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Background Diabetes mellitus is a major public health issue at present. Previous studies have shown that ambient air pollution is a risk factor for diabetes. Objective This study aims to explore the acute effects of ambient air pollution on diabetes related death in Shanghai Jing’an District. Methods Daily air pollution data, meteorological data, and diabetes related mortality data in 2013−2019 in Shanghai Jing’an District were collected. A generalized additive model (GAM) was established to conduct time-series analysis on the short-term effect of ambient air pollution on diabetes related mortality, and gender- and age-stratified analysis on susceptibility of various groups to ambient air pollution exposures. Results For every 10 μg·m−3 increase of the concentrations of PM2.5, PM10, SO2, and NO2, the diabetes related mortality increased by 2.47% (95%CI: 1.56%−3.38%), 2.02% (95%CI: 1.29%−2.75%), 5.75% (95%CI: 2.99%−8.58%), and 3.93% (95%CI: 2.49%−5.39%) at lag05 respectively (P<0.05). In the stratified analysis, exposures to increased concentrations of PM2.5, PM10, SO2, and NO2 raised the mortality risks from diabetes in male, female, and ≥65 years oldgroups (P<0.05). However, the differences in mortality risks from diabetes due to air pollution within gender and age groups were statistically insignificant. Conclusion In Shanghai Jing'an District, the elevated levels of ambient air pollutants, including PM2.5, PM10, SO2, and NO2, are significantly associated with the increase of diabetes related mortality, and there are lag effects and cumulative effects. The ≥65 years olds are more susceptible to the impact of air pollution on diabetes related deaths.
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Objective:To analyze birth defects in perinatal infants in Huainan city, Anhui province.Methods:The data of perinatal infants with birth defects born during 2015-2019 who were monitored in nine national and provincial birth defect monitoring hospitals in Huainan City were collected. The changes in birth defects, the incidence of birth defects in infants ≥ 28 weeks, urban and rural area distribution of birth defects, type of defects, and the related factors of birth defects during a 5-year study period were analyzed.Results:A total of 90 466 perinatal infants with the incidence of birth defects of 89.87/10 000 were monitored during 2015-2019. The incidence of birth defects in Anhui Province was 139.74/10 000. The proportion of preterm infants < 28 weeks with birth defects among full-term births with birth defects was 30.93% and the proportion increased year by year during 2015-2019, with the proportion of 14.84%, 31.69%, 34.83%, 32.84% and 34.02% respectively. The top five birth defects detected during 2015-2019 were multiple fingers (toes) ( n = 189, 20.89/10 000), cleft lip ( n = 96, 10.61/10 000), external ear deformity ( n = 79, 8.73/10 000), congenital heart disease ( n = 65, 7.19/10 000) and syndactyly ( n = 40, 4.42/10 000). The incidence of birth defects in males and females was 102.77/10 000 and 85.28/10 000, respectively. The incidence of birth defects in urban and rural areas were 107.38/10 000 and 79.60/10 000, respectively. Conclusion:The incidence of birth defects in preterm infants < 28 weeks in Huainan City was lower than that in the whole Anhui Province. The incidence of birth defects in Huainan City differed in different years. The incidence of birth defects in males was higher than that in females. From 2016, the incidence of birth defects in urban area was higher than that in rural area. Birth defects mainly consisted of multiple fingers (toes), external ear deformity, congenital heart disease, cleft lip and syndactyly. The detection rate of birth defects in preterm (< 28 weeks) patients was increased year by year. Early intervention effectively decreased the incidence of birth defects and improved the quality of the population in Huainan City.
