[Current status and perspectives of obstetrics in China: an insight from evidence-based medicine]

Nationwide epidemiological data on pregnancy and childbirth was lacking in China during the last decades. Since the establishment of the national data monitoring network and the booming of regional epidemiological studies, more information has emerged. The results and suggestions from the China Labor and Delivery Survey are crucial for improving current clinical practices. Researches that are conducted based on national data monitoring network and hospital-based medical history system, and multicenter clinical trials will provide plenty of useful evidences. These high-quality evidences would further improve clinical practice and development of obstetrics in China.

A nomogram integrating ferroptosis-and immune-related biomarker for prediction of prognosis and diagnosis in kidney renal clear cell carcinoma

OBJECTIVE

Approximately 60% of patients with kidney renal clear cell carcinoma (KIRC) die within the first 2-3 years. The prognosis for patients with KIRC and its metastases is poor. Ferroptosis and providing immunity are novel treatment targets for several cancers, including KIRC. Therefore, it is important to identify suitable ferroptosis- and immune-related signatures to predict the prognosis and diagnosis of patients with KIRC.

MATERIALS AND METHODS

The corresponding data of patients with KIRC were obtained from the Cancer Genome Atlas. Univariate and multivariate Cox regression analyses were used to screen candidate biomarkers in patients with KIRC.

RESULTS

We found that four FI-DEGs (BID, MET, LTB4R, and HMOX1) were independently associated with the overall survival of patients with KIRC. The prognosis and diagnosis model constructed using these four biomarkers could predict the outcome of KIRC, as measured by the receiver operating characteristic analyses.

CONCLUSIONS

We identified 4 FI-DEGs that could be used as biomarkers in patients with KIRC. The present study not only contributes to understanding the roles of ferroptosis and immunity in the development of KIRC, but also to the diagnosis and prognosis of KIRC, although it remains to be further studied.

What is an appropriate caesarean delivery rate for China: a multicentre survey

Objective

To assess the current status of caesarean delivery (CD) in China, propose reference CD rates for China overall, and by regions, investigate the main indications for CDs and identify possible areas for safe reduction.

Design

A multicentre cross‐sectional study.

Setting

A total of 94 hospitals across 23 provinces in China.

Population

A total of 73 977 randomly selected deliveries.

Methods

We used a modified Robson classification to characterise CDs in subgroups and by regions, and the World Health Organization (WHO) C‐Model to calculate reference CD rates.

Main outcome measures

CD rates in China.

Results

In 2015–2016, the overall CD rate in China was 38.9% (95% CI 38.6–39.3%). Considering the obstetric characteristics of the population, the multivariable model‐based reference CD rate was estimated at 28.5% (95% CI 28.3–28.8%). Accordingly, an absolute reduction of 10.4% (or 26.7% relative reduction) may be considered. The CD rate varied substantially by region. Previous CD was the most common indication in all regions, accounting for 38.2% of all CDs, followed by maternal request (9.8%), labour dystocia (8.3%), fetal distress (7.7%) and malpresentation (7.6%). Overall, 12.7% of women had prelabour CDs, contributing to 32.8% of the total CDs.

Conclusions

Nearly 39% of births were delivered by caesarean in China but a reduction of this rate by a quarter may be considered attainable. Repeat CD contributed more than one‐third of the total CDs. Given the large variation in maternal characteristics, region‐specific or even hospital‐specific reference CD rates are needed for precision management of CD.

Tweetable abstract

The caesarean rate in 2015–2016 in China was 38.9%, whereas the reference rate was 28.5%.

The caesarean rate in 2015–2016 in China was 38.9%, whereas the reference rate was 28.5%.

Linked article This article is commented on by M Varner, p. 148 in this issue. To view this mini commentary visit https://doi.org/10.1111/1471-0528.16953.

Second-trimester abdominal circumference discordance and adverse perinatal outcomes in monochorionic twins

OBJECTIVE

The perinatal outcomes in second-trimester abdominal circumference (AC) discordant twins are yet to be established. The aim of this study was to ascertain perinatal risks associated with second-trimester AC discordance in monochorionic (MC) twins.

METHOD

We conducted a retrospective study of all MC twin pregnancies over a 7-year period. Intertwin AC discordance at 14-26 gestational weeks was analyzed in relation to Doppler abnormalities, obstetric complications, and perinatal adverse outcomes.

RESULTS

A total of 246 MC twin pregnancies were included in the analysis. The smaller twins of second-trimester AC discordant pairs were at increased prevalence of abnormal umbilical artery flow (50% versus 24%, p < .001) and low positive A wave of ductus venous flow (24% versus 9%, p = .002). The second-trimester AC discordant twins were at increased risk of oligohydramnios in smaller twin (OR = 2.44, 95% CI = 1.37-4.32, p < .01), cardiomegaly in larger twin (OR = 2.95, 95% CI = 1.01-8.60, p < .05), birth weight of either twin below the 10th percentile for gestational age (OR = 5.56, 95% CI = 2.67-11.59, p < .001), birth weight discordance > 25% (OR = 9.41, 95% CI = 4.46-19.87, p < .001), IUFD (OR = 3.26, 95% CI = 1.76-6.05, p < .001), and severe neonatal morbidity (OR = 1.83, 95% CI = 1.03-3.26, p < .05). The intact survival rate in discordant and concordant twin pairs was 70% and 89%, respectively (p < .001).

CONCLUSIONS

Early and increase fetal surveillance of the second-trimester AC discordant twins should be utilized to establish perinatal risks, thus allowing prenatal care to improve.

