Background Exposure to perfluoroalkyl and polyfluoroalkyl substances (PFAS) during pregnancy might affect thyroid-related hormone levels in pregnant women. However, most previous studies focused on the effects of PFAS containing 8-10 carbon atoms, and few studies have estimated the associations between PFAS with longer carbon chain and thyroid-related hormone levels. Objective To examine the associations between PFAS exposure and thyroid-related hormones in pregnant women. Methods The present study was based on the Jiashan Birth Cohort from September 2016 to April 2018. We analyzed 13 PFAS in maternal blood samples (n=781) by high-performance liquid chromatography-tandem mass spectrometry, as well as total triiodothyronine (T3), total thyroxine (T4), free T3 (FT3), free T4 (FT4), thyroid stimulating hormone (TSH), thyroglobulin antibody (TG-Ab), and thyroid peroxidase antibody (TPOAb) by electrochemiluminescence immunoassay. PFAS were divided into three groups:low concentration, medium concentration and high concentration according to the tertile of their concentrations. We estimated the associations between PFAS concentrations and thyroid-related hormones in pregnant women by multiple linear regression. Results In the multiple linear regression models, a change in perfluorododecanoic acid (PFDoA) concentrations from the low concentration group to the high concentration group was associated with a −0.10 (95%CI: −0.20, 0) nmol·L⁻¹ change in T3, −0.15 (95%CI: −0.28, −0.02) pmol·L⁻¹ change in FT3, and −3.02 (95%CI: −5.66, −0.39) pmol·L⁻¹ change in FT4, respectively. A change in perfluorotridecanoic acid (PFTrDA) concentrations from the low concentration group to the high concentration group was associated with a −0.10 (95%CI: −0.20, 0) nmol·L⁻¹ change in T3. Compared with the low concentration group, the concentration of T4 in the medium concentration group of perfluorohexane sulfonate (PFHxS) increased by 6.10 (95%CI: 0.44, 11.75) nmol·L⁻¹. No statistically significant associations were found between PFAS and TSH concentration. The negative associations of PFAS with thyroid-related hormones were more pronounced in pregnant women with positive TG-Ab and/or TPOAb. Conclusion Exposure to PFAS during pregnancy may affect thyroid-related hormone homeostasis in pregnant women, and the effect is stronger in TG-Ab and/or TPOAb-positive pregnant women.

Objective:To analyze the current situation of Investigator-Initiated Trials in medical and health institutions in Shandong Province, the problems in the process of conducting clinical research, and put forward proposals for the establishment of a clinical research management system with effective supervision, sound systems and supporting services, taking into account the progress of the projects since the pilot work was carried out.Methods:A questionnaire was created, an online survey was conducted, a database was set up, a status analysis was conducted and a post-launch analysis of the progress of the pilot was carried out using the National Medical Research Registry Information System, culminating in recommendations using the literature summary method and empirical analysis.Results:Statistical analysis of the questionnaire found that 29.39% of the institutions have a dedicated clinical research management department, and 75.97% of the institutions have a management approach. 25.52%, 40.30%, and 43.07% of institutions established biobanks, clinical research centers, and follow-up centers. There was a statistically significant difference in the establishment of clinical research centers, biobanks, and follow-up centers in secondary and tertiary medical institutions ( P<0.05). The number of general clinical research projects filed, the number of submissions and the number of ethics committees filed in the filing system have all increased significantly after the pilot work, with growth percentages of 126%, 141% and 62% respectively. Conclusions:Shandong Province clinical research pilot work has begun to bear fruit, the current clinical research project still exists in the lack of special funding support, perfect service platform and system support and training system to be improved and other issues.

