Objective To analyze the characteristics of pre-gestational diabetes mellitus (PGDM) diagnosed during pregnancy (missed diagnosis before pregnancy), and to evaluate the effects of diagnostic time on pregnancy outcomes. Methods A retrospective study of 746 pregnant women who were diagnosed PGDM and delivered in Peking University First Hospital from January 1st, 2005 to December 31st, 2015 was conducted. The patients were divided into 2 group. Those diagnosed PGDM before pregnancy were defined as Group diagnosed before pregnancy, and those diagnosed during pregnancy were defined as Group diagnosed during pregnancy. In Group diagnosed during pregnancy, those diagnosed before 24 gestational weeks were defined as Group diagnosed during pregnancy A, and those diagnosed after 24 weeks were defined as Group diagnosed during pregnancy B. The prevalence of adverse pregnancy outcomes in each group were analyzed. Results (1) Rate of missed diagnosis for PGDM:the incidence of PGDM diagnosed before pregnancy was 32.2% (240/746), and those diagnosed during pregnancy (missed diagnosis before pregnancy) was 67.8% (506/746). (2) Blood glucose control during pregnancy: ①Group diagnosed before pregnancy and Group diagnosed during pregnancy: the highest glycosylated hemoglobin (HbA1c) in Group diagnosed before pregnancy was (6.6±1.1)%, higher than that in Group diagnosed during pregnancy [(6.3± 1.0)%, P=0.019]. However, there was no significant difference in the average HbA1c level between the 2 groups (P=0.616). The insulin needed percentage [90.8%(218/240) vs. 53.8%(272/506)] in Group diagnosed before pregnancy were higher than that in Group diagnosed during pregnancy (P<0.01).②Group diagnosed during pregnancy A and B:the highest HbA1c in Group diagnosed during pregnancy A was (6.9± 1.3)%, higher than that in Group diagnosed during pregnancy B [(6.1 ± 0.8)%, P<0.05]. And the average HbA1c in Group diagnosed during pregnancy A [(6.4±0.8)%] was also higher than that in Group diagnosed during pregnancy B [(6.0 ± 0.8)%, P<0.05]. In Group diagnosed during pregnancy B, 46.1%(187/406) used insulin, lower than the percentage in Group diagnosed during pregnancy A (85.0%, 85/100;P<0.01). ③There were no significant differences in the highest HbA1c and the average HbA1c between Group diagnosed during pregnancy A and Group diagnosed before pregnancy (P=0.020, P=0.037). There was neither no significant difference in the percentage used insulin during pregnancy between them (P=0.128). There were significant differences in the highest HbA1c and the average HbA1c between Group diagnosed during pregnancy B and Group diagnosed before pregnancy (P<0.01, P=0.014). There was also significant difference in the percentage used insulin during pregnancy between them (P<0.01). (3) Pregnancy outcome:①Group diagnosed before pregnancy and Group diagnosed during pregnancy: the cesarean section rate [72.5% (174/240) vs. 59.7% (302/506)] in Group diagnosed before pregnancy were higher than those in Group diagnosed during pregnancy (P<0.01). However, there were no significant differences in preterm birth rate, pre-eclampsia, macrosomia percentage, percentage of neonates being hospitalized between the 2 groups (P=0.546,P=1.000,P=0.671,P=0.804). ②There was no significant difference in preterm birth rate, cesarean delivery rate, macrosomia percentage, pre-eclampsia rate, percentage of neonates being hospitalized between Group diagnosed during pregnancy A and Group diagnosed during pregnancy B (P=0.887, P=0.495, P=0.841, P=1.000, P=1.000).③There was no significant difference in preterm birth rate, cesarean delivery rate, macrosomia percentage, pre-eclampsia rate, percentage of neonates being hospitalized between Group diagnosed during pregnancy A and Group diagnosed before pregnancy (P=0.875, P=0.093, P=0.662, P=1.000, P=0.837). The cesarean delivery rate was lower in Group diagnosed during pregnancy B than that in Group diagnosed before pregnancy (P=0.001). However, there were no significant differences in preterm birth rate, macrosomia percentage, pre-eclampsia rate, percentage of neonates being hospitalized between them (P=0.530, P=0.776, P=1.000, P=0.797). Conclusions The diagnosis of PGDM is commonly missed before pregnancy. Fasting plasma glucose should be used as screening test to identify PGDM at pre-pregnancy examination or first antenatal care. Using abnormal value of 2-hour glucose after 24 gestational weeks as the only way to diagnose PGDM is not suitable.

