人早孕蜕膜间充质干细胞移植治疗大鼠宫腔粘连

目的：探讨人早孕蜕膜间充质干细胞（hDMSCs）治疗大鼠宫腔粘连（IUA）的可行性和有效性。方法：体外分离、培养、纯化、鉴定h DMSCs。将30只雌性SD大鼠随机分为3组：蜕膜间充质干细胞治疗组（IUA＋hDMSCs）、IUA模型组和假手术（sham）组,每组各10只。IUA＋hDMSCs组和IUA组复制IUA模型后10 min内,IUA＋hDMSCs组经尾静脉注射2×10~6个Dio标记的hDMSCs,每3天补充1次,连续注射3次;IUA组经尾静脉注射相同容量的PBS;sham组仅行开腹手术。3个动情周期后取子宫行HE染色和Masson染色,测量子宫内膜厚度、子宫内膜腺体数目、子宫内膜小血管数目和纤维化面积比率,并行免疫组化检测子宫内膜组织细胞角蛋白、波形蛋白、转化生长因子（TGF）-β1及整合素αγβ3的表达量,q PCR检测IUA相关基因含量,免疫荧光观察h DMSCs在内膜中的分布情况,并评估大鼠的生育能力。结果：IUA组部分子宫腔闭锁,内膜萎缩,腺体减少,大量纤维化改变。IUA＋hDMSCs组与IUA组相比子宫间质厚度明显增加（P〈0.05）,大量腺体增生和小血管新生（P〈0.05）,纤维化程度减小（P〈0.05）,与sham组比较无统计学差异。IUA＋hDMSCs组细胞角蛋白、波形蛋白和整合素αγβ3表达量明显高于IUA组（P〈0.05）,而TGF-β1表达量低于IUA组（P〈0.05）。qPCR结果显示与IUA组相比,除TNF-α和结缔组织生长因子下调外,IUA＋hDMSCs组的干细胞因子、血管内皮生长因子、碱性成纤维细胞生长因子和thrombospondin-1均明显上调。免疫荧光结果显示Dio- DMSCs主要分布于腔上皮层,部分位于间质。IUA＋hDMSCs组大鼠双侧子宫均妊娠,平均胎鼠数量与IUA组相比有统计学差异（P〈0.05）。结论：hDMSCs可在受损的大鼠子宫内膜中存活、增殖,有效修复大鼠的子宫内膜,抑制IUA。

Biology, staging, and treatment of breast cancer during pregnancy: reassessing the evidences

Breast cancer is one of the most frequently diagnosed malignancies during pregnancy. Here, we review the management of women with breast cancer during pregnancy(BCP), focusing on biology, diagnosis and staging, local and systemic treatments, obstetric care and long-term follow-up of children with prenatal exposure to anticancer treatments.

Safety of lamivudine treatment for chronic hepatitis B in early pregnancy

AIM:To evaluate the safety of lamivudine(LAM) treatment for chronic hepatitis B in early pregnancy.METHODS:A total of 92 pregnant women who received LAM treatment either before pregnancy or in early pregnancy were enrolled in this study.All of the pregnant women volunteered to take lamivudine during pregnancy and were not co-infected with hepatitis C virus,human immunodeficiency virus,cytomegalovirus,or other viruses.All infants received passiveactive immunoprophylaxis with 200 IU hepatitis B immunoglobulin and three doses of 10 μg hepatitis B vaccines(0-1-6 mo) according to the guidelines for the prevention and treatment of chronic hepatitis B.Adverse events were observed throughout the entire pregnancy and perinatal period,and the effectiveness of lamivudine treatment for blocking mother-to-infant transmission of hepatitis B virus(HBV) was evaluated.All adverse events in mothers and infants during pregnancy and the perinatal period and the HBV motherto-infant transmission blocking rate were compared with the literature.RESULTS:Among the 92 pregnant women,spontaneous abortions occurred in 11 cases,while 3 mothers had a second pregnancy after the initial abortion;72 mothers delivered 73 live infants,of whom 68 infants were followed up for no less than 6 mo,and 12 mothers were still pregnant.During pregnancy,the main maternal adverse events were vaginitis(12/72,16.7%),spontaneous abortion(11/95,11.6%),and gestational diabetes(6/72,8.3%);only one case had 1-2 degree elevation of the creatine kinase level(195 U/L).During the perinatal period,the main maternal adverse events were premature rupture of the membranes(8/72,11.1%),preterm delivery(5/72,6.9%),and meconium staining of the amniotic fluid(4/72,5.6%).In addition,2 infants were found to have congenital abnormalities;1 had a scalp hemangioma that did not change in size until 7 mo,and the other had early cerebral palsy,but with rehabilitation training,the infant's motor functions became totally normal at 2 years of age.The incidence of adverse events among the mothers or abnormalities in the infants was not higher than that of normal mothers or HBV-infected mothers who did not receive lamivudine treatment.In only 2 cases,mother-to-infant transmission blocking failed;the blocking rate was 97.1%(66/68),which was higher than has been previously reported.CONCLUSION:Lamivudine treatment is safe for chronic HBV-infected pregnant mothers and their fetuses with a gestational age of less than 12 wk or throughout the entire pregnancy.

