Application of hepatitis B immunoglobulin in prevention of mother-to-child transmission of chronic hepatitis B in HBsAg- and HBeAg-positive mother.

The aim of our study was to compare the efficacy of two dosages of hepatitis B immunoglobulin (HBIG) combined with HBV vaccine (HBVac) to prevent mother-to-child transmission (MTCT) of hepatitis B in HBsAg- and HBeAg-positive mother. We enrolled 331 mother-infant pairs with HBsAg- and HBeAg-positive maternal state from the Women's Hospital School of Medicine of Zhejiang University. Newborns were randomly distributed into two groups according to the dosages of HBIG injection: 100 IU and 200 IU. Newborns from both groups were injected with HBVac in the same doses. We compared the immune outcomes between the two groups and explore the influencing factors of immune outcomes through regression analysis. There was no statistically significant relationship between HBsAg serological transmission of newborns and dosages of HBIG in HBsAg- and HBeAg-positive mother (p > .05). The Logistic regression showed that high DNA load is a risk factor for passive-active immunoprophylaxis failure for both 100 IU and 200 IU group, but higher-dosage HBIG is not necessary for higher-viral-load pregnant women with HBsAg- and HBeAg-positive. In conclusion, combined application of HBVac and a single dose of 100 IU HBIG can achieve the ideal MTCT interruption results for HBsAg- and HBeAg-positive pregnant women.IMPACT STATEMENTWhat is already known on this subject? Passive-active immunoprophylaxis is proved to be effective in preventing mother-to-child transmission of hepatitis B. Hepatitis B vaccine combined with 100 IU or 200 IU immunoglobulin is mostly recommended in China.What do the results of this study add? At present, there is still a lack scientific basis for improving existing strategies and measures to prevent mother-to-child transmission of hepatitis B in China.What are the implications of these findings for clinical practice and/or further research? 100 IU and 200 IU immunoglobulin show equivalent blocking effect, and combined use of hepatitis B vaccine and 100 IU immunoglobulin is more cost-effective.

MicroRNAs derived from urinary exosomes act as novel biomarkers in the diagnosis of intrahepatic cholestasis of pregnancy.

We aimed to investigate the value of cholestasis-related miRNAs in the diagnosis of intra-hepatic cholestasis of pregnancy (ICP) as well as the molecular mechanisms underlying the role of these miRNAs in the pathogenesis of ICP. In this study, electron microscopy was utilized to observe the exosomes present in the urine samples collected from both ICP patients and healthy pregnant women. Real-time PCR and area under curve (AUC) analysis were performed to predict the values of several miRNAs in the diagnosis of ICP. Bioinformatics analysis and luciferase assays were conducted to identify the target genes of miR-21, miR-29a and miR-590-3p, whose regulatory relationships were then established using real-time PCR, immunohistochemistry (IHC) assay and Western Blot. In the exosomes isolated from urine samples, several miRNAs, including miR-21, miR-29a and miR-590-3p, were differentially expressed between ICP patients and healthy pregnant women. In addition, the gene of intercellular adhesion molecule 1 (ICAM1) was identified as a shared target of miR-21, miR-29a and miR-590-3p, all of which inhibited ICAM1 expression. Therefore, up-regulated expression of miR-21, miR-29a and miR-590-3p in urinary exosomes reduced the expression of ICAM1, which in turn increased the incidence of ICP.

Protective effects of apigenin on LPS-induced endometritis via activating Nrf2 signaling pathway.

Endometritis is a puzzling disease that often associates with severe pelvic pain. In this study, we aimed to detect whether apigenin had protective effect against LPS-induced endometritis, if so, the underlying mechanism was further investigated. Apigenin was administrated 1 h before LPS treatment. The levels of inflammatory cytokines were measured by ELISA. The expression of NF-κB and Nrf2 were detected by Western blot analysis. The results showed that LPS treatment induced severe histological alteration of uterus and this change was attenuated by the treatment of apigenin. Apigenin significantly attenuated LPS-induced MPO activity, MDA content, and inflammatory cytokines TNF-α and IL-1ß production. LPS-induced NF-κB activation was suppressed by apigenin. Furthermore, apigenin elevated the expression of Nrf2 and HO-1 in uterine tissues. In conclusion, the present study demonstrated that apigenin protected against LPS-induced endometritis through activation of Nrf2 signaling pathway and inhibition of NF-κB signaling pathway.

Expectant management of heterotopic cesarean scar pregnancy.

BACKGROUND: Heterotopic cesarean scar pregnancy (HCSP) is a very rare but life-threatening entity and there is no optimal management strategy. Here we report a successfully managed case of HCSP with expectant treatment in a tertiary referral hospital. METHODS: A woman with HCSP after in vitro fertilization-embryo transfer opted for expectant treatment after five days of mild bleeding and ultrasound demonstrated cardiac activity disappearance of the scar pregnancy at 8(+4) weeks of gestation. RESULTS: The patient had mild to moderate bleeding during close monitoring. Three days later, speculum examination revealed the gestational mass was partly protruding at the os of the cervix and it was removed with forceps without massive hemorrhage. A healthy male baby was delivered by cesarean section at gestational age of 36(+4) weeks. CONCLUSIONS: The expectant method might be an alternative option for a HCSP with loss of cardiac activity of the scar pregnancy, when applied under supportive management and with available emergency surgery facilities.

