The effectiveness of prophylactic internal iliac artery balloon occlusion in the treatment of patients with pernicious placenta previa coexisting with placenta accreta.

Aim: This study aimed to explore the therapeutic effectiveness of prophylactic internal iliac artery balloon occlusion (IIABO) during cesarean delivery in the management of patients with pernicious placenta previa (PPP) coexisting with placenta accreta (PA).Methods: This retrospectively study enrolled 83 patients diagnosed with PPP coexisting with PA in our hospital between January 2014 and December 2017. The patients were divided into the study group (n = 58, receiving routine cesarean section followed prophylactic IIABO) and control group (n = 25, receiving routine cesarean section alone). The general situation, intraoperative conditions, maternal and neonatal outcomes, and postoperative complications between the two groups were compared.Results: The two groups were comparable due to no significant difference in the general situation of patients. The intraoperative conditions, such as intraoperative and postoperative blood loss, transfusion volume and the incidence rate of transfusion in the study group were significantly lower than those in the control group, but the incidence rate of disseminated intravascular coagulation and hysterectomy did not exhibit significant differences. Moreover, maternal and neonatal outcomes were not significantly different. Besides, in the study group, a patient with left foot numbness appeared left popliteal artery thrombosis and four patients experienced fever of <38.5 °C and lower abdominal pain. In the control group, a patient underwent hysterectomy.Conclusions: Prophylactic IIABO is an alternative method to control postpartum hemorrhage in the treatment of PPP coexisting with PA. However, it may not decrease the incidence of hysterectomy.

Antibacterial mechanism of high-mobility group nucleosomal-binding domain 2 on the Gram-negative bacteria Escherichia coli.

OBJECTIVE: To investigate the antibacterial mechanism of high-mobility group nucleosomal-binding domain 2 (HMGN2) on Escherichia coli K12, focusing on the antibacterial and antibiofilm formation effects. Its chemotactic activity on human neutrophils was also investigated. METHODS: Human tissue-derived HMGN2 (tHMGN2) was extracted from fresh uterus fiber cystadenoma and purified by HP1100 reversed-phase high-performance liquid chromatography (RP-HPLC). Recombinant human HMGN2 (rHMGN2) was generated in E. coli DE3 carrying PET-32a-c(+)-HMGN2. Antibacterial activity of HMGN2 was determined using an agarose diffusion assay and minimum inhibitory concentration (MIC) of HMGN2 was determined by the microdilution broth method. Bacterial membrane permeability assay and DNA binding assay were performed. The antibiofilm effect of HMGN2 was investigated using a crystal violet assay and electron microscopy scanning. The activating effect and chemotactic activity of HMGN2 on neutrophils were determined using a nitroblue tetrazolium (NBT) reduction assay and Transwell chamber cell migration assay, respectively. RESULTS: HMGN2 showed a relatively high potency against Gram-negative bacteria E. coli and the MIC of HMGN2 was 16.25 µg/ml. Elevated bacterial membrane permeability was observed in HMGN2-treated E. coli K12. HMGN2 could also bind the bacterial plasmid and genomic DNA in a dose-dependent manner. The antibiofilm effect of HMGN2 on E. coli K12 was confirmed by crystal violet staining and scanning electron microscopy. However, the activating effects and chemotactic effects of HMGN2 on human neutrophils were not observed. CONCLUSIONS: As an antimicrobial peptide (AMP), HMGN2 possessed a good capacity for antibacterial and antibiofilm activities on E. coli K12. This capacity might be associated with disruption of the bacterial membrane and combination of DNA, which might affect the growth and viability of E. coli.

Hemoglobin and its derived peptides may play a role in the antibacterial mechanism of the vagina.

BACKGROUND: Hemoglobin is a precursor of antibacterial peptides. Our aim was to identify an antibacterial peptide in human endometrium. We tested the antimicrobial activities of hemoglobin and a derived peptide in vitro and in vivo in rats. METHODS: Samples (n = 3) were scraped from the surface of endometrium. Acid-soluble proteins underwent electrophoresis followed by gel overlay assay and reversed-phase high-performance liquid chromatography. Antibacterial activities were determined by agar radial diffusion assay. Purified peptides were further characterized by electrophoresis, mass spectrometry, N-terminal amino acid (AA) sequencing and protein structure analysis. A rat model was used to test the inhibitory activity of human hemoglobin on vaginal infection with Escherichia coli, using one experimental group (intravaginal hemoglobin, n = 9) and three control groups (n = 14). Vaginal histology was studied. RESULTS: The purified peptide exhibited potent antibacterial activities against E. coli ML-35P. The N-terminal AA sequence was F L S F P T T K T Y, identical to AA 32-41 of the human hemoglobin alpha chain, and it had the same mass (m/z = 6776.8) as the alpha chain 32-93 AA fragment, with at least three alpha-helices. Histology indicated that the hemoglobin group changed significantly compared with the matrix control group (no treatment after infection): the surface layer of stratified squamous epithelium was smoother, inflammatory cell infiltration was relieved in the lamina propria and congestion pattern was decreased. CONCLUSIONS: These results suggest that erythrocytes from endometrium are another source of the antimicrobial molecules. Hemoglobin and its derived peptides may play a role in the host defense against pathogens in human vagina.

[Study on antimicrobial activity of human hemoglobin and its fragments both in vitro and in vivo].

OBJECTIVE: To isolate human hemoglobin and its fragrments, compare their antimicrobial activity in vitro and pilot study of their antimicrobial activity in vivo. METHODS: The alpha and beta chains of hemoglobin were separated by cation exchange chromatography and gel chromatography; The alpha and beta chains were cleaved by cyanogens bromide respectively. The cleaved fragments were purified by reverse phase high performance liquid chromatography. Antimicrobial activity of hemoglobin and its fragments was determined by agrose radial diffusion assay. After establishment of E. coli vaginal infection model, the rats were randomized into the experimental group (hemoglobin group) and the control group. The histologically pathological section was observed. RESULTS: Hemoglobin, alpha/beta chain and their fragments had similar antibacterial activities in vitro, which were mainly against Gram-negative bacteria E. coli; except alpha1-32 had a comparatively lower activity. Antimicrobial activity in vivo: a comparison of the hemoglobin group with the matrix control group (no treatment after infection), the surface layer of vaginal stratified squamous epithelium was smoother, inflammatory cells were significantly reduced in the lamina propria and congestion was obviously decreased. CONCLUSION: Human hemoglobin and its fragments had antibacterial activity in vitro, hemoglobin might relieve the inflammation of E. coil vaginal infection in rats moreover.