Perinatal Morbidity, Mortality, and Neurodevelopmental Outcomes of Neonates with Fetal Growth Restriction

Objective: This study aimed to assess perinatal morbidity, mortality rates, and neurodevelopmental outcomes in the management of fetal growth restriction (FGR) at a single tertiary institute. Methods: Among 2465 deliveries between 2013 and 2019, 109 cases of FGR were reviewed retrospectively for causes, indications for pregnancy termination, perinatal death, overall neonatal outcomes, and long-term prognosis. Results: Excluding FGR due to congenital anomalies (n = 17), the mortality rate was 3.3% (3/92). One neonate delivered at 23 weeks developed cerebral palsy (1.1%). Retinopathy of prematurity occurred in four neonates (4.3%). Neurodevelopmental disorders were present in six neonates (6.5%), all of whom were delivered at 32 - 38 weeks. Significantly lower gestational age at delivery, lower birth weight, and higher umbilical artery resistance indices were observed in neonates with neurodevelopmental disorders. Conclusions: Intact survival before 27 weeks of gestation at delivery with FGR is uncommon. Neurodevelopmental disorders may still develop after delivery at 32 - 38 weeks;consideration should be given to the timing of delivery usingfetal ductus venosus Doppler waveforms measurements to reduce neurodevelopmental disorders.

Fucoidan enhances intestinal barrier function by upregulating the expression of claudin-1

AIM:To evaluate the protective effects of fucoidan on oxidative stress-induced barrier disruption in human intestinal epithelial cells.METHODS:In Caco-2 cell monolayer models,the disruption of barrier function by oxidative stress is mediated by H2O2.The integrity of polarized Caco-2 cell monolayers was determined by measuring the transepithelial resistance(TER)and permeability was estimated by measuring the paracellular transport of FITC-labeled4-kDa dextran(FD4).The protective effects of fucoidan on epithelial barrier functions on polarized Caco-2 cell monolayers were evaluated by TER and FD4 flux.The expression of tight junction(TJ)proteins was assessed using reverse-transcription polymerase chain reaction(RT-PCR)and immunofluorescence staining.RESULTS:Without H2O2treatment,fucoidan significantly increased the TER compared to control(P<0.05),indicating a direct enhancement of intestinal epithelial barrier function.Next,H2O2disrupted the epithelial barrier function in a time-dependent manner.Fucoidan prevented the H2O2-induced destruction in a dosedependent manner.Fucoidan significantly decreased H2O2-induced FD4 flux(P<0.01),indicating the prevention of disruption in paracellular permeability.RTPCR showed that Caco-2 cells endogenously expressed claudin-1 and-2,and occludin and that H2O2reduced the mRNA expression of these TJ proteins.Treatment with fucoidan attenuated the reduction in the expressions of claudin-1 and claudin-2 but not occludin.Immunofluorescence staining revealed that the expression of claudin-1 was intact and high on the cell surface.H2O2disrupted the integrity of claudin-1.Treatment with fucoidan dramatically attenuated the expression of claudin-1.CONCLUSION:Fucoidan enhanced intestinal epithelial barrier function by upregulating the expression of claudin-1.Thus,fucoidan may be an appropriate therapy for the treatment of inflammatory bowel diseases.

Cytokines in adipose-derived mesenchymal stem cells promote the healing of liver disease

Adipose-derived mesenchymal stem cells(ADSCs) are a treatment cell source for patients with chronic liver injury. ADSCs are characterized by being harvested from the patient's own subcutaneous adipose tissue, a high cell yield(i.e., reduced immune rejection response), accumulation at a disease nidus, suppression of excessive immune response, production of various growth factors and cytokines, angiogenic effects, antiapoptotic effects, and control of immune cells via cellcell interaction. We previously showed that conditioned medium of ADSCs promoted hepatocyte proliferation and improved the liver function in a mouse model of acute liver failure. Furthermore, as found by many other groups, the administration of ADSCs improved liver tissue fibrosis in a mouse model of liver cirrhosis. A comprehensive protein expression analysis by liquid chromatography with tandem mass spectrometry showed that the various cytokines and chemokines produced by ADSCs promote the healing of liver disease. In this review, we examine the ability of expressed protein components of ADSCs to promote healing in cell therapy for liver disease. Previous studies demonstrated that ADSCs are a treatment cell source for patients with chronic liver injury. This review describes the various cytokines and chemokines produced by ADSCs that promote the healing of liver disease.

