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OX40 is a costimulatory receptor that is expressed primarily on activated CD4+, CD8+, and regulatory T cells. The ligation of OX40 to its sole ligand OX40L potentiates T cell expansion, differentiation, and activation and also promotes dendritic cells to mature to enhance their cytokine production. Therefore, the use of agonistic anti-OX40 antibodies for cancer immunotherapy has gained great interest. However, most of the agonistic anti-OX40 antibodies in the clinic are OX40L-competitive and show limited efficacy. Here, we discovered that BGB-A445, a non-ligand-competitive agonistic anti-OX40 antibody currently under clinical investigation, induced optimal T cell activation without impairing dendritic cell function. In addition, BGB-A445 dose-dependently and significantly depleted regulatory T cells in vitro and in vivo via antibody-dependent cellular cytotoxicity. In the MC38 syngeneic model established in humanized OX40 knock-in mice, BGB-A445 demonstrated robust and dose-dependent antitumor efficacy, whereas the ligand-competitive anti-OX40 antibody showed antitumor efficacy characterized by a hook effect. Furthermore, BGB-A445 demonstrated a strong combination antitumor effect with an anti-PD-1 antibody. Taken together, our findings show that BGB-A445, which does not block OX40-OX40L interaction in contrast to clinical-stage anti-OX40 antibodies, shows superior immune-stimulating effects and antitumor efficacy and thus warrants further clinical investigation.
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Mice , Animals , Receptors, Tumor Necrosis Factor/physiology , Receptors, OX40 , Membrane Glycoproteins , Ligands , Antibodies, Monoclonal/pharmacology , Antineoplastic Agents/pharmacologyABSTRACT
OBJECTIVE To expl ore the clinical significance of folic acid metabolic gene detection in methotrexate （MTX） treatment of acute myeloid leukemia （AML）. METHODS Therapeutic drug monitoring （TDM）pharmacists participated in the treatment process of an AML patient who had neurotoxic side effects such as dizziness ，headache，and vomiting after intrathecal injection of MTX. According to the results of the test of the folic acid metabolic gene MTHFR C677T（rs1801133）（mutant homozygous）and the results of MTX blood concentration monitoring （＜0.05 μmol/L），combined with clinical manifestations ，it was recommended to stop MTX ，give intravenous drip of calcium folinate for rescue ，and consider using azacytidine for follow-up treatment. RESULTS The doctor took the advice of TDM pharmacist ，and the above symptoms were significantly relieved after the patient rescued for 2 times and successfully discharged from the hospital. CONCLUSIONS For AML patients who meet the indications and receive intrathecal injection of MTX ，drug metabolism genetics testing and MTX drug concentration monitoring can be performed before medication ，which helps doctors and pharmacists evaluate the feasibility of drug treatment options and reduce medical risks.
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Sequential immunization is one of the special means to solve the shortage of vaccines, respond to SARS-CoV-2 variants and improve the efficacy of vaccines in the current pandemic period. This article mainly reviewed five sequential immunization strategies using the vaccines authorized by World Health Organization: priming with inactivated vaccine and boosting with recombinant protein vaccine, vector vaccine or mRNA vaccine; priming with vector vaccine and boosting with mRNA vaccine; prime-boost immunization with mRNA vaccines produced by different manufactures. Results of the related studies showed that heterologous sequential immunization strategies were safe and effective, and higher immunogenicity and efficacy could be achieved by sequential immunization. In addition, sequential immunization could provide certain protective effects against SARS-CoV-2 variants.
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Objective To explore the clinical efficacy of acupuncture combined with SSRIs in the treatment of patients with depression. Methods A total of 83 patients with depression admitted to our hospital between January 2019 and January 2020 were selected as the research objects. Patients in the control group were treated with SSRIs, and the combined treatment (observation) group was treated with acupuncture on the basis of the control group. The clinical efficacy, anxiety (HAMD) and depression scale (HAMD) of patients in the two groups were compared. Results After treatment, the clinical efficacy of depression patients in the observation group was significantly higher than that in the control group (P<0.05). HAMA and HAMD scores showed statistical difference between the two groups. HAMA and HAMD scores of patients in the observation group were lower than those in the control group (P<0.05). Conclusion Acupuncture combined with SSRIs in the treatment of depression can significantly improve the patient's condition, reduce the patient's anxiety and depression, and has a positive significance for the treatment of the patients.
