Objective:To identify the risk factors for postpartum hemorrhage(PPH)in patients with gestational diabetes mellitus(GDM)and to develop and validate a predictive model.Methods:A retrospective study was conducted on GDM patients who delivered at The Third Affiliated Hospital of Zhengzhou University between Janu-ary 2021 and December 2023.A total of 137 GDM patients with PPH were included in the case group,and 190 GDM patients without PPH were included in the control group.Univariate analysis and multivariate Logistic regres-sion analysis were used to identify independent risk factors for PPH in GDM patients.Anomogram prediction mod-el was subsequently constructed.The predictive performance of the model was evaluated by the Hosmer-Leme-show goodness-of-fit test,receiver operating characteristic(ROC)curve,Bootstrap resampling method,and deci-sion curve analysis(DCA).Results:Univariate analysis revealed statistically significant differences between the two groups in multiple factors(P<0.05),including age≥35 years,pre-pregnancy body mass index(BMI)≥24 kg/m2,suboptimal glycemic control,assisted reproduction,gestational anemia,polyhydramnios,macrosomia,acute chorioamnionitis,gestational hypertension,prenatal fasting blood glucose(FBG),prenatal glycosylated he-moglobin(HbA1c),fibrinogen(FIB),postpartum blood loss,dystocia,neonatal admission to ICU,neonatal Apgar score at 1 minute,and Apgar score at 5 minutes.Multivariate Logistic regression analysis indicated that age≥35 years,pre-pregnancy BMI≥24 kg/m2,suboptimal glycemic control,gestational anemia,macrosomia,polyhydram-nios,and elevated prenatal HbA1c levels were independent risk factors for PPH(OR>1,P<0.05),while elevat-ed FIB levels were identified as a protective factor for PPH(OR<1,P<0.05).The nomogram demonstrated good calibration(Hosmer-Lemeshow test:χ2=6.367,DF=8,P=0.606).The area under the ROC curve(AUC)was 0.821(95%CI 0.774-0.868),with a sensitivity of 71.5%and a specificity of 83.7%,indicating good discrimi-native ability of the model.Internal validation using the Bootstrap resampling method showed a C-index of 0.821,suggesting good consistency and predictive accuracy.DCA curve further confirmed that the model had favorable clinical application value.Conclusions:age≥35 years,pre-pregnancy BMI≥24 kg/m2,suboptimal glycemic con-trol,gestational anemia,macrosomia,polyhydramnios,and elevated prenatal HbA1c levels are independent risk factors for PPH in GDM patients,while elevated FIB levels are identified as an independent protective factor.The constructed prediction model for PPH in GDM patients exhibits good discriminative ability,calibration,and predic-tive performance,demonstrating high clinical application value.

Objective:To identify the risk factors for postpartum hemorrhage(PPH)in patients with gestational diabetes mellitus(GDM)and to develop and validate a predictive model.Methods:A retrospective study was conducted on GDM patients who delivered at The Third Affiliated Hospital of Zhengzhou University between Janu-ary 2021 and December 2023.A total of 137 GDM patients with PPH were included in the case group,and 190 GDM patients without PPH were included in the control group.Univariate analysis and multivariate Logistic regres-sion analysis were used to identify independent risk factors for PPH in GDM patients.Anomogram prediction mod-el was subsequently constructed.The predictive performance of the model was evaluated by the Hosmer-Leme-show goodness-of-fit test,receiver operating characteristic(ROC)curve,Bootstrap resampling method,and deci-sion curve analysis(DCA).Results:Univariate analysis revealed statistically significant differences between the two groups in multiple factors(P<0.05),including age≥35 years,pre-pregnancy body mass index(BMI)≥24 kg/m2,suboptimal glycemic control,assisted reproduction,gestational anemia,polyhydramnios,macrosomia,acute chorioamnionitis,gestational hypertension,prenatal fasting blood glucose(FBG),prenatal glycosylated he-moglobin(HbA1c),fibrinogen(FIB),postpartum blood loss,dystocia,neonatal admission to ICU,neonatal Apgar score at 1 minute,and Apgar score at 5 minutes.Multivariate Logistic regression analysis indicated that age≥35 years,pre-pregnancy BMI≥24 kg/m2,suboptimal glycemic control,gestational anemia,macrosomia,polyhydram-nios,and elevated prenatal HbA1c levels were independent risk factors for PPH(OR>1,P<0.05),while elevat-ed FIB levels were identified as a protective factor for PPH(OR<1,P<0.05).The nomogram demonstrated good calibration(Hosmer-Lemeshow test:χ2=6.367,DF=8,P=0.606).The area under the ROC curve(AUC)was 0.821(95%CI 0.774-0.868),with a sensitivity of 71.5%and a specificity of 83.7%,indicating good discrimi-native ability of the model.Internal validation using the Bootstrap resampling method showed a C-index of 0.821,suggesting good consistency and predictive accuracy.DCA curve further confirmed that the model had favorable clinical application value.Conclusions:age≥35 years,pre-pregnancy BMI≥24 kg/m2,suboptimal glycemic con-trol,gestational anemia,macrosomia,polyhydramnios,and elevated prenatal HbA1c levels are independent risk factors for PPH in GDM patients,while elevated FIB levels are identified as an independent protective factor.The constructed prediction model for PPH in GDM patients exhibits good discriminative ability,calibration,and predic-tive performance,demonstrating high clinical application value.

