Comparison of Magnetic Resonance Imaging of the Lower Uterine Segment in Pregnant Women with Central Placenta Previa with and without Placenta Accreta Spectrum from a Single Center.

BACKGROUND Placenta accreta spectrum (PAS) includes placenta increta, placenta percreta, and placenta accreta. PAS is due to abnormal decidualization and can lead to severe maternal hemorrhage and occurs in up to 3% of women with central placental previa (CPP). This study from a single center aimed to compare the magnetic resonance imaging (MRI) changes in the lower uterine segment in pregnant women with CPP, with and without PAS. MATERIAL AND METHODS This retrospective study includes 90 pregnant women with PAS and 66 pregnant women without PAS. All participants were confirmed to have CPP by MRI. Eight MRI parameters were assessed and compared with perinatal outcomes for mothers and newborns. RESULTS The pregnancies in the non-PAS group had less operative time (P=0.001), less intrapartum hemorrhage (P<0.001), and less blood transfusion than the PAS group (P<0.001). The 8 MRI variables with different odds ratios were placenta thickness (4.20), cervical lengths (3.27), placental dark T2 bands area (5.10), cervical marginal sinus (3.04), bladder bulge (3.55), myometrial thinning (6.41), lower uterine segment bulge (4.61), and placental signals in the cervix (9.14). The sensitivity and specificity of MRI in the diagnosis of PAS were 82.22% and 91.09%, respectively, by the combined 8 MRI features, and the area under the curve (AUC) was 0.816. CONCLUSIONS The findings from this study showed that MRI of the lower uterine segment had high sensitivity and specificity for the diagnosis of PAS in pregnant women with CPP.

Identification of Differential Expression Cytokines in Hemolysis, Elevated Liver Enzymes, and Low Platelet Syndrome by Proteome Microarray Analysis and Further Verification.

To screen the differential expression cytokines (DECs) in hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome, establish its differential cytokines spectra, and provide the clues for its diagnosis and pathogenic mechanism researches. Sera from four HELLP syndrome patients and four healthy controls were detected by proteome microarray. Then the analysis of Gene Ontology (GO) enrichment, Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway, and protein-protein interaction (PPI) network were performed and possible hub proteins were selected out, further verified by Enzyme Linked Immunosorbent Assay (ELISA) in sera from 21 HELLP syndrome patients and 21 healthy controls. Thirty DECs were defined according to P-value and fold change between HELLP group and control group. GO enrichment analysis showed that DECs were mainly involved in the regulation of inflammatory response and have relationship to growth factor binding, transmembrane receptor protein kinase, and cytokine receptor activity. Seven possible hub proteins were defined by PPI analysis, including IGFBP-3/Follistatin-like 1/FLRG/Fetuin A and MMP-13/Thrombospondin-5/Aggrecan. ELISA showed higher serum levels of Fetuin A/IGFBP-3/FLGR/MMP-13/Thrombospondin-5 in HELLP group than those in controls, while the levels of Follistatin-like 1 and Aggrecan were lower in HELLP patients (all P < 0.05 or <0.01).The serological DECs spectra of HELLP syndrome was established and seven possible hub proteins that may be more closely related to the disease have been verified, providing new clues for its pathogenesis, diagnosis, and clinical treatment.

New indicators in evaluation of hemolysis, elevated liver enzymes, and low platelet syndrome: A case-control study.

