Maternal and neonatal outcomes in women undergoing Roux-en-Y gastric bypass: A systematic review and meta-analysis.

BACKGROUND: To summarize evidence of benefits and risks of maternal and neonatal outcomes among pregnant women after Roux-en-Y gastric bypass surgery. METHODS: A systematic search was conducted in MEDLINE, EMBASE, Web of Science, Ovid and Cochrane Library until 24th May 2021. Inclusion criteria were randomized trails or observational studies including at least one of maternal or neonatal outcomes from pregnant women who had a history of Roux-en-Y gastric bypass surgery with a control group of pregnant women with no history of bariatric surgery. Non-English studies were excluded. Both fixed-effect and random-effect models were used in the meta-analyses. Newcastle-Ottawa Scale was used to assess quality of studies. RESULTS: Twelve retrospective articles were eligible including 13 848 pregnant women with a history of Roux-en-Y gastric bypass surgery and 255 008 pregnant women without a history of bariatric surgery. The results of meta-analysis showed a lower incidence of preterm premature rupture of membranes (OR 0.53, 95% CI [0.47, 0.60], p < 0.00001), large gestational age infants (OR 0.28, 95%CI [0.22, 0.37], p < 0.00001) or macrosomia (OR 0.26, 95%CI [0.23, 0.30], p < 0.00001) in women after Roux-en-Y gastric bypass surgery. On the other hand, infants born to mothers with a history of Roux-en-Y gastric bypass surgery had an increased risk of small gestational age (OR 2.24, 95% CI [1.55, 3.24], p < 0.00001). CONCLUSION: Roux-en-Y gastric bypass surgery reduces significantly of risks of preterm premature rupture of membranes and large for gestational age/ macrosomia, but increase the risk of small for gestational age.

Chemokines in post-traumatic stress disorder: A network meta-analysis.

BACKGROUND: Previous studies on the association between chemokines concentrations and post-traumatic stress disorder (PTSD) yielded inconsistent results. Therefore, the purpose of this network meta-analysis was to summarize these results. METHODS: The databases of PubMed, Web of Science, Psyc-ARTICLES, Embase and Cochrane Library were searched for relevant articles published not later than January 15, 2020. Then, eligible studies were selected based on predefined study selection criteria. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated as group differences in chemokines concentrations. Moreover, network meta-analysis was used to rank chemokines effect values according to their respective surface under cumulative ranking curve (SUCRA) probabilities. FINDINGS: A total of 18 eligible studies that investigated the association between 9 different chemokines and PTSD were identified. They involved 1,510 patients and 2,012 controls. Results of the meta-analysis showed that the concentrations of CCL3, CCL4 and CCL5 in the PTSD patients were significantly higher than that in the controls (SMDs of 4.12, 6.11 and 1.53 respectively). However, although not statistically significant, concentrations of CCL2 tended to be lower in PTSD patients than in the controls (SMD = -0.76); whereas concentrations of CXCL12 tended to be higher in PTSD patients than in the controls (SMD = 0.37). SUCRA probabilities showed that, among all the chemokines studied, the effect of CCL5 was the highest in PTSD patients. INTERPRETATION: Concentrations of CCL3, CCL4 and CCL5 may be associated with a trauma and/or PTSD. Also, CXCL12 and CCL2 may be the underlying biomarkers for trauma and/or PTSD. Thus, future studies with large population based samples are needed to further assess these associations. In addition, future research should explore possible mechanisms underlying these associations, with the aim to develop new diagnostics for PTSD. PROSPERO CRD42019147703.

Breast feeding after caesarean delivery on maternal request: protocol of a systematic review and meta-analysis.

