Prevalence and influencing factors analysis of the polycystic ovary syndrome among female college students in Fuzhou City， Jiangxi Province / 上海预防医学

ObjectiveTo investigate the prevalence of polycystic ovary syndrome （PCOS） among female college students at a university in Fuzhou City， Jiangxi Province， and to facilitate early detection and intervention of PCOS. MethodsUsing a stratified sampling method， a total of 450 female freshmen were randomly selected for PCOS screening. A self-designed questionnaire was used for data collection， covering menstrual status， high androgen signs， lifestyle， dietary habits， and awareness of PCOS. Sample t test and χ2 test were used to compare the basic information and dietary habits between PCOS and non-PCOS cases. The correlation between various indicators and the prevalence of PCOS was analyzed by a logistic regression model. ResultsA total of 12 PCOS cases were identified， with a prevalence rate of 2.99%. PCOS cases exhibited statistically significant differences compared to non-PCOS cases in terms of waist-to-hip ratio， waist circumference， abdominal obesity， the proportion of overweight or obese individuals， and a preference for sweet food （all P<0.05）. Multivariate logistic regression analysis revealed a significant correlation between preference for sweet food and the occurrence of PCOS （OR=4.858， 95%CI=1.199‒19.675，P=0.027）， as well as a significant correlation with PCOS accompanied by abdominal obesity （OR=7.083， 95%CI=0.773‒64.937， P=0.048）. Among the female college students surveyed， 37.90% had never heard of PCOS， 51.62% were only familiar with the name of the disease， and 10.47% had attempted to search for PCOS-related information. ConclusionThe prevalence of PCOS among female college students should not be overlooked and unhealthy dietary habits may be a crucial factor contributing to the occurrence of PCOS during this period. Early screening for PCOS during puberty is crucial.

Treatment Progress in Diminished Ovarian Reserve: Western and Chinese Medicine / 中国结合医学杂志

Diminished ovarian reserve (DOR), generally defined as a decreased number or quality of oocytes, has a significant impact on quality of life and fertility in women. In recent years, the incidence of DOR has been increasing and the ages of patients are younger. The search for an effective DOR treatment has emerged as one of the preeminent research topics in reproductive health. An effective DOR therapy would improve ovarian function, fertility, and quality of life in patients. In this review we evaluated DOR treatment progress both in Western medicine and Chinese medicine, and elucidated the characteristics of each treatment.

Clinical characteristics and risk factors of gastrointestinal involvement in patients with systemic lupus erythematosus / 中华风湿病学杂志

