The number of women entering pregnancy with chronic liver disease is rising， and gestational liver disorders affect 3% of the pregnant population. Both can be associated with significant maternal and fetal morbidity and mortality. An international panel of experts with extensive experience in managing liver disease during pregnancy from various continents contributed to the formulation of these guidelines. This edition of the International Federation of Gynecology and Obstetrics guidelines on liver disease and pregnancy systematically addresses the most common diseases of gestational liver disorders and pregnancy comorbid with acute and chronic liver diseases and summarizes evidence-based clinical guidance and management recommendations， in order to enhance the clinical management of this patient population.

The pattern differentiation method is the most representative part of the inheritance of the experience of renowned practitioners of traditional Chinese medicine,reflecting their clinical thinking characteristics. Among them,Professor LYU Renhe proposed and developed the theory of abdominal masses in the long-term diagnosis and treatment of kidney diseases. Based on his clinical experience,he formed the method of differentiation of Shenluozhengjia (tangible or intangible abdominal masses of kidney collaterals). This differentiation method is characterized by its simple and easy clinical application. Tangible or intangible abdominal masses of kidney collaterals refer to chronic kidney disease,which is based on the basic cause of kidney deficiency. External or internal pathogenic factors cannot be eliminated,and prolonged illness invades the kidney collaterals,causing pathological products,such as qi stagnation,blood stasis,phlegm dampness,heat toxin,and turbid toxin to stagnate in the kidney collaterals,resulting in damage to the kidney body and loss of kidney function. The basic pathogenesis is a deficiency of kidney qi and the formation of tangible or intangible abdominal masses of the kidney collaterals. During pattern differentiation,the type is determined by the deficiency,which is fixed,and the pattern is determined by the excess,which is constantly changing with the condition and can be combined. Furthermore,he summarized the dietary principles as having more essence and less coarseness,more milk and less meat,a phased diet,and the selection of the symptomatic diet. To inherit and improve the theory and clinical practice of the pattern differentiation theory of tangible or intangible abdominal masses of kidney collaterals,this article reviews and summarizes the unique pattern differentiation method of the kidney collateral pattern from the aspects of definition,theoretical origin,etiology and pathogenesis,differentiation and treatment,and regulation,providing a basis for forming suitable diagnosis and treatment method for clinical promotion.

OBJECTIVE: To explore the effect of mindfulness meditation training for improving anxiety, depression and sleep disorders in perimenopausal women. METHODS: Intervention by menopause meditation training was delivered in 121 perimenopausal women with anxiety, depression or sleep disorders in Baiyun District, Guangzhou. Before and after the intervention, the Self-rating Anxiety Scale, Self-rating Depression Scale and Pittsburg Sleep Quality Index were used for assessment of changes in the conditions of the women. RESULTS: After menopausal meditation training, the perimenopausal women showed significant improvement in the mean scores of Self-rating Anxiety Scale (48.26 ± 6.47; =3.865, < 0.01), Selfrating Depression Scale (50.27 ± 6.54; =4.541, < 0.01) and Pittsburgh Sleep Questionnaire (10.64 ± 4.38; =5.596, < 0.01). The symptom remission rates differed significantly among the women with different self-practice frequencies ( < 0.01). The remission rates of anxiety, depression and sleep disorder increased significantly with the frequency of self-exercise ( < 0.01). CONCLUSIONS Mindfulness meditation training can effectively alleviate the symptoms of anxiety and depression and improve the quality of sleep in perimenopausal women, and the frequency of the exercise is positively correlated with the improvements. Mindfulness meditation training can be an effective intervention for improving the mental health of perimenopausal women.
Anxiety ; Depression ; Female ; Humans ; Meditation ; Mindfulness ; Perimenopause ; Sleep

Objective To understand the related influencing factors of pleural effusion caused by severe congestive heart failure to provide an idea for clinical diagnosis and treatment.Methods Three hundreds patients with severe congestive heart failure admitted to the cardiology department of this hospital from January to June 2015 were selected.The sex,age,heart failure degree,pleural effusion,type of heart disease,diabetes mellitus,atrial fibrillation,B-type pro-brain natriuretic peptide,white blood cell,neutrophil percentage,hemoglobin,blood urea nitrogen,serum albumin and hospital stay were recorded and performed the statistical analysis.Results The sex,heart failure degree,ejection fraction,B-type pro-brain natriuretic peptide,neutrophil percentage and serum albumin had statistical differences between the patients with pleural effusion caused by severe congestive heart failure and patients without pleural effusion(P＜0.05).The left atrial diastolic diameter/left ventricular end-diastolic diameter,white blood cell,hemoglobin,blood urea nitrogen,type of heart disease,diabetes,atrial fibrillation and hospitalization stay had no statistically significant differences(P＞0.05).Conclusion Pleural effusion caused by severe congestive heart failure has the correlation with the sex,heart failure degree,hypoproteinemia and neutrophil percentage.

