The prenatal diagnosis and prognosis of fetal right aortic arch and double aortic arch malformation: A single-center study.

AIM: This study aimed to characterize the pathological types, diagnosis, chromosomal abnormalities, and postnatal clinical manifestations of right and double aortic arch malformations in fetuses. METHODS: In this retrospective study, all fetuses diagnosed with right or double aortic arch anomalies for whom conventional two-dimensional echocardiography combined with spatio-temporal image correlation was performed at our tertiary referral center between December 2012 and December 2021 were included. RESULTS: In total, 234 fetuses with aortic arch abnormalities were identified. Forty-one cases lost to follow-up. One hundred ninety-three cases were included in this study. One hundred eighty-seven cases with right aortic arch. Six cases with double aortic arch. Most cases of right aortic arch with aberrant left subclavian artery (77/101, 76.2%) were isolated lesions, whereas most of those with mirror-image branching (45/75, 60%) were associated with intracardiac or extracardiac anomalies. Chromosomal abnormalities were screened prenatally in 113 fetuses with right aortic arch, among whom three with aberrant left subclavian artery (3/63, 4.8%) and eight with mirror-image branching (8/50, 16%) had chromosome anomalies (p < 0.05). Furthermore, three cases had microdeletion 22q11.2 and these were significantly associated with intracardiac malformations. CONCLUSIONS: Most cases of isolated right aortic arch do not present with clinical symptoms except isolated left subclavian artery and isolated left brachiocephalic trunk. In addition, the risk of chromosomal abnormalities in patients with isolated right aortic arch is very low. We recommend that pregnant women should be informed of the risks and benefits of undergoing invasive prenatal chromosomal detection.

ANXA4 promotes trophoblast invasion via the PI3K/Akt/eNOS pathway in preeclampsia.

The inadequate trophoblast invasion is associated with the development of preeclampsia (PE). Considering that annexin A4 (ANXA4) enhances tumor invasion, we aimed to explore the functional role of ANXA4 in trophoblast cells and to examine the underlying mechanism. ANXA4 expression in PE placentas was analyzed using immunohistochemistry and Western blotting. Cell proliferation, invasion, and apoptosis were determined using a MTT assay, Transwell assay, and flow cytometry, respectively. The expression levels of matrix metalloproteinase (MMP)-2, MMP-9, phosphoinositide 3-kinase (PI3K), Akt, phosphorylated (p)-Akt, and phosphorylated endothelial nitric oxide synthase (p-eNOS) were detected by Western blotting. Placentas were prepared for pathological examination using hematoxylin and eosin staining and apoptosis determination using the TUNEL method. Expression of ANXA4, PI3K, p-Akt and p-eNOS was downregulated in human PE placentas and PE placenta-derived extravillous cytotrophoblasts (EVCTs). Furthermore, ANXA4 overexpression promoted cell proliferation and invasion, inhibited cell apoptosis, and upregulated protein expression of PI3K, p-Akt, and p-eNOS in human trophoblast cells HTR-8/SVneo and JEG-3. By contrast, ANXA4 knockdown exerted the opposite effects. Furthermore, inhibition of the PI3K/Akt pathway by LY294002 abrogated the ANXA4 overexpression-mediated effects on trophoblast behavior. Furthermore, eNOS knockdown abrogated the ANXA4 overexpression-induced promotion of cell invasion and MMP2/9 expression. Additionally, in N-nitro-l-arginine methyl ester (l-NAME)-induced PE rats, ANXA4 overexpression alleviated PE progression, accompanied by an increase in expression of PI3K, p-Akt, and p-eNOS in rat placentas. Our findings demonstrate that ANXA4 expression is downregulated in PE. ANXA4 may promote trophoblast invasion via the PI3K/Akt/eNOS pathway.

Identification of a de novo fetal variant in osteogenesis imperfecta by targeted sequencing-based noninvasive prenatal testing.

