Objective To evaluate the measurement uncertainty of endocrine test items by"top-down"method.Methods The"top-down"method in the technical report of CNAS-CL01-G003:2021"Medical Laboratory-Evaluation and Expression of Measurement Uncertainty"was used,collecting the laboratory's internal quality control data and the external quality assurance results of Beijing Clinical Laboratory Center from 2019 to 2021.To evaluate the measurement uncertainty of 11 endocrine tests including free triiodothyronine(FT3),total triiodothyronine(TT3)and free thyroxine(FT4).Results The relative expanded uncertainties of 11 endocrine test items in laboratory were FT3:12.658％,TT3:13.372％,FT4:10.468％,total thyroxine(TT4):32.382％,thyroid stimulating hormone(TSH):8.594％,estradiol(E2):18.656％,follicle-stimulating hormone(FSH):14.650％,luteinizing hormone(LH):29.384％,progesterone(PRO):28.806％,prolactin(PRL):13.810％and testosterone(TESTO):31.610％.At the normal concentration level,the relative expanded uncertainties were FT3:12.424％,TT3:12.462％,FT4:8.606％,TT4:14.130％,TSH:12.536％,E2:19.586％,FSH:14.382％,LH:23.400％,PRO:38.346％,PRL:16.014％and TESTO:39.352％.The relative expanded uncertainties at high concentration levels are FT3:13.882％,TT3:14.096％,FT4:11.040％,TT4:8.614％,TSH:7.782％,E2:14.366％,FSH:13.436％,LH:14.804％,PRO:11.574％,PRL:17.742％,TESTO:39.322％.The relative extended measurement uncertainty of TT4,LH near low concentration levels,PRO near low and normal concentration levels,and TESTO near three concentration levels was higher than the target uncertainty(25％),and the remaining items are less than the target uncertainty.Conclusion The quality control data in the laboratory can reflect the measurement uncertainty of 11 endocrine detection items including FT3,TT3 and FT4 in Abbott i2000SR automatic chemiluminescence immunoassay analyzer,which has important clinical application value.

Objective To evaluate the clinical efficacy of enameloplasty sealant technique (EST) com-bined with fluoride releasing flowable resin in pit and fissure enamel caries.Methods A total of 247 young permanent molars diagnosed as early pit and fissure enamel caries from 125 children aged 6-12 years in Uru-mqi Stomatological Hospital were selected as the study subjects.They were divided into four groups:group A (conventional cleaning of pit and fissure+conventional sealant) 32 cases,62 teeth;group B (conventional cleaning of pit and fissure+fluorine releasing flowable resin) 29 cases,62 teeth;group C (EST+conven-tional sealant) 33 cases,62 teeth;group D (EST+fluorine releasing flowable resin) 31 cases,61 teeth.After 6 and 18 months of follow-up,the retention rate of sealants and rate of caries-free were compared among the various groups.Results After 6 months of follow-up,the retention rates of sealant in groups A,B,C and D were 75.00％,76.67％,93.33％ and 95.00％ respectively,and which after 18 months of follow-up were 45.76％,41.38％,71.93％ and 94.92％ respectively,and the differences were statistically significant (P<0.05).The results of further multiple comparisons showed that there were statistically significant differences in the retention rate of sealant between group A and group C,group B and group D after 6 and 18 months of follow-up (P<0.0083),moreover there was statistically significant difference in the retention rate of sealant between group C and group D after 18 months of follow-up (P<0.0083).After 18 months of follow-up,the rates of caries-free in groups A,B,C and D were 66.10％,63.79％,94.74％ and 98.31％,respectively.The re-sults of further multiple comparisons showed that the rates of caries-free between group A and group C,group B and group D were statistically significantly different (P<0.0083).Conclusion The retention rate of seal-ant and long-term caries prevention effect of adopting the EST in the treatment of pit and fissure enamel caries are superior to the conventional sealant technique.EST combining with fluorine releasing flowable resin could further increase the retention rate of sealant.

