Overexpression of secretory leukocyte peptidase inhibitor (SLPI) does not modulate experimental osteoarthritis but may be a biomarker for the disease.

OBJECTIVE: Osteoarthritic cartilage destruction can be regulated by the balance between proteases and anti-proteases. Here, we sought to identify novel cellular protease inhibitors associated with osteoarthritis (OA) pathogenesis. METHODS: Candidate molecules were screened from microarray data of chondrocytes treated with OA-associated catabolic factors. The functions of candidate molecules in OA pathogenesis were examined in primary-culture mouse articular chondrocytes and mouse models of OA, such as those stimulated by destabilization of the medial meniscus (DMM) or intra-articular (IA) injection of adenovirus expressing the candidate gene. The value of the selected candidate molecule as a biomarker of OA was examined by measuring its circulating levels in human and mouse blood. RESULTS: Bioinformatic analysis identified secretory leukocyte peptidase inhibitor (SLPI) as a highly upregulated cellular protease inhibitor in chondrocytes treated with pathogenic catabolic factors, including interleukin (IL)-1ß, hypoxia-inducible factor (HIF)-2α, and zinc importer ZIP8. The adenovirus-mediated overexpression of SLPI in joint tissues did not cause any OA-like change or modulate DMM- or HIF-2α-induced experimental OA in mice. SLPI also did not markedly modulate the expression of OA-associated catabolic or anabolic factors in chondrocytes. However, SLPI was specifically upregulated in OA cartilage, and the serum SLPI levels were significantly elevated in human OA patients and experimental OA mice, suggesting that SLPI may be a biomarker of OA. CONCLUSION: Although SLPI is upregulated in OA chondrocytes, it does not appear to per se modulate OA development in mice. However, it may be a potential biomarker of OA in humans and animal models.

Pro-inflammatory mediators and signaling proteins in the decidua of pre-eclampsia.

OBJECTIVE: To evaluate the role of CD68+ macrophages and inflammatory/signaling proteins in the decidua of singleton pregnancies with late-onset pre-eclampsia. PATIENTS AND METHODS: This study was designed as a prospective case-control study. Decidual tissue samples were obtained from twenty healthy pregnant women as a control group and twenty pregnant women with late-onset pre-eclampsia showing severe symptoms as the study group. We examined the abundance of CD68+ macrophages in both groups using flow cytometry. Protein and mRNA expression levels of inflammatory/signaling proteins, including inducible nitric oxide synthase, nuclear factor-κB inhibitor α, cyclooxygenase-2, and phosphorylated c-Jun N-terminal kinase, in the decidua of both groups were measured using Western blotting and Reverse Transcription-Polymerase Chain Reaction, respectively. Student's t-tests were performed for statistical analysis. RESULTS: The numbers of CD68+ macrophages were similar in the study and control groups (p=0.47). However, the levels of inducible nitric oxide synthase, nuclear factor-κB, cyclooxygenase-2, and phosphorylated c-Jun N-terminal kinase were significantly increased in the study group. Therefore, pro-inflammatory mediators and signaling proteins in the decidua during pre-eclampsia may be related to the pathogenesis of pre-eclampsia. CONCLUSIONS: Pre-eclampsia-induced alterations in the expression of inflammatory/signaling proteins in the decidua during singleton pregnancies may play a critical role in the pathogenesis of pre-eclampsia.

Daily skin care habits and the risk of skin eruptions and symptoms in cancer patients.

BACKGROUND: Cancer patients are at high risk for skin problems because rapidly proliferating skin cells are susceptible to anticancer therapies. However, the effects of daily skin care habits on development of skin problems in cancer patients have rarely been studied. PATIENTS AND METHODS: We conducted a survey of daily skin care habits and the presence of skin problems in 866 cancer patients. RESULTS: Hot water bath>1 h significantly increased the risk of definite eruptions [odds ratio (OR) 4.09] and the risk of itching or pain on the skin (OR 1.73). Diligent use of moisturizers did not decrease the risk of definite eruptions and symptoms, and daily bathing, scrubbing off the skin while bathing, and sun protection did not influence the risk of definite eruptions and symptoms. Subgroup analysis of 183 breast cancer patients showed results similar to the total results, including that hot water bath>1 h significantly increased the risk of definite eruptions (OR 3.41). CONCLUSIONS: Being a cross-sectional study, our study could not prove causality. However, at the present stage of knowledge, avoidance of hot water baths of protracted duration should be first emphasized in patient education to prevent skin problems in cancer patients.

