Objective:To investigate the relationship between cardio-metabolic abnormalities in the first trimester and adverse pregnancy outcomes (APO).Methods:This cohort study recruited singleton pregnancies in the first trimester (6-13 +6 weeks of gestation) from Shenzhen Maternal and Child Health Care Hospital between January 1, 2021, and October 31, 2022. Cardiometabolic markers, including body mass index (BMI), blood pressure, fasting plasma glucose (FPG), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG), were recorded during the first trimester. Incidence of APO, including gestational hypertension, preeclampsia, gestational diabetes mellitus, preterm birth, fetal growth restriction, small for gestational age infant, and placental abruption, was documented. Cardiovascular metabolic abnormalities in the first trimester were defined as meeting one or more of the following criteria: elevated BMI (BMI≥24 kg/m2), elevated TG (TG≥1.7 mmol/L), decreased HDL-C (HDL-C<1.0 mmol/L), elevated blood pressure (systolic pressure≥130 mmHg (1 mmHg=0.133 kPa) and/or diastolic pressure≥85 mmHg), elevated FPG (FPG≥5.6 mmol/L). Enrolled women were categorized into abnormal cardio-metabolic and normal cardio-metabolic groups. Poisson regression was employed to analyze the association between cardio-metabolic abnormalities in the first trimester and APO. Results:The study included 14 197 pregnant women with an age of (32.0±4.1) years. There were 8 139 women in the normal cardio-metabolic group and 6 058 women in the abnormal cardio-metabolic group. Women with cardio-metabolic disorders in the first trimester had a younger gestational age and higher incidence rates of preterm birth, gestational hypertension, preeclampsia, and gestational diabetes mellitus (all P<0.05). In multivariable Poisson regression, elevated BMI ( RR=1.22, 95% CI 1.15-1.29), elevated FPG ( RR=1.59, 95% CI 1.38-1.82), elevated TG ( RR=1.22, 95% CI 1.13-1.31), and elevated blood pressure ( RR=1.50, 95% CI 1.39-1.63) were independent risk factors for APO, while decreased HDL-C ( RR=0.93, 95% CI 0.70-1.23) was not. Elevated blood pressure ( RR=5.57, 95% CI 4.58-6.78), elevated BMI ( RR=1.71, 95% CI 1.40-2.09), and elevated TG ( RR=1.38, 95% CI 1.10-1.74) had the greatest impact on the risk of developing preeclampsia. Elevated FPG ( RR=1.70, 95% CI 1.45-1.99) had the greatest impact on the risk of gestational diabetes. Conclusions:Elevated blood pressure, BMI, TG and FPG in the first trimester are closely related to APO.

Pulmonary blast injury has become the main type of trauma in modern warfare, characterized by externally mild injuries but internally severe injuries, rapid disease progression, and a high rate of early death. The injury is complicated in clinical practice, often with multiple and compound injuries. Currently, there is a lack of effective protective materials, accurate injury detection instrument and portable monitoring and transportation equipment, standardized clinical treatment guidelines in various medical centers, and evidence-based guidelines at home and abroad, resulting in a high mortality in clinlcal practice. Therefore, the Trauma Branch of Chinese Medical Association and the Editorial Committee of Chinese Journal of Trauma organized military and civilian experts in related fields such as thoracic surgery and traumatic surgery to jointly develop the Clinical treatment guideline for pulmonary blast injury ( version 2023) by combining evidence for effectiveness and clinical first-line treatment experience. This guideline provided 16 recommended opinions surrounding definition, characteristics, pre-hospital diagnosis and treatment, and in-hospital treatment of pulmonary blast injury, hoping to provide a basis for the clinical treatment in hospitals at different levels.

Objective:To explore the application of PDCA cycle combined with project management method in the assessment and management of special skills training in clinical skills center.Methods:From January to December in 2018, the PDCA cycle combined with project management method was used to manage the special skills training project team. The utilization rate of special skills simulation equipment before and after management was compared. A questionnaire survey was conducted to investigate the satisfaction with the management model among the students involved in the special skills training in 2018.The data was analyzed by SPSS 13.0.Results:The utilization rate of special skills simulation equipment was significantly improved, and the students were highly satisfied with the management model.Conclusion:Using PDCA cycle combined with project management method, this paper explores a management model of special skills training and assessment in clinical skills center, which improves the quality of special skills training and assessment management in clinical skills center, and is worthy of further exploration and practice.

