Recommendations for the diagnosis and treatment of maternal SARS-CoV-2 infection / 中华围产医学杂志

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has spread worldwide and threatened human's health. With the passing of time, the epidemiology of coronavirus disease 2019 evolves and the knowledge of SARS-CoV-2 infection accumu-lates. To further improve the scientific and standardized diagnosis and treatment of maternal SARS-CoV-2 infection in China, the Chinese Society of Perinatal Medicine of Chinese Medical Association commissioned leading experts to develop the Recommendations for the Diagnosis and Treatment of Maternal SARS-CoV-2 Infection under the guidance of the Maternal and Child Health Department of the National Health Commission. This recommendations includes the epidemiology, diagnosis, management, maternal care, medication treatment, care of birth and newborns, and psychological support associated with maternal SARS-CoV-2 infection. It is hoped that the recommendations will effectively help the clinical management of maternal SARS-CoV-2 infection.

A multicenter, double-blind, randomized controlled clinical trial comparing ergometrine with oxytocin and oxytocin alone for prevention of postpartum hemorrhage at cesarean section / 中华妇产科杂志

Objective:To compare oxytocin combined with ergometrine with oxytocin alone in terms of primary prophylaxis for postpartum hemorrhage (PPH) at the time of cesarean section (CS).Methods:This was a multicenter double-blind randomized controlled interventional study comparing ergometrine combined with oxytocin and oxytocin alone administered at CS. From December 2018 to November 2019, a total of 298 parturients were enrolled in 16 hospitals nationwide. They were randomly divided into experimental group (ergometrine intra-myometrial injection following oxytocin intravenously; 148 cases) and control group (oxytocin intra-myometrial injection following oxytocin intravenously; 150 cases) according to 1∶1 random allocation. The following indexes were compared between the two groups: (1) main index: blood loss 2 hours (h) after delivery; (2) secondary indicators: postpartum blood loss at 6 h and 24 h, placental retention time, incidence of PPH, the proportion of additional use of uterine contraction drugs, hemostatic drugs or other hemostatic measures at 2 h and 24 h after delivery, the proportion requiring blood transfusion, and the proportion of prolonged hospital stay due to poor uterine involution; (3) safety indicators: nausea, vomiting, dizziness and other adverse reactions, and blood pressure at each time point of administration.Results:(1) The blood loss at 2 h after delivery in the experimental group [(402±18) ml] was less than that in the control group [(505±18) ml], and the difference was statistically significant ( P<0.05). (2) The blood loss at 6 h and 24 h after delivery in the experimental group were less than those in the control group, and the differences were statistically significant (all P<0.05). There were no significant differences between the two groups in the incidence of PPH, the proportion of additional use of uterine contraction drugs, hemostatic drugs or other hemostatic measures at 2 h and 24 h after delivery, the proportion requiring blood transfusion, and the proportion of prolonged hospital stay due to poor uterine involution (all P>0.05). (3) Adverse reactions occurred in 2 cases (1.4%, 2/148) in the experimental group and 1 case (0.7%, 1/150) in the control group. There was no significant difference between the two groups ( P>0.05). The systolic blood pressure within 2.0 h and diastolic blood pressure within 1.5 h of drug administration in the experimental group were higher than those in the control group, and the differences were statistically significant ( P<0.05), but the blood pressure of the two groups were in the normal range. Conclusion:The use of ergometrine injection in CS could reduce the amount of PPH, which is safe and feasible.

Comparison of four-coagulation-tests values in normal pregnant women during early and late pregnancy and the influence of age / 中华妇产科杂志

