Secular trends of age at menarche and age at menopause in women born since 1951 from a county of Shandong Province, China / 北京大学学报(医学版)

OBJECTIVE@#To describe the secular trends of age at menarche and age at natural menopause of women from a county of Shandong Province.@*METHODS@#Based on the data of the Premarital Medical Examination and the Cervical Cancer and Breast Cancer Screening of the county, the secular trends of age at menarche in women born in 1951 to 1998 and age at menopause in women born in 1951 to 1975 were studied. Joinpoint regression was used to identify potential inflection points regarding the trend of age at menarche. Average hazard ratios (AHR) of early menopause among women born in different generations were estimated by performing multivariate weighted Cox regression.@*RESULTS@#The average age at menarche was (16.43±1.89) years for women born in 1951 and (13.99±1.22) years for women born in 1998. The average age at menarche was lower for urban women than that for rural women, and the higher the education level, the lower the average age at menarche. Joinpoint regression analysis identified three inflection points: 1959, 1973 and 1993. The average age at menarche decreased annually by 0.03 (P < 0.001), 0.08 (P < 0.001), and 0.03 (P < 0.001) years respectively for women born during 1951-1959, 1960-1973, and 1974-1993, while it remained stable for those born during 1994-1998 (P=0.968). As for age at menopause, compared with women born during 1951-1960, those born during 1961-1965, 1966-1970 and 1971-1975 showed a gradual decrease in the risk of early menopause and a tendency to delay the age at menopause. The stratified analysis presented that the risk of early menopause gradually decreased and the age of menopause showed a significant delay among those with education level of junior high school and below, but this trend was not obvious among those with education level of senior high school and above, where the risk of early menopause decreased and then increased among those with education level of college and above, and the corresponding AHRs were 0.90 (0.66-1.22), 1.07 (0.79-1.44) and 1.14 (0.79-1.66).@*CONCLUSION@#The age at menarche for women born since 1951 gradually declined until 1994 and leveled off, with a decrease of nearly 2.5 years in these years. The age at menopause for women born between 1951 and 1975 was generally delayed over time, but the trend of first increase and then decrease was observed among those with relatively higher education levels. In the context of the increasing delay in age at marriage and childbearing and the decline of fertility, this study highlights the necessity of the assessment and monitoring of women' s basic reproductive health status, especially the risk of early menopause.

Development of membrane anatomy theory in gastric cancer surgery / 中华胃肠外科杂志

In the past decade, the concept of membrane anatomy has been gradually applied in gastric cancer surgery. Based on this theory, D2 lymphadenectomy plus complete mesogastric excision (D2+CME) has been proposed, which has been demonstrated to significantly reduce intraoperative bleeding and intraperitoneal free cancer cells during surgery, decrease surgical complications, and improve survival. These results indicate that membrane anatomy is feasible and efficacious in gastric cancer surgery. In this review, we will describe the important contents of membrane anatomy, including "Metastasis V"(2013, 2015), proximal segmentation of dorsal mesogastrium (2015), D2+CME procedure (2016), "cancer leak"(2018), and surgical outcomes of D2+CME (2022).

Epidemiological investigation of 201 emergency adult sudden death patients and analysis of the influence of leukocyte count and lactic acid concentration on prognosis / 中国综合临床

Objective:To investigate the clinical situation of 201 emergency adult sudden death patients, and analyze the influence of white blood cell count and arterial blood lactate level on prognosis.Methods:The clinical data of 201 patients diagnosed with sudden death in the emergency department of Medical College of Cangzhou people's Hospital from January 2017 to January 2021 were retrospectively analyzed. The gender, age, disease composition and etiology of the patients were statistically analyzed. The independent sample t-test was used to compare the measurement data with normal distribution, the χ 2 test or Fisher exact probability method was used to compare the counting data between groups, and the logistic regression model was used to screen the risk factors of emergency death, and the impact of white blood cell count and arterial blood lactate level on the prognosis was analyzed. Results:After active rescue, 11.44% (23/201) of the patients were successfully rescued, and 88.56% (178/201) of the patients were ineffective; ≥46-≤65 years old was the age group with high incidence of sudden death (55.22%(111/201)). The proportion of male (43.28% (87/201), 23.38% (42/201)) in the age group of ≥46-≤65 years old and the age group over 65 years old were higher than that of female (11.94% (24/201), 14.43% (29/201)), with a statistically significant difference (χ 2=4.801, 9.209; P=0.028, 0.002). In the past history of sudden death patients, the proportion of cardiovascular disease (53.23% (107/201)) was the highest; the proportion of patients may have inducements before sudden death was 74.13% (149/201), the proportion of patients have premonitory symptoms before sudden death was 67.66% (136/201), and sudden cardiac death was the first cause. Logistic regression analysis showed that white blood cell count ( OR=4.442,95% CI: 1.898-10.395), arterial blood lactic acid concentration ( OR=4.272,95% CI: 2.024-9.016), and albumin concentration ( OR=2.657,95% CI: 1.302-5.422) were independent risk factors affecting emergency sudden death patients ( P values were 0.001, <0.001, 0.007, respectively). Conclusions:There are some differences in gender, age and past history of adult sudden death patients. Most of them have premonitory symptoms and inducements. Sudden cardiac death is the primary cause. The increases of white blood cell count and lactic acid level, the decrease of albumin level are the risk factors of sudden death.

