Different Fetal and Neonatal Growth between Early- and Late-Onset Preeclampsia

Preeclampsia is a heterogeneous disease, and there are major differences in severity, fetal growth and poor placentation between early- and late-onset preeclampsia. Here, we examined the effect of onset period on fetal and neonatal growth in preeclampsia with a cross-sectional study including 102 pregnant women with preeclampsia visited Okayama University Hospital from 2009 to 2013. The subjects were retrospectively compared in terms of body mass index (BMI), weight gain during pregnancy, complications, weeks of delivery, neonatal body weight and BMI at birth, fetal growth restriction (FGR), small for gestational age (SGA), pathological findings in the placenta, and infant’s weight at 1 month after birth. Neonatal body weight and BMI at birth were significantly lower and the extent of FGR and the frequency of SGA were higher in early-onset group compared with late-onset group. Mean daily weight gain during the neonatal period was significantly lower in the early-onset group compared with the late-onset group, however the weight gain rate during the neonatal period in the early-onset group was higher than that in late-onset group. In conclusions, there are significant differences in fetal and neonatal growth between early- and late-onset preeclampsia and the catch up for growth might start during neonatal period.

Sorl1 knockout inhibits expression of brain-derived neurotrophic factor:involvement in the development of late-onset Alzheimer's disease

Sortilin-related receptor 1(SORL1)is a critical gene associated with late-onset Alzheimer’s disease.SORL1 contributes to the development and progression of this neurodegenerative condition by affecting the transport and metabolism of intracellularβ-amyloid precursor protein.To better understand the underlying mechanisms of SORL1 in the pathogenesis of late-onset Alzheimer s disease,in this study,we established a mouse model of SorI1 gene knockout using cluste red regularly inters paced short palindro mic repeats-associated protein 9 technology.We found that Sorl1-knocko ut mice displayed deficits in learning and memory.Furthermore,the expression of brain-derived neurotrophic factor was significantly downregulated in the hippocampus and co rtex,and amyloidβ-protein deposits were observed in the brains of 5orl1-knockout mice.In vitro,hippocampal neuronal cell synapses from homozygous Sorl1-knockout mice were impaired.The expression of synaptic proteins,including Drebrin and NR2B,was significantly reduced,and also their colocalization.Additionally,by knocking out the Sorl1 gene in N2a cells,we found that expression of the N-methyl-D-aspartate receptor,NR2B,and cyclic adenosine monophosphate-response element binding protein was also inhibited.These findings suggest that SORL1 participates in the pathogenesis of late-onset Alzheimer s disease by regulating the N-methyl-D-aspartate receptor NR2B/cyclic adenosine monophosphate-response element binding protein signaling axis.

Low-molecular-weight heparin and preeclampsia—does the sword cut both ways?Three case reports and review of literature

BACKGROUND Low-molecular-weight heparins(LMWH)are the most commonly used anticoagulants during pregnancy.It is considered to be the drug of choice due to its safety in not crossing placenta.Considering the beneficial effect in the improvement of microcirculation,prophylactic application of LMWH in patients with preeclampsia became a trend.However,the bleeding risk related with LMWH in preeclampsia patients has seldomly been evaluated.This current study aimed to identify the potential risks regarding LMWH application in patients with preeclampsia.CASE SUMMARY Herein we present a case series of three pregnant women diagnosed with preeclampsia on LMWH therapy during pregnancy.All the cases experienced catastrophic hemorrhagic events.After reviewing the twenty-one meta-analyses,the bleeding risk related with LMWH seems ignorable.Only one study analyzed the bleeding risk of LMWH and found a significantly higher risk of developing PPH in women receiving LMWH.Other studies reported minor bleeding risks,none of these were serious enough to stop LMWH treatment.Possibilities of bleeding either from uterus or from intrabdominal organs in preeclampsia patients on LMWH therapy should not be ignored.Intensive management of blood pressure even after delivery and homeostasis suture in surgery are crucial.CONCLUSION Consideration should be given to the balance between benefits and risks of LMWH in patients with preeclampsia.

