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BACKGROUND@#Massive bleeding is the main concern for the management of placenta percreta (PP). Intra-abdominal aortic balloon occlusion (IABO) is one method for pelvic devascularization, but the efficacy of IABO is uncertain. This study aims to investigate the outcomes of IABO in PP patients.@*METHODS@#We retrospectively reviewed the clinical data of PP cases from six tertiary centers in China between January 2011 and December 2015. PP cases with/without the use of IABO were analyzed. Propensity score matching analysis was performed to reduce the effect of selection bias. Postpartum hemorrhage (PPH) and the rate of hysterectomy, as well as neonatal outcomes, were analyzed.@*RESULTS@#One hundred and thirty-two matched pairs of patients were included in the final analysis. Compared with the control group, maternal outcomes, including PPH (68.9% vs. 87.9%, χ2 = 13.984, P < 0.001), hysterectomy (8.3% vs. 65.2%, χ2 = 91.672, P < 0.001), and repeated surgery (1.5% vs. 12.1%, χ2 = 11.686, P = 0.001) were significantly reduced in the IABO group. For neonatal outcomes, Apgar scores at 1 minute (8.67 ± 1.79 vs. 8.53 ± 1.68, t = -0.638, P = 0.947) and 5 minutes (9.43 ± 1.55 vs. 9.53 ± 1.26, t = 0.566, P = 0.293) were not significantly different between the two groups.@*CONCLUSIONS@#IABO can significantly reduce blood loss, hysterectomies, and repeated surgeries. This procedure has not shown harmful effects on neonatal outcomes.
Subject(s)
Female , Humans , Infant, Newborn , Pregnancy , Aorta , Balloon Occlusion/methods , Blood Loss, Surgical , Hysterectomy , Placenta Accreta/surgery , Placenta Previa/surgery , Postpartum Hemorrhage , Retrospective StudiesABSTRACT
Objective To investigate the level of mammalian target of rapamycin (mTOR) in serum and the expression of mTOR,nuclear factor-κ B (NF-κ B) and sterol regulatory element binding protein 2 (SREBP2) in placenta among gravidas with preeclampsia.Methods From August 2015 to August 2017,60 gravidas including 40 with severe preeclampsia (SPE) and 20 with mild preeclampsia (MPE) who underwent regular prenatal care and delivered by caesarean section were selected from the Second Xiangya Hospital of Central South University.According to the ratio of 2:1,30 gravidas who delivered through caesarean section due to cephalopelvic disproportion,abnormal fetal position or social factors during the same period were enrolled as the control group.Peripheral blood samples were obtained to determine the concentrations of serum mTOR,high density lipoprotein-cholesterol (HDL-C),low density lipoprotein-cholesterol (LDL-C),triglyceride (TG) and total cholesterol (TC) by enzyme linked immunosorbent assay (ELISA).The expression of mTOR,phospho-mTOR (p-mTOR),NF-κ B and SREBP2 in placenta were measured by Western blot.Clinical datas were statistically analyzed using one-way ANOVA,Bonferroni or Dunnett's T3 test,and Pearson's correlation analysis.Results (1) The serum levels of mTOR and LDL-C in the SPE and MPE group were both higher than that in the control group [mTOR:(11 765.56± 1 698.95) and (8 278.56±1 106.59) vs (4 366.19±716.43) pg/ml;LDL-C:(7.81 ±1.90) and (4.11 ±0.75) vs (2.42±0.45) mmol/L,all P＜0.05].Furthermore the serum levels of mTOR and LDL-C in the SPE group were both higher than those in the MPE group (both P＜0.05).The serum level of HDL-C in the SPE and MPE group were lower than that in the control group [(0.36±0.12) and (0.85±0.11) vs (1.33± 0.16) mmol/L,both P＜0.05],and that in the SPE group was lower than that in the MPE group (P＜0.05).Women in the SPE group showed higher TG level when comparing with the MPE and control group [(46.19± 18.92)vs (35.55±6.54) and (33.24±9.78) nmol/L,both P＜0.05],while the TC levels in the SPE and MPE group were higher than that in the control group[(24.72±7.17) and (21.83±4.19) vs (16.32±3.88) nmol/L,both P＜0.05].(2) The placental expressions of mTOR,p-mTOR,NF-κ B and SREBP2 protein in the SPE and MPE group were higher compared with that in the control group [mTOR:(0.52±0.09) and (0.38±0.08) vs (0.24±0.05);p-mTOR:(0.42±0.08) and (0.26±0.05) vs (0.14±0.03);NF-κ B:(0.58±0.10) and (0.36±0.05) vs (0.21 ± 0.03);SREBP2:(0.52 ± 0.08) and (0.33 ± 0.05) vs (0.20 ± 0.05);all P＜0.05],and those expressions of the SPE group also higher comparing with the MPE group.Otherwise the p-mTOR/mTOR ratios in the SPE group and MPE group were higher than that in the control group [(0.75±0.10) and (0.69±0.14) vs (0.59 ±0.13),both P＜0.05].