SPTLC2 gene mutation leads to intermediate Charcot-Marries-Tooth disease: a family report / 中华神经科杂志

Objective:To report a SPTLC2 gene mutation in a family with a phenotype of Charcot-Marie-Tooth disease.Methods:To screen the family of patients with pathogenic mutations of SPTLC2 gene from the database of hereditary peripheral neuropathy in the Department of Neurology, Peking University First Hospital, and to collect their clinical data, peripheral nerve conduction examination, nerve ultrasound examination, pathological examination of the peroneal nerve and whole exome sequencing results of prohand.Results:One family was screened, the proband was a 16-year-old female with 4 years of sensory loss and anhidrosis of both lower limbs and 16 months of walking difficulty who admitted to Peking University First Hospital in January 2022. Physical examination showed sensory loss, dry skin and weakness in distal limbs. Her father had numbness and dry skin in the distal lower limbs from childhood,weakness and atrophy of his lower limbs in adulthood. He died at age of 52 years old. The nerve conduction study revealed no action potentials of the sensory and motor nerves of the lower limbs in the proband. The amplitude of the compound muscle action potential of the motor conduction of the bilateral ulnar nerve and median nerve decreased, and the nerve conduction velocity of the bilateral median nerve were 32 m/s and 24 m/s. Neurosonography showed thickening of peripheral nerves. Sural biopsy revealed severe loss of myelinated and unmyelinated nerve fibers with onion bulbs formation. SPTLC2 gene showed a known heterozygous p.G435V mutation. The lower limb weakness was improved after oral L-serine.Conclusions:SPTLC2 gene mutation can lead to an intermediate Charcot-Marie-Tooth disease phenotype. L-serine can improve the limb weakness.

Thyroid function of first-trimester twin pregnant women and its association with preterm delivery / 北京大学学报(医学版)

OBJECTIVE@#To describe the thyroid function abnormality of first-trimester twin pregnant women according to different references, and to explore its association with preterm delivery.@*METHODS@#Participants, first-trimester twin pregnant women, were recruited at Peking University Third Hospital from March 2017 to February 2020. The thyroid hormone reference for ordinary adults identified on the assay kits by Siemens incorporation, thyroid hormone reference specifically for singleton pregnancy established previously, and thyroid hormone reference specifically for twin pregnancy established previously were used in the description of hypothyroidism and hyperthyroidism for first-trimester twin pregnant women. Thyroid autoantibody reference identified on the assay kits by Siemens incorporation was used in the description of positive thyroid autoantibody. Multivariable log-binomial regression was conducted to examine the association between thyroid function and preterm delivery, in which normal pregnant women according to the three references and normal pregnant women according to twin pregnancy reference accompanied with negative thyroid autoantibody were taken as control respectively.@*RESULTS@#A total of 570 twin pregnant women were finally included. Rates of hypothyroidism according to the three references were 1.2%, 1.6% and 3.5%, respectively. Rates of hyperthyroidism according to the three references were 32.6%, 18.1% and 1.1%, respectively. After adjustment for potential confounding factors, risk of preterm delivery significantly increased in pregnant women with hyperthyroidism according to the twin specific pregnancy reference [adjusted relative risk (ARR)=1.41, 95%CI: 1.14-1.75], while no significant increase was found in those with normal thyroid function according to the twin specific pregnancy reference but hyperthyroidism according to the singleton specific pregnancy reference (ARR=1.00, 95%CI: 0.81-1.25) and in those with hyperthyroidism purely according to the ordinary adult reference (ARR=1.06, 95%CI: 0.85-1.32), compared with those normal according to all the references. Risks of preterm delivery almost significantly or significantly increased in pregnant women with hypothyroidism according to the ordinary adult or singleton specific pregnancy reference (ARR=1.40, 95%CI: 0.88-2.22) and those with hypothyroidism according to the twin specific pregnancy reference (ARR=1.53, 95%CI: 1.03-2.28). Overall analysis of thyroid function according to the twin specific pregnancy reference and thyroid autoantibody showed that risks of preterm delivery almost significantly or significantly increased in pregnant women with simple hypothyroidism (ARR=1.46, 95%CI: 0.93-2.27), simple positive thyroid autoantibody (ARR=1.32, 95%CI: 1.15-1.52), and hypothyroidism accompanied with positive thyroid autoantibody (ARR=1.78, 95%CI: 1.30-2.44), compared with those normal according to the twin specific pregnancy reference with negative thyroid autoantibody.@*CONCLUSION@#The ordinary adult reference and that of singleton pregnancy may lead to under-diagnosis of hypothyroidism and over-diagnosis of hyperthyroidism in first-trimester twin pregnant women. Compared with pregnant women with normal thyroid function, those missed in the diagnosis of hypothyroidism were at a higher risk of preterm delivery, while those over-diagnosed as hyperthyroidism had a similar risk of preterm delivery, indicating a need to develop and generalize twin-pregnancy-specific reference on common indicators of thyroid function. Moreover, the thyroid autoantibody should be taken into consideration in the prenatal diagnosis and treatment to twin pregnant women with hypothyroidism.

