Objective:To analyze the effectiveness and interobserver agreement of the Parer five-tier, the National Institute of Child Health and Human Development (NICHD) three-tier, and the International Federation of Gynecology and Obstetrics (FIGO) three-tier electronic fetal monitoring (EFM) systems in identification of neonatal acidosis during labor.Methods:This retrospective study was conducted on full-term singleton cephalic deliveries with neonatal acidosis (umbilical artery blood gas pH≤7.1) and normal newborns (umbilical artery blood gas pH≥7.2) in the Nanjing Drum Tower Hospital, Nanjing University Medical School from January to December 2020. EFM tracings during the last 30-60 min before delivery were collected. Four obstetricians independently described the features of randomly sorted and coded EFM tracings. Another obstetrician categorized these tracings using the NICHD three-tier, FIGO three-tier, and Parer five-tier evaluation systems based on the features. All researchers were masked to the clinical characteristics and maternal and neonatal outcomes. The sensitivity and specificity for identifying neonatal acidosis, as well as the interobserver agreement, were analyzed for all three systems. Independent sample t-test, Chi-square (or Fisher's exact test) and Mann-Whitney U tests were used for statistical analysis. Inter-group comparisons of sensitivity and specificity between the three evaluation systems were assessed using McNemar's test. The Kappa statistic was used to analyze interobserver agreement. Results:This study included a total of 3 558 cases. After propensity score matching, there were 44 cases of neonatal acidosis and 78 control cases. There were no significant differences in parity, gestational weeks, modes of delivery, placental abruption, or analgesia rates between the two groups. The rates of instrumental vaginal delivery and neonatal intensive care unit (NICU) admission in the acidosis group were significantly higher than those in the control group [15.8% (7/44) vs. 2.6% (2/78), χ2=8.45, P=0.003; 31.8% (14/44) vs. 12.8% (10/78), χ2=8.45, P=0.004], while the umbilical artery blood pH and mean base excess were lower in the acidosis group than in the control group [7.04±0.07 vs. 7.30±0.05, t=4.98; (－12.40±3.32) vs. (－5.64±1.95) mmol/L, t=13.61; both P<0.001]. (2) Using the NICHD three-tier system, 95.5% (42/44) of the acidosis cases and 89.7% (70/78) of the control cases were classified as having category Ⅱ EFM tracings, indicating potential fetal acid-base imbalance; category Ⅲ EFM tracings were only observed in 4.5% (2/44) of the cases in the acidosis group. With the FIGO three-tier system, 81.8% (36/44) of the acidosis cases were categorized as having "pathological" tracings, and with the Parer five-tier system, 86.4% (38/44) of the acidosis cases were correctly classified into the "orange or red" risk zones that indicated acid-base imbalance. Among the control cases, there were 28.2% (22/78) with EFM tracings of "normal patterns" categorized by the FIGO three-tier system, and 41.0% (32/78) classified into the "green or blue" risk zones by the Parer five-tier system, which indicated good fetal conditions. None of the acidosis cases were misdiagnosed as being normal by the Parer five-tier system. (3) Compared with the NICHD three-tier system, both the FIGO three-tier and the Parer five-tier systems showed increased diagnostic sensitivity [4.5% (1.2%- 14.5%) vs. 81.8% (66.8%-89.4%) and 86.4% (71.8%-92.4%)], but decreased specificity [100.0% (95.3%- 100.0%) vs. 87.2% (78.0%-92.9%) and 84.6% (75.0%-91.0%)]. There was no statistically significant difference in the sensitivity or specificity between the FIGO three-tier and Parer five-tier systems for identifying neonatal acidosis ( P=0.727 and 0.791). (4) When reading the tracings of control cases, the total agreement rate for the NICHD three-tier system by different observers was as high as 94.2%, while the total agreement rates for the FIGO three-tier and Parer five-tier systems were 69.7% and 67.7%, respectively. In the interpretation of EFHR tracings for acidosis cases, the interobserver agreement for the Parer five-tier system was excellent [Kappa (95% CI): 0.87 (0.79-0.95)], while both the NICHD three-tier and FIGO three-tier systems showed good agreement [Kappa (95% CI): 0.77 (0.66-0.88) and 0.72 (0.60-0.84)]. Conclusions:The Parer five-tier and the FIGO three-tier systems have higher sensitivity in identifying neonatal acidosis than the NICHD three-tier system, and the Parer five-tier system achieves a higher negative predictive value and a greater agreement in the interpretation of pathological EFM patterns.

