Therapeutic Abortion by Intra-amniotic Injection of Prostaglandins

Intra-amniotic injection of either prostaglandin F₂α or prostaglandin E₂ was used in an attempt to induce therapeutic abortion in mid-pregnancy in 27 patients. Termination of pregnancy was successful in 11 out of 13 cases when prostaglandin E₂ alone was used, but in only 6 out of 14 cases when prostaglandin F₂α was used. A further eight patients aborted after additional intravenous oxytocin stimulation, but the combined procedures failed altogether in two patients who were initially given prostaglandin F₂α. The technique was simple, free from serious side effects, and reasonably effective when prostaglandin E₂ was used.     

Oral Administration of Prostaglandins for the Induction of Labour

Prostaglandins E₂ and F₂α administered by mouth were used to induce labour in 100 patients between 35 and 44 weeks of gestation. The usual effective dose of prostaglandin E₂ was 0·5 and of F₂α 5 mg. These were repeated every two hours until labour was established. Induction was successful in 79 out of 80 women treated with oral prostaglandin E₂ and in 16 out of 20 women treated with F₂α     

Midtrimester abortion induced by serial intravaginal administration of prostaglandin E2 suppositories in conjunction with a contraceptive diaphragm

Midtrimester abortion was successfully induced in 68 of 69 patients with serial intravaginal administration of prostaglandin E₂ suppositories behind a contraceptive diaphragm. The mean abortion time for the successful inductions was 13.07 hours; multiparous patients aborted somewhat faster, mean 12.72 hours, as compared to nulliparous patients, mean 14.22 hours. In 36 patients the PGE₂ suppositories were placed behind an intact diaphragm and the mean abortion time was 14.89 hours. In 33 patients the PGE₂ suppositories were placed behind a diaphragm modified by having an opening incised in the center, the mean time in these patients was 11.96 hours. Of the 68 successful abortions 59% of the patients aborted in 12 hours or less and 88% aborted within 24 hours. The most frequently encountered side effect was temperature elevation of 2° F or higher which occurred in 68% of the patients. Temperatures returned to normal levels within 4 to 6 hours after the last administration of PGE₂. Gastrointestinal side effects occurred in 45% of patients, but these side effects were well tolerated and did not require termination of drug administration in any of the patients. Intravaginal administration of PGE₂ suppositories is a very effective abortifacient technique during the midtrimester, however the use of PGE₂ in conjunction with a diaphrgam did not appreciabley improve the technique although the amount of drug administered and the incidence of side effects was somewhat lower than when the PGE₂ suppositories are used alone. If a diaphragm is to be used, a modified diaphragm is indicated since it simplifies the clinical management of the abortion, eases administration of the suppositories and permits a more accurate estimation of cervical changes, vaginal bleeding and abortion.     

Induction of midtrimester abortion by serial intravaginal administration of 15(S)-15-methyl-prostaglandin F2α (THAM) suppositories

Midtrimester abortion was successfully induced in 13 of 22 patients by serial intravaginal administration of 15(S)-15-methyl-prostaglandin F_2α (THAM) suppositories. Nine patients, 4 nulliparas and 5 multiparas, failed to abort after 24 hours of prostaglandin administration and a concomitant infusion of oxytocin was initiated. Seven of the nine patients aborted within 7 hours of the combined therapy and one patient on methadone maintainence aborted after 17.5 hours of combined therapy, 41.5 hours after the first dose of prostaglandin. A single patient failed to abort, despite the concomitant prostaglandin-oxytocin administration and underwent surgical evacuation. The mean abortion time for the 21 successful abortions was 22.56 hours. Nulliparous patients aborted somewhat faster, mean 21.79 hours, than multiparous patients, mean 23.80 hours, but this difference was not statistically significant. In this study, one patient aborted in less than 12 hours, and 62% of the successful cases aborted within 24 hours. The plasma levels of 15-ME-PGF_2α were analyzed by radioimmunoassay in 10 patients. Plasma prostaglandin levels rose significantly 30 minutes after the insertion of the first suppository, but there was a wide variation in levels from patient to patient. It was observed that the 2 patients with the highest levels had the fastest abortion times and episodes of gastro-intestinal side effects appeared related to a rise in prostaglandin levels. Sixty-four percent of the patients in this study had no gastro-intestinal side effect related to prostaglandin administration.     

