The placenta contributes to activation of the renin angiotensin system in twin-twin transfusion syndrome

The renin-angiotensin system (RAS) in twin-twin transfusion syndrome (TTTS) is up-regulated in the donor fetus's kidneys, but down-regulated in the recipient's. Ultrasonographic and echocardiographic features suggest that the recipient is also exposed to RAS components. In this study we investigated the role and origin of RAS components in the recipient fetus. Monochorionic diamniotic (MCDA) pregnancies were recruited from a tertiary fetal medicine service. Cord blood was collected from MCDA twins (TTTS and control non-TTTS) at delivery for renin and angiotensin II immunoassays. Placental tissue was flash-frozen for mRNA and protein expression or formalin-fixed for immunohistochemistry. Archival placenta and kidney samples were used for immunohistochemistry and in-situ hybridization. Plasma renin levels were elevated (p<0.05) in recipients (median 201pg/ml, range 54-315pg/ml) and donors (125pg/ml, 25-296) with TTTS compared to controls (2.5pg/ml, 1.1-1.5pg/ml). The same was found with angiotensin II with high levels in both recipients (300.5pg/ml, 86.1-488pg/ml) and donors (239pg/ml, 76.6-422) compared to controls (169.5pg/ml, 89-220pg/ml, p<0.05). Renin mRNA expression, and protein appeared qualitatively higher in the placental territory of the recipient compared to that of the donor and non-TTTS controls. We conclude that both fetuses in TTTS are exposed to high levels of RAS components; these appear to be produced from different sites, namely the kidney of the donor, and the placenta of the recipient. Given the markedly different phenotypes in the genetically identical fetuses with TTTS, we suggest that the source of RAS components may influence their clinical manifestations.     

Histamine-induced contraction and relaxation of placental chorionic plate arteries

Studies of the human placental vasculature suggest a low resistance circulation. Using wire myography, endothelial-dependent relaxation of human chorionic plate arteries has been difficult to demonstrate with any consistency. However, histamine has been suggested to relax placental vessels in the perfused organ in vitro. Here we aimed to demonstrate endothelial-dependent relaxation to histamine under physiological conditions of stretch and oxygenation. Histamine administration to pre-contracted arteries induced a triphasic response; an initial contraction followed by a dilatation which stabilized to a significant relaxation compared to time control arteries. Relaxation was partially inhibited by blockers of endothelial-dependent relaxation pathways. The initial contraction was abolished by H(1)-receptor blockade with mepyramine. The relaxation was significantly reduced by H(2)-receptor blockade with famotidine but only abolished in the presence of both H(1)- and H(2)-receptor antagonists. In conclusion, histamine induced contraction and relaxation of human chorionic plate arteries. Our data suggest that contraction is mediated by activation of H(1)-receptors. Relaxation occurs directly, via activation of H(2)-receptors on vascular smooth muscle cells, and indirectly via H(1)-receptor stimulation of endothelial-dependent relaxation.     

腹主动脉球囊阻断术在凶险性前置胎盘剖宫产中的应用价值

目的 探讨凶险性前置胎盘剖宫产术前行腹主动脉球囊预置,术中暂时阻断腹主动脉对母婴妊娠结局的影响.方法 回顾性分析2012年4月至2017年3月在安徽医科大学附属妇幼保健院产科住院分娩的86例凶险性前置胎盘病例资料.其中,观察组31例,剖宫产术前行腹主动脉球囊预置术,术中暂时行腹主动脉阻断;对照组55例,剖宫产术前未行腹主动脉球囊预置术.比较两组对象术中、术后情况,相关并发症差异及新生儿结局.结果 观察组术中出血量为(925.81±513.79)mL,输血量为(412.90±557.82)mL,对照组术中出血量为(1345.45±841.31)mL,输血量为(786.36±1061.07)mL,差异均有统计学意义(P<0.05);两组对象手术时间、胎盘植入率、新生儿体质量及窒息发生率比较,差异均无统计学意义(P>0.05);在合并胎盘植入的病例中,两组对象手术时间及子宫切除率分别为(81.57±20.07)min、14.3％和(112.25±25.80)min、66.7％,差异均有统计学意义(P<0.05).结论 对于凶险性前置胎盘尤其是合并胎盘植入的对象,剖宫产术前行腹主动脉球囊预置可有效控制术中出血量,减少输血量,缩短手术时间,降低子宫切除风险.     

柴油车尾气颗粒物对小鼠胚胎发育不良影响的初步研究

目的 初步探讨柴油车尾气颗粒对胚胎发育的不良影响.方法 从孕鼠妊娠起经腹腔注射从某交通繁华路段收集的柴油车尾气颗粒,按高剂量7.4mg/(kg·d)、低剂量组(4.4/(kg·d)和二甲亚砜对照组进行研究.结果 高剂量组非存活胎鼠发生率(23.8%)和活胎鼠宫内发育迟缓发生率(9.8%)均高于对照组;高低剂量组均出现外...     

