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Cholesterol-lowing statins such as pravastatin have been contraindicated in pregnant women for a long time, but recent clinical evidence has demonstrated its safety. Studies have found that pravastatin can correct the imbalance in angiogenesis, reduce vascular inflammation and improve the conditions in patients with placental and maternal vascular dysfunction-related diseases, such as preeclampsia, fetal growth restriction and antiphospholipid syndrome. However, universal administration of pravastatin in pregnancy still requires more evidence on its safety from human clinical trials with larger sample sizes. This article reviews the current situation and prospect of pravastatin in pregnancy.
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Objective:To study the risk factors for abnormal glucose metabolism in pregnant women with a history of gestational diabetes mellitus (GDM).Methods:A retrospective analysis was performed on pregnant women who had two consecutive deliveries and were was complicated by GDM in the previous pregnancy at the First Affiliated Hospital of Sun Yat-sen University from January 2011 to May 2019. Clinical data of both pregnancies were collected, including general information, fasting blood glucose in early pregnancy and 75 g oral glucose tolerance test (OGTT) results, glycosylated hemoglobin A1c and blood lipid profile at 24-28 gestational weeks. The incidence and risk factors of abnormal glucose metabolism in these cases during the present pregnancy were analyzed. Analysis of variance, Kruskal-Wallis test, SNK- q or LSD- t-test, and Chi-square test were used for data analysis. Single-factor logistic regression analysis was used to analyze the high-risk factors, and multifactor logistic regression analysis was performed to fit the model. Variable collinearity diagnosis was performed using the coldiag2 command. Results:(1) A total of 455 cases were enrolled in the study. According to the fasting glucose level in the first trimester and the OGTT results in the present pregnancy, they were divided into three groups: normal OGTT group ( n=240), GDM group ( n=189), and pre-gestational diabetes mellitus group (PGDM, n=26). The incidence of abnormal glucose metabolism in these patients during the present pregnancy was 47.2% (215/455). (2) Those with a history of GDM had higher pre-pregnancy weight, lower weight gain, higher cesarean section rate, smaller gestational age at delivery, and higher neonatal birth weight in the present pregnancy than those in the previous pregnancy [(55.6±8.5) vs (53.3±7.9) kg, t=-4.059; (11.2±4.2) vs (12.5±4.4) kg, t=4.435; 47.9% (218/455) vs 33.0% (150/455), χ2=20.481; (38.6±1.3) vs (38.8±1.3) weeks, t=2.288; (3 177±463) and (3 114±460) g, t=-2.044; all P<0.05]. (3) In the PGDM group, the 2-h plasma glucose level after 75 g OGTT was higher than that in the previous pregnancy [(11.4±1.1) vs (9.9±1.7) mmol/L, t=-3.299, P=0.002]. (4) In the present pregnancy, the PGDM group had the highest fasting blood glucose in early pregnancy, followed by the GDM group and the normal OGTT group [4.6 mmol/L (4.2-7.6 mmol/L), 4.3 mmol/L (4.0-4.6 mmol/L) and 4.1 mmol/L (3.8-4.4 mmol/L), χ2=34.498, P<0.001]. The PGDM group had the least postpartum weight retention, followed by the normal OGTT group and the GDM group [(1.2±3.9), (1.6±3.9), and (2.6±4.9) kg, F=3.086, P<0.05]. (5) Multivariate logistic regression analysis showed postpartum weight retention and the 1-h and 2-h plasma glucose levels after 75 g OGTT in the previous pregnancy were independent risk factors for abnormal glucose metabolism in pregnant women with a history of GDM (postpartum weight retention: OR=1.054, 95% CI: 1.005-1.106; 1-h plasma glucose: OR=1.284, 95% CI: 1.087-1.516; 2-h plasma glucose: OR=1.272, 95% CI: 1.071-1.511). Conclusions:The incidence of abnormal glucose metabolism is higher in subsequent pregnancy in women with GDM history, which may be related to various factors, such as postpartum weight retention and plasma glucose after 75 g OGTT in the previous pregnancy.
