miR-27b-3p reduces muscle fibrosis during chronic skeletal muscle injury by targeting TGF-ßR1/Smad pathway.

BACKGROUND: Fibrosis is a significant pathological feature of chronic skeletal muscle injury, profoundly affecting muscle regeneration. Fibro-adipogenic progenitors (FAPs) have the ability to differentiate into myofibroblasts, acting as a primary source of extracellular matrix (ECM). the process by which FAPs differentiate into myofibroblasts during chronic skeletal muscle injury remains inadequately explored. METHOD: mouse model with sciatic nerve denervated was constructed and miRNA expression profiles between the mouse model and uninjured mouse were analyzed. qRT/PCR and immunofluorescence elucidated the effect of miR-27b-3p on fibrosis in vivo and in vitro. Dual-luciferase reporter identified the target gene of miR-27b-3p, and finally knocked down or overexpressed the target gene and phosphorylation inhibition of Smad verified the influence of downstream molecules on the abundance of miR-27b-3p and fibrogenic differentiation of FAPs. RESULT: FAPs derived from a mouse model with sciatic nerves denervated exhibited a progressively worsening fibrotic phenotype over time. Introducing agomiR-27b-3p effectively suppressed fibrosis both in vitro and in vivo. MiR-27b-3p targeted Transforming Growth Factor Beta Receptor 1 (TGF-ßR1) and the abundance of miR-27b-3p was negatively regulated by TGF-ßR1/Smad. CONCLUSION: miR-27b-3p targeting the TGF-ßR1/Smad pathway is a novel mechanism for regulating fibrogenic differentiation of FAPs. Increasing abundance of miR-27b-3p, suppressing expression of TGF-ßR1 and inhibiting phosphorylation of smad3 presented potential strategies for treating fibrosis in chronic skeletal muscle injury.

Therapeutic Effectiveness of Leukocyte- and Platelet-rich Fibrin for Diabetic Foot Ulcers: A Retrospective Study.

OBJECTIVE: Diabetic foot ulcer (DFU) is one of the most serious complications of diabetes. Leukocyte- and platelet-rich fibrin (L-PRF) is a second-generation autologous platelet-rich plasma. This study aims to investigate the clinical effects of L-PRF in patients with diabetes in real clinical practice. METHODS: Patients with DFU who received L-PRF treatment and standard of care (SOC) from 2018 to 2019 in Tongji Hospital were enrolled. The clinical information including patient characteristics, wound evaluation (area, severity, infection, blood supply), SOC of DFU, and images of ulcers was retrospectively extracted and analyzed. L-PRF treatment was performed every 7±2 days until the ulcer exhibited complete epithelialization or an overall percent volume reduction (PVR) greater than 80%. Therapeutic effectiveness, including overall PVR and the overall and weekly healing rates, was evaluated. RESULTS: Totally, 26 patients with DFU were enrolled, and they had an ulcer duration of 47.0 (35.0, 72.3) days. The severity and infection of ulcers varied, as indicated by the Site, Ischemia, Neuropathy, Bacterial Infection, and Depth (SINBAD) scores of 2-6, Wagner grades of 1-4, and the Perfusion, Extent, Depth, Infection and Sensation (PEDIS) scores of 2-4. The initial ulcer volume before L-PRF treatment was 4.94 (1.50, 13.83) cm3, and the final ulcer volume was 0.35 (0.03, 1.76) cm3. The median number of L-PRF doses was 3 (2, 5). A total of 11 patients achieved complete epithelialization after the fifth week of treatment, and 19 patients achieved at least an 80% volume reduction after the seventh week. The overall wound-healing rate was 1.47 (0.63, 3.29) cm3/week, and the healing rate was faster in the first 2 weeks than in the remaining weeks. Concurrent treatment did not change the percentage of complete epithelialization or healing rate. CONCLUSION: Adding L-PRF to SOC significantly improved wound healing in patients with DFU independent of the ankle brachial index, SINBAD score, or Wagner grade, indicating that this method is appropriate for DFU treatment under different clinical conditions.

