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Objective: To investigate the risk factors for gestational diabetes mellitus (GDM) in elderly multipara women in the next pregnancy. Methods: A total of 219 elderly multipara women with 2 consecutive delivery records in Tianjin Binhai New Area Tanggu Obstetrics and Gynecology Hospital from January 2018 to May 2019 were included. Among them, 141 had normal glucose tolerance (NGT) and 78 of them had GDM. The clinical data of the previous and current pregnancy were collected to analyze the risk factors of GDM in elderly multipara women. Results: The average ages of 219 elderly women in previous pregnancy and this pregnancy were (31.9±2.2) and (36.7±1.5) years old, and the prevalence of GDM was 35.62% (78 cases). Compared to NGT group, GDM patients had higher fasting blood glucose(previous (5.51±1.43) vs (4.63±0.62) mmol/L; current (5.26±0.63) vs (4.59±0.30) mmol/L, 1 h blood glucose(previous (11.74±2.36) vs (9.50±1.82) mmol/L; current (11.03±2.03) vs (9.51±1.14) mmol/L) in 75 g oral glucose tolerance test (OGTT) in both previous and current pregnancy. The rates of cesarean section, in both previous and current pregnancy were higher in GDM group (previous 34.6% vs 4.3%; current 52.6% vs 22.0%). Furthermore, prenatal weight and body mass index (BMI) of the previous pregnancy, pre-pregnancy weight and BMI, and prenatal BMI of this pregnancy were also higher in GDM group, and the differences were all statistically significant (all P<0.05). Logistic multivariate regression analysis indicated cesarean section history ( OR =10.80, 95% CI : (4.09-28.54)), GDM history of previous pregnancy ( OR =10.64, 95% CI : (4.02-28.20)), 75 g OGTT fasting blood glucose≥ 4.86 mmol/L ( OR =2.70, 95% CI : (1.27-5.70)), 1 h blood glucose after glucose administration ≥ 8.45 mmol/L ( OR =1.78, 95% CI : (1.37-2.31)) were risk factors for GDM in elderly multipara women of this pregnancy. Conclusion: The risk of GDM in elderly multipara women with a history of cesarean section and GDM increases significantly. Results of OGTT in previous pregnancy also has predictive value.

Objective: To describe the clinical manifestations, neuroimaging, cerebrospinal fluid(CSF) cytology and prognosis of Leptomeningeal metastases(LM). Methods: The clinical manifestations, imaging features and CSF cytology of LM patients admitted to Henan Provincial People's Hospital from May 1, 2015 to May 31, 2020 were retrospectively analyzed. The overall survival (OS) was evaluated by the time from the diagnosis of LM to death. Results: A total of 88 patients with LM were enrolled in the study, and the median age was 59 years (range:28-78 years). There were 42 males (47.7%) and 46 females (52.3%). According to the pathological classification, it was lung cancer in 58 cases (65.9%), gastric cancer in 13 cases (14.8%), breast cancer in 7 cases (8.0%), melanoma in 1 case, esophageal cancer in 1 case, gallbladder cancer in 1 case, renal cell carcinoma in 1 case, double source cancer in 2 cases, and unknown source in 4 cases. The median Karnofsky Performance Scale (KPS) score was 50. LM was the initial manifestation of cancer in 34 patients. All patients had LM-related clinical symptoms, including headache in 73 cases (83.0%), nausea and vomiting in 63 cases (71.6%), abnormal physical and mental behaviors in 37 cases (42.0%), seizure in 41 cases (46.6%). Cranial nerve involvement was observed in 23 patients (39.0%) and spinal nerve involvement in 20(33.9%). There were 61 patients (83.6%) who showed neuroimaging features of LM. Tumor cells or atypical cells were found in 90.8% of patients for the first time, and activated monocytes in 47 cases (54.7%). The median OS was 13.0 weeks (95% CI :2.9-23.1) with the 1-year survival rate of 19.1%. Univariate analysis of survival indicated that lung cancer, lower KPS score, tyrosine kinase inhibitors (TKIs) and whole brain radiotherapy were favorable predictors of survival ( P <0.05). Conclusions: The overall prognosis of LM is poor. Good physical condition, TKIs treatment and whole brain radiotherapy might improve clinical outcomes of LM patients.

