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ObjectiveTo evaluate the diagnostic accuracy of the 2011 International Federation for Cervical Pathology and Colposcopy (IFCPC) colposcopic terminology.MethodsThe clinicopathological data of 2262 patients who underwent colposcopy from September 2012 to September 2016 were reviewed. The colposcopic findings, colposcopic impression, and cervical histopathology of the patients were analyzed. Correlations between variables were evaluated using cervical histopathology as the gold standard.ResultsColposcopic diagnosis matched biopsy histopathology in 1482 patients (65.5%), and the weighted kappa strength of agreement was 0.480 (P<0.01). Colposcopic diagnoses more often underestimated (22.1%) than overestimated (12.3%) cervical pathology. There was no significant difference between the colposcopic diagnosis and cervical pathology agreement among the various grades of lesions (P=0.282). The sensitivity, specificity for detecting high-grade lesions/carcinoma was 71.6% and 98.0%, respectively. Multivariate analysis showed that major changes were independent factors in predicting high-grade lesion/carcinoma, whereas transformation zone, lesion size, and non-stained were not statistically related to high-grade lesion/carcinoma.ConclusionsThe 2011 IFCPC terminology can improve the diagnostic accuracy for all lesion severities. The categorization of major changes and minor changes is appropriate. However, colposcopic diagnosis remains unsatisfactory. Poor reproducibility of type 2 transformation zone and the significance of leukoplakia require further study.

Objective Pre‐eclampsia (PE) is a pregnancy‐associated condition initiated by placental factors. We have demonstrated that placental extracellular vesicles (pcEVs) cause hypertension and proteinuria in pregnant and non‐pregnant mice. Study design An observational study with both case‐control and longitudinal designs. Setting A single centre at the Department of Obstetrics and Gynaecology, Tianjin Medical University. Population We collected blood samples and clinical information from 54 PE patients, 33 normally pregnant women at 30–36 gestational weeks and on postpartum days 1 and 4 for the cross‐sectional study, and at 22–31, 32–35 and 36–40 weeks for the longitudinal study. Non‐pregnant women were also recruited. Methods Blood samples were analysed using flow cytometry, coagulation tests and ELISA. Main outcome measures The primary outcome was plasma pcEV and other extracellular vesicles (EVs), and their expressions of anionic phospholipids and von Willebrand factor (VWF). Secondary variables included coagulation, ADAMTS‐13 and the anionic phospholipid‐binding proteins. Results Plasma pcEVs progressively increased from pregnant women during non‐menstrual period (NW) to PE patients (interquartile range [IQR] for NW: 206/microlitre [116–255], normal pregnancy [NP]: 1108/microlitre [789–1969] and PE: 8487/microlitre [4991–16 752]) and predicted PE. EVs from endothelial cells, platelets and erythrocytes accounted for <10% of pcEVs. VWF became hyper‐adhesive in PE patients and contributed to the pregnancy‐associated hypercoagulability. Conclusion Placental, platelet‐ and endothelial cell‐derived EVs were significantly elevated in PE patients, but only pcEVs predicted PE. These EVs played a causal role in the pregnancy‐induced hypercoagulability. Tweetable abstract Placenta‐derived extracellular vesicles predict pre‐eclampsia and the associated hypercoagulability.

Preeclampsia (PE) occurs specifically during pregnancy characterized by new-onset hypertension. The pathogenesis of PE was complicated, and inflammation may be central to the pathogenesis of PE. Ferulic acid (FA) is recognized to prevent cell damage and apoptosis induced by oxidative stress and inflammation. In our study, we used NG-nitro-l-arginine methyl ester (L-NAME)-induced rat model of PE to investigate whether FA improved PE and its possible mechanism. We found that FA significantly reduced blood pressure, urine volume, and urinary protein level in rats with PE. Meanwhile, FA decreased L-NAME induced higher expression of circulating TNF-α、IL-6、IL-1β and PlGF, it reduced placental TNF-α and NF-κB p65. Furthermore, FA rescued L-NAME induced decreasing expression of IL-4 and IL-10 expression in the circulation and placenta of rats. FA also ameliorated placental apoptosis in L-NAME induced rats by increasing Bcl-2 whereas decreasing Bax expression in placenta. It suggested FA as a potential candidate for the treatment of various disorders including L-NAME induced preeclampsia in rats through decreasing placental inflammation and apoptosis.