Maternal Preconception Serum Alanine Aminotransferase Levels and Risk of Preterm Birth among Reproductive-Aged Women - China, 2013-2017.

What is already known about this topic?: The significance of maternal liver health concerning preterm birth (PTB) is well recognized; however, there is a gap in understanding the precise influence of preconception serum alanine aminotransferase (ALT) levels on the risk of PTB. What is added by this report?: In this retrospective cohort study, a J-shaped relationship between preconception serum ALT levels and risk of PTB was observed, indicating that both significantly elevated and decreased ALT levels may contribute to the risk. What are the implications for public health practice?: Maintaining optimal preconception serum ALT levels may reduce the risk of PTB, thereby informing specific preventive measures for women of reproductive age.

Husband smoking is associated with Wife's thyrotropin abnormality: A population-based cohort study among Chinese reproductive-aged women.

OBJECTIVES: To comprehensively assess the association of husband smoking with wives' thyrotropin abnormality. METHODS: This population-based retrospective cohort study included 2 406 090 Chinese reproductive-aged women who had participated twice in the National Free Pre-pregnancy Checkups Project between 2010 and 2020. Multivariate-adjusted odds ratios and 95% confidence intervals for subnormal and supranormal thyrotropin were estimated according to the husband's smoking status. RESULTS: Husband smoking at the first visit was associated with a 17% (15%-20%) and 26% (24%-28%) increased odds of subnormal thyrotropin and supranormal thyrotropin respectively compared to participants in neither-smoker group. In non-smoking participants with normal thyrotropin levels at the first visit, the corresponding increased risk of subnormal thyrotropin and supranormal thyrotropin at the second visit were 15% (12%-18%) and 19% (16%-21%) in contrast to participants without husband-smoking exposure. In non-smoking participants with abnormal thyrotropin levels at their first visit, husband smoking cessation was associated with 27% (17%-35%) and 36% (31%-40%) reduced odds of subnormal thyrotropin and supranormal thyrotropin at the second visit compared with the participants whose husband still smoking at the second visit. CONCLUSION: Husband smoking was associated with wives' subnormal thyrotropin and supranormal thyrotropin, and cessation of husband smoking could reduce the odds of thyrotropin abnormality. Couple-focused smoking intervention should be developed to reduce the burden of asymptomatic thyroid disease in females.

An immune window of opportunity to prevent spontaneous abortion: prepregnancy peripheral leukocytes and subsets were associated with a decreased risk of spontaneous abortion.

