Abstract:Objective:　To investigate the involvement of diazepam binding inhibitor (DBI) in the regulation of anabolic steroid hormone gene expression in trophoblast cells. Methods:　Villous tissues, from the 6th to the 8th week of gestation, were obtained from normal pregnancy and spontaneous abortion. Immunohistochemistry was used to determine the protein expression and localization of DBI in the tissues while Western blot was used to compare the protein expression of DBI between the two groups. Immunofluorescence was used to determine the protein expression of DBI in BeWo cells. Fusion of BeWo cells was induced with forskolin, and siRNA-mediated knockdown of DBI was used to determine the effect of DBI on the expression of the anabolic hormones. The mRNA expression of hormone synthase was detected by RT-qPCR, and the proliferation ability of the BeWo cells was determined by the EdU kit. Results:　The expression of DBI in the spontaneous abortion villous tissues was lower than that in the normal group. Forskolin treatment induced the expression of DBI, while DBI knockdown inhibited the expression of P450scc, HSD3β1 and CYP19A1, and upregulated hormone synthetase. Also, the number of proliferating si-DBI BeWo cells was decreased. Conclusion:　DBI may affect trophoblast anabolic hormone gene expression by regulating P450scc. This suggests that downregulation of DBI in the placenta might associate spontaneous abortion.

Abstract:Objective:　To investigate the effect of the plant extract resveratrol on autophagy of granulosa cells in the rats with polycystic ovarian syndrome (PCOS) and to explore its mechanism of action. Methods:　Forty female SD (Sprague Dawley) rats were randomized into two groups: PCOS model group (n=30) and model control group (n=10). PCOS granulosa cells identified and confirmed by immunocytochemistry were cultured in vitro, and dealt with different concentrations of resveratrol, and the changes of cell proliferation rate were observed by CCK-8. Electron microscope was used for the changes of autophagy level in granular cells. Western blot was used to detect the expression of light chain 3Ⅰ (LC3Ⅰ), light chain 3Ⅱ (LC3Ⅱ), Beclin1, total (phosphorylated) protein kinase B[T (p) -Akt], and total (phosphorylated) mammalian target of rapamyoin [T (p) -mTOR], and the expression of these proteins in cells after the action of Akt inhibitor LY294002 was detected. Results:　Compared with the model control group, the immunocytochemical results showed that the expression of follicle-stimulating hormone (FSH) in ovarian granulosa cells in the model group was significantly enhanced, which indicated that the model was successfully constructed and isolated. The CCK-8 results showed that resveratrol could improve the proliferation rate of granulosa cells, with concentration-time dependence. The Western blot results showed that resveratrol could decrease the expression of LC3Ⅰ, LC3Ⅱand Beclin1, but increase the protein expression of p-Akt and p-mTOR. After LY249002 treatment, the expression of LC3I, LC3Ⅱand Beclin1 increased significantly, while the expression of p-Akt and p-mTOR decreased significantly. Conclusion:　Resveratrol can significantly reduce the autophagy level of ovarian granulosa cells in PCOS and affect the cell proliferation rate, and its mechanism may be closely related to the upregulation of Akt/mTOR.