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Objective To investigate the morbidity, diagnostic profile and perinatal outcome of pregestational diabetes mellitus (PGDM) in 15 hospitals in Guangdong province. Methods A total of 41338 women delivered in the 15 hospitals during the 6 months,195 women with PGDM(PGDM group) and 195 women with normal glucose test result(control group)were recruited from these tertiary hospitals in Guangdong province from January 2016 to June 2016. The morbidity and diagnostic profile of PGDM were analyzed. The complications during pregnancy and perinatal outcomes were compared between the two groups. In the PGDM group, pregnancy outcomes were analyzed in women who used insulin treatment (n=91) and women who did not (n=104). Results (1)The incidence of PGDM was 0.472%(195/41338). Diabetes mellitus were diagnosed in 59 women (30.3%, 59/195) before pregnancy, and 136 women (69.7%,136/195) were diagnosed as PGDM after conceptions. Forty-six women (33.8%) were diagnosed by fasting glucose and glycohemoglobin (HbA1c) screening. (2) The maternal age, pre-pregnancy body mass index (BMI), prenatal BMI, percentage of family history of diabetes, incidence of macrosomia, concentration of low density lipoprotein were significantly higher in PGDM group than those in control group (all P<0.05). Women in PGDM group had significantly higher HbA1c concentration((6.3±1.3)% vs (5.2±0.4)%), fasting glucose [(6.3±2.3) vs (4.8±1.1) mmol/L], oral glucose tolerance test(OGTT)-1 h glucose((12.6±2.9) vs (7.1± 1.3) mmol/L)and OGTT-2 h glucose [(12.0±3.0) vs (6.4±1.0) mmol/L] than those in control group (P<0.01). (3)The morbidity of preterm births was significantly higher (11.3% vs 1.0%, P<0.01), and the gestational age at delivery in PGDM group was significantly smaller [(37.6±2.3) vs (39.2±1.2) weeks, P<0.01]. Cesarean delivery rate in the PGDM group (70.8% vs 29.7%) was significantly higher than the control group (P<0.01). There was significantly difference between PGDM group and control in the neonatal male/female ratio (98/97 vs 111/84, P=0.033). The neonatal birth weight in PGDM group was significantly higher((3159±700) vs (3451±423) g, P<0.01). And the incidence of neonatal hypoglycemia in the PGDM group was higher than the control group (7.7% vs 2.6%, P=0.036).(4)In the PGDM group, women who were treated with insulin had a smaller gestational age at delivery [(36.9±2.9) vs (37.9±2.5) weeks, P<0.01], and the neonates had a higher neonatal ICU(NICU)admission rate (24.2% vs 9.6% , P<0.01). Conclusions The morbidity of PGDM in the 15 hospitals in Guangdong province is 0.472%. The majority of PGDM was diagnosed during pregnancy; HbA1c and fasting glucose are reliable parameters for PGDM screening. Women with PGDM have obvious family history of diabetes and repeated pregnancy may accelerate the process of diabetes mellitus. Women with PGDM have higher risk for preterm delivery and neonatal hypoglycemia. Unsatisfied glucose control followed by insulin treatment may increase the need for NICU admission.
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Objective To understand the characteristics and distribution of injury related deaths in residents aged ≥60 years in Jing'an district of Shanghai and provide evidence for the prevention of injury and effective intervention in this population.Methods According to the data from diseases surveillance and death-reporting system in Jing'an during 1975-2014,the causes of 5 199 injury related deaths were analyzed.Results The average injury related mortality in the elderly aged ≥60 years in Jing'an was 159.37/100 000 during this period.The injury related mortality increased with age.Fall was the first cause of injury related death,accounting for 53.30％.The characteristics and distribution of injury related deaths varied with age and gender.Conclusion Injury has become an important cause affecting the health of the elderly.It is necessary to conducted targeted injury prevention and control in the elderly in communities.
