Effect of butorphanol on postoperative analgesia in cesarean section / 中国医师进修杂志

Objective:To evaluate the analgesic effect and adverse reactions of butorphanol after stopping patient controlled intravenous analgesia (PCIA) pump in cesarean section.Methods:One hundred and twenty patients with cesarean section in Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology from March 20, 2021 to December 8, 2021 were divided into three groups as follows: butorphanol group, diclofenac sodium suppository group and control group and there were 40 patients in each group. The vital signs, analgesic effect and adverse reactions among the three groups were compared. Meantime, the bladder and gastrointestinal function recovery and neonatal jaundice in three groups were also compared.Results:The visual analogue score (VAS) in butorphanol group was significantly lower than that of control group at 3 and 4 h after stopping PCIA pump: (2.16 ± 0.09) scores vs. (2.72 ± 0.25) scores, (2.21 ± 0.10) scores vs. (2.72 ± 0.21) scores, P< 0.05, but there was no significant difference in VAS at 6 and 12 h after stopping PCIA pump. VAS in diclofenac sodium suppository group was significantly lower than that of control group at 3 h after stopping PCIA pump: (2.06 ± 0.10) scores vs. (2.16 ± 0.09) scores, P<0.05, but there was no significant difference in VAS at 4, 6 and 12 h ( P>0.05). The 3 h VAS of butorphanol group was lower than that of diclofenac sodium suppository group, but the difference was not statistically significant ( P>0.05). The VAS of butorphanol group was lower than that of diclofenac sodium suppository group at 4 h after operation: (2.21 ± 0.10) scores vs. (2.56 ± 0.12) scores, and the difference was statistically significant ( P<0.05). The first time of getting out of bed and urination time in butorphanol group were later than diclofenac sodium suppository group and control group: (28.32 ± 1.36) h vs. (25.94 ± 0.92) h and (24.50 ± 0.64) h, (29.05 ± 1.67) h vs. (26.76 ± 1.05) h and (25.06 ± 0.65) h, and the difference was statistically significant ( P<0.05). While the anal exhaust time in diclofenac sodium suppository group was delayed, but the difference was not statistically significant ( P>0.05). Conclusions:The analgesic effect of butorphanol is better than diclofenac sodium suppository after stopping PCIA pump in cesarean section, but nursing care should be strengthened to urge patients to take early activities to reduce the occurrence of urinary retention.

Exploring biological connotation of blood stasis syndrome of rheumatoid arthritis and establishment of improved animal models based on syndrome-symptom mapping / 药学学报

Blood stasis syndrome is one of the core clinical syndrome of rheumatoid arthritis (RA), but the biological connotation of this syndrome is not clear, and there is a lack of disease improved animal models that match the characteristics of this disease and syndrome. The aim of this study was to screen the candidate biomarker gene set of blood stasis syndrome of RA, reveal the biological connotation of this syndrome, and explore and evaluate the preparation method of the improved animal model based on the characteristics of "disease-syndrome-symptom". The study was approved by the ethics committee of Guang'anmen Hospital, Chinese Academy of Traditional Chinese Medicine (No. 2019-073-KY-01) and the First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine (No. TYLL2021[K]018), and the study subjects gave their informed consent. Animal welfare and experimental procedures followed the regulations of the Experimental Animal Ethics Committee of the Chinese Academy of Traditional Chinese Medicine (No. IBTCMCACMS21-2207-01). The whole blood samples were collected clinically from RA patients with blood stasis syndrome (3 cases) or other syndromes (7 types, 3 cases/type), and healthy volunteers (4 cases), and then transcriptome sequencing, KEGG, gene set enrichment analysis (GSEA) and weighted correlation network analysis (WGCNA) analysis were performed. 126 pivotal genes were screened, and their functional annotation results were significantly enriched in "immune-inflammation" related pathways and lipid metabolism regulation (sphingolipids, ether lipid metabolism and steroid biosynthesis). Syndrome-symptom mapping of hub gene set to the TCM primary and secondary symptoms, Western phenotypic symptoms and pathological links showed that joint tingling, abnormal joint morphology, petechiae and abnormal blood circulation are representative of blood stasis syndrome of RA. The results of the improved animal model showed that the rats in the collagen-induced arthritis + adrenaline hydrochloride (CIA+Adr) 3 model group had increased blood rheology, coagulation, platelet function and endothelial function abnormalities compared with the CIA-alone model group, suggesting that the rats with blood stasis syndrome of RA may be in a state of "blood stasis". The results of the study can help to advance the objective study of the evidence of blood stasis syndrome in RA, and provide new ideas for the establishment of an animal model that reflects the clinical characteristics of the disease and syndrome.

Gestational hypothyroxinemia and offspring autism / 中华内分泌代谢杂志

Hypothyroxinemia is a common subclinical thyroid dysfunction in pregnant women. Epidemiological studies have shown that the offspring of maternal hypothyroxinemia have a significantly increased risk of autism, but mechanisms remain unclear. Studies from clinical and animals suggest that thyroid hormone deficiency may lead to irreversible damage to brain development, which may contribute to autism. This review explores the clinical evidence of gestational hypothyroxinemia and autism in offspring and the underlying mechanisms that promote the development and progression of autism. It also emphasizes the importance of early diagnosis and treatment of thyroid disease in pregnancy for the prevention of neurodevelopmental abnormalities in offspring.

