Fetoscopic photography

Fetoscopic visualization may be used for the prenatal diagnosis of external structural malformations of the fetus. Objective documentation of these fetoscopic findings would be desirable. The photographic equipment and techniques required for fetoscopic photography have been investigated, and the results of these investigations with standard fetoscopic instruments in current clinical usage are described. The factors evaluated include the light source, camera equipment, camera settings and film.     

Dissociation of acetylcholine- and cyclic GMP-induced currents inXenopu oocytes

InXenopus follicular oocytes, activation of muscarinic receptors evokes a slow potassium current (H-response); a similar current is evoked by intracellular injection of cyclic guanosine 3,5-monophosphate, cGMP (Dascal et al. 1984). We have tested the hypothesis that cGMP may be the second messenger that mediates the opening of K channel by acetylcholine (ACh). ACh elevated the intracellular level of cGMP with a time course similar to that of the development of the muscarinic H-response; maximal increase in cGMP concentration above the control was about 0.2 pmole/oocyte. The amount of injected cGMP that produced a detectable K current (threshold dose) varied between 0.5 and 3 pmole/oocyte. At low doses of cGMP, the slope of log dose-log response curve was about 2.5, suggesting involvement of a biochemical process with a positive cooperativity of at least 3. Higher doses of cGMP evoked, in addition to the outward current, an irregular, rapidly developing, long-lasting inward current, that never reached amplitudes comparable to those of ACh-evoked Cl currents. The K current elicited by cGMP was insensitive to elevation or depletion of external Ca. It was potentiated by isobutylmethylxanthine (IBMX). ACh strongly inhibited the cGMP-evoked K current when applied at the plateau of the latter. 4-Phorbol 12,13-dibutyrate (PDBu) (1 M) rapidly and completely inhibited the cGMP response. It is concluded, that most of the results presented in this report contradict the hyothesis that cGMP is the intracellular mediator of ACh-induced changes in membrane conductance in the oocytes.Abbreviations ACh acetylcholine - cAMP cyclic adenosine 3,5-monophosphate - cGMP cyclic guanosine 3,5-monophosphate - EGTA ethylenediaminetetraacetic acid - Hepes N-2-hydroxyethyl-piperazinc-N-2-hydroxypropanesulphonic acid - IBMX 3-isobutyl-l-methylxanthine - IP₃ inositol 1,4,5-trisphosphate - PDBu 4-phorbol 12,13-dibutyrate     

Dimethyl sulfoxide elevates intracellular Ca2+ and mimics effects of increased light intensity in a photoreceptor

A 1% (v/v) solution of dimethyl sulfoxide (DMSO) added to the saline bath of isolated Balanus eburneus photoreceptors increased receptor potential amplitude by 40–50% and shortened time to peak amplitude and latency by 20–25%. The light-sensitive membrane current of voltage-clamped cells was increased systematically as DMSO concentration was increased from 1% to 10%. The null potential of the light sensitive current was unaffected by DMSO with short pulses of light, indicating that DMSO has no direct effect on ion selectivity of the light-sensitive channel. Absorbance changes of cell injected with the calcium indicator arsenazo III show that DMSO elevates intracellular Ca²⁺ (Ca_i). Current-voltage relations in darkness reveal that DMSO induces a small sustained inward current (5 nA) which has a null potential similar to the lightinduced current. DMSO may activate the light-sensitive conductance via the increase in Ca_i However, the altered kinetics and increased amplitude of the receptor current are opposite to the desensitizing effects normally observed with increased Ca_i.     

早孕期胎儿颈项透明层增厚与鼻骨缺失的产前诊断价值

目的探讨早孕期胎儿颈项透明层(NT)增厚与鼻骨缺失的产前诊断价值。 方法选择2016年10月至2019年4月,于东莞市人民医院进行早孕期胎儿超声检查发现胎儿NT增厚和(或)鼻骨缺失的488例单胎妊娠胎儿为研究对象。回顾性分析其孕母的临床病例资料。对单纯NT增厚、单纯鼻骨缺失、NT增厚+鼻骨缺失、NT增厚+其他结构畸形、NT增厚+鼻骨缺失+其他结构畸形5种情况胎儿的染色体病发生率,采用χ²检验进行统计学比较。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》要求。 结果①本组接受产前诊断的NT增厚、鼻骨缺失胎儿的染色体病发生率分别为17.6%(46/262)和14.3%(29/203)。②本组单纯NT增厚、单纯鼻骨缺失、NT增厚+鼻骨缺失、NT增厚+其他结构畸形、NT增厚+鼻骨缺失+其他结构畸形5种情况胎儿的染色体病发生率分别为8.5%(17/200)、3.9%(3/77)、53.5%(23/43)、43.5%(10/23)、42.9%(6/14)。单纯NT增厚与单纯鼻骨缺失胎儿染色体病发生率比较,差异无统计学意义(χ²＝1.759,P＝0.090);NT增厚+鼻骨缺失、NT增厚+其他结构畸形、NT增厚+鼻骨缺失+其他结构畸形3种情况胎儿染色体病发生率比较,差异无统计学意义(χ²＝0.837,P＝0.658);但是这3种情况的胎儿染色体病发生率,均显著高于单纯NT增厚胎儿,并且差异均有统计学意义(χ²＝52.080、23.716、16.101,均为P<0.001)。 结论建议对早孕期孕妇进行胎儿超声检查时,将鼻骨缺失筛查列为胎儿染色体病筛查的有价值指标之一,中孕期对鼻骨缺失胎儿的影像学追踪亦很重要。早孕期胎儿NT增厚合并鼻骨缺失和(或)其他结构畸形时,强烈建议孕妇进行产前诊断,以了解胎儿染色体病发生情况。     