Abstract:Objective:　To explore if any difference exists in genotypic distribution and allele frequency of sFlt-1 gene rs4769613 loci polymorphism in patients with preeclampsia (PE) at relatively low and high altitudes in Yunnan Province. Methods:　A total of 124 pregnant women of Han nationality who gave birth in the obstetrics department of Yunnan First People's Hospital from January 2018 to December 2019 were selected as the low altitude group, including 61 PE pregnant women and 63 normal full-term pregnant women, and 122 pregnant women of Han nationality who gave birth in the obstetrics department of Diqing Tibetan Autonomous Prefectural People's Hospital during the same period, including 61 PE pregnant women and 61 normal full-term pregnant women were selected into the high altitude group. We investigated the genotypic distribution and allele frequency of sFlt-1 gene at rs4769613 locus by performing TaqMan probe real-time fluorescence PCR on them. Results:　Firstly, we did find rs4769613 loci polymorphism of sFlt-1 gene in PE and control groups for both low and high altitude of Yunnan. Secondly, TT, CC and TC genotype in PE group at high altitude accounted for 18.03% (11/61), 29.51% (18/61) and 52.46% (32/61) respectively. Compared to control group at high altitude, TT, CC and TC genotype frequency accounted for 34.43% (21/61), 21.31% (13/61) and 44.26% (27/61). In the PE group at low altitude, TT, CC and TC genotype accounted for 13.11% (8/61), 27.87% (17/61) and 59.02% (36/61) respectively, and in the control group at low altitude, TT, CC and TC genotype accounted for 30.16% (19/63), 25.40% (16/63) and 44.44% (28/63). Thirdly, TT genotype distribution in the PE group were significantly lower than that in the control group (18.03% vs.34.43%, P=0.039, OR=0.419, 95%CI=0.181-0.970), but there were no significant differences in CC and CT genotype between the PE group and the control group at high altitude area. The TT genotype distribution in the low altitude PE group were significantly lower than that in the control group (13.11% vs.30.16%, P=0.021, OR=0.349, 95%CI=0.139-0.875), but there was no significant difference in CC and CT genotype between the low altitude PE group and the low altitude control group. There were no significant differences in the expression of TT, TC and CC genotype between PE group at high altitude and control group at low altitude. Conclusion:　The SNP rs4769613 C>T of sFlt-1 gene may be related to the pathogenesis of PE in pregnant women, and the TT genotype of sFlt-1 gene may have protective effect on PE in pregnant women at Yunnan Plateau. There was no significant difference in the genotype distribution and allele frequency of The SNP rs4769613 of sFlt-1 gene between pregnant women with PE nor normal pregnant women in Yunnan Plateau.

Abstract:Objective:　To explore significant differentially expressed genes (DEGs) through bioinformatics in tobacco exposed pregnant women and find Hub genes by analyzing and predicting the involved function of DEGs. Methods:　The human mRNA gene chip dataset GSE30032 was extracted from common gene chip data platform of gene expression omnibus (GEO). GEO2R analysis was performed to obtain DEGs, gene ontology (GO) and kyoto encyclopedia of genes and genomes (KEGG) signal pathway enrichment analysis were performed on the basis of DAVID database, the cytoscape software was used to construct the pathway network and GeneMANIA database was utilized for further protein interaction analysis. Results:　A total of 34 DEGs were screened, of which 24 mRNAs were up-regulated and 10 mRNAs were down-regulated (FC≥1.5&P<0.05). GO analysis indicated that several functional pathways, such as positive regulation of transcription (P=0.009) and cellular response to iron ion (P=0.013) were enriched, and KEGG analysis showed the DEGs were enriched in prostate cancer (P=0.016) and hepatitis B (P=0.038) KEGG pathways. Eight genes including CDKN1A, SFN, TFAP2A and others were identified as Hub genes. GeneMANIA database showed that protein co-expression and physical interactions were the primary interaction pattern, accounting for 91.62%. Conclusion:　This paper effectively screens and analyzes DEGs after pregnant women exposing to tobacco via various databases, providing thoughts for further investigating tobacco-functioned targets and molecular mechanism.

Abstract:Objective:　To investigate the influence of moderate-severe ovarian hyperstimulation syndrome (OHSS) on terminal singleton and twin pregnancy outcome of in vitro fertilization and embryo transfer (IVF-ET). Methods:　A total of 260 patients underwent IVF-ET in our department from January 2008 to December 2015 were selected and clinical data and pregnancy outcome of 115 patients with moderate-severe OHSS were retrospectively analyzed. A total of 156 patients underwent IVF-ET according to age, cause of infertility and the number of mature oocytes, and did not develop OHSS within the fresh transplantation cycle were selected as the control group. According to the newborn amount, patients were divided into the singleton group and twin group, indicators including age, infertility duration, body mass index (BMI), basic of follicle-stimulation hornone (bFSH), total Gn amount, serum estradion (E2) on the day of human chorionic gonadotropin (HCG), the number of retrieved oocytes, 2PN number, high quality embryos, endometriai thickness on the day of embryo transfer, transferable embryos, gestational age of delivery, birth weight, preterm birth rate, cesarean section rate, small for gestation age infant (SGA), and morbidity of pregnancy complications (including, gestational diabetes mellitus, gestational hypertension, postpartum hemorrhage, placenta previa and placenta increta rate) between two groups were compared. Results:　E2 level on the day of HCG and SGA rate in the singleton groupwere higher than that in the non OHSS group, with statistically significant difference (P=0.00, P=0.00). BMI in the OHSS group was lower than that in the non-OHSS group, with statistically significant difference (P=0.00). General data and pregnancy outcome in two groups had no significant differences. Conclusion:　Moderate-severe OHSS can increase the risk of SGA in singleton pregnancy; moderate-severe OHSS has no obvious influence on terminal pregnancy outcome of twin pregnancy.

