Publications by authors named "Huixia Yang"

133 Publications

An Immune-Gene-Based Classifier Predicts Prognosis in Patients With Cervical Squamous Cell Carcinoma.

Front Mol Biosci 2021 5;8:679474. Epub 2021 Jul 5.

Department of Gynecology and Obstetrics, Beijing Friendship Hospital, Capital Medical University, Beijing, China.

Immunity plays a vital role in the human papilloma virus (HPV) persistent infection, and closely associates with occurrence and development of cervical squamous cell carcinoma (CSCC). Herein, we performed an integrated bioinformatics analysis to establish an immune-gene signature and immune-associated nomogram for predicting prognosis of CSCC patients. The list of immunity-associated genes was retrieved from ImmPort database. The gene and clinical information of CSCC patients were obtained from The Cancer Genome Atlas (TCGA) website. The immune gene signature for predicting overall survival (OS) of CSCC patients was constructed using the univariate Cox-regression analysis, random survival forests, and multivariate Cox-regression analysis. This signature was externally validated in GSE44001 cohort from Gene Expression Omnibus (GEO). Then, based on the established signature and the TCGA cohort with the corresponding clinical information, a nomogram was constructed and evaluated Cox regression analysis, concordance index (C-index), receiver operating characteristic (ROC) curves, calibration plots and decision curve analyses (DCAs). A 5-immune-gene prognostic signature for CSCC was established. Low expression of , and high expression of , , were risk factors for CSCC prognosis indicating poor OS. Based on this signature, the OS was significantly worse in high-risk group than in low-risk group (-value < 0.001), the area under curves (AUCs) for 1-, 3-, 5-years OS were, respectively, 0.784, 0.727, and 0.715. A nomogram incorporating the risk score of signature and the clinical stage was constructed. The C-index of this nomogram was 0.76. AUC values were 0.811, 0.717, and 0.712 for 1-, 3-, 5-years OS. The nomogram showed good calibration and gained more net benefits than the 5-immune-gene signature and the clinical stage. The 5-immune-gene signature may serve as a novel, independent predictor for prognosis in patients with CSCC. The nomogram incorporating the signature risk score and clinical stage improved the predictive performance than the signature and clinical stage alone for predicting 1-year OS.
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http://dx.doi.org/10.3389/fmolb.2021.679474DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8289438PMC
July 2021

Epitaxial growth of Bi(110) and BiSethin films on a ferromagnetic insulator substrate of CrGeTe.

J Phys Condens Matter 2021 Aug 3;33(41). Epub 2021 Aug 3.

Key Laboratory of Advanced Optoelectronic Quantum Architecture and Measurement, Ministry of Education, School of Physics, Beijing Institute of Technology, Beijing, 100081, People's Republic of China.

When a topological insulator (TI) is brought to the proximity of a ferromagnetic insulator (FMI), the breaking of the time-reversal symmetry may give rise to quantum anomalous Hall effect (QAHE). The physical properties of such TI-FMI systems are greatly affected by the interfacial structures of the components. Here, we report the growth and structural properties of Bi(110) and BiSethin films on a FMI of CrGeTe(CGT) substrate by scanning tunneling microscopy. We observed various defects and impurities on the CGT surfaces, which serve as the preferential sites for initial nucleation and epitaxial growth of Bi(110) thin films. The exposure of the as-grown Bi(110) thin films to Se vapor leads to the formation of polycrystalline BiSethin films with randomly distributed holes. The structure and composition of the as-prepared BiSethin films were further confirmed by Raman spectroscopy and x-ray photoelectron spectroscopy. Our work shows that the quality of the CGT crystals is vital for the growth of high-quality TIs on CGT substrates for QAHE.
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http://dx.doi.org/10.1088/1361-648X/ac1535DOI Listing
August 2021

Real-World Acceptance of COVID-19 Vaccines among Healthcare Workers in Perinatal Medicine in China.

Vaccines (Basel) 2021 Jun 27;9(7). Epub 2021 Jun 27.

Departments of Laboratory Medicine and Biomedicine Statistics, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing 210008, China.

Surveys showed that vaccine hesitancy may influence the acceptance of COVID-19 vaccines in healthcare workers (HCWs) and the general population. Currently, the actual acceptance of COVID-19 vaccination in HCWs has rarely been reported. In the present survey, we investigated the real-world acceptance of COVID-19 vaccination in HCWs in perinatal medicine during the first three-month period of vaccination in China and to identify the main reason for the decline of vaccination. HCWs (1087) who participated in a Chinese national symposium on perinatal medicine during 16-18 April 2021 were invited to answer a 27-question questionnaire online. A total of 1051 HCWs completed the questionnaire. Of them, 86.2% (906/1051) accepted the COVID-19 vaccination and 13.8% (145/1051) declined the vaccination. Because of the vaccine hesitancy, one-fourth of the vaccinated participants did not accept the vaccination until consulted with others or requested by employers. The main reason for the decline of vaccination in 145 unvaccinated HCWs was the concern about vaccine safety. The results indicate that vaccination request by employers may promote vaccine acceptance. More convincing data on the safety of COVID-19 vaccines appears to be important to increase the acceptance of vaccination.
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http://dx.doi.org/10.3390/vaccines9070704DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8310137PMC
June 2021

Expectant management of cesarean scar pregnancy in 13 patients.

J Matern Fetal Neonatal Med 2021 Jun 23:1-6. Epub 2021 Jun 23.

Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China.

Objective: To monitor Cesarean scar pregnancy (CSP) patients preferring to continue their pregnancy and analyze their clinical characteristics as well as maternal and fetal outcomes.

Methods: A retrospective cohort study including 13 pregnant women diagnosed with CSP (including types I, II, III) and continued their pregnancy with cautious monitoring at Peking University First Hospital between January, 2014 and December, 2018.

Results: 8/13 (61.5%) of them delivered after 28 weeks and finally gave birth to healthy babies with 3 term births and 5 preterm births (one of them which suspected placenta percreta received hysterectomy for massive bleeding and hemorrhagic shock at 34 weeks). 2/13 (15.4%) of them terminated their pregnancy at second trimester by Cesarean section for ultrasonic manifestation of placenta percreta with or without threatened uterine rupture. 1/13 (7.7%) of them went through induced labor due to inevitable abortion and needed dilatation and evacuation afterwards at 20 weeks. 2/13 (15.4%) of those patients with twin pregnancy chose fetal reduction to keep the non-CSP fetus at 8 weeks and 11 weeks. No maternal or fetal death was observed.

