Difference of urinary protein components and the correlation between urinary protein quantification and glomerular filtration rate in pregnant women with pre-eclampsia / 中华妇产科杂志

Objective:To investigate the difference of urinary protein components in pregnant women with pre-eclampsia (PE) with different degrees of proteinuria and the correlation between 24-hour urinary protein quantification and estimated glomerular filtration rate (eGFR).Methods:Clinical data of 101 PE pregnant women who were delivered in Renji Hospital, Shanghai Jiao Tong University School of Medicine from July 2018 to June 2022 were retrospectively analyzed. According to 24-hour urinary protein quantification, they were divided into 3 groups, including 40 cases of mild proteinuria group (24-hour urinary protein quantification ≤2.0 g), 21 cases of moderate proteinuria group (2.0 g<24-hour urinary protein quantification ≤5.0 g), 40 cases of severe proteinuria group (24-hour urinary protein quantification >5.0 g). The general clinical data, urinary protein index and renal function index of PE pregnant women in 3 groups were compared. The eGFR was calculated based on age, serum creatinine (sCr), blood urea nitrogen (BUN) and serum albumin (sAlb). Correlation analysis was conducted between 24-hour urinary protein quantification and each index of eGFR.Results:(1) General clinical data: the median PE onset week (31 weeks) and delivery gestational week [(36.4±3.6) weeks] of PE pregnant women in the mild proteinuria group were later than those in the moderate proteinuria group [median PE onset: 22 weeks, delivery: (32.2±4.2) weeks] and severe proteinuria group [median PE onset: 25 weeks, delivery: (29.6±3.4) weeks]; systolic blood pressure, diastolic blood pressure, alanine aminotransferase, aspartate aminotransferase levels and the incidence of fetal growth restriction were lower than those in the moderate and severe proteinuria groups; median newborn birth weight (3 150 g) was higher than those in the moderate proteinuria group (1 305 g) and the severe proteinuria group (1 042 g), respectively. The differences were statistically significant (all P<0.05). (2) Urinary protein index: the 24-hour urinary protein quantification, urinary microalbumin (mAlb) and urinary transferrin (TRF) levels of PE pregnant women in the mild proteinuria group, moderate proteinuria group and severe proteinuria group were increased successively, and the differences were statistically significant (all P<0.05). The median urinary α1-microglobulin (α1-MG) level of PE pregnant women in the severe proteinuria group (50 mg/L) was significantly higher than those in the mild proteinuria group (17 mg/L) and moderate proteinuria group (22 mg/L; all P<0.05), but there was no significant difference between the mild proteinuria group and the moderate proteinuria group ( P>0.05). There was no significant difference in the median urinary β2-microglobulin (β2-MG) level among the 3 groups ( P=0.632). (3) Renal function index: sAlb and eGFR of PE pregnant women in the mild proteinuria group, moderate proteinuria group and severe proteinuria group were successively decreased, and BUN was successively increased, respectively, and the differences were statistically significant (all P<0.05). The sCr level of PE pregnant women in the severe proteinuria group was significantly higher than those in the mild proteinuria group and the moderate proteinuria group (all P<0.05), but there was no significant difference between the mild proteinuria group and the moderate proteinuria group ( P>0.05). (4) Correlation analysis: the 24-hour urinary protein quantification of PE pregnant women was significantly negatively correlated with eGFR ( r=-0.645, P<0.001), and was correlated with the variables sAlb ( r=-0.549, P<0.001), sCr ( r=0.582, P<0.001) and BUN ( r=-0.657, P<0.001) in the eGFR calculation formula. The 24-hour urinary protein quantification were significantly negatively correlated with the gestational weeks of PE onset, gestational weeks of termination of pregnancy and newborn birth weight (all P<0.05). Conclusions:The protein composition in the urine of PE pregnant women with different degrees of proteinuria is not different, but the protein level is significantly different. There is a significant negative correlation between the increase of 24-hour urinary protein quantification and the decrease of eGFR.

Research progress on pathogenesis and potential therapeutic target of sarcopenia obesity / 中国临床药理学与治疗学

Sarcopenia obesity (SO), a specific disease with co-occurrence of obesity and sarcopenia, is shown clinically as abnormal accumulation of fat, decreased mass and strength of muscle, and increased risk of incidence and mortality of other chronic diseases. Currently, there exist various definitions and diagnoses about SO in the various regions of the world. Its prevalence in populations elevates in an age-dependent manner. This article summarized the possible pathogenesis of SO from the view of chronic inflammation, oxidative stress, insulin resistance, and Hippo pathway, subsequently listed and analyzed potential pharmacological targets (fibroblast growth factor, CD44, adiponectin, etc) involved in treating SO, in order to provide new ideas for clinical diagnosis, treatment of SO patients and research and development of innovative drugs.

