BACKGROUND & AIMS: :A 31-year-old woman complained of dyspnea and orthopnea at 38 weeks of gestation. A grade 3/6 pansystolic murmur was heard, and echocardiography revealed severe mitral regurgitation with a hyperechoic obstacle on the posterior mitral valve leaflet, consistent with a diagnosis of acute heart failure due to a ruptured chordae tendineae or an infectious endocarditis. An emergency cesarean section was performed under general anesthesia. A male infant was born weighing 2928 g with Apgar scores of 7 and 8 at 1 and 5 min, respectively. The patient was managed in the intensive care unit and underwent open-heart surgery for mitral valve repair on postpartum day 3. The two chordal tendineae appeared torn and frail, and a mitral annuloplasty was performed. No finding of infectious endocarditis was observed. Because it is a dramatic and life-threatening clinical situation, proper diagnosis and treatment in the intensive care unit assure a good outcome for both mother and fetus.

背景与目标： : 一名31岁的妇女在妊娠38周时抱怨呼吸困难和正呼吸。听到了3/6级的全收缩期杂音，超声心动图显示严重的二尖瓣反流，二尖瓣后叶上有高回声障碍，这与由于腱索破裂或感染性心内膜炎引起的急性心力衰竭的诊断一致。在全身麻醉下进行紧急剖宫产。出生时体重为2928  g的男婴，分别在1和5  min时Apgar评分为7和8。该患者在重症监护病房接受治疗，并于产后第3天接受心脏直视手术进行二尖瓣修复。两个腱索出现撕裂和脆弱，并进行了二尖瓣环成形术。未发现感染性心内膜炎。由于这是一个戏剧性的，危及生命的临床情况，因此在重症监护病房中进行适当的诊断和治疗可确保母亲和胎儿的良好结局。

BACKGROUND & AIMS: :The aim of this study was to investigate alterations in the leukocyte and differential leukocyte counts in different trimesters of pregnancy and the initial postpartum period. The study population consisted of 40,325 pregnant women. A full blood count and automated differential leukocyte count were performed and all the haemogram results in the different trimesters of pregnancy were recorded. Percentiles were calculated using statistical software. A total of 82,786 complete blood count evaluations were performed in 40,325 subjects from the 6th to 41st week of pregnancy and in the initial postpartum period. The leukocyte counts increased from the 1st to the 3rd trimester and peaked in the initial postpartum period. Our reference values for the total and differential leukocyte counts may assist clinicians in distinguishing between leukocytosis and pathological elevation of the white blood cell count during pregnancy and the initial postpartum period. Impact statement Pregnancy requires profound adaptation by multiple systems to accommodate the demands of the developing foetus. Similar to all other systems, many haematological changes occur during pregnancy. Studies of normal variation in leukocyte counts were insufficient to distinguish normal from abnormal leukocyte counts during pregnancy and in the initial postpartum period, due to small numbers of patients and a lack of differential leukocyte counts. Without reference leukocyte levels, infections may be more difficult to assess during pregnancy and in the postpartum period. In this study, we report the 3rd, 5th, 10th, 50th, 95th and 99th percentile values for the total and differential leukocyte counts according to trimester in normal pregnancy and the initial postpartum period. Our reference values for the total and differential leukocyte counts in each trimester and the initial postpartum period may assist clinicians in distinguishing between normal leukocytosis and pathological elevation of the white blood cell count during pregnancy and the initial postpartum period. Our results may prevent misdiagnosis of physiological elevated leukocytes as bacterial infection that leads to unnecessary medication use that may compromise the foetus.

