Objective To evaluate the accuracy of continuous noninvasive hemoglobin ( Hb ) monitoring in the patients undergoing cesarean section. Methods A total of 200 patients, at 36-42 weeks of gestation, aged 19-40 yr, with body mass index of 20.5-35.1 kg∕m2 , of ASA physical statusⅠorⅡ, undergoing elective cesarean section from June 2014 to October 2014 in our hospital, were enrolled. A sensor was positioned at patient′s finger and connected to the Masimo Radical?7 Pulse CO?Oximeter, a continuous noninvasive Hb measurement device. Noninvasive Hb obtained with Pulse CO?oximeter ( SpHb) was recorded. Before skin incision ( T0 ) , after delivery of the placenta ( T1 ) , after suturing the uterus ( T2 ) and at the end of operation ( T3 ) , blood samples from the radical artery were collected for determination of total Hb ( tHb) , and SpHb was also recorded. The agreement between two methods was assessed using Bland?Altman analysis. Results At T0-T3, tHb was 111±9, 103±8, 94±8 and (89±7) g∕L, respectively, and SpHb was 124 ± 9, 120 ± 12, 108 ± 9 and ( 103 ± 8 ) g∕L, respectively. Bland?Altman analysis showed that at T0-T3 , the mean difference between SpHb and tHb was 13.5, 17.1, 14.1 and 13.9 g∕L, respectively, and 95% confidence interval was 13.1-13.9, 16.5-17.7, 13.6-14.6 and 13.4-14.4 g∕L, respectively. The limit of agreement was 8.4-18.6, 9.1-25.1, 7.8-20.4 and 7.4-20.4 g∕L at T0-T3 , respectively, and the interchangeable limits of the two methods ranged between 3.5-23.5, 7.1-27.1, 4.1-24.1 and 3.9-23.9 g∕L at T0-T3 , respectively. The repeatability coefficient of tHb and SpHb was 16.5 and 15.8 g∕L, respectively. The relative error of SpHb was (4.6±1.0)%, (5.3±1.4)%, (4.9±1.2)% and (4.8±1.2)% at T0-T3, respectively. Conclusion Continuous noninvasive Hb monitoring provides good accuracy in the patients undergoing cesarean section.

BACKGROUND: As one of the most common endocrinal disorders for women at childbearing age, the diagnostic criteria of polycystic ovary syndrome (PCOS) have been defined differently among different international health organizations. Phenotypic heterogeneity of PCOS also brings about difficulties for its diagnosis and management assessment. Therefore, more efficient biomarkers representing the progression of PCOS are expected to be integrated into the monitoring of management process using metabolomic approaches. METHODS: In this prospective randomized controlled trial, 117 PCOS patients were enrolled from December 2016 to September 2017. Classical diagnostic parameters, blood glucose, and metabolome were measured in these patients before and at 2 months and 3 months of different medical interventions. The receiver operating characteristic (ROC) curves were built based on multivariate statistical analysis using data at baseline and 3 months' management, and combinational biomarkers with appreciable sensitivity and specificity were selected, which then validated with data collected at 2 months. RESULTS: A set of metabolites including glutamic acid, aspartic acid, 1-methylnicotinamide, acetylcarnitine, glycerophosphocholine, and oleamide were filtered out with high performance in representing the improvement through 3-month management of PCOS with high sensitivity and specificity in ROC analysis and validation with other two groups showed an appreciable area under the curve over 0.96. CONCLUSIONS: The six metabolites were representative of the remission of PCOS through medical intervention, making them a set of potential biomarkers for assessing the outcome of PCOS management. TRIAL REGISTRATION ClinicalTrials.gov, NCT03264638.
Biomarkers ; Female ; Humans ; Metabolomics ; Polycystic Ovary Syndrome/diagnosis* ; Prospective Studies ; ROC Curve

