RESUMEN

Objective: To investigate the effects of cervical cold knife conization (CKC) on preterm delivery, other pregnancy complications and neonatal outcomes, and explore the relationship between preterm delivery risk and the depth and volume of conization. Methods: The clinical data and pregnancy outcomes of 272 women who underwent CKC in Peking Union Medical College Hospital from January 2002 to March 2018 (conization group) and 1 647 pregnant women who gave birth in Peking Union Medical College Hospital during January to December 2019 (control group) were collected. The preterm delivery, premature rupture of membranes, other pregnancy complications and neonatal outcomes of the two groups were compared, and the relationship between the depth and volume of conization and the risk of preterm delivery in postoperative singleton pregnancy was analyzed. Results: (1) There were no significant differences between the two groups in delivery age, parity, proportion of singleton pregnancy, proportion of assisted reproductive technology (all P>0.05). (2) The rate of preterm delivery in the conization group was significantly higher than that in the control group [14.8% (39/264) vs 5.7% (91/1 589); χ2=28.397, P<0.001]. There were still significant differences in preterm delivery rates between the two groups at <34 weeks and 34-37 weeks (all P<0.01). There was no significant difference in the incidence of premature rupture of membrane between the two groups [23.5% (62/264) vs 23.4% (372/1 589); χ2=0.001, P=0.979], but the incidence of preterm premature rupture of membrane in the conization group was significantly higher than that in the control group [11.4% (30/264) vs 2.2% (35/1 589); χ2=56.132, P<0.001]. (3) The rate of cesarean section in the conization group was higher than that in the control group [59.6% (162/272) vs 38.8% (639/1 647); χ2=41.377, P<0.001]. The birth weight of preterm infants in the conization group was significantly higher than that in the control group [(2 409±680) vs (2 150±684) g; t=2.184, P=0.030]. However, there were no statistically significant differences in the incidence of gestational diabetes mellitus, hypertensive disorders in pregnancy, the birth weight of full-term infants, incidence of small for gestational age infant and neonatal intensive care unit admission rate between the two groups (all P>0.05). (4) The preterm delivery rates of coning depth >15 mm, cone size ≥2 cm3 and cone size <2 cm3 were higher than that in the control group (all P<0.05). When the coning depth ≤15 mm, the preterm delivery rate in the conization group was higher than that in the control group, but there was no significant difference (P=0.620). The rate of preterm delivery of pregnant women with coning depth >15 mm was significantly higher than those with coning depth ≤15 mm (RR=3.084, 95%CI: 1.474-6.453; P=0.001). There was no significant difference in the preterm delivery rate between pregnant women with cone size >2 cm3 and those with cone size ≥2 cm3 (RR=1.700, 95%CI: 0.935-3.092; P=0.077). Conclusion: The risk of preterm delivery and preterm premature rupture of membranes in subsequent pregnancies are increased after cervical CKC, and the risk of preterm delivery is positively correlated with the depth of cervical coning.

Asunto(s)

Cuello del Útero , Conización , Rotura Prematura de Membranas Fetales , Resultado del Embarazo , Nacimiento Prematuro , Humanos , Femenino , Embarazo , Conización/efectos adversos , Conización/métodos , Nacimiento Prematuro/epidemiología , Adulto , Rotura Prematura de Membranas Fetales/epidemiología , Complicaciones del Embarazo/epidemiología , Estudios Retrospectivos , Recién Nacido , Neoplasias del Cuello Uterino/cirugía , Neoplasias del Cuello Uterino/epidemiología , Neoplasias del Cuello Uterino/patología , Displasia del Cuello del Útero/cirugía , Displasia del Cuello del Útero/epidemiología

RESUMEN

Pregnancy-associated pulmonary embolism (PE) is a type of venous thromboembolism (VTE) that seriously threatens the lives of pregnant women and has gained more attention in clinical practice. Due to physiological and anatomical characteristics, the incidence of VTE during pregnancy and postpartum is significantly higher than that during non-pregnancy periods. Currently, guidelines widely acknowledge the exploration of appropriate risk assessment models to evaluate the risk of pregnancy-associated VTE and to take corresponding preventive measures from mechanical to medication methods according to different risk levels. For patients suspected of PE, initial assessments can be made based on whether they exhibit clinical manifestations of deep vein thrombosis, with options including vascular compression ultrasonography or chest X-ray examination. Confirmation relies on CT pulmonary angiography or V/Q imaging. For patients with shock, echocardiography can be quickly used for the diagnosis and differential diagnosis of PE. The management of pregnancy-associated pulmonary embolism PE depends on the patient's hemodynamic status, with options including reperfusion therapy or anticoagulation therapy. Extracorporeal membrane oxygenation may also be beneficial in high risk patients. The overall evidence level for the prevention and management of pregnancy-associated PE is low, and further exploration in clinical practice is still needed to promote the safety of pregnant women.

