Epidural labor analgesia aims to provide effective medical services to alleviate labor pain in parturients, while adhering to the principles of voluntary participation and clinical safety. In 2018, Peking Union Medical College Hospital(PUMCH)became one of the first pilot units for labor analgesia in China, and has achieved satisfactory results in high-quality development of labor analgesia. This article mainly introduces the achievements and experience of labor analgesia at PUMCH, including: (1) prioritizing maternal and infant safety, arranging personnel rationally, and developing standardized treatment processes through multidisciplinary collaboration to ensure safe and comfortable childbirth; (2) leveraging the hospital's comprehensive capabilities in emergency treatment, and improving collaborative rescue plans for critically ill parturients and newborns; (3) implementing advanced teaching methods to effectively train and conduct simulated drills for labor analgesia and rescue of critically ill parturients; (4) conducting patient education and informative lectures to help parturients acquire a scientific understanding of labor analgesia. We hope that this experience can provide reference and inspiration for other hospitals.

China prospective multicenter birth cohort (Prospective Omics Health Atlas birth cohort, POHA birth cohort) study was officially launched in 2022. This study, in collaboration with 12 participating units, aims to establish a high-quality, multidimensional cohort comprising 20 000 naturally conceived families and assisted reproductive families. The study involves long-term follow-up of parents and offspring, with corresponding biological samples collected at key time points. Through multi-omics testing and analysis, the study aims to conduct multi-omics big data research across the entire maternal and infant life cycle. The goal is to identify new biomarkers for maternal and infant diseases and provide scientific evidence for risk prediction related to maternal diseases and neonatal health.

Objective:To investigate the correlation between atmospheric particulate matter 2.5 (PM 2.5) concentration and the number of chronic kidney disease (CKD) hospital admissions in the elderly in Taiyuan city. Methods:The atmospheric PM 2.5 concentration in Taiyuan city during 2019—2021 was used as the environmental exposure data, and the number of CKD admission of the elderly patients (> 60 years old) in Taiyuan city at the same time was used as the disease progression index. The distributed lag nonlinear model was used to analyze overall and lag effects of PM 2.5 average daily concentration on the elderly patients admitted to CKD. Results:A total of 6 037 cases elderly patients with CKD admitted to hospital were included, with a male-to-female ratio of 1.36∶1. The average daily concentration of PM 2.5 was 52.80 μg/m 3, which did not exceed China's air quality standard (75 μg/m3); But in autumn and winter, the average daily concentration of PM 2.5 significantly exceeded the normal reference value, with the highest value reaching 302 μg/m 3. The relationship between the average daily concentration of PM 2.5 and the number of elderly patients admitted to CKD was nonlinear and there was a lag effect. The relative risk ( RR) value reached the maximum when PM 2.5 average daily concentration was 87 μg/m 3 with lag time of 11 days [1.074(95% CI 1.018-1.321)]. The subgroup analysis results showed that the risk of admission of elderly female CKD patients was higher than that of male patients with lag time of 10 days, and the RR was 1.073(95% CI 1.001-1.151). Elderly CKD patients with hypertension (PM 2.5 87 μg/m 3) and diabetes (PM 2.5 88 μg/m 3) had a higher risk of admission when exposed to PM 2.5, with maximum RR values of 1.067(95% CI 1.002-1.136) and 1.162(95% CI 1.021-1.320), respectively. Conclusions:High atmospheric PM 2.5 concentration in Taiyuan city can increase the risk of admission in elderly patients with CKD, especially in women and patients with hypertension or diabetes.

