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Objective:To summarize the features of stenosis or premature closure of fetal ductus arteriosus and to investigate the perinatal management strategies.Methods:Three cases diagnosed with stenosis or premature closure of fetal ductus arteriosus in Peking University First Hospital between January 2022 and June 2022 were retrospectively enrolled. Clinical features and perinatal management strategies were summarized.Results:Fetal cardiac abnormalities (right heart enlargement and tricuspid regurgitation) were detected in the three cases by routine prenatal ultrasound at the gestational weeks of 24, 30 and 23, respectively. Fetal echocardiography confirmed the diagnosis of stenosis or premature closure of fetal ductus arteriosus and no other structural anomalies were detected. All three pregnant women denied taking non-steroidal anti-inflammatory drugs. Case 1 and case 2 underwent emergency cesarean section due to suspected fetal cardiac dysfunction with a cardiovascular profile score of 6 and 5. The two neonates were transferred to the neonatal intensive care unit and discharged with good prognosis (normal cardiac function) on the 56th and 42nd day after birth. During a close monitoring, the stenosis of fetal ductus arteriosus improved in case 3 and a full-term neonate was delivered at 38 weeks by elective cesarean section because of a history of cesarean section.Conclusions:In the second and third trimesters of pregnancy, attention should be drawn to the fetal ductus arteriosus during ultrasound imaging, especially when right heart enlargement and tricuspid regurgitation were detected. For fetuses with suspected ductus arteriosus stenosis, a close monitor of the ductus arteriosus and the ultrasound findings indicating cardiac dysfunction is needed and the cardiovascular profile score should also be involved. Fetuses with premature closure of the ductus arteriosus should be delivered promptly and the postnatal cardiac outcomes are good.
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Fetal arrythmia is a common cardiac abnormality, which can be categorized into three major types: extrasystoles, tachycardia and bradycardia. Most fetal arrythmias do no harm to the fetus, but few severe fetal arrythmia, including supraventricular tachycardia, atrial flutter and conduction block do, resulting in congestive heart dysfunction, hydrops fetalis and even intrauterine death. Therefore, timely intrauterine management may help to improve the fetal outcomes. This article reviews intrauterine treatment strategies for different types of fetal arrythmia.
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Fetal echocardiography includes the screening of structural abnormalities of the fetal heart as well as the assessment of cardiac function. Fetal cardiac function can reflect the adaptability of the cardiovascular system and hemodynamics in various conditions, providing more information on the pathophysiology of diseases and enabling timely interventions to improve short- and long-term outcomes in fetuses. Some ultrasound and Doppler indicators have been used to assess fetal cardiac function, but their correlation with fetal cardiovascular diseases is still under investigation. With the development of ultrasound, updated technical methods are constantly emerging. This article reviews the existing methods for evaluating fetal cardiac function and their application.
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Objective:To study the clinical significance of early detection of soluble growth stimulating gene 2 protein (sST2) and prealbumin (PAB) in patients with chronic pulmonary heart disease (CPHD) complicated with refractory heart failure.Methods:From September 2017 to June 2019, 112 CPHD patients complicated with refractory heart failure were admitted to Hengshui People's Hospital. The selected patients met the revised guidelines for the diagnosis and treatment of chronic obstructive pulmonary disease (2013 revision) and the cardiac function grade Ⅲ-Ⅳ according to the grading criteria of the New York Cardiology Society. Cardiogenic shock, severe liver and kidney dysfunction, malignant tumors, anemia, and autoimmune diseases were excluded. Patients were divided into the high PAB group (≥200 mg/L) and the low PAB group (<200 mg/L) according to the PAB level on admission. The pulmonary artery systolic blood pressure (PASP), pulmonary artery mean pressure (MPAP), and left ventricular ejection fraction (LVEF) were observed in the two groups before and after the treatment. PAB, total bilirubin (TBIL), hypersensitive C reactive protein (hs-CPR), N-terminal B type brain natriuretic peptide (NT-proBNP) and sST2 levels were detected. Measurement data were expressed in terms of mean ± standard deviation, the counting data were compared using χ 2 test. Correlation analysis was conducted using Spearman correlation test. Results:There were 40 cases in the high PAB group and 72 cases in the low PAB group. There were no statistically significant differences in general data between the high PAB and low PAB groups ( P>0.05). Hospitalization time was significantly different between the two groups ( P<0.05). Before the treatment, there were no significant differences in PASP, MPAP, NT-proBNP and LVEF between the two groups ( P>0.05). High sST2 was significantly different between the two groups ( P<0.05). After the treatment, PASP, MPAP, NT-proBNP and sST2 were decreased in both groups, and the improvement was more obvious in the high PAB group than in the low PAB group, with statistical significance ( P<0.05). Before the treatment, the levels of TBIL and hs-CPR were not statistically different between the high PAB and low PAB groups ( P>0.05). However, the levels of TBIL and hs-CPR were beyond the normal range. After the treatment, TBIL and hs-CPR were decreased in both groups, and there was statistically significant difference between the two groups ( P<0.05). Spearman correlation analysis showed that PAB was negatively correlated with sST2 ( r=-0.778, P=0.001). There was a positive correlation between cardiac function and sST2 ( r=0.569, P=0.034), hospitalization time ( r=0.572, P=0.033) in patients with refractory heart failure. The higher the sST2 of CPHD with refractory heart failure, the longer the patient hospitalization time, and the more serious the heart failure was. The area under the combined ROC curve of PAB and sST2 was 0.756. CPHD patients with refractory heart failure had the greatest predictive value. Conclusion:The combined test of sST2 and PAB can evaluate the condition and outcome of CPHD patients with refractory heart failure, and guide the clinic.
