Effects of galactooligosaccharides on maternal gut microbiota, glucose metabolism, lipid metabolism and inflammation in pregnancy: A randomized controlled pilot study.

Background: Gut microbiota of pregnant women change with the gestational week. On the one hand, they participate in the metabolic adaptation of pregnant women. On the other hand, the abnormal composition of gut microbiota of pregnant women is more likely to suffer from gestational diabetes mellitus (GDM). Therefore, gut microbiota targeted treatment through dietary supplements is particularly important for prevention or treatment. Prebiotic supplements containing galactooligosaccharides (GOS) may be an intervention method, but the effect is still unclear. Objective: This study aims to evaluate the feasibility and acceptability of prebiotic intervention in healthy pregnant women during pregnancy, and to explore the possible effects of intervention on pregnant women and the influence on gut microbiota as preliminaries. Methods: After recruitment in first trimester, 52 pregnant women were randomly assigned to receive GOS intervention or placebo containing fructooligosaccharides. 16S rRNA sequencing technology was used to detect the composition, diversity and differential flora of gut microbiota. Lipid metabolism, glucose metabolism and inflammatory factors during pregnancy were also analyzed. Results: The adverse symptoms of GOS intervention are mild and relatively safe. For pregnant women, there was no significant difference in the GDM incidence rates and gestational weight gain (GWG) in the GOS group compared with placebo (P > 0.05). Compared with the placebo group, the levels of FPG, TG, TC, HDL-C LDL-C, and IL-6 had no significant difference in GOS group (P > 0.05). For newborns, there was no significant difference between GOS group and placebo group in the following variables including gestational week, birth weight, birth length, head circumference, chest circumference, sex, and delivery mode (P > 0.05). And compared with the placebo group, the GOS group had a higher abundance of Paraprevotella and Dorea, but lower abundance of LachnospiraceaeUCG_001. Conclusions: GOS prebiotics appear to be safe and acceptable for the enrolled pregnancies. Although GOS intervention did not show the robust benefits on glucose and lipid metabolism. However, the intervention had a certain impact on the compostion of gut microbiota. GOS can be considered as a dietary supplement during pregnancy, and further clinical studies are needed to explore this in the future.

The Impact of Cardiac Dysfunction Based on Killip Classification on Gastrointestinal Bleeding in Acute Myocardial Infarction.

Background: Owing to limited data, the effect of cardiac dysfunction categorized according to the Killip classification on gastrointestinal bleeding (GIB) in patients with acute myocardial infarction (AMI) is unclear. The present study aimed to investigate the impact of cardiac dysfunction on GIB in patients with AMI and to determine if patients in the higher Killip classes are more prone to it. Methods: This retrospective study was comprised of patients with AMI who were admitted to the cardiac intensive care unit in the Heart Center of the Beijing Chaoyang Hospital between December 2010 and June 2019. The in-hospital clinical data of the patients were collected. Both GIB and cardiac function, according to the Killip classification system, were confirmed using the discharge diagnosis of the International Classification of Diseases, Tenth Revision coding system. Univariate and multivariate conditional logistic regression models were constructed to test the association between GIB and the four Killip cardiac function classes. Results: In total, 6,458 patients with AMI were analyzed, and GIB was diagnosed in 131 patients (2.03%). The multivariate logistic regression analysis showed that the risk of GIB was significantly correlated with the cardiac dysfunction [compared with the Killip class 1, Killip class 2's odds ratio (OR) = 1.15, 95% confidence interval (CI): 0.73-1.08; Killip class 3's OR = 2.63, 95% CI: 1.44-4.81; and Killip class 4's OR = 4.33, 95% CI: 2.34-8.06]. Conclusion: This study demonstrates that the degree of cardiac dysfunction in patients with acute myocardial infarction is closely linked with GIB. The higher Killip classes are associated with an increased risk of developing GIB.

The Influence of Maternal Vitamin E Concentrations in Different Trimesters on Gestational Diabetes and Large-for-Gestational-Age: A Retrospective Study in China.