Abstract:Objective:　To establish the reference value range of trimester-specific thyroid hormone in pregnant women in our hospital, and to explore the impact of chronic lymphocytic thyroiditis (Hashimoto's thyroiditis) and hypothyroidism on pregnancy outcome. Methods:　Levels of thyroid stimulating hormone (TSH), free thyronine (FT4) and free triiodothyronine (FT3) of pregnant women in our hospital from January 2018 to June 2019 were retrospectively collected and reference value ranges of different indexes in different trimesters were established. In addition, the pregnancy outcomes and neonate status of chronic lymphocytic thyroiditis, pregnancy hypothyroidism (TPO-Ab and TG-Ab negative) and normal pregnant women were retrospectively compared. Results:　①There were 1 216 women in the first trimester, 646 in the second trimester and 1287 in the third trimester. The reference value range of serum TSH in three trimesters were 0.04-3.73 μIU/mL, 0.10-4.03 μIU/mL and 0.68-4.32 μIU/mL, respectively; FT4 were 13.2-23.0 pmol/L, 9.8-17.4 pmol/L and 10.7-20.1 pmol/L; FT3 were 3.8-6.2 pmol/L, 3.3-5.7 pmol/L and 3.1-5.0 pmol/L.②There were 182 women in the Hashimoto's group, 180 in the hypothyroidism group and 180 in the normal control group. For the comparison of previous abortion rate in three groups, there were 38 patients (31.4%) in the the Hashimoto's group, which were significantly higher than 19 patients (17.4%) of the hypothyroidism group and 5 patients (4.8%) of the normal group, with statistically significant difference (P<0.05).③In the Hashimoto's thyroiditis group, 12 women had premature birth (6.6%) and 41 women had gestational diabetes mellitus (22.5%), which were higher than those in the antigen-negative hypothyroidism group (n=5, 2.8%; n=30, 16.7%) and in the normal group (n=3, 1.7%; n=20, 11.1%), with statistically significant differences (P<0.05).④In the Hashimoto's group, 12 women (6.6%) had fetal growth restriction, which was higher than that in the hypothyroidism group (n=4, 2.2%) and the normal group (n=2, 1.1%), with statistically significant differences (P<0.05). But there were no significant differences in birth weight, body length, Apgar score and blood gas analysis of pH and BE among three groups (P>0.05). Conclusion:　The reference value range of thyroid function differs in different gestational periods. Therefore, establishing a reference range suitable for specific thyroid hormone is essential for screening and diagnosing thyroid diseases. Pregnancy complicated with chronic lymphocytic thyroiditis will increase the risk of miscarriage, premature delivery, gestational diabetes mellitus and fetal growth restriction. In order to diagnose thyroid diseases early and reduce the risk of adverse pregnancy outcome, diagnosis and treatment of Hashimoto's thyroditis and screening thyroid function and TPO-Ab and TG-Ab are essential during pregnancy.

