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Clinical Management Guidelines for Intrahepatic Cholestasis of Pregnancy

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Maternal-Fetal Medicine 2024年第1期6卷 13-22页

作者： Obstetrics Group of the Gynecology and Obstetrics Branch of Chinese Medical Association Perinatal Medicine Branch of Chinese Medical Association Xinyang Yu huixia yang Hongbo Qi 不详 Medical University Chongqing 400016China Department of Obstetrics and Gynecology Peking University First HospitalBeijing 100034China Department of Obstetrics and Gynecology Women and Children's Hospital of Chongqing Medical UniversityChongqing 401147China

Intrahepatic cholestasis of pregnancy(ICP)is a significant gestational complication in late pregnancy,potentially leading to severe perinatal complications such as intrauterine fetal demise and preterm birth.The Obstetrics Group of the Gynecology and Obstetrics Branch and the Perinatal Medicine Branch of the Chinese Medical Association organized a panel of domestic experts to deliberate and propose recommendations based on domestic and international guidelines,recent evidence-based medical evidence about key clinical issues including risk factors,clinical manifestations,perinatal outcomes,diagnosis,severity grading,maternal and fetal monitoring,treatment methods,timing,and methods of pregnancy termination,and postpartum follow-up for ICP,with the aim to guide its clinical diagnosis,treatment,and management.

关键词： Cholestasis,Intrahepatic Bile Acids Stillbirth Preterm Birth Diagnostic and Therapeutic Guidelines(Theme)

Atomic tracking of thermally-driven structural evolution in 2D crystals:Case of NbSe_(2)

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InfoMat 2024年第2期6卷 90-98页

作者： Baofei Hou Teng Zhang Tingting Wang Hongyan Ji huixia yang Liangguang Jia Xu Han Jingsi Qiao Yu Zhang Liwei Liu Hong-Jun Gao Yeliang Wang School of Integrated Circuits and Electronics&yangtze Delta Region Academy Beijing Institute of TechnologyBeijingthe People's Republic of China Institute of Physics Chinese Academy of SciencesBeijingthe People's Republic of China

Advanced atomic tracking techniques play a critical role in characterizing structural evolution,elucidating fundamental mechanisms of exotic phenomena and tailoring delicate properties.Thermally driven structural modulation in 2D crystals,such as the charge density wave(CDW),often leads to intriguing quantum properties,making them a valuable platform for exploring fundamental physics and potential device applications.However,despite their significance,experimental studies addressing atomic tracking of thermally-driven structural evolution in 2D crystals have been limited.Herein,we utilize high-accuracy variable-temperature atomic tracking measurements with scanning tunneling microscopy(STM)to directly observe a series of structural transitions in a model 2D crystal,namely NbSe_(2).With the atomic tracking technique,we confirm the existence of the universal thermally-driven CDW transition hysteresis between the heating and cooling cycles.This transition hysteresis,characterized by a constant temperature offset,represents a new phenomenon of structural evolution.Our findings provide a feasible method to track CDW transitions at the atomic scale in 2D crystals,significantly contributing to a better understanding and the potential modulation of these materials'functions in nanodevices.

关键词： 2D crystal atomic tracking technique structural evolution temperature hysteresis

Early life 1000 days: opportunities for preventing adult diseases

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Chinese Medical Journal 2022年第5期135卷 516-518页

作者： Juan Juan huixia yang Department of Obstetrics and Gynecology Peking University First HospitalBeijing 100034China

With the rapid socioeconomic development, improvements in living standards, and changes in lifestyle, adult diseases, such as cardiovascular diseases, type 2 diabetes mellitus (T2DM), hypertension, obesity, and so on, are increasing dramatically over the past decades, which have caused a huge economic and health burden at both population and individual levels in China.[1] The increased burden of adult diseases has become the main public health issue, and prevention of adult diseases in China has become a formidable task during recent years. In 2016, China has put forward the concept of whole life-course health and efforts have been made on shifting the focus from treating diseases to prevention. In view of the poor effects of prevention of diseases in adulthood, it is suggested that prevention and management of adult diseases should be extended to early life, which is the critical window for physiological programming and has profound and enduring effects on the whole life-cycle health.[2,3,4] In 2018, an article named "To Prevent Cardiovascular Disease, Pay Attention to Pregnancy Complications" published in Journal of the American Medical Association (JAMA) also illustrated that pregnancy is a window to future health[5].

