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Objective To investigate the detection and significance of anti-Müllerian hormone (AMH) and inhibin B (INHB) in patients with polycystic ovary syndrome (PCOS). Methods This study randomly selected 240 PCOS patients from January to October 2018 in Obstetrics and Gynecology Hospital of Fudan University, and 240 healthy women who were admitted to the physical examination center of Obstetrics and Gynecology Hospital of Fudan University as control group during the same period. Retrospective study was adopted. Serum samples of patients were collected and the serum estradiol (E2), luteinizing hormone (LH), follicle stimulating hormone (FSH), testosterone (T), sex hormone binding globulin (SHBG), AMH and INHB were detected. The data were analyzed by single sample Kolmogorov-Smimov test, independent sample T test and logistic regression analysis. Results The detection values of AMH, INHB, E2, LH, FSH, T, SHBG and INHB/AMH in PCOS group were (8.55±3.17) ng/ml, (101.7±15.2) pg/ml, (63± 50) pg/ml, (13.0±5.8) mIU/ml, (6.5±1.5) mIU/ml, (0.68±0.23) ng/ml, (62±52) nmol/ml and (24.03±26.35) respectively. In the control group, the detection values of AMH, INHB, E2, LH, FSH, T, SHBG, INHB and AMH were (4.34±2.07) ng/ml, (83.3±7.7) pg/ml, (66±25) pg/ml, (7.1±3.7) mIU/ml, (7.2±1.9) mIU/ml, (0.40± 0.11) ng/ml, (67±37) nmol/ml and (42.83±62.22). The detection values of AMH, INHB, LH, T and SHBG in PCOS group were higher than those in control group (the t values were 9.843, 7.373, 9.021, 9.349 and 3.867), and the difference was statistically significant (P<0.05). The detection values of E2 and FSH in PCOS group were lower than those in control group(the t values were 0.762 and -1.342), with no significant difference (P>0.05). The INHB/AMH value was lower than that in control group(the t value was -2.332), and the difference was statistically significant(P<0.05). The area under the curve of AMH, INHB and AMH+INHB in the diagnosis of PCOS was 0.762, 0.677 and 0.789, respectively. The cut-off value of AMH in predicting polycystic ovary syndrome was 6.96 ng/mL, the sensitivity was 61.0％, and the specificity was 82.1％. The cut-off value of INHB in predicting polycystic ovary syndrome was 94.9 pg/mL, with a sensitivity of 59.0％ and a specificity of 74.1％. The sensitivity and specificity of combined detection of AMH and INHB in predicting polycystic ovary syndrome were 83.6％ and 60.6％. The positive rates of ultrasound, T, AMH and INHB in PCOS group were 51.25％, 61.25％, 69.58％ and 66.25％, respectively. Conclusion The combined detection of AMH and INHB may improve the sensitivity and specificity of PCOS diagnosis, and its serum level is stable.
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Objective To evaluate the value of non-invasive prenatal testing (NIPT) as first-trimester screen (FTS) for the detection of trisomies 21, 18 and 13. Methods This was a retrospective study. 8517 pregnancies who performed NIPT at Obstetrics and Gynecology Hospital of Fudan University from 2017 May to 2018 June. 14 cases (0.16％) were failed. 8503 pregnancies were divided into 2 groups:NIPT joint traditional screening, NIPT. High risk pregnancies were verified by prenatal diagnosis. Evaluate the performance of NIPT. All pregnancies were followed up. Frequencies were compared with Fisher′s exact test. Results 8517 pregnancies underwent NIPT. 14 cases (0.16％) were failed. 83 cases of remaining 8503 cases had high risk results, among which 29 were trisomy 21, 14 were trisomy 18, 6 were trisomy 13 and 34 were sex chromosome aneuploidies (SCA). In 2996 cases who underwent NIPT joint traditional screening, NIPT found 14 cases of common aneuploidies 12 cases of SCA. 11 and 3 cases were validated by invasive prenatal diagnosis, respectively. In 5507 NIPT cases, 35 cases of common aneuploidies and 22 cases of SCA were found, among which 29 and 11 cases were validated. There was no significant differences between two groups for common aneuploidies (P=1.00). The sensitivity were 11/11 and 29/29 respectively,the specificity were 99.90％(2982/2985) and 99.89％(5472/5478), the positive predictive value (PPV) were 78.57％(11/14) and 82.86％(29/35), the negative predictive value (NPV) were 100％(2982/2982) and 100％ (5472/5472), respectively. Besides, the sensitivity and PPV of NIPT for SCA were 100％ and 41.18％. No false negative was found. Conclusions The proportion of pregnancies underwent NIPT alone was 64.77％. NIPT had excellent performance (the specificity and PPV) for common aneuploidies, and also had a certain value for SCA, which greatly reduced in invasive diagnosis. NIPT is a commendable essay as a first-line prenatal screening. Invasive diagnosis is still necessary for pregnancies with high-risk of NIPT.
