Objective] To sum up Pro. Cheng Zhiqing’s clinical experience in treating hypertension with insomnia in menopause. [Method] Select 3 classical cases of the disease above treated by Pro. Cheng Zhiqing for analysis and discussion, and summarize her differentiation thought and treatment features. [Result] In her view, such disease is mostly concerned with liver, as well as related to heart, kidney, etc., the pathological course concerns mother-organ disorder involving its child-organ, so the therapy shall center on stretching liver, clearing liver, smoothing liver and tonifying liver, also purging child-organ in excess, nourishing mother-organ in deficiency, treating multi-organ in the same time, therefore to get better clinical effect. [Conclusion] For the hypertension with insomnia in menopause, Pro. Cheng Zhiqing is good at grasping disease mechanism, revising famous and recipe decoctions in generations, with close compatibility of medicines, definite cure effect, worth reference.

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 know the drinking water quality in the rural areas in Shanxi province in order to enhance the management of drinking water and provide the scientific basis for water improvement in the rural areas. Methods 11 counties were selected based on the geographical condition in Shanxi province and 10 investigation sites were selected in each county based on the population proportion of different drinking-water types. 14 indicators were determined for every water sample. Results In the rural areas, most drinking water sources were ground water and the type of water supply was mainly non-central water supply. The indexes that exceeded the related standard limit were fluoride,arsenic and bacteria indicators. The hygienic state of central water supply was much better(?2=4.13, P

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

Objective To review the complications after endovascular aneurysm repair (EVAR) of high-risk abdominal aortic aneurysms in our medical center.Methods Fifty eight elective high-risk EVAR cases from January 2008 to December 2013 were analyzed retrospectively.Results The technical success rate was 96.6％ (56 of 58 patients).The overall complication rate in perioperative period was 32.8％ (19/58).Eleven systemic complications (19.0％),16 primary endoleaks (27.6％),7 access of site complications(12.1％) were observed.The follow-up rate was 86.2％ (51/58).During the follow up period,the mortality was 7.8％ (4/51),the re-intervention rate was 7.8％ (4/51).The overall complication rate was 29.4％ (15/51),including systemic complications (2/51),secondary endoleak (9.8％) and graft-related complications (11.8％,6/51).Conclusions Endoleak,graft-related complications continue to be the main causes of re-intervention in high-risk aneurysm patients after EVAR.

