Uterine torsion complicated by severe placental abruption in the second trimester: a case report and literature review.

BACKGROUND: Uterine torsion is a rare obstetric event that can occur during pregnancy and is difficult to diagnose. Its occurrence may lead to serious adverse pregnancy outcomes. CASE INTRODUCTION: The patient was a 33-year-old woman at 30+ 5 weeks' gestation with a singleton pregnancy. The pregnancy course, including fetal growth, and prenatal examinations were regular. Except for a small amount of vaginal bleeding in early pregnancy and treatment with progesterone, there were no prenatal abnormalities, and the patient denied any trauma or sexual history. The patient was admitted to the emergency department with persistent severe pain in the lower abdomen and slight vaginal bleeding during night sleep. Abdominal pain started two hours prior to admission and was accompanied by nausea, vomiting, and dizziness. Examination revealed positive abdominal tenderness, high uterine tone, and no significant intermittent period of uterine contractions, and measurement of the fetal heart rate by means of the nonstress test revealed a rate of 60 beats per minute. Therefore, placental abruption was highly suspected. Subsequently, an emergency cesarean section was performed under general anesthesia. The newborn boy, with Apgar scores of 0-3-4 after birth and weighing 1880 g, was transferred to the neonatal intensive care unit (NICU) and died two days later due to ineffective rescue. After the uterine incision was sutured, the examination revealed that the uterine incision was located on the posterior wall of the uterus, and the uterus was twisted 180° to the right. The diagnosis after cesarean section was 180° uterine torsion to the right, severe placental abruption, and severe neonatal asphyxia. On the fifth day after surgery, the patient recovered and was discharged from the hospital. CONCLUSIONS: Posterior uterine incision cesarean section may be performed in unexpected circumstances and is also feasible as a safe option for resetting if torsion is not complete. Abdominal pain during pregnancy is less likely to be diagnosed as uterine torsion, which often leads to premature birth, fetal asphyxia, placental abruption, and even perinatal death. Therefore, for abdominal pain during pregnancy, obstetricians should consider the possibility of uterine torsion.

Effect of in situ simulation training for emergency caesarean section on maternal and infant outcomes.

BACKGROUND: Emergency caesarean section (ECS) is an effective method for rapid termination of pregnancy and for saving maternal and foetal life in emergencies. Experts recommend that the interval from decision of operation to the decision to delivery interval (DDI) should be shortened as much as possible. Studies have shown that improving communication skills among staff by performing simulation drills shortens DDI, thus reducing the occurrence of adverse obstetric events and protecting maternal and child safety. In situ simulation (ISS) training is a simulation-based training approach for clinical team members conducted in a real-world clinical setting. In August 2020, Anhui Maternal and Child Health Hospital began ISS training on the rapid obstetric response team (RRT) in our hospital area for emergency caesarean section. This study aimed to investigate the effect of implementing in situ simulation training for emergency caesarean section on maternal and child outcomes by comparing maternal and child-related data on emergency caesarean section in two hospital areas. METHODS: Data on cases of emergency caesarean delivery implemented in two hospital districts from August 2020 to August 2022 were collected: 19 in the untrained group and 26 in the training group. The two groups were compared concerning the interval from the decision of operation to the decision to delivery interval (DDI), the interval from the decision of operation to the initiation of skin incision, the interval from skin incision to the decision to delivery interval, and the neonatal situation. RESULTS: Primary outcome comparison: The training group had a significantly shorter interval between the DDI compared to the untrained group (8.14 ± 3.13 vs. 11.03 ± 3.52, P = 0.006). Secondary outcomes comparison: The training group had a significantly shorter interval between the decision to cut skin compared to the untrained group (6.45 ± 2.21 vs. 9.95 ± 4.02, P = 0.001). However, there was no significant difference in the interval between cutting skin and infant delivery between the two groups (2.24 ± 0.08 vs. 2.18 ± 0.13, P > 0.05). Additionally, the Apgar score at 1 min after birth was higher in the training group compared to the untrained group (7.29 ± 2.38 vs. 6.04 ± 1.46, P < 0.05). CONCLUSIONS: The DDI for emergency caesarean section procedures can be significantly shortened, and neonatal Apgar scores at 1 min improved by implementing in situ simulation training for emergency caesarean section in obstetric rapid response teams. In situ simulation training is an effective tool for training in emergency caesarean section procedures and is worth promoting.

Chlorogenic acid-chitosan copolymers: Synthesis, characterization and application in O/W emulsions for enhanced ß-carotene stability.

