简介：AbstractAssisted reproductive technology (ART) has evolved rapidly over the last 40 years, offering hope to individuals and couples struggling with infertility. As technology continues to evolve, simulating a realistic female reproductive system environment has become a common goal for all types of ARTs, thereby reducing the impact of the artificial microenvironment on perinatal and offspring health. In this review, we provide a brief history of the development of each major ART and discuss the impact of ART on perinatal and offspring health. We also explore how the negative consequences of ART may be overcome and how its benefits can be maximized.

简介：AbstractPregnancy is rare and difficult in Sheehan syndrome patients. With the help of assisted reproductive technology, the patients even with panhypopituitarism can get pregnant again. Moreover, women with hypopituitarism have increased risk of pregnancy complications. Here we report a patient who suffered acute and severe Sheehan syndrome with panhypopituitarism and central diabetes insipidus got pregnant again by in vitro fertilization and embryo transfer. A regular and careful antenatal care was given by the cooperation between obstetricians and endocrinologists. Finally, she delivered a healthy female baby at 37+6weeks of gestation with Apgar scores of 10 and 10 at 1 and 5 minutes, respectively. The patient and her baby were doing well at postpartum follow-up. The related articles were also reviewed. This case report is aimed to help clinical practitioners to make better decisions on the management of Sheehan syndrome or other type of hypopituitarism during pregnancy.

简介：AbstractCongenital diaphragmatic hernia is a congenital fetal disease, which mainly causes pulmonary hypoplasia and pulmonary hypertension. Effective early prenatal diagnosis can detect and predict the prognosis of congenital diaphragmatic hernia in infants, thus provide a reference for prenatal counseling, early intervention, and potential choices for the child’s family. Ultrasound and magnetic resonance imaging are the most commonly used methods for non-invasive examination of the fetus. This paper discusses evaluation parameters based on these two imaging modalities.

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简介：AbstractObjective:The aim of the study is to investigate the relationship between antenatal depression and adverse perinatal outcomes.Methods:This prospective cohort study enrolled pregnant women between gestational ages of 12-20 weeks to complete the Chinese version of the Zung Self-Rating Depression Scale (SDS) and followed them for delivery from September 2015 to September 2016. Participants were classified into mild, moderate, and severe depression groups according to the SDS scores. Logistic regression was performed to assess the association between antenatal depression and perinatal outcomes including preterm birth (PTB), cesarean section use, hypertension disorders, gestational diabetes, and thyroid diseases during pregnancy. An age-stratified analysis was performed.Results:A total of 4,663 pregnant women were analyzed. As a result, 13.8%, 1.7%, and 0.2% of women were classified as mild, moderate, and severe depression, respectively. Severely depressed mothers were at higher risk for PTB (adjusted odds ratio [OR] =11.31, 95% confidence interval [CI] 2.13-60.03), especially spontaneous PTB. Moderate-depressed women were at higher risk for hyperthyroidism during pregnancy (adjusted OR = 3.67, 95% CI 1.10-12.27), while women with mild depression tended to choose cesarean sections (OR = 1.24, 95% CI = 1.04-1.49). Age-stratified analysis indicated an elevated risk of adverse outcomes associated with depression in women aged <25 years, but the association was not significant.Conclusions:Antenatal depression was associated with PTB, hyperthyroidism, and cesarean use. Studies with large sample sizes should verify the relationship between PTB and antenatal depression to avoid casual events.

简介：AbstractGroup B streptococcus (GBS) is a leading cause of neonatal infection. Maternal vaginal-rectal colonization with GBS during the intrapartum period is a prerequisite for GBS early-onset disease (EOD). The obstetric measures for effective prevention of GBS EOD include universal prenatal screening by vaginal-rectal culture, correct specimen collection and processing, appropriate implementation of intrapartum antibiotic prophylaxis, and coordination with pediatric care providers. It is now recommended to universal screen GBS between 360/7 and 376/7 weeks of gestation and to identify groups of women who are eligible for intravenous intrapartum antibiotic prophylaxis as a means of preventing GBS EOD.

