Objective:To investigate the prevention and treatment status of venous thromboembolism (VTE) of pregnant women in general hospitals and specialized hospitals in China.Methods:This study was a cross-sectional survey about VTE prevention and treatment in 112 hospitals across China from January 1st to December 31st, 2019, including general information, resource accessibility, hospital system and strategy. According to the characteristics, the hospitals were divided into general hospital group (70 hospitals) and specialized hospital group (42 hospitals). The basic information, VTE diagnosis and treatment resources, prevention systems and the preference of the VTE risk assessment form of the two groups were compared. Logistic regression was used to analyze the proportion of VTE incidence and related factors in the two groups of hospitals.Results:(1) The median annual delivery volume of the general hospital group was significantly lower than that of the specialized hospital group (3 428 vs 9 969 cases, P<0.01), the diagnostic accessibility of CT pulmonary angiography (CTPA) was significantly higher than that of the specialized hospital [92.9% (65/70) vs 59.5% (25/42), P<0.01], and the proportion of obstetric VTE risk assessment was significantly higher than that of the specialized hospital group [85.7% (60/70) vs 66.7% (28/42), P=0.017]. (2) Among the 88 hospitals using the VTE risk assessment sheet, the utilization rate of the evaluation sheet recommended by the obstetric VTE guideline in specialized hospitals (78.6%, 22/28) was higher than that of general hospitals (48.3%, 29/60), and the difference was statistically significant ( P=0.007). (3) The proportion of VTE incidence in general hospital group was 0.126% (360/286 517), and the proportion of VTE incidence in specialized hospital group was 0.032% (154/484 111). Logistic regression analysis showed that the OR value of the specialized hospital group was 0.253 (95% CI: 0.209-0.305) and the difference was statistically significant ( P<0.01) compared with the general hospital group. After adjusting the hospital level, B-ultrasonography and CTPA accessibility, whether to establish a risk assessment and obstetric VTE system, the proportion of VTE incidence in specialized hospitals was still lower than that in general hospitals ( OR=0.307, 95% CI: 0.251-0.376, P<0.01). Conclusions:General hospitals have higher access to resources for diagnosing VTE than specialized hospitals, and the VTE evaluation system is better implemented. The utilization rate of the obstetric VTE guidelines in specialized hospitals is higher than that of general hospitals.

OBJECTIVE: To compare the efficacy of metformin plus megestrol acetate (MA) with that of MA alone for treating endometrial atypical hyperplasia (EAH). METHODS: This pilot study included 16 EAH patients who met at least one metabolic syndrome (MS) criterion and received either adjunctive metformin plus MA (MET group) or MA monotherapy (MA group). Each patient in the MA group received 160 mg of MA daily, whereas patients in the MET group received the same dose of MA plus 0.5 g of metformin thrice daily. Treatment response was assessed by histological examination of dilation and curettage specimens obtained after 12 weeks of therapy. RESULTS: Each group had eight patients, and half of the patients in each group were diagnosed with MS. The complete response (CR) rate was 75% (6/8) in the MET group and 25% (2/8) in the MA group (p=0.105). Complications of MS did not affect the response rates in either group. In the MET group, 75% (3/4) of the patients had CR in the presence or absence of MS. In the MA group, 50% (2/4) of the patients with MS had CR, whereas no patient without MS had CR. No irreversible toxicities were observed. CONCLUSION: Metformin plus MA may be a potential alternative therapy for treating EAH, and the MS status of patients may have no effect on the efficacy of metformin plus MA therapy.
Adult ; Antineoplastic Agents, Hormonal/*therapeutic use ; Drug Therapy, Combination ; Endometrial Hyperplasia/complications/*drug therapy/metabolism ; Female ; Humans ; Hypoglycemic Agents/*therapeutic use ; Megestrol Acetate/*therapeutic use ; Metabolic Syndrome X/complications/metabolism ; Metformin/*therapeutic use ; Pilot Projects ; Receptors, Estrogen/metabolism ; Receptors, Progesterone/metabolism ; Single-Blind Method ; Treatment Outcome

Objective To explore the predictive accuracy of two estimated fetal weight ( EFW ) standards ( INTERGROWT H and Hadlock) and Doppler parameters for late-onset fetal growth restriction ( FGR) . Methods A prospective cohort of women with singleton pregnancies who attended research scans and had a livebirth at the obstetrics and gynecology hospital of Fudan University during 32 - 41 weeks of gestation was involved . The markers of ultrasound examinations (including growth measurements ,umbilical artery and middle cerebral artery parameters) were obtained every two weeks . The INTERGROWT H -EFWc and Hadlock-EFWc data were obtained from the last ultrasonography ( within 7 days before delivery) and were used to predict later-onset FGR in a single model or in combined models with other Doppler parameters by logistic regression analyses ,respectively . According to delivery gestation of age and Chinese birth weight (BW) standards ,all cases were divided into a control group ( non-FGR ,BW ≥ 10th ％ ) and a FGR group ( Late-onset FGR ,BW < 10th ％ ) . ROC curve analyses were performed to compare the predictive accuracy for the late-onset FGR between the Hadlock-EFWc and INTERGROWT H-EFWc . Results A total of 820 eligible women were identified and 676 had finished the follow-up and were enrolled in this prospective cohort study . Among them ,116 neonates were assigned to the late-onset FGR group ,and 560 as control group ( non-FGR) . The cut-off value of the INTERGROWT H-EFWc was percentile 27 .5 ,at which had a sensitivity and specificity of 71 .4％ and 83 .7％ . The corresponding sensitivity and specificity were 87 .3％ and 82 .8％ at a cut-off value of percentile 22 .6 of the Hadlock-EFWc . The Hadlock-EFWc had a higher predictive accuracy for the late-onset FGR than the INTERGROWT H-EFWc ,their AUC were 0 .930 ( 0 .908 - 0 .953 ) and 0 .847 ( 0 .807 - 0 .888 ) ,respectively . The accuracy of Doppler single-parameter ( umbilical artery and middle cerebral artery) for late-onset FGR were low ( AUC < 0 .7) ,but the accuracy of combined model- Ⅰ and Ⅱ were high ( AUC 0 .865 and 0 .936 ,respectively) ,similar to their corresponding EFWc models ,respectively . Conclusions The INTERGROWT H-EFWc could predict effectively for late-onset FGR ,however ,its predictive accuracy is lower than that of the Hadlock-EFWc . The predictive accuracy of Doppler parameters for late-onset FGR are poor ,routine monitoring of non-selected populations is not recommended .

