20th Week Research Articles

Reproductive Implications and Management of Congenital Uterine Anomalies: Scientific Impact Paper No. 62.

Congenital uterine anomalies (CUAs) are malformations of the uterus (womb) that develop during fetal life. When a female baby is in her mother's uterus, her uterus develops as two separate halves from two tubular structures called Müllerian ducts, which fuse together before she is born. Anomalies that occur during the baby's development can be variable, from complete absence of the uterus through to more subtle anomalies, which are classified into specific categories. While conventional ultrasound is good at detecting CUAs, 3D ultrasound is used to confirm a diagnosis. If a complex uterine anomaly is suspected, additional investigations may be used, including MRI scanning, laparoscopy (where a camera is inserted into the cavity of the abdomen) and/or hysteroscopy (where a camera is placed in the uterine cavity). As there can be a link between CUAs and anomalies of the kidney and bladder, scans of these organs are also usually requested. Although CUAs are present at birth, adult women typically do not have any symptoms, although some may experience painful periods. Most cases of CUA do not cause difficulties in becoming pregnant, and the outcome of pregnancy, in most cases, is good. However, these uterine anomalies are often discovered during investigations for infertility or miscarriage. Moreover, depending upon the type and severity of CUA, there may be increased risk of first and second trimester miscarriages, preterm birth, fetal growth restriction (smaller and lighter babies for the stage of pregnancy), pre-eclampsia (development of high blood pressure and protein in urine after the 20th week of pregnancy) and fetal malpresentation (baby not facing head-first down the birth canal) at birth. Surgical treatment may be considered for those who have had recurrent miscarriages and have a septate uterus, i.e. the uterine cavity is divided by a partition. In this case, surgery may reduce the chances of miscarriage. However, women should be informed that there is inconclusive and conflicting evidence regarding the improved likelihood of live births in this context. Further evidence from large randomised controlled trials are required to provide conclusive evidence-based recommendations for surgical treatment for septate uterus. Surgical treatment for other types of CUAs is not usually recommended as the risks outweigh potential benefits, and evidence for any benefits is lacking. Women with CUAs may be at an increased risk of preterm birth even after surgical treatment for a septate uterus. These people, if suspected to be at an increased risk of preterm birth based on the severity of CUA, should be followed up using an appropriate protocol for preterm birth as outlined in UK Preterm Birth Clinical Network Guidance.

A comprehensive review of the roles of T-cell immunity in preeclampsia

Preeclampsia (PE) is an obstetrical disorder that occurs after the 20th week of gestation. It is recognized as one of the “Great Obstetrical Syndromes” and principally contributes to maternal morbidity and mortality. PE has been associated with a range of immune disorders, including a preponderance of T helper (Th) 1 over Th2 cells and imbalanced levels of Th17 and T regulatory cells (Tregs). During pregnancy, T cells safeguard the placenta against immune rejection and aid embryo implantation while involved in pregnancy complications, such as PE. Promoting alloantigen-specific Treg cells is a potential preventive and therapeutic strategy for PE. However, ensuring the safety of mothers and infants is of the utmost importance since the risk-benefit ratio of reproductive and obstetric conditions differs significantly from that of immune diseases that pose a life-threatening risk. In this review, we systematically summarize the roles of T-cell immunity in the peripheral blood, reproductive tissues, and at the maternal-fetal interface of PE patients. Furthermore, the recent therapeutic approaches centered on targeting T cell immunity in PE are critically appraised.

Effect of different colors and intensity of light emitting diode on the production performance, egg quality, hormonal profile and the economics of layers kept in environment control house.

This study examined the effect of LED light colors and intensities on production performance and economic feasibility of 720 Babcock® White layers. The layer birds were reared for 13weeks from 17 to 30weeks of age during the layer production cycle.Light treatments of 6 different colors, i.e., cool white (control group), red, blue, green, yellow, and warm white light with 3 different levels of light intensities (15, 20 and 25lx), were provided. Weekly growth parameters, egg production, egg quality characters and economics were evaluated. Hormonal profile (FSH, LH, GnRH, estrogen, progesterone, cortisol) and antibody titers against Newcastle Disease (ND) and Infectious Bronchitis (IB) were also evaluated. The graphical presentation was done by Origin Pro 2024. The results showed that red light increased feed intake (p < 0.05) but led to lower body weights and inefficient feed conversion ratios (FCR), whereas birds under warm white light at 25lx gained higher weight (p < 0.05), had better FCR (1.89 in the 30th week), laid more eggs (97.34% by the 30th week), with improved egg quality (p < 0.05). Mortality rates and hormonal levels also varied notably with light conditions, with warm white light showing the lowest mortality (p < 0.05) and optimal hormonal balances conducive to productivity. Birds kept under yellow and warm white light having 15lx intensity may be applied during (17-30) weeks of age to reduce the cost of production for better profitability in commercial layer farming in Pakistan.

