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Represented herein is a new manner to form fluorenones via direct excitation of substrate instead of photocatalyst to activate sp2 C-H bond under redox-neutral condition. Our design relies on the photoexcited triplet state of aromatic aldehyde intermediates with higher reactivity that can be intercepted by cobaloxime catalyst through single electron transfer for following β-H elimination. The simple generation of acyl radical and successful interception by a metal catalyst cobaloxime avoid the use of both photocatalyst and stoichiometric external oxidants, affording a series of highly substituted fluorenones, even for six-membered ketones, such as xanthone and thioxanthone derivatives in good to excellent yields, and H2 is as the only byproduct. This catalytic system features the readily available metal catalyst, mild reaction conditions and broad substrate scope, in which sunlight reaction and scale-up experiment by the continuous-flow approach make the developed methodology sustainable and amenable for potentially operational procedures.

High-nitrogen austenitic stainless steel (HNASS) has many excellent properties, such as high strength and toughness, high strain-hardening ability, strong corrosion resistance and low magnetization compared with the traditional widely used Ni–Cr austenitic stainless steel. The high nitrogen content in HNASS leads to the welded joint in the risk of many problems, such as nitrogen escape and loss, nitride precipitation, formation of pores and thermal cracks, resulting in the poor welding performance. The HNASS joints without obvious defects were obtained by metal inert gas (MIG) welding and laser-MIG hybrid welding, separately. The microstructures and properties of welded joints were compared. The nitrogen content in fusion zones of the two joints was tested by an oxygen, nitrogen and hydrogen analyzer. The tensile strength and the impact absorption energy of laser-MIG hybrid welded joint were about 27% and 20% higher than those of MIG welded joint, respectively. It could be attributed to the stronger solid solution strengthening effect resulted by the high nitrogen content of laser-MIG hybrid welded joint. The finer grains and the reduction of ferrite and precipitation phase in the microstructure of laser-MIG hybrid welded joint contributed to the improvement of toughness.

Laser beam offset welding of GH3128 and molybdenum (Mo) dissimilar joints was studied with an emphasis on the role of laser beam offset (LBO). It was found that the change of LBO significantly affected the properties of GH3128/Mo dissimilar joints. When the LBO increased from − 0.1 mm (i.e., laser spot was centered on Mo surface) to + 0.3 mm (i.e., laser spot was centered on GH3128 surface) at the step size of 0.1 mm, the amount of melted Mo gradually declined; the welding mode gradually changed from fusion welding to welding–brazing; macro-segregation of Mo-rich phases in fusion zone (FZ) gradually disappeared; the average microhardness of FZ significantly decreased, and therefore, microhardness distribution in FZ became more uniformly; the quantity of grain boundary liquation observed in heat-affected zone (HAZ) of GH3128 side gradually decreased; and recrystallization of grains in the HAZ of Mo was gradually suppressed. Joints with the optimal LBO of + 0.2 mm reached the maximum tensile strength of about 560 MPa. When using a small LBO, i.e., LBOs were + 0.1, 0, − 0.1 mm, the HAZ of Mo was greatly softened and embrittled. When adopting a large LBO, i.e., LBO was + 0.3 mm, the melt near Mo-FZ interface might fail to moisten Mo surface and spread on Mo surface, thus resulting in the reduction in tensile strength.

OBJECTIVE: To study the value of bedside echocardiography in predicting persistent patency of the ductus arteriosus during the early postnatal period in very low birth weight (VLBW) infants. METHODS: A retrospective analysis was performed for 51 VLBW infants who were admitted from March 2020 to June 2021, with an age of ≤3 days and a length of hospital stay of ≥14 days. According to the diameter of patent ductus arteriosus (PDA) on days 14 and 28 after birth, the infants were divided into three groups: large PDA group (PDA diameter ≥2 mm), small PDA group (PDA diameter

Aims The aim of the study was to evaluate the suitability of the current caffeine dosing regimen for the Chinese population using modelling and simulation approach. Methods Pharmacokinetic samples were collected from 99 Chinese newborns with premature apnoea. The median (range) of gestational age and postmenstrual age were 28.3 (25.0-33.4) weeks and 31.1 (26.4-38.0) weeks, respectively. Newborns were receiving caffeine citrate at a loading dose of 20 mg/kg/d and a maintenance dose of 5-10 mg/kg/d. Caffeine concentrations and CYP1A2 polymorphisms were investigated. Population pharmacokinetic modelling of caffeine in Chinese preterm newborn on a population-wide scale was conducted using NONMEM. Results A 1-compartment model with first-order elimination was used to describe population pharmacokinetic. With current weight implemented using 0.75 allometric scaling, clearance (CL) was positively related to current weight and postmenstrual age, but a negative relationship was observed with serum creatinine concentration. Eight genotypes of CYP1A2 were tested and none of them had a significant impact on caffeine pharmacokinetic parameters. Interindividual variability of CL and volume of distribution was 7.70 and 65.9%. The median (range) of 95% confidence intervals of CL were 0.0128 (0.0128-0.0131) L/h/kg. Monte Carlo simulation demonstrated that 80% (loading dose) and 98% (maintenance dose) of premature infants treated with a labelled dosing regimen attained the concentration target range of 5-20 mg/L. Conclusion A population PK model of caffeine was developed in Chinese newborns. Body weight-implemented allometric scaling, postmenstrual age and serum creatinine concentration markedly affected caffeine clearance. The labelled dosing regimen is suitable for Chinese premature infants.

