ABSTRACT
Objective To investigate the safety of trial of labor after cesarean (TOLAC) and clinical factors associated with successful TOLAC and to compare TOLAC with elective repeat caesarean section (ERCS) in terms of obstetric and neonatal outcomes.Methods A prospective cohort study was conducted among gravidas who had a history of lower segment cesarean section and were hospitalized in the Department of Obstetrics and Gynecology,the Affiliated Drum Tower Hospital of Medical School of Nanjing University from January to December 2014.Exclusion criteria included indications for caesarean section (such as placenta previa,placenta accreta,twin pregnancy,breech presentation and severe preeclampsia),serious maternal complications after cesarean section,lower uterine segment thinner than 3 mm and poor healing of uterine incision.Totally,287 gravidas were enrolled.Among them,142 chose TOLAC and the other 145 requested ERCS.Clinical data of those gravidas were collected and statistically analyzed by t-test,Log-rank test,Chi-square or Fisher's exact test.Results (1) The success rate of TOLAC was 90.8％ (129/142).There was no significant difference in maternal age,gestational age,thickness of lower uterine segment,interval between the two deliveries and neonatal birth weight and asphyxia rate between the successful (n=129) and unsuccessful (n=13) groups (all P＞0.05).Although the two groups had no significant difference in postpartum hemorrhage (PPH) rate,the gravidas who failed in TOLAC lost more blood than those who succeeded [425 (195-675) vs 200 (50-1 400) ml,P＜0.05].Moreover,higher amniotic fluid contamination rate was observed in the unsuccessful group [6/13 vs 17.1％ (22/129),P＜0.05].In the TOLAC group,99.3％ (141/142) were under continuous fetal heart rate monitoring.Incomplete uterine rupture occurred in one women without serious maternal or neonatal outcomes.The reasons for 13 failed TOLAC cases were unbearable pain during labor,abnormal labor,fetal distress and threatened rupture of uterus.(2) Compared with the ERCS group,the TOLAC group showed shorter interval from last cesarean section to the indexed delivery[5 (2-18) vs 6 (2-19) years],younger maternal age [(31±4) vs (33 ±4) years old] and less blood loss [200 (50-1 400) vs 300 (100-1 500) ml] (all P＜0.05).Conclusion Our study shows that,those who preferred TOLAC were younger,or had shorter pregnancy interval from last cesarean section.The success rate of TOLAC is high for women undergoing systematic prenatal assessment and close management during labor with less blood loss and non-serious maternal and neonatal complications compared with ERCS.
ABSTRACT
Soladulcidine is a steroidal alkaloid abundant in Solanum dulcamara L. with antitumor and other biological activities. In this study, ten soladulcidine derivatives were synthesized through esterification at C-3-hydroxy group, modification at NH group of F ring of esterification of E ring-opening products. The in vitro antiproliferative activity of these synthesized derivatives against prostate cancer (PC-3) cell line was assessed. Within this series of compounds, compound 19 exhibited the most potent inhibitory effect against the proliferation of PC-3 cell line (IC50=4.80±.9μmol/L).
ABSTRACT
<p><b>OBJECTIVE</b>To describe the distribution of plasma folate concentrations and prevalence of folate deficiency in adults aged 35 to 64 years in some areas and different seasons in China.</p><p><b>METHODS</b>Study subjects were sampled from the representative rural and urban areas in the south and north of China aged 35 to 64 years totaling 2 545, and their plasma folate concentrations were determined and analyzed.</p><p><b>RESULTS</b>Plasma concentrations of folate in the southern population were significantly higher (16.9 nmol/L) than those in the north (8.3 nmol/L), and the prevalence of folate deficiency in the south (5.8%) was significantly lower than that in the north (37.1%). Plasma folate concentration varied with season either in the south or north. Plasma concentrations of folate were lower during the summer and the fall (15.0 nmol/L) than those during the winter and the spring (18.8 nmol/L) in the south, but without significant changes in the prevalence of folate deficiency in different seasons. However, the plasma folate concentrations were significantly higher during the summer and the fall (9.7 nmol/L) than those during the winter and the spring (7.1 nmol/L) in the north. And the prevalence of folate deficiency in the north was significantly higher in winter and spring (48.0%) than that in summer and fall (26.2%).</p><p><b>CONCLUSIONS</b>There existed significant difference in plasma folate concentrations in adults between varied geographic areas in China, which differed from their seasonal changes.</p>