Intravaginal Misoprostol for Cervical Ripening and Labor Induction in Nulliparous Women: A Double-blinded, Prospective Randomized Controlled Study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>In China, no multicenter double-blinded prospective randomized controlled study on labor induction has been conducted till now. This study is to evaluate the efficacy and safety of intravaginal accurate 25-μg misoprostol tablets for cervical ripening and labor induction in term pregnancy in nulliparous women.</p><p><b>METHODS</b>This was a double-blinded, prospective randomized controlled study including nulliparous women from 6 university hospitals across China. Subjects were randomized into misoprostol or placebo group with the sample size ratio set to 7:2. Intravaginal 25-μg misoprostol or placebo was applied at an interval of 4 h (repeated up to 3 times) for labor induction. Primary outcome measures were the incidence of cumulative Bishop score increases ≥3 within 12 h or vaginal delivery within 24 h. Safety assessments included the incidences of maternal morbidity and adverse fetal/neonatal outcomes.</p><p><b>RESULTS</b>A total of 173 women for misoprostol group and 49 women for placebo were analyzed. The incidence of cumulative Bishop score increases ≥3 within 12 h or vaginal delivery within 24 h was higher in the misoprostol group than in the placebo (64.2% vs. 22.5%, relative risk [RR]: 2.9, 95% confidence interval [CI]: 1.4-6.0). The incidence of onset of labor within 24 h was significantly higher in the misoprostol group than in the placebo group (48.0% vs. 18.4%, RR: 2.6, 95% CI: 1.2-5.7); and the induction-onset of labor interval was significantly shorter in the misoprostol group (P = 0.0003). However, there were no significant differences in the median process time of vaginal labor (6.4 vs. 6.8 h; P = 0.695), incidence (39.3% vs. 49.0%, RR: 0.8, 95% CI: 0.4-1.5) and indications (P = 0.683) of cesarean section deliveries, and frequencies of maternal, fetal/neonatal adverse events between the groups.</p><p><b>CONCLUSION</b>Intravaginal misoprostol 25 μg every 4 h is efficacious and safe in labor induction and cervical ripening.</p>

Glycated haemoglobin in diagnosis of diabetes mellitus and pre-diabetes among middle-aged and elderly population: Shanghai Changfeng study / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To investigate the optimal glycated haemoglobin (HbA1c) cut off points and evaluate the impact of HbA1c on diabetes and pre-diabetes in middle-aged and elderly population.</p><p><b>METHODS</b>Subjects were recruited from Shanghai Changfeng Study. A total of 1973 community-based participants (age ⋝45) without known diabetes underwent oral glucose tolerance test (OGTT) by using a 75-g oral glucose load and HbA1c was measured by using high performance liquid chromatography (HPLC). Subjects were classified as normal glucose tolerance (NGT), pre-diabetes(impaired glucose regulation, IGR) and new diagnosed diabetes (NDD) per 1999 WHO criteria. Two tests are compared with receiver operating characteristic curve (ROC).</p><p><b>RESULTS</b>Among 1973 subjects, 271 (13.7%) were diagnosed as NDD and 474 (24.0%) as IGR by using OGTT. HbA1c was 5.7%±0.7% in this population. Use of 6.5% as the HbA1C cutoff point has sensitivity of 38.7% and specificity of 98.5%. We recommend 6.0% as a better cutoff value for diagnosis of diabetes in this population (AUC 0.829, 95% CI 0.798-0.860, P<0.001) with its sensitivity and specificity as 66.1% and 86.8%. For IGR, the results showed low sensitivity (44.9%) and specificity (66.7%) with an AUC of 0.571 for HbA1c when 5.8% was used as the cutoff point. Participants detected with HbA1c⋝6.0% were associated with nearly the same metabolic characteristics, including body mass index (BMI), blood pressure, lipid profile and urine albumin-creatinine ratio (uACR) compared with diabetic subjects detected by OGTT.</p><p><b>CONCLUSION</b>The optimum HbA1c cutoff point for diabetes in our study population was lower than ADA criteria, and HbA1c may not be used to identify IGR.</p>

