Objective To investigate the influencing factors of adverse pregnancy outcomes in patients with preeclampsia and the predictive value of serum trace elements in the second trimester.Methods A total of 98 patients with preeclampsia admitted to Qujing First People's Hospital from January 2019 to June 2022 were enrolled in the study.Patients were divided into poor outcome group and good outcome group according to whether they had adverse pregnancy outcomes.The clinical data of all patients enrolled in the study were col-lected and the serum levels of trace elements calcium,copper,zinc and iron were detected in the second trimes-ter.Univariate analysis and multivariate Logistic regression were used to analyze the influencing factors of ad-verse pregnancy outcomes in patients with preeclampsia.The levels of serum trace elements in the second tri-mester of pregnancy were compared between the poor outcome group and the good outcome group.The re-ceiver operating characteristic(ROC)curve was used to evaluate the predictive value of serum trace elements calcium,copper,zinc and iron for adverse pregnancy outcomes in patients with preeclampsia.Results Univari-ate analysis showed that compared with the good outcome group,the poor outcome group had significantly higher systolic blood pressure,24 h urinary protein quantitation,and D-dimer level(P＜0.05)and significantly less gestational age and platelet count at admission(P＜0.05).Multivariate Logistic regression analysis showed that 24 h urinary protein quantification,D-dimer and platelet count were the influencing factors of ad-verse pregnancy outcomes in patients with preeclampsia(P＜0.05).The levels of serum trace elements calci-um,copper,and zinc in the poor outcome group were significantly lower than those in the good outcome group(P＜0.05),and the level of iron was significantly higher than that in the good outcome group(P＜0.05).ROC curve analysis showed that the areas under the curves(AUCs)of serum calcium,copper,zinc,and iron in the second trimester of pregnancy for predicting adverse pregnancy outcomes in preeclampsia patients were 0.830(95％CI:0.780-0.880),0.855(95％CI:0.805-0.905),0.847(0.797-0.897)and 0.861(95％CI:0.811-0.911),respectively.Conclusion Adverse pregnancy outcomes in patients with preeclampsia are re-lated to 24 h urine protein,D-dimer and platelet count.The levels of serum trace elements calcium,copper,zinc and iron in the second trimester of pregnancy change significantly in patients with adverse pregnancy out-comes,which may become predictive markers of adverse pregnancy outcomes.

Long-term inhalation of silica dust can cause silicosis, but also may induce autoimmune diseases, such as systemic sclerosis, rheumatoid arthritis, systemic lupus erythematosus, Sjogren's syndrome, anti-histidyl tRNA synthetase antibody (JO-1 antibody) syndrome. These two diseases can be isolated or combined. In this paper, the clinical characteristics of 5 cases of silicosis complicated with connective tissue diseases were analyzed and summarized to strengthen the clinical understanding of silicosis complicated with connective tissue diseases, so as to reduce its misdiagnosis and missed diagnosis, and provide reference for clinicians in diagnosis and treatment.

Long-term inhalation of silica dust can cause silicosis, but also may induce autoimmune diseases, such as systemic sclerosis, rheumatoid arthritis, systemic lupus erythematosus, Sjogren's syndrome, anti-histidyl tRNA synthetase antibody (JO-1 antibody) syndrome. These two diseases can be isolated or combined. In this paper, the clinical characteristics of 5 cases of silicosis complicated with connective tissue diseases were analyzed and summarized to strengthen the clinical understanding of silicosis complicated with connective tissue diseases, so as to reduce its misdiagnosis and missed diagnosis, and provide reference for clinicians in diagnosis and treatment.