Different natural courses of chronic hepatitis B with genotypes B and C after the fourth decade of life

AIM: To investigate the different impact of genotypes B and C on the development of liver cirrhosis (LC) among different age groups of patients with chronic hepatitis B (CH-B). METHODS: We examined the outcome of 121 patients with CH-B, divided by age and genotype. Univariate analyses were used to compare different groups. The Cox proportional hazard model was employed to evaluate factors affecting the development of LC. RESULTS: In patients < 30 years old, there were no significant predictors for development of LC. However, in patients ≥ 30 years old, genotype C was the only significant predictor. In the genotype C group, 8 of 12 patients who progressed to LC were 30-49 years old at initial diagnosis of chronic hepatitis (7 patients were positive for HBeAg). In the genotype B group, 4 of 8 patients who developed LC were ≥ 50 years old at initial diagnosis and were HBeAg-negative. CONCLUSION: The rate of development of LC was comparable in patients infected with genotypes B and C when CH-B occurred at < 30 years old. However, CH-B patients infected with genotype C showed poor prognosis if they were 30-49 years old and were positive for HBeAg. Age-specific natural course of CH-B should be considered when patients with CH-B are treated with antiviral drugs.

An autopsy case of a primary aortoenteric fistula: A pitfall of the endoscopic diagnosis

A primary aortoenteric fistula (PAEF), defined as a communication between the native aorta and the gastrointestinal tract, is a rare cause of gastrointes-tinal bleeding. The preoperative diagnosis of PAEF is extremely difficult. Consequently, PAEF may cause sudden and unexpected death. We present an autopsy case of a 68-year-old man who died of massive gastro-intestinal bleeding due to a PAEF. Autopsy revealed a pinhole rupture located on the third part of the duode-nal mucosa and fistulized into the adjacent abdominal aortic aneurysm (AAA). Our case indicates that the aortoenteric fistula can result in fatal gastrointestinal bleeding. Consequently, a PAEF should be included in the differential diagnosis of gastrointestinal bleeding.

Endoscopic and histopathological study on the duodenum of Strongyloides stercoralis hyperinfection

AIM:To investigate endoscopic and histopathological findings in the duodenum of patients with Strongyloides stercoralis(S.stercoralis)hyperinfection. METHODS:Over a period of 23 years(1984-2006),we investigated 25 patients withS.stercoralis hyperinfection who had had an esophagogastroduodenoscopy before undergoing treatment for strongyloidiasis.The clinical and endoscopic findings were analyzed retrospectively. RESULTS:Twenty-four(96%)of the patients investigated were under immunocompromised condition which was mainly due to a human T lymphotropic virus type 1(HTLV-1)infection.The abnormal endoscopic findings,mainly edematous mucosa,white villi and erythematous mucosa,were observed in 23(92%) patients.The degree of duodenitis including villous atrophy/destruction and inflammatory cell infiltration corresponded to the severity of the endoscopic findings. The histopathologic yield for identifying larvae was 71.4% by duodenal biopsy.The endoscopic findings of duodenitis were more severe in patients whose biopsies were positive for larvae than those whose biopsies were negative(Endoscopic severity score:4.86±2.47vs 2.71 ±1.38,P<0.05). CONCLUSION:Our study clearly demonstrates that,in addition to stool analysis,endoscopic observation and biopsies are very important.We also emphasize that S.stercoralis and HTLV-1 infections should be ruled out before immunosuppressive therapy is administered in endemic regions.

