Objective: To investigate the risk factors of pregnancy termination at second and third trimester in women with scarred uterus and placenta previa .Mtehods:Clinical data of 24 pregnant women of second and third trimester with a scarred uterus and placenta previa ,who requested termination in Women ’s Hospital Zhejiang University School of Medicine from July 2009 to June 2014 , were retrospectively analyzed .The method of mifepristone combined with ethacridine lactate was adopted for all cases . Mifepristone combined with ethacridine lactate and uterine artery embolization were routinely given for patients with complete placenta previa . Cesarean section was performed for patients who failed to delivery or underwent massive vaginal bleeding before delivery. Age, gestational weeks, gravidity and parity, times of previous cesarean section , the interval from previous operation , the position and the type of placenta previa , placenta accretet , the indication and method of termination , postpartum hemorrhage , successful rate of labor induction , placental retention ratio and uterus rupture were documented .Results: The successful rate of labor induction was 83 .3%.The analysis showed that age , gestational weeks , gravidity and parity and times of previous cesarean section were not risk factors for failed labor induction , however the interval time from previous operation was related to induction failure ( P<0.05 ) .Patients with previous cesarean section ≥13 years were more likely to require cesarean section than those <13 years ( P<0 .05 ) .The placenta adhered to the antetheca of the uterus or placenta accrete increased risk to have cesarean section . There were no significant differences in postpartum hemorrhage , the successful rate of labor induction, placental retention ratio and the rate of uterine rupture between patients with uterine artery embolization and those without .Conclusion: The labor induction would be feasible for women with a scarred uterus and placenta previa in second and third-trimester pregnancy.The previous operation ≥13 years, the antetheca placenta or placenta accrete might increase the incidence of labor induction , while the uterine artery embolization would rise the successful rate of labor induction .

Glomerular filtration rate(GFR)is a critical indicator of renal function assessment,which exhibits age-dependency in children and may differ from adults under various disease conditions.In recent years,there has been a growing focus on GFR among scholars,with an increasing number of clinical studies dedicated to refining and optimizing GFR estimation to span all pediatric age groups.However,the methods and assessment equations for estimating GFR may vary under different disease conditions,affecting the accuracy and applicability of assessments.This article reviews the peculiarities of renal function in children,explores GFR measurement methods,and evaluates the application of various GFR assessment equations in pediatric clinical practice,providing a reference for clinical assessment of renal function in children.

Objective To compare the difference of cutpoint and clinical significance of HbA1C for the diagnosis of abnormal glucose metabolism in two population groups with different ages.Methods According to oral glucose tolerance test(OGTT),the cutpoint and clinical significance of HbA1C for the diagnosis of type 2 diabetes and impaired glucose regulation(IGR)were investigated in the two population groups.Results The mean HbA1C of 1 064 young subjects in an academy and 1 671 aged subjects in a community were 5.31% ±0.41% and 5.79% ±0.71%,respectively.The cutpoints of HbA1C for diagnosis of diabetes were 5.7%(specificity 86.7%,sensitivity 66.7%)and 5.9%(specificity 73.8%,sensitivity 80.1%)in the two population groups,and 5.6% for diagnosis of IGR (specificity 82.8%,sensitivity 55.8%)and 5.7%(specificity 60.9%,sensitivity 64.3%),respectively.87.8%,78.7%,and 38.5% were diagnosed diabetes by current OGTT criteria at HbA1C levels of ≥5.7%,≥5.9%,and≥6.5%,IGR being 61.6%,39.6%,and 4.1%,and normal glucose tolerance being 24.4%,10.0%,and 0.4%.Conclusion The cutpoints of HbA1C for diagnosis of diabetes and IGR are different in populations with different ages and HbA1C levels.As one of diagnostic criteria for diabetes,HbA1C 6.5% with relatively higher specificity and lower sensitivity must be combined with fasting blood glucose,random blood glucose,and OGTT.

OBJECTIVETo compare the effects of dust exposure and smoking on mortality of respiratory system diseases (RSD).

METHODSBased on the Guangzhou Occupational Health Surveillance Record System established between 1989 and 1992, 80,987 factory workers, aged 30 years old or older, occupationally exposed or not exposed to dusts, were included in a prospective cohort study.

RESULTS(1) The mean age of the cohort was 43.5. Most subjects were workers, had secondary education, and almost all were married. The dust exposure rate was 16.3%, the smoking rate 43.7% and the alcohol-drinking rate 33.5%. (2) The cohort was followed up for 8 years on average, but 35 people (0.04%) were lost for follow up. Among the 1593 deaths, 219 and 90 people died of lung cancer and non-cancer respiratory system diseases (NCRSD) respectively. (3) The adjusted relative risk (RR) of death of lung cancer for smokers, 3.32, was 2.2 times of that for dust exposed workers, 1.53, and the RR of death of NCRSD for dust exposed workers, 2.41, 1.28 times of that for smokers, 1.89, especially for silica dust-exposed workers, 5.72, 3.03 times of that for smokers. Dust exposure combined with smoking caused significantly higher RR of death of RSD. (4) In male, the death risks of RSD were increased with the amount of smoking per day and years of smoking.

