Objective To discuss the influence of H1N1 influenza on maternal and fetal outcomes and obstetric management. Methods Totally, data were collected on 19 women, affected by H1N1 influenza and admitted to Shengjing Hospital of China Medical University from November 7, 2009 to December 15,2009, and retrospective analysis was performed on the maternal and fetal outcomes. Results Among the 19 cases, three were( 15. 8%, 3/19) in puerperium, who were all mild cases and recovered. Sixteen (84.2%, 16/19)women were diagnosed as H1N1 influenza during pregnancy, among which two in early pregnancy (12. 5%), seven (43. 8%) in mid-term pregnancy and seven (43. 8%) in late pregnancy. According to the severity of H1N1 influenza, six were mild cases (37. 5% ,6/16), two (12. 5% ,2/16)were severe cases and eight (50. 0% ,8/16)were critical. For these 16 pregnant women, thc two cases in early pregnancy (mild cases) were terminated after recovery from H1N1 influenza. Among the seven mid-term cases, four mild and one of the three severe and critical cases delivered till term, and two of the three severe and critical cases were delivered abdominally because of fetal death intrauterine or maternal severe complications at 27 or 23 weeks of gestation. All of the seven late pregnant cases underwent emergent cesarean section due to maternal or fetal reasons, and two fetuses died in the uterus at late pregnancy and five survived including four preterm babies and one full term baby. Altogether, nine cases (56. 3%, 9/16)underwent emergent cesarean section, and six babies born alive and five survived without any symptom of influenza, two women died (10. 5%,2/19) after the operation. Conclusions Pregnant women during late pregnancy infected by H1N1 influenza are susceptible to develop into severe and critical conditions. Termination of the pregnancy in time is effective in both life-saving of the mothers and babies and prevent neonatal infection against H1N1.

Objective To evaluate the diagnostic value of magnetic resonance imaging (MRI) on fetal ventriculomegaly identified through prenatal ultrasonography and the outcomes of these newborns were followed up. Methods From March 2006 to July 2008, MRI was performed on 135 pregnant women whose fetuses diagnosed as fetal ventriculomegaly at an average of 32 gestational weeks in Shengjing Hospital Affiliated to China Medical University. Mild ventriculomegaly was defined when the width of unilateral or bilaeral fetal cerebral ventricle triangle was 10-15 mm, moderate ventriculomegaly 16-20 mm and severe ventriculomegaly >20 mm. We introduced the Denver developmental screening test(DDST) to follow-up the mild ventriculomegaly and normal babies, confirmed by MRI, at 6-12 months after birth and a case-control study was conducted. The intelligence and growth of these infants were analyzed. Results (1) Diagnostic rate of fetal ventriculomegaly through MRI: Among the 135 gravidas, 60 (44.4%) showed isolated ventriculomegaly, 5 (3.7%) complicated with ventricular hemorrhage; 12 (8.9%) complicated with agenesis of corpus callosum (ACC) and 2 (1.5%) complicated with cerebellar hypoplasia, while 56 (41.5%) were normal. Seventy-nine cases had fetal ventriculomegaly on MRI and 15.2% (n=12) of them complicated with ACC. (2) Degree of fetal ventriculomegaly on MRI: Among the 60 isolated ventriculomegaly cases, 55 (91.7%) were mild and 5 (8.3%) moderate ones. Among the 5 cases complicated with ventricular hemorrhage, one was mild ventriculomegaly, and 4 moderate or severe cases. Among the 12 cases with ACC, 8(66.7%) were moderate ventriculomegaly and 4 (33.3%) severe cases. The 2 cases with cerebellar hypoplasia were both moderate ventriculomegaly fetuses. (3) Follow-up at 6-12 months after birth : thirty out (case group) of the 55 isolated ventriculomegaly cases, 38 out of the 56 normal babies and 42 babies with normal MRI results were followed up, and the later 80 cases were taken as control. Four infants (13.3%) in the case group and 10 (12.5%) in the control group showed abnormal or suspected results in DDST (P>0.05), the rest babies were all normal. (4) Clinical outcomes of the 79 ventriculomegaly fetuses diagnosed by MRI: thirty mild ventriculomegaly babies and 5 moderate ones were born at term and showed normal at follow ups. However, 7 gravidas were not compliant, 6 pregnancies were terminated, and 12 were last. Three of the 12 cases with ACC continued the pregnancy, and postnatal MRI of the babies showed the same with the prenatal MRI, 8 pregnancies were induced and one was lost. All of the 5 fetuses with ventricufar hemorrhage were induced and the prenatal diagnosis was confirmed by autopsy. One of the 2 fetuses with cerebellar hypoplasia was term delivered and diagnosed as cerebral palsy at the age of 6 months, and the other one was induced. Conclusions MRI is an indispensable complementary diagnostic method for fetal ventriculomegaly diagnosed through ultrasound. The development of intelligence and growth of babies born with mild isolated ventriculomegaly is the same as normal ones.