Exercise-induced Musclin determines the fate of fibro-adipogenic progenitors to control muscle homeostasis.

The effects of exercise on fibro-adipogenic progenitors (FAPs) are unclear, and the direct molecular link is still unknown. In this study, we reveal that exercise reduces the frequency of FAPs and attenuates collagen deposition and adipose formation in injured or disused muscles through Musclin. Mechanistically, Musclin inhibits FAP proliferation and promotes apoptosis in FAPs by upregulating FILIP1L. Chromatin immunoprecipitation (ChIP)-qPCR confirms that FoxO3a is the transcription factor of FILIP1L. In addition, the Musclin/FILIP1L pathway facilitates the phagocytosis of apoptotic FAPs by macrophages through downregulating the expression of CD47. Genetic ablation of FILIP1L in FAPs abolishes the effects of exercise or Musclin on FAPs and the benefits on the reduction of fibrosis and fatty infiltration. Overall, exercise forms a microenvironment of myokines in muscle and prevents the abnormal accumulation of FAPs in a Musclin/FILIP1L-dependent manner. The administration of exogenous Musclin exerts a therapeutic effect, demonstrating a potential therapeutic approach for muscle atrophy or acute muscle injury.

Study on detection rate of polyps and adenomas in artificial-intelligence-aided colonoscopy.

BACKGROUND/AIM: To study the impact of computer-aided detection (CADe) system on the detection rate of polyps and adenomas in colonoscopy. MATERIALS AND METHODS: A total of 1026 patients were prospectively randomly scheduled for colonoscopy with (the CADe group, CADe) or without (the control group, CON) the aid of the CADe system, together with visual notification and voice alarm, so as to compare the detection rate of polyp. RESULTS: Compared with group CON, the detection rate of adenomas increased in group CADe, the average number of adenomas increased, the number of small adenomas increased, the number of proliferative polyps increased, and the differences were statistically significant (P < 0.001), but the comparison for the number of larger adenomas showed no significant difference between the groups (P> 0.05). CONCLUSIONS: The CADe system is feasible for increasing the detection of polyps and adenomas in colonoscopy.

Microsized Antimony as a Stable Anode in Fluoroethylene Carbonate Containing Electrolytes for Rechargeable Lithium-/Sodium-Ion Batteries.

Metallic antimony (Sb) is an attractive anode material for lithium-/sodium-ion batteries (LIBs/SIBs) because of its high theoretical capacity (660 mA h g-1), but it suffers from poor cycling performance caused by the huge volume expansion and the unstable solid electrolyte interphase (SEI). Here, we report a high-performing microsized Sb anode for both LIBs and SIBs by coupling it with fluoroethylene carbonate (FEC) containing electrolytes. The optimum amount of FEC (10 vol %) renders a stable LiF/NaF-rich SEI on Sb electrodes that can suppress the continuous electrolyte decomposition and accommodate the volume variation. The microsized Sb electrode gradually evolves into a porous integrity assembled by nanoparticles in FEC-containing electrolytes during cycling, which is totally different from that in the FEC-free counterpart. As a result, the microsized Sb electrodes exhibit a reversible capacity of 540 mA h g-1 with 85.3% capacity retention after 150 cycles at 1000 mA g-1 for LIBs and 605 mA h g-1 with 95.4% capacity retention after 150 cycles at 200 mA g-1 for SIBs. More impressively, the prototype full Li-based (i.e., Sb/LiNi0.8Co0.1Mn0.1O2 cell) and Na-based (i.e., Sb/Na3V2(PO4)2O2F cell) batteries also achieve good cycling durability. This facile strategy of electrolyte formulation to boost the cycling performance of microsized Sb anodes will provide a new avenue for developing stable alloying-type materials for both LIBs and SIBs.

Maternal Serum Angiogenic Factor sFlt-1 to PlGF Ratio in Preeclampsia: A Useful Marker for Differential Diagnosis and Prognosis Evaluation in Chinese Women.

