Assessment of Awareness and Understanding of Hemolytic Disease of the Fetus and Newborn in the Beninese Population

Background: Hemolytic Disease of the Fetus and Newborn (HDFN) arises from blood group incompatibility, especially the RhD antigen. In Benin, systematic ABO RhD blood grouping is poorly understood by many midwives and nurses. Nearly one in ten women risk having children with HDFN. This study aimed to determine the level of knowledge of the Beninese population on HDFN. Methods: Data were collected from June 2023 to March 2024. Participants completed a Kobotoolbox questionnaire on WhatsApp, with in-person assistance for illiterate participants. The study involved 521 participants from across Benin. Data were analyzed using SigmaPlot version 14.0. Results: Among the 521 participants, 298 were women (57.20%) aged 18 to 77 years. The majority (40.69%) were aged 26 - 35. Over a third (35.51%) did not know their RhD blood group. Most (59.12%) were unaware of the risks for RhD discordant couples. Among those with a partner, 25.16% were in at-risk couples for HDFN, and over half (59.12%) were unaware of this risk. There was no significant association between being in a high-risk union and knowledge of the risk or education level. Conclusion: Only 40.88% of the Beninese population are aware of HDFN, indicating a low level of knowledge.

Hepatic hydrothorax:An update and review of the literature

This review considers the modern concepts of pathogenesis,diagnostic methods,and treatment principles of hepatic hydrothorax(HH).HH is the excessive(>500 mL)accumulation of transudate in the pleural cavity in patients with decompensated liver cirrhosis but without cardiopulmonary and pleural diseases.It causes respiratory failure which aggravates the clinical course of liver cirrhosis,and the emergence of spontaneous bacterial pleural empyema may be the cause of death.The information was collected from the PubM ed database,the Google Scholar retrieval system,the Cochrane reviews,and the reference lists from relevant publications for 1994-2016 using the keywords:"liver cirrhosis","portal hypertension","hepatic hydrothorax","pathogenesis","diagnostics",and"treatment".To limit the scope of this review,only articles dealing with uncomplicated hydrothorax in patients with liver cirrhosis were included.The analysis of the data showed that despite the progress of modern hepatology,the presence of HH is associated with poor prognosis and high mortality.Most patients suffering from it are candidates for orthotopic liver transplantation.In routine clinical practice,stratification of the risk for an adverse outcome and the subsequent determination of individual therapeutic strategies may be the keys to the successful management of the patient’s condition.The development of pathogenetic pharmacotherapy and optimization of minimally invasive treatment will improve the quality of life and increase the survival rate among patients with HH.

Cardiovascular Cast Model Fabrication and Casting Effectiveness Evaluation in Fetus with Severe Congenital Heart Disease or Normal Heart

To investigate the application and effectiveness of vascular corrosion technique in preparing fetal cardiovascular cast models, 10 normal fetal heart specimens with other congenital disease（control group） and 18 specimens with severe congenital heart disease（case group） from induced abortions were enrolled in this study from March 2013 to June 2015 in our hospital. Cast models were prepared by injecting casting material into vascular lumen to demonstrate real geometries of fetal cardiovascular system. Casting effectiveness was analyzed in terms of local anatomic structures and different anatomical levels（including overall level, atrioventricular and great vascular system, left-sided and right-sided heart）, as well as different trimesters of pregnancy. In our study, all specimens were successfully casted. Casting effectiveness analysis of local anatomic structures showed a mean score from 1.90±1.45 to 3.60±0.52, without significant differences between case and control groups in most local anatomic structures except left ventricle, which had a higher score in control group（P=0.027）. Inter-group comparison of casting effectiveness in different anatomical levels showed no significant differences between the two groups. Intra-group comparison also revealed undifferentiated casting effectiveness between atrioventricular and great vascular system, or left-sided and right-sided heart in corresponding group. Third-trimester group had a significantly higher perfusion score in great vascular system than second-trimester group（P=0.046）, while the other anatomical levels displayed no such difference. Vascular corrosion technique can be successfully used in fabrication of fetal cardiovascular cast model. It is also a reliable method to demonstrate three-dimensional anatomy of severe congenital heart disease and normal heart in fetus.

