Objective To explore the prevalence and the relative factors of the overweight and the obese in a population of Gansu Province pre-pregnancy women.and the effects of pre-pregnancy maternal body mass index (BMI) on gestational weight gain and pregnant outcome.Methods We conducted a populationbased birth cohort study in Gansu Province Maternity and Child Health Care Hospital from February,2010 to December,2011.Single live term birth women who have complete anthropometry were enrolled this study.They were categorized into four BMI groups according to World Health Organization's BMI recommendations for Asian populations.We explored the prevalence and the relative factors of the overweight and the obese,and the effects of pre-pregnancy maternal body mass index on gestational weight gain and birth outcomes by Chi-square test,analysis of variance.Results A total of 6 400 cases included in this study.The BMI range is from 13.3 to 38.1,the average BMI is (20.6 ±2.7).Among 6 400 cases,636 cases(9.9％) and 416 cases (6.5％) were overweight and obese.The average age (unit:years) is increase gradually in low weight group (27.8±3.8),normal group (29.1 ±4.3),overweight group (30.3 ±4.7) and obese group (30.6±4.6),the difference was statistically significant (F=77.490,P＜0.01).The result prompt that the median BMI increased with the increasing of maternal age (r=0.18,P＜0.01).The BMI of multiparous women (21.22 ±2.63) is higher than nulliparous women (20.43 ± 2.64),the difference was statistically significant (t=-9.630,P＜0.01).The BMI has negatively correlated with education level and economic income level (r=-0.06,P＜0.01; r=-0.04,P=0.036).With the increase of BMI,the weight gain of early (13 weeks) pregnancy (F=8.892,P＜ 0.01) and the total weight gain during whole pregnancy (F=21.700,P＜ 0.01) gradually reduced in four groups.The neonatal birth weight in overweight group is largest,in turn higher than obesity group,normal group and low weight group,the difference was statistically significant (F=11.261,P＜0.01).With increasing BMI,the incidence of pre eclampsia (x2=85.758,P＜0.05),gestational diabetes mellitus (x2=58.913,P＜0.05),postpartum hemorrhage (x2=13.501,P＜0.05),neonatal hypoglycemia (x2=6.563,P＜0.05) and neonatal pulmonary hyaline membrane (x2=9.579,P＜0.05) was increased.The incidence of caesarean section (x2=125.442,P＜0.05),macrosomia (x2=62.963,P＜0.05) and birth defects (x2=9.087,P＜0.05) also increased.The incidence of abnormal umbilical cord in overweight group is highest,in turn higher than normal group,low weight group,and the obesity group (x2=15.82g,P=0.001).The incidence of neonatal electrolyte disorder in obesity group was higher than low weight group,normal group,and the overweight group (x2=12.092,P=0.007).The incidence of preterm birth in overweight group is highest,in turn higher than obesity group,normal group and the low weight group (x2=7.865,P=0.049).Compared with the normal group,the risk of caesarean section (OR=l.700,95％ CI:1.325-2.181),pre-eclampsia (OR=2.436,95％ CI:1.578-3.761),gestational diabetes (OR=3.182,95％ CI:1.049-9.653) and abnormal umbilical cord (OR=2.252,95％ CI:1.267-4.004) in overweight group was increased.the risk of pre eclampsia (OR=2.585,95％ CI:1.020-6.914),macrosomia (OR=2.484,95％ CI:1.017 6.070),neonatal electrolyte disorder (OR=4.430,95％ CI:1.290-t5.217) in obesity group was increased.Conclusions The median BMI before pregnancy increased with increasing maternal age,parity,but decreased with education level and income level.The weight gain of early (13 weeks) pregnancy and the total weight gain during whole pregnancy decreased with increasing BMI.Overweight and obesity before pregnancy increased the risk the caesarean section,preeclampsia,gestational diabetes,macrosomia and neonatal electrolyte disorder.

Objective To evaluate the application of health education in patients with cholecystectomy. Methods From October 2009 to July 2010, 93 patients in our hospital with cholecystectomy were randomly divided into the control group (45 cases) and the observation group(48 cases). The control group was given routine nursing care, the observation group received perioperative health education in addition to the routine nursing care, then compared the nursing effect of two groups. Results In the observation group, the patients' knowledge and awareness rate of their own disease was 95.8%, and the control group was 80.0%, the difference was statistically significant between two groups. The recovery of gastrointestinal function in the observation group was significantly better than the control group, the difference was statistically significant between two groups. Conclusions Health education can enable patients with cholecystectomy correct understanding of their disease, eliminate negative emotions, and help the recovery of gastrointestinal function in patients, which is worthy of attention.

