[Research of placental vascular distribution and clinical outcome in monochorionic twins].

OBJECTIVE: To study the placental vascular distribution of monochorionic (MC) twins with twin-to-twin transfusion syndrome (TTTS) or birth weight discordance. METHODS: Twenty-eight MC placentas were injected in Peking University Third Hospital between Feb. 2010 and Feb. 2011. The vascular distribution type (parallel, crossed, mixed and monoamniotic), the anastomosis of vessels and the placental sharing were recorded. The outcome of pregnancy and the placental characteristics of birth weight discordance (birth weight discordance≥20%) in non-TTTS MC twins were analyzed. RESULTS: (1) The outcome of pregnancy: the miscarriage or gestational weeks of 28 MC twins were 20 to 38 weeks (median of 35 weeks). Six cases were TTTS, 3 of which received fetoscopic laser occlusion of communicating vessels (FLOC). There were 48 live births, with an average birth weight of (2036±623) g. (2) Type of placental vascular distribution:in the 28 MC placentas, number of parallel, crossed, mixed and monoamniotic type of placental vascular distribution were 4 (14%), 14 (50%), 6 (21%) and 4 (14%) cases, respectively. No parallel type was found in TTTS. There was no significant difference of vascular anastomosis or unequal placental sharing among the different placental vascular distribution types (P>0.05). (3) Characteristics of placental vascular distribution in birth weight discordance twins:there were 20 non-TTTS MC twin pregnancies, all of which got live births of both babies. Birth weight discordance equal to or more than 20% was found in 6 pairs of newborns, while birth weight discordance less than 20% was found in the rest 14 cases. Ratio of unequal placental sharing was significantly different between the two groups (P<0.01). There was no significant difference of umbilical cord insertion, placental vascular distribution and anastomosis in the two groups (P>0.01). CONCLUSIONS: Vascular distribution type of MC twins might be related to TTTS. Unequal placental sharing is a risk factor of birth weight discordance in non-TTTS MC twins.

[Left ovarian vein thrombosis after cesarean section: a case report].

To investigate the clinical presentation, diagnosis and therapy of the postpartum ovarian vein thrombosis. Retrospective analysis was made of one case in our hospital of postpartum ovarian vein thrombosis. Literature was reviewed to investigate the clinical presentation,diagnosis and therapy of postpartum ovarian vein thrombosis. The patient presented with fever, abdominal pain, lower back pain, and ultrasound showed pyelectasis. Her blood and urine bacterial culture was negative, and the antibiotic treatment had no significant effect, which was diagnosed by CT finally. The patient's blood routine returned to normal 3 days after anti-inflammatory and anticoagulant therapy, and thrombosis was significantly reduced. She was followed-up and her condition was stable. Postpartum ovarian vein thrombosis patients often present with high temperature with unknown causes and one side abdominal pain, and CT diagnosis is needed. Timely and effective anti-inflammatory and anticoagulant therapy can significantly improve the prognosis.

Life-threatening postpartum hemorrhage (≥ 5000 mL): a single center experience.

OBJECTIVES: To investigate the etiology, interventions and outcome of life-threatening postpartum hemorrhage (PPH) (≥ 5000 mL). MATERIAL AND METHODS: Retrospective analysis was performed on the clinical data of 42 patients with life-threatening PPH in Peking University Third Hospital from January 2010 to December 2019. According to the causes of PPH, 35 patients were divided into the placenta accrete spectrum (PAS) group and seven patients into the uterine atony group. RESULTS: Compared with the uterine atony group, the gravidity, parity, times of cesarean section, abortion and intrauterine operation of the PAS group were significantly higher, but the gestational age of delivery and the birth weight of newborn were significantly lower (33.35 ± 3.94 weeks vs 37.31 ± 1.93 weeks; 2228.29 ± 840.49 g vs 2809.00 ± 500.99 g; p < 0.05). For all the patients, the transfusion volume of packed red blood cell (PRBCs), fresh frozen plasma (FFP) and platelets were respectively 23.49 ± 8.42 U, 2345.24 ± 826.16 mL and 0.81 ± 1.19 U, the ratio was basically conformed to the recommended massive transfusion protocol (MTP) (1:1:1). The catheter placement time in the PAS group was significantly longer (7.88 ± 6.05 days vs 3.86 ± 0.90 days, p < 0.05). There were no significant differences in complications and maternal outcomes. No maternal deaths. CONCLUSIONS: Placenta accrete spectrum (PAS) is the most important cause of life-threatening PPH. For these patients, MTP is effective, multidisciplinary cooperation and management lead to a good prognosis.

