Objective To explore the effects of oligohydramnios in the late trimester of pregnancy on perinatal infants.Methods Two hundred and sixty-eight pregnant women with oligohydramnios,admitted from June 2000 to June 2007,were involved in present study,and homochronous 300 pregnant women with normal volume of amniotic fluid were enrolled as control group.The clinical data were analyzed to evaluate the influence of oligohydramnios on perinatal infants and on the outcome of delivery.Results The incidences of newborn distress,meconium-contaminated amniotic fluid,apnoea neonatorum,aspiration pneumonia and perinatal infant mortality were obviously higher in the oligohydramnios group than those in control group(P

Objective To evaluate the efficacy of double filtration plasmapheresis (DFPP) in the treatment of patients with refractory rheumatoid arthritis (RA). Methods Eighty-two patients were randomly aesigned,42 to the DFPP group and 40 to the no-DFPP group. All patients previously experienced an incomplete response to 2-3 dis-ease-modifying antirheumatic drugs (DMARDs) and 1-2 nonsteroidal anti-inflammatory drugs (NSAIDs) or predni-sene. All patients received sulphasalazine (SASP,0.75 g three times daily) plus methotrexate (MTX, 10 mg orally once weekly). DFPP was performed once a week for 2-3 sessions. A total of 121 plasmapheresis procedures were per-formed in 42 patients. Control patients did not receive sham DFPP. The efficacy measures recorded one day after the final treatment and latest month in follow up for 12～24 months included the American College of Rheumatology 20% ,50% ,and 70% improvement criteria (ACR20, ACR50, and ACR70), the Health Assessment Questionnaire estimate of disability (HAQ); and the disease activity index. Results Patients in the DFPP group had ACR 20, ACR 50 and ACR 70 improvements of 100% ,92.9% and 81.0%,as compared with the patients in no-DFPP group 17.5% ,0,and 0 (P<0.001). Significant change from baseline was observed in HAQ scores in the DFPP group but not in the no-DFPP group (P<0.001). The changes from baseline in the disease activity scores were significantlygreater than in the no-DFPP group (P<0.001). Conclusion DFPP therapy significantly alters the signs and symp-toms of refractory RA. There are significant increases in physical function and improvement in quality of life.

Objective To investigate the clinical significance of children bronchial asthma detection by using negative expiratory pressure (NEP) technique.Methods The children with bronchial asthma admitted to Department of Pediatrics of Zhejiang Provincial Integrated Traditional Chinese and Western Medicine Hospital from March 2016 to March 2018 were enrolled.They were divided into mild group (0-4 scores) and severe group (5-12 scores) according to asthma clinical scoring criteria.The children undergoing physical examination at the same period were served as healthy control group.NEP technique and tidal volume (VT) were detected by the pulmonary function instrument.Respiratory flow-volume curves (F-V curves) without NEP were compared with tidal F-V curves after NEP application to assess expiratory flow limitation (EFL).EFL index was calculated according to the percentage of expiratory VT after EFL and expiratory VT when NEP was not used.Pearson correlation method was used to analyze the relationship between EFL index and severity of bronchial asthma.Receiver operating characteristic (ROC) curve was plotted to analyze the value of EFL index in evaluating the severity of bronchial asthma in children.Results A total of 86 children with bronchial asthma were enrolled in the study,and 84 patients completed the test and 2 children withdrew due to other diseases.Finally,84 patients were included in the final analysis,including 41 mild and 43 severe children.Forty-two healthy children in the same period were served as healthy control group.There was no significant difference in gender or age among the groups,and no adverse reactions occurred during the test.The EFL index of children with bronchial asthma was significantly higher than that of the healthy control group,and it was increased with the severity of the disease [mild group compared with healthy control group:(30.60± 6.03)％ vs.(6.64 ± 2.37)％,severe group compared with healthy control group:(33.70 ± 5.41)％ vs.(6.64 ± 2.37)％,both P ＜ 0.05].There was no significant difference in respiratory rate (RR) or VT between mild group or severe group and healthy control group [RR (times/min):31.45 ± 4.18,32.81 ± 4.07 vs.31.97 ± 4.01,VT (mL/kg):6.29 ± 1.14,5.96 ± 0.90 vs.6.30 ± 1.20,all P ＞ 0.05].It was shown by the correlation analysis that EFL index was positively correlated with the severity of asthma (r =0.836,P =0.000).It was shown by ROC curve analysis that the area under ROC curve (AUC) of EFL index for predicting the severity of bronchial asthma in children was 0.801 [95％ confidence interval (95％C/) =0.725-0.878];when the best cut-off value of EFL index was 29.21％,the sensitivity was 85.7％,the specificity was 69.2％,the positive predictive value was 75.1％,and the negative predictive value was 60.2％.Conclusions The EFL index measured by NEP technology was closely related to the severity of bronchial asthma.The higher the EFL index,the more serious of the condition.The severity of bronchial asthma could be early judged by EFL index,which provided a basis for the evaluation and treatment of bronchial asthma.