Background: Globally, the proportion of child deaths that occur in the neonatal period remains a high level of 37–41%. Differences of cause in neonate death exist in different regions as well as in different economic development countries. The specific aim of this study was to investigate the causes, characteristics, and differences of death in neonates during hospitalization in the tertiary Neonatal Intensive Care Unit (NICU) of China. Methods: All the dead neonates admitted to 26 NICUs were included between January l, 2011, and December 31, 2011. All the data were collected retrospectively from clinical records by a designed questionnaire. Data collected from each NICU were delivered to the leading institution where the results were analyzed. Results: A total of 744 newborns died during the 1-year survey, accounting for 1.2% of all the neonates admitted to 26 NICUs and 37.6% of all the deaths in children under 5 years of age in these hospitals. Preterm neonate death accounted for 59.3% of all the death. The leading causes of death in preterm and term infants were pulmonary disease and infection, respectively. In early neonate period, pulmonary diseases (56.5%) occupied the largest proportion of preterm deaths while infection (27%) and neurologic diseases (22%) were the two main causes of term deaths. In late neonate period, infection was the leading cause of both preterm and term neonate deaths. About two-thirds of neonate death occurred after medical care withdrawal. Of the cases who might survive if receiving continuing treatment, parents' concern about the long-term outcomes was the main reason of medical care withdrawal. Conclusions: Neonate death still accounts for a high proportion of all the deaths in children under 5 years of age. Our study showed the majority of neonate death occurred in preterm infants. Cause of death varied with the age of death and gestational age. Accurate and prompt evaluation of the long-term outcomes should be carried out to guide the critical decision.

Purpose Delta-like ligand 4 (DLL4) and Jagged1 (JAG1), 2 vascular Notch ligands, are involved in the process of tumor angiogenesis. The present study investigates their relationship with microvascularization and the prognostic effect in primary glioblastoma. Methods Tumor tissues from 61 glioblastomas were analyzed using immunohistochemistry for DLL4/JAG1 expression and microvascular formations. The correlations between DLL4/JAG1 and microvascularization were analyzed. The survival probabilities were computed using the Kaplan-Meier method. The Cox proportional hazards regression model was used for multivariate analysis of time to progression (TTP) and overall survival (OS). Results The results showed increased DLL4 and JAG1 expression in glioblastoma tissues. Five types of basic microvascular formations, including microvascular sprouting, vascular cluster, vascular garland, glomeruloid vascular proliferation, and vasculogenic mimicry, were detected. Glioblastomas with the type I microvascular pattern (MVP) that displayed prominent microvascular sprouting and vascular clusters tended to have higher DLL4 expression, whereas those with the type II MVP that had numerous vascular garlands, glomeruloid vascular proliferations, and vasculogenic mimicries showed upregulated JAG1 expression. Univariate analysis documented that high DLL4 expression, high JAG1 expression, and type II (MVP) were statistically associated with reduced TTP and OS. Multivariate analysis confirmed high DLL4 expression, high JAG1 expression, and type II MVP as significant prognostic factors for both shorter TTP and OS, independent of age, Karnofsky performance scale, and other molecular markers (vascular endothelial growth factor, Ki67, and P53). Conclusions DLL4 and JAG1 may have opposing effects on tumor angiogenesis in glioblastoma. The Notch pathway may be a new target for antiangiogenic therapy in glioblastoma.

Joining technology for zirconium (Zr) and molybdenum (Mo) dissimilar joints exerts significance on innovative design of nuclear power equipment. Fiber laser beam welding (LBW) of Zr-Mo dissimilar joints with and without Ti insert were welded in butt configuration with one centered pass. It was found that a transition layer containing brittle Mo2Zr phase with the thickness of about 2 μm formed at the interface of Mo and welded seam zone (FZ) after LBW. Transverse cracks and significant macro-segregation were observed in the FZ. Moreover, plenty of needle-like α' phases alternatively distributed in β phase matrix were found in FZ where the average microhardness was about 350 HV, which was significantly higher than those of base metals (BMs) of Mo (250 HV) and Zr (130 HV). The tensile strength of the welded joint was about 76 MPa and appeared the mixed of inter- and trans-granular fracture mode. Noting that titanium (Ti) exhibited a favorable metallurgical compatibility with both base metals (Zr and Mo), a pure Ti interlayer with width of 1 mm was inserted into the Zr/Mo interface to further conduct welding. It was found that, by adding Ti interlayer, macro-segregation in FZ was inhibited, needle-like microstructures in FZ greatly reduced and the average microhardness of FZ decreased to about 253 HV. During the tensile test, the joint with Ti addition was fractured in BM of Zr and showed the tensile strength of about 321 MPa.

OBJECT Peritumoral brain edema (PTBE) is a common phenomenon associated with high-grade gliomas (HGGs). In this study, the authors investigated the expression of Notch delta-like ligand 4 (DLL4) and its correlation with PTBE and prognosis in patients with an HGG. METHODS Tumors from 99 patients with HGG were analyzed for DLL4 expression using immunohistochemistry. PTBE on preoperative MR images and the relationship between PTBE and DLL4 expression were evaluated. The effect of DLL4 on patient prognosis was assessed by using Kaplan-Meier survival and Cox proportional hazard models. RESULTS Immunohistochemistry results revealed that the expression of DLL4 was distributed primarily within the cytoplasm of tumor vascular endothelial cells and seldom detected in tumor cells. DLL4 expression was correlated positively with the degree of edema (r = 0.845 and p < 0.001, Spearman’s test). In addition, DLL4 was an independent predictor of prognosis in patients with HGGs (p = 0.001). CONCLUSIONS DLL4 expression was correlated positively with the degree of PTBE and was an independent unfavorable prognostic indicator in patients with HGG.

