High AMH levels are associated with gestational hypertension in patients with PCOS who underwent IVF/ICSI-ET

BACKGROUND

Patients with polycystic ovary syndrome (PCOS) have a higher risk of obstetric complications. The association between anti-Müllerian hormone (AMH) and gestational hypertension in these patients is poorly understood.

OBJECTIVE

To determine the association between serum AMH levels and gestational hypertension in patients with PCOS undergoing fresh embryo transfer.

METHODS

This retrospective study included 649 patients with PCOS who had singleton live births after undergoing fresh embryo transfers. The association of AMH with gestational hypertension in these patients was estimated before and after propensity score matching (PSM).

RESULTS

Patients with gestational hypertension had higher AMH levels than those without gestational hypertension. In single-factor logistic regression, the odds of gestational hypertension increased by 11.7% and 18.6% for every 1 ng/mL increase in AMH before and after adjusting for confounding factors [OR 1.117, 95% CI(1.025, 1.217), P = 0.012; adjusted OR 1.186, 95% CI(1.061, 1.327), adjusted P = 0.003], respectively. The odds of gestational hypertension increased more than 100% [adjusted OR 2.635, 95% CI(1.132, 6.137), adjusted P = 0.025] in the 75th percentile group (>9.30 ng/ml) and more than thrice [adjusted OR 4.75, 95% CI(1.672, 13.495), adjusted P = 0.003] in the 90th percentile group (>12.31 ng/ml) as compared to the without-gestational hypertension group. AMH level was still associated with gestational hypertension after PSM. The area under the curve of AMH predicting gestational hypertension was 0.654 [95% CI (0.532, 0.776), P = 0.011] with an optimal cutoff value of 11.975 ng/mL.

CONCLUSIONS

High serum AMH level pre-pregnancy (especially at levels > 9.30 ng/mL) indicates a high odds of gestational hypertension in patients with PCOS undergoing fresh embryo transfer.

[Effects of early debridement and conservative eschar removal followed by wound coverage with acellular dermal matrix in the treatment of children with deep burns]