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The tumor microenvironment is a dynamic network, which includes various types of cells (such as tumor cells, vascular endothelial cells, fibroblasts, immune cells, and pericytes) and extracellular components (such as cytokines, growth factors, and extracellular matrix). The impact of tumor microenvironment on the development of tumor is becoming more and more attractive. Tumor angiogenesis is a hallmarker in growth, invasion and metastasis of solid tumor. More and more studies show that tumor angiogenesis is closely related to tumor microenvironment, but the precise mechanism is still unclear. In this review, the effect of tumor microenvironment on tumor angiogenesis is analyzed in detail, so as to provide a broader thinking for anti-tumor angiogenesis research.
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Objective To discuss the clinical value of bidirectional quantitative detection of MSCT in the diagnosis of diabetic lung injury.Methods From May 2016 to July 2017,120 patients with diabetes in Wenzhou Hospital of Traditional Chinese Medicine were selected as diabetic group,and 50 healthy people were selected as control group.The two groups received the pulmonary function test ( PFT) and the MSCT bidirectional quantitative detection,the test results of the two groups were analyzed.And the correlation of indicators of MSCT bidirectional detection and PFT detection indicators was analyzed.Results After examination,the maximum inspiratory lung volume (Vin),maximum expiratory volume (Vex),respiratory volume (EVvin,EVvex)-emphysema,EIvin (%),EIvex (%) in the diabetic group were (3 627.64 ±867.43)mL,(3 785.34 ±835.64)mL,(476.95 ±326.25)mL,(236.53 ±86.18)mL,(9.26 ±4.85)%,(4.11 ±2.58)%,respectively,which were significantly lower than those in the control group (t＝11.151,13.809,21.317,21.623,24.76,26.708,all P＜0.05).The Vin,Vex,EVvin,EVvex,EIvin(%),EIvex(%) in the patients with ≤5 years of diabetes were (3 627.64 ±867.43)mL,(3 785.34 ± 835.64)mL,(326.25 ±56.95) mL,(236.53 ±86.18) mL,(9.26 ±4.85)%,(4.11 ±2.58)%,respectively,which were significantly higher than those in the patients with ＞5-10 years of diabetes mellitus (t＝129.09,36.01,21.03,12.38,22.17,19.48,all P＜0.05).Conclusion MSCT bidirectional quantitative detection is of great signif-icance for patients with diabetes lung injury,and plays a significant role in clinical treatment.
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Objective To analyze the relationship between preoperative serum sodium concentration and preoperative status of liver transplantation recipients and it's effect on early prognosis. Methods Retrospectively collected the clinical data of 281 patients underwent liver transplantation in First Affiliated Hospital of Zhengzhou University from January 2016 to September 2017. According to the preoperative serum sodium concentration, they were divided into hyponatremia group (< 130 mmol/L) 18 patients, normonatremia group (130-145 mmol/L)232 patients and hypernatremia group(> 145 mmol/L) 31 patients. The SPSS 21.0 statistical software was used to analyze the difference of preoperative MELD score, Child-Pugh score, postoperative survival rate and the incidence of graft dysfunction among three groups. Multivariate comparisons of measurement data were performed using analysis of variance. Pairwise comparisons between groups were performed using the LSD-t test. Chi-square tests were used to compare the count data sets. Results The preoperative MELD score was(19.27 ±7.35) scores, Child-Pugh score was(10.39±2.28) scores, serum creatinine concentration was(95.89 ± 49.40) μmol/L in hyponatremia group, the preoperative MELD score was(12.17土8.79) scores(P=0.001), Child-Pugh score was(8.50±2.68) scores (P =0.004) and serum creatinine was(66.07 ±24.13) μmol/L(P <0.05) in normonatremia group, the difference between two groups were statistically significant. There were no significant difference in the length of postoperative ICU stay and postoperative hospital stay among the three groups, there were no significant difference between the 30th and 90th postoperative survival rates and the incidence of graft dysfunction. Conclusions Hyponatremia is an indicator of poor preoperative status in liver transplantation recipients. Preoperative serum sodium concentration has no significant effect on early prognosis of liver transplantation.