Objective: To study the pollution status of polybrominated diphenyl ethers (PBDEs), polychlorinated biphenyls (PCB), polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) in cord blood of newborns in an e-waste dismantling area of Guangdong Province. Methods: We recruited 20 eligible mothers and newborns who could meet the inclusion criteria in local hospitals of Guiyu in 2007. The inclusion criteria included directly engaged in dismantling e-waste during pregnancy and within 1 year before pregnancy; living in the e-waste dismantling workshops or the distance between living place and the e-waste dismantling areas was ≤200 m; the father of newborn was directly engaged in electronic waste dismantling for more than 1 year; the frequency of visiting the e-waste dismantling workshop during pregnancy was ≥3 times in a week. Questionnaires and physical examinations were performed on maternal and neonatal, and cord blood was collected from newborns to detect PCDD/Fs, PCB and PBDE. The concentration level of organic pollutants was corrected by the blood lipid content, and the total toxicity equivalent was calculated. The correlation between three compounds was analyzed by Spearman correlation. Results: The mothers of the 20 newborns were (23.45±3.27) years old and lived for more than 5 years. The number of one parent engaged in e-waste dismantling, the mother or father smoking, and parent engaged in e-waste dismantling work were 3, 13, 15 and 19, respectively. The weight of newborns ranged from 2.5 to 3.6 kilogram and the Apgar score was 10 points. No adverse birth outcomes such as preterm birth, malformation or stillbirth were found. The median (maximum, minimum) concentration of PCBs, PCDD/Fs and PBDEs in cord blood were 263.22 (328.29, 244.19), 38.42 (147.49, 12.68), 39.33 (265.11, 14.81) pg/g lipid, respectively. The median (maximum, minimum) of toxic equivalence concentrations of PCDD/Fs and PCB were 3.94 (9.24, 2.69) and 15.95 (26.64, 9.28) pg TEQ/g lipid. PBDE, the proportion of PBDE, PCB and PCDD/Fs in cord blood was 50.41%, 49.25% and 0.34%, respectively. PCBs and PBDEs were positively correlated ( r= 0.733, P= 0.039). Conclusion: The high concentrations of PCDD/Fs, PCB, and PBDE were detected in the e-waste dismantling area. It is recommended that the risk of such substances on the health of local people should be assessed in a timely manner.

Objective: To study the potential of differentiation of menstrual blood-derived mesenchymal stem cells (MenSC) into endometrial epithelial cells (EEC) in vitro . Methods: Endometrial stromal cells (ESC) and MenSC were cultured and identified by certain methods.MenSC were co-cultured with ESC, added 10 ng/ml TGF-β1, 10 ng/ml EGF, 10 ng/ml PDGF-BB and 1×10(-7) mol/L 17-β-estradiol.The expression of cytokeratin, which was marker of EEC, was tested by immunofluorescence in differentiated MenSC. Results: MenSC proliferated quickly in vitro, and showed fusiform shape and clear structure within 10 generations.The expression rate of superficial markers of MenSC, CD44, CD90, CD73, and CD29, were 98.4%, 90.77%, 94.75% and 97.01% respectively.The expression of vimentin, which was stromal marker, was positive in cultured ESC (P3). After co-cultured with ESC for 3 weeks, MenSC morphology changed from fibroblast-like cells into epithelial-like cells.Immunofluorescence assay showed that the differentiated MenSC expressed cytokeratin. Conclusion: Under the condition of co-culture with ESC, MenSC has the ability to differentiate into endometrial epithelial cells. Cell growth factor and estrogen play the important roles in this process.

