妊娠合并血小板减少的临床分析

目的:分析妊娠合并血小板减少(Pregnancy with thrombocytopenia,PT)的原因及其对母婴预后的影响,为PT的预防及母婴结局的改善提供参考。方法:选取我院2013年至2016年收治的133例PT患者作为观察组,并选取同期100名正常孕妇作为对照组,分析导致PT发生的危险因素。比较两组产妇母婴结局的差异,探讨PT对母婴结局的影响。结果:观察组年龄低于对照组,其产前贫血发生率、临床出血发生率高于对照组,差异有统计学意义(P<0.05)。PAT是导致PT的最常见原因,占46.62%,其次为ITP,占21.80%;病因为PHD、ITP患者,其剖宫产率明显高于其他病因患者,差异有统计学意义(P<0.05);不同病因患者治疗有效率比较,差异无统计学意义(P>0.05)。随着产妇分娩前PLT的降低,其产后出血发生率逐渐升高,组间差异有统计学意义(P<0.05)。PLT>50×109/L的PT患者,其新生儿结局与正常组比较,差异无统计学意义(P>0.05);PLT≤50×109/L的PT患者,随着其PLT的降低,新生儿双顶径、体质量、1 min Apgar评分逐渐下降,宫内窘迫率、发育迟缓率逐渐升高,差异有统计学意义(P<0.05)。结论:PT病因复杂且往往伴有产前贫血、临床出血症状,并对母婴结局存在明显不良影响。     

妊娠合并心脏病患者分娩方式选择及母婴结局

目的:分析妊娠合并心脏病患者分娩方式选择及母婴结局,探讨妊娠合并心脏病患者的剖宫产指征。方法:2013年4月至2016年4月135例妊娠合并心脏病患者,按照患者心功能分级,将其分别纳入心功能Ⅰ~Ⅱ级组(n=96)、心功能Ⅲ~Ⅳ级组(n=39),比较两组患者分娩方式、母婴结局的差异。结果:心功能Ⅰ~Ⅱ级组阴道分娩率高于心功能Ⅲ~Ⅳ级组,其心脏病类型以先天性心脏病、心律失常、风湿性心脏病为主,心功能Ⅲ~Ⅳ级组心脏病类型以心肌病、高血压性心脏病为主,差异有统计学意义(P<0.05)。心功能Ⅰ~Ⅱ级组、心功能Ⅲ~Ⅳ级组阴道分娩产妇心衰发生率均高于同组剖宫产产妇,心功能Ⅲ~Ⅳ级组产妇终止妊娠孕周低于心功能Ⅰ~Ⅱ级组,其产妇心衰发生率高于后者,差异有统计学意义(P<0.05)。心功能Ⅰ~Ⅱ级组、心功能Ⅲ~Ⅳ级组阴道分娩新生儿出生体质量、早产率均高于同组剖宫产产妇,其1 min Apgar评分低于后者,心功能Ⅲ~Ⅳ级组新生儿出生体质量、1 min Apgar评分低于心功能Ⅰ~Ⅱ级组,其新生儿早产率高于后者,差异有统计学意义(P<0.05)。结论:妊娠合并心脏病患者阴道分娩风险较高,心功能Ⅰ~Ⅱ级者应适当放宽剖宫产指征,心功能Ⅲ~Ⅳ级者建议适时行剖宫产终止妊娠,以保证母婴结局。     

妊娠合并甲亢的妊娠结局分析

目的 :分析妊娠合并甲亢孕妇妊娠结局,为妊娠结局预测及妊娠合并甲亢的临床治疗提供参考依据。方法 :选取我院2010年4月—2015年4月收治的163例甲亢孕妇为患者组,按照患者组甲亢控制情况,分为控制组和未控制组2个亚组,同期64例正常孕妇作为对照组,比较各组妊娠结局,总结处理对策。结果 :正常组住院时间、住院费用、产检次数显著低于患者组,新生儿体重高于未控制组,差异有统计学意义(P<0.05);控制组与正常组新生儿体重比较,差异无统计学意义(P>0.05)。控制组住院时间显著低于未控制组,其产检次数、新生儿体重显著高于未控制组,差异有统计学意义(P<0.05)。控制组妊高征、心力衰竭、胎膜早破、流产、早产、剖宫产、贫血、产后出血发生率显著低于未控制组,差异有统计学意义(P<0.05),控制组与正常组产妇妊娠结局比较,差异无统计学意义(P>0.05)。控制组低体重儿、新生儿窒息、甲减、甲亢及新生儿死亡或死胎发生率显著低于未控制组,差异有统计学意义(P<0.05),控制组与正常组围生儿结局比较,差异无统计学意义(P>0.05)。结论 :妊娠合并甲亢显著增加母婴风险,按照产妇甲状腺功能实施早期、规范的甲亢控制治疗可有效降低妊娠不良结局发生风险,改善母婴结局。     

