To explore the role of the "Clinical Practice Guidelines" column and others in the Medical Joumnal of Peking Union Medical College Hospital (Med J PUMCH) in promoting diseiplinary development.

Background Exposure to perfluoroalkyl and polyfluoroalkyl substances (PFAS) during pregnancy might affect thyroid-related hormone levels in pregnant women. However, most previous studies focused on the effects of PFAS containing 8-10 carbon atoms, and few studies have estimated the associations between PFAS with longer carbon chain and thyroid-related hormone levels. Objective To examine the associations between PFAS exposure and thyroid-related hormones in pregnant women. Methods The present study was based on the Jiashan Birth Cohort from September 2016 to April 2018. We analyzed 13 PFAS in maternal blood samples (n=781) by high-performance liquid chromatography-tandem mass spectrometry, as well as total triiodothyronine (T3), total thyroxine (T4), free T3 (FT3), free T4 (FT4), thyroid stimulating hormone (TSH), thyroglobulin antibody (TG-Ab), and thyroid peroxidase antibody (TPOAb) by electrochemiluminescence immunoassay. PFAS were divided into three groups:low concentration, medium concentration and high concentration according to the tertile of their concentrations. We estimated the associations between PFAS concentrations and thyroid-related hormones in pregnant women by multiple linear regression. Results In the multiple linear regression models, a change in perfluorododecanoic acid (PFDoA) concentrations from the low concentration group to the high concentration group was associated with a −0.10 (95%CI: −0.20, 0) nmol·L⁻¹ change in T3, −0.15 (95%CI: −0.28, −0.02) pmol·L⁻¹ change in FT3, and −3.02 (95%CI: −5.66, −0.39) pmol·L⁻¹ change in FT4, respectively. A change in perfluorotridecanoic acid (PFTrDA) concentrations from the low concentration group to the high concentration group was associated with a −0.10 (95%CI: −0.20, 0) nmol·L⁻¹ change in T3. Compared with the low concentration group, the concentration of T4 in the medium concentration group of perfluorohexane sulfonate (PFHxS) increased by 6.10 (95%CI: 0.44, 11.75) nmol·L⁻¹. No statistically significant associations were found between PFAS and TSH concentration. The negative associations of PFAS with thyroid-related hormones were more pronounced in pregnant women with positive TG-Ab and/or TPOAb. Conclusion Exposure to PFAS during pregnancy may affect thyroid-related hormone homeostasis in pregnant women, and the effect is stronger in TG-Ab and/or TPOAb-positive pregnant women.

Objective:To analyze the clinical features, treatment, and outcomes of fetal/neonatal atrial flutter (AFL) at the onset of the perinatal period to improve the management of this condition.Methods:This retrospective study analyzed the clinical data, treatment, and follow-up results of fetal/neonatal AFL cases transferred to Shanghai Children's Medical Center from November 2013 to August 2021. Clinical characteristics, cardioversion procedures, and outcomes were summarized. Descriptive method was used for statistical analysis.Results:A total of 21 fetuses/neonates presenting with AFL in the perinatal period were involved in this study, including 17 males and four females. Ten of them were born at full term, and 11 were preterms. All of the patients were delivered by cesarean section at 32 to 41 gestational weeks [ (36.6±1.9) weeks] with a birth weight of 2 130 to 4 450g [ (3 059±528) g]. Increased fetal heart rate was all detected after 32 weeks of gestation, and three of them were diagnosed with AFL by fetal echocardiography before being born. The heart rate remained elevated in all cases after birth. All were diagnosed as AFL based on an electrocardiogram on the day of birth, which showed a 2 to 6 over one ratio of atrioventricular conduction. Among the six cases of cardiac insufficiency and low blood pressure complicated by dyspnea and cyanosis, the symptoms were relieved in four cases after mask oxygenation and two cases after ventilation. Among the 21 cases, one was converted spontaneously to normal sinus rhythm and the other 20 recovered after medication or electrical cardioversion. Seven cases were initially treated by drug conversion with a success rate of 5/7 and hospitalized for 23 d (13-25 d). There was one with cardiac insufficiency before treatment and three newly developed cardiac insufficiency during treatment among the seven cases. Thirteen cases were offered electrical cardioversion initially, and the success rate of cardioversion was 12/13. There were five cases of cardiac insufficiency before treatment, while no new cases of cardiac insufficiency was reported during treatment. The duration of hospitalization was 11 d (9-14 d). Apart from one case, the rest 20 infants were followed up from one month to eight years old, and no recurrence was reported.Conclusions:For fetal/neonatal AFL with the onset during the perinatal period, the symptoms mainly manifest in late pregnancy. Its diagnosis depends on fetal echocardiography before birth or electrocardiogram after birth, and electrical cardioversion is a fast and effective measure. While the prognosis of perinatal-onset AFL is generally good.

