Objective To investigate the effects of perineal massage combined with hip joint exercise on the outcome of delivery and mental resilience of primipara.Methods 90 pregnant women in the third trimester(after 36 weeks)who obtained the knowledge about perineal massage from midwife clinic were randomly divided into two groups with 45 cases each.The control group received regular antenatal examination and family self-exercise;the experimental group received perineal massage and hip joint training combined treatment.The delivery outcome,birth experience and maternal mental resilience of the two groups were compared.Results the number of vaginal delivery in the experimental group were higher than that in the control group(P<0.05);the second stage of labor was significantly shorter than that of the control group(P<0.05);the perineal integrity rate was higher than that of the control group(P<0.05);the scores of all dimensions in delivery experience questionnaire were higher than that of the control group(P<0.05);the scores of all dimensions in maternal mental resilience were higher than those of the control group(P<0.05)after intervention.Conclusion The perineal massage which conducted by midwives combined with hip movement can effectively improve the quality of delivery,relieve the negative emotions of pregnant women,improve the psychological elasticity level of pregnant women,and improve the delivery outcomes.

Objective To explore the application of Plan-Do-Check-Act(PDCA)cycle management to continuously im-prove the service quality of outpatient pharmacy and enhance patient satisfaction.Methods To address the problem of long wait-ing time for patients in outpatient pharmacy,we applied PDCA cycle to investigate the factors affecting patients'waiting time in the process of medicine collection,analyze the current situation,determine the expected goals,formulate the service quality im-provement plan of outpatient pharmacy,implement the improvement plan,follow up and supervise,and summarize and analyse the problems regularly until it was solved.Results After implementing the PDCA cycle in the management,the service quality of outpatient pharmacy was improved,the waiting time was significantly shortened and the satisfaction of medical treatment was in-creased.Conclusion The application of PDCA cycle method is effective in improving the service quality of outpatient pharmacy.Therefore,it is recommended for broader implementation.

AIM:To observe the effect of folic acid(FA)on C2C12 myoblast proliferation and differentia-tion,and to explore its mechanism.METHODS:During the proliferation stage,C2C12 myoblasts were treated with vari-ous concentrations of FA(0,2.5,5,10 and 20 μmol/L).The cell status was observed under a microscope,cell viability was detected using the MTT method,and cell proliferation was assessed using the EdU method.In the differentiation stage,C2C12 cells were divided into control(Ctrl)group(0 μmol/L FA)and FA group(10 μmol/L FA).On day 2 or 4 of differentiation,immunofluorescence staining and Western blot were employed to detect the expression of myoblast differen-tiation-related proteins,myoblast determination protein 1(MyoD),myogenin(MyoG)and myosin heavy chain(MyHC).The myotubule formation in each group was analyzed.On day 4 of differentiation,C2C12 cells were treated with FA for 0,1,3 and 6 h,and the protein levels of p-JNK,JNK,p-p38 MAPK and p38 MAPK at each time point were detected by Western blot.Additionally,C2C12 cells after 4-day differentiation were divided into Ctrl group,FA group,FA+ SP600125(specific inhibitor of JNK)group,and FA+SB203580(specific inhibitor of p38)group.The cells in FA+ SP600125 and FA+SB203580 groups were treated with 10 μmol/L SP600125 or SB203580 for 1 h,followed by treatment with 10 μmol/L FA for 24 h.The cells in FA group were treated with 10 μmol/L FA for 24 h,while the cells in Ctrl group were left untreated.The protein levels of p-JNK,JNK,p-p38 MAPK,p38 MAPK and MyHC were detected by Western blot.RESULTS:(1)Compared with 0 μmol/L FA group,the number of the cells in other concentration groups in-creased,cell viability was raised(P＜0.05 or P＜0.01),and the rate of EdU positive cells increased(P＜0.05).(2)Com-pared with Ctrl group,the expression levels of MyoD,MyoG and MyHC in FA group were increased(P＜0.05),and the myotube fusion index was raised(P＜0.05 or P＜0.01).(3)Compared with 0 h group,the ratios of p-JNK/JNK and p-p38 MAPK/p38 MAPK were elevated after FA treatment for 1,3 and 6 h(P＜0.05 or P＜0.01),and showed a trend of gradual increase with the extension of treatment time.(4)After FA treatment,the ratios of p-JNK/JNK and p-p38 MAPK/p38 MAPK,and the expression of MyHC were elevated(P＜0.01).Treatment with SP600125 decreased the ratio of p-JNK/JNK and the expression of MyHC(P＜0.05),while SB203580 intervention cut down the ratio of p-p38 MAPK/p38 MAPK and the expression of MyHC(P＜0.05 or P＜0.01).CONCLUSION:Folic acid can promote the differentiation of C2C12 myoblasts by activating the JNK/p38 MAPK signaling pathway.

