AIM: To investigate the differentiated whole genome expression profiling of gastric high- and low-grade intraepithelial neoplasia and early-stage adenocarcinoma. METHODS: Gastric specimens from an upper magnifying chromoendoscopic targeted biopsy were collected from March 2010 to May 2013. Whole genome expression profiling was performed on 19 low-grade intraepithelial neoplasia (LGIN), 20 high-grade intraepithelial neoplasia (HGIN), 19 early-stage adenocarcinoma (EGC), and 19 chronic gastritis tissue samples using Agilent 4 × 44K Whole Human Genome microarrays. Differentially expressed genes between different types of lesions were identified using an unpaired t-test and corrected with the Benjamini and Hochberg false discovery rate algorithm. A gene ontology (GO) enrichment analysis was performed using the GeneSpring software GX 12.6. The differentially expressed gene was verified using a real-time TaqMan^® PCR assay with independent tissue samples, including 26 LGIN, 15 HGIN, 14 EGC, and 20 chronic gastritis. The expression of G₀S₂ were further validated by immunohistochemical staining (IHC) in 24 LGIN, 40 HGIN, 30 EGC and 61 chronic gastritis specimens. RESULTS: The gene expression patterns of LGIN and HGIN tissues were distinct. There were 2521 significantly differentially expressed transcripts in HGIN, with 951 upregulated and 1570 downregulated. A GO enrichment analysis demonstrated that the most striking overexpressed transcripts in HGIN compared with LGIN were in the category of metabolism, defense response, and nuclear factor κB (NF-κB) cascade. While the vast majority of transcripts had barely altered expression in HGIN and EGC tissues, only 38 transcripts were upregulated in EGC. A GO enrichment analysis revealed that the alterations of the immune response were most prominent in the progression from HGIN to EGC. It is worth noting that, compared with LGIN, 289 transcripts were expressed at higher levels both in HGIN and EGC. A characteristic gene, G₀/G₁ switch 2 (G₀S₂) was one of the 289 transcripts and related to metabolism, the immune response, and the NF-κB cascade, and its expression was validated in independent samples through real-time TaqMan^® PCR and immunohistochemical staining. In real-time PCR analysis, the expression of G₀S₂ was elevated both in HGIN and EGC compared with that in LGIN (P < 0.01 and P < 0.001, respectively). In IHC analysis, G₀S₂ immunoreactivity was detected in the cytoplasmic of neoplastic cells, but was undetectable in chronic gastritis cells. The G₀S₂ expression in HGIN was higher than that of LGIN (P = 0.012, χ² = 6.28) and EGC (P = 0.008, χ² = 6.94). CONCLUSION: A clear biological distinction between gastric high- and low-grade intraepithelial neoplasia was identified, and provides molecular evidence for clinical application.

UNICEF Baby Friendly Initiative (BFHI) is the global standard for maternity and community services requiring all practitioners to be trained to support mothers in the essential skills of supporting positioning and attachment, and hand expression. These studies aim to rigorously assess knowledge in nurses, midwives, and doctors in these skills, tested before and after watching short videos demonstrating these skills. Practitioners were attending BFHI education, and the video study was additional. In Phase 1 clinicians in England were randomised to one of two videos (practitioner role play or clinical demonstration). The results showed improvements in knowledge and confidence, and a preference for clinical demonstration by mothers and infants. The clinical demonstration video was evaluated in China in Phase 2 where expert trainers viewed the video after completing the BHFI workshop, and in Phase 3 practitioners viewed the video before the BHFI workshop. Phase 2 with expert trainers only showed improvement in knowledge of hand expression but not positioning and attachment. In Phase 3 clinicians showed improved knowledge for both skills. In all Phases there were statistically significant improvements in confidence in practice in both skills. Viewing short videos increased knowledge, particularly about teaching hand expression, and confidence in both skills.

Despite almost all babies being breastfed initially, the exclusive breastfeeding rate at six months is less than 30% in China. Improving professionals’ knowledge and practical skill is a key government strategy to increase breastfeeding rates. This study aimed to test the effectiveness of a breastfeeding DVD training method for clinicians on improving their knowledge and confidence in the breastfeeding support skills of teaching mothers Positioning and Attachment (P & A) and Hand Expression (HE). A randomised controlled trial was conducted in three hospitals in Zhejiang province, China in 2014. Participants were recruited before their routine breastfeeding training course and randomly allocated to intervention group (IG) and control group (CG). The 15 min “Breastfeeding: Essential Support Skills DVD” was the intervention for IG and a vaginal delivery DVD was used for CG. All participants completed questionnaires of job information, knowledge and confidence in the two skills before (baseline) and immediately after viewing the DVD (post DVD). Out of 210 participants, 191 completed knowledge assessments before and after watching the DVD (IG n = 96, CG n = 95), with the response rate of 91.0%. At baseline, there are no significant differences in job variables, total knowledge scores and confident scores. The total knowledge score significantly increased post-DVD for IG (pre-DVD: M = 5.39, SD = 2.03; post-DVD: M = 7.74, SD = 1.71; t (95) = − 10.95, p < 0.01), but no significant change in total knowledge score for CG between pre- and post-DVD (pre-DVD: M = 5.67, SD = 1.70; post-DVD: M = 5.56, SD = 1.63; t (94) = 0.85). The total confidence scores were significantly higher post-DVD than pre-DVD in IG (pre-DVD: M = 66.49, SD = 11.27; post- DVD: M = 71.81, SD = 9.33; t (68) = − 4.92, p < 0.01), but no significant difference was seen in CG between pre- and post-DVD total confidence scores (pre-DVD: M = 68.33, SD = 11.08; post-DVD: M = 68.35, SD = 11.40; t (65) = − 0.25). Personal and job variables did not mediate these effects. The breastfeeding training DVD improved professionals’ knowledge and confidence of the two breastfeeding support skills. However, the effect on professionals’ practice and on breastfeeding outcomes needs to be examined in the future.

