Objective To investigate the association between the duration of second stage of labor and maternal and neonatal outcomes in pregnant women complicated with hypertensive disorders,dysglycaemia (including gestational diabetes mellitus and diabetes mellitus complicating pregnancy) or primipara-inadvanced-age,and in normal pregnant women after implementation of new partogram.Methods A retrospective analysis was performed on all nulliparous women with the duration of second stage of labor ≥2 h at Beijing Obstetrics and Gynecology Hospital,Capital Medical University between October 1,2014 and March 31,2015.Women with preterm labor,multiple gestation,noncephalic presentations,fetal malformations,placenta previa,or induction of labor after fetal death were excluded.And 279 women who met the inclusion criteria served as study group.Among the 279 women,25 had hypertensive disorders (hypertension group),46 had dysglycaemia (dysglycaemia group),and 35 had primipara-in-advanced-age (primipara-in-advanced-age group),and the remaining 177 women served as ordinary study group.According to the duration of second stage,the ordinary study group was divided into three subgroups:≥ 2-＜2.5 h (n=90),≥ 2.5-＜3 h (n=51),and ≥ 3 h(n=36).And 340 women with the duration ＜ 2 h were selected randomly as control group,including 24 with hypertensive disorders (hypertension control group),61 with dysglycaemia (dysglycaemia control group),and 41 with primipara-in-advanced-age (primipara-in-advanced-age control group);the remaining 226 women served as ordinary control group.Maternal and neonatal outcomes in these two groups were analyzed with Rank sum test,Chi-square test or Fisher's exact test.Results (1) Dysglycaemia group had a longer first stage of labor,lower rate of spontaneous labor and higher rate of forcep-assisted delivery than its counterpart control group [11.88(8.42-16.06) vs 8.17(5.00 14.12) h,67.4％(31/46) vs 91.8％(56/61),and 30.4％(14/46) vs 8.2％(5/61),respectively,all P＜0.05].Primipara-in-advanced-age group had a longer first stage of labor,higher intervention rate,lower spontaneous labor rate and higher rate of forcep-assisted delivery than its counterpart control group [12.33(7.17-20.50) vs 7.50(4.00-15.12) h,61.8％(21/34) vs 36.6％(15/41),60.0％(21/35) vs 90.2％(37/41),and 34.3％(12/35) vs 9.8％(4/41),respectively,P＜0.05].Compared with ordinary control group,women in the ordinary study group,≥ 2-＜2.5 h,≥ 2.5-＜3 h and ＞3 h subgroup had a longer first stage of labor,higher labor intervention rate,and lower spontaneous labor rate (all P＜0.05).Ordinary study group and ≥ 3 h subgroup had higher rates of labor analgesia and forcep-assisted delivery than the ordinary control group.The forcepassisted delivery rate in ≥ 2.5-＜3 h subgroup and cesarean section rate in ≥ 3 h subgroup were all higher than in ordinary control group (P＜0.05).(2) Hypertension group had a higher incidence of postpartum hemorrhage than its corresponding control group while primipara-in-advanced-age group had a higher incidence [48.0％(12/25)vs 20.8％(5/24),and 34.3％(12/35) vs 7.3％(3/41),both P＜0.05).Ordinary study group,≥ 2.5-＜3 h subgroup and ≥ 3 h subgroup had higher rates of postpartum hemorrhage and adverse wound healing than the ordinary control group (all P＜0.05).(3) Compared with ordinary control group,≥ 2-＜2.5 h subgroup had a higher rate of neonatal asphyxia,≥ 2.5-＜3 h subgroup had higher fetal macrosomia proportion,and ≥ 3 h subgroup had a higher rate of admission to neonatal intensive care unit (all P＜0.05).In ordinary study group,6(3.4％) out of the 177 cases had neonatal asphyxia,all in the ≥ 2-＜2.5 h subgroup [6.7％(6/90)],which was higher than in the ordinary control group [0.9％ (2/226)],P＜0.05.Conclusions With the prolonged duration of the second stage,the risk of adverse matemal and neonatal outcomes increases.For pregnant women complicated with hypertensive disorders,dysglycaemia or primipara-in-advanced-age,the duration of the second stage of should not be prolonged.

