Objective:To investigate the impact of the number of cesarean deliveries on adverse maternal and neonatal outcomes.Methods:A retrospective analysis was conducted on 11 904 singleton pregnant women who underwent cesarean delivery at the Third Affiliated Hospital of Guangzhou Medical University from January 1st, 2019 to December 31st, 2023. The women were grouped according to the number of cesarean deliveries: those undergoing their first cesarean delivery (1CD group, 7 231 cases), those undergoing their second cesarean delivery (2CD group, 3 749 cases), those undergoing their third cesarean delivery (3CD group, 841 cases), and those undergoing their fourth or more cesarean deliveries (4CD group, 83 cases). Differences in clinical characteristics, related surgical procedures, and adverse maternal and neonatal outcomes among the groups were compared. Binary logistic regression analysis was used to assess the impact of the number of cesarean deliveries on related surgical procedures and adverse maternal and neonatal outcomes.Results:(1) During the 5-year period, the total number of women undergoing cesarean delivery in our hospital showed a slight downward trend, while the proportion of women undergoing three or more cesarean deliveries increased. (2) Compared with women undergoing their first cesarean delivery, women in each repeat cesarean delivery group were older, had higher proportions of advanced maternal age and pre-pregnancy body mass index, and had more pregnancies, deliveries, and induced abortions; the incidence of placenta previa, placental implantation, antepartum hemorrhage, gestational hyperglycemia, and failed trial of labor requiring conversion to surgery was higher, while the incidence of premature rupture of membranes was lower; the proportions of ureteral stent placement, adhesiolysis of the pelvic and abdominal cavities, uterine rupture, uterine reconstruction, uterine artery ligation, hysterectomy, postpartum hemorrhage, and postoperative intestinal obstruction were higher, and the amount of postpartum hemorrhage was greater; the gestational age at delivery of neonates was earlier, but the rates of preterm birth at 28-31 +6 and 32-33 +6 weeks of gestation were lower; the differences were statistically significant ( P<0.05) for all comparisons. (3) The number of cesarean deliveries was not an independent risk factor for the dose-dependent occurrence of placenta previa (a OR=0.99, 95% CI: 0.98-1.01; P=0.261). In women without placenta previa, the number of cesarean deliveries was not a risk factor for placental implantation (a OR=1.12, 95% CI: 0.90-1.39; P=0.320). However, in women with placenta previa, the number of cesarean deliveries was a risk factor for placental implantation (a OR=4.01, 95% CI: 3.08-5.22; P<0.001). In the overall population, the number of cesarean deliveries was a risk factor for ureteral stent placement, adhesiolysis of the pelvic and abdominal cavities, bladder rupture repair, uterine rupture, uterine reconstruction, uterine artery ligation, hysterectomy, postpartum hemorrhage, and preterm birth (all P<0.05). However, the number of cesarean deliveries was not a risk factor for postoperative intestinal obstruction, admission to the intensive care unit, neonatal asphyxia, admission to the neonatal intensive care unit, or neonatal death (all P<0.05). Conclusions:The number of cesarean deliveries could lead to adverse maternal and neonatal outcomes, but the relationship is not simply dose-dependent. It is speculated that the occurrence of severe adverse maternal and neonatal outcomes is more closely related to maternal complications and comorbidities, as well as whether multidisciplinary comprehensive management was received.