Abstract:Objective:　To investigate the expression and significance of Fibrillin-1, Fibulin-5 and lysyl-oxidase-1 (LOXL-1) on the anterior vaginal wall in patients with pelvic floor organ prolapse. Methods:　A total of 108 patients with pelvic floor organ prolapse who underwent surgery in our hospital from January 2018 to February 2019 were selected as the observation group, including 67 patients with POP-Q ofⅡdegree and 41 patients with POP-Q ofⅢdegree. At the same time, 92 patients with cervical intraepithelial neoplasia or gynecological benign lesions who underwent total hysterectomy were selected as the control group. The tissue of anterior vaginal wall was taken. The expression of Fibrillin-1, Fibulin-5 and LOXL-1 was detected by immunohistochemistry; the expression level of Fibrillin-1, Fibulin-5 and LOXL-1 mRNA in the tissue samples were quantitatively measured by RT-PCR, and then were compared and analyzed. Meanwhile, the relationship of Fibrillin-1, Fibulin-5 and LOXL-1 was analyzed. Results:　The positive expression rate of Fibrillin-1, Fibulin-5 and LOXL-1 in the observation group was significantly lower than that in the control group, and the difference had statistical significance according to chi-square test and t test (all P=0.000). The positive expression rate Fibrillin-1, Fibulin-5 and LOXL-1 protein and the relative expression of mRNA in patients with POP-Q ofⅡdegree were higher than those in patients with POP-Q ofⅢdegree, and the difference had statistical significance by chi-square test and t test (P=0.031, P=0.017, P=0.008, P=0.000, P=0.000, P=0.013, respectively). The expression of Fibrillin-1 and Fibulin-5, Fibrillin-1 and LOXL-1, and Fibulin-5 and LOXL-1, and relative mRNA expression in the anterior vaginal wall of POP patients were significantly positively correlated according to Spearman rank correlation and Pearson correlation (all P=0.000). Conclusion:　The expression of Fibrillin-1, Fibulin-5 and LOXL-1 in vaginal tissues of patients with pelvic floor organ prolapse is decreased, which is closely related to the degree of prolapse, and the correlation among them is significant through the cross linking.

Abstract:Objective:　To explore the risk factors of early pelvic floor dysfunction (PFD) in healthy maternal women. Methods:　Glazer protocol was used to evaluate the pelvic floor function of the healthy puerpera who came to Chongqing Health Center for Women and Children from January 2018 to July 2019, and logistic regression analysis of single factor and multi factor was conducted to analyze the possible risk factors. Results:　Compared with cesarean section, the risks of pelvic floor overactivity in vaginal delivery (with or without aspirator or forceps) were significantly lower in the pre and post rest stage (P=0.000), but the risks of fast muscle strength, slow muscle strength and endurance damage were significantly increased in vaginal delivery (P=0.000); compared with women with fetal birth weight≥4 000 g, the risk of fast muscle damage in women with infant birth weight less than 4 000 g was significantly lower (P=0.004); compared with women with perineum muscle damage in childbirth, the risk of fast muscle damage in women without perineum muscle damage was significantly lower (OR=0.815, 95%CI=0.683-0.973). Conclusion:　Cesarean section or vaginal delivery may cause early postpartum pelvic floor dysfunction, and cesarean section has no obvious protective effect on pelvic floor muscle. Infant overweight and perineum muscle damage during delivery are also independent factors leading to early pelvic floor dysfunction.

Abstract:Polycystic ovary syndrome (PCOS) is a disease related to female endocrine metabolism. Its main clinical manifestations are menstrual disorder, hyperandrogenemia, insulin resistance and polycystic ovarian changes. In recent years, relevant scholars have conducted in-depth studies on the relationship between vitamin D and the development of PCOS, and found that the vitamin D content in the body can affect the metabolic disorder, reproductive dysfunction, and other symptoms of PCOS. Vitamin D supplementation is beneficial to improve the symptoms of PCOS. In this paper, the relationship between vitamin D and PCOS is reviewed.

Abstract:The human-derived tumor xenografts (PDX) model can retain the original tumor heterogeneity and the microenvironment of tumor growth. It has a high degree of similarity with the patient's tumor tissue in histopathology and molecular phenotype, which can reflect the patient's clinical outcomes very well, more accurately predict the clinical efficacy of new drugs, and provide a reliable preclinical model for patients with urinary tract tumors including renal carcinoma, bladder cancer, and prostate cancer, especially for the study of drug-resistant relapse and metastatic tumors after clinical treatment. The PDX model is of great significance in the application of new drug development, biomarker screening, personalized treatment, and so on, which has laid the foundation for the research of urological tumor precision medicine and translational medicine. This article has reviewed the progress in the construction and application of PDX model in urological tumors.

