Vanadate enhances insulin-receptor binding in gestational diabetic human placenta

Although vanadium is found abundantly in animal and plant kingdoms its biological effects are not clear. Vanadate compounds have been shown to normalize blood glucose levels in streptozotocin treated rats, enhance glucose oxidation and improve the sensitivity to insulin by enhanced receptor binding in rat adipocytes. The aim of the present study was to investigate the effect of vanadate, at high (0–8 mmol l^?1) and low (0–1·0 mmol l^?1) physiological concentrations, on [¹²⁵I]-insulin binding in the placenta of three groups of pateints, namely from normal (N) controls, gestational diabetics (GDM) and women with risk factors in their medical history for developing diabetes mellitus (RF). Vanadate at low concentrations (0·2–0·6 mmol l^?1) enhanced the maximal binding 2-fold in GDM placenta but only increased (up to 1·2-fold) the binding slightly at high cncentrations (5 mmol l^?1). However with placenta from normal or women at risk, vanadate increased the [¹²⁵I]-insulin binding up to 1·2-fold both at low and high concentrations. Thus it appears that vanadate augements insulin binding in the placenta from women with gestational diabetes mellitus.     

Serum metabonomics study of pregnant women with gestational diabetes mellitus based on LC-MS

ObjectiveThrough metabolomics method, the objective of the paper is to differentially screen serum metabolites of GDM patients and healthy pregnant women, to explore potential biomarkers of GDM and analyze related pathways, and to explain the potential mechanism and biological significance of GDM.MethodsThe serum samples from 30 GDM patients and 30 healthy pregnant women were selected to conduct non-targeted metabolomics study by liquid chromatography-mass spectrometry. The differential metabolites between the two groups were searched and the metabolic pathway was analyzed by KEGG database.ResultsMultivariate statistical analysis found that serum metabolism in GDM patients was different significantly from healthy pregnant women, 36 differential metabolites and corresponding metabolic pathways were identified in serum, which involved several metabolic ways like, fatty acid metabolism, butyric acid metabolism, bile secretion, and amino acid metabolism.ConclusionThe discovery of these biomarkers provided a new theoretical basis and experimental basis for further study of the early diagnosis and pathogenesis of GDM. At the same time, LC-MS-based serum metabolomics methods also showed great application values in disease diagnosis and mechanism research.     

Circadian Rhythm of Blood Pressure Challenges Office Values as the “Gold Standard” in the Diagnosis of Gestational Hypertension

Despite poor sensitivity and specificity, office blood pressure (BP) determinations are still the “gold standard” for diagnosing gestational hypertension. This prospective blind study evaluates the prognostic value of office values as compared with ambulatory monitoring in pregnancy. We analyzed 2175 BP series systematically sampled from 355 non-preeclamptic pregnant women for 48 h every 4 wks from the first hospital visit until delivery. Women were divided for comparative purposes into three groups: “detected” gestational hypertension, defined on the basis of casual clinical BP>140/90 mm Hg after 20 wks of gestation and hyperbaric index (area of BP excess above the upper limit of a time-specified tolerance interval adjusted for the circadian pattern of the reference population) consistently above the threshold for diagnosing hypertension in pregnancy; “undetected” gestational hypertension, women with office BP<140/90 mm Hg but hyperbaric index consistently above the threshold for diagnosis; and normotension, women with both office values and hyperbaric index below the respective thresholds for diagnosis. Small and insignificant differences in the 24 h mean BP between “detected” and “undetected” gestational hypertension is observed in all trimesters, in contrast with highly significant differences between these two groups and normotensive pregnancies. Normotensive women are characterized by highly significant lesser incidence by 60% in preterm delivery, 70% in intrauterine growth retardation, and 50% in delivery by cesarean section (P<0.001) compared with women with “detected” and “undetected” gestational hypertension (P>0.715). In pregnancy, the hyperbaric index is markedly superior to office BP measurements for diagnosis of what should be truly considered gestational hypertension, and for prediction of the outcome of pregnancy.     

