Correlation analysis of vitamin D level and anti-Müllerian hormone in infertile female and the role in predicting pregnancy outcome / 北京大学学报(医学版)

OBJECTIVE@#To investigate the relationship between serum 25(OH)D and anti-Müllerian hormone (AMH) among infertile females and their predictive impacts on in vitro fertilization and embryo transfer pregnancy outcome.@*METHODS@#Totally 756 infertile females treated with assisted reproductive technology were enrolled and divided into three groups according to their vitamin D levels (group A with serum 25(OH)D≤10 μg/L, group B with serum (10-20) μg/L, and group C with serum ≥20 μg/L). The serum AMH levels were detected. The differences among the groups were analyzed, as well as the correlation between vitamin D levels and serum AMH levels in various infertility types (fallopian tube/male factor, polycystic ovary syndrome (PCOS), ovulation disorders excluded PCOS, endometriosis, unexplained infertility, and others). Also, the predictive roles of vitamin D and AMH in pregnancy outcome in all the infertile females were discussed.@*RESULTS@#(1) 87.7% of the enrolled females were insufficient or deficient in vitamin D. (2) The serum AMH levels in the three groups with different vitamin D levels were 1.960 (1.155, 3.655) μg/L, 2.455 (1.370, 4.403) μg/L, 2.360 (1.430, 4.780) μg/L and there was no significant difference in serum AMH levels among the three groups (P>0.05). (3) Serum 25(OH)D and AMH levels presented seasonal variations (P < 0.05). (4) There was no prominent correlation between the serum AMH level and serum 25(OH)D level in females of various infertility types after adjusting potential confounding factors [age, body mass index (BMI), antral follicle count (AFC), vitamin D blood collection season, etc.] by multiple linear regression analysis (P>0.05). (5) After adjusting for confounding factors, such as age, BMI, number of transplanted embryos and AFC, the results of binary Logistics regression model showed that in all the infertile females, the serum AMH level was an independent predictor of biochemical pregnancy outcome (P < 0.05) while the serum 25(OH)D level might not act as a prediction factor alone (P>0.05). In the meanwhile, the serum 25(OH)D level and serum AMH level were synergistic predictors of biochemical or clinical pregnancy outcome (P < 0.05).@*CONCLUSION@#Based on the current diagnostic criteria, most infertile females had vitamin D insufficiency or deficiency, but there was not significant correlation between serum 25(OH)D and ovarian reserve. While vitamin D could not be used as an independent predictor of pregnancy outcome in infertile females, the serum AMH level could predict biochemical pregnancy outcome independently or jointly with vitamin D.

Effect of di-(2-ethylhexyl) phthalate exposure on placental development in pregnant mice / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the effect of di-(2-ethylhexyl) phthalate (DEHP) exposure on the growth and development of placenta, uterine natural killer (uNK) cell number and angiogenesis at the maternal-fetal interface in pregnant mice.</p><p><b>METHODS</b>From day 1 of pregnancy, pregnant mice were exposed daily to DEHP by oral gavage at 125, 250, or 500 mg/kg for 13 consecutive days. The uterine and placental tissues were then harvested for HE staining and immunohistochemistry to examine the effect of DEHP exposure on the growth and development of the placenta and angiogenesis and uNK cell number at the maternal-fetal interface.</p><p><b>RESULTS</b>Compared with the control group, the mice exposed to 500 mg/kg DEHP, but not those exposed to 125 and 250 mg/kg, showed significantly reduced number of embryo implantation (P<0.05). DEHP exposure significantly increased the rate of abortion. DEHP exposure at 125, 250, and 500 mg/kg significantly and dose-dependently lowered the placental weight compared with that in the control group (0.0637±0.0133, 0.0587±0.0176, 0.0524±0.0183 g vs 0.0786±0.0143 g, respectively; P<0.01), and significantly reduced the total area of the placenta and area of spongiotrophoblasts. DEHP exposure resulted in a significant reduction in the number of fetal vascular branches, and collapse and atresia of blood vessels. The mice exposed to DEHP at 125, 250, and 500 mg/kg had significantly lowered numbers of uNK cells (83.2±10.3, 60.7±12.4, and 50.4±14.5/HP, respectively) as compared with the control group (105.1±14.2/HP) at the maternal-fetal interface (P<0.01).</p><p><b>CONCLUSION</b>DEHP exposure significantly affects the growth and development of the placenta in mice possibly by suppressing angiogenesis and reducing uNK cell number at the maternal-fetal interface during pregnancy.</p>