Objective:To synthesize non-contrast-enhanced CT images from enhanced CT images using deep learning method based on convolutional neural network, and to evaluate the similarity between synthesized non-contrast-enhanced CT images by deep learning(DL-SNCT) and plain CT images considered as gold standard subjectively and objectively, as well as to explore their potential clinical value.Methods:Thirty-four patients who underwent conventional plain scan and enhanced CT scan at the same time were enrolled. Using deep learning model, DL-SNCT images were generated from the enhanced CT images for each patient. With plain CT images as gold standard, the image quality of DL-SNCT images was evaluated subjectively. The evaluation indices included anatomical structure clarity, artifacts, noise level, image structure integrity and image deformation using a 4-point system). Paired t-test was used to compare the difference in CT values of different anatomical parts with different hemodynamics (aorta, kidney, liver parenchyma, gluteus maximus) and different liver diseases with distinct enhancement patterns (liver cancer, liver hemangioma, liver metastasis and liver cyst) between DL-SNCT images and plain CT images. Results:In subjective evaluation, the average scores of DL-SNCT images in artifact, noise, image structure integrity and image distortion were all 4 points, which were consistent with those of plain CT images ( P>0.05). However, the average score of anatomical clarity was slightly lower than that of plain CT images (3.59±0.70 vs. 4) with significant difference ( Z = -2.89, P<0.05). For different anatomical parts, the CT values of aorta and kidney in DL-SNCT images were significantly higher than those in plain CT images ( t=-12.89, -9.58, P<0.05). There was no statistical difference in the CT values of liver parenchyma and gluteus maximus between DL-SNCT images and plain CT images ( P>0.05). For liver lesions with different enhancement patterns, the CT values of liver cancer, liver hemangioma and liver metastasis in DL-SNCT images were significantly higher than those in plain CT images( t=-10.84, -3.42, -3.98, P<0.05). There was no statistical difference in the CT values of liver cysts between DL-SNCT iamges and plain CT images ( P>0.05). Conclusions:The DL-SNCT image quality as well as the CT values of some anatomical structures with simple enhancement patterns is comparable to those of plain CT images considered as gold-standard. For those anatomical structures with variable enhancement and those liver lesions with complex enhancement patterns, there is still vast space for DL-SNCT images to be improved before it can be readily used in clinical practice.

Background Environmental pollutants can affect N⁶-methyladenosine (m⁶A) level in the body, but the change of m⁶A level in kidney after being exposed to cadmium (Cd) and the molecular mechanism of renal injury need to be further studied. Objective To analyze the associations of m⁶A modification and methyltransferases/demethylases with microRNA-21 (miR-21) and transforming growth factor- β1 (TGF - β1) in kidney of rats exposed to Cd. Methods Twenty-four SPF male SD rats were divided into 4 groups, with 6 rats in each group, and were exposed to Cd by subcutaneous injection of 2.0, 1.0, and 0.5 mg·kg⁻¹ cadmium chloride (CdCl₂) and equal volume of normal saline for 2 weeks, 7 d a week, respectively. The levels of N-acetyl-β-D-glucosidase (UNAG) and albumin (UALB) in urine, and the levels of m⁶A methylation and TGF-β1 in kidney were detected by enzyme-linked immunosorbent assay (ELISA). The level of blood urea nitrogen (BUN) was measured by urease method. The levels of renal oxidative stress indicators such as malondialdehyde (MDA), superoxide dismutase (SOD), and glutathione peroxidase (GSH-Px) were detected by total bile acid method, water-soluble tetrazolium asssay, and colorimetric method respectively. The relative levels of TGF-β1, methyltransferases, and demethylases in kidney were measured by reverse transcription-polymerase chain reaction. The expression of miR-21 in kidney was detected by fluorescent quantitative polymerase chain reaction. Results After 2 weeks of exposure to Cd, the body weights of rats in the 2.0 and 1.0 mg·kg⁻¹ cadmium chloride groups decreased, and the ratio of kidney/body weight and the levels of BUN, UNAG, and TGF-β1 mRNA and protein increased in the 2.0 mg·kg⁻¹ cadmium chloride group (P<0.05). The expression levels of m⁶A modification, methyltransferases METTL3, METTL14, Wilms’ tumor 1-associated protein (WTAP), and miR-21 were increased both in the 2.0 and 1.0 mg·kg⁻¹ cadmium chloride groups, with significant differences compared with the control group (P<0.05). The results of correlation analysis showed that the m⁶A modification level was negatively correlated with SOD (r=−0.4489, P<0.05) and GSH-Px (r=−0.4874, P<0.05), METTL3 was negatively correlated with MDA (r=−0.5158, P<0.05), while there was a positive correlation between FTO and GSH-Px (r=0.4802, P<0.05). In addition, miR-21 was positively correlated with METTL3 (r=0.7491), METTL14 (r=0.6157), and WTAP (r=0.6660) (P<0.05), TGF-β1 was positively correlated with METTL3 (r=0.5025, P<0.05) but negatively correlated with FTO (r=−0.5634, P<0.05) . Conclusion Cd can induce m⁶A methylation and up-regulation of METTL3, METTL14, WTAP, and miR-21 expression levels in rat kidney tissues, indicating that m⁶A and miR-21 may be associated with Cd-induced renal fibrosis.

