OBJECTIVE:To provide reference for reasonable iron supplement during pregnancy. METHODS:5023 iron sup-plement prescriptions for 800 delivery women receiving antenatal care and childbearing in our hospital in 2014 were analyzed retro-spectively. According to international authoritative guideline for gestational iron supplement,the rationality of iron supplement for pregnant women in our hospital was investigated in terms of timing,duration and dosage. RESULTS:The iron supplement timing and duration of 800 pregnant women all met the criteria;among 5023 iron supplement prescriptions,62 prescriptions of preventive iron supplement and 3875 prescriptions of iron supplement for iron deficiency were up to the standard. CONCLUSIONS:The dos-age of gestational iron supplement are unreasonable in our hospital at a certain extent. It is necessary to strengthen clinical medica-tion management to guarantee safe and rational iron supplement in pregnant women.

Objective To investigate the molecular types of carbapenem-non-susceptible Esche-richia coli ( E.coli) isolates and their mechanism of carbapenem resistance .Methods Twenty-two carbap-enem-non-susceptible E.coli strains were isolated from 3 hospitals in Hangzhou from 2007 to 2011.The mini-mum inhibitory concentrations ( MICs) of antimicrobials to those isolates were determined by agar dilution method and E-test.The molecular mechanisms of carbapenem resistance of E.coli isolates were analyzed by conjugation experiment,PCR and DNA sequencing.Pulsed-field gel electrophoresis (PFGE),multilocus se-quence typing ( MLST ) , and phylogenetic typing were performed to analyze the molecular epidemiology of those isolates.Results The MICs of imipenem and meropenem to 22 E.coli isolates were ranged from 1 μg/ml to 16 μg/ml,and the MICs of ertapenem were 2 μg/ml to 64 μg/ml.All E.coli isolates produced the KPC-2 carbapenemase and various β-lactamases , and some of them also produced plasmid-mediated AmpC enzymes.Carbapenem resistance was transferred by conjugation and transformation from 22 E.coli iso-lates to E.coli EC600 strains.The E.coli transconjugants or transformants acquired the blaKPC-2 gene and showed similar antibiotic susceptibility patterns in comparison with donor strains .Only a few isolates were in-distinguishable or closely related as indicated by PFGE .Four sequence types including ST131 (9 isolates), ST648 (5 isolates),ST38 (2 isolates) and ST405 (2 isolates) were identified by MLST.Phylogenetic analy-sis indicated that 9 ST131 isolates belonged to phylogenetic group B 2 and the other isolates belonged to group D (11 isolates),group B1 (1 isolate) and group A (1 isolate),respectively.Conclusion The sequence type of prevalent E.coli isolates producing KPC-2 from Hangzhou was ST131,which is an international epi-demic,multidrug-resistant clone,followed by ST648.

Objective To investigate the impact of neoadjuvant chemotherapy on surgery and prognosis in patients with stage Ⅲ gastric cancer.Methods The 90 cases staging Ⅲ gastric cancer were randomly divided into neoadjuvant chemotherapy group and surgery group.Both surgical complications and prognosis were compared.Results The overall effective rate of neoadjuvant chemotherapy was 53％ (24/45),disease control rate of neoadjuvant chemotherapy was 91％ (41/45).Blood loss (t =4.102,P =0.037),local adhesions surgery (x2 =19.756,P =0.000),local tissue necrosis (x2 =13.512,P =0.000),tissue fragility (x2 =12.870,P =0.000) number of cases found in neoadjuvant chemotherapy group were higher than surgery group,and the data were statistically significant.There were no statistically significance between two groups about operation time (t =2.391,P =0.129),tissue congestion (x2 =0.865,P =0.352),postoperative bleeding(x2 =0.720,P =0.396),postoperative fistula (x2 =1.047,P =0.306).The survival time of neoadjuvant chemotherapy group was longer than surgery group,but it was not statistically significant(t =1.086,P =0.372).Conclusions Neoadjuvant chemotherapy could reduce the stage of the gastric cancer and increase the complexity of surgery.Thus preoperative evaluation should be prepared before the surgery.

