Publications by authors named "Yumei Wei"

47 Publications

Patterns of yeast diversity distribution and its drivers in rhizosphere soil of Hami melon orchards in different regions of Xinjiang.

BMC Microbiol 2021 Jun 6;21(1):170. Epub 2021 Jun 6.

College of life Science / Xinjiang Production and Construction Corps Key Laboratory of Oasis Town and Mountain-basin System Ecology, North 4 Street, College of life Science, Shihezi University, Shihezi, 832003, People's Republic of China.

Background: The unique climatic conditions of the Xinjiang region nurture rich melon and fruit resources, the melon and fruit sugar sources provide sufficient nutrients for the survival of yeast, and the diverse habitats accompanied by extreme climatic conditions promote the production of yeast diversity and strain resources. However, the relationship between yeast species and their relationship with environmental factors in the soil of Xinjiang specialty cash crop Hami melon is not clear. Here, we aimed to characterize the diversity, community structure, and relationship between yeast species and environmental factors in Hami melon orchards soils in different regions of Xinjiang, China.

Results: Based on Illumina MiSeq high-throughput sequencing analysis of the D1 domain of the LSU rRNA genes, the community richness of yeast in the soil of Northern Xinjiang was higher than in the Southern and Eastern Xinjiang, but the community diversity was significantly lower in the Northern Xinjiang than in the Southern and Eastern Xinjiang. A total of 86 OTUs were classified into 59 genera and 86 species. Most OTUs (90.4%) belonged to the Basidiomycota; only a few (9.6%) belonged to Ascomycota. The most dominant species in the Southern, Eastern and Northern Xinjiang were Filobasidium magnum (17.90%), Solicoccozyma aeria (35.83%) and Filobasidium magnum (75.36%), respectively. Principal coordinates analysis (PCoA) showed that the yeast community composition in the soils of the three regions were obviously different, with the Southern and Eastern Xinjiang having more similar yeast community. Redundancy analysis (RDA) showed that soil factors such as conductivity (CO), total phosphorus (TP) and Total potassium (TK) and climate factors such as average annual precipitation (PRCP), relative humidity (RH) and net solar radiation intensity (SWGNT) were significantly correlated with yeast communities (P < 0.05).

Conclusion: There are abundant yeast resources in the rhizosphere soil of Hami melon orchard in Xinjiang, and there are obvious differences in the diversity and community structure of yeast in the three regions of Xinjiang. Differences in climatic factors related to precipitation, humidity and solar radiation intensity and soil factors related to conductivity, total phosphorus and total potassium are key factors driving yeast diversity and community structure.
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http://dx.doi.org/10.1186/s12866-021-02222-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8180054PMC
June 2021

Novel approach of rigid bronchoscopy concurrent with cesarean section and bronchial arterial embolism for patients with massive hemoptysis during pregnancy: case reports and literature review.

Ann Transl Med 2021 Apr;9(7):582

Department of Critical Care Medicine, Peking University First Hospital, Beijing, China.

Massive hemoptysis can be life-threatening and is frequently encountered in clinical practice, but rare during pregnancy. There have been limited case reports of massive hemoptysis in pregnancy in patients with conditions such as Takayasu's arteritis, bronchiectasis, bronchial carcinoid tumor, and tuberculosis. The most important management is early control of the hemorrhage and airway protection. We report on 2 patients at 33 and 27 gestational weeks who were admitted to the emergency department because of massive hemoptysis. Therapeutic rigid bronchoscopy with the application of high-frequency jet ventilation was performed under general anesthesia during cesarean section to control potential bleeding and stabilize the airway; this was then followed by bronchial artery embolization (BAE) postsurgically. The lives of both mothers and infants were saved. At the 16- and 11-month follow-ups, the patients showed no symptoms. To our knowledge, this is the first report on the application of therapeutic rigid bronchoscopy concurrent with cesarean section in order to protect the airway and reduce the side effects of the subsequent treatment for both mother and fetus in hemoptysis cases. By reporting these cases and conducting a literature review, we present a novel treatment method for massive hemoptysis in pregnant patients that may improve patients' outcomes.
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http://dx.doi.org/10.21037/atm-20-2502DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8105789PMC
April 2021

Evaluation of the value of fasting plasma glucose in the first trimester for the prediction of adverse pregnancy outcomes.

Diabetes Res Clin Pract 2021 Apr 8;174:108736. Epub 2021 Mar 8.

Department of Obstetrics and Gynecology of Peking University First Hospital, Beijing, China; Beijing Key Laboratory of Maternal Fetal Medicine of Gestational Diabetes Mellitus. Electronic address:

Aims: To evaluate the importance and usefulness of fasting plasma glucose (FPG) in the first trimester in predicting adverse pregnancy outcomes.

Methods: A retrospective study of 22,398 singleton pregnancies was conducted. Participants were divided into subgroups according to first-trimester FPG (low FPG, FPG < 5.1 mmol/L; medium FPG, 5.1 mmol/L ≤ FPG < 5.6 mmol/L; high FPG, 5.6 ≤ FPG < 7.0 mmol/L) and oral glucose tolerance test(OGTT) results (normal and abnormal) during pregnancy. Patient characteristics and risk of adverse pregnancy outcomes were compared. Then, the whole population of women with abnormal OGTT served as a reference, and the relative risks of maternal and neonatal complications in normal OGTT women were analyzed by categorical analyses and logistic regression. Subgroup analyses were performed according to pre-pregnancy body mass index (BMI).

Results: The frequency of adverse pregnancy outcomes increased with increasing FPG levels during the first trimester, regardless of OGTT results. High FPG + Abnormal OGTT had the worst outcome. Compared to the whole population of women with abnormal OGTT, Normal OGTT + Medium FPG showed the same risk of PIH and macrosomia. Normal OGTT + High FPG showed the same risk of PIH, macrosomia as well as LGA and preterm birth. Additionally, Normal OGTT + Medium FPG + BMI ≥ 24 kg/m showed significantly higher risk of PIH (OR = 1.867, 1.245-2.800), macrosomia (OR = 1.748, 1.304-2.344) and LGA (OR = 1.274, 1.019-1.593). Furthermore, the OR value for PIH was 3.759 (1.680-8.412) in Normal OGTT + High FPG + BMI ≥ 24 kg/m compared to women with abnormal OGTT.

Conclusions: First-trimester FPG values can help identify women at increased risk for adverse pregnancy outcomes. Increased attention and management should be given to women with early pregnancy FPG ≥ 5.10 mmol/L despite a normal OGTT, especially if their BMI ≥ 24 kg/m.
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http://dx.doi.org/10.1016/j.diabres.2021.108736DOI Listing
April 2021

The Efficacy of Low Postoperative Radiation Dose in Patients with Advanced Hypopharyngeal Cancer without High-Risk Factors.

Cancer Manag Res 2020 21;12:7553-7560. Epub 2020 Aug 21.

Department of Head and Neck Radiotherapy, Shandong Provincial ENT Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China.

Objective: To evaluate the feasibility and efficacy of low postoperative radiotherapy (PORT) dose in patients with advanced hypopharyngeal squamous cell carcinoma (HPSCC) and identify prognostic factors in this group.

Patients And Methods: Between January 2013 and September 2015, 110 consecutive patients with HPSCC with no high-risk factors were treated postoperatively to 50 Gy (n=89), 56 Gy (n=12), and 60 Gy (n=9) in 2 Gy/fraction. Overall survival (OS), 3-year progression-free survival (PFS), 3-year loco-regional recurrence-free survival (LRFS), and treatment-related toxicities were analyzed.

