简介：摘要Background and objectiveCloser monitoring and treatment is vital for pregnant carbon monoxide (CO) poisoning cases due to fetal poisoning component. Permanent damage can occur in both the mother and the baby. It may cause stillbirth even though no serious clinical symptoms occur in the mother. Hyperbaric oxygen (HBO) treatment is advised for all pregnant patients regardless of their clinical symptoms. Pregnant CO poisoning patients that received HBO treatment and their fetal status were evaluated in this study.MethodsPregnant patients poisoned with CO treated in the same hyperbaric clinic were evaluated. Pregnant patients that received HBO treatment in a multiplace chamber were evaluated in terms of clinical status, demographic structure, laboratory tests, fetal effects and progress of the fetus until birth and 6 months postpartum.ResultsA total number of 32 pregnant cases were treated. COHb values were over 20% (min 6.9- max 40.2) in 23 patients, 11 patients had a history of syncope. All patients took HBO treatment under 2.4 ATA pressure for 120 min. 3 patients received more than 1 session of HBO treatments due to fetal stress; all other cases took 1 session of HBO treatment. No spontaneous abortus occurred in early follow-ups; only 4 babies were born prematurely. 2 of the babies were lost in the early phases after birth, due to causes non-related to CO poisoning complications (cyanotic heart disease, necrotizing enterocolitis). No significant difference were observed in the comparison of laboratory results of patients with syncope and of those who did not have syncope and comparison of patients with COHb value higher than 20% and patients with COHb value lower than 20% (P>0.05)．ConclusionHBO is not advisable for pregnant patients except for CO poisoning. In this study it is observed that HBO treatment under 2.4 ATA pressure for 120 min has no harmful effects on the mother and the fetus. It is observed that continuation of HBO treatment in the cases with fetal distress findings has beneficial effects. COHb levels and syncope were shown to have no significant effect on clinical symptoms and on blood tests.

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简介：AbstractThe obstetric issues and management styles in China are different from that in Western countries. Chinese medical education, residency training, obstetric care structure, and management of common obstetric complications are briefly reviewed and compared to the United States. Maternal-fetal medicine (MFM) is rapidly developing in China, but the development of MFM may not follow the same trajectory as in the West. Understanding the difference between China and the West may facilitate communication and foster mutual development.

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简介：AbstractBackground:Nearly 300 children and 20 mothers die from preventable causes daily, in Uganda. Communities often identify and introduce pragmatic and lasting solutions to such challenging health problems. However, little is known of these solutions beyond their immediate surroundings. If local and pragmatic innovations were scaled-up, they could contribute to better health outcomes for larger populations. In 2017 an open call was made for local examples of community-based solutions that contribute to improving maternal and child health in Uganda. In this article, we describe three top innovative community-based solutions and their contributions to maternal health.Main text:In this study, all innovations were implemented by non-government entities. Two case studies highlight the importance of bringing reproductive health and maternal delivery services closer to populations, through providing accessible shelters and maternity waiting homes in isolated areas. The third case study focuses on bringing obstetric imaging services to lower level rural health facilities, which usually do not provide this service, through task-shifting certain sonography services to midwives. Various health system and policy relevant lessons are highlighted.Conclusions:The described case studies show how delays in access to health care by pregnant women in rural communities can be systematically removed, to improve pregnancy and delivery outcomes. Emphasis should be put on identification, capacity building and research to support the scale up of these community-based health solutions.

简介：AbstractIt shows that detrimental exposures and conditions in mothers can lead to the development of obesity and type 2 diabetes in offspring. This can lead to a vicious cycle of metabolic dysfunction, where rising rates of obesity, pre-diabetes, and diabetes in individuals of reproductive age, propagating risks to subsequent generations. It is well established that regular exercise has important health benefits for people with obesity and type 2 diabetes. Recently, increasing studies aim to examine the effects of maternal exercise on metabolic health in offspring. This review aims to demonstrate the evidence linking maternal exercise during critical periods of development and its implications for glucose metabolism in offspring, including intervention timing, sexual dimorphism, different exercise type, and intensity. Then we further examine the potential role of epigenetic modifications in this process.

