Prediction of birth weight in pregnancy with gestational diabetes mellitus using an artificial neural network / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

Gestational diabetes mellitus (GDM) is common during pregnancy, with the prevalence reaching as high as 31.0% in some European regions (McIntyre et al., 2019). Dysfunction of the glucose metabolism in pregnancy can influence fetal growth via alteration of the intrauterine environment, resulting in an increased risk of abnormal offspring birth weight (McIntyre et al., 2019). Infants with abnormal birth weight will be faced with increased risks of neonatal complications in the perinatal period and chronic non-communicable diseases in childhood and adulthood (Mitanchez et al., 2015; McIntyre et al., 2019). Therefore, accurate estimation of birth weight for neonates from women with GDM is crucial for more sensible perinatal decision-making and improvement of perinatal outcomes. Timely antenatal intervention, with reference to accurately estimated fetal weight, may also decrease the risks of adverse long-term diseases.

Comparison of the effectiveness and pregnancy outcomes of labor induction with dinoprostone or single-balloon catheter in term nulliparous women with borderline oligohydramnios / 中华医学杂志(英文版)

BACKGROUNDS@#At present, there is no consensus on the induction methods in term pregnancy with borderline oligohydramnios. This study aimed to compare the effectiveness and pregnancy outcomes of labor induction with dinoprostone or single-balloon catheter (SBC) in term nulliparous women with borderline oligohydramnios.@*METHODS@#We conducted a retrospective cohort study from January 2016 to November 2018. During the study period, a total of 244 cases were enrolled. Of these, 103 cases were selected for induction using dinoprostone and 141 cases were selected for induction with SBC. The pregnancy outcomes between the two groups were compared. Primary outcomes were successful vaginal delivery rates. Secondary outcomes were maternal and neonatal adverse events. Multivariate logistic regression was used to assess the risk factors for vaginal delivery failure in the two groups.@*RESULTS@#The successful vaginal delivery rates were similar between the dinoprostone group and the SBC group (64.1% [66/103] vs. 59.6%, [84/141] P = 0.475), even after adjustment for potential confounding factors (adjusted odds ratio [aOR]: 1.07, 95% confidence interval [CI]: 0.57-2.00, P = 0.835). The incidence of intra-amniotic infection was lower in the dinoprostone group than in the SBC group (1.9% [2/103] vs. 7.8%, [11/141] P < 0.001), but the presence of non-reassuring fetal heart rate was higher in the dinoprostone group than in the SBC group (12.6% [13/103] vs. 0.7%, [1/141] P < 0.001). Multivariate logistic regression showed that nuchal cord was a risk factor for vaginal delivery failure after induction with dinoprostone (aOR: 6.71, 95% CI: 1.96-22.95). There were three factors related to vaginal delivery failure after induction with SBC, namely gestational age (aOR: 1.51, 95% CI: 1.07-2.14), body mass index (BMI) >30 kg/m2 (aOR: 2.98, 95% CI: 1.10-8.02), and fetal weight >3500 g (aOR: 2.49, 95% CI: 1.12-5.50).@*CONCLUSIONS@#Term nulliparous women with borderline oligohydramnios have similar successful vaginal delivery rates after induction with dinoprostone or SBC, with their advantages and disadvantages. In women with nuchal cord, the risk of vaginal delivery failure is increased if dinoprostone is used in the induction of labor. BMI >30 kg/m2, large gestational age, and estimated fetal weight >3500 g are risk factors for vaginal delivery failure after induction with SBC.

Perinatal outcome and risk factors of precipitate labor in term primipara: an analysis of 381 cases / 浙江大学学报·医学版

