Objective: To analyze the impact of maternal metal exposure during early pregnancy on the physical development of offspring at 1 and 3 years of age, so as to provide scientific evidence for reducing the adverse effects of heavy metals on their health. Methods: From 2024 to 2018, a total of 1 588 mother child pairs from the Jiangsu Birth Cohort (JBC) were included in this study. Multiple linear regression models, generalized estimating equations (GEE), and weighted quantile sum (WQS) regression models were used to assess the associations between 24 urinary metal mass concentrations (adjusted for specific gravity, SG) during early pregnancy and offspring growth outcomes, including length/height for age Z score(HAZ), weight for age Z score(WAZ), weight for length/height Z score(WHZ), and head circumference for age Z score(HCAZ) at 1 and 3 years of age. Results: After adjusting for confounders, GEE analysis revealed that each natural log unit increase in maternal urinary concentrations of vanadium, tin, cerium, lead, and uranium during early pregnancy was associated with an average reduction in HCAZ by 14.29%, 4.82%, 2.62 %, 5.04 %, and 8.33%, respectively, at 1 and 3 years of age (FDR- P <0.05). Multiple linear regression analysis revealed that increased urinary vanadium concentration was associated with reduced HAZ at 1 year of age, while increased urinary concentrations of vanadium, chromium, tin, antimony, and uranium were associated with reduced HCAZ at 1 year of age (FDR- P <0.05). In the WQS regression model, each unit increase in the WQS index was associated with a 22.64% reduction in HCAZ at 1 year of age, with tin (22.2%) contributing the highest weight, followed by uranium (16.2%), lead (11.5%), vanadium (10.0%), arsenic (6.5%), and chromium (5.0%). Conclusions Prenatal exposure to specific metals and their mixtures may significantly impact the physical development of offspring at 1 and 3 years of age, particularly head circumference. These findings highlight the need to enhance monitoring of maternal metal exposure during early pregnancy to reduce the potential health risks posed by environmental metal pollution to infants and young children.

The occurrence of diabetes mellitus （DM） is closely related to insulin resistance and islet β cell dysfunction. Modern studies have found that macrophages are widely present in the liver，fat，skeletal muscle，islets， and other tissues and organs. Macrophage M1/M2 polarization plays an important role in the occurrence and development of diabetes mellitus and its related complications by intervening in inflammatory response，improving insulin resistance，and promoting tissue repair. Most of the traditional Chinese medicines that regulate the activation and polarization of macrophages are Qi-replenishing and Yin-nourishing，heat-clearing， and detoxicating medicinal，which are consistent with the etiology and pathogenesis of diabetes and its related complications. Therefore，by summarizing the mechanisms between macrophage activation，polarization， and insulin resistance in various tissues，this paper reviewed traditional Chinese medicine and its effective components and compounds in improving diabetes mellitus and its related complications through multi-channel regulation of macrophage polarization and regulation of M1/M2 ratio，providing references for the future treatment of DM and its related complications with traditional Chinese medicine.

OBJECTIVE To establish an HPLC method for determination of the related substances in papaverine hydrochloride. METHODS NanoChrom ChromCore 120 C8 column was used; the mobile phase A consisted of 3.4 g·L−1 potassium dihydrogen phosphate aqueous solution, adjust pH to 3.5 with phosphoric acid-acetonitrile(90∶10), the mobile phase B was methanol, with gradient elution at the flow rate of 0.8 mL·min−1; the detection wavelength was 238 nm; the column temperature was 50 ℃. RESULTS The minimum separation between the main component and each impurity was >1.5; Papaverine and its thirteen impurities showed a good linear relationship in the self-concentration range(r>0.999); and the average recoveries were 93.1%−101.2% with RSDs of 2.3%−8.1%. CONCLUSION The method is accurate, sensitive and reliable, which is suitable for the determination of related substances in papaverine hydrochloride.

