[Relationship between pigment epithelium-derived factor expressed in placentas and the pathogenesis of preeclampsia disease].

OBJECTIVE: To investigate the effect of pigment epithelium-derived factor (PEDF) on the pathogenesis of preeclampsia disease, by detecting the expression of PEDF in the placentas, as well as the relationship between PEDF and the production of placental vessels. METHODS: A study was performed in 60 cases of pregnant women with preeclampsia in the obstetrical department of Nanfang Hospital affiliated to southern medical university from October 2011 to January 2013, in which 30 cases were patients with mild preeclampsia(mPE) and other 30 cases were those with severe preeclampsia (sPE).40 normal pregnant women who also been hospitalized and delivered were selected as control group. The expression of PEDF and micro-vessel density (MVD) in placentas were assayed by using western blot and SP immunohistochemical method, then the relationship between PEDF and MVD was analyzed. RESULTS: (1) The pathological changes of placentas:the placental weight were lightened obviously in the mild preeclampsia and severe preeclampsia groups, the reduced blood vessels and luminal stegnosis were found in chorionic villus, basement membrane of trophocytes were thickening. The hyperplasia syneytiotrophoblast were like nodosity, with focus infarction, fibrinoid necrosis, or thrombogenesis.While there was no the above mentioned pathological alteration in normal control group. (2)The levels of PEDF expression in mild and severe preeclampsia group were 0.63 ± 0.09, 0.93 ± 0.07, while 0.47 ± 0.04 in control group, which in mild and sever preeclampsia groups were significantly higher than that in normal group (P < 0.05). Compared to mild preeclampsia group, the expression of PEDF was significantly increased in severe preeclampsia group, there was statistical significance between the difference (P < 0.05).(3) The amount of microvessel density (MVD) in mild and severe preeclampsia group were 106 ± 9, 93 ± 8, while 136 ± 9 in control group, which were significantly reduced in mild and severe preeclampsia group, compared to that in normal control group (P < 0.05). And it was significantly lower in severe preeclampsia group than that in mild preeclampsia group (P < 0.05). (4) The expression of PEDF was negatively correlated with the amount of MVD in mild and severe preeclampsia group (r = -0.426, P < 0.05; and r = -0.646, P < 0.05 respectively), which was also negative in control group (r = -0.589, P < 0.05). CONCLUSION: Increased PEDF expression in placentas of women with preeclampsia induce the dysfunction of the placental vascular reconstruction and the pathological alteration like ischemic and hypoxia in placentas, which may be involved in pathogenesis and pathogenic progress of preeclampsia.

Morbidity and risk factors for surgical site infection following cesarean section in Guangdong Province, China.

AIM: To estimate the incidence of and identify the risk factors for a surgical site infection after a cesarean section. METHOD: A survey of women who underwent a cesarean section was conducted in eight hospitals in Guangdong Province, China. The rate of surgical site infection was estimated and a nested case control study was then carried out to identify the risk factors. RESULTS: Among 13 798 women surveyed, 96 (0.7%) developed a surgical site infection after a cesarean section. Multivariate logistic regression analysis identified six factors independently associated with an increased risk of surgical site infection, which included obesity, premature rupture of membranes, lower preoperative hemoglobin, prolonged surgery, lack of prophylactic antibiotics and excessive anal examinations performed during hospitalization. CONCLUSION: Surgical site infection occurs in approximately 0.7% of cesarean section cases in the general obstetric population in China. Obesity, premature rupture of membranes, lower preoperative hemoglobin, prolonged surgery, lack of prophylactic antibiotics and excessive anal examinations during hospitalization are considered to be independent risk factors.

[Clinical efficacy and perinatal outcome of nifedipine for severe preeclampsia: meta-analysis].