Biological connotation of four traditional Chinese medicine syndromes of rheumatoid arthritis based on "disease-syndrome-symptom" association network / 中国中药杂志

The present study explored the biological connotation of traditional Chinese medicine(TCM) syndromes of rheumatoid arthritis(RA) from the "disease-syndrome-symptom" association network. RA patients with four TCM syndromes(dampness-heat obstruction, phlegm-stasis obstruction, Qi-blood deficiency, and liver and kidney deficiency), three for each type, were assigned as the RA TCM syndrome group, and three healthy volunteers as the normal control group. The differential gene sets of four syndromes were screened out through transcriptome expression profiling and bioinformatics mining. The relevant gene sets of syndrome-related clinical symptoms were collected from TCMIP v2.0(http://www.tcmip.cn/). The "disease-syndrome-symptom" association networks of four RA syndromes were established by using the intersection genes of syndrome-related differential genes and symptom-related genes, and the key network target genes of each syndrome were screened out and the corresponding biological functions were mined through topological feature calculation and enrichment analysis. The genes associated with clinical symptoms such as vasculitis, joint pain, and fever in the damp-heat obstruction syndrome ranked the top, and the key network target genes of this syndrome were most significantly enriched in the pathways related to material and energy metabolism and thermal reaction biological processes. The clinical symptom-related genes of the phlegm-stasis obstruction syndrome were most significantly enriched in the pathways related to "immunity-inflammation", nervous system regulation, and sensory response. The clinical symptoms such as hypoglycemia, hypotension, weight loss, palpitation, and arrhythmia in Qi-blood deficiency syndrome were predominant, and its key network target genes were most significantly enriched in the pathways related to the nervous system and "immunity-inflammation" response. The abnormal symptoms in the liver and kidney in the liver and kidney deficiency syndrome were commonly seen, and its key network target genes were most significantly enriched in the "immunity-inflammation" regulatory pathways, and liver and kidney development and metabolic response. In conclusion, the differences and connections of the biological basis between different TCM syndromes of RA are in line with the theoretical interpretation of TCM on the etiology and pathogenesis of RA. This study summarized the objective essence of syndromes to a certain extent from the "disease-syndrome-symptom" association network and is expected to provide a theoretical basis for the discovery of serum biomarkers of RA syndromes.

Using quantile regression to re-evaluate the epidural labor analgesia under new partogram: a prospective cohort study / 中华围产医学杂志

Objective To investigate the influence of epidural analgesia on labor duration under the new partogram recommendations using quantile regression.Methods In this study,we recruited 300 nulliparous women at full term who were hospitalized in Department of Obstetrics and Gynecology,Tongji Medical College,Huazhong University of Science and Technology from May to September,2018.The participants who were willing to receive epidural analgesia during labor were assigned to the epidural group (n=150),and those who were not to the control group (n=150).Labor duration and delivery outcomes were analyzed by Student's t test,Mann-Whitney U test,Chi-square test and Fisher's exact test.Quantile regression models were also used to investigate the effect of epidural analgesia on labor duration.Results The median durations of first-and second-stage labor in the epidural group were 600(400-840) and 66(45-98) min,respectively,which were significantly longer than those of the control group [420(320-610) and 52(33-87) min] (Z=-4.273,P＜0.001;Z=-3.210,P=0.001).Quantile regression analysis showed that,for the first stage of labor,epidural analgesia was associated with labor prolongation,and had significant effects on all the percentiles (all P＜0.05).The regression coefficients increased (95.630-285.000) correspondingly as the percentiles of the labor duration (from 10th to 90th percentiles) increased.For the second stage of labor,epidural analgesia showed a significant impact on prolongation only between the 25th and 75th percentiles (coefficients:10.000～18.143;all P＜0.05).Although the epidural group had a significant higher episiotomy rate [46.8％(65/139) vs 33.3％(48/144),x2=5.318,P=0.021],more times of urine catheterization during labor [1(0-1) vs 0(0-1),Z=-0.974,P=0.001]and higher rate of oxytocin administration during labor [48.7％(73/150) vs 30.0％(45/150),x2=10.952,P=0.001],when compared with the control group,there was no significant difference in cesarean section rate,assisted vaginal delivery rate and neonatal outcomes between the two groups (all P＞0.05).Conclusions Epidural analgesia may associated with the prolongation of the first and second stage of labor,especially with the first stage of labor,but has no adverse effects on maternal and neonatal outcomes.

Increased expression of Siglec-1 on peripheral blood monocytes and its relationship with inflammatory reaction in autoimmune thyroiditis / 中华内分泌代谢杂志

Objective To investigate the expression of sialic acid-binding immunoglobulin-like-lectin-1 (Siglec-1)in the peripheral blood mononuclear cell (PBMC) of patients with autoimmune thyroiditis ( AIT) and its relationship with AIT. To explore the moduratory role of activated Siglec-1 on the differentiation of T cells and the promotion of in flammation after PBMC culture. Methods The peripheral whole blood and serum samples were collected from 30 AIT patients with normal thyroid function and 30 sex-and age-matched controls. The expression of sSiglec-1 in serum was detected by ELISA. The expression of Siglec-1 in PBMC was detected by RT-PCR and WB. The expression of Siglec-1 in CD14+ monocytes and the proportion of Th1 and Th17 cells in each group were detected by flow cytometry. The PBMC in AIT or control was stimulated with NaI in the presence or absence of LPS for 72 h. The expression of Siglec-1 in CD14+ monocytes and the proportion of Th1 and Th17 cells were detected by flow cytometry. Results sSiglec-1 in serum, Siglec-1 mRNA, and Siglec-1 protein in AIT patients'PBMC were higher than those in control group ( P＜0. 01). The expression of Siglec-1 in CD14+ monocytes by flow cytometry and differentiation of Th1 and Th17 cells were significantly higher than that in control group ( both P＜0. 01). The expression of Siglec-1 in control and AIT patients was up-regulated by 5×10-5 mmol/L to 1×10-2 mmol/L stimulated with NaI in the presence or absence of LPS for 72 h (P＜0.01), but the differentiation of Th1 and Th17 cells was up-regulated only in patients (P＜0.01), and in a dose-dependent manner. Conclusion Elevated Siglec-1 expression in PBMCs and monocytes can potentially serve as a biomarker for AIT. Iodine may affect Th1 and Th17 cell differentiation by activating Siglec-1 to adjust the AIT immune response.