Objective:To explore the latent categories of outpatient nurses' conflict management styles and analyze their influencing factors.Methods:A total of 408 outpatient nurses from six hospitals of Jiangsu Province were selected as study participants by convenience sampling. Data were collected using a general information questionnaire, the Rahim Organizational Conflict Inventory Scale, the Nurse Burnout Scale, the Caring Ability Inventory Scale and the Wong and Law Emotional Intelligence Scale. Latent profile analysis was used to classify the conflict management styles of outpatient nurses, and logistic regression analysis was applied to identify the influencing factors of different categories.Results:A total of 408 questionnaires were distributed, and 372 valid responses were received, with an effective response rate of 91.18%. Outpatient nurses' conflict management styles were divided into two categories: the "Integration-Concession Group" and the "Dominance-Avoidance Group." Logistic regression analysis showed that being an only child, receiving interpersonal communication training, nurse burnout, humanistic care ability, and emotional intelligence were significant influencing factors of the latent categories of conflict management styles ( P<0.05) . Conclusions:There is heterogeneity in outpatient nurses' conflict management styles. It is recommended that nursing administrators adopt a comprehensive approach, conduct thorough assessments of nurses' general conditions and personality traits, guide nurses toward adopting positive conflict management methods, and enhance their abilities in problem-solving and conflict resolution. This can improve interpersonal relationships and work efficiency in medical settings, stabilize the outpatient nursing workforce, and improve the overall quality of nursing services.

ObjectiveTo explore the correlation among knee hyperextension angle, lower limb joints kinematics parameters and the activation of main muscles of lower limb in stroke hemiplegic patients with knee hyperextension during walking. MethodsFrom August, 2020 to September, 2021, 24 stroke hemiplegic patients with knee hyperextension and 24 healthy subjects matched with sex, age, height and body mass with knee hyperextension were analyzed with three-dimensional gait analysis system and the wireless surface electromyography acquisition system, to record the range of motion of pelvis, hip, knee and ankle joints in sagittal plane, and the activation of bilateral gluteus maximus, biceps femoris, vastus medialis and gastrocnemius medialis. ResultsAs the maximum of knee hyperextension, range of motion of the joints in sagittal plane and the activation of the muscles were different between the patients and the healthy subjects during the single-support phase of walking (|t| > 3.080, P < 0.01), and the maximum of knee hyperextension correlated with the activation of gluteus maximus in the patients (r = -0.532, P < 0.01), and the range of motion of ankle plantar flexion in both the patients and the healthy subjects (r > 0.686, P < 0.001). ConclusionThe correction for knee hyperextension gait in stroke hemiplegic patients may not only need to pay attention to knee joint control, but also need further treatment of ankle control and hip muscle function.

Objective:To evaluate the effect of white noise on reducing procedural pain of premature infants.Methods:Randomized controlled trials (RCTs) on the effect of white noise on reducing procedural pain in premature infants were searched for in PubMed, Embase, Web of Science, Cochrane Library, CINAHL, CNKI, VIP, Wanfang database and China Biology Medicine disc. The retrieval time was from the establishment of the databases to January 12, 2023. After independent literature screening, data extraction and bias risk assessment by two researchers, Meta-analysis was conducted using RevMan 5.3 software.Results:A total of 8 RCTs with 689 premature infants were finally included. The Meta-analysis results showed that compared with conventional procedures, the use of white noise alone could reduce the pain score ( SMD=-2.29, 95% CI: -2.78--1.79, P<0.000 01) in preterm infants during and after procedures ( SMD=-2.55, 95% CI: -4.52--0.58, P=0.01) , reduce the heart rate ( MD=-7.38, 95% CI: -7.97--6.80, P<0.000 01) during and after procedures ( MD=-10.36, 95% CI: -13.58--7.14, P<0.000 01) , and increase blood oxygen saturation during operation ( MD=3.78, 95% CI: 3.54-4.02, P<0.000 01) and after operation ( MD=2.19, 95% CI: 1.84-2.54, P<0.000 01) . Conclusions:White noise can effectively relieve the procedural pain of premature infants and maintain the stability of physiological indicators. In the future, more high-quality and large sample randomized controlled trials should be conducted to verify the application effect of white noise in relieving pain of premature infants.