OBJECTIVE: To assess the efficacy, side effects and perinatal outcome of nifedipine compared with other antihypertensives for treating severe preeclampsia in pregnant women. METHODS: Randomized controlled trials (RCTs) that comparing nifedipine with other antihypertensives for severe preeclampsia were searched in PubMed, EMBase, Cochrane library, CNKI and VIP database etc(till January 2012). The quality of the included RCTs was evaluated, and Meta-analysis was performed with Rev Man 5.1 software. RESULTS: Nine trials were included, involving 386 women in the nifedipine group, and 378 women in other antihypertensives group. Compared with other antihypertensives, nifidepine was associated with greater effective control of blood pressure (OR = 2.65, 95%CI: 1.65 - 4.25, P < 0.01). There was no clear difference in the time needed to control blood pressure (WMD = -3.64, 95%CI: -10.90 - 3.61, P = 0.32). Nifedipine could prolong gestation better than other antihypertensives (WMD = 5.14, 95%CI: 3.29 - 6.99, P < 0.01). There were no clear differences in maternal side effects headache (P = 0.28), palpitation (P = 0.06), and nausea vomiting (P = 0.28). No noticeable difference was found between the two groups in the Apgar score at five minutes (WMD = -0.21, 95%CI: -0.32 - 0.91, P = 0.72), neonatal respiratory distress syndrome (OR = 1.24, 95%CI: 0.57 - 2.67, P = 0.59), or perinatal deaths (OR = 0.49, 95%CI: 0.22 - 1.11, P = 0.09). CONCLUSION: Nifedipine is associated with greater effective control of blood pressure and prolongation of gestation, with no additional neonatal respiratory distress syndrome or perinatal deaths, compared with other antihypertensives for women with severe preeclampsia.

Ultrasound Features Improve Diagnostic Performance of Ovarian Cancer Predictors in Distinguishing Benign and Malignant Ovarian Tumors.

To determine whether ultrasound features can improve the diagnostic performance of tumor markers in distinguishing ovarian tumors, we enrolled 719 patients diagnosed as having ovarian tumors at Nanfang Hospital from September 2014 to November 2016. Age, menopausal status, histopathology, the International Federation of Gynecology and Obstetrics (FIGO) stages, tumor biomarker levels, and detailed ultrasound reports of patients were collected. The area under the curve (AUC), sensitivity, and specificity of the bellow-mentioned predictors were analyzed using the receiver operating characteristic curve. Of the 719 patients, 531 had benign lesions, 119 had epithelial ovarian cancers (EOC), 44 had borderline ovarian tumors (BOT), and 25 had non-EOC. AUCs and the sensitivity of cancer antigen 125 (CA125), human epididymis-specific protein 4 (HE4), Risk of Ovarian Malignancy Algorithm (ROMA), Risk of Malignancy Index (RMI1), HE4 model, and Rajavithi-Ovarian Cancer Predictive Score (R-OPS) in the overall population were 0.792, 0.854, 0.856, 0.872, 0.893, 0.852, and 70.2%, 56.9%, 69.1%, 60.6%, 77.1%, 71.3%, respectively. For distinguishing EOC from benign tumors, the AUCs and sensitivity of the above mentioned predictors were 0.888, 0.946, 0.947, 0.949, 0.967, 0.966, and 84.0%, 79.8%, 87.4%, 84.9%, 90.8%, 89.1%, respectively. Their specificity in predicting benign diseases was 72.9%, 94.4%, 87.6%, 95.9%, 86.3%, 90.8%, respectively. Therefore, we consider biomarkers in combination with ultrasound features may improve the diagnostic performance in distinguishing malignant from benign ovarian tumors.

[Effect of limited volume resuscitation on hemodynamic changes in pregnant rabbit with hemorrhagic shock].

