Early diagnostic test for acute fatty liver of pregnancy: a retrospective case control study.

BACKGROUND: Early diagnosis is important to lower the mortality rate of acute fatty liver of pregnancy (AFLP). The Swansea criteria is commonly used to diagnose AFLP, but some terms could only be reached when symptoms and signs have progressed, or are not efficient in clinical practice. Therefore, it is necessary to select cost effective tests to simplify and facilitate early suspicion of acute fatty liver of pregnancy. METHODS: This is a retrospective study of 28,800 medical records at the Second Xiangya Hospital from 2009 to 2015, including 41 patients with AFLP and 172 other diseases that could show similar symptoms to AFLP. The evaluated variables included past history of liver diseases, blood pressure, gastrointestinal symptoms, blood count, liver function test, coagulation function test and blood sugar test. The sensitivity, specificity, positive predict value and negative predict value were calculated for models in diagnosing AFLP. RESULTS: The significant variables associated with AFLP included gastrointestinal symptoms, blood pressure > 140/90 mmHg, aminotransferase> 42 IU/l, total bilirubin> 0.8 mg/dl, total bilirubin acid> 10.0 µmol/L, activated partial prothrombin time(APTT) > 34 s, prothrombin time(PT) > 14 s, white blood cells> 11 *106/l and blood sugar< 72 mg/dl. Gastrointestinal symptoms +aminotransferase +bilirubin +bile acid +APTT/PT showed 97.6% sensitivity and 97.1% specificity to diagnose AFLP. Adding blood pressure, blood sugar or white blood cells decreased the accuracy of the statistical model. CONCLUSIONS: Application of a statistical model including maternal symptoms, biochemical and haematological parameters has high diagnostic accuracy for earlier identification of AFLP. However, this finding needs to be tested in another cohort to determine whether this statistical model has the same performance.

[Effect of adipose-derived mesenchymal stem cell transplantation on cyclophosphamide-induced ovarian damage in rats].

OBJECTIVE: To explore the effect of adipose-derived mesenchymal stem cells (ADMSCs) on ovarian damage induced by cyclophosphamide (CTX) and its mechanism.
 Methods: ADMSCs isolated from adipose tissue of female SD rats were cultured and divided into a blank group and a CTX group (n=15 in each group). CTX (75 mg/kg) was injected intraperitoneally to establish a model of ovarian damage in rats. A total of 45 female SD rats were also divided into 3 groups: Group A (15 rats, only injected intraperitoneally with 75 mg/kg CTX diluted with 1 mL 0.9% saline), Group B [15 rats, injected intraperitoneally with 75 mg/kg CTX diluted with 1 mL 0.9% saline, after 4 estrus cycles, injected 0.6 mL ADMSCs (6×105 cells) by the tail vein], and Group C [15 rats, injected intraperitoneally with 75 mg/kg CTX diluted with 1 mL 0.9% saline, after 4 estrus cycles, injected 40 mL ADMSCs (20 mL per side, 2×104 cells) in situ ovarian]. After 4 estrus cycles, the changes of quality of life, ponderal growth were recorded, the sex hormone levels [estradiol (E2), follicle-stimulating hormone (FSH)] were tested by ELISA, and the morphology of ovarian tissue and follicle count were observed by HE staining. The expression of BMP-15, Bcl-2 and Bax in ovarian tissues were tested by immunohistochemistry, real-time PCR or Western blotting. The apoptosis rate of follicular cells was detected by TdT-mediated dUTP nick end labeling (TUNEL) assay.
 Results: After transplantation of ADMSCs, compared with the Group A, their quality of life of rats in the Group B and C was improved, and the ponderal growth was increased (both P<0.01). Compared with the Group A, the serum E2 levels in the Group B and the Group C were increased (P<0.01, P<0.05), and the FSH levels in the Group B and C were decreased (both P<0.01). The granular cell layer, the number of corpus lutein and the count of various grade follicles were significantly increased, and many new follicles and mature oocytes were observed in the Group B and C. Compared with Group A, the count of primitive follicles, sinusoidal follicles, pre-ovulation follicles and total follicles, and pre-sinusoidal follicles were dramatically increased in the Group B. The follicle at all levels count was increased in the Group C than that in the Group A (all P<0.01). Comparing with the Group A, the expressions of BMP-15 and Bcl-2 were increased (all P<0.01), the expressions of Bax was decreased (both P<0.01), and the apoptosis rates of follicular cells were decreased in the Group B and C (both P<0.01). However, there was no difference between the Group B and the Group C in the above indexes (all P>0.05).
 Conclusion: ADMSCs transplantation can effectively repair ovarian damage induced by CTX in rats, which may be achieved by inhibiting mitochondrial apoptosis of granulosa cells.

