ObjectiveTo compare the incidence of postoperative shivering between female patients undergoing gynecological and general surgery and to examine perioperative factors associated with postoperative shivering. MethodsThis retrospective study included 12 186 patients who underwent gynecological or general surgery between January 1， 2022， and March 15， 2024， of whom 10 884 female patients constituted the primary analysis population. Among the female patients， 1：1 nearest-neighbor propensity score matching was performed using a caliper of 0.02 on the raw propensity score scale， with exact matching on American Society of Anesthesiologists （ASA） physical status. After matching， the incidence of postoperative shivering was compared using the McNemar test. Conditional logistic regression stratified by matched pair was used to assess the associations of surgical categories and perioperative factors with postoperative shivering. ResultsBefore propensity score matching， the incidences of postoperative shivering were 2.98% （28/940） in the general surgery group and 4.94% （491/9 944） in the gynecological surgery group （P=0.007）. After matching， 881 matched pairs were obtained， and the absolute standardized mean differences （SMDs） for all covariates were < 0.10. The incidences of postoperative shivering were 3.06% （27/881） in the general surgery group and 4.99% （44/881） in the gynecological surgery group. The McNemar test without continuity correction yielded P=0.044， whereas the exact McNemar test showed a P value of 0.057. Unifactorial conditional logistic regression showed that gynecological surgery was associated with higher odds of postoperative shivering than general surgery ［odds ratio （OR）=1.63， 95% confidence interval （CI）： 1.01-2.63， P=0.046］. However， the association was not statistically significant in the multifactorial conditional logistic regression ［adjusted odds ratio （aOR）=1.62， 95%CI： 0.78-3.37， P=0.197］. Each 30-min increase in the duration of surgery was associated with 32% higher odds of postoperative shivering （aOR=1.32， 95%CI： 1.07-1.62， P=0.009）. Each 1 °C increase in the minimum intraoperative body temperature was associated with lower odds of postoperative shivering， although the association did not reach statistical significance （aOR=0.32， 95%CI： 0.10-1.02， P=0.053）. ConclusionAfter propensity score matching， the incidence of postoperative shivering was higher among female patients undergoing gynecological surgery than among those undergoing general surgery； however， neither the exact comparison nor the adjusted association reached statistical significance. A longer duration of surgery was associated with higher odds of postoperative shivering， whereas a higher minimum intraoperative body temperature may be associated with lower odds.

ObjectiveTo compare the incidence of postoperative shivering between female patients undergoing gynecological and general surgery and to examine perioperative factors associated with postoperative shivering. MethodsThis retrospective study included 12 186 patients who underwent gynecological or general surgery between January 1， 2022， and March 15， 2024， of whom 10 884 female patients constituted the primary analysis population. Among the female patients， 1：1 nearest-neighbor propensity score matching was performed using a caliper of 0.02 on the raw propensity score scale， with exact matching on American Society of Anesthesiologists （ASA） physical status. After matching， the incidence of postoperative shivering was compared using the McNemar test. Conditional logistic regression stratified by matched pair was used to assess the associations of surgical categories and perioperative factors with postoperative shivering. ResultsBefore propensity score matching， the incidences of postoperative shivering were 2.98% （28/940） in the general surgery group and 4.94% （491/9 944） in the gynecological surgery group （P=0.007）. After matching， 881 matched pairs were obtained， and the absolute standardized mean differences （SMDs） for all covariates were < 0.10. The incidences of postoperative shivering were 3.06% （27/881） in the general surgery group and 4.99% （44/881） in the gynecological surgery group. The McNemar test without continuity correction yielded P=0.044， whereas the exact McNemar test showed a P value of 0.057. Unifactorial conditional logistic regression showed that gynecological surgery was associated with higher odds of postoperative shivering than general surgery ［odds ratio （OR）=1.63， 95% confidence interval （CI）： 1.01-2.63， P=0.046］. However， the association was not statistically significant in the multifactorial conditional logistic regression ［adjusted odds ratio （aOR）=1.62， 95%CI： 0.78-3.37， P=0.197］. Each 30-min increase in the duration of surgery was associated with 32% higher odds of postoperative shivering （aOR=1.32， 95%CI： 1.07-1.62， P=0.009）. Each 1 °C increase in the minimum intraoperative body temperature was associated with lower odds of postoperative shivering， although the association did not reach statistical significance （aOR=0.32， 95%CI： 0.10-1.02， P=0.053）. ConclusionAfter propensity score matching， the incidence of postoperative shivering was higher among female patients undergoing gynecological surgery than among those undergoing general surgery； however， neither the exact comparison nor the adjusted association reached statistical significance. A longer duration of surgery was associated with higher odds of postoperative shivering， whereas a higher minimum intraoperative body temperature may be associated with lower odds.