Background Essential and non-essential elements have an important impact on the development of the central nervous system during fetal development. Due to their less developed brain, preterm infants are more sensitive to element exposure, and are high-risk groups of neurodevelopmental abnormalities. However, it is not clear whether the effects of element exposure in utero on postpartum neurodevelopment are different between full-term infants and preterm infants. Objective To evaluate the effects of element exposure levels during pregnancy on neurodevelopment of children aged 6-24 months (of corrected age), and compare the effects between preterm and full-term children. Methods A prospective study design was adopted and this study was conducted based on the Maoming Birth Cohort Study (MBCS) in Maoming City, Guangdong Province. Twenty elements in cord blood of 197 preterm infants and 297 full-term infants were measured, including 11 essential trace elements [vanadium (V), chromium (Cr), manganese (Mn), cobalt (Co), nickel (Ni), copper (Cu), zinc (Zn), selenium (Se), strontium (Sr), tin (Sn), and iron (Fe)], and 9 non-essential trace elements [aluminum (Al), arsenic (As), thallium (Tl), lead (Pb), uranium (U), cerium (Ce), antimony (Sb), cadmium (Cd), and yttrium (Y)]. The neurodevelopment of the children at 6, 12, and 24 months were evaluated by the Ages and Stages Questionnaires-the Third Edition (ASQ-3). A generalized estimating equation (GEE) model was adopted to evaluate the associations between elements and neurodevelopment in full-term and preterm children separately. Results The positive rates of 10 elements (Mn, Cu, Zn, Se, Sr, Fe, Sb, Tl, Pb, and As) in cord blood were greater than 80%. Among the preterm birth children, the results of GEE analysis showed that after adjusting for the covariates, for each increase of interquartile range (IQR) in ln-transformed concentration, As was associated with problems/delay in the communication and problem-solving sub-scales, with the adjusted odds ratios (OR) and 95% confidence intervals (CI) of 1.36 (1.03-1.80) and 1.55 (1.10-2.20), respectively; the adjusted OR (95%CI) of problems/delay in the fine motor and problem-solving sub-scales were 1.44 (1.00-2.07) and 1.76 (1.09-2.84) for Sb, respectively; the adjusted OR (95%CI) of problems/delay in the communication sub-scale was 1.37 (1.09-1.74) for Se. No statistically significant associations between umbilical cord blood element concentrations and neurodevelopment indicators were observed among full-term children. The results of stratified analysis by sex showed that the associations between umbilical cord blood element concentrations and neurodevelopment problems/delay were only significant among female preterm children. Conclusion Exposures to As, Se, and Sb during pregnancy may increase the risk of neurodevelopment problems/delay in preterm children aged 6-24 months, and female seem to be more vulnerable.

Diabetes have been shown to cause progressive neuronal injury with pain and numbness via advanced glycation end-products (AGEs)-induced neuronal cell apoptosis; however, the valuable drug targets for diabetic neuropathy have been poorly reported so far. In this study, we discovered a natural small-molecule schisandrol A (SolA) with significant protective effect against AGEs-induced neuronal cell apoptosis. ATP6V0D1, a major subunit of vacuolar-type ATPase (V-ATPase) in lysosome was identified as a crucial cellular target of SolA. Moreover, SolA allosterically mediated ATP6V0D1 conformation via targeting a unique cysteine 335 residue to activate V-ATPase-dependent lysosomal acidification. Interestingly, SolA-induced lysosome pH downregulation resulted in a mitochondrial-lysosomal crosstalk by selectively promoting mitochondrial BH3-only protein BIM degradation, thereby preserving mitochondrial homeostasis and neuronal cells survival. Collectively, our findings reveal ATP6V0D1 is a valuable pharmacological target for diabetes-associated neuronal injury via controlling lysosomal acidification, and also provide the first small-molecule template allosterically activating V-ATPase for preventing diabetic neuropathy.

We report the diagnosis and treatment of a rare case of epidural analgesia failure followed by postpartum subdural hematoma. The patient underwent vaginal delivery under epidural analgesia at 32 +6 gestational weeks due to threatened premature labor, during which an unexpected dural rupture occurred. She gave no history of headache and there was no obvious abnormality during the pregnancy. However, on postpartum day 4, the patient complained of headache that could not be relieved when supine, but without any other neurological symptoms. A prompt cranial CT examination showed a left frontotemporal subdural hematoma. After conservative management with intravenous drip of mannitol, re-examination of cranial CT showed that the left frontotemporal subdural hematoma was mostly absorbed and the patient was discharged on postpartum day 18. The patient was healthy during follow up. Intracranial subdural hematoma after dural puncture is a rare and serious complication that requires early recognition and treatment.