STUDY QUESTION: Do prepregnancy peripheral leukocytes (PPLs) and their subsets influence the risk of spontaneous abortion (SAB)? SUMMARY ANSWER: PPLs and their subsets are associated with the risk of SAB. WHAT IS KNOWN ALREADY: Compelling studies have revealed the crucial role of maternal peripheral leukocytes in embryo implantation and pregnancy maintenance. Adaptive changes are made by PPLs and their subsets after conception. STUDY DESIGN, SIZE, DURATION: This population-based retrospective cohort study was based on data from the National Free Pre-pregnancy Check-up Project (NFPCP) in mainland China. Couples preparing for pregnancy within the next six months were provided with free prepregnancy health examinations and counseling services for reproductive health. The current study was based on 1 310 494 female NFPCP participants aged 20-49 who became pregnant in 2016. After sequentially excluding 235 456 participants lost to follow-up, with multiple births, and who failed to complete blood tests, a total of 1 075 038 participants were included in the primary analysis. PARTICIPANTS/MATERIALS, SETTING, METHODS: PPLs and their subset counts and ratios were measured. The main outcome was SAB. A multivariable logistic regression model was used to estimate the odds ratio (OR) and 95% CI of SAB associated with PPLs and their subsets, and restricted cubic spline (RCS) was used to estimate the nonlinear exposure-response relationship. MAIN RESULTS AND ROLE OF CHANCE: Of the included pregnant participants, a total of 35 529 SAB events (3.30%) were recorded. Compared to participants with reference values of PPLs, the ORs (95% CIs) of leukopenia and leukocytosis for SAB were 1.14 (1.09-1.20) and 0.74 (0.69-0.79), respectively. The RCS result revealed a monotonous decreasing trend (Pnonlinear < 0.05). Similar relationships were observed for the neutrophil count and ratio, monocyte count, and middle-sized cell count and ratio. The lymphocyte ratio showed a positive and nonlinear relationship with the risk of SAB (Pnonlinear < 0.05). Both eosinophils and basophils showed positive relationships with the risk of SAB (eosinophil Pnonlinear > 0.05 and basophil Pnonlinear < 0.05). LIMITATIONS, REASONS FOR CAUTION: Chemical abortion events and the cause of SAB were not collected at follow-up. Whether women with abnormal PPLs had recovered during periconception was not determined. WIDER IMPLICATIONS OF THE FINDINGS: PPLs and their subsets are associated with the risk of SAB. Leukopenia and neutropenia screening in women preparing for pregnancy and developing a feasible PPL stimulation approach should be emphasized to utilize the immune window of opportunity to prevent SAB. STUDY FUNDING/COMPETING INTEREST(S): This study was approved by the Institutional Research Review Board of the National Health and Family Planning Commission. This study was supported by the National Key Research and Development Program of China (grants 2021YFC2700705 [Y.Y.] and 2016YFC100307 [X.M.]) and the National Natural Science Foundation of China (grant no. 82003472 [L.W.]). The funding source was not involved in the study design, data collection, analysis and interpretation of the data, writing the report, or the decision to submit this article for publication. No competing interests. TRIAL REGISTRATION NUMBER: N/A.

Maternal fasting serum C-peptide concentrations in the first and second trimesters and subsequent risk of gestational diabetes mellitus: A nested case-control study among Chinese women.

OBJECTIVE: To examine the association of serum connecting peptide (C-peptide) concentrations with gestational diabetes mellitus (GDM) risk among Chinese women. METHODS: A nested case-control study was conducted on 436 reproductive-aged women, involving 218 GDM cases and 218 controls matched at 1:1 by maternal age, in Beijing, China between January 2016 and December 2017. Fasting serum C-peptide were successively determined at 10-14 and 15-20 weeks of gestation. Restricted cubic spline and logistic regression analyses were utilized, and receiver operating characteristic (ROC) curves were generated to evaluate the predictive capacity of C-peptide for GDM. RESULTS: Fasting serum C-peptide concentrations exhibited a significant decrease from the initial to the subsequent trimester in females with normal glucose tolerance (NGT). For each 1 log ng/mL increase of fasting serum C-peptide during the first and second trimesters, GDM risk increased by 2.38-fold [odds ratio (OR): 2.38, 95% confidence intervals (95%CI): 1.33-4.40] and 3.07-fold (OR: 3.07, 95%CI: 1.49-6.62), respectively. The areas under the ROC curves for the first- and second-trimester C-peptide were 80.4% and 82.4%. CONCLUSION: Our findings revealed a positive correlation between fasting serum C-peptide during the first and second trimesters and the risk of GDM or its subtypes, underscoring the potential of C-peptide as a predictor for GDM development.

Mechanism of HCG regulating epithelial-mesenchymal transition progression in endometrial cells through the FoxO1/miR223-5p/Wnt5α pathway.