简介：瞄准：调查是否仙子出生的事件，子宫内或产后，以后在生命与主要致硬化的胆管炎(PSC)的发展被联系。方法：从有在瑞典的成年PSC的97个病人的出生记录被考察。在怀孕，怀孕期长度，出生重量和长度期间包括药和复杂并发症的出生的事件被收集的仙子的信息。一样的性的二个控制孩子为每个题目被选择。有条件的多重逻辑回归被用来估计仙子的协会有PSC的开发的出生的措施。结果：没有重要协会为母亲在怀孕期间包括感染或药在医药复杂并发症的妊娠的年龄，出生长度，母乳喂养，和多数之间被发现或为孩子们产后。阴道流血和外部水肿与PSC显示出协会，与5.70的匹配的机会比率(95%CI，1.13-28.83)并且2.28(95%CI，1.04-5.03)分别地。结论：与随后的PSC的阴道流血和水肿的协会不能乐意地被解释，因此我们的调查结果强烈不支持仙子的一个重要角色的假设出生的事件作为为在生命以后的PSC的发展的风险。

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简介：AIM:TodeterminethevisualoutcomesinadultpatientswhosustainedopenglobeinjuriesandtodeterminewhetherthevisualprognosisfollowinganeyeinjuryinanAfricansettingdiffersfromthepredictedoutcomesaccordingtotheOcularTraumaScore(OTS)study.AsecondaryaimwastoestablishtheeviscerationratefortheseinjuriesandassesshowthisformofinterventionaffectedoutcomesincomparisontotheOTS.·METHODS:Aprospectivecaseseriesofallpatientsadmittedwithopenglobeinjuriesoveratwo-year(July2009toJune2011)period.InjurieswerescoredusingtheOTSandthesurgicalinterventionwasrecorded.Thebestcorrectedvisualacuityatthreemonthswasregardedasvisualoutcome.·RESULTS:Therewere249openglobeinjuries,ofwhich169patients(169eyes)completedthe3-monthfollow-up.Allpatientsunderwentprimarysurgery,175(70.3%)repairs,61(24.5%)eviscerationsand13(5.2%)otherprocedures.GlobeeviscerationsweremainlydoneonOTSCategory1cases,butoutcomesinthiscategorywerenotfoundtobedifferentfromOTSoutcomes.OutcomesweresignificantlyworseinCategory2,butwhentheentiredistributionwastested,thedifferenceswerenotstatisticallysignificant.TheoverallassociationbetweenOTSoutcomesandthefinalvisualoutcomesinthisstudywasfoundtobeastrong(P<0.005).·CONCLUSION:Reliableinformationregardingtheexpectedoutcomesofeyeinjurieswillinfluencemanagementdecisionsandpatientexpectations.TheOTSisavaluabletool,theuseofwhichhasbeenvalidatedinmanypartsoftheworld-itmayalsobeavalidpredictorinanAfricansetting.

简介：目的：探讨针刺疗法结合康复对围产期脑损伤高危儿智力及运动发育的影响。方法：对97例经新生儿重症监护室（NICU）救治存活的围产期脑损伤高危儿，按患儿家长意愿划分两组，针刺组53例，采用针刺结合康复治疗。对照组44例，采用常规育儿方式。两组均系统跟踪随访至2周岁，于6、12、24月龄时由专人定期采用婴幼儿智能发育量表进行智能测定。结果：针刺组在2岁时智力发育指数（MDI）与运动发育指数（PDI）分别高于对照组14．69、9．82分；针刺组智能异常率为15．1％，明显低于对照组40．9％，两组间差异具有统计学意义（χ2=8．1659，P〈0．01）。结论：针刺结合康复能有效地促进围产期脑损伤高危儿智力及运动发育，是改善预后、减少伤残率．提高患儿生存质号自勺有效丰段．

