Objective:To study the risk factors of adverse pregnancy outcomes for the diagnosis and treatment of pregnancy after cesarean section complicated with placenta previa.Methods:A national multicenter retrospective study was conducted to select a total of 747 pregnant women with the third trimester singleton pregnancy after cesarean section complicated with placenta previa from 12 tertiary hospitals in January 1st to December 31st, 2018. The risk factors of severe adverse outcomes [hysterectomy, intraoperative blood loss ≥1 000 ml, intraoperative diagnosis of placenta accreta spectrum disorders (PAS)] in pregnant women with second pregnancy complicated with placenta previa after cesarean section were investigated by logistic regression analysis. The roles of prenatal ultrasonography and magnetic resonance imaging (MRI) in the prediction of PAS and severe adverse outcomes were observed. According to whether vascular intervention was performed (uterine artery embolization or abdominal aortic balloon occlusion), the pregnant women were divided into the blocked group and the unblocked group, and the maternal and infant perinatal outcomes between the two groups were compared.Results:(1) General information: the hysterectomy rate of 747 pregnant women with second pregnancy complicated with placenta previa after cesarean section was 10.4% (78/747), the intraoperative blood loss ≥1 000 ml in 55.8% (417/747), and PAS was confirmed in 47.5% (355/747). The incidence of uterine rupture was 0.8% (6/747). (2) Analysis of risk factors for severe adverse outcomes: based on binary unconditioned logistic regression univariate and multivariate analysis, the risk factors for hysterectomy were the mode of vascular embolization and intraoperative blood loss. The probability of hysterectomy with uterine artery embolization was 5.319 times higher than that with abdominal aortic balloon occlusion (95% CI: 1.346-21.018). The risk factors of intraoperative blood loss ≥1 000 ml were the number of cesarean section delivery, ultrasonography indicated PAS and suspected PAS, intraoperative PAS and complete placenta previa. The risk factors for intraoperative PAS were uterine scar thickness, ultrasonography indicated PAS and suspected PAS, MRI indicated PAS and suspected PAS, and complete placenta previa. (3) The roles of ultrasonography and MRI in predicting PAS: the sensitivity and specificity of ultrasonography in predicting PAS were 47.5% and 88.4%; the kappa value was 0.279 ( P<0.001), with fair agreement. The sensitivity and specificity of MRI to predict PAS were 79.2% and 97.8%, respectively. The kappa value was 0.702 ( P<0.001), indicating a good agreement. The intraoperative blood loss and hysterectomy rate of pregnant women with PAS indicated by ultrasonography and MRI were significantly higher than those with PAS only by ultrasonography or MRI. (4) Influence of vascular occlusion on pregnancy outcome: there were no significant differences in intraoperative blood loss and incidence of intraoperative bleeding ≥1 000 ml between the blocked group and the unblocked group (all P>0.05). There was no significant difference in intraoperative blood loss between the pregnant women with abdominal aortic balloon occlusion, uterine artery embolization and those without occlusion ( P=0.409). The hysterectomy rate of pregnant women with uterine artery embolization was significantly higher than those with abdominal aortic balloon occlusion [39.3% (22/56) vs 10.0% (5/50), P=0.001]. Conclusions:In the third trimester of pregnancy with placenta previa after cesarean section, MRI examination has better consistency in predicting PAS than ultrasonography examination. Ultrasonography examination combined with MRI examination could effectively predict the hysterectomy rate and intraoperative blood loss. Vascular occlusion could not reduce the amount of intraoperative blood loss. The hysterectomy rate of pregnant women with uterine artery embolization is higher than those with abdominal aortic balloon occlusion.