Objective To investigate the application value of amlodipine atorvastatin calcium tablet(AACT)combined with evidence-based emotional nursing mode(EENM)in elderly patients with hypertension complicated by coronary heart disease(HTN-CHD).Methods HTN-CHD patients admitted to the department of cardiology of The Second Affiliated Hospital of Wenzhou Medical University from June 2021 to June 2023 were selected retrospectively as study subjects.According to the intervention methods,the HTN-CHD patients were divided into the AACT group and the EENM group.Patients in the AACT group were given AACT combined with the usual care intervention,and the EENM group was given EENM on the basis of the AACT group.The changes of psychological status(SDS,SAS,and SPBS),adherence(medication compliance,daily exercise behavior,poor management behavior,and dietary management behavior)and blood pressure[(systolic blood pressure,SBP)and diastolic blood pressure(DBP)]were compared between two groups.The incidence of cardiovascular events in the two groups at 6 months was observed and compared.Results A total of 118 HTN-CHD patients(55 in AACT group and 63 in EENM group)were included in this study.Before the intervention,there was no significant statistical difference in the SDS,SAS,SPBS,medication compliance,daily exercise,poor management,diet management scores,SBP and DBP between AACT and EENM groups(P＞0.05).After the intervention,SDS,SAS,SPBP scores,SBP and DBP of the HTN-CHD patients significantly decreased in both AACT and EENM groups compared with before(P＜0.05).However,the medication compliance behavior score,daily exercise behavior score,bad management behavior score and diet management behavior score increased significantly compared with before(P＜0.05);SDS,SAS,SPBS scores,SBP and DBP of the patients in EENM group decreased more than those in the AACT group(P＜0.05),however,the increase of medication compliance,daily exercise,poor management and diet management behavior scores of the EENM group was higher than that in the AACT group(P＜0.05).Furthermore,the incidence of cardiovascular events was lower in the EENM group than in the AACT group(P＜0.05).Conclusion EENM combined with AACT intervention is beneficial to improve the compliance with HTN-CHD patients,improve the psychological status and blood pressure values,and reduce the incidence of cardiovascular events.

Objective:To investigate the dose-response relationship between serum polycyclic aromatic hydrocarbon adducts and serum complement C3 and C4 levels among children from a city in East China.Methods:In September 2016, two boarding schools in the air pollution exposure area and the control area (beyond the upwind of 30 km in the air pollution exposure area) in a city in East China were selected as the research site, and the eligible school-age children were recruited as the research objects. A total of 273 children were included, including 163 in the exposure group and 110 in the control group. The annual air pollutant data (PM 2.5, PM 10 and NO 2) of the two regions during the study period were collected. The exposure level of tobacco was evaluated by cotinine in urine. The levels of serum complement C3 and C4 were determined by automatic biochemical analyzer. The serum anti-7, 8, -dihydrodiol-9, 10-epoxide benzo[a]pyrene (BPDE)-albumin adduct levels were detected by ELISA. Linear regression model was used to explore the dose-response relationship between BPDE-albumin adducts and serum complement C3 and C4. Results:The age of 273 subjects was (13.67±0.37) years old, including 165 boys (60.4%). The average annual exposure levels of PM 2.5, PM 10 and NO 2 and the level of serum BPDE-albumin adducts in the exposure group were higher than those in the control group ( P<0.05). The results of linear regression model analysis showed that after adjusting age, sex, BMI z-score and urinary cotinine level, when the serum BPDE-albumin adduct level increased by 10%, the serum complement C4 level decreased by 1.2% ( P=0.017). After adjusting age, BMI z-score and urinary cotinine level, for every 10% increase in serum BPDE-albumin adduct level in boys, the serum complement C4 level decreased by 1.68% ( P=0.024). After adjusting age, sex and BMI z-score, the levels of serum complement C3 and C4 decreased by 1.31% and 3.57% respectively for every 10% increase in serum BPDE-albumin adducts among children in the urinary cotinine detection group ( P<0.05). Conclusion:There is a significant dose-response relationship between serum BPDE-albumin adducts and the complement C4 among children.