Objective: To observe the clinical efficacy of different dialysis frequency and methods in the treatment of chronic renal failure uremia patients, and to provide a reliable reference for clinical practice. Methods: From February 2016 to February 2017, 140 chronic renal failure uremic patients who admitted to the Department of Nephrology at Taizhou Central Hospital were selected and divided into the observation group and the control group by complete random distribution method, with 70 cases in each group.The patients in the control group received 3 times of regular hemodialysis treatment per week, while the observation group received 3 times of regular hemodialysis combined with 1 time of hemodiafiltration treatment per week.The clinical treatment effects and complications of the two groups were compared. Results: Compared with blood uric acid(BUA)[(532.09±71.05)mmol/L], serum creatinine(Scr)[(734.34±63.08)μmol/L], blood urea(BUN)[(23.84±2.58)mmol/L], serum phosphorus[(1.98±0.37)mmol/L], parathyroid hormone(PTH)[(464.37±113.92)ng/L], β₂ microglobulin(β₂-MG)[(13.48±6.38)mg/L]in the control group, BUA[(495.89±58.23)mmol/L], Scr[(684.34±77.32)μmol/L], BUN[(20.62±1.77)mmol/L], serum phosphorus[(1.74±0.44)mmol/L], PTH[(352.14±123.25)ng/L], β₂-MG[(9.58±5.45)mg/L] were significantly lower in the observation group, the differences were statistically significant (t=3.29, 4.19, 8.61, 3.49, 5.59, 3.88, all P<0.01). Compared with the incidence rate of pruritus in the control group(61.43%), the incidence rate of pruritus in the observation group(34.29%) was significantly lower (χ²=9.72, P<0.01), the incidence of other complications had no statistically significant differences(χ²=1.14, 1.58, 3.08, all P>0.05). Conclusion Hemodialysis 3 times combined with 1 time of hemodiafiltration per week has significant advantage in the treatment of chronic renal failure uremia patients, which can effectively remove urine toxin molecules and reduce the incidence of complications, and it is worthy of clinical application.

Objective: To understand the status of constipation, anxiety and depression among patients with placenta previa and to explore the relationship between them, in order to identify early predictor of constipation. Methods: Zung′s Self-Rating Anxiety Scale (SAS) and Zung′s Self-Rating Depressive Scale (SDS) were applied among 92 patients with placenta previa. Finally, 83 valid questionnaires were recovered. Results: The incidence of anxiety and depression were 50.6%(42/83) and 33.73%(28/83) respectively within 48 hours of hospitalization and the incidence of constipation was 71.08%(59/83) within three days in hospital. The incidence of constipation in emotional disorder group were greater than that in non-emotional disorder group (χ²=11.97, 6.81, P < 0.01). The degree of anxiety and depression were positively correlated with the occurrence of constipation (r=0.48, 0.35, P < 0.01 or 0.05). The correlation of anxiety and constipation was higher. Conclusions The heavier degree of negative emotions, the higher occurrence of constipation in patients with placenta previa during hospitalization. Anxiety can be used as an early predictor of constipation.

Objective:To explore the effects of Bailing capsules combined with salvianolate on inflammatory cytokines, renal vas-cular endothelia and renal function in diabetic nephropathy inⅣphase. Methods:Totally 60 patients with diabetic nephropathy in IV phase were randomly divided into the control group (30 cases) and the treatment group (30 cases). The control group was given the conventional and salvianolate therapy, and the treatment group was treated with Bailing capsules additionally. The treatment course was 3 months. The changes of serum creatine(SCr), urean itrogen (BUN), creatinine clearance rate (Ccr), ethelin (ET-1), interleukin-6 (IL-6), tumor necrosis factor (TNF-a) and C-reactive protein (CRP) were detected before and after the treatment. Results:After the 3-month treatment, SCr, BUN, IL-6, TNF-a, CRP and ET-1 were significantly decreased in the two groups with statistical signifi-cance, and Ccr was significantly increased in the treatment group (P<0. 05), and the changes in the treatment group were significant-ly better than those in the control group (P<0. 05). After the treatment, the blood glucose, blood lipids, glycosylated hemoglobin and the other indicators had no significant changes in the two groups (P>0. 05). There was no significant difference in the incidence of adverse drug reactions between the two groups (P>0. 05). Conclusion:The combination of Bailing capsules and salvianolate can re-duce the inflammatory reaction and improve renal vascular endothelial function and renal function in the patients with diabetic nephrop-athy in Ⅳ phase with promising safety and few adverse reactions.

Objective To investigate the effect of ultrashort wave therapy on edema and inflammatory reaction after spinal cord injury (SCI) in rats. Methods 56 Sprague-Dawley rats were divided into sham-operated group (n=8), model group (n=24) and ultrashort wave group (n=24). The model was established with Allen's method. The sham-operated group was exposed endorhachis without hit. The ultra-short wave group was exposed to ultrashort wave radiation 7 minutes, once a day, 24 hours after modeling until the animals were sacrificed. Locomotors functional recovery was assessed every week post operation period by BBB score. Immunohistochemical staining was per-formed to observe the expression of the aquaporin-4(AQP-4) and ED-1. Results The BBB scores increased in the model group and the ultra-short wave group after treatment, and was higher in the ultrashort wave group than in the model group from 1 week after treatment (t>3.368, P<0.01). The expressions of AQP-4 and ED-1 were higher in the model group and ultrashort wave group than in the sham-operated group, and decreased as time went on. They were lower in the ultrashort wave group than in the model group(t>3.156, t>4.466, P<0.05). Conclu-sion Ultrashort wave therapy can alleviate the edema after SCI, reduce the activation and infiltration of inflammatory cells, and promote the recovery of neurological function.

