High-Pressure Inactivation of Bacillus cereus in Human Breast Milk

Although Holder pasteurization is the recommended method for processing breast milk, it does affect some of its nutritional and biological properties and is ineffective at inactivating spores. The aim of this study was to find and validate an alternative methodology for processing breast milk to increase its availability for newborn babies and reduce the financial loss associated with discarding milk that has become microbiologically positive. We prepared two series of breast milk samples inoculated with the Bacillus cereus (B. cereus) strain to verify the effectiveness of two high-pressure treatments: (1) 350 MPa/5 min/38 °C in four cycles and (2) cumulative pressure of 350 MPa/20 min/38 °C. We found that the use of pressure in cycles was statistically more effective than cumulative pressure. It reduced the number of spores by three to four orders of magnitude. We verified that the method was reproducible. The routine use of this method could lead to an increased availability of milk for newborn babies, and at the same time, reduce the amount of wasted milk. In addition, high-pressure treatment preserves the nutritional quality of milk.

An alternative approach to validation of liquid chromatography-mass spectrometry methods for the quantification of endogenous compounds

Despite the progress in the quantification of xenobiotics, the development and validation of methods designed for endogenous substances still remain challenging due to the natural presence of the analytes in a biological matrix, leading to the inability to obtain a blank sample. Several generally recognized procedures are described to solve this issue, like using surrogate or analyte-depleted matrices or surrogate analytes. However, the workflows used do not always meet the requirements for developing a reliable analytical method or are cost-intensive. This study aimed to design an alternative approach for preparing validation reference samples using authentic analytical standards while preserving the nature of the biological matrix and solving the problem with the inherent presence of analyzed compounds in a studied matrix. The methodology used is based on the standard-addition type procedure. However, unlike the original method, the addition is modified according to a previously measured basal concentration of monitored substances in the pooled biological sample to obtain a predefined concentration in reference samples according to the European Medicines Agency (EMA) validation guideline. The study shows the advantages of described approach on an example of LC-MS/MS analysis of 15 bile acids in human plasma and compares it with other methods commonly used in this field. The method was successfully validated according to the EMA guideline with lower limit of quantification of 5 nmol/L and linearity in the range of 5 - 2000 nmol/L. Finally, the method was used in a metabolomic study on a cohort of pregnant women (n = 28) to confirm intrahepatic cholestasis, the major liver disease observed in pregnancy.

Quantitative Risk Assessment of Bacillus cereus Growth during the Warming of Thawed Pasteurized Human Banked Milk Using a Predictive Mathematical Model

Bacillus cereus is relatively resistant to pasteurization. We assessed the risk of B. cereus growth during warming and subsequent storage of pasteurized banked milk (PBM) in the warmed state using a predictive mathematical model. Holder pasteurization followed by storage below −18 °C was used. Temperature maps, water activity values, and B. cereus growth in artificially inoculated PBM were obtained during a simulation of manipulation of PBM after its release from a Human Milk Bank. As a real risk level, we chose a B. cereus concentration of 100 CFU/mL; the risk was assessed for three cases: 1. For an immediate post-pasteurization B. cereus concentration below 1 CFU/mL (level of detection); 2. For a B. cereus concentration of 10 CFU/mL, which is allowed in some countries; 3. For a B. cereus concentration of 50 CFU/mL, which is approved for milk formulas. In the first and second cases, no risk was detected after 1 h of storage in the warmed state, while after 2 h of storage, B. cereus concentrations of 102 CFU/mL were occasionally encountered. In the third case, exceeding the B. cereus concentration of 102 CFU/mL could be regularly expected after 2 h of storage. Based on these results, we recommend that post-pasteurization bacteriological analysis be performed as recommended by the European Milk Bank Association (EMBA) and using warmed PBM within 1 h after warming (no exceptions).

Comparison of opinions of Slovak and Czech female medical students on HPV vaccination

OBJECTIVES

This study aims to identify the differences in the use of HPV vaccination between female medical students in the Czech and Slovak Republics and their possible causes.

METHODS

We performed a cross-sectional survey among female students of general medicine in all faculties of medicine in the Czech and Slovak Republics.

RESULTS

We obtained 630 questionnaires from the Czech Republic and 776 questionnaires from the Slovak Republic. In the Czech Republic, 65.4% of female medical students underwent HPV vaccination, while in the Slovak Republic, the figure was 21.1%. In the Czech Republic, residency and religion of students did not influence their rate of vaccination. However, in the Slovak Republic, village residency with less than 5,000 inhabitants lowered the probability of vaccination with OR = 0.56 (95% CI: 0.38-0.84), and the Catholic religion lowered the probability of vaccination with OR = 0.40 (95% CI: 0.28-0.57). Czech students were informed about the possibility of vaccination by a paediatrician in 55.7% of cases, while the figure for Slovak students was 26.8%. In the Czech Republic, 75.7% of students participated in regular cervical oncologic screening, while in the Slovak Republic, the figure was 57.7%. Vaccination of relatives would be recommended by 86.5% and 80.5% of Czech and Slovak students, respectively.

CONCLUSIONS

The adoption of an oncologic prevention programme and the more extensive propagation by paediatricians are probably the medical reasons for the higher HPV vaccination among Czech students. Demographic factors - village residency and religion - are also important.

Mid-trimester amniotic fluid proteome's association with spontaneous preterm delivery and gestational duration

BACKGROUND

Amniotic fluid is clinically accessible via amniocentesis and its protein composition may correspond to birth timing. Early changes in the amniotic fluid proteome could therefore be associated with the subsequent development of spontaneous preterm delivery.

OBJECTIVE

The main objective of this study was to perform unbiased proteomics analysis of the association between mid-trimester amniotic fluid proteome and spontaneous preterm delivery and gestational duration, respectively. A secondary objective was to validate and replicate the findings by enzyme-linked immunosorbent assay using a second independent cohort.