Stillbirths in China: a nationwide survey

Objective

To estimate a stillbirth rate at 24 or more gestational weeks in 2015–2016 and to explore potentially preventable causes in China.

Design

A multi‐centre cross‐sectional study.

Setting

Ninety‐six hospitals distributed in 24 (of 34) provinces in China.

Population

A total of 75 132 births at 24 completed weeks of gestation or more.

Methods

COX Proportional Hazard Models were performed to examine risk factors for antepartum and intrapartum stillbirths. Population attributable risk percentage was calculated for major risk factors. Correspondence analysis was used to explore region‐specific risk factors for stillbirths.

Main outcome measures

Stillbirth rate and risk factors for stillbirth.

Results

A total of 75 132 births including 949 stillbirths were used for the final analysis, giving a weighted stillbirth rate of 13.2 per 1000 births (95% CI 7.9–18.5). Small for gestational age (SGA) and pre‐eclampsia/eclampsia increased antepartum stillbirths by 26.2% and 11.7%, respectively. Fetal anomalies increased antepartum and intrapartum stillbirths by 17.9% and 7.4%, respectively. Overall, 31.4% of all stillbirths were potentially preventable. Advanced maternal age, pre‐pregnant obesity, chronic hypertension and diabetes mellitus were important risk factors in East China; low education and SGA were major risk factors in Northwest, Southwest, Northeast and South China; and pre‐eclampsia/eclampsia and intrapartum complications were significant risk factors in Central China.

Conclusions

The prevalence of stillbirth was 13.2 per 1000 births in China in 2015–2016. Nearly one‐third of all stillbirths may be preventable. Strategies based on regional characteristics should be considered to reduce further the burden of stillbirths in China.

Tweetable abstract

The stillbirth rate was 13.2 per 1000 births in China in 2015–2016 and nearly one‐third of all stillbirths may be preventable.

The stillbirth rate was 13.2 per 1000 births in China in 2015–2016 and nearly one‐third of all stillbirths may be preventable.

Dual inoculation of alfalfa (Medicago sativa L.) with Funnelliformis mosseae and Sinorhizobium medicae can reduce Fusarium wilt

AIMS

This study was designed to evaluate the biocontrol of the arbuscular mycorrhizal fungus (AMF) Funnelliformis mosseae and the rhizobium Sinorhizobium medicae on alfalfa (Medicago sativa) wilt caused by Fusarium oxysporum, a severe soil-borne fungal pathogen.

METHODS AND RESULTS

The effects of co-inoculation of F. mosseae and S. medicae on alfalfa growth, nitrogen, phosphorus uptake and wilt caused by F. oxysporum were tested. Plant defence-related chemicals were measured to reveal the biochemical mechanism by which alfalfa responds to pathogen infection and how it is regulated by AMF and rhizobium. Pathogen infection caused typical yellowing of alfalfa leaflets and significantly reduced plant AMF colonization. AMF or rhizobium alone and the co-inoculation reduced the plant disease index by 83·2, 48·4 and 81·8% respectively. Inoculation with AMF or rhizobium alone increased the dry weight of alfalfa by more than 13 and 3 times respectively; it also increased plant chlorophyll content by 65·6 and 16·6% respectively. Co-inoculation of AMF and rhizobium induced the plant to accumulate more disease-related antioxidant enzymes, plant hydrolase and plant hormones, such as superoxide dismutase, β-1,3-glucanase, chitinase, and phenylalanine ammonialyase, abscisic acid, ethylene and H₂ O₂ , under pathogen stress.

CONCLUSIONS

Co-inoculation with F. mosseae and S. medicae offered complementarily improved alfalfa nutrient uptake and growth, which increased plant health. The co-inoculation of AMF and rhizobium regulated plant physiological and biochemical processes and induced plants to produce defence-related compounds, thus decreasing the severity of disease. The simultaneous application of F. mosseae and S. medicae is a potential biocontrol strategy to increase the systemic defence responses of alfalfa to Fusarium wilt.

SIGNIFICANCE AND IMPACT OF THE STUDY

This research showed that complex plant-pathogen interactions are affected by rhizobium and AMF, providing insight into plant-microbiome interactions in the rhizosphere as well as the application of the microbiome in agriculture production.

Arbuscular mycorrhizal fungus alleviates alfalfa leaf spots caused by Phoma medicaginis revealed by RNA-seq analysis

AIMS

One of the major limitations to the production of alfalfa (Medicago sativa) is the fungus Phoma medicaginis, which infects alfalfa and causes leaf spots. This study aims to understand alfalfa's response to P. medicaginis infection, the colonization of arbuscular mycorrhizal fungus (AMF) and the effect of AMF on plant-pathogen interactions.

METHODS AND RESULTS

Transcriptome analysis (RNA-seq) was used to identify differentially expressed genes (DEGs) in alfalfa infected by P. medicaginis and colonized by AMF Rhizophagus intraradices. AMF ameliorated the effects of P. medicaginis infection on alfalfa by reducing leaf spot incidence and disease index by 39·48 and 56·18% respectively. Inoculation with pathogen and AMF induced the activity of defence pathways, including peroxidase (POD), polyphenol oxidase activities and jasmonic acid (JA), salicylic acid concentration. Plants showed differential expression of P. medicaginis resistance-related genes, including genes belonging to pathogenesis-related (PR) proteins, chitinase activity, flavonoid biosynthesis, phenylpropanoid biosynthesis, glutathione metabolism, phenylalanine metabolism and photosynthesis. Inoculation with AMF led to changes in the expression of genes involved in PR proteins, chitinase activity, phenylalanine metabolism and photosynthesis.

