简介：AbstractThe obstetric issues and management styles in China are different from that in Western countries. Chinese medical education, residency training, obstetric care structure, and management of common obstetric complications are briefly reviewed and compared to the United States. Maternal-fetal medicine (MFM) is rapidly developing in China, but the development of MFM may not follow the same trajectory as in the West. Understanding the difference between China and the West may facilitate communication and foster mutual development.

简介：AbstractSince the 1970s, electronic fetal monitoring (EFM) also known as cardiotocography (CTG) has been used extensively in labor around the world, despite its known failure to help prevent many babies from developing neonatal encephalopathy and cerebral palsy. Part of EFM’s poor performance with respect to these outcomes arises from a fundamental misunderstanding of the differences between screening and diagnostic tests, subjective classifications of fetal heart rate (FHR) patterns that lead to large inter-observer variability in its interpretation, failure to appreciate early stages of fetal compromise, and poor statistical modeling for its use as a screening test. We have developed a new approach to the practice and interpretation of EFM called the fetal reserve index (FRI) which does the following: (1) breaking FHR components down into 4 components, (heart rate, variability, accelerations, and decelerations); (2) contextualizing the metrics by adding increased uterine activity; (3) adding specific maternal, fetal, and obstetric risk factors. The result is an eight-point scoring metric that, when directly compared with current American College of Obstetricians and Gynecologists EFM categories, even in version 1.0 with equal weighting of variables, shows that the FRI has performed much better for identifying cases at risk before damage had occurred, reducing the need for emergency deliveries, and lowering overall Cesarean delivery rates. With increased data, we expect further refinements in the specifics of scoring that will allow even earlier detection of compromise in labor.

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简介：<正>产科超声检查高度依赖操作者技术水平,胎儿异常的发现取决于操作者的受训程度和操作技巧。英国胎儿医学基金会(FetalMedicineFoundation),即FMF,是由Nicolaides教授于1996年创建,致力于促进胎儿医学研究和培训的非赢利性慈善机构。

简介：AbstractVenous thromboembolism (VTE) is a leading cause of maternal morbidity and mortality though with low rates. Compared to non-pregnant women of comparable age, women during pregnancy have five- to ten-fold increased risk of VTE, additional risk factors for VTE during pregnancy include a personal history of thrombosis, the presence of a thrombophilia, cesarean delivery, obesity, hypertension, preeclampsia, autoimmune disease, heart disease, sickle cell disease and multiple gestation. Thus, early clinical evaluation, preferably in peri-conceptional period, is crucial for VTE risk detection and, thus, for prophylaxis decision making. VTE thromboprophylaxis brought significant advantages in pregnancy outcomes and maternal deaths. Common pharmacological and mechanical forms of thromboprophylaxis includes heparin compounds, anti-embolic stockings and intermittent pneumatic compression devices. Low-molecular-weight heparin as first line strategy. Current guidelines or expert opinions on VTE treatment or prophylaxis during pregnancy diverge significantly. High quality research in this area is still needed, and China needs to develop its own VTE guidelines. Importantly, absolute risks and potential benefits of VTE thromboprophylaxis should be evaluated to make the best decisions on VTE screening, prevention, and treatment.

简介：AbstractObjective:To build a reference fetal growth chart for the Chinese population based on fetal ultrasound measurements.Methods:This was a multicenter, population-based retrospective cohort study. Longitudinal ultrasound measurement data were collected from 24 hospitals in 18 provinces of China from 1st September through 31st October of 2019. The estimated fetal weight (EFW) was calculated based on head circumference, abdominal circumference, and femur length using Hadlock formula 3. Fetal growth curves were estimated using a two-level linear regression model with cubic splines. All participants were divided into two groups: the northern group (n = 5829) and the southern group (n = 3246) based on the geographical division of China and male fetus group (n = 4775) and female fetus group (n = 4300) based on fetal gender. The EFW was compared by fetal gender and geographical group. All statistical models were adjusted for maternal sociodemographic characteristics.Results:A total of 9075 participants with 31,700 ultrasound measurement records were included in this study. Male fetuses demonstrated significantly larger EFW compared to female ones starting at 16 weeks of gestation and extending to delivery (global test P < 0.01). The overall geographic difference in EFW was significant (global test P = 0.03), and week-specific comparisons showed that the northern group had a greater EFW starting at 15 weeks of gestation and extending to 29 weeks of gestation, although this difference did not extend to the time of delivery. The Z-score of EFW confirmed that our Chinese fetal growth charts differed from previously published standards.Conclusion:This study provides EFW and ultrasound biometric reference measurements for Chinese fetuses and reveals differences from other fetal growth charts. The chart is worth promoting in more regions of China but should be tested prudently before use.