Effect of hemoperfusion in treatment of children with acute poisoning / 中华儿科杂志

<p><b>OBJECTIVE</b>In China, with the development of public health and medical treatment, accident became the first cause of death of children aged form 1 to 14 years, and poisoning became one of the main causes. The present study was conducted to investigate the efficacy of hemoperfusion (HP) on poisoning, and the pharmacokinetics of the poison during and after HP. The study was also to observe the effect of HP on blood cell and blood biochemistry, blood flow and dosage of heparin during HP in children.</p><p><b>METHODS</b>Thirty-five children with acute poisoning (including 26 boys and 9 girls aged from 10 months to 13 years, mean 3.35 +/- 2.50 years) were treated with HP for one to three times. Among them 12 children were treated with HP for two times and 4 children for three times. Two ml blood samples of 6 children with Fluoroacetamide (FAM) poisoning and 10 children with Tetramine (TET) poisoning were collected. The concentration of poison was measured by gas chromatography (GC).</p><p><b>RESULTS</b>The poisoning symptoms of all cases were relieved or alleviated obviously. In the end, 27 (77%) cases recovered and 6 (17%) cases improved, while 2 (6%) cases died of multi-organ failure (MOF). Clinical symptom happened again 6 - 24 hours after HP in 1 case with FAM poisoning and 3 cases with TET whose clinical symptoms were relieved during HP. The PLT, RBC counts and Hb decreased significantly after HP compared with pre-HP (P < 0.05), while WBC, alanine aminotransferase (ALT), aspartate aminotransferase (AST), reatine kinase (CK), blood urea nitrogen (BUN), creatinine (CRE), Creatine kinase isoenzymes (CK-MB), total protein (TP), albumin (ALB) and globulim (GLO) after HP did not significantly change (P > 0.05). The FAM concentration was significantly reduced (P < 0.030). The concentration of TET in the poisoned children also significantly decreased with the treatment (P = 0.001). The cleaning efficacy of HP was higher during the first hour than that during the second hour of HP. The concentration of poison rose again 2 - 6 hours after HP in 1 case with FAM poisoning and 3 cases with TET poisoning, but the level was lower compared with pre-HP level. The t(1/2) of FAM and TET with and without HP was (2.40 +/- 0.66) h, (15.60 +/- 8.22) h, (4.10 +/- 1.66) h and (67.01 +/- 48.42) h, respectively. The first dose of heparin was (0.54 +/- 0.15) mg/kg; then (0.20 +/- 0.06) mg/kg was added for every 30 minutes. The velocity of blood flow was (4.39 +/- 0.99) ml/min.</p><p><b>CONCLUSIONS</b>The t(1/2) of the poison was shortened, and the poison clearing was accelerated by HP. The HP is a safe and effective therapy in children. The concentration of poison in some patient may rise again 2 to 6 hours after HP temporarily. The charcoal HP cannot remove the poison that conjugated with plasma albumin and globulin. The charcoal HP can cause temporary reduction of platelet and erythrocyte. The dosage of heparin used in children was lower than that in adult.</p>

Evaluation of charcoal hemoperfusion in dogs with acute fluoroacetamide poisoning / 中华儿科杂志

