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Objective:To explore the difference of high-risk factors between early-onset and late-onset pre-eclampsia, and to further understand high-risk factors of pre-eclampsia.Methods:Clinical data of pre-eclampsia pregnant women in 160 medical institutions in China in 2018 were retrospectively analyzed, including 8 031 cases of early-onset pre-eclampsia and 12 969 cases of late-onset pre-eclampsia. The proportion of high-risk factors, different body mass index (BMI) and age stratification between early-onset group and late-onset group were compared.Results:(1) Univariate analysis of high-risk factors: the proportions of high-risk factors in early-onset group and late-onset group were compared, and the differences were statistically significant (all P<0.05). Among them, the proportions of primipara and multiple pregnancy in early-onset group were lower than those in late-onset group, while the proportions of pregnant women with advanced age, irregular antenatal examination, obesity, family history of hypertension, pre-eclampsia, diabetes, kidney diseases, immune system diseases and assisted reproductive technology were higher than those in late-onset group. (2) Hierarchical analysis of BMI: the proportion of pregnant women with BMI≥24 kg/m 2 in early-onset group [48.2% (2 828/5 872) vs 45.5% (4 177/9 181), respectively; P=0.001] and the proportion of pregnant women with BMI ≥28 kg/m 2 in early-onset group [19.5% (1 143/5 872) vs 18.0% (1 656/9 181), respectively; P=0.028] were significantly higher than those in late-onset group. (3) Age stratification analysis: the proportion of pregnant women aged 35-39 years in the early-onset group [21.8% (1 748/8 023) vs 17.5% (2 110/12 068), respectively; P<0.01], the proportion of pregnant women 40-44 years old [6.8% (544/8 023) vs 5.4% (648/12 068), respectively; P<0.01], and the proportion of pregnant women ≥45 years old [0.7% (58/8 023) vs 0.5% (57/12 068), respectively; P=0.021] were significantly higher than those in the late-onset group. (4) Multivariate analysis: advanced age (≥35 years old), multiple pregnancy, irregular antenatal examination or transfer from other hospitals, family history of hypertension (including paternal, maternal and parental lines), previous history of pre-eclampsia, kidney diseases, immune system diseases (systemic lupus erythematosus, antiphospholipid antibody syndrome) and assisted reproductive technology pregnancy were the risk factors affecting the severity of pre-eclampsia (all P<0.05). Conclusion:Pregnant women with high risk factors such as age ≥35 years old, BMI ≥24 kg/m 2 before pregnancy, family history of hypertension, history of pre-eclampsia, chronic kidney diseases, immune diseases (mainly including systemic lupus erythematosus and antiphospholipid syndrome) and assisted reproductive technology are more likely to have early-onset pre-eclampsia.
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Ossifying fibroma (OF) and fibrous dysplasia (FD) are two fibro-osseous lesions with overlapping clinicopathological features, making diagnosis challenging. In this study, we applied a whole-genome shallow sequencing approach to facilitate differential diagnosis via precise profiling of copy number alterations (CNAs) using minute amounts of DNA extracted from morphologically correlated microdissected tissue samples. Freshly frozen tissue specimens from OF (n = 29) and FD (n = 28) patients were obtained for analysis. Lesion fibrous tissues and surrounding normal tissues were obtained by laser capture microdissection (LCM), with ~30-50 cells (5 000-10 000 µm
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Humans , DNA Copy Number Variations , Diagnosis, Differential , Fibroma, Ossifying/genetics , Fibrous Dysplasia of Bone/genetics , Galactosyltransferases , Jaw , Neoplasm Recurrence, Local , Nuclear ProteinsABSTRACT
