Gestational Weight Gain, Pregnancy Outcomes, and Use of Perinatal Health Services

This dissertation consists of three studies that were undertaken to better understand 1) the role of gestational weight gain (GWG) during early pregnancy on subsequent blood pressure changes and the risk of pregnancy-induced hypertension (PIH), 2) the causal effect of GWG in both early and mid-late pregnancy on the subtypes of preterm births, and 3) the impact of personal capital on the use of perinatal health services (i.e., prenatal care use and preconception care counseling). The first two studies were based on the data from the 1988 National Maternal and Infant Health Survey and the third study employed the data from the 2007 and 2010 Los Angeles Mommy and Baby Survey. In the first study, the latent class growth model revealed four trajectories of GWG in early pregnancy. Then using linear mix model as well as generalized equation method, we found women with high growth trajectory of GWG during early pregnancy had higher blood pressure and in higher risk of PIH . In the second study, using marginal structure models we found that among women who were in normal body mass index before pregnancy, both inadequate and excessive GWGs in mid-late pregnancy were associated the increased odds of spontaneous preterm births, while excessive GWG in mid-late pregnancy increased the odds of medically indicated preterm births. Among women who were overweight or obese before pregnancy, those with inadequate weight gain in early pregnancy were protected from medically indicated preterm births. In the third study, using multilevel analysis, we found that higher personal capital was associated with higher odds of receiving preconception counseling among Whites and Asians and was negatively associated with late prenatal care initiation among Hispanics, Blacks and Asians. Sub-components such as internal resources, partner support, social support and neighborhood supported were associated differently with the utilization of perinatal health services among racial groups. In conclusion, appropriate weight gain in pregnancy holds promise to reduce the risks of PIH and preterm births and to increase personal capital can be an effective strategy to improve women’s use of perinatal health services

Cardiovascular Diseases Factors in Women Enrolled in the Wisewoman Program

Cardiovascular diseases (CVD) is worldwide problem, which has many risk factors including age, gender, race, family history of CVD, hypertension, obesity, dyslipidemia, diet and physical activity. WISEWOMAN is a new program in SC, which provides screening and lifestyle interventions to 40-64 years old, low-income, uninsured, or under-insured women. In this thesis, we describe the program and characteristics of participants in SC. Comparisons of women aged between 40-46 and 47-64 years old, registered in Region 4 and Region 6, and received lifestyle intervention and did not received lifestyle intervention are implemented in the analysis. We illustrated the risk factors of CVD in the WISEWOMAN program, proved the appropriateness of only including women aged 47-64 years old and analyzed the difference of risk factors existed between women received lifestyle intervention and did not received intervention. At the nano scale, thermally responsive Pluronic F127 based nanocapsules using chitosan as the crosslinker were synthesized. The Pluronic F127-chitosan nanocapsules were found to have excellent biocompatibility, presumably due to the biocompatible nature of the two constituent polymers. In particular, Pluronic F127 has been approved by the Food and Drug Administration (FDA) for use as food additives and pharmaceutical ingredients. Moreover, the nanocapsules were found to be capable of not only encapsulating small hydrophilic molecules for intracellular delivery but achieving temperature controlled release of the small molecules. By breaking up the endosomal membrane through temperature-dependent volume change of the nanocapsule, this novel nanomaterial may be used to achieve cytosol-specific delivery of small anticancer drugs and therapeutic agents for improved cancer treatment

A novel application of generation model in foreseeing ‘future’ reactions

Deep learning is widely used in chemistry and can rival human chemists in certain scenarios. Inspired by molecule generation in new drug discovery, we present a deep learning-based reaction generation approach to perform reaction generation with the Trans-VAE model in this study. To comprehend how exploratory and innovative the model is in reaction generation, we constructed the dataset by time-split. We applied the Michael addition reaction as the generation vehicle and took the reactions reported before a certain date as the training set and explored whether the model could generate reactions that were reported after the date. We took 2010 and 2015 as the time points for the splitting of the Michael addition reaction respectively. Among the generated reactions, 911 and 487 reactions were applied in the experiments after the respective split time points, accounting for 12.75% and 16.29% of all reported reactions after each time point. The generated results were in line with expectations and additionally generated a large quantity of new chemically feasible Michael addition reactions, which also demonstrated the learnability of the Trans-VAE model for reaction rules. Our research provides a reference for future novel reaction discovery using deep learning

