Decreased placental and muscular expression of the fibroblast growth factor 19 in gestational diabetes mellitus.

AIMS/INTRODUCTION: Fibroblast growth factor (FGF)19 has been shown to improve glycemic homeostasis and lipid metabolism in animal models. In humans, decreased FGF19 level has been described in diabetes. The present study aimed to investigate the expression of FGF19 in gestational diabetes mellitus (GDM) patients. MATERIALS AND METHODS: Samples for measurement were obtained from 20 women with GDM and 25 healthy controls. The messenger ribonucleic acid (mRNA) and protein expression levels of FGF19, FGF21 and co-receptor ß-klotho (KLB) in the placenta, rectus muscle and subcutaneous fat tissues were quantified by real-time quantitative polymerase chain reaction, western blot and immunohistochemistry, respectively. RESULTS: Women with GDM had significantly lower mRNA and protein expressions of FGF19 than control women in the placenta (mRNA 0.33 ± 0.05 vs 0.72 ± 0.09; protein 0.34 ± 0.13 vs 0.85 ± 0.20) and rectus muscle (mRNA 0.83 ± 0.11 vs 1.28 ± 0.19; protein 0.78 ± 0.24 vs 1.23 ± 0.39). However, there were no significant differences between GDM women and controls with respect to the expression levels of FGF21 and ß-klotho in the placenta and rectus muscle. There were almost no detectable FGF19 and FGF21 expressions in subcutaneous fat tissue. Furthermore, ß-klotho expression levels were not different between the GDM and control group in subcutaneous fat. CONCLUSIONS: FGF19 expressions are decreased in the placenta and rectus muscle of women with GDM. This might contribute to the pathophysiology or development of GDM.

Early usage of Bakri postpartum balloon in the management of postpartum hemorrhage: a large prospective, observational multicenter clinical study in South China.

AIM: To evaluate the success rate and protocol of the Bakri balloon for postpartum hemorrhage (PPH) in the course of a prospective observational multicenter cohort study in South China. METHODS: At 20 hospitals in South China, women with postpartum bleeding who failed to respond to the first-line conservative management and received the Bakri balloon were recruited for the study. Maternal characteristics, PPH characteristics, PPH management and outcomes in regard to the Bakri balloon use were recorded. RESULTS: A total of 472 women had a Bakri balloon tamponade and 407 (86.23%) women were enrolled (67 after vaginal delivery and 340 either during or after cesarean delivery). The success rate of the Bakri balloon in this study was 91.65% (373/407 women). During vaginal deliveries, the group with a hemorrhage >2000 mL before balloon insertion had significantly more blood loss (551.67±635.17 mL vs. 242.06±313.69 mL, P=0.039) and lower maternal hemoglobin (73±21.77 g/L vs. 92.06±19.60 g/L, P=0.029) after using Bakri balloon than the group with a hemorrhage <1000 mL. Similar data were found during cesarean deliveries. The blood loss before and after balloon insertion were significantly higher in the Bakri balloon failure group (1700±1429.88 mL before and 1209.58±1139.72 mL after using the balloon) than those in the success group [918±493.92 mL before (P=0.002) and 266.57±361.60 mL after using the balloon (P=0.001)]. CONCLUSION: Rapid diagnosis or prognosis of PPH, in combination with early usage of the Bakri postpartum balloon is more effective for the management of PPH.