Objective:To investigate the therapeutic efficacy of different modes of neoadjuvant therapy for locally advanced rectal cancer (LARC) with proficient in mismatch repair intact (pMMR) or microsatellite stability (MSS).Methods:A retrospective case series study was conducted. A total of 210 LARC patients with pMMR or MSS admitted to the First Affiliated Hospital of Zhengzhou University from January 2020 to December 2022 were selected. Patients were divided into the chemotherapy alone group (98 cases) and the total neoadjuvant therapy (TNT) group (112 cases) based on different neoadjuvant treatment modes. The pathological complete remission (pCR) rate of both groups was compared. In the TNT group, 24 patients received short-course radiotherapy (SCRT) plus chemotherapy (group A), 62 patients received SCRT plus chemotherapy combined with immunotherapy (group B), 23 patients received long-course radiotherapy (LCRT) plus chemotherapy (group C), and 3 patients received LCRT plus chemotherapy combined with immunotherapy (group D). The pCR rate, tumor down-staging and the incidence of adverse reactions were compared between the 4 groups. A subgroup analysis was performed in 87 patients with the distance from the tumor site to anal verge >5 cm and T 2-3N 0-2M 0 TNM staging. And then 87 patients were divided into the chemotherapy alone group (47 cases) and the TNT group (40 cases), and the overall survival (OS) and disease-free survival (DFS) of patients were compared between the 2 groups. Results:Among the 210 LARC patients, 126 cases were male and 84 cases were female, with the age of (51±11) years. There were 3 cases in clinical stage Ⅱ and 207 cases in clinical stage Ⅲ; 68 cases with the distance from the tumor site to the anal verge <5 cm and 142 cases with the distance from the tumor site to the anal verge ≥ 5 cm. The pCR rate of the TNT group was higher than that of the chemotherapy alone group [40.2% (45/112) vs. 7.2% (7/98)], and the difference was statistically significant ( χ2 = 30.62, P < 0.001). In group D, 1 patient achieved pCR, but no statistical comparison was made due to the small sample size. There was no statistically significant difference in pCR rate between group A and group C [25.0% (6/24) vs. 21.7% (5/23), χ2 = 0.07, P = 0.792]. The pCR rate of group B was higher than that of group A and group C [53.2% (33/62) vs. 25.0% (6/24), 53.2% (33/62) vs. 21.7% (5/23)], and the differences were statistically significant ( χ2 = 5.56, P = 0.029; χ2 = 6.73, P = 0.013). However, there were no statistically significant differences in T and N down-staging among group A, group B and group C (all P > 0.05). During neoadjuvant treatment, the incidence of grade 3-4 myelosuppression was 10.7% (12/112) in the TNT group, and no grade 3-4 radiation proctitis was observed. The incidence of granulocytopenia in group B was lower than that in group A, and the incidence of thrombocytopenia in group was lower than that in group C; and the differences were statistically significant (all P < 0.05). In the subgroup analysis, there were no statistically significant differences in OS and DFS between the chemotherapy alone group and the TNT group ( χ2 = 2.17, P = 0.141; χ2 = 0.24, P = 0.624). Conclusions:The neoadjuvant treatment of SCRT combined with immunotherapy has a high pCR rate and a good safety in LARC patients with pMMR or MSS. TNT is not effective in improving the survival of low-risk LARC patients with tumors located in the mid to high segment of the rectum and may have the risk of overtreatment.

