Ciprofloxacin Accelerates Angiotensin-II-Induced Vascular Smooth Muscle Cells Senescence Through Modulating AMPK/ROS pathway in Aortic Aneurysm and Dissection.

Aortic aneurysm and dissection (AAD) is a cardiovascular disease that poses a severe threat to life and has high morbidity and mortality rates. Clinical and animal-based studies have irrefutably shown that fluoroquinolones, a commonly prescribed antibiotic for treating infections, significantly increase the risk of AAD. Despite this, the precise mechanism by which fluoroquinolones cause AAD remains unclear. Therefore, this study aims to investigate the molecular mechanism and role of Ciprofloxacin definitively-a type of fluoroquinolone antibiotic-in the progression of AAD. Aortic transcriptome data were collected from GEO datasets to detect the genes and pathways expressed differently between healthy donors and AAD patients. Human primary Vascular Smooth Muscle Cells (VSMCs) were isolated from the aorta. After 72 h of exposure to 110ug/ml Ciprofloxacin or 100 nmol/L AngII, either or combined, the senescent cells were identified through SA-ß-gal staining. MitoTracker staining was used to examine the morphology of mitochondria in each group. Cellular Reactive Oxygen Species (ROS) levels were measured using MitoSox and DCFH-DA staining. Western blot assay was performed to detect the protein expression level. We conducted an analysis of transcriptome data from both healthy donors and patients with AAD and found that there were significant changes in cellular senescence-related signaling pathways in the latter group. We then isolated and identified human primary VSMCs from healthy donors (control-VSMCs) and patients' (AAD-VSMCs) aortic tissue, respectively. We found that VSMCs from patients exhibited senescent phenotype as compared to control-VSMCs. The higher levels of p21 and p16 and elevated SA-ß-gal activity demonstrated this. We also found that pretreatment with Ciprofloxacin promoted angiotensin-II-induced cellular senescence in control-VSMCs. This was evidenced by increased SA-ß-gal activity, decreased cell proliferation, and elevation of p21 and p16 protein levels. Additionally, we found that Angiotensin-II (AngII) induced VSMC senescence by promoting ROS generation. We used DCFH-DA and mitoSOX staining to identify that Ciprofloxacin and AngII pretreatment further elevated ROS levels than the vehicle or alone group. Furthermore, JC-1 staining showed that mitochondrial membrane potential significantly declined in the Ciprofloxacin and AngII combination group compared to others. Compared to the other three groups, pretreatment of Ciprofloxacin plus AngII could further induce mitochondrial fission, demonstrated by mitoTracker staining and western blotting assay. Mechanistically, we found that Ciprofloxacin impaired the balance of mitochondrial fission and fusion dynamics in VSMCs by suppressing the phosphorylation of AMPK signaling. This caused mitochondrial dysfunction and ROS generation, thereby elevating AngII-induced cellular senescence. However, treatment with the AMPK activator partially alleviated those effects. Our data indicate that Ciprofloxacin may accelerate AngII-induced VSMC senescence through modulating AMPK/ROS signaling and, subsequently, hasten the progression of AAD.

Inducing aortic aneurysm/dissection in zebrafish: evaluating the efficacy of ß-Aminopropionic Nitrile as a model.