Objective:To evaluate the associations of COVID-19 vaccination during pregnancy with the risk of pregnancy complications and neonatal adverse birth outcomes, and to provide evidence for improving strategies for COVID-19 vaccination during pregnancy.Methods:"covid-19 vaccines" "covid19" "covid 19" "vaccin*" "neonatal outcomes" "perinatal outcomes" "pregnancy outcomes" "premature birth" were used as the main search terms. Articles published from January 1st 2020 to May 27th 2022 were searched in PubMed, Web of Science, Scopus, Cochrane library, CNKI, Wanfang Database, VIP Database and Chinese Biomedical Literature Database by adopting the method of the combination of MeSH words and free words. Stata16.0 software was used to calculate pooled effect values, perform heterogeneity test and sensitivity analysis and assess publication bias.Results:According to the inclusion and exclusion criteria, a total of 12 English papers were included from 482 relevant literatures retrieved, with 88 682 pregnant women vaccinated during pregnancy. Meta-analysis results showed that COVID-19 vaccination in pregnancy did not increase the risk of gestational hypertension, postpartum hemorrhage, neonatal preterm birth, small-for-gestational-age infants, and 5 min Apgar score<7, with pooled relative risk ( RR) and 95% confidence interval (95% CI) of 0.97 (0.91-1.05), 1.01 (0.83-1.23), 0.92 (0.77-1.10), 0.97 (0.90-1.04) and 0.93 (0.87-1.00), respectively. There was no significant difference in neonatal birth weight between the two groups of pregnant women who received COVID-19 vaccine or not, and the combined mean difference (MD) and 95% CI was -18.26 (-40.39-3.87) g. However, COVID-19 vaccination in pregnancy may increase the risk of gestational diabetes and the combined RR (95% CI) was 1.14 (1.03-1.26). In addition, sensitivity analysis showed that the results were stable and reliable. Egger's test and Begg's test showed that there was no publication bias among the included studies. Conclusion:This study does not support the increased risk of pregnancy complications and neonatal adverse birth outcomes for pregnant women vaccinated against COVID-19, but more researches are still needed to provide evidence of the safety of COVID-19 vaccination in pregnancy.

Objective:To evaluate the associations of COVID-19 vaccination during pregnancy with the risk of pregnancy complications and neonatal adverse birth outcomes, and to provide evidence for improving strategies for COVID-19 vaccination during pregnancy.Methods:"covid-19 vaccines" "covid19" "covid 19" "vaccin*" "neonatal outcomes" "perinatal outcomes" "pregnancy outcomes" "premature birth" were used as the main search terms. Articles published from January 1st 2020 to May 27th 2022 were searched in PubMed, Web of Science, Scopus, Cochrane library, CNKI, Wanfang Database, VIP Database and Chinese Biomedical Literature Database by adopting the method of the combination of MeSH words and free words. Stata16.0 software was used to calculate pooled effect values, perform heterogeneity test and sensitivity analysis and assess publication bias.Results:According to the inclusion and exclusion criteria, a total of 12 English papers were included from 482 relevant literatures retrieved, with 88 682 pregnant women vaccinated during pregnancy. Meta-analysis results showed that COVID-19 vaccination in pregnancy did not increase the risk of gestational hypertension, postpartum hemorrhage, neonatal preterm birth, small-for-gestational-age infants, and 5 min Apgar score<7, with pooled relative risk ( RR) and 95% confidence interval (95% CI) of 0.97 (0.91-1.05), 1.01 (0.83-1.23), 0.92 (0.77-1.10), 0.97 (0.90-1.04) and 0.93 (0.87-1.00), respectively. There was no significant difference in neonatal birth weight between the two groups of pregnant women who received COVID-19 vaccine or not, and the combined mean difference (MD) and 95% CI was -18.26 (-40.39-3.87) g. However, COVID-19 vaccination in pregnancy may increase the risk of gestational diabetes and the combined RR (95% CI) was 1.14 (1.03-1.26). In addition, sensitivity analysis showed that the results were stable and reliable. Egger's test and Begg's test showed that there was no publication bias among the included studies. Conclusion:This study does not support the increased risk of pregnancy complications and neonatal adverse birth outcomes for pregnant women vaccinated against COVID-19, but more researches are still needed to provide evidence of the safety of COVID-19 vaccination in pregnancy.

