Comparison of serum cancer antigen 125, human epididymis protein 4, ROMA, and CPH-I for diagnosis of ovarian cancer in Chinese patients with ovarian mass / 南方医科大学学报

OBJECTIVE@#To compare the performance of serum cancer antigen 125 (CA125), human epididymis protein 4 (HE4), Risk of Ovarian Malignancy Algorithm (ROMA) and Copenhagen index (CPH-I) for differential diagnosis of benign and malignant diseases in patients with ovarian mass.@*METHODS@#We retrospectively analyzed the data of 719 women with pelvic mass, and the performance of preoperative serum levels of CA125 and HE4, ROMA and CPH-I for differential diagnosis of the masses was compared.@*RESULTS@#Of the 710 women analyzed, 531 were diagnosed with benign ovarian lesions, 44 with borderline ovarian tumors (BOTs), 119 with epithelial ovarian cancers (EOCs), and 25 with non-EOCs. In differentiating ovarian cancer (OC) and BOT from benign lesions, the area under the receiver-operator characteristic (ROC) curve (AUC) was 0.854 for HE4, 0.856 for ROMA, 0.854 for CPH-I, and 0.792 for CA125, demonstrating better diagnostic performance of HE4, ROMA, and CPH-I than CA125 alone; the diagnostic sensitivity was 56.9% for HE4, 70.2% for CA125, 69.1% for ROMA, and 63.8% for CPH-I; the specificity was the best with HE4 (94.4%) and CPH-I (94.7%). In sub-analysis of EOC benign lesions, the AUCs of HE4, ROMA, and CPH-I increased to 0.946, 0.947, and 0.943, respectively, all greater than that of CA125 (0.888). In other sub-analyses, HE4, ROMA, and CPH-I all showed greater AUCs than CA125 alone.@*CONCLUSIONS@#This study confirms the accuracy of HE4, ROMA, and CPH-I for differentiating malignant from benign ovarian mass, and all these 3 tests show better performance than CA125. Furthermore, HE4 and CPH-I is superior to ROMA and CA125 in terms of specificity, while CA125 and ROMA have better diagnostic sensitivities.

Comparison of PG-SGA, NRS 2002 and BIA in nutritional assessment and screening of patients with gynecologic cancers / 肠外与肠内营养

Objective:To evaluate the application of PG-SGA,NRS 2002 and BIA in nutritional assessment and screening of patients with gynecologic cancers.Methods:118 patients were randomly selected.Nutritional status were evaluated by PG-SGA,NRS 2002 and BIA,and consistency between each tools were compared.Results:The prevalence of malnutrition or nutritional risk of patients were 64.4％ (PG-SGA),57.6％ (NRS 2002),and 33.9％ (BIA) respectively.In all patients,the consistency of PG-SGA and NRS 2002 was high (P ＜ 0.001),while there were not significantly consistent between BIA and PG-SGA,or between BIA and NRS 2002 (P ＜ 0.001).Conclusion:According to the evaluation of PG-SGA or NRS 2002 in gynecologic patients,the prevalence of malnutrition or nutritional risk is high,and these two scales are suitable for nutritional assessment and screening of gynecologic cancer patients,especially in ovarian cancer patients.In addition,BIA may be a promising tool to evaluate cervical cancer patients' nutritional status.

Protective effect of estrogen on acute lung injury after hemorrhagic shock in pregnant rabbit / 中华妇产科杂志

