BACKGROUND: The role of inflammation in the development of gestational diabetes mellitus (GDM) has recently become a focus of research. The systemic immune-inflammation index (SII) and systemic inflammation response index (SIRI), novel indices, reflect the body's chronic immune-inflammatory state. This study aimed to investigate the associations between the SII or SIRI and GDM. METHODS: A prospective birth cohort study was conducted at Beijing Obstetrics and Gynecology Hospital from February 2018 to December 2020, recruiting participants in their first trimester of pregnancy. Baseline SII and SIRI values were derived from routine clinical blood results, calculated as follows: SII = neutrophil (Neut) count × platelet (PLT) count/lymphocyte (Lymph) count, SIRI = Neut count × monocyte (Mono) count/Lymph count, with participants being grouped by quartiles of their SII or SIRI values. Participants were followed up for GDM with a 75-g, 2-h oral glucose tolerance test (OGTT) at 24-28 weeks of gestation using the glucose thresholds of the International Association of Diabetes and Pregnancy Study Groups (IADPSG). Logistic regression was used to analyze the odds ratios (ORs) (95% confidence intervals [CIs]) for the the associations between SII, SIRI, and the risk of GDM. RESULTS: Among the 28,124 women included in the study, the average age was 31.8 ± 3.8 years, and 15.76% (4432/28,124) developed GDM. Higher SII and SIRI quartiles were correlated with increased GDM rates, with rates ranging from 12.26% (862/7031) in the lowest quartile to 20.10% (1413/7031) in the highest quartile for the SII ( Ptrend <0.001) and 11.92-19.31% for the SIRI ( Ptrend <0.001). The ORs (95% CIs) of the second, third, and fourth SII quartiles were 1.09 (0.98-1.21), 1.21 (1.09-1.34), and 1.39 (1.26-1.54), respectively. The SIRI findings paralleled the SII outcomes. For the second through fourth quartiles, the ORs (95% CIs) were 1.24 (1.12-1.38), 1.41 (1.27-1.57), and 1.64 (1.48-1.82), respectively. These associations were maintained in subgroup and sensitivity analyses. CONCLUSION The SII and SIRI are potential independent risk factors contributing to the onset of GDM.
Humans ; Female ; Pregnancy ; Diabetes, Gestational/immunology* ; Prospective Studies ; Adult ; Inflammation/immunology* ; Glucose Tolerance Test ; Birth Cohort

Objective:To describe the positive rates of high-risk human papillomavirus (HR-HPV) DNA and serum-neutralizing antibody in cervical intraepithelial neoplasia (CIN) tissues of rural women in Xiangyuan County, Shanxi Province, and evaluate the association of HR-HPV DNA and neutralizing antibody positive status with the occurrence of CIN.Methods:In a cohort of 1 897 women aged 35-45 years established by the Shanxi Province Cervical Cancer Screening StudyⅠ, DNA typing (SPF10 PCR-DEIA-LiPA25) was performed by using tissue samples of women with positive HR-HPV test results [Hybrid CaptureⅡ(HC2)] or abnormal cytological or pathological results. Serum HR-HPV neutralizing antibody detection was conducted with multicolor pseudovirion-based neutralization assay. Cochran-Armitage trend test was used to analyze the changing trend of the positive rate of HR-HPV DNA and neutralizing antibody with the progression of CIN. Multivariate logistic regression models were used to evaluate the influence and multiplicative interaction of HR-HPV DNA and neutralizing antibody positive status on the occurrence of CIN. The relative excess risk ( RERI), attributable proportion of interaction ( AP), and the synergy index ( SI) of the interaction were calculated to evaluate the additive interaction of HR-HPV DNA and neutralizing antibody on the occurrence of CIN. Results:The positive rate of any type of HR-HPV DNA (HPV16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68) in 479 women who were HC2 positive or had abnormal cytological or pathological detection results was 37.16%. In normal, CIN1, CIN2, and CIN3+ groups, the HR-HPV DNA positive rates were 18.03%, 49.53%, 90.24% and 94.59%, respectively. The positive rate of any type of HR-HPV neutralizing antibody was 63.88%. In normal, CIN1, CIN2, and CIN3+ groups, the positive rates of HR-HPV neutralizing antibody were 63.95%, 57.94%, 70.73%, and 72.97%, respectively. The positive rate of any type of HR-HPV neutralizing antibody was 53.31% in 1 418 women who were HC2 negative and had normal cytopathology, and the most common types were HPV51 (27.36%) and HPV39 (24.96%). Multivariate logistic regression analysis showed that any type of HR-HPV DNA positive status ( OR=9.15, 95% CI: 5.99-14.20, P<0.001) was the independent factor for the occurrence of CIN, HR-HPV neutralizing antibody positive status was not associated with the occurrence of CIN ( OR=0.95, 95% CI: 0.61-1.48, P=0.815). The OR value of the multiplication of HR-HPV DNA and neutralizing antibody positive status of the occurrence of CIN was 1.63 (95% CI: 0.67-3.95), P=0.283. Quantitative analysis of interaction showed that RERI was 1.65 (95% CI:-3.56-6.86), SI was 1.28 (95% CI: 0.58-2.82), and AP was 0.19 (95% CI:-0.36-0.75). Conclusions:HR-HPV DNA positive status was a risk factor for the occurrence of CIN, but neutralizing antibody positive status was not associated with the occurrence of CIN. They had no significant multiplicative or additive interaction with the occurrence of CIN.

