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Objective:To analyze the lipid levels, adverse perinatal outcome and their correlation in Tibetan pregnant women in high altitudes in late pregnancy.Methods:Retrospective analysis was performed on clinical and laboratory data of 523 Tibetan singleton pregnant women who delivered after 28 weeks at the Department of Obstetrics and Gynecology, Chaya People's Hospital, Changdu City. The subjects were divided into three groups according to the altitude of their long-term residence, including altitude<3 500 m (Group A, n=161), altitude ≥3 500 m and <4 000 m (Group B, n=203) and altitude≥4 000 m (Group C, n=159). In addition, the subjects were also grouped into high TG group (TG≥3.23 mmol/L, n=80) and control group (TG<3.23 mmol/L, n=443). The baseline information, levels of lipid and perinatal outcome were compared among Group A,B and C, and also between the high TG and control group, respectively, using Mann-whitney U test, Kruskal-Wallis H test, LSD- t, Chi-square test, or Fisher exact test. Multivariate logistic regression analysis was also applied to analyze the correlation between hypertriglyceridemia and adverse perinatal outcome. Results:The maternal age, gravidity and parity, body mess index, blood pressure on admission and total cholesterol (TC), TG, high density lipoprotein-cholesterol (HDL-C), low density lipoprotein-cholesterol (LDL-C), TG/HDL-C ratio and LDL-C/HDL-C ratio in late pregnancy and the occurrence of adverse perinatal outcome did not show any significant differences among Group A, B and C (all P>0.05). However, the hemoglobin (Hb) level increased with the elevation of altitude as expected, and that in Group C was higher than that in Group A and B [121.0 g/L (108.0-132.0 g/L) vs 115.0 g/L (103.5-128.0 g/L) and 117.0 g/L (101.0-127.0 g/L), H=2.37 and 1.97, both P<0.05]. The proportion of women with hypertriglyceridemia, the high TG group, in late pregnancy was 15.3% (80/523), and no significant difference was found in HDL-C or Hb levels between the high TG and control group [1.7 mmol/L (1.5-2.0 mmol/L) vs 1.8 mmol/L (1.5-2.1 mmol/L), Z=－1.51;123.5 g/L (110.0-131.8 g/L) vs 117.0 g/L (104.0-128.0 g/L), Z=1.69; both P>0.05]. Higher rates of cesarean section [13.8% (11/80) vs 6.6% (29/443), χ2＝4.98], hypertensive disorders of pregnancy (HDP) [16.3% (13/80) vs 7.5% (33/443), χ2＝6.54], preeclampsia (PE) [8.8% (7/80) vs 1.6% (7/443), χ2＝13.37], hyperglycemia during pregnancy [11.3%( 9/80) vs 3.6% (16/443), χ2＝8.69], preterm birth (PB) [7.5% (6/80) vs 2.0% (9/443), χ2＝7.27], microsomia [5.0% (4/80) vs 0.9% (4/443), Fisher exact test] and neonatal asphyxia [8.8%(7/80) vs 2.5% (11/443), χ2＝8.01] were observed in the high TG group than in the control group (all P<0.05). Regarding the pregnant women at different altitude, TG was negatively correlated with Hb ( r=－0.17, P=0.037) only in Group C .Multivariate logistic regression analysis revealed higher risk of HDP ( OR=2.42,95% CI:1.17-5.00), PE ( OR=5.25, 95% CI:1.73-16.00), hyperglycemia during pregnancy ( OR=3.77, 95% CI:1.56-9.09), PB ( OR=4.33, 95% CI:1.42-13.22), microsomia ( OR=4.33, 95% CI:1.42-13.22), neonatal asphyxia ( OR=3.45, 95% CI:1.27-9.35) and fetal demise ( OR=4.94, 95% CI:1.01-24.21) in women with high TG level in late pregnancy (all P<0.05). Conclusions:There were no differences in adverse perinatal outcomes or serum lipid levels in late pregnancy among women living at different high altitudes. However, hypertriglyceridemia at the third trimester is closely associated with the incidence of HDP, PE, hyperglycemia during pregnancy, PB, microsomia, neonatal asphyxia and fetal demise in this group of women.