Objective:To explore the experience of the treatment of patella inferior pole fracture with non excitation tension band technique.Methods:From April 2009 to December 2019, 76 patients with inferior patellar fracture were treated with non excitation tension band technique. There were 42 males and 34 females; The age was 35.48 ± 18.12 years (17-66 years), with an average of 35 years. There were 45 cases on the left and 31 cases on the right. Causes of injury: fall injury in 46 cases, bicycle injury in 16 cases and traffic accident injury in 14 cases. The time from injury to operation was 0.25-5 d, with an average of 3.2 d. There were 18 cases of open fractures, 64 cases of articular surface fractures and 52 cases of comminuted fractures. Open fracture patients were debridement first, and all cases were fixed with non excitation tension band technique. The intraoperative fracture reduction, postoperative fracture healing and internal fixation were observed. The knee function was evaluated according to the degree of claudication, the use of supports, the feeling of joint strangulation, joint instability, pain, swelling, stair climbing and squatting.Results:All 76 patients successfully completed the operation and were followed up for 18.24 ± 6.18 months (range 12-24 months). There was no wire fracture during and after operation. All incisions healed in the first stage after operation, and there was no deep venous thrombosis of lower limbs. The X-ray film showed that there was no further fracture and fracture displacement after operation, and there was no Kirschner wire slip before the internal fixation was taken out. Only one case had steel wire relaxation due to buckle (which did not affect fracture healing). All fractures healed well, with an average of 7.5 weeks, and the fracture line basically disappeared. 12 months after operation, according to Lysholm knee score standard, the knee function of patients was evaluated. The score of 76 cases was 95.40±4.60 points (range 82-100 points): excellent in 54 cases, good in 21 cases and fair in 1 case. The excellent and good rate was 98.7%. According to the visual analogue scale (VAS) pain score standard, the patients were scored for postoperative pain. The score of 76 cases was 0.09±2.05 points (range 0-3 points): 4 cases had mild pain, with an average score of 0.09.Conclusion:The results of the treatment of patellar inferior pole fracture with tension free band technique are satisfactory, the pain caused by tissue irritation by the internal fixation was lower, clinical application can be popularized.

Objective:To investigate the clinical value of magnetic resonance imaging (MRI) plain scan and diffusion weighted imaging (DWI) in the diagnosis of brain metastases.Methods:The MRI plain imaging findings of 105 cases with brain metastases and 103 cases without brain metastases confirmed by enhanced MRI examination and clinical diagnosis were retrospectively analyzed. The comparisons of plain MRI findings including T1 weighted image (T1WI), T2WI, T2/fluid attenuated inversion recovery (T2/FLAIR), DWI and apparent diffusion coefficient (ADC) values were made between brain metastases and non-brain metastases.Results:The numbers of hypo-intensity, iso-intensity, hyper-intensity and heterogeneous signal intensity of T1WI in the brain metastatic group were 54, 23, 9 and 19, respectively, while the numbers of hypo-intensity and iso-intensity in the non-brain metastatic group were 52 and 51, respectively, with statistically significant difference ( P<0.001). The numbers of hypo-intensity, iso-intensity, hyper-intensity and heterogeneous signal intensity of T2WI in the brain metastatic group were 1, 9, 72 and 23, respectively, while the numbers of iso-intensity and hyper-intensity in the non-brain metastatic group were 11 and 92, respectively, with statistically significant difference ( P<0.001). The numbers of hypo-intensity, hyper-intensity and heterogeneous signal intensity of DWI in the brain metastatic group were 4, 31 and 65, respectively, while the number of hyper-intensity in the non-brain metastatic group was 4 and others were iso-intensity, respectively, with statistically significant difference ( P<0.001). The numbers of hypo-intensity, iso-intensity, hyper-intensity and heterogeneous signal intensity of T2WI/FLAIR in the brain metastatic group were 4, 5, 60 and 36, respectively, while all cases in the non-brain metastatic group were hyper-intensity, with statistically significant difference ( P<0.001). The number of lesion accompanied with peripheral edema in the brain metastatic group were 69 cases, significantly higher than 0 cases in the non-brain metastatic group ( P<0.001). The mean ADC value in the brain metastatic group were (0.919±0.019)×10 -3 mm 2/s, significantly lower than (1.098±0.012)×10 -3 mm 2/s of non-brain metastatic group ( P<0.05). Conclusions:For patients with a history of primary malignancy, the MRI plain scan signals of T1WI, T2WI, T2WI/FLAIR and DWI are significantly different between brain metastatic tumor and non-metastatic tumor. The mixed signal, peripheral edema and the restriction of DWI diffusion indicate brain metastases. The combined application of the above parameters can improve the diagnostic efficacy of predicting brain metastases, and contrast enhancement MRI examination should be performed for the confirmation of diagnosis.