CONCLUSIONOccupational dust exposure and smoking may cause excessive lung cancer and NCRSD death with synergistic effects. Smoking has higher RR of Lung cancer death than dust exposure. However, the dust exposure contributes to higher RR of NCRSD death. There is a significant dose-effect relationship between smoking and the death risk of RSD.

Adult ; China ; epidemiology ; Cohort Studies ; Dust ; Female ; Humans ; Male ; Middle Aged ; Occupational Exposure ; adverse effects ; Prospective Studies ; Respiratory Tract Diseases ; etiology ; mortality ; Risk Assessment ; Risk Factors ; Smoking ; adverse effects

Objective To investigate the clinical efficacy of three-dimensional visualization technique (3DVT) combined with enhanced recovery after surgery (ERAS) in the treatment of hepatolithiasis.Methods The retrospective cohort study was conducted.The clinicopathological data of 64 patients with hepatolithiasis who were admitted to Zhujiang Hospital of Southern Medical University from November 2015 to August 2018 were collected.There were 17 males and 47 females,aged from 30 to 82 years,with a median age of 55 years.Of the 64 patients,23 who completed preoperative assessment and planning using 3DVT,and furthermore received ERAS for perioperative management were divided into 3DVT + ERAS group,and 41 who received preoperative assessment merely under the guidance of 3DVT,combined with conventional perioperative management were divided into 3DVT + conventional group.Observation indicators:(1) preoperative CT and 3DVT assessment;(2) perioperative conditions;(3) follow-up.The follow-up was conducted by outpatient service,e-mail or telephone interview to detect the postoperative recurrence of hepatolithiasis up to March 2019.The measurement data with normal distribution were expressed as Mean±SD,and the t test was used for comparison between groups.The measurement data with skewed distribution were expressed as M (P25,P75),and the Mann-Whitney U test was used for comparison between groups.The count data were expressed as absolute numbers or percentages,and the comparison between groups was pedormed using the chi-square test or Fisher exact probability.Results (1) Preoperative CT and 3DVT assessment:23 patients in the 3DVT + ERAS group underwent preoperative CT examination and 3DVT assessment,the consistency between CT results and intraoperative findings was 91.3％ (21/23),and the consistency between 3DVT results and intraoperative findings was 95.7％(22/23).Fourty-one patients in the 3DVT + conventional group underwent preoperative CT examination and 3DVT assessment,the consistency between CT results and intraoperative findings was 90.2％ (37/41),and the consistency between 3DVT results and intraoperative findings was 95.1％ (39/41).(2) Perioperative conditions:the volume of intraoperative blood loss,duration of postoperative hospital stay,postoperative total bilirubin,postoperative direct bilirubin,postoperative albumin,postoperative alanine aminotransferase,postoperative aspartate aminotransferase and postoperative hemoglobin were 50 mL (10 mL,100 mL),8 days (7 days,9 days),12 μmol/L (9 μmol/L,16 μmoL/L),6 μmol/L (4 μmoL/L,8 μmol/L),(37±4)g/L,44 U/L (18 U/L,85 U/L),32 U/L (20 U/L,65 U/L),(117±18)g/L in the 3DVT + ERAS group,and 100 mL (50 mL,300 mL),13 days (10 days,16 days),17 μmol/L (12 μmoL/L,33 μmoL/L),11 μmoL/L (7 μmoL/L,21 μmol/L),(29±6)g/L,78 U/L (43 U/L,122 U/L),121 U/L (72 U/L,176 U/L),(106±13)g/L in the 3DVT + conventional group,respectively;there were significant differences between two groups (Z =-3.084,-4.827,-2.953,-3.632,t =5.261,Z=-2.960,-4.625,t =2.773,P＜0.05).Two patients had pulmonary infection and 2 had pleural effusion in the 3DVT + ERAS group,and all the 4 patients were cured after treatment.One case of biliary fistula,4 cases of pulmonary infection and 5 cases of pleural effusion occurred in the 3DVT + conventional group,and these patients were cured by adequate abdominal drainage,antibiotic therapy and thoracocentesis,respectively.There was no perioperative death in either group.(3) Follow-up:64 patients were followed up for 6-36 months,with a median time of 23 months.During the follow-up,no recurrent hepatolithiasis in the 3DVT + ERAS group,and 1 case of recurrent hepatolithiasis was confirmed by ultrasound in the 3DVT + conventional group.No cholangiocarcinoma occurred in either group.Conclusion The combination of 3DVT and ERAS is effective,safe and feasible in the management of hepatolithiasis,which can accelerate the postoperative recovery of liver function,thus enhancing perioperative recovery and improving the prognosis of patients simultaneously.

