ObjectiveTo introduce the basic design， development plan and objectives of a population-based birth cohort in Shanghai， and further present the main data and baseline characteristics of enrolled participants in the cohort， and to provide key information for reproductive health-related studies. MethodsThe Shanghai population-based birth cohort initiated on January 1， 2005， included newborns born in Shanghai every year and their parents， and collected information on reproductive health， reproductive treatment， birth characteristics， growth and development status， as well as the incidence， treatment and death of diseases by employing data linkage technology and investigations. This formed a birth cohort spanning the entire life cycle. ResultsAs of October 2022， a total of 2 978 538 newborns and their parents were included in the cohort. Among them， 2 905 135 （97.54%） were naturally conceived （NC）， and 73 403 （2.46%） were born through assisted reproductive technologies （ART）. The average age of parents was （32.56±4.12） years old for females and （34.62±5.34） years old for males in the ART group， which was higher than （28.02±4.71） years and （30.07±5.54） years for parents in the NC group. Among parents， females and males aged 30 and above accounted for 77.12% and 85.08%， respectively， which were higher than that of parents （35.28% for females and 49.66% for males） in the NC group. Furthermore， the percentage of parents with a college degree or above in the ART group was 73.23% for females and 73.66% for males， which were higher than those in the NC group （49.98% and 50.91%， respectively）. The multiple births rate in the ART group was 33.81%， which was higher than that in the NC group （1.88%）. The incidence of premature birth and low birth weight in the ART group were 24.47% and 19.08%， respectively， which was higher than that in the NC group （5.47% and 3.73%）. ConclusionThe comprehensive collection of reproductive health-related information in the birth cohort in Shanghai can provide essential resources to determine the influence of genetics， environment， reproductive treatment and other related factors on the health of offspring after birth.

ObjectiveTo establish the Shanghai twin birth cohort （STBC） and analyze the effects of genetic factors， shared environment， and non-shared environment interactions on birth health and growth and development of newborns. MethodsBased on the population-wide birth cohort in Shanghai， a comprehensive survey was conducted on the families with double and multiple babies born after January 1， 2015 to collect information on birth health， growth and development， and the family environment of the babies. ResultsBy December 31， 2021， a total of 7 195 pairs （14 405 cases） of twins were successfully included in the STBC survey. The average birth length of twins was 47.2 cm and average birth weight was 2 465.3 g. Heterozygous twins accounted for 69.05% and preterm babies accounted for 57.07%. The average age of the mothers of twins was 31.82 years， and the average age of the fathers was 33.87 years， with more than 80% of the parents having a college degree or above. 44.50% of the mothers used assisted reproductive technologies， 7.40% had illnesses during pregnancy， and 15.90% were exposed to passive smoking during pregnancy. During the survey period， the average monthly increase in the length of the twin infants was 2.09 cm， and the average monthly weight gain was 0.53 kg. ConclusionThe incidence of adverse outcomes such as maternal cesarean section rate， preterm birth， and low birth weight is higher in the twin birth population. Information on birth health as well as growth and development in childhood and adolescence in the twin birth population is collected based on STBC， which can provide a solid data foundation for studying children’s chronic non-communicable diseases， psychological and behavioral disorders and other complex health problems caused by the combined effects of genetics and the environment.

ObjectiveTo design a prospective nested case-control study based on a city-wide birth cohort of Shanghai， so as to understand their health status and explore the influencing factors of birth defects. MethodsBased on the birth registration covering the entire city of Shanghai， the nested case-control study of children with severe birth defects was designed. Children born with severe birth defects were selected as the case group， and healthy children were matched as the control group. Basic information， health status， maternal pregnancy history， and survival outcome of children both in the case group and the control group were collected through medical history review and home visits. The logistic regression model was used for multivariate analysis. ResultsA total of 18 875 infants born between January 1， 2011， and December 31， 2021， were included， among which 11 500 （60.93%） were children with severe birth defects and 7 375 （39.07%） were healthy children. The logistic regression model analysis showed that being male （OR=1.20， 95%CI：1.13‒1.29）， non-Shanghai residency （OR=1.16， 95%CI： 1.06‒1.25）， multiple births （OR=8.41， 95%CI：6.25‒11.30）， artificial insemination （OR=2.31， 95%CI：1.34‒3.99）， in vitro fertilization （IVF） （OR=1.85， 95%CI：1.44‒2.38）， maternal exposure to radiation （OR=1.83， 95%CI：1.07‒3.14）， maternal illness during pregnancy （OR=1.61， 95%CI：1.49‒1.74）， experiencing a traumatic event during pregnancy （OR=2.34， 95%CI：1.88‒2.92）， paternal chemical exposure （OR=1.88， 95%CI：1.32‒2.69）， paternal radiation exposure （OR=1.65， 95%CI： 1.18‒2.33）， family history of birth defects （OR=8.18， 95%CI： 3.96‒16.89）， being overweight before pregnancy （OR=1.16， 95%CI： 1.07‒1.27）， being obese before pregnancy （OR=1.15， 95%CI：1.03‒1.30）， and being excessively obese before pregnancy （OR=1.52， 95%CI：1.26‒1.83） were risk factors for the occurrence of birth defects. Analysis by type of birth defect found that prematurity was a risk factor for cardiac malformations and cheilopalatoschisis （OR=27.87， 95%CI： 20.84‒37.27）， especially ranking first in cardiac malformations. ConclusionAfter controlling for influencing factors， maternal overweight， obesity， and excessive obesity before pregnancy， artificial insemination， and IVF are independent risk factors for the occurrence of birth defects. Choosing a healthy lifestyle， improving physical and mental health during pregnancy， and controlling BMI during pregnancy are beneficial in reducing the risk of birth defects.