晚孕期孕妇生殖道B族链球菌感染对母儿结局的影响

目的探讨晚孕期孕妇生殖道B族链球菌(GBS)感染的影响因素及其对母儿结局的影响。 方法选择2016年8月至2018年8月,在苏州高新区人民医院进行产前检查,并于35～37孕周时采取荧光定量PCR进行GBS DNA检测的1 149例晚孕期孕妇为研究对象。采用回顾性分析方法,将其分为研究组(n＝81,GBS DNA呈阳性)与对照组(n＝1 068,GBS DNA呈阴性)。对研究组GBS感染孕妇,采取产时抗菌药物预防(IAP)措施。收集2组受试者年龄、受教育程度、孕次、产次、流产史、分娩方式,分娩孕龄与人体质量指数(BMI)、血清维生素D含量,妊娠期糖尿病(GDM)、胎膜早破与产后出血发生情况,以及研究组新生儿出生后第4周GBS感染随访结果,并采用成组t检验、Mann-Whitney U检验、χ²检验等进行统计学比较。采用多因素非条件logistic回归分析,对晚孕期孕妇GBS感染影响因素进行分析。本研究遵循的程序符合2013年新修订的《世界医学协会赫尔辛基宣言》要求,并通过苏州高新区人民医院伦理委员会审批(审批文号：[2016]伦审批第001号)。 结果①2组孕妇中,初产妇与经产妇构成比、流产史、GDM发生率、血清维生素D含量比较,差异均无统计学意义(P>0.05),而2组孕妇年龄、受教育程度构成比与分娩时BMI分别比较,差异均有统计学意义(t＝-2.004、P＝0.045,χ²＝69.972、P<0.001,t＝7.054、P<0.001)。②晚孕期孕妇GBS感染影响因素的多因素非条件logistic回归分析结果显示,分娩时BMI≥25 kg/m²与受教育程度为高中及以下,均为晚孕期孕妇GBS感染的独立危险因素(OR＝2.901、6.137,95%CI：1.782～4.722、3.737～10.078,均为P<0.001)。③研究组孕妇产褥期感染、新生儿肺炎发生率分别为3.7%(3/81)与4.9%(4/81),分别显著高于对照组的0.8%(9/1 068)与1.0%(11/1 068),并且差异均有统计学意义(P＝0.047,χ²＝6.150、P＝0.013)。④研究组孕妇分娩的81例新生儿的出生后1周GBS阳性率为53.1 %(43/81),早发型GBS肺炎发生率为2.5%(2/81)。 结论分娩时孕妇BMI≥25 kg/m²与受教育程度为高中及以下,均为其GBS感染的独立危险因素。晚孕期孕妇GBS感染可导致其产褥期感染及新生儿肺炎发生率增高。     

孕早期外周血中lnc-C17orf64-1:1对子痫前期的预测价值

目的 探究孕早期孕妇外周血中lnc-C17orf64-1∶1的表达及其在子痫前期发病中的预测价值。方法 选择2018年9月至2019年9月于上海交通大学医学院附属国际和平妇幼保健院就诊分娩的孕妇,留取其孕早期(11~13周)外周血样本。根据妊娠结局是否为子痫前期分组:正常孕妇29例为对照组,子痫前期孕妇20例为子痫前期组。收集孕产妇相关临床资料,采用实时荧光定量PCR(qRT-PCR)检测孕早期外周血中lnc-C17orf64-1∶1的表达水平(ΔCT值),分析其与病情相关临床指标的相关性,并通过受试者工作特征(receiver operating characteristi, ROC)曲线分析其预测价值。结果 子痫前期组孕妇孕早期外周血中lnc-C17orf64-1∶1表达升高(ΔCT值降低);ROC曲线分析发现孕早期外周血lnc-C17orf64-1∶1预测子痫前期发病的曲线下面积(area under the curve, AUC)为0.9172(95%置信区间:0.8445-0.9899),敏感度80.00%,特异度86.21%,最大约登指数0.6621,最佳截断点13.71(ΔCT值),阳性预测值80.00%,阴性预测值86.21%;Spearman相关性分析发现孕早期外周血lnc-C17orf64-1∶1的ΔCT值与收缩压及舒张压均呈负相关。结论 孕早期外周血lnc-C17orf64-1∶1高表达与子痫前期密切相关,且对子痫前期早期诊断有一定预测价值。     