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Objective To understand the characteristics and distribution of injury related deaths in residents aged ≥60 years in Jing'an district of Shanghai and provide evidence for the prevention of injury and effective intervention in this population.Methods According to the data from diseases surveillance and death-reporting system in Jing'an during 1975-2014,the causes of 5 199 injury related deaths were analyzed.Results The average injury related mortality in the elderly aged ≥60 years in Jing'an was 159.37/100 000 during this period.The injury related mortality increased with age.Fall was the first cause of injury related death,accounting for 53.30％.The characteristics and distribution of injury related deaths varied with age and gender.Conclusion Injury has become an important cause affecting the health of the elderly.It is necessary to conducted targeted injury prevention and control in the elderly in communities.
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Objective To investigate the effects of down-regulation of Beclin 1, which is an autophagy regulatory molecule, expression induced by RNA interference on the proliferation and apoptosis in skin fibroblasts of naked mole rat. Methods The expression levels of Beclin 1 were detected after starvation or H2 O2 treatment.The fibroblasts were transi-ently transfected with specific siRNA targeting Beclin 1 and then screened by real-time PCR and Western blot.Cell prolifer-ation and apoptosis were determined using CCK-8 detection kit and flow cytometry ( FCM ) .The expressions of related genes were detected by Western blot.Results The expression of Beclin 1 gene at mRNA and protein levels was signifi-cantly lower in fibroblasts of the naked mole rat.Starvation and H2 O2 treatment induced changes of the Beclin 1 expression. Inhibition of Beclin 1 gene expression can inhibit cell proliferation and induce early and late apoptosis.The protein levels of p53, BAX, Bcl2, LC3B, p-AKT and mTOR were reduced after transient transfection with Beclin 1-siRNA.Conclusions The expression of Beclin 1 in fibroblasts of naked mole rat are changed in response to starvation or H2 O2 stimulation.Inhi-bition of Beclin 1 gene expression can inhibit cell proliferation and induce apoptosis.Therefore, Beclin1 gene may play a regulatory role in autophagy, proliferation and apoptosis in the skin fibroblasts of naked mole rat.
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Objective The purpose of this study was to analyze the relation of blood glucose variability and 28-day mortality in patients with different degree sepsis. Methods From September 1, 2010 to September 30, 2012, all adult patients diagnosed with sepsis and treated at least 3 days in Emergency ICU (EICU) of the first affiliated hospital of Kunming Medical University were enrolled in the study. Then the blood glucose levels and the other requisite clinical data were obtained from historical electronic medical records of patients excluding the patients reached exclusive criteria. The maximum and mean of blood glucose, and the glucose variability (the standard deviation,SD of blood glucose) in each patient were calculated. The patients were assigned according to severity of sepsis, then the relationship between SD of blood glucose and 28-day mortality was statistically assessed. Results There was an important correlation between SD of blood glucose and 28-day mortality (OR=4.237, =0.021) . The glucose variability increased with the serious of sepsis ( = 0.016) . Conclusion Glucose variability is an independent predictor of 28-day mortality in septic patients. In addition, the severity of sepsis has a positive correlation with blood glucose variability.
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Objective The purpose of this research is to calculate the prevalence of thyroid dysfunction during pregnancy and to discuss the relationship between gestational thyroid diseases and pregnancy outcomes.Methods There were 3 745 pregnant women who took antenatal care at Sun Yat-sen Memorial Hospital,Sun Yat-sen University were chosen as the research objects during March 2012 to February 2014.All of them were given close monitoring and tracking till the termination of pregnancy.These subjects took thyroid function testing (TT4,FT4,TSH,thyroid peroxidase antibody),if the result was abnormal,they were followed up periodically.Results The prevalence of overt hyperthyroidism is 1.90％,1.20％ for subclinical hyperthyroidism,1.17％ for hypothyroidism,6.78％ for subclinical hypothyroidism,and 3.82％ for isolated hypothyroxinemia.Compared with normal thyroid function group,the morbidity of placental abruption increased in overt hyperthyroidism group (5.8％ vs 1.0％,P＜ 0.01) ; the incidence of gestational diabetes mellitus was increased in subclinical hyperthyroidism group (37.5 ％ vs 16.6％,P＜0.01) ; and the morbidity of preterm birth increased in subclinical hypothyroidism group (14.3％ vs 7.7％,P =0.002).Conclusion Gestational thyroid diseases may increase the incidence of adverse pregnancy outcomes ; such as placental abruption,gestational diabetes mellitus,and premature birth.