Objective:To investigate the therapeutic efficacy of different modes of neoadjuvant therapy for locally advanced rectal cancer (LARC) with proficient in mismatch repair intact (pMMR) or microsatellite stability (MSS).Methods:A retrospective case series study was conducted. A total of 210 LARC patients with pMMR or MSS admitted to the First Affiliated Hospital of Zhengzhou University from January 2020 to December 2022 were selected. Patients were divided into the chemotherapy alone group (98 cases) and the total neoadjuvant therapy (TNT) group (112 cases) based on different neoadjuvant treatment modes. The pathological complete remission (pCR) rate of both groups was compared. In the TNT group, 24 patients received short-course radiotherapy (SCRT) plus chemotherapy (group A), 62 patients received SCRT plus chemotherapy combined with immunotherapy (group B), 23 patients received long-course radiotherapy (LCRT) plus chemotherapy (group C), and 3 patients received LCRT plus chemotherapy combined with immunotherapy (group D). The pCR rate, tumor down-staging and the incidence of adverse reactions were compared between the 4 groups. A subgroup analysis was performed in 87 patients with the distance from the tumor site to anal verge >5 cm and T 2-3N 0-2M 0 TNM staging. And then 87 patients were divided into the chemotherapy alone group (47 cases) and the TNT group (40 cases), and the overall survival (OS) and disease-free survival (DFS) of patients were compared between the 2 groups. Results:Among the 210 LARC patients, 126 cases were male and 84 cases were female, with the age of (51±11) years. There were 3 cases in clinical stage Ⅱ and 207 cases in clinical stage Ⅲ; 68 cases with the distance from the tumor site to the anal verge <5 cm and 142 cases with the distance from the tumor site to the anal verge ≥ 5 cm. The pCR rate of the TNT group was higher than that of the chemotherapy alone group [40.2% (45/112) vs. 7.2% (7/98)], and the difference was statistically significant ( χ2 = 30.62, P < 0.001). In group D, 1 patient achieved pCR, but no statistical comparison was made due to the small sample size. There was no statistically significant difference in pCR rate between group A and group C [25.0% (6/24) vs. 21.7% (5/23), χ2 = 0.07, P = 0.792]. The pCR rate of group B was higher than that of group A and group C [53.2% (33/62) vs. 25.0% (6/24), 53.2% (33/62) vs. 21.7% (5/23)], and the differences were statistically significant ( χ2 = 5.56, P = 0.029; χ2 = 6.73, P = 0.013). However, there were no statistically significant differences in T and N down-staging among group A, group B and group C (all P > 0.05). During neoadjuvant treatment, the incidence of grade 3-4 myelosuppression was 10.7% (12/112) in the TNT group, and no grade 3-4 radiation proctitis was observed. The incidence of granulocytopenia in group B was lower than that in group A, and the incidence of thrombocytopenia in group was lower than that in group C; and the differences were statistically significant (all P < 0.05). In the subgroup analysis, there were no statistically significant differences in OS and DFS between the chemotherapy alone group and the TNT group ( χ2 = 2.17, P = 0.141; χ2 = 0.24, P = 0.624). Conclusions:The neoadjuvant treatment of SCRT combined with immunotherapy has a high pCR rate and a good safety in LARC patients with pMMR or MSS. TNT is not effective in improving the survival of low-risk LARC patients with tumors located in the mid to high segment of the rectum and may have the risk of overtreatment.

Objective:To evaluate whether FOXO4-DRI could reverse radiation-induced pulmonary fibrosis (RIPF) and to explore the underlying mechanism.Methods:C57BL/6 mice were randomly divided into 4 groups: control, FOXO4-DRI, radiation, and radiation+ FOXO4-DRI. Mice in radiation or radiation+ FOXO4-DRI groups received 17 Gy X-ray radiation on the right side of the whole chest. Mice in FOXO4-DRI and radiation+ FOXO4-DRI groups were injected with FOXO4-DRI intraperitoneally at 16 and 20 weeks after irradiation, respectively. The right lungs were collected at 24 weeks after irradiation and subjected to HE staining and Masson trichrome staining to observe the morphological changes and collagen deposition. Immunohistochemistry was used to evaluate the expressions of col1α1 and α-SMA in lung tissues. β-gal staining was used to observe senescent cells. The level of reactive oxygen species in lung tissue was detected. The expressions of P21, P16 Ink4a and senescence-associated secretory phenotype (SASP) mRNA were detected by qRT-PCR, and the expression of related proteins were assessed by Western blot. Results:FOXO4-DRI reduced collagen deposition ( t=6.18, P<0.05), down-regulated the expression of col1α1 and α-SMA ( t=4.69, 3.20, P<0.05), and reduced the number of β-gal positive cells ( t=6.09, P<0.05) in the lung tissue of RIPF mice. FOXO4-DRI also down-regulated the gene and protein expressions of P21 and P16 Ink4a ( t=5.31, 3.32 and 4.77, 3.37, P<0.05) and inhibited the expressions of SASP genes IL-1α, IL-1β, TNF-α and MMP2 ( t=4.36, 4.84, 4.47, 3.82, P<0.05), reduced reactive oxygen species ( t=2.84, P<0.05), and promoted the activation of p-AKT and p-PI3K proteins ( t=-7.13, -12.61, P< 0.05) in the lung tissue of RIPF mice. Conclusions:FOXO4-DRI reverses RIPF by activating the PI3K/AKT signaling pathway, reducing oxidative stress and inhibiting cellular senescence.

