Dan Shan

Background: Placenta accreta spectrum can cause catastrophic hemorrhage. Knotless barbed suture line has been considered to reduce bleeding during cesarean section (CS). The purpose of this study was to determine whether the use of knotless barbed suture line could effectively reduce bleeding in patients with placenta accreta and placenta increta. Methods: After obtaining ethical approval, we performed a retrospective cohort study between women with the barbed suture (n = 42) and no barbed suture (control, n = 42). In the barbed suture group, the bleeding site from the damaged myometrium layer caused by the placenta villous invasion was sutured by barbed line with a continuous running suture made in the myometrium layer. In the control group, the uterine incision was repaired with two layers of a continuous suture using the conventional polyglactin suture line. Primary outcomes were the blood loss during the CS and blood loss in the first 24 hours after surgery. Results: The total sample size was 84 (42 in the barbed suture group, another 42 in the control group). Blood loss during CS was significantly lower than the control group by an average of approximately 200 mL (848.57 ± 373.20 mL in the barbed suture group vs. 1055.95 ± 470.88 mL in the control group, p = 0.028). Blood loss during the first 24 hours was also diminished in the barbed suture group (42.70 ± 36.71 mL in the barbed suture group vs. 65.60 ± 61.44 mL in the control group, p = 0.041). Conclusions: The application of barbed suture line reduced blood loss both during CS and after 24 hours of CS.

Both thyroid hormones and irisin have profound influences on the metabolism of the human body. Based on their similarities, several studies have been conducted to explore changes in irisin levels in patients with hypothyroidism and hyperthyroidism. This study was conducted in accordance with the PRISMA statement and the MOOSE reporting guideline. Based on a preregistered protocol (PROSPERO—CRD42019138430), a comprehensive search of eight databases was performed from inception to April 2020. Studies with original data collected from patients with thyroid dysfunction were included. Subgroup analysis was performed based on the different types of clinical manifestations and patient characteristics. The quality of each study and the presence of publication bias were assessed by the Newcastle‐Ottawa score (NOS) and funnel plot with Egger’s test, respectively. A total of 11 studies with 1210 participants were included. Ten studies were identified as high‐quality studies. Pooled analysis indicated decreased irisin levels in patients with hypothyroidism (MD ‐10.37, 95% CI ‐17.81 to ‐2.93). Subgroup analysis revealed an even lower level of irisin in patients with clinical‐type hypothyroidism (MD ‐17.03, 95% CI ‐30.58 to ‐3.49) and hypothyroidism caused by autoimmune disease (MD ‐19.38, 95% CI ‐36.50 to ‐2.26). No differences were found after achieving euthyroid status from levothyroxine treatment in patients with hypothyroidism compared with controls. No differences were found between patients with hyperthyroidism and controls. Correlation analyses revealed a possible negative correlation between irisin and TSH and positive correlations between irisin and both fT3 and fT4. Irisin was correlated with TSH receptor antibodies.

Since the discovery of cell-free foetal DNA in the plasma of pregnant women, many non-invasive prenatal testing assays have been developed. In the area of skeletal dysplasia diagnosis, some PCR-based non-invasive prenatal testing assays have been developed to facilitate the ultrasound diagnosis of skeletal dysplasias that are caused by de novo mutations. However, skeletal dysplasias are a group of heterogeneous genetic diseases, the PCR-based method is hard to detect multiple gene or loci simultaneously, and the diagnosis rate is highly dependent on the accuracy of the ultrasound diagnosis. In this study, we investigated the feasibility of using targeted capture sequencing to detect foetal de novo pathogenic mutations responsible for skeletal dysplasia. Three families whose foetuses were affected by skeletal dysplasia and two control families whose foetuses were affected by other single gene diseases were included in this study. Sixteen genes related to some common lethal skeletal dysplasias were selected for analysis, and probes were designed to capture the coding regions of these genes. Targeted capture sequencing was performed on the maternal plasma DNA, the maternal genomic DNA, and the paternal genomic DNA. The de novo pathogenic variants in the plasma DNA data were identified using a bioinformatical process developed for low frequency mutation detection and a strict variant interpretation strategy. The causal variants could be specifically identified in the plasma, and the results were identical to those obtained by sequencing amniotic fluid samples. Furthermore, a mean of 97% foetal specific alleles, which are alleles that are not shared by maternal genomic DNA and amniotic fluid DNA, were identified successfully in plasma samples. Our study shows that capture sequencing of maternal plasma DNA can be used to non-invasive detection of de novo pathogenic variants. This method has the potential to be used to facilitate the prenatal diagnosis of skeletal dysplasia.