Objective:To investigate the incidence and risk factors of neonatal asphyxia in twin pregnancy.Methods:This study retrospectively recruited 2 035 women with twin pregnancy and their 4 070 twin neonates in the Obstetrics and Gynecology Hospital of Fudan University from January 2010 to December 2018. There were 211 cases suffered from neonatal asphyxia (asphyxia group) and 3 859 did not (non-asphyxia group). The demographic information of the women and their newborns and the incidence of perinatal complications were compared between the two groups by two independent samples t-test and Chi-square test. Multivariate logistic regression was used to analyze the risk factors of neonatal asphyxia in twin pregnancy. Results:The age of 2 035 women was (31.8±4.4) years old (17-52 years old). The gestational age of the twins at delivery was (35.2±2.2) weeks (25-40 weeks). There were 1 330 (65.4%) premature births, including 997 (49.0%) born at ≥34 weeks. Monochorionic diamniotic twin pregnancies accounted for 22.6% (460/2 035). The total incidence of neonatal asphyxia was 5.2% (211/4 070), 5.0% (102/2 035) in the first- and 5.4% (109/2 035) in the second-born twin infants, and the three figures were all decreased with the increase of gestational age ( χ2trend=1 601.965, 549.693 and 1 089.709, all P<0.001) as well as birth weight ( χ2trend=1 273.386, 437.906 and 848.007, all P<0.001). Univariate analysis showed that the asphyxia group had smaller gestational age and lower birth weight [(34.1±2.8) vs (35.3±2.1) weeks, t=6.279; (2 113.3±565.7) vs (2 339.6±478.7) g, t=5.700], but a higher ratio of male infants [58.3% (123/211) vs 48.5% (1 878/3 859), χ2=7.704], vaginal delivery [10.4% (22/211) vs 4.5% (173/3 859), χ2=15.493], monochorionic diamniotic twins [27.5% (58/211) vs 22.3% (862/3 859), χ2=7.714], special complications related to monochorionic diamniotic twin pregnancies [8.1% (17/211) vs 2.5% (95/3 859), χ2=23.403] and fetal distress [13.7% (29/211) vs 3.8% (148/3 859), χ2=47.222] than the non-asphyxia group (all P<0.05). After adjusting for the gestational age, birth weight and gender, multivariate logistic regression found that vaginal delivery ( OR=1.748, 95% CI: 1.069-2.861), special complications related to monochorionic diamniotic twin pregnancies ( OR=3.200, 95% CI: 2.056-4.982) and fetal distress ( OR=2.017, 95% CI: 1.073-3.791) were the risk factors for asphyxia in twin neonates (all P<0.05). Conclusions:The incidence of neonatal asphyxia is high in twins with small gestational age and low birth weight. Vaginal delivery, fetal distress and special complications related to monochorionic diamniotic twin pregnancies are the high-risk factors. Clinicians should be well prepared for resuscitation when encountering neonatal asphyxia.

OBJECTIVETo explore the central regulatory mechanism of electroacupuncture (EA) on patients with post-traumatic stress disorder (PTSD).

METHODSFourteen patients of PTSD were selected as study objects and treated with "regulating mind and restoring consciousness" acupuncture method, in which Baihui (GV 20) and Shenting (GV 24) were used as main acupoints and Sishencong (EX-HN 1) and Fengchi (GB 20) were used as supporting acupoints for acupuncture. After the arrival of qi, Han's acupoint nerve stimulator was connected for 30 min per treatment, three times a week for consecutive 12 weeks. Before treatment and 12 weeks into treatment, the clinician administered PTSD scale (CAPS), self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were evaluated; a Siemens 3.0 T magnetic resonance imaging system was used to perform resting-state scan, and bilateral hippocampus were taken as region of interested to perform encephalic function connectivity analysis.

