Surgical repair of gastroschisis complicated by tracheostenosis in a very premature infant / 中华围产医学杂志

We describe the diagnosis and treatment of a very premature female infant with gastroschisis complicated by tracheostenosis. The pregnant woman, whose fetus was diagnosed with gastroschisis by ultrasound at 22 weeks in a local hospital, was admitted to the Second Affiliated Hospital of Wenzhou Medical University at 28 +1 weeks with oligohydramnios. Ultrasound after admission confirmed the previous diagnosis. A live baby girl was born by vaginal breech delivery at 29 +1 weeks after spontaneous rupture of the membranes. Because of the unstable oxygen saturation, the neonate finally received Silo in the delivery room prior to the closure of abdominal fissure 7 d after birth, and during the placement difficult endotracheal intubation was evident. She was diagnosed with having congenital tracheal stenosis via chest CT scans with 3-dimensional reconstruction 3 weeks after birth and received transbronchoscopic balloon dilatation at 3 months after birth. During the 2-year follow-up, she grew well without any complications.

Identification of core contents of health education for patients with pemphigus by using the Delphi method / 中华皮肤科杂志

Objective:To identify core contents of health education for patients with pemphigus by using the Delphi method.Methods:On the basis of literature review and group discussions, two rounds of questionnaire survey were performed in 17 experts to evaluate the importance of health education items for patients with pemphigus by using the Delphi method. Indices including importance score, coefficient of variation, authority coefficient and Kendall coefficient of concordance were calculated to identify core contents of health education for patients with pemphigus.Results:In the two rounds of questionnaire survey, all experts complete the questionnaires, the coefficients of variation were all less than 0.35, the authority coefficient was 0.893, and the Kendall coefficients of concordance were 0.283 and 0.288 respectively ( χ2= 168.17, 181.25, respectively, both P < 0.001) . After the two rounds of expert consultation, the core contents of health education for patients with pemphigus were finally confirmed, which consisted of 6 primary items and 32 secondary items, and the primary items included "disease knowledge", "medication guidance", " dietary guidance", "skin care", "rest, activities and psychological guidance" and " follow-up and medical guidance". Conclusion:By using the Delphi method, the core contents of health education have been successfully identified for patients with pemphigus, which provide a basis for systematization and scientization of health education contents for patients with pemphigus.

USP33 suppresses lung adenocarcinoma lung cell invasion and metastasis by down-regulating SLIT2/ROBO1 signaling pathway / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the role of USP33 as an independent prognostic marker in the regulation of SLIT2/ROBO1 signaling pathway to inhibit lung adenocarcinoma invasion and metastasis.</p><p><b>METHODS</b>The expression of USP33 in 20 lung adenocarcinoma specimens was detected by qPCR and immunohistochemistry. A549 and SPC-A-1 cells with small interfering RNA (siRNA)-mediated USP33 silencing were examined for changes in invasion and metastasis abilities using scratch assay and Matrigel assay. Western blotting was used to detect the expression of SLIT2 and ROBO1 in the cells after USP33 silencing and the expression of USP33 after interleukin-6 (IL-6) stimulation.</p><p><b>RESULTS</b>qPCR and immunohistochemistry showed that USP33 was significantly decreased in lung adenocarcinoma tissues as compared with the adjacent tissues. USP33 silencing in A549 and SPC-A-1 cells significantly promoted the cell migration, invasion and metastasis and obviously down-regulated the expressions of SLIT2 and ROBO1. IL-6 stimulation of the cells obviously enhanced the expression of USP33.</p><p><b>CONCLUSIONS</b>USP33 silencing can promote the migration, invasion and metastasis of lung adenocarcinoma cells , and the mechanism may involve IL-6 and SLIT2/ROBO1 signaling pathways.</p>

Fecal microbiota transplantation in treatment of inflammatory bowel disease in children / 中华实用儿科临床杂志

Inflammatory bowel disease(IBD)is a group of chronic,relapsing and nonspecific intestinal inflammatory diseases of unknown etiology.More and more evidence indicated that the intestinal microflora might play an important role in the pathogenesis of IBD.Fecal microbiota transplantation(FMT)has been used in intestinal flora imbalance related diseases and achieved favorable results.This article mainly reviewed the application of FMT in the treatment of children with IBD.

