辅助生殖多胎妊娠的社会心理风险因素

Objective: To determine if increased psychosocial risks are associated with ea ch increase in birth multiplicity (i.e., singleton, twin, triplet) resulting fro m assisted reproduction. Design: Stratified random sample (n = 249). Setting: An academic teaching hospital and private practice infertility center. Patient(s): Mothers raising 1-to 4-year-old children (n = 128 singletons, n = 111 twins, and n = 10 triplets) conceived through assisted reproduction. Intervention(s): Self-administered, mailed survey. Main Outcome Measure(s): Scales measuring mat erial needs, quality of life, social stigma, depression, stress, and marital sat isfaction. Result(s): Using multivariate logistic regression models, for each ad ditional multiple birth child, the odds of having difficulty meeting basic mater ial needs more than tripled and the odds of lower quality of life and increased social stigma more than doubled. Each increase in multiplicity was also associat ed with increased risks of maternal depression. Conclusion(s): To increase patie nts’informed decision-making, assisted reproduction providers might consider i ncorporating a discussion of these risks with all patients before they begin fer tility treatment, and holding the discussion again if the treatment results in a multiple gestation. These data may also help providers to identify appropriate counseling, depression screening, and supports for patients with multiple births .

台湾翼状胬肉患者TNF-α和IL-1β的多态性研究

Purpose: Pterygium, a complex disease, is associated with ultraviolet radiation, immunoinflammatory process, genetic factors, and virus infection. Ultraviolet radiation induces secretion of proinflammatory cytokines by the ocular surface epithelium, inflammatory cells in the tear fluid, or both. Among these cytokines, tumour necrosis factor (TNF)αand interleukin (IL)-1βactivate pterygium body fibroblasts, resulting in a phenotype capable of expressing various proteinases associated with extracellular matrix remodelling, angiogenesis, and fibroblast proliferation,which are important for pterygiumformation and recurrence. The genetic factor was proposed to play a role in pterygium formation,but therewere fewstudies to clarify this proposition. For investigating genetic factors, the association between pterygium and TNF-αand IL-1βpolymorphisms is evaluated in this study. Methods: A total of 128 pterygium patients and 103 volunteers without pterygium were enrolled in this study. Polymerase chain reaction-based analysis was used to resolve the TNF-α-308 promoter, IL-1β-511 promoter, IL-1βexon 5, and IL-1 receptor antagonist (IL-1 Ra) polymorphisms. Results: There were no significant differences in the frequency of genotypes and alleles of TNF-α-308 promoter, IL-1β-511 promoter, IL-1βexon 5, and IL-1 Ra polymorphisms between both groups. Conclusions: The correlation between pterygium and TNF-α-308 promoter, IL-1β-511 promoter, IL-1βexon 5, and IL-1 Ra polymorphisms does not exist and those polymorphisms are not useful genetic markers for pterygium susceptibility. Further studies on other polymorphisms or haplotypes of TNF-αand IL-1βare necessary.

延髓内侧和小脑后下动脉区联合梗死综合征

Cerebellar and medial medullary infarctions are well known vertebrobasilar st roke syndromes. However, their development in a patient with distal vertebral ar tery occlusion has not been previously reported. A 49 year old man with longst anding hypertension suddenly developed vertigo, right sided Horner syndrome, an d left sided weakness. An MRI of the brain showed acute infarcts in the right i nferior cerebellum (posterior inferior cerebellar artery territory) and the righ t upper medial medulla (direct penetrating branches of vertebral artery). Magnet ic resonance angiogram showed occlusion of the distal vertebral artery on the ri ght side. Atherothrombotic occlusion of the distal vertebral artery may cause th is unusual combination of vertebrobasilar stroke.

母体-胎儿外科手术后的母体发病率

Objective: There is a paucity of published data on the maternal risks of fetal surgical interventions. We analyzed maternal morbidity and mortality that were associated with different types of fetal intervention (open hysterotomy, various endoscopic procedures and percutaneous techniques) to quantify this risk. Study design: We performed a retrospective evaluation of a continuous series of 187 cases that had been performed between July 1989 and May 2003 at the Fetal Treatment Center, a highly specialized interdisciplinary center for fetal surgery at the University of California, San Francisco. The primary outcome was the frequency of maternal morbidity for open, endoscopic, and percutaneous procedures to access the fetus. Results: There were 187 pregnant women with confirmed major fetal malformations who were candidates for intrauterine fetal intervention. Maternal- fetal surgery was performed in 87 cases by open hysterotomy, in 69 cases by endoscopic procedures, and in 31 cases by percutaneous techniques. There were no maternal deaths, but significant short- term morbidity was observed. There were no significant differences in the incidence of premature rupture of membranes, pulmonary edema, placental abruption, postoperative vaginal bleeding, preterm delivery, or interval from maternal- fetal surgery to delivery between endoscopic procedures and open surgery. Complications were significantly less in the percutaneous ultrasound- guided procedures. Endoscopic procedures, even with a laparotomy, showed statistically significantly less morbidity compared with the open hysterotomy group regarding cesarean delivery as delivery mode (94.8% vs 58.8% ; P < .001), requirement for intensive care unit stay (1.4% vs 26.4% ; P < .001), length of hospital stay (7.9 vs 11.9 days; P = .001), and requirement for blood transfusions (2.9% vs 12.6% ; P = .022). Chorionamnion membrane separation (64.7% vs 20.3% ; P < .001) was seen more often in the endoscopy group. Conclusion: Short-term morbidities include increased rates of cesarean birth, treatment in intensive care, prolonged hospitalization, and blood transfusion, all of which were more common with hysterotomy compared with other techniques. Maternal- fetal surgery can be performed without maternal death. Results from this study provide helpful data for counseling prospective patients.