Objective:To analyze the positive detection rate, main genotypes of β-thalassemia in western region of Guangxi Zhuang Autonomous Region (referred to as Guangxi).Methods:Retrospective analysis of 26 189 individuals who underwent gene testing for thalassemia at the Affiliated Hospital of Youjiang Medical University for Nationalities from January 2013 to December 2019. Using the crossing breakpoint PCR (Gap-PCR) and reverse dot blot (RDB) techniques to detect Chinese common type of 7 kinds of α-thalassemia and 17 kinds of β-thalassemia genotypes, high-throughput sequencing(Sanger) was performed for suspected rare β-thalassemia. Gap-PCR was used for suspected deletion β-thalassemia types.Results:β-thalassemia was diagnosed in 4 495 (17.16%) of 26 189 samples. A total of 6 177 alleles of 20 types of β-thalassemia were detected, mainly CD17 (2 712 cases, 43.90%) and CD41-42 (2 240 cases, 36.26%), including 7 rare alleles: Gγ +( Aγδβ) 0, SEA-HPFH, Hb New York, Hb G-Taipei, Hb Hezhou, Hb G-Coushatta and IVS-Ⅱ-81. There were 3 903 case (86.83%) heterozygous, 273 case (6.07%) double heterozygous, and 319 case (7.10%) homozygous among 4 495 β-thalassaemia subjects. A total of 48 genotypes were detected. The two most common genotypes were CD17/β N (1 890 cases, 42.05%) and CD41-42/β N (1 212 cases, 26.96%), accounted for 69.01% (3 102/4 495). Seven rare genotypes were detected: Gγ +( Aγδβ) 0/β N in 3 cases, Hb New York/β N in 3 cases, Hb G-Taipei/β N in 2 cases, SEA-HPFH/β N, Hb Hezhou/β N, Hb G-Coushatta/β N and IVS-Ⅱ-81/β N in 1 case each. A total of 1 041 cases (3.97%, 1 041/26 189) of 116 types of αβ-thalassemia were detected, mainly -- SEA/αα composite CD17/β N (144 cases, 13.83%), followed by -α 3.7/αα composite CD17/β N (112 cases, 10.76%). Conclusions:Western region of Guangxi is a high prevalence area of β-thalassemia, CD17/β N and CD41-42/β N are the main genotypes. The variation spectrum of β-thalassemia is complex and diverse, with rich genotype.

ObjectiveTo investigate the characteristics of gender difference and the trend of the mortality rate of senile dementia in registered population in Shanghai from year 2002 to 2018， and to provide the basis for formulating relative intervention measures before and after senile dementia from an public-health view. MethodsBased on the collected data of death registration， focused on the senile dementia disease codes F03，G30.0，G30.1，G30.8，G30.9 according to The International Classification of Diseases 10th revision （ICD-10）. We analyzed the characteristics of gender difference in the mortality rate of senile dementia in registered population in Shanghai from year 2002 to 2018. According to ASR， we calculated the standardized mortality rate of senile dementia， and used the chi-square test to compare the difference between the gender mortality rates. The trend and the turning point of the mortality rate of senile dementia were determined by linear regression analysis by Join-point. ResultsThe crude mortality rate of senile dementia in the registered population in Shanghai from year 2002 to 2018 was 5.46/10⁵， 3.50/10⁵ in males and 7.43/10⁵ in females. The standardized mortality rate of senile dementia was 2.61/10⁵， 1.67/10⁵ in males and 3.56/10⁵ in females. The trend of the standardized mortality rate of senile dementia in 17 years decreased ［APC=-5.5（-6.5，-4.5）%，P<0.01］. The trend of the standardized mortality rate of senile dementia decreased in both males ［APC=-4.9（-6.2，-3.6）%，P<0.01］ and females ［APC=-5.9（-6.9，-4.9）%，P<0.01］. The trend of the gender difference decreased ［APC=-6.8（-8.2，-5.3）%，P<0.01］. The mortality rate of senile dementia was higher in females than in males ［（χ²=33.63，P<0.01）］. ConclusionThe mortality rate of senile dementia in females is higher than in males in Shanghai， though the trend of the gender difference decreased. This gender difference is worth of attention.

