Antibody microarray analysis of amniotic fluid proteomes in women with cervical insufficiency and short cervix, and their association with pregnancy latency length.

INTRODUCTION: This study aimed to investigate amniotic fluid (AF) proteins that were differentially expressed between patients with cervical insufficiency (CI) and asymptomatic short cervix (SCX, ≤ 25 mm), and whether these proteins could be predictive of spontaneous preterm birth (SPTB) in these patients. METHOD: This was a retrospective cohort study of 129 singleton pregnant women with CI (n = 80) or SCX (n = 49) at 17 to 26 weeks who underwent amniocentesis. An antibody microarray was used to perform comparative proteomic profiling of AF from matched CI (n = 20) and SCX (n = 20) pregnancies. In the total cohort, an ELISA validation study was performed for 15 candidate proteins of interest. Subgroup analyses of patients with CI and SCX were conducted to evaluate the association between the 15 proteins and SPTB at < 32 weeks of gestation. RESULTS: Eighty-six proteins showed intergroup differences. ELISA validation confirmed significantly higher levels of AF EN-RAGE, IL-8, lipocalin-2, MMP-9, S100A8/A9, thrombospondin-2, and TNFR2 in patients with CI than in those with SCX. Multivariable analysis showed that increased AF levels of EN-RAGE, S100A8/A9, and uPA were independently associated with SPTB at < 32 weeks in patients with CI; whereas in patients with SCX, high AF levels of APRIL, EN-RAGE, LBP, and TNFR2 were independently associated with SPTB at < 32 weeks. CONCLUSIONS: Multiple AF proteins show altered expression in patients with CI compared with SCX controls. Moreover, several novel mediators involved in inflammation were identified as potential biomarkers for predicting SPTB after the diagnosis of CI and SCX. These results provide new insights into target-specific molecules for targeted therapies to prevent SPTB in patients with CI/SCX.

[Latex sensitization prevalence through prick test in patients with genitourinary malformations and more than 3 surgeries]. / Prevalencia de sensibilización al látex mediante prueba cutánea (prick test) en pacientes con malformaciones genitourinarias con más de tres intervenciones quirúrgicas.

BACKGROUND: Latex allergy is a public health issue. It presents elevated prevalence in known risk groups, especially in those patients with spine bifida condition, urinal malformation and for those with orthopedic problems - multiple surgeries. Health Services in Mexico do not have the enough studies about prevalence and risk associated to latex allergy. OBJECTIVE: Determine latex sensitization prevalence through PRICK test in patients with genitourinary malformations and more than 3 surgeries in UMAE pediatric CMNO unit, considering too related factors. MATERIAL AND METHOD: An analytical and descriptive cross-sectional study was performed, which included men and women from 1 to 16 years with genitourinary malformations and more than three surgeries performed. A survey to know the risk factors associated and skin puncture test was performed with latex extract, with positive and negative control. Serum levels of total IgE and eosinophils were measured in peripheral blood. RESULTS: The study exposed prevalence of 30.72%. Related to associated factors as follows: atopy (p=0.047), previous antecedent reaction to latex products (p=0.003) specific for balloons (p=0.000) and gloves (p=0.002). There was not association related to amount of surgeries and surgical interventions on early age, either for high levels of total serum IgE. CONCLUSION: Prevalence to latex sensitization is high in risk groups. Especially in those with atopy thereby is important for health personal to identify these patients in order to implement on time the preventive primary/secondary measures. With these actions potential mortal risks like anaphylaxis will be avoided. This will decrease sanitary costs and mortality.

