Objective To investigate se rum concentration of tumor necrosis factor(TNF)-? and its correlation with insulin resistance in pregnant women with gestational diabetes mellitus (GDM). Methods Enzyme-linked immunosorbent assay was used to measure th e fasting serum TNF-? levels of 42 women with GDM (28～39 gestational weeks), a n d 40 cases of normal pregnant women in the third trimester. Fasting plasma gluc ose, insulin, C-peptide and glycosylated hemoglobin (HbA1c) were also measured at the same time. Insulin sensitive index (ISI) was calculated. Res u lts (1)Significantly elevated serum TNF-? was found in the women w i th GDM(5.2?1.6) ng/L as compared with the healthy pregnant women in third t rimester (4.5?0.5)ng/L(P

Objective To analyze the application of quality control cycle (QCC) in reducing the false negative rate of minimal residual disease (MRD) of flow cytometry in patients with acute myeloid leukemia (AML). Methods In AML patients with abnormal fusion gene detected in hematology laboratory of Changhai Hospital during the year of 2014, the prevalence of AML-MRD detected both by flow cytometry (FCM) and real-time fluorescence quantitative polymerase chain reaction (FQ-PCR) were analyzed retrospectively. The possible causes of false negative rate of flow cytometric MRD referring to PCR were further deeply analyzed, and the improvement measures were adapted from January 2015 to December 2015 and further judged all according to the QCC methods. Results Pareto diagram showed that the dilution and coagulation of the specimen, the improper analysis strategy and the incomplete combination of the MRD index [composition ratio:83.3 % (60/72)] were the main factors leading to the leakage of FCM MRD in 2014. The QCC group devised measures to reduce the dilution probability of bone marrow and develop a standard operating procedures (SOP) for sampling and testing, strengthen the maintenance of the flow instrument and more importantly, focused on optimizing the antibody panels and gated strategies referring to the current two main kinds of MRD detection combination modes on the basis of the latest advances published in 2015. Finally, the undetected rate of AML-MRD was reduced by FCM from 14.8 % (72/486) in 2014 to 2.6 % (16/620) in 2015. Conclusions The QCC can effectively reduce the leakage rate of flow cytometric AML MRD, improve the ability of laboratory quality control and the ability to solve problems. Solving problems with QCC is thus worthy of being popularized.

Objective To investigate the diagnosis, treatment and prognosis of acute promyelocytic leukemia (APL) with NPM_RARα fusion gene positive. Methods One APL patient with NPM_RARα fusion gene positive who was diagnosed by using morphology, immunology, cytogenetics, molecular biology and multiplex fluorescence in situ hybridization in Changhai Hospital in November 2014 was retrospectively analyzed, and the patient was induced with retinoic acid and treated with DA (daunorubicin + cytarabine) regimen, followed by 4 courses of cytarabine consolidation therapy. Results Abnormal promyelocyte accounted for 0.64 by morphology. And the group of cells expressed myeloperoxidase (MPO), CD13, CD15, CD117, and CD7, CD11c, CD79a, CD123 weakly expressed or not by immunophenotype analysis; karyotype analysis showed 45, XY, t(5;17), 7p-,-16[8]/46, idem,+20[5]/45, idem,-8,+20[2]/46, XY[5]; the fusion gene screening showed that the expression level of NPM_RARα was 416.98% compared with that of APL; molecular complete remission was obtained after the consolidation therapy, but the patient relapsed after 34 months. Finally, the patient died of abnormal coagulation and respiratory failure, with overall survival of 35 months. Conclusion APL with NPM_RARα fusion gene positive is a rare type of acute leukemia, and the main treatment method is retinoic acid combined with myeloid chemotherapy regimen, which has a favorable efficacy but a poor prognosis.

Tacrolimus is a commonly used medication for the treatment of nephrotic syndrome.Due to its narrow therapeutic window and significant pharmacokinetic differences among individuals,therapeutic drug monitoring is required during its clinical use.In the process of therapeutic drug monitoring,machine learning-based personalized dosing prediction models for tacrolimus can excavate medication patterns from a large amount of clinical data,assist in clinical decision-making,and achieve individualized precise medication.Machine learning models,the application progress of machine learning in personalized administration of tacrolimus for patients with nephrotic syndrome,modeling points of machine learning prediction models,and the limitations of current prediction models were reviewed in this paper,which could provide references for future research in this field.