INTRODUCTION: Caesarean delivery under maternal request (CDMR) is a major factor contributing to the rising global rates of caesarean section (CS) procedure. The choice of CDMR without medical indications could provide a sense of assured safety by avoiding the experiences and complications of vaginal birth, and the risks related to an emergency CS. However, it might adversely influence women's breast feeding patterns and produce a long-lasting impact on maternal and neonatal health. This study aims to systematically review the current evidence relating to the effects of intentions of performing CDMR on breast feeding. METHODS AND ANALYSIS: A comprehensive literature search will be performed in three English-language electronic databases, major clinical study registries and other sources for original studies reporting the breast feeding outcomes after a planned CDMR or vaginal delivery. The three databases Medline, Embase and the Cochrane Central Register of Controlled Trials will be searched via Ovid from inception to February 2020. Randomised controlled trials (RCTs), pseudo-RCTs, cohort studies and case-control studies on this topic will be included. Participants in the experimental or case group should meet the Robson criteria of classes 2B or 4B and have experienced planned CS undertaken for no maternal or foetal indication, whereas participants in the control group have undergone scheduled vaginal delivery. All kinds of breast feeding outcomes will be included. Meta-analyses will be attempted to provide an estimate of the pooled effect and will be stratified by different study designs. A qualitative description will be provided if quantitative synthesis proves to be fruitless. ETHICS AND DISSEMINATION: This study is a secondary literature review that does not need ethical approval. No primary data will be collected from the participants. Findings of this study will be presented at scientific conferences and be published in scientific journals. PROSPERO REGISTRATION NUMBER: CRD42020160303.

Systematic review and meta-analysis of adverse cardiovascular events associated with proton pump inhibitors used alone or in combination with antiplatelet agents.

The potential association between major adverse cardiovascular events (MACE) and concomitant treatment with proton pump inhibitors (PPIs) and clopidogrel has been debated since 2009. Recent reports, however, suggest that PPIs may increase the risk of MACE independently of clopidogrel. This review evaluates epidemiological findings relevant to the association between PPIs, taken alone or concomitantly with antiplatelets, and the risk of MACE. A systematic review and meta-analysis were conducted. Relevant studies were identified from MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials and then screened. Included studies were categorized into three groups: Group A: PPIs versus no PPIs; Group B: combined PPIs and clopidogrel versus clopidogrel alone; Group C: combined PPIs and other drugs versus other drugs. Pooled risk ratios (RRs) were calculated for each outcome of interest in each comparison group. Of the 1667 studies identified, 118 were included in the systematic review, of which 66 were included in the meta-analyses. Among Group A observational studies, RRs for MACE outcomes were statistically significant for some patient populations but not others. Pooled RRs from Group A RCTs were not statistically significant for any outcome. Pooled RRs for Group B observational studies were statistically significant for all-cause mortality and MI, but were diminished in magnitude when pooling was restricted to propensity score matched studies or post hoc analyses of RCTs. Group C studies did not demonstrate an association with MACE. Findings do not consistently support an association between MACE and PPIs when taken alone, or concomitantly with antiplatelets.

Occurrence and predictors of vacuum and forceps used sequentially for vaginal birth.

BACKGROUND: Sequential use of vacuum and obstetric forceps for vaginal delivery is associated with increased risks of adverse maternal and infant outcomes. METHODS: We conducted a retrospective cohort study to estimate the frequency of sequential use of vacuum and forceps for planned vaginal delivery and to identify predictors, using data collected in Ontario between 2004 and 2007. Multivariate logistic regression models were used to estimate the adjusted odds ratios and 95% confidence intervals of predictors of sequential use of vacuum and forceps. RESULTS: Of 186 988 pregnant women with a singleton, vertex presentation at term and a planned vaginal birth, 1062 (0.57%) required the sequential use of vacuum and forceps for delivery. The major predictors for sequential use of vacuum and forceps were mother's primary language being other than English or French, nulliparity, a history of Caesarean section, dystocia, use of epidural or other pain relief, labour induction, labour augmentation, fetal macrosomia, and advanced gestational age. CONCLUSION: In this population-based study we found that 0.57% of planned vaginal births were delivered with sequential use of vacuum and obstetric forceps. Abnormal labour, fetal macrosomia, language barriers, and advanced gestational age are significant predictors of requiring this sequential use.