Salivary C-reactive protein and mean platelet volume as possible diagnostic markers for late-onset neonatal pneumonia

BACKGROUND Neonatal sepsis,a formidable threat to newborns,is a leading cause of neonatal mortality,with late-onset sepsis manifesting after 72 hours post-birth being particularly concerning.Pneumonia,a prevalent sepsis presentation,poses a significant risk,especially during the neonatal phase when lung defenses are compromised.Accurate diagnosis of pneumonia is imperative for timely and effective interventions.Saliva,a minimally invasive diagnostic medium,holds great promise for evaluating infections,especially in infants.AIM To investigate the potential of serum C-reactive protein(CRP),salivary CRP(sCRP),and mean platelet volume(MPV)as diagnostic markers for late-onset neonatal pneumonia(LONP).METHODS Eighty full-term neonates were systematically examined,considering anthropometric measurements,clinical manifestations,radiology findings,and essential biomarkers,including serum CRP,sCRP,and MPV.RESULTS The study reveals noteworthy distinctions in serum CRP levels,MPV,and the serum CRP/MPV ratio between neonates with LONP and healthy controls.MPV exhibited a robust discriminatory ability[area under the curve(AUC)=0.87]with high sensitivity and specificity at a cutoff value of>8.8.Correlations between serum CRP,sCRP,and MPV were also identified.Notably,sCRP demonstrated excellent predictive value for serum CRP levels(AUC=0.89),underscoring its potential as a diagnostic tool.CONCLUSION This study underscores the diagnostic promise of salivary and serum biomarkers,specifically MPV and CRP,in identifying and predicting LONP among neonates.These findings advocate for further research to validate their clinical utility in larger neonatal cohorts.

Elabela is a reliable biomarker for predicting early onset preeclampsia:A comparative study

BACKGROUND Preeclampsia(PE)is a multisystemic metabolic disease with an undetermined etiology.PE is a worldwide cause of maternal and perinatal morbidity,subdivided into early(EoPE)and late-onset(LoPE)according to 34 wk of gestation as a divider.Many researchers investigated biomarkers for predicting PE to halt its consequences on the feto-maternal outcome.Elabela(Ela)is a newly discovered peptide hormone that was implicated in PE pathogenesis.Earlier rodent studies discussed Ela’s role in controlling blood pressure.Moreover,Ela deficiency was associated with PE development.AIM To test whether plasma Ela could serve as a reliable marker for predicting PE based on the time of onset(EoPE vs LoPE)compared to age and body mass matched healthy controls since no definitive treatment exists for PE but to terminate a pregnancy.METHODS This case-control study recruited(n=90)pregnant who fulfilled inclusion criteria;they were allocated into three groups:EoPE(30/90)(<34 wk of gestation);LoPE(30/90)(≥34 wk of gestation);and healthy pregnant(30/90).Demographic criteria;biochemical,hematological,and maternal plasma Ela levels were recorded for comparison.RESULTS Serum Ela was significantly reduced in EoPE compared to LoPE and healthy controls(P=0.0023).The correlation confirmed a strong inverse relationship with mean atrial blood pressure(r=-0.7,P<0.001),while gestational age and platelets count showed a moderate correlation with(r=0.4 with P<0.0001).No correlation was confirmed between the body mass index(BMI)and urine albumin.The predictive ability of 25 centile serum Ela had an Odds ratio of 5.21,95%confidence interval(1.28,21.24),P=0.02 for predicting EoPE.The receiver operator characteristic curve defined the Ela cutoff value at>9.156 with 96.7%and 93.3%sensitivity and specificity,P<0.0001 in predicting EoPE.CONCLUSION A strong correlation of serum Ela with PE parameters with excellent sensitivity and specificity in distinguishing EoPE independent of the BMI,age,and blood pressure which makes Ela a recommendable marker in screening.Further research is warranted to explore prognostic and therapeutic applications for Ela in PE.

Maternal TMPRSS6 Gene Polymorphism rs855791SNP in Women with Preeclampsia

Introduction: Preeclampsia can lead to several maternal and perinatal adverse effects. There are few published data on the association between transmembrane serine protease 6 (TMPRSS6) gene polymorphism and preeclampsia. Objective: To assess the association between TMPRSS6 gene polymorphism rs855791SNP in women with preeclampsia compared with healthy pregnant women. Method: A case-control study (60 women in each arm) was conducted at Saad Abuaela Maternity Hospital in Khartoum, Sudan. Sociodemographic and clinical data were gathered through a questionnaire. The participant was genotype for TMPRSS6 gene rs855791SNP using Polymerase Chain Reaction and Restriction Fragment Length Polymorphism (PCR-RFLP). The results were confirmed by DNA sequencing. Result: There was no significant difference in the median of age, parity, and body mass index. The distribution of the genotypes and alleles of TMPRSS6 rs855791 was consistent with the HWE. The overall TMPRSS6 rs855791 polymorphism was not significantly associated with preeclampsia. However, the proportion of heterozygotes (TC) was considerably higher in the women with preeclampsia (46.7%) than in the control group (23.3%) (p = 0.001;OR = 2.71;95% CI = 1.21 - 6.07). The proportion of homozygotes (TT) and T alleles was not significantly different between women with preeclampsia and the control group. Conclusion: The overall TMPRSS6 rs855791 polymorphism was not significantly associated with preeclampsia and healthy control.