Results: Median follow-up time was 40 months (range=6-75 months). The 3-year local-regional control (LRC) and 3-year neck control rate were 86.3% and 91.8%, respectively. The 3-year OS, PFS, and LRFS were 69.9%, 65.5%, and 80.5%, respectively. In a univariate analysis, T stage showed a significant correlation with improved OS, PFS, and LRFS (=0.008, =0.039, =0.034). On multivariate analysis, T stage showed a significant correlation with improved OS and PFS. N stage showed a significant correlation with improved PFS. However, interval surgery-radiotherapy, reconstructive methods, and RT dose cannot serve as a significant prognostic factor for survival outcome.

Conclusion: This study suggests that treating no high-risk factors for locally advanced HPSCC with a dose of 50 Gy to the whole operative bed and elective lymph node levels cannot compromise disease control and survival.
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http://dx.doi.org/10.2147/CMAR.S249725DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7468485PMC
August 2020

Perturbations of gut microbiota in gestational diabetes mellitus patients induce hyperglycemia in germ-free mice.

J Dev Orig Health Dis 2020 12 14;11(6):580-588. Epub 2020 Sep 14.

Department of Obstetrics and Gynaecology, Peking University First Hospital, Beijing, China.

Shifts in the maternal gut microbiota have been implicated in the development of gestational diabetes mellitus (GDM). Understanding the interaction between gut microbiota and host glucose metabolism will provide a new target of prediction and treatment. In this nested case-control study, we aimed to investigate the causal effects of gut microbiota from GDM patients on the glucose metabolism of germ-free (GF) mice. Stool and peripheral blood samples, as well as clinical information, were collected from 45 GDM patients and 45 healthy controls (matched by age and prepregnancy body mass index (BMI)) in the first and second trimester. Gut microbiota profiles were explored by next-generation sequencing of the 16S rRNA gene, and inflammatory factors in peripheral blood were analyzed by enzyme-linked immunosorbent assay. Fecal samples from GDM and non-GDM donors were transferred to GF mice. The gut microbiota of women with GDM showed reduced richness, specifically decreased Bacteroides and Akkermansia, as well as increased Faecalibacterium. The relative abundance of Akkermansia was negatively associated with blood glucose levels, and the relative abundance of Faecalibacterium was positively related to inflammatory factor concentrations. The transfer of fecal microbiota from GDM and non-GDM donors to GF mice resulted in different gut microbiota colonization patterns, and hyperglycemia was induced in mice that received GDM donor microbiota. These results suggested that the shifting pattern of gut microbiota in GDM patients contributed to disease pathogenesis.
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http://dx.doi.org/10.1017/S2040174420000768DOI Listing
December 2020

Effect of hydroxychloroquine on preeclampsia in lupus pregnancies: a propensity score-matched analysis and meta-analysis.

Arch Gynecol Obstet 2021 02 3;303(2):435-441. Epub 2020 Sep 3.

Department of Obstetrics and Gynecology, Peking University First Hospital, Peking University, No. 1, Xi 'anmen Street, Xicheng, Beijing, China.

Background: Hydroxychloroquine (HCQ) is the primary medication in the treatment of pregnancy with systemic lupus erythematosus (SLE) for its efficacy and safety. However, the effect of HCQ on preeclampsia prevention remains controversial.

Objective: This study aimed to investigate whether HCQ has an effect on preeclampsia prevention and other pregnancy outcomes among lupus pregnancy.

Methods: We conducted a retrospective cohort study of 119 pregnant women with SLE. After the propensity score matching of baseline characteristics, the population was divided into the HCQ treatment group and HCQ nontreatment group. Then, we compared the preeclampsia and other pregnancy outcomes between HCQ treatment and nontreatment groups. Furthermore, we combined our data and previous studies for a meta-analysis.

Results: In our data, HCQ did not increase the risk of premature rupture of membranes, bleeding during pregnancy, preeclampsia, intrauterine distress, gestational age at delivery, preterm birth, and postpartum hemorrhage. There was no significant association between HCQ treatment and preeclampsia prevention. Besides, the meta-analysis showed a similar result that HCQ did not significantly decrease the rate of preeclampsia (RR = 0.61, 95%CI = 0.34-1.11).

Conclusion: This study found that HCQ treatment was safe, but did not significantly reduce preeclampsia among lupus pregnancies.
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http://dx.doi.org/10.1007/s00404-020-05762-5DOI Listing
February 2021

Is it suitable for DM diagnosis using an abnormal two-hour glucose value only after 24th gestational weeks in China.

J Matern Fetal Neonatal Med 2020 Jul 16:1-6. Epub 2020 Jul 16.

Peking University First Hospital, Beijing, China.

Objective: To investigate the postnatal outcomes of diabetes mellitus (DM) women diagnosed according to two-hour glucose value ≥11.1 mmol/L after 24th gestational weeks in China, and to evaluate if it is suitable for DM diagnosis using the criteria that two-hour glucose value ≥11.1 mmol/L after 24th gestational weeks only. We conducted a retrospective cohort study of the pregnant women with gestational hyperglycemia participated in gestational hyperglycemia day care and delivered in Peking University First Hospital from June 2016 to May 2018. A total of 168 women diagnosed with DM according to the criteria that two-hour glucose value ≥11.1 mmol/L after 24th gestational weeks were included, and 75 DM women did the oral glucose tolerance test (OGTT) from 6 weeks to 1 year postpartum. The general information collected and analyzed included age, prepregnancy body mass index (BMI), prepregnancy weight, gestational weight gain (GWG), OGTT value during pregnancy, OGTT value of postpartum, gestational weeks, and neonatal birth weight.

Results: There were 168 women diagnosed with DM according to the criteria that two-hour glucose value ≥11.1 mmol/L after 24th gestational weeks, and 75 (75/168, 44.6%) women underwent an OGTT from 6 weeks to 1 year postpartum. Among the women followed-up, 56 (56/75, 74.7%) women were diagnosed as hyperglycemia and 19 (19/75, 25.3%) women were diagnosed as normal glucose metabolism. In hyperglycemia women, there are eight (8/56, 10.7%) women diagnosed as DM, 24 (24/56, 32.0%) women diagnosed as impaired glucose tolerance (IGT), eight (8/56, 10.7%) women diagnosed as impaired fasting glucose (IFG), and 16 (16/56, 21.3%) women diagnosed as IFG and IGT. Compared with normal glucose metabolism women, the age of hyperglycemia women is higher significantly (34.8 ± 3.8 versus 32.7 ± 4.7). The incidence of IFG, pharmacy treatment, and the value of HbA1c is also higher in hyperglycemia women than the normal glucose metabolism women, in which it is not statistically significant but clinically significant.

Conclusion: In DM women diagnosed according to the criteria that two-hour glucose value ≥11.1 mmol/L after 24th gestational weeks, there were only eight (10.7%) women could meet DM diagnostic criteria according to the OGTT value of postpartum. Moreover, 25% women had normal OGTT value postpartum. Due to the characteristics of glucose metabolism in Asian population, an abnormal two-hour glucose value in OGTT may not be suitable to diagnose DM during pregnancy in China.
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http://dx.doi.org/10.1080/14767058.2020.1742690DOI Listing
July 2020

A multicenter all-inclusive prospective study on the relationship between glycemic control markers and maternal and neonatal outcomes in pregnant women.

J Matern Fetal Neonatal Med 2020 Jul 15:1-8. Epub 2020 Jul 15.

Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China.

Objective: Pregnant women afflicted with gestational diabetes mellitus (GDM) and diabetes mellitus (DM) are prone to both maternal and neonatal complications. Due to this, it is of importance to sustain a strict glycemic control during this time. Unfortunately, there is a lack of evidence-based medical research for the control criteria during pregnancy. Therefore, to develop better method of glycemic control for pregnant women, we conducted a multicenter all-inclusive prospective study to investigate the association between glycemic control markers and maternal and neonatal outcomes. Four hundred fifty-two women were included in the study. Fasting blood glucose (FBG), HbA1c and glycated albumin (GA), and ferritin levels were measured at different gestational periods and compared to the pregnancy outcomes.

