Objective:To investigate and analyze the predictive value of inhibin A (INHA), galectin-13 (Gal-13), leucine rich alpha-2-glycoprotein 1 (LRG1) in serum for adverse pregnancy outcomes in pregnant women with gestational diabetes mellitus (GDM) .Methods:From Jan. 2022 to Dec. 2023, 87 GDM pregnant women admitted to Obstetrics Department of Shanxi Children’s Hospital were included as the study group, and were assigned into a good outcome group ( n=54) and an adverse outcome group ( n=33) based on pregnancy outcomes. Meantime, another 87 healthy pregnant women who underwent normal prenatal examinations at our hospital and had no complications were selected as the control group. ELISA method was applied to detect serum levels of INHA, LRG1, and Gal-13. Multiple factor Logistic regression model was constructed to analyze the factors affecting adverse pregnancy outcomes in GDM pregnant women. Receiver operating characteristic (ROC) curves were applied to evaluate the efficacy of the three methods in predicting adverse pregnancy outcomes in GDM pregnant women. Results:Compared with the control group, the levels of INHA and LRG1 in the serum of pregnant women in the study group were obviously higher, and the level of Gal-13 in the serum was obviously lower ( P<0.05). Compared with the good outcome group, the adverse outcome group showed an increase in serum INHA and LRG1 levels and a decrease in serum Gal-13 level ( P<0.05). Elevated levels of serum INHA and LRG1 were risk factors for adverse pregnancy outcomes in GDM pregnant women, while elevated level of serum Gal-13 was a protective factor ( P<0.05). The AUC values for predicting adverse pregnancy outcomes in GDM pregnant women based solely on serum INHA, Gal-13, and LRG1 levels were 0.859, 0.850, and 0.841, respectively. The AUC predicted by the combination of the three factors was 0.978, which was better than the individual predictions of serum INHA, Gal-13, and LRG1 ( Zcombination-HA=2.378, Z combination-Gal-13=3.193, Zcombination-LRG1=3.050, P=0.017, 0.001, 0.002) . Conclusions:Serum levels of INHA and LRG1 are elevated in GDM pregnant women, while serum level of Gal-13 is decreased. All three are potential factors that affect the pregnancy outcomes of GDM pregnant women, and the combination of the three shows higher efficacy in predicting adverse pregnancy outcomes in GDM pregnant women.

Objective:To investigate and analyze the predictive value of inhibin A (INHA), galectin-13 (Gal-13), leucine rich alpha-2-glycoprotein 1 (LRG1) in serum for adverse pregnancy outcomes in pregnant women with gestational diabetes mellitus (GDM) .Methods:From Jan. 2022 to Dec. 2023, 87 GDM pregnant women admitted to Obstetrics Department of Shanxi Children’s Hospital were included as the study group, and were assigned into a good outcome group ( n=54) and an adverse outcome group ( n=33) based on pregnancy outcomes. Meantime, another 87 healthy pregnant women who underwent normal prenatal examinations at our hospital and had no complications were selected as the control group. ELISA method was applied to detect serum levels of INHA, LRG1, and Gal-13. Multiple factor Logistic regression model was constructed to analyze the factors affecting adverse pregnancy outcomes in GDM pregnant women. Receiver operating characteristic (ROC) curves were applied to evaluate the efficacy of the three methods in predicting adverse pregnancy outcomes in GDM pregnant women. Results:Compared with the control group, the levels of INHA and LRG1 in the serum of pregnant women in the study group were obviously higher, and the level of Gal-13 in the serum was obviously lower ( P<0.05). Compared with the good outcome group, the adverse outcome group showed an increase in serum INHA and LRG1 levels and a decrease in serum Gal-13 level ( P<0.05). Elevated levels of serum INHA and LRG1 were risk factors for adverse pregnancy outcomes in GDM pregnant women, while elevated level of serum Gal-13 was a protective factor ( P<0.05). The AUC values for predicting adverse pregnancy outcomes in GDM pregnant women based solely on serum INHA, Gal-13, and LRG1 levels were 0.859, 0.850, and 0.841, respectively. The AUC predicted by the combination of the three factors was 0.978, which was better than the individual predictions of serum INHA, Gal-13, and LRG1 ( Zcombination-HA=2.378, Z combination-Gal-13=3.193, Zcombination-LRG1=3.050, P=0.017, 0.001, 0.002) . Conclusions:Serum levels of INHA and LRG1 are elevated in GDM pregnant women, while serum level of Gal-13 is decreased. All three are potential factors that affect the pregnancy outcomes of GDM pregnant women, and the combination of the three shows higher efficacy in predicting adverse pregnancy outcomes in GDM pregnant women.