Objective To retrieve and evaluate the evidence related to surgical instrument management,and to integrate the evidence to provide an evidence-based basis for clinical surgical instrument management practice.Methods Evidence on surgical instrument management,including guidelines,expert consensuses,and clinical decision-making,was systematically searched from domestic and international databases and related websites.The search timeframe was from database construction to 4 November 2024.Literature was screened and evaluated,and the evidence was integrated by 2 researchers.Results A total of 16 papers were included,including 2 systematic evaluations,1 class experimental study,2 clinical decisions,4 expert consensuses,5 guidelines,and 2 evidence summaries,resulting in a total of 33 pieces of evidence in 5 areas,including requirements for surgical instrument management,general principles of surgical instrument handling,logistics and supply chain management of surgical instruments,surgical instrument pre-treatment and cleaning,disinfection,and sterilisation processes,and personnel training.Conclusion This study summarises the best available evidence on the management of surgical instruments in hospitals and provides an evidence-based basis for healthcare professionals to manage surgical instruments,thereby improving the quality and efficiency of surgical instrument disposal.

Objective To explore the necessity,significance,and implementation forms of integrating tumor health sci-ence popularization education and communication practice into clinical undergraduate oncology teaching.Methods Science pop-ularization education was conducted among clinical undergraduate oncology students at Guangzhou Medical University who partici-pated in science communication activities.Before and after the activities,online questionnaires were distributed via Wenjuanxing.Student questionnaires were collected within the deadline,while two different versions of questionnaires were randomly distributed to 30 parents and 20 faculty members involved in oncology teaching to assess their views and attitudes toward the necessity of pub-lic cancer prevention science communication,as well as the integration of science popularization education and communication practice into oncology teaching,and to evaluate its educational significance.Results The analysis of the questionnaires showed that nearly all or the vast majority of students,parents,and teachers highly recognized the necessity of public cancer prevention science education and awareness-raising,as well as the importance of medical students disseminating tumor health knowledge.They also strongly supported the inclusion of science popularization education in oncology teaching.Most students felt that their knowledge level improved significantly after the education sessions.Conclusion The integration of tumor science popularization education and communication practice into oncology teaching is highly necessary and meaningful.It significantly enhances students' health science literacy,sense of mission,and responsibility.It is recommended to incorporate such content into oncolo-gy teaching.

Objective To explore the effect of life reconstruction training on anxiety and depression among individuals with chronic spinal cord injury(SCI)and their caregivers,and to analyze the influencing factors.Methods A total of 216 SCI patients and 79 caregivers who participated in life reconstruction training were recruited from the Hope House for SCI individuals in Shanghai Yangzhi Rehabilitation Hospital from May,2017 to Octo-ber,2019.They were assessed with Self-Rating Anxiety Scale(SAS)and Self-Rating Depression Scale(SDS)be-fore and after intervention.Results After intervention,the scores of SAS and SDS decreased(P<0.05)in both SCI patients and their caregivers.SAS scores were more likely to reduce in SCI patients who suffered anxiety at admission(OR=2.315,95%CI 1.328 to 4.033,P=0.003)and their caregivers(OR=3.632,95%CI 1.270 to 10.390,P=0.016),as well as non-agricultural-registered SCI patients(OR=1.908,95%CI 1.074 to 3.391,P=0.028).Being unmarried,having an injury duration≥21 years,injury due to disease,and having depression at admission significantly promoted the reduction in SDS scores among SCI patients(P<0.05).Caregivers with a junior-high-school education or less were more likely to experience reductions in scores of SAS and SDS compared with those with higher education(P<0.05).Caregivers with five to 15 years of caregiving experience achieved more anxiety reduction(OR=7.155,95%CI 1.806 to 28.342,P=0.005).Conclusion Life reconstruction training is effective on anxiety and depression among individuals with chronic SCI and their caregivers.It is recommended to prioritize anxiety interventions for patients with rural household registra-tion in China,along with depression management for the married/divorced/widowed individuals,with<21 years since injury,and trauma-induced lesions.For caregivers,it is needed to focus to anxiety and depression in better-educated individuals,as well as anxiety in those with either<5 or≥15 years of caregiving experience.

