Administration Of Prostaglandin E2 Research Articles

Is Antithrombotic Therapy Necessary Following Replantation of an Amputated Digit?

Antithrombotic therapy following replantation remains controversial, and the survival of replanted digits is affected by various other factors, such as the state of vascular damage and the surgeon's level of skill. The present study's aim is to obtain clinical evidence for postoperative antithrombotic therapy in replantation, with antithrombotic therapy being the only variable. This was a single-center retrospective study of patients who underwent replantation of a completely amputated digit by the same surgeon. The subject sample included 17 patients/19 digits (group A) in whom heparin and prostaglandin E1 (PGE1) were used postoperatively during a 1-year period, 19 patients/22 digits (group B) in whom heparin was not used postoperatively but PGE1 was used for a 1-year period, and 16 patients/19 digits (group C) in whom neither heparin not PGE1 were used postoperatively for a 1-year period. Patient background and surgical procedure were not significantly different among groups, and only the postoperative use of heparin and/or PGE1 showed differences. Incidence of arterial occlusion, venous occlusion, or vascular spasm were not significantly different among groups (arterial occlusion: 1 digit in group A, 2 in group B, and two in group C, p = 1; venous occlusion: 1 digit in group A, 2 in group B, and three in group C, p = 0.67; vascular spasm: 1 digit in group A, 2 in group B, and one in group C, p = 1). Postoperative bleeding was significantly more common in the group using heparin (7 patients in group A, 0 in group B, and zero in group C, p < 0.001). These results suggest that heparin and PGE1 administration do not improve impaired blood flow following replantation. Considering the potential complications, heparin and PGE1 following replantation do not seem necessary.

Efficacy and safety of administering oral misoprostol by titration compared to vaginal misoprostol and dinoprostone for cervical ripening and induction of labour: study protocol for a randomised clinical trial

BackgroundAmong the various methods available, the administration of prostaglandins is the most effective for inducing labour in women with an unfavourable cervix. Recent studies have compared treatment with various titrated doses of oral misoprostol with vaginal misoprostol or dinoprostone, indicating that the use of an escalating dose of an oral misoprostol solution is associated with a lower rate of caesarean sections and a better safety profile. The objective of this study is to assess which of these three therapeutic options (oral or vaginal misoprostol or vaginal dinoprostone) achieves the highest rate of vaginal delivery within the first 24 h of drug administration.MethodsAn open-label randomised controlled trial will be conducted in Araba University Hospital (Spain). Women at ≥41 weeks of pregnancy requiring elective induction of labour who meet the selection criteria will be randomly allocated to one of three groups: 1) vaginal dinoprostone (delivered via a controlled-release vaginal insert containing 10 mg of dinoprostone, for up to 24 h); 2) vaginal misoprostol (25 μg of vaginal misoprostol every 4 h up to a maximum of 24 h); and 3) oral misoprostol (titrated doses of 20 to 60 μg of misoprostol following a 3 h on + 1 h off regimen up to a maximum of 24 h). Both intention-to-treat analysis and per-protocol analysis will be performed.DiscussionThe proposed study seeks to gather evidence on which of these three therapeutic options achieves the highest rate of vaginal delivery with the best safety profile, to enable obstetricians to use the most effective and safe option for their patients.Trial registrationNCT02902653 Available at: https://clinicaltrials.gov/show/NCT02902653 (7th September 2016).