Role of FOXP3 in Immunohistochemical Expression in Preeclampsia

Background: FoxP3 gene variants have been linked to endometriosis, infertility, and autoimmune illnesses, according to numerous researches. Maternal sensitivity to the PE gene and the genetic variations of FoxP3 has not been thoroughly investigated. Objective: Investigation of the immune-histochemical expression of FoxP3 in placental tissue of PE patients. Methods: A total of 26 pre-eclamptic women as a case and 26 ethnically matched healthy pregnant women as a control group aged between 18 and 40 years old of different gravidity and parity referred to the labor ward for delivery either by vaginal delivery or cesarean section was enrolled to investigate the immunohistochemical expression of FOXP3 in placental tissue of PE patients. Results: Lower expression of FOXP3 IHC was statistically significant and noted in the group of preeclampsia compared to the healthy control group. Lower gestational age at delivery and a higher percentage of cesarean section were statistically significant and noted in the group of preeclampsia compared to the healthy control group. Conclusion: In comparison to the healthy control group, preeclampsia patients had statistically significantly lower FOXP3 IHC expression, and FOXP3 polymorphism was associated with the development of PE. Our findings can serve as a guide for statistical analyses and functional investigations that are more in-depth.

UCK2 promotes the proliferation,migration,and invasion of trophoblast cells in preeclampsia by activating the STAT3 pathway

Background:Preeclampsia(PE),characterized by hypertension and proteinuria,leads to serious maternal and infant complications.Uridine-cytidine kinase 2(UCK2)belongs to the UCK family,a class of enzymes that catalyzes the conversion of uridine and cytidine to monophosphate form.However,the role of UCK2 in PE has not been reported.Methods:The expression of UCK2 was detected in the placenta of PE patients and N(ω)-nitro-L-arginine methyl esterinduced PE mouse model.Through forced up-regulation or down-regulation of UCK2 in vitro,we examined the effects of UCK2 on the proliferation,apoptosis,migration,and invasion of trophoblast cells.Stattic,the inhibitor of STAT3 pathway,was used to investigate whether the STAT3 pathway mediates the biological function of UCK2 in trophoblast cells.Results:The present study found that UCK2 showed low expression in the placenta of PE patients and PE mouse model.MTT(3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide)and flow cytometry assays verified that up-regulation of UCK2 promoted the proliferation of trophoblast cells,while the silence of UCK2 suppressed cell proliferation.Besides,flow cytometry and TdT-mediated dUTP Nick-End Labeling assays demonstrated that knockdown of UCK2 resulted in apoptosis of trophoblast cells.The wound healing and transwell assays showed that the migration and invasion activities of the trophoblast cells were facilitated by the overexpression of UCK2 and were blocked by the silence of UCK2.Furthermore,the expression of phosphorylated STAT3 was increased with the upregulation of UCK2 and decreased with the inhibition of UCK2.When the STAT3 pathway was blocked by its inhibitor stattic,the promotion effects of UCK2 on trophoblast cells were suppressed.Conclusion:UCK2 promotes the proliferation,migration,and invasion of trophoblast cells,and these effects may be partly mediated by the activation of the STAT3 pathway.

Rationale of a Cross-Sectional Descriptive Study on Temporal Evolution of Frequency, Risk Factors and Complications of Preeclampsia in the University Clinics of Kinshasa, DR Congo

Background: Knowledge of temporal evolution of preeclampsia (PE) in its various aspects is essential in strategies to reduce maternal and perinatal morbidity and mortality. Preeclampsia is a public health problem due to maternal mortality associated with it worldwide (5.6%). Improving quality of its management is a major challenge in low-income countries where, despite progress made in this field, PE remains a major factor in maternal morbidity and mortality. Objective: To evaluate temporal evolution of frequency, risk factors and complications of PE at the University clinics of Kinshasa (UCK). Methods: Descriptive and cross-sectional study concerning minimum simple size of 119 pregnant women who consulted for antenatal care at the University clinics of Kinshasa from January 2012 to December 2022. Results will be reported as percentage proportion, mean and standard deviation. Comparison of proportion and means between groups will be made using Student’s t-test and Pearson’s chi-square test, respectively. The test will be statistically significant for a p value ≤ less than 0.05. Data will be collected and analysed anonymously and confidentially. Conclusion: This study will allow us to evaluate the effectiveness of different prevention and treatment modalities used over time in management of preeclampsia in our setting.