The ratio of soluble fms-like tyrosine kinase-1 to placental growth factor (sFlt-1/PlGF) is elevated and proved to be useful in preeclampsia (PE) diagnosis. Its value in differential diagnosis with other pregnancy complications and prediction of pregnancy duration has yet to be clarified in Chinese population. We retrospectively analyzed 118 singleton pregnancies with suspected or diagnosed PE at the Peking Union Medical College Hospital (PUMCH) in China. Among these, 62 pregnancies were diagnosed as PE (48 early onsets and 14 late onsets, with 39 and 5 severe PE, respectively), 12 gestational hypertension (GH), 15 chronic hypertension (chrHTN), 16 autoimmune diseases, and 13 pregnancies with uncomplicated proteinuria. And 76 normal pregnancies were included as control. The results showed (1) the sFlt-1/PlGF ratio in early onset PE subgroup was significantly higher than that in GH, chrHTN, and control groups; the sFlt-1/PlGF ratio in late onset PE subgroup was significantly higher than that in chrHTN and control groups, but similar as GH group; the sFlt-1/PlGF ratio was similar among GH, chrHTN, and control groups. (2) The sFlt-1/PlGF ratio was significantly increased in the PE group compared with autoimmune disease and uncomplicated proteinuria pregnancies. (3) By ROC curve analysis, the cutoff value of the sFlt-1/PlGF ratio was less than 21.5 to rule out PE and higher than 97.2 to confirm the diagnosis of PE. (4) The sFlt-1/PlGF ratio was higher in PE pregnancies delivering within 7 days than those more than 7 days, either in early onset PE or severe PE. In conclusion, we show that maternal sFlt-1/PlGF ratio is an efficient biomarker in the diagnosis and differential diagnosis of PE. This ratio can be used to predict the timing of delivery for PE pregnancies.

Interleukin-15 facilitates muscle regeneration through modulation of fibro/adipogenic progenitors.

BACKGROUND: Chronic muscle injury is characteristics of fatty infiltration and fibrosis. Recently, fibro/adipogenic progenitors (FAPs) were found to be indispensable for muscular regeneration while were also responsible for fibrosis and fatty infiltration in muscle injury. Many myokines have been proven to regulate the adipose or cell proliferation. Because the fate of FAPs is largely dependent on microenvironment and the regulation of myokines on FAPs is still unclear. We screened the potential myokines and found Interleukin-15 (IL-15) may regulate the fatty infiltration in muscle injury. In this study, we investigated how IL-15 regulated FAPs in muscle injury and the effect on muscle regeneration. METHODS: Cell proliferation assay, western blots, qRT-PCR, immunohistochemistry, flow cytometric analysis were performed to investigate the effect of IL-15 on proliferation and adipogensis of FAPs. Acute muscle injury was induced by injection of glycerol or cardiotoxin to analyze how IL-15 effected on FAPs in vivo and its function on fatty infiltration or muscle regeneration. RESULTS: We identified that the expression of IL-15 in injured muscle was negatively associated with fatty infiltration. IL-15 can stimulate the proliferation of FAPs and prevent the adipogenesis of FAPs in vitro and in vivo. The growth of FAPs caused by IL-15 was mediated through JAK-STAT pathway. In addition, desert hedgehog pathway may participate in IL-15 inhibiting adipogenesis of FAPs. Our study showed IL-15 can cause the fibrosis after muscle damage and promote the myofiber regeneration. Finally, the expression of IL-15 was positively associated with severity of fibrosis and number of FAPs in patients with chronic rotator cuff tear. CONCLUSIONS: These findings supported the potential role of IL-15 as a modulator on fate of FAPs in injured muscle and as a novel therapy for chronic muscle injury.

Role of the TSLP-DC-OX40L pathway in asthma pathogenesis and airway inflammation in mice.