Objective:To investigate the differences in polyunsaturated fatty acid metabolites in seminal plasma between normal group and low sperm motility group, and their relationship with sperm motility.Methods:Totally 581 human seminal plasmas collected from Guizhou Province were divided into normal group and low sperm motility group according to the motility rate. The metabolite products of 24 kinds of polyunsaturated fatty acids were detected by liquid phase tandem mass spectrometry/mass spectrometry (LC-MS/MS). Through the in vitro culture experiment of sperm, the culture supernatant was collected during the culture of the upstream screening sperm for 24 h, and the polyunsaturated fatty acid products with different differences detected in the different groups of seminal plasma were also verified by LC-MS/MS method. Results:Among the polyunsaturated fatty acid metabolites detected in seminal plasma, the concentrations of 9-hydroxyoctadecadienoic acid (9-HODE) and 13-hydroxyoctadecadienoic acid (13-HODE) in the seminal plasma of the low sperm motility group were significantly different from those in the normal seminal plasma group ( P=0.001, P=0.033). In vitro culture experiments showed that the concentration of 9-HODE and 13-HODE in the culture medium increased significantly with the prolongation of culture time and the decrease of sperm motility rate ( P=0.003, P=0.035). Statistical analysis showed that the concentrations of 9-HODE and 13-HODE were significantly negatively correlated with sperm motility （ r=-0.91， P=0.045； r=-0.95， P=0.026）. Considering the sperm density factor in the analysis of polyunsaturated fatty acid metabolites and sperm motility in the seminal plasma of the population, the results showed that 9-HODE and 13-HODE were significantly higher in the low sperm motility group than in the normal group ( P<0.000 1). And there was a negative correlation ( r=-0.38) with the sperm motility rate ( P<0.000 1). Conclusion:9-HODE and 13-HODE are released into the culture medium and seminal plasma by sperm cell metabolism, which is a potential indicator of the degree of sperm membrane damage, which may be helpful in judging and detecting the asthenospermia.

Objective:To investigate the differences in polyunsaturated fatty acid metabolites in seminal plasma between normal group and low sperm motility group, and their relationship with sperm motility.Methods:Totally 581 human seminal plasmas collected from Guizhou Province were divided into normal group and low sperm motility group according to the motility rate. The metabolite products of 24 kinds of polyunsaturated fatty acids were detected by liquid phase tandem mass spectrometry/mass spectrometry (LC-MS/MS). Through the in vitro culture experiment of sperm, the culture supernatant was collected during the culture of the upstream screening sperm for 24 h, and the polyunsaturated fatty acid products with different differences detected in the different groups of seminal plasma were also verified by LC-MS/MS method. Results:Among the polyunsaturated fatty acid metabolites detected in seminal plasma, the concentrations of 9-hydroxyoctadecadienoic acid (9-HODE) and 13-hydroxyoctadecadienoic acid (13-HODE) in the seminal plasma of the low sperm motility group were significantly different from those in the normal seminal plasma group ( P=0.001, P=0.033). In vitro culture experiments showed that the concentration of 9-HODE and 13-HODE in the culture medium increased significantly with the prolongation of culture time and the decrease of sperm motility rate ( P=0.003, P=0.035). Statistical analysis showed that the concentrations of 9-HODE and 13-HODE were significantly negatively correlated with sperm motility （ r=-0.91， P=0.045； r=-0.95， P=0.026）. Considering the sperm density factor in the analysis of polyunsaturated fatty acid metabolites and sperm motility in the seminal plasma of the population, the results showed that 9-HODE and 13-HODE were significantly higher in the low sperm motility group than in the normal group ( P<0.000 1). And there was a negative correlation ( r=-0.38) with the sperm motility rate ( P<0.000 1). Conclusion:9-HODE and 13-HODE are released into the culture medium and seminal plasma by sperm cell metabolism, which is a potential indicator of the degree of sperm membrane damage, which may be helpful in judging and detecting the asthenospermia.

Objective To explore the clinical application effect of multiple end-to-side anastomosis in free anterolateral thigh perforator flap transplantation.Methods From January,2013 to October,2017,29 cases were applied the technology of multiple end-to-side anastomosis to the same recipient vessel in anterolateral thigh perforator flap transplantation for wound repair.Fifteen cases treated with multiple end-to-side anastomosis on flap arteries,and 2-3 arteries were anastomosed,with the average of 2.13.Nine cases were treated with venous multiple end-to-side anastomosis,and 2-4 veins were anastomosed,with the average of 3.11.Five cases treated with arterial and venous multiple end-to-side anastomosis,and 4-6 vessels were anastomosed,with the average of 5.20.Distribution of wounds:10 cases with hands and wrists wounded,15 cases with forearms and elbow joints wounded,and 4 cases with lower legs and feet wounded.The soft tissue defect size was 5 cm×13 cm-11 cm×27 cm,and the flap area was 6 cm× 15 cm-12 cm×29 cm.Postoperative followed-up was performed every 3-6 months to review flap survival.Results All flaps of 29 cases survived.Venous congestion occurred in 2 flaps within 48 h after the operation,among which,1 was overcomed after released the dressing and sutures,and the other underwent surgical exploration.The venous end-to-side anastomotic stomas were unobstructed,and hematoma was formed.After the hematoma compression was removed,circulation was recovered and the flap survived.With followed-up for 6 months to 2.5 years,both donor site and recipient site of the flaps healed well and the injured distal limbs had no hemodynamic disorder.Conclusion The application of multiple end-to-side anastomosis to the same recipient vessel for free transplantation of anterolateral thigh perforator flaps is safe and reliable.