Objective: To explore the effects of early debridement and conservative eschar removal followed by wound coverage with acellular dermal matrix (ADM), i.e., early surgery, in the treatment of children with deep burns. Methods: This study was a retrospective cohort study. From January 2017 to December 2022, 278 deep burned hospitalized children aged 1-7 years who met the inclusion criteria were admitted to Central Hospital Affiliated to Shandong First Medical University. According to the differences in treatment processes, 134 children who underwent early surgery+routine dressing change were enrolled in eschar removal+dressing change group (77 males and 57 females, aged 1 (1, 2) years), and 144 children who underwent only routine dressing change were enrolled in dressing change alone group (90 males and 54 females, aged 1 (1, 2) years). Fifty-one children without full-thickness burns in eschar removal+dressing change group were enrolled in eschar removal+dressing change group 1 (26 males and 25 females, aged 1 (1, 2) years), and 57 cases of the 83 children with full-thickness burns who did not undergo autologous skin grafting at the same time of early surgery (namely early skin grafting) in eschar removal+dressing change group were included in eschar removal+dressing change group 2 (37 males and 20 females, aged 1 (1, 2) years). Seventy-six children without full-thickness burns in dressing change alone group were included in dressing change alone group 1 (51 males and 25 females, aged 1 (1, 3) years), and 68 children with full-thickness burns in dressing change alone group were included in dressing change alone group 2 (39 males and 29 females, aged 1 (1, 2) years). For deep partial-thickness burn wounds and small full-thickness burn wounds in eschar removal+dressing change group, the eschar removal was performed on the basis of retaining a thin layer of denatured dermis so as to preserve the healthy tissue of the wound base, and ADM was applied to all wounds externally after eschar removal. For larger full-thickness burn wounds in this group, especially those located in the functional part of joints, eschar removal to the plane layer of viable tissue and early autologous skin grafting was needed. When the superficial wounds of children healed or tended to heal, the residual wounds were evaluated, and elective autologous skin grafting was performed if it was difficult to heal within 14 days. The healing time, intervention healing time, times of operation/dressing change, and times of intervention operation/dressing change in children with deep partial-thickness burn wounds of children in eschar removal+dressing change group, dressing change alone group, eschar removal+dressing change group 1, and dressing change alone group 1 were recorded. At the last follow-up (follow-up period was set to 7-12 months), the modified Vancouver scar scale (mVSS) scores of the most severe area of scar hyperplasia of healed deep partial-thickness burn wounds of 54 children in eschar removal+dressing change group and 48 children in dressing change alone group were recorded. The healing time and times of operation/dressing change of all burn wounds of children in eschar removal+dressing change group and dressing change alone group, and the healing time and times of operation/dressing change of full-thickness burn wounds of children in eschar removal+dressing change group 2 and dressing change alone group 2 were recorded. The incidences of wound infection, sepsis, fever, and fever after 5 days of burns in children of eschar removal+dressing change group and dressing change alone group during wound healing. Results: Compared with those in dressing change alone group, the healing time and intervention healing time were significantly shortened, and the times of operation/dressing change and times of intervention operation/dressing change were significantly reduced in children with deep partial-thickness burn wounds in eschar removal+dressing change group (with Z values of -11.00, -11.33, -12.64, and -11.65, respectively, P<0.05). Compared with those in dressing change alone group 1, the healing time and intervention healing time were significantly shortened, and the times of operation/dressing change and times of intervention operation/dressing change were significantly reduced in children with deep partial-thickness burn wounds in eschar removal+dressing change group 1 (with Z values of 6.57, 6.46, 8.04, and 6.57, respectively, P<0.05). At the last follow-up, the mVSS score of the most severe scar hyperplasia area of healed deep partial-thickness burn wounds of 54 children in eschar removal+dressing change group was 4.00 (3.00,5.00), which was significantly lower than 6.50 (5.00,7.00) of 48 children in dressing change alone group (Z =-4.67, P<0.05).Compared with those in dressing change alone group, the healing time was significantly shortened, and times of operation/dressing change was significantly reduced in all burn wounds in eschar removal+dressing change group (with Z values of -5.20 and -6.34, respectively, P<0.05). Compared with those in dressing change alone group 2, the healing time was significantly shortened, and times of operation/dressing change was significantly reduced in full-thickness burn wounds in eschar removal+dressing change group 2 (with Z values of -5.22 and -5.73, respectively, P<0.05). During wound healing, the probabilities of fever and fever after 5 days of burns in children of eschar removal+dressing change group were significantly lower than those in dressing change alone group (with χ2 values of 4.13 and 3.91, respectively, P<0.05); only 1 child in dressing change alone group developed sepsis, and there was no statistically significant difference in the wound infection rate of children in the two groups (P>0.05). Conclusions: For children with deep burns, early surgery, and early skin grafting or elective autologous skin grafting as needed, have better short-term and long-term effects than those without early surgery.

Live imaging of nitric oxide release in vascular endothelial cells in response to mechanical stimuli on an organ chip

Background

Nitric oxide (NO), released from vascular endothelial cells in response to mechanical stimuli, regulates cardiac contractility and are also involved in the prevention of the development of cardiac hypertrophy.

Purpose

To establish an experimental system for live observation of NO release in response to mechanical stimuli on an organ chip.

Methods

Organ chips, which we used for the development of a heart-on-a-chip in the previous study [1], were used.

We seeded 300,000 human umbilical vein endothelial cells on a stretchable elastic membrane coated with Matrigel of a chip channel. Shear stress was applied to the cells by increasing flow rate of a peristaltic pump connected to the chip channel (Figure 1A). Pressure stimulus was applied by hydrostatic pressure. Stretch stimulus was applied by suction to the side ports of a chip using an electric syringe pump (Figure 1B). Cells were stained with 10 μM 4,5-diaminofluorescein diacetate for fluorescent live NO imaging.