OBJECTIVE@#To investigate the perinatal outcome and risk factors of precipitate labor in term primipara.@*METHODS@#A total of 6951 full-term singleton primiparas with cephalic vaginal delivery in Women's Hospital, Zhejiang University School of Medicine from January 2020 to December 2020 were enrolled, among whom 381 cases of precipitate labor were classified as the precipitate labor group and 762 cases of normal labor were randomly selected as the control group. The perinatal outcomes of the two groups were compared, and the risk factors of precipitate labor were analyzed by multivariate logistic regression.@*RESULTS@#The incidence of precipitate labor in full-term, singleton pregnancy and cephalic primiparas was 5.48% (381/6951). The durations of the first and second stages of labor in the precipitate labor group were significantly shorter than that in the control group ( P<0.01); while there was no significant difference in the duration of the third stage of labor between the two groups ( P>0.05). Compared with the control group, the incidence of soft birth canal laceration in the precipitate labor group was increased ( P<0.01). However, there was no significant difference in postpartum hemorrhage and neonatal related perinatal outcomes between the two groups (all P>0.05). Multivariate logistic regression analysis showed that maternal height ( OR=1.038, 95% CI: 1.010-1.067, P<0.01), gestational age at delivery ( OR=0.716, 95% CI: 0.618-0.829, P<0.01), late miscarriage ( OR=1.986, 95% CI: 1.065-3.702, P<0.05), membrane rupture before labor ( OR=1.802, 95% CI: 1.350-2.406, P<0.01), labor induction by transcervical balloon ( OR=3.230, 95% CI: 2.027-5.147, P<0.01), labor induction by propess ( OR=2.332, 95% CI: 1.632-3.334, P<0.01) and labor induction by oxytocin ( OR=0.291, 95% CI: 0.219-0.386, P<0.01) were independently associated with precipitate labor.@*CONCLUSIONS@#The incidence of precipitate labor in full-term, singleton pregnancy was not low. Precipitate labor could lead to a significant increase in perineal laceration. Maternal height, history of late miscarriage, membrane rupture before labor and labor induction by transcervical balloon, labor induction by propess are risk factors, while labor induction by oxytocin and late gestational time of delivery are protective factors for precipitate labor in term primipara.

Impact of pre-pregnancy body mass index, weight gain and blood lipid level during pregnancy on pregnancy outcome in patients with gestational diabetes mellitus / 浙江大学学报·医学版

To explore the effects of pre-pregnancy body mass index (BMI), weight gain and blood lipid level during pregnancy on pregnancy outcome in patients with and without gestational diabetes mellitus(GDM). A total of 12 650 singleton pregnant women without history of hypertension and diabetes who were admitted at Women's Hospital, Zhejiang University School of Medicine for delivery from January 2018 to April 2019 were enrolled in the study. There were 2381 cases complicated with gestational diabetes (GDM group) and 10 269 cases without GDM (non-GDM group). The pre-pregnancy BMI and weight gain during pregnancy were documented in two groups. The factors related to perinatal outcome were analyzed. In both GDM and non-GDM pregnant women, pre-pregnancy overweight and excessive weight gain during pregnancy were independent factors of large for gestational age infant (LGA), small for gestational age infant (SGA) and first cesarean section (<0.01 or <0.05). Excessive weight gain during pregnancy was also an independent risk factor of preeclampsia (<0.05). Triglyceride levels in the second trimester were independently associated with multiple adverse pregnancy outcomes, such as LGA, preeclampsia, initial cesarean delivery, premature delivery. Controlling excessive or insufficient weight gain during pregnancy can significantly reduce the incidence of LGA and SGA. And controlling BMI before pregnancy can effectively reduce the incidence of LGA, preeclampsia and the first cesarean section. For non-GDM pregnant women, abnormal blood lipid levels in the second trimester may be closely related to multiple adverse pregnancy outcomes, and active dietary guidance or treatment is also required.

Impact of family history of diabetes on blood glucose, lipid levels and perinatal outcomes in pregnant women with gestational diabetes mellitus / 浙江大学学报·医学版

To investigate the impact of family history of diabetes (FHD) on blood glucose, lipid levels and perinatal outcomes in pregnant women with gestational diabetes mellitus (GDM). A total of 1265 GDM women who gave childbirth in Women's Hospital, Zhejiang University School of Medicine during January to December 2019 were enrolled in the study, including 253 women with FHD and 1012 women without FHD. The -test or test were used to compare the blood lipid, blood glucose levels and perinatal outcomes including large for gestational age infant, small for gestational age infant, macrosomia, cesarean delivery, preeclampsia, preterm labor, postpartum hemorrhage, fetal distress. The correlation between FHD and perinatal outcomes were estimated by Logistic regression analysis. The high density lipoprotein level at third-trimester was significantly lower in GDM women with FHD (<0.05); and the women with FHD also had higher fasting blood glucose oral glucose tolerance test (OGTT)1 h, OGTT 2 h and glycosylated hemoglobin level (all <0.01). In GDM women, FHD was an independent risk factor for preeclampsia (=3.27, 95%: 1.39-7.68). GDM women with FHD have lower high density lipoprotein and higher glucose levels. FHD is an independent risk factor for preeclampsia in GDM women.

