Yiling Ding

Serum screening in first trimester to predict pre-eclampsia, small for gestational age and preterm delivery: systematic review and meta-analysis

BackgroundEarly assessment before the establishment of placental dysfunction has the potential to improve treatment and prognosis for clinical practice.The objective of the study is to investigate the accuracy of serum biochemical markers(Pregnancy- Associated Plasma Protein-A (PAPP-A), human Chorionic Gonadotropin (hCG), Placental Growth Factor (PlGF), Placental Protein 13 (PP13) used in first trimester serum screening in predicting preelampsia, small for gestational age (SGA) and preterm delivery.MethodsThe data sources included Medline, Embase, Cochrane library, Medion, hand searching of relevant journals, reference list checking of included articles and contact with experts. Two reviewers independently selected the articles. Two authors independently extracted data on study characteristics, quality and results.ResultsThe results showed low predictive accuracy overall. For preeclampsia, the best predictor was PlGF; LR + 4.01 (3.74, 4.28), LR-(0.67, 0.64, 0.69). The predictive value of serum markers for early preeclampsia was better than that of late preeclampsia. For SGA the best predictor was PP13; LR+ 3.70 (3.39, 4.03), LR- 0.70 (0.67, 0.73). For preterm delivery, the best predictor was PP13; LR+ 4.16 (2.72, 5.61), LR- 0.56 (0.45, 0.67).ConclusionFirst trimester screening analytes have low predictive accuracy for pre-eclampsia, small for gestational age and preterm delivery. However, the predict value of first trimester analytes is not worse than that of the second trimester markers.

Chemerin plays a protective role by regulating human umbilical vein endothelial cell-induced nitric oxide signaling in preeclampsia

The aim of this study was to determine chemerin levels in preeclampsia and to assess the effects of this anti-inflammatory factor on endothelial nitric oxide synthase (eNOS), nuclear factor (NF)-κB, and vascular cell adhesion molecule (VCAM) expression in human umbilical vein endothelial cells (HUVECs). Serum chemerin and eNOS levels were measured by enzyme-linked immunosorbent assays, while chemerin mRNA and protein levels were measured by fluorescent quantitative polymerase chain reaction and Western blotting, respectively. Nitric oxide (NO) concentrations were determined with a colorimetric method. Akt and eNOS phosphorylation were assessed by Western blotting. We also tested the effects of the phosphoinositide 3-kinase inhibitor LY294002 and the eNOS inhibitor L-NAME. NF-κB p65 and VCAM-1 phosphorylation were assessed by Western blotting to investigate the role of chemerin in tumor necrosis factor (TNF)-α-induced HUVEC injury. Serum chemerin levels were increased in preeclampsia, while eNOS was decreased. Chemerin mRNA and protein were both increased in placentae from patients with preeclampsia. Furthermore, chemerin serum level positively correlated with blood pressure, body mass index, and serum insulin and was negatively correlated with serum eNOS. Chemerin dose-dependently increased NO concentrations in supernatants. Chemerin can increase eNOS and Akt levels in HUVECs, and these results could be partly blocked by LY294002 and L-NAME. Chemerin significantly decreased TNF-α-induced NF-κB and VCAM-1 in HUVECs, and these changes were partly inhibited by LY294002 and L-NAME. Chemerin may play a protective role by regulating NO signaling. Future studies should assess the role of chemerin in preeclampsia and other vascular diseases.

The impact of intrahepatic cholestasis of pregnancy with hepatitis B virus infection on perinatal outcomes

Introduction To investigate the impact of intrahepatic cholestasis of pregnancy (ICP) with hepatitis B virus (HBV) infection on perinatal outcomes. Methods In the study, 200 pregnant women were divided into four groups, including 50 cases with ICP and HBV infection, 50 cases with ICP, 50 cases with HBV infection, and 50 healthy pregnancies. The delivery process and perinatal outcomes were analyzed among different groups. Results When compared to the healthy pregnancy group, significantly increased rates of premature rupture of membranes, meconium-stained amniotic fluid, and cesarean section were observed in cases of ICP, HBV infection, or ICP patients with HBV (P<0.05). Specifically, the rates of HBV infection in the newborn, fetal distress, neonatal asphyxia, and birth defects in the newborn, and infant Apgar scores were higher in ICP pregnancies with HBV (56%, 48%, 16%, and 48%, respectively) than in the other groups (P<0.05). Conclusion ICP combined with HBV infection has a clear influence on perinatal infant outcomes.