Objective:To study the clinical features and prognostic risk factors of gastrointestinal (GI) involvement in systemic lupus erythematosus (SLE), and improve clinicians' understanding of GI involvement in SLE.Methods:The clinical data of SLE patients admitted to the First Affiliated Hospital of Guangxi Medical University from September 1, 2012 to September 1, 2019 were retrospectively analyzed. Two hundred and forty-three patients with GI system involvement were the GI system affected group, and 486 patients with-out GI system involvement at the same period were randomly selected as the control group. The clinical mani-festations, laboratory tests and treatment effects of the two groups were compared by t test, Wilcoxon signed-rank test and χ2 test and Logistic regression was used to analyze the prognostic risk of SLE with GI system involvement. Results:① There were 243 SLE patients with GI involvement, with the proportion of GI involvement in SLE patients of 6.4%(243/3 820), and as the first manifestation with GI system symptoms accounted for 20.2%(49/243). The common causes were lupus hepatitis accounted for 52.3%(127/243), lupus mesenteric vasculitis (LMV) for 35.0%(85/243), pseudo Intestinal obstruction (IPO) for 9.9%(24/243), lupus-related pancreatitis for 8.6%(21/243), and protein-losing enteropathy (PLE) as 7.0%(17/243). ② Compared with the control group, the group with GI involvement had a lower average age [(38±14) year vs(32±15) year, t=-2.47, P=0.014], a shorter median duration of illness [12.0(3.0, 72.0) months vs 5.0(1.1, 24.8) months, Z=-5.67 , P<0.001], a higher median systemic lupus erythematosus disease activity index (SLEDAI) score [10(6,28) vs 16(9, 37), Z=2.24 , P<0.001], the occurrence of skin rash (38.7% vs 53.5%, χ2=14.46), arthritis (36.4% vs 46.7%, χ2=7.12 , P=0.008), myositis (43.0% vs 56.4%, χ2=11.53 , P=0.001), pericarditis [(216±111)×10 9/L vs (175±114)×10 9/L, t=-4.69 , P<0.001], thrombocytopenia, and hydroureterosis (1.0% vs 12.8%, χ2=47.47 , P<0.001) were high, but the incidence of pulmonary arterial hypertension (PAH) (31.2% vs 10.7%, χ2=36.99 , P<0.001) was low; Serum alanine aminotransferase (ALT) [17(10, 29) U/L vs 59(16, 127) U/L, Z=9.65 , P<0.001], aspartate aminotransferase (AST) [25.0 (18.0, 37.0) U/L vs 82.5(25.0, 289.0) U/L, Z=10.57 , P<0.001], alkaline phosphatase (ALP) [58(46, 76) U/L vs 82(56, 187)U/L, Z=8.42 , P<0.001], Creatine kinase (CK) [44.0(28.0, 83.0) U/L vs 58.5(34.0, 176.0) U/L, Z=4.46 , P<0.001], lactate dehydrogenase (LDH) [(309±206) U/L vs (443±332) U/L, t=5.64 , P<0.001], fasting blood glucose (FBS) [(5.0±1.5) mmol/L vs (5.3±1.7) mmol/L, t=2.16 , P=0.031], triglyceride (TG) [(2.0±1.3) mmol/L vs (2.7±2.2) mmol/L, t=4.55 , P<0.001] increased, albumin (ALB) [(30±7) g/L vs (27±7) g/L, t=5.87 , P<0.001)] and high-density lipoprotein (HDL) [(1.1±0.8) mmol/L vs (0.9±0.5) mmol/L, t=-4.20 , P<0.001] decrease, and anti SSB antibody positive rate (16.0% vs 9.5%, χ2=5.60 , P=0.018) decreased.③ After 3 months' follow-up, 203 patients with SLE GI involvement were relieved, 30 patients (12.3%) died, and 9 patients (1.8%) died in the control group. Ninety-five (46.8%) patients in the remission group had a significantly higher rate of cyclophosphamide treatment when compared with 5(12.5%) in the non-remission group ( χ2=16.23, P<0.001) . Logistic regression analysis showed that no increase of PAH, elevated erythrocyte sedimentation rate (ESR), ALT, glutamyl transpeptidase (GGT), indirect bilirubin (IBIL) and high SLEDAI scores, hydroureteral dilatation, decreased ALB and HDL were independent related factors for SLE GI involvement, while ascites and elevated FBS were SLE GI involvement factors of poor prognosis. Conclusion:SLE patients with GI involvement have a high mortality rate, and lupus hepatitis and LMV are common. Hydroureterosis, high SLEDAI score, abnormal liver function are risk factors for GI involvement. Jaundice and elevated FBS are the risk factors for poor prognosis, and treatment with cyclophosphamide is the protective factor.

Effects of Transcutaneous Electrical Acupoint Stimulation on Ovarian Responses and Pregnancy Outcomes in Patients Undergoing IVF-ET: A Randomized Controlled Trial / 中国结合医学杂志

OBJECTIVE@#To evaluate the influence of different transcutaneous electrical acupoint stimulation (TEAS) modes on ovarian responses and pregnancy outcomes in patients with infertility undergoing in vitro fertilization and embryo transfer (IVF-ET).@*METHODS@#Two hundred infertility patients undergoing IVF-ET were divided randomly into experimental groups (TEAS groups: E-I, E-II, E-III, and E-IV, 40 cases each group) and a control group (mock TEAS group, 40 patients) using the random number method. The patients in the experimental groups received TEAS treatment of 20, 30, 40 and 50 mA for the E-I, E-II, E-III and E-IV groups, respectively. The control group received a treatment of 5 mA. TEAS was applied at acupoints of Guanyuan (RN 4), Zhongji (RN 3), Sanyinjiao (SP 6), Zigong (EX-CA 1), and Taixi (KI 13), once a day for 30 min each time for a treatment period of 10-13 d. Treatment effect was assessed using the following indicators: endometrial thickness on the 6th day of gonadotropin treatment (GN6 day), endometrial thickness on the day on chorionic gonadotropin administration (HCG day), number of ovarian follicles on HCG day, number of ova captured, amount of estrogen required for each harvested ova, number of mature ova divided by the total number of ova, percentage of high-quality embryos, and clinical pregnancy.@*RESULTS@#Endometrial thickness in the experimental groups on the HCG day was significantly better than that of the control group after TEAS stimulation (P=0.01). TEAS exhibited a greater impact on the number of ova captured (P=0.003). However, the effect of TEAS stimulation on the high-quality embryo rate and clinical pregnancy in patients was not statistically significant (P>0.05).@*CONCLUSIONS@#TEAS is an effective method in improving the ovarian state. When the stimulus intensity was at 40 mA and above, it could be helpful to improve the patient's endometrial condition and endometrial receptivity and to retrieve more oocytes. (Trial registration No. ChiCTR-TRC-11001780).

