Objectives:To investigate the impact of the Micra AV leadless pacemaker on cardiac function.Methods:A total of 76 patients who received the implantation of Micra AV leadless pacemaker due to sick sinus syndrome or atrioventricular block at Ruijin Hospital,Shanghai Jiao Tong University School of Medicine from September 2022 to April 2023 were included in this study.Among them,26 patients(34.2%)had sick sinus syndrome,and 50 patients(65.8%)had atrioventricular block.The patients were followed up for 1 year postoperatively.Cardiac function was evaluated by echocardiography,and the parameters of the pacemaker were collected through the outpatient clinic programming system.Results:After a follow-up of 120(87,181)days,compared with the preoperative state,the left ventricular ejection fraction(LVEF)decreased postoperatively([66.6±5.6]%vs.[63.8±5.2]%,P<0.001),and the cardiac output increased[(4.3±1.2)L/min vs.(5.3±1.5)L/min,P<0.001].There were no statistically significant differences in various cardiac function indexes of patients with sick sinus syndrome between the postoperative and preoperative states(all P>0.05).Compared with the preoperative state,in patients with atrioventricular block,the LVEF decreased postoperatively([67.0±5.1]%vs.[63.4±4.4]%,P<0.001),the cardiac output increased([4.2±1.1]L/min vs.[5.2±1.2]L/min,P<0.001),and the left ventricular end-diastolic diameter decreased[(49.9±5.4)mm vs.(48.6±5.0)mm,P=0.044].Firth's logistic regression analysis indicated that the preoperative LVEF(for every 1%increase,OR=1.56,95%CI:1.12-2.17,P=0.001),stroke volume(for every 1 ml increase,OR=1.15,95%CI:1.04-1.28,P=0.001),body mass index(for every 1 kg/m2 increase,OR=1.49,95%CI:1.02-2.17,P=0.020),and hypertension(OR=12.71,95%CI:1.11-145.13,P=0.039)were independent risk factors for the decrease in LVEF after surgery in patients with atrioventricular block.After the implantation of the MciraTM AV leadless pacemaker,the overall atrioventricular synchrony rate was 81.2%(68.8%,89.0%).The atrioventricular synchrony rates of patients with sick sinus syndrome and those with atrioventricular block were 70.6%(59.5%,83.4%)and 82.4%(74.2%,89.3%)respectively(P<0.05).Firth's logistic regression analysis indicated that sick sinus syndrome(OR=0.26,95%CI:0.07-0.89,P=0.029)and preoperative LVEF(for every 1%increase,OR=1.18,95%CI:1.03-1.35,P=0.015)were independent predictive factors for the atrioventricular synchrony rate>80%.Conclusions:There are differences in the impacts of the Micra AV leadless pacemaker on the LVEF and atrioventricular synchrony rate between patients with sick sinus syndrome and those with atrioventricular block.The preoperative LVEF,stroke volume,body mass index,and hypertension have independent predictive effects on the decrease in postoperative LVEF in patients with atrioventricular block.Sick sinus syndrome and preoperative LVEF are independent predictive factors for the atrioventricular synchrony rate>80%after surgery.

Objective:To explore the mediating effect of accompanied childbirth experience among spouses of primipara on dynamic adjustment after marriage and paternal role adaptation, with the aim of providing reference for further improving accompanying childbirth services.Methods:Spouses of primipara who participated in accompanying childbirth at Nanjing Drum Tower Hospital Group Suqian Hospital from January 2023 to June 2024 were selected as the research subjects through convenience sampling. The general information questionnaire, the Chinese version of Dynamic Adjustment Scale, the Parents' Experiences of Childbirth and the Newborn Father's Role Adaptation Questionnaire were used to conduct a cross-sectional survey, and establish the intermediary model between the dynamic adjustment after marriage and the paternal role adaptation.Results:A total of 244 spouses of primipara were included, with an age of (28.86 ± 5.77) years. The score for dynamic adjustment in spouses of primipara was (110.82 ± 16.33) points, the score for experiences of childbirth was (124.27 ± 13.89) points, and the score for paternal role adaptation was (71.66 ± 9.22) points. The accompanied childbirth experience among spouses of primipara was positively correlated with the dynamic adjustment after marriage and the paternal role adaptation ( r=0.197, 0.511, both P<0.01). The dynamic adjustment after marriage was positively correlated with the paternal role adaptation ( r=0.403, P<0.01). The accompanied childbirth experience among spouses had a partial mediating effect between the dynamic adjustment after marriage and the parental role adaptation, which the mediating effect was 0.182, accounting for 32.79% of the total effect. Conclusions:The dynamic adjustment after marriage can directly predict the paternal role adaptation, and the experience of accompanying childbirth has a partial mediating effect between the two. The role adaptation level of the spouses of the primiparas should be improved by further improving the delivery service to meet the needs of the primiparas and their spouses.

