Objective:To investigate the factors affecting the delivery of macrosomic infants in pregnant women with gestational diabetes mellitus, and utilize data to construct a nomogram model and validate it.Methods:A total of 1 493 pregnant women with gestational diabetes mellitus who received treatment at Shaanxi Provincial People's Hospital from January 2023 to January 2024 were included in this study. A retrospective study was conducted to analyze the proportion of pregnant women with gestational diabetes mellitus who delivered macrosomic infants. The influential factors in pregnant women with gestational diabetes who delivered macrosomic infants were analyzed using both univariate and multivariate analyses. A predictive model for macrosomia in pregnant women with gestational diabetes mellitus was established, and its predictive efficiency was evaluated.Results:Among the 1 493 pregnant women with gestational diabetes mellitus included in this survey, 51 delivered macrosomic infants, accounting for 3.42%. Univariate analysis revealed that weight gain during pregnancy [(14.11 ± 3.25) kg vs. (10.62 ± 2.72) kg, t = 8.94], pre-pregnancy body mass index [(24.31 ± 2.51) kg/m2 vs. (23.25 ± 2.13) kg/m2, t = 8.94], gestational week [(39.14 ± 0.42) weeks vs. (38.92 ± 0.51) weeks, t = 3.04], fasting blood glucose [(5.15 ± 0.41) mmol/L vs. (4.75 ± 0.35) mmol/L, t = 7.97], blood glucose level during the oral glucose tolerance test at 0 hours [(5.71 ± 0.42) mmol/L vs. (5.49 ± 0.41) mmol/L, t = 3.76], and insulin resistance index [(0.54 ± 0.13) vs. (0.41 ± 0.10), t = 9.02] had a significant impact on the delivery of macrosomic infants (all P < 0.05). Multivariate logistic analysis indicated that weight gain during pregnancy, fasting blood glucose, and insulin resistance index were independent risk factors for delivering macrosomic infants in pregnant women with gestational diabetes mellitus ( OR = 1.685, 27.113, 25.816, all P < 0.05). The multivariate logistic regression model demonstrated good goodness of fit (Hosmer-Lemeshow χ2 = 10.34, P > 0.05). Based on the factors identified through multivariate analysis, a nomogram risk model was constructed, yielding a C-index of 0.742. The independent risk factors from the logistic regression model and their prediction probabilities were utilized to generate the receiver operating characteristic curve for predicting the likelihood of delivering macrosomic infants among pregnant women with gestational diabetes mellitus. The areas under the curve were 0.815, 0.779, 0.795, and 0.938, respectively. Conclusion:The predictive model established based on weight gain during pregnancy, fasting blood glucose levels, and the insulin resistance index demonstrates significant predictive value for the delivery of macrosomic infants in pregnant women with gestational diabetes mellitus.

OBJECTIVE To construct the drug clinical comprehensive evaluation index system and quantitative grading in China， and to provide a reference for scientifically carrying out comprehensive clinical evaluation of drugs. METHODS The analytic hierarchy model was used to establish the drug clinical comprehensive evaluation index system， the weight of the evaluation index and the quantitative grading of each index were determined through expert consultation and model calculation. RESULTS The results of expert consultation were integrated by using the analytic hierarchy model， and the drug clinical comprehensive evaluation index system was obtained： including six first-level indicators of effectiveness， safety， economy， suitability， accessibility and innovation， as well as twenty-three second-level indicators of recommended status， medication for special populations， and drug treatment costs； the weight of each indicator was calculated through estimation-matrix method. CONCLUSIONS The analytic hierarchy model can construct the drug clinical comprehensive evaluation index system and quantitative grading in China， which can provide methodological references for comprehensive analysis and decision-making， thus making the clinical comprehensive evaluation of drugs completer and more scientific.

At present， there are still some problems in China’s clinical comprehensive drug evaluation， such as the unscientific design of the evaluation content， the nonstandard evaluation method and organizational process， and the evaluation results not meeting the decision-making needs. It is urgent to carry out quality control over the whole process of the clinical comprehensive drug evaluation project. From the technical point of view， the quality control methods of clinical comprehensive drug evaluation are discussed through three links of the evaluation content and design （giving the quality control key points of the theme selection process and scheme design）， the evaluation method （discussing the quality control elements of two common evaluation methods， i. e. documentary evidence method and real-world research） and result application transformation （giving suggestions on quality control from the comprehensive analysis of evaluation results， transformation of evaluation results and decision-making）， so as to promote the quality improvement of clinical comprehensive drug evaluation.

