Objective To explore the mechanism by which hyperandrogenic states induce preeclampsia in advanced maternal age through the LAMA3-PI3K/Akt pathway and assess its effects on the invasion and migration abilities of human trophoblast cells.Methods Human trophoblast cells were stimulated with dihydrotestosterone(DHT),followed by RNA sequencing(RNA-Seq)to identify differen-tially expressed genes,with gene ontology(GO)and Kyoto encyclopedia of genes and genomes(KEGG)analysis revealing LAM A3 as a key molecule.The mRNA and protein expression levels of LAMA3 were detected using real-time quantitative PCR(RT-qPCR)and Western blot.LAMA3-overexpressing human trophoblast cells were obtained by plasmid transfection.The invasion ability was assessed using the Matrigel-based Transwell assay,and the migration ability was evaluated by the scratch assay.Results DHT stimulation sig-nificantly inhibited the invasion and migration abilities of trophoblast cells.RNA-Seq analysis revealed that LAM A3 might be a key mole-cule involved,and further Western blot and RT-qPCR analyses showed that the protein and mRNA expression of LAM A3 in the placenta of advanced maternal age pregnancies were significantly higher than in normal pregnancies and consistent with findings in the placenta of preeclampsia patients.Overexpression of LAM A3 significantly suppressed trophoblast cell invasion and migration abilities,while also up-regulating the phosphorylation levels of PI3K and Akt.Treatment with a PI3K inhibitor restored both cell function and phosphorylation lev-els to normal.Conclusion Elevated androgen levels in trophoblast cells from advanced maternal age induce specific changes in LAMA3 expression,and LAMA3 regulates trophoblast migration and invasion through the PI3K/Akt signaling pathway.

Objective:To investigate the risk factors for delirium after free flap reconstruction surgery in elderly patients with head and neck cancer.Methods:This study retrospectively collected clinical data from 309 elderly patients with head and neck cancer who underwent radical resection and free flap reconstruction surgery in the Department of Operation & Anesthesiology, College & Hospital of Stomatology, Guangxi Medical University from January 2018 to December 2022. Among them, there were 197 males (63.8%) and 112 females (36.2%), with an average age of (66.8±5.5) years old. Based on the delirium diagnostic criteria outlined in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, patients were evaluated for postoperative delirium within one week after surgery. They were then divided into a delirium group ( n=75) and a non-delirium group ( n=234). Perioperative indicators potentially related to postoperative delirium, including age, gender, past medical history, tumor characteristics, hematological tests, perioperative sleep disturbances, surgical procedures, intraoperative fluid intake and output, anesthetic dosage, postoperative pain, etc, were collected from the relevant medical record system.Variables with P<0.05 were included in a multivariate Logistic regression model to screen for independent risk factors for delirium. Results:The incidence of delirium after free flap reconstruction surgery for head and neck cancer in elderly patients was 24.3% (75/309). Multivariate Logistic regression analysis showed that male gender ( OR=2.802, P=0.005), perioperative sleep disturbances ( OR=7.104, P<0.001), and moderate-to-severe postoperative pain ( OR=6.903, P<0.001) were risk factors for postoperative delirium. Conclusions:Male gender, perioperative sleep disturbances, and moderate-to-severe postoperative pain are independent risk factors for delirium in these patients.

