Intrauterine Interventions for the Treatment of Twin Anemia-Polycythemia Sequence: A Systematic Review

BackgroundTwin anemia-polycythemia sequence (TAPS) is a complication of monochorionic, multiple gestation pregnancies in which blood shunting through placental anastomoses results in chronic anemia in one fetus and chronic polycythemia in another. The outcomes of different treatment modalities for TAPS are not well known.ObjectiveTo determine the outcomes of the intrauterine interventions used to treat TAPS.Study DesignA systematic literature search of MEDLINE, EMBASE, and CENTRAL was performed in June 2016. Primary outcomes were mortality, morbidity, and adverse perinatal outcomes. Data were summarized in the form of weighted means, and statistical difference was determined.ResultsTwenty-one articles were identified for inclusion in this review and were composed of 105 cases of TAPS. In the cases presented in the literature, there was no statistically significant difference in mortality, morbidity, or emergent Caesarean section rates between expectant management, intrauterine transfusion (IUT), and laser ablation therapy. Laser ablation therapy and IUT were found to have a significantly lower rate of adverse perinatal outcomes when compared to expectantly managed cases.ConclusionsThe literature looking into the treatment of TAPS is very limited, with no randomized controlled trials and only one includable comparative study. Based on the data in the case report and case study literature, there is no mortality difference between any of the treatment modalities. Expectant management may be associated with an increase in adverse perinatal outcomes when compared to laser therapy and IUT. More comparative studies are needed to assist clinicians in adopting an evidence-based approach to the treatment of TAPS.     

Contraception in autoimmune diseases

Autoimmune diseases (AIDs) affect women and men with a 2:1 ratio, which suggests that hormonal contraceptives play a role in their clinical course.Combined oral contraceptives have complex, sometimes contradictory, effects on AIDs; they can worsen the situation in women with systemic lupus erythematosus and with anti-phospholipid syndrome, conditions in which they are contraindicated. Early studies indicated a positive effect on rheumatoid arthritis (RA), whereas more recent trials failed to do so, possibly because of the lowering of oestrogen content. Evidence of effects on multiple sclerosis (MS) is conflicting: risk may vary depending on the progestin used. Minor adverse effects may exist on inflammatory bowel diseases, and no significant effect was found on autoimmune thyroid diseases. Women can become sensitised to sex hormones.Progestin-only contraceptives may be used, although copper-releasing intra-uterine devices represent the best option.Finally, several organisations have issued guidelines for contraceptive use in women with AIDs.     

A case of congenital herpes simplex virus infection diagnosed at 8 months of age

We present the case of an 8-month-old boy with the repeated recurrence of vesicles from the time of birth and who subsequently manifested psychomotor developmental delay. We retrospectively diagnosed the patient with congenital herpes simplex virus (HSV) infection. Computed tomography showed multiple calcifications in the periventricular white matter and thalami. The bilateral deep white matter showed an abnormally high signal intensity on T2-weighted magnetic resonance imaging. The patient required consecutive, suppressive therapy with valacyclovir to prevent the repeated recurrence of vesicles. This case presented a milder phenotype of congenital HSV infection in comparison to previous reports, and highlights the importance of the careful examination for this disease when neonates present with skin lesions.     

How does tobacco smoke influence the morphometry of the fetus and the umbilical cord?—Research on pregnant women with intrauterine growth restriction exposed to tobacco smoke

Proper structure of the umbilical cord is important for the fetal development. We evaluated effects of toxic factors from tobacco smoke on fetal and umbilical cord morphometry. 109 women in weeks 29–40 of pregnancy (31 smokers with intrauterine growth restriction (IUGR); 28 non-smoking women with IUGR; 50 healthy pregnancies) were included. In smokers with IUGR, cotinine, cadmium and lead concentrations were significantly higher than in controls (mean 55.23 ng/l; 1.52 ng/ml; 14.85 ng/ml vs 1.07; 0.34; 9.42) and inverse correlation between lead concentration and uncoiled umbilical cord was significant (r = −0.80). In smokers with IUGR, area of Wharton’s jelly was increased compared to nonsmokers and controls. Inverse correlations occurred between cotinine and cadmium concentration and fetal percentile in smokers (r = −0.87; r = −0.87) and non-smokers (r = −0.47; r = −0.78) with IUGR. Exposure to tobacco smoke measured by cotinine, cadmium and lead concentration has an impact on fetal growth and umbilical cord morphometry and correlates with intensity of IUGR.     