Control of lupus activity during pregnancy via the engagement of IgG sialylation: novel crosstalk between IgG sialylation and pDC functions / 医学前沿

Immunoglobulin (IgG) glycosylation affects the effector functions of IgG in a myriad of biological processes and has been closely associated with numerous autoimmune diseases, including systemic lupus erythematosus (SLE), thus underlining the pathogenic role of glycosylation aberration in autoimmunity. This study aims to explore the relationship between IgG sialylation patterns and lupus pregnancy. Relative to that in serum samples from the control cohort, IgG sialylation level was aberrantly downregulated in serum samples from the SLE cohort at four stages (from preconception to the third trimester of pregnancy) and was significantly associated with lupus activity and fetal loss during lupus pregnancy. The type I interferon signature of pregnant patients with SLE was negatively correlated with the level of IgG sialylation. The lack of sialylation dampened the ability of IgG to suppress the functions of plasmacytoid dendritic cells (pDCs). RNA-seq analysis further revealed that the expression of genes associated with the spleen tyrosine kinase (SYK) signaling pathway significantly differed between IgG- and deSia-IgG-treated pDCs. This finding was confirmed by the attenuation of the ability to phosphorylate SYK and BLNK in deSia-IgG. Finally, the coculture of pDCs isolated from pregnant patients with SLE with IgG/deSia-IgG demonstrated the sialylation-dependent anti-inflammatory function of IgG. Our findings suggested that IgG influences lupus activity through regulating pDCs function via the modulation of the SYK pathway in a sialic acid-dependent manner.

Multidisciplinary approach for the management of term pregnancy complicated by Eisenmenger syndrome / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

Pregnancy in patients with Eisenmenger syndrome (ES) is associated with high maternal mortality rates of 30%‒50%, or even up to 65% in the case of a cesarean section (Yuan, 2016). Here, we report a case of term pregnancy complicated with ES and severe pulmonary artery hypertension (PAH), which was managed by a multidisciplinary team (MDT) and resulted in an uncomplicated delivery via elective cesarean section. The goal of this study is to emphasize the importance of multidisciplinary approach in the management of pregnancy with ES, which can profoundly improve maternal and infant outcomes.

Association Between Osteogenic Differentiation in Soft Tissue Lump and Clinicopathological Characteristics of Osteosarcoma Patients / 肿瘤防治研究

Objective To investigate the association between the osteogenic differentiation in the soft tissue lump and the clinicopathological characteristics of osteosarcoma patients. Methods We retrospectively reviewed the clinical data of conventional osteosarcoma patients with soft tissue lumps, including Enneking stages, chemotherapy sensitivity, overall survival and post-metastatic survival time. The ossification level in soft tissue lumps was assessed by imaging and the proportion of osteoid matrix was assessed by pathological examination. Results A total of 189 cases were included in this study. In patients with Enneking IIIB, non-osteoblastic, partially osteoblastic and osteoblastic types accounted for 30.2%, 9.6% and 6.3%, respectively. Non-osteoblastic osteosarcoma patients had a higher rate of initial metastasis (P < 0.05); Chemotherapy efficiency of non-osteoblastic, partially osteoblastic and osteoblastic types were 60.5%, 59.6% and 31.3%, respectively. The osteoblastic osteosarcoma held the worst rate of chemotherapy sensitivity (P < 0.05). The overall survival of non-osteoblastic osteosarcoma was shorter than those of partially osteoblastic and osteoblastic types (P < 0.05). Post-metastatic survival time of osteoblastic osteosarcoma was longer than that of non-osteoblastic osteosarcoma (P=0.078). Conclusion For conventional osteosarcoma, the osteogenesis level in soft tissue lumps is related to the surgical stage, chemotherapy sensitivity and prognosis of tumors, which may provide guidance for the individual decision regarding chemotherapy and surgery timing on patients.

Comparative analysis of high risk factors between early-onset pre-eclampsia and late-onset pre-eclampsia / 中华妇产科杂志

Objective:To explore the difference of high-risk factors between early-onset and late-onset pre-eclampsia, and to further understand high-risk factors of pre-eclampsia.Methods:Clinical data of pre-eclampsia pregnant women in 160 medical institutions in China in 2018 were retrospectively analyzed, including 8 031 cases of early-onset pre-eclampsia and 12 969 cases of late-onset pre-eclampsia. The proportion of high-risk factors, different body mass index (BMI) and age stratification between early-onset group and late-onset group were compared.Results:(1) Univariate analysis of high-risk factors: the proportions of high-risk factors in early-onset group and late-onset group were compared, and the differences were statistically significant (all P<0.05). Among them, the proportions of primipara and multiple pregnancy in early-onset group were lower than those in late-onset group, while the proportions of pregnant women with advanced age, irregular antenatal examination, obesity, family history of hypertension, pre-eclampsia, diabetes, kidney diseases, immune system diseases and assisted reproductive technology were higher than those in late-onset group. (2) Hierarchical analysis of BMI: the proportion of pregnant women with BMI≥24 kg/m 2 in early-onset group [48.2% (2 828/5 872) vs 45.5% (4 177/9 181), respectively; P=0.001] and the proportion of pregnant women with BMI ≥28 kg/m 2 in early-onset group [19.5% (1 143/5 872) vs 18.0% (1 656/9 181), respectively; P=0.028] were significantly higher than those in late-onset group. (3) Age stratification analysis: the proportion of pregnant women aged 35-39 years in the early-onset group [21.8% (1 748/8 023) vs 17.5% (2 110/12 068), respectively; P<0.01], the proportion of pregnant women 40-44 years old [6.8% (544/8 023) vs 5.4% (648/12 068), respectively; P<0.01], and the proportion of pregnant women ≥45 years old [0.7% (58/8 023) vs 0.5% (57/12 068), respectively; P=0.021] were significantly higher than those in the late-onset group. (4) Multivariate analysis: advanced age (≥35 years old), multiple pregnancy, irregular antenatal examination or transfer from other hospitals, family history of hypertension (including paternal, maternal and parental lines), previous history of pre-eclampsia, kidney diseases, immune system diseases (systemic lupus erythematosus, antiphospholipid antibody syndrome) and assisted reproductive technology pregnancy were the risk factors affecting the severity of pre-eclampsia (all P<0.05). Conclusion:Pregnant women with high risk factors such as age ≥35 years old, BMI ≥24 kg/m 2 before pregnancy, family history of hypertension, history of pre-eclampsia, chronic kidney diseases, immune diseases (mainly including systemic lupus erythematosus and antiphospholipid syndrome) and assisted reproductive technology are more likely to have early-onset pre-eclampsia.

