DNA detection can better ensure blood safety.

Objective:To investigate the effect and mechanism of tumor necrosis factor α (TNF-α) and its inhibitor etanercept (ETA) on the invasion ability of extravillous trophoblast in patients with unexplained recurrent spontaneous abortion (URSA).Methods:(1) Patients were collected from March to June in 2019. They were divided into the URSA group ( n=15) and the normal control group ( n=15), according to whether diagnosed with URSA or not. The mRNA expression levels of TNF-α in villi tissue of patients in the two groups were detected by quantitative real-time PCR (qRT-PCR). (2) The mRNA and protein expression levels of matrix metalloproteinase-2 (MMP-2), Slug and CXC chemokine rceptor 4 (CXCR4) in HTR-8/SVneo cells were detected by qRT-PCR or western blot after being stimulated by exogenous TNF-α (0.2, 2, 20 ng/ml) alone or TNF-α along with ETA, or phosphate buffered saline (PBS) as control. (3) The invasion ability of HTR-8/SVneo cells was investigated by transwell test after stimulating by TNF-α alone or TNF-α along with ETA. (4) The mRNA and protein expression levels of MMP-2, Slug and CXCR4 in HTR-8/SVneo cells, which were stimulated by TNF-α (2 ng/ml) alone after nuclear factor-κB (NF-κB) inhibitor, BAY 11-7028, preconditioning, were detected by qRT-PCR or western blot. Results:(1) The mRNA expression level of TNF-α in villi tissue of URSA group (4.10±0.49) was 4.1 times as much as the normal control group ( t=10.51, P<0.05). (2) The mRNA and protein expression levels of MMP-2, Slug and CXCR4 in HTR-8/SVneo cells of TNF-α group were significantly lower than those in PBS control group ( P<0.05) and those in TNF-α along with ETA group ( P<0.05). (3) The invasion ability of HTR-8/SVneo cells in TNF-α group was significantly decreased than PBS group and TNF-α along with ETA group (78±14 vs 373±26 vs 227±44, P<0.05). (4) The mRNA and protein expression levels of MMP-2, Slug and CXCR4 in HTR-8/SVneo cells with BAY 11-7028 preconditioning (mRNA: 1.03±0.10, 1.03±0.06, 1.09±0.08; protein: 1.09±0.03, 1.49±0.03, 1.12±0.03) were significantly higher than without preconditioning after being stimulated by TNF-α (all P<0.05). Conclusions:The expression of TNF-α in the villi of URSA patients is much higher than normal early pregnant women. TNF-α could decrease the capacity of invasion by suppressing the expression of MMP-2, Slug and CXCR4 through NF-κB signaling pathway in extravillous trophoblast cells. While ETA could improve the invasiveness capability of extravillous trophoblast cells through inhibiting the negative effect of TNF-α.

Maternal obesity and excessive weight gain during pregnancy are associated with adverse perinatal outcomes, and have a long-term adverse influence on general health outcomes related to heart, respiration, metabolism, and cognition in offspring. Obesity and weight gain in women are important modifiable risk factors in pregnancy, which can be managed through dietary and lifestyle to prevent excessive intake of calories, and reduce weight gain, stress and depression during pregnancy. Given that maternal pre-pregnancy body mass index plays a more important role in pregnancy outcomes than gestational weight gain, preconception care is critical for improving long-term health outcomes in their children. Therefore, future prevention strategies should focus on interventions for excess weight and obesity before pregnancy.

Objective To investigate the current status of uterine rupture in pregnant women in China and analyze the impacts of different surgical histories on the pregnancy outcomes of pregnant women with uterine rupture. Methods The clinical records and pregnancy outcomes of 84 uterine rupture cases were collected and analyzed retrospectively. All cases came from 21 hospitals of 13 provinces (or municipality) in China, dated from January 1st 2014 to December 31st 2015. The total deliveries were 283 614 during the period. For 84 pregnant women with symptomatic uterine rupture, the impacts of different surgical histories on pregnancy outcomes were compared and the results were statistically analyzed.Results (1) Totally, 84 cases of uterine rupture were with symptoms and diagnosed. The median age, median gestational age were 32.5 years old (23.0-44.0 years old) and 35.7 weeks (9.3-41.0 weeks), respectively. The incidence of uterine rupture was 0.03%(84/283 614). The proportion of patients with cesarean section history was 66.7% (56/84). The proportion of patients with other gynecological surgery history was 20.2%(17/84). (2)Compared with the group of cesarean section history, the group with other gynecological surgery history had a significant increase in complete uterine rupture (16/17 vs 66.1%, P<0.05). Meanwhile, regarding the massive blood transfusion (red blood cell transfusion≥1 000 ml) in the treatment of uterine rupture, patients with other gynecological surgery history had significant more cases than the group with cesarean section history (9/17 vs 23.2%, P<0.05). There was no statistical difference for the other outcomes. Compared with the patients with cesarean section history, the rate of hysterectomy was higher in the group without major surgery history when uterine rupture happened (4/11 vs 7.1%, P<0.05). The incidence of postpartum hemorrhage significantly increased in patients without major surgery history, compared with those with cesarean section (8/11 vs 28.6%, P<0.05). There were no statistic difference for other outcomes.(3) Patients with uterine rupture in the non-abdominal pain group had a significantly increased risk of massive blood transfusion (5/8 vs 27.6%, P<0.05),and the incidence of neonatal asphyxia and hypoxic ischemic encephalopathy (4/7 vs 22.2%, P<0.05) were significantly increased. There were no significant difference between two groups regarding the other outcomes, such as preoperative diagnosis, complete rupture of uterus, hysterectomy, postpartum hemorrhage, shock, intrauterine fetal death or neonatal death, admission to neonatal ICU. Conclusions In addition to considering cesarean section history as one of the known risk factors, patients with non-cesarean section uterine surgery history should also be considered. The management of these patients should be strengthened during their pregnancy and delivery. There might be much more dangerous maternal and neonatal outcomes for the patients with uterine rupture who does not have any abdominal pain during pregnancy and delivery. To reduce the incidence of severe complications, uterine rupture should be diagnosed earlier. The early recognition and diagnosis of uterine rupture helps to improve maternal and neonatal outcomes.

