Complete androgen insensitivity syndrome(CAIS) is characterized by lack of androgen response in target organs due to androgen receptor dysfunction, resulting in feminized external genitalia. Individuals with CAIS are typically advised to live as females. This article reports a patient diagnosed with CAIS and gender dysphoria in adulthood. Following the removal of a left pelvic mass, pathology indicated cryptorchidism with a concurrent Leydig cell tumor. Genetic testing revealed a deletion mutation in exon 3 of androgen receptor gene. During follow-up, the patient underwent gender reassignment, transitioning socially from female to male. This case provides new insights into gender allocation for CAIS patients.

BACKGROUND: Congenital heart disease (CHD) is one of the most common congenital malformations in humans. Inconsistent results emerged in the existed studies on associations between air pollution and congenital heart disease. The purpose of this study was to evaluate the association of gestational exposure to air pollutants with congenital heart disease, and to explore the critical exposure windows for congenital heart disease. METHODS: The nested case-control study collected birth records and the following health data in Tianjin Women and Children's Health Center, China. All of the cases of congenital heart disease from 2013 to 2015 were selected matching five healthy controls for each case. Inverse distance weighting was used to estimate individual exposure based on daily air pollution data. Furthermore, the conditional logistic regression with distributed lag non-linear model was performed to identify the association between gestational exposure to air pollution and congenital heart disease. RESULTS: A total of 8,748 mother-infant pairs were entered into the analysis, of which 1,458 infants suffered from congenital heart disease. For each 10 µg/m³ increase of gestational exposure to PM_2.5, the ORs (95% confidence interval, 95%CI) ranged from 1.008 (1.001-1.016) to 1.013 (1.001-1.024) during the 1^st-2^nd gestation weeks. Similar weak but increased risks of congenital heart disease were associated with O₃ exposure during the 1^st week and SO₂ exposure during 6^th-7^th weeks in the first trimester, while no significant findings for other air pollutants. CONCLUSIONS This study highlighted that gestational exposure to PM_2.5, O₃, and SO₂ had lag effects on congenital heart disease. Our results support potential benefits for pregnancy women to the mitigation of air pollution exposure in the early stage, especially when a critical exposure time window of air pollutants may precede heart development.
Infant ; Pregnancy ; Child ; Humans ; Female ; Air Pollutants/analysis* ; Case-Control Studies ; Prenatal Exposure Delayed Effects/epidemiology* ; Heart Defects, Congenital/etiology* ; China/epidemiology* ; Particulate Matter/adverse effects* ; Maternal Exposure/adverse effects*

Objective:To investigate the status of cognitive function in patients with acute cerebral infarction after intravenous thrombolysis, and analyze its influencing factors.Methods:From August 2020 to December 2021, convenience sampling was used to select 100 patients with cognitive impairment after intravenous thrombolysis for acute cerebral infarction admitted to the Department of Neurology of Shaoxing People's Hospital as the research object. The patients were followed up three months after intravenous thrombolysis. The Montreal Cognitive Assessment (MoCA) Scale and Self-made Cognitive Motor Training Compliance Scale and Exercise Training Compliance Scale were used to evaluate the cognitive function recovery and training compliance of the patients. Univariate analysis of variance and Logistic regression were used to analyze the influencing factors of cognitive function in patients with acute cerebral infarction after intravenous thrombolysis. A total of 100 questionnaires were distributed, 100 valid questionnaires were recovered with the recovery rate of 100%.Results:Three months after intravenous thrombolysis in patients with acute cerebral infarction, there were 85 patients with good cognitive function and 15 patients with abnormal cognitive function. Multivariate Logistic regression analysis showed that combined with hypertension, combined with abnormal glucose and lipid metabolism, National Institutes of Health Stroke Scale scores, thrombolysis time, infarct site, compliance with cognitive training and motor training were risk factors for cognitive function of patients with acute cerebral infarction after intravenous thrombolysis ( P<0.05) . Conclusions:Cognitive function of patients with acute cerebral infarction after intravenous thrombolysis is related to hypertension, abnormal glucose and lipid metabolism, NIHSS score, thrombolysis time, infarct location, and compliance cognitive with training, motor training. Ultra-early intravenous thrombolysis can protect cognitive function in patients with acute cerebral infarction. It is recommended to strengthen the prevention and control of the above risk factors and carry out early cognitive training and motor training to promote the early recovery of patients.