Objective: To compare the mortality, survival rate and the therapeutic efficacy between mitral valve repair and replacement as treatment for severe ischemic mitral regurgitation (IMR), and explore the middle- and long-term outcomes. Methods: Between January 2000 and January 2016, 378 patients with severe IMR underwent coronary artery bypass grafting (CABG) combined with mitral valve repair ( n =162) or mitral valve replacement ( n =216) in the Department of Cardiovascular Surgery of Nanjing First Hospital. Clinical data, in-hospital morbidity and mortality of patients were retrospectively reviewed. The patients were followed up for the long term survival rate, heart function and re-admission. Results: No statistically significant differences of baseline data and operation details were found between the two groups except for left ventricular end-diastolic diameter[(61.3±10.2)mm in replacement group vs (56.2±9.0)mm in repair group, P <0.001]. Seven patients died during the perioperative period, with a total operation mortality of 1.9%.No significant difference of mortality was found between the two groups (5 cases in the replacement group and 2 cases in the repair group). The early outcome after the surgery showed that the rate of low cardiac output and ventricular arrhythmia of patients were significantly higher in the replacement group compared with the repair group (both P <0.05). The mortality of patients received mitral valve replacement was better than who received mitral valve repair when left ventricular end-diastolic diameter was over 65 mm (5.9% vs 10.0%, P =0.036). No significant differences were observed between the two groups in the middle- and -long term survival rate (87% for replacement group vs 85% for repair group, P =0.568). The follow-up time was 1-85 (52.8±21.5) months and the follow-up rate was 93%. The rate of valve-related complications was significantly higher in the repair group compared with the replacement group (8.82% vs 3.82%, P =0.003). Conclusions: We should choose the surgical methods carefully (replacement or repair) for severe IMR patients according to degree of left ventricular remodeling and pathological changes of mitral valve. Mitral valve replacement with preservation of the subvalvular apparatus is a safe and effective surgical alternative for mitral valve repair, especially for patients with complications or complex reflux.

Objective: To define the potential causative gene mutation in a Chinese pedigree with progressive cardiac conduction defect (PCCD)., Methods: Sanger sequencing was performed to define potential causative gene mutation in a four-generation family with 68 members including seven PCCD patients (5 male) from 2010 to 2015.No causative gene was detected by screening known candidate genes related to PCCD including SCN5A, NKX2.5 and LMNA.High-throughput sequencing technology on exon-enriched DNA was then used to search the causative genes in 2 patients and one normal family member., Results: Eight new non-synonymous single nucleotide variants including AQP7 gene (exon5: c.T343C: p.Y115H), CACNA1B gene (NM&#95;001243812: exon19: c.A2986G: p.T996A), CATSPERB gene (exon27: c.C3254G: p.P1085R), CLCA2 gene (exon11: c.G1725T: p.W575C), CLCA3P gene (ncRNA&#95;intronic), MYLK-AS1 gene (ncRNA&#95;intronic), TTN gene (ncRNA&#95;UTR3), LMNA gene (LMNA: NM&#95;170708: exon5: c.C922T: p.Q308X) were identified by comparing and filtering the results with known public databases.Then, more detailed biological analysis on these 8 genes was conducted.Traditional Sanger sequencing validated the exome sequencing results, and found that the mutation c. 1725G﹥T in gene CLCA2 segregated with the phenotype of this PCCD pedigree.The mutation c. 1725G﹥T in gene CLCA2 was thus be considered as the causative PCCD gene in this pedigree from the perspective of genetics and genomics., Conclusion: The heterozygote mutation c. 1725G﹥T in gene CLCA2 might be causative gene in this PCCD pedigree.This finding adds new gene mutation variant responsible for PCCD.

