Objective To review outcomes in randomized controlled trials comparing labetalol with other anti hypertensives/placebo/no drug for mild to moderate hypertension in pregnancy.Methods We searched PubMed,China Knowledge Resource Integrated Database and VIP Database and performed a meta analysis of randomized controlled trials of labetalol for hypertension in pregnancy.Data were entered into RevMan software for analysis [relative risk (RR) and its 95％ confidence interval (CI)].Results Seven studies were included in the meta-analysis.Four trials (553 women) compared labetalol with methyldopa for mild to moderate hypertension in pregnancy.Labetalol reduced the risk of severe hypertension (RR=0.52,95％CI:0.31-0.88) and proteinuria (RR=0.57,95％CI:0.36 0.91).The incidence of preterm birth and small-for-gestational-age infants was similar between these two groups.Five trials (720 women) compared labetalol with placebo/no drug for mild to moderate hypertension in pregnancy.Labetalol reduced the risk of severe hypertension (RR=0.29,95％CI:0.16-0.53) and proteinuria (RR-0.73,95％CI:0.56-0.95) and showed no effect on preterm birth and small-for-gestational-age infants.Conclusions The results support the use of labetalol for mild to moderate hypertension in pregnancy.Labetalol is more effective in treating hypertension than methyldopa.However,due to the quality of the included studies,clinical effects of labetalol need to be evaluated in high quality randomized controlled trials.

Objective To evaluate the diagnostic value of colonoscopy for patients with chronic diarrhea.Methods Data of 2449 patients with chronic diarrhea who underwent colonoscopy from January,1999 to December,2008 were reviewed.A total of 2110 patients who underwent colonoscopy screening for health checkup during the same period were used as controls.The rates of clinic-relevant abnormal endoscopic findings and negative finding were compared between two groups.Results Lesions with clinic significance were found in 44.1％ of patients with chronic diarrhea (1080/2449) and in 41.7％ of controls (870/2110,x2 =2.756,P =0.097).Compared with controls,incidence of non-IBD and noninfectious colitis (x2 =58.578,P ＜ 0.001),IBD (x2 =59.609,P ＜ 0.001),malignant tumor (x2 =21.649,P ＜0.001),terminal ileitis (x2 =6.275,P =0.012),infectious colitis (x2 =17.019,P ＜0.001),intestinal tuberculosis (x2 =7.021,P =0.008),melanosis coli (x2 =6.040,P =0.014) and parasitic infection (x2 =4.245,P =0.039) were all significantly higher in patients with chronic diarrhea.However,incidences of adenomatous polyps (x2 =14.124,P ＜ 0.001),non-adenomatous polyps (x2 =33.427,P ＜0.001) and diverticular disease (x2 =9.921,P =0.002) were significantly higher in the control group.There was no significant difference in incidences of the benign tumor (x2 =1.627,P =0.202) and angiodysplasia (x2 =0.231,P =0.631) between the two groups.The overall screening rate of colonic polyps,diverticulosis,and vascular lesions was 37.3％ in chronic diarrhea group.Conclusion Colonic polyps,diverticulitis,benign tumors and angiodysplasia may not be the causes of chronic diarrhea.Etiology of more than 1/3 patients with chronic diarrhea remains unknown after colonoscopy.

Objective To establish a quantitative model to rapidly determine content of 3-butylphthalide in Angelicae Sinensis Radix based on near-infrared diffuse reflectance spectroscopy (NIR). Methods Totally 145 batches of samples of Angelicae Sinensis Radix from 14 areas of Gansu and Yunnan Provinces were collected and dried in the shade. With the content of 3-butylphthalide determined by RP-HPLC-DAD as reference, the NIR spectra of 145 batches of Angelicae Sinensis Radix were collected by integrating sphere diffuse reflectance, and the PLS (partial least squares) quantitative analysis model was established between 7415-4056 cm-1. Results The Rc (correlation coefficient between actual content and predicted content), RMSEC (the root-mean-square error of calibration), RMSEP (the root-mean-square error of prediction), Rcv (cross-validation correlation coefficient), RMSECV (the root-mean-square error of cross-validation), and average predicted recovery reached 0.976 7, 0.614 3, 0.706 5, 0.897 8, 1.155 4 and 102.08%, respectively. Conclusion This prediction model was accurate, reliable, and can be used to quantitatively determine the content of 3-butylphthalide in Angelicae Sinensis Radix.

