Fetal growth in the baboon during the second half of pregnancy

PURPOSE: The purpose of this study was to determine the prevalence of feeding tube placement errors in children. DESIGN AND METHODS: The hospital records of 201 children having both an enteral tube and at least one radiograph showing tube placement were retrospectively reviewed. Chart review was also used to determine the risk factors associated with these errors. Tube placement error was defined as tube tip or orifices in the esophagus or intestine (if the tube was supposed to be in the stomach) or tip or orifices in the esophagus or stomach (if the tube was supposed to be in the intestine.) RESULTS: On the first day, a radiograph documenting tube placement showed that 32 of the 201 children (15.9%) had tube placement errors. Overall, 53 tube placement errors were evident during the 385 observation days on which radiographs were obtained (13.8%). Of the 201 children, 42 (20.9%) had experienced tube placement errors at some time during the period reviewed. Over all radiograph days, activity level was independently related to radiographic tube placement (p = < 0.02), with more errors among active children. Also, classification regression tree analysis showed that age, level of consciousness (alert or comatose versus semicomatose), abdominal distention, vomiting, and orogastric tubes were associated with more tube placement errors. NURSING IMPLICATIONS: Nurses need to be especially careful in assessing tube placement if the pediatric client has one or more of the identified risk factors. Health care providers need to carefully weigh the benefits and risks of feeding by nasal or oral enteral tubes versus the benefits and risks of feeding by endoscopically or surgically placed enteral tubes.     

What does an elevated mean arterial pressure in the second half of pregnancy predict--gestational hypertension or preeclampsia?

OBJECTIVE: The purpose of this study was to determine the predictive value of elevated mean arterial pressure in the second half of pregnancy for both preeclampsia and gestational hypertension. STUDY DESIGN: This was a cohort of 588 nulliparous pregnant women studied prospectively from the twentieth week until delivery. Mean arterial pressure was obtained by means of a random-zero sphygmomanometer at 20, 26, and 31 weeks of gestation. The best cutoff point for the determination of predictive values was established by a receiver-operator characteristic curve. RESULTS: Patterns of mean arterial pressure throughout pregnancy were different between preeclamptic and gestational hypertensive women. Receiver-operator characteristic curves for mean arterial pressure showed better predictive capacity for gestational hypertension than for preeclampsia. Sensitivity of mean arterial pressure to predict preeclampsia ranged between 39% and 48%, whereas for prediction of gestational hypertension it varied from 72% to 92%. Specificities for both groups were moderate (60% to 86%). Positive predictive values were low for all groups (5% to 33%). CONCLUSION: Elevated mean arterial pressure in the second half of pregnancy is a good predictor of gestational hypertension but is a poor predictor of preeclampsia.     

Relaxin increases the accumulation of new epithelial and stromal cells in the rat cervix during the second half of pregnancy

Both cervical and vaginal growth are relaxin dependent during rat pregnancy. We recently reported a relaxin-dependent 1.5-fold increase in cervical and vaginal DNA content from midpregnancy until term. This finding indicated that relaxin probably promotes cervical and vaginal growth at least in part by promoting cellular proliferation. The objective of this study was to identify and quantify cells in the cervix and vagina that proliferate during the second half of rat pregnancy in response to relaxin. Primiparous pregnant rats were ovariectomized or sham ovariectomized (group C; n = 8) on day 9 of pregnancy (D9). Ovariectomized rats were then treated with physiological doses of progesterone plus estrogen (n = 7) or progesterone, estrogen, and porcine relaxin (n = 7). Cellular proliferation was determined by continuously administering a low dose of 5-bromo-2'-deoxyuridine (BrdU) via miniature osmotic pump from D9-D22. On D22, cervices and vaginas were collected, fixed in formalin, paraffin embedded, and serially sectioned (4 microm). Adjacent serial sections were either immunostained for BrdU to assess cell proliferation or stained with hematoxylin to determine total cell number. Cell proliferation was evaluated by counting BrdU-positive nuclei and total nuclei in the same area on adjacent sections. Cell counts were determined using computerized digital morphometric analysis at x575. In control rats, nearly 75% of the epithelial cells and 55% of the stromal cells within the cervix at term had proliferated during the second half of pregnancy. The accumulation of approximately half of the new cells was relaxin dependent. Within the cervical stroma, relaxin increased the accumulation of cells associated with blood vessels and also the number of isolated cells (probably fibroblasts). Relaxin did not appear to affect smooth muscle cell proliferation in the cervix. In contrast to the cervix, a minority of vaginal epithelial cells (45%) and stromal cells (20%) proliferated during the second half of pregnancy. Although relaxin appeared to have a tendency to increase the accumulation of new vaginal epithelial and stromal cells, morphometric analysis did not provide support for such an effect. In conclusion, this study demonstrates that relaxin promotes a marked increase in the accumulation of new epithelial cells and stromal cells within the cervix. The relaxin-induced increase in new epithelial and stromal cells probably contributes to relaxin's effects on growth and remodeling of the cervix that are required for rapid and safe delivery.     