Tegafur Substitution for 5-Fu in Combination with Actinomycin D to Treat Gestational Trophoblastic Neoplasm.

Although 5-fluorouracil (5-Fu) combination chemotherapy provides a satisfactory therapeutic response in patients with gestational trophoblastic neoplasms (GTNs), it has severe side effects. The current study analyzed the therapeutic effects and side effects of tegafur plus actinomycin D (Act-D) vs. 5-Fu plus Act-D for the treatment of GTNs based on controlled historical records. A total of 427 GTN cases that received tegafur and Act-D combination chemotherapy at the Second Xiangya Hospital of XiangYa Medical School between August 2003 and July 2013 were analyzed based on historical data. A total of 393 GTN cases that received 5-Fu plus Act-D between August 1993 and July 2003 at the same hospital were also analyzed, which constituted the control group. The therapeutic effects, toxicity and side effects after chemotherapy were compared between the groups. The overall response rate was 90.63% in the tegafur+Act-D group (tegafur group) and 92.37% in the 5-Fu+Act-D group (5-Fu group); these rates were not significantly different (P > 0.05). However, the incidence rates of myelosuppression (white blood cell decline), gastrointestinal reactions (nausea, vomiting, dental ulcer, and diarrhea), skin lesions and phlebitis were lower in the tegafur group than in the 5-Fu group (P < 0.05). The results of this study may provide useful data for the clinical application of tegafur in GTN treatment.

Elevated serum chemerin in Chinese women with hyperandrogenic PCOS

Abstract Objectives: To compare serum chemerin levels between women with classic hyperandrogenic PCOS, euandrogenic PCOS and matched control subjects. Research design and methods: This study was carried out at the Second XiangYa Hospital between July 2012 and April 2013. Sixty-seven women with PCOS and 20 controls were included. Blood pressure, body mass index (BMI), waist to hip ratio (WHR), fasting insulin, fasting plasma glucose and blood serum hormone and blood lipid were measured. Transvaginal ultrasound was performed. Serum chemerin was measured by ELISA. Results: Serum chemerin was significantly higher in classic hyperandrogenic PCOS compared with euandrogenic PCOS and controls (311.07 ± 141.87 ng/mL versus 228.03 ± 119.66 ng/mL and 225.87 ± 86.44 ng/mL, p < 0.05). Serum chemerin was positively related to follicle count, ovarian volume, the level of testosterone, luteinizing hormone/follicle-stimulating hormone, low-density lipoprotein, triglycerides, fasting blood insulin, insulin resistance by homeostasis model assessment, WHR and BMI, while negatively related to the level of high-density lipoprotein. Multiple linear regression analyses revealed ovarian volumes and WHR were the significant influencing factors of chemerin (p < 0.05). The area under the receiver operating characteristic curve for chemerin reached a value of 0.684 (0.572–0.796, 95% confidence interval). The best compromise between sensitivity (80.0%) and specificity (47.6%) was obtained with a cutoff value of 200.94 ng/mL. Conclusions: Serum chemerin level was increased in Chinese women with classic hyperandrogenic PCOS. Serum chemerin measurement offers a relatively moderate diagnostic potency with a sensitivity of 80.0% and a specificity of 47.6% at 200.94 ng/mL. This suggested that chemerin may be involved in the development of the metabolic syndrome of classic PCOS. Chinese abstract 目的：传统高雄激素型PCOS女性、非高雄激素型PCOS女性和健康对照组女性血清趋化素水平的比较 研究设计及方法：本研究从2012年7月至2013年4月在湘雅第二医院开展，研究对象为67名PCOS女性和20名健康对照女性，测量血压、体重指数、腰臀比、空腹胰岛素、空腹血糖、血激素水平、血脂，行经阴道超声检查。通过ELISA法检测血清趋化素水平。 结果：传统高雄激素型女性血清趋化素水平比非高雄激素型PCOS女性和对照组女性显著升高（311.07 ± 141.87 ng/mL vs 228.03 ± 119.66 ng/mL 和 225.87 ± 86.44 ng/mL, p＜0.05）。血清趋化素水平与卵泡数量、卵巢体积、雄激素水平、黄体生成素/卵泡刺激素比值（LH/FSH）、低密度脂蛋白（LDL-C）、甘油三酯（TG）、空腹胰岛素水平、胰岛素抵抗指数、腰臀比（WHR）、体重指数（BMI）成正相关关系，与高密度脂蛋白（HDL-C）成负相关关系。多元线性回归分析显示卵巢体积和腰臀比对血清趋化素的影响最大（p＜0.05），趋化素的ROC曲线下面积达0.684 (95% CI, 0.572–0.796)， 截断值为200.94 ng/mL时灵敏度（80%）和特异度（46.7%）达到最佳平衡。 结论：传统的高雄激素型中国PCOS女性血清趋化素水平升高，血清趋化素的测定提供了一个相对温和的诊断效能，当值为200.94 ng/mL时灵敏度达80.0%，特异度达47.6%。这提示趋化素可能参与传统的PCOS女性代谢综合征的发展。