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Objective:To explore the association between dopamine-β-hydroxylase (DβH), norepinephrine transporter (NET) gene polymorphisms and panic disorder(PD).Methods:The structured clinical interview for the diagnostic and statistical manual of mental disorders fourth edition (DSM-Ⅳ) axis Ⅰ disorders was administered by trained clinical psychiatrist, 139 patients with PD(PD group) and 196 healthy controls(control group) were enrolled in the study.Single nucleotide polymorphism(SNP) genotyping was performed using an improved multiplex ligation detection reaction technique.SPSS 16.0 and PLINK softwares were used to compare the allele frequency and genotype distribution.Results:(1)Compared with control group, PD group carried more G allele(76.3% vs 68.4%) and fewer A allele(23.7% vs 31.6%) in NET rs5569, and the difference was significant(χ 2=4.986, OR=0.67, 95% CI: 0.47-0.95, P<0.05). However, the correlation was no longer significant after adjusting for Bonferroni’s multiple testing( P>0.05). (2)The additive model of NET rs5569 showed a association with PD ( OR=0.68, 95% CI: 0.48-0.96, P<0.05). And the recessive model of DβH rs1611114 showed a association with PD( OR=0.42, 95% CI: 0.18-0.96, P<0.05). However, these correlations were no longer significant after adjusting for Bonferroni's multiple testing( P>0.05). (3)No matter allele or genotype, there were no significant differences in DβH (rs129882, rs1611114, rs1611115) and NET (rs2242446, rs28386840) gene polymorphisms between panic disorder group and control group(all P>0.05). Conclusion:The present study indicates that there is no significant association of DβH and NET gene polymorphisms with PD.

Objective: To construct the public health performance evaluation index system for the county medical community, so as to provide reference for the assessment of the public health work in the county medical community. Methods: According to the 2019 Public Health Tasks of Zhejiang Province and the current status of the county medical community's public health work, a framework was developed. Twenty experts from universities, CDCs, and county medical community were invited to construct the index system after two rounds of Delphi expert consultation, and the index weight was determined by the analytic hierarchy process. Results : The experts aged ( 46.10±6.41 ) years and worked for ( 23.85±7.37 ) years, all of whom had a bachelor degree or above, and 18 had associate senior titles or above. The response rates of two rounds of consultation was both 100.00%; the authority coefficient was 0.811; the values of Kendall's W all had statistical significance ( P<0.05 ) , which in the second round were higher than those in the first round. The public health performance evaluation index system for county medical community finally included 10 first-level indexes, among which priority diseases surveillance and management weighed most ( 0.165 7 ) ; 32 second-level indexes, among which food-borne diseases surveillance, infectious diseases/public health emergencies reporting and infectious diseases/public health emergencies response weighed the top three ( 0.071 5, 0.064 7, 0.063 8 ); 120 third-level indexes, among which the timely reporting rate of food safety incidents, the reporting rate of infectious diseases and the information response rate of infectious diseases/public health emergencies weighed the top three ( 0.039 4, 0.022 1, 0.021 7 ). Conclusion The public health performance evaluation index system of the county medical community has been established, which can provide reference for the health administrative departments.

Intrahepatic cholangiocarcinoma (ICC) is the second most common primary liver cancer with a very poor prognosis.In order to guide better clinical management of ICC patients,the American Joint Committee on Cancer (AJCC) cancer staging manual (7th edition) have established a unique TNM staging scheme for separating ICC from hepatocellular carcinoma (HCC) for the first time,and reflected a difference between risk factor of ICC and HCC.This TNM staging system for ICC has been most recently updated by the AJCC cancer staging manual (8th edition),in which T staging has been redefined without gross features,and lymph node metastasis (N1) in N staging has been grouped as stage Ⅲ B,but not stage Ⅳ as required by the 7th edition of AJCC cancer staging manual.In addition,region lymphatic and distant metastases have been clearly redefined by the AJCC cancer staging manual (8th edition) that also requires recovering at least 6 lymph nodes for the N staging scheme.The apparent advantages of the AJCC cancer staging manual (8th edition) for ICC pathologic staging may better stratify the prognosis of ICC patients and provide an improved guidance in clinical practice.