The Principles of Starch Gelatinization and Retrogradation

The polysaccharides, such as κ-carrageenan, ι-carrageenan, agarose (agar), gellan gum, amylose, curdlan, alginate, and deacetylated rhamsan gum, in water changed into an ice-like structure with hydrogen bonding between polymer and water molecules, and between water-water molecules even at a concentration range of 0.1% - 1.0% (W/V) at room temperature, resulting in gelation. Such dramatic changes from liquid into gels have been understood at the molecular level in principles. In this review, we describe the structure-function relationship of starch on the view point of rheological aspects and discuss gelatinization and retrogradation mechanism including water molecules at molecular level. The starch molecules (amylose and amylopectin) play a dominant role in the center of the tetrahedral cavities occupied by water molecules, and the arrangement is partially similar to a tetrahedral structure in a gelatinization process. The arrangement should lead to a cooperative effect stabilizing extended regions of ice-like water with hydrogen bonding on the surface of the polymer molecules, where hemiacetal oxygen and hydroxyl groups might participate in hydrogen bonding with water molecules. Thus, a more extended ice-like hydrogen bonding within water molecules might be achieved in a retrogradation process. Though many investigations not only include starch gelatinization and retrogradaion, but also the gelling properties of the polysaccharides have been undertaken to elucidate the structure-function relationship, no other researchers have established mechanism at the molecular level. There is reasonable consistency in our investigations.

Magnetic resonance angiography for the primary diagnosis of pulmonary embolism: A review from the international workshop for pulmonary functional imaging

Pulmonary contrast enhanced magnetic resonance angiography(CE-MRA) is useful for the primary diagnosis of pulmonary embolism(PE). Many sites have chosen not to use CE-MRA as a first line of diagnostic tool for PE because of the speed and higher efficacy of computerized tomographic angiography(CTA). In this review, we discuss the strengths and weaknesses of CEMRA and the appropriate imaging scenarios for the primary diagnosis of PE derived from our unique multiinstitutional experience in this area. The optimal patient for this test has a low to intermediate suspicion for PE based on clinical decision rules. Patients in extremis are not candidates for this test. Younger women(< 35 years of age) and patients with iodinated contrast allergies are best served by using this modality We discuss the history of the use of this test, recent technical innovations, artifacts, direct and indirect findings for PE, ancillary findings, and the effectiveness(patient outcomes) of CE-MRA for the exclusion of PE. Current outcomes data shows that CE-MRA and NM V/Q scans are effective alternative tests to CTA for the primary diagnosis of PE.

Origin of the regional stress field along the Liquine-Ofqui Fault Zone(LOFZ),Southern Chilean Andes by means of FE Simulation

The Liquine-Ofqui Fault Zone(LOFZ) of southern Chilean Andes is one of the largest active strike-slip fault zones.There is an ongoing debate regarding the origin of the stress field along the LOFZ due to its complex geometry.This paper represents a study of the origins of the LOFZ regional stress field.Stress fields are calculated by finite element(FE) analysis.The two possible stress origins, i.e., oblique plate convergence and ridge collision/indenter tectonics of Chile ridge against Peru-Chile trench, have been emphasized in the present study.Three types of boundary conditions for the three particular models have been applied to calculate stress fields.Models are assumed to be elastic and plane stress condition.Modeling results are presented in terms of four parameters, i.e., orientation of maximum horizontal stress(σ H max ), displacement vector, s train distribution, and maximum shear stress(τmax ) contour line within the model.The results of the first model with oblique plate convergence show inconsistency between the geometric shape of the LOFZ and the distribution of the four parameters.Although more realistic results are obtained from the second model with normal ridge collision, there are few coincident in the LOFZ geometry and regional stress field.The third model with normal and oblique ridge collision is reasonable in understanding the origin of stress field and geometrical condition in the lithosphere of the LOFZ.