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简介：AbstractThis paper provides ethical guidance for the professionally responsible clinical investigation of maternal-fetal investigation for fetal or neonatal benefit and its transition into clinical practice. We present an ethical framework based on the ethical principles of beneficence, respect for autonomy, and justice, the professional virtue of integrity, and the ethical concept of the fetus as a patient. We identify the implications of this ethical framework for the qualifications that centers for maternal-fetal intervention should satisfy. These centers have the ethical obligation to provide prospective review and oversight of both innovation (an experiment undertaken to benefit an individual patient) and research (an experiment undertaken to create generalizable knowledge). We describe ethically justified criteria for innovation and early-phase research, for randomized clinical trials, and for the responsible transition into clinical practice. We also identify the elements of the informed consent process, including measures to prevent therapeutic misconception by pregnant patients during the informed consent process. The scientific, clinical, and ethical requirements of maternal-fetal investigation are demanding. However, the commitment to safety and quality requires that they be met. Fulfilling this commitment will result in well-documented professionally responsible investigation of maternal-fetal intervention for fetal and neonatal benefit.

简介：SincePresidentObamaannouncedthePrecisionMedicineInitiativeintheUnitedStates,moreandmoreattentionhasbeenpaidtoprecisionmedicine.However,clinicianshavealreadyusedittotreatconditionssuchascancer.Manycardiovasculardiseaseshaveafamilialpresentation,andgeneticvariantsareassociatedwiththeprevention,diagnosis,andtreatmentofcardiovasculardiseases,whicharethebasisforprovidingprecisecaretopatientswithcardiovasculardiseases.Large-scalecohortsandmultiomicsarecriticalcomponentsofprecisionmedicine.Herewesummarizetheapplicationofprecisionmedicinetocardiovasculardiseasesbasedoncohortandomicstudies,andhopetoelicitdiscussionaboutfuturehealthcare.

简介：我们几乎每天都会谈到“医”这个字和接触到与“医”有关的许多事。在汉英语之间，也习惯了将“医”翻译为“Medicine”。因此，说“医”，自然就会想到“Medicine”，很少去细嚼它们的语义文化区别，而实际上，“医”和“Medicine”在字面上虽然相通，但其间的语义内涵和文化特质却十分不同。

简介：Ginsengisarootvegetablewhoseshaperesemblesthehumanbody,anditsname(pronounced'insam'inKorean)containstheChinese

简介：AbstractFetal growth restriction (FGR) has a prevalence of about 10% worldwide and is associated with an increased risk of perinatal mortality and morbidity. FGR is commonly caused by placental insufficiency and can begin early (<32 weeks) or in late (≥32 weeks) gestational age. A false positive antenatal diagnosis may lead to unnecessary monitoring and interventions, as well as cause maternal anxiety. Whereas a false negative diagnosis exposes the fetus to an increased risk of stillbirth and renders the pregnancy ineligible from the appropriate care and potential treatments. The clinical management of FGR pregnancies faces a complex challenge of deciding on the optimal timing of delivery as currently the main solution is to deliver the baby early, but iatrogenic preterm delivery of infants is associated with adverse short-and long-term outcomes. Early and accurate diagnosis of FGR could aid in better stratification of clinical management, and the development and implementation of treatment options, ultimately benefiting clinical care and potentially improving both short-and long-term health outcomes. The aim of this review is to present the new insights on biomarkers of placenta insufficiency, including their current and potential value of biomarkers in the prediction and prevention for FGR, and highlight the association between biomarkers and adverse outcomes in utero to explore the specific mechanism of impaired fetal growth that establish the basis for disease later in life.

