Tectonic and orbital forcing of the South Asian monsoon in central Tibet during the late Oligocene.

The modern pattern of the Asian monsoon is thought to have formed around the Oligocene/Miocene transition and is generally attributed to Himalaya-Tibetan Plateau (H-TP) uplift. However, the timing of the ancient Asian monsoon over the TP and its response to astronomical forcing and TP uplift remains poorly known because of the paucity of well-dated high-resolution geological records from the TP interior. Here, we present a precession-scale cyclostratigraphic sedimentary section of 27.32 to 23.24 million years ago (Ma) during the late Oligocene epoch from the Nima Basin to show that the South Asian monsoon (SAM) had already advanced to the central TP (32°N) at least by 27.3 Ma, which is indicated by cyclic arid-humid fluctuations based on environmental magnetism proxies. A shift of lithology and astronomically orbital periods and amplified amplitude of proxy measurements as well as a hydroclimate transition around 25.8 Ma suggest that the SAM intensified at ~25.8 Ma and that the TP reached a paleoelevation threshold for enhancing the coupling between the uplifted plateau and the SAM. Orbital short eccentricity-paced precipitation variability is argued to be mainly driven by orbital eccentricity-modulated low-latitude summer insolation rather than glacial-interglacial Antarctic ice sheet fluctuations. The monsoon data from the TP interior provide key evidence to link the greatly enhanced tropical SAM at 25.8 Ma with TP uplift rather than global climate change and suggest that SAM's northward expansion to the boreal subtropics was dominated by a combination of tectonic and astronomical forcing at multiple timescales in the late Oligocene epoch.

Atorvastatin reduces contrast media-induced pyroptosis of renal tubular epithelial cells by inhibiting the TLR4/MyD88/NF-κB signaling pathway.

BACKGROUND: Contrast-induced acute kidney injury (CI-AKI) is the third most common cause of hospital-acquired renal failure. However, there is no effective treatment of CI-AKI, and its mechanism is unknown. Interestingly, atorvastatin has been reported to be effective in renal injury. Therefore, the aim of this study was to explore the effect and possible molecular mechanism of atorvastatin in CI-AKI. METHODS: On the CI-AKI in vitro model, rat tubular epithelial cells (NRK-52E) were treated with 18 mg I/ml meglumine diatrizoate (MEG) and then pretreated with atorvastatin. pcDNA3.1-TLR4 treatment was performed to overexpress toll-like receptor 4 (TLR4) in NRK-52E cells. Cell Counting Kit-8 (CCK-8) and lactate dehydrogenase (LDH) kits were used to detect NRK-52E cell viability as well as LDH release in each group, respectively; qRT-PCR to determine mRNA expression of TLR4 in cells; western blot to detect protein expression levels of pyroptosis-related proteins (NLRP3, caspase-1, ASC, and GSDMD) and TLR4/MyD88/NF-κB signaling pathway-related proteins (TLR4, MyD88, NF-κBp65, and p-NF-κB p65) in cells. RESULTS: MEG treatment significantly inhibited the viability of NRK-52E cells, increased pro-inflammatory factor levels and promoted pyroptosis, representing successful establishment of a rat tubular epithelial cell (NRK-52E) CI-AKI in vitro model. Notably, atorvastatin increased the activity of MEG-treated NRK-52E cells and alleviated cell injury in a concentration-dependent manner. In addition, atorvastatin significantly down-regulated the expression of TLR4 in MEG-treated NRK-52E cells. However, overexpression of TLR4 inhibited the effects of atorvastatin on increasing cell viability, alleviating cell injury, reducing pro-inflammatory factors (IL-1ß, IL-6, and TNF-α) levels, and inhibiting apoptosis (by down-regulating the expression of NLRP3, caspase-1, ASC, and GSDMD). Furthermore, atorvastatin also inhibited the expression of TLR4/MyD88/NF-κB pathway-related proteins (TLR4, MyD88, and p-NF-κB p65). CONCLUSION: Atorvastatin can attenuate CI-AKI through increasing the activity of MEG-treated renal tubular epithelial cells, relieving cell injury, as well as inhibiting pyroptosis and inflammation. More importantly, the mechanism was achieved by inhibiting the TLR4//MyD88/NF-κB signaling pathway.