Objective:To explore and compare the reference ranges of four coagulation tests in normal pregnant women during early and late pregnancy and the influence of age.Methods:Values of four coagulation tests from 4 974 pregnant women, who gave single birth at Peking University First Hospital, Obstetrics and Gynecology Hospital of Fudan University, West China Second University Hospital, Peking University Third Hospital and Shengjing Hospital of China Medical University from February 2017 to July 2020, were measured and analyzed in this study, including prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (Fib) and thrombin time (TT). The four normal reference ranges of coagulation during early and late pregnancy phases were expressed as P2.5- P97.5. The difference of two pregnancy phases was compared by non-parametric test of two related samples. And the difference between pregnant women of advanced and non-advanced age in the same pregnancy phase was compared by independent sample non-parametric test. Chi-square test was used to compare the incidence of pregnancy complications in different coagulation reference ranges. Results:The reference ranges of PT of normal pregnant women′s early and late pregnancy were 10.0-13.9 s and 9.6-12.3 s, the reference ranges of APTT were 22.6-35.3 s and 22.4-30.9 s, the reference ranges of Fib were 2.4-5.0 g/L and 3.0-5.7 g/L, the reference ranges of TT were 12.0-19.0 s and 11.5-18.4 s. Compared with early pregnancy, PT, APTT and TT shortened significantly, while the Fib significantly increased in late pregnancy (all P<0.001). PT, APTT and TT of advanced and non-advanced age pregnant women were significantly different (all P<0.01). Compared with the ranges of non-pregnant population, more pregnant women were included in the normal pregnant reference ranges of PT in early pregnancy and APTT in the early and late pregnancy, while the incidence of pregnancy complications had no significant differences (all P>0.05). The incidence of fetal distress was higher and the incidence of preterm birth was lower in the reference range of PT in late pregnancy. The incidence of gestational diabetes mellitus was higher in the early and late gestational Fib reference ranges, and the incidence of hypertensive disorders in pregnancy was higher in the late gestational Fib reference range (all P<0.05). Conclusions:The coagulation function of pregnant women increases significantly with the growth of pregnancy, and there is a significant difference between advanced significantly and non-advanced age pregnant women. The recommended ranges of normal pregnant women′s early and late pregnancy PT are 10.0-13.9 s and 9.6-12.3 s, the recommended ranges of APTT are 22.6-35.3 s and 22.4-30.9 s, the recommended ranges of TT are 12.0-19.0 s and 11.5-18.4 s. The appropriate ranges of normal pregnant women′s early and late pregnancy Fib still need further exploration.

Evaluation the application of intra-operative cell salvage in cesarean section based on multicenter data / 中华妇产科杂志

Objective:To investigate the safety, efficacy and application indication of intra-operative cell salvage (IOCS) in cesarean section.Methods:A total of 1 265 pregnant women who received IOCS blood transfusion during cesarean section in 11 tertiary A hospitals from August 2016 to January 2019 were collected and divided into <1 500 ml group (796 cases) and ≥1 500 ml group (469 cases) according to the amount of blood loss during cesarean section. The general clinical data, ultrasonic imaging data, perinatal and puerperium indicators were analyzed retrospectively. The risk factors of intraoperative blood loss ≥1 500 mL using IOCS transfusion were analyzed by logistic multivariate regression.Results:(1) A total of 848 001 ml of blood was recovered and a total of 418 649 ml of blood was transfused in 1 265 pregnant women who received IOCS transfusions, which was equivalent to 23 258 U red blood cell suspension, greatly saving medical resources. The intraoperative blood loss in <1 500 ml group and ≥1 500 ml group was 800 ml (300-1 453 ml) and 2 335 ml (1 500-20 000 ml), respectively. No amniotic fluid embolism, severe adverse reactions, shock and death occurred in the two groups. (3) Multivariate regression analysis showed that age ≥35 years ( OR=1.5, 95% CI: 1.1-1.9), prenatal hemoglobin level <110 g/L ( OR=1.7, 95% CI: 1.3-2.2), history of uterine surgery ( OR=1.8, 95% CI: 1.3-2.6), placenta previa ( OR=1.9, 95% CI: 1.1-3.1), placenta accreta ( OR=2.6, 95% CI: 1.8-3.9), blood pool in the placenta ( OR=1.6, 95% CI: 1.1-2.3), abnormal posterior placenta muscle wall ( OR=1.8, 95% CI: 1.2-2.6), placenta projecting to the anterior uterine wall ( OR=3.0, 95% CI: 1.3-7.0) were risk factors for blood loss ≥1 500 ml in obstetric transfusion using IOCS technique, with statistical significance (all P<0.05). Conclusion:IOCS is safe and effective in cesarean section, which could save the medical resources and reduces medical expenses, however, it is necessary to strictly master the application indication.

The comparative superiority of IgM-IgG antibody test to real-time reverse transcriptase PCR detection for SARS-CoV-2 infection diagnosis

BackgroundAs the increasing number of Corona Virus Disease 2019 (COVID-19) patients caused by the severe acute respiratory coronavirus 2 (SARS-CoV-2), which caused an outbreak initiated from Wuhan, China in December, 2019, the clinical features and treatment of COVID-19 patients have been understood. However, it is urgent to need the rapid and accurate detection for SARS-CoV-2 infection diagnosis. We aimed to evaluate the antibodies-based and nucleic acid-based tests (NAT) for SARS-CoV-2-infected patients. MethodWe retrospectively and observationally studied 133 patients diagnosed with SARS-CoV-2 and admitted in Renmin Hospital of Wuhan University, China, from Feb 17 to Mar 1, 2020. Demographic data, symptoms, clinical examination, laboratory tests, and clinical outcomes were collected. Data were compared between IgM-IgG antibody test and real-time RT-PCR detection for COVID-19 patients. ResultsOf 133 patients with SARS-CoV-2 infection, there were 44 moderate cases, 52 severe cases, and 37 critical cases with no significant difference of gender and age among three subgroups. Overall, the positive ratio in IgM antibody test was higher than in RT-PCR detection. In RT-PCR detection, the positive ratio was 65.91%, 71.15%, and 67.57% in moderate, severe, and critical cases, respectively. Whereas, the positive ratio of IgM/IgG antibody detection in patients was 79.55%/93.18%, 82.69%/100%, and 72.97%/97.30% in moderate, severe, and critical cases, respectively. Moreover, the concentrations of antibodies were also measured in three subgroups. ConclusionThe IgM-IgG antibodies-based test exhibited a comparative superiority to the NAT for COVID-19 diagnosis, which provides an effective complement to the false negative results from NAT for SARS-CoV-2 infection diagnosis.

