Autophagic and apoptotic cell death in amniotic epithelial cells

The aim of this paper is to determine if autophagic cell death is associated with apoptosis and whether it participates in the process of term amniotic rupture. Forty pieces of fresh term amnions, including twenty from a position near the margin of the placentas and twenty from the margin of the naturally ruptured part of the placentas in term gestation were collected, respectively. The amnions were examined by scanning electron microscopy (SEM) and amniotic epithelial (AE) cells were examined by transmission electron microscopy (TEM). Autophagic and apoptotic cell death (PCD) were assayed by laser scanning confocal microscopy (LSCM) or flow cytometry using monodansylcadaverin (MDC) and propidium iodide (PI) stain. BCL(2) and BAX were examined by immunoblotting. Under SEM the amniotic epithelia appeared normal in the position near the placenta. They had an atrophied appearance in the margin of their natural broken parts. In the AE cells PCD was divided into three subtypes by TEM: autophagic cell death with positive stains of MDC and PI; apoptotic cell death; and the mixed type. Quantitative detection showed that there were more death cells, including autophagic and apoptotic, in the AE cells near the ruptured parts than near the placentas. An increased expression of BAX and a decreased expression of BCL(2) protein in the AE cells near the broken margin were observed. Apoptotic and autophagic cell death by the intrinsic pathway are the basic event in the AE cell and they are involved in the cause of membrane rupture of the human amnion in term gestation.     

What women with ovarian cancer think and know about genetic testing

ObjectivesFew women with ovarian cancer undergo genetic testing for the Breast and Ovarian Cancer susceptibility genes, BRCA1 and BRCA2. With the prospect of BRCA-directed therapeutics, we investigated ovarian cancer patients' knowledge and willingness to undergo genetic testing.MethodsAll ovarian cancer patients seen in the Gynecology Center of a cancer center and a private clinic were asked to complete an anonymous questionnaire regarding knowledge and willingness to undergo BRCA testing. Women who had prior genetic testing were asked not to participate. Data was analyzed using Fisher's exact test.ResultsTwo-hundred and thirty seven ovarian cancer patients voluntarily completed the questionnaire. Fifty-five percent (131/237) of participants had not heard of BRCA testing. Of Caucasian respondents, 51% were unaware of BRCA testing, compared to 70% of Hispanic and 88% of African American respondents (p = 0.008). Awareness was correlated with education (p < 0.001). Eighty-nine percent of participants were willing to be tested if it would directly affect their therapy and 86.9% would be tested to benefit their family. Seventy-four percent of patients would pay 20% of the cost of testing, only 25.1% would pay in full.ConclusionsA majority of women with ovarian cancer are not aware of the availability of BRCA testing. This lack of awareness is more profound in minorities. Despite lack of knowledge, most patients would undergo testing if it would impact their care. However, cost may be a barrier. Given the willingness of patients to undergo testing and the possibility of targeted therapy, clinicians who care for these patients should work to make appropriate genetic counseling referrals.     

Second-trimester maternal serum free-beta-human chorionic gonadotropin and alpha-fetoprotein levels in normal twin and singleton pregnancies: a report of local Chinese population

OBJECTIVES: The study evaluated the differences between Chinese normal twin and singleton pregnancies in the levels of maternal serum free-beta-human chorionic gonadotropin (free beta-hCG) and alpha-fetoprotein (AFP) used in second-trimester Down syndrome (DS) screening. METHODS: The concentrations of maternal serum markers of 456 twin pregnancies and 12 067 singleton controls in gestational 15 to 20 weeks were measured by time-resolved fluoroimmunoassay, and the levels of markers were compared between the twins and singletons. RESULTS: Significant differences were found between the levels of free beta-hCG in twins and twice of those in singletons in 16, 17 and 19 gestational weeks (p < 0.05 for all); while considering AFP, significant differences were found in 16 and 19 gestational weeks (p < 0.05 for both). No correlations were found in twins between the levels of markers and maternal weights in most gestational weeks (Free beta-hCG: p > 0.05 for 15 to 18 and 20 gestational weeks; AFP: p > 0.05 for 16 to 20 gestational weeks). CONCLUSIONS: The Chinese gestational age-specific levels of maternal serum markers in normal twins are not twice as those in singletons. The current weight-correction model for DS screening may be not feasible for twins.     

The combined detection of umbilical cord nucleated red blood cells and lactate: early prediction of neonatal hypoxic ischemic encephalopathy

OBJECTIVE: To establish a simple and quick method that could be used to predict the occurrence of hypoxic ischemic encephalopathy (HIE) as early as possible by investigating the variations of nucleated red blood cells per 100 white blood cell (NRBC/100 WBC) counts and lactate levels in cord blood. METHODS: In 46 cases of acute fetal distress (AFD) and 54 cases of chronic fetal distress (CFD) neonates we measured the percentage (NRBCs/100 WBC) and lactate in the umbilical blood. RESULTS: Both lactate levels and NRBC/100WBC counts were higher in CFD and AFD groups than in controls (both P<0.01). The numbers of NRBC/100 WBC and the values of lactate in moderate-severe HIE group were higher than in mild-HIE group (P=0.002 and P=0.042, respectively). The combined sensitivity and specificity was 94% and 96% at 15NRBC/100WBC and 4.25 mmol/L level by combined detecting NRBC and lactate to predict HIE. Three infants (including 1 death and 2 survivors) had the highest levels of NRBC/100WBC and lactate in cord blood, and the 2 survivors had the lowest mental development index (MDI) and psychomotor development index (PDI). CONCLUSIONS: Combined detection with NRBC/100WBC and lactate allows early prediction of development and severity of HIE. The levels of these parameters are related to the neurodevelopment outcome of HIE infants.     

