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Background: To investigate the clinical effect of modified Baihe Gujin Decoction in treatment of cough during pregnancy.

Methods: A total of 31 pregnant women with cough were recruited from First Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine and Shanghai Qingpu District Hospital of Traditional Chinese Medicine from February 2016 to June 2020. The patients were treated with modified Baihe Gujin Decoction for two weeks according to their unique symptoms and signs. The cough symptoms were evaluated and the symptom scores were calculated at Day 0 (time of enrollment), Day 7, and Day 14, respectively.

Results: Of 31 cases, 4 cases were clinically cured and 24 cases showed marked improvement, with 3 cases showing no improvement.

Conclusions: Modified Baihe Gujin Decoction can significantly improve the symptoms of cough during pregnancy.

Zika virus infection during pregnancy can have devastating effects on the foetus leading to congenital Zika syndrome. It is relevant therefore for couples living in countries with endemic Zika virus to understand the strategies they can utilise to reduce the chance of infection. In addition, couples planning pregnancy, or who are already pregnant, travelling to countries with Zika virus need to be informed of the potential risk and implications for future reproductive planning.

Background and objective: Day-5 blastocyst embryos are usually chosen for assisted reproductive therapy. We compared the reproductive outcomes of the euploid blastocysts developed on Day 5 versus Day 6.

Methods: This single-center, retrospective observational study analyzed patients aged 25–45 years, who underwent intracytoplasmic sperm injection from December 2014 to November 2018. Depending on the day of trophectoderm biopsy, patients were categorized into Day-5 and Day-6 groups. Percentages of euploid embryos were calculated for both groups, and elective single euploid blastocysts were transferred in a frozen embryo transfer (FET) cycles. The study endpoints were the comparisons of the reproductive outcomes including clinical pregnancy rate (CPR), implantation rate (IR), miscarriage rate (MR), and live birth rate (LBR) between Day-5 and Day-6 euploid FET groups.

Results: A total of 801 embryos from 184 patients were evaluated [Day 5 ($n=769$); Day 6 ($n=32$); 42.45% were euploid] with the rate of euploidy in Day-5 and Day-6 groups at 42.52% and 40.62%, respectively. A total of 126 patients underwent FET with 126 elective single euploid embryos (Day 5: 117; Day 6: 9). For Day-5 versus Day-6 groups, a significantly higher IR (61.54% vs. 44.44%; $p=0.0531$), CPR (61.54% vs. 44.44%; $p=0.0531$), and LBR (61.54% vs. 33.33%; $p=0.0014$) were reported. Multivariate analysis on ANOVA suggested, comparable pregnancy rates at Day 5 and Day 6 ($p=0.728$).

Conclusions: Day-5 euploid blastocysts seem to offer better reproductive outcomes than Day-6 euploid blastocysts. Further research is recommended to evaluate the reproductive outcomes of Day-6 blastocysts.

Oogenesis in mammalian females, including humans, is arrested prior to birth. Females, therefore, are born with a limited number of primary oocytes. This is in direct contrast to males in whom spermatogenesis continues during the entire lifespan following puberty. Here, we discuss possible evolutionary advantages that this confers and contrast this with age-related decline in oocyte quality that results in diminished fertility with advancing maternal age. We believe that a better understanding of these processes would be helpful in developing strategies to preserve fertility as maternal age increases, especially in the context of the current demographic shift with more and more women seeking fertility treatment at advanced age.

Decidual leukocytes make up approximately 30% of all decidual stromal cells in early pregnancy, of which 70% are uterine natural killer (uNK) cells. uNK cells are phenotypically distinct from peripheral blood NK cells, being CD56${}^{\text{bright}}$CD16${}^{-}$. A recent single-cell sequencing project of the decidua identified three subsets of uNK cells, but we are yet to determine how they differ functionally. Several roles for uNK cells in implantation are starting to emerge including biosensing of poor-quality embryos, killing of bacteria infected trophoblast, spiral artery remodeling, and regulation of trophoblast invasion. Altered numbers of uNK cells have been identified in several pathological conditions, but whether this is causative of the condition is currently unclear.

Background and Aims: Extracytoplasmic oocyte abnormalities such as Large Perivitelline Space (LPVS) and Fragmented Polar Body (FrPB) are frequently detected in human oocytes during IVF procedures. The purpose of this research is to determine the relationship of LPVS, FrPB, and their combination on embryo quality and pregnancy loss.

Method: The 36 positive pregnancy cases from under 40 years old patients that underwent ICSI using normospermia at RS Pondok Indah IVF Centre were observed. Patients were stimulated with r-FSH utilizing an antagonist protocol for 10-11 days, then r-HCG was administered as a trigger 36 hours before retrieval. Oocytes were classified as follows: (a) normal, (b) large perivitelline space (LPVS), (c) polar body fragmentation (FrPB), and (d) a combination of LPVS and FrPB. The Shapiro-Wilk and Kruskal-Wallis tests were used to determine the effect between each of the categories of oocyte with D3 and D5 embryo quality, along with pregnancy loss.

