Search

The study aimed to investigate whether serum sFlt-1 (soluble fms-like tyrosine kinase-1) at 11-13 weeks’ gestation in pregnancies that subsequently developed preeclampsia was different from those without preeclampsia and compare screening performance of the International Prediction of Pregnancy Complications (IPPIC) reported models, which include various combinations of maternal factors, systolic blood pressure, diastolic blood pressure, PlGF (placental growth factor) and sFlt-1 and the competing risk (CR) models, which include various combinations of maternal factors, mean arterial pressure (MAP) and PlGF for predicting any-onset, early-onset, and late-onset preeclampsia. This was a prospective multicenter study in 7877 singleton pregnancies. The differences of the predictive performance between the IPPIC and CR models were compared. There were 141 women (1.79%) who developed preeclampsia, including 13 cases (0.17%) of early-onset preeclampsia and 128 cases (1.62%) of late-onset preeclampsia. In pregnancies that developed preeclampsia compared to unaffected pregnancies, median serum sFlt-1 levels and its MoMs were not significantly different ( p >0.05). There was no significant association between gestational age at delivery and log 10 sFlt-1 and log 10 sFlt-1 MoM ( p >0.05). The areas under the curve of CR models were significantly higher than the IPPIC models for the prediction of any-onset and late-onset preeclampsia but not for early-onset preeclampsia. In conclusion, there are no significant differences in the maternal serum sFlt-1 levels at 11-13 weeks’ gestation between women who subsequently develop preeclampsia and those who do not. Moreover, the CR models for the prediction of any-onset and late-onset preeclampsia perform better than the IPPIC reported model.

To evaluate the efficacy of transcervical intralesional vasopressin injection to submucous myoma in hysteroscopic myomectomy from 2011 to 2014.This was a prospective, randomized, double-blind study in a single center. Forty premenopausal women with symptomatic submucous myoma requiring hysteroscopic myomectomy were randomized to transcervical intralesional vasopressin injection or placebo in a 4:4 ratio. The primary outcome was operative time. Secondary outcomes including fluid volumes, blood loss, and visual clarity were compared between the two groups.The median duration for myomectomy was 19.9 minutes (range 3.1-54.2 minutes) in the vasopressin group compared with 29.0 minutes (range 8.0-60.9 minutes) in the placebo group, a nonsignificant difference (P=.14). There were significant reductions in the median volume of fluid used (4,200 mL [range 1,300-21,000 mL] compared with 9,800 mL (range 1,500-23,000 mL; P=.004) and fluid intravasation (0 mL [range 0-3,100] compared with 300 mL [range -150-3,150 mL; P=.029) in the vasopressin group. The median intraoperative blood loss was reduced (5 mL [range 1-50 mL] compared with 20 mL [range 1-150 mL; P=.002). The operative surgeon rated that 95% of the vasopressin group had "minimal" bleeding compared with 36.8% in the placebo group. The surgical field (visual analog scale [VAS] 9 [range 2-10] compared with 6 [range 2-10; P.001]; 0=worst visual clarity, 10=best visual clarity) and the effluent fluid (VAS 1 [range 0-7] compared with 4 [range 0-8; P.001]; 0=clear, 10=unclear) were statistically significantly clearer in the vasopressin group.Transcervical intralesional vasopressin injection in hysteroscopic myomectomy did not reduce operative time but did reduce volume of inflow fluid, fluid intravasation, intraoperative blood loss, and improving visual clarity.Centre for Clinical Research and Biostatistics, http://www.cct.cuhk.edu.hk/Registry/publictriallist.aspx, CUHK_CCT00291.

UNLABELLED The objective of the present preliminary study was to determine if a difference in the pattern of gene expression exists between tumors that were subsequently found to be sensitive to radiotherapy and tumors found to be resistant to radiotherapy. PATIENTS AND METHODS A total of 16 patients with invasive squamous cell carcinoma of the uterine cervix were included in this study. All patients were treated with standardized radiotherapy alone. Ten of the tumors were clinically radiosensitive and six were radioresistant. Total RNA, extracted from tumor specimens obtained prior to treatment, was hybridized onto an oligonucleotide microarray with probe sets complementary to over 20,000 transcripts. The genes were first subjected to a statistical filter to identify genes with statistically significant differential expression levels between those that were radiosensitive and those that were radioresistant. A back-propagation neural network was then constructed to model the differences so that patterns could be easily identified. RESULTS Although a number of genes were found to express differentially between radiosensitive and radioresistant tumors; the 10 most discriminating genes were used to construct the model. Using the expressions from these 10 genes, we found that neural networks constructed from random subsets of the whole data were capable of predicting radiotherapy responses in the remaining subset, which appears stable within the dataset. DISCUSSION This study shows that such an approach has the potential to differentiate tumor radiosensitivity, although confirmation of such a pattern using other larger independent datasets is necessary before firm conclusions can be drawn.