Electro-microenvironment modulated inhibition of endogenous biofilms by piezo implants for ultrasound-localized intestinal perforation disinfection.

Endogenous bacterial infections from damaged gastrointestinal (GI) organs have high potential to cause systemic inflammatory responses and life-threatening sepsis. Current treatments, including systemic antibiotic administration and surgical suturing, are difficult in preventing bacterial translocation and further infection. Here, we report a wireless localized stimulator composed of a piezo implant with high piezoelectric output serving as an anti-infective therapy patch, which aims at modulating the electro-microenvironment of biofilm around GI wounds for effective inhibition of bacterial infection if combined with ultrasound (US) treatment from outside the body. The pulsed charges generated by the piezo implant in response to US stimulation transfer into bacterial biofilms, effectively destroying their macromolecular components (e.g., membrane proteins), disrupting the electron transport chain of biofilms, and inhibiting bacterial proliferation, as proven by experimental studies and theoretical calculations. The piezo implant, in combination with US stimulation, also exhibits successful in vivo anti-infection efficacy in a rat cecal ligation and puncture (CLP) model. The proposed strategy, combining piezo implants with controllable US activation, creates a promising pathway for inhibiting endogenous bacterial infection caused by GI perforation.

Tracking the Stepwise Formation of a Water-Soluble Fluorescent Tb12 Cluster for Efficient Doxorubicin Detection.

Doxorubicin (DOX) is an anthraquinone drug used for the efficient treatment of a variety of tumors in human beings. Unfortunately, its poor biodegradability causes incomplete metabolism in the body. Therefore, it is of great significance to synthesize a sensitive and selective material for DOX detection. In this paper, we report a water-soluble Tb12 cluster and track its step-by-step formation (L → Tb1L1 → Tb2L1 → Tb2L2 → Tb3L2 → Tb4L2 → Tb12L6). Tb12 can be used to determine the presence of DOX, which quenches the luminescence of the Tb12 aqueous solution, and the detection limit can reach 13 nM (KSV = 8.7 × 105 M-1). Tb12 has advantages of high sensitivity and high selectivity for the detection of DOX in a simulated environment of human urine and serum.

[Endometrial Injury and Preservation after Magnetic Resonance-guided Focused Ultrasound Ablation of Uterine Fibroids].

Objective To explore the risk factors for incident endometrial injury and 3-month endometrial injury after magnetic resonance-guided focused ultrasound(MRgFUS)ablation of uterine fibroids(UF). Methods UF patients who were diagnosed in Peking Union Medical College Hospital and underwent MRgFUS ablation in Amcare Women's and Children's Hospital from August 2016 to October 2020 were retrospectively enrolled in this study.Clinical data of 66 UF patients were collected and compared between endometrial injury group and non-injury group.Stepwise regression was employed to determine the risk factors for the incident endometrial injury and 3-month endometrial injury.Multivariate logistic regression analysis was performed to explore the relationship of endometrial injury with age,pre-ablation tumor size,multiple UF,International Federation of Gynecology and Obstetrics(FIGO)classification,T2WI signal intensity,and treatment time.Results In terms of incident endometrial injury,the 66 patients included 41(62.1%)cases with no injury,4 cases(6.1%) with grade 1 injury,5 cases(7.6%)with grade 2 injury,and 16 cases(24.2%)with grade 3 injury.In terms of 3-month endometrial injury,the 66 patients included 49 cases(74.2%)with no injury,5 cases(7.6%)with grade 1 injury,2 cases(3.0%)with grade 2 injury,and 10 cases(15.2%)with grade 3 injury.Stepwise regression analysis indicated that FIGO classification was significantly associated with incident endometrial injury(B=-0.121,SE=0.045,ß=-0.326,t=-2.670,P=0.010)and 3-month endometrial injury(B=-0.125,SE=0.042,ß=-0.375,t=-2.989,P=0.004).Multivariate logistic regression analysis showed that FIGO classification was an independent risk factor for incident endometrial injury[OR=0.518(0.307-0.873),P=0.014]and 3-month endometrial injury[OR=0.456(0.253-0.824),P=0.009].Conclusions Endometrial injury could be controlled after MRgFUS ablation of UF and recover to some extent after 3 months.FIGO classification was an independent risk factor for both incident and 3-month endometrial injury.