Analysis of rs4420638A/G and -317H1/H2 polymorphisms of APOC1 gene among Chinese patients with pre-eclampsia / 中华医学遗传学杂志

OBJECTIVE@#To assess the association of apolipoprotein (apo) C1 (APOC1) gene rs4420638A/G and -317H1/H2 polymorphisms with the risk of pre-eclampsia (PE) and the influence of their genotypes on the clinical and metabolic indexes among Chinese women.@*METHODS@#In total 289 PE patients and 824 women with uncomplicated pregnancies were included. The rs4420638A/G genotype was determined by a Taqman real-time PCR allelic discrimination assay. The -317H1/H2 genotype was measured through PCR and restriction fragment length polymorphism analysis. Serum lipid and apo levels were measured by an enzymatic kit and a PEG-enhanced immunoturbidimetric assay.@*RESULTS@#Allelic and genotypic frequencies of the APOC1 gene rs4420638A/G and -317H1/H2 were not significantly different between the two groups (all P> 0.05). However, patients carrying the G allele of the rs4420638A/G locus had higher serum levels of triglyceride, non-HDL-C and apoB, and a higher apoB/apoA1 ratio compared with those with an AA genotype (all P< 0.05). Patients carrying the H2 allele of the -317H1/H2 polymorphism had smaller delivery gestational weeks compared with those with the H1H1 genotype (P< 0.05).@*CONCLUSION@#Polymorphisms of the APOC1 gene rs4420638 and -317H1/H2 sites may be associated with abnormal lipoprotein metabolism among Chinese patients with PE, though no association was found between variants of the APOC1 gene and the risk of PE among them.

Relationship between hepatitis C virus and serine protease inhibitor Kazal1 / 中华实验和临床病毒学杂志

Objective@#To explore the effect of hepatitis C virus (HCV) on the expression of serine protease inhibitor Kazal1 (SPINK1) and its clinical implication.@*Methods@#mRNA and protein expression of SPINK1 in Huh7.5.1 cells infected by HCV JFH-1 and the control cells were measured by RT-PCR and western blotting, SPINK1 levels in the cell supernatants and sera of HCV patients were measured by enzyme-linked immunosorbent assay (ELISA), the difference of SPINK1 levels between healthy controls and HCV patients was analyzed.@*Results@#Expression of SPINK1 mRNA and protein was higher in Huh7.5.1 cells infected by HCV JFH-1 than in the control cells, serum SPINK1 levels was much higher in HCV patients than in healthy controls (P=0.016).@*Conclusions@#HCV can upregulate the expression of SPINK1.

Survey of prevalence of iron deficiency and iron deficiency anemia in pregnant women in urban areas of China / 中华妇产科杂志

Objective To investigate the prevalence of iron deficiency(ID)and iron deficiency anemia (IDA) in pregnant women in urban areas of China. Methods The study was a national cross-sectional survey conducted from September 19th, 2016 to November 20th, 2016. According to the classification of the National Bureau of Statistics, all survey sites were set up in 6 regions of the country. Pregnant women were continuously selected using multistage stratified sampling. A total of 12 403 pregnant women were collected and examined for serum ferritin and hemoglobin levels. Results The median serum ferritin level during pregnancy was 20.60 μg/L(11.78-36.98 μg/L), the hemoglobin level was(118±12)g/L. With the progress of pregnancy, the levels of serum ferritin and hemoglobin decreased gradually. The median serum ferritin levels in the first, second trimester and third trimester were 54.30 μg/L(34.48-94.01 μg/L), 28.60 μg/L(16.40-50.52 μg/L), and 16.70 μg/L(10.20-27.00 μg/L)respectively(P<0.01). The mean hemoglobin levels were(127 ± 10)g/L,(119 ± 11)g/L and(117 ± 11)g/L respectively(P<0.01). The prevalence of ID in urban pregnant women was 48.16%(5 973/12 403), and IDA prevalence was 13.87% (1 720/12 403). The prevalence of IDA in the first, second trimester and third trimester were 1.96% (20/1 019), 8.40%(293/3 487)and 17.82%(1 407/7 897), respectively(P<0.01). The prevalence of standardized ID and IDA were significantly different in various regions of China(P<0.01). The standardized prevalence of ID were relatively higher in East China and Northeast China, 57.37% and 53.41% respectively, while it was the lowest in Southwest China, 30.51%. The standardized prevalence of IDA in South Central, Northwest, and East China were relatively high, 21.30%, 16.97% and 17.53% respectively, and the standardized prevalence of IDA in Southwest China was the lowest, 5.44%,the differents in various regions were significant(all P<0.01). Conclusion The current phenomenon of ID and IDA in pregnant women is still very common,and nutrition and health care during pregnancy should be strengthened.

