OBJECTIVE:To observe the short-term efficacy and ADR of tenofovir disoproxil fumarate(TDF)in the treatment of multi-drug resistant chronic hepatitis B(CHB). METHODS:32 patients with multi-drug resistant CHB were analyzed retrospec-tively,and HBV drug-resistant genes were detected before treatment;there were a number of points to resistance;they were gave TDF orally. The recovery rate of serum alanine aminotransferase(ALT),HBV-DNA conversion rate,lactic acid and renal function were observed before and after treatment. RESULTS:The recovery rate of ALT reached 100% at 3 months,and the conversion rate of HBV-DNA reached 96.88%. The lactic acid levels and renal dysfunction was not found during treatment. CONCLUSIONS:TDF take effect quickly on multi-drug resistant CHB,and no obvious ADR is found.

Objective: To analyze risk factors, cardiovascular complications, time of death, gestational age of delivery and offspring outcomes in the maternal deaths with cardiovascular diseases (CVD). Methods: Totally 4 112 cases of pregnant women with CVD in Shanghai obstetric heart disease intensive care unit within 26 years (from January 1993 to December 2018) were collected, and 20 maternal deaths within these cases were analyzed retrospectively. Results: (1) Among the 20 deaths, structural heart diseases accounted for 90% (18/20), pregnancy induced heart diseases was 10% (2/20) while there was no dysfunctional heart disease. The mortality of pregnant women with CVD was 0.486% (20/4 112). (2) The following risk factors were common in these women, getting pregnant without counselling (95%, 19/20) , New York Heart Association classⅢ or Ⅳcardiac function (70%, 14/20), complicated with pulmonary hypertension (75%, 15/20) and prior heart events (60%, 12/20). And 85% (17/20) deaths occurred in puerperium, 15% (3/20) occurred before labor,while no death occurred during labor. And 65% (13/20) deaths died due to heart failure, 20% (4/20) deaths were due to pulmonary hypertension crisis, 5% (1/20) died on sudden cardiac arrest, rupture of aortic dissection and sudden death, respectively. Conclusions Women with CVD should get pregnant after strict evaluation. Pulmonary hypertension is one of the most severe contraindications to pregnancy, especially in patients with moderate to severe pulmonary hypertension. The puerperium period is a critical period that threatens the safety of these patients. Since heart failure is the most common cause of death, it is necessary to prevent and treat heart failure and to monitor heart function dynamically, especially in those with structural abnormal heart diseases. Moreover, it is also of importance to standardize antenatal care and to identify the severity of heart diseases in time.

Congenital heart disease (CHD) is a class of cardiovascular malformation caused by abnormal development of cardiovascular system,developmental disorders,or degenerative tissue which should be degenerated after birth during embryonic development,and tetralogy of Fallot is one of the most serious types of CHD,including ventricular septal defect (VSD),overriding aorta (OA),pulmonic stenosis (PS) and right ventricular hypertrophy (RVH).Up to now,a series of clinical evidence shows that genetic factors have been involved in the occurrence of TOF,and some gene mutations are associated with the occurrence of TOF,of which NKX2-5,GATA4,TBX5 and TBX20 have been confirmed to be highly correlated with TOE Based on the existing research results,this paper expounds the relationship between etiology and pathogenesis of tetralogy of Fallot and the mutations of NKX2-5,GATA4,TBX5 and TBX20.

