Objective To analyze the relevant factors of vaginal delivery postpartum hemorrhage,and discussion how to prevent postpartum hemorrhage.Methods 2 417 maternal women who hospitalized vaginal delivery were selected.Preeclampsia,macrosomia,placental abruption,obesity,premature rupture of membranes,high blood pressure,gestational age,maternal age,maternal time,the number of abortion,scar uterus vaginal delivery,oxytocin induced labor,misoprostol for cervical mature,forceps midwifery,and the correlation of postpartum hemorrhage were analyzed.Results The incidence rate of postpartum hemorrhage was 15.22%.Pre -eciampsia,macrosomia,placental abruption had significant association with postpartum hemorrhage(χ2 =26.75,0.16,22.26,all P <0.01).Obesity, premature rupture of membranes were associated with postpartum hemorrhage(χ2 =6.53,4.98,all P <0.05).High blood pressure,gestational age,maternal age,maternal time,the number of abortion,scar uterus vaginal delivery had no statistical correlation with postpartum hemorrhage (P >0.05 ).Oxytocin induced labor,misoprostol for cervical mature,forceps midwifery were significantly associated with postpartum hemorrhage(χ2 =45.66,21.77,88.06,all P <0.01 ).Conclusion Prenatal maternal and neonatal weight control,prevention of preeclampsia,placental abruption occurred to prevent postpartum hemorrhage;Intrapartum avoid no indications oxytocin,misoprostol for cervical mature,forceps midwifery and reduce postpartum hemorrhage;Postpartum accurately estimated blood loss, active treatment,avoid serious complications.

Objective To discuss the effect of the occurrence of congestive heart failure on the outcome of pregnant women with pulmonary hypertension. Methods Fifty-four pregnant patients complicated with pulmonary hypertension were admitted from January 2000 through December 2010. Among them, 34 had comorbidity of congestive heart failure. The timing and mode of pregnancy termination, and perinatal outcomes were studied, and comparison was made between those with and without heart failure. Results ① Of all 54 pregnant women with pulmonary hypertension, 34 had congestive heart failure. The incidences of congestive heart failure in patients with mild, moderate and severe degree of pulmonary hypertension were 27.78% (5/18), 73.33% (11/15) and 85.71% (18/21), respectively (P<0.05).②The rate of maternal complications was 47.06% (16/34) and maternal mortality was 17.65% (6/34) in the patients with combined pulmonary hypertension and heart failure. The rate of iatrogenic fetal loss was 29.41% ( 10/34) , preterm labor 52.94% (18/34), neonatal asphyxia 35.29% (12/34) and neonatal mortality 23.53% (8/34) in case of patients with pulmonary hypertension complicated with congestive heart failure. ③The rate of Cesarean section was 91. 18% (31/34) in the patients with combined pulmonary hypertension and heart failure. ④ The rates of iatrogenic induction, premature delivery, maternal complications and mortality, neonatal asphyxia and fetal or neonatal fatality were significantly higher in women with combined pulmonary hypertension and heart failure than those with simple pulmonary hypertension ( P < 0. 05). Conclusions The risk of heart failure increases with the severity of pulmonary hypertension. The occurrence of heart failure is the most important factor affecting the outcome of patients in pregnancy already complicated with pulmonary hypertension , and Cesarean section is the safer mode of termination of pregnancy in this cohort of women.

Objective To study the potential role of tumor necrosis factor-α (TNF-α) induction in the development of mucosal barrier dysfunction in rats caused by acute intestinal ischemia-reperfusion injury, and to examine whether pretreatment with monoclonal antibody against TNF-α (TNF-α MoAb) would affect the release of D(-)-lactate after local gut ischemia followed by reperfusion. Methods Anesthetized Sprague-Dawley rats underwent superior mesenteric artery occlusion for 75 min followed by reperfusion for 6 hr. The rats were treated intravenously with either TNF-α MoAb (20 mg/kg) or albumin (20 mg/kg) 30 min prior to the onset of ischemia. Plasma D(-)-lactate levels were measured in both the portal and systemic blood by an enzymatic spectrophotometric assay. Intestinal TNF-αmRNA expression as well as protein levels were also measured at various intervals. In addition, a postmortem examination was performed together with a macropathological evaluation based on a four-grade scoring system.Results Intestinal ischemia resulted in a significant elevation in D(-)-lactate levels in the portal vein blood in both the control and treatment groups ( P ＜0.05). However, animals pretreated with TNF-α MoAb at 6 hr after reperfusion showed significant attenuation of an increase in both portal and systemic D(-)-lactate levels when compared with those only receiving albumin (P ＜ 0.05). In the control animals, a remarkable rise in intestinal TNF-α level was measured at 0.5 hr after clamp release ( P ＜ 0.01); however, prophylactic treatment with TNF-α MoAb completely annulled the increase of local TNF-α levels seen in the control animals. Similarly, after anti-TNF-α MoAb administration, intestinal TNF-α mRNA expression was markedly inhibited, which showed significant differences when compared with the control group at 0.5 hr, 2 hr and 6 hr after the release of occlusion ( P ＜ 0.05-0.01 ). In addition, the pathological examination showed marked intestinal lesions that formed during ischemia, which were much worse upon reperfusion,particularly at the 6 hr time point. These acute injuries were obviously attenuated in animals receiving TNF-α MoAb.Conclusions It appeared that acute intestinal ischemia was associated with failure of the mucosal barrier, resulting in increased plasma D(-)-lactate levels in both portal and systemic blood. These results suggest that TNF-α appears to be involved in the development of local damage associated with intestinal ischemic injury. Moreover, prophylactic treatment with TNF-α MoAb exerts preventive effects on ischemia/ reperfusion-induced circulating D (-)-lactate elevation and gut injury. ( J Geriatr Cardiol 2004;1(2):119-124. )