Aortic aneurysm/dissection (AAD) poses a life-threatening cardiovascular emergency with complex mechanisms and a notably high mortality rate. Zebrafish (Danio rerio) serve as valuable models for AAD due to the conservation of their three-layered arterial structure and genome with that of humans. However, the existing studies have predominantly focused on larval zebrafish, leaving a gap in our understanding of adult zebrafish. In this study, we utilized ß-Aminopropionic Nitrile (BAPN) impregnation to induce AAD in both larval and adult zebrafish. Following induction, larval zebrafish exhibited a 28% widening of the dorsal aortic diameter (p < 0.0004, n = 10) and aortic arch malformations, with a high malformation rate of 75% (6/8). Conversely, adult zebrafish showed a 41.67% (5/12) mortality rate 22 days post-induction. At this time point, the dorsal aortic area had expanded by 2.46 times (p < 0.009), and the vessel wall demonstrated significant thickening (8.22 ± 2.23 µM vs. 26.38 ± 10.74 µM, p < 0.05). Pathological analysis revealed disruptions in the smooth muscle layer, contributing to a 58.33% aneurysm rate. Moreover, the expression levels of acta2, tagln, cnn1a, and cnn1b were decreased, indicating a weakened contractile phenotype. Transcriptome sequencing showed a significant overlap between the molecular features of zebrafish tissues post-BAPN treatment and those of AAD patients. Our findings present a straightforward and practical method for generating AAD models in both larval and adult zebrafish using BAPN.

Transcriptome analysis reveals therapeutic potential of NAMPT in protecting against abdominal aortic aneurysm in human and mouse.

Abdominal Aortic Aneurysm (AAA) is a life-threatening vascular disease characterized by the weakening and ballooning of the abdominal aorta, which has no effective therapeutic approaches due to unclear molecular mechanisms. Using single-cell RNA sequencing, we analyzed the molecular profile of individual cells within control and AAA abdominal aortas. We found cellular heterogeneity, with increased plasmacytoid dendritic cells and reduced endothelial cells and vascular smooth muscle cells (VSMCs) in AAA. Up-regulated genes in AAA were associated with muscle tissue development and apoptosis. Genes controlling VSMCs aberrant switch from contractile to synthetic phenotype were significantly enriched in AAA. Additionally, VSMCs in AAA exhibited cell senescence and impaired oxidative phosphorylation. Similar observations were made in a mouse model of AAA induced by Angiotensin II, further affirming the relevance of our findings to human AAA. The concurrence of gene expression changes between human and mouse highlighted the impairment of oxidative phosphorylation as a potential target for intervention. Nicotinamide phosphoribosyltransferase (NAMPT, also named VISFATIN) signaling emerged as a signature event in AAA. NAMPT was significantly downregulated in AAA. NAMPT-extracellular vesicles (EVs) derived from mesenchymal stem cells restored NAMPT levels, and offered protection against AAA. Furthermore, NAMPT-EVs not only repressed injuries, such as cell senescence and DNA damage, but also rescued impairments of oxidative phosphorylation in both mouse and human AAA models, suggesting NAMPT supplementation as a potential therapeutic approach for AAA treatment. These findings shed light on the cellular heterogeneity and injuries in AAA, and offered promising therapeutic intervention for AAA treatment.

Cardiopulmonary prognosis of prophylactic endotracheal intubation in patients with upper gastrointestinal bleeding undergoing endoscopy.

BACKGROUND: It is controversial whether prophylactic endotracheal intubation (PEI) protects the airway before endoscopy in critically ill patients with upper gastrointestinal bleeding (UGIB). The study aimed to explore the predictive value of PEI for cardiopulmonary outcomes and identify high-risk patients with UGIB undergoing endoscopy. METHODS: Patients undergoing endoscopy for UGIB were retrospectively enrolled in the eICU Collaborative Research Database (eICU-CRD). The composite cardiopulmonary outcomes included aspiration, pneumonia, pulmonary edema, shock or hypotension, cardiac arrest, myocardial infarction, and arrhythmia. The incidence of cardiopulmonary outcomes within 48 h after endoscopy was compared between the PEI and non-PEI groups. Logistic regression analyses and propensity score matching analyses were performed to estimate effects of PEI on cardiopulmonary outcomes. Moreover, restricted cubic spline plots were used to assess for any threshold effects in the association between baseline variables and risk of cardiopulmonary outcomes (yes/no) in the PEI group. RESULTS: A total of 946 patients were divided into the PEI group (108/946, 11.4%) and the non-PEI group (838/946, 88.6%). After propensity score matching, the PEI group (n=50) had a higher incidence of cardiopulmonary outcomes (58.0% vs. 30.3%, P=0.001). PEI was a risk factor for cardiopulmonary outcomes after adjusting for confounders (odds ratio [OR] 3.176, 95% confidence interval [95% CI] 1.567-6.438, P=0.001). The subgroup analysis indicated the similar results. A shock index >0.77 was a predictor for cardiopulmonary outcomes in patients undergoing PEI (P=0.015). The probability of cardiopulmonary outcomes in the PEI group depended on the Charlson Comorbidity Index (OR 1.465, 95% CI 1.079-1.989, P=0.014) and shock index >0.77 (compared with shock index ≤0.77 [OR 2.981, 95% CI 1.186-7.492, P=0.020, AUC=0.764]). CONCLUSION: PEI may be associated with cardiopulmonary outcomes in elderly and critically ill patients with UGIB undergoing endoscopy. Furthermore, a shock index greater than 0.77 could be used as a predictor of a worse prognosis in patients undergoing PEI.