Vitamin E can protect pregnant women from oxidative stress and further affect pregnancy outcomes. This study aimed to investigate maternal vitamin E concentration in each trimester and its associations with gestational diabetes (GDM) and large-for-gestational-age (LGA). The data were derived from Peking University Retrospective Birth Cohort in Tongzhou, collected from 2015 to 2018 (n = 19,647). Maternal serum vitamin E were measured from blood samples collected in each trimester. Logistic regressions were performed to analyze the association between maternal vitamin E levels and outcomes. The median levels of maternal vitamin E increased from the first (10.00 mg/L) to the third (16.00 mg/L) trimester. Among mothers who had inadequate vitamin E levels, most of them had excessive amounts. Excessive vitamin E level in the second trimester was a risk factor for GDM (aOR = 1.640, 95% CI: 1.316-2.044) and LGA (aOR = 1.334, 95% CI: 1.022-1.742). Maternal vitamin E concentrations in the first and second trimesters were positively associated with GDM (first: aOR = 1.056, 95% CI: 1.038-1.073; second: aOR = 1.062, 95% CI: 1.043-1.082) and LGA (first: aOR = 1.030, 95% CI: 1.009-1.051; second: aOR = 1.040, 95% CI: 1.017-1.064). Avoiding an excess of vitamin E during pregnancy might be an effective measure to reduce GDM and LGA. Studies to explore the potential mechanisms are warranted.

Impact of Prior Digestive System Disease on In-Hospital Gastrointestinal Bleeding in Patients with Acute Myocardial Infarction.

OBJECTIVE: Patients presenting with acute myocardial infarction (AMI) with prior digestive system disease are more likely to suffer from gastrointestinal (GI) bleeding than those without these diseases. However, few articles reported how the different conditions of the digestive tract produced different risks of GI bleeding. METHODS: A single-center study on 7464 patients admitted for AMI from December 2010 to June 2019 in the Beijing Chaoyang Heart Center was retrospectively examined. Patients with major GI bleeding (n = 165) were compared with patients without (n = 7299). Univariate and multivariate logistic regression models were constructed to test the association between GI bleeding and prior diseases of the digestive tract, including gastroesophageal reflux disease, chronic gastritis, peptic ulcer, hepatic function damage, diseases of the colon and rectum, and gastroenterological tract tumors. RESULTS: Of the 7464 patients (mean age, 63.4; women, 25.6%; STEMI, 58.6%), 165 (2.2%) experienced major GI bleeding, and 1816 (24.3%) had a history of digestive system disease. The risk of GI bleeding was significantly associated with peptic ulcer (OR = 4.19, 95% CI: 1.86-9.45) and gastroenterological tumor (OR = 2.74, 95% CI: 1.07-7.04), indicated by multivariate logistic regression analysis. CONCLUSION: Preexisting peptic ulcers and gastroenterological tract tumors rather than other digestive system diseases were indicators of gastrointestinal bleeding in patients with AMI who undergo standard antithrombotic treatment during hospitalization.

CT radiomics features as a diagnostic tool for classifying basal ganglia infarction onset time.

OBJECTIVE: This study was aimed to discuss the application of radiomics using CT analysis in basal ganglia infarction (BGI) for determining the time since stroke onset (TSS) which could provide critical information to clinicians in deciding stroke treatment options such as thrombolysis. METHODS: This study involved 316 patients with BGI (237 in the training cohort and 79 in the independent validation cohort). Region of interest segmentation and feature extraction was done by ITK-SNAP software. We used the existing medical history to binarize the TSS into two categories: positive (< 4.5 h) and negative (≥ 4.5 h). The key radiomic signature features were retrieved by the least absolute shrinkage and selection operator multiple logistic regression model. Receiver operating characteristic curve and AUC analysis were used to evaluate the performance of the radiomic signature in both the training and validation cohorts. RESULTS: 295 features were extracted from a manually outlined infarction region. Five features were selected to construct the radiomic signature for TSS classification purposes. The performance of the radiomic signature to distinguish between positive and negative in the training cohort was good, with an AUC of 0.982, a sensitivity of 0.929, and a specificity of 0.959. In the validation cohort, the radiomic signature showed an AUC of 0.974, a sensitivity of 0.951, and a specificity of 0.961. CONCLUSION: A unique radiomic signature was constructed for use as a diagnostic tool for discriminating the TSS in BGI and may guide decisions to use thrombolysis in patients with unknown times of BGI onset.

Design, synthesis, biological evaluation, structure-activity relationship, and toxicity of clinafloxacin-azole conjugates as novel antitubercular agents.

Based on the advantages of azole molecules and fluoroquinolone drugs, we designed and synthesized 34 clinafloxacin-azole conjugates using fragment-based drug design and drug combination principles. The in vitro activities of the synthesized conjugates against Mycobacterium tuberculosis (H37Rv), Hela cell as well as Gram-positive and Gram-negative bacteria were assayed. The bioassay results revealed that most of the target molecules had anti-tuberculosis (anti-TB) activity, of which 14 compounds had very strong anti-TB activity [minimum inhibitory concentration (MIC) < 2 µM]. In addition, the compounds with strong activity towards H37Rv had weak activity towards Gram-negative and Gram-positive bacteria, showing obvious selectivity towards H37Rv. Predicted toxicity data indicated that 27 molecules were less toxic or equivalent to that of the original drug (clinafloxacin). Especially, it is demonstrated that compound TM2l exhibited the strongest anti-TB activity (MIC = 0.29 µM), low antibacterial activity, negligible toxicity, and good drug-likeness values, which can be considered as an ideal lead molecule for future optimization.