Protective and Therapeutic Effects of Orlistat in Combination with Elettaria cardamomum “Cardamom” Extract on Learning, Memory, Anxiety, and Neuroinflammation in Obese Mice

Introduction and Objective: Obesity has increased worldwide, and existing anti-obesity medications have treatment limitations that diminish their overall benefits. This study aimed to investigate the effects of orlistat in combination with Elettaria cardamomum “Cardamom” (CAR) extract on working memory, recognition memory, anxiety, and inflammation within hippocampal tissue. Methods: Mice were categorized into two groups: a control group (CD) and a cafeteria diet (CAF) group induced with obesity (CAF) for 10 weeks. The groups were then subdivided into a CAF group treated with orlistat (CAF-ORL), a CAF group treated with orlistat and Elettaria cardamomum (CAF-ORL-CARD), and a group that continued on the CAF. The CAF-ORL group received orlistat at a dosage of 10 mg/kg/day for four weeks, while the CAF-ORL-CARD group received 10 mg/kg/day of orlistat and 500 mg/kg of CAR extract via oral gavage. In the 14th week, various assessments were conducted, including the novel object recognition (NOR) test, Y maze test, marble-burying test (MBT), open-field test, and TNF-α levels in the hippocampus. Result: TNF-α levels in the hippocampal tissue of the CAF group were elevated compared to the CD group (p &lt; 0.01), whereas the CAF-ORL group exhibited reduced TNF-α levels compared to the CAF group (p &lt; 0.01). Moreover, TNF-α levels in the CAF-ORL-CARD group were significantly lower than in the CAF-ORL group (p &lt; 0.01). The recognition index was notably higher in the CAF-ORL group compared to the CAF group (p &lt; 0.01) and higher in the CAF-ORL-CARD group compared to the CAF-ORL group (p &lt; 0.01). However, there were no changes in the open-field test and Y maze test (p &gt; 0.05). Conclusions: Orlistat combined with CAR has positive effects on neuroinflammation and memory, suggesting that this combination may offer potential therapeutic benefits for cognitive impairments and hippocampal dysfunction associated with obesity.

Universal First-Trimester Screening Biomarkers for Diagnosis of Preeclampsia and Placenta Accreta Spectrum

Background: Disruptions in epigenetic mechanisms regulating placentation, particularly imbalances in the levels of small non-coding RNAs, contribute to various pregnancy complications, including preeclampsia (PE) and placenta accreta spectrum (PAS). Given that abnormal trophoblast differentiation, invasiveness, and angiogenesis—reduced in PE and excessive in PAS—are central to the pathogenesis of these conditions, this study aimed to identify universal circulating piRNAs and their targets. Methods: Small RNA deep sequencing, quantitative reverse transcription combined with real-time polymerase chain reaction, magnetic bead-based multiplex immunoassay, ELISA, and Western blotting were employed to quantify circulating piRNAs and proteins in the blood serum of pregnant women during the 11th–14th weeks of gestation. Results: Statistically significant negative correlations were identified between PE- and PAS-associated piRNAs (hsa_piR_019122, hsa_piR_020497, hsa_piR_019949, and piR_019675) and several molecules, including Endoglin, IL-18, VEGF-A, VEGF-C, Angiopoietin-2, sFASL, HB-EGF, TGFα, and Clusterin. These molecules are involved in processes such as angiogenesis, inflammation, the epithelial–mesenchymal transition, cell proliferation, adhesion, and apoptosis. A first-trimester pregnancy screening algorithm was developed using logistic regression models based on Clusterin concentration and the levels of hsa_piR_020497, hsa_piR_019949, piR_019675, and hsa_piR_019122. Conclusions: The proposed screening tool for early pregnancy monitoring may enable the prediction of PE or PAS in the first trimester, allowing timely interventions to reduce maternal and perinatal morbidity and mortality.