简介：AbstractImportance:The diversity of pediatric genitourinary malignancies requires a timely resource detailing tumor characteristics and survival.Objective:To determine the incidence, demographics, and outcomes of all pediatric genitourinary tumors within the United States.Methods:A population-based search for patients diagnosed with genitourinary cancers under age 15 was performed using the National Cancer Institute’s Surveillance, Epidemiology, and End Results 18 registry. Information on primary tumor location, histologic type, patient age, sex, year of diagnosis, race, treatment, cause of death, and survival months was extracted. Descriptive epidemiological and survival statistics were calculated for all variables.Results:A total of 4576 cases from 1973 through 2015 were identified. The most common primary tumor sites were the kidney (80.3%), testis (12.3%), bladder (2.8%), and vagina (1.5%). Nephroblastoma (87.9%) and sarcoma (3.4%) were the most common renal malignancies. Rhabdomyosarcoma was common in the vagina, bladder, and testis at rates of 66.2%, 61.2%, and 24.6%, respectively. Germ cell tumors (71.0%) were the most common primary tumor of the testis. Ten-year overall survival (OS) for renal nephroblastoma and sarcoma was 88% and 82%, respectively. Ten-year OS for RMS of the testis was 91%, the bladder was 79%, the vagina was 79%, and the prostate was 56%. Germ cell tumor 10-year OS were 96% in the testis and 100% in the vagina.Interpretation:A better understanding of the overall distribution and outcomes associated with pediatric genitourinary cancers allows physicians to best understand the patient’s disease in the context of current frequency in a genitourinary setting and reported outcomes.

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简介：AIM:ToinvestigatetheepidemiologiccharacteristicsandoutcomesofopenglobeinjuryinShanghai.METHODS:Aretrospectivestudywasconductedfor148unilateralopenglobeinjurycasespresentingtoatertiaryreferralhospitalofShanghai.Electronicmedicalrecordswerereviewedandphonesurveyswereconductedtocollectandanalyze1)backgroundofpatient;2)settingofinjuryandclinicalsignsatpresentation;3)treatmentprocedureandoutcome;4)qualityoflifeafterinjury.RESULTS:Thereweremoremalepatients(77.03%)thanfemales(22.97%),moretemporaryhabitants(79.05%)thanresidents(20.95%).ThesubjectsinthisstudypresentedasignificantlylowerconstitutionalstatusofeducationthanthatofthewholeShanghaipopulation(P<0.001).Occupationalinjurywasthefirstcauseofinjuries(39.86%),followedbyhomeaccident(20.27%),roadaccident(16.89%),violentbehavior(16.89%)andoutdoorinjury(6.08%).The143subjects(96.62%)werenotwearingspectaclesatthetimeofinjury.Ofallpatients,77subjects(52.03%)hadtheoutcomeofnovision(includingenucleation).Theclassificationandregressiontree(CART)prognosispresents59.58%sensitivitytopredictvisualsurvivalcorrectlyand80.19%specificitytopredictnovisioncorrectly.Thepatientswhoseinjuredeyehadnovisionreportedmorereductionoflifequality.CONCLUSION:Wefoundthatmalesubject,temporaryhabitants,loweducationalstatusandnoeyewearareriskfactorsofopenglobeinjuryinShanghai.Occupationalinjuryistheleadingcause.CARTanalysispresentsacertainagreementtotheactualvisualoutcome.Theinjuryimposesnegativeimpactonqualityoflifeespeciallyinnovisioncases.Theeducationofeyeprotectionmayhelptoavoidtheinjury.

简介：AbstractAlthough considerable advances have been made in the field of assisted reproductive technology (ART), millions of couples still suffer from infertility and miscarriage. In a large number of cases, the etiology of these common reproductive failures remains unknown. However, the significance of autoantibodies in infertility and miscarriage has sparked extensive interest because of their pleiotropic roles in disrupting normal pregnancy. This review discusses the pleiotropic roles of a series of autoantibodies in infertility and miscarriage. A brief recapitulation of how the autoantibodies interfere with ART outcomes and treatments for this type of idiopathic infertility or miscarriage is also provided. While several disputes remain to be resolved, further studies employing better designs and larger sample sizes are required in view of the therapeutic potential of autoantibody inhibitors and the future of contraceptive vaccines.