[Expressions of HIF-α and its target gene in monochorionic twin placentas with twin-twin transfusion syndrome].

OBJECTIVE: To determine hypoxia-inducible factor 1α (HIF-1α) and its target gene, vascular endothelial growth factor (VEGF) and receptor (VEGFR-1) concentrations in the placentas of the donor and recipient in monochorionic twin pregnancies with twin-twin transfusion syndrome (TTTS). METHODS: Twenty monochorionic twin pregnancy cases were included in the study (10 with and 10 without TTTS). Tissue protein expressions of HIF-1α,VEGF and VEGFR-1 were determined by using immunohistochemistry. Western blot analysis were used to quantify and compare the protein expression. RT-PCR were used to compare their mRNA expressions. RESULTS: HIF-1α was mainly observed in trophoblastic cells and villi capillaries endothelial cells, and VEGF in trophoblastic cells, endothelial cells and villi stromal cells; VEGFR-1 was mainly observed in villi trophoblastic cells and vascular endothelial cells. The placenta protein and mRNA expression of HIF-1α and its target gene in the donor placenta increased significantly (P<0.001) compared with that in the control placenta, but the expression of HIF-1α and its target gene in the recipients tended to be similar in the controls (P>0.05). There was no difference between the controls. CONCLUSION: When the monochorionic twin placenta is formed in the early period, HIF-1α, VEGF and VEGFR-1 are over-expressed, which may affect the placenta angiogenesis and induce TTTS .

A Hematological-Related Prognostic Scoring System for Patients With Newly Diagnosed Glioblastoma.

BACKGROUND: Glioblastoma is the most common primary malignant brain tumor. Recent studies have shown that hematological biomarkers have become a powerful tool for predicting the prognosis of patients with cancer. However, most studies have only investigated the prognostic value of unilateral hematological markers. Therefore, we aimed to establish a comprehensive prognostic scoring system containing hematological markers to improve the prognostic prediction in patients with glioblastoma. PATIENTS AND METHODS: A total of 326 patients with glioblastoma were randomly divided into a training set and external validation set to develop and validate a hematological-related prognostic scoring system (HRPSS). The least absolute shrinkage and selection operator Cox proportional hazards regression analysis was used to determine the optimal covariates that constructed the scoring system. Furthermore, a quantitative survival-predicting nomogram was constructed based on the hematological risk score (HRS) derived from the HRPSS. The results of the nomogram were validated using bootstrap resampling and the external validation set. Finally, we further explored the relationship between the HRS and clinical prognostic factors. RESULTS: The optimal cutoff value for the HRS was 0.839. The patients were successfully classified into different prognostic groups based on their HRSs (P < 0.001). The areas under the curve (AUCs) of the HRS were 0.67, 0.73, and 0.78 at 0.5, 1, and 2 years, respectively. Additionally, the 0.5-, 1-y, and 2-y AUCs of the HRS were 0.51, 0.70, and 0.79, respectively, which validated the robust prognostic performance of the HRS in the external validation set. Based on both univariate and multivariate analyses, the HRS possessed a strong ability to predict overall survival in both the training set and validation set. The nomogram based on the HRS displayed good discrimination with a C-index of 0.81 and good calibration. In the validation cohort, a high C-index value of 0.82 could still be achieved. In all the data, the HRS showed specific correlations with age, first presenting symptoms, isocitrate dehydrogenase mutation status and tumor location, and successfully stratified them into different risk subgroups. CONCLUSIONS: The HRPSS is a powerful tool for accurate prognostic prediction in patients with newly diagnosed glioblastoma.