Development of liver diseases during pregnancy is not uncommon. They are caused by either a disorder that is unique to pregnancy or an acute or chronic liver disease that already exists or coincidentally develops as a comorbidity of pregnancy. Liver diseases unique to pregnancy include hyperemesis gravidarum; hypertensive disorders of pregnancy, such as pre‐eclampsia/eclampsia; hemolysis, elevated liver enzymes, and low platelet count syndrome; intrahepatic cholestasis of pregnancy; and acute fatty liver of pregnancy. Chronic liver diseases that affect pregnancy, or are affected by pregnancy, mainly include autoimmune liver diseases and non‐alcoholic fatty liver disease. Prompt diagnosis and management of liver diseases in pregnancy, while very challenging, is extremely important, as they might cause adverse maternal and fetal outcomes. Therefore, a multidisciplinary, collaborative approach involving both hepatologists and obstetricians is required. In this review article, the up‐to‐date epidemiology, etiology, clinical features, and outcomes of liver diseases in pregnancy are discussed, to promote a deeper understanding among physicians, and subsequently improved outcomes.
BackgroundAccumulating evidence from medical workforce research indicates that poor work/life balance and increased work/home conflict induce psychological distress. In this study we aim to examine the existence of a priority gap between ideal and real lives, and its association with psychological burnout among academic professionals.MethodsThis cross-sectional survey, conducted in 2014, included faculty members (228 men, 102 women) at a single medical university in Tokyo, Japan. The outcome of interest was psychological burnout, measured with a validated inventory. Discordance between ideal- and real-life priorities, based on participants’ responses (work, family, individual life, combinations thereof), was defined as a priority gap.ResultsThe majority (64%) of participants chose “work” as the greatest priority in real life, but only 28% chose “work” as the greatest priority in their conception of an ideal life. Priority gaps were identified in 59.5% of respondents. A stepwise multivariable general linear model demonstrated that burnout scores were associated positively with respondents’ current position (P < 0.0018) and the presence of a priority gap (P < 0.0001), and negatively with the presence of social support (P < 0.0001). Among participants reporting priority gaps, burnout scores were significantly lower in those with children than in those with no children (P interaction = 0.011); no such trend was observed in participants with no priority gap.ConclusionsA gap in priorities between an ideal and real life was associated with an increased risk of burnout, and the presence of children, which is a type of “family” social support, had a mitigating effect on burnout among those reporting priority gaps.
SUMMARYIt has been reported tiiat the binding of some antiphospholipid antibodies (APA) to phospholipids requires llic presence of /frglycoprotein I (/(:-GPI), Using a new ELISA. in which well coaled phosphoiipids were treated witiiaeonstantamount of"puriiied/^-GPI. we tried to detect liie presence of APA which binds lo phosphoiipid//^;-GPI eomplex or to phospholipids sueh as eardioiipin (CA) and phnsphittidylserine (PS) in preeeiampsia. and to check for cliniciii abnormaiilies in iintibodypositivc eases. Serum satnples were taken from 43 cases of preeeiampsia. ineiuding 26 cases of the severe lype. and 47 normal pregnant women. Positive rates of antieardioiipin antibody (ACA) by ELISA using CA/^:-GPI complex in miid. severe and totai preeeiampsia were 200%, i7-4% and 18-4% respeetively. No antibody-positive eases were found in normal pregnancies. ACA was deteeted tntieh more frequently when eardiolipin,7?:-GPI complex was used in ELISA eompared with ELISA wiihout /(-GPI. Positive rales of anliphosphatidylserine antibody (APSA) in mild, severe and totai preeclampsia were 5-9%. li-5'^ and 9-3% respectively. APSA was aiso deteeted mueh more frequently when the phosphatidylserine,//^-GP! eomplex was used in ELISA. The frequency of inirauierine growth retardation (lUGR) in liie ACA-positive subjeets was higher than that of ACA negatives. We suggest that Lhe ACA and APSA which bind lo phospholipiiJ//f2-OPI complex are delectable in preeclampsia, and that these antiphospholipid antibodies arc rciated to fctai growth.
Summary In order to investigate the pathophysiologica! significance of anti-endothelial cell antibody (AECA) in pre-eclampsia, the effects of AECA on endothelin-1 (ET-I) and prostaglandin I-, (PGI-,) release from cultured human umbilical vein endothelial cells (HUVEC) was evaluated. Serum samples were taken from 85 pre-eclamptic and 20 normal pregnant women. Anti-endothelial cell antibody was measured by ELISA using HUVEC. The release of ET-1 and 6-keto PGEl-a, a stable metabolite of PGI,, from HUVEC were evaluated after incubation with IgG-AECA-positive sera and IgG isolated from AECA-positive sera. The incidence of IgG-and IgM-AECA was 24.7 and R.2%, respectively. The release of ET-I in the medium containing IgG-AECA-positive sera was significantly greater than in the medium containing IgG-AECA-negative sera. There was signiticant correlation between the levels of IgG-AECA and the release of ET-1 from endothelial cells. The ET-1 relea.se by IgG isolated from AECA-positive sera was greater than that from AECAnegative .sera. However, the release of 6-keto PGFI-a by AECA-positive sera was not significantly different from that of AECA-negative sera. ]( is concluded that IgG-AECA in pre-eclampsia increases ET-I release from endothelial cells and that AECA may affect local vascular function in this disorder.
The results suggest that one cause of preeclampsia is the production of antiphospholipid antibodies that bind to placental villous membrane antigens.
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