Management of chronic hepatitis B in pregnancy

Pregnancy associated with chronic hepatitis B (CHB) is a common and important problem with unique challenges. Pregnant women infected with CHB are different from the general population, and their special problems need to be considered: such as the effect of hepatitis B virus (HBV) infection on the mother and fetus, the effect of pregnancy on replication of the HBV, whether mothers should take HBV antiviral therapy during pregnancy, the effect of these treatments on the mother and fetus, how to carry out immunization of neonates, whether it can induce hepatitis activity after delivery and other serious issues. At present, there are about 350 million individuals with HBV infection worldwide, of which 50% were infected during the perinatal or neonatal period, especially in HBV-endemic countries. Currently, the rate of HBV infection in thechild-bearing age group is still at a high level, and the infection rate is as high as 8.16%. Effective prevention of mother-to-child transmission is an important means of reducing the global burden of chronic HBV infection. Even after adopting the combined immunization measures, there are still 5%-10% of babies born with HBV infection in hepatitis B e antigen positive pregnant women. As HBV perinatal transmission is the main cause of chronic HBV infection, we must consider how to prevent this transmission to reduce the burden of HBV infection. In this population of chronic HBV infected women of childbearing age, specific detection, intervention and follow-up measures are particularly worthy of attention and discussion.

Liver disease in pregnancy

Liver diseases in pregnancy may be categorized into liver disorders that occur only in the setting of pregnancy and liver diseases that occur coincidentally with pregnancy. Hyperemesis gravidarum, preeclampsia/eclampsia, syndrome of hemolysis, elevated liver tests and low platelets (HELLP), acute fatty liver of pregnancy, and intrahepatic cholestasis of pregnancy are pregnancy-specific disorders that may cause elevations in liver tests and hepatic dysfunction. Chronic liver diseases, including cholestatic liver disease, autoimmune hepatitis, Wilson disease, and viral hepatitis may also be seen in pregnancy. Management of liver disease in pregnancy requires collaboration between obstetricians and gastroenterologists/hepatologists. Treatment of pregnancy-specific liver disorders usually involves delivery of the fetus and supportive care, whereas management of chronic liver disease in pregnancy is directed toward optimizing control of the liver disorder. Cirrhosis in the setting of pregnancy is less commonly observed but offers unique challenges for patients and practitioners. This article reviews the epidemiology, pathophysiology, diagnosis, and management of liver diseases seen in pregnancy.