Practice of the hospital emergency management in fighting against the outbreak of COVID-19 from the aspects of man, machine, material, method, environment and monitoring / 西安交通大学学报(医学版)

In fighting against the outbreak of coronavirus disease 2019 (COVID-19), focusing on the six key points of man, machine, material, method, environment and monitoring in quality management, our hospital took a series of effective measures in advance to intervene in the key factors that affected the quality of emergency management of public health emergencies. With the development of the epidemic situation, they were further improved with continuous evaluation and adjustment. The emergency response ability and emergency management quality of our hospital have been greatly improved and patients’ safety has been ensured.

Regulation of Organophosphorus Hydrolase Nanocapsules and the Effect on Enzyme Activity and Stability / 中国生物化学与分子生物学报

Nanocapsuling organophosphorus hydrolase (OPH) is a promising strategy, which can improve OPH stability and put it into practical application. Nanocapsule can protect OPH from deactivation, but on the other hand it may block the contact of enzymes and substrates to some extent. Thus, it is worth exploring the influences of nanocapsule density on the enzyme activity and stability. In this study, OPH surface was modified by N-acryloxysuccinimide (NAS), and then the in situ radical polymerization technique was applied to construct a polymer shell around the surface to form the OPH nanocapsule (nOPH). Transmission electron microscope (TEM) and Fourier Transform Infrared (FTIR) was used to characterize the structure of nOPH. The nOPH activity is not influenced by the presence of nanocapsule when the feed ratio of NAS to OPH is below 75. On the contrary, it decreases with the increasing of NAS feed ratio when it is above 75. Furthermore, nOPH activities at high temperatures and in 20% DMSO solutions both first increase and then decrease with the increasing of NAS feed ratio. The results showed that the appropriate density of the nanocapsule could retain the enzyme activity to the maximum extent during the preparation of nOPH nanocapsule, and significantly improve its thermal stability and organic solvent stability. Hence, the results are of great significance to further realize the OPH practical application.

Predictive value of stroke-related early tracheotomy score for tracheotomy in neurocritical patients / 中华危重病急救医学

Objective:To explore the predictive value of stroke-related early tracheotomy score (SET) for tracheotomy in neurocritical patients.Methods:A retrospective analysis of the clinical data of neurocritical patients admitted to the department of intensive care unit (ICU) of the Xindu District People's Hospital of Chengdu from January 1st to December 31st, 2019. Patients were divided into tracheostomy group and non-tracheostomy group according to whether they underwent tracheotomy during hospitalization; according to SET score, patients were divided into groups with SET score < 10 points and SET score ≥ 10 points. The differences in gender, age, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ), Glasgow coma score (GCS), SET score, the length of ICU stay and mechanical ventilation time were compared between the two groups. The receiver operator characteristic curve (ROC curve) was used to analyze the predictive value of SET score for the length of ICU stay > 10 days, mechanical ventilation time > 5 days, and tracheotomy treatment, and the predictive value of APACHEⅡ score for tracheotomy treatment.Results:Among 66 patients, 35 cases underwent a tracheotomy, 31 cases did not; SET score < 10 points in 19 cases, while SET score ≥ 10 points in 47 cases. Compared with the non-tracheostomy group, there were more male patients in the tracheostomy group (cases: 27 vs. 13), the GCS score was lower (7.00±2.41 vs. 11.52±2.00), the APACHEⅡ score and the SET score were higher (22.43±4.45 vs. 19.58±5.86, 16.11±3.67 vs. 8.61±4.27), and the length of ICU stay and mechanical ventilation time was longer [days: 27.54±18.82 vs. 7.45±5.30, 13 (9, 19) vs. 0 (0, 2)], and all differences were statistically significant (all P < 0.05). Compared with SET score < 10 points group, the proportion of traumatic brain injury and tracheotomy in the SET score ≥ 10 points group was higher (44.68% vs. 15.79%, 70.21% vs. 5.26%), the GCS score was lower (8.00±2.87 vs. 11.89±1.97), APACHEⅡ score was higher (22.30±4.80 vs. 18.11±5.49), and the length of ICU stay and mechanical ventilation time was longer [days: 22.38±18.74 vs. 7.53±4.60, 9 (4, 16) vs. 0 (0, 2)], and the differences were statistically significant (all P < 0.05). ROC curve analysis showed that the area under the curve (AUC) of SET score predicting the length of ICU stay > 10 days of neurocritical patients was 0.877, and the 95% confidence interval (95% CI) was 0.790-0.964 ( P = 0.000), and its cut-off value was 13.50, the sensitivity was 80.0%, and the specificity was 87.1%. The SET score predicts the AUC for mechanical ventilation time > 5 days was 0.915, the 95% CI was 0.851-0.979 ( P = 0.000), the cut-off value was 13.50, the sensitivity was 78.4%, and the specificity was 89.7%. SET score predicts the AUC of tracheotomy treatment was 0.919, 95% CI was 0.853-0.985 ( P = 0.000), its cut-off value was 13.50, the sensitivity was 82.9%, and the specificity was 90.3%, which was significantly better than that of APACHEⅡ score in predicting the value of tracheotomy (AUC was 0.647, 95% CI was 0.512-0.783, P = 0.040, its cut-off value was 17.50, the sensitivity was 91.4%, and the specificity was 41.9%). Conclusion:SET score has a good predictive value for the length of ICU stay, mechanical ventilation time and tracheotomy in neurocritical patients.

