Objective:To explore the effects of interpregnancy interval (IPI) on pregnancy outcomes of subsequent pregnancy.Methods:A multicenter retrospective study was conducted in 21 hospitals in China. Information of age, height, pre-pregnancy weight, IPI, history of diseases, complications of pregnancy, gestational age of delivery, delivery mode, and pregnancy outcomes of the participants were collected by consulting medical records of pregnant women who had two consecutive deliveries in the same hospital during 2011 to 2018. The participants were divided into 4 groups according to IPI:<18 months, 18-23 months, 24-59 months and ≥60 months. According to the WHO′s recommendation, with the IPI of 24-59 months group as a reference, to the effects of IPI on pregnancy outcomes of subsequent pregnancy were analyzed. Stratified analysis was further carried out based on age, history of gestational diabetes mellitus (GDM), macrosomia, and premature delivery, to explore the differences in the effects of IPI on pregnancy outcomes among women with different characteristics.Results:A total of 8 026 women were included in this study. There were 423, 623, 5 512 and 1 468 participants in <18 months group, 18-23 months group, 24-59 months group and ≥60 months group, respectively. (1) The age, pre-pregnancy body mass index (BMI), history of cesarean section, GDM, gestational hypertension and cesarean section delivery rate of <18 months group, 18-23 months group, 24-59 months group and ≥60 months group were gradually increased, and the differences were statistically significant ( P<0.05). (2) After adjusting for potential confounding factors, compared with women in the IPI of 24-59 months group, the risk of premature delivery, premature rupture of membranes, and oligohydramnios were increased by 42% ( OR=1.42, 95% CI: 1.07-1.88, P=0.015), 46% ( OR=1.46, 95% CI: 1.13-1.88, P=0.004), and 64% ( OR=1.64, 95% CI: 1.13-2.38, P=0.009) respectively for women in the IPI≥60 months group. No effects of IPI on other pregnancy outcomes were found in this study ( P>0.05). (3) After stratified by age and adjusted for confounding factors, compared with women in the IPI of 24-59 months group, IPI≥60 months would significantly increase the risk of oligohydramnios for women with advanced age ( OR=2.87, 95% CI: 1.41-5.83, P=0.004); and <18 months could increase the risk of premature rupture of membranes for women under the age of 35 ( OR=1.59, 95% CI: 1.04-2.43, P=0.032). Both the risk of premature rupture of membranes ( OR=1.58, 95% CI: 1.18-2.13, P=0.002) and premature delivery ( OR=1.52, 95% CI: 1.07-2.17, P=0.020) were significantly increased in the IPI≥60 months group. After stratified by history of GDM and adjusted for confounding factors, compared with women in the IPI of 24-59 months group, IPI≥60 months would lead to an increased risk of postpartum hemorrhage for women with a history of GDM ( OR=5.34, 95% CI: 1.45-19.70, P=0.012) and an increased risk of premature rupture of membranes for women without a history of GDM ( OR=1.44, 95% CI: 1.10-1.90, P=0.009). After stratified by history of macrosomia and adjusted for confounding factors, compared with women in the IPI of 24-59 months group, IPI≥60 months could increase the proportion of cesarean section for women with a history of macrosomia ( OR=4.11, 95% CI: 1.18-14.27, P=0.026) and the risk of premature rupture of membranes for women without a history of macrosomia ( OR=1.46, 95% CI: 1.12-1.89, P=0.005). After stratified by history of premature delivery and adjusted for confounding factors, compared with women in the IPI of 24-59 months group, IPI≥60 months would significantly increase the risk of premature rupture of membranes for women without a history of premature delivery ( OR=1.47, 95% CI: 1.13-1.92, P=0.004). Conclusions:Both IPI≥60 months and <18 months would increase the risk of adverse pregnancy outcomes in the subsequent pregnancy. Healthcare education and consultation should be conducted for women of reproductive age to maintain an appropriate IPI when they plan to pregnant again, to reduce the risk of adverse pregnancy outcomes in the subsequent pregnancy.