Surgical strategies for petroclival meningioma in 57 patients / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Resection of petroclival meningioma (PCM) is difficult for neurosurgeons and usually brings poor performance status. In this study, we evaluated the possible risk factors for unfavorable clinical outcomes of surgical treatment of PCM, and tried to explore the optimal surgical strategies for better postoperative quality of life.</p><p><b>METHODS</b>We recruited 57 patients (14 male, 43 female, mean age, 50.5 years) who underwent surgical resection of PCM in Huashan Hospital during 2002 - 2006. The primary outcomes including postoperative neurological deficits, modified Rankin scale (mRS) score and recurrence rate were evaluated, and all potential risk factors were assessed by the χ(2) test. Odds ratio and 95% confidence interval were calculated by univariate Logistic regression. The mean follow-up time was 34 months.</p><p><b>RESULTS</b>Gross total resection was achieved in 58% of patients. One patient died during the perioperative period because of intracranial hemorrhage. Sixty-seven percent of patients experienced new postoperative neurological deficits and 26% had a higher mRS score at follow-up assessment. Postoperative complications were observed in 24 patients. Within the follow-up period, radiographic recurrence occurred in 12.3% of patients at a mean follow-up of 42 months. Postoperative radiosurgery was administered to 19 patients who had residual tumors or recurrence and no further progression was found. Tumor adhesion, hypervascularity and engulfment of neurovascular structures were three risk factors for increased mRS score (P = 0.0002; P = 0.0051; P = 0.0009). Tumor adherence to adjacent structures clearly affected the extent of resection (P = 0.0029). The risk of postoperative cranial nerve deficits increased with tumor engulfment of neurovascular structures (P = 0.0004).</p><p><b>CONCLUSIONS</b>Intraoperatively defined tumor characteristics played a critical role in identifying postoperative functional status. An individual treatment strategy after careful preoperative evaluation could help improve quality of life.</p>

The impact of air temperature variation on the visits to emergency room in Shanghai / 中华流行病学杂志

Objective To assess the association between air temperature and emergency room visits among patients covered by medical care program from ' third-grade' hospitals in Shanghai.Methods Generalized additive model (GAM) was used to analyze time series,and AR(P) was used to deal with auto correlation of time series.After controlling factors as both medium-term and long-term trends,day of the week,vocation,typical pneumonia and pollutants,the association between air temperature and emergency room visits in virtue of quadratic curve and differential coefficient principle were estimated.Results When air temperature was below 14.71℃,the increase of 95% confidence interval to relative risk in corresponding emergency room visits along with 1℃ increase of air temperature,was less than 1.However,when air temperature was above 19.59℃,the relative risk' s 95% confidence interval was greater than 1.When air temperature varied at the range of 14.71℃-19.59℃,the 95% confidence interval of the relative risk would include 1.Hence,air temperature range between 14.71℃-19.59℃,was called the optimum temperature range.Conclusion Our findings indicated that the current air temperature had an acute impact on the number of emergency room visits among patients covered by medical care program visiting those third grade hospitals in Shanghai.

Study on the status of institutional delivery and its determinants in rural Guangxi autonomous region / 中华流行病学杂志

