Objective To investigate factors and neonatal outcomes associated with histologic chorioamnionitis (HCA) in preterm premature rupture of membranes (PPROM).MethodsFrom Jan.2008 to Jun.2011,230 women with PPROM at 28 -33 +6 weeks of gestation undergoing deliveries in the Second Affiliated Hospital of Wenzhou Medical College were studied retrospectively.According to placental histopathologic findings,those patients were categorized into two groups,including 138 cases in histologic chorioamnionitis (HCA group ) and 65 cases in non-chorioamnionitis (control)group.Age,parity,gestational age of PPROM and delivery,latency period,oligohydramnios,white blood cell (WBC) count and serum C-reactive protein (CRP) level at admission and before delivery,the incidence of neonatal respiratory distress syndrome (NRDS),neonatal pneumonia,bronchopulmonary dysplasia,necrotizing enterocolitis,early-onset neonatal sepsis,abnormal brain sonography findings and mortality were compared between two groups.Results( 1 ) The incidence of HCA was 68.0.％ ( 138/203 ) in all 203 cases with PPROM.(2) The occurring ruptured membrane gestation in HCA group was ( 31.1 ± 1.5 ) weeks,which were significantly earlier than (32.0 ± 1.3 ) weeks in control group ( P ＜ 0.05 ).The level of CRP of (8.2 ± 14.9) mg/L before delivery in HCA group was significantly higher than (5.5 ±7.2) mg/L in control group (P ＜ 0.05).The rate of oligohydramnios and cesearean sections were 55.1％ (76/138) and 45.7％ (63/138) in HCA group,which were significantly higher than 30.8％ (20/65) and 29.2％ (19/65) in control group (P ＜0.05).There were no significant difference in patient's age,parity,WBC count and CRP at admission between two groups (P ＞ 0.05 ).The latency period did not show significant difference between (140± 116) hours in HCA group and (129 ± 125) hours in control group (P ＞ 0.05).(3) Using multivariable logistic regression models,oligohydramnios ( OR =2.937 ),gestational age of PPROM ＜ 32 weeks ( OR =2.352),serum CRP level ＞ 8 mg/L before delivery ( OR =4.923 ) and latency period ＞ 48 -168 hours (OR =4.439) were significantly associated with HCA (P ＜0.05).(4) The gestational age of delivery and birth weight of HCA group were significantly lower than those of control group [ ( 32.0 ± 1.5 ) weeks vs.( 32.7 ± 1.5 ) weeks,( 1680 ± 379) g vs.(2017 ± 333) g,respectively,P ＜ 0.05 ].The incidence of Apgar ＜7,abnormal brain sonograhy findings, neonatal pneumonia,bronchopulmonary dysplasia,early-onset neonatal sepsis and mortality in HCA group were significantly higher than those in control group [20.3％ (28/138) vs.7.7％ (5/65),14.5％ (20/138) vs.4.6％ (3/65),12.3％ (17/138) vs.3.1％(2/65),5.8％ (8/138) vs.0,6.5％ (9/138) vs.0,12.3％ (17/138) vs.3.1％ (2/65),respectively,P ＜ 0.05 ].The incidence of necrotizing enterocolitis ( 1.5％,2/138 ) in HCA group was higher than that of controlgroup(0) and the incidence of NRDS ( 18.8％,26/138) in HCA group did not show statistical difference with 21.4％ ( 14/65 ) in control group ( P ＞ 0.05 ).ConclusionsIt was found that HCA was significantly correlated with lower gestational age of PPROM,higher serum CRP level before delivery,prolonged latency period and oligohydramnios in PPROM.HCA could increase the neonatal morbidity and mortality.

