Beckwith-Wiedemann Syndrome ; Female ; Humans ; Infant, Newborn

Objective To investigate the clinical features,critical laboratory parameters,and fetal monitoring methods in intrahepatic cholestasis of pregnancy(ICP).Methods A retrospective analysis of 21 cases of ICP suffered with fetal death in Women's hospital.School of Medicine.Zhejiang University from January 1999 to December 2010 were discussed.Results(1)The average age of ICP patients suffered with fetal death were(30.2±4.6)years old.Among them,4 cases were older than 35 years,six cases were multipara.oneo of them suffered stillbirth 2 year before.Twenty cases were singleton pregnancies and 1 cage was twin pregnancy.(2)All 21 cases of fetal death occurred in the third trimester,12 cases occurred before 37 weeks,9 cases after 37 weeks.Nine cases were diagnosed by ultrasound in outpatient clinics,fetal heart beat disappeared in 9 patients after admission because of ICP, two disappeared after labor, one during anesthesia before emergent surgery. Perinatal mortality rate of ICP was 0. 148% (21/14 184), and fetal death occurred from 29 to 41 weeks with an average gestational age of ( 33.8 ± 4. 2 ) weeks, ( 3 ) Puritus occurred in all 21 cases while 11 of them had pruritus all over the body. Ten pregnant women felt the fetal movement decreased or disappeared before diagnosis of fetal death. The glycocholic acid levels increased in all of the 21 cases. Among them, glycocholic acid levels in 11 cases were (21.49 -64. 48) μmol/L, while in 10 cases were ≥64. 48 μmol/L Serum bile acid levels elevated in 16 cases which had been analyzed ( the other 5 cases had not been checked ), and the highest level reached 270 μmol/L Serum alanine aminotransferase and aspartate aminotransferase were increased in 14 cases. Seven cases had their total bilirubin ＞21 μmoL/L, and 12 cases had their direct bilirubin levels significantly elevated. Among the 21 cases of ICP, 15 cases were in severe status, while the other 6 cases were mild. (4) Nine patients had no antepartum surveillance since fetal death were diagnosed before admission. The results of antepartum surveillance were as follows: 2 cases had nonreassuring nonstress test (NST), one had mild "V" type deceleration. Absence of diastolic flow in umbilical artery were found in 3 cases, and low fetal biophysical score was got in one case. ( 5 ) All 21 patients had vaginal delivery. Six of them delivered after natural contraction, and the remaining 14 cases delivered after oral intake of mifepristone and amniotic injection of ethacridine, or oxytocin induced labor within 48 hours, only one case delivered after additional dinoprostone suppositories. The appearance of fetus, placentas and membranes were normal, the lengths of umbilical cord were average. Four cases were found with cords binding the necks or the bodies. Eighteen cases had grade Ⅲ amniotic fluid with meconium-stained, and 2 cases complicated by oligohydramnios. Ten cases had their fetuses and placentas examined by pathologist. Among them, one case had multiple malformations, no more obvious pathological abnormalities were found in other fetuses. Pathologic examination showed that fibrin deposited around chorion and deciduas basalis, large vessels accompanied by calcification, degeneration,hemorrhagic infarction, and increased focal syncytial nodules could be seen in all of the ten placentas. Conclusions Fetal death in pregnant women with ICP of ten occurs after the contractions, Severe ICP may be a key factor that involved in the occurrence of fetal death. Up to now, there is no valid indicators in fetal monitoring, which can predict fetal death. Extensive assessment of the severity and careful antepartum surveillance should be achieved before timely termination of pregnancy.

Adolescent ; Blood Vessels ; pathology ; Female ; Femur Head ; blood supply ; pathology ; Femur Head Necrosis ; pathology ; Humans ; Male