背景与目标： : 这项研究的目的是调查妊娠不同三个月和产后初期白细胞和白细胞计数差异的变化。研究人群由40,325名孕妇组成。进行了全血细胞计数和自动差异白细胞计数，并记录了妊娠不同三个月的所有血象结果。使用统计软件计算百分位数。从怀孕的第6周至第41周和产后初期，对40,325名受试者进行了总共82,786次全血细胞计数评估。白细胞计数从第1个月到第3个月增加，并在产后初期达到峰值。我们的总白细胞计数和差异白细胞计数参考值可以帮助临床医生区分白细胞增多和妊娠和产后初期白细胞计数的病理升高。影响声明怀孕需要多个系统进行深刻的适应，以适应发育中的胎儿的需求。与所有其他系统相似，许多血液学变化发生在怀孕期间。由于患者人数少且缺乏差异的白细胞计数，对白细胞计数正常变化的研究不足以区分妊娠期间和产后初期的正常白细胞计数与异常白细胞计数。如果没有参考白细胞水平，则在怀孕期间和产后期间可能更难评估感染。在这项研究中，我们根据正常妊娠和产后初期的三个月报告了总白细胞计数和差异白细胞计数的第3、5、10、50、95和99个百分位数值。我们在每个孕期和产后初期的总白细胞计数和差异白细胞计数的参考值可以帮助临床医生区分正常的白细胞增多和妊娠和产后初期的白细胞计数的病理升高。我们的结果可以防止将生理性白细胞升高误诊为细菌感染，从而导致不必要的药物使用，从而可能损害胎儿。

BACKGROUND & AIMS: INTRODUCTION:Chronic lymphocytic leukemia (CLL) is a disorder of mature but dysfunctional monoclonal B cells. Microenvironment, antigenic stimulation and genetical mutations are demonstrated in etiopathogenesis. We aimed to evaluate the expression of CD11c in patients with CLL and its possible clinical significance. METHODS:Data of 259 patients with CLL between 2010 and 2016 in Trakya University Faculty of Medicine, including age at diagnosis, sex, whole blood count, stage, percentage of CLL cells in bone marrow, line of treatments, development of Richter's transformation and secondary tumors, autoimmune complications, IgG level, prognostic cytogenetic analysis, and length of survival were recorded from files. RESULTS:151 patients were male (58.3%) and 108 were male (41.7%). Mean age was 70 (21-92) years. CD11c was observed to be positive (>%20) in 103 patients (39.8%). Development of Richter's transformation, secondary tumors and ITP was significantly frequent in patients with CD11c positivity (P values .000, .003, .000 respectively). Also, IgG levels were significantly lower in this group (P = .000). Hemoglobin level, RAI stage and bone marrow CLL infiltration percentage were statistically related with CD11c (P values .036, .037, .000 respectively). Finally, CD11c was statistically related (in positive group 70 months, negative group 79 months, P = .001). CONCLUSION:CD11c, expressed not only in Hairy cell leukemia but also in dendritic cells, macrophages and monocytes is a differentiation marker for inflammation. Prolonged inflammation in the microenvironment of CLL cells may cause a susceptibility to autoimmune disorders and secondary tumors in CLL, in this way, an increase in mortality.

背景与目标：

BACKGROUND & AIMS: :This paper reports the proceedings of a consensus meeting on the incidence and complications of multiple gestation in Canada. In addition to background presentations about current and possible future practice in Canada, the expert panel also developed a set of consensus points. The need for infertility to be understood, and funded, as a healthcare problem was emphasized, along with recognition of the emotional impact of infertility. It was agreed that the goal of assisted reproduction treatment is the delivery of a single healthy infant and that even though many positive outcomes have resulted from twin or even triplet pregnancies, the potential risks associated with multiple pregnancy require that every effort be made to achieve this goal. The evidence shows that treatments other than IVF (such as superovulation and clomiphene citrate) contribute significantly to the incidence of multiple pregnancy. There is an urgent need for studies to understand better the usage and application of these other fertility technologies within Canada, as well as the non-financial barriers to treatment. The final consensus of the expert panel was that with adequate funding and good access to treatment, it will be possible to achieve the goal of reducing IVF-related multiple pregnancy rates in Canada by 50%.