OBJECTIVE To prepare Arg-Gly-Asp（RGD）-modified doxorubicin （DOX）-loaded “core-shell” nanoparticles （RGD@DOX-LPNs）， characterize the nanoparticles， and investigate their antitumor effects. METHODS RGD@DOX-LPNs were prepared using the nanoprecipitation method. Their morphology was examined by visual inspection and electron microscopy. Particle size， polydispersity index （PDI）， and Zeta potential were determined， and differential scanning calorimetry （DSC） and X-ray diffraction （XRD） were employed. Encapsulation efficiency （EE）， drug loading （DL）， and stability were evaluated. The in vitro release kinetics， mucus diffusion， and tumor cell uptake [tracked using coumarin 6 （COU）] were investigated. The in vivo tissue distribution and gastrointestinal retention [labeled with 11-chloro-1， 1′-dipropyl-3， 3， 3′， 3′-tetramethyl-10， 12- trimethyleneindotricarbocyanine iodide （IR780）] were investigated. Using 4T1 tumor-bearing mice as the experimental subjects， the effects of the prepared formulation on tumor volume， tumor weight， and cell apoptosis rate were evaluated. RESULTS RGD@DOX-LPNs presented as orange transparent liquid with uniform and near-spherical particles. The particle size was （159.67± 8.02） nm， PDI was 0.15±0.06， and Zeta potential was （－19.70±0.79） mV. After modification with RGD， the thermal absorption peak and crystalline diffraction peak of DOX disappeared. EE and DL of RGD@DOX-LPNs were （72.65±4.37）% and （4.62± 0.38）% ， respectively. No obvious changes in appearance， particle size， or EE were observed after storage at 4 ℃ and 25 ℃ for 7 days. The cumulative drug release at 4 h was approximately 73%， which was lower than that of free DOX（almost completely released within 1 h）. The amount of COU in the first segmental mucus layer of COU-LPNs was significantly lower than that in the corresponding segment of RGD@COU- LPNs， whereas it was significantly higher in the 2nd to 5th segmental mucus layers compared to RGD@COU-LPNs （P＜0.01）. Cellular uptake of RGD@COU-LPNs was significantly higher than that of COU-LPNs（P＜0.05）. The isolated tissue fluorescence intensity of RGD@IR780-LPNs was stronger than that of IR780-LPNs， indicating better small intestinal retention. Compared with free DOX and unmodified nanoparticles （DOX-LPNs）， RGD@DOX-LPNs exhibited a higher tumor inhibition rate of 65.74%， significantly reduced tumor volume and weight， and increased apoptosis rate（P＜0.01）. CONCLUSIONS RGD@DOX-LPNs are successfully prepared with sustained release properties， which can improve gastrointestinal mucus retention， enhance cellular uptake of DOX， and have potent antitumor activity against breast cancer.

Objective:To investigate the association between blood pH measured by blood gas analysis during the first postnatal week and mortality in periviable extremely preterm infant (PEPI).Methods:This retrospective study analyzed 48 PEPIs (gestational age<24 weeks) admitted to the neonatal intensive care unit of Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University between January 2021 and December 2023. According to the clinical outcomes during hospitalization, they were divided into two groups: death group ( n=12, including deaths despite active treatment and deaths due to treatment withdrawal) and survival group ( n=36, including cured and improved cases). Blood gas pH and base excess (BE) values during the first week were collected. Mann-Whitney U test and Chi-square test (or Fisher exact test) were used to compare maternal perinatal conditions and neonatal blood pH values between the two groups. The percentiles ( P3 and P90) of blood pH and BE values were described for the survival group by age. Results:(1) Among the 48 PEPIs, four were born at 21 weeks, 11 at 22 weeks, and 33 at 23 weeks of gestation. The clinical outcomes showed a cure rate of 60.4% (29/48), improvement rate of 14.6% (7/48), mortality due to poor prognosis with treatment withdrawal of 8.3% (4/48), and mortality under active treatment of 16.7% (8/48). (2) There was statistically significant difference in the death after treatment withdrawal among the PEPIs born at 21, 22, and 23 weeks of gestation [1/4, 2/11, and 3.0% (1/33); χ2=7.41, P=0.025]. The death group had higher proportions of infants with Apgar score≤3 at 1, 5, or 10 min after birth as compared with the survival group [7/12 vs. 25.0% (9/36), χ 2=4.50; 7/12 vs.16.7% (6/36), χ 2=7.91; 5/12 vs. 5.6% (2/36), χ 2=9.42; all P<0.05]. (3) The median blood pH values in the death group were lower than those in the survival group at 1-4, and 6 d after birth [7.13 (7.06-7.24) vs. 7.25 (7.23-7.31), Z=－3.44; 7.03 (7.00-7.18) vs. 7.21 (7.16-7.24), Z=－3.07; 7.02 (7.02-7.11) vs. 7.18 (7.13-7.21), Z=－3.51; 7.14 (7.13-7.20) vs. 7.18 (7.16-7.21), Z=－2.38; 7.15 (7.13-7.19) vs. 7.19 (7.17-7.22), Z=－2.08; all P<0.05].The pH value of the deceased infants rapidly declined within three days after birth, with the median pH values at two days and three days of age both falling below 7.05. In deceased infants due to poor prognosis, the median pH value at 4-7 days of age remained consistently at or below 7.15. In the survivors, the blood pH and BE values decreased after birth and hit the bottom at 3 and 5 days of age, respectively ( P3: pH=7.10, BE=－16.10 mmol/L) before gradual recovery. Conclusions:PEPI tend to present with low blood pH during the first postnatal week. However, excessively low blood pH warrants vigilance against adverse outcomes.