In this study, chlorogenic acid-chitosan (CA-CS) copolymers were prepared with varying Chitosan (CS): chlorogenic acid (CA)ratios and characterized for their water solubility, antioxidant capacity, and emulsions stability. Results showed that CA-CS samples exhibited up to 90.5 % increase in DPPH scavenging efficiency and 20 % increase in hydroxyl radical scavenging efficiency compared to CS alone. CA-CS copolymers used to stabilize oil in water (O/W) emulsions, which were evaluated for their potential in encapsulating and protecting ß-carotene. Microscopic observations revealed homogeneous spherical droplets in stable emulsions, suggesting effective interfacial structures. The selected CA-CS-stabilized O/W emulsions demonstrated encapsulation efficiencies of 74.8 % and 75.26 % for ß-carotene. The CA-CS stabilized O/W emulsions provided the most effective protection against ß-carotene degradation under UV exposure, retaining over 80 % of ß-carotene content after 12 h of testing. These findings indicate that CA-CS-based O/W emulsions show promise as carriers and protectors for bioactive compounds, due to their improved antioxidant capacity, emulsions stability, and protection against degradation.

Preparation of amphoteric double network hydrogels based on low methoxy pectin: Adsorption kinetics and removal of anionic and cationic dyes.

The objective of this research was to devise a functional hydrogel was synthesized using pectin (PE), acrylic acid (AA), dimethyldiallyl ammonium chloride (DC), and polyvinyl alcohol (PVA), designed to adsorb both cationic and anionic dyes concurrently. The low methoxy pectin formed double network hydrogel through chemical and physical crosslinking with AA and PVA respectively. DC is combined into the hydrogel system through copolymerization reaction. Analysis of hydrogel's physicochemical properties was conducted using techniques such as infrared spectroscopy, texture analysis, thermogravimetry, and scanning electron microscopy. Dyes adsorption studies showed that the LP/AA/DC/PVA-2 hydrogel, prepared at the molar ratio of AA to DC of 1:2, exhibited higher adsorption efficiency for methylene blue (MB) and Congo red (CR). Kinetics and isotherms studies indicated that the adsorption behavior conformed to the pseudo-second-order kinetic model and Langmuir isotherm model. By the Langmuir isotherm fitting, the maximum adsorption capacities of MB and CR by LP/AA/DC/PVA-2 were recorded to be 222.65 mg/g and 316.46 mg/g, respectively. The adsorption mechanism is dominated by the hydrogen bonding and electrostatic interactions. Further, the adsorption and desorption experiments demonstrated that LP/AA/DC/PVA-2 hydrogel have excellent reusability.

Novel Pickering emulsion gels stabilized solely by phenylalanine amidated pectin: Characterization, stability and curcumin bioaccessibility.

Pickering emulsion gels represent a novel class of non-toxic and biocompatible emulsions, offering extensive applications in the pharmaceutical and food additive sectors. This study delineates the synthesis of Pickering emulsion gels utilizing native and amidated pectin samples. Phenylalanine amidated pectin (AP) was procured via an ultra-low temperature enzyme method, while the control group (LP) adhered to an identical procedure without papain catalysis. Experimental outcomes revealed that the AP Pickering emulsion gel manifested superior stability compared to pectin emulsion samples (PE and LP). The Pickering emulsion gel from 5 % amidated pectin (5AP) retained stability throughout a 14-day emulsion stability assessment. Furthermore, all emulsion samples were evaluated for their capacity to deliver and sustain curcumin within an in vitro digestion simulation. Rheological properties and oil droplet size results indicated that the 5AP Pickering emulsion gel exhibited optimal cream index and emulsion stability, effectively inhibiting premature water-oil stratification within the emulsion and augmenting curcumin bioaccessibility. Within the in vitro digestion simulation, the 5AP Pickering emulsion gel demonstrated the highest curcumin bioaccessibility, measured at 17.96 %.

Evaluation of amidated pectin as fat substitutes for minced chicken breast: Physicochemical properties and edible quality.

An investigation was conducted to assess the gelation characteristics of amino acid amidated pectin and its subsequent influence on the quality of minced chicken breast (MCB) when employed as a lipid substitute. Through experimentation, it was evidenced that amidated pectin, such as glycine amidated pectin (AP@Gly), glutamic amidated pectin (AP@Glu), and lysine amidated pectin (AP@Lys), demonstrated superior viscosity and gelation capacity in comparison to their native pectin (PE) counterpart. In contrast to PE, amidated pectin samples exhibited the potential to form high-strength hydrogels under conditions of minimal restriction. Additionally, evaluations conducted on all samples established that MCB samples enriched with pectin and amidated pectin demonstrated superior water retention capability. Before thermal processing, MCB samples fortified with amidated pectin showcased higher hardness and L* values in comparison to PE and the control group. However, upon thermal processing, no significant divergence was found in the chroma and texture profile analysis (TPA) attributes across all MCB samples, and the electronic tongue sensory evaluation was closely aligned with the control group. This evidence substantiates the effectiveness of amidated pectin samples as viable lipid substitutes in MCB products.

