Objective To investigate the risk factors of postpartum haemorrhage(PPH) in placenta previa. Methods A retrospective analysis of 136 cases with placenta previa from Jun.1996 to Dec. 2000 was performed. Results The incidence of placenta previa was 1.24%(136/10967) and the rate of postpartum haemorrhage was 22.06%(30/136). The associated factors of postpartum haemorrhage in placenta previa were history of multiple abortions (more than twice) , previous cesa rean section, elder age, type of placenta previa, no prenatal check, prenatal bleeding and other complications. PPH might happen when the high risk factor score was more than 4. Conclusions The relative factors of postpartum haemorrhage in placenta previa are abortions more than twice, previous cesarean section, older age, types of placenta previa, absence of prenatal check, antepartum hemorrhage and other complications. We can predict PPH by high risk factor score.

Objective To study the clinical characteristics, the outcome of pregnancy and the risk factors of uteroplacental apoplexy complicating severe placental abruption. Methods A retropectively study of the 52 cases of placental abruption who had delivered in our hospital from Jan. 2002 to Dec. 2006 was conducted. These cases were divided into 2 groups: 17 cases of uteroplacental apoplexy complicating placental abruption as observation group, the others with no uteroplacental apoplexy as control group. The risk factors of disease, clinical characteristics and the outcome of pregnancy between the two groups were compared. Results (1)The incidence of placental abruption was 0. 15% (52/35 049) among the total deliveries patients with uteroplacental apoplexy complicating placental abruption took up 0. 05% (17/35 049) of all deliveries and 33% (17/52) of all abruption cases. (2) General information and delivery : There were no significant differences ( P > 0. 05 ) regarding their mean age and BMI in two groups. All women in observation group had C-section delivery, which were 21 in control group. 14 women had vaginal delivery. The incidence of premature labour was 88% ( 15/17 ) in observation group, and 49% (17/35 ) women in control group delivered after 37 weeks. Significant differences were observed regarding delivery methods and gestational weeks(P <0. 01 ). (3)Risk factors: the incidence of preeclampsia, 71% (12/17), and the duration of disease, 6. 4 hours, in observation group were more than those in control group, 20% (7/35) and 4. 2 hours( P < 0.01 ). There were no significant differences between two groups in premature rupture, polyhydroamnions ( P > 0. 05 ). (4) Clinical characteristics in two groups : bloody amniotic fluid, fetal distress, hematometra and postpartum hemorrhage occurred in 82% (14/17) vs 26% (9/35), 65%(11/17) vs 29% (10/35), 35% (6/17) vs 6% (2/35), and 59% (10/17) vs 11% (4/35), with a significant difference (P <0. 01), but no statistical difference existed between indices such as abdominal pain, vaginal bleeding and abdominal tension ( P > 0. 05 ). (5) Placenta sites and abruption areas: placenta sites were distributed from anterior or posterior of uterine body 5/17 vs 24/35 , the fundus or cornu of uterus 12/17 vs 11/35 ( P < 0. 01 ). All cases in observation group presented abruption areas> 1/3, and 9 cases ≥2/3, 27 cases abruption areas < 1/3 and 8 cases abruption areas 1/3 -2/3 in control group (P<0.01). (6) Other complications and outcome: Hemorrhagic shock 3 vs 0, DIC 3 vs 0, hysterectomy 1 vs 0, intrauterine fetal death 3 vs 2, neonatal asphyxia 8 vs 5 and neonatal death 1 vs 0. There were significant differences ( P < 0. 01 ) between the two groups. Conclusions Preeclampsia, long duration of disease and fundal or cornual placenta a risk factors for uteroplacental apoplexy complicating placental abruption, which may lead to a poor maternal-fetal prognosis.

Colorectal polyps are common digestive system diseases in children. The important role of endoscopy in the di-agnosis and treatment of colorectal polyps in children has been recognized. With the continuous development of endoscopic techniques, the diagnosis and treatment of colorectal polyp has become safer, more convenient and more effective. In this re-view, the progress in endoscopy for diagnosis and treatment of colorectal polyps in children has been summarized.