CONCLUSION

The physiological and transcriptional changes caused by P. medicaginis infection in non-mycorrhizal and mycorrhizal alfalfa provides crucial information for understanding AMF's association with pathogenic systems.

SIGNIFICANCE AND IMPACT OF THE STUDY

This study showed that AMF alleviated alfalfa leaf spots demonstrating that AMF can serve as a biocontrol strategy for alfalfa disease management.

Expression of APOB, ADFP and FATP1 and their correlation with fat deposition in Yunnan's top six famous chicken breeds

1. Adipose differentiation related protein (ADFP), fatty acid transport protein 1 (FATP1) and apolipoprotein B (APOB) are suspected to play an important role in determining intramuscular fat and in overall meat quality. 2. Yunnan's top six famous chicken breeds (the Daweishan Mini, Yanjin Black-bone, Chahua, Wuding, Wuliangshan Black-bone and Piao chicken) are known for the high quality of their meat, but little is known about their expression of these three genes. 3. The present study aimed to examine the ADFP, FATP1 and APOB genes in different tissues of these six breeds at different development stages. The subcutaneous fat from the back midline and front, abdominal fat, liver and muscle tissue was sampled at 28, 49, 70, 91 and 112 days. The expression of ADFP, FATP1 and APOB was measured by real-time PCR. 4. The results showed that the expression of the three genes differed depending on age, tissue types and breeds. However, the expression of the three genes correlated with fat traits. In conclusion, the expression of the ADFP, FATP1 and APOB genes is associated with the fat traits of Yunnan's top six chicken breeds. These results could help with molecular marker screening and marker-assisted breeding to improve the quality of poultry for meat production.

Effects of Δ(9)-tetrahydrocannabinol (THC) on human amniotic epithelial cell proliferation and migration

BACKGROUND

The deleterious effects of cannabis consumption for fertility and pregnancy outcome are recognized for years. The main psychoactive molecule of cannabis, Δ(9)-tetrahydrocannabinol (THC) is able to cross the placenta barrier and cause alterations in fetal growth, low birth weight and preterm labor. However, the effects of THC on the human placenta amnion are still unknown.

METHODS

The distributions of CB1R and CB2R in human amnion tissues were observed by immunohistochemistry (IHC). Human amniotic epithelial cell proliferation and migration in response to THC treatment were measured by MTS and transwell assays, respectively. The PCR array was performed to study the key regulators involved in the cell migration. The protein levels of CB1R, CB2R in amnion tissues and MMP2, MMP9 in cells were detected by western blotting. Small interfering RNAs (siRNAs) were used to knockdown MMP2 and MMP9 in WISH cells.

RESULTS

Our results indicated that both CB1R and CB2R primarily identified in the epithelial layer of human placental amnion tissue. The CB1R expression in the amnion tissue was higher in the preterm group than normal control. High-dose of THC (30uM, but not 20 and 10uM) significantly inhibited (p<0.01) human amniotic epithelial cell lines (WISH) proliferation. Meanwhile, THC at both 10uM and 20uM (p<0.05) significantly suppressed cells migration in both WISH and primary human amniotic epithelial cells. The PCR array data and siRNA experiments demonstrated that MMP2/9 were tightly involved in the regulation of THC-inhibited cell migration in WISH cells.

CONCLUSION

These results suggested that THC inhibited the migration of human amniotic epithelial cell through the regulation of MMP2 and MMP9, which in turn altered the development of the amnion during the gestation and partially resulted in preterm labor and other adverse pregnancy outcomes.

Plasma microRNA expression profiles in Chinese patients with rheumatoid arthritis

The outstanding characteristics of circulatory microRNAs (miRNAs) attract much attention in research on disease biomarkers and disease pathogenesis. This study aimed to identify the expression profiles of plasma miRNAs in patients with rheumatoid arthritis (RA). Thirty-three miRNAs were screened using an miRNA array, of which 9 miRNAs were validated as differentially expressed in the plasma of RA patients compared with healthy controls (HCs). miRNA-4634 (miR-4634), miR-181d and miR-4764-5p expression levels were increased, whereas miR-342-3p, miR-3926, miR-3925-3p, miR-122-3p, miR-9-5p and miR-219-2-3p expression levels were decreased in RA patients. The areas under the curve (AUCs) were generated to estimate the sensitivity and specificity of each miRNA or the panel of all 9 miRNAs as biomarkers for RA. AUCs for 9 individual miRNAs ranged from 0.6254 to 0.818; however, the AUC for the panel of 9 miRNAs reached 0.964. Levels of miR-122-3p, miR-3925-3p, miR-342-3p and miR-4764-5p expression showed significant differences between RA and other control groups. miR-4764-5p, miR-4634, miR-9-5p and miR-219-2-3p exhibited significant correlations with either plasma cytokine and chemokine levels or clinical features. In conclusion, this study identified 9-plasma miRNAs signature in Chinese patients with RA which may serve as noninvasive biomarkers for the diagnosis of RA.

