Pulmonary arterial hypertension (PAH) is an abnormal remodeling of the pulmonary vascular wall due to various causes, resulting in severe cardiovascular disease characterized by increased pulmonary vascular resistance and pressure. The mortality and morbidity of pregnant women with PAH are extremely high. This article reports a woman with severe PAH associated with connective tissue disease who developed cardiac arrest, PAH crisis, and right heart failure during her two consecutive pregnancies without regular prenatal examination. After multidisciplinary consultation and extracorporeal membrane oxygenation, effective cardiopulmonary support was timely, and the patient was finally discharged from the hospital in stable condition. After ten months of follow-up, the mother and child both had good outcomes. Although the mother and her child were survived, severe PAH is a contraindication for pregnancy due to its severely harmful effect on endangering maternal and fetal health.

Substantial progress in the use of chemo-photodynamic nano-drug delivery systems (nano-DDS) for the treatment of the malignant breast cancer has been achieved. The inability to customize precise nanostructures, however, has limited the therapeutic efficacy of the prepared nano-DDS to date. Here, we report a structurally defined tandem-responsive chemo-photosensitive co-nanoassembly to eliminate primary breast tumor and prevent lung metastasis. This both-in-one co-nanoassembly is prepared by assembling a biocompatible photosensitive derivative (pheophorbide-diphenylalanine peptide, PPA-DA) with a hypoxia-activated camptothecin (CPT) prodrug [(4-nitrophenyl) formate camptothecin, N-CPT]. According to computational simulations, the co-assembly nanostructure is not the classical core-shell type, but consists of many small microphase regions. Upon exposure to a 660 nm laser, PPA-DA induce high levels of ROS production to effectively achieve the apoptosis of normoxic cancer cells. Subsequently, the hypoxia-activated N-CPT and CPT spatially penetrate deep into the hypoxic region of the tumor and suppress hypoxia-induced tumor metastasis. Benefiting from the rational design of the chemo-photodynamic both-in-one nano-DDS, these nanomedicines exhibit a promising potential in the inhibition of difficult-to-treat breast tumor metastasis in patients with breast cancer.

Objective:To investigate the diagnosis and management of partial or complete hydatidiform mole with coexistent intrauterine pregnancy.Methods:Clinical data of 10 cases of hydatidiform mole with coexistent intrauterine pregnancy admitted to the Third Affiliated Hospital of Guangzhou Medical University, from September 2009 to May 2019 were retrospectively described.Results:(1) During the same period, 65 960 women were delivered at our hospital, and hydatidiform mole with coexistent intrauterine pregnancy was accounted for 1/6 596, among which complete hydatidiform mole and coexisting fetus (CHMCF) and partial hydatidiform mole and coexistent fetus (PHMCF) were found in four and six cases, respectively. The mean age of the ten patients were (30.9±4.1) years old, ranging from 26 to 35 years old, with 2.5 (1-4) times of pregnancies. Nine cases were identified at 22 +3 (12 +3-32 +3) gestational weeks and one at 9 + weeks. (2) Recurrent vaginal bleeding during pregnancy occurred in six cases, nausea and vomiting in three cases, and hyperthyroidism in mid- and late pregnancy in two cases. One patient developed preeclampsia and one case of severe mitral regurgitation with mild pulmonary hypertension. (3) In the 10 patients, the summit serum β -hCG level was 139 935 (16 990-546 033) U/L, and CHMCF and PHMCF patients were 212 500 (200 000-546 033) U/L and 60 768 (16 990-225 000) U/L, respectively. (4) The ultrasound results revealed a dark honeycomb area of the placenta in five cases, placental thickening in two cases, and vesicular placenta in one case. One case was found with bilateral giant luteinized ovarian cyst by ultrasound, multiple metastases in the left lower lobe of the lung by chest CT, multiple nodules in the pleural wall of the left lung by lung MRI, and CHMCF by pelvic MRI. In one case, ultrasound at 14 weeks of gestation showed interrupted fetal abdominal wall, visible mass, gastric bubble, liver, part of the intestinal echoes, and omphalocele. One case was found with embryo arrest. (5) The karyotype analysis of one case through amniocentesis was 46,XX with no anomalies, and chromosome microarray analysis was arr[hg19](1-22)×2. Prenatal diagnosis was refused in the remaining cases. (6) Among the ten patients, three were terminated by rivanol intra-amniotic injection, two received drug abortion, and uterine evacuation, and two with spontaneous abortion followed by curettage with a visible fetus and hydatidiform tissue. Total hysterectomy was performed in one patient due to partial invasion of the uterus by hydatidiform mole. One patient underwent a cesarean section on account of the left lower lung metastasis. One case developed preeclampsia at 33 +4 weeks of gestation and delivered two premature infants by cesarean section. Pathology examination found a complete and partial vesicular fetal mass in four and six cases, with P57 (－) and P57 (+), respectively. (7) During the follow-up, two women developed the persistent trophoblastic disease and received chemotherapy, while the remaining eight cases did not. Conclusions:When hydatidiform mole with coexistent intrauterine pregnancy is found, a timely differential diagnosis between CHMCF and PHMCF is needed. CHMCF is at a higher risk of abortion, intrauterine death, premature delivery, preeclampsia, and other maternal complications. Therefore, termination of CHMCF should be individualized. Most PHMCF patients have fetal malformation or fetal loss; thereby, timely termination is recommended.