Objective:To investigate the impact of the number of cesarean deliveries on adverse maternal and neonatal outcomes.Methods:A retrospective analysis was conducted on 11 904 singleton pregnant women who underwent cesarean delivery at the Third Affiliated Hospital of Guangzhou Medical University from January 1st, 2019 to December 31st, 2023. The women were grouped according to the number of cesarean deliveries: those undergoing their first cesarean delivery (1CD group, 7 231 cases), those undergoing their second cesarean delivery (2CD group, 3 749 cases), those undergoing their third cesarean delivery (3CD group, 841 cases), and those undergoing their fourth or more cesarean deliveries (4CD group, 83 cases). Differences in clinical characteristics, related surgical procedures, and adverse maternal and neonatal outcomes among the groups were compared. Binary logistic regression analysis was used to assess the impact of the number of cesarean deliveries on related surgical procedures and adverse maternal and neonatal outcomes.Results:(1) During the 5-year period, the total number of women undergoing cesarean delivery in our hospital showed a slight downward trend, while the proportion of women undergoing three or more cesarean deliveries increased. (2) Compared with women undergoing their first cesarean delivery, women in each repeat cesarean delivery group were older, had higher proportions of advanced maternal age and pre-pregnancy body mass index, and had more pregnancies, deliveries, and induced abortions; the incidence of placenta previa, placental implantation, antepartum hemorrhage, gestational hyperglycemia, and failed trial of labor requiring conversion to surgery was higher, while the incidence of premature rupture of membranes was lower; the proportions of ureteral stent placement, adhesiolysis of the pelvic and abdominal cavities, uterine rupture, uterine reconstruction, uterine artery ligation, hysterectomy, postpartum hemorrhage, and postoperative intestinal obstruction were higher, and the amount of postpartum hemorrhage was greater; the gestational age at delivery of neonates was earlier, but the rates of preterm birth at 28-31 +6 and 32-33 +6 weeks of gestation were lower; the differences were statistically significant ( P<0.05) for all comparisons. (3) The number of cesarean deliveries was not an independent risk factor for the dose-dependent occurrence of placenta previa (a OR=0.99, 95% CI: 0.98-1.01; P=0.261). In women without placenta previa, the number of cesarean deliveries was not a risk factor for placental implantation (a OR=1.12, 95% CI: 0.90-1.39; P=0.320). However, in women with placenta previa, the number of cesarean deliveries was a risk factor for placental implantation (a OR=4.01, 95% CI: 3.08-5.22; P<0.001). In the overall population, the number of cesarean deliveries was a risk factor for ureteral stent placement, adhesiolysis of the pelvic and abdominal cavities, bladder rupture repair, uterine rupture, uterine reconstruction, uterine artery ligation, hysterectomy, postpartum hemorrhage, and preterm birth (all P<0.05). However, the number of cesarean deliveries was not a risk factor for postoperative intestinal obstruction, admission to the intensive care unit, neonatal asphyxia, admission to the neonatal intensive care unit, or neonatal death (all P<0.05). Conclusions:The number of cesarean deliveries could lead to adverse maternal and neonatal outcomes, but the relationship is not simply dose-dependent. It is speculated that the occurrence of severe adverse maternal and neonatal outcomes is more closely related to maternal complications and comorbidities, as well as whether multidisciplinary comprehensive management was received.

Objective:To investigate the current situation and analyze the influencing factors of job satisfaction of infectious disease physicians in Jiangsu Province.Methods:From April to May 2021, a stratified random sampling method was used to select 10 municipal level infectious disease hospitals in Jiangsu province. An electronic questionnaire survey was conducted on the infectious disease physicians of these hospitals using an online questionnaire platform. The questionnaire mainly included the job satisfaction scale developed by Greenhaus and Wormley, and a self-designed job satisfaction influencing factor scale based on resource conservation theory. At the same time, semi-structured interviews were made with relevant insiders on such issues as salary and benefits, and career development among others. Descriptive analysis was conducted on the questionnaire data, while single factor analysis and multiple linear regression analysis were used to identify the factors that affect their job satisfaction, and the results of the interviews were studied with Colaizzi 7-step analysis.Results:A total of 457 valid questionnaires were recovered. The job satisfaction score of infectious disease physicians was (3.38±0.76). The results of univariate analysis showed significant differences in job satisfaction scores among infectious disease physicians of different ages, educational backgrounds, professional titles, and positions. The results of multiple linear regression analysis showed that salary and benefits ( B=0.141, P<0.001), work environment ( B=0.128, P<0.001), leadership support ( B=0.112, P=0.014), development security ( B=0.117, P<0.001), self-efficacy ( B=0.084, P=0.045) and social support ( B=0.285, P<0.001) were both influencing factors of their job satisfaction. The interview results identified such problems as low salary, insufficient salary security, large gap in social security levels between in-staff and off-staff physicians, and insufficient career development potential. Conclusions:The job satisfaction of infectious disease physicians in Jiangsu Province was found at an average level. It is recommended that the government increase the investment in personnel expenses for infectious disease physicians, optimize the salary and benefits structure, pay attention to the career development needs of middle-aged and young physicians, and care about the social relationship needs of infectious disease physicians to improve their job satisfaction.