ObjectiveTo analyze the influencing factors of pulmonary dysfunction among community-based population at high-risk for chronic obstructive pulmonary disease (COPD), and to establish a risk assessment model to provide a reference basis for accelerating the beforehand prevention and control of COPD and promoting the respiratory health of community-based residents. MethodsIndividuals aged >35 years old, with at least one risk factor except age illustrated in the Guidelines for Primary Diagnosis and Treatment of Chronic Obstructive Lung Disease (2018), and participated in the early screening for COPD from July 2022 to December 2023 were selected as the research subjects, and their lung function was assessed by the forceful expiratory volume in the first second after inhalation of bronchodilator (FEV₁)/ forced vital capacity (FVC) <70% and/or the ratio of FEV₁ to predicted value (FEV₁%Pred) <80% as the diagnostic criteria. In addition, risk factors related to pulmonary dysfunction were analyzed for the establishment of risk assessment model. ResultsA total of 823 individuals aged between 35‒76 years were included, among which 298 (36.21%) were diagnosed with pulmonary dysfunction, 167 (20.29%) with COPD, and 131 (15.92%) with preserved ratio but impaired spirometry. Logistic regression analysis revealed that male gender, increasing age, more frequent smoking, insufficient physical activity, recurrent wheezing, the presence of post-exercise wheezing or coughing, insensitive to airborne allergens, and history of chronic bronchitis or bronchial asthma were correlated with pulmonary dysfunction. The incidence rate of pulmonary dysfunction was 1.99 times higher in males than that in females, 1.81 times more common in those aged between 70‒76 years than those aged <60 years, 2.42 times more common in those who smoked 50‒200 pack-years than in those who smoked 0‒14 pack-years, 1.78 times higher in those who underwent physical activity <600 MET‑min·week^-1 than in those who underwent physical activity ≥600 MET‑min·week^-1, 2.61 times higher in those suffered recurrent wheezing than in those did not, 1.53 times higher in those with symptoms of post-exercise wheezing or coughing than in those without, 1.61 times higher in those insensitive to airborne allergens than those sensitive, 2.02 times higher in patients with chronic bronchitis than in those without, and 2.41 times higher in patients with bronchial asthma than in those without. The risk assessment model for pulmonary dysfunction constructed on this basis had a total score of 28 points, and the area under the subject operating characteristic (ROC) curve was 0.72, reaching the cut-off point of ROC curve while taking scores ≥10 points as the cut-off value for pulmonary dysfunction. ConclusionIn community-based high-risk COPD population, the incidence rate of pulmonary dysfunction is higher in males than that in females, in addition, which increases with the advancement of age. Smoking,insufficient physical activity,recurrent wheezing,post-exercise wheezing or coughing,insensitive to airborne allergens,and history of chronic bronchitis or bronchial asthma are high risk factors for pulmonary dysfunction. The risk assessment model constructed based on these factors has a good predictive effect in screening high-risk population of COPD, but its effectiveness in screening people at general risk needs to be further validated.

Objective:To investigate the risk factors for delirium after free flap reconstruction surgery in elderly patients with head and neck cancer.Methods:This study retrospectively collected clinical data from 309 elderly patients with head and neck cancer who underwent radical resection and free flap reconstruction surgery in the Department of Operation & Anesthesiology, College & Hospital of Stomatology, Guangxi Medical University from January 2018 to December 2022. Among them, there were 197 males (63.8%) and 112 females (36.2%), with an average age of (66.8±5.5) years old. Based on the delirium diagnostic criteria outlined in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, patients were evaluated for postoperative delirium within one week after surgery. They were then divided into a delirium group ( n=75) and a non-delirium group ( n=234). Perioperative indicators potentially related to postoperative delirium, including age, gender, past medical history, tumor characteristics, hematological tests, perioperative sleep disturbances, surgical procedures, intraoperative fluid intake and output, anesthetic dosage, postoperative pain, etc, were collected from the relevant medical record system.Variables with P<0.05 were included in a multivariate Logistic regression model to screen for independent risk factors for delirium. Results:The incidence of delirium after free flap reconstruction surgery for head and neck cancer in elderly patients was 24.3% (75/309). Multivariate Logistic regression analysis showed that male gender ( OR=2.802, P=0.005), perioperative sleep disturbances ( OR=7.104, P<0.001), and moderate-to-severe postoperative pain ( OR=6.903, P<0.001) were risk factors for postoperative delirium. Conclusions:Male gender, perioperative sleep disturbances, and moderate-to-severe postoperative pain are independent risk factors for delirium in these patients.

