Serum levels of the adipokine zinc-α2-glycoprotein are increased in preeclampsia.

BACKGROUND: Preeclampsia (PE) is associated with facets of the metabolic syndrome and an increased future metabolic and cardiovascular risk for mother and newborn. Recently, zinc-α2-glycoprotein (ZAG) has been proposed as a new adipokine involved in the pathogenesis of obesity. AIM: In the current study, we investigated ZAG serum levels in PE patients as compared to healthy gestational age-matched controls. SUBJECTS AND METHODS: We quantified serum concentrations of ZAG in patients with PE (no.=37) as compared to healthy gestational age-matched controls (no.=37) by enzyme-linked immunosorbent assay. Furthermore, association of this adipokine with renal function, glucose and lipid metabolism, as well as inflammation was studied. RESULTS: Median serum ZAG levels were 1.4-fold higher in PE patients (58.8 mg/l) as compared to controls (41.9 mg/l) (p<0.01). Furthermore, circulating ZAG was positively correlated to systolic and diastolic blood pressure, creatinine, triglycerides, and leptin in univariate analyses. In multiple regression analysis, creatinine remained independently associated with ZAG. CONCLUSIONS: We demonstrate that maternal ZAG serum concentrations are significantly increased in PE. Furthermore, renal function is an independent predictor of circulating ZAG.

[Use of angiogenic factors (sFlt-1/PlGF ratio) to confirm the diagnosis of preeclampsia in clinical routine: first experience]. / Angiogene Faktoren zur Diagnosesicherung bei Präeklampsie in der klinischen Routine: erste Erfahrungen.

INTRODUCTION: In the clinical routine, the diagnosis of preeclampsia is often challenging. Not all pregnant women with signs and symptoms of preeclampsia develop the disease. Recently, the assessment of the sFlt-1/PlGF ratio in the serum of pregnant women has been proposed as an aid in the diagnosis of preeclampsia. PATIENTS AND METHODS: In a retrospective, monocentric case-control study, we reviewed 30 cases of patients who presented with the clinical symptoms of hypertensive disorders of pregnancy in the delivery ward. Next to the standard diagnostic algorithm for preeclampsia, the sFlt-1/PlGF ratio was determined using the automated Elecsys® platform. RESULTS: In 12/30 cases (40%), the diagnosis of a hypertensive pregnancy disorder was confirmed with an sFlt1/PlGF ratio of >85. In 18/30 (60%) cases, a ratio <85 excluded the diagnosis of preeclampsia at the time of presentation and allowed an adaptation of the patient's surveillance programme. CONCLUSION: In the clinical setting of "suspected preeclampsia", determination of the sFlt-1/PlGF ratio can serve as an aid in the diagnosis of hypertensive disorders in pregnancy. The reliable exclusion of the diagnosis "preeclampsia" can help in an appropriate and cost-effective management of patients with signs and symptoms of the disease.

Maternal and neonatal outcome after vaginal breech delivery at term after cesarean section - a prospective cohort study of the Frankfurt breech at term cohort (FRABAT).

OBJECTIVE: To compare the neonatal and maternal outcomes as well as the mode of delivery of intended vaginal breech deliveries in women with a prior cesarean section to primiparous patients. STUDY DESIGN: The prospective monocenter cohort study was conducted among 604 women who presented for an intended vaginal singleton breech delivery at term between January 2007 and December 2016. RESULTS: Out of 37 women with a prior cesarean 19 had a successful vaginal delivery. 344 of 567 primiparous women had a successful vaginal delivery. Neonatal morbidity and mortality as well as maternal outcome were not significantly different in successful vaginal deliveries of women with prior cesarean compared to primiparous patients. The cesarean section rate was not significantly higher in the group of women with a prior cesarean (49%) compared to the group of primipara (39%). CONCLUSION: A prior cesarean should not be taken as an exclusion criterion for a planned vaginal delivery out of a breech presentation at term. Large multicenter, case-controlled studies are necessary to implement international guidelines.

PP052. The course of sFlt-1 and PLGF reflects different progression pattern in early- versus late-onset preeclampsia and HELLP syndrome.

INTRODUCTION: Preeclampsia (PE), a serious multisystem disorder in pregnancy, is a leading cause of maternal and fetal morbidity and mortality worldwide and angiogenic factors like sFlt-1 and PlGF are closely related to the clinical course of preeclampsia. OBJECTIVES: We wondered, if these factors and the sFlt-1/PlGF ratio are a tool to differentiate the clinical progression pattern between early and late-onset PE and HELLP syndrome. METHODS: This retrospective study included 30 patients with PE out of which 7 patients had HELLP syndrome. Early onset PE was defined as patients with gestational age <34 weeks. Serial measurements of sFlt-1 and PlGF using the automated Elecsys platform (Roche®) were done from admission until delivery. RESULTS: Early-onset PE is characterized by an increase of sFlt-1 of 66% leading to an 137% increase of the sFlt-1/PlGF ratio. Late-onset PE shows a slower progression with an increase of the sFlt-1/PlGF ratio of only 39%. Patients with HELLP syndrome show comparable progression pattern. CONCLUSION: Angiogenic factors characterize PE and HELLP syndrome as continuously progressive diseases with a uniform development towards an antiangiogenic state. Early-onset subtypes show a more aggressive progression with a faster sFlt-1 increase.

[Light- and electron microscopy studies on the cerebellum in 12-day-old rats after treatment with 6-aminonicotinamide (6-AN)]. / Licht- und elektronenmikroskopische Untersuchung am Kleinhirn 12 Tage alter Ratten nach Behandlung mit 6-Aminonikotinamid (6-AN)

Light- and electron-microscopie studies were performed in glia cells and neurons of the cerebellum of 12-day-old rats until 48 following intraperitoneal application of 8 mg/kg 6-aminonicotinamide (6-AN), an antimetabolite of nicotinamide that inhibits the oxidative pentose-phosphate pathway. Particularly sensitive were the neuroblasts of the external granular layer. The migration of the neuroblasts was clearly reduced. Parts of the internal granular layer were damaged, while the Purkinje cells and astrocytes remained unchanged. Oligodendrocytes and astrocytes showed vacuolar degeneration. Swelling of the myelin sheath occurred in the form of a status spongiosus. 48 h after 6-AN injection some mitoses and phagocytic cells were found in the internal granular layer.

[Linear relationship between body length and brain weight]. / Lineare Zusammenhänge zwischen Körperlänge und Hirnmasse.

A total of 3406 brains were used to determine the relationship between length of body and weight of brain, which at a correlation coefficient of approximately 0.3 are not very close. Individual results are in good agreement with those reported in a similar paper by Polish authors. It is suggested that additional influential factors be included in such considerations.

[Ultrastructural reaction of the multipotential glia in the cerebellum of the rat after treatment with 6-aminonicotinamide]. / Ultrastrukturelle Reaktion der multipotenten Glia im Kleinhirn der Ratte nach Behandlung mit 6-Aminonikotinamid

6-Aminonicotinamide (6-AN), an antimetabolite of nicotinamide, damages the astrocytes and oligodendrocytes through a blockade of the pentose phosphate pathway. Both types of glia cells become hydropic. A third type of glia cell, described by VAUGHN and PETERS, the multipotential glia, is affected to a lesser extent. These cells phagocytize and form pseudopodia after treatment with 6-AN. Thus the multipotential glia cells are 'marked' by the action of 6-AN, since they are obviously less dependent on the pentose phosphate pathway in the carbohydrate metabolism.