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Objective To establish the model and software for quality assessment of fetal nuchal translucency ultrasound image using computer image recognition technology.Methods The proposed approach firstly divided the input image into four sub-image blocks:the nasal bone(NB) area,the nuchal translucency (NT) area,the midbrain area,and the jaw and chest area.For each sub-image block,the algorithm compared the image block with the corresponding area of the standard training image set,and then determined whether the current image block was the qualified one using the the Gabor feature and Bayesian decision.The input ultrasound image was determined to be qualified only if it had four qualified sub-image blocks.Results The difference between our automatic method and the manual screening by experts wasting small,the method obtained Kappa =0.795 and P ＜0.001.Moreover,the efficiency of our method was much higher than the manual screening method.Conclusions Image recognition technology can effectively assist the sonographer to assess the quality of fetal NT of ultrasound image.The proposed approach can reduce the subjectivity and randomness of the manual evaluation of NT image.
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Objective To assess the value of contrast enhanced ultrasound (CEUS) in diagnosing subtypes of postpartum placenta accreta.Methods 31 puerperal clinically diagnosed of postpartum placenta accreta were collected.They were inspected by using CEUS and 2-dimensional color Doppler ultrasound,respectively.The operation was used as a reference.Results Both 2-dimensional color Doppler and CEUS could identify the sizes of residual placenta for the patients,but CEUS showed more explicit boundary for placenta and uterus and the rich/poor blood flow areas in the placenta.Among the 31 patients,7,23 and 1 were classified of accreta,increta and percreta,respectively,by using 2-dimensional color Doppler ultrasound,while 11,16 and 4 were classified of accreta,increta and percreta,respectively,by using CEUS based on the myometrial thickness and contrast agent subsided time.With respect to operation,10 patients were confirmed of accrete,with the other diagnosed of increta and percreta.The misclassification rate of 2-dimensional color Doppler ultrasound was 19.6 ％,while CEUS had only 6.5 ％.CEUS had a good agreement with operation (Kappa =0.859,P ＜ 0.001).Conclusions CEUS has higher accuracy in diagnosing subtypes of postpartum placenta accrete compared with 2-dimensional color Doppler ultrasound.CEUS can increase the accuracy and reliability for diagnosing those who were clinically considered of postpartum placenta accrete,and can provide helpful guidelines for clinical treatment.
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Objective To observe and compare the variation of insulin resistance and pancreatic β-cell function in pregnant women with abnormal and normal glucose metabolism during the first,second,and third trimesters,and to explore the feasibility of early diagnosis of gestational diabetes mellitus(GDM).Methods This is a prospective study.507 pregnant women with regular antenatal care from February 2009 to March 2010 were included in the study.Based on the results of oral glucose tolerance test,the patients with GDM consisted of 58,86,and 66 subjects respectively in the first,second,and third trimesters.The control group included 72,164,and 66 subjects respectively in the first,second,and third trimesters.Homeostasis model assessment insulin resistance index( HOMA-IR),homeostasis model assessment β-cell function (HOMA-β),area under curve of glucose (AUCG),area under curve of insulin ( AUCI ),30-minute insulin increase to 30-minute glucose increase ( △I30/△G30 ),and insulin sensitivity index composite(ISIcomp) were calculated for the evaluation of insulin resistance and pancreatic β-cell function.Results ( 1 ) AUCG and AUCI in the GDM group were statistically higher than those in control group while △I30/△G30and ISlcomp in the GDM group were statistically lower than those in the control group during the first trimester(P＜0.05),but HOMA-IR showed no statistically significant difference between two groups.In the GDM groups HOMA-IR,AUCG,and AUCI were statistically higher,whereas △I30/△G30 and ISIcomp were statistically lower than those in the control groups during the second and third trimesters (P ＜ 0.05 ). HOMA-β showed no statistically significant differences between the GDM groups and control groups during 3 trimesters.( 2 ) During thefirst,second,and third trimesters,blood glucose reached its peak by 0.5 h in the oral glucose tolerance test,and insulin reached its peak by 0.5-1 h in the control groups; while in the GDM groups the respective figures were 1 h and 2 h.Conclusions The insulin resistance in GDM patients diagnosed during the first,second,and third trimesters was higher than in pregnant women with normal glucose metabolism,and the peaks of blood glucose and insulin reached in oral glucose tolerance test were respectively delayed.The impaired pancreatic β-cell insulin secretion in GDM patients was present from early pregnancy.Thus for high-risk groups,oral glucose tolerance test during early pregnancy will be helpful for screening abnormal glucose metabolism.