Objective:To investigate the dose-response relationship between serum polycyclic aromatic hydrocarbon adducts and serum complement C3 and C4 levels among children from a city in East China.Methods:In September 2016, two boarding schools in the air pollution exposure area and the control area (beyond the upwind of 30 km in the air pollution exposure area) in a city in East China were selected as the research site, and the eligible school-age children were recruited as the research objects. A total of 273 children were included, including 163 in the exposure group and 110 in the control group. The annual air pollutant data (PM 2.5, PM 10 and NO 2) of the two regions during the study period were collected. The exposure level of tobacco was evaluated by cotinine in urine. The levels of serum complement C3 and C4 were determined by automatic biochemical analyzer. The serum anti-7, 8, -dihydrodiol-9, 10-epoxide benzo[a]pyrene (BPDE)-albumin adduct levels were detected by ELISA. Linear regression model was used to explore the dose-response relationship between BPDE-albumin adducts and serum complement C3 and C4. Results:The age of 273 subjects was (13.67±0.37) years old, including 165 boys (60.4%). The average annual exposure levels of PM 2.5, PM 10 and NO 2 and the level of serum BPDE-albumin adducts in the exposure group were higher than those in the control group ( P<0.05). The results of linear regression model analysis showed that after adjusting age, sex, BMI z-score and urinary cotinine level, when the serum BPDE-albumin adduct level increased by 10%, the serum complement C4 level decreased by 1.2% ( P=0.017). After adjusting age, BMI z-score and urinary cotinine level, for every 10% increase in serum BPDE-albumin adduct level in boys, the serum complement C4 level decreased by 1.68% ( P=0.024). After adjusting age, sex and BMI z-score, the levels of serum complement C3 and C4 decreased by 1.31% and 3.57% respectively for every 10% increase in serum BPDE-albumin adducts among children in the urinary cotinine detection group ( P<0.05). Conclusion:There is a significant dose-response relationship between serum BPDE-albumin adducts and the complement C4 among children.

Objective:To qualitatively analyze the elasticity characteristics of boundaries and surrounding liver tissue of focal liver lesions (FLL) by real-time shear wave elastography (SWE), and to analyze the relating influencing factors.Methods:One hundred and fifty-two patients with FLLs (152 lesions) from February 2012 to October 2013 in the First Affiliated Hospital of Sun Yat-Sen University were collected. SWE of FLLs and the surrounding liver tissue was performed and baseline clinical data were collected. The elastic boundary (clear or not clear) of FLLs and elasticity distributions of surrounding liver tissue and their influencing factors were analyzed.Results:A total of 26 benign lesions and 126 malignant lesions were included in this study. Twenty-five cases (96.2%) of benign lesions showed clear elastic boundaries and 1 case (3.8%) showed unclear elastic boundary while 82 cases (65.1%) of malignant lesions showed clear elastic boundaries and 44 cases (34.9%) showed unclear elastic boundaries. Multivariate analysis showed benign/malignant lesion was an independent influencing factor for elastic boundary ( P<0.05). Twenty cases (76.9%), 6 cases (23.1%) and 0 case of liver tissue around benign lesions showed type A, B and C elastic distribution respectively while 17 cases (13.5%), 60 cases (47.6%), and 49 cases (38.9%) of liver tissue around malignant lesions showed type A, B, and C elastic distribution. There were statistically significant differences of benign and malignant lesions, different viral hepatitis backgrounds, different gender, and different ALB, TBIL, ALT levels in elasticity distributions of surrounding liver tissue of FLLs among type A, B and C (all P<0.05) while there was no significant difference in different lesion size( P=0.036). Conclusions:The elasticity characteristics of boundaries and surrounding liver tissue of FLLs on SWE images can provide a reference for differential diagnosis of benign and malignant FLLs. The elastic characteristics of surrounding liver tissue of FLLs are influenced by the nature of lesions and the background of liver disease, but are not influenced by lesion size. Further quantitative studies of elasticity characteristics of boundaries and surrounding liver tissue are needed for the differential diagnosis of different types of FLLs.

