BACKGROUND & AIMS: :The dual oxidases (DUOXes) 1 and 2 are named based on their having both a domain homologous to the NADPH-oxidase of the phagocyte NADPH-oxidase gp91( phox )/NOX2 and a domain homologous to thyroid peroxidase. The DUOX1 and DUOX2 mRNAs were originally cloned from thyroid tissue, and the corresponding proteins were recognized as intricate components of the thyroid hormone synthesis process, providing hydrogen peroxide essential for the organification of iodide. The function of DUOX2 in thyroid hormonogenesis has been firmly established by linking the congenital hypothyroid phenotype "total iodide organification defect" to biallelic inactivating DUOX2 mutations. Based on the expression of both DUOXes in combination with a peroxidase in a range of different tissues and functional studies; the concept evolves that DUOX is important not only for thyroid hormonogenesis but also as an integral part of the host defense system of mucosal surfaces, participates in the control of epithelial infection, augments surface B-cell receptor signaling in lymphocytes, and is involved in generating a respiratory burst at fertilization.

背景与目标： : 双重氧化酶 (DUOXes) 1和2的命名是基于它们具有与吞噬细胞NADPH氧化酶gp91( phox )/NOX2的NADPH氧化酶同源的结构域和与甲状腺过氧化物酶同源的结构域。DUOX1和DUOX2 mrna最初是从甲状腺组织中克隆的，相应的蛋白质被认为是甲状腺激素合成过程的复杂成分，为碘化物的有机化提供了必不可少的过氧化氢。通过将先天性甲状腺功能减退表型 “总碘化物器官化缺陷” 与双等位基因失活DUOX2突变联系起来，已经牢固地确立了DUOX2在甲状腺激素发生中的功能。基于在一系列不同组织和功能研究中结合过氧化物酶的表达; 该概念演变为DUOX不仅对甲状腺激素发生很重要，而且作为粘膜表面宿主防御系统的组成部分，参与控制上皮感染，增强淋巴细胞中的表面b细胞受体信号传导，并参与受精时产生呼吸爆发。

BACKGROUND & AIMS: OBJECTIVE:Acute stress reactions (ASR) and postpartum depressive symptoms (PDS) are frequent after childbirth. The present study addresses the change and overlap of ASR and PDS from the 1- to 3-week postpartum and examines the interplay of caregiver support and subjective birth experience with regard to the development of ASR/PDS within a longitudinal path model. METHOD:A total of 219 mothers completed questionnaires about caregiver support and subjective birth experience (Salmon's Item List) at 48-6-h postpartum. ASR and PDS were measured for 1- and 3-week postpartum. The Impact of Event Scale (IES) was used to assess ASR, and the Edinburgh Postnatal Depression Scale (EPDS) was used to assess PDS. RESULTS:ASR was frequent 1-week postpartum (44.7%) and declined till week 3 (24.8%, p <.001), while the prevalence of PDS was continuous (14.2% week 1; 12.6% week 3; p = .380). Favorable reports of caregiver support were related to better subjective childbirth experience, which was related to lower ASR and PDS (controlled for age, mode of delivery, parity, EDA and duration of childbirth). CONCLUSION:High quality of intrapartum care and positive birth experiences facilitate psychological adjustment in the first 3-week postpartum.

背景与目标：

BACKGROUND & AIMS: :To quantify the economic burden of maternal health care services on Indian households and examine the levels of expenditure incurred in public and private health care institutions at the national, state and community levels. Cross-sectional population data from the 2004 National Sample Survey Organisation were used, which considered 9,643 households for the analysis where at least one woman received maternal health care services during the year preceding the survey. Multilevel linear regression techniques were used to estimate the effect of household, cluster and state characteristics on the proportion of maternal health care expenditures over total household expenditures. Over 80 % of households reported paying for maternal health care services, with those using private care facilities paying almost 4 times more than those using public facilities. Multilevel analyses show evidence of high burden of maternal health care expenditures, which varied significantly across states according to the level of health care utilisation, and with considerable heterogeneity at the household and community levels. Maternal health care services in India are offered free at the point of delivery, yet many families face significant out-of-pocket expenditures. The recent governmental policy interventions to encourage institutional births by providing nominal financial assistance is a welcome step but this might not help to compensate mothers for other indirect expenditures, especially those living in rural areas and poorer communities who are increasingly seeking care in private facilities.