Aortic size distribution among normal, hypertension, bicuspid, and Marfan populations.

Aims: Large-scale investigations on ascending aortic diameter, especially in the Asian population, are lacking. Furthermore, relevant evidence regarding the distribution of hypertension (HP), bicuspid aortic valve (BAV), and Marfan syndrome (MFS) is scarce. We aimed to examine the distribution of ascending aortic diameter in these populations in China. Methods and results: The data of a total number of 698 795 individuals who underwent cardiac ultrasound were subjected to retrospective analysis. After screening, 647 087 individuals were included in the final analysis. In the normal population, the mean ascending aortic diameter was 28.1 ± 3.2 mm (27.2 ± 3.1 mm in women vs. 29.0 ± 3.1 mm in men) (P < 0.001). Aortic diameter increased gradually with age (P < 0.001). The prevalence of aortic dilation, aneurysm, and dissection in individuals with HP was 12.83%, 2.70%, and 4.77%, respectively. In individuals with MFS, the corresponding rates were 43.92%, 35.31%, and 26.11%. Notably, although BAV patients had high incidences of aortic dilation (37.00%) and aortic aneurysm (16.46%), the incidence of aortic dissection was relatively low (0.74%). Most cases of aortic dissection occurred at an aortic diameter of less than 55 mm. However, in the overall population, the incidence of aortic dissection significantly increased with the increase in the aortic diameter, revealing the existence of an 'aortic paradox'. Conclusions: (i) The ascending diameter increases with age and is larger in men than in women; (ii) 'Aortic paradox' is explained; (iii) BAV bears a high rate of aortic dilation, but a low incidence of aortic dissection.

Giant fetal lymphangioma at chest wall and prognosis: case report and literature review.

OBJECTIVE: To report a rare liveborn case with a giant, septated, chest wall lymphangioma that underwent prenatal expectation treatment. CASE REPORT: A case of giant fetal chest wall cystic lymphangioma was diagnosed prenatally at 19 weeks gestation. Expectation treatment was performed, carefully after prenatal counseling, ruling out other structural abnormalities. At 38 weeks gestation, ultrasound showed a multilocular, subcutaneous cystic mass of 12.3 cm × 9.2 cm × 11.0 cm located on the left chest wall and left upper arm. The tumor was surgically removed 4 days after birth, and no recurrence was observed in the following 18 months. CONCLUSION: Our experience suggests that a large, septated fetal lymphangioma may still merit prenatal expectation treatment if there is no evidence for chromosomal and structural abnormality.

The changes in maternal mortality in 1000 counties in mid-Western China by a government-initiated intervention.