OBJECTIVE: To determine the effects of two fluid resuscitation strategies on the changes of hemodynamic variables, serum concentration of tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) in a clinically relevant model of uncontrolled hemorrhagic shock in pregnant rabbits. METHODS: Hemorrhagic shock was induced by bleeding via carotied artery, followed by transection of a medium vessel in gestational sac. Experimental design consisted of three phases, shock phase (0-30 min), prehospital phase (30-90 min) and hospital phase (90-180 min). Twenty pregnant rabbits were randomly divided into two groups (n=10 /group), aggressive fluid resuscitation group (PNL group) and limited volume resuscitation group (PLH group). In the shock phase, animals were hemorrhaged by blood withdrawal to mean arterial pressure (MAP) of 40-45 mm Hg (1 mm Hg=0.133 kPa) via carotid artery. In the prehospital phase, a medium vessel in the gestational sac was transected, then the animals in the PNL group and PLH group were resuscitated with 0.9% normal saline (NS) and shed blood to MAP of 80, 60 mm Hg respectively. In the hospital phase, bleeding was controlled by surgical intervention and all the animals were reinfused with shed blood and NS to MAP 80 mm Hg. Hemodynamic variables and respiration rate were monitored and blood samples were collected for TNF-alpha and IL-6 measurement, and finally subsequent volume resuscitation and survival rate were recorded. RESULTS: (1) At 120 min, the respiration rate and heart rate in the animals assigned to PLH group was (66+/-16) bpm, (235+/-41) bpm respectively, which were significantly lower than those in PNL group (P<0.01), while MAP and central venous pressure in the PLH group was (80.4+/-7.2) mm Hg, (8.0+/-4.4) cm H2O, respectively, which were significantly higher than those in PNL group (P<0.01); (2) The serum concentration of TNF-alpha, IL-6 of all the animals were markedly increased after hemorrhagic shock, and peak at 24 min. The serum concentration of TNF-alpha, IL-6 in animals assigned to PLH group were (105+/-67) ng/L, (118+/-51) ng/L respectively, which were significantly lower than those in PNL group (P<0.01). The serum concentration of TNF-alpha, IL-6 in the animals assigned to PLH group were decreased to normal at 480 min; (3) The subsequent blood transfusion volume and NS resuscitation volume in PLH group in prehospital phase were (16.0+/-2.2) ml, (39.0+/-5.5) ml respectively, while those in hospital phase were (28.0+/-6.7) ml, (90.0+/-7.1) ml respectively, which were significantly lower than those in PNL group (P<0.05); (4) The 24 and 72 hours survival rate in the animals assigned to PLH group were 100%, 90% respectively; which were significantly higher than those in PNL group (P<0.01). CONCLUSION: Limited volume resuscitation improves thermodynamic changes of pregnant rabbit, attenuates the increase of serum concentration of TNF-alpha, IL-6, and results in higher survival rate. Limited volume resuscitation is an ideal means for hemorrhagic shock resuscitation in pregnant rabbit.

[Diagnostic value of CA125, HE4 and Copenhagen Index in differentiating benign from malignant epithelial ovarian tumors].

OBJECTIVE: To analyze diagnostic value of Copenhagen Index based on pretreatment serum CA125, HE4 and age in differentiating benign and malignant epithelial ovarian tumors. METHODS: The clinical data were analyzed for 208 consecutive patients with epithelial ovarian tumors (including 100 with malignant and 108 with benign tumors) treated in our department between September, 2014 and September, 2016. The receiver-operating characteristic curve was drawn based on the golden standard of pathological diagnosis for calculation of the diagnostic sensitivity and specificity of CA125, HE4 and the Copenhagen Index. RESULTS: In the overall cases, early stage cases and advanced stage cases, the prediction probabilities of CA125, HE4 and Copenhagen Index were all significantly higher for malignant than in benign tumors (P<0.001). The sensitivities of CA125, HE4, Copenhagen Index for differentiating benign and malignant tumors were 81.0%, 86.0% and 91.0% in the overall cases, 64.0%, 68.0% and 72.0% in early stage cases, and 86.7%, 92.0% and 97.3% in advanced stage cases, and their diagnostic specificities were 88.0%, 93.5% and 96.3%, respectively. Copenhagen Index had the highest diagnostic sensitivity (but not in early stage cases) and specificity followed by HE4 and then by CA125 (P<0.001) (P>0.05). CONCLUSION: Copenhagen Index combined with CA125, HE4 and age hase better diagnostic value than HE4 or CA125 alone for differentiation between benign and malignant epithelial ovarian tumors, and can be used clinically to improve the early diagnostic rate of epithelial ovarian cancer.