Low-Frequency Magnetic Stimulation of Shenmen Acupoint Reduces Blood Oxygen Levels in the Prefrontal Cortex of Healthy Subjects: A Near-Infrared Brain Functional Imaging Study / 中国结合医学杂志

OBJECTIVE@#To explore the effect of low-frequency magnetic stimulation at Shenmen (HT 7) acupoint on blood oxygen levels in the prefrontal cortex of healthy subjects.@*METHODS@#Functional near-infrared spectroscopy (fNIRS) technology was used to collect real-time data of oxygenated hemoglobin (oxy-Hb) in the prefrontal cortex of 16 healthy subjects at resting state and low-frequency magnetic stimulation of Shenmen. The mean and integral values of blood oxygen concentration were analyzed.@*RESULTS@#Compared with the resting state, the mean and integral values of blood oxygen concentration were decreased during the task period, recovery period, and the whole process in the magnetic stimulation of Shenmen acupoint (P<0.05). In particular, the difference was statistically significant in the recovery period (P<0.01).@*CONCLUSIONS@#The prefrontal cortex was widely activated and produced an immediate effect by reducing the local blood oxygen concentration at low-frequency magnetic stimulation of Shenmen acupoint, which verifies the sedative effect of Shenmen acupoint.

Network pharmacology study on anti-stroke of Xiaoshuan Tongluo formula based on systematic compound-target interaction prediction models / 药学学报

Xiaoshuan Tongluo formula is effective in treating mental retardation and speech astringency caused by cerebral thrombosis, but its mechanism remains unclear. In this investigation, by collecting the chemical constituents from Xiaoshuan Tongluo formula and the targets related to stroke, we obtained 1 251 constituents from the formula and 10 drug targets related with stroke. We established 18 prediction models of compound-target interaction for 10 stroke-related targets, using molecular docking method and machine learning methods includes Naive Bayesian and recursive partitioning based on the input of molecular fingerprints and molecular descriptors. Using these models, we predicted the active chemical constituents from Xiaoshuan Tongluo formula and their drug targets, 153 potential active constituents were discovered, 22 among them could interact with at least two drug targets related with stroke. On this basis, the chemical constituent-target network was constructed using network construction software, and then the important metabolic pathways of the targets were identified by using Gene-Ontology (GO) enrichment analysis, such as blood coagulation, positive regulation of angiogenesis, positive regulation of ion transport and so on. On this basis, a target-pathway network was constructed. In conclusion, using machine learning, molecular docking, virtual screening, data mining and network construction, this study explored and partially revealed the active chemical constituents and chemical constituent-target-pathway network action mechanism of Xiaoshuan Tongluo formula against stroke, which will provide important information for its further study.

Immunosuppressive therapy for the treatment of COVID-19 in terms of immunopathogenesis / 中华微生物学和免疫学杂志

Since December 2019, the global outbreak of COVID-19 has posed a serious threat to the lives and health of people in the world. Based on the immunopathogenesis of COVID-19, this article analyzed the changes in the immune system, lymphopenia and cytokine storm caused by 2019-nCoV infection, and summarized the present situation and the advantages and disadvantages of immunosuppressants for the treatment of COVID-19, aiming to explore effective immunosuppressive therapy and provide reference for clinical application.

Perinatal complications and live-birth outcomes following assisted reproductive technology: a retrospective cohort study / 中华医学杂志(英文版)