(3) Pearson's correlation analysis showed that serum level of mTOR and placental expressions of mTOR and p-mTOR in the SPE group were positively correlated with serum LDL-C (r=0.682,0.584 and 0.504,all P＜0.05),TG (r=0.612,0.658 and 0.422,all P＜0.05),while serum level of mTOR and placental expressions of mTOR in the SPE group were positively correlated with TC (r=0.598 and 0.452,all P＜0.05),but were negatively correlated with serum HDL-C (r=-0.375,-0.442 and-0.390,all P＜0.05).The NF-κ B expression in placenta of the SPE group was significantly positively correlated with the mTOR expression in placenta and serum LDL-C (r=0.375 and 0.391,both P＜0.05).Moreover,in the SPE group,the SREBP2 level in placenta was significantly positively correlated with placental expression of mTOR and serum TC level (r=0.364 and 0.392,both P＜0.05).(4) In the MPE group,mTOR level in serum and levels of mTOR and p-mTOR in placenta were significantly positively correlated with serum LDL-C (r=0.813,0.641 and 0.465,all P＜0.05),TG (r=0.646,0.529 and 0.502,all P＜0.05) and TC (r=0.558,0.482 and 0.483,all P＜0.05),while the level of serum mTOR was negatively correlated with the level of serum HDL-C (r=-0.606,P＜0.05).The NF-κ B level in placenta in MPE group was positively correlated with the mTOR in placenta and the serum LDL-C (r=0.458 and 0.595,both P＜0.05),while the SREBP2 level in placenta was significantly positively correlated with mTOR in placenta and serum TC (r=0.580,0.560,respectively;both P＜0.05) in the MPE group.Conclusions mTOR,NF-κ B and SREBP2 may play important roles in the onset and development of preeclampsia by interfering lipid metabolism.
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Objective To evaluate the risk factors and sonographic findings of pregnancies complicated by placenta increta or placenta percreta. Methods Totally, 2219 cases were retrospectively analyzed from 20 tertiary hospitals in China from January 2011 to December 2015. The data were collected based on the original case records. All cases were divided into two groups, the placenta increta (PI) group (79.1％, 1755/2219) and the placenta percreta (PP) group (20.9％, 464/2219), according to the degree of placental implantation. The risk factors and sonographic findings of placenta increta or percreta were analyzed by uni-factor and logistic regression statistic methods. Results The risk factors associated with the degree of placental implantation were age, gravida, previous abortion or miscarriage, previous cesarean sections, and placenta previa (all P<0.05), especially, previous cesarean sections (χ2=157.961) and placenta previa (χ2=91.759). Sonographic findings could be used to predict the degree of placental invasion especially the boundaries between placenta and uterine serosa, the boundary between placenta and myometrium, the disruption of the placental-uterine wall interface and loss of the normal retroplacental hypoechoic zone(all P<0.01). Conclusions Previous cesarean sections and placenta previa are the main independent risk factors associated with the degree of placenta implantation. Ultrasound could be used to make a prenatal suggestive diagnosis of placenta accreta spectrum disorders.
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Objective To evaluate the protective effect of Bletilla striata polysaccharide ( BSPS) on immunological and chemical liver injury in mice. Methods Thirty Kunming male mice were randomly divided into five groups, including the normal control group,model control group,and low-,middle-,and high-dose BSPS groups (n=6 each).Tail vein injection of ConA was carried out to establish the ConA-induced liver injury model.After different treatments,all the animals were sacrificed,and the plasma levels of ALT and AST were tested.Additionally,sixty Kunming male mice were randomly divided into six groups,including the normal control group,model control group,silymarin group,and low-,middle-,and high-dose BSPS groups (n=10 each).Tail vein injection of CCl4 was performed to establish the CCl4-induced acute liver injury model.After different treatments,the plasma levels of ALT and GSH were tested.The effects of BSPS on the weights of the liver and spleen were examined. Results The levels of ALT and AST were reduced in BSPS-treated mice when compared with those experiencing only ConA-induced liver injury ( model control group) ,and significant difference was found between the middle-and high-dose BSPS groups and the model control group (P<0.01,P<0.05).The weights of the liver and spleen and the level of ALT were reduced in BSPS-treated mice as compared with those with only CCl4-induced acute liver injury (model control group),while the level of GSH was significantly increased in middle-and high-dose BSPS groups (P<0.05). Conclusion BSPS at low,middle,and high doses can prevent against the ConA-induced immunological liver injury and CCl4-induced acute liver injury in mice.