BACKGROUND: Indices such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), mean platelet volume (MPV), platelet distribution width (PDW), and red cell distribution width (RDW) are considered new markers of the systemic inflammatory response (SIR), and have been widely implemented for the diagnosis of patients with inflammatory diseases. These new indicators have also been widely investigated in preeclampsia (PE) but less analyzed in hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome. AIM: To compare SIR markers among HELLP patients, PE only patients, and healthy gravidae. METHODS: This retrospective case-control study enrolled 630 cases, including 210 patients with HELLP syndrome (HELLP group), 210 patients with only PE (PE group) and 210 healthy gravidae (control group). The three groups were matched by age, parity, status of assisted reproduction, and multiple pregnancies. Birthweight, gestational age at complete blood count collection, gestational age at delivery, mode of delivery, etc. were recorded. The main indices as NLR, PLR, MPV, PDW, and RDW among the groups were compared, as well as some secondary outcomes including neutrophil, platelets, and hemoglobin. RESULTS: The NLR (6.4 vs 4.3 vs 3.5), MPV (11.9 vs 11.2 vs 10.7), PDW (16.4 vs 13.3 vs 14.2), leukocyte (12.4 × 109/L vs 9.7 × 109/L vs 8.7 × 109/L) and neutrophil count (9.9 × 109/L vs 7.3 × 109/L vs 6.1 × 109/L) were highest in the HELLP group, lower in the PE group, and lowest in the control group. Both the overall comparisons between the three groups (all b P < 0.01) and pairwise comparisons between every two groups elicited statistically significant differences (all d P < 0.01, except control vs PE: c P < 0.05 in PDW). The average lymphocyte counts were 1.4 (1.1, 2.0) × 109/L in the HELLP group, 1.6 (1.3, 2.0) × 109/L in the PE group and 1.7 (1.4, 2.0) × 109/L in the control group. The overall comparison of lymphocyte count within the three groups had statistically significant differences (P = 0.000). The pairwise comparisons between every two groups demonstrated that the HELLP group had a lower lymphocyte count than both the PE (P = 0.019) and control groups (P = 0.000), but the difference between the PE and control groups was not statistically significant (P = 0.432). The overall comparisons on platelet counts and the PLR among these three groups also showed statistically significant differences (both P = 0.000), from low to high being those in the HELLP group (43.4 × 109/L, 64.0), control group (180.5 × 109/L, 103.6) and PE group (181.5 × 109/L, 112.8). Pairwise comparisons of neither index displayed statistically significant differences between the PE and control groups (both P > 0.05), while the differences in the two indices between the HELLP group and the two other groups were still statistically significant (all P = 0.000). RDW values were highest in the HELLP group (14.5% [13.6, 15.3]), lower in the control group (14.1% [13.5, 14.8]) and lowest in the PE group (13.9% [13.4, 14.9]). The difference between the PE and control group did not show statistical significance (P = 1.000), while RDW values in the HELLP group were higher than those in the other two groups (c P < 0.05 vs control, d P < 0.01 vs PE). CONCLUSION: SIR markers such as NLR, RDW, MPV, and PDW were increased and PLR was decreased in HELLP. These SIR markers may become new indicators in the evaluation of HELLP syndrome.

Effectiveness of high-dose glucocorticoids on hemolysis, elevating liver enzymes, and reducing platelets syndrome.

OBJECTIVE: To investigate the effectiveness of high-dose glucocorticoids on hemolysis, elevating liver enzymes, and reducing platelets (HELLP) syndrome. METHODS: A total of 151 patients with HELLP syndrome were analyzed and divided into two groups. Six subgroups of treatment and control groups were divided into three grades in accordance with the American Mississippi Diagnostic Criteria. RESULTS: There were no differences in general characteristics of the patients, primipara rate, minimum platelet recovery time, postpartum hemorrhage volume, postpartum hemorrhage rate, cumulative average of maternal damage, intensive care unit admission rate, perinatal mortality rate, and overall incidence rate of adverse outcomes in fetuses among the groups. The primipara rate in the control group of the third grade was significantly higher than that in the treatment group of the third grade. The treatment group of the second grade (88.7%) had a significantly higher preterm delivery rate than that in the control group of the second grade (66.7%). There were no differences in minimum hemoglobin, and maximum lactate dehydrogenase, alanine aminotransferase, and aspartate aminotransferase levels among the groups and subgroups. CONCLUSION: High-dose glucocorticoids cannot significantly improve maternal and fetal prognoses and laboratory indices. However, our results might offer some clinical evidence for HELLP syndrome therapy.

Effects of particulate matter exposure during pregnancy on birth weight: A retrospective cohort study in Suzhou, China.

BACKGROUND: Recent studies have identified that exposure to particulate matter during pregnancy could result in adverse birth outcomes, but the effects of exposure at trimester-specific intervals are inconsistent. OBJECTIVE: Our primary goal was to investigate whether particulate matter exposure during pregnancy could affect birth weight and gestational age of neonates. METHODS: A retrospective cohort study was conducted to examine the relationship between maternal particulate matter exposure and neonatal birth weight. We collected 14,455 births records linked to hospital admission records (delivery and antenatal) from January 2013 to December 2015 in Suzhou Municipal Hospital. Air monitoring data in the same timeframe were also collected from Suzhou Environmental Protection Agency. The risk of low birth weight due to the exposure to PM2.5 (with median aerodynamic diameter≤2.5µm) and PM10 (with median aerodynamic diameter≤10µm) at each trimester and throughout the entire pregnancy were assessed. Linear regression models were applied and potential confounding factors were adjusted for data analysis. Gestational age, which was another important birth outcome, and its association with maternal particulate matter exposure were also studied. RESULTS: The final analysis included 10,915 singleton live births. Using multiple linear regression models, we found that gestational exposure to PM2.5 and PM10 at 10µg/m3 increments in the second trimester led to decreases in birth weight of 4.94g (95% confidence interval: -9.828, -0.046) and 5.65g (95% confidence interval: -10.110, -1.188), respectively. However, gestational age was not significantly associated with maternal particulate matter exposure in term neonates. CONCLUSION: These findings indicate that pregnant women might be more susceptible to particulate matter during the second trimester which may lead to decreased neonatal birth weight.