<p><b>OBJECTIVE</b>In the past the mortality and sequelae rate of the patients with severe fluoroacetamide (FAM) poisoning treated only with traditional remedies was high. During the recent ten years the authors treated children with severe FAM poisoning with charcoal hemoperfusion (HP) and achieved better results. However evidence was not sufficient to show that reduced mortality and sequelae rates were obtained from HP without traditional treatment because of lack of prospective randomized, controlled clinical studies. Thus, a dog model for FAM poisoning was designed in order to study the therapeutic effect, high-efficiency time of HP, the time of tissue-poisoning to release after HP, and to investigate the toxicokinetics of the poison in the course of treatment and after HP.</p><p><b>METHOD</b>Fourteen dogs were given intraperitoneal FAM at a dose of 0.3 mg/kg body weight. HP was performed on 9 poisoned dogs for 30 - 120 minutes post intoxication. Each procedure lasted for 4 hours. Blood samples of the 9 poisoned dogs were collected before HP and 30, 60, 90, 120, 180, 240 minutes during HP and 2, 6, 24 hours after HP. Blood plasma was separated from blood samples and stored at -20 degrees C. The concentration of the poison was measured by gas chromatography (GC). The clinical symptoms of all the dogs were observed for one day.</p><p><b>RESULTS</b>The FAM concentration (ng/ml) of blood samples in poisoned dogs before HP, and 60, 120, 180, 240 minutes during HP were 230.11 +/- 52.48, 184.56 +/- 62.57, 141.00 +/- 44.83, 126.78 +/- 61.04, 113.11 +/- 54.65 respectively. The differences were significant (chi(2) = 31.978, P < 0.0005). The dispersion count between pre-HP and HP for 1 was 45.55, between 1 h and 2 h was 43.56, between 2 h and 3 h was 14.22 and between 3 h and 4 h was 13.67. The values of FAM had declined by 38.7%, 45.0% and 50.8% respectively at 2 h, 3 h, 4 h of HP compared with pre-HP. The rate of cleaning efficacy of FAM of every hour during HP were 19.79%, 23.6%, 10.09% and 10.78% respectively during HP 1, 2, 3, 4 h. The cleaning efficacy of HP was high within 2 hours during HP. The concentration of FAM slightly rose again 6 h after HP. The level of FAM had declined at 24 hour after HP when compared with pre-HP level. The reduction rate of FAM level for every hour during HP was higher than that after HP (12.71% vs 0.27% - 2.22%). The t(1/2) of FAM with and without HP were (4.50 +/- 1.20) h and (49.60 +/- 10.56) h. All the 5 poisoned dogs not treated with HP died. However 6 poisoned dogs treated with HP kept alive after HP. Three dogs had frequent seizures again 4h after HP. After HP the charcoal container was washed by 0.9% saline and FAM could not be detected in the douche.</p><p><b>CONCLUSIONS</b>Charcoal HP was an effective treatment for severe FAM poisoning. T(1/2) of the poison was shortened, and the poison clearing rate was accelerated by HP. The high-efficiency time of HP was 2 - 2.5 h. Activated charcoal can adsorb the poison vigorously, and return of blood to the body after HP by using 0.9% saline was feasible and safe.</p>

Significance of Monitoring Serum Level of Gentamycin in Children with Serious Illness / 实用儿科临床杂志

Objective To explore the serum level of gentamycin for orally in children with serious illness.Methods The serum level of gentamycin in 41 children who were in serious illness [multiple organ dysfunction(MODS)group with 21 cases and non-MODS group with 20 cases ] were monitored and the patients were treated with select decontamination of the digestive tract(SDD) from October 2004 to April 2005.Dosage:10 mg/(kg?d),orally taken three times(every 8 hours) one day.The blood after taking the drug one hour later in the fourth day was selected and the serum level of getamycin was monitored.Results Thirty-six children of 41 cases serum level of gentamycin were negative and 5 children(4 in MODS group and 1 in non-MODS group) who had alimentary tract hemorrhage were masccline in serum after taking gentamycin one hour later in the forth day.The absorption of gentamycin from enteric after orally was not(rela)-ted to MODS.There were statistics value between the gestrintestinal tract ulcer and serum level of gentamycin.Conclusions The safety for treating the children in serious illness with gentamycin for SDD is obvious.But we suggest to monitor the serum level of gentamycin for who has severe alimentary tract hemorrhage together with insufficiency of liver and kindey.