Interaction of polycyclic aromatic hydrocarbon DNA adducts and telomere length on missed abortion / 中华预防医学杂志

Objective: To analyze the contribution and interaction of polycyclic aromatic hydrocarbons (PAH)-DNA adducts and changes of telomere length (TL) on missed abortion. Methods: From March to December 2019, patients with missed abortion in the First Hospital of Shanxi Medical University and pregnant women with normal pregnancy but voluntary abortion in the same department during the same period were selected and divided into a case group and a control group. Questionnaire was used to investigate the general situation and the pregnancy situation of the subjects. The abortion villi were collected and the content of PAH-DNA adducts and TL was detected. Logistic regression model was used to analyze the associated factors of missed abortion. R epiR package and Mediation package were used to analyze the effect and relationship between PAH-DNA adducts and TL on missed abortion. Results: The age of the subjects was(29.92±5.69)years old. The M(Q1,Q3)of PAH-DNA adducts was 453.75(404.61, 504.72) pg/ml. The M(Q1,Q3)of TL was 1.21(0.77, 1.72). The content of PAH-DNA adducts in the case group was higher than that in the control group (Z=-2.10, P=0.036), while the TL was lower than that in the control group (Z=-4.05, P<0.001). Multivariate logistic regression showed that low, medium and high levels of PAH-DNA adducts (OR=3.17,95%CI:1.41-7.14;OR=2.85,95%CI:1.25-6.52;OR=2.46,95%CI:1.07-5.64), and long, medium and short levels of TL (OR=2.50,95%CI:1.11-5.63;OR=3.32,95%CI:1.45-7.56;OR=3.22,95%CI:1.42-7.26) were all risk factors for missed abortion. The medium level of PAH-DNA adducts had a 2.76-fold higher risk of shortened TL than those with the lowest level, and no mediating role of TL was found. The stratified analysis showed that when the TL level was longer (>1.21), the low and high levels of PAH-DNA adducts were associated with missed abortion (all P<0.05); when the TL level was shorter (<1.21), the medium level of PAH-DNA adducts was associated with abortion (P=0.025). At lower levels of PAH-DNA adducts, no effect of TL on missed abortion was observed, while, at higher levels, TL was strongly associated with missed abortion (OR=7.50,95%CI:1.95-28.82;OR=6.04,95%CI:1.54-23.65;OR=9.05,95%CI:2.34-35.04). The interaction analysis found that the AP was 0.72 (95%CI: 0.46-0.99), and the SI was 5.21 (95%CI: 2.30-11.77). Conclusion: The high level of PAH-DNA adducts and shortened TL may increase the risk of missed abortion, and there may be a positive additive interaction between the two factors on missed abortion.

Pregnancy outcomes after chemotherapy for trophoblastic neoplasia / Futuro reprodutivo após tratamento quimioterápico da neoplasia trofoblástica

SUMMARY Introduction The successful development of chemotherapy enabled a fertilitysparing treatment for patients with trophoblastic neoplasia. After disease remission, the outcome of a subsequent pregnancy becomes a great concern for these women. Objective To analyze existing studies in the literature that describe the reproductive outcomes of patients with trophoblastic neoplasia treated with chemotherapy. Method Systematic review was performed searching for articles on Medline/ Pubmed, Lilacs and Cochrane Library databases, using the terms “gestational trophoblastic disease” and “pregnancy outcome”. Results A total of 18 articles were included. No evidence of decreased fertility after chemotherapy for trophoblastic neoplasia was observed. The abortion rates in patients who conceived within 6 months after chemotherapy was higher compared to those who waited longer. Some studies showed increased rates of stillbirth and repeat hydatidiform moles. Only one work showed increased congenital abnormalities. Conclusion The pregnancies conceived after chemotherapy for trophoblastic neoplasia should be followed with clinical surveillance due to higher rates of some pregnancy complications. However, studies in the literature provide reassuring data about reproductive outcomes of these patients.