Perinatal and early life risk factors for inflammatory bowel disease

AIM:To investigate associations between perinatal risk factors and subsequent inflammatory bowel disease (IBD) in children and young adults.METHODS:Record linked abstracts of birth registrations,maternity,day case and inpatient admissions in a defined population of southern England.Investigation of 20 perinatal factors relating to the maternity or the birth:maternal age,Crohn's disease (CD) or ulcerative colitis (UC) in the mother,maternal social class,marital status,smoking in pregnancy,ABO blood group and rhesus status,pre-eclampsia,parity,the infant's presentation at birth,caesarean delivery,forceps delivery,sex,number of babies delivered,gestational age,birthweight,head circumference,breastfeeding and Apgar scores at one and five minutes.RESULTS:Maternity records were present for 180 children who subsequently developed IBD.Univariate analysis showed increased risks of CD among children of mothers with CD (P=0.011,based on two cases of CD in both mother and child) and children of mothers who smoked during pregnancy.Multivariate analysis confirmed increased risks of CD among children of mothers who smoked (odds ratio=2.04,95% CI=1.06-3.92) and for older mothers aged 35+ years (4.81,2.32-9.98).Multivariate analysis showed that there were no significant associations between CD and 17 other perinatal risk factors investigated.It also showed that,for UC,there were no significant associations with the perinatal factors studied.CONCLUSION:This study shows an association between CD in mother and child;and elevated risks of CD in children of older mothers and of mothers who smoked.

Physical activity during pregnancy and the role of theory in promoting positive behavior change:A systematic review

Background: Physical activity(PA) during pregnancy provides physical and psychological benefits for mother and child. U.S. guidelines recommend ≥30 min of moderate exercise for healthy pregnant women most days of the week; however, most women do not meet these recommendations. Theory assists in identifying salient determinants of health behavior to guide health promotion interventions; however, the application of theory to examine PA among pregnant women has not been examined cohesively among multiple levels of influence(e.g.,intrapersonal, interpersonal, neighborhood/environmental, and organizational/political). Subsequently, this systematic review aims to identify and evaluate the use of health behavior theory in studies that examine PA during pregnancy.Methods: Articles published before July 2014 were obtained from Pub Med and Web of Science. Inclusion criteria applied were:(1) empiricallybased;(2) peer-reviewed;(3) measured factors related to PA;(4) comprised a pregnant sample; and(5) applied theory. Fourteen studies were included. Each study's application of theory and theoretical constructs were evaluated.Results: Various theories were utilized to explain and predict PA during pregnancy; yet, the majority of these studies only focused on intrapersonal level determinants. Five theoretical frameworks were applied across the studies—all but one at the intrapersonal level. Few determinants identified were from the interpersonal, neighborhood/environmental, or organizational/political levels.Conclusion: This systematic review synthesized the literature on theoretical constructs related to PA during pregnancy. Interpersonal, community,and societal levels remain understudied. Future research should employ theory-driven multi-level determinants of PA to reflect the interacting factors influencing PA during this critical period in the life course.

Inflammatory bowel disease in pregnancy

Crohn's disease and ulcerative colitis affect women in their child-bearing years. Family planning has come to be a common discussion between the gastroenterologist and the inflammatory bowel disease (IBD) patient. Disease control prior to desired conception and throughout pregnancy is the most important thing to keep in mind when caring for the IBD patient. Continued medical management during pregnancy is crucial in optimizing outcomes. Studies indicate that quiescent disease prior to conception infer the best pregnancy outcomes, similar to those in the general population. Active disease prior to and during pregnancy, can lead to complications such as pre-term labor, low birth weight, and small for gestational age infants. Although there are no definitive long term effects of pregnancy on IBD, there are some limited studies that suggest that it may alter the disease course. Understanding the literature and its limitations is important in the modern era of IBD care. Educating the patient and taking a team approach with the obstetrician will help achieve successful outcomes for mother and baby.

Pregnancy related issues in inflammatory bowel disease: Evidence base and patients' perspective

Inflammatory bowel disease (IBD) affects women of childbearing age and can influence fertility, pregnancy and decisions regarding breastfeeding. Women with IBD need to consider the possible course of disease during pregnancy, the benefits and risks associated with medications required for disease management during pregnancy and breastfeeding and the effects of mode of delivery on their disease. When indicated, aminosalicylates and thiopurines can be safely used during pregnancy. Infliximab and Adalimumab are considered probably safe during the first two trimesters. During the third trimester the placenta can be crossed and caution should be applied. Methotrexate is associated with severe teratogenicity due to its folate antagonism and is strictly contraindicated. Women with IBD tend to deliver earlier than healthy women, but can have a vaginal delivery in most cases. Caesarean sections are generally recommended for women with active perianal disease or after ileo-anal pouch surgery. While the impact of disease activity and medication has been addressed in several studies, there are minimal studies evaluating patients' perspective on these issues. Women's attitudes may influence their decision to have children and can positively or negatively influence the chance of conceiving, and their beliefs regarding therapies may impact on the course of their disease during pregnancy and/or breastfeeding. This review article outlines the impact of IBD and its treatment on pregnancy, and examines the available data on patients' views on this subject.

