In order to better construct important diseases of traditional Chinese medicine ( TCM ) clinical re-search base , and strengthen the construction of medical and clinical research of TCM information sharing sys-tem, Hubei Provincial Hospital of Traditional Chinese Medicine has constructed research type clinic. The con-struction idea of research type clinic is the mode of real world TCM clinical research . The construction of research type clinic mode was from three aspects, which were the clinical research, health management and distinctive diagnosis and treatment .

This study was aimed to explore the correlation between traditional Chinese medicine (TCM) patterns of hepatopathy and the objective inspection indicators so as to provide objective evidences for the syndrome differentiation and treatment of hepatopathy.General information of hepatopathy inpatients from January 2015 to June 2016 was collected.In order to distinguish the most effective factors and establish the discriminant function,the data in 2015 was selected as training samples with stepwise discriminatory analysis;and the data of the first half of 2016 was used as testing samples.A discriminant function was established by stepwise discriminant analysis,which including 13 inspection indicators out of 127 indicators.Stepwise discriminant analysis was also employed to predict TCM syndrome patterns of the samples.The recognition accuracy of the training sample set 224 samples in 2015 was 84.38％ and that of the test sample set 109 samples in 2016 was 74.31％.It was concluded that the stepwise discriminant analysis had a relatively high discriminant accuracy rate.It can provide references in the clinical diagnosis.

Objective To investigate the associations of urinary iodine concentration ( UIC) and blood selenium levels with subclinical hypothyroidism and thyroid antibodies during the first half pregnancy in women. Methods A total of 239 pregnant women(7-20 weeks)were selected. The baseline data were collected, and serum TSH, FT4 , thyroid peroxidase antibody ( TPOAb), thyroglobulin antibody ( TgAb), blood selenium, and urinary iodine concentration(UIC) levels were measured. Results The median level of urinary iodine among 239 women was 156. 96 μg/ L. The distributions of pregnant women with iodine deficiency, iodine adequate, more-than-adequate or excessive iodine intake were 43. 9％ , 38. 9％ , 17. 2％ , respectively. The percentage of more-than-adequate and excessive iodine in women with subclinical hypothyroidism was higher than that in women with euthyroidism. The serum TSH level in women with UIC≥250 μg/ L was higher than those with 150≤UIC<250 μg/ L and UIC<150 μg/ L (P<0. 05). The serum TSH level in women with blood selenium<95 μg/ L was higher than those with selenium≥95μg/ L(P<0. 05). Logistic regression analysis showed that the risk of subclinical hypothyroidism in women with UIC≥250 μg/ L was increased by 3. 498 fold(95％ CI 1. 588-7. 704)as compared with those with 150≤UIC<250 μg/ L. The risk of subclinical hypothyroidism in women with blood selenium <80 μg/ L was increased by 2. 667 fold (95％ CI 1. 123-6. 331) compared with those with 90 ≤ selenium < 100 μg/ L. After adjusting for age, gestational weeks, residential district, TPOAb, TgAb, taking compound nutritional supplements, more-than-adequate and excessive iodine still increased the risk of subclinical hypothyroidism(OR= 3. 014, 95％ CI 1. 310-6. 938). Women with UIC≥250 μg/ L and blood selenium <95 μg/ L revealed the increased risk of subclinical hypothyroidism as compared to those with 150≤UIC<250 μg/ L and selenium≥95 μg/ L(OR=5. 429, 95％ CI 1. 929-15. 281). After adjusting for age, gestational weeks, residential district, TPOAb, TgAb, taking compound nutritional supplements, the fingdings still existed. Conclusion The nutrient condition of iodine and selenium of the pregnant women in Tianjin during the first half pregnancy should be noticed. The individualized supplement of iodine and selenium, if needed, should be performed to decrease the risk of subclinical hypothyroidism.