Objective The paper is an attentative effort to evaluate the reaction and mechanism of estrogen on pregnant rabbits with acute lung injury caused by hemorrhagic shock. Methods Sixty pregnant New Zealand white rabbits were randomly divided into 6 groups, with 10 rabbits in each group, namely normal control group (NG group, with anesthesia only), estrogen group (E2G group, with additional estrogen injection at 60 min) and the other four hemorrhagic shock groups underwent hemorrhagic shock (i.e. E2SG, FSG, SBSG, E2SBSG group;mean blood pressure-40 mmHg(1 mmHg=0.133 kPa)by phlebotomy for 15 min. After maintenance of the pressure for 45 min, the rabbits were treated with E2(0.37 mg/kg), fructose injection(5%,2 ml/kg), the p38 mitogen-activated protein kinases(p38MAPK) inhibitor SB-203580 (2 mg/kg) or E2 plus SB-203580. Tumor necrosis factor alpha(TNF-α), interleukin-6(IL-6) were measured at different time points(0 min, 60 min, 80 min and 260 min), lung tissue methane dicarboxylic aldehyde(MDA) level, lung tissue myeloperoxidase(MOP), superoxide dismutase(SOD) activity, lung tissue dry weight/wet weight (DW/WW) value were measured after the experiment was finished, pulmonary pathology of the rabbits was observed. Result (1) Serum TNF-α level of NG group and E2SG group were not significantly different compared with the other four groups at the 0 min and 60 min. At 80 min and 260 min of experiment, serum TNF-αlevel of all the four shock groups were increased, E2SG group [(172.4±16.0) and (216.7±18.6) ng/L], FSG group [(171.6 ± 9.1) and (263.9 ± 7.8) ng/L], SBSG group [(172.8 ± 7.2) and (300.6 ± 4.8) ng/L], E2SBSG group [(167.9±4.8 )and (261.8±9.6) ng/L], and significantly higher than NG group and E2G group, separately (P<0.05). (2) Serum IL-6 level of NG group and E2SG group were not significantly different compared with the other four groups at the 0 min, 60 min and 80 min. At 260 min, the serum IL-6 level[(98.3 ± 0.9) and (110.4 ± 1.8) ng/L;(120.9 ± 2.3)and (109.8 ± 2.6) ng/L] of the four shock groups (E2SG, FSG, SBSG, E2SBSG group) were significantly higher than NG group and E2G group (P<0.05). (3) Lung tissue MDA level [(2.20± 0.12),(2.57±0.11),(3.17±0.08), (2.75±1.09) nmol/mg] and MPO activity [(4.45±0.25),(6.65±0.56),(9.55±0.30), (6.78 ± 0.11) U/mg] of the four shock groups (E2SG, FSG, SBSG, E2SBSG group) were higher than NG group and E2G group (P<0.05). (4) Lung tissue SOD activity [(51.8 ± 1.8),(40.2 ± 1.5), (30.0 ± 1.7),(41.2 ± 2.0) U/mg] was significantly higher in the four shock groups(E2SG, FSG, SBSG, E2SBSG group) compared with NG group and E2G group (P<0.05). (5) Lung tissue DW/WW value(0.143 ± 0.008, 0.127 ± 0.008, 0.109 ± 0.006, 0.125 ± 0.008) was significantly lower in the four shock groups(E2SG, FSG, SBSG, E2SBSG group) compared with NG group and E2G group (P<0.05). (6) Lung tissue of the rabbits in NG group and E2G group is basically normal without obvious pathology changes. Lung tissue pathological damage of rabbits was observed in the four shock groups, and the pathological damage of rabbits in SBSG group was most serious. Conclusion Estrogen can reduce acute lung injury of pregnant rabbits with hemorrhagic shock, the p38MAPK pathway plays a critical role in mediating the salutary effects of E2 on shock-induced acute lung injury.

Effects of estrogen on renal function of pregnant rabbits with hemorrhagic shock / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the effects of estrogen on renal function of pregnant rabbits with hemorrhagic shock.</p><p><b>METHODS</b>Forty pregnant New Zealand white rabbits were randomized into 4 groups, namely normal control group (NG group, with anesthesia only), estrogen group (E2 group, with additional estrogen injection at 60 min), estrogen-hemorrhagic shock (E2SG) group and fructose-hemorrhagic shock (FSG) group. In the latter two groups, the rabbits were subjected to phlebotomy for 15 min to induce hemorrhagic shock with a blood pressure of 40 mmHg; after maintenance of the pressure for 45 min, intravenous injections of estrogen or fructose were given before resuscitation 20 min later. Blood urea nitrogen (BUN) and creatinine (Cr) concentration were measured at different time points and renal pathology of the rabbits was observed.</p><p><b>RESULTS</b>No significant differences were founding serum BUN and Cr levels between NG and E2G groups during the experiment. In FSG and E2SG groups, serum BUN level began to increase at 80 min after hemorrhagic shock and was significantly higher in FSG group (P<0.05); serum Cr level increased progressively from the start of the experiment and began to decrease at 60 min, with a faster rate of reduction in E2SG group (P<0.05).</p><p><b>CONCLUSION</b>Estrogen can effectively lower serum BUN and Cr levels and ameliorate renal pathologies to offer protective effect in pregnant rabbits against hemorrhagic shock.</p>