METHODS

Women undergoing a mid-trimester genetic amniocentesis at Sahlgrenska University Hospital/Östra between September 2008 and September 2011 were enrolled in this study, designed in three analytical stages; 1) an unbiased proteomic discovery phase using LC-MS analysis of 22 women with subsequent spontaneous preterm delivery (cases) and 37 women who delivered at term (controls), 2) a validation phase of proteins of interest identified in stage 1, and 3) a replication phase of the proteins that passed validation using a second independent cohort consisting of 20 cases and 40 matched controls.

RESULTS

Nine proteins were nominally significantly associated with both spontaneous preterm delivery and gestational duration, after adjustment for gestational age at sampling, but none of the proteins were significant after correction for multiple testing. Several of these proteins have previously been described as being associated with spontaneous PTD etiology and six of them were thus validated using enzyme linked immunosorbent assay. Two of the proteins passed validation; Neutrophil gelatinase-associated lipocalin and plasminogen activator inhibitor 1, but the results could not be replicated in a second cohort.

CONCLUSIONS

Neutrophil gelatinase-associated lipocalin and Plasminogen activator inhibitor 1 are potential biomarkers of spontaneous preterm delivery and gestational duration but the findings could not be replicated. The negative findings are supported by the fact that none of the nine proteins from the exploratory phase were significant after correction for multiple testing.

Cesarean scar defect - manifestation, diagnostics, treatment

OBJECTIVE

To summarize current knowledge concerning cesarean scar defects and its manifestation, diagnostics and treatment possibilities.

DESIGN

Review.

SETTING

Department of Obstetrics and Gynecology, University Hospital Hradec Kralove.

METHODOLOGY

Research from available literature works and studies regarding facts about cesarean scar defects.

CONCLUSION

Cesarean scar defect is one of known complication after cesarean section which has become more common in consequence of rising cesarean delivery rate. It is associated with sundry gynecological and obstetric difficulties like abnormal uterine bleeding, pelvic pain, infertility, cesarean scar defect pregnancy or uterine rupture. The most common diagnostic way is using transvaginal ultrasound, sonohysterography or hysteroscopy. Treatment choice is due to a size of cesarean scar defect and also pregnancy planning. Alternatives of treatment including hormonal contraception and various surgery such as hysteroscopy, laparoscopy, laparotomy and transvaginal procedures.

Lactobacillus crispatus dominant vaginal microbita in pregnancy

OBJECTIVE

To summarize current knowledge regarding Lactobacillus crispatus-dominated vaginal microbiota in pregnancy, as well as an association between the presence of Lactobacillus crispatus-dominated vaginal microbiota and pregnancy complications.

DESIGN

Review.

SETTING

Department of Obstetrics and Gynecology, University Hospital Hradec Kralove.

MATERIAL AND METHODOLOGY

In this review, the results from literature available about the presence of L. crispatus-dominated microbiota in pregnancy are summarized.

RESULTS

Pregnant women with Lactobacillus crispatus-dominated vaginal microbiota is very common in pregnancy and it is associated with a lower risk of preterm delivery.

CONCLUSION

Lactobacillus crispatus-dominated vaginal microbiota represents an optimal vaginal microbiota in pregnancy.

Lactobacillus iners-dominated vaginal microbiota in pregnancy

OBJECTIVE

To summarize current knowledge regarding Lactobacillus iners-dominated vaginal microbiota in pregnancy, as well as an association between the presence of Lactobacillus iners and pregnancy complications Type of study: Review.

SETTING

Department of Obstetrics and Gynecology, University Hospital Hradec Kralove, Charles University, Faculty of Medicine in Hradec Kralove.

METHODS AND RESULTS

In this review, the results from literature available about the presence of L. iners-dominated microbiota in pregnancy and the association between the presence of L. iners-dominated microbiota and abortion, spontaneous preterm delivery with intact membranes, and preterm prelabor rupture of membranes are summarized.

CONCLUSION

L. iners-dominated vaginal microbiota appears to be associated with an increased risk of the development of specific pregnancies pathologies.

Change of tear osmolarity after refractive surgery

  Purpose: To compare the influence of the LASIK and ReLEx SMILE refractive method on tear osmolarity Methods: Prospective non-randomized comparative study. We evaluated the results in two groups of patients who underwent binocular refractive surgery to remove myopia and possibly astigmatism in the eye clinic of Horní Počernice. In each group were 15 patients (30 eyes), patients of one group undergoing FS-LASIK refractive surgery, in the second group a ReLEx SMILE procedure. Bilateral measurement of the tear film osmolarity using the TearLab instrument on the day of surgery, the first day after surgery, one month and 3 months after surgery was performed on each patient. Results: The mean preoperative value of the osmolarity of the tear film was practically the same in both groups, in the ReLEx SMILE group 294.9 ± 13.4 mOsm/l and in the FS-LASIK group 296.4 ± 13.1. One and three months after the surgery in the ReLEx SMILE group, these values increased to 301.4 and 296.4 ± 13.3 mOsm/l respectively, the elevation of values one month after surgery was statistically significant. In the FS-LASIK group, one month after surgery, the osmolarity was 320.1 ± 14.7, three months postoperatively 306.5 ± 13.1 mOsm / l. Both of these values compared to the preoperative value were statistically significantly higher. The increase of the mean osmolarity was statistically significantly higher in the FS-LASIK group compared to the ReLEx SMILE. Three months after surgery, the difference between groups was not statistically significant. Conclusion: In our group of patients, after the FS-LASIK refraction procedure, we noted a higher mean osmolarity of tear film in comparison with patients after the ReLEx SMILE in all evaluated timepoints (1 day, 1 month and 3 months after surgery). We consider ReLEx SMILE as a method with less impact on the quality of tear film, with a faster return to original osmolarity and potentially higher patient comfort. Key words: Tear osmolarity, Relex SMILE, FS-LASIK.