Objective:To perform a prospective cohort study to identify individual susceptibility of glucocorticoid (GC) -associated osteonecrosis of the femoral head (GA-ONFH) and their clinical and genetic risk factors. Methods:The present prospective cohort study enrolled patients who received their first GC therapy between July 2015 and January 2018 at Zhongshan Hospital. All patients did not receive any GC treatment before enrollment. Further, they planned to start GC treatment with the dose (equivalent prednisone) of ≥30 mg/d, lasted ≥3 weeks, or pulse dose ≥200 mg/d, lasted ≥3 d. Blood samples were collected before GC treatment to evaluate bone metabolism and its released factors. Hip MRI was performed at the 1st, 3rd, 6th, 12th and 24th month to diagnose GA-ONFH. All patients were followed-up for ≥2 years. The endpoint was regarded as diagnosis of GA-ONFH or completion of 2 years follow-up. Lasso regression was performed to determine which clinical features were associated with GA-ONFH. A nested case-control sub-cohort (A, n=12) was established prospectively based on the main cohort by 1∶1 matching. Whole exome sequencing was performed to screen differential and functional candidate single nucleotide polymorphisms and insertion-deletions (SNP/InDels). Another sub-cohort (B, n=50) was constructed retrospectively in patients with GA-ONFH and non-ONFH patients received standard high dose GC treatment for more than two years. The candidate SNP/InDels were verified by Sanger sequencing based on the patients from sub-cohort B. Results:A total of 96 patients were enrolled of which 88 of them (32 males and 56 females, mean age 42.30 years) completed follow-up. Eight cases (9.1%) were diagnosed with GA-ONFH. The median time from the start of GC therapy to the diagnosis of ONFH was 53.00(34.00,13.50) days. The baseline characteristics, such as age, sex and body mass index, indicated no significant difference between the ONFH group and the non-ONFH group. The cumulative GC dose of the ONFH patients in the first month was higher than that of non-ONFH [32.74(29.55, 47.05) mg/kg vs. 24.00(21.10, 29.45) mg/kg, Z=-2.410, P=0.016]. However, there was no significant difference of patients who underwent pulse therapy (37.5% vs. 10.0%, adjusted χ 2=2.829, P=0.093). The ratio of serum apolipoprotein B/apolipoprotein A1 (ApoB/ApoA1) in patients with ONFH was higher than that in non-ONFH group before GC use [0.95(0.80, 1.50) vs. 0.70(0.60, 0.80), Z=-2.875, P=0.000]. Due to the multicollinearity, Lasso regression model was performed to reduce overfitting. All variables were included in the model. The results suggested that higher ApoB/ApoA1 ratio, lower serum β-c-terminal telopeptide (β-CTX) and higher cumulative GC dose in the first month were the top three risk factors of GA-ONFH. This model had an accuracy of 0.982 in internal validation. Seven differential candidate SNP/InDels were found by whole exome sequencing of sub-cohort A. We further verified these SNP/InDels in sub-cohort B. The patients with COLEC12 mutation (rs2305027, G1816A) were at risk of GA-ONFH ( OR=6.00, 95% CI: 1.17, 30.73). Conclusion:Higher first-month GC dose, lower serum β-CTX level before treatment, higher ApoB/ApoA1 ratio and COLEC12 mutation (rs2305027, G1816A) could increase the risk of GA-ONFH.