背景与目标： : 量化孕产妇保健服务对印度家庭的经济负担，并检查国家，州和社区各级公共和私人保健机构的支出水平。使用了2004全国抽样调查组织的横断面人口数据，该数据考虑了9,643家庭进行分析，其中至少有一名妇女在调查前一年接受了孕产妇保健服务。使用多级线性回归技术来估计家庭，集群和州特征对孕产妇保健支出占家庭总支出的比例的影响。超过80% 的家庭报告为孕产妇保健服务付费，使用私人护理设施的家庭付费几乎是使用公共设施的家庭付费的4倍。多层次分析表明，孕产妇保健支出负担很高，根据保健利用水平，各州之间的差异很大，并且在家庭和社区层面具有相当大的异质性。印度的产妇保健服务在分娩时免费提供，但许多家庭面临着大量的自付费用。最近的政府政策干预措施通过提供名义财政援助来鼓励机构分娩是一个可喜的步骤，但这可能无助于补偿母亲的其他间接支出，特别是那些生活在农村地区和贫困社区的母亲，他们越来越多地在私人设施中寻求护理。

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: :The effect of immobilization on cell physiology and how this determines cell metabolic performance is an important concern for developing bioprocess. This is particularly true for genetically modified microorganisms and their genetic stability. For this reason the stability and physiological state of plasmid-bearing E. coli cells were ascertained by flow cytometry. Differences in the cellular DNA and protein content (15-20%) permit discrimination of control and plasmid-bearing cells, as well as adaptation to continuous cultivation conditions in both freely suspended and immobilized states to be monitored. Moreover, the observed metabolic burden due to maintenance and over-expression of plasmid-coded genetic material and slow cell growth in poorly-viable immobilized cells were found to be the main factors contributing to strain stabilization.

背景与目标： : 固定化对细胞生理的影响以及这如何决定细胞代谢性能是发展生物过程的重要问题。对于转基因微生物及其遗传稳定性尤其如此。因此，通过流式细胞术确定了带有质粒的大肠杆菌细胞的稳定性和生理状态。细胞DNA和蛋白质含量 (15-20%) 的差异允许区分对照和携带质粒的细胞，以及适应在自由悬浮和固定状态下的连续培养条件，以进行监测。此外，发现由于质粒编码的遗传物质的维持和过度表达以及活动性较差的固定化细胞中的细胞生长缓慢而导致的代谢负担是导致菌株稳定的主要因素。

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: PURPOSE:After the Fontan procedure, children exhibit reduced peak exercise capacity, yet their submaximal exercise response remains unclear. This study sought to determine the relationship between submaximal and peak exercise capacity and physical activity in Fontan patients. METHODS:This cross-sectional study recruited 50 Fontan patients (59% males) with a median age of 9 yr (range = 6-12 yr). The median age at Fontan procedure was 2.9 yr (range = 1.6-9.1 yr). Study assessments included medical history, exercise testing, and accelerometry. RESULTS:Significantly lower submaximal oxygen consumption (V˙O2) and HR in response to a standardized workload than published values for healthy children (mean ± SD) of -1.72 ± 5.24 (P < 0.001) and -1.45 ± 1.98 (P < 0.001), respectively, suggest enhanced submaximal work efficiency in this group of patients after Fontan. Higher submaximal V˙O2 z-score was associated with higher submaximal HR z-score (P = 0.02) and lower body mass index z-score (P = 0.01). Higher V˙O2peak was associated with higher submaximal V˙O2 z-score (P < 0.01), male sex (P = 0.03), higher RER (P = 0.02), lower submaximal HR z-score (P < 0.01), and higher chronotropic responsiveness (P < 0.0001). Exercise test duration z-score was associated with lower submaximal HR z-score (P = 0.02) and higher chronotropic responsiveness (P = 0.02). CONCLUSIONS:Fontan patients exhibited a lower submaximal V˙O2 and HR responsiveness at a given workload than healthy controls did during standardized exercise testing. Thus, they may be better adapted to perform submaximal exercise. Although peak exercise capacity is limited, Fontan patients are able to perform submaximal physical activities at the same level as their healthy peers.