Objective:To compare the accuracy of the needle tip reaching the target tissue between two subcutaneous injection techniques under ultrasound imaging in order to provide a basis for clinical injection to make a safe and reasonable decision.Methods:This was a parallel controlled non-inferiority comparative study. A total of 68 patients who received subcutaneous injections in the outpatient injection room of Nanjing Drum Tower Hospital Affiliated to Nanjing University from June 2021 to September 2022 were selected as the research subjects, and they were divided intothe A and B group according to the random number table method, there were 34 cases in each group. Group A received pinched skin injections, and group B received taut skin injections. Unify the injection site, injection needle length, and needle insertion angle. The accuracy rate of the needle tip reaching the target tissue, namely the subcutaneous fat layer, was compared between the two groups by ultrasound imaging, and the pain scores and the imaging performance during the injection process were observed.Results:The accuracy of the needle tip reaching the subcutaneous fat layer in the group A was 97.1%(33/34), which compared with the 100.0%(34/34) in the group B, there was no significant difference ( χ2 = 0.53, P>0.05). There was no significant difference about the distribution of pain scores between the two groups ( χ2 = 0.67, P>0.05). There were no significant differences about age, subcutaneous fat thickness and the distance from the needle tip to the myofascial in patients with different pain scores ( F = 1.20, 0.44, H = 0.64, all P>0.05). Conclusions:Under certain conditions, pinching the skin and tightening the skin have the same accuracy and safety when the needle tip reaches the subcutaneous fat layer of the target tissue, and the choice should be made according to the clinical situation. Imaging observations have enlightening significance for the practice of subcutaneous injection.

Objective To report one case of the children's acute rhabdomyolysis(RM) with myocardial hypertrophy for the first time and the related data in order to improve the clinical diagnose and the treatment efficacy.Methods Clinical data of the patient with myocardial hypertrophy and pericardial effusion treated in the Heart Center of Beijing Children's Hospital Affiliated to Capital Medical University were retrospectively analyzed.According to the symptoms,signs,laboratory examination,the diagnosis was made and related literature was reviewed.Results A 7-years-old girl was characterized by myalgia,weakness,and dark urine.Physical examination showed extremity swelling,clammy skin,lower extremity muscle tenderness positive.Creatine kinase (CK) and myoglobin levels increased.So she was clearly diagnosed of acute RM undoubtedly.Without physical,metabolic and autoimmune factors,the patient was only had positive mycoplasma antibodies and might be coursed by mycoplasma infection.The muscular involvement was so severe that the patient had the heart failure,myocardial hypertrophy and pericardial effusion was conformed to ultrasound cardiogram(UCG).After treatment with hydration,alkalization,anti-infection,support and symptomatic therapy for a few days,the clinical symptoms improved obviously,CK returned to normal,myocardial hypertrophy and pericardial effusion disappeared.One-year-follow-up study indicated that the child's animal force and body movements were norrmal,and CK and UCG were negative.Conclusions Acute RM is a rare disorder and less recognized in children,and myocardial hypertrophy and pericardial effusion may be caused by acute RM.If the diagnosis and treatment are done earlier,the prognosis will be good,without permanent complications.