Objective:To explore the role and molecular mechanism of hepatocyte nuclear factor 4γ (HNF4γ) in proliferation and stemness of gastric cancer.Methods:A total of 102 cases of paraffin-embedded gastric cancer tissues and matched adjacent gastric tissues and 42 cases of fresh-frozen tissues derived from gastric patients who received radical gastrectomy were collected from the First Affiliated Hospital of Zhengzhou University between 2012 to 2015. The expression of HNF4γ was tested by immunohistochemical staining, quantitative real-time polymerase chain reaction (qRT-PCR). HNF4γ overexpressed (AGS-HNF4γ) and shRNA silenced (HGC27-shHNF4γ) gastric cell lines were established. The effects of HNF4γ on cell proliferation and stemness were verified by XTT, clone formation and sphere formation assay. The expression of CD44 was detected by western blot.Results:The mRNA expression level of HNF4γ in fresh-frozen gastric cancer tissue was (12.43±2.702), which was significantly higher than (3.639±1.109) in normal tissue ( P<0.001). The high protein expression rate of HNF4γ in paraffin-embedded gastric cancer tissues was 41.2% (42/102), which was significantly higher than 8.8% (9/102) in normal gastric mucosa tissue ( P< 0.001). The protein expression of HNF4γ was closely related to the tumor differentiation, infiltration depth, lymph node metastasis and tumor stage ( P<0.05). The median survival interval of patients with HNF4γ high expression was 25 months, the 3-year survival rate was 4.8% (2/42), significantly lower than 38 months and 51.7% (31/60) of patients with normal HNF4γ expression ( P<0.001). The proliferation and CD44 protein expression of AGS-HNF4γ cells were significantly higher than those of the AGS-Vector cells. The number of clone formation, sphere formation rate of AGS-HNF4γ cells were 243.5±24.5 and (83.5±3.9)%, significantly higher than 81.0±16.0 and (21.8±5.6)% of AGS-Vector cells ( P=0.030 and P=0.010, respectively). The proliferation and CD44 protein expression of HGC27-shHNF4 cells were significantly lower than those of the HGC27-vector cells. The number of clone formation, sphere formation rate of HGC27-shHNF4 cells were 26.0±1.0 and (20.8±8.4)%, significantly higher than 83.5±4.5 and (72.5±4.8)% of HGC27-vector cells ( P=0.006 and P=0.030, respectively). Conclusions:HNF4γ is upregulated in the gastric cancer tissues and related with the poor prognosis of patients with gastric cancer. Overexpression of HNF4γ promotes the proliferation and remains the stemness of gastric cancer cells by upregulating the expression of CD44.

Objective:To explore the role and molecular mechanism of hepatocyte nuclear factor 4γ (HNF4γ) in proliferation and stemness of gastric cancer.Methods:A total of 102 cases of paraffin-embedded gastric cancer tissues and matched adjacent gastric tissues and 42 cases of fresh-frozen tissues derived from gastric patients who received radical gastrectomy were collected from the First Affiliated Hospital of Zhengzhou University between 2012 to 2015. The expression of HNF4γ was tested by immunohistochemical staining, quantitative real-time polymerase chain reaction (qRT-PCR). HNF4γ overexpressed (AGS-HNF4γ) and shRNA silenced (HGC27-shHNF4γ) gastric cell lines were established. The effects of HNF4γ on cell proliferation and stemness were verified by XTT, clone formation and sphere formation assay. The expression of CD44 was detected by western blot.Results:The mRNA expression level of HNF4γ in fresh-frozen gastric cancer tissue was (12.43±2.702), which was significantly higher than (3.639±1.109) in normal tissue ( P<0.001). The high protein expression rate of HNF4γ in paraffin-embedded gastric cancer tissues was 41.2% (42/102), which was significantly higher than 8.8% (9/102) in normal gastric mucosa tissue ( P< 0.001). The protein expression of HNF4γ was closely related to the tumor differentiation, infiltration depth, lymph node metastasis and tumor stage ( P<0.05). The median survival interval of patients with HNF4γ high expression was 25 months, the 3-year survival rate was 4.8% (2/42), significantly lower than 38 months and 51.7% (31/60) of patients with normal HNF4γ expression ( P<0.001). The proliferation and CD44 protein expression of AGS-HNF4γ cells were significantly higher than those of the AGS-Vector cells. The number of clone formation, sphere formation rate of AGS-HNF4γ cells were 243.5±24.5 and (83.5±3.9)%, significantly higher than 81.0±16.0 and (21.8±5.6)% of AGS-Vector cells ( P=0.030 and P=0.010, respectively). The proliferation and CD44 protein expression of HGC27-shHNF4 cells were significantly lower than those of the HGC27-vector cells. The number of clone formation, sphere formation rate of HGC27-shHNF4 cells were 26.0±1.0 and (20.8±8.4)%, significantly higher than 83.5±4.5 and (72.5±4.8)% of HGC27-vector cells ( P=0.006 and P=0.030, respectively). Conclusions:HNF4γ is upregulated in the gastric cancer tissues and related with the poor prognosis of patients with gastric cancer. Overexpression of HNF4γ promotes the proliferation and remains the stemness of gastric cancer cells by upregulating the expression of CD44.