Psoriasis is an autoimmune skin disease in which dendritic cells (DCs) trigger the progression of psoriasis by complex interactions with keratinocytes and other immune cells. In the present study, we aimed to load celastrol, an anti-inflammatory ingredient isolated from Chinese herbs, on mannosylated liposomes to enhance DC uptake as well as to induce DC tolerance in an imiquimod-induced psoriasis-like mouse model. Mannose was grafted onto liposomes to target mannose receptors on DCs. The results demonstrated that compared with unmodified liposomes, DCs preferred to take up more fluorescence-labeled mannosylated liposomes. After loading celastrol into mannose-modified liposomes, they effectively inhibited the expression of maturation markers, including CD80, CD86 and MHC-II, on DCs both in vitro and in vivo. Additionally, after intradermal injection with a microneedle, celastrol-loaded mannose-modified liposomes (CEL-MAN-LPs) achieved a superior therapeutic effect compared with free drug and celastrol-loaded unmodified liposomes in the psoriasis mouse model in terms of the psoriasis area and severity index, histology evaluation, spleen weight, and expression of inflammatory cytokines. In conclusion, our results clearly revealed that CEL-MAN-LPs was an effective formulation for psoriasis treatment and suggested that this treatment has the potential to be applied to other inflammatory diseases triggered by activated DCs.

【Objective】 To investigate the status of blood donation of pregnant women's family members, so as to recruit their family members and establish potential blood donation team. 【Methods】 Questionnaire survey was carried out among family members of pregnant women who participated in blood preparation plan by random sampling. 【Results】 The motivations of self-efficacy, internal reward, severity and stress of blood donors were significantly higher than those of non-donors, but non-donors concerned more about negative feelings of phlebotomy(P<0.05). People with rare blood type, low age, high income, weak negative motivation and strong positive motivation had stronger blood donation intention and higher probability of blood donation behavior(P<0.05). 【Conclusion】 It is necessary to expand blood sources through multiple channels by organizing publicity activities around targeted groups, such as establishing channels for blood donation reservation, taking the lead role of the donated crowd, so as to build up a recruitment team for voluntary blood donation.

Psoriasis is an autoimmune inflammatory disease, where dendritic cells (DCs) play an important role in its pathogenesis. In our previous work, we have demonstrated that topical delivery of curcumin-loaded poly (lactic-

【Objective】 To analyze the influencing factors of blood re-donation among street voluntary blood donors in Nanjing, and to provide basis for increasing the proportion of blood donation/donors. 【Methods】 29 650 street voluntary blood donors in Nanjing from May 21, 2017 to May 21, 2018 in the information management system of Nanjing Red Cross Blood Center were taken as the sampling population, and 2 965 (10%) were randomly selected to ask whether they donated again and reasons by telephone calls. They were divided into re-donation group and lapsed group.The demographic variables and donation frequency of street blood donors in the two groups were analyzed and compared by Chi-square test, and multivariate logistic regression was used to analyze the influencing factors of re-donation of blood donors. 【Results】 The response rate of this survey was 63.37% (1 879/2 965), and the re-donation rate of street blood donors in Nanjing from May 2017 to May 2018 was 40.34% (758/1 879), which was lower than the re-donation rate of global blood donors as 50%. The primary motivation for street blood donors in Nanjing to donate blood again was "help others", accounted for 62.27% (472/758), and the primary deterrent to redonate blood again was "too busy to donate blood", accounted for 49.15% (551/1 121). 【Conclusion】 There is a certain gap between the rate of blood re-donation in Nanjing and worldwide, therefore, further incentive measures are needed and flexible recruitment and blood donation methods should be adopted to facilitate blood donation for donors.