简介：Accordingtothemostrecentepidemiologicaldata,theprevalenceofhypertensionrangedfromabout25%inChineselivingeitherinthemainlandorinTaiwanandKoreans,toapproximately40%inMongolians.Thecontrolrateofhypertensionwasabout35%inKoreansandJapanese,24%inMongolians,andlessthan10%inChinese.Fourplacebo-controlledtrialsinChinaunequivocallyprovedthatantihypertensivetherapymaypreventstrokeandothercardiovascularcomplicationsinhypertensionorpatientswithahistoryofstrokeortransientischemicattack.Fouractively-controlledtrialsinJapandidnotshowsignificantdifferencebetweenvariousclassesorcombinationsofantihypertensivedrugs.TwotrialsthatcomparedintensivewithlessintensivebloodpressurecontrolinelderlyJapanesehypertensivepatientsdidnotshowfurtherbenefitofcontrollingsystolicbloodpressuretoalevelbelow140mmHgincomparisonwithbloodpressurecontroltoalevelof140mmHgorabove.Thesetrialsthatcomparedvariousclassesofantihypertensivedrugsorintensivewithlessintensivebloodpressurecontroloftenhadsmallsamplesizeandhenceinadequatepowertodetectmodestormoderatebenefit.ThereisstillaneedforhighqualityoutcometrialdatainEastAsians.

简介：AbstractGestational diabetes mellitus (GDM) is a well-established risk factor for fetal macrosomia. A significant number of patients with GDM also suffer from obesity, a factor associated with fetal macrosomia. An important question is whether GDM is independently associated with fetal macrosomia, or whether this relationship is merely the result of maternal obesity acting as a confounder. In this review of the literature, we attempt to further elucidate the relationship between GDM, maternal obesity, and fetal macrosomia.

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简介：AbstractObjective:This article aimed to compare the peripheral blood flow intensity (BFI) in the maternal right and left kidney in uncomplicated third trimester pregnancies and to study possible associations between parenchymal BFI in the kidneys and maternal, labor and new-born characteristics.Methods:We conducted a prospective cohort study in third trimester pregnancies at Trondheim University Hospital, Norway, from January to April 2018. The BFI in the maternal kidneys was examined with color Doppler ultrasound and the peripheral BFI was calculated using the Pixel Flux-method which is a method based on pixel wise calculation of color in an image. Velocity was coded by the color bar in the ultrasound device. The peripheral BFI was calculated as the product of velocity and area encoded by all colored pixels divided by all pixels within the cortical layer by a software examining the color in each pixel of a standardized region of interest of the renal parenchyma in video-clips through a complete heart cycle. BFI (cm/s) was thus calculated as follows:The primary outcome measure was peripheral BFI in the renal cortex. We also examined associations between BFI in the entire cortex with maternal age, body mass index, blood pressure, pH in the umbilical artery, Apgar score after 5 minutes and birthweight.Results:In all, 51 pregnant women were included in the study, but 17 were excluded, mainly due to movement artifacts from the pulsating aorta, leaving 34 women in the final study population. We found significantly lower BFI in the cortex of the left kidney compared with the right kidney, 0.37 cm/s versus 0.69 cm/s, respectively (P = 0.04). Dividing into regions, the BFI was significantly lower in the proximal 25% of the left renal cortex compared to the corresponding right side (P= 0.01), and in the proximal 50% cortex (P= 0.02), but the differences were not significantly different in the distal 25% (P= 0.06) or in the distal 50% (P= 0.20) of the renal cortex.We observed a significant negative correlation between peripheral BFI in the left kidney and both systolic blood pressure (r = -0.38; P= 0.03) and diastolic blood pressure (r= -0.36; P= 0.04), and no significant correlations between BFI with maternal age, body mass index, blood pressure, pH in the umbilical artery, Apgar score after 5 minutes and birthweight in the left kidney (P > 0.05). We did not observe any significant correlations between BFI in the right kidney and maternal or new-born characteristics (P > 0.05).Conclusion:The BFI in the left renal cortex was lower compared with the right renal cortex, and BFI in the left renal cortex was negatively correlated with blood pressure, but not significantly correlated with maternal age, body mass index or newborn characteristics. We did not observe any significant correlations between BFI in the right kidney and maternal or new-born characteristics.