Background@#With the development of assisted reproductive technology (ART) and its increasing success rate in the mainland of China, more attention has been paid to the safety of ART. In this study, we explored the associations between conception by ART and pregnancy/perinatal complications, and neonatal outcomes compared with similar outcomes following spontaneous conception.@*Methods@#This retrospective cohort study of pregnancies over a 3-year period (2013-2015) was performed at Beijing Obstetrics and Gynecology Hospital, Beijing, China. Subjects were divided into two groups: conception by ART (n = 2256) or spontaneous conception (n = 6768). According to different fertilization modes, the ART group was divided into in vitro fertilization (IVF, n = 1873) and intracytoplasmic sperm injection (ICSI, n = 383) subgroups. The ART group was also divided into two different embryo transfer methods; fresh embryo transfer (ET, n = 1583) and frozen embryo transfer (FET, n = 673) subgroups. Pregnancy complications, perinatal complications, and neonatal outcomes of the enrolled subjects were investigated and analyzed by univariate analysis and multivariate logistic regression.@*Results@#After adjustment for maternal age, gravidity, parity, maternal education, smoking, alcohol consumption, and body mass index (BMI), pregnancies conceived by ART were associated with a significantly increased incidence of gestational diabetes mellitus (GDM; OR 1.88, 95% CI 1.56-2.27), gestational hypertension (OR 2.18, 95% CI 1.83-2.60), and intrahepatic cholestasis of pregnancy (ICP) (OR 2.79, 95% CI 2.15-3.64), compared with spontaneous conception. These associations were similar for the singleton group. In the twin group, only the incidence of ICP was significantly higher than in controls. We found that pregnancies conceived by ART were associated with perinatal complications, including placental abruption (OR 2.14, 95% CI 1.33-3.45), premature rupture of membranes (PROM; OR 1.24, 95% CI 1.06-1.45), postpartum hemorrhage (OR 2.89, 95% CI 2.33-3.59) and polyhydramnios (OR 2.01, 95% CI 1.29-3.16). The singleton group had a similar result with placental abruption, but not with fetal membranes ruptures before labor and polyhydramnios. There were no significant differences in the incidence of these perinatal complications in the twin group. Some neonatal outcomes, including preterm labor (OR 4.29, 95% CI 3.84-4.80) and low birth weight (OR 1.72, 95% CI 1.42-2.08), were more likely to occur with singleton births after ART. However, there were no significant differences for these outcomes from twin pregnancies. Perinatal complications and neonatal outcomes were consistent between the IVF and ICSI subgroups. The FET and ET subgroups showed a similar increase in complications, except for the incidence of placental abruption. After taking into account the effects of parity, birth plurality and maternal age, the ART group still exhibited increased maternal and neonatal complications, although some differences narrowed or disappeared.@*Conclusions@#This retrospective cohort study demonstrated that patients who underwent ART were at increased risk of several adverse pregnancy outcomes compared with women who conceived spontaneously. These complications may be attributed in part to the relatively high multiple pregnancy rate after ART. Elective single embryo transfer should be promoted in China to reduce the obstetrical risks of ART pregnancy. Singletons of ART pregnancy exhibited increased maternal and neonatal complications as well, suggesting that underlying infertility or other maternal or parental factors may contribute to the adverse outcomes.

The role of pinocembrin in t-PA thrombolysis-induced hemorrhagic transformation / 药学学报

Hemorrhagic transformation (HT) is a frequent complication of ischemic stroke, especially after thrombolytic therapy. This event is associated with increased morbidity and mortality. Tissue plasminogen activator (t-PA), the only FDA proved drug for breaking blood clots, is underutilized in ischemic stroke, because of its limited therapeutic window and hemorrhagic complications. Due to the lack of clear understanding of the pathological mechanism, there are no effective drugs to decrease the incidence of HT. Pinocembrin is a natural flavonoid compound and has neuroprotective effects in animal ischemic stroke models. In this study, we investigated the role of pinocembrin in t-PA thrombolysis-induced HT in rat thromboembolic stroke model. t-PA was administrated 6 h after ischemia and pinocembrin (5, 10 and 20 mg·kg-1) was given 5 min before t-PA administration. Infarct volume, neurological score and hemoglobin content were evaluated at 24 h after ischemia. Evans blue leakage was used to detect blood-brain barrier (BBB) permeability. All procedures were approved by the Institutional Animal Care and Use Committee of the Peking Union Medical College. The results showed that treatment with t-PA at 6 h after ischemia aggravated brain injury and increased the risk of HT, with infarct volume and brain water content reached 39% and 83.4%, respectively. Pretreatment with pinocembrin decreased the infarct volume and brain water content to 28.5% and 80.3%, and improved neurological function. In addition, the combined application of pinocembrin with t-PA reduced hemoglobin content and Evans blue content in brain tissue by 50% and 40%, indicating that pinocembrin could protect the BBB permeability and reduce the occurrence of HT. Among these doses, 10 mg·kg-1 is most effective. In conclusion, our results demonstrate that the combination of pinocembrin with t-PA protects against cerebral ischemia, reduces the occurrence of HT induced by t-PA thrombolysis. Thus, pinocembrin may be a potential therapeutic drug for t-PA induced HT.

Comparison of antithrombotic effects between salvianolic acid A and aspirin / 药学学报

