Debates persist regarding the efficacy and safety of azvudine, particularly its real-world outcomes. This study involved patients aged ≥60 years who were admitted to 25 hospitals in mainland China with confirmed SARS-CoV-2 infection between December 1, 2022, and February 28, 2023. Efficacy outcomes were all-cause mortality during hospitalization, the proportion of patients discharged with recovery, time to nucleic acid-negative conversion (T _NANC), time to symptom improvement (T _SI), and time of hospital stay (T _HS). Safety was also assessed. Among the 5884 participants identified, 1999 received azvudine, and 1999 matched controls were included after exclusion and propensity score matching. Azvudine recipients exhibited lower all-cause mortality compared with controls in the overall population (13.3% vs. 17.1%, RR, 0.78; 95% CI, 0.67-0.90; P = 0.001) and in the severe subgroup (25.7% vs. 33.7%; RR, 0.76; 95% CI, 0.66-0.88; P < 0.001). A higher proportion of patients discharged with recovery, and a shorter T _NANC were associated with azvudine recipients, especially in the severe subgroup. The incidence of adverse events in azvudine recipients was comparable to that in the control group (2.3% vs. 1.7%, P = 0.170). In conclusion, azvudine showed efficacy and safety in older patients hospitalized with COVID-19 during the SARS-CoV-2 omicron wave in China.

Objective To investigate the correlation between serum insulin like growth factor 1 receptor(IGF1R)and epidermal growth factor-like domain-containing protein 7(EGFL7)levels and the condition and pregnancy outcome of patients with preeclampsia(PE).Methods A total of 120 PE patients admitted to the hospital from January 2021 to January 2024(PE group)and 60 healthy pregnant women during the same peri-od(control group)were selected.The PE patients were divided into severe PE group(68 cases)and mild PE group(52 cases)according to their conditions,and divided into poor group(62 cases)and good group(68 ca-ses)according to the pregnancy outcome.Enzyme-linked immunosorbent assay was used to detect serum IGF1R,EGFL7 levels.Using the pregnancy outcome of PE patients as the dependent variable,multivariate un-conditional Logistic regression was used to determine the influencing factors of their pregnancy outcomes,and receiver operating characteristic curve was used to evaluate the predictive value of serum IGF1R and EGFL7 levels.Results Compared with the control group,serum IGF1R levels were reduced and EGFL7 levels were increased in the PE group(t=-16.908,16.234,P＜0.001).Serum IGF1R levels were decreased and EGFL7 levels were increased in the severe PE group compared with the mild PE group(t=-5.317,5.305,P＜0.001).The incidence of adverse pregnancy outcomes in PE patients was 51.67％(62/120).The independent risk factors for adverse pregnancy outcomes in patients with PE were severe PE(OR=3.906,95％CI:1.305-11.689),elevated 24-h urinary protein(OR=2.030,95％CI:1.290-3.194),elevated EGFL7(OR=1.116,95％CI:1.040-1.198),and the independent protective factor was elevated IGF1R(OR=0.908,95％CI:0.865-0.954,P＜0.05).The area under the curve for serum IGF1R and EGFL7 levels alone and in com-bination to predict adverse pregnancy outcomes in PE patients was 0.791(95％CI:0.707-0.860),0.784(95％CI:0.700-0.854),and 0.866(95％CI:0.781-0.911),and serum IGF1R and EGFL7 levels were grea-ter jointly(Z=2.456,2.244,P＜0.05).Conclusion Decreased serum IGF1R levels and increased EGFL7 levels are associated with exacerbation and adverse pregnancy outcomes in patients with PE,and the combina-tion of serum IGF1R and EGFL7 levels is of high value in predicting adverse pregnancy outcomes in patients with PE.