Plasmodium falciparum Genotype Diversity in Artemisinin Derivatives Treatment Failure Patients along the Thai-Myanmar Border

Genetic characteristics of Plasmodium falciparum may play a role in the treatment outcome of malaria infection. We have studied the association between diversity at the merozoite surface protein-1 (msp-1), msp-2, and glutamate-rich protein (glurp) loci and the treatment outcome of uncomplicated falciparum malaria patients along the Thai-Myanmar border who were treated with artemisinin derivatives combination therapy. P. falciparum isolates were collected prior to treatment from 3 groups of patients; 50 cases of treatment failures, 50 recrudescences, and 56 successful treatments. Genotyping of the 3 polymorphic markers was analyzed by nested PCR. The distribution of msp-1 alleles was significantly different among the 3 groups of patients but not the msp-2 and glurp alleles. The allelic frequencies of K1 and MAD20 alleles of msp1 gene were higher while RO33 allele was significantly lower in the successful treatment group. Treatment failure samples had a higher median number of alleles as compared to the successful treatment group. Specific genotypes of msp-1, msp-2, and glurp were significantly associated with the treatment outcomes. Three allelic size variants were significantly higher among the isolates from the treatment failure groups, i.e., K1_270-290, 3D7_610-630, G_650-690, while 2 variants, K1_150-170, and 3D7_670-690 were significantly lower. In conclusion, the present study reports the differences in multiplicity of infection and distribution of specific alleles of msp-1, msp-2, and glurp genes in P. falciparum isolates obtained from treatment failure and successful treatment patients following artemisinin derivatives combination therapy.     

Conscious Sedation Procedures Using Intravenous Midazolam for Dental Care in Patients with Different Cognitive Profiles: A Prospective Study of Effectiveness and Safety

The use of midazolam for dental care in patients with intellectual disability is poorly documented. This study aimed to evaluate the effectiveness and safety of conscious sedation procedures using intravenous midazolam in adults and children with intellectual disability (ID) compared to dentally anxious patients (DA). Ninety-eight patients with ID and 44 patients with DA programmed for intravenous midazolam participated in the study over 187 and 133 sessions, respectively. Evaluation criteria were success of dental treatment, cooperation level (modified Venham scale), and occurrence of adverse effects. The mean intravenous dose administered was 8.8±4.9 mg and 9.8±4.1 mg in ID and DA sessions respectively (t-test, NS). 50% N₂O/O₂ was administered during cannulation in 51% of ID sessions and 61% of DA sessions (NS, Fisher exact test). Oral or rectal midazolam premedication was administered for cannulation in 31% of ID sessions and 3% of DA sessions (p<0,001, Fisher exact test). Dental treatment was successful in 9 out of 10 sessions for both groups. Minor adverse effects occurred in 16.6% and 6.8% of ID and DA sessions respectively (p = 0.01, Fisher exact test). Patients with ID were more often very disturbed during cannulation (25.4% ID vs. 3.9% DA sessions) and were less often relaxed after induction (58.9% ID vs. 90.3% DA) and during dental treatment (39.5% ID vs. 59.7% DA) (p<0.001, Fisher exact test) than patients with DA. When midazolam sedation was repeated, cooperation improved for both groups. Conscious sedation procedures using intravenous midazolam, with or without premedication and/or inhalation sedation (50% N₂O/O₂), were shown to be safe and effective in patients with intellectual disability when administered by dentists.     