Cardiac fibrosis is characterized by an elevated amount of extracellular matrix (ECM) within the heart. However, the persistence of cardiac fibrosis ultimately diminishes contractility and precipitates cardiac dysfunction. Circular RNAs (circRNAs) are emerging as important regulators of cardiac fibrosis. Here, we elucidate the functional role of a specific circular RNA CELF1 in cardiac fibrosis and delineate a novel feedback loop mechanism. Functionally, circ-CELF1 was involved in enhancing fibrosis-related markers' expression and promoting the proliferation of cardiac fibroblasts (CFs), thereby exacerbating cardiac fibrosis. Mechanistically, circ-CELF1 reduced the ubiquitination-degradation rate of BRPF3, leading to an elevation of BRPF3 protein levels. Additionally, BRPF3 acted as a modular scaffold for the recruitment of histone acetyltransferase KAT7 to facilitate the induction of H3K14 acetylation within the promoters of the Celf1 gene. Thus, the transcription of Celf1 was dramatically activated, thereby inhibiting the subsequent response of their downstream target gene Smad7 expression to promote cardiac fibrosis. Moreover, Celf1 further promoted Celf1 pre-mRNA transcription and back-splicing, thereby establishing a feedback loop for circ-CELF1 production. Consequently, a novel feedback loop involving CELF1/circ-CELF1/BRPF3/KAT7 was established, suggesting that circ-CELF1 may serve as a potential novel therapeutic target for cardiac fibrosis.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective:To search the best evidence for perioperative nutrition management in pancreatic cancer patients, so as to provide evidence basis for optimization of perioperative nutrition management in pancreatic cancer patients.Methods:Evidence on perioperative nutrition management for pancreatic cancer patients was systematically searched in Cochrane Library, British Medical Journal (BMJ) Best Practice, UpToDate, National Institute for Health and Clinical Excellence, PubMed, China National Knowledge Infrastructure, WanFang Data, VIP, Chinese Medical Association Network and other domestic and foreign databases and nutrition related websites. The search types included clinical decision-making, guidelines, expert consensus, evidence summary, and systematic review. The search period was from database establishment to February 10, 2023.Results:A total of 17 articles were included, including 8 guidelines, 6 expert consensus, and 3 systematic reviews. A total of 26 pieces of evidence were summarized from 6 aspects, including management general principles, energy and protein requirements, nutritional risk screening and assessment, nutritional support, complication management, and post discharge management.Conclusions:The process of extracting the best evidence of perioperative nutrition management for pancreatic cancer patients is scientific and rigorous. Medical and nursing staff can improve the quality of nutrition management for patients with pancreatic cancer and promote the recovery of patients according to the actual clinical situation.

Objective:To analyze the correlation between serum interleukin-6 (IL-6) and osteopontin (OPN) levels and bone metabolism markers in pregnant women with gestational diabetes mellitus.Methods:A total of 89 pregnant women with GDM who were admitted to Shanxi Children’s Hospital from Aug. 2020 to May. 2022 were selected as the observation group, and 85 normal pregnant women who underwent regular health examination were selected as the control group. Clinical data of the two groups were compared and GDM related factors were analyzed. Serum IL-6, OPN, bone metabolic markers β collagen special sequence (β-CTX), type I procollagen N-terminal propeptide (PINP), n-terminal mid-section osteocalcin (N-MID), fasting blood glucose (FBG) and fasting insulin (FINS) levels of the two groups were detected. Insulin resistance index (HOMA-IR) was calculated, and the relationship between serum IL-6, OPN and β-CTX, PINP and N-MID was analyzed.Results:The age, gestational times and pre-pregnancy BMI of the observation group were higher than those of the control group, and the family history of diabetes was more than that of the control group, with statistical significance between the two groups ( t=14.31, 31.46, 9.47, 10.33, P<0.05). Logistic regression analysis showed that the older the age and the more pregnancies, the higher the pre-pregnancy BMI. Independent risk factors for developing GDM were associated with a large family history of diabetes mellitus [ ( OR (95% CI) =1.569 (1.370-1798), 8.533 (5.067-14.367), 1.460 (1.301-1.639), 3.677 (1.611-8.396). P<0.05) ]; Serum levels of IL-6, OPN, FBG, FINS and HOMA-IR in observation group were higher than those in control group ( t=16.64, 24.76, 10.97, 11.01, 55.70, all P<0.05). The β-CTX of observation group was higher than that of control group, and the PINP and N-MID of observation group were lower than that of control group ( t=3.64, 12.19, 12.52, P<0.05). Spearman correlation analysis showed that serum IL-6 and OPN were positively correlated with β-CTX ( r=0.781, 0.746, P<0.05). Serum IL-6 and OPN were negatively correlated with PINP and N-MID ( r=-0.264, -0.305; -0.208, -305, P<0.05) . Conclusions:In pregnant women with GDM, serum IL-6 and OPN are positively correlated with β-CTX, and serum IL-6 and OPN are negatively correlated with PINP and N-MID, respectively. These indicators can be used as indicators of disease monitoring, and play an important role in protecting the health of pregnant women with GDM.