From compression to injections: Prostaglandins paving a new direction for venous leg ulcer treatment

Objective: Venous ulcers play a major burden on the patient and health-care system in terms of morbidity and medical expenditure. The objective of the study was to evaluate the efficacy of prostaglandin E1 (PGE1) administered via intravenous infusion in the healing time of venous leg ulcer and to evaluate the safety of prostaglandin intravenous infusion. Materials and Methods: This was a prospective observational study at a single tertiary care center. Patients who had proven venous ulcers of the legs which are not healing for more than 3 months with conventional therapy were included. About 500 μg PGE1 was given in equally divided doses over 5 days as intravenous infusion along with regular compression therapy. Ulcers were followed up every 3 weeks for 18 weeks and measurement of ulcer area done. Results: A total of 47 patients with 50 ulcers were included in the study with a mean age of 55.9 years. About 50% of ulcers healed 9 weeks after PGE1 administration and 92% healed after 18 weeks of treatment. The estimated healing time of 25%, 50%, and 75% of the patients treated with PGE1 was 40, 63, and 86 days, respectively, which was statistically significant compared to the previous studies with compression therapy alone. The only factor to independently affect healing time was found to be the initial ulcer size. There were no major adversities with PGE1 administration, 2 patients developed minor symptoms, in the form of hypotension and tachycardia, which were managed with stoppage of infusion for short duration. Conclusion: The study shows the effectiveness of PGE1 in reducing the healing time of VLUs, thereby allowing patients for lesser hospitalization and quicker return to work and life producing improvement in the quality of life. The adverse effects were also very minor with PGE1 treatment, overall, acceptable and were well tolerated by the patients.

Effects of short-term intravaginal progestagen treatment on fertility and prolificacy after natural breeding in sheep at different reproductive seasons

ABSTRACT The present study indicates that short-term progestagen-based protocols for synchronization of estrus and ovulation in sheep involving 7 days of progestagen insertion with administration of prostaglandin F2α at either insertion or removal of the progestagen sponge resulted in 80–90% fertility during the breeding season, while a classical long-term protocol of 14 days of progestagen insertion resulted in 77% fertility. During the non-breeding season, fertility was significantly higher for the 7-day protocol with prostaglandin administration at sponge insertion (79.2%) and for the 14-day protocol (80%) than for the 7-day protocol with prostaglandin administration at sponge removal (59.1%; P = 0.018). Prolificacy, in contrast, varied significantly with genotype, being higher in prolific breeds, but it did not vary with progestagen protocol or breeding season. These results suggest that short-term progestagen-based treatments can provide similar reproductive efficiency as long-term treatments, which may help practitioners reduce welfare and health issues while maintaining productivity.

Dosage and routes of administration of prostaglandin: Practical implications for the reproduction of cows, mares and pigs

Prostaglandin F2α and its synthetic analogues, because of their luteolytic properties, have found wide application in the reproduction of domestic animals, including cattle, swine and horses. They are used to induce and synchronize heat, ovulation and parturition, as well as to improve the results of insemination and early-stage pregnancy termination. The ongoing discussions regarding animal welfare include the question of the lowest effective dose of hormones in individual species and how it could be reduced by selecting the optimal route of hormone administration. Intramuscular injection is the recommended method of administering prostaglandins to cows, pigs and mares. Due to the different sensitivities of these species to prostaglandins, the recommended therapeutic dose varies significantly from one species to another. The luteolytic effect also depends on the route of administration. Studies on alternative routes of injection report good therapeutic effects after administration of the hormone subcutaneously (SC), into intravaginal submucosa (IVSM), at the BAI-HUI acupuncture point or at the ischiorectal fossa (IRF). The injection site, the dose and the type of prostaglandin used may intensify negative effects, such as an increase in the heart or breathing rate and increased sweating.

Pathogenetic justification and clinical significance of using arginine for prevention of critical ischemia of lower extremities and fatal manifestations of multifocal atherosclerosis