Objective:To compare the safety and efficacy of terbutaline and nifedipine for acute intrapartum fetal resuscitation (IUFR).Methods:This was a prospective randomized controlled study involving 110 pregnant women with non-reassuring fetal heart rate tracings (NRFHT) during delivery at Guangzhou Women and Children's Medical Center between January and April 2021. These women were randomly allocated to receive subcutaneous terbutaline sulphate (0.25 mg, terbutaline group) or oral nifedipine (10 mg, nifedipine group), with 55 subjects in each group. Hemodynamic parameters including blood pressure, heart rate, and oxygen saturation before and 5, 15 and 30 min after treatment as well as the success rate of intrapartum resuscitation, the onset time of medication, and the incidence of postpartum hemorrhage were analyzed using t test, Chi-square test or Fisher's exact test. Results:Two groups both showed no significant difference in the mean arterial pressure or oxygen saturation before or after treatment (all P>0.05). The heart rate was not affected in nifedipine group at any time points ( P>0.05). While the patients treated with terbutaline showed accelerated maternal heart rate 5, 15 and 30 min after administration as compared with the baseline[(97.0±20.2), (99.2±13.8), (91.8±12.6) vs (81.7±11.3) bpm, all P<0.001], but it began to decrease at 30 min, with a drop of 6.4 bpm compared with that at 15 min (95% CI: 1.5-11.2, P<0.05). None of the pregnant women had adverse reactions requiring medical intervention. The rates of successful acute resuscitation were similar in the two groups [terbutaline: 78.2% (43/55) vs nifedipine: 70.9% (39/55), χ 2= 0.77, P=0.381]. Terbutaline had a shorter onset time than nifedipine in slowing the frequency of contractions and returning fetal heart rate to class Ⅰ category [2(1-6) vs 6(1-10) min, U=2 348.50, P<0.001]. No significant difference was found between the two groups in terms of NRFHT-indicated cesarean section, assisted vaginal delivery, or second dose of tocolysis within 1 h (all P>0.05) nor in blood loss volume, postpartum hemorrhage rate, low Apgar score, low umbilical artery pH value (pH<7.2), neonatal asphyxia rate, or neonatal intensive care admission rate (all P>0.05). Conclusion:Terbutaline spends less time than nifedipine to take effect and may be an alternative for acute IUFR without significant adverse outcomes.

Objective:The research was aimed to investigate the association between serum total homocysteine (tHcy) and subacute combined degeneration of the spinal cord (SCD).Methods:A retrospective survey of 106 newly diagnosed patients with SCD were enrolled in this research who were treated in the department of neurology of Xijing Hospital from January 2008 to February 2019, meanwhile, 121 patients with spinal cord lesion (not SCD) and 104 neurology mild outpatients were selected as controls. Serum tHcy level was determined by using the chemiluminescent immunoassay assay. A multivariate logistic regression model was used to analyze the risk factors for SCD. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve, sensitivity, specificity and Youden index were used to evaluate the diagnostic efficacy of tHcy. Spearman correlation analysis was used to observe the correlation between tHcy and SCD severity. The SCD patients were categorized into normal or mild tHcy group, moderate tHcy group, and severe tHcy group based on tHcy levels. Clinical symptoms, nerve conduction velocity, magnetic resonance imaging (MRI) findings from the patients were studied.Results:The serum tHcy levels in SCD patients were 64.3(26.5, 98.8) μmol/L, while in patients with spinal cord lesion (not SCD) group were 13.7(10.8, 19.2) μmol/L, neurology mild outpatients were 10.6(8.2, 13.0) μmol/L, which was higher in SCD group ( H=112.020, P<0.001), ( H=165.525, P<0.001).The multivariate logistic regression model showed tHcy is the impact factor of SCD ( OR=1.107, 95% CI:1.077-1.139, P<0.001). At ROC analysis, tHcy showed diagnostic value with an optimal cut-off value of 24.9 μmol/L (AUC 0.913, 95% CI: 0.875-0.951, sensitivity 79.2%, specificity 91.6%). Spearman correlation analysis showed that tHcy was positively correlated with functional disability rating scale ( r=0.254, P=0.009). Conclusions:Serum tHcy is the risk factor for SCD and related to its disability. Focus on the increased level of tHcy plays a positive role in the diagnosis of SCD.

