Hyperthyroidism （HT） is frequently complicated by atrial fibrillation （AF） in clinical practice. Based on traditional Chinese medicine （TCM） zang-xiang （藏象） theory and clinical experience， both HT and AF are closely associated with dysfunction of the liver. The pathogenesis is initiated by the liver failing to govern the free flow of qi， and liver constraint and qi stagnation， with the key turning points being liver constraint transforming into fire and the internal stirring of liver wind， ultimately leading to liver blood depletion and insufficient nourishment of the heart spirit. Thus， it is proposed to treat the disease from the liver， with stage-specific therapeutic approaches according to the evolution of the disease. In the early stage， the treatment should focus on soothing the liver and relieving constraint to reduce goiter and calm the heart， while in the progressive stage， the method of clearing liver and draining fire is suggested to subdue yang and stabilize palpitations. In the acute stage， the strategy is calming the liver and nourishing yin to subdue yang and extinguish wind. In the later stage， it is suggested to soften the liver and benefit qi， so as to nourish yin and restore pulse. These methods are sequentially applied to synergistically reduce goiter and stabilize palpitations， providing a therapeutic approach for HT complicated by AF.

Objective:To evaluate the fetal adrenal gland volume (AGV) and corrected adrenal gland volume (cAGV) in intrauterine growth restriction (IUGR) fetuses and observe their associations with the adverse perinatal outcomes.Methods:From February 2021 to August 2022, 32 IUGR fetuses who underwent fetal ultrasound examination in the Second Xiangya Hospital of Central South University were prospectively selected as the IUGR group, and 32 normal fetuses matched for gestational age during the same period were selected as the control group. Three-dimensional ultrasound was used to obtain fetal adrenal volume images, and the virtual organ computer-aided analysis (VOCAL) was used to measure AGV, then the cAGV was calculated. The values of AGV and cAGV were appropriately compared between the IUGR and the control groups. The pregnancy outcomes were noted. Multiple logistic regression analysis was employed to evaluate the relationship between the cAGV and adverse perinatal outcomes in IUGR fetus, with maternal age and the CPR included as covariates to control for confounding factors.Results:A total of 32 fetuses with IUGR and 32 controls were involved in this prospective study. There was no significant difference in the AGV between these two groups ( P=0.417). The cAGV of the IUGR fetus was substantially larger than that of the normal fetus ( P=0.034). In the multivariate logistic regression analysis, after adjusting for maternal age and fetal CPR, the fetal cAGV was noticeably associated with the fetal distress (adjusted OR=0.005, 95% CI=0.000-0.587, P=0.029) and the total adverse perinatal outcomes (adjusted OR=0.014, 95% CI=0.000-0.475, P=0.018). Conclusions:The value of cAGV is increased in the IUGR fetuses and associated with adverse perinatal outcomes. The evaluation of fetal AGV could be beneficial to monitoring and managing IUGR fetuses.

Objective:To evaluate the effect of implementation of prevention from mother-to-child transmission of syphilis in Minhang district of Shanghai from 2013 to 2019.Methods:The data of 284 pregnant women with syphilis infection diagnosed by 6 midwifery medical institutions in Minhang District from January 2013 to December 2019, were collected from the database of national management information system for prevention of mother to child transmission of AIDS, syphilis and hepatitis B. Among them there were 1 case of spontaneous abortion, 4 cases of ectopic pregnancy, 42 cases of lost follow-up; the remaining 237 parturients were included in this study. The Implementation Program of prevention of mother-to-child transmission of AIDS, syphilis and hepatitis B (2015 edition) has been implemented since 2015 in Minhang district. The maternal and neonatal outcomes between the period of 2013-2015 (before program implemented, 123 cases) and the period of 2016-2019 (after program implemented, 114 cases) were compared. Results:Between 2013 and 2019, the syphilis detection rate of pregnant women remained 100.00% (100 761/100 761). The detection rates during pregnancy before and after program implementation were 95.92% (51 855/54 288) and 98.87% (45 949/46 473); the prevalence rate of syphilis was 2.93‰ (159/54 288) and 2.69‰ (125/46 473), respectively. The rate of anti-syphilis treatment was 62.60% (77/123) and 85.96% (98/114), the standard treatment rate was 20.33% (25/123) and 49.12% (56/114), the neonatal preventive treatment proportion/rate was 1/12 and 94.74% (72/76). The detection rate during pregnancy, anti-syphilis treatment rate, standardized treatment rate and neonatal preventive treatment rate after program implementation were significantly higher than those of before implementation (χ 2=988.88, 16.72, 21.81, 54.72, all P<0.01). The rate of non- Treponema pallidum antigen titer ≥ 1∶8 was 36.89% (38/103) and 17.48% (18/103), respectively in two periods; the incidence of neonatal adverse health problems was 21.49% (26/121) and 6.03% (7/116); congenital syphilis report incidence rate was 152.12/100 000 live births (83/54 562) and 23.46/100 000 live births (11/46 890), respectively. All these indicators showed a significant reduction (χ 2=9.81, 11.80, 45.10, all P<0.01). The treatment rate of pregnant women with previously diagnosed syphilis infection was 63.27% (62/98), which was lower than that of those with initially diagnosed (81.29%, 113/139) ( cOR=2.52, 95 %CI: 1.40-4.56, χ 2=9.672, P<0.01). Among whose with lost follow-up, the floating pregnant women accounted for 92.86% (39/42), 57.14% (24/42) of whom were unable to contact and 30.95% (13/42) refused to be followed up. Conclusions:After the implementation of prevention program, the rates of detection and diagnosis, standardized treatment, neonatal preventive treatment, as well as the maternal and neonatal outcomes of pregnant women with syphilis infection have been significantly improved in Minhang district of Shanghai.