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Background: Hypertrophic cardiomyopathy (HCM) is a common inherited genetic cardiac disease during pregnancy. Studies of risk factors are of great significance for maternal and fetal outcomes., Aim: The aim of the study was to identify predictive risk factors for cardiac complications in pregnant women with HCM., Methods: One hundred patients with HCM who delivered at the Shanghai obstetrical cardiology intensive care center between January 2000 and December 2022 were retrospectively reviewed. A logistic regression model was used to identify independent risk factors for cardiac complications., Results: Twenty-one cases were obstructive HCM (21%), 16 with cardiac function grade I and 5 with grade II; 79 cases were non-obstructive HCM (79%), 67 with cardiac function grade I, 11 with grade II, and 1 with grade III. Ninety-one cases had abnormal electrocardiogram (ECG) (91%), mainly with ST-T changes (77%). The average interventricular septum was 19.39 ± 6.13 mm by echocardiography (21.75 ± 5.86 mm for obstructive HCM and 18.73 ± 6.08 mm for non-obstructive HCM). The main cardiac complications were maternal death (n = 2, 2%), heart failure (n = 7, 7%), and sustained ventricular tachyarrhythmia (n = 1, 1%). Cardiac complications occur commonly during the third trimester and postpartum period. Three independent risk factors to predict cardiac complications in pregnant women with HCM were obstructive HCM (P = 0.036), New York Heart Association (NYHA) class ≥II (P = 0.022), and previous history of syncope (P = 0.037)., Conclusions: HCM increases the risk of maternal death, heart failure, and malignant arrhythmia. More attention should be given to risk assessment and pregnancy management. Early detection of risk factors can reduce the incidence of maternal mortality and cardiac complications., (Copyright © 2024 Copyright: © 2024 Nigerian Journal of Clinical Practice.)

Objective: To investigate the difference of urinary protein components in pregnant women with pre-eclampsia (PE) with different degrees of proteinuria and the correlation between 24-hour urinary protein quantification and estimated glomerular filtration rate (eGFR). Methods: Clinical data of 101 PE pregnant women who were delivered in Renji Hospital, Shanghai Jiao Tong University School of Medicine from July 2018 to June 2022 were retrospectively analyzed. According to 24-hour urinary protein quantification, they were divided into 3 groups, including 40 cases of mild proteinuria group (24-hour urinary protein quantification ≤2.0 g), 21 cases of moderate proteinuria group (2.0 g<24-hour urinary protein quantification ≤5.0 g), 40 cases of severe proteinuria group (24-hour urinary protein quantification >5.0 g). The general clinical data, urinary protein index and renal function index of PE pregnant women in 3 groups were compared. The eGFR was calculated based on age, serum creatinine (sCr), blood urea nitrogen (BUN) and serum albumin (sAlb). Correlation analysis was conducted between 24-hour urinary protein quantification and each index of eGFR. Results: (1) General clinical data: the median PE onset week (31 weeks) and delivery gestational week [(36.4±3.6) weeks] of PE pregnant women in the mild proteinuria group were later than those in the moderate proteinuria group [median PE onset: 22 weeks, delivery: (32.2±4.2) weeks] and severe proteinuria group [median PE onset: 25 weeks, delivery: (29.6±3.4) weeks]; systolic blood pressure, diastolic blood pressure, alanine aminotransferase, aspartate aminotransferase levels and the incidence of fetal growth restriction were lower than those in the moderate and severe proteinuria groups; median newborn birth weight (3 150 g) was higher than those in the moderate proteinuria group (1 305 g) and the severe proteinuria group (1 042 g), respectively. The differences were statistically significant (all P <0.05). (2) Urinary protein index: the 24-hour urinary protein quantification, urinary microalbumin (mAlb) and urinary transferrin (TRF) levels of PE pregnant women in the mild proteinuria group, moderate proteinuria group and severe proteinuria group were increased successively, and the differences were statistically significant (all P <0.05). The median urinary α1-microglobulin (α1-MG) level of PE pregnant women in the severe proteinuria group (50 mg/L) was significantly higher than those in the mild proteinuria group (17 mg/L) and moderate proteinuria group (22 mg/L; all P <0.05), but there was no significant difference between the mild proteinuria group and the moderate proteinuria group ( P >0.05). There was no significant difference in the median urinary β2-microglobulin (β2-MG) level among the 3 groups ( P =0.632). (3) Renal function index: sAlb and eGFR of PE pregnant women in the mild proteinuria group, moderate proteinuria group and severe proteinuria group were successively decreased, and BUN was successively increased, respectively, and the differences were statistically significant (all P <0.05). The sCr level of PE pregnant women in the severe proteinuria group was significantly higher than those in the mild proteinuria group and the moderate proteinuria group (all P <0.05), but there was no significant difference between the mild proteinuria group and the moderate proteinuria group ( P >0.05). (4) Correlation analysis: the 24-hour urinary protein quantification of PE pregnant women was significantly negatively correlated with eGFR ( r =-0.645, P <0.001), and was correlated with the variables sAlb ( r =-0.549, P <0.001), sCr ( r =0.582, P <0.001) and BUN ( r =-0.657, P <0.001) in the eGFR calculation formula. The 24-hour urinary protein quantification were significantly negatively correlated with the gestational weeks of PE onset, gestational weeks of termination of pregnancy and newborn birth weight (all P <0.05). Conclusions: The protein composition in the urine of PE pregnant women with different degrees of proteinuria is not different, but the protein level is significantly different. There is a significant negative correlation between the increase of 24-hour urinary protein quantification and the decrease of eGFR.