Analysis of clinical efficacy of C expanded half lamina excision combined with unilateral open-door laminoplasty for multiple segmental cervical spinal cord compression syndrome / 中国骨伤

OBJECTIVE@#To explore the clinical efficacy of C expanded half lamina excision combined with unilateral open door laminoplasty for multiple segmental cervical spinal cord compression syndrome.@*METHODS@#The clinical data of 58 patients with multiple segmental cervical spinal cord compression syndrome underwent surgical treatment between September 2014 and May 2018 were retrospectively analyzed. There were 34 males and 24 females with a mean age of 64.4 years old (ranged from 46 to 78 years old). Among them, 28 cases received the surgery of C expanded half lamina excision combined with C-C unilateral open-door laminoplasty (improvedgroup), and 30 cases received a single C-C unilateral open-door laminoplasty (traditional group). Operation time, intraoperative blood loss, complications including C nerve root palsy and axial symptoms were compared between two groups. To evaluate the situation of the imaging indicators by measuring the space available for the spinal cord through cross sectional MRI of cervical spine at the narrowest segment of C (including intervertebral disc levels of C). Pre- and post-operative Japanese Orthopedic Association(JOA) score, Neck Disability Index(NDI) score, and improvement rate of neurological function, were recorded and analyzed between the two groups.@*RESULTS@#All the patients were followed up for 12 to 18 months with an average of(14.5±1.8) months for improved group and (14.5±1.9) months for traditional group, and no significant difference was found between the two groups (>0.05). There was no significant difference in intraoperative blood loss and C nerve root palsy between the two groups (>0.05). The operation time (119±10) min vs (126±12) min and axial symptoms 7.1%(2/28) vs 26.6%(8/30) was significant difference between the two groups (0.05).@*CONCLUSION@#C expanded half lamina excision combined with unilateral open-door laminoplasty is an effective method to treat multiple segmental cervical spinal cord compression syndrome, for it can not only fully relieved spinal cord compression, but also achievedgood effect in preventing complications such as axial symptoms by reducing stripping of muscles from C2 spinous process.

Multidisciplinary team model for patients with oral cancer and systemic diseases: an expert consensus / 华西口腔医学杂志

Large general hospitals currently play an increasingly important role in the diagnosis and treatment for acute critical patients and difficult diseases because of the development of dual referral system and hierarchical diagnosis, as well as the formation of medical treatment alliance. Patients with oral cancers are often associated with systemic diseases, which increases the complexity of the condition. Thus, meeting the demand through the traditional single medical model is difficult. As such, a multidisciplinary team (MDT) model has been proposed and has achieved a good clinical effect. To standardize the application of this model, we organized an event in which relevant experts discussed and formulated a consensus to provide standardized suggestions on the MDT process and the diagnosis and treatment of common systemic diseases as reference for clinical practice.

Relationship of plasma vitamin A levels between neonates and pregnant women in third trimester / 北京大学学报(医学版)