Shock index reference ranges in the first 48h postpartum following elective cesarean delivery: A prospective cohort study.

To determine the reference values for the shock index (SI) in postpartum patients undergoing elective cesarean delivery with regional anesthesia. This prospective study was conducted at our tertiary center between August 1, 2023, and March 1, 2024. We calculated the reference values for the SI within the first 48h postpartum for patients who underwent elective cesarean delivery after the 34th week of gestation. We excluded cases of vaginal delivery, post-term delivery (≥42weeks of gestation), multiple pregnancies, stillbirths, fetal abnormalities, maternal cardiac disease, anemia, untreated hypo- or hyperthyroidism, and any hypertensive disorders diagnosed before or during pregnancy. Data collection, measurement of vital signs, and the administration of fluids pre-, intra-, and post-operatively, as well as the use and dosing of uterotonic agents for the prevention of postpartum hemorrhage (PPH), were standardized for all patients. Our final analysis included 311 patients, with a mean SI value of approximately 0.7 (0.67-0.77) for all measurement performed within the first 48h of the postpartum period. Further analyses revealed that the 90th and 95th percentiles of SI were around 0.9 throughout the study period. Additionally, SI reference values analyzed at different time points were consistent. Our analysis demonstrated that SI values were not influenced by the presence of a previous caesarean section, the administration of oxytocin or carbetocin, or parity in this particular cohort. Our analyses of vital signs also indicated that the 95th percentile of heart rate (HR) ranged from 96 to 100bpm. An SI value of 0.9 represents the 95th percentile of SI values throughout the first 48h of the postpartum period. Any greater value should be evaluated carefully for potential adverse outcomes.

Sex differences in the affective-cognitive dimension of neuropathic pain: Insights from the Spared Nerve Injury rat model

Over 40% of neuropathic pain patients experience mood and cognitive disturbances, often showing reduced response to analgesics, with most affected individuals being female. This highlights the critical role of biological sex in pain-related affective and cognitive disorders, making it essential to understand the emotional and cognitive circuits linked to pain for improving treatment strategies. However, research on sex differences in preclinical pain models is lacking. This study aimed to investigate these differences using the spared nerve injury (SNI) rat model, conducting a comprehensive series of behavioural tests over 100 days post-injury to identify key time points for observing sex-specific behaviours indicative of pain-related conditions. The findings revealed that female rats exhibited greater mechanical and cold hypersensitivity compared to males following nerve injury and showed earlier onset of depression-related behaviours, while males were more prone to anxiety, social, and memory-related alterations. Interestingly, by the 14th week post-injury, females displayed no signs of these emotional and cognitive impairments. Additionally, fluctuations in the oestrous cycle or changes in testosterone and oestradiol levels did not correlate with sex differences in pain sensitivity or negative affect. Recognizing the influence of biological sex on pain-induced affective and cognitive alterations, especially in later stages post-injury, is crucial for enhancing our understanding of this complex pain disorder. Data availabilityAccess to the raw data constituting the findings presented in this manuscript can be requested from the corresponding author of the publication.

Ozone Exposure and Gestational Diabetes in Twin Pregnancies: Exploring Critical Windows and Synergistic Risks

The relationship between ozone (O3) exposure and gestational diabetes mellitus (GDM) in twin pregnancies remains unexplored. This study aimed to investigate the association between O3 exposure and GDM risk in twin pregnancies, and to explore the synergistic effects of O3 exposure with other maternal factors. A total of 428 pregnancies recruited from a prospective twin cohort were included. Cox proportional hazard models with distributed lag non-linear models (DLNMs) were applied to examine the associations between O3 exposure and the risk of GDM and to identify the critical windows. The multiplicative and additive interaction were further analyzed to test the synergistic effects. A 10 μg/m3 increase in average O3 exposure during the 12 weeks before pregnancy was associated with a 26% higher risk of GDM. The critical windows were identified in the period from the 3rd week before gestation to the 2nd gestational week as well as from the 17th to 19th gestational week. There were synergistic effects between high O3 exposure during preconception and advanced maternal age, and a history of preterm birth/abortion/stillbirth. Periconceptional O3 exposure could increase the risk of GDM in twin pregnancy women, and the synergism of O3 exposure with certain GDM risk factors was observed.