The aim — to investigate the results of treatment with L‑arginine of patients with intermittent claudication for prevention of critical stages of limb ischemia.Materials and methods. 86 patients with intermittent claudication were randomly divided into two groups of 43 patients each. Patients of the first group received 8 g of L‑arginine (Tivortin) twice a day, patients of the second group — 40 mg of prostaglandin E1 (PGE1) twice a day.Results and discussion. Administration of L‑arginine contributed to an increase in the distance of painless walk by 230 ± 63 %, the absolute walk distance — by 155 ± 48 % (p < 0.05), the administration of PGE1 — by 209 ± 63 % and 144 ± 28 %, respectively (p < 0.05). Treatment with L‑arginine increased the value of the coefficient of L‑arginine/asymmetric dimethylarginine in plasma and the excretion of nitrates and cGMP in the urine, which indicated the normalization of the biosynthesis of endogenous NO. PGE1 therapy did not significantly affect endothelium‑dependent vasodilation parameters. The coefficient of quality of life, estimated in an analog scale, increased from 3.51 ± 0.18 to 8.3 ± 0.4 in the arginine group and to 7.0 ± 0.5 in the PGE1 group (all p < 0.05).Conclusions. Arginine is a drug of choice to prevention of severe forms of lower limbs ischemia and other manifestations of multifocal atherosclerosis.

Fetal hemodymanic effects on ductus arteriosus development and influences on postnatal management in infants with ductal-dependent pulmonary blood flow.

The ductus arteriosus (DA) has been studied since Galen. Initially after birth in neonates with obstruction to pulmonary blood flow, DA patency is integral to ensure output and oxygenation. While DA stenting dates back 25 years, there is emerging interest in better understanding how and when to utilize this strategy as an alternative to surgical shunt placement or ongoing prostaglandin administration. Understanding the normal fetal circulation and the perturbations that affect flow and oxygenation is integral to comprehending how normal DA anatomy and morphology may change and how this may influence technical and clinical considerations. In the normal human fetus the great majority of descending aorta circulation comes from the DA, whereas this is a small minority in pulmonary outflow lesions, resulting in size and angle abnormalities. Study of the DA morphology has previously sought to identify patients requiring early intervention and more novel classifications are contributing to knowledge of complications and increasing the likelihood of success. As well, optimal patient selection for aorto-pulmonary shunt vs DA stent remains unclear. This review seeks to convey how fetal circulation can affect the DA, how other clinical considerations such as neurocognitive development support these finding and influence management, and emphasize that the variability in the DA will affect suitability for stenting, which requires further study as guidelines and standards are developed.

Effect of intramuscular administration of dexamethasone on the duration of labor induction

Introduction: induction of labor is a common obstetric procedure which is performed for a variety of medical and non-medical indications. If the cervix is unfavorable, prior ripening of the cervix makes induction of labor easier and more successful. There are different methods for ripening of the cervix and making it ready for induction. These methods included medical methods such as the administration of prostaglandins and mechanical methods such as extra amniotic saline infusion, traction on the cervix with Foley catheter and laminaria. Aim: The aim of the study is to evaluate the efficacy of intramuscular dexamethazone injection prior to induction in improving progression and duration of labour phases. Subjects and Methods: This study started with 100 Nulliparous Pregnant women who were conducted at the labor wards of Ain-Shams Maternity Hospital. The studied subjects were randomized into two groups ; dexamethasone group (group A) including 50 Nulliparous women (N=50) and control group (group B) including 50 Nulliparous woman (N=50).Results: In this study, the duration of active and second stages decreased without changing the mode of delivery. The study showed no significant statistical differences between the two studied groups regarding fetal heart rate. The duration of second stage in dexamethasone group was shorter than in the control group. Dexamethasone intramuscularly prior to induction significantly shortens duration of normal labor in normal parturient with minimal complications.Conclusion: An intramuscular injection of dexamethasone before labor induction shortens the duration of labor induction by decreasing the interval between the initiation of induction and the beginning of the active phase, duration of active phase and duration of second stage of labor with no observed maternal or neonatal complications.Recommendation: Further research with more patients undertaken for the assessment of the effects of the corticosteroids on the duration of labor on the patients with unfavorable cervix as well as maternal and perinatal morbidity and mortality rate.

