Guoqiang Sun

Prophylactic abdominal aortic balloon occlusion (AABO) is a hemostasis intervention for patients with placenta accreta spectrum (PAS). However, many PAS patients with prophylactic AABO still experience postpartum hemorrhage (PPH). This study aimed to investigate the risk factors for PPH in PAS patients undergoing prophylactic AABO. This retrospective study (2018-2024) was conducted at a tertiary hospital. PAS women undergoing prophylactic AABO before cesarean section were enrolled and divided into the PPH group and the non-PPH (NPPH) group. The clinical characteristics, ultrasound and magnetic resonance imaging (MRI) findings, and delivery outcomes were compared. The LASSO regression and multivariable logistic regression were used to identify risk factors for PPH and to construct a nomogram prediction model. In total, 126 women were included, of whom 56 experienced PPH (44.4%). Compared to those in the NPPH group, the PPH group had higher gravidity (P = 0.022) and parity (P = 0.002), fewer gestational weeks at cesarean (34.9 vs. 35.6, P = 0.026), higher ultrasound scores (7 vs. 11, P < 0.001) and MRI-based PAS grades (P < 0.001). By integrating the results of the two regression methods, we constructed the nomogram to predict PPH risk. The ROC curve of the nomogram showed moderate discriminative ability, with an AUC of 0.749 (95% CI: 0.664-0.834). Prophylactic AABO does not completely prevent the occurrence of PPH. The nomogram intergrating gravidity, parity, ultrasound score and MRI-based PAS grades can assist clinicians in identifying high-risk PAS patients at an early stage, which is beneficial for the preoperative assessment.

Purpose: This study aimed to investigate the predictive effects of atherogenic indices and remnant cholesterol on the risk of GDM. Patients and Methods: This observational study was conducted based on the Hospital’s clinical information system. A total of 6619 participants including 2054 GDM patients and 4565 controls were obtained. Serum lipid data, including triglyceride (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL−C), and low-density lipoprotein cholesterol (LDL−C) levels were collected. Atherogenic indices including TG/HDL−C, TC/HDL−C, and LDL−C/HDL−C, and remnant cholesterol were regarded as independent variables, and GDM was regarded as the dependent variable. Logistic regression analyses, nomogram analysis, decision curve analysis (DCA), and restricted cubic spline (RCS) analysis were applied to explore the impact of atherogenic indices and remnant cholesterol on GDM. Results: The prevalence of GDM was 31.03% in this study. In comparison to the 1st quartile, the 4th quartile levels of atherogenic indices and remnant cholesterols were significantly associated with increased risks of gestational diabetes mellitus (GDM). The odds ratios (OR) for these associations were as follows: OR = 1.66 (95% CI: 1.41, 1.96) for TG/HDL−C; OR = 1.47 (95% CI: 1.24, 1.73) for TC/HDL−C; OR = 1.47 (95% CI: 1.24, 1.73) for LDL−C/HDL−C; and OR = 1.39 (95% CI: 1.18, 1.64) for remnant cholesterol. The DCA results confirmed the reliable clinical utility of GDM prediction by atherogenic indices and remnant cholesterol. The RCS regression analysis revealed the nonlinear relationships between the atherogenic indices, remnant cholesterol and GDM. Conclusion: This study revealed the potential predictive effects of atherogenic indices and remnant cholesterol on GDM. These findings underscore the potential of routine lipid testing as a cost-effective strategy for the early identification and management of GDM in clinical settings.

