[Analysis of adverse pregnancy outcomes and related factors in pregnant women with syphilis infection in Guangxi of China, 2014-2018].

Objective: To analyze the status and related factors of adverse pregnancy outcomes in pregnant women with syphilis infection in Guangxi Zhuang Autonomous Region. Methods: A total of 9378 pregnant women with syphilis infection who were diagnosed by Guangxi medical and health care institutions at all levels and were registered in the national "Management information system for mother-to-child transmission of AIDS, syphilis and hepatitis B" . The delivery date of these pregnant women were from 1 January 2014 to 31 December 2018, and their demographic characteristics, treatment, non-treponema pallidum titer, and pregnancy outcomes were collected. Multivariate logistic regression model was used to analyze the related factors of adverse pregnancy outcome. Results: The age of the pregnant women with syphilitic infection was (30.05±6.07) years old. There were 1 184 cases with an adverse pregnancy outcome. The incidence of adverse pregnancy outcome was 12.63%, and 83.30% (7 812 cases) of patients received syphilis treatment, of which 50.32% (3 931 cases) were treated with standard treatment. The results of multivariate analysis showed that, the probability of an adverse pregnancy outcome for a 35-year-old was higher than those of the <25 year old [OR (95%CI)=1.37(1.13-1.67)]. The possibility of the occurrence of an adverse pregnancy outcome in 1-2 times of delivery was lower than that of 0 times of delivery in the past, with the OR (95%CI) value was 0.81 (0.70-0.94). Compared with those who tested for syphilis in the early stages of pregnancy, patients with gestational weeks ≥ 28 weeks of initial examination were more likely to have adverse pregnancy outcomes, with the OR (95%CI) value was 1.54 (1.26-1.88). Compared with the first test titer level was <1:8, the probability of an adverse pregnancy outcome was higher in the titer of ≥1:8, with the OR (95%CI) value was 1.33 (1.12-1.57). There was a higher probability of an adverse pregnancy outcome in the untreated patients compared to the treatment of the syphilitic, with the OR (95%CI) value was 1.41(1.19-1.68). Patients with unregulated treatment were more likely to have adverse pregnancy outcomes than those with standardized treatment, with the OR (95%CI) value was 1.27 (1.09-1.47). Conclusion: Gestational weeks of first examination in pregnant women with syphilis infection, the first test titer, and the treatment condition were closely related to the occurrence of the adverse pregnancy outcome. Pregnant women with syphilis infection without treatment and unstandardized treatment were more likely to have adverse pregnancy outcomes than those of treatment and standardized treatment.

Ischemic preconditioning reduces deep hypothermic circulatory arrest cardiopulmonary bypass induced lung injury.

PURPOSE: Ischemic preconditioning (IP) has been used to reduce ischemia-reperfusion injury in several models. It remains unknown whether IP is sufficient to prevent deep hypothermic circulatory arrest (DHCA) cardiopulmonary bypass (CPB) induced lung injury. MATERIALS AND METHODS: Twenty-four piglets were randomly divided into four groups: routine CPB (CPB), CPB + DHCA (DHCA), CPB + IP + DHCA (IP-1) and CPB + hypoxia-ischemia preconditioning + DHCA (IP-2). Lung static compliance (Cstat) and pulmonary vascular resistance (PVR) were measured as indicators of lung function at three points during CPB. TNF-α, IL-8 and IL-10 expressions were detected by radioimmunoassay. CD18 expression was determined by flow cytometer. Some lung tissues were excised to measure the wet/dry weight ratio (W/D) and some were fixed to observe pathological changes. RESULTS: Cstat significantly decreased whereas PVR increased in DHCA group. IP prevented DHCA-induced lung functional impairment, especially IP-2 treatment. More cytokines were produced after CPB in all groups, but with varying level. Left atrium/pulmonary artery ratio of CD18 expression on monocytes decreased only in DHCA group, whereas which on polymorphonuclear neutrophils decreased in DHCA group, IP-1 group at 1h post-CPB and IP-2 group. Although lung W/D was increased in IP-2 group compared with pre-CPB, but significantly lower than that in DHCA group. Histological findings showed less lung injuries in IP groups than DHCA group. CONCLUSIONS: DHCA aggravates lung inflammatory injury and IP may reverse this injury. Maintaining ventilation with pulmonary artery perfusion in the lung IP process during CPB seems to be more superior to single pulmonary artery perfusion.

[Study on the characteristics of major birth defects in 1.69 million cases of fetus in Guangxi Zhuang Autonomous Region].