BACKGROUND: Since 2000, the Chinese government has implemented an intervention program to reduce maternal mortality and eliminate neonatal tetanus in accordance with the Millennium Development Goals 5. To assess the effectiveness of this intervention program, we analyzed the level, trend and reasons defining the maternal mortality ratio (MMR) in the 1,000 priority counties before and after implementation of the intervention between 1999 and 2007. METHODOLOGY/PRINCIPAL FINDINGS: The data was obtained from the National Maternal and Child Health Routine Reporting System. The intervention included providing basic and emergency obstetric equipment and supplies to local medical hospitals, and also included providing professional training to local obstetric doctors, development of obstetric emergency centers and "green channel" express referral networks, reducing or waiving the cost of hospital delivery, and conducting community health education. Based on the initiation time of the intervention and the level of poverty, 1,000 counties, containing a total population of 300 million, were categorized into three groups. MMR significantly decreased by about 50%, with an average reduction rate of 9.24%, 16.06%, and 18.61% per year in the three county groups, respectively. The hospital delivery rate significantly increased. Obstetric hemorrhage was the leading cause of maternal deaths and significantly declined, with an average decrease in the MMR of 11.25%, 18.03%, and 24.90% per year, respectively. The magnitude of the MMR, the average reduction rate of the MMR, and the occurrence of the leading causes of death were closely associated with the percentage of poverty. CONCLUSIONS/SIGNIFICANCE: The intervention program implemented by the Chinese government has significantly reduced the MMR in mid-western China, suggesting that well-targeted interventions could be an efficient strategy to reducing MMR in resource-poor areas. Reduction of the MMR not only depends on conducting proven interventions, but also relies on economic development in rural areas with a high burden of maternal death.

Uterine packing during cesarean section in the management of intractable hemorrhage in central placenta previa.

OBJECTIVE: To determine the safety and effectiveness of uterine packing in the management of intractable hemorrhage during cesarean section for central placenta previa. METHODS: This retrospective study was conducted on 70 pregnant women with central placenta previa from May 2005 to March 2010. Patients with uterine packing in the control of massive hemorrhage during cesarean section were identified. The indications, uterine packing procedures, estimated blood loss, postoperative complications, and packing material used were reviewed. RESULTS: A total of 70 patients were identified among 1,121 women with placenta previa during the study period. Sixty-five cases were successful in the control of intraoperative bleeding using uterine packing. Two patients with severe placenta accreta had hemorrhage during cesarean section, and packing with gauze in the uterine cavity was not able to control the bleeding, thereby resulting in cesarean hysterectomy. One case demonstrated failure in packing because of disseminated intravascular coagulation occurring before hospital admission. The remaining two patients had massive vaginal bleeding after uterine packing in cesarean section and underwent laparotomy or hysterectomy 4 h postoperative. CONCLUSION: Uterine packing is a safe and effective technique in the control of intractable hemorrhage in cesarean section. It is a reasonable alternative to further surgical intervention in patients with intractable obstetric hemorrhage, especially in developing countries.

[Relationship between the levels of maternal serum sTNFR II and the mRNA expression of placental TNFR II in preterm labor with chorioamnionitis and polymorphism in -196 site of tumor necrosis factor-beta receptor II].

OBJECTIVE: To investigate the role of Tumor necrosis factor receptor II (TNFR II) in preterm labor with chorioamnionitis and their gene polymorphisms in genetic susceptibility to preterm labor with chorioamnionitis in Chengdu. METHODS: We collected 46 cases maternal serum and partial placental tissues of preterm labor (21 cases of infectious group with chorioamnionitis, 25 cases of noninfectious group without chorioamnionitis), and 50 cases maternal serum and 20 cases placental tissues of term labor in corresponding period. TNFR II mRNA in placental tissue were tested by RT-PCR, maternal serum levels of sTNFR II were measured by ELISA. According to preliminary studies on TNFR II -196 site of the gene type, we analyze the sites of different genotypes in patients with premature placental TNFR II mRNA and maternal blood levels of sTNFR II difference, and with different genotypes chorioamnionitis relevance. RESULTS: In patients with preterm labor, the results of placental TNFR II mRNA and serum sTNFR II were no statistically significant higher in TG (GG) than in TT (P > 0.05). The levels of maternal serum sTNFR II and the mRNA expression of placental TNFR II in preterm labor with chorioamnionitis were significantly higher than those of preterm labor without chorioamnionitis and term labor (P < 0.05). There were no significant difference between term labor and preterm labor without chorioamnionitis (P > 0.05). Close correlation was observed between the different genotypes and the chorioamnionitis (chi2 = 11.088, P<0.05). The odds ratio (OR)for TG + GG genotype was 12.65, 95 CI 2.359-67.848, with more than 12.65 times probability of chorioamnionitis than that of TT genotype group. CONCLUSION: It suggested that TNFR II -196 polymorphism might not play a role by affecting TNFR II production in preterm labor. The site polymorphism is associated with higher serum sTNFR II and placenta TNFR II mRNA expression in patient with chorioamnionitis. It can be a useful marker for early prediction and diagnosis of preterm labor with chorioamnionitis.