Dynamic quantification of canopy structure to characterize early plant vigour in wheat genotypes

Early vigour is an important physiological trait to improve establishment, water-use efficiency, and grain yield for wheat. Phenotyping large numbers of lines is challenging due to the fast growth and development of wheat seedlings. Here we developed a new photo-based workflow to monitor dynamically the growth and development of the wheat canopy of two wheat lines with a contrasting early vigour trait. Multiview images were taken using a 'vegetation stress' camera at 2 d intervals from emergence to the sixth leaf stage. Point clouds were extracted using the Multi-View Stereo and Structure From Motion (MVS-SFM) algorithm, and segmented into individual organs using the Octree method, with leaf midribs fitted using local polynomial function. Finally, phenotypic parameters were calculated from the reconstructed point cloud including: tiller and leaf number, plant height, Haun index, phyllochron, leaf length, angle, and leaf elongation rate. There was good agreement between the observed and estimated leaf length (RMSE=8.6mm, R (2)=0.98, n=322) across both lines. Significant contrasts of phenotyping parameters were observed between the two lines and were consistent with manual observations. The early vigour line had fewer tillers (2.4±0.6) and larger leaves (308.0±38.4mm and 17.1±2.7mm for leaf length and width, respectively). While the phyllochron of both lines was quite similar, the non-vigorous line had a greater Haun index (more leaves on the main stem) on any date, as the vigorous line had slower development of its first two leaves. The workflow presented in this study provides an efficient method to phenotype individual plants using a low-cost camera (an RGB camera is also suitable) and could be applied in phenotyping for applications in both simulation modelling and breeding. The rapidity and accuracy of this novel method can characterize the results of specific selection criteria (e.g. width of leaf three, number of tillers, rate of leaf appearance) that have been or can now be utilized to breed for early leaf growth and tillering in wheat.

Implantation of muscle satellite cells overexpressing myogenin improves denervated muscle atrophy in rats

This study evaluated the effect of muscle satellite cells (MSCs) overexpressing myogenin (MyoG) on denervated muscle atrophy. Rat MSCs were isolated and transfected with the MyoG-EGFP plasmid vector GV143. MyoG-transfected MSCs (MTMs) were transplanted into rat gastrocnemius muscles at 1 week after surgical denervation. Controls included injections of untransfected MSCs or the vehicle only. Muscles were harvested and analyzed at 2, 4, and 24 weeks post-transplantation. Immunofluorescence confirmed MyoG overexpression in MTMs. The muscle wet weight ratio was significantly reduced at 2 weeks after MTM injection (67.17±6.79) compared with muscles injected with MSCs (58.83±5.31) or the vehicle (53.00±7.67; t=2.37, P=0.04 and t=3.39, P=0.007, respectively). The muscle fiber cross-sectional area was also larger at 2 weeks after MTM injection (2.63×10³±0.39×10³) compared with MSC injection (1.99×10³±0.58×10³) or the vehicle only (1.57×10³±0.47×10³; t=2.24, P=0.049 and t=4.22, P=0.002, respectively). At 4 and 24 weeks post-injection, the muscle mass and fiber cross-sectional area were similar across all three experimental groups. Immunohistochemistry showed that the MTM group had larger MyoG-positive fibers. The MTM group (3.18±1.13) also had higher expression of MyoG mRNA than other groups (1.41±0.65 and 1.03±0.19) at 2 weeks after injection (t=2.72, P=0.04). Transplanted MTMs delayed short-term atrophy of denervated muscles. This approach can be optimized as a novel stand-alone therapy or as a bridge to surgical re-innervation of damaged muscles.

Potential involvement of placental AhR in unexplained recurrent spontaneous abortion

Recurrent spontaneous abortion (RSA) is a common complication of pregnancy. Recent studies have demonstrated that the aryl hydrocarbon receptor (AhR) might play important roles in establishing and maintaining early pregnancy. In this study, we found that placental AhR protein levels were significantly lower and placental CYP1A1 mRNA levels were higher in unexplained RSA (URSA) patients than in control subjects. The results of immunohistochemical analyzes showed that placental AhR was expressed in syncytiotrophoblast cells and that the level of AhR was markedly lower in these cells in URSA subjects than in control subjects. β-Naphthoflavone (β-NF, an AhR ligand) at 5μM significantly inhibited proliferation and migration in HTR-8/SVneo cells and was associated with the activation of AhR. Moreover, overexpressing AhR in JAR cells significantly increased CYP1A1 mRNA levels and inhibited cell migration. These results indicate that AhR is highly activated in URSA placentas and that the activation of AhR in the placenta might impair trophoblast cell proliferation and migration, possibly leading to the occurrence of URSA.

Folic acid attenuates dexamethasone-induced placental growth restriction

OBJECTIVE

Intrauterine glucocorticoid (GC) exposure is associated with disturbances in feto-placental growth. This study aimed to investigate whether folic acid supplementation can prevent dexamethasone (Dex)-induced feto-placental growth restriction.

MATERIALS AND METHODS

Female C57BL/6J mice were subject to four different treatments, respectively: normal drinking water plus saline injection (NN), normal drinking water plus Dex injection (ND), drinking water supplemented with folic acid plus saline injection (FN), and drinking water supplemented with folic acid plus Dex injection (FD). Folic acid (100 µg/L) was administrated since 2 weeks before the mating and throughout pregnancy. Dex injection (100 µg/kg•d) was performed from E12.5 to E16.5. The placentas were collected at E17.5.

RESULTS

The parameters including placental and fetal weight, the maximum placental diameter, volume of junctional and labyrinthine zones, and vascular density in the ND group were significantly smaller compared to the NN group. Except the maximum placental diameter, each of the above parameters in the FD group was significantly larger compared to the ND group. The levels of glucocorticoid receptor (GR) protein, and endothelial growth factor A, C (VEGFA, VEGFC) and placental growth factor (PIGF) mRNAs were significantly lower in the ND group compared to NN group. The VEGFA and PIGF mRNA level in the FD group was significantly higher than that in the ND group, as well as VEGFA and VEGFC protein level.