Objective To investigate the effect ofatorvastatin on angiogenesis of brain tissues in focal cerebral ischemia rats,and explore the corresponding mechanism.Methods Ninety male SD rats were randomly divided into sham-operated group,model group and treatment group (n=30);and then,each group was divided into three subgroups:1 d group,3 d group and 7 d group (n=10).The focal cerebral ischemia models were induced by middle cerebral artery occlusion (MCAO);3 h after MCAO,rats in the treatment group received a gavage of atorvastatin 4 mg/(kg.d),and others were given the same amount of normal saline at corresponding time.The nerve function defects were estimated at 3 h after MCAO and before being killed;the protein expressions of vascular endothelial cell markers CD105 and glucose-regulated protein 78 (GRP78) were analyzed by immunohistochemistry;the vascular endothelial growth factor (VEGF) mRNA expression was analyzed by real time-PCR;the caspase-12 protein expression was analyzed by Western blotting.Results (1) Nerve function defects scores:there was no significantly statistical difference between model group and treatment group at 3 h after MCAO (P＞0.05),but statistical differences at different time points before being killed were noted (P＜0.05).(2) Microvessel density (MVD):at all time points,that of model group was increased as compared with that of sham-operated group,that of treatment group was increased as compared with that of model group,and the differences were all statistically significant (P＜0.05).(3)The VEGF rmRNA expression gradually increased over time;at all time points,the VEGF mRNA expression of model group was significantly higher than that in the sham-operated group,and that of treatment group was significantly higher than that in the model group (P＜0.05).(4)The GRP78 and caspase-12 expressions were gradually decreased over time;at all time points,the GRP78/BiP and caspase-12 expressions in the model group were significantly higher than those in the sham-operated group;those in the treatment group were statistically lower than those in the model group,but obviously higher than those in the sham-operated group (P＜0.05).Conclusion The angiogenesis of brain tissues in MCAO rats is obvious,and atorvastatin can enhance this effect;the mechanism may be that atorvastatin can weaken the endoplasmic reticulum stress,and then,reduce the apoptosis of endothelial cells.

Objective:To study the cut-off values of urinary microalbumin (mAlb), transferrin (TRF) and α1-microglobulin (α1-MG) during pregnancy in pre-eclampsia (PE) with proteinuria.Methods:A total of 210 pregnant women were enrolled in Renji Hospital from January 2016 to December 2019, including 92 (43.8%) cases of PE pregnant women and 118 (56.2%) cases of normal pregnant women. According to the diagnostic test evaluation method, the positive predictive values, negative predictive values and accuracy of non-pregnant cut-off values of urinary mAlb, TRF and α1-MG for the quantitative determination of 24-hour proteinuria were analyzed. The receiver operating characteristic (ROC) curve was applied to determine the optimal cut-point values of urinary mAlb, TRF and α1-MG during pregnancy.Results:(1) The diagnostic study of non-pregnant adults urinary mAlb, TRF and α1-MG cut-off values for the determination of 24-hour proteinuria value: when urinary mAlb was 30.0 mg/L, TRF was 2.5 mg/L, α1-MG was 12.5 mg/L as the cut-off value, the positive predictive values of the corresponding 24-hour proteinuria value≥ 300 mg were 88.1% (89/101), 88.2% (90/102) and 78.9% (75/95), its negative predictive values were 97.2% (106/109), 98.1% (106/108) and 85.2% (98/115), its diagnostic accuracy were 92.9% (195/210), 93.3% (196/210) and 82.4% (173/210), respectively. As the 24-hour proteinuria value≥ 300 mg was the golden standard, there were significant differences between the diagnostic method of the non-pregnant cut-off value of urinary mAlb, TRF and the golden standard ( P<0.05). There was no significant difference between the diagnostic method of the non-pregnant cut-off value of urinary α1-MG and the golden standard ( P>0.05). (2) Research on the ROC curve and the optimal cut-point value of urinary mAlb, TRF and α1-MG value: as the 24-hour proteinuria value≥ 300 mg as the criterion, the ROC curve of urinary mAlb, TRF and α1-MG were 0.992, 0.984 and 0.907, respectively. The optimal cut-point values of urinary mAlb, TRF and α1-MG were 86.5 mg/L (Youden index=0.927), 5.5 mg/L (Youden index=0.923), and 15.4 mg/L (Youden index=0.687). (3) The diagnostic study of the optimal cut-point value of urinary mAlb, TRF and α1-MG for the determination of 24-hour proteinuria value: according to the ROC results, when urinary mAlb was 86.5 mg/L, urinary TRF was 5.5 mg/L, and urinary α1-MG was 15.4 mg/L as the cut-off value, the positive predictive values of the corresponding 24-hour proteinuria value≥300 mg were 98.9% (86/87), 95.7% (88/92), 87.7% (71/81), and its negative predictive values were 95.1% (117/123), 96.6% (114/118), 83.7% (108/129), and its accuracy were 96.7% (203/210), 96.2% (202/210), 85.2% (179/210). As the 24-hour proteinuria value≥ 300 mg was the golden standard, there was no significant difference between the diagnostic method of the best cut-off values of urinary mAlb, TRF, α1-MG and the golden standard ( P>0.05). Conclusion:It is recommended to define the cut-off values of mAlb, TRF and α1-MG as 86.5 mg/L, 5.5 mg/L and 15.4 mg/L, respectively, during pregnancy.