Objective To evaluate the diagnostic value of MRI in the cases suspected of ventriculomegaly by prenatal uhrasonography.Methods 104 patients of suspected fetal ventriculomegaly (VM) diagnosed by uhrasonography were included from the Shengjing Hospital,China Medical University from March 2006 to October 2007.All cases were divided into 4 groups based on the standard of Gaglioti:10-12 mm(66 cases),13-15 mm(22 cases),16-20 mm(14 cases),and 21-25 mm(2 cases);they included 75 eases of single intracerebroventricular expansion and 29 eases of double intracerebroventricular expansion.All of them were subjected to MRI scan within 48 h of uhrasonographic examination to determine the prenatal diagnosis by MRI pregnancy outcomes.Results Among the 26 072 cases who received prenatal uhrasonography,104 cases (0.39%) were VM. (1) MRI detected 3 cases (5%) in 10-12 mm group:one ease of cerebellar hypoplasia,vascular malformation,chest and abdominal anomalies each; 5 cases(23%)in 13 -15 mm group:one case of agenesis of corpus callosum (ACC),cerebral hemorrhage,cerebral hemorrhage with cerebral meningocele,cerebral meningocele,intracranial mass meningocele each; 6 cases(43% )in 16 -20 mm group:4 cases of ACC,one case of intraventricular hemorrhage and ACC combined with ventricular hemorrhage each; 2 cases in 21-25 mm group:one case of ACC and intraventricular hemorrhage each.(2) MRI detected 4 eases(5%) among 75 unilateral VM cases and 12 eases (41%) among 29 bilateral VM eases.The differences were significant (P＜0.01).MRI diagnosis rate was 15.38% (16 cases).Follow-up of the outcomes of the pregnancy showed induction of 0labor in 15 cases (14%) all of which were the same as MRI results on autopsy,full-term delivery of 88 cases,of which all the neonates were healthy.Conclusions When the expansion width is above 16 mm or bilateral VM is suspected by ultrasonography,we suggest MRI examination to determine fetal central nervous system disease.

Objective To observe the effect of kinesiotherapy-combined scalp acupuncture plus rehabilitation on the joint range of motion (ROM) and activities of daily life (ADL) in kids with spastic cerebral palsy. Method Fifty-one eligible patients with spastic cerebral palsy were divided into a treatment group of 23 cases and a control group of 28 cases by the random number table. The control group received conventional rehabilitation, whereas the treatment group received kinesiotherapy-combined scalp acupuncture in addition to the rehabilitation therapy. Before and after treatment, a joint protractor was used to measure the passive ROM of ankle, knee, and hip joints; the Modified Ashworth Scale was used to evaluate the muscular tension of the adductor muscles of lower limbs, hamstring muscles, and gastrocnemius; the scale for ADL was adopted to evaluate the ADL. Result The joint ROM was significantly improved by different degrees in the treatment group after intervention (P<0.05), and the popliteal angle and dorsal flexion of foot in the treatment group were significantly different from that in the control group (P<0.05). In the treatment group, the muscular tension of hamstring muscles and gastrocnemius after treatment was significantly different from that before treatment (P<0.05); the change of the muscular tension of gastrocnemius in the treatment group after intervention was significantly different from that in the control group (P<0.05); the change of ADL in the treatment group after intervention was significantly different from that in the control group (P<0.05). Conclusion Kinesiotherapy-combined scalp acupuncture plus conventional rehabilitation can markedly improve the ROM and ADL in patients with spastic cerebral palsy.

A cross-section study was designed to investigate clinical utility of lipid measures for prediction of insulin resistance(IR).A total of 793 healthy volunteers were divided to IR group or non-IR group based on the value of HOMA-IR.Area under receiver operating characteristic curve(ROC)found that TG/HDL-C was more related with IR in comparison with other lipid ratios,and could be used as a measure in predicting IR.