Serum screening in first trimester to predict pre-eclampsia, small for gestational age and preterm delivery: systematic review and meta-analysis.

BACKGROUND: Early assessment before the establishment of placental dysfunction has the potential to improve treatment and prognosis for clinical practice.The objective of the study is to investigate the accuracy of serum biochemical markers(Pregnancy- Associated Plasma Protein-A (PAPP-A), human Chorionic Gonadotropin (hCG), Placental Growth Factor (PlGF), Placental Protein 13 (PP13) used in first trimester serum screening in predicting preelampsia, small for gestational age (SGA) and preterm delivery. METHODS: The data sources included Medline, Embase, Cochrane library, Medion, hand searching of relevant journals, reference list checking of included articles and contact with experts. Two reviewers independently selected the articles. Two authors independently extracted data on study characteristics, quality and results. RESULTS: The results showed low predictive accuracy overall. For preeclampsia, the best predictor was PlGF; LR + 4.01 (3.74, 4.28), LR-(0.67, 0.64, 0.69). The predictive value of serum markers for early preeclampsia was better than that of late preeclampsia. For SGA the best predictor was PP13; LR+ 3.70 (3.39, 4.03), LR- 0.70 (0.67, 0.73). For preterm delivery, the best predictor was PP13; LR+ 4.16 (2.72, 5.61), LR- 0.56 (0.45, 0.67). CONCLUSION: First trimester screening analytes have low predictive accuracy for pre-eclampsia, small for gestational age and preterm delivery. However, the predict value of first trimester analytes is not worse than that of the second trimester markers.

Elevated serum chemerin in Chinese women with hyperandrogenic PCOS.

OBJECTIVES: To compare serum chemerin levels between women with classic hyperandrogenic PCOS, euandrogenic PCOS and matched control subjects. RESEARCH DESIGN AND METHODS: This study was carried out at the Second XiangYa Hospital between July 2012 and April 2013. Sixty-seven women with PCOS and 20 controls were included. Blood pressure, body mass index (BMI), waist to hip ratio (WHR), fasting insulin, fasting plasma glucose and blood serum hormone and blood lipid were measured. Transvaginal ultrasound was performed. Serum chemerin was measured by ELISA. RESULTS: Serum chemerin was significantly higher in classic hyperandrogenic PCOS compared with euandrogenic PCOS and controls (311.07 ± 141.87 ng/mL versus 228.03 ± 119.66 ng/mL and 225.87 ± 86.44 ng/mL, p < 0.05). Serum chemerin was positively related to follicle count, ovarian volume, the level of testosterone, luteinizing hormone/follicle-stimulating hormone, low-density lipoprotein, triglycerides, fasting blood insulin, insulin resistance by homeostasis model assessment, WHR and BMI, while negatively related to the level of high-density lipoprotein. Multiple linear regression analyses revealed ovarian volumes and WHR were the significant influencing factors of chemerin (p < 0.05). The area under the receiver operating characteristic curve for chemerin reached a value of 0.684 (0.572-0.796, 95% confidence interval). The best compromise between sensitivity (80.0%) and specificity (47.6%) was obtained with a cutoff value of 200.94 ng/mL. CONCLUSIONS: Serum chemerin level was increased in Chinese women with classic hyperandrogenic PCOS. Serum chemerin measurement offers a relatively moderate diagnostic potency with a sensitivity of 80.0% and a specificity of 47.6% at 200.94 ng/mL. This suggested that chemerin may be involved in the development of the metabolic syndrome of classic PCOS.

