Pregnancy Outcomes of Freeze-All versus Fresh Embryo Transfer in Women with Adenomyosis: A Retrospective Study.

Adenomyosis has been associated with adverse fertility and pregnancy outcomes, and its impact on the outcomes of in vitro fertilization (IVF) has received much attention. It is controversial whether the freeze-all strategy is better than fresh embryo transfer (ET) in women with adenomyosis. Women with adenomyosis were enrolled in this retrospective study from January 2018 to December 2021 and were divided into two groups: freeze-all (n = 98) and fresh ET (n = 91). Data analysis showed that freeze-all ET was associated with a lower rate of premature rupture of membranes (PROM) compared with fresh ET (1.0% vs. 6.6%, p = 0.042; adjusted OR 0.17 (0.01-2.50), p = 0.194). Freeze-all ET also had a lower risk of low birth weight compared with fresh ET (1.1% vs. 7.0%, p = 0.049; adjusted OR 0.54 (0.04-7.47), p = 0.642). There was a nonsignificant trend toward a lower miscarriage rate in freeze-all ET (8.9% vs. 11.6%; p = 0.549). The live birth rate was comparable in the two groups (19.1% vs. 27.1%; p = 0.212). The freeze-all ET strategy does not improve pregnancy outcomes for all patients with adenomyosis and may be more appropriate for certain patients. Further large-scale prospective studies are needed to confirm this result.

Serum peptidomic screening identified circulating peptide biomarkers predictive for preeclampsia.

Background: Reliable biomarkers are needed to improve preeclampsia (PE) prediction accuracy. With the investigational tool of peptidomics, we aimed to identify and validate potential serum peptide biomarkers in cohorts suspected for PE development in middle or late pregnancy. Methods: Totally 195 serum samples were prospectively collected from pregnant women with PE-related syndromes who were followed up for PE development until delivery. Serum peptidomic analysis was performed in the discovery cohort of 115 samples using matrix-assisted laser desorption ionization-time of flight coupled with Linear Trap Quadropole Orbitrap mass spectrometry. The candidate biomarkers were further validated using an in-house developed liquid chromatography tandem mass spectrometry (LC-MS/MS) method in an independent validation cohort of 80 serum samples. Results: We identified 8 peptides that were differentially expressed and originated from fibrinogen alpha chain (FGA), inter-alpha-trypsin inhibitor heavy chain H4 (ITIH4) and complement component 3. In the subsequent LC-MS/MS quantitation analysis, the levels of the three peptides (FGA-1033.4, ITIH4-2026.9, ITIH4-2051.1) exhibited a significant difference between the PE-positive and PE-negative groups. Further, the three-peptide panel yielded an area under the ROC curve (AUC) of 0.985 [95% confidence interval (CI) 0.965-1.000] and 0.923 (95% CI 0.845-1.000) in the discovery and validation cohorts respectively, with negative predictive values of 98.1-98.8% and positive predictive values of 73.1-85.3% that were much improved when compared with that of soluble fms-like tyrosine kinase-1/placental growth factor (sFlt-1/PlGF) ratio. Conclusions: We have discovered and validated a novel three-peptide biomarker panel predictive for the occurrence PE in pregnant women.

Establishment of trimester-specific reference intervals of serum lipids and the associations with pregnancy complications and adverse perinatal outcomes: a population-based prospective study.

BACKGROUND: Disturbances in maternal lipid metabolism may increase the risk of developing pregnancy complications and adverse perinatal outcomes. However, there is no consensus as to what constitutes normal serum lipid ranges during pregnancy. Our study was aimed to establish trimester-specific serum lipid reference intervals (RIs) and investigate the associations between maternal dyslipidaemia and adverse outcomes in a population-based study. METHODS: The first- and third-trimester lipid profiles were derived from 16,489 singlet pregnant women for regular antenatal check-ups between 2017 and 2019. The serum samples were assayed for total cholesterol (TC), triglycerides (TG), high-density lipoprotein-cholesterol (HDL-C), and low-density lipoprotein-cholesterol (LDL-C) in the institutional clinical laboratory. The trimester-specific lipid RIs were estimated with both of the direct observational and the indirect Hoffmann methods. The associations between maternal lipid profiling and pregnancy complications and perinatal outcomes were assessed statistically. RESULTS: Serum levels of TC, TG, LDL-C and HDL-C were all increased significantly in the third trimester of pregnancy. There was no significant difference between the observed RIs established with healthy pregnant women and the calculated RIs derived from the Hoffmann method. A trend towards increased risks of gestational complications and adverse perinatal outcomes was observed in the subjects with elevated levels of TC, TG, and LDL-C or decreased level of HDL-C. CONCLUSIONS: In pregnancy, increased serum levels of TC, TG and LDL-C, and a decreased level of HDL-C posed higher risks of developing pregnancy complications and adverse perinatal outcomes.Key messagesIt is necessary to establish trimester-specific reference intervals for serum lipids including TC, TG, LDL-C and HDL-C that were found significantly increased as the gestational age went up. More importantly, around the upper reference limits of TC, TG and LDL-C (or the lower reference limit of HDL-C), the higher the serum lipid levels were (or the lower the HDL-C level was), the higher risks of developing pregnancy complications and adverse perinatal outcomes were observed.

