Objective To establish and validate the reference interval for serum anti-Müllerian hormone(AMH)in healthy women of childbearing age in Shenzhen using an indirect method based on mathematical statistics.Methods Collected the AMH data for women aged 21～50 in outpatient and physical examination populations in Shenzhen Maternity and Child Health Care Hospital from 2017 to 2023.Grouping by age range of five,first performed normality tested on each group of data,and used the interquartile range method to remove outliers for non-normal data.Then established reference intervals for AMH in different age groups through indirect method(Hoffmann method)and verified them.Compared with the reference interval of the reagent instructions and analyzed the correlation be-tween serum AMH levels and age.Results The correlation coefficient between serum AMH and age in women of childbearing age was-0.642,and the difference was statistically significant(P<0.001).The distribution of AMH levels among women in six age groups was compared,and the difference was statistically significant(H=28 392.655,P<0.05),and AMH levels showed a decreasing trend with age.The reference range of serum AMH at ages 21～25,26～30,31～35,36～40,41～45 and 46～50 yesrs were 0.92～11.30,0.68～9.43,0.38～7.51,0.12～6.93,<4.42 and<1.83ng/ml,respectively,and all reference intervals in each group had been validated.Compared to the age groups provided by the manufacturer,the age groups in this study are more refined,the reference range was narrower,and the interpretation of clinical and laboratory data was more accurate.Conclusion This study used Hoffmann's indirect method for the first time to establish a reference range for AMH in women aged 21～50 years in Shenzhen.The reference interval established is more in line with the actual situation and is a simple and reliable acquisition mode,suitable for promotion and wide application in clinical labo-ratories.

Objective To establish and validate the reference interval for serum anti-Müllerian hormone(AMH)in healthy women of childbearing age in Shenzhen using an indirect method based on mathematical statistics.Methods Collected the AMH data for women aged 21～50 in outpatient and physical examination populations in Shenzhen Maternity and Child Health Care Hospital from 2017 to 2023.Grouping by age range of five,first performed normality tested on each group of data,and used the interquartile range method to remove outliers for non-normal data.Then established reference intervals for AMH in different age groups through indirect method(Hoffmann method)and verified them.Compared with the reference interval of the reagent instructions and analyzed the correlation be-tween serum AMH levels and age.Results The correlation coefficient between serum AMH and age in women of childbearing age was-0.642,and the difference was statistically significant(P<0.001).The distribution of AMH levels among women in six age groups was compared,and the difference was statistically significant(H=28 392.655,P<0.05),and AMH levels showed a decreasing trend with age.The reference range of serum AMH at ages 21～25,26～30,31～35,36～40,41～45 and 46～50 yesrs were 0.92～11.30,0.68～9.43,0.38～7.51,0.12～6.93,<4.42 and<1.83ng/ml,respectively,and all reference intervals in each group had been validated.Compared to the age groups provided by the manufacturer,the age groups in this study are more refined,the reference range was narrower,and the interpretation of clinical and laboratory data was more accurate.Conclusion This study used Hoffmann's indirect method for the first time to establish a reference range for AMH in women aged 21～50 years in Shenzhen.The reference interval established is more in line with the actual situation and is a simple and reliable acquisition mode,suitable for promotion and wide application in clinical labo-ratories.

Objective:To explore the association of human betaine-homocysteine methyltransferase ( BHMT) and BHMT2 gene polymorphisms with non-syndromic congenital heart disease (CHD). Methods:A hospital-based case-control study was conducted, in which children with CHD who attended Hunan Children′s Hospital from January 2018 to May 2019 were enrolled as the case group, and children without any congenital deformity who attended the hospital during the same period were enrolled as the control group on a 1∶1 basis. A self-administered questionnaire survey was performed to collect information about the study subjects and their mothers, and then venous blood samples were collected from the subjects to detect BHMT and BHMT2 gene polymorphisms. Logistic regression analyses were used to evaluate the association of BHMT and BHMT2 gene polymorphisms and their haplotypes with CHD. Crossover analyses and logistic regression were used to explore the gene-gene and gene-environment interactions. Results:The case and control group both enrolled 620 children. The multivariate logistic regression showed that BHMT gene polymorphisms at rs3733890 (AA vs. GG: OR=3.476, Q FDR<0.001; GA vs. GG: OR=1.525, Q FDR=0.036), at rs1915706 (CC vs. TT: OR=3.464, Q FDR<0.001) and at rs1316753 (GG vs. CC: OR=1.875, Q FDR=0.020) increased the risk of CHD. Children with haplotype of A-G-A had an increased risk of CHD ( OR=1.468, 95% CI: 1.222-1.762). Interaction analysis showed that a statistically significant positive interaction between rs3733890 and rs1915706 on both additive ( RERI=0.628, 95% CI: 0.298-0.958) and multiplicative ( OR=3.754, 95% CI: 1.875-7.519) scales. Gene-environment interactions were found between the BHMT gene with secondhand smoke exposure before pregnancy and in early pregnancy, tea consumption before pregnancy and in early pregnancy, alcohol consumption before pregnancy, and folic acid supplementation before or during pregnancy. Conclusion:BHMT gene rs3733890, rs1915706 and rs1316753 polymorphisms may be associated with the risk of CHD. In addition, there is an association of cooperative interaction between rs3733890 and rs1915706 on both additive and multiplicative scales with the risk of CHD, and the BHMT gene interacts with multiple environmental factors.