The capability of joining molybdenum (Mo) to 304L stainless steel (304L) is of significance for nuclear energy industry, while no effective methods have been developed to produce high strength joints. Laser beam offset welding was used to join pure Mo and 304L. The results demonstrate that: (i) when laser beam shifts to 304L for 0.1 mm, the performance of joints are the best and tensile strength is about 110 MPa; (ii) by presetting a nickel (Ni) foil at Mo/304L interface, tensile strength of the joints is increased to about 280 MPa; (iii) after adding Ni, diffusion ability of Mo at Mo/FZ interface increases and diffusion depth of Mo rises from 7.4 μm to 9.7 μm; content of Mo in fusion zone (FZ) rises, so that the microhardness of FZ increases from 175 HV to 220 HV, which is close to that of the HAZs of Mo and 304L, and the gradient of microhardness of the joints obviously decreases; moreover, Mo-rich grains inserting into FZ are found at Mo/FZ interface after adding Ni and the depth of insertion in can be up to 20 μm. These results are favorable for improving bonding strength of Mo/FZ interface, as well tensile strength of Mo/304L joint. Keywords: Laser welding, Dissimilar joint, Pure molybdenum, 304L, Minor Ni addition

Persistent pulmonary hypertension of the newborn (PPHN) is a clinical syndrome characterized by increased medial and adventitial thickness of the lung vasculature. The underlying mechanisms that regulate the cell phenotype alteration during PPHN remodeling are largely unknown. We randomly selected newborn rats that were exposed to hypoxia (10-12%) or room air for 2 weeks and used a microarray to identify the lung tissue microRNAs (miRNAs) involved in PPHN progression. The role of a key miRNA that affects the endothelial-to-mesenchymal transition (EndMT) in primary cultured rat pulmonary microvascular endothelial cells (RPMECs) was investigated. The expression of miR-126a-5p was elevated in the PPHN model according to microarray analysis. The relative expression of miR-126a-5p in RPMECs increased when they were exposed to hypoxia (P0.05), consistent with the microarray results. Pecam1 expression decreased, whereas alpha-smooth muscle actin (α-SMA) increased in the hypoxic RPMECs. Knockdown of miR-126a-5p in RPMECs followed by treatment with hypoxia for 48 h resulted in a significant increase in the expression of Pecam1 and a reduction in α-SMA expression, with a simultaneous increase in PI3K (p85β) and phosphorylation of AKT at serine 473 compared with the negative control. Finally, the circulating miR-126a-5p concentration was upregulated in the PPHN model compared with healthy neonates. We concluded that hypoxia changed the cell homeostasis and that miR-126a-5p was upregulated in PPHN, which is partly responsible for hypoxia-induced EndMT. The mechanism underlying the upregulation of miR-126a-5p by hypoxia probably acts through the p85-β/p-AKT pathway.

Objective To investigate the factors influencing the prognosis of patent ductus arteriosus (PDA) in very low birth weight (VLBW) infants. Methods A total of 194 VLBW infants who were admitted from January 2012 to December 2014 were enrolled as study subjects. According to cardiac ultrasound findings and treatment outcome, these infants were divided into non-PDA group, spontaneous closure group, pharmaceutical closure group, and surgical closure group. Their clinical and echocardiographic characteristics were analyzed. Results The spontaneous closure rate of PDA was 58.7%. The spontaneous closure group showed significantly higher gestational age, birth weight, and proportion of small-for-gestational-age infants than the pharmaceutical and surgical closure groups (P < 0.05). The pharmaceutical and surgical closure groups had a significantly higher incidence rate of neonatal respiratory distress syndrome and a significantly higher proportion of infants who were given pulmonary surfactant (PS) than the spontaneous closure group (P < 0.05). During different periods of time, the spontaneous closure group had a significantly smaller ductus arteriosus diameter than the pharmaceutical and surgical closure groups (P < 0.05). The multivariate logistic regression analysis showed that gestational age, application of PS, and ductus arteriosus diameter at 48 hours were significantly associated with the prognosis of PDA. The major transductal flow pattern in the spontaneous closure group was closing pattern, while in the pharmaceutical and surgical closure groups, the main flow patterns were pulmonary hypertension and growing patterns within 48 hours and growing pattern on days 4 and 7. Conclusions The VLBW infants have a high spontaneous closure rate of PDA. A decreased closure rate of PDA is associated with the lower gestational age and the application of PS. PDA with a large ductus arteriosus diameter and a growing or pulsatile flow pattern cannot easily achieve spontaneous closure.

Background Obstetric hemorrhage remains a leading cause of maternal death internationally. Polydatin is an effective drug in ameliorating microcirculatory insufficiency and increasing survival rate in non-pregnant animal model of controlled hemorrhagic shock. In the present study, we investigated the effects of hypotensive resuscitation combined with Polydatin administration on microcirculation and survival rate in a clinically relevant model of uncontrolled hemorrhagic shock in pregnancy. Materials and Methods Twenty anesthetized New Zealand white rabbits at mid and late gestation were anesthetized, and an ear chamber was prepared to examine microvessels by intravital microscopy. Shock was induced by transecting a small artery in mesometrium, followed by blood withdrawal via the femoral artery to a mean arterial pressure (MAP) of 40–45mm Hg. Animals were randomly divided into two groups ( n = 10 per group): 30min after hemorrhage induction, hypotensive resuscitation with Ringer's solution to MAP of 60mm Hg, followed by a single volume infusion of 4mL/Kg of normal saline or Polydatin at 60min after hemorrhage induction (group NS, PD). Finally all the animals received hemorrhage control and resuscitated with half of the heparinized shed blood and Ringer's solution to MAP of 80mm Hg. Results At the end of resuscitation, compared with group NS, group PD showed significantly improved capillary perfusion as indicated by increased arteriole diameter [0.95 ± 0.02 of baseline (PD), 0.71 ± 0.05 of baseline (NS); P = 0.000] and higher functional capillary density[95.3% ± 2.6% (PD), 57.2% ± 4.1% (NS); P = 0.000]. Median survival time was significantly longer in group PD than that in group NS [4 d (PD), 2 d (NS); P = 0.000]. Conclusions On the basis of hypotensive resuscitation, Polydatin administration improved microcirculation and prolonged survival time in pregnant rabbit model of uncontrolled hemorrhagic shock.