Numerical Modeling of Neotectonic Movements and State of Stresses in the Central Seismic Gap Region,Garhwal Himalaya

This paper presents finite element modeling(FEM) to simulate the present-day stress field and crustal deformation using NE-SW structural section in the central Seismic Gap region of the Garhwal Himalaya.Our study deals with the effect of geometrical characteristics and rock layer parameters on the upper crust.Modeling results show that two types of tectonic regimes developed in the central Seismic Gap region:the geotectonics of the northern part has been controlled by regional compression,whereas southern part is characterized by regional extension.Correspondingly,thrust faults are induced in the northern part and normal faults are extensively developed in the southern front.Those evidences noticeably indicate that the compressive tectonic environment of the Himalaya becomes change into the extensional tectonic regime in its front.The computed shear stress accumulation along the northern flat of Main Himalayan Thrust(MHT) implies that considerable amount of interseismic stress is building up along the MHT system in the Himalaya,which ultimately release through the possible future great Himalayan earthquake(M>8).The comparison between our modeled stress field,faulting pattern and horizontal shortening rate with the distribution of the microseismic events,focal mechanism solutions,active faulting and GPS data in the central Seismic Gap region shows good agreement.

Validation and Application of Skeletochronology for Age Determination of the Ryukyu Ground Gecko, Goniurosaurus kuroiwae(Squamata: Eublepharidae)

Skeletochronology is a method commonly used for estimating the age of amphibians and reptiles in the wild.However,the number of lines of arrested growth(LAGs)does not necessarily reflect age in some species.We validated the applicability of this method to an endangered eublepharid gecko,Goniurosaurus kuroiwae,then inferred its longevity and age structures in wild populations.We classified young geckos into three groups using previously published data for early growth:Group 1 contained hatchlings before the first winter,Group 2 contained hatchlings after the first winter,and Group 3 included yearlings after the second winter.LAG numbers in these groups were then compared.All individuals in Group 1 possessed a single LAG,which was considered as a hatching line.Most individuals in Groups 2and 3 possessed one and two additional LAGs,respectively(LAG1 and LAG2),corroborating the notion that LAGs are formed annually.A few geckos exhibited fewer LAGs than expected.Analysis of variations in LAG and marrow cavity diameter demonstrated that in animals with fewer LAGs,endosteal resorption or fusion of hatching line and LAG1had occurred.LAG2 was never lost by endosteal resorption and was identifiable by its diameter.Thus,the age of adult geckos could be determined by counting LAGs outward from LAG2.Application of this method to wild populations revealed that the longevity of this species is not less than 83 months,but that almost all individuals in fragmented habitats die before 50 months,suggesting lower population sustainability in such habitats.

Factors that affect the process of professional identity formation in public health nurses

Objective: The aim of this study was to elucidate the process of professional identity formation and the factors that affect the process in public health nurses (PHNs). Methods: We performed an inductive qualitative analysis based on semi-structured interviews and focus group interviews of 65 PHNs. Results: At years 1 - 5, PHNs did not have a professional self-identity. Therefore, it was important for them to recognize the significance of their own work. At years 6 - 10, PHNs acquired self-assurance as a practitioner through feedback from residents. It was important for them to have a better understanding, broader viewpoints and more affection for their own community. At years 11 - 20, PHNs felt ambivalent toward the challenges and heavy responsibilities based on the objective assessment of their jobs and roles. PHNs felt embarrassed by role changes when they became a manager or an expert. It was important for them to become aware of their new role through managerial education and training. However, some PHNs who were unable to establish a clear PHN identity experienced setbacks at each developmental stage. Conclusions: Our data suggest that a differential approach dependent on the stage and level of confidence in an individual’s PHN identity is required for the formation of PHN identity.

Cesarean Scar Pregnancy: A Report of 11 Cases and Review of the Literature Regarding Subsequent Pregnancy

Background: There is no consensus regarding the optimal treatment for cesarean scar pregnancy (CSP) because treatment efficacy, safety, and the influence on subsequent pregnancy must be taken into consideration. Here we report our experience with 11 cases of CSP and review the literature regarding subsequent pregnancy. Methods: Records of 11 CSP cases that were treated at our hospital were retrospectively reviewed. CSP was treated by local methotrexate (MTX) injection or laparotomic or laparoscopic removal of the gestational mass and myometrial repair. Outcome of subsequent pregnancy after treatment was followed-up until delivery. Results: Local MTX injection was performed for six cases, laparotomic removal of the gestational mass and myometrial repair was performed for two, and laparoscopic removal of the gestational mass and myometrial repair was performed for three. The uterus was preserved in all cases. After CSP treatment, eight pregnancies occurred in five cases, resulting in six live births and two miscarriages. Conclusion: Advantages and disadvantages of various treatment methods for CSP continue to be elucidated. Serum hCG level, location of the gestational mass, thickness of the lower uterine segment at the time of diagnosis, and whether the patient wishes for fertility preservation should be considered when choosing a treatment plan.