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Acute ischemic stroke has ischemic penumbra and actual infarct core, and when there is a bigger difference in the volume of the two, it is called " mismatch". It is not only manifested as a mismatch between the clinical manifestations and the infarct core, but also as a mismatch between the infarct core and the perfusion area. The advancement of neuroimaging technology enables this " mismatch" phenomenon to be manifested through different imaging methods or different sequences of the same imaging method, thereby providing more guidance for the further diagnosis and treatment process.
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Objective To investigate clinical characteristics and prognostic factors for hospitalized patients aged 95 years and older with community-acquired pneumonia(CAP).Methods A retrospective study was conducted on CAP patients aged ≥95 years hospitalized in Jiangsu Province Hospital or Jiangsu Province Hospital of TCM between January 2014 and January 2018.Clinical characteristics were collected.The shock index (SI),Charlson comorbidity index (CCI),neutrophil/lymphocyte rate (NLR)and CURB-65 score were calculated.The predictive value of the related factors was evaluated by using the Logistic regression model and the subjects' receiver operating characteristic curve (ROC).Results A total of 205 cases were enrolled in this study.The hospital mortality rate was 36.1 ％ (73/205).The heart rate,white blood cell count,mononuclear cell count,neutrophil count (N),NLR,fasting blood glucose,blood urea nitrogen(BUN) and D-dimer results revealed significant differences between the death group and the survival group(all P＜0.05).Scores of CCI and CURB-65 were higher in the death group than in the survival group[(2.90 ±1.88) vs.(1.91 ± 1.81),(2.34 ±0.69)vs.(1.76±0.69),both P＜0.05].Multivariate Logistic analysis showed that heart rate≥84.73 beat per minute(OR =2.452,95％CI:1.054～5.702),NLR≥11.43(OR =5.499,95％CI:2.132～14.180),BUN≥12.95 mmol/L(OR =2.546,95％CI:1.025～6.319),CCI≥3(OR =4.453,95％CI:1.191～10.113),CURB-65≥2 scores(OR =3.888,95％CI..1.288～11.735)and respiratory failure (OR =2.875,95 ％CI:1.204～6.806)were risk factors for death in hospitalized elderly aged 95 years and older with CAP.ROC analysis showed that CCI combined with the CURB-65 score or CCI combined with the CURB-65 score plus NLR could better predict the in-hospital mortality of elderly patients than CCI or the CURB-65 score used alone.Conclusions Hospitalized patients aged≥95 with CAP are prone to multiple complications and high mortality rates.Combined application of multiple evaluation systems and indicators can improve the prognosis of outcomes for patients in this age group.
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Objective To investigate the health status of centenarian hospitalized patients and analyze the risk factors for in-hospital death in Nanjing district.Methods All centenarians hospitalized patients who were discharged from wards of 10 upper first-class general hospitals in Nanjing district during the past five years were retrieved from their hospital information systems.Then,a retrospective study was performed on centenarians' data of general information,laboratory test results,Charlson comorbidity index (CCI),neutrophil to lymphocyte ratio (NLR) and shock index(SI),etc.were calculated and collected.Relevant risk factors for in-hospital death were analyzed by multivariate logistic regression analysis.Results A total of 156 patients aged 100 years and over,with an average age of (101.0±2.1)years,were enrolled during the past 5 years.The top 3 admitting diagnosis for the patients were pulmonary infection(30.1％,47/156 cases),coronary heart disease(10.9％,17/156 cases)and cerebrovascular disease(7.1％,11/156 cases).Fifty patients died during hospitalization,with a mortality of 32.1％ (50/156).Pneumonia was the most common admitting diagnosis(40.0％,20/50 case).Among causes of death,the combined admitting diagnosis with dementia,chronic renal insufficiency,one or more basic disease were significantly associated with death.There were statistically significant differences between bad vs.good vs.indifferent prognosis in heart rate,shock index,leukocyte count,neutrophil count,NLR,hemoglobin,albumin,albumin/globulin,fasting blood glucose,blood urea nitrogen,serum creatinine,C-reactive protein(CRP)and CCI levels.Multivariate logistic regression analysis suggested that NLR≥13.18,fasting blood glucose ≥7.56 mmol/L,blood urea nitrogen ≥20.74 mmol/L,CRP≥65 mg/L and CCI≥3 might be predictors for in-hospital death in the cohort(OR =48.91、3.43、1.22、6.55、1.55,all P＜0.05).Conclusions Pulmonary infection is the most common reason for admission and the cause of death in centenarian inpatients.Comorbidities increase the risk of death.To lower in-hospital mortality,CCI and other assessment indicators should be used to strengthen the comprehensive assessment and chronic disease management of hospitalized centenarians.Infectious diseases should be prevented beforehand.