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Objective In order to understand the distribution and drug resistance of the extended-spectrumβ-lactamase-producing (ESBLs) Enterobacteriaceae in female vaginal secretions and to provide the basis for clinical treatment.Methods 939 strains of Enterobacteriaceae isolated from female vaginal secretions were collected from Obstetrics and Gynecology Hospital of Fudan University from January 2014 to December 2017.The strain identification and drug sensitivity test of VITECK 2 Compact-totally automatic bacterial identification analyzer were used to analyze the detection rate and drug resistance of ESBLs Enterobacteriaceae.Results 257 strains of ESBLs-producing strains were detected in 939 strains of Enterobacteriaceae with a detection rate of 27％, including 220 Escherichia coli, 34 Klebsiella pneumoniae, 2 Stink-nose Klebsiella and 1 strain of Acidogenic Klebsiella.ESBLs Escherichia coli and Klebsiella pneumoniae were all resistant to Ampicillin and Cefazolin, and to Ceftazidime, Nitrofurantoin, SMZ, Amikacin, Ciprofloxacin, Gentamicin, tobramycin, Ampicillin/Sulbactam, Ceftriaxone, Ertapenem, Piperacillin/Tazobactam, Aztreonam, Cefepime, Levofloxacin the drug resistance rates of were 36％and 44％, 2％ and 41％, 67％ and 68％, 2％ and 15％, 58％ and 38％, 51％ and65％, 14％and 26％, 65％and 76％, 99％and 97％, 0％and 29％, 0％and 3％, 50％and 65％, 26％and 18％, 57％ and 32％, but they are all sensitive to Imipenem and Cefotetan.Conclusion The inicdence of ESBLs Enterobacteriaceae in female vaginal secretions is high, and Imipenem, Cefotetan, Piperacillin/Tazobactam have high antibacterial activity, which can be used as the experience of initial treatment.
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Objectives To investigate the homology and drug resistance gene of Group B Streptococcus ( GBS) Resistance induced by Clindamycin and provide basic data for clinical prevention and treatment of GBS Resistance infection induced by Clindamycin .Methods 921 strains of GBS were isolated at Obstetrics&Gynecology Hospital of Fudan University from January , 2014 to December , 2015.VITEK2-compact automatic bacterial susceptibility instrument was used to test their sensitivity to 7 antibacterial drugs.63 positive strains were chosen through D-inhibition zone trial which were drug resistant to Erythromycin and susceptible or intermediary to Clindamycin .The strain′s sequence type was identified by the method of multilocus sequence typing ( MLST typing ) .The drug resistance genes mefA & ermB to Erythromycin were detected by using PCR method .The analysis was carried out to reveal the relevance to drug resistance , multilocus sequence typing and drug resistance gene .Results Among 921 strains of GBS , the drug resistance rate was respectively 53.4％ ( 492/921 strains ) to Erythromycin , 50.2％ ( 462/921 strains) to Clindamycin, 34.7％ ( 320/921 strains ) to Levofloxacin and 7.5％ ( 69/921 strains ) to Nitrofurantoin.The drug resistance rate of Levofloxacin for 63 GBS strains was 27.0％(17/63 strains) and no drug resistant strain was found to Penicillin , Vancomycin & Nitrofurantoin.12 different ST types were involved in total, including a new ST type:ST1072.The most common ones were ST12 (30.1％) (20/63 strains) &ST19 (25.4％) (16/63 strains).The drug resistance rate of Levofloxacin with ST 19 (75.0％) (12/16 strains) was much higher than that of other ST types .The relevance ratio of mefA and ermB among 63 GBS strains was respectively 27.0％(17/63 strains) and 41.3％(26/63 strains).Conclusions The genetic diversity existed in Group B Streptococcus resistance induced by Clindamycin detected in this study . There was significant difference on drug resistance and relevant drug resistant genes among different ST types.
