Objective To investigate the expression of autoantibodies to the angiotensin Ⅱ type Ⅰreceptor (AT1-AA) and endothelin-1 (ET-1) in pregnant women's blood and explore their correlation with the pathogenesis of preeclampsia.Methods Ninety pregnant women who delivered from June 2011 to December 2011 in the First Affiliated Hospital of Zhengzhou University were chosen as the study objects.They were divided into mild preeclampsia group (n =30),severe preeclampsia group (n =30) and normal group (control group,n =30).The levels of AT1-AA and ET1 in maternal peripheral blood and umbilical cord blood were detected by ELISA,and the mRNA expression levels of AT1-AA and ET1 in placenta tissues were determined by reverse transcription (RT) PCR.Moreover,the correlation clinical indexes were detected and analysed.Results (1) The levels of AT1-AA and ET1 in maternal peripheral blood of preeclampsia [mild group:(114 ± 19) ng/L and (31 ± 9) ng/L,severe group:(145 ± 15) ng/L and (38 ± 10) ng/L] were both significantly higher than that of control group [(59 ± 5) ng/L,(17 ±4) ng/L].In addition,compared with mild group,the levels of AT1-AA and ET1 in severe group were significantly higher (P ＜0.05).(2) The levels of AT1-AA and ET1 in umbilical cord blood of preeclampsia [mild group:(105 ± 14) ng/L and (35 ±6) ng/L,severe group:(118 ± 14) ng/L and (40 ±5) ng/L] were significantly higher than that of control group [(61 ± 12) ng/L,(24 ± 5) ng/L].In addition,compared with mild group,the levels of AT1-AA and ET1 in severe group were significantly higher (P ＜0.05).(3) The mRNA expression levels of AT1-AA and ET1 in placenta tissues of mild group (0.313 ± 0.039,0.296 ±0.028) and severe group (0.568 ±0.052,0.577 ±0.046) were significantly higher than that in control group (0.198 ± 0.017,0.137 ± 0.012),and the levels in severe group were significantly higher than that in mild group (P ＜0.05).(4) There was an evident positive correlation between AT1-AA and ET1 levels of preeclampsia women's peripheral blood,umbilical cord blood and placenta (P ＜ 0.05).(5) The level of AT1-AA in umbilical cord blood of preeelampsia pregnant women was positively correlated with S/D value of umbilical artery (P ＜ 0.05),and negatively correlated with the weight of the birth and the placental (P ＜ 0.05).Conclusion The AT1-AA in the blood of pregnant women plays an important role in promoting the generation and development of preeclampsia by increasing the ET1 secretion.

Objective To investigate the clinical characteristics,diagnosis,therapy and maternal and perinatal prognosis of generalized pustular psoriasis of pregnancy.Methods Clinical data for seven inpatients with generalized pustular psoriasis of pregnancy were retrospectively analyzed from January 1,2005 to December 31,2012.Results Three patients had family history of psoriasis and five had previous history of psoriasis.All skin lesions were large patches of erythema,with needlepoint to miliary size pustules and scales.Two patients had oral involvement and three had nail involvement.Biopsy and bacterial culture were performed on five patients,in whom histopathological changes of pustular psoriasis were found,and bacterial culture was negative except in one patient.Among the patients,four had confirmed cause of disease; six patients were complicated with fever; four had increased leukocytes; seven had elevated neutrophils and C-reactive protein;five had increased total protein; and six had increased albumin.The disease was diagnosed according to the clinical manifestations and laboratory tests.Comprehensive treatment with glucocorticosteroids,antibiotics and local treatment were performed.Four patients had live births,and three patients underwent odinopoeia.Two babies were healthy,one had died,and another had varus foot deformity.Three patients had pustular relapse after labor.Conclusions Fetal-placental functions of patients with generalized pustular psoriasis of pregnancy should be monitored closely.Early diagnosis,treatment and termination of pregnancy can improve the maternal and perinatal prognosis.