Objective:To explore the association of human betaine-homocysteine methyltransferase ( BHMT) and BHMT2 gene polymorphisms with non-syndromic congenital heart disease (CHD). Methods:A hospital-based case-control study was conducted, in which children with CHD who attended Hunan Children′s Hospital from January 2018 to May 2019 were enrolled as the case group, and children without any congenital deformity who attended the hospital during the same period were enrolled as the control group on a 1∶1 basis. A self-administered questionnaire survey was performed to collect information about the study subjects and their mothers, and then venous blood samples were collected from the subjects to detect BHMT and BHMT2 gene polymorphisms. Logistic regression analyses were used to evaluate the association of BHMT and BHMT2 gene polymorphisms and their haplotypes with CHD. Crossover analyses and logistic regression were used to explore the gene-gene and gene-environment interactions. Results:The case and control group both enrolled 620 children. The multivariate logistic regression showed that BHMT gene polymorphisms at rs3733890 (AA vs. GG: OR=3.476, Q FDR<0.001; GA vs. GG: OR=1.525, Q FDR=0.036), at rs1915706 (CC vs. TT: OR=3.464, Q FDR<0.001) and at rs1316753 (GG vs. CC: OR=1.875, Q FDR=0.020) increased the risk of CHD. Children with haplotype of A-G-A had an increased risk of CHD ( OR=1.468, 95% CI: 1.222-1.762). Interaction analysis showed that a statistically significant positive interaction between rs3733890 and rs1915706 on both additive ( RERI=0.628, 95% CI: 0.298-0.958) and multiplicative ( OR=3.754, 95% CI: 1.875-7.519) scales. Gene-environment interactions were found between the BHMT gene with secondhand smoke exposure before pregnancy and in early pregnancy, tea consumption before pregnancy and in early pregnancy, alcohol consumption before pregnancy, and folic acid supplementation before or during pregnancy. Conclusion:BHMT gene rs3733890, rs1915706 and rs1316753 polymorphisms may be associated with the risk of CHD. In addition, there is an association of cooperative interaction between rs3733890 and rs1915706 on both additive and multiplicative scales with the risk of CHD, and the BHMT gene interacts with multiple environmental factors.

Objective:To evaluate the accuracy of ultrasound measurement of airway parameters in predicting difficult mask ventilation (DMV).Methods:Ninety-six patients, aged 18-90 yr, with body mass index of 16-39 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, undergoing elective endotracheal intubation under general anesthesia, were included in this study. Clinical airway evaluation was performed at 1 day before surgery, and modified Mallampati classification, thyromental distance and rating of the upper lip bite test were recorded. At 30 min before anesthesia induction, mandibular condylar motion, tongue longitudinal cross-sectional area and transverse diameter of tongue were measured by ultrasound, and the tongue volume (product of tongue longitudinal cross-sectional area and transverse diameter of tongue) was calculated. Mask ventilation was performed after induction of anesthesia, mask ventilation difficulty grade ≥Ⅲ was defined as DMV, the patients were divided into 2 groups according to whether DMV occurred: non-DMV group (NDMV group) and DMV group. Correlations between the clinical airway evaluation indexes and ultrasonic airway parameters with statistically significant differences between groups and DMV were assessed using Spearman′s rank correlation. The area under the receiver operating characteristics curve was used to evaluate the accuracy of each parameter in predicting DMV, the critical value was determined, and the accuracy, sensitivity, specificity, positive and negative predictive values were calculated. Results:The modified Mallampati classification, rating of the upper lip bite test, ultrasonic tongue longitudinal cross-sectional area, transverse diameter of tongue and tongue volume were positively correlated with DMV, and thyromental distance and mandibular condylar motion were negatively correlated with DMV ( P<0.05). The area under the receiver operating characteristics curve of mandibular condylar motion and tongue volume in predicting DMV were 0.898 and 0.862, respectively, the cut-off values were 1.19 cm and 99.94 cm 3, respectively, and the sensitivity and specificity were all over 70% and 90%, respectively, the positive predictive values were 92.31% and 88.46%, respectively. Conclusions:Ultrasonic measurements of mandibular condylar motion and tongue volume can accurately predict DMV.