Objective To observe the effects of 1,25-dihydroxyvitamin D3 on the expressions of transforming growth factor-β1(TGF-β1), fibronectin(FN),and vascular endothelial growth factor(VEGF) in rats with diabetic nephropathy(DN), and to elucidate the protective mechanism played by 1,25-dihydroxyvitamin D3. Methods DN models were estabolished by injecting streptozotoein ( STZ ) into male SD rats, which were divided into TGF-β1 overexpression group, TGF-β1 overexpression plus vitamin D3 group, TGF-β1 low-expression group, TGF-β1 low-expression plus vitamin D3 group, TGF-β1 normal-expression group, and TGF-β1 normal-expression plus vitamin D3 group. After 1,25-dihydroxyvitamin D3 treatment for 37 days, renal function and blood biochemical parameters were evaluated. The morphology and fibrosis of kidney tissues were observed. The expressions of TGF-β1, FN, and VEGF in kidney cortex were measured by immunohistochemistry, realtime PCR, and Western blotting. Results The levels of cholesterol, triglyceride, creatinine,plasma glucose, HbA1C , and 24 h urinary protein were lower in vitamin D3treated groups than those in corresponding control groups(P<0. 05). The degree of renal fibrosis was raised with the increased level of TGF-β1. Vitamin D3 treatment decreased the fibrosis in diabetic kidney. There were significant differences in the mRNA and protein expressions of TGF-β1 in three control groups(P<0. 05). With the increased levels of TGF-β1, the expressions of FN and VEGF were increased. The expressions of TGF-β1, FN, and VEGF were lowered by vitamin D3compared with the corresponding control groups(P<0. 05). Conclusion 1,25-dihydroxy-vitamin D3 may protect the renal tissure in diabetic rats via inhibiting the expressions of TGF-β1, FN, and VEGF in the kidney.

Objective To analyze the genomic sequences of Cryptococcus neoformans var grubii strains of two genotypes with different virulence and to screen out the virulence-associated genes. Methods A clinical strain (IFM56800) with the strongest virulence and an environmental strain (IFM56731) with the weakest virulence were screened out for whole genome sequencing analysis. The results of sequencing analy-sis were comprehensively analyzed by using the method of comparative genomics. Genetic variations were ex-tensively screened by using the strategies of non-synonymous single nucleotide polymorphisms ( nsSNPs), nonsense SNPs and the insertions or deletions ( InDels) causing frameshift mutations. The filtered genes were sequenced in 20 experimental strains. The whole RNAs were extracted and then the full-length cDNAs were sequenced by using the rapid amplification of 5′ and 3′ cDNA ends (RACE) method. Results By whole genome sequencing, valid data with high coverage (127 times and 111 times) was obtained in both the environmental strain IFM56731 and the clinical strain IFM56800. The data of InDels and SNPs were statisti-cally analyzed, respectively. Six genes were chosen for further analysis based on the strategies of nonsense SNPs and the InDels causing frameshift mutations. The six genes were amplified and sequenced in all of the experimental strains, three of which were further analyzed with cDNA sequencing. Ultimately, the location and structure of CNAG_01032 gene were determined. The predicted nonsense mutation locus was verified to present in the actual mRNA. Conclusion The strategies of nonsense SNPs and the InDels causing frame-shift mutations showed high-efficiency in screening potential virulence-associated genes. The CNAG_01032 gene was screened out as a novel virulence-associated gene.

Objective To explore the expression of tankyrase (TNKS) and its relationship with WNT/β-catenin signal?ing pathway in lung acinar adenocarcinoma. Methods Seventy-two samples of single subtype alveolar like lung adenocarci?noma (lung adenocarcinoma group) and 67 specimens of normal lung tissue adjacent to carcinoma (adjacent to carcinoma group) were collected. Immunohistochemical method was used to detect expressions of TNKS, beta-catenin (β-catenin) and c-myc protein. The correlation of each protein expression in lung adenocarcinoma tissues was analyzed. The differential ex?pression of TNKS was detected by Western blot assay in two groups. Results Tankyrase protein was mainly expressed in cy?toplasm. The expression ofβ-catenin protein was mainly in cytoplasm and nuclear of lung adenocarcinoma. The expression ofβ-catenin was mainly in cytoplasm, and a small amount was in nuclear of the adjacent group. The c-myc protein was ex?pressed mainly in the nucleus. The positive expression rates of TNKS,β-catenin and c-myc protein were significantly high?er in lung adenocarcinoma group than those of adjacent to carcinoma group (P<0.05). The expression ofβ-catenin in cyto?plasm and nucleus was positively correlated with the expression of TNKS and c-myc (P<0.05). Western blot analysis showed that the relative expression level of TNKS was significantly higher in lung adenocarcinoma group than that of adja?cent to carcinoma group (0.497 ± 0.021 vs. 0.237 ± 0.015, t=13.00, P<0.01). Conclusion Abnormally high expression of TNKS in lung adenocarcinoma may promote the occurrence of lung cancer by regulating the WNT signaling pathways. Inhib?iting TNKS expression may become a new target to treat lung adenocarcinoma.