Preoperative infrarenal abdominal aorta balloon catheter occlusion combined with Bakri tamponade reduced maternal morbidity of placenta increta/percreta

Background: Placenta increta/percreta is an increasingly common and life-threatening obstetric complication. It poses a management challenge to clinicians. The present study aimed to evaluate efficacy and safety of preoperative placement of infrarenal abdominal aorta balloon catheter (IAABC) alone or combined with Bakri tamponade for the management of cases with placenta increta/percreta. Methods: We retrospectively analyzed all cases with placenta increta/percreta at a tertiary referral teaching hospital in China between the year 2014 and 2017. Statistical analysis considered the individual subgroups: IAABC placed group and control group (without IAABC), and compared their maternal–fetal outcomes. Results: The study covered 86 cases with placenta increta. For cases in the IAABC placed group (n = 48), significant reductions were noted in maternal morbidity including estimated blood loss (EBL), EBL ≥ 2000 mL, blood products transfusions, postpartum hemorrhage, operative time, intensive care unit admission, and postoperative days (P < .05 for all). The overall rate of hysterectomy was much lower (4.2%vs 23.7%, P = .018), compared with those in the control group (n = 38). Furthermore, in the IAABC placed group, hysterectomy was avoided in a further 17 cases combined with Bakri tamponade. In the control group, 10 cases were successful in preserving uterus by Bakri tamponade. Four cases failed and needed reoperation (3 uterine arterial embolism, 1 hysterectomy). There were no differences in fetal outcomes between the 2 groups. Eighteen cases were diagnosed with placenta percreta. Almost all the cases (17/18) inevitably underwent caesarean hysterectomy. Only 1 case was treated with a combination of IAABC and Bakri tamponade, and successfully reserved uterus. No differences were observed in any other outcomes, except for a significant less mean operative time (P = .017) in cases with IAABC placed (n = 10), compared with those without IAABC (n = 8). Only 1 case had a femoral artery thrombosis directly related to IAABC placement and recovered after conservative treatment. There was no maternal or neonatal death in this study. Conclusion: Prophylactic insertion of IAABC alone or combined with Bakri tamponade should be safe and effective in controlling intraoperative bleeding due to placenta increta, thus hysterectomy could be avoided. It seems to be less beneficial to women with placenta percreta. Bakri tamponade can be a good choice in the management of placenta increta/percreta before more aggressive surgeries.

Establishment of reference intervals for procalcitonin in healthy pregnant women of Chinese population

OBJECTIVE To establish reference intervals (RIs) for procalcitonin (PCT) in healthy pregnant women of Chinese population. METHODS Serum PCT levels were measured by electrochemiluminescence immunoassay (ECLIA) in 1246 healthy Chinese women, including 124 cases in the first trimester, 128 cases in the second trimester, 125 cases in the third trimester, 125 cases of vaginal delivery, 124 cases at the 3rd day after vaginal delivery, 122 cases at the 10th day after vaginal delivery, 126 cases with Cesarean delivery, 126 cases at the 3rd day after Cesarean delivery, 124 cases at the 10th day after Cesarean delivery, and 122 cases involving non-pregnant women. All cases were independent. The RIs for PCT were defined using nonparametric 95% intervals. RESULTS The RIs for PCT were 0.018-0.051μg/L for the first and second trimester; 0.020-0.152μg/L for the third trimester; 0.022-0.195μg/L for vaginal delivery; 0.019-0.021μg/L for Cesarean delivery; 0.049-5.537μg/L and 0.020-0.148μg/L for 3rd and 10th days after vaginal delivery, respectively; 0.022-0.724μg/L and 0.024-0.129μg/L for the 3rd and 10th days after Cesarean delivery, respectively; and 0.015-0.061μg/L for non-pregnant healthy women. CONCLUSION The RIs for PCT in pregnant women by trimester, days postpartum, and mode of delivery were established, thus providing a clinical reference for doctors.