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P A twin pregnancy with a complete hydatidiform mole with a coexistent foetus [CHMF] is a rare condition that typically results in poor pregnancy outcomes. For patients with refractory vaginal bleeding, termination of pregnancy is more appropriate. However, unified methods for termination remain to be explored. In the present study, we reviewed the termination measures in four cases of twin pregnancy with CHMF. Additional understanding of this condition will aid in the treatment of women with this condition and improve their pregnancy outcomes
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OBJECTIVE@#To determine the effect of human corticotrophin-releasing hormone (CRH) on the expression of connexin-43 phosphate (P-Cx43) in human myometrial smooth muscle cells (SMCs) and the function of cell gap junction intercellular communication in SMCs.@*METHODS@#Human non-conceive myometial SMCs were cultured with different concentrations of CRH (0, 5.85, 58.5, 585 and 5850 pmol/L). Western blot was used to test P-Cx43 and Cx43 non-phosphate (NP-Cx43) of protein expression. Cell scratch was used to test cell gap junction intercellular communication opening status in human myometrial SMCs.@*RESULTS@#Compared with the control group, the expression of P-Cx43 was higher in the CRH groups (P0.05). The transmission of cell layers in the CRH groups was higher than that in the control group (P<0.01), and as the concentration of CRH increased, the time was concentration-dependent (P<0.01).@*CONCLUSION@#CRH can enhance the expression of P-Cx43 and the function of gap junction intercellular communication in the primary cultured myometrial SMCs.
Subject(s)
Female , Humans , Cell Communication , Cells, Cultured , Connexin 43 , Metabolism , Corticotropin-Releasing Hormone , Pharmacology , Gap Junctions , Myocytes, Smooth Muscle , Metabolism , Myometrium , Cell Biology , PhosphorylationABSTRACT
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.
Subject(s)
Adult , Female , Humans , Pregnancy , Abnormal Karyotype , Amniocentesis , Methods , Cordocentesis , Methods , Evaluation Studies as Topic , Karyotyping , Methods , Prenatal Diagnosis , Methods , Retrospective StudiesABSTRACT
OBJECTIVE@#To determine the accuracy of two dismensional sonography and color doppler in diagnosing placenta previa accreta in patients with previous cesarean section.@*METHODS@#Forty-one patients with previous cesarean sections were confirmed to have partial or total placenta previa in the current pregnancy and were given ultrasound examinations after the 28th week of gestation. Specific ultrasound features of the placenta and its interphase with the uterus and the bladder for placenta accreta were checked by two-dimensional ultrasonography and color Doppler. All the patients were traced until delivery. The golden standard in diagnosis was the intraoperative finding and the pathologic exam.@*RESULTS@#Twenty-two patients had ultrasonographic evidence of placenta previa, 20 of which were later confirmed placenta previa accreta intraoperatively. Nineteen patients had no ultrasound evidence of placenta previa, and 1 of which was later confirmed placenta previa accreta. The sensitivity and specificity of antenatal ultrasound diagnosis of placenta previa accreta were 95.24% and 94.74% respectively. The most prominent feature to suggest placenta accreta in twodismensional sonography was the presence of multiple lakes that represented dilated vessels extending from the placenta through the myometrium. The most prominent color Doppler feature was the presence of interphase hypervascularity with abnormal vessels linking the placenta to the bladder, and the rate was 95.24%.@*CONCLUSION@#Placenta previa accreta can be diagnosed made with a thorough two dimensional ultrasonographic and color Doppler examination in patients with previous cesarean scar and placenta previa.
Subject(s)
Adult , Female , Humans , Pregnancy , Young Adult , Cesarean Section , Cicatrix , Placenta Accreta , Diagnostic Imaging , Placenta Previa , Diagnostic Imaging , Ultrasonography , Methods , Ultrasonography, Doppler, Color , Uterus , PathologyABSTRACT