Objectives: As current studies on the relationships between air pollutants exposure during the first trimester and birth defects were not fully elucidated, this study aimed to assess the association between selected air pollutants and birth defects. Design: An observational study. Participants: We obtained 70 854 singletons with gestational age 10 ), PM ≤2.5 µm diameter (PM _2.5 ), sulfur dioxide (SO ₂ ) and nitrogen dioxide (NO ₂ ) were obtained. Logistic regression analysis was applied to assess the association between maternal air pollutants exposure during first trimester and total birth defects, congenital heart defects (CHDs), limb defects and orofacial clefts with adjustments of potential covariates. Results: There were a total of 1352 birth defect cases included in this study, with a prevalence of 19.08‰. Maternal exposed to high concentrations of PM ₁₀ , PM _2.5 , NO ₂ and SO ₂ in the first trimester were significantly associated with elevated ORs of birth defects (ORs ranged from 1.13 to 1.23). Additionally, for male fetuses, maternal exposed to high PM _2.5 concentration was associated with an elevated odd of CHDs (OR 1.27, 95% CI 1.06 to 1.52). In the cold season, the ORs of birth defects were significantly increased among women exposed to PM _2.5 (OR 1.64, 95% CI 1.41 to 1.91), NO ₂ (OR 1.22, 95% CI 1.08 to 1.38) and SO ₂ (OR 1.26, 95% CI 1.07 to 1.47). Conclusions: This study showed unfavourable effects of air pollutants exposure during the first trimester on birth defects. Especially, the association between maternal PM _2.5 exposure and CHDs was only observed among male fetuses, and stronger effects of PM _2.5 , NO ₂ and SO ₂ exposure on birth defects were observed in the cold season.

Impaired invasion of EVTs results in inadequate remodelling of arteries and poor placentation, leading to PE. TMBIM4 was found to promote the migration and invasion of human osteosarcoma U2-OS and breast cancer MCF7 cell lines. However, the effect of TMBIM4 on trophoblast biological behaviour and its relevance to PE pathophysiology remain unclear. In this study, we confirmed that TMBIM4 was highly expressed in cytotrophoblasts, syncytiotrophoblasts, and EVTs of the human placenta during early pregnancy. By comparing the expression levels of TMBIM4 in the placenta of women with normal-term pregnancy and PE, TMBIM4 was found to be significantly decreased in PE. Thereafter, we determined the expression of TMBIM4 in the LPS-treated first-trimester human trophoblast cell line HTR-8/SVneo (mimicking a PE-like cell model), and determined the effect of TMBIM4 on trophoblast function and its underlying mechanism. LPS treatment reduced the expression of TMBIM4 and induced NLRP3 inflammasome activity in HTR-8/SVneo cells. KO of TMBIM4 in the HTR-8/SVneo cell line impaired cell viability, migration, and invasion, which was more severe in the LPS/ATP-treated TMBIM4-KO cell line. Moreover, TMBIM4 deficiency enhanced NLRP3 inflammasome activity and promoted subsequent pyroptosis, with or without LPS/ATP treatment. The negative relationship between TMBIM4 expression and NLRP3 inflammatory activity was verified in PE placentas. Inhibiting the NLRP3 inflammasome with MCC950 in HTR-8/SVneo cells alleviated LPS/ATP-induced pyroptosis and damaged cell function in the TMBIM4-KO cell line. Overall, this study revealed a new PE-associated protein, TMBIM4, and its biological significance in trophoblast pyroptosis mediated by the NLRP3 inflammasome. TMBIM4 may serve as a potential target for the treatment of placental inflammation-associated PE.