Investigation for anti-tumor effects of CIK cells induced by TLR7 agonist instead of IFN-γ / 中国免疫学杂志

Objective:To investigate the immune effects of CIK cells induced by Toll like receptor 7 agonist (Tlr7a) instead of IFN-γon killing lymphoma cells in vitro .Methods: Mononuclear cells were isolated from healthy human peripheral blood .CIK were induced by Tlr7a in vitro instead of IFN-γ.Two groups were divided as follows:CIK group,Tlr7a-CIK group.Then the main investigation on immune effects included immune phenotype was detected respectively , and cytotoxicity of the effectors was analyzed .Results: In Tlr7a-CIK group,the amount of CD56+cells was more than CIK group (P<0.05),and the cytotoxicity was also stronger (P<0.05). Conclusion:Tlr7a instead of IFN-γcould promote the immune effects of CIK cells on killing tumor cells in vitro .

Gastrointestinal disorders in children treated with fecal microbiota transplantation / 中华实用儿科临床杂志

Fecal microbiota transplantation (FMT) is a therapy with at least 1 700 years in the world medical history.In recent years,FMT has gained rapidly development.The recent studies demonstrated that FMT has obvious clinical efficacy and safety on the treatment of Clostridium difficile infection,inflammatory bowel disease and other diseases in adult.The present article will discuss efficacy of FMT in treating digestive diseases in children.

Correlation of insulin-like growth factor 1 expression in placenta with DNA methylation and fetal macrosomia / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To explore the correlation between methylation of insulin-like growth factor 1 (IGF-1) gene promoter and its placenta-specific expression and fetal macrosoma.</p><p><b>METHODS</b>One hundred twenty nine healthy pregnant women were recruited between April 2011 and March 2012. Baseline data were collected with self-report questionnaires. Real-time quantitative PCR was used to determine the expression of IGF-1 mRNA in the placenta. Methylation level of the IGF 1 gene was determined with matrix-assisted laser desorption/ionization-time of flight mass spectrometry.</p><p><b>RESULTS</b>The expression of IGF-1 in placenta and its methylation level showed no significant difference between macrosomic fetuses and controls. No linear correlation was found between IGF-1 mRNA expression and methylation level of IGF-1 promoter (r=0.128, P=0.295). IGF-1 promoter region in placenta showed a hypomethylation status. However, a positive correlation was found between IGF-1 expression and birth weight below 4260 g (r=0.264, P=0.022). The expression of IGF-1 mRNA was significantly higher in those with a birth weight below 4260 g, which suggested that placental IGF-1 expression may contribute to increased birth weight. In regard to fetal overgrowth, however, there seemed to be a negative correlation in which placental IGF-1 expression was downregulated to limit fetal overgrowth.</p><p><b>CONCLUSION</b>No linear correlation was found between placental IGF-1 expression and methylation level of IGF-1 promoter with a hypomethylation status. The contribution of placental IGF-1 expression to birth weight is bidirectional. Increased expression seems to promote fetal growth, while decreased expressions may curb overgrowth, therefore control fetal growth in a relatively normal range.</p>

Effects of isocorydione on cell proliferation in SiHa human cervi-cal carcinoma cell lines / 中国肿瘤临床

Objective:This paper aimed to investigate the effects of isocorydinone on cell proliferation in SiHa human cervical carcinoma cell lines. Methods:Different concentrations of isocorydione (100, 200, 400, 800, and 1200 μmol/L) were used to treat SiHa human cervical carcinoma cells in vitro for 24, 48, and 72 h. Methyl thiazolyl tetrazolium (MTT) assays were conducted to determine the inhibitory action of isocorydione. Flow cytometry was performed to detect the cell cycle in SiHa human cervical carcinoma cells af-ter treatment with 400 μmol/L isocorydione. Hoechst 33342 staining was used to observe the micro-morphological changes of SiHa cell nucleus after the treatment. The expression of Bcl-2, Bax, and caspase-3 proteins in cervical carcinoma SiHa cell lines was determined using western blot analysis. Results: MTT assays showed that isocorydione inhibits the proliferation of SiHa cells in a dose- and time-dependent manner (P<0.05). The flow cytometry results showed that SiHa cervical carcinoma cells treated with different concen-trations of isocorydione exhibited increased cell cycle. Compared with the control group, Hoechst 33342 staining showed that SiHa cells became narrow, with nuclear pyknosis and fragmentation, and formed an apoptotic body after treatment with 400 μmol/L isocoryd-ione for 48 h. Furthermore, western blot analysis proved that isocorydione significantly inhibited the proliferation of SiHa cell lines, and the expression of Bax protein was increased. By contrast, the expression of Bcl-2 protein decreased gradually. Consequently, the ra-tio of Bax/Bcl-2 increased, as well as the expression of caspase-3 protein. Conclusion:Isocorydione exhibited an overt inhibitory ac-tion on SiHa cells. Isocorydione promoted the occurrence of cell apoptosis, which may be associated with related proteins of mitochon-drial apoptotic pathway.

