Objective To determine the critical value of the Edinburgh postnatal depression scale (EPDS) in preliminary screening of postpaitum depression (PPD) in puerpera of Chengdu. Methods A prospective cohort of 732 women completed the Chinese version of EPDS and the Beck depression inventory (BDI) three to fourteen days after giving birth. Results The optimal critical value for EPDS to screen PPD was as follows: score no higher than 5 symboled no or slight PPD;score between 6 and 9 represented mild PPD, score equal to or higher than 10 showed moderate or severe PPD. Conclusions The EPDS is reliable in screening PPD in Chengdu, and it has optimal critical value at which it is sensitive to identify PPD in puerperas of Chengdu.

Objective To explore the effect of fortified human milk feeding on growth,metabolism and complications of premature infants during hospital stay.Methods Totally,148 premature infants of gestational age ≤36 weeks and birth weight ≤1800 g,admitted to NICU of Peking Union Medical College Hospital between January 1st,2009 and December 31st,2012,were retrospectively enrolled and divided into two groups.Infants fed predominantly (＞50％) with human breast milk,combined with human milk fortification (HMF) formula when breast milk was insufficient during hospital stay,were named HMF group (n =73),and those fed exclusively with premature formula were called premature formula feeding group (PF group,n =75).Data of infants on growth,metabolism and incidence of various complications were compared between the two groups.Clinical data were expressed with mean± standard deviation or median and quartiles [M(P25,P75)].Statistical analysis was performed with t-test,x2 test or non-parameter test.Results Among the 148 infants included,there was no significant difference in gestational age,birth weight,head circumference,length at birth,time for regaining birth weight,SGA at birth,neonatal respiratory distress symdrome,intraventricular hemorrhage (over grade Ⅲ) and asphyxia rate between HMF and PF group(all P＞0.05).Infants of the HMF group showed shorter duration of parenteral nutrition [18 d(14 d,25 d) vs 24 d (18 d,31 d),Z=-2.950,P=0.003],smaller age to achieve 120 ml/(kg · d) through enteral feeding [16 d(12 d,23 d) vs 22 d (16 d,30 d),Z=-2.895,P=0.004],smaller age to achieve total energy intake of 120 kcal/(kg · d) [11 d(8 d,15 d) vs 14 d (10 d,18 d),Z=-2.392,P=0.017] than those of the PF group.Medical cost during hospital stay in the HMF group was significantly less than in the PF group [RMB:47 078 yuan(30 802 yuan,67 039 yuan) vs 58 400 yuan (38 166 yuan,82 737 yuan),Z=-1.970,P=0.049].The time for initial feeding,rate of feeding intolerance,daily weight gain after regaining birth weight,weekly increase of body length and head circumference,weight,body length and head circumference at discharge,proportion of small for gestational age infants at discharge,z scores of both birth weight and weight at discharge showed no significant difference (all P＞ 0.05).The level of blood alkaline phosphates before discharge in HMF group was significantly higher than that of the PF group [(347.7±149.4) U/L vs (288.6±108.8) U/L,t=2.570,P=0.011].None of the other biochemical indicator showed any statistical difference.The incidence of sepsis in the HMF group was slightly lower than that in the PF group [11.0％ (8/73) vs 20.0％ (15/75)] without significant difference (x2 =2.30,P＞ 0.05),neither the morbidity of retinopathy of premature,chronic lung disease,necrotizing enterocditis of newborns (all P＞0.05).Conclusions HMF for premature infants may ensure the same growth pattern as those fed by premature formula,and it also can accelerate the enteral feeding process,reduce the incidence of sepsis and decrease the medical cost during hospital stay.

Objective To determine the human milk insulin(HMI) concentrations of healthy,gestational diabetes mellitus (GDM) and gestational impaired glucose tolerance (GIGT) lactating mothers and their correlative factors and to explore the effect of HMI on growth and development of neonates. Methods HMI of colostrum and mature milk collected from 148 healthy lactating mothers and 46 GDM/GIGT mothers were determined by radioimmnuoassay. The intergroup HMI levels were compared by Wilcoxon test. Results (1) In the GDM/GIGT group, colostrum HMI was 28.81 μU/ml(13. 84-43.14 μU/ml), significantly lower than that of mature milk which was 57.50 μU/ml(36. 70-82. 73 μU/ml) (Z=-4. 828,P=0. 000). HMI of mature milk in the healthy group was 35.88 μU/ml(25.91-46.85 μU/ml), lower than in the GDM/GIGT group (Z=-2.874,P=0.004). ( 2 ) The colostrum HMI of the mothers underwent cesarean section was 23.64 μU/ml (14.90-38.51 μU/ml) lower than in the vaginal delivery ones which was 38.89 μU/ml(23.14-65.54 μU/ml)(Z= -4. 510, P= 0. 000). (3) HMI of mature milk in mixed feeding cases was 42.58 μU/ml (26.60-73.06 μU/ml),significantly higher than that of breast feeding ones which was 36.32 μU/ml(26.00-46.16 μU/ml)(Z=-2. 377,P=0.019). (4) Both HMI in colostrum and mature milk were positively correlated with maternal BMI (P＜0.05). Conclusions The mode of delivery significantly affects the HMI in colostrum. GDM/GIGT and the feeding patterns have some effects on HMI levels in mature breast milk. The HMI level is positively correlated with maternal BMI.