Objective To investigate the relationship between gestational hypothyroidism and preeclampsia.Methods A retrospective study was conducted on 1 776 patients with gestational hypothyroidism,who gave birth in the International Peace Maternity & Child Health Hospital of China Welfare Institute,Shanghai Jiaotong University School of Medicine from January 2013 to December 2014.They were divided into three groups,including Improving Group (n=1 469),Progressing Group (n=133) and Remaining Group (n=174),based on their thyroid function at the first and third trimesters.Levels of thyroid hormones in the first and third trimesters were analyzed.Incidences of preeclampsia in those patients were calculated.And the correlation between thyroid function and incidence of preeclampsia was analyzed.T-test,Mann-Whitney U test,Chi-square test,variance analysis (SNK method) and Kruskal-Wallis H test or Logistic regression were performed for statistical analysis.Results (1) There were no statistical differences in age,gravidity and parity among the three groups.The pregestational body mass index in Progressing Group was lower than that in Improving group (21.1 ±2.9 vs 21.8±2.8,P＜0.05).(2) In the first trimester,the level of thyroid stimulating hormone (TSH) in Remaining Group was higher than those in Improving and Progressing Groups [(4.21 ± 1.69) vs (3.77±.3.03) and (2.00±0.57) mU/L,F=27.635,P＜0.01],and that in Improving Group was higher than that in Progressing Group (P＜0.05).The level of free thyroxine (FT4) in Progressing Group was higher than those in Improving and Remaining Groups [(16.18±9.67) vs (14.58± 1.71) and (14.54± 1.74) pmol/L,F=16.188,P＜0.01].In the third trimester,the TSH level in Remaining Group was higher than those in Improving and Progressing Groups [(5.07±0.86) vs (2.57±0.77) and (4.31 ±0.87) mU/L,F=28.986,P＜0.01],while the TSH level in Improving Group was higher than that in Progressing Group (P＜0.05).No statistical differences in FT4 levels (in the third trimester) and positive rates of thyroid peroxidase antibody (TPOAb) Were observed in the three groups.(3) Blood pressures (including diastolic and systolic blood pressures) in the first trimester and diastolic pressures in the third trimester showed no significant differences among the three groups.Systolic pressure of Improving Group in the third trimester was lower than that of Progressing Group [(119.4± 11.9) vs (121.8± 14.2) mmHg,P＜0.05,1 mmHg=0.133 kPa].(4) The incidence of preeclampsia in Progressing Group was higher than those in Improving and Remaining Groups [7.52％ (10/133) vs 1.29％ (19/1 469) and 3.45％ (6/174),x2=26.646,P＜0.01],and the incidence in Progressing Group was higher than those in Remaining and Improving Groups (both P＜0.05).The incidence of severe preeclampsia in Progressing Group was higher than that in Improving Group [6.02％ (8/133) vs 0.41％ (6/1 469),P＜0.05].There were no significant differences in incidences of mild preeclampsia among the three groups.(5) After adjusting for age,body mass index,gravidity and parity,the risk of severe preeclampsia in Improving Group was lower than that in Remaining Group (OR=0.233,95％CI:0.057-0.946,P＜0.05).Conclusions By improving thyroid function in pregnant women with hypothyroidism,the risk of preeclampsia,especially severe preeclampsia,could be reduced,which could improve maternal and neonatal outcomes.

Objective To investigate the timing for delivery in twin pregnancies to improve the perinatal outcome. Methods A multicentered and retrospective study was conducted on 655 women with twin pregnancies in 6 hospitals of Shanghai from Jan 1993 to Oct 2003. The average birthweight(BW) for both twins in different gestation, the incidence of small for gestational age (SGA) and severe neonatal asphyxia were analyzed. Results For the smaller babies in all twins, the 50 percentile of the birth weight was far behind the singletons throughout the pregnancy. But for the larger babies, it was similar to the singletons if delivered before 33 weeks, lighter than the singletons if after 33 weeks and remarkable difference was shown beyond 39 weeks. The largest BW of the larger babies was 3073 g presented at 39 weeks, while 2670 g for the smaller babies at 40 weeks after which the average BW was decreased. It reached 2555 g and 2303 g at 41 weeks for the larger and smaller babies, respectively (P