<p><b>OBJECTIVE</b>To understand the situation of institutional delivery of rural pregnant women in Guangxi Autonomous Region in the period of 1998 - 2003 and to identify the determinants on institutional delivery utilization.</p><p><b>METHODS</b>Using Andersen's behavioral model as analytical framework and Guangxi databank of the 3rd National Health Service Survey as data source, we described the status of institutional delivery with the rural women having had live birth history in the period of 1998 - 2003 as subjects, while and the univariate analysis and multivariate logistic analysis were done to identify determinants of institutional delivery utilization.</p><p><b>RESULTS</b>Among a total number of 407 women with live birth history, 39.80 percent of them delivered at the health-care facilities. The rate of institutional delivery increased annually in 1998 - 2003 (P< 0.0001). The proportion of delivery in township health centers increased and the proportion of home delivery decreased by year (P< 0.0001). Results from both univariate and multivariate analysis showed that parity, education background of women, type of drinking water, time needed to get to the nearest healthcare facilities by the most convenient traffic,frequency of prenatal checkup, together with whether or not being advocated on institutional delivery etc. were determinants of delivery utilization. The OR value were 1.749 for multipara, 1.995 for those going to the nearest healthcare facilities by the most convenient traffic in less than 10 minutes, 3.011 for those drinking tap water, 5.435 for those with the education of high school, 29.149 for those with over 5 times in terms of frequency of prenatal checkup and 37.822 for those being advocated on institutional delivery.</p><p><b>CONCLUSION</b>Socio-economic situation, status of maternal health care and parity made main contribution to institutional delivery and skilled birth attendance for women in rural Guangxi.</p>

A time series analysis of outdoor air pollution and preterm birth in Shanghai, China / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To investigate the relation between air pollution exposure and preterm birth in Shanghai, China.</p><p><b>METHODS</b>We examined the effect of ambient air pollution on preterm birth using time-series approach in Shanghai in 2004. This method can eliminate potential confounding by individual risk factors that do not change over a short period of time. Daily numbers of preterm births were obtained from the live birth database maintained by Shanghai Municipal Center of Disease Control and Prevention. We used the generalized additive model (GAM) with penalized splines to analyze the relation between preterm birth, air pollution, and covariates.</p><p><b>RESULTS</b>We observed a significant effect of outdoor air pollution only with 8-week exposure before preterm births. An increase of 10 microg/m3 of 8-week average PM10, SO2, NO2, and O3 corresponded to 4.42% (95%CI 1.60%, 7.25%), 11.89% (95%CI 6.69%, 17.09%), 5.43% (95%CI 1.78%, 9.08%), and 4.63% (95%CI 0.35%, 8.91%) increase of preterm birth. We did not find any significant acute effect of outdoor air pollution on preterm birth in the week before birth.</p><p><b>CONCLUSION</b>Ambient air pollution may contribute to the risk of preterm birth in Shanghai. Our analyses also strengthen the rationale for further limiting air pollution level in the city.</p>

Interaction between ambient particles and ozone and its effect on daily mortality / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To examine the effect of particulate matter (PM) less than 10 microns in diameter (PM10) and ozone (O3) on daily mortality in Shanghai, China.</p><p><b>METHODS</b>A generalized additive model with penalized spline function was used to observe the acute effect of PM10 and O3 on daily mortality.</p><p><b>RESULTS</b>Higher PM10 significantly increased the effect of O3 on total mortality, and O3 also increased the effect of PM10 although the estimated increment was statistically insignificant.</p><p><b>CONCLUSION</b>Our findings provide further evidence for the effect of PM10 and O3 on daily mortality.</p>

An epidemiological study on diabetic retinopathy among type 2 diabetic patients in Shanghai / 中华流行病学杂志

<p><b>OBJECTIVE</b>To investigate the prevalence and risk factors of diabetic retinopathy (DR) among type 2 diabetic patients aged over 30 in Shanghai central area.</p><p><b>METHODS</b>1039 patients diagnosed with type 2 diabetes mellitus (DM) aged over 30 were investigated by randomized cluster sampling in Shanghai central area and data from 767 of those patients were analyzed.</p><p><b>RESULTS</b>(1) Among all of the 1534 digital ocular fundus images from 767 patients, 87.6% of the images from 672 patients were gradable. (2) Among all of the 672 patients with gradable ocular fundus images, the prevalence of non-proliferative diabetic retinopathy (NPDR) was 21.6%, while proliferative diabetic retinopathy (PDR) was 1.3%. The rates of mild, moderate and severe NPDR were 8.8%, 11.2% and 1.6% respectively. (3) DR patients were characterized with elder age, higher HbA1c, urea nitrogen and serum creatinine. DM duration and the level of fasting plasma glucose were risk factors for DR.</p><p><b>CONCLUSION</b>The overall prevalence of DR in type 2 diabetic patients aged over 30 in Shanghai central area was 22.9% and the DR risk factors were found to include duration of diabetes and fasting plasma glucose level.</p>