Abstract:Due to the changes of living habits and diet structure, the number of obese people in the world is increasing gradually, and the proportion of obese people in developing countries is also increasing greatly. Obese people have unbalanced energy intake, excessive obesity accumulation, interfering the normal metabolism of human body, and causing cardiovascular diseases and metabolic syndrome. And the obesity can cause systemic and local inflammatory response, excessive oxidative stress and apoptosis, and damage the internal environment of spermatogenesis and maturation by affecting male reproductive endocrine regulation, resulting in male sexual dysfunction, decreased sperm quality and fertility.

Abstract:Objective:　To explore differentially expressed genes of adrenal cortical carcinoma (ACC) through bioinformatics, so as to provide new biomarkers for diagnosing ACC. Methods:　Gene data sets of GSE14922, GSE19776 and GSE12368 were selected from the GEO database, and the differentially expressed genes of adrenocortical carcinoma tissues and normal adrenal tissues were screened by GEO2R tool online analysis. DAVID and STRING online databases were used to online analyze differentially expressed genes and construct a protein-protein interaction network. Cytoscape software was used to screen for hub genes. GEPIA was used to analyze the relationship between hub genes and ACC prognosis. Results:　A total of 229 differentially expressed genes were screened out, of which 51 genes were up-regulated and 178 genes were down-regulated. Analysis showed that they were significantly enriched in the cell cycle and P53 signaling pathway and its molecular functions were mainly related to cytoskeletal protein combination and growth factor binding function. MCC selected eight key genes, namely cyclinB1 (CCNB1), cyclinA2 (CCNA2), cyclin-dependent kinases (CDK1), three-protein kinase BUB1 beta (BUB1B), mitotic arrest deficient 2 like 1 (MAD2L1), ribonucleotide reductase M2 (RRM2), targeting protein for xenopus kinesin-like protein 2 (TPX2) and aurora kinase A (AURKA); GEPIA online database was used to verify they were highly expressed in ACC and were closely related to the overall survival rate and disease-free survival rate of ACC patients. Conclusion:　Eight genes, including CCNB1, CCNA2, CDK1, BUB1B, MAD2L1, RRM2, TPX2 and AURKA, may be used as new biomarkers to assist the diagnosis and treatment of ACC.

Abstract:Objective:　To analyze the clinicopathological characteristics of bladder cancer with diabetes mellitus, and to provide reference for the clinical diagnosis and treatment of bladder cancer. Methods:　The data of patients with primary urothelial bladder cancer treated in urology department of Xijing Hospital from January 2014 to February 2019 were collected retrospectively. Patients with diabetes mellitus were classified as diabetic group (DM group) and patients without diabetes mellitus were classified as non-diabetic group (No-DM group). The clinical and pathological characteristics of the patients were analyzed. Results:　The age and the proportion of hypertension in DM group were higher than that in No-DM group, with statistical significance (P<0.05). There was no significant difference between the two groups in the constituent ratio of clinical characteristics such as gender, education level, smoking, drinking, body mass index (BMI), complaint symptoms, course of disease, urinary tract infection and hyperplasia of prostate (P>0.05). There was significant difference in the constituent ratio of tumor grade between the two groups (P=0.007), and the proportion of high grade carcinoma in DM group (52.8%) was higher than that in No-DM group (34.2%). There was no significant difference in tumor stage, tumor number and tumor size between the two groups (P>0.05). Multivariate logistic regression analysis showed that age (P<0.05), course of disease (P=0.045) and diabetes mellitus (P=0.026) were independent influencing factors of cancer grade, while gender, smoking, drinking, hypertension and BMI had no statistical significance in malignant grade of bladder cancer (P>0.05). Conclusion:　Age, course of disease and diabetes mellitus were independent factors influencing the pathological grade of bladder cancer. We should pay attention to the diagnosis and treatment characteristics of bladder cancer patients with diabetes mellitus, which has a certain positive significance for improving its prognosis.