Objective:To explore the clinical significance of chromosome microarray analysis (CMA) in the prenatal detection of DMD gene variants in fetuses without family history during prenatal diagnosis.Methods:A retrospective analysis was conducted on amniotic fluid samples from 12 629 pregnant women who underwent CMA prenatal diagnosis due to high-risk factors at Women and Children′s Hospital Affiliated to Qingdao University between January 2019 and December 2024. Samples with CMA-indicated DMD gene variants were further verified by multiplex ligation-dependent probe amplification (MLPA).Results:(1) Among 12 629 amniotic fluid samples, CMA detected 11 samples with DMD gene deletions or duplications (6 male and 5 female fetuses), which were confirmed by MLPA. (2) All 11 samples with DMD gene variants had no family history of genetic diseases, including 5 deletions and 6 duplications. All of the 5 DMD gene deletions occurred in male fetuses and were all pathogenic, and the pregnant women chose to terminate the pregnancies. Among the 6 DMD gene duplications cases, 1 male fetus was diagnosed as pathogenic and had pregnancy termination; the other 5 duplication cases were female fetuses, in which 1 were pathogenic and 4 were likely pathogenic. They continued pregnancy until delivery, and follow-up showed no DMD-related symptoms. (3) Pedigree analysis revealed that among the 11 samples with DMD gene variants, 3 were de novo mutations, 7 were inherited from mothers, and 1 had an unknown origin.Conclusions:For fetuses without pseudohypertrophic muscalar dystrophy family history but requiring invasive prenatal diagnosis for other reasons, CMA helps to increase the detection of DMD gene variants in fetuses. Testing pregnant women for DMD pathogenic gene carriers could effectively prevent the birth of pseudohypertrophic muscalar dystrophy children.

Objective:To investigate whether continued low-dose aspirin (LDA) intervention affects the incidence of pre-eclampsia (PE) and adverse pregnancy outcomes in pregnant women with high-risk PE screening in the first trimester and reassessed as low risk at 28 weeks of gestation.Methods:This study was a prospective observational cohort study. From April 2022 to April 2024, a total of 106 pregnant women who underwent prenatal examination in the Affiliated Jiangyin Hospital of Nantong University were enrolled. They were assessed as high risk of PE by multiple indicators combined screening at 11-13 +6 weeks of gestation, received LDA intervention, and were reassessed as low risk of PE at 28 weeks of gestation. The patients were divided into withdrawal group (49 cases) and continuation group (57 cases). The incidence of PE and adverse pregnancy outcomes were compared between the two groups. Results:(1) There were no statistically significant differences in general conditions and the incidence of pregnancy complications between the two groups (all P>0.05). During the PE risk screening at 11-13 +6 weeks of gestation, there were no statistically significant differences in mean arterial pressure (MAP) and ultrasound uterine artery pulsation index (UtPI) between the two groups (all P>0.05), but the placental growth factor (PlGF) level in the withdrawal group was significantly lower than that in the continuation group ( P=0.023). There was no significant difference in the proportion of pregnant women with high risk of PE before 32 weeks and 34 weeks of pregnancy between the two groups (all P>0.05). (2) There were 7 cases (14%, 7/49) of PE in the withdrawal group, including 1 case (2%, 1/49) of early-onset PE and 3 cases (6%, 3/49) of PE before 37 weeks of pregnancy. There were 11 cases (19%, 11/57) of PE in the continuation group, including 2 cases (4%, 2/57) of early-onset PE and 4 cases (7%, 4/57) of PE before 37 weeks of pregnancy. There were no significant differences in the incidence of PE (including early-onset PE and PE before 37 weeks of pregnancy), gestational hypertension, severe PE, chronic hypertension complicated with PE and chronic hypertension complicated with pregnancy between the two groups (all P>0.05). (3) There were no significant differences in cesarean section rate, preterm birth rate, placental abruption, postpartum hemorrhage, fetal growth restriction, fetal distress rate, neonatal birth weight, neonatal asphyxia, and 1-minute and 5-minute Apgar scores between the two groups (all P>0.05). No stillbirth occurred in the two groups. Conclusion:For pregnant women with high risk of PE screening in the first trimester and taking LDA intervention, there is no difference in the incidence of PE and adverse pregnancy outcomes whether to continue LDA or not after being reassessed as low risk at 28 weeks of gestation.