Contexte : L'utilisation séquentielle d'une ventouse obstétricale et de forceps obstétricaux dans le cadre d'un accouchement vaginal est associée à des risques accrus d'obtenir des issues indésirables maternelles et néonatales. Méthodes : Nous avons mené, au moyen de données recueillies en Ontario entre 2004 et 2007, une étude de cohorte rétrospective en vue d'estimer la fréquence de l'utilisation séquentielle d'une ventouse obstétricale et de forceps dans le cadre d'un accouchement vaginal planifié, et d'identifier des facteurs prédictifs. Des modèles de régression logistique multivariée ont été utilisés pour estimer les rapports de cotes corrigés et les intervalles de confiance à 95 % des facteurs prédictifs de l'utilisation séquentielle d'une ventouse obstétricale et de forceps. Résultats : Chez 186 988 femmes présentant une grossesse monofœtale en présentation du sommet à terme et ayant connu un accouchement vaginal planifié, 1 062 (0,57 %) ont nécessité l'utilisation séquentielle d'une ventouse obstétricale et de forceps aux fins de l'accouchement. Les principaux facteurs prédictifs de l'utilisation séquentielle d'une ventouse obstétricale et de forceps ont été le fait que la langue maternelle de la mère ne soit pas l'anglais ou le français, la nulliparité, les antécédents de césarienne, la dystocie, l'utilisation d'une péridurale ou d'un autre analgésique, le déclenchement du travail, l'accélération du travail, la macrosomie fœtale et l'âge gestationnel avancé. Conclusion : Dans le cadre de cette étude en population générale, nous avons constaté que 0,57 % des accouchements vaginaux planifiés ont eu recours à l'utilisation séquentielle d'une ventouse obstétricale et de forceps obstétricaux. Un travail anormal, la macrosomie fœtale, les obstacles linguistiques et l'âge gestationnel avancé sont des facteurs prédictifs importants de la nécessité d'avoir recours à une telle utilisation séquentielle.

The impact of increasing obesity class on obstetrical outcomes.

OBJECTIVE: Nationally, rates of obesity continue to rise, resulting in increased health concerns for women of reproductive age. Identifying the impact of maternal obesity on obstetrical outcomes is important to enhance patient care. METHODS: We conducted a retrospective cohort study of 6674 women who delivered a singleton infant at ≥ 20 weeks' gestation between December 1, 2007, and March 31, 2010, at The Ottawa Hospital. Maternal pre-pregnancy BMI was used to classify women into normal, overweight, and obese (class I/II/III) categories according to WHO classifications. Obstetrical outcomes among obese women were compared with those of women with normal BMI. Multivariable regression models were used to determine adjusted odds ratios and 95% confidence intervals. RESULTS: Compared with women with normal BMI, obese women had significantly higher rates of preeclampsia, gestational hypertension, and gestational diabetes, and these rates increased with increasing BMI (trend-test P < 0.001). There was a significant increase in rates of induction of labour in the obesity categories, from 25.3% in women with normal BMI to 42.9% in women with class III morbid obesity (aOR 1.67; 95% CI 1.43 to 1.93). Rates of primary Caesarean section rose with increasing BMI and were highest in women with class III morbid obesity (36.2% vs. 22.1% in women with normal BMI) (aOR 1.46; 95% CI 1.23 to 1.73). CONCLUSION: Increasing BMI is associated with increasing rates of preeclampsia, gestational hypertension, and gestational diabetes. There is a significant increase in rates of induction of labour with increasing obesity class, and a significantly increased Caesarean section rate with higher BMI. Obstetrical care providers should counsel obese patients about the risks they face and the importance of weight loss before pregnancy.

(E)-2-(4-Chloro-phen-oxy)-N'-(pyridin-4-yl-methyl-idene)acetohydrazide.

In the title compound, C14H12ClN3O2, the acyl-hydrazone base [C(=O)-N-N=C] is essentially planar, with an r.m.s. deviation of 0.0095 Å, and makes a dihedral angle of 12.52 (10)°with the pyridine ring. In the crystal, molecules are linked via pairs of N-H⋯O hydrogen bonds, forming inversion dimers with an R2(2)(8) graph-set motif. The dimers are linked via C-H⋯π interactions forming chains along [101].

Diethyl pyrazine-2,5-dicarboxyl-ate.