Fabrication of phenylalanine amidated pectin using ultra-low temperature enzymatic method and its hydrogel properties in drug sustained release application.

In this study, pectin was modified with phenylalanine by ultra-low temperature enzymatic method to improve its gel properties. The grafting ratio of phenylalanine amidated pectin was studied under different reaction conditions. The highest value (29.21 %) was reached a reaction temperature of -5 °C and time of 12 h. Further analysis indicated that phenylalanine and high methoxyl pectin combined at the solid-liquid two phase interface under the catalysis of papain to form phenylalanine amidated pectin. Moreover, the physicochemical properties of pectin hydrogel and its feasibility as a sustained-release drug carrier were discussed. The results showed that phenylalanine amidated pectin can form hydrogel with a certain strength under acidic conditions, and there is no need to add a lot of soluble solids and divalent cations. Besides, the phenylalanine amidated pectin hydrogel as a sustained release carrier of drugs showed more sustained and complete drug release.

Preparation of amidated pectins through enzymatic method: Structures, hydrogel properties and its application potential in fat substitutes.

In this paper, α-alanine and ß-alanine were used as modifiers to prepare α-alanine amidated pectin (α-AP) and ß-alanine amidated pectin (ß-AP) through enzymatic method. The effects of alanine and its isomer on the amidation degree and physicochemical properties of pectin were studied. Fourier transform infrared spectrum, proton nuclear magnetic resonance analysis, X-ray photoelectron spectrum and elemental analysis indicated that the amino groups from α-C and ß-C could be aminated with the carboxyl group of pectin to form the corresponding aminated pectin. The alanine grafting ratio of α-AP and ß-AP were 21.99% and 18.92%, respectively. The results showed that the dynamic viscosity of ß-AP was significantly higher than that of α-AP due to the influence of amino acid side chain. However, due to the higher alanine grafting ratio of α-AP, the strength of hydrogel prepared by α-AP was higher than that of ß-AP, and it also has the highest elastic modulus and swelling capacity. In addition, pectin, as a carbohydrate-based fat substitute, has been widely used in the field of food to simulate the smooth and delicate taste of fat. Compared with High methoxy pectin (HMP) and ß-AP, α-AP had better colloid stability and smaller hydrogel particles in the composite system. The results provide references for the application of amidated pectin in low-fat food.

Effects of labor induction in obesity with delayed pregnancy: A retrospective study based on Chinese obese primipara.

Objective: To test the hypothesis that obese primiparous women with an unfavorable cervix in delayed pregnancy may experience a worse induction of labor. Study design: In total, 467 primiparas with poor cervical condition and delayed pregnancy (gestational age [GA]: >40weeks) were divided into an obese primiparas group (body mass index [BMI] >30kg/m2; n=166) and a non-obese primiparas group (BMI < 30kg/m2; (n=301). Labor was induced by various methods, double balloon, dinoprostone inserts, and amniotomy combined with oxytocin depending on the Bishop score. Experimental data were analyzed by Statistical Product Service Solutions (SPSS). Results: BMI in the obese primiparas group was higher than in the non-obese group (33.91 ± 2.67 versus 24.09 ± 5.78, p<0.001), and there were significant differences in uterine tone and duration of contractions between the two groups in the second stage of labour (p=0.041, p=0.026, respectively).The rate of cesarean section (CS) was significantly higher in the primiparas group (23.49% versus 12.29%; P=0.002). There was a significant difference between the two groups in terms of the duration of time to vaginal delivery (VD) (18h versus 8h; P <0.001) while the duration until VD in the obese primiparas group within 12 hours and 24 hours was significantly longer (P <0.001). After adjusting for possible confounders, caesarean section rates remained high in the obese primiparas women (OR: 2.564;95%CI1.919,3.864;P<0.001). Similarly, after adjusting for the same confounding factors, obese primiparas women increased the duration until VD within 24 h by 3.598 hours. Conclusion: Obese primiparas with an unfavorable cervix in delayed pregnancy have a significantly higher risk of CS and a longer duration until VD than non-obese primiparas during labor induction.