Study on the cut-off values of urinary microalbumin, transferrin and α1-microglobulin during pregnancy in pre-eclampsia with proteinuria / 中华妇产科杂志

Objective:To study the cut-off values of urinary microalbumin (mAlb), transferrin (TRF) and α1-microglobulin (α1-MG) during pregnancy in pre-eclampsia (PE) with proteinuria.Methods:A total of 210 pregnant women were enrolled in Renji Hospital from January 2016 to December 2019, including 92 (43.8%) cases of PE pregnant women and 118 (56.2%) cases of normal pregnant women. According to the diagnostic test evaluation method, the positive predictive values, negative predictive values and accuracy of non-pregnant cut-off values of urinary mAlb, TRF and α1-MG for the quantitative determination of 24-hour proteinuria were analyzed. The receiver operating characteristic (ROC) curve was applied to determine the optimal cut-point values of urinary mAlb, TRF and α1-MG during pregnancy.Results:(1) The diagnostic study of non-pregnant adults urinary mAlb, TRF and α1-MG cut-off values for the determination of 24-hour proteinuria value: when urinary mAlb was 30.0 mg/L, TRF was 2.5 mg/L, α1-MG was 12.5 mg/L as the cut-off value, the positive predictive values of the corresponding 24-hour proteinuria value≥ 300 mg were 88.1% (89/101), 88.2% (90/102) and 78.9% (75/95), its negative predictive values were 97.2% (106/109), 98.1% (106/108) and 85.2% (98/115), its diagnostic accuracy were 92.9% (195/210), 93.3% (196/210) and 82.4% (173/210), respectively. As the 24-hour proteinuria value≥ 300 mg was the golden standard, there were significant differences between the diagnostic method of the non-pregnant cut-off value of urinary mAlb, TRF and the golden standard ( P<0.05). There was no significant difference between the diagnostic method of the non-pregnant cut-off value of urinary α1-MG and the golden standard ( P>0.05). (2) Research on the ROC curve and the optimal cut-point value of urinary mAlb, TRF and α1-MG value: as the 24-hour proteinuria value≥ 300 mg as the criterion, the ROC curve of urinary mAlb, TRF and α1-MG were 0.992, 0.984 and 0.907, respectively. The optimal cut-point values of urinary mAlb, TRF and α1-MG were 86.5 mg/L (Youden index=0.927), 5.5 mg/L (Youden index=0.923), and 15.4 mg/L (Youden index=0.687). (3) The diagnostic study of the optimal cut-point value of urinary mAlb, TRF and α1-MG for the determination of 24-hour proteinuria value: according to the ROC results, when urinary mAlb was 86.5 mg/L, urinary TRF was 5.5 mg/L, and urinary α1-MG was 15.4 mg/L as the cut-off value, the positive predictive values of the corresponding 24-hour proteinuria value≥300 mg were 98.9% (86/87), 95.7% (88/92), 87.7% (71/81), and its negative predictive values were 95.1% (117/123), 96.6% (114/118), 83.7% (108/129), and its accuracy were 96.7% (203/210), 96.2% (202/210), 85.2% (179/210). As the 24-hour proteinuria value≥ 300 mg was the golden standard, there was no significant difference between the diagnostic method of the best cut-off values of urinary mAlb, TRF, α1-MG and the golden standard ( P>0.05). Conclusion:It is recommended to define the cut-off values of mAlb, TRF and α1-MG as 86.5 mg/L, 5.5 mg/L and 15.4 mg/L, respectively, during pregnancy.

Epidemiological characteristics of traumatic spinal cord injury in China in 2018 / 中华创伤杂志