Background and Aim: Maternal near-miss (MNM) surveillance has been developed to identify severe complications in pregnancy since 2011 in China. However, very little is known about MNM in China. This study aims to explore the prevalence of MNM, the risk factors, and perinatal outcomes using the WHO near-miss approach in a developed Chinese province. Materials and Methods: We used data from China’s National Maternity Near Miss Obstetrics Surveillance System for the period 2012 to 2017, which included 18 hospitals in Zhejiang Province. Chi-squared tests were used to compare the socio-demographic factors, obstetric complications and perinatal outcomes between women with and without MNM. Logistic regression was used to examine the independent risk factors for MNM. Results: A total of 612,264 pregnant women were recruited. There were 3208 MNM cases and 34 maternal deaths. The MNM incidence ratio was low at 5.9 per 1,000 live births, with an MNM mortality ratio of 98:1 and mortality index of 1.1%. Among 3208 women with MNM, postpartum hemorrhage was the commonest cause at 76.3% followed by severe anemia at 23.7% and placenta previa at 23.0%. Embolism was identified as having the highest risk for MNM (AOR 46.0; 95% CI 19.1– 110.7), followed by postpartum hemorrhage (AOR 41.0; 95% CI 35.7– 47.0), and severe anemia (AOR 36.6; 95% CI 16.0– 84.1). MNM cases were significantly associated with severe perinatal outcome, including premature birth, low birth weight, multiple fetuses, stillbirth rates and neonatal mortality. Conclusion: Overall near-miss indicators suggested a relatively high quality of maternal health care in a developed province of China. The identified risk factors may be helpful in developing targeted interventions for improving maternal safety.

Objectives: The aim of this study was to assess patient safety culture (PSC) in maternal and child health (MCH) institutions in China and its individual, organizational, and regional variations. Methods: Using the PSC survey for MCH institutions (PSCS-MCHI), 2021 valid respondents from 25 participating institutions were investigated in three regions (Beijing, Zhejiang, and Jiangxi) of China. Patient safety culture and its subscale scores (1–5) and factors associated with PSC as revealed by multilevel modeling. Results: The respondents had an average PSC score of 3.55 (SD = 0.35), with subscale scores ranging between 2.46 (“staffing and workload”) and 4.02 (“work commitment”). There were limited regional differences in PSC: a three-level regression model was only confirmed for the subscale “staff empowerment” (P = 0.006). However, significant organizational variations in PSC were evident: a two-level regression model was assumed for the PSC scale and nine subscales (P < 0.001). The fixed-effect models showed that male respondents, frontline workers, those who were in their mid-career (11–20 y), overloaded (≥9 hours), and had a masters or higher degree reported worse PSC. Frontline workers were less positive than managers in ratings on “managerial response to risks” (−0.11 [−0.20 to −0.02]), “management support” (−0.18 [−0.28 to −0.07]), and “staff empowerment” (−0.23[−0.35 to −0.11]). Conclusions: Patient safety culture in MCH institutions is shaped by organizational and individual characteristics. We observed a gap in perceived PSC between frontline worker, who are less positive, and managers. Actions for improving PSC should consider interventions on organizational management (such as appropriate staffing and workload management) and engagement of frontline workers in the development of management and training activities.

Objective: Postpartum hemorrhage (PPH) is a leading cause of maternal mortality worldwide, and its risk factors vary regionally. This study assessed the incidence and determinants of PPH in Zhejiang Province, China. Methods: We conducted a cross-sectional study using data from the Maternity Near Miss Surveillance System in Zhejiang Province, collected from January to December 2020. The cohort included 56,014 pregnant women at a gestational age of 28 weeks or more. PPH was defined as blood loss of ≥500 mL for vaginal deliveries and ≥1,000 mL for cesarean sections within 24 h of delivery. Logistic regression analyzed the risk factors for PPH. Results: Of the pregnant women, 2,016 (3.60%) experienced PPH. The mortality rate associated with PPH was 1.74 per 100,000 live births. Significant independent risk factors included multiple births (OR 3.10; 95% CI 2.42–3.98; P < 0.01), vaginal delivery (OR 3.00; 95% CI 2.62–3.42; P < 0.01), macrosomia (OR 2.30; 95% CI 1.97–2.68; P < 0.01), hypertensive disorders of pregnancy (OR 1.79; 95% CI 1.50–2.13; P < 0.01), and a lower educational level (OR 1.20; 95% CI 1.07–1.36; P < 0.01). Conclusion: The incidence and mortality rates of PPH in Zhejiang Province are low. Identified risk factors such as multiple births, vaginal delivery, macrosomia, hypertensive disorders, and lower education level can guide interventions to mitigate PPH risk.