Objective To analyze the effect of circLRP6 on high glucose-induced renal tubular epithelial cell injury via miR-31-5p/high mobility group protein A1(HMGA1)axis regulation.Methods Human renal tubular epithelial HK-2 cells were cultured in vitro and divided into eight groups:control,high glucose,high glucose+si-NC,high glucose+si-circLRP6,high glucose+si-circLRP6+miR-NC,high glucose+si-circLRP6+miR-31-5p inhibitor,high glucose+si-circLRP6+miR-31-5p inhibitor+si-NC,and high glucose+si-circ-LRP6+ miR-31-5p inhibitor+si-HMGA1.The circLRP6,miR-31-5p,and HMGA1 mRNA levels were determined using real-time quantitative PCR.Cell supernatant IL-6 and tumor necrosis factor-α(TNF-α)levels,lactate dehydrogenase(LDH)activity,and malondialdehyde(MDA)content were also determined.Furthermore,flow cytometry was used to observe cell apoptosis.HMGA1,Bax,and Bcl-2 protein expression was detected by Western blotting.Finally,dual luciferase assay was used to report the targeting relationship of miR-31-5p with circLRP6 and HMGA1.Results Compared with the high glucose group,the HK-2 cell proliferation inhibition rate;cell superserum IL-6,TNF-α,LDH,and MDA levels;apoptosis rate;and Bax protein expression in the high glucose+si-circLRP6 group decreased significantly,whereas Bcl-2 protein expression increased significantly(all P＜0.05).Consequently,miR-31-5p downregulation possibly weakened the protective effect of si-circLRP6 on high glucose-induced renal tubular epithelial cell injury.HMGA1 expression inhibition reversed the effect of the si-circLRP6+miR-31-5p inhibitor on high glucose-induced renal tubular epithelial cell injury.Finally,miR-31-5p exhibited a targeting relationship with circLRP6 and HMGA1.Conclusion Si-circLRP6 protects high glucose-induced renal tubular epithelial cell injury via miR-31-5p upregulation and HMGA1 expression inhibition.

Objective:To explore the effects of status epilepticus(SE)on neuronal processes and synapses in the cerebral cortex and hippocampus of young mice.Methods:The young mice of SE model was established by intraperito-neal injection of lithium chloride and pilocarpine.Morris water maze test was used to detect the behavioral changes in the mice.Immunofluorescence staining was used to observe the morphological changes of axons,dendrites and synaptic connections of neurons in the cerebral cortex and hippocampus of mice,and the ultrastructural changes of synapses of pyramidal neurons in the mouse hippocampus were observed with transmission electron microscopy.Results:The sei-zure rate of grade IV and above in mice was 80％,and the mortality rate was 25％.The escape latency of SE mice was prolonged(P＜0.05),the trajectory of exploring the platform was significantly longer and more complicated,and the time spent in the target quadrant and the number of crossing the platform were significantly reduced(P＜0.05).Posi-tive expression of axonal neurofilament marker protein SMI312 and microtubule-associated protein 2(MAP2)were found in the cerebral cortex and hippocampus of both groups,and the axonal neurofilaments and neuronal dendrites in the SE group were of different lengths and arranged densely and scatteredly.The positive expression of synaptophysin(SYP)and the number of positive spots increased significantly in in the hippocampus of SE group(P＜0.01).The number of synaptic vesicles in the SE group increased significantly,and the postsynaptic density(PSD)thickness decreased significantly(P＜0.01).Conclusion:SE might lead to acute injury of synapses in the cerebral cortex and hippocampal area of young mice,induce synaptic vesicle circulation disorders,and then cause widespread destruction and disorder of the axon and dendrite networks,the reactive or compensatory reconstruction of synaptic.

