Objective To investigate whether no asphyxia neonates with intrauterine distress are complicated with myocardial injury and determine the sensitive biochemical diagnostic parameters. Methods A total of 89 neonates born in the First Affiliated Hospital of Sun Yat-sen University from July 2009 to December 2009 were enrolled. Fifty-three fetal distress cases with Apgar score ＞ 7 at 1 and 5 minites were enrolled in the study group; while the rest 36 healthy neonates, whose Apgar score = 10 at 1 and 5 minites, were the control group. Umbilical artery blood samples of all cases were collected for blood gas analysis and biochemical measurement. Results(1)pH(7.23±0.07) and BE [(-4.8±3.0)mmol/L] in the study group were significantly lower than pH (7.31 ±0.03) and BE [(-2.1±1.5)mmol/L] in the control group (P＜0.05).The lactic acid of study group [(5.2±2.3)mmol/L] was higher than that of the control group [(2.3±1.1)mmol/L], and the difference was significant (P＜0.01). However, there was no significant difference between the two groups in PaO2[(16.2±7.9)mm Hg(1 mm Hg=0.133 kPa) vs. (17.5±6.7)mm Hg] and PaCO2[(54.0±11.2)mm Hg vs. (48.5±5.4) mm Hg; P＞0. 05]. (2) The level of CK-MB in neonates with fetal distress[(48 ±59) U/L] was significantly higher than that of healthy neonates [(36±27)U/L]. However, no significant difference was found in CK [(194±73)U/L vs. (162±95) U/L]and BNP levels[(519±309)ng/L vs.(481±216)ng/L;P ＞ 0.05]. (3) Spearman rank correlation analysis showed that CK-MB level was negatively correlated with pH(r=-0.296, P＜0.05) and BE (r=-0.318,P＜0.05) of umbilical artery blood,while BNP level was positively correlated with umbilical lactic acid (r=0.278, P＜0.05). No correlation was found between other parameters (P＞0.05).Conclusions Intrauterine distress without neonatal asphyxia had effect on fetal myocardial injury. CK-MB can be used as a sensitive parameter for monitoring the development of myocardial injury. The severity of myocardial injury was related to fetal acidosis.

Objective To study the prognostic factors of gastrointestinal stromal tumors (GIST).Methods A total of 144 GIST patients treated at the First Affiliated Hospital of Guangxi Medical University between January 1996 and December 2011 were analyzed restrospectively.Kaplan-Meier,log-rank test and Cox regression model were used.Results The overall 5-year survival was 59.6％.Log-rank univariate survival analysis showed that the primary location,tumor size,metastasis,operational method,type of tumor cells,invasion of the surrounding organs and tissues,invasion of the smooth muscle,cellularity of the tumor,mitotic counts of the tumor cells,Ki-67 labeling index,P53 expression and targeting therapy were significant prognostic factors (P ＜ 0.05).Cox regression model showed that tumor size,metastasis,operational method,surrounding organs and tissues invasion,cellularity of the tumor,mitotic counts of the tumor cells,P53 and targeting therapy were essential to improve the survival.Conclusions The study suggests that early diagnosis and comprehensive treatment consisting of operation and targeting therapy can significantly improve the survival of GIST.

Objective To investigate the status and significance of KIT,PDGFRA and DOG1 gene mutation in gastrointestinal stromal tumors (GIST).Methods 100 GIST patients treated in the First Affiliated Hospital of Guangxi Medical University between May 2002 and May 2013 were analyzed restrospectively.DNA was isolated and amplified for the all exons of KIT,PDGFRA and DOG1.Each PCR product was sequenced to find the position and type of mutation.Results KIT mutations were identified in 75 cases (75％).PDGFRA mutations were found in 16 cases (16％).No DOG1 mutations were found.The overall 5-year survival was 58.8％.Log-rank univariate survival analysis showed that the primary location,tumor size,metastasis,operational mode,type of tumor cells,invasion of the smrounding organs,invasion of the smooth muscle,mitotic counts of the tumor cells,deletions in exon 11 KIT and targeting therapy were significant prognostic factors (all P ＜ 0.05).COX regression model showed that tumor size,metastasis,operational method,invasion of the surrounding organs,mitotic counts of the tumor cehs,deletions in exon 11 KIT and targeting therapy were related to prognosis.Conclusion KIT and PDGFRA mutations are mutually exclusive.The overexpression mechanism of DOG1 is not related to DOG1 gene mutation.The related gene mutations affect the prognosis of GIST.