Formation of the arterial media during vascular development

We are still in the earliest stages of studying the molecular biology of vascular development. Key questions, even simple questions, such as the origin of endothelial precursors from the epiblast or the mesoderm, remain largely unanswered. For the smooth muscle cell, we do not even have a satisfactory molecular definition of cell type, because the known cell type-specific markers generally disappear when these cells are placed in vitro, and even in vivo smooth muscle cells identified by location can be very undifferentiated. A few bright spots illuminate this cloudy prospect. We do have endothelial lineage markers, and, given the powerful tools of promoting analysis, it seems likely that we will soon known a lot more about the identification of the endothelial lineage. It is hoped that this will help us understand how patterns of development of the vessel wall are controlled. Similarly, the failure of our early studies to identify molecules responsible for investment by smooth muscle can be seen as an exciting finding. If platelet-derived growth factor, fibroblast growth factor, and transforming growth factor beta are not expressed until after smooth muscle investment, still other as yet unidentified factors must be present to account for this stage of development of the vessel wall.     

Fetal risks due to warfarin therapy during pregnancy

Two mothers with heart valve prosthesis were treated with warfarin during pregnancy. In the first case a caesarean section was done one week after replacement of warfarin with heparin. The baby died of cerebral and pulmonary hemorrhage. The second mother had a male infant by caesarean section. The baby showed warfarin-induced embryopathy with nasal hypoplasia and stippled epiphyses (chondrodysplasia punctata). Nasal hypoplasia with or without stippled epiphyses has now been reported in 11 infants born to mothers treated with warfarin during the first trimester, and a causal association is probable. In view of the risks to both mother and fetus in women with prosthetic cardiac valves it is recommended that therapeutic abortion be advised as the first alternative.     

The second dorsal metacarpal flap with vascular pedicle composed of the second dorsal metacarpal artery and the dorsal carpal branch of radial artery

A pedicle second dorsal metacarpal flap, comprising the second dorsal metacarpal artery, the partial carpal arterial arch of the dorsal hand, and the dorsal carpal branch of radial artery, was designed. The flap may be rotated through two axes of rotation, one at the entry of carpal branch of radial artery into the first dorsal interosseous muscle and one at the entry of the recurrent cutaneous branch arising from the second dorsal metacarpal artery into the skin. The method introduced can increase as much as possible the length of the vascular pedicle of the second dorsal metacarpal flap. Thus, it can cover a small defect at a more distant area. If the width of this flap is not more than 3 cm, the donor site can be closed directly. The flap had been used in five cases with no necrosis of the flap or complication of the donor site. In further investigation of the postoperative patients, no stiffness and tightness have been observed through a short period of rehabilitation of the hand. The results are satisfactory. The anatomy, the operative technique, and three selective cases are described here.     

Traumatic rupture of the thoracic aorta during the second trimester of pregnancy

A 36-year-old woman in the second trimester of pregnancy underwent emergent operative repair of a traumatic aortic disruption caused by a motor vehicle accident. Left atrial-to-femoral artery bypass was used to maintain fetal circulation during the cross-clamp period. Her healthy, full-term child was subsequently delivered 3 months later by normal vaginal delivery.     

上半年钢铁行业运行情况及下半年面临的形势

[本刊讯]在7月30日召开的中国钢铁工业协会三届八次常务理事（扩大）会议上，单尚华秘书长在作题为《加快结构调整，转变发展方式，努力实现我国钢铁工业科学发展》的工作报告中，回顾了上半年钢铁行业运行情况及存在的问题，分析了下半年行业面临的形势。     

Biological action and half life in plasma or intramuscular sulprostone for termination of second trimester pregnancy

Sulprostone levels in plasma, platelet function and clinical effects were examined in four patients after intramuscular injection of 500 microgram sulprostone for induction of missed and therapeutic abortion in the second trimester of pregnancy. The half life of sulprostone in plasma was 34 (30-45) minutes. The highest sulprostone levels were found 10 to 20 minutes after injection (0.25-0.77 ng/ml) and after 120-240 minutes the values in plasma were no longer distinguishable from zero. Platelet count remained constant. 20 minutes after the injection platelet aggregation was slightly decreased, but not to a significant level. There was no correlation between sulprostone levels in plasma and pain of labour or induction abortion times. Side effects were minimal.     