Objective:To investigate the association between blood pH measured by blood gas analysis during the first postnatal week and mortality in periviable extremely preterm infant (PEPI).Methods:This retrospective study analyzed 48 PEPIs (gestational age<24 weeks) admitted to the neonatal intensive care unit of Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University between January 2021 and December 2023. According to the clinical outcomes during hospitalization, they were divided into two groups: death group ( n=12, including deaths despite active treatment and deaths due to treatment withdrawal) and survival group ( n=36, including cured and improved cases). Blood gas pH and base excess (BE) values during the first week were collected. Mann-Whitney U test and Chi-square test (or Fisher exact test) were used to compare maternal perinatal conditions and neonatal blood pH values between the two groups. The percentiles ( P3 and P90) of blood pH and BE values were described for the survival group by age. Results:(1) Among the 48 PEPIs, four were born at 21 weeks, 11 at 22 weeks, and 33 at 23 weeks of gestation. The clinical outcomes showed a cure rate of 60.4% (29/48), improvement rate of 14.6% (7/48), mortality due to poor prognosis with treatment withdrawal of 8.3% (4/48), and mortality under active treatment of 16.7% (8/48). (2) There was statistically significant difference in the death after treatment withdrawal among the PEPIs born at 21, 22, and 23 weeks of gestation [1/4, 2/11, and 3.0% (1/33); χ2=7.41, P=0.025]. The death group had higher proportions of infants with Apgar score≤3 at 1, 5, or 10 min after birth as compared with the survival group [7/12 vs. 25.0% (9/36), χ 2=4.50; 7/12 vs.16.7% (6/36), χ 2=7.91; 5/12 vs. 5.6% (2/36), χ 2=9.42; all P<0.05]. (3) The median blood pH values in the death group were lower than those in the survival group at 1-4, and 6 d after birth [7.13 (7.06-7.24) vs. 7.25 (7.23-7.31), Z=－3.44; 7.03 (7.00-7.18) vs. 7.21 (7.16-7.24), Z=－3.07; 7.02 (7.02-7.11) vs. 7.18 (7.13-7.21), Z=－3.51; 7.14 (7.13-7.20) vs. 7.18 (7.16-7.21), Z=－2.38; 7.15 (7.13-7.19) vs. 7.19 (7.17-7.22), Z=－2.08; all P<0.05].The pH value of the deceased infants rapidly declined within three days after birth, with the median pH values at two days and three days of age both falling below 7.05. In deceased infants due to poor prognosis, the median pH value at 4-7 days of age remained consistently at or below 7.15. In the survivors, the blood pH and BE values decreased after birth and hit the bottom at 3 and 5 days of age, respectively ( P3: pH=7.10, BE=－16.10 mmol/L) before gradual recovery. Conclusions:PEPI tend to present with low blood pH during the first postnatal week. However, excessively low blood pH warrants vigilance against adverse outcomes.