This study aimed to explore the effect of the TSLP-DC-OX40L pathway in asthma pathogenesis and airway inflammation in mice. For this, 65 male BALF/c mice were distributed among the control, asthma, immunoglobulin G (IgG) + asthma (IgG, 500 µg/500 µL, intratracheal injection of 50 µL each time), LY294002 (OX40L inhibitor) + asthma (intratracheal injection of 2 mg/kg LY294002), and anti-TSLP + asthma (intratracheal injection of 500 µg/500 µL TSLP antibody, 50 µL each time) groups. ELISA was applied to measure the serum levels of immunoglobulin E (IgE), ovalbumin (OVA)-sIgE, interleukin-4 (IL-4), IL-5, IL-13, and interferon-γ (IFN-γ); flow cytometry was employed to detect Treg cells and dendritic cell (DC) and lymphopoiesis. RT-qPCR and Western blot assays were used to measure the levels of TSLP, OX40L, T-bet, GATA-3, NF-κB, p38, and ERK. Treatment with LY294002 and anti-TSLP resulted in increases in the numbers of total cells, eosinophils, neutrophils, and lymphocytes in the bronchoalveolar lavage fluid; total serum levels of IgE, OVA-sIgE, IL-4, IL-5, and IL-13; levels of DC cells; lymphopoiesis; and levels of TSLP, OX40L, GATA-3, NF-κB, p38, and ERK, whereas there were decreases in the levels of IFN-γ and CD4+CD25+Treg cells; CD4+Foxp3+Treg cells; and T-bet. The TSLP-DC-OX40L pathway may contribute to asthma pathogenesis and airway inflammation by modulating the levels of CD4+CD25+Treg cells and inflammatory cytokines.

Monitoring results of soil-transmitted nematodiasis in national surveillance site of Huaiyang County in Henan Province,2006-2015 / 中国血吸虫病防治杂志

Objective To understand the epidemic situation of soil-transmitted nematodiasis in the national surveillance site in Henan Province. Methods Over 1000 fecal samples from inhabitants in Huaiyang County of Henan Province,which was a national surveillance site,were collected each year from 2006 to 2015,the eggs of soil-transmitted nematodes and other intesti-nal helminths were examined by Kato-Kats technique. The cellophane swab method was used to detect Enterobius vermicularis eggs in children aged 3 to 12 years. In addition,the soil samples were collected from vegetable fields,lavatories,courtyards and kitchens of 10 families randomly selected in each year to examine Ascaris eggs by a modified saturated sodium nitrate floatation method. Results From 2006 to 2015,10419 persons were investigated,and the eggs of five species of intestinal helminths, Ascaris lumbricoides,Trichuris trichiura,hookworm,E. vermicularis,and Trichostrongylus orientalis,were detected,The aver-age infection rate of soil-transmitted nematodes in residents in Huaiyang County was 3.69%. The intensity of infection was mild and a family clustering was obvious. Both the infection rates of E. vermicularis in children and soil-transmitted nematodes in vil-lagers had no significant differences between different genders (both P>0.05). The infection rates of soil-transmitted nema-todes,A. lumbricoides and E. vermicularis all reached the highest in the age group of 1-10 years. For different education back-ground,the people with primary school education had the highest infection rate,and the infection rate showed a decreasing trend with the increase of the educational level. The infection rate of soil-transmitted nematodes in the national surveillance site in Henan Province showed a decreasing trend from 2006 to 2015. Unfertilized and fertilized A. lumbricoides eggs were detected in the soil samples,but the positive rate was very low. Conclusions In the recent 10 years,the infection rate of soil-transmit-ted nematodes in the national surveillance site in Henan Province shows a decreasing trend and maintains at a low level. The in-fection shows a family clustering. The children,especially those aged 3-9 years are the main infected population,and E. vermic-ularis infection is the key point of prevention and control.

[Role of transient receptor potential vanilloid 1 in airway inflammation in asthmatic mice].

