Efficacy and safety of oral and vaginal administration of misoprostol for induction of labor in high-risk obese pregnant women with hypertension or diabetes mellitus.

OBJECTIVE: This study aims to compare the safety and efficacy of misoprostol administered orally and vaginally in obese pregnant women at term with either gestational hypertension or diabetes. METHODS: A total of 264 pregnant women were enrolled and categorized into two groups based on their primary condition: hypertension (134 cases) or diabetes mellitus (130 cases) and were further divided into subgroups for misoprostol administration: orally (Oral group) or vaginally (Vaginal group). The primary outcomes measured were changes in the Bishop score following treatment, induction of labor (IOL) success rates, requirement for oxytocin augmentation, duration of labor, mode of delivery, and cesarean section rates. RESULTS: Significant enhancements in Bishop scores, decreased cesarean section rates and increased success rates of IOL were noted in both administration groups. The incidence of vaginal delivery within 24 h was significantly higher in the Vaginal group compared to the Oral group. Adverse effects, including nausea, uterine overcontraction, hyperfrequency of uterine contraction and uterine hyperstimulation without fetal heart rate deceleration, were significantly more prevalent in the Vaginal group than in the Oral group. CONCLUSION: Misoprostol administration, both orally and vaginally, proves effective for labor induction in obese pregnant women with hypertension or diabetes. However, the oral route presents a lower risk of adverse maternal and neonatal outcomes, suggesting its preference for safer labor induction in this demographic.

A new C22 polyacetylene and seven isoprenylated pterocarpans from Erythrina subumbrans.

A new C22 polyacetylene, erysectol A (1), and seven isoprenylated pterocarpans, phaseollin (2), phaseollidin (3), cristacarpin (4), (3'R)-erythribyssin D/(3'S)-erythribyssin D (5a/5b) and dolichina A/dolichina B (6a/6b) were isolated from the twigs and leaves of Erythrina subumbrans. Their structures were determined based on their NMR spectral data. Except for 2-4, all the other compounds were isolated from this plant for the first time. Erysectol A was the first reported C22 polyacetylene from plants. Polyacetylene was isolated from Erythrina plants for the first time.

Two new C-benzylated chalcones and one new mimosin-type homoisoflavonoid from the twigs and leaves of Caesalpinia digyna.

Two new C-benzylated chalcones, 2',4'-dihydroxy-3'-(2-hydroxylbenzyl) chalcone (1) and 2',4'-dihydroxy-5'-(2-hydroxybenzyl) chalcone (2), one new and one known mimosin-type homoisoflavonoid, mimosol H (7) and mimosol G (8), together with four known chalcones (3-6) and four known sappanin-type homoisoflavonoids (9-12), were isolated from the twigs and leaves of Caesalpinia digyna. Their structures were characterized by comprehensive spectroscopic analyses (including NMR and HRESIMS). Compounds 1, 2 and 8 exhibited moderate cytotoxicity against SMMC-7721, A-549 and/or MDA-MB-231 cell lines with IC50 values ranging from 11.41 ± 0.88 to 30.01 ± 1.56 µM. Notably, C-benzyl chalcones (1 and 2) were isolated from species of the genus Caesalpinia for the first time. Homoisoflavonoids 7 and 8 are the first examples of mimosin-type homoisoflavonoids reported in Caesalpinia digyna.

[Impact of different referral timing on the pregnancy outcomes of severe pre-eclampsia in the referral system].