Purpose: The prevalence of multi-morbidities with colorectal cancer (CRC) is known to be increasing. Particularly prognosis of CRC patients co-diagnosed with metabolic syndrome (MetSyn) was largely unknown. We aimed to examine the death risk of CRC patients according to the multiple MetSyn morbidities. Materials and Methods: We identified CRC patients with MetSyn from the electronic medical records (EMR) systems in five independent hospitals during 2006-2011. Information on deaths was jointly retrieved from EMR, cause of death registry and chronic disease surveillance as well as study-specific questionnaire. Cox proportional hazards regression was used to calculate the overall and CRC-specific hazards ratios (HR) comparing MetSyn CRC cohort with reference CRC cohort. Results: A total of 682 CRC patients in MetSyn CRC cohort were identified from 24 months before CRC diagnosis to 1 month after. During a median follow-up of 92 months, we totally observed 584 deaths from CRC, 245 being in MetSyn cohort and 339 in reference cohort. Overall, MetSyn CRC cohort had an elevated risk of CRC-specific mortality (HR, 1.49; 95% confidence interval [CI], 1.07 to 1.90) and overall mortality (HR, 1.43; 95% CI, 1.09 to 1.84) compared to reference cohort after multiple adjustment. Stratified analyses showed higher mortality risk among women (HR, 1.87; 95% CI, 1.04 to 2.27) and specific components of MetSyn. Notably, the number of MetSyn components was observed to be significantly related to CRC prognosis. Conclusion Our findings supported that multi-morbidities of MetSyn associated with elevated death risk after CRC. MetSyn should be considered as an integrated medical condition more than its components in CRC prognostic management.

Purpose: The prevalence of multi-morbidities with colorectal cancer (CRC) is known to be increasing. Particularly prognosis of CRC patients co-diagnosed with metabolic syndrome (MetSyn) was largely unknown. We aimed to examine the death risk of CRC patients according to the multiple MetSyn morbidities. Materials and Methods: We identified CRC patients with MetSyn from the electronic medical records (EMR) systems in five independent hospitals during 2006-2011. Information on deaths was jointly retrieved from EMR, cause of death registry and chronic disease surveillance as well as study-specific questionnaire. Cox proportional hazards regression was used to calculate the overall and CRC-specific hazards ratios (HR) comparing MetSyn CRC cohort with reference CRC cohort. Results: A total of 682 CRC patients in MetSyn CRC cohort were identified from 24 months before CRC diagnosis to 1 month after. During a median follow-up of 92 months, we totally observed 584 deaths from CRC, 245 being in MetSyn cohort and 339 in reference cohort. Overall, MetSyn CRC cohort had an elevated risk of CRC-specific mortality (HR, 1.49; 95% confidence interval [CI], 1.07 to 1.90) and overall mortality (HR, 1.43; 95% CI, 1.09 to 1.84) compared to reference cohort after multiple adjustment. Stratified analyses showed higher mortality risk among women (HR, 1.87; 95% CI, 1.04 to 2.27) and specific components of MetSyn. Notably, the number of MetSyn components was observed to be significantly related to CRC prognosis. Conclusion Our findings supported that multi-morbidities of MetSyn associated with elevated death risk after CRC. MetSyn should be considered as an integrated medical condition more than its components in CRC prognostic management.

The effect of anti-programmed cell death 1 (anti-PD-1) immunotherapy is limited in patients with hepatocellular carcinoma (HCC). Yes-associated protein 1 (YAP1) expression increased in liver tumor cells in early HCC, and Akkermansia muciniphila abundance decreased in the colon. The response to anti-PD-1 treatment is associated with A. muciniphila abundance in many tumors. However, the interaction between A. muciniphila abundance and YAP1 expression remains unclear in HCC. Here, anti-PD-1 treatment decreased A. muciniphila abundance in the colon, but increased YAP1 expression in the tumor cells by mice with liver tumors in situ. Mechanistically, hepatocyte-specific Yap1 knockout (Yap1^LKO) maintained bile acid homeostasis in the liver, resulting in an increased abundance of A. muciniphila in the colon. Yap1 knockout enhanced anti-PD-1 efficacy. Therefore, YAP1 inhibition is a potential target for increasing A. muciniphila abundance to promote anti-PD-1 efficacy in liver tumors. Dihydroartemisinin (DHA), acting as YAP1 inhibitor, increased A. muciniphila abundance to sensitize anti-PD-1 therapy. A. muciniphila by gavage increased the number and activation of CD8⁺ T cells in liver tumor niches during DHA treatment or combination with anti-PD-1. Our findings suggested that the combination anti-PD-1 with DHA is an effective strategy for liver tumor treatment.