Objective:To analyze the correlation between serum interleukin-6 (IL-6) and osteopontin (OPN) levels and bone metabolism markers in pregnant women with gestational diabetes mellitus.Methods:A total of 89 pregnant women with GDM who were admitted to Shanxi Children’s Hospital from Aug. 2020 to May. 2022 were selected as the observation group, and 85 normal pregnant women who underwent regular health examination were selected as the control group. Clinical data of the two groups were compared and GDM related factors were analyzed. Serum IL-6, OPN, bone metabolic markers β collagen special sequence (β-CTX), type I procollagen N-terminal propeptide (PINP), n-terminal mid-section osteocalcin (N-MID), fasting blood glucose (FBG) and fasting insulin (FINS) levels of the two groups were detected. Insulin resistance index (HOMA-IR) was calculated, and the relationship between serum IL-6, OPN and β-CTX, PINP and N-MID was analyzed.Results:The age, gestational times and pre-pregnancy BMI of the observation group were higher than those of the control group, and the family history of diabetes was more than that of the control group, with statistical significance between the two groups ( t=14.31, 31.46, 9.47, 10.33, P<0.05). Logistic regression analysis showed that the older the age and the more pregnancies, the higher the pre-pregnancy BMI. Independent risk factors for developing GDM were associated with a large family history of diabetes mellitus [ ( OR (95% CI) =1.569 (1.370-1798), 8.533 (5.067-14.367), 1.460 (1.301-1.639), 3.677 (1.611-8.396). P<0.05) ]; Serum levels of IL-6, OPN, FBG, FINS and HOMA-IR in observation group were higher than those in control group ( t=16.64, 24.76, 10.97, 11.01, 55.70, all P<0.05). The β-CTX of observation group was higher than that of control group, and the PINP and N-MID of observation group were lower than that of control group ( t=3.64, 12.19, 12.52, P<0.05). Spearman correlation analysis showed that serum IL-6 and OPN were positively correlated with β-CTX ( r=0.781, 0.746, P<0.05). Serum IL-6 and OPN were negatively correlated with PINP and N-MID ( r=-0.264, -0.305; -0.208, -305, P<0.05) . Conclusions:In pregnant women with GDM, serum IL-6 and OPN are positively correlated with β-CTX, and serum IL-6 and OPN are negatively correlated with PINP and N-MID, respectively. These indicators can be used as indicators of disease monitoring, and play an important role in protecting the health of pregnant women with GDM.