Diagnosis in the first trimester of placenta accreta with previous Cesarean section.

The prenatal diagnosis of adherent placenta is clinically very important, as this condition can seriously affect perinatal mortality and morbidity. The outcome is generally worse in cases with a history of Cesarean section. Here we report a case of placenta increta associated with previous Cesarean delivery, diagnosed by sonography during the first trimester, enabling earlier counseling of the parents and planning of appropriate treatment.

Sonographic findings of placental lacunae and the prediction of adherent placenta in women with placenta previa totalis and prior Cesarean section.

OBJECTIVE: To investigate the value of transvaginal sonographic findings of intraplacental lacunae for predicting adherent placenta and clinical outcome in patients with placenta previa totalis and a history of Cesarean section. METHODS: Fifty-one patients with placenta previa totalis diagnosed by transvaginal sonography and with a history of Cesarean section who delivered at our hospital were included in the study. The sonographic findings of intraplacental lacunae were classified into one of four grades. Pathological analysis of the placenta was performed for all patients who delivered, and in cases of hysterectomy, examination of the uterus was also performed. The placental findings and obstetric complications, including massive transfusion, intensive care unit admission and Cesarean hysterectomy, were compared with the grade of lacuna. RESULTS: Lacunae were classified as Grade 1+ in 10 cases, Grade 2+ in 11 cases, Grade 3+ in five cases and as Grade 0 (i.e. lacunae were absent) in the remaining 25 cases. When lacunae of > or = Grade 1+ were considered, the sensitivity, specificity, positive predictive value and negative predictive value of diagnosing adherent placenta were 86.9%, 78.6%, 76.9% and 88.0%, respectively. When lacunae of > or = Grade 2+ were considered, the sensitivity, specificity, positive predictive value and negative predictive value of diagnosing placenta increta or percreta were 100%, 97.2%, 93.8% and 100%, respectively. Hysterectomy was performed in 18 cases, among whom two cases showed Grade 1+ lacunae, 11 cases showed Grade 2+ lacunae, and five cases showed Grade 3+ lacunae. No hysterectomy was performed in any case in which lacunae were absent. Compared to those without lacunae, the number of massive transfusions and intensive care unit admissions and cases of disseminated intravascular coagulopathy and Cesarean hysterectomy were significantly greater in those with lacunae (P < 0.0001). CONCLUSION: Transvaginal sonographic findings of intraplacental lacunae in patients with placenta previa totalis and a history of Cesarean section are useful in the prediction of adherent placenta and may have a role in the prediction of clinical outcome.

Clinical outcomes of pregnancy with one elevated glucose tolerance test value.

OBJECTIVE: To evaluate clinical outcomes of pregnancies with one elevated glucose tolerance test. METHODS: We performed a 50 g glucose challenge test (GCT) in 5,019 pregnant women at 24-28 weeks of gestation. In 1,170 women with plasma glucose levels over 130 mg/dl, a 100 g oral glucose tolerance test (OGTT) was performed at 28-32 weeks of gestation. During follow-up, 282 patients were lost and in the 888 cases that were followed-up, 189 were excluded because of GDM. Therefore 699 study patients were divided into four groups: No Elevated group (NE, N = 577) with all four normal 100 g OGTT values, and Groups 1 (N = 16), 2 (N = 35), and 3 (N = 71) with one elevated 100 g OGTT value after 1, 2 and 3 h, respectively. RESULTS: Poor maternal outcomes (NE group, Group 1, Group 2, Group 3: 17.5%, 37.6%, 22.9%, 25.3%) with pre-eclampsia, cesarean delivery for cephalopelvic disproportion, failure to progress, or fetal distress, was highest in Group 1 (odds ratio 2.94; 95% confidence interval 1.02-8.42). Poor perinatal outcomes (15.8%, 43.1%, 14.3%, 21.1%) with any one of the following; fetal distress, Apgar score of < 7 at 5 min, hypoglycemia, respiratory distress syndrome, small for gestational age and perinatal death, was also highest in Group 1 (odds ratio 4.24; 95% confidence interval 1.02-17.52). CONCLUSION: Pregnancies with one elevated glucose tolerance test value after 1 h exhibited increased adverse maternal and perinatal outcomes compared with the group with all normal OGTT values or the groups with an elevated glucose tolerance test value after 2 or 3 h.