Objective: To explore the impact of different referral timing on postponing early-onset pre-eclampsia (PE), postponing severe pre-eclampsia (SPE), reducing SPE severe complications and improving maternal and neonatal outcomes by analyzing the pregnancy outcomes of SPE patients who were referred from primary hospitals to tertiary referral center in the referral system. Methods: The clinical data of 159 SPE patients who were referred from primary hospitals, treated and then terminated their pregnancy in Peking University Third Hospital from January 2020 to October 2021, were observed and analyzed in this clinical observational study. According to the clinical stage of PE at the time of referral, they were divided into four groups: 38 cases were referred after onset of SPE severe complications (SPE-C group), 72 cases were referred after onset of SPE (a-SPE group), 15 cases were referred after onset of PE (a-PE group) and 34 cases were referred after detection of PE early warning-signs (Warn-s group). And then these 159 cases were divided into different color groups according to the project management system for high-risk pregnant women. Patients of Red color (highest risk) and Orange color (higher risk) were required to be referred to tertiary hospitals (Red-Orange group, 113 cases), and patients of Yellow color (high risk) could be treated under tertiary hospitals (Yellow group, 46 cases). The maternal and neonatal outcomes of different referral timings were analyzed and compared. Results: (1) Pregnancy outcomes of different referral timings grouped by PE clinical stage at the time of referral: the later the referral timing, the higher the rate of SPE severe complications, the shorter the interval from referral to termination of pregnancy. The rate of SPE severe complications in the SPE-C group was significantly higher than those of the other three groups, and the interval from referral to termination of pregnancy in the SPE-C group was significantly shorter than those of the other three groups (all P<0.05). The referral gestational age of Warn-s group was earlier than those of the other three groups (all P<0.05). The average gestational ages for onset of SPE, termination of pregnancy, and onset of SPE severe complications were all after 34 gestational weeks, and were later than those of a-SPE group and SPE-C group; the rates of SPE onset before 34 gestational weeks, SPE severe complications onset before 34 gestational weeks, terminating pregnancy before 34 gestational weeks, neonatal intensive care unit (NICU) hospitalization, and pregnancy giving up before 28 gestational weeks were lower than those of a-SPE group and SPE-C group, the length of NICU stay was shorter than those of a-SPE group and SPE-C group, and its rate of take-home-babies was 100%, significantly higher than those in a-SPE group and SPE-C group (all P<0.05). The gestational ages for onset of SPE and termination of pregnancy in a-PE group were later than those in a-SPE group and SPE-C group, the rates of SPE onset before 34 gestational weeks, terminating pregnancy before 34 gestational weeks, and NICU hospitalization were lower than those of a-SPE group and SPE-C group, the length of NICU stay was shorter than those of a-SPE group and SPE-C group (all P<0.05). (2) Pregnancy outcomes of different referral timings grouped by the color classification of PE clinical characteristics: among the 159 cases of SPE, 113 cases (71.1%, 113/159) were in the Red-Orange group which were required to be referred to tertiary hospitals, and 46 cases (28.9%, 46/159) were in the Yellow group,which were not in the range of referral requirements, but actually referred to the tertiary hospital and eventually developed SPE. Gestational ages for onset of SPE, termination of pregnancy, and onset of SPE severe complications in the Yellow group were later than those of the Red-Orange group, while the rates of SPE onset before 34 gestational weeks, SPE severe complications onset before 34 gestational weeks, terminating pregnancy before 34 gestational weeks, NICU hospitalization, and pregnancy giving up before 28 gestational weeks were lower than those of the Red-Orange group, the length of NICU stay was shorter than that of the Red-Orange group, and its rate of take-home-babies was higher than that in the Red-Orange group (all P<0.05). (3) Analysis of different clinical referral timings in the Yellow group: among these 159 SPE patients, 46 cases (28.9%, 46/159) would be excluded from the range of referral requirements which belonged to the Yellow color grade, but 6 cases still developed SPE severe complications (4 cases in Warn-s group and 2 cases in a-PE group), 17 cases were terminated pregnancy before 34 weeks of gestation (12 cases in Warn-s group and 5 cases in a-PE group), and 23 cases developed SPE before 34 weeks of gestation (17 cases in Warn-s group and 6 cases in a-PE group). (4) Multivariate analysis: referral after detection of PE early warning signs was the independent protective factor for postponing the onset of SPE severe complications (P<0.05). Referral after detection of PE early warning signs and referral after onset of PE were both protective factors for postponing the onset of SPE and early-onset PE (all P<0.05). Conclusions: Different referral timing in the referral system is one of the key points that affect the maternal and neonatal outcomes of SPE. Referral after detection of PE early warning signs and timely referral after onset of PE would reduce early-onset PE, postpone the onset of SPE and reduce the severe complications of SPE. The clinical development and evolution of PE is really complicated, and referral based on specific clinical situations is better than referral based on fixed mode.

(±) Erysectin A, a new isoprenylated isoflavone with a rare acetonyl group from Erythrina secundiflora Hassk.

(±) Erysectin A (1), a new isoprenylated isoflavone with a rare acetonyl group, along with 15 known compounds including eight isoprenylated isoflavones (2-9), two isoprenylated flavanones (10-11), three flavanones (12-14), a flavone (15), and a chalcone (16), was isolated from the twigs and leaves of Erythrina secundiflora Hassk. Their structures were identified based on their 1 D and 2 D NMR spectral data. All the compounds were isolated from this plant for the first time. Compound 1 showed moderate cytotoxicity on several cancer cell lines.[Formula: see text].

Alkaloids from the stem barks of Erythrina stricta.

Four previously undescribed erythrinan alkaloids, 8α-acetonylerythristemine, 8α-acetonylerysotrine, 10ß-hydroxy-11ß-methoxyerysotramidine and 3-epierysotrine, one undescribed pyrrolidine derivative, S-1-(4-hydroxy-3-methoxyphenethyl)-5-hydroxy pyrrolidin-2-one, and one undescribed amide, N-(3-hydroxy-4-methoxyphenethyl)-4-hydroxylbutanamide, along with thirteen known alkaloids were isolated from the stem barks of Erythrina strica Roxb. (Leguminosae). Their structures were identified by extensive analysis of physical, spectroscopic and spectrometric data. It's very interesting that the coexistence of 3-methoxytyramine, erythrinarbine, S-1-(4-hydroxy-3-methoxyphenethyl)-5-hydroxy pyrrolidin-2-one and N-(3-hydroxy-4-methoxyphenethyl)-4-hydroxylbutanamide that may be closely related in biosynthesis, supports the hypothetical biogenetic pathway of pyrrolo [2,1-a]isoquinoline alkaloids.