ObjectiveTo assess the relationship between the location,quantity and leukodystrophy of cerebral infarction and vascular cognitive impairment ( VCI ),and to compare the differences of the severity and domains of cognitive impairment among the different types of cerebral infarction,which will provide the pathophysiological evidence to the mechanism for the development of VCI. MethodThe patients suffering from cerebral infarction or leukodystrophy were recruited from either the ward or clinic in Tianjin General Hospital from April 2009 to April 2010,then assessed the cognition,and classified into different groups according to the location,size,quantity,whether or not they have leukodystrophy and the severity.The Logistic regression analysis was taken with whether or not the patients have had developed to the VCI as the dependent variable,and with the location,size,quantity,whether or not they have leukodystrophy and the severity as the independent variables.The differences of the score of NIHSS,Bathel index and the level of cognitive impairment were compared among patients with different types of lesions.Moreover,the difference of the score of MoCA for each cognitive domain were compared among patients with different types of lesions.ResultsThere was a relationship between key position infarction in the subcortex and white leukodystrophy with VCI.The position infarction in the subcortex and white leukodystrophy ( grade Ⅱ and Ⅲ ) might be the independent risk factors for the VCI( OR =1.752,2.135,3.753; 95％ CI 1.533-3.821,1.541-6.787,1.432-6.821,all P ＜0.05).There were significant differences in the domains of excusive ability,attention,calculation,fluent language and orientation.The average scores of the domain of excusive ability in the subcortical group (3.40 ± 1.90) and the mix group (3.83 ± 1.27) were significantly lower than the cortical disease group(4.28 ± 0.89,t =0.050,0.857,both P ＜ 0.05 ).The average scores of the domains of attention,calculation,fluent and orientation in the mix group were significantly lower than the subcortical group and cortical disease group.ConclusionsThere is a significant association of the key infarction in the subcortex and leukodystrophy with VCI.The patients with both the subcortex infarction and leukodystrophy are susceptible to VCI.The development of VCI is depended on the position of infarction instead of the quantity and size of infarction.The development of VCI is not only related to the white matter disease but also related to the severity of the leukodystrophy.The data highlights the need to small vessel disease.The patients with subcortical lesions mainly impair the executive ability.The patients with mix lesions may have more extensive domains and more severe cognitive impairment.

Although the treatment of aneurysmal subarachnoid hemorrhage (SAH) has made considerable progress in recent years,its mortality and disability have not been effectively controlled.Ischemic brain injury after SAH is considered to be an important reason for the poor prognosis of patients; however,its mechanism is still not fully understood.Studies have shown that the cerebral microcirculation disturbance after SAH is closely associated with ischemic brain injury.This article reviews the advances in research on cerebral microcirculation disturbance and ischemic brain injury after SAH.

Objective To investigate the optimal gestational weight gain (GWG) in twin pregnancies and to analyze the impact of GWG on pregnant outcomes.Methods A retrospective cohort study of twin pregnancies was conducted on women who gave birth in International Peace Maternity and Child Health Hospital,Shanghai Jiaotong University School of Medicine from January 1,2012 to the June 30,2015.An optimal range of GWG was calculated based on the amount of weight gain in 711 subjects who gave birth to normal twins and with uncomplicated pregnancy.Another 504 twin pregnant women without gestational complications were recruited for further analysis of the relationship between GWG and gestational outcomes.T-test,analysis of variance and Chi-square test were used for statistical analysis.Results (1) The optimal range of GWG for full-term twin-pregnancy was 15.3-21.4 kg.In those with low body mass index (BMI,＜18.5),normal BMI (≥ 18.5-＜25.0) and overweight/obesity (≥ 25.0),the GWG [M(P25-P75)] were 18.5 (15.8-22.2),18.3 (15.3-21.3) and 18.1 (14.9-21.5) kg,respectively.There was no significant difference in GWG among those groups (F=0.121,P=0.886).(2) According to the optimal GWG mentioned above,we divided the 504 cases into three groups,including lower GWG group (less than the optimal GWG,n=137),normal GWG group (in the GWG range,n=238) and higher GWG group (more than the optimal GWG,n=129).The neonatal birth weights in the three groups were (2 626.1 ±225.8),(2 680.14-237.9) and (2 751.9±257.1) g (F=9.189,P＜0.01),respectively,indicating that neonatal birth weight was increased by increasing GWG.The proportion of both twins with birth weights of more than 2 500 g was slightly increased,but there was no significant difference among the three groups [51.1 ％ (70/137),60.5％ (144/238) and 64.3％ (83/129),respectively,x2=5.279,P=0.071].The incidence of gestational diabetes mellitus (GDM) was reduced along with increased GWG [31.4％ (43/137),14.7％ (35/238) and 9.3％ (12/129),respectively,x2=25.144,P＜0.01],while the incidence of hypertensive disorders in pregnancy (HDP,including gestational hypertension and preeclampsia) in the three groups showed no significant difference.There were 90 cases (17.8％) of GDM in the 504 cases with a pre-pregnancy BMI of 22.5±2.8,which was higher than that of the non-GDM cases (21.21±2.9),(t=3.735,P＜0.01).Among the 504 cases,there were 67 cases (13.3％) of HDP (including gestational hypertension and preeclampsia) with a pre-pregnancy BMI of 22.4±2.8,which was higher than that of the non-HDP patients (21.3 ± 2.9,t=2.767,P=0.006).Conclusions The pre-pregnancy BMI has little influence on GWG in twin pregnancies.Increasing GWG to the recommended optimal range or above,and within a certain range,could promote an increase in neonatal birth weight without adding the risks of gestational complications,such as gestational diabetes mellitus,gestational hypertension and preeclampsia.

