Objective To study the maternal and fetal outcome in pregnancy with overt diabetes. Methods Retrospective study was made on 88 pregnancies with overt diabetes from 1981 to 2001 in department of Obstetrics & Gynaecology, first teaching hospital, Beijing university to study the maternal and fetal outcome in pregnancy with overt diabetes and its relationship with the level of blood glucose. One case with artificial abortion and 2 cases with metaphase induced labor were rejeceted from the 88 cases, we devided the other 85 cases into two groups. Group A with well controlled glucose had 42 cases; group B without well controlled glucose had 43 cases. Results In this study, we found 5 cases of fetal death in group B, 3 of them were perinatal death. Nine cases of newborn malformation were all found in those people without well controlled glucose in early pregnancy, the incidence of newborn malformation was 10.2%. The rate of asphyxia of newborn in group B (24.4%) is significant higher than in group A (4.8%) ( P =0.011). The rate of pregnancy induced hypertension in group B (44.2%) is significantly higher than that in group A (21.4%) ( P = 0.026). The rate of premature labor in group B (30.2%) is significantly higher than that in group A (9.2%) ( P =0.017). Conclusions Maternal blood glucose with ideal control throughout pregnancy may reduce the maternal complications and perinatal morbidity and mortality in pregnancy with overt diabetes.

Objective To study the relationship of gestational diabetes mellitus(GDM) and ~family history of diabetes (FHD), clinical characteristics and maternal and infant outcomes of GDM and gestational impaired glucose tolerance (GIGT). Methods A prospective case-control study was performed in 244 women with GDM/ GIGT, including 93 patients with family history of diabetes and 151 without FHD, and 244 normal OGTT cases as control from Feb. 2004 to Aug. 2004 in Dept of OB &GYN of Peking University First Hospital. Univariate analysis was used to estimate the odds ~ratios with 95% CI. Results (1)FHD was a risk factor of GDM/GIGT, OR=2.9.The co-effect of parents DM on transmission was excessive. (2)Maternal≥30 years old with FHD were greater than those without FHD (75.3% vs 62.9%). More intakes of fruits and carbohydrate per day and more weight gain during pregnancy in pregnant women with FHD were lower than those in patients without FHD. (3) The prevalence of GDM was indifferent ~between patients with and without FHD. 50 g OGCT plasma glucose (PG), fasting PG and 3 h PG in 75 g OGTT of patients with FHD were higher than those of patients without FHD. The number of pregnant women treated by insulin was significantly different between patients with and without FHD. (4) No difference was found between family and non-family history of diabetes in the prevalences of pre-eclampsia, FGR, polyhydramnios, preterm labor, LGA and SGA. Conclusions (1) FHD is a risk of GDM/GIGT, and exposure to a diabetic intrauterine environment is a mechanism responsible for this excessive maternal inheritance. (2)~Besides family history of diabetes, more intake of fruits or carbohydrate and larger gain of body weigh during pregnancy may result in GDM/GIGT.

Objective To investigate the characteristics of insulin requirements during pregnancy in women with pre-gestational diabetes mellitus. Methods A retrospective study was conducted on 116 pregnant women with pre-gestational diabetes admitted to the Department of Obstetrics & Gynaecology, First Hospital, Peking University from 1981 to 2003. Ninty-five among the 116 cases required insulin during pregnancy among which 82 cases were enrolled in the observational group. Results Eighteen women in the observational group had OGTT performed during pregnancy whose values were above the diagnostic criteria of non-pregnant diabetes. The insulin requirements increased with the gestational age with the peak dose at 32~36 weeks followed by slight decrease till delivery. Among all the women who used animal insulin, the average BMI of those whose dose

Objective To explore the normal range of serum glycated albumin (GA) during the second trimester in non-gestational diabetes mellitus (GDM) population and the value of serum GA in the blood glucose monitoring during pregnancy.Methods The GA was measured in 101 healthy gravida during the second trimester and 80 gravida with GDM and diabetes mellitus who were in treatment at Peking University First Hospital between August 2011 and December 2011,in order to analyze the normal range of GA and the relationship between GA and the level of blood glucose.Results (1) The normal range of GA during the second trimester was 10.9％-15.3％,which was negatively correlated with body mass index (P＜0.01).(2) Significant correlations were observed between GA and the level of hemoglobin A1c (HbA1c),preprandial,postprandial and mean plasma glucose in gravida with GDM and diabetes mellitus (r:0.361,0.252,0.338,0.310 ; all P ＜ 0.05).(3) When the level of GA was 13.97％,the sensitivity and specificity index for glucose control were 78.0％ and 74.4％.Conclusions GA could evaluate the severity of disease in gravida with GDM and diabetes mellitus.10.9％-15.3％ could be suggested as normal range of GA for the gravida at the second trimester.