Results

Monolayers of the endothelial cells formed intercellular junctions confirmed by CD31 staining (Figure 1C, yellow). Apparent permeability, which was measured by Texas red dye (MW 3000), was maintained at a low level of ∼3x10–6 cm/s until day 30, suggested the formation of robust intercellular junction.

When the endothelial cells were subjected to a pressure stimulus of 60 mmHg for 60 s, NO release was observed that lasted for &gt;2 minutes (Figure 2A). A peak value of 1.46±1.08 (mean ± standard deviation) times the baseline was observed 271 s after the beginning of the pressure stimulus (n=251 cells). When the cells were subjected to a 1% stretch for 60 s, a peak value of 1.29±0.33 times the baseline was observed 105 s after the beginning of the stretch stimulus (Figure 2B). A shear stress of 0.01 dyn/cm2 hardly increased NO release (1.20±0.27 times the baseline, Figure 2C).

Conclusion

The system for live NO imaging in vascular endothelial cells in response to mechanical stimuli was established using organ-on-a-chip. The heart-on-a-chip with endothelial cells will be useful in elucidating the effects of mechanical stimulus such as hypertension on the contractile function and the remodeling of the heart.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Japan Society for the Promotion of Science

Machado-Joseph disease in pedigrees of Azorean descent is linked to chromosome 14

A locus for Machado-Joseph disease (MJD) has recently been mapped to a 30-cM region of chromosome 14q in five pedigrees of Japanese descent. MJD is a clinically pleomorphic neurodegenerative disease that was originally described in subjects of Azorean descent. In light of the nonallelic heterogeneity in other inherited spinocerebellar ataxias, we were interested to determine if the MJD phenotype in Japanese and Azorean pedigrees arose from mutations at the same locus. We provide evidence that MJD in five pedigrees of Azorean descent is also linked to chromosome 14q in an 18-cM region between the markers D14S67 and AACT (multipoint lod score +7.00 near D14S81). We also report molecular evidence for homozygosity at the MJD locus in an MJD-affected subject with severe, early-onset symptoms. These observations confirm the initial report of linkage of MJD to chromosome 14; suggest that MJD in Japanese and Azorean subjects may represent allelic or identical mutations at the same locus; and provide one possible explanation (MJD gene dosage) for the observed phenotypic heterogeneity in this disease.

MR evaluation of the brain in central diabetes insipidus

OBJECTIVE

To evaluate the role of magnetic resonance (MR) imaging in determining the cause of central diabetes insipidus (CDI) by using MR imaging to describe the findings in the hypothalamic-pituitary area in patients with CDI.

METHODS

Thirty-one cases of clinically proved CDI were prospectively studied. A control study was also conducted in 200 normal subjects. MR imaging was performed on a 1.0 T superconductive unit with T1-weighted images obtained in the sagittal, coronal and axial planes.

RESULTS

Hypothalamic-pituitary masses or structural changes were identified in 26 cases and normal structures in 5. The normal high signal intensity of the posterior pituitary lobe was absent in 29 cases, but remained unchanged in 2. In the control group, the frequency of the high signal of the posterior lobe was 93%.

CONCLUSIONS

The absence of the normal high signal in the posterior pituitary lobe is closely related to the loss of hypothalamic-pituitary function. MR imaging is very sensitive in demonstrating the changes in this area in CDI and it can provide an accurate diagnosis when combined with the clinical information.

Dendritic mast cells in prurigo nodularis skin

Mast cells are traditionally recognized as round or oval connective tissue cells containing many specialized cytoplasmic granules. During recent years, more and more mast cell functions and properties have been clarified, and it is now evident that the mast cells are of different subtypes. The present study, utilizing chymase and tryptase immunofluorescence double-labelling and conventional electron microscopy techniques, has identified a kind of mast cells with obvious dendritic features in the lesional dermis of prurigo nodularis skin. This group of mast cell have enlarged cell bodies and contain fewer cytoplasmic granules, especially within certain dendrites. The morphological identification of such subgroups of mast cells could contribute to the understanding of mast cell heterogeneity.

