[Study of fraction amplitude of low frequency fluctuation on resting-state functional magnetic resonance imaging in adultperipheral facial paralysis].

Objective: To analysis the change of brain functional activity in the left and right peripheral facial paralysis by using resting-state functional magnetic resonance imaging (R-fMRI) of fraction amplitude of low frequency fluctuation(fALFF) measurement technique, and research the abnormal brain region with different side patients whether there are differences. Methods: A total of 43 patients with peripheral facial paralysis patients (patient groups, divided into left / right two subgroups) and 21 healthy volunteers (control group) in this study.Resting-state fMRI were acquired for each volunteer and patient. The fALFF approach was used to compare the peripheral facial paralysis groups to healthy group.Functional analysis was performed with brain function analysis software REST and DPARSFA , and then analysis the difference of two groups of patients and control group in two sample t test.At the same time, the correlation analysis between fALFF parameters map of the left and right side of two groups of patients and corresponding facial nerve grading TFGS score.Ultimately obtain a statistically significant brain regions. Results: Compared to healthy group, the decreased fALFF areas in the left side facial paralysis were showed in the right superior temporal gyrus , the pole of the right temporal, right middle temporal gyrus, the left occipital gyrus, and left medial cingulate gyrus, left paracentral lobule, and the left supplementary motor area; while the increased brain regions have the right superior frontal gyrus, right middle frontal gyrus, the right precentral gyrus, bilateral inferior temporal gyrus and middle temporal gyrus.Compared to healthy group, the decreased fALFF areas in the right side facial paralysis were showed in the right inferior temporal gyrus and fusiform gyrus, the left inferior occipital gyrus, the left superior parietalgyrus, the left inferior parietalgyrus, left precuneus, left paracentral lobule, the left supplementary motor area; while the increased brain regions have the left Calcarine, right lingual gyrus, corpus callosum, right medial cingulum gyrus.In the left facial paralysis group TFGS score was positively correlated with brain regions have left middle frontal gyrus, left precuneus and left cuneus, while the negatively related brain area on the right lingual gyrus.In the right facial paralysis groups TFGS score was positively correlated with brain areas have right inferior temporal gyrus and middle temporal gyrus, left inferior parietalgyrus; while the negatively correlated brain area on the left superior temporal gyrus, the right medial frontal gyrus. Conclusion: The left and right side facial paralysis patient's mood and motor function integration mechanism may be different, and the patient's emotional and psychological changes may be associated with disease severity.

Astrocytic Cx 43 and Cx 40 in the mouse hippocampus during and after pilocarpine-induced status epilepticus.

Astrocytes have now been well accepted to play important roles in epileptogenesis by controlling gliotransmitter release and neuronal excitability, contributing to blood-brain barrier dysfunction and involving in brain inflammation. Recent studies indicate that abnormal expression of gap junction protein connexin (Cx) may also be a contributing factor for seizure generation. To further address this issue, we investigated the progressive changes of Cx 43 and Cx 40 in the mouse hippocampus at 4 h, 1 day, 1 week and 2 months during and after pilocarpine-induced status epilepticus (PISE). The co-localization of Cx 43 and Cx 40 with glial fibrillary acidic protein (GFAP) was also examined. We observed that Cx 43 and Cx 40 protein expression remained unaltered at 4 h during and at 1 day (acute stage) after PISE. However, their expression was significantly increased in CA1 and CA3 areas and in the dentate gyrus at 1 week (latent stage) and 2 months (chronic stage) after PISE. Double immunofluorescence labeling indicated the localization of Cx 43 and Cx 40 in astrocytes. Combined with progressive neuronal loss in the mouse hippocampus, our results suggest that the increase in gap junctions in the neuronoglial syncytium of reactive astrocytes may be implicated in synchronization of hippocampal hyperactivity leading to neuronal loss and epileptogenesis.

The effect of a Foley catheter balloon on cervical ripening.