Objective To provide detailed clinical and molecular genetic findings and describe the characteristics of natural history in Chinese choroideremia (CHM) patients.Methods The patients with CHM who met the inclusion criteria of at least two visits over a minimum period of 5 years were recruited on a voluntary basis at the Ophthalmic Genetics Clinic in Peking Union Medical College Hospital from April 2009 to August 2017.Molecular genetic analysis results,best-corrected visual acuity (BCVA),color fundus photograph,optical coherence tomography (OCT),visual field (VF),full-field electroretinography (fERG) were obtained.This study protocol was approved by the Institutional Review Board of Peking Union Medical College Hospital (S-K125).Written informed consent was obtained from each participant.Results Ten Chinese Han patients from seven CHM families were included.The mutations were confirmed by molecular genetic analysis,and two novel mutations were found.The median age of 10 patients at first visit was 44 years (range 8-52 years).The mean first-last visit period was 6.08 years (range 5.03-7.24 years).The mean BCVA at first visit in logMAR equivalents was 0.56 (range 0.0-2.0) or approximately 0.28 decimal acuity.The correlation between BCVA at first visit and age showed that relative good vision remained until 35 years old and BCVA subsequently reduced rapidly.OCT showed a thickening of the central retinal thickness at early stage,followed by a thinning over decades.Outer retinal tabulation (ORT) was shown in some patients.There was a strong negative correlation (r=-0.861,P＜0.001) between residual VF and age.Five patients did not need to record fERG because of serious fundus lesions.Two patients exhibited decreased amplitudes for both rod and cone-driven responses,and three patients exhibited no fERG amplitudes.Conclusions The progression of CHM may be severer and faster in Chinese patients than that in Western patients.ORT is an important manifestation of OCT in CHM patients.VF and fERG are applicable to evaluate the condition of very-early phase of CHM.

OBJECTIVE: To investigate the factors that influence the progression-free survival time (PFS) of patients with non-squamous cell carcinoma type non-small cell lung cancer (NSCLC) after first chemotherapy, and to provide reference for the formulation of clinical individual treatment regimen. METHODS: Clinical information of 84 patients with non-squamous cell carcinoma type NSCLC after first chemotherapy were selected from our hospital during Jan. 2012-Dec. 2014. The effects of patient's factors [gender, age, performance status (PS) score], disease factors [tumor staging, tumor marker (TM) level] and treatment factors (chemotherapy regimen and treatment course, chemotherapy efficacy) on PFS were analyzed retrospectively. RESULTS: All patients were followed up for 11. 933 months averagely (final follow-up time of Jun. 30th, 2017), and their median PFS was 4. 017 months. The median PFS of male was slightly shorter than that of female; the median PFS of patients aged more than 65 year-old was slightly shorter than that of patients aged below 65 year-old; the median PFS of patients with PS score of 0-1 was slightly longer than that of patients with PS score of 2-4, without statistical significance (P＞0. 05). The median PFS of Ⅱ -Ⅲ stage patients was significantly longer than that of Ⅳ stage patients; the median PFS of patients with at least one TM index was 10 times higher than the upper limit of the normal value was significantly shorter than that of patients with four TM indexes were all 10 times lower than the upper limit of the normal value; the median PFS of patients underwent 1-3 treatment courses was significantly shorter than that of patients underwent 4-6 treatment courses; the median PFS of patients with progressive disease efficacy was significantly shorter than that of patients with stable disease efficacy or above, with statistical significance (P＜0. 05). Among 84 patients, 81 patients selected PP regimen (pemetrexed disodium+platinum), and other patients chose non-PP regimen. Due to the large difference in the number of cases, the effect of the chemotherapy regimen on the patient' s PFS was not investigated. CONCLUSIONS: The disease factor and treatment factor of patients may be associated with PFS. Tumor staging, at least one TM index was 10 times higher than the upper limit of the normal value, the number of completed chemotherapy treatment course, chemotherapy efficacy are independent influential factors of PFS in patients with non-squamous cell carcinoma type NSCLC.