Conclusions: During expectant management, type I CSP patients were at little risk for developing into placenta percreta and rather save for continue pregnancy to having babies. Type II and type III CSP patients usually ended up with placenta percreta and better terminated their pregnancy immediately.
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http://dx.doi.org/10.1080/14767058.2021.1940942DOI Listing
June 2021

O-GlcNAcylation in Hyperglycemic Pregnancies: Impact on Placental Function.

Front Endocrinol (Lausanne) 2021 1;12:659733. Epub 2021 Jun 1.

Department of Obstetrics and Gynaecology, Peking University First Hospital, Beijing, China.

The dynamic cycling of -acetylglucosamine, termed as O-GlcNAcylation, is a post-translational modification of proteins and is involved in the regulation of fundamental cellular processes. It is controlled by two essential enzymes, O-GlcNAc transferase and O-GlcNAcase. O-GlcNAcylation serves as a modulator in placental tissue; furthermore, increased levels of protein O-GlcNAcylation have been observed in women with hyperglycemia during pregnancy, which may affect the short-and long-term development of offspring. In this review, we focus on the impact of O-GlcNAcylation on placental functions in hyperglycemia-associated pregnancies. We discuss the following topics: effect of O-GlcNAcylation on placental development and its association with hyperglycemia; maternal-fetal nutrition transport, particularly glucose transport, the mammalian target of rapamycin and AMP-activated protein kinase pathways; and the two-sided regulatory effect of O-GlcNAcylation on inflammation. As O-GlcNAcylation in the placental tissues of pregnant women with hyperglycemia influences near- and long-term development of offspring, research in this field has significant therapeutic relevance.
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http://dx.doi.org/10.3389/fendo.2021.659733DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8204080PMC
June 2021

Expression of the Carbohydrate Lewis Antigen, Sialyl Lewis A, Sialyl Lewis X, Lewis X, and Lewis Y in the Placental Villi of Patients With Unexplained Miscarriages.

Front Immunol 2021 31;12:679424. Epub 2021 May 31.

Department of Obstetrics and Gynaecology, University Hospital LMU Munich, Munich, Germany.

Background: Lewis antigens such as Sialyl Lewis A (sLeA), Sialyl Lewis X (sLeX), Lewis X (LeX), and Lewis Y (LeY) are a class of carbohydrate molecules that are known to mediate adhesion between tumor cells and endothelium by interacting with its selectin ligands. However, their potential role in miscarriage remains enigmatic. This study aims to analyze the expression pattern of sLeA, sLeX, LeX, and LeY in the placental villi tissue of patients with a medical history of unexplained miscarriages.

Methods: Paraffin-embedded slides originating from placental tissue were collected from patients experiencing a miscarriage early in their pregnancy (6-13 weeks). Tissues collected from spontaneous (n = 20) and recurrent (n = 15) miscarriages were analyzed using immunohistochemical and immunofluorescent staining. Specimens obtained from legally terminated normal pregnancies were considered as control group (n = 18). Assessment of villous vessel density was performed in another cohort (n = 10 each group) of gestation ages-paired placenta tissue. Protein expression was evaluated with Immunoreactive Score (IRS). Statistical analysis was performed by using Graphpad Prism 8.

Results: Expression of sLeA, sLeX, LeX, and LeY in the syncytiotrophoblast was significantly upregulated in the control group compared with spontaneous and recurrent miscarriage groups. However, no prominent differences between spontaneous and recurrent miscarriage groups were identified. Potential key modulators ST3GAL6 and NEU1 were found to be significantly downregulated in the recurrent miscarriage group and upregulated in the spontaneous group, respectively. Interestingly, LeX and LeY expression was also detected in the endothelial cells of villous vessels in the control group but no significant expression in miscarriage groups. Furthermore, assessment of villous vessel density using CD31 found significantly diminished vessels in all size groups of villi (small villi <200 µm, = 0.0371; middle villi between 200 and 400 µm, = 0.0010 and large villi >400 µm, = 0.0003). Immunofluorescent double staining also indicated the co-localization of LeX/Y and CD31.

Conclusions: The expression of four mentioned carbohydrate Lewis antigens and their potential modulators, ST3GAL6 and NEU1, in the placenta of patients with miscarriages was significantly different from the normal pregnancy. For the first time, their expression pattern in the placenta was illustrated, which might shed light on a novel understanding of Lewis antigens' role in the pathogenesis of miscarriages.
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http://dx.doi.org/10.3389/fimmu.2021.679424DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8202085PMC
May 2021

USP22 regulates the formation and function of placental vasculature during the development of fetal growth restriction.

Placenta 2021 Aug 9;111:19-25. Epub 2021 Jun 9.

Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China. Electronic address:

Introduction: Fetal growth restriction (FGR) is a common obstetric complication that can lead to a variety of adverse perinatal outcomes and is associated with chronic diseases in adulthood. Since ubiquitin-specific protease 22 (USP22) is closely related to cell growth, differentiation and proliferation, we aimed to investigate the role of USP22 in FGR development.

Methods: USP22 expression was detected in the placentas of eight normal and eight pregnant women with FGR. To observe changes in the formation and function of placental vasculature, USP22 expression was downregulated in human umbilical vein endothelial cells (HUVECs) using CRISPR/Cas9 and siRNAs. In addition, HUVECs with low and normal USP22 expression were analysed using RNA-seq.

Results: We found that USP22 expression was significantly lower in the placentas of pregnant women with FGR than in normal pregnant women and that HUVECs were unable to survive after USP22 had been knocked out. Moreover, USP22 down-regulation in HUVECs led to decreased proliferation, angiogenesis, vasodilation, apoptosis, and systolic function. RNA-seq identified 3730 differentially expressed genes that were enriched in multiple signalling pathways, including cell cycle regulation, apoptotic signalling, and PI3K/Akt.

Discussion: Together, the findings of this study demonstrate for the first time that abnormal USP22 expression may affect HUVEC proliferation and apoptosis, as well as essential angiogenesis and vasomotor functions during the development of FGR.
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http://dx.doi.org/10.1016/j.placenta.2021.05.003DOI Listing
August 2021

Analysis of the changes of electron transfer and heterogeneity of photosystem II in Deg1-reduced Arabidopsis plants.

Photosynth Res 2021 May 16. Epub 2021 May 16.

Photosynthesis Research Center, Key Laboratory of Photobiology, Institute of Botany, Chinese Academy of Sciences, Beijing, 100093, China.

