Objective:To study the changes of cord blood neutrophil gelatinase-associated lipocalin (NGAL) under different levels of hypoxia at birth and its correlations with hypoxic organ damage (including liver, kidney and heart).Methods:From April to October 2022, all neonates born in our hospital were prospectively enroll in the study. The neonates without perinatal risk factors were assigned into the control group. The neonates with intrauterine distress or hypoxia during labor were assigned into the hypoxia group (no asphyxia at birth) and the asphyxia group (with asphyxia at birth). Cord blood was collected from the umbilical artery and cord blood gas (CBG) and NGAL were measured. Liver enzymes, kidney function and cardiac enzymes as biomarkers for hypoxic organ damage were measured 24~48 h after birth. The correlations of NGAL and the biomarkers were analyzed.Results:A total of 161 neonates were enrolled, including 91 in the control group, 49 in the hypoxia group and 21 in the asphyxia group. NGAL in the asphyxia group was significantly higher than the hypoxia group and the control group [(1.81±0.71) ng/ml vs. (1.22±0.53) ng/ml, (0.88±0.47) ng/ml], NGAL in the hypoxia group significantly higher than the control group ( P<0.05). NGAL was negatively correlated with Apgar score, pH and BE of CBG ( r<-0.3, P<0.05) and positively correlated with lactate, ALT, creatinine ( r>0.3, P<0.05). No significant correlations existed between NGAL and gender, gestational age, birth weight, mother's age, BMI and CK-MB ( P<0.05). ROC curve showed that sensitivity and specificity of NGAL for predicting hypoxic organ damage were 84.3% and 60.3%, respectively, with a cut-off value of 1.07 ng/ml. Conclusions:Cord blood NGAL may increase with the deterioration of hypoxia at birth and may be associated with hypoxic organ damage.

Fecal incontinence is a very common problem in critically ill and elderly patients and long-term hospitalized bedridden patients, which can easily cause complications such as perianal dermatitis, pressure ulcers and infections, increase patient suffering, and increase medical expenses. Devices that effectively transfer or drain feces are critical to reducing complications after fecal incontinence. This article uses this as a starting point to summarize the main components, current status of use and evaluation indicators of built-in drainage devices at home and abroad, which provides a reference for the development of more scientific and feasible auxiliary tools for fecal incontinence.

Objective:To investigate the effect of different cleaning methods on the cleaning effect of Da Vinci robotic electrosurgical instruments and the feasibility of adenosine triphosphate(ATP) fluorescence detection technology for evaluating the cleaning effect of Da Vinci robotic electrosurgical instruments.Methods:A total of 180 electrosurgical instruments were divided into control group and test group by random digits table method from June 2018 to June 2019 after robotic surgery. For the control group, 90 cases were manually cleaned to complete the device cleaning process, and for the test group, 90 cases were mechanically cleaned to complete the device cleaning process. Through visual observation, magnifying glass examination and ATP fluorescence detection technology, the cleaning effect of the two methods and the correlation between the evaluation results obtained by ATP fluorescence detection technique and traditional inspection method were compared.Results:The qualified rate of visual observation, magnifying lens examination and ATP fluorescence detection in the control group were 95.56%(85/90), 86.67% (78/90) and 84.44% (76/90), respectively, and that in the test group were 100.00% (90/90), 97.78% (88/90) and 98.89% (89/90), respectively. The test group was higher than the control group. The difference between the two groups was statistically significant ( χ2 values were 4.310, 7.745, 12.291, P<0.05 or 0.01). In the control group, there was a positive correlation between the qualified rate of ATP fluorescence detection and visual observation ( r value was 0.374, P < 0.01), and a significant positive correlation between the qualified rate of magnifying lens examination ( r value was 0.538, P < 0.01). In the test group, There was also a significant positive correlation between the qualified rate of ATP fluorescence detection and visual observation ( r value was 0.754, P < 0.01), and between the qualified rate of magnifying lens examination( r value was 0.556, P < 0.01). Conclusions:Mechanical cleaning is used to clean Da Vinci robotic electrosurgical instruments, which is superior to traditional manual cleaning. ATP fluorescence detection technology is feasible for evaluating the cleaning effect of Da Vinci robotic electrosurgical instruments.