Maternal alcohol consumption during pregnancy and the risk of childhood acute leukemia:a meta-analysis

Objective： The authors used a meta-analytic technique to quantify the evidence of an association between ma- ternal alcohol consumption during pregnancy and childhood acute leukemia （AL）, which provided a basis for the prevention of childhood AL. Methods： Relevant literatures of maternal alcohol consumption during pregnancy were comprehensively searched and screened. Subgroup meta-analysis was conducted according to the type of leukemia. Results of research data of maternal alcohol consumption during pregnancy were tested for heterogeneity. Combined OR values and 95% CIs were statistically calculated with RevMan 4.2 software; Funnel plots were applied to conduct bias analysis for those included litera- tures. Results： Ten related literatures were included after data screening, 4593 cases in AL group and 6157 cases in control group respectively. According to heterogeneity test result （X2 = 16.26, P 〈 0.05）, the combined OR values and 95% CI were calculated with random effects model, which were 1.02 （0.92-1.14）, Z = 0.41, P = 0.68 〉 0.05, indicating that there was no significant difference between maternal alcohol consumption during pregnancy and the risk of childhood acute leukemia （AL）. Subgroup analysis： for the association between maternal alcohol consumption during pregnancy and childhood acute lympho- blastic leukemia （ALL）, the combined OR value and 95% CI were 0.92 （0.84-1.00）, Z = 1.92, P = 0.05, indicating that there was significant difference between two groups; for the association between maternal alcohol consumption during pregnancy and childhood acute non-lymphoblastic leukemia （ANLL）, the combined OR values and 95% CI were 0.82 （0.61-1.11）, Z = 1.30, P = 0.19 〉 0.05, indicating that there was no significant difference between two groups. Conclusion： Maternal alcohol consumption during pregnancy is a risk factor in childhood ALL, but not in childhood ANLL.

Effect of chemotherapy before or after termination in pregnancy-associated breast cancer patients: two cases report

Pregnancy-associated breast cancer （PABC） is defined as breast cancer occurring anytime during gestation, lactation, or within 1 year after delivery. The incidence is between 1 in 3000 and 1 in 10,000 pregnancies and comprises about 0.2% to 3.8% of all breast cancers diagnosed in women under the age of 50 years. As women tend to delay childbearing into their third and fourth decades, the incidence of PABC is expected to increase. Here we reported two PABC patients with similar clinic and pathologic characters received chemotherapy before or after termination of pregnancy respectively, and found that the former got pathologic complete response. Based on the phenomena and the fact that endocrine hormones may have chemosensiUzation role in cancer chemotherapy, which is called hormonosensitizing chemotherapy （HSCT）, endocrinosensitizing chemotherapy （ESCT） or neoendocrinochemotherapy （NECT）, suggestion is proposed that chemotherapy should be taken before or immediately after termination for PABC, especially for the patients who prefer to artificial abortion, which may possibly acquire improved chemotherapeutic effect.