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Objective To investigate the resistance rates of the Candida albicans strains isolated from patients with vulvovaginal candidiasis to 5 antifungal agents and examine the mechanism of azole resistance in these strains.Methods A total of 1 646 C.albicans strains were collected in Obstetrics and Gynecology Hospital of Fudan University from January to December 2015.The resistance rates of these isolates to five antifungal agents were analyzed.Azole-resistant (n=30),dose dependent sensitive (S-DD) (n=13),and susceptible isolates (n=10) were randomly selected from the microbiology laboratories of three obstetrics and gynecology hospitals in Shanghai.The expression levels of drug efflux pump related gene CDR1,CDR2,MDR1 and drug target enzyme gene ERG11 were analyzed by real-time fluorescence quantitative polymerase chain reaction (PCR).At the same time,the ERG11 and ERG3 genes were amplified by PCR and sequenced,and analyzed for resistance-related mutations.Results Of the 1 646 C.albicans strains,5.2％,3.2％,2.5％ and 2.1％ were resistant to itraconazole,voriconazole,fluconazole and 5-fluorocytosine,respectively.All isolates were sensitive to amphotericin B.The expression of ERG11 gene was significantly higher in S-DD group and azole-resistant group than in azole-sensitive group (P＜0.05).The expression of CDR1,CDR2 and MDR1 did not show significant difference among the three groups.There were 13 missense mutations in the ERG11 gene,of which T123I,P98S and Y286D amino acid substitutions were newly discovered.Both T123I and Y132H were identified in 26 resistant isolates,of which 16 gene mutation was detected in two pan-azole-resistant isolates.Conclusions The C.albicans strains isolated from vulvovaginal candidiasis showed higher resistance rates to azole antifumgal agents than that to 5-fluorocytosine and amphotericin B.Mutation and over-expression ofERG11 gene may be one of the prevalent molecular mechanisms underlying azole resistance in C.albicans.were pan-azole-resistant.In addition,the ERG3 heterozygous
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Objective To investigate the prevalence and transmission mechanisms of plasmid-mediated blaoxa-23 resistance genes in Acinetobacter baumannii.Methods One hundred and one Acinetobacter baumannii were collected from Obstetrics and Gynecology Hospital of Fudan University and Renji Hospital Shanghai Jiaotong University School of Medicine.Antibiotic susceptibility of carbapenems were determined by standard agar dilution method.Molecular typing of Carbapenem-resistant Acinetobacter baumannii (CRAB) was performed by MLST.blaoxa-23、blaoxa-24、blaoxa-51、blaoxa-58、blaIMP-1、blaVIM-1/2 and blaAmp-C were analyzed by PCR.The analysis of blaoxa-23 transposons for carbapenems resistant A.baumannii isolates was also performed by PCR.Plasmid was analyzed by gel electrophoresis.Conjugation experiments were performed to determine the transferability of blaoxa-23.Results The antibiotic susceptibility tests showed the resistant rates to carbapenems were extremely high , and the ones of imipenem and meropenem were 64.4%and 69.3%.Fifty-six (53%) isolates were carbapenems-resistant A.baumannii.Main clone ST208 includes 28 isolates(50%) in CRAB.A total of the CRAB isolates harbored blaoxa-23 and blaoxa-51 (100%), 44 for blaIMP-1(78.6%) and 54 for blaAmp-C(96.4%), while blaoxa-24, blaoxa-58 and blaVIM-1/2 was undetected.Two previously identified transposons ( Tn2006 and Tn2008 ) was found in the isolates.Plasmid gel electrophoresis results showed that the isolates carried 2-4 plasmids and blaoxa-23 were transferable by plasmids.Conclusions There is high carbapenems resistance of A.baumannii infections.ST208 was the most prevalent molecular type.The mainly drug-resistant genes of A.baumannii are blaoxa-23.Based on the findings, blaoxa-23 is plasmid mediated, suggesting that it may transfer by plasmids carrying Tn 2008 transposon, thus induced isolates resistant to carbapenemase.
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Objective To analyze the levels of IL-35, IL-10 and TGF-β in women with or without pregnancy and to investigate the correlation between IL-35 and recurrent spontaneous abortion.MethodsLevels of IL-35, IL-10 and TGF-β in serum were analyzed by enzyme-linked immunosorbent assay (ELISA) in 120 gravidas with normal pregnancy, 40 gravidas with a history of recurrent spontaneous abortion, 40 healthy postpartum women and 40 healthy non-pregnant women of childbearing age.Single factor logistic regression analysis was used for correlation analysis.Results The level of serum IL-35 in normal pregnancies was significantly higher than that in non-pregnant women [333.6 (59.32, 1 391) pg/ml vs 123.9 (8.763, 471.7) pg/ml, P0.05].The level of serum IL-35 in gravidas with recurrent spontaneous abortion was significantly lower than that in healthy gravidas in their first trimester [220.4 (4.951, 702.0) pg/ml vs 386.5 (64.37, 1 355) pg/ml, P<0.05].Serum IL-35 was negatively correlated with the occurrence of recurrent spontaneous abortion (regression coefficient=-0.003, OR=0.997).Conclusion The level of serum IL-35 increases in healthy gravidas, but decreases in gravidas with recurrent spontaneous abortion.IL-35, rather than IL-10 or TGF-β, is recognized as an active player in maternal-fetal immune tolerance.