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Objective@#To investigate the tendency and safety of percutaneous umbilical cord blood sampling (PUBS) in prenatal screening and diagnosis, and the possibilities of avoiding unnecessary PUBS.@*Methods@#This was a retrospective study of pregnant women who underwent PUBS for prenatal diagnosis in Peking University First Hospital from January 2015 to December 2017. Clinical indications, timing of PUBS, further investigations (chromosome karyotype, molecular genetics and pathogen testing), results, and pregnancy outcomes were collected and analyzed. One-way analysis of variance (ANOVA), Chi-square test for linear trend, Fisher's exact probability test/Cochran-Armitage analysis and Cruskal-Wallis rank-sum test were used for statistical analysis.@*Results@#(1) A total of 412 singleton pregnancies underwent PUBS at 20-38 gestational weeks during the study period, and 379 (92.2%) of them received PUBS before 34 gestational weeks. The positive test results accounted for 10.4% (43/412). There were six (1.5%) miscarriages after PUBS. In vitro cell culture failure occurred in two cases, one in 2015 and the other in 2016. (2) Among the 412 cases, 304 (73.8%) had only one indication. Fourteen cases could be identified as high risk in the first trimester, such as advanced maternal age (AMA, >35 years), pregnant history with chromosomal abnormal fetus and one of the couples carrying abnormal genes. There were four, zero and one case receiving PUBS only for AMA in 2015, 2016 and 2017, respectively. Indications, including high risk suggested by serum screening and fetal abnormality found by ultrasound were identified in 290 cases (70.4%) in the second or third trimester. Other than AMA, there were no statistically significant differences in single indicators. The proportion PUBS with double indicators increased from 2015 to 2017 but without significant difference. AMA and positive serum screening as indicators of aneuploidy screening accounted for 7.6% (8/105) in double-indicator group and 1.9% (8/412) in all. (3) There were 363 PUBS (88.1%) performed for ultrasound abnormalities. Among them, 76.9% (280/363) only had abnormal ultrasound findings, and the percentage was decreased year by year. The other 83 cases (80 with double indicators and three with triple indicators) also presented with other indicators, including AMA, adverse pregnancy history and positive serum screening. The proportion of PUBS performed with the presence of multiple indicators tended to increase recently, but no statistically significant difference was found. All the 18 cases with abnormality diagnosed by molecular genetic testing had abnormal ultrasound findings.@*Conclusions@#Although PUBS's complications are rare, it carries some risks. The constitution of single indication has been declined every year. With the improvement of prenatal screening system and application of molecular karyotyping, the necessity of invasive prenatal diagnosis with PUBS is greatly reduced. An improvement in reasonable and standardized application of PUBS needs to be achieved.