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In recent years, the artificial intelligence machine learning and deep learning technology have made leap progress. Using clinical decision support system for auxiliary diagnosis and treatment is the inevitable developing trend of wisdom medical. Clinicians tend to ignore the interpretability of models while pursuing its high accuracy, which leads to the lack of trust of users and hamper the application of clinical decision support system. From the perspective of explainable artificial intelligence, the authors make some preliminary exploration on the construction of clinical decision support system in the field of liver disease. While pursuing high accuracy of the model, the data governance techniques, intrinsic interpretability models, post-hoc visualization of complex models, design of human-computer interactions, providing knowledge map based on clinical guidelines and data sources are used to endow the system with interpretability.
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Objective:To explore the associations between thyroid function in the first trimester in twin pregnancies and gestational diabetes mellitus (GDM) and the risk factors of twin pregnancies complicated by GDM.Methods:Retrospective analysis was performed on 745 twin pregnancies delivered after 28 weeks at the Third Affiliated Hospital of Sun Yat-sen University from January 2015 to December 2021, and they were divided into GDM group ( n=186) and the control (non-GDM) group ( n=559). Thyroid dysfunction was diagnosed based on the reference range of singleton and twin pregnancies recommended by the Guideline on diagnosis and management of thyroid diseases (2nd edition) in China and the literature, respectively. Independent sample t-test, Chi-square test, or Fisher exact test, and Mann-Whitney U test were used to compare the general clinical characteristics and thyroid function between the two groups. Spearman rank correlation analysis was performed to analyze the correlation between free thyroxine (FT 4), thyroid stimulating hormone (TSH), thyroid peroxidase antibody (TPOAb), and fasting plasma glucose (FPG) in the first trimester as well as glucose levels in 75 g oral glucose tolerance test (OGTT). The associations between FT 4, TSH at different levels, and the detection rate of GDM, and the risk factors of GDM in twin pregnancies were analyzed using logistic regression. Results:(1) The prevalence of GDM in twin pregnancies was 25.0% (186/745). The positive rate of TPOAb was 13.6% (101/745). FPG in the first trimester was higher in the GDM group than that in the control [(4.7±0.5) vs (4.5±0.4) mmol/L, t=－5.08, P<0.001]. (2) No correlation between FT 4, TSH levels, the positive rate of TPOAb in the first trimester and FPG in the first trimester as well as OGTT results was found (all P>0.05). (3) There was no significant difference when using the thyroid function reference range for twin or singleton pregnancy in detecting hypothyroidism [0.5% (4/745) vs 0.4% (3/745)] and subclinical hypothyroidism [1.2% (9/745) vs 1.3% (10/745)] among the included subjects (both P>0.05), however, there were significant differences in the detection rates of hypothyroxinemia alone [25.0% (186/745) vs 12.9% (96/745)], hyperthyroidism [2.4% (18/745) vs 12.9% (96/745)] and subclinical hyperthyroidism [5.8% (43/745) vs 12.1% (90/745)]( χ2 were 35.43, 33.43 and 18.24, all P<0.001). There was no significant difference in the detection rate of thyroid disease between the GDM and control groups (all P>0.05). (4) FT 4 and TSH levels were grouped into quartiles ( Q1, Q2, Q3, and Q4), which showed that the detection rate of GDM was the highest [27.8% (52/187)] in women with FT 4 in Q1 and was the lowest [23.0% (43/187)] in those with FT 4 in Q2. However, the detection rate was the lowest in women with TSH in Q1 [24.1% (45/187)] and was the highest [27.4%(51/186)] in those with TSH in Q4. Taking Q1 of FT 4 and TSH as a reference, the logistic regression model showed that there were no statistically significant differences between FT 4, TSH at different levels, and GDM, even after adjusting for age, preconception-body mass index (pre-BMI), family history of diabetes, mode of conception, and chorionicity (all P>0.05). (5) Multivariate logistic regression analysis showed that maternal age ( OR=1.10, 95% CI: 1.05-1.15), pre-BMI ( OR=1.13, 95% CI: 1.07-1.21), family history of diabetes ( OR=2.73, 95% CI: 1.53-4.85), and FPG in the first trimester ( OR=2.14, 95% CI: 1.38-3.32) were independent risk factors for twin pregnancies complicated by GDM. Conclusions:Twin pregnant women with higher maternal age, pre-BMI, FPG in the first trimester and family history of diabetes were at higher risk of GDM. No significant correlation is found between maternal thyroid function in the first trimester and GDM in twin pregnancies.