OBJECTIVE： To prepare pogostone transfersomes， and to evaluate its quality. METHODS： Film dispersion method was used to prepare pogostone transfersomes. Using the accumulative penetration volume （Qn） and accumulative penetration ratio （PR） of pogostone as evaluation indexes， the types of surfactant， formulation were screened in respects of the dosage of surfactant and the dosage of pogostone. The pogostone transfersomes were prepared with optimal formulation； the morphology， particle size distribution and Zeta potential were observed and the entrapment efficiency was measured. RESULTS： The optimal formulation was as follows as the sodium cholate was selected as surfactant； the dosage of sodium cholate was 0.25 g； the dosage of pogostone was 15 mg. The optimal pogostone transfersomes were ivory-white suspension； average particle size was （115.6±3.65） nm （RSD＝3.20％，n＝3）； PDI was 0.185±0.008 （RSD＝4.30％， n＝3）； Zeta potential was （－13.76±0.225） mV （RSD＝1.70％，n＝3）； entrapment efficiency of pogostone was （46.01±0.40）％ （RSD＝0.87％，n＝3）； Qn was （378.76±0.61）   μg/cm2 （RSD＝0.20％，n＝3）； PR was （89.02±0.96）％ （RSD＝1.10％，n＝3）. CONCLUSIONS： Prepared pogostone transfersomes are in line with quality requirements， which can provide reference for the further study of new dosage form of pogostone.

Objective To evaluate the clinical effect of combination of acupuncture and medicine combined with auricular pointsfor the children of MT.Methods A total of 70 children with MT who met the inclusion criteria, were divided into the treatment group and control group according to random number table method (n=35); The treatment group was given acupuncture treatment and prescription ofZishen-Tiaogan and auricular points; and the control group was given Haloperidol tablets. Both groups were treated for 2 months. The severity of the children's convulsing symptoms and the clinical efficacy were assessed by the Yale Global Tie Severityb Scale (YGTSS).Results After 1 course of treatment, the total effective rate of the treatment group was 82.9% (29/35), while the control group was 57.1% (20/35), and the difference was statistically significant (Z=-2.276,P=0.023); after 2 courses of treatment, the total effective rate of the treatment group was 88.6% (31/35) and the control group was71.4% (25/35).The difference was statistically significant (Z=-2.346, P=0.019). After 1 course of treatment, YGTSS score was (14.6 ± 6.9vs. 17.3 ± 7.5,t=4.604), and after 2 course of treatment,YGTSS score was (8.0 ± 5.3vs. 10.3 ± 4.9,t=5.521) in the treatment group wwere significantly lower than the control group (P<0.05).Conclusions Combination of acupuncture and medicine combined with auricular points can alleviate the clinical symptoms of children with MT and improve the clinical effect.

Objective To enhance patients' abilities in self-management. Methods We used the nursing project method to analyze reasons and develop standard process of follow-up management and health education. A retro-spective analysis of 84 patients with stage 3 to 4 CKD was performed by nursing project method. This analysis compared the changes after the intervention program,including the ability of self-management,follow-up,medication and diet compliance,and the control rate of physiological indicators. Results By comparison with the intervention before and after,there were significant improvements in each dimension of self-management ability (P<0.001),follow-up, medication and diet compliance were significantly improved(P<0.05),and there were significant improvements in the control rate of systolic pressure and blood uric acid(P<0.001),the differences were statistically significant. Conclusion The application of nursing project can improve self-management ability,the compliance of follow-up,medication and diet as well as physiological indicators in patients with stage 3 to 4 CKD.

Objective To test the hypothesis that the macular pigment may be a marker of foveal cone function and consequently the structural integrity of foveal cones. Methods Sixteen patients (32 eyes) diagnosed to have Stargardt dystrophy and three patients with full thickness macular holes by clinical criteria were studied with a scanning laser ophthalmoscopy (SLO) comparing argon laser blue and infra-red images for the presence or absence of macular pigment (MP) in the fovea. An C ++ computer based program was used to evaluate the density of MP. Eyes were graded into three categories: those without foveal macular pigment, those with partial pigment and those with normal amounts of macular pigment. These categories were compared with visual acuity determined by the Snellen chart. Results Thirteen eyes with a visual acuity of 20/200 or worse had no macular pigment in the fovea. Eleven eyes with visual acuity of 20/40 or better had a normal amount of macular pigment in the fovea and 1 eye had partial macular pigment. Eleven eyes with partial macular pigment had intermediary acuity value. Conclusions Foveal macular pigment is closely related to foveal cone acuity and therefore may be a marker for the presence of foveal cones. Infrared light is a sensitive indicator of early macular diseases