Objective:To explore the clinical significance of chromosome microarray analysis (CMA) in the prenatal detection of DMD gene variants in fetuses without family history during prenatal diagnosis.Methods:A retrospective analysis was conducted on amniotic fluid samples from 12 629 pregnant women who underwent CMA prenatal diagnosis due to high-risk factors at Women and Children′s Hospital Affiliated to Qingdao University between January 2019 and December 2024. Samples with CMA-indicated DMD gene variants were further verified by multiplex ligation-dependent probe amplification (MLPA).Results:(1) Among 12 629 amniotic fluid samples, CMA detected 11 samples with DMD gene deletions or duplications (6 male and 5 female fetuses), which were confirmed by MLPA. (2) All 11 samples with DMD gene variants had no family history of genetic diseases, including 5 deletions and 6 duplications. All of the 5 DMD gene deletions occurred in male fetuses and were all pathogenic, and the pregnant women chose to terminate the pregnancies. Among the 6 DMD gene duplications cases, 1 male fetus was diagnosed as pathogenic and had pregnancy termination; the other 5 duplication cases were female fetuses, in which 1 were pathogenic and 4 were likely pathogenic. They continued pregnancy until delivery, and follow-up showed no DMD-related symptoms. (3) Pedigree analysis revealed that among the 11 samples with DMD gene variants, 3 were de novo mutations, 7 were inherited from mothers, and 1 had an unknown origin.Conclusions:For fetuses without pseudohypertrophic muscalar dystrophy family history but requiring invasive prenatal diagnosis for other reasons, CMA helps to increase the detection of DMD gene variants in fetuses. Testing pregnant women for DMD pathogenic gene carriers could effectively prevent the birth of pseudohypertrophic muscalar dystrophy children.

Objective:To investigate whether continued low-dose aspirin (LDA) intervention affects the incidence of pre-eclampsia (PE) and adverse pregnancy outcomes in pregnant women with high-risk PE screening in the first trimester and reassessed as low risk at 28 weeks of gestation.Methods:This study was a prospective observational cohort study. From April 2022 to April 2024, a total of 106 pregnant women who underwent prenatal examination in the Affiliated Jiangyin Hospital of Nantong University were enrolled. They were assessed as high risk of PE by multiple indicators combined screening at 11-13 +6 weeks of gestation, received LDA intervention, and were reassessed as low risk of PE at 28 weeks of gestation. The patients were divided into withdrawal group (49 cases) and continuation group (57 cases). The incidence of PE and adverse pregnancy outcomes were compared between the two groups. Results:(1) There were no statistically significant differences in general conditions and the incidence of pregnancy complications between the two groups (all P>0.05). During the PE risk screening at 11-13 +6 weeks of gestation, there were no statistically significant differences in mean arterial pressure (MAP) and ultrasound uterine artery pulsation index (UtPI) between the two groups (all P>0.05), but the placental growth factor (PlGF) level in the withdrawal group was significantly lower than that in the continuation group ( P=0.023). There was no significant difference in the proportion of pregnant women with high risk of PE before 32 weeks and 34 weeks of pregnancy between the two groups (all P>0.05). (2) There were 7 cases (14%, 7/49) of PE in the withdrawal group, including 1 case (2%, 1/49) of early-onset PE and 3 cases (6%, 3/49) of PE before 37 weeks of pregnancy. There were 11 cases (19%, 11/57) of PE in the continuation group, including 2 cases (4%, 2/57) of early-onset PE and 4 cases (7%, 4/57) of PE before 37 weeks of pregnancy. There were no significant differences in the incidence of PE (including early-onset PE and PE before 37 weeks of pregnancy), gestational hypertension, severe PE, chronic hypertension complicated with PE and chronic hypertension complicated with pregnancy between the two groups (all P>0.05). (3) There were no significant differences in cesarean section rate, preterm birth rate, placental abruption, postpartum hemorrhage, fetal growth restriction, fetal distress rate, neonatal birth weight, neonatal asphyxia, and 1-minute and 5-minute Apgar scores between the two groups (all P>0.05). No stillbirth occurred in the two groups. Conclusion:For pregnant women with high risk of PE screening in the first trimester and taking LDA intervention, there is no difference in the incidence of PE and adverse pregnancy outcomes whether to continue LDA or not after being reassessed as low risk at 28 weeks of gestation.