Engraftment and Reconstitution of Hematopoiesis Is Dependent on Endothelial Cell Expressed Prostaglandin EP4 Receptor Signaling Mediated Regeneration of Vascular Niche

Defining the cellular and molecular components of the bone marrow (BM) niche that regulate the homeostasis and regeneration of hematopoietic stem and progenitor cells (HSPCs) can facilitate targeted interventions to improve hematopoietic recovery after injury and enhance stem cell engraftment after transplantation. We have recently shown that BM niche prostaglandin E2 (PGE2) signaling via the EP4 receptor is crucial for hematopoietic reconstitution, as transplantation of wild-type donor cells into EP4 receptor deficient recipient mice shows reduced stem cell engraftment. However, the specific contribution of EP4 signaling on different niche constituents in hematopoietic regeneration is unknown. To investigate which niche constituent/stromal population EP4 signaling functionally contributes to hematopoietic regeneration, we utilized genetic mouse models, in which EP4 could be deleted in specific stromal cell types.We conditionally deleted EP4 expression in nestin expressing mesenchymal stem cell (MSC), leptin receptor expressing mesenchymal stromal cell or tie 2 expressing endothelial cell (EC) invivo using a cre-recombinase approach. At steady-state, selective deletion of EP4 from nestin+ MSC (nestin-cre EP4flox/flox mice), leptin receptor+stromal cell (leptin R-cre EP4flox/flox mice) or tie 2+EC (tie 2-cre EP4flox/flox mice) showed no change in BM MSC (CD45-Ter119-CD31-CD51+PDGFR+), leptin receptor+stromal cells (CD45-Ter119-leptin R+) and EC (CD45-ter119-CD31+VE-cadherin+) number and survival. We next determined whether loss of EP4 expression/signaling in stromal cell specific genetic knockout mouse models affects BM niche constituents after exposure to ionization radiation. Interestingly, loss of EC but not nestin/leptin EP4 expression severely disrupted the BM vasculature and reduced EC and MSC survival at 24 hours post total body lethal (TBI) irradiation, compared to wild-type irradiated mice, and was associated with reduced expression of Survivin and increased expression of Bax, anti-apoptotic and pro-apoptotic factors respectively. In addition, niche EC and MSC regeneration at 2-month post irradiation was substantially reduced in tie 2-cre EP4flox/flox mice compared to wild-type mice. Nestin-cre EP4flox/flox mice and leptin R-cre EP4flox/flox niche restoration was equivalent to wild-type mice. To determine whether loss of EP4 receptor in different niche cells differentially regulates hematopoietic regeneration, we transplanted wild-type donor cells into nestin-cre EP4flox/flox or tie 2-cre EP4flox/flox recipient mice. Chimeric mice made with EC-specific EP4 deficient stroma showed reduced HSPC engraftment compared to chimeric mice made with wild-type stroma. In contrast, stem cell engraftment in chimeric mice made with MSC-specific EP4 deficient stroma was not reduced. In addition, in vivo administration of PGE2 into wild-type recipient mice at six-hour post irradiation enhanced donor cell engraftment. However, PGE2 treatment failed to enhance donor cell engraftment into tie 2-cre EP4flox/flox recipient mice. These data suggest that EC EP4 expression is important for niche restoration and hematopoietic regeneration after transplantation. To identify the mechanism involved in EP4 signaling mediated niche restoration, we measured angiocrine factors in the BM niche of lethally irradiated wild-type and tie 2-cre EP4flox/flox mice. Interestingly, we found that vascular endothelial growth factor (VEGF) expression was substantially reduced in the BM of tie 2-cre EP4flox/flox mice compared to wild-type mice. To investigate whether EP4 signaling regulates niche restoration by stimulating VEGF expression/production, we treated lethally irradiated tie 2-cre EP4flox/flox mice with recombinant VEGF (20 ng/mouse/day) for 3 days. In vivo administration of recombinant VEGF substantially enhanced niche restoration in tie 2-cre EP4flox/floxmice compared to control tie 2-cre EP4flox/flox. In conclusion, our study suggests that EC specific EP4 receptor signaling-mediated increased expression of VEGF promotes vascular niche restoration after myelosuppression and supports hematopoietic regeneration. DisclosuresNo relevant conflicts of interest to declare.