Anti-ß2 glycoprotein I antibodies and pregnancy outcome in antiphospholipid syndrome.

The relation between pregnancy outcome and single- or double-positivity of anticardiolipin (aCL) and ß2 glycoprotein I (aß2GPI) in antiphospholipid syndrome (APS) has yet to be clearly documented. In this article, a total of 191 lupus anticoagulant-negative pregnant women with primary APS were retrospectively divided into three groups: aCL(+) /aß2GPI(-) ; aCL(+) /aß2GPI(+) ; aCL(-) /aß2GPI(+) . All women had received medical therapy consisting of prednisone (10-15 mg/day), low-dose aspirin (50 mg/day), and low molecular weight heparin (40 mg/day). The miscarriage rate in the double-positive group was significantly higher than that in the aCL(+) /aß2GPI(-) group (46.2% vs. 22.1%, p < 0.05); the miscarriage rate in the aCL(-) /aß2GPI(+) group (36.4%) was not significantly different from the rates of the other two groups (p > 0.05). Thus, double-positivity may be a risk factor for pregnancy loss and aß2GPI antibody may be a better prognostic marker than aCL antibody for pregnancy outcome.

Alcohol intake induces diminished ovarian reserve in childbearing age women.

AIM: To investigate the adverse effects of alcohol on ovarian reserve in women of childbearing age. MATERIAL AND METHODS: Twenty bar hostesses between the ages of 18 and 29 with moderate alcohol consumption for over 3 years and 16 healthy women between the ages of 18 and 28 with alcohol consumption under a healthy standard were recruited. Their ovarian reserve was evaluated by measuring menstrual cycle day three (CD3) serum follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), prolactin (PRL) and testosterone (TST) levels, and by transvaginal B-ultrasound examination of uterine size, ovarian size and number of antral follicles. RESULTS: Moderate consumption of alcohol significantly increased serum FSH level (P=0.001), but had no effect on serum LH, E2, PRL and TST levels. Moderate alcohol consumption significantly decreased ovarian volume (P=0.000) and number of ovarian antral follicles (P=0.015), but had no effect on uterus size. Moderate alcohol consumption significantly increased the occurrence of menstrual flow abnormalities (P=0.001 and P=0.036, respectively), but had no effect on menstrual cycle. The amount of alcohol consumed positively correlated with FSH, and negatively correlated with ovarian volume and number of antral follicles in women with moderate alcohol consumption. CONCLUSION: Long-term moderate alcohol consumption may lead to diminished ovarian reserve.

[Application and evaluation of invasive prenatal diagnostic techniques and analysis of chromosomal karyotype].

OBJECTIVE: To evaluate the safety, effectiveness and complications of serial invasive prenatal diagnostic techniques, and to investigate the prenatal diagnosis indication as well as to analyze the abnormal chromosomal karyotype. METHODS: We retrospectively studied all patients from March 2005 to May 2012 who received amniocentesis and cordocentesis in the prenatal diagnosis center of Second Xiangya Hospital. The indication of the procedure, successful rate and complications were evaluated, and 25 abnormal chromosome nuclear types were analyzed. RESULTS: A total of 669 patients received invasive prenatal diagnosis from March 2005 to May 2012 in Second Xiangya Hospital: 598 received amniocentesis and 71 cordocentesis carried out. Compared with the cordocentesis group, the amniocentesis group had higher achievement ratio (91.54% vs 100%, P<0.05), lower spontaneous abortion rate (1.41% vs 0.33%, P<0.05), fewer abnormal karyotypes (11.27% vs 2.84%, P<0.05) and lower expenditure (880 yuan vs 800 yuan, P<0.05). Positive screening, advanced maternal age, and ultrasonography abnormality were the top 3 indications of amniocentesis and cordocentesis. We found 25 abnormal karyotypes, including 6 cases of trisomy 21, 4 sex chromosomal abnormalities, 7 autosomal balanced translocations, 1 marker chromosome, and 7 mosaics. CONCLUSION: As a widely used invasive prenatal diagnosis, amniocentesis is safe and effective. The complications of cordocentesis are much higher than those of amniocentesis, which is not a proper routine procedure for prenatal diagnosis of abnormal karyotype. The analysis of karyotype not only can identify fetal chromosome abnormality, but also provide the scientific basis for pregnancy continuation, thus reducing the ratio of birth defect.