Objective To investigate the role of diffusion kurtosis imaging (DKI) in indeterminate solitary pulmonary nodules (SPN) diagnosis and to compare with conventional diffusion weighted imaging (DWI). Methods From March 2016 to Dec 2017, forty-three consecutive patients (30 male, 13 female, age: 56 ± 11 years) with indeterminate SPNs were included. All patients underwent axial multi-b factor DWI (with b values=0, 50, 200, 400, 800, 1400, 2000 s/mm2) examination and were divided into benign group (19 cases) and malignant group (24 cases) according to pathological results of SPN. ADC Kurtosis (K) and Diffusivity (Dk) values were compared between malignant and benign group and among different subtypes of lung cancer using independent t test (normal distribution and homogeneity of variance) and Mann-Whitney U test (skewed distribution or variance). Receiver operating characteristic (ROC) curves were employed to evaluate the diagnostic performance. Results K values were significantly higher for malignant SPNs than for benign SPNs (0.839 ± 0.197 vs. 0.718 ± 0.120;t=2.359, P=0.023). ADC values were found to be significantly higher in benignity than malignant SPNs [(1.605 ± 0.422) × 10-3mm2/s vs. (1.278 ± 0.210) × 10-3mm2/s; t=-3.089, P=0.005). No difference was observed in Dk between the two groups (P=0.922). All parameters cannot differentiate subtypes of lung cancer. The ADC value had higher AUC (area under ROC curve) than that of K value. The sensitivity (70.8％) and accuracy (72.1％) of ADC value was higher than K value, the specificity of both methods was equal. Conclusion DKI is a feasible non-invasive tool which has comparable capability of conventional DWI in SPNs differentiation, although with lower sensitivity and accuracy. DKI can provide additional information for SPNs characterization and has a potential to be a robust way in SPNs interpretation.

Objective:To learn about the monitoring indicators and patient management in coal-burning-borne endemic arsenic poisoning areas in Shaanxi Province, and provide a basis for consolidating and improving the prevention and control achievements.Methods:From March to December 2023, in accordance with the requirements of the "Notice of the Office of Shaanxi Provincial Health Commission on Issuing of the Monitoring Plan for Key Endemic Diseases Such as Kashin-Beck Disease" and "The Monitoring Plan for Endemic Fluorosis and Arsenic Poisoning in Shaanxi Province", a basic situation investigation was conducted in the affected villages of all counties (districts) with coal-burning-borne endemic arsenic poisoning in Shaanxi Province, and on-site visits were conducted to check the management of high arsenic coal mines. Using the simple random sampling method, 30 families in each village were selected to investigate the use of stoves and the formation of health-related behaviors. A survey on arsenic poisoning was carried out among all populations in the affected villages. According to the requirements of the provincial monitoring program, 720 people were randomly selected from 12 affected villages in 3 monitoring counties to measure their urinary arsenic level. The determination was based on the "Guidelines for the Safety of Urinary Arsenic in Population" (WS/T 665-2019). The evaluation for elimination of disease areas was carried out in accordance with the "National Health Commission Issued the Evaluation Approach for Control and Elimination of Priority Endemic Diseases (2019 edition)".Results:A total of 2 cities, 8 counties (districts), 99 townships, and 1 414 affected villages were monitored. All 53 high arsenic coal mines had stopped mining. The rate of qualified improved stoves was 99.97%; the correct utilization rate of qualified improved stoves, and the correct drying rate of corn and chili peppers provided for human consumption in the affected villages were 100.00%. A total of 2 064 138 people were examined, and 2 682 cases of arsenic poisoning were detected, all of whom were historical patients. There were no new cases of arsenic poisoning or skin cancer. There were currently 2 682 arsenic poisoning patients who had received family doctor contract services and implemented follow-up management. The geometric mean of urinary arsenic was 0.016 7 mg/L, which was lower than the safety guideline value for human urinary arsenic (0.032 mg/L).Conclusions:The monitoring indicators in the coal-burning-borne endemic arsenic poisoning areas in Shaanxi Province have reached the elimination standards. In the future, we should continue to strengthen the management of high arsenic coal mines, implement comprehensive prevention and control measures mainly focused on furnace and stove renovation and health promotion, and do a good job in patient management to continuously consolidate and improve the prevention and control achievements.