Effect of yoga practice in reducing blood pressure,platelet blood count,and proteinuria in pregnant women with mild preeclampsia

Objective:In determining the effects of yoga practice on mild preeclampsia,this study examines the blood pressure,blood platelet(PLT)count,and proteinuria status in pregnant women over 20 weeks of pregnancy.Materials and Methods:This research is an experimental study with a pre–post intervention design.We collected forty pregnant women with mild preeclampsia from all populations.All participants agreed to practice 30 min of yoga every week for 1 month.The blood pressure,the blood PLT count,and proteinuria were measured before and after the yoga intervention.The statistical analysis used the t‑test for the blood PLT count variable,the McNemar test for the proteinuria variable,and the Wilcoxon test for the blood pressure variable.Results:The results showed a decrease in systole blood pressure from 134.17±7.17 mmHg before a yoga intervention to 120±4.17 mmHg after yoga intervention(P<0.001)and a decrease in diastole blood pressure from 89.58±5.5 mmHg before the intervention to 79.38±4.25 mmHg after the intervention(P<0.001).However,there was no significant difference in blood PLT count(P=0.104)and proteinuria(P=0.063)before and after a yoga intervention in pregnant women with mild preeclampsia patients.Conclusions:Yoga exercise during pregnancy(upper 20 weeks of gestation)significantly decreased systolic and diastolic blood pressure in mild preeclampsia patients.

Association between Placenta Malaria Parasites and Preeclampsia/Eclampsia among Parturient Mothers in Alex Ekwueme Federal University Teaching Hospital Abakaliki

In tropical countries, malaria and preeclampsia/eclampsia are common diseases of pregnancy;and placenta have been implicated in the pathophysiology of both disease processes. The two diseases have pathophysiologic similarities in the placenta such as placenta ischaemia, endothelial dysfunction and production of pro-inflammatory cytokine. Yet, there is paucity of studies on the association of these two disease processes. Determining the association between the two disease processes may help to unravel the pathogenesis of preeclampsia and also help in its prevention and patient management. Objective: Determined the association between placenta malaria parasitemia and preeclampsia/eclampsia among parturients at Alex Ekwueme Federal University Teaching Hospital Abakaliki. Materials and Methods: This was a case control study that was conducted in the Labour wards of department of Obstetrics and Gynaecology, Alex Ekwueme Federal University Teaching Hospital Abakaliki (AEFUTHA) and Mile 4 Missionary Hospital Abakaliki, a comprehensive health care centre in Abakaliki, Ebonyi state. It was conducted over a period of 6 months between 1st October 2021 and 31st March, 2022. The cases in this study were parturients that developed preeclampsia/eclampsia in the course of pregnancy, while the controls were parturient without preeclampsia/eclampsia. Interviewer-administered questionnaires were used to collect data on socio-demographic characteristics, obstetrics and medical histories. Histological examinations were conducted to isolate plasmodium falciparum parasites from placenta samples obtained from the maternal surface of the placenta. The data was processed using Epi Info software. Categorical variables were analyzed using Mc Nemar X2 test, with a p-value of 0.05 considered statistically significant. Logistic regression models were used to estimate the odds ratios (OR) and 95% CI of the association between placenta malaria parasites and preeclampsia/eclampsia was conducted. Relative risk with 95% CI was used to determine both fetal and maternal outcomes. Results: The prevalence of preeclampsia during the study period was 2.9%. Placenta malaria was positive in twenty one (21) of the 67 cases of preeclampsia/eclampsia analyzed, giving a prevalence of 31.3% and in eleven (11) out of 68 controls (normotensive) patients analyzed, giving a prevalence of 16.2%. The presence of placenta malaria significantly increased the odds of developing preeclampsia/eclampsia among parturients (OR = 2.4, 95% CI = 1.0 - 5.4, P value = 0.04). Presence of placenta malaria in mothers with preeclampsia/eclampsia was associated with adverse pregnancy outcomes such as cerebrovascular accident (RR = 19.2, 95% CI = 1.1 - 341.7, P value = 0.04), DIC (RR = 10.9, 95% CI = 1.4 - 88.0, P value = 0.02), abruptio placenta (RR = 2.4, 95% CI = 1.2 - 4.8, P value = 0.01), pulmonary edema (RR = 2.7, 95% CI = 1.1 - 25.9, P value = 0.03), IUGR (RR = 2.1, 95% CI = 1.1 - 4.5, P value = 0.03) and IUFD (RR = 3.8, 95% CI = 1.3 - 11.7, P value = 0.02). Presence of placenta malaria also increased the risk of NICU admission (RR = 2.6, 95% CI = 1.1 - 6.0, P value = 0.03), Low 1st minute APGAR score (RR = 2.7, 95% CI = 1.2 - 6.1, P value = 0.02) and Low 5th minute APGAR score (RR = 3.0, 95% CI = 1.0 - 8.6, P value = 0.04) among neonates delivered by mothers with preeclampsia/eclampsia. However, presence of placenta malaria did not significantly increase maternal and perinatal mortalities. Conclusion: There is a higher prevalence of placenta malaria among mothers with preeclampsia/eclampsia when compared with normotensive controls and this was associated with increased risk of certain maternal and perinatal morbidities. Placental malaria was not associated with increased risk of either maternal or perinatal mortality.