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ObjectiveTo investigate the risk factors of preterm birth, as well as the clinical characteristics in dichorionic diamniotic (DCDA) twins and monochorionic diamniotic (MCDA) twins. MethodsA retrospective study was conducted on 290 premature cases out of 363 twin pregnancies who delivered alive babies in the First Affiliated Hospital, Sun Yat-sen University from September 2012 to March 2015. The selected cases, including 219 cases of DCDA and 71 cases of MCDA,were divided into three groups according to their gestational age at delivery: 28-31+6, 32-33+6 and 34-36+6 weeks. The clinical features, causes and risk factors were described between these three groups. Analysis of variance,Chi-square test and multi-variant Logistic regression were used for statistical analysis.ResultsThe incidence of premature delivery in twin pregnancies was 79.9% (290/363), while this figure was lower in DCDA twins than in MCDA [76.3%(219/287) vs 93.4%(71/76),χ2=10.955,P=0.001]. The three leading causes of preterm birth in DCDA twins were gestational age≥36 weeks (33.8%, 74/219), preterm labor (30.6%, 67/219) and preterm premature rupture of membrane (PPROM) (8.7%, 19/219), while in MCDA twins were preterm labor (31.0%, 22/71), selective intrauterine growth restriction (21.1%, 15/71) and gestational age≥36 weeks (19.7%, 14/71). Logistic regression analysis showed that the independent risk factors of preterm birth in twins at 28-31+6 weeks was PPROM (OR=2.390, 95%CI: 1.006-5.872,P=0.043), and for those twins at 32-33+6 weeks, the independent risk factors were MCDA (OR=2.758, 95%CI: 1.243-6.118,P=0.013), preeclampsia (OR=12.176, 95%CI:4.685-31.642,P=0.000), PPROM (OR=5.348, 95%CI: 2.151-13.294,P=0.000) and preterm labor (OR=3.274, 95%CI:1.453-7.375,P=0.004). MCDA (OR=3.666, 95%CI: 1.364-9.585,P=0.010) and preeclampsia (OR=8.086, 95%CI:1.044-62.617,P=0.045) were the risk factors in the group of 34-36+6 weeks.ConclusionsAlthough preterm birth in MCDA and DCDA twins is due to different reasons, the former has a higher incidence than the latter. The risk factors of premature delivery at different gestations are also different.
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Objective:To observe the effect of acupuncture on gastric motility, plasma motilin and serum gastrin in patients with diabetic gastroparesis (DGP) and evaluate its clinical efficacy. Methods:A total of 100 eligible cases were randomly allocated into an acupuncture group (n=50) and a control group (n=50). Patients in the acupuncture group were treated by needling Zhongwan (CV 12), Zusanli (ST 36) and Neiguan (PC 6), whereas patients in the control group were treated with oral administration of Domperidone. The clinical efficacies of the two groups were compared; and changes in gastric motility, plasma motilin and serum gastrin in both groups were observed before and after treatment. Results:After treatment, the symptom scores, gastric motility and contents of plasma motilin and serum gastrin were significantly improved in both groups (P Conclusion:Acupuncture is effective for DGP and can reduce the levels of plasma motilin and serum gastrin.
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Objective To determine the effects of adiponectin on high glucose induced BeWo cell proliferation in vitro. Methods BeWo cells were seeded in 96-well plates at the appropriate density. After treatments with high glucose (25 mmol/L), western blot analysis of cyclin D1 and a colorimetric assay (cell counting kit-8, CCK-8) were used to analyse BeWo cells′proliferation, and western blot was used to detect the expression of adiponectin. Moreover, we added adiponectin (20μg/ml) in the culture medium and three methods were utilized for cell proliferation analysis: CCK-8, cell cycle analysis (by flow cytometry) and proliferating cell nuclear antigen (PCNA) immunocytochemical staining. Results Compared to BeWo cells cultured by normal glucose and high mannitol, the proliferation of BeWo cells treated by high glucose increased (P<0.05). Compared with BeWo cells cultured by high mannitol, the expression of adiponectin in BeWo cells treated by high glucose decreased. After added adiponectin in the culture medium, the proliferation of BeWo cells treated by adiponectin+high glucose decreased than that of cells treated by high glucose (0.770±0.050 versus 0.990±0.070, P<0.05);the proportion of G2+S phases of BeWo cells treated by adiponectin+high glucose decreased than that of cells treated by high glucose [(40.7±2.1)%versus (44.9± 3.9)%, P<0.05];the rate of PCNA positive cell in BeWo cells treated by adiponectin+high glucose decreased than that of cells treated by high glucose [(28 ± 5)% versus (44 ± 5)%, P<0.05]. Conclusion Adiponectin could inhibit proliferation of high glucose induced BeWo cells in vitro.