Asunto(s)

Embolia Pulmonar , Humanos , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/prevención & control , Embolia Pulmonar/terapia , Embarazo , Femenino , Complicaciones Cardiovasculares del Embarazo/diagnóstico , Complicaciones Cardiovasculares del Embarazo/terapia , Complicaciones Cardiovasculares del Embarazo/prevención & control , Anticoagulantes/uso terapéutico , Tromboembolia Venosa/prevención & control , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/terapia , Tromboembolia Venosa/etiología , Factores de Riesgo , Trombosis de la Vena/diagnóstico , Trombosis de la Vena/prevención & control , Trombosis de la Vena/terapia , Ecocardiografía , Oxigenación por Membrana Extracorpórea

RESUMEN

OBJECTIVE: To evaluate the efficacy and safety of pelvic arterial embolization (PAE) in women with intractable primary postpartum hemorrhage (PPH). METHODS: Clinical data of 36 cases were analyzed retrospectively in which women underwent PAE for intractable primary PPH in Peking Union Medical College Hospital between Jan 2006 and Jan 2015. The success rate of PAE were measured and possible predictive risk factors associated with treatment failure were analyzed. The complications secondary to PAE were also recorded. RESULTS: (1) The etiology of PPH. Among the 36 cases, 21 patients delivered viginally (Group VD) and 15 received cesarean section (Group CS). The most frequent cause of PPH was uterine atony (72%, 26/36). The less common causes were placental problems (28%, 10/36), genital tract trauma (6%, 2/36) and coagulation defects (3%, 1/36) in turn. Three patients (8%, 3/36) had combined causes. (2) Interventions before PAE. Uterotonic medications were used in all patients. 31 patients received carboprost methylate suppositorites, 27 received carbetocin and 31 received carboprost tromethamine. Besides, 20 patients received one or more surgical interventions before PAE. PAE was performed when these interventions failed. (3) Characteristics of PAE. Altogether 78 arteries were embolized in 36 cases. Embolization of bilateral uterine arteries was performed in 31 cases, right internal iliac artery and bilateral inferior epigastric arteries were embolized in one case. Right internal pudendal artery, bilateral uterine arteries and bilateral internal iliac arteries were embolized in one case. And bilateral uterine arteries, bilateral internal iliac arteries were embolized in one case. In the other 2 cases, bilateral internal iliac arteries were embolized. (4) Efficacy of PAE. The overall technical success rate of PAE was 100%(36/36), while the clinical success rate was 94%(34/36). All patients survived. (5) Complications of PAE. 15 patients were transferred to ICU after PAE for 1 to 7 days. Except self-limited fever, no puncture site hematoma, buttock necrosis or vessel rupture was observed. The effect on menstrual cycle and fertility were followed in 25 patients. 17 (68%, 17/25) reported resumption of normal menses and 8 (32%, 8/25) reported amenorrhea. Three pregnancies after PAE were observed. CONCLUSION: PAE is a safe and effective treatment for intractable primary PPH which can prevent hysterectomy and preserve fertility of patients.

Asunto(s)

Embolización Terapéutica/métodos , Arteria Ilíaca , Hemorragia Posparto/terapia , Femenino , Fertilidad , Humanos , Histerectomía , Ciclo Menstrual , Pelvis , Embarazo , Estudios Retrospectivos , Factores de Riesgo , Seguridad , Insuficiencia del Tratamiento , Resultado del Tratamiento , Arteria Uterina , Inercia Uterina

RESUMEN

p53 tumor suppressor is a transcription factor that functions, in part, through many of its downstream target genes. We have identified a p53-inducible gene by performing mRNA differential display on IW32 murine erythroleukemia cells containing a temperature-sensitive p53 mutant allele, tsp53(Val-135). Sequence analysis of the full-length cDNA revealed its identity as the mouse homologue of the human thiamine transporter 1 (THTR-1). Induction of the mouse THTR-1 (mTHTR-1) mRNA was detectable as early as 1 h at 32.5 degrees C; upon shifting back to 38.5 degrees C, mTHTR-1 transcript was rapidly degraded with a half-life of less than 2 h. Elevation of mTHTR-1 expression was found in DNA damage-induced normal mouse embryonic fibroblast cells, but not in p53(-/-) mouse embryonic fibroblast cells, suggesting that mTHTR-1 induction was p53-dependent. A region within the first intron of the mTHTR-1 gene bound to p53 and conferred the p53-mediated transactivation. Furthermore, increased thiamine transporter activities were found in cells overexpressing mTHTR-1 and under conditions of DNA damage or p53 activation. Our findings indicate that p53 may be involved in maintaining thiamine homeostasis through transactivation of THTR-1.