Objective:To investigate the serum measles antibody in children with tumor and to provide the clinical evidence for measles vaccination strategy for this special population.Methods:From January 2016 to December 2018, the blood samples of children who were diagnosed with hematological malignancy or solid tumors and received chemotherapy in the Department of Hematology or Oncology Surgery of Children′s Hospital of Fudan University were collected. Enzyme-linked immunosorbent assay was used to quantitatively detect the level of measles IgG antibody, and dynamically monitor the changes of measles antibody level during chemotherapy. Kruskal-Wallis test and chi-square test were used for statistical analysis.Results:A total of 441 children with tumors were enrolled, with the positive rate of measles antibody of 79.1%(349/441), and only 43.3%(191/441) of children had the protective level of IgG antibody. There was a statistically significant difference of the antibody protection rate in children aged0.05). The protection rate of serum measles antibody in children with hematological malignancy and solid tumor were 45.6%(78/171) and 41.9%(113/270), respectively, and there was no statistically significant ( P>0.05). There were 16.3%(16/98) of children who were observed to lose the pre-existing protective antibody during chemotherapy. There was no statistically significant difference of the protection rate of serum among children who had finished chemotherapy 0.05). Conclusions:Serum measles antibody is below the protective level in more than 50% of children with malignancy after chemotherapy. Chemotherapy can compromise the protective antibody against measles. It is recommended for this special population to re-schedule measles vaccine after individualized evaluation to acquire the immuneprotection against measles.

Objective:To summarize critical cases of emergency helicopter transferring between hospitals and improve the quality and safety of critical care.Methods:The task records of Guangxi Aviation Medical Rescue Training Base from September 2017 to September 2020 were retrieved. The mission acceptance, implementation results, disease spectrum composition, pre-transfer preparation and medical intervention on board were summarized.Results:① General information: a total of 168 patients of helicopter transfer requests were registered, of which 36 patients were transferred, 35 patients were successful, 1 patient had cardiac arrest during the landing phase, and died several hours after continuous resuscitation. Of the 36 patients 30 were males and 6 were females, with median age of 50.5 (29.8, 66.0) years old, the average transfer time was (54.95±17.89) minutes, and the average transfer distance was (205.74±74.68) km. ② Disease spectrum included 11 cases of stroke (30.55%), 7 cases of trauma (19.45%), 5 cases of severe pneumonia (13.89%), 5 cases of heart and macro-vascular diseases (13.89%), 5 cases of abdominal emergency (13.89%), and 3 other conditions (8.33%).③ Severity: 31 patients (86.11%) were severe (≥15) according to acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score; 19 patients (52.78%) were high-risk emergency transport (≥6) according to Hamilton early warning score (HEWS); 6 patients (85.71% of trauma patients) were severe trauma (≥16) according to injury severity score (ISS). ④ Preparation before transfer: remote consultation was carried out to evaluate the latest state of the patient's condition, especially the respiratory and circulatory conditions. Relevant items were reviewed and emergency treatments were implemented when necessary. Targeted preparation was made for accidents that might occur during transfer, such as electrocardiogram (94.44%), blood gas analysis (94.44%), brain CT (36.11%) and other auxiliary examinations, endotracheal intubation or tracheotomy (72.22%), deep vein catheterization (91.67%), placement of gastric tube (86.11%) and urinary tube (88.89%), adjustment of sedative (38.89%), vasoactive drugs (58.33%) and drugs for dehydration and lowering intracranial pressure (33.33%), and fixation of fracture (11.11%), etc. ⑤ On-board medical intervention: cardiac monitoring, blood pressure, respiration and blood oxygen monitoring were carried out in all patients. The parameters of patients using ventilator were adjusted in time (66.67%). The dosage of patients using micropump was adjusted in time (91.67%). Other aspects included the use of sedative and analgesics (38.89%), sputum suction nursing (75.00%), all kinds of catheter nursing (endotracheal intubation/incision nursing of 72.22%, indwelling catheter nursing of 88.89%), and cardiopulmonary resuscitation for patient with cardiac arrest (2.78%).Conclusion:As the patients transferred by helicopter are mainly those of critically ill at this stage, the requirements for airborne medical equipment and rescue technology are high, and there is an urgent need to establish technical specifications and personnel training standards.