Change of uterine leiomyoma size during pregnancy and the influencing factors: A cohort study.

OBJECTIVE: To evaluate the changes of uterine leiomyoma size during pregnancy and determine the factors influencing it. METHODS: A prospective study was conducted from June 2016 to June 2018. Women with pregnancies complicated by leiomyoma were recruited. Ultrasound examinations were conducted to measure the size of leiomyoma during 6-7, 11-14, 22-24, 28-34 weeks of pregnancy and before delivery. The clinical characteristics and delivery details of the pregnant women were collected. Changes in leiomyoma size during different gestation periods and the influencing factors were analyzed. RESULTS: Leiomyoma size commonly increased before 22-24 weeks of pregnancy and the fastest growth occurred before 11-14 weeks. From 22-24 weeks to the date of delivery, the size of leiomyoma remained unchanged. The initial size of the leiomyoma showed negative correlation with the changes in leiomyoma diameters during pregnancy. Pre-pregnancy body mass index, fetus number, leiomyoma location, and parity were positively correlated with the size changes in leiomyoma from 22-24 to 28-34 weeks of pregnancy. CONCLUSION: Before 22-24 weeks of pregnancy, the size of the leiomyoma was gestation-dependent, which increases with gestational weeks. The fastest growth rate was before 11-14 weeks. The growth of leiomyoma is affected by multiple factors, and different factors can play different roles during different periods of the pregnancy.

Clinical characteristics and outcomes in pregnant women with epilepsy.

BACKGROUND: Epilepsy in pregnancy can lead to substantial maternal and neonatal morbidity and mortality. Early intervention in pregnant women with epilepsy (WWE), accurate assessment of the severity of their condition, and effective treatment are required to improve maternal and neonatal prognosis. Many obstetricians lack experience in monitoring and treating pregnant WWE. AIMS: The aim of this study was to describe the demographic and clinical characteristics of pregnant WWE and examine maternal and neonatal outcomes. METHODS: Medical records of 75 pregnant women with a history of epilepsy who delivered at Beijing Tiantan Hospital, China between January 2006 and December 2019 were retrospectively reviewed. Pregnant women with a history of epilepsy were matched 1:2 with a control group of 150 pregnant women without epilepsy who delivered at Beijing Tiantan Hospital during the same time period. Information including type and frequency of epilepsy and seizures, maternal complications, medication, delivery mode, newborn weight, and newborn Apgar score were recorded. In subgroup analyses, pregnant WWE were stratified according to presence or absence of seizures during pregnancy and generalized seizure vs. nongeneralized seizure. RESULTS: The incidence of anemia, hypertensive disorder of pregnancy, premature rupture of membranes (PROM), cesarean section, and postpartum hemorrhage was significantly higher (p < 0.05), and mean newborn weight and newborn Apgar score were significantly lower (p < 0.05) in pregnant WWE compared with pregnant women without epilepsy. The incidence of premature delivery was significantly higher (p < 0.05), and mean newborn weight was significantly lower (p < 0.05) in pregnant WWE with seizures vs. without seizures. Mean newborn weight was significantly lower (p = 0.01) in pregnant WWE with nongeneralized seizures vs. generalized seizures. CONCLUSION: Pregnant WWE are at high risk of anemia, gestational hypertension, PROM, cesarean section, postpartum hemorrhage, and low newborn weight and Apgar score. Women with epilepsy who experience seizures during pregnancy are at high risk of preterm birth and having low birth weight infants. Pregnant WWE who experience nongeneralized seizures are at high risk of having low birth weight infants. These data emphasize the need to routinely monitor fetal weight on ultrasound and offer appropriate intervention. These findings highlight the need for healthcare providers to take a multidisciplinary approach to the management of pregnant WWE. SYNOPSIS: Pregnant WWE are at high risk of obstetric complications. Women with epilepsy who experience seizures during pregnancy are at high risk of preterm birth and having low birth weight infants. Pregnant WWE who experience nongeneralized seizures are at high risk of having low birth weight infants. These data highlight the need for healthcare providers to take a multidisciplinary approach to the management of pregnant WWE.

The clinical characteristics of pregnant women with epilepsy in China.