Clinical analysis of the specific reference intervals of thyroid index for normal pregnant women / 中华妇产科杂志

Objective To explore the reference intervals of thyrotropin(TSH)and free thyroxine (FT4)in normal pregnant women. Methods Prospective and longitudinal sequential collection of the cases were performed. A total of 155 singleton pregnant women who had regular prenatal examination and delivery in West China Second Hospital of Sichuan University from January 2015 to December 2015 were included as the research group. Blood samples were sequentially collected from the pregnant women at the first(9-13+6 weeks), the second (24-27+6 weeks), the third (32-36 weeks) trimesters, respectively. Another 155 non-pregnant women were selected as the control group simultaneously, in an effort to establish a range of reference intervals of thyroid index in each period of pregnancy. Meanwhile, neonatal plantar blood were also collected on special filter paper and TSH levels were measured. Results (1)TSH reference intervals [percentile 2.5-percentile 97.5(P2.5-P97.5)] were 0.08-3.29 mU/L, 0.59-4.22 mU/L and 0.81-4.33 mU/L in three trimesters respectively. FT4 reference intervals were 11.88-20.06 pmol/L, 9.89-15.80 pmol/L and 9.22-15.77 pmol/L in three trimesters respectively. (2)The median serum TSH in the first trimester (1.35 mU/L)was lower than that in the second trimester(2.15 mU/L), the third trimester(2.19 mU/L), and the control group (2.19 mU/L). The differences were all statistically significant (P<0.05). There was no significant difference in median serum TSH between the second trimester and the third trimester, the second trimester and the control group, and the third trimester versus the control group.(3)The median serum FT4 in the first trimester(15.16 pmol/L)was higher than that in the second trimester(12.39 pmol/L)and the third trimester (12.26 pmol/L). The differences were both statistically significant (P<0.05). The median FT4 in the second trimester and the third trimester was lower than that in the control group(15.64 pmol/L), and the differences were both statistically significant(P<0.05).(4)In the first trimester, the median serum total triiodothyronine(TT3)level(2.32 nmol/L)was higher than that in the control group(1.56 nmol/L), total thyroxine(TT4)level(154.60 nmol/L)was also higher than that in the control group(98.25 nmol/L), and free triiodothyronine (FT3) level (4.70 pmol/L) was lower than that in the control group (4.84 pmol/L), the differences were all statistically significant(P<0.05).(5)The TSH levels of all neonatus were normal [(2.1± 1.3)mU/L]. Conclusions The thyroid hormone levels between pregnant women and non-pregnant women are significantly different. Moreover, the reference intervals are vary with pregnancy period. It is important to establish the specific reference intervals of thyroid hormones in the first, second and third trimester of pregnancy specific to local region or unit.

Association study between 834+7G/A and +1332C/T polymorphisms in the growth arrest specific 6 gene and risk of severe preeclampsia in Chinese population / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To investigate the relationship between polymorphisms of the growth arrest specific 6 (GAS6) gene and severe preeclampsia in a South West Han Chinese population.</p><p><b>METHODS</b>Blood samples from 167 patients with severe preeclampsia and 312 normal pregnant women as controls from Han Chinese in Chengdu area were analyzed by polymerase chain reaction-restriction fragment length polymorphisms.</p><p><b>RESULTS</b>C and T allele frequencies for +1332C/T site were 85.63% and 14.37% in the patient group, respectively, and 78.04% and 21.96% in control group, respectively. The TT genotype and variant T allelic frequencies of the +1332C/T polymorphism were significantly lower in patients with severe preeclampsia than in the control group (both P<0.05), and the odds ratio for the risk of severe preeclampsia was 0.602 (95%CI: 0.401-0.904) in carriers for the variant T allele (χ=6.045, P=0.014). G and A allele frequencies for 834+7G/A site were 72.75% and 27.25% in case group, respectively, and 74.36% and 25.64% in control group, respectively. The genotype and allele frequencies of the 834+7G/A polymorphism in patients with severe preeclampsia and controls showed no significant differences (both P>0.05). In addition, there was no significant association between the polymorphisms and blood pressure levels in the patient or control groups.</p><p><b>CONCLUSION</b>The variant GAS6+1332 T allele is associated with a decreased risk for severe preeclampsia in a South West Han Chinese population. On the other hand, the 834+7G/A polymorphism has no effect on the severe preeclampsia.</p>