背景与目标：

BACKGROUND & AIMS: OBJECTIVE:The present study examined whether ethanol exposure influences lactation parameters. Specifically, selected constituents in maternal blood and milk and the lactation performance of Chinese lactating mothers were evaluated after they had consumed chicken soup flavoured with sesame oil and rice wine (CSSR), a diet traditionally prescribed during the postpartum 'doing-the-month' ritual. DESIGN:Twenty-three lactating mothers were examined. Informed consent was obtained from each subject. Each subject was tested on two occasions separated by a week. The target alcohol dosage was 0.3 g/kg body weight. Milk and blood samples were collected prior to consumption of soup and at 120 and 150 min, respectively, after consumption. Levels of various constituents were measured. The time for ejection of the first milk droplet and total milk volume yielded were also measured. RESULTS:Consumption of CSSR influenced TAG, insulin and lactate levels in maternal blood. Likewise, consumption of the soup affected milk composition and its nutritional status, particularly total protein, TAG, fatty acid, beta-hydroxybutyrate and lactate levels. CSSR intake significantly affected TAG and lactate levels in milk. The time for the first milk droplet to be ejected was significantly longer in the CSSR group, indicating that the milk-ejecting reflex is inhibited. However, blood prolactin level increased slightly after ethanol intake. Milk yields were reduced after ingestion of CSSR although the difference was not statistically significant. CONCLUSION:Consumption of CSSR affects not only the composition of maternal blood and milk, but also lactation performance. These findings suggest that an alcoholic diet should be avoided during lactation.

背景与目标：

BACKGROUND & AIMS: :We examined whether maternal educational level as an indicator of socioeconomic status is associated with gestational hypertension. We also examined the extent to which the effect of education is mediated by maternal substance use (that is smoking, alcohol consumption and illegal drug use), pre-existing diabetes, anthropometrics (that is height and body mass index (BMI)) and blood pressure at enrollment. This was studied in 3262 Dutch pregnant women participating in the Generation R Study, a population-based cohort study. Level of maternal education was established by questionnaire at enrollment, and categorized into high, mid-high, mid-low and low. Diagnosis of gestational hypertension was retrieved from medical records using standard criteria. Odds ratios (OR) of gestational hypertension for educational levels were calculated, adjusted for potential confounders and additionally adjusted for potential mediators. Adjusted for age and gravidity, women with mid-low (OR: 1.52; 95% CI: 1.02, 2.27) and low education (OR: 1.30; 95% CI: 0.80, 2.12) had a higher risk of gestational hypertension than women with high education. Additional adjustment for substance use, pre-existing diabetes, anthropometrics and blood pressure at enrollment attenuated these ORs to 1.09 (95% CI: 0.70, 1.69) and 0.89 (95% CI: 0.50, 1.58), respectively. These attenuations were largely due to the effects of BMI and blood pressure at enrollment. Women with relatively low educational levels have a higher risk of gestational hypertension, which is largely due to higher BMI and blood pressure levels from early pregnancy. The higher risk of gestational hypertension in these women is probably caused by pre-existing hypertensive tendencies that manifested themselves during pregnancy.

背景与目标： : 我们检查了孕产妇的教育水平作为社会经济地位的指标是否与妊娠高血压有关。我们还研究了母亲物质使用 (即吸烟，饮酒和非法药物使用)，先前存在的糖尿病，人体测量学 (即身高和体重指数 (BMI) 的影响程度。和入组时的血压。这项研究是在参加R世代研究的3262名荷兰孕妇中进行的，该研究是一项基于人群的队列研究。在入学时通过问卷调查确定了孕产妇的教育水平，并分为高，中高，中低和低。使用标准标准从病历中检索妊娠高血压的诊断。计算了受教育程度的妊娠高血压的优势比 (OR)，针对潜在的混杂因素进行了调整，并针对潜在的中介因素进行了调整。经年龄和妊娠调整后，中低 (OR: 1.52; 95% CI: 1.02，2.27) 和低教育程度 (OR: 1.30; 95% CI: 0.80，2.12) 的女性比高学历女性有更高的妊娠期高血压风险。入组时对物质使用，先前存在的糖尿病，人体测量学和血压的额外调整使这些or分别减弱为1.09 (95% CI: 0.70，1.69) 和0.89 (95% CI: 0.50，1.58)。这些衰减主要是由于入组时BMI和血压的影响。受教育程度相对较低的女性患妊娠期高血压的风险较高，这在很大程度上是由于怀孕初期较高的BMI和血压水平。这些妇女患妊娠期高血压的风险较高，可能是由于怀孕期间出现的先前存在的高血压倾向引起的。

