ABSTRACT
Presently, surgery is the only treatment approach for gastric cancer and improving the prognosis of locally advanced gastric cancer is one of the key factors in promoting gastric cancer survival benefit. The MAGIC study was the first to demonstrate the efficacy of neoadjuvant chemotherapy (NAC) in European countries. In recent years, several clinical trials have provided evidence for the use of NAC in Asian patients with locally advanced gastric cancer. However, clinical practice guidelines vary between Asian and non-Asian populations. Optimal NAC regimens, proper target populations, and predictors of NAC outcomes in Asian patients are still under investigation. Herein, we summarized the current progress in the administration of NAC in Asian patients with gastric cancer.
ABSTRACT
There are an increasing number of women with CHD seeking to bear children,and once pregnant,the risk of heart and maternal and fetal complications increases,and heart function is furhter damaged.The risk depends on the type of congenital heart disease,degree of hemodynamic impairment,and potential complications.Strengthening the comprehensive management of such patients,conducting careful individual and multidisciplinary risk assessment,and formulating detailed plans for follow-up during pregnancy,delivery and postpartum treatment can reduce the risk and improve perinatal outcomes,which has important significance for reducing maternal mortality.
ABSTRACT
One of the new requirements for modern standardized management in obsterics is the use of ultrasound in the delivery room.Ultrasound can help clinicians to identify the fetal condition,fetal presentation and placental location,and the circumstances of uterine and abdominal cavity quickly and accurately in managing obstetric emergencies.It can also guide the management of labour progress,the selection of suitable mode of delivery,the appropriate operation to assist delivery,and the interventional operations. In recent years,there have been many progresses in the application of ultrasound in the labor ward,such as new indicators for the evaluation of labor progressing with ultrasonic,ultrasound-guided anesthesia and tracheal intubation,and evaluation of cardiac volume load and cardiac function and so on.So it can provide further protection for maternal and infant safety.
ABSTRACT
Amniotic fluid embolism is a rare and se-rious pregnancy complication and is an important cause of maternal death.Up to now,amniotic fluid embolism still lacks a clear and unified diagnostic standard,and it is only an exclusion diagnosis based on the clinical manifestations such as pulmonary hypertension,hypoxemia,hypotension,and coagulation dysfunction before massive hemorrhage that cannot be explained during labor and within 30 minutes after delivery.It is not recommended that any laboratory diagnosis be used for the diagnosis or exclusion of AFE,but blood routine,coagulation function,blood gas analysis,electrocardiogram,myocardial enzyme spectrum,chest X-ray,echocardiography,thromboelastic diagram,and hemodynamic monitoring are helpful for the diagnosis,condition monitoring and treatment of amniotic fluid embolism.Early treatment can improve the prognosis,so for every case of sudden pulmonary hypertension,hypoxemia,hypotension,coagulation dysfunction and other maternal symptoms,the possibility of amniotic fluid embolism should be considered.For clinically highly suspected amniotic fluid embolism,treatment can be performed before a definite diagnosis.
ABSTRACT
The ureteral injury is one of the significant complication of cesarean section.High risk factors include emergency caesarean section,history of caesarean section,hysterectomy during cesarean section,history of hypogastric zone operation,pelvic infection,etc.The lower uterine segment,especially1.5-3cm from UVJ,is the most common injury level,and more injuries occur on the left side than on the right.It is difficult to recognize the ureteral injuries intraoperatively.Postoperative diagnosis can be made by ultrasound,CTU or retrograde pyelography.Early recognition and repair of the ureteral injury are essential to the patient outcome and preventing late complications and reducing the cost.If the injuries are diagnosed postoperatively,the delayed operation can be performed between 6 weeks and 3months after cesarean section if conditions permitted.The key to avoiding ureteral injury during cesarean section is prevention.This requires us to observe the course of labor closely and handle abnormal labor process in time to avoid emergency caesarean section after long trial.The incidence of ureteral injuries can be reduced by careful operation.
ABSTRACT
Objective To investigate the operative indication,timing,method,selective standards of fetieided fetus and the number of reduced fetuses of selective multifetal pregnancy reduction in second trimester,and the pregnancy outcome of multifetal pregnancy by this operation.Methods Trans-abdominal selective multifetal pregnancy reductions in 37 cases of multiple pregnancy (twins 6 cases,triplets 21cases, quadruplets 8 cases,and quintuplets 2 cases) during 12~(+1) -25 weeks were performed under ultrasound guidance.The fetus to be reduced was injected potassium chloride (KC1) intraeardiacally until the fetal heartbeat stopped gradually.Totally 46 fetuses were reduced.Periodic prenatal examination and monitoring of coagulation function were carried out after the procedure.The pregnancy complications and pregnancy outcome of all cases were recorded.Results (1) The successful ratio of reduction was 100% (46/46 fetuses) and the successful pregnancy ratio was 88.9% (24/27).(2) Among all the 37 cases,fifteen deliveried after 36 weeks,seven deliveried in 32-36 weeks,three deliveried in 28-32 weeks,two aborted after feticide,and ten cases were in pregnancy at the time of this study.The mean gestational age of all was (34.9?4.1) weeks,and the delivery ratio after 28 weeks was 92.6% (25/27).(3) The mean birth weight of singletons was (3014?640) g,and of twins was (2557?573) g.The neonates of three triplets all died except for in one case two fetuses were alive.(4) Except in two cases after reducing one fetus of monoamniotie twins,another one died within 24 hours,the remaining fetuses were all alive.(5) Pre- eclampsia occurred in three cases.None of the cases had blood coagulation disturbances.Conclusion (1) Selective muhifetal pregnancy reduction in second trimester can feticide the abnormal fetus objectively or reduce the fetal number effectively.It is a safe procedure to decrease the complications of multifetal pregnancy and increase the birth weight.(2) ff the intention is reducing the fetal number,we choose the fetus who lies in the fundus uteri and reduce the muhifetal pregnancy to twins.(3) It is advised to aviod performing the procedure during vaginal bleeding.We reduce fetus after vaginal bleeding stops for one or more weeks.(4) Selective second-trimester multifetal pregnancy reduction will not result in the disturbance of blood coagulation and the death of remaining fetus.The incidence of pre-eclampsia is decreased after muhifetal pregnancy reduction.
ABSTRACT
Objective To investigate the effects of anticardiolipin antibodies positive serum from patients with recurrent pregnancy loss on the proliferation of BeWo cells as well as the modulation of heparin on the growth of BeWo cell.Methods Thirty patients with recurrent pregnancy loss whose anticardiolipin antibodies were positive and thirty healthy women with a history of term delivery were selected.Their sera were separately added to BeWo cell culture systems which contained either heparin or not.After 24 hours, the PCNA and 490 nm A value were detected by immunofluorescence and methyl thiazolyl tetrazolium (MTT),and the proliferation of BeWo cell was evaluated.Results In the culture systems with heparin and normal serum,normal serum,heparin and serum with positive autoantibody,serum with positive autoantibody,the mean fluorescence gray scale values of PCNA were 34.8?3.1,33.8?1.8,33.4?2.2 and 25.1?2.3,the 490 nm A values were 0.0560?0.0033,0.0535?0.0024,0.0524?0.0027 and 0.0350?0.0040,respectively.Conclusions The serum with anticardiolipin antibodies from patients with recurrent pregnancy loss can influence the prospective potency of BeWo cell,inhibit cell proliferation in vitro.Through this direct effect on biological behaviour of the trophoblastic cell,it will lead to recurrent pregnancy loss,whereas heparin can increase the ratio of pregnancy by reversing such effects in those patients.