Objective To investigate the sustained release of BSA from chitosan-OREC/BSA films coated mats in vitro.Methods The negatively charged cellulose acetate (CA) fibrous mats were modified with multilayers of the positively charged chitosan or chitosan-OREC intercalated composites and the negatively charged bovine serum albumin (BSA) via electrostatic layer-by-layer (LBL) self-assembly technique.The adsorption and rinsing steps were repeated until the desired number of deposition bilayers was obtained.The in vitro BSA encapsulation and release experiments demonstrated that OREC could affect the degree of protein loading capacity and release ficiency of the LBL films coating.Results In the pH-gradient release assay,only a small amount of BSA was released from the mats in 1 h.As the time increased,the release rate of BSA of all the samples gradually went up to the maximum data within 8 h.For the samples with identical number of bilayers and record time,obvious increasing of the release amount could be seen in pH 7.4,in comparison with pH 1.2.Besides,doubling bilayers film-coated mats generally.Meanwhile,it was slightly distinguishable between 5 and 5.5 as well as 10 and 10.5 bilayers (t=0.651～ 1.324,P＞0.05).Interestingly,it could be seen that protein release of the chitosan-OREC/BSA films coated mats remarkably increased compared with that of chitosan/BSA films coated mats(t=2.264～ 2.305,P＜0.05).Conclusion The release of protein in the initial time could be controlled by adjusting the number of deposition bilayers,the outmost layer and the composition of coating bilayers.

Objective To investigate the risk of emergency cesarean section during labor with the pre-pregnancy body mass index or gestational weight gain.Methods A total of 6 908 healthy nullipara with singleton pregnancy and cephalic presentation who was in term labor in Beijing Obstetrics and Gynecology Hospital from August 1st,2014 to September 30th,2015 were recruited.They were divided into two groups,the vaginal delivery group (92.88％,6 416/6 908) and the emergency cesarean section group (7.12％,492/6 908).According to WHO body mass index (BMI) classification criteria and the pre-pregnancy BMI,the 6 908 women were divided into three groups,the underweight group(BMI＜18.5 kg/m2;17.39％,1 201/6 908),the normal weight group(18.5-24.9 kg/m2;73.00％,5 043/6 908),the overweight and obese group (≥ 25.0 kg/m2;9.61％,664/6 908).According to the guidelines of Institute of Medicine (IOM),they were divided into three groups,the inadequate gestational weight gain (GWG) group (16.72％,1 155/6 908),the appropriate GWG group (43.11％,2 978/6 908),the excessive GWG group (40.17％,2 775/6 908).Unadjusted and adjusted odds ratio (OR) and confidence interval (CI) of the risk of emergency cesarean section were calculated by bivariate logistic regression.Results (1) Comparing to the vaginal delivery group,women in the emergency cesarean section group were older,with a lower education level.Their prepregnancy BMI was higer and had more gestational weight gain.They had higher morbidity of pregnancy induced hypertension and gestational diabetes mellitus.Comparing to the vaginal delivery group,the neonates in the emergency cesarean section group were elder in gestational week,with higher birth weight.More male infants and large for gestation age infants were seen in the emergency cesarean section group (all P ＜ 0.05).(2) Overweight and obesity were associated with the increased risk of emergency cesarean section for nullipara,with the unadjusted OR of 1.98 (95％CI:1.54-2.54),adjusted OR(aOR) of 1.66 (95％CI:1.27-2.16).In the inadequate GWG group and the excessive GWG group,overweight and obese women had increased risk of emergency cesarean section,with adjusted OR of 2.33 (95％CI:1.06-5.14) and 1.62 (95％CI:1.44-2.28),respectively.In the appropriate GWG group,there was no significant difference in the risk of emergency cesarean section between the overweight and obese women and the normal weight women,with aOR of 1.54 (95％CI:0.94-2.54).The underweight group was associated with decreased risk of emergency cesarean section (OR=0.55,95％CI:0.40-0.74;aOR=0.66,95％ CI:0.48-0.90).While no significant difference in the risk of emergency cesarean section was found between the underweight women,the overweight and obese women,with the aOR of 0.31 (95％CI:0.07-1.32),0.73 (95％CI:0.48-1.10),0.66 (95％CI:0.38-1.12),respectively.(3) Absolute value of gestational weight gain was associated with the increased risk of emergency cesarean section,(aOR=1.03,95％CI:1.01-1.05).GWG above IOM giudelines did not independently affect the risk of emergency cesarean section (OR=1.30,95％CI:1.07-1.58;aOR=1.01,95％CI:0.82-1.24).In the underweight group,the normal weight group and the overweight or obese group,the excessive GWG women and the appropriate GWG women had no significant difference in the risk of emergency cesarean section (aOR=1.03,95％CI:0.55-1.12;aOR=1.02,95％CI:0.80-1.30;aOR=1.03,95％ CI:0.59-1.78),respectively.GWG below IOM giudelines was associated with decreased risk of emergency cesarean section (OR=0.62,95％ CI:0.45-0.85;aOR=0.64,95％ CI:0.46-0.88).In the underweight group and the overweight or obese group,there was no significant difference in the emergency cesarean section risk between the inadequate GWG women and the appropriate GWG within women (aOR=0.24,95％CI:0.06-1.01;aOR=0.90,95％CI:0.40-2.04).In the normal weight group,the inadequate GWG women had lower risk of emergency cesarean section (aOR=0.65,95％ CI:0.45-0.95).Conclusions Overweight and obese women have increased risk of emergency cesarean section.The prepregnancy BMI is supposed to be an appropriate level.Absolute value of gestational weight gain is associated with increased risk of emergency cesarean section.There is no correlation between the excessive GWG and the risk of emergency cesarean section.

