[Analysis on depression state outcomes and influencing factors of persistent depression in pregnant and perinatal women in China].

Objective: To investigate the depression status of pregnant and perinatal women in early, medium-term, late pregnancy and postpartum period in China and the outcomes of depression in each period, analyze the influential factors of depression status. Methods: By using the pregnant and perinatal women mental health cohort established by National Center for Women and Children's Health of Chinese Center for Disease Control and Prevention, Haidian District Maternal and Child Health Hospital of Beijing, Women Health Center of Shanxi, Jilin Women and Children Health Hospital, Zhuhai Center for Maternal and Child Health Care and Shenzhen Maternity and Child Healthcare Hospital of Guangdong province, a follow up study was conducted at 7 time points during pregnancy and perinatal period in pregnant and perinatal women in Beijing, Shanxi, Jilin and Guangdong from August 1, 2015 to October 31, 2016. The self-filled questionnaire and Edinburgh Postpartum Depression Scale (EPDS) were used to obtain the general demographic information and depression status of the pregnant and perinatal women, and the depression status and natural outcomes of the pregnant and perinatal women were analyzed. Results: A total of 1 284 pregnant and perinatal women were recruited. In this study, a total of 1 210 subjects who completed follow-up at least 6 times and postpartum 42 day follow up were included in the final analysis. The EPDS depression score at the gestation week 13 was used to indicate the depression status in early pregnancy, the average EPDS score of gestation week 17 and 24 were used to indicate the depression status in medium-term pregnancy, and the average EPDS score of gestation week 31 and 37 were used to indicate depression in late pregnancy. The average EPDS score of postpartum day 3 and 42 were used to indicate postpartum depression status. A total of 321 (26.5%), 218 (18.0%), 189 (15.6%) and 219 (18.1%) pregnant and perinatal women were found to have depression, respectively, in early, medium-term and late pregnancy and in postpartum period. The depression status in early, medium-term and late pregnancy and postpartum period were positively correlated (P<0.001), the correlation between early and middle pregnancy was strong (r=0.678), the correlation between medium-term and late pregnancy was strong (r=0.771), and the correlation between postpartum period and late pregnancy was strong (r=0.706). Among the pregnant women with depression in early pregnancy, 26.2% were depressed during the whole study period, 42.7% were depressed during postpartum period, and the results of multifactorial analysis showed that the education level of college or above of the pregnant and perinatal women (OR=0.437, 95%CI: 0.212-0.900, P=0.025), exercise during pregnancy (OR=0.586, 95%CI: 0.348-0.987, P = 0.044), high marital satisfaction (OR = 0.370, 95%CI: 0.221-0.620, P<0.001), normal body mass index (BMI) (OR=0.516, 95%CI: 0.270-0.985, P=0.045) reduced the risk for depression. Unsatisfactory living environment (OR=1.807, 95%CI: 1.074-3.040, P=0.026) increased the risk for depression. Conclusions: In pregnant and perinatal women in China, the detection rate of depression in early pregnancy was highest compared with those in medium-term and late pregnancy. The detection rate of depression increased again in postpartum period. The depression status detected in the early pregnancy remained in the medium-term and late pregnancy and postpartum period. Exercise, BMI, educational level, living environment satisfaction and marital satisfaction can affect the incidence of depression in pregnant and perinatal women.

[The status of menopause outpatient clinics in maternal and children health institutions and general hospitals in 11 provinces of China].

Objective: To understand the status of menopause outpatient clinics in maternal and children health (MCH) institutions and general hospitals. Methods: A total of 314 health administrative departments, MCH health institutions and general hospitals in 11 provinces of China were enrolled by using multi-stage random sampling method. A self-made questionnaire was used to investigate the development of normative documents for menopausal health work, and the establishment, services, health resources, system and information management of menopause outpatient clinics. The current situation of menopause outpatient clinics in MCH institutions was compared with that in general hospitals. Results: All health administrative departments did not formulate normative documents for menopausal health care. Among MCH health institutions and general hospitals, 53.4% (111/208) established menopause outpatient clinic. About 60.9% (64/105) of MCH institutions established menopause outpatient clinic, which was higher than that of general hospitals [45.6% (47/103)] (P<0.05). From high priority to less, the services of menopause outpatient clinics were menopausal disease diagnosis and treatment, counseling, health education and disease referral. 90.1% (100/111) of menopause outpatient clinics provided routine medical examinations, and only 55.9% (62/111) and 59.5% (66/111) of them provide psychological and nutritional status assessment. The allocation rate of commonly used examination equipment in menopause outpatient clinics was 81.1%-96.4%, while only 28.8%-37.8% of them had psychological status assessment tool, human body composition analyzer and nutrition status assessment tool. Among 111 menopause outpatient clinics, 46.8% (n=52), 36.0% (n=40), and 34.2% (n=38) of them established outpatient consultation process, referral (consultation) work system, and follow-up work system, and 49.5% (n=55), 29.7% (n=33), 42.3% (n=47), and 17.1% (n=19) of them established visit registration, health records, follow-up records of referrals, and reported outpatient services, respectively. Conclusion: Menopause outpatient clinics in 11 provinces of China have been initially established, and policy guidance and human resources allocation should be further strengthened.

[Analysis of the reported data of national rural cervical cancer screening project from 2012 to 2013, China].