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Objective To investigate the epidemiological characteristics and interruption of 228 hepatitis B virus (HBV) positive pregnant women, and to provide more references for clinical education and treatment. Methods A total of 228 chronic HBV pregnant women underwent maternal-neonatal transmission blocking treatment in Third Affiliated Hospital of Sun Yat-sen University from January 2015 to April 2019 were enrolled. Self-designed follow-up questionnaires were used to collect pregnant women's data. Then the relationship of epidemiological characteristics and HBV-DNA load levels with the genotype, hepatitis B e antigen (HBeAg), and alanine aminotransferase (ALT) was analyzed, moreover, the prevention of mother-to-child transmission was also analyzed. Results A total of 228 HBV-positive pregnant women were mainly over 30 years old, with a family history of liver disease, low education level (
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Objective: To evaluate the usefulness of a fasting plasma glucose [FPG] at the first trimester in predicting gestational diabetes mellitus [GDM] and the association between FPG and adverse pregnancy outcomes
Methods: The levels of FPG in women with singleton pregnancies were measured at 9-13+6 weeks. A two hour 75-g oral glucose tolerance test [OGTT] was completed at 24-28 weeks and the International Association of Diabetes and Pregnancy Study Groups [IADPSG] criteria was used. Adverse pregnancy outcomes were assessed and recorded
Results: Among 2112 pregnant women enrolled in the study, 224 [10.6%] subjects were diagnosed with GDM. The AUC for FPG in predicting GDM was 0.63 [95% CI 0.61- 0.65] and the optimal cutoff value was 4.5 mmol/L [sensitivity 64.29% and specificity 56.45%]. Higher first-trimester FPG increased the prevalence of GDM, large for gestational age [LGA] and assisted vaginal delivery and/or cesarean section [all P < 0.05]
Conclusion: FPG at first trimester could be used to predict GDM and higher first-trimester FPG was associated with adverse pregnancy outcomes
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Objective To investigate the distribution of host animals and the serological distribution and virulence gene of Yersinia eterocolitica in Gaomi City.Methods Sample stools of poultry and domestic and diarrhea patients,as well as flies and chilled (frozen) poultry and domestic animal meats in Gaomi City were preliminarily identified and the suspected strains isolated were sent to Shandong Provincial Center for Disease Control and Prevention for further identification from 2012 to 2015.The bacteria were analyzed by the systematic biochemistry to determine the serotypes,bio-types and virulence genes [Yersinia enterocolitica adhesion aggression site gene (ail),heat-tolerance enterotoxin gene (ystA),organism type 1A enterotoxin gene (ystB),adhesin (yadA),yop regulator transcription activation action factor (virF)].Results Eighty-five stains of Yersinia enterocolitica were detected in 2 860 specimens and the detection rate was 3.0％ (85/2 860).The chicken strains accounted for 50.6％ (43/85),the swine strains accounted for 20.0％ (17/85),and the sheep strains accounted for 10.6％ (9/85).In all the serotypes,the highest was O ∶ 8 (24.7％,21/85),followed by O ∶ 5 (12.9％,11/85),the bacteria were detected in the stools of chickens,duck,and swine etc.,as well as in diarrhea patients and chilled (frozen) poultry and domestic animal meats,biotype is 1A.One strain O ∶ 3/4 was detected from swine stool with ail,ystA,yadA and virF genes.Conclusions The Yersinia enterocolitica is widely distributed and both pathogenic and non-pathogenic strains coexist in Gaomi City;the main serological types are O ∶ 5/1A and O ∶ 8/1A;the pathogenic serotype is O ∶ 3/4,and chicken,swine and sheep are the main host animals.