Multi_CycGT: A Deep Learning-Based Multimodal Model for Predicting the Membrane Permeability of Cyclic Peptides

Cyclic peptides are gaining attention for their strong binding affinity, low toxicity, and ability to target “undruggable” proteins; however, their therapeutic potential against intracellular targets is constrained by their limited membrane permeability, and researchers need much time and money to test this property in the laboratory. Herein, we propose an innovative multimodal model called Multi_CycGT, which combines a graph convolutional network (GCN) and a transformer to extract one- and two-dimensional features for predicting cyclic peptide permeability. The extensive benchmarking experiments show that our Multi_CycGT model can attain state-of-the-art performance, with an average accuracy of 0.8206 and an area under the curve of 0.8650, and demonstrates satisfactory generalization ability on several external data sets. To the best of our knowledge, it is the first deep learning-based attempt to predict the membrane permeability of cyclic peptides, which is beneficial in accelerating the design of cyclic peptide active drugs in medicinal chemistry and chemical biology applications

Incidence of Inadvertent Intraoperative Hypothermia and Its Risk Factors in Patients Undergoing General Anesthesia in Beijing: A Prospective Regional Survey.

Inadvertent intraoperative hypothermia (core temperature 2 h (OR = 3.44, 95% CI 1.90-6.22,), and intravenous un-warmed fluid (OR = 2.45, 95% CI 1.45-4.12) significantly increased the risk of hypothermia.The incidence of inadvertent intraoperative hypothermia in Beijing is high, and the rate of active warming of patients during operation is low. Concern for the development of intraoperative hypothermia should be especially high in patients undergoing major operations, requiring long periods of anesthesia, and receiving un-warmed intravenous fluids

Intraoperative hypothermia and its clinical outcomes in patients undergoing general anesthesia: National study in China.

Inadvertent intraoperative hypothermia (core temperature 2 h) (OR = 2.60, 95% CI 2.09-3.24).The incidence of intraoperative hypothermia in China is high, and the rate of active warming of patients during operation is low. Hypothermia is associated with more postoperative shivering, increased ICU admissions, and longer postoperative hospital days

Risk factors associated with intraoperative hypothermia, Beijing, China (N = 830).

<p>OR, Odds Ratio, Significant level indicates as P<0.05.</p><p>¹ adjusted OR were presented after adjusting all the variables in above table.</p><p>² patients receiving unwarmed IV fluid only</p><p>Risk factors associated with intraoperative hypothermia, Beijing, China (N = 830).</p

Change of intraoperative core temperature during operations.

<p>Patients’ core temperature was measured at the tympanic membrane beginning every 15 minutes after the induction of anesthesia and until the end of the operation. A total of 830 subjects were enrolled in the study; 89 (10.7%) received active warming, and 741(89.3%) received no warming.</p

Patient Demographics and Anesthesia/Surgery Data, Beijing, China (N = 830).

<p>¹ Magnitude of surgery as below: minor surgery: excision of lesion of skin; drainage of breast abscess, etc. Intermediate surgery: primary repair of inguinal hernia; excision of varicose vein(s) of leg; tonsillectomy/adenotonsillectomy; knee arthroscopy, etc. major surgery: total abdominal hysterectomy; endoscopic resection of prostate; lumbar discectomy; thyroidectomy, etc. major surgery plus: total joint replacement; lung operations; colonic resection; radical neck dissection; neurosurgery; cardiac surgery)</p><p>² Arthroscopic, laparoscopic, etc</p><p>³ Time from incision to closure</p><p>⁴ Time from induction to discontinuation of anesthetic agents</p><p>Patient Demographics and Anesthesia/Surgery Data, Beijing, China (N = 830).</p