Objective To evaluate the effects of maternal iodine nutrition levels on postpartum thyroid function, and to provide clinical evidence for accurate iodine supplementation in women with subclinical hypothyroidism during pregnancy. Methods This study collected single-pregnant women who had no history of thyroid diseases before pregnancy in our city. Thyroid function and urinary iodine results were continuously recorded during pregnancy and lactation. All subjects were divided into subclinical hypothyroidism group and euthyroidism group according to their thyroid function during pregnancy. The relationship between urinary iodine levels during pregnancy and lactation with postpartum thyroid function were analyzed. Results A total of 148 maternal women were collected, including 41 cases of subclinical hypothyroidism group and 107 cases of euthyroidism group. The urinary iodine level in pregnant women was higher than that in lactation ( median 174.75 vs 149.89μg/L, P<0.05) . However, the iodine deficiency ratio(23.6％) during pregnancy was higher than that during lactation (5.4％). There were significant differences in the change of urinary iodine in each time interval during pregnancy and lactation ( P<0.05). A total of 56 maternal women developed postpartum thyroiditis ( PPT). The incidence of PPT in pregnant women with TPOAb-positive in early pregnancy was higher than that in TPOAb-negative patients (χ2=10.811, P=0.001) . The urinary iodine concentration in the 12-month postpartum period was lower in women with PPT than that in womenwithoutPPT(P<0.05).Coxregressionanalysisshowedthatiodinedeficiencyduringlactation(HR=3.870, 95％CI 1.595-9.392, P=0.003) and TPOAb positive in early pregnancy (HR=3.679, 95％ CI 1.466-9.233, P<0.05) increased the risk of PPT. Subgroup analysis also showed a similar risk increase of PPT in women with hypothyroidism during pregnancy (HR=8.318, 95％CI 2.383-29.029, P<0.05). However, this association was not found in euthyroidism group. Conclusion The urinary iodine level of women during pregnancy and lactation in our iodine suitable areas is within normal range, but attention should still be paid to the effect of iodine deficiency on breast-feeding women, especially among those with subclinical hypothyroidism.

Objective:To investigate the application value of pelvic floor ultrasound in screening early postpartum stress urinary incontinence (SUI).Methods:A total of 220 postpartum women, who were admitted by the Department of Gynecology and Obstetrics of The People's Hospital of Hechi from January 2018 to June 2019, were selected for this study. These women were divided into SUI ( n = 52) and no SUI ( n = 168) groups according to whether SUI occurred within 42 days after delivery. Pelvic floor ultrasound parameters and clinical data were compared between the two groups. The effects of each ultrasound parameter on postpartum SUI were assessed. The receiver operating characteristic (ROC) curve was plotted for each parameter. The area under the ROC was calculated. The risk factors for postpartum SUI were investigated using the logistic regression analysis. Results:The number of deliveries (≥ 2 times), the proportion of women subjected to vaginal delivery, and neonatal weight in the SUI group were significantly higher than those in the no SUI group [ χ2 = 4.13, 3.30, t = 4.43, all P < 0.05]. There were significant differences in the bladder neck position and levator hiatus area in the resting state between the two groups ( t = 2.29, 3.09, both P < 0.05). There were significant differences in the bladder neck position, levator hiatus area, urethral rotation angle, and bladder neck mobility during the Valsalva movement between the two groups ( t = 13.14, 4.27, 15.64, 8.54, all P < 0.05). The areas under the ROC of bladder neck position and levator hiatus area in the resting state and the areas under the ROC of bladder neck position, levator hiatus area, urethral rotation angle, and bladder neck mobility during the Valsalva movement were 0.707, 0.725, 0.730, 0.771, 0.813, and 0.836, respectively. The area under the ROC of parameters used in combination was 0.849. Logistic regression analysis results revealed that the number of deliveries (≥ 2 times), bladder neck position (> 27.286 mm) and levator ani hiatus area in resting state (> 16.663 cm 2), and bladder neck position (< -2.774 mm), levator hiatus area (> 21.915 cm 2), urethral rotation angle (> 80.445°), and bladder neck mobility (> 30.501°) during the Valsalva movement were the risk factors for postpartum SUI. Conclusion:Combined use of pelvic floor ultrasound parameters is valuable for the diagnosis of postpartum SUI. Abnormal changes in the bladder neck position, levator ani hiatus area, urethral rotation angle, and bladder neck mobility are closely related to the occurrence of postpartum SUI. Therefore, combined use of pelvic floor ultrasound parameters can be preferred to screen early postpartum SUI.