The Foley catheter balloon may affect cervical ripening through changes in biochemical mediators by immunoassay and immunohistochemistry, when it is used for pre-induction cervical ripening. The aim of the study was to evaluate the changes in the biochemical mediators from the extra-amniotic space and immunohistochemistry in ripened cervical tissue after the insertion of a Foley catheter balloon (FCB) for pre-induction cervical ripening. A total of 18 pregnant women with a Bishop's score < 6, who were undergoing labour induction, were evaluated in this prospective study. The FCB was irrigated with 10 ml of phosphate buffered saline and the irrigant was collected 0, 2, 4 and 8 h after placement of the FCB or until spontaneous expulsion of the FCB occurred. Irrigant specimens were also collected from 10 spontaneous labouring (SL) women in the active phase of labour. The levels of interleukin (IL)-6, IL-8, matrix metalloproteinase (MMP)-8 and NO were measured. Cervical specimens were obtained from 12 women, including four undergoing induction; four SL and four non-pregnant (NP) women. Immunohistochemical staining was performed to localise hyaluronic acid synthase (HAS)-1, IL-6, IL-8, MMP-8, endothelial nitric oxide synthase (eNOS) and inducible NOS (iNOS). Results showed that the levels of IL-6, IL-8, and MMP-8 significantly increased over time in FCB group (p < 0.01). In the immunohistochemical analysis of cervical tissues, immunoreactivity of HAS-1 in the after FCB group was stronger than any of the other groups. The protein expressions of IL-6, IL-8, MMP-8, eNOS and iNOS were more prominent in the after FCB and SL groups than in the NP and the before FCB groups. iNOS was only observed in the after FCB and SL groups. It was concluded that FCB may affect cervical ripening through changes in biochemical mediators by immunoassay and immunohistochemistry, when it is used for pre-induction cervical ripening.

PP177. The usefulness of gestation-corrected hyperuricemia as a predictor of the development of preeclampsia on subsequent pregnancy.

INTRODUCTION: Hyperuricemia has been described commonly in preeclamptic pregnancies, often preceding the diagnosis of preeclampsia and historically was used as a diagnostic marker of preeclampsia. OBJECTIVES: The aim of this study was to determine the usefulness of uric acid to predict the preeclampsia on subsequent pregnancy. METHODS: The retrospective chart review was done. The pregnant women who had previous preeclampia or gestational hypertension and checked serum uric acid were enrolled in this study. Fifty-eight women were collected. Hyperuricemia was defined as being one standard deviation above the gestation-specific mean . And we used uric acid z-scores ([serum uric acid value - gestation specific mean]/standard deviation of the population) to account for gestation-specific alterations in uric acid and tested this as a continuous variable. Linear regression analysis was used to assess the relationship between gestation-corrected hyperuricemia and development of preeclampsia on subsequent pregnancy. RESULTS: Of 58 women, nineteen had the development of recurrent preeclampsia (37.5%). Linear regression analysis showed that the absence or presence of gestation-corrected hyperuricemia was not associated with the development of preeclampsia on subsequent pregnancy (p=0.353, 95% CI 0.418-11.520). And gestation-specific uric acid z-score as a continuous variable did not show any association with the prediction of preeclampsia on subsequent pregnancy (p=0.353, 95% CI 0.087-2.394). CONCLUSION: Gestation-corrected hyperuricemia does not predict the development of preeclampsia on subsequent pregnancy.

Hydrogen peroxide-producing Lactobacilli in the vaginal flora of pregnant women with preterm labor with intact membranes.

OBJECTIVES: To investigate the role of vaginal infection in preterm delivery, we studied characteristics of vaginal discharge related to hydrogen peroxide-producing Lactobacilli. METHODS: Vaginal specimens were obtained from 66 women with normal pregnancy and 30 women with preterm labor with intact membranes. pH, leukocyte counts on wet smear, and scores by Nugent criteria on Gram stain were measured. Lactobacilli were tested for their production of hydrogen peroxide. RESULTS: Leukocyte levels in wet smears and Nugent scores of Gram-stained smear of women with preterm labor with intact membranes were significantly higher than those of normal pregnant women (P<0.01, P<0.05). Hydrogen peroxide-producing Lactobacilli levels in the vaginal flora of women with preterm labor with intact membranes were significantly lower (P<0.01). CONCLUSION: Distribution of hydrogen peroxide-producing Lactobacilli in vaginal flora as defense factors for infection may have an important role in the pathophysiology of preterm labor.

