Background and AimsWomen with severe intrahepatic cholestasis of pregnancy (ICP) are at higher risks of fetal complications and without effective treatments. Changes in gut microbiota in pregnancy were found to be related to the altered intestinal bile acid composition, so we aimed to explore the alterations of microbiota in the gut of ICP patients.MethodsA total of 90 women were recruited, including 45 ICP patients and 45 healthy controls. The gut microbiota communities of ICP group were compared to control group through 16S ribosomal RNA gene sequencing. The results were then confirmed by real-time polymerase chain reaction (PCR) and generalized linear model (GLM). Furthermore, we analyzed the relationships between microbiota and the severity of ICP.ResultsA total of seven genera and nine taxa with differential abundances between the ICP patients and the controls were identified. All of the seven genera were verified through real-time PCR, and three key genera Parabacteroides, Flavonifractor, and Megamonas were confirmed by using the GLM model. Further analysis found that the genera Escherichia_Shigella, Olsenella, and Turicibacter were enriched in the severe ICP group, the microbial gene function related to biosynthesis of unsaturated fatty acids and propanoate metabolism were also increased in them.ConclusionsOverall, our study was the first in Asia to demonstrate an association between gut microbiota and ICP. Our findings would contribute to a better understanding of the occurrence of ICP.

To investigate the clinical significance of prenatal diagnosis and prognosis evaluation of congenital choledochal cyst (CCC), we reviewed CCC cases of diagnosed antenatally in our hospital from 2007 to 2013, summarised and analysed prenatal sonographic features and clinical outcomes, and followed these cases up to six months after birth. We found that induced labour was conducted in 7 cases, and term labour progressed smoothly in 14 cases among the 21 cases. Operations were completed within 3 months after birth and all the operation cases received a good prognosis. We suggest that CCC is one kind of non-lethal congenital malformation which can be treated after birth. Prenatal diagnosis is important for its treatment after birth, because early surgery after birth is associated with good treatment outcomes and prognosis.

Objective. The metabolism of three major nutrients (sugar, lipid, and protein) will change during pregnancy, especially in the second trimester. The present study is aimed at evaluating carnitine alteration in fatty acid metabolism in the second trimester of pregnancy and the correlation between carnitine and GDM. Methods. 450 pregnant women were recruited in the present prospective study. Metabolic profiling of 31 carnitines was detected by LC-MS/MS in these women. Correlation between carnitine metabolism and maternal and neonatal complication with GDM was analyzed. Results. We found the levels of 7 carnitines increased in age>35, BMI≥30, weight gain>20 kg, and ART pregnant groups, but the level of free carnitine (C0) decreased. Nine carnitines were specific metabolites of GDM. Prepregnancy BMI, weight gain, and carnitines (C0, C3, and C16) were independent risk factors associated with GDM and related macrosomia. C0 was negatively correlated with FBG, LDL, TG, and TC. A nomogram was developed for predicting macrosomia in GDM based on carnitine-related metabolic variables. Conclusion. The carnitine metabolism in the second trimester is abnormal in GDM women. The dysfunction of carnitine metabolism is closely related to the abnormality of blood lipid and glucose in GDM. Carnitine metabolism abnormality could predict macrosomia complicated with GDM.

Coronavirus disease 2019 (COVID-19) is associated with increased morbidity and mortality among kidney transplant recipients (KTRs). The administration of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination is the only reliable strategy to prevent COVID-19 and alleviate the severity of COVID-19 in this particular population. The aim of this article was to evaluate the clinical protection by vaccines (breakthrough infections, deaths, and hospitalizations) in KTRs. There were 135 KTRs with COVID-19 breakthrough infections for whom patient-level data were available in PubMed and Web of Science. There was a male predominance (61.4%), 97 were given the standard vaccination regimen, and 38 received three or four doses of the vaccine. The median age was 59.0 (IQR: 49.0–69.0) years. A total of 67 patients were hospitalized, and 10 patients died. In 72.6% of cases, triple-maintenance immunosuppression was employed. The deceased patients were older than the survivors (p < 0.05); an age over 60 years was a risk factor for death (p < 0.05). The KTRs with booster vaccines had a longer time interval from the last vaccine to COVID-19 infection and lower hospitalization rates than the individuals who received the standard vaccination regimen (33.3% vs. 54.8%, p < 0.05). The hospitalized patients were older than the outpatients (p < 0.05). Among 16,820 fully vaccinated or boosted KTRs from 14 centers, there were 633 breakthrough infections (3.58%) and 73 associated deaths (0.41%). The center-level breakthrough infection rates varied from 0.21% to 9.29%. These findings highlight the need for booster doses for KTRs. However, more research is needed to define the long-term effectiveness and immunogenicity of booster doses and to identify methods to boost the protective response to vaccination in these immunocompromised patients.

Objective Dyslipidemia in the second trimester and associated gestational diabetes are increasing worldwide. Carnitine plays a key role in lipid metabolism. We aim to describe metabolic profiling in the second trimester based on carnitine related metabolomics in GDM and high risk pregnancy, and to find the potential risk factors in GDM and candidate metabolites for diagnosing GDM induced macrosomia.Methods We have randomly investigated 450 pregnant women and their neonates in this retrospective study and 56 (12.4%) GDM cases were diagnosed. We used LC-MS/MS performing metabolic profiling about 12 amino acids and 31 acylcarnitines (containing C0) to assess circulating metabolites concentration in different subgroup according maternal and newborn clinical characteristic. We also calculated the correlation coefficient between maternal and newborn. GDM potential metabolic risk factors were screened by PLS-DA. Multivariate regression analyses were used in identifying independent risk factors for GDM and macrosomia. Based on these carnitine-related factors, a nomogram for estimating macrosomia was developed.Results We found 14 AA (Ala, Arg, Met, BCAA, AAA) and AC (C0, C2, C3, C4DC+C5OH, C5, C16, C18, C18:1) were increased in Age > 35 group, BMI ≥ 30, weight gain > 20 kg group, using assistant reproductive technology group, but the level of C0, Gly were decreased. In fetal clinical data, we obtained AA and AC level in fetuses are higher than their mothers and the metabolic trend was similar with maternal result. PLS-DA showed 15 metabolism(C0, LEU+ILE+PRO-OH, Phe, C18, TYR, etc)play main roles in class separation of GDM. Multivariate analysis showed pre-pregnancy BMI, weight gain, LEU+ILE+PRO-OH, TYR, C0/acylcarnitine, C0, C3, C16, C18 are independent risk factors associated with GDM. Finally, we developed a nomogram predicting macrosomia based on carnitine-related metabolic variables.Conclusion Metabolomics was proved as a powerful tool in identifying the metabolic alteration during the second trimester. These metabolic risk factors in GDM may help understanding of the underlying biochemical pathology of GDM and help physician diagnosing macrosomia.