Drug resistance of Helicobacter pylori in nodular gastritis in children / 临床儿科杂志

Objective To analyze the drug resistance of Helicobacter pylori (H.pylori) in nodular gastritis in children and to further explore the rational use of antibiotics for drug-resistant H.pylori strains. Methods A total of 473 children with upper gastrointestinal symptoms undergoing gastroscopy from January 2013 to June 2014 in our hospital were enrolled. Two pieces of gastric antral mucosa in children with nodular gastritis were collected for H.pylori rapid urease test and H.pylori culture. The resistance of H.pylori to amoxicillin, clarithromycin, metronidazole, moxilfoxacin and levolfoxacin was detected by agar dilution method and E-test. Results In 473 cases of nodular gastritis, 258 cases were H.pylori culture-positive. The resistance rate of H. pylori isolates to amoxicillin, clarithromycin, metronidazole, moxilfoxacin, levolfoxacin was 6.2%, 34.9%, 49.2%, 8.9%and 5.0%, respectively. Dual resistance to clarithromycin and metronidazole was 23.3%. Moreover, 405 cases had a family history of H.pylori infection. Conclusions Nodular gastritis is a special sign of H.pylori infection in children. H.pylori infection has obvious familial aggregation. The low resistance rate of H.pylori to amoxicillin in children with nodular gastritis indicates that amoxicillin can be used as the main drug for eradication of H.pylori. Meanwhile, clarithromycin should be applied according to the drug sensitive test due to high resistance rate of H.pylori to clarithromycin.

A dose-escalation safety and immunogenicity study of a new live attenuated human rotavirus vaccine (Rotavin-M1) in Vietnamese children.

We tested a candidate live, oral, rotavirus vaccine (Rotavin-M1™) derived from an attenuated G1P [8] strain (KH0118-2003) isolated from a child in Vietnam. The vaccine was tested first for safety in 29 healthy adults. When deemed safe, it was further tested for safety and immunogenicity in 160 infants (4 groups) aged 6-12 weeks in a dose and schedule ranging study. The vaccine was administered in low titer (10(6.0)FFU/dose) on a 2-dose schedule given 2 months apart (Group 2L) and on a 3-dose schedule given 1 month apart (Group 3L) and in high titer (10(6.3)FFU/dose) in 2 doses 2 months apart (Group 2H) and in 3 doses 1 month apart (Group 3H). For comparison, 40 children (group Rotarix™) were given 2 doses of the lyophilized Rotarix™ vaccine (10(6.5)CCID(50)/dose) 1 month apart. All infants were followed for 30 days after each dose for clinical adverse events including diarrhea, vomiting, fever, abdominal pain, irritability and intussusception. Immunogenicity was assessed by IgA seroconversion and viral shedding was monitored for 7 days after administration of each dose. Two doses of Rotavin-M1 (10(6.3)FFU/dose) were well tolerated in adults. Among infants (average 8 weeks of age at enrollment), administration of Rotavin-M1 was safe and did not lead to an increased rate of fever, diarrhea, vomiting or irritability compared to Rotarix™, indicating that the candidate vaccine virus had been fully attenuated by serial passages. No elevation of levels of serum transaminase, blood urea, or blood cell counts were observed. The highest rotavirus IgA seroconversion rate (73%, 95%CI (58-88%)) was achieved in group 2H (2 doses--10(6.3)FFU/dose, 2 months apart). The 2 dose schedules performed slightly better than the 3 dose schedules and the higher titer doses performed slightly better than the lower titer doses. These rates of seroconversion were similar to that of the Rotarix™ group (58%, 95%CI (42-73%)). However more infants who received Rotarix™ (65%) shed virus in their stool after the first dose than those who received Rotavin-M1 (44-48%) (p<0.05) and the percent shedding decreased after subsequent doses of either vaccine. Rotavin-M1 vaccine is safe and immunogenic in Vietnamese infants. A trial in progress will assess the safety, immunogenicity and efficacy of Rotavin-M1 (2 doses at 10(6.3)FFU/dose) in a larger number of infants. The trial registration numbers are NCT01375907 and NCT01377571.