A comparison of epidermal growth factor receptor mutation testing methods in different tissue types in non-small cell lung cancer.

The detection of somatic epidermal growth factor receptor (EGFR) mutations is valuable when an appropriate therapy, either EGFR-tyrosine kinase inhibitor (TKI) therapy or chemotherapy, for patients with advanced non-small cell lung cancer (NSCLC) needs to be selected. Although it is well­understood that EGFR mutation detection is significant for the decision­making regarding treatment, no consensus on the methodology that should be the most preferebale for detecting mutations in clinical practice has been reached. The presence of false positives due to the technique carried out for mutation analysis affects the accurate estimation of response EGFR-TKI therapy. Furthermore, false negatives directly exclude the potential application of an EGFR-TKI. In the present study, we present the results of detecting EGFR mutations in individual sample types using three different low- or high-sensitivity techniques. We suggest that the choice of the method used should be made based on the type of the sample. Our results revealed that EGFR mutations were less frequently detected in bronchoscopic biopsies, regardless of the method used. However, the amplification refractory mutation system (ARMS) was optimal owing to the small amount of DNA prepared for biopsy. The cytology sample was a valuable alternative to traditional samples, given that a sensitive method for detecting mutations was used. For surgical resections, the testing method may be selected based on the expertise of each laboratory, but direct sequencing is highly recommended. We also suggest that two methods should be used sequentially (the screening and targeted methods) in clinical practice due to the presence of non-neglected discordance between any method from its own benefits and drawbacks.

Maspin expression is regulated by the non-canonical NF-κB subunit in androgen-insensitive prostate cancer cell lines.

Dysregulation of Maspin expression and constitutive activation of NF-κB subunits are important events in tumorigenesis of prostate cancer. Recent finding points that RelB, which contributes to the alternative NF-κB activity, interferes with carcinogenesis in the prostate. We report here, that both the classical and the alternative NF-κB activities are constitutively present in androgen-insensitive human prostate cancer cells. Maspin and RelB expression is correlated negatively in prostate cancer tissues at the later stage. TNF-α signaling triggers the nuclear accumulation of RelB and the concomitant reduction of Maspin expression in a time-dependent manner. In addition, the proteasome inhibitor-induced Maspin expression is accompanied by the reduction of RelB expression. A successful depletion of RelB expression, but not RelA expression, induces Maspin expression. RelB-deficiency abrogates the proteasome inhibitor-induced Maspin expression. Moreover, we demonstrate that the enforced expression of RelB protein in prostate cancer cells inhibits Maspin expression. We propose that RelB is an essential molecule controlling the endogenous and the proteasome inhibitor-induced Maspin expression. Developing a RelB-targeted therapeutic intervention, which might be coupled with the induction of a tumor suppressor Maspin, is valuable in treating advanced, metastatic prostate cancer.

[Surgical treatment and pathological findings of hematological malignancies patients complicated with lung diseases.].

OBJECTIVE: To determine the pulmonary pathological changes in hematological malignancy patients with pulmonary complications. METHODS: 17 hematological malignancy patients underwent surgical treatment were evaluated retrospectively. The pathological changes of all the surgical specimens were examined postoperatively by standard hematoxylin and eosin (HE) staining. RESULTS: Pathological examination confirmed: aspergillus infection in 9 patients, sub-acute inflammation (fibrosis and hematoma formation) in 3, and each in 1 of pulmonary infarction with granulomatous tissue in the periphery; granulomatous inflammation with calcified tubercle; alveolar dilation and hemorrhage, interstitial fibrosis and focal vasculitis; intercostal neurilemmoma; and moderate-differentiated adenocarcinoma accompanied by intrapulmonary metastasis. And several operative complications (1 case of fungal implantation, 3 pleural effusion and adhesions and 2 pulmonary hematoma) were occurred. The coincidence rate of pre- and post-operative diagnosis was 9/14 (64.3%). After surgery, 8 patients were received hematopoietic stem cell transplantation (HSCT, allo-gene or autologous), with 7 succeeded. On effective secondary antifungal prophylaxis, 4 of 5 patients of aspergillosis succeeded in transplantation with free from mycotic relapse, one patient died from fungal relapse. CONCLUSION: Hematological malignancies with persistent and/or resistant pulmonary infection, hemoptysis, or unexplained lung diseases, should be treated in time by surgery operation to effectively eliminate residual disease and obtain a definitive diagnosis, so as to create a prerequisite condition for the following treatments. Moreover, the secondary antifungal prophylaxis can provide active roles for patients scheduled for chemotherapy and/or HSCT.