前置胎盘临床高危因素分析及其与妊娠结局的相关性研究

目的探讨前置胎盘的临床高危因素及其对母婴的影响,为其预防提供理论依据。方法选取2010年9月—2013年6月期间住院的单胎前置胎盘孕产妇(112例)为研究组,同期住院的健康、单胎、非前置胎盘孕产妇(177例)为对照组,回顾性分析前置胎盘临床常见病因及其对母婴的影响。结果研究组中年龄≥35岁者43例,占38.4%,无业30例,占26.8%,工人32例,占28.6%,分娩史≥3次者29例,占25.9%,人工流产史≥3次者48例,占42.9%,剖宫产史者22例,占19.6%,盆腔炎史者39例,占34.8%,均高于对照组;经统计学分析比较,两组患者年龄、人工流产史、剖宫产史、分娩史、盆腔炎史差异有统计学意义(均P0.05),Logistic回归分析显示,高龄、多次人工流产史、剖宫产史及分娩史暴露率相对较高,是前置胎盘的常见病因;两组产妇妊娠结局比较,研究组剖宫产、胎盘粘连、胎盘植入、产后出血、产褥期感染、早产、低出生体重儿、新生儿窒息发生率明显高于对照组,差异均有统计学意义(均P0.05)。结论年龄、人工流产史、剖宫产史、分娩史是前置胎盘的高危因素,严重威胁母婴生命,应做好生殖卫生、实行计划生育、减少人工流产次数、降低剖宫产率等防治措施。     

牦牛胎盘粉对小鼠免疫脏器的影响

目的:通过牦牛胎盘粉对小鼠免疫脏器影响的研究,探讨牦牛胎盘粉的药用价值,为进一步开发和利用牦牛胎盘提供理论依据。方法:采取健康牦牛的成熟胎盘,加工成胎盘粉,连续灌服小白鼠25d后,观察它们免疫学方面的变化。结果:试验结果表明在相同的饲养条件下,试验小鼠连续灌服牦牛胎盘粉、人胎盘粉25d后与对照组相比免疫器官胸腺、脾脏的重量、K值有明显变化(P<0.05)。且牦牛胎盘组和人胎盘组的胸腺皮质部较对照组的明显增厚,脾脏脾小梁周围脾窦增宽,有大量成熟淋巴细胞,脾小结也较对照组的明显。结论:小鼠服用牦牛胎盘粉与人胎盘粉产生同样的生物学效应。     

人胎盘叶酸受体蛋白的提取、纯化及鉴定

目的 建立人胎盘叶酸受体蛋白的提取及纯化方法,并对其进行定性定量检测. 方法 采集医院分娩的正常人的胎盘样品.将胎盘剪碎,组织匀浆,酸化及中和,过柱提纯,组分鉴定,除杂并用分子筛进一步纯化.利用Bradford检测蛋白浓度,用SDS-聚丙烯酰胺凝胶电泳和银染方法进行蛋白分子量检测,用Western Blot对提取蛋白进行定性鉴定. 结果 用于本实验的胎盘湿重370 g.在经过亲和层析柱抽提后的8个留样组分中,组分2～5含有目的蛋白的粗提物.经过分子筛等方法除杂后,Bradford蛋白检测显示本次共提取蛋白总量345 μg.SDS-聚丙烯酰胺凝胶电泳和银染方法结果证实此蛋白分子量大约为35 ～40 KDa.Western Blot方法显示此蛋白与叶酸受体抗体特异结合. 结论 使用本研究方法能够从人胎盘中成功提取并纯化人源的叶酸受体蛋白,每100 g胎盘可提取叶酸受体蛋白93 μg.本研究为以后的叶酸受体抗体检测奠定了基础.     

子宫动脉栓塞术在孕6月余合并中央性前置胎盘引产中的应用一例

患者37岁,G4P2,因停经6个月,反复无痛性少量阴道出血4个月,加重3 d入院.该患者停经2个月后反复出现无痛性少量阴道出血,间隔约40 d 1次,每次持续2～3 d,较平时月经量少,休息后能自止,未就诊.3 d前无明显诱因出现阴道出血500～600 ml,不伴腹痛.入院时,血压130/80 mmHg,中度贫血貌,心肺未闻及异常.宫高、腹围与停经月份符,胎心音140次/min,臀位,宫口未开,无宫缩.辅助检查:血红蛋白(Hb)71 g/L;B超示臀位胎儿,宫颈内口处见胎盘组织回声.     

人体胎盘脂多糖辅助治疗初治菌阳肺结核患者疗效及细胞因子观察

目的观察人体胎盘脂多糖辅助治疗初治菌阳肺结核疗效及细胞因子的变化.方法将60例初治菌阳肺结核患者随机分为治疗组和对照组,两组各为30例,均用相同的抗结核治疗,治疗组加用人体胎盘脂多糖.结果治疗二个月后,治疗组痰菌阴转率为96.7%,X线病灶吸收好转率93.3%;与对照组80%,70%,相比较差异有显著性(P＜0.05).T淋巴细胞亚群和血清细胞因子IL-4治疗前后及IFN-γ两组比较均有差异显著(P＜0.01),未见明显副作用.结论人体胎盘脂多糖与化疗药物联合应用可提高初治菌阳肺结核疗效,使用安全.并能提高患者细胞免疫,使初治菌阳阴转率高,病灶吸收快.     

上海市剖宫产出血计量研究

目的研究剖宫产手术至术后24h出血总量.方法上海市6所医院用吸引器抽吸及纱布称重法分阶段测量剖宫产手术,术后2h,术后4h及术后24h以及两者的出血总量.结果539例剖宫产手术至术后24h失血总量为(494.34±211.16)ml,失血总量大于500ml、600ml及700ml者各为43.79%,23.94%及12.44%.6所医院剖宫产至术后24h失血量在(387.94±161.32)ml至(797.7±205.52)ml,手术中的失血量约占总失血量的三分之二,失血量与前置胎盘及巨大儿有明显关系,并可能与促子宫收缩剂的剂量有关.结论本研究的剖宫产手术至术后24h平均失血总量约为500ml,建议剖宫产的产后出血定义应修改为≥600ml.