RESULTSAfter the treatment, the scores of CAPS, SAS and SDS were all reduced compared with those before treatment (all P<0.05) ; function connectivity was enhanced in bilateral hippocampus, right posterior central gyrus and left superior parietal lobule (2.3

CONCLUSIONElectroacupuncture has certain improving effects on PTSD symptoms, which is likely to be related with enhancing the connectivity between parietal lobe and hippocampus, suppressing the connectivity between hippocampus and parahippocampal gyrus, amygdaloid, leading to an indirect influence on limbic system.

Acupuncture Points ; Adolescent ; Adult ; Brain ; diagnostic imaging ; physiopathology ; Electroacupuncture ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Radiography ; Stress Disorders, Post-Traumatic ; diagnostic imaging ; physiopathology ; therapy ; Young Adult

ObjectiveTo summarize the clinical features and risk factors of neonatal clavicle fracture so as to decrease the incidence of this disease.MethodsA total of 85 cases of neonatal clavicle fracture admitted to the Gynecology and Obstetrics Hospital of Fudan University between January 1, 2013 and December 31, 2015 were enrolled in this study. The full-term neonates with natural delivery by the same midwives or doctors on the same day were selected as control group with 1∶1 matched. Clinical features and risk factors of neonatal clavicle fracture based on three factors: mother factors, labor factors and neonatal factors, were analyzed retrospectively. Two independent samplest-test, rank sum test andChi-square test were used for statistical analysis.ResultsThe incidence rate of neonatal clavicle fractures was 0.14% (85/59 991). There were 45 (53%) males and 40 (47%) females; 80 (94%) cases of vaginal delivery, and 5 (6%) cases of cesarean section. According to the relationship between the location of the fracture and the position of the fetus, the fracture occurred in the anterior shoulder in 65 cases (76%) and in the posterior shoulder in 20 cases (24%);and 18 cases (21%) were in the left and 67 cases (79%) in the right. Fifty-five cases (65%) were diagnosed by physical examination, and 30 cases (35%) by X-ray. Two patients (2%) were complicated with brachial plexus injury. Twenty cases (24%) were diagnosed on the day of birth, 32 cases (38%) on the second day after birth, 16 (19%) on the third day, and four (5%) on the 4-6 days. Thirteen (15%) cases were diagnosed in the outpatient department 42 days after birth. All the fractures were cured without special treatment. Compared with the control group, the birth weight of fracture group was significantly higher [(3 646±361) vs (3 447±409) g,t=2.339], and the ratio of the cases complicated with shoulder dystocia was also higher [15% (13/85) vs 2% (2/85),χ2=9.524] (bothP<0.05). The differences in the factors of maternal age, parity, times of pregnancy, gestational age, forceps delivery, time of the second stage of labor and fetal distress between the two groups were not statistically significant.ConclusionsNeonatal clavicle fracture is related to birth weight and shoulder dystocia. Not all fractures can be diagnosed through physical examination on the day of birth, therefore, daily routine physical examinations after birth are necessary. The prognosis of neonatal clavicle fracture is good.

Objective:To provide a normal reference range for anogenital distance (AGD) in full-term neonates and to investigate factors possibly affecting neonatal AGD.Methods:Neonates with gestational age ≥37 weeks who were delivered in the Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine from November 2017 to March 2019 were enrolled.General information on mothers and newborns were collected and neonatal AGD were measured.The distance from the male anus center to the base of the scrotum was determined to be the male AGD, and the distance from the female anus center to the posterior labia was recorded as the female AGD.The effects of maternal and neonatal factors on neonatal AGD were analyzed.Results:A total of 1 078 newborns were included, including 586 males and 492 females.Male AGD [(22.90±3.80) mm] was significantly greater than female AGD [(11.80±2.10) mm] ( t=22.316, P<0.05). The AGD of singleton neonates was significantly greater than that of neonatal twins [males: (23.01±3.82) mm vs.(21.18±1.88) mm, females: (11.89±2.08) mm vs.(10.98±1.75) mm, t=26.185, 18.326, all P<0.05]. Neonatal gestational age, birth weight, head circumference and length were significantly associated with AGD (all P<0.05). Maternal factors (including age, height, weight, body mass index, gravidity, parity, occupation, etc.) were not significantly associated with neonatal AGD (all P>0.05). The AGD of 10 children with genital malformation was significantly smaller than that of males with normal genital appearance [(22.89±1.99) mm vs.(23.55±3.78) mm]( t=15.362, P=0.006). Conclusions:The reference ranges of AGD in full-term males and females in Shanghai are(22.90±3.80) mm and (11.80±2.10) mm, respectively.The neonatal gestational age, birth weight, head circumference and length may be the intrinsic factors affecting neonatal AGD.