Noninvasive prenatal testing (NIPT), which involves analysis of circulating cell-free fetal DNA (cffDNA) from maternal plasma, is highly effective for detecting feto-placental chromosome aneuploidy. However, recent studies suggested that coverage-based shallow-depth NIPT cannot accurately detect smaller single or multi-loci genetic variants. To assess the fetal genotype of any locus using maternal plasma, we developed a novel genotyping algorithm named pseudo tetraploid genotyping (PTG). We performed paired-end captured sequencing of the plasma cell-free DNA (cfDNA), in which case a phenotypically healthy woman is suspected to be carrying a fetus with genetic defect. After a series of independent filtering of 111,407 SNPs, we found one variant in COL1A1 graded with high pathogenic potential which might cause osteogenesis imperfecta (OI). Then, we verified this mutation by Sanger sequencing of fetal and parental blood cells. In addition, we evaluated the accuracy and detection rate of the PTG algorithm through direct sequencing of the genomic DNA from maternal and fetal blood cells. Collectively, our study developed an intuitive and cost-effective method for the noninvasive detection of pathogenic mutations, and successfully identified a de novo variant in COL1A1 (c.2596 G > A, p.Gly866Ser) in the fetus implicated in OI.

Integrated management and prognosis analysis of 30 cases of fetal pulmonary valve abnormalities during pregnancy and perinatal period: a retrospective study.

Background: Fetal pulmonary valve anomaly (PVA) can be detected during pregnancy, and is necessary to reconstruct the right ventricle-pulmonary artery circulation as soon as possible after birth. Currently, there are limited reports on prenatal consultation, integrated management during the perinatal period, and prognosis evaluation of fetal PVA especially in China. This study aims to investigate integrated management methods, and the prognosis of fetal PVA. Methods: A retrospective analysis was conducted on the integrated perinatal management and prognosis of 30 fetal PVA cases at Peking University People's Hospital from January 2019 to March 2023. Results: Among the 30 PVA fetuses, 6 (20.0%) had pulmonary atresia with intact ventricular septum (PA/IVS), and 24 (80%) had pulmonary stenosis (PS). Of the 6 PA/IVS fetuses, 5 (5/6) had no abnormalities detected via chromosome analysis, and 1 did not undergo amniocentesis. Four (4/6) PA/IVS patients were delivered by Caesarean section (CS) at the gestational week of (37.0-39.2) weeks and birth weight of (3,000-3,560) g. All of them received alprostadil intravenous pumping (6.00-13.00 ng/min/kg) after birth, followed by transthoracic balloon (pulmonary) valvuloplasty (TBV) + modified Blalock-Taussig shunt (BT) + ligation of ductus arteriosus within 3-7 days. All patients recovered well after follow-up. Among the 24 patients with PS, 4 had severe PS (4/24), 20 had mild PS (20/24). One of them had single-nucleotide polymorphism microarray (SNP array) abnormalities (1/24). Of the 24 patients, 7 (7/24) opted for pregnancy termination. Among the 17 (17/24) PS patients who delivered, 7 (7/17) had spontaneous labor, 1 (1/17) had forceps, and 9 (9/17) had CS. The average gestational week of delivery was (37.8±1.0) weeks, and the average birth weight of newborns was 3,288.8±404.6 g. Three (3/17) severe PS neonates underwent TBV+ modified BT + ligation of ductus arteriosus within 7 days after birth and recovered well after follow-up. Among 14 mild PS patients (14/17), 1 died within 1 week after birth (1/14). Two cases (2/14) underwent surgical treatment and recovered well. Seven cases (7/14) diagnosed with fetal mild PS did not require surgical treatment after birth. PS was not detected in 4 cases (4/14) by echocardiography after birth. The positive predictive value of prenatal ultrasound diagnosis for mild PS was 71.4%. Conclusions: For PVA fetuses, it is recommended to conduct chromosomal karyotype analysis and SNP array, and make an individualized evaluation and management based on the condition of fetal PVA and related abnormalities. The mode of delivery can be selected according to the obstetric situation. When necessary, newborns should be administered alprostadil to keep the ductus arteriosus open and be timely transferred to pediatric cardiac surgery. If the newborns do not experience any other complications after birth, surgery can achieve a good prognosis.