背景与目标： : 本文报告了关于加拿大多次妊娠的发生率和并发症的共识会议的会议记录。除了关于加拿大当前和可能的未来做法的背景介绍之外，专家小组还制定了一套共识点。强调了将不孕症理解为医疗保健问题并为其提供资金的必要性，并认识到不孕症的情感影响。与会者一致认为，辅助生殖治疗的目标是分娩一个健康的婴儿，尽管双胞胎甚至三胞胎怀孕产生了许多积极的结果，但与多胎妊娠相关的潜在风险需要尽一切努力实现这一目标。证据表明，除IVF以外的其他治疗方法 (例如超排卵和柠檬酸克罗米芬) 对多胎妊娠的发生率有显着贡献。迫切需要进行研究，以更好地了解加拿大境内这些其他生育技术的使用和应用，以及治疗的非金融障碍。专家小组的最后共识是，有足够的资金和良好的治疗机会，将有可能实现到50% 年将加拿大与IVF相关的多胎妊娠率降低的目标。

BACKGROUND & AIMS: :Periacetabular osteotomy (PAO) is a well established method to treat hip dysplasia in the adult. There is, however, a lack of information on the subjective outcome of patients with complications after PAO. The purpose of this study was therefore to assess the influence of complications on the patients' post-operative wellbeing and function: 60 PAOs on 50 patients were investigated retrospectively after a mean follow-up of 7.4 years. The patients' self-reported assessment of health and function was evaluated by the Medical Outcomes Short Form-36 (SF-36) and the Western Ontario and McMaster Universities (WOMAC) questionnaires at last follow-up. Forty healthy persons served as a control group. Of the 60 interventions 13 had no complications. Minor complications occurred in 25 (41%) and in 22 (37%) at least one major complication occurred. SF-36 summary measure was 76.4 for PAO patients and 90.3 for the control group. Mean WOMAC score was 25.1. Patients with major complications had a similar subjective outcome as patients with minor or without complications, but persistent dysaesthesia due to lateral femoral cutaneous nerve dysfunction led to a worse subjective function. Lesions of the lateral femoral cutaneous nerve have much greater influence on patients' self-assessed functional outcome after PAO than previously reported and greater attention has to be given to this supposedly minor complication.

背景与目标： : 髋臼周围截骨术 (PAO) 是治疗成人髋关节发育不良的公认方法。但是，缺乏有关PAO术后并发症患者的主观结果的信息。因此，本研究的目的是评估并发症对患者术后健康和功能的影响: 平均随访7.4年后，对50例患者的60个pao进行了回顾性调查。在最后的随访中，通过医疗结果简表36 (SF-36) 以及西安大略和麦克马斯特大学 (WOMAC) 问卷对患者的自我报告的健康和功能评估进行了评估。40名健康人作为对照组。在60种干预措施中，有13种没有并发症。轻微并发症发生在25 (41%) 和22 (37%) 中，至少发生了一种主要并发症。PAO患者的SF-36总结措施为76.4，对照组为90.3。平均WOMAC得分为25.1。有重大并发症的患者的主观结局与有轻微或没有并发症的患者相似，但是由于股外侧皮肤神经功能障碍而导致的持续感觉障碍导致主观功能恶化。PAO术后股外侧皮神经病变对患者自我评估功能结果的影响比以前报道的要大得多，因此必须对这种所谓的轻微并发症给予更多关注。