Tumor metastasis is responsible for chemotherapeutic failure and cancer-related death. Moreover, circulating tumor cell (CTC) clusters play a pivotal role in tumor metastasis. Herein, we develop cancer-specific calcium nanoregulators to suppress the generation and circulation of CTC clusters by cancer membrane-coated digoxin (DIG) and doxorubicin (DOX) co-encapsulated PLGA nanoparticles (CPDDs). CPDDs could precisely target the homologous primary tumor cells and CTC clusters in blood and lymphatic circulation. Intriguingly, CPDDs induce the accumulation of intracellular Ca

Pure drug-assembled nanomedicines (PDANs) are currently under intensive investigation as promising nanoplatforms for cancer therapy. However, poor colloidal stability and less tumor-homing ability remain critical unresolved problems that impede their clinical translation. Herein, we report a core-matched nanoassembly of pyropheophorbide a (PPa) for photodynamic therapy (PDT). Pure PPa molecules are found to self-assemble into nanoparticles (NPs), and an amphiphilic PEG polymer (PPa-PEG

Objective:To investigate the appropriate method of labor induction in the second trimester for complete placenta previa patients.Methods:The labor induction outcomes of 85 cases with complete placenta previa in the second trimester were retrospectively analyzed. Twenty patients in group A were treated with cesarean section, 30 patients in group B were treated with ethacridine and mifepristone combined with uterine artery embolization (UAE), and 35 patients in group C were induced by using ethacridine and mifepristone. The clinical features and induction outcomes of three groups were compared.Results:The total duration of labor in group B [(28.7±30.1) hours] was significantly longer than that of group C [(24.3±21.9) hours; P<0.05]. The total amount of blood loss during induction and labor in group B [(302±271) ml] was significantly lower than those of group C [(393±523) ml] and group A [(626±487) ml; P<0.05]. The incidence of fever in group B (13%, 4/30) was significantly higher than those of group C (11%, 4/35) and group A (10%, 2/20; P<0.05). In group C, 13 patients (37%, 13/35) underwent emergency UAE, and 2 patients (6%, 2/35) underwent emergency cesarean section. As to average hemoglobin level and blood transfusion rate, there were no difference among the three groups (all P>0.05). Conclusion:Prophylactic UAE combined with drug induction in patients with complete placenta previa in the second trimester could significantly reduce the amount of bleeding during induction and reduce the risk of emergency procedures.