Rationale of a Cross-Sectional Descriptive Study on Associated Factors and Prognosis Maternal-Fetal Links to Early Onset Preeclampsia at the University Clinics of Kinshasa, DR Congo

Background: Preeclampsia (PE) is one of the forms of hypertensive diseases that occur during pregnancy. Early-onset preeclampsia (EOP), which occurred before 34 weeks, proved to be the deadliest. Indeed, it is characterized by a poor maternal and fetal prognosis. EOP has a disparate incidence in the world varying between 0.9% and 31%. Several risks factors are associated with the occurrence of EOP, which is responsible of several adverse obstetrical outcomes. Complications can affect up to 85% of pregnant women with EOP, especially when EOP appears very early, before 28 or even 25 weeks’ gestation. Objectives: To determine frequency of EOP at the University Clinics of Kinshasa, to describe sociodemographic and clinical characteristics of pregnant women with EOP and to identify its risks factors and its association adverse obstetrical outcomes. Methods: The study will be a cross-sectional analytical study in University Clinics of Kinshasa from January 2016 to December 2022. The minimal size will be 119. Our study population will consist of pregnant women who consult for antenatal best care and are neonates in our Clinic. Result will be presented as percentage proportion. Comparison and proportion means between groups will be made using Student’s test and Pearson’s chi-square test, respectively. Our test will be statistically significant for a p-value ≤ than less 0.05. Data will be collected and analysed anonymously and confidentiality. Conclusion: We believe that our study should enable us to identify profile of gestational carriers at risk of EOP in our environment, as well as prognosis associated with this entity, with a view to arousing particular interest in EOP.

Effect of Salvia Miltiorrhiza Injection on Blood Pressure and Cardiac Function in Rats with Gestational Hypertension and Preeclampsia

Objective: This study is to observe the effects of Salvia miltiorrhiza injection on blood pressure and cardiac function in rats with pregnancy-induced hypertension and preeclampsia. Methodology: Syncytiotrophoblast microvilli (stbm) and l-arginine nitrosyl methyl ester were screened out via caudal vein injection. Twenty gestational hypertension-preeclampsia model SD (Sprague Dawley) rats successfully induced by L-NAME (L-arginine Nitrosyl methyl ester) were randomly divided into 2 groups (model group and Danshen injection group, n = 10). Then another 10 normal pregnant SD rats without model were selected as blank control group. The Salvia miltiorrhiza injection group was given Salvia miltiorrhiza injection (0.5 g?kg?1?d?1) through tail vein, and the control group and model group were given equal volume of normal saline through tail vein injection. All three groups were treated by tail vein injection once a day (d) for 7 days. After treatment, heart rate (HR), Systolic pressure (SP), diastolic pressure (DP) and mean arterial pressure (MAP) were measured by tail artery. Left ventricular end-diastolic diameter (LVDd) and Left ventricular end systolic diameter (LVDs) were recorded by echocardiography. Left ventricular end diastolic pressure (LVEDP), left ventricular systolic pressure (LVSP), left ventricular ejection fraction (left ventricular ejection) fraction, LVEF) and the maximum rate of increase/decrease of left ventricular pressure during isovolemic systole (+dp/dtmax/?dp/dtmax);Endothelin-1 (ET-1) levels in rat tail vein blood were detected by ELISA. Results: SP, DP, MP, HR, LVSP, LVDs and ?dp/dtmaxx were all decreased, plasma ET-1 expression was low, and LVDd, LVEDP, LVEF, and +dp/dtmax were all increased in the Salvia miltiorroot injection group, with statistical significance compared to the model group (p Conclusion: Salvia miltiorrhiza injection can improve the cardiac function and reduce blood pressure in rats with pregnancy-induced hypertension and preeclampsia, and the mechanism may be related to alleviating systemic arteriolar spasm by regulating ET-1 level.