The mol-ecule of the title compound, C(10)H(12)N(2)O(4), is located around an inversion center. The carboxyl-ate groups are twisted slightly with respect to the pyrazine ring, making a dihedral angle of 2.76 (19)°. In the crystal, mol-ecules are stacked along the c axis via weak C-H⋯O hydrogen bonds.

Aqua-[6-carboxyl-ato-N'-(pyridin-2-yl-methyl-idene)pyridine-2-carbohydrazidato]copper(II) trihydrate.

In the title compound, [Cu(C(13)H(8)N(4)O(3))(H(2)O)]·3H(2)O, the complex molecule, except for the aqua ligand, is essentially planar [r.m.s. deviation = 0.034 (2) Å]. The coordination polyhedron of the Cu(2+) cation is a square-pyramid, with the aqua ligand at the apex. The compound exhibits a three-dimensional structure, which is is stabilized by O-H⋯O and O--H⋯N hydrogen bonds and π-π inter-actions [centroid-centroid distance = 2.987 (3) Å].

Dimethyl disulfide is an induced systemic resistance elicitor produced by Bacillus cereus C1L.

BACKGROUND: Bacillus cereus C1L is a plant growth-promoting rhizobacterium and can elicit induced systemic resistance (ISR) in plants against necrotrophic pathogens. However, little is known about ISR elicitors produced by B. cereus C1L, and no ISR elicitor has been identified and characterised. Therefore, the objective of this study is to identify volatile ISR elicitor(s) produced by B. cereus C1L. RESULTS: The volatile metabolites produced by B. cereus C1L were extracted, separated and identified by solid-phase microextraction, gas chromatography and mass spectrometry. Dimethyl disulfide (DMDS) was the only separated metabolite being determined. Afterwards, application of DMDS by means of soil drench significantly protected tobacco and corn plants against Botrytis cinerea and Cochliobolus heterostrophus, respectively, under greenhouse conditions. The results reveal that DMDS could play an important role in ISR by B. cereus C1L. CONCLUSION: This is the first report of DMDS as an elicitor produced by an ISR-eliciting B. cereus strain and its ability to suppress plant fungal diseases under greenhouse conditions. It is suggested that DMDS has potential for practical use in controlling plant foliar diseases besides soil fumigation.

The effect of maternal Class III obesity on neonatal outcomes: a retrospective matched cohort study.

OBJECTIVES: To compare outcomes of neonates born from women with Class III obesity with those whose mothers were of normal body weight. METHODS: A retrospective cohort study of live-born singleton infants was undertaken. Maternal prepregnancy body mass index (BMI) defined matched normal and Class III obese cohorts. Multivariable regression models were used to determine adjusted relative odds ratios (aOR) and 95% confidence intervals (CI) for selected adverse neonatal outcomes. RESULTS: Newborns exposed to maternal Class III obesity had greater risks of fetal overgrowth and low cord artery pH. Class III obesity was protective against small for gestational age and low birthweight. There was no difference in the risk of preterm delivery, meconium in the amniotic fluid or breastfeeding initiation. CONCLUSIONS: The new knowledge generated by this study provides further information on unique challenges faced by newborns of women with Class III obesity, suggesting more specialized care in the intrapartum and neonatal periods may be beneficial.

Preclinical evaluation of destruxin B as a novel Wnt signaling target suppressing proliferation and metastasis of colorectal cancer using non-invasive bioluminescence imaging.

In continuation to our studies toward the identification of direct anti-cancer targets, here we showed that destruxin B (DB) from Metarhizium anisopliae suppressed the proliferation and induced cell cycle arrest in human colorectal cancer (CRC) HT29, SW480 and HCT116 cells. Additionally, DB induced apoptosis in HT29 cells by decreased expression level of anti-apoptotic proteins Bcl-2 and Bcl-xL while increased pro-apoptotic Bax. On the other hand, DB attenuated Wnt-signaling by downregulation of ß-catenin, Tcf4 and ß-catenin/Tcf4 transcriptional activity, concomitantly with decreased expression of ß-catenin target genes cyclin D1, c-myc and survivin. Furthermore, DB affected the migratory and invasive ability of HT29 cells through suppressed MMPs-2 and -9 enzymatic activities. We also found that DB targeted the MAPK and/or PI3K/Akt pathway by reduced expression of Akt, IKK-α, JNK, NF-κB, c-Jun and c-Fos while increased that of IκBα. Finally, we demonstrated that DB inhibited tumorigenesis in HT29 xenograft mice using non-invasive bioluminescence technique. Consistently, tumor samples from DB-treated mice demonstrated suppressed expression of ß-catenin, cyclin D1, survivin, and endothelial marker CD31 while increased caspase-3 expression. Collectively, our data supports DB as an inhibitor of Wnt/ß-catenin/Tcf signaling pathway that may be beneficial in the CRC management.