BACKGROUND:Currently,there are many studies concerning the pathogenesis,process,and damage of glaucoma,however,there is not an ideal glaucoma modelOBJECTIVE:To prepare rabbit intraocular hypertension models using three different material injections,and to verify the practical value of intraocular hypetension modelsMETHODS:Thidy New Zealand rabbits were divided randomly into 3 groups,with 10 animals in each group.One eye of each rabbit was served as the experimental eyes and the other eye as control eyes.Autoblood.methyl cellulose,C3F8 was injected into the anterior chamber of the experimental eyes.and the normal saline was injected into the control eyes.The intraocular pressure(IOP)was monitored prior to injection and at hours 0,24,36,48,72,96.120 and 168 after injection.RESULTS AND CONCLUSION:Intraocular hype Rension models could be induced by injecting 3 kinds of materials,and the IOP was obviously increased after injection(P＜0.05),and the ranges and periods of increasing were varied.The periods of increasing of 3 materials were 1,3 and 7 days,respectively,which could maintain for longer time for a second injection.The IOP ranged 1.86-6.65 kPa,and mild anterior segment inflammation could be found.The experiment demonstrated that intraocular hypeansion models using three different material injections are ideal models,which is characterized by simple,reliable and controllable.The suitable model can be selected for acute or chronic glaucoma research.

BACKGROUND:Al ogeneic bone has anatomical appearance and biological features similar to autogenous bone, which is an excel ent biological scaffold material. Mesenchymal stem cel s originating from autogenous bone marrow have mutli-lineage differentiation potential, can differentiate into osteoblasts and chondrocyte, and thus can accelerate the formation of bone tissue and cartilage tissue. OBJECTIVE:To establish the osteogenic ability of al ogeneic bone with autogenous bone marrow mesenchymal stem cel s for repairing major mandibular defects. METHODS:The left mandibular teeth of 24 beagles were extracted, and at 2 months after wound healing, mandibular defects were made artificial y. The beagles were divided into two groups:control group treated with lyophilized al ogeneic bone, and experimental group with autogenous bone marrow mesenchymal stem cel s and lyophilized al ogeneic bone. Densitometry with CT and Micro-CT was conducted 4, 12, and 24 weeks after surgery. RESULTS AND CONCLUSION:Compared with the control group, the bone density of the mandible was significantly higher in the experimental group at 12 weeks after transplantation (P<0.05). Over time, the bone densities in the two groups were both increased, but the bone density in the experimental group was always higher than that in the control group. Bone structure parameters were progressively increased or decreased in the two groups, especial y in the experimental group. At 24 weeks after surgery, the degree of trabecular separation in regions of interest was higher in the experimental group than the control group (P<0.05), but the bone volume fraction, number of trabecular bone, and bone trabecular thickness were significantly lower in the experimental group than the control group (P<0.05). These findings indicate that bone marrow mesenchymal stem cel s are capable of accelerating the reconstruction of al ogeneic bones.

BACKGROUND:The favorable structure and biological characteristics of al ogeneic temporomandibular joint become an effective solution for condylar defect, but immunologic rejection and slow ossification are the main problem for the presence of bone al ograft. OBJECTIVE:To meet the requirements of rebuilding mandible defect by lyophilizing canine mandible. METHODS:The periosteum, soft tissue, and cartilage of 12 canine mandibles were removed. 1 mm diameter hole was dril ed with 1 to 2 cm intervals in their cortical bones with a fissure bur. After washing, they were placed into a-4 ℃ refrigerator for 12 hours, and then stored at-80℃gradual y for 1 week. The mandibles were put in a drier. When the moisture content of osseous tissue decreased to 5%, the bones were packed in aseptic environment, radio pasteurized, and stored in vacuum container at atmosphere temperature. A biomechanical test was conducted after the lyophilization. RESULTS AND CONCLUSION:The maximum shifts of lyophilized mandibles in compression and bending tests were slight according to the steep load-shift curve. The plastic zone was insignificant and fractures appeared immediately when the pressure exceeded the plastic zone. The maximum load, maximum shift, and rigidity in the compression test were (5 163.10±730.16) N, (0.78±0.19) mm and (11 069.17±1 758.12) N/mm, respectively. The data in bending test were (486.67±134.12) N, (0.67±0.15) mm and (1 151.67±256.46) N/mm, respectively. It is concluded that the dehydrated and lyophilized canine mandibles have good shape and support ability and can meet the mechanical requirements in repairing and reconstructing mandibular defect.

