Extracellular vesicles for the treatment of preeclampsia.

Preeclampsia is a common pregnancy complication, characterized by hypertension, proteinuria, or other organ or system lesions that appear after 20 weeks of gestation. Preeclampsia, a systemic multisystem disease of placental origin, is also one of the leading causes of maternal mortality. Serious complications such as HELLP syndrome and placental abruption that occur in patients with preeclampsia without active treatment will be life threatening. In recent years, extracellular vesicles, especially those derived from mesenchymal stem cells, have been widely used in the treatment of various diseases due to their excellent anti-inflammatory, tissue regeneration-promoting, and immunomodulatory properties. In this review, we attempt to summarize recent advances in the use of different sources of extracellular vesicles for the treatment of preeclampsia, and also describe the biological pathways and molecules involved in each study. Extracellular vesicle therapy has a good repair effect on trophoblast and endothelial system, and is a promising treatment for preeclampsia.

Study on the ratio of blood transfusion components in disseminated intravascular coagulation caused by sever postpartum hemorrhage / 中国输血杂志

【Objective】 To investigate the transfusion ratio of plasma to RBC suspension during DIC caused by sever postpartum hemorrhage, so as to improve the clinical blood transfusion protocol. 【Methods】 A total of 82 parturients, who gave birth in our obstetrics department from January 2008 to December 2019 and treated successfully for DIC due to sever postpartum hemorrhage, were selected for the study. According to the plasma/RBC suspension ratio range (from 0.4 to 2.0) during DIC rescue, the included population was divided into four groups according to the ratio interval of 0.4: Group 1: 0.4~0.8 (13 people, median 0.7), Group 2 : 0.8~1.2(30 people, median 1.0), Group 3: 1.2~1.6(30 people, median 1.3), and Group 4: 1.6~2.0 (9 people, median 1.8). The general conditions, way of delivery, number of uterine artery perfusion embolization and surgical operations performed in the 4 groups were recorded. Once spontaneous postpartum hemorrhage occurred, blood cell analysis and coagulation function examinations were carried out every 1 to 2 hours until the condition was stable. The 24-hour blood loss, transfusion units of RBC suspension, fresh frozen plasma(FFP), platelet apheresis and fibrinogen during DIC and throughout the rescue of 4 groups were recorded and compared. Locally Weighted Regression (Lowess) method was applied to analyze the nonlinear association between the plasma/RBC suspension ratio and the duration of DIC, according to the duration of DIC in 4 groups. 【Results】 1) The shortest duration of DIC (326.15 min) was observed in DIC patients transfused with a plasma/ red blood cell suspension ratio=1.8. The duration of DIC (min) in the four groups were 505.21±259.53, 435.67±307.18, 420.93±259.43, and 247.86±215.77, respectively (P<0.05). 2) The coagulation indexes PT(s), INR, APTT(s) and Fib(g/L) gradually recovered between 2.9~13.9 h after transfusion in all four groups, especially in group 4 (median plasma/RBC suspension ratio of 1.8), whose changes were most pronounced in PT, INR, and Fib at 4.3 h, 2.9 h, and 5 h, respectively (P<0.05). 【Conclusion】 Fresh frozen plasma should be given as early as possible during blood transfusion treatment of DIC rescue. The increase of the ratio of plasma/RBC suspension is beneficial to the early recovery of DIC, and the optimal ratio of plasma to RBC suspension is 1.8.