Blood Lead Levels During Pregnancy and Its Influencing Factors in Nanjing,China

Objective To investigate the blood lead levels （BLLs） in the duration of pregnancy and 6-12 weeks after delivery, and analyze the influencing factors of BLLs in healthy pregnant women. Methods Pregnant women were recruited from September 2009 to February 2010 at the prenatal clinic in Nanjing Maternity and Child Health Care Hospital. Altogether 174 healthy pregnant women without pregnant or obstetric complications or abnormal pregnancy outcomes were enrolled as the gravida group, and 120 healthy non-pregnant women as the control group. BLLs during pregnancy were determined by flame atomic absorption spectroscopy. Results BLLs in all the three pregnancy trimesters and postpartum were 59.8±24.3, 55.4±20.1, 55.9±19.7, and 67.6±17.4 μ/L, respectively, and the mean BLL in control group was 67.5±21.3 μg/L. BLLs during all the three trimesters were lower in the gravida group than in the control group （P=0.043, 0.021, and 0.028）. Furthermore, occupations, nutrients supplementation, and time of house/apartment painted were associated with BLLs in pregnant women. Lead-related occupations, cosmetics use, and living in a house painted less than 1 year before are risk factors of high BLLs among pregnant women, while calcium, iron, zinc, and milk supplements are protective factors. Conclusion Supplementing calcium, iron, zinc, and milk, or avoiding contact with risk factors may help people, especially pregnant women, to reduce lead exposure.

The effect of spleen on the change of Treg cells during mouse pregnancy

Objective:To analyze the effect of spleen on the Treg cells during pregnancy. Methods: The mononuclear cells were separated from the peripheral, spleen and uterus or placenta blood. Flow cytometry was employed to analyze the percent of Treg cells in total T cells in different stages of pregnancy. Immunohistochemical staining was used to make sure the distribution of Treg in spleen in different stages of pregnancy. Results: The results of immunohistochemical staining showed that compared with spleen Treg cells in normal unpregnant mice, spleen Treg cells on day 7 and 14 of pregnancy significantly increased. After splenectomy, peripheral blood and placenta Treg cells on day 7 of pregnancy markedly decreased as compared with the normal pregnancy(P<0.01). And the cells on day 14of pregnancy were markedly recovered as compared with the normal pregnancy. Conclusion: Our study indicated that the spleen and its Treg cells might play important roles in transient tolerance during pregnancy.

Urgent need to change clinical practices about postpartum contraception

In the United States, maternal mortality and unintended pregnancy rates are increasing. There are growing disparities in maternal health between indigent, minority women and Caucasian women of higher socioeconomic status. Family planning has long been viewed as a solution to these problems. As reliance on permanent contraception has diminished, timely access to highly effective contraceptive methods, namely long acting reversible contraceptives, which includes the contraceptive hormonal implant and intrauterine device- has become even more important. For women in the United States and abroad, the time of delivery is the one reliable opportunity for women to receive medical care. Consistently, research has shown that providing contraception in the immediate postpartum period is safe, effective, feasible and cost effective. However, misperceptions, lack of supplies, and reimbursement issues combine to defeat attempts to provide the most effective methods of contraception during that hospitalization. We believe that it is time to tackle the problem of unintended and rapid repeat pregnancy using an evidence-based, patient-centered paradigm and to eradicate systemic barriers blocking access to contraceptive methods during hospital stay. This editorial will outline some of the more compelling evidence supporting this move and will provide insights from successful programs.

Caffeine Intake during Pregnancy： What Are the Real Evidences？

Caffeine is a substance presented in foods such as coffee, tea, soft drinks, chocolates and medicines and is commonly consumed by pregnant women. Due to its ability to cross the placental membrane and accumulate in the fetus body, caffeine and its metabolites have been contraindicated or recommended in small doses during pregnancy. Studies in rodents relate caffeine intake to lower rates of fertilization, embryonic implantation, changes in placental structure, increased occurrence of low fetal and placental weights, abortion and stillbirth. However, in humans, studies involving caffeine consumption are inconclusive. Methodological complexity, difficulty for measuring caffeine intake and ethical reasons are limiting factors for a more accurate conclusion. So far, caffeine recommendation ranges from 100 to 300 mg/day. Even though researches have recommended low caffeine consumption by pregnant women in order to avoid deleterious consequences during gestation, a safe dose has not been established until now. The aim of the present review is to describe the main findings on the effects of caffeine consumption during pregnancy in both human and rodent experimental models.

Endometrial stromal sarcoma:a case diagnosed during infertility treatment

The patient with irregular menstruation went to our Department(Gynecological Department,the Third Affiliated Hospital,Sun Yat-sen University,Guangzhou,China) with the complaint of no pregnancy at the age of 26 in 2007,and oral contraceptive pills were given when simple type of endometrial hyperplasia was pathologically diagnosed,and then ovulation induction was performed.But after nearly two years from the beginning of infertility treatment,endometrial stromal sarcoma was diagnosed and radical treatment was performed for the young patient.And the relative relationship between endometrial stromal sarcoma and infertility is worth discussing.