BACKGROUND: Epilepsy during pregnancy and puerperium is infrequent, and it can induce severe complications and poor prognosis. Pregnancy in women with epilepsy (WWE) is usually uneventful. Previous studies have mainly focused on the effects of different treatments on prognosis. However, few articles have addressed if different epilepsy types were associated with a higher incidence of seizure breakthrough/recurrence and pregnancy outcomes. METHODS: In the present study, based on a unique sample with a low incidence of epilepsy, we evaluated the main clinical characteristics of epilepsy patients. RESULTS: Mean age of pregnant WWE was 29.95±4.65 (range, 21-42) years. Pregnancies were at a mean gestational age of 33.80±9.14 (range, 7-41) weeks, and 88.24% (52/61) of WWE were in their third trimester. There was 9.84% (6/61) of pregnant WWE underwent abortion or induced labor in midpregnancy to ensure maternal safety. There was 75.41% (46/61) of pregnant WWE using antiepileptic drugs (AEDs), of which 52.46% (32/61) were taking a single AED and 22.95% (14/61) were using multiple AEDs. There was 47.54% (29/61) of WWE experiencing seizures during their pregnancy. We found that the type of epilepsy did not affect seizures during pregnancy or the prognosis. However, more pregnant WWE with hypertensive disorder had seizures compared with pregnant WWE without hypertensive disorder. CONCLUSIONS: The study highlighted a novel direction for effectively improving seizures during pregnancy and the prognosis of pregnancy-associated epilepsy.

Early-life exposure to air pollutants and adverse pregnancy outcomes: protocol for a prospective cohort study in Beijing.

INTRODUCTION: The association between early exposure to ambient air pollution and adverse pregnancy outcomes in China is unclear. This study will assess the risk of early-life exposure to air pollutants in Beijing and explore the viability of 8-hydroxydeoxyguanosine (8-OHdG) as a biological indicator to assess oxidative stress induced by early-life exposure to air pollution. METHODS AND ANALYSIS: Here, 2500 women with singleton pregnancies and their infants will be recruited from the Beijing Obstetrics and Gynecology Hospital. We will collect nine types of biological samples, including maternal serum, urine, placental tissue, umbilical cord tissue and umbilical cord blood during all three trimesters. The air pollution data (particulate matter (PM)2.5, PM10 and similar factors) will be recorded at official fixed-site monitoring stations closest to where the pregnant women live. We plan to assess the effect of air pollutants on adverse pregnancy outcomes and infant respiratory and circulatory disease using Cox regression and competitive risk analysis and explore possible critical windows of exposure during pregnancy using daily pollutant concentrations averaged over various periods of pregnancy combined with individual activity and physiological parameters. Maternal and umbilical cord blood samples (1000 samples) will be randomly selected for 8-OHdG assays to assess the correlation between exposures to air pollutants and oxidative stress. We will determine whether air pollutant exposure or 8-OHdG levels are associated with adverse pregnancy outcomes. SPSS and SAS statistical software will be used for data analysis. Cox regression and competing risk analysis will be used to compute the HR and population attributable risk. ETHICS AND DISSEMINATION: This research protocol has already been approved by the Medical Ethics Committee of Beijing Obstetrics and Gynecology Hospital. Written informed consent will be obtained from all study participants prior to enrolment. The results will be published in peer-reviewed journals or disseminated through conference presentations. TRIAL REGISTRATION NUMBER: This study has been registered in WHO International Clinical Trial Register-Chinese Clinical Trial Registry under registrationnumber ChiCTR-ROC-16010181 (http :// www.chictr.org.cn / showproj.aspx ?proj=17328).

Improved Fertility Following Enucleation of Intramural Myomas in Infertile Women.

BACKGROUND: The relationship between intramural myomas and fertility remains unclear. The main debate rests on whether cavity-distorting intramural myomas (CDMs) adversely affect fertility more than non-CDMs. We aimed to compare the effects of enucleating non-CDMs and CDMs on fertility improvement in females with unexplained infertility. METHODS: We prospectively recruited 83 women undergoing myomectomy for unexplained infertility with intramural myomas between June 2008 and November 2012 and classified them into non-CDMs group (n = 45) and CDMs group (n = 38). We then compared postoperative infertility rates, spontaneous pregnancy rates, pregnancy outcomes, live birth rates, and obstetric complications. For continuous variables, we calculated the mean ± standard deviation, median and interquartile range, and analyzed the data using Student's t-test and the Mann-Whitney U-test. For categorical variables, the Pearson's Chi-square test, the continuity correction test, and Fisher's exact test were used. RESULTS: Patients' demographics and myoma characteristics were comparable between the two groups. The overall spontaneous pregnancy rate increased from 0% to 68.42% following myomectomy. The postoperative infertility rate was significantly higher in the non-CDMs group than that in the CDMs group (50.00% vs. 23.53%, t = 5.579, P = 0.018), whereas the postoperative spontaneous pregnancy rate was significantly lower in the non-CDMs group than that in the CDMs group (47.62% vs. 70.59%, t = 4.067, P = 0.044). Compared with the enucleation of non-CDM, the enucleation of CDM patients was a protective factor for the fertility restoration (risk ratio [RR] = 3.717, 95% confidence interval [CI]: 1.284-10.753, P = 0.015), although postoperative fertility restoration declined with age (RR = 1.141, 95% CI: 1.005-1.295, P = 0.041). CONCLUSIONS: Intramural myomas are associated with impaired fertility. Women experiencing unexplained infertility, and possessing intramural myomas, have a better chance of conception following myomectomy, and these benefits are more obvious for younger patients and patients with CDM.