44例不同孕周脐带脱垂患者的临床资料分析

目的:探讨不同孕周脐带脱垂患者相关因素的差异。方法:回顾性比较分析2012年01月至2017年12月我院收治的44例脐带脱垂患者的临床资料。将患者按照脐带脱垂发生的孕周分为足月组、早产组及流产组,使用SPSS18.0统计软件处理数据。结果:我院近六年脐带脱垂总的发病率为1.829/1000。44例患者中,足月组7人,占15.91%;早产组22人,占50%;流产组15人,占34.09%。三组患者的年龄、产次及孕次均无显著统计学差异(P0.05)。足月组新生儿apgar评分最高,与其它两组相比均有统计学差异(P0.05),早产组apgar评分显著高于流产组(P0.05);足月组剖宫产率为100%,早产组为63.64%,流产组则为13.13%,三组患者剖宫产率比较存在统计学差异(P=0.000),足月组剖宫产率与早产组比较无统计学差异(P=0.075),足月组剖宫产率与流产组比较有统计学差异(P=0.000),早产组剖宫产率与流产组比较有统计学差异(P=0.003)。足月组异常胎方位的发生率显著低于早产组(P=0.038)。早产组胎儿数(单胎、双胎)与足月组及流产组相比均有统计学差异(P0.05),而足月组与流产组胎儿数则无统计学差异(P0.05)。早产组双胎妊娠占比例更高。三组患者发生脐带脱垂的地点比较无统计学差异(P=0.256)。结论:不同孕周是否发生脐带脱垂与患者的年龄、产次、孕次及地点无关。脐带脱垂较多发生于早产者,且早产患者中双胎、异常胎方位发生率更高。一旦发生脐带脱垂,尤其是有机会存活的胎儿,应以最快的方式娩出胎儿,提高新生儿存活几率。     

胰岛素不同给药方式对妊娠期糖尿病患者围手术期血糖控制的效果研究

目的:研究胰岛素不同给药方式对妊娠期糖尿病患者围手术期血糖控制的效果与安全性。方法:选择2013年11月～2016年11月于我院接受治疗的92例妊娠期糖尿病患者,所有患者按随机数字表法分为对照组和研究组,每组46例。对照组围手术期予以皮下注射胰岛素治疗,研究组围手术期予以胰岛素泵治疗。比较两组空腹血糖(FBG),餐后2 h血糖(2hPBG),血糖达标情况,抗生素使用情况,切口愈合情况、住院时间及并发症的发生情况。结果:治疗后12 h、24 h及36 h,两组FBG、2hPBG水平均较治疗前显著下降,且研究组以上指标均低于对照组(P0.05)。研究组血糖达标、抗生素使用、切口愈合及住院时间均明显短于对照组(P0.05)。两组均有低血糖、切口感染发生,研究组并发症发生率低于对照组(P0.05)。结论:胰岛素泵输注胰岛素对妊娠期糖尿病患者围手术血糖的控制效果明显优于皮下注射胰岛素,且其安全性更高。     

Elabela and Apelin actions in healthy and pathological pregnancies

Pregnancy is a dynamic and precisely organized process during which one or more baby develops. Embryonic development relies on the formation of the placenta, allowing nutrient and oxygen exchange between the mother and the fetus. Dysfunction of placental formation lead to pregnancy disorders such as preeclampsia (PE) with serious deleterious consequences for fetal and maternal health. Identifying factors involved in fetoplacental homeostasis could inform better diagnostic and therapeutic strategies for these pathological pregnancies. Here, we summarize actions of elabela, apelin and their common receptor APJ in the fetoplacental unit. Studies indicate that elabela is crucial for embryo cardiovascular system formation and early placental development, while apelin acts in mid/late gestation to modulate fetal angiogenesis and energy homeostasis. Most of these findings, drawn from animal models, indicate a key role of elabela/apelin-APJ system in the fetoplacental unit. This review also provides an overview of clinical studies investigating elabela/apelin-APJ system in pathological complicated pregnancies such as PE and gestational diabetes mellitus (GDM). While elabela-deficient mice display all the features of PE, current clinical studies show no difference in circulating elabela levels between PE and control patients which does not support a role in PE development. Conversely, apelin levels are increased during PE, but the use of apelin as an early PE marker remains to be fully investigated.     

The association between serum selenium and gestational diabetes mellitus: A systematic review and meta-analysis

BackgroundResults of the studies about association between serum selenium concentration and gestational hyperglycemia are inconsistent. Some studies have demonstrated that women with gestational diabetes mellitus (GDM) have lower Se concentrations while contrary results are reported in other studies.AimThe aim of this study is to compare the serum Se concentration in women with GDM and normoglycemic pregnant women via a systematic review and meta-analysis.MethodsA computerized literature search on four databases (PubMed, Cochrane register of control trials, Scopus and Google scholar) was performed from inception through August 2013. Necessary data were extracted and random effects model was used to conduct the meta-analysis.ResultsSix observational studies (containing 147 women with GDM and 360 normoglycemic pregnant women) were found, which had compared serum Se concentration in women suffering from GDM with normal pregnant ones. Our meta-analysis revealed that serum Se concentration was lower in women with GDM compared to normoglycemic pregnant women (Hedges = −1.34; 95% CI: −2.33 to −0.36; P < 0.01). Stratified meta-analysis demonstrated that concentration of Se in the sera of women with GDM was lower than normal pregnant women both in second and third trimesters, but the result was not significant in second trimester (second trimester: Hedges = −0.68; 95% CI: −1.60−0.25; P = 0.15, third trimester: Hedges = −2.81; 95% CI: −5.21 to −0.42; P < 0.05). It was also demonstrated that serum Se status was lower in pregnant women with impaired glucose tolerance (IGT) compared to normoglycemic pregnant women (Hedges = −0.85; 95% CI: −1.18 to −0.52).ConclusionThe available evidences suggest that serum Se concentration is significantly lower in pregnant women with gestational hyperglycemia compared to normal pregnant women.     

