Does the Addition of Serum PAPP-A and β-hCG Improve the Predictive Value of Uterine Artery Pulsatility Index for Preeclampsia at 11–14 Weeks of Gestation? A Prospective Observational Study

Purpose of StudyTo study the role of uterine artery Doppler pulsatility index (UtA-PI), serum pregnancy-associated plasma protein-A (PAPP-A) and free beta human chorionic gonadotropin (fβ-hCG) levels, individually and in combination with each other, at 11–14 weeks of gestation for prediction of preeclampsia (PE).MethodsIn a prospective observational study, a total of 100 low-risk gravid females were recruited at 11–14-weeks of gestation. UtA-PI, PAPP-A and fβ-hCG levels were estimated. These women were followed up until delivery for the development of PE and gestational hypertension (GH).ResultsThe best individual marker for screening PE and GH was UtA-PI with ROC AUC (± standard error) = 0.934 ± 0.028, p < 0.0001. UtA-PI at a cutoff value of ≥ 2.8 (95th percentile) had 77.8% sensitivity, 98.9% specificity, 97.8% NPV and 87.5% PPV in detecting PE. PAPP-A (MoM) at a cutoff value of ≤ 0.27 (5th percentile) demonstrated 44.4% sensitivity, 95.6% specificity, 94.5% NPV and 50% PPV. fβ-hCG (MoM) at a cutoff value of ≤ 0.5 (5th percentile) had a specificity of 94.5%. Among the combined markers, UtA-PI along with PAPP-A estimation served best with a sensitivity and specificity of 44% and 100%, respectively. Addition of fβ-hCG to either UtA-PI or PAPP-A levels was not found sensitive for detecting PE but yielded 100% specificity and 96% NPV.ConclusionUtA-PI as a stand-alone test was found most useful for the prediction of PE. Addition of either or both of PAPP-A and fβ-hCG to UtA-PI did not improve the sensitivity of combined test with only a slight improvement in specificity and NPV. Their routine addition to UtA-PI studies is not recommended for prediction of PE at 11–14 weeks of gestation in low- and lower-middle-income countries (LMIC).     

巨大子宫肌瘤供血动脉的MSCTA表现及临床应用价值

目的探讨巨大子宫肌瘤供血动脉在多层螺旋CT血管造影（MSCTA）中的表现特点及临床应用价值。方法搜集术前经多层螺旋CT检查并术后病理证实的巨大子宫肌瘤患者32例,采用容积再现（vR）血管生长技术（AV）进行肿瘤供血动脉重建,研究其血供特点。结果32例子宫肌瘤均可显示其供血动脉,显影率100％,表现为双侧子宫动脉供血为主型或一侧子宫动脉供血为主型;4例显示双侧卵巢动脉参与供血,2例显示一侧卵巢动脉参与供血。结论MSCTA能清楚显示巨大子宫肌瘤供血动脉及侧支循环,能作为判断肿瘤起源的依据及为制定手术切除方案或栓塞介入治疗方案提供依据。     

产科急症子宫切除相关危险因素Logistic回归分析

目的 探讨产科急症子宫切除的发生率、产科急症子宫切除的危险因素.方法 回顾性分析商丘市4家市级医院分娩产妇病历资料,将80例行产科急症子宫切除患者作为子宫切除组,按随机数字表法随机抽取同期56例剖宫产产后出血子宫未切除患者作为对照组,分析与产科急症相关的危险因素.结果 (1)分娩总人数共65 259例,剖宫产率为47.46％(30 972/65 259),剖宫产产后出血率为4.61％(1 429/30 972),剖宫产子宫切除率为0.18％(56/30 972),阴道分娩产后出血率3.28％(1 124/34 287),院内阴道分娩急症子宫切除率为0.03％(12/34 287),刮宫产产后出血率及产科急症子宫切除率均高于阴道分娩产后出血率及子宫切除率,差异有统计学意义(x2=77.22、33.24,均P＜0.05).(2)单因素分析,前置胎盘并植入、胎盘早剥、合并多发或巨大子宫肌瘤、子宫破裂、凝血功能障碍、出血量＞2 000 ml、术中联用缩宫素率在两组之间均差异有统计学意义(P＜0.01).(3)非条件多因素Logistic回归分析,胎盘早剥、子宫破裂、合并多发或巨大子宫肌瘤、凝血功能障碍、出血量＞2 000 ml是导致产科急症子宫切除的独立危险因素,术中联用缩宫素与切除子宫之间具有负相关,是保护因素.结论 产科急症行子宫切除术与多种因素相关,加强围产期保健,积极预防急症子宫切除术的危险因素对降低子宫切除率具有重要意义.     