Objective To explore the general surgery patients with postoperative incision infection(SSI)of pathogenic microorganism distribution characteristics and serum lactate dehydrogenase(LDH),interleukin(IL)-6 to the predictive value of infection.Methods A total of 100 patients who underwent surgery in the General Surgery Department of the hospital from January 2021 to June 2023 were selected as the research ob-jects.According to the occurrence of postoperative infection,the patients were divided into infection group(28 cases)and non-infection group(72 cases).The basic data of the patients were collected,including age,gender,operation type,operation time,incision type,and incision healing.Bacterial culture and pathogen identification were performed on the incision secretion of patients under sterile conditions.At the same time,the serum LDH and IL-6 levels of the patients on the first and third day after operation were detected,and the differences of LDH and IL-6 levels between the infection group and the non-infection group were compared.Pearson cor-relation analysis was used to analyze the correlation between serum LDH level and IL-6.Multivariate Logistic regression analysis was used to analyze the influencing factors of SSI.The receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic efficacy of serum LDH and IL-6 levels for SSI.Results A-mong the 100 patients,28 patients developed SSI,and the infection rate was 28％.There were significant differences in age,operation time,and incision type between the infection group and the non-infection group(P＜0.05).The results of bacterial culture showed that a total of 35 strains of bacteria were isolated from the patients in the infection group,of which Gram-positive bacteria accounted for 54.29％and Gram-negative bac-teria accounted for 45.71％,mainly Staphylococcus aureus(14 strains),Pseudomonas aeruginosa(7 strains),and Escherichia coli(5 strains).The serum levels of LDH and IL-6 in the infection group were higher than those in the non-infection group on postoperative days 1 and 3(P＜0.05).The serum level of LDH in the in-fection group was positively correlated with IL-6(r=0.512,P＜0.001).Multivariate Logistic regression a-nalysis showed that age,operation time,type of incision,and serum LDH and IL-6 levels on postoperative day 3 were independent risk factors for SSI(P＜0.05).ROC curve analysis showed that serum LDH and IL-6 lev-els had a high diagnostic efficacy for SSI,with an area under the curve of 0.89 and 0.88,the best cut-off values of 210 U/L and 15 pg/mL,the sensitivity of 82.14％and 85.71％,and the specificity of 78.57％and 80.36％,respectively.Conclusion Staphylococcus aureus and Pseudomonas aeruginosa are the main pathogenic micro-organisms of SSI in general surgical patients.Serum LDH and IL-6 levels can be used as predictors of SSI,which is of great significance for early diagnosis and treatment of infection.

Objective:To analyze regional differences in MMACHC gene variations among patients with cblC-type methylmalonic acidemia (MMA) in China and to explore the relationship between these variations and neonatal screening, biochemical markers and prognosis.Methods:Retrospective case summary. Clinical and laboratory data, including general condition, biochemical markers and genetic analysis, were collected from 1 859 cblC MMA patients from 2005 to 2023. Patients were divided into 7 groups according to their regions: north China, northeast China, east China, central China, south China, southwest China and northwest China. They were also classified into neonatal screening and non-neonatal screening groups. Mann-Whitney U and Kruskal-Wallis tests were used to compare biochemical marker levels. In contrast, the Chi-square test was applied to compare MMACHC gene variant frequencies, neonatal screening proportion, onset age and prognosis between groups. Results:Among 1 859 cases of cblC MMA, 1 019 were male and 840 were female, with a consultation age of 1.0 (0.1, 5.0) month. A total of 1 787 cases carried compound heterozygous or homozygous variants and only 1 variant site was identified in 72 cases. The 10 most frequent variants were c.609G>A (1 238 cases), c.658_660delAAG (343 cases), c.80A>G (284 cases), c.482G>A (239 cases), c.567dupT (191 cases), c.656_658delAGA (131 cases), c.217C>T (109 cases), c.394C>T (105 cases), c.445_446delTG (51 cases) and c.1A>G (50 cases). The frequency of the c.609G>A was the lowest in northwest China (28.8% (44/154), χ2=-18.42, P<0.05). The frequency of the c.567dupT was the most common in southwest China (25.0% (20/80), χ2=71.70, P<0.001) and c.656_658delAGA had the highest frequency in northeast China (9.3% (19/205), χ2=32.08, P<0.001). Non-missense variants (91.2% (62/68), 88.5% (46/52)) and early-onset patients (90.0% (36/40), 94.4% (34/36)) were both more prevalent in southwest and south China ( χ2=14.95, 31.69, both P<0.05). The proportion of neonatal screening was the lowest in south China (22.2% (8/36), χ2=98.48, P<0.05), where the mortality rate was the highest (19.1% (4/21), χ2=38.98, P<0.001). East China exhibited the highest frequency of missense variants (21.5% (339/1 579)), the highest proportion of patients identified through neonatal screening (54.5% (465/853)), and a more significant proportion of patients with good prognosis (36.6% (227/621), χ2=14.57, 93.49, 38.98, all P<0.05). In addition, the c.482G>A variant was more frequent in patients diagnosed by neonatal screening compared to those diagnosed by other methods (8.3% (132/1 586) vs. 5.9% (122/2 060), χ2=7.97, P<0.05). Conclusions:The frequency of MMACHC gene variation varies across different regions. The c.609G>A was least frequent in northwest China, c.567dupT was most common in southwest China, and c.656_658delAGA was most prevalent in northeast China. South China had the lowest neonatal screening rate and the highest mortality. At the same time, east China exhibited the highest frequency of missense variants, the highest proportion of patients identified through neonatal screening and the best prognosis. The c.482G>A variant was more frequent in patients diagnosed by neonatal screening compared to those diagnosed by other methods.