OBJECTIVE@#To study the correlation of plasma vitamin A (VitA) levels between neonates and pregnant women in third trimester.@*METHODS@#A total of 688 pregnant women were recruited in Yuanshi and Laoting counties of Hebei Province, from May to June 2009. Venous blood samples of women before delivery and cord blood samples of newborns were collected and measured for retinol (retinol concentration was used to reflect VitA level) using high performance liquid chromatography assay. According to venous blood plasma retinol concentration, maternal VitA nutritional status was divided into deficiency (<0.70 μmol/L), marginal deficiency (0.70-<1.05 μmol/L), and sufficiency (≥1.05 μmol/L). According to cord blood plasma retinol concentration, neonatal VitA nutritional status was divided into deficiency (<0.35 μmol/L), marginal deficiency (0.35-<0.70 μmol/L), and sufficiency (≥0.70 μmol/L); neonatal VitA relative deficiency was further defined as cord blood plasma retinol concentration lower than the 10th percentile. VitA placental transport ratio was defined as retinol concentration in the neonates divided by that in pregnant women. Multivariable fractional polynomials (MFP) model and Pearson correlation were used to study the dose-response relationship between maternal and neonatal plasma VitA levels, Logistic regression model to estimate the effect of maternal VitA nutritional status on neonatal VitA deficiency, and MFP model and Spearman correlation to describe the relationship between maternal VitA level and VitA placental transport ratio.@*RESULTS@#The average retinol concentration of the pregnant women was (1.15±0.30) μmol/L, and the prevalence of VitA deficiency and marginal deficiency were 4.5% and 37.8%, respectively. Average retinol concentration of the neonates was (0.78±0.13) μmol/L, and no neonates were VitA deficiency, 28.2% of the neonates were marginal deficiency. After multivariable adjustment, the VitA level of the neonates was positively and linearly related to maternal VitA level (pm=1, P<0.05), with the corresponding Pearson correlation coefficient of 0.13 (P<0.01). As compared with the women with sufficient VitA, those with VitA deficiency (crude OR=2.20, 95%CI:1.04-4.66) and marginal deficiency (crude OR=1.43, 95%CI:1.01-2.02) had higher risks to deliver neonates with VitA marginal deficiency; while the risks turned to be non-significant after multivariable adjustment. The pregnant women with VitA deficiency had higher risk to deliver neonates with relative VitA deficiency before and after multivariable adjustment (crude OR=3.02, 95%CI:1.21-7.50; adjusted OR=2.76, 95%CI:1.05-7.22). The maternal VitA level was negatively and non-linearly correlated with placental transport ratio (pm= -0.5, P<0.05), with corresponding adjusted Spearman correlation coefficient of -0.82 (P<0.001).@*CONCLUSION@#There was a positive linear dose-response relationship between VitA levels of newborns and pregnant women in third trimester, indicating that neonatal VitA storing levels at birth was affected by maternal VitA nutritional status.

Design of Compression/Release Stabilized Transfemoral Prosthetic Socket Based on Magnetic Resonance Imaging Based Three-dimensional Reconstruction Model of Residual Limb / 中国康复理论与实践

Objective:To study the design and fabrication of the sub-ischial compression/release stabilized (CRS) transfemoral prosthetic socket based on 3D reconstructed residual limb. Methods:The magnetic resonance imaging (MRI) of a transfemoral amputee's residual limb was used for 3D construction. The base of the socket was constructed by the surface of the 3D geometry of residual limb in SolidWorks, and then the sketching and swept surface function was applied to create the compression and release structure. The CRS socket was analyzed by finite element method. The simulation was then validated experimentally. Results:The transfemoral CRS socket was successfully constructed in SolidWorks and assembled with the residual limb for finite element modeling. The simulation results showed the residual limb pressure distribution over the CRS socket compression areas. The maximum residual limb pressure was predicted to be 218.5 kPa by the finite element model, and experimentally measured was 239 kPa. The maximum residual limb pressure was within the pain threshold and pain tolerance range, and the patient was satisfied with the socket. Conclusion:This attempt of reconstructing residual limb MRI to design the CRS prosthetic socket provided another way to study the socket behavior in the prosthesis fitting process. The FEM-CAD method can improve the socket design and fitting process with computer simulation to reduce the trial on patients.

Mobile terminal-based survey on the birth characteristics for Chinese newborns / 北京大学学报(医学版)

OBJECTIVE@#To describe the birth characteristics for Chinese newborns, to assess the feasibility of collecting basic data on maternal and child health, and to conduct relevant epidemiological studies by using mobile terminals.@*METHODS@#From June 2016 to January 2017, pregnant women who delivered in hospitals were recruited in 166 hospitals scattered across 23 provinces of China. The data on their maternal and child health including delivery mode, gestational age and birth weight, were collected by self-administered questionnaires embedded in a mobile application. The incidences or means of cesarean section, preterm birth, birth weight, length and head circumference were calculated and compared with recognized national data, including 2005 Growth Standards for Chinese Children Under 7 Years of Age, 2006 World Health Organization Child Growth Standards and 2014 Chinese Neonatal Birth Weight Standards by Gestational Age.@*RESULTS@#A total of 9 986 women were investigated, among whom those aged ≥35 years accounted for 11.7% and those received well education (college and above) accounted for 70.2%. The rate of cesarean section, preterm delivery, low birth weight and macrosomia were 38.1%, 4.5%, 2.2%, and 7.8%, respectively. The means were (3.33±0.44) kg [male (3.36±0.44) kg, female (3.29±0.43) kg] for birth weight, (50.97±2.32) cm [male (51.04±2.32) cm, female (50.89±2.32) cm] for birth length, and (33.99±1.56) cm [male (34.01±1.57) cm, female (33.97±1.55) cm] for head circumference, respectively. As compared with the national data, the cesarean section rate and birth weights by gestational age for term-born neonates were similar to the latest national data in 2014, while the means of birth weight and length were obviously higher than those of the 2005 Growth Standards for Chinese Children Under 7 Years of Age and 2006 World Health Organization Child Growth Standards.@*CONCLUSION@#As compared with the national data 10 years ago, the mean birth weights for male and female newborns were increased by 40 g and 80 g respectively and mean lengths by 0.6 cm and 1.3 cm, but changes for mean head circumferences were negligible, indicating that the physical health condition for Chinese newborns improved significantly over past 10 years and emerging information technology likely provided a new approach for epidemiological research.

