A case of fetal isolated ventricular noncompaction with TNNT2 gene mutation and literature review.

BACKGROUND: Ventricular noncompaction (VNC) is a cardiomyopathy characterized by overdeveloped ventricular trabeculaes and deep recess, which has been rarely reported. CASE PRESENTATION: A 29-year-old Chinese pregnant woman with no obvious fetal abnormality in regular prenatal examination during first and second trimester. However, at 32 weeks of gestation, both obstetric growth scan and fetal echocardiogram revealed an enlarged heart with grid-like changes at the apical region. Eventually, the genetic and autopsy findings indicated the deceased infant with VNC. CONCLUSION: Isolated VNC could be detected prenatally, even during the late pregnancy. Fetuses suspected of VNC should be offered genetic tests.

Predicting thermal pleasure experienced in dynamic environments from simulated cutaneous thermoreceptor activity.

Research into human thermal perception indoors has focused on "neutrality" under steady-state conditions. Recent interest in thermal alliesthesia has highlighted the hedonic dimension of our thermal world that has been largely overlooked by science. Here, we show the activity of sensory neurons can predict thermal pleasure under dynamic exposures. A numerical model of cutaneous thermoreceptors was applied to skin temperature measurements from 12 human subjects. A random forest model trained on simulated thermoreceptor impulses could classify pleasure responses (F1 score of 67%) with low false positives/negatives (4%). Accuracy increased (83%) when excluding the few extreme (dis)pleasure responses. Validation on an independent dataset confirmed model reliability. This is the first empirical demonstration of the relationship between thermoreceptors and pleasure arising from thermal stimuli. Insights into the neurophysiology of thermal perception can enhance the experience of built environments through designs that promote sensory excitation instead of neutrality.

Membranous Nephropathy in Pregnancy.

BACKGROUND: Primary membranous nephropathy (pMN) is less common in women of child-bearing age. The kidney risk factors to adverse maternal-fetal outcomes and the effects of pregnancy on pMN process need to be investigated. METHODS: We retrospectively screened all the patients with biopsy-proven pMN from 2008 to 2018. Any cases of pregnancy that occurred at the time of pMN diagnosis or during follow-up were included in the study. Clinical and pathological data were collected from all patients at the time of kidney biopsy and their gestational results were recorded. RESULTS: Of the 27 pregnancies with gestational time of 35.9 ± 4.5 weeks, 10 adverse maternal-fetal events occurred, including fetal loss (11%), preterm delivery (26%), and severe preeclampsia (15%). The kidney parameters were relatively stable with all preserved kidney function. Time-averaged urinary protein (p < 0.001) and serum albumin (p < 0.001), maximum urinary protein (p = 0.001) and minimum serum albumin (p = 0.01) before week 20, anti-phospholipase A2 receptor (PLA2R) positivity (p = 0.03), and no remission during pregnancy (p = 0.004) were risk factors to adverse maternal-fetal outcomes. Time-averaged urinary protein and serum albumin correlated with the birth weight percentile of neonates. CONCLUSIONS: Pregnancy in pMN patients showed risks to adverse maternal-fetal events. Heavy proteinuria, especially before week 20 of gestation, severe hypoalbuminemia, positive anti-PLA2R, and no remission were risk factors to worse outcomes.

Detection of Driving Capability Degradation for Human-Machine Cooperative Driving.

Due to the limitation of current technologies and product costs, humans are still in the driving loop, especially for public traffic. One key problem of cooperative driving is determining the time when assistance is required by a driver. To overcome the disadvantage of the driver state-based detection algorithm, a new index called the correction ability of the driver is proposed, which is further combined with the driving risk to evaluate the driving capability. Based on this measurement, a degraded domain (DD) is further set up to detect the degradation of the driving capability. The log normal distribution is used to model the boundary of DD according to the bench test data, and an online algorithm is designed to update its parameter interactively to identify individual driving styles. The bench validation results show that the identification algorithm of the DD boundary converges finely and can reflect the individual driving characteristics. The proposed degradation detection algorithm can be used to determine the switching time from manual to automatic driving, and this DD-based cooperative driving system can drive the vehicle in a safe condition.

A Concise Synthesis of Presilphiperfolane Core through a Tandem TMTU-Co-Catalyzed Pauson-Khand Reaction and a 6π Electrocyclization Reaction (TMTU=Tetramethyl Thiourea).