关键词： diseases prevention cardiovascular

SARS-CoV-2 infection and pregnancy:clinical update and perspective

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Chinese Medical Journal 2023年第16期136卷 1891-1893页

作者： Chen Wang huixia yang Department of Obstetrics and Gynecology Peking University First HospitalBeijing 100034China

Since the emergence of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)in December 2019,the virus has overwhelmed the world’s health.Pregnant women as a vulnerable group,the broad implications of SARS-CoV-2 for obstetrical care and perinatal outcomes have raised concern and promoted the rapid development of research.Chinese clinicians and scientists working in obstetrics rapidly reported globally the clinical characteristics,pregnancy outcomes,and vertical transmission potential of SARS-CoV-2 infection in pregnancy on February 12,2020[1]and published clinical management consensus specific for SARS-CoV-2 infection in pregnancy at the earliest time,[2]which were valuable for preventive and clinical practice in China and elsewhere in the early stages of the pandemic.With the passing of time and updating of information,developments have been achieved in our understanding of obstetric outcomes,vertical transmission,and therapeutics for the treatment and prevention of SARS-CoV-2 infection;furthermore,the progress shed light on the gaps in current knowledge for future work.

关键词： pregnancy clinical infection

Maternal circulating biomarkers associated with placenta accreta spectrum disorders

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Chinese Medical Journal 2023年第8期136卷 995-997页

作者： Zhirong Guo huixia yang Jingmei Ma Department of Obstetrics and Gynecology Peking University First HospitalBeijing 100034China Beijing Key Laboratory of Maternal Fetal Medicine of Gestational Diabetes Mellitus Beijing 100034China

To the Editor:Placenta accreta spectrum(PAS)disorders refer to a spectrum of abnormal placentation.PAS subtypes include placenta accreta(creta or adherenta,PA),placenta increta(PI),and placenta percreta(PP).The incidence of PAS has dramatically increased over the past four decades.A study using a nationally representative sample in the United States showed that the prevalence of PAS was 0.29%among women who underwent cesarean delivery with live birth.[1]Women with PAS are at a considerably higher risk of concurrent hemorrhage,bladder and urinary tract injury,and hysterectomy during delivery.[1]

关键词： bladder disorders spectrum

High Risk Factors for Placenta Accreta Other than Pregnancy and Their Impact on Patient Prognosis

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Maternal-Fetal Medicine 2023年第3期5卷 137-143页

作者： Xinrui yang Weiran Zheng Jie Yan huixia yang Department of Obstetrics and Gynecology Peking University First HospitalBeijingChina

Objective This study aimed to determine the most pertinent factors responsible for placenta accreta spectrum disorders in patients without any history of pregnancy and evaluate their prognostic implications.Methods This retrospective cohort study included 1009 patients diagnosed with placenta accreta spectrum disorders based on standardized diagnostic criteria across 10 tertiary hospitals in China between January 1,2018,and December 31,2018;45 patients without a history of pregnancy were selected.The collected data mainly included demographic characteristics(including age,operative history,and ultrasound findings)and maternal-fetal outcomes(including any history of intraoperative bleeding,blood transfusion details,maternal-fetal complications,and fetal Apgar scores).SPSS 24.0 was used for statistical analyses.The Mann-Whitney U test and logistic regression were performed;a two-tailed P0.050).Endometrial damage led to lower Apgar scores on both univariate(1 minute:U=29.500,P=0.027;and 5 minutes:U=33.500,P=0.031)and multivariate(1 minute:β=−1.510,95%confidence interval,−2.639 to 0.381,P=0.010;and 5 minutes:β=−0.968,95%confidence interval,−1.779 to 0.157,P=0.021)analyses.Conclusion In patients who had no history of pregnanc

关键词： Placenta accreta Ultrasound Risk factor Prognosis Complication

Exercise intervention during pregnancy induces DNA methylation alterations in maternal blood and cord blood

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Chinese Medical Journal 2023年第13期136卷 1624-1626页

作者： Jie Yan Chen Wang Yumei Wei huixia yang Department of Obstetrics and Gynecology Peking University First HospitalBeijing 100034China Beijing Key Laboratory of Maternal Fetal Medicine of Gestational Diabetes Mellitus Beijing 100034China

To the Editor:Obesity characterized with excess accumulation of white adipose tissue increases the prevalence of gestational diabetes mellitus(GDM).Exposure to intrauterine hyperglycemia increases the long-term sequelae including cardiovascular abnormalities and metabolic syndrome in adult offspring.[1]As early as two decades ago,Dr.David Barker provided evidence that nutritional exposures in utero has a lasting impact on offspring’s health status in adulthood.[2]This emphasizes the critical role of early intrauterine environmental exposures and highlights the potential origins of adult metabolic diseases.

关键词： alterations cardiovascular pregnancy

Low-dose aspirin in the prevention of pre-eclampsia in China: postpartum hemorrhage in subgroups of women according to their characteristics and potential bleeding risk

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Chinese Medical Journal 2023年第5期136卷 550-555页

作者： Jiahui Chen Jing Huai Li Lin Boya Li Yuchun Zhu huixia yang Department of Obstetrics and Gynecology Peking University First HospitalBeijing 100034China Beijing Key Laboratory of Maternal Fetal Medicine of Gestational Diabetes Mellitus Beijing 100034China.