Application of superselective lingual artery embolization in treatment of severe hemorrhange in patients with carcinoma of tongue / 中华口腔医学杂志

To explore the clinical value of superselective lingual artery embolization in treating the severe hemorrhage in patients with advanced carcinoma of tongue. Four patients with advanced tongue cancer hemorrhage from March 2014 to February 2016 were enrolled in this study. T3N2M0 (2 cases) and T4N1M0 (2 cases) were diagnosed preoperatively. Two cases of advanced tongue carcinoma tumors had severe bleeding and the other 2 cases of hemorrhage were after radiotherapy. All cases including 3 squamous cell carcinoma and 1 adenocarcinoma were firstly demonstrated by arterigraphy under seldinger technique with digtial subtraction angiogarphy to ensure the rupture site and then all cases were followed by superselective artery embolization. The efficacy and complications of interventional embolizationg were observed. There was no serious complication of central nervous system injury such as hemorrhage and hemiplegia during follow-up. Superselective lingual artery embolization can accurately locate the responsibility of blood vessels, and the injury is small, significant effect, fewer complications.

Therapeutic Effects of Transthoracic Pulmonary Artery Denervation in a Rat Model of Pulmonary Arterial Hypertension / 中国循环杂志

Objectives:The aim of this study was to observe whether transthoracic pulmonary artery denervation (TPADN) could reduce the pulmonary arterial pressure and attenuate pulmonary vascular remodeling in rats with pulmonary arterial hypertension induced by monocrotaline. Methods:Twenty-four healthy male SD rats were randomly divided into control group, sham operation group and operation group (n=8 per group). Rats in sham operation group and operation group received single subcutaneous injection of monocrotaline (MCT, 60 mg/kg). After four weeks, the mean pulmonary arterial pressure (mPAP) and other hemodynamic parameters were measured with the right heart catheter in rats of these two groups. Then, operation group received the surgery of TPADN, which included thoracotomy in left 2-3 rib, exposing pulmonary artery, and removing the near connective tissue of the pulmonary artery trunk. After two weeks of operation, the mPAP and other hemodynamic parameters were measured again by the right heart catheter. The microstructure changes of the heart and pulmonary vessels was observed by immunohistochemistry and immunofluorescence. Meanwhile, RV cardiomyocyte cross-sectional area (CSA) and the right hearthy pertrophy index (RVHI= RV/[LV+S]) were used to evaluate the degree of right ventricular hypertrophy. Results:After four weeks of injection of MCT, the mPAP was significantly higher in the operation group and the sham operation group than in control group (P＜0.01). Two weeks after the surgery of TPADN, the mPAP was significantly reduced in the operation group than compared in the sham group(P＜0.01). Meanwhile, the percentage of medial thickness to outer diameter of the small pulmonary arterioles, right ventricular myocardial cell cross-sectional area and RVHI were also significantly decreased in the operation group compared to sham operation group(all P＜0.01). Conclusions:Our results show that TPADN could reduce the mean pulmonary arterial pressure and attenuate the hypertrophy of medial thickness of small pulmonary arterioles and of right ventricle in PAH rats induced by monocrotaline.