We report a case of primary hyperparathyroidism(PHPT) with depressive symptoms as initial manifestation. Literature review was conduct to further analyze the etiology, clinical manifestations, diagnosis, treatment and prognosis of the disease. The initial symptoms of the patients was the mental system depression and kidney stones was found by physical examination. She first visited a doctor in the urology department after a kidney stones was found. Blood calcium 2.86 mmol/L was found. At second visit, a doctor from endocrinology department conducted a comprehensive examination on the patient′s coexisting mental and renal system symptoms, clearly identified, her as PHPT. The clinical manifestations of PHPT are diverse. Symptoms such as depression, anxiety, mood swings, etc. are rarely evaluated. PHPT patients with onset or accompanied by psychiatric symptoms should be paid attention to by doctors, Measures should be taken to improve the quality of life and prognosis of patients through early screening of blood calcium and parathyroid hormone for timely diagnosis.

Objectives To detect the cord blood vitamin D level in neonates and to determine the association between the cord blood vitamin D level and neonatal outcomes. Methods A total of 223 eligible mother-and-singleton-offspring pairs were recruited. The information of mothers' pregnancy was collected by questionnaires. The weight, length, and head circumference of neonates were measured. The levels of 25(OH)D in cord blood of neonates and in blood of late pregnancy mothers were determined by chemiluminescence immunoassay. Results The median concentration of 25(OH)D in cord blood was 20.7 nmol/L, and 82.1% of neonate had vitamin D deficiency, and 12.1% had severe vitamin D deficiency (<10 nmol/L). The concentration of 25(OH)D in cord blood was consistent with that in blood of late pregnancy mother. The distribution of concentration of 25(OH)D in cord blood was significantly different in neonates in different seasons of birth (P<0.05). There were more cases <10 nmol/L in winter and spring. The concentration of 25(OH)D in cord blood had no significant associations with the incidences of low birth weight (LBW) and small for gestational age (SGA) (P>0.05). After the variables of sex, gestational age and birth season are controlled, the birth weight and head circumference were significantly different in neonates with different concentrations of 25(OH)D in cord blood (P<0.05). Conclusions The concentration of 25(OH)D in cord blood in term neonates was generally lower. The vitamin D status in neonates was consistet with that in their late pregnancy mothers. Cord blood 25(OH) D levels were associated with neonates' birth weight and head circumference, but it should be confirmed by larger sample size in the future.

Objective To investigate the temporal and spatial distribution of Schistosoma infection of population and its risk factors in Eastern Dongting Lake area in 2012 and 2014,so as to provide the reference for formulating effective intervention mea-sures. Methods Junshan District was selected as a study field in Eastern Dongting Lake area. The method of spatial autocorre-lation analysis was applied to analyze the change of spatial distribution of Schistosoma infection in Junshan District in 2012 and 2014. The spatial regression model was fitted to detect the risk factors for human infection. Results The livestock infection rate in 2013 was lower than that in 2011. The average infection rate of schistosome was reduced to 0.55%in 2014. The spatial auto-correlation existed on the distribution of schistosomiasis in Junshan District in both 2012 and 2014 and 4 high incidence villages were identified. The results of the spatial error model showed that the prevalence of human infection was positively correlated with the infection rate of the livestock and the area of the susceptible environment in 2012. The spatial lag model showed that the prevalence of human schistosomiasis was positively correlated with the area of the susceptible environment ,but not with the in-fection rate of livestock. Conclusion The measures involving grazing prohibition and phasing out cattle and sheep are remark-ably effective and should continue on the basis of the current spatial distribution of schistosomiasis in this area.