Results: The reference interval of GA and HbA1c was determined in Trimester I, II, III: 11.0-16.3%, 10.1-15.2%, and 9.5-14.6%, and 4.8-5.7%, 4.4-5.4%, and 4.7-5.8%, respectively. It was found that at the later stages of pregnancy, there was a reduction in ferritin levels and increase in HbA1c levels. Only in the GDM group, it was noticed that the frequency of total neonatal and maternal complications were significantly higher on comparison with the normal group (30.1 vs. 18.4%, 017 and 21.0% vs. 12.0%, 031, respectively). For the frequency of cesarean section and macrosomia in GDM group, GA > 15.69% group was significant higher compared to those of GA ≤ 15.69% group (021 and 001, respectively). For HbA1c, no significant differences were observed.

Conclusions: A reference interval of HbA1c and GA was developed for Chinese pregnant women. We found that the GDM group had a higher frequency of neonatal and maternal complications. As only GA levels and not HbA1c, were associated with cesarean section and macrosomia in GDM, we hypothesize that GA could be an appropriate glycemic control marker for pregnant mothers.
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http://dx.doi.org/10.1080/14767058.2019.1678139DOI Listing
July 2020

Coronin3 Promotes Nasopharyngeal Carcinoma Migration And Invasion By Induction Of Epithelial-To-Mesenchymal Transition.

Onco Targets Ther 2019 13;12:9585-9598. Epub 2019 Nov 13.

Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, People's Republic of China.

Purpose: Coronin3 is a cytoskeletal protein that has been implicated in metastasis in many cancer types. Here, we demonstrate its effect in nasopharyngeal carcinoma (NPC) and propose a new probable mechanism of CORO1C-mediated cell migration and invasion by regulation of epithelial-to-mesenchymal transition (EMT) and CDH11.

Patients And Methods: First, we measured the differential expression of CORO1C between NPC and non-NPC cells in both cell lines and clinical specimens, using public datasets. Then, we investigated its relationship with clinicopathological factors and its potential as a biomarker to predict the prognosis of NPC patients. We also explored its influence on the cell behaviors of migration and invasion by upregulating and downregulating the expression of CORO1C and attempted to determine the underlying mechanism.

Results: The results verified our original hypothesis. CORO1C was overexpressed in both NPC cell lines and clinical specimens, in both public datasets and our own samples. NPC patients with lower CORO1C expression levels in primary cancer tissues had longer OS (hazard ratio [HR] 1.814, 95% CI 0.831-3.960, p=0.0341) and PFS (HR 1.798, 95% CI 0.907-3.564, p=0.0155), indicating that it could be used as a prognostic biomarker. It was also confirmed that CORO1C enhanced cells' migration and invasion abilities, by inducing morphological and marker changes typical of EMT. Finally, we found that expression was correlated with and regulated CDH11 expression in NPC cell lines.

Conclusion: Our study provided evidence for the contribution of CORO1C to NPC metastasis, and indicated that it could be used as a new therapeutic target and prognostic biomarker.
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http://dx.doi.org/10.2147/OTT.S215674DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6859123PMC
November 2019

Preconception diabetes mellitus and adverse pregnancy outcomes in over 6.4 million women: A population-based cohort study in China.

PLoS Med 2019 10 1;16(10):e1002926. Epub 2019 Oct 1.

China DOHaD Research Center, National Human Genetic Resources Center, Beijing, China.

Background: Diabetes mellitus (DM) increases the risk of adverse maternal and neonatal outcomes, and optimization of glycemic control during pregnancy can help mitigate risks associated with diabetes. However, studies seldom focus precisely on maternal blood glucose level prior to pregnancy. We aimed to evaluate the associations between preconception blood fasting plasma glucose (FPG) level and subsequent pregnancy outcomes.

Methods And Findings: We conducted a population-based retrospective cohort study among 6,447,339 women aged 20-49 years old who participated in National Free Pre-Pregnancy Checkups Project and completed pregnancy outcomes follow-up between 2010 and 2016 in China. During the preconception health examination, serum FPG concentration was measured, and self-reported history of DM was collected. Women were classified into three groups (normal FPG group: FPG < 5.6 mmol/L and no self-reported history of DM; impaired fasting glucose [IFG]: FPG 5.6-6.9 mmol/L and no self-reported history of DM; and DM: FPG ≥ 7.0 mmol/L or self-reported history of DM). The primary outcomes were adverse pregnancy outcomes, including spontaneous abortion, preterm birth (PTB), macrosomia, small for gestational age infant (SGA), birth defect, and perinatal infant death. Logistic regression model was used to calculate odds ratio (OR) and 95% confidence interval (CI) after adjusting for confounding variables. The mean age of women was 25.24 years, 91.47% were of Han nationality, and 92.85% were from rural areas. The incidence of DM and IFG was 1.18% (76,297) and 13.15% (847,737), respectively. Only 917 (1.20%) women reported a history of DM (awareness of their DM status), of whom 37.28% (337) had an elevated preconception FPG level (≥ 5.6 mmol/L), regarded as noncontrolled DM. A total of 1,005,568 (15.60%) women had adverse pregnancy outcomes. Compared with women with normal FPG, women with IFG had higher risks of spontaneous abortion (OR 1.08; 95% CI 1.06-1.09; P < 0.001), PTB (1.02; 1.01-1.03; P < 0.001), macrosomia (1.07; 1.06-1.08; P < 0.001), SGA (1.06; 1.02-1.10; P = 0.007), and perinatal infant death (1.08; 1.03-1.12; P < 0.001); the corresponding ORs for women with DM were 1.11 (95% CI 1.07-1.15; P < 0.001), 1.17 (1.14-1.20; P < 0.001), 1.13 (1.09-1.16; P < 0.001), 1.17 (1.04-1.32; P = 0.008), and 1.59 (1.44-1.76; P < 0.001). Women with DM also had a higher risk of birth defect (OR 1.42; 95% CI 1.15-1.91; P = 0.002). Among women without self-reported history of DM, there was a positive linear association between FPG levels and spontaneous abortion, PTB, macrosomia, SGA, and perinatal infant death (P for trend <0.001, <0.001, <0.001, 0.001, <0.001). Information about hypoglycemic medication before or during pregnancy was not collected, and we cannot adjust it in the analysis, which could result in underestimation of risks. Data on 2-hour plasma glucose level and HbA1c concentration were not available, and the glycemic control status was evaluated according to FPG value in women with DM.

Conclusions: Women with preconception IFG or DM had higher risk of adverse pregnancy outcomes, including spontaneous abortion, PTB, macrosomia, SGA, and perinatal infant death. Preconception glycemic control through appropriate methods is one of the most important aspects of preconception care and should not be ignored by policy makers.
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http://dx.doi.org/10.1371/journal.pmed.1002926DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6771981PMC
October 2019

Epigenetic alteration of Rho guanine nucleotide exchange Factor 11 (ARHGEF11) in cord blood samples in macrosomia exposed to intrauterine hyperglycemia.

J Matern Fetal Neonatal Med 2021 Feb 30;34(3):422-431. Epub 2019 Apr 30.

Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China.

