Objective: To create a prediction model for stroke risk among middle-aged and elderly populations, so as to provide a basis for early identification of high-risk population for stroke. Methods: From October to December 2023, residents aged ≥45 years in Chongchuan District, Nantong City, Jiangsu Province were selected using a multi-stage stratified random sampling method. The demographic information, life behavior, and chronic disease data were collected through a questionnaire survey. The standardized prevalence of stroke was calculated using data from the seventh National Population Census. The subjects were randomly divided into the training set and the internal validation set according to the ratio of 8∶2. The basic demographic information, life behavior, and chronic diseases of residents aged ≥45 years in Rugao City were collected from July to August 2023 as the external validation set. Predictive factors were selected using multivariable logistic regression model, and a nomogram for stroke among residents aged ≥45 years was established. The prediction effect was evaluated using the area under the curve (AUC) of the receiver operating characteristic (ROC), calibration curve, and Hosmer-Lemeshow goodness of fit test. Results: A total of 6 290 residents aged ≥45 years were included, including 2 975 males (47.30%) and 3 315 females (52.70%). The average age was (61.90±10.20) years. The prevalence of stroke was 3.80%, and the standardized prevalence was 3.36%. The multivariable logistic regression showed that age, smoking, hypertension, and hyperlipidemia were predictors of stroke risk among residents aged ≥45 years, and the prediction model was ln[p/(1-p)]=-4.619+0.046×age+0.383×smoking+0.887×hypertension+0.678×hyperlipidemia. The AUC values of the training set, internal validation set, and external validation set were 0.748, 0.755, and 0.738, respectively. The consistency indexes were 0.748, 0.755, and 0.738, respectively. The Hosmer-Lemeshow goodness of fit test showed a good fitting effect (P>0.05). Conclusion The prediction model based on age, smoking, hypertension, and hyperlipidemia has good discrimination and calibration, and can be used to predict the risk of stroke among middle-aged and elderly populations aged ≥45 years.

Cardiovascular dysfunction and reduced exercise capacity are common adverse effects of anti-cancer treatments, severely impacting the prognosis and quality of life of cancer patients. This review summarizes the intervention protocols and application effects of resistance training on cardiovascular function and/or exercise capacity in cancer patients. The aim is to provide a reference for the practice of exercise interventions targeting cardiovascular function and exercise capacity among cancer patients in China.

OBJECTIVE: To study the influence of maternal sex chromosomal abnormalities on the prediction of fetal sex chromosome abnormalities (SCAs) by non-invasive prenatal testing (NIPT). METHODS: Thirty-six pregnant women with a prediction for fetal SCAs by NIPT were verified as false positive after prenatal diagnosis using amniotic fluid samples. With informed consent, these women were subjected to chromosomal karyotyping or copy number variations (CNVs) analysis through high-throughput sequencing. RESULTS: Sex chromosomal abnormalities were found in 8 women, which yielded an abnormal rate of 22.22% (8/36). Among these, 3 had sex chromosome aneuploidies (47, XXX), 4 had sex chromosome mosaicisms, and 1 carried structural chromosomal abnormalities. Reanalysis of the results of NIPT were consistent with the maternal CNVs by large. With the ratio of cffDNA (ChrX)/cffDNA was more than 2, 6 of the eight women were found to harbor sex chromosome abnormalities, and the fetal karyotype was normal. However, with a ratio of less than 2, only 2 of the 38 pregnant women had sex chromosome abnormalities, and 10 of the fetuses were confirmed as positive. CONCLUSION The presence of maternal sex chromosomal abnormalities can greatly influence the result of NIPT, which may also be an important reason for false prediction for fetal SCAs by NIPT. When NIPT indicates abnormal SCAs, it is necessary to analyze maternal sex chromosomes. The ratio of cffDNA(ChrX)/cffDNA may help to determine the source of abnormal signals.