Objective To determine the relationship of cytochrome P-450 epoxygenase metabolites of arachidonic acids with impaired endothelium-dependent vasorelaxation in the healthy elderly. Methods A case-control study was employed.The study enrolled 60 healthy young adults (group A) and 60 healthy senior citizens (group B) of Han population in Shanghai. Serum contents of 14,15-dihydroxyeicosatrienoic acid (14,15-DHET) (a stable metabolite of 14,15-EET), 6-Kote-PGF1a (a stable metabolite of prostaglandin) and TXB2 (a stable metabolite of thromboxane A2) were measured using ELISA kits. The endothelium-dependent vasorelaxation (EDV) and endothelium-independent vasorelaxation (NEDV) in brachial arteries were determined by color Doppler ultrasound. Results Compared with group A, group B had significant higher levels of hemoglobin A1c, triglyceride and cholesterol levels (P＜0.01), and significant lower levels of 14,15-DHET and 6-Kote-PGF1a (P＜0.001), leading to increased values of TXB2/6-Kote-PGF1a and TXB2/14,15-DHET. There was bigger basal interior diameter of brachial arterials with reduced EDV and NEDV response (P＜0.01 and P＜0.05, vs. group A respectively) in group B. Moreover, the age was negatively correlated with 14,15-DHET and TXB2/14,15-DHET. Conclusions Our results indicate that the impaired EDV and NEDV in aging are associated with reduced production of arachidonic acid metabolites through cytochrome P-450 epoxygenase pathway and cyooxygenase pathway of endothelium in the healthy elderly.

Objective To investigate the application of "Guidelines for performing fetal cardiac scan", issued by the International Society of Ultrasound in Obstetries and Gynecology in 2006, in prenatal screening of fetal congenital heart disease (CHD). Method Totally, 5000 singleton pregnancies presented at the Maternal-Fetal Medical Center of the Affiliated Drum Tower Hospital of Nanjing University Medical School from September 2006 to July 2007, for prenatal screening were included in this study, with the median maternal age of 28 ( range, 18～48 ) and the median gestation of 27 ( range, 18～40 ) weeks. Ultrasound screenings were performed on each fetal heart according to "Guidelines for performing fetal cardiac scan" via the four-chamber and outflow tracts & three-vessel views and fetal echocardiographies were further conducted for suspected cases. Once congenital heart disease was confirmed, amniocentesis or cordocentesis was suggested for fetal karyotyping for ongoing pregnancies and autopsy was performed when the pregnancy was terminated after formal consent. Bom babies were followed up at 2～6 months of age using echocardiography. Result The four-chamber views were successfully obtained in 97.64% (4882/5000) of all the pregnancies , among which the left ventricular and right ventricular outflow tracts and three-vessel views were obtained in 87.69% ( 4281/4882 ), 82.51% ( 4028/4882 ) and 96.29% ( 4701/4882 ), respectively. Higher successful rate was found in the second trimester than the third trimester in obtaining the standard views (P<0.05). Finally, 73 (1.50%) among the 4882 cases were diagnosed as CHD. Fifty of them were diagnosed prenatally (24 cases in the second trimester and 26 cases in the third trimester) and 23 were missed and 1 misdiagnosed by prenatal ultrasound. Eighteen cases were found with extracardiac malformations. Autopsy was performed in 19 CHD which diagnosed prenatally, and all autopsy reports were consistent with ultrasound foundings. Twelve babies received postnatal echocardiography among which 11 were unanimous, and 1 baby diagnosed as tricuspid insufficiency prenatally was confirmed normal after birth. Abnormal karyotype was found in 7 out of the 23 who had karyotyping performed. Altogether, 28 cases were diagnosed by four chamber view only and 50 cases by combining other views, giving the sensitivity, specificity, false negative rate and false positive rate of 69% (50/73), 99.98% (4808/4809), 0.48% (23/4831) and 2% ( 1/51 ) ,respectively. Conclusion The "Guidelines for performing fetal cardiac scan" is practical and easy to abide by. The optimal time for fetal cardiac examination is at 18～27 weeks of gestation. Four-chamber view together with the outflow tracts and three-vessel views examination can detect 69% of CHD in utero.

Objective To study the effect of designing and application of portable thermometer transceiver and its application. Methods A portable thermometer transceiver was designed and used to measure the temperature of 31,386 patients. Meanwhile, the traditional temperature measurement method was used among 31,378 patients. The two groups were compared in view of time for assigning and collecting the meter. Results The time for assigning the portable thermometer transceiver and receiver was (0.08 ±0.03) min, while that for the traditional measurement method was (1.06 ±0.03) min. There was statistically significant difference between the groups (t=29.231, P<0.001). Conclusion The portable thermometers for temperature measurement can save time and improve the efficiency of nursing staff.