To compare the distribution characteristics of common syndrome types and syndrome elements of menopause syndrome in perimenopausal and postmenopausal women on the basis of standardized syndrome differentiation extracted by experts' experiences.

Objective:To analyze the pregnancy complications and outcomes in adolescent women in minority areas in China and the factors affecting the pregnancy outcomes.Methods:This retrospective study enrolled 697 singleton pregnant women who were younger than 20 years old and delivered at Sanjiang Dong Autonomous County People's Hospital of Liuzhou City from January 1, 2014, to December 31, 2018, as the case group. Meanwhile, 2 592 cases aged between 20 to 25 years and delivered during the same period were selected as the control group in an allocation ratio of 1∶4. Chi-square test, t test and binary logistic regression were used for comparing the differences of general characteristics, pregnancy complications, comorbidities and pregnancy outcomes between the two groups. Results:(1) The body mass index before delivery of the case group was lower than that of the control group [(24.7±3.4) vs (25.1±3.1) kg/m 2, t=－2.062, P=0.039]. The proportion of Dong minority was accounted for 48.06%(335/697) in the case group and 52.04%(1 349/2 592) in the control group. The proportion of women with junior school education or lower was higher in the case group than that in the control group [95.41% (665/697) vs 90.27% (2 340/2 592), χ2=45.086, P<0.001]. (2) The case group was noted for higher incidence of anemia [24.25% (169/697) vs 15.20% (394/2 592), χ2=31.683], premature delivery [7.17% (50/697) vs 4.55% (118/2 592), χ2=7.786], premature rupture of membranes [13.34% (93/697) vs 9.10% (237/2 592), χ2=10.731] and oligohydramnios [9.76% (68/697) vs 7.02% (182/2 592), χ2=5.848] than the control group (all P<0.05). (3) The incidence of cesarean section [27.26% (190/697) vs 38.04% (986/2 592), χ2=27.791, P<0.001] and the neonatal birth weight [(3 047.29±453.46) vs (3 131.01±472.44) g, t=－4.188, P<0.001] in the case group were lower, but the incidence of episiotomy [40.17% (280/697) vs 8.72% (226/2 592)] and the proportion of neonatal intensive care unit admission[10.76% (75/697) vs 3.82% (99/2 592)] were higher when comparing to the control group ( χ2=417.439 and 52.816, both P<0.001). (4) Multivariate binary logistic regression analysis showed that the risk of cesarean section ( aOR=0.62, 95% CI: 0.51-0.75) was reduced in adolescent women, but the risks of episiotomy ( aOR=6.20, 95% CI: 4.99-7.71) and neonatal intensive care unit admission ( aOR=2.68, 95% CI: 1.92-3.75) increased. Conclusions:Most of the pregnant adolescents are less-educated and ethnic minorities in this study, among which the Dong minority was predominant. Adolescent pregnancies are at a higher risk of anemia, preterm birth and premature rupture of membranes. Therefore, enhanced perinatal management of adolescent pregnancy is recommended to reduce adverse pregnancy outcome.