Objective:The research was aimed to investigate the association between serum total homocysteine (tHcy) and subacute combined degeneration of the spinal cord (SCD).Methods:A retrospective survey of 106 newly diagnosed patients with SCD were enrolled in this research who were treated in the department of neurology of Xijing Hospital from January 2008 to February 2019, meanwhile, 121 patients with spinal cord lesion (not SCD) and 104 neurology mild outpatients were selected as controls. Serum tHcy level was determined by using the chemiluminescent immunoassay assay. A multivariate logistic regression model was used to analyze the risk factors for SCD. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve, sensitivity, specificity and Youden index were used to evaluate the diagnostic efficacy of tHcy. Spearman correlation analysis was used to observe the correlation between tHcy and SCD severity. The SCD patients were categorized into normal or mild tHcy group, moderate tHcy group, and severe tHcy group based on tHcy levels. Clinical symptoms, nerve conduction velocity, magnetic resonance imaging (MRI) findings from the patients were studied.Results:The serum tHcy levels in SCD patients were 64.3(26.5, 98.8) μmol/L, while in patients with spinal cord lesion (not SCD) group were 13.7(10.8, 19.2) μmol/L, neurology mild outpatients were 10.6(8.2, 13.0) μmol/L, which was higher in SCD group ( H=112.020, P<0.001), ( H=165.525, P<0.001).The multivariate logistic regression model showed tHcy is the impact factor of SCD ( OR=1.107, 95% CI:1.077-1.139, P<0.001). At ROC analysis, tHcy showed diagnostic value with an optimal cut-off value of 24.9 μmol/L (AUC 0.913, 95% CI: 0.875-0.951, sensitivity 79.2%, specificity 91.6%). Spearman correlation analysis showed that tHcy was positively correlated with functional disability rating scale ( r=0.254, P=0.009). Conclusions:Serum tHcy is the risk factor for SCD and related to its disability. Focus on the increased level of tHcy plays a positive role in the diagnosis of SCD.

Objective To observe the bone marrow signals of acetabulum and proximal femur of asymptomatic non?professional marathoners by 3.0 T magnetic resonance imaging (MRI) T1WI, and evaluate the bone marrow transformation, so as to obtain the effect of Marathon exercise on bone marrow composition and function. Methods The study group was randomly selected to participate in and complete the whole marathon at least once a year in the past two years. The training mileage of long?distance running was not less than 1 600 kilometers per year. There were no symptoms such as hip pain. There were no abnormalities in hip joint physical examination. The age of 22?53 years old. A total of 31 and 62 hips were evaluated. The control group was randomly selected 29 healthy persons (58 hip joints), aged 23?53 years, without hip pain and regular exercise. All subjects underwent hip joint MRI scan, and the hip joint MRI showed normal. At least 12 hours before MR scan, he did not engage in long?distance running or other sports. The bone marrow signal intensity of acetabulum and proximal femur in T1WI was compared with that of surrounding muscles and fat. The signal intensity was graded from low to high and evaluated by grade. The research group was divided into two groups according to the training years of marathon (running age). The running age of group A was more than 4 years and group B was less than 4 years. The distribution of bone marrow signal in proximal femur was also evaluated by a more intuitive 3?4 classification method. Mann?Whitney U test was used for statistical analysis. Results Bone marrow signal grading evaluation showed that there were significant differences in bone marrow signal grade distribution between the two groups (Z=-6.828, -4.779, -3.046,-5.266,-3.490,-5.053, P<0.05). In the study group, there were 14, 28 hips and 168 parts in group A, 17, 34 hips and 204 parts in group B, bone marrow signals were graded. There were significant differences in acetabulum, femoral neck and upper femoral shaft bone (Z=-2.202, -2.214, -2.730, P<0.05), but no significant differences in femoral head, trochanter and trochanter bone (Z=-0.886,-1.642,-0.711, P>0.05). To evaluate the classification of bone marrow signals in proximal femur, 62 cases of bone marrow signals in the study group were classified as follows: 10 cases with type 1a, 24 cases with type 1b, 17 cases with type 2 and 11 cases with type 3. In the control group, 58 cases of bone marrow signals in proximal femur were classified as follows: 2 cases with type 1a, 13 cases with type 1b, 26 cases with type 2 and 17 cases with type 3. There were significant differences between the two groups (Z=-4.003, P<0.05). Conclusion The T1WI signal intensity of asymptomatic non?professional marathoners′acetabulum and proximal femur bone marrow is lower than that of non?marathoners; the T1WI signal intensity of acetabulum, femoral neck and upper femoral shaft bone marrow of the elderly runners is lower; that is, marathon exercise has certain influence on the bone marrow signal of acetabulum and proximal femur, that is, the change of bone marrow signal in weight?bearing area has a certain phase with the amount of exercise.