Value of serum cystatin C level in assessing renal damage in preeclamptic patients / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the significance of the serum cystatin C (Cys-C) in assessing renal dysfunction in preeclamptic women.</p><p><b>METHODS</b>Ninety-six women with normal pregnancies and 48 with severe preeclampsia were examined for 24-hour creatinine clearance (CrCl), serum creatinine (Scr), Cys-C, uric acid (UA) and beta microglobulin (MG) concentrations during the second and third trimesters and postpartum in severe preeclamptic patients. These indexes were analyzed to estimate the glomerular filtration rate.</p><p><b>RESULTS</b>The concentrations of Scr, UA and MG were significantly higher in the third trimester than in the second trimester in women with normal pregnancies, where serum Cys-C levels showed no significant variations. Severe preeclamptic patients exhibited significantly higher serum Cys-C levels in the third than in the second trimester. Correlation analyses demonstrated significant negative correlations between Cys-C and 24-hour CrCl in the second and third trimesters in all the 144 pregnant women and in the postpartum period in severe preeclamptic patients.</p><p><b>CONCLUSION</b>Serum Cys-C can serve as a good indicator for assessing renal function in severe preeclamptic women from antepartum to postpartum periods.</p>

Relationship between pigment epithelium-derived factor expressed in placentas and the pathogenesis of preeclampsia disease / 中华妇产科杂志

Objective To investigate the effect of pigment epithelium-derived factor (PEDF) on the pathogenesis of preeclampsia disease,by detecting the expression of PEDF in the placentas,as well as the relationship between PEDF and the production of placental vessels.Methods A study was performed in 60 cases of pregnant women with preeclampsia in the obstetrical department of Nanfang Hospital affiliated to southern medical university from October 2011 to January 2013,in which 30 cases were patients with mild preeclampsia(mPE) and other 30 cases were those with severe preeclampsia (sPE).40 normal pregnant women who also been hospitalized and delivered were selected as control group.The expression of PEDF and micro-vessel density (MVD) in placentas were assayed by using western blot and SP immunohistochemical method,then the relationship between PEDF and MVD was analyzed.Results (1) The pathological changes of placentas:the placental weight were lightened obviously in the mild preeclampsia and severe preeclampsia groups,the reduced blood vessels and luminal stegnosis were found in chorionic villus,basement membrane of trophocytes were thickening.The hyperplasia syneytiotrophoblast were like nodosity,with focus infarction,fibrinoid necrosis,or thrombogenesis.While there was no the above mentioned pathological alteration in normal control group.(2)The levels of PEDF expression in mild and severe preeclampsia group were 0.63 ± 0.09,0.93 ± 0.07,while 0.47 ± 0.04 in control group,which in mild and sever preeclampsia groups were significantly higher than that in normal group (P ＜ 0.05).Compared to mild preeclampsia group,the expression of PEDF was significantly increased in severe preeclampsia group,there was statistical significance between the difference (P ＜ 0.05).(3) The amount of microvessel density (MVD) in mild and severe preeclampsia group were 106 ±9,93 ±8,while 136 ±9 in control group,which were significantly reduced in mild and severe preeclampsia group,compared to that in normal control group (P ＜ 0.05).And it was significantly lower in severe preeclampsia group than that in mild preeclampsia group (P ＜ 0.05).(4) The expression of PEDF was negatively correlated with the amount of MVD in mild and severe preeclampsia group (r =-0.426,P ＜ 0.05 ; and r =-0.646,P ＜ 0.05 respectively),which was also negative in control group (r =-0.589,P ＜ 0.05).Conclusion Increased PEDF expression in placentas of women with preeclampsia induce the dysfunction of the placental vascular reconstruction and the pathological alteration like ischemic and hypoxia in placentas,which may be involved in pathogenesis and pathogenic progress of preeclampsia.