To establish a stable and reliable model of refractory hypoxemia acute respiratory distress syndrome (ARDS) and examine its pathological mechanisms, a total of 144 healthy male Wistar rats were randomized into 4 groups: group I (saline control group), group II (LPS intravenous "single-hit" group), group III (LPS intratracheal "single-hit" group) and Group IV (LPS "two-hit" group). Rats were intravenously injected or intratracheally instilled with a large dose of LPS (10 mg/kg in 0.5 mL) to simulate a single attack of ARDS, or intraperitoneally injected with a small dose of LPS (1 mg/kg) followed by tracheal instillation with median dose of LPS (5 mg/kg) to establish a "two-hit" model. Rats in each group were monitored by arterial blood gas analysis and visual inspection for three consecutive days. Arterial blood gas values, lung wet/dry weight ratio and pathological pulmonary changes were analyzed to determine the effects of each ALI/ARDS model. Concentrations of TNF-alpha, IL-1 and IL-10 in the bronchoalveolar lavage fluid (BALF) and blood plasma were measured by using enzyme-linked immunosorbent assays (ELISA). Our resulsts showed that single LPS-stimulation, whether through intravenous injection or tracheal instillation, could only induce ALI and temporary hypoxemia in rats. A two-hit LPS stimulation induces prolonged hypoxemia and specific pulmonary injury in rats, and is therefore a more ideal approximation of ARDS in the animal model. The pathogenesis of LPS two-hit-induced ARDS is associated with an uncontrolled systemic inflammatory response and inflammatory injury. It is concluded that the rat ARDS model produced by our LPS two-hit method is more stable and reliable than previous models, and closer to the diagnostic criteria of ARDS, and better mimics the pathological process of ARDS.

Objective To investigate the relationship between gestational hyperglycemia and adverse pregnancy outcomes and find out the optimum diagnostic criteria of gestational diabetes mellitus in China. Methods A retrospective population-based study of 14 593 pregnant women, who delivered between Jan. 2005 and Dec. 2009 and accepted the gestational diabetes mellitus ( GDM ) screening and diagnosis was performed. The prevalence of gestational hyperglycemia according to different criteria was calculated, and the incidence of adverse pregnant outcomes relation to gestational hyperglycemia according to different criteria was analyzed. Results ( 1 ) According to National Diabetes Data Group (NDDG) criteria and International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria, the prevalence of gestational hyperglycemia that intervention required was 8.9% (1293/14 593 ) and 14.7% (2138/14 593 )respectively; the prevalence of gestational hyperglycemia differed significantly between NDDG and IADPSG criteria ( P ＜ 0. 05 ). ( 2 ) The prevalence of macrosomia, large for gestational ages ( LGA), cesarean section,preterm birth and neonatal hypoglycemia etc would increase in gestational glucose metabolic disorders according to any criteria. The prevalence of the complications in gestational hyperglycemia according to NDDG criteria, IADPSG criteria and the patients with normal glucose metabolism is as follows, macrosomia:8.4% ( 108/1293), 11.3% (241/2138) and 6. 7% ( 835/12 403 ); LGA: 9. 7% ( 125/1293 ), 11.7% (250/2138) and 5.5% (687/12 403); cesarean section: 59. 0% (763/1293), 60. 4% ( 1291/2138 ) and 51.6%(6397/12403); preterm birth: 11.4% (147/1293), 9.5% (203/2138) and 6.3% (777/12 403); neonatal hypoglycemia: 2. 6% ( 33/1293 ), 2. 2% (46/2138) and 0. 7% ( 89/12 403 ). ( 3 )About 71.3% (922/1293) of the gestational hyperglycemia according to NDDG criteria could be well control only by diet control. Conclusion The prevalence of perinatal complications would increase in gestational hyperglycemia that achieved IADPSG criteria without intervention, so IADPSG criteria is reasonable in China.

Acute lung injury(ALI)/acute respiratory distress syndrome(ARDS),the complicated and devastating illness,resulted from various processes of systemic inflammatory response syndrome(SIRS),injure directly or indirectly the lung.With the advance of investigations in SIRS and multiple organs disfunction syndrome(MODS),inflammation development and control have been considered to be the important mechanism of ALI/ARDS.The research hotspot is also focused on the inflammatory cells and cytokines.Dachengqi decoction can influence on the functions of inflammatory cells and cytokines,so the strategies of anti-inflammatory treatment on immunoregulation became the key point for prevention and treatment of ALI/ARDS with traditional Chinese medicine.

