Macrophage polarisation in caesarean scar diverticulum.

AIMS: To determine immunohistochemical features and correlations between M1/M2 polarisation status with disease severity of post-caesarean scar diverticulum (CSD). METHODS: Histological and immunohistological stainings were performed and inflammatory (CD16, CD163 and tumour necrosis factor-α (TNF-α)), fibrosis (α-smooth muscle actin (α-SMA)) and angiogenic (CD31) markers were examined in uterine tissues collected from patients with uterine scar diverticula (CSD) (n=37) and caesarean section (CS) (n=3). RESULTS: CSD tissues have higher expression of α-SMA, TNF-α, CD16 and CD31 and lower expression of CD163 than CS tissue (p<0.05). Compared with adjacent tissues, thick-walled blood vessels, glands and fibrotic sites have higher expression of α-SMA, TNF-α and CD16. Statistical correlation was observed between the expression of CD16 and TNF-α (R=0.693, p<0.001), α-SMA (R=0.404, p<0.05) and CD31 (R=0.253, p<0.05) in CSD tissues, especially with the ratio of CD16/CD163 (R=0.590, p<0.01). A more significant difference was observed between the expression of CD16/CD163 and α-SMA (R=0.556, p<0.001), TNF-α (R=0.633, p<0.0001) and CD31 (R=0.336, p<0.05). CONCLUSIONS: In this study, TNF-α, α-SMA, CD16 and CD31 proteins were overexpressed in all CSD cases, and CD16/CD163 was positively correlated with tissue inflammation, fibrosis and neovascularisation. Abnormal mononuclear macrophage infiltration may be involved in the origin and progression of CSD.

An injectable thermosensitive Pluronic F127/hyaluronic acid hydrogel loaded with human umbilical cord mesenchymal stem cells and asiaticoside microspheres for uterine scar repair.

Uterine scar was one of the long-term complications cesarean section. In this study, an thermo-responsive injectable hydrogel loaded with human umbilical cord mesenchymal stem cells (UCMSCs) and asiaticoside microspheres (AMs) was used for uterine scar repair, which was prepared by optimizing the mixed ratio of aldehyde-functionalized Pluronic F127 (F127-CHO) and adipic dihydrazide-modified hyaluronic acid (AHA). The asiaticoside was loaded in Poly (DL-lactide-co-gycolide) (PLGA) by emulsion- diffusion-evaporation method. The hydrogel had appropriate pore size, good mechanical property, and slow release ability of asiaticoside. In vitro cell experiments demonstrated that F127-CHO/AHA/AMs could effectively promote stem cell adhesion and proliferation, promote angiogenesis, and provide a suitable microenvironment for cell survival. The F127-CHO/AHA/AMs/UCMSCs hydrogel was further used to repair uterine scar in female SD rats. The results showed that the prepared hydrogel could promote the proliferation of rat endometrial cells, promote the regeneration of glands, reduce the degree of endometrial fibrosis and restore the morphology of uterine cavity. The hydrogel could upregulate expression of Ki67 and IGF-1, downregulate TGF-ß1 expression and promote M1-M2 transition of macrophages. This study confirmed that the prepared hydrogel could be used as an effective transplantation strategy, which could be expected to achieve clinical transformation of uterine scar repair.

UCP1 modulates immune infiltration level and survival outcome in ovarian cancer patients.

BACKGROUND: The uncoupling proteins (UCPs) are critical genes associated with tumorigenesis and chemoresistance. However, little is known about the molecular mechanism of the UCPs in ovarian cancer (OV). MATERIAL AND METHODS: UCPs expression analysis was conducted using Gene Expression Profiling Interactive Analysis (GEPIA), and its potential in clinical prognosis was analyzed using Kaplan- Meier analyses. The influence of UCPs on immune infiltration was analyzed by TIMER. In addition, the correlation between UCPs expression and molecular mechanisms was investigated by TIMER and Cancer Single-cell State Atlas (CancerSEA). RESULTS: UCP1, UCP2, UCP3 and UCP5 expression levels correlated with a favorable prognosis and tumor progression. Moreover, UCP1 expression correlated to several immune cell markers and regulated tumorigenesis, such as tumor invasion, EMT, metastasis and DNA repair. In addition, UCP1 potentially involved in genes expression of SNAI2, MMP2, BRCA1 and PARP1. CONCLUSIONS: These results implied a critical role of UCP1 in the prognosis and immune infiltration of ovarian cancer. In addition, UCP1 expression participated in regulating multiple oncogenes and tumorigenesis.

[Three-dimensional modeling of female urinary system based on MRI and CT data].

