Ga Hyun Son

Comparison of serum and urinary nephrin levels between normal pregnancies and severe preeclampsia

OBJECTIVE To compare the levels of urinary excretion of nephrin in women experiencing either normotensive or severe preeclamptic pregnancies, and to examine the relationship between urinary nephrin levels and clinical parameters of preeclampsia. STUDY DESIGN In a case control study we collected serum and urine specimens from women with normal pregnancy (n=30) and from women with severe preeclampsia (n=43). Serum nephrin levels and urinary nephrin concentrations were measured in all patients. RESULTS Both serum and urine concentrations of nephrin were significantly higher in the severe preeclamptic group than in the normal pregnancy group. In addition, we identified a significant relationship between urinary nephrin levels and urine protein concentrations in the severe preeclamptic group. Urine nephrin concentrations were also correlated with serum creatinine levels and with diastolic blood pressure in the severe preeclamptic group. CONCLUSION The positive correlations observed in this study suggest that urinary nephrin excretion might play an important role in the pathogenesis of proteinuria during preeclampsia and could be a good indicator of renal damage.

Risk Factors for Cesarean Delivery after Induction of Labor in Nulliparous Women with an Unfavorable Cervix at or beyond 41 Weeks of Gestation

Aims: To investigate risk factors for cesarean section (CS) following labor induction in nulliparas with an unfavorable cervix at or beyond 41 weeks of gestation. Methods: In this retrospective cohort study, a total of 276 nulliparas with an unfavorable cervix (Bishop score ≤6) who underwent labor induction for prolonged pregnancies were included out of a total of 646 patients who delivered ≥41 weeks (2002-2011). Results: 82 (29.7%) patients of the 276 delivered by CS. The patients who underwent CS had less cervical dilatation and a lower Bishop score on admission than those patients who delivered vaginally (0.76 ± 0.47 vs. 0.92 ± 0.58 cm, p = 0.03 and 1.16 ± 1.25 vs. 1.51 ± 1.34, p = 0.04, respectively). Neonatal birth weight and biparietal diameter (BPD) were significantly smaller in the vaginal delivery group (3,414.93 ± 361.37 vs. 3,534.81 ± 383.05 g, p = 0.01 and 9.43 ± 0.35 vs. 9.65 ± 0.42 cm, p < 0.01). After multiple logistic regression analysis, maternal height, BPD, and early rupture of membranes (ROM) were independently related with CS. Early ROM was defined as spontaneous ROM that occurred before the onset of the active phase of labor. Conclusion: Maternal height, BPD, and early ROM were risk factors for CS following labor induction in nulliparas at or beyond 41 weeks of gestation.

A nontoxic derivative of lipopolysaccharide increases immune responses to Gardasil HPV vaccine in mice

Human papillomavirus (HPV) is the causative agent of cervical cancer, the second most common cause of cancer death in women worldwide. The licensed HPV vaccine Gardasil((R)) from Merck & Co. is a quadrivalent vaccine containing virus-like particles (VLPs) of the L1 proteins from HPV types 6, 11, 16, and 18 adsorbed on aluminum salts (alum). CIA07 is an immunostimulatory agent comprised of bacterial DNA fragments (CIA02) and a nontoxic derivative of lipopolysaccharide (CIA05) that has been shown to have antitumor activity and adjuvant activity for viral and bacterial vaccine antigens. We investigated whether these CIAs are capable of promoting the immune response to Gardasil. Balb/c mice were immunized intramuscularly twice three weeks apart with 1/20 human dose of Gardasil alone or in combination with CIA02, CIA05 or both, and immune responses were assessed. The serum anti-HPV16 L1 VLP IgG antibody titer was significantly higher in mice administered CIA05 or CIA05 plus CIA02, but not in those given CIA02, compared with mice given Gardasil alone. A secreted alkaline phosphatase (SEAP)-based pseudovirus neutralization assay showed increased neutralizing antibody titers in both CIA05 and CIA05 plus CIA02 groups. Coadministration of CIA05 with Gardasil led to a marked increase in serum IgG2a antibody titer and the percentage of interferon (IFN)-gamma(+) cells in the spleen, indicating that CIA05 effectively promotes Th1-type immune responses. These data indicate that CIA05, in synergy with alum, enhances the immune response to HPV L1 VLPs and suggest its potential as an adjuvant for the development of a potent prophylactic HPV vaccine.