ObjectiveTo investigate the risk factors of fertility behaviors with preterm birth and low birth weight， and to develop a nomogram model to predict the occurrence of low birth weight. MethodsBirth registration information in Shanghai from 2010 to 2020 was collected， and ANOVA and Chi-square tests were used to compare the differences in reproductive behavior factors and newborn health status across time. The odds ratio （OR） value and 95%CI were calculated by a multi-classification logistic regression model to determine the association between reproductive behavior factors and preterm birth or low birth weight infants. A nomogram model was established based on logistic model and the area under the ROC curve was used to assess the effect of the model. ResultsThis analysis included 2 089 384 live newborns. The incidence of full-term low birth weight， preterm normal weight and preterm low birth weight in Shanghai was 0.94%， 2.48% and 2.01%， respectively. From 2010 to 2020， 40.00% women had a history of abortion， the proportion of women who gave birth at age ≥40 years old increased from 1.05% to 2.24%， the proportion of fathers aged ≥40 years increased from 4.79% to 7.48%， and the proportion of women with postgraduate or above increased from 4.81% to 11.74%. The incidence of preterm low birth weight in Shanghai showed an increasing trend over time. Logistic regression analysis showed that the risk of preterm low birth weight was lower in female than in male infants （OR=0.97， 95%CI： 0.95‒0.98）， and the risk of full-term low birth weight was higher than in male infants （OR=1.85， 95%CI： 1.80‒1.90）. The risk of preterm birth and low birth weight was lower for couples of childbearing age with higher education. The risk of preterm low birth weight in newborns tended to increase with maternal age at childbirth >30 years， paternal age ≥40 years， and the number of abortions >2 times. Mother <25 or >35 years， father aged 30‒34 years， and the number of abortions >3 times were the risk factors of full-term low birth weight infants. ConclusionCouples of childbearing age who choose to have children at too high or too low age may increase the risk of preterm birth or low birth weight， so it is necessary to strengthen population awareness and promote age-appropriate childbirth. Multiple abortions are also associated with preterm birth and low birth weight， and it is advisable to popularize the scientific knowledge of contraception and birth control to reduce unnecessary abortions. The nomogram in the study can visualize the risk of full-term and low birth weight infant at different levels of factors， which can assist couples preparing for pregnancy in making decisions about the timing of childbirth and understanding the level of risk.

ObjectiveTo analyze the dynamic response relationship between urban development and mortality rate in Shanghai， and to predict the trend of mortality rate changes. MethodsBy analyzing the total mortality rate （TMR）， gross domestic product （GDP） and socio-demographic index （SDI） in Shanghai from 1978 to 2017， a vector autoregressive （VAR） model was constructed to evaluate the impact of urban development on the mortality rate. ResultsThe fitted R2 of the VAR model was 0.92. The short-term effect of GDP on the improvement of death level was negative， while the long-term effect was positive， and the SDI was negative regardless of the short-term and long-term effects. By the tenth year， GDP and SDI contributed 10.61% and 27.25% to TMR changes， respectively. The model predicted that the mortality rate in Shanghai would be 9.17 per thousand by 2030. ConclusionLong-term economic growth can effectively promote a decline in population mortality. However， as the economy develops vigorously， the adverse effects of declining birth rates and population aging on population health during the era of high-level population development should not be ignored.

Transcranial direct current stimulation (tDCS) has become a new method of post-stroke rehabilitation treatment and is gradually accepted by people. However, the neurophysiological mechanism of tDCS in the treatment of stroke still needs further study. In this study, we recruited 30 stroke patients with damage to the left side of the brain and randomly divided them into a real tDCS group (15 cases) and a sham tDCS group (15 cases). The resting EEG signals of the two groups of subjects before and after stimulation were collected, then the difference of power spectral density was analyzed and compared in the band of delta, theta, alpha and beta, and the delta/alpha power ratio (DAR) was calculated. The results showed that after real tDCS, delta band energy decreased significantly in the left temporal lobes, and the difference was statistically significant ( P < 0.05); alpha band energy enhanced significantly in the occipital lobes, and the difference was statistically significant ( P < 0.05); the difference of theta and beta band energy was not statistically significant in the whole brain region ( P > 0.05). Furthermore, the difference of delta, theta, alpha and beta band energy was not statistically significant after sham tDCS ( P > 0.05). On the other hand, the DAR value of stroke patients decreased significantly after real tDCS, and the difference was statistically significant ( P < 0.05), and there was no significant difference in sham tDCS ( P > 0.05). This study reveals to a certain extent the neurophysiological mechanism of tDCS in the treatment of stroke.
Brain/physiopathology* ; Brain Waves/physiology* ; Electroencephalography/methods* ; Humans ; Stroke/therapy* ; Stroke Rehabilitation/methods* ; Transcranial Direct Current Stimulation/methods*