Objective To explore the changes in gravida's age and its influences on maternal and neonatal complications under China's two-child policy.Methods This study retrospectively analyzed the clinical data such as adverse gestational complications and fetal condition of 42 771 gravidas delivering at Changzhou Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University from July 2013 to December 2017.According to their age at delivery,they were divided into three groups:the younger maternal age group (1 140 cases,＜20 years),the advanced maternal age group (4 307 cases,≥ 35 years) and the median maternal age group (37 324 cases,≥ 20 and ＜35 years).Chi-square test was used to compare the differences among groups.Cochran-Armitage test was used for trend analysis.The risks of various complications in younger and advanced maternal age groups were analyzed by binary logistic regression analysis.Results (1) The proportion of advanced maternal age pregnancies tended to rise gradually year by year (Z=-9.909,P＜0.001).However,the figure of younger gravidas remained low and presented a downward trend (Z=10.685,P＜0.001).(2) The incidence of pregnant complications in the younger,advanced and the median maternal age groups were 52.8％ (602/1 140),72.3％ (3 116/4 307) and 56.5％ (21 091/37 324),respectively.Compared with the median maternal age group,the advanced maternal age group was at greater risks of premature delivery [9.0％ (3 343/37 324) vs 11.6％ (499/4 307),x2=124.233,P＜0.001],fetal growth restriction (FGR) [0.6％ (218/37 324) vs 1.2％ (50/4 307),x2=20.087,P＜0.001],postpartum hemorrhage [5.7％ (2 120/37 324) vs 7.8％ (336/4 307),x2=31.299,P＜0.05],hypertensive disorders in pregnancy(HDP) [4.2％ (1 561/37 324) vs 8.7％ (376/4 307),x2=180.013,P＜0.001],gestational diabetes mellitus (GDM) [7.6％ (2 845/37 324) vs 15.1％ (650/4 307),x2=280.126,P＜0.001]and placenta previa [1.7％ (621/37 324) vs 3.8％ (165/4 307),x2=97.904,P＜0.001],and the younger maternal age group was at greater risks of HDP [4.2％ (1 561/37 324) vs 5.9％ (67/1 140),x2=4.234,P=0.040],fetal distress [3.5％ (1 325/37 324) vs 5.1％ (58/1 140),x2=7.546,P=0.006],premature delivery [9.0％ (3 343/37 324) vs 15.0％ (171/1 140),22=48.668,P＜0.001] and FGR [0.6％ (218/37 324) vs 1.1％ (12/1 140),x2=4.086,P=0.043].(3) Gestational complications in the younger maternal age group were mainly related to the fetuses such as premature rupture of membranes (PROM) and premature delivery,while the advanced maternal age group had a higher incidence of maternal complications,especially GDM and HDP.(4) Most of the gravidas of advanced maternal age with HDP developed severe preeclampsia (47.9％,180/376),while mild preeclampsia was dominant in the median maternal aged HDP women (45.4％,708/1 561).(5) The advanced maternal age group had higher risk of stillbirth,premature delivery,FGR,placenta previa,GDM,HDP and postpartum hemorrhage [OR(95％CI):1.91 (1.29-2.84),1.33 (1.21-1.46),1.66 (1.21-2.28),2.56 (2.15-3.04),2.39 (2.19-2.61),2.36 (2.11-2.65),1.46 (1.31-1.62);all P＜0.05],but lower risks of fetal distress and PROM [OR(95％CI):0.79 (0.65-0.95) and 0.88 (0.81-0.96);both P＜0.05].The younger maternal age group had a higher risk of premature delivery [OR(95％CI):1.97 (1.61-2.40);P＜0.001],but significant lower risks of PROM and GDM [OR(95％CI):0.77 (0.62-0.95) and 0.05 (0.02-0.16);both P＜0.05].Conclusions Maternal age is closely related to the adverse outcomes of pregnancy.Two-child policy in China will bring about changes in maternal age and composition of pregnant complications.

OBJECTIVETo explore the cause of failure of non-invasive prenatal testing (NIPT) using cell-free fetal DNA from peripheral maternal blood.

METHODSA total of 31 832 cases of NIPT were retrospectively analyzed. The clinical data of pregnant women were analyzed and the outcome of pregnancy was followed up.

RESULTSAmong the 31 832 cases, 200 patients have failed for the first NIPT test. Second test has succeeded in 171 (85.9%) of 199 cases, while 28 cases (14.1%) still yielded no effective results. This gave rise for a total failure rate of 0.088%. Of the 28 cases, 11 (39.2%) were due to high content of total free DNA and could not be sequenced, 17 (60.7%) were found to have the fetal DNA content of less than 4%. Among the 171 cases which have obtained a valid result, NIPT showed that there were 4 patients with high risk of trisomy 21, 18 cases with high risk of 18 trisomy and 1 case with high risk of 13 trisomy. Karyotyping analysis of the amniocytic chromosomes has identified 3 cases with 47,XN,+21, 1 case with 46,XN,rob(21;21), 1 case with 47,XN,+18, while the 13 trisomy case was found to be false positive. For the 28 cases with failed NIPT retest, 14 had normal delivery, with no anomaly noticed in the neonates. Nine patients had opted for artificial abortion during middle or late pregnancy due to maternal factors (4 cases) or fetal factors (5 cases). Four patients developed complications of pregnancy. One case was in good condition upon follow-up. Four cases were lost during follow-up. Of the 11 pregnant women who had failed the NIPT test due to high content of total free DNA, 6 (54.5%) had opted for artificial abortion during midterm pregnancy, which was significantly higher than that of pregnant women with low free DNA content (17.6%).