Objective:To establish a model based on two-dimensional shear wave elastography (2D-SWE) for predicting post-hepatectomy liver failure (PHLF) among patients with hepatocellular carcinoma (HCC).Methods:One hundred and one consecutive patients with HCC undergoing hepatectomy from August 2018 to July 2019 were enrolled prospectively in the First Affiliated Hospital of Sun Yat-Sen University. Laboratory tests, shear wave elastography in liver parenchyma, and abdominal contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI) were performed preoperatively. Liver functional reserve, liver stiffness (LS), and tumor-related imaging parameters were assessed. PHLF was defined according to the definition of International Study Group of Liver Surgery Recommendations (ISGLS). A predictive model was developed by logistic regression analysis and the performance thereof was evaluated by receiver operating characteristic (ROC) curve analysis and Hosmer-Lemeshow test.Results:PHLF occurred in 39 patients (38.9%). Logistic regression analysis identified that international normalized ratio ( OR=1.09, P=0.026), LS( OR=1.297, P=0.004) and the largest nodule diameter( OR=1.191, P=0.015) were independent risk factors of PHLF.The area under curve (AUC) of the model was 0.842(95% CI =0.763-0.921), which was significantly higher than those of ALBI score, MELD score and Child-Pugh score (AUC 0.626-0.688, P<0.05). The model also showed good calibration in Hosmer-Lemeshow test ( P=0.498). Conclusions:A model based on 2D-SWE provides good preoperative prediction of PHLF among patients with HCC, which might have the potential in better customizing treatment strategy in those patients.

Objective: To investigate the risk factors of postpartum hemorrhage in elderly parturients after cesarean section based on logistic regression analysis and to explore nursing strategies. Methods: From January 2018 to March 2019, a total of 210 elderly women with cesarean section and postpartum hemorrhage in the Integrated Traditional Chinese and Western Medicine Hospital of Wenzhou were selected as the study group.And 420 elderly women who underwent cesarean section and did not have bleeding were selected as the control group, which may cause postoperative bleeding.Factors were analyzed and multivariate logistic regression analysis was performed on the factors that caused significant effects. Results: The incidence of pregnancy hypertension, abortion history, uterine atony, macrosomia and placenta previa in the observation group was significantly higher than that in the control group (t=4.118-83.345, P=0.000-0.042). There were no statistically significant differences in gestational diabetes mellitus, postpartum hemorrhage, coagulation function and depression between the two groups(t=0.006-0.788, P=0.375-0.938). Multivariate logistic regression analysis showed that gestational hypertension, history of abortion, uterine atony, macrosomia and placenta previa were risk factors for postpartum hemorrhage in elderly parturients after cesarean section (OR=2.114-19.521, P=0.035-0.001). Conclusion Pregnancy-induced hypertension, history of abortion, uterine atony, macrosomia and placenta previa are the main factors affecting postpartum hemorrhage in elderly women with cesarean section.This provides an effective basis for the nursing of cesarean section postpartum hemorrhage in elderly women.

Objective To evaluate the efficacy and safety of ilaprazole sodium for injection in the treatment of peptic ulcer bleeding.Methods It was designed as a multi-center,stratified randomized,double-blind,positive drug parallel controlled and non-inferiority study.From October 2014 to April 2015,at 40 hospitals,patients with peptic ulcer hemorrhage confirmed by gastroendoscopy were enrolled and divided into the ilaprazde sodium group (10 mg ilaprazole sodium for injection every 24 h,the first dose doubled) and the positive control group (40 mg of omeprazole sodium for injection every 12 h).The course of both treatment was 72 h.The hemostasis rate of overall group at 72 h,the clinical rebleeding rate at four to seven days,the blood transfusion rate,the incidence of switching to other treatments and the incidence of adverse reactions were compared between the two groups.A chi-square test or Fisher's exact probability method were performed for statistical analysis.Results A total of 533 patients with peptic ulcer bleeding were enrolled,355 patients in the ilaprazole sodium group and 178 patients in the positive control group.The hemostasis rates of ilaprazole sodium group and positive control group at 72 h were 97.69 ％ (339/347) and 97.14 ％ (170/175),respectively,and the difference was not statistically significant (P＞0.05).There were no rebleeding patients in both groups at four to seven days.The blood transfusion rates of ilaprazole sodium group and positive control group were 5.07 ％ (18/355) and 3.37 ％ (6/178).The incidence of switching to other treatments was 0.56％ (2/355) and 0.56％ (1/178),respectively,and the differences were not statistically significant (both P＞ 0.05).The incidence of adverse reactions in the ilaprazole sodium group was 3.94％ (14/355),which was lower than that of positive control group (8.43％,15/178).And the difference was statistically significant (Fisher's exact probability method,P=0.042).Conclusions The efficacy of ilaprazole sodium for injection in the treatment of peptic ulcer bleeding is similar to that of omeprazole sodium for injection.Moreover,the smaller the dose,the lower the frequency of administration and the better the safety.