[Comparision of HER2/neu oncogene detected by chromogenic in-situ hybridization and immunohistochemistry in breast cancer].

OBJECTIVE: Through comparison of HER2/neu oncogene detected by chromogenic in situ hybridization (CISH) and immunohistochemistry (IHC) in breast cancer, to explore the effect of CISH on detecting gene amplification of HER2. METHODS: Selected formalin-fixed paraffin-embedded breast samples whose pathological types were infiltrating ductal carcinomas (255 retrospective samples, 271 prospective samples), and these samples were detected by IHC and CISH. RESULTS: (1) In the retrospective study, CISH identified gene amplification in 91.6% of IHC score 3+ tumors (120/131) and in 56.5% of IHC score 2+ tumors (39/69), thus the concordant ratio between IHC and CISH was 81.2% (207/255). The two results showed significant correlation (P<0.01). (2) In the prospective study, the ratio of HER2 protein over expression detected by IHC was 31.7%, the ratio of HER2 gene amplification detected by CISH was 27.3%. CISH identified gene amplification in 91.4% of IHC score 3+ tumors (53/58) and in 46.4% of IHC score 2+ tumors (13/28), Concordant ratio between IHC and CISH was 89.7% (243/271). Two results showed significant correlation (P<0.01). (3) Paired CISH/FISH results were concordant in 14 of 15 cases. The remaining case was detected by FISH, but showed no HER2 gene amplification by CISH. (4) The gene amplification by CISH had a significantly reverse correlation with ER and PR expression (P<0.01). CONCLUSIONS: The results of HER2 gene amplification detected by CISH have high concordance with the results detectd by IHC and FISH. CISH is a novel technique for detecting HER2 gene amplification.

[Pathologic and X-ray features of primary malignant fibrous histiocytoma of bone--a report of 16 cases].

BACKGROUND & OBJECTIVE: Malignant fibrous histiocytoma (MFH) is a common soft tissue tumor, which rarely occur in the skeleton. Its histological origin still remains controversial. This study was to investigate the pathologic and X-ray features of primary MFH of bone, and provide reference for imaging diagnosis. METHODS: Clinical data and X-ray images of 16 MFH patients, treated from Jan. 1982 to Jun. 2002 in the First Affiliated Hospital of Soochow University, were analyzed retrospectively. RESULTS: Pathologic manifestations of the patients were malignant multinucleated giant cells, pleomorphic and bizarre form of the tumor cells, and wheel-spoke arrangement of the fibroblast-like cells. Pathologically, the tumor tissue was consisted of various kinds of cells, which were mainly fibroblasts and histiocytes. The principal X-ray manifestations included solitary osteolytic changes, cortical expansion around the tumor, the penetration of the cortex with soft tissue mass formation, slight periosteal reaction and pathologic fracture. CONCLUSION: The diagnosis of MFH mainly depends on pathologic examination and X-ray manifestations.

Expression of survivin and its significance in colorectal cancer.

AIM: To study the expression of survivin, a novel member of inhibitors of apoptosis protein (IAP) and its significance in colorectal carcinoma. METHODS: Survivin mRNA expression was evaluated by semi-quantitative reverse transcriptase polymerase chain reaction (RT-PCR) in 52 colorectal carcinoma samples and 48 adjacent normal colorectal tissue samples. PCR product was sequenced to verify the desired result. Expressions of survivin protein, proliferating cell nuclear antigen labelling index (PI) and apoptotic index (AI) were detected immunohistochemically in 52 human colorectal carcinomas. RESULTS: The expression of survivin mRNA was detected in a significantly greater proportion of colorectal carcinoma samples than in adjacent normal colorectal tissues (67.3% vs 25%; P<0.01). There was no relationship between survivin mRNA expression in colorectal carcinomas and sex, tumor size, histological types, lymphnode metastasis, distant metastasis and Dukes' stage. The PCR product shared 99% of homology with human counterparts. Survivin expression was observed immunohistochemically in 27 of 52 cases of colorectal carcinoma (51.9%). The AI was significantly lower in survivin positive group than in survivin negative group (0.67+/-0.18% vs 1.14+/-0.42%; P<0.001), while the PI was greater in survivin positive group than in survivin negative group (51+/-22% vs 27+/-18%, P<0.001). CONCLUSION: Survivin is a special tumor marker independent of histopathological characteristics. It may play an important role during human colorectal tumorigenesis by inhibiting apoptosis and accelerating proliferative activity of colorectal tumor cells.