Objective To explore the relationship between total bile acid(TBA)concentration and fetal pulmonary surfactant in intrahepatic cholestasis of pregnancy(ICP).Methods Fifry five patients with ICP(ICP group)who received cesarean section from April 2008 to February 2010 in Second Xiangya Hospital,Central South University,were recruited.The general conditions of the neonates within 7 days after birth in ICP group were recorded.Those with fetal distress,neonatal asphyxia,or neonatal respiratory distress syndrome were referred as pathological neonates, others were referred as normal neonates. Over the same period, 23 healthy gravidas were recruited as control group. Enzymatic method was used to detect the TBA concentrations in maternal blood, cord blood and amniotic fluid. ELISA was employed to measure the urfactant protein A (SP-A) concentration in cord blood. High performance liquid chromatography system was used to detect the concentrations of phesphatidylcholine (PC),phosphatidylinositol (PI),lysophosphatidylcholine ( LPC), and sphingomyelin(SM) in amniotic fluid. Results ( 1 ) The concentrations of TBA in maternal blood, cord blood and amniotic fluid were ( 30. 1 ± 7.9 ), (9. 3± 3. 3 ) and (4. 4 ± 1.5 ) mmol/L in ICP group, (4. 8 ± 2. 2), (4. 9 ± 0. 9) and ( 1.4 v 1.1 ) mmol/L in control group, respectively. The differences between the two groups were significant ( P ＜ 0. 05 ). ( 2 ) The SP-A concentration in cord blood in ICP group was ( 29. 5 ± 6. 4 ) μg/L, significantly higher than that in control group, which was ( 22. 6 ± 7. 4 )μg/L ( P＜ 0. 05 ). ( 3 ) There were 20 pathological neonates and 35 normal neonates in ICP group. In pathological neonates, the concentrations of TBA and SP-A in cord blood were (10.9 ± 2.2) mmol/L,(37.0 ± 5.9 ) μg/L, respectively; and were ( 8.0 ± 2. 8 ) mmol/L, ( 26. 7 ± 4. 8 ) μg/L in normal neonates. The differences were significant (P＜ 0. 05 ). (4) There was a positive correlation between TBA concentration in cord blood and in maternal blood ( r1 = 0. 706, P＜0. 05 ). The TBA concentration in cord blood was positively correlated with SP-A concentration as well ( r3 = 0. 494,P ＜ 0. 05 ). (5) The PC and PI concentrations in amniotic fluid were (65.4 ± 7.2) mg/L and ( 3. 8 ± 0. 6 ) mg/L in ICP group, ( 69. 7 ±3.7) mg/L and (4. 3 ± 0. 7 ) mg/L in control group, respectively. The differences were significant (P ＜0. 05 ). The concentration of LPC in amniotic fluid in ICP group was (4. 8 ±0. 9) mg/L, significantly higher than that in control group (P＜0. 05), which was (4. 2 ±0. 6) mg/L. The concentration of SM in amniotic fluid was (3.5±0. 8) mg/L in ICP group, (4. 0 ± 0. 5 ) mg/L in control group, with no significant difference ( P＞0. 05 ). (6) The ratio of PC/LPC in ICP group ( 14. 2± 3. 2 ) was significantly lower than that in control group ( 16. 9 ± 2. 5 ) ( P＜ 0. 05 ). ( 7 ) The TBA concentration in cord blood was negatively correlated with PC and PI concentrations (r1 = -0. 561, r2 = -0. 407, P ＜ 0. 05 ), and had no correlation with LPC concentration (r3 = 0. 260, P＞ 0. 05). Conclusions ( 1 ) The fetal TBA concentrations in both cord blood and amniotic fluid of patients with ICP was higher than those of healthy gravidas, they were also positively correlated with maternal TBA concentration. (2) ICP resulted in the change of fetal pulmonary surfactant and this change was associated with TBA concentrations in both cord blood and amniotic fluid.
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Objective To investigate the expression of HIF-1α protein in the placenta bed and the concentration of von Willrand factor (vWF) in maternal peripheral blood from pre-eclampsia and normal pregnancy, and to determine the effect of HIF-1α and vWF on the pathogenesis of pre-eclampsia. Methods Forty pre-eclampsia patients (20 mild and 20 severe) were recruited as 2 study groups, and another 20 normal pregnant women were served as a normal group.Western blot was used to detect the expression of HIF-1α protein in the placenta bed. ELISA was adopted to detect the concentration of vWF in the maternal peripheral blood.Correlation between HIF-1α protein expression and vWF level was analyzed by Spearman method.Results The expression of HIF-1α protein in the placenta bed was the highest in the severe pre-eclampsia patients among 3 groups, followed by the mild pre-eclampsia patients and the normal controls.There was significant difference (among) 3 groups (P＜0.001).The concentration of vWF in the maternal peripheral blood was the highest in the severe pre-eclampsia patients, followed by the mild pre-eclampsia patients and the normal controls.There was significant difference among the 3 groups (P＜0.05). Postive correlation was found between the expression of HIF-1α protein in the placenta bed and the concentration of vWF in the maternal peripheral blood in patients with pre-eclampsia (r_1=(0.65,) P＜(0.001)),and between the concentration of vWF in the maternal peripheral blood and the pathogenetic condition degree of pre-eclampsia (r_2=(0.61,)P＜0.001).Conclusion HIF-1α in coordination with vWF may play an important role in the pathogenesis of pre-eclampsia.