Effects of ovarian reserve and hormone therapy on hearing in premenopausal and postmenopausal women: A cross-sectional study.

OBJECTIVES: To observe the hearing function around menopause, to analyze the effects of ovarian reserve and hormone therapy on hearing, and to study factors related to hearing loss among women around menopause. STUDY DESIGN: In this cross-sectional study, we evaluated 109 women around menopause aged 45-55 years, including 40 women with ovarian failure, 48 with ovarian non-failure, and 21 receiving hormone therapy. All women underwent an audiologic evaluation, and hormone blood testing was performed. The general condition, reproductive history, medical history, lifestyle, and menopausal symptoms were collected through a questionnaire. MAIN OUTCOME MEASURE: The auditory threshold and anti-Mullerian hormone level. RESULTS: Women in the ovarian failure group presented with a decreased hearing level in all frequency bands compared with those in the ovarian non-failure group; the significant differences occurred at 8000 Hz, 10 000 Hz, 12 500 Hz, and 16 000 Hz in the right-ear air conduction. The auditory threshold was lower in the hormone therapy group than in the ovarian failure group, but the difference was statistically significant only in the right-ear air conduction at 10 000 Hz. There were two risk factors for hearing loss: an anti-Mullerian hormone level <0.01 ng/mL (odds ratio [OR] = 2.624) and frequent earphone use (OR = 3.846). CONCLUSIONS: A decline in ovarian function is associated with hearing loss in women, especially in relation to extended high-frequency air conduction of the right ear. Preserving ovarian function and reducing earphone use are important measures to protect women's hearing. However, the effect of hormone therapy on hearing requires further investigation.

Inequality of obstetric and gynaecological workforce distribution in China.

BACKGROUND: Women's health is defined as a continuum throughout their whole lives. In China, women receive life-round preventative and curative health care from the health system, although the universal access to reproductive health has already been basically achieved in China, the situation of women's access to curative health care is still unknown. METHODS: Data from the national maternal and child health human resource investigation were analysed. Lorenz curves, Gini coefficients, and Theil L indexes were drawn and calculated to reflect the inequality. Demographically, we found that the Obstetric and gynaecological (OB/GYN) workforce was the least equitable regarding the distribution of live births. RESULTS: Demographically, we found that the OB/GYN workforce was the least equitable regarding the distribution of live births. The geographic distribution of the OB/GYN workforce was found to be severely inequitable, especially in the West region. Most of the inequality was found to come from inner-regions. CONCLUSION: For the first time, the distribution inequality of OB/GYN workforce in China was analysed. The findings in this study can be adopted in making national or regional OB/GYN workforce allocation policies, but further studies are still needed to reveal the detailed sources of inequality and to provide evidence for local policy-making.

Inequality of Paediatric Workforce Distribution in China.

Child health has been addressed as a priority at both global and national levels for many decades. In China, difficulty of accessing paediatricians has been of debate for a long time, however, there is limited evidence to assess the population- and geography-related inequality of paediatric workforce distribution. This study aimed to analyse the inequality of the distributions of the paediatric workforce (including paediatricians and paediatric nurses) in China by using Lorenz curve, Gini coefficient, and Theil L index, data were obtained from the national maternal and child health human resource sampling survey conducted in 2010. In this study, we found that the paediatric workforce was the most inequitable regarding the distribution of children <7 years, the geographic distribution of the paediatric workforce highlighted very severe inequality across the nation, except the Central region. For different professional types, we found that, except the Central region, the level of inequality of paediatric nurses was higher than that of the paediatricians regarding both the demographic and geographic distributions. The inner-regional inequalities were the main sources of the paediatric workforce distribution inequality. To conclude, this study revealed the inadequate distribution of the paediatric workforce in China for the first time, substantial inequality of paediatric workforce distribution still existed across the nation in 2010, more research is still needed to explore the in-depth sources of inequality, especially the urban-rural variance and the inner- and inter-provincial differences, and to guide national and local health policy-making and resource allocation.

China's human resources for maternal and child health: a national sampling survey.