The synthesis of strained polycyclic systems from readily available precursors with a minimum number of steps and with regio- and stereochemical control constitutes an important synthetic challenge. Herein, we report a tandem reaction comprising Co-TMTU (tetramethyl thiourea)-catalyzed Pauson-Khand (PK) and 6π-electrocyclization reactions for the formation of the highly strained core of presilphiperfolanols. The developed chemistry has been applied to the total syntheses of 4-epi-presilphiperfolan-8-ol and 7-epi-presilphiperfolan-1-ol.

Association between decreased plasma levels of soluble human leukocyte antigen-G and severe pre-eclampsia.

OBJECTIVE: The aim of this study was to investigate the levels of different isoforms of soluble human leukocyte antigen-G (sHLA-G) in maternal plasma during early and late pregnancy, and to investigate the expression of sHLA-G isoforms in women with early or late-onset severe preeclampsia. METHODS: This prospective, nested, case-control study was performed in 24 early-onset severe preeclamptic, 34 late-onset severe preeclamptic, and 74 uncomplicated pregnant women. Plasma levels of sHLA-G1/5 were measured using ELISA. RESULTS: Plasma sHLA-G1 levels in women with late-onset severe preeclampsia were markedly lower compared with normal controls (median: 0 vs. 1.22 ng/mL) at the first trimester, and plasma sHLA-G1 levels in women with early-onset severe preeclampsia were markedly lower compared with normal controls at the second (median: 0 vs. 1.24 ng/mL) and third (median: 0 vs. 1.34 ng/mL) trimesters. There was no difference between the late-onset and early-onset groups at three trimesters. As for sHLA-G5, there was no difference in concentrations among the three groups at any time point. However, compared with controls, more women with early- or late-onset severe preeclampsia had undetectable sHLA-G5 levels in the first (71.4% and 76.2% vs. 14.1%), second (75.0% and 73.3% vs. 19.0%), and third (100.0% and 70.4% vs. 14.8%, respectively) trimester (all P<0.05). sHLA-G1 levels in the first (odds ratio [OR]=0.254, 95% confidence interval [CI]=0.109-0.591, P=0.010), second (OR=0.315, 95% CI=0.158-0.627, P=0.001), and third (OR=0.170, 95% CI=0.054-0.533, P=0.002) trimester was a risk factor for severe preeclampsia. CONCLUSION: Severe preeclampsia was associated with low/undetectable maternal plasma levels of sHLA-G. Low sHLA-G1 levels might be a risk marker for severe preeclampsia.

[Clinical analysis of double-balloon catheter for cervical ripening in 66 cases].

OBJECTIVE: To evaluate the efficacy and safety for cervical ripening by double-balloon catheter among full-term pregnancy women underwent labor induction. METHODS: It was a prospective non-randomly controlled research. Totally 128 singleton-pregnancy women in full-term who had to undergo labor induction because of pregnancy complications or comorbidities from August 2011 to April 2013 in Peking University First Hospital were selected as study subjects. Participants were allocated to preinduction cervical ripening with either a double-balloon catheter (66 participants, study group) or prostaglandin vaginal insert (62 participants, control group). Compare the efficacy for cervical ripening and adverse reactions between the two groups. RESULTS: The efficacy for cervical ripening (Bishop scores improved by ≥ 2) had no significant differences between study and control groups [82% (54/66) compared with 81% (50/62), P > 0.05]. The time interval between intervention and parturiency was significantly higher in the double balloon catheter group than in the prostaglandin vaginal insert group [(24.2 ± 8.5) compared with (14.5 ± 8.0) hours, P < 0.05]. The proportion of women who achieved parturiency within 12 hours was significantly lower in the double-balloon catheter group than that in the control group [9% (6/66) compared with 21% (13/62), P < 0.05]. The cesarean section rate showed no significant differences [41% (27/66) compared with 43% (27/62), P > 0.05]. The prevalence of intrauterine infection demonstrated by clinical diagnosis was significantly higher in the double- balloon catheter group [11% (7/66) compared with 6% (4/62), P < 0.05]. The double-balloon catheter group had significantly lower rates of contraction over frequency [0(0/66) compared with 42% (26/62), P < 0.05], hyperthermia [3% (2/66) compared with 19% (12/62), P < 0.05], fetal heart rate abnormalities before removing the device or drug [5% (3/66) compared with 19% (12/62), P < 0.05], as well as precipitate labour [2% (1/66) compared with 16% (10/62), P < 0.05]. CONCLUSIONS: The efficacy of a double- balloon transcervical catheter is similar to that of a prostaglandin vaginal insert. However, the double- balloon catheter cannot significantly reduce the cesarean section rate while it increases the risk of intrauterine infection. The maternal and fetal safety of transcervical catheter is superior to the prostaglandin vaginal insert. In cases of oligohydramnios, fetal growth restriction, pregnancy complicated with asthma, hypertension and scar uterine are in favor of a balloon catheter using for cervical ripening on account of high risk of using prostaglandin.