Relationship of abnormal mid-term oral glucose tolerance test and maternal weight gain with adverse pregnancy outcomes in women with gestational diabetes mellitus / 浙江大学学报·医学版

To explore the correlation of mid-term oral glucose tolerance test (OGTT) and maternal weight gain with adverse pregnancy outcomes in women with gestational diabetes mellitus (GDM). A total of 2611 pregnant women with GDM who were examined and delivered in Women's Hospital, Zhejiang University School of Medicine from July 1st 2017 to 30th June 2018 were enrolled in this study. According to the number of abnormal items of mid-term OGTT results or maternal gestational weight gain (GWG), patients were classified. The incidence of adverse perinatal outcomes in each group and its relation with OGTT results and GWG were analyzed. The incidence of gestational hypertension, premature delivery, macrosomia and large for gestational age infant (LGA) in three abnormal items GDM patients were significantly higher than those in one or two abnormal items GDM patients (all <0.017). The incidence of gestational hypertension and premature delivery in two abnormal items GDM patients were higher than those in one abnormal item GDM patients (all <0.017). The incidence of gestational hypertension and macrosomia in excessive GWG patients were significantly higher than those in inadequate and appropriate GWG patients (all <0.017), and the incidence of LGA were higher than that in inadequate GWG patients (all <0.017). The incidence of premature delivery and low birth weight infants in appropriate GWG patients were significantly lower than those in inadequate and excessive GWG patients, and the incidence of small for gestational age infant (SGA) were significantly lower than that in inadequate GWG patients (all <0.017). In one abnormal item GDM patients, inadequate GWG was a risk factor for premature delivery and SGA (=1.66, 95%: 1.10-2.52; =2.20, 95%: 1.07-4.53), and protective factor for LGA (=0.40, 95%: 0.27-0.59). And excessive GWG was a risk factor for gestational hypertension, premature delivery and low birth weight infants (=2.15, 95%: 1.35-3.41; =1.80, 95%: 1.20-2.72; =2.18, 95%: 1.10-4.30).In two abnormal items GDM patients, inadequate GWG was a protective factor for macrosomia and LGA (=0.24, 95%: 0.09-0.67; =0.54, 95%: 0.34-0.86), while excessive GWG was risk factor for premature delivery (=1.98, 95%: 1.23-3.18).In three abnormal items GDM patients, there was no significant relationship between GWG and adverse pregnancy outcomes. For GDM women with one or two items of elevated blood glucose in OGTT, reasonable weight management during pregnancy can reduce the occurrence of adverse pregnancy outcomes. For those with three items of elevated blood glucose in OGTT, more strict blood glucose monitoring and active intervention measures should be taken in addition to weight management during pregnancy.

Interventional effect of dietary fiber on blood glucose and pregnancy outcomes in patients with gestational diabetes mellitus / 浙江大学学报·医学版

To investigate the effect of dietary fiber on blood glucose and pregnancy outcomes in patients with gestational diabetes mellitus (GDM). One hundred and twelve patients with GDM in the second trimester of pregnancy were recruited from Women's Hospital, Zhejiang University School of Medicine. Patients were randomized into two groups with 56 in each group: the control group received basic nutrition support; while the dietary fiber group were given additional dietary fiber ( total dietary fiber per day) before meals in addition to basic nutrition support. Intervention for all cases lasted for 8 weeks. Fasting blood glucose and postprandial blood glucose (2 h BG) were measured every week, and oral glucose tolerance test (OGTT) was performed at 42 d postpartum to evaluate the glycemic outcomes. Perinatal outcomes were recorded. The dietary fiber intervention markedly improved 2 h BG in patients with GDM and significantly elevated the glucose compliance rate from the 3rd to 8th week compared to the control group ( <0.05 or <0.01). OGTT 2 h glucose and the incidence of impaired glucose tolerance in the dietary fiber group were significantly lower than those in the control group, while the glucose compliance rate was significantly higher than that in the control group (all <0.01). Moreover, the rates of adverse perinatal outcomes, such as premature rupture of membranes and neonatal hyperbilirubinemia were declined in the dietary fiber group (<0.05 or <0.01). Dietary fiber intervention can ameliorate hyperglycemia in GDM patients, improve perinatal outcomes and reduce the incidence of postpartum impaired glucose tolerance.