Objective To explore the application effect of visualization pre-hospital and in-hospital information connection technique in pre-examination and triage of emergency critically ill patients.Methods The critically ill patients transferred by 120 ambulances to the Affiliated Hospital of Jiaxing University,the First Hospital of Jiaxing from March to August 2023 were selected as research objects.Prospective non-concurrent control was adopted.The 90 critically ill patients transferred by 120 ambulances to our hospital from June to August 2023 were used as an experimental group,while the 90 critically ill patients transferred by 120 ambulances to our hospital from March to May 2023 were used as a control group.Before establishing visualization pre-hospital and in-hospital information connection technique,the patients or their family members in the control group called an ambulance;after pre-hospital rescuers sent the patients to the hospital,they connected with in-hospital medical workers in an oral or written form;pre-examination nurses received the patients,performed illness evaluation,obtained their identity information,and helped card registration;and meanwhile,the in-hospital medical workers conducted standardized treatment for the patients.After establishing visualization pre-hospital and in-hospital information connection technique,the patients or their family members in the experimental group called an ambulance;pre-hospital rescuers input corresponding basic information of the patients(including name,gender,age,vital sign,severity of illness,etc.)via the special APP of the emergency center,and pushed relevant information to the target network hospital;pre-examination nurses received the message that the ambulance was about to arrive via the pre-hospital and in-hospital collaborative treatment platform,obtained the basic information of the patients provided before admission in the emergency pre-examination system,performed card registration in advance,and opened a green channel;and meanwhile in-hospital medical workers developed a rescue plan according to the severity of illness assessed by 120 doctors.The time of critically ill patients setting up a medical card,the time of pre-examination nurses completing triage,and the satisfaction of the patients and their family members with the emergency treatment process were compared between the two groups.Results The time of critically ill patients setting up a medical card and the time of pre-examination nurses completing triage in the experimental group were significantly shorter than those in the control group[the time of critically ill patients setting up a medical card(minutes):1.3±0.3 vs.2.6±0.4,the time of pre-examination nurses completing triage(minutes):1.1±0.3 vs.3.5±0.7,both P<0.05].Moreover,the satisfaction of the patients and their family members on the emergency treatment process in the experimental group was obviously higher than that in the control group[95.6%(86/90)vs.86.7%(78/90),P<0.05].Conclusion The establishment of visualization pre-hospital and in-hospital information connection technique can achieve pre-hospital and in-hospital data transmission and accomplish"information goes ahead of patients",which effectively shortens pre-examination and triage time for critically ill patients,wins an opportunity to rescue them,improves pre-examination and triage efficiency for ordinary patients,and enhances their medical experience.