[Vein of Galen aneurysmal malformation]

OBJECTIVE

A case report of the pregnancy complicated by the presence of vein of Galen aneurysmal malformation in fetus.

DESIGN

The case report.

SETTING

Department of Obstetrics and Gynaecology, Masaryks Hospital, Jilemnice; Obstetrics and Gynecology Clinic, University Hospital in Hradec Králové.

CASE REPORT

The description of the pregnancy complicated by the presence of vein of Galen aneurysmal malformation in a fetus 32 weeks gestation which led to a progressive heart failure and the development of the hydrocephalus.

CONCLUSION

The vein of Galen aneurysmal malformation is a rare cerebrovascular malformation of the fetus, the diagnosis of this malformation is usually detectable during prenatal ultrasound examination possibly also by magnetic resonance imaging.

Redefining 3Dimensional placental membrane microarchitecture using multiphoton microscopy and optical clearing

INTRODUCTION

Remodeling of human placental membranes (amniochorionic or fetalmembrane) throughout gestation, a necessity to accommodate increasing uterine volume, involves continuous alterations (replacement of cells and remodeling of extracellular matrix). Methodologic limitations have obscured microscopic determination of cellular and layer-level alterations. This study used a combination of advanced imaging by multiphoton autofluorescence microscopy (MPAM) and second harmonic generation (SHG) microscopy along with tissue optical clearing to characterize the 3Dimensional multilayer organization of placental membranes.

METHODS

Placental membranes biopsies (6 mm) collected from term, not-in-labor cesarean deliveries (n = 7) were fixed in 10% formalin (native) or treated with 2,2'-thiodiethanol to render them transparent for deeper imaging. Native and cleared tissues were imaged using MPAM (cellular autofluorescence) and SHG (fibrillar collagen). Depth z-stacks captured the amnion epithelium, underlying matrix layers, and in the cleared biopsies, the decidua layer.

RESULTS

MPAM and SHG revealed fetal membrane epithelial topography and collagen organization in multiple matrix layers. Term amnion layers showed epithelial shedding and gaps. Optical clearing provided full-depth imaging with improved visualization of collagen structure, mesenchymal cells in extracellular matrix layers, and decidua morphology. Layer thicknesses measured by imaging corroborated with histology. Mosaic tiling of MPAM/SHG image stacks allowed large area visualization of entire biopsies.

CONCLUSION

MPAM-SHG microscopy allowed for study of this multi-layered tissue and revealed shedding, gap formation, and other structural changes. This approach could be used to study structural changes associated with membranes as well as other uterine tissues to better understand events in normal and abnormal parturition.

[Ultrasound diagnosis of fetal inflammatory response syndrome in women with preterm premature rupture of membrane]

OBJECTIVE

The aim of this review is to analyze the existing possibilities of using ultrasound in the diagnosis of the fetal inflammatory response.

DESIGN

Review.

SETTINGS

Gynekologicko-porodnická klinika, Fakultní nemocnice Ostrava.

METHODS

Preterm delivery is defined as a delivery before completed 37 weeks of gestation. Approximately one-thirdof these cases is associated with preterm premature rupture of membranes. About forty percent of preterm premature rupture of membranes is complicated by the fetal inflammatory response syndrome, which is associated with the development of severe perinatal morbidity. Recent prenatal diagnosis of the fetal inflammatory response syndrome is based on the invasive methods (amniocentesis, cordocentesis), which are limited by several risk factors accompanying these procedures and technical difficulties. Therefore, there is an effort to replace them by non-invasive approach. The development of ultrasound, as a diagnostic method through the last decade, and knowledge of pathophysiological and morphological changes in fetal organs associated with the fetal inflammatory response may lead to more specific diagnosis in the future and improvement of neonatal outcome.

CONCLUSION

Early identification of fetuses affected by FIRS in pregnancies with PPROM is necessary for right management of these pregnancy pathology. At this moment, ultrasonography examination of fetal lineal vein and fetal echocardiography, seems to be suitable for diagnosing FIRS.

Preterm Premature Rupture of the Membranes and Genital Mycoplasmas

Objective: The purpose of this study was to evaluate the prevalence of cervical colonization by genital mycoplasmas in patients with preterm premature rupture of the membranes (PPROM). Method: We studied 225 women between 24 and 36 weeks of gestation with PPROM. Cervical swabs were obtained for genital mycoplasmas and standard vaginal smears of bacterial culture were performed at the time of patients’ admission. In the control group were 225 women with a normal pregnancy. Results: Ureaplasma urealyticum was detected in 68 % (152/225) and Mycoplasma hominis was detected in 28 % (63/225) of the patients with PPROM between 24 and 36 weeks of gestation and. In the control group Ureaplasma urealyticum was found in 17 % (38/225) and Mycoplasma hominis in 15 % (35/225) pregnant women. Conclusion: Our results provide evidence of an association between cervical colonization with genital mycoplasmas and preterm premature rupture of the membranes.

Oxidative stress damage-associated molecular signaling pathways differentiate spontaneous preterm birth and preterm premature rupture of the membranes

STUDY HYPOTHESIS

In women with preterm premature rupture of the membranes (PPROM), increased oxidative stress may accelerate premature cellular senescence, senescence-associated inflammation and proteolysis, which may predispose them to rupture.

STUDY FINDING

We demonstrate mechanistic differences between preterm birth (PTB) and PPROM by revealing differences in fetal membrane redox status, oxidative stress-induced damage, distinct signaling pathways and senescence activation.

WHAT IS KNOWN ALREADY

Oxidative stress-associated fetal membrane damage and cell cycle arrest determine adverse pregnancy outcomes, such as spontaneous PTB and PPROM.

STUDY DESIGN, SAMPLES/MATERIALS, METHODS

Fetal membranes and amniotic fluid samples were collected from women with PTB and PPROM. Molecular, biochemical and histologic markers were used to document differences in oxidative stress and antioxidant enzyme status, DNA damage, secondary signaling activation by Ras-GTPase and mitogen-activated protein kinases, and activation of senescence between membranes from the two groups.