Humans ; Nitric Oxide ; Carcinoma, Non-Small-Cell Lung/drug therapy* ; Lung Neoplasms ; Lung ; Nitric Oxide Synthase ; Macrophages, Alveolar ; Pulmonary Alveoli

Aristolochic acids (AAs) have long been considered as a potent carcinogen due to its nephrotoxicity. Aristolochic acid I (AAI) reacts with DNA to form covalent aristolactam (AL)-DNA adducts, leading to subsequent A to T transversion mutation, commonly referred as AA mutational signature. Previous research inferred that AAs were widely implicated in liver cancer throughout Asia. In this study, we explored whether AAs exposure was the main cause of liver cancer in the context of HBV infection in mainland China. Totally 1256 liver cancer samples were randomly retrieved from 3 medical centers and a refined bioanalytical method was used to detect AAI-DNA adducts. 5.10% of these samples could be identified as AAI positive exposure. Whole genome sequencing suggested 8.41% of 107 liver cancer patients exhibited the dominant AA mutational signature, indicating a relatively low overall AAI exposure rate. In animal models, long-term administration of AAI barely increased liver tumorigenesis in adult mice, opposite from its tumor-inducing role when subjected to infant mice. Furthermore, AAI induced dose-dependent accumulation of AA-DNA adduct in target organs in adult mice, with the most detected in kidney instead of liver. Taken together, our data indicate that AA exposure was not the major threat of liver cancer in adulthood.

Corona virus disease 2019 (COVID-19) patients with trauma are at high risk of venous thromboembolism (VTE), which must be taken seriously in the therapeutic processes. Hypercoagulable state is induced by 2019 novel coronavirus (2019-nCoV) in many ways, such as increasing the level of inflammatory factors and fibrinogen, and inducing endothelial cell injury. The venous wall injuries from trauma and operation directly or indirectly trigger off the exogenous coagulation pathway and the microcirculation can be damaged at the same time, which may initiate the exogenous pathway of VTE. Immobilization of limbs and forced bed rest during the treatment of traumatic patients will slow venous blood flow. Chronic non-communicable diseases such as diabetes in the elderly were independent risk factors for VTE. Furthermore, the persistent fever, severe lung disease, respiratory failure, sepsis and invasive technology application add the risk of VTE and the difficulty of treatment. In order to help effective prevention VTE of for COVID-19 patients with trauma, the authors put forward relevant technical suggestions for prevention and nursing of VTE to provide basis for nursing work during pandemic of COVID-19.

Objective:To explore the effects of 5E rehabilitation nursing model on self-management behavior and fatigue symptoms of patients with chronic obstructive pulmonary disease (COPD) .Methods:Totally 110 COPD patients admitted in Yantai Yuhuangding Hospital from October 2018 to September 2019 were selected by convenient sampling, and divided into the control group ( n=53) and the experimental group ( n=57) according to the random number table. Excluding missing patients and patients with incomplete data, finally 48 patients were included in the control group and 51 patients were included in the experimental group. Patients in the control group received routine care and health guidance, while patients in the experimental group received care based on the 5E rehabilitation nursing model. The Self-Management Scale for COPD Patients and the Functional Assessment of Chronic Illness Therapy-Fatigue Scale (FACIT-F) were used to evaluate the effects of interventions in the two groups. Results:There was no statistically significant difference in the scores of the Self-Management Scale between the two groups before intervention ( P>0.05) ; the scores of all dimensions the Self-Management Scale of the experimental group were higher than those of the control group 12 weeks after discharge, and the differences were statistically significant ( P<0.05) . There was no statistically significant difference in fatigue scores between the two groups before intervention and 12 weeks after discharge ( P>0.05) . Conclusions:The 5E rehabilitation nursing model can improve the self-management behavior of COPD patients, but it cannot ameliorate the fatigue symptoms of patients. Large-sample, multi-center, and long-term research will be further needed in the future to explore the effects of the 5E rehabilitation nursing model on patients' fatigue symptoms.

Objective To compare the sonographic features as well as clinical histopathological features of follicular variant papillary thyroid carcinoma(FVPTC) and conventional papillary thyroid carcinoma (CPTC) in pediatric patients.Methods From Jan.2006 to Dec.2017,26 FVPTC patients and 82 CPTC patients were enrolled in this study.The clinical histopathological findings and the sonographic features were compared between the two groups.FVPTCs and CPTCs were divided into PTC-like and follicular neoplasm(FN)-like based on sonographic characteristics.Results The mean nodule size of FVPTCs was larger than that of conventional PTCs.Extrathyroid invasion and cervical lymph node metastasis did not have significant difference between CPTC and FVPTC patients(53.8％ vs 62.2％ and 76.9％ vs 82.9％,respectively).Multiple nodules(P=0.000)and distant pulmonary metastases(P=0.024) were more frequent in CPTCs than in FVPTCs(P＜0.05).The rate of an ill-defined margin (P=0.000) and calcification (P=0.003)in terms of sonographic features were lower in FVPTCs than conventional PTCs(P＜0.05).A Ⅴ+Ⅵ diagnosis of PTC on FNAC of FVPTCs was less common than that of conventional PTCs (P=0.014).Multifocality(P=0.000),extrathyroidal invasion (P=0.000),and lymph node metastasis (P=0.000) were significantly different between PTC-like FVPTCs and FN-like FVPTCs.Conclusion FVPTC in children and adolescents shows a relatively larger size,more benign sonographic features,and a lower diagnostic rate of PTC by FNAC compared with conventional PTCs in pediatric patients.