A fascinating presentation of hepatic hydrothorax

We report this case of a 43-year-old woman with hepatitis-C cirrhosis who presented with a large right sided pleural effusion complicated by hypoxic respiratory failure and altered mentation necessitating dependence on mechanical ventilation. The pleural effusion spontaneously resolved upon initiation of mechanical positive pressure ventilation and recurred almost immediately after weaning the patient off the ventilator. The preventilation, ventilation and post-ventilation chest X-ray films in chronological order present a striking visual demonstration of fluid dynamics and pathophysiology of hepatic hydrothorax, thereby obviating the need for a dedicated diagnostic test. We also report this case to highlight the treatment strategies for this often intractable complication.

Prognosis of 591 Fetuses with Ultrasonic Soft Markers during Mid-Term Pregnancy

The present study aimed to examine the value of ultrasonic soft markers in prenatal screening by analyzing the clinical outcome of fetuses with ultrasonic soft markers during the second trimester of pregnancy. A retrospective analysis was performed to evaluate the outcome of 591 fetuses with ultrasonic soft markers from January 2015 to August 2016 in Zhongnan Hospital of Wuhan University, China. It was found that 591 fetuses showed ultrasonic soft markers in 4927 cases with the occurrence rate being 12.0%. Among them, 564 fetuses（95.4%） were delivered and the remaining 27 cases（4.6%） were aborted. Five hundred and sixty-seven cases had single ultrasonic soft marker, including echogenic intracardiac focus（n=343）, mild renal pelvis dilatation（n=116）, short long bones（n=72）, single umbilical artery（n=31）, mild lateral ventriculomegaly（n=21）, choroid plexus cysts（n=19）, and echogenic bowel（n=13）, with the disappearing rates in pregnancy being 97.1%（333/343）, 77.6%（90/116）, 0%（0/72）, 0%（0/31）, 57.1%（12/21）, 89.5%（17/19） and 61.5%（8/13） respectively. The rate of pregnancy termination due to single ultrasonic soft marker was 3.4%（19/567）, and that was 33.3%（8/24） due to two ultrasonic soft markers with the difference being statistically significant（P〈0.05）. The reasons of pregnancy termination included malformations（polycystic kidney, cleft lip and palate, congenital heart diseases, pcromphalus, hypospadias, hydrocephalus）, chromosome abnormality, and stillbirth. It was concluded that single ultrasonic soft marker is usually transient manifestation in pregnancy. Without the other structural defects, single ultrasonic soft marker usually disappears spontaneously with favorable prognosis in a low-risk population. It is suggested that ultrasonic soft markers should be appropriately interpreted to avoid unnecessary invasive examination.

Study of concentration of amniotic fluid Alpha-fetal protein in thalassemia fetus

Objective:To test the hypothesis that concentration of amniotic fluid alpha-fetal protein(AFAFP) is increased in thalassemia fetus.Methods:A total of 135 cases of amniocentesis admitted from July 2013 to December 2014 were included in this study.Among them 98 cases of normal fetuses were assigned into control group and 37 cases of thalassemia fetus were included as thalassemia fetus group.Alpha-fetoprotein levels detected by enzyme linked immunosorbent assay and the alpha-fetoprotein concentration were compared between the two groups.There is no significant difference in gestrational age between the two groups.Results:1.AFP concentration in thalassemia fetus group was significantly higher than that of normal control group [(1541.65±734.78) μg/mL vs.(2728.84± 1539.97) μg/mL ],and amniotic fluid AFP concentration was related to fetal thalassemia.2.AFAFP concentration in pureα-thalassemia fetus was higher than that of β thalassemia fetus or mixed αand was not significant.Conclusions:Concentration of a β thalassemia fetus,but the difference mniotic fluid alpha-fetal protein is increased in thalassemia fetus.AFP concentration inα-thalassemia fetus was higher than that of β thalassemia or mixed αand lore β thalassemia fetus but difference was not significance.Further studies are needed to exp the possible correlation between Down syndrome and biochemical markers of Thalassemia.