Objective The purpose was to describe the outcomes and characteristics of the obstetric patients with concurrent eclampsia and hemolysis, elevated liver enzymes, and low platelets syndrome (HELLP) syndrome. Methods We retrospectively collected the materials between December 1999 and December 2008 in Obstetric Critical Care Center of Guangzhou. There were 76 patients in rolled then they were divided into two groups according to with or without HELLP syndrome. All the patients were injected Magnesium Sulfate to control seizure and to prevent the recurring of seizure. We analyzed the characteristics (such as age, gestational weeks, blood pressure after seizure), complications, biochemistry markers, the rate for intensive care unit (ICU) admittion, the need for mechanical ventilation, the Glasgow coma score (GCS) when admitted into ICU, computed tomography scan (CT) or magnetic resonance imaging (MRI),death rate of maternal and others, then compared between the two groups. Results ( 1 ) General data:There were 17 patients admitted with both eclampsia and HELLP syndrome, and 59 patients admitted eclampsia without HELLP syndrome. The incidence of eclampsia with HELLP syndrome was 22% (17/76).In eclampsia with HELLP syndrome group, the systolic blood pressure was higher and the rate of preterm also was higher [ (182 ± 20) mm Hg (1 mm Hg=0. 133 kPa)vs. (159± 21 ) mm Hg, P ＜ 0. 05 ]. But in regard to the age, gestational weeks, the rate of regular prenatal care and diastolic blood pressure, there were no differences between the two groups. (2) Biochemistry markers: the aspartate transaminase (AST), lanine transaminase (ALT), blood urea nitrogen and creatinine were significantly increased in eclampsia with HELLP syndrome group than eclampsia without HELLP syndrome group [ (879 ± 337) U/L vs. (90 ± 27)U/L, (344 ±83) U/Lvs. (43 ±11)U/L, (2245 ±294) U/L vs. (485 ±61)U/L, (14 ±9) mmol/L vs.(7 ± 3) mmol/L, ( 140 ± 92) μmol/L vs. (83 ± 28 ) μmol/L, P ＜ 0. 01, P ＜ 0. 05 ], and the platelet was lower in eclampsia with HELLP syndrome group [ (38 ± 13) × 109/L vs ( 172 ±46) × 109/L, P ＜0. 01 ].(3) Clinical outcomes: The maternal death rate was 35% (6/17) in eclampsia with HELLP syndrome patients, and significantly higher than the rate in eclampsia without HELLP syndrome group (3%, 2/59)(P ＜ 0. 05 ). There were more patients admitted to ICU and more patients who need mechanical ventilation in eclampsia with HELLP syndrome (13/17 vs. 34%, 9/17 vs. 24/, P ＜0. 05), also more patients with GCS ≤8 in eclampsia with HELLP syndrome when admitted to ICU ( 8/17 vs. 7/59, P ＜ 0. 05 ), compared to the eclampsia without HELLP syndrome group. There were more patients complicated with cerebral venous thrombosis and cerebral hemorrhage in eclampsia with HELLP syndrome group than other group (8/17 vs.7%, P ＜ 0. 05 ). Five of six patients died of cerebral hemorrhage in eclampsia with HELLP syndrome group,while other two missing cases in eclampsia without HELLP syndrome group all died of cerebral hemorrhage.The all missing cases were performed CT or MRI and seven (7/8) of them showed cerebral hemorrhage.Conclusion The incidence of concurrent eclampsia and HELLP syndrome was not rare, it happened seriously and with more mortalities, such as cerebral hemorrhage, and also the maternal mortality rate was significantly higher. It should be warning that the obstetrician should take great attention for these women,and consider life support treatment for them.

Objective To investigate the effects of miRNA and hypersensitive C?reactive protein ( hs?CRP ) on non?targeted vessels in patients with acute coronary syndromes ( ACS ) after percutaneous coronary intervention( PCI) procedure. Methods The serum samples were collected from 217 cases ACS patients to detect the level of miRNA?14?5P and hs?CRP during admission and follow?up periods.All patients underwentPCI with stent implantation and coronary angiography,and CAG was performed at the time of 12?month follow?up.According to CAG results,the patients were divided into non target lesion progression group(progressiongroup) with 76 cases and non target lesion no progression group(no progression group) with 141 cases.Results The expression level of hs?CRP was significantly higher in progression group than the no progression group((1.65±0.18) mg/L vs.(1.52±0.37) mg/L,t = 3.478,P<0.001).The expression level of miRNA?142?5Pwas higher in progression group than the no progression group(27.12±2.11 vs.34.73±2.67,t = 23.035,P<0.001).Multi?factor regression analysis indicated that high expression levels of hs?CR and miRNA?142?5Pduring admission were the predictors of advance of non?targeted vessels patients(OR = 3.496,95%CI 2.046-5.981,P =0.001;OR =1.208,95%CI 1.073-1.361,P =0.002).Conclusion The serum level of hs?CRP andmiRNA?142?5P can predict non?targeted vessels in patients with ACS after PCI.

To develop an inquiry scale for diagnosis of heart system syndromes, and to discuss the provisional standardization of the inquiry method in traditional Chinese medicine (TCM).