MAIN RESULTS AND THE ROLE OF CHANCE

Oxidative stress was higher and antioxidant enzymes were lower in PPROM compared with PTB. PTB membranes had minimal DNA damage and showed activation of Ras-GTPase and ERK/JNK signaling pathway with minimal signs of senescence. PPROM had higher numbers of cells with DNA damage, prosenescence stress kinase (p38 MAPK) activation and signs of senescence.

LIMITATIONS, REASONS FOR CAUTION

Samples were obtained retrospectively after delivery. The markers of senescence that we tested are specific but are not sufficient to confirm senescence as the pathology in PPROM.

WIDER IMPLICATIONS OF THE FINDINGS

Oxidative stress-induced DNA damage and senescence are characteristics of fetal membranes from PPROM, compared with PTB with intact membranes. PTB and PPROM arise from distinct pathophysiologic pathways. Oxidative stress and oxidative stress-induced cellular damages are likely determinants of the mechanistic signaling pathways and phenotypic outcome.

STUDY FUNDING AND COMPETING INTERESTS

This study is supported by developmental funds to Dr R. Menon from the Department of Obstetrics and Gynecology at The University of Texas Medical Branch at Galveston and funds to Dr M. Kacerovský from the Ministry of Health Czech Republic (UHHK, 001799906). The authors report no conflict of interest.

[Nonculture techniques of microorganisms determination in amniotic fluid in patients with preterm prelabor rupture of membranes]

OBJECTIVE

The preterm prelabor rupture of membranes is a serious obstetric complication that is frequently complicated by the presence of microorganisms in amniotic fluid. The aim of our work is to characterize current status of nonculture detection of microbial invasion into the amniotic cavity and the experience with the technique performed in University Hospital in Hradec Kralove.

DESIGN

Original survey article.

SETTING

Institute of Clinical Biochemistry and Diagnostics - molecular biology department, University Hospital Hradec Kralove.

CONCLUSION

Application of nonculture techniques of microorganisms determination in amniotic fluid in patients with preterm prelabor rupture of membranes is currently available. According to the detection of genital mycoplasmas as the dominant pathogens in the amniotic fluid this technique should be regarded as the standard examination method in these patients.

Prevalence of Mycoplasma hominis and Ureaplasma urealyticum in women undergoing an initial infertility evaluation

AIMS

Mycoplasma hominis and Ureaplasma urealyticum are potentially pathogenic bacterial species that are frequently isolated from the urogenital tract of women. These pathogens could be responsible for various genitourinary diseases and have been associated with adverse pregnancy outcomes and female fertility problems. The aim of this study was to analyse the presence of M. hominis and U. urealyticum in the cervical canal of uterus of women with and without fertility problems.

METHODS

Endocervical swabs obtained from women with reproductive problems and fertile women were tested by both cultivation and polymerase chain reaction. The antimicrobial susceptibility to the azithromycin, ciprofloxacin, doxycycline and erythromycine of the isolated strains of M. hominis and U. urealyticum was also tested by the microdilution broth method.

RESULTS

A total of 111 women with fertile problems were examined. U. urealyticum was detected in samples from 44 (39.6%) women. M. hominis was detected in significantly fewer samples, i.e. only from 9 (8.1%) samples. From these, 6 (5.4%) women were positive for both microorganisms. The fertile group consisted from 23 women. The presence of U. urealyticum was detected in 8 (34.7%) of them. M. hominis was detected only in the mixture with U. urealyticum in 3 (13.0%) cases. The most effective antibiotic against both species in our study was doxycycline.

CONCLUSION

The results show slightly higher incidence of M. hominis and U. urealyticum in the genitourinary tract of women with fertility problems compare with control group. The potential negative effect of these species on the reproduction ability of women was not observed.

[Cesarean scar ectopic pregnancy]

OBJECTIVE

To summarize current knowledge about cesarean scar pregnancy and to provide a review about available managements of this serious pregnancy pathology.

DESIGN

Review article.

SETTING

Department of Gynecology and Obstetrics, District Hospital Náchod.

RESULTS

Cesarean scar pregnancy is likely to be a result of impaired healing of the scar along with an increased affinity of trophoblast cells to extracellular matrix. A transvaginal ultrasonography represents a key tool in the cesarean scar pregnancy identification. The main goal of the cesarean scar pregnancy treatment is to preserve fertility. There are different approaches how to manage this pregnancy complication. A surgical treatment is characterized by an exstirpation of ectopic pregnancy. This approach makes a repair of lower uterine segment possible and it may improve a prognosis for subsequent pregnancy. However, the most common management is a conservative treatment with a methotrexate administration. Recently, an innovative mini-invasive treatment with a Foley catheter has been reported. A regular evaluation of βhCG concentrations and a transvaginal ultrasound examination are used for a follow-up. Subsequent pregnancy is possible, yet it should be considered as a high-risk.

CONCLUSION

Despite the fact the frequency of cesarean scar pregnancy increases, cesarean scar pregnancy still represents a rare but serious pregnancy pathology. In case of an early diagnosis, it should be managed with respect to preserve fertility.

Agreement on intrapartum cardiotocogram recordings between expert obstetricians

RATIONALE, AIMS AND OBJECTIVES

To evaluate obstetricians' inter- and intra-observer agreement on intrapartum cardiotocogram (CTG) recordings and to examine obstetricians' evaluations with respect to umbilical artery pH and base deficit.

METHODS

Nine experienced obstetricians annotated 634 intrapartum CTG recordings. The evaluation of each recording was divided into four steps: evaluation of two 30-minute windows in the first stage of labour, evaluation of one window in the second stage of labour and labour outcome prediction. The complete set of evaluations used for this experiment is available online. The inter- and intra-observer agreement was evaluated using proportion of agreement and kappa coefficient. Clinicians' sensitivity and specificity was computed with respect to umbilical artery pH, base deficit and to Apgar score at the fifth minute.