The expression of TUSC3 in Preeclampsia and the function in trophoblast cell

Objective:In this study,we aimed to explore the expression of TUSC3 in Preeclampsia and to research the potential function of TUSC3 in placental trophoblast cells.Methods:We collected 10 cases of normal placental tissues and preeclampsia placental tissues,respectively.These parturient received treatment at the First Affiliated Hospital of Hainan Medical University between June 1,2020,and December 31,2022.The expression of TUSC3 in placenta was detected by immunohistochemistry.The effect of TUSC3 on the migration and invasion of HTR8/SVneo cells was analyzed by migration assay and Transwell assay.Results:The expression of TUSC3 was slightly increased in placental villis in preeclampsia.Immunohistochemistry and qRT-PCR were used to detect the expression of TUSC3 protein and mRNA in placental tissues.TUSC3 was markedly upregulated in PE placental tissues(P<0.01).The results of migration assay and Transwell assay showed that the migration rate and the number of invasive cells were significantly decreased in HTR8 overexpressing TUSC3(P<0.01).Conclusions:TUSC3 was markedly increased in PE placental tissues and inhibited trophoblast cells migration and invasion.

Construction and validation of a personalized prediction model for postpartum anxiety in pregnant women with preeclampsia

BACKGROUND Preeclampsia is a pregnancy-specific multi-system disease with multi-factor and multi-mechanism characteristics.The cure for preeclampsia is to terminate the pregnancy and deliver the placenta.However,it will reduce the perinatal survival rate,prolong the pregnancy cycle,and increase the incidence of maternal complications.With relaxation of the birth policy,the number of elderly pregnant women has increased significantly,and the prevalence rate of preeclampsia has increased.Inappropriate treatment can seriously affect the normal postpartum life of pregnant women.Studies have shown that postpartum anxiety in women with preeclampsia can affect physical and mental health,as well as infant growth and development.AIM To analyze the factors influencing preeclampsia in pregnant women complicated with postpartum anxiety,and to construct a personalized predictive model.METHODS We retrospectively studied 528 pregnant women with preeclampsia who delivered in Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine between January 2018 and December 2021.Their basic data were collected,and various physiological and biochemical indicators were obtained by laboratory examination.The self-rating anxiety scale was used to determine whether the women had postpartum anxiety 42 d after delivery.The independent factors influ-encing postpartum anxiety in early pregnant women with eclampsia were analyzed with multifactor logistic regression and a predictive model was constructed.The Hosmer-Lemeshow test and receiver operating characteristic(ROC)curve were used to evaluate the calibration and discrimination of the predictive model.Eighty pregnant women with preeclampsia admitted to our hospital from January 2022 to May 2022 were retrospectively selected to verify the prediction model.RESULTS We excluded 46 of the 528 pregnant women with preeclampsia because of loss to follow-up and adverse outcomes.A total of 482 cases completed the assessment of postpartum anxiety 42 d after delivery,and 126(26.14%)had postpartum anxiety.Bad marital relationship,gender discrimination in family members,hematocrit(Hct),estradiol(E2)hormone and interleukin(IL)-6 were independent risk factors for postpartum anxiety in pregnant women with preeclampsia(P<0.05).Prediction model:Logit(P)=0.880×marital relationship+0.870×gender discrimination of family members+0.130×Hct-0.044×E2+0.286×IL-6-21.420.The area under the ROC curve of the model was 0.943(95%confidence interval:0.919-0.966).The threshold of the model was-1.507 according to the maximum Youden index(0.757),the corresponding sensitivity was 84.90%,and the specificity was 90.70%.Hosmer-Lemeshowχ^(2)=5.900,P=0.658.The sensitivity,specificity and accuracy of the model were 81.82%,84.48%and 83.75%,respectively.CONCLUSION Poor marital relationship,family gender discrimination,Hct,IL-6 and E2 are the influencing factors of postpartum anxiety in preeclampsia women.The constructed prediction model has high sensitivity and specificity.