Identifying and comparing the chemical constituents of wild silkworm cocoon and silkworm cocoon is of great significance for understanding the domestication of silkworm. In this study, we used high temperature and high pressure and methanol-water system to extract cocoon chemical constituents. We used UHPLC-MS to identify and compare cocoon chemical constituents of wild silkworm and domestic silkworm Dazao and Haoyue strains. The cocoon metabolic fingerprints of wild silkworm and domestic silkworm Dazao and Haoyue strains were obtained by using the UHPLC-MS in the positive ion mode and negative ion mode. By annotation, we found that cocoon chemical compounds with high abundances contained amino acids, flavonoids, alkaloids, terpenes, organic acids, and lignans. PLS-DA showed that the cocoon components were significantly different among the wild silkworm and two domestic silkworm strains Dazao and Haoyue. Proline, leucine/isoleucine and phenylalanine showed significantly higher abundances in the cocoon of domestic silkworm Dazao strain than in those of wild silkworm and domestic silkworm Haoyue strain. The flavonoid secondary metabolites are abundant in the Dazao cocoon, including quercetin, isoquercetin, quercetin 3-O-sophoroside, quercetin-3-O-α-L-rhamnoside, quercetin-3-O- rutinoside, and kaempferol. The other secondary metabolites, alkaloids, terpenes and lignans, showed higher abundances in the wild silkworm cocoon than in the domestic silkworm cocoon, including neurine, candicine, pilocarpidine, artemisiifolin, eupassopin, and eudesobovatol. By exposing cocoons to UV light and observing the green fluorescence of flavonoids, we found that Dazao cocoon had the most flavonoids, and Haoyue cocoon had least flavonoids and wild silkworm cocoon had mediate flavonoids. Alkaloids and organic acids are good anti-insect and antimicrobial agents, which have high abundance in the wild silkworm cocoon and could enhance the defense ability of wild silkworm cocoon. Flavonoids are abundant in the cocoon of domestic silkworm Dazao strain, which the main factors are leading to the yellow-green cocoon of Dazao.
Animals ; Bombyx ; Chromatography, High Pressure Liquid ; Flavonoids ; Mass Spectrometry

Objective To investigate the characterization of adenoid cystic carcinoma (ACC) in major salivary glandby conventional and contrast-enhanced ultrasound (CEUS).Methods The conventional and contrast-enhanced ultrasound images of 17 ACC in major salivary gland with pathological confirmation were retrospectively reviewed.Results 12 (70.6％) cases in 17 were found in submandibular,while 5 cases (29.4％) were in parotid.All the patients complained a mass,52.9％ had cheek pain,and 17.6％ had hadfacial nerve or lingual nerve paralysis;these symptoms had been present from 3 to 240 months (mean duration was 42.9± 62.1 months).14 cases (82.4％) were primary focuses,and 3 cases (17.6％) were recurrences with recurrence time from 36 to 132 months (mean recurrence time was 70.7±43.2 months).All lesions were hypoechoic with irregular shape,and only 17.6％ had a homogeneous echotexture,64.7％ heterogeneous.64.7％ of all tumors were well-defined.On CDFI,blood flow signal hadn't detected in 23.5％ patients,and 64.7％ hadintermediate (+ and + +) grades of vascularity.Only 11.8％ had the highest grade of vascularity (+ + +).The CEUS images of ACC in major salivary showed slow fill-in,centripetal,higher enhancement,inhomogeneous enhancement,poorly defined margins and after enhancing the size unchanged.No enhancement orlow enhancement area were common in the AC.Facial nerve invasion can be seen in all cases,including 3 cases (17.6％) of lingual nerve invasion,4 cases (23.5％) of blood vessel invasion;4 cases (23.5％) of striated muscle infiltration;1 case with mandibular involvement;1 case (5.9％) with cervical lymph node metastasis.94.1％ of ACC in major salivary gland were cribriform patterns,and 5.9％ were solid pattems.Conclusions ACC in major salivary gland are more likely to happen in the submandibular gland,which has especially high tendency of facial nerve invasion and cheek pain.Conventional Ultrasound and CEUS imaging characteristics can be used to differentiate ACC firom other tumors in major salivary gland,which would help clinicians to diagnose.The clinical course is characterized by very late recurrences;consequently,longer following-up with ultrasound is proposed.