Deg1 protease functions in protease and chaperone of PSII complex components, but few works were performed to study the effects of Deg1 on electron transport activities on the donor and acceptor side of PSII and its correlation with the photoprotection of PSII during photoinhibition. Therefore, we performed systematic and comprehensive investigations of electron transfers on the donor and acceptor sides of photosystem II (PSII) in the Deg1-reduced transgenic lines deg1-2 and deg1-4. Both the maximal quantum efficiency of PSII photochemistry (F/F) and the actual PSII efficiency (Φ) decreased significantly in the transgenic plants. Increases in nonphotochemical quenching (NPQ) and the dissipated energy flux per reaction center (DI/RC) were also shown in the transgenic plants. Along with the decreased D1, CP47, and CP43 content, these results suggested photoinhibition under growth light conditions in transgenic plants. Decreased Deg1 caused inhibition of electron transfer on the PSII reducing side, leading to a decline in the number of Q-reducing centers and accumulation of Q-nonreducing centers. The Tm of the Q band shifted from 5.7 °C in the wild-type plant to 10.4 °C and 14.2 °C in the deg1-2 and deg1-4 plants, respectively, indicating an increase in the stability of SQ in transgenic plants. PSIIα in the transgenic plants largely reduced, while PSIIβ and PSIIγ increased with the decline in the Deg1 levels in transgenic plants suggesting PSIIα centers gradually converted into PSIIβ and PSIIγ centers in the transgenic plants. Besides, the connectivity of PSIIα and PSIIβ was downregulated in transgenic plants. Our results reveal that downregulation of Deg1 protein levels induced photoinhibition in transgenic plants, leading to loss of PSII activities on both the donor and acceptor sides in transgenic plants. These results give a new insight into the regulation role of Deg1 in PSII electron transport.
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http://dx.doi.org/10.1007/s11120-021-00842-2DOI Listing
May 2021

Low-dose aspirin for the prevention of severe preeclampsia in patients with chronic kidney disease: a retrospective study : This is the study for kidney and pregnancy...

J Nephrol 2021 Apr 29. Epub 2021 Apr 29.

Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, 100034, People's Republic of China.

Objective: The objective of the study was to investigate the effects of low-dose aspirin (LDA) during pregnancy on the prevention of preeclampsia in patients with chronic kidney disease (CKD).

Methods: The clinical data of pregnant women with CKD were retrospectively analyzed at Peking University First Hospital between January 2013 and January 2020. Among 287 pregnant women with stage 1-2 CKD, 63 patients who were treated with LDA were included in study group 1, and 63 patients who were not treated with aspirin were allocated to control group 1. Among 41 pregnant women with stage 3-5 CKD, 22 patients who were treated with LDA were included in study group 2, and 19 patients were allocated to control group 2. Pregnancy outcomes of the patients with stage 1-2 and stage 3-5 CKD who received LDA during pregnancy and those who did not were compared.

Results: No significant difference was observed in the incidence of preeclampsia or severe preeclampsia between study and control group 1. The patients in study group 2 had a lower incidence of severe preeclampsia than those in control group 2 (3/22 [13.6%] vs. 8/19 [42.1%], P = 0.04). Among the patients with stage 3-5 CKD, LDA therapy during pregnancy was associated with a lower risk of severe preeclampsia (odds ratio = 0.22, 95% confidence interval: 0.074-0.993; P = 0.049).

Conclusions: LDA therapy during pregnancy can reduce the risk of severe preeclampsia in patients with stage 3-5 CKD. Prospective studies are  needed to further explore the preventive effects of aspirin on preeclampsia in patients with stage 1-2 CKD.
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http://dx.doi.org/10.1007/s40620-021-01049-3DOI Listing
April 2021

Tuning Molecular Superlattice by Charge-Density-Wave Patterns in Two-Dimensional Monolayer Crystals.

J Phys Chem Lett 2021 Apr 5;12(14):3545-3551. Epub 2021 Apr 5.

MIIT Key Laboratory for Low-Dimensional Quantum Structure and Devices, School of Information and Electronics, Beijing Institute of Technology, Beijing 100081, China.

Charge density wave (CDW) in two-dimensional (2D) crystals plays a vital role in tuning the interface structures and properties. However, how the CDW tunes the self-assembled molecular superlattice still remains unclear. In this study, we investigated the self-assembled manganese phthalocyanine (MnPc) molecular superlattice on single-layered 1T- and 2H-NbSe crystals under regulation by distinct CDW patterns. We observe that, in low coverage, MnPc molecules preferentially adsorb on 2H-NbSe compared to 1T-NbSe. With increasing coverage, MnPc can form a highly ordered superlattice on 2H-NbSe; however, it is randomly distributed on 1T-NbSe. We reveal a perfect geometric commensurability between the molecular superlattice and intrinsic CDW pattern in 2H-NbSe and a poor commensurability for that of 1T-NbSe. We believe that the subtly different geometric commensurability dominates the different adsorption and arrangement of the molecular superlattices on 2D CDW patterns. Our study provides a pioneering approach for tuning the molecular superlattices using the CDW patterns.
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http://dx.doi.org/10.1021/acs.jpclett.1c00230DOI Listing
April 2021

Evaluation of the value of fasting plasma glucose in the first trimester for the prediction of adverse pregnancy outcomes.

Diabetes Res Clin Pract 2021 Apr 8;174:108736. Epub 2021 Mar 8.

Department of Obstetrics and Gynecology of Peking University First Hospital, Beijing, China; Beijing Key Laboratory of Maternal Fetal Medicine of Gestational Diabetes Mellitus. Electronic address:

Aims: To evaluate the importance and usefulness of fasting plasma glucose (FPG) in the first trimester in predicting adverse pregnancy outcomes.

Methods: A retrospective study of 22,398 singleton pregnancies was conducted. Participants were divided into subgroups according to first-trimester FPG (low FPG, FPG < 5.1 mmol/L; medium FPG, 5.1 mmol/L ≤ FPG < 5.6 mmol/L; high FPG, 5.6 ≤ FPG < 7.0 mmol/L) and oral glucose tolerance test(OGTT) results (normal and abnormal) during pregnancy. Patient characteristics and risk of adverse pregnancy outcomes were compared. Then, the whole population of women with abnormal OGTT served as a reference, and the relative risks of maternal and neonatal complications in normal OGTT women were analyzed by categorical analyses and logistic regression. Subgroup analyses were performed according to pre-pregnancy body mass index (BMI).