BACKGROUND & AIMS: BACKGROUND:Although maternal serum alpha-fetoprotein (MSAFP) is a highly sensitive marker for certain congenital malformations such as open neural tube and ventral wall defects, its usefulness as a screening test for fetal hydrocephalus is uncertain. We wished to determine the distribution of maternal serum alpha-fetoprotein levels associated with fetal hydrocephalus in a population-based screening program in Manitoba, and their potential relationship to additional anomalies. METHODS:Cases of fetal hydrocephalus unrelated to neural tube defects were ascertained from multiple sources and reviewed. Cross-reference with the Manitoba Maternal Serum Screening Program database determined which mothers had undergone maternal serum screening. Mean MSAFP levels in both isolated and complex hydrocephalus were calculated and compared with the general population of screened pregnancies using Independent Samples T-tests. RESULTS:Mean MSAFP levels in 70 cases of fetal hydrocephalus were significantly higher than those of the general population of screened pregnancies (P = 0.029). This was due to the fact that mean MSAFP levels in those cases with other major anomalies were increased over those of the general population (P = 0.041); cases with hydrocephalus alone showed no significant difference (P = 0.203). Only seven cases (10%) had MSAFP levels > or = 2.3 multiples of the median, the cut-off used in Manitoba. However, six of these (86%) had additional major and/or minor malformations. CONCLUSION:MSAFP screening has low sensitivity for fetal hydrocephalus and is rarely elevated in isolated cases. However, when fetal hydrocephalus is detected, elevated MSAFP levels indicate that the fetus is at significant risk to have additional malformations and further investigations, including chromosome breakage studies, may be indicated.

背景与目标：

BACKGROUND & AIMS: :We investigated the expression of prion protein gene both on mRNA and protein levels in bovine and ovine female reproductive organs during gestation and various tissues of their fetuses. The fetal tissues of both species included brain, cotyledon, heart, intestine, kidney, liver, lung, and muscle. In cattle, prion protein gene (PRNP) transcripts were detected by semiquantitative RT-PCR in reproductive tissues such as ovary, oviduct, endometrium, myometrium, follicles, and granulosa cells. In various tissues of 2-month-old fetuses, higher expression levels were found in brain and cotyledon compared to the other tissues. To detect the expression of the gene transcript in in vivo preimplantation embryos and 1-month-old fetuses, real-time PCR was performed showing that the level of gene expression in zygote stage was significantly higher (p < or = 0.05) than that of the other stages. Sheep were categorized as resistant (RI) or high susceptible (R5) to scrapie according to their PRNP genotype. In both genotype groups, the PRNP mRNA was detectable in all tissues studied including ovary, oviduct, endometrium, myometrium, and caruncle of ewes and all tissues of 2-month-old fetuses of both groups. Comparison between reproductive organs demonstrates the highest expression level in caruncle tissue of R1 ewes, whereas the level was high in brain and low in liver of both R1 and R5 fetuses. In addition, real-time RT-PCR was performed in immature oocytes, mature oocytes, in vivo embryos at morula stage, and 1-month-old fetuses. The results showed that the relative expression levels of the ovine PRNP mRNA in mature oocytes and morula stage embryos were significantly lower than those in immature oocytes and 1-month-old fetuses (p < or = 0.05). Western blot analyses revealed the immunoreactive bands corresponding to the cellular prion protein (PrPc) in all maternal and fetal tissues examined of both cattle and sheep. Moreover, immunohistochemical staining implicated localization of the PrPc in ovarian cortex and ovarian medulla of both species. However, PrPc was not detected in oocyte, granulosa cells, theca cells, and corpus luteum in this study.

背景与目标： : 我们研究了妊娠期间牛和绵羊雌性生殖器官及其胎儿各个组织中prion蛋白基因在mRNA和蛋白质水平上的表达。这两个物种的胎儿组织包括大脑，子叶，心脏，肠，肾脏，肝脏，肺和肌肉。在牛中，通过半定量rt-pcr在生殖组织 (例如卵巢，输卵管，子宫内膜，子宫肌层，卵泡和颗粒细胞) 中检测到prion蛋白基因 (PRNP) 转录本。在2个月大的胎儿的各种组织中，与其他组织相比，大脑和子叶中的表达水平更高。为了检测基因转录本在体内植入前胚胎和1个月大的胎儿中的表达，进行了实时PCR，显示受精卵阶段的基因表达水平显着高于其他阶段 (p <或 = 0.05)。根据绵羊的PRNP基因型，绵羊被分为对瘙痒病的抗性 (RI) 或高敏感性 (R5)。在两个基因型组中，在所有研究的组织中都可以检测到PRNP mRNA，包括卵巢，输卵管，子宫内膜，子宫肌层和母羊以及两组2个月大胎儿的所有组织。生殖器官之间的比较表明，R1母羊的肉鸡组织中表达水平最高，而R1和R5胎儿的大脑中表达水平较高，肝脏中表达水平较低。此外，在未成熟卵母细胞，成熟卵母细胞，桑胚期的体内胚胎和1个月大的胎儿中进行了实时rt-pcr。结果表明，绵羊PRNP mRNA在成熟卵母细胞和桑胚期胚胎中的相对表达水平明显低于未成熟卵母细胞和1月龄胎儿 (p <或 = 0.05)。Western印迹分析显示，在所有检查的牛和羊的母体和胎儿组织中，与细胞病毒蛋白 (PrPc) 相对应的免疫反应带。此外，免疫组织化学染色暗示PrPc在两种物种的卵巢皮质和卵巢髓质中的定位。然而，在本研究中未在卵母细胞，颗粒细胞，卵泡膜细胞和黄体中检测到PrPc。