Serum APPL1 level is elevated in newly diagnosed cases of type 2 diabetes mellitus / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate serum APPL1 level in patients with newly diagnosed type 2 diabetes mellitus (T2DM) and analyze its correlation with body mass index (BMI), waist-to-hip ratio (WHR), blood pressure, fasting plasma glucose, fasting blood insulin, HbA1c, and insulin resistance (HOMA-IR).</p><p><b>METHOD</b>Serum APPL1 levels were determined using ELISA in 22 normal control subjects and 63 patients with newly diagnosed T2DM, and HOMA-IR of the subjects was calculated using the HOMA model.</p><p><b>RESULTS</b>The diabetic patients had significantly elevated levels of serum APPL1 compared with the control subjects (85.71∓27.39 vs 64.52∓16.28 pg/ml, P<0.01), with also significantly increased BMI, WHR, SBP, FINS, LgHOMA-IR (P<0.01) and LDL-C (P<0.05) but lowered HDL-C (P<0.01). Fasting serum APPL1 levels were positively correlated with FPG, FINS, and HOMA-IR (r=0.215, 0.297, 0.334, P=0.014, 0.006, 0.002, respectively). In multiple linear regression analysis with APPL1 as the dependent variable, HOMA-IR (β=0.329, P=0.002) was included in the equation.</p><p><b>CONCLUSION</b>Patients with newly diagnosed T2DM have elevated serum APPL1 levels, suggesting the involvement of APPL1 in the development of T2DM.</p>

Factors and neonatal outcomes associated with histologic chorioamnionitis after premature rupture of membranes in the preterms / 中华妇产科杂志

Objective To investigate factors and neonatal outcomes associated with histologic chorioamnionitis (HCA) in preterm premature rupture of membranes (PPROM).MethodsFrom Jan.2008 to Jun.2011,230 women with PPROM at 28 -33 +6 weeks of gestation undergoing deliveries in the Second Affiliated Hospital of Wenzhou Medical College were studied retrospectively.According to placental histopathologic findings,those patients were categorized into two groups,including 138 cases in histologic chorioamnionitis (HCA group ) and 65 cases in non-chorioamnionitis (control)group.Age,parity,gestational age of PPROM and delivery,latency period,oligohydramnios,white blood cell (WBC) count and serum C-reactive protein (CRP) level at admission and before delivery,the incidence of neonatal respiratory distress syndrome (NRDS),neonatal pneumonia,bronchopulmonary dysplasia,necrotizing enterocolitis,early-onset neonatal sepsis,abnormal brain sonography findings and mortality were compared between two groups.Results( 1 ) The incidence of HCA was 68.0.％ ( 138/203 ) in all 203 cases with PPROM.(2) The occurring ruptured membrane gestation in HCA group was ( 31.1 ± 1.5 ) weeks,which were significantly earlier than (32.0 ± 1.3 ) weeks in control group ( P ＜ 0.05 ).The level of CRP of (8.2 ± 14.9) mg/L before delivery in HCA group was significantly higher than (5.5 ±7.2) mg/L in control group (P ＜ 0.05).The rate of oligohydramnios and cesearean sections were 55.1％ (76/138) and 45.7％ (63/138) in HCA group,which were significantly higher than 30.8％ (20/65) and 29.2％ (19/65) in control group (P ＜0.05).There were no significant difference in patient's age,parity,WBC count and CRP at admission between two groups (P ＞ 0.05 ).The latency period did not show significant difference between (140± 116) hours in HCA group and (129 ± 125) hours in control group (P ＞ 0.05).(3) Using multivariable logistic regression models,oligohydramnios ( OR =2.937 ),gestational age of PPROM ＜ 32 weeks ( OR =2.352),serum CRP level ＞ 8 mg/L before delivery ( OR =4.923 ) and latency period ＞ 48 -168 hours (OR =4.439) were significantly associated with HCA (P ＜0.05).(4) The gestational age of delivery and birth weight of HCA group were significantly lower than those of control group [ ( 32.0 ± 1.5 ) weeks vs.( 32.7 ± 1.5 ) weeks,( 1680 ± 379) g vs.(2017 ± 333) g,respectively,P ＜ 0.05 ].The incidence of Apgar ＜7,abnormal brain sonograhy findings, neonatal pneumonia,bronchopulmonary dysplasia,early-onset neonatal sepsis and mortality in HCA group were significantly higher than those in control group [20.3％ (28/138) vs.7.7％ (5/65),14.5％ (20/138) vs.4.6％ (3/65),12.3％ (17/138) vs.3.1％(2/65),5.8％ (8/138) vs.0,6.5％ (9/138) vs.0,12.3％ (17/138) vs.3.1％ (2/65),respectively,P ＜ 0.05 ].The incidence of necrotizing enterocolitis ( 1.5％,2/138 ) in HCA group was higher than that of controlgroup(0) and the incidence of NRDS ( 18.8％,26/138) in HCA group did not show statistical difference with 21.4％ ( 14/65 ) in control group ( P ＞ 0.05 ).ConclusionsIt was found that HCA was significantly correlated with lower gestational age of PPROM,higher serum CRP level before delivery,prolonged latency period and oligohydramnios in PPROM.HCA could increase the neonatal morbidity and mortality.