ObjectiveTo explore the efficacy and safety of infliximab combined withdiseasemodifying antirheumatic drugs (DMARDs) in the treatment of psoriatic arthritis.MethodsThis was an openlabeled trial.All subjects fulfilled the Moll and Wright criteria for definite PsA and-had poor response to DMARDs.The patients received combined infliximab and DMARDs.Infliximab 3 mg/kg was infused at weeks 0,2,6,14.After week 14,patients received infliximab 3 mg/kg every 8 weeks.The primary end point was the improvement of psoriatic arthritis response criteria(PsARC) response.The secondary end point was the percentage of patients who had 20％ improvement of modified American College of Rheumatology (ACR20)response.Parameters for efficacy for psoriatic rash was defined as the proportion of modified 50％ and 75％improvement of psoriasis area and severity index scores (PASI).All adverse reactions in the whole observation period were recorded.Chi-square test and repeated measurement data analysis of variance were used for the statistical analysis.ResultsTwenty-one patients completed the 14 weeks treatment.Five patients completed 26-104 weeks treatment,including 2 cases for 104 weeks.At week 14,the percentage of patients achieving PsARC was 84％,the percentage of patients achieving ACR20 was 77％,and the percentage of patients achieving PASI 50 was 76％.At week 14,tender joint counts,swollen joint counts,patient's assessment of pain,patient's global assessment(PGA),physician's global assessment,dermatology life quality index (DLQI),health assessment questionnaire(HAQ) were significantly improved compared with base-line(P＜0.05).Five patients received 26-104 weeks follow-up,including 2 cases for 104 weeks,four patients was stable,the rash and joint symptoms of 1 patient recurred at 104 weeks.The most frequently occurred adverse reactions were upper respiratory tract infection and skin as well as appendage damages.The second most common adverse effect was elevation of liver enzymes.ConclusionThe infliximab combined with DMARDs is effective and safe for the treatment of psoriatic arthritis.

Objective To study the changes of Th17 cell, regulatory T cell (Treg) and interleukin (IL)-6 in the peripheral blood of patients with systemic lupus erythematosus (SLE) and their relationship with disease activity. Methods Percentage of Th17 and Treg in the peripheral blood of 103 patients with SLE and 28 healthy volunteers were detected by flow cytometry. The concentration of IL-6 in SLE patients and healthy volunteers was detected by cytometric bead array (CBA). The disease activity of SLE was measured by SLEDAI. SLE patients were divided into two groups: stable SLE (SLEDAI≤ 9, n=37) and active SLE (SLEDAI＞9, n= 66). The change of Th17, Treg, IL -6 and their relationship with disease activity were analyzed. Nonparamentric tests, t -test and spearman correlation were used for statistical analysis. Results The percentage of Th17 cells and the concentration of IL-6 in the peripheral blood in patients with SLE was higher than that in normal controls [respectively for (1.2±1.1)%, (35±92) pg/ml and (0.6±0.4)%, (6±3) pg/ml, P＜0.05]. However, the percentage of Treg in patients with SLE was lower than that in normal controls [respectively for (1.6±1.2)%,(2.6±1.8)%, P＜0.05]. The percentage of Th17, Th17/Treg IL-6 level in active SLE patients was higher than those in inactive SLE and those in normal controls (P＜0.05). However, the percentage of Treg in active SLE was lower than that in stable SLE patients and that in normal controls (P＜ 0.05). The percentage of Th17, Th17/Treg and concentration of IL-6 was positively correlated to disease activity(P＜0.05). But the percentage of Treg had negative correlation with the percentage of Th17 and disease activity (P＜0.05). Conclusion Th17, Treg and serum IL-6 in SLE patients are abnormal and they maybe contribute to the pathogenesis of SLE.