The effect of syphilis treatment during pregnancy on serological test results in infants born to syphilis mothers / 中华传染病杂志

Objective To discuss the effect of syphilis treatment during pregnancy on serological test results in infants born to syphilis mothers.Methods Data of pregnant women with syphilis and their infants in Zhejiang Province between January 2013 and December 2014 were retrospectively analyzed and the effect of syphilis treatment during pregnancy on non-treponemal antigen serological test results in infants were compared.x2 test was used for positive rate of serological tests,incidence of congenital syphilis,and neonatal mortality in infants with syphilis,and rank sum test was used to compare the titers of rapid plasma reagin (RPR) test and tolulized red unheated serum teat (TRUST).Results A total of 3 953 infants were born to 3 901 mothers with syphilis.Of which 3 262 were tested,including 2 226 by RPR and 1 036 by TRUST.The rate of infants with positive RPR was significant lower in treated mothers (45.02％)compared with untreated mothers (55.04％;x2 =12.88,P＜0.01).The significant differences of titers of RPR or TRUST were observed among mothers with or without treatment (RPR:Z=-2.45,P=0.01;TRUST:Z=-2.65,P=0.01),different course of treatment (RPR:Z=-2.33,P=0.02;TRUST:Z=-2.60,P=0.01).Fifty-seven infants were diagnosed with congenital syphilis.The rate of congenital syphilis was 3.50％(27/772) born to untreated mothers,which was dramatically higher than treated mothers (0.96 ％,30/3 129,x2 =27.72,P＜ 0.01).Forty-two infants died.Neonatal mortality was also higher in the untreated group (2.59 ％,20/772) than the treated group (0.70％,22/3 129,x2 =20.72,P＜ 0.01).Conclusion Adequate treatment for women with syphilis during pregnancy could decrease serological tests of RPR and TRUST among new infants and improve the infants their outcomes.

Adverse pregnancy outcomes among women with syphilis in Zhejiang province, 2013-2014 / 中华皮肤科杂志

Objective To investigate the incidence of adverse pregnancy outcomes among women with syphilis in Zhejiang province during 2013-2014,and to explore the influence of anti?syphilis treatment on pregnancy outcomes. Methods A retrospective study was carried out according to the Information Management System for preventing mother?to?child transmission(PMTCT)of syphilis in Zhejiang province during 2013-2014. The incidence of adverse pregnancy outcomes was compared between women with syphilis and general women without syphilis, between treated and untreated women with syphilis, as well as between women with syphilis receiving and not receiving standard anti?syphilis treatment. The effects of anti?syphilis treatment and standard anti?syphilis treatment on pregnancy outcomes were analyzed. Results Data were collected from 3 985 women with syphilis and their children. Of these women, 12 had a stillbirth, and 3 973 a live birth. Totally, 3 210(80.55%)women received anti?syphilis treatment, 967(30.12%, 967/3 210) women received substandard treatment, and 775(19.45%)did not receive anti?syphilis treatment. Of the 3 985 fetuses or neonates born to women with syphilis, 45(1.13%)had abnormal clinical symptoms/signs. The incidence rates of low birth weight and early neonatal death were 7.00%(279/3 985) and 1.13%(45/3 985) respectively in fetuses or neonates born to women with syphilis, both significantly higher than those in fetuses or neonates born to general women without syphilis (3.18%[26 092/819494] and 0.13%[1 029/819 494], respectively, both P < 0.01). Among 775 untreated women with syphilis, the incidence rates of premature birth, low birth weight, early neonatal death, congenital syphilis and abnormal neonatal symptoms/signs were 15.61%(121/775), 10.84%(84/775), 2.45%(19/775), 3.48%(27/775)and 2.84%(22/775)respectively, all significantly higher than those in 3 210 women receiving anti?syphilis therapy (8.26%, 6.07%, 0.81%, 0.81% and 1.03%,respectively, all P < 0.01). Besides, the 967 women receiving substandard anti?syphilis treatment showed higher incidence rates of premature birth, low birth weight, early neonatal death, congenital syphilis and abnormal neonatal symptoms/signs than the 2 243 women receiving standard treatment (10.44%vs. 7.31%, 8.17%vs. 5.17%, 1.55%vs. 0.49%, 1.65%vs. 0.45%, 1.96%vs. 0.62%, respectively, all P<0.01). Conclusions The incidence of adverse pregnancy outcomes is high among women with syphilis in Zhejiang province during 2013-2014. Untreated and inadequately treated maternal syphilis is strongly associated with adverse pregnancy outcomes.