CONCLUSIONS

Folic acid may attenuate Dex-induced restriction on placental growth by elevating the expression of VEGFA and PIGF, and further raising vascular density.

[CCL21 promotes the metastasis of human pancreatic cancer Panc-1 cells via epithelial- mesenchymal transition]

OBJECTIVE

To investigate the mechanism underlying that chemokine (C-C motif) ligand 21 (CCL21) promotes the metastasis ability of human pancreatic cancer Panc-1 cells.

METHODS

Transwell(TM) was used to access the chemotaxis effect of CCL21 on Panc-1 cells. Real-time quantitative PCR was performed to detect the expression of C-C chemokine receptor type 7 (CCR7) mRNA in the upper and lower chambers. Immunofluorescence staining and Western blotting were employed to examine the expressions of the epithelial-mesenchymal transition (EMT)-related proteins and CD133 of Panc-1 cells in the lower chamber, which were compared with those of the upper chamber as the control.

RESULTS

The numbers of the Panc-1 cells induced by 0, 50, 100, 200 ng/mL CCL21 were 13.00 ± 3.00, 78.00 ± 9.00, 161.00 ± 11.00, 281.00 ± 17.00, respectively; with the increase of the concentration of CCL21, there were more cells migrating from the upper to the lower chamber; and the cells in the lower chamber expressed higher level of CCR7 mRNA than the ones staying in the upper chamber. The relative protein expressions of MMP-9, vimentin, E-cadherin and CD133 in the lower chamber were 0.42 ± 0.04, 0.36 ± 0.03, 0.12 ± 0.02, 0.46 ± 0.03, respectively, which were statistically significantly different from those in the upper chamber (0.15 ± 0.02, 0.25 ± 0.02, 0.25 ± 0.03, 0.13 ± 0.02, respectively).

CONCLUSION

CCL21/CCR7 axis maybe play an important role in the metastasis of pancreatic cancer stem cells by EMT and up-regulation of MMP-9.

Functional characterization of myeloid-derived suppressor cell subpopulations during the development of experimental arthritis

Recent evidence indicates the existence of subpopulations of myeloid-derived suppressor cells (MDSCs) with distinct phenotypes and functions. Here, we characterized the role of MDSC subpopulations in the pathogenesis of autoimmune arthritis in a collagen-induced arthritis (CIA) mouse model. The splenic CD11b(+) Gr-1(+) MDSC population expanded in CIA mice, and these cells could be subdivided into polymorphonuclear (PMN) and mononuclear (MO) MDSC subpopulations based on Ly6C and Ly6G expression. During CIA, the proportion of splenic MO-MDSCs was increased in association with the severity of joint inflammation, while PMN-MDSCs were decreased. MO-MDSCs expressed higher levels of surface CD40 and CD86 protein, but lower levels of Il10, Tgfb1, Ccr5, and Cxcr2 mRNA. PMN-MDSCs exhibited a more potent capacity to suppress polyclonal T-cell proliferation in vitro, compared with MO-MDSCs. Moreover, the adoptive transfer of PMN-MDSCs, but not MO-MDSCs, decreased joint inflammation, accompanied by reduced levels of serum cytokine secretion and the frequencies of Th1 and Th17 cells in draining lymph nodes. These results suggest that there could be a shift from potently suppressive PMN-MDSCs to poorly suppressive MO-MDSCs during the development of experimental arthritis, which might reflect the failure of expanded MDSCs to suppress autoimmune arthritis.

Opening the black box: outcomes of interactions between arbuscular mycorrhizal (AM) and non-host genotypes of Medicago depend on fungal identity, interplay between P uptake pathways and external P supply

We investigated the physiology that underlies the influence of arbuscular mycorrhizal (AM) colonization on outcomes of interactions between plants. We grew Medicago truncatula A17 and its AM-defective mutant dmi1 in intragenotypic (two plants per pot of the same genotype, x2) or intergenotypic (one plant of each genotype, 1 + 1) combinations, inoculated or not with Rhizophagus irregularis (formerly Glomus intraradices) or Gigaspora margarita. We measured plant growth, colonization, contributions of AM and direct P uptake pathways using (32)P, and expression of plant Pi transporter genes at two levels of P supply. A17 (x2) responded positively to inoculation only at low P. The response was enhanced with 1 + 1 even at high P where colonization in A17 was reduced. With R. irregularis P uptake by the AM pathway was unaffected by P supply, whereas with G. margarita, the AM pathway was lower at high P, and direct uptake higher. Gene expression varied and was unrelated to P uptake through the two pathways. There was no evidence of plant control of P uptake via R. irregularis at high P but there was via G. margarita. Importantly, growth responses of plant genotypes grown alone did not predict outcomes of intergenotypic interactions.

Detection of common deafness mutation by maternal plasma cell-free DNA

OBJECTIVES

The aim is to investigate the use of the ligase detection reaction (LDR) microarray to examine the difference of the single nucleotide between the pregnant woman and the fetus by cell-free DNA in the maternal plasma in congenital deafness.

MATERIALS AND METHODS

The proband and the couples' venous blood samples and the amniotic fluid/ chorionic villi collected from seven deafness families for prenatal diagnosis were analyzed. The cell-free DNA from maternal plasma was examined to determine if they carried the mutations of GJB2 235delC.

RESULTS

Three samples were found to carry the mutation of GJB2 235delC. It is in agreement with the sequencing results. The affected fetuses were suggested to take invasive procedure for confirmation.

CONCLUSIONS

The chip may be a potential method to screen for congenital deafness based on maternal plasma DNA.