RESEARCH QUESTION: Does human chorionic gonadotrophin (HCG) influence endometrial receptivity and epithelial-mesenchymal transition (EMT) via the FoxO1/miR223-5p/Wnt5α pathway? DESIGN: This study aimed to establish the co-culture system of human embryonic trophoblast cell line (HTR-8-Svneo) cells and human endometrial epithelial cell line (HEEC) cells. The expression of Wnt5α protein and EMT-related proteins in HTR-8-Svneo and HEEC cells treated in a gradient-dependent manner using HCG and exosome inhibitor GW4869 were detected in the co-culture system. RESULTS: In the HTR-8-Svneo/HEEC co-culture system, miR223-5p in HEEC cells increased significantly with induction of HTR-8-Svneo cells by 100 IU/ml HCG for 48 h (P = 0.046), and Wnt5α protein decreased significantly in HEEC cells (P = 0.021). Pretreatment of HTR-8-Svneo cells with GW4869, and knockdown of FoxO1 in HTR-8-Svneo cells, significantly inhibited the above effects of HCG on miR223-5p and Wnt5α expression in HEEC cells in the HTR-8-Svneo/HEEC co-culture system. HTR-8-Svneo cells induced with 100 IU/ml HCG for 48 h significantly enhanced the logarithmic phase proliferation activity of HEEC cells in the co-culture system (P < 0.001), while knockdown of FoxO1 in HTR-8-Svneo cells and inhibition of miR223-5p in HEEC cells suppressed proliferation of HEEC cells in the HTR-8-Svneo/HEEC co-culture system (P < 0.001). CONCLUSIONS: HCG exposure induces HTR-8-Svneo cells to up-regulate miR223-5p expression, which enters HEEC cells in the co-culture system through the exosomal pathway, and inhibits Wnt5α expression and the progress of EMT.

Preparation of 1,8-dichloroanthraquinone/graphene oxide/poly (vinylidene fluoride) (1,8-AQ/GO/PVDF) mediator membrane and its application to catalyzing biodegradation of azo dyes.

Anthraquinone is a redox mediator that can effectively catalyze the degradation of azo dyes by promoting the electron transfer. In this study, a mediator membrane with poly (vinylidene fluoride) (PVDF) as the membrane support and 1,8-dichloroanthraquinone (1,8-AQ) and graphene oxide (GO) as the additives was prepared and characterized by X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FTIR), X-ray photoelectron spectroscopy (XPS), scanning electron microscopy (SEM), mercury intrusion porosimetry (MIP), atomic force microscopy (AFM) and water contact angle. The introduction of GO increases the pure water flux of the membrane to 258.56±12.93 L/(m2·h). Its catalytic performances for the biodegradation of azo dyes were evaluated. Under the optimized conditions, the 1,8-AQ/GO/PVDF composite membrane is able to improve the dye degradation efficiency 2.2 times for reactive red X-3B and 1.1 times for acid red B, as compared with PVDF membrane. In addition, the mediator membrane maintains stable and high catalytic efficiency in the cyclic test and over 90 % dye degradation efficiency is still obtained after 5 cycles of decolorization. These results suggest the great application potentials of the 1,8-AQ/GO/PVDF membrane in the dye wastewater treatment.

Declined prevalence, improved awareness and control of hypertension are associated with spousal educational attainment: A mega-data study.

Cardiovascular diseases, including hypertension, have posed a serious threat to human health in recent decades. Family-centered health promotion and disease control for the management of hypertension is gaining attention. In this study, we assessed the association between spousal educational attainment (SEA) and hypertension prevalence, awareness, and control, intending to provide new directions for family health care. A total of 71 211 191 reproductive-aged participants from the National Free NFPCP during 2013-2019 were included in the current study. Inverse probability weighting (IPW) via propensity models were used to adjust for the imbalance by SEA. Both multivariable-adjusted ORs and inverse-probability-weighted ORs were used to assess the association between SEA and the prevalence, awareness, and control of hypertension. ORs of prevalence, awareness, and control of hypertension with SEA stratified by sex, age, and residency type were also reported. Compared with participants with SEA of compulsory education, the inverse-probability-weighted ORs for hypertension were 0.97 (0.96-0.97), 0.99 (0.98-1.00), and 0.91 (0.88-0.93) for participants with SEA of senior high, college, and postgraduate, respectively. The corresponding ORs for hypertension awareness were 1.12 (1.10-1.13), 1.15 (1.13-1.16), and 1.38 (1.34-1.41). The increment of hypertension control associated with SEA was only identified in urban areas. Modification analyses revealed that urban participants were observed to have more healthy benefits associated with SEA; additional decreased prevalent hypertension and increased hypertension awareness associated with SEA were observed in wives and husbands respectively. Thus, SEA was associated with decreased prevalent hypertension and increased awareness and control of hypertension. Our findings call for increased participation of spouses in family-centered healthcare, with consideration of modified effects by gender, age, and residency type, to improve chronic disease prevention and control including hypertension.