Pulse Oximetry Values in Newborns with Critical Congenital Heart Disease upon ICU Admission at Altitude.

Pulse oximetry screening for critical congenital heart disease (CCHD) has been recommended by the American Academy of Pediatrics (AAP). The objectives of this study are to describe saturation data, and to evaluate the effectiveness of AAP-recommended pulse oximetry screening guidelines applied retrospectively to a cohort of newborns with known CCHD at moderate altitude (5557 feet, Aurora, Colorado). Data related to seven critical congenital heart disease diagnoses were extracted from electronic health records (pulse oximetry, prostaglandin administration, and oxygen supplementation). Descriptive epidemiologic data were calculated. 158 subjects were included in this analysis; the AAP pulse oximetry screening protocol was applied to 149 subjects. Mean pre-ductal and post-ductal pulse oximetry values of the infants known to have CCHD at 24 h of life were 87.1% ± 7.2 and 87.8% ± 6.3, respectively. Infants treated with prostaglandins and oxygen had lower oximetry readings. The screening algorithm would have identified 80.5% of infants with known CCHDs (120/149 subjects). Additionally, sequential pulse oximetry screening based on the AAP-recommended protocol was able to identify a true positive screen capture rate of 80.5% at moderate altitude.

Rabbit plasma metabolomic analysis of Nitroproston®: a multi target natural prostaglandin based-drug.

Nitroproston® is a novel multi-target drug bearing natural prostaglandin E2 (PGE2) and nitric oxide (NO)-donating fragments for treatment of inflammatory and obstructive diseases (i.e., asthma and obstructive bronchitis). To investigate the effects of Nitroproston® administration on plasma metabolomics in vivo. Experimental in vivo study randomly assigning the target drug (treatment group) or a saline solution without the drug (vehicle control group) to 12 rabbits (n = 6 in each group). Untargeted (5880 initial features; 1869 negative-4011 positive ion peaks; UPLC-IT-TOF/MS) and 84 targeted moieties (Nitroproston® related metabolites, prostaglandins, steroids, purines, pyrimidines and amino acids; HPLC-QQQ-MS/MS) were measured from plasma at 0, 2, 4, 6, 8, 12, 18, 24, 32 and 60min after administration. PGE2, 13,14-dihydro-15-keto-PGE2, PGB2, 1,3-GDN and 15-keto-PGE2 increased in the treatment group. Steroids (i.e., cortisone, progesterone), organic acids, 3-oxododecanoic acid, nicotinate D-ribonucleoside, thymidine, the amino acids serine and aspartate, and derivatives pyridinoline, aminoadipic acid and uric acid increased (p < 0.05 AUCROC curve > 0.75) after treatment. Purines (i.e., xanthine, guanine, guanosine), bile acids, acylcarnitines and the amino acids L-tryptophan and L-phenylalanine were decreased. Nitroproston® impacted steroidogenesis, purine metabolism and ammonia recycling pathways, among others. Nitroproston®, a multi action novel drug based on natural prostaglandins, altered metabolites (i.e., guanine, adenine, cortisol, cortisone and aspartate) involved in purine metabolism, urea and ammonia biological cycles, steroidogenesis, among other pathways. Suggested mechanisms of action, metabolic pathway interconnections and useful information to further understand the metabolic effects of prostaglandin administration are presented.

Label-free quantitative proteomics of rat hypothalamus under fever induced by LPS and PGE2