Expression of nestin in ovarian serous cancer and its clinicopathologic significance

OBJECTIVE

Nestin has been found to be overexpressed in several human malignancies. The primary goal of this research was to investigate whether nestin expression correlates with the occurrence and development of ovarian cancer.

PATIENTS AND METHODS

Expression of nestin was evaluated by immunohistochemistry in 315 cases of various epithelial ovarian lesions as well as 52 cases of normal ovarian epithelia. The association between nestin expression and various clinical pathological parameters was analysed.

RESULTS

Immunohistochemical results showed that the positive correlation of nestin expression gradually increased from benign and borderline to malignant ovarian tumours. Nestin overexpression was associated with more advanced International Federation of Gynaecology and Obstetrics stage and higher histological grade in serous adenocarcinoma. Nestin expression was significantly associated with chemoresistance. However, there was no significant correlation between nestin expression and the age and level of CA125 in patients.

CONCLUSIONS

We propose that nestin expression might contribute to the initiation, promotion, and progression of serous ovarian carcinoma; nestin expression is associated with poor chemoresponse. It could be a potential therapeutic target in patients with epithelial ovarian carcinoma.

Increased Dickkopf-1 expression in patients with unexplained recurrent spontaneous miscarriage

Wnt pathways play an important role in pre-implantation embryo development, blastocyst implantation, and post-implantation uterine decidualisation. However, little is known about the potential role that Wnt signaling plays in patients with unexplained recurrent spontaneous miscarriage (URSM), and no single biomarker with a high predictive value of maternally caused URSM has been identified. We aim to study the molecular mechanisms by which the Wnt pathway controls the progression of early pregnancy by investigating the expression of Dickkopf-1 (DKK1), one of the Wnt agonists, in URSM patients. Plasma and fresh decidual tissues samples were collected from 59 subjects (29 patients with URSM and 30 patients with normal, early pregnancy). Time-resolved immunofluorometric assay system and quantitative real-time RT-PCR were used to determine the serum levels of DKK1 and DKK1 mRNA in the deciduas, respectively. Western blot and immunohistochemistry were used to measure DKK1 protein levels in the deciduas. Serum DKK1 levels were significantly higher in URSM patients compared to the control group (P < 0·001); the expression of DKK1 mRNA and protein in URSM patients were higher relative to healthy controls (P = 0·013). Glandular epithelium from decidual tissues demonstrated cytoplasmic signals for DKK1 in URSM patients, and DKK1 did not stain in healthy controls. Furthermore, serum DKK1 levels significantly correlated with those in the decidual tissues. Our study suggests that DKK1 may be a valuable biomarker of URSM; it can be reliably and conveniently detected in serum, thus obviating the need for decidual tissue analysis.

Three-year outcomes from BENEFIT-EXT: a phase III study of belatacept versus cyclosporine in recipients of extended criteria donor kidneys

Recipients of extended-criteria donor (ECD) kidneys have poorer long-term outcomes compared to standard-criteria donor kidney recipients. We report 3-year outcomes from a randomized, phase III study in recipients of de novo ECD kidneys (n = 543) assigned (1:1:1) to either a more intensive (MI) or less intensive (LI) belatacept regimen, or cyclosporine. Three hundred twenty-three patients completed treatment by year 3. Patient survival with a functioning graft was comparable between groups (80% in MI, 82% in LI, 80% in cyclosporine). Mean calculated GFR (cGFR) was 11 mL/min higher in belatacept-treated versus cyclosporine-treated patients (42.7 in MI, 42.2 in LI, 31.5 mL/min in cyclosporine). More cyclosporine-treated patients (44%) progressed to GFR <30 mL/min (chronic kidney disease [CKD] stage 4/5) than belatacept-treated patients (27-30%). Acute rejection rates were similar between groups. Posttransplant lymphoproliferative disorder (PTLD) occurrence was higher in belatacept-treated patients (two in MI, three in LI), most of which occurred during the first 18 months; four additional cases (3 in LI, 1 in cyclosporine) occurred after 3 years. Tuberculosis was reported in two MI, four LI and no cyclosporine patients. In conclusion, at 3 years after transplantation, immunosuppression with belatacept resulted in similar patient survival, graft survival and acute rejection, with better renal function compared with cyclosporine. As previously reported, PTLD and tuberculosis were the principal safety findings associated with belatacept in this study population.

The Sp1 transcription factor is crucial for the expression of 11beta-hydroxysteroid dehydrogenase type 2 in human placental trophoblasts

CONTEXT

Overexposure of the fetus to glucocorticoids early in gestation is detrimental to fetal development. Glucocorticoid concentrations in the fetal circulation are kept low by 11β-hydroxysteroid dehydrogenase type 2 (11β-HSD2, encoded by HSD11B2) in the placental syncytiotrophoblasts. However, cytotrophoblasts, the progenitors of syncytiotrophoblasts, express low levels of 11β-HSD2. Here we studied the molecular mechanisms underlying 11β-HSD2 induction upon syncytialization.

METHODS

Freshly isolated human term placental cytotrophoblasts and in vitro differentiated syncytiotrophoblasts were examined to determine the methylation status of HSD11B2 promoter. The transcription factor responsible for 11β-HSD2 induction was identified by observing its expression upon syncytialization, the effect of its attenuation, and its binding to the HSD11B2 promoter.