Objective To investigate the relationship between time and mode of delivery and gestational outcomes in uncomplicated twin pregnancies.Methods A total of 347 women with uncomplicated twin pregnancies who gave birth in First Affiliated Hospital of Sun Yat-Sen University between November 2012 and June 2015 were reviewed retrospectively,including 291 dichorionic diamniotic twin pregnancies (DCDA) and 56 monochorionic diamniotic twin pregnancies (MCDA).The general information,gestational complications,time and mode of delivery,gestational outcomes were recorded and the relationship between time and mode of delivery and gestational outcomes in DCDA and MCDA groups were analyzed.Ttest,Chi-square,Fisher's exact test and logistic regression analysis were used for statistical analysis.Results (1) The incidence of adverse neonatal outcomes in DCDA group [49.1％ (281/572)] was significantly lower than in MCDA group [75.5％ (83/110)] (x2=25.698,P＜0.05).In DCDA group,women delivered at 36-36+6 weeks,37-37+6 weeks and 38 38+6 weeks had lower rates of admission to neonatal intensive care unit (NICU),neonatal respiratory distress syndrome (NRDS) and other neonatal diseases than those delivered at ＜34 weeks,34-34+6 weeks and 35-35+6 weeks (all P＜0.05),while those delivered at 38-38+6 weeks had a higher incidence of pathological jaundice (2/8) than at 36-36+6 weeks and 37-37+6 weeks (3.1％ and 1.9％) (x2=10.133 and 13.510,both P＜0.05).In MCDA group,the rate of admission to the NICU decreased gradually from 100.0％ (30/30) (＜35 weeks) to 3/12 (37-37+6 weeks) (P＜0.05).In DCDA group,the odds ratio (OR) and 95％ confidence interval(95％CI) of adverse neonatal outcomes in 35-35+6,36-36+6 and 37-37+6 weeks were 0.237(0.116-0.482),0.056(0.029-0.108) and 0.054(0.026-0.112),respectively (all P＜0.05).In MCDA group,OR (95％CI) of adverse neonatal outcomes in 34 34+6 and 35-35+6 weeks were 38.894 (3.084-490.552)and 18.858 (1.538-231.222),respectively (both P＜0.05).(2) With regard to mode of delivery,ten cases of DCDA and two cases of MCDA had vaginal deliveries.In DCDA group who gave birth at less than 34 weeks,the incidence of neonatal pathological jaundice in vaginal delivery group (8/14) was higher than that in cesarean delivery group [22.7％ (15/66)] (x2=5.104,P=0.024).Conclusions The optimal time of delivery for uncomplicated twins is 36-37+6 weeks.The appropriate mode of delivery should be determined by the status of both the mother and the twins.

Objective To determine the effects of adiponectin on high glucose induced BeWo cell proliferation in vitro. Methods BeWo cells were seeded in 96-well plates at the appropriate density. After treatments with high glucose (25 mmol/L), western blot analysis of cyclin D1 and a colorimetric assay (cell counting kit-8, CCK-8) were used to analyse BeWo cells′proliferation, and western blot was used to detect the expression of adiponectin. Moreover, we added adiponectin (20μg/ml) in the culture medium and three methods were utilized for cell proliferation analysis: CCK-8, cell cycle analysis (by flow cytometry) and proliferating cell nuclear antigen (PCNA) immunocytochemical staining. Results Compared to BeWo cells cultured by normal glucose and high mannitol, the proliferation of BeWo cells treated by high glucose increased (P<0.05). Compared with BeWo cells cultured by high mannitol, the expression of adiponectin in BeWo cells treated by high glucose decreased. After added adiponectin in the culture medium, the proliferation of BeWo cells treated by adiponectin+high glucose decreased than that of cells treated by high glucose (0.770±0.050 versus 0.990±0.070, P<0.05);the proportion of G2+S phases of BeWo cells treated by adiponectin+high glucose decreased than that of cells treated by high glucose [(40.7±2.1)%versus (44.9± 3.9)%, P<0.05];the rate of PCNA positive cell in BeWo cells treated by adiponectin+high glucose decreased than that of cells treated by high glucose [(28 ± 5)% versus (44 ± 5)%, P<0.05]. Conclusion Adiponectin could inhibit proliferation of high glucose induced BeWo cells in vitro.