Results: The frequency of adverse pregnancy outcomes increased with increasing FPG levels during the first trimester, regardless of OGTT results. High FPG + Abnormal OGTT had the worst outcome. Compared to the whole population of women with abnormal OGTT, Normal OGTT + Medium FPG showed the same risk of PIH and macrosomia. Normal OGTT + High FPG showed the same risk of PIH, macrosomia as well as LGA and preterm birth. Additionally, Normal OGTT + Medium FPG + BMI ≥ 24 kg/m showed significantly higher risk of PIH (OR = 1.867, 1.245-2.800), macrosomia (OR = 1.748, 1.304-2.344) and LGA (OR = 1.274, 1.019-1.593). Furthermore, the OR value for PIH was 3.759 (1.680-8.412) in Normal OGTT + High FPG + BMI ≥ 24 kg/m compared to women with abnormal OGTT.

Conclusions: First-trimester FPG values can help identify women at increased risk for adverse pregnancy outcomes. Increased attention and management should be given to women with early pregnancy FPG ≥ 5.10 mmol/L despite a normal OGTT, especially if their BMI ≥ 24 kg/m.
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http://dx.doi.org/10.1016/j.diabres.2021.108736DOI Listing
April 2021

Validation of a scoring system for prediction of obstetric complications in placenta accreta spectrum disorders.

J Matern Fetal Neonatal Med 2021 Mar 8:1-7. Epub 2021 Mar 8.

Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China.

Background: Placenta accreta spectrum (PAS) refers to a spectrum of conditions characterized by the abnormal adherence of the placenta to the implantation site and has been a challenge due to the risk of postpartum hemorrhage, peripartum hysterectomy and maternal mortality. Despite of sonographic findings, no consensus on the prenatal evaluation of PAS has been established yet. We are aiming to establish a scoring system to increase the accuracy of prediction of PAS severity, especially to differentiate placenta percreta and placenta increta.

Methods: We conducted a retrospective study and collected 2,219 cases of placenta increta and placenta percreta obtained from 20 tertiary care centers in China. Demographic information, clinical characteristics, and sonographic findings were collected. Logistic regression analysis was used to determine the risk factors and sonographic features that were significantly associated with a clinical diagnosis of placenta percreta. The formula and subsequent scoring system were generated. This scoring system was then verified in 67 cases of placenta increta or placenta percreta in Peking University First Hospital from 2016 to 2017. Diagnosis of placental invasion was confirmed by surgical findings or histopathologic results. The scoring system was evaluated using a receiver operating characteristic (ROC) curve.

Results: The scoring system combined maternal risk factors and ultrasound features and was then verified in 67 cases. According to ROC curve, the area under the curve (AUC) of our scoring system for prenatal diagnosis of placenta percreta is 0.96 (95%CI, 0.91-1.00,  < .001), for severe postpartum hemorrhage (≥1500 ml) is 0.76 (95%CI, 0.62-0.91,  = .005), for hysterectomy is 0.98 (95%CI, 0.93-1.000,  = .023).

Conclusions: Our scoring system combining maternal risk factors and ultrasound features can improve the predictive accuracy of placenta percreta and obstetric outcomes (severe hemorrhage and hysterectomy).
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http://dx.doi.org/10.1080/14767058.2020.1847077DOI Listing
March 2021

and Affect Various Stages of Species Biofilm Formation.

Front Cell Infect Microbiol 2021 19;11:568178. Epub 2021 Feb 19.

Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China.

Bacterial vaginosis (BV) and its recurrence are most commonly associated with the formation of species biofilm. Probiotics are typically used to treat BV; however, the optimal period of probiotic application in BV treatment remains uncertain. The present study aimed to explore the effects of and on various stages of biofilm formation in species. The biofilm-forming ability of seven strains, including one ATCC 14018 and six clinically isolated species, was determined gentian violet staining assay. Moreover, the sensitivity of the planktonic and biofilm forms toward metronidazole and clindamycin was assessed microdilution broth method. Xbb-LR-1 and Xbb-LC-1 were added during various stages of biofilm formation in species and were cocultured for 24 h. The biofilm thickness of each sample was determined confocal laser scanning microscopy (CLSM). The absolute quantities of species in each sample was obtained real time polymerase chain reaction method, and the pH value was obtained using a pH indicator paper. Biofilm formation by species in a medium with distinct pH values was observed gentian violet staining, CLSM, and scanning electron microscopy (SEM). The biofilm increased the resistance of species toward metronidazole and clindamycin. added at the initial biofilm formation stage in species exhibited highest inhibitory effect, with a percentage inhibition of 38.17% ± 1.35%. When the pH value of the culture medium was <4.5 or >6.5, ATCC 14018 could hardly form a biofilm; however, at pH ≥4.5 and ≤6.5, it was able to form a stronger biofilm. The amount of biofilm attained maximum value at optical density of 3.29 ± 0.28 (595 nm), pH 5.5, and at 36 h. Biofilm formation increases the resistance of species toward antibiotics. Maintaining an acidic vaginal environment with pH <4.5 and a vaginal microbiota dominated by remarkably prevents the formation of species biofilm at the initial stage, which further has a significant impact on the treatment and prevention of biofilm-related infections.
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http://dx.doi.org/10.3389/fcimb.2021.568178DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7933028PMC
June 2021

Association of Implementation of a Comprehensive Preconception-to-Pregnancy Management Plan With Pregnancy Outcomes Among Chinese Pregnant Women With Type 1 Diabetes: The CARNATION Study.

Diabetes Care 2021 Apr 24;44(4):883-892. Epub 2021 Feb 24.

Faculty of Medicine, Imperial College London, London, U.K.

Objective: To investigate the effect on pregnancy outcome of integrating a comprehensive management plan for patients with type 1 diabetes (T1D) into the World Health Organization universal maternal care infrastructure.

Research Design And Methods: A comprehensive preconception-to-pregnancy management plan for women with T1D was implemented in 11 centers from 8 Chinese cities from 2015 to 2017. Sequential eligible pregnant women ( = 133 out of 137 initially enrolled) with T1D and singleton pregnancies attending these management centers formed the prospective cohort. The main outcome was severe adverse pregnancy outcome comprising maternal mortality, neonatal death, congenital malformations, miscarriage in the second trimester, and stillbirth. We compared pregnancy outcomes in this prospective cohort with two control groups with the same inclusion and exclusion criteria: a retrospective cohort ( = 153) of all eligible pregnant women with T1D attending the same management centers from 2012 to 2014 and a comparison cohort ( = 116) of all eligible pregnant women with T1D receiving routine care from 2015 to 2017 in 11 different centers from 7 cities.

Results: The rate of severe adverse pregnancy outcome was lower in the prospective cohort (6.02%) than in either the retrospective cohort (18.30%; adjusted odds ratio [aOR] 0.31 [95% CI 0.13-0.74]) or the contemporaneous comparison cohort (25.00%; aOR 0.22 [95% CI 0.09-0.52]).

