Clinical characteristics of severe pre-eclampsia in a single tertiary referral center of Xiamen City / 中华妇产科杂志

Objective: To explore the key points for preventing and reducing severe pre-eclampsia (SPE) and its severe complications in the tertiary medical referral system of a second-tier city by analyzing the clinical characteristics of SPE. Methods: The clinical data of 341 patients with SPE who terminated pregnancy in Women and Children's Hospital, School of Medicine, Xiamen University, from January 1, 2020 to December 31, 2022 were retrospectively analyzed, and the pre-eclampsia (PE) risk factors, clinical characteristics and severe complications of SPE between the patients referred from primary hospitals (referral group) and the patients received regular prenatal care in the tertiary referral center (central group) were compared, as well as the influence of the referral timing on the maternal and perinatal outcomes. Results: Among the 341 cases of SPE, 92 cases were in the referral group and 249 cases were in the central group. (1) Analysis of PE risk factors: there was no statistical difference in the proportion of risk factors of PE between these two groups [75.0% (69/92) vs 71.9% (179/249); χ2=0.328, P=0.567]. (2) Analysis of clinical features: the gestational ages at the PE early warning factors onset, at the PE first symptom onset and at SPE diagnosed, pregnancy terminated and onset of SPE severe complications in the referral group were significantly earlier than those in the central group (all P<0.05), the proportions of terminating pregnancy before 32 weeks of gestation, between 32 and 34 weeks of gestation, intensive care unit (ICU), neonatal ICU hospitalization and fetal growth restriction in single pregnancies were higher than those in the central group, while the live birth rate was lower than that in the central group (all P<0.05). (3) Analysis of SPE severe complications: the rates of SPE severe complications in the referral group was higher than that in the central group [28.3% (26/92) vs 13.7% (34/249); χ2=9.885, P=0.002]. Among them, the rates of placental abruption [7.6% (7/92) vs 2.8% (7/249); χ2=3.927, P=0.048] and still birth [6.5% (6/92) vs 0.4% (1/249); χ2=9.656, P=0.002] in the referral group were significantly higher than those in the central group. (4) Analysis of referral timings: the timings included referral after onset of SPE severe complications (9.8%, 9/92), referral after SPE diagnosed (63.0%, 58/92), referral after detection of SPE early warning signs (20.7%, 19/92) and referral after detection of PE risk factors (6.5%, 6/92). The gestational ages at SPE diagnosed and pregnancy terminated in group of referral after onset of SPE severe complications and group of referral after SPE diagnosed were significantly earlier than those in group of referral after detection of PE early warning signs and group of referral after detection of PE risk factors (P<0.05). The earlier the referral, the higher the live birth rates (P<0.05). Conclusions: The tertiary referral center of the second-tier city plays an important role in reducing the maternal and perinatal damage of PE. The timing of referral in primary medical institutions is the key point of reducing the occurrence of SPE severe complications and maternal, perinatal damage of PE. It is necessary for medical institutions of all levels in all regions to improve the ability of early identification and early intervention for PE, to enhance the awareness of SPE and its severe complications prevention and control. Primary medical institutions should especially pay attention to raise the consciousness of PE risk factors and early warning signs, and to improve the ability of PE risk factors and early warning signs screening.

Expression of CD44 and NANOG in epithelial ovarian cancer and its clin-ical significance / 中国病理生理杂志

AIM:To investigate the expression of CD44 and transcription factor NANOG in epithelial ovarian cancer(EOC)and its clinical significance.METHODS:The expression of CD44 and NANOG in EOC and benign ovarian tumor tissues were detected by immunohistochemical method.The correlation between the expression of CD 44 and NANOG in EOC was analyzed.The expression of CD44 and NANOG in ovarian cancer cell line SKOV3 after treatment with cisplatin at different concentrations were detected by Western blot.RESULTS:The positive expression rates of CD44 and NANOG in EOC were significantly higher than those in benign ovarian tumor tissues(P<0.01).In EOC,positive correlation was observed between the expression of CD 44 and NANOG(r=0.346,P<0.01).The positive expression rate of CD44 was associated with clinical stage and lymphatic metastasis(P<0.05), and had no relationship with age, histological grade, pathological types and the location of tumors.The positive expression rate of NANOG was associated with clinical stage and histological grade(P<0.05),and had no relationship with age,lymphatic metastasis,pathological types and the location of tumors.Increased expression of CD44 and NANOG were detected in ovarian cancer cell line SKOV 3 after treatment with cisplatin(P<0.05).CONCLUSION:The over-expression of CD44 and NANOG are associated with the occurrence and development of EOC.The expression of cancer stem cells marker CD 44 and the pluripotent gene product pertaining to em-bryonic stem cells NANOG are increased in cisplatin-induced SKOV3 cells.Cancer stem cells and the expression of stem-ness-related gene may well be the underlying pathogenesis that promotes the onset, progression, and chemotherapy resist-ance of EOC.