Lipid metabolism in ketosis-prone type 2 diabetes mellitus patients classified by Aβ classification scheme / 中国医师进修杂志

ObjectiveTo investigate the lipid metabolism in ketosis-prone type 2 diabetes mellitus (T2DM) patients classified by Aβ classification scheme.Methods Two hundred and seventy-seven ketosis-prone T2DM patients were classified according to the A β classification scheme which was based on the presence or absence of pancreatic islet β-cell autoantibody and fasting C peptide:A-β- group (78 cases ),A+ β -group (41 cases ),A- β + group ( 113 cases ) and A+ β + group (45 cases).The levels of blood lipid were determined and compared in the four groups.ResultsIn A- β -,A+ β -,A- β + and A+ β +groups,the levels of triglyeride (TG) were separately (1.72 ± 1.07),(1.86 ± 1.04),(2.21 ± 1.66) and (2.60 ± 1.87 )mmol/L,the levels of very low density lipoprotein-cholesterol(VLDL-C) were separately (0.57 ±0.45),(0.61 ±0.48),(0.79 ±0.63) and(0.81 ±0.62) mmol/L,and there were significant differences in TG and VLDL-C among the four groups(P =0.004 and 0.010).There were significant differences in TG and VLDL-C between β + group ( 158 cases) and β - group ( 119 cases) [ (2.32 ± 1.72) mmol/L vs.(1.77 ± 1.06)mmol/L,(0.80 ±0.63) mmol/L vs.(0.58 ±0.46) mmol/L,P =0.001 and 0.001 ].Conclusions Ketosis-prone T2DM patients with different situations of pancreatic islet β-cell autoimmunity and function are different in lipid metabolism,so it is very lmportant to evaluate the blood lipid and perform related lipid-lowering therapy in order to reduce the occurrence of diabetic complication.

The introduction of teaching design of basic life support / 中华医学教育探索杂志

In this paper,we exhaustively discussed the teaching design of basic life support in processing teaching materials,choosing the methods of teaching and learning,planning the teaching process and reflection after teaching and so on,to introduce how to use the pedagogy and the psychology principles to guide teaching design,for the purpose of improving the teaching quality.

