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Lacerations are common after vaginal birth.Although most obstetric lacerations ended with good outcomes,those severe ones are associated with increased risk of several short-and long-term problems,including pelvic floor injury,fecal or urinary incontinence,postpartum pain,and sexual dysfunction.The American College of Obstetricians and Gynecologists (ACOG) published a practice bulletin about the prevention and management of obstetric lacerations at vaginal delivery in 2018,providing an evidence-based comprehensive guideline for prevention,identification,and repair of obstetric lacerations and episiotomy.This article presented the essence of the guideline in order to improve the awareness of the new strategies of prevention and management of obstetric lacerations among gynecologists and obstetricians.
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Objective To investigate the activation of mammalian target of rapamycin (mTOR) signaling pathway in placental tissues of gestational diabetes mellitus (GDM) women and in JEG3 cells after high glucose treatment. Methods Placental tissues were collected from 60 singleton pregnant women at term, who underwent elective cesarean section in Peking University First Hospital from December 2016 to June 2017, including 30 GDM women (GDM group) and 30 normal glucose tolerance (NGT) women (NGT group). Expressions of mTOR, Rictor, Raptor, S6 kinase (S6K) and phosphorylated-S6K (p-S6K), which were mTOR signaling pathway-related molecules in those placental tissues were detected by real-time fluorescence quantitative polymerase chain reaction, Western blotting and immunohistochemistry. At the same time, JEG3 cells were treated with glucose of different concentrations (5.5, 10.0, 15.0, 25.0 and 50.0 mmol/L) for 24 h, and the expressions of mTOR, S6K and p-S6K were detected by Western blotting. Two independent samples t-test, one-way analysis of variance test and Spearman correlation analysis were used for statistical analysis. ResuLts Compared with the NGT group, the pre-pregnancy body mass index(BMI), neonatal birth weight, fasting blood glucose(FBG), and 1 h and 2 h post-load blood glucose in oral glucose tolerance test (OGTT) of the GDM group were significantly increased [pre-pregnant BMI: (21.6±2.7) vs (23.4±3.5) kg/m2, t= － 2.192; neonatal birth weight: (3 337.5±347.7) vs (3 618.3±580.9) g, t=－2.727; FBG: (4.6±0.4) vs (5.2±0.8) mmol/L, t=－3.947; 1 h glucose level: (7.4±1.2) vs (9.6±1.9) mmol/L, t=－5.332; 2 h glucose level: (6.3±1.0) vs (8.1±1.5) mmol/L, t=－5.314; all P<0.05]. The mRNA expressions of mTOR, Rictor and Raptor were significantly higher in the GDM group than in the NGT group (0.051±0.015 vs 0.031±0.011, t=－5.635; 0.038±0.017 vs 0.026±0.010, t=－3.485; 0.036±0.012 vs 0.025±0.011, t=－3.312; all P<0.05). The expression of mTOR, Rictor, Raptor and p-S6K protein in the GDM group were enhanced as compared with those in the NGT group (0.834±0.432 vs 0.386±0.361, t= － 2.249;0.589±0.236 vs 0.262±0.075, t= － 3.726; 0.767±0.345 vs 0.323±0.109, t= － 3.472; 1.847±1.025 vs 0.834±0.432, t=－2.575; all P<0.05). The results of immunohistochemistry also showed that the p-S6K in the placental tissues of the GDM group was higher than that of the NGT group (0.29±0.09 vs 0.18±0.08, t=－3.122, P=0.004). The expressions of mTOR protein (0.190±0.085, 0.301±0.089, 0.419±0.065, 0.562±0.108, 0.412±0.058, F=18.351, P<0.05) and p-S6K protein (0.753±0.150, 1.146±0.289, 2.148±0.188, 2.248±0.115, 2.134±0.214, F=66.242, P<0.05) in JEG3 cells treated with different concentrations of glucose (5.5, 10.0, 15.0, 25.0 and 50.0 mmol/L) were significantly different and increased with increasing concentrations of glucose (r=0.314, P=0.035; r=0.457, P=0.002). ConcLusions The up-regulated expressions of mTOR signaling pathway-related molecules in GDM placenta and high glucose-treated trophoblast cells (JEG3 cells) indicate a possible correlation between mTOR signaling pathway and GDM. However, the specific mechanisms need further study.
ABSTRACT
As a common pregnancy complication,hyperglycemia in pregnancy has an important impact on pregnancy outcomes and the short-and long-term health of both mothers and babies.Placenta is important for maternal-fetal transport of nutrients and its capability of glucose transportation,which is influenced by the expression and regulation of glucose transporters,is crucial for hyperglycemia in pregnancy women.In this review,we summarized research results on the distribution and expression of several common placental glucose transporters in women with different types of hyperglycemia in pregnancy and their association with offspring development,as well as the main regulatory mechanisms affecting the expression of glucose transporters in order to provide evidences for understanding the mechanism of the effect of hyperglycemia in pregnancy on maternal and fetal health.
