Distribution characteristics of asthma in preschool children and the protective effect of breastfeeding / 中国学校卫生

Objective@#To clarify the distribution of asthma in preschool children aged 3-6 years old and the protective effect of breastfeeding on asthma in three provinces in the middle and lower reaches of the Yangtze river in China.@*Methods@#The parents of 27 200 preschoolers chosen from kindergartens in 11 cities of Hubei, Jiangsu and Anhui Province were investigated with children’s asthma and breastfeeding during October to November in 2017.@*Results@#The asthma detection rate for preschoolers was 4.0%,5.0% for boys and 2.9% for girls. The asthma detection rate for children aged 3,4,5,and 6 years old was 3.2%,3.7%,4.4%,and 4.9%. 3 448 (12.7%) and 7 630 (28.1%) preschoolers were never breastfed or mainly breastfed. The rate of exclusive breastfeeding was 50.0% for 1 to 5 months and only 10.2% over 6 months. Meanwhile,there was a significant protective effect on asthma (OR=0.88,95%CI=0.77-0.89) by exclusive breastfeeding for 1-5 months,which was still statistically significant after adjusting for confounding factors. After adjusting for confounding factors,exclusive breastfeeding over 6 month have significant effected on preschool children aged 4 years old without allergic conjunctivitis history (OR=0.63,95%CI=0.40-0.99). Furthermore,exclusive breastfeeding over 6 month had important effect on preschool children aged 4 years old with eczema history (OR=0.52,95%CI=0.27-0.99).@*Conclusion@#Exclusive breastfeeding has protective effect on asthma in preschool children. Exclusive breastfeeding over 6 months even has better protective effect on asthma for the 4-years-old children without the history of allergic conjunctivitis and eczema.

Association of gestational weight gain with perinatal outcomes and optimal weight gain for twin pregnancies / 中华围产医学杂志

Objective To study the association of gestational weight gain (GWG) with perinatal outcomes in twin pregnant women categorized by different prepregnant body mass index (BMI) and to explore the optimal GWG.Methods A retrospective cohort study was conducted on 1 297 twin pregnancies delivered at Beijing Obstetrics and Gynecology Hospital,Capital Medical University from January 2013 to December 2016.Based on the prepregnant BMI categories defined by World Health Organization (WHO),these subjects were divided into four groups:under weight (n=154,BMI＜18.5 kg/m2),normal weight (n=890,BMI ≥ 18.5-＜ 25 kg/m2),overweight (n=209,BMI ≥ 25-＜30 kg/m2) and obese (n=44,BMI ≥ 30 kg/m2) groups.Women with BMI＜18.5 kg/m2 were excluded from the study and the rest 1 143 subjects were categorized into three groups according to the Institute of Medicine (IOM) guidelines:inadequate GWG (n=334),appropriate GWG (n=634) and excessive GWG groups (n=175).The association of maternal prepregnant BMI and GWG with maternal complications and neonatal weight were studied.Only 585 women who delivered twins weighted ≥ 2 500 g on average at ≥ 37 gestational weeks were included when exploring the optimal GWG.The P25-P75 of pregnant women with different prepregnant BMI was calculated to be the suitable range for weight gain during pregnancy.Chi-square test and multivariate logistic regression analysis were used for statistical analysis.Results (1) Compared with the normal weight group,the under weight group had an increased risk of low birth weight twins (OR=1.64,95％CI:1.16-2.31),but decreased risks of gestational diabetes mellitus (GDM) and cesarean section (OR=0.58,95％CI:0.35-0.96;OR=0.41,95％CI:0.22-0.77).The risks of preeclampsia (OR=1.64,95％CI:1.09-2.49;OR=2.63,95％CI:1.29-5.37) and GDM (OR=2.07,95％CI:1.49-2.89;OR=4.12,95％CI:2.23-7.60) increased in overweight and obese women.(2) Compared with the women with appropriate GWG,the risks of preterm delivery (OR=1.46,95％CI:1.12-1.91) and low birth weight twins (OR=2.03,95％CI:1.55～2.65) increased,while those of preeclampsia (OR=0.49,95％CI:0.31-0.79) and cesarean section (OR=0.38,95％CI:0.21-0.70) decreased in inadequate GWG women.Subgroup analysis according to prepregnant BMI showed that inadequate GWG increased the risks of preterm birth (OR=1.46,95％CI:1.08-1.97) and low birth weight twins (OR=2.22,95％CI:1.64-3.02) in the normal weight women,but decreased the risks of preeclampsia in both normal weight and overweight and obese women (OR=0.55,95％CI:0.31-0.97;OR=0.39,95％CI:0.16-0.94).Moreover,the risks of cesarean section for women with inadequate GWG were reduced in both normal weight and overweight and obese groups (OR=0.43 and 0.23,95％CI:0.22-0.85 and 0.06-0.96).Compared with the women with appropriate GWG,the risk of small for gestational age (SGA) (OR=0.63,95％CI:0.42-0.95)decreased,but the risk of preeclampsia increased (OR=1.71,95％CI:1.11-2.62) in excessive GWG women.Subgroup analysis by prepregnant BMI showed that excessive GWG decreased the risks of SGA (OR=0.10,95％CI:0.02-0.45) and low birth weight twins (OR=0.28,95％CI:0.11-0.71) in the overweight and obese group,but increased the risk of preeclampsia in the normal weight group (OR=2.08,95％CI:1.26-3.43).(3) Multivariate logistic regression analysis revealed that inadequate GWG was a risk factor for preterm birth (OR=1.44,95％CI:1.31-1.59) and low birth weight twins (OR=2.08,95％CI:1.70-2.53),but a protective factor for preeclampsia (OR=0.51,95％CI:0.32-0.82) and cesarean section (OR=0.38,95％CI:0.20-0.69).Excessive GWG reduced the risk of SGA (OR=0.61,95％CI:0.50-0.75),but increased the risk of preeclampsia (OR=1.65,95％CI:1.07-2.55).(4) The total GWG reference values (P25-P75) for twin pregnancies at term were 17-25 kg for under weight women,17-24 kg for normal weight women,14-22 kg for overweight women and 9.5-17 kg for obese women.Conclusions Adverse perinatal outcomes might be increased in either inadequate or excessive GWG in normal prepregnant weight women with twins,so IOM guidelines is recommended in GWG management in this population.The optimal total GWG reference values (P25-P75) for non-obese twin pregnancies are consistent with the IOM recommendations,but those for obese women are yet to be explored.

