Effect of alanine aminotransferase in early pregnancy on neonatal birth weight / 中华内分泌代谢杂志

Objective:To investigate the effect of alanine aminotransferase(ALT) level in early pregnancy and its interaction with maternal body mass index(BMI) on neonatal birth weight.Methods:Data of full-term singleton delivery mother-infant pairs from 2014 to 2016 in Wenzhou were collected. The exposure(ALT>40 U/L) and non-exposure(ALT≤40 U/L) groups were matched using 1∶4 propensity score matching. Logistic regression analysis was used to analyze the relationship between increased ALT level in the first trimester and abnormal birth weight as well as the effect of its interaction with BMI on abnormal birth weight.Results:Multivariate analysis showed that the risks of macrosomia and large for gestational age(LGA) in pregnant women with ALT>40 U/L were 1.584(95% CI 1.323-1.896) and 1.292(95% CI 1.142-1.461) compared with those with ALT≤40 U/L. ALT in the first trimester displayed an additive interaction with BMI on the risk of macrosomia [the relative excess risk due to interaction( RERI)=2.032, 95% CI 0.307-3.757, the attributable proportion due to interaction( API)=0.448, 95% CI 0.221-0.684, the synergy index( S)=2.348, 95% CI 1.274-4.324]. In addition, there was no interaction between ALT and BMI on the risk of LGA, and nor did the association of ALT in the first trimester with low birth weight or small for gestational age exist. Conclusion:ALT>40 U/L in the first trimester increases the risk of high birth weight, especially in overweight or obese pregnant women in the first trimester. Therefore, it is suggested to strengthen the monitoring of ALT level in obese pregnant women during the first trimester.

Mean corpuscular volume ≤100 fl was an independent prognostic factor in patients with myelodysplastic syndrome and bone marrow blast<5 percent / 中华血液学杂志

Objective@#To explore the prognostic effects of mean corpuscular volume (MCV) in patients with myelodysplastic syndromes (MDS) .@*Methods@#321 newly diagnosed, untransfused primary MDS patients who administered from December 2009 to December 2017 were enrolled. The association of MCV with prognosis and several clinical features and genetic mutations were analyzed.@*Results@#Patients were divided into MCV≤100 fl (n=148) and MCV>100 fl (n=173) cohorts. Median overall survival of patients with MCV≤100 fl was shorter than their counterparts (27 months vs 72 months, P<0.001) . In subgroup analysis, MCV≤100 fl patients had worse survivals in bone marrow blast <5% cohort (34 months vs not reached, P=0.002) , but not so in ≥5 % cohort (17 months vs 20 months, P=0.078) . MCV≤100 fl was still an independent adverse variable (HR=1.890, 95%CI 1.007-3.548, P=0.048) after adjusting for clinical and laboratory variables and mutation topography in bone marrow blasts<5% cohort. In bone marrow blasts<5% cohort, patients with MCV≤100 fl had higher hemoglobin levels [90 (42-153) g/L vs 78.5 (28-146) g/L, P=0.015].The proportions of Revised International Prognostic Scoring System (IPSS-R) high/very high risks and poor/very poor IPSS-R karyotypes were higher in MCV≤100 fl cohort (28.8% vs 10.8%, P=0.003; 24.7% vs 12.9%, P=0.049) . MCV≤100 fl cohort had more genetic mutations than those with MCV>100 fl though without significance (0.988 vs 0.769, P=0.064) . Mutated SF3B1 was less frequently in MCV≤100 fl cohort (4.7% vs 15.4%, P=0.018) .@*Conclusion@#MCV≤100 fl was an independent adverse variable after adjusting for clinical and laboratory variables and mutation topography in MDS patients with bone marrow blasts<5%.

Clinical implications and prognostic value of TP53 gene mutation and deletion in patients with myelodysplastic syndromes / 中华血液学杂志

Objective@#To explore the clinical implications and prognostic value of TP53 gene mutation and deletion in patients with myelodysplastic syndromes (MDS) .@*Methods@#112-gene targeted sequencing and interphase fluorescence in situ hybridization (FISH) were used to detect TP53 mutation and deletion in 584 patients with newly diagnosed primary MDS who were admitted from October 2009 to December 2017. The association of TP53 mutation and deletion with several clinical features and their prognostic significance were analyzed.@*Results@#Alterations in TP53 were found in 42 (7.2%) cases. Of these, 31 (5.3%) cases showed TP53 mutation only, 8 (1.4%) cases in TP53 deletion only, 3 (0.5%) cases harboring both mutation and deletion. A total of 37 mutations were detected in 34 patients, most of them (94.6%) were located in the DNA binding domain (exon5-8) , the remaining 2 were located in exon 10 and splice site respectively. Patients with TP53 alterations harbored significantly more mutations than whom without alterations (z=-2.418, P=0.016) . The median age of patients with TP53 alterations was higher than their counterparts[60 (21-78) years old vs 52 (14-83) years old, z=-2.188, P=0.029]. TP53 alterations correlated with complex karyotype and International prognostic scoring system intermediate-2/high significantly (P<0.001) . Median overall survival of patients with TP53 alterations was shorter than the others[13 (95%CI 7.57-18.43) months vs not reached, χ2=12.342, P<0.001], while the significance was lost during complex karyotype adjusted analysis in multivariable model.@*Conclusion@#TP53 mutation was more common than deletion in MDS patients. The majority of mutations were located in the DNA binding domain. TP53 alterations were strongly associated with complex karyotype and always coexisted with other gene mutations. TP53 alteration was no longer an independent prognostic factor when complex karyotype were occurred in MDS.