RESULTS

The overall proportion of agreement between clinicians reached 48% with 95% confidence intervals (CI) (CI: 47-50). Regarding the different classes, proportion of agreement ranged from 57% (CI: 54-60) for normal to 41% (CI: 36-46) for pathological class. The sensitivity of clinicians' majority vote to objective outcome was 39% (CI: 16-63) for the umbilical artery base deficit and 27% (CI: 16-42) for pH. The specificity was 89% (CI: 86-92) for both types of objective outcome.

CONCLUSIONS

The reported inter-/intra-observer variability is large and this holds irrespective of clinicians' experience or work place. The results support the need of modernized guidelines for CTG evaluation and/or objectivization and repeatability by introduction of a computerized approach that could standardize the process of CTG evaluation within the delivery ward.

Markers of endothelial activation in preeclampsia

BACKGROUND

The study aimed at finding a laboratory approach to detect endothelial damage in normal pregnancy as well as in pregnancy complicated by preeclampsia using selected markers of endothelial activation.

MATERIALS

A total of 403 healthy pregnant women without a history of deep vein thrombosis and/or hypertension were prospectively studied. From all women, venous blood was collected before the end of the 1st trimester, between weeks 24 and 28 of gestation, and in the 3rd trimester (weeks 34-36). Assays of tissue plasminogen activator, plasminogen activator inhibitor-1, von Willebrand factor activity and antigen, thrombomodulin, endothelial protein C receptor, and endothelial microparticles activated by TF were performed.

RESULTS

When comparing women who developed preeclampsia during pregnancy (the average levels were 23.41 μg/L, 34.33 μg/L, and 53.56 μg/L in the 1st, 2nd, and 3rd trimesters, respectively) with healthy pregnant women (the average levels were 19.05 μg/L, 28.47 μg/L, and 39.86 μg/L in the 1st, 2nd, and 3rd trimesters, respectively) significant differences in the levels of thrombomodulin were found in all three trimesters. By contrast, no statistically significant differences in the levels of vWF (both antigen and activity), t-PA, EPCR, EMPs, MMP-2, MMP-9, and TIMP-9 were found in any trimesters in the same group.

CONCLUSIONS

Pregnancy and preeclampsia strongly influence the levels of studied markers. The findings of this work confirm the possible predictive potential of thrombomodulin and PA-1.

[Vacuum-assisted vaginal delivery does not significantly contribute to the higher incidence of levator ani avulsion]

OBJECTIVE

To draw a comparison between spontaneous vaginal delivery and vacuum-assisted vaginal delivery in relation to the incidence and the type of levator ani avulsion in primiparas.

DESIGN

Retrospective observational study. SETTIMG: Department of Obstetrics and Gynaecology, University Hospital of Ostrava.

METHODOLOGY

In the study, the primiparas who were from 6 to 12 months after spontaneous vaginal delivery (group A, n = 52) or after childbirth with vacuum extraction (group B, n = 51) underwent translabial 3D ultrasound. The obstetric data had been obtained from the hospital database. Translabial 3D ultrasound examination were performed by two sonographists. The monitored parameter was the distance between urethra and fibres of musculus levator ani - levator urethra gap [6]. The distance longer than 25 mm was considered an avulsion injury [6, 22]. Other parameters assessed in relation to the avulsion were: women's age, BMI, epidural analgesia, episiotomy performance, the length of the first and the second stages of labour, and fetal weight.

RESULTS

Musculus levator ani avulsion was diagnosed in 10 women - unilateral in 8 cases and bilateral in 2 cases. In group A, women after spontaneous birth, we noticed avulsion injury in 7.7% of cases, whereas in group B, women after vacuum extraction, we recorded avulsion injury in 11.8% of cases. Thus the use of vacuum extraction is not statistically significant risk factor for avulsion musculus levator ani. Statistically significant difference in comparison group A and B was recorded in BMI, the length of the second stages of labour and episiotomy performance.

CONCLUSION

We did not prove a statistically significant connection between avulsion injury and delivery with the use of vacuum extraction in comparison to avulsion injury incidence in uncomplicated vaginal delivery group (tab. 1). Vacuum extraction does not appear as a risk factor for avulsion in contrast to forceps delivery.

[Practical comments on examination of placenta in the second and third trimester of gravidity]

The authors present a short summary of placental pathology for the general pathologist. Practical tips for macroscopic examination of formalin-fixed material are listed and several cases are presented for illustration of the theoretical text.

[Management of preterm prelabor rupture of membranes with respect to the inflammatory complications - our experiences]

OBJECTIVE

Preterm prelabor rupture of membranes is responsible for approximately one third of all preterm deliveries. The most common complications associated with this pregnancy pathology are microbial invasion of the amniotic cavity, intraamniotic inflammation, intraamniotic infection and histological chorioamnionitis. This article explains these complicatioss and their relation to the optimal management of preterm prelabor rupture of membranes.

DESIGN

Overview study.

SETTING

Department of Obstetrics and Gynecology, Charles University in Prague, Faculty of Medicine and University Hospital Hradec Kralove.

METHODS

To analyze current knowledge and our own experiences regarding inflammatory complications of preterm prelabor rupture of membranes.

CONCLUSION

Inflammatory complications of preterm prelabor rupture of membranes are associated with risk of development of early onset sepsis. Nevertheless, gestational age is a main confounder affecting neonatal morbidity and mortality.

[Development of number of endothelial cells after cataract surgery performed by femtolaser in comparison to conventional phacoemulsification]

PURPOSE

Compare the effect of cataract surgery with conventional phacoemulsification and cataract surgery performed on the cornea assisted by femtolaser with the help of contactless endothelial microscope. THE GROUP OF PATIENTS AND METHODS: In each group there were 25 eyes (25 patients) after the cataract surgery with conventional phacoemulsification and 25 eyes (25 patients) after cataract surgery performed on the cornea assisted by femtolaser with the help of contactless endothelial microscope. The number of endothelial cells was measured preoperatively, 1 day, 1 week and 1 month after the surgery.