Objective:To investigate the prevention and treatment status of venous thromboembolism (VTE) of pregnant women in general hospitals and specialized hospitals in China.Methods:This study was a cross-sectional survey about VTE prevention and treatment in 112 hospitals across China from January 1st to December 31st, 2019, including general information, resource accessibility, hospital system and strategy. According to the characteristics, the hospitals were divided into general hospital group (70 hospitals) and specialized hospital group (42 hospitals). The basic information, VTE diagnosis and treatment resources, prevention systems and the preference of the VTE risk assessment form of the two groups were compared. Logistic regression was used to analyze the proportion of VTE incidence and related factors in the two groups of hospitals.Results:(1) The median annual delivery volume of the general hospital group was significantly lower than that of the specialized hospital group (3 428 vs 9 969 cases, P<0.01), the diagnostic accessibility of CT pulmonary angiography (CTPA) was significantly higher than that of the specialized hospital [92.9% (65/70) vs 59.5% (25/42), P<0.01], and the proportion of obstetric VTE risk assessment was significantly higher than that of the specialized hospital group [85.7% (60/70) vs 66.7% (28/42), P=0.017]. (2) Among the 88 hospitals using the VTE risk assessment sheet, the utilization rate of the evaluation sheet recommended by the obstetric VTE guideline in specialized hospitals (78.6%, 22/28) was higher than that of general hospitals (48.3%, 29/60), and the difference was statistically significant ( P=0.007). (3) The proportion of VTE incidence in general hospital group was 0.126% (360/286 517), and the proportion of VTE incidence in specialized hospital group was 0.032% (154/484 111). Logistic regression analysis showed that the OR value of the specialized hospital group was 0.253 (95% CI: 0.209-0.305) and the difference was statistically significant ( P<0.01) compared with the general hospital group. After adjusting the hospital level, B-ultrasonography and CTPA accessibility, whether to establish a risk assessment and obstetric VTE system, the proportion of VTE incidence in specialized hospitals was still lower than that in general hospitals ( OR=0.307, 95% CI: 0.251-0.376, P<0.01). Conclusions:General hospitals have higher access to resources for diagnosing VTE than specialized hospitals, and the VTE evaluation system is better implemented. The utilization rate of the obstetric VTE guidelines in specialized hospitals is higher than that of general hospitals.
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Objective:To investigate the risk factors of birth weight discordance in dichorionic diamniotic (DCDA) twins.Methods:This study retrospectively analyzed 1 757 cases of DCDA twin pregnancies from 11 Chinese hospitals from January 1, 2014, to December 31, 2017. Birth weight discordance was defined as ≥ 20% difference between the twins. All cases were divided into two groups: the concordant group ( n=1 520) and discordant group ( n=237). General information was compared and the high-risk factors of birth weight discordance were analyzed. Mann-Whitney U test, Chi-square test or Fisher's exact test, and logistic regression analysis were used as statistical methods. Results:Compared with the concordant group, the discordant group showed a higher incidence of hypertensive disorders of pregnancy [24.5% (58/237) vs 12.8% (194/1 520), χ2=22.882, P<0.05], fetal structural malformations [4.2% (10/237) vs 1.0% (15/1 520), χ2=15.160, P<0.05], fetal distress [6.3% (15/237) vs 1.4% (21/1 520), χ2=22.602, P<0.05], umbilical cord abnormalities [3.8% (9/237) vs 1.2% (18/1 520), χ2=7.607, P<0.05] and abnormal placental cord insertion [3.8% (9/237) vs 1.4% (21/1 520), χ2=34.904, P<0.05], but lower incidence of premature rupture of membranes [11.0% (26/237) vs 16.5% (250/1 520), χ2=4.645, P=0.034]. Logistic regression analysis showed that the independent risk factors of birth weight discordance in DCDA twins were hypertensive disorders of pregnancy ( OR=2.258, 95% CI: 1.620-3.184, P<0.001), fetal structural malformations ( OR=4.268, 95% CI: 1.892-9.631, P<0.001), umbilical cord abnormalities ( OR=2.889, 95% CI: 1.245-6.705, P=0.014) and abnormal placental cord insertion ( OR=2.318, 95% CI: 1.012-5.311, P=0.047). Conclusions:Hypertensive disorders of pregnancy, fetal structural malformations, umbilical cord abnormalities and abnormal placental cord insertion may be the risk factors of birth weight discordance in DCDA twins.