甲状腺功能减退孕妇糖代谢、肾功能指标的变化及临床意义

目的:探究妊娠期甲状腺功能减退患者糖代谢及肾功能变化及临床意义。方法:选择2015年6月至2019年8月来我院就诊的甲状腺功能减退孕妇60例作为甲减组及同期健康孕妇60例作为对照组。比较两组患者甲状腺功能[促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT_3)及游离甲状腺素(FT_4)]、糖代谢指标[空腹血糖水平(FBG)、糖化血红蛋白(HbA1C)、餐后2 h抽取肘静脉血测定餐后2 h葡萄糖水平(2hPG)、胰岛素抵抗指标(HOMA-IR)]及肾功能[血清肌酐(Cr)、血清尿酸(UA)、血尿素氮(BUN)],分析甲状腺功能与糖代谢及肾功能的关系,比较两组患者的妊娠结局。结果:甲减组孕妇的TSH、糖代谢、肾功能各指标水平较对照组显著升高,FT_4较对照组明显降低(P0.05)。TSH与糖代谢各指标均呈正相关(P0.05);FT_4与糖代谢各指标均呈负相关(P0.05),FT_3与Cr呈负相关(P0.05),TSH、FT_4与Cr、UA、BUN均无明显相关性(P0.05)。甲减组的不良妊娠结局率为20.00%,显著高于对照组(6.67%,P0.05)。结论:妊娠期甲状腺功能减退患者存在糖代谢紊乱、肾功能异常,可能导致不良妊娠结局。     

孕妇肠道微生物组成与孕妇及新生儿糖脂代谢相关性研究

目的研究孕妇肠道微生物组成与孕妇以及新生儿糖脂代谢的相关性。方法选择2017年6月至2018年9月在大连市妇幼保健院定期产检的诊断为妊娠期糖尿病(GDM)的孕妇89例为GDM组,血糖正常孕妇96例为对照组。收集孕妇一般资料,孕妇和新生儿糖脂代谢物、孕妇粪便进行微生物检测。结果 GDM组孕妇空腹血糖、甘油三酯明显高于对照组,高密度脂蛋白水平明显低于对照组(均P<0.05)。GDM新生儿脂联素和血糖明显低于对照组,胰岛素和糖化血红蛋白明显高于对照组(均P<0.05)。对照组孕妇肠道微生物中拟杆菌(Bacteroides)丰富度最高(36.6%),其次是普雷沃菌(Prevotella)(15.3%)、柔嫩梭菌(Faecalibacterium)(10.2%)、考拉杆菌(Phascolarctobacterium)(7.2%)。GDM组孕妇肠道微生物中拟杆菌(Bacteroides)丰富度最高(29.4%),其次是柔嫩梭菌(Faecalibacterium)(19.7%)、普雷沃菌(Prevotella)(11.1%)、考拉杆菌(Phascolarctobacterium)(9.3%)。柔嫩梭菌(Faecalibacterium)与孕妇空腹血糖呈正相关(r=0.377 6,P=0.027 6),拟杆菌(Bacteroides)、埃希菌(Escherichia)与孕妇甘油三酯呈负相关(r=-0.027 5,-0.585 8,P=0.023 7,0.041 3)。柔嫩梭菌(Faecalibacterium)与新生儿空腹血糖呈负相关(r=-0.397 6,P=0.027 6)。结论 GDM孕妇肠道微生物构成与血糖正常孕妇不同,菌群丰富度和多样性较低,并且孕妇肠道菌群与其及新生儿的糖脂代谢相关,调节孕妇肠道菌群或有利于改善其与新生儿的糖脂代谢功能。     

高通量测序分析妊娠期糖尿病对早产儿肠道菌群的影响

目的通过高通量测序技术探究妊娠期糖尿病对早产儿肠道菌群的影响,并对相关功能及代谢通路进行预测。方法选取符合入组条件的早产儿40例,依据孕母是否患有妊娠期糖尿病分为妊娠期糖尿病组(GDM组)和对照组,各20例,于出生后24 h内收集早产儿胎便进行16S rRNA基因测序,对测序结果进行物种分类学分析及生物信息学分析。结果 GDM组显示出更低的物种丰富度及多样性(P=0.048)。两组物种组成存在显著差异(P=0.048),GDM组厚壁菌门与拟杆菌门比值明显升高,机会致病菌相对丰度增加,同时革兰阴性杆菌比例上升。PICRUSt功能预测分析表明,GDM组在碳水化合物转运及代谢、细胞外结构、环境信息处理代谢通路和免疫性疾病代谢通路的功能丰度增高。结论妊娠期糖尿病可导致早产儿肠道微生态平衡被破坏,肠道菌群失调或为母亲患有GDM的早产儿多种疾病发病率增高的原因之一。