Clinical features of recurrent preeclampsia: a retrospective study of 109 recurrent preeclampsia patients.

Our study aimed to investigate the clinical features of recurrent preeclampsia (rPE) and evaluate the preventive effect of low-dose aspirin (LDA) in rPE. We retrospectively analyzed the data of 109 patients who experienced preeclampsia in two consecutive pregnancies and delivered at Peking University First Hospital from January 2016 to December 2022. We analyzed the pregnancy outcomes of patients with rPE and assessed whether the use of LDA during pregnancy could improve these outcomes. Our results revealed that patients with rPE had a higher body mass index (BMI) and a higher incidence of diabetes during pregnancy compared to their first onset of preeclampsia (29.01 ± 4.70 kg/m2 vs. 27.13 ± 4.25 kg/m2, P < 0.05; 11.01% vs. 1.83%, P < 0.05). Furthermore, the incidence of severe preeclampsia was higher at recurrence in patients with rPE compared to their first onset (83.49% vs. 70.64%, P < 0.05), as well as the incidence of severe preeclampsia with chronic hypertension (34.86% vs. 8.26%, P < 0.05). Additionally, the incidence of gestational diabetes and postpartum hemorrhage was higher in patients with rPE compared to their first preeclampsia onset (25.69% vs. 5.50%, P < 0.05; 20.18% vs. 5.83%, P < 0.05). Compared to the first onset of preeclampsia, patients with rPE had an earlier gestational age at delivery (35.42 ± 3.06 weeks vs. 36.60 ± 2.74 weeks, P < 0.05), lower birth weight of neonates (2478.39 ± 828.44 g vs. 2883.71 ± 712.94 g, P < 0.05), and a higher risk of premature birth (67.00% vs. 47.19%, P < 0.05). However, in patients with rPE, the use of LDA delayed the gestational age at delivery, increased the birth weight of the neonate, reduced the premature birth rate, and increased the perinatal survival rate. In conclusion, patients with rPE are at an increased risk of adverse maternal and fetal outcomes. However, the use of LDA during pregnancy effectively improves these outcomes.

Risk prediction for preeclampsia in CKD patients: development of a model in a retrospective cohort.

BACKGROUND: Chronic kidney disease (CKD) may affect women of childbearing age and may lead to substantial maternal and foetal morbidity and mortality in pregnancy. There is a lack of prediction models for  preeclampsia and adverse pregnancy outcomes in pregnant women with CKD. This study aimed to create a prediction nomogram for these issues. METHODS: This retrospective cohort study included clinical data from 627 women with CKD and their 627 pregnancies at Peking University First Hospital between January 1, 2009, and December 31, 2022. Multivariate logistic regression analysis was conducted to identify independent prognostic factors and develop a nomogram for predicting the occurrence of preeclampsia. The identified risk factors were utilised to construct the nomogram, which was subsequently internally validated using receiver operating characteristic (ROC) analysis and calibration curve assessment. RESULTS: According to our multivariate analysis, age, blood urea nitrogen (BUN), serum creatinine (Scr), mean arterial pressure (MAP), 24-h proteinuria, and CKD stage were identified as predictors of preeclampsia. Additionally, Scr, MAP, BUN, and 24-h proteinuria were found to be predictors of adverse pregnancy outcomes. The nomogram for predicting preeclampsia had an area under the ROC curve of 0.910, while the nomogram for predicting adverse pregnancy outcomes had an area under the ROC curve of 0.906. Both models demonstrated excellent discriminatory ability. CONCLUSIONS: A nomogram based on 24-h proteinuria, serum creatinine, serum urea and age, and MAP allows predicting the occurrence of preeclampsia and other adverse pregnancy-related outcomes in CKD patients.