Macrosomia at birth is associated with maternal hyperglycemia and leads to subsequent susceptibility to obesity, abnormal glucose metabolism, hypertension, and dyslipidemia in offspring. Epigenetic reprogramming has been reported to be involved in the development of human diseases caused by suboptimal environmental or nutritional factors. The study was aiming to explore epigenetic mechanism influences on macrosomic infants exposed to intrauterine hyperglycemia. We performed a genome-wide analysis of DNA methylation in cord blood from macrosomic infants born to women with gestational diabetes in order to identify genes related to fetal growth or early adipose tissue development. To analyze the epigenetic patterns in umbilical cord blood in gestational diabetes mellitus (GDM), we collected umbilical cord blood from women with GDM (mean pregestational BMI of 24.4 kg/m and mean neonatal birth weight of 4366 g) and normal glucose-tolerant women (mean pregestational BMI of 19.8 kg/m and mean neonatal birth weight of 3166 g). Differentially methylated genes in the GDM group were identified using the Infinium HumanMethylation450 BeadChip array. A total of 1251 genes were differentially methylated compared to the controls ( < .01). The methylation microarray data showed that two specific CpG sites (cg12604331 and cg08480098) in the gene body of were significantly hypomethylated in the cord blood in macrosomic infants. Altered DNA methylation levels of were negatively correlated with glucose levels and neonatal birth weight. Exposure to adverse intrauterine environments can alter fetal development, such as by affecting the nutritional status of the fetus. Such exposure can also result in significant epigenetic modifications, including DNA methylation, which could serve as a potential marker for nutrition and metabolic conditions at the neonatal stage or even in the adult.
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http://dx.doi.org/10.1080/14767058.2019.1609929DOI Listing
February 2021

Recommended reference values for serum lipids during early and middle pregnancy: a retrospective study from China.

Lipids Health Dis 2018 Oct 31;17(1):246. Epub 2018 Oct 31.

Department of Obstetrics and Gynecology of Peking University First Hospital, Beijing, China.

Background: Disturbances in maternal lipid metabolism have been shown to increase the risk of adverse pregnancy outcomes. However, there is no consensus as to what constitutes normal maternal lipid values during pregnancy. Thus, the aim of this study was to establish serum lipid reference ranges during early and middle pregnancy.

Methods: We conducted a retrospective survey in Beijing from 2013 to 2014. A total of 17,610 singleton pregnancies with lipid data from early and middle pregnancy were included. First, after excluding women with adverse pregnancy outcomes, we performed a descriptive analysis of total cholesterol (TC), triglycerides (TG), high-density lipid cholesterol (HDL-C) and low-density lipid cholesterol (LDL-C) levels using means and standard deviations to determine appropriate percentiles. Second, in the total population, we examined the lipid levels in different trimesters with the risk of adverse pregnancy outcomes using categorical analyses and logistic regression models. Third, we determined the lipid reference range in early and middle pregnancy based on the first two results. Finally, based on the reference ranges we determined, we assessed whether the number of abnormal lipid values affected the risk of adverse pregnancy outcomes.

Results: (1) Serum levels of TC, TG, LDL-C and HDL-C all increased significantly from early to middle pregnancy, with the greatest increase in TG. (2) A trend towards an increasing incidence of adverse pregnancy outcomes was observed with increasing levels of TC, TG, and LDL-C and decreasing levels of HDL-C in both early and middle pregnancy. (3) We recommend that serum TC, TG and LDL-C reference values in early and middle pregnancy should be less than the 95th percentiles, whereas that of HDL-C should be greater than the 5th percentile, i.e., in early pregnancy, TC < 5.64 mmol/L, TG < 1.95 mmol/L, HDL-C > 1.23 mmol/L, and LDL-C < 3.27 mmol/L, and in middle pregnancy, TC < 7.50 mmol/L, TG < 3.56 mmol/L, HDL-C > 1.41 mmol/L, and LDL-C < 4.83 mmol/L. (4) Higher numbers out-of-range lipids during early and middle pregnancy were correlated with a higher risk of adverse pregnancy outcomes.

Conclusions: The reference ranges recommended in this paper can identify pregnant women with unfavourable lipid values.
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http://dx.doi.org/10.1186/s12944-018-0885-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6211477PMC
October 2018

The value of the 24-h proteinuria in evaluating the severity of preeclampsia and predicting its adverse maternal outcomes.

Hypertens Pregnancy 2018 Aug 24;37(3):118-125. Epub 2018 Jul 24.

k Department of Obstetrics and Gynecology , The Second Hospital of Hebei Medical University , Shijiazhuang , China.

Background: To identify the 24-h proteinuria value with quantitative analysis and how it correlates with the severity of preeclampsia and subsequent adverse maternal outcomes in the Chinese population.

Study Design: Eleven hospitals in 10 provinces across China were chosen, in which 1,738 pregnant women complicated by hypertensive disorders of pregnancy (HDP) with the records of 24 h proteinuria were enrolled. They were allocated into four groups: patients with maximal quantified proteinuria < 0.3 g/24 h (Group 1, n = 328); patients with maximal quantified proteinuria ≥ 0.3 g/24 h and < 2.0 g/24 h (Group 2, n = 638); patients with maximal quantified proteinuria ≥ 2.0 g/24 h and < 5.0 g/24 h (Group 3, n = 353); and patients with maximal quantified proteinuria ≥ 5.0 g/24 h (Group 4, n = 419). Logistic regression analysis were conducted to assess the differences in maternal outcomes between different subgroups of 24-h proteinuria and to identify independent risk factors of adverse maternal outcomes in preeclampsia. The multivariable risk prediction model of adverse maternal outcome for HDP was established with receiver operating characteristic curve (ROC) curve and its predicted value was assessed.

Results: Thrombocytopenia and cerebral or visual symptoms were more frequent in Groups 3 and 4 than Groups 1 and 2 but no differences were found between Groups 3 and 4 or Groups 1 and 2. Maternal complications were more frequent in Groups 3 and 4 than in Groups 1 and 2 [Group 3 vs. Group 1, odds ratios (ORs) = 3.359 (1.067-10.571); Group 4 vs. Group 1, OR = 3.628 (1.189-11.086); Group 3 vs. Group 2, OR = 2.845 (1.155-7.003); Group 4 vs. Group 2, OR = 3.082 (1.304-7.288)]. However, no significant difference was found between Groups 4 and 3 or between Groups 2 and 1. The proteinuria ≥ 2 g/24 h had an area under the receiver operating characteristic curve (AUC ROC) of 0.668 (95% confidence interval (CI) 0.632-0.705) for predicting adverse maternal outcome. After adjusting for the effects of other symptoms, signs, and laboratory tests, it was the independent risk factor and predictor factor of the adverse maternal outcome (OR = 3.683, 95% CI 2.439-5.562, P<0.001). The final risk prediction model had an AUC ROC of 0.800 (95% CI 0.769-0.830, P<0.001).

Conclusion: The proteinuria ≥ 2 g/24 h is an independent predictive factor of adverse maternal outcomes in preeclampsia, but its individual predictive value is limited. The risk prediction model is effective in assessing the risk of adverse maternal outcomes in patients with HDP.
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http://dx.doi.org/10.1080/10641955.2018.1487564DOI Listing
August 2018

Hemoglobin levels during the first trimester of pregnancy are associated with the risk of gestational diabetes mellitus, pre-eclampsia and preterm birth in Chinese women: a retrospective study.

BMC Pregnancy Childbirth 2018 Jun 26;18(1):263. Epub 2018 Jun 26.

Department of Obstetrics and Gynecology of Peking University First Hospital, Xianmen Street No. 1, Xicheng District, Beijing, 100034, China.

Background: Hemoglobin (Hb) measurement is a standard test among pregnant women during the first perinatal visit that is used to evaluate physical status and anemia. However, studies focusing on Hb levels and pregnancy outcomes are scarce. This study aimed to determine whether Hb levels in early pregnancy were associated with the risk of gestational diabetes mellitus (GDM), pre-eclampsia (PE) and preterm birth.

Methods: A hospital-based retrospective study was conducted among 21,577 singleton, non-smoking pregnancies between June 2013 and January 2015. The demographic data and medical information of each participant were collected individually through questionnaires and patient medical records. Odds ratios were generated using a multivariate logistic regression analysis to evaluate the relative risk of GDM, PE and preterm birth continuously and across different hemoglobin ranges in the overall population and in women from different pre-pregnancy body mass index (BMI) categories, respectively. The level of statistical significance was set at 0.05.