OBJECTIVE: To reconstruct a three-dimensional model of female urinary system based on magnetic resonance imaging (MRI) and tomography angiography (CTA) data. METHODS: MRI and CTA datasets were collected from 20 patients in our department in 2018 for reconstructing 3D models of the bladder urethra in resting state using Mimics19.0 software combined with engineering software. The metric parameters of the bladder urethra were analyzed in the reconstructed 3D model. RESULTS: The bladder and urethra were successfully reconstructed using 10 MRI datasets, and the kidney, ureter and bladder were reconstructed using 10 CTA datasets. Using engineering software, we measured a number of cysto-urethral geometric parameters, including the cysto-urethral posterior angle (151.1±17.9°), beta angle (137.3±14.0°), urethral pubic angle (47.8± 12.1°), urethral tilt angle (21.5±7.3°), alpha angle (83.8±13.8°), the posterior pubic space (15.3±3.0 mm), and the urethral striated muscle thickness (2.6±0.6 mm). CONCLUSIONS: Three-dimensional reconstruction of the anatomical model of the human urinary system provides a platform for studying the fine anatomy of the female urinary system and allows measurement of multiple parameters to better understand the functional differences of the bladder and urethra in different populations.

Functionalized GO Nanovehicles with Nitric Oxide Release and Photothermal Activity-Based Hydrogels for Bacteria-Infected Wound Healing.

Bacteria-infected wounds are attracting increasing attention, as antibiotic misuse and multidrug-resistant bacteria complicate their treatment. Herein, we reported a photothermal activity-based drug consisting of ß-cyclodextrin (ßCD)-functionalized graphene oxide (GO) near-infrared light-responsive nanovehicles combined with the nitric oxide donor BNN6, in a methacrylate-modified gelatin (GelMA)/hyaluronic acid graft dopamine (HA-DA) hydrogel. The synergistic effects of photothermal and gas therapies are expected to improve antibacterial efficiency and reduce drug resistance. The results revealed that GelMA/HA-DA/GO-ßCD-BNN6 was an ideal antibacterial material that improved collagen deposition and angiogenesis and promoted wound healing in a mouse model of full-thickness skin repair, compared to the commercially available Aquacel Ag dressing. We developed a multifunctional nanocomposite hydrogel that exhibited antibacterial and angiogenic properties, adhesiveness, and mechanical properties that enhance the regeneration of bacteria-infected wounds.

Comparison of cervical length measured by POP-Q C-D and MRI: Why is POP-Q C-D not accurate?

OBJECTIVE: To investigate the relationship between the cervical length evaluated by Pelvic Organ Prolapse Quantification (POP-Q) point C minus D (C-D; ECL) and the magnetic resonance imaging (MRI)-based cervical length (MCL). STUDY DESIGN: This was a retrospective study of patients with POP II-IV who underwent MRI. The ECL was calculated based on the absolute value of C-D according to POP-Q. The MCL was defined as the distance between the internal and external cervical os on MRI. Intraobserver reliability using the Bland-Altman method. Continuous variables were compared by paired 2-tailed t-tests. Multiple linear regression analysis was used to analyse the factors influencing differences between the ECL and MCL. RESULTS: Among 105 eligible patients, 89 patients were eventually included in the study. The Bland-Altman scatter plots show that the intraobserver reliability of MCL was excellent. Furthermore, the mean ECL was significantly longer than the mean MCL (48.15 mm ±â€¯27.46 vs. 28.25 mm ±â€¯10.27, P = 0.000).Body mass index, parity, menopausal status or total vaginal length did not affect the difference between ECL and MCL. However, The larger the point Ba, the larger the difference between the ECL and MCL. The larger the point Bp, the smaller the difference between the ECL and MCL. CONCLUSION: In general, POP-Q C-D was longer than the cervical length measured by MRI. Deep analysis found that when uterine prolapse is combined with larger anterior vaginal wall prolapse, the difference between ECL and MCL is greater; when uterine prolapse with larger posterior vaginal wall prolapse, the difference between ECL and MCL is smaller.

Two new models for the estimation of foetal weight more than a week before delivery: An MRI study.

PURPOSE: To develop and evaluate new formulas to determine the magnetic resonance imaging (MRI)-based estimated foetal weight (EFW) more than a week before delivery. METHODS: The study included 153 women with singleton pregnancies who gave birth to live, normal neonates within 15-21 days of the MRI examination for whom foetal body volume biometry data were available at term. All foetuses were randomly divided into a testing group (102) and a validation group (51). Regression analysis was used to determine the single volume or the combination of volume and MRI-to-delivery interval that determined the EFW. The accuracy of the two new models and the primary existing model developed by Baker et al. were evaluated in validation group. RESULTS: The two new models had similar mean percentage errors (MPEs) (3.9% vs 3.9%) and proportions of pregnancies with an MPE < 10% (92.2% vs 90.2%); the model incorporating volume and MRI-to-delivery had relatively higher proportions of pregnancies with an MPE < 5% (72.5% vs 64.7%) and EFWs in agreement with the birth weights. The error in the Baker model was almost twice that in the new models. CONCLUSION: The accuracy of foetal weight estimation more than one week before delivery using the model developed by Baker et al. was poor and was significantly improved by the new models. A combination of the foetal body volume and MRI-to-delivery interval will enable the more accurate determination of the EFWs.

A modified model can improve the accuracy of foetal weight estimation by magnetic resonance imaging.