OBJECTIVE To investigate the effect of polymorphisms of solute carrier organic anion transporter family, member 1B3(SLCO1B3) gene on the pharmacodynamics of mycophenolate mofetil(MMF) in patients with lupus nephritis. METHODS Patients with lupus nephritis who were treated in Jieyang People’s Hospital from September 2019 to April 2021 were selected. All subjects were treated with MMF for at least 12 months, or discontinued due to poor efficacy. The efficacy of MMF was evaluated. The SLCO1B3 334T>G/699G>A(rs4149117/rs7311358) genotype was detected using Agena MassARRAY®, and the correlation between gene polymorphisms and MMF pharmacodynamics was analyzed using SPSS 25.0 software. RESULTS The genotype frequencies of SLCO1B3 334T>G/699G>A were in Hardy-Weinberg equilibrium. The probability of poor MMF treatment effect of 334GG/699AA carriers was significantly higher than that of 334TT/699AA and 334TG/699GA carriers(P<0.001); Logistic regression showed that both 334GG/699AA and urine protein>2.5 g·(24 h)−1 were the risk factors for poor MMF treatment[OR=4.038(1.731, 9.420), P<0.001; OR=4.157(1.705, 10.137), P=0.002]. Combined analysis showed that patients with both 334GG/699AA genotype and urine protein>2.5 g·(24 h)−1 were at higher risk for poor efficacy[OR=8.563(3.301, 22.216), P<0.001]. CONCLUSION SLCO1B3 334T>G/699G>A is related to the efficacy of MMF treating lupus nephritis, and 334GG/699AA carriers are more likely to result in poor efficacy.

Mucinous adenocarcinoma of the renal pelvis is rare in clinical practice. This article reported a case of primary renal pelvis mucinous adenocarcinoma mixed with signet ring cell carcinoma. The patient was admitted to hospital due to right low back pain, and was diagnosed with right kidney stones accompanied by hydrops and infection, right kidney abscess, and nonfunctional right kidney after complete examination. Right renal puncture drainage was performed twice, followed by laparoscopic robot assisted right neprectomy. The postoperative pathological diagnosis was right renal pelvis primary mucinous adenocarcinoma (mixed with signet-ring cell carcinoma). Eleven months after the operation, regular "sodium folinate + oxaliplatin + 5-fluorouracil" chemotherapy was performed for 12 courses, and imaging showed no signs of recurrence or metastasis.

Pheochromocytomas and paragangliomas(PPGLs)cause symptoms by altering the circulation levels of catecholamines and peptide hormones.Currently,the diagnosis of PPGLs relies on diagnostic imaging and the detection of catecholamines.In this study,we used ultra-performance liquid chromatography(UPLC)/quadrupole time-of-flight mass spectrometry(Q-TOF MS)analysis to identify and measure the perioperative differential metabolites in the plasma of adrenal pheochromocytoma patients.We identified differentially expressed genes by comparing the transcriptomic data of pheochromocytoma with the normal adrenal medulla.Through conducting two steps of metabolomics analysis,we identified 111 differential metabolites between the healthy group and the patient group,among which 53 metabolites were validated.By integrating the information of differential metabolites and differentially expressed genes,we inferred that the cysteine-methionine,pyrimidine,and tyrosine metabolism pathways were the three main metabolic pathways altered by the neoplasm.The analysis of transcription levels revealed that the tyrosine and cysteine-methionine metabolism pathways were downregulated in pheochromocytoma,whereas the pyrimidine pathway showed no significant difference.Finally,we developed an optimized diagnostic model of two metabolites,L-dihydroorotic acid and vanylglycol.Our results for these metabolites suggest that they may serve as potential clinical biomarkers and can be used to supplement and improve the diagnosis of pheochromocytoma.

Objective:To explore the effect of multidisciplinary management combined with 60-second high-risk diabetic foot screening in diabetic foot.Methods:From January to December 2022, 138 patients with diabetic foot were selected from Xinxiang Central Hospital by convenience sampling. The patients were randomly divided into a control group and an observation group, with 69 cases in each group. Control group implemented routine follow-up management of diabetic foot, and observation group carried out multidisciplinary management combined with 60-second high-risk diabetic foot screening on the basis of control group, and the intervention lasted for six months. The progress of Wagner grading of diabetic foot and foot self-care were compared between the two groups.Results:After intervention, the number of Wagner grading progression patients in observation group and control group was four cases (5.80%) and 10 cases (14.49%), respectively. The number of progression patients in observation group was less than that in control group, and the difference was statistically significant (χ 2=4.161, P=0.041). The total score and dimension scores of diabetic foot self-management in the two groups after the intervention were higher than those before the intervention, but only the scores of observation group before and after the intervention were statistically significant ( P<0.05). After intervention, the total score and dimension scores of diabetic foot self-management in observation group were higher than those in control group, with a statistically significant difference ( P<0.05) . Conclusions:Multidisciplinary management combined with 60-second high-risk diabetic foot screening can effectively delay the progress of diabetic foot and improve patients' foot self-care.