[Multiposition spiral suture of the lower uterine segment: a new technique to control the intraoperative bleeding of pernicious placenta previa].

Objective: To explore the efficacy and safety of multiposition spiral suture of the lower uterine segment, a new technique to control the intraoperative bleeding of pernicious placenta previa(PPP). Methods: From May 2014 to May 2015, 38 patients were diagnosed PPP in Tongji Hospital and cesarean sections were performed. After removing the placenta, multiposition spiral suture was used when massive bleeding occurred, and bilateral descending branches of uterine artery ligation was conducted when necessary. Results: 18 of the 38 PPP patients(47%,18/38)were diagnosed placenta accreta. The average cervical canal length of 38 PPP patients was(3.1±0.6)cm. There were 12 cases(32%, 12/38)with 4 regions sutured, 23 cases(61%, 23/38)with 2-3 regions sutured and 3 cases(8%, 3/38)with only posterior wall area sutured. Twelve cases(32%, 12/38)underwent uterine artery ligation, 3 cases(8%, 3/38)underwent uterine artery ligation and COOK balloon. None of them was postpartum hemorrhage or performing internal iliac artery embolization. Two patients received hysterectomy. The average blood loss in the operation was(1 696± 1 397)ml. In 16(42%,16/38)patients, the blood loss exceeded 1 500 ml, and the heaviest one was 4 500 ml. Three patients had haematuria in the first 3 days after the operation. No complication was found in 6 months after the operation. Conclusions: The multiposition spiral suture technique is a simple, safe and effective way to control the massive bleeding in the cesarean section of PPP patients. It is also beneficial for the recovery of the uterus.

[Influences of inhaling glucocorticoid on sIgA and HBD-2,3 in pharyngeal mucosa of and T cell subsets in blood of patients with chronic persistent asthma].

Objective:The aim of this study was to investigate the inhaled glucocorticoid therapy affects sIgA and HBD 2,3 secreted by mucous membrane of throat and T lymphocyte subsets in patients with chronic persistent asthma. Method:One hundred patients diagnosed with chronic persistent asthma were randomly divided into control group (submitted to conventional non-hormonal therapy) and treatment group (submitted to inhaled glucocorticoid therapy) with 50 cases in each group. Ventolin aerosol had been promised in on demand use and the dosage of nonhormonal drugs should be adjusted according to the severity of illness in each group. No matter if asthma was fully under control or not, the observation would be terminated in 3 months. The secretion samples of pharyngeal mucosa and venous blood samples had been collected before and after treatment. The content of sIgA, HBD-2 and HBD-3 were detected by ELISA method. T lymphocyte subsets were detected by flow cytometry.Result:Compared with control group, the content of sIgA, HBD-2 and HBD-3 were lower in treatment group(P<0.05). Nevertheless, there were no significant differences of T lymphocyte subsets including CD3+,CD4+ and CD4+/CD8+ between two groups(P>0.05).Conclusion:The inhaled glucocorticoid therapy could bring adverse effects on the immune function of local mucous membrane in patients with asthma, with no significant effect on peripheral blood T cell subsets.

Promoter hypomethylation and increased maspin expression in preeclamptic placentas in a Chinese population.

OBJECTIVE: Preeclampsia is thought to begin with shallow trophoblast invasion and inadequate spiral artery remodeling. Maspin, a tumor-suppressor gene, plays a regulatory role in trophoblast invasion and motility. The tissue-specific methylation of the maspin promoter can regulate maspin gene expression in various cancers. We sought to detect maspin gene expression and assess the degrees of methylation of maspin promoter regions in preeclamptic placentas in the Han Chinese population and to investigate the potential role of maspin in the pathophysiology of preeclampsia. METHODS: We conducted RT-PCR, immunohistochemistry and western blotting to characterize maspin gene expression and protein levels in the placentas from normal and preeclamptic pregnancies. Finally, using methylation-specific PCR and bisulfite sequencing PCR, we detected the degrees of methylation of the promoter regions of maspin in each of the two studied groups. RESULTS: Maspin expression was increased at the mRNA and protein levels in the preeclamptic placentas compared to the control group. Maspin immunohistochemical staining revealed positive staining in the syncytio-cytotrophoblast layers and more diffuse staining in the preeclamptic group. The mean methylation level of the analyzed promoter region was significantly hypomethylated in the preeclamptic placentas compared to the control placentas, pointing to a negative relationship between maspin promoter methylation and gene expression. DISCUSSION: Hypomethylation of the maspin promoter results in increased expression of maspin in preeclamptic placentas, which suggests a negative relationship between maspin methylation and maspin expression in this Han Chinese population. Thus, maspin is likely involved in the etiology of preeclampsia.