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Objective To explore the the expression of Klotho mRNA and protein in placenta of macrosomia and its relationship with the birth weight of neonates. Methods The cases were from November 2014 to March 2015 in Shengjing Hospital of China Medical University, divided into 4 groups:the gestational diabetes with macrosomia group (GM), the gestational diabetes with normal birth weight group (GN), the normal pregnancy with macrosomia group (NM) and the normal pregnancy with normal birth weight group (NN). Klotho mRNA and protein expression in the placenta were detected by immunohistochemistry SP method, real-time fluorescent quantitative PCR and western blot, respectively, and were compared among the 4 groups. Results (1) Immunohistochemical detection showed the positive rate of Klotho protein was significantly higher in the placenta of GM (93%,28/30) than in the GN (73%,22/30;P0.05). Conclusions The up-regulation of Klotho gene may be associated with macrosomia. The relationship is not affected by the complication of gestational diabetes.
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Objective To evaluate the relationship between placental expression of Gab1 and neonatal birth weight in mothers with gestational diabetes mellitus (GDM).Methods From the singleton and full-term cesarean delivered women in Shengjing Hospital Affiliated to China Medical University between October 2014 and May 2015,30 macrosomia babies with maternal GDM were selected as GDM macrosomia group,30 cases of GDM with normal neonatal birth weight as GDM normal group,30 cases without GDM but with macrosomia as normal macrosomia group,and 30 cases without GDM and with normal neonatal birth weight as the normal control group.Gab1 protein and mRNA expression in placentas were detected using immunohistochemistry,Western blot and real-time quantitative-polymerase chain reaction.Analysis of variance,LSD,Dunnett's T3,Chi-square test and Pearson's correlation analysis were used for statistical analysis.Results (1) Gab 1 protein location and positive expression rate:Gab 1 protein expression in human placenta tissue was located in the nucleus.The positive epression rate of Gab 1 protein in the GDM macrosomia group was higher than in the GDM normal group and normal macrosomia group [93％(28/30),73％(22/30) vs 73％(22/30)] and those in the normal macrosomia group and GDM normal group were higher than in the normal control group[47％(14/30)](x2=4.320,4.320,4.444 and 4.444,all P＜0.05).(2) The expression levels of Gabl protein and mRNA:The expression level of Gab1 protein in the GDM macrosomia group was higher than in the GDM normal group and normal macrosomia group (1.43 ± 0.58 vs 1.05 ± 0.67 and 0.95± 0.59),and that in the normal macrosomia group and GDM normal group were higher than in the normal control group (0.64±0.38) (LSD test,all P＜0.05).The expression levels of Gab1 mRNA showed the same trend as the expression levels of Gab1 protein in the four groups.(3) Gab 1 protein expression level was positively associated with neonatal birth weight (r=0.320,P=0.320).Conclusions The expression of Gab1 in placenta is involved in the regulation of birth weight in GDM mothers.
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OBJECTIVE@#To evaluate the effect of allergen specific immunotherapy (SIT) in patients with allergic rhinitis and asthma. METHOD A total of 68 patients with allergic rhinitis and asthma sensitized to dust mite were recruited into the study. They were randomly divided into two groups: SIT group n = 34 and symptomatic therapy (ST) group: n = 34. Patients in ST group received medication to treat, the symptoms, patients in SIT group received medication and 3 years of standardized allergen vaccine therapy. Evaluation index of therapy includes: rhinitis symptoms score, asthma symptoms score, drug score, skin prick test, serum specificity IgE (sIgE) , peripheral eosinophil (Eos) counting, lung function. The new sensitinogen rate was also assessed.@*RESULT@#Clinical symptom scores, drug scores, lung function, blood eosinophil numbers and skin test result were all improved significantly after 3-year treatment in SIT group compared to those in ST group (P < 0.01). Although the level of serum slgE was decreased,there exited no statistic diferences between two groups. Only 8.8% patients have the new sensitization in SIT group, and 52.9% in ST group. There were no serious adverse reactions in treatment process.@*CONCLUSION@#SIT for patients with AR and asthma can obtain excellent clinical efficacy.
