A single blinded randomized clinical trial on the effects of oxytocin discontinuation versus continuous oxytocin infusion during the active phase of labor / Philippine Journal of Obstetrics and Gynecology

BACKGROUND: Oxytocin is a drug widely used for induction of labor. Despite its widespread use, data on the benefit from continuous oxytocin infusion for labor induction beyond the onset of active phase of labor are scarce. To address this, a single-blind randomized clinical trial was done comparing the course and outcome of labor of patients given continuous oxytocin versus those whose oxytocin were discontinued during the active phase of labor. METHOD: Term, singleton primigravid patients admitted in a tertiary hospital from January 1 to May 31, 2013 were included in the study. After careful assessment, 64 primigravids who fulfilled the inclusion criteria, (32 per group), were randomized to 2 groups, Group 1 (received continuous oxytocin infusion) and Group 2 oxytocin was discontinued during the active phase of labor). Analysis of data collected was done using SPSS software version 17, student T test, Chi square tests, z test of proportion were used. RESULTS: There was no statistically significant difference found between the two groups with regards to the outcome during the latent phase of labor as well as the second stage of labor. However, there was significant difference in the duration of the active phase of labor among patients from Group 1 (those given continuous oxytocin). In terms of mode of delivery, there was no statistically significant difference between 2 groups. Some of the patients from both groups eventually required abdominal delivery, this outcome was found to be not statistically significant. The neonatal outcome in terms of APGAR score, clearance given to be roomed-in immediately and the need for antibiotics were also found to be not statistically significant. CONCLUSION: In this study, results show that discontinuing oxytocin during active phase of labor does not increase the abdominal delivery rate, affect labor and fetal outcomes.

Serum autoantibodies against cytochrome P450 2E1 (CYP2E1) predict severity of necroinflammation of recurrent hepatitis C.

We previously reported that autoantibodies against cytochrome P4502E1 (CYP2E1) are frequent in patients with chronic hepatitis C. As autoimmune reactions are increasingly detected after orthotopic liver transplantation (OLT), this study investigates prevalence and significance of anti-CYP2E1 autoantibodies in 46 patients with post-OLT recurrent hepatitis C. IgG against recombinant human CYP2E1 above the control threshold was detected in 19 out 46 (41%) sera collected immediately before OLT and in 15 out 46 (33%) sera collected at the time of the 12 months follow-up liver biopsy. Although anti-CYP2E1 reactivity was not modified by OLT, the patients with persistently elevated anti-CYP2E1 IgG (n = 12; 26%) showed significantly higher prevalence of recurrent hepatitis with severe necroinflammation and fibrosis than those persistently negative or positive only either before or after OLT. Moreover, the probability of developing severe necroinflammation was significantly higher in persistently anti-CYP2E1-positive subjects. Multivariate regression and Cox analysis confirmed that the persistence of anti-CYP2E1 IgG, together with a history of acute cellular rejection and donor age >50 years, was an independent risk factor for developing recurrent hepatitis C with severe necroinflammation. We propose that autoimmune reactions involving CYP2E1 might contribute to hepatic damage in a subgroup of transplanted patients with recurrent hepatitis C.

ERCP and short-term stent-trial in patients with anastomotic biliary stricture following liver transplantation.