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Objective To investigate the changes of human leukocyte antigen-G (HLA-G) protein expression and Th1/Th2 type cytokines in intrahepatic cholestasis of pregnancy (ICP) and their relativity to the etiology of ICP. Methods Peripheral blood and placental tissues were obtained from 26 ICP patients (the ICP group) and 22 normal pregnant women (the NP group) in the operation room for Cesarean birth. Immunohistochemistry was used to detect the expression of HLA-G protein in the placental tissues. Meanwhile we tested the concentrations of tumor necrosis factor-α (TNF-α) and interleukin-4 (IL-4) by enzyme-linked immunosorbent assay (ELISA) in the peripheral blood and checked the levels of TBA in the serum.Results TBA level in the ICP group was (27.05±6.08) μmol/L, significant higher than that in the NP group (4.35±2.68)μmol/L (P＜0.01). The positive expression of HLA-G protein in extravillous trophoblast in the ICP group was significantly lower than that in the NP group (P＜0.01). The mean optical density (MOD) of positive expression of HLA-G protein in the placenta tissues in the ICP group (52.91±7.19) was significantly lower than that in the NP group (69.26±7.72) (P＜0.01). The concentration of TNF-α was significantly higher in the ICP group (101.31±19.30) pg/mL than that in the NP group (54.51±23.72) pg/mL (P＜0.01). The concentration of IL-4 was lower in the ICP group (22.16±6.55) pg/mL than that in the NP group (31.69±8.25) pg/mL (P＜0.01). The ratio of TNF-α/IL-4 was higher in the ICP group (4.52±1.91) than that in the NP group (1.72±0.61) (P＜0.01). There was a negative correlation between the MOD of HLA-G protein and TNF-α (r=-0.98, P＜0.01) in the ICP group. No correlation with IL-4 and TNF-α/IL-4 was seen (P＞0.05). There was a positive correlation between TBA and TNF-α (r=0.99, P＜0.01), and a negative correlation between TBA and the MOD of HLA-G protein (r=-1.00, P＜0.01) in the ICP group. No correlation with IL-4 and TNF-α/IL-4 was seen (P＞0.05). Conclusion There is an imbalance of Th1/Th2 cytokines to the Th1 type in the peripheral blood of ICP patients. The expression of HLA-G protein in the placenta of ICP patients decreases, leading to an increase of Th1 type cytokines that may be one of the reasons for liver destroy in ICP.
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Objective To investigate the relationship of fetal total bile acid (TBA) concentration with the change of fetal pancreas endocrine secretion and its impact on fetal growth and development in intrahepatic cholestasis of pregnancy(ICP). Methods The concentrations of TBA, insulin, glucagon and glucose in the cord blood were measured in 30 fetuses with maternal ICP (case group) and 30 fetuses of normogravidas(control group) after elective cesarean section during the same period in the Department of Obstetrics of Xiangya Second Hospital of Central South University from March 2007 to February 2008. The cord blood TBA concentration was investigated by enzyme method and the concentrations of insulin and glucagon were investigated by radioimmunoassay. The glucose was measured by oxidase-superoxide method. The neonatal weight, length and the ponderal index (PI) were measured after parturition. Results (1) The cord blood insulin concentration (9.0±3.3) mU/L and the ratio of insulin over glucagon 0. 048±0. 028 in the case group was significantly lower than that of controls(10.1±3.7) mU/L,0.050±0. 020 (P<0.05). The concentrations of TBA(10.3±3. 8)μmol/L and glucagon(235±57) ng/L in case group were obviously higher than that in controls (4.1±1.3)μol/L, (205±34) ng/L(P<0.05). But no difference was shown in the glucose concentration in cord blood between the ease and control groups [(3.4±1.1) mmol/L vs (3.6± 1.2 )mmol/L, P > 0.05]. (2)The neonatal weight and length in case group were significantly lower than that of control [(3163±478) g vs (3498±393)g, (46.5±2.3) cm vs (49.3±1.9)cm, P<0.01]; while the Ponderal index in ease group was significantly higher than that of control group (3.13±0. 23 vs 2. 92±0. 29,P <0.01). (3) The cord blood TBA concentration respectively showed a linear relationship with the cord blood insulin concentration, the cord blood glucagon concentration and the ratio of insulin over glucagon in the case group. With the increase in cord blood TBA concentration, the cord insulin concentration and the ratio of insulin over glucagon decreased; meanwhile the cord blood glucagon concentration rose(P<0.01). The cord blood insulin concentration and the ratio of insulin over glucagon in case group were respectively positively correlated with the neonatal weight and length, and were negatively correlated with the PI (P<0.01); while the cord glucagon concentration was respectively negatively correlated with the neonatal weight and length, and positively correlated with the P1 (P < 0.01 ).Conclusions In 1CP fetus pancreas, there are hypoinsulinism, glucagon oversecretion, and decrease of the ratio of insulin over glucagon, which is closely correlated with fetal TBA concentration. The endocrine function of fetal pancreas affects the fetal growth and development.
