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Jin J, Xia H, Su Y, Qi T, Hong X, Xie Y, Xu J. Correlation Between Postpartum Myometrial Elasticity and Obstetric Complications in Pregnant Women with Gestational Diabetes Mellitus. J Multidiscip Healthc 2023; 16:4139-4147. [PMID: 38143796 PMCID: PMC10749112 DOI: 10.2147/jmdh.s440448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 12/07/2023] [Indexed: 12/26/2023] Open
Abstract
Objective To investigate postpartum myometrial elasticity in pregnant women with gestational diabetes mellitus (GDM) using shear wave elastography (SWE) and analyze the correlation between myometrial SWE values and obstetric complications. Methods Clinical data of women who gave birth at Affiliated Hospital of Yangzhou University from August 2022 to July 2023 were retrospectively analyzed and divided into two groups based on GDM diagnosis: the GDM group and the healthy control group. SWE was used to measure the elasticity values of the anterior and posterior myometrial walls in both groups. Differences in placental attachment position and SWE values at the placental attachment site were compared between the two groups. Spearman correlation analysis was utilized to evaluate the correlation between SWE values and obstetric complications. Results Glycated hemoglobin (HbA1c), homeostasis model assessment of insulin resistance (HOMA-IR), fasting plasma glucose (FPG), 2-hour postprandial glucose (2h PG), triglycerides (TG), and total cholesterol (TC) levels were higher in the GDM group than in the healthy control group (P<0.05). There was a statistically significant difference in placental attachment position between the two groups (P<0.05). In both the GDM (17.52±0.42 vs 25.29±0.74, P=0.001) and control groups (14.06±5.01 vs 22.20±6.34, P=0.001), mean SWE values were significantly lower for anterior versus posterior placental attachment, and mean SWE values were also significantly higher in the GDM versus control group for both anterior (17.52±0.42 vs 14.06±5.01, P=0.001) and posterior placental attachment (25.29±0.74 vs 22.20±6.34, P=0.001). Spearman correlation analysis showed that postpartum hemorrhage (r=0.632, P=0.017), preeclampsia (r=0.818, P=0.014), premature rupture of membranes (r=0.710, P=0.012), placental abruption (r=0.732, P=0.031), and ketoacidosis (r=0.729, P=0.022) were negatively correlated with average myometrial SWE values in the GDM group (P<0.05). Conclusion SWE values at the placental attachment site were higher in GDM patients than in healthy pregnant women, and myometrial elasticity was positively correlated with obstetric complications.
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Affiliation(s)
- Jing Jin
- Department of Ultrasound, Medical Imaging Center, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, 225009, People’s Republic of China
| | - Han Xia
- Department of Ultrasound, Medical Imaging Center, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, 225009, People’s Republic of China
| | - Yanan Su
- Department of Radiology, Baoying County People’s Hospital, Yangzhou, 225800, People’s Republic of China
| | - Tingyue Qi
- Department of Ultrasound, Medical Imaging Center, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, 225009, People’s Republic of China
| | - Xia Hong
- Department of Gynaecology and Obstetrics, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, 225009, People’s Republic of China
| | - Yanyan Xie
- Department of Gynaecology and Obstetrics, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, 225009, People’s Republic of China
| | - Jun Xu
- Department of Ultrasound, Medical Imaging Center, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, 225009, People’s Republic of China
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Bui NT, Kazemi A, Sit AJ, Larson NB, Greenleaf J, Chen JJ, Zhang X. Non-invasive Measurement of the Viscoelasticity of the Optic Nerve and Sclera for Assessing Papilledema: A Pilot Clinical Study. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:2227-2233. [PMID: 37517885 PMCID: PMC10529623 DOI: 10.1016/j.ultrasmedbio.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/06/2023] [Accepted: 07/09/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate our novel ultrasound vibro-elastography (UVE) technique for assessing patients with papilledema by non-invasively measuring shear wave speed (SWS), elasticity and viscosity properties of the optic nerve and sclera. METHODS Shear wave speeds were measured at three frequencies-100, 150 and 200 Hz-on the optic nerve and sclera tissues for assessing patients with papilledema resulting from idiopathic intracranial hypertension (IIH). The method was evaluated in six papilledema patients and six controls on two separate locations for each participant (i.e., optic nerve and posterior sclera). SWSs of the optic nerve and sclera were analyzed by using a 2-D speed map technique within a circular region of interest (ROI) (i.e., the diameter of the ROI was 1.5 mm × 3.0 mm at the optic nerve and sclera, respectively). Elasticity and viscosity were then analyzed using the wave speed dispersion over the three frequencies. RESULTS We measured values of SWS at both locations, optic nerve and sclera, of the right eye and left eye at three different frequencies in IIH patients and controls. The SWS (mean ± standard deviation [m/s]) of the right eye was significantly higher at the sclera in IIH patients compared with controls (i.e., patients vs. controls: 5.91 ± 0.54 vs. 3.86 ± 0.56, p < 0.0001 at 100 Hz), but there was no significant difference at the optic nerve (i.e., patients vs. controls: 3.62 ± 0.39 vs. 3.36 ± 0.35, p = 0.1100 at 100Hz). We observed increased elasticity (kPa) in IIH patients, indicating there are significant differences in elasticity between patients and controls at the optic nerve and sclera (i.e., right eye [patients vs. controls]: 14.42 ± 6.59 vs. 6.5 ± 5.71, p = 0.0065 [optic nerve]; 33.04 ± 10.62 vs. 9.16 ± 7.15, p < 0.0001 [sclera]). Viscosity was also (Pa·s) higher in the sclera and optic nerve of the left eye (i.e., left eye [patient vs. control]: 8.89 ± 4.37 vs. 7.27 ± 5.01, p = 0.3790 (optic nerve); 16.05 ± 10.79 vs. 8.49 ± 6.09, p < 0.0194 [sclera]). CONCLUSION This research illustrates the feasibility of using our UVE system to evaluate stiffness of different tissues in the eye non-invasively. It suggests that the viscoelasticity of the posterior sclera is higher than that of the optic nerve. We found that the posterior sclera is stiffer than the optic nerve in patients with papilledema resulting from IIH, making UVE a potential non-invasive technique for assessing papilledema.