Asunto(s)

Proteínas de Transporte de Membrana/genética , Tiamina/metabolismo , Transcripción Genética/fisiología , Proteína p53 Supresora de Tumor/fisiología , Secuencia de Aminoácidos , Animales , Células Cultivadas , Clonación Molecular , ADN Complementario/análisis , Humanos , Ratones , Datos de Secuencia Molecular , Secuencias Reguladoras de Ácidos Nucleicos/fisiología , Homología de Secuencia de Aminoácido , Transfección , Células Tumorales Cultivadas

RESUMEN

The biological activity of p53 in IW32 erythroleukemia cells was investigated. IW32 cells had no detectable levels of p53 mRNA and protein expression. By transfecting a temperature-sensitive mutant p53 cDNA, tsp53val135, into the cells, we have established several clones stably expressing the mutant p53 allele. At permissive temperature, these p53 transfectants were arrested in G1 phase and underwent apoptosis. Moreover, differentiation along the erythroid pathway was observed as evidenced by increased benzidine staining and mRNA expression of beta-globin and the erythroid-specific delta-aminolevulinic acid synthase (ALAS-E). Treatment of cells with protein tyrosine phosphatase inhibitor vanadate blocked the p53-induced differentiation, but not that of cell death or growth arrest. Increased protein tyrosine phosphatase activity as well as mRNA levels of PTPbeta2 and PTPepsilon could be observed by wildtype p53 overexpression. These results indicate that p53 induced multiple phenotypic consequences through separate signal pathways in IW32 erythroleukemia cells, and protein tyrosine phosphatase is required for the induced differentiation.

Asunto(s)

Genes p53 , Leucemia Eritroblástica Aguda/patología , Proteínas de Neoplasias/fisiología , Procesamiento Proteico-Postraduccional , Proteínas Tirosina Fosfatasas/fisiología , Proteína p53 Supresora de Tumor/fisiología , 5-Aminolevulinato Sintetasa/biosíntesis , 5-Aminolevulinato Sintetasa/genética , Animales , Apoptosis , Diferenciación Celular , ADN Complementario/genética , Inducción Enzimática , Fase G1 , Regulación Leucémica de la Expresión Génica , Globinas/biosíntesis , Globinas/genética , Leucemia Eritroblástica Aguda/enzimología , Leucemia Eritroblástica Aguda/genética , Ratones , Proteínas de Neoplasias/biosíntesis , Proteínas de Neoplasias/genética , Fenotipo , Fosforilación , Proteínas Tirosina Fosfatasas/biosíntesis , Proteínas Tirosina Fosfatasas/genética , ARN Mensajero/biosíntesis , ARN Neoplásico/biosíntesis , Proteínas Tirosina Fosfatasas Clase 3 Similares a Receptores , Proteínas Tirosina Fosfatasas Clase 4 Similares a Receptores , Proteínas Recombinantes de Fusión/fisiología , Transfección , Células Tumorales Cultivadas

RESUMEN

We have identified a novel p53 regulated gene designated DDA3 through differential mRNA display on IW32 erythroleukemia cells containing a temperature sensitive p53 allele, tsp53val-135. DDA3 mRNA induction could be observed in all sublines expressing tsp53val-135 cultured at permissive temperature as well as in NIH3T3 cells undergoing DNA damage. Upregulation of DDA3 could be detected within 2 h after down-shifting the temperature to 32.5 degrees C; upon shifting back to 38.5 degrees C, DDA3 mRNA rapidly degraded with a half-life of less than 2 h. Actinomycin D, but not cycloheximide, inhibited the p53 dependent DDA3 induction, suggesting that the activation is through transcriptional regulation and does not require de novo protein synthesis. DDA3 was expressed in multiple mouse tissues including brain, spleen, lung, kidney and testis. Full-length DDA3 cDNA was cloned and it contained an open reading frame predicted to encode a proline rich protein of 329 amino acids. Overexpression of DDA3 in H1299 lung carcinoma cells suppressed colony formation. These results suggest that DDA3 is a p53-regulated gene that might participate in the p53-mediated growth suppression.