Objective:Lung ultrasound (LUS) has been used in the diagnosis of neonatal respiratory distress syndrome(RDS) successfully, but there have been no multicenter prospective studies to verify its reliability or determine how to grade RDS with LUS findings.This study aimed to discuss the necessity and feasibility of using LUS findings to determine RDS grades through a multicenter prospective study.Methods:Every researcher participated in the National Neonatal Lung Ultrasound Training Course and receiving 3-6 months of lung ultrasound system training at the National Neonatal Lung Ultrasound Training Center.Patients between June 2018 and May 2020 who met the RDS ultrasound diagnostic criteria and had full available clinical data were included in this study.The LUS examination was completed immediately after the patients were admitted to the hospital.Some of them also underwent chest X-ray examination.Arterial blood gas analysis was completed immediately before or after the LUS ultrasound examination.RDS grading was performed according to the LUS findings and whether the patient had serious complications.Results:A total of 275 qualifying cases were included in this study, which included 220 premature infants and 55 full-term infants, and the primary RDS occurred in 117 cases (42.5%), and secondary RDS occurred in 158 cases (57.5%). LUS manifestations of RDS patients can be divided into three categories: (1)A ground-glass opacity sign: which could be found among 50 infants when they were admitted to the hospital (that was, at their first LUS examination). Twenty-eight of these infants were considered to have wet lungs and were not sent for special management on admission, but LUS showed typical snowflake-like lung consolidation within 0.5 to 4 hours.Twenty-two of them were given mechanical ventilation with exogenous pulmonary surfactant; Eighteen cases were controlled within 6-12 hours, but the lung lesions became more severe in the other 4 infants (due to severe intrauterine infection). (2)Snowflake-like lung consolidations: the first LUS on admission showed typical snowflake-like lung consolidation involving areas ranging from 1-2 intercostal spaces to 12 lung divisions in 204 cases.Thirty-eight infants among them the lung consolidation only had involvement of 1-2 intercostal spaces at the time of admission; Fifteen of them received invasive respiratory support and recovered within 4-12 hours.Twelve patients received noninvasive respiratory support; Seven of them recovered, while five cases developed severe lung illness.The remaining 11 patients who were not given any form of ventilator support developed severe conditions within 1-4 hours.Thirty of them showed snowflake signs involving 12 lung regions at admission.The remaining 136 patients had lung consolidation degree between the two degree above condition.(3)Snowflake-like sign with complications: Twenty-one patients had severe complications such as pneumothorax, pulmonary hemorrhage or/and persistent pulmonary hypertension of the newborn or large area atelectasis, etc, although snowflake lung consolidation did not involve all lung regions.Conclusion:(1) LUS is reliable and accurate for diagnosing RDS.RDS has the same characteristics on ultrasound for both preterm and full-term infants, both primary and secondary RDS.(2) To facilitate the management of RDS, it is necessary to classify RDS according to the ultrasound findings and the presence of severe complications.(3) Based on the results of this study, it is recommended that RDS can be divided into mild, moderate and severe degrees.The exact standards for grading are as follows: Mild RDS: the early stage of RDS, in which lung consolidation shows as a ground-glass opacity sign on ultrasound; Moderate RDS: lung consolidation shows a snowflake sign on ultrasound, not all of the lung fields are involved; Severe RDS meets one or more of the following criteria: lung consolidation shows as a snowflake sign on ultrasound and all lung regions are involved, or regardless of its degree and extent, lung consolidation has caused serious complications, such as pulmonary hemorrhage, pneumothorax, persistent pulmonary hypertension of the newborn, or/and a large area of pulmonary atelectasis.

Objective:To explore the curative effect of ginger combined with tropisetron on preventing nausea and vomiting caused by chemotherapy in patients with breast cancer.Methods:80 patients with breast cancer who received first chemotherapy from Beijing Tiantan Hospital from April 2019 to December 2019 were selected by the convenient sampling method. According to the random number table method, they were divided into the control group and the intervention group, with 40 cases in each group. The control group received intravenous tropisetron before routine chemotherapy to prevent nausea and vomiting. On this basis, patients in the intervention group took slices of fresh ginger under the tongue 30 min before chemotherapy and applied the slices of fresh ginger to Shenque acupoint and Neiguan acupoint. The degree of nausea and vomiting after chemotherapy and compliance with chemotherapy were compared between the two groups.Results:On 0 to 5 d after chemotherapy, there were 7 patients with nausea of grade Ⅱ and Ⅲ in the intervention group and 18 patients with nausea of grade Ⅱ and Ⅲ in the control group. There were 4 patients with vomiting of grade Ⅱ and Ⅲ in the intervention group and 18 patients with vomiting of gradeⅡ and Ⅲ in the control group. There were statistically significant differences in the degrees of nausea and vomiting between the two groups ( Z=-2.980, -4.151; P<0.05) . There was no statistically significant difference in chemotherapy compliance between the two groups ( P>0.05) . Conclusions:Ginger in mouth and ginger point application combined with tropisetron can effectively alleviate chemotherapy-induced nausea and vomiting symptoms.