Background: Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease during pregnancy. Studies of risk factors are of great significance to maternal and fetal outcomes in patients with TOF., Aims: To identify predictive risk factors for maternal and perinatal complications in women with TOF., Subjects and Methods: 78 patients with TOF who delivered at Shanghai Obstetrical Cardiology Intensive Care Center between January 1993 and December 2017 were retrospective reviewed. A logistic regression model was used to identify risk factors for maternal and perinatal complications., Results: There was no maternal death, five patients developed cardiac failure, sustained arrhythmias requiring treatments were recorded among 2 patients. Factors identified for maternal complications included previous cardiac events and oxygen saturation <90%. Oxygen saturation <90% was found to be independent predictor of maternal cardiac complications (RR = 21.455, 95%CI 2.186-210.572, P = 0.009). The perinatal survival rate was 87.18%, there were 52 term deliveries (66.67%). Perinatal poor outcomes include 9 therapeutic abortions (11.54%), 1 neonatal death (1.28%), 16 premature births (20.51%), 18 small for gestational age children (23.08%), 3 neonatal asphyxia (3.85%), and 3 neonatal cardiac malformations (3.85%). Factors identified for perinatal complications included without cardiac surgery, higher hemoglobin values, higher hematocrit values, oxygen saturation <90%, right ventricular hypertrophy, pulmonary stenosis, ventricular septal defect, and pulmonary hypertension. Oxygen saturation <90% was found to be independent predictor of perinatal complications (RR = 8.270, 95%CI 1.374-49.790, P = 0.021)., Conclusions: Oxygen saturation <90% is associated with maternal and perinatal risks. Women with TOF whose oxygen saturation <90% are not recommended for pregnancy because of high maternal and perinatal complications., Competing Interests: None

Objective: To investigate and analyze disease status and risk factors of venous thromboembolism (VTE) during pregnancy and puerperium in our country. Methods: Clinical datas were collected from 575 patients diagnosed with VTE during pregnancy and puerperium and hospitalized in nine medical institutions in our country from January 1, 2015 to November 30, 2019, and retrospectively analyzed it's disease status and risk factors. Results: (1) The proportion of VTE in pregnancy and puerperium was 50.6% (291/575) and 49.4% (284/575), respectively. Four patients died, the mortality rate was 0.7% (4/575). The cause of death was pulmonary embolism. (2) The location of VTE during pregnancy and puerperium was mainly in the lower limb vascular (76.2%, 438/575), followed by pulmonary vessels (7.1%, 41/575). (3) In the risk factors of VTE, cesarean section accounted for 32.3% (186/575), maternal advance age accounted for 27.7% (159/575), braking or hospitalization during pregnancy accounted for 13.6% (78/575), other risk factors accounted for more than 5% were previous VTE, obesity, preterm birth, assistant reproductive technology conception and so on, pre-eclampsia and multiple pregnancy accounted for 4.9% (28/575) respectively. In addition, some patients with VTE did not have any of the above risk factors, and the incidence rate was as high as 23.1% (133/575). Conclusions: The occurrence of VTE during pregnancy and puerperium is related to multiple risk factors, and could lead to matemal death, It is very necessary to screen VTE risk factors for all pregnant women, to make corresponding prevention and control measures.