Objective:To analyze the incidence and epidemiological characteristics of traumatic spinal cord injury in China in 2018.Methods:Multi-stage stratified cluster sampling was used to randomly select hospitals capable of treating patients with spinal cord injury from 3 regions，9 provinces and 27 cities in China to retrospectively investigate eligible patients with traumatic spinal cord injury admitted in 2018. National and regional incidence rates were calculated. The data of cause of injury，injury level，severity of injury，segment and type of fracture，complications，death and other data were collected by medical record questionnaire，and analyzed according to geographical region，age and gender.Results:Medical records of 4，134 patients were included in this study，with a male-to-female ratio of 2.99∶1. The incidence of traumatic spinal cord injury in China in 2018 was 50.484 / 1 million （95% CI 50.122-50.846）. The highest incidence in the Eastern region was 53.791 / 1 million （95% CI 53.217-54.365）. In the whole country，the main causes of injury were high falls （29.58%），as well as in the Western region （40.68%），while the main causes of injury in the Eastern and Central regions were traffic injuries （31.22%，30.10%）. The main injury level was cervical spinal cord in the whole country （64.49%），and the proportion of cervical spinal cord injury in the Central region was the highest （74.68%），and the proportion of lumbosacral spinal cord injury in the Western region was the highest （32.30%）. The highest proportion of degree of injury was incomplete quadriplegia （55.20%），and the distribution pattern was the same in each region. A total of 65.87% of the patients were complicated with fracture or dislocation，77.95% in the Western region and only 54.77% in the Central region. In the whole country，the head was the main combined injury （37.87%），as well as in the Eastern and Central regions，while the proportion of chest combined injury in the Western region was the highest （38.57%）. A total of 32.90% of the patients were complicated with respiratory complications. There were 23 patients （0.56%） died in hospital，of which 17（73.91%） died of respiratory dysfunction. Conclusions:The Eastern region of China has a high incidence of traumatic spinal cord injury. Other epidemiological features include high fall as the main cause of injury cervical spinal cord injury as the main injury level，incomplete quadriplegia as the main degree of injury，head as the main combined injury，and respiratory complications as the main complication.

Survey of related factors of maternal venous thromboembolism in nine hospitals of China / 中华妇产科杂志

Objective:To investigate and analyze disease status and risk factors of venous thromboembolism (VTE) during pregnancy and puerperium in our country.Methods:Clinical datas were collected from 575 patients diagnosed with VTE during pregnancy and puerperium and hospitalized in nine medical institutions in our country from January 1, 2015 to November 30, 2019, and retrospectively analyzed it′s disease status and risk factors.Results:(1) The proportion of VTE in pregnancy and puerperium was 50.6% (291/575) and 49.4% (284/575), respectively. Four patients died, the mortality rate was 0.7% (4/575). The cause of death was pulmonary embolism. (2) The location of VTE during pregnancy and puerperium was mainly in the lower limb vascular (76.2%, 438/575), followed by pulmonary vessels (7.1%, 41/575). (3) In the risk factors of VTE, cesarean section accounted for 32.3% (186/575), maternal advance age accounted for 27.7% (159/575), braking or hospitalization during pregnancy accounted for 13.6% (78/575), other risk factors accounted for more than 5% were previous VTE, obesity, preterm birth, assistant reproductive technology conception and so on, pre-eclampsia and multiple pregnancy accounted for 4.9% (28/575) respectively. In addition, some patients with VTE did not have any of the above risk factors, and the incidence rate was as high as 23.1% (133/575).Conclusions:The occurrence of VTE during pregnancy and puerperium is related to multiple risk factors, and could lead to matemal death, It is very necessary to screen VTE risk factors for all pregnant women, to make corresponding prevention and control measures.

Detection of periprosthetic joint infection pathogens by metagenomic next-generation sequencin / 中华骨科杂志

Objective@#To investigate and compare the capability of metagenomic next-generation sequencing (mNGS) in detecting pathogens and diagnosing of periprosthetic joint infection (PJI) from synovial fluid and sonicate fluid of patients who underwent revision arthroplasty.@*Methods@#Thirty-five consecutive patients who underwent revision arthroplasty from May 2018 to November 2018 were included prospectively. There were 22 males and 13 females, 11 hip revisions and 24 knee revisions. All the patients were divided into the PJI group and aseptic loosening (AL) group. Synovial fluid and sonicate fluid of the explanted prostheses were obtained for microbiological culture and mNGS tests. Periprosthetic tissues were only collected for culture. Synovial fluid of three patients undergoing primary arthroplasty been treated by sonication as the negative control group concurrently. Comparisons of microbiological results and diagnostic value from mNGS and culture tests were performed.@*Results@#In the 13 culture-positive PJI patients, mNGS results of synovial fluid were positive in 12 cases, while culture and mNGS results were completely consistent at species level in 7 cases, consistent at the genus level in 1 case. mNGS results of sonicate fluid were positive in 13 cases, while culture and mNGS results were completely consistent at species level in 9 cases, consistent at the genus level in 1 case. In 7 culture-negative PJI patients, 6 cases had consistent mNGS results at species level both from synovial fluid and sonicate fluid, however, one case had positive mNGS result only from sonicate fluid. All culture results and mNGS results of synovial fluid were negative in all 15 AL patients, however, mNGS results of sonicate fluid was positive in 1 AL case. Cultures and mNGS results were negative in all three pairs of negative-control samples. In all 70 samples, mNGS detected 24 pathogens in sonicate fluids and 22 pathogens in synovial fluids. There was no significant difference in number of raw reads and human reads ratio between mNGS of sonicate fluid and synovial fluid. mNGS of sonicate fluid generated significantly higher number of microbial reads and of stringently mapped reads of pathogen in species-level than that of synovial fluids. There was no significant difference in diagnostic sensitivity of PJI between mNGS of sonicate fluids and synovial fluids (90.0% vs 100.0%). Both of them were significantly higher than that of culture of synovial fluid, periprosthetic tissues. Diagnostic sensitivity of sonicate fluid mNGS was not significantly higher than that in culture of sonicate fluid (65%). The specificities were similar among various microbiological testing methods.@*Conclusion@#mNGS of either synovial fluid or sonicate fluid from patients who underwent revision arthroplasty can be used to detect the presence of pathogens effectively and diagnose PJI accurately. mNGS can identify more pathogens and generate a higher number of pathogenic reads from sonicate fluids than synovial fluid. mNGS of synovial fluids has met the clinical diagnostic demands for most PJI patients. mNGS of sonicate fluid could be applied in some cases.