High leptin level and leptin receptor Lys656Asn variant are risk factors for preeclampsia.

The aim of this study was to investigate the relationship between the leptin receptor (LEPR) polymorphism/serum leptin level and preeclampsia. The prevalence of a single nucleotide polymorphism in the LEPR gene exon 14 at -656 and the serum leptin concentrations in 97 preeclamptic pregnant mothers were compared to those of 110 healthy controls. The Lys656Asn genotype and Lys656Asn + Asn656Asn frequencies in the LEPR gene were significantly more prevalent in preeclampsia mothers than in controls (P < 0.05). The serum leptin levels of preeclampsia cases were significantly higher than those of controls. In addition, there were higher serum leptin levels in individuals with the GC + CC genotype both in the total cohort and in women with preeclampsia than in those with the GG genotype. Our findings suggest that the Lys656Asn polymorphism is a functional variant in the LEPR, which can affect the interaction of leptin and its receptor. Furthermore, high leptin level and the LEPR variant are risk factors for preeclampsia in Chinese women.

Lamivudine in late pregnancy to prevent perinatal transmission of hepatitis B virus infection: a multicentre, randomized, double-blind, placebo-controlled study.

This randomized, double-blind, placebo-controlled study evaluated whether lamivudine given during late pregnancy can reduce hepatitis B virus (HBV) perinatal transmission in highly viraemic mothers. Mothers were randomized to either lamivudine 100 mg or placebo from week 32 of gestation to week 4 postpartum. At birth, infants received recombinant HBV vaccine with or without HBIg and were followed until week 52. One hundred and fifty mothers, with a gestational age of 26-30 weeks and serum HBV DNA >1000 MEq/mL (bDNA assay), were treated. A total of 141 infants received immunoprophylaxis at birth. In lamivudine-treated mothers, 56 infants received vaccine + HBIg (lamivudine + vaccine + HBIg) and 26 infants received vaccine (lamivudine + vaccine). In placebo-treated mothers, 59 infants received vaccine + HBIg (placebo + vaccine + HBIg). At week 52, in the primary analyses where missing data was counted as failures, infants in the lamivudine + vaccine + HBIg group had a significant decrease in incidence of HBsAg seropositivity (10/56, 18%vs 23/59, 39%; P = 0.014) and in detectable HBV DNA (11/56, 20%vs 27/59, 46%; P = 0.003) compared to infants in the placebo + vaccine + HBIg group. Sensitivity analyses to evaluate the impact of missing data at week 52 resulting from a high dropout rate (13% in the lamivudine + vaccine + HBIg group and 31% in the placebo + vaccine + HBIg group) remained consistent with the primary analysis in that lower transmission rates were still observed in the infants of lamivudine-treated mothers, but the differences were not statistically significant. No safety concerns were noted in the lamivudine-treated mothers or their infants. Results of this study suggest that lamivudine reduced HBV transmission from highly viraemic mothers to their infants who received passive/active immunization.

[Significance of sex hormone binding globulin and free androgen index in the estimation of androgenic cases]. / Die Bedeutung des sexualhormonbindenden Globulin und des freien Androgen-Index für die Beurteilung androgenetischer Krankheitsbilder.

Hormone analyses for hirsute women suggested that free testosterone was most revealing in biological effects and sex-hormone-binding globulin (SHBG) was quantitatively persuative. Presented in this paper are the measurements of testosterone, androstendion, dehydroepiandrosterone-sulfate (DHAS), SHBG, androstandiol and free androgen index (FAI) in 51 women with hirsutism. 92% of the hirsute women with elevated androgen level showed decrease in SHBG values and increase in FAI. 17 females with hirsutism revealed abnormally high androstandiol values which were highly related to the values of total and free testosterone (r = 0.78, r = 0.80, respectively). It is suggested that in clinical practice SHBG and FAI should also be measured besides testosterone and DHAS.