Mononitrato de isosorbide o misoprostol vaginal para la maduración cervical en embarazos a término / Vaginal isosorbide mononitrate or misoprostol for cervical ripening in term pregnancies

Objetivo Comparar la efectividad del mononitrato de isosorbide con la del misoprostol vaginal en la maduración cervical en embarazos a término. Método Se seleccionaron y asignaron al azar pacientes para ser tratadas con 40mg de mononitrato de isosorbide (grupo A) o 100 μg de misoprostol (grupo B) que asistieron para maduración cervical e inducción del parto. Se evaluaron la tasa de eficacia, el tiempo entre el inicio de la maduración y la obtención del recién nacido, las complicaciones neonatales y los efectos adversos. Resultados No se encontraron diferencias estadísticamente significativas entre los grupos con relación a las características generales (p=ns). Las pacientes tratadas con misoprostol presentaron un período significativamente menor desde la administración de la primera dosis hasta la obtención del recién nacido que las pacientes tratadas con isosorbide (p<0,05). No se encontraron diferencias significativas con relación al número de partos vaginales entre ambos grupos (p=ns). Los recién nacidos de las pacientes del grupo B presentaron valores promedio significativamente más bajos de Apgar al minuto y a los 5min al compararlos con el grupo A (p<0,05). El efecto adverso más común en el grupo A fue la cefalea (16 casos, 53,3%), mientras que en el grupo B fue la diarrea (5 casos, 16,7%).Conclusiones El misoprostol y el mononitrato de isosorbide vaginal tienen una efectividad similar en la maduración cervical en embarazos a término cuando son administrados (AU)

Objective To compare the effectiveness of vaginal isosorbide mononitrate or misoprostol in cervical ripening in term pregnancies. Methods Patients undergoing cervical ripening and induction of labor were selected and randomly assigned to receive 40mg isosorbide mononitrate (group A) or 100 mcg misoprostol (group B). The efficacy rate, time between cervical ripening and delivery, neonatal outcome and adverse effects were evaluated. Results There were no significant differences between the groups in general characteristics (p=ns). Patients treated with misoprostol showed a shorter period from first dose administration to newborn delivery than those treated with isosorbide (p<0.05). There were no significant differences in the number of vaginal births between the two groups (p=ns). Newborns in group B had significantly lower mean Apgar scores at 1 and 5min than those in group A (p<0.05). The most common adverse effect in group A was headache (16 cases, 53.3%) and diarrhea (five cases, 16.7%) in group B. Conclusion The effectiveness of vaginal misoprostol and isosorbide mononitrate is similar in cervical ripening in term pregnancy (AU)

Peroxisome proliferator activated receptor-gamma, leptin and tumor necrosis factor-alpha mRNA expression during very low calorie diet in subcutaneous adipose tissue in obese women.

BACKGROUND: PPAR gamma, leptin and TNF alpha are three major factors that play a key role in influencing adipocyte differentiation and both adipose tissue function and metabolism. However, the regulation of these three genes during a dynamic period of weight loss is unknown. We therefore investigated the concomitant regulation of the mRNA expression of PPAR gamma, leptin and TNF alpha in adipose tissue during a 21-day very low calorie diet (VLCD) in 12 non-diabetic obese women. METHODS: The mRNA levels of PPAR gamma, leptin and TNF alpha were quantified by quantitative RT-competitive PCR in abdominal subcutaneous adipose tissue before and during VLCD (940 kcal/day). RESULTS: VLCD induced weight loss (approximately 6 kg) and improved insulin sensitivity. Simultaneously, VLCD induced the reduction in the adipose tissue mRNA abundances of PPAR gamma (-13%, p < 0.05) and of leptin (-58%, p < 0.005), whereas TNF alpha mRNA levels increased (+78%, p < 0.005). PPAR gamma and leptin mRNA levels were correlated before (r = 0.778, p < 0.01) and after VLCD (r = 0.797, p < 0.01). Serum HDL-cholesterol concentrations were positively associated with PPAR gamma (r = 0.696, p < 0.03) and leptin (r = 0.806, p < 0.01) mRNA levels. CONCLUSIONS: The increase in TNF alpha mRNA levels suggested that a local increased expression of this cytokine in adipose tissue might play a role in the control of the fat mass during weight loss. PPAR gamma and leptin mRNA levels were positively associated both before and after VLCD, suggesting that common regulatory mechanism(s) might control their expression. More strikingly, we found strong positive correlations between circulating HDL-cholesterol and both PPAR gamma and leptin mRNA levels, suggesting the existence of physiological links between circulating lipoprotein metabolism and adipose tissue function.

Protection against autoimmune diabetes with oral insulin is associated with the presence of IL-4 type 2 T-cells in the pancreas and pancreatic lymph nodes.

Oral administration of antigens has been proposed in the prevention and treatment of autoimmune diseases. We reported that oral administration of 0.8 mg of recombinant human insulin to 6-week-old NOD mice every other day for a month generated regulatory T-cells that were able to reduce the severity of insulitis and the percentage of clinical diabetes in naive irradiated recipients when co-injected with diabetogenic T-cells. In the present study, immunohistochemical analysis of the pancreatic glands revealed that injection of T-cells from insulin-fed mice upregulated the number of interleukin (IL)-4-secreting cells within the islets. Using two strains of NOD mice congenic at the Tbeta, or Thy1, locus, we observed a higher proportion of T-cells from insulin-fed mice in both the spleen (7.73 +/- 0.3 vs. 5.57 +/- 0.2%; P < 0.001) and the pancreatic lymph nodes (10.1 +/- 0.8 vs. 7.2 +/- 0.7%; P < 0.05) of cotransferred mice. By reverse transcription-polymerase chain reaction (RT-PCR) analysis, mice reconstituted with T-cells from insulin-fed animals had detectable amounts of IL-4 mRNA, specifically in the pancreatic lymph nodes (8 of 9 experimental mice vs. 1 of 9 control mice) and the pancreas (3 of 3 experimental mice vs. 0 of 3 control mice). Gamma-interferon mRNA was detectable in all cotransferred animals, but IL-10 mRNA and transforming growth factor beta mRNA were undetectable. These results suggested a shift from a T-helper 1 (Th1) to a Th2 pattern of cytokine expression and underlined the role of pancreatic lymph nodes in the protection. Repeated injections of 500 microg s.c. of anti-IL-4 monoclonal antibody led to an accentuation of the severity of islet infiltration and to the development of clinical diabetes. We concluded that oral administration of insulin can induce the presence of regulatory T-cells in the pancreas and the corresponding draining lymph nodes, initiate the secretion of IL-4 in this microenvironment sufficiently to suppress the activity of Th1 autoreactive T-cell clones, and ultimately provide protection against autoimmune diabetes.