The relationship between changes in ideal cardiovascular health score and the carotid intima-media thickness among the middle age and elderly population / 中华心血管病杂志

<p><b>OBJECTIVE</b>To explore the relationship between changes in ideal cardiovascular health score(ΔICHS) and the carotid intima-media thickness(CIMT) among the middle age and elderly population.</p><p><b>METHODS</b>A total of 5 852 cases were enrolled from 101 510 Kailuan Group employees who participated in the health examination in 2006-2007 and 2010-2011 through stratified random sampling. A total of 5 440 individuals met the inclusion criteria (≥40 years old; no history of stroke, transient ischemic attack, or myocardial infarction). CIMT was measured by ultrasound during 2010-2011 examination. Excluding individuals with incomplete data, 4 367 cases were included for the final analysis. According to the AHA definition of ideal cardiovascular health metric, individual ΔICHS was evaluated and the subjects were divided into 3 groups: group reduced (ΔICHS<0, n=1 355), invariant group (ΔICHS=0, n=1 451) and elevated group (ΔICHS>0, n=1 561). ΔICHS was derived from the difference between 2010-2011 and 2006-2007. Multivariate linear regression and logistic regression analysis were used to analysis the relationship between ΔICHS and CIMT.</p><p><b>RESULTS</b>The ICHS was 3.03 ± 1.27 in 2006-2007 study population and 3.09 ± 1.40 (P<0.01) in 2010-2011 study population. Multivariate linear regression analysis showed that ΔICHS was inversely related to CIMT. For every 1 score increase in ΔICHS, CIMT decreased by 0.009 mm(B=-0.009, P<0.01). Multivariate logistic regression analysis showed that after adjusting for multiple confounding factors, the risk of CIMT wall thickening was lower in the ΔICHS invariant group (OR=0.73, 95%CI: 0.59-0.91) and in ΔICHS elevated group(OR=0.66, 95%CI: 0.52-0.82) compared to the ΔICHS reduce group.</p><p><b>CONCLUSION</b>Elevated ΔICHS is an independent protective factors of CIMT increase in the middle age and elderly population.</p>

Analysis of the effect and safety of atorvastatin in the treatment of septic shock / 中国基层医药

Objective To explore the clinical efficacy and safety of atorvastatin in the treatment of patients with septic shock.Methods 67 patients with septic shock were randomly divided into the treatment group (34 cases) and control group(33 cases).The control group was treated with conventional therapy ,and the observation group was administered with atorvastatin based on the control group .Before and after treatment ,the inflammatory index ,cytokines levels,the number of MODS cases,the number of deaths at 28th day,and the incidence of adverse reactions were com-pared between the two groups .Results The heart rate ,respiratory rate ,white blood cell count of the treatment group were significantly better than the control group ,the cytokines levels were significantly lower than the control group ,the differences were statistically significant (t=4.181,3.622,4.879,all P0.05).Conclusion Atorvastatin can effectively reduce the degree of inflammatory reaction in patients with septic shock ,decrease the incidence of MODS , and has potential benefits on the prognosis of patients , but still need to be further confirmed by clinical research .