Objective To explore the mechanism by which hyperandrogenic states induce preeclampsia in advanced maternal age through the LAMA3-PI3K/Akt pathway and assess its effects on the invasion and migration abilities of human trophoblast cells.Methods Human trophoblast cells were stimulated with dihydrotestosterone(DHT),followed by RNA sequencing(RNA-Seq)to identify differen-tially expressed genes,with gene ontology(GO)and Kyoto encyclopedia of genes and genomes(KEGG)analysis revealing LAM A3 as a key molecule.The mRNA and protein expression levels of LAMA3 were detected using real-time quantitative PCR(RT-qPCR)and Western blot.LAMA3-overexpressing human trophoblast cells were obtained by plasmid transfection.The invasion ability was assessed using the Matrigel-based Transwell assay,and the migration ability was evaluated by the scratch assay.Results DHT stimulation sig-nificantly inhibited the invasion and migration abilities of trophoblast cells.RNA-Seq analysis revealed that LAM A3 might be a key mole-cule involved,and further Western blot and RT-qPCR analyses showed that the protein and mRNA expression of LAM A3 in the placenta of advanced maternal age pregnancies were significantly higher than in normal pregnancies and consistent with findings in the placenta of preeclampsia patients.Overexpression of LAM A3 significantly suppressed trophoblast cell invasion and migration abilities,while also up-regulating the phosphorylation levels of PI3K and Akt.Treatment with a PI3K inhibitor restored both cell function and phosphorylation lev-els to normal.Conclusion Elevated androgen levels in trophoblast cells from advanced maternal age induce specific changes in LAMA3 expression,and LAMA3 regulates trophoblast migration and invasion through the PI3K/Akt signaling pathway.

Objective To evaluate MRI and clinicopathological prognostic factors in predicting disease-free survival(DFS)of stage ⅢC1p cervical cancer patients.Methods A total of 102 stage ⅢC1p cervical cancer patients who underwent surgical treatment were selected.Based on survival status,stage ⅢC1p cases were divided into two subgroups:progression group and no progression group.The influencing factors of clinicopathological indexes and MRI features on prognosis in the two groups were analyzed.Results The results of the univariate analysis showed that squamous cell carcinoma antigen(SCC-Ag)level,T stage and location of lymph node metastasis(LNM)were correlated with the prognosis of stage ⅢC1p cervical cancer patients(P<0.05).Multivariate analysis results showed that late T stage,SCC-Ag>13 ng/mL,and LNM location≥3 were the high risk factors affecting the 3-year DFS decline in stage ⅢC1p cervical cancer patients.Conclusion SCC-Ag,T stage,and LNM location are independent risk factors for 3-year DFS in stage ⅢC1p cervical cancer patients.

Objective To explore the relationship between androgen level and adverse pregnancy outcome of pregnant women at advanced maternal age.Methods A total of 192 pregnant women who were admitted to Changzhou Maternal and Child Health Care Hospital for delivery from May to October 2022 were selected as the study objects.According to guidelines for diagnosis and treatment of hypertensive disorder complicating pregnancy and maternal age,the study objects were divided into simple pregnant women at advanced maternal age group,pregnant women at advanced maternal age complicated with hypertensive disorder complicating pregnancy,healthy control group and age-appropriate pregnant women complicated with hypertensive disorder complicating pregnancy group.Serum levels of five androgens[total testosterone(TT),sex hormone binding globulin(SHBG),free testosterone index(FTI),dehydroepiandrosterone sulfate(DHEAS)and androstendi-one(A2)]in each group were detected by chemiluminescence method.Results Compared with the healthy control group,TT,A2,FTI were significantly increased and SHBG was significantly decreased in the age-ap-propriate pregnant women complicated with hypertensive disorder complicating pregnancy group,the level of DHEAS was decreased in the simple pregnant women at advanced maternal age group,and the differences were statistically significant(P＜0.05).Pearson correlation analysis showed that TT was negatively correla-ted with age(P＜0.05),positively correlated with systolic blood pressure,diastolic blood pressure and body mass index(P＜0.05),and had no correlation with offspring sex and offspring weight(P＞0.05).Multivari-ate Logistic regression analysis showed that TT and body mass index were independent risk factors for hyper-tensive disorder complicating pregnancy in pregnant women(P＜0.05).Conclusion The level of androgen in pregnant women at advanced maternal age is related to the occurrence of hypertensive disorder complicating pregnancy.