BACKGROUND & AIMS: BACKGROUND & OBJECTIVE:Estimation of maternal mortality has been difficult because of large sample size requirement. A study using snowball technique for identification of households where maternal death has taken place and its related causes was conducted. We present here the feasibility of carrying out the snowball technique for capturing maternal deaths as against house-to-house survey and to obtain the estimates of maternal mortality ratio (MMR) in some selected States of India. METHODS:Five states representing high MMR (Uttar Pradesh), medium MMR (Maharashtra, Karnataka, Uttranchal) and low MMR (Delhi) were selected. A total of 8 PHCs and 3 (UFS) were covered. Study used both house-to-house survey and snowball technique to enumerate the maternal deaths in the selected PHCs in rural area and urban frame survey (UFS) in urban area. RESULTS:In all, 94 maternal deaths were captured through snowball technique as against 83 through house-to-house survey. The estimate of MMR for the five States combined was 356 per 100,000 live births, as compared to assumed 400 per 100,000 live births for the country as a whole. The relative standard error of the estimate of MMR was about 10 per cent. INTERPRETATION & CONCLUSION:Snowball technique captured more maternal deaths than those in house-to-house survey particularly in rural areas. The estimates also indicated the feasibility of replicating the proposed methodology for estimation of MMR as a time and cost-effective methodology.

背景与目标：

BACKGROUND & AIMS: :This study was designed to evaluate the effects of maternal obesity and diabetes mellitus on the risk of nonchromosomal congenital defects. We used data from 22,951 pregnant women enrolled in a prospective cohort study of early prenatal exposures and pregnancy outcome. The relative risks [prevalence ratios (PRs)] of major nonchromosomal congenital defects associated with obesity and diabetes, alone or in combination, were calculated using multiple logistic regression analysis. In this study, in the absence of diabetes, obese women (body mass index > or =28) had no higher risk, overall, of having an offspring with a major defect [PR = 0.95; 95% confidence interval (CI) = 0.62-1.5]. Their offspring, however, did have a higher prevalence of certain types of defects, including orofacial clefts; club foot; cardiac septal defects; and, to a lesser extent, hydrocephaly and abdominal wall defects. Women with pre-existing or gestational diabetes who were not obese also had no excess risk overall of having offspring affected by a major defect (PR = 0.98; 95% CI = 0.43-2.2), although they did have a higher prevalence of musculoskeletal defects. The pregnancies of women who were both obese and diabetic were 3.1 times as likely (95% CI = 1.2-7.6) to result in an offspring with a defect than were those of nonobese, nondiabetic women, which suggests that obesity and diabetes mellitus may act synergistically in the pathogenesis of congenital anomalies. The defects were largely craniofacial or musculoskeletal.

背景与目标： : 本研究旨在评估母亲肥胖和糖尿病对非染色体先天性缺陷风险的影响。我们使用了来自22,951名参加产前早期暴露和妊娠结局的前瞻性队列研究的孕妇的数据。使用多元logistic回归分析计算单独或合并与肥胖和糖尿病相关的主要非染色体先天性缺陷的相对风险 [患病率 (PRs)]。在这项研究中，在没有糖尿病的情况下，肥胖妇女 (体重指数> 或 = 28) 总体上没有较高的风险，其后代具有重大缺陷 [PR = 0.95; 95% 置信区间 (CI) = 0.62-1.5]。但是，他们的后代确实存在某些类型的缺陷，包括口面部裂隙; 俱乐部足; 心脏间隔缺损; 以及在较小程度上的脑积水和腹壁缺损。既往或未肥胖的妊娠糖尿病女性也没有患主要缺陷 (PR = 0.98; 95% CI = 0.43-2.2) 的额外风险，尽管她们的肌肉骨骼缺陷患病率较高。肥胖和糖尿病妇女的怀孕导致后代缺陷的可能性是非肥胖，非糖尿病妇女的3.1倍 (95% CI = 1.2-7.6)，这表明肥胖和糖尿病可能协同作用在先天性异常的发病机理中。缺陷主要是颅面或肌肉骨骼。