Objective To investigate the relationship between multi‐dimensional myocardial strain and global cardiac function in different stages of cardiac dysfunction in spontaneously hypertensive rats ( SHR ) by two‐dimensional strain echocardiography . MethodsAccording to cardiac function measurements ,SHR of 28 to 102 weeks were divided into 3 groups :Normal group[ Group A , normal left ventricular ejection fraction( LVEF) and left ventricular end‐diastolic pressure( LVEDP) , n ＝13] ,diastolic dysfunction group ( Group B , normal LVEF but increased LVEDP , n ＝24) ,and systolic dysfunction group ( Group C ,decreased LVEF and increased LVEDP , n ＝ 17 ) ,with WKY rats at similar weeks of age as controls ( group a , n ＝ 7 ;group b , n ＝ 12 ; and group c , n ＝ 16 ) . Morphological parameters of left ventricular were measured by echocardiography . Using EchoPac workstation ,systolic peak longitudinal strain ,circumferential and radial strain were calculated at the left ventricular middle levels . Extracellular collagen content was observed histologically . Results Left atrial dimension increased in group B and larger in group C ,and dilated left ventricular and thickened wall were only found in group C .Systolic peak longitudinal strain of group B was significantly lower than group A and group a ( all P ＜ 0 .05 ) ,and deteriorated in group C( P ＜ 0 .05 ) ,while systolic peak circumferential and radial strain and LVEF were only significantly decreased in group C ( all P＜ 0 .05 ) ,w hile there was no significant difference between Group A and Group B( all P ＞0 .05) . Collagen content in endocardial and mid‐layer myocardium increased in group B and C , and increased epicardial collagen occurred in group C . Systolic peak longitudinal strain , circumferential and radial strain were correlated positively with LVEF( r ＝0 .65 ,0 .80 ,0 .80 ,all P ＜0 .01) . Conclusions In SHR ,systolic peak longitudinal strain obtained by echocardiography is decreased in the period of diastolic dysfunction ,w hile the damage of systolic peak circumferential and radial strain leads to the systolic dysfunction .

Objective: To investigate the relationship between multi-dimensional myocardial strain and global cardiac function in different stages of cardiac dysfunction in spontaneously hypertensive rats (SHR) by two-dimensional strain echocardiography. Methods: According to cardiac function measurements, SHR of 28 to 102 weeks were divided into 3 groups: Normal group[Group A, normal left ventricular ejection fraction(LVEF) and left ventricular end-diastolic pressure(LVEDP), n=13], diastolic dysfunction group (Group B, normal LVEF but increased LVEDP, n=24), and systolic dysfunction group (Group C, decreased LVEF and increased LVEDP, n=17), with WKY rats at similar weeks of age as controls (group a, n=7; group b, n=12; and group c, n=16). Morphological parameters of left ventricular were measured by echocardiography. Using EchoPac workstation, systolic peak longitudinal strain, circumferential and radial strain were calculated at the left ventricular middle levels. Extracellular collagen content was observed histologically. Results: Left atrial dimension increased in group B and larger in group C, and dilated left ventricular and thickened wall were only found in group C. Systolic peak longitudinal strain of group B was significantly lower than group A and group a(all P<0.05), and deteriorated in group C(P<0.05), while systolic peak circumferential and radial strain and LVEF were only significantly decreased in group C (all P<0.05), while there was no significant difference between Group A and Group B(all P>0.05). Collagen content in endocardial and mid-layer myocardium increased in group B and C, and increased epicardial collagen occurred in group C. Systolic peak longitudinal strain, circumferential and radial strain were correlated positively with LVEF(r=0.65, 0.80, 0.80, all P<0.01). Conclusions In SHR, systolic peak longitudinal strain obtained by echocardiography is decreased in the period of diastolic dysfunction, while the damage of systolic peak circumferential and radial strain leads to the systolic dysfunction.

