Whole blood RNA sequencing reveals a differential transcriptomic profile associated with cervical insufficiency: a pilot study.

BACKGROUND: The uterine cervix is a mechanical and immunological barrier against ascending infection during pregnancy. Cervical insufficiency (CI), a painless cervical dilation that occurs in the mid-trimester, is an important cause of extremely preterm birth. We hypothesized that women with CI have a differential transcriptomic profile. Therefore, we compared the transcriptomic profile of peripheral blood in women with CI and that of controls. METHODS: RNA sequencing was used to generate the global gene expression profiles of 11 women with CI and 4 controls, and differential expression analysis was performed to identify genes showing significant expression changes between the CI (n = 11) and control (n = 4) groups as well as between the CI-preterm (n = 7) and CI-term (n = 4) groups. Gene set enrichment was assessed in terms of Gene Ontology processes, and a subset of differentially expressed genes in CI was validated in a different sample-set by qRT-PCR and ELISA. RESULTS: Thirty genes were differentially expressed between the CI and control groups. Differentially upregulated genes in the CI group included neutrophil-mediated immunity-associated (DEFA3 and ELANE) and bicarbonate transport-related genes. The serum concentration of alpha defensin 3 was significantly higher in women with CI than in controls (P = 0.014). Analysis of differential gene expression according to pregnancy outcomes revealed 338 differentially expressed genes between the CI-term and CI-preterm groups. Immune and defense response to organism-associated genes and influenza A and NOD-like receptor signaling pathways were upregulated in the CI-term group. CONCLUSIONS: Our results revealed significant differences in the whole blood transcriptomic profiles of women with CI compared to those of controls. Different immune responses in women with CI may affect pregnancy outcomes.

Percutaneous Transhepatic Biliary Drainage and Percutaneous Balloon Dilatation for Patients with Biliary Duct Stones and Biliary Obstruction in Whom an Endoscopic Approach Is Difficult to Use: Case Series of 21 Patients at a Single Institution / 대한췌담도학회지

BACKGROUND/AIM: The aim of this study was to evaluate the stability and simplicity of papillary balloon dilatation by retrospectively analyzing the results of performing concurrent papillary balloon dilatation in conjunction with percutaneous transhepatic biliary drainage (PTBD) in the patients with biliary obstruction due to common bile duct stones or a tumor who were difficult to treat with an endoscopic approach. METHODS: We retrospectively analyzed a total of 21 patients who were treated through a percutaneous transhepatic biliary approach after they were diagnosed with biliary obstruction due to a tumor and biliary stones in a single medical institution for four years from 2012 to 2015. RESULTS: Sixteen out of 21 patients (76.2%) underwent percutaneous transhepatic biliary drainage and papillary balloon dilatation. For 5 patients (23.8%) in whom it was difficult to perform the procedure simultaneously due to the patient's poor overall condition such as pancreatitis and septic shock, papillary balloon dilatation was performed 5-8 days after biliary drainage. Nineteen of 21 patients (90.5%) were successfully treated by a single procedure without residual stones or restenosis, but in two patients, stones were removed two times and three times. CONCLUSIONS: The use of a percutaneous transhepatic biliary approach to patients in whom endoscopy cannot be performed is considered safe and effective. In addition, unless the procedure is specifically contraindicated, the use of papillary balloon dilatation performed simultaneously with PTBD can reduce patient inconvenience and procedure frequency.