Objective To investigate the effects of bone marrow stromal cells(BMSCs)transplantation combined with low dose ultrashort wave (USW)radiation on functional recovery and the expression of glial fibrillary acidic protein(GFAP)and ED?1 after spinal cord injury(SCI)in rats,and further discuss its action mechanism. Methods Female Sprague?Dawley rats(n=30)were randomly divided into 5 groups:sham?oper?ated,as well as control,USW,BMSCs,and USW+BMSCs that were subjected to spinal cord injury(SCI). Basso?Beattie?Bresnahan(BBB)tests were carried out before the operation and at 1 d,1 week,2 weeks,3 weeks,4 weeks after SCI. 4 weeks later,animals were sacrificed and tissues were collected to make paraffin section. Immunohistochemical staining was performed to observe the expression of GFAP and ED?1. Results 4 weeks after SCI,BBB scores were significantly higher in the USW and USW+BMSCs groups than in the control group(both P<0.001). No signifi?cant difference was observed between the BMSCs group and control group. On the expression of GFAP ,only USW+BMSCs group showed signifi?cantly decreased compared with the control group(P<0.05). All treatment groups exhibited lower ED?1 expression than the control group(all P<0.05). Conclusion Our results indicate that USW radiation alone can obviously improve neural functional recovery after SCI. The USW radi?ation and BMSCs transplantation treatment can reduce inflammation ,and USW radiation is more effective. The combination therapy did not show a synergistic action on promoting functional recovery ,but do have an effect on reducing the inflammatory response and glial scar formation.

Objective:To explore the therapeutic effect on blood glucose, lipid, and renal function of Bailing capsules combined with calcium dobesilate dispersible tablets in the treatment of diabetic nephropathy. Methods: Totally 216 patients with diabetic ne-phropathy in phase Ⅳ were randomly divided into the control group (108 cases) and the treatment group (108 cases). The control group was given the conventional therapy, and the treatment group was treated with Bailing capsules combined with calcium dobesilate dispersible tablets additionally. The levels of serum creatine (Scr), urean ntrogen (BUN), endothelin (ET-1), β2-microglobulin (β2-MG) ,cystatin C ( CYC) and urinary albumin excretion rate ( UAER) were detected for all the patients before and after the treat-ment. The adverse drug reactions were observed as well. Results:After the treatment, all the indices in the two groups were all obvi-ously decreased (P<0. 05), and those in the treatment group were significantly lower than those in the control group (P<0. 05). There were no significant changes in blood glucose, blood lipid and glycosylated hemoglobin before and after the treatment in the two groups (P>0. 05). The adverse drug reactions showed no significant differences between the two groups (P>0. 05). Conclusion:The effect of Bailing capsules combined with calcium dobesilate dispersible tablets is better than that of calcium dobesilate dispersible tablets in the treatment of diabetic nephropathy in phase IV, which can improve the renal function indices with high safety and without notable influence on blood glucose and lipid.

BACKGROUND: The nano-hydroxyapatite/bacterial cellulose (nHAP/BC) nanocomposites has a good prospect of application in bone tissue engineering, and the bone tissue engineered materials and its degradation products Should have excellent compatibility. This study further assessed DAN synthesis cycle using flow cytometry on the basis of evaluating cell compatibility by metabolic 3-(4, 5-dim ethylthiazo 1-2-y 1) -2, 5-Dipheny 1-2H-tetrazolium (MTT) assay. OBJECTIVE: To evaluate the cytocompatibility of a new-pattern nHAP/BC nanocomposites and its residues. METHODS: Effects of nHAP/BC nanocomposites and its residues on morphclogicel changes in osteoblasts were observed using in vitro cell culture method. Effects of nHAP/BC nanocomposites and its residues on osteoblast growth and prclifera'don were evaluated by MTT assay. Cell cycle phase changes were detected using flow cytometry to evaluate matsdal effects on cell proliferation on molecular levels. RESULTS AND CONCLUSION: The nHAP/BC nanocomposites and its residues had neither remarkable effects on cell morphology, nor significant inhibition on osteoblast growth and proliferation. Test of MTT cytotoxicity showed that the average cell proliferation rate was over 80% after treated with the material and its residues, with the cytotoxity grade of 1 (non-toxic). Flow cytometry indicated that the rate of G_0/G_1 was reduced, and the rates of S, G2/M were increased, and the synthesis of DNA was increased, the cellular growth and repair in osteoblasts was accelerated. These indicated that nHAP/BC nanocomposites have good cytocompatibility, and it will be safe and prospected scaffolds in bone tissue engineering.