Objective:To clarify the distribution and composition of drug-resistant genes of carbapenem-resistant Klebsiella pneumoniae (CRKP) in Qingdao City and to provide rationale for clinical application of antibacterial treatment by screening for carbapenemase phenotype and detecting resistance genes of CRKP. Methods:Fifty-four clinically isolated non-repeating CRKP from five Third Grade & Class A Hospitals in Qingdao City from October 2016 to September 2019 were collected. Kirby-Bauer method was used for drug sensitivity tests of commonly used antibacterial drugs; modified Hodge test was used for carbapenemase phenotypic screening; and polymerase chain reaction (PCR) was used to amplify blaKPC-2, blaNDM-1, blaOXA-48, blaIMP, blaVIM target genes. The amplified products were subjected to agarose gel electrophoresis. Results:Drug susceptibility tests showed that CRKP had the lowest resistance rate to amikacin (35.2%), followed by compound sinomine (53.7%), gentamicin (55.6%), levofloxacin (75.9%), and imipenem-cilastatin (88.9%); piperacillin-tazobactam, meropenem, cefotaxime, and cefoperazone-sulbactam were all higher than 90%. There were 43 positive strains in the modified Hodge test (the positive rate was 79.63%) and 11 negative strains. A total of 40 strains with carbapenemase resistance were detected by PCR resistance gene detection. The detection rate of target drug-resistant genes was 74.07%. Among them, 35 strains carry the KPC-2 gene, 7 strains carry the OXA-48 gene, 4 strains carry the NDM-1 gene, and 1 strain carries the IMP gene. All strains carrying the OXA-48 gene also carried the KPC-2 gene, which was not detected. Strains carrying the VIM gene were identified, and the remaining 14 strains did not detect the target carbapenem gene.Conclusion:The carbapenem-producing genes carried by CRKP in five hospitals in Qingdao City are mainly KPC-2, followed by OXA-48 and NDM-1.

Objective Based on health economics,the influencing factors on prevalence rate of drinking-water-borne dental fluorosis were studied.Methods Collect panel data on the prevalence and influencing factors of dental fluorosis in drinking water-type endemic fluorosis (referred to as fluorosis) in 26 provinces (municipalities and autonomous regions) from 2005 to 2015.The theoretical hypothesis model of influencing factors on the prevalence of drinking-water-borne dental fluorosis was constructed from six aspects:economic operation status (electricity consumption),urbanization status (urban population ratio),natural environmental protection (per capita public green space area),urban water supply capacity (urban water population),health expenditure,and fixed assets investment of health institutions.And then Eviews 7.2 was used for panel data regression analysis.Results From 2005 to 2015,the prevalence rate of drinking-water-borne dental fluorosis in China showed a downward trend (r =-0.881,P ＜0.05).The electricity consumption,urban population ratio,per capita public green space area,urban water population and health expenditure had significant impacts on the prevalence rate of drinking-water-borne dental fluorosis (P ＜ 0.05).In this model,per capita public green space area and urban population ratio had the greatest impacts on the prevalence of drinking-water-borne dental fluorosis (absolute value of the standard coefficient ＞ 1).Then,the absolute value of standard coefficient on urban water population was 0.750,and that of electricity consumption and health expenditure were the lowest (absolute value of the standard coefficient =0.266).Conclusion Favorable natural environment,urbanization,construction of urban water supply facilities,reasonable increase of health expenditure and sustainable development of regional economy are powerful impetus to reduce the prevalence rate of drinking-water-borne dental fluorosis and to promote public health development.