The role of abdominal CT scan as follow-up after complete remission with successful Helicobacter pylori eradication in patients with H. pylori-positive stage I(E1) gastric MALT lymphoma

Background: Eradication of Helicobacter pylori with antibiotics is the established initial treatment of patients with localized gastric mucosa‐associated lymphoid tissue (MALT) lymphoma. However, there are few reports on follow‐up modalities to identify sustained remission in patients who achieve complete remission (CR). We therefore investigated the role of abdominal computed tomography (CT) as follow‐up after CR with H. pylori eradication. Patients and Methods: We retrospectively analyzed 122 patients with H. pylori‐positive stage I_E1 gastric MALT lymphoma who achieved CR with successful H. pylori eradication. Results: The median follow‐up after CR was 35 months (range 3–140months). At a median of 17 months (range 12–21 months) after CR, 7 of 122 patients (5.7%) experienced lymphoma recurrence, all cases of which were confined to the gastric mucosa and were detectable only by endoscopy with multiple biopsies. At the time of recurrence, four of seven patients showed re‐infection by H. pylori. Eradication therapy was successful in these patients, resulting in both bacterial eradication and tumor regression. Three patients who experienced histologic recurrence without H. pylori re‐infection were observed by a watch and wait strategy and again achieved CR. Conclusions: None of the patients with H. pylori‐positive stage I_E1 gastric MALT lymphoma who experienced tumor recurrence after CR with successful H. pylori eradication showed recurrence at extragastric sites, including lymph nodes without gastric mucosal lesion. These findings indicate that endoscopic biopsies without abdominal CT scans are sufficient to detect recurrence in these patients.     

Early mid trimester abortion — By intramuscular 15 methyl prostaglandin E2

Intramuscular administration of 15(s) 15 Methyl Prostaglandin E₂ was successful in terminating twelve of thirteen second trimester pregnancies. Two patients had an incomplete abortion and one case was classified a failure. Side effects were limited to nausea and vomiting in seven cases, diarrhea in eight cases, chills in twelve cases and and elevated temperatures in eight cases. The intramuscular route does offer an advantage in early second trimester abortions and in patients where the intra-amniotic route is not available.     

Mid-trimester abortion with 15 (S) methyl prostaglandin F2α

A Prostaglandin analog 15 Methyl PG F_2α administered intra-muscularly was used to induce mid-trimester abortion in 16 patients. The average dose given was 789 ± 60 ugm, and this resulted in only 9 successful abortions. The incidence of side effects was thought to be prohibitive. PG appears to produce two types of action on the myometrium, a membrane effect, and a more fundamental intracellular regulatory effect.     

Prostaglandin bibliography

Intramuscular administration of 15(s) 15 Methyl Prostaglandin E₂ was successful in terminating twelve of thirteen second trimester pregnancies. Two patients had an incomplete abortion and one case was classified a failure. Side effects were limited to nausea and vomiting in seven cases, diarrhea in eight cases, chills in twelve cases and and elevated temperatures in eight cases. The intramuscular route does offer an advantage in early second trimester abortions and in patients where the intra-amniotic route is not available.     

Production of 2,3-butanediol from HF-hydrolyzed aspen wood

Hydrolyzates from hydrogen fluoride (HF) treated aspenwood were predominantly composed of oligosaccharides which are not readily utilized by Klebsiella pneumoniae. Attempts at further hydrolyzing these oligosaccharides using a variety of glycolytic and xylanolytic enzymes (i.e., amylases, cellulases, and xylanases) were only partially successful. When a post-hydrolysis step was carried out using 3% H₂SO₄, significant amounts of the component monosaccharides were detected. Sugars released by acid or enzymatic hydrolysis of the HF treated aspenwood were utilized by K. pneumoniae for the production of butanediol and ethanol.     

Establishment of peripheral lymphoid cell cultures from patients with Hodgkin's disease depending on Epstein-Barr-Virus-reactivity and cellular immunity.

Peripheral blood lymphocytes from 43 patients with Hodgkin's disease were studied for spontaneous growth in longterm cultures in vitro. The rate of culture establishment in Hodgkin's patients was dependant on a positive Epstein-Barr-Virus (EBV)-seroreactivity and intact delayed hypersensitivity reaction to tuberculin. Localized and inactive disease, as well as the absence of atypical mononuclear cells in the peripheral blood had a favourable influence on the longterm in vitro growth. The overall establishment rate in Hodgkin patients was 18 out of 60 attempts (30%), 16 out of 34 (47%) in patients without treatment, only 2 out of 26 (7.7%) attempts during treatment. These results were compared with culture attempts of peripheral blood cells from healthy individuals and umbilical cord blood lymphocytes. Only 12 out of 60 attempts in healthy donors (18.2%) and 0 out of 49 attempts with umbilical cord blood lymphocytes were successful.     