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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] Compare the outcomes of vacuum extractors and forceps in assisted vaginal delivery.[Methods] One hundred and sixty-four pregnant women with operative vaginal delivery who received prenatal examination and delivered in our hospital were enrolled.Eighty-two women with vacuum extractors were assigned into vacuum extractors group,another eighty-two women with low or outlet forceps were assigned into forceps group.Occiput transverse or posterior position women before operative vaginal delivery were assigned into abnormal fetal position group.Compare the maternal and neonatal outcomes of vacuum extractors and forceps in assisted vaginal delivery.[Results] The vaginal laceration rate of forceps group was significant higher than vacuum extractors group (56.1％ vs 24.2％,P ＜ 0.01),but neonatal subscalp hematoma and hyperbilirubinemia rate were lower than vacuum extractors group (P ＜ 0.05).The vaginal laceration rate of abnormal fetal position forceps group was also higher than abnormal fetal position vacuum extractors group (76.5％ vs 22.2％,P ＜ 0.05),but neonatal hyperbilirubinemia rate was lower than abnormal fetal position vacuum extractors group (P ＜ 0.05).The Interval time from decision to delivery,postpartum hemorrhage volume with 24 hours,leukocyte and neutrophil count after 24 hours,asphyxia of newborn rate,intracranial hemorrahge,subgaleal hemorrahge,referral rate and hypoxic-ischemic encephalopathy did not significantly differ between vacuum extractors group and forceps group (all P ＞ 0.05).[Conclusions] Vacuum extractors can reduce the incidence of vaginal laceration rate,especial for abnormal fetal position,but increase the incidence of neonatal subscalp hematoma and hyperbilirubinemia rate.
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Objective To investigate the antenatal influencing factors associated with birth weight of twins and the risk factors for the occurrence of discordant twins. Methods Totally, 834 twins delivered at the Third Affiliated Hospital from January 2000 to December 2009 and the First Affiliated Hospital of SUN Yat-sen University, from January 2000 to June 2009, were recruited in the study. The diagnosis criteria of discordant twins was intrapair birth weight difference more than 25 %.Antenatal factors on birth weight were retrospectively investigated among twins and discordant twins respectively with Logistic analysis. Results (1) There were several factors associated with birth weight of twins, including maternal age, conceptive style, chorionicity, gestational diabetes mellitus and placental cord insertion ( P = 0. 021, 0. 000, 0. 000, 0. 012 and 0. 017, respectively). While hypertensive disorder in pregnancy, parity and fetal gender differences were not associated with the birth weight of twins (P＞0.05). Hypertensive disorder in pregnancy (OR=2. 600, 95% CI:1. 566-4. 316) and monochorionicity (OR= 1. 833, 95% CI: 1.010-3. 582) were risk factors of discordant twins. All 834 twin pregnancies were divided into 4 groups according to materal age, ＜25 yrs (n=69), 25-30 yrs (n=312), 30-35 yrs (n=325) and ≥35 yrs (n=128). The average birth weight of twins were (2205±483) g, (2347±406) g, (2381±439) g and (2352±455) g. Significant difference was found bewteen every two groups (P＜0. 05) except that between the 30-35 yrs and ≥35 yrs group (P＞0.05). Among twins of different gender (n=270), the average birth weight of boys and girls were (2416±-514) g and (2322±488) g, and that of female twins (n=272) and male twins (n=292) were (2301±418) g and (2381±428) g. Significant difference was shown between every two groups (P＜0.05) except that between the male twins and male fetus of twins of different gender (P＞0.05).Conclusions The fetal birth weight of twins decreases remarkably when maternal age ＜25, or monochorionicity twins, or complicated with marginal or velamentous placental cord insertion or female pairs.However, birth weight of twins would increase if the pregnancy conceived by assisted reproductive technology or complicated with gestational diabetes mellitus. Twin pregnancy complicated with hypertensive disorder in pregnancy or monochorionicity should alert the clinicians of discordance twins.
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Objective To investigate the relationship of insulin resistance and secretion during late pregnancy in women with glucose intolerance.Methods Immunoenzymetric assay was used to measure the fasting serum insulin levels in 122 pregnant women which including of 36 pregnant women with gestational diabetes mellitus(GDM),34 pregnant women with gestational impaired glucose tolerance(GIGT),and 52 pregnant women with normal glucose tolerance(NGT).The fasting plasma glucose levels were measured by glucose oxidase method.The insulin sensitivity index(ISI) and islet secretive function index(IFI) were compared between the three groups.Results ISI had an increasing trend from NGT group,GIGT group to GDM group(P