Objective: To reveal the levels and distribution of polybrominated diphenyl ethers (PBDEs) in fish and egg products at retail in Shenzhen, and to evaluate the local people's exposure to PBDEs from these food., Methods: 27 fish and egg samples were collected from supermarket and farmer's market in Shenzhen during August and October in 2008. According to the guideline of USEPA1614 method, the accelerated solvent extraction (ASE) technology was used for the extraction of PBDEs from fish and egg samples. After a series of purification processes including treatments of FMS column chromatography, acidic silica gel, silica gel and Al2O3 column, the levels of eight PBDEs congeners in the samples were determined by isotope dilution high resolution gas chromatography-high resolution mass spectrometry (HRGC-HRMS) method., Results: When BDE-209 was not taken into account, the median concentrations of ΣPBDEs in fish products was 914.7 pg/g wet weight, among which the datas for fresh water fish and sea fish were 328.2 and 1108.8 pg/g wet weight, respectively, showing a statistical significant difference (P < 0.05). BDE-47 was the predominant congener in fresh water fish and sea fish by a contribution proportion of 61% and 57%, respectively. The median concentrations of ΣPBDEs in egg products were 99.8 pg/g wet weight and the predominant congeners are BDE-47 and BDE-99, with a contribution proportion above 70%. BDE-209 was not detected in fresh water fish and the median concentration in sea fish and egg products are 243.7 and 472.6 pg/g wet weight, respectively, which caused the predominant congener changed to BDE-209 in egg products when BDE-209 was take into account. The median dietary intake of PBDEs from fish and egg products among local residents in Shenzhen was estimated as 102 ng/d., Conclusion: The level of ΣPBDEs in fish and egg products in Shenzhen is relatively high. The characteristics of PBDEs pollution are quite different between fish and egg products. The level of daily dietary intake of PBDEs from fish and egg products among local residents in Shenzhen is also relatively high.

Objective: To explore the clinical experiences, efficacies and postoperative left ventricular remodeling changes of surgical ventricular reconstruction in the treatment of post-infarction left ventricular aneurysm., Methods: The investigators reviewed retrospectively the clinical data, operative approaches and follow-up outcomes of consecutive 194 patients with post-infarction left ventricular aneurysm, who underwent surgical ventricular reconstruction between January 1997 and December 2009. There were 54 cases in the linear group and 137 cases in the endoventricular patch plasty group. The changes of ventricular remodeling were measured by peri-operative and follow-up echocardiography., Results: All patients underwent surgery with a mean cardiopulmonary bypass duration of (103 ± 35) min and aortic cross clamp duration of (62 ± 26) min. There were 8 per-operative deaths with a mortality rate of 2.2%. Angina pectoris of other cases disappeared and heart function greatly improved. After operation, the ventricular remodeling results showed that in the linear group, there was not significant difference in the changes of ventricular remodeling of post-op 2 weeks, 6 months, 1 year and 5 years versus pre-operation. However, in the endoventricular patch group, the changes of ventricular remodeling of post-op 2 weeks and follow-up 6 months versus pre-operation were significantly reduced (P < 0.05). End-systolic volume (LVESV) reduced from (129 ± 27) ml to (65 ± 8) ml and end-systolic volume index (LVESVI) decreased from (104 ± 14) ml/m(2) to (44 ± 6) ml/m(2) and the subgroup of LVEF < 35% was the most significant in the changes of LVESV and LVESVI. But LVEF improved significantly at post-operation and follow-up (from preoperation 42% ± 11% to 52% ± 7% during follow-up)., Conclusions: For patients with infarction left ventricular aneurysm, left ventricular reconstruction is quite effective. The choice of operative approaches is determined by the size and range of ventricular aneurysm. Both string suture and endoventricular patch plasty technique can yield similarly satisfactory surgical outcomes. After operation, ventricular volume significantly decreases and cardiac function greatly improves.