Objective To investigate the change of indications of emergency obstetric hysterectomy and the clinical application of intraoperative interventions. And to provide evidence for prevention of hysterectomy and improvement of obstetric quality. Methods Clinical data were collected from 97 patients who received emergency obstetric hysterectomy at Shengjing Hospital of China Medical University between January 1st, 2004 and December 31st, 2013. The patients were divided into two groups by the time point of January 1st, 2009: the first group was cases treated between January 1st, 2004 and December 31st, 2008, while the second group was cases treated between January 1st, 2009 and December 31st, 2013. The clinical indicators, surgical indications, intraoperative interventions, and blood loss between the two groups were analyzed retrospectively. Results (1) Incidence:54 857 women delivered at Shengjing Hospital of China Medical University between January 1st, 2004 and December 31st, 2013. Of them, 97 patients received emergency obstetric hysterectomy, with an incidence of 0.177% (97/54 857). (2) The 17 patients delivered vaginally (18%,17/97) and 80 by caesarean section (83%,80/97). Forty-nine patients experienced repregnancy with scar uterus (51%, 49/97). About 41 patients underwent abdominal total hysterectomy (42%,41/97) and 56 received subtotal hysterectomy (58%,56/97). (3) The number of patients were comparable between the two groups (50 vs 47;P>0.05). (4) The main surgical indication was uterine inertia (45%, 44/97). The main causes of uterine inertia were excessive uterine tension (45%, 20/44) and placental abruption due to gestational hypertension (32%, 14/44). Of all the indications, 29 patients in the first group (58%, 29/50) and 15 patients in the second group (32%, 15/47) suffered from postpartum hemorrhage. Pathological placenta embedment occurred in 15 patients in the first group (30%, 15/50) and 25 patients in the second group (53%, 25/47). The incidences of postpartum hemorrhage due to uterine inertia or pathological placenta embedment were significantly different between the two groups (both P<0.05), respectively. (5) In the first group, the average preoperative blood loss was (2 900±1 900) ml, and the average intraoperative amount of infused white&red blood cells was (5.9±3.5) U, with the average operation time of (2.2 ± 1.8) hours and the average in-hospital duration of (7.8 ± 2.3) days. In the second group, the average preoperative blood loss was (3 100± 2 200) ml, and the intraoperative amount of infused white&red blood cells was (6.2± 5.2) U, with the average operation time of (2.5± 2.1) hours and the average in-hospital duration of (7.9 ± 2.9) days. There was no significant difference between the two groups in any of these indicators (P>0.05). Postpartum hemorrhage was usually treated with uterine packing in the first group, but was preferentially treated with potent uterine contraction agents, arterial ligation, uterine balloon compression or B-Lynch suture in the second group. The therapeutic effects of these new treatments were significantly better than uterine packing (P<0.05). Conclusions The incidence of emergency obstetric hysterectomy did not change significantly in the past decade. However, the indications and intraoperative interventions have changed significantly in the second five years compared with the first five years. The main surgical indications were uterine inertia and postpartum hemorrhage due to pathological placenta embedment. Therefore, strict control of caesarean section indications was important to reduce emergency obstetric hysterectomy.

Based on the results of oral glucose tolerance test( OGTT )and the levels of 1-h plasma glucose ( 1 hPG),793 subjects were classified into three groups:583 with NGTN ( normal 1 hPG in OGTT),127 with NGT1 H( higher 1 hPG in OGTT) and 83 with IGT( impaired glucose tolerance).NGT1H group had large waist circumference,higher body mass index,fasting plasma glucose( FPG),triglyceride,and lower high density lipoprotein-cholesterol than those of NGTN group.NGT1 H group had higher homeostasis model assessment insulin index ( 1.2 ± 0.6),lower homeostasis model assessment β3 ( HOMA-β ) (4.5 ± 0.7 ) and insulinogenic index (2.1 ±0.7) than those of NGTN group(0.5 ±0.6,4.8 ±0.7,2.7 ±0.9,respectively,all P ＜0.05 ).HOMA-β of NGT1 H group was higher than that of IGT group(4.5 ±0.7 vs.4.4 ±0.6,P ＜0.05 ).The results indicate that 1 hPG in OGTT may identify a condition of glucose metabolic abnormalities characterized by insulin resistance and reduced β-cell function.