Objective To investigate the role of S100 calcium binding protein A12 (S100A12) in the pathogenesis of preeclampsia. Methods Sixty patients with preeclampsia were recruited from March 2013 to December 2013 in the First Affiliated Hospital of Zhengzhou University. Among them, thirty cases were defined as the mild preeclampsia group and thirty cases were defined as the severe preeclampsia group. The other thirty healthy pregnant women were recruited in the healthy pregnant women group. The levels of S100A12 protein in maternal peripheral blood were detected by enzyme-linked immunosorbent assay (ELISA). Immunohistochemistry of streptavidin peroxidase biotin (SP) method was used to measure the protein expression of S100A12. The trophoblast cells were cultured in vitro with plasma from the three groups, and a blank control group was set up as well. Transwell was used to detect the cytotrophoblast invasion ability. Western blot was used to measure the protein expression level of receptor for advanced glycation end products (RAGE). Results (1) The levels of S100A12 in maternal peripheral blood of patients with preeclampisa [mild group:(30.8 ± 2.7)μg/L, severe group:(49.3 ± 4.1)μg/L] were significantly higher than that of the control group [(15.8 ± 1.4) μg/L]. In addition, compared with the mild preeclampsia group, the level of S100A12 in the severe preeclampsia group was significantly higher (P<0.05). (2)Positive immunostaining of S100A12 was observed in the cytoplasm of cytotrophoblast, decidual cells and the placentas from the three groups. The positive rate in the mild preeclampisa group was 77%(23/30);in the severe preeclampsia group it was 93%(28/30);and in the healthy pregnant women group it was 23%(7/30). The positive rates of placenta in the mild and severe preeclampsia groups were significantly higher than that in the healthy pregnant women group (P<0.05). In addition, compared with the mild preeclampsia group, the positive rate of immunostaining of S100A12 in the severe group was significantly higher (P<0.05).(3) Cytotrophoblast invasion ability and the expression of RAGE in the mild preeclampsia group were 29.1±3.2 and 0.479 ± 0.038, respectively;in the severe preeclampsia group they were 16.8 ± 2.5 and 0.652 ± 0.059;in the healthy pregnant women group they were 38.6 ± 24.3 and 0.327 ± 0.024; and in the blank control group they were 42.6 ± 5.6 and 0.194 ± 0.011. Cytotrophoblast invasion ability and the expression of RAGE protein in the mild and severe preeclampsia groups were significantly higher than those in the healthy pregnant women group and the control group(P<0.05). Conclusions The expression of S100A12 increased in materal peripheral blood and placenta, and the receptor protein of S100A12 RAGE also had high expression. It suggested that the S100A12 may have some effect on the pathogenesis of preeclampsia.

Objective To observe the effect of DNA methyltransferase 1 (DNMT1 ) gene silencing by RNA interfering technology on the proliferation and apoptosis of HeLa cells. Methods Recombinant plasmid pshRNA-DNMT1-A, B and C were respectively transfected into HeLa cells by lipofectamine 2000, while cells transfected plasmid vector pSilencer3.1-HI and cells untreated as control groups. RT-PCR was adopted to select the recombinant plasmid which showed the most optimal inhibition effect. RT-PCR and western blotting was used to detected the mRNA and protein expression of DNMT1 in HeLa cells transfected for 24, 48 and 72 hours. Cell counting kit-8 (CCK-8 ) assay was used to investigate the proliferation of the HeLa cells after transfection, while apoptosis was detected by flowcytometry(FCM ) method. Results Three DNMT1-targeted short hairpin RNA (shRNA) A,B and C were successfully inserted into the plasmid vector PShRNA, and the coding sequences of the obtained shRNA were consistent with the designed fragments. The results indicated that both recombinant plasmid pshRNA-DNMT1-A and B could effectively knock down the expression of DNMT1 gene in human cervical cancer cells, of which pshRNA-DNMTI-B was the better choice. While no effect of pshRNA-DNMTI-C was seen. BT-PCR results showed that the relative mRNA expression of DNMT1 gene in Helm cells transfected with pshRNA-DNMT1 for 24, 48 and 72 hours were 0.406±0.057,0.191±0.036 and 0.104±0.015, which were significantly lower than that in Helm cells transfected by empty vector and non-transfected cells (0.520±0.020, 0.537±0.041, respectively, P ＜ 0.05 ). The western blotting analysis manifested that the relative expression of DNMT1 protein of Helm cells transfected by pshRNA-DNMT1 for 24, 48 and 72 hours were 0.197±0.024, 0.075±0.015, 0.040± 0.013, which were significantly lower than that in transfected cells by empty vector and non-transfected cells (0.273±0.010, 0.283±0.016, respectively, P ＜0.05). The CCK-8 results showed that the cell survival rates of HeLa cells transfected by pshRNA-DNMT1 for 24, 48, 72, 96 and 120 hours were 70.8%, 64.8%, 51.6%, 45.3% and 38.0%, there were statistically different compared with cells transfected by empty vector and non-transfected cells at different time-points (P ＜ 0.01 ). The results of FCM indicated that the apoptesis rate of HeLa cells trandected with pshRNA-DNMTI for 24, 48 and 72 hours were (17.7± 1.3 ) %, (35.3±1.3 ) %, (47.6±1.6 ) %, which were significantly higher than empty vector transfected cells and non-transfected cells [(4.9±0.5 ) %, (5.1±0.7 ) %, respectively, P ＜ 0.05]. Conclusions DNMT1 can be successfully silenced by RNA interfering in cervical Helm cells. Downregulation of DNMT1 can inhibit cervical cancer cells proliferation and induce cell apoptosis.