Effect of propofol and sevoflurane on postoperative fatigue after laparoscopic hysterectomy.

BACKGROUND: Postoperative fatigue syndrome (POFS) is an important factor in postoperative recovery. However, the effect of anesthetic drugs on postoperative fatigue in female patients has been rarely studied. This study compared the effects of maintaining general anesthesia with propofol or sevoflurane on the incidence of POFS in patients undergoing laparoscopic hysterectomy. METHODS: This prospective, single-blind, randomized controlled trial enrolled patients scheduled for laparoscopic hysterectomy. Eligible patients were randomized into the propofol and sevoflurane groups. The primary outcome was the incidence of POFS within 30 Days, defined by a simplified identity consequence fatigue scale (ICFS-10) scores≥24 or Visual Analogue Scale (VAS) scores of fatigues>6. Secondary outcomes were perioperative grip strength, early ambulation and anal exhaust after surgery, and inpatient days. RESULTS: 32 participants were assigned to the propofol group (P) and 33 to the sevoflurane group (S). Incidence of POFS on postoperative D1 was P (8/32) vs. S (10/33) (p = 0.66, 95% confidence interval [CI]: 16.4-27.00); D3 P (2/32) vs. S (5/33) (p = 0.45,95% CI:5.96-23.76). POFS were not found on postoperative D5 and D30. There were no differences in perioperative grip strength, early ambulation and anal exhaust after surgery, and inpatient days between the two groups. CONCLUSIONS: POFS after scheduled laparoscopic hysterectomy was unaffected by anesthesia with propofol vs. sevoflurane. The incidence of POFS was highest on the first postoperative day, at 27.7%, and declined progressively over the postoperative 30 days. Trial registration Chinese Clinical Trial Registry (No. ChiCTR 2,000,033,861), registered on 14/06/2020).

Acupoint catgut embedding for chronic non-specific low back pain: A protocol of randomized controlled trial.

Chronic non-specific low back pain (CNLBP) is one of the leading causes of disability worldwide. Acupoint embedding (ACE) is widely used in China for the treatment of chronic non-specific low back pain, but there are no rigorous randomized controlled trials (RCTs) to confirm the effectiveness and safety of ACE for chronic non-specific low back pain. In this study, we design a single-center, single-blind, prospective RCT, with the aim of evaluating the efficacy and safety of ACE for CNLBP. 82 participants with CNLBP will be randomized in a 1:1 ratio into an ACE group and a sham ACE group. Participants will receive either ACE treatment or sham ACE treatment at once every 2 weeks, for an 8-week period, and followed by 6 months of follow-up. The primary outcome will be the change in visual analog scale (VAS) scores before and after treatment. Secondary outcomes will include the Oswestry Disability Index (ODI), the Roland Morris Disability Questionnaire (RMDQ) and the Short Form 36-Health Survey (SF-36). Adverse events that occur during the course of the trial will be recorded. Data will be analyzed according to a predefined statistical analysis plan. This study was approved by the medical ethics committee of Guangzhou Panyu Hospital of Chinese Medicine (202230). Written informed consent from patients is required. This trial is registered in the Chinese Clinical Trial Registry (ChiCTR2200059245). Trial results will be published in a peer-reviewed academic journal. Clinical trial registration: https://www.chictr.org.cn, identifier ChiCTR2200059245.

Acupoint catgut embedding for chronic low back pain: A protocol for systematic review and meta-analysis.