CONCLUSIONFailure of NIPT testing should attract attention from researchers. Failure of single NIPT test should not be regarded as a high risk signal for fetal chromosomal aneuploidies. For those where the test has failed again, genetic counseling and strengthened perinatal care should be provided for the pregnant women.

Objective To evaluate the clinical efficacy of dexamethasone in the treatment of severe pregnancy induced hypertension with thrombocytopenia syndrome .Methods 50 cases of severe pregnancy induced hypertension with thrombocytopenia syndrome were selected .The patients were randomly divided into the magnesium sulfate group and dexamethasone group according to the digital table ,25 cases in each group.The magnesium sulfate group was given magnesium sulfate treatment,the dexamethasone group was treated with dexamethasone .The treatment effect,the neonatal mortality rate,premature delivery rate,neonatal asphyxia rate,cesarean section rate,incidence of symptoms and prognosis were compared between the two groups .Results The effective rate of the dexamethasone group (92%) was higher than that of the magnesium sulfate group (68%,χ2 =5.164,P <0.05).The incidence rate of concurrent symptoms in the dexamethasone group (4%) was significantly lower than that in the magnesium sulfate group (20%,χ2 =4.287,P <0.05).The liver function recovery time,ALT recovery time,platelet recovery time in the dexametha-sone group were (3.12 ±1.23)d,(2.09 ±0.26)d,(2.45 ±0.25)d,respectively,which were obviously shorter than those in the magnesium sulfate group (t =3.011,3.872,3.456,all P <0.05).Conclusion Dexamethasone in the treatment of severe pregnancy induced hypertension with thrombocytopenia syndrome has prominent treatment effect , the neonatal mortality,premature birth,neonatal asphyxia rate,cesarean section rate and incidence rate of complica-tions are low,the prognosis is good,it is worthy of further study.

Objective To observe the clinical curative effect of Gong Yanping capsule combined with recombinant human interferon α2b vaginal effervescent tablets in the treatment of human papillomavirus infection.Methods80 cases of patients with cervical HPV infection in Xiangshan hospital of traditional Chinese medicine from May 2014 to May 2016 were selected, these patients were divided into Gong Yanping capsule combined with interferon treatment group (combined treatment group, 40cases) and pure Gongyanping capsule treatment group (single treatment group, 40cases) two groups according to the treatment methods, the clinical curative effects, HPV-DNA levels, HPV infection status, incidences of adverse reactions of the two groups were statistically analyzed.ResultsThe clinical total efficiency of the combined treatment group 95% (38/40) was significantly higher than the single treatment group 80% (32/40) (P<0.05), the HPV-DNA level was significantly lower (P<0.05), the HPV infection negative rate 1 months after treatment 2.5% (1/40) was significantly lower than the single treatment group 10% (4/40) (P<0.05), the negative rates 2 months, 3 months after treatment 67.5% (27/40), 97.5% (39/40) were significantly higher than the single treatment group 40% (16/40), 77.5% (31/40) (P<0.05);The difference of incidences of adverse reactions between the two groups 12.5% (5/40), 7.5% (3/40) was not significant.ConclusionThe clinical curative effect of Gong Yanping capsule combined with Recombinant Human Interferon α2b Vaginal Effervescent Tablets in the treatment of human papillomavirus infection is more significant than pure Gongyanping capsule treatment, it will not increase the adverse reactions of patients in a great extent, is safe and effective.

Objective To investigate the clinical effect of potting net capsule combined with antibiotics in the treatment of chronic pelvic inflammatory disease.MethodsThe clinical data of 156 patients with chronic pelvic inflammatory disease admitted from October 2013 to October 2016 were retrospectively analyzed.The patients were randomly divided into control group (n=77) and observation group (n=79).Routine antibiotic therapy and Pelvic acid net capsule combined with antibiotic therapy.The changes of TCM syndromes and treatment efficiency and the level of serum inflammatory factors were observed, and the incidence of adverse reactions was observed and compared.ResultsAfter treatment, the scores of TCM syndromes were evaluated and compared between the two groups.There were significant differences between the two groups.The scores of the control group were significantly higher than those in the observation group (P<0.05).The treatment group was 93.67%, which was significantly higher than that of the control group (72.73%), and the difference was statistically significant (P<0.05).There were no significant differences in CRP, TNF-α, IL-6 and IL-1β levels between the two groups before and after treatment.After different treatment, the two groups were compared (P<0.05), and there was significant difference between the two groups after treatment.There were statistically significant differences between the two groups after treatment.The observation group was significantly lower than the control group (P<0.05).There were no adverse reactions in both groups.ConclusionThe treatment of chronic pelvic inflammatory disease with conventional antibiotic therapy combined with pelvic inflammatory capsule can improve the clinical symptoms, reduce the inflammatory level and improve the therapeutic effect.It is a safe and effective treatment program.