Background —Gonadotropin-releasing hormone agonists (GnRHas) are a group of drugs that with long-term use induce a pseudomenopausal state in which estrogen production is suppressed. They are commonly used in the treatment of sex steroid–dependent conditions. “Add-back” hormone replacement therapy is used to prevent menopause-like symptoms and bone loss during GnRHa treatment, but it is also recognized that hypoestrogenism adversely affects vascular function. The aim of this study was to examine the effect of GnRHa and add-back therapy on vascular reactivity. This model serves as a paradigm for the effect of hormone replacement therapy in postmenopausal women. Methods and Results —Measurements of endothelium-dependent and endothelium-independent vascular reactivity were compared in 2 groups of women treated with a GnRHa for 6 months. One group received estrogen/progestogen add-back therapy during the second 3 months of GnRHa treatment. Vascular reactivity was examined by use of ultrasound measurements of changes in brachial artery diameter. Endothelium-dependent changes were assessed during reactive hyperemia, whereas endothelium-independent changes were measured after the administration of glyceryl trinitrate sublingual spray. Treatment with the GnRHa alone had an inhibitory effect on endothelium-dependent relaxation. However, endothelium-dependent relaxation significantly improved in the group receiving add-back therapy (14.6%) compared with the group treated with GnRHa alone (8.6%) ( P Conclusions —These results suggest that the administration of add-back therapy has a protective effect on vascular function in GnRHa-induced hypoestrogenism. As a model for the menopause, these results also suggest that the long-term administration of hormone replacement therapy would result in endothelium-dependent arterial relaxation, an observation previously attributed only to the acute administration of estrogen.

Objective To test the hypothesis that increasing the sampling interval affects the intrapartum fetal heart rate (FHR) variability measurement. Methods Fetal electrocardiograms were obtained from women in labor. Using the peak of the fetal R wave, the R-R interval and FHR were calculated on a beat-to-beat basis. Retrospectively, the original data were repartitioned using different intervals (2–900 seconds) to generate a window of measurement (epoch). The mean value for each epoch and the last FHR in that epoch (epochal value) were compared with published animal and human data. Errors were quantified by comparing the epochal and mean values for each epoch. Fetal heart rate variability between epochs and within each epoch was compared. Results Fetal heart rate and R-R interval were measured in 146 cases. The FHR had a normal distribution (mean 140.1 beats per minute, ± standard deviation [SD] 15.6, skew −0.07), but its inverse, the R-R interval, was not normally distributed (mean 432 milliseconds, ± SD 52.4, skew 1.78). Using a single value for an epoch duration of 2 seconds resulted in an error that was similar to the within-epoch variability (± SD of 2.2 beats per minute difference between mean and epochal value compared to ± SD of 2 beats per minute within epoch) but which increased with epoch duration. Conclusion An epoch duration of 2 seconds and a single sampled value within this period may be appropriate for measurement of both medium and long-term variability in any computerized intrapartum FHR interpretation system. Fetal heart rate (not R-R interval, because of its normal distribution) should be used to design such a computerized system.

The morbidity and perinatal deaths associated with vaginal breech delivery have prompted an alternative approach: external cephalic version (ECV). Although ECV is safe and cost-effective, many clinicians and patients avoid the procedure because of fear of complications as well as a lack of experience. In this prospective observational study, the pressure applied during ECV was quantified using gloves that incorporate ultrathin pressure-force sensors. Participants were 92 women presenting at or after 36 weeks gestation with breech presentation, all of whom lacked contraindications to ECV. The degree of force applied for each attempt at version, or pressure-time integral (PTI-A), was estimated in relation to numerous patient-related and ultrasound factors. ECV succeeded in nearly three fourths (73%) of women entered into the study. The number of attempts at version for each patient ranged from one to 6. The sum of pressure-time integral of all attempts at version (PTI-ECV) was lowest in women having a single attempt. Those having 2 attempts had PTI-ECV figures that were twice those of the single-attempt group, and values were highest for women having 3 or more attempts. No significant differences were noted among women having 3 to 6 attempts at version. The median PTI-A of successful attempts in women who completed version after one or 2 attempts was significantly lower than that for women who needed 3 or more attempts for version to succeed. For individual women, there was no difference in PTI-A between the successful attempt and the preceding failed attempt. This suggests that failures may reflect inefficient application of force rather than insufficient force. The only clinical variable that correlated significantly with the degree of applied force was uterine tone; a more tense uterus was associated with greater applied force. The 2 operators who attempted version in these cases applied comparable degrees of force. The degree of force required for successful ECV in this study was quite variable. The investigators believe that failed version most often results not from inadequate force, but from less-than-efficient force application and that greater emphasis on ECV skill may improve the results.