Bis[µ-N'-(2-oxidobenzyl-idene)thio-phene-2-carbohydrazidato]bis-[dimethanol-nickel(II)].

In the crystal structure of the centrosymmetric binuclear title complex, [Ni(2)(C(12)H(8)N(2)O(2)S)(2)(CH(3)OH)(4)], there are inter-molecular O-H⋯O, O-H⋯N and O-H⋯S hydrogen bonds. These help to stabilize the structure and link the mol-ecules, forming a three-dimensional network structure. The Ni(2+) cation exists in a slightly distorted octahedral NiNO(5) coordination environment. The thio-phene rings are disordered over two equivalent conformations with occupancies of 0.881 (3) and 0.119 (3).

catena-Poly[[aqua-bromidocopper(II)]-µ(3)-(picolinato N-oxide)].

The title complex, [CuBr(C(6)H(4)NO(3))(H(2)O)](n), exhibits a layered structure which is stabilized by inter-molecular O-H⋯O and O-H⋯Br(-) hydrogen bonds, van der Waals forces and π-π inter-actions [centroid-centroid distance = 3.747(4) Å] between the parallel pyridine rings from two neighboring layers.

Insulin-Mimetic Action of Rhoifolin and Cosmosiin Isolated from Citrus grandis (L.) Osbeck Leaves: Enhanced Adiponectin Secretion and Insulin Receptor Phosphorylation in 3T3-L1 Cells.

Citrus grandis (L.) Osbeck (red wendun) leaves have been used in traditional Chinese medicine to treat several illnesses including diabetes. However, there is no scientific evidence supporting these actions and its active compounds. Two flavone glycosides, rhoifolin and cosmosiin were isolated for the first time from red wendun leaves and, identified these leaves are rich source for rhoifolin (1.1%, w/w). In differentiated 3T3-L1 adipocytes, rhoifolin and cosmosiin showed dose-dependent response in concentration range of o.oo1-5 µM and 1-20 µM, respectively, in biological studies beneficial to diabetes. Particularly, rhoifolin and cosmosiin at 0.5 and 20 µM, respectively showed nearly similar response to that 10 nM of insulin, on adiponectin secretion level. Furthermore, 5 µM of rhoifolin and 20 µM of cosmosiin showed equal potential with 10 nM of insulin to increase the phosphorylation of insulin receptor-ß, in addition to their positive effect on GLUT4 translocation. These findings indicate that rhoifolin and cosmosiin from red wendun leaves may be beneficial for diabetic complications through their enhanced adiponectin secretion, tyrosine phosphorylation of insulin receptor-ß and GLUT4 translocation.

Constituents isolated from Cordyceps militaris suppress enhanced inflammatory mediator's production and human cancer cell proliferation.

