Mechanism of neutrophil extracellular traps generation and their role in trophoblasts apoptosis in gestational diabetes mellitus.

Gestational diabetes mellitus (GDM) is a metabolic syndrome occurring in pregnant women and increases the risk of placental dysplasia. Neutrophil extracellular traps (NETs) may play a critical role in placental dysplasia. NETosis (neutrophil cell death by NET release) depends on NADPH/ROS pathway. In view of the adiponectin which is widely believed to be reduced in GDM patients suppresses NADPH oxidase and ROS generation of neutrophil. We speculate that increased NET release is associated with hypoadiponectinemia. Trophoblast apoptosis is significantly increased in GDM patients, but it is not clear whether NETs promotes cell apoptosis. This study aims to reveal the mechanism of Neutrophil Extracellular Traps generation and their role in trophoblast apoptosis in Gestational Diabetes Mellitus. We investigated the generation of NETs by cell-free DNA (cf-DNA) quantification, live-cell imaging, and reactive oxygen species (ROS) measurement. ERK1/2 and p38 MAPK signalling pathway proteins were detected by western blotting. The Cell Counting Kit-8 (CCK-8) assay, flow cytometry, and western blotting were performed to explore the effects of NETs on trophoblast apoptosis. We found that adiponectin inhibited NET release by suppressing ROS production, and p38 MAPK and ERK1/2 proteins were involved in the process. Further, NETs promoted trophoblast apoptosis by activating the ROS-dependent mitochondrial pathway, which is mediated by ERK1/2 signalling. The current study demonstrated that hypoadiponectinemia is the cause of NETs formation and NETs promoting trophoblast apoptosis.

SARS-CoV-2 on the ocular surface: is it truly a novel transmission route?

Since December 2019, the novel COVID-19 outbreak has spread rapidly around the globe and infected millions of people. Although the major transmission route of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is considered to be airborne droplets and close contact, the ocular transmission route has been reported with great concern. The current work summarises the characteristics of SARS-CoV-2, the ocular distribution of the major SARS-CoV-2 binding protein, and the experimental and clinical evidence of the ocular transmission route. Although it seems that the likelihood of the ocular surface being an infection gateway is low, SARS-CoV-2 infection or transmission via the ocular surface may cause conjunctivitis and other ocular discomfort. Therefore, good eye protection is an essential safeguard procedure, especially for medical staff.

Noninvasive Swansea criteria are valuable alternatives for diagnosing acute fatty liver of pregnancy in a Chinese population.

BACKGROUND: This study aims to assess the diagnostic and prognostic value of Swansea criteria in diagnosing acute fatty liver of pregnancy (AFLP) in a Chinese population. METHODS: A retrospective study was conducted on 52 Chinese women diagnosed with AFLP. All selected cases were reassessed using the Swansea criteria with special focus on the noninvasive criteria, since performing a liver biopsy for this indication is rare in a Chinese population. RESULTS: Ninety point four percent of patients fulfilled five or more of the Swansea criteria. Thirty-one cases were positive for six or more Swansea criteria, but there were no significance differences between patients when using a cutoff criteria <6 or >6. When patients were positive for less than seven criteria, frequency of stillbirth, continuous blood purification (CBP) treatment, hysterectomy, and postpartum hemorrhage were not increased. However, patients who were positive for seven or more criteria had a significantly higher risk of stillbirth and a higher rate of CBP treatment (p < 0.05). Areas under the receiver operating characteristic (ROC) curve of postpartum hemorrhage was 0.670, which reached a statistical significance (p = 0.040). We observed a significantly elevated postpartum hemorrhage along with positivity of the Swansea criteria (p = 0.040). CONCLUSIONS: Swansea criteria without liver biopsy are good screening tools for AFLP diagnosis, and may be useful for assessing disease severity.

[Clinical analysis of pregnancy outcomes and fetal loss after fetal reduction of triplets to twins or singleton pregnancy].

OBJECTIVE: To investigate and evaluate the pregnancy outcomes and fetal loss after fetal reduction of triplets to twins or singleton pregnancy. METHODS: 282 cases of triplets who received multi-fetal pregnancy reduction (MFPR) at Shandong Provincial Hospital affiliated to Shandong University were recruited from Sep 2001 to Mar 2014. According to the remaining fetal number after MFPR, 231 cases were opted to reduce to twins (twins group) while 51 cases were opted to singleton pregnancy (singleton group). The indication of the former group was fetal abnormalities under ultrasound or on patients' demand; while the indication for the later group included dichorionic triamniotic (DCTA) triplets or patients' aspiration. Potassium chloride was injected into the targeted fetal heart until cardiac standstill was obtained. The pregnancy outcomes, gestational age at delivery, birth weight of newborns of the two groups were recorded. Successful pregnancy was defined as take-home at least one baby. RESULTS: (1) The overall rate of successful pregnancy was 91.5% (258/282). There were 413 neonates in the twins group, including 4 neonatal deaths and 409 live babies, with the successful rate of 90.5% (209/231). There were 49 neonates in the singleton group, including 2 cases of fetal loss. Thus the successful rate was 96.1% (49/51). There was no difference of successful pregnancy rate between the two groups (P>0.05). (2) The mean gestational age at operation for the twins group and singleton group were (16.5±3.5) weeks and (14.2±2.0) weeks, respectively. Each group was divided into three periods, 11-13(+6) weeks, 14-16(+6) weeks and ≥17 weeks. In the twins group, the cases in each time period were 129 (55.8%, 129/231), 50 (21.6%, 50/231) and 52 (22.5%, 52/231), respectively. While in the singleton group, the cases in each time period were 27 (53%, 27/51), 16 (31%, 16/51) and 8 (16%, 8/51). There was no difference between the two groups at each time period (P>0.05). (3) The fetal loss rate in the twins group were 7% (9/129), 12% (6/50), 10% (5/52) at each time period, respectively. While for the singleton group they were 4% (1/27), 0 (0/16) and 1/8, respectively. There was no significant difference between the two groups at each time period (P>0.05). (4) The mean birth weight of the twins group was lower than the singleton group [(2,555±447) g vs (3,084±550) g, respectively, P<0.05]. The rates of low birth weight infants (<2,499 g) in the twins group and the singleton group were 45.5% (188/413) and 8% (4/49), respectively (P<0.05). The rate of very low birth weight infants (≤1,499 g) was 3.9% (16/413) in the twins group compared with 0 (0/49) in the singleton group (P>0.05). (5) The gestational age at delivery of the twins group was earlier than the singleton group [(36.2±2.4) weeks vs (38.3±2.2) weeks, respectively, P<0.05]. The labor rate of the two groups was significantly different for both 34-36(+6) weeks and ≥ 37 weeks (P<0.05). The full-term delivery rate in the twins group was 47.6% (110/231), and was 88.2% (45/51) in the singleton group (P < 0.05). The fetal loss rate before 28 weeks did not differ between the two groups [8.7% (20/231) vs 3.9% (2/51), P>0.05]. CONCLUSIONS: Reduction to one fetus led to significantly better outcome than two fetuses, with no significant difference in fetal loss rate. It is better to advise patients with triplets reduce to singleton pregnancy.