An exploratory study on midwives' fear of childbirth in Türkiye.

This study examines Fear of Childbirth (FoC) among pregnant midwives in Türkiye using the Wijma Delivery Expectancy/Experience Questionnaire-Version A (W-DEQ A). A cross-sectional design was employed, including 270 healthy pregnant midwives in their 28th to 40th gestational weeks, who were employed in healthcare and had internet and social media access. Data were gathered through social media between platforms February and July 2023 using the Participant Introduction Form and W-DEQ A, and analyzed with SPSS 25.0 (p<0.05).The mean W-DEQ A score was 78.70 (±26.59), indicating severe FoC, with 53.3% experiencing clinically significant levels. FoC scores were higher among midwives working in labor and gynecology units compared to postnatal wards (p<0.05). Positive correlations were identified between FoC and variables such as age, midwifery experience, and perceived labor pain severity. These findings underscore the influence of professional settings on FoC, emphasizing the need for targeted support and training to improve outcomes.

Association Between Periodontal Health Status and Pregnancy and Delivery Complications in Type 1 Diabetes Mellitus Pregnant Women: A Case-Control Study.

To assess the association between periodontal health and pregnancy or delivery complications in type 1 diabetic (TIDM) and non-diabetic pregnant women. 15 TIDM and 15 non-diabetic primiparous women were enrolled in the prospective case-control study. We compared periodontal status, levels of glycosylated hemoglobin (HbA1c), gestational week of birth, birth weight of a newborn and pregnancy or delivery complications between the groups. TIDM pregnant women gave birth statistically significantly earlier (2 weeks) (p = 0.034), but not before the 37th week of gestation. The odds ratio (OR) for pregnancy or delivery complications was ~ 5 times greater (95% CI: 1.1-26.4; p = 0.033) and for Caesarean section (C-section) ~ 6 times greater (95%CI: 1.2-30.7; p = 0.032) in TIDM group. The association between periodontal disease (PD) and pregnancy or delivery complications was not statistically significant in either group. The presence of TIDM (p = 0.002; R2 = 0.28), a higher bleeding-on-probing/full-mouth bleeding score (FMBS) (p = 0.043; R2 = 0.14), and a higher level of HbA1c (p = 0.026; R2 = 0.16) were statistically significantly more often associated with an earlier gestational week of birth. Higher levels of HbA1c were statistically significantly positively associated with a higher frequency of pregnancy or delivery complications (p = 0.024) and a higher frequency of C-section (p = 0.051). There are strong indications that both endocrinological and periodontal therapy should form a part of preventive prenatal care.

The role of Anti-Müllerian hormone in women health.

Anti-Müllerian hormone (AMH), also known as Müller duct inhibitory factor and primarily known for its role in sexual differentiation. In female fetuses, AMH production by granulosa cells begins around the 36th week of gestation and continues in women until menopause. It is becoming more significant in the endocrine and gynecological diagnosis of adult women. The suppressive effect of AMH on follicle-stimulating hormone (FSH)-induced aromatase production likely plays a role in hyperandrogenism in polycystic ovary syndrome (PCOS) and may increase insulin resistance. Female adolescent with type 1 diabetes (T1D) have an increased likelihood of developing PCOS, but it is not known whether they also show elevated AMH levels. The elevated AMH levels observed in prepubertal girls with T1D suggest that there are more small follicles in their ovaries, probably in response to insulin treatment. Elevated levels of androgens and anti-Müllerian hormone have been previously reported in non-pregnant women with diabetes. The increased AMH concentrations can be associated with reduced systemic inflammation [lower c-reactive protein (CRP) values], irrespective of the type of diet and greater insulin sensitivity in old obese males. AMH can also serve as a valuable marker for granulosa cell tumors (folliculomas) and their recurrence. In these clinical scenarios, AMH levels can be significantly elevated and correspond with the size of the tumor.