Conclusions: The substantial improvements in the prospective cohort are evidence of a potentially clinically important effect of the comprehensive management plan on pregnancy outcomes among Chinese pregnant women with pregestational T1D. This supports the development of similar approaches in other countries.
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http://dx.doi.org/10.2337/dc20-2692DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7985418PMC
April 2021

Distribution characteristics of intestinal microbiota during pregnancy and postpartum in healthy women.

J Matern Fetal Neonatal Med 2021 Feb 4:1-8. Epub 2021 Feb 4.

Department of Obstetrics and Gynaecology, Peking University First Hospital, Beijing, China.

The characteristics of microbial community changes in pregnant women are still unclear. To investigate the changes in gut microbiota during pregnancy and after delivery in healthy women, we enrolled 47 healthy pregnant women who received obstetric care in our hospital from October 2016 to April 2017 and obtained their fecal samples at different time periods: T1 (11-13 W), T2 (23-28 W), and T3 (33-38 W) during pregnancy, and PP6W (6 weeks postpartum) and PP6M (6 months postpartum). Based on 16S rRNA gene sequencing results, there was no significant difference ( .05) in the index of alpha-diversity between the pregnancy and postpartum periods. Principal coordinate analysis indicated that gut microbiota clustering during the postpartum period was significantly different from that during pregnancy. Phylum-level comparison of species identified using T1, T2, T3, PP6W, and PP6M samples showed higher abundance of Actinobacteria, Firmicutes, and Proteobacteria, while the abundance of Bacteroidetes decreased. At the genus level, 31 types of bacteria were found to be significantly different among these five groups. , and showed higher abundance during pregnancy, while , group and showed higher abundance after delivery. Therefore, the diversity and function of the gut microbiota in healthy pregnant women remained unchanged during pregnancy; however, the composition of the intestinal microbiota in the postpartum period changed significantly. Our results provide the basis for in-depth studies of the composition of perinatal gut microbial communities in women.
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http://dx.doi.org/10.1080/14767058.2020.1812571DOI Listing
February 2021

Role of Peroxisome Proliferator-Activated Receptors (PPARs) in Trophoblast Functions.

Int J Mol Sci 2021 Jan 4;22(1). Epub 2021 Jan 4.

Center of Gynecological Endocrinology and Reproductive Medicine, Department of Gynecology and Obstetrics, Ludwig-Maximilians University of Munich, Marchioninistr. 15, 81377 Munich, Germany.

Peroxisome proliferator-activated receptors (PPARα, PPAR, and PPAR) belong to the transcription factor family, and they are highly expressed in all types of trophoblast during pregnancy. The present review discusses currently published papers that are related to the regulation of PPARs via lipid metabolism, glucose metabolism, and amino acid metabolism to affect trophoblast physiological conditions, including differentiation, maturation, secretion, fusion, proliferation, migration, and invasion. Recent pieces of evidence have proven that the dysfunctions of PPARs in trophoblast lead to several related pregnancy diseases such as recurrent miscarriage, preeclampsia, intrauterine growth restriction, and gestational diabetes mellitus. Moreover, the underlying mechanisms of PPARs in the control of these processes have been discussed as well. Finally, this review's purposes are to provide more knowledge about the role of PPARs in normal and disturbed pregnancy with trophoblast, so as to find PPAR ligands as a potential therapeutic target in the treatment and prevention of adverse pregnancy outcomes.
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http://dx.doi.org/10.3390/ijms22010433DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7795665PMC
January 2021

Preventive effect of aspirin on preeclampsia in high-risk pregnant women with stage 1 hypertension.

J Clin Hypertens (Greenwich) 2021 05 5;23(5):1060-1067. Epub 2021 Jan 5.

Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China.

Studies reported that women in a low-risk cohort with stage 1 hypertension defined as 130-139 mmHg/80-89 mmHg, according to the American College of Cardiology/American Heart Association, are more likely to develop into preeclampsia than women with normotensive in the early gestation. In this study, the authors investigated whether preeclampsia was more likely to occur in stage 1 hypertensive women compared to the normotensive pregnant women in a high-risk cohort, which was based on the randomized controlled trial of "Low-dose Aspirin in the Prevention of Preeclampsia in China." Meanwhile, the authors further evaluated the preventive effect of aspirin for preeclampsia in stage 1 hypertension subset. In women enrolled at or before 16 weeks of gestation, in the control group, the preeclampsia occurrence was significantly higher in stage 1 hypertensive woman than in the normotensive women (20.4% vs. 6.2%, aOR 3.960, 95% CI 1.299-12.074, p = .016), while no difference was observed in the aspirin group (4.5% vs. 4.2%, aOR 0.921, 95% CI 0.140-6.070, p = .932). In stage 1 hypertension, the incidences of preeclampsia and preterm birth were significantly lower in the aspirin group as compared to the control group (4.5% vs. 20.4%, aOR 0.139, 95% CI 0.027-0.716, p = .018; 4.5% vs. 18.4%, aOR 0.141, 95% CI 0.025-0.782, p = .025). Compared with the control group, the aspirin group displayed significantly prolonged gestational age at delivery (38.6 ± 1.2 vs. 37.4 ± 3.4, p = .042). This study indicates that the newly classified stage 1 hypertension might be an additional risk factor for preeclampsia in Chinese high-risk pregnant women, and aspirin intervention might be useful.
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http://dx.doi.org/10.1111/jch.14149DOI Listing
May 2021

Prevalence, Prevention, and Lifestyle Intervention of Gestational Diabetes Mellitus in China.

Int J Environ Res Public Health 2020 12 18;17(24). Epub 2020 Dec 18.

Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing 100034, China.

Gestational diabetes mellitus (GDM) has become an epidemic and has caused a tremendous healthy and economic burden in China, especially after the "two-child policy" put into effect on October 2015. The prevalence of GDM has continued to increase during the past few decades and is likely to see a further rise in the future. The public health impact of GDM is becoming more apparent in China and it might lead to the development of chronic non-communicable diseases in the long-term for both mothers and their children. Early identification of high-risk individuals could help to take preventive and intervention measures to reduce the risk of GDM and adverse perinatal outcomes. Therefore, a focus on prevention and intervention of GDM in China is of great importance. Lifestyle interventions, including dietary and physical exercise intervention, are effective and first-line preventive strategies for GDM prevention and intervention. The GDM One-day Care Clinic established in 2011, which educates GDM patients on the basic knowledge of GDM, dietary intervention, physical exercise, weight management, and blood glucose self-monitoring methods, sets a good model for group management of GDM and has been implemented throughout the hospitals as well as maternal and child health centers in China. The current review focus on the prevalence, risk factors, as well as prevention and lifestyle intervention of GDM in China for better understanding of the latest epidemiology of GDM in China and help to improve maternal and neonatal pregnancy outcomes and promote long-term health for women with GDM.
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http://dx.doi.org/10.3390/ijerph17249517DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7766930PMC
December 2020

Nomogram to predict the risk of preterm birth before 37 weeks and 34 weeks in pregnant women with a short cervix.