Therapeutic value of EUS-guided dehydrated ethanol lavage for pancreatic cystic neoplasms / 中华消化内镜杂志

Objective To evaluate the safety and feasibility of endoscopic ultrasonography(EUS)-guided dehydrated ethanol lavage on treatment of pancreatic cystic neoplasms(PCN). Methods The data of 15 patients with PCN treated by EUS-guided dehydrated ethanol lavage in Nanjing Drum Tower Hospital from April 2014 to December 2016 were retrospectively analyzed. All the patients underwent EUS-guided fine needle aspiration, and then the cyst cavity was lavaged with dehydrated ethanol. The curative effects and complications were evaluated after the procedure. Results Each patient had one operation and all the operations were successful. No operation-related intraoperative or postoperative complications occurred. Patients were followed up for a median time of 15 months(range from 3-30 months).Twelve patients finished a long term follow-up,including 6 cases of complete remission and 6 cases of partly remission. None of the patients underwent surgical resection. Conclusion Dehydrated ethanol lavage is safe and feasible for treatment of PCN.

Malignant progression and survival analysis for intraductal papillary mucinous neoplasms based on risk stratification / 中华消化内镜杂志

Objective To evaluate the potential malignancy, prognosis and risk factors for intraductal papillary mucinous neoplasm(IPMN), which were classified into different risk levels based on Fukuoka guideline. Methods A retrospective analysis of patients with IPMN diagnosed at Nanjing Drum Tower Hospital from 2009 to 2016 was conducted. Clinical characteristics,treatment and prognosis of IPMNs were analyzed. Results A total of 94 IPMN patients were included and divided into 3 groups according to Fukuoka guideline,46 patients in high-risk(HR)group,30 in group of worrisome features(WF), and 18 in low-risk(LR)group. For patients undergoing surgery treatment, there were 5 cases(19.2%,5/26)in HR group and 2 cases(12.5%,2/16)in WF group whose postoperative pathological findings were malignant (P=0.690). The 5-year survival rates after operations were 73.9% and 77.0% in HR and WF group, respectively(P=0.830). For patients without surgery treatment, in a 5-year follow-up, there were 6 cases (33.3%,6/18),2 cases(16.7%,2/12)and 0(0.0%,0/18)progressing into pancreatic cancers in HR, WF and LR groups,respectively(P<0.05). In addition,among the three groups,the 5-year survival rates were 49.5%,85.7% and 100.0%(P=0.025). Jaundice was significantly related to prognosis(P<0.01) and the hazard ratio was 8.883(95%CI:2.953-26.721). Conclusion Jaundice is a predictive risk factor for survival of IPMN. As for the treatment to IPMN, patients in HR group should receive surgery treatment while those in LR group can be followed up. For patients in WF group,the treatment should be customized, with evaluation of predictive risk factors,and operations can be performed when needed.

Clinical study on vaginal birth after cesarean / 中华妇产科杂志

Objective To investigate the incidence and pregnant outcome on vaginal birth after cesarean (VBAC). Methods From January 2005 to December 2015, clinical data of 507 cases with VBAC in West China Second Hospital were studied retrospectively. There were 370 cases of VBAC from January 2013 to December 2015 as study group (VBAC group), in contrast, 740 cases of elective repeat cesarean section (ERCS group) and 740 primiparas of vaginal delivery without history of cesarean section as control groups, the pregnancy outcome were analyzed between the study group and control groups respectively. Results (1) There were 76 547 total births from January 2005 to December 2015. Among these, 10 178 (13.296%, 10 178/76 547) patients had a single prior low transverse cesarean section, of which 4.981%(507/10 178) had VBAC. The incidence of VBAC was rising from 1.020%-3.704%during 2005-2012 to 6.028%-7.662% during 2013-2015. The rate of scared uterus during 2013-2015 was 18.269% (5 539/30 319), of which 9.26%(513/5 539) chose trial of labor after cesarean section (TOLAC). Successful VBAC occurred in 72.12%(370/513) of patients with TOLAC, and 27.88%(143/513) delivered by emergency cesarean. (2) The following parameters of the successful group and the unsuccessful VBAC group were compared, maternal age (29±4) versus (34±4) years, body mass index at prenatal visit (22.2±1.4) versus (22.6±1.4) kg/m2, gestational age (38.7±0.9) versus (39.6±1.3) weeks, birth weight (3 326±317) versus (3 404±285) g, and the rate of induction of labor 0 (0/370) and 6.29%(9/143), there were significant differences (all P0.05). (4) The postpartum hemorrhage and hospitalization duration in VBAC group incidence were respectively (194±34) ml and (2.32±0.49) days, and the indexes of the ERCS group were respectively (419 ± 57) ml and (4.14 ± 0.78) days, there were significant differences (all P0.05). Conclusions The majority of patients choose ERCS rather than TOLAC. It′s important to assess the indications and contraindications of patients for the successful VBAC, and to monitor maternal and fetal conditions during the delivery process. The premise of TOLAC is a comprehensive understanding of closely monitoring the progress of delivery. Compared with the ERCS, VBAC could reduce patients′ postpartum hemorrhage and hospitalization duration, improve the outcomes of pregnancy, and the cesarean section rate could be reduced.