A study of clinical characteristics and prognosis of primary myelofibrosis patients with thrombocytopenia in varied degrees / 中华血液学杂志

Objective@#To evaluate clinical characteristics and prognosis of primary myelofibrosis (PMF) patients with thrombocytopenia in varied degrees.@*Methods@#Clinical features and survival data of 1 305 Chinese patients with PMF were retrospectively analyzed. The prognostic value of thrombocytopenia in patients with PMF was evaluated.@*Results@#320 subjects (47%) presented severe thrombocytopenia (PLT<50×109/L), 198 ones (15.2%) mild thrombocytopenia [PLT (50-99)×109/L] and 787 ones (60.3%) without thrombocytopenia (PLT ≥ 100×109/L). The more severe the thrombocytopenia, the higher the proportions of HGB<100 g/L, WBC<4×109/L, circulating blasts ≥ 3%, abnormal karyotype and unfavourable cytogenetics (P<0.001, P<0.001, P=0.004, P<0.001 and P<0.001, respectively) were observed in this cohort of patients. The more severe the thrombocytopenia, the lower the proportion of JAK2V617F positive (P<0.001) was also noticed. Platelet count was positively correlated with splenomegaly, HGB and WBC (P<0.001, correlation coefficients were 0.131, 0.445 and 0.156, respectively). Platelet count was negative correlated with constitutional symptoms and circulating blasts (P=0.009, P=0.045, respectively; correlation coefficients were -0.096 and -0.056, respectively). The median survival of patients with severe thrombocytopenia, mild thrombocytopenia and without thrombocytopenia were 32, 67 and 89 months, respectively (P<0.001). Multivariate analysis identified thrombocytopenia in varied degrees (HR=1.693, 95%CI 1.320-2.173, P<0.001) and Dynamic Internation Prognostic Scoring System(DIPSS) prognostic model (HR=2.051, 95%CI 1.511-2.784, P<0.001) as independent risk factors for survival.@*Conclusion@#PMF patients with severe thrombocytopenia frequently displayed anemia, leucopenia, circulating blasts and short survival, so active treatment measures should be taken especially in these patients.

Feasibility and clinical significance of lung ultrasound score in assessment on pulmonary lesions and prognosis in neonates with respiratory distress syndrome / 中国医学影像技术

Objective To evaluate the value of lung ultrasound score (LUS) in the quantitative assessment of the severity of neonatal respiratory distress syndrome (NRDS) and the value of clinical diagnosis and treatment.Methods Totally 74 NRDS cases and 30 normal neonates were studied.LUS was compared with X-ray examination,clinical data,ventilator assisted ventilation and ventilator parameters.ROC curve was used to calculate sensitivity and specificity of LUS to predict the severity of NRDS and application of invasive ventilator treatment.Results The main findings of the lung ultrasound in NRDS included diffuse distribution of dense B line,disappeared A line,pleural line abnormalities,decreased pulmonary slip sign and pulmonary consolidation.LUS in patients with NRDS was significantly correlated with X ray grades,clinical grades,assisted ventilation mode grades,number of days on ventilator and ventilator parameters (all P＜0.05).LUS value to predict mild,moderate and severe NRDS were 13.0,22.5,and 29.5,respectively.The best cutoff point for LUS to predict the adoptation of invasive assisted ventilation was 22.5,which had sensitivity of 86.0 ％ and specificity of 64.5 ％.Conclusion LUS can be used to diagnose and evaluate the severity of the desease,and to guide the clinical diagnosis and treatment.