Objective To investigate the varaiation of the incidence of macrosomia and its influencing factors. Methods A population-based study of 25 944 pregnant women,who delivered in Peking University First Hospital in term birth,with singleton,between Jan. 1,2006 and Dec. 31,2013 and accepted the gestational diabetes mellitus(GDM)screening and diagnosis,was performed. The women are grouped according to the different clinical interventions at different period. Women delivered between Jan. 1, 2006 and Dec. 31,2006 was defined as Group 2006,and they were diagnosed with glucose metabolism disorder [gestational impaired glucose tolerance(GIGT)and GDM] and intervened only when meeting National diabetes data group(NDDG)criteria. Women delivered between Jan.1,2007 and Apr. 30,2011 were defined as Group post 2007,and NDDG criteria was also applied in this period. Women delivered between May. 1,2011 and Dec. 31,2013 were defined as Group post 2011,and Ministry of Health(MOH)of China was used for GDM diagnosis in this group. All pregnant women in Group post 2007 accepted the preliminary pregnancy nutrition advice and weight management. All participants met MOH criteria were diagnosed as glucose metabolism disorder in this study,in which women diagnosed and intervened in pregnancy were defined as Group diagnosis and those not being identified during pregnancy were defined as Group missed diagnosis. It was analyzed retrospectively for the incidence of macrosomia and the influencing factor. Results (1)The prevalence of macrosomia and cesarean section was decreased every year from Jan. 2006 to Dec. 2013. The incidence of macrosomia was 9.14%in 2006,reduced to 8.02%in 2007-2011 and 6.79%in 2011-2013. The incidence of cesarean section was 55.22%,reduced to 51.04%in 2007-2011 and 44.15%in 2011-2013. However,there was not remarkable change in the prevalence of small for gestational age(P>0.05).(2)Compared with Group 2006,the incidence of cesarean section was lower in Group post 2007 [51.04%(6 504/12 744)vs 55.22%(1 371/2 483)],and the difference is significantly(P<0.05). Meanwhile,the incidence of cesarean section(44.15%,4 732/10 717)and macrosomia(6.79%,728/10 717) in Group post 2011 was lower significantly than Group 2006 and Group post 2007(P<0.05).(3)The incidence of macrosomia was 7.41%(1 129/15 227)and 6.61%(1 006/15 227)respectively in Group diagnosis and Group missed diagnosis before May 2011,combined 14.02%(2 135/15 227)in total. It was increased significantly in the incidence of GDM 21.41%(2 294/10 717)after May 2011 compared with that before (P<0.05). The incidence of macrosomia was decreased significantly using MOH criteria in GDM women since 2011. It was the downtrend in the incidence of macrosomia since 2007 in non GDM women. However,there was no difference in SGA in different period.(4)In glucose metabolism disorder women, compared with Group 2006 and Group post 2007,the incidence of macrosomia and cesarean section was lower in Group post 2011,and the difference is significantly(P<0.05). However,there was no significant difference in the incidence of macrosomia and cesarean section between Group 2006 and Group post 2007, and there was no difference in SGA in the 3 groups(P>0.05). In non GDM women,the incidence of macrosomia and cesarean section was lower in Group post 2011 than Group 2006(P<0.05);meanwhile,it was the downtrend in the incidence of macrosomia in Group post 2007 compared to Group 2006,and the difference of the incidence of cesarean section was significant(P<0.05). Conclusion The prevalence of macrosomia and cesarean section might be reduced by application of suitable criteria for diagnosis of GDM and education on nutrition during pregnancy.

Objective:To explore effects of Ningshen Mixture on contents of sexual hormones,interleukin-2(IL-2)and the therapeutic effect in the patient of menopausal syndrome.Methods:Patients in the Ningshen Mixture group were treated with Ningshen Mixture and the control group with Gengnianan.Level of follicle stimulating hormone(FSH),luteinizing hormone(LH),estradiol(E_2)and IL-2 and the therapeutic effect were investigated.Results:After treatment E_2 level was increased in both groups with a significant difference as compared with that before treatment(P0.05).Conclusion:Ningshen Mixture can increase E_2 level,which is possibly one of the mechanisms.

