Objective: To construct a prediction model for preterm birth risk among pregnant women, so as to provide the reference for screening high-risk population and preventing preterm birth. Methods: Pregnant women who received antenatal examination and delivered at the Women's Hospital, School of Medicine, Zhejiang University from January 1 to December 31, 2019 were selected as the study subjects, among them, 80% were included in the modeling group, and 20% were included in the validation group. Demographic and clinical information were collected. A multivariable logistic regression model was used to analyze the predictive factors of preterm birth risk in the modeling group, and a preterm birth risk prediction model was established based on the OR values of predictive factors. The model was validated with the data from the validation group. The Youden index was used to determine the critical score for predicting preterm birth risk. The prediction performance of the model was evaluated using the receiver operating characteristic (ROC) curve. Results: A total of 15 197 pregnant women were surveyed, including 12 131 pregnant women in the observation group and 3 066 pregnant women in the validation group. There was no statistically significant difference in age, education level and gravidity between the two groups of pregnant women (all P<0.05). Multivariable logistic regression analysis identified the number of pregnancies, education level, place of residence, hypertension, diabetes, history of preterm birth, twin-pregnancy, placenta praevia, and gestational hypertension as risk prediction factors for preterm birth risk among pregnant women. The risk score system for preterm birth was established as follows: >2 pregnancies (2 points), high school education or below (4 points), college degree or above (-4 points), rural residence (5 points), hypertension (7 points), diabetes (11 points), history of preterm birth (11 points), twin-pregnancy (28 points), placenta previa (19 points), and gestational hypertension (12 points). The total score of the preterm birth risk scoring system ranged from -4 to 99 points. When the critical score was 8 points, the Youden index was the highest at 0.480, with an area under the ROC curve of 0.749 (95%CI: 0.732-0.767), a sensitivity of 0.610, and a specificity of 0.886, indicating good prediction performance of the model. Conclusion The preterm birth risk prediction model established in this study based on demographic and clinical characteristics of pregnant women can effectively predict the risk of preterm birth among pregnant women.

OBJECTIVE: To explore the genetic basis of a child with holoprosencephaly. METHODS: Genomic DNA of the child was extracted and subjected to whole exome sequencing. Suspected variant was verified by Sanger sequencing of her family members. RESULTS: Cranial MRI suggested lobulated holoprosencephaly with partial absence of corpus callosum. Genetic testing revealed that she has carried a heterozygous c.517C>G (p.His173Asp) variant of the SIX3 gene, for which both of her parents were of wild type. Based on the American College of Medical Genetics and Genomics guidelines, the c.517C>G variant of SIX3 gene was predicted to be pathogenic (PS2+PM1+PM2+PM5+PP3). CONCLUSION The SIX3 gene c.517C>G variant probably underlay the multiple malformations in this child. Above finding has enabled her definite diagnosis.
Child ; Family ; Female ; Heterozygote ; Holoprosencephaly/genetics* ; Humans ; Mutation ; Whole Exome Sequencing

Objective:To analyze the clinical characteristics, diagnosis and treatment process, and prognosis of human immunodeficiency virus (HIV) positive patients with systemic lupus erythematosus (SLE).Methods:A retrospective study was used to collect and analyze the clinical characteristics, treatment and prognosis of eight HIV-positive patients with SLE treated in Yunnan Provincial Infectious Diseases Hospital from August 2017 to January 2020.Results:All of the eight patients were diagnosed with SLE after HIV infection. All of the patients were female. CD4 + T lymphocyte counts were >500/μL in four cases, 350 to 499/μL in two cases, and 200 to 349/μL in the remaining two cases. Case 6 presented with butterfly erythema on the face. In Case 1, hemoglobin was 40 g/L and urine occult blood was (+ + ). The hemoglobin of Case 2 was 76 g/L, the platelet count was 2×10 9/L, and the granulocyte count was 0.6×10 9/L. The lung computed tomography (CT) examination of Case 3 showed diffuse exudative lesions in both lungs. The 24 h urinary protein levels of Case 4 and 5 were 2 231.6 mg and 2 761.0 mg, respectively, and urine occult blood were (+ + ). The total bilirubin of Case 4 was 70.0 μmol/L and alanine aminotransferase (ALT) was 49 U/L. The total bilirubin of Case 7 was 129.6 μmol/L and ALT was 56 U/L. The lung CT examination of Case 8 showed moderate to massive pericardial effusion in the pericardium. Seven patients received antiviral therapy and immunotherapy, and their conditions were stable without relapse. Case 1 was refractory SLE complicated with autoimmune hemolytic anemia. After treated with rituximab combined with cyclophosphamide the patient achieved clinical remission. Case 7 was injection drug user and died after giving up treatment. Conclusions:The clinical characteristics of HIV-positive patients with SLE are heterogeneous, and the prognosis is generally good after antiviral therapy and immunotherapy. For patients with refractory SLE complicated with autoimmune hemolytic anemia, clinical remission can also be achieved through active treatment.

China's healthcare payment reform seeks to combine a medical insurance point-system with a global budget.The focus and difficulty in implementing the payment reform is how to make effectively link.On the basis of theoretical analysis,it selects the regions that have implemented the payment by disease under regional total budget and the payment by disease under institutional total budget,and summarizes the synergistic mechanism of total budget and payment by disease,including the strict control of total budget at the regional level,the reasonable setup of the budget or the standard of expected service volume at the institutional level,and the rate fluctuation and discount mechanism for the settlement of excess service;and further sort out the additional incentive mechanism to support innovation and quality enhancement under the background of the total budget and the payment by disease.Lessons can be drawn from the experiences of typical regions to strengthen the synergy between regional budgets,institutional budgets and payment by type of disease,and cautiously deal with the risks of excessive competition and"punching points"that may arise from the regional point method.