高强度聚焦超声治疗子宫肌瘤的超声图像研究

目的评价超声图像作为高强度聚焦超声治疗子宫肌瘤时作用及地位。方法利用高强度聚焦超声治疗子宫肌瘤患者16例,观察子宫肌瘤术中及术后超声图像的变化,同时对照手术前后核磁共振(MRI)的动态变化。结果HIFU治疗时,可见超声灰阶增强,术后随访肌瘤血流减少或消失,术后MRl显示治疗靶区坏死明显,坏死区与超声定位治疗靶区相一致,提示超声定位及监控准确。周围邻近脏器未见损伤。结论超声定位是目前高强度聚焦超声治疗子宫肌瘤较好的定位及治疗监控手段。     

Sleep-induced hypotension precipitates severe myocardial ischemia

STUDY OBJECTIVES: Epidemiologic studies have shown a high frequency of major cardiac events at night in patients with coronary artery disease. This has been attributed to the sympathetic surges accompanying rapid eye movement (REM) sleep; the role of non-REM sleep, which comprises 80% of total sleep duration, has been largely neglected. Accordingly, we evaluated the effect of non-REM sleep on contractile function in a region of the left ventricular wall supplied by a flow-limiting coronary stenosis. DESIGN: Eight domestic pigs were chronically instrumented to measure regional left ventricular contractile function (wall thickening), coronary blood flow, and systemic hemodynamic variables. Measurements were obtained: (1) during wakefulness, i.e., conscious condition, prior to imposition of coronary stenosis; (2) during wakefulness following imposition of coronary stenosis (30% reduction of baseline coronary blood flow from 40 +/- 4 to 27 +/- 3 mL/min); and (3) during non-REM sleep with coronary stenosis maintained. RESULTS: During wakefulness, coronary stenosis reduced wall thickening (from 23.3 +/- 3.4% to 15.7 +/- 2.0%), whereas mean arterial pressure and heart rate were unchanged. With coronary stenosis maintained, the onset of non-REM sleep caused 20% decreases in mean arterial pressure and coronary blood flow, accompanied by a cessation of regional wall thickening, i.e., akinesis (wall thickening = 0.2 +/- 2.8%), indicating severe myocardial ischemia. CONCLUSIONS: The arterial hypotension, and associated reduction in coronary blood flow, during non-REM sleep precipitated severe myocardial ischemia in a region of the left ventricular wall supplied by flow-limiting coronary stenosis. Such episodes would occur repeatedly during the sleep cycle and could potentially set the stage for a major cardiac event during the sympathetic activation accompanying REM sleep or morning activities.     

子宫角妊娠18例临床分析

目的　提高对子宫角妊娠的早期诊断水平。方法　回顾性分析我院二十年间收治的 18例子宫角妊娠病例 ,总结其临床表现、诊断、处理。结果　子宫角妊娠占同期异位妊娠的 1.5 6%,术前确诊率为 44 .44 %,易误诊为流产、输卵管妊娠。结论　认为血 β -HCG、B超及腹腔镜检查对本病的早期诊断有重要意义 ,避免了如子宫破裂、胎盘滞留等严重并发症     

Correlations between reduced expression of the metastasis suppressor gene KAI-1 and accumulation of p53 in uterine carcinomas and sarcomas

Kangai (KAI)-1 (CD82) is a metastasis suppressor gene, which belongs to the family of tetraspanin proteins. A loss of KAI-1 expression is associated with the advanced stages of many human malignancies. The present study was designed to investigate the expression pattern of KAI-1 in the normal endometrium and uterine tumors and to correlate it with the expression of tumor suppressor protein p53. KAI-1 could be found in the normal endometrium throughout the menstrual cycle. Thirteen of 42 endometrial carcinomas demonstrated moderate KAI-1 expression, but low expression of p53. Twenty-nine of 42 endometrial carcinomas showed reduced or absent KAI-1 expression, which correlated with strong expression of p53 (p < 0.001). There were significant correlations between KAI-1 expression and histological type, e.g., 93% of endometrioid carcinomas displayed a low or moderate immunostaining for KAI-1, whereas nearly all of the serous/clear cell carcinomas were KAI-1 negative (p < 0.001); tumor grading, e.g., 73% of high grade tumors showed no KAI-1 expression (p < 0.001). Most of the investigated uterine sarcomas were negative for KAI-1, whereas they displayed a strong immunostaining for p53. In conclusion, KAI-1 and p53 show inverse expression. The reduced KAI-1 expression may be the result of dysregulated p53 function and could be an important step in the endometrial carcinogenesis.     

Peutz–Jeghers syndrome-associated atypical mucinous proliferation of the uterine cervix: A case of minimal deviation adenocarcinoma (‘adenoma malignum’) in situ

We describe a case of a non-invasive precursor of minimal deviation adenocarcinoma (MDA) of the uterine cervix, associated with Peutz–Jeghers syndrome (PJS). A 27-year-old woman, who had been followed for PJS, was referred to the gynecology clinic. Colposcopic examination demonstrated a small polypoid lesion in the transformation zone. Microscopic examination of the biopsy specimen demonstrated papillary proliferation of the mucinous epithelium with bland nuclear morphology. Conization revealed lobular endocervical glandular hyperplasia (LEGH) with distinct nuclear anaplasia, as well as papillary proliferation of the mucinous epithelium with mild to moderate nuclear abnormalities. This case suggests that the incipient phase of PJS-associated MDA is related to atypical LEGH (“MDA in situ”), and indicates the importance of early screening and surveillance by gynecologists in cases of PJS to detect cervical adenocarcinomas.     