RESULTS

11β-HSD2 expression was markedly increased upon syncytialization in vitro. No methylation differences of HSD11B2 promoter were found between cytotrophoblasts and syncytiotrophoblasts. Expression of the transcription factor Sp1 was markedly induced during syncytialization and further increased by activation of the cAMP pathway, which correlated with 11β-HSD2 expression. Importantly, small interfering RNA-mediated knockdown of Sp1 expression or inhibition of Sp1 activity with mithramycin A markedly attenuated not only basal but also cAMP pathway-stimulated expression of 11β-HSD2 in the syncytiotrophoblasts. Stimulation of the cAMP pathway also increased the binding of Sp1 and RNA polymerase II to HSD11B promoter in syncytiotrophoblasts. Concomitantly, acetylation at histone H3K9 was increased whereas methylation at histone H3K9 was decreased.

CONCLUSIONS

11β-HSD2 induction upon syncytialization is at least in part due to the increased expression of Sp1 upon activation of the cAMP pathway rather than the differential methylation of the HSD11B2 promoter.

Cross talk between cAMP and p38 MAPK pathways in the induction of leptin by hCG in human placental syncytiotrophoblasts

Leptin produced by the placental syncytiotrophoblasts participates in a number of processes in pregnancy including implantation, proliferation of the cytotrophoblasts, and nutrient transfer across the placenta. Despite the functional significance of leptin in pregnancy, the regulation of leptin synthesis is poorly understood in human placental syncytiotrophoblasts. In this study, we investigated the role of endogenous human chorionic gonadotropin (hCG) in the regulation of leptin production as well as the underlying mechanism involving the cross talk between cAMP and p38 mitogen-activated protein kinase (MAPK) pathways. We found that neutralization of endogenous hCG with its antibody dose dependently decreased leptin mRNA level and secretion, whereas exogenous hCG increased leptin mRNA level and secretion. Activation of the cAMP pathway with dibutyryl cAMP (db cAMP) or forskolin recapitulated the stimulatory effect of hCG on leptin expression. Inhibition of protein kinase A with H89 not only reduced the basal leptin expression but also attenuated the induced leptin expression by hCG. Treatment of the syncytiotrophoblasts with db cAMP and hCG phosphorylated p38 MAPK. Inhibition of p38 MAPK with SB203580 not only reduced the basal leptin production but also attenuated the leptin-induced production by both hCG and db cAMP. These data suggest that endogenous hCG plays a significant role in maintaining leptin production in human placental syncytiotrophoblasts, and this effect involves a cross talk between cAMP and p38 MAPK pathways.

Inhibin A, activin A, placental growth factor and uterine artery Doppler pulsatility index in the prediction of pre-eclampsia

OBJECTIVES

To evaluate whether the measurement of maternal serum inhibin A, activin A and placental growth factor (PlGF) at 12 + 0 to 16 + 0 weeks of gestation alone or in combination with second-trimester uterine artery Doppler pulsatility index (PI) is useful in predicting pre-eclampsia.

METHODS

This was a case-control study of pre-eclampsia. From pregnant women attending their first antenatal examination at 12-16 weeks we collected serum samples and stored them at - 80 °C. All patients also underwent uterine artery Doppler examination to measure the PI at 22-24 weeks' gestation. We retrieved for analysis frozen samples from women who then developed pre-eclampsia, as well as three control samples per woman, matched for gestational age and storage time. Inhibin A, activin A and PlGF were measured using an enzyme-linked immunosorbent assay (ELISA) by an examiner who was blinded to the pregnancy outcome.

RESULTS

There were 31 cases with pre-eclampsia and 93 controls. Second-trimester uterine artery PI and marker levels were expressed as multiples of the median (MoM). The uterine artery PI was increased in pregnancies with pre-eclampsia compared with controls (mean ± SD, 1.45 ± 0.31 MoM vs. 1.02 ± 0.25 MoM, P < 0.001), as were the level of inhibin A (mean ± SD, 1.57 ± 0.34 MoM vs. 1.08 ± 0.43 MoM, P < 0.001) and the level of activin A (mean ± SD, 1.68 ± 0.38 MoM vs. 1.06 ± 0.42 MoM, P < 0.001). The level of PlGF was decreased in pre-eclampsia compared with controls (mean ± SD, 0.69 ± 0.23 MoM vs. 1.00 ± 0.26 MoM, P < 0.001). Receiver-operating characteristics curves were analyzed for controls and cases and areas under the curve (AUC) were 0.796 (95% CI, 0.712-0.880, P < 0.001) for inhibin A, 0.823 (95% CI, 0.746-0.899, P < 0.001) for activin A, 0.831 (95% CI, 0.752-0.910, P < 0.001) for PlGF and 0.851 (95% CI, 0.783-0.920, P < 0.001) for uterine artery PI. The combination of activin A, inhibin A and PI using logistic regression analysis yielded an AUC of 0.907 (95% CI, 0.830-0.938, P < 0.001) with a sensitivity of 87% and a specificity of 80%. The combination of activin A, PlGF and PI gave an AUC of 0.925 (95% CI, 0.852-0.978, P < 0.001) with a sensitivity of 90% and a specificity of 80%. Combining all four markers gave an AUC of 0.941 (95% CI, 0.891-0.990, P < 0.001) with a sensitivity of 93% and a specificity of 80%.

CONCLUSION

Early second-trimester serum inhibin A, activin A, PlGF and second-trimester uterine artery Doppler PI may add further information for the prediction of pre-eclampsia. The combination of the three serum markers and uterine artery Doppler PI has the highest prediction value for pre-eclampsia.