Objective: To analyze the efficiency of ureteroscope and biopsy in the diagnosis of tumor grade, muscle-invasiveness and multifocality in suspected upper tract urinary carcinoma (UTUC) patients in order to find out whether it can be used in the risk stratification of UTUC patients.Methods: A retrospective study of 76 UTUC patients who underwent preoperative ureteroscope and/or biopsy and received radical nephroureterectomy in Peking University Third Hospital during January 2014 to December 2016 was undertaken.Results: In this study, 76 patients were included.There were 31 males (40.8%), and 45 females (59.2%).The median age was 64.5 years (31-88), and 51 patients had the symptom of hematuresis.The tumor was located in renal pelvis in 39 patients, and in ureter in 37 patients.Post-operative pathology confirmed that all the 76 patients included in this study suffered from UTUC, of whom 21 (21.6%) were of low-grade, 51 (67.1%) were of high-grade, 4 (5.3%) were undetermined, and 47 (61.9%) patients were muscle-invasive, and 27 (35.5%) were not, and 2 (2.6%) were undetermined.Among the 50 patients, in whom the grade of the tumor could be diagnosed by biopsy, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value for low-grade tumor was 88.2%, 69.7%, 76.0%, 60.0% and 92.0%, respectively.Among the 27 patients, in whom the muscle-invasiveness could be diagnosed by biopsy, 5 patients were diagnosed with muscle-invasiveness, all confirmed by pathology after surgery and 22 patients were diagnosed with none muscle-invasiveness, turned out to be 50% muscle-invasive and 50% none-muscle invasive after surgery.The accuracy was 59.3%.The accuracy of ureteroscopic biopsy to diagnosis multifocality was 61.0%.On univariate ana-lysis, biopsy grade was associated with postoperative pathology (P=0.001), while gender, age, side, body mass index (BMI), hematuresis, preoperative estimated glomerular filtration rate (eGFR), hydronephrosis, tumor size, location, multifocality and sessile were not associated with postoperative pathology grade.Biopsy grade (P=0.02), preoperative eGFR<90 mL/(min·1.73 m2)(P=0.025) and tumor located in pelvis (P=0.049) were associated with muscle invasiveness.Gender, age, side, BMI, hematuresis, hydronephrosis, tumor size, multifocality and sessile were not significantly associated with muscle invasiveness.Conclusion: Ureteroscope and biopsy can assist risk stratification in upper tract urothelial carcinoma patients.

BACKGROUND:B cell activating factor belonging to tumor necrosis factor family(BAFF)is essential to B cell differentiation,maturation,survival,and antibody secretion via binding to its receptors,and may play a role in the development of T cell response.Whether or not BAFF signal participates in the kidney allograft rejection is worthy of studying.OBJECTIVE:To analyze the expression and potential bioactivity of BAFF in the peripheral lymphocytes of kidney transplant recipients.DESIGN,TIME AND SETTING:A case observation was performed at the Department of Urology,Third Affiliated Hospital of Soochow University from June 2006 to March 2007.PARTICIPANTS:Eighty-six kidney transplant recipients comprising 60 males and 26 females,aged 12-62 years old,who received first-time kidney transplantation,were included.The serum creatinine levels ranged between 65-267 μmol/L.METHODS:Peripheral blood of follow-up recipients was taken for anticoagulation using EDTA-Na2.Renal graft biopsy samples of some patients were collected.MAIN OUTCOME MEASURES:The expression rates of BAFF+,BAFF-R+,CD4+,CD8+,CD4+ CD25+ CD127-/low,CD134+,CD4+ CD 134+ and CD19+ BAFF-R+ in peripheral mononuclear cells were analyzed,and the ratio of CD4/CD8 was calculated.Biopsy tissue was subjected to pathological and immunohistochemical analyses.RESULTS:BAFF expression rate on the peripheral mononuclear cells was between 0.18%-76.97%.15%was used as the cut-off value.In the ≥15%group,the mean value of BAFF expression rate was 36.91%;BAFF+ mononuclear cells were not significantly correlated to the ratio of peripheral CD4+/CD8+ and the CD4+ CD25+ CD127-/low T lymphocytes.However,there were significant correlations between BAFF+ mononuclear cells and CD134+ lymphocytes or CD4+ CD134+ lymphocytes(P ＜0.01,P ＜0.05,respectively).While in the ＜15%group,there were no significant correlations among all indices.Pathological diagnosis confirmed that BAFF was expressed in the renal tubular epithelial cell cytoplasm and cytomembrane staining of some chronic rejection sections.CONCLUSION:Abnormal high expression of BAFF in peripheral mononuclear cells may be related to renal allograft rejection.