Determination of cardiac reserve in preterm infants.

We aimed in this study to determine the cardiac reserve in preterm infants with phonocardiogram. One hundred and fifty-four preterm infants participated in this study. The ratio of the first heart sound to the second heart sound (S1/S2), the ratio of diastolic to systolic duration (D/S) and the cardiac contractility change trend after stimulation (CCCTS) were measured in all infants. The preterm neonatal S1/S2 decreased with increasing gestational age, but the differences between each gestational stage were not significant (p > 0.05), while the D/S significantly increased with increasing gestational age (p < 0.05). After crying induced by vaccination, the D/S was significantly lower than that in quiet state at each gestational stage (p < 0.05). The CCCTS increased with increasing gestational weeks, but the differences between each gestational stage were not significant (p > 0.05).

Clinical analysis of 828 cases of iatrogenic preterm births.

AIM: To investigate the incidence, causes and delivery methods of iatrogenic preterm births. MATERIAL & METHODS: A retrospective study was conducted to review a cohort of preterm birth records to learn the incidence, causes and delivery methods of 828 iatrogenic preterm births from January 2004 to June 2007. The chi-squared and two tailed Student's t-test were used for statistical analysis. RESULTS: During the 3.5-year study period, the total incidence of iatrogenic preterm birth was 6.4%, accounting for 49.8% of the total recorded preterm births. Specifically, the proportion of iatrogenic preterm births to the total recorded preterm births in 2005 was 51.9%, the highest during the study. The top three etiologies of iatrogenic preterm birth were intrahepatic cholestasis of pregnancy, hemorrhage and hypertensive disorder complicating pregnancy. Among the preterm births studied, 62 pregnancies delivered prior to term were for no recorded indications. Seven hundred and twenty-nine iatrogenic preterm births underwent cesarean section. CONCLUSIONS: Iatrogenic preterm birth has become the main reason for preterm births and no recorded indications have become one cause of it. Cesarean delivery was the main delivery method among iatrogenic preterm births. Obstetricians should choose the delivery method strictly.

Preventable maternal mortality: geographic/rural-urban differences and associated factors from the population-based Maternal Mortality Surveillance System in China.