Objective: To assess the association of single nucleotide polymorphisms (SNPs) CHRNA4 gene with response to selective serotonin re-uptake inhibitors (SSRIs) for the treatment of major depressive disorder (MDD). Methods: For 304 patients receiving drug treatment for major depression, 2 SNPs, namely rs4522666 and rs4603829, of the CHRNA4 gene were determined by matrix-assisted laser desorption/ionization time of flight (MALDI-TOF) mass spectrometry. HAMD-17 was adopted as the primary rating tool to evaluate the severity of depression on the baseline and at the end of 1st, 2nd, 4th and 6th weeks treatment. Results: The frequency of GG genotype/G allele for rs4522666 differed significantly from that of TT and GT genotypes/T allele between responders and non-responders (P =0.015 and P=0.006, respectively). No significant difference was found in genotypic and allelic frequencies of rs4603829 between the two groups (P > 0.05). Conclusion SNPs of the CHRNA4 gene may play an important role in the response to antidepressant drugs among ethnic Han Chinese with MDD.

Objective: A predictive model of WHO/ISUP grading of renal clear cell carcinoma was constructed based on CT radiomics. Methods: The clinical data of 104 patients with ccRCC confirmed by operation or biopsy from March 2014 to December 2018 in the Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine were retrospectively analyzed. There were 70 males and 34 females, and the age was 61.2±11.7 years. The patients were randomly divided into development cohort (73 cases) and validation cohort (31 cases) by stratified sampling according to 7∶3 ratio. According to the WHO/ISUP pathological grading criteria of renal cancer in 2016, Ⅰ and Ⅱ were defined as low-grade group, Ⅲ and Ⅳ were defined as high-grade group. The radiomics features of ccRCC were calculated in cortical phase images of CT enhanced scanning. LASSO regression was used to reduce the radiomics feature dimensionality in the training group, and to establish radiomics risk scores. The binary logistic regression was used to build the prediction model, which was used in the validation group. Bootstrap method was used to validate the model of training and validation group. AUC, sensitivity and specificity were calculated respectively. Hosmer-Lemeshow goodness-of-fit test was used to evaluate model calibration degree. Results: After dimensionality reduction, the radiomics risk score of ccRCC was established. The low and high-level risk scores of the training group were -2.49±1.73 and 1.23±2.17, with significant difference (t=-7.785, P < 0.01). The binary logistic regression multivariate analysis showed that the radiomics risk score was an independent risk factor in identifying low or high-grade ccRCC with odds ratio of (OR=3.576, 95%CI 1.964~6.513). The predictive model was Y=1/[1+ exp(-Z)], Z=1.274×radiomics risk score+ 0.072. The AUC of radiomics risk score in training group was 0.940 (95%CI 0.883-0.998) with 95.5% sensitivity and 88.2% specificity after internal verification by Bootstrap method, and good Hosmer-Lemeshow goodness-of-fit test (χ²=4.463, P>0.05). The low and high-level risk scores of the Validation group were -2.27±2.02 and 0.82±2.08, with significant difference (t=-3.832, P<0.01). The AUC in validation group was 0.859(95%CI 0.723-0.995) with 77.8% sensitivity and 81.8% specificity, and with good Hosmer-Lemeshow goodness-of-fit test (χ²=14.554, P=0.068) as well. Conclusions The prediction model based on CT radiomics has high accuracy in predicting high or low grade of ccRCC.