J Matern Fetal Neonatal Med 2020 Dec 15:1-10. Epub 2020 Dec 15.

Department of Obstetrics and Gynecology, Peking University First Hospital, Peking University, Beijing, China.

Objectives: This study investigated the potential factors that predict the risk of preterm birth (PTB) in pregnancies with a short cervix. These factors were used to create nomogram, which might be highly sensitive tools to predict the incidence of PTB.

Methods: This retrospective cohort study enrolled pregnancies with a short cervix from 1 January 2017 to 1 January 2018. The primary outcomes were preterm birth <37 and 34 weeks. Logistic regression model was used to identify potential predictors of PTB. The identified risk factors were used to establish nomograms, which were validated using the receiver operating characteristic (ROC) curve and calibration curve.

Results: In the multivariate analysis, overweight or obesity, parity ≧3 times, twin pregnancy, fertilization and embryo transfer (IVF-ET), gestational age at first observation of short cervix, cervical length (CL) at first observation of short cervix, history of PTB, and autoimmune disease were found to be predictors of PTB <37 weeks, while twin pregnancy, gestational age at first observation of short cervix, CL of short cervix, history of PTB, and prepregnancy hypertension were predictors of PTB <34 weeks. The area under the ROC curve of the nomogram predicting PTB <37 weeks and PTB <34 weeks were 0.803 and 0.771, respectively. Both models showed good discrimination.

Conclusions: Gestational age at first observation of short cervix, CL of short cervix and other factors are strong predictors of PTB in pregnancies with a short cervix. Both nomograms showed good discrimination and calibration, and hence might be effective in predicting PTB for this population.
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http://dx.doi.org/10.1080/14767058.2020.1860931DOI Listing
December 2020

The trend of caesarean birth rate changes in China after 'universal two-child policy' era: a population-based study in 2013-2018.

BMC Med 2020 09 15;18(1):249. Epub 2020 Sep 15.

Department of Obstetrics and Gynecology, Peking University First Hospital, No.1 Xi'anmen Street, Xicheng District, Beijing, 100034, China.

Background: The universal two-child policy in China which was announced in October 2015 might affect the caesarean birth rate. Few studies reported the caesarean birth rate affected by the policy especially after the universal two-child policy period. This study aimed to demonstrate the caesarean birth rate changes before and after the universal two-child policy and further elaborate the underlying influencing factors.

Methods: This nationwide, retrospective, population-based study was based on National Free Pre-Pregnancy Check-ups Project (NFPCP). Couples planning to conceive in next 6 months were encouraged to participate in NFPCP. Baseline information was collected using a standardized questionnaire with a face-to-face interview, and medical examinations were conducted. Two rounds of follow-up interviews were then conducted by trained nurses to update pregnancy status and outcomes. NFPCP participants who completed deliveries before December 31, 2018, were included in the current study. We used marginal effect of year to examine the trend of caesarean birth rate over time and interrupted time series (ITS) analysis to determine impacts of the universal two-child policy on the trend of caesarean birth rate.

Results: A total of 9,398,045 participants were included in the final analysis. High-risk factors to increase caesarean birth rate were identified. In the current study, the standardized caesarean birth rate declined from 34.1% in 2013 to 31.8% in 2015 and increased to 35.6% in 2018. ITS analysis showed the caesarean birth rate decreased by 0.1% (95% CI 0.1-0.1) per month before the release of universal two-child policy, 1.3% (95% CI 0.6-2.1%) absolute drop during the policy release month, and increased by 0.2% (95% CI 0.1-0.2%) per month after the policy implementation. For the period after the policy release, the increasing trends were observed in rural participants and urban primiparas. The prevalence of caesarean birth rates within China varied regionally.

Conclusions: The decreasing trend of caesarean birth rate was reported after immediate release of the universal two-child policy. An increasing trend of caesarean birth rate was observed 2-3 years after the policy. It reminds us that the caesarean birth rate control is a long-lasting process and all the strategies need to be continually reinforced.
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http://dx.doi.org/10.1186/s12916-020-01714-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7491061PMC
September 2020

Perturbations of gut microbiota in gestational diabetes mellitus patients induce hyperglycemia in germ-free mice.

J Dev Orig Health Dis 2020 12 14;11(6):580-588. Epub 2020 Sep 14.

Department of Obstetrics and Gynaecology, Peking University First Hospital, Beijing, China.

Shifts in the maternal gut microbiota have been implicated in the development of gestational diabetes mellitus (GDM). Understanding the interaction between gut microbiota and host glucose metabolism will provide a new target of prediction and treatment. In this nested case-control study, we aimed to investigate the causal effects of gut microbiota from GDM patients on the glucose metabolism of germ-free (GF) mice. Stool and peripheral blood samples, as well as clinical information, were collected from 45 GDM patients and 45 healthy controls (matched by age and prepregnancy body mass index (BMI)) in the first and second trimester. Gut microbiota profiles were explored by next-generation sequencing of the 16S rRNA gene, and inflammatory factors in peripheral blood were analyzed by enzyme-linked immunosorbent assay. Fecal samples from GDM and non-GDM donors were transferred to GF mice. The gut microbiota of women with GDM showed reduced richness, specifically decreased Bacteroides and Akkermansia, as well as increased Faecalibacterium. The relative abundance of Akkermansia was negatively associated with blood glucose levels, and the relative abundance of Faecalibacterium was positively related to inflammatory factor concentrations. The transfer of fecal microbiota from GDM and non-GDM donors to GF mice resulted in different gut microbiota colonization patterns, and hyperglycemia was induced in mice that received GDM donor microbiota. These results suggested that the shifting pattern of gut microbiota in GDM patients contributed to disease pathogenesis.
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http://dx.doi.org/10.1017/S2040174420000768DOI Listing
December 2020

Effect of hydroxychloroquine on preeclampsia in lupus pregnancies: a propensity score-matched analysis and meta-analysis.