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Objective To investigate the effect of metformin used during early pregnancy on pregnancy outcome of pregnant women with polycystic ovary syndrome (PCOS).Methods Two hundred and fifteen pregnant women with PCOS history were selected into our investigation from March 2007 to February 2010,among which,58 patients were taken as metformin group as they had taken metformin during early pregnancy,or with impaired glucose tolerance complicated by marked hyperinsulinemia and history of recurrent miscarriage.All patients in the study group received metformin (1.0～1.5 g/d) during early pregnancy.The rest 157 gravidas with PCOS history did not receive metformin as control group.The outcomes of pregnancy in the two groups were compared with x2 or t test.Results The early spontaneous miscarriage rate of metformin group was significantly lower than that of control group (5.2 ％ vs 28.7 ％,x2 =13.476,P＜0.01).There was no statistical difference in the rate of late abortion (6.90％ vs 6.4 ％ ),hypertension during pregnancy (3.9％ vs 4.9％),preeclampsia (3.9％ vs 3.9％),preterm birth (13.7％ vs 20.6％) and oligohydramnios (5.9％ vs 3.0％) between control group and metformin group (P ＞ 0.05 respectively).And there was no significant difference in neonatal birth weights [(2925±530) g vs (2910± 659) g],the rate of asphyxia (3.7％ vs 6.8％),malformation (0.0％ vs 0.9％),hypoglycaemia ( 5.6％ vs 6.8％),fetal macrosomia ( 1.9％ vs 3.4％),fetal growth restriction (5.6％ vs 6.0％) and rate of neonatal intensive care unit admission (18.0％ vs 27.4％) between the two groups (P＞0.05,respectively).The infants were followed up for 3 years and all are physically and mentally normal.Conclusions Metformin administration during early pregnancy might reduce the early spontaneous miscarriage rate of PCOS patients,and the adverse effects of metformin have not been identified on fetals and infants.
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Objective To investigate the effectiveness of oxytoein antagonist atosiban in the alternative rescue therapy of preterm labor.MethodsAlternative toeolysis atosiban was given as rescue therapy to 35 women,who had received ritodrine or magnesium sulphate but failed,due to either progression of labour or intolerable adverse events.Atosiban was administered for up to 48 hours.Efficacy and tolerability were assessed based on the proportion of women who did not deliver and did not need alternative toeolytie therapy at 48 hours and 7 days after therapy initiation.The numbers of maternal adverse events and neonatal morbidity were also assessed.ResultsEfficacy and tolerability at 48 hours and 7 days after atosiban nitiation were 77％(27/35)and 60％(21/35).One woman presented drug-related side effects with mild nausea and omiting.Thirty-four women have delivered and one bigemina(28 weeks)is being followed-up.In 34 women,11 delivered before 28 gestational weeks,17 delivered after 28 gestational weeks,3 delivered after 34 weeks and 3 had term delivery.Pregnancies were rolonged by 4 hours to 14+2 weeks.There were nine neonatal deaths,with gestational ages less than 28 weeks at delivery.Conclusion xytocin antagonist atosiban could be given as alternative rescue therapy if therapy with ritodrine or magnesium sulphate fails in the treatment of preterm labor,and it is safe and effective.