BACKGROUND & AIMS: :This study examined the effects of human pregnancy and advancing gestation on the intensity of respiratory discomfort (dyspnea) during cycle exercise. Fourteen pregnant women (PG) performed a progressive cycle ergometer exercise test involving 20 W/min increases in work rate to symptom limitation and/or a heart rate of 170-175 beats/min at 19.7+/-1.2 weeks (ENTRY), 28.2+/-0.3 weeks (TM2) and 36.3+/-0.3 weeks (TM3) gestation. Eight, age-matched, sedentary non-pregnant women (CG) were also studied for comparison purposes. Measurements included dyspnea intensity (Borg scale), minute ventilation (VE), breathing pattern and other cardiorespiratory parameters. At peak exercise, neither pregnancy nor advancing gestation had an effect on dyspnea, VE, breathing pattern, oxygen uptake or work rate (p>0.05). VE was significantly greater (by 11 L/min at 100 W) in the PG at TM3 versus CG (p<0.05) at all submaximal work rates. VE also increased progressively from ENTRY to TM2 and TM3 during submaximal exercise. Dyspnea was not significantly different at any submaximal work rate in the PG at TM3 versus CG or with advancing gestation in the PG. In addition, dyspnea at a standardized exercise VE of 40 L/min was not different at TM3 versus ENTRY or in the PG at TM3 versus CG. Neither pregnancy nor advancing gestation were associated with increased respiratory discomfort during strenuous non-weight bearing cycle ergometer exercise, despite substantial increases in VE and progressive mechanical adaptations of the respiratory system to accommodate the increasing size of the gravid uterus.

背景与目标： : 这项研究检查了人类怀孕和妊娠对周期运动期间呼吸不适 (呼吸困难) 强度的影响。14名孕妇 (PG) 进行了渐进式循环测力计运动测试，包括在19.7周 +/-1.2周 (进入) 时，工作速率增加20 W/min，以达到症状限制和/或心率170-175次/min，28.2 +/-0.3周 (TM2) 和36.3 +/-0.3周 (TM3)。为了比较目的，还研究了八名年龄匹配的久坐不动的非孕妇 (CG)。测量包括呼吸困难强度 (Borg量表)，分钟通气量 (VE)，呼吸模式和其他心肺参数。在运动高峰时，怀孕和妊娠均不会影响呼吸困难，VE，呼吸方式，摄氧量或工作效率 (p>0.05)。在所有次最大工作速率下，TM3的PG相对于CG (p<0.05) 的VE显着更高 (在100 W下为11 l/min)。在次最大运动期间，VE也从进入TM2和TM3逐渐增加。在TM3相对于CG的PG中，在任何亚最大工作速率下，或在PG中进行妊娠时，呼吸困难均无显着差异。此外，在标准化运动VE为40 l/min时的呼吸困难在TM3与ENTRY或PG在TM3与CG时没有差异。尽管VE的显着增加和呼吸系统的进行性机械适应以适应妊娠子宫的增加，但在剧烈的非负重循环测力计运动中，怀孕和妊娠都不会增加呼吸不适。