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Objective:To investigate the relationship between the methylation of apelin receptor early endogenous ligand ( APELA) gene promoter and preeclampsia. Methods:A systematic review was conducted to evaluate the cg02779075 locus methylation in APELA gene associated with preeclampsia in six previous studies on placenta genome-wide methylation based on the GEO gene expression database from 2007 to 2017. After testing the heterogeneity, the random-effects model was applied for meta-analysis. Placenta samples of 17 preeclamptic patients and 24 healthy gravidas were retrospectively collected in Obstetrics and Gynecology Hospital of Fudan University from 2008 to 2010. MassARRAY was used to quantify the methylation level of CpGs, and the expression of APELA gene was determined by qRT-PCR. All data were analyzed by t test or Mann-Whitney U test. Results:(1) Analysis of the six genome-wide methylation studies showed significant heterogeneity ( I2=0.64, P=0.016) and the meta-analysis using random-effects model showed that the methylation of cg02779075 locus in the placenta samples of preeclamptic women was down-regulated significantly ( Pmeta=6.7×10 -6). (2) Placenta tissue analysis revealed that the methylation of CpG1 [0.12 (0.00-0.25) vs 0.21 (0.09-0.33), U=-2.569] and CpG2 [0.07 (0.01-0.14) vs 0.17 (0.09-0.34), U=-4.160] in patients with preeclampsia was significantly reduced compared with those in healthy control (both P<0.05). The expression of APELA gene in the placenta was up-regulated in patients with preeclampsia, but no significant difference was observed between the two groups ( U=0.891, P=0.384). Conclusions:Aberrant methylation of APELA gene promoter was detected in the placentas of patients with preeclampsia.
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Objective To evaluate the changes of hypoxic conditions in non-small cell lung cancer (NSCLC) patients before and after radiotherapy and assess the value of 18F-fluoromisonidzaole (FMISO)PET/CT for radiotherapy efficacy evaluation.Methods A total of 21 NSCLC patients (15 males,6 females,age 30-74 years) from January 2014 to October 2016 were prospectively enrolled.18F-FMISO PET/CT was performed before and after radiotherapy,and all patients underwent 18F-fluorodeoxyglucose (FDG)PET/CT before radiotherapy.Routine chest CT was performed at the 3rd and 6th month after radiotherapy.The maximum standardized uptake value (SUVmax) of tumor and muscle,tumor volume and hypoxic volume (HV) were measured.Tumor-to-muscle (T/M) value of 18F-FMISO was calculated,and T/M ≥ 1.3 was considered as the hypoxia cut-off value.Data were analyzed using Pearson correlation,paired t test,signed rank sum test and Wilcoxon rank sum test.Results Totally 81.0％(17/21) of NSCLC patients had hypoxia.There were significant positive correlations between 18F-FMISO T/M value and tumor volume or 18F-FDG SUVmax(r:0.72,0.60,both P＜0.05).The T/M value after radiotherapy was significantly lower than that before radiotherapy (1.42± 1.12 vs 2.08±0.71;t =3.62,P＜0.05),and median HV was also significantly lower than that before radiotherapy (6.53 vs 12.41 cm3;z =-3.83,P＜0.05).The median T/M values of effective group (n =14) and ineffective group (n =7) before radiotherapy were significantly different (2.14 vs 2.87;z=-2.27,P＜0.05),and the median HV of 2 groups before radiotherapy was also significantly different (6.43 vs 10.20 cm3;z=-2.14,P＜0.05).Conclusions Most NSCLC patients have hypoxia before radiotherapy.The larger tumor volume,the higher degree of hypoxia.Radiotherapy can alleviate the hypoxia of tumors.18F-FMISO PET/CT imaging before radiotherapy can be used to predict the efficacy of patients with NSCLC.
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Objective To study the changes in cesarean delivery rate (CSR) and indications against the background of two-child policy. Methods Maternal information and indications for cesarean delivery were retrospectively obtained from medical records of 62007 women who delivered at the Obstetrics and Gynecology Hospital of Fudan University between January 2013 and December 2016. Indications for cesarean section were divided into 16 categories, such as maternal or fetal indication, repeat cesarean section, maternal request, labor arrest disorders, fetal distress, and so on. Changes in CSR and the proportion of cesarean delivery for each indication were evaluated. One-way analysis of variance, Chi-square or Fisher's exact test were used for statistical analysis. The average annual percent change (AAPC) in cesarean delivery rate was calculated by Joinpoint Analyses software. Relative contribution of each indication to the overall increase or decrease in CSR was analyzed using the data of the years of 2013 and 2016. Results The CSR dropped from 45.2％ (6683/14798) in 2013 to 38.3％ (6546/17104) in 2016. The rate of cesarean delivery due to maternal request and labor arrest disorders decreased significantly (χ2=49.402 and 14.617, both P<0.05) .The rate of cesarean