BACKGROUND: Most maternal deaths in developing countries can be prevented. China is among the 13 countries with the most maternal deaths; however, there has been a marked decrease in the maternal mortality ratio (MMR) over the last 3 decades. China's reduction in the MMR has contributed significantly to the global decline of the MMR. This study examined the geographic and rural-urban differences, time trends and related factors in preventable maternal deaths in China during 1996-2005, with the aim of providing reliable evidence for effective interventions. METHODS: Data were retrieved from the population-based maternal mortality surveillance system in China. Each death was reviewed by three committees to determine whether it was avoidable. The preventable maternal mortality ratio (PMMR), the ratios of PMMR (risk ratio, RR) and 95% confidence intervals (CI) were used to analyze regional disparities (coastal, inland and remote regions) and rural-urban variations. Time trends in the MMR, along with underlying causes and associated factors of death, were also analysed. RESULTS: Overall, 86.1% of maternal mortality was preventable. The RR of preventable maternal mortality adjusted by region was 2.79 (95% CI 2.42-3.21) and 2.38 (95% CI: 2.01-2.81) in rural areas compared to urban areas during the 1996-2000 and 2001-2005 periods, respectively. Meanwhile, the RR was the highest in remote areas, which was 4.80(95%CI: 4.10-5.61) and 4.74(95%CI: 3.86-5.83) times as much as that of coastal areas. Obstetric haemorrhage accounted for over 50% of preventable deaths during the 2001-2005 period. Insufficient information about pregnancy among women in remote areas and out-of-date knowledge and skills of health professionals and substandard obstetric services in coastal regions were the factors frequently associated with MMR. CONCLUSIONS: Preventable maternal mortality and the distribution of its associated factors in China revealed obvious regional differences. The PMMR was higher in underdeveloped regions. In future interventions in remote and inland areas, more emphasis should be placed on improving women's ability to utilize healthcare services, enhancing the service capability of health institutions, and increasing the accessibility of obstetric services. These approaches will effectively lower PMMR in those regions and narrow the gap among the different regions.

Hospitalized delivery and maternal deaths from obstetric hemorrhage in China from 1996 to 2006.

OBJECTIVES: To evaluate the role of hospitalized delivery in reducing maternal deaths from obstetric hemorrhage in urban and rural areas of China. DESIGN: Longitudinal, retrospective study and review of maternal deaths based on data from the Maternal and Child Health Surveillance System (MCHSS). SETTING: The surveillance areas of Maternal and Child Health in China from 1996 to 2006. SAMPLE: A total of 6 259 336 live births and 1 418 maternal deaths from hemorrhage. METHODS: Data on maternal deaths were retrieved from the MCHSS. The leading factors contributing to these deaths were reviewed by three committees. MAIN OUTCOME MEASURES: Maternal mortality ratio (MMR), relative risk (RR), leading factors contributing to deaths. RESULTS: The MMR due to hemorrhage significantly decreased with increasing hospitalized delivery rates in rural areas, but it did not decrease in urban areas. The RR of maternal deaths from hemorrhage in women with non-hospitalized delivery in comparison to hospitalized delivery were 2.52 (95% confidence interval (CI): 1.71~3.70) in urban areas, and 5.52 (95% CI: 4.79~6.36) in rural areas. The level of knowledge and skills of medical professionals was the leading factor contributing to 79.6% (urban) and 81.0% (rural) of the deaths during hospitalized delivery. CONCLUSION: The quality of obstetric care in hospitals has become one of the most important factors influencing the risk of maternal deaths from hemorrhage in China. The knowledge and skills of medical professionals need to be improved, especially in primary hospitals.

Pregnancy complicating systemic lupus erythematosus: a series of 86 cases.

OBJECTIVE: To investigate the timing of pregnancy and pregnancy termination and its management in women with pregnancy complicating systemic lupus erythematosus (SLE). METHODS: A series of 86 cases of pregnancy complicating SLE treated in our hospital from January 2005 to June 2010 were retrospectively reviewed, including 54 cases of planned pregnancy and 32 cases of unplanned pregnancy. The pregnancy courses and clinical outcomes were analyzed. RESULTS: While 12 patients in planned pregnancy group showed active SLE during pregnancy, all 32 patients in the unplanned pregnancy group presented severe SLE complications. The incidences of pregnancy loss, preterm delivery and neonatal asphyxia in the unplanned pregnancy group were significantly higher than planned pregnancy group (P < 0.05), and the infant body weight was lower in the unplanned pregnancy group (P < 0.05). A total of 78 live infants were born and no mortality was reported, including 15 preterm infants and one neonatal SLE. CONCLUSION: Planned pregnancy during stable stage, appropriate treatment in pregnancy and close monitoring can improve the security of pregnancy complicating SLE. In situations that the drug treatment is ineffective and the mother and infant are threatened, or the fetus is mature, the pregnancy should be terminated promptly, thereby reducing the complications, and increasing the success rate of pregnancy and perinatal survival rate.