Objective:To investigate the clinical value of magnetic resonance imaging (MRI) plain scan and diffusion weighted imaging (DWI) in the diagnosis of brain metastases.Methods:The MRI plain imaging findings of 105 cases with brain metastases and 103 cases without brain metastases confirmed by enhanced MRI examination and clinical diagnosis were retrospectively analyzed. The comparisons of plain MRI findings including T1 weighted image (T1WI), T2WI, T2/fluid attenuated inversion recovery (T2/FLAIR), DWI and apparent diffusion coefficient (ADC) values were made between brain metastases and non-brain metastases.Results:The numbers of hypo-intensity, iso-intensity, hyper-intensity and heterogeneous signal intensity of T1WI in the brain metastatic group were 54, 23, 9 and 19, respectively, while the numbers of hypo-intensity and iso-intensity in the non-brain metastatic group were 52 and 51, respectively, with statistically significant difference ( P<0.001). The numbers of hypo-intensity, iso-intensity, hyper-intensity and heterogeneous signal intensity of T2WI in the brain metastatic group were 1, 9, 72 and 23, respectively, while the numbers of iso-intensity and hyper-intensity in the non-brain metastatic group were 11 and 92, respectively, with statistically significant difference ( P<0.001). The numbers of hypo-intensity, hyper-intensity and heterogeneous signal intensity of DWI in the brain metastatic group were 4, 31 and 65, respectively, while the number of hyper-intensity in the non-brain metastatic group was 4 and others were iso-intensity, respectively, with statistically significant difference ( P<0.001). The numbers of hypo-intensity, iso-intensity, hyper-intensity and heterogeneous signal intensity of T2WI/FLAIR in the brain metastatic group were 4, 5, 60 and 36, respectively, while all cases in the non-brain metastatic group were hyper-intensity, with statistically significant difference ( P<0.001). The number of lesion accompanied with peripheral edema in the brain metastatic group were 69 cases, significantly higher than 0 cases in the non-brain metastatic group ( P<0.001). The mean ADC value in the brain metastatic group were (0.919±0.019)×10 -3 mm 2/s, significantly lower than (1.098±0.012)×10 -3 mm 2/s of non-brain metastatic group ( P<0.05). Conclusions:For patients with a history of primary malignancy, the MRI plain scan signals of T1WI, T2WI, T2WI/FLAIR and DWI are significantly different between brain metastatic tumor and non-metastatic tumor. The mixed signal, peripheral edema and the restriction of DWI diffusion indicate brain metastases. The combined application of the above parameters can improve the diagnostic efficacy of predicting brain metastases, and contrast enhancement MRI examination should be performed for the confirmation of diagnosis.