Diagnosis and treatment of uterine fistula after cesarean section / 中国实用妇科与产科杂志

Uterine fistula after cesarean section mainly occurs in developing countries.With the development of social economy,the incidence of uterine fistula in China is gradually decreasing.However,in recent years,the incidence of placenta previa–accreta is increasing and the intraoperative injury is increasing.We describe the most common uterine fistula after cesarean section to provide reference and basis for its diagnosis and treatment.

Analysis of factors influencing X-ray images of spinal injury in patients with ankylosing spondylitis / 中华风湿病学杂志

Objective@#To investigate factors affecting X-ray structure of the spine in patients with ankylosing spondylitis (AS).@*Methods@#A total of 206 AS patients were recruited. Clinical and laboratory parameters in AS patients were recorded in detail. Disease activity index [Bath ankylosing spondylitis disease activity index (BASDAI), ankylosing spondylitis disease activity score (ASDAScrp)], X-ray structural damage index-modified stoke ankylosing spondylitis spine score (mSASSS) and grading results of radiographic examination of sacroiliac joint were calculated. Statistical analysis using Statistical Package form Soci-science(SPSS) 17.0 Chi-square test, rank test, Logistics regression analysis and other statistical methods were used. Differences of mSASSS levels, spine involvement (mSASSS>0) and rates of bone bridge formation were compared between different groups.@*Results@#Incidences of spine involvement (100%) and bone bridge formation(65.2%) in AS patients ≥40 years old were significantly higher than those in AS patients <40 years old (90.6%、31.9%)(χ2=4.651, P=0.031; χ2=16.647, P<0.01), and the level of mSASSS was also higher (Z=5.575, P<0.01). In AS patients with BMI ≥24 kg/m2, disease duration ≥5 years (49.2%, 50.4%), rates of bone bridge formation was significantly higher than those in AS with BMI <24 kg/m2, but the disease duration (34.5%, 19.7%)(χ2=4.014, P=0.045; χ2=18.173, P=0.03), and mSASSS values were significantly higher (Z=2.281, P=0.023, Z=4.828, P<0.01). Bone bridge formation rate in smoking patients (50.6%) was significantly higher than that in non-smoking patients (31.0%) (χ2=7.346, P=0.007) and mSASSS value was significantly higher (Z=2.045, P=0.041). Bone bridge formation rates in AS with high-ESR and high-CRP(48.6%, 49.0%) were significantly higher than those in patients with normal-ESR and normal-CRP(25.6%, 28.9%)(χ2=10.784, P=0.001; χ2=8.102, P=0.004) and mSASSS value was clearly higher(Z=2.379, P<0.01; Z=3.112, P<0.01). Bone bridge formation rate in AS with BASDAI≥4 or ASDAScrp≥2.1 groups (52.8%, 46.4%) were significantly higher than that in AS with BASDAI<4 or ASDAScrp<2.1 groups (34.2%, 30.7%) (χ2=5.681, P=0.017; χ2=4.646, P=0.031) and mSASSS values were significantly higher (Z=3.887, P<0.01; Z=3.895, P=0.004). Rates of bone bridge formation among different X-ray grading of sacroiliac joint (10.8%, 35.6%, 60.3%) and MRI findings (33.3%, 50.0%, 15.4%) differed with each other (χ2=25.714, P<0.01; χ2=6.855, P=0.032). Logistics regression analysis showed that BMI [OR(95%CI)=1.145(1.037, 1.265), P<0.01], disease duration [OR(95%CI)=1.144(1.055, 1.239), P<0.01], smoking [OR(95%CI)=2.832(1.343, 5.969), P<0.01] and sacroiliac joint X-ray staging [OR(95%CI)=2.584(1.337, 4.997), P<0.01] were risk factors for the bone bridge formation in spine of AS.@*Conclusion@#Spinal involvement in AS is related to disease activity. Bone bridge formation correlateswith disease duration, BMI and disease-status, especially with smoking.