Objective To explore the effect of group painting art therapy on social function rehabili-tation and quality of life of chronic schizophrenia patients. Methods Totally 104 inpatients with schizophre-nia were assigned to study group with 53 cases and control group with 51 cases by random number table method. Patients in study group received group painting art therapy intervention,medication and other reha-bilitation activities. While the patients in control group were only given medication and other rehabilitation activities. All patients in both groups received positive and negative symptoms scale(PANSS),schizophrenia quality of life scale(SQLS) and scale of social-skills for psychiatric inpatients(SSPI) before and after the in-tervention. The results were analyzed by independent sample t test. Results Before treatment,there were no significant differences of the total scores and the dimensional subscores of PANSS,SQLS and SSPI between the study group and control group( all P>0. 05). Compared with control group,the difference score between pre-test and post-test of PANSS ((12. 26±6. 87) vs (5. 11±3. 11),t=13. 11,P<0. 01) and negative symp-tom ((-7. 96±5. 44) vs (-2. 82±3. 47),t=-12. 30,P<0. 01),score of SQLS ((27. 45±12. 22) vs (2. 41 ±10. 68),t=-11. 11,P<0. 01) and score of SSPI((-20. 40±8. 10) vs (-0. 94±8. 01),t=12. 31,P<0. 01) in study group changed statistically(all P<0. 01). Conclusion These results suggest that group painting art therapy intervention can improve the negative symptoms,the quality of life and the recovery of social function in patients with chronic schizophrenia.

Objective To study the methods to estimate absorbed dose to eye lens of infants from CT scanning using different protocols and try to find a practical quick way for estimating absorbed dose to eye lens.Methods By scanning one-year old anthropomorphic phantom using 7 kinds of different protocols,all TLDs were measured for final estimation of absorbed dose to eye lens using two different dose conversion methods.Meanwhile,linear regression equation was established between absorbed dose to eye lens and CTDI.Results Absorbed doses to eye lens of infants from children CT scanning using 7 kinds of different protocols were (9.96±0.69) mGy in head axis,(7.01±0.42) mGy in head helical,(12.60± 0.97) mGy in sinus,(12.97±0.42) mGy in inner ear,(0.63±0.03) mGy in neck soft tissue,(8.89± 0.44) mGy in cervical vertebra,and (0.34± 0.01) mGy in chest,respectively.There were statistically significant difference in doses among different groups (F =846.826,P ＜ 0.05).For different scanning locations,there was linear relation between absorbed dose to eye lens and CTDI(r=0.986-0.999,P＜ 0.05).Conclusions Absorbed dose to eye lens of infants from children CT scaning with single dose may not be above threshold dose.In addition,absorbed dose to eye lens can be estimated quickly by linear regression equation between absorbed dose to eye lens and CTDI.

OBJECTIVETo assess the association of TPH2 gene polymorphisms with the response or remission to selective serotonin reuptake inhibitors (SSRIs) drugs during treatment of major depressive disorder.

METHODSFor 304 patients receiving SSRIs treatment for major depression disorder, 3 single nucleotide polymorphisms (SNPs) (rs1007023, rs1023990 and rs4570625) in the TPH2 gene were genotyped by MALDI-TOF mass spectrometry using a MassArray Analyzer 4 system. HAMD-17 was adopted as the primary rating tool to evaluate the severity of depression on the baseline and at the end of 1st, 2nd, 4th and 6th week of treatment.

RESULTSThe frequency of GG genotype/G allele for rs4570625 differed significantly with the frequency of TT and GT genotypes/T allele between responders and non-responders (P=0.013 and 0.007, respectively). Genotypic and allelic frequencies of the other polymorphisms did not differ significantly between the two groups (P>0.05). No association of TPH2 gene polymorphism with remission was found with the 3 SNPs.

CONCLUSIONThe polymorphisms of TPH2 gene may play an important role in response to antidepressant drug therapy.