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Objective To study the influence of total bile acid (TBA) of maternal serum and cord blood on neonatal cardiac function in women with intrahepatic cholestasis of pregnancy (ICP). Methods The concentration of TBA in the maternal peripheral blood and neonatal cord blood were measured by enzyme in 30 women with ICP as patients group matched with 30 normogravidas as control group. The concentration of cardiac troponin Ⅰ (cTnI) in cord blood was detected by monoclonal enzymelinked immunosorbent assay.Fetal left ventricle Tei index was evaluated by color Doppler uhrasonoscope. Results (1) TBA concentration of maternal serum and cord blood at ICP group were significantly higher than that of control group [ (36.0±9.6) μmol/L vs. (3.8±0.9) μmol/L, (10.1±2.0) p, mol/L vs. (5.5±0.4 )μmol/L,P <0.01 ]. TBA concentration of maternal serum at ICP group was significantly higher than that of neonatal cord blood(P<0.01 ). Meanwhile, TBA concentration of maternal serum at control group was significantly lower than that of neonatal cord blood (P<0.01 ). (2) The Tel index of neonatal left ventricle at ICP group were significantly higher than that of control (0.58±0.04 vs. 0.43±0.03, P<0.01 ). (3) The concentration of cTnI from cord blood(0.92±0.23)μg/L at ICP group were obviously higher than that of control group [ (0.52±0.10)μg/L, P<0.01]. (4) The TBA concentration of cord blood at ICP group showed positive correlation with maternal blood TBA, cord blood cTnI and fetal left ventricle Tei index respectively( r=0.769, 0.635, 0.758,P<0.01). In the mean time, the positive correlation between the concentration of cTnI from cord blood and fetal left ventricle Tel index was also observed (r=0.637.P<0.01). Conclusions Left ventricular dysfunction and myocardial injury were shown in the neonates with ICP, which might be associated with with the elevated TBA level of maternal blood. The Tel index of fetal left ventricle could be used as a reliable parameter to monitor cardiac function and the degree of injured myocardial muscles.
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Objective To investigate the role of RhoA and Rho kinase system in the onset of labor. Methods Forty term pregnant women, who delivered through cesarean section at the Xiangya Second Hospital of Central South University from February 2007 to November 2007, were selected and divided into 2 groups: 20 in labor group and 20 in non-labor group. Another 20 non-pregnant women undergoing hysterectomy due to cervical intraepithelial neoplasia were chosen as the control. Real-time fluorescence quantitative RT-PCR and western blot were applied to detect the expression RhoA and ROCKⅠ mRNA and protein in uterine smooth muscle tissue and the correlation between the mRNA and protein expression of RhoA and ROCKⅠ were analyzed. Results (1) The mRNA expressions of both RhoA and ROCKⅠ were detected in all groups, and higher levels were found in the labor group than in the non-labor group and the control [RhoA mRNA: (3.51±0.56)×10-3 vs. (2.75±0.52)×10-3 and (2.11±0.54)×10-3; ROCKⅠ mRNA: (4.07±0.66)×10-3 vs. (2.71±0.52)×10-3 and(2.01±0.23)×10-3, P<0.01]. (2) RhoA and ROCKⅠ proteins were also identified in all three groups, and the expressions in the labor and non-labor group were higher than those of the control (RhoA protein: 0.72±0.23 and 0.64±0.17 vs. 0.46±0.15; ROCKⅠ protein: 0.56±0.14 and 0.42±0.16 vs. 0.29±0.08, P<0.01). (3) The expression of RhoA mRNA and ROCKⅠ mRNA were positively correlated in each of the three groups (r=0.73,P<0.01), and the same was found in the expression of RhoA protein and ROCKⅠ protein (r=0.37,P<0.01). Conclusion The increased expression of RhoA and Rho kinase may play an important role in the initiation of labor.
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OBJECTIVE@#To investigate the effect of hyperglycaemia on the cardiomyodial change of rat fetus.@*METHODS@#Thirty clean SD pregnant rats were randomly dividing into group A, B and C, 10 in each group. Group A were injected intraperitoneally 50 mg/kg streptozotocin on the 6th day of pregnancy, Group B were injected the same dose on the 13th day of pregnancy, while Group C were injected intraperitoneally 0.1 mmol/L citrate buffer solution on the 6th day of pregnancy. All rats were killed on the 21st day of pregnancy, the total fetus, live fetus, weight, and length of fetus were recorded. The blood glucose in the fetal rats was measured, and the fetal hearts were collected. The fetal hearts were pathologically examined under light microscope and electron microscope. Immunohistochemical staining was applied to determine Caspase-3 in the heart of fetus.@*RESULTS@#(1) The blood glucose of pregnant rats in the 3 groups showed no difference before intervening (P>0.05). There was significant difference between Group A and C, Group B and C after intervening (P0.05). (2 )The fetus in Group A and B was heavier and longer than in Group C, with significant difference (P0.05). The blood glucose of fetus in Group A and B was lower than that in Group C, with significant difference (P0.05). The rate of fetal death in Group A, B, and C were 31.96%,12.84%, and 3.88%, respectively. Significant deviation existed in the 3 groups (P<0.01). (3) Under light microscope, fetal hearts in Group A and B showed disorder, cardiac muscle cells swelled. There were vacuoles in cytolymph and necrosis in the myocardial tissue. Significant deviation in the integral of fetal necrosis existed in the 3 groups (P<0.01). (4) Caspase-3 was detected in the fetal hearts, the positive area ratio and mean OD value had significant deviation in the 3 groups (P<0.01).(5) Under the electron microscope, cardiomyocytes wrinkled, mitochondrion decreased, myofibril ruptured, while sarcomere blurred. The density of mitochondria in cardiamyocyte in Group A was lower than that in Group B and C (P<0.01), and the average volume of mitochondria of Group A and B was higher than that in Group C (P<0.01).@*CONCLUSION@#There is apparent pathological change of fetal hearts in pregnant rats with hyperglycaemia. The longer the duration, the more obvious the change.