BACKGROUND: Anastomotic biliary stricture represents one of the possible factors leading to liver dysfunction after transplantation. PURPOSE: Our aims were to evaluate the role of endoscopic retrograde cholangio-pancreatography and a short-term stenting (stent-trial) in assessment of the clinical relevance of the biliary stricture. MATERIALS AND METHODS: Thirty transplanted patients for HCV (n=17) or non-HCV (n=13)-related cirrhosis (27M, median age 53 yr, range 24-67 yr) who developed persistently abnormal liver function tests and presented with an anastomotic biliary stricture suggested by non-invasive cholangiography, underwent endoscopic retrograde cholangio-pancreatography. If the stricture was confirmed, dilation was performed and a plastic stent was placed. Clinical and biochemical evaluation was done one and two months later. Resolution of symptoms and normalization or > 50% reduction of at least one liver function test were needed to consider the stricture as clinically relevant. Patients were followed up for a median of 19 months. RESULTS: Endoscopic retrograde cholangio-pancreatography was successful in 29 patients and confirmed the anastomotic biliary stricture in 19 (66%); 14 patients underwent endoscopic dilation and stenting and five patients underwent surgery. The stent-trial suggested the stricture to be clinically relevant in 7 of 14 patients, confirmed by prolonged stenting and follow-up. A trend towards a higher likelihood of a clinically relevant stricture was observed in HCV-negative compared to HCV-positive patients (5 of 7, 71% vs 2 of 7, 29% , respectively; p=0.1). CONCLUSIONS: Our data suggest that endoscopic retrograde cholangio-pancreatography is a valuable tool to evaluate the clinical relevance of an anastomotic stricture, when coupled with a short-term stent-trial.

Transient elastography predicts fibrosis progression in patients with recurrent hepatitis C after liver transplantation.

OBJECTIVE: Transient elastography (TE) allows non-invasive evaluation of the severity of liver disease in patients with chronic hepatitis C. This procedure, however, warrants further validation in the setting of liver transplantation (LT), including patients under follow-up for recurrent hepatitis C. SETTING: Tertiary referral hospital. PATIENTS: 95 patients (75 males) transplanted for end-stage liver disease due to hepatitis C virus. INTERVENTIONS: Paired liver biopsy (LB) and TE were carried out 6-156 (median, 35) months after LT. 40 patients with recurrent hepatitis C sequentially evaluated 6-21 months apart. MAIN OUTCOME MEASURES: Clinical, laboratory and graft histological features influencing TE results. RESULTS: Median TE values were 7.6 kPa in the 90 patients with a successful TE examination, being 5.6 kPa in the 30 patients with Ishak fibrosis score (S) of 0-1, 7.6 kPa in the 38 with S2-3; 16.7 kPa in the 22 with S4-6, (p < 0.0001). Areas under the ROC curves were 0.85 (95% CI, 0.76 to 0.92) for S > or = 3, 0.90 (95% CI, 0.82 to 0.95) for S > or = 4 with 7.9 and 11.9 kPa optimal TE cut-off (81% and 82% sensitivity, 88% and 94% negative predictive value, respectively). Fibrosis, necroinflammatory activity and higher than 200 IU/l gamma-glutamyl transpeptidase levels independently influenced TE results. During post-LT follow-up, TE results changed in parallel with grading (r = 0.63) and staging (r = 0.71), showing 86% sensitivity and 92% specificity in predicting staging increases. CONCLUSIONS: TE accurately predicts fibrosis progression in LT patients with recurrent hepatitis C, suggesting that protocol LB might be avoided in patients with improved or stable TE values during follow-up.

Investigations into the production and interconversion of phomoidrides A-D.

[structure: see text] Fermentation of ATCC 74256 led to the isolation and identification of C7 epimers of phomoidride A (CP-225,917) and phomoidride B (CP-263,114). We suggest the names phomoidrides C and D for these new fermentation products. Studies on the effect of pH on the distribution of phomoidrides A-D suggest phomoidride B (CP-263,114) is the first-formed secondary metabolite and the source of the remaining three phomoidrides.

Investigations into a biomimetic approach toward CP-225,917 and CP-263,114.

A biosynthesis of the structurally complex nonadride CP-225,917 (1) is outlined. A key step in this proposal is the dimerization of a C(16) anhydride derived from the condensation of lauric acid and oxaloacetic acid. An important element of this step is a templating effect imposed by two thioester linkages, reminiscent of a polyketide or fatty acid synthase pathway. On the basis of this principle, the dimerization of two C(11) anhydrides, templated by a 1,n-diol tether, leading to the core structure of CP-225,917 and CP-263,114 was investigated.