Objective To compare and analyze the effect of dinoprostone misoprostol and oxytocin in cervical ripening and labor induction.Methods 120 pregnant women in labor in our hospital from January 2015 to January 2017 were selected as the object in this study, all pregnant women were randomly divided into 3 groups, respectively dinoprostone group, misoprostol group and oxytocin group, 40 pregnant in each group., Dinoprostone was placed in vaginal fornix in dinoprostone group;misoprostol was placed in vaginal fornix in misoprostol group;Oxytocin was injected in oxytocin group.The delivery time, rupture time of fetal membranes, labor time and successful rate of induced labor in the 3 groups were compared.Results The dinoprostone group after treatment in pregnant women take delivery time,time and labor rupture time were significantly shorter than the other two groups(P<0.05),the difference was statistically significant;dinoprostone group of pregnant women, the success rate was significantly higher than that of oxytocin group, compared between the two groups(P<0.05),with statistical significance difference;dinoprostone group did not appear abnormal, less adverse reaction.Conclusion Dinoprostone used for cervical ripening and labor induction, the effect is significant, compared with misoprostol and oxytocin, less adverse reaction, high safety, and is worthy of popularization and application.

BACKGROUND: Currently, the materials used in clinical practice to repair cruciate ligament of knee joint contain auto-graft bone- mid 1/3 patella tendon-bone (B-T-B), auto-semitendinous muscle, gracilis muscle and allogenic tissue graft. All of them are limited to a certain degree in clinical application. Therefore, people hope to consistently develop artificial ligaments to take the place of auto- and allografts. OBJECTIVE: To investigate the feasibility to construct artificial biological ligament (ABL) by applying a novel biochemical technique using porcine tendon as the raw material. DESIGN: Research of new biological material. SETTING: Department of Orthopedics, Third Affiliated Hospital of Sun Yat-sen University. MATERIALS: Adult pigs of either gender were provided by the Animal Center of Sun Yat-sen University. Scanning electron microscope (SEM, S-520) was provided by Hitachi, Japan, and micro-controlled electron tension-testing device (Model LWK-10B) by Guangzhou Experimental Devices Factory. METHODS: The experiment was performed at the Animal Center of Sun Yat-sen University from January 2004 to June 2005. ABL was established by means of treating porcine tendon with epoxy cross-linking fixation, diversified antigen minimization process, mechanic enhancement modification and surface activating process. Under aseptic condition, a 6-month-old goat's bone marrow was abstracted, and then the bone marrow matrix stem cells were cultured in ABL stent for 3 weeks. Scanning electron microscope was used to observe structure and compatibility of artificial ligament, and mechanics test was used to analyze biomechanics characteristics of ABL. MAIN OUTCOME MEASURES: Structural features, cell compatibility and biomechanics characteristics of ABL.RESULTS: ① Structural features of ABL: The appearance of ABL was similar to that of the normal human ligament. Histological examination showed that the ABL was collagen fibers with no cells. Electron microscope examination revealed that the ABL was composed of hair-looking and fiber-like objects running uniformly in a certain direction and closely parallel-arranged. ② Cell compatibility: Three weeks after xenogenic marrow matrix cells were cultured on the surface of the ABL, it was noted that cells adhered and the matrix secreted by the cells precipitated around the cells. There were no cells found inside the ABL. ③ Mechanical strength of the ligament: The average diameter of ABL was 5 mm and the mechanical test at a speed of 100 mm/min showed that its averaged tensile limit was 927.19 N and the tension-resistant strength was 47.22 N/mm those were close to the corresponding parameters of the normal goat's ACL. The normal goat's ACL was 5 mm. The greatest tensile load was 807.50 N and the tension-resistant strength was 41.13 N/mm.CONCLUSION:As we used the unique biochemical technique and minimized the xenogenic protein immunogenicity of the porcine tendon, ABL has acceptable biomechanical properties and superior biocompatibility. As a substitute of the ligament in the reconstruction of the ACL, ABL has a promising prospect in clinical applications.