Objective To assess the osteogenic ability after co-culture BMSC and ADSC in vivo and in vitro.Methods ADSC and BMSC were obtained by adherent screening method and enzymatic digestion method.Flow cytometry was used to confirm the phenotypes of ADSC and BMSC.Oil red O was used to induce MSC to fat.Alkaline phosphatase (ALP) and alizarin red staining were used in osteogenic group.This sample was divided into four groups,no-induced stem cells group;BMSC osteogenic induction group;ADSC osteogenic induction group;co-culture of BMSC and ADSC osteogenic induction group.ALP activities and Calcium absorbance were determined during different periods of osteogenic introduction.OCN and Runx2 expression level were tested via RT-PCR and western blot methods after osteogenic induction for 2 weeks.Furthermore,cells in each group were seeded on HA/CS/PLLA composite scaffolds,and the scaffolds with cells were planted into bone defects in rat models.The rats were sacrificed by overdose anesthesia at 8 weeks after surgery and the scaffolds were removed for further analysis.Results Oil red O staining demonstrated red after adipogenic induction.Alkaline phosphatase and Alizarin red staining showed flaky red under condition of osteogenic induction.There had no statistical change among each group after osteogenic induction for 3 days,and ALP activity significantly increased after osteogenic induction for 5 days.Meanwhile,the ALP activity in co-culture of BMSC and ADSC group was markedly higher than the other three groups.However,there had no significant change in A value of calcium absorbance among each group after osteogenic induction for 7 days,while it increased at 14th day and ALP activity in co-culture of BMSC and ADSC group was significantly higher than the other three groups.After osteogenic induction for 2 weeks,the mRNA expression of OCN and Runx2 in co-culture of BMSC and ADSC group was 78.24±8.11 and 1 180.13±121.16 respectively,and the protein expression of OCN and Runx2 was 6.54±0.59 and 4.43±0.51.These mRNA and protein expression level in co-culture of BMSC and ADSC group enhanced significant compared with the other 3 groups.Histological assay demonstrated that the new bone tissues formed in co-culture of BMSC and ADSC group were 497.75±7.44 μm2,which was larger than that in the other 3 groups at 8 weeks after implantation.Conclusion Co-culture BMSC and ADSC may up-regulated the osteogenic ability in vivo and in vitro.

The prediction of survival time for advanced cancer patients undergoing palliative care has important clinical and social value. The prediction of survival time of advanced cancer patients includes clinical prediction and statistical prediction. Due to the late start of palliative medicine in China, it is particularly important to evaluate the widely used survival prediction tools in clinical practice. In this paper, we will review the common survival prediction tools of advanced cancer patients from the perspective of Western and Traditional Chinese Medicine,to provide reference for development and application of a survival prediction system in China.