[Effects of docosahexaenoic acid on cell apoptosis, invasion and migration of cervical cancer cells in vitro].

OBJECTIVE: To investigate the effect of docosahexaenoic acid (DHA) on apoptosis, migration and invasion of cervical cancer cell lines. METHODS: cervical cancer cell lines Hela and Siha in logarithmic phase were treated different concentrations of DHA. The morphological changes of the cells were observed microscopically and cell apoptosis was observed using Hoechst 33258 fluorescent staining. MTT assay was used to evaluate the effect of DHA in suppressing cell growth, and flow cytometry was employed to analyze the changes of cell apoptotic rate following DHA stimulations. Wound healing assay and Transwell migration assay were used to evaluate the migration of the cell lines. The expression levels of Bax, Bcl-2 cleaved caspase3, MMP-9 and VEGF proteins were detected by Western blotting. RESULTS: DHA exposure of the cells caused obvious morphological changes and dose-dependently increased the number of apoptotic bodies in the cells. MTT assay showed that DHA inhibited the growth of the cancer cells in a time- and concentration-dependent manner. DHA also effectively suppressed migration and invasion of the cancer cells. The cells exposed to DHA showed significantly down-regulation of Bcl-2, MMP-9 and VEGF proteins and up-regulation of cleaved-caspase 3 and Bax. CONCLUSION: DHA can promote cervical carcinoma cell apoptosis by down-regulating the anti-apoptotic proteins Bax, Bcl-2 and cleaved-caspase3 and suppress cell invasion by decreasing MMP-9 and VEGF expressions.

[Intraoperative and postoperative risk factors for surgical site infection following cesarean section].

OBJECTIVE: To investigate intraoperative and postoperative high-risk factors for surgical site infection after cesarean section. METHODS: We retrospectively reviewed cesarean section cases in terms of emergency operation, anesthesia methods, operating time, blood loss, hospital stay, surgical skills of the surgeon, and postoperative nursing care to identify the high risk-factors of surgical site infection during and after the operation. A retrospective case-controlled study of all the parturients with postoperative surgical site infection was conducted. RESULTS: In the risk factors examined, anesthesia methods, operative time, and length of hospital stay showed significant differences between the two groups, while volume of blood loss and emergency operation did not. CONCLUSION: Effective measures need to be taken to eliminate the intraoperative and postoperative high-risk factors of surgical-site infection following cesarean section.

[Clinical application of GnRHa before uterine myomectomy: report of 20 cases].

OBJECTIVE: To study the clinical application of GnRHa prior to uterine myomectomy and its effect on the clinical outcome of pregnancy. METHODS: A retrospective review of the medical records in 20 cases of uterine myomectomy over a period of 6 years was performed. The changes of uterus and myoma volumes in response to preoperative GnRHa was observed, and the rate of relapse in the follow-up, time of impregnation, spontaneous abortion after the impregnation, time of delivery after the operation and the aura threatening uterine rupture, and uterine rupture during the delivery were assessed. RESULTS: Application of GnRHa produced significant improvement in the clinical symptoms and resulted in obviously reduced volumes of the uterus and myoma. The myoma volume reduction was close to 50% in these cases, and relapse occurred in only 1 case. No spontaneous abortion was found after GnRHa application. The average time of pregnancy was 34+/-3.5 weeks, and aura for uterine rupture was found in 1 case at 33 weeks of pregnancy after GnRHa application. CONCLUSION: Application of GnRHa can correct anemia, decrease the relapse rate of myoma, reduce uterus and myoma volumes, to make possible smaller incision for uterine myomectomy that leaves smaller scar in the uterus and decrease intraoperative bleeding, also relieving endometrial injuries to promote the conditions for impregnation and minimize the risks of uterine rupture and total hysterectomy for the benefit of normal delivery.