A health behaviors research about the community-dwelling older people with different risk of osteoporotic fractures / 中华行为医学与脑科学杂志

Objective To find out a health behaviors about the community-dwelling older people with different risk of osteoporotic fractures,and to provide the interventions basis for high risk population.Methods By fracture risk assessment tool(FRAX).Stratified sampling method was used.Data were collected by face-to-face interviews with questionnaires in 450 people aged 60 years and over who come from the three communities.Results By the statistical test,the scores of behavior between high and low risk older people had statistical significance(P＜0.01 ).The scores of high risk of osteoporotic fractures behavior in older people were 30.59 ± 4.67,which rate was 56.6％.There were 86 people who scored 33 and over,pass rate was only 37.2％ ; The behavior scores of low risk of osteoporotic fractures older people were 32.01 ± 4.49,which rate was 59.3％.There were 102 people who scored 33 and over,pass rate was only 46.6％.The one way ANOVA found that theeducation level were main factors for low risk of osteoporotic fractures elderly people in prevention behavior.By the multiple liner stepwise regression,gender and monthly income were main factors for high risk of osteoporotic fractures elderly people in prevention behavior.Conclusion Focus on those older people who have the low-income,male group in high risk of osteoporotic fractures to improving health behavior intervention,which include those in low risk of osteoporotic fractures but have low level of education.

Correlation between serum level of visfatin and type 2 diabetes mellitus / 中国医师进修杂志

Objective To investigate the correlation between serum level of visfatin and type 2 diabetes mellitus (T2DM). Methods Impaired glucose regulation (IGR) group consisted of 40 patients,T2DM group consisted of 106 patients, while control group consisted of 86 subjects. The serum visfatin levels of all groups were detected by enzyme linked immunosorbent assay (ELISA). Results Fasting serum visfatin levels in IGR group and T2DM group were significantly higher than those in control group [(19.93 ±6.89) μg/L and (29.53 ± 11.33) μg/L vs. (16.12 ± 5.24) μ g/L, P ＜ 0.01]. Fasting serum visfatin levels positively correlated with waist-to-hipratio (WHR) (r = 0.161, P ＜ 0.05); significantly positively correlated with triacylglycerol (TG), low density lipoprotein cholesterol (LDL-C), glycosylated hemoglobin (HbA1c),fasting plasma glucose (FPG), fasting insulin (FINS), lg Homeostasis model assessment-insulin resistance index (HOMA-IR) (r = 0.189,0.266,0.643,0.574,0.285,0.526,P ＜ 0.01), and significantly negatively correlated with high density lipoprotein cholesterol (HDL-C)(r =-0.377,P ＜0.01). When visfatin was analyzed as a dependent variable in multiple linear regression, HbA1c (β = 0.512, P = 0.000), lg HOMA-IR (β= 0.172, P = 0.026), WHR (β = 0.119, P = 0.036) were into the equation. Conclusion Visfatin may be involved in glucose and lipid metabolism regulation, and closely related with insulin resistance; visfatin may be a risk factor for T2DM.

Study on the association between sex hormone-binding globulin and newly diagnosed type 2 diabetes mellitus / 中国医师进修杂志

Objective To explore the possible mechanism of sex hormone-binding globulin (SHBG) in diabetes mellitus by detecting the level of serum SHBG in patients with newly diagnosed type 2 diabetes mellitus (T2DM),and analyze the correlation between serum SHBG and insulin resistance.Methods SHBG levels were determined by enzyme linked immunosorbent assay (ELISA) in 30 normal controls (control group) and 60 newly diagnosed T2DM patients(T2DM group).HOMA-IR was calculated.Results The levels of serum SHBG in T2DM group were significantly lower than those in control group [(22.6 ±9.7)mmol/L vs.43.1 ±11.9) mmol/L,P <0.05]; SHBG level was negatively correlated with triglyceride(TG),low density hpoprotein cholesterol(LDL-C),fasting insulin(FINS),hemoglobintHbA1c) and lgHOMA-IR (r =-0.351,-0.361,-0.426,-0.645,-0.483,P <0.05),and positively correlated with high density lipoprotein cholesterol (HDL-C) (r =0.453,P <0.01).When SHBG was analyzed as a dependent variable by multiple linear regression,HbA1c (β =-0.614,P =0.000),lgHOMA-IR (β =-0.473,P = 0.014) and HDL-C (β = 0.234,P= 0.048) were into the equation.Conclusions Patients who have diagnosed T2DM show low level of serum SHBG.HOMA-IR and HbA1c are key indicators of SHBG,suggesting that SHBG may be closely related with T2DM.