Redox-Mediated Artificial Non-Enzymatic Antioxidant MXene Nanoplatforms for Acute Kidney Injury Alleviation.

Acute kidney injury (AKI), as a common oxidative stress-related renal disease, causes high mortality in clinics annually, and many other clinical diseases, including the pandemic COVID-19, have a high potential to cause AKI, yet only rehydration, renal dialysis, and other supportive therapies are available for AKI in the clinics. Nanotechnology-mediated antioxidant therapy represents a promising therapeutic strategy for AKI treatment. However, current enzyme-mimicking nanoantioxidants show poor biocompatibility and biodegradability, as well as non-specific ROS level regulation, further potentially causing deleterious adverse effects. Herein, the authors report a novel non-enzymatic antioxidant strategy based on ultrathin Ti3 C2 -PVP nanosheets (TPNS) with excellent biocompatibility and great chemical reactivity toward multiple ROS for AKI treatment. These TPNS nanosheets exhibit enzyme/ROS-triggered biodegradability and broad-spectrum ROS scavenging ability through the readily occurring redox reaction between Ti3 C2 and various ROS, as verified by theoretical calculations. Furthermore, both in vivo and in vitro experiments demonstrate that TPNS can serve as efficient antioxidant platforms to scavenge the overexpressed ROS and subsequently suppress oxidative stress-induced inflammatory response through inhibition of NF-κB signal pathway for AKI treatment. This study highlights a new type of therapeutic agent, that is, the redox-mediated non-enzymatic antioxidant MXene nanoplatforms in treatment of AKI and other ROS-associated diseases.

Spectrum of thrombotic complications and their outcomes in Chinese children with primary nephrotic syndrome.

BACKGROUND: Thromboembolism is a life-threatening, limb-threatening or organ-threatening complication that occurs in patients with primary nephrotic syndrome (NS). There are few studies on the spectrum, complications and outcomes of thrombosis in children with NS. This study aimed to determine the spectrum of thrombosis and its relationship with the nephrotic state, treatment and outcomes in children and adolescents with primary NS. METHODS: The medical records of subjects aged 1-18 years with NS complicated with thromboembolism treated at our centre within the last 26 years were retrieved. Data on the status of NS, site, symptoms and signs, laboratory investigations, diagnosis, treatment, complications and outcomes of thrombosis were collected and reviewed retrospectively. A severe complication was defined as a condition associated with thrombosis requiring a special diagnostic modality to confirm or a specific treatment such as surgical intervention. The outcome of thrombosis was defined as the status of thrombosis, as determined by imaging methods and the functional status with respect to the anatomic sites of thrombosis at the last follow-up. The permanent dysfunction of an organ or limb related to thrombosis was defined as a sequela. RESULTS: We observed thrombosis in 1.4% (27/1995) of subjects with NS during the study period. There were 27 subjects with thrombosis, including 21 males and 6 females. Thrombosis was observed in 51.9% (14/27) of the study participants with steroid resistant NS. Most episodes of thrombosis occurred during the active stage of NS; however, 7.4% of thrombosis cases occurred during the remission of proteinuria. Renal vein thrombosis (33.3%) and pulmonary embolism (25.9%) were the most common types of thrombosis. Among the 17 subjects biopsied, minimal change disease and membranous nephropathy were the two most common findings. Six (22.2%) subjects experienced severe complications or sequelae; 1 had persistent intracranial hypertension, 1 had intestinal perforation, 1 had hypoxemia and pulmonary hypertension, 1 had lameness, 1 had epilepsy, and 1 had an askew mouth due to facial paralysis. In 19 (70.4%) subjects, the symptoms resolved completely or improved without severe complications or sequelae. CONCLUSIONS: Thrombosis mostly occurred in males of school age during the active stage of NS. Renal vein thrombosis and pulmonary embolism were the most common types of thrombosis. In most patients with thrombosis, the symptoms improved completely without complications with standard anticoagulation therapy. However, 22.2% had severe complications or sequelae requiring an advanced diagnostic modality and aggressive treatment.