Objective To evaluate the risk factors and sonographic findings of pregnancies complicated by placenta increta or placenta percreta. Methods Totally, 2219 cases were retrospectively analyzed from 20 tertiary hospitals in China from January 2011 to December 2015. The data were collected based on the original case records. All cases were divided into two groups, the placenta increta (PI) group (79.1％, 1755/2219) and the placenta percreta (PP) group (20.9％, 464/2219), according to the degree of placental implantation. The risk factors and sonographic findings of placenta increta or percreta were analyzed by uni-factor and logistic regression statistic methods. Results The risk factors associated with the degree of placental implantation were age, gravida, previous abortion or miscarriage, previous cesarean sections, and placenta previa (all P<0.05), especially, previous cesarean sections (χ2=157.961) and placenta previa (χ2=91.759). Sonographic findings could be used to predict the degree of placental invasion especially the boundaries between placenta and uterine serosa, the boundary between placenta and myometrium, the disruption of the placental-uterine wall interface and loss of the normal retroplacental hypoechoic zone(all P<0.01). Conclusions Previous cesarean sections and placenta previa are the main independent risk factors associated with the degree of placenta implantation. Ultrasound could be used to make a prenatal suggestive diagnosis of placenta accreta spectrum disorders.

Objective To investigate the immune status characteristics of primary ITP patients with abnor-mal auto-antibodies. Methods A total of 110 patients were enrolled in our study,who were admitted in Fu-Xing Hospital affiliated to Capital Medical University from January 2001 to July 2015.According to whether the patients have autoimmune diseases and the presence of auto-antibodies,we divided the patients into 3 groups,including the primary ITP with abnormal auto-antibodies(PITP-ANA)group,the primary ITP(PITP)group and the second-ary ITP(SITP)group.We compared the T-cell subsets,regulatory T cells,B lymphocytes,changes of immunoglob-ulin and bone marrow biopsy and cytology of patients among the three groups,retrospectively. Results The per-centage of CD3+T cells(61.72 ± 10.60)% in PITP-ANA group was lower than that in PITP group(69.57 ± 11.99)%. The percentage of CD8+T lymphocyte(24.00 ± 7.67)% was significantly lower than that of PITP group (30.59 ± 11.08)%(P<0.05).The proportion of Treg in PITP group,PITP-ANA group and SITP group were(6.12 ± 1.41)%,(7.50 ± 2.76)% and(8.49 ± 2.47)%,respectively,with statistically significant differences.The ra-tio of CD19+T cell in PITP-ANA group(25.75 ± 9.98)%was significantly higher than that in PITP group(16.16 ± 8.19)%(P < 0.01). The concentration of IgG、IgA、κ light chain and λ light chain in PITP group,PITP-ANA group and SITP group showed an upward trend and the highest level was in the SITP group,with statistically signifi-cant differences among the three groups. A variety of abnormal auto-antibodies could be found in both PITP-ANA group and SITP group. Conclusions We consider that the immune function abnormity of patients in PITP-ANA group were worse than that in PITP group,because the concentration of immunoglobulin,the percentage of B lym-phocyte and Treg ratio are higher in than those in PITP group.

In order to investigate the distribution of Yersinia enterocolitica in Citellus dauricus plague focuses in Inner Mongolia,three different ecological environ/ments were chosen as the sampling area.Feces,tongue roots throat swabs,and intestinal contents of rodent,livestock,and poultry were separately collected,and different Y.enterocolitica strains were isolated,and identified.PCR analysis was conducted to detect the toxicity genes of Y.enterocolitica.Statiscal analysis was performed by chisquare test.Of the 3 260 samples,65 Y.enterocolitica strains were isolated and the overall detection rate was 1.99％.To include O ∶ 3/3,O ∶ 5/1A,O ∶ 4/4 serum biological type,the pathogenic strain of serotype O ∶ 3 and biological typt 3 carryinq toxicity genes ail,ystA,VirF yadA and rfbc was isolated from pigs in Citellus dauricus plague focuses,Inner Mongolia are the major carrier of pathogenic Y.enterocolitica distributed in three different ecological environment,and distributed mainly in agricultural area.

OBJECTIVETo establish an indicator system of risk assessment for mechanical cuts, and to validate the system using examples.

METHODSAn indicator system was proposed by the expert investigation method. The index weight, expert authority coefficient, and degree of coordination were determined. The reasonability and stability of the expert questionnaire were evaluated by the reliability analysis. Some on-site examples were given to validate the indicator system.

RESULTSAn indicator system containing 3 first-class indicators, 10 second-class indicators, and 34 third-class indicators was obtained by screening indicators using the boundary value method and the assignment transformation method. The average expert authority coefficient was 0.79. The average expert coordination coefficient was 0.47. The overall reliability coefficient was 0.884. The scores obtained using the indicator system were significantly correlated with the actual injury results in six workplaces (r=0.866, P<0.01).

CONCLUSIONThe indicator system of risk assessment for mechanical cuts proposed in this study is reasonable and highly consistent with the actual injury results. However, this indicator system still needs further validation and optimization.