Objective To investigate risk factors for and clinical features of steroid-induced diabetes mellitus due to glucocorticoid treatment.Methods Clinical data were collected from 798 patients who received systemic glucocorticoid treatment in Department of Dermatology of Hangzhou Third People's Hospital from 2013 to 2016,and analyzed retrospectively.Logistic regression analysis was performed to analyze the factors influencing the occurrence of steroid-induced diabetes mellitus (SDM),repeatedmeasures analysis of variance to compare peripheral blood glucose levels of patients with SDM after breakfast,lunch and dinner,and t test to compare the levels of fasting blood glucose and glycosylated hemoglobin (HbA1 c) between patients with SDM and those with type 2 diabetes mellitus.Results Of the 798 patients,38 developed SDM due to glucocorticoid treatment.The average age was significantly older in the patients with SDM ([66.86 ± 13.30] years,n =38) than in those without SDM ([39.95 ± 17.01] years,n =760;t =8.86,P ＜ 0.01),but there was no significant difference in the gender ratio between the patients with and thhose without SDM (x2 =1.61,P =0.20).The prevalence of fatty liver,hyperlipidemia,hypertension,abnormal liver function and family history of diabetes mellitus was significantly higher in the patients with SDM than in those without SDM (x2 =12.25,19.25,32.69,21.47,16.70 respectively,all P ＜0.01).Logistic regression analysis showed that age,fatty liver,hyperlipidemia,hypertension,abnormal liver function,dosage of glucocorticoids,duration of glucocorticoid therapy,use of immunosuppressive agents and family history of diabetes mellitus were risk factors for SDM (all P ＜ 0.05).There were no significant differences in fasting blood glucose levels or postprandial peripheral blood glucose levels among the SDM patients receiving glucocorticoid therapy at different dosages of 0.50-0.74,0.75-0.99,1.00-1.25 mg·kg-1· d-1 (P ＞ 0.05).The peripheral blood glucose levels after breakfast,lunch and dinner were (11.50 ± 2.90),(16.02 ± 5.81) and (16.81 ± 4.52) mmol/L respectively in the patients with SDM.The levels of fasting blood glucose and glycosylated HbA 1 c were both significantly lower in the patients with SDM than in those with type 2 diabetes mellitus (t =3.74,9.92 respectively,both P ＜ 0.001).Conclusions The risk factors for SDM are age,dosage of glucocorticoids,duration of glucocorticoid therapy,fatty liver,hyperlipidemia,hypertension,abnormal liver function,use of immunosuppressive agents and family history of diabetes mellitus.The patients with SDM showed obviously elevated blood glucose levels mostly after lunch and dinner,but slightly increased levels of fasting blood glucose and glycosylated HbA 1c,which can be used to distinguish between SDM and type 2 diabetes mellitus.

Objective To evaluate the effect of narrow-band ultraviolet (NB-UVB) radiation on the autophagy of cultured human melanocytes in vitro,and to explore possible mechanisms underlying the treatment of vitiligo by NB-UVB.Methods In vitro cultured human melanocytes were divided into 4 groups to be irradiated with NB-UVB at different irradiation doses of 0 (control group),50,100 and 200 mJ/cm2 (50-,100-and 200-mJ/cm2 NB-UVB groups) respectively.After 24-hour treatment,the cells were collected,and monodansylcadaverin (MDC) staining was conducted to detect changes of autophagosomes in melanocytes.Western blot analysis was performed to determine the protein expression of autophagy signals including phosphorylated