delivery due to labor arrest disorders in all cases decreased sharply from 14.7‰ in 2013 to 0.9‰ in 2016 at an annual decrease of 48.0％ (95％CI: - 67.6％- - 21.5％). It was also worth noting that the rate of cesarean delivery on maternal request in all cases decreased from 119.3 ‰ in 2013 to 40.7 ‰ in 2016 at an average annual decrease of 30.1％ (95％CI: - 31.3％- - 28.9％). Despite of a limited number of cesarean delivery cases for uterine scar caused by leiomyoma resection, its rate increased from 1.4 per 1000 deliveries in 2013 to 2.9 per 1000 deliveries in 2016 with the highest average annual increase of 32.3％ (95％CI: 10.1％-60.9％), followed by the rate of cesarean delivery due to maternal pyrexia, increasing from 6.6 per 1000 deliveries in 2013 to 16.4 per 1000 deliveries in 2016 at an average annual increase of 27.4％ (95％CI: 11.0％-46.5％), and the rate of cesarean delivery due to repeat cesarean section, increasing from 67.6 per 1000 deliveries in 2013 to 113.9 per 1000 deliveries in 2016 at an average annual increase of 19.0％ (95％CI: 5.0％-34.6％). The first two positive contributors to the total decrease of CSR were maternal request and labor arrest disorders (144.2％ and 27.7％, respectively), while the first two negative contributors were repeat cesarean section and maternal pyrexia (-102.3％ and -18.9％, respectively). Conclusions The CSR is reduced after the implementation of two-child policy through active control on maternal request and application of new partogram.
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Objective To explore the high risk factors of stillbirth. Methods 176 cases of stillbirth were collected in the Obstetrics and Gynecology Hospital of Fudan University from January 1st, 2010 to December 31st, 2016. All cases were analyzed retrospectively, including general profile, high risk factors of stillbirth in different years and pregnancy periods. Results (1) The incidence of stillbirth was 0.178%(176/98 785). Stillbirth occured mostly at 28-28+6gestational weeks (10.8%,19/176), and the second peak was 29-29+6weeks(10.2%,18/176),while the third common period was 37-37+6weeks(9.1%,16/176).After 39 weeks,it maintained at a low level.(2)The top 5 high risk factors of stillbirth were infection (18.2%,32/176), unexplained (13.6%,24/176), hypertention disorders in pregnancy (13.1%, 23/176), umbilical cord torsion(12.5%,22/176)and fetal malformations(10.2%,18/176).(3)From 2010 to 2012,the top 3 high risk factors were unexplained, the umbilical cord torsion and infection, while hypertention in pregnancy,infection and fetal malformation became the top 3 high risk factors after 2013.(4)Early stillbirth (20-27+6weeks)accounted for 21.6%(38/176);and unexplained(47.4%,18/38),fetal edema(13.2%,5/38), infection(13.2%,5/38),umbilical cord torsion(5.3%,2/38)were the top 4 high risk factors.Late stillbirth(≥28 weeks)accounted for 78.4%(138/176),with infection(19.6%,27/138),hypertention in pregnancy(15.9%, 22/138), umbilical cord torsion (14.5%,20/138) and fetal malformation(12.3%,17/138)being the top 4 high risk factors. Conclusions More attention should be paid to maternal complications, especially infection and hypertension in pregnancy. Antenatal fetal monitoring, timely termination of pregnancy, standard management of stillbirth and looking for the causes may help reduce the incidence of stillbirth.
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Background:1 α,25-dihydroxyvitamin D3 [1,25 (OH) 2 D3],the active form of vitamin D,is reported in some studies having antifibrotic potential in liver fibrosis,however,its mechanism is not fully clarified.MicroRNAs (miRNAs) have recently been shown could regulate the proliferation and activation of hepatic stellate cells (HSCs),and are involved in the promotion or inhibition of liver fibrosis.Aims:To explore whether the inhibiting effect of 1,25 (OH) 2 D3 on activation of HSCs is by regulating miRNAs expression.Methods:Literature review and qPCR method were used to screen out the differentially expressed miRNAs between transforming growth factor-β1 (TGF-β1)-stimulated (activated) HSCs and the inactivated HSCs.Then the HSCs were co-cultured with TGF-β1 and the mimic of differentially expressed miRNA,the negative control mimic,1,25(OH)2D3 and DMSO,respectively,and the cell viability and apoptosis were determined by CCK-8 assay and flow cytometry.Results:Expression of miR-146a was down-regulated in activated HSCs (P ＜ 0.05).Compared with HSCs in DMSO group,the expression of miR-146a was significantly up-regulated in HSCs treated with 1,25 (OH) 2 D3;meanwhile,the cell viability was decreased and the apoptosis was increased (P all ＜ 0.05).In HSCs transfected with miR-146a mimic,the expression of miR-146a was up-regulated,the cell viability was decreased,and the apoptosis was increased similarly with HSCs in 1,25 (OH)2D3 group (P all ＜ 0.05).Conclusions:Regulation of miR-146a expression might be one of the important mechanisms of 1,25 (OH) 2 D3 in inhibiting TGF-β1-stimulated HSC activation and inducing apoptosis in HSCs.