Objective:To understand the current status of core measures of enhanced recovery after surgery (ERAS) nursing in Anhui Province and analyze its promotion strategies, so we can provide reference for further implementation and promotion of clinical practice guidelines of ERAS.Methods:Design a Development Questionnaire of Enhanced Recovery After Surgery in Anhui Province based on the Clinical Practice Guidelines for Enhanced Recovery After Surgery in China (2021 edition) (I) and, a cross-sectional survey was conducted on surgical nurses in 132 secondary and above hospitals in Anhui Province from July to September 2023 by the convenience sampling method.Results:A total of 1 375 nurses from 13 cities in Anhui province participated in the survey. The nurses′ awareness rate of ERAS concept was 100.00%, but only 52.51% (722/1 375) of the nurses had received standardized ERAS training, and only 26.11% (359/1 375) of the nurses indicated that they had a multidisciplinary team such as medical care, anesthesia and nutrition were involved in the implementation of the ERAS. Nearly 38.33% (527/1 375) of the nurses said that the department lacked the relevant nursing quality control system, and the overall implementation rate of quality control training, development, feedback and monitoring was not high. Only 55.71% (766/1 375) of nurses reported that a quality control team has been established within their department, and only 40.44% (556/1 375) of departments conduct monthly checks on the implementation and progress of ERAS. In terms of the implementation of core measures, preoperative thromboprevention therapy, intraoperative temperature monitoring and management, postoperative multimodal analgesia were better; however, the implementation of preoperative fasting time ≤ 6 h, water ban time≤ 2 h, oral carbohydrate drinks or clean streaming drinks, oral intake of enteral nutritional supplementation when less than 60% of the normal amount was poor.Conclusions:There are still many deficiencies in the overall development of ERAS nursing in Anhui Province, and the implementation level of core measures also needs to be improved. It is necessary to combine the concept of precision nursing, strengthen the whole process management and quality control, so as to promote the clinical practice and promotion of ERAS.

Sleep disorders,a common concern in modern society,seriously affect people's physical and mental health.Reported findings suggest that both acute exercise intervention and long-term regular exercise intervention can improve the disrupted sleep structure and normalize the duration and proportion of the different phases of sleep.Moreover,exercise intervention has a positive effect on the endocrine functions,the metabolic functions,the immune response,the autonomic nervous system,and cardiac functions during sleep.It is a non-medicative therapeutic strategy for improving sleep disorders.The specific type of exercise intervention(aerobic exercise,resistance exercise,or meditative movement)adopted is one of the moderating variables of exercise intervention programs.Different types of exercise improve sleep disorders by way of different mechanisms.Exercise volume and intensity are another moderating variable of exercise intervention programs.The optimal amount and intensity of exercise for different individuals to improve sleep disorders may vary.Exercise interventions implemented at the different times throughout a day can also have varying degrees of impact on sleep disorders and there is no consensus on the optimal exercise time for improving sleep quality at present.Herein,we summarized the mechanisms by which exercise intervention improves sleep disorders from four perspectives,including epigenetics,hyperarousal,human circadian rhythm,and body temperature regulation.In addition,we discussed the current gaps and prospects of research in this field,aiming to provide a theoretical basis for the development of exercise prescriptions for sleep disorders.

Objective:To understand the current status of core measures of enhanced recovery after surgery (ERAS) nursing in Anhui Province and analyze its promotion strategies, so we can provide reference for further implementation and promotion of clinical practice guidelines of ERAS.Methods:Design a Development Questionnaire of Enhanced Recovery After Surgery in Anhui Province based on the Clinical Practice Guidelines for Enhanced Recovery After Surgery in China (2021 edition) (I) and, a cross-sectional survey was conducted on surgical nurses in 132 secondary and above hospitals in Anhui Province from July to September 2023 by the convenience sampling method.Results:A total of 1 375 nurses from 13 cities in Anhui province participated in the survey. The nurses′ awareness rate of ERAS concept was 100.00%, but only 52.51% (722/1 375) of the nurses had received standardized ERAS training, and only 26.11% (359/1 375) of the nurses indicated that they had a multidisciplinary team such as medical care, anesthesia and nutrition were involved in the implementation of the ERAS. Nearly 38.33% (527/1 375) of the nurses said that the department lacked the relevant nursing quality control system, and the overall implementation rate of quality control training, development, feedback and monitoring was not high. Only 55.71% (766/1 375) of nurses reported that a quality control team has been established within their department, and only 40.44% (556/1 375) of departments conduct monthly checks on the implementation and progress of ERAS. In terms of the implementation of core measures, preoperative thromboprevention therapy, intraoperative temperature monitoring and management, postoperative multimodal analgesia were better; however, the implementation of preoperative fasting time ≤ 6 h, water ban time≤ 2 h, oral carbohydrate drinks or clean streaming drinks, oral intake of enteral nutritional supplementation when less than 60% of the normal amount was poor.Conclusions:There are still many deficiencies in the overall development of ERAS nursing in Anhui Province, and the implementation level of core measures also needs to be improved. It is necessary to combine the concept of precision nursing, strengthen the whole process management and quality control, so as to promote the clinical practice and promotion of ERAS.