Objective To investigate the therapeutic effect of uteroplasty aided with temporary balloon occlusion of abdominal aorta in treating pernicious placenta previa combined with placenta percreta.Methods Sixty-two third-trimester gravidas who were diagnosed as pernicious placenta previa combined with placenta percreta by prenatal ultrasound and magnetic resonance imaging (MRI) in the First Affiliated Hospital of Zhengzhou University from January 1,2013 to May 31,2016 were enrolled in this study.All of them received cesarean section and then underwent uteroplasty following temporary balloon occlusion of abdominal aorta.Efficacy of that treatment was evaluated from the perspectives of blood loss,operation time,complications and postoperative recovery.All data were analyzed by descriptive analysis.Results All of the 62 cases were diagnosed with placenta percreta during operation including 10 cases (16.1％) with perimetrium invasion,46 cases (74.2％) with invasion to the muscular layer of bladder and six cases (9.7％) with bladder invasion.The average blood loss of all cases during and within 24 hours after operation was (1 377.3±605.2) ml and (140.6±66.3) ml,respectively.The average operation time was (72.3 ±24.5) min and the average length of postoperative hospital stay was (5.8± 1.6) d.The six cases of placenta percreta with bladder invasion received bladder repair.Sixty-one cases had their uterus preserved and the other one case had a sub-total hysterectomy due to amniotic fluid embolism.One woman developed phlebothrombosis in her lower limbs after operation.No intestinal or ureteral injury,puerperal infection,uterine ischemia necrosis or death was reported.In addition to three cases lost to follow-up,the other 59 patients were followed up to May 31,2017.Results of physical examination indicated that the 59 cases had normal uterine involution after operation.Menses returned in 58 of the 59 cases without any difference from before,and did not return in one case due to breastfeeding.Conclusion Uteroplasty aided with temporary balloon occlusion of abdominal aorta is a safe and effective uterus-preserving surgery for patients with pernicious placenta previa combined with placenta percreta.

Objective To explore the relationship among clinicians' work pressure,perceived social support and compassion fatigue,and to provide a new prospective for the localization studying of intervention and treatment to compassion fatigue.Methods Data of scale for occupational stressors on clinician,perceived social support scale and professional quality of life scale were collected from a sample of 533 clinicians and analyzed with structural equation modeling to study the relationship among clinicians' work pressure,perceived social support and compassion fatigue.Results (1)Work pressure(2.40±0.45),burnout (2.14±0.54) and secondary traumatic stress(1.93±0.60) scores of the clinicians with high perceived social support were significantly lower than that of the clinicians with low perceived social support (2.78±3.67,2.73± 0.59,2.32±0.71;t=7.68,-9.44,8.77,5.07;P＜0.01).Compassion satisfaction scores (4.15±0.63) of the clinicians with high perceived social support were significantly higher than that of the clinicians with low perceived social support (3.40±0.71,t =-9.44,P＜0.01).(2) According to relevant results,work pressure was significantly negative correlation with both perceived social support (r=-0.34,P＜0.01) and compassion satisfaction (r=-0.44,P＜0.01),and significantly positive correlation with both burnout (r=0.69,P＜0.01) and secondary traumatic stress(r=0.53,P＜0.01);while perceived social support was significantly positive correlation with compassion satisfaction (r=0.42,P＜0.01),and significantly negative correlation with burnout (r=-0.40,P＜0.01) and secondary traumatic stress(r=-0.26,P＜0.01).(3) According to the results of structural equation modeling,perceived social support played a partly mediating role in the effect of work pressure toward compassion satisfaction and fatigue with the intermediary effect of 55.4％ and 12.5％.Conclusion Perceived social support plays a mediation role between work pressure and compassion fatigue for clinicians,and better social support of the clinician is beneficial to clinicians mental health level.