Objective To investigate the prevalence of HIV,HBV and HCV infections in children aged 1-13 years in Yi ethnic area in Sichuan province.Methods A cross-sectional study was conducted in the form of field survey in four townships selected from Yi ethnic area of Sichuan during 2014-2015.Participants were children aged 1-13 years by sample size of 900 and were screened for HIV antibody,HBV surface antigen and HCV antibody,and laboratory comfirmation was conducted.The area,age,gender and ethnic group specific infection rates were compared by using Fisher' s exact test,and multiple comparisons were corrected by using Bonferroni correction.Results A total of 677 children aged 1-13 years were surveyed.The infection rates of HIV,HBV and HCV were 1.03％ (7/677,95％CI:0.42％-1.12％),6.65％ (45/677,95％CI:4.89％-8.79％) and 0.15％ (1/677,95％CI:0％-0.82％),respectively.The infection rates of HIV differed among townships (P=0.000),the infection rate was higher in township D than in township B,the difference was significant (P＜0.001).The differences in HIV infection rate among different age,gender and ethnic groups were not significant.The differences in HBV and HCV infections were not significant among different townships,age,gender and ethnic groups.The difference in HBV viral load between age group 5-9 years and age groups 10-13 years was not significant (U=115.000,P=0.967).Conclusions The burden of HIV and HBV infections in children aged 1-13 years was heavy in rural area of Yi ethnic area in Sichuan.Therefore,it is necessary to take effective measures to block the vertical transmission of HIV and HBV as well as to increase the coverage of HBV vaccination.

We constructed different N-terminal truncated variants based on Bacillus acidopullulyticus pullulanase 3D structure (PDB code 2WAN), and studied the effects of truncated mutation on soluble expression, enzymatic properties, and application in saccharification. Upon expression, the variants of X45 domain deletion existed as inclusion bodies, whereas deletion of CBM41 domain had an effective effect on soluble expression level. The variants that lack of CBM41 (M1), lack of X25 (M3), and lack both of CBM41 and X25 (M5) had the same optimal pH (5.0) and optimal temperature (60 degrees C) with the wild-type pullulanase (WT). The K(m) of M1 and M5 were 1.42 mg/mL and 1.85 mg/mL, respectively, 2.4- and 3.1-fold higher than that of the WT. k(cat)/K(m) value of M5 was 40% lower than that of the WT. Substrate specificity results show that the enzymes exhibited greater activity with the low-molecular-weight dextrin than with high-molecular-weight soluble starch. When pullulanases were added to the saccharification reaction system, the dextrose equivalent of the WT, M1, M3, and M5 were 93.6%, 94.7%, 94.5%, and93.1%, respectively. These results indicate that the deletion of CBM41 domain and/or X25 domain did not affect the practical application in starch saccharification process. Furthermore, low-molecular-weight variants facilitate the heterologous expression. Truncated variants may be more suitable for industrial production than the WT.
Bacillus ; enzymology ; Glycoside Hydrolases ; metabolism ; Molecular Weight ; Protein Conformation ; Sequence Deletion ; Substrate Specificity ; Temperature

The elimination of Oncomelania hupensis snails is important to schistosomiasis control. Recently,the application of molluscicidal organisms is considered as a safe and efficient method for snail elimination. In order to provide scientific evi?dences for effective control of O. hupensis and schistosomiasis,this paper summarizes the researches of molluscicidal microor?ganisms against O. hupensis.

Objective To explore the effect of motor imagery therapy and its combination with counterbalance exercise on the fall efficacy of elderly people.Methods Totals of 156 eligible elderly people with fear of falling ( FOF) were selected as objects and randomly divided into three groups. The first group was the control group, treated with routine rehabilitation nursing. People in the second group were treated with routine rehabilitation nursing plus motor imagery therapy. People in the third group were treated with routine nursing plus motor imagery therapy, combined with counterbalance exercise. The intervention lasted for 2 weeks. People in the three groups were assessed by fall efficacy and depression scales before and after the intervention. Results Regarding fall efficacy before and after the intervention, there were not significant differences in the control group [(3.79±1.46) points vs. (4.01±1.35)points, t=0.798, P>0.05)], or in the second group [(3.88±1.86) vs. (4.38±1.14), t=1.653, P>0.05)], but there was significant difference in the third group [(3.91±1.54) vs. (5.75±1.43), t=6.314, P<0.01)]. As for depression scores before and after the intervention, there was not significant difference in the control group [(56.68±8.64) vs. (54.21±8.28), t=1.489, P>0.05)], but there were significant differences in the second group [(55.58±7.42) vs. (47.45± 6.89), t=5.790, P<0.01)], and in the third group [(56.23±6.54) vs. (46.23±7.21), t=7.408, P<0.01)].Conclusions The motor imagine therapy alone can not significantly improve fall efficacy of the elderly with FOF, but can significantly reduce their depression. Combined use of motor imagery therapy and counterbalance exercise can significantly increase their fall efficacy and reduce their depression.