Abstract:Objective:　To construct a tissue-engineered bladder patch with multilayer structure and abundant vascularization on the basis of bladder acellular matrix (BAM) combined with various cells wrapped up in omentum. Methods:　Bone marrow mesenchymal stem cells (BMSCs), bladder epithelial cells and bladder smooth muscle cells of rabbits were seeded on the surface of BAM at 1.0×10⁶cells/mL, respectively. After 10 days of cultivation, bladder epithelial cells-smooth muscle cells-BMSCs-BAM tissue engineered bladder patch was prepared. In the experimental group, tissue engineered bladder patch were wrapped on silica gel catheter and implanted into rabbit omentum for culture. In the control group, BAM patch was wrapped on silica gel catheter and implanted into rabbit omentum for culture. Samples in two groups were taken for immunohistochemistry after 4 weeks and 8 weeks respectively. The epithelial layer was detected by CKAE1/AE3 antibody, the smooth muscle layer was detected by α-SMA antibody and the angiogenesis was detected by CD31 antibody. Results:　After 4 weeks, epithelial layer and smooth muscle layer were formed in the experimental group, and obvious neovascularization were found in the bladder patch and CKAE1/AE3, α-SMA and CD31 were expressed positively. After 8 weeks, the epithelial layer and smooth muscle layer in the experimental group became thicker, and the blood vessels became denser and thicker. However, the BAM patch in the control group had only minute angiogenesis, without epithelial layer and smooth muscle layer. Conclusion:　Tissue engineered bladder patch with multilayer structure and abundant vascularization can be constructed by BAM combined with bladder epithelial cells, smooth muscle cells and BMSCs and wrapped up in omentum.

Abstract:Objective:　To investigate the recent and mid-term pulmonary function changes in neonates with congenital diaphragmatic hernia repair. Methods:　From January 2009 to March 2016, the clinical data and follow-up data of postoperative pulmonary function of children who underwent congenital diaphragmatic hernia repair in our hospital were collected, and 27 valid reports were obtained. According to different lung function measurement methods, they were divided into infant group (aged 0-3 years, 12 cases were measured by tidal volume analysis and infant box test) and older children group (aged over 3 years, 15 cases were measured by mandatory breath measurement). Healthy infants (12 cases) aged 0 to 3 years were selected as the infant control group. Results:　For the infant group, tPTEF% tE, VPEF% VE, Ratio tI to tE and TEF 25% were lower than those in the infant control group. For the older children group, FEV1/FVC, PEF and MEF75 of the children were within the normal range, but lower than the normal predicted values (P<0.01). Conclusion:　Pulmonary function test shows obstructive lesions of the small airway in the neonates with congenital diaphragmatic hernia repair. The pulmonary function improves with the increase of age, and becomes normalized in older children, whereas there are some values still a little lower than predicted values.

Abstract:Objective:　To investigate the effect of renal sympathetic denervation (RDN) on the morning blood pressure surge in patients with primary hypertension. Methods:　A total of 161 patients diagnosed with hypertension in our hospital from January 2017 to June 2019 were collected in this study. According to levels of the morning blood pressure surge, the patients were divided into the morning blood pressure surge group and non-morning blood pressure surge group. All patients were treated with RDN. The morning blood pressure surge before treatment and 1 d, 3 d, 7 d, 1 month, 6 months and 12 months after treatment of the two groups, and 24 h average systolic blood pressure and diastolic blood pressure; the renal function indicators [blood urea nitrogen (BUN), creatinine (Cr), estimated glomerular filtration rate (eGFR)] before treatment and 1 month after treatment; the quality of life before and 6 months after surgery [the short form 36 health survey (SF-36)]; and adverse reactions after surgery were recorded and compared within the 2 groups. Results:　Before the treatment, compared with the non-morning blood pressure surge group, the BUN and Cr were significantly increased (P<0.05), and the eGFR was significantly decreased (P<0.05) in the morning blood pressure surge group. After the treatment, the BUN and Cr were significantly reduced (P<0.05), the eGFR was increased (P<0.05) in both groups. There was no significant differences in BUN, Cr and eGFR between the 2 groups (P>0.05). Before treatment, compared with the non-morning blood pressure surge group, the morning blood pressure surge, systolic and diastolic blood pressure of the morning blood pressure surge group were significantly higher (P<0.05). After treatment, the morning blood pressure surge, systolic and diastolic blood pressure of 2 groups were significantly reduced (P<0.05). There was no significant differences in the morning blood pressure surge, systolic and diastolic blood pressure between the 2 groups (P>0.05). Before treatment, compared with the non-morning blood pressure surge group, the SF-36 of the morning blood pressure surge group was significantly reduced (P<0.05). After treatment, the SF-36 of 2 groups were significantly increased (P<0.05). There was no significant differences in the SF-36 between 2 groups (P>0.05). Both groups were followed up for 12 months after the surgery, a few cases had renal artery stenosis and hematoma after RDN, which were cured after symptomatic treatment. Conclusion:　RDN can effectively reduce the morning blood pressure surge, systolic and diastolic blood pressure in hypertension patients, and significantly improve the renal function and quality of life for them.