Construction of double-network hydrogel based on low methoxy pectin/polyvinyl alcohol and its structure and properties.

In this study, an interpenetrating double-network hydrogel (LMP/AA/PVAH) was prepared based on low methoxy pectin (LMP), acrylic acid (AA) and polyvinyl alcohol (PVA). The first rigid network of chemical crosslinking was constructed via free radical polymerization of LMP and AA, and the second of ductile physical crosslinking network was constructed via cyclic freeze-thaw of PVA. The first cycle hardness and elasticity of the LMP/AA/PVAH significantly increased from 13.08 N and 0 to 24.28 N and 0.79, respectively, when the second network structure was constructed in the hydrogel by PVA. Besides, the PVA network might enhance the ductile and limit the swelling of hydrogel. In addition, the adsorption properties of LMP/AA/PVAH were evaluated by adsorption of methylene blue (MB). The adsorption behavior of MB by LMP/AA/PVAH conformed to the pseudo-second-order kinetic model. Besides, after 4 cycles of adsorption, there was no significant difference in adsorption capacity of LMP/AA/PVAH. The results showed that LMP/AA/PVAH had good reusability.

Investigation of a Lipase-Catalyzed Reaction between Pectin and Salicylic Acid and Its Isomers and Evaluation of the Emulsifying Properties, Antioxidant Activities, and Antibacterial Activities of the Corresponding Products.

This study presents a method for modifying pectin with phenolic acids catalyzed by lipase in a two-phase system of water/tetrahydrofuran. Salicylic acid (SA) and its isomers, including m-hydroxybenzoic acid (MHBA) and p-hydroxybenzoic acid (PHBA), were grafted onto pectin, and the products were characterized via UV-vis, Fourier transform infrared spectroscopy (FTIR), and 1H NMR analyses to explore the reaction process and mechanism between pectin and the three phenolic acids. Results indicated that lipase played a dual role in the reaction, namely, catalyzing the hydrolysis of the methyl group in the aqueous phase and esterifying the carboxyl group of pectin with the phenolic hydroxyl group of the phenolic acids in tetrahydrofuran. The grafting ratio of SA-modified pectin, MHBA-modified pectin, and PHBA-modified pectin was 1.89, 10.58, and 20.32%, respectively, and it was affected by the position of phenolic hydroxyl. Moreover, the effects of phenolic acids on the emulsifying properties, antioxidant activities, and antibacterial activities of the native and modified pectins were evaluated. In several aspects, the emulsifying properties of the modified pectins were better than those of native pectin. Moreover, the grafting of phenolic acids only slightly affected the 1,1-diphenyl-2-picryl hydrazine (DPPH) clearance of the modified pectins but substantially improved their inhibition ratio in a ß-carotene bleaching assay. Furthermore, the modified pectins exhibited better bacteriostatic activity against both Escherichia coli and Staphylococcus aureus than native pectin.

Preparation of acylated pectin with gallic acid through enzymatic method and their emulsifying properties, antioxidation activities and antibacterial activities.

In this study, native pectin (Na-Pe) was acylated with gallic acid through enzymatic method. UV-Vis, Fourier transform infrared spectroscopy and proton NMR analyses demonstrated that the phenolic hydroxyl group on gallic acid attacked the carbomethoxy of Na-Pe and replaced the methoxy group to form a new ester group under catalysis. The galloyl content of acylated pectin prepared via 24-h reaction (Ac1-Pe) was 16.8%, while that prepared via 48-h reaction (Ac2-Pe) reached 20.7%. The emulsifying properties, antioxidation activities and antibacterial activities of acylated pectin was significantly improved compared with those of Na-Pe. The emulsion activity and emulsion stability of the pectin emulsion improved from 1.08% and 56.13% (Na-Pe) to 1.57% and 88.27% (Ac1-Pe) and 1.71% and 93.3% (Ac2-Pe), respectively. The DPPH clearance of the pectin improved from 2.68% (Na-Pe) to 68.92% (Ac1-Pe) and 76.98% (Ac2-Pe) and the inhibition ratio in the ß-carotene bleaching assay of the pectin increased from 3.15% (Na-Pe) to 73.02% (Ac1-Pe) and 78.96% (Ac2-Pe). The inhibition rate of the pectin against Escherichia coli and Staphylococcus aureus also improved from 2.93% and 8.92% (Na-Pe) to 26.95% and 42.18% (Ac1-Pe) and 31.56% and 47.87% (Ac2-Pe), respectively.