Objective:To investigate the effect of miR-106a on osteoarthritis.Methods:Twenty-four S-D female rats were randomly divided into three groupsaccording to the random number table: the sham operation group, the osteoarthritis (OA) group and the miR-106a mimic group. Eightweeks after operation, all rats were killed and articular cartilage was separated from the medial tibial plateau of each rat. Histopathology was used to observe the morphological changes and denatured quantity of chondrocytes, the level of inflamm-atory cytokines [interleukin (IL)-1, IL-6, tumor necrosis factor (TNF)-β 1], the expression of apoptosis receptor p65, DR6 protein and the expression of mir-106a RNA. The mean between groups was compared by one-way analysis of variance (ANOVA), and the least significant difference (LSD)- t test was used for the comparison between the two groups. Results:Histopathological staining results showed that the articular surface and synovium of rats in the sham operation group were intact, the chondrocytes were arranged horizontally, and the articular cartilage edge was smooth.In the OA group, the articular cartilage edge was seriously damaged and the arrangement of chondrocytes was disordered.In the miR-106a simulation group, the cartilage structure tended to be normal, occasionally uneven, and the articular cartilage surface was not smooth. Compared with sham operation group, the expression of miR-106a in OA group was significantly decreased ( F=918.02, P<0.01); the expression of inflammatory mediators (IL-1, IL-6, TNF-β) in OA group was also signifi-cantly increased ( F=41 914.86, P<0.01; F=64 85.16, P<0.01; F=8 873.31, P<0.01). The expression levels of DR6 and p65 in OA group were higher ( F=2 319.338, P<0.01; F=1 253.882, P<0.01). Compared with OA group, the levels of inflammatory mediators (IL-1, IL-6, TNF-β) in miR-106a mimetic group were significantly decreased (1.270±0.020, 6.040±0.170, 5.690±0.080), and the expressions of DR6 and p65 were decreased (1.53±0.09, 0.41±0.04). Conclusion:miR-106a can reduce the inflammatory changes and the degeneration of chondrocytes in osteoarthritis rats.

The different growing habitats of Bupleurum chinense were investigated in Donglin mountain & Wuling mountain areas, the saikosaponin a and d in samples of B. chinense collected from different habitats were determined by HPLC. Results showed that B. chinense distributed in various habitats, such as meadow, understory and brushy. Significant differences of saikosaponin contents were observed. The higher saikosaponins contents were showed in samples from meadow habitats, while the lower saikosaponins contents in samples from understory and brushy habitats. The ventilation situation and light condition showed positive correlation with the saikosaponins accumulation in B. chinense. It could be concluded that growing habitats play an important role in accumulation of saikosaponins in B. chinense.
Bupleurum ; chemistry ; China ; Chromatography, High Pressure Liquid ; DNA Primers ; genetics ; Ecosystem ; Oleanolic Acid ; analogs & derivatives ; analysis ; Saponins ; analysis