Objective:To analyze the genetic etiology of spontaneous abortion in the first trimester.Methods:This study was a retrospective analysis. The subjects were 815 pregnant women who voluntarily underwent genetic testing of pregnancy miscarriage embryos due to spontaneous abortion or embryonic development arrest in six to thirteen gestational weeks from January 2021 to December 2022. High-throughput sequencing technology was used to detect the abortion tissue, and the results were analyzed by bioinformatics method. Statistical analysis was conducted using the Chi-square test. Results:(1) Chromosomal abnormalities were detected in 525 out of 815 cases (64.4%), including 479 cases (91.2%) of numerical abnormalities (421 cases of aneuploidy and 58 cases of triploidy), 44 cases (8.4%) of structural abnormalities (copy number variation, CNV), and two cases (0.4%) of uniparental disomy. (2) Among the numerical abnormalities, aneuploidy was the most common (87.9%, 421/479), involving all chromosomes except chromosome 1. Trisomy 16 had the highest frequency (17.5%, 84/479), followed by monosomy X (13.4%, 64/479) and trisomy 22 (11.3%, 54/479). Multiple chromosomal abnormalities were present in 27 cases (5.6%). Among the nine cases of autosomal monosomy, there were seven cases of monosomy 21, and one case each of monosomy 18 and monosomy 4. (3) Among the 44 cases of structural abnormalities, 62 pathogenic or possible pathogenic CNVs were identified, with fragment lengths ranging from 1.08 Mb to 103.81 Mb, averaging 19.58 Mb.Chromosome 8 was the most involved in CNV, with 16 cases (25.8%, 16/62), followed by chromosome 4 and 18 with six cases each (9.7%,6/62).Of the 62 CNVs, ten (16.1%) were ≤5 Mb in size, including three cases of microdeletion syndromes.(4) For embryos without autosomal numerical abnormalities indicated by low-depth copy number variation sequencing (CNV-seq) results, quantitative fluorescence polymerase chain reaction verification was performed, detecting two cases of complete uniparental disomy, both of which were paternal uniparental disomy and identified as complete hydatidiform moles. (5) Among the 44 cases where CNV-seq results indicated the presence of CNV in the embryos, 32 cases opted for peripheral blood karyotype analysis, with nine cases (28.1%) identified as carriers of balanced chromosomal translocations in one of the parents. These nine samples all involved variations in two chromosomes, both located at the chromosome ends. For CNV with fragment sizes≤5 Mb, two cases underwent CytoScan 750K array testing, and the chip results were consistent with the CNV-seq sequencing results. (6) Among the 32 couples who underwent peripheral blood karyotype analysis, nine underwent fluorescence in situ hybridization (FISH) testing for chromosomal regions, with six cases showing normal results and three showing abnormalities. The FISH abnormal regions were consistent with the karyotype results. (7) The rate of chromosomal abnormalities in embryos from pregnant women aged≥35 years, as well as the rate of numerical chromosomal abnormalities, were significantly higher than in those aged <35 years [75.8% (182/240) vs. 59.6% (343/575), χ2=23.37; 73.3% (176/240) vs. 53.2% (306/575), χ2=19.34; both P<0.001]. There was no statistically significant difference in the rate of structural chromosomal abnormalities between the two groups. Conclusion:Abnormal chromosome number is the main cause of spontaneous abortion in the first trimester, which is more obvious in pregnant women with abortion age≥35 years. CNV-seq may be more suitable for the detection of spontaneously aborted embryos in the first trimester.

Circulating tumor DNA(ctDNA)is a kind of cell-free DNA derived from tumors,which carries comprehensive tumor genetic information;Recent studies have found that ctDNA detection can play a role in the early diagnosis,targeted therapy,and prediction of recurrence in tumors.Human papillomavirus(HPV)-associated gynecological malignancies include most cervical cancer,some vulvar cancer,and vaginal cancer.High-risk HPV long-term infection and integration with cell genome are important causes of these cancers.Studies found that the use of ctDNA detection technology to dynamically monitor changes in HPV-ctDNA can provide valuable information for the clinical management and prognosis of these cancers.Thus,HPV-ctDNA is expected to become an biomarker for HPV-associated tumors.

Objective:To explore the effect of standardized operation procedure of prone position placement in patients undergoing posterior vertebral pedicle screw system internal fixation.Methods:From May 2019 to May 2021, 98 patients with spinal stenosis who were treated with posterior vertebral pedicle screw system internal fixation in Wuxi Second People's Hospital were selected as the study subject by convenience sampling. The patients were randomly divided into the control group and the observation group with 49 cases in each group. The control group was given routine nursing, and the observation group received standardized operation procedure of prone position placement. The time needed to complete the position placement, the time of position recovery, the incidence of pipeline accidents and the total incidence of pressure injuries were compared between the two groups.Results:After the intervention, the time of position placement and recovery in the observation group were shorter than those in the control group, with statistical differences ( P<0.05) . The incidence of pipeline accidents in the observation group was 2.05%, lower than that in the control group 12.24%; the total incidence of stress injury in the observation group was 6.12%, lower than 18.37% in the control group; but there was no significant difference between the two groups ( P>0.05) . Conclusions:Standardized operation procedure of prone position placement can clarify the division of labor, shorten the prone position placement and recovery time of patients undergoing posterior vertebral pedicle screw system internal fixation, to some extent, it can reduce the risk of pipeline accidents and pressure injuries, and provide safe surgical experience for patients.