Association of serum and follicular fluid leptin concentrations with granulosa cell phosphorylated signal transducer and activator of transcription 3 expression in fertile patients with polycystic ovarian syndrome.

OBJECTIVE: Our objective was to evaluate whether polycystic ovarian syndrome (PCOS)-associated infertility is related to alterations of leptin, leptin receptor (Ob-R), and the phosphorylated signal transducer and activator of transcription 3 (p-STAT3)/suppressor of cytokine signal 3 (SOCS3) system in the ovary. DESIGN AND SETTING: A case-control study was conducted in a university hospital. PATIENTS: Thirty-one infertile PCOS women with oligoovulation plus polycystic ovarian morphology and 79 infertile women with tubal blockage (control) participated in the study. The subjects were stratified according to in vitro fertilization outcomes: successful and failed subgroups. METHODS: Serum and follicular fluid (FF) leptin levels were measured with ELISA. RT-PCR and Western blotting were performed to assess expression of mRNA encoding leptin and Ob-R and proteins of p-STAT3 and SOCS3 in granulosa cells (GCs). RESULTS: Leptin levels in serum and FF of PCOS women were significantly higher than those of control (P < 0.01). There were no significant differences in expression of leptin mRNA and short and long Ob-Rs between PCOS and control (P > 0.05). The p-STAT3 level was decreased in PCOS compared with control (P < 0.01), whereas SOCS3 remained significantly unchanged (P > 0.05). Further analysis showed that serum and FF leptin levels were significantly higher, whereas p-STAT3 in GCs was lower in the failed subgroup of PCOS than those in the successful subgroup of PCOS (P < 0.05). CONCLUSION: Hyperleptinemia and high FF leptin are important pathologies of PCOS with infertility. Lower levels of p-STAT3 in GCs may be related to ovarian leptin resistance and fecundity in PCOS women. Relatively high serum and FF leptin and low p-STAT3 in GCs may account for decreased fertilization, implantation, and pregnancy rates of in vitro fertilization in PCOS women.

[Outcome of in vitro fertilization-embryo transfer in treatment of polycystic ovarian syndrome].

OBJECTIVE: To evaluate the outcome of in vitro fertilization embryo transfer (IVF-ET) in treatment of polycystic ovarian syndrome (PCOS) with infertility. METHODS: A retrospective analysis was performed from 52 patients with PCOS (PCOS group) and 408 cases with tubal infertility (control group). Both groups underwent IVF-ET treatment from 2001 to 2004. The duration of stimulation, amps of gammaFSH, the level of serum E2, P on the day of HCG injection, the number of oocytes retrieved, the rates of fertilization, cleavage, implantation and pregnancy, the incidence of ovarian hyperstimulation syndrome (OHSS) and cancelled rate of ET were compared between the two groups. RESULT: The duration of stimulation and amps of gammaFSH were not significantly different between the two groups. The concentration of serum E2, P on the day of HCG injection, the numbers of oocytes retrieved and cleavaged embryos were significantly higher in PCOS group (P <0.01, <0.05). Fertilization rate was significantly lower in PCOS group (P <0.01). The implantation, pregnancy and miscarriage rates per ET were not statistically significant. The OHSS rates and cancelled rates of ET were higher in PCOS group (P <0.01). CONCLUSION: Women with PCOS have a lower fertilization rate compared with those with tubal-factor fertility during IVF-ET. However, more oocytes are recovered and the preimplanted embryo has a normal chance of implantation leading to similar pregnancy rates. The OHSS rates and cancelled rates of ET are higher in PCOS because of a greater number of oocytes developed and a higher level of E2.

[Changes of serum cardiotrophin I and cystatin C in preeclampsia and clinical significance thereof].

