Heterotopic pregnancy is the coexistence of living or dead intrauterine pregnancy, single or multiple, and extrauterine pregnancy located in the oviduct, ovary, uterine corner, cervix or peritoneal cavity. This condition is very rare (1:30 000 pregnancies). Nevertheless, in the latter years because of the development and accessibility of assisted reproductive techniques, the incidence of heterotopic pregnancies increased to 1:100 of pregnancies. The aim of this report is to present a case of early recognized intrauterine and extrauterine pregnancy. The case refers to 25-year-old patient, pregnant for the second time, in more or less 6th week of gestation, who had not been stated any heterotopic pregnancy incidence risk factors. After the observation lasting for several days in the Clinic, the presence of a living intrauterine and coexisting extrauterine pregnancy located in the right oviduct was stated. The patient had her right oviduct removed by means of laparoscopy. After the surgery the patient with the living intrauterine pregnancy was released from the Clinic. Normal further course of intrauterine pregnancy. The patient gave birth around her expected delivery date. The presented case indicates the significance of correctly and carefully performed ultrasound examination. Moreover, it is a warning for the doctors performing ultrasound examinations in the early weeks of pregnancy – the visualization of a normal pregnancy in the ultrasound examination does not release the examiner from a necessity of precise imaging of adnexa of the uterus. Early diagnosis of this pathology, thanks to a precise ultrasound examination, decreases the risk of complication incidence as well as women mortality.
Upregulation of chemokine CX3CL1 and its receptor CX3CR1 occurs in the diabetic human placenta. Metformin, an insulin-sensitizing biguanide, is used in the therapy of diabetic pregnancy. By preventing the activation of NF-κB, metformin exhibits anti-inflammatory properties. We examined the influence of hyperglycemia (25 mmol/L glucose; HG group; N = 36) on metformin-mediated effects on CX3CL1 and TNF-α production by placental lobules perfused extracorporeally. Additionally, CX3CR1 expression and contents of CX3CR1, TNF-α receptor 1 (TNFR1), and NF-κB proteins in the placental tissue were evaluated. Placentae perfused under normoglycemia (5 mmol/L glucose; NG group; N = 36) served as the control. Metformin (2.5 and 5.0 mg/L; subgroups B and C) lowered the production of CX3CL1 and TNF-α in a dose-dependent and time-dependent manner. Hyperglycemia did not weaken the strength of these metformin effects. Moreover, CX3CL1 levels after perfusion with 5.0 mg/L metformin were reduced by 33.28 and 33.83% (at 120 and 150 min, respectively) in the HG-C subgroup versus 24.98 and 23.66% in the NG-C subgroup, which indicated an augmentation of the metformin action over time in hyperglycemia. CX3CR1 expression was significantly higher in the HG-B and HG-C subgroups compared to that in the NG-B and NG-C subgroups. Increased CX3CR1 protein content in the placental lysates was observed in subgroups B and C. The two higher metformin concentrations significantly decreased the levels of NF-κBp65 protein content in both groups. However, the decrease was significantly stronger in hyperglycemia. TNFR1 upregulation in the HG group was not affected by metformin. Further studies on metformin therapy during pregnancy are needed, including safety issues.
HPV is common sexually transmitted infection. Based on the oncogenic potential, low‐risk and high‐risk HPV types were distinguished among approximately 40 HPV genotypes identified within the mucosa of the anogenital tract. Epithelial HBDs act as a potent protein adjuvants promoting cellular and humoral immune responses in viral infections. Unlike alpha‐defensins, HBDs are upregulated in HPV infections. We compared strenght of this response in respect to oncogenic (types 16 and 18) and non‐oncogenic (6 and 11) HPVs (groups I and II, respectively). After normal pregnancies (N = 96) HAEC were isolated from the amnions using trypsinization and divided into three groups (including negative controls; group III), according to the results of the vaginal smear real‐time PCR test for detection of HPV DNA. HAEC stimulated with lipopolysaccharide (1μg/ml) were cultured in vitro for 5 days. HBD‐1, HBD‐2, and HBD‐3 were quantified by ELISA in the culture media samples. Observed mean increases for HBDs were 5.7‐, 3.4‐, and 4.6‐fold, compared to the controls. The mean increases in HBDs concentrations were weaker in the oncogenic HPV infection, compared to the non‐oncogenic HPVs, and the differences between group I and II reached statistical significance (p < 0.05) for HBD‐1 and HBD‐3. Thus, HPV‐related HBD overproduction depends on the virus genotype. Subdued response to oncogenic HPVs may be included in their pathomechanism.
Grant Funding Source: Supported by WUM grant: 2M2‐W2‐13.
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