RESULTS

We compared the loss of endothelial cells during 3 various periods. The first day after the surgery we noticed an average decrease in number of endothelial cells by 1, 1% in the group with femtosecond laser, in the group with conventional phacoemulsification we noticed an average decrease of 3, 8 %. The first week after the surgery we noticed an average decrease in number of endothelial cells by 4, 5 % in the group with femtosecond laser, in the group with conventional phacoemulsification we noticed on average decrease of 6, 2 %. One month after surgery we noticed on average decrease in number of endothelial cells by 5, 1 % in the group with femtosecond laser, in the group with conventional phacoemulsification we noticed on average decrease of 9, 3 %. The difference between the average values in both groups was not at any point statistically significant (indication of statistically significance was value of P < 0. 05).

CONCLUSION

Cataract surgery performed on the cornea assisted by femtolaser reduces trauma of the cornea and it reduces the lost of endothelial cells in comparison to conventional phacoemulsification.

[Umbilical cord blood soluble Toll-like receptor 2 in pregnancies complicated by preterm premature rupture of membranes]

OBJECTIVE

To determine whether umbilical cord blood concentrations of soluble Toll-like receptor (sTLR2) is of value in the diagnosis of histological chorioamnionitis (HCA) and funisitis in pregnancies complicated by preterm premature rupture of membranes.

DESIGN

Retrospective study.

SETTING

Charles University in Prague, Faculty of Medicine and University Hospital, Hradec Kralove, Department of Clinical Immunology and Allergy, Department of Obstetric and Gynecology.

METHODS

Eighty six women with PPROM between gestation ages 24 and 36 weeks were included in the study. The samples of the umbilical cord blood were taken from the clamped umbilical cord immediately after delivery of the newborn. The placenta, fetal membranes and umbilical cord were evaluated for the presence of inflammatory changes. The concentrations of sTLR2 in the umbilical cord blood were measured by ELISA method.

RESULTS

Women with HCA did not have different umbilical cord blood sTLR2 levels than women without HCA (with HCA: median 7.6 ng/mL, interquartile range [IQR] 5.1 - 12.3 vs. without HCA: median 8.0 ng/mL, IQR 6.0 - 9.4; p = 0.79). No differences between women with and without funisitis were found (median 7.2 ng/mL, IQR 5.5 - 22.3 vs. without funisitis: median 7.9 ng/mL, IQR 5.2 - 10.5; p = 0.31).

CONCLUSION

Umbilical cord blood sTRL2 levels are not affected by the presence of either HCA or funisitis in pregnancies complicated with PPROM.

Organic cation transporter 3 (OCT3/SLC22A3) and multidrug and toxin extrusion 1 (MATE1/SLC47A1) transporter in the placenta and fetal tissues: expression profile and fetus protective role at different stages of gestation

In our previous study, we described synchronized activity of organic cation transporter 3 (OCT3/SLC22A3) and multidrug and toxin extrusion 1 (MATE1/SLC47A1) transporter in the passage of organic cations across the rat placenta and the role of these transporters in fetal defense; in this study, we hypothesized that changes in placental levels of OCT3 and MATE1 throughout gestation might affect the fetal protection and detoxification. Using quantitative RT-PCR, Western blot analysis, and immunohistochemistry, we were able to detect Oct3/OCT3 and Mate1/MATE1 expression in the rat placenta as early as on Gestation Day (gd) 12 with increasing tendency toward the end of pregnancy. Comparing first versus third trimester human placenta, we observed stable expression of OCT1 and decreasing expression of OCT2 and OCT3 isoforms. Contrary to the current literature, we were able to detect also MATE1/MATE2 isoforms in the human placenta, however, with considerable inter- and intraindividual variability. Using infusion of 1-methyl-4-phenylpyridinium (MPP(+)), a substrate of OCT and MATE transporters, into pregnant dams, we investigated the protective function of the placenta against organic cations at different gds. The highest amount of MPP(+) reached the fetus on gd 12 while from gd 15 onward, maternal-to-fetal transport of MPP(+) decreased significantly. We conclude that increased expression of placental OCT3 and MATE1 along with general maturation of the placental tissues results in significantly lower transport of MPP(+) from mother to fetus. In contrast, decreasing expression of OCT3 and MATE1 in human placenta indicates these transporters may play a role in fetal protection preferentially at earlier stages of gestation.

[Proteomics and biomarkers for detection of preterm labor: a systematic review]

OBJECTIVE

To review the published articles about identification of biomarkers of spontaneous preterm birth using a proteomic approach and to create a list of potential biomarkers.

DESIGN

Systematic review of literature.

SETTING

Department of Obstetrics and Gynecology, Medical Faculty Charles University Hradec Kralove.

METHODS

The following databases were accessed in search of relevant citation: MEDLINE, SCOPUS and PubMed. Totally 101 references were identified and relevant 37 abstracts were screened. As appropriated were pointed 16 studies. Finally, the data were extracted from five articles.

CONCLUSION

The implementation of high-throughput technologies is necessary in the field of spontaneous preterm birth research. A compelling option is the use of proteomics in the area spontaneous preterm birth biomarkers identification in amniotic fluid, maternal serum/plasma, cervical-vaginal fluid and placental tissue. The data was extracted from published articles and a list of 72 proteins was created.

[Aquaporins and the regulation of amniotic fluid circulation]

OBJECTIVE

The purpose of this study was to focuse on aquaporins and their role in the regulation of amniotic fluid circulation.

DESIGN

Review.

SETTING

Department of Obstetrics and Gynecology Medical Faculty Charles University Hradec Kralove.