Exosome-derived miR-146a-5p from decidual macrophages in preeclampsia inhibits the viability and invasive ability of trophoblast cells by targeting HIF1α

Objective:To investigate the effect of exosomes secreted by decidual macrophages on trophoblast cells and their molecular mechanism.Methods:The decidual tissues of patients with preeclampsia(PE)and normal-term pregnant women were collected.Macrophages were obtained by the density gradient method and then flow cell sorting,then the exosomes were extracted.The structure of the exosomes was observed by transmission electron microscope.The expression of CD63,a marker protein of the exocrine body,was detected by western blot,and the exosomes were identified.CCK-8 was used to detect the effect of exosomes on trophoblast cell viability.Transwell migration experiment was used to detect the influence on migration ability.The expression of miR-146a-5p in exosomes was detected by qPCR.The effect of exosomes on the expression of HIF1αprotein in trophoblasts was detected by western blot and detection of the binding site between miR-146a-5p and HIF1αby double luciferase reporter gene was conducted.Results:The exosomes of macrophages present a"cake"structure with a middle depression about 30-130 nm in diameter,and CD63 is highly expressed,which conforms to the characteristics of exosomes.Compared with the normal group,the exosomes of decidual macrophages in the PE group inhibited the activity and migration of trophoblast cells(P<0.001).The expression of miR-146a-5p in the exosomes of decidual macrophages in the PE decreased significantly,and after exosomes of PE decidual macrophages treating trophoblast cells,the protein expression of HIF1αin trophoblast cells was significantly increased.There are targeted binding sites between miR-146a-5p and HIF1α.Conclusion:PE decidual macrophage exosomes can inhibit the viability and migration of trophoblast cells,which may be related to the decreased expression of miR-146a-5p in exosomes,thus promoting HIF1αprotein expression of trophoblast cells.

Clinical implication of platelet to lymphocyte ratio in early onset preeclampsia:A single-center experience

BACKGROUND Preeclampsia(PE)is a pregnancy syndrome of undetermined etiology;inflammation was one of the proposed theories for its development.AIM To examine the platelet to lymphocyte ratio(PLR),an inflammatory biomarker,as a marker to predict poor maternal-neonatal outcomes in early-onset PE(EoPE).METHODS A cross-sectional study enrolled 60 pregnant women with EoPE(at 32-30 wk of gestation)at a university hospital.Demographic criteria and hematological indices were collected,including platelet counts and indices(mean platelet volume and platelet distribution width),PLR,and the Doppler study,which calculated estimated fetal weight(EFW),amniotic fluid index(AFI),resistance index(RI),and pulsatility index(PI).Participants were followed until delivery,where maternal outcomes were recorded,including;delivery mode and reason for cesarean section,and neonatal outcomes,including fetal growth restriction(FGR),meconium-stained liquid,the 5-min Apgar score,and admission to the intensive care unit.RESULTS There was a trend of insignificant increases in cesarean sections.Sixty-one-point two percent(37/60)fetuses were admitted to the neonatal care unit;70.0%of admitted fetuses were meconium-stained liquor,and 56.7%of them had FGR.PLR was positively correlated with AFI and EFW as r=0.98,0.97,P<0.001;PLR showed negative correlations with PI and RI as r=-0.99,-0.98,P<0.001.The Apgar score and the number of days admitted to the intensive care unit had a positive and negative correlation(0.69,-0.98),P<0.0001,respectively.Receiver operating characteristic calculated a PLR cutoff value(7.49)that distinguished FGR at 100%sensitivity and 80%specificity.CONCLUSION Strong,meaningful relationships between PLR and FGR parameters and a poor neonatal outcome with a significant P value make it a recommendable biomarker for screening EoPE-related complications.Further studies are suggested to see the impact on maternal-neonatal health.

子痫前期胎盘组织中神经型Wiskott-Alrdich综合征蛋白的表达及其意义

目的研究子痫前期胎盘组织中神经型Wiskott-Alrdich综合征蛋白(N-WASP)的表达情况及其临床意义。方法选取2020年7月至2021年12月于中国医科大学附属盛京医院分娩的65例孕产妇作为研究对象,并将其分为早发型子痫前期组(15例)、早发对照组(15例)、晚发型子痫前期组(15例)、晚发对照组(20例)。采用实时定量PCR(RT-qPCR)检测各组胎盘组织中N-WASP mRNA的相对表达量,采用Western blotting和免疫组织化学法检测各组胎盘组织中N-WASP蛋白的表达情况及定位情况。结果RT-q PCR、Western blotting结果显示,早发型子痫前期组胎盘组织N-WASP mRNA和蛋白表达水平显著低于早发对照组(0.50±0.19 vs.0.93±0.73,0.35±0.17 vs.0.72±0.21),晚发型子痫前期组胎盘组织中N-WASP mRNA和蛋白表达水平显著低于晚发对照组(0.83±0.34 vs.1.15±0.34,0.39±0.16 vs.0.76±0.20),差异均有统计学意义(均P<0.05)。N-WASP mRNA在胎盘组织中的表达与早发型及晚发型子痫前期的发生均呈负相关(r=-0.37,P=0.042;r=-0.39,P=0.019)。免疫组织化学检测显示N-WASP蛋白定位于合体滋养细胞、细胞滋养细胞、绒毛间质细胞和血管内皮细胞的胞质中。结论N-WASP低表达可能与子痫前期的发生密切相关。