Objective To analyze the epidemiological characteristics of morning hypertension in people with eseential hypertension in Dali Bai autonomous prefecture,and to study the management model for morning hypertension. Methods From May 2015 to January 2017,302 patients with hypertension in the People's Hospital of Dali Bai Autonomous Prefecture were divided voluntarily into two groups,including single management group (group 1)and systematic management group (group 2 ).During six to twelve months follow －up,the changes in control rate of morning hypertension,serum biochemical indicators,KAP and Mofisky score were observed before and after intervention. Results The proportion of morning hypertension in people with hypertension was 62.25%,61.11% in men and 62.86%in females.The patients with morning hypertension had higher age,BMI,WC,TC,LDL－C,SBP,DBP,CRP, FBG,SCr,Sokolow－Lyon,Cornell,LVMI,UACR and MAU,more cervical plaque,and lower HDL －C and eGFR compared with non－morning hypertension(P＜0.05 －0.001).The number of patients with target organ damage was most in patients with morning hypertension by home blood pressure monitoring(HBPM),second in ambulatory blood pressure monitoring(ABPM),least in clinic blood pressure monitoring (CBPM)(P＜0.05 －0.001).After six to twelve months follow－up,compared with before intervention,the control rate of morning hypertension was increased (43.78%vs.61.39%),and SBP,DBP,HR,BMI,WC,TC,TG,UA,Scr were decreased in both two groups,which in the group 2 were lower than those in the group 1(P＜0.05 ).Compared with before intervention,the KAP score and Mofisky in the two groups after intervention were significantly improved(P＜0.05－0.01)[K score:(9.63 ±3.01)points vs.(14.26 ±2.89)points in the group 1,(10.11±2.34)points vs.(17.23 ±1.06)points in the group2;A score:(2.05 ±1.21)points vs.(2.98 ±0.25)points in the group 1,(2.08 ±1.65)points vs.(3.56 ±0.42)points in the group 2,P score:(4.39 ±2.36)points vs.(5.89 ±3.24)points in the group 1,(4.71±3.42)points vs.(7.26 ± 1.21)points in the group 2,Mofisky questionnaire score:(61.23 ±5.79)points vs.(72.36 ±6.18)points in the group 1,(60.89 ±6.47)points vs.(88.45 ±5.48)points in the group 2],which in the group 2 were higher than those in the group 1(P＜0.01).Conclusion The control rate of morning hypertension in patients with hypertension in Dali Bai autonomous prefecture is low,the HBPM is better way to predict the target organ damage,and systematic management model is effective to improve the control rate of morning hypertension and so do in KAP and Morisky score.

Objective To study the relationship between carotid atherosclerosis (CAS) and serum markers in elderly essential hypertension (EH) patients.Methods Three hundred and eightyeight elderly EH patients who underwent carotid colour ultrasonography and biochemical testing served as an EH group and 82 subjects undergoing physical examination served as a control group.The patients in EH group were divided into plaque-free group (n =142),stable plaque group (n=132),and unstable plaque group (n=114).The relationship between CAS and serum FPG,Hcy,TBIL,DBIL,IBIL,UA,ferritin,fibrinogen,CRP levels was analyzed.Results The incidence of CAS and serum Hcy level were significantly higher in EH group than in control group (63.40％ vs 31.71％,12.69±3.58 μmol/L vs 6.96±2.89 μmol/L,P＜0.01).The incidence of CAS was 63.40％ in EH patients.The serum levels of FPG,TC,TG,LDL-C,Hcy,UA,ferritin,fibrinogen,CRP were significantly higher while those of TBIL,DBIL,and IBIL were significantly lower in stable plaque group than in unstable plaque group (P＜0.05,P＜0.01).Logistic regression analysis showed that stable CAS was negatively related with serum levels of TBIL and IBIL and positively related with those of FPG,TC,LDL-C,Hcy,UA,ferritin,fibrinogen and CRP,history of smoking,incidence of DM and hypertension (P＜0.05).Conclusion Serum levels of TBIL and IBIL are the protective factor for CAS while those of FPG,Hcy,UA,ferritin,fibrinogen and CRP are the risk factors for CAS in elderly EH patients.