Objective: To investigate the levels of polychlorinated dibenzo-p-dioxins and polychlorinated dibenzo-p-furans (PCDD-Fs) in human breast milk of the mothers who lived in non-directly persistent organic pollutants (POPs) polluted area in Shenzhen, and the correlation of exposure risk factor was analyzed., Methods: From July to November in 2007, 60 primiparas by vaginal delivery after parturition 3 weeks to 2 months were sampled for breast milk who aged from 20 - 34 years old and has lived in Shenzhen non-directly POPs polluted areas over 5 years. PCDD-Fs were extracted from the frozen-dried samples with accelerated solvent extraction (ASE), cleaned up by fluid management system (FMS) and quantified by high-resolution gas chromatography-high resolution mass spectrometry (HRGC-HRMS) using isotope dilution methodology. TEQ were calculated. The correlation relationship among infant's birth weight and length, participatory's dietary, age, inhabitation period, environment and the body burden of PCDD-Fs in mother was statistically analyzed by SPSS 13.0., Results: The participants aged from 20 - 34 years old (28 years on average) and lived in Shenzhen for 5 - 29 years (10 years on average). The concentration of PCDD-Fs in 60 breast milk samples were 26.957 143 - 669.583 333 pg/g fat (mean: 7.224 817 pg/g fat, median: 84.176 062 pg/g fat), and TEQ-PCDD-Fs in samples were 2.420 793 - 29.014 277 pg/g fat (mean: 8.645 992 pg/g fat, median: 7.751 804 pg/g fat). 2, 3, 4, 7, 8-PeCDF, 1, 2, 3, 7, 8-PeCDD, 2, 3, 7, 8-TCDD were the dominant contributors to the total TEQ, which were 3.691 654 pg/g fat (42.689 378%), 2.478 315 pg/g fat (28.652 356%), and 0.980 995 pg/g fat (11.343 995%) respectively. Significant positive correlations were found among age (r = 0.26, P < 0.05), inhabitation period (r = 0.49, P < 0.05), the consumption of fish (r = 0.37, P < 0.05) and the concentrations of TEQ-PCDD-Fs in the study., Conclusion: The levels of dioxin chemicals in the breast milk samples in non-directly POPs polluted areas of Shenzhen are high. Significant positive correlations were found among age, inhabitation period, the consumption of fish and the concentration of PCDD-Fs.

Objective: To summarize the surgical experience of aortic arch operation under deep hypothermic circulatory arrest., Methods: 22 patients suffering from aortic dissection or descending aorta aneurysm with the involvement of aortic arch received operation under deep hypothermic circulatory arrest. Eight patients underwent ascending aorta and partial aortic arch replacement, one patient received aortic root, ascending aorta, and partial aortic arch replacement, 2 patients received ascending aorta and total arch replacement, 2 patients received aortic valve replacement plus ascending aorta and partial aortic arch replacement, 8 patients underwent ascending aorta and total arch replacement plus elephant trunk technique (stunted elephant trunk used in 6 cases), and 1 patient received left partial aortic arch and descending aorta replacement. Coronary artery bypass grafting was performed concomitantly in 4 cases., Results: Three patients died peri-operatively with a mortality rate of 13.6%. One patient had aortic dissection rupture before operation leading to cardiac tamponade, acute inferior myocardial infarction, and cardiac arrest. This patient received operation while resuscitation. After operation, the patient had severe right heart failure and died 16 hours later. One patient had bleeding and multi-organ failure, and died 3 days later. The third patient, with acute aortic dissection did not awake after operation, had pulmonary infection and multi-organ failure, and died 39 days later. Re-thoracotomy for bleeding was required in 3 cases; delayed awareness occurred in 3 cases; and 2 cases had renal failure after operation., Conclusions: Aortic arch operation includes partial aortic arch replacement, total arch replacement, and total arch replacement with elephant trunk technique. The operation procedure is selected according to the primary lesion and how aortic arch has been affected. Deep hypothermic circulatory arrest with selective cerebral perfusion facilitates complicated aortic arch operation, resulting in a reduction of mortality and morbidity for arch aneurysms or dissection.