METHODS

The summary about aquaporins which were first described as channels increased permeability of lipid membranes to water in response to osmotic and/or hydrostatic gradients.

CONCLUSION

The present review summarizes the results of clinical and experimental research on aquaporins and the regulation of amniotic fluid circulation.

[Amniotic fluid interleukin 6 levels in preterm premature rupture of membranes]

OBJECTIVE

The purpose of this study was to determinate the changes of amniotic fluid interleukin 6 (IL-6) concentrations in patients with preterm premature rupture of the membranes (PPROM), and in the presence of microbial invasion of the amniotic cavity (MIAC) and histological chorioamnionitis (HCA). The aim was to examine amniotic fluid IL-6 in relation to MIAC and HCA.

DESIGN

Prospective study.

SETTING

Department of Obstetrics and Gynecology Medical Faculty Charles University Hradec Králové.

METHODS

We studied 37 women between 24 and 36 weeks of gestation with PPROM. Samples of amniotic fluid were collected by transabdominal amniocentesis. Polymerase chain reaction for the genital mycoplasmas and culture for aerobic and anaerobic bacteria were performed. Twenty-eight of 37 patients placentas were collected and assessed for presence or absence HCA. IL-6 concentration in amniotic fluid were determined using a sensitive and specific diagnostic kit Human IL-6 Quantikine ELISA manufactured R&D Systems, USA.

RESULTS

There was significant difference in the median amniotic fluid IL-6 concentration between patients with preterm rupture of the membranes with and without MIAC and HCA (patients with MIAC and HCA: median 915 pg/ml, range 651-1854 pg/ml vs. patients without MIAC and HCA: median 780 pg/ml, range 184-1059 pg/ml; p=0.047). There was no significant difference in the median amniotic fluid IL-6 concentration between patients with preterm rupture of the membranes with and without MIAC (patients with MIAC: median 915 pg/ml, range 195-1854 pg/ml vs. patients without MIAC: median 792 pg/ml, range 184-1993 pg/ml; p=0.53). There was no significant difference in the median amniotic fluid IL-6 concentration between patients with preterm rupture of the membranes with and without HCA (patients with HCA: median 829 pg/ml, range 195-1992 pg/ml vs. patients without HCA: median 768 pg/ml, range 184-1890 pg/ml; p = 0.31).

CONCLUSION

Amniotic fluid IL-6 concentrations patients with PPROM with presence HCA and MIAC were significantly higher than IL-6 concentration patients without HCA and MIAC.

Application of proteomics in biomarker discovery: a primer for the clinician

Ever since proteomics was proven to be capable of characterizing a large number of differences in both protein quality and quantity, it has been applied in various areas of biomedicine, ranging from the deciphering molecular pathogenesis of diseases to the characterization of novel drug targets and the discovery of potential diagnostic biomarkers. Indeed, the biomarker discovery in human plasma is clearly one of the areas with enormous potential. However, without proper planning and implementation of specific techniques, the efforts and expectations may very easily be hampered. Numerous earlier projects aimed at clinical proteomics, characterized by exaggerated enthusiasm, often underestimated some principal obstacles of plasma biomarker discovery. Consequently, ambiguous and insignificant results soon led to a more critical view in this field. In this article, we critically review the current state of proteomic approaches for biomarker discovery and validation, in order to provide basic information and guidelines for both clinicians and researchers. These need to be closely considered prior to initiation of a project aimed at plasma biomarker discovery. We also present a short overview of recent applications of clinical proteomics in biomarker discovery.

[Proteomics and biomarkers for detection of cervical cancer]

OBJECTIVE

The purpose of this study was to focus on recent developments in the rapidly evolving field of biomarker discovery and validation techniques using proteomics platform with respect to cervical cancer.

DESIGN

Review.

SETTING

Department of Obstetrics and Gynecology Medical Faculty Charles University Hradec Kralove.

METHODS

The last decade has seen major changes in the technologies used to identify diagnostic markers for early stages of cervical cancer. Significant advances were achieved in three key areas: protein profilling, multidimensional liquid chromatography combined with cutting edge mass spectrometry and high-throughput validation techniques. These new technologies hold significant promise in identifying more robust, sensitive and specific markers for cervical cancer.

CONCLUSION

The present review summarizes the results of clinical and experimental research on biomarkers of cervical cancer.

[Proteomics and biomarkers for detection of endometrial carcinoma]

OBJECTIVE

The purpose of this study was to focuse on recent developments on the evolving field of biomarker discovery and validation techniques using proteomics platforms for endometrial carcinoma.

DESIGN

Review.

SETTING

Department of Obstetrics and Gynecology Medical Faculty Charles University Hradec Kralove.

METHODS

The last decade has seen major changes in the technologies used to identify markers for diagnosing endometrial carcinoma. Currently the major developments were made in proteomics area. This new technology hold significant promise in identifying more robust markers for endometrial carcinoma.

CONCLUSION

The present review summarizes the results of clinical and experimental research on biomarkers of endometrial carcinoma.

[Proteomics and biomarkers for detection of ovarian cancer]

OBJECTIVE

The purpose of this study was to focuse on recent developments on the evolving field of biomarker discovery and validation techniques using proteomics platforms for ovarian cancer.

DESIGN

Review.

SETTING

Department of Obstetrics and Gynecology Medical Faculty Charles University Hradec Kralove. Institute of Molecular Pathology. Faculty of Military Health Sciences, University of Defense, Hradec Kralove.

METHODS

The last decade has seen major changes in the technologies used to identify markers for diagnosing early stages of ovarian cancer. Currently the major developments were made in three distinct areas: protein profilig, highthroughput validation techniques and solid and liquid phase protein microarray platforms for analyzing candidate markers across stages hold significant of ovarian cancer. These new technologies hold significant promise in identifying more robust markers for ovarian cancer.

CONCLUSION

The present review summarizes the results of clinical and experimental research on biomarkers of ovarian cancer.