Analysis of maternal deaths with cardiovascular diseases in Shanghai obstetric heart disease intensive care unit within twenty-six years / 中华妇产科杂志

Objective@#To analyze risk factors, cardiovascular complications, time of death, gestational age of delivery and offspring outcomes in the maternal deaths with cardiovascular diseases (CVD).@*Methods@#Totally 4 112 cases of pregnant women with CVD in Shanghai obstetric heart disease intensive care unit within 26 years (from January 1993 to December 2018) were collected, and 20 maternal deaths within these cases were analyzed retrospectively.@*Results@#(1) Among the 20 deaths, structural heart diseases accounted for 90% (18/20), pregnancy induced heart diseases was 10% (2/20) while there was no dysfunctional heart disease. The mortality of pregnant women with CVD was 0.486% (20/4 112). (2) The following risk factors were common in these women, getting pregnant without counselling (95%, 19/20) , New York Heart Association classⅢ or Ⅳcardiac function (70%, 14/20), complicated with pulmonary hypertension (75%, 15/20) and prior heart events (60%, 12/20). And 85% (17/20) deaths occurred in puerperium, 15% (3/20) occurred before labor,while no death occurred during labor. And 65% (13/20) deaths died due to heart failure, 20% (4/20) deaths were due to pulmonary hypertension crisis, 5% (1/20) died on sudden cardiac arrest, rupture of aortic dissection and sudden death, respectively.@*Conclusions@#Women with CVD should get pregnant after strict evaluation. Pulmonary hypertension is one of the most severe contraindications to pregnancy, especially in patients with moderate to severe pulmonary hypertension. The puerperium period is a critical period that threatens the safety of these patients. Since heart failure is the most common cause of death, it is necessary to prevent and treat heart failure and to monitor heart function dynamically, especially in those with structural abnormal heart diseases. Moreover, it is also of importance to standardize antenatal care and to identify the severity of heart diseases in time.

Detection of periprosthetic joint infection pathogens by metagenomic next?generation sequencin / 中华骨科杂志

Objective To investigate and compare the capability of metagenomic next?generation sequencing (mNGS) in detecting pathogens and diagnosing of periprosthetic joint infection (PJI) from synovial fluid and sonicate fluid of patients who un?derwent revision arthroplasty. Methods Thirty?five consecutive patients who underwent revision arthroplasty from May 2018 to November 2018 were included prospectively. There were 22 males and 13 females, 11 hip revisions and 24 knee revisions. All the patients were divided into the PJI group and aseptic loosening (AL) group. Synovial fluid and sonicate fluid of the explanted pros?theses were obtained for microbiological culture and mNGS tests. Periprosthetic tissues were only collected for culture. Synovial fluid of three patients undergoing primary arthroplasty been treated by sonication as the negative control group concurrently. Com?parisons of microbiological results and diagnostic value from mNGS and culture tests were performed. Results In the 13 culture? positive PJI patients, mNGS results of synovial fluid were positive in 12 cases, while culture and mNGS results were completely consistent at species level in 7 cases, consistent at the genus level in 1 case. mNGS results of sonicate fluid were positive in 13 cas?es, while culture and mNGS results were completely consistent at species level in 9 cases, consistent at the genus level in 1 case. In 7 culture?negative PJI patients, 6 cases had consistent mNGS results at species level both from synovial fluid and sonicate fluid, however, one case had positive mNGS result only from sonicate fluid. All culture results and mNGS results of synovial fluid were negative in all 15 AL patients, however, mNGS results of sonicate fluid was positive in 1 AL case. Cultures and mNGS results were negative in all three pairs of negative?control samples. In all 70 samples, mNGS detected 24 pathogens in sonicate fluids and 22 pathogens in synovial fluids. There was no significant difference in number of raw reads and human reads ratio between mNGS of sonicate fluid and synovial fluid. mNGS of sonicate fluid generated significantly higher number of microbial reads and of stringent?ly mapped reads of pathogen in species?level than that of synovial fluids. There was no significant difference in diagnostic sensitivi?ty of PJI between mNGS of sonicate fluids and synovial fluids (90.0% vs 100.0%). Both of them were significantly higher than that of culture of synovial fluid, periprosthetic tissues. Diagnostic sensitivity of sonicate fluid mNGS was not significantly higher than that in culture of sonicate fluid (65%). The specificities were similar among various microbiological testing methods. Conclusion mNGS of either synovial fluid or sonicate fluid from patients who underwent revision arthroplasty can be used to detect the pres?ence of pathogens effectively and diagnose PJI accurately. mNGS can identify more pathogens and generate a higher number of pathogenic reads from sonicate fluids than synovial fluid. mNGS of synovial fluids has met the clinical diagnostic demands for most PJI patients. mNGS of sonicate fluid could be applied in some cases.