Objective To analyze risk factors, cardiovascular complications, time of death, gestational age of delivery and offspring outcomes in the maternal deaths with cardiovascular diseases (CVD). Methods Totally 4 112 cases of pregnant women with CVD in Shanghai obstetric heart disease intensive care unit within 26 years (from January 1993 to December 2018) were collected, and 20 maternal deaths within these cases were analyzed retrospectively. Results (1) Among the 20 deaths, structural heart diseases accounted for 90% (18/20), pregnancy induced heart diseases was 10% (2/20) while there was no dysfunctional heart disease. The mortality of pregnant women with CVD was 0.486% (20/4 112). (2) The following risk factors were common in these women, getting pregnant without counselling (95%, 19/20), New York Heart Association classⅢorⅣcardiac function (70%, 14/20), complicated with pulmonary hypertension (75%, 15/20 ) and prior heart events (60%, 12/20). And 85% (17/20) deaths occurred in puerperium, 15% (3/20) occurred before labor , while no death occurred during labor. And 65% (13/20) deaths died due to heart failure, 20% (4/20) deaths were due to pulmonary hypertension crisis, 5% (1/20) died on sudden cardiac arrest, rupture of aortic dissection and sudden death, respectively. Conclusions Women with CVD should get pregnant after strict evaluation. Pulmonary hypertension is one of the most severe contraindications to pregnancy, especially in patients with moderate to severe pulmonary hypertension. The puerperium period is a critical period that threatens the safety of these patients. Since heart failure is the most common cause of death, it is necessary to prevent and treat heart failure and to monitor heart function dynamically, especially in those with structural abnormal heart diseases. Moreover, it is also of importance to standardize antenatal care and to identify the severity of heart diseases in time.

Objective:To investigate the perinatal outcomes and risk factors of perinatal complications in preg-nant women with hypertrophic cardiomyopathy(HCM).Methods:A retrospective analysis was carried out on clini-cal data of 100 pregnant women with HCM who delivered in Obstetrical Cardiology Intensive Care Center of Shanghai Renji Hospital between Jan.2000 and Dec.2022.Analyze the incidence of perinatal complications inclu-ding miscarriage,premature birth,small for gestational age infants,neonatal asphyxia,neonatal cardiac malforma-tions and perinatal mortality.Independent risk factors of perinatal complications in pregnant women with HCM were identified using univariate and multivariate Logistic regression.Results:①The mean age was 29.21±4.41 years old,the average gestational age upon admission is 34.46±6.43 weeks.There were 16 patients with a fam-ily history of cardiomyopathy(16％),21 cases with obstructive HCM(21％)and 79 cases of non-obstructive HCM(79％),91 cases with abnormal ECG(91％),mainly with ST-T changes(77 cases,77％).The average in-terventricular septum was 19.39±6.13mm by echocardiography.②Among the 100 pregnancies of 100 HCM pa-tients,6 cases(6％)were miscarriages,94 newborns survived(94％),including 91 cases of cesarean section(91％)and 3 cases of vaginal delivery(3％).The predominant perinatal complications were preterm delivery(39 cases,39％),small for gestational age(5 cases,5％),neonatal asphyxia(3 cases,3％)and neonatal cardiac malformation(2 cases,2％).There were no perinatal deaths.③Univariate Logistic regression analysis showed that pre pregnancy heart function ≥ Grade Ⅱ,increased left atrial diameter,and concomitant pulmonary hyperten-sion were risk factors for perinatal complications in pregnant women with HCM(OR＞1,P＜0.05).Multivariate Lo-gistic regression analysis found that pre pregnancy heart function ≥ Grade Ⅱ was an independent risk factor for predicting the occurrence of perinatal complications in pregnant women with HCM(OR 6.270,P＜0.05).Conclu-sions:HCM during pregnancy can induce poor perinatal outcome.More attention should be paid to risk assess-ment and pregnancy management.Early detection of risk factors can reduce the incidence of perinatal complica-tions.