[Amniotic fluid heat shock protein 70 concentration in preterm premature rupture of membranes]

OBJECTIVE

The purpose of this study was to determinate the changes of amniotic fluid HSP 70 concentrations in patiens with preterm premature rupture of the membranes, and in the presence of intraamniotic infection and histological changes of inflammations.

DESIGN

Prospective study.

SETTING

Department of Obstetrics and Gynecology Medical Faculty Charles University Hradec Králové.

METHODS

We studied 30 women between 24 and 36 weeks of gestation with preterm premature rupture of the membranes. Samples of amniotic fluid were collected by transabdominal amniocentesis. These patients were divided into 2 groups. In group 1 were patiens with intraamniotic infection. In group 2 were patiens without intraamniotic infection. Among 76% (35/30) patients placenta were collected and assessed for presence or absence acute inflammatory lesions. HSP70 concentration in amniotic fluid were determined using a sensitive and specific diagnostic kit Hsp 70- ELISA kit manufactered Assay Desings, USA.

RESULTS

There was no significant difference in the median amniotic fluid HSP70 concentration between patients with preterm rupture of the membranes with IAI and without IAI (patients with IAI: median 5.12 ng/ml, range 3.01-90.37 ng/ml vs. patients without IAI: median 4.68 ng/ml, range 0.58-84.28 ng/ml; p = 0.56). There was no significant difference in the median amniotic fluid HSP70 concentration between patients with preterm rupture of the membranes with presence and absence histological of acute inflammatory lesions in the placenta and membranes (patients with presence: median 6.97 ng/ml, range 2.61-90.37 ng/ml vs. patients with absence: median 4.63 ng/ml, range 0.58-84.28 ng/ml; p = 0.68).

CONCLUSION

Intraamniotic levels HSP70 were not associated with intraamniotic infection and acute inflammatory lessions in the placenta and membranes.

[Fetal thymic involution on ultrasound]

OBJECTIVE

The purpose of this study was to summarize the published data on the fetal thymus, the fetal thymic involution and the possible use of the measurement of the fetal thymus in the clinical practice.

DESIGN

Review.

SETTING

Department of Obstetrics and Gynecology Medical Faculty Charles University Hradec Kralove.

METHODS

We summarized published data on the fetal thymic involution and relationship between the sonographic fetal thymus size and the presence of an intrauterinne infection in patiens with preterm labor or preterm prelabour rupture of membranes.

CONCLUSION

The present review summarizes the results of clinical and experimental research on the fetal thymic involution.

[Ductus venosus Arantii in the fetal venosus circulation: anatomical and clinical aspects]

OBJECTIVE

The purpose of this study was to summarize the published data on the anatomical structure of the ductus venosus, the mechanism of regulation of the ductus venosus shunting and its role in the fetal survival and the possible use of the measurement of the ductus venosus shunting in the clinical practice.

DESIGN

Review.

SETTING

Department of Obstetrics and Gynecology Medical Faculty Charles University Hradec Králové.

METHODS

We summarized published data on the ductus venosus shunting in the fetal venosus circulation with the regulatory mechanisms, doppler ultrasound diagnostic methods and the medical importance.

CONCLUSION

The present review summarizes the results of clinical and experimental research on the ductus venosus in the fetal circulation.

[Preterm premature rupture of membranes and Ureaplasma urealyticum]

OBJECTIVE

The purpose of this study was to evaluate the prevalence of the maternal lower genital tract colonization by Ureaplasma urealiticum and Mycoplasma hominis in patiens with preterm premature rupture of the membranes.

DESIGN

Retrospective study.

SETTING

Department of Obstetrics and Gynecology Medical Faculty Charles University Hradec Králové.

METHODS

We studied 150 women between 24 and 34 weeks of gestation with preterm premature rupture of the membranes. These patients were divided into 2 groups. In group 1 swabs were obtained for genital mycoplasmas. In both groups 1 and 2 were obtained standard swabs for aerobic and anaerobic cultivation. Control group 3 were women with normal pregnancy.

RESULTS

Ureaplasma urealyticum was detected in 96% (72/75) of the patients with PPROM between 24 and 34 weeks of gestation and in 32% (24/75) of the patiens of the control group (normal pregnancy).

CONCLUSION

The maternal lower genital tract colonization by Ureaplasma urealyticum might be associated with preterm premature rupture of the membranes and chorioamniitis.

[Acute fatty liver of pregnancy (AFLP)--case report]

OBJECTIVE

Description of case report and summary of the knowledge about acute fatty liver of pregnancy.

DESIGN

Case report.

SETTING

Department of Obstretrics and Gynecology Most.

SUBJECT

The case of 30-year-old woman primigravida with acute fatty liver in early postpartum period. The diagnosis of AFLP was initially suggested by the typical history of prodromal as malaise, anorexia and polydypsia before the delivery and the rapid onset of deeply jaundice developed with elevated bilirubin and liver enzymes in early postpartum period.

CONCLUSION

Acute fatty liver of pregnancy is a rare, potentional fatal disease that occurs in third trimester or early postpartum period. It is thought to be caused by a disordered metabolism of fatty acids by mitochondria in the fetus, caused by deficiency in the long-chain 3-hydroxyacyl-CoA dehydrogenase.

[Delayed interval delivery in twins pregnancy--the case report]

OBJECTIVE

The autors demonstrate the case report of the 70 days delayed interval delivery in twins pregnancy in 24 g.w.

DESIGN

Case report.

SETTING

Department of Gyneacology and Obstetrics Most.

METHOD

31-years old primipara after IVF pregnancy with preterm rupture of membranes of fetus A, after induced uterine contractions terminated the abortion of fetus A. The contractions stopped with tokolysis and after one month of expectation interval was performed cerclage suture of cervix.

CONCLUSION

After the abortion of twin A, we succesfully delayed interval delivery for 70 days. The borderline mature neonate was born in good clinical condition and survive.