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Animals , Humans , Asthma , Drug Therapy , Desensitization, Immunologic , Eosinophils , Immunoglobulin E , Blood , Leukocyte Count , Pyroglyphidae , Rhinitis, Allergic , Drug Therapy , Sensitivity and Specificity , Skin TestsABSTRACT
Objective To investigate the clinical efficacy of sequential acupuncture in treating post-stroke dysphagia. Methods One hundred and ten patients with post-stroke dysphagia were randomly allocated to treatment and control groups, 55 cases each. The control group received routine medication and the treatment group, “cortex-pharynx-tongue root” sequential acupuncture in addition. The pre-/post-treatment difference in the Kubota’s water drinking test score was observed in the two groups and the clinical therapeutic effects were compared between the two groups after 14 days of treatment.Results There was a statistically significant pre-/post-treatment difference in the Kubota’s water drinking test score in the two groups (P<0.01,P<0.05). There was a statistically significant post-treatment differences in the Kubota’s water drinking test score between the treatment and control groups (P<0.05). The total efficacy rate was 89.1% in the treatment group and 67.3% in the control group; there was a statistically significant difference between the two groups (P<0.05).Conclusion Sequential acupuncture is an effective way to treat post-stroke dysphagia.
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<p><b>OBJECTIVE</b>To evaluate the long-term effect of house dust mite subcutaneous immunotherapy (SCIT) in patients with allergic rhinitis (AR).</p><p><b>METHODS</b>A total of 102 patients with allergic rhinitis (not associated asthma) were recruited into the study. These patients were randomly divided into two groups: SCIT group and ST (symptomatic therapy) group. The patients were investigated for SCIT with standardized allergen vaccine for 3 years or no SIT only symptomatic therapy respectively. After the termination of SCIT, these patients were followed-up continuously for another 2 years. The therapeutic evaluation index included: rhinitis symptoms score, drug score, skin prick test, serum specific IgE (sIgE), as well as the number of development of asthma and the new sensitization. SPSS 11.0 software was used to analyze the data.</p><p><b>RESULTS</b>Clinical symptom scores, drug scores, and skin test result all improved significantly after the treatment with SCIT compared to SCIT before and ST group (P < 0.01). Two years after the termination of SCIT, the same parameters showed no significant difference compared to 3 years before (P > 0.05). No rhinitis patients in SCIT group developed to asthma, only 4.7% of patients had been found to have new allergen. In the meantime, 22.0% of the patients with rhinitis in ST group developed asthma, and 41.5% patients were found to have new allergen. No severe adverse events occurred.</p><p><b>CONCLUSIONS</b>The symptoms of the patients with allergic rhinitis were obviously improved by SCIT and a long-term curative effect could be maintained. It should be early applicated, which could prevent allergic rhinitis developed to asthma.</p>
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Animals , Humans , Asthma , Immunoglobulin E , Blood , Immunotherapy , Methods , Injections, Subcutaneous , Pyroglyphidae , Rhinitis, Allergic , Therapeutics , Skin Tests , Treatment Outcome , Vaccines , Therapeutic UsesABSTRACT
Objective To compare the efficacy and safety of the treatment of panic disorder by electro-acupuncture(EA) and paroxetine.Methods 59 patients were randomly divided into paroxetine group (30 cases) and EA group (29 cases), the therapeutic course was 4 weeks.SAS, HAMA, CGI-EI, BI scale were given to evaluate the efficacy and adverse reactions at 1,2,4 weekend before treatment and after treatment .Results EA group total effective rate was 86 .66%, the paroxetine group total effective rate was 82.76%, the two groups total efficacy difference was not statistically significant;efficacy index and onset time between the two groups had significant differences .Conclusion The overall curative effects were similar in patients of the two groups , but onset short electro-acupuncture , the curative effect was high and adverse reactions were fewer .