Objective To evaluate the Muller-Hinton (MH) mediums from different manufactures and the differences in the activity of tigecycline against Acinetobacter baumannii by different susceptibility test methods in vitro.Methods Testing the activity of tigecycline against 160 strains of clinical isolated Acinetobacter baumannii in vitro by microdilution method when choosing Oxoid MH Broth medium and by agar dilution method or disk diffusion method when choosing Oxoid MH Agar (Oxoid MHA),Oxoid MH Broth + 1.5％ Oxoid Agar(Oxoid MHB + Agar),Becton Dickinson BBL MH Ⅱ Agar(BD MHA) and bioMérieux MH Ⅱ Agar(bioMérieux MHA),respectively.Using atomic absorption spectroscopy method to determine the concentration of calcium,copper,lead,magnesium,cadmium,manganese,iron,nickel and zinc in different medium,simultaneously.Results The susceptibility of tigecycline to Acinetobacter baumannii are 34.4％/53.8％,100.0％/96.9％,63.8％/62.5％,35.6％/29.4％ by agar dilution method or disk diffusion method when using Oxoid MHA,Oxoid MHB + Agar,BD MHA and bioMérieux MHA,respectively,while the susceptibility of tigecycline to Acinetobacter baumannii is 91.3％ by microdilution method when choosing Oxoid MHBroth medium.Conclusion Compared with the results of other MHA mediums,using Oxoid MHB + 1.5％ Agar medium by disk diffusion method can provide a more similar result to those of the broth dilution method when test the activity of tigecycline against Acinetobacter baumannii in vitro.

Objective To investigate influence factors of diarrhea,thrush and multi-system damage in hospitalized children with lower respiratory infection (LRI).Methods A total of 9135 children with LRI who were hospitalized in our hospital were divided into four groups according to whether they had diarrhea and/or thrush:A (simple LRI group) has 7716 children,B (LRI complicated with diarrhea group) has 1057 children,C (LRI complicated with thrush group) has 200 children,D (LRI complicated with diarrhea and thrush group) include 162 children.All clinical data of four groups were collected and retrospectively reviewed.Results Infants less than six months of the group B,C and D had the highest incidence,followed by babies from six months to one year old,the lowest was the group that over the age of five.The incidence of group B and D was highest in winter.The incidence of in hospital or out of hospital for more than 14 d in group D was higher than that for less than 14 d.The incidence of premature infants in group C and group D were 3.70％ and 3.90％,higher than 2.10％ and 1.65％ of the full-term infants.The incidence of children with atopic in group B and D was 16.83％ and 3.00％,which was higher than 10.70％ and 1.57％ in children with non-atopic.The incidence of severe children in group B,C and D were 15.97％,3.92％ and 4.20％,which was significantly higher than 11.39％,2.12％ and 1.68％ of the normal patients;and 15.29％,4.00％,4.09％ in children who use antibiotics for more than 14 d which was higher than 10.44％,1.64％,1.07％ for less than 14 d.The proportion of multiple antibiotic user in group D was 2.16％,which was significantly higher than 1.12％ of the single antibiotic user.The rate of hormone application in group B and D was 13.25％ and 2.07％,which was significantly higher than 9.98％ and 1.49％ of non-hormone users.The levels of CD3 + in group B,C,D were significantly lower than that in group A,and the percentage of CD3 + CD8 + was below the normal reference value.The percentages of CD3-CD19 + and CD19 + CD23 + in four groups were significantly higher than the normal reference value.Conclusion The high incidence of diarrhea and/or thrush in pediatric patients with LRI was associated with some factors,including winter admission,premature,atopic,long course of hospital and out of hospital,severe disease,long-term or joint use of antibiotic,hormone therapy or low level of CD3 +.In clinical practice,reasonable and positive intervention and immune regulation in the early stage of disease will help to reduce the occurrence of diarrhea and/or thrush in children with LRI,promote disease recovery,reduce the use of medical resources and cases of severe,critical and refractory.

OBJECTIVETo investigate the risk factors of pregnancy termination at second and third trimester in women with scarred uterus and placenta previa.