Objective:To analyze the clinical characteristics of AIDS complicated with plasmablastic lymphoma (PBL).Methods:Clinical data and laboratory test of 7 AIDS patients complicated with PBL admitted to Yunnan Infectious Disease Hospital from January 2016 to October 2022 were retrospectively analyzed.Results:There were 6 male patients and 1 female patient with a median age of 48 years (41-56 years). All patients had oral and maxillofacial involvement, and only 1 case was stage Ⅱ at the initial Ann Arbor stage, while 6 cases were stage Ⅲ or higher. Six patients had systemic symptoms. All patients had a Ki-67 proliferation index greater than 80% and all presented MYC gene rearrangements, and 6 patients were positive for EBER. All patients received DA-EPOCH-based first-line chemotherapy and antiretroviral therapy (ART), Five patients initiated ART at the same time as chemotherapy, and 2 patients initiated ART before chemotherapy. Four patients achieved complete remission after chemotherapy according to PET-CT evaluation, and 3 patients died.Conclusions:Active chemotherapy combined with ART can maximize the therapeutic benefits of AIDS patients with PBL. The introduction of ART in the first chemotherapy cycle can avoid the rapid disease deterioration in the patients.

China's healthcare payment reform seeks to combine a medical insurance point-system with a global budget.The focus and difficulty in implementing the payment reform is how to make effectively link.On the basis of theoretical analysis,it selects the regions that have implemented the payment by disease under regional total budget and the payment by disease under institutional total budget,and summarizes the synergistic mechanism of total budget and payment by disease,including the strict control of total budget at the regional level,the reasonable setup of the budget or the standard of expected service volume at the institutional level,and the rate fluctuation and discount mechanism for the settlement of excess service;and further sort out the additional incentive mechanism to support innovation and quality enhancement under the background of the total budget and the payment by disease.Lessons can be drawn from the experiences of typical regions to strengthen the synergy between regional budgets,institutional budgets and payment by type of disease,and cautiously deal with the risks of excessive competition and"punching points"that may arise from the regional point method.

China's healthcare payment reform seeks to combine a medical insurance point-system with a global budget.The focus and difficulty in implementing the payment reform is how to make effectively link.On the basis of theoretical analysis,it selects the regions that have implemented the payment by disease under regional total budget and the payment by disease under institutional total budget,and summarizes the synergistic mechanism of total budget and payment by disease,including the strict control of total budget at the regional level,the reasonable setup of the budget or the standard of expected service volume at the institutional level,and the rate fluctuation and discount mechanism for the settlement of excess service;and further sort out the additional incentive mechanism to support innovation and quality enhancement under the background of the total budget and the payment by disease.Lessons can be drawn from the experiences of typical regions to strengthen the synergy between regional budgets,institutional budgets and payment by type of disease,and cautiously deal with the risks of excessive competition and"punching points"that may arise from the regional point method.

China's healthcare payment reform seeks to combine a medical insurance point-system with a global budget.The focus and difficulty in implementing the payment reform is how to make effectively link.On the basis of theoretical analysis,it selects the regions that have implemented the payment by disease under regional total budget and the payment by disease under institutional total budget,and summarizes the synergistic mechanism of total budget and payment by disease,including the strict control of total budget at the regional level,the reasonable setup of the budget or the standard of expected service volume at the institutional level,and the rate fluctuation and discount mechanism for the settlement of excess service;and further sort out the additional incentive mechanism to support innovation and quality enhancement under the background of the total budget and the payment by disease.Lessons can be drawn from the experiences of typical regions to strengthen the synergy between regional budgets,institutional budgets and payment by type of disease,and cautiously deal with the risks of excessive competition and"punching points"that may arise from the regional point method.

China's healthcare payment reform seeks to combine a medical insurance point-system with a global budget.The focus and difficulty in implementing the payment reform is how to make effectively link.On the basis of theoretical analysis,it selects the regions that have implemented the payment by disease under regional total budget and the payment by disease under institutional total budget,and summarizes the synergistic mechanism of total budget and payment by disease,including the strict control of total budget at the regional level,the reasonable setup of the budget or the standard of expected service volume at the institutional level,and the rate fluctuation and discount mechanism for the settlement of excess service;and further sort out the additional incentive mechanism to support innovation and quality enhancement under the background of the total budget and the payment by disease.Lessons can be drawn from the experiences of typical regions to strengthen the synergy between regional budgets,institutional budgets and payment by type of disease,and cautiously deal with the risks of excessive competition and"punching points"that may arise from the regional point method.

China's healthcare payment reform seeks to combine a medical insurance point-system with a global budget.The focus and difficulty in implementing the payment reform is how to make effectively link.On the basis of theoretical analysis,it selects the regions that have implemented the payment by disease under regional total budget and the payment by disease under institutional total budget,and summarizes the synergistic mechanism of total budget and payment by disease,including the strict control of total budget at the regional level,the reasonable setup of the budget or the standard of expected service volume at the institutional level,and the rate fluctuation and discount mechanism for the settlement of excess service;and further sort out the additional incentive mechanism to support innovation and quality enhancement under the background of the total budget and the payment by disease.Lessons can be drawn from the experiences of typical regions to strengthen the synergy between regional budgets,institutional budgets and payment by type of disease,and cautiously deal with the risks of excessive competition and"punching points"that may arise from the regional point method.