Objective: In this study we analyzed the genetic characteristics of echovirus 30 (E-30) VP1 gene sequences from Yunnan province isolated from viral meningitis (VM) cases in 2010-2013. Methods: RT-PCR and VP1 gene sequencing were done for 9 E-30 strains isolated from VM cases in 2010-2013. VP1 gene sequences of E-30 reference strains were downloaded from the GenBank and their nucleotide (nt) and amino acid (aa) diversities were calculated by MEGA 5.1 software, the phylogenetic tree was constructed and the genetic characteristics and molecular epidemiology were analyzed. Results: In 2010-2013, 9 strains of E-30 viruses were detected from 79 VM cases caused by echoviruses, accounting for 11.39%(9/79), the overall positive rate was 1.63%(9/553). Phylogenetic analysis revealed that E-30 strains can be divided into four genotypes (genotype A, B, C and D), and genotype D can be further divided into seven sub-genotypes. Nine Yunnan VM isolates were distributed in D7 sub-genotype, and can be further clustered into 3 branches: 5 strains isolated in 2010 were clustered in branch 1, it is evident that these viruses were responsible for an aseptic meningitis outbreak in Kunming in that year; one 2011 isolate, together with 2013 isolate and one isolate from healthy children in 2010 were clustered in branch 2, these two branches were Yunnan special branches, and two 2011 isolates had the highest homology with 2003 VM outbreaks′ strains isolated from Shandong, Jiangsu, and Zhejiang, showing that these strains may have the same evolutionary sources. Conclusions Nine Yunnan VM isolates were distributed in D7 sub-genotype, and these strains have different evolutionary sources, showing that at different times E-30 viruses in the same sub-genotypes branch might prevail in different areas.

BACKGROUNDOrthotopic liver transplantation (OLT) has become the therapeutic option of choice for end-stage liver disease. The aim of this study was to investigate the changes of splenic morphology, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), apparent diffusion coefficient (ADC) values and explore their value in evaluating the therapeutic effects of orthotopic liver transplantation (OLT) on portal hypertension at 1.5 Tesla MRI.

METHODSTwenty patients with portal hypertension undergoing OLT were included in this study. Conventional MRI and diffusion-weighted image (DWI) (b value = 600 s/mm(2)) sequences were applied on each patient before and after OLT, and these patients were referred to as the preoperative and postoperative groups. Twenty healthy individuals were selected as the normal group. After image acquisition, the splenic width (W), thickness (T), length (L), the diameter of the portal vein (PD) and splenic vein (SD) were measured and the splenic volume (V) was calculated. The SNR and CNR were measured on T2WI. The ADC maps were calculated using the b600 in DWIs and the ADC values were measured.

RESULTSCompared with the preoperative group, the splenic V, PD and SD decreased significantly in the postoperative group (P < 0.05). All splenic morphological values were significantly different between preoperative and normal groups (P < 0.05). The splenic L and V were significantly different (P < 0.05) between postoperative and normal groups. The SNR and CNR values were 17.66 ± 4.62 and 13.18 ± 3.12, 11.50 ± 1.64 and 7.44 ± 4.32, 4.24 ± 1.24 and 3.03 ± 2.41 in the preoperative, postoperative and normal groups, respectively. Both SNR and CNR decreased after OLT, but they was still higher than the normal values. The SNR was significantly different between any two groups (P < 0.05). The CNR was significantly different (P < 0.05) between the preoperative and postoperative groups, preoperative and normal groups. The splenic ADC values were (1.339 ± 0.482) × 10(-3) mm(2)/s, (1.120 ± 0.254) × 10(-3) mm(2)/s and (0.997 ± 0.447) × 10(-3) mm(2)/s in the preoperative, postoperative and normal groups, respectively. The difference of ADC values were significant (P < 0.05) between the preoperative and postoperative groups, and the preoperative and normal groups.