[Study on related factors of premature delivery and perinatal management].

OBJECTIVE: To study the etiological factors, perinatal management of premature delivery and the outcome of the premature infants. METHODS: The medical records of normal deliveries over the past 8 years in our hospital were respectively reviewed to analyze the difference between full-term and premature delivery cases in terms of maternal age, perinatal factors and manner of delivery. The states of birthing and outcomes of premature were reviewed. RESULTS: Preterm premature rupture of the membranes and in vitro fertilization-embryo transfer (IVF-ET) were the major causes of premature delivery, which was also related to such factors as placenta previa and pregnancy-induced hypertension. Premature delivery with unknown causes had been decreasing over these years. The maternal age and history of previous birth did not vary significantly between the full-term and the premature groups, but the later had significantly higher rates of cesarean section, in which 67.64% of the cases had Apgar scores

The application of serum cystatin C in estimating the renal function in women with preeclampsia.

OBJECTIVE: Serum cystatin C (Cys-C) is known to reflect the glomerular filtration rate (GFR) more precisely in native kidney diseases and renal dysfunctions secondary to other diseases. This study investigated the serum Cys-C in estimating the renal function in preeclamptic women. METHODS: A total of 96 patients with normal pregnancy (controls) and 48 cases of severe preeclampsia were recruited in this study. We measured the 24-hour creatinine clearance (CrCl), serum creatinine, Cys-C, uric acid (UA), and beta trace protein (BTP) concentrations on all the pregnant women in the second trimester and third trimester and in the postpartum of the patients with severe preeclampsia. Multiple comparisons and correlation analysis were used to analyze the indexes estimating the GFR. RESULTS: In the normal pregnancies, the concentrations of serum creatinine, UA, and BTP were significantly higher in the third trimester compared to the second trimester, however with no significant differences in the serum Cys-C levels. Comparison between the second and third trimester in patients with severe preeclampsia indicated that significant difference existed in the serum Cys-C, with higher concentration in third trimester. Correlation analyses demonstrated that significant negative correlations could be detected between Cys-C and 24-hour CrCl in the second trimester and third trimester of all the 144 pregnant women and in the postpartum of the patients with severe preeclampsia, and better correlations in normal participants than in participants with preeclampsia. CONCLUSIONS: Serum Cys-C seems to reflect the GFR precisely in women with severe preeclampsia and can be a good marker to monitor the renal function from antepartum to postpartum.

Vascular network modeling reveals significant differences in vascular morphology in growth-restricted placentas.

AIM: To construct and examine models of the vascular networks using the technique of vascular corrosion casting in placentas collected from normal pregnancies and from pregnancies complicated by fetal growth restriction (FGR). METHODS: Twenty placentas were collected from normal term pregnancies (Group NP) and an equal number from pregnancies with idiopathic term FGR (Group FGR) and placental vascular network models constructed by perfusing an acrylic-based solution separately into the umbilical vein and arteries. Placental blood volumes and blood vessel characteristics (number of branches, diameter, and morphology) were then examined and compared. RESULTS: In placentas from Group NP, the veins branched five to seven times with a peripheral artery-to-vein ratio ranging from 1:2 to 1:3. In placentas from Group FGR, the veins branched only four to five times with an artery-to-vein ratio of 1:1 to 2:1 and increased evidence of nodularity and pitting of the vessel walls. The two groups showed significant differences in placental blood volume and in the mean diameters of umbilical veins and arteries. In Group FGR, significant positive correlations could be found between birth weight and placental volume, venous diameters, and select arterial diameters. CONCLUSION: Vascular network models can be constructed from term placentas. Such modeling may provide novel insights and improve our understanding of the placental vascular system in both health and disease.

[Protective effect of limited fluid resuscitation against intestinal ischemia-reperfusion injury in postpartum rabbits with uncontrolled hemorrhagic shock].