Objective: Tracking the information on 1.69 million fetal cases across Guangxi Zhuang Autonomous Region (Guangxi) so as to study the occurrences of total and major birth defects in order to evaluate the ability on related prevention and control programs in Guangxi. Methods: Using the self-developed "Gui Women's System" to establish a database of 1.69 million fetal cases in Guangxi and to analyze the distribution of time, space and population, as well as the outcomes of pregnancy, using the big data. Results: During the 29 months of observation, the overall live birth rate was 99.25%, with stillbirth rate during pregnancy as 0.44%, stillbirth rate during birth as 0.02%, and the 0-6 days mortality rate as 0.14%. The total detection rate on birth defects was 197.63/10 000; the incidence rate was 103.04/10 000, the birth rate was 102.55/10 000. The overall discovery rate of major birth defects was 48.33/10 000, with the incidence rate as 783 000, the birth rate as 0.58/10 000. The discovery rates of major birth defects in 14 cities were between 35 and 68/10 000, and the birth rate dropped significantly to less than 1.00 in 10 000. Nationalities showed that the number of pregnant women with birth defects more than 50 000 would include Hui (9.68/10 000), Yao (9.57/10 000), and Jing (9.37/10 000). With the increasing age of gestation, number of birth defects, incidence of major birth defects also increased. Ninety-five percent of the major birth defects were found within <28 weeks and with the top 5 kinds of major birth defects as complicated congenital heart disease (9.11/10 000), alpha thalassemia (8.36/10 000), and 21-trisomy syndrome (7.85/10 000), beta thalassemia (5.32/10 000) and fetal edema syndrome (4.92/10 000). The top 5 major birth defects appeared as complicated congenital heart disease (9.11/10 000), alpha thalassemia (8.36/10 000), and 21-trisomy syndrome (7.85/10 000), beta thalassemia (5.32/10 000) and fetal edema syndrome (4.92/10 000). Conclusion: Programs leading to increase the rate on discovery of major birth defects were fundamental in effectively reducing the major birth defects.

Predictive validity of a national examination for medical graduates in the People's Republic of China.

National examinations for medical graduates were introduced on an experimental basis in the People's Republic of China in 1982. To estimate the predictive validity of the National Medical Examination (NME), an investigation of the postgraduate competence of a sample of the participating examinees was conducted in 1984. The sample consisted of 1,717 of the 4,995 graduates from 13 medical colleges who had taken the initial NME. Their scores on the NME and the ratings given them by directors of postgraduate programs in nine aspects of clinical competence were compared by frequency distribution and product-moment correlation coefficients. Scores on the NME were consistent with measures of postgraduate clinical competence and, as a whole, correlated significantly with the ratings of clinical competence, supporting the use of the score on the NME as a predictor of postgraduate clinical competence. However, the extent of the relationship between the NME score and postgraduate clinical competence varied according to the specialty program of postgraduate medical training.

Caesarean scar pregnancy: treatment with bilateral uterine artery chemoembolization combined with dilation and curettage.

OBJECTIVE: This study investigated bilateral uterine artery chemoembolization (BUACE) combined with dilation and curettage (D&C) in caesarean scar pregnancy (CSP). METHODS: Nineteen women with CSP were referred for interventional radiology. In 13 patients, BUACE was performed before D&C, following a diagnosis of CSP. A further six patients received BUACE for massive vaginal bleeding after D&C for inevitable miscarriage; the diagnosis of CSP was subsequently confirmed ultrasonographically. BUACE of the uterine arteries was performed using gelfoam particles following intra-arterial infusion of 100 mg/m(2) methotrexate. RESULTS: BUACE was technically successful and immediate haemostasis was achieved in all patients. Blood loss was significantly greater during D&C undertaken before BUACE compared with D&C after BUACE, but this bleeding was controlled by BUACE. No patient required further surgical intervention and there were no severe complications. The gestational sac and placenta could no longer be detected ultrasonographically and the menstrual cycle returned to normal 2-3 months after treatment in all patients. CONCLUSIONS: BUACE followed by D&C seems to be a safe and effective treatment for CSP and should be considered as a treatment of choice.

Silica subsurface amine effect on the chemical stability and chromatographic properties of end-capped immobilized artificial membrane surfaces.

The silica surface of immobilized artificial membranes containing phosphatidylcholine (IAM.PC) has approximately two aminopropyl groups per immobilized phosphatidylcholine molecule. Primary amines near the silica subsurface adsorb biomolecules and also decrease the chemical stability of IAM.PC surfaces. Consequently, subsurface amines were end-capped by several methods including silylating reagents, acetyl analogues, glycidol, methyl glycolate, short-chain anhydrides (3-6 carbons/anhydride chain), and long-chain anhydrides (10-12 carbons/anhydride chain). All end-capping reactions resulted in loss of the initially immobilized phosphatidylcholine molecule. However, the amount of PC loss during end capping was very low (for alkyl anhydride end-capping reactions) to very high (for silylation end-capping reactions). After end capping, IAM.PC showed increased chemical stability compared to non end-capped IAM.PC surfaces. The chemical stability of IAM packing material was monitored by phospholipid leaching from IAM surfaces exposed to organic and aqueous solvents using thin-layer chromatography, 1H NMR spectroscopy, infrared spectroscopy, and mass spectrometry. IAM.PC packing material end capped with long-chain anhydrides exhibited the greatest chemical stability, i.e., little or no detectable phospholipid leaching when challenged with aqueous and/or organic solvents. The chromatography of acidic and basic compounds on end-capped and non-end-capped IAM.PC surfaces was studied. Compared to non-end-capped IAM.PC HPLC columns, the chromatographic retention times of acidic compounds (deoxynucleotides) decreased after end capping. In contrast, the retention times of basic compounds (amphetamine analogues) increased on end-capped IAM.PC HPLC columns relative to non-end-capped IAM.PC HPLC columns. This indicates that these solutes have access to the silica subsurface amines during chromatography.