Purpose: In order to gain more knowledge on the risk of gestational diabetes mellitus (GDM), and to provide evidence for clinical guidance on the optimum level of serum folic acid and vitamin B12, this study aimed to clarify the relationship between serum folic acid and vitamin B12 and the risk of GDM. Patients and Methods: This retrospective case−control study was conducted based on the clinical information system of the Maternal and Child Health Hospital of Hubei Province. Clinical data including maternal socio-demographical characteristics, serum folic acid, and vitamin B12 were collected. Logistic regression analyses and restricted cubic splines were performed to examine the impact of serum folic acid and vitamin B12 on the risk of GDM. Results: Significantly elevated risks of GDM were observed in groups with high serum folic acid concentration (OR = 1.84, 95% CI: 1.07− 3.16), and in low vitamin B12 concentration (OR = 2.14, 95% CI: 1.26− 3.65). After stratified by age, the increased risk of GDM was still noticed in a low level of vitamin B12 among mothers aged < 30 years (OR = 4.76, 95% CI: 1.45− 15.61). In mothers with pre−pregnancy BMI < 24, elevated risk of GDM was significantly associated with a high folic acid (OR = 2.09, 95% CI: 1.11− 3.93) or a low vitamin B12 concentration (OR = 2.24, 95% CI: 1.22− 4.14). Moreover, the risk of GDM was on the decline with the increased level of folic acid in the beginning, and it started to manifest an upward trend when the serum folic acid reached 19.02 ng/mL. Conclusion: This study demonstrated that serum folic acid excess or vitamin B12 deficiency could contribute to the increased risk of GDM, and revealed the potential side effect of serum folic acid overdose. As serum folic acid and vitamin B12 tests are widely applied in clinical practice, this finding could help clinicians to evaluate maternal risk from a new perspective.

Cervical cancer (CC) is one of the most common gynecological malignancies, ranking fourth in both incidence and mortality in women worldwide. Early screening and treatment are of great significance in reducing the incidence and mortality of CC. Due to the complex molecular mechanisms of tumor progression, the predictive power of traditional clinical information is limited. In this study, an effective molecular model is established to assess prognosis of patients with CC and guide clinical treatment so as to improve their survival rate. Three high quality datasets (GSE138080, GSE52904, GSE67522) of expression profiling were obtained from gene expression omnibus (GEO) database. Another mRNA expression and clinicopathological data of CC were obtained from The Cancer Genome Atlas (TCGA) dataset. The bioinformatic analyses such as univariate analysis, multivariate Cox proportional-hazards model (Cox) analysis and lasso regression analysis were conducted to select survival-related differentially expressed genes (DEGs) and further establish a prognostic gene signature. Moreover, the performance of prognostic gene signature was evaluated based on Kaplan–Meier curve and receiver operating characteristic (ROC) curve. Gene set enrichment analysis (GSEA) and tumor immunity analysis were carried out to elucidate the molecular mechanisms and immune relevance. A 4-gene signature comprising procollagen-lysine, 2-oxoglutarate 5-dioxygenase 2 (PLOD2), spondin1 (SPON1), secreted phosphoprotein 1 (SPP1), ribonuclease H2 subunit A (RNASEH2A) was established to predict overall survival (OS) of CC. The ROC curve indicated good performance of the 4-gene signature in predicting OS of CC based on the TCGA dataset. The 4-gene signature classified the patients into high-risk and low-risk groups with distinct OS rates of CC. Univariate analysis and multivariate Cox regression analysis revealed that the 4-gene signature was an independent factor affecting the prognosis of patients with CC. Our study developed a 4-gene signature capable of predicting the OS of CC. The findings may be beneficial to individualized clinical treatment and timely follow-up for patients with CC.

Corrigendum: Impact of SARS-CoV-2 Infection During Pregnancy on Infant Neurobehavioral Development: A Case-Control Study