Objective:To investigate the effect of hyperbaric oxygen（HBO）on enhancing the drug sensitivity of esophageal cancer cell line ECA109 to paclitaxel（Pac）and its mechanism of action.Methods:After the in vitro culture of esophageal cancer ECA109 cells was completed，the cells were divided into four groups according to the experimental design：the control group，the Pac group，the HBO group，and the HBO + Pac group. The control group received Dimethyl sulfoxide；the Pac group received 5 mg/L of Pac（referring to the IC 50 value）；the HBO group was exposed to HBO alone for 90 minutes；the HBO + Pac group was exposed to HBO for 90 minutes first and then treated with 5 mg/L of Pac. The proliferation ability of ECA109 cells was detected by the CCK-8 method，the apoptosis of ECA109 cells was detected by flow cytometry，and the expressions of apoptotic proteins，drug resistance-associated proteins，and mitogen-activated protein kinase（MAPK）signaling pathway-associated proteins in ECA109 cells were detected by Western blotting. Results:Compared with the control group and the HBO group，the survival rate of ECA109 cells in the Pac group was significantly decreased，and the apoptosis rate was significantly increased（ P<0.05）. Compared with the Pac group，the survival rate of ECA109 cells in the HBO + Pac group was significantly decreased，and the apoptosis rate was significantly increased（ P<0.05）. Compared with the control group and the HBO group，the expressions of proteins（Bcl-2，caspase-9，and ERK）in ECA109 cells of the Pac group and the HBO + Pac group were significantly decreased（ P<0.05），and the expressions of proteins（Bad，caspase-3，PARP，p-JNK，and p38）were significantly increased（ P<0.05）. Compared with the Pac group，the expressions of proteins（Bad and caspase-3）in ECA109 cells of the HBO + Pac group were significantly increased，and the expression of protein P-gp was significantly decreased（ P<0.05），while the expressions of proteins（Bcl-2，caspase-9，and PARP）were not significantly changed（ P>0.05）. Conclusion:HBO combined with Pac treatment can enhance the proliferation inhibitory and apoptosis-inducing effects of Pac on ECA109 cells，and its mechanism of action may be achieved by regulating the MAPK signaling pathway in ECA109 cells.

Objective:To investigate the effect of hyperbaric oxygen（HBO）on enhancing the drug sensitivity of esophageal cancer cell line ECA109 to paclitaxel（Pac）and its mechanism of action.Methods:After the in vitro culture of esophageal cancer ECA109 cells was completed，the cells were divided into four groups according to the experimental design：the control group，the Pac group，the HBO group，and the HBO + Pac group. The control group received Dimethyl sulfoxide；the Pac group received 5 mg/L of Pac（referring to the IC 50 value）；the HBO group was exposed to HBO alone for 90 minutes；the HBO + Pac group was exposed to HBO for 90 minutes first and then treated with 5 mg/L of Pac. The proliferation ability of ECA109 cells was detected by the CCK-8 method，the apoptosis of ECA109 cells was detected by flow cytometry，and the expressions of apoptotic proteins，drug resistance-associated proteins，and mitogen-activated protein kinase（MAPK）signaling pathway-associated proteins in ECA109 cells were detected by Western blotting. Results:Compared with the control group and the HBO group，the survival rate of ECA109 cells in the Pac group was significantly decreased，and the apoptosis rate was significantly increased（ P<0.05）. Compared with the Pac group，the survival rate of ECA109 cells in the HBO + Pac group was significantly decreased，and the apoptosis rate was significantly increased（ P<0.05）. Compared with the control group and the HBO group，the expressions of proteins（Bcl-2，caspase-9，and ERK）in ECA109 cells of the Pac group and the HBO + Pac group were significantly decreased（ P<0.05），and the expressions of proteins（Bad，caspase-3，PARP，p-JNK，and p38）were significantly increased（ P<0.05）. Compared with the Pac group，the expressions of proteins（Bad and caspase-3）in ECA109 cells of the HBO + Pac group were significantly increased，and the expression of protein P-gp was significantly decreased（ P<0.05），while the expressions of proteins（Bcl-2，caspase-9，and PARP）were not significantly changed（ P>0.05）. Conclusion:HBO combined with Pac treatment can enhance the proliferation inhibitory and apoptosis-inducing effects of Pac on ECA109 cells，and its mechanism of action may be achieved by regulating the MAPK signaling pathway in ECA109 cells.