Smart Ti3C2Tx MXene Fabric with Fast Humidity Response and Joule Heating for Healthcare and Medical Therapy Applications.

An increasing utilization of flexible healthcare electronics and biomedicine-related therapeutic materials urges the development of multifunctional wearable/flexible smart fabrics for personal therapy and health management. However, it is currently a challenge to fabricate multifunctional and on-body healthcare electronic devices with reliable mechanical flexibility, excellent breathability, and self-controllable joule heating effects. Here, we fabricate a multifunctional MXene-based smart fabric by depositing 2D Ti3C2Tx nanosheets onto cellulose fiber nonwoven fabric via special MXene-cellulose fiber interactions. Such multifunctional fabrics exhibit sensitive and reversible humidity response upon H2O-induced swelling/contraction of channels between the MXene interlayers, enabling wearable respiration monitoring application. Besides, it can also serve as a low-voltage thermotherapy platform due to its fast and stable electro-thermal response. Interestingly, water molecular extraction induces electrical response upon heating, i.e., functioning as a temperature alarm, which allows for real-time temperature monitoring for thermotherapy platform without low-temperature burn risk. Furthermore, metal-like conductivity of MXene renders the fabric an excellent Joule heating effect, which can moderately kill bacteria surrounding the wound in bacteria-infected wound healing therapy. This work introduces a multifunctional smart flexible fabric suitable for next-generation wearable electronic devices for mobile healthcare and personal medical therapy.

OFD1 mutation induced renal failure and polycystic kidney disease in a pair of childhood male twins in China.

BACKGROUND: Oral-facial-digital syndrome type 1 (OFD1) is a rare ciliopathy mainly with an X-linked dominant pattern of inheritance, which is caused by mutations in the OFD1 gene. The OFD1 protein is located within the centrosomes and basal bodies of the primary cilia. It is reported that approximately 15%-50% cases of OFD1 progress to end-stage renal disease (ESRD) following development of polycystic kidney diseases (PKD). Here we report a pair of childhood male twins who presented only renal failure and PKD caused by an OFD1 mutation in China. CASE SUMMARY: A pair of 14-year male twins were hospitalized with a complaint of abnormal renal function for nine days. They both complained of ankle pain for 3 mo vs 2 wk, respectively. They denied fever, abdominal pain, daytime or nighttime enuresis, urgency, dysuria, or gross hematuria. Laboratory tests at a local hospital showed renal failure (serum creatinine 485 µmol/L vs 442 µmol/L, blood urea nitrogen 14.7 mol/L vs 14.5 mol/L) and anemia (hemoglobin 88 g/L vs 98 g/L). The twins are monozygotic. There was no abnormal birth, past medical, or family history. Clinical data were analyzed and genetic analysis on PKD was carried out in the twins by next-generation sequencing. The results showed that the twins presented low-molecular-weight proteinuria, hyposthenuria, anemia, renal failure, and renal polycystic changes. Genetic tests showed that the twins both carried a hemizygous mutation in exon 19 c.2524G>A (p. G842R) of the OFD1 gene. Their mother heterozygously carried the same mutation as the twins but was without any phenotypes while their father was normal. CONCLUSION: We have reported a pair of childhood male twins with an OFD1 mutation who presented ESRD and PKD but without any other phenotypes of OFD1 in China.

Therapeutic strategy of patent ductus arteriosus in extremely preterm infants.