Objective To investigate the characteristics of multislice spiral CT in solitary pulmonary mucinous adenocarcinoma and its relationship with pathology. Methods The clinical data, CT characteristics and pathological features of 16 patients with solitary pulmonary mucinous adenocarcinoma confirmed by pathology from March 2010 to May 2018 were analyzed, and the number, distribution, size, shape, boundary, density, adjacent structure changes and intensifying performance were observed and compared with pathological results. Results The single lesion was distributed in the lung lobe in 16 cases, in the lower lobe in 13 cases, in the middle lobe in 1 case, and in the upper lobe in 2 cases, of which 12 cases were located under the pleura. There were 2 cases of central type and 14 cases of peripheral type. The longest diameter of tumor was 1.2- 3.0 cm, with an average of (2.1 ± 0.9) cm. Eleven lesions were round or approximately round, 5 lesions were irregular, 8 lesions had clear boundary, 6 lesions had irregular boundary and burr sign, 12 lesions had shallow or deep lobulation, 2 lesions had small vacuoles and 2 lesions had vascular aggregation. Multislice spiral CT plain scan showed that the density of lesions was lower than that of the same level muscle density. Enhanced scanning showed mild to moderate homogeneous or heterogeneous enhancement. Microscopic examination revealed that the cytoplasm of tumor cells contained large amounts of mucus and mucus was fluid. Most of the tumor cells were attached to the cell wall. Some of the tumor cells were floating in mucus and flowing with mucus. Conclusions If the tumor distribution and morphology is associated with the gravity factor, the enhanced scan is stripe like, and there is no invasion of the pleural, no pleural effusion and no metastasis when the tumor is large, and the solitary pulmonary mucinous adenocarcinoma should be highly suspected.

OBJECTIVETo summarize the treatment status of gastric gastrointestinal stromal tumor (GIST) in Shandong province,by analyzing the clinicopathological features and prognostic factors.

METHODSClinicopathological and follow-up data of 1 165 patients with gastric GIST between January 2000 and December 2013 from 23 tertiary referral hospitals in Shandong Province were collected to establish a database. The risk stratification of all cases was performed according to the National Institutes of Health(NIH) criteria proposed in 2008. Kaplan-Meier method was used to calculate the survival rate. Log-rank test and Cox regression model were used for univariate and multivariate prognostic analyses.

RESULTSAmong 1 165 cases of gastric GIST, 557 were male and 608 were female. The median age of onset was 60 (range 15-89) years. Primary tumors were located in the gastric fundus and cardia in 623 cases(53.5%), gastric body in 346 cases(29.7%), gastric antrum in 196 cases(16.8%). All the cases underwent resection of tumors, including endoscopic resection (n=106), local resection (n=589), subtotal gastrectomy(n=399), and total gastrectomy(n=72). Based on the NIH risk stratification, there were 256 cases (22.0%) at very low risk, 435 (37.3%) at low risk, 251 cases (21.5%) at intermediate risk, and 223 cases (19.1%) at high risk. A total of 1 116 cases(95.8%) were followed up and the median follow-up period was 40 (range, 1-60) months. During the period, 337 patients relapsed and the median time to recurrence was 34 (range 1-60) months. The 1-, 3-, and 5-year survival rates were 98.6%, 86.1% and 73.4%, respectively. The 5-year survival rates of patients at very low, low, intermediate, and high risk were 93.1%, 85.8%, 63.0% and 42.3% respectively, with a statistically significant difference (P=0.000). Multivariate analysis showed that primary tumor site (RR=0.580, 95%CI:0.402-0.835), tumor size (RR=0.450, 95%CI:0.266-0.760), intraoperative tumor rupture(RR=0.557, 95%CI:0.336-0.924), risk classification (RR=0.309, 95%CI:0.164-0.580) and the use of imatinib after surgery (RR=1.993, 95%CI:1.350-2.922) were independent prognostic factors.

CONCLUSIONSThe choice of surgical procedure for gastric GIST patients should be based on tumor size. All the routine procedures including endoscopic resection, local excision, subtotal gastrectomy and total gastrectomy can obtain satisfactory curative outcomes. NIH classification has a high value for the prediction of prognosis. Primary tumor site, tumor size, intraoperative tumor rupture, risk stratification and postoperative use of imatinib are independent prognostic factors in gastric GIST patients.