Results: (1) For women who were underweight, normal-weight, overweight and obese, early pregnancy Hb levels were 127.8 ± 10.1 g/L, 129.6 ± 9.7 g/L, 132.2 ± 9.5 g/L and 133.4 ± 9.4 g/L, respectively. (2) Women with GDM and PE had significantly increased Hb levels during early pregnancy compared with controls, whereas women with preterm birth processed significantly decreased Hb levels. (3) After adjusting for confounders, the risks for GDM and PE increased with high maternal Hb (OR: 1.27 for Hb 130-149; OR: 2.06 for Hb ≥ 150 g/L), and the risk for preterm birth decreased with high maternal Hb (OR: 1.30 for Hb 130-149; OR: 2.38 for Hb ≥ 150 g/L) and increased with low maternal Hb (OR: 1.41 for Hb <  110 g/L). Among women whose BMI was < 24 kg/m, high GDM (OR: 1.27 for Hb 130-149; OR: 1.84 for Hb ≥ 150 g/L) and low preterm rates (OR: 0.77 for Hb 130-149; OR: 0.23 for Hb ≥ 150 g/L) were observed with high Hb, whereas in women whose BMI was ≥24 kg/m, only high GDM rates were observed with Hb > 150 g/L (OR: 2.33).

Conclusion: These findings suggest that Hb levels during early pregnancy play a role in predicting the risk of GDM, PE and preterm birth.
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http://dx.doi.org/10.1186/s12884-018-1800-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6020184PMC
June 2018

A case report about oligodendrogliomas of the fourth ventricle.

Medicine (Baltimore) 2018 Apr;97(17):e0594

Department of Oncology, Laiyang Central Hospital of Yantai,Yantai, ShanDong, China.

Rationale: Oligodendrogliomas are usually located in the frontal, parietal and the temporal lobe, with the ones in the fourth ventricle quite rare. Hence we want to introduce a case about the rare disease.

Patient Concerns: An eight-year old boy complained of progressive headache, dizziness and vomit for about 2 months. Then the slight ataxia was found by the physical examinations, with no sensory disturbances and other motor disturbances.

Diagnoses: Abnormal signals on the fourth ventricle were found by the preoperative brain computed tomography (CT) scan and magnetic resonance imaging (MRI) scan. So the patient accepted a gross total resection of the lesion with pathologically confirmed oligodendroglioma.

Interventions: Radiotherapy was then delivered in 27 fractions at 2Gy per fraction after the operation, with one fraction daily for five days weekly. No other therapies were used for the patient.

Outcomes: The brain MRI was used for follow-up every three months until now when he has finished all therapies for more than one year. No progressive behaviors (for example, headache, dizziness, vomit and other symptoms about cerebellar tonsillar hernia) or images have been presented. And the follow-up will be continued.

Lessons: Although oligodendrogliomas are usually located in the frontal lobe, with the ones of fourth ventricle extremely rare, they must be kept in mind all times. Treatments applied to our case may be provided as a reference for clinicians. Furthermore, the maximal range of resection, histologically proved oligodendroglioma and the 1p/19q loss of heterozygosity are associated with favorable prognosis.
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http://dx.doi.org/10.1097/MD.0000000000010594DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5944537PMC
April 2018

Effects of megavoltage computed tomographic scan methodology on setup verification and adaptive dose calculation in helical TomoTherapy.

Radiat Oncol 2018 Apr 27;13(1):80. Epub 2018 Apr 27.

Department of Radiation Oncology, Shandong Cancer Hospital and Institute, 440# Jiyan Road, Jinan, 250117, Shandong Province, People's Republic of China.

Background: To evaluate the effect of pretreatment megavoltage computed tomographic (MVCT) scan methodology on setup verification and adaptive dose calculation in helical TomoTherapy.

Methods: Both anthropomorphic heterogeneous chest and pelvic phantoms were planned with virtual targets by TomoTherapy Physicist Station and were scanned with TomoTherapy megavoltage image-guided radiotherapy (IGRT) system consisted of six groups of options: three different acquisition pitches (APs) of 'fine', 'normal' and 'coarse' were implemented by multiplying 2 different corresponding reconstruction intervals (RIs). In order to mimic patient setup variations, each phantom was shifted 5 mm away manually in three orthogonal directions respectively. The effect of MVCT scan options was analyzed in image quality (CT number and noise), adaptive dose calculation deviations and positional correction variations.

Results: MVCT scanning time with pitch of 'fine' was approximately twice of 'normal' and 3 times more than 'coarse' setting, all which will not be affected by different RIs. MVCT with different APs delivered almost identical CT numbers and image noise inside 7 selected regions with various densities. DVH curves from adaptive dose calculation with serial MVCT images acquired by varied pitches overlapped together, where as there are no significant difference in all p values of intercept & slope of emulational spinal cord (p = 0.761 & 0.277), heart (p = 0.984 & 0.978), lungs (p = 0.992 & 0.980), soft tissue (p = 0.319 & 0.951) and bony structures (p = 0.960 & 0.929) between the most elaborated and the roughest serials of MVCT. Furthermore, gamma index analysis shown that, compared to the dose distribution calculated on MVCT of 'fine', only 0.2% or 1.1% of the points analyzed on MVCT of 'normal' or 'coarse' do not meet the defined gamma criterion. On chest phantom, all registration errors larger than 1 mm appeared at superior-inferior axis, which cannot be avoided with the smallest AP and RI. On pelvic phantom, craniocaudal errors are much smaller than chest, however, AP of 'coarse' presents larger registration errors which can be reduced from 2.90 mm to 0.22 mm by registration technique of 'full image'.

Conclusions: AP of 'coarse' with RI of 6 mm is recommended in adaptive radiotherapy (ART) planning to provide craniocaudal longer and faster MVCT scan, while registration technique of 'full image' should be used to avoid large residual error. Considering the trade-off between IGRT and ART, AP of 'normal' with RI of 2 mm was highly recommended in daily practice.
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http://dx.doi.org/10.1186/s13014-018-0989-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5921977PMC
April 2018

Prevalence, risk factors and associated adverse pregnancy outcomes of anaemia in Chinese pregnant women: a multicentre retrospective study.

BMC Pregnancy Childbirth 2018 04 23;18(1):111. Epub 2018 Apr 23.

Department of Obstetrics and Gynaecology, Peking University First Hospital, Xi'anmen Street No.1, Xicheng District, Beijing, 100034, China.

Background: Anaemia in pregnant women is a public health problem, especially in developing countries. The aim of this study was to assess the prevalence and related risk factors of anaemia during pregnancy in a large multicentre retrospective study (n = 44,002) and to determine the adverse pregnancy outcomes in women with or without anaemia.

Methods: The study is a secondary data analysis of a retrospective study named "Gestational diabetes mellitus Prevalence Survey (GPS) study in China". Structured questionnaires were used to collect socio-demographic characteristics, haemoglobin levels and pregnancy outcomes from all the participants. Anaemia in pregnancy is defined as haemoglobin < 110 g/L. We used SPSS software to assess the predictors of anaemia and associated adverse pregnancy outcomes.

Results: The overall prevalence of anaemia was 23.5%. Maternal anaemia was significantly associated with maternal age ≥ 35 years (AOR = 1.386), family per capita monthly income< 1000 CNY (AOR = 1.671), rural residence (AOR = 1.308) and pre-pregnancy BMI < 18.5 kg/m (AOR = 1.237). Adverse pregnancy outcomes, including GDM, polyhydramnios, preterm birth, low birth weight (< 2500 g), neonatal complications and NICU admission, increased significantly (P < 0.001) in those with anaemia than those without.

Conclusions: The results indicated that anaemia continues to be a severe health problem among pregnant women in China. Anaemia is associated with adverse pregnancy outcomes. Pregnant women should receive routine antenatal care and be given selective iron supplementation when appropriate.
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http://dx.doi.org/10.1186/s12884-018-1739-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5914057PMC
April 2018

Perspectives on diagnostic strategies for hyperglycemia in pregnancy - dealing with the barriers and challenges in China.