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Affiliation(s)
- Ngoc Thang Bui
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Arash Kazemi
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA
| | - Arthur J Sit
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA
| | | | - James Greenleaf
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - John J Chen
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA; Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Xiaoming Zhang
- Department of Radiology, Mayo Clinic, Rochester, MN, USA; Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA.
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Oxytocin receptor DNA methylation is associated with exogenous oxytocin needs during parturition and postpartum hemorrhage. COMMUNICATIONS MEDICINE 2023; 3:11. [PMID: 36707542 PMCID: PMC9882749 DOI: 10.1038/s43856-023-00244-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 01/12/2023] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The oxytocin receptor gene (OXTR) is regulated, in part, by DNA methylation. This mechanism has implications for uterine contractility during labor and for prevention or treatment of postpartum hemorrhage, an important contributor to global maternal morbidity and mortality. METHODS We measured and compared the level of OXTR DNA methylation between matched blood and uterine myometrium to evaluate blood as an indicator of uterine methylation status using targeted pyrosequencing and sites from the Illumina EPIC Array. Next, we tested for OXTR DNA methylation differences in blood between individuals who experienced a postpartum hemorrhage arising from uterine atony and matched controls following vaginal birth. Bivariate statistical tests, generalized linear modeling and Poisson regression were used in the analyses. RESULTS Here we show a significant positive correlation between blood and uterine DNA methylation levels at several OXTR loci. Females with higher OXTR DNA methylation in blood had required significantly more exogenous oxytocin during parturition. With higher DNA methylation, those who had oxytocin administered during labor had significantly greater relative risk for postpartum hemorrhage (IRR 2.95, 95% CI 1.53-5.71). CONCLUSIONS We provide evidence that epigenetic variability in OXTR is associated with the amount of oxytocin administered during parturition and moderates subsequent postpartum hemorrhage. Methylation can be measured using a peripheral tissue, suggesting potential use in identifying individuals susceptible to postpartum hemorrhage. Future studies are needed to quantify myometrial gene expression in connection with OXTR methylation.
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Wang XL, Lin S, Lyu GR. Advances in the clinical application of ultrasound elastography in uterine imaging. Insights Imaging 2022; 13:141. [PMID: 36057675 PMCID: PMC9440970 DOI: 10.1186/s13244-022-01274-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 07/20/2022] [Indexed: 11/10/2022] Open
Abstract
Changes in tissue stiffness by physiological or pathological factors in tissue structure are identified earlier than their clinical features. Pathological processes such as uterine fibrosis, adenomyosis, endometrial lesions, infertility, and premature birth can manifest as tissue elasticity changes. In clinical settings, elastography techniques based on ultrasonography, optical coherence tomography, and magnetic resonance imaging are widely used for noninvasive measurement of mechanical properties in patients, providing valuable tool and information for diagnosis and treatment. Ultrasound elastography (USE) plays a critical role in obstetrics and gynecology clinical work because of its simplicity, non-invasiveness, and repeatability. This article reviews the recent progress of USE in uterine tumor diagnosis (especially early diagnosis and treatment effect evaluation), prediction of preterm birth, and intrauterine insemination. We believe that USE, especially shear wave elastography, may serve as a potential means to assess tissue stiffness, thereby improving the diagnosis and treatment of adenomyosis, fibroids, endometrial lesions, cervical cancer, and precise management of preterm birth and intrauterine insemination monitoring.
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Affiliation(s)
- Xia-Li Wang
- Department of Ultrasound, The Second Affiliated Hospital of Fujian Medical University, No. 34 North Zhongshan Road, Quanzhou, 362000, Fujian Province, China.,Department of Clinical Medicine, Quanzhou Medical College, Quanzhou, 362000, Fujian Province, China
| | - Shu Lin
- Department of Ultrasound, The Second Affiliated Hospital of Fujian Medical University, No. 34 North Zhongshan Road, Quanzhou, 362000, Fujian Province, China. .,Centre of Neurological and Metabolic Research, The Second Affiliated Hospital of Fujian Medical University, No. 34 North Zhongshan Road, Quanzhou, 362000, Fujian Province, China. .,Diabetes and Metabolism Division, Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst, Sydney, NSW, 2010, Australia.
| | - Guo-Rong Lyu
- Department of Ultrasound, The Second Affiliated Hospital of Fujian Medical University, No. 34 North Zhongshan Road, Quanzhou, 362000, Fujian Province, China. .,Department of Clinical Medicine, Quanzhou Medical College, Quanzhou, 362000, Fujian Province, China.
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