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Objective To investigate the distribution and molecular epidemiology of Candida strains isolated from vulvovaginal candidiasis in Shanghai,and conduct molecular phylogenetic analysis of the strains.Methods Candida pathogens were collected from the patients with vulvovaginal candidiasis during the period from August 2015 to February 2016 in Obstetrics and Gynecology Hospital of Fudan University,Shanghai First Maternity and Infant Hospital,and Intemational Peace Matemity and Child Health Hospital.All the strains were identified and statistically analyzed.ATB FUNGUS 3 kit was used to determine the minimum inhibitory concentration of antifungal agents against these strains in vitro.Molecular typing was conducted using multilocus sequence typing (MLST) method.Phylogenetic analysis was carried out by eBURST and MEGA 6 software.Results Of the 2 185 strains of Candida,1 988 were identified as Candida albicans,149 Candida glabrata,20 Candida tropicalis and 28 other Candida species.Overall,6.5％ of the Candida albicans strains were resistant to fluconazole.Twenty-six diploid sequence types (DSTs) were identified among the 93 strains of Candida albicans analyzed,including 50 fluconazole-susceptible strains with sporadic genotypes,but 43 fluconazole-resistant strains clustered as one clonal complex (CC 69) on the same branch (MLST Clade 1) of phylogenetic tree.Conclusions Candida albicans was the main pathogen of vulvovaginal candidiasis in the three obstetrics & gynecology hospitals in Shanghai,which showed slightly higher resistance to fluconazole.It is necessary to monitor the spread of fluconazole-resistant Candida albicans in these hospitals,especially clonal dissemination of CC 69 clone.
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Group B Streptococcus ( GBS) is a conditional pathogenic bacteria related to late-term abortion, premature delivery, premature rupture of membranes, perinatal infection, neonatal sepsis and other diseases.Prevention and treatment guidelines by the US Centers for Disease Control and Prevention ( CDC) suggest that all the pregnant women at 35-37 gestational weeks should screen for GBS .The detection methods for GBS include microbiology , immunology, molecular biology, etc.The appropriate method should be chosen depending on circumstances .Penicillin is recommended for the preventive treatment of GBS , and the treatment for the insensitive should base on the antibiotic susceptibility results .No vaccine against GBS is currently available for clinical use .
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Objective To investigate the molecular epidemiology of 114C. albicans strains isolated from the vaginal discharge of female patients treated in three obstetrics and gynecology hospitals in Shanghai by analyzing the relationship between the main genotypes and resistance proifle, and the relationship between genetic diversity and cluster ofC. albicans.Methods A total of 114 strains ofC. albicans were collected from the Obstetrics & Gynecology Hospital of Fudan University, Shanghai First Maternity and Infant Hospital Corporation and the International Peace Maternity & Child Health Hospital of China welfare institute. Phylogenetic analysis of strains were carried out by eBURST.C. albicans strains were also analyzed by multilocus sequence typing (MLST). The susceptibility of theC. albicans strains was tested by ATB FUNGUS 3.Results A total of 47 diploid strain types (DSTs) were identiifed from the 114 strains, 30 of which were known types. DST 79 and DST 435 were the main types. Of the 114C. albicans strains, 96.5% were susceptible to lfucytosine, 100% to amphotericin B, 85.1% to lfuconazole, 55.2% to itraconazole and 84.3% to voriconazole.Conclusions The pathogenicC. albicans strains isolated from different obstetrics and gynecology hospitals in Shanghai were originated from multiple clones, the main type of which was DST 79 and DST 435 with certain degree of antifungal resistance. MLST typing suggests that genetic diversity is present in theC. albicans strains isolated in Shanghai area. The clustering analysis ofC. albicans strains is consistent with its genotypes.