Diabetes Res Clin Pract 2018 Nov 19;145:84-87. Epub 2018 Apr 19.

Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing 100034, China. Electronic address:

Hyperglycemia is one of the most common medical conditions women encounter during pregnancy. Hyperglycemia in pregnancy (HIP) is an issue of increasing concern to both obstetricians and administrators and it brings health issues for both mothers and offspring, not only early complications, but also long-term effects. HIP may either have been pre-gestational diabetes mellitus (pGDM), or gestational diabetes mellitus (GDM). After two-child policy fully carried out in China, the incidence of HIP would be increased further. There are many important issues such as the high prevalence of DM misdiagnosis, the diagnostic criteria of GDM, the strategies of GDM management in China need to deal with. We would focus on the barriers and challenges of diagnostic strategies for hyperglycemia in pregnancy in China.
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http://dx.doi.org/10.1016/j.diabres.2018.04.005DOI Listing
November 2018

Fatty acid-binding protein 4 predicts gestational hypertension and preeclampsia in women with gestational diabetes mellitus.

PLoS One 2018 2;13(2):e0192347. Epub 2018 Feb 2.

Peking University First Hospital, Beijing, China.

Objective: Fatty acid-binding protein 4 (FABP4) has been proposed to be a potential predictive factor of gestational hypertension or preeclampsia (GH/PE) because of its integrating metabolic and inflammatory responses. Women with gestational diabetes mellitus (GDM) are more likely to develop both GH/PE, than the normal population. The aim of our study was to examine the relationship between plasma FABP4 in the second trimester of pregnancy and the risk of GH/PE in women with GDM.

Methods: This was a nested case-control study conducted within a large on-going prospective cohort study conducted at Peking University First Hospital. A total of 1344 women, who were diagnosed with GDM, according to a 75 g oral glucose tolerance test, participated in the GDM One-Day Clinic at Peking University First Hospital from February 24, 2016 to February 9, 2017. Of the 748 GDM women who agreed to the blood sample collection, 637 were followed until their delivery. The cases included GDM patients who developed gestational hypertension or preeclampsia (GDM-GH/PE group, n = 41). Another 41 matched GDM women without major complications were selected as the control group (GDM group).

Results: The incidence of GH/PE was 6.44% and 3.30% for preeclampsia. The level of the second trimester plasma FABP4 in the GDM-GH/PE group was significantly higher than the GDM group (17.53±11.35 vs. 12.79±6.04 ng/ml, P = 0.020). The AUC ROC for the second trimester plasma FABP4 predicted GH/PE in the GDM patients alone was 0.647 (95%CI 0.529-0.766). Multivariate analysis showed that the elevated second trimester FABP4 level was independently associated with GH/PE in the GDM patients (OR 1.136 [95% CI 1.003-1.286], P = 0.045).

Conclusions: Increased second trimester plasma FABP4 independently predicted GH/PE in GDM patients.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0192347PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5796716PMC
April 2018

Reply.

Am J Obstet Gynecol 2017 09 11;217(3):380-381. Epub 2017 May 11.

Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China. Electronic address:

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http://dx.doi.org/10.1016/j.ajog.2017.05.010DOI Listing
September 2017

Clinical study of the time of repeated computed tomography and replanning for patients with nasopharyngeal carcinoma.

Oncotarget 2017 Apr;8(16):27529-27540

Department of Radiation Oncology VI, Shandong Cancer Hospital Affiliated to Shandong University, Jinon, Shandong, China.

Purpose: To study the necessity of repeat computed tomography (CT) scan and replanning and know a more accurate time using weekly kilovoltage cone beam computed tomography (kV-CBCT) scans for patients with nasopharyngeal carcinoma (NPC) during radiotherapy.

Methods And Materials: Thirteen NPC patients treated with IMRT were enrolled into this prospective study. Weekly pretreatment kV-CBCT scans were performed on the 1st, 6th, 11st, 16th, 21st and 26th radiation time, respectively. Target delineations were contoured on all fractionated CBCT images, including the gross tumor volume of the primary nasopharyngeal tumor (GTVnx) and parotid glands. The volumes of GTVnx and parotid glands were calculated automatically using the Pinnacle3 8.0 system. Compared to the original GTVnx, the percentage of shrinking volume (ΔP) ≥ 50% was considered significantly.

Results: As the radiation proceeding, the GTVnx had a trend of shrinkage. Of all 13 patients, 11 cases (84.6%) had the volume shrinking ≥ 50% before the 21st radiation and 12 cases (92.3%) before the 26th radiation. And the parotid volume decreased significantly in the first four-week radiation, 6.45 ± 3.16cm3 (range, 3.06-13.9cm3) for the left parotid gland and 5.78 ± 2.39cm3 (range, 2.70-11.2cm3) for the right. Furthermore, only a little displacement occurred to bilateral parotid glands.

Conclusion: The replanning for NPC patients with IMRT is necessary, and the time between the 21st to 25th radiations is appropriate.
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http://dx.doi.org/10.18632/oncotarget.16770DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5432355PMC
April 2017

A randomized clinical trial of exercise during pregnancy to prevent gestational diabetes mellitus and improve pregnancy outcome in overweight and obese pregnant women.

Am J Obstet Gynecol 2017 Apr 1;216(4):340-351. Epub 2017 Feb 1.

Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China. Electronic address:

Background: Obesity and being overweight are becoming epidemic, and indeed, the proportion of such women of reproductive age has increased in recent times. Being overweight or obese prior to pregnancy is a risk factor for gestational diabetes mellitus, and increases the risk of adverse pregnancy outcome for both mothers and their offspring. Furthermore, the combination of gestational diabetes mellitus with obesity/overweight status may increase the risk of adverse pregnancy outcome attributable to either factor alone. Regular exercise has the potential to reduce the risk of developing gestational diabetes mellitus and can be used during pregnancy; however, its efficacy remain controversial. At present, most exercise training interventions are implemented on Caucasian women and in the second trimester, and there is a paucity of studies focusing on overweight/obese pregnant women.

Objective: We sought to test the efficacy of regular exercise in early pregnancy to prevent gestational diabetes mellitus in Chinese overweight/obese pregnant women.

Study Design: This was a prospective randomized clinical trial in which nonsmoking women age >18 years with a singleton pregnancy who met the criteria for overweight/obese status (body mass index 24≤28 kg/m) and had an uncomplicated pregnancy at <12 weeks of gestation were randomly allocated to either exercise or a control group. Patients did not have contraindications to physical activity. Patients allocated to the exercise group were assigned to exercise 3 times per week (at least 30 min/session with a rating of perceived exertion between 12-14) via a cycling program begun within 3 days of randomization until 37 weeks of gestation. Those in the control group continued their usual daily activities. Both groups received standard prenatal care, albeit without special dietary recommendations. The primary outcome was incidence of gestational diabetes mellitus.