Arch Gynecol Obstet 2021 02 3;303(2):435-441. Epub 2020 Sep 3.

Department of Obstetrics and Gynecology, Peking University First Hospital, Peking University, No. 1, Xi 'anmen Street, Xicheng, Beijing, China.

Background: Hydroxychloroquine (HCQ) is the primary medication in the treatment of pregnancy with systemic lupus erythematosus (SLE) for its efficacy and safety. However, the effect of HCQ on preeclampsia prevention remains controversial.

Objective: This study aimed to investigate whether HCQ has an effect on preeclampsia prevention and other pregnancy outcomes among lupus pregnancy.

Methods: We conducted a retrospective cohort study of 119 pregnant women with SLE. After the propensity score matching of baseline characteristics, the population was divided into the HCQ treatment group and HCQ nontreatment group. Then, we compared the preeclampsia and other pregnancy outcomes between HCQ treatment and nontreatment groups. Furthermore, we combined our data and previous studies for a meta-analysis.

Results: In our data, HCQ did not increase the risk of premature rupture of membranes, bleeding during pregnancy, preeclampsia, intrauterine distress, gestational age at delivery, preterm birth, and postpartum hemorrhage. There was no significant association between HCQ treatment and preeclampsia prevention. Besides, the meta-analysis showed a similar result that HCQ did not significantly decrease the rate of preeclampsia (RR = 0.61, 95%CI = 0.34-1.11).

Conclusion: This study found that HCQ treatment was safe, but did not significantly reduce preeclampsia among lupus pregnancies.
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http://dx.doi.org/10.1007/s00404-020-05762-5DOI Listing
February 2021

Comparison of the rates of preterm birth and low birth weight of vanishing twin and primary pregnancies conceived with assisted reproductive technology.

J Perinat Med 2020 Aug 17;49(1):50-53. Epub 2020 Aug 17.

Department of Obstetrics and Gynecology, Hebei Xingtai Infertility Hospital, Xingtai, Hebei, P.R. China.

Objectives: The purpose of this study was to compare the rate of preterm birth, low birth weight, and foetal growth restriction in assisted reproductive technology (ART) singleton pregnancies diagnosed with vanishing twin (VT) syndrome to those of ART pregnancies that were originally singleton pregnancies.

Methods: In this retrospective study, 177 pregnancies diagnosed with VT syndrome were matched and compared with 218 primary singleton pregnancies. The preterm birth and low birth weight rates of these two groups were evaluated. All pregnancies were conceived through ART and delivered at Peking University First Hospital and Hebei Xingtai Infertility Hospital from 2014 to 2016.

Results: The preterm delivery rate (20.90 vs. 8.72%, p<0.05) was significantly higher in the ART singletons with VT syndrome than in the control singleton group. The proportion of low-birth-weight (<2500 g) infants was also higher in the VT group than in the primary singleton group (10.73 vs. 3.67%, p<0.05). In addition, the preterm birth rate of the naturally conceived singletons was significantly lower than that of the ART singletons (6.00 vs. 14.18%, p<0.05).

Conclusions: ART singleton pregnancies with VT syndrome have higher rates of preterm birth and low-birth-weight new-borns than ART pregnancies that were originally singleton pregnancies.
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http://dx.doi.org/10.1515/jpm-2020-0176DOI Listing
August 2020

Early Life Oxidative Stress and Long-Lasting Cardiovascular Effects on Offspring Conceived by Assisted Reproductive Technologies: A Review.

Int J Mol Sci 2020 Jul 22;21(15). Epub 2020 Jul 22.

Department of Obstetrics and Gynecology, University Hospital, LMU Munich, 81377 Munich, Germany.

Assisted reproductive technology (ART) has rapidly developed and is now widely practised worldwide. Both the characteristics of ART (handling gametes/embryos in vitro) and the infertility backgrounds of ART parents (such as infertility diseases and unfavourable lifestyles or diets) could cause increased oxidative stress (OS) that may exert adverse influences on gametogenesis, fertilisation, and foetation, even causing a long-lasting influence on the offspring. For these reasons, the safety of ART needs to be closely examined. In this review, from an ART safety standpoint, the origins of OS are reviewed, and the long-lasting cardiovascular effects and potential mechanisms of OS on the offspring are discussed.
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http://dx.doi.org/10.3390/ijms21155175DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7432066PMC
July 2020

Is it suitable for DM diagnosis using an abnormal two-hour glucose value only after 24th gestational weeks in China.

J Matern Fetal Neonatal Med 2020 Jul 16:1-6. Epub 2020 Jul 16.

Peking University First Hospital, Beijing, China.

Objective: To investigate the postnatal outcomes of diabetes mellitus (DM) women diagnosed according to two-hour glucose value ≥11.1 mmol/L after 24th gestational weeks in China, and to evaluate if it is suitable for DM diagnosis using the criteria that two-hour glucose value ≥11.1 mmol/L after 24th gestational weeks only. We conducted a retrospective cohort study of the pregnant women with gestational hyperglycemia participated in gestational hyperglycemia day care and delivered in Peking University First Hospital from June 2016 to May 2018. A total of 168 women diagnosed with DM according to the criteria that two-hour glucose value ≥11.1 mmol/L after 24th gestational weeks were included, and 75 DM women did the oral glucose tolerance test (OGTT) from 6 weeks to 1 year postpartum. The general information collected and analyzed included age, prepregnancy body mass index (BMI), prepregnancy weight, gestational weight gain (GWG), OGTT value during pregnancy, OGTT value of postpartum, gestational weeks, and neonatal birth weight.

Results: There were 168 women diagnosed with DM according to the criteria that two-hour glucose value ≥11.1 mmol/L after 24th gestational weeks, and 75 (75/168, 44.6%) women underwent an OGTT from 6 weeks to 1 year postpartum. Among the women followed-up, 56 (56/75, 74.7%) women were diagnosed as hyperglycemia and 19 (19/75, 25.3%) women were diagnosed as normal glucose metabolism. In hyperglycemia women, there are eight (8/56, 10.7%) women diagnosed as DM, 24 (24/56, 32.0%) women diagnosed as impaired glucose tolerance (IGT), eight (8/56, 10.7%) women diagnosed as impaired fasting glucose (IFG), and 16 (16/56, 21.3%) women diagnosed as IFG and IGT. Compared with normal glucose metabolism women, the age of hyperglycemia women is higher significantly (34.8 ± 3.8 versus 32.7 ± 4.7). The incidence of IFG, pharmacy treatment, and the value of HbA1c is also higher in hyperglycemia women than the normal glucose metabolism women, in which it is not statistically significant but clinically significant.