Objective     To explore the correlation between the quantitative and qualitative features of CT images and the invasiveness of pulmonary ground-glass nodules, providing reference value for preoperative planning of patients with ground-glass nodules. Methods    The patients with ground-glass nodules who underwent surgical treatment and were diagnosed with pulmonary adenocarcinoma from September 2020 to July 2022 at the Third Affiliated Hospital of Kunming Medical University were collected. Based on the pathological diagnosis results, they were divided into two groups: a non-invasive adenocarcinoma group with in situ and minimally invasive adenocarcinoma, and an invasive adenocarcinoma group. Imaging features were collected, and a univariate logistic regression analysis was conducted on the clinical and imaging data of the patients. Variables with statistical difference were selected for multivariate logistic regression analysis to establish a predictive model of invasive adenocarcinoma based on independent risk factors. Finally, the sensitivity and specificity were calculated based on the Youden index. Results     A total of 555 patients were collected. The were 310 patients in the non-invasive adenocarcinoma group, including 235 females and 75 males, with a meadian age of 49 (43, 58) years, and 245 patients in the invasive adenocarcinoma group, including 163 females and 82 males, with a meadian age of 53 (46, 61) years. The binary logistic regression analysis showed that the maximum diameter (OR=4.707, 95%CI 2.060 to 10.758), consolidation/tumor ratio (CTR, OR=1.027, 95%CI 1.011 to 1.043), maximum CT value (OR=1.025, 95%CI 1.004 to 1.047), mean CT value (OR=1.035, 95%CI 1.008 to 1.063), spiculation sign (OR=2.055, 95%CI 1.148 to 3.679), and vascular convergence sign (OR=2.508, 95%CI 1.345 to 4.676) were independent risk factors for the occurrence of invasive adenocarcinoma (P<0.05). Based on the independent predictive factors, a predictive model of invasive adenocarcinoma was constructed. The formula for the model prediction was: Logit(P)=–1.293+1.549×maximum diameter of lesion+0.026×CTR+0.025×maximum CT value+0.034×mean CT value+0.72×spiculation sign+0.919×vascular convergence sign. The area under the receiver operating characteristic curve of the model was 0.910 (95%CI 0.885 to 0.934), indicating that the model had good discrimination ability. The calibration curve showed that the predictive model had good calibration, and the decision analysis curve showed that the model had good clinical utility. Conclusion     The predictive model combining quantitative and qualitative features of CT has a good predictive ability for the invasiveness of ground-glass nodules. Its predictive performance is higher than any single indicator.

Objective: To investigate the prevalence of work-related musculoskeletal disorders (WMSDs) and influencing factors among vegetable greenhouse workers, so as to provide insights into relevant intervention measurements. Methods: Workers from 4 vegetable greenhouse villages were sampled in the suburbs of Xining City using a cluster sampling method from March to April 2023. Participants' demographic information, characteristics of greenhouse operation and prevalence of WMSDs were collected using questionnaire surveys. Factors affecting the prevalence of WMSDs among vegetable greenhouse workers were identified using a multivariable logistic regression model. Results: A total of 550 questionnaires were distributed, and 518 valid questionnaires were recovered, with an effective response rate of 94.18%. There were 264 males (50.97%) and 254 females (49.03%), and 269 participants (51.93%) aged 50 years and older. The prevalence of WMSDs among vegetable greenhouse workers was 40.93% (212 cases). Waist, neck and back were mainly affected, with 185 (35.71%), 157 (30.31%), and 153 (29.54%) cases, respectively. Multivariable logistic regression analysis showed that workers who smoke (OR=2.406, 95%CI: 1.133-5.110), worked 8 hours and longer per day (OR=6.618, 95%CI: 3.492-12.542) and lift heavy loads of about 20 kg (OR=1.770, 95%CI: 1.013-3.092) had a higher risk of WMSDs. Conclusions WMSDs occurred in 40.93% of vegetable greenhouse workers in Xining City, and waist, neck and back were mainly affected. Smoking, working duration and lifting heavy loads may influence the prevalence of WMSDs among vegetable greenhouse workers in Xining City.