Objective:To establish mice models of Staphylococcus aureus bloodstream infections so as to investigate the inflammatory responses and histopathological changes in bloodstream infections (BSIs) mice.Methods:C57BL/6 mice were inoculated with S.aureus intravenously or intraperitoneally to induce BSIs.Survival rate , weight loss and murine sepsis scores ( MSS ) were ob-served.Blood samples and tissue homogenates were plated on agar to determine bacterial burden .Inflammatory proteins ( CRP,PCT) and cytokines ( IL-1β, IL-6 and TNF-α) were determined by ELISA kits.Histopathologic changes were also assessed by pathological inflammation scores(PIS),macroscopic and microscopic examination.Results: About 70% survival rate was observed in 4.5×108 CFU/ml S.aureus induced BSIs mice.Body weight decreased and sepsis scores increased significantly since 24 h post-infection in BSIs mice,and more prominent in IV group.The counts of WBC began to significantly increase at 3 h post-infection,while CRP and PCT levels peaked at 48 hours in IV and IP groups ( 60.80 ±5.63 vs 40.58 ±7.54 for CRP;6.796 ±1.16 vs 2.740 ±0.36 for PCT ) . Moreover,the levels of IL-1β,IL-6 and TNF-αin serum and tissue homogenates ( liver,lungs,and kidneys ) were significantly elevated in BSIs mice.Pathological changes in tissues (liver,lungs and kidneys) and higher pathological inflammation scores (PIS) were also observed in BSIs mice.Conclusion:Our study represents an effective approach for S.aureus BSIs model to mimic human sepsis.Our results demonstrated that inflammation protein (PCT,CRP) and cytokines(IL-6,IL-1βand TNF-α) play an important role in the in-flammatory response and histopathological changes during BSIs caused by S .aureus.

The background,features,dimension and contents of 22 international appraisal tools for clinical guidelines were analyzed,and their history,evolution,rules and problems were described,in order to provide the evidence for developing appraisal tools for domestic clinical guidelines. In the study,it was found that the guideline evaluation tools have been classified and there is a constant strive to achieve the balance between comprehensiveness and practicability. But the existing evaluation tools are insufficient for clinical practical contents of guidelines. The scoring system should be improved. In addition,conflicts of interest,value choice and patients' involvement should be considered increasingly, and should become an important part of the guideline evaluation tools.

Aim To investigate the brain targeting of ginkgolide B prodrug (PGB ) and its mechanism. Methods The liquid chromatography tandem mass spectrometry (LC-MS /MS)method was applied to in-vestigate the pharmacokinetics of PGB in rat brain tis-sue after intravenous injection of PGB.Also the brain targeting was evaluated on the basis of the pharmacoki-netic parameter of PGB.The incomplete cerebral is-chemia model was induced in mouse,the effect of PGB on cerebral capillary permeability was observed by Ev-ans blue method.High performance liquid chromatog-raphy (HPLC)was used to determine the partition co-efficients (logP)of PGB in octanol-water system.PGB and P-glycoprotein (P-gp)was docked by using Mole-gro Virtual Docker (MVD)software to predict its bind-ing abilities with P-gp.The interaction of PGB with ATPase activity of human P-gp membrane was esti-mated by measuring inorganic phosphate liberation. Results The brain targeting of PGB was evaluated by treatment effective (TA ) and drug targeting index (DTI),the calculated value were 6.87 and 4.1 4 re-spectively.Preventive medication of PGB could signifi-cantly decrease cerebral capillary permeability (P <0.05).The lipo-hydropartition coefficient of PGB was higher than that of GB,their logP data were 1 .03 and 0.61 respectively.PGB displayed the stronger binding affinity with P-gp than GB according to the molecular docking calculations,their MolDock Score toward P-gp were -1 43.36 and -1 1 6.40KJ·mol -1 respectively. ATP-hydrolisis showed that PGB increased ATPase activity with a Km of approximately 237.75 μmol · L -1 ,however GB with a Km of approximately 841 .24μmol·L -1 .PGB might interact with P-gp with a high-er affinity and exhibit more effect than GB.Conclu-sion PGB is characterized by its brain targeting. Higher liposolubility of PGB results in good blood-brain permeability,which is advantageous to its brain targe-ting.Besides,PGB can effectively inhibit the efflux effect of P-gp to GB because of its increased P-gp AT-Pase activity.

A Monte Carlo model for optical coherence tomography of human skin is proposed. The new model includes importance sampling technique which is designed to suit for the multi-layer human skin, new rules for back scattered photon classification are correspondingly proposed. Based on the new simulation model, we analyzed the focusing of Gaussian beam through skin and the maximum detecting depth of optical coherence tomography. The experimental results show that there exists focus distortion when beam propagates in skin, including focus shift and diffusion. Object lens with greater NA will lower the maximum detecting depth of optical coherence tomography.
Humans ; Models, Theoretical ; Monte Carlo Method ; Photons ; Skin ; Tomography, Optical Coherence