Subject(s)
Animals , Female , Pregnancy , Rats , Blood Glucose , Metabolism , Caspase 3 , Metabolism , Diabetes Mellitus, Experimental , Blood , Diabetes, Gestational , Blood , Fetal Heart , Maternal-Fetal Exchange , Random Allocation , Rats, Sprague-DawleyABSTRACT
Objective: To study the relation of bile acid levels and fetal hypoxia and brain injury in Intrahepatic Cholestasis of Pregnancy (ICP). Methods: From May. 2006 to Sep. 2006, we selected 30 cases of ICP as the study group, and randomly selected 30 cases of normal pregnant women for delivery during the same period as the control group in our hospital. Color Doppler ultrasound was used to measure the peak systolic velocity to end-diastolic velocity (S/D) and the resistive index (RI) of fetal middle cerebral artery, and the automatic biochemical analyzer be used to detect the total bile acid (BA) in maternal blood, and BA, pH as well as lactate in umbilical arterial serum; neuron-specific enolase (NSE) in umbilical artery serum was detected by ELISA. The results were analyzed and compared. Results:①The BA concentration in maternal blood and newborn umbilical artery blood of the study group was significantly higher than that of the control group ( P<0.01). In the study group, the BA in maternal and newborn blood were positively correlated ( r=0.937, P< 0.01) ;②Lactate and the NSE Concentration in newborn umbilical artery of the study group was significantly higher than that of the control group ( P< 0.01). The pH value innewbom umbilical artery and The S/D, RI value of fetal middle cerebral artery in the study group was significantly lower than those of control group ( P< 0.01); ③ In the study group, the NSE concentration was positively correlated with BA and lactate concentration in newborn umbilical artery, while negatively correlated with the S/D and RI values of fetal middle cerebral artery and the pH value in newborn umbilical artery ( P<0.01). Conclusions: There is the existence of hypoxia and brain injury in fetus of ICP. By measuring the blood flow changes of fetal cerebral artery with Color Doppler and detecting pH, lactate as well as NSE levels in umbilical arterial blood, we could early predict the fetal hypoxia and diagnose the fetal brain injury in ICP.
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Objective To study the expression of activator protein-1(AP-1)and connexin 43(Cx43)in uterine smooth muscle of term pregnancy and its relationship with preterm delivery.Methods Immuno-histochemistry was applied for 15 uterine smooth muscle samples of term pregnancy without labor(Group Ⅰ),15 of term pregnancy in labor(group Ⅱ)and 10 of preterm delivery in labor(group Ⅲ)to investigate the expression of two subunits of AP-1(c-Jun and c-Fos)and Cx 43. Results (1)The expression of Cx43 in group Ⅰ and Ⅱ(4.33±0.51 and 4.20±0.42)were significantly higher than that in group Ⅲ(3.15±0.41,P<0.01).Lable index of c-Jun protein in group Ⅲ,Ⅱ and Ⅰ was(52.34±4.18)%,(45.25±5.24)%and(34.14±4.26)%,respectively (P<0.01),and the lable index of c-Fos protein was(53.48±4.36)%,(43.32±6.21)%and(31.29±3.34)%,respectively(P<0.01).Positive correlation was found between the expression of Cx43and c-Jun,c-Fos in pregnancy uterine smooth muscle(r=0.65,0.63,P<0.01). ConclusionsThe Cx43 plays an important role in the onset of labor.The expressions of Cx43 is positively related with the expression of AP-1 in pregnancy uterine smooth muscle.
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Objective To explore the effects of maternal hypercholanemia on the myocardium changes in rat fetus. Methods Thirty clean SD female rats were equally randomized to three groups after mating successfully.From the 13th to 20th day of gestation,group A and B were injected injected with sodium chloride(NS) as control.Total bile acid(TBA) and cardiac troponin I(cTnI) were measured in the maternal and fetal serum on the 21st day when all rats were killed.Fetal cardiac muscle cells were also collected for examination with light microscope and electronic microscope.Results (1)TBA in maternal and fetal serum were(22.32±8.12)μmol/L and(28.84±8.06) μmol/L,respectively in group A,(9.77±3.56)/μmol/L and(9.34±3.54) μmol/L in group B,and (3.60±1.78) μmol/L and(3.95±1.19) μmol/L in group C.Significant differences were found among groups(P<0.01).(2)Fetal death rates were significantly different among the three groups (P<0.05),with 30.11%,16.85%,and 7.05%,respectively.(3)Fetal cTnl were also found significant difference among groups(P<0.01),with(19.98±7.75)ng/ml,(11.41±3.64)ng/ml and(4.38±1.19)ng/ml,respectively.(4)The integrated scores of fetal necrosis area were significantly different in three groups(P<0.05),with 1.92±0.43,1.36±0.37 and 0.44±0.12,respectively.(5)Under electronic microscope,the number density of mitochondria in group A was lower than that in group C(P<0.05)while the average volume of mitochondria was larger in group A (P<0.05).The average volume of mitoehondria in group B was larger than that in group C(P<0.05) while no difference was found with regard to the number density between the two groups.The number density and average volume of myofibril in group A were lower than those in group C(P<0.05).The number density of myofibril in group B was higher than that in group C(P<0.05) while no difference was found with the average volume.(6)Positive correlations were found in maternal TBA,fetal TBA,fetal cTnI and the integrate of fetal necrosis area when comparing every two of the above factors. Conclusions Fetal myocardium is impaired obviously in hypercholanemia rats.The serum level of TBA and cTnI in fetal rats are positively correlated with each other.