Objective:To explore the protective effect of hypothermia plus extracorporeal membrane oxygenation(ECMO)on kidney in brain-dead kidney transplant donors.Methods:From July 2017 to July 2018 at Institute of Transplantation Medicine, Hospital No. 923 of PLA, 29 patients with circulatory dysfunction brain death donors fulfilling the organ donation criteria were randomly divided into sub-hypothermia group according to the treatment of extracorporeal membrane oxygenation(body temperature 34.0~35.0℃, 15 cases)and normal temperature group(36.5~37.5℃, 14 cases). Hemodynamic profiles and renal function changes were compared between two groups during ECMO.And renal complications of two groups were followed up.Results:The hemodynamic parameters of two groups remained stable during ECMO period.Heart rate of 5 MO-organs was lower in hypothermia group than that in normal temperature group( P<0.05). Systolic and diastolic pressures before ECMO 3 h-organ acquisition were higher than normal temperature group( P<0.05). No significant difference existed between PaO 2 and normal temperature groups( P>0.05). Donor serum creatinine(SCr)and blood urea nitrogen(BUN)were lower in hypothermia group than in normal temperature group( P<0.05). The postoperative recipient levels of BUN were lower in mild hypothermia group than those in normothermia group( P<0.05)and no significant difference between SCr and normal temperature groups( P>0.05). The postoperative hospital stay was(16.52±3.59)days in mild hypothermia group. And it was lower than that in normal temperature group( P<0.05). Delayed renal function was lower than normal temperature group(3.45% and 21.43%, P<0.05). Conclusions:Mild hypothermia plus ECMO can reduce hemodynamic fluctuations in circulatory unstable donors after brain death, improve renal function and lower the incidence of delayed functional recovery after renal transplantation.

Objective:To evaluate the efficacy and safety of continuous infusion of low-dose intravenous (Ⅳ) heparin during perioperative period of simultaneous pancreas-kidney (SPK) transplantation for donation after citizen death (DCD) donor to prevent pancreatic thrombosis post-transplantation.Methods:From January 2015 to August 2019, 46 DCD donors undergoing SPK were divided into retrospective cohort groups 1 ( n=27) and 2 ( n=19). Group 1 received aspirin enteric-coated tablets only at Day 1 post-SPK. In Group 2, 5-7 days of continuous infusion of heparin 260 IU per hour at Day 1 post-SPK was followed by a daily intake of aspirin enteric-coated tablets of 100 mg. Incidence of thrombus, recovery of graft function and adverse reactions of anticoagulant therapy were observed. Results:Thrombosis occurred in (5.3%, 1/19 vs 14.8%, 4/27) in heparin and non-heparin groups. Thrombosis and graft loss were significantly lower in heparin group than those in non-heparin group ( P<0.05). Conclusions:Continuous infusion of low-dose heparin vein is effective and safe in preventing thrombosis after SPK transplantation.

Objective:To establish an evaluation index system of hospital culture construction led by Party building in public hospitals, and to explore the relationships among Party building, hospital culture and patient satisfaction, and explain the mediating effect of hospital culture between Party building and patient satisfaction.Methods:Literature review and two rounds of Delphi method were used to create an evaluation index system of hospital culture construction led by Party building in public hospitals. On such basis, a questionnaire was designed and 429 staff from 33 public hospitals in Shanghai were surveyed through April and June 2021. Cronbach α coefficient method and exploratory factor analysis were used to test the reliability and validity of the indexes, and the regression analysis method was used to verify the mediating effects. Results:Following two rounds of Delphi survey run by 14 experts, a performance evaluation index system for the hospital culture construction was constructed, comprising 5 level-1, 13 level-2 and 29 level-3 indexes. The Cronbach α coefficients of overall indexes and 5 level-1 indexes fell in the range of 0.860-0.901( P<0.01), and the retest reliability of overall index and 5 level-1 indexes fell between 0.91-0.93( P<0.01). Based on the exploratory factor analysis, all of the characteristic roots of the factors generated by orthogonal rotation were>1, and the total variance explained contribution rate was 56.84%, proving the good validity of the indexes. The effect of Party building on patient satisfaction was significant( β1=0.139, P<0.01), and that on hospital culture effect significant as well( β2=0.168, P<0.01), while that on patient satisfaction was also significant( β3=0.115, δ=0.448, P<0.01)with hospital culture effect introduced as the mediating effect. Conclusions:The evaluation index system of hospital culture construction led by Party building proves highly scientific and effective, and hospital culture plays to some extent a mediating role between Party building and patient satisfaction. This proves that Party building presents a significant transmission effect on patient satisfaction through hospital culture building. The study provides a reference for strengthening Party building and hospital culture construction and improving patient satisfaction in public hospitals.