Combination of hyaluronic acid and bone marrow mesenchymal stem cells promotes cardiac function after myocardial infarction / 中国组织工程研究

BACKGROUND: The poor retention and survival of donor cells implanted into the myocardium limit the efficacy of cell therapy for myocardial infarction. Embedding cells in natural or synthetic biomaterials is a strategy to address this issue. OBJECTIVE: To explore the effects of bone marrow mesenchymal stem cells (BMSCs) encapsulated in hyaluronic acid (HA) hydrogel on cardiac function after myocardial infarction. METHODS:BMSCs from male Sprague-Dawley rats were isolated and cultured,and then HA-encapsulated BMSCs were cultured in vitro in the three-dimensional manner. A model of myocardial infarction was made by cutting the anterior descending artery of female Sprague-Dawley rats. After 1 week, the model rats were screened by ultrasonic testing and then eligible ones were randomly divided into four groups: PBS group (n=8), HA group (n=8), BMSCs group (n=29), and HA-encapsulated BMSCs group (n=29). At 1 week after modeling, the model rats underwent the secondary thoracotomy and the implants were injected into the marginal zone and infarcted region in corresponding groups. The survival rate and apoptosis of implanted cells were examined at post-injection day 1, week 1 and week 2 by RT-PCR and TUNEL respectively. At post-injection week 4, changes of cardiac microstructure and function were evaluated by histological examination and echocardiography. RESULTS AND CONCLUSION: Compared with the BMSCs group, HA hydrogel significantly enhanced the survival rate and reduced the apoptotic rate of BMSCs at post-injection day 1 and week 2 (both P < 0.05). At post-injection week 4, the HA+BMSCs combined treatment yielded the best recovery of cardiac function (P < 0.05). To conclude, HA hydrogel can act as a vehicle for BMSCs delivery and improve the beneficial effects of implanted BMSCs in early myocardial repair(within 2 weeks after infarction)via enhancing cell retention and survival.

The value of perineal ultrasonography in long-term stress urinary incontinence after total abdominal hysterectomy / 重庆医学

Objective To evaluate the value of transperineal pelvic ultrasound(TPUS) on long-term stress urinary incontinence (SUI) after total abdominal hysterectomy (TAH).Methods Thirty patients with TAH at least 2 years after operation were diagnosed as SUI according to clinical criteria and ultrasound criteria.They were divided into non-SUI group (Group Ⅱ,66 cases) and SUI group (Group Ⅲ,54 cases),72 cases of healthy patients were selected as the control group (group Ⅰ).TPUS was performed.The bladder neck rotation angle (△vBA),bladder urethral relief angle (rUJV,vUJV),urethral rotation angle (△vUIA),bladder neck mobility (BND),and the displacement of the bladder neck (vsB) were measured and recorded during the rest period and Valsalva state.Results According to the findings of ultrasound combined with pelvic floor parameters,the absolute values of △vBA,rUJV,vUJV,△vUIA,BND,vsB were increased in group Ⅱ compared with group Ⅰ (P＜0.05),which indicated that supportive function of the long-term pelvic floor tissue after TAH for a long-term was reduced.Compared with the non SUI group,the absolute values of △vBA,rUJV,vUJV,△vUIA,BND and vsB increased in the SUI group after TAH for a long term (P＜0.05).The absolute values of △vBA,rUJV,vUJV,△vUIA,BND,and vsB increased in the SUI group compared with the non-SUI group (P＜0.05),which indicated that after TAH,compared with non-SUI patients,the value of pelvic ultrasound parameters in patients with SUI increased more significantly.Conclusion The pelvic floor support function decreased after TAH,and pelvic floor function could be dynamically detected by TPUS in the early stage of TAH.

A comparative study of two ventilation modes in the weaning phase of preterm infants with respiratory distress syndrome / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To compare the efficacy between synchronized intermittent mandatory ventilation (SIMV) and pressure support ventilation with volume guarantee (PSV+VG) in the weaning phase of preterm infants with respiratory distress syndrome (RDS).</p><p><b>METHODS</b>Forty preterm infants with RDS who were admitted to the neonatal intensive care unit between March 2016 and May 2017 were enrolled as subjects. All infants were born at less than 32 weeks' gestation and received mechanical ventilation. These patients were randomly and equally divided into SIMV group and PSV+VG group in the weaning phase. Ventilator parameters, arterial blood gas, weaning duration (from onset of weaning to extubation), duration of nasal continuous positive airway pressure (NCPAP) after extubation, extubation failure rate, the incidence rates of pneumothorax, patent ductus arteriosus (PDA) and bronchopulmonary dysplasia (BPD), and the mortality rate were compared between the two groups.</p><p><b>RESULTS</b>The PSV+VG group had significantly decreased mean airway pressure, weaning duration, duration of NCPAP after extubation, and extubation failure rate compared with the SIMV group (P<0.05). There were no significant differences in arterial blood gas, mortality, or incidence rates of pneumothorax, PDA and BPD between the two groups (P>0.05).</p><p><b>CONCLUSIONS</b>For preterm infants with RDS, the PSV+VG mode may be a relatively safe and effective mode in the weaning phase. However, multi-center clinical trials with large sample sizes are needed to confirm the conclusion.</p>