miR-7 and miR-218 epigenetically control tumor suppressor genes RASSF1A and Claudin-6 by targeting HoxB3 in breast cancer.

Many microRNAs have been implicated as key regulators of cellular growth and differentiation and have been found to dysregulate proliferation in human tumors, including breast cancer. Cancer-linked microRNAs also alter the epigenetic landscape by way of DNA methylation and post-translational modifications of histones. Aberrations in Hox gene expression are important for oncogene or tumor suppressor during abnormal development and malignancy. Although recent studies suggest that HoxB3 is critical in breast cancer, the putative role(s) of microRNAs impinging on HoxB3 is not yet fully understood. In this study, we found that the expression levels of miR-7 and miR-218 were strongly and reversely associated with HoxB3 expression. Stable overexpression of miR-7 and miR-218 was accompanied by reactivation of tumor suppressor genes including RASSF1A and Claudin-6 by means of epigenetic switches in DNA methylation and histone modification, giving rise to inhibition of the cell cycle and clone formation of breast cancer cells. The current study provides a novel link between overexpression of collinear Hox genes and multiple microRNAs in human breast malignancy.

Chronic alcohol administration increases serum prolactin level and pituitary cell proliferation, and alters hypothalamus neurotransmitters in rat.

OBJECTIVES: Alcohol induces hyperprolactinemia in both alcoholic men and women, but the mechanism is not fully established. The aim is to investigate the mechanism involved in elevation of serum prolactin level after chronic alcohol administration. METHODS: In this study, healthy female SD rats were given alcohol for 8 weeks and checked for serum prolactin level by radioimmunoassay. Interior pituitary cell proliferation was determined by immunohistochemistry score of Ki-67, and hypothalamic neurotransmitters were detected by Coulomb HPLC electrochemical array. RESULTS: We demonstrated that serum prolactin level and wet pituitary weight of alcohol-fed rats were significantly increased. Interior pituitary cell proliferation was significantly enhanced; hypothalamic dopamine, 5-HT and GABA levels were reduced while glutamate level was increased by chronic alcohol administration; hypothalamic noradrenalin level remained unchanged. CONCLUSION: Our study suggested that chronic alcohol administration resulted in elevated serum prolactin level in normal SD rats probably through enhancing pituitary gland cell proliferation combined with altered hypothalamic neurotransmitters that regulate prolactin level.

Quantitative proteome analysis of multidrug resistance in human ovarian cancer cell line.

In order to understand the molecular mechanisms of multidrug resistance (MDR) in ovarian cancer, we employed the proteomic approach of isobaric tags for relative and absolute quantification (iTRAQ), followed by LC-MS/MS, using the cisplatin-resistant COC1/DDP cell line and its parental COC1 cell line as a model. A total number of 28 proteins differentially expressed were identified, and then the differential expression levels of partially identified proteins were confirmed by Western blot analysis and/or real-time RT-PCR. Furthermore, the association of PKM2 and HSPD1, two differentially expressed proteins, with MDR were analyzed, and the results showed that they could contribute considerably to the cisplatin resistance in ovarian cancer cell. The differential expression proteins could be classified into eight categories based on their functions, that is, calcium binding proteins, chaperones, extracellular matrix, proteins involved in drug detoxification or repair of DNA damage, metabolic enzymes, transcription factor, proteins related to cellular structure and proteins relative to signal transduction. These data will be valuable for further study of the mechanisms of MDR in the ovarian cancer.