High power focused-beam microwave hyperthermia combined with intrapleural injection of Shapeilin in the treatment of patients with malignant hydrothorax

Objective:The aim of the study was to evaluate the efficacy and toxicity of high power focused-beam microwave hyperthermia with intrapleural injection of Shapeilin for patients with malignant hydrothorax.Methods:Fifty-eight patients with malignant hydrothorax were divided into group A and group B randomly.All patients underwent indwelling pleural catheter and were treated by intrapleural injection of Shapeilin once three days.Treatment was composed of 3 times injection.Patients of group B received high power focused-beam microwave hyperthermia after injection of Shapeilin.Results:The response rate of group B(79.3%) was higher than that of group A(48.3%)(P < 0.05).Incidence of main adverse reactions,associated with Shapeilin,of two groups including fever and thoracodynia were similar(P > 0.05).Patients of group B didn't encounter severe toxicities of microwave hyperthermia.Conclusion:High power focused-beam microwave hyperthermia combined with intrapleural injection of Shapeilin is effective and tolerable for patients with malignant hydrothorax.

A Clinical observation of the therapy for malignant hydrothorax by intra-thoracic injection using IL-2 combining with Cisplatin

Objective: The aim of our study was to explore the short-term effects and complication of interleukin-2 (IL-2) combining with Cisplatin in the treatment of malignant hydrothorax.Methods: Sixty-two cases patients with malignant hydrothorax were randomly divided into two groups.Observation group was 31 examples,thoracic cavity injection IL-2 and Cisplatin;31 cases in control group using Cisplatin alone intra-thoracic injection.The regime of every week for 1–4 weeks was used to observe short term effects and complications.Results: The total response rate in observe group was higher than that in control group (90.3% vs.68.1%),which had statistically significant difference (P < 0.05).The complications included gastrointestinal tract reaction,bone marrow inhibition,chest pain and fever.The incidence rates of chest pain and fever in observe group was slightly higher than that in control group,but there was no statistically significant difference (P > 0.05).Conclusion: The IL-2 combining with Cisplatin intra-thoracic injection for malignant hydrothorax has the features of good therapeutic effects and slight poisonous side effects,which is worth to be used in clinic.

Evaluating factors associated with the risk of hydrothorax following standard supracostal percutaneous nephrolithotomy

Objective:To report our experience with supracostal percutaneous nephrolithotomy(SC-PNL)and evaluate factors which could predict the risk of hydrothorax following SC-PNL.Methods:We reviewed 347 patients who underwent SC-PNL from January 2011 to December 2019.Patients were assessed for demographic characteristics,indication for the supracostal access,level of supracostal access,anatomy of the kidney(normal or malrotated),site of the puncture in relation to the mid-scapular line(medial or lateral),and whether another subcostal tract for stone clearance was required or not.Patients were assessed for the incidence of hydrothorax and requirement of intercostal drain depending on the level of percutaneous access.In addition,a multivariable logistic regression analysis model was developed to identify factors which could predict the occurrence of hydrothorax following SC-PNL.Results:Of the 347 patients with SC-PNL,248(71.5%)underwent a supra-12th rib approach,while the rest needed a supra-11th(n=85;24.5%)or a supra-10th(n=14;4.0%)rib tract.Overall,17(4.9%)patients developed a hydrothorax,while an intercostal-drain was required in seven of these 17 patients for 48 h.None of the patients with a supra-12th rib puncture required an intercostal-drain.More than a third of the patients with a supra-10th puncture developed a hydrothorax(35.7%)and all of them required an intercostal drain.Factors such as anteriorly malrotated kidney(odds ratio[OR]=2.722;95%confidence interval[CI]=1.042-5.617,p=0.03),puncture medial to the mid-scapular line(OR=1.669;CI=0.542-1.578,p=0.03),and an access higher than the supra-12th level(OR=5.265;CI=1.292-9.342,p<0.001)proved to be independent predictors of hydrothorax following a SC-PCNL on multivariable analysis.Conclusion:Incidence of clinically significant hydrothorax requiring an intercostal-drain after SC-PNL is very low.Knowledge of the predicting factors will help to anticipate the risk of hydrothorax in a particular patient and take necessary peri-operative measures.