Results: From December 2014 through July 2016, 300 singleton women at 10 weeks' gestational age and with a mean prepregnancy body mass index of 26.78 ± 2.75 kg/m were recruited. They were randomized into an exercise group (n = 150) or a control group (n = 150). In all, 39 (26.0%) and 38 (25.3%) participants were obese in each group, respectively. Women randomized to the exercise group had a significantly lower incidence of gestational diabetes mellitus (22.0% vs 40.6%; P < .001). These women also had significantly less gestational weight gain by 25 gestational weeks (4.08 ± 3.02 vs 5.92 ± 2.58 kg; P < .001) and at the end of pregnancy (8.38 ± 3.65 vs 10.47 ± 3.33 kg; P < .001), and reduced insulin resistance levels (2.92 ± 1.27 vs 3.38 ± 2.00; P = .033) at 25 gestational weeks. Other secondary outcomes, including gestational weight gain between 25-36 gestational weeks (4.55 ± 2.06 vs 4.59 ± 2.31 kg; P = .9), insulin resistance levels at 36 gestational weeks (3.56 ± 1.89 vs 4.07 ± 2.33; P = .1), hypertensive disorders of pregnancy (17.0% vs 19.3%; odds ratio, 0.854; 95% confidence interval, 0.434-2.683; P = .6), cesarean delivery (except for scar uterus) (29.5% vs 32.5%; odds ratio, 0.869; 95% confidence interval, 0.494-1.529; P = .6), mean gestational age at birth (39.02 ± 1.29 vs 38.89 ± 1.37 weeks' gestation; P = .5); preterm birth (2.7% vs 4.4%, odds ratio, 0.600; 95% confidence interval, 0.140-2.573; P = .5), macrosomia (defined as birthweight >4000 g) (6.3% vs 9.6%; odds ratio, 0.624; 95% confidence interval, 0.233-1.673; P = .3), and large-for-gestational-age infants (14.3% vs 22.8%; odds ratio, 0.564; 95% confidence interval, 0.284-1.121; P = .1) were also lower in the exercise group compared to the control group, but without significant difference. However, infants born to women following the exercise intervention had a significantly lower birthweight compared with those born to women allocated to the control group (3345.27 ± 397.07 vs 3457.46 ± 446.00 g; P = .049).

Conclusion: Cycling exercise initiated early in pregnancy and performed at least 30 minutes, 3 times per week, is associated with a significant reduction in the frequency of gestational diabetes mellitus in overweight/obese pregnant women. And this effect is very relevant to that exercise at the beginning of pregnancy decreases the gestational weight gain before the mid-second trimester. Furthermore, there was no evidence that the exercise prescribed in this study increased the risk of preterm birth or reduced the mean gestational age at birth.
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http://dx.doi.org/10.1016/j.ajog.2017.01.037DOI Listing
April 2017

Adverse pregnancy outcome among women with pre-gestational diabetes mellitus: a population-based multi-centric study in Beijing.

J Matern Fetal Neonatal Med 2017 Oct 8;30(20):2395-2397. Epub 2016 Nov 8.

b Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva and the Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel.

Objective: To investigate the prevalence of pre-gestational diabetes mellitus (pGDM) incidence and to evaluate whether the 2-h plasma glucose value of the oral glucose tolerance test (OGTT) should be used to diagnose pGDM during pregnancy.

Design: Observational cohort study of 15 194 women in 15 medical centers in Beijing from 20 June 2013 to 30 November 2013. The incidence of adverse pregnancy outcomes among women with pGDM was compared stratified according to diagnostic time and criteria.

Results: The prevalence of pGDM was 1.4% (208/15 194), of which only 32.2% (67/208) were diagnosed before pregnancy. The incidence of cesarean delivery (53.8% versus 67.2% and 66.3%), preeclampsia (1.9% versus 11.9% and 8.0%), insulin required (38.5% versus 65.7% and 52.8%) in those with 2-h plasma glucose ≥11.1 mmol/L during is lower than those with pGDM known prior pregnancy or diagnosed during pregnancy according to hemoglobin A1c (HbA1C) ≥ 6.5% or fasting plasma glucose (FPG) ≥ 7.0 mmol/L.

Conclusions: More than two-thirds of pGDM patients were diagnosed during pregnancy. FPG should be used as screening test to identify pGDM at first antenatal care. An abnormal 2-h glucose value only may not be suitable to diagnose pGDM during pregnancy in China.
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http://dx.doi.org/10.1080/14767058.2016.1250257DOI Listing
October 2017

Is It Time to Change Our Reference Curve for Femur Length? Using the Z-Score to Select the Best Chart in a Chinese Population.

PLoS One 2016 26;11(7):e0159733. Epub 2016 Jul 26.

General Hospital of Jingmei Group, Beijing, China.

Objective: To use Z-scores to compare different charts of femur length (FL) applied to our population with the aim of identifying the most appropriate chart.

Methods: A retrospective study was conducted in Beijing. Fifteen hospitals in Beijing were chosen as clusters using a systemic cluster sampling method, in which 15,194 pregnant women delivered from June 20th to November 30th, 2013. The measurements of FL in the second and third trimester were recorded, as well as the last measurement obtained before delivery. Based on the inclusion and exclusion criteria, we identified FL measurements from 19996 ultrasounds from 7194 patients between 11 and 42 weeks gestation. The FL data were then transformed into Z-scores that were calculated using three series of reference equations obtained from three reports: Leung TN, Pang MW et al (2008); Chitty LS, Altman DG et al (1994); and Papageorghiou AT et al (2014). Each Z-score distribution was presented as the mean and standard deviation (SD). Skewness and kurtosis and were compared with the standard normal distribution using the Kolmogorov-Smirnov test. The histogram of their distributions was superimposed on the non-skewed standard normal curve (mean = 0, SD = 1) to provide a direct visual impression. Finally, the sensitivity and specificity of each reference chart for identifying fetuses <5th or >95th percentile (based on the observed distribution of Z-scores) were calculated. The Youden index was also listed. A scatter diagram with the 5th, 50th, and 95th percentile curves calculated from and superimposed on each reference chart was presented to provide a visual impression.

Results: The three Z-score distribution curves appeared to be normal, but none of them matched the expected standard normal distribution. In our study, the Papageorghiou reference curve provided the best results, with a sensitivity of 100% for identifying fetuses with measurements < 5th and > 95th percentile, and specificities of 99.9% and 81.5%, respectively.

Conclusions: It is important to choose an appropriate reference curve when defining what is normal. The Papageorghiou reference curve for FL seems to be the best fit for our population. Perhaps it is time to change our reference curve for femur length.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0159733PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4961440PMC
July 2017

Comparison of long-term survival and toxicity of simultaneous integrated boost vs conventional fractionation with intensity-modulated radiotherapy for the treatment of nasopharyngeal carcinoma.

Onco Targets Ther 2016 31;9:1865-73. Epub 2016 Mar 31.

Department of 6th Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan University-Shandong Academy of Medical Sciences, Jinan, People's Republic of China.

Aim: In recent years, the intensity-modulated radiotherapy with simultaneous integrated boost (IMRT-SIB) and intensity-modulated radiotherapy with conventional fractionation (IMRT-CF) have been involved in the treatment of nasopharyngeal carcinoma (NPC). However, the potential clinical effects and toxicities are still controversial.

Methods: Here, 107 patients with biopsy-proven locally advanced NPC between March 2004 and January 2011 were enrolled in the retrospective study. Among them, 54 patients received IMRT-SIB, and 53 patients received IMRT-CF. Subsequently, overall survival (OS), 5-year progression-free survival (PFS), 5-year locoregional recurrence-free survival (LRFS), and relevant toxicities were analyzed.

Results: In the present study, all patients completed the treatment, and the overall median follow-up time was 80 months (range: 8-126 months). The 5-year OS analysis revealed no significant difference between the IMRT-SIB and IMRT-CF groups (80.9% vs 80.5%, P=0.568). In addition, there were also no significant between-group differences in 5-year PFS (73.3% vs 74.4%, P=0.773) and 5-year LRFS (88.1% vs 90.8%, P=0.903). Notably, the dose to critical organs (spinal cord, brainstem, and parotid gland) in patients treated by IMRT-CF was significantly lower than that in patients treated by IMRT-SIB (all P<0.05).

Conclusion: Both IMRT-SIB and IMRT-CF techniques are effective in treating locally advanced NPC, with similar OS, PFS, and LRFS. However, IMRT-CF has more advantages than IMRT-SIB in protecting spinal cord, brainstem, and parotid gland from acute and late toxicities, such as xerostomia. Further prospective study is warranted to confirm our findings.
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http://dx.doi.org/10.2147/OTT.S99403DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4821392PMC
April 2016

The Predictive Effects of Early Pregnancy Lipid Profiles and Fasting Glucose on the Risk of Gestational Diabetes Mellitus Stratified by Body Mass Index.