Repeated medical abortions and the risk of preterm birth in the subsequent pregnancy.

PURPOSE: The aim of this study was to determine the impact of repeated first trimester mifepristone-induced medical abortions on the risk of preterm birth in a subsequent pregnancy. METHODS: This is a pregnancy-based cohort study. Clinical data were collected from seven public hospitals in Chengdu, China from January 2006 to December 2009. Pregnant women with one or more first trimester mifepristone-induced medical abortions, and/or one or more surgical abortions, or no previous induced abortions were included in the study. The women were monitored through pregnancy and birth. Samples for analysis included 18,024 singleton births. RESULTS: The risk of preterm birth among women with one or more first trimester mifepristone-induced abortions did not differ significantly from the risk among primigravida women (OR 1.03, 95% confidence interval 0.53-1.63). The risks of preterm birth were higher among women with repeated surgical abortions in comparison to women with repeated medical abortions (OR 1.22, 95% confidence interval 1.03-1.64). CONCLUSIONS: A history of multiple first trimester mifepristone-induced abortions is not associated with a higher risk of preterm delivery among singleton births in the first subsequent pregnancy.

Predictive power progesterone combined with beta human chorionic gonadotropin measurements in the outcome of threatened miscarriage.

PURPOSE: To investigate the predictive power of progesterone combined with beta human chorionic gonadotropin (ß-HCG) measurements in the outcome of threatened miscarriage. METHODS: This retrospective study was conducted on 245 intrauterine pregnant women from January 2006 to October 2008. 175 women with threatened miscarriages who consulted for vaginal bleeding received exogenous progesterone supplements. There were 108 patients with ongoing pregnancies until delivery and 67 patients with inevitable miscarriages. Control group included 70 pregnant women. Serum concentrations of progesterone and ß-HCG were measured by Microparticle enzyme immunoassay between the fourth and fifth gestational weeks. The discrimination attained between the two study groups (ongoing pregnancies and inevitable miscarriages) was evaluated by logistic regression and receiver operating characteristic curve analysis. RESULTS: The mean serum levels of progesterone and ß-HCG in patients with inevitable miscarriages (13.76 ± 5.52 ng/ml, 3,647.00 ± 2,123.00 mIU/ml, respectively) were significantly lower than these levels in normal intrauterine pregnancies (31.67 ± 5.86 ng/ml, 13,437.00 ± 6,256.00 mIU/ml, respectively) and ongoing pregnancies (25.47 ± 6.18 ng/ml, 8,492.00 ± 2,389.00 mIU/ml, respectively) (P < 0.001). Serum progesterone combined with ß-HCG measurements, with a diagnostic accuracy of 85.7% (sensitivity 88.1%, specificity 84.3%), had the best prognostic reliability and significant differences were found when this parameter was compared with the predictive value of a single progesterone (diagnostic accuracy 72.5%, sensitivity 76.1%, specificity 70.4%) or ß-HCG (diagnostic accuracy 74.8%, sensitivity 64.1%, specificity 81.4%) determinations. A combination of two biochemical parameters shows substantial improvement over a single-marker strategy. CONCLUSIONS: Progesterone combined with ß-HCG measurements may be useful for predicting the outcome of threatened miscarriage.

[Gene polymorphism of tumor necrosis factor-alpha receptor II in 196 site and premature births in Chinese Han Population].