Asunto(s)

Regulación de la Expresión Génica , Fosfoproteínas/genética , ARN Mensajero/genética , Células 3T3 , Secuencia de Aminoácidos , Animales , Secuencia de Bases , Carcinoma de Pulmón de Células no Pequeñas , Núcleo Celular/metabolismo , Clonación Molecular , Regulación Neoplásica de la Expresión Génica , Humanos , Leucemia Eritroblástica Aguda , Neoplasias Pulmonares , Masculino , Ratones , Datos de Secuencia Molecular , Especificidad de Órganos , Fosfoproteínas/biosíntesis , Fosfoproteínas/química , Alineación de Secuencia , Homología de Secuencia de Aminoácido , Transcripción Genética , Células Tumorales Cultivadas , Proteína p53 Supresora de Tumor/metabolismo

Asunto(s)

Carcinoma Hepatocelular/cirugía , Cirrosis Hepática/cirugía , Neoplasias Hepáticas/cirugía , Trasplante de Hígado , Antibióticos Antineoplásicos/uso terapéutico , Carcinoma Hepatocelular/complicaciones , Carcinoma Hepatocelular/tratamiento farmacológico , Doxorrubicina/uso terapéutico , Humanos , Cirrosis Hepática/complicaciones , Neoplasias Hepáticas/complicaciones , Neoplasias Hepáticas/tratamiento farmacológico , Trasplante de Hígado/fisiología , Estudios Retrospectivos

RESUMEN

Changes in phosphate energy metabolism with time in a rat flap model were followed noninvasively with in vivo 31P-NMR. The influence of age on high-energy phosphate metabolites in perfused and ischemic ends of 3 x 10 cm dorsal flaps was noted from 30 minutes to 7 days after closure in 6-, 12-, and 24-month-old (n = 4, 7, and 8, respectively) male Fischer 344 rats. Phosphocreatine to inorganic phosphate ratios showed younger animals exhibiting significant returns to preinjury energy status in 2- and 3-mm ischemic layers. This behavior, 24 to 72 hours after closure, coincides with neovascularization of the flap tissue. By contrast, 12- and 24-month-old animals experienced statistically significantly lesser high-energy rebound, developing greater necrosis in the ischemic regions. Early intracellular pH lowering, indicative of lactate production, was somewhat greater in the flaps of younger animals. The in vivo 31P-NMR methods thus provide metabolic insights into flap behavior correlating with physiologic influences of aging.

Asunto(s)

Envejecimiento/fisiología , Metabolismo Energético/fisiología , Piel/metabolismo , Colgajos Quirúrgicos/fisiología , Animales , Espectroscopía de Resonancia Magnética , Masculino , Necrosis , Fósforo , Ratas , Ratas Endogámicas F344 , Piel/patología , Colgajos Quirúrgicos/patología

RESUMEN

A 3D projection reconstruction (3DPR) method was used to obtain in vivo 11B images in a large canine brain tumor model and in a human infused with borocaptate sodium (BSH). Studies were performed in dogs with and without gliosarcomas implanted and grown to a size of 2-3 cm. The 3DPR method demonstrates a signal-to-noise ratio (SNR) that allows qualitative kinetic studies of the boron compound in normal and tumor tissue of the head. The measurements indicate initial uptake of the BSH compound in tumor to be less than that in muscle with no uptake in normal brain tissue. Moreover, uptake of BSH in tissue was found to lag the boron concentration in blood with delays that depend on tissue type. In addition, the first human boron images were obtained on a patient who underwent surgical resection and volumetric debulking of a large (7 cm) glioblastoma multiforme. BSH was readily taken up in residual tumor tissue, while diffusion into the resection volume was slower.

Asunto(s)

Borohidruros , Neoplasias Encefálicas/diagnóstico , Encéfalo/patología , Glioblastoma/diagnóstico , Gliosarcoma/diagnóstico , Imagen por Resonancia Magnética/métodos , Compuestos de Sulfhidrilo , Animales , Borohidruros/farmacocinética , Boro/farmacocinética , Terapia por Captura de Neutrón de Boro , Perros , Humanos , Procesamiento de Imagen Asistido por Computador/métodos , Isótopos , Trasplante de Neoplasias , Compuestos de Sulfhidrilo/farmacocinética

RESUMEN

The interaction between borocaptate sodium, Na2B12H11SH (BSH), and three types of serum albumin--bovine, human and dog (BSA, HSA and DSA)--has been investigated quantitatively using 11B NMR. The 11B chemical shifts and relaxation rates of BSH were studied with various concentrations of serum albumin (1-5%, w/v) at 295-310 degrees K. Correction of the longitudinal relaxation rate (R1) due to protein viscosity effects was accomplished. The corrected R1 values were analyzed mathematically using a saturation function and linear regression. The linewidths of 11B resonances, which are related to the spin-spin relaxation rates (R2), were also measured. The binding fractions (P), the number of binding sites (NBS), and the binding constants (Kb) of BSH at various concentrations of the three types of serum albumin (1-5%, w/v) were determined at 295 and 310 degrees K. We speculate that the nature of this interaction may be electrostatic.

Asunto(s)

Borohidruros/química , Albúmina Sérica/química , Compuestos de Sulfhidrilo/química , Animales , Sitios de Unión , Boro/química , Bovinos , Perros , Humanos , Espectroscopía de Resonancia Magnética , Albúmina Sérica Bovina/química , Temperatura