Objective: To observe the bone marrow signals of acetabulum and proximal femur of asymptomatic non-professional marathoners by 3.0 T magnetic resonance imaging (MRI) T₁WI, and evaluate the bone marrow transformation, so as to obtain the effect of Marathon exercise on bone marrow composition and function. Methods: The study group was randomly selected to participate in and complete the whole marathon at least once a year in the past two years. The training mileage of long-distance running was not less than 1 600 kilometers per year. There were no symptoms such as hip pain. There were no abnormalities in hip joint physical examination. The age of 22-53 years old. A total of 31 and 62 hips were evaluated. The control group was randomly selected 29 healthy persons (58 hip joints), aged 23-53 years, without hip pain and regular exercise. All subjects underwent hip joint MRI scan, and the hip joint MRI showed normal. At least 12 hours before MR scan, he did not engage in long-distance running or other sports. The bone marrow signal intensity of acetabulum and proximal femur in T₁WI was compared with that of surrounding muscles and fat. The signal intensity was graded from low to high and evaluated by grade. The research group was divided into two groups according to the training years of marathon (running age). The running age of group A was more than 4 years and group B was less than 4 years. The distribution of bone marrow signal in proximal femur was also evaluated by a more intuitive 3-4 classification method. Mann-Whitney U test was used for statistical analysis. Results: Bone marrow signal grading evaluation showed that there were significant differences in bone marrow signal grade distribution between the two groups (Z=-6.828, -4.779, -3.046, -5.266, -3.490, - 5.053, P<0.05). In the study group, there were 14, 28 hips and 168 parts in group A, 17, 34 hips and 204 parts in group B, bone marrow signals were graded. There were significant differences in acetabulum, femoral neck and upper femoral shaft bone (Z=-2.202, -2.214, -2.730, P<0.05), but no significant differences in femoral head, trochanter and trochanter bone (Z=-0.886, -1.642, -0.711, P>0.05). To evaluate the classification of bone marrow signals in proximal femur, 62 cases of bone marrow signals in the study group were classified as follows: 10 cases with type 1a, 24 cases with type 1b, 17 cases with type 2 and 11 cases with type 3. In the control group, 58 cases of bone marrow signals in proximal femur were classified as follows: 2 cases with type 1a, 13 cases with type 1b, 26 cases with type 2 and 17 cases with type 3. There were significant differences between the two groups (Z=-4.003, P<0.05). Conclusion The T₁WI signal intensity of asymptomatic non-professional marathoners′ acetabulum and proximal femur bone marrow is lower than that of non-marathoners; the T₁WI signal intensity of acetabulum, femoral neck and upper femoral shaft bone marrow of the elderly runners is lower; that is, marathon exercise has certain influence on the bone marrow signal of acetabulum and proximal femur, that is, the change of bone marrow signal in weight-bearing area has a certain phase with the amount of exercise.

Objective To observe the bone marrow signals of acetabulum and proximal femur of asymptomatic non?professional marathoners by 3.0 T magnetic resonance imaging (MRI) T1WI, and evaluate the bone marrow transformation, so as to obtain the effect of Marathon exercise on bone marrow composition and function. Methods The study group was randomly selected to participate in and complete the whole marathon at least once a year in the past two years. The training mileage of long?distance running was not less than 1 600 kilometers per year. There were no symptoms such as hip pain. There were no abnormalities in hip joint physical examination. The age of 22?53 years old. A total of 31 and 62 hips were evaluated. The control group was randomly selected 29 healthy persons (58 hip joints), aged 23?53 years, without hip pain and regular exercise. All subjects underwent hip joint MRI scan, and the hip joint MRI showed normal. At least 12 hours before MR scan, he did not engage in long?distance running or other sports. The bone marrow signal intensity of acetabulum and proximal femur in T1WI was compared with that of surrounding muscles and fat. The signal intensity was graded from low to high and evaluated by grade. The research group was divided into two groups according to the training years of marathon (running age). The running age of group A was more than 4 years and group B was less than 4 years. The distribution of bone marrow signal in proximal femur was also evaluated by a more intuitive 3?4 classification method. Mann?Whitney U test was used for statistical analysis. Results Bone marrow signal grading evaluation showed that there were significant differences in bone marrow signal grade distribution between the two groups (Z=-6.828, -4.779, -3.046,-5.266,-3.490,-5.053, P<0.05). In the study group, there were 14, 28 hips and 168 parts in group A, 17, 34 hips and 204 parts in group B, bone marrow signals were graded. There were significant differences in acetabulum, femoral neck and upper femoral shaft bone (Z=-2.202, -2.214, -2.730, P<0.05), but no significant differences in femoral head, trochanter and trochanter bone (Z=-0.886,-1.642,-0.711, P>0.05). To evaluate the classification of bone marrow signals in proximal femur, 62 cases of bone marrow signals in the study group were classified as follows: 10 cases with type 1a, 24 cases with type 1b, 17 cases with type 2 and 11 cases with type 3. In the control group, 58 cases of bone marrow signals in proximal femur were classified as follows: 2 cases with type 1a, 13 cases with type 1b, 26 cases with type 2 and 17 cases with type 3. There were significant differences between the two groups (Z=-4.003, P<0.05). Conclusion The T1WI signal intensity of asymptomatic non?professional marathoners′acetabulum and proximal femur bone marrow is lower than that of non?marathoners; the T1WI signal intensity of acetabulum, femoral neck and upper femoral shaft bone marrow of the elderly runners is lower; that is, marathon exercise has certain influence on the bone marrow signal of acetabulum and proximal femur, that is, the change of bone marrow signal in weight?bearing area has a certain phase with the amount of exercise.