Age at Menarche Mediating Visceral Adipose Tissue's Influence on Pre-eclampsia: A Mendelian Randomization Study.

CONTEXT: The association between visceral adipose tissue (VAT) and pre-eclampsia (PE) shows inconsistent results and the underlying mediator remains unknown. OBJECTIVE: We aimed to explore the causal effect of VAT on PE risks and the mediation role of age at menarche (AAM) in explaining this relationship. METHODS: Summary data for PE were obtained from the FinnGen genome-wide association study (3556 cases and 114 735 controls). For exposure data, 70 genetic variants associated with the predicted VAT in 161 149 European women from UK Biobank were used as instrumental variables. Inverse variance weighted and multiple sensitivity analyses were applied. We also conducted multivariable Mendelian randomization (MR) analyses to test the association between VAT-associated single-nucleotide variations and PE. Next, mediation analyses were performed to study whether the association between VAT and PE was mediated via AAM. RESULTS: In univariable MR analysis, higher volume of VAT was associated with the advancement of AAM and increased PE risk (beta = -0.33; 95% CI, -0.49 to -0.16 for AAM; odds ratio 1.65, 95% CI, 1.23 to 2.20 for PE). After adjusting for waist circumference, waist to hip ratio, and hip circumference, the multivariable MR results presented the consistent positive causality of VAT on PE. Two-step MR analysis proved an estimated 14.3% of the positive effect of VAT on PE was mediated by AAM. CONCLUSION: Our findings provided evidence of the causal relationship between VAT and PE and proved VAT could accelerate AAM and then contribute to the risk of incident PE.

Twenty-four-hour proteinuria levels are associated with adverse pregnancy outcomes among women with CKD.

Background: Proteinuria is commonly measured to assess the renal status of chronic kidney disease (CKD) patients before the 20th week of gestation during pregnancy. High levels of proteiuria have been associated with adverse pregnancy outcomes. However, researchers have not clearly determined what baseline proteinuria levels would be associated with adverse pregnancy outcomes. This study aimed to analyse associations between proteinuria levels and adverse pregnancy outcomes among CKD patients treated with or without steroids/immunosuppressive therapy in early pregnancy. Methods: This retrospective study included the clinical information of 557 pregnant patients with CKD from 1 January 2009 to 31 December 2021. A multivariable logistic regression analysis was conducted to evaluate the risk of adverse pregnancy outcomes across various proteinuria ranges, which were further stratified by whether the patients were receiving steroids/immunosuppressive therapy. Results: (i) Proteinuria was assessed on 24-h urine collection. The median (quartile) baseline proteinuria levels were 0.83 g (0.20, 1.92) and 0.25 g (0.06, 0.80) in the steroids/immunosuppressive therapy and therapy-free groups, respectively. (ii) CKD patients with adverse pregnancy outcomes had significantly higher proteinuria levels in the first trimester than patients without adverse pregnancy outcomes. (iii) The risk of adverse pregnancy outcomes increased with increasing baseline proteinuria levels (P < .001). (iv) In the early-pregnancy steroids/immunosuppressive therapy group, the risk of severe preeclampsia was higher in patients with higher baseline proteinuria levels (P < .007) [odds ratio (OR) 30.86 for proteinuria ≥5.00 g/24 h]; in the therapy-free group, the risks of severe preeclampsia, very-low-birth-weight infants, early preterm birth and foetal-neonatal death were higher in patients with higher baseline proteinuria levels (OR 53.16 for proteinuria ≥5.00 g/24 h; OR 37.83 for proteinuria ≥5.00 g/24 h; OR 15.30 for proteinuria ≥5.00 g/24 h; and OR 18.83 for proteinuria ≥5.00 g/24 h, respectively; P < .001, P < .001, P < .001 and P = .006, respectively). Conclusions: As shown in the present study, a baseline 24-h proteinuria level >1.00 g was associated with adverse maternal outcomes. Furthermore, a 24-h proteinuria level >2.00 g increased the incidence of adverse foetal events among CKD patients.

[Expression of various subtypes of human leukocyte antigen-G in placenta of patients complicated with severe pre-eclampsia].