Objective To explore the application of temporary balloon occlusion in multidisciplinary management of cesarean sec-tion for patients with pernicious placenta previa/accreta.Methods 42 patients with a diagnosis of placenta previa /accrete accepted the temporary aortic balloon occlusion in cesarean section in DSA hybrid operation room were retrospectively studied.Before cesare-an section,intravascular balloon catheter was placed in abdominal aortic.After delivery,the midpoint of filling state balloon was placed at the midpoint of the two renal arteries openings before placental dissection.The amount of blood loss and blood transfusion, operation time,the infants'radiation doses and postoperative complications were determined.Results All patients were successfully fulfilled cesarean section and conserved uteri.The amount of blood loss,blood transfusion,operation time,occlusion time and the infants’radiation doses were (586±355)mL,(422±283)mL,(75.5±1 1.9)min,(22.4±7.2)min and (4.2±2.9)mGy,respec-tively.During follow-up,complications were not found during operation and after operation.Conclusion In women with pernicious placenta previa/accreta,temporary aortic balloon occlusion can effectively control postpartum hemorrhage and reduce the risk of un-desirable hysterectomy.

Objective To study the operative technique and effect of temporary balloon occlusion of the abdominal aorta for preventing intraoperative bleeding during cesarean for patients with pernicious placenta previa and placenta accreta. Methods Retrospective analysis was conducted on the intraoperative situation of forty-one cases and information of follow-up twenty-nine cases, which were pernicious placenta previa and placenta accreta and delivered in the First Affiliated Hospital of Zhengzhou University from May 1, 2013 to June 30, 2014. Diagnosis was confirmed by line of color Doppler ultrasound and MRI for all patients before operations. An interventional physician performed right femoral artery puncture and preset the abdominal aortic balloon catheter in the digital subtraction angiography operation room before cesarean. At the same time of fetal delivery, 10 ml normal saline was injected into the balloon immediately, which results in filling of the balloon and blocking of the aorta. According to the area and depth of placenta implantation and implantation or penetration of the posterior bladder wall, placenta separation, partial resection of the uterine wall and partial bladder resection and repair were performed correspondingly. Meanwhile, saline in the balloon was pumped out gradually until empty. Condition of placenta implantation, blood loss and blood transfusion volume during the operation, intraoperative and postoperative complications, the duration and dose of fetal radiation exposure, and Apgar score of neonates were analyzed. Results Among the 41 cases, penetrative placenta and implanted placenta were observed in five cases and 36 cases, respectively. The latter 36 cases including 28 cases of bladder posterior wall accreta and eight cases of bladder posterior wall penetration. For all cases, the average operation time was (68.5±15.3) min, the mean blood loss in the operation was (1 058±960) ml, among which eight received blood transfusion with an average of (600±400) ml, and the mean hospital stay was (8.2±2.3) d. Uteruses were reserved in all cases. The mean duration and dose of fetal radiation exposure was (8.1±3.6) s and (5.2±2.9) mGy, and the Apgar score of neonates was 8.7±0.5 at 1 min and 9.5±0.3 at 5 min, respectively. The patients were followed up until October 31, 2014. Among them, six were lost, six were still in puerperium, 18 were breast-feeding, and the menses of 11 had returned. Conclusion Preset abdominal aortic balloon catheter in pernicious placenta previa and placenta accrete patients might effectively reduce the blood loss during cesarean section as well as the risk of hysterectomy through temporary occlusion of the abdominal aorta.