INTRODUCTION: The apolipoprotein E ( METHODS: We classified the RESULTS: The baseline serum levels of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) were significantly lower in carriers of CONCLUSION Polymorphism in the
Apolipoproteins E/genetics* ; Atherosclerosis/genetics* ; Cardiovascular Diseases ; Genotype ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use* ; Lipids

Objective:To identify the risk factors for intrapartum fever during labor analgesia and establish the prediction model.Methods:The medical records from pregnant women with intrapartum fever during labor analgesia were retrospectively analyzed. According to whether the highest body temperature ≥38 ℃, the parturients were divided into intrapartum fever group and non-fever group. The general data from patients, duration of hospital stay before labor, induced labor, prenatal hemoglobin concentration, body msaa index (BMI) during pregnancy, artificial rupture of membranes in the incubation period, frequency of vaginal examination and etc. were collected. The risk factors of which P values were less than 0.05 would enter the logistic regression analysis to stratify intrapartum fever-related risk factors, and the weighted score regression prediction model was established. Hosmer-Lemshow Test was used to assess the fit of the model, and the receiver operating characteristic curve was drawn to evaluate the model. The nomogram was drawn for visually presenting the regression model. The clinical calibration curve, decision curve analysis and clinical impact curve were drawn to assess the created prediction model. Results:There were 99 parturients developed fever during labor analgesia, with an incidence of 34.7%. The results of logistic regression analysis showed that duration of hospital stay before labor, prenatal hemoglobin concentrations, BMI during pregnancy, induced labor, artificial rupture of membranes in the incubation period and frequency of vaginal examination were the independent risk factors for intrapartum fever during labor analgesia. The area under the receiver operating characteristic curve was 0.943, 95% confidence interval was 0.916-0.969, the sensitivity was 86.9%, the specificity was 88.6%, and the Youden index was 0.755. The prediction model of the line chart was assessed by Hosmer-Lemshow, P=0.898. Conclusions:Duration of hospital stay before labor, hemoglobin concentrations, BMI during pregnancy, induced labor, artificial rupture of membranes in the incubation period and frequency of vaginal examination are independent risk factors for intrapartum fever during labor analgesia in parturients, and the risk prediction model developed can effectively predict the occurrence of intrapartum fever during labor analgesia.

Objective To investigate the effect of dietary intake on the childbirth outcomes of pri-mipara women with full-term labor analgesia.Methods A total of 400 primipara women with full-term labor analgesia were randomly divided into observation group and control group.The observation group received intake management and individualized dietary guidance,while the control group ate and drank according to their own wishes.The childbirth quality,the incidence of vomiting,the use of oxytocin due to uterine atony,the rate of intrapartum fever,the rate of perineal incision,the rate of cesarean section,the rate of vaginal assisted delivery,and the rate of postpartum hemorrhage were compared be-tween the two groups.The duration of the first stage of labor,the duration of the second stage of labor,the duration of labor analgesia,and the amount of postpartum hemorrhage within 2 hours were also compared.Neonatal Apgar score,random blood glucose,umbilical artery blood pH value,umbilical ar-tery blood lactic acid(Lac)value,the incidence of neonatal asphyxia,the incidence of neonatal fever,and the incidence of neonatal hypoglycemia were compared between the two groups.Results The ob-servation group had lower incidences of vomiting,oxytocin use rate due to uterine atony,intrapartum fever rate,perineal incision rate,transferring cesarean section rate,and vaginal assisted delivery com-pared to the control group(P＜0.05).The observation group had lower rates of postpartum hemor-rhage,shorter duration of the first and second stages of labor,shorter duration of labor analgesia,and less postpartum hemorrhage within 2 hours compared to the control group,and the incidences of neonatal hyperglycemia and hypoglycemia in the observation group were lower than those in the control group(P＜0.05).There were no statistically significant differences in umbilical artery blood pH value,Lac value,neonatal Apgar score,random blood glucose,neonatal asphyxia rate,and neo-natal fever rate between the two groups(P＞0.05).Conclusion Intake management and individ-ualized dietary guidance during labor can reduce the incidence of uterine atony,shorten the duration of labor,decrease the incidence of dystocia,reduce postpartum hemorrhage within 2 hours and de-crease the incidence of neonatal glucose abnormality.