Objective: To analyze the trends and influencing factors of endurance performance of 19-22 years old college students in Hunan Province from 1985 to 2019, so as to provide objective and scientific basis for sports and health work in colleges and universities. Methods: A retrospective analysis was conducted on the data of 14 490 college students aged 19-22 in Hunan Province from 8 consecutive National Student Physical Fitness and Health Surveys conducted from 1985 to 2019. The analysis indexes were 1 000 m running for boys and 800 m running for girls. Results: From 1985 to 2019, the endurance running time of 19-22 years old Han college students in Hunan Province showed an obvious trend of decline. The 1 000 m running time of urban and rural male students increased by 41.9 and 45.4 s on average, and the 800 m running time of urban and rural female students increased by 29.5 and 30.6 s on average, respectively. Multiple linear regression analysis showed that age ( β =0.17), urban students (rural students as reference; β =0.44), GDP ( β =0.94) and urbanization level ( β = 0.44 ) were positively correlated with the average endurance running time of males. Urban students ( β =0.92), GDP ( β = 1.38 ) and Engel coefficient ( β =0.93) were positively correlated with the average endurance running time of females. BMI ( β =-0.47) was negatively correlated with the females mean time of endurance running ( P ＜0.05). Conclusion The endurance performance of Han college students in Hunan Province showed a declining trend from 1985 to 2019,which is associated with age, urban and rural distribution, regional GDP, Engel s coefficient, urbanization level and BMI. Effective measures should be taken to improve the physical quality of college students.

Objective:To study the risk factors of adverse pregnancy outcomes for induced abortion of cesarean scar pregnancy in midtrimester.Methods:A national multicenter retrospective study was conducted. A total of 154 singletons pregnant women with cesarean scar pregnancy during the second trimester induced abortion by various reasons in 12 tertiary A hospitals were selected, their pregnant outcomes were observed and the risk factors of serious adverse outcomes were analyzed with univariate and multivariate logstic regression; the role of ultrasound and MRI in predicting placenta accreta and severe adverse outcomes was evaluated, the effectiveness of uterine artery embolization (UAE) in preventing hemorrhage in pregnant women with and without placenta accreta was compared.Results:Among 154 subjects, the rate of placenta accreta was 42.2% (65/154), the rate of postpartum hemorrhage≥1 000 ml was 39.0% (60/154), the rate of hysterectomy was 14.9% (23/154), the rate of uterine rupture was 0.6% (1/154). The risk factor of postpartum hemorrhage≥1 000 ml and hysterectomy was placenta accreta ( P<0.01). For each increase in the number of parity, the risk of placenta accreta increased 2.385 times (95% CI: 1.046-5.439; P=0.039); and the risk of placenta accreta decreased with increasing ultrasound measurement of scar myometrium thickness ( OR=0.033, 95% CI: 0.001-0.762; P=0.033). The amount of postpartum hemorrhage and hysterectomy rate in the group with placenta accreta diagnosed by ultrasound combined with MRI were not significantly different from those in the group with placenta accreta diagnosed by ultrasound only or MRI only (all P>0.05). For pregnant women with placenta accreta, there were no significant difference in the amount of bleeding and hysterectomy rate between the UAE group [median: 1 300 ml; 34% (16/47)] and the non-embolization group (all P>0.05); in pregnant women without placenta accreta, the amount of bleeding in the UAE group was lower than that in the non-embolization group (median: 100 vs 600 ml; P<0.01), but there was no significant difference in hysterectomy rate [2% (1/56) vs 9% (3/33); P>0.05]. Conclusions:(1) Placenta accreta is the only risk factor of postpartum hemorrhage≥1 000 ml with hysterectomy for induced abortion of cesarean scar pregnancy in midtrimester; multi-parity and ultrasound measurement of scar myometrium thickness are risk factors for placenta accreta. (2) The technique of using ultrasound and MRI in predicting placenta accreta of cesarean scar pregnancy needs to be improved. (3) It is necessary to discuss of UAE in preventing postpartum hemorrhage for induced abortion of cesarean scar pregnancy in midtrimester.