Objective:To investigate the association between visceral adipose tissue (VAT) thickness in early pregnancy and the risk of gestational diabetes mellitus (GDM).Methods:Based on the Qingdao Women and Children Health Cohort, pregnant women in the first trimester (11-13 +6 weeks of gestation) were enrolled in this cohort study between May 2019 and October 2022. The VAT was measured in first trimester and determined as the distance from the inner margin of the rectus abdominis muscle to the anterior wall of the great artery using multi-functional color ultrasound. The 75 g oral glucose tolerance test (OGTT) results were followed up at 24-28 weeks and the participants were divided into GDM group and non-GDM group. The pregnant women were divided into 4 groups according to the VAT quartile. Log-binomial model and linear regression model were used to analyze the association between VAT and GDM/blood glucose. Results:A total of 3 686 pregnant women were included in this study, the mean age of participants was (30.56±4.05) years and 722 were diagnosed with GDM, with an incidence of 19.6%. The log-binomial regression model results showed that compared with VAT thickness Q1 (VAT<14.70 mm), the GDM risk in Q3 (21.65≤VAT≤29.69 mm) and Q4 (VAT ≥29.70 mm) increased by 34% [ RR(95% CI): 1.34 (1.08-1.67)], and 61% [ RR(95% CI): 1.61 (1.30-2.00)], respectively. Among women with gestational age<35 years old, compared with VAT thickness Q1, the risk of GDM increased by 42% in Q3 [ RR(95% CI): 1.42 (1.22-1.65)] and 70% [ RR(95% CI): 1.70 (1.46-1.98)] in Q4, whereas no associations were found in women with gestational age ≥35 years old ( P>0.05). The association between VAT and GDM risk was only found in pregnant women with pre-pregnancy BMI <24.0 kg/m 2, and the GDM risk increased by 57% [ RR(95% CI): 1.57 (1.22-2.04)] in Q3 and 65% [ RR(95% CI): 1.65 (1.24-2.19)] in Q4 compare with Q1. The results of multiple linear regression analysis showed that VAT was positively correlated with fasting blood glucose, 1-hour blood glucose after 75 g OGTT and 2-hours blood glucose after 75 g OGTT (all Pfor trend<0.001). Conclusion:High VAT thickness in early pregnancy is an independent risk factor for GDM, and the GDM risk increases with the raising of VAT depth.

Objective:To investigate the association between visceral adipose tissue (VAT) thickness in early pregnancy and the risk of gestational diabetes mellitus (GDM).Methods:Based on the Qingdao Women and Children Health Cohort, pregnant women in the first trimester (11-13 +6 weeks of gestation) were enrolled in this cohort study between May 2019 and October 2022. The VAT was measured in first trimester and determined as the distance from the inner margin of the rectus abdominis muscle to the anterior wall of the great artery using multi-functional color ultrasound. The 75 g oral glucose tolerance test (OGTT) results were followed up at 24-28 weeks and the participants were divided into GDM group and non-GDM group. The pregnant women were divided into 4 groups according to the VAT quartile. Log-binomial model and linear regression model were used to analyze the association between VAT and GDM/blood glucose. Results:A total of 3 686 pregnant women were included in this study, the mean age of participants was (30.56±4.05) years and 722 were diagnosed with GDM, with an incidence of 19.6%. The log-binomial regression model results showed that compared with VAT thickness Q1 (VAT<14.70 mm), the GDM risk in Q3 (21.65≤VAT≤29.69 mm) and Q4 (VAT ≥29.70 mm) increased by 34% [ RR(95% CI): 1.34 (1.08-1.67)], and 61% [ RR(95% CI): 1.61 (1.30-2.00)], respectively. Among women with gestational age<35 years old, compared with VAT thickness Q1, the risk of GDM increased by 42% in Q3 [ RR(95% CI): 1.42 (1.22-1.65)] and 70% [ RR(95% CI): 1.70 (1.46-1.98)] in Q4, whereas no associations were found in women with gestational age ≥35 years old ( P>0.05). The association between VAT and GDM risk was only found in pregnant women with pre-pregnancy BMI <24.0 kg/m 2, and the GDM risk increased by 57% [ RR(95% CI): 1.57 (1.22-2.04)] in Q3 and 65% [ RR(95% CI): 1.65 (1.24-2.19)] in Q4 compare with Q1. The results of multiple linear regression analysis showed that VAT was positively correlated with fasting blood glucose, 1-hour blood glucose after 75 g OGTT and 2-hours blood glucose after 75 g OGTT (all Pfor trend<0.001). Conclusion:High VAT thickness in early pregnancy is an independent risk factor for GDM, and the GDM risk increases with the raising of VAT depth.