Objective:To investigate the effect of pelvic packing on the control of intractable postpartum hemorrhage after emergency perinatal hysterectomy (EPH).Methods:Eleven cases with complete clinical data of pelvic packing due to failure of hemostasis after EPH were collected to evaluate the outcome, complications, hospital stay of pregnant women, and to analyze the factors affecting the effect of pelvic packing. The cases included patients who were admitted to the Third Affiliated Hospital of Guangzhou Medical University after pelvic packing treatment in the other hospital due to continuous bleeding after EPH or who were referred to our hospital for pelvic packing treatment due to continuous bleeding after EPH from January 2014 to August 2021.Results:The median gestational week of 11 pregnant women was 38.3 weeks(38.0-39.9 weeks) , and the methods of termination of pregnancy were cesarean section in 7 cases (7/11) and vaginal delivery in 4 cases (4/11). The median time between postpartum hemorrhage and pelvic tamponade was 10 hours (5-57 hours), the median amount of bleeding was 8 500 ml(4 800-15 600 ml) , the median number of pelvic tamponade was 3 pieces (2-7 pieces), and the median retention time of gauze pad was 6.0 days (3.0-6.0 days). The median frequency of laparotomy in this pregnancy was 3 times (2-3 times), with a maximum of 4 among the 11 cases, the first pelvic packing was successful in hemostasis in 9 cases, and the final successful treatment in all of the 11 cases. All parturients had hemorrhagic shock (11/11) and disseminated intravascular coagulation (11/11) before pelvic packing. Other common complications were multiple organ dysfunction syndrome (9/11), cardiac arrest (4/11), deep vein thrombosis (3/11), septic shock (3/11), and intestinal obstruction (1/11). All parturients took out the gauze after the coagulation function returned to normal and there was no active bleeding. The recovery time of coagulation function in 11 cases was 3 days (3-5 days), the retention time of gauze pad was 6 days (3-6 days), the median length of stay in intensive care unit was 14 days (11-26 days), and the median total length of stay was 22 days (16-49 days).Conclusions:Pelvic packing could be used as a temporary strategy for intractable postpartum hemorrhage after EPH, which provides a key time for injury control resuscitation for patients with unstable vital signs. This technology provides an opportunity for referral to superior medical institutions and further treatment.

As an emerging non-invasive brain stimulation technique, transcranial direct current stimulation (tDCS) has received increasing attention in the field of stroke disease rehabilitation. However, its efficacy needs to be further studied. The tDCS has three stimulation modes: bipolar-stimulation mode, anode-stimulation mode and cathode-stimulation mode. Nineteen stroke patients were included in this research (10 with left-hemisphere lesion and 9 with right). Resting electroencephalogram (EEG) signals were collected from subjects before and after bipolar-stimulation, anodal-stimulation, cathodal-stimulation, and pseudo-stimulation, with pseudo-stimulation serving as the control group. The changes of multi-scale intrinsic fuzzy entropy (MIFE) of EEG signals before and after stimulation were compared. The results revealed that MIFE was significantly greater in the frontal and central regions after bipolar-stimulation ( P< 0.05), in the left central region after anodal-stimulation ( P< 0.05), and in the frontal and right central regions after cathodal-stimulation ( P< 0.05) in patients with left-hemisphere lesions. MIFE was significantly greater in the frontal, central and parieto-occipital joint regions after bipolar-stimulation ( P< 0.05), in the left frontal and right central regions after anodal- stimulation ( P< 0.05), and in the central and right occipital regions after cathodal-stimulation ( P< 0.05) in patients with right-hemisphere lesions. However, the difference before and after pseudo-stimulation was not statistically significant ( P> 0.05). The results of this paper showed that the bipolar stimulation pattern affected the largest range of brain areas, and it might provide a reference for the clinical study of rehabilitation after stroke.
Humans ; Transcranial Direct Current Stimulation/methods* ; Electroencephalography ; Stroke Rehabilitation ; Stroke/therapy* ; Electrodes