Successful Use of Surgically Placed Impella 5.0 and Central Extracorporeal Membrane Oxygenation Circuit in a Patient with Postcardiotomy Shock

The Impella 5.0, a percutaneously inserted left ventricular assist device, has been used to support patients who have severe heart failure or who are undergoing high-risk percutaneous coronary intervention. We report our surgical placement of the Impella 5.0, through a graft sewn to the aorta, to unload the left ventricle of a 59-year-old man who was undergoing venoarterial extracorporeal membrane oxygenation for postcardiotomy shock. The patient underwent successful placement of a long-term left ventricular assist device before his discharge from the hospital. The versatility of the Impella 5.0 is exemplified in this patient who was successfully bridged to long-term support.     

Application of the adverse outcome pathway framework to genotoxic modes of action

In May 2017, the Health and Environmental Sciences Institute's Genetic Toxicology Technical Committee hosted a workshop to discuss whether mode of action (MOA) investigation is enhanced through the application of the adverse outcome pathway (AOP) framework. As AOPs are a relatively new approach in genetic toxicology, this report describes how AOPs could be harnessed to advance MOA analysis of genotoxicity pathways using five example case studies. Each of these genetic toxicology AOPs proposed for further development includes the relevant molecular initiating events, key events, and adverse outcomes (AOs), identification and/or further development of the appropriate assays to link an agent to these events, and discussion regarding the biological plausibility of the proposed AOP. A key difference between these proposed genetic toxicology AOPs versus traditional AOPs is that the AO is a genetic toxicology endpoint of potential significance in risk characterization, in contrast to an adverse state of an organism or a population. The first two detailed case studies describe provisional AOPs for aurora kinase inhibition and tubulin binding, leading to the common AO of aneuploidy. The remaining three case studies highlight provisional AOPs that lead to chromosome breakage or mutation via indirect DNA interaction (inhibition of topoisomerase II, production of cellular reactive oxygen species, and inhibition of DNA synthesis). These case studies serve as starting points for genotoxicity AOPs that could ultimately be published and utilized by the broader toxicology community and illustrate the practical considerations and evidence required to formalize such AOPs so that they may be applied to genetic toxicity evaluation schemes. Environ. Mol. Mutagen. 61:114–134, 2020. © 2019 Wiley Periodicals, Inc.     

Immunization with BLS-Stx2B chimera totally protects dams from early pregnancy loss induced by Shiga toxin type 2 (Stx2) and confers anti-Stx2 immunity to the offspring

Shiga toxin producing Escherichia coli (STEC) are bacterial pathogens involved in food-borne diseases. Shiga toxin (Stx) is the main virulence factor of STEC and is responsible for systemic complications including Hemolytic Uremic Syndrome (HUS). It has been previously demonstrated that Shiga toxin type 2 (Stx2) induces pregnancy loss in rats in early stage of pregnancy. The main purpose of this study was to determine if an active immunization prevents Stx2 mediated pregnancy loss and confers passive protective immunity to the offspring. For that purpose Sprague Dawley female rats were immunized with the chimera based on the enzyme lumazine synthase from Brucella spp. (BLS) and the B subunit of Shiga toxin 2 (Stx2B) named BLS-Stx2B. After immunization females were mated with males. At day 8 of gestation, dams were challenged intraperitoneally with a sublethal and abortifacient dose of Stx2. The immunization induced high anti-Stx2B-specific antibody titers in sera and most important, prevented pregnancy loss. Pups born and breastfeed by immunized dams had high anti-Stx2B-specific antibody titers in sera. Cross-fostering experiments indicated that passive protective immunity against Stx2 was transmitted through lactation. These results indicate that immunization of adult female rats with BLS-Stx2B prevents Stx2-induced pregnancy loss and confers anti Stx2 protective immunity to the offspring.     