Clinical study of serum vitamin D binding protein in patients with rheumatoid arthritis associated with secondary osteoporosis / 中华风湿病学杂志

Objective To explore the changes of serum vitamin D binding protein (VDBP) levels in patients with rheumatoid arthritis (RA) and the clinical significance of association between serum VDBP with secondary osteoporosis (OP) in RA.Methods One hundred and sixty patients with RA were enrolled in the study.Eighty-three normal subjects were recruited as the control group.The concentration of serum VDBP was determined by enzyme-linked immuno sorbent assay (ELISA),and bone mineral density (BMD) was measured by dual energy X-ray absorptiometry.Clinical and laboratory indexes of RA patients were recorded in detail and disease activity (DAS28) score,health assessment questionnaire (HAQ) and Sharp score according to X-ray examination of both hands were calculated simultaneously.The t test was used to compare the metrological data between the two groups,and the x2 test was used to compare the intergroup rate.The correlation analysis was tested by Pearson correlation analysis,the ROC curve was used to analyze the threshold of the serum VDBP,and the multivariate logistic regression analysis was used for multivariate analysis.Results ① Serum levels of VDBP in RA patients were higher than that in control group [(414±12) ng/ml vs (79±12) ng/ml,t=20.082,P＜0.01].Positive rate of serum levels of VDBP was 67.0％(118/176) in RA patients,which was higher than that in the control group (4.8％)(x2 =87.651,P＜0.01).② The threshold of serum VDBP levels for diagnosing RA was 193.74 ng/ml (AUC=0.943,Youden index=0.796,P＜0.01).③ DAS28 sore in group with positive VDBP was significantly higher than that in group with negative VDBP (P9=0.025).There was significant difference regarding on the incidence of OP in female RA patients between groups with positive and negative VDBP [41.9％(54/129) vs 31.8％(14/44),x2=4.325,P=0.038].④ Linear correlation analysis found that DAS28in RA patients was positively correlated with serum VDBP levels (r=0.252,P=0.019).And anti-CCP was negatively correlated with serum VDBP levels (r=-0.150,P=0.049).⑤ Results of logistic regression analysis showed that sex [OR=9.841,95％CI (1.349,71.810),P=0.024],age [OR=1.154,95 ％CI (1.069,1.245),P＜0.01] and Sharp score [OR=1.102,95％CI (1.002,1.021),P=0.018] were risk factors for OP in RA patients.Conclusion Serum VDBP levels are significantly higher in patients with RA.Meanwhile,serum VDBP levels are correlated with disease activity and secondary OP in RA.

Clinical study of serum fibroblast growth factor 23 levels in patients with rheumatoid arthritis and their association with osteoporosis / 中华风湿病学杂志

Objective To explore the serum levels of fibroblast growth factor 23 (FGF23) in patients with rheumatoid arthritis (RA) and to investigate the relationship between FGF23 and RA disease activity and the occurrence of osteoporosis (OP).Methods Serum levels of FGF23 from 174 cases of patients with RA and 88 normal subjects were detected by enzyme linked immunosorbent assay (ELISA).Bone mineral density (BMD) was measured by dual energy X-ray absorptiometry.All the clinical and laboratory indexes of RA patients were recorded in details,disease activity score (DAS28) and health assess questionnaire (HAQ) were also calculated in the meantime.Radiographic changes in both hands of RA patients were assessed by Sharp's method.T test,nonparametric test,x2 test,correlation analysis and Logistic regressive analysis were used for statistical analysis.Results Serum levels of FGF3 [145.46(67.67,245.93) pg/ml] in RA patients were higher than the control group [32.64(12.34,44.70) pg/ml,Z=11.416,P＜0.01].The positive rate of serum levels of FGF23 (≥71.95 pg/ml) in RA was 74.7％(130/174),while the positive rate in control was 4.5％(4/88,x2=115.16,P＜0.01).The threshold of FGF23 serum levels for diagnosing RA was 48.56 pg/ml (AUC=0.932,Youden index=0.743,P＜0.01,sensitivity 89.1％,specificity 85.2％).In RA patients with serum FGF23 ≥48.56 pg/ml,compared with negative FGF23 group,VAS,HAQ,number of joint swelling and BMD at femoral neck,Ward,GT,Total hip,L4 and L1-4 were significantly higher in FGF23 positive group (P＜0.05).Linear correlation analysis found that in RA patients with serum FGF23 ≥48.56 pg/ml,anti-CCP was negatively correlated with serum FGF23 levels (r=-0.171,P=0.035).And DAS28 was positively correlated with serum FGF23 (r=0.163,P=0.045).BMD at femoral neck,Ward,GT,Total hip,L4 and L1-4 were negatively correlated with serum FGF23 (P＜0.05).Results of logistic regression analysis showed that sex (OR=8.518,95％CI (2.636,27.522),P＜0.01,age [OR=1.129,95％CI (1.079,1.180),P＜0.01] and Sharp score [OR=1.008,95％CI(1.003,1.013),P=0.001]were risk factors for OP in RA patients.BMI[OR=0.801,95％CI(0.707,0.909),P=0.001] was a protective factor for OP in RA patients.Conclusion Serum FGF23 level is significantly higher in RA patients.Meanwhile,the serum FGF23 level correlates with RA disease activity and BMD.

Discussion on Etiology and Pathogenesis of Rheumatoid Arthritis from the Theory of Fuxie / 浙江中医药大学学报

[Objective] To explore the etiology and pathogenesis of rheumatoid arthritis from the perspective of the theory of Fuxie, so as to more comprehensively understand the rheumatoid arthritis, broaden the thinking of clinical diagnosis and treatment, and improve the clinical efficacy. [Methods] The theory of Fuxie theory was summarized, from the aspects of interpretation, theoretical origin, modern medical knowledge and so on, combined with the regularity of the pathogenesis of the pathogen, the etiology, pathogenesis and treatment of rheumatoid arthritis were discussed. [Results] Fuxie theory is originally derived from Huangdi Neijing, it is considered that Fuxie is divided into exogenous and endogenous Fuxie foxier, etiology of rheumatoid arthritis with hidden pathogenic objective basis, its pathogenesis with hidden pathogenic mechanism, the treatment principle and treatment method by pathogen consistentcy. [Conclusion] Understanding of rheumatoid arthritis, according to the characteristics and development of Fuxie disease transmission rules, can better grasp the nature of the disease, diagnosis and treatment of Fuxie theory of rheumatoid arthritis has important clinical significance, rheumatoid arthritis from Fuxie theory provides new ideas and methods for clinical treatment.