Objective To evaluate the value of glycosylated hemoglobin (HbAlc) level in glucose monitoring,insulin therapy and neonatal birth weight prognosis in gestational diabetes mellitus (GDM) patients.Methods Data of 1074 women who were diagnosed as GDM and delivered at Peking University First Hospital between January 1,2005 and August 31,2011 were collected and retrospective analysis was conducted.The relationship of HbAlc level with plasma glucose level of oral glucose tolerance test (OGTT),insulin administration and neonatal birth weight were investigated with Pearson correlation analysis,Logistic regression analysis or receiver operating characteristic (ROC) curve.Results OGTT was done on 1074 women with (31.8± 4.0) years old during the second and third trimester and diagnosed GDM at (27.6 ± 3.4) weeks of gestational age.Among them,glucose level of fasting and 1 and 2 hours after OGTT were (5.2 ± 0.7),(10.9± 1.4) and (9.4±1.5) mmol/L.The levels of HbAlcwere (5.57±0.48)％ at the fist time of HbAlc testing at (31.8±4.3) weeks of gestational age.(1)The average value of HbAlc in 726 women determined at one month after OGTT was (5.54±0.47)％,and increased from (5.34±0.41)％ in women with one abnormal item in OGTT to (5.47±0.41)％ and (5.71±0.46)％ in women with two or three abnormal items inOGTT (t=3.025 and 6.399,all P＜0.01).(2) HbAlc level in women received insulin therapy was higher than those who did not [(5.78±0.58) ％ vs (5.42±0.37) ％,t=9.431,P＜0.01].The sensitivity and specificity were 57.8％ and 75.5％ respectively in predicting insulin requirement in women with GDM at the cut-off value of 5.67％ for HbAlc (Logistics analysis:OR＝6.847,95％CI:4.588-10.218,P＜0.01).(3) Maternal HbAlc levelat the third trimester was higher in large for gestational age(LGA) group than that in non-LGA group [(5.75±0.52)％ vs (5.54±0.42)％,t=6.845,P＜0.01].The sensitivity and specificity were 44.8％ and 73.8％ respectively in predicting LGA at the cut-off value of 5.75％ for HbAlc (Logistics analysis:OR=2.187,95％CI:2.097-3.783,P＜0.01).(4) Maternal HbAlc level at the third trimester was higher in macrosomia group than that in non-macrosomia group [(5.88±0.53)％ vs (5.57±0.45)％,t=5.990,P＜0.01].The sensitivity and specificity were 50.4％ and 79.8％ respectively in predicting macrosomia at the cut-off value of 5.85％ for HbAlc (Logistics analysis:OR=3.299,95％CI:2.237-4.865,P＜0.01).Conclusions HbAlc level at the time of GDM diagnosis could imply the severity of disease and might predict insulin requirement.While maternal HbAlc level at the third trimester may predict the occurrence of LGA and macrosomia.

Objective· To investigate whether vitamin E could reverse the disruptive effects of bisphenol A (BPA) on steroidogenesis and to explore the optimal vitamin E concentration.Methods· Rat primary granulosa cells were extracted and exposed to BPA (0,0.01,0.1,1,10,100 μmol/L).After 48 h of incubation,culture medium was collected and estradiol (E2) and progesterone (P4) were measured using ELISA kits.Then,granulosa cells were incubated with 5 μmol/L(average concentration in follicular fluid) or 25 μmol/L (high concentration in follicular fluid) vitamin E (α-tocopherol) or vitamin E (5 μmol/Lor 25 μmol/L) plus BPA (10 μmol/L or 100 μmol/L) for 48h,E2 and P4 were measured.Results· BPA at 10 μmol/L and 100 μmol/L suppressed E2 and P4 production in a dose-dependent manner (P＜0.05).Vitamin E at 25 μmol/L significantly increased E2 and P4 levels by (44.89±15.18) ％ and (43.33±8.82) ％(P＜0.05),respectively.Coincubation of the granulosa cells with BPA and vitamin E (5 μmol/L or 25 μmol/L) restored the productions of E2 and P4,which were not significantly different from the control group (P＞0.05).Conclusion· Vitamin E (5 μmol/L/25 μmol/L) could reverse BPA-induced reduction in steroid hormone production in rat ovary granulosa cells,and the antagonistic effect of 25 μmol/L vitamin E was more obvious than that of 5 μmol/L vitamin E.

As a new kind of perioperative management strategy and ideas,enhanced recovery after surgery (ERAS) brings a series of traditional perioperative treatment measures for optimization based on evidence-based medicine.Its primary aim is to decrease surgery-related stress,complications,and also to facilitate recovery with multimodal treatments.The ERAS pathway has been widely applied and proved to be efficient in gastrointestinal,colorectal,orthopedic,thoracic and gynecological surgery.Owing to the complexity of surgical procedure,long operation time and high perioperative complication rate in liver transplantation compared with other surgeries.This new concept has not been widely accepted or recommended in liver transplantation,although some previous studies have validated its safety and effectiveness.This paper overviewed the recent literature on the specific procedures,efficacy,safety and development of ERAS applied in liver transplantation.