[Study on the electrothermal tissue effects during transcervical resection of endometrium]

OBJECTIVE

To investigate the tissue electrothermal effects and to seek the appropriate setting of operative wattage during transcervical resection of endometrium (TCRE).

METHODS

The power setting were 60 W, 80 W, 100 W for cutting and 30 W, 60 W, 80 W, 100 W for coagulation when performing endometrial resection in vitro or in vivo with operating time 3-5 seconds or 6-8 seconds respectively. After operation the uterine specimens were stained by hemaloxylin-eosin, and respiratory enzyme dehydronicotinamide adenine dinucleotide phosphate diaphorase methods for evaluating the tissue damage.

RESULTS

(1) The depth of endometrial damage under cutting was considerably less severe than those under coagulation with the same power setting. (2) When the power of cutting and coagulation were 80 W, 100 W and 30 W, 60 W respectively and operating time prolonged more than 5 seconds, the thermal damage covered endometrium and 2-3 mm of myometrium in depth. (3) At such wattage and operating time the deepest destruction was only 16.27% of uterine wall.

CONCLUSION

(1) There is significant difference in the depth of thermal damage between cutting and coagulation during hysteros copic surgery. (2) The appropriate power setting should be 80-100 W for cutting and 30-60 W for coagulation.

[The influence of recombinant human growth hormone on the metabolism of glucose and protein in severely burned patients]

OBJECTIVE

To investigate the influence of recombinant human growth hormone (rhGH) on the metabolism of glucose and protein in severely burned patients.

METHODS

The serum levels of total protein and albumin and the incidence of hyperglycemia in 24 cases of severely burned patients treated by rhGH were determined and compared with those in patients without rhGH treatment (control group).

RESULTS

The serum levels of total protein (TP) and albumin in burned patients after being treated by rhGH were much higher than those before treatment and those in control group. The blood level of glucose increased within 2 weeks, especially 1 week postburn. The incidences of hyperglycemia were 52.38%, 50.24% and 20% on 0 similar 3, 4 similar 7 and 8 similar 14 postburn days (PBDs), respectively. And the incidences of hyperglycemia were 100%, 50% and 0% when the administration of rhGH started within 1, 2 and after 2 weeks respectively.

CONCLUSION

The systemic protein synthesis in severely burned patients could be accelerated by the use of rhGH. But early administration of rhGH in burned patients could affect blood sugar level obviously. And the optimal time to give rhGH is 2 weeks after burn injury.

[The management of posterior capsular in cataract operations of high myopia]

OBJECTIVE

To study the management of posterior capsular in cataract operation of high myopia in order to avoid posterior capsular opacity(PCO).

METHODS

Twenty-two cases(30 eyes) of high myopia with an average axial length of 31.62 mm were analyzed. Cataract phacoemulsification were performed in all cases, among which 12 eyes were operated with continuous curvilinear capsulorhexis (group I) of posteror capsular and 18 eyes were operated with capsulorectomy combined with anterior segment vitrectomy (group II). No artificial lenses were implanted in all cases.

RESULTS

The post-operative naked vision were improved in both groups. Group I: The VA > or = 0.1 in all 12 eyes(100%), > or = 0.3 in seven eyes (58.3%) and no complication happened. Group II: The VA > or = 0.1 in 16 eyes(88.9%), > or = 0.3 in nine eyes (50%), and one eye with hemmorhage choroid detachment in the operation and three eyes with retina tear after the operation.

CONCLUSION

Continuous curvilinear capsulorhexis of posteror capsular in treating PCO of high myopia with cataract is a safe effective and economic way compared with capsulorectomy combined with anterior segment vitrectomy.