Nurses' turnover intention and associated factors in general hospitals in China: A cross-sectional study.

AIM: To measure nurses' turnover intention and identify associated factors in general hospitals in China. BACKGROUND: Understanding nurses' turnover intention is important to retain nurses, but factors associated with turnover intention require elucidation. METHOD: A cross-sectional survey was conducted across 23 hospitals in China to investigate nurses' (N = 12,291) turnover intention and its associated factors. Associated factors were explored by univariate and multilevel multiple logistic regression analysis. RESULTS: The mean total score for nurses' turnover intention was 13.97 ± 3.63. High proactive personality score, a seriously ill family member, experience of negative workplace events, high work pressure and high work-family conflict increased the risk for turnover intention. A low turnover intention was associated with being a non-local resident nurse, position title, high salary level, good person-organisation fit and person-group fit, and high family-work facilitation. CONCLUSION: Nurses with a proactive personality, heavy family care burden, experience of negative workplace events, no position title and a low salary may merit special consideration. IMPLICATIONS FOR NURSING MANAGEMENT: Nurses' personality traits should be further focused on, and it is important to build a nurse-oriented organisation atmosphere, including protecting nurses from workplace violence, establishing friendly relationships with their families and expanding career paths.

Predictive values of various serum biomarkers in women with suspected preeclampsia: A prospective study.

BACKGROUND: Preeclampsia (PE) prediction has been shown to improve the maternal and fetal outcomes in pregnancy. We aimed to evaluate the PE prediction values of a series of serum biomarkers. METHODS: The singleton pregnant women (20-36 gestational weeks) with PE-related clinical and/or laboratory presentations were recruited and had the blood drawn at their first visits. The following markers were tested with the collected serum samples: soluble fms-like tyrosine kinase 1 (sFlt-1), placental growth factor (PlGF), thrombomodulin (TM), tissue plasminogen activator inhibitor complex (tPAI-C), complement factors C1q, B, H, glycosylated fibronectin (GlyFn), pregnancy-associated plasma protein-A2 (PAPP-A2), blood urea nitrogen (BUN), creatinine (Cre), uric acid (UA), and cystatin C (Cysc). RESULTS: Of the 196 recruited subjects, 25% (n = 49) developed preeclampsia before delivery, and 75% remained preeclampsia negative (n = 147). The serum levels of sFlt-1, BUN, Cre, UA, Cysc, and PAPP-A2 were significantly elevated, and the PlGF level was significantly decreased in the preeclampsia-positive patients. In the receiver operating characteristics (ROC) analyses, the area under the curves were listed in the order of decreasing values: 0.73 (UA), 0.67 (sFlt-1/PlGF), 0.66 (Cysc), 0.65 (GlyFn/PlGF), 0.64 (PAPP-A2/PlGF), 0.63 (BUN), 0.63 (Cre), and 0.60 (PAPP-A2). The positive predictive values of these serum markers were between 33.1% and 58.5%, and the negative predictive values were between 80.9% and 89.5%. CONCLUSIONS: The serum markers investigated in current study showed better performance in ruling out than ruling in PE. Absence of pre-defined latency period between blood draw and the onset of PE limits the clinical utility of these markers.

Nursing resources and major immobility complications among bedridden patients: A multicenter descriptive study in China.