Objective:To investigate the perinatal outcomes and risk factors of perinatal complications in preg-nant women with hypertrophic cardiomyopathy(HCM).Methods:A retrospective analysis was carried out on clini-cal data of 100 pregnant women with HCM who delivered in Obstetrical Cardiology Intensive Care Center of Shanghai Renji Hospital between Jan.2000 and Dec.2022.Analyze the incidence of perinatal complications inclu-ding miscarriage,premature birth,small for gestational age infants,neonatal asphyxia,neonatal cardiac malforma-tions and perinatal mortality.Independent risk factors of perinatal complications in pregnant women with HCM were identified using univariate and multivariate Logistic regression.Results:①The mean age was 29.21±4.41 years old,the average gestational age upon admission is 34.46±6.43 weeks.There were 16 patients with a fam-ily history of cardiomyopathy(16％),21 cases with obstructive HCM(21％)and 79 cases of non-obstructive HCM(79％),91 cases with abnormal ECG(91％),mainly with ST-T changes(77 cases,77％).The average in-terventricular septum was 19.39±6.13mm by echocardiography.②Among the 100 pregnancies of 100 HCM pa-tients,6 cases(6％)were miscarriages,94 newborns survived(94％),including 91 cases of cesarean section(91％)and 3 cases of vaginal delivery(3％).The predominant perinatal complications were preterm delivery(39 cases,39％),small for gestational age(5 cases,5％),neonatal asphyxia(3 cases,3％)and neonatal cardiac malformation(2 cases,2％).There were no perinatal deaths.③Univariate Logistic regression analysis showed that pre pregnancy heart function ≥ Grade Ⅱ,increased left atrial diameter,and concomitant pulmonary hyperten-sion were risk factors for perinatal complications in pregnant women with HCM(OR＞1,P＜0.05).Multivariate Lo-gistic regression analysis found that pre pregnancy heart function ≥ Grade Ⅱ was an independent risk factor for predicting the occurrence of perinatal complications in pregnant women with HCM(OR 6.270,P＜0.05).Conclu-sions:HCM during pregnancy can induce poor perinatal outcome.More attention should be paid to risk assess-ment and pregnancy management.Early detection of risk factors can reduce the incidence of perinatal complica-tions.