Objective To investigate the effect of one-lung ventilation (OLV) on the occurrence of subcutanous emphysema during retroperitoneal laparoscopic urologic surgery (RPLUS).Methods Twenty-seven ASA Ⅰor Ⅱ patients,aged 29-64 yr,with body mass index 19-25 kg/m2,scheduled for elective RPLUS,were randomly divided into 2 groups:two-lung ventilation (TLV) group (group Ⅰ,n =15) and OLV group (group Ⅱ,n =12).In group Ⅰ,the patients were tracheal intubated and TLV was performed.In group Ⅱ,the left-sided double lumen endobronchial tube was inserted and TLV was performed,OLV on the non-operated side was performed starting from 10-15 min before pneumoperitoneum and TLV resumed at the end of pneumoperitoneum.The end-tidal CO2 partial pressure and minute ventilation volume were measured before pneumoperitoneum (T1),at 30 and 60 min of pneumoperitoneum (T2,3),and at 30 min after the end of pneumoperitoneum (T4).The CO2 absorption capacity was calculated.The degree of pneumoderma was assessed and the occurance of pneumoderma was recorded at the end of pneumoperitoneum.Results Compared with group Ⅰ,the CO2 absorption capacity was significantly reduced,and the degree and incidence of pneumoderma were significantly decreased in group Ⅱ (P ＜ 0.05).Conclusion OLV on the non-operated side can reduce the CO2 absorption capacity,decrease the degree of subcutaneous emphysema and reduce the occurrence of subcutanous emphysema during pneumoperitoneum in patients undergoing RPLUS.

Objective To explore the correlation between the patients with hypopharyngeal squamous cell carcinoma of the selective neck lymph dissection of lymph nodes detected quantity and prognosis.Methods Retrospective analysis of the clinical data of 96 cases underwent selective dissection of cervical lymph node in patients with squamous cell carcinoma of the hypopharynx.Results All patients with unilateral selective neck dissection of lymph nodes detected a number of 19.3 ± 11.0,the number of positive lymph nodes 0.8 ± 0.6.Preoperative radiotherapy patients (43 eases) was detected in lymph nodes and the number of positive lymph nodes was 13.8 ± 7.9 and 0.2 ± 0.2,without radiotherapy patients (53 cases) of lymph nodes detected number 23.2 ± 11.9 and 1.0 ± 0.2,the comparison between the two (P ＜ 0.01).According to the number of positive lymph nodes were divided into ≤ 15 group (42 cases) and ＞ 15 group (54 cases),＞ 15 group,the overall survival rate at 3 years and 3 years disease free survival rate and neck control rate was significandy higher than that of ≤ 15 group [70.4％(38/54) vs.38.1％(16/42),61.1％(33/54) vs.33.3％ (14/42),96.3％(52/54) vs.76.2％(32/42)] (P ＜ 0.01 or ＜ 0.05).Multivariate analysis showed that lymph nodes detected a number ＞ 15 was the survival rate of the independent risk factors for overall survival in patients with and without effect (P ＜ 0.05).Conclusion Selective neck dissection of lymph nodes detected number can be used to predict prognosis in patients with squamous cell carcinoma of the hypopharynx.

OBJECTIVETo observe protective effects of Schisandra extract (SE) on embryotoxicity and reproductive toxicity of early pregnant rats exposed to Benzo[a]pyrene (Bap).

METHODSPregnant rat model was prepared using periodic screening cage method. Totally 50 female pregnant SD rats were divided into five groups by randomized block design according to the weight, i.e., the BaP model group, the low dose SE group, the middle dose SE group, the high dose SE group, the normal control group, 10 rats in each group. Rats in the BaP model group were administered with BaP at a daily dose of 2 mg/kg by gastrogavage. Rats in low, middle, and high dose SE groups were administered by gastrogavage with BaP (at a daily dose of 2 mg/kg) plus SE at a daily dose of 40, 200, and 1 000 mg/kg, respectively. Equal volume of olive oil was administered to rats in the normal control group by gastrogavage. All medication was performed for 8 successive days. Changes of rat body weight in each period were observed. The uterus embryonic total quality and ovary quality were measured, and organ index calculated. The number of corpus luteum, the number of embryo implantation, and the number of absorbed embryo were statistically calculated respectively. The implantation rate and the absorbed embryos rate were calculated. Serum levels of human chorionic gonadotrophin β (β-HCG) and progesterone (PROG) were detected by ELISA.

RESULTSCompared with the normal control group, the weight of 9-day pregnant rats, the number of embryo implantation, the uterus embryonic total index, ovary index, serum levels of β-HCG and PROG all decreased in the Bap model group with significant difference (P < 0.05, P < 0.01). Compared with the Bap model group, body weight, the uterus embryonic total index, and the PROG level increased in 3 dose SE groups (P < 0.05, P < 0.01). Ovary index and serum β-HCG increased in middle and high dose SE groups (P < 0.05, P < 0.01). The number of implantation obviously increased in the high dose SE groups (P < 0.01).

CONCLUSIONSE could reduce the embryotoxicity and reproductive toxicity of early pregnant rats exposed to Benzo[a]pyrene.