Correlation between 24 h urinary protein quantitation and pregnancy outcome in patients with pre-eclampsia / 新乡医学院学报

Objective To investigate the correlation between 24 h urinary protein quantitation and pregnancy outcome in patients with pre-eclampsia.Methods A total of 332 pre-eclampsia patients were selected in Tongji Hospital from January 2014 to December 2016.The patients were divided into microalbuminuria group(24 h urinary protein quantification ＜ 0.3 g,n =46),mild proteinuria group (0.3 g ≤ 24 h urinary protein quantification ＜ 2.0 g,n =98),moderate proteinuria group (2.0 g ≤ 24 h urinary protein quantification ＜ 5.0 g,n =71) and severe proteinuria group(24 h urinary protein quantification ≥ 5.0 g,n =117) according to the results of 24 h urinary protein quantification.The pregnancy outcomes were compared between the four groups.Results The 24 h urinary protein quantification and the serum creatinine,urea nitrogen,uric acid levels in the mild proteinuria group,moderate proteinuria group and severe proteinuria group were significantly higher than those in the microalbuminuria group (P ＜ 0.05);and gestational week was significantly shorter than that in the microalbuminuria group (P ＜ 0.05).The 24 h urinary protein quantification and serum urea nitrogen,uric acid levels in the moderate proteinuria group were significantly higher than those in the mild proteinuria group (P ＜ 0.05);and gestational week was significantly shorter than that in the mild proteinuria group (P ＜ 0.05);but there was no significant difference in serum creatinine level between the two groups (P ＞ 0.05).The 24 h urinary protein quantification,serum creatinine,urea nitrogen and uric acid levels in the severe proteinuria group were significantly higher than those in the mild proteinuria group (P ＜ 0.05);and the gestational week was significantly lower than that in the mild albuminuria group (P ＜ 0.05).The 24 h urinary protein quantification in the severe proteinuria group was significantly higher than that in the moderate proteinuria group (P ＜ 0.05),but there was no significant difference in the gestational week and serum creatinine,urea nitrogen,uric acid levels between the two groups (P ＞0.05).There was no significant difference in the rates of cesarean section and spontaneous labor between the four groups (P ＞0.05).The rate of induced labor in the moderate proteinuria group and the severe proteinuria group was significantly higher than that in the mild albuminuria group and the microalbuminuria group (P ＜ 0.05).There was no significant difference in the rate of induced labor between the mild proteinuria group and the microalbuminuria group (P ＞ 0.05).There was no significant difference in the rate of induced labor between the severe proteinuria group and the moderate proteinuria group (P ＞ 0.05).The incidence of complications in microalbuminuria group,mild proteinuria group,moderate proteinuria group and severe proteinuria group was 30.43％ (14/46),47.96％ (47/98),74.65％ (53/71) and 74.36％ (87/117) respectively;the incidence of complications in the moderate proteinuria group and the severe proteinuria group was significantly higher than that in the microalbuminuria group and the mild albuminuria group (P ＜ 0.05),but there was no significant difference in the incidence of complications between microalbuminuria group and mild albuminuria group (P ＞ 0.05),there was no significant difference in the incidence of complications between the moderate proteinuria group and the severe proteinuria group (P ＞0.05).The incidences of premature birth and neonatal asphyxia in the mild proteinuria group were significantly higher than that in the microalbuminuria group (P ＜ 0.05),and the body mass of the neonates was significantly lower than that in the microalbuminuria group (P ＜0.05),but there was no significant difference in the perinatal mortality rate and the incidences of fetal growth restriction(FGR) and poor neonatal resuscitation between the two groups (P ＞ 0.05).The incidences of FGR,premature birth,neonatal asphyxia,poor neonatal resuscitation and the perinatal mortality in the moderate proteinuria group and severe proteinuria group were significantly higher than those in the microalbuminuria group (P ＜ 0.05);and neonatal body mass was significantly lower than that in the mieroalbuminuria group (P ＜ 0.05).The incidences of FGR,premature birth and poor neonatal resuscitation and perinatal mortality in the moderate proteinuria group were significantly higher than those in the mild proteinuria group (P ＜ 0.05);and the neonatal body mass was significantly lower than that in the mild proteinuria group (P ＜ 0.05);but there was no significant difference in the neonatal asphyxia incidence between the two groups (P ＞ 0.05).The incidences of FGR,premature birth,neonatal asphyxia,poor neonatal resuscitation and perinatal mortality in the severe proteinuria group were significantly higher than those in the mild proteinuria group (P ＜ 0.05);and the body mass of the newborns was significantly lower than that in the mild albuminuria group (P ＜ 0.05).The incidence of neonatal asphyxia in the severe proteinuria group was significantly higher than that in the moderate proteinuria group (P ＜ 0.05),but there was no significant difference in the incidences of FGR,premature birth,poor neonatal resuscitation,perinatal mortality and neonatal body mass between the two groups (P ＞ 0.05).Conclusions The of 24 h urinary protein quantitation is closely related to the pregnancy outcome in patients with pre-eclampsia,the 24 h urinary protein quantification should be regularly detected in the patients with pre-eclampsia.When the urinary protein quantitation is more than 2.0 g,the incidences of maternal complications and poor prognosis of the perinatal infants is significantly higher,but the boundary value of the 24 h urinary protein quantitation for the diagnosis of severe pre-eclampsia still needs further large sample study.