Delayed euDKA Associated With Dapagliflozin After Pancreatitis.

Euglycemic diabetic ketoacidosis (euDKA) is a rare but life-threatening adverse effect of sodium-glucose cotransporter 2 (SGLT2) inhibitors. We present a case of delayed euDKA seven days after cure of acute pancreatitis and discharge from the hospital of a 51-year-old man with type 2 diabetes mellitus (T2DM) managed with a combination of antidiabetic medications, including the SGLT2 inhibitor dapagliflozin. Prior acute pancreatitis was postulated to be a contributing factor to the development of SGLT2 inhibitor-associated euDKA in this patient discharged from the hospital. The patient was managed accordingly and improved clinically while his oral hypoglycemic agents were stopped. The risk of euDKA from SGLT2 inhibitor therapy may be increased by some stress factors (eg, infection, surgery, acute illness, low-carbohydrate diet, excessive alcohol intake). As these SGLT2 inhibitors become a popular therapeutic strategy for the management of hyperglycemia in T2DM, clinicians should be aware that acute illnesses such as pancreatitis in patients with T2DM can be potential predisposing factors for the development of SGLT2 inhibitor-associated euDKA.

Nomogram to predict FSH starting dose in poor ovarian response women in progestin primed ovarian stimulation protocol.

Prediction of individual ovarian response to exogenous gonadotropin is a cornerstone for success and safety in all controlled ovarian stimulation (COS) protocols. Providing the best FSH starting dose according to each woman's own characteristics is the key to the success of individualized treatment. The objective of this investigation was to evaluate the potential application of a novel nomogram based on antral follicle counting (AFC), anti-Müllerian hormone (AMH) and body mass index (BMI) as a tool to optimize the follicle-stimulating hormone (FSH) starting dose in women with poor ovarian response in in-vitro fertilization (IVF)/intra-cytoplasmic sperm injection (ICSI) cycles in progestin-primed ovarian stimulation (PPOS). We performed a retrospective analysis involving 130 poor ovarian responders undergoing IVF/ICSI cycles in a PPOS protocol from June 2017 to February 2019 in our reproductive center. The individual FSH starting dose was selected according to patients' clinical history and characteristics. The influence of variables including age, BMI, AMH and AFC on the FSH starting dose was assessed through multiple regression analysis. We used the variables reaching the statistical significance for calculation for the final predictive model. In the univariate analysis, BMI, AMH and AFC were significant (P < 0.05) predictors of FSH starting dose, age was canceled. In the multivariate analysis, BMI, AMH and AFC remained significant (P < 0.05). According to the nomogram, 118 patients (90.77% of 130) would have received a higher FSH starting dose and 12 patients (9.23% of 130) a lower FSH starting dose than practice dose. The application of the nomogram based on three variables easily determined in clinical practice: BMI, AMH and AFC would lead to a more tailored FSH starting dose in women with poor ovarian response.

Hematological Parameters in the First Trimester and the Risk of Gestational Diabetes Mellitus - Beijing, China, 2017-2020.

What is already known about this topic?: Hematological parameters may indicate the presence of chronic low-grade inflammation and increasing viscosity, which are involved in the pathological processes of gestational diabetes mellitus (GDM). However, the association between several hematological parameters in early pregnancy and GDM has yet to be elucidated. What is added by this report?: Hematological parameters in the first trimester, particularly red blood cell (RBC) count and systematic immune index, have a significant impact on GDM incidence. The neutrophils (NEU) count in the first trimester was particularly pronounced for GDM. The upward trend of RBC, white blood cell (WBC), and NEU counts was consistent across all GDM subtypes. What are the implications for public health practice?: Early pregnancy hematological parameters are associated with the risk of GDM.