Analysis of maternal deaths with cardiovascular diseases in Shanghai obstetric heart disease intensive care unit within twenty-six years / 中华妇产科杂志

Objective To analyze risk factors, cardiovascular complications, time of death, gestational age of delivery and offspring outcomes in the maternal deaths with cardiovascular diseases (CVD). Methods Totally 4 112 cases of pregnant women with CVD in Shanghai obstetric heart disease intensive care unit within 26 years (from January 1993 to December 2018) were collected, and 20 maternal deaths within these cases were analyzed retrospectively. Results (1) Among the 20 deaths, structural heart diseases accounted for 90% (18/20), pregnancy induced heart diseases was 10% (2/20) while there was no dysfunctional heart disease. The mortality of pregnant women with CVD was 0.486% (20/4 112). (2) The following risk factors were common in these women, getting pregnant without counselling (95%, 19/20), New York Heart Association classⅢorⅣcardiac function (70%, 14/20), complicated with pulmonary hypertension (75%, 15/20 ) and prior heart events (60%, 12/20). And 85% (17/20) deaths occurred in puerperium, 15% (3/20) occurred before labor , while no death occurred during labor. And 65% (13/20) deaths died due to heart failure, 20% (4/20) deaths were due to pulmonary hypertension crisis, 5% (1/20) died on sudden cardiac arrest, rupture of aortic dissection and sudden death, respectively. Conclusions Women with CVD should get pregnant after strict evaluation. Pulmonary hypertension is one of the most severe contraindications to pregnancy, especially in patients with moderate to severe pulmonary hypertension. The puerperium period is a critical period that threatens the safety of these patients. Since heart failure is the most common cause of death, it is necessary to prevent and treat heart failure and to monitor heart function dynamically, especially in those with structural abnormal heart diseases. Moreover, it is also of importance to standardize antenatal care and to identify the severity of heart diseases in time.

Mid-term clinical outcomes and radiological results of anterior cervical surgery for Hirayama disease / 中华骨科杂志

Objective　To evaluate the effect of anterior cervical fusion or non-fusion surgery for the treatment of Hirayama disease.Methods　The patients with Hirayama disease who underwent anterior cervical surgery in our hospital from July 2008 to December 2015 were retrospectively enrolled in this study.These cases were divided into two groups:fusion group(11 cases)and non-fusion group(12 cases).In fusion group,there were 9 males and 2 females,with an average age of 17.92±0.61 years(range,15-29).In the non-fusion group,there were 10 males and 1 female,with an average age of 19.18±1.14 years(range,15-23).Muscle strength,muscular atrophy,and the Michigan score for hand function were compared between the two groups preoperatively and postoperatively.The indexes such as arc cervical physiological curvature index,the maximum flexion angle,the maximal range of motion(ROM),flexion ROM of adjacent segments of lower(cervical vertebra were measured from the X-ray of the two groups,and the cross-sectional area of spinal cord was measured and compared on neutral position MRI.Results　There were no significant differences between the two groups in grip strength,preoperative hand function Michigan score,cervical physiological(curvature index,the maximum flexion angle,the maximal ROM,flexion ROM of adjacent segments of lower cervical vertebra,and cross-sectional area of spinal cord on neutral position MRI(P>0.05).Patients in fusion group were followed up for 38-103 months with an average of 59.73±5.57 months,while patients in non-fusion group were followed up for 40-95 months with an aver-age of 56.25±4.57 months.Clinical outcomes:At the last follow-up,the finger tremor and cold paralysis were alleviated in all patients,but the symptoms in fusion group and non-fusion group were not completely disappeared in 2 and 3 cases,respectively.The grip strength of fusion group(preoperative 17.14±6.09,postoperative 17.47±5.64)and the non-fusion group(preoperative 17.75±5.49,postoperative 17.40±4.58)were not significantly improved compared with preoperative(P>0.05).The Michigan score for hand function of fusion group(preoperative 10.27±0.41,postoperative 6.64±0.24)and the non-fusion group(preoperative 9.25±0.35,postoperative 6.83±0.24)were significantly improved compared with preoperative(P<0.05).There was no significant difference in postoperative Michigan score between the two groups(P>0.05).Radiological outcomes:The cervical physiological curvature index and cross-sectional area of the spinal cord of the two groups increased after operation,while the maximum flexion angle,the maximal ROM decreased.There was no significant difference in these indexes between the two groups postoperatively(P>0.05).The spinal cord had no compression on flexion MRI.The cross-sectional area of C4-C7 spinal cord in Neutral MRI were significantly increased at C6 and C7 levels in both groups.There was no significant difference in the cross-sectional area of C4-C7 spinal cord between the two groups postoperatively(P>0.05).Two cases of internal fixation loosening occurred in non-fusion group 3 years after the operation,while there were no cases of loosening in the fusion group.Conclusion　Anterior cervical fusion or nonfusion surgery can limit excessive cervical kyphosis in patients with Hirayama disease,reduce atrophy of compressed cervical spinal cord,and alleviate the disease progress of muscular atrophy of the distal upper limb.It can be selected as a treatment method for Hirayama disease.However,there is a risk of internal fixation loosening in non-fusion cases,and also a risk of adjacent segment degeneration in fusion cases.The appropriate cases should be selected carefully for surgery.