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Objective To establish a medical quality evaluation system for gynecology wards in specialized gynecology hospitals by means of DRGs. Methods DRGs method was used to adjust risks of the information of gynecology inpatients discharged in 2016. On such basis, the medical quality evaluation system was built on the three dimensions of medical ability, medical efficiency and medical safety, while a general scoring was obtained by multiplying the scoring of the dimension with its respective weighting coefficients. Results The general scoring of the 10 wards ranged between 0. 89-1. 08, averaging 0. 99. That of Ward B ranked the highest, and Ward I the lowest of the ten. The medical ability scoring ranged between 0. 87-1. 12, averaging 1. 00;That of Ward B ranked the highest,and Ward I the lowest of the ten. Medical efficiency scoring ranged between 0. 93 -1. 23, averaging 1. 00;That of Ward J ranked the highest,and Ward E the lowest of the ten. Safety scoring ranged between 0. 89-0. 99, averaging 0. 94; That of Ward F ranked the highest, and Ward A the lowest of the ten. Conclusions The medical quality evaluation system based on DRGs can effectively evaluate wards of a gynecology department, supporting their fine management.
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Objective To establish a medical quality evaluation system for gynecology wards in specialized gynecology hospitals by means of DRGs. Methods DRGs method was used to adjust risks of the information of gynecology inpatients discharged in 2016. On such basis, the medical quality evaluation system was built on the three dimensions of medical ability, medical efficiency and medical safety, while a general scoring was obtained by multiplying the scoring of the dimension with its respective weighting coefficients. Results The general scoring of the 10 wards ranged between 0. 89-1. 08, averaging 0. 99. That of Ward B ranked the highest, and Ward I the lowest of the ten. The medical ability scoring ranged between 0. 87-1. 12, averaging 1. 00;That of Ward B ranked the highest,and Ward I the lowest of the ten. Medical efficiency scoring ranged between 0. 93 -1. 23, averaging 1. 00;That of Ward J ranked the highest,and Ward E the lowest of the ten. Safety scoring ranged between 0. 89-0. 99, averaging 0. 94; That of Ward F ranked the highest, and Ward A the lowest of the ten. Conclusions The medical quality evaluation system based on DRGs can effectively evaluate wards of a gynecology department, supporting their fine management.
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Objective To explore the effect of preeclampsia on the expression of hypothalamic-pituitary-adrenal (HPA) axis related genesin the hippocampus of adolescent offspring rats.Methods The pregnant Sprague-Dawley rats were randomly divided into two groups to be given 125 mg · kg-1 ·d-1 L-NAME or 1 mL pure saline by daily injection from day 14 to delivery.Serum corticosterone (CORT) levels in neonatal offspring rats were detected by ELISA.The mRNA and protein levels of glucocorticoid receptor (GR),corticotropin releasing hormone (CRH),CRH receptor 1 (CRHR1) and IL-6 in the hippocampus of 8-week offspring rats were determined by real-time PCR and Western blot,respectively.Results Compared with normal neonatal rats,the serum CORT concentration of neonatal rats with preeclampsia was increased (P＜0.05).Compared with normal adolescent offspring,the levels of GR,CRH and CRHR1 mRNA and protein were increased in the hippocampus of adolescent rats with preeclampsia (P＜0.05),accompanied by increased IL-6 mRNA and protein (P＜0.05),as a downstream inflammatory gene of the GR.Conclusions We found that adolescent SD rats exposed to preeclampsia showed alteration in the expression of HPA related genes in the hippocampus,which played a role in the impairment of learning and memory in children.