[Summary] Sodium glucose cotransporter 2 (SGLT2) inhibitors have been developed as a new antidiabetic agent .The antihyperglycemic effect of SGLT 2 inhibitors is independent of insulin secretion and insulin action .SGLT2 inhibitors improve IS and islet βcell function with the possible mechanisms of reducing glucotoxicity ,weight loss and increasing GLP‐1 response .

Objective To investigate the incidence of glucose metabolism disorder during pregnancy and establish the diagnosis criteria for gestational diabetes mellitus (GDM) among Chinese patients.Method A prospective popolation-bused study of 16 286 pregnant women,who received 50 g glucose challenge test (GCT) for the first time between Apr 1,2006 and Sept 30,2006,was performed throughout 18 cities in China. Results According to national diabetes data group (NDDG)criteria,the overall incidence of GDM and glucose impaired glucose tolerance (GIGT) was 2.763% (450/16 286) and 3.862% (629/16 286),respectively; it changed to 5.078% (827/16 286)and 5.268% (858/16 286) when using American diabetes association (ADA) criteria.If the women who had 2 or more abnormal oral glucose tolerance test (OGTT) values meeting or exceeding ADA criteria was classified as group 1,and the women who had one or more meeting or exceeding NDDG criteria was group 2,the ratio of women who met both the criteria of ADA and NDDG in group 1 was 94.2%.The 95% CI of normal glucose when using ADA criteria were fasting glucose 5.3 mmol/L,1 hour 10.4 mmol/L,2 hour 8.7 mmol/L,3 hour 7.7 mmol/L,which is close to ADA criteria.Conclusions ADA criterion is more suitable for Chinese patients.According to NDDG criteria,it is reasonable to treat the patient with 1 or more abnormal OGTT values,and if choosing ADA criteria,2 or more abnormal OGrIT values is more reasonable.

Objective To investigate the relationship of different types of gestational diabetes mellitus (GDM) and pregnancy outcomes.Methods A total of 4090 cases,who received prenatal examination and delivered in Peking University First Hospital and performed a 75 g oral glucose tolerance test (75 g OGTT) at 24-28 gestational weeks,from January.1st,2011 to Jul 31st,2012,were divided into 2groups.Normal blood glucose group:the result of OGTT (fasting plasma glucose,1 hour glucose and 2 hour glucose) was normal; Gestational diabetes mellitus group (GDM group):the result of OGTT was abnormal at any time point.GDM group were separated into A,B and C.GDM A means fasting plasma glucose annormal but others were normal,GDM B:fasting plasma glucose,1 hour and/or 2 hour glucose abnormal,GDM C:fasting plasma glucose normal.To analyse the effect of different number of abnormal result of OGTT on pregnancy outcomes,GDM group were divided into Ⅰ,Ⅱ and Ⅲ.GDM Ⅰ means one abnormal blood glucose of OGTT result,GDM Ⅱ:two abnormal blood glucose and GDM Ⅲ:three abnormal blood glucose.We analyzed the pregnant outcomes of each group.Results (1) Among the 4090 cases,858 cases (21.98％) were diagnosed as GDM (GDM group),and 82 cases (9.6％,82/858) were treated with insulin,other 3232 cases with normal blood glucose (normal blood glucose group).In GDM group,the rate of cesarean section (51.9％,445/858),premature delivery (8.4％,72/858) and LGA (5.9％,51/858)were respectively significantly higher than those of normal blood glucose group [(43.5％,1406/3232),(5.8％,189/3232) and (4.2％,137/3232)] (P ＜ 0.05).But,there was no statistically significant differences for the rate of macrosomia (P ＞ 0.05) between the GDM group (6.8％,58/858) and normal blood glucose group (6.2％,199/3232).(2)In the GDM group,GDM A was 317 cases (36.9％),GDM B 239 cases (27.8％),GDM C 302 cases (35.2％).The incidence of Macrosomia and LGA in GDM B was significantly higher than that in GDM C and normal blood glucose group (P ＜ 0.05).Comparing with GDM A,there was no statistically significance in GDM B and GDM C (P ＞ 0.05).(3)In GDM group,GDM Ⅰ was 521 cases (60.7％),GDM Ⅱ203 cases (15.6％),GDM Ⅲ 134 cases (23.7％).Compared with the normal blood glucose group,GDM Ⅲ had a significantly higher incidence of macrosomia and LGA and cesarean section(P ＜ 0.01) ;and GDM Ⅱ had only a significantly higher incidence of cesarean section (P ＜ 0.01).(4) Among the 4090 cases,there were 1118 patients (27.3 ％) whose fasting blood glucose was below 4.4 mmol/L,of which 55 cases were diagnosed as GDM.There were 4 premature infants and 1 macrosomia.Conclusions The GDM group with more than FBG ≥5.1 mmol/L had a higher incidence of adverse pregnancy uutcomes,it suggested that we should pay more attention and take actively intervented;the pregnant woman is not recommended for 75g OGTT detection when fasting blood glucose was below 4.4 mmol/L because of the low rate of GDM and adverse pregnancy outcomes among them.