Urinary Excretion of Nephrin in Patients with Severe Preeclampsia: Urinary Nephrin in Preeclampsia

Objective. The objective of this study was to examine whether nephrin is present in the urine of patients with severe preeclampsia. Methods. A total of 45 women were recruited for this study, and 25 of these patients had severe preeclampsia. Twenty gestational age-matched normotensive women without proteinuria served as a control group. Urine samples were collected close to delivery, typically ≤24 h before delivery. Western blot analysis was performed to assess the excretion of nephrin in urine. Results. Nephrin was detected in all urine samples from all the women with severe preeclampsia but not in urine from normotensive controls. Conclusion. In pregnancy complicated by severe preeclampsia, urinary nephrin shedding, reflecting the damage in the glomerular slit diaphragm, was observed.

Mode of Delivery Influences the Regression of Abnormal Cervical Cytology

Aims: The purpose was to investigate the influence of delivery mode on the postpartum regression of abnormal cervical cytology. Methods: A retrospective review was conducted of 64 pregnant women with abnormal cervical cytology at Yonsei University Health System in Korea between 2001 and 2008. A Papanicolaou smear and pathological data were categorized into three groups by cervical intraepithelial neoplasia classification. Postpartum evaluation was taken 3–6 months after delivery. The regression rates of cervical cytologic findings were compared between the vaginal delivery group and Cesarean section group. p < 0.05 was considered significant. Results: Of the 64 women, 45 (70.3%) were delivered vaginally and 19 (29.7%) by cesarean section. No significant difference was found between the two groups with respect to age, gestational age, parity, smoking, and HPV (human papilloma virus) screening. Postpartum regression was shown in 39 (92.9%) women who delivered vaginally and in 12 (63.2%) women who underwent cesarean section (p = 0.016). In the cesarean section group, 1 patient had progressed from CIN2 to microinvasive cancer and 2 patients from carcinoma in situ to invasive cancer. Conclusion: The rate of spontaneous regression of antepartum abnormal cervical cytology was higher after vaginal delivery.

OC04.03: Frontomaxillary facial angle measurement may not be a useful early screening marker in Korean population

Objective: The aim of the study was to compare the shortening fraction of left ventricle (SFLV) values in euploid and fetuses with trisomy 21 in the first trimester. Methods: Between September 2008 and February 2009, we measured SFLV in two groups of fetuses: 49 euploid and 5 trisomy 21 fetuses (CRL: 45,2-83,1 mm). To obtain the measurement, the heart was imaged in one of two ways: the two ventricles were either viewed in the long axis with the ventricular septum being as close to parallel to the face of the transducer as possible or in the short axis view. The image of the heart was significantly magnified. An M-mode cursor was then placed through the two ventricles at a right angle to the ventricular septum beneath the level of the A-V valves and measurements of the LV end-diastolic diameter (LVDD) and endsystolic diameter (LVSD) were obtained. SFLV was calculated using the following formula: [(LVDD-LVSD)/LVDD] × 100. Multiple gestations and fetuses with an apparent heart defect were excluded from the study. The data were analyzed using Kruskal-Wallis test. Results: The measurements of SFLV differed significantly between the group of euploid fetuses [38,0 (95%CI:33.72–42.27)] and the fetuses with trisomy 21 [52,07 (95%CI:45,93-58,21)] (p=0.0003). There was also a significant difference in NT measurements between the two groups: 1,78 mm (95%CI:1,08-2,48) in the euploid population vs. 5.06 (95%CI:3.69–6.43) in the fetuses with trisomy 21 (p=0.0003). There were no significant differences between the CRL 66,81 (95%CI:58,28–75,35) vs. 74.68 (95%CI:67.46–81.90), LVDD 3,35 (95%CI:2,67–4,03) vs. 3,66 (95%CI:2,98–4,34) and LVSD 2,09 (95%CI:1,58–2,60) vs. 1,78 (95%CI:1,27–2,29) values between the two groups (p>0.05). Conclusions: SFLV is a well defined and simple measurement of systolic function of fetal myocardium. SFLV values in fetuses with trisomy 21 appear to be significantly higher than in euploid fetuses. Further studies are needed to confirm its usefulness as marker of trisomy 21 in the first trimester.