OBJECTIVE: To study the effects of the change in transient receptor potential vanilloid 1 (TRPV1) channel activity on the degree of airway inflammation in asthmatic mice. METHODS: BALB/c mice were randomly divided into control, asthma, capsaicin (TRPV1 agonist), capsazepine (TRPV1 antagonist), and dexamethasone groups. The asthmatic mouse model was established by intraperitoneal injection of mixed ovalbumin-aluminium hydroxide solution and ultrasonic atomization with OVA for sensitization and challenge. The capsaicin, capsazepine, and dexamethasone groups were given intraperitoneal injection of capsaicin (30 µg/kg), capsazepine (10 µmol/kg), and dexamethasone (2 mg/kg) respectively, at 30 minutes before challenge. Hematoxylin and eosin staining was used to observe the degree of pulmonary inflammation. ELISA was used to measure the content of interleukin-8 (IL-8) and interleukin-13 (IL-13) in bronchoalveolar lavage fluid (BALF). Real-Time PCR was used to measure the relative content of TRPV1 mRNA in lung tissue. RESULTS: Compared with the asthma group, the capsazepine and dexamethasone groups showed reduced pulmonary inflammation, while the capsaicin group showed aggravated pulmonary inflammation. Compared with the control group, the asthma and capsaicin groups showed increases in the content of IL-13 and IL-8 in BALF and the mRNA expression of TRPV1 in lung tissue (P<0.05). Compared with the asthma group, the capsazepine and dexamethasone groups showed reductions in the content of IL-13 and IL-8 in BALF and the mRNA expression of TRPV1 in lung tissue (P<0.05). The capsaicin group showed increases in the content of IL-13 and IL-8 in BALF (P<0.05). CONCLUSIONS: TRPV1 channel agonist and antagonist can influence the degree of airway inflammation in asthmatic mice. Dexamethasone may reduce airway inflammation through regulating TRPV1 level.

A Location Method Using Sensor Arrays for Continuous Gas Leakage in Integrally Stiffened Plates Based on the Acoustic Characteristics of the Stiffener.

This paper proposes a continuous leakage location method based on the ultrasonic array sensor, which is specific to continuous gas leakage in a pressure container with an integral stiffener. This method collects the ultrasonic signals generated from the leakage hole through the piezoelectric ultrasonic sensor array, and analyzes the space-time correlation of every collected signal in the array. Meanwhile, it combines with the method of frequency compensation and superposition in time domain (SITD), based on the acoustic characteristics of the stiffener, to obtain a high-accuracy location result on the stiffener wall. According to the experimental results, the method successfully solves the orientation problem concerning continuous ultrasonic signals generated from leakage sources, and acquires high accuracy location information on the leakage source using a combination of multiple sets of orienting results. The mean value of location absolute error is 13.51 mm on the one-square-meter plate with an integral stiffener (4 mm width; 20 mm height; 197 mm spacing), and the maximum location absolute error is generally within a ±25 mm interval.

A new method of using sensor arrays for gas leakage location based on correlation of the time-space domain of continuous ultrasound.

This paper proposes a time-space domain correlation-based method for gas leakage detection and location. It acquires the propagated signal on the skin of the plate by using a piezoelectric acoustic emission (AE) sensor array. The signal generated from the gas leakage hole (which diameter is less than 2 mm) is time continuous. By collecting and analyzing signals from different sensors' positions in the array, the correlation among those signals in the time-space domain can be achieved. Then, the directional relationship between the sensor array and the leakage source can be calculated. The method successfully solves the real-time orientation problem of continuous ultrasonic signals generated from leakage sources (the orientation time is about 15 s once), and acquires high accuracy location information of leakage sources by the combination of multiple sets of orientation results. According to the experimental results, the mean value of the location absolute error is 5.83 mm on a one square meter plate, and the maximum location error is generally within a ±10 mm interval. Meanwhile, the error variance is less than 20.17.

[Investigation and OCRL mutation analysis of a family with oculocerebrorenal syndrome of Lowe].

Oculocerebrorenal syndrome of Lowe (OCRL) is an X-linked recessive disorder. This study investigated the history of a Chinese family with OCRL and used direct DNA sequencing to screen all exons of OCRL gene for mutations. A missense mutation (1736 A→G) in exon 15 was revealed, which resulted in the change of His (H) 507 to Arg (R). The patient's mother was the carrier of the heterozygous mutation in X-chromosome. To our knowledge, H507R mutation in OCRL gene has not been reported in Chinese people.

Genetic counseling, prenatal screening and diagnosis of Down syndrome in the second trimester in women of advanced maternal age: a prospective study.