The grey dynamic model GM(1, 1), which is based on the grey system theory, has recently emerged as a powerful tool for short term load forecasting (STLF) problem. However, GM(1, 1) is only a first order single variable grey model, the forecasted accuracy is unsatisfactory when original data show great randomness. In this paper, we propose improved grey dynamic model GM(2, 1), a second order single variable grey model, to enhance the forecasted accuracy. Then it is applied to improve STLF performance. We provide a viewpoint that the derivative and background value of GM(2, 1) model can be expressed in grey number. Then cubic spline function is presented to calculate the derivative and background value in grey number interval. We call the proposed model as 3spGM(2, 1) model. Additionally, Taylor approximation method is applied to 3spGM(2, 1) for achieving the high forecasted accuracy. The improved version is defined as T-3spGM(2, 1). The power system load data of ordinary and special days are used to validate the proposed model. The experimental results showed that the proposed model has better performance for STLF problem.

Aim We sought to compare the effects of conservative hypotensive and aggressive normotensive resuscitation strategies on blood loss, fluid requirements, blood lactate and survival rate in a clinically relevant model of uncontrolled hemorrhagic shock in pregnancy. Method 60 anesthetized New Zealand white rabbits at late gestation underwent uncontrolled hemorrhagic shock by transecting a small artery in the mesometrium, followed by blood withdrawal via the carotid artery, to a mean arterial pressure (MAP) of 40–45mmHg. They were randomly divided into six groups ( n =10 per group): sham shock (group SS); shock without resuscitation (group SH); hypotensive resuscitation in the simulated prehospital phase with Ringer's solution to MAP of 50, 60, or 70mmHg, respectively (groups RE50, RE60, RE70); and aggressive resuscitation in the prehospital phase with Ringer's solution to MAP of 80mmHg (group RE80). Finally, in the simulated hospital phase, animals in the resuscitated groups underwent surgical control of bleeding and were fully resuscitated with half of the heparinized shed blood and Ringer's solution to MAP of 80mmHg. Results Hypotensive resuscitation significantly decreased blood loss and subsequent volume infusion, leading to higher hematocrit, lower lactate concentration, and shorter prothrombin time and activated partial thromboplastin time. Median survival time in group RE60 (4.3±0.6 days) was significantly longer than that in groups RE50 (2.7±0.4 days), RE70 (2.3±0.3 days), and RE80 (1.7±0.3 days) ( P Conclusions We conclude that in this rabbit model of uncontrolled hemorrhage in pregnancy, hypotensive resuscitation to MAP of 60mmHg may be an optimal target MAP before hemorrhage can be controlled by surgical intervention.

The cumulative curve prediction has been widely used in many manufacturing systems to achieve the efficient control and management for production processes. In this paper, the grey model GM(1, 1), a single-variable first-order grey model, which is based on the grey system theory, is proposed to resolve the prediction problem of cumulative curve. To improve the prediction capability of GM(1, 1), the cubic spline function is integrated into GM(1, 1). The newly generated model is defined as 3spGM(1, 1). Then, the particle swarm optimization (PSO) algorithm is applied to 3spGM(1, 1) so that the prediction performance can be further improved. We refer to the optimal version as P-3spGM(1, 1). Finally, a residual compensation approach based on artificial neural network (ANN) is proposed to acquire the best prediction performance. The cumulative curve in the production process is used to validate the proposed models.

The machining accuracy prediction has been widely studied in many manufacturing processes to achieve efficient control for production process. In this paper, a dynamic analysis model is proposed to develop the prediction model of machining accuracy. The dynamic analysis model has the advantage of high predictable power of the GM(1,1) model while at the same time utilizing the prediction power of the Markov chain model from stochastic process theory. Furthermore, Taylor approximation method is employed to enhance the prediction accuracy. The effectiveness of the proposed model is validated with a real case.

Glioblastoma is a highly aggressive brain tumor. Aberrant Notch pathway has been implicated in the formation and progression of glioblastoma. The present study attempted to investigate the expression of Notch ligand Jagged1 and its association with patient outcome in primary glioblastoma. Tumor tissues from 82 patients with primary glioblastoma were analyzed using immunohistochemistry for Jagged1 expression. Relationships between Jagged1 expression and clinical features (age, gender, KPS, symptom duration, extent of resection and Ki67 index) were evaluated. The prognostic value of Jagged1 was assessed using the Kaplan–Meier survival estimates and the Cox proportional hazard models. Immunohistochemistry results showed markedly increased Jagged1 expression in glioblastoma tissues compared to adjacent non-neoplastic brain tissues. Univariate analysis documented that high Jagged1 expression in tumor cells (TC) and endothelial cells (EC) were both statistically associated with reduced time to progression (TTP) (P

To assess the diagnostic value of amplitude-integrated electroencephalography (aEEG) in predicting outcome of newborns who were at high risk for central nervous system without severe hypoxic-ischemic encephalopathy.Forty-two consecutive patients at risks for neurological disorders referred to our level-III NICU were prospectively enrolled in the study over a period of 3 years. They were classified on the basis of their primary diagnoses including hypoglycemic brain damage, meningoencephalitis, bilirubin encephalopathy, and metabolic disease. Clinical data were collected. Amplitude-integrated and raw EEG tracings were assessed for background pattern, sleep-wake cycling, and epileptiform activity. The neuromotor development of survivors was assessed by using the Infant Neurological International Battery (INFANIB).The characteristic of aEEG tracings in 42 infants showed continuous normal voltage (CNV)(n = 15), discontinuous voltage (DC)(n = 9), burst-suppression (BS) BS(+) (n = 6), BS(-)(n = 7), flat (FT, n = 5); mature sleep-wake cycling (SWC, n = 4), immature SWC (n = 14), no SWC (n = 24); 30 infants (71.4%) had electrical seizures: single seizure (n = 6); repetitive seizures (n = 7), and status epilepticus (SE) (n = 17).aEEG of 20 infants who had poor outcome showed FT (n = 5), BS(-)/SE (n = 6), BS(-)/ repetitive seizures (n = 1) , BS(+)/SE (n = 1), BS(+)/repetitive seizures (n = 1), DC/SE(n = 6). Chi-square analysis and Spearman rank correlation analysis showed the classification of aEEG background pattern, SWC and comprehensive score (score system was developed by evaluation of the above 3 variables) were correlated with the outcome of these infants at high neurological risks.Amplitude-integrated electroencephalography can provide important information of the status of cerebral function in neonates at high neurological risk and help to predict their outcome.