Role of human chorionic gonadotropin in maintaining 11beta-hydroxysteroid dehydrogenase type 2 expression in human placental syncytiotrophoblasts

Proper glucocorticoid exposure in utero is vital for normal fetal organ maturation, but excess glucocorticoids are detrimental to fetal growth and can even predispose the individuals to the high risk of having certain diseases in adulthood. The fetus is protected from 10 times higher maternal glucocorticoid levels by the placental enzyme 11beta-hydroxysteroid dehydrogenase 2 (11beta-HSD2), which converts biologically active cortisol to inactive cortisone. Thus it is of primary importance to understand how this enzyme is regulated. Activation of cAMP/PKA pathway is known to upregulate 11beta-HSD2 expression in placental syncytiotrophoblasts, however the endogenous hormones utilizing this pathway remain largely unknown. By using cultured human placental syncytiotrophoblasts, we demonstrated that inhibition of protein kinase A with H89 attenuated 11beta-HSD2 expression in the syncytiotrophoblasts, suggesting endogenous factors from the syncytiotrophoblasts using this pathway to maintain 11beta-HSD2 expression in the syncytiotrophoblasts. Neutralization of human chorionic gonadotropin (hCG) secreted by the syncytiotrophoblasts with hCG antibody decreased 11beta-HSD2 promoter activity, mRNA and protein expression as well as intracellular cAMP level, while treatment of the syncytiotrophoblasts with exogenous hCG increased 11beta-HSD2 expression, which was attenuated by H89. Furthermore, we found that cortisol increased both hCG expression and secretion. The up-regulation of 11beta-HSD2 expression by cortisol was significantly attenuated by co-treatment with hCG antibody or H89 in the syncytiotrophoblasts. In conclusion, hCG is an important paracrine or autocrine hormone maintaining 11beta-HSD2 expression and the up-regulation of 11beta-HSD2 expression by cortisol may be mediated in part by hCG in the syncytiotrophoblasts.

[Clinical studies on the effects of burn trauma on pituitary-testis axis]

OBJECTIVE

To investigate the effects of burn trauma on pituitary-testis axis.

METHODS

The changes in serum estradiol(E2), testosterone(T), luteinizing hormone(LH), and follicle stimulating hormone(FSH) levels were dynamically investigated by RIA in 30 days after thermal injury in 28 burnt men.

RESULTS

The serum FSH, LH, and T levels significantly decreased after injury, and there was some increase from PBD(postburn day) 14 to 30. In patients in group II and III (BSA > 30% TBSA), not all of their FSH, LH, and T levels reached the normal control on the PBD 30. Serum E2 levels were elevated after injury, then returned gradually to normal. In three patients who died, their mean T levels were significantly lower than patients who survived, but mean E2 levels were significantly higher than that of survivors.

CONCLUSION

The activity of pituitary might be depressed after burn trauma. The imbalance between E2 and T might play a role in the processes of immuno-depression after injury. The changed extent of E2 and T levels was correlated to burn size. They could be sensitive indicators of burn stress.

[The treatment of intrauterine growth retardation with ant polyrhachis vicina roger]

OBJECTIVE

To study the growth promoting effect of ant Polyrhachis Vicina Roger.

METHODS

Mated rats were divided into 3 groups, group A was non-smoking control group, group B was smoking induced intrauterine growth retardation (IUGR) group, group C was smoking induced IUGR rats fed with ant Polyrhachis Vicina Roger, then growth indices of fetal rats in each group were evaluated.

RESULTS

The result showed that, the average birth weight, body length and tail length of fetal rats in treatment group were significantly higher than those of two control groups (P < 0.01); the incidence of IUGR was significantly lower in treatment group than that of two control groups (P < 0.01); the fetal mortality rate was significantly lower in treatment group than that of two control groups (P < 0.01).

CONCLUSION

Ant Polyrhachis Vicina Roger is rich in amino acids, vitamines and trace elements, which could help the growth of fetal rats. Polyrhachis Vicina Roger is also rich in ecdysterone, that is growth hormone of insects, it has a strong protein anabolic effect, which might contribute to the growth promoting effect of Polyrhachis Vicina Roger.

[Investigation on the causes of pregnancy induced hypertension]

OBJECTIVE

To investigate some possible causes of pregnancy induced hypertension (PIH).

METHODS

Plasma antithrombin (AT-II), fibronectin (Fn), plasminogen activator inhibitor (PAI) levels were determined at 26-28, 37-38 gestational weeks and 24-72 hours after delivery in 114 pregnant women whose mean arterial pressure (MAP) > or = 12 kPa or body weight index > or = 0.24. Women were longitudinally followed to observe whether PIH developed and its relation to the changes of the above parameters.

RESULTS

AT-II level decreased and Fn, PAI levels increased significantly in PIH patients (P < 0.01).

CONCLUSIONS

The endothelial cells damage results in an increase of thromboxane A2 (TXA2), decrease of prostaglandin I2 (PGI2), and increase of PAI, Fn, decrease of AT-II, as well as the increase of angiotensin II sensitivity. All these changes lead to vascular constriction. As the results, renal and uterine placenta blood flow decrease, then PIH occurrs.

[Morphological and functional changes of the human vascular endothelial cells in pregnancy induced hypertension patients]

Normal human vascular endothelial cells were cocultured with sera from pregnancy induced hypertension (PIH) patients. After staining it was found that sera from PIH patients could induce stress fibers production from the endothelial cells and which sometime destroy the integrity of normal monolayer structure of endothelium, thus result in endothelial damage. Sera from PIH patients could also induce intracellular adhesion molecules on the cell surface, thus result in the blood cells adhesion to vascular wall, and loss of endothelial cells from vascular wall under certain condition, thereby causing endothelial damage.