Objective To evaluate the utility of the Chinese version of the Edinburgh postnatal depression scale(EPDS)when being used in puerperas in Chengdu.Methods Following translation and back translation,the EPDS was commented by six experts,then a prospective cohort of 732 women completed the EPDS and the Beck depression inventory(BDI)three to fourteen days after siring birth.Rusuits The concordance rates of translation and back translation were all 100%;the content validity ratio of the EPDS was 0.9333;the Cronbaeh's alpha coefficient of the EPDS was 0.76,the cumulative variance contribution of the two factors was 44.979%,and the spearman correlation coefficient between the EPDS and BDI was 0.584,＜0.01.Conclusions The EPDS possesses good cknical pefformanee,is very concise,easy to read and understand and well accepted by mainland Chinese puerperas and researchers.It is a good instrument for screening for postnatal depression in puerperas of Chengdu.

Objective To determine the clinical characteristics of neonatal asymmetric crying facies and to review the latest progress in clinical research of this condition. Methods Clinical and laboratory data of a case of neonatal asymmetric crying facies syndrome admitted to Peking Union Medical College Hospital in March, 2013 was reported. Clinical charateristics, chromosome abnormalities, treatment and prognosis of neonatal asymmetric crying facies reported in China were analyzed, and pertinent literatures in China Knowledge Resource Integrated Database and CQVIP Database were reviewed. Results Eighteen Chinese reports on this syndrome were retrieved and 48 patients, 31 males and 17 females including our patient, were analyzed. Twelve patients had neonatal asymmetric crying facies and 36 patients had neonatal asymmetric crying facies syndrome. Anomalies in these children included malformations of the heart (26 cases, 72.2%), ear (11 cases, 30.6%), gastrointestinal tract (4 cases, 11.1%), cleft palate (2 cases, 5.6%) and fingers (2 cases, 5.6%). Standard chromosome analysis in three studies was normal. In one case, chromosome 22q11.2 microdeletion was not found using flucrescence in situ hyloridization analysis. There were few studies with long-term follow-up in China. Conclusions Neonatal asymmetric crying facies are complicated with a high rate of other malformations. Identification of associated malformations and close follow-up are required, and intervention should be carried out earlier so as to ensure a good outcome.

Seventy patients with type 2 diabetes (T2DM),23 subjects with impaired glucose tolerance (IGT) and 35 individuals with normal glucose tolerance (NGT) were recruited in the study.Fasting free fatty acids (fFFA) and postprandial free fatty acids (2 hFFA) after oral glucose tolerance test (OGTT) were measured; homeostasis model assessment of insulin resistance (HOMA-IR),area under the curve of free fatty acids (AUCFFA) were calculated.The carotid artery intima-media thickness (IMT) was assessed by color ultrasonography.HOMA-IR,fFFA,2 hFFA,AUCFFA and IMT in T2DM group were 3.3 ±3.2,(0.55 ± 0.20) mmol/L,(0.28 ±0.18)mmol/L,(0.83 ±0.34)mmol · L-1 · h-1 and (0.12±0.05) cm,which were significantly higher than those in NGT group,respectively [1.9 ± 1.3,(0.41 ±0.15) mmol/L,(0.12 ± 0.10) mmol/L,(0.53 ± 0.20) mmol · L-1 · h 1 and (0.09 ± 0.03) cm,all P ＜0.05].Both HOMA-IR and IMT were positively correlated with fFFA,2 hFFA and AUCFFA (all P ＜ 0.05).The results indicate that the levels of fasting and postprantial free fatty acid were related with insulin resistance and atherosclerosis of carotid artery.