[Objective]To investigate the influence of different pre-pregnancy body mass index(BMI)on blood glucose and serum lipid and pregnancy outcome during pregnancy.[Methods]Clinical records of 1115 singleton pregnant women who underwent obstetric examination and delivered in the first affiliated hospital of Sun Yat-sen University between January 1,2013 and December 31,2013 were collected. The patients were divided into 3 groups based on pre-pregnancy BMI,underweight(G1):BMI<18.5 kg/m2, normal weight(G2):18.5 ~ 23.9 kg/m2 ,overweight (G3):≥ 24.0 kg/m2. The characteristics of blood glucose ,serum lipid and pregnancy outcome during pregnancy were analyzed and compared among groups.[Results](1)1 115 cases of pregnant women were Included in the study. The cases of G1 to G3 were 245,757 and 113.(2)With the increase of pre-pregnancy BMI,the blood glucoseof 75 oral glucose tolerance test(OGTT)fasting,1 h and glycosylated hemoglobin(HbA1c)was gradually rising(P < 0.05). The average blood glucose of 75 OGTT fasting among groups were(4.21 ± 0.34)(4.34 ± 0.35)(4.56 ± 0.50)mmol/L,75 OGTT 1 h were (7.51 ± 1.60),(7.83 ± 1.59),(8.83 ± 1.88)mmol/L,HbA1c were(4.81 ± 0.37)(4.90 ± 0.34)(5.03 ± 0.38)%,there was statistical difference among groups(P<0.05). The average FBG of G1 was lower than that of G2 and G3 group(P<0.05). The average blood glucose of 75 g OGTT 2 h of G3 was obviously higher than that of G1 and G2 group(P < 0.05). By Pearson analysis,FBG,75 g OGTT fasting ,1 h ,2 h ,HbA1c had significantly positive relationship with pre-pregnancy BMI(P < 0.05). The incidence of gestational diabetes of G3 group was higher than that of G1 and G2 group,but the incidence of gestational diabetes between G1 and G2 group had no obvious difference.(3)The triglycerides(TG)of G3 was obviously higher than that of G1 and G2 group(P<0.05), the total cholesterol(TC)and high density lipoprotein cholesterol(HDL-C)of G3 was lower than that of G1 and G2(P < 0.05). But There was no statistical difference about apolipoprotein A1(apoA1),B(apoB),E(apoE),Lp(a),Apo A1/Apo B among groups (P > 0.05). By Pearson analysis,TG had significantly positive relationship with pre-pregnancy BMI(P < 0.05),but TC,LDL-C, HDL-C had negative relationship with pre-pregnancy BMI(P<0.05).(4)With the increase of pre-pregnancy BMI,the weight and head circumference of the newborn was gradually rising(P < 0.05). The average weight of the newborn among groups were(3.03 ± 0.42),(3.18 ± 0.45),(3.30 ± 0.46)kg,the head circumference were(32.98 ± 1.59),(33.43 ± 1.64),(33.87 ± 1.60)cm,there was statistical difference among groups(P<0.05). The shoulder circumference of the newborn of G1 was obviously lower than that of G2 and G3 group(P<0.05). Pearson analysis showed that the weight,body length,head circumference,shoulder circumference of the newborn had positive relationship with pre-pregnancy BMI(P < 0.05).[Conclusion]With the increase of pre-pregnancy BMI, the blood glucose at each time point,serum lipid and growth index of the newborn was gradually rising. We suggest that overweight and obese women should lose weight before pregnancy.