AMP-activated protein kinase (p-AMPK),phosphorylated mammalian target of rapamycin (p-mTOR),microtubule-associated protein 1 light chain 3 Ⅱ/Ⅰ (LC3 Ⅱ/Ⅰ) and P62,and transmission electron microscopy to observe ultrastructural changes of autophagosomes and melanosomes in the melanocytes.Statistical analysis was done by using one-way analysis of variance (ANOVA) for the comparison of Western blot results,and by Kruskal-Wallis H test for the comparison of the number of melanosomes,autophagosomes and autolysosomes.Results MDC staining showed that the percentages of autophagosome-positive melanocytes were significantly higher in the 100-,200-mJ/cm2 NB-UVB groups (38.08％ ± 4.10％,40.23％ ± 1.45％,respectively) than in the control group (21.83％ ± 3.50％,both P ＜ 0.05) and 50 mJ/cm2 NB-UVB group (23.66％ ± 4.12％,both P ＜ 0.05).As Western blot analysis revealed,the 100-,200-mJ/cm2 NB-UVB groups showed significantly increased expression of p-AMPK and LC3 Ⅱ/Ⅰ,but significantly decreased expression of p-mTOR and P62 compared with the control group (all P ＜ 0.05).Transmission electron microscopy showed that the number of autophagosomes and autolysosomes was significantly higher in the 100-,200-mJ/cm2 NB-UVB groups (5.12 ± 1.13,5.25 ± 1.04) than in the control group (1.88 ± 1.18,both P ＜ 0.05).Meanwhile,the number of melanosomes was significantly higher in the 50-,100-and 200-mJ/cm2 NB-UVB groups (39.12 ± 9.42,57.38 ± 7.11,59.75 ± 15.15,all P ＜ 0.05) than in the control group (18.50 ± 4.18,all P ＜ 0.05).Conclusion NB-UVB radiation can not only promote the formation of melanosomes,but also activate the autophagy signal pathways in the melanocytes and promote the formation of autophagosomes and autolysosomes,which may be one of the mechanisms underlying the treatment of vitiligo by NB-UVB.

Objective To analyze the clinocopathological characteristics of infectious granulomas.Methods The clinical features,histopathological manifestations of 39 patients with infectious granulomas were analyzed retrospectively.Results Among 39 cases of infectious granulomas,there were 15 males and 24 females,and 17 cases of fungal granuloma and 22 cases of tuberculous granuloma.There was no statistically significant difference in gender and age between fungal granulomas and tuberculous granulomas.The mean course of tuberculous granuloma aud tuberculous granuloma was (0.88 ± 0.67) years and (5.54 ± 3.49) years,respectively (t =4.51,P =0.00);there was no significant difference in mean age of onset in fungal granuloma patients and tuberculous granuloma patients [(54.6 ± 19.6) vs.(47.6 ± 18.1) years,P ＞0.05)].There were 4 and 18 cases of fungal and tuberculous granulomatosis at the face,and 13 and 3 cases at the extremities (all P =0.00);the lesions occurred in the trunk in one case of tuberculous granuloma.The clinical manifestations of fungal and tuberculous granulomas as plaques/nodules were in 14 cases aud 22 cases (P =0.08);as ulcers and pus exudates were in 10 and 2 cases,respectively (P =0.00).The histopathological features showed epidermal hyperplasia in 12 and 4 cases,infiltrative patterns in 4 and 21 cases,infiltration of neutrophils in 14 and 3 cases,infiltration of plasma cells in 15 and 5 cases,infiltration of eosinophils in 10 and 0 cases,necrosis in 1 and 10 cases in fungal granulomas and tuberculous granulomas,respectively (P =0.00,0.00,0.00,0.00,0.00,0.01).Conclusion Fungal granuloma and tuberculous granuloma are different in the lesion sites,clinical manifestations and histopathological features.