Risk factors of peripartum hysterectomy in placenta previa：a retrospective study of 3 840 cases / 中华妇产科杂志

Objective To investigate the risk factors of peripartum hysterectomy in placenta previa through retrospective study of 3 840 placenta previa cases. Methods The clinical data of 3 840 patients with placenta previa who delivered in West China Second University Hospital between Jan 2005 and June 2014 were analyzed retrospectively. The relationship of certain factors and peripartum hysterectomy was analyzed, including maternal age, residence place, parity, prior curettage, prior cesarean section, twin or multiple pregnancy, antenatal vaginal bleeding, type of placenta previa, suspected placenta accreta, antenatal level of hemoglobin and gestational age at delivery. Results The prevalence of placenta previa was 4.84% (3 840/79 304) in West China Second University Hospital during the study period, and the incidence of preipartum hysterectomy in patients with placenta previa was 2.76% (106/3 840). One-factor analysis demonstrated that residence place, parity, times of prior curettage, prior cesarean section, prenatal vaginal bleeding, anterior placenta, type of placenta previa, placenta accreta, antenatal anemia and gestational age at delivery were potential risk factors for peripartum hysterectomy (P<0.01). Variables with P<0.1 in one-factor analysis were introduced to multi-factor logistic regression analysis, which suggested that one prior cesarean section (OR=12.9,95%CI:6.3-26.3), two or more prior cesarean sections (OR=14.4, 95%CI:3.9-53.2), anterior placenta (OR=4.8, 95%CI:2.1-10.7), complete placenta previa (OR=5.9, 95%CI:1.8-42.5), placenta accreta (OR=11.2, 95%CI:6.8-18.6), antenatal hemoglobin<100 g/L (OR=1.7, 95%CI:1.0-2.8) and delivery before 34 gestational weeks (OR=3.2, 95%CI:1.6-6.3) were independent risk factors of peripartum hysterectomy in patients with placenta previa (P<0.05). Conclusions Prior cesarean section, anterior placenta, complete placenta previa, placenta accreta, antenatal anemia and delivery before 34 gestational weeks are high risk factors of peripartum hysterectomy in placenta previa patients. Perinatal care and risk evaluation before cesarean section are important to improve perinatal outcomes and reduce peripartum hysterectomy.

Study on the effect of influenza virus on the expression of collagen triple helix repeat containing 1 / 实用医学杂志

Objective To investigate the effect of influenza virus on the expression of collagen triple he-lix repeat containing 1 (CTHRC1). Methods A549 cells were infected with influenza virus. mRNA and protein levels of CTHRC1 were determined by RT-PCR and Western blot , CTHRC1 levels in the cell supernatants and sera of influenza virus infected patients were determined by enzyme-linked immunosorbent assay (ELISA). The difference of CTHRC1 levels between healthy controls and HCV patients was analyzed. Results Compared with controls, mRNA and protein levels of CTHRC1 were higher in A549 cells infected with H3N2. Serum CTHRC1 levels were higher in influenza virus infected patients than in healthy controls (P < 0.05). Conclusion Influenza virus can promote the synthesis and secretion of CTHRC1.

Patient-controlled paravertebral block in optimizing cellular immune function after radical resection of pulmonary carcinoma performed via video-assisted thoracoscope / 中华麻醉学杂志