This study was designed to compare the antithrombotic effects of salvianolic acid A and aspirin. The anti-platelet aggregation and anticoagulant effects of salvianolic acid A and aspirin in vitro and in vivo were investigated in normal rats. The anti-cerebral ischemia and anti-platelet aggregation effects of salvianolic acid A and aspirin were also investigated in rats with thrombotic cerebral ischemia. All animal care and experimental procedures were reviewed and approved by the Animal Ethics Committee of Chinese Academy of Medical Sciences. The results of antiplatelet aggregation in vitro and in vivo showed that salvianolic acid A could mildly inhibit adenosine diphosphate (ADP), arachidonic acid (AA) and thrombin (THR)-induced antiplatelet aggregation in a dose-dependent manner, while aspirin played a strong inhibitory effect on AA-induced platelet aggregation in vivo. The effects of salvianolic acid A and aspirin on the coagulation system were similar. At the same time, the results of maximum platelet aggregation rate (MAR) in the rat cerebral ischemia model [MARADP= (41.67±4.55)%, MARAA= (53.22±2.83)%, MARTHR= (73.33±5.04)%] indicated that salvianolic acid A could mildly inhibit ADP and AA-induced antiplatelet aggregation [MARADP= (26.13±4.60)%, MARAA= (35.53±13.73)%, P<0.01], while aspirin played a strong inhibitory effect on AA-induced platelet aggregation [MARAA= (8.13±2.99)%]. Salvianolic acid A (10 mg·kg-1) significantly improved the neurological function, cerebral infarction volume [(10.77±7.80)%] and brain edema [(79.72±0.83)%] compared with the model group [(43.50±12.69)%, (82.25±0.89)%] (P<0.01), while the effect of aspirin (100 mg·kg-1) was not obvious. The above results suggest that compared with aspirin, salvianolic acid A provided a mild inhibitory effect on platelet aggregation and protected against cerebral ischemia induced by thrombus. Therefore, salvianolic acid A has a good application prospect in the prevention and treatment of thrombotic diseases.

Perinatal complications and live-birth outcomes following assisted reproductive technology: a retrospective cohort study / 中华医学杂志(英文版)

BACKGROUND@#With the development of assisted reproductive technology (ART) and its increasing success rate in the mainland of China, more attention has been paid to the safety of ART. In this study, we explored the associations between conception by ART and pregnancy/perinatal complications, and neonatal outcomes compared with similar outcomes following spontaneous conception.@*METHODS@#This retrospective cohort study of pregnancies over a 3-year period (2013-2015) was performed at Beijing Obstetrics and Gynecology Hospital, Beijing, China. Subjects were divided into two groups: conception by ART (n = 2256) or spontaneous conception (n = 6768). According to different fertilization modes, the ART group was divided into in vitro fertilization (IVF, n = 1873) and intracytoplasmic sperm injection (ICSI, n = 383) subgroups. The ART group was also divided into two different embryo transfer methods; fresh embryo transfer (ET, n = 1583) and frozen embryo transfer (FET, n = 673) subgroups. Pregnancy complications, perinatal complications, and neonatal outcomes of the enrolled subjects were investigated and analyzed by univariate analysis and multivariate logistic regression.@*RESULTS@#After adjustment for maternal age, gravidity, parity, maternal education, smoking, alcohol consumption, and body mass index (BMI), pregnancies conceived by ART were associated with a significantly increased incidence of gestational diabetes mellitus (GDM; OR 1.88, 95% CI 1.56-2.27), gestational hypertension (OR 2.18, 95% CI 1.83-2.60), and intrahepatic cholestasis of pregnancy (ICP) (OR 2.79, 95% CI 2.15-3.64), compared with spontaneous conception. These associations were similar for the singleton group. In the twin group, only the incidence of ICP was significantly higher than in controls. We found that pregnancies conceived by ART were associated with perinatal complications, including placental abruption (OR 2.14, 95% CI 1.33-3.45), premature rupture of membranes (PROM; OR 1.24, 95% CI 1.06-1.45), postpartum hemorrhage (OR 2.89, 95% CI 2.33-3.59) and polyhydramnios (OR 2.01, 95% CI 1.29-3.16). The singleton group had a similar result with placental abruption, but not with fetal membranes ruptures before labor and polyhydramnios. There were no significant differences in the incidence of these perinatal complications in the twin group. Some neonatal outcomes, including preterm labor (OR 4.29, 95% CI 3.84-4.80) and low birth weight (OR 1.72, 95% CI 1.42-2.08), were more likely to occur with singleton births after ART. However, there were no significant differences for these outcomes from twin pregnancies. Perinatal complications and neonatal outcomes were consistent between the IVF and ICSI subgroups. The FET and ET subgroups showed a similar increase in complications, except for the incidence of placental abruption. After taking into account the effects of parity, birth plurality and maternal age, the ART group still exhibited increased maternal and neonatal complications, although some differences narrowed or disappeared.@*CONCLUSIONS@#This retrospective cohort study demonstrated that patients who underwent ART were at increased risk of several adverse pregnancy outcomes compared with women who conceived spontaneously. These complications may be attributed in part to the relatively high multiple pregnancy rate after ART. Elective single embryo transfer should be promoted in China to reduce the obstetrical risks of ART pregnancy. Singletons of ART pregnancy exhibited increased maternal and neonatal complications as well, suggesting that underlying infertility or other maternal or parental factors may contribute to the adverse outcomes.