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简介：AbstractPurpose:Fingertip injuries are common in industrial production activities as well as in domestic work. Loss of pulp hampers daily life activities. Functional and aesthetic aspects are important in fingertip reconstruction. The bone is usually exposed along with soft tissue loss. Therefore to reconstruct the pulp flap with adequate bulk is required.Methods:We reported a case series of 12 patients with the injury over the volar aspect of distal phalanx of the index or middle finger. In all cases, laterally based thenar flap was chosen. The flap donor site was closed primarily in most of cases, while 4 patients required skin graft. The flap was detached between 2-3 weeks. Functional assessment was done using static and dynamic 2-point discrimination and range of motion at each joint. The aesthetic outcome was assessed through questionnaire. The results were analyzed using the unpaired t-test (SPSS version 21).Results:Partial necrosis occurred in 2 cases while rest of flaps survived successfully. Static 2-point discrimination ranged from 6-10 mm, mean 8.6 mm; and dynamic 2-point discrimination ranged from 8-10 mm, mean 8.9 mm. The mean satisfaction score was (4.0 ± 0.55).Conclusion:Thenar flap is a good choice for reconstruction of the finger pulp as it provides the bulk with good functional and aesthetic outcome.

简介：客观：调查创伤的有三个尖头的不足的外科的治疗的最佳的时间和过程。方法：从1984年5月到2004年9月，八个病人为创伤的有三个尖头的阀门不足经历了操作。所有病人，男性，从7～67年变老[中部：38年，意味着：（38。5±18。1)年]。在损伤和操作之间的间隔从1个月到20年[中部：19个月，意味着：(52.5±80.3)月)]。Inseven病人，有三个尖头的不足被归因在三个病人包括车辆事故弄钝胸损伤，另外的病人是一处stab创伤。诊断是证实的byechocardiography。在病人的外科手术前的心脏的功能作为纽约HeartAssociation(NYHA)班Ⅱ-Ⅳ被分类。在手术期间，有三个尖头的阀门的前面的传单完全或部分在所有病人由于索的破裂被乱摆。氏族的传单的索的破裂在一个病人被发现。前面的传单在二个病人被穿孔。Septalleaflet被缩回并且支持者到在二个病人的室的中隔。阀门修理为所有病人被打算。最后，阀门修理在3个病人成功地被执行，有三个尖头的代替在5个病人被执行。结果：没有早或迟了的死亡发生了。与follow-upthrough为7-129月的临床的表明和回响心动描记法[中部：39个月，平均数:(53.4±42.8)月]，所有病人作为NYHA班Ⅰ被分类，没有任何changes.Conclusions：创伤的有三个尖头的不足的令人满意的治疗能被外科的治疗获得。更早的外科可以增加有三个尖头的阀门修理的可行性并且阻止恰好室的功能的恶化。

简介：lObjectiveTalar身体破裂是稀罕的并且有差的处理结果。学习是报导关上的talardomefractures.MethodsEight的长期的外科的治疗结果的这的目的关上了talar身体破裂，在我们的水平与小碎片cancellous螺丝钉或Herbert螺丝钉由开的减小和内部固定对待我损伤中心回顾地被分析。脚(antero以后、侧面、倾斜的看法)和脚关节的外科手术前、手术后的拍(antero以后，侧面并且榫眼看法)被获得。病人被跟随在上面放射学地并且机能上地(脚功能索引，FFI)在3以后，星期，6个星期，3个月，6个月然后annually.ResultsThere是五压碎破裂并且三砍破裂(二sagittal砍并且一个花冠砍)，与5年的平均后续。没有早复杂并发症在这些病人被注意。迟了的复杂并发症在四个病人在talar身体的六个病人和osteonecrosis包括了subtalar/ankle关节的osteoarthrosis。在功能的评价以后，在5年以后的吝啬的FFI是104.63个点，更坏的结果在压碎损害和花冠被注意砍破裂。Sagittal砍破裂有对通过手术对待的talar身体破裂随后的复杂并发症是的好功能、放射学的outcome.ConclusionsLate不可避免尽管准确减小和僵硬固定被完成，因此，病人们应当关于不利结果被建议。尽管压碎和花冠砍，破裂有差的结果，sagittal损害在长期的评估上有好预后。

