Background Previous research on chlorinated paraffins (CPs) in fine particulate matter (PM_2.5) has predominantly focused on short- and medium-chain chlorinated paraffins (SCCPs and MCCPs), and few studies could simultaneously determine short-, medium-, and long-chain chlorinated paraffins (LCCPs). Simultaneous extraction and determination of SCCPs, MCCPs, and LCCPs in PM_2.5 could provide technical support for their environmental monitoring and human health risk assessment. Objective To establish a method based on QUEChERS pretreatment method in conjunction with ultra-performance liquid chromatography-quadrupole/orbitrap high resolution mass spectrometry for simultaneously determining the levels of SCCPs, MCCPs, and LCCPs in PM_2.5. Methods The extraction solvents, extraction salts, and extraction steps of a QuEChERS method were optimized. The extraction efficiencies of the target substances were compared under 4 extraction solvents [acetonitrile, dichloromethane, and n-hexane solvents in sequence; acetonitrile: dichloromethane: n-hexane = 1: 1: 2 (v/v/v) mixed solvent; 1% acetic acid-acetonitrile: dichloromethane: n-hexane = 1: 1: 1 (v/v/v) mixed solvent; acetonitrile: dichloromethane: n-hexane = 1: 1: 1 (v/v/v) mixed solvent], 2 dehydrated salts (anhydrous MgSO₄+NaCl and anhydrous Na₂SO₄+NaCl), 2 purification salts (C18 and PSA), and 4 vortex time (5, 7.5, 10, and 12.5 min) conditions. Then internal standard was utilized to estimate linear range and detection limit of the refined QuEChERS approach. Results The linearities of SCCPs, MCCPs, and LCCPs were good in the range of 10~1000 ng·mL⁻¹ with the correlation coefficients all greater than 0.96. The method detection limits (MDLs) ranged from 0.01 to 0.29 ng·m⁻³. The spiked recoveries of SCCPs, MCCPs, and LCCPs at the low, medium, and high concentrations were 77.38%-81.64%, 93.11%-99.78%, and 87.41%-101.39%, respectively, and the relative standard deviations (RSDs) were 2.90%-12.84%. This method was used to determine the CPs levels in 11 PM_2.5 samples from Shijiazhuang. The positive rates of ∑SCCPs, ∑MCCPs, and ∑LCCPs were all 100%, the concentration ranges were 0.24-2.18 ng·m⁻³ (mean 0.84 ng·m⁻³), 0.17-1.67 ng·m⁻³ (mean 0.70 ng·m⁻³), and 0.01-0.16 ng·m⁻³ (mean 0.04 ng·m⁻³), respectively, and the percentages to ΣCPs were 52.95%, 44.39%, and 2.66%, respectively. Conclusion The method established in this study is simple, time-saving, solvent saving, and can simultaneously detect SCCPs, MCCPs, and LCCPs in PM_2.5, which is suitable for the determination of PM_2.5 samples in large quantities, and can also provide a reference for the detection methods of other halogenated organic compounds in PM_2.5.

Objective:To evaluate the application effect of the "group-based" teaching assistant (TA) guidance model in homogenized clinical skill training.Methods:A pilot study was conducted on the cardiopulmonary resuscitation training course, and 32 students majoring in clinical integrative Chinese and Western medicine (five-year program) who were admitted to Shanghai University of Traditional Chinese Medicine in 2018 were randomly divided into control group ( n = 16) and TA group ( n = 16). The control group received traditional teaching methods, and the TA group was further divided into subgroups A, B, C, and D, with four graduate TAs providing group-based teaching. The groups were compared in terms of their satisfaction and test scores. SPSS 25.0 was used for t-test and analysis of variance. Results:The satisfaction survey showed that compared with the control group, the TA group had significantly higher degree of satisfaction with the increased practical opportunities, clinical skill practical ability, learning effect, and overall satisfaction. The immediate test showed that there was no significant difference in test score between the TA group (85.19±2.93) points and the control group (82.75±4.52) points. The test 30 days later showed that the TA group (83.50±5.13) points had a significantly higher test score than the control group (74.68±3.87) points, and the control group had a significantly lower test score than that in the immediate test ( P <0.001); however, there was no significant difference in the TA group's score between the immediate test and the test 30 days later. Conclusion:The "group-based" TA guidance model has a good effect in homogenized clinical skill training, and has a stable long-term effect, with high student satisfaction.