剖宫产疤痕子宫再次妊娠分娩方式对母婴结局的影响

目的:分析剖宫产疤痕子宫再次妊娠分娩方式对母婴结局的影响。方法:以我院2011年8月至2014年8月收治的143例剖宫产后再次妊娠产妇为研究对象,按照其分娩方式分为剖宫产组及阴道分娩组,比较2组母婴结局。结果:93例行阴道试产产妇中,56例(60.2%)阴道分娩成功。阴道分娩组产妇出血量、初次母乳喂养时间、住院时间、再出血率、产褥期感染率均显著低于剖宫产组(P<0.05)。阴道分娩组新生儿窒息发生率显著低于剖宫产组(P<0.05),2组新生儿出生体质量、Apgar评分比较,差异无统计学意义(P>0.05)。结论:剖宫产疤痕子宫再次妊娠阴道分娩有着较高的成功率,且较剖宫产更有利于母婴结局的改善,建议不存在剖宫产绝对指征的产妇接受阴道试产。     

先兆流产保胎成功后妊娠结局分析

目的:观察先兆流产保胎成功后妊娠结局,总结先兆流产保胎适应证。方法:选取我院2012年3月—2015年3月收治的327例孕产妇,将先兆流产保胎成功者纳入保胎组,将无先兆流产及其他高危因素者纳入对照组,比较2组产妇妊娠结局,随访新生儿生长发育情况。结果:2组产妇妊娠期及分娩期并发症发生情况、新生儿不良结局、新生儿0~3岁综合能力评分比较,差异均无统计学意义(P>0.05)。结论:先兆流产保胎成功后不会对妊娠结局造成不良影响,但需注意保胎适应证选择,以保证妊娠的安全性及新生儿发育质量。     

腹腔镜下不同子宫肌瘤剔除方式妊娠结局的比较

目的:比较不同子宫肌瘤剔除方式对妊娠结局的影响。方法:217例患者中注射垂体后叶素组84例(A组),子宫动脉阻断组61例(B组),单纯腹腔镜下子宫肌瘤剔除患者126例(C组)。比较3组患者手术情况、术后并发症、治疗效果及妊娠结局。结果:B组手术时间高于A组、C组,其术中出血量低于其他2组;A组、B组术中出血量、术后肛门排气时间、住院时间均低于C组,差异均有统计学意义(P<0.05)。A组、B组术后并发症发生率分别为4.92%(3/61)、5.95%(5/84),组间比较差异无统计学意义(P>0.05),C组术后并发症发生率为9.52%(12/126),高于其他2组,差异有统计学意义(P<0.05)。B组肌瘤残留率、复发率低于A组、C组,A组肌瘤残留率、复发率低于C组,差异有统计学意义(P<0.05)。3组患者妊娠时间、妊娠结局比较,差异无统计学意义(P>0.05)。结论:与单纯腹腔镜、局部注射垂体后叶素后子宫肌瘤剔除相比,子宫动脉阻断后切除病灶虽然技术要求较高,但能够在保证治疗效果与妊娠结局的前提下,进一步减少手术创伤、缩短术后恢复时间、降低术后并发症发生风险。     

输卵管妊娠患者输卵管开窗取胚术及切除术后输卵管功能与妊娠结局分析

目的 :分析输卵管妊娠患者输卵管开窗取胚术及切除术后输卵管功能与妊娠结局分析。方法 :195例有生育需求的输卵管妊娠患者,行输卵管开窗取胚术96例为开窗组,行输卵管切除术99例为切除组。比较两组患者手术情况、术后并发症发生情况、术后输卵管功能与妊娠结局。结果:术后7d,切除组83例(83.84%)患者β-HCG恢复至正常水平,高于开窗组的66.67%(64/96),切除组术后7dβ-HCG下降率高于开窗组,差异有统计学意义(P<0.05),两组患者手术时间、术中出血量、术后3dβ-HCG下降率比较,差异无统计学意义(P>0.05)。两组患者手术均顺利实施,无中转开腹者,术后均未见皮下气肿、切口疝等并发症发生。两组患者术后12个月妊娠结局比较,差异无统计学意义(P>0.05)。开窗组术后3个月患侧输卵管通畅率为11.46%(11/96),低于对侧输卵管的95.96%(95/96),差异有统计学意义(P<0.05)。结论 :与输卵管切除术相比,输卵管开窗取胚术未促进患者术后输卵管功能与妊娠结局的改善,且患者术后β-HCG恢复较慢,对于多数患者而言,输卵管切除术仍为首选术式。     