Clinical evaluation of endocervical prostaglandin E2-triacetin-gel for preinduction cervical softening in pregnant women at term

In an open randomized clinical trial 100 pregnant women with low Bishop Scores at term were treated either with intracervical Prostaglandin (PG) E₂ (0.5 mg in 2.5 ml triacetin-gel) 12 hours before labor induction with intravenous oxytocin or with oxytocin infusion alone. In 46 of the 50 pretreated patients (92 %) the Bishop Score progressed at least 3 points, in four cases only 2 points. The mean Bishop score in the untreated patients increased insignificantly. After PGE₂-gel administration 16 patients delivered during the 12 hour interval compared to 3 in the group without pretreatment. The first induction attempt was successful in 14 (64 %) of the 22 patients that were left to be induced after cervical softening and in 26 (57 %) of the 47 women without cervical priming. The Cesarean section rate was 10% (n=5) in the PGE₂-gel group and 12% (_n=6) in the control group. Dosage of oxytocin required for labor induction was significantly lower after cervical softening. No serious fetal or maternal side effects were observed after PGE₂ pretreatment.     

The induction of labour by the intravenous infusion of prostaglandin F2α

labour was induced by the intravenous infusion of prostaglandin F_2α in 106 patients at 36–44 weeks of pregnancy. The induction was successful in 80% of the women. The total dose needed ranged from 0.1 to 14.2 mg of PGF_2α. The uterine activity and fetal heart rate were recorded by cardiotocography. The contraction pattern and induction-delivery time were the same as reported for induction with oxytocin. In one case uterine hyperactivity occurred after rupture of the membranes. No serious adverse effects were seen, but in a few cases local irritation was noted at the site of infusion. The condition of the infants was generally good.It might be concluded that PGF_2α seems valuable for the induction of labour, but due to the risk for overstimulation careful supervision is needed.     

6MWT在评价老年肺结核应用及与血气分析相关性

摘要 目的：探究6分钟步行试验（6-minute walk test,6MWT）在评价老年肺结核患者病情中的应用,并分析6MWT同肺结核患者血气指标的相关性。方法：选择2019年1月至2019年12月于我院接受治疗的200例高龄肺结核患者为实验组,另选取同期于我院接受体格检查的50例健康个体为对照组,分别对两组患者实施6MWT实验,测量两组个体的步行距离、实验前后血氧饱和度（SpO₂）,计算SpO₂下降率,并对所有实验组患者实施肺功能实验,评估肺功能相关指标同6MWT相关性。结果：（1）对比显示实验组患者的6MWT、SpO₂、PaO₂明显低于对照组,PaCO₂高于对照组（P<0.05）;（2）实验前后比较显示实验组患者试验后的SpO₂、PaO₂低于实验前,PaCO₂高于实验前（P<0.05）;（3）相关性分析显示,实验组患者的6MWT同FEV1、FEV1/FVC呈正相关（P<0.05）;（4）相关性分析显示实验组患者的6MWT同SpO₂、PaO₂呈正相关,同PaCO₂呈负相关（P<0.05）。结论：6MWT同高龄肺结核患者肺功能及血气相关指标存在明显的相关性,可将6MWT作为老年肺结核患者病情评估指标之一。     

Adriamycin in the Treatment of Acute Leukaemia

In a preliminary study a new antitumour antibiotic, adriamycin, was found to be capable of inducing complete remission in 6 out of 17 patients with acute lymphoblastic leukaemia and in one out of four with lymphoblastic lymphosarcoma despite the fact that these patients had either failed to respond or had relapsed after chemotherapy with agents recognized to be potentially successful in each condition. In five cases of acute lymphoblastic leukaemia adriamycin was used in combination with cytosine arabinoside—three achieved complete remission and two good partial remissions. This combination seems to merit further study in patients who have relapsed on the more conventional chemotherapeutic regimens in acute lymphoblastic leukaemia.In 13 patients with acute myelogenous leukaemia previously treated with daunorubicin and cytosine arabinoside no remissions were obtained with the dose range used.     