Monoclonal antibodies specific for rat relaxin. X. Endogenous relaxin induces changes in the histological characteristics of the rat vagina during the second half of pregnancy

This study employed morphometric analysis to evaluate changes in the histological characteristics that accompany relaxin-induced growth and softening of the vagina during the second half of rat pregnancy. There were three treatment groups (N = 4/group). Five milligrams of a monoclonal antibody for rat relaxin, designated MCA1, were injected i.v. daily on days 12-21 of gestation to treatment group MCA1. Control groups received either 5 mg of monoclonal antibody for fluorescein (MCAF; monoclonal antibody control) or 0.5 ml PBS (vehicle control). Vaginas were removed on day 22 of pregnancy, fixed in 10% neutral-buffered formalin, and embedded in paraffin. Tissue sections (5 microm) were stained with Gomori's trichrome to visualize collagen, or orcein to visualize elastin. Measurements were performed with a light microscope equipped with a video camera connected to a computer. Within the vaginal stroma, the density of collagen fiber bundles was lower, the length of elastin fibers was shorter, and the cross-sectional area and wall thickness of arteries were greater in relaxin-replete control rats than in relaxin-deficient MCA1-treated rats. These relaxin-induced changes in the stroma appear to account, at least in part, for the hormone's softening effect on the vagina. Within the epithelium, there were approximately 2-fold more basal and mucus-secreting cells in relaxin-replete control rats than in MCA1-treated rats. The relaxin-induced accumulation of epithelial cells appears to contribute to vaginal growth. We conclude that relaxin plays a role in preparing the vagina as well as the cervix for rapid and safe delivery in pregnant rats.     

钢铁行业上半年运行情况及下半年发展趋势分析

一、2008年上半年我国钢铁工业运行情况 2008年是极不平凡的一年，全球经济不确定因素增加，国内遭受严重自然灾害，增加了宏观凋控的难度。在复杂多变的宏观形势下，我国经济发展的基本面没有改变，钢铁行业认真贯彻落实国家宏观调控的方针政策，以科学发展观统领发展全局，努力转变发展方式，进一步提高经济运行的质量和效益，1-6月全行业经济运行呈现良好的态势，向着宏观调控的预期方向发展。主要有以下六个特点：     

协会上半年主要工作回顾和下半年重点工作

[本刊讯]在7月30日召开的中国钢铁工业协会三届八次常务理事（扩大）会议上，单尚华秘书长在作题为（（加快结构调整，转变发展方式，努力实现我国钢铁工业科学发展》的工作报告中，回顾了上半年协会开展的主要工作及下半年重点工作要求。     

2008年上半年协会开展的重点工作及下半年重点工作安排

在7月30日召开的中国钢铁工业协会三届四次常务理事（扩大）会议上，中国钢铁工业协会秘书长单尚华在作题为《扎实推进结构调整和发展方式转变，实现钢铁行业又好又快发展》工作报告中，介绍了协会上半年开展的重点工作，并提出了下半年重点工作任务。     

2003年上半年锌市场回顾与下半年展望

文章回顾了今年上半年国内外锌市场概况,同时对下半年的锌市场进行了分析和预测。认为国内外锌价继续在历史低谷波动;冶炼能力仍处于净增长状态;锌消费增长快于产量增长,但全年仍将供应过剩;下半年锌价仍以区间震荡为主,但底部将抬高。     

Obstructive sleep apnea during pregnancy resulting in pulmonary hypertension

Obesity is known to increase maternal morbidity and mortality. We describe a case of obstructive sleep apnea due to obesity and discuss our treatment of the resulting pulmonary hypertension. A patient was transferred to our hospital at 29 weeks' gestation with severe anasarca and more than a 100-pound weight gain during pregnancy. Pulmonary hypertension due to obstructive sleep apnea was diagnosed. The patient was treated with nasal continuous positive airway pressure (CPAP) during sleep and remained in the hospital the remainder of her pregnancy. She had a massive spontaneous diuresis during her hospital stay and lost more than 100 pounds. She was delivered at term via cesarean section because of transverse lie. Preoperative hemodynamic monitoring confirmed the diagnosis of pulmonary hypertension. This represents the first case in the literature of obstructive sleep apnea leading to pulmonary hypertension in pregnancy. This patient responded well to nasal CPAP as evident by the massive diuresis and good maternal outcome.     

全面把握钢铁工业发展形势切实转变发展方式——2007年上半年我国钢铁行业运行情况及下半年运行态势分析

一、2007年上半年我国钢铁行业运行情况2007年以来,我国钢铁行业认真贯彻落实国家宏观调控的方针政策,全面把握我国面临工业化、城镇化、市场化、国际化的大趋势,以科学发展观统领发展全局,努力转变发展方式,进一步提高经济运行     

骨折患者术后夜间疼痛的护理体会

骨折病人术后夜间疼痛是临床中最普通、最重要的现象,是不舒适中最严重的形式,是难以控制的.由于夜间麻醉作用消失,而损伤的组织仍持续释放某些致痛物质,并作用于游离神经末梢,降低疼痛受体的高阈值,使患者产生疼痛,睡眠发生异常,影响机体康复,故术后夜间疼痛护理尤为重要.