Effect of maternal age on pregnancy outcome in patients with structural heart disease / 中华妇产科杂志

Objective To analyze the effect of maternal age on pregnancy outcome in patients with structural heart disease. Methods Totally 986 patients diagnosed with structural heart disease who had their delivery at Renji Hospital from January 1st,2003 to December 31st,2016 were divided into 5 groups according to maternal age. Sixteen(1.6%)were in age group <20 years, 204(20.7%)were in age group 20-24 years,461(46.8%)were in age group 25-29 years,222(22.5%)was in age group 30-34 years and 83(8.4%)was in age group ≥35 years.The incidence of cardiac,obstetric and fetal complications among these groups were analyzed. Results Among the 986 patients with structural heart disease, 82(8.3%) experienced adverse cardiac events(some patients had more than 1 complication), including infective endocarditis(0.4%,4/986), malignant arrhythmia(3.3%, 33/986), heart failure(5.3%, 52/986), cardiac death(0.9%,9/986).The incidence of cardiac complications were respectively 12.5%,11.3%,4.8%,10.4% and 14.5% in each age group,with statistically significant differences when compared with one another(P=0.004). There was no statistically significant difference in the incidence of obstetric complications(P>0.05). The incidence of fetal complications in each group showed statistically significant differences(P=0.001);which was 25.0%,30.4%,24.1%,29.3% and 47.0% respectively. Conclusions Age group 25-29 years presented the lowest risk of cardiac complications and is potentially the optimal age for pregnancy and delivery.Age group<20 or≥35 years is at higher risk for cardiac complications. The highest rate of fetal complications is in age group≥35 years.

Analysis of the difference of serum immunoglobulins, β2-microglobulin and transferrin in pre-eclampsia and pregnancies complicated with chronic kidney disease / 中华妇产科杂志

Objective To observe and analyze the difference of serum immunoglobulin IgA, IgG, IgM, β2-microglobulin and transferrin in pre-eclampsia (PE) and pregnancies complicated with chronic kidney disease.Methods Totally 46(40.0%)pregnancies with PE(PE group),36(31.3%)pregnancies with chronic kidney disease(chronic kidney disease group)and 33(28.7%)normal pregnancies with normal blood pressure and proteinuria without any complication(control group)delivered in Renji Hospital were recruicted in this study from February 2017 to July 2017.Serum IgA,IgG,IgM,β2-microglobulin and transferrin levels were detected. Correlation tests were conducted between these indicators and blood pressure, 24 hours proteinuria value and delivery weeks. Results (1) Comparison of general situation of pregnancies in the 3 groups:there were no significant difference in the age and child bearing history between the 3 groups(all P>0.05),while there was a significant difference in the blood pressure and deliver week(all P<0.01).There was no significant difference in 24 hours proteinuria values between PE group and chronic kidney disease group (Z=-0.187, P=0.852). (2) Comparison of serum immunoglobulin, β2-microglobulin and transferrin levels in pregnant women with three groups: serum IgA level in chronic kidney disease group was significantly higher than those in PE and control groups[(2.4±0.9)vs(1.8±0.9)vs(1.6±0.6)g/L;F=9.959,P<0.01].The serum IgG and IgM values had no significant difference between the 3 groups(all P>0.05).Serum β2-microglobulin in chronic kidney disease group was significantly higher than those in PE and control groups[(4.0±2.6)vs(2.7±0.7)vs(2.0±0.5)mg/L;F=15.892,P<0.01].Serum transferrin in chronic kidney disease group was significantly lower than those in PE and control groups[(3.0±0.8)vs(3.7±1.1)vs(3.6±0.6) g/L; F=6.284, P<0.01]. (3) The correlation between serum immunoglobulin, β2-microglobulin, transferrin and blood pressure, proteinuria value and delivery weeks in PE group: the blood pressure level was not correlated with serum IgA,β2-microglobulin and transferrin values in PE group(all P>0.05).So,24 hours proteinuria value was positively correlated with β2-microglobulin (r=0.557, P<0.01), which was negatively correlated with transferrin (r=-0.442, P<0.01) and was not correlated with IgA(r=0.089, P=0.556). There was a negative correlation between delivery weeks and β2-microglobulin(r=-0.328,P=0.026),and positive correlation with transferrin (r=0.315, P=0.035) and no correlation with IgA (r=-0.169, P=0.260). (4) The correlation between serum immunoglobulin, β2-microglobulin, transferrin and blood pressure, proteinuria value and delivery weeks in chronic kidney disease group:the blood pressure level was positively correlated with β2-microglobulin(systolic pressure: r=0.598,P<0.01;diastolic pressure:r=0.557,P<0.01),which was not correlated with IgA and transferrin in chronic kidney disease group (all P>0.05). So,24 hours proteinuria value was positively correlated with β2-microglobulin and IgA(r=0.568,r=0.330,both P<0.05), and not correlated with transferrin (r=0.255, P=0.133). Delivery weeks had a negative correlation with β2-microglobulin(r=-0.574,P<0.01),while it had a positive correlation with transferrin(r=0.369,P=0.027). No correlation was found between delivery weeks and IgA values (r=-0.257, P=0.131). Conclusion The serum levels of IgA,β2-microglobulin and transferrin in PE and pregnancies with chronic kidney disease are significantly different,which may provide clinical value for the diagnosis of PE and pregnancies with chronic kidney disease in future.