Objective:To examine the occurrence of complications in elderly patients who have undergone radical surgery for colorectal cancer.Additionally, this study aims to identify the various risk factors associated with these complications.Methods:This study included elderly patients with colorectal cancer who underwent radical surgery at Beijing Hospital between January 2013 and December 2020.These patients were divided into two groups based on their age.In this study, we examined a total of 906 patients who underwent surgery, with 695 patients under the age of 80 and 211 patients aged 80 and above.We classified postoperative complications into two categories: medical and surgical complications.Our analysis compared comorbidities, clinicopathological factors, perioperative variables, and postoperative morbidity and mortality between the two age groups.We utilized both univariate and multivariate analyses to identify any potential risk factors for postoperative morbidity.Results:When comparing patients under 80 years old to those aged 80 or older, it was found that the latter group had a lower body mass index, worse ASA scores, and more comorbidities.Additionally, the proportion of elderly patients with right colon cancer, pT3-4, and pN+ disease was higher compared to those under 80 years old.Furthermore, the elderly patients aged 80 or older had a lower rate of laparoscopic surgery compared to those under 80 years old.The study found that elderly patients aged 80 years and older had significantly shorter operation times compared to those younger than 80 years[(191.0±70.6)min vs.(214.0±83.3)min, t=3.642, P<0.001]. However, the overall complication rate was higher in the elderly group(32.7%)than in the younger group(22.6%)( χ2=8.839, P=0.004). Upon further analysis, it was found that medical complications increased significantly(20.9% vs.7.5%, χ2=30.547, P<0.001), whereas the rate of surgical complications did not show any statistical difference(15.6% vs.16.4%, χ2=0.069, P=0.832). The mortality rate during the perioperative period was found to be significantly higher in elderly patients aged 80 years and above compared to those below 80 years(1.9% vs.0.3%, χ2=6.316, P=0.029). Further analysis revealed that age was an independent risk factor for medical complications( HR=2.822, 95% CI: 1.804-4.414, P<0.001). Laparoscopic surgery has been shown to significantly decrease surgical complications( HR=0.475, 95% CI: 0.317-0.711, P=0.001). However, if the operation time exceeds 200 minutes, there is a significant increase in surgical complications( HR=1.942, 95% CI: 1.278-2.888, P=0.002). Conclusions:The incidence of postoperative medical complications in very elderly patients with colorectal cancer who undergo radical surgery has risen, although the rate of surgical complications has remained steady.Radical surgery for elderly patients with colorectal cancer is both safe and feasible, but it is important to prioritize the prevention and management of medical complications.

Objective:To investigate the short-term and long-term efficacy of laparoscopic surgery for colorectal cancer in elderly patients aged 80 and over.Methods:This study included patients aged 80 and over with sigmoid or rectal cancer who had undergone radical surgery in Beijing Hospital between January 2013 and December 2020.Of the enrolled patients, 47 underwent laparoscopic surgery, and 44 received open surgery.After 1∶1 propensity score matching(PSM), there were 32 cases in each group.Patient clinicopathological characteristics, surgery data, post-operative outcomes and long-term survival were compared.Results:Before PSM, there were significant differences in sex composition and tumor locations between the open surgery and laparoscopic surgery groups.After PSM, there was no significant difference in clinicopathological characteristics between the two groups.Before and after PSM, the operative time for laparoscopic surgery was statistically longer than that for open surgery.The intraoperative blood loss, the postoperative complication rate and the number of harvested lymph nodes were not significantly different between the two groups before and after PSM.Before and after PSM, the postoperative hospital stay in the laparoscopic operation group was shorter than that in the open surgery group, but the difference was not statistically significant.Before PSM, the 1-year, 3-year and 5-year survival rates of the open surgery group were 92.4%, 69.5% and 58.1%, respectively, and the 1-year, 3-year and 5-year survival rates of laparoscopic group were 91.3%, 79.8% and 69.5%, respectively.There was no significant difference in overall survival between the two groups before PSM( χ2=0.591, P=0.422). After PSM, the 1-year, 3-year and 5-year survival rates in the open surgery group were 89.3%, 67.1% and 52.2%, respectively, and the 1-year, 3-year and 5-year survival rates in the laparoscopic surgery group were 90.6%, 74.3% and 65.0%, respectively.There was no significant difference in the overall survival between the two groups after PSM( χ2=1.316, P=0.251). Conclusions:For elderly colorectal cancer patients aged 80 and over, laparoscopic surgery and open surgery have similar rates of complications and long-term survival.This study provides evidence for the safety of laparoscopic surgery.Further prospective randomized controlled clinical trials are needed to confirm these findings.