Objective To explore the necessity,significance,and implementation forms of integrating tumor health sci-ence popularization education and communication practice into clinical undergraduate oncology teaching.Methods Science pop-ularization education was conducted among clinical undergraduate oncology students at Guangzhou Medical University who partici-pated in science communication activities.Before and after the activities,online questionnaires were distributed via Wenjuanxing.Student questionnaires were collected within the deadline,while two different versions of questionnaires were randomly distributed to 30 parents and 20 faculty members involved in oncology teaching to assess their views and attitudes toward the necessity of pub-lic cancer prevention science communication,as well as the integration of science popularization education and communication practice into oncology teaching,and to evaluate its educational significance.Results The analysis of the questionnaires showed that nearly all or the vast majority of students,parents,and teachers highly recognized the necessity of public cancer prevention science education and awareness-raising,as well as the importance of medical students disseminating tumor health knowledge.They also strongly supported the inclusion of science popularization education in oncology teaching.Most students felt that their knowledge level improved significantly after the education sessions.Conclusion The integration of tumor science popularization education and communication practice into oncology teaching is highly necessary and meaningful.It significantly enhances students' health science literacy,sense of mission,and responsibility.It is recommended to incorporate such content into oncolo-gy teaching.

Objective:To describe the positive rates of high-risk human papillomavirus (HR-HPV) DNA and serum-neutralizing antibody in cervical intraepithelial neoplasia (CIN) tissues of rural women in Xiangyuan County, Shanxi Province, and evaluate the association of HR-HPV DNA and neutralizing antibody positive status with the occurrence of CIN.Methods:In a cohort of 1 897 women aged 35-45 years established by the Shanxi Province Cervical Cancer Screening StudyⅠ, DNA typing (SPF10 PCR-DEIA-LiPA25) was performed by using tissue samples of women with positive HR-HPV test results [Hybrid CaptureⅡ(HC2)] or abnormal cytological or pathological results. Serum HR-HPV neutralizing antibody detection was conducted with multicolor pseudovirion-based neutralization assay. Cochran-Armitage trend test was used to analyze the changing trend of the positive rate of HR-HPV DNA and neutralizing antibody with the progression of CIN. Multivariate logistic regression models were used to evaluate the influence and multiplicative interaction of HR-HPV DNA and neutralizing antibody positive status on the occurrence of CIN. The relative excess risk ( RERI), attributable proportion of interaction ( AP), and the synergy index ( SI) of the interaction were calculated to evaluate the additive interaction of HR-HPV DNA and neutralizing antibody on the occurrence of CIN. Results:The positive rate of any type of HR-HPV DNA (HPV16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68) in 479 women who were HC2 positive or had abnormal cytological or pathological detection results was 37.16%. In normal, CIN1, CIN2, and CIN3+ groups, the HR-HPV DNA positive rates were 18.03%, 49.53%, 90.24% and 94.59%, respectively. The positive rate of any type of HR-HPV neutralizing antibody was 63.88%. In normal, CIN1, CIN2, and CIN3+ groups, the positive rates of HR-HPV neutralizing antibody were 63.95%, 57.94%, 70.73%, and 72.97%, respectively. The positive rate of any type of HR-HPV neutralizing antibody was 53.31% in 1 418 women who were HC2 negative and had normal cytopathology, and the most common types were HPV51 (27.36%) and HPV39 (24.96%). Multivariate logistic regression analysis showed that any type of HR-HPV DNA positive status ( OR=9.15, 95% CI: 5.99-14.20, P<0.001) was the independent factor for the occurrence of CIN, HR-HPV neutralizing antibody positive status was not associated with the occurrence of CIN ( OR=0.95, 95% CI: 0.61-1.48, P=0.815). The OR value of the multiplication of HR-HPV DNA and neutralizing antibody positive status of the occurrence of CIN was 1.63 (95% CI: 0.67-3.95), P=0.283. Quantitative analysis of interaction showed that RERI was 1.65 (95% CI:-3.56-6.86), SI was 1.28 (95% CI: 0.58-2.82), and AP was 0.19 (95% CI:-0.36-0.75). Conclusions:HR-HPV DNA positive status was a risk factor for the occurrence of CIN, but neutralizing antibody positive status was not associated with the occurrence of CIN. They had no significant multiplicative or additive interaction with the occurrence of CIN.

