Objective To investigate various types and quantities of fetal cells getting into peripheral blood of pregnant women and immune status related to pregnancy induced hypertension syndrome (PIH) and analyze the etiology of PIH.Methods (1) Three markers of fetal nucleated red blood cells (fNRBCs) in normal pregnant women(n=43)and PIH patients (n=39)were measured by flow cytometry: CD71,HbF/iAg and HbF/CA.(2)We detected the levels of sub-groups of lymphocytes and some plasma cytokines.such as TNF-α and IL-6.The blood samples were from normal pregnant subjects and patients of PIH.Results In the peripheral blood of patients of PIH and normal pregnant subjects,(1) The quantities of fetal cells using three different methods in PIH [6.56(11.37)%、0.09(0.16)%、0.06(0.11)%]were significantly different from normal pregnant subjects[1.58(3.35)%、0.04(0.08)%、0.02(0.06)%],Z= -5.31,-2.97,-4.13 respectively,P＜0.01.(2)Except CD8,the levels of CD3 (76.4±8.5)%,CD4(42.6±6.4)%,CD4/CD8(1.5±0.4)%,CD19(10.5±3.9)%,CD16/CD56 (12.2±7.7)%,TNF-α (1.4 ±0.6)μg/L and IL-6(89.6±12.9)μg/L in PIH were significantly different from normal pregnant subjects[CD3(70.4±8.3)%,CD4(35.3±6.9)%,CD4/CD8(1.2±0.4)%,CD19(8.2±2.8)%,CD16/CD56(20.5±8.9)%,TNF-α(0.5±0.2)μg/L and IL-6(22.0±5.7)μg/L,respectively,P＜0.001].There were no significant differences observed in the level of CD8(P＞0.05).Conclusion The increment of fNRBCs getting into peripheral blood of pregnant women and associated immune status were implicated in the development of PIH.

Objective:To clarify the anatomical characteristics and adjacent relationship of the superior segment of the inferior vena cava during laparoscopic surgery.Methods:In December 2018, two frozen and two fresh adult cadavers were dissected. The chest of the frozen cadavers was opened along the bilateral midline of the clavicle, the anterior pericardial wall was opened, and the superior vena cava and the inferior vena cava was dissected. The abdominal cavity was opened along the midline of the abdomen, the left and right hepatic lobes were turned over, the inferior vena cava and the second hilum of the posterior segment of the liver were exposed, and the hiatus of the inferior vena cava was opened and entered the pericardium.The anatomical characteristics and adjacent relationship of the superior segment of the inferior vena cava were observed, and the length of the superior segment of the inferior vena cava was measured. The fresh frozen cadaver patients underwent laparoscopic surgery.Five 12 mm trocars were placed at the side of umbilicus, right rectus abdominis about 4 cm from umbilicus, midline of abdomen about 6 cm above umbilicus, right axillary front about 2 cm below inferior edge of liver, left midline of clavicle about 2 cm below inferior edge of liver. Laparoscopic-assisted turning of the left and right hepatic lobes, exposing the posterior inferior vena cava and the second hilum of the liver, opening of the vena cava hiatus into the pericardium.The anatomical characteristics and adjacent relationship of the upper diaphragmatic segment of the inferior vena cava were observed.Results:In two autopsies, the inferior vena cava entered the chest through the cava sulcus of the liver and the phrenic foramen cava, and then through the fibrous pericardium into the right atrium. The length from the diaphragm of inferior vena cava to the right atrium was 1.67 cm, 2.57 cm. In laparoscopic operation, the diaphragm entrance of the posterior segment of the liver inferior vena cava, the second hepatic portal and the inferior vena cava could be well exposed.The diaphragm could be opened along the hole of the vena cava with a relatively non vascular anatomical layer of adipose tissue.There was a large anatomical gap between the pericardium and the right atrium, and the inferior vena cava, the superior vena cava and the right atrium could be well exposed, and the whole diaphragm could be completely and continuously exposed from the bottom to the inferior vena cava at the entrance segment of the right atrium.Conclusions:There was a relatively avascular anatomical layer beside the inferior vena cava. During laparoscopic operation, opening the diaphragm through the abdominal cavity could safely enter the pericardium and expose the inferior vena cava, the superior vena cava and the right atrium, which provides a possibility for the removal of Mayo Ⅳ grade inferior vena cava tumor thrombus through this approach.