Diagnostic Ideas and Management Strategies for Thrombocytopenia of Unknown Causes in Pregnancy.

Objective: To summarize the clinical characteristics and treatment options together with the maternal and neonatal prognoses in women with different degrees of thrombocytopenia of unknown causes during pregnancy. Materials and Methods: One hundred twenty-nine cases meeting the inclusion and exclusion criteria were retrospectively analyzed. Patients were divided into group A (50*109/L) and group B (50*109/L to 100*109/L) according to the lowest level of platelet count during pregnancy. Patients were divided into those found to have thrombocytopenia in the relatively early, middle, and late stages according to the detection period of maternal thrombocytopenia during pregnancy. Results: There were 72 cases in group A, and 57 cases in group B. There existed statistically significant differences in terms of the proportion of primipara, the proportion with a history of thrombocytopenia, and the median length of pregnancy between the two groups (p < 0.05). The proportion of patients with severe thrombocytopenia as an indication for cesarean delivery was higher in group A than in group B (p < 0.05). More cases were detected at the relatively early stages of pregnancy in group A than in group B (p < 0.05). There was no difference in neonatal hemorrhage and events of thrombocytopenia between the two groups. Conclusion: Patients with platelet counts below 50*109/L were mostly primipara with a history of thrombocytopenia, most often detected at a relatively early stage of pregnancy, and continued pregnancy might lead to aggravation of the disease. Combination therapy was required for patients with platelet counts below 30*109/L to maintain the platelet counts within a safe range. Cesarean delivery was selected to terminate the pregnancies, and platelet counts should be raised above 50*109/L before surgery. Close monitoring was required for those with platelet counts above 30*109/L. There was no direct correlation between the maternal and neonatal platelet counts.

Meta-analysis of heparin combined with aspirin versus aspirin alone for unexplained recurrent spontaneous abortion.

BACKGROUND: Unexplained recurrent spontaneous abortion (URSA) frustrates women of childbearing age profoundly, and effective therapies are particularly important. OBJECTIVE: To compare the efficacy of heparin combined with aspirin and aspirin alone for URSA. SEARCH STRATEGY: Electronic databases (PubMed, Medline, Web of Science, Clinical key and Cochrane Library) were searched for relevant studies from database inception to August 2019. SELECTION CRITERIA: Studies of women of childbearing age with at least two consecutive abortions were included. DATA COLLECTION AND ANALYSIS: Relevant items were extracted, tabulated, and subjected to STATA for data analysis. Study women were divided into group A (taking heparin plus aspirin) and group B (taking aspirin alone). The primary outcome was the rate of live birth. MAIN RESULTS: Women from eight randomized controlled trials were included: 493 in group A and 501 in group B. The number of live births was significantly higher in group A (P=0.003). The result remained the same in subgroup analysis by presence of antiphospholipid antibodies. Among women who had a live birth, gestational age at delivery tended to be older in group B (P=0.054). No differences in birthweight or intrauterine growth restriction were observed. Adverse effects were sporadically reported. CONCLUSION: Among women with URSA, heparin combined with aspirin increased the live birth rate as compared with aspirin alone. There was a beneficial tendency of taking aspirin-only to prolong gestation week.

Retrieval Practice Promotes Pictorial Learning in Children Aged Six to Seven Years.

Little is known about "retrieval practice" learning strategies in early childhood, and very few studies have tracked them over long intervals. This study explored the promotion of retrieval practices in six- and seven-year-old children's memories of pictures at different time intervals. One hundred and four first-grade students were asked to remember the contents of 15 pictures in four retrieval practice conditions: with feedback, with elaboration, retrieval practice without feedback, and repetitive learning. Recognition was tested after 5-minute, one-week, and one-month intervals after completion of the study. The results indicate that retrieval with feedback promotes memory more effectively than elaboration. Scores in the retrieval practice with feedback group were higher than those in the elaboration group at all three delay intervals, and the advantage of retrieval without feedback may increase at longer intervals. For example, the hit rates in the retrieval practice without feedback group were higher than those in the repetitive learning group after one month, but no significant differences were found after 5 minutes or one week. The findings provide preliminary evidence that practicing retrieval strategies may be efficient in early elementary education.

Coding and Noncoding Variants in CFH Act Synergistically for Complement Activation in Immunoglobulin A Nephropathy.