Renal Function and the Role of the Renin–Angiotensin–Aldosterone System (RAAS) in Normal Pregnancy and Pre-Eclampsia

Objective: Pre-eclampsia (PE) is a complex, advancing condition marked either by the recent emergence of hypertension and proteinuria or by the recent onset of hypertension accompanied by notable end-organ impairment, which may occur with or without proteinuria. PE usually appears in the postpartum phase or after the 20th week of gestation, though it might appear sooner in cases of molar pregnancy. Pathophysiology: This disorder is a serious multisystem condition during pregnancy that can lead to serious, life-threatening complications for both the mother and the fetus if it is not diagnosed and managed promptly. These changes result from widespread and intense vasoconstriction caused by renin, angiotensin II (Ang II), aldosterone, and catecholamines. The renin–angiotensin–aldosterone system (RAAS) and its sequence of signaling reactions demonstrate its crucial role in regulating blood pressure and electrolyte balance that diverges in PE from that observed in healthy pregnancies. However, it is widely recognized that the above description is incomplete for pre-eclampsia and further relationships should be analyzed. The purpose of this article is to review and synthesize alterations in renal function and the RAAS during normal pregnancy and pre-eclampsia. We aim to provide clinical gynecologists with a comprehensive understanding of how pregnancy-specific adaptations can impact renal function and the RAAS, as well as the deviations observed in pre-eclampsia. Conclusion: This information is essential to enhance clinical awareness, improve the accuracy of diagnosis, and support evidence-based decision-making in the management of pregnant patients, especially those complicated by pre-eclampsia.

P-29 HONEYMOON IN LATE PREGNANCY

Abstract Introduction During pregnancy there is a partial decrease in the function of immune system which would end with suppression of autoimmune diseases, even type 1 diabetes (T1DM) (1-2). We report a pregnant women with T1DM who was suffering from severe hypoglycemia even with very low insulin dosages in her third trimester. Clinical Case A 27 year old young lady was referred to our clinic with HbA1c level of 12.7%. She had no symptom other than slight nausea and dry mouth. Her β-HCG level was 55 mIU/ml and her plasma glucose level was 435 mg/dl. She was diagnosed with T1DM about one year ago, was started with intensive insulin regimen about 80 IU/day totally, which she did not use ever since. We hospitalized her and started intravenous (IV) hydration and IV insulin, which we switched to subcutaneous insulin. She was educated by our dietitian and by our diabetes-clinic nurse. As the insulin dosages increased, it was detected that she was pregnant. She was offered for therapeutic abortus but did not accept. Her blood glucose measurements improved and she was discharged with morning: 12 IU, afternoon:8 IU, evening:15 IU insulin aspart and night:18 IU insulin detemir dosages. In the follow up, her Hba1c level decreased to 8.7 % in the 2nd month and to 6.7% at the 20th week. Her fasting blood glucose levels were between 87-102 mg/dl and 1st hour postprandial levels were between 110-137 mg/dl. She dropped from the follow up by her own decision. At her 30th pregnancy week, she came with hypoglycemia and she had decreased her insulin dosages to morning: 2 IU, afternoon: 2IU, evening: 3IU insulin aspart and no insulin detemir. Her plasma cortisol level was 18 mcg/dl, alanine aminotransferase (ALT): 12 IU/L, gamma glutamyl transferase (GGT): 28 IU/L, creatinine (Cre):0.8 mg/dl, and Hba1c:5.3%. Her abdominal ultrasonography (USG) was normal. She was diagnosed with honeymoon period in T1DM and was informed about strict blood glucose measurement. Conclusion T1DM would disappear for a long while or regress greatly in some pregnant women even in the late years of their disease (2). Insulin -free period after the pregnancy would last even two and a half years or huge reduction in insulin dosage during pregnany period would even start after 20 years of T1DM (2). In our case, the patient started to use very low insulin dosages at around 30th pregnancy week and after one and half year of her diagnosis of T1DM.

The Innovative Approaches to Treating Apnea of Prematurity: From Sensory Stimulation to Aromatherapy

Apnea of prematurity (AOP) is a significant health issue affecting neonates born before the 37th week of gestation. It results from the immaturity of respiratory control mechanisms and is often exacerbated by various coexisting factors, which can intensify symptoms and lead to severe health consequences. Despite extensive research on the underlying mechanisms of AOP, a single effective treatment has yet to be identified. Current therapies, such as caffeine administration, are associated with potential adverse effects. Emerging interventions, including sensory stimulation, carbon dioxide inhalation, positional changes, and aromatherapy, offer promising alternatives. These approaches have the potential to complement standard treatments while being less invasive.