Gene mutations from 511 myelodysplastic syndromes patients performed by targeted gene sequencing / 中华血液学杂志

Objective@#To study the characteristics of gene mutations in Chinese myelodysplastic syndromes (MDS) patients.@*Methods@#A total of 511 Chinese patients with MDS performed 112-gene targeted sequencing were retrospectively analyzed.@*Results@#Eighty-three distinct mutant genes were found in 511 patients with MDS. Amongst these, the most frequent mutations was associated with epigenetics (50%) , followed by spliceosome (37%) , signal transduction (34%) , transcription factors (24%) and cell cycle/apoptosis (17%) . 439 subjects (86%) had at least one gene mutation. The mean number of mutations in refractory anemia with unilineage dysplasia (RCUD) was 1.25, refractory anemia with multilineage dysplasia (RCMD) was 1.73, refractory anemia with ring sideroblasts (RARS) was 2.79, refractory anemia with excess blasts-1 (RAEB-1) was 2.22, RAEB-2 was 2.34, MDS with isolated 5q- was 2.67, MDS, unclassified (MDS-U) was 2.00. U2AF1 mutant subjects were more likely to have isolated+8[Q<0.001, OR=4.42 (95% CI 2.23-8.68) ]and less likely to have complex karyotypes[Q=0.005, OR=0.22 (95% CI 0.04-0.72) ]. According to the number of gene mutations, all subjects were categorized into three groups, namely group with 0-1 mutation, with 2 mutations and with three or more mutations. There was a significant difference in overall survival (OS) among three groups (P=0.041) .@*Conclusion@#About 90% patients with MDS have at least one gene mutation. Genes associated with epigenetics and spliceosome are most common mutated genes in MDS. The increased numbers of gene mutations accompany with disease evolution and associate with poor prognosis.

Clinical Observation of Hysteroscopy Combined with Drospirenone Ethinylestradiol in the Treatment of Endometrial Polyps / 沈阳医学院学报

Objective:To explore the clinical efficacy of hysteroscopy combined with drospirenone ethinylestradiol in the treatment of endometrial polyps. Methods:A total of patients with endometrial polyps from Feb 2014 to Dec 2015 were randomly divided into 2 groups.The control group was given hysteroscopic surgery. Intravenous infusion of oxytocin and antibiotics after operation was done. The observation group on the basis of the control group received oral administration of drospirenone and ethinylestradiol tablets (1 tablet/d), taking 3 consecutive weeks, and a total of 3 cycles. In the postoperative 4 months follow-up, the curative effect and complications was compared. Results: There was significant difference in menstrual improvement rate in 2 groups (P<0.05) . The recurrence rate in the control group was significantly higher than that in the observation group (P<0.05), but there was no difference in the pregnancy within 6 months after the surgery and adverse reactions (P>0.05) . Conclusion:The endometrial polyps performed hysteroscopic surgery combined with drospirenone ethinyl estradiol can effectively improve menstrual bleeding and cycle,reduce the recurrence of endometrial polyp,and the adverse reaction.

Application of E- learning in training of related knowledge about public health emergencies in Emergency department / 中国实用护理杂志

Objective To apply E- learning in training of related knowledge about public health emergencies in emergency department in order to improve the treatment level of medical staff in public health emergencies. Methods The medical staff was divided into the observation group and the control group with 50 persons in each group according to the odd and even grouping method. The control group was given conventional training method, while the observation group received E- learning based on conventional training method. The theoretical test results and training effect were compared between two groups. Results The scores of the observation group were obviously higher than that of the control group [ (90.88 ± 4.09) points vs. (84.36± 4.92) points ], Z= -5.895, P<0.01. Conclusions The application of E- learning in the training of public health emergencies is beneficial to help the medical staff to obtain and share information resources more conveniently, to enhance the ability of the clinic medical workers of understanding the condition of emergent public health affairs, to elevate the grades of theoretical learning of the relevant knowledge and to improve the management level of training, training effect and efficiency.

Clinical features of full-term neonates with respiratory syncytial virus pneumonia / 中国小儿急救医学

Objective To explore the clinical features of respiratory syncytial virus(RSV) pneumonia in full-term neonatal patients.Methods All 422 full-term newborns diagnosed as pneumonia in NICU of Shenzhen Children's Hospital during January 2014 to January 2015 were included in this study.They had been detected for RSV in the way of direct immunofluorescence assay.According to the detection results, they were divided into RSV positive group and RSV negative group, the clinical data in two groups were analyzed.Results Forty-five cases were RSV positive,377 cases were RSV negative.The proportion of breast feeding was 42.22％ vs.65.25％ ,the proportion of cesarean section was 20.00％ vs.76.12％ in two groups,there were significant differences between the two groups.Hospitalization time, birth weight, gestational age, the age of admission showed no difference between two groups.The incidencs of cough (100％), shormess of breath (88.89％), three depressions (48.89 ％), fine rales (66.67 ％), wheezing (22.22％) in RSV positive group were higher than those in the RSV negative group(84.88％ ,42.44％, 13.26％, 13.53％ ,3.98％ respectively), there were significant differences between the two groups.The incidences of fever, saliva, nasal showed no significant difference between the two groups.There was significant difference in the X-ray chest film performance between two groups,RSV positive group was more emhrysema(71.11％ vs.6.9％) ,and less patch shadow(88.89％ vs.93.10％).The laboratory examination of blood routine test, C-reactive protein,respiratory failure, the positive rate of sputum culture, pneumothorax, pleural effusion were without differences.Conclusion RSV is an important pathogen of full-term neonates with infectious pneumonia.Breastfeeding and eutocia can reduce the incidence of RSV infection.Cough, shortness of breath, pulmonary rales, and emphysema in X-ray were common in RSV pneumonia.