Humans ; Aminoquinolines/therapeutic use* ; Carcinoma, Non-Small-Cell Lung/genetics* ; Lung Neoplasms/genetics* ; Mutation/genetics* ; Standard of Care

Objective:To identify the transmission relationship between HIV infection cases the non-marital non-commercial heterosexual contact in Zhejiang Province.Methods:When HIV positive was informed during January 2020 to January 2022, the staff conducted an epidemiological investigation to collect cases information on sociodemographic characteristics, mobility information, past HIV testing history, high-risk sexual behaviors, sexual partners, and etcetera. At the same time, 6-8 ml of blood from the new diagnosis of people infected with HIV before antiviral treatment was collected to separate the bleeding plasma. pol gene was amplified by nucleic acid extraction and PCR, sequenced by Sequencer 5.0 software, and Cytoscape 3.6.0 software was used to draw HIV molecular transmission network. Results:From January 2020 to January 2022, 88 HIV infected individuals were found in Pujiang County, of which 74 were transmitted through heterosexual transmission, of which 31 were infected through non-marital non-commercial heterosexual contact. Preliminary case studies have found that three female cases have engaged in unprotected non-marital non-commercial heterosexual contact with one male case. Among the 4 infected individuals, 2 of their spouses tested positive for HIV antibodies. Molecular transmission network monitoring was carried out on 65 newly diagnosed cases of heterosexual transmission with acquired sequences, forming 9 transmission clusters. The largest cluster contained 10 cases. A total of 11 HIV-infected individuals were involved in this HIV cluster epidemic. They were 3 males and 8 females, all over 50 years old and were farmers or rural housewives. They were traced to 7 sexual partners (6 negatives of HIV, 1 undetected). Among the 18 respondents' sexual social network relationships, there were 6 couples, 8 permanent partners, and 3 temporary partners. Among 11 HIV infected individuals, there were 9 cases of non-marital non-commercial heterosexual transmission and 2 cases of intramarital transmission. The epidemiological association between 7 non-married non-commercial heterosexual partners and case 2 (56-year-old male farmer), 3 cases confirmed by epidemiological investigation and molecular transmission cluster results, 3 cases confirmed by molecular transmission cluster and epidemiological investigation results, and 1 case confirmed by epidemiological investigation results.Conclusions:The transmission mode of this cluster epidemic was to spread HIV through heterosexual sex with a male case as the core, then cause the transmission within marriage and between fixed sexual partners. The combination of epidemiological investigation and molecular transmission network traceability survey supports the conclusion of this study.

Objective:Using the classical concept analysis method of Avant & Walker, this paper made an in-depth analysis of the concept of childbirth trauma, obtained its operational definition, and provided a reference for clinical practice.Methods:We systematically searched CNKI, VIP, Wanfang, SinoMed, Web of Science, PubMed, and Embase, and the retrieval period was from the establishment of the database to August 10, 2022. We analyzed and defined childbirth trauma by Avant & Walker's classical concept analysis.Results:A total of 34 articles were included. The defining attributes of childbirth trauma were identified as persistent psychological trauma, lack of social support, loss of control, impaired dignity, and poor interaction with care providers. The antecedents could be discussed from demographic factors and disease history, obstetric nurses and midwives, and delivery environment. Consequences included affected women's physiology, behavior, and psychology.Conclusions:Birth trauma has brought lasting negative consequences to women's lives and families. Medical staff should recognize its severity, identify birth trauma in clinical practice with the help of the concept of birth trauma and operational definition, find it early, and effectively prevent it.