Uterine Penetrating Wounds in Pregnant Women—Review and Case Study

Introduction: Uterine penetrating wounds in pregnant women are rare. Usually, they are caused by traffic accidents, but sometimes they are an effect of violence, accidental injuries, or deliberate self-harm. Case Report: We present a case of a stab wound to the uterus in a 25-year-old woman in the 37th week of pregnancy, which was the result of a knife attack. Emergency splenectomy and cesarean section were performed less than an hour after the attack. The child required resuscitation and long-term intensive therapy. Both the woman and the newborn survived; however, the newborn’s condition remained poor. The child died a few months later, according to community-acquired pneumonia. Discussion: Cases of wounds penetrating the uterus have been described for many years around the world. They are often the result of violence, most often from the partner. Statistically, pregnant women are more likely to be victims of violence. Sometimes, the wounds penetrating the uterus are accidental and arise, for example, as a result of a fall. A rare but not isolated case is self-mutilation to terminate a pregnancy. Women often inflict such injuries on themselves using sharp tools, sometimes firearms. There are also cases of another person helping to terminate a pregnancy in this way. Conclusions: Violence against women, including pregnant women, remains a significant social problem in all regions of the world and poses a challenge to uniformed services, medical professions, and social services. Regardless of the mechanism of injury, in the event of an imminent threat to the life of the mother and fetus, it is crucial to make quick decisions aimed at saving lives.

Evaluation of Statistical Models of NDVI and Agronomic Variables in a Protected Agriculture System

Vegetable production in intensive protected agriculture systems has evolved due to its intensity and economic importance. Sensors are increasingly common for decision-making in crop management and control of environmental variables, obtaining optimal yields, such as estimating vegetation indices. Innovation and technological advances in unmanned vehicle platforms have improved spatial, spectral, and temporal resolution. However, in protected agriculture systems, the use is limited due to the assumption of having controlled environmental conditions for indeterminate vegetable production. Therefore, sequential monitoring of NDVI is proposed during the 2022 and 2023 agricultural cycles using the Green Seeker® sensor and agronomic variables. This has created a database to generate predictive models of development and yield as a function of nutrient status. The results obtained indicate high significance levels for the development and NDVI curves in all phenological stages; in contrast to the yield predictive models, this is due to the maximum values (close to one) recorded for NDVI inside the greenhouse in comparison to the yield prediction obtained from the 18th week of harvest. Evaluating the models between NDVI and agronomic variables is not an index that offers certainty in predicting yield in indeterminate crops in protected agriculture production systems. This is due to the constant optimal development in response to controlled environmental conditions, nutrient status, and water supply inside the greenhouse, without the sustainability of yield, which decreases in the final stages of production until production becomes economically unprofitable.

Fetal Radiation Dose in Common Diagnostic Radiology Procedures for Pregnant Patients: Findings from In-Phantom Measurements

The diagnosis of emergent conditions during pregnancy can be delayed due to insufficient knowledge of fetal radiation doses in different imaging modalities. The aim of this article is to investigate the ranges of fetal doses in most common diagnostic and interventional radiology procedures. Procedures were carried out on an anthropomorphic phantom, Tena, representing a pregnant woman in the 18th week of pregnancy with the fetus in breech position. Different clinical scenarios using computer tomography (CT), radiography, fluoroscopy and digital subtraction angiography were selected in three teaching hospitals. Measurements were performed using radiophotoluminescent glass dosimeters placed in dedicated holes in the fetal head and fetal body. Measured fetal doses were below 1 mGy when the fetus was not in the primary beam. The highest fetal doses, up to 47 mGy, were measured after a CT scan for polytrauma and up to 24 mGy after a CT scan of the abdomen and pelvis. Significant variability in fetal doses for the same procedure was found between different hospitals but within the same hospital also. All obtained results are below the threshold for deterministic effects given by the International Commission for Radiation Protection but can be reached with two or more imaging procedures employed. The variability in fetal doses for the same procedures highlights the need for the improved optimization of imaging protocols.