简介：Globaldemographicchangesrelatedtolongevityareleadingtoincreasingnumbersoftheelderly,forwhomhearinglossisasignificantcauseofmorbidityanddisability.Oncemetwithreticence,severelyhearingimpairedolderadultsareincreasinglybeingconsideredforcochlearimplantation(CI).SignificantdataindicatethatCIintheelderlypopulationissafe,well-tolerated,andeffective.RisksfromCIsurgeryandanesthesiaarelowandgenerallycomparabletoratesinotheragegroups.OutcomesstudiesregardingCIinolderadultshaveshownexcellentimprovementstospeechperception,qualityoflife,andevencognition.Overall,currentlyavailabledatasuggeststhatadvancedageshouldnot,initself,beconsideredabarriertoimplantation.ThisreviewpaperwillhighlightselectedarticlesfromrecentmedicalliteratureregardingthesafetyandefficacyofCIintheelderlypopulation.

简介：BackgroundManypatientshavesymptomssuggestiveofcoronaryarterydisease(CAD)andareoftenevaluatedwiththeuseofdiagnostictesting,althoughtherearelimiteddatafromrandomizedtrialstoguidecare.MethodsWerandomlyassigned10,003symptomaticpatientstoastrategyofinitialanatomicaltestingwiththeuseofcoronarycomputedtomographicangiography(CTA)ortofunctionaltesting(exerciseelectrocardiography,nuclearstresstesting,orstressechocardiography).Thecompositeprimaryendpointwasdeath,myocardialinfarction,hospitalizationforunstableangina,ormajorproceduralcomplication.SecondaryendpointsincludedinvasivecardiaccatheterizationthatdidnotshowobstructiveCADandradiationexposure.ResultsThemeanageofthepatientswas60.8±8.3years,52.7%werewomen,and87.7%hadchestpainordyspneaonexertion.ThemeanpretestlikelihoodofobstructiveCADwas53.3±21.4%.Overamedianfollow-upperiodof25months,aprimaryend-pointeventoccurredin164of4996patientsintheCTAgroup(3.3%)andin151of5007(3.0%)inthefunctional-testinggroup(adjustedhazardratio,1.04;95%confidenceinterval,0.83to1.29;P=0.75).CTAwasassociatedwithfewercatheterizationsshowingnoobstructiveCADthanwasfunctionaltesting(3.4%vs.4.3%,P=0.02),althoughmorepatientsintheCTAgroupunderwentcatheterizationwithin90daysafterrandomization(12.2%vs.8.1%).ThemediancumulativeradiationexposureperpatientwaslowerintheCTAgroupthaninthefunctional-testinggroup(10.0mSvvs.11.3mSv),but32.6%ofthepatientsinthefunctional-testinggrouphadnoexposure,sotheoverallexposurewashigherintheCTAgroup(mean,12.0mSvvs.10.1mSv;P<0.001).ConclusionsInsymptomaticpatientswithsuspectedCADwhorequirednoninvasivetesting,astrategyofinitialCTA,ascomparedwithfunctionaltesting,didnotimproveclinicaloutcomesoveramedianfollow-upof2years.

简介：胆囊疾病在发达国家是很普通的。复杂胆石疾病代表外科定期为被倡导的胆汁的混乱最经常。关于，胆囊炎代表普通腹的外科的干预；它能作为选任的干预或紧急情况外科被执行，在坏疽，穿孔，腹膜炎或败血的情况中。现在，laparoscopic途径被喜欢甚于开的剖腹术。全球性，众多的胆囊炎每天被执行；然而，小证据都不关于对跟随这些干预的生活(QOL)的surgical以后质量的评价存在。为了估计胆囊炎以后的QOL，事实上，高质量的照顾的文档服从于报导病人的结果满足的扩大讨论，和使用因为优秀改进被倡导几年了。然而，几乎没有很少研究，关于跟随胆囊炎的QOL结果出版；另外，许多当前的文学在以病人为中心的结果上缺乏系统的数据。然后，尽管几个工具被用来在胆囊炎以后测量QOL，困难留在选择有意义的参数以便获得可再现的数据反映手术后的QOL。这研究的目的是在QOL上为胆囊疾病考察外科的影响。这评论在QOL后面的胆囊炎上包括当前的文学的Medline搜索。大多数研究证明征兆的病人比收到选任的干预的病人从外科更获利。因此，在没有症状的外科，和病人少些获利或可以甚至在QOL有减小以前，在QOL的获得取决于一般条件。