BACKGROUND: In immunoglobulin A nephropathy (IgAN), complement activation occurs in both the systemic circulation and in situ (glomerular). A recent IgAN-genome-wide association study (GWAS) identified 1q32 as an IgAN susceptible locus that contained the complement regulatory protein coding gene complement factor H (CFH). Here, we explored the combined genetic effects of coding and noncoding variants in CFH, rs6677604 and rs800292 on complement activation in IgAN. METHODS: In total, 1,194 IgAN patients and 900 healthy controls who were the same as the Beijing Discovery Cohort in our recent IgAN-GWAS were recruited. The genotyping information of rs800292 and rs6677604 were extracted from GWAS data, while the information regarding plasma C3 levels and mesangial C3 deposits were collected from medical records. RESULTS: We found both rs800292-GG and rs6677604-GG were risk genotypes for complement activation in IgAN patients, as represented by lower plasma C3 levels in IgAN patients with rs800292-GG and a higher intensity of glomerular C3 deposits in those with rs6677604-GG, respectively. Additionally, IgAN patients with 2 risk genotypes (rs800292-GG and rs6677604-GG) showed a higher degree of complement activation compared to those with no risk genotypes (rs800292-AA/AG and rs6677604-AA/AG), as represented by both lower plasma C3 levels and a higher intensity of glomerular C3 deposits. Moreover, when compared to rs800292 or rs6677604 alone, the combined genetic effects of rs800292 and rs6677604 showed a stronger association with IgAN susceptibility. CONCLUSIONS: Our findings suggested that both coding and noncoding variants in CFH acted synergistically to regulate the degree of complement activation and thereby contributed to IgAN susceptibility.

[Screening, identification and antimicrobial activity of alkaloid produced by endophytic actinomycetes from Fritillaria unibracteata in western Sichuan plateau].

To explore the resource of endophytic actinomycete in Fritillaria unibracteata, and alleviate the shortage of F. unibracteata resource, using F. unibracteata as experimental materials which growth in the western Sichuan plateau and cut its healthy bulb. Pure culture, insert, TLC and Oxford cup were applied to observe the mycelial morphology, research the ability of producing alkaloid and its antibacterial activity. Totally, 14 endophytic actinomycete strains were isolated by using Gao culture media. Based on the color reaction, 5 typical strains were selected for producing alkaloid. Through the TLC technique, all strains produced 2 obvious alkaloids spots. Antibacterial activity determination showed that the antimicrobial effects of 2 strains is prominent, the diameter up to 11 mm.16S rRNA gene sequence comparison analysis showed that 5 strains belonging to the Streptomyces. The alkaloids produced by endophytic actinomycetes are not related to F. unibracteata, but its fermentation liquid has antibacterial effect, it is worthy of further study.

[Value of preventive tracheotomy in patients with acute cervical spinal cord injury].

OBJECTIVE: To evaluate the value of preventive tracheotomy in patients with acute cervical spinal cord injury. METHODS: A retrospective analysis was performed on 54 cases of severe C4-C8 cervical spinal cord injury patients undergoing anterior fixation. They were classified as A and B according to the criteria of American Spinal Injury Association. And no tracheotomy was performed preoperatively. The patients with a high risk of dyspnea and with an indication for preventive tracheotomy received a preventive tracheotomy right after anterior fixation. 11 cases were classified into tracheotomy group and 43 cases were in non-tracheotomy group. The preoperative and hospital stays, incidence of hypoxemia and pulmonary infection, incidence of surgical incision site infection and mortality were analyzed between two groups. RESULTS: The preoperative and hospital stays of tracheotomy group were shorter than those of non-tracheotomy group (2.9 ± 1.2 vs 5.7 ± 4.4 days, 10.3 ± 4.0 vs 16.5 ± 9.2 days). The incidence of hypoxemia was lower in tracheotomy group (9.1% vs 44.2%). There was difference existed between two groups. 44.2% patients in the non-tracheotomy group underwent tracheotomy or endotracheal intubation for dyspnea and hypoxemia. There was no significant difference between two groups in the incidence of pulmonary infection (9.1% vs 7.0%) or surgical incision site infection (0 vs 2.3%). The mortality of non-tracheotomy group was 3.07 folds of that of tracheotomy group (9.1% vs 27.9%). But there was no significant statistical difference. CONCLUSION: The preventive tracheotomy is an effective solution for the patients with respiratory compromises, a high risk of dyspnea and with an indication for preventive tracheotomy. The preventive tracheotomy for severe cervical spinal cord can improve respiratory function effectively and fixation may be performed earlier. And there are lower rates of mortality and infection.