Structure of Ulvan Isolated from the Edible Green Seaweed, Ulva pertusa

Ulvan, rhamnan sulfate, was extracted from the edible green seaweed, Ana-aosa (Ulva pertusa), which is grown on the coast of the Okinawa Islands. The yield of ulvan was 8.5% (W/W), and the total carbohydrates, uronic acid and sulfuric acid and ash contents were 67.3%, 23.8%, 19.7% and 22.6%, respectively. L-Rhamnose, D-xylose and D-glucose residues were identified by liquid chromatography, and their molar ratio was 4.0:0.1:0.3. D-Glucuronic and L-idulonic acid residues were also identified in molar ratio of 1.0:0.2. The NMR (13C and 1H) and methylation analysis revealed terminal β-D-glucruonic acid, terminal α-L-idulonic acid, 1,3-linked α-L-rhamnose, 1,4-linked α-L-rhamnose, 1,2,4-linked α-L-rhamnose, 1,3,4-linked α-L-rhamnose, 1,2,3,4-linked α-L-rhamnose and 1,3,4-linked β-D-xylose. The sulfate groups were attached at the C-2 and C-3 positions of the 1,4-linked α-L-rhamnose as well as C-3 of the 1,4-linked β-D-xylose residues. The chemical structure of the ulvan from Ulva pertusa was determined.

Numerical modeling of the development of southeastern Red Sea continental margin

The Red Sea continental margin (RSCM) corresponds to a wide hinge zone between Red Sea and Arabian plate. This margin has been studied through geological and geophysical observations primarily in regard to the evolution of Red Sea rift. This margin is characterized by occurrence of thin sediments, significant onshore uplift, tectonic subsidence of the offshore sedimentary basin, active faulting and seismicity. Studies indicate that sedimentary sequences of the margin are deformed by faults and folds resulting from at least two phases of extension and a phase of uplift. During the two phases of extension due to regional plate stress the sequence was cut by set of extensional faults. While during the phase of uplift the sequence was deformed by folding and faulting. The present paper aims to clear the structural development of RSCM during these tectonic episodes, taken as particular tectonic event, by two-dimensional finite element modeling on plane strain condition. Elastic rheology is assumed for the oceanic, continental and transitional crust along with syntectonic deposits. Stress field, shear stress and fault distribution suggests that mantle plume weakened the crust following rifting due to regional stress and developed the margin. These results are well consistent with those from present seismicity, active faulting and neotectonic studies.

Reevaluation of the Taxonomic Status of a Poorly Known Gecko, Gekko liboensis(Reptilia: Squamata)

Gekko liboensis Zhou and Li, 1982 is a poorly known gecko originating from Libo, Guizhou, southern China. Since the original description based on a single female from Libo, only three specimens(two females and one juvenile) have been reported from the type locality. Because of its close morphological resemblance to G. hokouensis Pope, 1927, G. liboensis is required to be reevaluated for its taxonomic status by studies based on additional specimens. Here we report for the first time the morphological features of 31 newly obtained specimens of G. liboensis from type locality and others, including males, and compare them with those of related species, chiefly on the basis of information from the literature. In addition, specimen-based comparisons were also made with G. hokouensis and an undescribed cryptic species known from the Ryukyus Islands, Japan. Results showed that the species is distinguished from its congeners in having a larger body size(60–91 mm), 0–2 small internasals, 10–13 supralabials, 10–13 infralabials, smooth enlarged tubercles present on the dorsum forming 4–10 irregular rows at the midbody but absent on the four limbs and tail, both fingers and toes without developed interdigital webs, a single cloacal spur on each side, and 10–12 precloacal pores in males. It most resembles G. hokouensis and its cryptic species but is clearly differentiated by having a larger body size, a predominantly absent internasal, fewer number of dorsal tubercle rows, larger number of precloacal pores, and conspicuous white marks on the dorsum and head. Judging from these results, we confirmed the taxonomic validity of G. liboensis. In addition, the geographic distribution of this gecko on the basis of obtained data was briefly discussed.