Objective To investigate the effect of dietary intake on the childbirth outcomes of pri-mipara women with full-term labor analgesia.Methods A total of 400 primipara women with full-term labor analgesia were randomly divided into observation group and control group.The observation group received intake management and individualized dietary guidance,while the control group ate and drank according to their own wishes.The childbirth quality,the incidence of vomiting,the use of oxytocin due to uterine atony,the rate of intrapartum fever,the rate of perineal incision,the rate of cesarean section,the rate of vaginal assisted delivery,and the rate of postpartum hemorrhage were compared be-tween the two groups.The duration of the first stage of labor,the duration of the second stage of labor,the duration of labor analgesia,and the amount of postpartum hemorrhage within 2 hours were also compared.Neonatal Apgar score,random blood glucose,umbilical artery blood pH value,umbilical ar-tery blood lactic acid(Lac)value,the incidence of neonatal asphyxia,the incidence of neonatal fever,and the incidence of neonatal hypoglycemia were compared between the two groups.Results The ob-servation group had lower incidences of vomiting,oxytocin use rate due to uterine atony,intrapartum fever rate,perineal incision rate,transferring cesarean section rate,and vaginal assisted delivery com-pared to the control group(P＜0.05).The observation group had lower rates of postpartum hemor-rhage,shorter duration of the first and second stages of labor,shorter duration of labor analgesia,and less postpartum hemorrhage within 2 hours compared to the control group,and the incidences of neonatal hyperglycemia and hypoglycemia in the observation group were lower than those in the control group(P＜0.05).There were no statistically significant differences in umbilical artery blood pH value,Lac value,neonatal Apgar score,random blood glucose,neonatal asphyxia rate,and neo-natal fever rate between the two groups(P＞0.05).Conclusion Intake management and individ-ualized dietary guidance during labor can reduce the incidence of uterine atony,shorten the duration of labor,decrease the incidence of dystocia,reduce postpartum hemorrhage within 2 hours and de-crease the incidence of neonatal glucose abnormality.

Objective:To investigate the association between metabolic syndrome and the risk of early renal function injury in chronic kidney disease(CKD) in the elderly.Methods:A retrospective cohort was established based on health check-up data of 4 495 elderly residents in Mengzi City, Yunnan Province from January 2016 to December 2018. The medial history, living habits, and related physical examination information were collected. Cox hazard regression model was used to explore the association between metabolic syndrome, along with its components, and the early renal function injury in CKD. Results:The median age of the elderly was 71.00(67.00, 75.00) years, with metabolic syndrome detection rate of 21.98%. Early renal function injury of CKD developed in 1 300(28.92%) subjects during the follow-up. Univariate Cox regression showed that the number of metabolic syndrome components was associated with the risk of early kidney development in CKD. The HRs were 1.23 (95% CI 1.03-1.47, P=0.022) with 1 component, 1.54 (95% CI 1.28-1.84, P<0.001) with 2, and 1.38 (95% CI 1.14-1.67, P<0.001) with 3 or more. Multivariate Cox regression showed that elevated fasting triglycerides( HR=1.20, 95% CI 1.07-1.36, P=0.003) and lower high density lipoprotein-cholesterol(HDL-C; HR=1.25, 95% CI 1.09-1.43, P=0.002) were risk factors for early kidney injury in CKD, while doing some physical activity( HR=0.57, 95% CI 0.33-0.98, P=0.042), or on daily basis( HR=0.57, 95% CI 0.49-0.66, P<0.001) was a protective factor for early kidney injury in CKD. Conclusion:The abnormality of one or more metabolic components can significantly increase the risk of early kidney injury in the elderly with CKD. Elevated triglyceride and decreased HDL-C may be the risk factors.