Objective To study the changes in cesarean delivery rate (CSR) and indications against the background of two-child policy. Methods Maternal information and indications for cesarean delivery were retrospectively obtained from medical records of 62007 women who delivered at the Obstetrics and Gynecology Hospital of Fudan University between January 2013 and December 2016. Indications for cesarean section were divided into 16 categories, such as maternal or fetal indication, repeat cesarean section, maternal request, labor arrest disorders, fetal distress, and so on. Changes in CSR and the proportion of cesarean delivery for each indication were evaluated. One-way analysis of variance, Chi-square or Fisher's exact test were used for statistical analysis. The average annual percent change (AAPC) in cesarean delivery rate was calculated by Joinpoint Analyses software. Relative contribution of each indication to the overall increase or decrease in CSR was analyzed using the data of the years of 2013 and 2016. Results The CSR dropped from 45.2％ (6683/14798) in 2013 to 38.3％ (6546/17104) in 2016. The rate of cesarean delivery due to maternal request and labor arrest disorders decreased significantly (χ2=49.402 and 14.617, both P<0.05) .The rate of cesarean delivery due to labor arrest disorders in all cases decreased sharply from 14.7‰ in 2013 to 0.9‰ in 2016 at an annual decrease of 48.0％ (95％CI: - 67.6％- - 21.5％). It was also worth noting that the rate of cesarean delivery on maternal request in all cases decreased from 119.3 ‰ in 2013 to 40.7 ‰ in 2016 at an average annual decrease of 30.1％ (95％CI: - 31.3％- - 28.9％). Despite of a limited number of cesarean delivery cases for uterine scar caused by leiomyoma resection, its rate increased from 1.4 per 1000 deliveries in 2013 to 2.9 per 1000 deliveries in 2016 with the highest average annual increase of 32.3％ (95％CI: 10.1％-60.9％), followed by the rate of cesarean delivery due to maternal pyrexia, increasing from 6.6 per 1000 deliveries in 2013 to 16.4 per 1000 deliveries in 2016 at an average annual increase of 27.4％ (95％CI: 11.0％-46.5％), and the rate of cesarean delivery due to repeat cesarean section, increasing from 67.6 per 1000 deliveries in 2013 to 113.9 per 1000 deliveries in 2016 at an average annual increase of 19.0％ (95％CI: 5.0％-34.6％). The first two positive contributors to the total decrease of CSR were maternal request and labor arrest disorders (144.2％ and 27.7％, respectively), while the first two negative contributors were repeat cesarean section and maternal pyrexia (-102.3％ and -18.9％, respectively). Conclusions The CSR is reduced after the implementation of two-child policy through active control on maternal request and application of new partogram.

Objective To evaluate the effectiveness and safety of flexible ureteroscopy lithotripsy (FURL) combined with holmium laser for the concurrent treatment of bilateral upper ureteral tract calculi.Methods The clinical data in 43 patients with bilateral upper ureteral tract calculi concurrently treated by FURL combined with holmium laser in our hospital from September 2014 to November 2016 were retrospectively analyzed.All cases conducted CT scanning before operation.The flexible ureteroscope was intraoperatively placed and the lithotripsy was conducted by using 200 μm optical fiber at a power of 0.8-1.0 J/10-20Hz,which was coordinated by reticular basket.After lithotripsy,bilateral urethral stents were placed.KUB or CT was re-examined on postoperative 1 d.The cases of residual stone were performed KUB again after removing urethral stent after 4-6 weeks.Results All cases were successfully placed the flexible ureteroscope by one time.The mean operation time was (101.5±37.2) min and the overall stone-free rate (SFR) was 81.4 ％ (35/43).SFR was 100％ in the patients with the stone burden less than 30 mm and 63.2％ in the patients with the stone burden ≥30 mm,the difference was statistically significant(P＜0.05).One case appeared fever (39.5 ℃) after operation,1 case developed subcapsular renal hematoma and no other severe complications occurred.Conclusion FURL combined with holmium laser is an effective means to concurrently treating bilateral upper ureteral calculi,especially for the patients with stone burden ＜30 mm,which has higher stone clearance rate with good safety.