The safety of trial of labor after cesarean section (TOLAC) versus elective repeat cesarean section (ERCS): a systematic review and meta-analysis.

OBJECTIVE: Women's choice of birth following a cesarean delivery either includes a trial of elective repeat cesarean section (ERCS) or a trial of labor after cesarean (TOLAC). No comprehensive overview or systematic summary is currently available. METHODS: EMBASE, PubMed, and the Cochrane Library databases were searched from inception to 1 February 2020. Studies reporting the safety of TOLAC and ERCS in pregnant women with prior cesarean delivery were included. Statistical analysis was performed using RevMan 5.3 and Stata 15.0. Odds ratios (ORs) and 95% confidence intervals (CIs) were adopted as the effective measures. RESULTS: A total of 13 studies covering 676,532 cases were included in this meta-analysis. The results demonstrated that the rates of uterine rupture (OR = 3.35, 95%CI [1.57, 7.15], I2 = 81%), neonatal asphyxia (OR = 2.32, 95%CI [1.76, 3.08], I2 = 0%) and perinatal death (OR = 1.71, 95%CI [1.29, 2.25], I2 = 0%) were higher in the TOLAC group compared with the ERCS group. The rates of peripartum hysterectomy (OR = 0.70, 95%CI [0.44, 1.11], I2 = 62%), blood transfusion (OR = 1.24, 95%CI [0.72, 2.12], I2 = 95%), and puerperal infection (OR = 1.11, 95%CI [0.77, 1.60], I2 = 95%) showed no significant differences between the two groups. CONCLUSION: TOLAC is associated with a higher risk of uterine rupture, neonatal asphyxia, and perinatal death compared with ERCS. Nevertheless, it should be noted that the risks of all complications were small in both groups. This information is important for healthcare providers and women choosing the delivery type.

Placenta-derived IL-32ß activates neutrophils to promote preeclampsia development.

Immune activation at the maternal-fetal interface is a main pathogenic factor of preeclampsia (PE). Neutrophils (PMNs) are activated in PE patients, but the mechanism and consequences of PMN activation need to be further explored. Here, we demonstrated that interleukin-32 (IL-32) expression was significantly upregulated in syncytiotrophoblasts (STBs) and that IL-32ß was the major isoform with increased expression in the placenta of severe PE (sPE) patients. Furthermore, the level of IL-32 expression in the placenta was correlated with its level in the serum of sPE patients, indicating that IL-32 in the serum is derived mainly from the placenta. Then, in vitro experiments showed that IL-32ß could highly activate PMNs and that these IL-32ß-activated PMNs were better able to adhere to endothelial cells (HUVECs) and enhance the expression of vascular cell adhesion molecule-1 (VCAM-1) and intercellular cell adhesion molecule-1 (ICAM-1) in HUVECs, which could be reversed by preincubation with the NADPH oxidase inhibitor VAS 2870. In addition, we showed that IL-32ß mainly activated PMNs by binding to proteinase 3. Finally, IL-32ß administration induced a PE-like phenotype in a pregnant mouse model. This study provides evidence of the involvement of IL-32ß in the pathogenesis of PE.

Improvement of chromium biosorption by UV-HNO(2) cooperative mutagenesis in Candida utilis.

The present study focused on the improvement of chromium resistance and biosorption efficiency in Candida utilis CR-001 utilizing protoplast mutagenesis technology. Through ultraviolet (UV) radiation, HNO(2) treatment and chromium acclimatization, six preferred mutants of C. utilis CR-001 were screened out, namely, CRU132-26, CRC7-2, CRC2811-1, CRC2811-2, CRC2814-8 and CRY182-1. The removal efficiency of these mutants for 20mg/L Cr(VI) solutions were 85.6%, 95.2%, 87.0%, 82.5%, 94.7% and 82.7%, respectively, noticeably greater than that of the parent strain CR-001 (79.5%). Furthermore, CRC2811-1 exhibited outstanding application potential with high removal efficiency and low dosage over a wide range of pH. Cell surface and inner details of CRC2811-1 and its parent strain CR-001 were analyzed by scanning electron microscopy (SEM) and atomic force microscopy (AFM) in order to explore possible changes caused by inducement. The results showed that Cr-sorption of CR-001 mainly depended on intracellular accumulation, but for CRC2811-1, cell surface deposition was also involved in improving its chromium biosorption capacity.

[Improvement of heavy metal removing strain by protoplast combination mutant].

Ultraviolet and HNO2 were selected as the mutagens to perform the single factor and multi-factor induction mutation towards Candida utilis CR-001. Six mutant strains which possessed high heavy metal removal efficiency and high resistance to Cr6+ were obtained through combined induction with UV and HNO2. After they were subcultured for 10 generations, the diameter of bacteriostatic circle of CRC2811-1 and CRC7-2 was reduced to 1.7 mm and 1.2 mm respectively, while the Cr6+ removal efficiency of CRC2811-1 was increased from 80.2% to 95.2%, and that of CRC7-2 was from 81.2% to 94.7%. The stability of the other 4 mutant strains was rather stable. Furthermore, precipitation of chromium outside or inside the cell was studied by using combined technique of scanning electron microscopy(SEM), transmission electron microscopy (TEM), and atomic force microscopy(AFM), and the mechanism of chromium removal improvement by the mutant strains was discussed.