Missed Opportunities for Intermittent Preventive Treatment among Pregnant Women, in a Secondary Health Facility, Cross River State, Nigeria

The study determined the magnitude and contributory factors for missed opportunities for the administration of IPTp （intermittent preventive treatment for malaria prevention）, during pregnancy among pregnant women attending a secondary health facility in Calabar. This study was a descriptive survey. Exit interviews were carried out on all pregnant and post natal women who attended the antenatal clinic of a secondary health facility for two weeks in November 2008. Data were analyzed using descriptive and inferential statistics. The mean age of respondents was 27.0 ± 5.4, mean parity was 2.4 ± 1.5, mean clinic attendance 4.9 ± 4.0 while mean gestational age at booking was 18.6± 7.7. The prevalence of missed opportunity among the pregnant women was 59.1% for IPTpl ＆ 56.0% for IPTp2; among pregnant PLWHA （people living with HIV/AIDS）, it was 100% for IPTp3, 70% for IPTp2 ＆ 80.0% for IPTpl. Factors accountable for missed opportunity include non-availability of SP （sulfadoxine-pyrimethamine）, lack of supervision, failure to prescribe medication, late booking and lack of knowledge. More women significantly received IPTp2 compared to IPTpl （P = 0.001）. Discussion： The findings establish the need for making SP available in the ANC （antenatal clinic）, educating health workers about current schedule and procedures for administration and early mobilization of pregnant mothers for ANC.

Discussion on the Measurement Method for the Coda Wave Quality Factor

The Quality factor is the parameter that can be used to describe the energy attenuation on seismic wave. In theory, we can obtain the relationship between the change of the coda wave quality factor with time and the strong earthquake preparation process on the basis of the quality factor of a coda wave in a same ray path. However, in reality the coda wave quality factor measured by different seismic coda waves corresponds to different seismic wave ray paths. The change of the quality factor with time is related to non-elastic characteristics of the medium and the volume of scattering ellipsoid constrained by scattered wave phase fronts, besides the change of regional stress field. This paper discusses the relationship between quality factor, epicenter distance and different lapse time, and then discusses the relationship between quality factor and frequency. Furthermore the determination method of the coda wave quality factor is put forward. The improved determination method of the quality factor, which removes the influence of different earthquakes or propagation depth of scattered waves, may increase measurement precision, thus information pertaining to abnormal changes in quality factor and the relationship between the quality factor and earthquake preparation process can be acquired.

Comparison of Two Different Protocols for Induction of Parturition in Heifers with or without Estradiol Benzoate

Objectives of this study were to investigate the efficacy of dexamethasone in combination with estradiol benzoate in controlled induction of parturition in heifers, especially in the subjects of retained fetal membranes and dystocia caused by fetal oversize. A total number of 100 Holstein-Friesian heifers aged 24-25 months, mean weight 450 kg and body condition score of 3-4 from a dairy herd located in the suburb of Tabriz with similar nutrition and management systems were allocated at random into two groups. Group A （Control, n = 50） heifers, after passing the minimum 270 d of pregnancy were injected with 30 mg dexamethasone IM. Group B （Treatment, n = 50） heifers with the same period of pregnancy received 30 mg dexamethasone plus 20 mg estradiol benzoate IM on the same days of pregnancy. The overall durations of initial treatments to induction of parturition were （41.50 ~ 2.65） h in group A and （37.50 ：i： 1.27） h in group B. In group A, more dystocia cases were observed than in group B. After parturition, group A showed a higher percentage of retention of fetal membranes as well as the calf mortality and dystocia compared to group B. The differences between two groups were statistically significant （P 〈 0.05）. In conclusion, our results indicate that induction of parturition by estradiol benzoate and dexamethasone together will be more effective than dexamethasone alone because of the less retention of fetal membranes, easy calving and shorter time from induction to parturition.