Objective: To analyze risk factors, cardiovascular complications, time of death, gestational age of delivery and offspring outcomes in the maternal deaths with cardiovascular diseases (CVD). Methods: Totally 4 112 cases of pregnant women with CVD in Shanghai obstetric heart disease intensive care unit within 26 years (from January 1993 to December 2018) were collected, and 20 maternal deaths within these cases were analyzed retrospectively. Results: (1) Among the 20 deaths, structural heart diseases accounted for 90% (18/20), pregnancy induced heart diseases was 10% (2/20) while there was no dysfunctional heart disease. The mortality of pregnant women with CVD was 0.486% (20/4 112). (2) The following risk factors were common in these women, getting pregnant without counselling (95%, 19/20) , New York Heart Association classⅢ or Ⅳcardiac function (70%, 14/20), complicated with pulmonary hypertension (75%, 15/20) and prior heart events (60%, 12/20). And 85% (17/20) deaths occurred in puerperium, 15% (3/20) occurred before labor,while no death occurred during labor. And 65% (13/20) deaths died due to heart failure, 20% (4/20) deaths were due to pulmonary hypertension crisis, 5% (1/20) died on sudden cardiac arrest, rupture of aortic dissection and sudden death, respectively. Conclusions: Women with CVD should get pregnant after strict evaluation. Pulmonary hypertension is one of the most severe contraindications to pregnancy, especially in patients with moderate to severe pulmonary hypertension. The puerperium period is a critical period that threatens the safety of these patients. Since heart failure is the most common cause of death, it is necessary to prevent and treat heart failure and to monitor heart function dynamically, especially in those with structural abnormal heart diseases. Moreover, it is also of importance to standardize antenatal care and to identify the severity of heart diseases in time.

At present, several clinical practice guidelines for osteoarthritis have been developed. Although contradictions about some recommendations are still in dispute, large number of clinical practice guidelines recommended core treatments, namely education, weight loss and exercise therapy. Thus, the diagnosis and treatment of primary osteoarthritis should focus on the above three treatments. However, we have to develop the clinical practice guidelines for osteoarthritis in primary hospital, based on the characteristics of osteoarthritis in China, the burden of disease, the health literacy of patients and the clinical decision-making of diagnosis and treatment of primary osteoarthritis in primary medical care.We suggest to formulate guidelines for the diagnosis and treatment of osteoarthritis in primary medical care to regulate primary interventions.

Introduction: The need for better durability and longevity in total hip arthroplasty for patients with various hip joint diseases remains a challenge. This study aimed to obtain medium-term results at a follow-up of >10 years for Zweymüller-Plus total hip arthroplasty with ceramic-on-polyethylene bearing., Methods: A retrospective study was conducted to review the results after a minimum of 12.4 years of 207 consecutive total hip arthroplasties in 185 patients in Peking University People's Hospital in China using the Zweymüller SL-Plus stem in combination with the Bicon-Plus threaded cup and ceramic-on-polyethylene bearing between October 1994 and April 2000., Results: During the study period, two patients (2 hips) died and 25 patients (28 hips) were lost to follow-up. Two hips were revised for aseptic loosening of the Bicon-Plus cup. The mean clinical and radiological follow-up was 14.1 years (range, 12.4-16.5 years) for the remaining 156 patients (175 hips). The mean (standard deviation) Harris Hip score for the 175 hips increased significantly from 39.3 (3.8) preoperatively to 94.1 (2.5) postoperatively at a mean follow-up of 14.1 years (P<0.05). Focal osteolysis was observed in seven (4.0%) of 175 stems and three (1.7%) of 175 cups. The Kaplan-Meier survival with revision for any reason as the end-point was 99.03% (95% confidence interval, 95%-100%)., Conclusions: The high survival rate of the cementless Zweymüller-Plus system with ceramic-on-polyethylene bearing at mid-term follow-up makes this total hip arthroplasty system reliable for patients with various hip joint diseases.

Aim: To determine the diagnostic value and major complications of fine-needle aspiration (FNA) for primary liver cancer (PLC) and its influence on the treatment outcome and prognosis., Methods: Information was gathered retrospectively for 3011 patients who presented with suspected PLC. Of which 2528 cases underwent ultrasound-guided fine-needle aspiration (US-FNA) biopsy. Patients were followed up through repeated office visits and imaging studies with a median follow-up of 7 months (range, 1-29 months)., Results: The sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy of cytological diagnosis by FNA biopsy for detection of liver malignancy were 91.5%, 100.0%, 100.00%, 59.1% and 92.4% respectively. All patients with AFP> or = 400 microg/L were associated with malignancy. Of 1154 patients with AFP<400 microg/L who were finally proved PLC, 945 were detected by FNA alone. Major complications included bleeding in 11 cases (5 of them died later), occurred mainly in hepatocellular carcinoma with superficial location, large tumors and severe cirrhosis, and implantation metastases in 5 cases, which were recognized as a subcutaneous nodule at the previous biopsy site. Implantation metastases were treated with resection or radiotherapy., Conclusion: FNA biopsy is valuable for the diagnosis of PLC. However, complications of post-biopsy hemorrhage should not be ignored, as such bleeding may be fatal. Implantation seems to have little effect on the prognosis.