[Study on the methylation of LCHAD gene promoter region in mitochondria of trophoblast cells incubated with long-chain fatty acids].

OBJECTIVE: To explore the methylation level of long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD) gene promoter region in mitochondria of trophoblasts incubated with long-chain fatty acids and the time-effect of methylation modification. METHODS: Primary human trophoblast cells and HTR8/Svneo cells were incubated with free fatty acids of various lengths. Long-chain free fatty acids (LC-FFA) was experimental group, short-chain fatty acids (SC-FFA) and medium-chain fatty acids (MC-FFA) were control groups, and blank control was without free fatty acid. Collecting cells and extract DNA at 24, 48 and 72 h incubation respectively. Predicted CpG island location access to 2 000 bp DNA sequences upstream of the transcription start site of LCHAD gene. We designed methylation detection sites and primer originally. Methylation of CpG sites in LCHAD gene promoter region were detected by MassARRAY and analyzed statistically. RESULTS: (1) We detected methylation of 65% (11/17) CpG sites, including 8 single sites and 3 composite sites, in ampliconic sequences. These CpG sites were at positions: -984, -960, -899, -853, -811, -796, -774, -727, -615, -595, -579, respectively. In different groups methylation level and changes of every site showed differences with the most significant changes at -899 site. (2) Methylation of CpG island in LCHAD gene promoter region: ① Methylation of CpG island in LC-FFA and MC-FFA groups showed rising trend with the time: Methylation level of LC-FFA group at 72 h (0.55±0.08) was significantly higher than that of 48 h (0.35±0.12) and 24 h (0.31±0.04) (P<0.05). Methylation level of MC-FFA group at 72 h (0.44±0.05) was significantly higher than that of 24 h (0.31±0.04) (P<0.05). ② Methylation of CpG island in LCHAD gene promoter region in different groups at different times: Methylation level of LC-FFA group at 72 h was significantly higher than that of the other two groups at 72, 48 and 24 h (P<0.05). (3) Methylation of 11 CpG sites in LCHAD gene promoter region in different groups at 72 h: Methylation level of -899 site in LC-FFA and MC-FFA groups were significantly higher than that of other sites (P<0.05). (4) Methylation level of -899 site in LCHAD gene promoter region in LC-FFA group showed rising trend with the time: (72 h (0.34±0.15), 48 h (0.14±0.05) and 24 h (0.10±0.02), P<0.05). Methylation level of LC-FFA group at 72 h was significantly higher than that of the other two groups at 72, 48 and 24 h (P<0.05). CONCLUSIONS: Methylation modification effect on LCHAD gene promoter region in trophoblast cells incubated with long-chain fatty acids is more significant than with medium-chain and short-chain fatty acids and shows obvious time-effect as incubation time prolonged. The changes at -899 site dominate the degree of methylation in LCHAD gene promoter region.

[The changes of LCHAD in preeclampsia with different clinical features and the correlation with NADPH P47-phox, p38MAPK-α, COX-2 and serum FFA and TG].