Animals ; Benzo(a)pyrene ; toxicity ; Chorionic Gonadotropin ; blood ; Embryo Implantation ; drug effects ; Female ; Ovary ; drug effects ; Plant Extracts ; pharmacology ; Pregnancy ; Progesterone ; blood ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Reproduction ; drug effects ; Schisandra ; chemistry ; Uterus ; drug effects

Objective To explore the experience of self-perceived burden in patients with chronic obstructive pulmonary disease (COPD) and provide evidence for clinical nursing interventions.Methods Indepth interviews were conducted among 17 patients with COPD using phenomenological method of qualitative research.Data were analyzed with the Colaizzi's method.Results 3 themes was identified:self-accusation and guilt,loss of dignity and powerlessness,concern and insecurity.Conclusions Nurses should take the experience of SPB in patients with COPD seriously and take the influence of SPB into account during the process of nursing interventions and evaluation.

Objective To evaluate the effects of propofol on apoptosis in the hippocampal neurons of fetal rats in vitro.Methods The isolated hippocampal neurons were seeded into 96-well plates or 24-well plates at a density of 5 × 104 cells/ml.The cells were randomly divided into 5 groups (n =18 each) using a random number table:control group (group C),in tralipid group (group Ⅰ) and propofol 1,10,100 μmol/L groups (P1-3 groups).In group Ⅰ,10％ intralipid was added to the culture media until the final concentration reached 100 μmol/L.In groups P1-3,propofol was added to the culture media until the final concentration reached 1,10 and 100 μmol/L,respectively,and the cells were then incubated for 3 h.The cell apoptosis was assessed by flow cytometry.The expression of Bcl-2 mRNA and caspase-3 mRNA was detected by semi-quantitative reverse transcription polymerase chain reaction (RT-PCR).The expression of Bcl-2 and actived-caspase-3 protein was determined by Western blot analysis.The apoptosis rate was calculated.Results Compared with group C,the apoptosis rate was significantly increased,the expression of Bcl-2 mRNA and protein was down-regulated,and the expression of caspase-3 mRNA and actived-caspase-3 protein was up-regulated in P1-3 groups (P ＜ 0.05).There was no significant difference in the parameters mentioned above between group Ⅰ and group C (P ＞ 0.05).Conclusion Propofol induces apoptosis in isolated hippocampal neurons by inhibiting Bcl-2 expression and enhancing caspase-3 activity in fetal rats.

Objective To investigate the value of urine liver?type fatty acid?binding proteins(L?FABP) for early diagnosis and progress predicting of acute kidney injury(AKI)after lung transplantation. Methods Urine L?FABP and Scr blood samples in perioperative periods of 119 lung transplant recipients (hospitalized between 2013?2014)were involved in the research. Patients were divided into AKI group and non?AKI group according to KDIGO. Changes in urine L?FABP and Scr of two groups at various time points were recorded. Results Of 119 patients,57 developed AKI after surgery. Urine L?FABP from 0 h to 48 h in the two groups increased significantly, and the difference at 6 h to 48 h between the two groups is significant. In terms of diagnostic value,ROC area of urine L?FABP at 6h is 0.818. When 2254.52 ng/mg Cr was taken as diagnostic dividing line ,sensitivity and specificity was 0.782 and 0.814. In predicting AKI progression ,AUC below AUC of urine L?FABP 0.852. When 4313.17 ng/mgCr was taken as diagnostic dividing line ,sensitivity and specificity was 0.867 and 0.700. Conclusion Urinary L?FABP appears to be a sensitive and specific marker of AKI in lung transplant recipients ,could be a biological marker in the early diagnosis and progression tendency of AKI.

Objective:To investigate the role of clinical pharmacists in the anti-infective treatment of one patient with complexity urinary tract infection with septic shock induced by cellulitis. Methods:Clinical pharmacists participated in one case of complexity uri-nary tract infection with septic shock induced by cellulitis, and according to the clinical curative effect and the patient' s condition change, clinical pharmacists adjusted the medication nine times and provided individualized pharmaceutical care and service in the whole process. Results:Physician accepted the suggestions of clinical pharmacists, the infection was controlled after the 38-day treat-ment, and then the patient was discharged from the hospital. Conclusion:Clinical pharmacists should participate in the clinical treat-ment, provide whole process of pharmaceutical care for severe patients and assist physician in drug treatment decisions to promote safe, effective and economical drug use.