Objective To investigate whether area under the curve (AUC) of oral glucose tolerance test (OGTT) could work as a predictor of outcomes of gestational diabetes mellitus (GDM) on condition that blood glucose is controlled. Methods A total of 1 796 women who had a standard antenatal care in Peking University First Hospital and gave single live births from July 1, 2011 to December 31,2 013 were included.They should be diagnosed of GDM by the diagnosis criteria of gestational diabetes published by the Ministry of Health of PRC and diabetes pre-pregnancy excluded. Data were analyzed with SPSS 17.0, grouping by AUC. Results (1)Women with higher AUC had a rising trend of age and a downward trend of gestational weight gain, however, not statistically significant [specifically, in the four group of less than 15.00 mmol·L-1·h-1, 15.00 to 16.79 mmol · L-1 · h-1, 16.80 to 17.99 mmol · L-1 · h-1 and 18.00 mmol · L-1 · h-1 or more, gestational weight gain was (15.3±5.2), (14.1±4.8), (13.5±4.7) and (13.1±4.8) kg]. The prevalence of macrosomia raised while AUC increased. Those with an AUC of lower than 15.00 (mmol·L-1·h-1) had a lower risk of macrosomia (P=0.04) . But those with an AUC of 18.00 (mmol·L-1·h-1) or more had a higher risk of macrosomia (P=0.02). There was a rising trend in premature birth and preeclampsia with AUC increasing but not significant (the prevalence of premature birth was 4.38%, 5.36%, 7.71%and 7.94%while that of preeclampsia was 2.85%, 4.69%, 4.67% and 5.08% in these four groups).(2)The prevalence of macrosomia was 12.76% (54/423) when overweight pre-pregnancy ,significantly higher compared with 5.87%(65/1 107) in normal group. The prevalence of preeclampsia was 5.91%(25/423) and 3.34%(37/1 107) in those two groups, which was also significantly different. The obese group had a statistically highest prevalence of preeclampsia of 9.23%(12/130). (3)AUC (P<0.05, OR=1.113, 95%CI:1.008-1.218), as well as gestational weight gain (P<0.05, OR=1.520, 95%CI:1.279-1.806) and pre-pregnancy BMI (P<0.05, OR=1.183, 95%CI:1.125-1.243) made a difference in the prevalence of macrosomia. Meanwhile, pre-pregnancy BMI made sense in the prevalence of premature labor (P<0.05, OR=1.059, 95%CI:1.003-1.119) and preeclampsia (P<0.01, OR=1.202, 95%CI:1.123-1.286). Conclusions AUC, as well as pre-pregnancy BMI and gestational weight gain have a significant impact on outcomes of GDM, macrosomia especially, though blood glucose is controlled. Meanwhile, AUC might be considered as a predictor of macrosomia.

Objective To investigate the imaging features of primary hepatic neuroendocrine carcinoma.Methods The imaging features of primary hepatic neuroendocrine carcinoma confirmed by pathology in 5 patients were reviewed retrospectively.Among the patients,plain and contrast enhanced CT in 4 and plain and contrast enhanced MRI in 1 were performed.Results CT showed a single lesion in 2 patients and multiple lesions in other 2 with the maximum diameter of 5.5 cm-10 cm.On plain CT,all lesions were hy-podensity with clear boundary and lower area in the center.The enhanced CT showed the lesions with obvious enhancement in arteri-al phase and gradually increasing enhanced area in portal vein and delayed phases but without enhancement in the lesion center.MRI showed the only one lesion in 1 patient with heterogenerous hypointensity on T1 WI,hyperintersity on T2 WI and DWI,and with mild to moderate delayed enhancement.The maximum diameter of the lesion was 5.0 cm,accompanied by a small round cystic structure at the periphery.The compression and displacement of peripheral blood vessels by the lesion without thrombus,and no lymphade-nopathy were also identified.Conclusion CT and MRI may show the imaging characteristics of the primary hepatic neuroendocrine carcinoma,which is helpful for the diagnosis of the tumor.

Objective To evaluate the feasibility of low dose CT perfusion imaging of brain using the tube voltage of 70 kV.Methods Twenty New Zealand white rabbits underwent cerebral CT perfusion imaging with tube voltage 70 and 80 kV separately,and the interval between two scans was 24 h.The effective dosage (E),cerebral perfusion parameters (CBF,CBV,MTT) and image quality indicator (SNR) of middle cerebral artery of each protocol were acquired and compared statistically.Results The effective dosage of70 kV group was 1.91 mSv,34.8％ lower than that of 80 kV group with the dose of 2.93 mSv.There were no significant differences between the cerebral perfusion parameters acquired at different corresponding ROI.SNR of 70 kV group and 80 kV group were (23.15 ± 5.98) and (21.23 ±9.18) with no significantly statistical difference.Conclusions The effective dosage of 70 kV cerebral CT perfusion imaging could be dramatically reduced with no significant influence on the results of perfusion parameters and image quality.