正念减压疗法对妊娠呕吐妇女负性情绪和生活质量的影响

目的 探析正念减压疗法对妊娠呕吐妇女负性情绪和生活质量的影响。 方法 将2017年5月-2018年5月在我院治疗的90例妊娠呕吐妇女纳入本研究,采用数字表法随机分成研究组和对照组,每组各45例。对照组接受宣教,研究组在对照组上实施正念减压疗法。分别于入组时、干预4周和干预8周采用焦虑自评量表(self-rating anxiety scale,SAS)、抑郁自评量表(self-rating depression scale,SDS)、生活质量综合评定问卷(generic quality of life inventory-74,GQOLI-74)进行评估,比较2组妊娠呕吐妇女负性情绪和生活质量。 结果 2组SAS、SDS评分及生活质量综合评定问卷总分在组间效应、时间效应及交互效应上差异具统计学意义。 结论 妊娠呕吐妇女进行正念减压疗法,能够显著减轻妊娠呕吐妇女负性情绪和提高生活质量,值得在临床上广泛应用。     

运用六经辨证治疗子嗽探析

妊娠期间,咳嗽不已,称"妊娠咳嗽",亦称"子嗽",孕妇咳嗽日久未见好转,咳嗽胸痛甚则咳而呕吐,或咳嗽剧烈或久咳不愈,可损伤胎气,导致堕胎、小产。笔者运用六经辨证治疗外感型中表寒里热证子嗽,认为此类患者病在太阳阳明,属于寒热错杂之表寒里热,采用《伤寒论》中方证麻杏甘石汤合止嗽散,使热从外泄,宣发卫气,散寒不助热、解表不伤正,故辨证论治取得了显著的疗效。同时子嗽治疗还需注意健脾固肾安胎,应将顾护胎元贯穿治疗妊娠咳嗽的始终。     

胎膜早破孕妇生殖道感染情况及对妊娠结局影响

目的 研究胎膜早破孕妇生殖道感染情况及对妊娠结局的影响。方法 选择2014年5月至2015年1月住院分娩的胎膜早破孕妇70例为早破组,同期无胎膜早破70例为对照组,检测两组生殖道病原微生物感染情况,并比较两组的妊娠结局。结果 早破组生殖道感染阳性率高于对照组,且剖宫产率,母体发生产后出血,绒毛膜羊膜炎,胎儿窘迫及新生儿窒息发生率均高于对照组,差异均有统计学意义(P<0.05)。结论 生殖道感染是胎膜早破最常见的诱因,积极筛查及治疗孕妇生殖道感染可以减少相关产科并发症的发生。     

Pangenomic Classification of Pituitary Neuroendocrine Tumors

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What women want: Fertility sparing surgery in Borderline ovarian tumours patients and pregnancy outcome

ObjectiveBorderline ovarian tumours (BOTs) are characterized by the presence of cellular proliferation and nuclear atypia without stromal invasion. Compared to malignant ovarian tumours, BOTs have better prognoses. The most important treatment of BOT is surgery. Considering the good prognosis of BOT, fertility-sparing surgery (FSS) can be considered for young women who desire to preserve fertility. Our study evaluated the pregnancy rate in patients with childbearing desire, the efficacy and risk of recurrence of women affected by BOTs who have undergone FSS.Materials and methodsPatients characteristics have been restrospectively retrieved for diagnosis made from June 2000 to December 2017 from San Raffaele Hospital and Policlinico Cagliari. Patients underwent FSS for BOT were interviewed about child wishing and pregnancy outcomes.Results85 patients were recruited for the study. Median age at diagnosis was 33 years. Unilateral salpingo-oophorectomy was performed in 33 patients (38%), unilateral cystectomy in 40 (47%) and 12 underwent both procedures (14%). 40 women (50%) tried to conceive after surgery. The pregnancy rate was 73% and live birth rate was 67%. Childbearing desire and age at diagnosis were significantly associated with the pregnancy rate.ConclusionsConservative surgical treatment seems to be a reasonable therapeutic option for women with BOTs who wish to preserve fertility. Our results suggest that the obstetric outcomes after FSS are promising. Maternal desire and the age of diagnosis are the most important factors affecting PR after surgery. Fertility counselling should be an integral part of the clinical management of women with BOT.     