METHODSClinical data of 24 pregnant women of second and third trimester with a scarred uterus and placenta previa,who requested termination in Women's Hospital Zhejiang University School of Medicine from July 2009 to June 2014, were retrospectively analyzed. The method of mifepristone combined with ethacridine lactate was adopted for all cases. Mifepristone combined with ethacridine lactate and uterine artery embolization were routinely given for patients with complete placenta previa. Cesarean section was performed for patients who failed to delivery or underwent massive vaginal bleeding before delivery. Age, gestational weeks, gravidity and parity, times of previous cesarean section, the interval from previous operation, the position and the type of placenta previa, placenta accretet, the indication and method of termination, postpartum hemorrhage, successful rate of labor induction, placental retention ratio and uterus rupture were documented.

RESULTSThe successful rate of labor induction was 83.3%. The analysis showed that age, gestational weeks, gravidity and parity and times of previous cesarean section were not risk factors for failed labor induction, however the interval time from previous operation was related to induction failure (P<0.05). Patients with previous cesarean section ≥ 13 years were more likely to require cesarean section than those <13 years (P<0.05). The placenta adhered to the antetheca of the uterus or placenta accrete increased risk to have cesarean section. There were no significant differences in postpartum hemorrhage, the successful rate of labor induction, placental retention ratio and the rate of uterine rupture between patients with uterine artery embolization and those without.

CONCLUSIONThe labor induction would be feasible for women with a scarred uterus and placenta previa in second and third-trimester pregnancy. The previous operation ≥ 13 years, the antetheca placenta or placenta accrete might increase the incidence of labor induction, while the uterine artery embolization would rise the successful rate of labor induction.

Abortion, Induced ; Cesarean Section ; Cicatrix ; Female ; Humans ; Placenta Previa ; pathology ; Pregnancy ; Pregnancy Trimester, Second ; Pregnancy Trimester, Third ; Retrospective Studies ; Risk Factors ; Uterus ; pathology

Sempervirine, a yohimbane-type alkaloid isolated from Gelsemium elegans, was found to significantly inhibit the cellular proliferation of U251 cells in vitro and in vivo in a dose-dependent manner. U251 cells were treated with 0-16 μmol·L^-1 of sempervirine for 24, 48 or 72 h. An MTT assay and clone formation assay were used to investigate cell survival and clone formation. Hoechst staining and Annexin V-FITC/PI staining were used to measure cell apoptosis. The expression of PI3K, AKT, p-AKT, Bax, Bcl-2, caspase-3 and cleaved caspase-3 was determined by Western blot analysis. The antitumor effect of sempervirine in vivo was investigated by inoculating nude mice with U251 cells. All animal experiments were in strict accordance with the regulations of the Biomedical Ethics Committee of Fujian Medical University (Fujian, China). The results show that sempervirine significantly inhibits the proliferation and induces the apoptosis of U251 cells, promotes cleavage of caspase-3, down-regulates the protein expression of PI3K and Bcl-2/Bax, and inhibits phosphorylation of AKT in vitro. Intraperitoneal injection of 4 or 8 mg·kg^-1·day^-1 of sempervirine inhibits U251 cells tumor growth in the xenograft nude mice, and tumor weight decreased by 44.76% and 61.26%, respectively. Our study shows that sempervirine significantly inhibits the proliferation of U251 cells in vitro and in vivo, laying a foundation for further research and development of its anti-glioma effect.

Objective::On the basis of previous research, to detect the changes of six main alkaloids in Gelsemium elegans rhizomes before and after being processed, so as to reveal its internal mechanism of processing. Method::The contents of gelsemine, humantenidine, koumine, gelsenicine, gelsevirine and humantenine in G. elegans rhizomes was determined simultaneously by HPLC, the content changes of these components before and after processing and its reasons were analyzed by cluster analysis and principal component analysis. The mobile phase was methanol (A)-0.1%formic acid aqueous solution (B) for gradient elution (0-10 min, 22%A; 10-20 min, 22%-30%A; 20-30 min, 30%-40%A). The flow rate was 1.0 mL·min^-1. The detection wavelength was set at 254 nm, the injection volume was 10 μL, and the column temperature was 30 ℃. Result::Before processing, contents of the above six components in raw products were 1.444, 1.129, 3.590, 1.603, 2.376, 1.631 mg·g^-1, after processing, the contents of these six components were 2.258, 0.343, 1.176, 0.115, 0.459, 0.281 mg·g^-1, respectively. Gelsenicine, the most toxic ingredient of G. elegans rhizomes, decreased most significantly with a decreasing rate of 92.83%, while the less toxic ingredient, gelsemine, increased by 56.37%after processing. The contents of other four components in G. elegans rhizomes decreased to varying degrees after processing. The results of cluster analysis indicated that G. elegans rhizomes were clearly divided into two categories before and after processing. Principal component analysis showed that the first principal component before and after processing was changed from koumine to gelsemine. Conclusion::The degradation of toxic components and content changes of other components may be one of the intrinsic mechanism of toxicity attenuation and efficacy reservation of G. elegans rhizomes being processed.