Objective To monitor the antifungal resistance of clinical isolates of Candida spp.in the East China region.Methods MALDI-TOF MS or molecular methods were used to re-identify the strains collected from January 2018 to December 2022.Antifungal susceptibility testing was performed using the broth microdilution method.The susceptibility test results were interpreted according to the breakpoints of 2022 Clinical and Laboratory Standards Institute(CLSI)documents M27 M44s-Ed3 and M57s-Ed4.Results A total of 3 026 strains of Candida were collected,65.33％of which were isolated from sterile body sites,mainly from blood(38.86％)and pleural effusion/ascites(10.21％).The predominant species of Candida were Candida albicans(44.51％),followed by Candida parapsilosis complex(19.46％),Candida tropicalis(13.98％),Candida glabrata(10.34％),and other Candida species(0.79％).Candida albicans showed overall high susceptibility rates to the 10 antifungal drugs tested(the lowest rate being 93.62％).Only 2.97％of the strains showed dose-dependent susceptibility(SDD)to fluconazole.Candida parapsilosis complex had a SDD rate of 2.61％and a resistance rate of 9.42％to fluconazole,and susceptibility rates above 90％to other drugs.Candida glabrata had a SDD rate of 92.01％and a resistance rate of 7.99％to fluconazole,resistance rates of 32.27％and 48.24％to posaconazole and voriconazole non-wild-type strains(NWT),respectively,and susceptibility rates above 90％to other drugs.Candida tropicalis had resistance rates of 29.55％and 26.24％to fluconazole and voriconazole,respectively,resistance rates of 76.60％and 21.99％to posaconazole and echinocandins non-wild-type strains(NWT),and a resistance rate of 2.36％to echinocandins.Conclusions The prevalence and species distribution of Candida spp.in the East China region are consistent with previous domestic and international reports.Candida glabrata exhibits certain degree of resistance to fluconazole,while Candida tropicalis demonstrates higher resistance to triazole drugs.Additionally,echinocandins resistance has emerged in Candida albicans,Candida glabrata,Candida tropicalis,and Candida parapsilosis.

Both morbidity and mortality of gastric cancer are in the front rank among malignant tumors.At present,enhanced CT is served as an important imaging method for preoperative diagnosis and assessment of gastric cancer,but it is mostly based on morphological evaluation and unable to perform quantitative analysis.The functional imaging technology represented by energy spectral CT and CT perfusion imaging has a variety of quantitative parameters,which is expected to make up for the shortcomings of conventional CT.The review introduces the basic principles of energy spectral CT and CT perfusion imaging,and summarizes their applications in the diagnosis,pathological classification,grading,staging and efficacy prediction of gastric cancer,aiming to improve the understanding of functional CT imaging for the pretreatment assessment in gastric cancer.

Purpose To investigate the application value in diagnosis,typing and staging of multimodal ultrasound in primary nodal diffuse large B-cell lymphoma(N-DLBCL).Materials and Methods A total of 96 patients(96 nodes)with a pathological diagnosis of N-DLBCL(51 nodes)or benign lymph nodes(45 nodes)in the First Affiliated Hospital of Nanjing Medical University from October 2020 to June 2022 were enrolled,retrospectively.All these patients were examined by high-frequency ultrasound,shear wave elastography(SWE)and contrast-enhanced ultrasonography(CEUS).The differences among the three ultrasound imaging methods in differentiating N-DLBCL from benign lymph nodes,typing and staging of N-DLBCL were analyzed.Receiver operating characteristic curve were drawn to obtain the diagnostic thresholds of SWE and CEUS quantitative indexes,and the efficacy of the different examination methods were assessed.Results Univariate analysis demonstrated 14 parameters were significantly different between the N-DLBCL and benign lymph nodes(χ2=12.289-32.934,all P<0.05).Multivariate analysis showed the difference in long diameter/short diameter(OR=11.205,P=0.012),cortical echo(OR=10.367,P=0.002),maximum elasticity(OR=0.180,P=0.014),peak time(OR=0.111,P=0.025),peak intensity-basic intensity(OR=0.061,P=0.002)and enhancement distribution(OR=0.065,P=0.001)were statistically significant between the two groups.There were statistically significant differences of maximum elasticity(χ2=5.299,P=0.021)between germinal center and non-germinal center N-DLBCL groups.There were statistically significant differences in blood flow pattern(χ2=9.663,P=0.017),arrival time(χ2=2.851,P=0.034)and peak time(χ2=6.702,P=0.018)between the limited and advanced N-DLBCL.The area under the curve for the diagnosis of N-DLBCL and benign lymph nodes by high-frequency ultrasound,SWE,CEUS and multimodal ultrasound were 0.754,0.839,0.875 and 0.963,respectively.Conclusion Multimodal ultrasound has high application value in differential diagnosis,classification and staging of N-DLBCL,and can provide basis for diagnosis and treatment of N-DLBCL.