Objective: To observe the bone marrow signals of acetabulum and proximal femur of asymptomatic non-professional marathoners by 3.0 T magnetic resonance imaging (MRI) T₁WI, and evaluate the bone marrow transformation, so as to obtain the effect of Marathon exercise on bone marrow composition and function. Methods: The study group was randomly selected to participate in and complete the whole marathon at least once a year in the past two years. The training mileage of long-distance running was not less than 1 600 kilometers per year. There were no symptoms such as hip pain. There were no abnormalities in hip joint physical examination. The age of 22-53 years old. A total of 31 and 62 hips were evaluated. The control group was randomly selected 29 healthy persons (58 hip joints), aged 23-53 years, without hip pain and regular exercise. All subjects underwent hip joint MRI scan, and the hip joint MRI showed normal. At least 12 hours before MR scan, he did not engage in long-distance running or other sports. The bone marrow signal intensity of acetabulum and proximal femur in T₁WI was compared with that of surrounding muscles and fat. The signal intensity was graded from low to high and evaluated by grade. The research group was divided into two groups according to the training years of marathon (running age). The running age of group A was more than 4 years and group B was less than 4 years. The distribution of bone marrow signal in proximal femur was also evaluated by a more intuitive 3-4 classification method. Mann-Whitney U test was used for statistical analysis. Results: Bone marrow signal grading evaluation showed that there were significant differences in bone marrow signal grade distribution between the two groups (Z=-6.828, -4.779, -3.046, -5.266, -3.490, - 5.053, P<0.05). In the study group, there were 14, 28 hips and 168 parts in group A, 17, 34 hips and 204 parts in group B, bone marrow signals were graded. There were significant differences in acetabulum, femoral neck and upper femoral shaft bone (Z=-2.202, -2.214, -2.730, P<0.05), but no significant differences in femoral head, trochanter and trochanter bone (Z=-0.886, -1.642, -0.711, P>0.05). To evaluate the classification of bone marrow signals in proximal femur, 62 cases of bone marrow signals in the study group were classified as follows: 10 cases with type 1a, 24 cases with type 1b, 17 cases with type 2 and 11 cases with type 3. In the control group, 58 cases of bone marrow signals in proximal femur were classified as follows: 2 cases with type 1a, 13 cases with type 1b, 26 cases with type 2 and 17 cases with type 3. There were significant differences between the two groups (Z=-4.003, P<0.05). Conclusion The T₁WI signal intensity of asymptomatic non-professional marathoners′ acetabulum and proximal femur bone marrow is lower than that of non-marathoners; the T₁WI signal intensity of acetabulum, femoral neck and upper femoral shaft bone marrow of the elderly runners is lower; that is, marathon exercise has certain influence on the bone marrow signal of acetabulum and proximal femur, that is, the change of bone marrow signal in weight-bearing area has a certain phase with the amount of exercise.

Objective To investigate the effects of miRNA and hypersensitive C?reactive protein ( hs?CRP ) on non?targeted vessels in patients with acute coronary syndromes ( ACS ) after percutaneous coronary intervention( PCI) procedure. Methods The serum samples were collected from 217 cases ACS patients to detect the level of miRNA?14?5P and hs?CRP during admission and follow?up periods.All patients underwentPCI with stent implantation and coronary angiography,and CAG was performed at the time of 12?month follow?up.According to CAG results,the patients were divided into non target lesion progression group(progressiongroup) with 76 cases and non target lesion no progression group(no progression group) with 141 cases.Results The expression level of hs?CRP was significantly higher in progression group than the no progression group((1.65±0.18) mg/L vs.(1.52±0.37) mg/L,t = 3.478,P<0.001).The expression level of miRNA?142?5Pwas higher in progression group than the no progression group(27.12±2.11 vs.34.73±2.67,t = 23.035,P<0.001).Multi?factor regression analysis indicated that high expression levels of hs?CR and miRNA?142?5Pduring admission were the predictors of advance of non?targeted vessels patients(OR = 3.496,95%CI 2.046-5.981,P =0.001;OR =1.208,95%CI 1.073-1.361,P =0.002).Conclusion The serum level of hs?CRP andmiRNA?142?5P can predict non?targeted vessels in patients with ACS after PCI.