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OBJECTIVE@#To evaluate the efficacy of mite allergen specific immunotherapy (SIT) to patients of allergic rhinitis.@*METHOD@#A total of 102 patients with mite allergy were recruited into the study. They were randomly divided into two groups: SIT group (n = 51) and ST (symptomatic therapy) group (n = 51). They were given SIT with standardized allergen vaccine for 3 years or only symptomatic therapy respectively. Observation items include: rhinitis symptom scores, drug score, skin prick test result, serum specificity IgE (sIgE), peripheral eosinophil counting. The development of asthma and new allergens sensitization was also assessed.@*RESULT@#The blood eosinophil numbers, skin test index, rhinitis symptom scores and drug scores were all decreased significantly after the treatment with SIT for 3 years compared to that of ST group (P < 0.01). Although the level of serum slgE was decreased, no statistic diferences were found. No patients developed asthma in SIT group, and only 2.1% of patients had new allergen sensitization; 17.4% of those in ST group developed asthma, 32.6% had new sensitization. No severe adverse events occurred.@*CONCLUSION@#Keeping long-term SIT is effective and safe for patients with allergic rhinitis induced by mite, which can also prevent new allergen sensitization and development for asthma.
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Adolescent , Adult , Child , Female , Humans , Male , Middle Aged , Young Adult , Antigens, Dermatophagoides , Desensitization, Immunologic , Follow-Up Studies , Rhinitis, Allergic , Therapeutics , Treatment OutcomeABSTRACT
OBJECTIVE@#To evaluate the efficacy and safety of mite allergen specific immunotherapy (SIT) in treating children with allergic asthma.@*METHOD@#A total of 136 patients with mite allergy were recruited into the study. They were randomly divided into two groups: SIT group (n = 66) and ST (symptomatic therapy) group (n = 70). They were investigated of SIT with standardized allergen vaccine or no SIT only symptomatic therapy respectively. Therapeutic evaluation index includes: asthma symptoms score, drug score, skin prick test, pulmonary function, serum specificity IgE (sIgE) and the new sensitization was also assessed. Local and systemic adverse reactions were used to evaluate the clinical safety.@*RESULT@#Clinical symptom scores, drug scores, Lung function, and skin test result all improved significantly after the treatment with SIT compared to ST group (P < 0.01). SIT groups do not have new sensitization and no fatal systemic reactions occurred.@*CONCLUSION@#The standardized dust mite allergen specific immunotherapy is efficacious and safe to Children with allergic asthma . SIT can reduce house dust mites skin sensitivity and prevent new allergen appeared.
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Adolescent , Animals , Child , Female , Humans , Male , Allergens , Therapeutic Uses , Antigens, Dermatophagoides , Therapeutic Uses , Asthma , Allergy and Immunology , Therapeutics , Dust , Hypersensitivity , Allergy and Immunology , Therapeutics , Immunotherapy , Methods , Pyroglyphidae , Allergy and Immunology , Safety , Sensitivity and Specificity , Skin Tests , Vaccines , Therapeutic UsesABSTRACT
Objective To explore the effects of microRNA(miR)-1283 on invasion,proliferation and apoptosis of HTR 8/SVneo cell line derived from human-trophoblast cells.Methods HTR-8/SVneo cells were divided into three groups,as-miR 1283 group was transfected with miR 1283 analogues,anti-miR-1283 group was transfected with miR-1283 inhibitors,and negative control group was transfected with non functional sequence.The levels of miR 1283 expression were detected by fluorescence quantitative polymerase chain reaction at 24 hours after transfection.The cell proliferation was measured by 3-(4,5)-dimethylthiazol-2-yl-(2,5)-diphenyl tetrazolium bromide assay at 24,48 and 72 hours after transfection.Apoptosis was evaluated by propidium iodide staining and flow cytometry at 48 hours after transfection.Transwell experiments were performed to evaluate cellular invasion abilities at 24 hours after transfection.Analysis of variance and Bonferroni method were applied as statistical methods.Results The level of miR 1283 in as miR 1283 group was higher than that in the negative control group with statistically significant difference (14.85±0.57 vs 7.08±0.20,P＜0.01).At 24,48 and 72 hours after transfection,the inhibitory rate of cell proliferation in as-miR-1283 group was (8.04 ± 0.27) ％,(32.47 ± 0.24) ％ and (9.23± 0.17) ％,higher than those in the negative control group [(0.72 ± 0.06) ％,(1.17 ± 0.04) ％ and (0.53 ± 0.05) ％] (P ＜ 0.01,respectively).Cell apoptosis rate was higher in as-miR 1283 group than in negative control group [(16.33 ± 0.40) ％ vs (9.39± 0.58) ％,P＜0.01].The transmembrane cell number was lower in as-miR-1283 group as comparing with the negative control group (7.25 ± 1.83 vs 16.33 ± 2.08,P＜0.01).miR-1283 expression,apoptosis and transmembrane cell number in anti-miR-1283 group had no statistical difference as compared to the negative control group (all P ＞ 0.05).Conclusions Up-regulated levels of miR-1283 could inhibit HTR-8/SVneo cell proliferation and invasion,but promote the cell apoptosis.