Objective:To investigate the abnormal results of chromosomal microarray analysis (CMA) in the subsequent pregnancy of women with adverse pregnancy history, and explore the applicability of CMA in women with different genetic etiology.Methods:Out of 5 563 pregnant women who received CMA test in Nanjing Drum Tower Hospital during June 2014 and July 2020, 169 cases that underwent prenatal diagnosis due to isolated adverse pregnancy history were retrospectively collected in this study. All the participants were divided into three groups based on the etiology type of probands, genetic origin and expected CMA outcome: high-risk group ( n=19, including 11 cases with inherited pathogenic copy number variations and eight cases with inherited chromosomal abnormalities), low-risk group ( n=113, including six cases with negative whole exome sequencing and/or CMA findings, 31 cases with confirmed monogenic disease, 47 cases with de novo pathogenic copy number variations and 29 cases with de novo chromosomal abnormalities), and unknown risk group ( n=40, none of the cases underwent genetic testing). Descriptive statistical analysis was used to summarize the abnormal detection of each group. Results:There were 169 mothers with 172 fetuses finally enrolled, including two twins and one woman with two singleton pregnancies. A total of nine cases of abnormal fetuses were detected by CMA, accounting for 5.2% (9/172). Among them, eight were in the high-risk group, which were all caused by parental abnormalities, and one case in the low-risk group was detected with a de novo 22q11.22q11.23 microduplication, which was arr[GRCh37]22q11.22q11.23(22,997,928-25,002,659)×3. No abnormality was detected in the 40 patients of unknown risk group. Conclusions:Clarifying the etiology of isolated adverse pregnancy history is crucial to the rational application of CMA. Monogenic disease, unknown cause or negative finding of CMA in probands may not be an indication for prenatal diagnosis of CMA.

Objective Preoperative autologous blood donation ( PABD) may reduce the need for allogeneic blood , but it may also cause a short massive blood loss in pregnant women , and its fetal and maternal safety has to be adequately assessed .This study was to evaluate the feasibility and safety of PABD for pregnant women and their fetuses . Methods A prospective observational study was conducted among the women who met the inclusion criteria and gave birth in Nanjing Drum Tower Hospital between January and December 2013 .According to the clinical validation of risk stratification criteria for peripartum hemorrhage of California 2013 , the ca-ses were classified into a low-, a medium-, and a high-risk group.Data on blood donation procedures , obstetric outcomes, and blood transfusions were collected after delivery for analysis . Results Totally, 92 pregnant women accomplished 115 blood donations .The median volumes of the donated blood were 300, 300, and 400 mL in the low-, medium-, and high-risk groups, respectively ( P>0.001).There were no significant changes in HR , SBP and SpO2 during the blood donation procedures (P>0.05) except for the fall of diastolic blood pressure by an average of 3.4 mmHg (P<0.05) at 5 minutes after blood collection, which was restored to normal later.Non-reassuring fetal heart rate patterns were not found in any of the cases .The levels of HB and HCT were remarkably lower af-ter donation than before it (P<0.05) but restored to normal before delivery in the PABD cases who donated once only (P>0.05), which were similar to those in the cases who donated twice , with no significant differences before and after the donation (P>0.05). Homologous blood transfusion was performed for 5 cases (17.9%) in the high-risk group, with the volume of blood loss >2000 mL in all the cases.All the newborns survived without asphyxia and there was no perinatal death . Conclusion PABD can provide timely autologous whole blood donation for pregnant women .Under strict management , PABD is feasible and safe for pregnant patients who are at a high risk for massive blood loss during delivery or have a rare type of blood no readily available .

The clinical characteristics and gene mutation characteristics of a child with typical maple syrup urine disease were analyzed retrospectively.The child is a boy, who showed unexplained milk refusal, poor reaction, foaming at the mouth, and encephalopathy symptoms 7 days after birth.The total leucine concentration was abnormally increased by blood tandem mass spectrometry, and the results of urine gas chromatography/mass spectrometry suggested that the concentrations of 2-hydroxy isovaleric acid, 2-keto isovaleric acid, 2-keto-3-methylpentanoic acid and 2-keto-isohexanoic acid were significantly increased.The gene detection results showed that c. 1028delC (p.S343Lfs*9) homozygous mutation was found in the BCKDHB gene.Understanding the clinical symptoms and gene mutation characteristics of this disease can help with the early detection and early diagnosis of this disease, so as to improve its prognosis to the greatest extent.

Radiation-induced bystander effect (RIBE) refers to that irradiated cells release signaling factors and induce responses in nonirradiated cells.In other words, it is the communication between irradiated and nonirradiated cells by intracellular signals. RIBE could influence the efficacy of tumor radiotherapy, but also has potential risk to the normal tissues outside of radiation field. Studies have found that ionizing radiation can induce the alteration of miRNA expression not only in the irradiated cells but also in adjacent nonirradiated tissues, and miRNAs may play an important role in the regulation of signaling pathways between irradiated and nonirradiated bystander cells. This article reviewed the roles of miRNAs in RIBE.