BACKGROUND & AIMS: BACKGROUND:Airway anastomosis complications continue to be a source of morbidity for lung transplant recipients. METHODS:This study analyzes incidence, treatment, and follow-up of airway anastomotic complications occurring in 127 consecutive lung transplant airway anastomoses (77 single lung and 25 bilateral sequential lung). Complications were categorized as stenosis (11), granulation tissue (8), infection (7), bronchomalacia (5), or dehiscence (3). Follow-up after treatment ranged from 6 months to 4 years. RESULTS:Nineteen airway anastomosis complications (15.0%) occurred in 18 patients. Telescoping the airway anastomosis reduced the complication rate to 12 of 97 (12.4%), compared with 7 of 30 (23.3%) for omental wrapping, (p = 0.15). Complications developed in 13 of 77 single-lung airway anastomoses (16.9%) versus 6 of 50 bilateral sequential lung recipients (12.0%). Treatment consisted of stenting (9 airway anastomoses), bronchodilation (8), laser debridement (4), rigid bronchoscopic debridement (2), operative revision (2), and growth factor application (2). There was no difference in actuarial survival between patients with or without airway anastomosis complications (p = 1.0). CONCLUSIONS:Airway anastomosis complications can be successfully managed in the immediate or late postoperative period with good outcome up to 4 years after intervention.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Anterior wall myocardial revascularization through a left anterior minithoracotomy is an increasingly accepted procedure. Technical failure at the anastomotic site, promoting persistent or recurrent angina, is known to occur and may be underrecognized. This report summarizes the incidence of technical failure in an initial clinical experience and describes potential causes of early postoperative complications. METHODS:Between December 1995 and May 1996, 15 patients underwent left internal mammary artery-to-left anterior descending artery revascularization without extracorporeal circulation. The surgical indication was single-vessel coronary disease in all patients. We exposed the left anterior descending artery target site through a 10-cm left anterior fourth space thoracotomy. The fourth costal cartilage was resected and the left internal mammary artery was harvested under direct visualization. Two 4-0 polypropylene sutures snared in tourniquets proximal and distal to the anastomotic site were used to obtain a bloodless field and stabilization of the left anterior descending artery. RESULTS:All patients had procedures initially deemed successful based on disappearance of angina or postoperative transthoracic Doppler examination of the internal mammary artery 3 to 5 days postoperatively. However, 3 patients presented with recurrent angina at 2, 6, and 8 weeks. Angiography or direct visualization at operation demonstrated the technical complication (stenosis at the anastomotic site in 2 and snare injury in the native vessel in 1). Two patients required reoperation. CONCLUSIONS:Initial results with minimally invasive coronary bypass grafting have generated great enthusiasm worldwide, but there is no consensus on how the procedure should be performed. These results suggest that a nonstabilized anastomosis results in an unacceptable failure rate. Furthermore, sutures encircling the left anterior descending artery should not be used for vessel stabilization as injury of the artery may occur.

背景与目标：

BACKGROUND & AIMS: The response to activated protein C (APC) was investigated in 28 healthy women, non-carriers of the Arg506-Gln mutation in factor V, throughout pregnancy (gestation weeks 12, 20, 28, 32 and 37) and after the delivery. A suppression of APC response was observed which reached lowest values by week 28 (nAPC-ratio 0.78 +/- 0.13), sustained low up to the end of pregnancy and rose after delivery (1.11 +/- 0.22; P < 0.05). APC resistance (nAPC ratio < 0.75) was registered in 16 of the 28 women (57%). A reduction of APC ratio was directly related to its value in the non-pregnant state, being most pronounced in the women with the highest APC ratio. Factor VIII increased during pregnancy and correlated inversely to APC ratio (Z coefficient = -0.645, P < 0.0001). The correlation became weaker in the course of pregnancy, losing significance by week 32. This was explained by the differences in profiles of the two variablesthe lowest measured APC ratio preceded the peak of factor VIII in most cases. The most pronounced rise of factor VIII was found in the women with minimal levels of APC ratio between 0.8 and 0.7. These results allowed us to speculate that APC response is closely regulated during pregnancy, aiming to maintain a certain relevant level. Transitory reduction of APC response is connected to factor VIII and discussed as a prevalent mechanism of functional APC resistance during pregnancy.

背景与目标： 在整个妊娠期间 (妊娠第12、20、28、32和37周) 和分娩后，对28名健康妇女 (非因子V Arg506-Gln突变携带者) 的活化蛋白C (APC) 的反应进行了研究。观察到APC反应的抑制，其在第28周达到最低值 (nAPC比0.78 +/- 0.13)，持续到妊娠结束并在分娩后上升 (1.11 +/- 0.22; P <0.05)。28名女性中有16名 (57% 名) 出现APC耐药 (nAPC比值 <0.75)。APC比率的降低与其在非怀孕状态下的价值直接相关，在APC比率最高的女性中最为明显。因子VIII在怀孕期间增加，并与APC比率成反比 (Z系数 = -0.645，P <0.0001)。相关性在怀孕过程中变弱，到第32周失去意义。这可以通过两个变量的分布差异来解释，在大多数情况下，最低的APC比率先于因子VIII的峰值。在0.8和0.7之间APC比率最低的女性中发现了因子VIII的最明显升高。这些结果使我们能够推测APC反应在怀孕期间受到密切调节，旨在维持一定的相关水平。APC反应的暂时性降低与因子VIII有关，并被认为是怀孕期间功能性APC抵抗的普遍机制。