The association between prepregnancy maternal body mass index and preterm delivery.

We investigated the association between prepregnancy maternal body mass index (BMI) and preterm delivery (PTD). The study included 44,421 American women presenting for care in Saint Louis, Missouri between 1990 and 2006. Only singleton gestations were included. The authors examined the associations between categories of BMI with PTD <37 and <34 weeks, respectively. A stratified analysis by subtypes of PTD was also performed. The subtypes of PTD evaluated included spontaneous PTD without preterm premature rupture of membranes (PPROM), PPROM, and indicated PTD. Univariate and multivariable analyses were used to estimate the association between maternal BMI categories and PTD <37 weeks, PTD <34 weeks, and subtypes of PTD. Among women meeting the inclusion criteria, PTD <37 occurred in 4783 (10.8%) and PTD <34 weeks in 1132 (2.5%). Being underweight was associated with increased risks of PTD <37 weeks (adjusted odd ratio [OR] = 1.3, 95% confidence interval [CI]: 1.2, 1.5). Being obese was associated with decreased risks of spontaneous PTD without PPROM <37 weeks (adjusted OR = 0.8, 95% CI: 0.7, 0.9) and increased risk of PPROM <37 weeks (adjusted OR = 1.3, 95% CI: 1.1, 1.6) and PPROM <34 weeks (adjusted OR = 1.4, 95% CI: 1.0, 2.0). Prepregnancy obesity increases the risk of PPROM and decreases risk of spontaneous PTD without PPROM.

Glucocorticoid or androgen for autoimmune premature ovary failure in mice.

OBJECTIVE: Using mouse autoimmune premature ovary failure (POF) model to seek theoretical evidence for a possible clinical therapy of autoimmune POF with glucocorticoid (GC) or androgen. METHODS: After autoimmune POF was induced in 60 mice by Pzp3, the mice were randomly assigned into 3 groups (n=20): Two groups were treated with GC or androgen and the control group was treated with distilled water. We observed the changes in the sexual cycles of the mice, the serum level of AzpAb, infiltration of cells positively expressing CD45 in the ovary, and pathological alterations of the ovary. RESULTS: The sexual cycle of each therapy group was significantly different from that of the control group. The mean serum level of AzpAb of each therapy group was significantly lower than that of the control group, and the mean serum level of AzpAb in the GC group was significantly higher than that of the androgen group. The percentage of growing follicles in the ovary of each therapy group was significantly higher than that of the control group.Ovaries infiltrated by cells positively expressing CD45 of each therapy group were significantly fewer than those of the control group. CONCLUSION: GC or androgen in mice with autoimmune POF could obviously ameliorate the pathogenetic conditions of the disorder, and both treatments have similar therapeutic efficacy.

Differential microRNA expression profile in the plasma of preeclampsia and normal pregnancies.

Preeclampsia is a common disease in pregnant women that can only be diagnosed from 20 weeks after fertilization. Developing early diagnosis markers is urgent and would be helpful in selecting appropriate treatment strategies. The present study aimed to identify the differential expression profiles of microRNAs in the plasma between patients with preeclampsia and normal pregnancies using microarray methods. Using quantitative polymerase chain reaction (qPCR), the differentially expressed microRNAs (miRNAs or miRs) identified from the microarray analysis were validated. A total of 3 miRNAs, including hsa-miR-1304-5p, hsa-miR-320a and hsa-miR-5002-5p, were upregulated in the plasma of patients with preeclampsia pregnancies. Examination of the functions of these miRNAs demonstrated that they were involved in cell proliferation, indicating that preeclampsia affected this pathway. In addition, 26 downregulated miRNAs were identified by microarray methods. The functions of these miRNAs included immune regulation, vascular development, cancer pathology and pathology of other disease (tuberculosis, oligozoospermia, psoriasis and Alzheimer's disease). Using qPCR, the most differentially expressed miRNAs were confirmed to be hsa-miR-1304-5p, hsa-miR-320a and hsa-miR-5002-5p, which were upregulated, as well as hsa-miR-188-3p, hsa-miR-211-5p, hiv1-miR-TAR-3p, hsa-miR-4432 and hsa-miR-4498 that were significantly downregulated in the plasma of preeclampsia patients. The present findings may be useful in the development of early diagnosis markers and treatment targets for preeclampsia.