Hysteroscopic observations in 348 consecutive cases of female genital tuberculosis: A prospective study

Study objectiveTo evaluate the hysteroscopic findings in female genital tuberculosis.DesignIt was a prospective study of hysteroscopic findings performed on 348 cases of female genital tuberculosis (FGTB).SettingIt was a prospective cross-sectional study in a tertiary referral centre.PatientsA total of 348 patients with infertility with FGTB on various tests.InterventionA total of 348 patients of infertility found to have FGTB on various investigations were enrolled in the study. A detailed history was taken. Clinical examination, endometrial sampling and diagnostic laparoscopy were performed was also performed in selected cases. All patients underwent hysteroscopy as part of evaluation for infertility and tuberculosis (TB) findings.Measurements and main resultsThe mean age, parity, body mass index and duration of infertility was 28.2 years, 0.31,23.1kg/m² and 3.44 years respectively. Infertility was primary in 81.03% and secondary in 18.96% cases. Diagnosis of FGTB was made by endometrial aspirate findings of positive AFB on microscopy (4.02%), positive culture (4.88%), positive PCR (83.90%), epithelioid granuloma (14.65%), positive AFB on microscopy or culture of peritoneal cytology (1.14%) or epithelioid granuloma on peritoneal biopsy (1.72%), definitive findings of TB on laparoscopy (41.95%) or probable findings of TB on laparoscopy (58.05%). Various hysteroscopic findings observed were normal findings (28.16%), pale endometrial cavity (54.31%), features of active TB (7.47%), features of chronic TB (19.54%), features of TB sequelae like obstructed ostia (both ostia in 13.79%, one ostia 14.94%, periostial fibrosis; (bilateral 4.59%, unilateral 5.17%), endometrial glands atrophy (12.35%), small shrunken cavity (6.32%), distorted cavity (5.17%), various grades of intrauterine adhesions (29.88%). Hysteroscopy in FGTB was associated with increased difficulties and complications like failed procedures, difficult visualisation, false passage and uterine perforation.ConclusionHysteroscopy is useful modality to detect endometrial TB but is associated with increased difficulty and complications.     

Delphi法确立宫内节育器综合评价指标体系

目的:采用德尔菲(Delphi)法对通过数理方法初步建立的IUD综合评价指标体系进行调整确立。方法:在数理方法初步建立的IUD综合评价指标体系基础上,按照Delphi法原理,选择副高级以上职称、对生殖健康领域研究感兴趣且在各自领域具有权威性的计划生育、妇产科和公共卫生学专家进行两轮咨询评分,总结归纳反馈意见,计算相关参数,调整确立IUD的综合评价体系,采用直接评分法和Satty's赋权法确定各指标权重。结果:调整确立了由3个一级指标、6个二级指标和20个三级指标及其权重构成的IUD综合评价体系。调整后的IUD综合评价体系与调整前相比,在指标数目上没有增减,但在二级指标项、三级指标项及其维度的划分、各指标权重方面均有较明显的变化。结论:Delphi法的结果及建立的IUD综合评价体系具有科学性、合理性和可靠性,可以应用其对IUD进行综合评价。     