Objective:To investigate the clinical characteristics and early identification of spontaneous rupture of uterus caused by placenta percreta.Methods:The clinical data of 12 patients with spontaneous uterine rupture caused by placenta percreta and admitted to the First Affiliated Hospital of Zhengzhou University from June 2014 to December 2019 were collected. The age, gestational age, gestational history, clinical manifestations, diagnostic methods, uterine operation history, rupture location, surgical method, treatment and outcome were analyzed.Results:(1) General condition: the median age of pregnant women was 37 years (range: 30-43 years), and the median gestational week of uterine rupture was 29 +6 weeks (range: 18 +3-36 +3 weeks). (2) Clinical manifestation: among the 12 pregnant women, 9 showed different degrees of abdominal pain; chest distress accompanied by waist soreness, abdominal distension in 2 cases; one asymptomatic pregnant women was found with uterine rupture during elective cesarean section. Preoperative color Doppler ultrasonography indicated that 9 of the 12 pregnant women had peritoneal effusion, and 6 of them underwent diagnostic peritoneal puncture or posterior vault puncture for non-clotting blood extraction. (3) Uterine operation history and rupture location: among the 12 cases of spontaneous rupture of uterus caused by placenta percreta pregnant women, 10 had placenta previa after cesarean section, including 4 cases of rupture at the incision of the original cesarean section, 3 cases of rupture at the penetrating placental implantation of the lower segment of the anterior wall of the uterus, and 1 case of placenta percreta occurred at the myomectomy site of the right angle of the uterus. Among the 2 pregnant women with spontaneous uterine rupture caused by penetrating placental implantation without a history of cesarean section, 1 case with history of multiple abortions, and uterine rupture occurred at the bottom of the palace, 1 had rupture of placental penetrating implantation after hysteroscopic electroresection of endometrial polyps, and the uterine rupture occurred at the anterior wall of the lower segment of the uterus. (4) Maternal and fetal outcomes: 11 pregnant women were injected with suspension RBC and 1 pregnant woman was not injected with blood products. Nine cases underwent hysteroplasty and 3 cases underwent subtotal hysterectomy. There were 11 maternal survivors and 1 maternal death; 7 neonates survived and 6 stillbirths. Conclusions:Uterine rupture caused by placenta percreta is of great harm to mother and infant, due to its heterogeneity in clinical manifestations, which increases the possibility of misdiagnosis. For pregnant women with risk factors of placenta percreta, early diagnosis should be made during pregnancy. For those who have been diagnosed with placenta percreta, when there is typical or atypical uterine rupture, doctors should be alert to the occurrence of uterine rupture.

Objective:To explore the effects of pregnancy complicated with Takayasu arteritis (TA) on maternal and fetal outcomes.Methods:The clinical data of 17 TA patients with pregnancy and finally terminated admitted to the First Affiliated Hospital of Zhengzhou University from January 2012 to December 2020 were collected and the maternal and infant outcomes were retrospectively analyzed.Results:Among the 24 pregnancies in 17 TA patients in our hispital, 11 patients in our hospital were primiparous (46%, 11/24) and 13 patients were multiparous (54%, 13/24); 4 cases of chronic hypertension before pregnancy (17%, 4/24), and 20 cases of non-hypertension (83%, 20/24) were abserved. Apart from the thoracoabdominal artery type, 15 cases (63%, 15/24) of brachiocephalic type, 8 cases (33%, 8/24) of extensive type, and 1 case of pulmonary artery type (4%, 1/24) were included in TA classification; the renal artery was damaged in 7 cases (7/8) of the extensive type. Among the 24 pregnancies of 17 TA patients, 8 cases of pregnancy complications occurred, including 4 cases (17%, 4/24) of preeclampsia, one case of (4%, 1/24) new-onset hypertension during pregnancy, exacerbation of existing hypertension, thrombocytopenia and ischemic stroke respectively; 3 cases of induced abortion, 1 case of induced labor, and 20 cases of final delivery were found. Of the 20 final deliveries, 3 cases (15%, 3/20) were delivered through the vagina; 17 cases (85%, 17/20) were delivered by cesarean section; 3 cases (15%, 3/20) of fetal growth restriction and 6 cases of oligohydramnios (30%, 6/20) were occurred. The median gestational age of pregnancy termination of 17 full-term neonates (85%, 17/20) and 3 premature neonates (15%, 3/20) was 38.4 weeks (range:29.6-40.9 weeks). All premature women were complicated with pre-eclampsia or severe pre-eclampsia, which lead to premature birth; the birth weight of the neonates was (2 791±783) g. Neonatal asphyxia occurred in 3 cases (15%, 3/20), and 6 cases (30%, 6/20) were admitted to the neonatal intensive care unit. None of the newborns died. The patients were followed up for 3 months to 7 years. Except for one case who underwent surgical treatment 3 years after delivery and died of intraoperative hemorrhage, the other 16 patients were in stable condition; all the newborns grew and developed well. The incidences of maternal and infant adverse events were higher in those with chronic hypertension, renal artery involvement, and no use of hormones and aspirin during pregnancy, but the differences were not statistically significant (all P>0.05). Conclusions:Pregnancy with TA has adverse effects on maternal and infant outcomes. To reduce the occurrence of maternal and child adverse events, the condition of TA patients should be fully assessed before pregnancy, multidisciplinary cooperation, regular treatment, strengthened monitoring of the condition, timely treatment of complications, selection of appropriate delivery methods after pregnancy, and vigilance of postpartum complications should be properly carried out.