BACKGROUND: The treatment of acupoint catgut embedding (ACE) effective and safe for patients with chronic low back pain (CLBP) is not yet known. This systematic review will objectively and systematically evaluate the efficacy and safety of ACE in CLBP according to the existing evidence. METHODS: The protocol of this systematic review and meta-analyses has been registered in PROSPERO with the registration number CRD42019142256. The following electronic databases from inception to November 29, 2022 will be searched: PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, Web of Science, China National Knowledge Infrastructure (CNKI), Wan Fang Data and Chinese Science Journal Database. Randomised controlled clinical(RCTs) using ACE to treat CLBP will be included. Outcomes will include pain intensity, instrument with assessment function and disability, quality-of-life, and costs. Adverse events will be reported for safety assessment. By screening the titles, abstracts, and full texts, two independent reviewers will select studies, extract data, and assess study quality. Data synthesis, sensitivity analysis, subgroup analysis and risk of bias assessment will be conducted using RevmanV.5.3 software. The Grading of Recommendations Assessment, Development and Evaluation system will be used to assess the quality ofthe evidence. RESULTS: The efficacy and safety of ACE in the treatment of CLBP has not yet been determined. CONCLUSION: This systematic review will objectively and systematically evaluate the efficacy and safety of ACE in CLBP according to the existing evidence, which can give high level clinical recommendations to improve patient care and clinical outcomes.

Intraperitoneal hemorrhage during pregnancy and parturition: Case reports and literature review.

We aim to investigate the diagnosis, treatment, and prognosis of intraperitoneal hemorrhage during pregnancy and parturition.Three cases with intraperitoneal hemorrhage during pregnancy and parturition admitted to our hospital from Jan. 2008 to Jan. 2018 were included in this study. One case showed fetal distress. Abdominal ultrasonography and abdominal CT showed pyoperitoneum in 2 cases. Abdominal puncture was performed in 2 patients, and noncoagulant blood was collected. The indications of emergency caesarean section in 3 cases were intraperitoneal hemorrhage. The etiology included rupture of posterior wall of uterus, rupture of blood vessel on uterine surface, and rupture of inflammatory vessel on uterine surface, respectively. The average volume of intraperitoneal bleeding was 2630 ml, and the average transfusion volume was 1530 ml. Caesarean section, and suture hemostasis were performed in 3 cases. The gestational age of delivery were 40 weeks, 40 weeks, and 25 weeks, respectively. There were 1 stillborn fetus and 2 live infants. All the puerperas were cured and discharged.Intraperitoneal hemorrhage in pregnancy is rare and is easily misdiagnosed. The mortality of pregnant women and perinatal infant is high. Therefore, early diagnosis, and timely operation is important.

Cluster-based copper(II) coordination polymers with azido bridges and chiral magnets.

Three homochiral layered complexes, [Cu3(R-chea)2(N3)6]n (1), [Cu3(S-chea)2(N3)6]n (2) (chea = 1-cyclohexylethylamine) and [Cu3(S-phpa)2(N3)6]n (3) (phpa = 1-phenylpropylamine), and three novel cluster-based coordination polymers, [Cu6(1,2-pn)4(N3)12]n (4) (1,2-pn = 1,2-diaminopropane), [[Cu8(en)4(N3)16] x H2O]n (5) (en = ethylenediamine) and [Cu6(N-Ipren)2(N3)12]n (6) (N-Ipren = N-isopropylethylenediamine), have been synthesized by the self-assembly reactions of Cu(NO3)2 x 3H2O, NaN3 and small organic amine ligands. Their crystal structures are determined by single-crystal X-ray diffraction. Complexes are composed of neutral 2D brick wall networks with only end-on azido bridges. Complexes and are 3D coordination polymers featuring copper-azido clusters and [Cu(diamine)2]2+ units which are linked by the azido bridges. Complex is a 3D coordination framework based on the hexanuclear copper(II) clusters [Cu6(N3)12(N-Ipren)2]. Magnetic studies show that complexes are interesting chiral ferromagnets with the magnetic transition temperature at ca. 5.0 K. Complexes and show ferromagnetic coupling in the copper-azido cluster units and antiferromagnetic interaction between neighboring units, while complex shows ferromagnetic ordering at 3.2 K.