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Objective To investigate the effects of PJ34,a poly ADP-ribose polymerase(PARP)inhibitor,on the expression of matrix metallopro-teinases-9( MMP-9 )and Claudin-5 in ischemic cortex of rats with focal cerebral ischemia-reperfusion(I/R)injury. Methods The focal cerebral ischemia-reperfusion model of middle cerebral artery occlusion(MCAO)was established by intraluminal suture . PJ34 was injected intraperitoneal-ly. Blood-brain barrier(BBB)permeability was quantitatively determined by Evans blue assay. Infarct volume changes were observed by 2,3,5-tri-phenyltetrazolium chloridedyeing(TTC)staining. The expression of the MMP-9 and Claudin-5 in rats of cerebral cortex were measured by immuno-histochemistry assay and western blot analysis . Results Compared with sham group,the expression of MMP-9,the contents of EB and infarct vol-ume increased progressively over time after I/R,and reached maximum levels at 48 h(P<0.05);The expression of Claudin-5,the contents of EB and infarct volume reduced significantly over time after I/R,and reached the minimum levels at 48 h in model group(P<0.05). Compared with model group,the expression of MMP-9,the contents of EB and infarct volume was reduced significantly and the expression of Claudin-5,the con-tents of EB and infarct volume was increased at the same time point in PJ34 group(P<0.05). Conclusion PJ34 maintained the blood-brain barri-er permeability by inhibiting the expression of MMP-9,and increasing the expression of Claudin-5,which had neuroprotection on cerebral ischemia-reperfusion injury.
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Objective To explore the correlation between serum homocysteine(Hcy) levels and behavioral and psychological symptoms dementia (BPSD) in patients with mild to moderate vascular dementia (VaD).Methods Two hundred and ninety-three patients with mild to moderate vascular dementia (aged 40 or over) admitted to the department of neurology of the First Affiliated Hospital of Liaoning Medical College from January 2012 to January 2015.Patients were diagnosed with dementia by NINDS-AIREN criteria,MMSE scores ≤26,Hachinski ischemic scale(≥4) and clinical dementia rating(1≤ C DR ≤ 2).VaD patients were divided into high Hcy(HHcy) group (Hcy≥ 15 μ,mol/L,n=188) and control group(Hcy＜15 μmol/L,n=105).The total scores and the scores of 12 functional domains of behavioral and psychological symptoms in NPI were analyzed by using comparative statistical methods.Results Prevalence of high homocysteine was 64.16％ (n=188) among mild to moderate VaD (n=293).The incidence of BPSD in HHcy group(80.9％) was significantly higher than that in the control group (57.1％),the difference was statistically significant (x2=18.932,P＜0.01).HHcy patients (27.95±5.04) had a significantly higher total score of NPI compared with control patients (16.87± 1.87),the difference was statistically significant (t=3.753,P＜0.01).In terms of scores in 12 functional domains in NPI,the scores in sleep disorders (2.99± 1.40),high (2.10±0.53),irritability/mood swings (2.64± 1.43),abnormal behavior (1.74±0.52),disinhibition (1.40±0.43),agitation (2.02±0.74) were higher than those in control groups (1.85±0.37,0.21±0.05,1.80 ±0.56,0.36±0.09,0.45±0.07,0.68±0.23),all the difference were significant(t=2.327,t=2.012,t=2.136,t=2.066,t=2.050,t=2.007,all P＜0.05).Binary logistic regression analysis showed that there were positive correlation between scores of NPI and plasma Hcy levels (OR=1.164,95％ CI:1.052-1.288,P=0.003).Compared with HHcy group and control group,there were no statistical significance in regard to infarcted brain focus including the frontal lobe,parietal lobe,temporal lobe,occipital lobe,basal ganglia,brain stem and cerebellum (x2=0.528,x2=0.043,x2=0.630,x2=0.166,x2=0.657,x2=1.010,x2=0.019,allP＞0.05).Conclusion High homocysteine levels are correlated with behavioral and psychological symptoms in patients with mild to moderate VaD,including performance of sleep disorders,high,irritability/mood swings,abnormal behavior,disinhibition and agitation.Moreover,the severity of BPSD is positively associated with homocysteine levels.The higher the homocysteine level,the more severe the BPSD.The serum homocysteine levels are no correlated with infarcted brain focus.