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Objective To evaluate the efficacy and safety of specific immunotherapy (SIT) to allergic rhinitis in children.Methods Sixty-four patients with mite allergy allergic rhinitis in children,were divided into two groups by random digits table:treatment group and control group,each group with 32 cases.Treatment group was given SIT with standardized allergen vaccine for 3 years on the basis of symptomatic therapy,control group only received symptomatic therapy.Observation indexs included rhinitis symptoms score,drug score,skin index (SI),serum specificity IgE (sIgE),peripheral eosinophil (Eos) counting,development of asthma and the new sensitization.Results The Eos counting,SI after treatment 3 years in treatment group were significantly better than those before treatment and those in control group after treatment 3 years[(0.14 ± 0.12) × 109/L vs.(0.74 ± 0.18) × 109/L,(0.78 ± 0.36) × 109/L and 1.03 ± 0.13 vs.1.51 ± 0.32,1.51 ± 0.37] (P ＜ 0.01).There was no statistically significant difference in sIgE between two groups (P ＞0.05).The rhinitis symptoms score,drug score in two groups after treatment 1,2,3 years were significantly better than those before treatment (P ＜ 0.01).The rhinitis symptoms score,drug score in treatment group after treatment 1,2,3 years were significantly better than those in control group(P ＜ 0.01).The rate of new sensitization in treatment group was significantly lower than that in control group [3.1％ (1/32)vs.34.4％ (11/32),P ＜ 0.01].Conclusion Keeping long-term SIT is effective and safe for children's allergic rhinitis induced by mite,it also prevents new allergen appeared and allergic rhinitis development for asthma.
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Objective To study the mRNA expression of two imprinted genes,paternally expressed gene 1(PEG1) and paternally expressed gene 3(PEG3),and their promoter methylation in human placenta of abnormal birth weight(BW)neonates. Methods Placentas were obtained after full term delivery,without any maternal complications during pregnancy,and were divided into 3 groups according to BW:high BW group(n=22,BW≥4000 g),normal BW group(n=14,BW>2500 g and<4000 g)and low BW group(n=24,BW≤2500 g).The mRNA expression of PEG1 and PEG3 were determined by real-time quantitative polymerase chain reaction.Promoter methylation was measured by the bisulfite genomic sequencing method.Results among different groups were compared. Results (1)The mRNA expression of PEGl and PEG3 were 11.66±9.01 and 16.45±10.13 in the high BW group,0.84±0.49 and 0.85±0.67 in the low BW group and 1.10±0.77 and 1.11±0.60 in the normal BW group,respectively.Both genes were significantly up-regulated in the high BW group compared to the normal BW group(P<0.05),but no significant difference was found between the normal and low BW group (P>0.05). (2) The levels of PEG1 promoter methylation were (49. 7± 2. 3) %, (50. 2 ± 2. 1 )% and (50. 3 ± 1.9)% in the high, low and normal BW group (P>0.05), while the levels of PEG3 promoter methylation in the high BW was significantly lower than in the normal BW group [(13.1± 2. 7) % vs (16.2 ±1.8)%, P<0. 05], but no difference was shown between the low BW group (16.7± 3.5)% and the normal BW group (P>0.05). (3)Negative correlation was detected between the expression of PEG:3 and DNA methylation level within the objective fragment of promoter region (r= -0. 963, P<0. 01). Conclusions The up-regulation of PEG1 and PEG3 may be associated with high BW. The reduction of methylation pattern in the promoter region of PEG3 might be involved in the up-regulation of PEG3 and contribute to the mechanism of high BW fetus in turn.