Blood Lead Dynamics of Lead-Exposed Pregnant Women and Its Effects on Fetus Development

The dynamics of blood lead (Pb-B) and blood zinc protoporphyrin (ZPP-B) of women in early pregnancy and parturient women with lead exposure and the effects on fetus development were investigated. Pb-B of lead-exposed women was high: 0.984 μmol/L (20.38 μg/dl) and ZPP was 84.52μg/dl. Cord blood Pb-B was 0.896 μmol/L(18.56μg/dl)and cord blood ZPP was 69.24μg/dl. In the control group, Pb-B was 0.261μmol/L(5.41μg/dl), ZPP-B, 37.59 μg/dl, cord blood, Pb-B 0.34 μmol/L (7.93 μg/dl), and cord ZPP-B 49.0μg/dl. There was a significant correlation between blood lead and blood ZPP, maternal Pb-B and cord Pb-B, maternal Pb-B and cord ZPP-B. The significance of the consistency of high level Pb-B and the effects on fetus development is discussed.

CLINICAL OBSERVATION ON CORRECTING MALPOSITION OF FETUS BY ELECTRO-ACUPUNCTURE

Forty-eight cases of malposition of fetus were treated by electro-acupuncture, using Zhiyin (UB 67) points. 39 cases were corrected with a rate of 81.3%, the average session of treatment being 1.41. Two control groups were set up: moxibustion and blank control group. Statistical analysis shows that efficacy of electro-acupuncture is markedly superior to that of the blank. Sessions of electro-acupuncture were less than that of moxibustion and the difference was statistically significant, though there is no significant difference of efficacy between the two groups.

Transjugular intrahepatic portosystemic stent shunt for medically refractory hepatic hydrothorax:A systematic review and cumulative meta-analysis

AIM:To assess the effectiveness of transjugular intrahepatic portosystemic stent shunt(TIPSS) in refractory hepatic hydrothorax(RHH) in a systematic review and cumulative meta-analysis.METHODS:A comprehensive literature search was conducted on MEDLINE,EMBASE,and Pub Med covering the period from January 1970 to August 2014.Two authors independently selected and abstracted data from eligible studies.Data were summarized using a random-effects model.Heterogeneity was assessed using the I2 test.RESULTS:Six studies involving a total of 198 patients were included in the analysis.The mean(SD) age of patients was 56(1.8) years.Most patients(56.9%) had Child-Turcott-Pugh class C disease.The mean duration of follow-up was 10 mo(range,5.7-16 mo).Response to TIPSS was complete in 55.8%(95%CI:44.7%-66.9%),partial in 17.6%(95%CI:10.9%-24.2%),and absent in 21.2%(95%CI:14.2%-28.3%).The mean change in hepatic venous pressure gradient post-TIPSS was 12.7 mm Hg.The incidence of TIPSS-related encephalopathy was 11.7%(95%CI:6.3%-17.2%),and the 45-d mortality was 17.7%(95%CI:11.34%-24.13%).CONCLUSION:TIPSS is associated with a clinically relevant response in RHH.TIPSS should be considered early in these patients,given its poor prognosis.

Application value of ATP based bioluminescence tumor chemosensitivity assay in the chemotherapy for hydrothorax caused by non-small cell lung cancer

Objective： The aim of the study was to investigate the clinical value and application of ATP based bioluminescence tumor chemosensitivity assay （ATP-TCA） in the chemotherapy for hydrothorax caused by non-small cell lung cancer （NSCLC）. Methods： Hydrothorax specimens from 120 NSCLC patients were analyzed by ATP-TCA and the most sensitive chemotherapeutic drugs were used in NSCLC patients （treatment group）. At the same time, 56 NSCLC patients with hydrethorax were admitted in our Hospital （Department of Oncology, The No. 2 People＇s Hospital of Yibin, China） and given chemotherapy without guidance of the ATP-TCA （control group）. Before the third chemotherapeutic cycle, clinical outcomes were analyzed in the two groups. Results： Effective rate of hydrothorax in treatment group was 67%, while 46% in control group （P 〈 0.05）. In refractory hydrothorax patients, they were 69% and 40% （P 〈 0.05）, respectively.In vitro results correlated well with clinical outcomes （P 〈 0.01）. Conclusion： Effective rate of chemotherapy for hydrothorax in NSCLC is higher in treatment group than that in control group. ATP-TCA is especially helpful for refractory hydrothorax.