Abstract:Objective:　To construct a perioperative rehabilitation training program for children with developmental dysplasia of the hip undergoing open reduction surgery to guide clinical application. Methods:　Based on the first draft of the construction program by literature analysis and qualitative interview, 17 experts from 8 "three A" hospitals in 8 regions of China were selected for two rounds of expert letter inquiry to determine the final program. Results:　The effective recovery rates of the two rounds of expert letters were 100%, the expert authority coefficients were 0.930 and 0.915 respectively, and the Kendall's W values were 0.209 (P<0.001) and 0.233 (P<0.001), respectively. The final perioperative rehabilitation training program for children with developmental dysplasia of the hip undergoing open reduction surgery included 4 first-level items and 62 second-level items. Conclusion:　The perioperative rehabilitation training program for children with developmental dysplasia of the hip undergoing open reduction surgery is reliable and scientific, which can be used for guiding perioperative rehabilitation training for children with clinical developmental dysplasia of the hip after the open reduction surgery.

Abstract:Objective:　To investigate the risk factors of adolescents with cancer and mental crisis status from the perspective of ecosystem theory, and to provide reference for constructing an intervention model of psychological crisis for adolescents with cancer. Methods:　Adolescents aged 8-18 with cancer and some healthy children were included in this study, they were investigated on spot with depression anxiety stress scale 21 (DASS-21), and the questionnaire data were input twice and analyzed. The correlation degree and mutual influence of individual, family, environment, disease and other factors of children were analyzed from micro, meso, appearance and macro system of ecological system theory, so as to clarify the key influencing factors. Results:　The investigation included in 218 adolescents with cancer, and 217 were analyzed. The detection rate of mental crisis was 45.6%, among which the detection rate of depression was 26.7%, the detection rate of anxiety was 45.6%, and the detection rate of stress was 24.4%. They were 12.5%, 13.5%, and 8.5% higher than those of health adolescents, respectively. Among the influencing factors, the detection rate of depression in male children was higher than that in female children, the detection rate of depression and stress in one-child children was higher than that in non-only children, the detection rate of depression and stress in children raised in authoritarian family was higher than that of children raised in democratic family, and the detection rate of anxiety in children with regular follow-up was higher than that of children not regularly followed up, with s statistical significance (P<0.05). The variables with P<0.05 were included in multivariate logistic analysis, and it was found that adolescents with cancer raised in authoritarian family had the highest risk of mental crisis. Conclusion:　Adolescents with cancer have mental crisis such as anxiety, depression and stress, especially the one-child children and the children raised in authoritarian family. It's necessary for hospitals, families, schools, and the whole society to carry out preventive intervention in order to create a good ecosystem for these children, promoting their physical and mental health.

Abstract:Objective:　To explore the clinical efficacy of artificial femoral head replacement and total hip replacement in the treatment of aged patients (aged≥75 years) with femoral neck fracture. Methods:　The clinical data of 140 aged patients (aged≥75 years) with femoral neck fracture who underwent artificial hip replacement during January 2014 to January 2018 were retrospectively analyzed, among which 70 patients who underwent artificial femoral head replacement were divided into group A, and 70 patients who underwent artificial total hip replacement were divided into group B. The pain scores of visual analogue scale (VAS), operation time, intraoperative blood loss, the first time for off-bed activity after operation, postoperative hospital stay, postoperative complications, and Harris scores of hip joint activities in 1 week, 3 months, 6 months, 12 months and 18 months after operation in patients of these 2 groups were compared and analyzed. Results:　The VAS scores of the two groups 3 days after operation were significantly lower than those before operation. The operating time, intraoperative blood loss, postoperative hospital stay, the time for off-bed activity after operation in patients of group B were significantly higher than those of patients in group A. And Harris scores of hip joint activities in 1 week, VAS after operation in patients of group A were significantly better than those of patients in group B. There was no significant difference in Harris scores of hip joint activities in 3 and 6 months in patients of these two groups. After follow-up for 12 and 18 months, Harris scores in patients of group B were significantly better than those of patients in group A. Conclusion:　For the aged patients (aged≥75 years) with femoral neck fracture, the two kinds of operation can quickly relieve the pain of hip joint, recover the function of hip joint earlier, and improve the quality of life of patients significantly. Artificial femoral head replace-ment with shorter operation time and less bleeding is suitable for aged patients with poor physical conditions, less activities before injury and low requirement on hip joint function. Total hip replacement should be the first choice for aged patients with better physical conditions after sufficient preparation.