Obstetric prognosis of the gestational thrombocytopenia.

To define clinical outcomes of marked gestational thrombocytopenia (GT) (<100,000/mm3) we identified twenty-nine infants born to 28 pregnancies at 26 women with GT among 8,364 deliveries during the years 1993- 1999. Cordocentesis was performed in 7 mothers with platelet counts less than 75,000/mm3. Cord blood platelet count was checked in all cases at delivery. The most significant decrease of platelet count in pregnancy with GT was less than 50,000/mm3 in 6 pregnancies (21.4%) and between 50,000 and 100,000/mm3 in 22 pregnancies (78.6%). In pregnancies with GT, 2 neonates (6.9%) had mild thrombocytopenia and 1 neonate (3.4%) moderate thrombocytopenia. Severe thrombocytopenia was not observed in any neonate born to mothers with GT. There were no cases of coagulation disturbance at delivery or in the postpartum period. Fourteen cases for which follow-up was carried out recovered platelet counts to more than 100,000/mm3 within one month postpartum. Two patients who became pregnant twice noticed recurrence of GT. In conclusion, GT is not associated with bleeding diathesis in the mother, resolves spontaneously during the postpartum period, and can recur in subsequent gestations, and the association of severe fetal/neonatal thrombocytopenia is very rare. No intervention is necessary during pregnancy or delivery, apart from a careful maternal and fetal surveillance if there is no obstetric indication.

Red blood cell life span in the ovine fetus.

Red cell life span within the fetal circulation has not been reported, although erythrocyte life span has been studied in the adult and newborn. The present study quantified red cell life span in 12 chronically catheterized fetal sheep at 97-136 days gestation (term = 150 days) with the use of autologous red cells labeled with [(14)C]cyanate. Cyanate forms a permanent covalent bond with hemoglobin and acts as a permanent red cell label. In the fetuses, blood (14)C activity decreased in a curvilinear fashion with time and reached 50% of the initial activity at 16.4 +/- 1.6 (SE) days. In contrast, (14)C activity of autologous red cells in two adult ewes decreased linearly with time as expected, reached 50% of the initial (14)C activity in 59 days, and yielded life spans of 117 and 121 days. Computer modeling and parameter optimization taking into account growth and skewed life span distribution were used to analyze the (14)C disappearance curve in each fetus. The mean life span of all red cells in the fetal circulation was 63.6 +/- 5.8 days. Mean red cell life span increased linearly from 35 to 107 days as fetal age increased from 97 to 136 days (r = 0.83, P < 0.001). Life span of cells produced at the time of labeling was significantly greater than the mean life span. Fetal growth rate estimated from parameter optimization was 3.28 +/- 0.72%/day; this compared well with the rate of 3.40 +/- 0.14%/day calculated from fetal weights at autopsy. Mean corpuscular volume decreased as a function of gestational age, but the decrease was small compared with the large increase in red cell life span. We conclude the following: 1) red cell life span in the fetal circulation is short compared with the adult; 2) red cells in younger fetuses have shorter life spans than in near-term fetuses; 3) the curvilinear disappearance of labeled red cells in the fetus appears to be due primarily to an expanding blood volume with fetal growth; and 4) red blood cell life span in a growing organism will be significantly underestimated unless the expansion of blood volume with growth is taken into account.

Prenatal diagnosis of severe tricuspid insufficiency in Ebstein's anomaly with pulmonary atresia and intact ventricular septum: a case report.