肠道微生态对子痫前期发病的影响

目的探讨肠道微生态对子痫前期(pre-eclampsia,PE)发病的影响及机制。方法选取2021年1月至2022年6月甘肃省妇幼保健院妇产科收治的40例PE患者及40例健康孕妇作为研究对象,按照孕期不同分为4组,26周PE孕妇作为A1组(n=20),36周PE孕妇作为A2组(n=20);26周健康孕妇作为B1组(n=20),36周健康孕妇作为B2组(n=20)。收集4组研究对象清晨粪便标本,提取粪便细菌DNA基因,采用16S rDNA的扩增及测序,得到肠道菌群α多样性及肠道菌群差异性。结果B2组Chao1及Observed-Species指数均低于B1组(P<0.001);与B1组相比,B2组艰难梭状芽胞杆菌(Clostridium)、马氏羊蹄菌(Fournierella)、普雷沃菌(Prevotella)、梭杆菌属(Fusobacterium)丰度升高,双歧杆菌(Bifidobacterium)及普拉梭菌(Faecalibacterium)的丰度降低。A1组Chao1及Observed-Species指数均低于B1组(P<0.001)。与B1组相比,A1组Clostridium、Fournierella、Prevotella、Fusobacterium丰度升高,Bifidobacterium及Faecalibacterium的丰度降低。A2组Chao1及Observed-Species指数均第于B2组(P<0.001);与B2组相比,A2组Clostridium、Fournierella、Prevotella、Fusobacterium丰度升高,Bifidobacterium及Faecalibacterium的丰度降低。A2组Chao1及Observed-Species指数均低于A1组(P<0.001);与A1组相比,A2组Clostridium、Fournierella、Prevotella、Fusobacterium丰度升高,Bifidobacterium及Faecalibacterium的丰度降低。结论健康孕妇会随着孕周的延长肠道菌群α多样性降低,致病菌丰度增加;PE肠道菌群致病性高于健康孕妇,且α多样性降低;PE会随着孕周的增加,肠道菌群α多样性降低,且上述致病菌丰度升高,有益菌降低,认为加强PE机体肠道菌群的监测对于预防炎症性疾病具有重要意义。

胎盘ULK1表达与自噬及子痫前期的相关性研究

目的比较子痫前期与正常产妇胎盘组织中Unc-51样激酶1(ULK1)表达和自噬水平,分析胎盘ULK1表达与自噬水平及子痫前期病情的相关性。方法选择2021年3月至2023年5月于福建省立医院分娩的25例子痫前期患者作为子痫前期组,同期住院且年龄、产次与分娩方式相配对的25例正常产妇作为对照组。免疫组织化学检测两组产妇胎盘组织中自噬标志蛋白微管相关蛋白1A/1B-轻链3B(LC3B)、苄氯素1(Beclin1)、螯合体1(SQSTM1/p62)和ULK1蛋白的表达水平,实时荧光定量PCR检测胎盘组织ULK1的mRNA表达,电化学发光法检测子痫前期患者外周血可溶性类fms酪氨酸激酶-1(sFlt-1)和胎盘生长因子(PlGF),采用Pearson法分析ULK1表达与sFlt-1/PlGF比值的相关性。结果免疫组织化学检测结果显示,对照组与子痫前期组胎盘均可见LC3B、Beclin1和p62表达,经半定量分析结果显示,子痫前期组产妇胎盘组织的LC3B和Beclin1表达相对量分别为695.32±77.82、534.19±77.60,明显高于对照组的630.11±64.14和438.66±91.71,p62表达相对量为529.66±85.62,明显低于对照组的638.37±127.62,差异均有统计学意义(P<0.05);经实时荧光定量PCR检测结果显示,子痫前期组产妇胎盘组织ULK1的mRNA表达水平1.01±0.13,明显高于对照组的0.86±0.08,差异有统计学意义(P<0.01);子痫前期组外周血PlGF和sFlt-1水平分别为(114.12±21.71)pg/mL和(8274.126±3453.49)pg/mL,sFlt-1/PlGF比值平均为81.94±57.84,经Pearson相关性分析表明,子痫前期组胎盘组织ULK1的mRNA表达水平与外周血sFlt-1/PlGF比值呈正相关(r=0.701,P<0.05)。结论子痫前期患者胎盘组织ULK1的表达水平明显上升,与自噬水平一致,并与子痫前期严重程度密切相关,有望作为子痫前期防治的新靶点。