To explore the Infant Neurological International Battery (Infanib) as a screening tool for early detection of gross motor developmental delay in preterm infants discharged from NICU, and to predict their later neuromotor dysfunction (cerebral palsy or motor retardation).A cohort of preterm infants who were admitted to the neonatal intensive care unit between June 2008 and March 2010 were enrolled in the study. Infanib assessment was performed at corrected age 3-4 months and 6-7 months. Peabody Developmental Motor scale-2 (PDMS-2) and neuro-examinations were used to confirm the last motor retardation. The sensitivity, specificity, positive predictive value and negative predictive value of the Infanib were calculated.A total of 147 preterm infants were participated in this study, and 129 infants were followed up at correct age 12 months or more than 12 months. Eleven (8.5%) had celebral palsy, 28 (21.7%) had motor retardation, and 90 (69.8%) normal mortor development. The predictive validity of the Infanib at correct age 3-4 months (n=14) was: sensitivity 84.6%, specificity 75.6%, positive predictive value 60.0% and negative predictive value 91.9%. The predictive validity of the Infanib at correct age 6-7 months (n=117) was: sensitivity 100%, specificity 91.7%, positive predictive value 82.5% and negative predictive value 100%.The Infanib can be used as an appropriate screening tool and validity measurement for early detection of gross motor developmental delay in preterm infants.

To investigate the prevalence and major risk factors of peripartum thromboembolic disease in different regions of Guangdong province.Data from 169 218 pregnant women in different regions of Guangdong province from January 2005 to June 2010 were analyzed retrospectively. The prevalence and epidemiological characteristics of thromboembolic disease during pregnancy or puerperium were investigated.Of the studied population, (1) 201 cases (1.3‰) suffered from thromboembolic disease during pregnancy or puerperium including 128 cases of deep vein thrombosis (DVT), 68 cases of cerebral venous thrombosis (CVT) and 5 pulmonary embolism, the prevalence rates were 0.8‰, 0.4‰, and 0.02‰ respectively. (2) Risk factors in different regions showed that, in the Pearl River Delta area, the major risk factors for DVT would include previous or family history of thrombosis, pregnancy complications, with medically involved diseases, prolonged bed rest and pregnancy weight gain15 kg etc. While in eastern, western, northern parts of Guangdong, the major risk factors for DVT would include pregnancy weight gain15 kg, prolonged bed rest, preeclampsia, cesarean section and complications during pregnancy. In Pearl River Delta region, the major risk factors for CVT would include eclampsia, preeclampsia, pregnancy complications, prolonged bed rest3 days, past history or family history of thrombosis. While eclampsia, preeclampsia, advanced age or younger age, pregnancy weight gain15 kg, complications during pregnancy were the major risk factors for CVT in the eastern, western or northern parts of Guangdong.Prevalence and major risk factors of peripartum thromboembolic disease in different regions of Guangdong were different. It was crucial to take effective measures in pregnant women with different epidemiological characteristics and risk factors to prevent and reduce the incidence of peripartum thromboembolic disease.

To discuss the clinical features, management, pregnancy outcome and prognosis of obstetric mirror syndrome.The clinical data of 12 cases with obstetric mirror syndrome at Shenzhen Maternity and Child Healthcare Hospital from April 2008 to December 2010 were collected to retrospectively analyze the clinical features, management, pregnancy outcome and prognosis.(1) ETIOLOGY: 12 cases with obstetric mirror syndrome included 9 cases of Bart's hydrops fetalis, 2 cases with fetal complicated congenital cardiac anomalies, and 1 case of unknown etiology. (2) Gestational age at diagnosis and at delivery: gestational age at diagnosis ranged from 28 to 36 weeks [mean (31.5 ± 4.7) weeks], and gestational age at delivery ranged from 28(+3) to 38 weeks [mean (32.9 ± 2.9) weeks]. There were no significant differences between the gestational age at diagnosis and at delivery in consistence with severe preeclampsia group and mild preeclampsia group [(31.8 ± 2.3) weeks vs. (30.9 ± 7.2) weeks, (32.5 ± 2.3) weeks vs. (33.5 ± 3.9) weeks, P0.05]. (3) The patients with obstetric mirror syndrome can present a preeclampsia-like syndrome: maternal extremity edema in 12 cases, headache and visual disturbance in 1 case, proteinuria in 11 cases, elevated blood pressure in 5 cases, elevated uric acid in 9 cases, hypoproteinemia in 12 cases, elevated creatinine in 3 case, elevated liver enzyme in 1 case, thrombocytopenia in 2 cases. The major complications included 1 case of HELLP syndrome, acute pulmonary edema, placental abruption, amnionic fluid embolism, DIC respectively, 3 cases of acute kidney failure and 6 cases of postpartum hemorrhage. (4) Sonographic findings: 1) Hydrops fetalis: fetal ultrasound revealed pleural fluid, fetal ascites, skin edema, scalp edema, encephalocolele enlargement, hydropericardium and increased cardio-chest ratio. 2) Placenta megaly: the placental pathological examination revealed edematous and large in 12 cases. Placental thickness was beyond 4 cm in all cases [(6.3 ± 1.9) cm]. 3) Hydramnios: hydramnios could be found in 11 cases [amniotic fluid index (19.7 ± 3.1) cm]. (5) Postnatal conditions:all blood pressure and laboratory findings including urine protein normalized within 5 to 7 days after delivery. (6) Pregnancy outcome:all 12 patients survived, however the perinatal mortality rate was 100%. Two of 12 cases with mirror syndrome underwent cesarean section, and 10 were vaginal delivery, of which 1 need uterine artery embolisom due to postpartum hemorrhage.Obstetric mirror syndrome seems to simulate preeclampsia although there are distinguishing features, such as hemodilution, placental edema, and polyhydramnios. When the specific cause of obstetric mirror syndrome can not be identified and corrected, the decision for delivery should be made as soon as possibly.