RESUMO Introdução o sucesso do desenvolvimento da quimioterapia no tratamento da neoplasia trofoblástica proporcionou a possibilidade de conservação da fertilidade das pacientes, tornando o futuro reprodutivo uma nova preocupação após a remissão da doença Objetivo analisar os estudos existentes na literatura que descrevem o futuro reprodutivo de pacientes com neoplasia trofoblástica tratadas com quimioterapia. Método revisão sistemática que buscou artigos nas bases de dados Medline/Pubmed, Lilacs e Biblioteca Cochrane, utilizando as palavras-chave “gestational trophoblastic disease” e “pregnancy outcome”. Resultados foram selecionados 18 artigos de acordo com critérios de inclusão e exclusão. Não foi observada diminuição da fertilidade após a quimioterapia para neoplasia trofoblástica. Pacientes que engravidaram até 6 meses do término da quimioterapia apresentaram maiores taxas de abortamento quando comparadas às que esperaram mais de 6 meses. Alguns artigos encontraram maiores taxas de natimorto e nova mola hidatiforme. Apenas um estudo mostrou aumento da taxa de malformação. Conclusão as gestações subsequentes à neoplasia trofoblástica devem ser acompanhadas com vigilância clínica em decorrência da maior taxa de complicações na gestação, principalmente nas mulheres que engravidam até 6 meses após o término da quimioterapia. No entanto, os dados encontrados nos estudos tranquilizam quanto ao futuro reprodutivo dessas pacientes.

Tabaquismo durante el embarazo / Smoking during pregnancy

El tabaquismo durante el embarazo ha sido relacionado a muchas patologías obstétricas y neonatales, como desprendimiento de placenta, placenta previa, embarazo ectópico, aborto, parto prematuro, síndrome de distress respiratorio del recién nacido, bajo peso de nacimiento, muerte súbita, síndromes neurocognitivos, entre otros. En relación a la patología respiratoria el tabaquismo durante el embarazo produce alteraciones en la función de la vía aérea, traducido por flujos espiratorios disminuidos, sibilancias recurrentes y asma bronquial, hiperreactividad bronquial, mayor frecuencia de hospitalizaciones e infecciones respiratorias bajas. Finalmente es fundamental aplicar medidas tendientes a evitar el tabaquismo en las mujeres embarazadas y en el producto de la concepción.

Anticoagulation for pregnant patients with mechanical heart valves.

Management of a pregnant patient with mechanical heart valve is a complex issue for all health care providers involved in the care of such patients. Complications may arise at any stage due to the increased haemodynamic load imposed by pregnancy or because of impaired cardiac performance often seen in these patients. In addition, the use of various cardiovascular drugs in pregnancy (especially anticoagulants) may lead tofoetal loss or teratogenic complications. Additionally, the risk of thrombo-embolic complications in the mother is increased by the hypercoagulable state of pregnancy. In this review, we have attempted to draw inferences to guide management of such patients based on the available literature. It seems that in pregnant women with mechanical heart valves, recent data support warfarin use throughout pregnancy, followed by a switch to heparin and planned induction of labour. However, the complexity of this situation demands a cafeteria approach where the patient herself can choose from the available options that are supported by evidence-based information. Unfortunately there is no consensus on such data. An overview of the available literature forms the basis of this review. In conclusion, a guideline comprising pragmatic considerations is preffered.

Malformations in the offspring of women with thyroid cancer treated with radioiodine for the ablation of thyroid remnants / Malformações na prole de mulheres com câncer de tireóide tratadas com radioiodo para ablação de remanescentes tireoideanos

RATIONALE: Since ovarian function is only temporarily compromised by radioiodine therapy, many women with thyroid cancer treated with radioiodine can become pregnant. The present study evaluated the evolution of these pregnancies and the consequences for the offspring. PATIENTS AND METHODS: We retrospectively analyzed 78 pregnancies of 66 women submitted to total thyroidectomy, followed by radioiodine therapy (3.7­5.5 GBq 131I, mean 4.64 GBq). In all patients, conception occurred one year after ablative therapy (mean of 30 months). Age ranged form 19 to 36 years (mean of 30.6 years) at the time of radioiodine treatment and from 23 to 39 years (mean of 32.8 years) at the time of conception. RESULTS: Four (5.1 percent) of the 78 pregnancies resulted in spontaneous abortions. Three (4 percent) of the 74 deliveries were preterm and there was no case of stillbirth. The birthweight was > 2500 g in 94.6 percent of the children (mean ± SD: 3350 ± 450 g) and only one infant (1.3 percent) presented an apparent malformation at birth (intraventricular communication). No difference in the age at the time of radioiodine therapy or conception or in radioiodine dose was observed between pregnancies with an unfavorable outcome and those with a favorable outcome. CONCLUSION: We conclude that pregnancies that occur 12 months after ablative therapy are safe.