Objective To investigate the possibility of inducing mesenchymal stem cells(MSCs)from human umbilical cord Wharton's Jelly to differentiate into spermatogonia.Methods To isolate,culture and purify MSCs with adherent method,the growth and proliferation of human umbilical cord-derived MSCs were observed,and their immunophenotypes were determined by flow cytometry;MSCs of the third generation were divided into 2 groups to be induced and cultured,MSCs of the control group were cultured in basal medium,while those of the experimental group with conditional medium.The morphologic and ultrastructure changes of control group and experimental group cells were compared with phase contrast microscopy,electron microscopy(EM)and transmission electron microscope(TEM)respectively ;the spermatogonial cells differentiated were then evaluated by immunohistochemistry stained for CD117and CD49f ;the method of Western-blot was used to test if the cells induced could express CD49f.Results A population of MSCs were isolated from human umbilical Wharton's Jelly;they were processed to obtain a fibroblast-like population of cells and could be maintained in vitro for extended periods with stable population doubling;After induction,the shape of MSCs changed greatly from the fibroblast to the round,even familiar to the tadpole;expressed the known molecular markers of spermatogonial cells,such as CD49f,CD117.Conclusion The induced MSCs not only undergo spfermatogonial-cell like morphologic changes,ultramicrostructure mature with increasing cell organs,but also express the spermatogonial cell markers,which show that human umbilical cord derived MSCs are capable of differentiating into spermatogonial cell.

Objective: To investigate the characteristics of dominant bacteria of colonic lavage fluid in patients with diarrhea-predominant irritable bowel syndrome (IBS). Methods: Forty-six patients with diarrhea-predominant IBS (observation group) and 46 patients with abdominal pain or discomfort who was excluded IBS (control group) from January 2016 to January 2019 in Department of Gastroenterology, Shenzhen Longhua District People′s Hospital were selected. During colonoscopy, 2 pieces of descending colonic mucosal tissues were taken by forceps, then 4 ml of colonic lavage fluid was collected from the mucosa tissues to extract total DNA, and 10 dominant bacteria were detected by real-time fluorescence quantitative polymerase chain reaction (including Bacteroides, Bacteriodes prevotella, Bifidobacterium, Clostridium, Enteropathogenic Escherichia coli, Dialister pneumosintes, Firmicutes, Faecalibacterium prausnitzii, Salmonella, Lactobacillus, and data were selected for logarithm). The correlation of dominant bacteria between colonic mucosal tissues and colonic lavage fluid was analyzed by Spearman correlation analysis. Results: The composition and change of dominant bacteria of colonic mucosal tissues and colonic lavage fluid were basically the same in 2 groups. The numbers of Bacteroides, Bacteriodes prevotella, Clostridium in colonic mucosal tissues and colonic lavage fluid, and the numbers of Faecalibacterium prausnitzii in colonic lavage fluid of observation group were significantly lower than those in the control group (colonic mucosal tissues: 3.68 ± 0.54 vs. 4.34 ± 0.27, 4.26 ± 0.28 vs. 5.33 ± 0.42, 4.46 ± 0.68 vs. 4.99 ± 0.61; colonic lavage fluid: 3.26 ± 0.61 vs. 4.09 ± 0.51, 3.10 ± 1.42 vs. 4.86 ± 1.03, 5.24 ± 0.54 vs. 5.95 ± 0.51, 2.24 ± 1.83 vs. 3.24 ± 1.46), and there were statistical differences (P<0.01 or <0.05). There was no statistical differences in other dominant bacteria in colonic mucosal tissues and colonic lavage fluid between 2 groups (P>0.05). Spearman correlation analysis result showed that the Bifidobacterium, Firmicutes, Faecalibacterium prausnitzii, Lactobacillus colonic mucosal tissues were positively correlated with colonic lavage fluid (r = 0.427, 0.689, 0.577 and 0.369; P = 0.041, 0.013, 0.024 and 0.035), and Enteropathogenic Escherichia coli and Salmonella were negatively correlated with colonic lavage fluid (r = -0.352 and -0.649, P = 0.026 and 0.013). Conclusions The composition of dominant bacteria in colonic mucosal tissues and colonic lavage fluid is basically the same, and an imbalance of the microbiota in colonic lavage fluid is found in diarrhea-predominant IBS patients. The numbers of Bacteroides, Bacteriodes prevotella, Clostridium and Faecalibacterium prausnitzii significantly decrease.