There is no information concerning the prevalence of thalassemia among pregnant women in Hubei Province currently. This study is aimed to explore the prevalence of α- and β-thalassemia genotypes among pregnant women in Hubei Province, and to explore the clinically applicable screening approach, as well as to investigate the pregnancy outcomes of α- and β-thalassemia carriers. Pregnant participants were recruited from 4 hospitals for the screening of α- and β-thalassemia mutations in Hubei Province. Polymerase Chain Reaction and flow cytometry methods were used to examine α- and β-thalassemia mutations. The hematological parameters and pregnancy outcomes of α- and β-thalassemia carriers were obtained from the hospital information system. The chi-square tests were used to evaluate the difference in hematological parameters between pregnant thalassemia carriers and the control group. Among 11,875 participants, 414 (3.49%) were confirmed with α-thalassemia carriers, 228 (1.92%) were confirmed with β-thalassemia carriers, and 3 (0.03%) were confirmed with both α- and β-thalassemia carriers. The frequency of –α^3.7 accounted for 2.05% and it was the most frequent genotype of α-thalassemia; the proportion of IVS-II-654 was 0.85% and it was the most frequent genotype of β-thalassemia in Hubei Province. Furthermore, the proportion of patients with low mean corpuscular volume (MCV) or mean cell hemoglobin (MCH) values was accounted for 36.64% and 93.97% among α-thalassemia and β-thalassemia carriers, respectively. And participants with normal MCV and MCH values were accounted for 95.07% among non-thalassemia participants. High prevalence of pregnancy-induced diabetes (16.97%), preterm birth (9.96%), pregnancy-induced hypertension (8.12%), and low birth weight (5.90%) were observed among pregnant thalassemia carriers. MCV and MCH values were suggested to apply on the preliminary screening of pregnant β-thalassemia; however, it's unpractical on that of α-thalassemia. Furthermore, thalassemia carriers might have a high risk of negative pregnancy outcomes. These findings could be useful for the preliminary screening of thalassemia and perinatal care for the pregnant thalassemia carriers.

Background: Previous studies on the pneumonia outbreak caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have focused on the general population and pregnant women, while little is known about the effects of SARS-CoV-2 on retardation during and after pregnancy. The purpose of this study was to evaluate the potential influence of SARS-CoV-2 on infant neurobehavioral development.Methods: A case-control study was conducted in Maternal and Child Health Hospital of Hubei Province. Nine pregnant women with SARS-CoV-2 infection and 9 controls matched by maternal age, parity, and status of chronic disease were included. Infantile neurobehavioral development was assessed through the Ages and Stages Questionnaires Edition 3 (ASQ-3).Results: The majority of pregnant women with SARS-CoV-2 experienced cesarean section (7 of 9), which was higher than the control group (5 of 9). The throat swabs of all newborn were negative. We found that compared with the control group, neonates of mothers with SARS-CoV-2 infection during pregnancy had lower scores in communication, gross movement, fine movement, problem solving, and personal-social domains; but only fine movement domain yielded statistical significance (P = 0.031).Conclusion: Infection with SARS-CoV-2 during pregnancy may have a certain impact on infant neurobehavioral development. Further studies with larger sample size are warranted for validation.

Objective: To build a reference fetal growth chart for the Chinese population based on fetal ultrasound measurements. Methods: This was a multicenter, population-based retrospective cohort study. Longitudinal ultrasound measurement data were collected from 24 hospitals in 18 provinces of China from 1^st September through 31^st October of 2019. The estimated fetal weight (EFW) was calculated based on head circumference, abdominal circumference, and femur length using Hadlock formula 3. Fetal growth curves were estimated using a two-level linear regression model with cubic splines. All participants were divided into two groups: the northern group (n = 5829) and the southern group (n = 3246) based on the geographical division of China and male fetus group (n = 4775) and female fetus group (n = 4300) based on fetal gender. The EFW was compared by fetal gender and geographical group. All statistical models were adjusted for maternal sociodemographic characteristics. Results: A total of 9075 participants with 31,700 ultrasound measurement records were included in this study. Male fetuses demonstrated significantly larger EFW compared to female ones starting at 16 weeks of gestation and extending to delivery (global test P < 0.01). The overall geographic difference in EFW was significant (global test P = 0.03), and week-specific comparisons showed that the northern group had a greater EFW starting at 15 weeks of gestation and extending to 29 weeks of gestation, although this difference did not extend to the time of delivery. The Z-score of EFW confirmed that our Chinese fetal growth charts differed from previously published standards. Conclusion: This study provides EFW and ultrasound biometric reference measurements for Chinese fetuses and reveals differences from other fetal growth charts. The chart is worth promoting in more regions of China but should be tested prudently before use.