Clinical research of sarcopenia and vitamin D deficiency in rheumatoid arthritis patients with osteoporosis / 中华风湿病学杂志

Objective To investigate the effect of sarcopenia and vitamin D deficiency on osteoporosis (OP) in patients with rheumatoid arthritis (RA).Methods Six hundred and forty-eight patients with RA were enrolled into the study,while 158 normal subjects were recruited as the control group.Bone mineral density (BMD) at total hip and lumbar vertebra 2-4 were measured by dual energy X-ray absorptiometry (DEXA),limbs skeletal muscle mass was determined in 267 patients with RA and 156 normal subjects by bioelectrical impedance method.Serum 25-hydroxy vitamin D [25(OH)D] levels were determined by electrochemiluminescence in 234 RA patients and 68 normal subjects.Clinical and laboratory features,daily dosage and duration of glucocorticoid (GC) were recorded.Numerical data and categorical data comparisons were analyzed using t test,x2 test,linear correlation analysis,single factor analysis of variance test and Logistic regression analysis test.Results ① Incidence of OP in RA (37.8％,245/648) was significantly higher than that in the controls (13.9％,22/158)(x2=32.712,P＜0.01).Incidence of sarcopenia was evidently higher in RA,compared with normal subjects [55.8％(149/267),9.0％(14/156),x2=91.176,P＜0.01].Percentage of sarcopenia was higher in RA with OP compared with RA without OP group [76.6％(49/64),39.3％(35/89),x2=20.848,P＜0.01].②Compared to control group,serum 25 (OH)D levels were significantly lower in RA group [(13.4±9.7) ng/ml,(22.4±6.3) ng/ml,t=9.063,P＜0.01].Rate of vitamin D deficiency iu RA was also higher than that in controls [80.8％(189/234),36.8％(25/68),x2=49.412,P＜0.01].③The differences of serum 25 (OH)D levels among different bone metabolic state groups at lumbar vertebra in RA (normal bone mass,osteopenia,OP) were statistically significant (F=6.263,P=0.003),whichrepresented a clearly decreasing trend along with the decreasing of serum 25 (OH)D levels (P=0.001).④Linear correlation analysis found that skeletal muscle mass indexes at limbs in RA were positively correlated with BMD and serum 25 (OH)D levels (P＜0.05).⑥Logistic Regression analysis revealed that sarcopenia (OR=4.373,P=0.002),age (OR=1.083,P=0.001) and duration of disease (OR=1.074,P=0.029) were the risk factors for occurrence of OP in patients with RA.Conclusion Sarcopenia generally exists in patients with RA,which is correlated with decreasing of serum 25 (OH)D levels,and also is the risk factor for the occurring of OP in RA.

Value of patient global assessment on evaluating disease activity in patients with axial spondyloarthritis / 中华风湿病学杂志

Objective To explore the value of patient global assessment (PGA) on evaluating disease activity in patients with axial spondyloarthritis (SpA),Methods A total of 222 patients with axial SpA were recruited.Scores of PGA,disease activity index [Bath ankylosing spondylitis disease activity index (BASDAI),ankylosing spondylitis disease activity score (ASDAS)crp] and spondyloarthritis research consortium of Canada (SPARCC) were calculated.Differences of PGA scores between different disease activity groups in axial SpA were compared and correlations between different disease activity index with PGA scores were analyzed.Statistical analyses were performed using Statistical Product and Service Solutions (SPSS) software (version 17.0).Comparison of frequency among different groups was performed by x2 test.Rank-sum test was used to compare the median of measurement data in different groups when the data were skewed in distribution.Cut-off value of PGA for assessing disease activity in axial SpA was calculated by ROC curve.Results Medians of PGA score in groups with BASDAI remission[3(1,4) vs 5(4,7)] and ASDAScrp remission [1(1,2) vs 4(2,5)] were lower than that in disease activity group (P＜0.01).BASDAI scores [1.80(1.20,2.90) vs 3.40(2.28,4.63) vs 5.15 (4.08,5.88)] and ASDAScrp scores [2.19(1.34,2.76) vs 2.86(2.08,3.54) vs 4.08(2.96,4.41)] were significant different among PGA groups (≤3,4-6 and ≥7) (P＜0.01).Differences of SPARCC scores [6.00(0,18.00) vs 7.50(3.75,18.00) vs 18.50(6.75,24.50)] were statistically significant among PGA groups (Z=7.427,P=0.037).Erythrocyte sedimentation rate (ESR) [12.00(5.00,23.00) mm/1 h vs 19.50(7.00,44.50) mm/1 h vs 18.00(7.75,54.75) mm/1 h],C-reactive protein (CRP) [7.85(2.37,22.49) mg/L vs 10.07(3.02,28.51) mg/L vs 21.28(7.14,37.74) mg/L] and Bath ankylosing spondylitis functional index (BASFI) [0.70(0.10,1.30) vs 2.25(0.60,3.30) vs 2.85(0.83,6.53)] were also different among PGA groups (P＜0.01,separately).Proportion of axial SpA patients in BASDAI disease activity group or ASDAScrp higher disease activity group were different among PGA groups (P＜0.01,separately),while represented as positive correlations (P＜0.01,separately).Correlation analyses revealed that PGA was positively correlated with ASDAScrp (r=0.694),BASDAI(r=0.616),SPARCC (r=0.271),ESR (r=0.288),CRP(r=0.215),occipital wall distance (r=0.196),finger-floor distance (r=0.385) and negatively correlated with Sschober's test (r=-0.195) (P＜0.05).Receiver operator characteristic (ROC) curve analysis found that PGA-BASDAI AUC was 0.813,the cut off value of PGA was 3.5 and PGA-ASDAScrp AUC was 0.860,the cut off value of PGA was 2.5.Conclusion PGA has good correlations with the disease activity indexes in axial SpA patients.It can also reflect the degree of inflammation in iconography.PGA may reflect disease activity especially when the value of PGA is around 3.