Objective To evaluate the influences of abnormal glucose challenge test (GCT) on pregnancy outcomes and neonatal anthropometric data in women with normal oral glucose tolerance test (OGTT).Methods Totally 214 women who delivered in the First Affiliated Hospital of Sun Yat-sen University from November 2006 to December 2007 were enrolled.50 g GCT was performed at 24-28 weeks of gestation and 75 g OGTT would be followed if GCT≥7.8 mmol/L.Those patients,whose OGTT results below the following criteria (5.3 mmoL/L,10.0 mmol/L,8.6 mmol/L,7.8 mmol/L),were classified as normal OGTT.Altogether,116 of the 214 women with abnormal GCT and normal OGTT were collected as the study group and the rest 98 women with normal GCT as the control group.The pregnant outcomes of the two groups were analyzed.The neonatal anthropometry,including birth weight,body length,head circumference and shoulder circumference,were recorded.Other neonatal anthropometric data,such as upper arm circumference,tricep skinfold thickness and hypodermic fat thickness of abdomen were measured by a tape measure within 24 hours after birth.Results (1) Pregnant outcomes:No significant difference was found in the rate of assisted vaginal delivery,polyhydramnios,premature rupture of membranes and fetal distress between the study and control group[10.3% (12/116) vs 4% (4/98),5.2% (6/116) vs 10% (10/98),13.8% (16/116) vs 17% (17/98),20.7% (24/116) vs 13% (13/98),P ＞0.05,respectively],but the rate of cesarean section,spontaneous vaginal delivery and large for gestational age babies in the study group were different from those of the control[72.4% (84/116) vs 51% (51/98),17.2%(20/116) vs 45% (44/98),25.9% (30/116) vs 6% (6/98),P ＜0.05,respectively].(2)Neonatal anthropometry:The birth weight of the study group was significantly higher than that of the control group[(3.4 ±0.4) kg vs (3.3±0.4) kg,P ＜0.05],but no significant difference was shown in any other neonatal anthropometric results between the study and control group,including body length[(49.9 ±1.3)cm vs (49.7±1.4) cm],head circumference[(33.4±1.5)cm vs (33.8±1.7) cm],shoulder circumference [(35.4±2.3)cm vs (35.0±2.3)cm],upper arm circumference[(11.0±0.7)cm vs (10.9±0.8)cm],tricep skinfold thickness[(9.7±1.0)mm vs (9.9± 1.4)mm]and hypodermic fat thickness of abdomen[(7.2±1.2)mm vs (7.2+1.0)mm;all P＞0.05].Conclusion Women with abnormal GCT alone may have no significant influences on neonatal anthropometric data,but might have more cesarean section,large for gestational age babies,and neonatal birth weight than those women with normal GCT.

Objective To evaluate the effect of Parkinson's disease treatment guideline on the initial medicine therapy and to explore the impact of hospital grade level and type of insurance on the initial prescription for Parkinson's disease.Methods We identified 136 PD patients as part of a population-based study in Beijing and made a comparison between the patients with initial prescriptions of dopamine receptor agonists (DA) and levodopa (LD).Results Among 136 patients,excluding patients without initial medication of levodopa or dopamine receptor agonist,there were 61 cases with initial drug administration aged ≥ 65 years.Among the 61 cases,1 cases and 19 cases administrated dopamine receptor agonist and levodopa respectively before 2006,1 case and 11 cases respectively from 2007 to 2009,and 5 cases and 24 cases respectively after 2010.There was no significant difference in the percentage between patients with initial administration of levodopa and dopamine receptor agonist in the three periods (x2 =1.891,P =0.388).In 41 patients with initial drug administration of dopamine receptor agonist or levodopa aged＜65 years,1 cases and 23 cases administrated dopamine receptor agonist or levodopa respectively before 2006,0 case and 10 cases respectively from 2007 to 2009,and 3 cases and 4 cases respectively after 2010.There was significant differences in the percentage between patients with initial administration of levodopa and dopamine receptor agonist in the three periods (x2 =10.644,P=0.005).The percentage of patients with initial administration of dopamine receptor agonist aged＜65 years was increased after 2010 as compared before 2006 (x2 =7.219,P=0.028).There were no significant differences in the percentage of patients with initial administration of dopamine receptor agonist between grade 3 and non-grade 3 hospitals (13.6％ vs.6.3％,x2=0.675,P=0.686)and between patients with and without insurance (13.1％ vs.10.0％,x2=0.141,P=1.000).Conclusions The percentage of patients with initial administration of levodopa and dopamine receptor agonist has no significant difference between patients with initial drug administration aged ≥ 65 years before and after the introduction of Parkinson's disease treatment guideline,while the percentage is increased in patients with initial drug administration aged＜65 years.No impact of hospital grade level and type of insurance on initial administration for Parkinson's disease is found.