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Objective To investigate the tendency and safety of percutaneous umbilical cord blood sampling (PUBS) in prenatal screening and diagnosis,and the possibilities of avoiding unnecessary PUBS.Methods This was a retrospective study of pregnant women who underwent PUBS for prenatal diagnosis in Peking University First Hospital from January 2015 to December 2017.Clinical indications,timing of PUBS,further investigations (chromosome karyotype,molecular genetics and pathogen testing),results,and pregnancy outcomes were collected and analyzed.One-way analysis of variance (ANOVA),Chi-square test for linear trend,Fisher's exact probability test/Cochran-Armitage analysis and Cruskal-Wallis rank-sum test were used for statistical analysis.Results (1)A total of 412 singleton pregnancies underwent PUBS at 20-38 gestational weeks during the study period,and 379 (92.2％) of them received PUBS before 34 gestational weeks.The positive test results accounted for 10.4％ (43/412).There were six (1.5％) miscarriages after PUBS.In vitro cell culture failure occurred in two cases,one in 2015 and the other in 2016.(2) Among the 412 cases,304 (73.8％) had only one indication.Fourteen cases could be identified as high risk in the first trimester,such as advanced maternal age (AMA,＞35 years),pregnant history with chromosomal abnormal fetus and one of the couples carrying abnormal genes.There were four,zero and one case receiving PUBS only for AMA in 2015,2016 and 2017,respectively.Indications,including high risk suggested by serum screening and fetal abnormality found by ultrasound were identified in 290 cases (70.4％) in the second or third trimester.Other than AMA,there were no statistically significant differences in single indicators.The proportion PUBS with double indicators increased from 2015 to 2017 but without significant difference.AMA and positive serum screening as indicators of aneuploidy screening accounted for 7.6％ (8/105) in double-indicator group and 1.9％ (8/412) in all.(3) There were 363 PUBS (88.1％) performed for ultrasound abnormalities.Among them,76.9％ (280/363) only had abnormal ultrasound findings,and the percentage was decreased year by year.The other 83 cases (80 with double indicators and three with triple indicators) also presented with other indicators,including AMA,adverse pregnancy history and positive serum screening.The proportion of PUBS performed with the presence of multiple indicators tended to increase recently,but no statistically significant difference was found.All the 18 cases with abnormality diagnosed by molecular genetic testing had abnormal ultrasound findings.Conclusions Although PUBS's complications are rare,it carries some risks.The constitution of single indication has been declined every year.With the improvement of prenatal screening system and application of molecular karyotyping,the necessity of invasive prenatal diagnosis with PUBS is greatly reduced.An improvement in reasonable and standardized application of PUBS needs to be achieved.
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Objective To evaluate the risk factors and sonographic findings of pregnancies complicated by placenta increta or placenta percreta. Methods Totally, 2219 cases were retrospectively analyzed from 20 tertiary hospitals in China from January 2011 to December 2015. The data were collected based on the original case records. All cases were divided into two groups, the placenta increta (PI) group (79.1％, 1755/2219) and the placenta percreta (PP) group (20.9％, 464/2219), according to the degree of placental implantation. The risk factors and sonographic findings of placenta increta or percreta were analyzed by uni-factor and logistic regression statistic methods. Results The risk factors associated with the degree of placental implantation were age, gravida, previous abortion or miscarriage, previous cesarean sections, and placenta previa (all P<0.05), especially, previous cesarean sections (χ2=157.961) and placenta previa (χ2=91.759). Sonographic findings could be used to predict the degree of placental invasion especially the boundaries between placenta and uterine serosa, the boundary between placenta and myometrium, the disruption of the placental-uterine wall interface and loss of the normal retroplacental hypoechoic zone(all P<0.01). Conclusions Previous cesarean sections and placenta previa are the main independent risk factors associated with the degree of placenta implantation. Ultrasound could be used to make a prenatal suggestive diagnosis of placenta accreta spectrum disorders.
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Agmatine is an endogenous amine synthesized from the decarboxylation of arginine.It has a rich biological effects and presents in plants, bacteria and mammalian tissues.Agmatine is highly polar and has a low molecular weight.There are no UV and fluorescent absorption groups in agmatine structure, so it is difficult to gasify.In addition, the content of endogenous agmatine is low, and there are many interference components in biological samples, and the general method is difficult to detect.The pre-column derivatization of agmatine with fluorescence reagents not only increase the molecular weight of agmatine, but also make them with fluorescence, which greatly improve the detection sensitivity and enable the endogenous agmatine to be well separated.It is an important method to determine the content of agmatine.In this paper, several kinds of precolumn derivatives are summarized, and the advantages and disadvantages of various derivatives, the best derivation conditions and detection methods were also analyzed comprehensively.The aim is to determine the content of agmatine and to provide methods and ideas for its biological research.