Objective To evaluate the patient-controlled paravertebral block (PCPB) in optimizing the cellular immune function when used after radical resection of pulmonary carcinoma performed via video-assisted thoracoscope in patients.Methods Forty-one ASA physical status Ⅰ or Ⅱ patients of both sexes,aged 50-64 yr,with body mass index of 20-25 kg/m2,of TNM staging Ⅰ or Ⅱ,undergoing radical resection of pulmonary carcinoma performed via video-assisted thoracoscope,were randomly divided into 2 groups using a random number table:PCIA group (n =21) and PCPB group (n =20).PCIA solution contained sufentanil 2 μg/kg in 100 ml of normal saline.The PCIA pump was set up to deliver a 2 ml bolus dose with a 15-min lockout interval and background infusion at 2 ml/h.In PCPB group,the patients received paravertebral injection of 0.2％ ropivocaine 5 ml at T5 level on the affected side under ultrasound guidance at the end of operation,and then received PCPB.PCPB solution contained 0.75％ ropivacaine 67 ml in 250 ml of normal saline,and the pump was set up to deliver a 5 ml bolus dose,with a 15-min lockout interval and background infusion at 5 ml/h.VAS score was maintained ≤ 3,and analgesia lasted until 50 h after operation.Before induction of anesthesia (baseline),at end of operation,and at 1,3 and 5 days after operation,peripheral venous blood samples were collected to determine the levels of regulatory T cells,natural killer cells and natural killer T cells (by flow cytometry) and plasma concentrations of interleukin-10 and transforming growth factor-β (by ELISA).Results Compared with group PCIA,the level of regulatory T cells was significantly decreased,the levels of natural killer cells and natural killer T cells were increased,and the plasma concentrations of interleukin-10 and transforming growth factor-β were decreased at 1 and 3 days after operation,and no significant change was found in the rate of cellular immune function decline after operation in group PCPB.Conclusion PCPB provides no significant difference clinically in optimizing the cellular immune function when used after radical resection of pulmonary carcinoma performed via video-assisted thoracoscope in the patients.

Association study between -765G > C and -1195G > A functional polymorphisms in the cyclooxygenase 2 gene and risk of preeclampsia / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To investigate the relationship between two polymorphisms immediately upstream of the cyclooxygenase 2 (COX2) gene and preeclampsia in a South West Han Chinese population.</p><p><b>METHODS</b>Blood samples from 205 patients with preeclampsia and 276 normal pregnant women as controls from Han Chinese in Chengdu area were analyzed by polymerase chain reaction-restriction fragment length polymorphisms.</p><p><b>RESULTS</b>G and A allele frequencies for -1195G>A site were 48.54% and 51.46% in the patient group, respectively, and 40.40% and 59.60% in the control group, respectively. G and C allele frequencies for -765G>C site were 94.15% and 5.85% in the case group, respectively, and 94.38% and 5.62% in the control group, respectively. The AA genotype and variant A allelic frequencies of the -1195G>A SNP were significantly lower in patients with preeclampsia than in the control group (P<0.05), and the odds ratio for the risk of preeclampsia was 0.665 (95% CI: 0.444-0.982) in women homozygous for the variant COX2 A allele ( x²=4.233, P=0.047). The genotype and allele frequencies of the -765G>C polymorphism in patients with preeclampsia and controls showed no significant differences (P>0.05). Additional subgroup analyses (mild vs severe preeclampsia) of the two polymorphisms failed to reveal significant correlation for either genotypic or allelic frequencies. Furthermore, there was no significant association between the polymorphisms and blood pressure levels in the patient or control groups.</p><p><b>CONCLUSION</b>COX2 -1195A homozygosity is associated with a decreased risk for preeclampsia in a South West Han Chinese population. On the other hand, the -765G>C polymorphism has no effect.</p>

Meta-analysis of the risk factors for preeclampsia / 中华围产医学杂志

Objective To identify and evaluate the important risk factors for preeclampsia.Methods Databases of PubMed,Web of Science,Ovid CBM,China Knowledge Resource Integrated Database,Wanfang and VIP Database were searched from January 1,1990 to December 31,2012 to collect the cohort and case control studies involving the risk factors for preeclampsia.According to the inclusion and exclusion criteria,data of the included studies were extracted.Meta-analysis was performed using Stata 12.0 software with DerSimonian Laird model to calculate OR and its 95％CI of each risk factor.Results A total of 20 studies involving 53 393 patients in the research group and 1 197 773 cases in the control group were included.Fifteen risk factors for preeclampsia were investigated,including:history of preeclampsia (OR=10.27,95％CI:7.67-13.75),complication with chronic kidney diseases(OR=4.69,95％CI:1.94-11.33),history of chronic hypertension (OR-3.47,95％CI:2.39 5.04),multiple pregnancy (OR-2.98,95％CI:2.43-3.66),pre pregnancy body mass index (BMI) ≥ 25(OR=2.47,95％CI:1.97 3.09),maternal hyperglycemia(gestational diabetes and pre existing diabetes)(OR=2.84,95％CI:2.28-3.55),primiparity (OR=2.47,95％CI:2.12-2.82),physical work during pregnancy (OR=1.62,95％CI:1.30-2.02) ; family history of hypertension (OR=2.14,95％CI:1.84-2.50),basic diastolic blood pressure ≥ 70 mmHg (OR=2.17,95％CI:1.44-3.27),low education levels less than junior school (OR=1.69,95％CI:1.34 2.15),basic systolic blood pressure ≥ 120 mmHg (OR=2.31,95％CI:1.86-2.86),urinary tract infection (OR=1.96,95％CI:1.54-2.48),maternal age ≥ 35 or ≤ 20 years (OR=1.43,95％CI:1.29 1.57) and mental ademosyne (OR=1.35,95％CI:1.24-1.47).In addition,smoking before or during pregnancy was found to decrease the incidence of preeclampsia (OR-0.66,95％CI:0.56 0.79).Conclusions The main risk factors for preeclampsia are:history ofpreeclampsia,complication with chronic kidney diseases,history of chronic hypertension,multiple pregnancy,pre-pregnancy BMI ≥ 25,maternal hyperglycemia,primiparity,work during pregnancy and family history of hypertension.Smoking may decrease the incidence of preeclampsia.Nevertheless,more emphasis should be laid the adverse perinatal outcomes of smoking.