Pulmonary atresia with intact ventricular septum is an uncommon congenital cardiac anomaly which very often present varying degrees of downward displacement and dysplasia of the tricuspid valve. A 23-year-old woman was referred at 23 weeks' gestation because of fetal cardiomegaly detected by routine ultrasonography. Ebstein's anomaly with pulmonary atresia was diagnosed by fetal echocardiography. On pulsed Doppler examination, a severe tricuspid regurgitation was detected. Pulmonary atresia was suspected, as forward flow was not detected into pulmonary artery. The fetus was terminated at 25 weeks. At the postmorterm examination Ebstein's anomaly with pulmonary atresia and intact ventricular septum were confirmed. The finding of right atrial enlargement on an early sonogram should prompt the search for tricuspid valve abnormalities with tricuspid regurgitation and the presence or development of pulmonary atresia or stenosis. With the information provided, early detection of tricuspid valve disease should be possible so that the option of therapeutic abortion can be offered.

Fetal weight prediction by thigh volume measurement with three-dimensional ultrasonography.

OBJECTIVE: To evaluate the usefulness and accuracy of a simple method of predicting fetal weight by measuring fetal thigh volume with three-dimensional ultrasonography. METHODS: In 84 pregnant women, fetuses without structural or chromosomal anomalies were studied prospectively and cross-sectionally. Biparietal diameter (BPD), abdominal circumference (AC), and femur length (FL) were measured by two-dimensional ultrasound. Fetal thigh volume was measured by three-dimensional ultrasound, using three cross-sectional images of femur, from proximal, middle, and distal parts of femur diaphysis. Infants were delivered within 48 hours after ultrasound examinations. RESULTS: Modified thigh volume measurements using three cross-sectional images of femur by three-dimensional ultrasound were correlated strongly with birth weight (R(2) = 0.921, P <.001). Using linear and polynomial regression, we calculated a new best-fit formula: Birth weight (g) = 165.32 + 28.78 x modified thigh volume (mL). The mean and standard deviation of the residual were 121.8 and 110.4, respectively, in three-dimensional formulas, which were significantly smaller than those of two-dimensional formulas. CONCLUSION: Thigh volume measurement using three cross-sectional images of femur by three-dimensional ultrasound was simple, and there was better accuracy with this method than with two-dimensional ultrasound methods for predicting fetal weight during the third trimester of pregnancy.

Delayed interval delivery in multiple gestations.

Two multiple pregnancies with delayed delivery after expulsion of dead fetus are presented. Case 1: A woman with a twin pregnancy and one intrauterine fetal death at 20 weeks' gestation delivered a dead fetus at 27 weeks' gestation. She delivered a healthy male infant weighing 2430 g at 33 weeks' gestation (42 d after the delivery of the first twin). Case 2: A woman with quadruplets pregnancy (2 live fetuses, one empty sac, and one fetocide at 7 weeks' gestation) got a intrauterine fetal death at 21 weeks' gestation at one fetus among 2 live fetuses and delivered a dead fetus at 24 weeks' gestation. She delivered a healthy female infant weighing 2110 g at 33 weeks' gestation (58 d after the delivery of a dead fetus). On the basis of our experience and the review of literature, delayed delivery with careful observation of fetal and maternal condition is recommended for improved survival and decreased morbidity among latter-born siblings.

Low neonatal risk of thrombocytopenia in pregnancy associated with immune thrombocytopenic purpura.

OBJECTIVE: To estimate the risk of neonatal thrombocytopenia in infants born to mothers with immune thrombocytopenic purpura (ITP). METHODS: During the years 1993-1997, there were 6,082 deliveries. There were 32 infants born to 31 mothers with ITP. Cordocentesis was performed between 34 and 41 weeks of gestation in 16 mothers with ITP. The cord blood platelet count was checked in all cases at delivery. RESULTS: In mothers with ITP, 5 neonates (15.6%) had mild thrombocytopenia and 7 neonates (21.9%) moderate thrombocytopenia. Severe thrombocytopenia was not observed in any neonate born to mothers with ITP. CONCLUSIONS: The means of delivery in pregnant women with ITP can be determined solely on the basis of obstetric indications because the incidence of severe fetal and neonatal thrombocytopenia is very rare, neonatal intracranial hemorrhage is unlikely to be related to the mode of delivery and percutaneous umbilical blood sampling is technically difficult with a risk of fetal death.

