Background The incidence rate of missed abortion is increasing year by year, but the etiology has not been fully elucidated. Adverse pregnancy history and exposure to polycyclic aromatic hydrocarbons (PAHs) may increase the risk of missed abortion. Objective To investigate the interaction between adverse pregnancy history and PAHs exposure on missed abortion in early pregnancy, and to provide evidence for the etiologic research of missed abortion. Methods A total of 114 pregnant women diagnosed with missed abortion in the Department of Obstetrics of the First Hospital of Shanxi Medical University from March to December 2019 were selected as the case group, and 139 pregnant women who visited the same hospital for voluntary induced abortion in the same period as the control group, to collect basic information and medical information of abortion, stillbirth, intrauterine growth retardation, and other adverse pregnancy history. Abortion villus tissues were collected to detect PAH-DNA adducts levels, stratified by pregnancy and adverse pregnancy history and grouped by quartile method: Q₁ (< 404.61 ng·L⁻¹), Q₂ (404.61−453.75 ng·L⁻¹), Q₃ (453.76−506.72 ng·L⁻¹), and Q₄ (≥506.73 ng·L⁻¹). SPSS 25.0 statistical software was used for χ² test and multiple logistic regression, and additive and multiplicative models were used to investigate the interaction between adverse pregnancy history and PAH-DNA adducts level on missed abortion. The PAH-DNA adducts were grouped by tertiles and quartiles, and P₃₃, P₅₀, P₆₇ and P₇₅ were used as data cut points for sensitivity analysis. Results The proportion of adverse pregnancy history in the case group (32.46%) was higher than that in the control group (12.23%) (P < 0.001). Among 160 subjects with≥2 pregnancies, the proportion of adverse pregnancy history in the case group (57.81%) was higher than that in the control group (17.71%) (P < 0.001). The results of χ² test stratified by pregnancy for different PAH-DNA adducts levels between the two groups showed that the PAH-DNA adducts level was associated with missed abortion in subjects with≥2 pregnancies (χ²=10.14, P=0.017). Being further stratified by adverse pregnancy history, the PAH-DNA adducts level in subjects with no adverse pregnancy history was associated with missed abortion (χ²=9.70, P=0.021). The results of logistic regression analysis showed that adverse pregnancy history (OR=5.88, 95%CI: 2.79−12.39) and PAH-DNA adducts (OR=3.01, 95%CI: 1.22−7.40) increased the risk of missed abortion, but no interaction between them was found. The relative excess risk of interaction (RERI), the attributable percentage of interaction (AP), and the synergy index (SI) and its 95%CI were 0.60 (95%CI: −0.58−1.77), 0.74 (95%CI: −0.83−2.30), and 0.20 (95%CI: 0.01−5.43), respectively. Conclusions Adverse pregnancy history and PAH-DNA adducts in pregnant women may increase the risk of missed abortion. The effect of the interaction between them on the occurrence of missed abortion is not supported by the current study.

ObjectiveTo investigate effect of conducting training of autism spectrum disorder （ASD） early screening skill on improving the ability to early identify ASD of medical staffs in primary care hospitals. MethodsIn September 2021， the training of ASD early screening skills was carried out for medical staffs from 20 primary care hospitals in Chengdu. After training， the training effect was evaluated. The numbers of referrals from primary care hospitals to superior hospitals， confirmed ASD as well as their average diagnostic age of children with ASD before and after training were used as evaluation indicators. ResultsAfter training， the number of children with suspected ASD referred by primary care hospitals was more than that before training ［（16.65±11.60） vs. （3.40±2.23）， t=5.431， P<0.01］， the number of children diagnosed with ASD was more than that before training［（6.85±4.93） vs. （2.45±1.67）， t=4.171， P<0.01］， and the differences were statistically significant. As for the diagnosed age of ASD children， after training， the average age was lower than that before training ［（34.95±11.67） vs. （42.2±14.64）， t=-2.553， P=0.019］. ConclusionTraining of ASD early screening skills for medical staffs in primary care hospitals may help to improve their ability to early screening ASD children.