The polymorphism of HLA-DR and -DQ allelic genes associated with intrahepatic cholestasis of pregnancy.

OBJECTIVE This study was conducted to investigate the association of the polymorphisms of human leucocyte antigen (HLA) class II DRB1 and DQB1 alleles and the risk for intrahepatic cholestasis of pregnancy (ICP). METHODS Genomic DNA was extracted from peripheral venous blood leucocytes in 42 ICP patients and 38 normal controls and from their corresponding neonates. HLA class II DRB1 and DQB1 genotypes were determined using sequence-specific primer polymerase chain reaction (SSP-PCR). RESULTS Genotype analyses of HLA class revealed a significantly increased frequency of HLA-DR11 allele in ICP patients when compared with the controls (16.67% vs. 3.95%, p < 0.01), but no significant difference in other genotypes. Interestingly, analysis of the fetomaternals -DR and -DQ alleles showed no significant difference between the patient and control groups. CONCLUSIONS These results indicate that HLA-DR11 allele is associated with the susceptibility of ICP in the Chinese Changsha area.

Exploration of the Successful Treatment Algorithms Used in 23 Cases of Early Live Cesarean Scar Pregnancy

Without timely discovery and treatment, early live cesarean scar pregnancy (CSP) can cause hemorrhage, uterine rupture or excision, and in extreme cases, loss of fertility or death. This study explored the significance of early diagnosis and treatment algorithms for early live CSP. Twenty-three patients with early live CSP who were hospitalized at the Second Xiangya Hospital of Central South University from June 2012 to July 2013 were retrospectively analyzed. The patients were selected according to the number of days since the last menstrual period, the color Doppler ultrasound results, the β-HCG values, and the thickness of the lower uterine myometrium. Ultrasound-guided evacuation and Foley balloon compression hemostasis were conducted directly in the lower uterine segment to stop the bleeding. All 23 patients were cured, and their uteri and fertility were conserved. Timely and proper treatment algorithms can yield satisfactory outcomes in the treatment of CSP.

Nestin Improves Preeclampsia-Like Symptoms by Inhibiting Activity of Cyclin-Dependent Kinase 5

Background/Aims: Preeclampsia (PE) is a pregnancy-specific hypertensive disorder that is characterised by a high incidence of hypertension and proteinuria. Podocytes are involved in the formation of a split membrane, which is the last barrier preventing the leakage of protein into the urine. Nestin, a cytoskeleton protein, is expressed stably in podocytes. However, the association between the Nestin concentration in urine and the progression of PE and the role of Nestin in PE remains unclear. Methods: In the present study, a mouse podocyte cell line, PE-like animal model and PE patients’ urine samples were used. Eilsa kits were used to detect the levels of proteins expression in urine samples from patients and animal models. Western Blotting and immunofluorescence were used to detect proteins expression levels in cell samples and animal tissue samples. Flow cytometry was used to detect the level of apoptosis in cells. Tunel assay was used to detect the levels of apoptosis in animal tissue samples. Results: Nestin levels were significantly increased in PE patients than in hypertensive patients and healthy subjects, and positively correlated with proteinuria and podocalyxin. Ang II treatment decreased the expression of Nestin and Podocin in a time- and dose- dependent manner in podocytes. Restoration of the Nestin levels could reverse Ang II-induced F-actin degradation and attenuate Ang II-mediated podocyte apoptosis, while knockdown of the Nestin level exhibited the opposite. Moreover, the protective role of Nestin on podocytes is mediated by inhibition of the kinase activity of CDK5. In PE-like animal model induced by L-NAME injection, restoration of Nestin lowered the pressure and proteinuria concentration, attenuated the loss of podocytes, and decreased the expression of p35, p53 and the activity of CDK5 kinase, as compared with the control. Conclusions: Our findings suggest that Nestin could improve preeclampsia-like symptoms by inhibiting the activity of CDK5, and Nestin may become a new prognostic factor and a potential therapy target for PE.