Identification of Potential Biomarkers for Urine Metabolomics of Polycystic Ovary Syndrome Based on Gas Chromatography-Mass Spectrometry.

BACKGROUND: Polycystic ovary syndrome (PCOS) is a complex endocrine and metabolic disorder, and it's diagnosis is difficult. The aim of this study was to investigate the metabolic profiles of PCOS patients by analyzing urine samples and identify useful biomarkers for diagnosis of PCOS. METHODS: This study was carried out in the Department of Obstetrics and Gynecology of the Maternal and Child Health Hospital of Hunan Province from December 2014 to July 2016. In this study, the urine samples of 21 women with PCOS and 16 healthy controls were assessed through gas chromatography-mass spectrometry to investigate the urine metabolite characteristics of PCOS and identify useful biomarkers for the diagnosis of this disorder. The Student's t-test and rank sum test were applied to validate the statistical significance of the between the two groups. RESULTS: In total, 35 urine metabolites were found to be significantly different between the PCOS patients and the controls. In particular, a significant increase in the levels of lactose (10.01 [0,13.99] mmol/mol creatinine vs. 2.35 [0.16, 3.26] mmol/mol creatinine, P = 0.042), stearic acid (2.35 [1.47, 3.14] mmol/mol creatinine vs. 0.05 [0, 0.14] mmol/mol creatinine, P < 0.001), and palmitic acid (2.13 [1.07, 2.79] mmol/mol creatinine vs. 0 [0, 0] mmol/mol creatinine, P < 0.001) and a decrease in the levels of succinic acid (0 [0, 0] mmol/mol creatinine vs. 38.94 [4.16, 51.30] mmol/mol creatinine, P < 0.001) were found in the PCOS patients compared with the controls. It was possible to cluster the PCOS patients and the healthy controls into two distinct regions based on a principal component analysis model. Of the differentially expressed metabolites, four compounds, including stearic acid, palmitic acid, benzoylglycine, and threonine, were selected as potential biomarkers. CONCLUSIONS: This study offers new insight into the pathogenesis of PCOS, and the discriminating urine metabolites may provide a prospect for the diagnosis of PCOS.

[Characteristics of blood dynamic parameters in pregnant women with anticardiolipin antibodies and history of adversely pregnant complications].

OBJECTIVE: To study the characteristics of blood dynamic parameters in pregnant women with anticardiolipin antibody (aCL) and a history of adversely pregnant complications. METHODS: The study included a prospective cohort of pregnant women with (272 cases) and without (186 cases) aCL. Among the aCL positive pregnant women, 91 cases had the history of adversely pregnant complications including spontaneous abortion, still fetus. Serum antibodies to cardiolipin (CL) were measured by a specific enzyme linked immunosorbent assay. Blood dynamics parameters were measured by non-invasive cardiovascular parameters surveyor (TP-CBS). RESULTS: The women were divided into three groups: group A (91 cases)included women with both the history of adversely pregnant complications and positive aCL, group B (181 cases) with positive aCL alone and group C (186 cases) without either of them. In group A maximum blood viscosity (Vmax) was (4.7 +/- 0.5) mPa x s and in group B it was (4.6 +/- 0.7) mPa x s. Both was higher than normal. In group B the Vmax was higher (P < 0.05) than in group C [(4.4 +/- 0.4) mPa x s]. The wave form coefficient(K) was different in three groups: group A was 0.41 +/- 0.04, group B was 0.39 +/- 0.05 and group C was 0.39 +/- 0.04. In group A their wave form coefficient was higher than in group B (P < 0.05). Their total peripheral resistance (TPR) was higher (P < 0.05) in group A [(1.3 +/- 0.4) mm Hg x s x ml(-1)] than in group B [(1.2 +/- 0.4) mm Hg x s x ml(-1)]. The cardiac index (CI) was in group A [(43 +/- 15) ml/(s x m(2))], in group B [(48 +/- 16) ml/(s x m(2))] and in group C [(48 +/- 14) ml/(s x m(2))], lower in group A than in group B (P < 0.05). CONCLUSIONS: An important change of blood dynamic parameters of pregnant women with aCL is the increase of Vmax. If Vmax, K and TPR were increased and CI was decreased simultaneously in women with aCL, it would result in more chances of adversely pregnant complications. Measuring the blood dynamics parameters will help us discover the sub-clinical hypercoagulable state of patients with aCL and guide us to treat them promptly, so that to improve successful pregnancy rate.