Background The anomalous origin of the left coronary artery (LCA) from the pulmonary artery (ALCAPA) and congenital left main coronary artery atresia (CLMCA-A) are two kinds of very rare coronary heart diseases which affect heart function profoundly.This study aimed to retrospectively illustrate the clinical features and therapy experience of ALCAPA and CLMCA-A patients.Methods From April 1984 to July 2012,in Beijing Anzhen Hospital,23 patients were diagnosed with ALCAPA and 4 patients with CLMCA-A.We summarized the clinical data of the 27 cases and retrospectively analyzed the clinical manifestation,diagnosis,and treatments of these two kinds of congenital coronary abnormalities.Results The 23 patients (13 males and 10 females,aged ranging from 2.5 months to 65 years) identified with ALCAPA were classified into infantile type (age of onset younger than 12 months,16 cases) and adult type (age of onset older than 12 months,7 cases).Four patients were diagnosed with CLMCA-A (three males and one female,aged ranging from 3 months to 2 years).The main clinical manifestations of infantile-type ALCAPA and CLMCA-A include repeated respiratory tract infection,heart failure,dyspnea,feeding intolerance,diaphoresis,and failure to thrive.And these two congenital coronary abnormalities might be misdiagnosed as endocardial fibroelastosis,dilated cardiomyopathy,and acute myocardial infarction.As for the adult-type ALCAPA,cardiac murmurs and discomfort of the precordial area are the most common presentations and might be misdiagnosed as coronary heart disease,myocarditis,or patent ductus arteriosus.In ECG examination:Infantile-type ALCAPA and CLMCA-A showed abnormal Q waves with T wave inversion in leads I,avL,and V4-V6,especially in lead avL.However,ECG of adult-type ALCAPA lacked distinct features.In chest radiography:pulmonary congestion and cardiomegaly were the most common findings in infantile-type ALCAPA and CLMCA-A,while pulmonary artery segment dilation was more common in adult type.In echocardiography,the common features of infantile-type ALCAPA and CLMCA-A included left ventricular enlargement,left ventricular systolic function normal or mildly reduced in CLMCA-A or significantly reduced in ALCAPA,and moderate to large mitral valve.It was performed in 9 of 23 cases of ALCAPA and showed the origin of the dilated right coronary artery (RCA) from the right sinus of the aortic root and absence of LCA origin in angiography.After opacification of RCA,reverse flow in the LCA and pulmonary artery was visualized through coronary artery collateral circulation.Angio was performed in three of the four cases of CLMCA-A and showed left main coronary artery was a blind end,with diameter of only 1.1-2.0 mm.Treatment and prognosis:21 patients with ALCAPA had cardiac surgery and 6 of them died postoperatively.Fifteen postoperative patients survived without overt symptoms within the follow-up period of 6-166 months (median 17 months).As for treatment of CLMCA-A,four patients took digoxin and diuretics without undergoing cardiac surgery.Their clinical symptoms improved during the close follow-ups.Conclusions ALCAPA and CLMCA-A are two rare coronary artery abnormalities that affect cardiac function in infants and children.In younger patients with cardiomegaly and heart dysfunction these two congenital coronary diseases should be noticed.