Maternal Preconception Hepatitis B Virus Infection and Risk of Congenital Heart Diseases in Offspring Among Chinese Women Aged 20 to 49 Years.

Importance: Maternal hepatitis B virus (HBV) infection during early pregnancy has been related to congenital heart diseases (CHDs) in offspring. However, no study to date has evaluated the association of maternal preconception HBV infection with CHDs in offspring. Objective: To explore the association of maternal preconception HBV infection with CHDs in offspring. Design, Setting, and Participants: This retrospective cohort study used nearest-neighbor (1:4) propensity score matching of 2013 to 2019 data from the National Free Preconception Checkup Project (NFPCP), a national free health service for childbearing-aged women who plan to conceive throughout mainland China. Women aged 20 to 49 years who got pregnant within 1 year after preconception examination were included, and those with multiple births were excluded. Data were analyzed from September to December 2022. Exposures: Maternal preconception HBV infection statuses, including uninfected, previous, and new infection. Main Outcomes and Measures: The main outcome was CHDs, which were prospectively collected from the birth defect registration card of the NFPCP. Logistic regression with robust error variances was used to estimate the association between maternal preconception HBV infection status and CHD risk in offspring, after adjusting for confounding variables. Results: After matching with a 1:4 ratio, there were 3 690 427 participants included in the final analysis, where 738 945 women were infected with HBV, including 393 332 women with previous infection and 345 613 women with new infection. Approximately 0.03% (800 of 2 951 482) of women uninfected with HBV preconception and women newly infected with HBV carried an infant with CHDs, whereas 0.04% (141 of 393 332) of women with HBV infection prior to pregnancy carried an infant with CHDs. After multivariable adjustment, women with HBV infection prior to pregnancy had a higher risk of CHDs in offspring compared with women who were uninfected (adjusted relative risk ratio [aRR], 1.23; 95% CI, 1.02-1.49). Moreover, compared with couples who were uninfected with HBV prior to pregnancy (680 of 2 610 968 [0.026%]), previously infected women with uninfected men (93 of 252 919 [0.037%]) or previously infected men with uninfected women (43 of 95 735 [0.045%]) had a higher incidence of CHDs in offspring and were significantly associated with a higher risk of CHDs in offspring (previously infected women with uninfected men: aRR, 1.36; 95% CI, 1.09-1.69; previously infected men with uninfected women: aRR, 1.51; 95% CI, 1.09-2.09) with multivariable adjustment, while no significant association was observed between maternal new HBV infection and CHDs in offspring. Conclusions and Relevance: In this matched retrospective cohort study, maternal preconception previous HBV infection was significantly associated with CHDs in offspring. Moreover, among women with HBV-uninfected husbands, significantly increased risk of CHDs was also observed in previously infected women prior to pregnancy. Consequently, HBV screening and getting HBV vaccination-induced immunity for couples prior to pregnancy are indispensable, and those with previous HBV infection prior to pregnancy should also be taken seriously to decrease the CHDs risk in offspring.

Response of Rhizosphere Bacterial Communities to Near-Natural Forest Management and Tree Species within Chinese Fir Plantations.