OBJECTIVE: To investigate the different expression of various subtypes of human leukocyte antigen-G (HLA-G) in placenta of patients complicated with severe pre-eclampsia. METHODS: Ten placental samples from early-onset severe pre-eclamptic pregnancies and ten from late-onset severe pre-eclamptic pregnancies were collected as study group; ten placental samples from preterm pregnancies and ten from normal pregnancies were collected as control group. The levels of HLA-G protein in the four groups were measured by western blot and immunohistochemistry. RESULTS: (1) HLA-G1 protein decreased significantly in both the early-onset (2.4 ± 0.6 versus 2.9 ± 1.1, P < 0.05) and the late-onset pre-eclampsia groups (3.5 ± 2.1 versus 4.2 ± 2.4, P < 0.05). (2) HLA-G5 protein increased in the late-onset pre-eclampsia groups (1.8 ± 1.1 versus 1.1 ± 0.9, P < 0.05); the increase in the early-onset pre-eclampsia group is not obvious (1.6 ± 0.9 versus 1.4 ± 0.7, P > 0.05). (3) The level of HLA-G1 protein in placenta from patients complicated with premature labor is lower (2.9 ± 1.1 versus 4.2 ± 2.4, P < 0.05); HLA-G5 protein does not change significantly (1.4 ± 0.7 versus 1.1 ± 0.9, P > 0.05). (4) HLA-G1 and G5 proteins mainly express in the placenta extravillous cytotrophoblast cells. There is also a high level of expression around the blood vessels and in the extraembryonic mesoderm. CONCLUSIONS: (1) HLA-G1 decreased significantly in both the early-onset and late-onset pre-eclamptic patients. (2) HLA-G5 increased in both the early-onset and late-onset pre-eclamptic patients, and the increase in the late-onset pre-eclamptic patients is obvious. (3) In late pregnancy, the level of HLA-G1 is lower in patients complicated with premature labor, this may be the result of its earlier pregnancy week; HLA-G5 does not change significantly. (4) HLA-G1 and G5 mainly express in the placenta extravillous cytotrophoblast cells.

Equivalence tests for ratio of means in bioequivalence studies under crossover design.

There are several problems concerning the statistical definition of average bioequivalence provided by the U.S. Food and Drug Administration. We proposed a ratio of means based on the original bioavailability measure as the definition for average bioequivalence. Under the log-normal distribution assumption, we proposed a hypothesis testing-based method and a confidence interval-based method to answer the question of whether the ratio of means falls into a predetermined interval. For the hypothesis testing-based method, we decomposed the null two-sided hypothesis of the ratio of means into two one-sided hypotheses. With the intersection-union theorem for asymptotic tests, we constructed two asymptotic size-α tests for the original null hypothesis. The method of variance estimation recovery was adopted to develop the confidence interval-based method. Simulation studies showed that the proposed methods can maintain the empirical type I error rate closely at the nominal level and is as powerful as the two one-sided t-test for testing the ratio of means under different settings. The application of the proposed methods was illustrated through six datasets in real-world examples.

Plasma Levels of Vitamin A in Early Pregnancy and Correlationship with Hypertensive Disorder.

Objective. Analyzing the vitamin A content in early pregnancy and finding out the relationship between the serum levels of vitamin A of pregnant women and hypertensive disorder. Method. A total of 4,188 pregnant women who had took part in vitamin A testing in Miyun District Hospital from November 2016 to March 2020 were collected. The serum levels of vitamin A were determined by high performance liquid chromatography, and clinical and testing data were collected for statistical analysis. The original data outcome was finally analyzed with the SPSS. Results. 266 Hypertensive disorder cases and 2836 normal pregnancy cases were analyzed with 27 cases of twin pregnancy, 315 cases without follow-up and 744 of diabetic pregnancies excluded. The 266 women were divided into four groups: 110 women were diagnosed gestational hypertension, 65 women were diagnosed preeclampsia, 78 women were diagnosed pregnancy with chronic hypertension, and 13 women were diagnosed chronic hypertension with preeclampsia. The results shows that vitamin A level of the hypertensive group was 0.46(±0.08) mg/L, 0.47 (±0.012) mg/L, 0.47 (±0.09) mg/L, and 0.52 (±0.012) mg/L, respectively, while the level of normal group was 0.44 (±0.09) mg/L. We found that there were differences between the normal pregnant group and the preeclampsia group with statistical significance (P < 0.05). The difference between the pregnancy with chronic hypertension group and the normal group was statistically significant (P < 0.05). The difference between the chronic hypertension with preeclampsia group and the normal group was also statistically significant (P < 0.05). Conclusion. Serum levels of vitamin A in early pregnant women have a certain correlation with the hypertensive disorder.