简介：ObjectivesPercutaneousballoonmitralvalvuloplasty(PBMV)isonewaytoimprovetherheumaticmitralstenosis.Howdoestheprocedureworkingravidaandfetusisnotveryclear.WeanalyzedtheeffectsandsafetyofPBMVoperationonpregnantpatientswithsevererheumaticmitralstenosis.MethodsEightpregnantpatientssufferingfromseveremitralstenosisunderwentfacilitatedPBMVoperationwithInoueballoon,andwerefollowedupfor(2.0±1.1)years.Contentsincludedoutcomeofpregnancy,infantgrowth,hemodynamics,echocardiography,cardiacfunction,mitralvalvesreplacementorrepeatvalvuloplasty.ResultsMitralvalvearea(MVA)before,oneweekandoneyearafterfacilitatedPBMVwere(0.84±0.21)cm2,(1.69±0.23)cm2and(1.51±0.24)cm2respectively.Thetransmitralpressuregradientdroppedfrom(22.1±4.7)mmHgto(9.9±3.1)mmHg(P<0.001)(1mmHg=0.133kPa).AfterfacilitatedPBMV,allpatientsshowedremarkableimmediatesymptomaticandhemodynamicimprovementwithoutseveremitralregurgitation.AllofthesepatientscouldmaintainNewYorkheartassociation(NYHA)ⅠorⅡfor(2.0±1.1)yearsaftertheoperation.TwopatientsdemandedinducedabortionconcerningabouttheteratogeniceffectofX-rayonfetus.Alltheothersixpatientscontinuedtheirgestationandhadfull-termcesareansectionwithoutcomplications.Theirnewbornsdevelopedhealthyandnormallytillnow.ConclusionsFacilitatedPBMVisafeasible,safeandeffectivedeviceforselectedpregnantpatientswithmitralstenosis.Theoperationiswelltoleratedbythefetus.

简介：AbstractViral infections during pregnancy are associated with adverse pregnancy outcomes, including maternal and fetal mortality, pregnancy loss, premature labor, and congenital anomalies. Mammalian gestation encounters an immunological paradox wherein the placenta balances the tolerance of an allogeneic fetus with protection against pathogens. Viruses cannot easily transmit from mother to fetus due to physical and immunological barriers at the maternal-fetal interface posing a restricted threat to the fetus and newborns. Despite this, the unknown strategies utilized by certain viruses could weaken the placental barrier to trigger severe maternal and fetal health issues especially through vertical transmission, which was not fully understood until now. In this review, we summarize diverse aspects of the major viral infections relevant to pregnancy, including the characteristics of pathogenesis, related maternal-fetal complications, and the underlying molecular and cellular mechanisms of vertical transmission. We highlight the fundamental signatures of complex placental defense mechanisms, which will prepare us to fight the next emerging and re-emerging infectious disease in the pregnancy population.

简介：EffectsofmaternaldietaryzincdeficiencyonprenatalandpostnatalbraindevelopmentwereinvestigatedinICRstrainmice.Fromd1ofpregnancy(E0)untilpostnatald20(P20),maternalmicewerefedexperimentaldietsthatcontained1mgZn/kg/day(severezincdeficient,SZD),5mgZn/kg/day(marginalzincdeficient,MZD),30mgZn/kg/day(zincadequatelysupplied,ZA)or100mgZn/kg/day(zincsupplemented,ZSandpair-fed,PF).Brainsofoffspringfromthesedietarygroupswereexaminedatvariousdevelopmentalstagesforexpressionofnestin,anintermediatefilamentproteinfoundinneuralstemcellsandyoungneurons,Immunocytochemistryshowednestinexpressioninneuraltube10.5dpostcitrus(dpc)aswellasinthecerebralcortexandneuraltubefrom10.5dpctopostnatald10(P10).Nestinimmunoreactivitiesinbothbrainandneuraltubeofthosezinc-supplementedcontrolgroups(ZA,ZS,PF)werestrongerthanthoseinzinc-deficientgroups(SZDandMZD).Westernblotanalysisconfirmedthatnestinlevelsinpooledbrainextractsfromeachofthezinc-supplementedgroups(ZA,ZS,PF)weremuchhigherthanthosefromthezinc-deficientgroups(SZDandMZD)from10.5dpctoP10.ImmunostainingandWesternblotsshowednodetectablenestininanyoftheexperimentalandcontrolgroupbrainsafterP20.Theseobservationsofanassociationbetweenmaternalzincdeficiencyanddecreasednestinproteinlevelsinbrainsofoffspringsuggestthatzincdeficiencysuppressesdevelopmentofneuralstemcells,aneffectwhichmayleadtoneuroanatomicalandbehavioralabnormalitiesinadults.