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Objective To explore the serum lipids levels in healthy pregnant women,and to establish the reference intervals of serum lipids in middle and late pregnancy.Methods Triglyceride (TG),total cholesterol (TCH),high density lipoprotein (HDL),low density lipoprotein (LDL),apo-lipoprotein-A (APO-A) and apo-lipoprotein-B (APO-B) were measured in 3 200 pregnant women and 3 200 healthy women of childbearing age(the control group) from January 2014 to Febuary 2015 in Obstetrics and Gynecology Hospital of Fudan University.In the healthy pregnant women,serum lipids were measured at 14-20,24-28 and 37-40 gestational weeks,respectively.All the parameters were detected by Hitachi 7180 automatic biochemical analyzer.The test results were calculated and determined by the C28-A3 standard of the National Clinical and Laboratory Standards Institute.And the normal reference intervals of serum lipids in middle and late pregnancy were defined as 2.5％-97.5％.Results (1) The levels of TG,TCH,HDL,LDL,APO-A and APO-B in the control group were 0.8,4.2,1.0,2.7 mmol/L and 1.1,0.8 g/L,respectively.The levels of TG,TCH,HDL,LDL,APO-A and APO-B in middle and late pregnancy were significantly higher than those in the control group (P＜0.05).(2) The serum lipids levels at 14-20,24-28 and 37-40 gestational weeks in healthy pregnant women were compared with the control group as following.The TG levels were 1.9,3.8 and 4.4 folds of the control group;the TCH levels were 1.1,1.5 and 1.5 folds of the control group;the HDL levels were 1.2,1.6 and 1.5 folds of the control group;the LDL levels were 1.1,1.4 and 1.4 folds of the control group;the APO-A levels were 1.3,1.4 and 1.5 folds of the control group;and the APO-B levels were 1.1,1.5 and 1.5 fold of the control group respectively.The TG level was the most increased,and it increased gradually with gestational age (P＜0.01).(3) The median of LDL to HDL cholesterol ratio in the healthy pregnancy group at 14-20,24-28 and 37-40 gestational weeks were 2.7,2.5,2.6,respectively,which were significantly lower than that of the control group (2.8;P＜0.05).(4) Reference intervals of serum lipids at 14-20,24-28 and 37-40 gestational weeks in healthy pregnant women were as following.The TG levels were 0.7-3.9,1.7-6.3 and 1.6-8.1 mmol/L,respectively;the TCH were 3.3-6.9,4.3-8.3,4.3-8.7 mmol/L,respectively;the HDL were 0.8-1.8,1.0-2.1 and 1.0-2.1 mmol/L,respectively;the LDL were 2.1-4.5,2.7-5.1 and 2.6-5.2 mmol/L,respectively;the APO-A were 1.1-1.8,1.2-1.9 and 1.1-2.4 g/L,respectively;and the APO-B were 0.6-1.4,0.9-1.8 and 0.8-2.1 g/L,respectively.The LDL/HDL ratios were 2.3-3.1,2.2-2.9 and 2.1-3.0,respectively.Conclusions Serum lipids increased physiologically with gestational age in middle and late pregnancy.The establishment of reference intervals for serum lipids in pregnancy will help to distinguish abnormal serum lipid levels in middle and late pregnancy.
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Acinetobacter baumannii, a glucose-nonfermentative gram-negative coccobacillus, is an important pathogen isolated in nosocomial infections, and the clinical detection rate has been increasing in recent years. Acinetobacter baumannii attracts widespread attention due to strong viability, broad resistance spectrum and high rate of drug resistance. The resistance mechanisms include the production of β-lactamases, alterations in penicillin-binding proteins, decreased outer membrane permeability and overexpression of active efflux pumps. The mechanisms of Acinetobacter baumannii resistance to β-lactarn antibiotics, especially those of the outer membrane porin and active efflux system are reviewed in this paper.
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Objective To investigate the role of outer membrane protein in clinical isolated car-bapenem resistance Acinetobacter baumannii. Methods Carbapenem resistance and sensitive strains were collected from the same patient. After MIST and REP-PCR analysis, carbapenemases were detected by isoe-lectric focusing. Different expressed membrane proteins were identified by two-dimension electrophoresis and mass spectrometry analysis. We also used efflux pump inhibitor PAβN(Phe-Arg-β-naphthylamide) to con-firm the phenotype. Results Carbapenem resistance and sensitive strains were attributed to the same pat-tern. At positions of P17.6 and P19.0, two β-lactamases were expressed in two investigated strains, no cabapenemases were detected. Six differential expressed membrane proteins were identified, a 34 × 10~3 membrane protein that was confirmed by efflux pump inhibitor PAβN experiment (imiponem MIC decreased from far above 32 μg/ml to 8μ/ml) and OprD and CarO. Conclusion Up-regulation of exported protein accompanied with down-regulation of OprD and CarO other than carbaponemases are responsible for carbap-enem resistance in A. baumannii.