AIM OF THE STUDY: The purpose of this study is to isolate the pure compounds from the extracts of Cordyceps militaris obtained through solid-state cultivation process, and evaluate their anti-inflammatory and anticancer properties. MATERIALS AND METHODS: Silica gel column chromatographic purification of Cordyceps militaris extracts resulted in the isolation of 10 pure compounds (1-10). The compounds 1-10 were examined for their growth inhibitory properties against nitric oxide (NO), tumor necrosis factor (TNF)-alpha and interleukin (IL)-12 enhanced production from LPS/IFN-gamma-stimulated macrophages. Additionally, the anti-proliferation effects of 1-10 on human cancer cell lines, colon (colon 205), prostate (PC-3), and hepatoma (HepG2) cells were also analyzed. RESULTS: Compound 8 displayed potent growth inhibition on NO, TNF-alpha and IL-12 production with an IC(50) value of 7.5, 6.3, and 7.6 microg/ml, respectively. A similar inhibitory trend on these inflammatory mediators was observed for 3, 7, 9 and 10 with an IC(50) values ranging from 10.8 to 17.2 microg/ml. On the other hand, compounds 3 and 8 were potent anti-proliferative agents with an IC(50) value of 35.6 and 32.6 microg/ml toward PC-3 and colon 205 cell lines, respectively. The compounds 1 and 2 showed potent anti-proliferation in PC-3 and colon 205 cells, while only 3 displayed such effect in HepG2 cells. CONCLUSION: The present study provides scientific supporting information for the ethnopharmacological use of Cordyceps militaris as an anti-inflammatory and anticancer agent.

4-Eth-oxy-N'-propanoylpyridine-2-carbohydrazide.

In the crystal structure of the title compound, C(11)H(15)N(3)O(3), mol-ecules are linked into a chain by inter-molecular N-H⋯O hydrogen bonds.

Diisopropyl pyrazine-2,5-dicarboxyl-ate.

The mol-ecule of the title compound, C(12)H(16)N(2)O(4), is located on an inversion center. The carboxyl-ate groups are twisted slightly with respect to the pyrazine ring, making a dihedral angle of 6.4 (3)°.

Contraceptive use among Canadian women of reproductive age: results of a national survey.

OBJECTIVE: Past studies indicate that despite a wide range of contraceptive options, Canadian women tend to use a narrow selection of contraceptive methods. New contraceptive methods have recently been introduced in Canada. The objective of this research is to characterize Canadian women's current contraceptive choices and adherence to contraceptive regimens. METHODS: A national cross-sectional survey was conducted in November 2006. A standardized, confidential, Internet questionnaire was administered to female members of a previously recruited national market research panel. Percentages of current contraceptive use and consistency of use were calculated by age group, marital status, and province and were weighted according to age and region. Chi-square test was used to detect within-group differences for consistency of contraceptive use, oral contraceptive (OC) use, and condom use. Multivariate logistic regression analyses predicting consistent contraception use, OC use, and condom use were performed. RESULTS: Of 5597 survey respondents, 3253 were eligible for data analysis. Of these women, 2751 had had vaginal intercourse in the previous six months, were not trying to conceive, and reported whether they or their partner had used contraception. Of these 2751 women, 410 (14.9%) never used contraception. Among contraception users, the most frequently used methods of contraception were condoms (54.3%), OCs (43.7%), and withdrawal (11.6%). Newer contraceptive methods were used by less than 4%. Choice of contraceptive method varied by age. Only 65.2% of respondents who were sexually active and not trying to conceive "always used" contraception. Multivariate logistic regression analyses found significantly higher odds of no contraception use in women over 40 years of age, without higher education, living in PEI or Newfoundland, married or living common-law, or having annual household incomes under $100,000. CONCLUSION: Despite many contraceptive options, Canadian women continue to use a narrow range of contraceptive methods and to use contraception inconsistently. Consistent contraceptive use is influenced by a number of independent social variables. Future public health initiatives should focus on raising awareness of contraception options, increased access to a variety of contraceptive methods, and assisting with contraceptive adherence.

Opiniones y actitudes de los obstetras de ciudad de la Habana, Cuba, en relación al uso de la cesárea / Opinions and attitudes of obstetricians city of Havana, Cuba, regarding the use of cesarean

Cada vez se observa con más frecuencia una tendencia mundial hacia el crecimiento en las tasas de cesáreas, y Cuba no es la excepción. Objetivos: determinar las causas del aumento de las tasas de cesáreas en la Ciudad de la Habana, e identificar las posibles intervenciones que pudieran detener dicha tendencia; así como las preferencias de los obstetras cuando enfrentan ciertas situaciones clínicas. Metodología: se realizó un estudio descriptivo y exploratorio, para lo cual se administró un cuestionario anónimo a 132 obstetras que laboran en 5 hospitales maternos de la Ciudad de la Habana...