OBJECTIVE To know the distribution and drug resistance of the ventilator-associated pneumonia(VAP) bacteria in the intensive care unit(ICU),and to provide a reasonable basis for the clinical use of antibiotics. METHODS We used the Tiek Biagnostic systems to identifly microorganisms and antibiotic susceptibility.The result of the drug sensitivity test was analyzed with SPSS13.0. RESULTS A total of 538 strains were isolated from the sputum samples of the ventilator-associated pneumonia patients in the ICU over the last 4 years,in which Gram-negative bacteria were 361(the isolation rate 69.3%).Pseudomonas aeruginosa was the most common.Gram-positive bacteria were 143(the isolation rate 26.6%),in which Staphylococcus aureus was the most common.Twenty-two strain were fungi(the isolation rate 4.1%).Most of the pathogenic bacteria maintained high sensitivity rate to imipenem,vancomycin and quinupristin/daefopristin;but the drug resistance rate to other antibiotics was high and on the rise year by year. CONCLUSIONS The pathogens types of VAP was,complex,and multi-drug resistant.We should emphasize the reasonable application of the antibiotics and strengthen the monitoring of drug resistantce,and rational use of antibiotics to improve the cure rate.

OBJECTIVETo study the association between phthalate esters (PAEs) metabolites in maternal urine and 11beta-hydroxysteroid dehydrogenase type 2 (11β-HSD2 ) enzyme activity, explore the possible mechanism of PAEs effect on fetal development.

METHODSAll of 33 cases of intrauterine growth retardation (IUGR) newborn were selected by random sampling in 2012. And 33 cases of normal control newborn were enrolled, use high performance liquid chromatography-tandem mass spectrometry method was used to detect 4 kinds of phthalate esters (PAEs) metabolites in maternal urine: mono-n-butyl phthalate ester (MBP), mono (2-ethylhexyl) phthalate (MEHP), mono (2-ethyl-5-hydroxyhexyl) phthalate (MEHHP), mono (2-ethyl-5-oxohexyl) phthalate (MEOHP) and three kinds of cortisol corticosterone metabolites, tetrahydrocortisol (THF), allo-tetrahydrocortisol (allo-THF), tetrahydrocortisone (THE), and analyze the association between phthalate esters (PAEs) metabolites in maternal urine and 11β-HSD2 enzyme activity.

RESULTSMBP, MEHP, MEHHP, MEOHP metabolites can be detected in 98% (65 cases) , 89% (59 cases), 91% (60 cases), 91% (60 cases) of all 66 maternal urine samples, respectively. The median concentrations of test material in case group were 31.20 ng/ml for MBP, 24.61 ng/ml for MEHHP, 11.72 ng/ml for MEOHP and 48.67 ng/ml for SumDEHP which were significantly higher than those of the control group (were 17.32, 12.03, 5.68 and 28.64 ng/ml); 11β-HSD2 activity in case group ((THF+allo-THF)/THE = (0.79 ± 0.09) ng/ml) was significantly lower than that of the control group((THF+allo-THF)/THE = (0.58 ± 0.04) ng/ml); PAEs metabolites MBP (β' = 1.12), MEHHP(β' = 1.14), MEOHP(β' = 1.10), SumDEHP(β' = 1.08) in baby boy mother's urine was reversely correlated to 11β-HSD2 activity.

CONCLUSIONSPAEs could affect fetal development by inhibit 11β-HSD2 activity.