导致高龄孕妇不良妊娠结局危险因素分析

目的 :分析导致高龄孕妇不良妊娠结局危险因素,为高龄孕妇不良妊娠结局的预防提供参考依据。方法 :385例高龄(≥35岁)孕妇为研究对象,按照研究对象妊娠结局,将妊娠结局为早产、低体重、巨大儿、自然流产、出生缺陷者纳入不良妊娠结局组,将妊娠结局为正常足月儿者纳入正常妊娠结局组,计算高龄孕妇不良妊娠结局率,并比较两组患者年龄、文化程度、孕产次、孕期状况等一般临床资料,运用多因素Logistic回归分析,总结影响高龄孕妇不良妊娠结局的危险因素。结果 :385例高龄孕妇中,171例出现不良妊娠结局,占44.42%,孕妇不良妊娠结局以早产为主,占45.03%,其次为低体重儿,占34.50%。Logistic多因素回归分析结果,早孕反应程度重及有孕前疾病史是导致高龄孕妇不良妊娠结局的独立危险因素,文化程度中专以上为保护因素(P<0.05)。结论 :高龄孕妇不良妊娠结局发生风险较高,这与其早孕反应、孕前疾病及文化程度均具有密切关联,针对产妇存在的危险因素采取早期干预、注重围产期保健,有望在一定程度上降低不良妊娠结局发生率,改善人口质量。     

妊娠期糖尿病孕期综合管理对血糖及妊娠结局的影响

目的:探讨不同孕期干预对妊娠期糖尿病患者血糖及妊娠结局的影响。方法:选择2012年02月-2013年02月在本院建档行血糖筛查的孕妇1154例,将不同孕周筛查出的妊娠期糖尿病患者共143例为研究对象,根据首次筛查出妊娠期糖尿病的孕周分为三组:早期干预组(A组)、中期干预组(B组)、晚期干预及未干预组(C组),分别72人、54人、17人。随机选取该期间非妊娠期糖尿病患者70例为正常对照组。干预组给予健康教育、饮食指导及运动治疗,必要时加用胰岛素控制血糖,对照组仅作自然观察。分别对3组妊娠期糖尿病患者的血糖控制情况、妊娠并发症、围产儿并发症等相关临床指标进行组间比较分析,并与对照组患者的妊娠结局进行对比分析。结果:妊娠期糖尿病的发病率为17.68%。A组孕期糖化血红蛋白下降幅度与C组及对照组比较差异均具有统计学意义(P<0.05),但与B组比较未见统计学差异(P>0.05)。A组、B组围产期并发症及围产儿不良结局的发生率明显低于C组。结论:早孕期及中孕期综合管理对于妊娠期糖尿病患者血糖的改善和降低围产期并发症及围产儿不良结局具有积极的临床指导意义。     

孕妇肝功异常与不良妊娠结局相关性研究

目的 :探讨妊娠期合并肝功能异常对妊娠结局的影响。方法 :选取2010年1月至2014年6期间我院收治的97例孕前肝功能正常,孕后28周出现肝功能异常且待产时指标仍未正常产妇为研究对象,另选取50例肝功能正常孕妇为对照组。比较两组产妇胎膜早破、早产、产后出血、妊娠期高血压、妊娠期糖尿病发生率、剖宫产率、羊水污染情况以及新生儿体重、胎儿窘迫发生率。结果:肝功能异常组妊娠期高血压、早产、胎膜早破、产后出血发生率高于对照组,差异有统计学意义(P<0.05),肝功能异常组和对照组妊娠期糖尿病发病率、剖宫产率比较差异无统计学意义(P>0.05);肝功能异常组羊水污染程度重于对照组,差异有统计学意义(P<0.05);肝功能异常组新生儿平均体重低于对照组,差异有统计学意义(P<0.01),肝功能异常组胎儿窘迫发生率高于对照组,差异有统计学意义(P<0.05)。结论 :妊娠期合并肝功能异常可增加不良妊娠结局发生率,对母儿结局产生不良影响。应密切监测妊娠期合并肝功能异常产妇母儿情况,早期干预。     

Effects of docosahexaenoic acid or arachidonic acid supplementation on gene expression and contractile force of rat cardiomyocytes in primary culture