BACKGROUND & AIMS: OBJECTIVE:Preoperative glucocorticoid administration has been proposed to reduce postoperative morbidity. This is not frequently done before esophageal resection because of insufficient knowledge on its effectiveness. The purpose was to assess the effects of preoperative glucocorticoid administration in adults undergoing esophageal resection for esophageal carcinoma. METHODS:Studies were identified by searching the Cochrane Controlled Trials Register, Medline, Embase, Scielo and Cochrane Library, and by a manual search for relevant articles. In this systematic review, the last search for clinical trials was performed in December 2005. This review included randomized studies of patients with potentially resectable carcinomas of the esophagus that compared preoperative glucocorticoid administration with placebo. Data were collected by the reviewer, and quality of the trial was assessed using Jadad scoring. Odds ratio with 95% confidence intervals was used to assess the significance of the difference between treatment arms. RESULTS:Four randomized trials involving 169 patients were found. There were no differences in postoperative mortality, anastomotic leakage, hepatic and renal failure between the glucocorticoid and placebo groups. There were fewer postoperative respiratory complications (95% CI= 0.09-0.46), sepsis (95% CI= 0.10-0.81), and total postoperative complications (95% CI=0.06-0.23) with preoperative glucocorticoid administration. CONCLUSION:Prophylactic administration of glucocorticoids is associated with decreased postoperative complications.

背景与目标：

BACKGROUND & AIMS: :Cortisol is used in research as a biomarker of psychological stress. Logistical considerations argue for collecting as few samples as possible, balanced against diurnal rhythms and intra-individual variations. 100 pregnant women gave five saliva samples a day for 3 days, at waking, 30 min after waking, and 11:00 a.m., 5:00 p.m., and 9:00 p.m. Timing of collection was confirmed by monitors. Another sample was taken during a clinic visit. Using the 15 measures as the gold standard, correlations and mean area under the curve (AUC) were compared with subsets and the single clinic sample to evaluate alternate collection protocols. Five samples in 1 day, or protocols involving morning and night samples, had the highest correlations with mean AUC (correlation coefficient ranging from 0.82 to 0.88). Standardizing the clinic measurement to a single time of day did not substantially improve correlations with mean AUC. Correlations with measures of reported stress were also not strong.

背景与目标： : 皮质醇在研究中被用作心理压力的生物标志物。后勤方面的考虑主张收集尽可能少的样本，并与昼夜节律和个体内部变化保持平衡。100名孕妇每天在醒来时，醒来后30分钟以及上午11:00，下午5:00和下午9:00时每天提供五个唾液样本收集时间由监视器确认。在诊所就诊时采集了另一个样本。使用15项措施作为金标准，将相关性和曲线下平均面积 (AUC) 与子集和单个临床样本进行比较，以评估替代收集方案。1天内的5个样品或涉及早晨和夜间样品的方案与平均AUC的相关性最高 (相关系数范围从0.82到0.88)。将临床测量标准化为一天中的单个时间并没有显着改善与平均AUC的相关性。与报告的压力度量的相关性也不强。

BACKGROUND & AIMS: :Pregnancy is an evolutionarily important and mysterious process. The placenta, as the nutrient and gas exchange organ, plays an essential role during this process. In addition, the interaction between trophoblast and maternal immune cells at the maternal-fetal interface is also associated with successful pregnancy. Human leukocyte antigen (HLA) molecules on trophoblast cells are involved in protecting the fetus from maternal rejection. Trophoblast cells comprise three subpopulations, including syncytiotrophoblast cells, cytotrophoblast cells, and extravillous trophoblast cells, and these cells express different HLA molecules. Syncytiotrophoblast and extravillous trophoblast cells encounter maternal immune cells from different sources, such as blood or decidua. The increased γδ-T cells during human normal pregnancy indicate that these cells may play a role in this process. In peripheral blood, Vγ9Vδ2-T cells display cytotoxicity through the recognition of phosphoantigens derived from pathogens. However, HLA-E molecules protect the trophoblast cells from the cytotoxicity of Vγ9Vδ2-T cells through binding to the inhibitory receptor, CD94/NKG2A. In decidua, the main Vδ1-T cells maintain the pregnancy through the secretion of cytokines. In addition, the imbalance between Vγ9Vδ2-T and Vδ1-T cells, and the abnormal expression of the receptors on γδ-T cells were observed in adverse pregnancy.