Objective:To investigate the microRNA (miRNA) expression features in ectopic endometrial tissues of endometriosis (EMS) patients.Methods:From April 2018 to October 2019, ectopic endometrial tissues from EMS patients and eutopic endometrial tissues from control women who received treatment in the Department of Obstetrics and Gynecology of The First Affiliated Hospital of Xiamen University were used in subsequent experiments. Differentially expressed miRNAs were screened out in ectopic endometrial tissues by detecting miRNA sequence from Illumina. The potential roles of these differentially expressed miRNAs and their potential targeted genes in pathogenesis of EMS were analyzed by bioinformatics, and the differential expression levels of 6 miRNAs (miR-98-5p, miR-495-3p, let-7c-5p, miR-200b-3p, miR-200c-3p, miR-148b-3p) were validated by quantitative real-time polymerase chain reaction (qRT-PCR) and subsequently used to build the miRNA-gene regulatory network, then we verified its potential target gene.Results:The microarray results showed that 69 miRNAs might be differentially expressed in ectopic endometrial tissues compared with those in eutopic endometrial tissues (fold change>1.5, P<0.05), including 22 up-regulated miRNAs and 47 down-regulated miRNAs. Gene ontology (GO) analysis showed that the target genes of these differentially expressed miRNAs mainly participated in the protein modification, regulation of development, cell metabolism and morphological structure. KEGG pathway analysis showed that these targeted genes were involved in protein function, autophagy, AGE-RAGE and MAPK signaling pathways. The expression levels of miR-98-5p, let-7c-5p, miR-200b-3p and miR-200c-3p were validated to be significantly altered in ectopic endometrial tissues. The miRNA-gene co-expression network revealed the correlation between the 4 miRNAs and their predicted target genes. qRT-PCR validated results showed that the expression of miR-200b-3p and miR-200c-3p were significantly negatively correlated with ZEB2, while miR-98-5p was negatively correlated with PGRMC1, miR-98-5p and let-7c-5p were positively correlated with ADIPOR2. Conclusion:MiR-98-5p, let-7c-5p, miR-200b-3p and miR-200c-3p were significantly differentially expressed in the ectopic endometrial tissues of EMS patients, which may be involved in the development of EMS.

Objective:To investigate the microRNA (miRNA) expression features in ectopic endometrial tissues of endometriosis (EMS) patients.Methods:From April 2018 to October 2019, ectopic endometrial tissues from EMS patients and eutopic endometrial tissues from control women who received treatment in the Department of Obstetrics and Gynecology of The First Affiliated Hospital of Xiamen University were used in subsequent experiments. Differentially expressed miRNAs were screened out in ectopic endometrial tissues by detecting miRNA sequence from Illumina. The potential roles of these differentially expressed miRNAs and their potential targeted genes in pathogenesis of EMS were analyzed by bioinformatics, and the differential expression levels of 6 miRNAs (miR-98-5p, miR-495-3p, let-7c-5p, miR-200b-3p, miR-200c-3p, miR-148b-3p) were validated by quantitative real-time polymerase chain reaction (qRT-PCR) and subsequently used to build the miRNA-gene regulatory network, then we verified its potential target gene.Results:The microarray results showed that 69 miRNAs might be differentially expressed in ectopic endometrial tissues compared with those in eutopic endometrial tissues (fold change>1.5, P<0.05), including 22 up-regulated miRNAs and 47 down-regulated miRNAs. Gene ontology (GO) analysis showed that the target genes of these differentially expressed miRNAs mainly participated in the protein modification, regulation of development, cell metabolism and morphological structure. KEGG pathway analysis showed that these targeted genes were involved in protein function, autophagy, AGE-RAGE and MAPK signaling pathways. The expression levels of miR-98-5p, let-7c-5p, miR-200b-3p and miR-200c-3p were validated to be significantly altered in ectopic endometrial tissues. The miRNA-gene co-expression network revealed the correlation between the 4 miRNAs and their predicted target genes. qRT-PCR validated results showed that the expression of miR-200b-3p and miR-200c-3p were significantly negatively correlated with ZEB2, while miR-98-5p was negatively correlated with PGRMC1, miR-98-5p and let-7c-5p were positively correlated with ADIPOR2. Conclusion:MiR-98-5p, let-7c-5p, miR-200b-3p and miR-200c-3p were significantly differentially expressed in the ectopic endometrial tissues of EMS patients, which may be involved in the development of EMS.