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Objective To assess the safety and effect of intraoperative cell salvage (ICS) during cesarean section.Methods This was a case-control study in which 60 gravidas who received ICS (ICS group) and 60 gravidas who received allogenic transfusion (control group) during caesarean section in Obstetrics and Gynecology Hospital of Fudan University during January 2014 to December 2016 were enrolled.Subjects in the two groups were matched in age,gestational age,gestational complications (placenta increta,placenta previa,scarred uterine,leiomyomas and anemia) and hemorrhagic volume during cesarean section.Several indicators including complications of transfusion,postoperative recovery,expense of transfusion,as well as the complete blood count and body temperature before and after operation were compared between the two groups.T,rank-sum or Chi-square test was used for statistical analysis.Results (1) No significant difference in age,gestational age,twin gestation,complications,preoperative body temperature,or the volume of hemorrhage or transfusion was observed between the two groups (all P＞0.05).(2) The autotransfusion volume was 385 (161-583) ml in the ICS group.Fifteen cases (20.0％) in the ICS group also received additional transfusions of leukocyte-reduced red blood cell (RBC) suspension,fresh frozen plasma and cryoprecipitate and two cases (3.3％) received additional transfusions of leukocyte reduced RBC suspension and fresh frozen plasma.The two groups showed no significant difference in the cost of transfusion or per-capita transfusion volume of fresh frozen plasma or cryoprecipitate.However,the transfusion volume of leukocyte-reduced RBC suspension was lower in the ICS group as compared with that in the control group [M(P25-P75),1.9 (1.5-4.5) vs 4.1 (2.8-6.2) U,Z=-2.800,P=0.005].(3) There was no significant difference in complete blood count or coagulation function between the two groups before the operation.White blood cell (WBC) counts in the two groups were elevated following operation.Postoperative WBC count in the control group was higher than that in the ICS group,while the levels of RBC and hemoglobin were lower than those in the ICS group following operation (all P＜0.05).(4) No amniotic fluid embolism was reported in the two groups.Only one case of rash was reported in the ICS group,which was fewer than the transfusion reactions occurred in the control group [1.7％ (1/60) vs 13.3％ (8/60),x2=5.886,P=0.016].(5) The two groups showed no significant difference in preoperative temperature,the highest temperature within three days after operation or incision healing.Compared with the patients in the control group,those in the ICS group had shorter hospital stay [(4.7± 1.1) vs (6.3 ±1.8) d,t=3.341,P＜0.05].Conclusion ICS is a safe and effective measure for gravidas at higher risk of hemorrhage during cesarean section.
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Objective To investigate the rate of termination of pregnancy (TOP) in gravidas with prenatally diagnosed fetal malformation and to analyze the influences of medical and non-medical factors on decision making.Methods This was a prospective cohort study. Gravidas who took part in a multidisciplinary consultation due to fetal malformation and finished a questionnaire after consulting from September 12, 2012 to May 2, 2013 were recruited. Exclusion criteria were chromosomal disorders and isolated abnormal ultrasound soft markers. The questionnaire survey was conducted to understand the patient's backgrounds and to collect their feedbacks on the consultation. Decisions of the gravidas on TOP were followed up by phone in 2014 and 2016. If a gravida chose to continue her pregnancy, her baby's outcome was also recorded.T test,Chi-square test or Fisher's exact test, or rank-sum tests (Mann-Whitney or Wilcoxon) or Logistic regression was used for statistical analysis.Results (1) Altogether 229 gravidas were recruited and 10 of them were lost to follow-up, so 219 cases were finally analyzed. Among the 219 cases, 35.6% (78/219) chose to terminate their pregnancies. (2) Neonatal prognosis was predicted based on the type and severity of the disease and was divided into four levels including good prognosis (122 cases, 55.7%), medium prognosis (20 cases, 9.1%), poor prognosis (17 cases, 7.8%) and unsure prognosis (60 cases, 27.4%). (3) Gravidas who chose to terminate their pregnancies were younger than their counterparts choosing to continue to term (average age: 27.8±4.1 vs 29.0±3.9,t=2.257,P<0.05). Gravidas who went to the consultation before the 24th gestational week carried double risk of TOP than those after the 24th gestational week [termination rate: 52.5% (31/59) vs 29.4% (47/160),χ2=10.089,P<0.01). (4) Gravidas with fetal growth restriction (FGR) were at triple risk of TOP than those without (OR=2.850, 95%CI: 1.323-6.140) after adjusting for maternal age, gestational age at consultation and prognostic evaluation. Comparing with the good prognosis group, in which the rate of TOP was 19%, the unsure (OR=2.354, 95%CI: 1.108-5.004), medium (OR=16.188, 95%CI: 4.732-55.372) and poor (OR=14.515, 95%CI: 3.61-58.359) prognosis groups had higher risk of TOP. (5) There were 63 women informed us their reasons for TOP (multiple choices), among which 57 (90.5%) were due to unsure neonatal outcomes, and 10 (15.9%) were due to emotional factors. (6) Maternal satisfaction with neonatal prognosis was 2 to 5 points (medium score, ten-point system) lower in gravidas choosing to TOP than in those choosing to continue pregnancy regardless of good, unsure, or medium neonatal prognosis. No significant difference in maternal satisfaction was found among gravidas with poor neonatal prognosis.Conclusions The rate of TOP in gravidas with prenatally diagnosed fetal malformation remains high in China. Factors that can negatively influence the rate of TOP are consultation after the 24th gestational week, better perceived neonatal prognosis and higher maternal satisfaction with neonatal prognosis. Uncertainty of the neonatal prognosis is the leading cause of maternal dissatisfaction.