Objective: To compare the clinical features, ultrasonic imaging manifestations and therapeutic evaluations between elderly onset rheumatoid arthritis (EORA) and EORA with osteoarthritis (OA). Methods: Eighty-eight patients with rheumatoid arthritis were divided into two groups: group EORA (n=36) and group EORA+OA (n=52). The onset age of all patients was 60 years or older. General conditions, joint involvement distribution, ultrasonic manifestations and disease activity scores (DAS28-3) of patients in the two groups were analyzed. The χ² test/Fisher's exact probability test and the Student's t test/Mann-Whitney U test were used to analyze data. Results: There was no significant difference in the proportion of male and female patients and erythrocyte sedimentation rate (ESR) between the two groups (P>0.05). The onset age of patients in group EORA+OA [(68±4) years old] was higher than that in group EORA [(65±4) years old], and the difference was statistically significant (t=-3.465, P=0.001). Duration of the disease and body mass index in group EORA+OA were significantly higher respectively than those in group EORA. Joint involvement in the two groups was mainly found in shoulder, wrist, Metacarpophalangeal joint (MCP)2, MCP3, proximal inter-phalangeal joint (PIP)2, PIP3, PIP4, and knee joint (34.7%-86.5%). The percentage of MCP2[36.5%(38/104), 70.8%(51/72); χ²=20.02, P<0.01], MCP3[33.7%(35/104), 59.7%(43/72); χ²=11.72, P=0.001], MCP4[4.8%(5/104), 22.2%(16/72); χ²=12.28, P<0.01], PIP2[69.2%(72/104), 83.3%(60/72); χ²=4.51, P=0.034] and PIP3[53.8%(56/104), 70.8%(51/72); χ²=5.15, P=0.023] in the EORA+OA group was lower while the percentage of MCP1, DIP 2, DIP3, DIP4 and knee joints were higher than that in the EORA group (P<0.05). In group EORA+OA, the synovial thickness of the wrist joints [(4.2±0.5) mm] and knee joints [(7.7±0.8) mm] were significantly thicker than those in group EORA [(3.2±0.9) mm; (6.3±0.8) mm, t=-5.82, P<0.01; t=-7.22, P<0.01]; The proportion (70.0%) of level 2 and 3 of patients' wrist joint synovium pannus blood flow and knee joint synovium pannus in group EORA+OA were increased than group EORA (51.9%; 52.3%), the difference between the two groups was statistically significant (χ²=4.64, P=0.031; χ²=4.43, P=0.035). There was no significant difference in DAS28-3 scores between the two groups before patients received treatment. After 2 weeks and 12 weeks of glucocorticoid treatment, DAS28-3 scores in group EORA [3.62(2.88, 4.03); 2.35(2.26, 2.62) points] were significantly lower than group EORA+OA [5.01(4.68, 5.26); 3.38(2.28, 3.83) points] (Z=-7.766, P<0.01; Z=-3.461, P<0.01). Conclusion Compared with patients of EORA alone, patients of EORA with OA have more obvious joint symptoms, MCP1, DIP and knee joint are susceptible to the co-involvement among them, longer duration of disease, and were prone to synovial hyperplasia and pannus flow formation. The therapeutic effects of glucocorticoid on joint inflammation in patients of EORA alone are superior to those patients of EORA with OA.

Objective Idiopathic pulmonary fibrosis, the fibrosis score (i.e., the combined extent of reticulation and honeycombing) is associated with worse survival. The aim of this study was to identify high-resolution computed tomography (HRCT) patterns and patient characteristics that could predict poor prognosis in rheumatoid arthritis-related ILD (RA-ILD). Methods We retrospectively analyzed 130 patients with newly diagnosed RA-ILD from 2011 to 2017 at Shanxi People's Hospital. The Pearson correlation analysis was used for the correlation between the fibrosis score and the worse survival of RA-ILD, and Using Cox regression analysis was used to identify the associations with mortality. A value of P less than 0.05 was considered statistically significant. Results During a median follow-up of 65 months, 32/130 (24.6％) patients died. Univariate analysis identified 6 significant poor prognostic factors: lower baseline ％ predicted forced vital capacity [HR=0.97, 95％CI(0.94, 0.99);P=0.008], total interstitial disease score [HR=1.06, 95％CI(1.03, 1.08);P<0.01], reticulation score [HR=1.07, 95％CI (1.04, 1.09); P<0.01], traction bronchiectasis score [HR=2.04, 95％CI (1.21, 3.40);P=0.008], fibrosis score [HR=1.07, 95％CI (1.01, 1.13);P<0.01], and definite UIP pattern [HR=4.18, 95％CI (1.40, 12.51); P=0.010]. Fibrosis score remained to be an independent significant poor prognostic factor of survival on bivariate analysis [HR=8.136, 95％CI (2.87, 28.35); P=0.001]. Patients with a fibrosis score>20％ had high mortality. Conclusion This study has shown that fibrosis score is strongly associated with worse survival in RA-ILD, and patients with fibrosis score>20％ have a 8.136-fold increased risk of mortality.