Abstract: Objective To analyze the risk factors for neonatal preterm birth in 12 hospitals in Yunnan Province from 2016 to 2017, and to establish a nomogram prediction model for neonatal preterm birth, providing scientific evidence for the prevention of preterm birth. Methods A total of 20 445 pregnant women who gave birth in 12 hospitals in Yunnan Province from 2016 to 2017 were collected and grouped into a preterm group (n=1 186) and a full-term group (n=19 259) according to whether they had a premature delivery. The general information questionnaire of pregnant women designed by the research team was applied to understand the basic conditions and pregnancy information of the two groups, and the risk factors of preterm birth were determined by logistic regression analysis, R software was applied to draw a nomogram prediction model of neonatal preterm birth, and its predictive performance was tested. Results There were significant differences in the proportions of twins and above (9.11% vs 7.10%), pregnancy-induced hypertension (21.67% vs 18.57%), gestational diabetes mellitus (18.21% vs 15.90%), anemia (24.28% vs 20.70%), premature rupture of membranes (11.64% vs 9.76%), and abnormal placenta (7.08% vs 5.51%) between the preterm group and the full-term group (χ2=6.731, 7.055, 4.441, 8.691, 4.437, 5.232, all P<0.05); the logistic regression analysis showed that the risk factors for neonatal preterm birth were twins and above (OR=2.378), pregnancy-induced hypertension (OR=2.039), gestational diabetes mellitus (OR=1.824), anemia (OR=1.825), and premature rupture of membranes (OR=2.313) (all P<0.05); the discrimination (area under the curve was 0.794, 95%CI=0.738-0.850) and precision (goodness of fit HL test, χ2=8.864, P=0.312) of the nomogram model constructed to predict the occurrence of neonatal preterm birth were both good. Conclusions The nomogram model for preterm birth constructed based on 5 factors including number of fetuses, pregnancy-induced hypertension, gestational diabetes mellitus, anemia and premature rupture of membranes can predict the occurrence of neonatal preterm birth well, thus providing reference for the prevention of neonatal preterm birth.

Mycoplasma pneumoniae is a common pathogen of community-acquired pneumonia, and its pathogenesis mainly includes three aspects. Mycoplasma pneumoniae attaches to ciliated cells of the respiratory epithelium and then produces oxidative stress. It also releases the CARDS toxin, leading to airway damage. Through immunomodulation of the host immune response it enables establishment of persistent infections and causes autoimmune phenomena. My-coplasma pneumoniae can also lead to multiple organs damage, which pathogenic mechanism is not yet clear. Many clinical manifestations of acute infection as well as extrapulmonary complications are due to immunopathologic and in-flmmatory effects produced by the host, with or without blood clotting. This paper systematically reviewed the results of the current Mycoplasma pneumoniae pathogenic mechanisms.

Objective To explore the clinical effect of direct posterior restoration and screw-rod (plate) internal fixation technique for the treatment of children with congenital atlantoaxial subluxation.Methods Seven children with congenital atlantoaxial subluxation,admitted to our hospital from April 2008 to March 2011, were chosen in our study; and 3 of them were combined with tonsil hernia of cerebellum and 3 with occipitalization. Japanese Orthopedic Association (JOA) scale was used to evaluate the patient's condition. Five patients were treated by internal fixation with occipital bone screw-axis (C2) pedicle screw and 2 were with atlas C1-C2.Articulatio atlantoepistrophica repositioning was performed during the operation. The post-operative improvement degree and therapeutic effect of these patients were assessed based on the JOA scores and imaging. Results All the patients were followed up for 1-15 months (average 3.2 months). The clinical symptoms of all patients improved significantly. The positions of all screws were fine 1 month after operation. Three-dimensional CT showed that occipital/interbody fusions were good in 3 patients.JOA scores after the surgery were 7-16 with an average scores of (12.03±3.58),which were significantly different as compared with those before the surgery ([7.56±3.16], P＜0.05). Conclusion Direct posterior restoration and internal fixation technique is a safe and effective method for the treatment of children with congenital atlantoaxial subluxation.