Objective To analyze the natural changes of maternal thyroid function among women with subclinical thyroid dysfunction and euthyroid women during pregnancy.Methods A total of 4 042 singleton pregnant women received routine antenatal care in the Obstetrics and Gynecology Hospital of Fudan University between April and November 2012 were enrolled.Thyroid-stimulatinghormones (TSH),freetriiodothyronine (FT3) and free thyroxine (FT4) of 7 136 samples from 4 042 singleton pregnant women were tested at 8-12+6,13-19+6,20-27+6,and 28-40 weeks of gestation and were used to establish the normal gestationalspecific reference values of thyroid function.Among 3 895 women having thyroid function tested at 8-19+6 weeks of gestation with negative thyroid antibodies,there were 93 cases of subclinical hyperthyroidism,91 cases of subclinical hypothyroidism (SCH),three cases of hyperthyroidism and 3 708 cases euthyroid.There were 1 118 women [1 607 euthyroid cases,17 cases of subclinical hypothyroidism (SCH) and 34 cases of subclinical hyperthyroidism] had thyroid function retested at 20-27+6 and 28-40 weeks of gestation,and without medicinal intervention.Analysis of variance and LSD test were used to analyze the changes of maternal thyroid function.Results (1) The reference ranges of TSH at 8-12+6,13-19+6,20 27+6 and 28-40 weeks of gestation [median (Pz5-P97.5)] were 1.32 (0.03-4.17),1.83 (0.19-4.94),2.27 (0.70-5.42) and 2.34 (0.63-5.52) mU/L respectively.(2) Without medicinal intervention,thyroid function became normal in 80％ (45/56) SCH women at 20-27+6 weeks,but 20％ (9/45) of them developed SCH again at 28-40 weeks.The thyroid function became normal in 75％ (70/93) women with subclinical hyperthyroidism at 20-27+6 weeks,but in 15％ (14/93) of them,thyroid function remained abnormal at 28-40 weeks.9.40％ (30/319) and 6.25％ (21/336) euthyroid women with TSH ≥ 3 mU/L at 8-19+6 weeks of gestation developed SCH at 20-27+6 weeks and 28-40 weeks,while 0.42％ (5/1 202) and 0.86％ (10/1 163) euthyroid women with TSH ＜3 mU/L had SCH.1.66％ (20/1 202) and 1.98％ (23/1 163) euthyroid women with TSH＜3 mU/L at 8-19+6 weeks of gestation developed subclinical hyperthyroidism at 20-27+6 weeks and 28-40 weeks of gestation.(3) In comparison between 8-19+6 weeks and 20-27+6 weeks of gestation,TSH levels increased by (0.47±0.03) mU/L in euthyroid women,and more significantly in subclinical hyperthyroidism women [(0.82±0.06) mU/L],but decreased by (1.67±0.25) mU/L in SCH women (LSD test,all P＜0.05).The FT3 levels decreased by (0.47±0.02) pmol/L in euthyroid women,and more significantly in subclinical hyperthyroidism and SCH groups [(1.02± 0.18) and (0.72±0.08) pmol/L,LSD test,all P＜0.05].FT4 decreased by (2.31 ±0.04) pmol/L in euthyroid women,and more significanly in subclinical hyperthyroidism women [(4.63± 0.62) pmol/L] (LSD test,P＜0.05),but the decrement in SCH group [(1.78±0.28) pmol/L] was similar to euthyroid women (LSD test,P＞0.05).There were no significant differences in changes of TSH,FT3 and FT4 at 20-27+6 weeks and 28-40 weeks among euthyroid women,SCH and subclinical hyperthyroidism groups (F=1.01,1.14 and 2.04,all P＞0.05).Conclusions Women with subclinical thyroid dysfunction with negative thyroid antibodies experience significantly different natural changes when compared with euthyroid women,especially before 28 weeks of gestation.

AIM: To investigate the potential role of 14-3-3 tau in trophoblast cells on invasiveness. METHODS: 14-3-3 tau expression was detected in first-trimester villi, deciduas and human trophoblastic cell line (BeWo) by immunohistochemistry. Small interference RNA (siRNA) targeting 14-3-3 tau was transfected into BeWo cells. The effects of down-regulated 14-3-3 tau on invasion of human trophoblasts cell line BeWo were examined by matrigel invasion assay, and the transcription, translation of E-cadherin and snail were estimated by RT-PCR or Western blotting. U0126 was used to detect the extracellular-signal related kinase 1/2 (ERK1/2) function on down-regulation of 14-3-3 tau induced cell invasion. RESULTS: 14-3-3 tau was detected in the invasive trophoblastic cells in the first trimester villi and that invaded to the deciduas. BeWo cells also expressed 14-3-3 tau. Down-regulation of 14-3-3 tau increased the invasive cell-number of BeWo, as well as the expression of snail, and inhibited E-cadherin. U0126 inhibited the enhanced invasiveness in these cells induced by the down-regulation of 14-3-3 tau. CONCLUSION: 14-3-3 tau may regulate the invasiveness of human trophoblastic cells through ERK1/2 signaling pathway.

Objective To explore the related factors with skin flap necrosis,we concluded the cases of patients with skin defects after free flap plantation.Methods From 2001 to 2016,188 cases about 20 influencing factors were analyzed (The characteristics of patients:age,sex,smoke,diabetes,high blood pressure;Preoperative factors:injured sections,injured causes,preoperative wound infection,preoperative wound osteomyelitis,the time from injury to operation;Intraoperative factors:operator,operation time,anesthesia time,intraoperative rehydration fluids,the way of vascular anastomosis,the number of venous anastomosis,the area of flap;Postoperative factors:flap hematoma,flap infection,vascular crisis) and multivariate logistic regression analysis was used to analyze the relationship between these risk factors and flap necrosis.Results All 188 cases were treated with free anterolateral thigh flap to repair soft tissue defect and it was revealed that the 174 cases were successful (92.55％) and 23 cases were occured vascular crisis (12.23％),8 cases were arterial crisis,11 cases were vein crisis,4 cases were ateriovenous crisis.After the treatment,the rescue was successful in 5 cases (38.46％).After the analysis we made the conclusion that the number of venous anastomoses,flap hematoma and vascular crisis were related with the skin flap necrosis.Conclusion The number of venous anastomose (≥2) will increase blood return to make the flap easier to survive.Intraoperative stanching and drainage tube placement work will reduce the skin flap hematoma as a result of reducing the skin flap necrosis.Artery and venous crisis handled in time,can enhance the survival rate of flap.