BACKGROUND: The incidence of autosomal trisomy in livebirths is strongly dependent on maternal age. Special consideration is given to the provision of prenatal screening and cytogenetic testing to women of advanced maternal age (AMA). The aim of this study was to evaluate the effectiveness of second trimester prenatal screening and amniocentesis for Down syndrome (DS) and compare the trends of choice of screening and amniocentesis among AMA women. METHODS: A total of 5404 AMA patients with natural singleton pregnancy were recruited for this prospective study from January 2008 to December 2010. The gestational weeks were from 15 weeks to 20(+6) weeks. The patients referred were grouped into a screening group (2107 cases) and an amniocentesis group (3297 cases) by their own decision. The prevalence of DS was compared between the two groups by chi-square test. Choice rates for each maternal age with trends were compared by regression analysis. RESULTS: There were 18 cases of fetal DS detected in the screening group with a prevalence of 8.54‰ (18/2107). Twenty-five cases of fetal DS were diagnosed in the amniocentesis group with a prevalence of 7.58‰ (25/3297). No statistical difference was observed in the prevalence of DS between the screening and amniocentesis group (P = 0.928). The invasive testing rate for DS in the amniocentesis group was 5.54 times higher than that of the screening group (1/131.88 vs. 1/23.78). With the increase of the maternal age, the choice of amniocentesis increased while the choice of the screening showed an opposite trend. The choice of the AMA women between the screening and amniocentesis was significantly age relevant (P = 0.012). CONCLUSIONS: The second trimester serum screening in combination with maternal age was more effective than maternal age alone to screen for DS. We suggest educating the patients by recommending AMA women be informed of both screening and amniocentesis options.

[Pregnancy outcomes of eight pregnant women with congenital adrenal hyperplasia due to 21-hydroxylase deficiency].

OBJECTIVE: To investigate the clinical features and pregnant outcomes of the pregnant women with congenital adrenal hyperplasia (CAH) 21-hydroxylase deficiency (21-OHD). METHODS: The clinical features, therapies, pregnant outcomes of the pregnant women with 21-OHD were retrospectively reviewed in Peking Union Medical College Hospital, from January 2005 to April 2011. RESULTS: There were 8 pregnant women with 21-OHD including 5 simple virilizing patients and 3 nonclassical 21-OHD women. Eight patients were accepted progestational and prenatal continual lower glucocorticoid treatment. During the gestational period, the dosage of glucocorticoid was adjusted in one pregnancy. The serum level of 17-alpha hydroxyprogesterone (17-OHP) were elevated after pregnancy [(70 ± 38) versus (24 ± 23) nmol/L, P < 0.05]. The fertility and offspring rate of 8 patients was 8/12, the fertility and offspring rate of patients who started treatment at preadolescence was significantly increased (4/5 versus 4/7). Four patients were accepted genital reconstructive surgery (clitorectomy, clitoroplasty, vulvoplasty) before pregnancy. The incidence of GDM was 1/8. All patients selected caesarean at from 37(+6) gestation weeks to 39(+6) gestation weeks. The average newborn birth weight was (3210 ± 447) g, and height was (48 ± 2) cm of 8 neonates, none of them was CAH. CONCLUSIONS: Medical and surgical therapy provides satisfactory fertility and pregnancy outcomes for women with 21-OHD. It is safe to pregnant women with 21-OHD and their fetus in continual lower glucocorticoid treatment. The dosage of glucocorticoid should be carefully adjusted during the pregnancy individually according to serum level of 17-OHP.

[Relationship of adverse pregnancy outcomes and a high risk serum screen for Down syndrome in the second trimester].