OBJECTIVE The acute respiratory distress syndrome may complicate postpartum hemorrhagic shock and resuscitation, but its mechanisms are not yet well defined. We studied the lung inflammatory response to postpartum hemorrhagic shock and resuscitation in a rabbit model and the role of the nuclear factor-κB pathway. DESIGN Randomized, controlled, prospective study. SETTING University hospital laboratory. SUBJECTS Nonobstetric (not pregnant nor postpartum) and obstetrical (within 2 hrs postpartum) rabbits. INTERVENTIONS Nonobstetric and obstetric female New Zealand white rabbits underwent fixed-pressure or fixed-volume hemorrhagic shock for 30 mins and then were rapidly resuscitated with the shed blood and Ringer's solution. Finally, they were either monitored for survival time or euthanized by exsanguination for lung tissue examination 24 hrs after hemorrhage. MEASUREMENTS AND MAIN RESULTS After hemorrhagic shock and resuscitation, median survival time in obstetric rabbits (3 days) was significantly shorter (p

To investigate the ultrasound characteristics, etiology and prognosis in hydrops fetalis.From September 2002 to May 2010, 156 hydrops fetalis presented in Shenzhen Maternity and Child Healthcare Hospital were studied retrospectively, including ultrasound characteristics, etiology, and prognosis.All of the 112 typical hydrops fetalis, 20 cases with isolated ascites, 8 cases with isolated pleural effusion, 7 cases with isolated pericardial effusion, 5 cases with isolated subcutaneous edema, 4 cases with isolated placental thickening were observed by ultrasonography. The major etiology and associated diagnosis consisted of 35.9% (56/156) of non-immune anemia, 9.6% (15/156) of cardiac abnormalities, 7.1% (11/156) of intrauterine infection, 6.4% (10/156) of twin problems, 5.8% (9/156) of meconium peritonitis, 5.1% (8/156) of thoracic-lung disease, 4.5% (7/156) of chromosomal abnormalities, 1.9% (3/156) of immune anemia. Alpha thalassemia was the most common non-immune anemia (96%, 54/56). An etiology and associated diagnosis could be determined in 81.4% (127/156) of cases. Follow-up data showed that 7 cases were fetal death, 110 women elected to terminate their pregnancies, 3 cases lost follow-up, the other 36 cases preserve continuing pregnancy, including 28 liveborn infants and 8 fetal deaths. Etiology of twin-twin transfusion syndrome, meconium peritonitis, congenital chylothorax, intrauterine infection, cardiac abnormalities and so on had survived fetus cases. The survival rate of typical hydrops fetalis in the present series was 3.6% (4/112).Ascites is the most common characteristics of sonogram in hydrops fetalis. The etiology of hydrops fetalis is extremely complex. The prognosis is associated with the etiology and hydrops subtype.

To investigate the difference in the development of acute lung injury after hemorrhagic shock in postpartum and non-pregnant rabbits.Hemorrhagic shock/resuscitation was produced on 9 pregnant New-Zealand rabbits postpartum (within 24 hours after giving birth) and 9 non-pregnant controls via carotid artery bleeding and perfusion (i.v.) of lactate Ringer solution for 3 hours. The serum level of cytokine tumor necrosis factor-α (TNF-α) and interleukin-10 (IL-10) in the animals were measured at different time points. Lung tissue were taken 3 hours after resuscitation for the determination of malondialdehyde (MDA),the activity of superoxide dismutase (SOD), myeloperoxidase (MPO), dry/wet weight (D/W), nuclear factor-ΚB (NF-ΚB), and mRNA content of intercellular adhesion molecule-1 (ICAM-1).Serum TNF-α (ng/L) and IL-10 (ng/L) in antepartum pregnant rabbits were not significantly different from non-pregnant rabbits (TNF-α: 87.6 ± 6.8 vs. 83.2 ± 5.3; IL-10: 44.9 ± 3.9 vs. 42.7 ± 3.4, both P0.05). However, the serum TNF-α increased significantly after delivery (102.5 ± 8.1 vs. 87.6 ± 6.8, P0.05). TNF-α and IL-10 increased 1 hour after shock in both postpartum and non-pregnant rabbits. The serum TNF-α in postpartum rabbits was significant higher than non-pregnant rabbits in each resuscitation period (1 hour: 230.0 ± 14.9 vs. 202.0 ± 10.1, 2.5 hours: 290.0 ± 18.6 vs. 236.0 ± 14.4, 4 hours: 265.0 ± 15.9 vs. 217.0 ± 12.8, all P0.05), meanwhile the serum IL-10 in postpartum animals was significantly lower than the non-pregnant controls(1 hour: 104.3 ± 6.9 vs. 135.0 ± 7.8, 2.5 hours: 146.8 ± 9.4 vs. 178.3 ± 11.7, 4 hours: 126.0 ± 7.9 vs. 165.8 ± 9.6, all P0.05). The value of MDA, MPO, D/W, NF-ΚB activity and ICAM-1 mRNA content in lung tissue of postpartum rabbits were all significant higher than non-pregnant rabbits after resuscitation [MDA (nmol/mg): 52.6 ± 5.9 vs. 39.4 ± 4.7, MPO (U/mg): 4.62 ± 0.85 vs. 3.26 ± 0.62, D/W: 0.186 ± 0.025 vs. 0.143 ± 0.016, NF-ΚB activity (A value): 0.89 ± 0.27 vs. 0.46 ± 0.15, ICAM-1 mRNA: 4.6 ± 1.2 vs. 2.5 ± 0.7, all P0.05], but the activity of SOD (U/mg) was lower (47.8 ± 6.7 vs. 63.5 ± 8.2, P0.05) in the controls after resuscitation.Delivery causes significant increase in serum TNF-α in pregnant rabbits. Inflammatory lung injury is more severe in postpartum rabbits after resuscitation from hemorrhagic shock, and the increased serum level of inflammatory mediators may be part of the mechanism for such difference.