BACKGROUND: Being bedridden, which is a common clinical phenomenon, causes a series of complications related to immobilization. Effective management of immobility complications requires a reasonable allocation of nursing resources. Unit-level evidence about the relationship between nursing resources and immobility complications is lacking. OBJECTIVES: To gain insight into nursing resources in China and explore the relationship between nursing resources and the incidence of major immobility complications among bedridden patients. The major immobility complications included in our study were pressure ulcers, deep vein thrombosis, pneumonia and urinary tract infection. DESIGN: A nationwide, multicenter, cross-sectional survey. SETTING: From November 2015 to June 2016, 18 hospitals (six tertiary and 12 secondary) from six provinces and cities in different geographic regions (eastern, southern, western, northern and central) in China participated in our study. PARTICIPANT: Intensive care units, internal medicine and surgery wards with high proportions of bedridden patients were chosen as investigation sites. Of the total of 23,637 available patients in the selected wards, 19,530 were recruited. METHODS: Data on nursing resources and ward characteristics were collected mainly by questionnaire. The incidence of major immobility complications among bedridden patients was measured by trained investigators. Data on patient characteristics were collected from the patient record system of each hospital. Multilevel regression analysis was used to estimate the impact of nursing resources on the incidence of major immobility complications, adjusting for patient and ward characteristics. RESULTS: The study included 23,637 patients in 213 wards, and 19,530 were recruited. The incidence of the four complications was 0.77% (pressure ulcers), 0.82% (deep vein thrombosis), 3.39% (pneumonia) and 0.86% (urinary tract infection), and the overall incidence of major immobility complications was 5.41%. The incidence of major immobility complications was higher in wards not attaining the target bed-to-nurse ratios than in those that met these criteria (ß = 0.44, 95% confidence interval [CI]: 0.02-0.87; OR = 1.553, 95% CI: 1.002-2.387). The incidence of major immobility complications was negatively associated with the proportion of nurses with intermediate or senior job titles (ß = -2.12, 95% CI: -3.78 to -0.45; OR = 0.120, 95% CI: 0.023-0.638). However, the incidence of major immobility complications was unexpectedly positively associated with the proportion of nurses with a bachelor's degree or higher (ß = 1.06, 95% CI: 0.31-1.81; OR = 2.886, 95% CI: 1.363-6.110). CONCLUSIONS: Sufficient nurse staffing and higher professional titles of nurses might contribute to reducing the incidence of major immobility complications. Nurse experience was not related to the incidence of major immobility complications. However, the association between nurse education level and the incidence of major immobility complications requires further investigation. IMPLICATIONS FOR NURSING MANAGEMENT: More nurses,especially nurses with higher professional titles may reduce the incidence of major immobility complications.

The effects of emotional labor and competency on job satisfaction in nurses of China: A nationwide cross-sectional survey.

OBJECTIVES: This study aimed to explore the status of job satisfaction, emotional labour, core competencies and job stress and the associations of emotional labour and core competencies with the job satisfaction of nurses in China. METHODS: Data were collected by using a self-designed general information questionnaire, a job satisfaction questionnaire (McCloskey/Mueller Satisfaction Scale), a nurse emotional labour questionnaire, the Competency Inventory for Registered Nurses questionnaire, and a nurse job stressor questionnaire. A total of 13,448 nurses from 92 hospitals across mainland of China were surveyed, and 11,337 respondents (84.3% response rate) completed the questionnaires. RESULTS: The survey results indicated that Chinese nurses had average job satisfaction (24.77 ±â€¯5.23), moderate job stress (86.84 ±â€¯21.12), moderate to high emotional labour experiences (55.08 ±â€¯9.63) and high competency (195.77 ±â€¯37.61). Multiple linear regression indicated that surface acting was negatively correlated with job satisfaction (P < 0.01), while deep acting (P < 0.01) and nurses' core competence (P < 0.01) were positively associated with job satisfaction. Besides, The results also indicated job stress, geographical distribution, hospital category, gender, work shift, only children, parenting status, monthly salary, nursing experience, professional title, hospital area were the influencing factors of job satisfaction (P < 0.05). CONCLUSION: The improvement of the emotional labour and competency of nurses may help enhance their job satisfaction.

Evaluation of Reliability and Validity of the Hendrich II Fall Risk Model in a Chinese Hospital Population.

To translate, validate and examine the reliability and validity of a Chinese version of the Hendrich II Fall risk Model (HFRM) in predicting falls in elderly inpatient. A sample of 989 Chinese elderly inpatients was recruited upon admission at the Peking Union Medical College Hospital. The inpatients were assessed for fall risk using the Chinese version of the HFRM at admission. The reliability of the Chinese version of the HFRM was determined using the internal consistency and test-rested methods. Validity was determined using construct validity and convergent validity. Receiver operating characteristic (ROC) curves were created to determine the sensitivity and specificity. The Chinese version of the HFRM showed excellent repeatability with an intra-class correlation coefficient (ICC) of 0.9950 (95% confidence interval (CI): 0.9923-0.9984). The inter-rater reliability was high with an ICC of 0.9950 (95%CI: 0.9923-0.9984). Cronbach's alpha coefficient was 0.366. Content validity was excellent, with a content validity ratio of 0.9333. The Chinese version of the HFRM had a sensitivity of 72% and a specificity of 69% when using a cut-off of 5 points on the scale. The area under the curve (AUC) was 0.815 (P<0.001). The Chinese version of the HFRM showed good reliability and validity in assessing the risk of fall in Chinese elderly inpatients.

The relationship of asymptomatic intracranial artery stenosis and Framingham stroke risk profile in a Northern Chinese industrial city.