PURPOSE: To determine whether birth weight can be reliably estimated using three-dimensional (3D) magnetic resonance imaging (MRI) foetal body volume at term. METHOD: Foetuses between 37+5 weeks and 41 weeks of gestation were delivered within 7 days after MRI and ultrasound (US) examinations. 3D foetal models were reconstructed from MRI data, and body volume was calculated. The MRI-based weight estimations were calculated using the Baker equation and the modified Baker equation with a higher density coefficient. The US-based weight estimations were determined using the formula by Hadlock. Estimations based on MRI and US were compared with the birth weights. RESULTS: Among 22 foetuses that underwent both US and MRI evaluations within 48 h before labour, the mean random errors for the estimated weight based on US, the Baker equation and the modified Baker equation were 6.5%, 4.8%, and 4.8%, respectively, and these methods correctly estimated the weights of 77.3%, 86.4% and 100% of the foetuses to within 10% of the actual birth weight. The weights of 95.5% of the foetuses were underestimated by the Baker equation. Similar findings were observed among 103 estimations based on both US and MRI within 7 days before delivery. The mean relative error of the MRI-determined estimate of foetal weight using the modified Baker equation was not significantly associated with foetal sex, birth weight, gestational age at MRI examination, the MRI-to-delivery interval or the type of MRI scanner. CONCLUSION: A modified Baker equation with a high-density coefficient can improve the accuracy of foetal weight estimation based on 3D MRI foetal volume at term, and its accuracy was not significantly affected by foetal characteristics or the type of MRI scanner among births occurring within 7 days after examinations.

Study on the cephalopelvic relationship with cephalic presentation in nulliparous full-term Chinese pregnant women by MRI with three-dimensional reconstruction.

PURPOSE: To analyze the relationship between fetal head size and maternal pelvis size using magnetic resonance imaging (MRI) with a 3-D reconstruction technique. METHODS: A total of 301 nulliparous full-term Chinese pregnant women with cephalic presentation were enrolled and received MRI examinations before labor onset. Data were collected and imported into Mimics software to reconstruct the maternal pelvis and fetus. RESULTS: Of 301 pregnant women, 212 underwent vaginal delivery and 32 received cesarean section. The body mass index (BMI) was significantly different between the vaginal delivery group and the suspected cephalopelvic disproportion (CPD) group; the larger the BMI, the higher was the risk of CPD. The transverse diameter of the pelvic inlet and the posterior sagittal diameter of the midpelvis were significantly larger in the vaginal delivery group, compared with the suspected CPD group. Fetal weight > 3.5 kg could be used as a diagnostic indicator for CPD. CONCLUSIONS: BMI is a risk factor for CPD, and fetal weight < 3.5 kg is an important diagnostic indicator for natural delivery in Chinese pregnant women.

[Comparison of levator ani muscles in three-dimensional MRI-based models in women with and without pelvic organ prolapse at rest].

OBJECTIVE: Comparison of the levator ani muscles in three-dimensional (3D) MRI-based models in women with and without pelvic organ prolapse at rest to analyze the morphological characteristics of levator ani muscles in women with POP. METHODS: Twenty-five women with POP and 22 women with normal pelvic support were selected from Nanfang Hospital of Southern Medical University. Axial, sagittal, and coronal T2-weighted pelvic magnetic resonance scans were obtained with the women in the supine position.The 3D models were reconstructed from the source images. Morphological changes was compared within the two groups of levator ani muscles, and the 3D models were measured to determine the levator ani muscle volume (LVOL), levator plate angle (LPA), levator hiatus width (LH-W) and length (LH-L), distance between symphysis and levator sling muscle (LSG). RESULTS: There were no puborectalis avulsions in control, in POP, 3 cases of avulsions just in left, 3 cases of avulsions just in right, 7 cases in bilateral. The shape of iliococcygeus were all dome-shaped in control, 11 cases were U-shaped and 14 cases were dome-shaped in POP. The shape of levator hiatus were 7 cases of U-shape, 12 cases of V-shape, 3 cases of irregular in control; 5 cases of U-shape, 4 cases of V-shape, 16 cases of irregular in POP. POP versus control: LH-L: (68.0 ± 8.9) versus (61.6 ± 7.2) mm (P < 0.05); LH-W: (41.4 ± 3.9) versus (38.0 ± 3.2) mm (P < 0.05); LSG-L: (29.6 ± 7.4) versus (24.6 ± 3.7) mm (P < 0.05); LSG-R: (28.4 ± 6.8) versus (23.9 ± 3.2) mm (P < 0.05); LPA: (51.0 ± 11.3)° versus (40.6 ± 6.3)° (P < 0.05); LVOL: (23.7 ± 5.8) versus (24.6 ± 5.0) cm³ (P > 0.05). CONCLUSIONS: It is possible to assess the morphologic changes of levator ani by using 3D MRI models objectively, our 3D data demonstrate larger in LVOL, LPA, LH-W, LH-L, LSG, and the changes in shape. It is helpful to diagnose and assess the specific situation of patients POP in clinic.