Objective:To explore the value of Gestational Diabetes Mellitus Risk Score in monitoring hypoglycemia among neonates delivered by mothers with gestational diabetes mellitus (GDM) .Methods:From February 2018 to June 2020, 240 neonates delivered by mothers with GDM admitted to the Shanghai First Maternity and Infant Hospital affiliated to Tongji University were selected as the study subject. The patients were assessed and divided into groups by the Gestational Diabetes Mellitus Risk Score and the Supplementary Gestational Diabetes Mellitus Risk Score from 12 to 20 weeks. The low-risk group ( n=63) was defined as the score of Gestational Diabetes Mellitus Risk Score ≤ 20 and the score of Supplementary Gestational Diabetes Mellitus Risk Score<33 from 12 to 20 weeks. The group with the score of Gestational Diabetes Mellitus Risk Score>20 and the score of Supplementary Gestational Diabetes Mellitus Risk Score <33 from 12 to 20 weeks was classified as the medium-risk group ( n=49) . High-risk group ( n=128) was defined as the score of Gestational Diabetes Mellitus Risk Score >20 and the score of Supplementary Gestational Diabetes Mellitus Risk Score >33 from 12 to 20 weeks. Three groups of patients were tested for fasting blood glucose (FPG) . Within one hour after birth, neonates were tested for blood glucose using the glucose oxidase blood glucose meter and given early sucking. Within 72 hours after birth, continuous dynamic blood glucose monitoring methods were used to measure blood glucose in neonates. This study compared the blood glucose within one hour and at 6, 12, 24, 48, and 72 hours after birth and the incidence of hypoglycemia at 72 hours after birth among three groups. Results:Among the 240 neonates in the risk group, 197 experienced hypoglycemia, with an incidence rate of 82.08%. There were statistically significant differences in the incidence of hypoglycemia before treatment, one occurrence of hypoglycemia within 72 hours, and recurrent hypoglycemia among the three groups of neonates ( P<0.01) . There were statistically significant differences in blood glucose among the three groups of newborns within one hour, 6, 12, and 24 hours after birth ( P<0.05) . There was no statistically significant difference in blood glucose among the three groups at 48 hours and 72 hours after birth ( P>0.05) . Conclusions:Neonates with gestational diabetes will suffer from repeated hypoglycemia. The higher the risk level, the higher the incidence of hypoglycemia. It is important to assess the risk of neonates with GDM, monitor their blood glucose in real time and treat them accordingly.

Objective : To understand the epidemiological characteristics of intentional injury cases in Jiaxing from 2009 to 2016,and to provide basis for prevention and control of intentional injury. Methods: Data from the injury surveillance hospitals in Jiaxing from 2009 to 2016 were collected to learn the distribution and trend of gender,age,injury intention,cause,occurrence place,injured body parts and severity in intentional injury cases. Results: There were 8 089 cases of intentional injury reported by injury surveillance hospitals in Jiaxing from 2009 to 2016,accounting for 3.40% of all injury cases reported（237 912）. A total of 7 489 cases aged between 15 to 64 years old,accounting for 92.58%. There were 6 906 cases of violence and 1 183 cases of suicide or self-inflicted injury,accounting for 85.38% and 14.62%,respectively. The male-female ratio in the cases of violence was 2.54∶1,while the one in the cases of suicide or self-inflicted injury was 1∶1.59. The cases of violence was mainly caused by blunt instruments,accounting for 75.17%（5 191 cases）,while the cases of suicide or self-inflicted injury was mainly caused by poisoning,accounting for 47.76%（565 cases）. The cases of violence mainly occurred in streets,accounting for 29.64%（2 047 cases）,while the cases of suicide or self-inflicted injury mainly occurred at home,accounting for 82.59%（977 cases）. Head was the main injured parts in the cases of violence,accounting for 66.81%（4 614 cases）,while digestive system was the main injured parts in the cases of suicide or self-inflicted injury,accounting for 31.45%（372 cases）. About 0.12% of cases of the violence and 1.44% of cases of suicide or self-inflicted injury caused to death. Conclusion Intentional injury cases in Jiaxing were mainly young or middle aged people. Violence was a common intention of injury in males and suicide or self-inflicted injury was a common intention of injury in females.