BACKGROUND: In order to achieve the Millennium Development Goals (MDG) 4 and 5, the Chinese Government has invested greatly in improving maternal and child health (MCH) with impressive results. However, one of the most important barriers for further improvement is the uneven distribution of MCH human resources. There is little information about the distribution, quantity and capacity of the Chinese MCH human resources and we sought to investigate this. METHODS: Cities at prefectural level were selected by random cluster sampling. All medical and health institutions providing MCH-related services in the sampled areas were investigated using a structured questionnaire. The data were weighted based on the proportion of the sampled districts/cities. Amount, proportions and numbers per 10,000 population of MCH human resources were estimated in order to reveal the quantity of the Chinese MCH human resources. The capacity of MCH human resources was evaluated by analyzing data on the education level and professional skills of the staff. RESULTS: There were 77,248 MCH workers in China in 2010. In general, 67.6% and 71.9% of the women's and children's health care professionals had an associate degree or higher, whereas around 30% had only high-school or lower degrees. More than 40% of the women's health workers were capable of providing skilled birth attendance, but these proportions varied between different institutions and locations. CONCLUSIONS: Evidence from this study highlights that Chinese MCH human resources are not in shortage in the national level. However, the quantity and capacity of MCH human resources are not evenly distributed among different institutions and locations. Finally there is a need in the improvement of the MCH services by improving the quality of MCH human resources.

An analysis of women's and children's health professional requirements in China in 2010 based on workload.

BACKGROUND: To make health services more equitable and accessible for women and children and to achieve a universal coverage, human resources for women and children's health (WCH) should be evaluated. However, since there is still no consensus on the real situation of Chinese WCH professionals, we aim with this study to compare the actual and required amount of WCH professionals for China. METHODS: The data of the actual number of WCH professionals and workload of each service type was obtained by a national institution-based sampling survey. We then estimated the time that a WCH professional spends at work (annually), the time norm of each service schedule and the required number of WCH professionals based on workload. We evaluated the situation of Chinese WCH professionals in 2010 by comparing the actual and required WCH professionals and by calculating the ratios of the actual-to-required number of staff. RESULTS: There were 515,778 health professionals providing WCH services in the investigated 5,168 medical/health institutions in 2010. Workloads of most WCH services in east areas were larger than that in the central and the west. For women's health, the numbers of required WCH professionals were 48510, 43992, 40571 and 133073 for the east, the central, the west areas and the whole nation respectively. For children's health professionals, the corresponding numbers were 56241, 36818, 40618 and 133677 for the east, the central, the west and the whole nation. CONCLUSIONS: The WCH professionals in China were sufficient for workload in 2010, there were still lots of potential capacities to provide better services, especially for women. Strategies should be taken to improve the quality of WCH professionals or their working motivation.

Utilisation of antenatal care in four counties in Ningxia, China.

OBJECTIVES: To analyse and evaluate the antenatal care services and its quality so as to improve the antenatal care, and make it more available and cost-effective. DESIGN: Retrospective survey. A multistage sampling technique was used to select townships and villages. SETTING: The four rural counties of a project in Ningxia Hui Autonomous Region in northwest China, where more than one half of the population was Hui ethnicity, the average hospital delivery rate was 47% in 2005, and the maternal mortality ratio was estimated to be higher than 65 deaths per 100,000 live births in 2005. PARTICIPANTS: Five hundred and fifty-four mothers of children under the age of five were interviewed at home using a structured questionnaire between August and September in 2006. No mothers refused to take part in the survey. MEASUREMENTS AND FINDINGS: The percentage using antenatal care, the number of antenatal visits and the timing of the first antenatal visit during the pregnancy of the youngest child were analysed. 78.2% of the mothers had received antenatal care services, but only 12.9% had at least five antenatal visits and 35.2% had their initial visit in the first trimester. Only 9.0% whose first antenatal visit took place during the first trimester had at least five antenatal visits. Ethnicity was an important factor determining antenatal care use. Hui mothers had significantly lower odds ratios of obtaining antenatal care in the first trimester (OR = 0.32, P < 0.001) or having at least five antenatal visits (OR = 0.11, P < 0.001) than Han mothers. KEY CONCLUSIONS: The quality of the antenatal care which the women received was low. It is necessary to rethink the current model of antenatal care, and to develop and standardise a new model of antenatal care.

[Forecast of the indicators on maternal and child health of China in 2020 using auto-regressive model].

OBJECTIVE: To forecast the indicators on maternal and child health of China in 2020. METHODS: Based on Surveillance data of the indicators on the maternal and child health in China since the 1990s, forecasting models were found using auto-regressive method, and the indicators on maternal and child health in China in 2020 were forecasted using the models after they had been tested and valued. RESULTS: Auto-regressive models on infant mortality rate (IMR), under-5 mortality rate (U5MR) and maternal mortality (MMR) were found. The models and their parameters passed statistical tests, and their mean absolute error was 5% or so and determination coefficients were all more than 90%. CONCLUSION: The IMR of China in 2020 was forecasted to be 0.635%, the U5MR 0.737% and the MMR 22.21/100 000.