BACKGROUND & AIMS: OBJECTIVES:To evaluate maternal left ventricular (LV) systolic and diastolic function during normal pregnancy by non-invasive measures of LV contractility incorporating loading conditions. METHODS:Sixty-five women were examined using echocardiography, including tissue Doppler and two-dimensional speckle tracking, and subclavian artery pulse trace recordings at gestational weeks 14-16, 22-24 and 36, and at 6 months postpartum. RESULTS:The mean ± SD age of the women was 32.0 ± 4.6 years. Cardiac output and LV end-diastolic volume were on average 20% and 23% higher, respectively, during pregnancy, compared to that at 6 months postpartum (both, P < 0.01). LV ejection fraction, global peak systolic strain and rate-corrected LV velocity of circumferential fiber shortening (Vcfc) were 11%, 6% and 6% lower, respectively, at 36 weeks' gestation compared to at 6 months postpartum (all, P < 0.01). Afterload, measured as LV end-systolic wall stress (ESWS) increased by 10% between 14-16 and 36 weeks' gestation (P < 0.01). Analysis of the relationship between Vcfc and ESWS revealed that LV contractility was lower during pregnancy than at 6 months postpartum. Changes in diastolic function were demonstrated by 11% lower mitral early diastolic (E) wave velocity, 8% lower tissue Doppler early diastolic velocity (e') and 13% higher left atrial area (all P < 0.01) during pregnancy. Tissue Doppler E/e' remained unaltered (P = 0.78). CONCLUSIONS:During normal pregnancy, LV contractility is lower than it is at 6 months postpartum. This is associated with increased LV and left atrial area, whereas filling pressures are unchanged. These findings suggest that pregnancy exerts a larger load on the cardiovascular system than previously assumed.

背景与目标：

BACKGROUND & AIMS: :Emerging evidence indicates that reactive oxygen species, especially superoxide and hydrogen peroxide, are important signaling molecules in cardiovascular cells. Their production is regulated by hormone-sensitive enzymes such as the vascular NAD(P)H oxidases, and their metabolism is coordinated by antioxidant enzymes such as superoxide dismutase, catalase, and glutathione peroxidase. Both of these reactive oxygen species serve as second messengers to activate multiple intracellular proteins and enzymes, including the epidermal growth factor receptor, c-Src, p38 mitogen-activated protein kinase, Ras, and Akt/protein kinase B. Activation of these signaling cascades and redox-sensitive transcription factors leads to induction of many genes with important functional roles in the physiology and pathophysiology of vascular cells. Thus, reactive oxygen species participate in vascular smooth muscle cell growth and migration; modulation of endothelial function, including endothelium-dependent relaxation and expression of a proinflammatory phenotype; and modification of the extracellular matrix. All of these events play important roles in vascular diseases such as hypertension and atherosclerosis, suggesting that the sources of reactive oxygen species and the signaling pathways that they modify may represent important therapeutic targets.

背景与目标： : 新兴证据表明，活性氧，尤其是超氧化物和过氧化氢，是心血管细胞中的重要信号分子。它们的产生受激素敏感酶 (例如血管NAD(P)H氧化酶) 调节，其代谢受抗氧化酶 (例如超氧化物歧化酶，过氧化氢酶和谷胱甘肽过氧化物酶) 协调。这两种活性氧都是激活多种细胞内蛋白质和酶的第二信使，包括表皮生长因子受体c-Src，p38丝裂原激活的蛋白激酶，Ras和Akt/蛋白激酶B。这些信号级联和氧化还原敏感的转录因子的激活导致诱导许多在血管细胞的生理和病理生理中具有重要功能作用的基因。因此，活性氧参与血管平滑肌细胞的生长和迁移; 调节内皮功能，包括内皮依赖性舒张和促炎表型的表达; 和细胞外基质的修饰。所有这些事件在诸如高血压和动脉粥样硬化等血管疾病中起着重要作用，表明活性氧的来源及其修饰的信号通路可能是重要的治疗靶点。