Percentages of peripheral blood γδ T cells and regulatory T cells and expression of associated cytokines in infants with human cytomegalovirus infection / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the percentages of peripheral blood γδ T cells and regulatory T cells (Treg) and the expression of associated cytokines, interleukin 17 (IL-17) and transforming growth factor-β1 (TGF-β1), in infants with human cytomegalovirus (HCMV) infection.</p><p><b>METHODS</b>Twenty-two infants with HCMV infection (HCMV group) and 22 healthy infants who underwent physical examination (control group) were enrolled in this study. The percentages of peripheral blood γδ T cells and Treg cells were determined by flow cytometry. The levels of IL-17 and TGF-β1 in plasma were measured using ELISA.</p><p><b>RESULTS</b>Compared with the control group, the HCMV group had significantly higher percentage of γδ T cells and IL-17 level (P<0.01) and significantly lower percentage of Treg cells and TGF-β1 level (P<0.01). In the HCMV group, the percentage of γδ T cells was negatively correlated with the percentage of Treg cells and TGF-β1 level (P<0.05), but positively correlated with IL-17 level (P<0.05); the percentage of Treg cells was positively correlated with TGF-β1 level (P<0.05), but negatively correlated with IL-17 level (P<0.05); there was no correlation between IL-17 level and TGF-β1 level (P>0.05).</p><p><b>CONCLUSIONS</b>There is an imbalance between γδ T cells and Treg cells in the peripheral blood of infants with HCMV infection, and γδ T cells may be involved in the secretion of IL-17.</p>

Clinical effect of recombinant adenovirus containing thymidine kinase suicide gene in preventing postoperative recurrence of hepatocellular carcinoma / 临床肝胆病杂志

Objective To investigate the clinical effect of surgical operation combined with gene therapy in preventing postoperative recurrence of hepatocellular carcinoma (HCC).Methods A total of 102 patients with single HCC (TNM stage 1-2,tumor diameter ＜ 10 cm) who were admitted to Beijing YouAn Hospital,Capital Medical University,from July 2006 to February 2013 were enrolled,and among these patients,60 underwent the gene therapy with recombinant adenovirus containing thymidine kinase suicide gene (ADV-TK) before and after surgery (gene group) and 42 underwent surgical resection alone (surgery group).The patients were followed up regularly after surgery to observe postoperative recurrence.The t-test was used for comparison of continuous data between groups,and the chi-square test was used for comparison of categorical data between groups.The log-rank test was used for the analysis of cumulative recurrencc rate,and univariate and multivariate Cox regression analyses were used to identify influencing factors for recurrence rate.Results The 1-,3-,and 5-year recurrence rates of tumor were 13.8％,33.7％,and 47.7％ in the gene group and 18.5％,53.2％,and 69.2％ in the surgery group,and there was a significant difference between the two groups (x2 =2.643,P =0.041).The gene group had a significantly higher proportion of patients with pyrexia after surgery than the surgery group,and there were no significant differences in the incidence rates of other complications and length of hospital stay between the two groups.The multivariate analysis showed that gene therapy was an independent influencing factor for cumulative rumulative recurrence rate (odds ratio =2.752,95 confidence interval:1.1 64-4.251,P =0.038).Conclusion Gene therapy conbined with surgical resection can effectively reduce postoperative recurrence of tumor,and therefore,it holds promise for clinical application.

An in vitro Vascular Model for Studying the Impact of Different Blood Oxygen Saturation on Main Pulmonary Artery Pressure Changes / 中国循环杂志

Objective: To establish an in vitro vascular model to study the impact of different blood oxygen (O2) saturation on main pulmonary artery pressure changes in order to further explore the mechanism of pulmonary hypertension. Methods: 20 New Zealand white rabbits were randomly divided into 4 groups: Normal control group and 3 experimental groups as High O2 (90％-100％)saturation group, Middle O2 (65％-75％)saturation group and Low O2 (40％-50％) saturation group, n=5 in each group. The in vitro pulmonary artery segments were treated with fresh heparinized rabbit blood and connected to extracorporeal circulation system for 48h at perfusion pressure at 40 mmHg; the condition of O2 saturation was regulated by membrane oxygenator. Pathological morphology was compared among different groups. Results:The bypass time in all 3 groups was 48h and the pressure was stably controlled at 40 mmHg. Blood O2 contents in High O2 saturation group, Middle O2 saturation group and Low O2 saturation group were (97.94±1.01) ％, (72.14±12.85) ％and (43.83±8.71) ％ respectively, P<0.05. Pathological analysis indicated that compared with Normal control group, 3 experimental groups had increased thickness in pulmonary artery wall; upon O2 saturation decreasing, the elastic fibers in pulmonary artery became increasing and more thickening accordingly. Conclusion: We established an in vitro vascular model to study the impact of different blood O2 saturation on main pulmonary artery pressure changes in experimental rabbits.