Objective:To explore the association between statins and colorectal cancer and provide evidence for the prevention of colorectal cancer.Methods:Literatures about statins and colorectal cancer published from January 2000 to January 2020 were retrieved from CNKI, Wanfang data, PubMed and Cochrane Library database. The literatures which met the inclusion criteria were collected, and the Newcastle-Ottawa Scale and Jadad score were used to assess the studies. Meta-analysis was performed with statistical software Revman 5.0 and Stata 12.1.Results:A total of 31 studies, involving more than 1.62 million subjects, were included in the analysis. The case-control study ( RR=0.93, 95% CI: 0.88-0.98), the cohort study ( RR=0.75, 95% CI: 0.63-0.88) and the randomized controlled trial ( RR=0.79, 95% CI: 0.65-0.97) showed moderate protective effect of statins. Using statin <5 years ( RR=0.86, 95% CI: 0.76-0.96), average daily dosage ≥34 mg ( RR=0.81, 95% CI: 0.66-0.98) and lipid-soluble statins ( RR=0.86, 95% CI: 0.74-0.99) also had preventive effect on colorectal cancer; while lovastatin ( RR=1.07, 95% CI: 1.00-1.14) increased the risk of colorectal cancer. Conclusion:Statins have protective effect on colorectal cancer.

Objective:To explore the effect of team positive psychological intervention on psychological state and coping style of nurses after being impacted by life events.Methods:From September 2020 to January 2021, 84 nurses who had suffered life events in Shanxi Provincial People's Hospital were selected by the convenient sampling method. According to the enrollment time, they were divided into the experimental group ( n=42) and the control group ( n=42) . The nurses in the control group were not give external intervention measures, while nurses in the experimental group adopted team positive psychological intervention. After 6 weeks of intervention, the Chinese version of Psychological Resilience Scale, Symptom Checklist 90 (SCL-90) and Simple Coping Style Questionnaire were used to compare changes in the psychological resilience level, mental health level and coping style of nurses in the two groups. Results:After intervention, the scores of toughness, strength and optimism dimensions and the total scores of Psychological Resilience Scale in the experimental group were significantly higher than those in the control group, and the differences were statistically significant ( P<0.05) . The total score of SCL-90 in the experimental group was significantly lower than that in the control group, and the difference was statistically significant ( P<0.05) . The score of positive coping dimension of nurses in experimental group was significantly higher than that in control group, and the score of negative coping dimension was significantly lower than that in control group, and the differences were statistically significant ( P<0.05) . Conclusions:Team positive psychological intervention can improve psychological resilience and mental health level of nurses who are impacted by life events. At the same time, it can also encourage them to adopt active coping methods to face problems, which is conducive to improving quality of nursing.

Objective:To observe the clinical characteristics and prognosis of patients with rapidly progressive glomerulonephritis (RPGN) caused by lupus nephritis, antineutrophil cytoplasmic antibodies (ANCA) - associated vasculitis, or primary glomerulonephritis who were treated with peritoneal dialysis (PD) and then withdrew PD because of renal recovery.Methods:Data of the above patients were retrospectively analyzed. The patients were diagnosed as RPGN and received PD therapy in Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University from February 2009 to August 2018. The patients were divided into early withdrawal group (PD time≤183 days, n=24) and late withdrawal group (PD time>183 day, n=24). The differences of clinical characteristics between the two groups were compared. The cumulative incidence of adverse events in both groups was analyzed using Kaplan-Meier curves. Cox proportional hazards model was used to analyze the risk factors influencing the prognosis of patients. Results:Forty-eight RPGN patients were included. The median time of maintaining PD was 178(76, 378) days. Compared with the late withdrawal group, the patients in early withdrawal group had lower levels of urine volume, serum albumin and parathyroid hormone, and lower rates of gross hematuria and hypertension at the beginning of PD, and received higher rates of methylprednisolone impulse, combined immunosuppressive agents, and hemodialysis or continuous renal replacement therapy (all P<0.05). At the time of PD withdrawal, the levels of serum creatinine, serum calcium, serum albumin and parathyroid hormone in the early withdrawal group were significantly lower than those in the late withdrawal group (all P<0.05). The Kaplan-Meier curves showed that there was no significant difference in the cumulative survival of patients in both groups (log-rank test χ2=3.485, P=0.062). Cox regression analysis revealed serum creatinine≥209 μmol/L at the time of PD withdrawal was an independent risk factor for poor prognosis ( HR=5.253, 95% CI 1.757-15.702, P=0.003). Conclusions:PD can be used for RPGN patients caused by lupus nephritis, ANCA-associated vasculitis and primary nephritis. Serum creatinine≥209 μmol/L at the time of PD withdrawal is an independent risk factor for poor prognosis.