Objective:To evaluate the effects of subclinical hypothyroidism during pregnancy treated with LT 4 on the growth and neuropsychology of offspring aged 0-36 months. Methods:A maternal-infant cohort was established in healthy singleton pregnant women aged 20-45 years without history of thyroid disease. Women developing subclinical hypothyroidism during pregnancy were treated with LT4. The weight, length, and head circumference of the offspring were recorded between 0 to 36 months after birth. Meanwhile, infant nutrition and family support were investigated. The Neuropsychological Development Questionnaire of 0-6 year old children was used to evaluate the neurodevelopment of offspring.Results:A total of 186 mother-infant pairs were included. All subjects were divided into the euthyroidism(ETH) group( n=136) and subclinical hypothyroidism(SHT) group( n=50) according to maternal thyroid function during pregnancy. The Z-scores(adjusted by months of age and gender) of weight, length, weight/length at birth, weight/length at 1 month, head circumference at 6 months, length at 8 months, weight/length at 24 months of SHT group were lower than those of the ETH group( P<0.05). Furthermore, the language competence of the SHT offspring at 12 months of age was also lower than that of the ETH group( P<0.05). Maternal subclinical hypothyroidism treated with LT 4 did not significantly affect preterm delivery, low birth weight, and developmental quotient <85, but reduced the risk of macrosomia(AOR 0.206, 95% CI 0.046-0.929, P=0.040). Conclusion:Although women with subclinical hypothyroidism received LT 4 treatment during pregnancy, the offspring still may suffer adverse effects on their growth and neural development.

Objective:To summarize initial experience of applying nanopore third-generation sequencing detection method (nanopore sequencing) for genetic diagnosis of non-classical 21 hydroxylase deficiency (NC 21-OHD), and to explore its performance and application prospects.Methods:Clinical data of the two NC 21-OHD patients, who were hospitalized at the First Affiliated Hospital of Zhengzhou University in May 2019, were collected. Peripheral venous blood was collected and genome DNA extracted. Genetic variants was detected by nanopore sequencing and underwent bioinformatic analysis. Pathogenetic mutations in CYP21A2 gene were validated with PCR-sanger sequencing in the two patients and their parents.Results:The average reads length and sequence depth in the patient one was 12, 792 bp and 27.19×. The average reads length and sequence depth in the patient two was 13, 123 bp and 21.34×. Compound variants of c.293-13C>G/c.844G>T (p.Val282Leu) and c.332_339delGAGACTAC (p.Gly111Valfs)/c.844G>T (p.Val282Leu) were detected in these two patients, which were consistent with clinical phenotype of NC 21-OHD. Further analysis showed that c.293-13C>G mutation was inherited from her father and c.844G>T (p.Val282Leu) mutation was inherited from her mother for the patient one. The c.844G>T (p.Val282Leu) mutation was inherited from her father and c.332_339delGAGACTAC (p.Gly111Valfs) mutation from her mother.Conclusions:The heterozygous mutations in CYP21A2 gene are the cause of NC 21-OHD in these two patients. Nanopore sequencing technique is a reliable new detection method for patients with NC 21-OHD.

Purpose: Anterior gradient 3 (AGR3) belongs to human anterior gradient (AGR) family. The function of AGR3 on cancer remains unknown. This research aimed to investigate if AGR3 had prognostic values in invasive ductal carcinoma (IDC) of breast cancer and could promote tumor progression. Materials and Methods: AGR3 expression was detected in breast benign lesions, ductal carcinoma in situ and IDC by immunohistochemistry analysis. AGR3’s correlations with clinicopathological features and prognosis of IDC patients were analyzed. By cell function experiments, collagen gel droplet-embedded culture drug sensitivity test and cytotoxic analysis, AGR3’s impacts on proliferation, invasion ability, and chemotherapeutic drug sensitivity of breast cancer cells were also detected. Results: AGR3 was up-regulated in luminal subtype of histological grade I-II of IDC patients and positively correlated with high risks of recurrence and distant metastasis. AGR3 high expression could lead to bone or liver metastasis and predict poor prognosis of luminal B. In cell lines, AGR3 could promote proliferation and invasion ability of breast cancer cells which were consistent with clinical analysis. Besides, AGR3 could indicate poor prognosis of breast cancer patients treated with taxane but a favorable prognosis with 5-fluoropyrimidines. And breast cancer cells with AGR3 high expression were resistant to taxane but sensitive to 5-fluoropyrimidines. Conclusion AGR3 might be a potential prognostic indicator in luminal B subtype of IDC patients of histological grade I-II. And patients with AGR3 high expression should be treated with chemotherapy regimens consisting of 5-fluoropyrimidines but no taxane.