胎盘植入性疾病的危险因素及妊娠结局分析

目的探讨胎盘植入性疾病的危险因素及妊娠结局。 方法回顾性分析2009年1月至2017年12月广州医科大学附属第三医院/广州重症孕产妇救治中心围产资料数据库中信息完整的单胎妊娠孕妇48 650例临床资料，将这些孕妇分为胎盘植入性疾病组和非胎盘植入性疾病组，分析胎盘植入性疾病的危险因素及其妊娠结局。 结果单因素分析显示，年龄≥35岁、高中教育水平及以下、孕次≥3次、经产妇、人工流产史、剖宫产史、体外受精－胚胎移植受孕、合并前置胎盘是胎盘植入性疾病的相关危险因素(P<0.05)。多因素logistic回归分析显示，胎盘植入性疾病的独立危险因素为剖宫产史(OR＝2.254，95%CI：1.917～2.650)、体外受精－胚胎移植受孕(OR＝1.591，95%CI：1.212～2.089)、合并前置胎盘(OR＝28.282，95%CI：24.338～32.866)；与非胎盘植入性疾病产妇相比，患有胎盘植入性疾病产妇早产、剖宫产、产后出血、弥散性血管内凝血、产褥期感染、子宫切除、低出生体重儿、新生儿Apgar评分相对较低(1 min)、产妇入住重症监护病房的发生率明显升高(P<0.05)。 结论剖宫产史、辅助生殖受孕、合并前置胎盘是引起胎盘植入性疾病的独立危险因素，胎盘植入性疾病的妊娠结局不良。     

逐瘀止血汤加减治疗慢性子宫内膜炎气虚血瘀证的疗效观察

目的 评价逐瘀止血汤加减对慢性子宫内膜炎（CE）气虚血瘀证患者妊娠结局的影响及对免疫炎症因子的调节作用。方法 将144例患者随机按数字表法分为观察组和对照组各72例。观察组脱落、失访4例，剔除2例，完成66例；对照组脱落、失访3例，剔除5例，完成65例。两组均给予抗感染治疗14 d。对照组口服妇科千金片，6片/次，3次/d。观察组内服逐瘀止血汤加减，1剂/d。两组疗程均为3个月，并随访6个月。记录治疗前后月经经量、经期和周期变化情况；进行治疗前后宫腔镜和阴道彩色多普勒超声检查，评价子宫内膜形态、子宫内膜容受性（CP）［子宫内膜厚度、阻力指数（RI），搏动指数（PI）和血流指数（FI）］等，并进行子宫内膜病理检查；进行治疗前后气虚血瘀证评分；检测治疗前后月经血白细胞介素-1β（IL-1β），IL-6和肿瘤坏死因子-α（TNF-α）水平和外周血测T淋巴亚群（CD3⁺，CD4⁺，CD8⁺）水平；随访记录妊娠情况和流产情况。进行安全性评价。结果 治疗后观察组经量、经期、周期和月经完全正常率均高于对照组（P<0.05）；观察组子宫内膜厚度和FI均高于对照组（P<0.01），RI和PI均低于对照组（P<0.01）；观察组月经血IL-1β，IL-6和TNF-α水平均低于对照组（P<0.01）；观察组CD3⁺，CD4⁺水平和CD4⁺/ CD8⁺均高于对照组（P<0.01），CD8⁺水平低于对照组（P<0.01）；在6个月随访期间，观察组妊娠率46.97%（31/66），高于对照组的27.69%（18/65）（χ²=5.197，P<0.05）；观察组子宫内膜形态疗效总有效率为96.97%（64/66），高于对照组的86.15%（56/65）（χ²=4.981，P<0.05）；观察组子宫内膜病理组织疗效总有效率为95.45%（63/66），高于对照组的84.62%（55/65）（χ²=4.304，P<0.05）；观察组综合临床疗效总有效率为93.94%（62/66），高于对照组的81.54%（55/65）（χ²=4.696，P<0.05）；两组治疗期间均未发现与中药相关不良反应。结论 逐瘀止血汤加减治疗CE气虚血瘀证患者，可调经月经、减轻临床症状，改善宫腔镜下内膜形态，调节全身和局部的免疫炎症反应，提高了CP，从而改善了妊娠结局，有着较好的综合疗效，且安全。