Cohesive Strength and Seismogenic Stress Pattern along the Active Basement Faults of the Precordillera-Sierras Pampeanas Ranges,Western Argentina:An Experimental Analysis by Means of Numerical Model

A two-dimensional finite element method (FEM) model that incorporates faults,elastic rock physical properties,topographical load due to gravity and far-field plate velocity boundary conditions was used to recognize the seismogenic stress state along the fold-and-thrust belt of the Precordillera-Sierras Pampeanas ranges of western Argentina. A plane strain model with nine experiments was presented here to examine the fault strength with two major rock phyical properties:cohesion and angle of internal friction. Mohr-Coulomb failure criterion with bulk rock properties were applied to analyse faults. The stress field at any point of the model was assumed to be comprised of gravitational and tectonic components. The analysis was focused to recognize the seismogenic shear strain concentrated in the internal-cristaline domain of the orogene shown by the modeling. Modeling results are presented in terms of four parameters,i. e.,(i) distributions,orientations,and magnitudes of principal stresses (σ1 and σ3),(ii) displacement vector,(iii) strain distribution,and (iv) maximum shear stress (τmax) contour line within the model. The simulation results show that the compressive stress is distributed in and around the fault systems. The overall orientation of σ1 is in horizontal directions,although some stress reorientations do occur within weaker parts,especially subsequent to the faults. A large-scale shear stress is accumulating along the active faults of Tapias-Villicum Fault (TVF),Salinas-Berros Fault (SBF),Ampacama-Niquizanga Fault (ANF) and Las Charas Fault (CF),which could act as local stress and strain modulators to localize the earthquakes occurrence.

A model of seasonal foliage dynamics of the subtropical mangrove species Rhizophora stylosa Griff.growing at the northern limit of its distribution

Background:Progress of forest production in response to the environment requires a quantitative understanding of leaf area development.Therefore,it is necessary to investigate the dynamics of seasonal crown foliage in order to understand the productivity of mangroves,which play an important role in the subtropical and tropical coastlines of the world.Method:Crown foliage dynamics of the mangrove Rhizophora stylosa were studies to reveal patterns of leaf recruitment,survival and seasonal leaf area growth.Results:Flushing of leaves occurred throughout the year,but both flushing and leaf area growth pattern of leaves varied with season.Maximum flushing occurred in summer,but leaf areas did not differ significantly with season.The half-expansion period is longer,and the intrinsic rate of increase was lower in winter.Summer flushed leaves grew faster at their initial stage and reached their maximum area over a shorter period of time.The difference in temperature and air vapor pressure deficit(VPD) between summer and winter contributed to the present dynamics of foliage patterns.The mean leaf longevity was estimated to be 13.1 month.The crown foliage area was almost stable throughout the year.Conclusions:Homeostatic control of the crown foliage area may be accompanied by the existence of ecophysiological mechanisms in R.stylosa.Integrating crown foliage dynamics into forest models represents an important step towards incorporating physiological mechanisms into the models for predicting growth responses to environmental changes and for understanding the complex responses of tree growth and litter production.

Successful treatment for esophageal carcinoma with lung metastasis by induction chemotherapy followed by salvage esophagectomy: Report of a case

我们这里从被由氟尿嘧啶和 nedaplatin 组成的联合化疗开始对待的食道的癌与肺转移报导一个 51 岁的人的一个案例。因为变形疾病消失了，抢救食管切除术被执行。尽管胸壁复发在胸廓切开术创伤发展了， 48 瞬间的延长幸存被本地肿瘤切除术和另外的化疗完成。这联合化疗为变形的食道的癌被认为是有希望、可观的治疗。