背景与目标： 怀孕是一个进化上重要而神秘的过程。胎盘作为营养和气体交换器官，在此过程中起着至关重要的作用。此外，滋养细胞与母体-胎儿界面处的母体免疫细胞之间的相互作用也与成功怀孕有关。滋养细胞上的人类白细胞抗原 (HLA) 分子参与保护胎儿免受母体排斥。滋养层细胞包含三个亚群，包括合体滋养层细胞，细胞滋养层细胞和绒毛外滋养层细胞，这些细胞表达不同的HLA分子。合体滋养层细胞和绒毛外滋养层细胞会遇到来自不同来源的母体免疫细胞，例如血液或蜕膜。在人类正常怀孕期间增加的 γ δ-T细胞表明这些细胞可能在此过程中发挥作用。在外周血中，Vγ9Vδ2-T细胞通过识别源自病原体的磷酸抗原而显示出细胞毒性。然而，hla-e分子通过与抑制性受体CD94/NKG2A结合，保护滋养层细胞免受Vγ9Vδ2-T细胞的细胞毒性。在蜕膜中，主要的Vδ1-T细胞通过分泌细胞因子来维持妊娠。此外，在不良妊娠中观察到Vγ9Vδ2-T和Vδ1-T细胞之间的失衡以及 γ δ-t细胞上受体的异常表达。

BACKGROUND & AIMS: PROBLEM:It is unclear if the immunologic alterations induced by pregnancy could persist. METHOD OF STUDY:Antenatal rubella sero-negativity was correlated with gravidity, abortions and parity in 112 083 gravidae managed during 1997-2015, with further analysis stratified for factors known to influence rubella serology. RESULTS:The 10.2% sero-negative gravidae had different characteristics, and the incidence showed significant difference and positive trend (P<.001 for both) with gravidity, abortions and parity. The pattern remained consistent when analysis was stratified for advanced age, high body mass index and medical history, but was negated by hepatitis B virus infection except for abortions, and by high body mass index for parity. For gravidity 2-4, no difference in rubella sero-negativity was found between gravidae with all previous pregnancies ended in abortion vs delivery. CONCLUSION:Prior pregnancies diminished rubella immunity in a dose-dependent manner, which may be a reflection of the cumulative effect of pregnancy-associated maternal immunologic alteration.

背景与目标：

BACKGROUND & AIMS: :The objective of this study was to determine if very early ultrasonographic measurements obtained from human and baboon are comparable. For this purpose, the gestational, amniotic and yolk sacs, embryonic crown rump length (CRL) and heart rate were measured ultrasonographically between 35 and 47 days from the mean day of a three-day mating period in baboons (n=18) and between 42 to 58 days from fertilization as calculated from the CRL measurements in human pregnancies (n=82). Ultrasonographic measurements from both species were then plotted in the same graph using Carnegie stages of embryonic development as the independent variable to allow for visual comparisons. Mean gestational age at ultrasonographic studies was significantly different for humans and baboons (50.4 vs. 41 days, respectively; p>0.01). Significant correlations (p>0.01) were noted between ultrasonographic measurements and Carnegie stages of development in both humans and baboons. Only the gestational and the yolk sacs were significantly smaller in baboons than in humans (p>0.05). The findings that embryonic CRL, extra-embryonic space and heart rate are very similar between the 17th and 23rd Carnegie developmental stages make the baboon a promising surrogate of human pregnancy for investigations using celocentesis.