[Management of heart failure and timing of delivery in pregnancy].

OBJECTIVE: To explore the management of heart failure, the timing of delivery in pregnancy, and the influence on pregnant prognosis. METHODS: We retrospectively analyzed the incidence of heart failure, treatment results, pattern of termination, and time of termination in 356 cases of pregnancy with heart disease. RESULTS: One hundred and thirty-six (38.20%) cases were diagnosed as heart failure and 76 (55.88%) were moderate or severe heart failure. Heart failure tends to occur more easily in rheumatic heart diseases than in congenital heart diseases. Heart failure occurred more frequently in pregnancy with rheumatic heart diseases without the heart operation before pregnancy than that of pregnancy with congenital heart diseases. The occurence of the moderate and severe heart failure in pregnancy decreased in rheumatic heart diseases with surgical therapies compared with those without surgical therapies (P <0.05). Compared with pregnancy with heart failure controlled inadequately, pregnancy with effectively controlled heart failure had better tolerance during delivery and through the pregnancy, and puerperium. CONCLUSION: Congenital heart diseases and rheumatic heart diseases are the chief causes of heart failure during the gestation. Therapy before pregnancy, especially surgery to the rheumatic heart diseases, may improve the cardiac function during pregnancy. Monitoring heart function and selecting the proper timing to terminate pregnancy after controlling the heart failure in late pregnant period will be helpful to improve the prognosis of pregnant and perineonate.

A rare occurrence of a malignant ovarian steroid cell tumor not otherwise specified: A case report and literature review.

Steroid cell tumors not otherwise specified (NOS) are a rare subgroup of sex cord-stromal tumors. The tumors can occur at any age, although the mean age of occurrence is 43 years old. The majority are benign, but have the capability of producing one or more steroids associated with virilization. The present study reports the case of a 29-year-old female who presented to the Second Xiangya Hospital suffering from lower back and leg pain that had persisted for five months. The patient had regular menstrual cycles and no virilization symptoms were present. Laboratory investigations revealed normal hormone levels. Multiple areas of bone destruction and a right ovarian mass were confirmed via positron emission tomography/computed tomography. The patient underwent an exploratory laparotomy, and a mass measuring ~6 cm in diameter was subsequently identified in the right ovary. A right salpingo-oophorectomy and pelvic washings for cytology were performed. Histopathological studies confirmed the diagnosis of a malignant steroid cell tumor NOS of the right ovary. The patient underwent eight cycles of chemotherapy (docetaxel, 120 mg and nedaplatin, 80 mg). The patient continued to have relatively good health, with no deterioration of the condition for one year and a half, however, the disease progressed and the patient succumbed to brain metastases six months later.

Characterization of the microRNA expression profile of cervical squamous cell carcinoma metastases.