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Objective To investigate the influence of poly(ADP-ribose)polymerase inhibitor PJ34 on blood brain barrier(BBB)in rats with cere-bral ischemia-reperfusion injury. Methods Rat model of cerebral ischemia-reperfusion injury was established by the middle cerebral artery occlu-sion. A total of 135 SD rats were randomly divided into 3 groups:sham-operated group(sham group),ischemia-reperfusion group(IR group)and PJ34 group(PJ34 group). 45 animals in each group were then equally divided into subgroups and the rats were sacrificed at 6 h,24 h,48 h after re-perfusion,respectively. BBB permeability was evaluated by detection of extravasated Evans blue(EB). The expression of tumor necrosis factorα(TNF-α)and matrix metalloproteinase 9(MMP-9)activity were measured by immunohistochemistry and western blot at different time points. Re?sults Compared with sham group,the contents of EB and the expressions of TNF-αand MMP-9 in IR group were increased significantly(P<0.05). Compared with IR group,the contents of EB and the expressions of TNF-αand MMP-9 in PJ34 group were markedly decreased at the same time point(P<0.05). Conclusion The present study provided in vivo evidence that PARP inhibitor PJ34 can protect against cerebral ischemia re-perfusion injury,and the mechanism might be related to maintaining the stability of blood-brain barrier by suppressing the expression of TNF-αand MMP-9 in ischemic cortex.
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Objective To investigate the correlation among Lp (a),cerebral infarction and carotid atherosclerosis.Methods 180 cases were equally divided into 3 groups (60 cases in each group).The patients with both cerebral infarction and carotid atherosclerosis composed one group(cerebral infarction group for short) ;the patients of carotid atherosclerosis which without cerebral infarction composed another group(no cerebral infarction group for short) ;the control group composed with those who had neither cerebral infarction nor carotid atherosclerosis.The level,outlier detection rate about Lp(a) and usual risk factors of cerebral infarction were compared in this research.Results The level and detection rate of Lp(a) in the cerebral infarction group were (512 ± 156) mg/L and 46.7％ ;the level and detection rate of Lp(a) in the no cerebral infarction group were (316 ± 87)mg/L and 20.0％ ;the level and detection rate of Lp(a) in the control group were (199 ± 123) mg/L and 5.0％.The differences of the level and outlier detection rate of Lp(a) among the three group were significant(F=13.87,x2 =29.394,P ＜0.01).Cerebral infarction patients had more usual risk factors of cerebral infarction (hypertension,diabetes,hyperlipemia,drinking,smoking,obesity and lack of exercise) than those who without cerebral infarction (x2 =15.523,P ＜ 0.01).Conclusion The abnormal of Lp(a) was an important risk factor of cerebral infarction.The general survey of Lp(a) was significant in the primary and secondary prevention of stroke.To the people whose assay of Lp(a) was abnormal,the control of governable risk factors of cerebral infarction should actively be carried out.