Objective To investigate the factors affecting the efficacy of leflunomide combined with medium/low dose corticosteroids in the treatment of progressive IgA nephropathy (IgAN).Methods Clinical and pathological parameters were collected retrospectively in patients of primary IgAN with proteinuria＞ 1.0 g/24 h and chronic kidney disease (CKD) stage 1-3 treated with leflunomide combined with medium/low dose corticosteroids in Ren Ji Hospital,School of Medicine,Shanghai Jiao Tong University from Jan 2005 to Dec 2010.According to the treatment effects,patients were divided into complete remission group and non-complete remission group.The biochemical and pathological indexes of the two groups were compared.Results A total of 42 patients were included.The remission rates at 3,6,9 and 12 months were 62％,64％,67％ and 74％,respectively.Seventeen (40.5％) and fourteen (33.3％) patients achieved complete and partial remission after one-year treatment,and the remission rate remained stable within one year after withdrawal of drugs.The 24hour proteinuria was 1.50 (0.67,2.66) g,which was significantly reduced compared with the baseline 2.44 (1.36,3.74) g (P ＜ 0.01).The decrease rate was 31.3％.There was a slight decrease in proteinuriawithin one year after withdrawal of drugs.Estimated glomerular filtration rate (eGFR) remained stable during the treatment and a year of follow-up.No serious adverse event was observed during the followup period.Among 31 responder patients,6(19.4％) patients relapsed.Logistic multivariate regression analysis suggested that the degree of renal interstitial inflammatory infiltration was an independent predictor of complete remission with one-year treatment of leflunomide combined with medium / low dose corticosteroids (HR=0.067,95％ CI 0.008-0.535,P=0.011).Conclusions IgAN treated with leflunomide and medium/low dose corticosteroids can achieve remission in early stage,and the remission rate remains stable after withdrawal of drugs.It is a safe option for the treatment of IgAN.Renal interstitial inflammatory infiltration is an independent predictor of complete remission.

Objective To identify the relations of secondary cerebral edema volume with aquaporin 4 (AQP4) and reactive oxygen species (ROS) levels in patients with spontaneous deep supratentorial intracerebral hemorrhage. Methods Forty-seven patients with spontaneous deep supratentorial intracerebral hemorrhage, admitted to our hospital from December 2016 to January 2018, were chosen in our study; on the 1st, 3rd, 14th and 28th d of onset, the hematoma volume and secondary cerebral edema volume were measured by CT scan. Serum AQP4 and ROS levels were measured by ELESA. The relations of perihematomal edema volume with AQP4 and ROS levels in patients with spontaneous deep supratentorial intracerebral hemorrhage were analyzed. Results The hematoma volumes on 14th and 28th d of onset were significantly decreased as compared with those on 1st and 3rd d of onset (P<0.05); the serum AQP4 and ROS levels gradually increased on 1st, 3rd, and 14th d of onset, with significant differences (P<0.05). The cerebral edema volume, and serum AQP4 and ROS levels on 28th d of onset were significantly decreased as compared with those on 3rd and 14th d of onset (P<0.05). Serum AQP4 and ROS levels were positively correlated with cerebral edema volume (r=0.331, P=0.000;r=0.541, P=0.000); serum ROS level was positively correlated with AQP4 level (r=0.298, P=0.000). Conclusion The changes of brain edema volume, and serum AQP4 and ROS levels in patients with spontaneous supratentorial intracerebral hemorrhage are consistent and positively correlated, which suggests that the antioxidant may reduce the AQP4 protein expression, reduce the degree of brain edema, and alleviate the deterioration of patients with spontaneous intracerebral hemorrhage.