To explore the differences of metabolic footprint in the conditioned culture medium of placental explants between early-onset and late-onset severe preeclampsia.In 13 cases of early-onset severe preeclampsia and 14 cases of late-onset severe preeclampsia, the placentas were sampled at the surface of the maternal placenta. High performance liquid chromatography-mass spectrometry (HPLC-MS) was used to determine the differences in the metabolites in the conditioned culture medium of the placental villous explants cultured in 6% atmospheric O(2) for 96 h. Standard samples were used to establish the tryptophan and kynurenine chromatography library by HPLC-MS to analyze the concentration of tryptophan and kynurenine in the conditioned culture medium.Thirty-six metabolites showed statistically significant differences between early-onset and late-onset severe preeclampsia (P0.05). The concentration of kynurenine was significantly higher in early-onset severe preeclampsia than in late-onset severe preeclampsia (P0.05).Early-onset and late-onset severe preeclampsia may have different pathogeneses. By detecting the concentration of metabolites, metabolomic strategies provide a new means for predicting the onset time of severe preeclampsia.

To analyze the clinical features and influential factors of parenteral nutrition associated cholestasis (PNAC) in preterm infants.A total of 159 infants with birth weight less than 2000 grams and/or gestational age less than 34 weeks were exposed to parenteral nutrition for longer than 14 days in NICU during the period from July 2007 to June 2009. Of these infants, 40 cases who had PNAC were aligned into the PNAC group, and the other 119 cases without PNAC were aligned into the non-PNAC group. PNAC occurring time, duration, the degree of PNAC and hepatic injury were observed. Logistic regression analysis was performed to evaluate the correlative factors of PNAC.PNAC occurred about (3.3 ± 1.6) weeks after beginning PN, usually lasted for (13.3 ± 5.4) weeks. The maximum direct bilirubin was (135.2 ± 65.5) µmol/L. Of the PNAC patients, 73.7% suffered from hepatic injury. Hepatic injury usually occurred (6.6 ± 3.0) weeks after beginning PN, and lasted for (9.5 ± 5.4) weeks. The highest alanine aminotransferase (ALT) was (121.5 ± 48.4) U/L. The logistic regression of the possible correlative factors showed that time to start enteric feeding, persistence time of PN, asphyxia, small for gestational age, intracranial hemorrhage, were related to PNAC.The prognosis of PNAC was good. Early enteral feeding, shorter time of PN, avoidance of the complications such as asphyxia and sepsis, were the important measures to lower PNAC.