Objective To observe the perioperative myocardial protection of high-dose atorvastatin to acute coronary syndrome(ACS) patients during percutaneous coronary artery interventional therapy(PCI).Methods One hundred and twenty patients with ACS undergoing elective PCI were divided into group A and group B with different oral dose of atorvastatin ( 80 mg/d and 20 mg/d ) for 3 days before operation by random digits table. Troponin I (cTnI), creatine kinase isozyme MB (CK-MB), high sensitive C-reactive protein (hs-CRP), interleukin (IL)-6 levels were measured before operation, 6 hours, 12 hours after operation and total cholesterol (TC), triglyeride (TG), low desity lipeprotein cholesterol (LDL-C), high density lipeprotein cholesterol (HDL-C) levels were measured before operation and 3 days after operation.Results cTnI,CK-MB,hs-CRP and IL-6 levels in the two groups were increased significandy 6 hours and 12 hours after operation (P <0.05). Six hours after operation, cTnI and CK-MB levels in group A were significantly lower than those in group B [(0.35±0. 18 ) μg/L vs. (0.48±0. 16 ) μg/L, ( 3.78±0.45 )μg/Lvs. (4.56±0.55 )μg/L] (P < 0.05 ). Twelve hours after operation , hs-CRP and IL-6 levels in group A were significantly lower than those in group B [(4.53±0.98 ) mg/L vs. (7.03±0.88 ) mg/L, ( 30.6±11.2) ng/L vs.(43.8±12.1) ng/L] (P <0.05). TC, TG, LDL-C, HDL-C levels in the two groups did not change significantly before and after operation (P >0.05). Conclusions Myocardial protective effects of ACS patients treated with atorvastatin 80 mg/d for 3 days are better than those treated with oral atorvastatin 20 mg/d. High-dose atorvastatin can produce more beneficial effects.

Objective To investigate the management and control of hypertension in patients with chronic kidney disease(CKD) and its associated factors.Methods Data of 726in-patients with CKD and hypertension who hospitalized in our hospital from March 2009 to April 2010 were studied.Results 91.74％ of patients was treated with antihypertensive medications,and 21.21％, 22.59％, 19.56％, 28.37％ of patients received 1, 2, 3, ≥4 antihypertensive drugs,respectively.42.4％ of patients with CKD and hypertension could be controlled up to the standard,and the mean blood pressure was(137.86±20.75)/(76.30±11.35) mm Hg.There was significant difference among stage 1 plus 2, 3, 4 plus 5 (non-dialysis), 5 (dialysis) kidney diseases, with the hypertension control rate being 50.8％, 46.7％, 42.0％, 33.5％, respectively.The hypertension control rate of non-dialysis patients was significantly higher than that of dialysis (44.9％ vs 33.5％,P＜0.05).There was no significant difference between blood dialysis group and peritoneal dialysis group(32.3％ vs 38.7％, P＞0.05).Multivariate Logistic regression analysis showed that female (OR=1.787, 95％CI 1.045-3.056)and ACEI application (OR=4.378, 95％CI1.830-10.472) were positively associated with hypertension control.Whereas, diabetes (OR=0.415, 95％CI 0.188-0.919)and pulse pressure (OR =0.847, 95％ CI 0.811-0.885) were associated with inadequate blood pressure control.ConclusionsDespite almost universal hypertension treatment is used in patients with CKD and high blood pressure, the hypertension control rate is still suboptimal.Female and ACEI are positively associated with adequate hypertension control, whereas diabetes and pulse pressure are negatively associated with the standard.

Based on the Miller Pyramid for assessing clinical competence, this article analyzed the existing problems in the practice of teaching physical examination and provided suggestions for possible reforms.