Clinical efficacy and perinatal outcome of nifedipine for severe preeclampsia: Meta-analysis / 中华妇产科杂志

Objective To assess the efficacy,side effects and perinatal outcome of nifedipine compared with other antihypertensives for treating severe preeclampsia in pregnant women. Methods Randomized controlled trials (RCTs) that comparing nifedipine with other antihypertensives for severe preeclampsia were searched in PubMed,EMBase,Cochrane library,CNKI and VIP database etc( till January 2012).The quality of the included RCTs was evaluated,and Meta-analvsis was performed with Rev Man 5.1software.Results Nine trials were included,involving 386 women in the nifedipine group,and 378 women in other antihypertensives group.Compared with other antihypertensives,nifidepine was associated with greater effective control of blood pressure ( OR =2.65,95％ CI:1.65 -4.25,P ＜0.01 ).There was no clear difference in the time needed to control blood pressure ( W.M D =- 3.64,95％ CI:- 10.90 - 3.61,P =0.32 ).Nifedipine could prolong gestation better than other antihypertensives ( WMD =5.14,95％ CI:3.29-6.99,P ＜0.01 ).There were no clear differences in maternal side effects headache (P =0.28),palpitation ( P =0.06 ),and nausea vomiting ( P =0.28 ).No noticeable difference was found between the two groups in the Apgar score at five minutes ( WMD =- 0.21,95％ CI:- 0.32 - 0.91,P =0.72),neonatal respiratory distress syndrome ( OR =1.24,95％ CI:0.57 - 2.67,P =0.59 ),or perinatal deaths ( OR =0.49,95％ CI:0.22 - 1.11,P =0.09 ).Conclusion Nifedipine is associated with greater effective control of blood pressure and prolongation of gestation,with no additional neonatal respiratory distress syndrome or perinatal deaths,compared with other antihypertensives for women with severe preeclampsia.

Effect of limited volume resuscitation on hemodynamic changes in pregnant rabbit with hemorrhagic shock / 中华妇产科杂志

Objective To determine the effects of two fluid resuscitation strategies on the changes of hemodynamic variables,serum concentration of tumor necrosis factor-alpha(TNF-α)and interleukin-6 (IL-6)in a clinically relevant model of uncontrolled hemorrhagic shock in pregnant rabbits.Methods Hemorrhagic shock was induced by bleeding via carotied artery,followed by transection of a medium vessel in gestational sac.Experimental design consisted of three phases,shock phase(0-30 min),prehospital phase(30-90 min)and hospital phase(90-180 min).Twenty pregnant rabbits were randomly divided into two groups(n=10/group),aggressive fluid resuscitation group(PNL group)and limited volume resuscitation group(PLH group).In the shock phase,animals were hemorrhaged by blood withdrawal to mean arterial pressure(MAP)of 40-45 mm Hg(1 mm Hg=0.133 kPa)via carotid artery.In the prehospital phase,a medium vessel in the gestational sac was transected,then the animals in the PNL group and PLH group were resuscitated with 0.9% normal saline(NS)and shed blood to MAP of 80,60 mm Hg respectively.In the hospital phase,bleeding was controlled by surgical intervention and all the animals were reinfused with shed blood and NS to MAP 80 mm Hg.Hemodvnamic variables and respiration rate were monitored and blood samples were collected for TNF-α and IL-6 measurement.and finally subsequent volume resuscitation and survival rate were recorded.Results (1)At 120 min,the respiration rate and heart rate in the animals assigned to PLH group was(66±16)bpm,(235±41)bpm respectively,which were significantly lower than those in PNL group(P＜0.01),while MAP and central venous pressure in the PLH group was(80.4±7.2)mm Hg,(8.0±4.4)cm H2O,respectively,which were significantly higher than those in PNL group(P＜0.01);(2)The serum concentration of TNF-α,IL-6 of all the animals were markedly increased after hemorrhagic shock.and peak at 24 min.The serum concentration of TNF-α,IL-6 in animals assigned to PLH group were(105±67)ng/L,(118±51)ng/L respectively,which were significantly lower than those in PNL group(P＜0.01).The serum concentration of TNF-α,IL-6 in the animals assigned to PLH group were decreased to normal at 480 min;(3)The subsequent blood transfusion volume and NS resuscitation volume in PLH group in prehospital phase were(16.0±2.2)ml,(39.0±5.5)ml respectively,while those in hospital phase were(28.0±6.7)ml,(90.0±7.1)ml respectively,which were significantly lower than those in PNL group(P＜0.05);(4)The 24 and 72 hours survival rate in the animals assigned to PLH group were 100%,90% respectively;which were significantly higher than those in PNL group(P＜0.01).Conclusion Limited volume resuscitation improves thermodynamic changes of pregnant rabbit,attenuates the increase of serum concentration of TNF-α,IL-6,and results in higher survival rate.Limited volume resuscitation is an ideal means for hemorrhagic shock resuscitation in pregnant rabbit.