Objective To analyze the changes and characteristics of cancer incidence and mortality among Jiaxing residents in the past 6 years,and to provide evidence for the prevention and control of cancer incidence and mortality.Methods Registered malignant tumor data from the Zhejiang Chronic Disease Information Monitoring and Management System were collected and analyzed based on the International Statistical Classification of Diseases (ICD-10).The statistical indexes used for analyses included crude incidence,standardized incidence,crude ortality,standardized mortality,potential years of life lost (PYLL),average years of life lost (AYLL),rate of potential years of life (PYLL‰) and so on.Results From 2010 to 2015,the crude incidence,the standardized incidence,the crude mortality,and the standardized mortality were 342.52/105,240.89/105,194.71/105 and 126.27/105,respectively.The crude incidence and mortality for males were both higher than those for females(378.44/105 vs.307.49/105,x2=763.06,P＜0.01;255.31/105vs.135.62/105,x2-3 814.11,P＜0.01).The PYLL,AYLL and PYLL‰ of residents in Jiaxing were 248,307 years,6.16 years and 12.00‰,respectively.The PYLL‰for males was significantly higher than that for females(x2=37073.85,P＜0.01).The AYLL for females was 6.50 years,higher than that for males(5.98 years)(t =125.15,P＜0.01).The incidence of malignant tumors increased with age,especially in the older than 40 age group,with the older than 80 age group showing the highest rate at 1 779.01/105 (x2 =38 840 907,P ＜ 0.01).Rates for Lung cancer (70.59/105),colorectal cancer (39.86/105),liver cancer (29.14/105),breast cancer(26.73/105) and stomach cancer (26.00/105) were the most common malignant tumors in Jiaxing.Conclusions The morbidity and mortality of malignant tumors are showing signs of rising and the incidences of lung cancer and gastrointestinal cancer are particularly pronounced in Jiaxing.In consequence,measures for the prevention and control of malignant tumors should be developed with clearly defined objectives and research on the pathogenesis of malignant tumors should be stepped upto reduce the incidence and mortality of malignant tumors.

Objective To apply the oral gastrointestinal ultrasound contrast agents for evaluating the gastric motility abnor‐mality in the patients with anxiety disorder .Methods Twenty patients with anxiety disorder complicating upper digestive tract symptoms without organic pathological changes were enrolled as the anxiety disorder group .Twenty healthy volunteers were en‐rolled as the control group in this study .The two groups orally took gastrointestinal ultrasound contrast agents .The antral contrac‐tion frequency ,antral contraction amplitude amd MI were measured at each time point .GER was calculated .The the gastric motility parameters in the patients with anxiety disorder were evaluated .Results The antral contraction frequency and MI at initial 2 min had no statistical difference between the anxiety group and the control group .The antral contraction amplitude ,antral contraction frequency amd MI at each time point during 5 -10 min after contrast in the anxiety disorder group were significantly decreased compared with the control group ,and the differences were statistically significant (P< 0 .05) .After 20 min ,GER in the control group was significantly higher than that in the anxiety group ,the difference was statistically significant (P<0 .05) .Conclusion O‐ral gastrointestinal ultrasound contrast agents is a economic ,strongly operable ,non‐invasive and highly repeatable method for evalu‐ating the gastric motility .