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Objective To improve the awareness of fetal cardiac rhabdomyomas (CRs) and investigate a better model for prenatal diagnosis and treatment through analyzing imaging findings and prognosis.Methods A retrospective study was conducted on 23 cases of CRs which were diagnosed by ultrasound in Obstetrics and Gynecology Hospital of Fudan University from January 2008 to November 2015.General conditions,imaging features,prognosis and follow-up data of the 23 cases were described.Results The average gestational age of the 23 fetuses at diagnosis was (29.8±4.1) (22.4-35.7) weeks.Seventeen out of the 23 gravidas received prenatal multidisciplinary consultation.Among all 23 gravidas,three (13％) were lost to follow-up,12 (52％) decided to terminate the pregnancy,and the other eight (35％) continued to term pregnancy and their babies were followed up for three years.Of these eight cases,two cases received prenatal brain MRI and no tuberous sclerosis complex (TSC) was detected,no CRs was identified during the follow-up,and their physical and mental developments were both normal.One case was diagnosed with suspected subependymal nodules by prenatal brain MRI in our hospital,but the MRI images was normal when scanned in the other hospital,and follow-up data revealed neither CRs nor abnormal physical and mental developments.Four cases did not received prenatal brain MRI,but the MRI images of neonatal brains indicated TSC,besides,follow-up data showed that seizures were observed,physical developments were all normal,but three of the four cases had mental retardation;CRs disappeared in only two of the four cases.One case had neither prenatal nor neonatal MRI,but follow-up data showed that CRs had disappeared and physical and mental developments were both normal.Conclusions Prenatal diagnosis of fetal tuberous sclerosis is crucial to the prognosis of CRs.Prenatal ultrasonography in combination with cranial MRI improves the accuracy of prenatal diagnosis of CRs complicated with TSC and assists in clinical decision-making and prognosis analysis.
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ObjectiveTo summarize the clinical features and risk factors of neonatal clavicle fracture so as to decrease the incidence of this disease.MethodsA total of 85 cases of neonatal clavicle fracture admitted to the Gynecology and Obstetrics Hospital of Fudan University between January 1, 2013 and December 31, 2015 were enrolled in this study. The full-term neonates with natural delivery by the same midwives or doctors on the same day were selected as control group with 1∶1 matched. Clinical features and risk factors of neonatal clavicle fracture based on three factors: mother factors, labor factors and neonatal factors, were analyzed retrospectively. Two independent samplest-test, rank sum test andChi-square test were used for statistical analysis.ResultsThe incidence rate of neonatal clavicle fractures was 0.14% (85/59 991). There were 45 (53%) males and 40 (47%) females; 80 (94%) cases of vaginal delivery, and 5 (6%) cases of cesarean section. According to the relationship between the location of the fracture and the position of the fetus, the fracture occurred in the anterior shoulder in 65 cases (76%) and in the posterior shoulder in 20 cases (24%);and 18 cases (21%) were in the left and 67 cases (79%) in the right. Fifty-five cases (65%) were diagnosed by physical examination, and 30 cases (35%) by X-ray. Two patients (2%) were complicated with brachial plexus injury. Twenty cases (24%) were diagnosed on the day of birth, 32 cases (38%) on the second day after birth, 16 (19%) on the third day, and four (5%) on the 4-6 days. Thirteen (15%) cases were diagnosed in the outpatient department 42 days after birth. All the fractures were cured without special treatment. Compared with the control group, the birth weight of fracture group was significantly higher [(3 646±361) vs (3 447±409) g,t=2.339], and the ratio of the cases complicated with shoulder dystocia was also higher [15% (13/85) vs 2% (2/85),χ2=9.524] (bothP<0.05). The differences in the factors of maternal age, parity, times of pregnancy, gestational age, forceps delivery, time of the second stage of labor and fetal distress between the two groups were not statistically significant.ConclusionsNeonatal clavicle fracture is related to birth weight and shoulder dystocia. Not all fractures can be diagnosed through physical examination on the day of birth, therefore, daily routine physical examinations after birth are necessary. The prognosis of neonatal clavicle fracture is good.