Near-natural forest management plays an important role in the maintenance of the long-term productivity and soil fertility of plantations. We conducted high-throughput absolute quantitative sequencing of 16S rRNA genes to compare the structures and diversity of rhizosphere soil bacterial communities among a pure Chinese fir (Cunninghamia lanceolata) plantation (S), a Cunninghamia lanceolata-Castanopsis hystrix-Michelia hedyosperma mixed plantation (SHX), and a Cunninghamia lanceolata-Castanopsis fissa mixed plantation (SD). The results revealed that near-natural forest management improved the rhizosphere soil properties of Chinese fir, especially the phosphorus content. Rhizosphere soil bacterial communities of Chinese fir in SHX and SD contained higher total absolute abundances and more unique operational taxonomic units (OTUs) than the pure plantation forest. Planctomycetes and Actinobacteria were abundant in SD, and Actinobacteria were enriched in SHX. The tree species also had an impact on the rhizosphere soil bacterial communities. For the rhizosphere soils of different tree species of SHX, the available phosphorus (AP) content of the rhizosphere of Chinese fir significantly surpassed those of Castanopsis hystrix and Michelia hedyosperma. Bacteria related to nitrogen fixing, such as Burkholderiales and Rhizobiales, were more abundant in Chinese fir in SD than in Castanopsis fissa. Acdiobacteria and Proteobacteria underpinned the differences found in the compositions of soil bacteria. The pH and soil organic matter were key variables influencing the rhizosphere soil bacterial communities. Our results demonstrated that in Chinese fir plantations, 12 years of near-natural management of introduced broad-leaved tree species can drive alterations of the physicochemical characteristics, bacterial community structure, and composition of rhizosphere soil, with tree species identity further influencing the rhizosphere soil bacterial community. IMPORTANCE Near-natural forest management is an important way to change the soil fertility decline and productivity reduction of pure Chinese fir plantations. At present, many detailed studies have been carried out on the impact of near-natural forest management on Chinese fir plantations at home and abroad. However, there are still few studies on the response of rhizosphere bacterial communities to near-natural forest management. Our study determined absolute quantities of Chinese fir rhizosphere bacterial communities in different mixed patterns. The results underscore the importance of near-natural forest management for Chinese fir plantation rhizosphere bacterial communities and provide new information on soil factors that affect rhizosphere bacterial communities in South China.

Mating pattern and pollen dispersal in an advanced generation seed orchard of Cunninghamia lanceolata (Lamb.) Hook.

Seed orchards represent the link between forest breeding and conifer production forests, and their mating patterns determine the genetic quality of seed orchard crops to a large extent. We genotyped the parental clones and their open pollination offspring in the third-generation seed orchard of Chinese fir using microsatellite markers and observed the synchronization of florescence in the seed orchard to understand the genetic diversity and mating structure of the seed orchard population. Genetic coancestry among parental clones was detected in the third generation seed orchard of Chinese fir, and the genetic diversity of the open-pollinated offspring was slightly higher than that of the parental clones. The external pollen contamination rate ranged from 10.1% to 33.7%, 80% of the offspring were produced by 44% of the parental clones in the orchard, and no evidence of selfing was found. We found that 68.1% of the effective pollination occurred within 50 m, and 19.9% of the effective pollination occurred in the nearest neighbors. We also found that successful mating requires about 30% of florescence overlap between males and females, and there was a significant positive correlation between male reproductive energy and male parental contribution. Our results provide a valuable reference for the management and design of advanced generation seed orchards.

A Comparison of Coagulation Function in Patients Receiving Aspirin and Cefoperazone-Sulbactam With and Without Vitamin K1: A Retrospective, Observational Study.