Objective:To explore the mechanism of Jianpi Qingchang Decoction in the treatment of UC by integrating network pharmacology, bioinformatics, molecular docking and experimental verification.Methods:The effective components and targets of Jianpi Qingchang Decoction were obtained from TCMSP database, and UC data sets GSE16879, GSE48958 and GSE75214 were obtained from GEO database, and differentially expressed genes were screened; intersection targets were obtained through Venn diagram, and GO function and KEGG pathway enrichment analysis was performed. An intersection target PPI network was constructed using STRING database and topology analysis was performed; hub genes were screened through lasso regression and the expression consistency of core targets in the dataset was verified through logistic regression. A UC mouse model was established and hub genes were validated.Results:A total of 213 drug targets of Jianpi Qingchang Decoction were obtained, and 499 common intersection targets of GSE16879, GSE48958 and GSE75214 were obtained by differential gene expression analysis. Thirty intersection targets of Jianpi Qingchang Decoction and UC were obtained, mainly acting on IL-17 signaling pathway, TNF signaling pathway, AGE-RAGE signaling pathway in diabetic complications, etc. PPI network topology analysis obtained 7 common intersection targets, including PTGS2, IL-1B, IL-6, MMP9, CXCL8, CCL2 and MMP2. IL-6 and MMP2 were selected as hub genes by lasso regression. Logistics regression analysis showed that IL-6 and MMP2 were risk factors for the disease. Compared with the model group, the expressions of IL-6 and MMP2 mRNA and protein in the colon tissue of the TCM group decreased ( P<0.05), and the morphology of colon tissue was improved compared with the model group. Conclusion:IL-6 and MMP2 are risk factors for UC, the therapeutic effect of Jianpi Qingchang Decoction is to mediate Il-17 signal pathway, TNF signal pathway and AGE-RAGE signal pathway in diabetic complications through the targets of IL-6, and MMP2, thereby treating UC.

Objective To establish and validate a prediction model for gastric cancer lymph node metastasis based on four machine learning (ML) algorithms. Methods A retrospective analysis was conducted on clinical data of 531 patients who underwent radical gastrectomy. The patients were randomly divided into training set (399 patients) and test set (132 patients) in a ratio of 3 to 1. Univariate analysis was used to screen for variables associated with gastric cancer lymph node metastasis, and Logistic regression, random forest, K-nearest neighbor algorithm, and support vector machine algorithm models were established to rank the importance of variables. All ML algorithm models were validated in the test set, and receiver operating characteristic (ROC) curves were plotted. The optimal ML algorithm model was determined based on the area under the curve (AUC), sensitivity, specificity, and accuracy. A nomogram model was constructed based on the variable importance ranking of the optimal ML algorithm model. The discrimination, calibration, and clinical applicability of the nomogram model were evaluated using ROC curves, calibration curves, and decision curves. Results The results of the comparison of the four ML algorithm models showed that the random forest model was the optimal algorithm model. The accuracy, sensitivity, and specificity of the random forest model in the training set were 72.7%, 69.9%, and 75.0%, respectively, with an AUC of 0.803. The accuracy, sensitivity, and specificity of the random forest model in the test set were 64.4%, 66.7%, and 62.5%, respectively, with an AUC of 0.751. A nomogram model was constructed based on the variables of the random forest algorithm model. The ROC curve showed that the AUCs of the nomogram model in the training set and test set were 0.721 and 0.776, respectively. Calibration curves and decision curves showed that the nomogram model had good calibration and clinical applicability in both the training set and test set. Conclusion The random forest model is the optimal algorithm model among the four ML algorithm models. The nomogram model based on the random forest model can accurately predict the risk of gastric cancer lymph node metastasis, thereby better guiding clinical diagnosis and treatment decisions.