背景与目标： : 这项研究的目的是确定从人类和狒狒获得的非常早期的超声检查结果是否具有可比性。为此，妊娠、羊膜和卵黄囊，从狒狒的三天交配期的平均一天 (n = 18) 和受精后的42至58天之间，超声测量了胚胎冠的臀部长度 (CRL) 和心率 (n = 82)。然后使用卡内基胚胎发育阶段作为自变量，将两个物种的超声测量结果绘制在同一图中，以进行视觉比较。在超声检查研究中，人类和狒狒的平均胎龄显着不同 (分别为50.4天与41天; p>0.01)。在人类和狒狒的超声测量与卡内基发育阶段之间发现了显着的相关性 (p>0.01)。狒狒中只有妊娠和卵黄囊明显小于人类 (p>0.05)。在第17和第23卡内基发育阶段之间，胚胎CRL，胚胎外空间和心率非常相似的发现使狒狒成为人类怀孕的有前途的替代品，可用于使用celecentesis进行研究。

BACKGROUND & AIMS: :This study aimed to determine whether karyomapping can be applied to couples requiring preimplantation genetic diagnosis (PGD) for single gene disorder (SGD) and/or chromosomal rearrangement. 75/82 (91.5%) and 6/82 (7.3%) couples were referred for autosomal SGD and X-linked disease, respectively. One couple (1.2%) was referred for SGD and chromosomal rearrangement. Of 608 embryos, 146 (24%, 95% CI 21-28) day-3 and 462 (76%, 95% CI 72-79) blastocyst biopsies were performed. A total of 81 embryo transfers were performed; 16/81 (20%) were following day-3 embryo biopsy, 65/81 (80%) were following blastocyst biopsy and cryopreserved embryo transfer. Of 81 embryo transfers with known pregnancy outcome, 51 (63%, 95% CI 52-73) were on-going pregnancies, 6/81 (7%, 95% CI 3-15) resulted in first trimester miscarriages and 24/81 (30%, 95% CI 21-40) were failed implantations. Of the 51 on-going pregnancies, 15 (29%, 95% CI 19-43) couples had a singleton live birth at the time of write up. There have been no reports of abnormal prenatal, genetic testing or diagnosis of phenotype at birth. Karyomapping is reliable, efficient and accurate for couples requiring PGD for SGD and/or chromosomal rearrangement. Additionally, it provides aneuploidy screening, minimising risks of miscarriage and implantation failure.

背景与目标： : 这项研究旨在确定是否可以将核映射应用于需要单基因疾病 (SGD) 和/或染色体重排的植入前遗传学诊断 (PGD) 的夫妇。75/82 (91.5%) 和6/82 (7.3%) 夫妇分别被转诊为常染色体SGD和X连锁疾病。一对夫妇 (1.2%) 被指用于SGD和染色体重排。在608胚胎中，进行了146 (24%，95% CI 21-28) 第3天和462 (76%，95% CI 72-79) 胚泡活检。总共进行了81个胚胎移植; 16/81 (20%) 在第3天胚胎活检之后，65/81 (80%) 在囊胚活检和冷冻保存的胚胎移植之后。在81例已知妊娠结局的胚胎移植中，有51例 (63%，95% CI 52-73) 正在进行妊娠，6/81例 (7%，95% CI 3-15) 导致孕早期流产，24/81例 (30%，95% CI 21-40) 植入失败。在进行的51例怀孕中，有15例 (29%，95% CI 19-43) 夫妇在撰写文章时单胎活产。没有产前、基因检测或出生时表型诊断异常的报告。对于需要PGD进行SGD和/或染色体重排的夫妇，Karyomapping是可靠，高效和准确的。此外，它提供了非整倍性筛查，最大程度地减少了流产和植入失败的风险。