Objective To assess the image quality of coronary CT angiography(CCTA) by using high-pitch spiral CT under 80 kV in patients with a normal body mass index(BMI), and to investigate the feasibility of low radiation dose.Methods 60 patients,who suspicious coronary artery diseases and BMI between 18.6-25.0 kg/m2 underwent CCTA in our hospital.All patients were randomly divided into group A and group B(each with 30).Patients in group A were given 100 kV CCTA and filter back-projection algorithm (FBP), and patients in group B were given 80 kV CCTA and iterative reconstruction(IR).CT values of aortic root, right coronary artery (RCA), left anterior descending artery (LAD), left circumflex (LCX) and standard deviation (SD) were measured.Then signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated.All images were given quality subjective scoring by using 3-score method.The CT dose index was recorded and effective radiation dose (ED) was calculated.Results ED of group A and group B was 0.8 mSv and 0.41 mSv, respectively.Statistically significant difference was found between these two groups.In the study, SD was (28±6) HU in group A and (46±9) HU in group B, and the difference was statistically significant between the two groups.The CT values of aortic root, RCA, LAD and LCX under 80 kV were significantly increased, and the difference was statistically significant between the two groups.There was no statistically significant difference between two groups in RCA-SNR, LAD-SNR and RCA-CNR.But in LCX-SNR, LAD-CNR, LCX-CNR, there was statistically significant difference between two groups.There was no significant difference between the two groups in coronary artery segments which could be used for diagnosis.Conclusion For patients with a normal BMI, CCTA using Flash spiral CT under 80 kV could diagnose coronary artery disease and significantly reduce the radiation dose.

Objective To study the clinical characteristicsand perioperative managementof complicated placenta increta, effectively reduce the maternal adverse perinatal outcomes. Methods Retrospective analysis 25 cases of complicated placenta increta between January 2013 and December 2015 in the Third Affiliated Hospital Of Guangzhou Medical University. Grouped into preoperative line 9 cases of ureteral catheter group and without catheter group 16 cases; Conventional hysterectomy group of 17 cases and the posterior hysterectomy group of 8 cases , compare the operation time , postpartum hemorrhage , blood transfusion amount , bladder injury or ureteral injury rate , rate of transferred to the ICU and hospital stay. Results 76% appear repeatedly painless vaginal bleeding during pregnancy , 56% appear bleeding before delivery. Prenatal diagnosis of 17 cases (68%). The preoperative line cystoscopy + bilateral retrograde ureteral catheter or after the posterior hysterectomy , shorter operation time , less postpartum hemorrhage , reduce blood transfusion volume , no urinary tract injury rate, transferred to the ICU rate is low, the difference was statistically significant (P < 0.05). Conclusions We should attach importance to repeated painless vaginal bleeding , improve prenatal diagnostic rate of complicated placenta increta. The perioperative managementis more comprehensive , effective and standard participation , preoperative ureteral catheter and the posterior hysterectomy can effectively reduce the maternal adverse perinatal outcomes.

Objective To investigate the risk factors of reversible posterior leukoencephalopathy syndrome (RPLS) in pre-eclampsia or eclampsia gravida. Methods This study was conducted in the Third Affiliated Hospital of Guangzhou Medical University between January 2013 and March 2016. A total of 100 patients who had no severe neurological diseases and were diagnosed pre-eclampsia or eclampsia, and underwent brain MRI were collected retrospectively. They were divided into 2 groups according to the MRI results, the RPLS group (n=49) and the non-RPLS group (n=51). The medical history, clinical symptoms and the results of laboratory examination were analyzed by the logistic regression, in order to explore the risk factors.Results In single factor analysis, HELLP syndrome, pregnancy associated with other diseases, poor prenatal care, grade 3 hypertension, elevated systolic blood pressure or diastolic blood pressure, elevated WBC, aspartate transaminase (AST), alanine aminotransferase (ALT), uric acid (UA) and lactate dehydrogenase (LDH), decreased platelet (PLT), headache, visual changes, seizures and conscious disturbance were more frequent in the RPLS group than those in the non-RPLS group (all P<0.05). According to the multivariate logistic regression analysis, the elevated WBC (OR=1.291, 95%CI:1.058-1.575, P=0.012), UA (OR=1.008,95%CI:1.001-1.016,P=0.032) and headache (OR=18.260, 95%CI:3.562- 93.607, P=0.000) were the independent risk factors.Conclusions Maternal history, clinical symptoms and some laboratory examinations might help in the early diagnosis of RPLS in pre-eclampsia or eclampsia gravida. Headache, the elevation of WBC and UA were the most significant factors.