Antecedentes: la alergia al látex tiene alta prevalencia en grupos de riesgo conocidos, especialmente en pacientes con espina bífida, malformaciones urinarias y ortopédicas con múltiples cirugías. En México no se cuenta con suficientes estudios que reporten la prevalencia y factores de riesgo asociados. Objetivo: determinar la prevalencia de sensibilización al látex mediante prueba de prick con extracto de látex en pacientes con malformaciones genitourinarias y más de tres cirugías en la Unidad Médica de Alta Especialidad de Pediatría del Centro Médico Nacional de Occidente, así como los factores asociados. Material y método: Se realizó un estudio transversal analítico y descriptivo, que incluyó hombres y mujeres de 1 a 16 años, con malformaciones genitourinarias y más de tres cirugías. Se aplicó una encuesta para conocer los factores de riesgo asociados y se realizó prueba cutánea por punción con extracto de látex, con control positivo y negativo. Se midieron niveles séricos de IgE total y eosinófilos en sangre periférica. Resultados: la prevalencia encontrada fue de 30.7% y los factores de riesgo asociados: atopia personal (p=0.047), antecedente de reacción previa con productos con látex (p=0.003), específicamente con globos (p=0.000) y guantes (p=0.002). No hubo asociación entre el número de cirugías e intervenciones quirúrgicas a edades tempranas, tampoco con concentraciones elevadas de IgE sérica total. Tuvieron reacción cruzada a frutas-látex 25% de los pacientes, los alimentos asociados fueron: aguacate, papaya, fresa y kiwi. Conclusión: la prevalencia de sensibilización al látex es alta en los grupos de riesgo, sobre todo con antecedente de atopia, por lo que es importante que el personal de salud identifique a estos pacientes a fin de implementar oportunamente las medidas de prevención primaria y secundaria; evitar efectos severos potencialmente mortales, como la anafilaxia, para disminuir la morbilidad y la mortalidad y los costos sanitarios.

Recurrent miscarriage: causes, evaluation and management.

Recurrent miscarriage is frustrating for the physician and a heartbreaking experience for the patient. Approximately 5% of couples trying to conceive have two consecutive miscarriages. Despite a thorough study of patients, the aetiology of this common obstetric complication is unknown in 50% of cases. Known causes include abnormal chromosomes, endocrinological disorders and uterine abnormalities. Although antiphospholipid antibodies have been demonstrated in miscarriages, the role played by alloimmune mechanisms remains unclear. New immunological approaches such as natural killer cells, regulatory T cells, tumour necrosis factor α, cell-derived microparticles, leptin, certain glycoproteins and cytokines should be considered. The management of thyroid diseases and immunological disorders is continuously evolving. Several genetic diagnostic procedures such as parental karyotyping and preimplantation genetic screening should probably not be used routinely. Antiphopholipid syndrome and some recurrent miscarriage-related endocrinological disorders can be effectively treated. Finally, new therapeutic approaches and the pleiotropic effects of old ones have led to improved fetal-maternal outcomes.

Absence of antisperm surface antibodies in prepubertal boys with cryptorchidism and other anomalies of the inguinoscrotal region before and after surgery.

PURPOSE: Although the prepubertal immune system cannot recognize postmeiotic germ cell antigens, an overall 21 to 28% incidence of antisperm antibodies directed at these antigens has been reported preoperatively in prepubertal children with cryptorchidism and other inguinoscrotal anomalies. We investigated the prevalence of antisperm antibodies in these prepubertal patients before and after surgery. MATERIALS AND METHODS: We examined 82 prepubertal boys 0.6 to 13.2 years old, including 33 with unilateral cryptorchidism, 21 with inguinoscrotal anomalies and 28 who were normal. IgG, IgM and IgA antisperm antibodies were determined by the indirect Immunobead test. Serum testing was repeated 1 and 2 years postoperatively and annually for 2 more years in the normal children. Also sera from 183 infertile men 21 to 47 years old with a history of cryptorchidism and/or inguinal hernia operated on in childhood were similarly studied. RESULTS: Of the adults 70 (39%) tested IgG positive, including 12 (7%) who were also IgA positive, and all tested IgM negative. Repeat measurements were negative for all IgG, IgA and IgM isotypes in all children, patients and controls. CONCLUSIONS: We conclude that there are no antibodies to sperm surface antigens in prepubertal children with cryptorchidism and inguinoscrotal anomalies before and within 2 years after surgery. Autoimmunity against postmeiotic sperm membrane antigens is apparent in adults only.