Study on the relationship between air temperature and daily mortality in Minhang district, Shanghai / 中华流行病学杂志

<p><b>OBJECTIVE</b>To assess the association between air temperature and mortality in Minhang district, Shanghai.</p><p><b>METHODS</b>Generalized additive model (GAM) to analyze time series was used. After controlling for medium-term and long-term trends,date in the week,situation of air pollution etc., this study estimated the association in virtue of quadratic curve and differential coefficient principle.</p><p><b>RESULTS</b>The study was able to estimate an optimum temperature range (11.67 degrees C-20.71degrees C) by relative risk and 95% confidence interval of deaths with air temperature variation. The mortality in Minhang district, Shanghai increased along with the fluctuation of temperature deviating from this range.</p><p><b>CONCLUSION</b>The findings from our study indicated that the current air temperature had an acute effect on mortality in Minhang district, Shanghai.</p>

Study on the detection of positive selected codons on HA1 sequence of human influenza A subtype H3N2 / 中华流行病学杂志

<p><b>OBJECTIVE</b>To elucidate the evolution pattern of human influenza virus A H3 subtype by detecting positive selected codons in hemagglutinin gene.</p><p><b>METHODS</b>All H3 sequences in NCBI GenBank and influenza sequence database were downloaded and two step cluster method was applied to divide sequences into six groups, which were corresponding to different period by turns. Fixed Effect Model was applied to detect positive selected codons in each group, and two step cluster method was then used again to summarize variation patterns of selective pressure among sites.</p><p><b>RESULTS</b>Positive selected codons were different in groups corresponding different periods. 50 amino acid codons had been identified as positive selected sites in at least one time span. Among them, 42 codons belonged to one of the five known antigen-combinng regions. A larger amount of sites as well as relatively higher selection pressure were identified in antibody combining regions A and B. Results showed that the 50 sites could be divided into seven different patterns. While other six patterns corresponding to positive selected codons at only one time span, the sites of the seventh pattern were under positive selection in several periods.</p><p><b>CONCLUSION</b>Positive selection codons in evolution of H3A1 strains were alternated in different time period whereas antibody combining regions A and B played more important roles in the evolution process. Other 8 identified codons out of the antibody combining regions might belong to unknown antigen regions.</p>

An investigation on sleeping conditions and factors related to insomnia in the elderly aged 60 years and over in Shanghai community / 中华全科医师杂志

Objective To study sleeping conditions and relevant factors for insomnia in the elderly people aged 60 years and over in the community of Shanghai,China.Methods A cross-sectional study on sleeping condition by questionnaire was conducted among 2789 elderly people aged 60 years and over during July to October 2005 in seven neighborhood committees of Jing'an District,Shanghai,China,with cluster sampling.Results Totally,2304 elderly people completed the study questionnaire with a response rate of 82.61%.Prevalence of insomnia was 14.84% (342/2304) in the elderly.Logistic regression analysis showed that age increasing (OR=1.02),female (OR=2.20),drinking before sleeping (OR=2.98), room light (OR=3.89),noise (OR=1.95),diabetes (OR=1.82),hypertension (OR=1.49),stroke (OR=1.65),osteoporosis (OR=1.76) and number of afflicted chronic diseases (OR=1.43) all were risk factors for insomnia in the elderly (P