Objective:To evaluate whether FOXO4-DRI could reverse radiation-induced pulmonary fibrosis (RIPF) and to explore the underlying mechanism.Methods:C57BL/6 mice were randomly divided into 4 groups: control, FOXO4-DRI, radiation, and radiation+ FOXO4-DRI. Mice in radiation or radiation+ FOXO4-DRI groups received 17 Gy X-ray radiation on the right side of the whole chest. Mice in FOXO4-DRI and radiation+ FOXO4-DRI groups were injected with FOXO4-DRI intraperitoneally at 16 and 20 weeks after irradiation, respectively. The right lungs were collected at 24 weeks after irradiation and subjected to HE staining and Masson trichrome staining to observe the morphological changes and collagen deposition. Immunohistochemistry was used to evaluate the expressions of col1α1 and α-SMA in lung tissues. β-gal staining was used to observe senescent cells. The level of reactive oxygen species in lung tissue was detected. The expressions of P21, P16 Ink4a and senescence-associated secretory phenotype (SASP) mRNA were detected by qRT-PCR, and the expression of related proteins were assessed by Western blot. Results:FOXO4-DRI reduced collagen deposition ( t=6.18, P<0.05), down-regulated the expression of col1α1 and α-SMA ( t=4.69, 3.20, P<0.05), and reduced the number of β-gal positive cells ( t=6.09, P<0.05) in the lung tissue of RIPF mice. FOXO4-DRI also down-regulated the gene and protein expressions of P21 and P16 Ink4a ( t=5.31, 3.32 and 4.77, 3.37, P<0.05) and inhibited the expressions of SASP genes IL-1α, IL-1β, TNF-α and MMP2 ( t=4.36, 4.84, 4.47, 3.82, P<0.05), reduced reactive oxygen species ( t=2.84, P<0.05), and promoted the activation of p-AKT and p-PI3K proteins ( t=-7.13, -12.61, P< 0.05) in the lung tissue of RIPF mice. Conclusions:FOXO4-DRI reverses RIPF by activating the PI3K/AKT signaling pathway, reducing oxidative stress and inhibiting cellular senescence.

Objective:To compare the safety and efficacy of terbutaline and nifedipine for acute intrapartum fetal resuscitation (IUFR).Methods:This was a prospective randomized controlled study involving 110 pregnant women with non-reassuring fetal heart rate tracings (NRFHT) during delivery at Guangzhou Women and Children's Medical Center between January and April 2021. These women were randomly allocated to receive subcutaneous terbutaline sulphate (0.25 mg, terbutaline group) or oral nifedipine (10 mg, nifedipine group), with 55 subjects in each group. Hemodynamic parameters including blood pressure, heart rate, and oxygen saturation before and 5, 15 and 30 min after treatment as well as the success rate of intrapartum resuscitation, the onset time of medication, and the incidence of postpartum hemorrhage were analyzed using t test, Chi-square test or Fisher's exact test. Results:Two groups both showed no significant difference in the mean arterial pressure or oxygen saturation before or after treatment (all P>0.05). The heart rate was not affected in nifedipine group at any time points ( P>0.05). While the patients treated with terbutaline showed accelerated maternal heart rate 5, 15 and 30 min after administration as compared with the baseline[(97.0±20.2), (99.2±13.8), (91.8±12.6) vs (81.7±11.3) bpm, all P<0.001], but it began to decrease at 30 min, with a drop of 6.4 bpm compared with that at 15 min (95% CI: 1.5-11.2, P<0.05). None of the pregnant women had adverse reactions requiring medical intervention. The rates of successful acute resuscitation were similar in the two groups [terbutaline: 78.2% (43/55) vs nifedipine: 70.9% (39/55), χ 2= 0.77, P=0.381]. Terbutaline had a shorter onset time than nifedipine in slowing the frequency of contractions and returning fetal heart rate to class Ⅰ category [2(1-6) vs 6(1-10) min, U=2 348.50, P<0.001]. No significant difference was found between the two groups in terms of NRFHT-indicated cesarean section, assisted vaginal delivery, or second dose of tocolysis within 1 h (all P>0.05) nor in blood loss volume, postpartum hemorrhage rate, low Apgar score, low umbilical artery pH value (pH<7.2), neonatal asphyxia rate, or neonatal intensive care admission rate (all P>0.05). Conclusion:Terbutaline spends less time than nifedipine to take effect and may be an alternative for acute IUFR without significant adverse outcomes.