Objectives:To investigate the impact of the Micra AV leadless pacemaker on cardiac function.Methods:A total of 76 patients who received the implantation of Micra AV leadless pacemaker due to sick sinus syndrome or atrioventricular block at Ruijin Hospital,Shanghai Jiao Tong University School of Medicine from September 2022 to April 2023 were included in this study.Among them,26 patients(34.2%)had sick sinus syndrome,and 50 patients(65.8%)had atrioventricular block.The patients were followed up for 1 year postoperatively.Cardiac function was evaluated by echocardiography,and the parameters of the pacemaker were collected through the outpatient clinic programming system.Results:After a follow-up of 120(87,181)days,compared with the preoperative state,the left ventricular ejection fraction(LVEF)decreased postoperatively([66.6±5.6]%vs.[63.8±5.2]%,P<0.001),and the cardiac output increased[(4.3±1.2)L/min vs.(5.3±1.5)L/min,P<0.001].There were no statistically significant differences in various cardiac function indexes of patients with sick sinus syndrome between the postoperative and preoperative states(all P>0.05).Compared with the preoperative state,in patients with atrioventricular block,the LVEF decreased postoperatively([67.0±5.1]%vs.[63.4±4.4]%,P<0.001),the cardiac output increased([4.2±1.1]L/min vs.[5.2±1.2]L/min,P<0.001),and the left ventricular end-diastolic diameter decreased[(49.9±5.4)mm vs.(48.6±5.0)mm,P=0.044].Firth's logistic regression analysis indicated that the preoperative LVEF(for every 1%increase,OR=1.56,95%CI:1.12-2.17,P=0.001),stroke volume(for every 1 ml increase,OR=1.15,95%CI:1.04-1.28,P=0.001),body mass index(for every 1 kg/m2 increase,OR=1.49,95%CI:1.02-2.17,P=0.020),and hypertension(OR=12.71,95%CI:1.11-145.13,P=0.039)were independent risk factors for the decrease in LVEF after surgery in patients with atrioventricular block.After the implantation of the MciraTM AV leadless pacemaker,the overall atrioventricular synchrony rate was 81.2%(68.8%,89.0%).The atrioventricular synchrony rates of patients with sick sinus syndrome and those with atrioventricular block were 70.6%(59.5%,83.4%)and 82.4%(74.2%,89.3%)respectively(P<0.05).Firth's logistic regression analysis indicated that sick sinus syndrome(OR=0.26,95%CI:0.07-0.89,P=0.029)and preoperative LVEF(for every 1%increase,OR=1.18,95%CI:1.03-1.35,P=0.015)were independent predictive factors for the atrioventricular synchrony rate>80%.Conclusions:There are differences in the impacts of the Micra AV leadless pacemaker on the LVEF and atrioventricular synchrony rate between patients with sick sinus syndrome and those with atrioventricular block.The preoperative LVEF,stroke volume,body mass index,and hypertension have independent predictive effects on the decrease in postoperative LVEF in patients with atrioventricular block.Sick sinus syndrome and preoperative LVEF are independent predictive factors for the atrioventricular synchrony rate>80%after surgery.