Objective Tostudy the effects ofRheu compositus (Dachengqi Decoction, DD) on the NF-κBactivity of alveolar macrophages in ARDS rats and its inflammatory cytokine expression, and hence to explore the molecular mechanism of the anti-inflammatory effects of DD. Method The 65 male Wistar rats were randomly di-vided into the control group (n = 12), the ARDS model group (n = 21), the DD treatment group (n = 16) and the dexamethasone treatment group (n = 16). The rots of model group received 1 mg/(kg·0.5 mL) LPS injected intra-poritoneally and LPS in dose of 5 mg/(kg·0. 5 mL) was administrated by slow dropping endotracbeally 16 hours later. Modeling was successfully established 6 hours later evidenced by arterial gas analysis. The rats of con-trol group received 0.5 mL normal saline injected intravenously through tail vein instead of LPS. Three days after establishment of modeling, DD was given to rats of DD treatment group by intragastric instillation for 3 days in dose of 2.31 g/(kg·d),in which the weight of drug was calculated on the basis of dried herbal medicine. In dexam-ethasone treatment group, rats had intra-peritoneal injection of 2 mg/kg dexamethasone for 3 days after modeling was established. Seventy-two hours later, the arterial blood gas analysis and pathological study were carried out, in rats of all groups, and the findings were graded. The levels of TNF-α, IL-1 and IL-10 both in the plasma and in the brenchoalveolar lavage fluid were determined by using the enzyme linked immunosorbent assay (ELISA). Besides the nucleopretein concentration of pulmonary alveolar macrophage (PAM) was maeasuredwith the BAC method, and the NF-κB activity was determined with the Western Blotting, and with the evaluation of the DD' s effect on the transcription activity of PAM inflammatory cytokines. All the experimental data were processed by the SPSS 13.0 for statistical analysis. The analysis of variance was used for the comparison between groups, and P < 0. 05 showed the statistical significance of the difference. Results DD didn' t significantly reduce the TNF-α level [(510.97±76.20) pg/mL,(476.16±98.03) pg/mL, P >0.05], but significantly deceased the plasma IL-1 level [(381.99±34.30) pg/mL, (300.69 ± 50.99) pg/mL, P <0.05]. At the same time, there was no signif-icant changes in the plasma IL-10 level [(345.96 ± 67.72) pg/mL, (345.30 ± 78.52) pg/mL, P > 0.05]. Whereas TNF-α level in BALF was significantly decreased [(130.94 ± 33.51) pg/mL, (106.59 ± 26.64) pg/ mL, P < 0. 05, so was the IL-1 level in BALF (82.5 ± 25.36) pg/mL, (63.89 ± 22.96) pg/mL, P < 0. 05], but IL-10 level in the BALF was significantly increased[(77.09 ± 26.05) pg/mL, (148.05 ± 53.50) pg/mL, P <0.01]. DD significantly reduced the nueleoprotein level of PAM[(5.35 ± 2.44) μg/μL, (3.54 ± 2.01) μg/ μL, P < 0.05]and significantly inhibited the NF-κB activity [electrophoretic band optical density × area/consult mtio:(1.45±0.71),(1.11±0.28), P <0.05]aswell. Conclusions DD regulated systemic pro-inflammato-ry media/anti-inflammatory media balance in rats with ARDS by mainly reducing the level of IL-1. The regulatory effects of DD on the local lung injury not only inhibit the producing of TNF-α and IL-1 level,but also increase the IL-10 level to reestablish the local pro-inflammatory factors/anti-inflammatory factors balance so as to inhibit the lo-cal excessive irranune response. DD inhibits the NF-κB activity in the PAM of ARDS rats so as to restrain the pro-duction of pro-inflammatory cytokines (TNF-α and IL-1). This kind of multi-target bidirectional regulation plays an active role in regulating the immune balance and protecting the target organ from the excessive injury.