P0021 Long non-coding RNAs as predictors of response to anti-TNF therapy in Ulcerative Colitis patients

Abstract Background Long non-coding RNAs (lncRNAs) are transcripts with more than 200 nucleotides that modulate molecular mechanisms in several ways, including epigenetic modification, transcription, post-transcription, translation, and post-translation. We have recently demonstrated the involvement of lncRNAs in the pathogenesis of inflammatory bowel disease (IBD) and their role in the accurate diagnosis of IBD patients 1,2. In this study, we aim to determine the potential of lncRNAs in predicting the response of ulcerative colitis (UC) patients to anti-TNF-α therapy. Methods Twenty-two UC patients who were naïve to Adalimumab biosimilar, CinnoRa enrolled in this prospective cohort study. Colonic tissue samples were collected at baseline and week 14 after treatment. Based on our previous reports, a list of important lncRNAs in IBD pathogenesis was prepared and their expression was evaluated by qRT-PCR. Machine learning algorithms were applied to evaluate the predictive potentiality of lncRNAs in differentiating UC non-responders (UCN) from UC Responders (UCR) at baseline. Results Among analyzed lncRNAs, significant dysregulation of H19 and TUG1 was observed in UCNs compared to UCRs before receiving anti-TNF therapy. Interestingly, this difference between the two patient groups was still detected in the 14th week after treatment. Machine learning algorithm results and receiver operating characteristic curve analysis demonstrated that these two lncRNAs could appropriately discriminate UCN patients from UCR with more than 90% accuracy and AUC &amp;gt; 0.8. Conclusion We concluded that expression profiles of lncRNAs are different in pretreatment lesions of UC patients before receiving anti-TNF therapy. Importantly, lncRNAs are involved in the distinctive molecular response of UC patients to anti-TNF monoclonal antibodies. Furthermore, H19 and TUG1 can serve as biomarkers in predicting the response of UC patients to anti-TNF therapy at baseline.

Trajectories of Maternal Urinary Iodine Concentration Are Associated With Gestational Diabetes Mellitus.

The relationship between iodine status and gestational diabetes mellitus (GDM) is inconclusive. This study aimed to explore the trajectories of urinary iodine concentrations (UIC) in pregnant women before GDM diagnosis and to assess the associations between maternal UIC trajectories and the risk of developing GDM. A prospective cohort study was conducted in China. Data from 1076 pregnant women who were recruited between August 2019 and December 2021 were analyzed. GDM screening was performed at the 28th week of pregnancy. Arsenic and cerium catalysis spectrophotometry was used to measure UIC. The latent class model was used to identify distinct UIC trajectories in pregnant women, using multiple urine specimens. We evaluated the association of UIC trajectories with the risk of GDM by logistic regression analysis. Three maternal UIC trajectories were identified: (1) high-stable trajectory (72.12%), (2) high-decreasing trajectory (3.07%), and (3) low-stable trajectory (24.81%). Compared with the pregnant women in high-stable trajectory group, women in the low-stable UIC trajectory group showed an increased risk of GDM before adjustment of covariates (OR: 1.58, 95% CI: 1.08-2.27). After adjusting for different covariates, a statistically significant association was observed only between low-stable trajectory trajectories and GDM. This study highlights a relationship between UIC and the risk of GDM. To better prevent iodine deficiency and GDM, persistent sufficient iodine status from pregnancy to delivery, should be emphasized.

Abdominal wound dehiscence after appendectomy during pregnancy treated by negative pressure wound therapy with subsequent vaginal delivery: A case report and literature review.

Negative pressure wound therapy (NPWT) is a very effective method in the treatment of dehiscent, infected, and non-healing wounds. Difficult wound healing occurs especially in late pregnancy due to the rapid enlargement of the uterus and the constantly increasing tension of the entire abdominal wall. In cases of dehiscence of the surgical wound during pregnancy, proper subsequent treatment is needed, where it is necessary to consider the safety of the mother as well as the fetus. We report the case of a 30-week pregnant patient who was surgically treated for acute appendicitis in pregnancy with an open appendectomy approach. Postoperative complications resulted in wound dehiscence with complete defect in fascia, which was treated with negative V.A.C. ATS® Therapy System. The therapy was started in the 30th week of pregnancy and continued until delivery with regular check-ups and regular redressing of the vacuum-assisted closure (VAC) system. At 38 weeks of pregnancy, the patient delivered vaginally with continued VAC therapy insitu. The final suture took place 3 days after vaginal delivery. Non-healing wounds with abdominal wall defects should be treated using a multidisciplinary approach, and NPWT can be used. This therapy can also be used during pregnancy. Vaginal delivery is preferred because it reduces the risk of further formation or deepening of the abdominal wall defect after a sufficient time interval from the start of the treatment. This complex case with a literature review of surgical complications in pregnancy treated with NPWT therapy highlights the advantage of a multidisciplinary approach.