Affective of EGR2 expression in Schwann cells line exposed in high glucose / 国际检验医学杂志

Objective To investigate the effects of different glucose concentration on EGR2 protein expression in Schwann cells . Methods Schwann cells were cultured in different glucose concentrations ,and they were divided into two groups ,normal glucose concentration (5 .5 mmol/L ,N group) and high glucose concentration(25 mmol/L ,H group) .Immunocytochemistry and Western blot were used to study EGR2 expression .Results The expression of EGR2 protein was higher in H group than that in N group the difference was statistically significont (P<0 .05) .Conclusion High glucose can lead to EGR2 protein upregulate in Schwann cells ,and EGR2 maybe one of the reasons of diabetic neuropathy .

Interaction between HLA-DRB1 gene polymorphism and environmental risk factors in the development of gestational diabetes mellitus / 中华妇产科杂志

Objective To explore the interactions between human leukocyte antigen ( HLA)-DRB1 gene polymorphism and environmental risk factors in gestational diabetes mellitus ( GDM ) pathogenesis.Methods Pregnant women who had prenatal cares in Obstetric Department , West China Second Hospital of Sichuan University were recruited from January 1st to December 31st in 2011.A prospective cohort study was conducted in the women who had a glucose challenge test ( GCT) or 75 g oral glucose tolerance test ( OGTT) during 24-28 gestational weeks.A total of 104 women diagnosed with GDM were randomly included in GDM group while another 103 normal women fell into the control group.The HLA-DRB1 polymorphism was detected by Polymerase Chain Reaction -Sequence Specific Primers ( PCR-SSP) method in both groups.The interactions between HLA-DRB1 polymorphism and environmental risk factors were analyzed based on the simple-case-study method.Results ( 1 ) There were 712 pregnant women with complete perinatal information during January 1st to December 31st, 2011, among whom 175 (24.6%) women were diagnosed with GDM.A logistic regression analysis showed that advanced maternal age (OR=1.081, 95%CI:1.027-1.138), imbalanced diet (OR=3.329, 95%CI:2.167 -5.116), high body mass index (BMI≥24.0 kg/m2) before pregnancy (OR=1.095, 95%CI:1.008 -1.190), HBsAg carrier status (OR=3.173, 95%CI:1.387-7.260) and family history of diabetes mellitus (DM) (OR=1.798, 95%CI:1.063 -3.041) were risk factors of GDM.(2) There were 49 HLA-DRB1 genotypes and 51 HLA-DRB1 genotypes in GDM group and the control group , respectively.We further compared the genotypes that occurred in over 3 cases in either group and found that HLA-DRB1*12,16 was only detected in 5 cases (5/103, 4.9%) in control group,and the difference was significant between the two groups (P=0.029).HLA-DRB1*11,16 and HLA-DRB1*09,09 were only detected in 4 cases (3.8%,4/104) and 5 cases (4.8%, 5/104) in GDM group respectively , but without significant differences between the two groups ( P >0.05 ).No significant difference was found in other genotype frequencies between the two groups ( P>0.05 ).( 3 ) Thirteen types of HLA-DRB1 allele were detected but no significant differences were observed in their frequencies between two groups ( P>0.05).(4) A positive interaction was detected between HLA-DRB1*07 polymorphism and advanced maternal ages (OR=5.952, 95%CI:1.314-26.970, P=0.022), while no interaction was found between HLA-DRB polymorphisms to other risk factors such as imbalanced diet , high body mass index ( BMI≥24.0 kg/m2 ) , HBsAg carrier status or DM family history.Conclusions Advanced maternal age, unbalanced diet, high body mass index (BMI≥24.0 kg/m2), HBsAg carrier status and DM family history are environmental risk factors of GDM in Chengdu.While HLA-DRB1*12,16 genotype may be a protective genotype for GDM.There is a positive interaction between HLA-DRB1*07 polymorphism and advanced maternal age which may play a critic role in GDM development.