Abstract:Objective:　To construct and validate the individualized nomogram model for predicting the risk of cardiorenal syndrome in patients with heart failure, by analyzing the independent risk factors of heart failure patients complicated with cardiorenal syndrome. Methods:　A total of 621 patients diagnosed with acute heart failure in our hospital from January 2010 to December 2019 were included in the study, and they were randomized into modeling group (70%) and validation group (30%). Univariate and multivariate logistic regression were used to analyze the independent risk factors of cardiorenal syndrome in patients with heart failure. R software was used to construct a nomogram model of the risk of cardiorenal syndrome in patients with heart failure. Results:　Multivariate logistic regression analysis showed that age, diabetes mellitus, NYHA grade and estimated glomerular filtration rate (eGFR) were independent risk factors of heart failure complicated with cardiorenal syndrome. Through the internal and external validation, the AUC value was 0.807 (95%CI=0.771-0.843) in the modeling group and 0.798 (95%CI=0.757-0.839) in the validation group. The calibration curves of both the modeling group and the validation group have indicated that the prediction model has good stability. Conclusion:　This nomogram can accurately predict the individualized risk of cardiorenal syndrome in patients with heart failure, and has high potential clinical application value.

Abstract:Objective:　To investigate influencing factors of the perceived effect of highly active antiretroviral therapy (HAART) in people living with HIV or AIDS (PLWH), and to provide scientific basis for the promotion of antiviral therapy. Methods:　Retrospective survey was conducted in this study, and face-to-face questionnaire survey was used to collect general demographic information, basic knowledge of AIDS, medication status, medication adherence, and perceived effect of HAART. Chi-square test, rank sum test and ordered categorical variable logistic regression were used as statistical methods. Results:　We collected complete information of 321 subjects, and the awareness rate of basic knowledge of AIDS was 88.16%. In the last year, 259 patients had been tested for HIV viral load, 258 of which had a viral load of<50 copies/mL, and the average CD4⁺T cell was (444.23±178.29) /μL for the last time.70.09% of PLWH perceived the therapeutic effect as "effective", and 6.23% of PLWH perceived the therapeutic effect as "very effective". Awareness of stopping or reducing drug taking while adverse reactions occurred (OR=0.337, 95%CI=0.178-0.638), the number of CD4⁺T cells before treatment (OR=2.931, 95%CI=1.479-5.807), duration of treatment (OR=0.438, 95%CI=0.230-0.835) had influence on perceived efficacy. Conclusion:　HAART has a good therapeutic effect, but it's inconsistent with the perceived effect. Family support, medication compliance, knowledge of AIDS prevention, CD4⁺T cell level before treatment, and treatment time were associated with self-perceived efficacy. It's suggested to take comprehensive intervention measures such as psychological intervention and compliance education to improve the self-perceived effect of PLWH.

Abstract:Objective:　To understand the etiology and aggravating and pathogenesis as well as skin types of female melasma patients. Methods:　Clinical questionnaires were conducted to investigate and analyze 460 patients who came to our hospital to treat melasma. Results:　Melasma was more common in young and middle-aged females who were between 25-35 years old, and was mostly distributed in both sides of the zygomatic region. Susceptible factors of melasma included heredity, pregnancy, mental factors, sun exposure and radiation, sleep, inappropriate skin care and cosmetology factors, etc. The skin types were mostly sensitive and dry. Conclusion:　This investigation found that the attack of melasma were related to heredity, pregnancy, mental factors, sun exposure and radiation, sleep, inappropriate skin care and cosmetology factors. And the most common skin types of melasma are sensitive and dry skin.