BACKGROUND: Intracranial artery stenosis may be the most frequent cause of ischemic stroke in the world. Early detection of asymptomatic intracranial artery stenosis may allow for therapeutic intervention. Most elements of the Framingham stroke risk profile (FSRP) are also risk factors for intracranial artery stenosis. Thus, the FSRP might play a role in detecting asymptomatic intracranial artery stenosis. OBJECTIVE: To investigate the relationship between the FSRP and asymptomatic intracranial artery stenosis. METHODS: A sample of 5852 subjects (age >40 years) was selected from the KaiLuan study. All participants received transcranial Doppler ultrasound examinations to detect the presence and quantify the severity of intracranial arterial stenosis. Demographic and clinical variables were investigated at the time of examination. Binary logistic regression analyses was performed to determine the odds ratio of FSRP components to asymptomatic intracranial stenosis before and after adjusted for gender, body mass index (BMI), and total cholesterol (TC). RESULTS: The subjects with intracranial artery stenosis were older than those without (68·2 versus 64·9), and the systolic blood pressure was higher in those with intracranial artery stenosis (146·86 versus 136·39). Among intracranial artery stenosis subjects, 77·5% had hypertension, 26·1% had diabetes, 8·9% had left ventricular hypertrophy, and 4·8% had atrial fibrillation. Logistic regression analyses revealed that age, systolic blood pressure, diabetes, atrial fibrillation, and left ventricular hypertrophy were risk factors for intracranial artery stenosis. The incidence of asymptomatic intracranial artery stenosis correlated with increasing FSRP scores. The odds ratios of intracranial artery stenosis from the lowest to the highest FSRP quartiles were as follows: 1 (reference group), 1·77 (95% CI: 1·23-2·56), 2·84 (95% CI: 2·02-3·98), 5·65 (95% CI: 4·03-7·93). CONCLUSION: FSRP plays an important role in detecting asymptomatic intracranial artery stenosis.

Metabolic syndrome and its components as predictors of stroke in middle-aged and elderly Chinese people.

BACKGROUND AND PURPOSE: Little information is available on the role of metabolic syndrome (MetS) to predict first-ever stroke in the Chinese mainland. In this study, we investigated whether the metabolic syndrome and its single components, defined by original National Cholesterol Education Program (NCEP), International Diabetes Federation (IDF) and updated NCEP, could predict stroke in the middle-aged and elderly (40-85 years) Chinese population. METHODS: In this prospective study, three metabolic syndrome definitions were applied to 19,369 subjects aged 40-85 years who were free of stroke and/or myocardial infarction at baseline and were followed up to 3 years. Multivariable Cox regression analysis was used to calculate the adjusted hazard ratios (HRs) and 95% confidence interval of metabolic syndrome and its single components with the first-ever stroke. RESULTS: The metabolic syndrome defined by the original NCEP, IDF and updated NCEP were all significantly associated with stroke even after adjustment for confounding variables (HRs: 1.51 to 2.14). For the single components of metabolic syndrome, the following components predicted stroke incidence in both genders: insulin resistance or previous diagnosis with diabetes (HRs: 1.48-1.54 for men and 1.66-1.92 for women); blood pressure ≥ 130/85 mmHg or using medication (HRs: 2.54 for men and 2.31 for women). For men, central obesity defined by the IDF or updated NCEP criteria (waist circumference ≥ 90 cm) had association with stroke (HR: 1.47). However, none of criteria of central obesity was associated with stroke in female. CONCLUSIONS: The metabolic syndrome is associated with first-ever stroke in this middle-aged and elderly Chinese population. Furthermore, blood pressure alone plays a more important role than metabolic syndrome in stroke risk in middle-aged and elderly Chinese population.

Comparison of different anthropometric measures as predictors of diabetes incidence in a Chinese population.

OBJECTIVE: We aimed to explore an optimal anthropometric indicator and optimal cut-off points for incident diabetes in Chinese adults. METHODS: 61,703 subjects were followed for a median duration of 2 years. Body mass index, waist circumference, waist-to-hip ratio and waist-to-height ratio were collected base on a standard protocol. Receiver Operating Characteristic curve analyses were used to compare the predictive power of baseline BMI, WC, WHpR and WHtR for development of type 2 diabetes. RESULTS: There were 2991 new cases of type 2 diabetes during follow-up. ROC curve analyses indicated that WHtR was the best predictor of type 2 diabetes for male (AUC = 0.633). For female, WHtR and WC had similar predictive ability (AUC = 0.701 and 0.695 respectively) and were superior to BMI. WHpR was the weakest predictor in both genders. The optimal WHtR cut-off values for incidence of type 2 diabetes were similar in both genders (0.53 vs. 0.52). BMI was higher in men (26 kg/m(2)) than women (24 kg/m(2)); and so did WC (91 cm in men vs. 85 cm in women). CONCLUSIONS: WHtR, and to some degree WC, are the best predictors of type 2 diabetes, followed by BMI then WHpR which is the weakest predictor in the tested adults.