Objective:To study the risk factors for abnormal glucose metabolism in pregnant women with a history of gestational diabetes mellitus (GDM).Methods:A retrospective analysis was performed on pregnant women who had two consecutive deliveries and were was complicated by GDM in the previous pregnancy at the First Affiliated Hospital of Sun Yat-sen University from January 2011 to May 2019. Clinical data of both pregnancies were collected, including general information, fasting blood glucose in early pregnancy and 75 g oral glucose tolerance test (OGTT) results, glycosylated hemoglobin A1c and blood lipid profile at 24-28 gestational weeks. The incidence and risk factors of abnormal glucose metabolism in these cases during the present pregnancy were analyzed. Analysis of variance, Kruskal-Wallis test, SNK- q or LSD- t-test, and Chi-square test were used for data analysis. Single-factor logistic regression analysis was used to analyze the high-risk factors, and multifactor logistic regression analysis was performed to fit the model. Variable collinearity diagnosis was performed using the coldiag2 command. Results:(1) A total of 455 cases were enrolled in the study. According to the fasting glucose level in the first trimester and the OGTT results in the present pregnancy, they were divided into three groups: normal OGTT group ( n=240), GDM group ( n=189), and pre-gestational diabetes mellitus group (PGDM, n=26). The incidence of abnormal glucose metabolism in these patients during the present pregnancy was 47.2% (215/455). (2) Those with a history of GDM had higher pre-pregnancy weight, lower weight gain, higher cesarean section rate, smaller gestational age at delivery, and higher neonatal birth weight in the present pregnancy than those in the previous pregnancy [(55.6±8.5) vs (53.3±7.9) kg, t=-4.059; (11.2±4.2) vs (12.5±4.4) kg, t=4.435; 47.9% (218/455) vs 33.0% (150/455), χ2=20.481; (38.6±1.3) vs (38.8±1.3) weeks, t=2.288; (3 177±463) and (3 114±460) g, t=-2.044; all P<0.05]. (3) In the PGDM group, the 2-h plasma glucose level after 75 g OGTT was higher than that in the previous pregnancy [(11.4±1.1) vs (9.9±1.7) mmol/L, t=-3.299, P=0.002]. (4) In the present pregnancy, the PGDM group had the highest fasting blood glucose in early pregnancy, followed by the GDM group and the normal OGTT group [4.6 mmol/L (4.2-7.6 mmol/L), 4.3 mmol/L (4.0-4.6 mmol/L) and 4.1 mmol/L (3.8-4.4 mmol/L), χ2=34.498, P<0.001]. The PGDM group had the least postpartum weight retention, followed by the normal OGTT group and the GDM group [(1.2±3.9), (1.6±3.9), and (2.6±4.9) kg, F=3.086, P<0.05]. (5) Multivariate logistic regression analysis showed postpartum weight retention and the 1-h and 2-h plasma glucose levels after 75 g OGTT in the previous pregnancy were independent risk factors for abnormal glucose metabolism in pregnant women with a history of GDM (postpartum weight retention: OR=1.054, 95% CI: 1.005-1.106; 1-h plasma glucose: OR=1.284, 95% CI: 1.087-1.516; 2-h plasma glucose: OR=1.272, 95% CI: 1.071-1.511). Conclusions:The incidence of abnormal glucose metabolism is higher in subsequent pregnancy in women with GDM history, which may be related to various factors, such as postpartum weight retention and plasma glucose after 75 g OGTT in the previous pregnancy.

Gestational diabetes mellitus (GDM) is defined as carbohydrate intolerance of variable severity with onset or first recognition during pregnancy.Short-and long-term effects of GDM on both mother and child depend on the severity of the condition and blood sugar level.Currently,relatively standardized guidance on management of GDM in China has greatly improved maternal and infant outcomes.Moreover,standardized postpartum management and monitoring are also essential for the prevention of long-term complications in this population.The guidelines issued by America Diabetes Association (ADA) and American College of Obstetricians and Gynecologists (ACOG) in 2018 recommended that GDM patients should be followed up at 4-12 weeks postpartum for a 75 g oral glucose tolerance test.For those who is normal at the first postpartum follow up,it is necessary to have their blood glucose tested once every 1-3 years.However,for those who is abnormal,medication should also be initiated when necessary in addition to more frequent follow-ups and nutritional intervention and physical exercise.