Objective To retrieve and evaluate the evidence related to surgical instrument management,and to integrate the evidence to provide an evidence-based basis for clinical surgical instrument management practice.Methods Evidence on surgical instrument management,including guidelines,expert consensuses,and clinical decision-making,was systematically searched from domestic and international databases and related websites.The search timeframe was from database construction to 4 November 2024.Literature was screened and evaluated,and the evidence was integrated by 2 researchers.Results A total of 16 papers were included,including 2 systematic evaluations,1 class experimental study,2 clinical decisions,4 expert consensuses,5 guidelines,and 2 evidence summaries,resulting in a total of 33 pieces of evidence in 5 areas,including requirements for surgical instrument management,general principles of surgical instrument handling,logistics and supply chain management of surgical instruments,surgical instrument pre-treatment and cleaning,disinfection,and sterilisation processes,and personnel training.Conclusion This study summarises the best available evidence on the management of surgical instruments in hospitals and provides an evidence-based basis for healthcare professionals to manage surgical instruments,thereby improving the quality and efficiency of surgical instrument disposal.

Objective To explore the association between walking exercise guided by 6 minute walking test(6MWT)and the incidences of 3-year major adverse cardiovascular event(MACE)in elderly patients with acute coronary syndrome(ACS)after percutaneous coronary intervention(PCI).Methods A total of 628 elderly ACS patients who undergoing PCI and obtaining success-ful coronary revascularization in our department from November 2018 to April 2019 were enrolled,and divided into 6MWT group(n=147)and control group(n=481)based on participa-ting in walking exercise guided by 6MWT or not.All of them were followed up for 3 years.The incidences of MACE[including coronary target vascular restenosis,acute myocardial infarction,heart failure,ischemic or hemorrhagic stroke]and all-cause death were observed.Univariate and multivariate Cox proportional analyses and Kaplan-Meier survival curve analysis were employed for data statistical analyses.Results At the end of follow-up,the incidences of target vascular restenosis(6.9％vs 2.0％,P=0.028),heart failure(3.7％vs 0％,P=0.036),stroke(3.7％vs 0％,P=0.036),and total MACE incidence(15.0％vs 4.1％,P=0.000)were statistically higher in the control group than the 6MWT group.Kaplan-Meier survival curve analysis showed that the cumulative incidence of MACE was significantly lower in the 6MWT group than the control group(Plog rank=0.001).Multivariate Cox regression analysis showed that not participating in walking exercise guided by 6MWT was an independent risk factor for occurrence of 3-year MACE(HR=3.102,95％CI:1.327-7.250,P=0.009).Conclusion Walking exercise guided by 6MWT reduces the incidence of 3-year MACE and improves the long-term prognosis of elderly ACS patients after PCI.

Objective To explore the effect of life reconstruction training on anxiety and depression among individuals with chronic spinal cord injury(SCI)and their caregivers,and to analyze the influencing factors.Methods A total of 216 SCI patients and 79 caregivers who participated in life reconstruction training were recruited from the Hope House for SCI individuals in Shanghai Yangzhi Rehabilitation Hospital from May,2017 to Octo-ber,2019.They were assessed with Self-Rating Anxiety Scale(SAS)and Self-Rating Depression Scale(SDS)be-fore and after intervention.Results After intervention,the scores of SAS and SDS decreased(P<0.05)in both SCI patients and their caregivers.SAS scores were more likely to reduce in SCI patients who suffered anxiety at admission(OR=2.315,95%CI 1.328 to 4.033,P=0.003)and their caregivers(OR=3.632,95%CI 1.270 to 10.390,P=0.016),as well as non-agricultural-registered SCI patients(OR=1.908,95%CI 1.074 to 3.391,P=0.028).Being unmarried,having an injury duration≥21 years,injury due to disease,and having depression at admission significantly promoted the reduction in SDS scores among SCI patients(P<0.05).Caregivers with a junior-high-school education or less were more likely to experience reductions in scores of SAS and SDS compared with those with higher education(P<0.05).Caregivers with five to 15 years of caregiving experience achieved more anxiety reduction(OR=7.155,95%CI 1.806 to 28.342,P=0.005).Conclusion Life reconstruction training is effective on anxiety and depression among individuals with chronic SCI and their caregivers.It is recommended to prioritize anxiety interventions for patients with rural household registra-tion in China,along with depression management for the married/divorced/widowed individuals,with<21 years since injury,and trauma-induced lesions.For caregivers,it is needed to focus to anxiety and depression in better-educated individuals,as well as anxiety in those with either<5 or≥15 years of caregiving experience.