MRI studies of cryoinjury infarction in pig hearts: ii. Effects of intrapericardial delivery of adipose-derived stem cells (ADSC) embedded in agarose gel

The purpose was to assess effects of intrapericardially deposited adipose‐derived stem cells (ADSC) as a source of angiogenic factors on cryoinjury infarction. To enhance this effect and reduce incorporation of ADSC into tissue, the cells were immobilized in agarose gel patches transplanted onto cryoinjured epicardium. In domestic pigs (15–20 kg) the left ventricular (LV) anterior wall of exposed hearts was cryoinjured using aluminum rod (Φ=25 mm) cooled in liquid nitrogen. Sterilized circular patches made of agarose gel were placed in a nylon bag and sutured to cryoinjured epicardium. In 4 pigs, the patches contained 650,000 human ADSCs; in control animals patches were cell‐free (n,=,2) or no patches were implanted (n,=,2). Cine and T₁‐weighted MRI was performed in vivo weekly (4 weeks) after injury using a 3 T imager. Following baseline imaging, a double bolus of gadopentate dimeglumine was injected (GdDTPA, 0.05 and 0.15 mmol/kg) and serial short axis images were acquired. In the 4‐week ADSC‐treated group, 2 pigs were assessed using GdDTPA and 2 pigs were assessed using MnCl₂ (70 micromol/kg/14 min). In all pigs, 5 × 10⁶ NIR fluorescent microspheres (15 µm FMS, 645/680 nm) were injected into the hearts, which were excised, sliced and examined with fluorescence imaging for FMS content. Triphenyltetrazolium chloride (TTC) staining was used to determine necrotic areas. Four‐week infarction areas were hypokinetic and appeared hyperintensive on Gd‐enhanced MR images, hypointensive on Mn‐enhanced images, and were TTC‐negative. First‐pass Gd enhancement kinetics was faster in the infarct area of ADSC‐treated hearts: 152 ± 89 vs 54 ± 5.3% of normal in control (p = 0.03). Accordingly, FMS fluorescence was much higher in the treated infarcts (144 ± 59% of remote, n = 4) relative to control hearts (58 ± 13%, n = 4), which correlated with 3 times higher microvascular density in treated hearts. LV wall thickening was partially restored by ADSC treatment. ADSC‐containing patches attached to cryoinjured epicardium greatly improved perfusion and microvascular density of scar tissue. Copyright © 2011 National Research Council Canada.     

Gestrinone inhibits growth of human uterine leiomyoma may relate to activity regulation of ERα, Src and P38 MAPK

The study was to investigate the effect of gestrinone on the growth of human uterine leiomyoma cells and on the levels and activity of p38, Src and estrogen receptor alpha (ERα). Human uterine leiomyoma cells were cultured and treated with dimethylsulfoxide (DMSO) or a gestrinone concentration gradient. Morphological changes were observed and apoptosis was evaluated. Levels of p38 and phosphorylated-p38 (pp38) were assayed by enzyme-linked immunosorbent assay (ELISA). Levels of ERα and Src were analyzed using real-time RT-PCR and Western blotting. The result showed that gestrinone significantly inhibited the growth of cultured human uterine leiomyoma cells in a concentration- and time-dependent manner, with a 50% inhibitory concentration (IC₅₀) value and corresponding 95% confidence intervals (CI) of 43.67 (23.46∼81.32), 27.78 (12.51∼61.68) and 15.25 (7.17∼32.43) μmol/L at 20, 40 and 60 h, respectively. Compared with control-treated leiomyoma cells, gestrinone significantly reduced both the expression of ERα (P < 0.05) and the levels of phospho-Ser167-ERα (P < 0.05). Gestrinone also markedly suppressed the level of phospho-Tyr416-Src (P < 0.05). Moreover, gestrinone significantly increased the ratio of phospho-p38/p38 mitogen-activated protein kinase (MAPK) (P < 0.05). However, no significant increase in apoptosis or cell cycle arrest was observed (P > 0.05) in response to the tested concentrations of 0.1 to 3.0 μmol/L. As a conclusion, gestrinone suppresses the proliferation of uterine leiomyoma cells mainly by regulating the activity of ERα/Src/p38 MAPK in a concentration-dependent manner at a low concentration of 0.1∼3.0 μM, but not significantly regulating apoptosis. Gestrinone opposes the growth of uterine leiomyoma through multiple genes.