Analyses of the factors that influence the quality of life of patients with systemic sclerosis / 中华风湿病学杂志

Objective To study the factors that may influence the quality of life (QoL) in patients with systemic sclerosis (SSc) by comprehensively evaluating of the patient's condition and to provide evidence for appropriate selection of treatment.Methods Out-patients with SSc in the First Affiliated Hospital of Guangxi Medical University from November 2015 to October 2016 were retrospectively enrolled into this cross-sectional study.Their clinical data were collected.Consecutive SSc patients and 30 healthy controls were recruited and were assessed by the MOS-36 Item Short-Form Health Survey (SF-36),Health Assessment Questionnaire (HAQ),Visual Analogue Scale (VAS) and the St.George's Respiratory Questionaire (SGRQ).The extent of skin involvement of SSc was assessed by the Modified Rodnan skin score (MRSS).The SSc group was divided to diffused SSc (dcSSc) and localized SSc (lcSSc) according's to extent of skin involvement.Pearson's correlation analysis was used to assess the associated clinical indications with the QoL.Results ① Sixty-eight SSc patients were studied [mean age (52±11) years,mean disease duration (35±48) months],in which 59(87％)patients had Raynaud's pheno-menon,9(13％) patients hadfinger ulcer,16(24％) patients were complicated with PAH,and anti-Scl-70 antibody was positive in 59(87％) cases.② The SSc patients had significantly lower SF-36 scale score,including physical function (PF) (64±29),role-physical (RP) (53 ±33),bodily pain (BP)(66±19),social function (SF) (53±20),general health (GH) (58±24),vitality (VT) (53±18),role emotional (RE)(47±35),mental health (MH) (45±21),compared with the healthy-control group (t=7.726,7.132,8.586,12.29,8.296,9.526,6.893,13.973,4.384),all P＜0.01).The SSc patients had significantly higher scale scores of HAQ (t=1 1.823),VAS (t=19.578) and SGRQ (t=14.043,16.688,21.210,20.053),all P＜0.01.③ Compared with lcSSc patients,the SF-36 of dcSSc patient in the PF (F=17.035,P=0.030),RP (F=17.579,P=0.033),BP (F=23.002,P=0.032),VT (F=35.737,P=0.008) were decreased.The HAQ and VAS scale of dcSSc patients were significantly higher than lcSSc patients (F=42.541 and 110.243,P＜0.01).④ The PF,RP,VT,SF,MH of SF-36 scale score in SSc patients was inversely associated with HRCT scores (r=-5.088,-2.896,-2.566,-3.450,-4.173),MRSS (r=-3.847,-3.044,-2.651,-2.571,-2.455),but positively correlated with Complement3 (C3)(r=2.372,2.133,2.370,2.493,2.387).BP,and HAQ scores,VAS were associated with Raynaud's phenomenon (r=2.502,-2.683,-3.703) and MRSS (r=2.141,-2.683,-3.703).And VAS score was correlated with arthralgia (r=-2.943).The symptom score,activity score,influence score of SGRQ were negatively associated with HRCT score (r=4.001,-3.213,2.478),smoking-state (r=-3.040,-2.007,-2.218),all P＜0.05.Conclusion The SSc patients have impaired physical and mental function in the QoL,limited mobility,increased physical pain compared to healthy controls.DcSSc patients have worse QoL index compared with lcSSc patients.For SSc patients with pulmonary fibrosis,extensive skin involvement,high C3 level might have poor QoL.

Clinical analysis of 34 cases with diffuse alveolar hemorrhage in systemic lupus erythematosus / 实用医学杂志

Objective To identify the clinical characteristics and therapeutic effect of systemic lupus erythematosus (SLE) patients with diffuse alveolar hemorrhage (DAH).Methods Clinical characteristcs,diagnosis,treatment and outcome in 34 patients hospitalized in The First Affiliated Hospital of Guangxi Medical University from January 2006 to December 2016 were retrospectively analyzed.Results The incidence of DAH involvement of SLE was about 0.39％.Median age was 19 (interquartile range (IQR) 11.75 ～ 32) years.The duration of SLE before clinical DAH was 6 months (IQR 2 ～ 15.75) months.The main clinical manifestations of DAH were cough,dyspnea and fever.The SLE disease activity index (SLEDAI) score was 19.5 (16 ～ 25)points and anti-dsDNA antibody titer elevated markedly (38.2％).The overall mortality rate was 73.5％,however patients who chose department of rheumatism have lower mortality (52.9％).And treatment of CTX was associated with mortality (OR =0.059,95％ CI 0.006 ～ 0.554,P =0.013),as well as steroids and immunosuppressant combination therapy.Conclusions The clinical symptoms of SLE with DAH is often atypical.There is manifestation of cough,fever,dyspnea and etc.Imaging and broncoscopy can assist the diagnosis and its prone to the pulmonary infection and high mortality.Early diagnosis and application of CTX combined with conventional dose of hormone theraphy can in early diagnosis and reduce the mortality.