AIM: To observe the effect of Retinervus luffae fructus (RLF) on the myocardial ischemia in mice. METHODS: Mice were supplied with RLF (166.7,333.3, 666.7 g/L) twice daily (0.01 mL/g, ig). One week later, 30 U/kg pituitrin was injected intraperitoneally. The electrocardiogram was recorded, and the content of lactose dehydrogenase (LDH) in the serum and the activities of superoxide dismutase (SOD), maleicdialdehyde (MDA) in the myocardium were examined. RESULTS: RLF reduced the height of T wave in electrocardigram in myocardial ischemia mice and inhibited the decrease in heart rate. RLF also reduced the content of LDH in serum and the content of MDA in myocardium. The increase in the activity of SOD in myocardium was also observed. CONCLUSION: RLF may protect myocardium against ischemia injury. The mechanism may be related to the increase in activity of SOD and the suppression of the lipid peroxidation.

Objective To investigate the outcomes of increased gestational diabetes mellitus (GDM) and the influencing factors after the implementation of the new GDM diagnostic criteria.Methods A total of 1 439 GDM women who delivered in the Peking University First Hospital between May 1,2011 and December 31,2012 were studied and divided into two groups.Group Ⅰ included the women who met the new GDM diagnostic criteria (fasting plasma glucose and 1 or 2 h plasma glucose levels for 75-g oral glucose tolerance test performed between 24 and 28 weeks of gestation were no less than 5.1,10.0 and 8.5 mmol/L),but did not meet the National Diabetes Data Group (NDDG) criteria;and Group Ⅱ included the women who met the NDDG criteria only.Women in Group Ⅰ were further divided into two subgroups according to whether attending the one-day GDM outpatient visit.Follow-up rate and detecting rate of abnormal glucose metabolism at 6-12 weeks after delivery were analyzed.Chi-square test,t test and multivariate Logistic analysis were used for statistical analysis.Results There were 849 GDM women in Group Ⅰ (59.0％,849/1 439) and 590 (41.0％,590/1 439) in Group Ⅱ.The follow-up rate in group Ⅰ was lower than in group Ⅱ [25.9％(220/849) vs 32.0％(189/590),x2=6.112,P=0.013].There were five cases of impaired fasting glucose and 34 impaired glucose tolerance in Group Ⅰ;and four cases of impaired fasting glucose,56 impaired glucose tolerance,eight impaired fasting glucose tolerance with impaired glucose tolerance and five diabetes mellitus in Group Ⅱ;there were significant differences [17.7％(39/220) vs 38.6％(73/189),x2=33.810,P=0.000].(2) In Group Ⅰ,the increased glucose level at 2 h in oral glucose tolerance test during pregnancy (OR=1.547,95％CI:1.038-2.306,P=0.032) and family history of diabetes mellitus (OR=1.879,95％CI:1.066-3.313,P=0.020) were risk factors for postpartum abnormal glucose metabolism,while breast-feeding was a protective factor (OR=0.290,95％CI:0.092-0.914,P=0.035).(3) In group Ⅰ,the follow-up rate in those who attended the one-day GDM outpatient visit was higher than those who did not [30.7％(185/603) vs 14.2％(35/246),x2=23.780,P=0.000],but the detecting rate of postpartum abnormal glucose metabolism were similar in women attending the one-day GDM outpatient visit and those not attending [17.8％(33/185) vs 17.1％(6/35),x2=0.020,P=0.887].Conclusions Increased GDM women still have glucose metabolism abnormality after delivery,especially those who have higher glucose level at 2 h after glucose intake in 75 g oral glucose tolerance test during pregnancy and who have a family history of diabetes mellitus.The one day GDM outpatient visit may improve the follow-up rate for these women.

Objective To investigate the efficiency of ring butterfly sewing in lower uterine segment aided with tourniquet in treating pernicious placenta previa combined with placenta percreta. Methods Twelve pregnant women diagnosed with pernicious placenta previa combined with placenta percreta by prenatal ultrasound in Peking University First Hospital from April 1, 2012 to November 30, 2014, were enrolled. All of them received elective cesarean delivery using ring butterfly sewing in lower uterine segment aided with tourniquet. The efficiency of this novel technique, in term of blood loss and vital signs during operation, blood transfusion, and postoperative recovery, was analyzed. Results Twelve cases were diagnosed with placenta percreta during operation, with placenta invading the perimetrium in seven cases and urinary bladder being involved in one case. Ring butterfly sewing in lower uterine segment aided with tourniquet during elective cesarean delivery was all successful in the 12 cases. The median amount of blood loss was 1 000(400-2 000) ml during operation and the amount of blood loss was lower than 1 000 ml in three cases. Two cases received no blood transfusion, and the median blood transfusion in the other 10 cases were 400(400-1 200) ml. The mean operation time was (75±22) min (43-131) min. Eleven cases had normal lochia and temperature after operation and the other one had placenta invading urinary bladder and partial placenta in situ, and developed fever at day 3 after operation, but recovered after antibiotic treatment, and no placenta tissue was seen by ultrasound at day 59 after operation. Conclusions The ring butterfly sewing in lower uterine segment aided with tourniquet is highly effective for the pernicious placenta previa combined with placenta percreta, and it is a simple, fast and fertility sparing technique with low blood loss and without usage of special equipment.