简介：AbstractFetal growth restriction (FGR) is associated with multiple adverse perinatal outcomes, such as increased risk of intrauterine death, neonatal morbidity and mortality, and long-term adverse outcomes. Genetic etiological factors are critical in fetuses with intrauterine growth restriction, including chromosomal abnormalities, copy number variants, single gene disorders, uniparental disomy, epigenetic changes, and confined placental mosaicism. This paper aims to provide an overview of genetic defects related to FGR and to highlight the importance of prenatal genetic counseling and testing for precise diagnosis and management of FGR.

简介：AbstractFetal growth restriction (FGR) is the condition in which a fetus does not reach its intrinsic growth potential and in which the shortterm and long-term risks of severe complications are increased. FGR is a frequent complication of pregnancy with a complex etiology and limited management options, other than timely delivery. The most common pathophysiological mechanism is placental insufficiency, due to many underlying causes such as maternal vascular malperfusion, fetal vascular malperfusion and villitis.Identifying truly growth restricted fetuses remains challenging. To date, FGR is often defined by a cut-off of the estimated fetal weight below a certain percentile on a population-based standard. However, small fetal size as a single marker does not discriminate adequately between fetuses or newborns that are constitutionally small but healthy and fetuses or newborns that are growth restricted and thus at risk for adverse outcomes. In 2016, the consensus definition of FGR was internationally accepted to better pinpoint the FGR population.In this review we will discuss the contemporary diagnosis and management issues. Different diagnostic markers are considered, like Doppler measurements, estimated fetal growth, interval growth, fetal movements, biomarkers, and placental markers.

简介：AbstractThe rising threats from antimicrobial resistance due to inappropriate utilization of antimicrobial agents in health care including the pediatric population has been a topic of concern at the global level for the last several decades. The antimicrobial stewardship program (ASP) is a multidisciplinary institutional initiative focusing primarily on the improvement of antimicrobial prescribing practices and limiting inappropriate use. ASPs play an important role in the implementation of healthcare strategies in pediatrics worldwide to reduce antimicrobial resistance. Many published reports demonstrate how adapted ASPs in pediatrics result in improvement of unnecessary antimicrobial utilization, decreasing drug resistance and treatment failure, minimization of adverse clinical outcomes, decreasing healthcare costs and hospital length of stay, and optimization of diagnostic strategies. However, some barriers in pediatric ASP still exist. This narrative review describes core elements of ASP, the impact of implemented ASPs on pediatric healthcare, and challenges of pediatric ASP as seen by the authors.

简介：1ThebackgroundofthedevelopmentofInternationalTravelMedicineinChina1.1Thenumberofexitpersonsin1993is93000000,duetotheexpansionofopenesstotheoutside,internationaltravelandthedevelopmentofforeigntrade.1.2Fitforthedevelopmentofthesocialistmarketeconomyandmeettheneedsofdaily—risinginternationaltravelhealthcareatdifferentlevels.

简介：在最近的年里，草药的药用的产品的治疗学、有毒的活动的评估上的研究变得可得到、流行。在现代生物工学的进展导致了许多新活跃成分的发现。然而，为草药的药用的产品的功效和安全建立药理学基础是经常的挑战。效果的更好的理解和phytopharmaceuticals的bioavailability能在发现合适、合理的治疗帮助。在这评论，我们在场在为一些重要的更多被进行了的免疫系统的bioavailability研究使用了phytopharmaceuticals。而且，值得在草药的药区域和他们的规章的机制也是的immunomodulating为药开发使用的各种各样的新药目标讨论了。不利效果，药相互作用，和禁止徵候也被讨论它证明当把phytopharmaceuticals与化学上导出的药品的部件相结合时，小心应该被行使。