Objective:To explore the effect of traditional teaching and standardized patient (SP) teaching in medical students' inquiry teaching through the phased examination results of practicing physicians.Methods:A total of 107 students from Class 1 and Class 2 of Batch 2013 majoring in clinical medicine of Qinghai University were selected as the control group, and 100 students from Class 1 and Class 2 of Batch 2014 were selected as the experimental group. In the inquiry teaching, the control group adopted the traditional teaching method, and the experimental group adopted the SP teaching method. The effect of the two groups of teaching methods was compared by collecting the scores of the medical history of the medical practitioners in the phased examination. SPSS 18.0 was used for t-test. Results:The scores of current medical history (81.43±8.19), case collection (8.19±0.70), inquiry content (47.63±4.55), examiner's total score (73.75±5.21), and total score (91.93±5.67) in the experimental group were higher than those in the control group [(71.65±8.29) (7.85±0.68) (43.68±4.76) (69.68±5.40) and (88.03±6.01)] and the difference was statistically significant ( P<0.001). The scores of communication ability (8.94±0.62) question expression (4.54±0.44) and communication skills (4.52±0.47) in the comprehensive performance of the control group were higher than those in the experimental group [(8.77±0.60) (4.33±0.54) and (4.38±0.46), respectively], and the difference was statistically significant ( P<0.05). Conclusion:The overall teaching effect of the SP teaching is better than that of the traditional teaching, but it has its own advantages and disadvantages in specific knowledge points. It is worth further discussion to combine the two to complement the advantages and complement each other to assist medical education.

Objective:To understand the current situation of nurses in 52 hospitals in China on mastery of knowledge about skin injury in the elderly based on the background of mixed-mode homogenization training.Methods:Using the convenient sampling method, a total of 1 067 nurses from 52 hospitals in China were selected as the research objects in January 2021. A self-designed questionnaire on knowledge of skin injury in the elderly was used to investigate the nurses through the questionnaire star and univariate analysis was used to analyze the influencing factors. A total of 1 067 questionnaires were distributed and 1 067 valid questionnaires were recovered, and the effective recovery rate was 100%.Results:The knowledge scores of pressure injury, incontinence-associated dermatitis, skin tear and xerosis cutis among 1067 nurses were (95.66±7.37) , (95.65±9.15) , (91.37±15.45) and (87.67±15.91) , respectively. The results of univariate analysis showed that hospital grade was the influencing factor of nurses' knowledge score of pressure injury, skin tear and incontinence-associated dermatitis ( P<0.05) , educational background was the influencing factor of nurses' knowledge score of skin tear ( P<0.05) , professional title was the influencing factor of nurses' knowledge scores of pressure injury, incontinence-associated dermatitis and xerosis cutis ( P<0.05) . Conclusions:Hospitals at all levels need to strengthen the theoretical and practical knowledge training for nurses on skin xerosis and skin tear in the elderly, especially for nurses with primary titles and lower education in grassroots hospitals.

Objective:To investigate the value of paraffin-embedded section of cell block in the diagnosis of lung adenocarcinoma in bloody pleural effusion.Methods:The data of 60 patients with lung adenocarcinoma diagnosed by bloody pleural effusion and confirmed by pathological biopsy in the First Affiliated Hospital of Xi'an Jiaotong University from June 2018 to June 2019 were retrospectively analyzed. Cell smears and paraffin-embedded sections of cell blocks using removed red blood cells sedim entation method were used to make cytological examination in bloody pleural effusion. The expressions of carcinoembryonic antigen (CEA), cytokeratin 7 (CK7), NapsinA, thyroid transcription factor 1 (TTF-1), cytokeratin 5/6 (CK5/6), calretinin, P63 and P40 in the specimens were detected by using immunohistochemistry. The results of histopathological examination were used as the gold standard, and the diagnostic values of cell block paraffin-embedded sections and cell smears for lung adenocarcinoma in bloody pleural effusion were evaluated and compared.Results:The cell block sections had a clear background, clear and easy to distinguish cell morphology, and can be made into permanent specimens. The bloody pleural effusion cell smears results of 60 cases of lung adenocarcinoma showed that 21 cases were diagnosed as atypical cells, 39 cases were diagnosed as adenocarcinoma, and the coincidence rate with the diagnosis of adenocarcinoma by histopathological examination results was 65% (39/60); the immunohistochemistry results of cell block paraffin-embedded sections of bloody pleural effusion showed that CK7, NapsinA, TTF-1 and CEA were positive, and P40, P63, CK5/6 and calretinin were negative, all 60 cases were diagnosed as adenocarcinoma according to the results, and the coincidence rate with the diagnosis of adenocarcinoma by histopathological examination results was 100% (60/60), which was significantly higher than that of cytological smears ( χ2 = 23.088, P < 0.01). Conclusions:The technique of paraffin-embedded section of cell block using removed red blood cells sedim entation method has a high diagnostic rate for lung adenocarcinoma in bloody pleural effusion, and it has a high coincidence rate with histopathological diagnosis. It can improve the accuracy of diagnosis of lung adenocarcinoma in bloody pleural effusion, and it also has a good reference value for cytological typing.