Intervention effect of remifentanil regulated human umbilical vein endothelial cell oxidative stress injury induced by hydrogen peroxide / 临床麻醉学杂志

Objective To establish oxidative stress model of hydrogen peroxide treatment by using human umbilical vein endothelial cells (ECS) as cell model to study the protective mechanism of anti oxidative stress and determine the signal transduction pathway of remifentanil.Methods Primary cultured human umbilical vein endothelial cells which were incubated with 0.1 M hydrogen peroxide to establish injury model to study remifentanil protection and related pathways.The experiment was divided into nine groups: control group (group C), Hydrogen peroxide group (group H1), Hydrogen peroxide+SP600125 group (group H2), Hydrogen peroxide+SB203580 group (group H3), Hydrogen peroxide+PD98059 group (group H4), hydrogen peroxide+remifentanil group (group HR1), hydrogen peroxide+remifentanil+SP600125 group (group HR2), hydrogen peroxide+remifentanil+SB203580 group (group HR3), hydrogen peroxide+remifentanil+PD98059 group (group HR4).Groups H1, H2, H3 and H4 only performed MAPK pathway blockade experiments.Groups HR1, HR2, HR3 and HR4 individually added remifentanil 10 ng/ml to protect 1 h.SOD activity, MDA level, Caspase-3 activity were detected and anti oxidative stress of remifentanil observed to confirm preliminary transduction pathway;Using RT-PCR expression levels of c-Jun before was observed before and after treated with remifentail 10 ng/ml.The aim was to determine the transduction pathway of the signaling molecules.Results Compared with group C, SOD activity were decreased significantly, MDA performance level were increased significantly in groups H1, H2, H3 and H4 (P<0.05).Compared with group H1, SOD activity was increased significantly, MDA performance level was decreased significantly in group HR1 (P<0.05).SOD activity difference and MDA performance level of groups HR2 and H2 had no statistical significance.Compared with group H3, SOD activity was increased significantly, MDA performance level was decreased siginificantly in group HR3 (P<0.05).Compared with group H4, SOD activity was increased significantly, MDA performance level was decreased significantly in group HR4 (P<0.05).Caspase-3 activity of groups H1, H2, H3 and H4 were higher significantly than that of group C (P<0.05).The level of C-Jun mRNA in group H1 was significantly higher than that of group C;But it was higher in group HR1 than that of group C, it was significantly lower than that of group H1 (P<0.05).Conclusion By activating the JNK pathway and its downstream signaling molecule c-Jun, remifentanil 10 ng/ml has the effect of increasing SOD activity, reducing the level of MDA expression and playing a role in anti oxidative stress.

Prognostic factors and prognostic value of acute organophosphorus pesticide poisoning / 预防医学

Objective To investigate theprognostic factors and prognostic value of acute organophosphorus pesticide poisoning. Methods Patients with acute organophosphorus pesticide from January 2009 to January 2017 in Cangzhou city emergency center from poisoning, describing the demographic characteristics, and clinical characteristics and prognosis of poisoning, using Logistic regression model analysis of admission when white blood cell count (WBC) , cholinesterase (ChE), lactic acid (Lac), blood glucose (GLU), serum myocardial enzymes (CK) and acute physiology and chronic health score (APACHE score) effects on the prognosis of patients, using Logistic regression probability prediction model and ROC curve analysis of the value of the index prediction on the prognosis of the patients. Results A total of 519 patients with acute organophosphorus pesticide poisoning were treated, the ratio of male to female was 1 :1.21 (235/284), the age was 20-50 years old (73.41%), mainly for farmers (64.74%), and the cause of poisoning was suicide (73.99%) . 87.09% patients were cured or improved, healed or dead patients accounted for 12.52%, accounting for 0.39% of the other. WBC (OR=5.056, 95% CI:1.714~14.915) , ChE (OR=5.190, 95% CI:1.396 ~ 19.298) , Lac (OR=5.124, 95% CI:1.347 ~ 19.497) , APACHE score (OR=10.098, 95% CI:1.311 ~ 77.767) is a risk factor for the prognosis of patients with organophosphorus poisoning. Logistic regression probability prediction results P=0.52, AUC:0.717 (95%CI:0.677~0.901), sensitivity: 0.70, specificity: 0.91, Kappa value: 0.460. The ROC curve was established by the APACHE II score alone, and the APACHE II score was 17.5 points, and AUC: 0.987 (95%CI:0.977~0.998), sensitivity: 0.99, specificity: 0.88, Kappa value: 0.543. Conclusion The scores of WBC, ChE, Lac and APACHE II were the prognostic factors of organophosphate poisoning. The predictive effect of the APACHE II score alone was better than that of WBC, ChE, Lac and APACHE II scoring.