The ductus arteriosus is likely to close without treatment in most infants born at gestational age (GA) > 28 weeks (73%), and those with birth weight > 1000 g (94%). However, the rates of spontaneous ductal closure among less mature or smaller infants with respiratory distress syndrome are not known. Extremely preterm infants born at GA < 28 weeks are associated with a high risk of severe intraventricular hemorrhage (IVH) or pulmonary hemorrhage, which usually occur within 72 h after birth and affect mortality and long-term neurological development. These serious hemorrhagic complications may be closely related to hemodynamic changes caused by a hemodynamically significant patent ductus arteriosus (hs-PDA). While prophylactic indomethacin has been shown to reduce the rates of PDA, PDA ligation, severe IVH and early pulmonary hemorrhage, the available evidence does not support its prophylactic use in preterm infants. Symptomatic or late treatment is associated with lower success rate, and increased complications of a hs-PDA. The issue of "to treat or not to treat a PDA" is controversial. Considering the relationship between the effectiveness and timing of pharmacological treatment, early targeted treatment may be an alternative approach for the early identification of a hs-PDA in specific high-risk patient population, especially infants <26 weeks GA who are at the highest risk of severe IVH or pulmonary hemorrhage. Serial echocardiographic studies can be used to select patients who are candidates for early targeted medical treatment of hs-PDA. Surgical ligation of PDA, and transcatheter closure if proven to be safe, can be used as back-up therapy for patients who fail medical treatment and continue to have cardiopulmonary compromise.

Innovation in sedation and analgesia training.

PURPOSE OF REVIEW: We reviewed evidence of recent innovations in sedation education and discuss experiences with sedation training in Taiwan. RECENT FINDINGS: Current Status of Sedation Training: Didactic training and supervised clinical mentoring are common methods of sedation training. Although training course designed by professional societies to meet individual hospital credentialing requirements, the course content and training expectations vary and are likely inadequate to non-anesthesiologist sedation practitioners. Less Common Forms of Sedation Training: These include screen-based simulation, high-fidelity manikin-based simulation. Screen-based simulation sedation training is popular, convenient, and relatively inexpensive. Although there are numerous courses available, course content has not been standardized. High-fidelity simulation has been accepted to improve knowledge, self-confidence, awareness of emergency, crisis resource management, and teamwork, but it is costly, time intensive, and requires expertise in using simulation equipment. Although screen-based training is attractive and convenient, there is no evidence to suggest that it can replace high-fidelity simulation. Another recently developed education modality is virtual reality simulation. It has gained recent popularity as an immersive approach to medical training, but minimal content has been developed for sedation training. Beyond training, several other potential innovations may improve sedation effectiveness and patient safety. These include adherence to practice guidelines established by professional organizations, utilization of a pre-procedure sedation checklist, interpreting capnography, and implementation of real-time bedside drug displays that provide predictions of concentrations and their associated effects. SUMMARY: Effective sedation education and training, especially for nonanesthesiologists, is essential to improve patient safety for procedural sedation. Several innovative approaches have been proposed and are relatively early in their development and implementation. Further studies designed to assess the impact of these new training modalities on patient safety and outcomes are warranted.

[Predictive Value of Texture Analysis in the Treatment of Magnetic Resonance-guided Focused Ultrasound Surgery for Symptomatic Uterine Fibroids].