Conclusion: In DM women diagnosed according to the criteria that two-hour glucose value ≥11.1 mmol/L after 24th gestational weeks, there were only eight (10.7%) women could meet DM diagnostic criteria according to the OGTT value of postpartum. Moreover, 25% women had normal OGTT value postpartum. Due to the characteristics of glucose metabolism in Asian population, an abnormal two-hour glucose value in OGTT may not be suitable to diagnose DM during pregnancy in China.
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http://dx.doi.org/10.1080/14767058.2020.1742690DOI Listing
July 2020

A multicenter all-inclusive prospective study on the relationship between glycemic control markers and maternal and neonatal outcomes in pregnant women.

J Matern Fetal Neonatal Med 2020 Jul 15:1-8. Epub 2020 Jul 15.

Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China.

Objective: Pregnant women afflicted with gestational diabetes mellitus (GDM) and diabetes mellitus (DM) are prone to both maternal and neonatal complications. Due to this, it is of importance to sustain a strict glycemic control during this time. Unfortunately, there is a lack of evidence-based medical research for the control criteria during pregnancy. Therefore, to develop better method of glycemic control for pregnant women, we conducted a multicenter all-inclusive prospective study to investigate the association between glycemic control markers and maternal and neonatal outcomes. Four hundred fifty-two women were included in the study. Fasting blood glucose (FBG), HbA1c and glycated albumin (GA), and ferritin levels were measured at different gestational periods and compared to the pregnancy outcomes.

Results: The reference interval of GA and HbA1c was determined in Trimester I, II, III: 11.0-16.3%, 10.1-15.2%, and 9.5-14.6%, and 4.8-5.7%, 4.4-5.4%, and 4.7-5.8%, respectively. It was found that at the later stages of pregnancy, there was a reduction in ferritin levels and increase in HbA1c levels. Only in the GDM group, it was noticed that the frequency of total neonatal and maternal complications were significantly higher on comparison with the normal group (30.1 vs. 18.4%, 017 and 21.0% vs. 12.0%, 031, respectively). For the frequency of cesarean section and macrosomia in GDM group, GA > 15.69% group was significant higher compared to those of GA ≤ 15.69% group (021 and 001, respectively). For HbA1c, no significant differences were observed.

Conclusions: A reference interval of HbA1c and GA was developed for Chinese pregnant women. We found that the GDM group had a higher frequency of neonatal and maternal complications. As only GA levels and not HbA1c, were associated with cesarean section and macrosomia in GDM, we hypothesize that GA could be an appropriate glycemic control marker for pregnant mothers.
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http://dx.doi.org/10.1080/14767058.2019.1678139DOI Listing
July 2020

Evaluation of the Inhibitory Effects of and on the Adhesion of Seven Common Lower Genital Tract Infection-Causing Pathogens to Vaginal Epithelial Cells.

Front Med (Lausanne) 2020 19;7:284. Epub 2020 Jun 19.

Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China.

colonization is important to maintain urogenital flora stability and prevent pathogenic infection. Different species have distinct properties and effects on the urogenital flora. To select probiotics that colonize the vagina and provide protection against pathogenic infection, we evaluated the adhesion of five strains and their inhibitory effects on the adhesion of pathogens to vaginal epithelial cells (VECs). (1) adhesion experiments: VK2/E6E7 and primary VECs were used to evaluate the adhesion of two and three strains. The adhesion of these five strains was compared. (2) Adhesion inhibition experiments: The inhibitory effects of the five strains on the adhesion of pathogens (, and ) were evaluated by adhesion exclusion, displacement, and competition experiments. (1) adhesion was stronger in the primary VECs than in the VK2/E6E7 VECs ( < 0.05). The adhesion of the three strains was stronger than that of the two strains ( < 0.05). 4# showed the strongest adhesion. (2) The exclusion, displacement, and competition experiments showed that all five strains significantly inhibited the adhesion of the seven pathogenic strains to the VECs ( < 0.05). The displacement effect was stronger than the exclusion and competition effects of each strain. (3) The results of the exclusion, displacement, and competition experiments indicated that 1# showed the strongest adhesion inhibition of and . 3# showed the strongest adhesion inhibition of , whereas 4# showed the strongest adhesion inhibition of , and . The source of the VECs might not affect the selection of the most adhesive strain. showed stronger VEC adhesion than . The degree of antagonism of the strains toward the different pathogens varied. This result provides incentives for personalized clinical treatment.
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http://dx.doi.org/10.3389/fmed.2020.00284DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7317292PMC
June 2020

Reply.

Authors:
Jie Yan Huixia Yang

Am J Obstet Gynecol 2020 11 9;223(5):784. Epub 2020 Jun 9.

Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing 100034, China. Electronic address:

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http://dx.doi.org/10.1016/j.ajog.2020.06.015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7282745PMC
November 2020

Conservative management versus cesarean hysterectomy in patients with placenta increta or percreta.

J Matern Fetal Neonatal Med 2020 Jun 4:1-7. Epub 2020 Jun 4.

Department of Obstetrics and Gynaecology, Peking University First Hospital, Beijing, P. R. China.

Objective: To compare conservative management and cesarean hysterectomy in patients with placenta increta or percreta.

Materials And Methods: In this multicenter retrospective study, we recorded data on 2219 patients with placenta increta or percreta from 20 tertiary care centers in China from 1 January 2011 to 31 December 2015. Propensity score analysis was used to control for baseline characteristics. We divided patients into conservative management (C) and hysterectomy (H) groups. The primary outcome was operative/postoperative maternal morbidity; secondary outcomes were maternal-neonatal outcomes.

Results: In total, 17.9% (398/2219) of patients had placenta increta and percreta; 82.1% (1821/2219) of the patients were in group C. After propensity score matching, 140 pairs of patients from the two groups underwent one-to-one matching. Group C showed less average blood loss within 24 h of surgery (1518 ± 1275 vs. 4309 ± 2550 ml in group H, <.001). There were more patients with blood loss >1000 ml in group H than in group C (93.6% [131/140] vs. 61.4% [86/140], <.001). More patients received blood transfusions in group H than in group C (=.014). There was no significant difference between the groups in terms of bladder injury, postoperative anemia, fever, and disseminated intravascular coagulation. Neonatal outcomes in the two groups were similar.

Conclusion: Either conservative management or hysterectomy should be considered after thorough evaluation and detailed discussion of risks and benefits. A balance between bleeding control and fertility can be achieved.
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http://dx.doi.org/10.1080/14767058.2020.1774871DOI Listing
June 2020
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