Objective? The Chinese version of the Violence Risk Screening-10 (V-RISK-10) was tested for its reliability and validity in evaluating people with schizophrenia in community, so as to examine its predictive effect on the occurrence of aggressive behaviors. Methods? A systematic random sampling method was used to select 385 schizophrenics from 22 streets in Zhanjiang city as subjects. In June 2018, the Chinese version of V-RISK-10 questionnaire was used to predict the risk of violence, and a total of 380 cases were completed. Among them, 45 patients were retested on the Chinese version of V-RISK-10 after 2 weeks. From July to December 2018, the Ministry of Health's risk assessment method was used to track and observe the occurrence of patient attacks. There were 6 sessions of the evaluation, once a month, and 379 patient attacks were followed. Results? The Chinese version of V-RISK-10 Cronbach's alpha coefficient was 0.729 (P＜0.001). The Pearson correlation coefficient of the total score of the retest reliability scale was 0.721 (P＜ 0.001). The Chi-square test showed that, there was a linear relationship between the Chinese version of V-RISK-10 assessment results and the actual incidence of aggressive attacks(χ2=26.743,P＜ 0.001). It was 0.267 of Kappa coefficient for consistency test, there was statistical significance(P＜ 0.001). The incidence of aggressive behavior was 15.57%. Taking the occurrence of aggressive behavior as the outcome variable, the area under the ROC curve of Chinese version of V-RISK-10 was 0.760 (95%CI: 0.694-0.825), and the sensitivity and specificity were 81.36% and 57.19%, respectively. The corresponding positive predictive value and negative predictive value were 25.95% and 92.33%, respectively. The incidence of severe aggression in patients was 2.64%. Taking the occurrence of severe aggression as the outcome variable, the area under the ROC curve of Chinese version V-RISK-10 was 0.799 (95%CI: 0.651-0.947). The sensitivity and specificity of the tool were 60.00% and 87.80%, respectively. Conclusions? The Chinese version of V-RISK-10 has good reliability and validity in evaluating patients with schizophrenia in community, and has a good prediction effect on the occurrence of aggressive behaviors. It can be used as an aggressive behavior screening tool for patients with schizophrenia, and it is suitable for the community care workers to utilize.

Objective? To investigate the prevalence, characteristics and influencing factors of violent behaviors in patients with schizophrenia during the onset stage of the disease in the community, and to provide targeted guidance for community and family when delivering care and rehabilitation for the patients. Methods? From March to July in 2018, a total of 235 newly admitted schizophrenic patients in two specialized hospitals and one general hospital in Zhanjiang city were selected by convenience sampling. By the use of the self-designed questionnaire, the main caregivers were investigated directly about the patients＇ general information, patients factors,family factors and violent behaviors. The influences of the patients factors and family factors on the violent behaviors were analyzed. A total of 226 properly filled questionnaires were retrieved. Results? Among the 226 patients, a total of 161 cases (71.24%) committed violence one week before admission in which 129 cases(57.08%) were general attack, and 32 cases (14.16%) were dangerous violence, 65 patients (28.76%) did not committed any violent behaviors. Ordinal Logistic regression analysis showed that the risk factors of the violence were the presence of conduct disorder before illness, previous verbal attacks, destruction of property, or personal attacks against others, as well as emotional vulnerability , verbal stimulation or behavior/action stimulation from surrounding environments(P＜0.05). Harmonious family relations and the main Guardians' good execution of doctors' advice were the protective factors (P＜ 0.05). Conclusions? Patients who have previously had verbal attacks,property damage, physical attacks against others, and who have behavioral disorders before illness should be the focus of community and family care. Creating a harmonious family and rehabilitation environment in community should be an important part of family and community care for schizophrenic patients. Health education of mental illness for patients, primary caregivers and community should be strengthened.