Proteomic analysis of adipose tissue during the last weeks of gestation in pure and crossbred Large White or Meishan fetuses gestated by sows of either breed

Background: The degree of adipose tissue development at birth may influence neonatal survival and subsequent health outcomes. Despite their lower birth weights, piglets from Meishan sows(a fat breed with excellent maternal ability) have a higher survival rate than piglets from Large White sows(a lean breed). To identify the main pathways involved in subcutaneous adipose tissue maturation during the last month of gestation, we compared the proteome and the expression levels of some genes at d 90 and d 110 of gestation in purebred and crossbred Large White or Meishan fetuses gestated by sows of either breed.Results: A total of 52 proteins in fetal subcutaneous adipose tissue were identified as differential y expressed over the course of gestation. Many proteins involved in energy metabolism were more abundant, whereas some proteins participating in cytoskeleton organization were reduced in abundance on d 110 compared with d 90. Irrespective of age,24 proteins differed in abundance between fetal genotypes, and an interaction effect between fetal age and genotype was observed for 13 proteins. The abundance levels of proteins known to be responsive to nutrient levels such as aldolase and fatty acid binding proteins, as wel as the expression levels of FASN, a key lipogenic enzyme, and MLXIPL, a pivotal transcriptional mediator of glucose-related stimulation of lipogenic genes, were elevated in the adipose tissue of pure and crossbred fetuses from Meishan sows. These data suggested that the adipose tissue of these fetuses had superior metabolic functionality, whatever their paternal genes. Conversely, proteins participating in redox homeostasis and apoptotic cel clearance had a lower abundance in Meishan than in Large White fetuses. Time-course differences in adipose tissue protein abundance were revealed between fetal genotypes for a few secreted proteins participating in responses to organic substances, such as alpha-2-HS-glycoprotein, transferrin and albumin.Conclusions: These results underline the importance of not only fetal age but also maternal intrauterine environment in the regulation of several proteins in subcutaneous adipose tissue. These proteins may be used to estimate the maturity grade of piglet neonates.

TREATMENT OF 80 CASES OF MALPOSITION OF FETUS BY MOXIBUSTION COMBINED WITH CHINESE DRUGS

On 80 patients with abnormal fetal position, we observed the effects of moxibustioncombined with Chinese herbs on the position of fetus. The results suggest this therapy is practical andeffective.

Bi-directional hepatic hydrothorax

A 59-year-old male with alcoholic cirrhosis presented to our hospital with an acutely painful umbilical hernia,and 4 mo of exertional dyspnea.He was noted to be tachypneic and hypoxic.He had a massive right sided pleural effusion with leftward mediastinal shift and gross ascites,with a tense,fluid-filled,umbilical hernia.Emergent paracentesis with drain placement and a large volume thoracentesis were performed.Despite improvement in dyspnea and drainage of 15 L of ascitic fluid,the massive transudative pleural effusion remained largely unchanged.He underwent a repeat large volume thoracentesis on hospital day 4.The patient subsequently developed a tension pneumothorax,which resulted in a dramatic reduction in the effusion.A chest tube was placed and serial radiographs demonstrated resolution of the pneumothorax but recurrence of the effusion.The radiographs illustrate the movement of fluid between the peritoneal and pleural cavities.In this case,the mechanism of pleural effusion was confirmed to be a hepatic hydrothorax via an unintended tension pneumothorax.Methods to elucidate a hepatic hydrothorax include Tc99m or indocyanine green injection into the ascitic fluid followed by its demonstration above the diaphragm.The unintended tension pneumothorax in this case additionally demonstrates bi-directional flow across the diaphragm.

THE EFFECT OF HBsAg ANTIGENEMIA IN PREGNANT WOMEN ON FETUSES AND INFANTS

We followed up 1576 pennant women prospectively from less than 24 weeks of pregnancy,in order to investigate the effect of HBsAg antigenemia on fetuses and infants.The resultsshowed that there was no difference between HBsAg-positive and negative pregnant women in the incidence of fetal distress,Premature labor,asphyxia neonatorum, perinatal death,low birth weight,and congenital malformation,P= 0. 6035, 0.2177,0.8722,0.4673,0.9508,and 0.7892,respectively.