Objective To explore the delirium incidence and risk factors among patients undergoing abdominal surgery in the post-anesthesia care unit(PACU),and establish a column chart prediction model.Methods A total of 1851 patients who underwent abdomi-nal surgery,with a surgery duration exceeding 4hours and were routinely transferred to the PACU after surgery in the First Affiliated Hos-pital of Wenzhou Medical University from January 2022 to December 2023 were selected.The patients were divided into a delirium group and a non-delirium group based on a nursing delirium screening scale score≥2.The relative factors of before and during the surgery were analyzed retrospectively.The LASSO regression was used to screen the variables,and the independent influencing factors were deter-mined using univariate and multivariate Logistic regression before creating a forest plot.The predictive efficacy of the column chart predic-tion model was evaluated by area under the curve(AUC)of receiver operating characteristic(ROC)and the Hosmer-Lemeshow test.Results A total of 113(6.1％)patients experienced delirium in the PACU.The result of the multivariate Logistic regression analysis in-dicated that gender,age,flurbiprofen,hypotension,hypothermia,hypercapnia,and surgery duration were independent influencing factors for delirium in the PACU,while a long surgery duration and using flurbiprofen were protective factors.The nomogram model was construc-ted based on the result and the AUC value of this model was 0.738.The Hosmer-Lemeshow goodness-of-fit test for the model demon-strated a good fit(P=0.686).Conclusion Medical staff should enhance intraoperative management,ensure sufficient analgesia,main-tain hemodynamic stability,reduce the incidence of intraoperative adverse events,pay attention to elderly male patients,and decrease the occurrence of delirium in the PACU.

Objective:To explore the mediating effect of accompanied childbirth experience among spouses of primipara on dynamic adjustment after marriage and paternal role adaptation, with the aim of providing reference for further improving accompanying childbirth services.Methods:Spouses of primipara who participated in accompanying childbirth at Nanjing Drum Tower Hospital Group Suqian Hospital from January 2023 to June 2024 were selected as the research subjects through convenience sampling. The general information questionnaire, the Chinese version of Dynamic Adjustment Scale, the Parents' Experiences of Childbirth and the Newborn Father's Role Adaptation Questionnaire were used to conduct a cross-sectional survey, and establish the intermediary model between the dynamic adjustment after marriage and the paternal role adaptation.Results:A total of 244 spouses of primipara were included, with an age of (28.86 ± 5.77) years. The score for dynamic adjustment in spouses of primipara was (110.82 ± 16.33) points, the score for experiences of childbirth was (124.27 ± 13.89) points, and the score for paternal role adaptation was (71.66 ± 9.22) points. The accompanied childbirth experience among spouses of primipara was positively correlated with the dynamic adjustment after marriage and the paternal role adaptation ( r=0.197, 0.511, both P<0.01). The dynamic adjustment after marriage was positively correlated with the paternal role adaptation ( r=0.403, P<0.01). The accompanied childbirth experience among spouses had a partial mediating effect between the dynamic adjustment after marriage and the parental role adaptation, which the mediating effect was 0.182, accounting for 32.79% of the total effect. Conclusions:The dynamic adjustment after marriage can directly predict the paternal role adaptation, and the experience of accompanying childbirth has a partial mediating effect between the two. The role adaptation level of the spouses of the primiparas should be improved by further improving the delivery service to meet the needs of the primiparas and their spouses.

Objective To explore the delirium incidence and risk factors among patients undergoing abdominal surgery in the post-anesthesia care unit(PACU),and establish a column chart prediction model.Methods A total of 1851 patients who underwent abdomi-nal surgery,with a surgery duration exceeding 4hours and were routinely transferred to the PACU after surgery in the First Affiliated Hos-pital of Wenzhou Medical University from January 2022 to December 2023 were selected.The patients were divided into a delirium group and a non-delirium group based on a nursing delirium screening scale score≥2.The relative factors of before and during the surgery were analyzed retrospectively.The LASSO regression was used to screen the variables,and the independent influencing factors were deter-mined using univariate and multivariate Logistic regression before creating a forest plot.The predictive efficacy of the column chart predic-tion model was evaluated by area under the curve(AUC)of receiver operating characteristic(ROC)and the Hosmer-Lemeshow test.Results A total of 113(6.1％)patients experienced delirium in the PACU.The result of the multivariate Logistic regression analysis in-dicated that gender,age,flurbiprofen,hypotension,hypothermia,hypercapnia,and surgery duration were independent influencing factors for delirium in the PACU,while a long surgery duration and using flurbiprofen were protective factors.The nomogram model was construc-ted based on the result and the AUC value of this model was 0.738.The Hosmer-Lemeshow goodness-of-fit test for the model demon-strated a good fit(P=0.686).Conclusion Medical staff should enhance intraoperative management,ensure sufficient analgesia,main-tain hemodynamic stability,reduce the incidence of intraoperative adverse events,pay attention to elderly male patients,and decrease the occurrence of delirium in the PACU.