Background:The APPEC study is a large-population randomized controlled trial in China evaluating the role of low-dose aspirin prophylactic treatment for pre-eclampsia.There was no statistically significant difference in postpartum hemorrhage(PPH)incidence between the aspirin and control groups.This study aimed to evaluate the potential bleeding risk of 100 mg aspirin in high-risk pregnant women and the difference in the incidence of PPH according to maternal characteristics.Methods:This is a secondary data analysis of the APPEC study.Platelet counts and coagulation test results were collected at five follow-up visits.Subgroups defined by maternal age(<35 years and≥35 years),pre-pregnancy body mass index(pre-BMI,<28 kg/m 2 and≥28 kg/m 2),parity,gestational age at enrollment,and medical history,including pre-eclampsia,chronic hypertension,and diabetes mellitus,were analyzed.Logistic regression analysis was used to determine the statistical significance of the difference in the incidence of PPH after aspirin administration in pregnant women in each subgroup.Adjustment using multiple logistic regression models followed these analyses.Binary logistic regression was used to determine the relationship between pre-BMI and PPH.Results:There was no significant difference between the aspirin and control groups in bleeding risk(3.4%[16/464]vs.3.0%[13/434],T=0.147,P=0.701).No significant difference was found in the incidence of PPH in total(relative risk=1.220,95%confidence interval[CI]=0.720–2.067,P=0.459;aspirin group vs.control group,6.5%[30/464]vs.5.3%[23/434],P=0.459)or in subgroup analysis.A significant correlation between pre-BMI and PPH was found in the aspirin group,while in the control group there was no significant correlation(aspirin group,odds ratio[OR]=1.086,95%CI=1.004–1.175,P=0.040;control group,OR=1.060,95%CI=0.968–1.161,P=0.209).Conclusions:A dosage of 100 mg of aspirin per day,initiated from 12 to 20 gestational weeks until 34 weeks of gestation,did not increase the risk of potential bleeding and PPH regard

关键词： APPEC study Aspirin Postpartum hemorrhage Body mass index Pre-eclampsia

Using the Delphi Technique to Achieve Consensus on Prevention and Treatment of Preterm Single Birth in China

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Maternal-Fetal Medicine 2023年第4期5卷 206-212页

作者： Taishun Li Zhe Liu huixia yang Yali Hu Medical Statistics and Analysis Center Nanjing Drum Tower HospitalThe Affiliated Hospital of Nanjing University Medical SchoolNanjing 210008China Department of Obstetrics and Gynecology Nanjing Drum Tower HospitalThe Affiliated Hospital of Nanjing University Medical SchoolNanjing 210008China Department of Obstetrics and Gynecology Peking University First HospitalBeijing 100034China.

Objective::This study aimed to reach a consensus among obstetric experts on the prevention and treatment of preterm single births in China.Methods::Based on the scoping literature review and the 2014 edition of preterm birth of Clinical Diagnosis and Treatment guidelines,we generated the Delphi survey statements with five evaluation dimensions,including the definition of preterm birth,exclusion of risk factors for preterm birth,prevention,and prediction of preterm birth,treatment of preterm birth,and evaluation of intervention outcomes of preterm birth.Obstetric experts from the Obstetrics and Gynecology Branch of the Chinese Medical Association formed the expert group for this survey.All the obstetric experts participated two-round modified Delphi survey via an anonymous online survey and an online panel.Mean scores,rank sum,full score ratio,and the lowest score ratio were calculated to reflect the concentration of expert opinions.The coefficient of variation and Kendall W coefficient were used to reflect the expert opinion coordination degree of the survey statement.Results::The expert response rate for both rounds of surveys was 100%(41/41).Experts reached an agreement on 36 statements in five dimensions of preterm birth prevention and treatment in the first round of the survey and reached a consensus on the remaining 13 statements in the second round.A total of 49 statements(mean scores≥3,full score ratio≥20%,coefficient of variation≤0.3)were explicitly included in this guideline to form recommendations,while the remaining three clinical issues that did not reach a consensus require further determination based on evidence quality.The Kendall W coefficient in the two rounds of the Delphi survey were 0.20(P<0.001)and 0.29(P<0.001).Conclusion::The five dimensions and 49 statements,agreed upon through a two-round Delphi study,determined the recommended statements to be included in the updated guidelines for the prevention and treatment of preterm birth in China.The defined lower limit is set at≥28 gestational wee

关键词： Premature birth Delphi technique Consensus Guidelines