Associations between uterine fibroids and obstetric outcomes in twin pregnancies.

OBJECTIVE: To examine potential associations between the presence of fibroids and obstetric outcomes in twin pregnancies. METHODS: A prospective cohort study compared obstetric outcomes between individuals with twin pregnancies who did and did not have fibroids. Patients were considered for inclusion if they underwent first-trimester ultrasonography examination, and went on to deliver at the Beijing Obstetrics and Gynecology Hospital between September 1, 2012 and December 31, 2014. Participants were grouped based on the presence or absence of fibroids and baseline demographics, fibroid characteristics, and obstetric outcomes were recorded and compared between the two groups. RESULTS: In total, 153 patients with twin pregnancies were recruited; 51 had fibroids and 102 did not. Patients in the fibroid group demonstrated a higher maternal age (P<0.001), higher pre-pregnancy body mass index (P=0.01), and higher rate of assisted reproductive technology use (P=0.04). The presence of fibroids was not associated with any change in obstetric outcomes, and obstetric outcomes were unaffected by the number, size, location, and type of fibroids (all P>0.05). CONCLUSION: Fibroids were not a risk factor for any adverse obstetric outcomes among patients with twin pregnancies.

Pregnancy outcomes following different surgical approaches of myomectomy.

AIM: The aim of this study was to compare the feasibility, reliability, safety and pregnancy outcomes following transabdominal myomectomy (TAM) and laparoscopic myomectomy (LM) at Beijing Obstetrics and Gynecology Hospital. MATERIAL AND METHODS: The study included two parts: between January 2005 and December 2010, data on 157 patients were retrospectively collected; and between January 2011 and January 2013, 111 patients were prospectively collected. All of them had fertility requirements following myomectomy. Patients' demographics, leiomyomas' characteristics, perioperative data regarding surgical complications, relapses, subsequent pregnancy outcomes and obstetric characteristics were collected. RESULTS: The patients' demographics and leiomyoma characteristics were comparable in the TAM and LM groups (P > 0.05). There was no significant difference in the average drop in hemoglobin between the two groups (P = 0.887), while the postoperative ileus duration, postoperative ambulation duration and dose of analgesia were significantly higher in the TAM group (P < 0.001). There was no significant difference in the overall relapse and subsequent cumulative pregnancy rates and obstetric complications between the two groups. The contraception interval after myomectomy was significantly longer (P = 0.038) after TAM, however the cesarean section rate only due to myomectomy history was higher (P = 0.034) after TAM than after LM. Four patients in the LM group were identified as having uterine scar defective repair on the site of the previous myomectomy scar during elective cesarean section, while this was not identified in any patient in the TAM group. CONCLUSION: LM is a feasible treatment for women who have fertility requirements but suffer from leiomyoma. Although LM does not increase the rate of uterine rupture in the subsequent pregnancy, it is advisable for surgeons to limit the use of electrosurgery.

Identification of DNA methylation of SOX9 in cervical cancer using methylated-CpG island recovery assay.

The aim of the present study was to identify novel methylation markers for cervical cancer screening and to test the clinical application of the most promising biomarker in cervical scrapings. Methylated-CpG island recovery assay-based microarray analysis was carried out on a discovery set consisting of cervical cancer tissue and normal cervical tissue to identify significantly hypermethylated genes. Five hundred and four CpG islands, corresponding to 378 genes, were differentially methylated between cervical cancer tissue and normal cervical tissue. Among them, 30 genes were significantly hypermethylated. Of the 30 genes, SOX9, PKLR and DLX4 were selected for further validation by direct bisulfite sequencing. The SOX9 gene revealed complete methylation in the cervical cancer tissue and complete non-methylation in the normal control tissue. A TaqMan-based real-time PCR assay was performed to detect the methylation levels of the SOX9 gene in 156 cervical scrapings, including 48 normal cervical scrapings, 30 scrapings with cervical intraepithelial neoplasia 1 (CIN1), 30 scrapings with CIN2-3 and 48 scrapings with squamous cell carcinoma (SCC). The methylation levels (methylation score) of the SOX9 gene increased significantly with the severity of cervical squamous lesions. The area under the receiver operating characteristic (ROC) curve (AUC) revealed that the methylation score of the SOX9 gene could be used to segregate SCC/CIN2-3 from CIN1/normal (AUC, 0.961; p=0.000). At the optimal cut-off value, a sensitivity of 92.3% and a specificity of 89.7% were obtained. In conclusion, SOX9 methylation is frequently involved in cervical carcinogenesis, and may provide a valuable molecular biomarker for early detection of cervical cancer.