Abnormally low expression of connexin 37 and connexin 43 in subcutaneously transplanted cryopreserved mouse ovarian tissue

Purpose

To analyze the gap junction proteins connexin 37 (Cx37) and connexin 43 (Cx43) after subcutaneous transplantation of cryopreserved mouse ovarian tissue.

Methods

Expression of gap junction genes was assessed by immunohistochemistry and real-time polymerase chain reaction (PCR) in transplanted cryopreserved ovarian tissue compared with that of normal ovarian tissue. Apoptosis of ovarian cells was evaluated by using the terminal deoxynucleotidyl transferase-mediated biotinylated deoxyuridine triphosphates nick end-labeling method.

Results

After subcutaneous transplantation, Cx37 and Cx43 mRNA and protein expression were significantly lower in cryopreserved than in normal ovarian tissue. Apoptosis was increased in granulosa cells from antral follicles of the cryopreserved tissue.

Conclusion

After cryopreservation and subcutaneous transplantation of ovarian tissue, proteins forming gap junctions between oocytes and granulosa cells are under-expressed compared with normal controls.     

Supracervical hysterectomy in patients with advanced epithelial ovarian cancer

OBJECTIVE: To assess whether supracervical hysterectomy (SCH) is a reasonable alternative to total abdominal hysterectomy in patients with advanced ovarian cancer. METHODS: We reviewed the records of patients with advanced ovarian cancer who underwent a SCH at one institution between 1993 and 2004 and a similar cohort who underwent total abdominal hysterectomy (TAH) at the same institution during the same period. Patients without complete surgical staging done at the institution were excluded. Independent-sample t tests, Fisher exact test, and log rank tests were used for statistical analysis. RESULTS: The study included 47 patients who underwent SCH (mean age, 59.6 years) and 190 who underwent TAH. There were no significant differences between the two groups in age (P=.51), preoperative CA 125 level (P=.55), or receipt of taxane-based and platinum-based chemotherapy (P=.84). Although limited by sample size, there were no significant differences between the two groups in rates of intraoperative complications (4 of 47 in the SCH group, or 8.5%, compared with 7 of 190 in the TAH group, or 3.7%; P=.24), vaginal or cervical recurrence (5 of 47 in the SCH group, or 10.6%, compared with 22 of 190 in the TAH group, or 11.6%; P=1.00), or in progression-free survival (SCH of 1.01 years compared with TAH of 1.19 years; P=.64) or overall survival (SCH of 3.28 years compared with TAH of 3.36 years; P=.12). CONCLUSION: Supracervical hysterectomy may be a reasonable alternative to TAH in patients with advanced ovarian cancer. LEVEL OF EVIDENCE: II.     

不完全型P450 17α酶缺乏症六例报道及分析

目的 探讨不完全型P45017α酶（17α羟化爵每／17,20裂解酶）缺乏症（17OHD）的临床特征、鉴别诊断和处理方法。方法 回顾性分析北京协和医院6例不完全型17OHD的临床特征,并通过文献复习讨论该病的发病机制和典型的临床特征。结果 6例中4例为46,XX不完全型17OHD患者,其临床特征包括女性表型、不同程度的乳房发育、阴毛少、月经稀发或继发闭经、反复发作的卵巢囊肿、性腺功能低下伴持续性血清孕酮和（或）17α羟孕酮水平升高、合并或不合并低钾性高血压;另2例为46,XY不完全型17OHD患者,伴有不同程度的外生殖器性别不清和低钾性高血压。结论 不完全型17OHD是一种极为罕见的先天性甾体合成酶缺乏,临床上出现月经异常、性发育幼稚、反复发作的卵巢囊肿或外生殖器性别不清时应考虑此病。     

精神科护士工作压力源调查分析

目的探讨精神科护士的工作压力源,为护理管理提供参考。方法采用问卷调查法对107名精神科在职护士进行调查。并与内、外科护士的国内常模进行对比分析。结果精神科护士工作压力源依次为：工作环境及资源方面的问题;护理专业及工作方面的问题;工作量及时间分配问题;病人护理方面的问题;管理及人际关系方面的问题。工作压力源总分及上述5个因子得分均低于内、外科护士国内常模．差异有显著或极显著性（P〈0．05或0．01）。结论缓解或消除精神科护士的工作压力源．可有效提高精神科的护理工作效率。