11-beta-Hydroxysteroid Dehydrogenase Type 2 ; Chromatography, Liquid ; Diethylhexyl Phthalate ; analogs & derivatives ; Fetal Development ; Humans ; Infant, Newborn ; Male ; Mass Spectrometry ; Phthalic Acids ; Tetrahydrocortisol ; analogs & derivatives ; Tetrahydrocortisone

Objective To study the association between phthalate esters ( PAEs ) metabolites in maternal urine and 11beta-hydroxysteroid dehydrogenase type 2(11β-HSD2 ) enzyme activity, explore the possible mechanism of PAEs effect on fetal development.Methods All of 33 cases of intrauterine growth retardation ( IUGR) newborn were selected by random sampling in 2012.And 33 cases of normal control newborn were enrolled , use high performance liquid chromatography-tandem mass spectrometry method was used to detect 4 kinds of phthalate esters ( PAEs) metabolites in maternal urine:mono-n-butyl phthalate ester (MBP), mono (2-ethylhexyl) phthalate (MEHP), mono (2-ethyl-5-hydroxyhexyl) phthalate(MEHHP), mono ( 2-ethyl-5-oxohexyl ) phthalate ( MEOHP ) and three kinds of cortisol corticosterone metabolites , tetrahydrocortisol (THF), allo-tetrahydrocortisol (allo-THF), tetrahydrocortisone (THE), and analyze the association between phthalate esters ( PAEs) metabolites in maternal urine and 11β-HSD2 enzyme activity.Results MBP,MEHP,MEHHP,MEOHP metabolites can be detected in 98%(65 cases),89%(59 cases), 91%(60 cases),91%(60 cases)of all 66 maternal urine samples, respectively.The median concentrations of test material in case group were 31.20 ng/ml for MBP, 24.61 ng/ml for MEHHP, 11.72 ng/ml for MEOHP and 48.67 ng/ml for SumDEHP which were significantly higher than those of the control group ( were 17.32,12.03,5.68 and 28.64 ng/ml); 11β-HSD2 activity in case group (( THF +allo-THF)/THE =(0.79 ±0.09) ng/ml) was significantly lower than that of the control group (( THF+allo-THF)/THE=(0.58 ±0.04) ng/ml);PAEs metabolites MBP(β′=1.12),MEHHP(β′=1.14),MEOHP(β′=1.10), SumDEHP (β′=1.08 ) in baby boy mother′s urine was reversely correlated to 11β-HSD2 activity.Conclusions PAEs could affect fetal development by inhibit 11β-HSD2 activity.

Objective To study the association between phthalate esters ( PAEs ) metabolites in maternal urine and 11beta-hydroxysteroid dehydrogenase type 2(11β-HSD2 ) enzyme activity, explore the possible mechanism of PAEs effect on fetal development.Methods All of 33 cases of intrauterine growth retardation ( IUGR) newborn were selected by random sampling in 2012.And 33 cases of normal control newborn were enrolled , use high performance liquid chromatography-tandem mass spectrometry method was used to detect 4 kinds of phthalate esters ( PAEs) metabolites in maternal urine:mono-n-butyl phthalate ester (MBP), mono (2-ethylhexyl) phthalate (MEHP), mono (2-ethyl-5-hydroxyhexyl) phthalate(MEHHP), mono ( 2-ethyl-5-oxohexyl ) phthalate ( MEOHP ) and three kinds of cortisol corticosterone metabolites , tetrahydrocortisol (THF), allo-tetrahydrocortisol (allo-THF), tetrahydrocortisone (THE), and analyze the association between phthalate esters ( PAEs) metabolites in maternal urine and 11β-HSD2 enzyme activity.Results MBP,MEHP,MEHHP,MEOHP metabolites can be detected in 98%(65 cases),89%(59 cases), 91%(60 cases),91%(60 cases)of all 66 maternal urine samples, respectively.The median concentrations of test material in case group were 31.20 ng/ml for MBP, 24.61 ng/ml for MEHHP, 11.72 ng/ml for MEOHP and 48.67 ng/ml for SumDEHP which were significantly higher than those of the control group ( were 17.32,12.03,5.68 and 28.64 ng/ml); 11β-HSD2 activity in case group (( THF +allo-THF)/THE =(0.79 ±0.09) ng/ml) was significantly lower than that of the control group (( THF+allo-THF)/THE=(0.58 ±0.04) ng/ml);PAEs metabolites MBP(β′=1.12),MEHHP(β′=1.14),MEOHP(β′=1.10), SumDEHP (β′=1.08 ) in baby boy mother′s urine was reversely correlated to 11β-HSD2 activity.Conclusions PAEs could affect fetal development by inhibit 11β-HSD2 activity.