PURPOSE: The study objective was to explore whether prophylaxis with vitamin K1 improves abnormal coagulation function-associated cefoperazone-sulbactam in patients treated in the long term with low-dose aspirin. METHODS: This retrospective, observational study assessed patients treated with long-term low-dose aspirin in a naval military hospital in China from 2004 to 2018, including all patients treated concurrently with cefoperazone-sulbactam with or without vitamin K1. Differences in the coagulation index were analyzed statistically before and after receipt of cefoperazone-sulbactam. FINDINGS: The cohort included 227 patients. After cefoperazone-sulbactam treatment, the mean (SD) prothrombin time (PT) was 14.07 (3.07) seconds, activated partial thromboplastin time (aPTT) was 35.15 (4.78) seconds, and international normalized ratio (INR) was 1.49 (0.49) in the cefoperazone-sulbactam group, which was significantly higher than the PT of 11.55 (1.29), aPTT of 31.37 (2.20), and INR of 1.12 (0.35) before cefoperazone-sulbactam treatment. No significant difference was in the cefoperazone-sulbactam plus vitamin K1 group. In addition, no significant difference was found in the thrombin time or fibrinogen level between before and after cefoperazone-sulbactam treatment in both groups. The mean (SD) platelet counts of the 2 groups were 197.34 (71.82) × 109/L and 187.75 (72.66) × 1 09/L after cefoperazone-sulbactam treatment, respectively, which was significantly lower than 231.77 (77.05) × 109/L and 232.08 (84.48) × 109/L before cefoperazone-sulbactam treatment. There were greater proportions of coagulation disorders (prolongation of PT, aPTT, INR, and bleeding) after cefoperazone-sulbactam treatment in the cefoperazone-sulbactam group compared with that in the cefoperazone-sulbactam plus vitamin K1 group. IMPLICATIONS: Results indicate that, after adding cefoperazone-sulbactam to the regimens of patients receiving long-term low-dose aspirin, therapy contributed to remarkable increase in abnormal coagulation function and coagulation disorders. Prophylaxis with vitamin K1 decreased the risk of these abnormalities in blood coagulation parameters associated with cefoperazone-sulbactam in patients taking long-term aspirin.

Identify Key Determinants of Contraceptive Use for Sexually Active Young People: A Hybrid Ensemble of Machine Learning Methods.

Sexually active young people face an increasing public health burden of unintended pregnancies and sexually transmitted diseases due to improper contraception. However, environmental and social factors related to young people's contraception remain unclear. To identify the key factors, we applied ensemble machine learning methods to the data of 12,280 heterosexual Chinese college students who reported sexual intercourse experience in the National College Student Survey on Sexual and Reproductive Health in 2020 (NCSS-SRH 2020). In the order of variable importance, convenient access to contraceptives, certain attitudes towards sex, sexual health knowledge level, being an only-child, and purchasing a bachelor's or master's degree were positively associated with a high frequency of contraceptive use. In contrast, smoking, free access to contraceptives, a specific attitude towards marriage, and negotiation with a sexual partner were negatively associated with a higher frequency of contraceptive use. Our analysis provides insights into young people's contraceptive use under a typically conservative culture of sexuality. Compared to previous studies, we thoroughly investigated internal and external factors that might impact young people's decision on contraception while having sex. Under a conservative culture of sexuality, the effects of the external factors on young people's contraception may outweigh those of the internal factors.

Carbon disulfide induces embryo loss by perturbing the expression of the mTOR signalling pathway in uterine tissue in mice.

Understanding of the mechanism of embryo loss is critical for successful pregnancy considering an increase in the incidence of infertility. In this study, we focus on the effect of alterations in the expression of the AKT/AMPK/mTOR signalling pathway in mouse uterine tissue after embryo loss induced by harmful environmental exposure to carbon disulfide (CS2). CS2 is a material used in certain production processes, and women are sometimes exposed to it in occupational settings. We created an animal model of gestating mice exposed to CS2 on gestation days 3 (GD3), 4 (GD4), 5 (GD5) and 6 (GD6) with various corresponding endpoints after the exposure. The uterine tissue was collected according to the endpoint time series to detect the expression levels of mTOR, p-mTOR, pAKT, and pAMPK using western blot, RT-PCR, immunohistochemistry staining, and ELISA. Dietary supplementation with N-carbamoyl glutamic acid (NCG) was used to verify the effect of the mTOR signalling pathway on embryo loss caused by CS2. We detected down-regulation of the levels of the mTOR and p-mTOR proteins; the levels of these two proteins were decreased by 49.35% and 51.44% at the GD5 endpoint after GD4 exposure and by 38.55% and 59.51% after GD3 exposure, respectively. The change in the expression level of mTOR mRNA was consistent with the protein expression, and the mRNA level at the GD5 endpoint was decreased by 55.0% after GD4 exposure (P < 0.05). Additionally, protein expression levels of pAKT were decreased by 49.05%, and the levels of pAMPK were increased by 25.51% at the GD5 endpoint after GD4 exposure (P < 0.05). A similar trend was observed for pAKT and pAMPK at the GD4 endpoint after GD3 exposure, at the GD6 endpoint after GD5 exposure, and at the GD7 endpoint after GD6 exposure (P < 0.05). Supplementation with NCG contributed to recovery from the effects of CS2 by increasing the protein expression levels of mTOR and pAKT by 47.54% and 63.79% (P < 0.05), respectively, while the pAMPK protein level was decreased by 37.15% (P < 0.05) at the GD5 endpoint after GD4 exposure. It should be noted that the number of implanted embryos was significantly increased after supplementation with NCG. Our results indicate that down-regulation of mTOR at the time of implantation is regulated by pAKT and pAMPK, that may be an important factor for embryo loss induced by CS2.