Tubulointerstitial lesions of patients with lupus nephritis classified by the 2003 International Society of Nephrology and Renal Pathology Society system.

The 2003 International Society of Nephrology/Renal Pathology Society (ISN/RPS) system for classifying patients with lupus nephritis was based on glomerular lesions exclusively, despite the fact that lupus nephritis affects all compartments of the kidney. Hence, we analyzed the tubulointerstitial lesions in patients with lupus nephritis within the different classes and subclasses of the 2003 ISN/RPS system. Among 313 patients from five centers in northern China with lupus nephritis, interstitial inflammatory cell infiltration, tubular atrophy, and interstitial fibrosis were severe in 170 patients with class IV, moderate in 55 with class III, and mild in 19 with class II and in 69 with class V disease, each with significance. The severity of tubulointerstitial lesions in classes IV-segmental and III was similar, whereas the score of interstitial inflammatory cell infiltration in patients with subclass IV-global was significantly higher than that in those with subclass IV-segmental. Interstitial fibrosis and tubular atrophy were each significantly more prominent in patients with both active and chronic lesions than in those with active lesions alone. The correlation coefficient ranged from 0.222 to 0.811 comparing glomerular and tubulointerstitial indices. In multivariate Cox hazard analysis of tubulointerstitial lesions, indices of interstitial infiltration, tubular atrophy, and interstitial fibrosis were confirmed as significant independent risk factors for renal outcome. Thus, we found that the 2003 ISN/RPS classification system of lupus nephritis, based on glomerular lesions, could also reflect related tubulointerstitial lesions. Hence, we suggest that the extent of tubulointerstitial lesions may be helpful in predicting renal outcome in patients with lupus nephritis.

[Impact of different drugs and different volumes injected intraspinally on the nerve function: experiment with rats].

OBJECTIVE: To investigate the impact of different drugs and different volumes injected intraspinally on the nerve function and find out the safe intraspinally injection volume. METHODS: Ninety-six adult Sprague-Dawley rats were randomly divided into 12 equal groups to be injected intraspinally with normal saline (NS) 2 microl, 4 microl, 6 microl, or 10 microl, viral buffer 2 microl, 4 microl, 6 microl, or 10 microl, or Ad-LacZ (1 x 10(9) pfu/ml) 2 microl, 4 microl, 6 microl, or 10 microl at the level of T13 respectively immediately after the laminectomy was performed. Another 6 adult SD rats only underwent T13 luminal decompression and used as controls. Basso-Beattie-Bresnahan locomotor rating scale was used to evaluate the motor function of their hind limbs after 1, 2, 3, 4, 5, and 6 days, and 1, 2, 3, and 4 weeks. One and 2 weeks after the injection 2 rats from each group were killed and the remaining 4 rats in each group were killed 4 weeks after the injection. Histological examination was done with HE staining and toluidine blue staining. X-gal staining was used to observe the expression of adenovirus in the spinal cord. RESULTS: The extent of motor deficits and tissue damage increased following the increase of intraspinal injection volume (P = 0.000). The severity of damage of the Ad-LacZ was significantly greater than those of the NS and virus buffer groups (P = 0.044), however, there were no significant differences in the severity of damage among NS groups and virus buffer groups (P = 1.000). X-Gal staining showed that the reporter gene LacZ was expressed in all Ad-LacZ groups. The great the dose the more severe the damage. Four weeks later the effective residual rates f the grey and white matters of the Ad-LacZ groups were all significantly lower than those of the other 2 groups, however, there were no significant differences in the effective residual rates f the grey and white matters among the NS and virus buffer groups. CONCLUSION: Intraspinal injection results in functional deficit and tissue damage in the spinal cord. The extent of tissue damage increases following the increase of intraspinal injection volume. Different drugs cause different tissue damage. The intraspinal injection of Ad-LacZ results in more tissue damage. The volume of 4 microl is the safe volume for injection, 6 microl is a critical volume.