Pregnancy in patients with stage 3-5 CKD: Maternal and fetal outcomes.

OBJECTIVE: To investigate pregnancy outcomes and the effects of pregnancy on kidney function in patients with stage 3-5 chronic kidney disease (CKD). METHODS: This was a retrospective study. The clinical data of women with pregnancies complicated by stage 3-5 CKD who delivered in the Peking University First Hospital from January 1st, 2013, to December 31st, 2020, were analyzed. RESULTS: Fifty-three patients with 54 pregnancies were studied. The mean levels of serum creatinine and eGFR in the first trimester were 138.4 ± 76.7 µmol/l and 44.9 ± 13.5 ml/min/1.73 m2, respectively. The perinatal mortality rate was 1.92%. The mean gestational age at birth was 35.4 weeks, and the average infant birth weight was 2333 g. The average gestational week at delivery of patients with stage 3a CKD was 36.8 ± 2.1 weeks and there were no adverse neonatal outcomes. Compared with that in early pregnancy, the mean eGFR at 6 months after delivery decreased (52.3 ± 7.3 vs 44.8 ± 10.5 ml/min per 1.73 m2, P < 0.01) in patients with stage 3a CKD and urine protein ≥ 1 g/24 h and in patients with stage 3b CKD and urine protein ≥ 1 g/24 h (38.0 ± 2.7 vs. 26.9 ± 10.1 ml/min per 1.73 m2, P = 0.03). CONCLUSION: The pregnancy outcomes of patients with stage 3a CKD and proteinuria<1 g/24 h are acceptable. Pregnancy accelerates renal function deterioration more significantly among patients with stage 3-5 CKD and urinary protein concentrations above 1 g/24 h.

Clinical practice guidelines for oral health care during pregnancy: a systematic evaluation and summary recommendations for general dental practitioners.

OBJECTIVE: To evaluate and summarize clinical practice guidelines on the prevention, diagnosis, and treatment of dental diseases during pregnancy, and to provide summary recommendations for general dental practitioners involved in the dental care of pregnant women. METHOD AND MATERIALS: Using keywords related to prenatal dental care in combination with guidelines or consensus statements, online databases, websites of professional organizations, and evidence-based practice platforms were searched. Published guidelines or consensus statements that met the inclusion criteria were selected and evaluated with the Appraisal of Guidelines for Research & Evaluation Instrument II (AGREE-II) tool. Key recommendations were summarized and assessed for consistency across the guidelines. RESULTS: A total of 15 guidelines or consensus statement documents for oral health care during pregnancy were found after the initial search, of which 7 documents met the inclusion criteria; these were analyzed with AGREE-II. These guidelines were developed by expert panels and consensus meetings after comprehensive review of the best available evidence, and consistently deliver clear messages that preventive, diagnostic, restorative, and periodontal procedures and tooth extractions are safe throughout pregnancy and effective in improving and maintaining the oral health of mothers and their children. Dental diseases should be treated in a timely manner and dental emergency treatments can be provided at any time during pregnancy. Dental examination and prophylaxis should be conducted every 6 months to maintain the oral health of pregnant women. CONCLUSION: Published clinical guidelines are consistent in delivering clear messages and providing guidance to dental practitioners for timely and effective dental care during pregnancy. Prevention, diagnosis, and treatment of oral diseases are safe throughout the pregnancy.

Dysregulation of complement system in HELLP syndrome.

OBJECTIVE: To investigate the expression of complement system's activation factors in patients with HELLP syndrome. METHODS: A case-control study was performed. Sixteen HELLP syndrome patients, 32 severe preeclampsia patients, and 48 normal pregnancy women were involved in this studyELISA was used to test C1q, C4d, MBL, Bb, C3a, C5a, sC5b-9, s-Endoglin, and sflt-1 in the plasma. RESULTS: The levels of C5a (P < 0.01) and sC5b-9 (P = 0.014) in HELLP syndrome were higher than those in severe preeclampsia patients. CONCLUSIONS: The abnormal activation of the complement system is more significant in the pathogenesis of HELLP syndrome than in severe preeclampsia.