Hemolytic jaundice induced by pharmacological dose ascorbic acid in glucose-6-phosphate dehydrogenase deficiency: A case report.

RATIONALE: Hemolysis induced by high dose ascorbic acid (AA) in patients with G6PD deficiency has been reported, but is rare. To our knowledge, this is the first reported case of a male with G6PD deficiency, coexpressed with cholecystolithiasis and cholecystitis, who developed extreme hemolysis and hyperbilirubinemia after receiving pharmacological doses ascorbic acid infusion. PATIENT CONCERNS: A 27-year-old man history with glucose-6-phosphate dehydrogenase deficiency was admitted to our hospital because of cholecystolithiasis and cholecystitis. He appeared with scleral jaundice and very deep colored urine after receiving pharmacological doses ascorbic acid infusion. DIAGNOSES: Clinical findings when combined with his medical history and various laboratory results confirmed the diagnosis as hemolysis and hyperbilirubinemia induced by ascorbic acid. INTERVENTIONS: The patient was treated with steroids, hepatoprotective drugs, and folic acid in addition avoidance of agents with known hemolysis risk (such as vitamin C). OUTCOMES: As a result, the patient's symptoms from hemolytic jaundice improved, hemoglobin remained stable, and the patient was discharged 11 days later. LESSONS: Clinicians should bear in mind the possibility that vitamin C exposure may result in hemolysis in patients with G6PD deficiency, especially in those with known severe disease.

ED50 of intrathecal ropivacaine for cesarean section under prophylactic infusion of phenylephrine: A consort study.

BACKGROUND: Studies have reported that prophylactic continuous infusion of phenylephrine during spinal anesthesia for cesarean section can decrease the spread of local anesthetics. We investigated the ED50 of intrathecal hyperbaric ropivacaine in parturient women undergoing cesarean section under prophylactic infusion of phenylephrine. METHODS: Sixty parturient women were allocated into 2 groups in this prospective study. Group P received 0.5 mL kg h of phenylephrine (5 mg/50 mL) at the start of intrathecal injection, and Group C (control group) received the same volume of saline. The dose of intrathecal ropivacaine for each subject was decided through up-down allocation method. The initial dose was set as 7.5 mg. Successful anesthesia was defined as the level of T6 or above achieved within 15 minutes after intrathecal injection and no additional epidural drug or venous analgesia to complete operation. The Massey formula was applied to calculate the ED50 of intrathecal ropivacaine in both groups. RESULTS: The ED50 of hyperbaric ropivacaine determined by up-and-down method was 7.2 mg (95% confidence interval (CI), 6.8-7.6 mg) in the Group P, and 6.8 mg (95% CI, 6.4-7.2 mg) in the Group C, there was significant difference between the 2 groups (P < .5). The ED50 of intrathecal ropivacaine increases compared with Group C when phenylephrine is prophylactic infused to prevent spinal induced hypotension in cesarean section. CONCLUSION: The ED50 of intrathecal hyperbaric ropivacaine is 7.2 mg when phenylephrine is prophylactic infused to prevent spinal induced hypotension in cesarean section, and more ropivacaine demands on spinal anesthesia for cesarean section (www.chictr.org.cn, registration number: ChiCTR-RIC-17011650).