Objective: To investigate the clinical value of gallbladder-preserving cholelithotomy by natural orifice transumbilical endoscopic surgery on patients with cholecystolithiasis. Methods: A retrospective study was performed on data of 15 patients with cholecystolithiasis, who underwent gallbladder-preserving cholelithotomy by natural orifice transumbilical endoscopic surgery from April 2018 to July 2018. The operative data, including situation of operation, operative time, intraoperative hemorrhage, and postoperative complications were recorded. Results: The procedure was performed successfully in all patients with a mean operative time of 108±12 min (ranged from 92-129 min). The intraoperative hemorrhage was 10-30 mL. Eight patients suffered from slight right upper abdominal pain, and 7 patients felt slight pain in umbilical a week after surgery. No fever, incision infection, umbilical hemia, peritonitis, and ascites were reported. The clear-liquid diet was recommended for one day after operation, and postoperative activity was allowed since the second day after operation. All patients were discharged on the fourth or fifth day, and all recovered to their normal life at one week after discharge. Follow-up showed that the scar was small and hidden in umbilical without visible incision after one month. Ultrasonic examination results showed that gallbladder contractile function worked perfectly in four patients and no gallbladder stone was found after three months. Conclusion Gallbladder-preserving cholelithotomy by natural orifice transumbilical endoscopic surgery is a safe and effective option for patients with cholecystolithiasis, provides excellent cosmetic outcomes, and can be appropriately carried out under the strict control of surgical indications.

Objective:To investigate the current state of missed nursing care during labor, explore the reasons why nursing care was missed, and examine the influencing factors of missed nursing care.Methods:Data were collected from 14 medical institutions of different levels in southwest China using a convenience sampling from February to April, 2023. A total of 491 midwives were included. A cross-sectional survey was conducted using a general information questionnaire and the Chinese version of the Perinatal Missed Care. Multiple linear regression analysis was conducted to identify the influencing factors on missed nursing care.Results:Among 491 midwives, there are 6 males and 485 females. 194 midwives aged ≤ 30, 205 midwives aged 31-40 years, and 92 midwives aged ≥41 years. 80.45%(395/491) of midwives reported missing at least one item of nursing care during labor in the past week, and the missing rate of single item ranged from 13.24% (65/491) to 53.36% (262/491). The average score across 23 items of missed nursing care during labor was 1.49 ± 0.58. The average scores of items spanning the three dimensions of basic care, necessary care and postnatal care were 1.67 ± 0.68, 1.36 ± 0.56, and 1.51 ± 0.70, respectively. The average score of 13 items representing reasons for missed nursing care was 1.82 ± 0.71. The average scores of items in three dimensions of communication, labor resources, and material resources were 1.75 ± 0.73, 1.97 ± 0.87, and 1.74 ± 0.83, respectively. The multiple linear regression analyses showed that gender, monthly average income level, and whether overtime hours were included in total working hours were independently associated with missed nursing care (all P<0.05). Conclusions:The current state of missed nursing care during labor needs to be improved. Missed basic care is common, and labor resources are the significant reasons, and is influenced by factors such as demographic and sociological factors. Human resource factors are an important reason for nursing deficiency, and targeted measures should be taken to reduce the occurrence of nursing deficiency.

Glioblastoma (GBM) is the most common and aggressive malignant brain tumor in adults and is poorly controlled. Previous studies have shown that both macrophages and angiogenesis play significant roles in GBM progression, and co-targeting of CSF1R and VEGFR is likely to be an effective strategy for GBM treatment. Therefore, this study developed a novel and selective inhibitor of CSF1R and VEGFR, SYHA1813, possessing potent antitumor activity against GBM. SYHA1813 inhibited VEGFR and CSF1R kinase activities with high potency and selectivity and thus blocked the cell viability of HUVECs and macrophages and exhibited anti-angiogenetic effects both in vitro and in vivo. SYHA1813 also displayed potent in vivo antitumor activity against GBM in immune-competent and immune-deficient mouse models, including temozolomide (TMZ) insensitive tumors. Notably, SYHA1813 could penetrate the blood-brain barrier (BBB) and prolong the survival time of mice bearing intracranial GBM xenografts. Moreover, SYHA1813 treatment resulted in a synergistic antitumor efficacy in combination with the PD-1 antibody. As a clinical proof of concept, SYHA1813 achieved confirmed responses in patients with recurrent GBM in an ongoing first-in-human phase I trial. The data of this study support the rationale for an ongoing phase I clinical study (ChiCTR2100045380).