Objective: To analyze the ratio of pulmonary valve ring to aortic valve ring (GA ratio), and to explore the application value of GA ratio in predicting the need of transannular patch in the radical operation of children with tetralogy of Fallot (TOF). Methods: A retrospective analysis was performed in 355 children (182 males and 173 females) with TOF and underwent radical operation in the Pediatric Cardiac Center of Beijing Anzhen Hospital Affiliated to Capital Medical University from January 2016 to December 2017.They were divided into transannular patch group and non-transannular patch group.The values of pulmonary valve ring and aortic valve ring in two groups were collected, and the Z-score of pulmonary artery and GA ratio were calculated respectively for statistical analysis. Results: Among the 355 patients, 156 children (43.9%) required a transannular patch, and 199 patients (56.1%) did not receive transannular patch.The GA ratio and the Z-score of of pulmonary artery in the transannular patch group were lower than those in the non-transannular patch group [0.45±0.12 vs. 0.54±0.15, (-1.75±0.98) scores vs.(-0.86±1.39) scores], and the differences were statistically significant (t=5.29, 6.32, all P<0.01). Receiver operating characteristic curve analysis showed that in the case of the Z-score of pulmonary artery of -2 for the children received transannular patch, the area under the curve (AUC) was 0.702 (95%CI: 0.64-0.76), sensitivity was 69%, and specificity was 83%; in the case of the GA ratio of 0.58 for the children received transannular patch, the AUC was 0.712 (95%CI: 0.66-0.77), sensitivity was 70%, and specificity was 87%. Conclusions The GA ratio is a simple and effective predictor of transannular patch in the radical operation of TOF and can be applied in clinical practice.

Objective To explore the clinical characteristics including the morbidity, clinical manifestation, and pathogens of late-onset sepsis (LOS) in very low birth weight (VLBW) infants in neonatal intensive care unit (NICU). Methods Clinical data of all VLBW infants in NICU from January 2011 to December 2013 were collected. According to the results of blood culture, the VLBW infants diagnosed with LOS were divided into confirmed LOS group and clinical LOS group. The morbidity, clinical manifestations, common pathogens, and drug sensitivity of LOS were retrospectively analyzed. Results In 226 VLBW infants, there were 117 cases of LOS with the morbidity at 51.8%. Forty-five infants were confirmed to have LOS by blood culture, accounting for 19.9% (45/226); another 72 infants were diagnosed with clinical LOS, accounting for 31.9% (72/226). The rates of tachycardia and temperature fluctuation in confirmed LOS group were higher than those in clinical LOS group, and there were significant differences (P<0.05). There were 51 strains of pathogenic bacteria, with 32 Gram-negative bacteria (62.7%), 16 Gram-positive bacteria (31.4%), and 3 fungi (5.9%).The common pathogenic bacteria were Klebsiella pneumoniae and coagulase negative Staphylococcus,the most of which were multidrug-resistant bacteria.Conclusions The incidence of LOS in VLBW infants is high. The main clinical manifestations are sudden changes in breathing, heart rate, mental state, and skin color. Although these manifestations are not specific,they could serve as early warning.The common pathogenic bacteria are Klebsiella pneumoniae and coagulase negative Staphylococcus,and both of them are multidrug resistant.

Objective To investigate the unmet needs of thyroid cancer patients undergoing 131Itreatment and their relationship with psychological distress and quality of life.Methods From October 2014 to March 2016,a total of 338 patients (106 males,232 females,average age (35.50±9.98) years) with thyroid cancer who were receiving 131I treatment were enrolled.The 34 items of Supportive Care Needs Survey Short Form (SNCS-SF34) were used to investigate the unmet care needs of patients.Patients' perceptions of distress and main causes of distress were measured by Distress Thermometers (DT) and issue list.The 12-item Short-Form Health Survey (SF-12) was used to measure patients' quality of life.Pearson correlation analysis was used to analyze the data.Results The degrees of patients' unmet care needs from high to low were as following:health information needs (65.38％,221/338),psychological needs (47.93％,162/338),patients' care and support needs (44.08％,149/338),physical and daily needs (36.09％,122/338) and sexual needs (34.32％,116/338).There were 47.93％(162/388) patients with DT score ＞ 4.The top three causes of patients' distress were fears,fatigue and memory deterioration.Degree of unmet needs for patients had positive correlation with the degree of psychological distress (r values:0.232-0.462,all P＜0.01).The unmet physiological and daily needs and psychological needs of patients had negative correlations with several dimensions of quality of life (r values:from-0.367 to-0.202,all P＜ 0.05).Conclusions The unmet care needs of patients with thyroid cancer have correlations with their psychological distress and quality of life.Evaluation of the unmet care needs of patients with thyroid cancer could be beneficial for providing the targeted care.