Crystal clear: visualizing the intervention mechanism of the PD-1/PD-L1 interaction by two cancer therapeutic monoclonal antibodies

Antibody-based PD-1/PD-L1 blockade therapies have taken center stage in immunotherapies for cancer, with multiple clinical successes. PD-1 signaling plays pivotal roles in tumor-driven T-cell dysfunction. In contrast to prior approaches to generate or boost tumor-specific T-cell responses, antibody-based PD-1/PD-L1 blockade targets tumor-induced T-cell defects and restores pre-existing T-cell function to modulate antitumor immunity. In this review, the fundamental knowledge on the expression regulations and inhibitory functions of PD-1 and the present understanding of antibody-based PD-1/PD-L1 blockade therapies are briefly summarized. We then focus on the recent breakthrough work concerning the structural basis of the PD-1/PD-Ls interaction and how therapeutic antibodies, pembrolizumab targeting PD-1 and avelumab targeting PD-L1, compete with the binding of PD-1/PD-L1 to interrupt the PD-1/PD-L1 interaction. We believe that this structural information will benefit the design and improvement of therapeutic antibodies targeting PD-1 signaling.

Relationship between follicular development and insulin like growth factor Ⅰ receptor in stimulated cycles / 中华妇产科杂志

Objective　To investigate the number of follicles and insulin-like growth factor I receptor (IGF-ⅠR) in stimulated cycles. Method　IGF-ⅠR mRNA and IGF-ⅠR in granulosa cells obtained during oocyte retrieval were respectively measured by reverse transcript polymerase chain reaction （RT-PCR） and Western blot technique. Results　The expression of IGF-ⅠR mRNA in poor responders (follicles≤3) was much lower than in normal responders (follicles 4～13) and high responders (follicles≥14) (1.70±0.23, 2.92±0.49,4.22±1.50 respectively). Similar results were obtained for IGF-ⅠR (1.32±0.31, 2.01±0.72, 4.39±2.31 respectively). Conclusion　The expression of IGF-ⅠR correlated with the effects of gonadotropin hormone on follicular development.

Effects of Insulin-like Growth Factor-Ⅰ and Insulin-like Growth Factor Binding-protein 1 on Development of Ovarian Follicles during Superovulation Cycle / 中华妇产科杂志

Objective To investigate the effects of insulin-like growth factor Ⅰ (IGF-Ⅰ) and insulin-like growth factor binding-protein 1 (IGFBP-1) on development of ovarian follicles during gonadotropin stimulation in in-vitro fertilization (IVF) program. Methods Enzyme-linked immunosorbent assay (ELISA) and radioimmunoassay were used to determine the levels of IGF-Ⅰ, IGFBP-1 and estradiol (E 2) in serum and follicular fluid obtained during oocyte pick-up (OPU) in 32 IVF-embryo transfer cycles. Results (1) Serum IGFBP-1 levels increased with growth of follicles [(3 5?1 0) ?g/L during OPU, (2 1?0 5) ?g/L before stimulation, P 0 05]. Significant positive correlation was found between serum IGFBP-1 and serum E 2 [(3 5?1 0) ?g/L, (3 293? 1 361) pmol/L, r =0 41, P

Investigation on the relationship among follicular development and insulin-like growth factor-Ⅰ and its receptor mRNA during ovulation stimulation period / 中华内分泌代谢杂志

Objective To observe the relationship among follicular development and insulin-like growth factor Ⅰ (IGF-Ⅰ) and IGF-Ⅰ receptor (IGF-ⅠR) mRNA during ovulation stimulation period in an in-vitro fertilization (IVF) program. Methods IGF-Ⅰ levels in serum samples obtained before (menstrual day 3) and after stimulated (at the time of ovum pick-up) and follicular fluid samples were measured by ELISA. The expression of IGF-Ⅰ mRNA in the granulosa cell obtained from follicular aspiration was determined by RT-PCR. Results There was no significant difference between IGF-Ⅰ levels of serum samples before or after stimulated and follicular fluid. In patients with less than 4 follicls (diameter≥14 mm) at the time of ovum pick-up the IGF-Ⅰ mRNA level was significantly lower than that in patients with more than 4 follicles. Conclusion The serum IGF-Ⅰ levels fail to predict the numbers of follicular development; the levels of IGF-ⅠR mRNA in granulosa cells forecast the responsiveness of ovary to the stimulation of gonadotropins in an IVF program.