Objective? To explore the nursing cooperation of laparoscopic radical distal gastrectomy. Methods? From January 2014 to December 2017, we summarized the main points of nursing cooperation among 41 patients with laparoscopic radical distal gastrectomy at Xi'an Gaoxin Hospital. Results? Among 41 patients, all operations were successful except four of them with laparotomy because of difficult peripheral tissue isolation of stomach or uncontrolled bleeding. The operation time, intraoperative blood loss and postoperative hospital stay were 240 to 350 min, (200±42) ml and (7.0±2.3) d respectively. No patients developed surgical complications during their hospital stay. Conclusions? During operations, nurses are familiar with the surgical procedure, performance as well as methods of application of laparoscopic instruments, and cooperate reasonably and precisely in operation which is the key to carrying out laparoscopic radical distal gastrectomy successfully.

Objective To investigate the effects of serum uric acid (SUA) on all?cause death and cardiovascular death in patients of maintaining peritoneal dialysis (PD). Methods One thousand and sixty?three PD patients in the First Affiliated Hospital of Zhejiang University Medical College were included. The SUA levels at 6 months after PD start were measured. Patients with SUA≥420 μmol/L were grouped in hyperuricemia group (492 cases) and patients with SUA<420 μmol/L were grouped in normal uric acid group (571 cases). The effects on all ? cause mortality and cardiovascular mortality were retrospectively analyzed. Results The median age of the patients was 51(41, 62) years; 557 cases were male (52.40％); the median follow?up time was 33(20, 54) months (6?96 months); 167 cases (15.71％) died during the follow?up period, including 64 cases (6.02％) withcardiovascular causes. The mortality in hyperuricemia group was 19.11％(94/492) and the cardiovascular mortality was 7.93％(39/492), both rates were higher than those in normal uric acid group, and the differences were statistically significant (P=0.005, P=0.015, respectively). Hyperuricemia (SUA≥420μmol/L) at 6 months after PD start (HR=1.572, 95％CI 1.155-2.141, P=0.004), high uric acid level (continuous variable) at 6 months after PD start (HR=1.002, 95％CI 1.001-1.004, P=0.008), and age≥65 years (HR=3.571, 95％CI 2.556-4.990, P<0.001), serum albumin≤30 g/L (HR=1.907, 95％CI 1.278-2.845, P=0.002), high Charlson comorbidity index (HR=1.209, 95％CI 1.032-1.417, P=0.019) at the beginning of PD start were independent risk factors for all ? causes death in PD patients. Hyperuricemia (SUA≥420 μmol/L) at 6 months after PD start (HR=1.734, 95％CI 1.033-2.912, P=0.037) and age≥65 years (HR=1.761, 95％CI 1.024-3.209, P=0.041), with diabetes (HR=2.775, 95％CI 1.358-5.671, P=0.005) at the beginning of PD start were independent risk factors for cardiovascular death in PD patients. Conclusions SUA at 6 months after PD is an independent risk factor for all?cause death and cardiovascular death in PD patients.