While fatty acids play essential roles in the physiology of the myocardium, conventional culture media contain little lipid. We previously revealed that rat neonatal myocardium mainly contains docosahexaenoic (DHA), linoleic (LA), and arachidonic (AA) acids as polyunsaturated fatty acids (PUFAs), and these contents in cultured cardiomyocytes derived from fetal rats were markedly lower than those in the neonatal myocardium. In this study, we first assessed the effects of supplementation of DHA, LA, or AA on the fatty acid contents and the percentage change of contractile area in primarily cultured rat cardiomyocytes. Based on this assessment, we then evaluated the effects of DHA or AA supplementation on mRNA expression and further directly measured the contractile force of cardiomyocytes with the supplementations. This study revealed that percentage change of contractile area was maximized under 20 μM DHA or 50 μM AA supplementation while LA supplementation did not affect this contraction index, and that a widespread upregulation tendency of the mRNA expression related to differentiation, maturity, fatty acid metabolism, and cell adhesion was seen in the cultured cardiomyocytes with supplementation of DHA or AA. In particular, upregulation of the gene expression of cellular adhesion molecules connexin43 and N-cadherin were remarkable, whereas the effects on differentiation and maturation were less pronounced. Correspondingly, the increase of the percentage change of the contractile area of cardiomyocyte clusters in culture dishes with the supplementations was significant, whereas the enhancement of the contractile force was modest. These results suggest that supplementation of DHA or AA to the fetal cardiomyocyte culture may play effective roles in preventing the de-differentiation of the cardiomyocytes in culture and that the enhancement of the contractile performance may be mainly attributed to the improvement of intercellular connection.     

不同花色映山红花中熊果酸和齐墩果酸的含量比较

结合超声技术提取不同花色映山红花中熊果酸和齐墩果酸,建立RP—HPLC法测定其含量。采用KromasilC18色谱柱（250mm×4．6mm,5μm）,流动相为甲醇-0．2％磷酸水溶液（88：12）,光电二极管阵列检测器,检测波长210nm,流速0．8mL／min,柱温30℃。以保留时间和紫外光谱对分离出的组分予以定性确证,用峰面积进行定量。组分的质量浓度与其峰面积在一定的范围内呈现良好的线性关系,相关系数均为0．9999,熊果酸进样量在0．443～7．088μg,齐墩果酸进样量在0．247～3．952μg时呈现良好的线性关系,平均加样回收率分别为98．53％和98．36％,RSD分别为1．3％和1．5％（n=5）。方法灵敏、准确,重现性好,可用于不同花色映山红花中熊果酸和齐墩果酸含量的测定。     

Failure criteria in thin film lubrication: Investigation of the different stages of film failure

The mechanisms of failure of sliding lubricated concentrated steel contacts have been studied using a newly developed tribometer which allows fast separation of the sliding surfaces at the different stages of film failure. The appearance of the corresponding contact topography was investigated by means of optical interference microscopy. The results indicate a gradual transition from full to partial elastohydrodynamic (EHD) lubrication as a function of increasing load and increasing bulk oil temperature until complete failure of the EHD film occurs at critical triplets of normal load, sliding velocity and bulk oil temperature.     

Effects of docosahexaenoic acid or arachidonic acid supplementation on the behavior of cardiomyocytes derived from human pluripotent stem cells

Background: Human heart changes its energetic substrates from lactate and glucose to fatty acids during the neonatal period. Noticing the lack of fatty acids in media for the culture of cardiomyocytes derived from human pluripotent stem cells (hiPS-CM), researchers have supplemented mixtures of fatty acids to hiPS-CM and reported the enhancement in the maturation of hiPS-CM. In our previous studies, we separately supplemented two polyunsaturated fatty acids (PUFAs), docosahexaenoic acid (DHA) or arachidonic acid (AA), to rat fetal cardiomyocytes and found that the supplementations upregulated the expressions of mRNAs for cardiomyocyte differentiation, fatty acid metabolism, and cellular adhesion. The enhancement in cellular contractility was attributed to the improvement in intercellular connection rather than a direct enhancement of the contractile force. Methods: This study reports the successive results of the effects of DHA or AA supplementation on hiPS-CM. In addition to the contractile force and mRNA measurements used in the previous study, we further investigated the effect of different cellular aggregations on the contractile force output by means of finite element analysis, measured glucose and fatty acids metabolites, and assessed cTNT and MLC2v expressions through immunofluorecsence evaluation. Results: It showed that the sole supplementation of albumin-conjugated DHA or AA can be taken up by hiPS-CM without other uptake-enhancing factors, and the supplementations may activate the CD36_­ERRγ metabolic pathway. DHA or AA supplementation increased the cellular contractile ratio on collagen gels and AA supplementation stimulated hiPS-CM aggregation to form cellular clusters. The enhancement effect on the hiPS-CM contractile force was modest since the increase in contractile force was not significant. AA supplementation was more effective than DHA supplementation because it significantly upregulated mRNA expressions of P300 and CD36. However, finite element analysis showed that the formation of clusters on a collagen gel attenuated the contractile force exerted by the gel on its surroundings. Conclusion: DHA and AA, as having been supplemented in infant formulas, have no direct and significant enhancement effect on the performance of the hiPS-CM when they were supplemented individually, although they were able to enter the cellular metabolic system. The AA supplementation showed some auxiliary effect on the maturation of hiPS-CM, which is worthy of further investigation under the consideration of membrane composition alteration and remodeling of membrane molecules.     