Objective To investigate the role of nuclear factor-κB(NF-κB)/NOD-like receptors family pyrin domain containing 3(NLRP3)pathway in limb ischemia-reperfusion injury(IRI)pretreated with ulinastatin(UTI).Methods Twenty-one SD rats were randomly divided into Sham group,IRI group,UTI group.In UTI group,ulinastatin was injected after anesthesia.After 10 minutes,the animal model was established by claming the femoral artery and ligaturing collateral circulation.After 3h of ischemia,the clamp and tourniquet were removed and the rats underwent 2h of reperfusion.In the other groups,the homologous saline was also injected in the same time.Plasma concentrations of lactate dehydrogenase(LDH)and creatine kinase(CK),interleukin(IL)-6,IL-18,tumor necrosis factor-α(TNF-α)were measured.The gastrocnemius muscle was harvested and immediately stored at-80℃.NF-κB and NLRP3 were detected by Western blot and PCR.The other section muscle was stored in triformol for HE staining.The wet/dry was also immediately detecting.Results The level of wet/dry,LDH,CK,IL-6,IL-18,TNF-α,NF-κB,NLRP3 IRI were higher than those in Sham group(P＜0.05).The level of wet/dry,LDH,CK,IL-6,IL-18,TNF-α,NF-κB,NLRP3 IRI were significantly lower than those in IRI group(P＜0.05).Conclusion Ulinastatin can reduce the cellular inflammatory response through the NF-κB/NLRP3 pathway,thereby achieving a protective effect on limb IRI in rats.

Objective:To analyze human papillomavirus (HPV) infection types and clinical characteristics in postmenopausal patients with high-grade squamous intraepithelial lesion or cervical cancer.Methods:The clinical data of 475 patients diagnosed with high-grade squamous intraepithelial lesions or cervical cancer, pathologically confirmed by colposcopic biopsy, were retrospectively analyzed. These patients received treatment at The Affiliated Suqian Hospital of Xuzhou Medical University (Nanjing Drum Tower Hospital Group Suqian Hospital) between September 2021 and September 2022. The patients were divided into two groups based on their menopausal status: the menopausal group and the non-menopausal group. The clinical data and the types of high-risk HPV infections were compared between the two groups.Results:Among the 475 patients, there were 142 in the menopausal group, with an average age of (57.63 ± 6.23) years, and 333 in the non-menopausal group, with an average age of (36.79 ± 6.85) years. The proportion of patients with no prior history of cervical cancer screening and those who sought medical attention due to clinical symptoms was higher in the menopausal group than in the non-menopausal group [23.2% (33/142) vs. 5.4% (18/333), χ2 = 33.03, P < 0.05]. Among the 475 patients, 347 underwent HPV typing tests, with the top five HPV types identified as 16, 52, 58, 33, and 18. The positive rate of HPV 16 was lower in the menopausal group compared with the non-menopausal group [43.8% (32/73) vs. 61.3% (168/274), χ2 = 7.53, P < 0.05], while the positive rate of HPV 52 was higher in the menopausal group [28.8% (21/73) vs. 13.5% (37/274), χ2 = 9.64, P < 0.05]. The proportion of multiple infections was also higher in the menopausal group compared with the non-menopausal group [47.9% (35/73) vs. 31.8% (87/274), χ2 = 6.63, P < 0.05]. The proportion of patients with type 3 transformation zone in the menopausal group was higher [63.4% (90/142) vs. 23.4% (78/333), χ2 = 69.52, P < 0.05], as was the proportion of cervical canal curettage [59.9% (85/142) vs. 33.6% (112/333), χ2 = 28.20, P < 0.05] compared with the non-menopausal group. The proportion of patients with cervical cancer in the menopausal group was higher than in the non-menopausal group [35.2% (50/142) vs. 8.7% (29/333), χ2 = 50.42, P < 0.05]. The proportion of patients with cervical cancer at stage ≥ IB in the menopausal group was 90% (45/50). Conclusion:In patients with high-grade squamous intraepithelial lesions or cervical cancer, HPV 16 is the most common type. In the menopausal group, there is a high proportion of patients who are positive for HPV 52, an elevated rate of multiple infections, a low cervical screening rate, and a high incidence of cancer, with many patients presenting at late stages.