Objective To investigate the distribution of endemic arsenism and to provide a scientific basis for control and prevention of the disease.Methods According to previous investigation,in the high-arsenic water areas,the arsenic diseased areas and the surrounding lands,35 counties were investigated.Water arsenic was screened in all the survey sites,villages with water arsenic exceeding the standard were quantitative surveyed of water arsenic and the disease conditions.Screening of arsenic content in drinking water was done by the method of half-quantitative fast reagent kit.Quantitative determination of arsenic in water was done by hydride generationatomic fluorescence spectrometry (HG-AFS).Patients of endemic arsenism were diagnosed by the Standard of Diagnosis for Endemic Arsenism (WS/T 211-2001).Identification of area was done by Definition and Division Standard for Endemic Arsenism (WS 277-2007).The data were analyzed using SPSS 13.0 for windows.Results Water arsenic of 151 villages in 15 counties among 1 771 villages were higher than the national drinking water quality level(0.05 mg/L).Exposure population of high arsenic was 177 018 people.The census results of high arsenic water sources indicated that the ratio of drinking water arsenic levels higher than the national standard was 35.10％ (2 355/6 709) and the highest contents of arsenic was 1.733 0 mg/L.The disease census indicated that there were 33 latency arsenism districts and 118 arsenism districts.There was totally 39 757 patients with latency arsenism.Totally 137 261 people lived in arsenism districts.Light,moderate and severe arsenism districts was 82,29 and 7,respectively.Totally 1 244 suspicious patients with endemic arsenism were discovered,and 3 473 light and more severe patients were discovered and the detected rate of light and more severe patients was 2.54％ (3 473/136 924).Most patient were not serious.Conclusions High arsenic areas and endemic arsenism areas are distributed in 15 counties of Shanxi Province.In the future primary task in prevention and control of endemic arsenism is comprehensive prevention and control measures.

Objective To improve the awareness of fetal cardiac rhabdomyomas (CRs) and investigate a better model for prenatal diagnosis and treatment through analyzing imaging findings and prognosis.Methods A retrospective study was conducted on 23 cases of CRs which were diagnosed by ultrasound in Obstetrics and Gynecology Hospital of Fudan University from January 2008 to November 2015.General conditions,imaging features,prognosis and follow-up data of the 23 cases were described.Results The average gestational age of the 23 fetuses at diagnosis was (29.8±4.1) (22.4-35.7) weeks.Seventeen out of the 23 gravidas received prenatal multidisciplinary consultation.Among all 23 gravidas,three (13％) were lost to follow-up,12 (52％) decided to terminate the pregnancy,and the other eight (35％) continued to term pregnancy and their babies were followed up for three years.Of these eight cases,two cases received prenatal brain MRI and no tuberous sclerosis complex (TSC) was detected,no CRs was identified during the follow-up,and their physical and mental developments were both normal.One case was diagnosed with suspected subependymal nodules by prenatal brain MRI in our hospital,but the MRI images was normal when scanned in the other hospital,and follow-up data revealed neither CRs nor abnormal physical and mental developments.Four cases did not received prenatal brain MRI,but the MRI images of neonatal brains indicated TSC,besides,follow-up data showed that seizures were observed,physical developments were all normal,but three of the four cases had mental retardation;CRs disappeared in only two of the four cases.One case had neither prenatal nor neonatal MRI,but follow-up data showed that CRs had disappeared and physical and mental developments were both normal.Conclusions Prenatal diagnosis of fetal tuberous sclerosis is crucial to the prognosis of CRs.Prenatal ultrasonography in combination with cranial MRI improves the accuracy of prenatal diagnosis of CRs complicated with TSC and assists in clinical decision-making and prognosis analysis.