A study on fetal urinary tract anomaly: antenatal ultrasonographic diagnosis and postnatal follow-up.

OBJECTIVE: To evaluate the incidence, associated anomalies, and the type of congenital urinary tract anomaly and to know the cause of congenital hydronephrosis. METHODS: In 4.5 years, 5,442 fetuses had ultrasonography and 48 cases of fetal urinary tract anomaly were detected. Ultrasonogram was done after delivery with further examination as necessary. RESULTS: The incidence of all types of anomaly was 4.3% (236/5,442) and the incidence of urinary tract anomaly was 0.9% (48/5,442, 8.8/1,000 births) of all babies born and 20.3% (48/236) of entire anomaly. Types of urinary tract anomaly were as follows; hydronephrosis (37 cases), multicystic dysplastic kidney (5 cases), polycystic kidney disease (2 cases), renal agenesis (2 cases), ectopic kidney (1 case) and hypoplastic kidney (1 case). Associated anomalies were found in 8 cases (16.7%) among 48. Causes of hydronephrosis were ureteropelvic obstruction in 13 cases, ureterovesical obstruction in 4 cases, vesicoureteral reflux in 2 cases, proximal ureteral obstruction in 2 cases, and no specific causes in 16 cases. CONCLUSIONS: Antenatal ultrasonography is a very useful diagnostic tool in the detection of urinary tract anomaly and a careful search for other anomalies is indicated when urinary tract anomaly is found.

Prenatal ultrasonographic diagnosis of congenital kyphosis due to anterior segmentation failure.

A few cases of congenital scoliosis due to segmentation failure have so far reported and the antenatal detection of pure congenital kyphosis without scoliosis due to segmentation failure has not been reported. We report the first prenatal identification using ultrasound of a fetus affected with pure congenital kyphosis due to anterior segmentation failure of the vertebral body between the second and third lumbar spine which was associated with ventriculomegaly, cleft palate, and hydramnios.

Treatment failure in malignant gestational trophoblastic disease.

One hundred and thirty-three patients with malignant gestational trophoblastic disease (GTD) were admitted. All patients (86/86) of the nonmetastatic and metastatic low-risk groups and 89.4% (42/47) of the metastatic high-risk group showed remission. The overall remission rate was 96.2%. Among 5 patients with brain metastases, however, only one (20%) survived. We arrived at two main conclusions. First, brain metastatic lesions did not successfully respond to therapy utilizing conventional chemotherapeutic regimens. Second, the key factors for successful outcome in brain metastases were early diagnosis and aggressive initial therapy. Therefore, early detection of brain metastases should be made with: (1) fine computerized tomography (CT) or magnetic resonance imaging (MRI), (2) measurement of the ratio of serum to cerebrospinal fluid hCG concentration, and (3) early recognition of their clinical features.

[Transplantation of free medial leg skin flap to bridge over electric burns at wrist].

Twelve wrists (in 11 patients) with electric burns were covered by the transplantation of free medial leg skin flaps. It was successful in 10 but failed in 2. Our experience is summarized as following: 1. The skin flaps can serve as bridge to allow blood to go through as well as good coverage for the wound. When the ulnar artery and the radial artery are injured, we can obtain a long segment of the posterior tibial artery, and portions of it can be used to repair these arteries. In this series two hands were saved with good function in three years follow-up. 2. The sites of the skin flaps are concealed. Harvesting of the flaps does not impaired the function of the donor site. Thickness of the flaps is adequate. The flaps are not excessively bulky. The anatomical site of the posterior tibial artery is constant. The calibre of the posterior tibial artery is similar to that of the radial arteries. The rate of success of the operation is high.