Comparison of clinical and laboratory features between patients with ankylosing spondylitis and non-radiolographic axial spondyloarthritis / 中华风湿病学杂志

Objective To analyze and compare the clinical and laboratory features between patients with ankylosing spondylitis (AS) and nonradiographic axial spondyloarthritis (nr-axSpA).Methods One hundred and forty-one patients with AS and 73 cases with nr-axSpA were recruited.Clinical and laboratory indexes of individuals were recorded in detail,Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score (ASDAS) crp were calculated.Spondyloarthritis research consortium of Canada (SPARCC) score standard was used to evaluate the degree of bone marrow edema in sacr-oiliac joint under magnetic resonance imaging scanning.T test,rank test and x2 test were used for statistical analysis.Results The average age of patients with AS was obviously higher than that of patients with nr-axSpA (t=4.962,P＜0.01).Patients with AS were more often male,and those with nr-axSpA were more often female (82.0％ of the AS patients were men and 49.3％ of the nr-axSpA patients were men (x2=24.079,P＜0.01).Disease duration of AS was significantly longer than that of the nr-axSpA (Z=6.396,P＜0.01).The incidence of human leukocyte antigen (HLA)-B27 positive in AS was 89.4％,which was similar to that in patients with nr-axSpA (84.9％) (x2=0.884,P＞0.05).21.6％ (21 cases) of patients with AS had peripheral swollen joints,which was higher than that in nr-axSpA (2.2％,x2=8.861,P=0.003).Forty cases in AS had tender joints (41.2％),only 6 patients in nr-axSpA had tender joints (13.3％,x2=11.458,P＜0.01).Serum erythrocyte sedimentation rate (ESR) and C reactive protein (CRP) levels in patients with AS were clearly higher than those in nr-axSpA (P＜0.01) patients.In AS,the patient global assessment (PGA),BASDAI and ASDAScrp value was significantly higher than that in nr-axSpA (P＜0.01).There were no differences in SPARCC score or incidence of bone marrow edema in sacroiliac joint in magnetic resonance imaging scanning between AS and nr-axSpA (P＞0.05).Percentage of patients with occipit-to-wall distance higher than 0 cm in AS was higher than that in nr-axSpA,and the mean distance of fingers to ground in AS was also higher than that in nr-axSpA (x2=19.844,P＜0.01;Z=5.724,P＜0.01).Chest expansion degree and Schboer's test in AS was much lower than that in nr-axSpA,respectively (Z=3.083,P=0.002;Z=5.103,P＜0.01).BASFI in AS was higher than that in nr-axSpA (Z=5.840,P＜0.01).The ratio of joint function in AS was obviously worse than that in nr-axSpA (x2=1 1.369,P=0.01).Conclusion Compared to patients with nr-axSpA,AS patients are male predominant,and have severer inflammation in clinical and laboratory findings and are worse in functional status.

Development of private medical institutions in Henan province:dilemmas and rationality / 中华医院管理杂志

This paper reviewed the policies on private medical institutions in Henan province since the new healthcare reform.Combined with relevant statistical data,the authors found that conceptual obstacles,policy implementation,lack of unified management and restriction of human resource flow as important constraints of the development of such institutions in the province.In view of this finding,the authors made in-depth study of the development positioning,general role of planning and market functions,as well as support and regulation in parallel of such institutions,in order to promote the healthy and sustainable development of private medical institutions in China.

Clinical Value of Serum 14-3-3η protein levels in patients with Rheumatoid Arthritis and Secondary Osteo-porosis / 实用医学杂志

Objective To investigate the clinical value of serum 14-3-3η protein levels in patients with rheumatoid arthritis (RA) and secondary osteoporosis (OP). Methods 259 RA patients and 80 healthy controls were recruited. Serum 14-3-3η levels were determined by ELISA and bone mineral density (BMD) were detected by the DEXA. Results Firstly, the levels and the positive rate of serum 14-3-3η protein were significantly high-er in RA patients than healthy controls (P < 0.000 1). Secondly, ROC curve revealed that the sensitivity of 14-3-3η protein for diagnosis of early RA was 91.7% and its specificity was 99.6% when the cut-off point was 0.879 ng/mL (AUC = 0.917, P < 0.000 1). Finally, 14-3-3η protein concentrations revealed significant differ-ence among the groups of bone mass normal, osteopenia and osteoporosis in early RA (χ2=7.974, P = 0.019). Conclusion Serum 14-3-3η protein levels increase significantly in RA , especially in early RA , which is relat-ed to clinical symptoms and osteoporosis.