OBJECTIVE: To analyze the reported data of national rural cervical cancer screening project from 2012 to 2013 and to evaluate the project implementation condition. METHODS: Data of the national breast carcinoma and cervical cancer (two-cancer) screening project for rural women were collected from the online report system of key women and children's public health service programs.The screening items included: preliminary screening of cervical lesions (cervical cytology, using Traian Bethesda System(TBS) or Pap grading for classification and reporting), acetate/iodide staining (VIA/VILI), colposcopy, histopathological examination, and pathological diagnosis. The study collected the quarterly reported data from 1 183 counties of 30 provinces in 2014 and 1 130 counties of 30 provinces in 2013. Chi-square test was used to test the difference of positive detection rate, as well as precancerous cervical lesions, and cervical cancer detection rates among difference preliminary screening methods in 2012 and 2013. RESULTS: In 2012 and 2013, the number of cervical cancer screening was 10 621 482 and 10 321 835. The percentage of using ThinPrep cytological test as the screening method was 77.17% (n=8 196 627) and 77.07% (n=7 954 949) in 2012 and 2013, respectively. Among these ThinPrep cytological tests in these two years, 65.49% (n=5 368 194) and 71.67% (n=5 701 033) used TBS report system. The abnormality rate of colposcopy increased from 27.29% (170 063/623 161) to 31.15% (203 397/652 935) (χ(2)=2 295.94,P<0.001). The abnormality rate of histopathology test increased from 19.54% (37 992/194 394) to 35.43% (59 004/166 518) (χ(2)=11 523.58, P<0.001). All together, 27 341 cervical cancer or precancerous lesions have been detected in these two years. The detection rate of invasive cervical cancer increased from 18.02/100 000 in 2012 to 19.71/100 000 (χ(2)=7.90,P=0.005) in 2013 and that of precancerous lesions rose from 106.85/100 000 to 119.26/100 000 (χ(2)=70.82,P<0.001). The early detection rate was 89.60% (11 883/13 263), and 89.57% (12 609/14 078), respectively in 2012 and 2013. In these two years, the rank of the detection rate of each cervical lesion were CIN1, CIN2, CIN3, invasive carcinoma, adenocarcinoma in situ, and microinvasive carcinoma, from the highest rate to the lowest rate. CONCLUSION: The program has achieved certain screening effect and the screening method has been improved. However, the quality of colposcope and histopathology should be enhanced.

Autophagic and apoptotic cell death in amniotic epithelial cells.

The aim of this paper is to determine if autophagic cell death is associated with apoptosis and whether it participates in the process of term amniotic rupture. Forty pieces of fresh term amnions, including twenty from a position near the margin of the placentas and twenty from the margin of the naturally ruptured part of the placentas in term gestation were collected, respectively. The amnions were examined by scanning electron microscopy (SEM) and amniotic epithelial (AE) cells were examined by transmission electron microscopy (TEM). Autophagic and apoptotic cell death (PCD) were assayed by laser scanning confocal microscopy (LSCM) or flow cytometry using monodansylcadaverin (MDC) and propidium iodide (PI) stain. BCL(2) and BAX were examined by immunoblotting. Under SEM the amniotic epithelia appeared normal in the position near the placenta. They had an atrophied appearance in the margin of their natural broken parts. In the AE cells PCD was divided into three subtypes by TEM: autophagic cell death with positive stains of MDC and PI; apoptotic cell death; and the mixed type. Quantitative detection showed that there were more death cells, including autophagic and apoptotic, in the AE cells near the ruptured parts than near the placentas. An increased expression of BAX and a decreased expression of BCL(2) protein in the AE cells near the broken margin were observed. Apoptotic and autophagic cell death by the intrinsic pathway are the basic event in the AE cell and they are involved in the cause of membrane rupture of the human amnion in term gestation.

Expression of Egr-1 gene and its correlation with the oncogene proteins in non-irradiated and irradiated esophageal squamous cell carcinoma.

We study the expression of early growth response gene-1 (Egr-1 gene) in non-irradiated and irradiated human esophageal cancer tissues, and its relationship with the expression of C-fos, C-jun onco-proteins as well as Egr-1 target gene proteins P53, Rb and Bax expression. In situ hybridization (ISH) and immunohistochemistry (IHC) were used respectively to detect Egr-1 mRNA, Egr-1, C-fos, C-jun, P53, Rb and Bax proteins in 80 surgically resected non-irradiated and irradiated tumor specimens of esophageal squamous cell carcinoma. Egr-1 gene mRNA and Bax protein were located in the cytoplasm, whereas Egr-1, C-fos, C-jun, P53, Rb proteins were located in the nuclei. Egr-1 was expressed in nine out of 40 cases (22.5%) of non-irradiated and 23 of 40 cases (57.5%) of irradiated tumor specimens. No correlation was found between Egr-1 gene expression and C-fos, C-jun onco-proteins expression, neither was any correlation disclosed between Egr-1 gene expression with its target gene protein expression. Patients who underwent radiotherapy with Egr-1 overexpressed in their cancer tissue had better prognosis. Radiotherapy up-regulates Egr-1 expression in esophageal carcinoma. Egr-1 overexpression may be a potential radiation response gene marker and may play an important role in prognosis of esophageal squamous cell carcinoma.