Advances in the study of mechanism of thrombolysis-induced hemorrhagic transformation and therapeutic drugs / 药学学报

Hemorrhagic transformation (HT) is a common complication of ischemic stroke, especially after thrombolytic therapy, which is associated with increased morbidity and mortality. Thrombolysis with tissue plasminogen activator (t-PA) increases the rate of HT by as much as 10-fold, and the mortality by about 60%. The patients who are eligible for t-PA treatment are still between 3.4% and 5.2% of all patients with acute ischemic stroke because of the narrow therapeutic time window. Due to the unknown mechanism and therapeutic target of HT, there are no effective drugs to decrease the incidence of HT. The main mechanism of HT is disruption of the blood-brain barrier (BBB) integrity and neurovascular homeostasis, involving a variety of molecular signaling pathways. In animal and clinical studies, combining therapeutic agents with t-PA, which may help to minimize BBB perturbations, reduces the incidence of HT and increases the safety of thrombolytic therapy. This article is prepared to review the mechanisms, targets and therapeutic drugs of t-PA induced HT in recent years to provide a reference to the basic research and drug development of HT.

Responses of Patients with Disorders of Consciousness to Habit Stimulation: A Quantitative EEG Study / 神经科学通报·英文版

Whether habit stimulation is effective in DOC patient arousal has not been reported. In this paper, we analyzed the responses of DOC patients to habit stimulation. Nineteen DOC patients with alcohol consumption or smoking habits were recruited and 64-channel EEG signals were acquired both at the resting state and at three stimulation states. Wavelet transformation and nonlinear dynamics were used to extract the features of EEG signals and four brain lobes were selected to investigate the degree of EEG response to habit stimulation. Results showed that the highest degree of EEG response was from the call-name stimulation, followed by habit and music stimulations. Significant differences in EEG wavelet energy and response coefficient were found both between habit and music stimulation, and between habit and call-name stimulation. These findings prove that habit stimulation induces relatively more intense EEG responses in DOC patients than music stimulation, suggesting that it may be a relevant additional method for eliciting patient arousal.

Key anatomies of DeLancey's three levels of vaginal support theory: an observation in laparoscopic surgery / 浙江大学学报·医学版

OBJECTIVE@#To observe and verify the key anatomies of DeLancey's three levels of vaginal support theory through laparoscopic surgery by space dissection technique.@*METHODS@#The features and stress performance of related anatomies were observed and analyzed in laparoscopic type C hysterectomy and pelvic lymphadenectomy for cervical cancer by natural space exposures.@*RESULTS@#The main ligament-like structure at level Ⅰ was the uterosacral ligament, which acted as the main apical fixation in the sacral direction, while the cardinal ligament was mainly composed of vascular system, lymph-vessels and loose connective tissue around them, lacking the tough connective tissue structures, which was connected to the internal iliac vascular system. There were no strong ligaments connected to the tendinous arch of pelvic fascia (ATFP) at the lateral side of vaginal wall at level Ⅱ. ATFP was the edge of the superior fascia of pelvic diaphragm, which was bounded by the fascia of the obturator. Its surface was smooth and close to the levator ani muscle and fuses with the vaginal fascia in about one thirds of middle lower segments of the vagina. When the ureter tunnel is separated, dense connective structures can be found in both anterior and posterior walls near the intersection of the ureter across uterine artery, fixing the bilateral angle of the bladder triangle, starting from the cervix and vagina and ending in the tunica muscularis vesicae urinariae.@*CONCLUSIONS@#Based on the laparoscopic anatomy, the pelvic floor fascia ligament support above the levator ani muscle can be considered mainly around the vagina, and fascial ligament above the levator ani muscle can be simply considered as two parallel planes forming a "double hammock" structure, which may provide more anatomic data for pelvic floor reconstruction.

Evaluating the safety of forsythin from Forsythia suspensa leaves by acute and sub-chronic oral administration in rodent models

OBJECTIVE@#To access the toxicity of forsythin from Forsythia suspensa leaves and evaluate its safety.@*METHODS@#Acute toxicity was determined by oral administration of a single dose of 18100 mg/kg forsythin in NIH mice. Sub-chronic toxicity was evaluated by oral administration of several doses of forsythin for 30 days at does of 0, 540, 1620, and 6480 mg/kg in SD rats.@*RESULTS@#In the acute toxicity study, mortality was not observed after 14 days. In addition, clinically relevant adverse effects, or variations in body weight or food consumption were not observed. Similarly, after 30 days in the sub-chronic toxicity study, no mortality or significant toxicological effects such as decreased food consumption, body weight, biochemical parameters and vital organs etc. were noticed.@*CONCLUSION@#The results revealed that the forsythin from Forsythia suspensa leaves has low or no toxicity via oral administration, and therefore is suitable for further development and applications.