to study the effects of hypotensive resuscitation on microvascular perfusion in a clinically relevant model of uncontrolled hemorrhagic shock in pregnancy.thirty New Zealand white rabbits at 15 - 25 days, pregnanal age were randomly divided into three groups; Group normal saline traditional aggressive resuscitation (NS), traditional aggressive resuscitation in the prehospital phase with a large quantity of normal saline and Ringer's solution to maintain mean arterial pressure (MAP) at the approximately 80 mm Hg (1 mm Hg = 0.133 kPa) level: Group normal saline hypotensive resuscitation (NH) and group hypertonic hyperosmotic hypotension resuscitation (HHH), hypotensive resuscitation in the prehospital phase with a bolus dose of 4 ml/kg normal saline or hypertonic hydroxyl ethyl starch (10% hydroxyl ethyl starch +7.5% NaCl), followed by Ringer's solution to maintain MAP at 60 mm Hg. Production pregnant rabbit model with hemorrhagic shock. The experiment consisted of four phases:basic phase (0 miniutes), shock phase (0 - 30 miniutes), prehospital phase (30 - 90 miniutes) and hospital phase (90 - 180 miniutes).(1) arteriole and venule diameter were continuously monitored by microcirculatory detecting instrument; (2) functional capillary density (FCD) of each phase was expressed by the percentage of opening capillaries segments relative to basic phase; (3) blood pH, BE PCO(2), PO(2) in pregnant rabbits were determined with a Medica Easy Blood Gas Analyzer.(1) there were no significant differences among three groups in arteriole and venule diameter at baseline (P0.05). After hemorrhagic shock arteriole diameter were NS (50.8 ± 5.6) µm, NH (47.6 ± 3.7) µm, HHH (51.3 ± 2.4) µm, respectively, with no significant differences between groups (P0.05). At the end of prehospital resuscitation phase and hospital resuscitation phase, significant differences were found in arteriole diameter in group NS (52.8 ± 4.9, 56.0 ± 3.8) µm, NH (61.3 ± 2.9, 65.4 ± 3.2)µm and HHH group (67.0 ± 4.1, 74.1 ± 4.8) µm (P0.05); after hemorrhagic shock venule diameter were NS (79.6 ± 7.0) µm, NH (75.3 ± 5.3) µm and HHH (76.2 ± 5.8) µm, respectively, with no significant differences between groups (P0.05). At the end of prehospital resuscitation phase and hospital resuscitation phase, venule diameter were NS (81.1 ± 6.7, 84.4 ± 6.0) µm, NH (82.8 ± 3.3, 85.4 ± 4.3) µm and HHH (86.9 ± 5.8, 89.4 ± 6.8) µm, respectively, with no significant differences between groups (P0.05). (2) The values of FCD in every groups were all 100%. After hemorrhagic shock FCD were NS (39.8 ± 6.8)%, NH (43.9 ± 4.0)%, HHH (44.0 ± 4.8)%, respectively, with no significant differences between groups (P0.05); at the end of prehospital resuscitation phase and hospital resuscitation phase, FCD were NS (54.5 ± 7.3, 59.7 ± 4.8)%, NH (63.1 ± 5.8, 70.3 ± 5.6)% and HHH (80.5 ± 6.9, 91.7 ± 4.7)%, respectively, with significant differences between groups (P0.05). (3) Blood gas parameter: the values of blood pH, BE, PO(2), PCO(2) in pregnant rabbits in all groups were within normal bounds at basic phase. Shock phase induced typical hyperventilation in all groups, with increase of arterial PO(2) and decrease of PCO(2); at the end of hospital resuscitation phase, there were no significant difference among the three groups in the values of blood PCO(2) (P0.05); the values of blood PO(2) at the hospital resuscitation phase were significantly lower in NS groups than corresponding values in the other groups (P0.05). After hemorrhagic shock there was significant metabolic acidosis as shown by decrease of pH, BE; at prehospital resucitation phase, pH, BE values tended to increase in all the groups but not reach to base period. At the end of hospital resucitation phase. The pH, BE value was significantly higher in NS group than those in the other two groups (P0.05). (4) Median survival time in NS (2.1 ± 0.2) days group was significantly shorter than NH (3.0 ± 0.3) days and HHH (3.6 ± 0.3) days group (P0.05). FCD at the end of the hospital resuscitation were significantly related with survival time (r = 0.655, P = 0.000).compared with traditional aggressive fluid resuscitation, hypotensive resuscitation reduce constriction of arterial and venule diameter, increase FCD, alleviate metabolic acidosis and improve long-term survival. Hypertonic hydroxyl ethyl starch resuscitation ameliorate microcirculation without improving survival rate.

In this paper, the particle swarm optimization (PSO) algorithm and genetic algorithm (GA) are employed to optimize the parameters of PID algorithm in order to improve the performance of PID control system. Moreover, we propose the grey model based on grey system theory to combine with PID control to establish the PID prediction control system. The proposed control system can realize the accurate control in realtime. Finally, we validated the effectiveness of the proposed control system by computer simulation.

To study the role of platelet-derived growth factor (PDGF) in the pathogenesis of preeclampsia (PRE).Thirteen normal and 20 PRE late-pregnancy women were enrolled in this study. The serum PDGF-BB levels were measured with enzyme-linked immunosorbent assay, and the expression of PDGF-B mRNA in the decidual blood vessel was determined using in situ hybridization.PDGF-BB levels in PRE group was significantly higher than that in normal pregnant women (83.54 -/+34.52 vs 39.61-/+18.20, P0.001), and the expression of PDGF-B mRNA in decidual blood vessel was also significantly higher in PRE group (P0.001), showing a positive correlation between serum PDGF and PDGF-B mRNA expression (r=0.603, P0.001).PDGF is associated with the pathology of decidual blood vessel. Elevated serum PDGF levels and PDGF-B mRNA expression in the decidual blood vessel may play an important role in the pathogenesis of PRE.

Delta-like ligand 4 (DLL4), 1 of the 5 known Notch ligands, is involved in a variety of tumor initiation and progression, particularly in the process of tumor angiogenesis. However, the clinical and prognostic significance of DLL4 in glioblastoma have not been fully elucidated. Tumor tissues from 69 glioblastoma patients were analyzed using immunohistochemistry for DLL4 expression. Peritumoral brain edema (PTBE) on preoperative magnetic resonance imaging of these patients and the relationship with DLL4 expression were evaluated. The effect on prognosis was assessed by using the Kaplan–Meier survival and the Cox proportional hazard model. The results showed that elevated DLL4 expression was primarily distributed in the cytoplasm of tumor vascular endothelial cells and rarely detected in tumor cells. Univariate analysis indicated significant correlation of high DLL4 expression with shorter time to progression (TTP) (P

In this paper, we propose a new dynamic analysis model, which combines the first-order one-variable grey differential equation model GM(1, 1) from grey system theory and Markov chain model from stochastic process theory, to develop the prediction model of Freight Throughput Capacity (FTC). We abbreviate the combined GM(1, 1) Markov Chain model as MGM(1, 1) model. In addition, we apply Taylor approximation method to MGM(1, 1) to enhance the prediction power. We call the improved version as T-MGM(1, 1) model. As the illustrative example, we use the statistical data recording of China's FTC of major coastal ports for a validation of the effectiveness of the T-MGM(1, 1) model.

The corrosion process often shows uncertain and complicated dynamic system behaviour, and it is difficult to determine all factors that influence the system. Moreover, in the corrosion trend testing of gas pipelines, the corrosion depth and speed are two important valuation indexes. The dynamic relationship between the corrosion depth and speed is very intensive, but a definite explicit or implicit function to describe it does not exist. In this paper, we developed a reliable model of corrosion depth with the corrosion speed as a leading indicator using a grey dynamic model based on grey system theory. We verified the effectiveness of the proposed model through using the corrosion depth of a gas pipeline in a natural gas well from the corresponding experimental data of the corrosion speed.