Objective To evaluate the predictive value of texture analysis in the treatment of magnetic resonance-guided focused ultrasound surgery(MRgFUS)for symptomatic uterine fibroids.Methods Totally 16 patients with symptomatic uterine fibroids who accepted MRgFUS in Peking Union Medical College Hospital from April 2010 to January 2013 were included. Enhanced magnetic resonance imaging(MRI)was performed before treatment,immediately after treatment,and during the 12-month follow-up. The TexRAD software was used to measure the texture parameters of the fibroids in T2WI sagittal images,and the texture indicators including means and standard deviations(SD),entropy,mean of positive pixels(MPP),skewness,and kurtosis were collected. The fibroid's volume and their change rates were calculated by measuring the relevant diameter of the target fibroid. The Uterine Fibroid Symptoms and Quality of Life(UFS-QOL)was used to calculate the symptom severity scores(SSS)and its change rate. The statistical difference of parameters among the groups was analyzed. The correlations between each texture parameter and the therapeutic outcome of the fibroids were analyzed respectively.Results The average volume for fibroids before treatment was(96.5±84.9)cm 3,which was reduced to(55.1±71.0)cm 3 after treatment for 12 months,and the volume change rate(εV%)was(49±20)%. The standardized SSS score before treatment was(34.18±15.29)scores,decreased to(17.78±11.84)scores 12 months after treatment,with a change rate of(45±32)%,and the non-perfused volume ratio(NPV%)was(62±20)%. There were significant differences among the parameters mean,SD,entropy,and MPP among three groups(all P<0.05),and the changes of them were regular,all of which showed a significant decrease immediately after treatment and a significant increase 12 months after treatment,and the increase degree was higher than the preoperative level. SD(SSF2:r=0.503,P=0.047;SSF4:r=0.529,P=0.035;SSF6:r=0.519,P=0.039)and entropy(SSF2:r=0.527,P=0.036;SSF4:r=0.517,P=0.040;SSF6:r=0.495,P=0.050)of the after-treatment group moderately associated with the εV%. Entropy of the before-treatment group was moderately associated with NPV%(SSF2:r=0.507,P=0.045;SSF4:r=0.543,P=0.030;SSF6:r=0.548,P=0.028).Conclusion There is a certain correlation between the changes of MRI texture parameters before and after treatment and the effect of MRgFUS in the treatment of uterine fibroids,and texture analysis may have certain value in the predicting the effect of MRgFUS on uterine fibroids.

[Quantitative Assessment of Skin Thickness using High Frequency Ultrasound in Systemic Sclerosis].

OBJECTIVE: To investigate the performance of high frequency ultrasound in the assessment of skin thickness in patients with systemic sclerosis (SSc). METHODS: The study included 82 SSc (SSc group) and 67 healthy volunteers (control group) from 2014 to 2016. The skin thickness at bilateral middle fingers and forearms,anterior chest and abdominal wall was measured using high frequency ultrasound. All the patients with SSc underwent the modified rodnan skin score (mRSS) over 17 anatomical sites by an experienced dermatologist. The differences in age,sex,height,body mass,body mass index (BMI) and skin thickness between SSc patients and healthy controls were compared. Receiver operating characteristic (ROC) curve analysis was performed to determine the performance of high frequency ultrasound in the differentiation of SSc from healthy skin,and the correlation of mRSS with skin thickness were analyzed. RESULTS: SSc patients and healthy controls shared similar demographic features (age,sex ratio,height,body mass,BMI) (P>0.05). Skin thickness values in SSc patients were increased significantly at fingers and forearms compared with healthy controls (P<0.05). The area under the curve (AUC) was 0.938, 0.905, 0.608, 0.586, 0.398, 0.321 at right and left finger,right and left forearm,chest and abdominal wall. Among them,AUC>0.9 of right and left fingers can be used for diagnosis,The skin thickness cut-off value for determining the diagnosis of SSc were as follows: 1.35 mm at the right finger with 84.1% sensitivity and 95.5% specificity,1.26 mm at the right forearm with 86.6% sensitivity and 89.6% specificity,respectively. Skin thickness increased significantly with mRSS. The correlation of total mRSS scores with total skin thickness was 0.599 (P<0.001),and the correlation of local mRSS score with local skin thickness were 0.400-0.623 (P<0.001),with the highest correlation coefficient at right finger and the lowest at abdomen. CONCLUSION: High frequency ultrasound may reflect extent of skin involvement of SSc,and skin thickness assessed with high frequency ultrasound appeared to be highly specific and sensitive at fingers.

Association of preterm birth and small for gestational age with metabolic outcomes in children and adolescents: A population-based cohort study from Taiwan.