Establishment of quantificative ELISA for determination of human decoy receptor 3 / 临床检验杂志

Objective To establish an ELISA for quantitative determination of decoy receptor 3 (DcR3) in human plasma.Methods A solid phase double antibody sandwich method was established for quantitative determination of DcR3.The anti-DcR3 antibody was immobilized onto ELISA plate.DcR3 in samples was captured by anti-DcR3 on ELISA plate and then detected by biotin-anti-DcR3 and subsequent peroxidase-labeled streptavidin,and the color was developed by adding substrate.The standard DcR3 samples on the same plate were detected simultaneously to calculate the DcR3 concentrations in unknown samples.The sensitivity,specificity,precision,recovery,linearity and DcR3 range in normal human adults were assessed.Results The sensitivity of the developed assay was 0.051 ng/mL.The intra-coefficient of variation (CV) was less than 10％ and inter-CV was less than 15％.The average recovery rate was 90.50％.When 2-fold amount of anti-TNF-α was added into the coated antibodies,10-fold amount of biotin-labeled anti-LIGHT,antiFAS or anti-TNF-α was added into the detection antibodies,or 10 fold amount of purified LIGHT protein was added into the standard DcR3 samples as competitor,no disturbing effects on standard curve were found.The linear range of the assay was from 0.25 to 16 ng/mL (r≥0.98).The concentration of DcR3 tested in 128 plasma samples from healthy adults was (0.21 ± 0.05) ng/mL with 95％ CI ranged from 0.14 to 0.28 ng/mL and no difference of age and sex was found.Conclusion The established ELiSA for determining plasma DcR3 exhibited high specificity,sensitivity,precision,fine linearity and wide detecting range.This method could be used for quantification of DcR3 in plasma.

Medical health integration continuance management mode in the prevention of elderly patients after dis-charge in bed household application effect analysis of pressure ulcers / 中华护理杂志

Objective Discuss medical health integration continuance management mode in the prevention of elderly patients after discharge in bed household application effect of pressure ulcers. Methods To 120 cases of elderly patients in bed in hospital time order is divided into control group and experimental group,by the medical health outreach group respectively in the hospital two days before the assessment of patients and family rehabilitation plan,the control group given conventional discharge and telephone follow-up after discharge,the experimental group according to the medical health integration management mode,made up of medical health outreach team to stay in bed for elderly patients after discharge pressure ulcer risk factors assessment,targeted prevention of pressure sores rehabilitation plan,group management,remote care joint family supervision,timely follow up the capa and the exami-nation of the effect,the pressure ulcer management and quality of life scale to compare two groups of patients at discharge,6 months after hospital discharge,the quality of life of 12 months after discharge and the incidence of pressure ulcers in a year. Results The experimental group was lower than those of control group,the incidence of pressure ulcers was statistically significant difference(P0.05). Conclusion Medical health integration continuance management can effectively reduce the incidence of pressure ulcers that occupy the home stay in bed for elderly patients,improve their quality of life.

Exploration on the Ethical Problems in the Implementation of the Two-Child Policy in China / 中国医学伦理学

The implementation of two-child policy has great significance.It can rationalize the population structure,diversify the family model,easethe pension problem significantly,and rationalize parent-child relationships.At the same time,there exist ethical problems in some aspects of society,such as the attribution of female reproductive fights,the anxiety the only child suffered from the second child,the continuing imbalance of gender,the occupational predicament of female reproduction,the effects on women health and family economy.Therefore,the country and society should respect and maintain women's reproductive rights,guarantee women's occupational stability,pay attention to the education of family ethics,promote the traditional values of respecting the old and cherishing the young,and develop the social old-age security system,thus to ensure the effective implementation of the two-child policy and build a harmonious family and society.

Vitamin D level in cord blood and neonatal outcomes in a birth cohort study in Shanghai / 临床儿科杂志

Objectives To detect the cord blood vitamin D level in neonates and to determine the association between the cord blood vitamin D level and neonatal outcomes. Methods A total of 223 eligible mother-and-singleton-offspring pairs were recruited. The information of mothers' pregnancy was collected by questionnaires. The weight, length, and head circumference of neonates were measured. The levels of 25(OH)D in cord blood of neonates and in blood of late pregnancy mothers were determined by chemiluminescence immunoassay. Results The median concentration of 25(OH)D in cord blood was 20.7 nmol/L, and 82.1% of neonate had vitamin D deficiency, and 12.1% had severe vitamin D deficiency (0.05). After the variables of sex, gestational age and birth season are controlled, the birth weight and head circumference were significantly different in neonates with different concentrations of 25(OH)D in cord blood (P<0.05). Conclusions The concentration of 25(OH)D in cord blood in term neonates was generally lower. The vitamin D status in neonates was consistet with that in their late pregnancy mothers. Cord blood 25(OH) D levels were associated with neonates' birth weight and head circumference, but it should be confirmed by larger sample size in the future.