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Objective To explore the relationship between serum creatinine ( Scr ) , blood urea nitrogen ( BUN) and lung image changes in uremic patients .Methods According to the chest CT ,X-ray and related findings , 256 patients with uremia were divided into 84 cases of uremia ( uremic lung group ) and non-uremic lung 172 cases ( non-uremic lung group ) .The chest CT and X-ray examination ,Scr and BUN levels were observed .Results Uremic lung group had five types of image findings,including alveolar edema (67.86%),pulmonary interstitial edema (16.67%),pulmonary congestion syndrome(8.33%),pleural effusion(4.76%) and pulmonary interstitial fibrosis (2.38%).The Scr[(1 145.6 ±236.4)μmol/L]and BUN [(38.9 ±6.1)mmol/L]levels in uremic lung group were significantly higher than those in the non-uremic lung group[(905.3 ±138.9)μmol/L,(23.8 ±5.6)mmol/L](t=8.128,4.782,all P<0.05).Conclusion The image of uremic lung is mainly pulmonary edema ,and radiological and pathological changes are closely related with Scr and BUN levels .
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ObjectiveTo explore changes of serum adiponectin and insulin resistance in patients with endometrial cancer and to evaluate the clinical significance and correlation.MethodsThe serum levels ofadiponectinandfastinginsulinweredeterminedbyELISA, electro-chemilluminometryand radioimmunoassay in 35 patients with endometrial cancer [ all patients divided into two groups,A1 group belonged to without postmenopausal when first visiting (n =20),A2 group belonged to postmenopausal when first visiting (n ＝ 15 ) ] and 30 cases of health control.The result of homeostasis nodel assessment-insulin resistance (HOMA-IR) index was calculated.ResultsThe levels of adiponectin in A1 group was lower than that ofhealth control group [(6.7±1.1) versus (10.0 ±1.4) ng/L,P＜0.05],and HOMA-IR was higher than that of health control group ( 3.5 ± 1.8 versus 1.1 ± 0.7,P ＜ 0.05 ).While there were not significant difference between A2 group and health control group (P ＞ 0.05 ).Adiponectin and insulin resistance was negatively correlated ( r =- 0.389,P ＜ 0.05 ).Conclusion Adiponectin reducing and insulin resistance in reproductive age patients may be the independent factors to promote endometrial cancers.
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Objective To explore the reliability of acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)to evaluate the severity of the neurologic diseases and its accuracy to predict the outcome of patients with these diseases.Metllods Four hundred and four consecutive patients with severe neurologic diseases between 2005 and 2006 were enrolled to obtain the APACHE Ⅱ scores at 0.24,48,72 h after admission to neurointensive care unit.Results The APACHE Ⅱ scores were positively associated with the outcome of the patients with severe neurologic diseases.The higher score corresponded with the higher mortality rate.The areas under the receiver operating characteristic curves of APACHE Ⅱ to predict the outcome was 0.866(95% CI 0.824 to 0.907.P=0.000).The optimal cutoff of APACHE Ⅱ scores to predict the outcome was 17 scores with the sensitivity of 76.7%and the specificity of 78.7%.The predictive chance that was mostly associated with the outcome was 72 h after admission in logistic regression model (x2=137.345,P=0.000,correct class%=85%).The factors that were the most statistically associated with the outcome in the 14 parameters of APACHE Ⅱ were GCS score,heart rate,serum creatinine,body temperature and WBC count.Conelusion APACHE Ⅱ favorably reflects the severity of the neurologic diseases and reliably and accurately predicts the prognosis of the patients.
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Objective To evaluate the clinical effect of ambulatory labor analgesia used in latent phase of the first stage of labor, which include labor progress, Apgar score after ambulatory labor analgesia begun to use when the cervix was different size dilatated. Methods Seventy-five parturient primiparas who had no complication were randomly divided into three groups: group Ⅰ: ambulatory labor analgesia was begun to use when the cervix was 1.0 cm dilated, group Ⅱ: ambulatory labor analgesia was begun to use when the cervix was 2-3 cm dilated, group Ⅲ: control group without use of ambulatory labor analgesia. Analgesic effects were observed, changes of uterine contraction were recorded by fetal monitor. Meanwhile, total stage of labor ,outcome of delivery and Apgar score were recorded. Results Duration of total stage of labor had no significant difference between group Ⅰ and group Ⅲ.The duration of the first labor stage was significantly longer in group Ⅰ than that in group Ⅱ(P