Shanghai University of TCM was the first Chinese medicine university that established field-grade experimental teaching center in China.And both of the Chinese medicine and Chinese herbs experimental teaching centers became national experimental teaching demonstration centers.There is general improvement in laboratories conditions,so the experimental teaching team building is the critical factor of improving experimental teaching quality.The experimental teaching team of Shanghai University of TCM consists of excellent teachers as its backbone,and lecturers and technicians from fields in traditional Chinese medicine Chinese herbs and clinical practices.The team members cooperate with each other by setting up experimental teaching research groups to improve teaching quality,which plays an important role in building experimental teaching demonstration center.

ObjectiveTo investigation the clinical features and immunophenotypes of mantle cell lymphoma (MCL).MethodsThe clinical data of 23 patients of MCL were reviewed prospectively.Age,sex,Ann-Arbor staging,symptoms and bone marrow biopsies were analyzed.Serum lactat dehydrogenates (LDH) level,CD5,CD20 and CyclinD1 were determined.ResultsThe median age was 62 years old (range 44-74),15 patients(65.2％)were more than 60 years old.Among 23 patients,the male-to-female ratio was 4.4∶1,Twenty-one patients (91％) presented with advanced stage (Ann Arbor stage Ⅲ 12 cases and Ⅳ 9 cases) at initial diagnosis.Twenty patients (87.0 ％) were lymph node involvement.The serum LDH level was high in 11 patients.CD5 was positively expressed in 14 (60.8 ％) of all patients.CD20 was positively expressed in 21 (91.3 ％) of all patients.Cyclin D1 was over-expression in 19 (82.6 ％) of all patients.ConclusionThe MCL shows a predilection for occurrence in older males.The majority of patients are advanced stage disease (Ann Arbor stage Ⅲ/Ⅳ ) are at initial diagnosis. Most of patients display lymph node involvement manifestations.Bone marrow infiltration is frequent.The immunophenotype of MCL resembles the mature B-lymphocyte (CD+20),with coexprssion of the T-cell antigen CD5.It has been demonstrated that CyclinD1 are over express in this histotype of MCL.CyclinDl over-expression could be considered as hallmark of MCL.

Objective To discuss the relationship between human leukocyte antigen (HLA) gene heredity and morbidity of cerebral infarction by a random survey on the allele expression of HLA-A, B and DRB1 seats of patients with cerebral infarction. Methods The genotypes of HLA-A, B and DRB1 alleles in 94 patients with cerebral infarction and 122 healthy blood donors were detected by polymerase chain reaction-sequencing based typing (PCR-SBT) method. Results Sixteen alleles in HLA -A locus,32 alleles in HLA -B locus and 25 alleles in HLA -DRB1 locus expressed themselves in these patients with cerebral infarction. The gene frequency of HLA -A*1102 in patients was lower than that in healthy controls, and negative association was found between HLA -A* 1102 allele and cerebral infarction (RR=0.06,P=0.019). Conclusion The research reveals susceptibility association of HLA -A*1102 with patients having cerebral infarction, displaying close genetic immunity correlation between HLA alleles and pathogenesis of cerebral infarction. So, the research in this paper is useful in the clinical prediction of this disease.

Objective To explore the features of patients with acute leukemia (AL) in Hematology Department of Shenzhen Hospital affliated to Beijing University during the past six years. Methods The data of the 1056 acute leukemia dignosed in our department between 2002-2007 were collected and analyzed retrospectively. Results The male patients was predominant (male/female ratio was 1.78). The number of patients with acute myeloid leukemia(AML) was higher than that of patients with acute lymphoblastic leukemia (ALL) (AML/ALL ratio was 1.85). Most of the AML patients were young adult (65 %) and elderly ALL patients were very rare(1.33 %). AL cases were tended to increase gradually by year. The ratio of treatment-related AL in Shenzhen was lower than that reported literature in other countries. The major cause of the treatment-related AL were chemotherapy/radiotherapy and psoriasis treated with bimolane. Conclusion Some of the features of AL patients in China were further confirmed and some new features were also found in this study. These changes should be demonstrated by the next national epidemiology survey of leukemia.