Perinatal outcomes in pregnant women with pulmonary hypertension and concurrent congestive heart failure / 中华急诊医学杂志

Objective To discuss the effect of the occurrence of congestive heart failure on the outcome of pregnant women with pulmonary hypertension. Methods Fifty-four pregnant patients complicated with pulmonary hypertension were admitted from January 2000 through December 2010. Among them, 34 had comorbidity of congestive heart failure. The timing and mode of pregnancy termination, and perinatal outcomes were studied, and comparison was made between those with and without heart failure. Results ① Of all 54 pregnant women with pulmonary hypertension, 34 had congestive heart failure. The incidences of congestive heart failure in patients with mild, moderate and severe degree of pulmonary hypertension were 27.78% (5/18), 73.33% (11/15) and 85.71% (18/21), respectively (P<0.05).②The rate of maternal complications was 47.06% (16/34) and maternal mortality was 17.65% (6/34) in the patients with combined pulmonary hypertension and heart failure. The rate of iatrogenic fetal loss was 29.41% ( 10/34) , preterm labor 52.94% (18/34), neonatal asphyxia 35.29% (12/34) and neonatal mortality 23.53% (8/34) in case of patients with pulmonary hypertension complicated with congestive heart failure. ③The rate of Cesarean section was 91. 18% (31/34) in the patients with combined pulmonary hypertension and heart failure. ④ The rates of iatrogenic induction, premature delivery, maternal complications and mortality, neonatal asphyxia and fetal or neonatal fatality were significantly higher in women with combined pulmonary hypertension and heart failure than those with simple pulmonary hypertension ( P < 0. 05). Conclusions The risk of heart failure increases with the severity of pulmonary hypertension. The occurrence of heart failure is the most important factor affecting the outcome of patients in pregnancy already complicated with pulmonary hypertension , and Cesarean section is the safer mode of termination of pregnancy in this cohort of women.

Expression of aquaporin 3 and aquaporin 9 in placenta and fetal membrane with idiopathic polyhydramnios / 中华妇产科杂志

Objective To investigate the pathogenesis role of aquaporin 3 and aquaporin 9 in idiopathic polyhydramnios by detecting their expression and distribution in fetal membranes and placenta.Methods Twenty-one of term pregnancy women with idiopathic polyhydramnios were enrolled as patient group matched with 30 women with normal term pregnancy as control group.The expression and localization of aquaporin 3 and aquaporin 9 in fetal membranes and placenta were detected by real-time polymerase chain reaction and streptavidin peroxidase immunohistochemiscal staining.Results (1)The mRNA expressions of aquaporin 3 and aquaporin 9 were detected in amnion,chorion and placental tissue in both patient group and control group.Both aquaporin 3 and aquaporin 9 were demonstrated positive staining in the amnion epithelia,chorion cytotrophoblasts and placental trophoblast.(2)The ratio of aquaporin 3 and aquaporin 9 mRNA expressions in amnion in patient group comparing to those in control group were 5.00 and 3.25,while in chorion they were 2.03 and 2.08.When compared with those in amnion and chorion of control group,there was a significant difference(P<0.01).However,the relative change fold of aquaporin 3 and aquaporin 9 in placental trophoblast in patient group were decreased in comparison of those in control group,which also showed statistical difference(P<0.01).(3)The expression of aquaporin 3 and aquaporin 9 protein in anmion were 7.5 ±2. 0 and 11.1 ± 1.8 in patient group, while they were 5.3 ± 1. 6 and 5.6 ± 2. 3 in control group. In chorion, the expression of aquaporin 3 and aquaporin 9 protein was 7.5±2. 0 and 10. 0 ±1.6 in patient group, respectively, while in control group, they were 5.4 ±2.2 and 5.6±2. 1. When compared with those proteins in control group, it exhibited statistical difference (P<0.05). However, in placental trophoblast of patient greup,the expression of aquaporin 3 and aquaporin 9 protein were 3.5±1.4and 4. 0±2. 5, respectively, which were significantly decreased than 5.6±1. 3 and 7. 1±2. 9 in control group(P< 0. 05). Conclusions The alterations of aquaporin 3 and aquaporin 9 expressions in fetal membrane and placenta might be an adaptive response to idiopathic polyhydramnios. Further investigation should be needed to clarify the regulatory mechanism of aquaporin 3 and aquaporin 9 expressions.