Effects of policosanol combined with simvastatin on serum lipids and sex hormones in male patients with hyperlipidemia / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the effects and safety of policosanol combined with simvastatin on serum lipids and sex hormones in male patients with hyperlipidemia.</p><p><b>METHODS</b>This randomized, single-blinded, placebo-controlled study included 120 male patients with hyperlipidemia. Patients were divided randomly into treatment group(n = 60) and control group(n = 60). Patients in the treatment group were administrated with simvastatin (40 mg/d) plus policosanol (20 mg/d),and those in the control group were treated with simvastatin (40 mg/d) plus placebo (20 mg/d). The values of total cholesterol(TC), triglyceride(TG), high density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol(LDL-C), testosterone(T) and estradiol (E2) were assessed before and after 16 weeks treatment.Drug-induced adverse effects were observed.</p><p><b>RESULTS</b>Baseline characteristics were similar between groups. TC,TG, LDL-C were (5.74 ± 0.99) , (1.62 ± 0.69), (3.60 ± 0.56) mmol/L in the treatment group at baseline and significantly reduced after 16 weeks treatment (4.57 ± 0.58), (1.54 ± 0.55), (2.68 ± 0.38) mmol/L (all P < 0.05). TC, LDL-C were (5.99 ± 0.93) , (3.76 ± 0.42) mmol/L in the control group at baseline and significantly reduced after 16 weeks treatment (5.03 ± 0.59) , (2.98 ± 0.28) mmol/L (all P < 0.05) while TG remained unchanged post 16 weeks therapy in the control group. Simvastatin plus policosanol achieved a significantly greater reduction in LDL-C and TC than simvastatin plus placebo (P < 0.05). HDL-C,T and E2 were similar before and after 16 weeks treatments in both groups (P > 0.05) .The adverse reactions were similar between the two groups, most of them were mild and happened at the beginning of drug therapy and could be well tolerated.</p><p><b>CONCLUSION</b>Simvastatin/policosanol produces greater decreases in TC, LDL-C than simvastatin/placebo without resulting more side effects and changes on sex hormones.</p>

Impacts of electroacupuncture on ubiquitin-proteasome system in rats with Parkinson's disease / 中国针灸

<p><b>OBJECTIVE</b>To explore action mechanism of electroacupuncture (EA) on treatment and prevention of Parkinson's disease (PD).</p><p><b>METHODS</b>Fifty clean-grade SD rats were randomly divided into a normal group, a control group, a model group, a pretreatment group and a treatment group, ten rats in each one. The PD model was established by subcutaneous injection of rotenone in neck-back skin (2 mg/kg, dissolved in sun-flower oil, 2 mg/mL in density). The equal-volume sun-flower oil that didn't include rotenone was applied in the control group at the same area as the model group. EA was applied in the treatment group at "Fengfu" (GV 16) and "Taichong" (LR 3) with interrupted wave, 2 Hz in frequency, 1 mA in density, for 20 min. The treatment was given once day for conti-nuous 28 days. Rats in the pretreatment group received the same EA as the treatment group for 7 days, and then put into model establishment. After the model establishment, the rats received no treatment and were sacrificed after 28 days. No EA was given in the normal group, model group and control group. The ethology changes were observed and scored. The expression of Parkin, ubiquitin C terminal hydrolase-L1 (UCH-L1) and ubiquitin activating enzyme-1 (UBE1) in substantia nigra was tested by Western-blot method. The positive cell numbers of alpha-synuclein, ubiquitin (UB) and tyrosine hydroxylase (TH) in substantia nigra was tested by immunohistochemical method.</p><p><b>RESULTS</b>There were abnormal ethology manifestation such as yellow and coarse hair, arched back, weaken behavior of resisting arrest and slow movement, which was more relieved in the treatment group and pretreatment group. Compared with normal group and control group, the expression of Parkin, UCH-L1, UBE1, UB, TH in the model group was obviously decreased while alpha-synuclein was obviously increased (all P<0.01). After EA or pretreatment, the expression of Parkin, UCH-L1, UBE1, UB, TH in the treatment group and pretreatment group was higher than that in the model group while expression of alpha-synuclein in the treatment group and pretreatment group was lower than that in the model group (all P<0.01).</p><p><b>CONCLUSION</b>EA or pretreatment could not only have protective effect for rats with PD, but also increase function of ubiquitin-proteasome system, indicating action mechanism of EA on treatment and prevention of PD may be related with ubiquitin-proteasome system.</p>

Analysis of learning curve of laparoscopic splenectomy / 中南大学学报(医学版)

OBJECTIVE@#To evaluate the surgical outcomes of laparoscopic splenectomy and to investigate the learning curve of laparoscopic splenectomy.@*METHODS@#Forty cases of laparoscopic splenectomy (performed by W.Y. between September 2008 and August 2010) in our general surgery department were reviewed, and the cases were divided equally into 4 groups (group I, II, III, IV) according the time sequence of the operations. The operating time, blood loss, conversion to open surgery, conversion to hand-assisted laparoscopic splenectomy, postoperative hospital stay, postoperative liquid diet recovery time, intra- and postoperative complications and the operative frequency were compared.@*RESULTS@#There were no statistical differences among the groups in age and gender (P>0.05). The operating time, blood loss and postoperative hospital stay of groups III and IV were significantly less than those of groups I and II (P0.05). Frequency of conversion to open surgery, of conversion to hand-assisted laparoscopic splenectomy, of complications among the four groups were also not statistically different (P>0.05). The operative frequency of group I-IV increased from 1.25/month to 2.5/month.@*CONCLUSION@#The learning curve of laparoscopic splenectomy for surgeon who was experienced in open splenectomy and laparoscope cholecystectomy is approximately 20 cases, and the operative frequency is about 1.33/month.