Purpose To analyze the correlation of right subclavian artery ultrasound and individual blood lipid level with coronary atherosclerosis (CA) using carotid ultrasound as control so as to explore the clinical value of them in predicting CA.Materials and Methods Coronary CT angiography (CCTA) and right subclavian artery/neck vessel ultrasound in 55 patients were retrospectively analyzed.Gensini score was used to calculate the degree of coronary artery lesions.According to the result of CCTA,patients were divided into normal group,mild coronary atherosclerosis group,severe coronary artery stenosis group.The intina-media thickness (IMT) at the origin of right subclavian artery and carotid artery bifurcation on ultrasound was measured to evaluate carotid lesions.The correlation between the IMT and Gensini score of coronary artery was analyzed.The blood lipid levels of the 3 groups were analyzed,and the efficacy of right subclavian artery,carotid artery ultrasound and blood lipid in predicting CA was evaluated.Results ① The IMT at right subclavian artery and carotid artery bifurcation were positively correlated with Gensini score,and the former had higher correlation than the latter (r=0.636,r=0.462,P＜0.01);the prediction efficacy of the IMT at right subclavian artery was slightly higher than that at carotid artery bifurcation (with sensitivity and specificity of 78.3％,64.5％,and 77.5％,60.0％ respectively).② Compared with normal control group,the levels of low-density lipoprotein cholesterol,triglycerides,total cholesterol were higher,but the level of highdensity lipoprotein cholesterol (HDL-C) was lower in mild coronary atherosclerosis and severe coronary artery stenosis group,and the difference between the severe coronary artery stenosis group and normal groups was bigger,among which the level of triglycerides had the largest difference among the three groups with no statistical significance (P＞0.05).The HDL-C had a more significant correlation with Gensini score than other index of blood lipid (r=-0.151).③ The combination of IMT and HDL-C had a sensitivity of 81.0％ and specificity of 66.7％ in predicting CA,which were higher than that of each individual index (with sensitivity of 78.3％,64.5％ and specificity of 64.3％,55.5％respectively).Conclusion The IMT at right subclavian artery has a better predictive value in determining the degree of coronary artery lesions than that at carotid artery bifurcation.The combined application of blood lipid levels and the IMT at right subclavian artery can improve the sensitivity and specificity of predicting CA.

Objective To determine the expression of CD4+ CD25+ FOXP3+ regulatory T cells(Treg cells) in peripheral blood of patients with hepatocellular carcinoma (HCC) and investigate the clinical significance of Treg cells determination in clinical practice. Methods Flow cytometry was employed to measure the levels of CD4+ CD25+ T cells and CD4+ CD25+ FOXP3+ T cells in peripheral blood of 18 HCC patients, 26 hospitalized patients without HCC (clinical control) as well as 24 healthy persons (healthy control). Results The percentage of CD4+ CD25+ T cells in total CD4+T cells isolated from the HCC patients(4.25% ± 3.98 % ) was elevated significantly compared to that in the clinical control group (1.34% ± 1.14%) or healthy control group (1.29% ±0.95%) (both P＜0.01). There was no difference in the percentage between the clinical control group and the healthy control group (P＞0.05). Meanwhile, the ratio between CD4+ CD25+ FOXP3+ T cells and CD4+ T cells in HCC patients (2.94%0.91%) also increased significantly compared to that in the clinical control group (0.76% ± 0.34%) or healthy control group (0.81% ± 0.29%) ( both P＜0. 001), which showed a more obvious increasing tendency than the ratio of CD4+ CD25+ T cells and CD4+ T cells. No difference in percentage of CD4+ CD25+ FOXP3+ T cells in CD4+ T cells was found between the clinical control group and the healthy control group (P＞0.05). Conclusion As the more accurate regulatory T cells, CD4+ CD25+ FOXP3+ T cells are able to detect the increase of population in HCC patients. Therefore, it is important to determine the levels of CD4+ CD25+FOXP3+ T cells in HCC patients for prevention and treatment of malignancy.

With DQOL (diabetes quality of life) scale, quality of life was evaluated before and after diabetic education in 136 type 2 diabetic patients. The Cronbach′s ? of DQOL scale was from 0.809 to 0.849, suggesting that the DQOL scale did effectively reflect the life quality of type 2 diabetic patients.

Objective To evaluate the feasibilities and advantages of different concentrations of sodium alginate (SA) solutions as a submucosal injection solution for endoscopic submucosal dissection (ESD). Methods In vitro study, different concentrations of sodium alginate solutions and normal saline were injected into submucosal of resected porcine esophagus and stomach respectively, then observe and measure the heights of each injection induced mucosal elevations, and their changes over time. In vivo study, the mimic ESD were conducted in healthy pigs to evaluate the mucosal elevation effect and other assistant effects of sodium alginate as a submucosal injection solution. Results The elevation heights of the experiment groups injected with SA solutions were much higher than the control group injected with normal saline. Specially, the elevation created by 1 % SA in porcine esophagus was significantly higher than that of normal saline (P < 0.01) and the elevation created by 3 % SA was significantly higher than that of normal saline in porcine stomach (P < 0.001). In the mimic ESD experiment, mucosal elevation with clear margin occurred immediately after injection with SA solution. And the durable submucosal fluid cushion created by SA protected deeper tissues while facilitating ESD procedure. Conclusion The elevation heights created by SA solutions were greater and more durable than that created by normal saline, which were crucial for ESD. The viscosity property enabled SA to form a stable protective cushion and prevent bleeding by squeezing tissue around the wound, which may decrease perforation and bleeding rate during ESD procedure. Therefore, sodium alginate can be an ideal clinical submucosal injection solution.