CONCLUSIONSOLT is an effective method of treatment for portal hypertension. In addition to dramatically decreasing the splenic V, it can also decrease the splenic SNR, CNR and ADC values in patients with portal hypertension. The changes of splenic SNR, CNR and ADC after OLT may be helpful in providing noninvasive supplementary information in assessing the therapeutic effect of OLT on portal hypertension.

Adult ; Aged ; Female ; Humans ; Hypertension, Portal ; diagnosis ; surgery ; Liver Transplantation ; Magnetic Resonance Imaging ; methods ; Male ; Middle Aged ; Retrospective Studies ; Splenomegaly ; diagnosis ; surgery

Objective To study the imaging apperances and the diagnostic value of conventional magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) in differentiating histopathological types of small hepatocellular carcinoma (sHCC).Methods 40 sHCC confirmed by histopathology were classified into 4 groups according to their degree of differentiation:well (n=6),well-moderate (n=5),moderate (n=27) and moderate-poor (n =2).All patients received conventional MRI and DWI (1.5T,b =0 and 600 s/mm2) before the operation.The ADC values of the sHCC were measured and compared.Results On T1WI,32 lesions showed hypointensity,4 hyperintensity (well) and 4 isointensity (well-moderate =2,moderate =2).On T2WI,hyperintensity was observed in 39 lesions and isointensity in 1 lesion (well).Steatosis in the sHCC was seen in 17 of 40lesions (17/40,42.5 ％,well=4,well-moderate=1 and moderate=12).A pseudocapsule was seen in 67.5 ％ sHCC (27/40,well=4,well-moderate=3,moderate=18 and moderate-poor=2).32 lesions showed hypervascularity on arterial phase,and 8 lesions showed hypovascularity (well=3,moderate =4,moderate-poor=1).On DWI,37 lesions showed hyperintensity,except for 3 lesions with welldifferentiated sHCC which showed isointensity (50％,3/6).The mean ADC values±S.D.of sHCC in the well,well-moderate,moderate and moderate-poor groups were (1.757 ± 0.337) × 10-3,(1.917±0.574)×103,(1.816±0.545)×103 and (1.723±0.217)×10-3,respectively.There were no significant differences among the 4 groups.Conclusion The imaging appearances of wellmoderate,moderate and moderate-poor sHCC on conventional MRI were classical which make diagnosis easy.Hyperintensity on DWI contributed to diagnosis.However,the imaging appearances of some well-differentiated sHCC were atypical.The lesions could be isointensity or hyperintensity on DWI.The combination of conventional MRI and DWI contributed to better diagnosis of sHCC,especial for atypical sHCC.

Objective To compare the values of biochemistry, ultrasonography ( US) , computed tomography(CT) and proton magnetic resonance spectroscopy ('H MRS) in the quantitative diagnosis of fatty liver. Methods Forty-five healthy New Zealand rabbits were enrolled in the study. Hepatic steatosis models were established by giving high fat, high sugar diet with drinking water containing five percent ethanol. Eighteen variable indexes were measured by biochemical examination, US,CT and ' H MRS. ROC analysis and Z test were used to compare the diagnostic efficacy of different clinical examinations. Results Among eighteen variable indexes,serum TC,ultrasound attenuation coefficient,liver CT value and ' H MRS fat peak area had the highest degree of relationship by biochemical examination, US, CT, ' H MRS in diagnosis of fatty liver, correlation coefficients were 0.886,0.483, -0. 764, 0. 558, and areas under curve were 0. 981, 0. 581, 0. 810, 0. 713, respectively. There were significant differences in areas under curve between every two groups except 'H MRS fat peak area and ultrasound attenuation coefficient, liver CT value. Conclusions The diagnostic values of imaging modalities in the hepatic steatosis grade, their order is CT >'H MRS> US; Serum TC maybe have important diagnostic value in evaluating hepatic steatosis grade,this is very worth further studying.