Evaluation of right ventricular volume and systolic function in normal fetuses using intelligent spatiotemporal image correlation

BACKGROUND Heart defects are the most common congenital malformations in fetuses.Fetal cardiac structure and function abnormalities lead to changes in ventricular volume.As ventricular volume is an important index for evaluating fetal cardiovascular development,an effective and reliable method for measuring fetal ventricular volume and cardiac function is necessary for accurate ultrasonic diagnosis and effective clinical treatment.The new intelligent spatiotemporal image correlation(iSTIC)technology acquires high-resolution volumetric images.In this study,the iSTIC technique was used to measure right ventricular volume and to evaluate right ventricular systolic function to provide a more accurate and convenient evaluation of fetal heart function.AIM To investigate the value of iSTIC in evaluating right ventricular volume and systolic function in normal fetuses.METHODS Between October 2014 and September 2015,a total of 123 pregnant women received prenatal ultrasound examinations in our hospital.iSTIC technology was used to acquire the entire fetal cardiac volume with off-line analysis using QLAB software.Cardiac systolic and diastolic phases were defined by opening of the atrioventricular valve and the subsequent closure of the atrioventricular valve.The volumetric data of the two phases were measured by manual tracking and summation of multiple slices and recording of the right ventricular end-systolic volume and the right ventricular end-diastolic volume.The data were used to calculate the right stroke volume,the right cardiac output,and the right ejection fraction.The correlations of changes between the above-mentioned indices and gestational age were analyzed.The right ventricular volumes of 30 randomly selected cases were measured twice by the same sonographer,and the intraobserver agreement measurements were calculated.RESULTS Among the 123 normal fetuses,the mean right ventricular end-diastolic volume increased from 0.99±0.34 mL at 22 wk gestation to 3.69±0.36 mL at 35+6 wk gestation.The mean right ventricular end-systolic volume increased from 0.43±0.18 mL at 22 wk gestation to 1.36±0.22 mL at 35+6 wk gestation.The mean right stroke volume increased from 0.62±0.29 mL at 22 wk gestation to 2.33±0.18 mL at 35+6 wk gestation.The mean right cardiac output increased from 92.23±40.67 mL/min at 22 wk gestation to 335.83±32.75 mL/min at 35+6 wk gestation.Right ventricular end-diastolic volume,right ventricular end-systolic volume,right stroke volume,and right cardiac output all increased with gestational age and the correlations were linear(P<0.01).Right ejection fraction had no apparent correlation with gestational age(P>0.05).CONCLUSION Fetal right ventricular volume can be quantitatively measured using iSTIC technology with relative ease and high repeatability.iSTIC technology is expected to provide a new method for clinical evaluation of fetal cardiac function.

Termination of a partial hydatidiform mole and coexisting fetus: A case report

BACKGROUND We describe the treatment strategy for a patient who was found to have a partial hydatidiform mole and coexisting fetus(PHMCF)during the second trimester.The patient was a 38-year-old Chinese woman who had become pregnant following in vitro fertilization and embryo transplantation.We wanted to determine the safest therapeutic strategy to terminate the PHMCF during the second trimester.CASE SUMMARY In this case,we present a patient who was found to have a PHMCF complicated with serious continuous vaginal bleeding and pre-eclampsia during the second trimester.After careful evaluation,the pregnancy was considered to be unsustainable and was terminated via caesarean section(CS).An infant with weak vital signs and a partially cystic placenta measuring 110 mm×95 mm×35 mm were delivered by CS.The patient was discharged after 4 d.The serum levels ofβ-human chorionic gonadotropin decreased to within a normal range 5 wk after the operation,and no evidence of persistent trophoblastic disease or lung metastases was noticed at the 6-mo follow-up.CONCLUSION CS termination of PHMCF during the second trimester may be a relatively safe therapeutic strategy.

Prenatal Diagnosis of Fetus in Fetu with a Well Formed Skull: A Rare Case Report

Fetus in fetu is an extremely rare condition embryologically arising in monozygotic diamniotic twins with an incidence of 1:500,000 births. To the best of our knowledge, number of reported cases should not be more than 100 with majority of cases presenting in post natal life with only 5 cases detected prenatally. We are presenting a case diagnosed at 24 weeks of gestation on ultrasound with presence of well formed skull, facial skeleton and bony orbit.