Objective To investigate the feasibility and application value of total enteroscopy with double balloon enteroscopy(DBE)for diagnosis and treatment of patients with obscure gastrointestinal bleeding(OGIB). Methods The clinical and endoscopic data of patients underwent DBE for OGIB in the Department of Gastroenterology,Remin Hospital of Wuhan University from January 2010 to December 2015 were retrospectively analyzed. Results Total enteroscopy was indicated in 36.3%(136/375)of patients. The success rate was 86.0%(117/136)and complication rate was 1.5%(2/136). Negative findings,non-small bowel lesions and small bowel lesions were detected in 44.4%(52/117), 6.8%(8/117), and 48.7%(57/117)of patients with total enteroscopy. Re-bleeding occurred in 8.9%(4/45)of patients with negative total enteroscopy,while 1 small bowel mesenchymoma and 1 gastric fundus Dieulafoy′s lesion were revealed subsequently. Re-bleeding occurred in 33.3%(5/15)of patients with incomplete enteroscopy,and 1 small bowel polyp and 1 small bowel angiectasis were revealed subsequently. Conclusion DBE can complete total enteroscopy within one day and provide important clinical information of OGIB. Non-small bowel lesions,small bowel lesion missed by DBE and potential bleeding lesions in small bowel beyond the reach of DBE should be considered in patients with negative enteroscopy.

Objective To compare the prevalence and clinical charecteristics of metabolic syndrome(MS) in aged people of Dali Bai Autonomous Prefecture under three diagnostic criteria.Methods A total of 1 386 patients in outpatient department or admitted to our hospital were recruited.The different prevalences under the World Health Organization(WHO) in 1999,the China Diabetes Society in 2004 (CDS 2004) and the China Diabetes Society in 2013(CDS 2013) definitions respectively were calculated and the results were compared by κ test.Results The prevalences of metabolic syndrome under WHO,CDS2004,and CDS2013 were 30.38％,33.77％ and 36.87％,respectively,it increased with age,and was most highest in ＞ 70～ 80 years aged group (P ＜ 0.05-0.01),the number of hypertension abnormality was more than 60.00％,and the most combination of abnormalities ＞ 3 in MS was hypertension + hyperglycemia + obesity (P ＜ 0.01);The 92.86％ concordance of MS cases was found between CDS2004 and CDS2013,90.19％ between WHO and CDS2013,and 80.23％ between WHO and CDS2013 (P ＜ 0.05-0.01).Conclusion The prevalence of MS increased with age in eldely people of Dali Bai Autonomous Prefecture,there is different between man and female,hypertension is the common abnormality in components of MS.The agreement among three criterias is relatively high,and the prevalence of MS has high level by CDS2013.

Objective To assess the value of double balloon enteroscopy (DBE) in etiological diagnosis of small bowel ulcer.Methods The clinical and endoscopic data of patients undergoing DBE at the Department of Gastroenterology, Renmin Hospital of Wuhan University from January 2010 to January 2016 were reviewed.For patients with small bowel ulcer revealed by DBE, the etiologic diagnosis was retrospectively analyzed.Results One hundred and three patients with small bowel ulcer were included in the analysis.The initial diagnosis based on morphology of ulcer was Crohn's disease (58.3%, 60/103), intestinal tuberculosis (18.4%,19/103), etiology unknown (24.3%, 25/103).The final diagnosis comprehensively based on pathology, clinical data and disease outcome was Crohn's disease (44.7%,46/103), intestinal tuberculosis (18.4%,19/103), lymphoma (3.8%,4/103), eosinophils enteritis (1.9%,2/103), non-steroidal anti-inflammatory drug enteritis (1.9%,2/103), adenocarcinoma (1.0%,1/103), stroma tumor (1.0%,1/103),ischemic enteritis (1.0%,1/103), vascular malformation (1.0%,1/103), Henoch-Schonlein purpura (1.0%,1/103), etiology unknown (24.3,25/103).The accurate diagnosis rate and misdiagnosis rate for Crohn's disease by DBE were 73.3%(44/60)and 10.0%(6/60).The accurate diagnosis rate and misdiagnosis rate for intestinal tuberculosis by DBE were 14/18 and 2/18.Conclusion There are diversity and complexity in etiologic diagnosis of small bowel ulcer.The diagnosis should be based on the comprehensive analysis of morphology of ulcer, endoscopic and surgical pathology and clinical data.Follow up of small bowel ulcer by DBE may provide important information for etiologic diagnosis.