Objective To understand the frequency distribution of CYP2C9 and VKORC1 gene single nucleotide polymor-phisms in Yunnan Han population.Methods CYP2C9(430C> T,1075A>C and 1080C> G)locus and VKORC1(-1639G> A and 1173C> T)locus gene polymorphisms in 202 samples were detected by adopting electrochemical gene sensor method,and the allele frequencies and genotype frequencies were performed the statistics and the gene polymorphism in relevant populations was an-alyzed.Results Among 202 samples,202 cases(100.0%)were genotype C/C at CYP2C9 * 2 locus,C allele frequency was 100.0%;185 cases(91.6%)were genotype A/A at CYP2C9*3 locus,15 cases(7.4%)were A/C genotype,2 cases(1.0%)were C/C genotype,A allele frequency was 95.3%,C allele frequency was 4.7%;CYP2C9*5 locus genotype C/C was in 202 cases (100.0%),C allele frequency was 100%;VKORC1 -1639G > A locus genotype A/A was in 145 cases(71.8%),57 cases (28.2%)were G/A genotype,A allele frequency was 85.9%,G was 14.1%;1173C> T locus genotype T/T was in 145 cases (71.8%),C/T gene type in 57 cases(28.2%),T allele frequency was 85.9%,and C was 14.1%.Conclusion The distribution of CYP2C9 gene in Yunnan Han population is similar to that in other regions of our country.The VKORC1 gene is different from the foreign population,Chinese Han nationality and partial minority nationalities.

OBJECTIVE:To observe the protective effect of ketamine and dexamethasone on lung injury in esophageal cancer thoracotomy. METHODS:60 patients with one-lung ventilation thoracotomy were randomly divided into 4 groups:blank group (group S),ketamine group(group K),dexamethasone group(group D)and ketamine and dexamethasone group(group KD)by number. After surgery,the patient-controlled epidural anaigesia (PCEA) was used to record the concentrations of IL-6,IL-8, TNF-α with the time point of preoperative 30 min (T0),60 min after one-lung ventilation (OLV)(T1),120 min after the OLV (T2),2 h after restore double-lung ventilation(T3),the changes of respiratory index(RI)in blood gas analysis and the analgesic effect and adverse reactions in 48 h after treatment. RESULTS:There was no obvious difference between the blood pressure and heart rate in 4 groups. Compared with T0,the RI values in T1,T2 and T3 were increased;compared with group KD,the RI values in T2 and T3 in group K,group D and group S were increased;compared with T0,the concentrations of IL-6 and IL-8 in T1,T2 and T3 were increased(P<0.05);compared with group S,the concentrations of IL-6 and IL-8 in T1,T2 and T3 in group D,group F and group KD were decreased(P<0.05);compared with group KD,the concentrations of IL-6 and IL-8 in T2 and T3 in group D and group K were higher(P<0.05),there was no significant difference between group D and group K(P>0.05)and the con-centration of TNF-α in 4 groups was lower than minimum detectable concentrations;compared with group KD,the scores of anal-gesia visual analogue scale(VAS)and Prince-Henry in postoperative 48 h in group K and group S were higher(P<0.05);com-pared with group D,group S and group K,the total number of press PCEA and the total amount of analgesic in group KD were de-creased (P<0.05) and the incidence of postoperative nausea was low (P<0.05);there was no significant difference in the inci-dence of postoperative delirium in 4 groups (P>0.05). CONCLUSIONS:Ketamine and dexamethasone can reduce the release of inflammatory mediators,decrease the RI values,increase the analgesia effect and has certain protective effect on lung injury.

Objective To investgate the effect of Tiao qi xing shui decoction combined with peritoneal injection DDP and IL-2 on Bax,Caspase-3, TGF-β1 gene expression in mouse with ascetes hepatoma,and explore its mechanism from molecular biology.Methods 72 pure lines of Kunming mice were randomly divided into control group,Chinese medicine group,combination of traditional Chinese and Western medicine,in high,middle,low dose group and Western medicine group,each had 12.All mices were killed after treatment,and the expression of Bax,Caspase-3,GF-β1 protein in mouse liver tumor tissues were detected by Immunohistochemical. Results Immunohistochemical results showed that,the positive expression of apoptosis gene Bax protein in high dose group of TCMand Western Medicine was higher than that of control group(P<0.01),and the positive expression of apoptosis gene Caspase-3,TGF-β1 protein in high and middle dose group of TCMand Western Medicine were higher than that of control group(P<0.01).Conclusion The high dose group of TCM and Western Medicine can significantly increase the expression of Bax protein,the high and middle dose guoup of TCMand Western Mdicine can significantly increase the expression of Caspase-3,TGF-β1 protein,induction apoptosis.