Objective To compare the efficacy and safety of leflunomide (LEF) combined with medium/low dose corticosteroids and full dose of corticosteroids in the treatment of IgA nephropathy. Method Primary IgAN patients diagnosed by renal biopsy with 18?65 years old and eGFR≥30 ml·min?1·(1.73 m2)?1 and proteinuria>0.5 g/24 h were enrolled in a prospective controlled clinical study. They were randomly divided into leflunomide combined with medium/low dose corticosteroids (LEF group) and corticosteroids alone (steroid group). The primary outcomes were (1) end stage renal disease or dialysis (2) 50% increase in serum creatinine above the baseline. Secondary outcome was the remission of proteinuria. Results Ninety patients completed the follow?up. The 24?hour proteinuria at baseline were 2.00(1.10, 2.88) g and 1.87(1.13 ,3.08) g in LEF group and steroid group respectively. Compared with baseline, it was significantly decreased in both groups at 6 months [0.30(0.11, 0.93) g, 0.30(0.14, 1.33) g] and 12 months [0.30(0.09, 0.82) g, 0.32(0.14, 0.66) g], (P<0.05). Estimated glomerular filtration rate (eGFR) at baseline, 6 months and 12 months were (80.39 ± 28.56), (87.12±28.70) and (88.20±30.26) ml·min-1·(1.73 m2)-1. It was decreased in steroid group (P<0.05), while no significant difference was detected in LEF group[baseline (87.63 ± 27.35), 6 months (86.91 ± 32.45), 12 months (90.06 ± 30.00) ml·min-1·(1.73 m2)-1, P>0.05]. At 6 and 12 months, there was no significant difference in terms of 24?hour proteinuria, serum creatinine and eGFR (CKD?EPI) between groups (P>0.05). There was no statistically significant difference in adverse events between groups during the treatment (9/40 cases in LEF group and 11/50 cases in steroid group, P>0.05). The average follow?up was 79 months, and there was no difference in the renal prognosis between the two groups. Multivariate Cox regression analysis revealed that serum creatinine at baseline and renal interstitial inflammatory cell infiltration predicted the risk of the progress of IgA nephropathy. Conclusion Leflunomide plus medium/low dose corticosteroids has a similar effect as full dose of corticosteroids in IgA nephropathy and does not increase the risk for adverse events during the treatment.

Objective To investigate the safety and efficacy of mechanical thrombectomy (MT) compared with In?tra-arterial Thrombolysis (IAT) treatment in patients with severe acute ischemic stroke (AIS) caused by large cerebral ar?tery occlusion. Method The patients with AIS caused by large cerebral artery occlusion and underwent MT or IAT from 2005 May to 2014 May was included. A retrospective analysis was conducted on the onset to emergency(OTE)time, emergency to acupuncture(ETA)time, acupuncture to recanalization (ATR) time, stroke severity as measured by the Na?tional Institutes of Health Stroke Scale (NIHSS) score, and site of arterial occlusion on magnetic resonance angiography (MRA). A comparison was made between MT and IAT patients in rates of recanalization, symptomatic intracranial bleed?ing (SIB), mortality, and functional outcome. Three-month favourable outcome was defined as a modified Rankin Scale (mRS) score≤2. Result One hundred and two AIS patients were treated with MT and 50 with IAT. There was no differ?ence between MT and IAT groups with regard to demographics, onset NIHSS score (13.37±6.95 vs. 12.70±6.11;P=0.572) and discharge NIHSS score (8.40 ± 6.69 vs. 7.53 ± 7.28, P= 0.522) and the change of NIHSS score (3.87 ± 7.14 vs. 4.26 ± 5.42, P=0.766). There were significantly differences between MT and IAT groups in the OTE time (Median 300 min vs. 120 min,Z=-5.704,P=0.000) , ATR time (Median 30 min vs. 65 min,Z=-5.011,P=0.001) ,recanalization (91.2%vs. 60.0%,P =0.01),the rate of AIB(21.7% vs. 36.0%,P =0.046),3-month mortality (16.6% vs. 26.0%,P =0.043). The above parameters were better in MT group than in the IAT group. There were no significant differences between MT and IAT groups in the rate of SIB (12% vs. 16%,P =0.055), the NIHSS change(Median 3 vs. 4,Z =-0.236,P =0.823) and mRS score on 90d ( 48.2%vs. 46.0%, P=0.823). MT patients had significantly higher percentages of stent use (22.5%vs. 8%,P=0.018) . The Recanalization for ICA(81.8%vs. 55.6%,P=0.048),BA(93.1%vs. 55.6%,P=0.032)and MCA( 97.5% vs. 60.0%,P =0.026)was higher in MT group than in IAT group .The SIB rate for ICA(13.8% vs. 33.3%,P =0.000),BA(13.8%vs. 33.3%,P=0.000)was lower in MT group than in IAT group . The mortality rate of was significant?ly lower in MT than in IAT group for MCA (2.5%vs. 20.0%,P=0.000) . the good outcome rate for BA was higher in MT group than in IAT group(41.3%vs. 22.2%,P﹤0.01). Conclusions Compared to IAT,MT can provide broader time win?dow,higher recanalization rate and better outcome in patients with severe acute ischemic stroke (AIS) caused by large ce?rebral artery occlusion.