Objective To evaluate the levels of ghrelin, adiponectin, leptin and true insulin in human milk from mothers with and without gestational diabetes mellitus (GDM), and to assess the effects of these parameters on infant growth. Methods Fifty-two GDM mothers and their healthy infants (GDM group) and 49 non-GDM mothers and their healthy infants (control group) were enrolled from Beijing Obstetrics and Gynecology Hospital and Peking Union Medical College Hospital from January 2010 to August 2010. The levels of ghrelin, adiponectin, leptin and true insulin in colostrum and human milk 90 days postpartum (mature milk) were determined by enzyme-linked immunosorbent assay. Infant weight, length and head circumference at birth and at 90 days old were measured. The two-sample t-test, sum-rank test and Spearman correlation analysis were used for statistical analysis. Results Compared with the control group, ghrelin was significantly lower in human milk from GDM mothers both in colostrum [136.7 (102.7-181.4) vs 175.4 (137.5-235.0) ng/L, t= -2.737] and mature milk [111.8 (77.5-184.2) vs 210.9 (147.3-381.9) ng/L, t= -3.268]. Adiponectin was also significantly lower in human milk from GDM mothers both in colostrum [21.7 (14.6-51.8) vs 57.0 (23.1-113.9)μg/L, t=-2.858] and mature milk [11.7 (8.4-14.4) vs 15.1 (11.9-18.5)μg/L, t=-2.625], however, true insulin level was higher in colostrum [22.8 (13.4-50.2) vs 20.4 (7.8-30.8) mU/L, t=-2.007] and mature milk [33.6 (22.5-54.1) vs 23.5 (13.5-31.6) mU/L, t=-2.009]. The differences were statistically significant (all P < 0.05). (2) In the colostrums of the GDM group, true insulin level was negatively associated with ghrelin (r=-0.342), but positively associated with adiponectin (r=0.305). In the control group, the level of true insulin in mature milk was positive associated with leptin in colostrums( r=0.456)and mature milk(r=0.629). The differences were statistically significant (all P < 0.05). (3) In the GDM group, adiponectin level in colostrum was negatively associated with neonatal birth weight (r= - 0.323, P=0.025); the leptin/adiponectin ratio was negatively associated with neonatal birth weight (r= -0.403, P=0.005) and head circumference (r= -0.327, P=0.039) at birth. Adiponectin level in mature milk was negatively associated with infant length 90 days postpartum (r=-0.406, P=0.040). In the control group, the leptin/adiponectin ratio in colostrum was negatively associated with neonatal head circumference at birth (r= -0.370, P=0.024). Adiponectin level in mature milk was positively associated with infant weight 90 days postpartum (r=0.432, P=0.007). Conclusion Women with GDM have different levels of ghrelin, adiponectin and true insulin in their milk from the normal controls, which may affect infant growth.

Objective To investigate the effect of sciatic nerve injection of dexmedetomidine on the nociceptive behavior and spi-nal c-fos expression in formalin mice .Methods Adult male Kunming mice ,20-25 g ,were divided into 4 groups randomly :mice in group A and D were given an injection of NS (10 μL) and 0 .1 μg dexmedetomidine in 10 μL adjacent to the right sciatic nerve , sepretely .Mice in group B received intacutaneous injection of 10μL formalin(5% ) in the right hindpaws .Mice in group C were giv-en an injection of 0 .1 μg dexmedetomidine in 10 μL adjacent to the right sciatic nerve 15 min before formalin injection in the right hindpaws .Paw licking/biting time was counted every 5 min for an hour after hindpaw injections ,calculated pain score .1 hour after behavior tests ,the L4-5 of spinal cord were harvested to immunofluorescence for c-fos expression in the dorsal corn of spinal cord . Results Mice in group A、C and D showed no obvious foot licking/biting behaviors and a low level of c-fos expression in the dorsal corn of spinal cord .Compared with group A ,mice in group B displayed obvious two phases foot licking/biting behaviors(P<0 .05 , both in Phase Ⅰ and Phase Ⅱ) and a significant increasing expression of c-fos(P<0 .05) .Compared with group B ,dexmedetomi-dine injected to the adjacent of right sciatic nerve decreased the pain score and spinal c-fos expression in goup C(P<0 .05) .Conclu-sion Injection of dexmedetomidine to the right sciatic nerve alleviated intraplantar injected formalin-induced acute inflammatory pain ,and reduced the expression of spinal c-fos protein .

0.05,respectively).The effect of test groups on the bacteria and fungi compared with that of control groups in dynamically monitoring showed significance(P

Objective To investigate abdominal visceral fat area and its relationship with insulin resistance in male patients with type 2 diabetes and normal body mass index (BMI).Methods Seven male patients with type 2 diabetes and normal BMI were divided into two groups according to the abdominal visceral fat area (VFA) measured by CT:visceral obesity group (VFA ≥ 100 cm2) and non-visceral obesity group.Indicators of glucose and lipids metabolism were measured in two groups.Results Among 70 patients 50 (71％) had visceral obesity.In 59 patients who had normal BMI and normal waist circumference (≤90 cm),41 presented visceral obesity (69％).Compared with non-visceral obesity group,the waist circumference,homeostasis model assessment of insulin resistance (HOMA-IR),triglyceride,and VFA were significantly higher in visceral obesity group [(86.4 ± 5.6) vs.(81.2 ± 4.8) cm,t =-2.980,P ＜ 0.01;2.83±2.31 vs.2.01±1.30,t=-2.025,P＜0.05;1.93(1.26-2.79) vs.1.11(0.75-1.46) mmol/L,Z=-3.777,P＜0.01;(143.6 ±31.8)vs.(73.7 ±17.3)cm2,t =-11.456,P＜0.01].Fasting insulin,fasting plasma glucose and glycosylated hemoglobin tended higher in visceral obesity group but not significantly (P ＞ 0.05).Multiple linear regression analysis showed that after adjustment for age and body mass index,abdominal VFA was positively correlated with HOMA-IR (r =0.240,P ＜ 0.05).Conclusion Male type 2 diabetic patients have a high rate of visceral obesity even when their body mass index and waist circumference are normal.Abdominal visceral fat area is closely associated with insulin resistance.