Effects of the ascorbic acid supplementation on NADH-diaphorase myenteric neurons in the duodenum of diabetic rats.

We assessed the ascorbic acid (AA) supplementation on the myenteric neurons in the duodenum of rats. Fifteen rats with 90 days of age were divided into three groups: control (C), diabetics (D) and ascorbic acid treated diabetics (DA). After 120 days of daily treatment with AA, the duodenum was submitted to the NADH-diaphorase (NADH-d) histochemical technique, which allowed us to evaluate the neuronal density in an area of 8.96 mm2 for each duodenum, and also to measure the cellular profile area of 500 neurons per group. The supplementation promoted an increase on AA levels. The neuronal density (p < 0.05) was higher in the group DA when compared to group D. There were no significant differences in the neuronal areas, when we compared groups C (204 +/- 16.5) and D (146.3 +/- 35.84) to groups D and DA (184.5 +/- 5.6) (p > 0.05). The AA-supplementation avoided the density reduction of the NADHd myenteric neurons in the duodenum of diabetic rats.     

Adsorption effect of a cationic surfactant at carbon paste electrode as a sensitive sensor for study and detection of folic acid

The present study is the first report on the effect of cetyltrimethylammonium bromide (CTAB) on the electrochemical behavior of folic acid (FA) at the surface of carbon paste electrode (CPE) in real samples. The studies were performed by cyclic voltammetry (CV), chronocoulometry and differential pulse voltammetry (DPV). CTAB, with a hydrophobic C–H chain, could absorb at the CPE surface by hydrophobic interaction and then changed the electrode/solution interface, and eventually affects the electrochemical response of FA, confirming from the remarkable oxidation peak current enhancement. For investigation of the electrode properties, CV technique was used at the various scan rates. Electrochemical parameters including diffusion coefficient (D), electron transfer coefficient (α) and ionic exchanging current density (j_o) were determined for the FA at the surface of the electrode. Under optimized conditions, the proposed method showed acceptable analytical performances for FA in terms of linearity (over the concentration range from 0.01 to 1.5 and 1.5 to 10.0 μM), detection limit (2.89 nM), repeatability (1.37%) and stability (13% reduction in peak current after 60 days). After studying on the effect of probable interferences it was found that the method was free of the interferences. Finally, the proposed method was successfully applied for the determination of FA in real samples.     

Immunohistochemical distribution of heat shock protein 70 and proliferating cell nuclear antigen in mouse placenta at different gestational stages

The aim of the present study was to investigate immunohistochemical distribution of heat shock protein 70 (Hsp70) and proliferating cell nuclear antigen (PCNA) in the mouse placenta at different gestational stages. For this purpose a total of 18 Swiss albino female mice at 12–14 weeks of age were used. Females were sacrificed on days 3 (early), 10 (mid‐), and 17 (late) of pregnancy and the implantation sites of the pregnant uterus were sampled. The sections were made transversely through the central region of the implantation site and stained with hematoxylin and eosin for histological examination. PCNA and Hsp70 was stained immunohistochemically. Since the definitive placenta was not still formed on day 3 of pregnancy, Hsp70 and PCNA positivity were evaluated in only luminal epithelium and decidual‐stromal cells. On days 10 and 17 of pregnancy, Hsp70 and PCNA positivity were evaluated in labyrinth zone, junctional zone and decidual layer of placenta. Hsp70 expression was observed trophoblast cells and decidual cells and was relatively constant throughout the pregnancy. This protein was strongly labeled in the trophoblast cells; while decidual cells were displayed moderate staining. In early pregnant mouse uteri, PCNA was mainly localized in decidual‐stromal cells. The trophoblast cells and decidual cells displayed highly proliferative activity at the midgestational period. However there was a significant decrease in the percentage of PCNA positive cells in late gestation. Microsc. Res. Tech. 79:251–257, 2016. © 2016 Wiley Periodicals, Inc.