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Objective To evaluate the effects of B-Lynch suture for postpartum hemorrhage due to uterine atony,and to clarify its influence on long-term fertility and next pregnancy outcome.Methods We retrospectively collected the medical records of 150 women who underwent B-Lynch suture during cesarean section due to intra-operative bleeding caused by uterine atony from January 1,2006 to December 31,2013 in Peking University First Hospital.Follow-up was carried out to assess postoperative menstruation and subsequent pregnancy outcomes.Results All the cases underwent B-Lynch suture which successfully retained the uterus.Satisfactory hemostasis was achieved in 131 women (87.3％) who underwent B-Lynch suture only,and in eighteen women (12.0％) who had bilateral uterine artery ascending branch ligation at the same time;and in one patient (0.7％) who underwent B-Lynch suture and uterine artery embolization four hours later due to poor uterine contraction.Of the 141 (94.0％) cases followed up after surgery,menstrual cycle was assessed in a total of 104 women:no changes in the menstrual cycle and bleeding volume were noted in 67 cases (64.4％),prolonged menstruation was observed in five cases (4.8％),menorrhagia in ten cases (9.6％),and hypomenorrhea in 22 cases (21.2％).Eleven women (23.9％) became pregnant and delivered in two to four years after the surgery,and all were full-term abdominal delivery.Conclusions B-Lynch suture is a simple,safe,and effective treatment for postpartum hemorrhage due to uterine atony,without significant change of menstruation.B-Lynch suture is not associated with infertility,and the postoperative pregnant outcome is good.
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Objective To evaluate narrow?band imaging(NBI)for early esophageal cancer and pre?cancerous lesions. Methods A total of 170 patients ( 192 lesions) diagnosed as having superficial esophageal carcinoma and precancerous lesions by endoscopy were retrospectively analyzed. Clinical data of endoscopy, narrow?band imaging (NBI) and iodine chromoscopy were analyzed.Results The detection rates of early esophageal cancer were both 100?? 0% in NBI(13/ 13) and iodine staining (13/ 13), with no statisti?cally significant difference (P>0?? 05).The detection rate of high grade intraepithelial neoplasia in NBI and i?odine staining was 94?? 9% (94/ 99) and 100?? 0% (99/ 99) respectively with no statistically significant differ?ence (P>0?? 05); The detection rate of low grade intraepithelial neoplasia in iodine staining was 100?? 0%(80/ 80), significantly higher than that of NBI 78?? 8% (63/ 80) (P<0?? 01).Conclusion NBI and iodine staining endoscopy show better diagnostic value for early esophageal cancer and similar diagnostic value for high grade intraepithelial neoplasia in precancerous lesions. But for the low grade intraepithelial neoplasia, the diagnostic value of iodine staining endoscopy is better than that of NBI.
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As the curriculum was unreasonable and teaching approac h was simple in the course of pharmaceutical analysis,the course curriculum was reconstructed and optimized to be more advanced and more scientific.Reasonable teaching approaches will be adopted according to different teaching contents and diverse teaching model which is benefit to the cultivation of students' innovative capability will be constructed.
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Objective To evaluate pit pattern analysis for detection of early colorectal carcinoma and precancerous lesions. Methods A total of 162 lesions in 144 patients were examined with magnifying colonoscopy after staining, and their pit patter was analyzed with morphology and pathologic diagnosis. Results With confirmation of pathology, there were 34 non-neoplastic lesions and 128 neoplastic ones, in which 12 were carcinomas. The pit patterns in most non-neoplastic lesions (76. 5%, 26/34) were type Ⅰ or Ⅱ , and those in most neoplastic lesions (96. 1% , 123/128) was type Ⅲ, Ⅳ or Ⅴ. Pit patterns of cancerous lesions were mainly type Ⅴ (75.0%, 9/12), and those of 3 cases of advanced cancers were all type Ⅴ N. Conclusion Pit pattern classification is a very important tool to differentiate between neoplastic, nonneoplastic lesions and early cancer, which helps to decide later therapeutic intervention.
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Objective To study the effects of mechanical strain on the proliferation of the human pulmonary epithelial cell and the redistribution of its membrane receptors, integrins ? 5 and ? 1. Methods A cyclic strain unit in vitro was designed. The cellular proliferative index was measured by flow cytometry and the redistribution of ? 5 and ? 1 integrins was analyzed in human pulmonary epithelial cell line H727 by laser confocal microscopy. Results The cellular proliferative index reduced significantly after cells were subjected to 15% elongation at frequencies of 20 cycles/min or 40 cycles/min for 24 h. In human pulmonary epithelial H727 cells, ? 5 and ? 1 integrins transferred from the apical layer to the basal layer and formed an adhesion plaque after 24 h exposure to 15% elongation at frequency of 40 cycles/min. Conclusion The results suggest that ? 5 and ? 1 integrins in pulmonary epithelial cells may play an important role in the transduction of mechanical stress.