Objective To determine the changing trend and causes of perinatal mortality in Changning District after the implementation of the universal two-child policy， and then explore effective interventions for preventing perinatal mortality. Methods Data of perinatal mortality in Changning District from 2011 to 2020 were retrospectively collected. Change of perinatal mortality， causes of death and related factors were compared in consecutive 5 years before and after the universal two-child policy. Results In total， there were 153 099 perinatal births from 2011 to 2020 in Changning District， in which 352 deaths were documented. The perinatal mortality was 2.30 per 1 000 births， showing an overall downward trend from 2011 to 2020 （ P <0.05）. Residents with local household registration had lower perinatal mortality， compared to those with non-local household registration， which was observed both before and after the universal two-child policy （ P <0.05）. Furthermore， the perinatal mortality showed an upward trend after the universal two-child policy （ χ ²_trend=5.481， P <0.05）. The major causes of perinatal death were fetus and its accessories， fetal malformation， and maternal diseases during pregnancy before the universal two-child policy； in contrast， the causes changed to maternal diseases during pregnancy， fetus and its accessories， and neonatal diseases after the policy. The proportion of pregnant women of advanced maternal age， menstrual delivery， and pregnancy complications or comorbidities were significantly higher after the policy than that before the policy （ P <0.05）. The most common pregnancy complication was gestational diabetes mellitus， gestational hypertension， and hypothyroidism during pregnancy after the universal two-child policy. Of them， the proportion of gestational hypertension increased from 6.56% （4/61） to 25.88% （22/85）. Conclusion Before and after the universal two-child policy， the perinatal mortality in non-local residents remains high and further shows an upward trend. Moreover， pregnant women advanced maternal age and those with complications or comorbidities may increasingly contribute to perinatal deaths after the policy. Therefore， health education should be strengthened to improve the awareness of self-health care， especially for non-local women. Hierarchical perinatal health service， primary prevention and treatment of pregnancy complications or comorbidities should be improved to further reduce perinatal mortality.

Objective To explore the effect of low-dose or standard-dose conjugated equine estrogen (CEE)combined with natural progesterone or dydrogesterone on bone density in menopause syndrome women.Methods Totally 123 patients with menopause syndrome were recruited and randomly assigned to 3 treatment groups: group A(low-dose CEE+progesterone), group B(standard-dose CEE+progesterone), group C(standard-dose CEE+dydrogesterone). Using continuous sequential regimen, the duration of intervention was 12 cycles.The bone mineral density of lumbar 2-4 and neck of femur,the bone metabolic markers, the level of FSH and estradiol were examined just before the drug administration and 12 months after the beginning of experiment. Results There were 107 cases completed the one year trial.(1)Bone density:after 12 cycles of treatment,there was no significant change in bone density in group A(P>0.05);lumbar vertebrae of group B and C increased significantly,at 3.0% and 2.1%respectively(all P<0.05).The bone density of left femoral neck of group C significantly increased by 2.9%(P=0.029). There was no significant difference among the treatment groups at the beginning of experiment(P>0.05).(2)Bone metabolic markers: after 12 cycles of treatment, the levels of calcium, phosphorus, alkaline phosphatase, Ca/Cr decreased significantly,the difference were statistically significant(all P<0.05).There was no significant difference among the treatment groups at the beginning of experiment(P>0.05).(3)Levels of FSH and estradiol:after 12 cycles of treatment,the levels of FSH in three groups were decreased significantly(all P<0.01). The levels of estradiol in three groups were increased significantly(all P<0.01). There was no significant difference among the treatment groups at the beginning of experiment(P>0.05). Conclusions Both low-dose and standard-dose menopause hormone therapy(MHT)could elevate the level of estradiol, reduce bone turnover, prevent bone loss of postmenopausal women effectively. The standard dose of MHT could also increase the density of vertebrae and femoral neck,and generate more clinical benefits.