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Objective To explore the effect of hemodialysis filtration and blood perfusion in the treatment of patients with uremic encephalopathy.Methods 30 patients with uremic encephalopathy were selected,they were treated with hemodialysis filtration and blood perfusion.After the treatment,the treatment effect and postoperative recovery of patients were compared.Results In the treatment,1 case coma for 5 days,after 2 times treatment with death;1 case coma for 7 days.After 3 times the combined treatment did not restore sanity;12 patients of combined treatment after 1 time of the symptoms disappeared completely;After 3 times of treatment on the patients with residual symptoms have less.Consciousness of patients was 25 cases (83.3%).Before treatment,BUN was (28.4 ± 3.1)mmol/L,Scr was (749 ±99.6)mol/L,PTH was (245.7 ±35.2)pg/g,K + was (4.7 ±1.4)mmol/L,Na + was (137.7 ±18.4)mmol/L,Cl -was (90.8 ±16.7)mmol/L,β2 -MG was (25.4 ±3.4)mg/L.After treatment,BUN was (9.1 ±2.4)mmol/L,Scr was (199.7 ±99.2)μmol/L,PTH was (105.6 ±33.6)pg/g,K + was (4.3 ± 1.3)mmol/L,Na + was (135.7 ±14.8)mmol/L,Cl - was (85.0 ±5.2)mmol/L,β2 -MG was (13.4 ±3.1)mg/L. The differences were statistically significant (all P <0.05).Conclusion In the treatment of patients with uremic encephalopathy,hemodialysis filtration and blood perfusion have good effect,should be used in clinical promotion.
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Objective To study the effect of tripterygium glycosides combined with prednisone in the treat-ment of adult patients with purpura nephritis.Methods 20 adult patients with purpura nephritis were selected and randomly divided to two groups according to the random number table method.10 cases of the control group were administered with prednisone,10 cases of the observation group were administered with tripterygium glycosides and prednisone.After treatment,the treatment effect and postoperative recovery of the two groups were compared.Results The markedly effective,effective,ineffective,the total effective rates of the observation group were 5 cases(50%), 40 cases(40%),1 case (10%),9 cases (90%),respectively,which of the control group were 3 cases (30%), 4 cases(40%),3 cases(30%),7 cases(70%),there was statistically significant difference in the total effective rate between the two groups(χ2 =4.32,P <0.05);The disappeared time of negative urinary protein,hematuria,edema disappeared,negative hypertension in the observation group were (31.5 ±5.6)d,(35.6 ±6.6)d,(29.6 ±6.4)d, (30.3 ±6.5)d,respectively,which of the control group were (37.5 ±6.5)d,(42.6 ±8.2)d,(35.6 ±7.5)d, (37.7 ±7.3)d,the differences were statistically significant between the two groups(t =2.57,2.62,2.60,2.81,all P <0.05 ).The gastrointestinal discomfort,decreased white blood cells,abnormal liver function,total incidence of adverse reaction rates of the observation group were 1 case(10%),1 case(10%),1 case(10%),3 cases(30%), which of the control group were 1 case(10%),1 case(10%),0 case(0%),2 cases(20%),there was no statistically significant difference in the total incidence of adverse reaction rate between the two groups(χ2 =1.13,P <0.05). Conclusion In the treatment of adult patients with purpura nephritis,tripterygium glycosides combined with predni-sone has good effect,and can improve the symptoms of patients required a shorter time.
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Purpose To investigate the application value in diagnosis of pleural effusion by cell block combined with immunohisto-chemistry. Methods 60 cases of pleural effusion were collected, and paraffin-embedded cell block was prepared and immunohisto-chemistry was used to detect the expression of CK7, TTF-1, E-cadherin, CEA and Calretinin. Results By use of cell block combined with immunohistochemistry, malignant detected rate was higher than that of the conventional centrifugal smear. There was statistical significance in the expression of CK7, TTF-1, E-cadherin, CEA and Calretinin between pleural effusion lung adenocarcinoma and reac-tive hyperplasia mesothelial cells (P<0. 05). CK7, TTF-1, E-cadherin and CEA were highly expressed in pleural effusion of lung ad-enocarcinoma cell. Calretinin was highly expressed in hyperplastic mesothelial cells. Conclusion Cell block and immunohistochemi-cal technique combination in the differential diagnosis of difficult pleural effusion has important clinical significance. It is worthy of popularization and further clinical application.