【Objective】 To explore the promote and deter factors of blood donation among street blood donors in Nanjing, in order to improve the accuracy of street blood donors recruitment. 【Methods】 A questionnaire with high confidence was designed based on the theory of planned behavior(TPB). The multi-stage hierarchical sampling method was adopted according to the geographical location and economic development level of 11 districts(regions) in Nanjing, and the street blood donors were divided into three groups according to the history of blood donation: one donation(n=361), donation numbers ≥ 2(n=417)and non-donation (n=241). The blood donation behavior was investigated from four aspects as external promote factors (such as seeking a free blood examination, self-interest factors, etc.), internal promote factors(such as altruistic, self-interest factors, blood donation can help others, etc.), external deter factors (too busy to donate blood, opposition from my family, etc.) and internal deter actors ( worry about dizziness after blood donation, fear of needles, ect.). The database was established using Epidata software, and chi-square test was applied for statistical analysis between groups. 【Results】 The groups mainly affected by the promote factors (altruistic and self-interest factors) of Nanjing street population in blood donation were unmarried, 18~24 years old, childless, below bachelor degree, and have barely no income. The main groups less affected by the deter factors were students, male, unmarried, 18~24 years old, childless and have barely no income.Promote factors increases with the number of blood donations, while deter factors decreases with the number of blood donation. 【Conclusion】 TBP can better analyze and explain the promote and deter factors affecting blood donation behavior among street blood donors in Nanjing, which is helpful for blood stations to formulate targeted measures to improve the availability of street blood donors.

【Objective】 To investigate the feelings of blood donors during blood donation and its influencing factors, thus providing references for high quality blood donation service for blood banks. 【Methods】 A self-developed questionnaire concerning voluntary blood donation was randomly issued by the research group and recruited investigators among blood donors in 6 street blood donation sites of Nanjing Red Cross Blood Center at weekends during December 1~23, 2018. The basic information of blood donors, the difference of feelings during blood donation and the influencing factors were analyzed by descriptive analysis, chi-square test and binary Logistic regression analysis, respectively. 【Results】 A total of 405 questionnaires were issued, and all 405 copies were valid, with the response rate at 100% (405/405). Among the valid questionnaires, 46.67% (189/405) were first-time blood donors, 27.65% (112/405) had donated for 2~3 times, and 25.68% (104/405) donated more than 4 times. 53.59%(97/181), 23.7%(43/181) and 22.65%(41/181) of the above three groups of blood donors worried about the needles, and 55.48%(81/146), 22.60%(33/146) and 21.92%(32/146) worried about the blood outflow, 52.69% (88/167), 28.14% (47/167), and 19.16% (32/167 )worried about the pain during blood collection (P<0.05). The anxiety of unqualified blood test was similar to that of poor service (P>0.05). There were differences in blood donation experience among the three groups (P<0.05), and gender (P<0.05) was its influencing factor showed by binary Logistic regression analysis. 【Conclusion】 The majority of blood donors, who have donated at the street sites of Nanjing, are worried during blood donation collection. Therefore, the blood centers should provide high-quality services and humanized nursing interventions as well as strengthen the citizens′ awareness of blood donation.

Objective:To observe the pronunciation of consonants among children with developmental speech sound disorder and explore the correlation between mispronounced consonants and short-term memory so as to determine the pathogenesis of the disorder.Methods:Thirty-six children with developmental speech sound disorder and aged 4 to 13 years were evaluated. Their pronunciation of consonants at the phoneme and lexical levels was tested to record the error types and error rate. Twelve of the children were then randomly chosen to form a voice disorder group. Another 10 healthy counterparts constituted a control group. The short-term memory of both groups was assessed and any correlation between pronunciation and short-term memory was analyzed.Results:The children with a developmental speech sound disorder differed significantly from the controls in terms of the numbers of errors in articulating blade-alveolar, blade-palatal and velar consonants. On the phoneme level, the highest substitution error rate occurred when pronouncing lingua-palatal consonants (42.86%), followed by supradental consonants (32%). The highest distortion and non-acquisition error rates were with blade-palatal consonants (14%) and lingua-palatal consonants (9.5%). On the vocabulary level, the highest substitution, distortion, ellipsis and non-acquisition error rates appeared when pronouncing lingua-palatal and velar consonants, velar and blade-palatal consonants, supradental consonants as well as blade-palatal consonants. Significant differences were found between the phoneme and lexical levels in the substitution of supradental and blade-palatal consonants as well as in the ellipsis of blade-alveolar consonants. They were moderately associated with pronunciation level. There was, however, no significant difference in working memory span between the two groups, and no significant correlation was observed between working memory span and pronunciation level.Conclusion:The mispronunciation of consonants by children with developmental speech disorders is higher at the lexical than at the phoneme level. They mainly substitute lingua-palatal and velar consonants and elide supradental consonants, which may be related to short-term memory span.