BACKGROUND: Previous studies have identified preterm birth and/or small for gestational age (SGA) as risk factors for features of the metabolic syndrome, including high blood pressure, insulin sensitivity and atherosclerosis, occurring later in life, with controversial results. We conducted this population-based cohort study to investigate metabolic outcomes in those with former preterm birth and/or SGA status in Taiwan. METHODS: Data were obtained from Taiwan's universal National Health Insurance Research Database. From 1996 to 2004, 37,119 preterm infants, 3386 SGA infants, and 162,020 matched controls were included. We investigated the risk of the metabolic disease, including hypertension, diabetes, and hyperlipidemia, which had been recorded by the end of 2008. RESULTS: The preterm and SGA cohort, combined into one, had a significantly increased risk of developing metabolic disorders when compared with the comparison cohort (HR = 2.46, 95% CI = 2.02-3.01). We observed that children with former preterm and SGA status in Taiwan had a higher risk of developing hypertension (HR = 3.24, 95% CI = 1.58-6.67), Type 1 diabetes mellitus (HR = 1.80, 95% CI = 1.05-3.07), Type 2 diabetes mellitus (HR = 2.49, 95% CI = 1.98-3.14), and hyperlipidemia (HR = 2.14, 95% CI = 1.29-3.52). CONCLUSION: Our study revealed the risk of metabolic disease in those with preterm birth and/or SGA. Further studies with a longer duration of follow-up are required to confirm if there is a tendency for the metabolic syndrome to develop in this study cohort.

Intrauterine inflammation, infection, or both (Triple I): A new concept for chorioamnionitis.

Chorioamnionitis is a common cause of preterm birth and may cause adverse neonatal outcomes, including neurodevelopmental sequelae. Chorioamnionitis has been marked to a heterogeneous setting of conditions characterized by infection or inflammation or both, followed by a great variety in clinical practice for mothers and their newborns. Recently, a descriptive term: "intrauterine inflammation or infection or both" abbreviated as "Triple I" has been proposed by a National Institute of Child Health and Human Development expert panel to replace the term chorioamnionitis. It is particularly important to recognize that an isolated maternal fever does not automatically equate to chorioamnionitis. This article will review the current literature on chorioamnionitis, and introduce the concept of Triple I, as well as recommendations for assessment and management of pregnant women and their newborns with a diagnosis of Triple I.

Correlation between diabetic peripheral neuropathy and cardiovascular diseases in patients with type 2 diabetes mellitus / 心血管康复医学杂志

Objective :To explore correlation between diabetic peripheral neuropathy (DPN) and cardiovascular disea-ses (CVD) in patients with type 2 diabetes mellitus (T2DM).Methods :A total of 375 T2DM patients ,who were treated in our community health service center from Jan 2014 to Jul 2016 ,were selected .Demographic characteris-tics ,systolic blood pressure (SBP) ,blood lipids ,blood glucose ,electromyogram and CVD were collected in all sub-jects using questionnaire .According to complicated CVD or not ,patients were divided into CVD group (n＝54) and non-CVD group (n＝321).Correlation among all indexes and CVD risk were analyzed .Multifactor Logistic regres-sion analysis was used to analyze independent risk factors for CVD risk .Results :Among the 375 T2DM patients ,54 cases (14. 4%) were complicated with CVD .Compared with non-CVD group ,there were significant rise in age≥65 years ,abnormal fasting blood glucose (FBG) , abnormal 2h postprandial blood glucose (2hPG) , abnormal glycosy-lated hemoglobin A1c (HbA1c) and SBP in CVD group , P＜0.05 or ＜0.01 .Spearman correlation analysis indica-ted that age ,FBG ,2hPG ,DPN ,SBP and HbA1c were significant positively correlated with CVD risk (r＝0.612～0.735 , P＝0.001 all).Multifactor Logistic regression analysis indicated that DPN , abnormal FBG and abnormal 2hPG were independent risk factors for CVD (OR＝1.248～2.023 , P＜0.05 all).Conclusion : Diabetic peripheral neuropathy is one of the independent risk factors for CVD in T2DM patients .Attention should be paid to preven-tion ,screening and early treatment of CVD in these patients in clinic .

Correlation of the leucocyte count with traditional and non-traditional components of metabolic syndrome.