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Objective To investigate the changes of umbilical cord and the vasoactive substance in umbilical vein in intrahepatic cholestasis of pregnancy.MethodsBy HE staining method we analyzed the pathologic change of umbilical cord of 25 women with intrahepatic cholestasis of pregnancy(ICP)and fetal distress(ICP fetal distress group),25 ICP women without fetal distress group(ICP control group)and 27 normal pregnancies(control group).The nitric oxide synthase(NOS)and endothelin-1(ET-1)were detected in human umbilical vein endothelial cells(HUVEC)by immunohistochemistry method.Umbilical vein total bile acid(TBA)and NOS and ET-1 were measured.Resuits(1)A remarkable high TBA level was found in umbilical vein in ICP,and it was higher in ICP fetal distress group(19.0±2.3)μmol/L than in ICP control group(9.0±1.7)μmol/L(P＜0.05);it was higher in ICP control group than the control group(4.4±1.5)μmol/L(P＜0.05).(2)A significant difference was found in the endotheliocytes of umbilical vein in ICP fetal distress group compared with ICP control group.The ratio of cells with pathological changes in ICP fetal distress group(92％,23/25)was higher than ICP control group(68％,17/25;P＜0.05).The occurrence of the pathological changes was associated with TBA.(3)The expression of eNOS in ICP fetal distress group 0.09±0.06 was lower than in ICP control group 0.21±0.08(P＜0.05),and it was lower in ICP control group than in control group 0.47±0.07(P＜0.05).In contrast.the expression of ET-1 in ICP fetal distress group 0.49±0.08 was higher than in ICP control group 0.32±0.07(P＜0.05),and it was higher in ICP control group than control group 0.14±0.06(P＜0.05).The expression of inducible nitric oxide synthase(iNOS)in ICP fetal distress group 0.20±0.04 and ICP control group 0.21±0.05 was lower than in control group 0.26±0.04(P＜0.05),but no significant difference was found in ICP fetal distress group and ICP control group(P＞0.05).(4)The expression of eNOS,iNOS and ET-1 was correlated with umbilical vein TBA in ICP(r1=-0.88,r2=-0.45,r3=0.79;P＜0.01),respectively.Conclusions High level of TBA in ICP is harmful to the umbilical vein endothelium,which is correlated with the raised expression of ET-1.and the decreased expression of eNOS,and iNOS in human umbilical cord endothelium cells.All these changes of umbilical vein may be associated with the occurrence of fetal distress in ICP.
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Objective To evaluate the clinic value of five different ultrasonographic fetal parameters for prenatal diagnosis of pulmonary hypoplasia.Methods Two hundred and seventy-one normal singleton pregnancies with well-established dates between 20 and 40 weeks of gestation were studied to establish normal reference range of five different ultrasonographic fetal parameters.The five parameters,which could reflect fetal lung mass,were as follows:lung area/body weight ratio,lung area,thoracic circumference/abdominal circumference ratio,lung area/thoracic area ratio and lung area/head circumference.Thirty pregnancies with risk factors for pulmonary hyperplasia were studied for the usefulness of five parameters.Two or more standard deviations below the mean control group measurement were considered abnormal.The prenatal ultrasonic diagnoses of pulmonary hyperplasia were confirmed at neonatal follow-up examinations,on autopsy and by pathologic findings.Results Lung area and lung area/head circumference increased with gestational age,lung area/body weight ratio decreased with gestational age.The relationships among the two ratios(thoracic circumference/abdominal circumference ratio,lung area/thoracic area ratio)and gestational age were relatively constant. Abnormal lung area/body weight ratio had a higher diagnostic accuracy than other parameters.Sensitivity of the parameters,including lung area,lung area/body weight ratio,thoracic circumference/abdominal circumference ratio,lung area/thoracic area ratio and lung area/head circumference were 83%,97%,50%,70% and 87%,respectively.Sensitivity of the lung area/bedy weight ratio was 95%(20/21 fetuses);specificity,9/9 fetuses;positive predictive value,100% (20/20fetuses);negative predictive value,9/10;and accuracy 97% (29/30 fetuses).Conclusion Lung area/body weight ratio is a good predictor of pulmonary hypoplasia.