Results: The results indicate that there was no significant distinction among the groups in terms of embryo quality on D3 and D5, as well as pregnancy loss (p=0.187, 0.881, and 0.561, respectively).

Conclusion: It could have been concluded that LPVS, FrPB, and their combination have no impact on embryo quality and pregnancy loss.

Rheumatic diseases occur commonly in patients of childbearing age. The compatibility of different Disease Modifying Anti-Rheumatic Drugs (DMARDs) during pregnancy and lactation can affect the management decision when treating these patients. With the development of promising biologics DMARDs (bDMARDs) and targeted synthetic DMARDs (tsDMARDs) in various rheumatic diseases, their safety in pregnancy and lactation is an issue for both patients and clinicians. Recently, three different guidelines on the compatibility of DMARDs during pregnancy and lactation has been published by ACR, EULAR and BSR respectively. This article summarizes their recommendations on the management of patients on DMARDs during pregnancy and lactation.

Takayasu vasculitis (TAK) is a form of large vessel vasculitis clinically manifesting as pulseless disease or hypertension. It is more common in South East Asia and Japan, India, and Mexico [1]. It is increasingly being recognized due to increased awareness among medical fraternity and better imaging modalities. Undetected hypertension, pulselessness, and syncope are more common symptoms and presentation during pregnancy is unusual and can lead to bad obstetric outcomes. Recent evidences support the use of tocilizumab for inducing remission in Takayasu arteritis. We report this rare case of vasculitis presenting in pregnancy as malignant hypertension. A 20-year-old pregnant woman (45 days) presented with headache and nausea but no fever. She had a history of intermittent claudication of legs for the past 3 years but not evaluated. During examination, pulses were felt normally and blood pressure (BP) 180/110, no murmurs in cardiac auscultation, but she had abdominal bruit (renal vessels). Other systems were normal. Echocardiogram (ECHO) showed dilated ascending aorta. Doppler of renal vessels showed narrowing of renal arteries. Unfortunately, she had to undergo termination of pregnancy (high BP in spite of antihypertensives). Her computed tomography (CT) angiogram showed features of TAK with type 5 pattern–she had methylprednisolone infusion 500 mg daily for 3 days, followed by injection tocilizumab 400 mg monthly 3 doses. Once remission was achieved, she had recanalization by percutaneous transluminal angioplasty of right renal artery. She is currently maintained on aspirin and telmisartan. Awareness of causes of high BP, inputs by radiologist, cardiologist, and rheumatologist and understanding by the patient and family helped to achieve good outcome albeit the miscarriage.

Electronic Health Records (EHR) contain detailed information about a patient’s medical history and can be helpful in understanding clinical outcomes among populations generally underrepresented in research, including pregnant individuals. A cesarean delivery is a clinical outcome often considered in studies as an adverse pregnancy outcome, when in reality there are circumstances in which a cesarean delivery is considered the safest or best choice given the patient’s medical history, situation, and comfort. Rather than consider all cesarean deliveries to be negative outcomes, it is important to examine other risk factors that may contribute to a cesarean delivery being an adverse event. Looking at emergency admissions can be a useful way to ascertain whether or not a cesarean delivery is part of an adverse event. This study utilizes EHR data from Penn Medicine to assess patient characteristics and pregnancy-related conditions as risk factors for an emergency admission at the time of delivery. After adjusting for pregnancy number and cesarean number for each patient, preterm birth increased risk of an emergency admission, and patients younger than 25, or identifying as Black/African American, Asian, or Other/Mixed, had an increased risk. Later pregnancies and repeat cesareans decreased the risk of an emergency delivery, and White, Hispanic, and Native Hawaiian/Pacific Islander patients were at decreased risk. The same risk factors and trends were found among cesarean deliveries, except that Asian patients did not have an increased risk, and Native Hawaiian/Pacific Islander patients did not have a reduced risk in this group.

Electronic Health Records (EHR) contain extensive information on various health outcomes and risk factors, and therefore have been broadly used in healthcare research. Integrating EHR data from multiple clinical sites can accelerate knowledge discovery and risk prediction by providing a larger sample size in a more general population which potentially reduces clinical bias and improves estimation and prediction accuracy. To overcome the barrier of patient-level data sharing, distributed algorithms are developed to conduct statistical analyses across multiple sites through sharing only aggregated information. The current distributed algorithm often requires iterative information evaluation and transferring across sites, which can potentially lead to a high communication cost in practical settings. In this study, we propose a privacy-preserving and communication-efficient distributed algorithm for logistic regression without requiring iterative communications across sites. Our simulation study showed our algorithm reached comparative accuracy comparing to the oracle estimator where data are pooled together. We applied our algorithm to an EHR data from the University of Pennsylvania health system to evaluate the risks of fetal loss due to various medication exposures.