Objective To investigate factors and neonatal outcomes associated with histologic chorioamnionitis (HCA) in preterm premature rupture of membranes (PPROM).MethodsFrom Jan.2008 to Jun.2011,230 women with PPROM at 28 -33 +6 weeks of gestation undergoing deliveries in the Second Affiliated Hospital of Wenzhou Medical College were studied retrospectively.According to placental histopathologic findings,those patients were categorized into two groups,including 138 cases in histologic chorioamnionitis (HCA group ) and 65 cases in non-chorioamnionitis (control)group.Age,parity,gestational age of PPROM and delivery,latency period,oligohydramnios,white blood cell (WBC) count and serum C-reactive protein (CRP) level at admission and before delivery,the incidence of neonatal respiratory distress syndrome (NRDS),neonatal pneumonia,bronchopulmonary dysplasia,necrotizing enterocolitis,early-onset neonatal sepsis,abnormal brain sonography findings and mortality were compared between two groups.Results( 1 ) The incidence of HCA was 68.0.％ ( 138/203 ) in all 203 cases with PPROM.(2) The occurring ruptured membrane gestation in HCA group was ( 31.1 ± 1.5 ) weeks,which were significantly earlier than (32.0 ± 1.3 ) weeks in control group ( P ＜ 0.05 ).The level of CRP of (8.2 ± 14.9) mg/L before delivery in HCA group was significantly higher than (5.5 ±7.2) mg/L in control group (P ＜ 0.05).The rate of oligohydramnios and cesearean sections were 55.1％ (76/138) and 45.7％ (63/138) in HCA group,which were significantly higher than 30.8％ (20/65) and 29.2％ (19/65) in control group (P ＜0.05).There were no significant difference in patient's age,parity,WBC count and CRP at admission between two groups (P ＞ 0.05 ).The latency period did not show significant difference between (140± 116) hours in HCA group and (129 ± 125) hours in control group (P ＞ 0.05).(3) Using multivariable logistic regression models,oligohydramnios ( OR =2.937 ),gestational age of PPROM ＜ 32 weeks ( OR =2.352),serum CRP level ＞ 8 mg/L before delivery ( OR =4.923 ) and latency period ＞ 48 -168 hours (OR =4.439) were significantly associated with HCA (P ＜0.05).(4) The gestational age of delivery and birth weight of HCA group were significantly lower than those of control group [ ( 32.0 ± 1.5 ) weeks vs.( 32.7 ± 1.5 ) weeks,( 1680 ± 379) g vs.(2017 ± 333) g,respectively,P ＜ 0.05 ].The incidence of Apgar ＜7,abnormal brain sonograhy findings, neonatal pneumonia,bronchopulmonary dysplasia,early-onset neonatal sepsis and mortality in HCA group were significantly higher than those in control group [20.3％ (28/138) vs.7.7％ (5/65),14.5％ (20/138) vs.4.6％ (3/65),12.3％ (17/138) vs.3.1％(2/65),5.8％ (8/138) vs.0,6.5％ (9/138) vs.0,12.3％ (17/138) vs.3.1％ (2/65),respectively,P ＜ 0.05 ].The incidence of necrotizing enterocolitis ( 1.5％,2/138 ) in HCA group was higher than that of controlgroup(0) and the incidence of NRDS ( 18.8％,26/138) in HCA group did not show statistical difference with 21.4％ ( 14/65 ) in control group ( P ＞ 0.05 ).ConclusionsIt was found that HCA was significantly correlated with lower gestational age of PPROM,higher serum CRP level before delivery,prolonged latency period and oligohydramnios in PPROM.HCA could increase the neonatal morbidity and mortality.