ARRAZOADO: Uma vez que a função ovariana está apenas temporariamente comprometida pela terapia com radioiodo, muitas mulheres com câncer de tireóide tratadas com radioiodo podem engravidar. O presente estudo avaliou a evolução dessas gravidezes e suas conseqüências para a prole. PACIENTES E MÉTODOS: Analisamos retrospectivamente 78 gravidezes de 66 mulheres submetidas a tiroidectomia total seguida de radioiodoterapia (3,7­5,5 GBq 131I, média 4,64 GBq). Em todas, a concepção ocorreu um ano após a terapia ablativa (média de 30 meses). A idade variou de 19 a 36 anos (media de 30,6) à época do tratamento com radioiodo e de 23 a 39 anos (média de 32,8) na época da concepção. RESULTADOS: Quatro (5,1 por cento) das 78 gravidezes resultaram em abortamento espontâneo. Três (4 por cento) dos 74 partos foram pré-termo, mas não houve nenhum natimorto. O peso ao nascer foi >2.500 g em 94,6 por cento das crianças (média ± DP: 3.350 ± 450 g) e somente uma delas (1,3 por cento) apresentou uma malformação aparente ao nascimento (comunicação intraventricular). Nenhuma diferença quanto à idade na época da radioiodoterapia ou na concepção ou na dose de radioiodo foi observada entre as gravidezes com ou sem um desfecho favorável. CONCLUSÃO: Gravidezes que ocorrem 12 meses após terapia ablativa com radioiodo são seguras.

Abortos espontáneos en Hospital de Llay-Llay y su relación con labores agrícolas de la madre / Spontaneous abortions in the Llay -Llay hospital an their relation to mother's agricultural labors

Los pesticidas son sustancias químicas usadas con frecuencia en las zonas agrícolas de nuestro país. Es un hecho bien establecido que estas sustancias pueden ser dañinas para la salud no sólo del trabajador agrícola sino también para su descendencia. Su objetivo es estudiar la asociación entre abortos espontáneos y la ocupación agrícola de la madre. Se efectuó un estudio descriptivo, recopilando las fichas clínicas de aquellas pacientes que presentaron aborto espontáneo registrados en el libro de procedimientos de la maternidad del Hospital San Francisco de Llay-Llay entre enero del 2002 y diciembre del 2003. Se calcula la tasa de incidencia de aborto espontáneo comparándola con las últimas cifras nacionales disponibles, y el porcentaje de ocupación agrícola de la madre en relación con la población femenina ocupada de 15 años o más de la misma área geográfica según Censo del 2002. Se realizó la prueba Z para comparación de proporciones, e intervalos de confianza para la razón entre las densidades de incidencia. La tasa de incidencia de aborto espontáneo fue 81,02 casos/1.000 RNV versus 9,5 casos/1.000 RNVen Chile 1996, otorgando una razón de incidencia de 8,5 veces (IC = 6,72-10,65). El porcentaje de ocupación agrícola es mayor que la población femenina ocupada de 15 años o más de la misma área geográfica. (p <0,0001). El riesgo de presentar aborto espontáneo en Llay-Llay y Catemu es mayor que el resto del país. La ocupación agrícola está relacionada con un mayor riesgo de aborto espontáneo, probablemente debida a la exposición a pesticidas.

Pesticides are chemical substances frequently used in agricultural areas of our country. It is a well established fact that these substances can be harmful to the health, not only of agricultural workers, but also to that of their offspring. The objective of this paper is that of studying the relation between spontaneous abortions and the agricultural occupation of the mother. A descriptive study was carried out assembling the clinical records of those patients presenting sponrtaneous abortion registered in the maternity book of procedures of the San Francisco de Llay-Llay Hospital between January 2002 and December 2003. The incidence of spontaneous abortion is calculated comparing it to the last available national figures, and the percentage of agricultural occupation of the mother in relation to the 15 year old and over female population of the same geographic area, according to the 2002 Census. The Z test was performed for comparison of proportions and confidence intervals for the ratio between incidence densities. The incidence rate for spontaneous abortion was 81.02 cases/1,000 live-newborn registrations (RNV) versus 9.5 cases/1,000 live-born registrations in Chile 1996, granting an incidence ratio of 8.5 (CI=6.72-10.65). The percentage of agricultural occupation is higher than the female 15 year old and over population of the same geographic area (p<0.0001). The risk of spontaneous abortion occurring in Llay-Llay or Catemu is higher than in the rest of the country. The agricultural occupation is related to a higher risk of spontaneous abortion, probably due to the exposure to pesticides.

Male exposure mediated adverse reproductive outcomes in carbon disulphide exposed rayon workers.

The authors examined 100 carbon disulphide (CS2) exposed male workers who had been employed ten years prior to study were selected for the study. They were virtually obliged to participate in the study by the Medical Labor Inspector and all of them participated voluntary. The aim was to assess the effects of occupational exposure to carbon disulphide concentrations below the threshold limit value (31 mg/m3) on the reproductive functions with special emphasis on miscarriages. Specially, workers history records were build up on number of children, miscarriages and general weakness, mental fatigue etc. It was found that the incidences of number of miscarriages against number of living children correlated well with environmental concentration of CS2. Where the average CS2 levels were 1.695 ppm, the incidences of miscarriages was 5.71% (group 1). Where as in group 2 environmental concentrations were 12.28 ppm and the incidences of miscarriages were 18.91%. It was also found that in the spinning department the exposure exceeds many times the Threshold Limit Values (TL V).