Objective: To establish the methods of Polychlorinated Dibenzo-p-Dioxins and Dibenzofurans (PCDD/Fs), polychlorinated biphenyls (PCBs) and polybrominated diphenyl ethers (PBDEs) compounds determination by isotope dilution HRGC/HRMS simultaneously in human placenta tissue from mothers, and assess the human exposure risk to dioxins and PBDEs in study., Methods: Concentrations of 17 PCDD/Fs and 12 dioxin-like PCBs as well as 7 PBDEs were measured in human placenta tissue samples by isotope dilution HRGC/HRMS. SigmaTEQ (PCDD + PCDFs + PCBs) concentration using WHO-TEF factor and PBDEs concentration was calculated respectively. Risk assessment of mother exposure to dioxins and PBDEs was evaluated., Results: Median of SigmaTEQ (PCDD + PCDFs + PCBs) concentration for six samples was 18.15 WHO-TEQ pg/g lipid, ranging from 5.14 - 67.01 WHO-TEQ pg/g lipid. Although the median of SigmaTEQ (PCDD + PCDFs + PCBs) was lower than that of human blood of EU and Japan, and close to that of Korea and Taiwan non-exposure as reported in the literatures, the highest SigmaTEQ (PCDD + PCDFs + PCBs) concentration of placenta sample exceeded the value of high dioxins exposure area subjects in Taiwan. The dominant contributor congener for WHO-TEQ were 2, 3, 4, 7, 8-PeCDF, 1, 2, 3, 7, 8-PeCDD, PCB126, totally accounted for 65 percent of SigmaWHO-TEQ. Median and average of PBDE concentration for six samples were 2.73 ng/g lipid and 7.17 ng/g lipid, respectively, ranging from 0.95 - 25.99 ng/g lipid. BDE47 was the dominant contributor congener for the total concentration, accounted for 35 percent., Conclusion: The methods of PCDD/Fs, PCBs and PBDEs compounds determined by isotope dilution HRGC/HRMS simultaneously in human placenta tissue from mothers were established successfully, and the human exposure risk to PCDD/Fs, PCBs and PBDEs should be surveyed for the donor with the highest SigmaTEQ (PCDD + PCDFs + PCBs) and PBDEs concentration of placenta sample in the future.

Objective: To analyse the levels of polychlorinated dibenzo-p-dioxins and dibenzo-furans (PCDD/Fs) in sea fish samples in some sea area in China surveyed by using isotope dilution HRGC/HRMS and was evaluated the local people with PCDD/Fs exposure from eating fish., Methods: Seven different kinds of fish and twenty fishes were sampled totally. Dibenzo-p-dioxins and dibenzo-furans were extracted from fish samples by Soxhlet extraction, concentrated and purified by FMS column chromatograph and enriched by carbon column. Confirmation and quantitative analysis at ng/kg level of PCDD/Fs was performed by HRGC/HRMS using multiple ion detection mode (MID)., Results: Carp-2 was the certified reference material obtained from the NRC Institute of Canada. The concentration of 9 compounds was consistent with the certified value, and precision was evaluated in this study. The relative standard deviation was less than 15 percent for three times determination. The average concentration of 20 sea fishes was 1.48 ng/kg wet weight, the range was in 0.21-8.10 ng/kg wet weight, and the average total toxicity equivalency factor (TEQ) was 0.292 ng TEQ/kg (wet weight basis) and the range was 0.030-1.291 ng TEQ/kg for these 20 fishes. The evaluation exposure from fish for local people was 0.58 pg WHO-TEQ/kg BW.day., Conclusion: The levels of PCDD/Fs was different from sample to sample, and the exposure from fish be less than WHO tolerance limit standard, however, the status for PCDD/Fs pollution should not be ignored especially when having an intake of multi-food.