J Diabetes Res 2016 15;2016:3013567. Epub 2016 Feb 15.

Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing 100034, China.

This study aimed at evaluating the predictive effects of early pregnancy lipid profiles and fasting glucose on the risk of gestational diabetes mellitus (GDM) in patients stratified by prepregnancy body mass index (p-BMI) and to determine the optimal cut-off values of each indicator for different p-BMI ranges. A retrospective system cluster sampling survey was conducted in Beijing during 2013 and a total of 5,265 singleton pregnancies without prepregnancy diabetes were included. The information for each participant was collected individually using questionnaires and medical records. Logistic regression analysis and receiver operator characteristics analysis were used in the analysis. Outcomes showed that potential markers for the prediction of GDM include early pregnancy lipid profiles (cholesterol, triacylglycerols, low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratios [LDL-C/HDL-C], and triglyceride to high-density lipoprotein cholesterol ratios [TG/HDL-C]) and fasting glucose, of which fasting glucose level was the most accurate indicator. Furthermore, the predictive effects and cut-off values for these factors varied according to p-BMI. Thus, p-BMI should be a consideration for the risk assessment of pregnant patients for GDM development.
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http://dx.doi.org/10.1155/2016/3013567DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4770134PMC
December 2016

[Characteristics of oral glucose tolerance test in 9803 pregnant women of different pre-pregnancy body mass index and its relationship with the incidence of gestational diabetes mellitus].

Zhonghua Fu Chan Ke Za Zhi 2015 Nov;50(11):830-3

Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing 100034, China.

Objective: To investigate the values and characteristics of 75 g oral glucose tolerance test (OGTT) in women with different pre-pregnancy body mass index (BMI) and to evaluate the risk of gestational diabetes mellitus (GDM).

Methods: Medical records of 9803 pregnant women attending the Peking University First Hospital and delivered between July 1, 2011 and December 31, 2013 were retrospectively analyzed. The frequency of adverse pregnancy outcomes across different degrees pre-pregnancy BMI was calculated. We divided participants into 4 groups based on pre-pregnancy BMI, underweight: BMI<18.5 kg/m(2) (1221 cases), normal weight: 18.5-23.9 kg/m(2) (6594 cases), overweight: 24-27.9 kg/m(2) (1549 cases), obesity: ≥28.0 kg/m(2) (439 cases). The diagnosis of GDM was made when any one of the values was met or exceeded in 75 g OGTT. The characteristics of 75 g OGTT and the incidence of GDM were analyzed.

Results: (1) The average age, pre-pregnancy weight, height and pre-pregnancy BMI of the participants was (30.5±3.7) years, (57.7±9.0) kg, (162.8±4.9) cm and (21.8±3.2) kg/m(2), respectively. All the values of 75 g OGTT were presented normal distribution. (2) There was statistical difference in the glucose levels among women with different pre-pregnancy BMI. The fasting, 1-hour, 2-hour glucose were (4.55±0.34), (7.31±1.54), (6.38±1.23) mmol/L in underweight women, (4.65±0.38), (7.70±1.59), (6.70±1.27) mmol/L in normal weight women, (4.82±0.47), (8.29±1.67), (7.04±1.29) mmol/L in overweight women and (4.94±0.48), (8.56±1.64), (7.10±1.35) mmol/L in obesity women (P<0.01). (3) The incidence of GDM was 21.76% (2133/9803) in our study. There were 1374 cases (64.42%, 1374/2133) with only one abnormal OGTT value while 759 cases (35.58%, 759/2133) with two or more abnormal values. The incidence of GDM in women with underweight, normal weight, overweight and obesity was 12.53% (153/1221), 19.71% (1300/6594), 32.73% (507/1549) and 39.41% (173/439), respectively (P<0.05). Meanwhile, the incidence of women with two and more abnormal OGTT value in GDM was increased as the pre-pregnancy increasing.

Conclusion: The risk of GDM is increased as pre-pregnancy BMI increasing, and the risk of GDM increases significantly in women with pre-pregnancy overweight or obesity.
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November 2015

Alteration in Expression and Methylation of IGF2/H19 in Placenta and Umbilical Cord Blood Are Associated with Macrosomia Exposed to Intrauterine Hyperglycemia.

PLoS One 2016 3;11(2):e0148399. Epub 2016 Feb 3.

Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China.

Objective: Macrosomia is one of the most common complications in gestational diabetes mellitus. Insulin-like growth factor 2 and H19 are two of the imprinted candidate genes that are involved in fetal growth and development. Change in methylation at differentially methylated region of the insulin-like growth factor 2 and H19 has been proved to be an early event related to the programming of metabolic profile, including macrosomia and small for gestational age in offspring. Here we hypothesize that alteration in methylation at differentially methylated region of the insulin-like growth factor 2 and H19 is associated with macrosomia induced by intrauterine hyperglycemia.

Results: The expression of insulin-like growth factor 2 is significant higher in gestational diabetes mellitus group (GDM group) compared to normal glucose tolerance group (NGT group) both in umbilical cord blood and placenta, while the expression of H19 is significant lower in GDM group in umbilical cord blood. The expression of insulin-like growth factor 2 is significant higher in normal glucose tolerance with macrosomia group (NGT-M) compared to normal glucose tolerance with normal birthweight group (NGT-NBW group) both in placenta and umbilical cord blood. A model with interaction term of gene expression of IGF2 and H19 found that IGF2 and the joint action of IGF2 and H19 in placenta showed significantly relationship with GDM/NGT and GDM-NBW/NGT-NBW. A borderline significant association was seen among IGF2 and H19 in cord blood and GDM-M/NGT-M. The methylation level at different CpG sites of insulin-like growth factor 2 and H19 in umbilical cord blood was also significantly different among groups. Based on the multivariable linear regression analysis, the methylation of the insulin-like growth factor 2 / H19 is closely related to birth weight and intrauterine hyperglycemia.

Conclusions: We confirmed the existence of alteration in DNA methylation in umbilical cord blood exposed to intrauterine hyperglycemia and reported a functional role in regulating gene associated with insulin-like growth factor 2/H19. Both of these might be the underlying pathogenesis of macrosomia. We also provided the evidence of strong associations between methylation of insulin-like growth factor 2/H19 and macrosomia induced by intrauterine hyperglycemia.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0148399PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4739655PMC
July 2016

Phase III study of cisplatin with pemtrexed or vinorelbine plus concurrent late course accelerated hyperfractionated radiotherapy in patients with unresectable stage III non-small cell lung cancer.

Oncotarget 2016 Feb;7(7):8422-31

Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong, P.R. China.

Our aim was to evaluate the efficacy and safety of cisplatin with pemtrexed or vinorelbine and concurrent late course accelerated hyperfractionated radiotherapy (LCAHRT). Patients with unresectable stage III non-small-cell lung cancer (NSCLC) were randomly assigned to two regimens. The experimental (PP) arm included cisplatin, pemtrexed and concurrent LCAHRT based on bilateral lung V20 = 33%. The control (NP) arm used cisplatin, vinorelbine with the same radiotherapy protocol. The primary endpoint was overall survival. Median survival times were 26.0 months (95% CI 23.2 to 28.7 months) and 28.5 months (95% CI 17.1 to 39.9 months) for the NP and PP arms, respectively (P = 0.26). Median progression-free survival was 12.5 months and 17.5 months in the NP and PP arms (P = 0.07). In both arms of the study, there were no differences in overall survival between patients with squamous and nonsquamous NSCLC. The incidences of grade 3 or 4 toxicity were higher in NP than PP arm. With concurrent LCAHRT, pemetrexed/cisplatin was equally as efficacious as vinorelbine/cisplatin, but showed a more favorable toxicity profile.
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http://dx.doi.org/10.18632/oncotarget.6871DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4885003PMC
February 2016