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Objective We compared the difference of diagnosing macrosomia using the body mass index (BMI)and body mass,so as to investigate whether BMI play an important role in the diagnosis and management of macrosomia in our clinical work.Methods We analysed 5522 newborns (without any maternal complication)delivered in Shengjing Hospital of China Medical University from Jan.2004 to Apr.2009,all of them were full term,singleton and with the birth body mass larger than 2500 g,among them 4989 were in the group with body mass <4000 g,that was 2510-4000 g.533 cases were in the group of body mass ≥4000 g.By both body mass and length,we got the BMI.According to statistical receiver operating characteristic curve(ROC),we determined the cutoff of BMI for diagnosing macrosomia,in addition the sensitivity and specificity of it. Using this newly gotten BMI cutoff as a method to diagnose macrosomia and analyse the results.Results (1)When the newborns with birth length 40-43 cm.the mean birth body mass was(3010 ±351)g,BMI was(17.0 ±2.7)kg/m2;the newborns with birth length 48-51 cm,the mean birth body mass was(3450 ±313)g,BMI was(13.2±1.4)kg/m2;newborns with birth length 56-60 cm,the mean birth body mass was(4332 ±456)g,BMI was(12.5 ±1.3)kg/m2,The longer the birth length,the larger the birth body mass,while the less BMI.(2)Determined by ROC curve,the BMI value could be used to diagnose macrosomia was 14.2 kg/m2.with sensitivity of 78.4% and specificity of 85.0%, the area of under curve was 0. 892. (3) By the BMI cutoff ( 14. 2 kg/m2 ), 111 macorsomia with birth body mass ≥4000 g were not macrosomia any more (20. 8%, 111/533 ),422 still were macrosomia (79.2% ,422/533) ; while for those birth body mass <4000 g, 728 were macrosomia determined by this BMI cutoff ( 14. 59%, 728/4989 ), 4261 were still not macrosomia ( 85.41%, 4261/4989 ). Using BMI cutoff 14. 2 kg/m2 to diagnose macrosomia, within the group of birth body mass ≥4000 g, their birth length in macrosomia and non macrosomia was (52. 2 ± 1.8) cm and ( 55.6 ± 1.3 ) cm respectively, the difference was significant (P <0. 01 ) ;while within the group with body mass <4000 g, the birth length of macrosomia and non-macrosomia was (49.0 ±2. 2) cm and (50. 8 ±2. 2) cm respectively,the difference was significant as well (P <0. 01 ). The whole incidence of macrosomia was 20. 83% (1150/5522) determined by this BMI cutoff. Conclusions Birth body mass and BMI in determining macrosomia show some bias, and birth length relates with this difference, which suggests birth length maybe play an important role in determine the macrosomia. We suggest it is very necessary to use BMI≥ 14. 2 kg/m2 in the diagnosis and management of macrosomia.
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Objective To study the expression of the imprinted gene H19 and IGF-Ⅱ in newborn placenta,and to discuss its influence on the birth body mass of the neonate. Methods The fresh placental tissues from full-term newborn (without trimester of pregnancy complica-tion and placenta and funic abnormality) with normal,high and low birth body mass (12,10 and 8 samples respectively)were collected. The expression of imprinted gene H19 and IGF-Ⅱ mRNA in the placenta were estimated by reakime fluorescence quantitative PCR Results The ex-pression of H19 mRNA in the placenta was negative correlation to the birth body mass (r =-0.403,P = 0.027).The expression of of IGF-H mRNA was positive correlated to the birth body mass (r = 0.444,P = 0.014). The H19 mRNA expression level in the high birth weight neonates (0.21 0.31) was significantly lower than that in the low birth body mass neonates (1.51 2.04)(P= 0.013). But the expression level of IGF-Ⅱ mRNA in the high birth body mass neonates (2.67±3.41) was significantly higher than that in the low birth body mass neonates (0.39±0.33)(P =0.013). Conclusion The expression of H19 and IGF-Ⅱ mRNA was significantly different in the placenta of normal,high and low birth body mass newboms. These two genes may be related to the birth body mass,and there may be some realation-ship between these two genes.