OBJECTIVE: To investigate the protective effect of limited fluid resuscitation against intestinal ischemia- reperfusion injury in postpartum rabbits with severe uncontrolled obstetrical hemorrhagic shock. METHODS: Twenty- four postpartum rabbits were randomly assigned into sham shock group (group P), shock group without interventions (group P0), conventional fluid resuscitation group (group PNL), and limited fluid resuscitation group (group PLH), and the model of severe uncontrolled hemorrhagic shock was established in the latter 3 groups. The rabbits were sacrificed 4 h later, and SOD activity and MDA content in the intestinal mucosa and the degree of injury to the intestinal mucosa were observed. RESULTS: Ischemia-reperfusion injury of the intestine due to uncontrolled hemorrhagic shock resulted in decreased SOD activity and increased MDA content. The MDA content was significantly lower and SOD activity was significantly higher in group PLH than in group PNL (P<0.05), and the intestinal mucosal tissue morphology and intestinal mucosa barrier lesion increased in group PLH. CONCLUSION: Initial limited fluid resuscitation can relieve intestinal ischemia-reperfusion injury in postpartum rabbits with severe uncontrolled obstetrical hemorrhagic shock.

Heparin for patients with growth restricted fetus: a prospective randomized controlled trial.

OBJECTIVE: Heparin was hypothesized to facilitate the growth of the growth-restricted fetus. Our study was to assess the efficiency of heparin in treating fetus with growth restriction and to explore the possible mechanisms. METHODS: Seventy-three pregnant women were selected in this study. Based on regular treatments, patients randomly received either heparin or dan-shen combined with low-molecular weight dextrose. A serial ultrasonography and hematological measurements were performed on each patient at the enrolment and 7 days after the first treatment. Neonatal birth weight, 1-min Apgar score and gestational age were recorded. Placentas were collected for apoptotic indices. RESULTS: Heparin significantly improved maternal hemorrheological indices, fetal growth velocities and neonatal outcomes. It also reduced apoptosis in trophoblasts. CONCLUSIONS: Our results provide evidence that heparin significantly improves the growth of the growth-restricted fetus. The growth improvement is probably achieved by the changes in maternal hemorrheology and the attenuated apoptosis in trophoblasts.

Increased survival with hypotensive resuscitation in a rabbit model of uncontrolled hemorrhagic shock in pregnancy.

AIM: We sought to compare the effects of conservative hypotensive and aggressive normotensive resuscitation strategies on blood loss, fluid requirements, blood lactate and survival rate in a clinically relevant model of uncontrolled hemorrhagic shock in pregnancy. METHOD: 60 anesthetized New Zealand white rabbits at late gestation underwent uncontrolled hemorrhagic shock by transecting a small artery in the mesometrium, followed by blood withdrawal via the carotid artery, to a mean arterial pressure (MAP) of 40-45mmHg. They were randomly divided into six groups (n=10 per group): sham shock (group SS); shock without resuscitation (group SH); hypotensive resuscitation in the simulated prehospital phase with Ringer's solution to MAP of 50, 60, or 70mmHg, respectively (groups RE50, RE60, RE70); and aggressive resuscitation in the prehospital phase with Ringer's solution to MAP of 80mmHg (group RE80). Finally, in the simulated hospital phase, animals in the resuscitated groups underwent surgical control of bleeding and were fully resuscitated with half of the heparinized shed blood and Ringer's solution to MAP of 80mmHg. RESULTS: Hypotensive resuscitation significantly decreased blood loss and subsequent volume infusion, leading to higher hematocrit, lower lactate concentration, and shorter prothrombin time and activated partial thromboplastin time. Median survival time in group RE60 (4.3+/-0.6 days) was significantly longer than that in groups RE50 (2.7+/-0.4 days), RE70 (2.3+/-0.3 days), and RE80 (1.7+/-0.3 days) (P<0.05). CONCLUSIONS: We conclude that in this rabbit model of uncontrolled hemorrhage in pregnancy, hypotensive resuscitation to MAP of 60mmHg may be an optimal target MAP before hemorrhage can be controlled by surgical intervention.