Objective:To investigate the effect of scar uterus on assisted reproduction treatment strategy.Methods:From January 1, 2017 to December 31, 2017, 109 cases of scar uterus group and 63 cases of vaginal delivery history group who underwent in vitro fertilization-embryo transfer (IVF-ET) assisted pregnancy fresh embryo transfer in our hospital were retrospectively analyzed. Results:⑴ There was no significant difference in the total amount of gonadotropin (Gn) and the total days of GN in patients <35 between scar uterus group and the vaginal delivery history group ( P>0.05), but there were significant differences in the number of oocytes, mature oocytes, two pronucleus (2PN) and excellent embryos between the scar uterus group and the vaginal delivery history group ( P<0.05). When the age was ≥35 years old, there was no significant difference in the total number of GN, the total days of GN, the number of oocytes obtained, the number of mature oocytes, the number of 2PN and the number of excellent embryos between the two groups ( P>0.05). ⑵ There were no statistically significant differences in clinical pregnancy rate and embryo implantation rate between the two groups of patients < 35 years old, no matter single embryo transplantation or double embryos transplantation. When transplant two embryos, the clinical pregnancy rate and embryo implantation rate in the scar uterus group were slightly lower than those in the vaginal delivery history group (57.57% vs 71.05% and 39.39% vs 47.37%, respectively), but with no significant difference ( P>0.05). There were no statistically significant differences in the clinical pregnancy rate and embryo implantation rate between single embryo transplantation and double embryo transplantation in patients≥35 years old ( P>0.05). ⑶ There were no statistically differences in biochemical pregnancy rate, early abortion rate, preterm birth rate and average newborn weight between the scar uterus group and the vaginal delivery history group ( P>0.05). Conclusions:Cesarean section may affect the ovarian function. For patients with previous cesarean section, early evaluation of ovarian function is recommended. Single embryo transfer does not reduce the outcome in IVF-ET. It is recommended to perform single embryo transfer for patients with scar uterus to reduce the risk during pregnancy of twin pregnancy.

Objective: To explore the correlation between hemoglobin and blood pressure. Methods: This study adopted the cross-sectional design method. Participants were recruited from grade 2 in primary school, grade 1 from junior and senior high school taking physical examination, including the hemoglobin test, organized by the Guangzhou Municipal Primary and Secondary School Health and Health Promotion Center from January to December in 2015. Correlation between blood pressure and hemoglobin and determinants of blood pressure were analyzed. Results: A total of 34 752 samples participated including 17 414 boys and 17 338 girls. Hemoglobin was negatively associated with systolic blood pressure (SBP) and diastolic blood pressure (DBP) among girls with anemia(P<0.01). Hemoglobin was positively associated with SBP and DBP among boys and girls with normal hemoglobin level(P<0.01). With each tertile increase in blood pressure, hemoglobin level increased by 1 mmHg. Logistic regression analysis showed that compared with peers from same grade with hemoglobin level lower than P25, the risk of suffering from pre-hypertension and hypertension among students from grade 2 with hemoglobin level greater than or equal to P75, and those from junior high and senior high schools with hemoglobin level higher than or equal to P50. Conclusion Among students without anemia population, a positive correlation between hemoglobin and SBP and DBP is observed.