OBJECTIVE: To investigate the changes and of serum cardiotrophin I (cTN I) and cystatin C in preeclampsia clinical significance thereof. METHODS: Peripheral blood samples were collected from 40 women with preeclampsia, aged 29 (18 - 39), with the medium gestational age of 35 weeks, and 40 age- and gestational age-matched controls. Serum cTN I and cystatin C were determined with ELISA and serum levels of creatinine kinase, creatinine, and uric acid were assayed by automatic biochemical analyzer. Comparison was made between the 2 groups. RESULTS: The serum cTn I of the preeclampsia group was 0.59 microg/L +/- 0.42 microg/L, significantly higher than that of the control group (0.09 microg/L +/- 0.22 microg/L P < 0.001), and the serum cystatin C of the preeclampsia group was 1.64 mg/L +/- 0.47 mg/L, significantly higher than that of the control group (1.08 mg/L +/- 0.19 mg/L, P < 0.001). And the serum cardiotrophin I and cystatin C concentrations of the patients with severe preeclampsia were 0.66 microg/L +/- 0.40 microg/L and 1.72 mg/L +/- 0.46 mg/L respectively, both significantly higher than those of the patients with mild preeclampsia (0.17 microg/L +/- 0.26 microg/L and 1.21 mg/L +/- 0.37 mg/L respectively, P < 0.001 and 0.05 respectively). CONCLUSION: Serum cTn I and cystatin C levels are elevated in preeclampsia and the elevation is associated with the severity of preeclampsia, suggesting that serum concentrations of cTn I and cystatin C are useful markers in the early diagnosis of cardiac and renal injury in patients of preeclampsia.

[Relationship between serum resistin level and preeclampsia].

OBJECTIVE: To investigate the alteration of serum resistin levels in normal pregnancy and preeclampsia. METHODS: Blood samples were take from 28 normal non-pregnant women, 27 women in the 1st, 26 in the 2nd and 26 in the 3rd trimester of normal pregnancy and 25 women with preeclampsia. Serum resistin concentration was determined using ELISA method. RESULT: Serum levels of resistin were not significantly different among non-pregnancy, the 1st and the 2nd trimester of pregnancy (P>0.05 for all). Serum resistin level was significantly elevated in the 3rd trimester of pregnancy as compared with non-pregnancy (P<0.01), the 1st (P<0.001) and the 2nd trimester of pregnancy (P<0.001). Serum resistin level was significantly lower in preeclampsia than in the 3rd trimester of normal pregnancy (P<0.001), but was comparable to that of non-pregnancy, the 1st and the 2nd trimester of pregnancy (P>0.05 for all). CONCLUSION: The decrease of serum resistin level in the preeclampsia may provide insight into the pathogenesis of the disease.

Nitric oxide mediates inhibitory effect of leptin on insulin-like growth factor I augmentation of 17beta-estradiol production in human granulosa cells.

In the present study the authors investigated if the inhibitory effect of leptin in the ovary was mediated via nitric oxide (NO) using human granulosa cells (GCs). Human GCs were obtained from preovulatory follicles of women who underwent IVF. Reverse transcription-polymerase chain reaction (RT-PCR) demonstrated that human GCs expressed mRNA of leptin and mRNA of isoforms of leptin receptor, including one long form and two types of short forms. Exposure of human GCs to leptin at concentrations of 3-30 ng/ml for 60 min dose-dependently increased the fluorescence of 4,5-diaminofluorescein (DAF-2), an NO-sensitive dye. The effect of leptin on DAF-2 fluorescence was inhibited by pretreatment of human GCs with 100 microM nitro-L-arginine methyl ester (L-NAME), an inhibitor of NO synthase (NOS), indicating that the increase in DAF-2 fluorescence properly reflected the intracellular NO production. FSH (1 ng/ ml) and IGF-I (30 ng/ml) stimulated 17beta-estradiol (E2) production in human GCs, respectively. FSH plus IGF-I induced a further increase in E2 production. Leptin did not significantly alter basal or FSH-dependent E2 production, but it inhibited the effect of IGF-I on E2 production and the synergistic effect of IGF-I on FSH-stimulated E2 production. The inhibitory effect of leptin on IGF-I argumentation of E2 production was attenuated by pretreatment of human GCs with 100 microM L-NAME. In conclusion, leptin could induce NO production in human GCs. The inhibitory effect of leptin on IGF-I augmentation of E2 production in human GCs was attenuated by L-NAME, strongly suggesting that NO may mediate the action of leptin in human GCs.

[Impact of leptin levels on outcome of in vitro fertilization-embryo transfer]

OBJECTIVE: To investigate the impact of ovarian stimulation on leptin levels and their effect on in vitro fertilization-embryo transfer (IVF-ET). METHODS: In 39 women who underwent IVF-ET, serum and follicular fluid leptin and E(2) levels were measured by enzyme-linked immunosorbent assay and radioimmunoassay. Blood samples were collected just prior to FSH and HCG injection and follicles puncture. Follicular fluid was collected at the time of oocyte retrieval. RESULTS: The serum leptin levels before HCG administration (26.1+/-2.3)&mgr;g/L were significantly higher than before FSH administration (9.3+/-1.0)&mgr;g/L and oocyte retrieval (15.8+/-2.3)&mgr;g/L(P<0.001). On the day of oocyte retrieval, there was no significant difference between the serum leptin(15.8+/-2.3)&mgr;g/L.and the follicular fluid leptin (18.5+/-2.2)&mgr;g/L. Serum and follicular leptin levels in successful pregnancies were significantly lower(P<0.05) than in women with failed conception. CONCLUSION: It could indicate that high leptin levels may interfere with the developing of dominant follicles.