Oligovalent Fab Display on M13 Phage Improved by Directed Evolution

Efficient display of antibody on filamentous phage M13 coat is crucial for successful biopanning selections. We applied a directed evolution strategy to improve the oligovalent display of a poorly behaving Fab fragment fused to phage gene-3 for minor coat protein (g3p). The Fab displaying clones were enriched from a randomly mutated Fab gene library with polyclonal anti-mouse IgG antibodies. Contribution of each mutation to the improved phenotype of one selected mutant was studied. It was found out that two point mutations had significant contribution to the display efficiency of Fab clones superinfected with hyperphage. The most dramatic effect was connected to a start codon mutation, from AUG to GUG, of the PelB signal sequence preceding the heavy chain. The clone carrying this mutation, FabM_GUG, displayed Fab 19-fold better and yielded twofold higher phage titers than the original Fab.     

Health related quality of life among patients with tuberculosis and HIV in Thailand

Introduction

Health utilities of tuberculosis (TB) patients may be diminished by side effects from medication, prolonged treatment duration, physical effects of the disease itself, and social stigma attached to the disease.

Methods

We collected health utility data from Thai patients who were on TB treatment or had been successfully treated for TB for the purpose of economic modeling. Structured questionnaire and EuroQol (EQ-5D) and EuroQol visual analog scale (EQ-VAS) instruments were used as data collection tools. We compared utility of patients with two co-morbidities calculated using multiplicative model (U_CAL) with the direct measures and fitted Tobit regression models to examine factors predictive of health utility and to assess difference in health utilities of patients in various medical conditions.

Results

Of 222 patients analyzed, 138 (62%) were male; median age at enrollment was 40 years (interquartile range [IQR], 35–47). Median monthly household income was 6,000 Baht (187 US$; IQR, 4,000–15,000 Baht [125–469 US$]). Concordance correlation coefficient between utilities measured using EQ-5D and EQ-VAS (U_EQ-5D and U_VAS, respectively) was 0.6. U_CAL for HIV-infected TB patients was statistically different from the measured U_EQ-5D (p-value<0.01) and U_VAS (p-value<0.01). In tobit regression analysis, factors independently predictive of U_EQ-5D included age and monthly household income. Patients aged ≥40 years old rated U_EQ-5D significantly lower than younger persons. Higher U_EQ-5D was significantly associated with higher monthly household income in a dose response fashion. The median U_EQ-5D was highest among patients who had been successfully treated for TB and lowest among multi-drug resistant TB (MDR-TB) patients who were on treatment.

Conclusions

U_CAL of patients with two co-morbidities overestimated the measured utilities, warranting further research of how best to estimate utilities of patients with such conditions. TB and MDR-TB treatments impacted on patients'' self perceived health status. This effect diminished after successful treatment.     

Effect of room temperature ionic liquid structure on the enzymatic acylation of flavonoids

Enzymatic acylation reactions of flavonoids (rutin, esculin) with long chain fatty acids (palmitic, oleic acids) were carried out in 14 different ionic liquid media containing a range of cation and anion structures. Classification of RTILs according to flavonoid solubility (using COSMO-RS) was the basis for structural selection. Overall, anion selection had a far greater influence on lipase activity than choice of cationic moiety. RTILs containing TF₂N⁻, PF₆⁻ and BF₄⁻ anions were most successful as reaction media while RTILs containing anions with stronger solvating properties (i.e. H-bonding ability) resulted in decreased yields, likely due to increased interactions with the protein structure of the lipase. Biosynthesis of rutin proceeded much slower than of esculin. All-in-all, judicious selection of RTILs was central to achieving high yields (>98% after 6 days for TOMA·TF₂N) since a balance must be struck that maximized flavonoid solubility with minimum negative impact on lipase activity. The process also benefitted from an increased reaction temperature which may have helped to reduced mass transfer limitations.