Pectus carinatum (PC) is one of the most common chest wall anomalies, which is characterized by the protrusion of the anterior chest wall including the sternum and adjacent costal cartilages. Mildly patients suffer from mental problems such as self-abasement, while severely suffering patients are disturbed by significant cardiopulmonary symptoms. The traditional Haller index, which is widely used clinically to evaluate the severity of PC, is deficient in diagnosis efficiency and classification. This paper presents an improved Haller index algorithm for PC: first, the contour of the patient chest in the axial computed tomography (CT) slice where the most convex thorax presents is extracted; and then a cubic B-spline curve is employed to fit the extracted contour followed by an eclipse fitting procedure; finally, the improved Haller index and the classification index are automatically calculated based on the analytic curves. The results of CT data analysis using 22 preoperative and postoperative patient CT datasets show that the proposed diagnostic index for PC can diagnose and classify PC patients correctly, which confirms the feasibility of the evaluation index. Furthermore, digital measurement techniques can be employed to improve the diagnostic efficiency of PC, achieving one small step towards the computer-aided intelligent diagnosis and treatment for pediatric chest wall malformations.

Objective To analyze the sexuality situation and the influencing factors of 1 732 cases of migrants in Chongqing , and provide the scientific basis for improving the sexual health of migrants and the service level of the relevant departments .Meth‐ods The multi stage random cluster sampling method was used to select the subjects .A total of 1 732 married and unmarried mi‐grants who had sexuality were included into the structured questionnaire survey .The SAS9 .3 software was use to statistical analy‐sis .The χ2 test and Ordinal regression analysis and Logistic regression analysis were use to univariate and multivariate analysis .Re‐sults The communication frequency of sexuality of male migrants was higher than the females ,OR=1 .53(95% CI:1 .24-1 .89);young people had the high communication frequency of sexuality ;the frequency of low education groups lower than higher .The fre‐quency of subjects worked in Hong Kong ,Taiwan ,overseas‐funded enterprises are higher than other workplace .The sexual life fre‐quency of male migrants is higher than the female ,OR=1 .84(95% CI:1 .40-2 .42);the sexual life frequency of low age group was higher than high age group ,the frequency of sexual life in factory workers was lower than the Hong Kong ,Taiwan ,overseas‐funded enterprises workers .Compared with the subjects who communicate the sexuality issues often ,the frequency of sexual depression and suppression was higher in the migrants who communicate general and rarely ,the OR was 2 .75 (95% CI:1 .71 -4 .41) and 2 .60 (95% CI:1 .45-4 .66) .Conclusion Male ,younger ,highly educated migrants have a high sexual issues communication frequency . The age and the workplace was the most important factor of the frequency of sexual life .Ease the work pressure and increase the communication of sexual issues will help to relax the sexual depression and depression .

Objective To survey the pain management knowledge and attitude among nurses from the ICU of four third grade class A hospitals in Jiangsu province , preliminary understand pain management knowledge level of the nurses from the ICU , attitude of ICU nurses pain knowledge training and provide the references for the future and the basis .Methods A total of 109 ICU nurses from four 3-A hospitals in Jiangsu province ( including 64 comprehensive ICU nurses and 45 college ICU nurses ) were surveyed using the Chinese version of Knowledge and Attitudes Survey Regarding Pain ( KASRP ) ( 2008 ) questionnaire .Collected data were analyzed using descriptive analysis , frequency , percentage , variance analysis .Results Correct ratio of 109 nurses to the questionnaire was from 25.00% to 62.50%.Average correct ratio if the questionnaire was 42.50%.Correct ratio of individual item ranged from 0.00% to 87.16%.Top 10 items which answered correctly were listed: individually dosage of opioid agents , cultural background of pain , pain assessment of children, relationship of pain tolerance and drug usage and analgesic effect of drug combination .Lowest ranked 10 items were case analysis question , postoperative analgesia using prn based on pain assessment , ratio of respiratory depression caused by opioid agents , physiological dependence and administration route of opioid agents, relationship between placebo and pain and relationship between pain and sleep .Conclusions Nurses′knowledge and attitude to pain management is insufficient and needs to be trained and evaluated in ICU .