Uso de plantas no ciclo grávido-puerperal / Use of medicinal plants during the puerperal gravid cycle

Os autores fizeram um exaustivo trabalho de pesquisa sobre o uso de plantas no ciclo grávido-puerperal, realizando inicialmente uma revisao bibliográfica da utilizaçao das diversas plantas de emprego fitoterápico, desde os tempos mais remotos até os dias atuais, catalogando os efeitos das mesmas em obstetrícia e ginecologia, relacionando os vegetais que podem provocar abortamentos, partos prematuros, metrorragias, restabelecimento do fluxo menstrual, entre outras indicaçoes, selecionando as existentes em nosso estado, como também as utilizadas em outras regioes do Brasil. Para realizaçao da pesquisa foi eleborado um questionários padronizado onde se consignavam os vegetais utilizados; preparo dos mesmos; associaçao com outras plantas ou com outros medicamentos; época da gestaçao em que foi administrado; sisntomas referidos; como ainda, foram registrados os aspectos da evoluçao da gestaçao: interrupçao por abortamento, prematuridade, condiçoes do parto, do puerpério, do aleitamento, ou uso para patologias ginecológicas como: amenorréias, metrorragias, leucorréias, entre outras. Após a avaliaçao e quantificaçao dos efeitos indesejáveis mais frequentes, os mesmos foram comparados com efeitos registrdos na literatura científica, e após a verificaçao dos riscos e benefícios da fitoterapia, os autores elaboraram uma cartilha com a finalidade educativa para informações junto aos profissionais da saúde, incluindo médicos, enfermeriras, nutricionistas. entre outros, como ainda, para transmissao de conhecimentos à comunidade leiga e a populaçao de modo geral

Study of the embryotoxic effects of an extract of rosemary (Rosmarinus officinalis) L

Extracts of rosemary, Rosmarinus officinalis L., have been used in folk medicine as a diuretic, an emenagogue, an antispasmodic and its aqueous extract does not present toxicity to man, presenting, however, abortive effects. In order to evaluate if this plant induces abortion and/or interferes with the normal development of the concepts, doses of 26 mg of a 30 percent (w/v)R. officinalis aqueous extract (13 mg solids/ml) made with leaves, flowers and stem were administered daily by gavage during two different periods of Wistar rat pregnancy. One group of animals (N = 12) received the extract from days 1 to 6 of pregnancy (preimplantation period) and another group (N = 14) received the same extract from days 6 to 15 of pregnancy (organogenic period). Control groups (N = 12) received saline in the same volume and during the same periods as their respective experimental groups. The animals were sacrificed at term. The treatment of the dams during either the preimplantation or the organogenic period did not cause significant changes in the postimplantation loss or in the number of anomalies or malformations of the term fetuses, which also showed a similar degree of development when compared with the respective controls. The percent of preimplantation loss in the group treated before embryo implantation increased, although the difference was not significant compared to the control. This result suggests that rosemary extract may present an anti-implantation effect without interfering with the normal development of the concept after implantation.

Gravidez tubária e igual a salpingectomia sempre? / Tubal pregnancy always leads to salpingectomy?

Ha um aumento da incidência de gravidez tubária, provavelmente devido ao aumento de infecçöes por clamidia, que aliado com novos métodos de tratamento tornam a patologia muito importante. O propósito deste estudo é uma revisäo do assunto. Foi realizada uma revisäo dos métodos do tratamento utilizando-se de trabalhos recentes e da experiência do autor. Quando a cirurgia de emergência e indicada, o tratamento mais utilizado e a salpingectomia, no entanto existem técnicas que preservam a trompa. Estes métodos säo utilizados dependendoda disponibilidade de recursos materiais e humanos, diagnóstico de certeza, estado hemodinâmico da paciente, o desejo de futuras gestaçoes, a idade da paciente e a história prévia de infertilidade. Conclui-se que a gravidez tubária näo e sempre igual a salpingectomia, no entanto este e o tratamento padräo.

Antifertility effects of (3R)-claussequinone in rats

Com o objetivo de verificar-se o efeito zigotóxico da (3R)-claussequinona em ratas, foram administradas 200 micron/100g de peso corporal/via intraperitoneal do composto a animais no 4§ dia de gestaçäo. A (3R)-claussequinona mostrou efeito zigotóxico causando 32,3% de abortos em embriöes implatados