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Objective To evaluate the effect of minimal-invasive installed tube aspiration treatment of hypertensive intracerebral hematoma by rt-PA.Methods Total 71 patients of hypertensive intracerebral hematoma were divided randomly into 3 groups.Group A with 23 patients,which were performed stereotactically placed catheter into the hematoma,and drained consistently;Group B with 24 patients,which were instilled urokinase to liquefy after stereotactically placed catheter and drained the hematoma in 8-hour intervals repeating 3 times over 6 hours;Group C with 24 patients,which were instilled rt-PA to liquefy after stereotactically placed catheter and drained the hematoma in 8-hour intervals repeating 3 times over 6 hours.One week later,the result of head CT scan were compared.Results The volume of hamatoma in CT scan decreased in three groups after therapy.Compared between pre-therapy and post-treatment, difference was significant (P＜0.05),but Group C was the effectivest.Conclusion It was effective and safe that using minimal-invasive installed tube aspiration treatment of hypertensive intracerebral hematoma by rt-PA.
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Objective To investigate the effects of early parenteral feeding with glutamine on nitrogen balance and clinieal prognosis in Pationts with acute severe pancreatitis.Methods120 acute severe pancreatitis patients with Ranson scale≥3 were studied.Patients were randomized to receive either an early parenteral diet(control group,n=60) or the same formula with glutamine added(study group,n=60).The diets were isocaloric and isonitrogenous [35 kcal ? kg-1 ? day-1 and 1.5g of protein/(kg-1 ? d)].Main outcome measures were the APACHE-Ⅱ scale,incidence of infection,the length of stay in the intensive care unit and the number of days requiring mechanical ventilation,and monitor the nitrogen balance.ResultsThe two groups were homogeneous in gender,age,nutritional status and admission.There was no mortality during the study period.The two group have no statistic defference in nitrogen balance of 4.7 day.The median(range) number of infections per patient was significantly greater(P
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ObjectiveTo discuss the effects and security o f intra-anmiotic administration of pulmonary surfactant for neonatal respiratory distress syndrome prophylaxis.MethodsForty-five cases of pr eterm delivery with immature fetal lungs were divided into two groups. Fifteen w omen of the study group were administered one dose of pulmonary surfactant into the amniotic cavity and delivered in several hours. Nothing was injected into th e amniotic cavity of the 30 women in the control group. The proportion of NRDS, mortality and the time in hospital were analyzed to make clear whether there wer e any differences between the two groups.ResulstsThere was n o difference between the two groups for neonatal Apgar score. Foam test demonstr ated that the proportion of lung maturity of the neonates was:56.3%(9/16)in the study group, 13.3%(4/30)in the control group,(P
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Objective To study the effect of SARS during pregnancy on the pregnant outcome. Methods Six pregnant women who suffered from SARS in the second or third trimester were observed. The fetuses and infants were followed up. SARS specific antibody and coronavirus RNA were detected in blood and pharyngeal secretion samples for both mothers and their infants. Results Among the 6 cases,2 were twins. Two cases were preterm birth,3 were fetal distress. One fetal death in one twin,the other fetus complicated with fetal growth restriction. None of the 7 neonates had asphyxia or any signs of SARS.SARS coronavirus IgG was positive in 7 mothers and 4 infants. SARS specific IgM and coronavirus RNA were negative in all 7 newborns. Physical and mental development in 3 premature infants was slightly delayed while normal in the 4 full-term infants. Conclusions SARS during pregnancy may have some harmful effects on the perinatal outcome. No intrauterine transmission of coronavirus has been found.