OBJECTIVES: To investigate correlation of the white blood cell (WBC) and its subtype count with the traditional and non-traditional components of the metabolic syndrome. METHODS: Between January 2012 and December 2013, 18,222 people were enrolled in this study. The height, weight, body mass index (BMI) and blood pressure were measured, and blood samples were tested for all subjects after an overnight fast. The count of WBC and its subtypes, total cholesterol, triglyceride, high density lipoprotein (HDL), low-density lipoprotein, aminotransferases, fibrinogen, uric acid, and fasting blood glucose were all assessed. RESULTS: Metabolic syndrome was found in 2502 of 18,222 healthy Chinese people (16.41%). The prevalence of metabolic syndrome was 22.61% for men significantly (P < 0.05) greater than for women (6.83%). The prevalence of obesity, hypertension, hyperglycemia and hyperlipidemia was significantly (P < 0.001) higher in people with than without metabolic syndrome. With increase of the WBC count, BMI, systolic and diastolic pressure, fasting blood glucose, triglyceride, glutamic-oxaloacetic transaminase, glutamic-pyruvic transaminase, glutamyltranspetidase, blood urea nitrogen fibrinogen and uric acid all went up significantly (P < 0.001) while HDL decreased significantly (P < 0.05). The creatinine remained relatively sTable After adjustment of age, sex, alcoholic drinking and education, the metabolic components of obesity, hypertension, diabetes and hyperlipidemia rose significantly (P < 0.05) positively with increased counts of the total WBC, neutrophil and lymphocyte, and the WBC and its subtypes were an independent risk factor for metabolic syndrome. CONCLUSION: Aminotransferases, fibrinogen and uric acid all significantly increase with increased WBC count in a dose-dependent manner. Increased counts of the total WBC and its subtypes are positively associated with presence of metabolic syndrome.

Efficacy of Medical Treatment for Infantile Hypertrophic Pyloric Stenosis: A Meta-analysis.

BACKGROUND: Infantile hypertrophic pyloric stenosis (IHPS) is a common disease in infancy. Pyloromyotomy is universally considered the treatment for IHPS; however, oral or intravenous atropine has been reappraised for the treatment of IHPS in the past 20 years. We investigated the efficacy of atropine in the medical management of IHPS by using meta-analysis and investigated the sonographic changes of the pyloric canal, as well as the efficacy and adverse effects of atropine. METHODS: Information was retrieved from PubMed, Ovid, and MEDLINE. The efficacy and adverse effects of atropine treatment for IHPS were reviewed using the standard process of meta-analysis. RESULTS: Eleven articles were obtained. Five reports showed that 77 of 110 (70%) infants who were administered oral atropine benefitted by the induced remission of IHPS. Six reports showed that 288 of 345 (83.5%) patients who were treated initially with intravenous atropine then changed to oral atropine showed beneficial effects and had no serious side effects. Time to pyloric muscle normalization ranged from 5 weeks to 15 months. CONCLUSION: The study results indicate that atropine is a possible alternative treatment for IHPS, particularly in infants with major concurrent disease, and is safe without obvious side effects.

Circulatory Management Focusing on Preventing Intraventricular Hemorrhage and Pulmonary Hemorrhage in Preterm Infants.

The goal of modern neonatal care of extremely preterm infants is to reduce mortality and long-term neurological impairments. Preterm infants frequently experience cerebral intraventricular or pulmonary hemorrhage, which usually occurs within 72 hours after birth and can lead to long-term neurological sequelae and mortality. These serious hemorrhagic complications are closely related to perinatal hemodynamic changes, including an increase in the afterload on the left ventricle of the heart after the infant is separated from the placenta, and an increased preload from a left-to-right shunt caused by a hemodynamically significant patent ductus arteriosus (PDA). The left ventricle of a preterm myocardium has limited ability to respond to such an increase in afterload and preload, and this can result in cardiac dysfunction and hemodynamic deterioration. We suggest that delayed umbilical cord clamping or umbilical cord milking to maintain optimal blood pressure and systemic blood flow (SBF), careful assessment to keep the afterload at an acceptable level, and a strategy of early targeted treatment of significant PDA to improve perfusion during this critical time period may reduce or prevent these serious complications in preterm infants.