Objective To investigate the impact of the Shared Medical Appointment (SMA) model on blood glucose levels and self-management behaviors in patients with gestational diabetes mellitus (GDM). Methods A total of 87 pregnant women diagnosed with GDM at the Obstetrics and Gynecology and Endocrinology Outpatient Departments of the Affiliated Suqian Hospital of Xuzhou Medical University from October 2021 to October 2022 were enrolled and divided into treatment group (n=44) and control group (n=43). The treatment group received SMA-based GDM management, while the control group underwent routine outpatient follow-up. Baseline data, flash glucose monitoring (FGM)-related indicators before and after treatment, and self-management behavior scale scores were compared between the two groups. Results No statistically significant differences were observed between the two groups in age, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood glucose (FBG), blood urea nitrogen (BUN), creatinine (Cr), uric acid (UA), triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and glycated hemoglobin (HbA1c) (P>0.05). After treatment, the time in range (TIR) of glucose was higher in the treatment group than that in the control group, while mean amplitude of glycemic excursions (MAGE), standard deviation of blood glucose (SDBG), coefficient of variation (CV), and mean blood glucose (MBG) were lower in the treatment group (P < 0.05). Within the treatment group, post-treatment TIR was higher, and MAGE, CV, SDBG, and MBG were lower than pre-treatment levels (P < 0.05). In the control group, post-treatment TIR was higher, and SDBG and MBG were lower than pre-treatment levels (P < 0.05). After treatment, the total score and scores for dietary management, exercise management, medication management, and blood glucose monitoring management in the self-management behavior scale were significantly higher in the treatment group than in the control group (P < 0.05). In the treatment group, post-treatment scores for all self-management behaviors were higher than pre-treatment levels, while post-treatment total scores and scores for medication management and blood glucose monitoring management in the control group were higher than pre-treatment levels (P < 0.05). Conclusion SMA management model can comprehensively improve blood glucose levels and enhance self-management behavior capabilities in GDM patients.

Objective:To analyze human papillomavirus (HPV) infection types and clinical characteristics in postmenopausal patients with high-grade squamous intraepithelial lesion or cervical cancer.Methods:The clinical data of 475 patients diagnosed with high-grade squamous intraepithelial lesions or cervical cancer, pathologically confirmed by colposcopic biopsy, were retrospectively analyzed. These patients received treatment at The Affiliated Suqian Hospital of Xuzhou Medical University (Nanjing Drum Tower Hospital Group Suqian Hospital) between September 2021 and September 2022. The patients were divided into two groups based on their menopausal status: the menopausal group and the non-menopausal group. The clinical data and the types of high-risk HPV infections were compared between the two groups.Results:Among the 475 patients, there were 142 in the menopausal group, with an average age of (57.63 ± 6.23) years, and 333 in the non-menopausal group, with an average age of (36.79 ± 6.85) years. The proportion of patients with no prior history of cervical cancer screening and those who sought medical attention due to clinical symptoms was higher in the menopausal group than in the non-menopausal group [23.2% (33/142) vs. 5.4% (18/333), χ2 = 33.03, P < 0.05]. Among the 475 patients, 347 underwent HPV typing tests, with the top five HPV types identified as 16, 52, 58, 33, and 18. The positive rate of HPV 16 was lower in the menopausal group compared with the non-menopausal group [43.8% (32/73) vs. 61.3% (168/274), χ2 = 7.53, P < 0.05], while the positive rate of HPV 52 was higher in the menopausal group [28.8% (21/73) vs. 13.5% (37/274), χ2 = 9.64, P < 0.05]. The proportion of multiple infections was also higher in the menopausal group compared with the non-menopausal group [47.9% (35/73) vs. 31.8% (87/274), χ2 = 6.63, P < 0.05]. The proportion of patients with type 3 transformation zone in the menopausal group was higher [63.4% (90/142) vs. 23.4% (78/333), χ2 = 69.52, P < 0.05], as was the proportion of cervical canal curettage [59.9% (85/142) vs. 33.6% (112/333), χ2 = 28.20, P < 0.05] compared with the non-menopausal group. The proportion of patients with cervical cancer in the menopausal group was higher than in the non-menopausal group [35.2% (50/142) vs. 8.7% (29/333), χ2 = 50.42, P < 0.05]. The proportion of patients with cervical cancer at stage ≥ IB in the menopausal group was 90% (45/50). Conclusion:In patients with high-grade squamous intraepithelial lesions or cervical cancer, HPV 16 is the most common type. In the menopausal group, there is a high proportion of patients who are positive for HPV 52, an elevated rate of multiple infections, a low cervical screening rate, and a high incidence of cancer, with many patients presenting at late stages.