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Objective To investigate the influence of gestational weight gain (GWG) on the incidence of macrosomia, and to establish the reference ranges of GWG based on the incidence of macrosomia. Methods A multicenter, cross-sectional study was conducted. Totally, 112485 women were recruited from 39 hospitals in 14 provinces in China. Totally, 61149 cases were eligible with singleton pregnancies and non-premature deliveries. The associations of pre-pregnancy body mass index (BMI), GWG, newborn gender and gestational diabetes with macrosomia were analyzed with logistic regression. The normal GWG ranges were calculated in all maternal BMI subgroups, based on the normal incidence of macrosomia was set as the range of 5.0% to 10.0%. Results In this study, the incidence of macrosomia was 7.46%(4563/611149). The macrosociam was positive related with maternal height, delivery week,pre-pregnancy BMI, GWG, gestational diabetes, primipara, and male babies significantly (P<0.05), based on unadjusted and adjusted logestic regression. The normal range of GWG 20.0-25.0, 10.0-20.0, 0-10.0 and 0-5.0 kg in subgroups of underweight (pre-pregnancy BMI<18.5 kg/m2), normal (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2) and obese (≥30.0 kg/m2), respectively. Conclusion The reference range of GWG in China based on the incidence of macrosomia is established.
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Drug-induced liver injury ( DILI) is a significant rea-son of acute liver failure and is the main cause of therapeutic drugs withdrawal from the market .Multiple mechanisms can cul-minate in DILI , but metabolism and genetics play distinct roles in this process .This review will cover papers we consider have addressed these mechanisms of DILI in commonly used medica-tions for adults , and discuss the hot issues .The aim is to gener-ate discussion about the potential clinical significance among these researchs and point out the key areas for further study of DILI.
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microRNAs ( miRNAs) are a family of short non-cod-ing RNAs that regulate the expression of target genes by binding to complementary regions. The miRNAs expression is readily al-tered by drugs, carcinogens, hormones, stress or diseases, and that might lead to changes in the drug metabolism, pharmacoki-netics or potency. Moreover, the evaluation of drug metabolic enzyme-related miRNAs would provide useful information for per-sonalized medicine. This review describes the current knowledge on the post-transcription regulation of drug metabolic enzymes by miRNAs.
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OBJECTIVE@#To study the effect of microRNA-205 (miRNA-205) on proliferation of laryngeal carcinoma cell line Hep-2.@*METHOD@#The expressions of miRNA-205 in 27 cases laryngeal carcinoma tissues and adjacent normal tissues were detected by Real-time quantitative PCR, the expression of PTEN protein was detected by Western blot. The expressions of PTEN were detected by Western blot after miRNA-205 inhibitor or miRNA-205 mimics was transfected into Hep-2 cells and Hep-2 cells proliferation was measured by CCK-8 kit.@*RESULT@#The expression level of miRNA-205 was significantly higher in laryngeal carcinoma tissues than in adjacent normal tissues (P < 0.01), and the expression of PTEN protein was lower in laryngeal carcinoma tissues than in adjacent normal tissues (P < 0.01). The proliferation rate of Hep-2 cells was decreased significantly and the expression of PTEN protein in Hep-2 cells was increased significantly after miRNA-205 inhibitor was transfected into (P < 0.01), and the proliferation rate of Hep-2 cells was increased significantly and the expression of PTEN protein in Hep-2 cells was decreased significantly after miRNA-205 mimics was transfected into (P < 0.01).@*CONCLUSION@#miRNA-205 might promote the proliferation of Hep-2 cells by regulating the expression of PTEN.