Objective To explore the influences of the comprehensive nurse-doctor collaboration intervention on sleep quality of the lung cancer patients receiving chemotherapy. Methods A total of 94 lung cancer patients receiving chemotherapy were selected from October 2012 to December 2013 and equally randomized into the observation group and control group, with 47 patients in each group. The patients of control group were treated with routine nursing for lung cancer. The patients of observation group adopted the “nurse-doctor collaboration” management model including psychotherapy, relaxation therapy, sleep restriction therapy,
adjust treatment on the basis of routine nursing. After four weeks intervention, the effects were evaluated according to the sleep quality of patients. Results A total of 30 patients could sleep well in the observation group whereas its number was 17 in the control group. The observation group and control group effectiveness were 63. 8% and 37. 8% respectively. The effect of sleep quality in observation group was significantly better than the control group (χ2 =7. 191,P=0. 007). Conclusions The comprehensive nurse-doctor collaboration measures can obviously correct the bad sleep habits and sleep behavior in lung cancer patients with chemotherapy, and improve the quality of sleep in those patients.

Drug resistance presents one of the major causes for the failure of cancer chemotherapy. Cancer stem-like cells (CSCs), a population of self-renewal cells with high tumorigenicity and innate chemoresistance, can survive conventional chemotherapy and generate increased resistance. Here, we develop a lipid-polymer hybrid nanoparticle for co-delivery and cell-distinct release of the differentiation-inducing agent, all-trans retinoic acid and the chemotherapeutic drug, doxorubicin to overcome the CSC-associated chemoresistance. The hybrid nanoparticles achieve differential release of the combined drugs in the CSCs and bulk tumor cells by responding to their specific intracellular signal variation. In the hypoxic CSCs, ATRA is released to induce differentiation of the CSCs, and in the differentiating CSCs with decreased chemoresistance, DOX is released upon elevation of reactive oxygen species to cause subsequent cell death. In the bulk tumor cells, the drugs are released synchronously upon the hypoxic and oxidative conditions to exert potent anticancer effect. This cell-distinct drug release enhances the synergistic therapeutic efficacy of ATRA and DOX with different anticancer mechanism. We show that treatment with the hybrid nanoparticle efficiently inhibit the tumor growth and metastasis of the CSC-enriched triple negative breast cancer in the mouse models.

Various c-mesenchymal-to-epithelial transition (c-MET) inhibitors are effective in the treatment of non-small cell lung cancer; however, the inevitable drug resistance remains a challenge, limiting their clinical efficacy. Therefore, novel strategies targeting c-MET are urgently required. Herein, through rational structure optimization, we obtained novel exceptionally potent and orally active c-MET proteolysis targeting chimeras (PROTACs) namely D10 and D15 based on thalidomide and tepotinib. D10 and D15 inhibited cell growth with low nanomolar IC₅₀ values and achieved picomolar DC₅₀ values and >99% of maximum degradation (D_max) in EBC-1 and Hs746T cells. Mechanistically, D10 and D15 dramatically induced cell apoptosis, G1 cell cycle arrest and inhibited cell migration and invasion. Notably, intraperitoneal administration of D10 and D15 significantly inhibited tumor growth in the EBC-1 xenograft model and oral administration of D15 induced approximately complete tumor suppression in the Hs746T xenograft model with well-tolerated dose-schedules. Furthermore, D10 and D15 exerted significant anti-tumor effect in cells with c-MET^Y1230H and c-MET^D1228N mutations, which are resistant to tepotinib in clinic. These findings demonstrated that D10 and D15 could serve as candidates for the treatment of tumors with MET alterations.

Thoracic aortic dissection (TAD) without familial clustering or syndromic features is known as sporadic TAD (STAD). So far, the genetic basis of STAD remains unknown. Whole exome sequencing was performed in 223 STAD patients and 414 healthy controls from the Chinese Han population (N = 637). After population structure and genetic relationship and ancestry analyses, we used the optimal sequence kernel association test to identify the candidate genes or variants of STAD. We found that COL3A1 was significantly relevant to STAD (P = 7.35 × 10
Aneurysm, Dissecting/genetics* ; Case-Control Studies ; Cluster Analysis ; Cohort Studies ; Collagen Type III/genetics* ; Computational Biology ; Genetic Predisposition to Disease ; Humans