Objective To investigate the value of induction chemotherapy in the treatment of stage N2.3M0 nasopharyngeal carcinoma with plasma Epstein-Barr virus (EBV) DNA＞4000 copies/ml.Methods A retrospective study was performed on clinical data from 210 patients with stage N2-3M0 nasopharyngeal carcinoma and plasma EBV DNA＞4000 copies/ml who were admitted to our hospital from 2009 to 2013.In the 210 patients,101 received induction chemotherapy plus concurrent chemoradiotherapy (NCRT) and 109 concurrent chemoradiotherapy alone (CCRT).The survival rates were calculated by the Kaplan-Meier method.The log-rank test was used for the analysis of survival rates and univariate analysis of the impacts of the changes in the plasma EBV DNA level after induction chemotherapy on the prognosis.Results The 3-year sample size was 154.The NCRT group had significantly higher 3-year disease-free survival (DFS) and distant metastasis-free survival (DMFS) rates than the CCRT group (80.1％ vs.70.6％,P =0.029;87.1％ vs.76.0％,P=O.036),while there was no significant difference in 3-year overall survival (OS) rate between the two groups (88.0％ vs.80.4％,P =0.210).Patients with stage N2 disease in the NCRT group had significantly higher 3-year DFS and DMFS rates than those in the CCRT group (P=O.031,O.014).Patients with stage N3 disease in the NCRT group had significantly higher 3-year OS,DFS,and DMFS rates than those in the CCRT group (P=0.029,0.012,0.019).In all the patients,the 3-year OS and DMFS rates were improved with the increase in the cycle number of induction chemotherapy (P =0.020,0.021).In the NCRT group,patients treated with 2,3,and 4 cycles of induction chemotherapy before radiotherapy had plasma EBV-DNA clearance rates of 51.85％,76.92％,and 88.57％,respectively (P=0.004).Using the complete clearance of plasma EBV-DNA as a predictor of progression,the sensitivity for the above three groups was 62.50％,66.67％ and 75.00 (P=0.910),respectively,and the specificity was 57.89％,90.00％ and 96.77％ (P=0.000),respectively.Conclusions In the treatment of nasopharyngealcarcinoma with plasma EBV DNA ＞ 4 000 copies/m1,induction chemotherapy improves DFS and DMFS inpatients with stage N2-3 M0 disease and OS in patients with stage N3 disease;induction chemotherapy dose not improve recurrence-free survival rate.The prognosis and plasma EBV DNA clearance rate are improved with the increase in the cycle number of induction chemotherapy.Using the complete clearance of plasma EBV DNA as a predictor of progression,the sensitivity and specificity in patients treated with 4 cycles of chemotherapy are superior over those in patients treated with 2 or 3 cycles of chemotherapy.

Objective To observe the transport of hepatitis B virus (HBV)-infected peripheral blood mononuclear cells (PBMC)through placental barrier set up by choriocarcinoma trophoblast cells (Bewo cells),and to explore the biological role of PBMC as a carrier for HBV transport.Methods Bewo cells and PBMC were cultured and their proliferation and activity were detected by cell counting kit (CCK)-8.One hundred μL serum containing 5 ×10 6 copy/mL HBV DNA was used to infect PBMC,and cells infected with HBV were labeled by fluorescent dye carboxyfluorescein diacetate succinimidyl ester (CFSE).A co-culture model of Bewo cells and HBV-infected PBMC was set up by transwell chamber. The migration of HBV-infected PBMC was detected by flow cytometry.Realtime fluorescence quantitative polymerase chain reaction method was used to detect HBV DNA contents of PBMC under transwell chamber.Results PBMC and Bewo cells proliferated at around 24 h and entered into growth stagnation at around 120 h.The contents of PBMC labeled by green fluorescent at 0,12,24 and 48 h during co-culture under chamber were (0.445 ±0.021)%,(21 .180 ± 4.653 )%,(34.830 ± 7.156 )% and (64.185 ± 3.161)%,respectively.The amount of PBMC marked green fluorescence increased over prolonged incubation time (F =68.983,P =0.001 ).PBMC HBV DNA contents at 24 and 48 h of co-culture under chamber were (1.925±0.431)×103 copy/mL and (2.565 ±0.361)×103 copy/mL,respectively,indicating that PBMC under chamber were infected with HBV.Conclusions PBMC may be a target for HBV infection in extrahepatic tissues.Placental trophoblastic barrier built by transwell chambers may provide new ideas to investigate HBV transmission across the placenta in vitro .