Objective:To evaluate the short-term efficacy of left colonic artery preservation in laparoscopic-assisted radical resection in elderly patients with rectal cancer.Methods:168 patients aged 65 and over who had undergonelaparoscopic-assisted radical resection of rectal cancer in the gastrointestinal surgery department of Beijing Hospital from December 2017 to December 2020 were retrospectively analyzed.According to different surgical methods, they were divided into the observation group with 90 subjects(the LCA group)and the control group with 78 subjects(the non-LCA group).Basic data, intraoperative, postoperative and clinicopathological data of the two groups were compared and analyzed.Results:There were no statistically significant differences between the two groups in operative time[(172.3±35.5)min vs.(155.5±28.7)min, t=2.182, P=0.103], intraoperative blood loss[(72.6±22.5)ml vs.(67.3±18.4)ml, t=1.473, P=0.128], number of group 253 lymph nodes dissected[(3.8±1.5) vs.(4.2±1.6), t=0.785, P=0.221], and total number of lymph nodes dissected[(14.1±4.3) vs.(15.8±5.0), t=1.652, P=0.113].There was no significant difference in the incidence of anastomotic hemorrhage[4.4%(4/90) vs.3.8%(3/78), χ2=1.182, P=0.133]and the incidence of urinary retention[4.4%(4/90) vs.6.4%(5/78), χ2=1.785, P=0.148].The time to first postoperative flatus[(52.4±23.2)h vs.(68.3±29.3)h, t=2.652, P=0.023]and length of postoperative hospital stay[(9.07±3.56)d vs.(10.68±4.94)d, t=2.785, P=0.017]in the LCA group were shorter than those in the non-LCA group.The incidences of anastomotic leakage in the LCA group and the non-LAC group were 2.2%(2/90)and 5.1%(4/78), respectively, and the difference was statistically significant( t=3.575, P=0.001). Conclusions:LCA preservation in laparoscopic-assisted radical resection of rectal cancer in elderly patients with rectal cancer is safe and feasible, reduces the incidence of anastomotic leakage, and shorten the time to first postoperative flatus and length of postoperative hospital stay.It has good practical clinical value.

Objective:To investigate the risk factors for delirium after intertrochanteric fracture surgery in the elderly.Methods:The data of 423 elderly patients with femoral intertrochanteric fracture were retrospectively analyzed who had been treated by closed reduction and internal fixation with proximal femoral nail antirotation (PFNA) at Department of Orthopedics, The Second Central Hospital of Baoding from December 2010 to April 2018. They were 205 males and 218 females, aged from 70 to 98 years (mean, 78.6 years). By AO classification, 239 fractures were type 31-A1, 141 ones type 31-A2, and 43 ones type 31-A3. Of them, 362 were complicated with disease of internal medicine. The interval from injury to surgery ranged from 4 to 72 hours with an average of 46.6 hours. The incidence of postoperative delirium was recorded. The risk factors were screened by univariate analysis from the hidden blood loss, gender, age, body mass index, complications, anesthesia method, preoperative preparation time and electrolyte disturbance; multivariate logistic regression analysis was used to determine the independent risk factors from the factors with P< 0.05. Results:Post-operative delirium occurred in 49 of the 423 patients (11.58%) (29 cases on the first postoperative day and 20 ones on the second postoperative day). It was not observed in the other 374 (88.42%) patients. Univariate analysis showed significant differences in the interval from injury to surgery, hidden blood loss and electrolyte disturbance between the patients with and without postoperative delirium ( P<0.05). Multivariate logistic regression analysis showed that the interval from injury to surgery >48 hours ( OR=3.386, 95% CI: 1.362 to 6.638), hidden blood loss>600 mL ( OR=10.292, 95% CI: 1.244 to 35.091) and electrolyte disturbance ( OR=4.157, 95% CI: 1.595 to 7.626) were the independent risk factors for postoperative delirium in elderly patients with intertrochanteric fracture. Conclusion:Long preoperative preparation, a large amount of hidden blood loss and postoperative electrolyte disturbance may be the risk factors for post-operative delirium in elderly patients with intertrochanteric fracture afterinternal fixation.

Objective:To explore the feasibility of soft copy image of chest digital radiography (DR SC) in pneumoconiosis diagnosis by observing the reading effect of DR SC and comparing it with high kV film-screen chest radiography (FSR HkV) . To provide a basis for the establishment of a regional information network platform for pneumoconiosis diagnosis. Methods:A total of 119 miners who were exposed to silica dust and engaged in copper or lead-zinc mining were collected by the Third People's Hospital of Yunnan from October 2017 to August 2019. The pulmonary X-ray findings of DRSC and FSR HkV in each case were independently judged and diagnosed by three experienced diagnostic physicians, and the final decision was made according to the consensus of most doctors. The consistency of the two imaging methods was analyzed by observing the main small opacity shape, the overall density, the range of distribution, the aggregation of the small opacity and the big opacity, and the diagnosis stage. Results:there were 118 males and 1 female with an average age of 46.21 years. Average exposure time 7.38 years. The pulmonary X-ray findings of 113 cases with two imaging methods were mainly the round small opacity of p,q and r,but the reticular irregular opacity were not prominent, Only one case of FSR HkV judgment p shape and DR SC judgment q shape were observed, The coincidence rate was 99.12% (112/113) . huger opacity were observed in the other 6 cases. The coincidence rate was 95.51% (4/89) between pneumoconiosis-free and stageⅠ, and there was no significant difference between stageⅡand stage Ⅲ (30/30, P>0.05) . Conclusion:The x-ray findings of Silicosis with small round shadow in lung can be used by DR SC in diagnosis and staging.