Characteristics of dermatitis herpetiformis in China: a literature review from 1995 to 2018 / 中华皮肤科杂志

Objective:To summarize characteristics of dermatitis herpetiformis (DH) patients in China.Methods:Published literature on DH in Chinese patients was searched in China National Knowledge Infrastructure database, Wanfang data and PubMed database from establishment of these databases to December 2020. Patients were screened according to the inclusion and exclusion criteria, and characteristics of patients meeting the diagnostic criteria were analyzed.Results:A total of 55 patients with DH were involved in this study. Among these patients, the average age of onset was 44.9 ± 18.5 years, the ratio of males to females was about 2.5∶1, and the average period of delayed diagnosis was 4.1 years. Skin lesions mainly manifested as tense blisters on an erythematous base, and were distributed on the buttocks, elbows, back, knees, etc. Histopathological examination of 39 cases showed subepidermal blisters in 37, and neutrophil infiltration in 17. Direct immunofluorescence study of perilesional skin tissues of 33 cases showed granular IgA deposition in 31, and IgA deposits limited to the dermal papilla in 23. Among 39 cases with available data on treatment, 25 were treated with dapsone alone or in combination with a gluten-free diet, most of whom achieved marked therapeutic outcomes with subsidence of skin lesions within 1 month.Conclusions:DH in China mainly clinically manifests as tense blisters on an erythematous base, and is mainly characterized by granular IgA deposition under a direct immunofluorescence microscope. Genetic factors are involved in its etiology, and dapsone is effective for its treatment.

Practice audits to reduce caesareans in a tertiary referral hospital in south-western China.

OBJECTIVE: To assess the effectiveness of a three-stage intervention to reduce caesarean deliveries in a Chinese tertiary hospital. METHODS: A retrospective study was conducted to assess whether educating staff, educating patients and auditing surgeon practices (introduced in 2005) had reduced caesarean delivery rates. Multiple logistic regression was used to check for a potential association between caesarean rates and rates of admission to the neonatal intensive care unit (NICU). FINDINGS: The caesarean delivery rate ranged from 53.5% to 56.1% in 2001-2004 and from 43.9% to 36.1% in 2005-2011. When 2001-2004 and 2005-2011 were treated as "before" and "after" periods to evaluate the intervention's impact on the mean caesarean section rate, a significant reduction was noted: from 54.8% to 40.3% (odds ratio, OR: 0.56; 95% confidence interval, CI: 0.52-0.59; χ(2) test: P < 0.001). The overall drop in the caesarean section rate was significant (χ(2) test: P < 0.001) and inversely correlated with the years (Spearman's ρ: -0.096; P < 0.001). Although complicated pregnancies increased after 2004, the primary caesarean section rate decreased annually by 20% on average in 2005-2011, after practice audits were implemented. Multiple logistic regression showed a positive association between the caesarean delivery rate and the rate of admission to the NICU (adjusted OR: 1.26; 95% CI: 1.14-1.40). CONCLUSION: Patient and staff education and practice audits reduced the Caesarean section rate in a tertiary referral hospital without an increase in admissions to the NICU.

Relationship between maternal red cell index in early pregnancy and gestational diabetes mellitus in Kunming / 中华围产医学杂志

Objective To investigate the role of hemoglobin (Hb),red blood cell count (RBC) and hematocrit (HCT) during the first trimester in predicting the occurrence of gestational diabetes mellitus (GDM) in the third trimester in nonanemic women in Kunming.Methods A prospective study was carried out.Routine blood tests were performed in 1189 nondiabetic singleton pregnant Chinese women at their initial prenatal healthcare before 14 gestational weeks in the First Affiliated Hospital of Kunming Medical University from January 1,2008 to December 31,2009.They were divided into four groups by quartiles of Hb,RBC and HCT levels respectively.Differences of GDM incidence at the third trimester were compared among groups.Kollmogorov Smirnov test was used to detect normal distribution of Hb,RBC and HCT results.Differences between rates of groups were detected by Chi-square test.Independent risk factors of GDM were screened by Logistic regression analysis.Results The incidence of GDM at the third trimester increased as quartile categories of Hb,RBC and HCT ascended.The GDM incidence (13.1 ％,34/259) of ≥75th Hb group was higher than that of ＜ 25th group (5.9 ％,18/304,x2 =8.53,P＜ 0.0 1),25th ～ group (9.2 ％,30/326,x2=4.18,P＜0.05) and 50th～ group (9.3％,28/300,x2=3.96,P＜0.05).The GDM incidence (11.7 ％,34/290) of 50th～ RBC group (RBC≥4.44 × 1012/L) was higher than that of ＜25th group (6.3％,19/304,x2=5.30,P＜0.05),25th～ group (7.0％,21/298,x2 =3.93,P＜0.05); and the GDM incidence (12.1％,36/297) of ≥75th group was also higher than that of ＜25th group (6.3％,19/304,x2 =6.49,P＜0.05),25th～ group (7.0％,21/298,x2=3.85,P＜0.05).The GDM incidence of ＜25th HCT group (5.3％,16/303) was lower than that of 25th～ group (9.3％,29/311,x2=7.04,P＜0.01),50th～ group (10.8％,31/287,x2=3.93,P＜0.05) and ≥75th group (11.8％,34/288,x2=6.49,P＜0.05).Logistic regression analysis showed that Hb (OR=1.031,95％ CI:1.010-1.052),RBC (OR=2.286,95％CI:1.318-3.963) and HCT (OR=1.106,95％ CI:1.037-1.179) were independent risk factors of GDM (all P＜0.05).Conclusions High maternal Hb,RBC and HCT levels in the first trimester could be used in predicting GDM in pregnant women in Kunming area.