OBJECTIVE: To investigate the changes of fatty acid oxidase in the placenta of preeclampsia cases with different clinical features, and the relationship with oxidative stress and inflammatory response. To study the correlation of serum free fatty acid (FFA) and triglycerides (TG) level in early second trimester with the molecular changes of the long-chain fatty acid oxidase in the third trimester. METHODS: This was prospective cohort study, in which cases with singleton pregnancies who archived in Haidian Maternal and Children's Hospital, Beijing, from January 1st 2012 to May 31st, with regular prenatal care were included. Doppler ultrasound was used for screening for the presence of early diastolic notch of uterine artery at 22-24 weeks of gestation. All the 101 cases with the early diastolic notch of uterine artery were included as the notch group, and 377 cases without the early diastolic notch of uterine artery were included as the non-notch group. The perinatal outcomes and the incidence of hypertensive disorders in pregnancy of the two groups were observed. The serum level of FFA and TG was tested, and the mRNA and protein expression of long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD), P47-phox subunit of nicotinamide adenine dinucleotide phosphate (NADPH) oxidase, p38 mitogen-activated protein kinase a (p38MAPK-α) and cyclooxygenase-2 (COX-2) were detected using real-time quantitative PCR and western blot. The relationship between serum level of FFA and TG and the mRNA and protein expression of LCHAD, NADPH P47-phox, p38MAPK-α and COX-2 of the placental tissue specimens were analyzed. RESULTS: (1) In the notch group, there were 9 cases of early-onset preeclampsia, 15 cases of late-onset preeclampsia and 10 cases of gestational hypertension;and there were 8 cases of late-onset preeclampsia and 18 cases of gestational hypertension in the non-notch group. 15 cases with normal blood pressure in each group were randomly selected as the control group. (2)The serum level of TG of cases of early-onset preeclampsia, late-onset preeclampsia and gestational hypertension in the notch group were (2.0 ± 0.8), (1.8 ± 0.6)and (1.9 ± 0.7)mmol/L, and that of FFA were(0.68 ± 0.26), (0.52 ± 0.10) and (0.52 ± 0.17)mmol/L, respectively. The serum level of TG of cases of late-onset preeclampsia and gestational hypertension in the non-notch group were (1.6 ± 0.6) and (1.4 ± 0.4)mmol/L, and that of FFA were (0.49 ± 0.11) and (0.48 ± 0.05)mmol/L, respectively. The serum level of TG and FFA in the control group were (1.4 ± 0.5) and (0.52 ± 0.06)mmol/L, respectively. The TG level of the notch group was higher than that of the control group, and the difference was statistically significant (P < 0.05). The FFA level of the early-onset preeclampsia in the notch group was higher than that of late-onset preeclampsia in the notch group, late-onset preeclampsia in the non-notch group and the control group, and the difference was statistically significant (P < 0.05). (3) The mRNA expression of LCHAD in the placenta of early-onset preeclampsia in the notch group was significantly lower than that of the late-onset preeclampsia in the notch group, late-onset preeclampsia in the non-notch group and the control group (P < 0.01). The mRNA expression of NADPH P47-phox of the early-onset preeclampsia in the notch group were significantly higher than that of late-onset preeclampsia in the notch group, late-onset preeclampsia in the non-notch group and the control group (P < 0.01). The mRNA expression of p38MAPK-α of the early-onset preeclampsia in the notch group were significantly higher than that of late-onset preeclampsia in the notch group, late-onset preeclampsia in the non-notch group and the control group (P < 0.01). The mRNA expression of COX-2 of the early-onset preeclampsia in the notch group were significantly higher than that of late-onset preeclampsia in the notch group, late-onset preeclampsia in the non-notch group and the control group (P < 0.01). (4)The protein expression of LCHAD in the placenta of early-onset preeclampsia in the notch group, late-onset preeclampsia in the notch group and gestational hypertension in the notch group were significantly lower than that of the control group (P < 0.01); and the protein expression of LCHAD in the placenta of early-onset preeclampsia in the notch group was significantly lower than that of late-onset preeclampsia in the non-notch group (P < 0.01). The protein expression of NADPH P47-phox in the placenta of early-onset preeclampsia in the notch group was significantly higher than that of late-onset preeclampsia in the non-notch group and control group (P < 0.05). The protein expression of p38MAPK-α in the placenta of early-onset preeclampsia in the notch group was significantly higher than that of late-onset preeclampsia in the notch group, late-onset preeclampsia in the non-notch group and control group (P < 0.01). The protein expression of COX-2 in the placenta of early-onset preeclampsia in the notch group, late-onset preeclampsia in the notch group, gestational hypertension in the notch group, late-onset preeclampsia in the non-notch group, and gestational hypertension in the non-notch group, were significantly higher than that of control group (P < 0.01). (5)The blood concentration of maternal FFA in the early-onset preeclampsia in the notch group was significantly negatively correlated with the mRNA and protein expression of placental LCHAD (r = -0.810, -0.932, P < 0.01). There was no correlation between maternal TG level and the mRNA and protein expression of placental LCHAD in each group(P > 0.05). (6)The mRNA expression of placental LCHAD in the early-onset preeclampsia in the notch group was significantly negatively correlated with the mRNA expression of placental NADPH P47-phox and COX-2 (r = - 0.877, -0.762, P < 0.05). The mRNA expression of placental LCHAD in the control group was significantly negatively correlated with the mRNA expression of placental COX-2 (r = -0.565, P < 0.01). The protein expression of placental LCHAD in the early-onset preeclampsia in the notch group was significantly negatively correlated with the protein expression of NADPH P47-phox (r = -0.818, P < 0.01). The protein expression of placental LCHAD in the control group was significantly negatively correlated with the protein expression of COX-2 (r = -0.502, P < 0.01). CONCLUSIONS: The placental mRNA and protein expression of long-chain fatty acid oxidation enzymes were different in different clinical features of preeclampsia, which were reduced more obviously in the early-onset preeclampsia in the notch group than that of the late-onset preeclampsia in the notch group, and were negatively correlated with the elevated serum FFA level, significantly enhanced oxidative stress and inflammatory response, but with no correlation with serum TG level.