OBJECTIVE: To investigate the the relationship of a high risk serum screen for Down syndrome in second trimester and adverse pregnancy outcomes, and to evaluate the predictive value for adverse pregnancy outcomes. METHODS: The tri-marker second trimester maternal serum screening for Down syndrome (alpha-fetoprotein, free beta-hCG and unconjugated estriol) was performed on the pregnant women at Peking Union Medical Hospital from January 2009 to January 2011. The cutoff valvue was 1/270. Pregnancy outcomes were followed up. The general condition and pregnancy complications of the pregnant women with high risk (high-risk group) were compared to that of the pregnant women with low risk (low-risk group); and with 35 years old as a demarcation, the incidences of adverse pregnancy outcomes were calculated in the two groups. RESULTS: (1) A total of 1935 cases were collected. And 1784 cases were with low risk, and 151 cases were with high risk. The difference of weight and gestational age between the two groups was not statistically significant (P > 0.05); the difference of age between the two groups was statistically significant (P < 0.01). (2) Pregnancy complications were found in 791 cases. In high-risk group, the incidences of gestational diaetes mellitus (GDM, 13.9%), neonatal asphyxia (4.0%) and small for gestational age infant (SGA, 4.6%) were higher than that in low-risk group (8.4%, 1.0%, 1.6%), the difference was statistically significant (P < 0.05). The incidences of gestational hypertension disease, premature labor, oligohydramnios, placenta previa, placenta abruption, fetal macrosomia in the two groups was not statistically different (P > 0.05). (3) In 1705 cases aged less than 35 years, 129 cases (7.6%) were GDM, 43 cases (2.5%) were gestational hypertension disease, 61 cases (3.9%) were premature labor; in 230 cases aged 35 years or more, 41 cases (17.8%) were GDM, 12 cases (5.2%) were gestational hypertension disease, 15 cases (6.5%) were premature labor, and the difference between the two groups was statistically significant (P < 0.05). In < 35 years old group, the incidences of GDM, neonatal asphyxia and SGA (12.3%, 4.4%, 5.3%) were higher in the high-risk group than that (7.2%, 0.9%, 1.6%) in the low-risk group, and the difference was statistically significant (P < 0.05). In ≥ 35 years old group, the incidences of GDM, neonatal asphyxia and SGA (18.9%, 2.7%, 2.7%) were slightly higher in the high-risk group than that (17.6%, 1.6%, 1.6%) in the low-risk group, the difference between the two groups was not statistically significant (P > 0.05). CONCLUSIONS: The present study revealed apparent increase in the adverse pregnancy outcomes in women with a high risk of Down syndrome screening test. Advanced age is the most important risk factor for a high risk of Down syndrome screening test and adverse pregnancy outcomes. More attention should be attached to the patients whose age were < 35 years old and with a high risk of Down syndrome screening test.

[Management of pregnancy with myasthenia gravis: 7 cases report].

OBJECTIVE: To discuss the interaction of pregnancy and myasthenia gravis (MG) and the management of pregnancy with MG. METHODS: Seven cases of pregnancy with MG in Peking Union Medical College Hospital were analyzed retrospectively, with respect to the therapy of MG, pregnancy complications and outcomes. RESULTS: Totally 38,683 pregnant women were admitted to Peking Union Medical College Hospital between Oct. 1983 and Oct. 2010. Among them there were 9 patients suffered from MG, with the incidence of 0.023%. Two pregnancies were terminated because of personal reasons, and seven continued. (1) Onset of MG: in the 7 cases, 6 were diagnosed before conception, with the mean course of 5.9 years. The other one occurred in the third trimester. (2) MANAGEMENT: all the cases were under close surveillance during pregnancy. Four women took thymectomy before conception, and one of them kept taking medication after surgery. In those who received thymectomy, 3 cases remained stable and 1 case worsened during pregnancy. The latter one took medication at 33 weeks, and continued to full term. MG exacerbated in the other three women who had not undergone thymectomy before conception. Among them, one woman complicated with systemic lupus erythematosus and lupus nephritis delivered the baby at 31 weeks. (3) Delivery and neonatal outcomes: cesarean deliveries were performed in 5 cases and the other two underwent vaginal deliveries. All the newborns were admitted to neonatal intensive care unit for surveillance. There were three smaller than gestational week (SGA) infants. No MG was observed in newborns. CONCLUSIONS: Patients with MG should have an overall evaluation before conception. The course of MG during pregnancy is unpredictable. They may get a promising outcome under the control of a multidisciplinary team including obstetricians and neurologists. Newborns should be carefully monitored for sings of transitory MG in the department of pediatrics.