HBV宫内感染儿童接种乙型肝炎疫苗免疫失败与IL-2及其受体的关系

目的从ＩＬ－２及其受体角度探讨宫内感染ＨＢＶ导致乙型肝炎（乙肝）疫苗免疫失败的机制。方法采用体外细胞培养、流式细胞仪和酶联免疫检测技术对２２例ＨＢＶ宫内感染儿童和１５例正常儿童的外周血单个核淋巴细胞（ＰＢＭＣ）在非特异性刺激（ＰＨＡ）和特异性刺激（ＨＢｓＡｇ）下的膜ＩＬ－２受体表达水平和ＩＬ－２含量进行了测定。结果在ＨＢｓＡｇ刺激情况下，ＨＢＶ宫内感染儿童接种乙肝疫苗无反应组ＰＢＭＣ的ＩＬ－２膜受体表达水平低于有反应组和正常儿童组。在ＰＨＡ或ＨＢｓＡｇ刺激情况下，ＨＢＶ宫内感染儿童接种乙肝疫苗无反应组ＰＢＭＣ细胞培养上清的ＩＬ－２水平低于有反应组和正常儿童组。结论ＩＬ－２分泌能力低下，以及ＩＬ－２膜受体表达不足可能是宫内感染ＨＢＶ导致乙肝疫苗免疫失败的机制之一。     

Effect of early nutrition on intestine development of intrauterine growth retardation in rats and its correlation to leptin

AIM: To investigate the intestine and body development of intrauterine growth retardation (IUGR) rats under early different protein diet and to analyze the correlation between leptin and intestine and body development. METHODS: An IUGR rat model was established by food restriction of pregnant female rats. Fifty-six neonatal IUGR rats and 24 neonatal normal rats were randomly divided into normal control group (C group), IUGR model group (SC group), low protein diet IUGR group (SL group), and high protein diet IUGR group (SH group). Eight rats were killed per group at wk 0, 4, and 12. Serum leptin, body weight (BW), body length (BL), intestinal weight (IW), intestinal length (IL), and intestinal disaccharidase (including lactase, maltase, and saccharase) were detected. RESULTS: BW (4.50±0.41 g), BL (5.96±0.40 cm), IW (0.05±0.01 g), and IL (15.9±2.8 cm) in neonatal IUGR rats were much lower than those in C group (6.01±0.55 g, 6.26±0.44 cm, 0.10±0.02 g, 21.8±2.7 cm, P<0.05), while intestinal lactase and maltase activities were higher than those in C group. SH group showed the fastest catch up growth and their BW, BL, IW, and IL reached the C group level at wk 4. SC group showed relatively slower catch up growth than SH group, and their BW, BL, IW did not reach the C group level at wk 4. SL group did not show intestine and body catch up growth. Intestinal maltase [344±33 μmol/(min·g)] and saccharase activities [138±32 μmol/(min·g)] in SL group were both markedly lower than those in C group [751±102, 258±27 μmol/(min·g), P<0.05]. There were no significant differences in lactase activities at wk 4 and disaccharidase activities at wk 12 among all groups (P>0.05). The leptin level in SL. group (0.58±0.12 ng/mL) was the highest in all groups, and much lower in SH group (0.21±0.03 ng/mL) than that in any other IUGR groups at wk 4 (P<0.05). Leptin was negatively related to BW (r=-0.556, P= 0.001), IW (r=-0.692, P=0.001) and IL (r=-0.738, P= 0.000) at wk 4, while no correlation was found at wk 12. CONCLUSION: High protein diet is a reasonable early nutritional mode to IUGR rats in promoting intestine and body catch up growth.     

肿瘤坏死因子-α基因多态性与乙型肝炎病毒宫内感染易感性的关系

目的 探讨肿瘤坏死因子-α(TNF-α)基因-238位点G／A单核苷酸多态性与乙型肝炎病毒(HBV)宫内感染易感性的关系。方法 应用实时荧光定量聚合酶链反应技术检测HBV标志物阳性母亲所生45例HBV宫内感染儿童(Ⅰ组)、85例宫内未感染儿童(Ⅱ组)和126例对照组儿童TNF-α基因-238位点G／A单核苷酸多态性。结果 HBV宫内感染组TNF-α基因-238位点A等位基因频率显著高于HBV宫内未感染组(X^2=6．797，P=0．009)和对照组(X^2=9．513，P=0．002)，HBV宫内未感染组和对照组之间差异无显著性(X^2=0．047，P=0．828)。结论 TNF-α基因启动子区-238位点A等位基因与HBV宫内感染易感性相关，可作为检测其遗传易感性的标志之一。