OBJECTIVE: To investigate the relationship between tumor necrosis factor receptor II (TNFR II) gene 196T/G polymorphism and preterm labor in Han population in Chengdu. METHODS: Samples were collected from 96 subjects in corresponding period, 46 preterm labor pregnant women (we collected partial placental tissues of preterm labor, 21 cases of infectious group with chorioamnionitis, 25 cases of noninfectious group without chorioamnionitis), and 50 normal labor pregnant women. The DNA was extracted from each sample by using Chelex-100 method, then PCR-RFLP was performed to determine the TNFR II 196 gene polymorphism. RESULTS: 1) TNFR II 196 genotype frequencies of 196M/M (TT), 196M/R (TG) + 196R/R (GG) were 71.7%, 21.7%+ 6.5% and 80.0%, 20.0%+0.0% in preterm labor and normal control group respectively. Allele frequencies of R (G), M (T) were 17.4%, 82.6% and 10.0%, 90.0%, respectively. There were no significant difference in frequencies of genotype and allele in TNFR II 196 gene polymorphism between two groups (P > 0.05, P > 0.05, respectively). 2) Close correlation was observed between the different genotypes and the chorioamnionitis (chi2 = 11.088, P < 0.05). The odds ratio (OR) for TG+GG genotype was 12.65, 95% CI 2.359, 67.848, with more than 12.65 times probability of chorioamnionitis than that of TT genotype group. CONCLUSION: Polymorphism in 196 site of TNFR II gene was not crucial in preterm labor genesis, TG (GG) genotype may contribute to susceptibility to chorioamnionitis in the process of preterm labor in Chinese Han population.

A relative value method for measuring and evaluating neonatal cardiac reserve.

OBJECTIVE: To devise some indicators for measuring and evaluating the neonatal cardiac reserve by using phonocardiogram test (PCGT). METHODS: Two hundred and thirty one (231) full term and one hundred and fifty four (154) preterm infants participated in this study. The amplitude ratio of the first heart sound to the second heart sound (S1/S2), the ratio of diastolic to systolic duration (D/S) and the cardiac contractility change trend after stimulation (CCCTS) of the neonates were measured, calculated and analyzed. RESULTS: The S1/S2, D/S and CCCTS of full preterm infants were higher than that of preterm infants. The differences of D/S and CCCTS between them were significant (P<0.05). According to the full term neonatal cardiac reserve data, a normal reference range of full term neonatal cardiac reserve was primarily known. CONCLUSION: The indicators S1/S2, D/S and CCCTS may be beneficial for evaluating the neonatal cardiac reserve. We can screen out neonates with reduced cardiac reserve by using the phonocardiogram test.

Challenges to maternal health care utilization among ethnic minority women in a resource-poor region of Sichuan Province, China.

We present a simple descriptive study of maternal health care utilization among ethnic minority women in a remote region of China. Factors that affect women obtaining care and their decision-making are explored. Results show that utilization of maternal health care services is associated with a range of social, economic, cultural and geographic factors as well as the policies of the state and the delivery of services. Utilization is not necessarily increased through easy access to a health facility. We identify potential for improving utilization through developing the role of village-based health care workers, expanding mobile antenatal care clinics and changing the way township hospital services are provided and funded. This would include modifications to rural health insurance schemes. Several of these changes are achievable at the township or county level. The findings of this study provide insights that can be used by local health providers, planners and decision-makers to improve the provision of maternal health care services to ethnic minority women.

Effect of progesterone treatment due to threatened abortion in early pregnancy for obstetric and perinatal outcomes.

Progesterone supplementation has been used in a large number of women with threatened abortion for decades, despite various degrees of success, and contradictory and ever-changing views about its efficacy. The majority of previous literature has mainly focused on evaluation the effect of progesterone on pregnancy outcome of threatened abortion. No controlled epidemiological studies of obstetric and perinatal outcomes, including preterm birth, pregnancy complications and low birth weight newborns, in pregnant women with progesterone treatment have been published. The data of 523 pregnant women with progesterone treatment in the second and third months of pregnancy due to threatened abortion was compared with the data of other 21,054 pregnant women in the Department of Obstetrics, West China Second University Hospital for a period of 6years from January 2002 to October 2008. There was no difference in mean gestational age at delivery and birth weight, in addition the rate of preterm birth, pregnancy complications and low birth weight newborns. Intramuscular progesterone treatment due to threatened abortion during early pregnancy did not associate with a higher risk for pregnancy complications, preterm birth and low birth weight newborns.