OBJECTIVES: MicroRNAs (miRNAs) are important regulators of many physiological and pathological processes, including tumorigenesis and metastasis. In this study, we sought to determine the underlying molecular mechanisms of metastatic cervical carcinoma by performing miRNA profiling. METHODS: Tissue samples were collected from ten cervical squamous cancer patients who underwent hysterectomy and pelvic lymph node (PLN) dissection in our hospital, including four PLN-positive (metastatic) cases and six PLN-negative (non-metastatic) cases. A miRNA microarray platform with 1223 probes was used to determine the miRNA expression profiles of these two tissue types and case groups. MiRNAs having at least 4-fold differential expression between PLN-positive and PLN-negative cervical cancer tissues were bioinformatically analyzed for target gene prediction. MiRNAs with tumor-associated target genes were validated by quantitative reverse transcription-polymerase chain reaction (RT-PCR). RESULTS: Thirty-nine miRNAs were differentially expressed (>4-fold) between the PLN-positive and PLN-negative groups, of which, 22 were up-regulated and 17 were down-regulated. Sixty-nine percent of the miRNAs (27/39) had tumor-associated target genes, and the expression levels of six of those (miR-126, miR-96, miR-144, miR-657, miR-490-5p, and miR-323-3p) were confirmed by quantitative (q)RT-PCR. CONCLUSIONS: Six MiRNAs with predicted tumor-associated target genes encoding proteins that are known to be involved in cell adhesion, cytoskeletal remodeling, cell proliferation, cell migration, and apoptosis were identified. These findings suggest that a panel of miRNAs may regulate multiple and various steps of the metastasis cascade by targeting metastasis-associated genes. Since these six miRNAs are predicted to target tumor-associated genes, it is likely that they contribute to the metastatic potential of cervical cancer and may aid in prognosis or molecular therapy.

Effect of prednisone, aspirin, low molecular weight heparin and intravenous immunoglobulin on outcome of pregnancy in women with antiphospholipid syndrome.

The aim of this study was to evaluate the effect of traditional treatment (prednisone and aspirin) and comprehensive treatment [prednisone, aspirin, low molecular weight heparin (LMWH) and IVIg] on the pregnancy outcome, obstetric complications and fetal outcome in women with antiphospholipid syndrome (APS). In the present trial, we observed and evaluated 129 women with APS. Eighty-seven patients received traditional treatment and 42 patients received comprehensive treatment. In the traditional treatment group and comprehensive treatment group, the live birth rate was 83.91 and 97.62% (P<0.05), respectively, and the obstetric morbidity was 22.99 and 7.14% (P<0.05), respectively. The neonatal weight in the comprehensive treatment group was increased compared with the traditional treatment group (P<0.05), however, no differences were found in gestational age at delivery or preterm labor. Comprehensive treatment improved the result of gestation and reduced obstetric complications, and is a more effective treatment for APS than the traditional method using prednisone and aspirin.

Low expression of mixed lineage kinase domain-like protein is associated with poor prognosis in ovarian cancer patients.

BACKGROUND: Mixed lineage kinase domain-like protein (MLKL) was initially identified as a key receptor interacting protein 3 downstream component of tumor-necrosis-factor-induced necrosis. In this study, we characterized the expression of MLKL in ovarian carcinomas and evaluated the prognostic value of MLKL in patients with ovarian cancer. MATERIALS AND METHODS: The ovarian cancer tissue specimens were collected from 153 patients diagnosed as primary ovarian cancer after operation at The Second Xiangya Hospital from January 2005 to December 2008. Immunohistochemistry was performed for MLKL and the protein expression score was quantified using an established scoring system. Kaplan-Meier survival curves were generated for disease-free survival (DFS) and overall survival (OS) for all patients. MLKL expression levels were correlated with DFS and OS using univariate and multivariate Cox regression analysis. RESULTS: Seventy-five patients (49%) were defined as having high MLKL expression and 67 patients (43.7%) had >80% of cells staining for MLKL. Remarkably, low MLKL expression was significantly associated with decreased DFS (median 40 months versus 25 months, P=0.0282) and OS (median 43 months versus 28 months, P=0.0032). In multivariate analysis, retained significance was also observed. CONCLUSION: Low MLKL expression was significantly associated with both decreased DFS and OS in patients with primary ovarian cancer. MLKL expression may serve as a potential prognostic marker in patients with ovarian cancer.