The HLA-DRB1 gene polymorphism of Naxi ethnic group of Yunnan Province, China was investigated for the first time using high resolution PCR-SBT method, which is based on sequences of HLA-DRB1 Intron 1 and Intron 2 with our improvement. From 60 individuals of Naxi 37 DRB1 alleles were detected. The distribution of allele frequencies is evenly spread for most of alleles detected in Naxi. However, the gene frequency for HLA-DRB1 * 12021 is 17.50%. The other common alleles (> 5%) were HLA-DRB1 * 1404(7.50%), 1504(5.83%), 04051(5.83%), 08032(5.83%), 09012(5%), 03011(5%), and they covered 35% of the total alleles detected from Naxi, and 52.49% after adding the frequency of HLA-DRB1 * 12021. HLA-DRB1 * 0305, 0438, 1123, 1132, 1310, 0812 were detected in Chinese for the first time, and were very rare in other ethnic groups worldwide. Using the HLA-DRB1 gene frequencies of various ethnic groups, we constructed the phylogenetic tree by Fitch-Margoliash and Least-Squares Distance Methods and Cavalli-Sforza's chord measure of genetic distance. In our dendrogram, the South China populations were clustered together, and Siberian, Japanese and Minority of North China were clustered together, in which two big clusters we thought represented the ancient Southern and Northern Mongolian. Our results showed Naxi was clustered with Lahu and Yao ethnic groups, which were in the cluster of South China population. Obviously Naxi belongs to the South China ethnic groups and can't trace its origin from northern ethnic groups with the HLA-DRB1 genetic data. But based on Naxi's historical folklore, it was down to Southern China from Northwest China. The preliminary analysis about its origin conundrum was discussed in this paper based on our genetic data in relationship with its history and ethnology studies.

HLA-DQB1 genes from 76 individuals of Yichu ethnic group in Yunnan Province were investigated, using PCR-SSO genotyping method. Of the 38 DQB1 alleles detected, DQB1 * 0301 (gene frequency: 36.18%-36.84%) was the most common gene. The frequencies of DQB1 * 0502(10.53%-11.18%), DQB1 * 0401 (9.21%), DQB1 * 0302(8.55%-9.21%), DQB1 * 0601(7.89%), DQB1 * 05031(6.58%), and DQB1 * 03032(5.92%-6.58%) are more than 5%. While DQB1 * 0504, DQB1 * 0604, DQB1 * 06052, DQB1 * 0606, DQB1 * 0607, DQB1 * 0608, DQB1 * 06112, DQB1 * 0613, DQB1 * 0615, DQB1 * 0203, DQB1 * 0305, DQB1 * 0306, DQB1 * 0307, and DQB1 * 0308 were not observed. Comparison of HLA-DQB1 allele frequencies of Yichu with those of 13 other Chinese ethnic groups showed some significant differences, suggesting Yichu is unique in the distribution of HLA alleles.

Eight strains of rotaviruses isolated from diarrheal animals (4 from calves and 4 from piglets) in China were compared by serotyping with reference animal rotavirus strains (bovine NCDV, porcine OSU and simian SA-11 and human rotavirus Wa strain). Two-way cross neutralization test showed no antigenic difference between all 4 local strains of bovine rotavirus (BRV007, BRV014, HN-7 and BRV6555) and reference NCDV, so they belonged to rotavirus serotype 6 (bovine rotavirus serotype 1 or NCDV-serotype). Meanwhile, the four strains of Chinese porcine rotavirus could be determined into 2 different serotypes. One (Li99) was neutralised to a high titer with the antiserum against reference OSU virus and probably related to OSU (serotype 5 or porcine serotype 1). The other three strains (Lin71, Nan86 and Jiang150) were antigenically obviously different from Li99 and did not react with the antiserum against OSU. They were tentatively considered as porcine rotavirus serotype 2. All the strains of bovine and porcine rotavirus did not cross-neutralise with simian SA-11 and human Wa strain. There was also no antigenic relationship between bovine rotaviruses and porcine rotaviruses.