[Early stage diagnosis of endometrial cancer based on near infrared spectroscopy and support vector machine].

Near-infrared spectroscopy combined with chemometrics methods for diagnosis of cancer has been reported in literatures. In our study, the NIR spectra of 77 specimens of different physiological stages of endometrium were collected. Spectral data were pretreated firstly by multiplicative scatter correction (MSC), orthogonal signal correction (OSC), and both of them, respectively, and then by SG smoothing. Latin partition method was used to select 3/4 samples as a training set, and the other 1/4 samples for test set. Support vector machine (SVM) model was built for classification, and the classification results was compared with that of partial least squares (PLS) model based on the same pretreatment methods. Samples of malignant, hyperplasia and normal endometrium were classified better by SVM (classification accuracy was 92%) than PLS (classification accuracy was 90%). The results suggested that classification accuracy was affected by pretreatment methods and models. SVM combined with endometrial tissue near infrared spectroscopy is expected to develop into a new approach to tumor diagnosis.

[Study of near infrared spectral preprocessing and wavelength selection methods for endometrial cancer tissue].

Near infrared spectroscopy was applied to measure the tissue slice of endometrial tissues for collecting the spectra. A total of 154 spectra were obtained from 154 samples. The number of normal, hyperplasia, and malignant samples was 36, 60, and 58, respectively. Original near infrared spectra are composed of many variables, for example, interference information including instrument errors and physical effects such as particle size and light scatter. In order to reduce these influences, original spectra data should be performed with different spectral preprocessing methods to compress variables and extract useful information. So the methods of spectral preprocessing and wavelength selection have played an important role in near infrared spectroscopy technique. In the present paper the raw spectra were processed using various preprocessing methods including first derivative, multiplication scatter correction, Savitzky-Golay first derivative algorithm, standard normal variate, smoothing, and moving-window median. Standard deviation was used to select the optimal spectral region of 4 000-6 000 cm(-1). Then principal component analysis was used for classification. Principal component analysis results showed that three types of samples could be discriminated completely and the accuracy almost achieved 100%. This study demonstrated that near infrared spectroscopy technology and chemometrics method could be a fast, efficient, and novel means to diagnose cancer. The proposed methods would be a promising and significant diagnosis technique of early stage cancer.

[Study on the relations between high risk human papillomavirus and cervical intraepithelial neoplasia in married women from Beijing].

OBJECTIVE: To investigate the prevalence and relationship between high risk human papillomavirus (HR-HPV) and cervical intraepithelial neoplasia (CIN) in married women from Beijing. METHODS: From March 2007 to September 2008, a total of 6185 married women were sampled, covering 137 communities in 12 districts. The samples were screened by high-risk HPV DNA test (HC2) and cytological test. For those participants with cytological test results ≥ ASCUS, pathological tests were performed. An interview was also carried out with the same questionnaire. Results from the tests were inputted into the database twice using EpiData 3.0, reviewed, analyzed, using SPSS 15.0. RESULTS: (1) The prevalence rates of HR-HPV and CIN were 9.9% and 6.0%, respectively for the age group 25 to 54. (2) The peak age groups for HR-HPV and CIN prevalence rates were 30 to 34 years old. (3) The prevalence rates of positive cytology (40.3%) and CIN (30.4%) in HR-HPV positive female population were significantly higher than that in HR-HPV negative group. (4) Data from unconditional logistic regression analysis showed that, when comparing with the normal subjects, the risk odds ratios of HR-HPV with low grade CIN and cervical cancer/high grade CIN were 8.385 and 97.416 and the attributable risk proportions with these groups were 88.1% and 99.0%, respectively. CONCLUSION: HR-HPV infection seemed to be the main risk factor for CIN. Married women, from age group 30 - 34, were under the high risk group in both HR-HPV infection and CIN incidence.

[Expression of microRNAs in endometrioid adenocarcinoma].

OBJECTIVE: To analyze miRNA expression profile of endometrioid adenocarcinoma. METHODS: Collect Endometrium was collected from cancer and park cancer tissue. And the total RNA was extracted. The microarray detection system was employed to analyze whether there was difference in microRNA expression between cancer tissue and park cancer tissue. RESULTS: A total of 111 differentially expressed miRNA were found, including 68 over-expression miRNA and 43 low-expression. CONCLUSION: MiRNA may play important roles in tumorigenesis of endometrioid adenocarcinoma. The study of miRNA contributes to elucidate the molecular mechanism of endometrial cancer.