中孕期胎儿染色体异常高危孕妇羊水细胞胎儿染色体核型及介入性产前诊断指征的大样本分析

目的探讨中孕期胎儿染色体异常(FCA)高危孕妇羊水细胞胎儿染色体核型(FK)及其介入性产前诊断(IPD)指征。方法选择2014—2018年,在四川大学华西第二医院产前诊断中心进行羊膜腔穿刺术羊水细胞FK检测的63581例FCA高危孕妇(孕龄为19~27+6孕周)为研究对象。回顾性分析孕妇不同IPD指征及其胎儿染色体核型异常(FKA)检测结果。本研究遵循的程序符合四川大学华西第二医院伦理委员会所制定的伦理学标准,并通过该伦理委员会批准[审批文号:医学科研2019伦审批第(077)号]。结果①本组63581例中孕期孕妇的FKA检出率为3.13%(1989/63581)。这63581例孕妇的IPD指征分别为高龄(预产期年龄≥35岁)(25648例)、血清学筛查高风险(29009例)、无创产前筛查(NIPT)高风险(333例)、夫妇一方为染色体异常携带者(603例)、超声筛查发现胎儿结构异常及超声软指标异常(2647例)、异常儿生育史(1546例)、于外院进行羊水细胞FK分析结果异常者(7例)、孕妇智力低下及合并智力低下家族史(149例)、孕妇早孕期有害物质接触史(1400例)、其他(2239例),FKA检出率分别为3.26%(836/25648)、2.04%(593/29009)、65.17%(217/333)、34.33%(207/603)、3.51%(93/2647)、1.68%(26/1546)、85.71%(6/7)、4.03%(6/149)、0.14%(2/1400)、0.13%(3/2239)。②351例孕妇的IPD指征为超声筛查发现胎儿结构异常中,IPD指征为胎儿淋巴水囊瘤、皮肤水肿的FKA检出率最高,为26.09%(6/23)。2296例孕妇的IPD指征为胎儿超声软指标异常中,IPD指征为胎儿颈项透明层(NT)值≥2.5 mm的FKA检出率最高,为7.74%(66/853)。结论孕妇高龄、血清学筛查高风险、NIPT高风险、夫妇一方为染色体异常携带者、超声筛查发现胎儿结构异常及超声软指标异常等,均为中孕期孕妇FCA的IPD指征,孕妇IPD指征类型不同,FCA风险不同。羊膜腔穿刺术羊水细胞FK检测,可预测有IPD指征孕妇的妊娠结局,为降低FKA出生率提供参考。     

《2020 ACOG实践简报:孕龄≤70 d药物流产(No.225)》解读

药物流产(MA)是早孕期避孕失败的补救措施,主要药物为米非司酮和米索前列醇,二者联合使用,可使早孕期孕妇完全终止妊娠率达到90%。但是,MA导致的患者阴道流血时间长、量多,甚至阴道大流血,而需采取急诊刮宫术治疗等,尚未被彻底解决。如何安全、有效终止早孕期妊娠,保护女性生殖健康是目前国内外该领域的研究重点。美国妇产科医师学学会(ACOG)发布的《2020 ACOG实践简报:孕龄≤70 d药物流产(No.225)》对早孕期孕妇终止妊娠,具有重要指导作用。笔者拟就该简报对MA用于孕龄≤70 d孕妇的临床效果评估,MA用药方案、禁忌证、适应证,MA前咨询和检查,MA疼痛管理,MA后观察、预防性抗菌药物使用、随访管理、避孕措施9个方面基于循证医学推荐进行解读。     

妊娠晚期羊水过少56例临床分析

目的：探讨妊娠晚期羊水过少的分娩方式,寻找正确的处理方法,降低围生儿死亡率。方法：对妊娠晚期羊水过少56例作回顾性分析。结果：56例中,30例以羊水过少作为指标行剖宫产,新生儿窒息率为0,19例在临产过程中12例并发胎儿窘迫,7例并发其它高危因素行剖宫产,新生儿窒息率为5．3％,7例经阴道分娩,新生儿均有不同程度窒息。结论：羊水过少一经确诊,应积极引产,估计短时间内不能分娩,及时剖宫产是处理羊水过少较为安全的重要措施。