Objective:To investigate the perinatal outcomes and risk factors of perinatal complications in preg-nant women with hypertrophic cardiomyopathy(HCM).Methods:A retrospective analysis was carried out on clini-cal data of 100 pregnant women with HCM who delivered in Obstetrical Cardiology Intensive Care Center of Shanghai Renji Hospital between Jan.2000 and Dec.2022.Analyze the incidence of perinatal complications inclu-ding miscarriage,premature birth,small for gestational age infants,neonatal asphyxia,neonatal cardiac malforma-tions and perinatal mortality.Independent risk factors of perinatal complications in pregnant women with HCM were identified using univariate and multivariate Logistic regression.Results:①The mean age was 29.21±4.41 years old,the average gestational age upon admission is 34.46±6.43 weeks.There were 16 patients with a fam-ily history of cardiomyopathy(16％),21 cases with obstructive HCM(21％)and 79 cases of non-obstructive HCM(79％),91 cases with abnormal ECG(91％),mainly with ST-T changes(77 cases,77％).The average in-terventricular septum was 19.39±6.13mm by echocardiography.②Among the 100 pregnancies of 100 HCM pa-tients,6 cases(6％)were miscarriages,94 newborns survived(94％),including 91 cases of cesarean section(91％)and 3 cases of vaginal delivery(3％).The predominant perinatal complications were preterm delivery(39 cases,39％),small for gestational age(5 cases,5％),neonatal asphyxia(3 cases,3％)and neonatal cardiac malformation(2 cases,2％).There were no perinatal deaths.③Univariate Logistic regression analysis showed that pre pregnancy heart function ≥ Grade Ⅱ,increased left atrial diameter,and concomitant pulmonary hyperten-sion were risk factors for perinatal complications in pregnant women with HCM(OR＞1,P＜0.05).Multivariate Lo-gistic regression analysis found that pre pregnancy heart function ≥ Grade Ⅱ was an independent risk factor for predicting the occurrence of perinatal complications in pregnant women with HCM(OR 6.270,P＜0.05).Conclu-sions:HCM during pregnancy can induce poor perinatal outcome.More attention should be paid to risk assess-ment and pregnancy management.Early detection of risk factors can reduce the incidence of perinatal complica-tions.

Objective:To investigate the perinatal outcomes and risk factors of perinatal complications in preg-nant women with hypertrophic cardiomyopathy(HCM).Methods:A retrospective analysis was carried out on clini-cal data of 100 pregnant women with HCM who delivered in Obstetrical Cardiology Intensive Care Center of Shanghai Renji Hospital between Jan.2000 and Dec.2022.Analyze the incidence of perinatal complications inclu-ding miscarriage,premature birth,small for gestational age infants,neonatal asphyxia,neonatal cardiac malforma-tions and perinatal mortality.Independent risk factors of perinatal complications in pregnant women with HCM were identified using univariate and multivariate Logistic regression.Results:①The mean age was 29.21±4.41 years old,the average gestational age upon admission is 34.46±6.43 weeks.There were 16 patients with a fam-ily history of cardiomyopathy(16％),21 cases with obstructive HCM(21％)and 79 cases of non-obstructive HCM(79％),91 cases with abnormal ECG(91％),mainly with ST-T changes(77 cases,77％).The average in-terventricular septum was 19.39±6.13mm by echocardiography.②Among the 100 pregnancies of 100 HCM pa-tients,6 cases(6％)were miscarriages,94 newborns survived(94％),including 91 cases of cesarean section(91％)and 3 cases of vaginal delivery(3％).The predominant perinatal complications were preterm delivery(39 cases,39％),small for gestational age(5 cases,5％),neonatal asphyxia(3 cases,3％)and neonatal cardiac malformation(2 cases,2％).There were no perinatal deaths.③Univariate Logistic regression analysis showed that pre pregnancy heart function ≥ Grade Ⅱ,increased left atrial diameter,and concomitant pulmonary hyperten-sion were risk factors for perinatal complications in pregnant women with HCM(OR＞1,P＜0.05).Multivariate Lo-gistic regression analysis found that pre pregnancy heart function ≥ Grade Ⅱ was an independent risk factor for predicting the occurrence of perinatal complications in pregnant women with HCM(OR 6.270,P＜0.05).Conclu-sions:HCM during pregnancy can induce poor perinatal outcome.More attention should be paid to risk assess-ment and pregnancy management.Early detection of risk factors can reduce the incidence of perinatal complica-tions.