Objective To evaluate the effect of tea polyphenol epigallocatechin gallate (EGCG)on ultraviolet B (UVB)-induced skin pigmentation,transfer and degradation of melanosomes in mice,and to explore the role of autophagy in the mechanism of melanosome degradation.Methods A total of 32 ears from 16 female C57/BL6 mice were randomly and equally divided into 4 groups:acetone control group topically treated with acetone solution daily,EGCG group topically treated with 10 g/L EGCG acetone solution daily,UVB irradiation group irradiated with 500 mJ/cm2 UVB once a day and 2 hours later topically treated with acetone solution,UVB + EGCG group irradiated with 500 mJ/cm2 UVB once a day and 2 hours later topically treated with EGCG acetone solution.Ten days later,all the mice were sacrificed,and skin tissue samples were collected from the ears.Transmission electron microscopy was performed to observe ultrastructural changes of melanosomes and autophagosomes,immunohistochemical study to measure expression of protease-activated receptor 2 (PAR2) and microtubule-associated protein light chain 3 (LC3) in the epidermis,and Western blot analysis to determine the protein expression of PAR2,Rasrelated protein Rab27a and LC3 in the epidermis.Results There was a significant difference in the number of melanosomes and autophagosomes among the acetone control group,EGCG group,UVB irradiation group and UVB + EGCG group (H =12.249,13.888,respectively,both P ＜ 0.05).Compared with the acetone control group,the UVB irradiation group showed significantly increased number of melanosomes (1.85 ± 0.32 vs.1.00 ± 0.41,P ＜ 0.05)and autophagosomes (1.94 ± 0.64 vs.1.00 ± 0.46,P ＜ 0.05) in epidermal keratinocytes in mouse skin.Compared with the UVB irradiation group,the UVB + EGCG group showed significantly decreased number of melanosomes (1.30 ± 0.44,P ＜ 0.05),but significantly increased number of autophagosomes (3.03 ± 0.75,P ＜ 0.05).Immunohistochemical study showed a significant difference in the level of PAR2 in the epidermis among the 4 groups (H =18.700,P ＜ 0.05),and the expression of PAR2 was significantly lower in the UVB + EGCG group than in the UVB irradiation group (7.94 ± 4.57 vs.12.54 ± 3.07,Z =2.143,P ＜ 0.05).However,the 4 groups all showed a low level of LC3,and there was no significant difference among the 4 groups (H =5.051,P ＞ 0.05).Western blot analysis revealed significant differences in the protein expression of PAR2 and Rab27a,as well as in the LC3-Ⅱ/LC3-Ⅰ ratio,among the 4 groups (F =18.739,25.967,24.022,respectively,all P ＜ 0.05).Compared with the UVB irradiation group,the UVB + EGCG group showed significantly decreased expression of PAR2 (0.91 ± 0.54 vs.3.12 ± 0.61,P ＜ 0.05) and Rab27a (0.99 ± 0.16 vs.1.42 ± 0.07,P ＜ 0.05),but significantly increased LC3-Ⅱ/LC3-Ⅰ ratio (1.67 ± 0.08 vs.1.24 ± 0.07,P ＜ 0.05).Conclusion Topical EGCG treatment can effectively suppress UVB-induced skin pigmentation,which may be related to the inhibition of melanosome transfer and promotion of melanosome autophagy.

A benzyl functionalized ionic liquid, 1-benzyl-3-methylimidazolium bis [( trifluoromethyl ) sulfonyl]imide ([BeMIM][Tf2 N]), was synthesized and characterized as an extraction solvent of dispersive liquid-liquid microextraction ( DLLME) for enrichment and determination of 5 organophosphorus pesticides (phoxim, fenitrothion, chlorpyrifos, phorate and parathion) and 2 aromatic compounds (chloronaphthalene and anthracene) from environmental water samples by high-performance liquid chromatography ( HPLC). [BeMIM] [ Tf2 N] had higher extraction efficiency than 1-octyl-3-methylimidazolium bis [( trifluoromethyl) sulfonyl]imide and common organic solvents such as CCl4 and C2 Cl4 . The extraction was performed using 40 μL of [BeMIM][Tf2N] and 1 mL of methanol as extraction solvent and dispersive solvent respectively with centrifugal time of 5 min. Under the optimal conditions, the method proposed here provided a good linearity for all analytes with correlation coefficients between 0. 9994 and 0. 9998. The repeatability values, described as intra-day and inter-day relative standard deviations (RSDs) of five replicate experiments at three different concentrations of 10, 40 and 100 μg / L, were 1. 1% -4. 3% and 0. 8% -4. 8% , respectively. The limits of detection (LOD) were 0. 01 μg / L-1. 0 μg / L at a signal-to-noise ratio (S / N) of 3. This developed method was convenient and speedy, and could be employed to detect the analytes in three real environmental water samples with satisfactory relative recovery of 82. 7% -118. 3% and RSD of 0. 7% -5. 6% . Introduction of benzyl group into the imidazolium could obviously enhance the extraction efficiecny for analytes due to the π-πinteraction between [BeMIM] [ Tf2 N] and analytes. [ BeMIM] [ Tf2 N] was a satisfactory extraction solvent with a high enrichment factor of 339 and extraction efficiency of 81. 4% . Partition coefficients of all analytes in [BeMIM][Tf2 N]-DLLME system were determined and the extraction mechanism was discussed.