Low-dose aspirin for the prevention of severe preeclampsia in patients with chronic kidney disease: a retrospective study : This is the study for kidney and pregnancy...

OBJECTIVE: The objective of the study was to investigate the effects of low-dose aspirin (LDA) during pregnancy on the prevention of preeclampsia in patients with chronic kidney disease (CKD). METHODS: The clinical data of pregnant women with CKD were retrospectively analyzed at Peking University First Hospital between January 2013 and January 2020. Among 287 pregnant women with stage 1-2 CKD, 63 patients who were treated with LDA were included in study group 1, and 63 patients who were not treated with aspirin were allocated to control group 1. Among 41 pregnant women with stage 3-5 CKD, 22 patients who were treated with LDA were included in study group 2, and 19 patients were allocated to control group 2. Pregnancy outcomes of the patients with stage 1-2 and stage 3-5 CKD who received LDA during pregnancy and those who did not were compared. RESULTS: No significant difference was observed in the incidence of preeclampsia or severe preeclampsia between study and control group 1. The patients in study group 2 had a lower incidence of severe preeclampsia than those in control group 2 (3/22 [13.6%] vs. 8/19 [42.1%], P = 0.04). Among the patients with stage 3-5 CKD, LDA therapy during pregnancy was associated with a lower risk of severe preeclampsia (odds ratio = 0.22, 95% confidence interval: 0.074-0.993; P = 0.049). CONCLUSIONS: LDA therapy during pregnancy can reduce the risk of severe preeclampsia in patients with stage 3-5 CKD. Prospective studies are  needed to further explore the preventive effects of aspirin on preeclampsia in patients with stage 1-2 CKD.

[Effects of gestational age on perinatal outcomes in patients complicated with early onset severe preeclampsia].

OBJECTIVE: To analysis the relationship between gestational age and perinatal outcomes in patients complicated with early onset severe preeclampsia. METHODS: Retrospective study was conducted on clinical documents of 221 patients with early onset severe preeclampsia (< 34 weeks) who delivered after 28 gestational weeks in Peking University First Hospital from July 1999 to June 2009. Patients were divided into three groups based on gestational weeks at delivery: group I (n = 81) delivered at 28 - 31 weeks(+6), group II (n = 78) at 32 - 33 weeks(+6) and group III (n = 62) after 34 weeks. The clinical characteristics and perinatal outcomes were compared among those three groups. RESULTS: (1) Outcome of neonates: Among 221 neonates, 13 neonates lost follow-up, including 9 in group I, 3 in group II, 1 in group III. The incidence of neonatal respiratory distress syndrome (RDS) of 26% (19/72) in group I were significantly higher than 7% (5/75) in group II and 10% (6/61) in group III (P < 0.05). The neonatal mortality rate of (43%, 31/72) in group I were significantly higher than 3% (2/61) in group III and 28% (21/75) in group II (P < 0.05). The incidence of maternal complications showed no statistical difference among three groups. (2) Neonatal death analysis: all neonatal death were due to parents' give up, including 26% (8/31) in group I, 67% (14/21) in group II and 1/2 in group III, which reached statistical difference (P < 0.05). CONCLUSIONS: The incidence of neonatal RDS in mother with early onset severe preeclampsia was decreased if delivered after 32 weeks, and the perinatal mortality was remarkably decreased if delivered after 34 weeks. Therefore, the perinatal survival rate in women with early onset severe preeclampsia can be improved by minimizing the impact of social factors.

Concise gram-scale synthesis of Euphorikanin A skeleton through a domino ring-closing metathesis strategy.

Euphorikanin A is a diterpenoid possessing a highly congested and unprecedented 5/6/7/3-fused tetracyclic ring skeleton. To access the challenging chemical structure of Euphorikanins, an efficient total synthetic approach is described. The stereoselective synthesis of the core structure of Euphorikanin A has been achieved from a simple dienyne building block, and a domino ring-closing metathesis (RCM) strategy was used for the gram-scale synthesis of the highly strained Euphorikanin A core. This paves the way for the synthesis of structurally diverse Euphorikanins.