The role of Toll-like receptor signal in inflammatory response in neonatal sepsis / 中国小儿急救医学

Objective To investigate the role of signal transduction of Toll-like receptors (TLRs) in inflammatory response of neonatal sepsis.Methods Twenty children with neonatal sepsis and 16 health neonates were studied.Real-time PCR were used to evaluate the levels of TLR1 ～ TLR10,myeloid differentiation protein 2 (MD-2),myeloid differentiation factor 88 (MyD88),interleukin (IL)-1β,IL-6,IL-8 and tumor necrosis factor-α (TNF-α) mRNA expression in peripheral blood mononuclear cells.Expressions of proinflammatory cytokines (IL-1β,IL-6,IL-8,TNF-α) were measured by ELISA.Results (1) Compared with control group,the mRNA levels of TLR2,TLR4 in neonatal sepsis group were up-regulated significantly (TLR2:55.16±12.78 vs 9.53 ± 3.73,P ＜ 0.01 ;TLR4:125.22 ±30.64 vs 23.17 ± 5.78,P ＜0.01),the differences were not significant as to other TLRs.(2) Transcription levels of MD-2 and MyD88 were significantly up-regulated in neonatal sepsis group (MD-2:376.83 ± 62.16 vs 12.92 ± 2.54,P ＜ 0.01 ; MyD88:11.97 ±2.48 vs 2.77 ±0.59,P ＜0.01).(3) Expressions of proinflammatory cytokines (IL-1β,IL-6,IL-8,TNF-α) in neonatal sepsis group were higher than those of control group [PCR:(IL-1β:21.72 ± 5.56 vs 5.69 ± 1.26,P ＜0.01 ;IL-6:71.39 ± 18.34 vs 9.65 ±2.13,P ＜0.01 ;IL-8:29.39 ±6.72 vs 8.72 ± 1.95,P＜0.01;TNF-α:65.42 ± 16.95 vs 12.33 ±3.45,P ＜0.01).ELISA:(IL-1β:2 977.36 ±653.97 vs 480.52 ± 120.36,P ＜ 0.01 ; IL-6:3 143.82 ± 775.08 vs 393.78 ± 96.55,P ＜ 0.01 ; IL-8:2 510.78 ± 686.77 vs 276.91 ±72.46,P ＜0.01 ;TNF-α:3 582.24 ± 876.13 vs 1 233.68 ± 289.39,P ＜ 0.01)].Conclusion Abnormal activation of TLRs and higher expressions of proinflammatory cytokines in neonatal sepsis,suggesting that aberrant activation of TLRs may be one of the initiating factors of immune aberrance in neonatal sepsis.

Clinical observation of cut healing with gelatin paste after cervical intraepithelial neoplasia surgery by LEEP / 中国基层医药

Objective To observe the poet-operative clinical inpact on cervical intraepithelial neoplasia surgery by Loop elcctrosurgical excision procedure(LEEP),gelatin paste to improve the healing of the Cut,prevent the post-operative bleeding,and find out effective methods of preventing LEEP complications.Methods 100 patients with cervical intraepithelial neoplasia underwent LEEP in clinic.Divide them into two groups randomly,60 patients were adopted gelatin paste post-LEEP ag the cure group.while 40 patients were adopted as control group.Observation Vaginal bleeding,infection and cervical rear in short-term.Results In 60 patients of cure group,never patients with vaginal bleeding,infection and the cut healing in the short time.In 40 patients of control group,three patients with vaginal bleeding,two patients with infection,and three patients with bad healing.The different between two group with vaginal bleeding,infection and the cut healing time was significant(P＜0.05).Condusion gelatin paste can reduce bleeding.infection and cervical repair bad cmpllcations after cervical intraepithelial neoplasia surgery by LEEP.

Study of Insulin-like Growth Factor 1 and Epidermal Growth Factor Level in Blood of Newborns with Asphyxiated / 医学研究杂志

Objective To study the change of Insulin-like growth factor 1(IGF-1)and Epidermal growth factor(EGF)level in blood of newborns with asphyxiated.Investigation the effect of stomach-intestine hormone to newborns asphyxiated.Methods plasma IGF-1,EGF level of 48 neonatal asphyxia and 36 normal newborns(1d,3d,7d)were tested by radioimmunoassay.Result In comparision with normal neonatal,IGF-1,EGF level of neonatal asphyxia reduced significantly(P