[The acute toxic effects of microcystin LR in SD rats].

OBJECTIVE: To assess Microcystin LR (MCLR)-induced acute toxic effects in male Sprague-Dawley rats. METHODS: The rats were injected with MCLR intraperitoneally in different doses for different days. The organs and serum with rats were collected at 1 and 7 days after injection, and 7 days after the final injection (total 14 days). Pathological and enzymatic changes were observed. RESULTS: The rats injected with 122 microg/kg MCLR showed myocardial cells damage including pyknosis, plasma dissolve and myofibrilla (pls check with dictionary) necrosis in the heart muscles after 24 hours. At the same time, the activities of serum glutamate-oxaloacetate transaminase (GOT), lactate dehydrogenase (LDH) and creatine phosphonase (CPK) were higher than these in the other groups (P < 0.01). The kidney was also damaged, kidney cell degeneration, and the increase of blood creatine (BCr) and blood urea nitrogen (BUN) were also seen. In liver pathological study, liver cell hemorrhage, degeneration and/or necrosis was observed. In serum the activities of glutamate-pyruvate transaminase (GPT), alkaline phosphatase (LDH) and GOT were higher than these in the other groups (P < 0.01). CONCLUSION: These results suggested that MCLR can injure the heart, kidney and the liver in SD rats, and there is a dose-response relationship between MCLR and the toxic effect.

[Teratosis and damage of viscera induced by microcystin in SD rat fetuses].

OBJECTIVE: To study the teratogenicity and traumatic effect of microcystin LR (MCLR) on pregnant SD rats and their fetuses. METHODS: Sixty pregnant SD rats were divided into four groups, 16 in each group: three experimental groups in which MCLR was injected into the abdominal cavity at the doses of 4 microgram/kg, 16 microgram/kg, and 62 microgram/kg respectively for 10 days, and control group injected with normal saline. Twenty days after, the pregnant rats were killed. The development, teratosis, and histology of viscera of the fetuses were examined. RESULTS: Deformities were found in the fetuses of the 62 microgram/kg group and 16 microgram/kg group with the teratogenic rate of 11.70 per thousand (2/172) and 6.76 per thousand (1/155). Petechial hemorrhage and severe hydropic degeneration in liver and maldevelopment of glomeruli and renal medulla were found in 62 microgram/kg group. Mild granular degeneration was found in the liver of fetuses in 4 microgram/kg group. CONCLUSION: MCLR passes through the placental barrier and causes damage in kidney and liver, which may be the basis of high incidence of liver cancer microgram in the fetus phase.

[Correlation of invasion, metastasis, and prognosis in low and middle rectal cancer].

BACKGROUND & OBJECTIVE: Several reports have showed that three histologic variables (venous invasion, regional lymph node status, and depth of primary tumor penetration) were associated with the prognosis of colorectal adenocarcinoma patients. Based on these variables, a new classification system has been recommended. This study was designed to evaluate prognostic significance and risk factors of neoplasm in low and middle rectal cancer. METHODS: Four hundreds and eighty-four consecutive patients with low and middle rectal cancer were treated by the abdominoperineal resection (APR) (356 patients) and the low anterior resection(LAR) (128 patients) between 1990 and 1996. To determine the independent prognostic variables, the variables were evaluated both univariately and multivariately from the perspectives of oncologic outcome. RESULTS: The 5-year survival rate for all patients was 71.1% (344/484), 63.5% (226/356) for APR and 92.2% (118/128) for LAR/SSR, respectively (P < 0.01). The resulting multivariate analysis using Cox regression showed that the three tumor variables were significantly associated with the 5-year survival (P < 0.01), the independent prognostic variables included venous invasion, tumor size, and TNM stages. CONCLUSIONS: The three tumor variables identified in multivariate analysis as bearing the strongest independent effect on the 5-year survival in low and middle rectal cancer were (in order to decrease prognostic impact) venous invasion, tumor size, and TNM stages. These three tumor variables may be used as important bases for a new classification system.