Fever is a brain-mediated increase in body temperature mainly during inflammatory or infectious challenges. Although there is considerable data regarding the inflammation pathways involved in fever, metabolic alterations necessary to orchestrate the complex inflammatory response are not totally understood. We performed proteomic analysis of rat hypothalamus using label-free LC–MS/MS in a model of fever induced by lipopolysaccharide (LPS) or prostaglandin E2 (PGE2). In total, 7021 proteins were identified. As far as we know, this is the largest rat hypothalamus proteome dataset available to date. Pathway analysis showed proteins from both stimuli associated with inflammatory and metabolic pathways. Concerning metabolic pathways, rats exposed to LPS or PGE2 presented lower relative abundance of proteins involved in glycolysis, pentose phosphate pathway and tricarboxylic acid cycle. Mitochondrial function may also be altered by both stimuli because significant downregulation of several proteins was found, mainly in complexes I and IV. LPS was able to induce downregulation of important proteins in the enzymatic antioxidant system, thereby contributing to oxidative stress. The results offered comprehensive information about fever responses and helped to reveal new insights into proteins potentially involved in inflammatory signaling and metabolic changes in the hypothalamus during systemic LPS and central PGE2 administration. SignificanceThe evolutionary persistence of fever, despite the elevated cost for maintenance of this response, suggests that elevation in core temperature may represent an interesting strategy for survival. Fever response is achieved through the integrated behavioral, physiological, immunological and biochemical processes that determine the balance between heat generation and elimination. The development of such complex response arouses interest in studying how the cell metabolism responds or even contributes to promote fever. Our results offered comprehensive information about fever responses, including metabolic and inflammatory pathways, providing new insights into candidate proteins potentially involved in inflammatory signaling and metabolic changes in the hypothalamus during fever induced by systemic LPS and central PGE2 perturbation.

Effect of Intramuscular Administration of Dexamethasone on the Duration of Labor Induction

Background: induction of labor is a common obstetric procedure which is performed for a variety of medical and non-medical indications. If the cervix is unfavourable, prior ripening of the cervix makes induction of labor easier and more succeful. There are different methods for ripening of the cervix and making it ready for induction. These methods included medical methods such as the administration of prostaglandins, and mechanical methods such as extra amniotic saline infusion, traction on the cervix with Foley catheter and laminaria. Aim of the Work: the aim of the study is to evaluate the efficacy of intramuscular dexamethazone injection prior to induction in improving progression and duration of labour phases. Patients and Methods: this study started with 100 Nulliparous Pregnant women who were conducted at the labor wards of Ain Shams Maternity Hospital. The studied subjects were randomized into two groups: Dexamethasone group: This group included 50 Nulliparous women (N=50), called A group. Control group: This group included 50 Nulliparous woman (N=50), called B group. Results: in this study the duration of active and second stages was decreased without change on mode of delivery. The study no significant statistical differences between the two studied groups as regards fetal heart rate. The duration of second stage in dexamethasone group was shorter than in the control group. Dexamethasone intramuscularly prior to induction significantly shortens duration of normal labor in normal parturants with minimal complications. Conclusion: an intramuscular injection of dexamethasone before labor induction is found to shorten the duration of labor induction by decreasing the interval between the initiation of induction and the beginning of the active phase, duration of active phase and duration of second stage of labor with no observed maternal or neonatal complications.

Prostaglandin E1 administration for prevention of contrast-induced acute kidney injury: A systematic review and meta-analysis of randomized controlled trials.

Background:PGE1 has been studied for prevention of CI-AKI in several RCTs and significant heterogeneous results exist.Methods:We searched PubMed, EMBase, and Cochrane Central Register of Controlled Trials up to December 26, 2017 for RCTs comparing PGE1 with placebo or other active medications for the prevention of CI-AKI in patients. Odds ratio and 95% confidence interval (CI) were used for pooling dichotomous data, while mean difference and 95% confidence interval for pooling continuous data.Results:Seven RCTs involving 1760 patients were included in this meta-analysis. All these 7 trials reported the incidence of CI-AKI and compared with placebo or other treatment options, PGE1 was associated with a reduced risk of CI-AKI (OR: 0.38, 95% CI: 0.28–0.53; P < .001) and only a trend for lower post procedure serum creatinine (Scr) levels compared with control groups at 48 hours (MD: −0.03 mg/dL, 95% CI: −0.08 to 0.02 mg/dL; P = .25; 6 trials combined). But the postprocedure Scr levels were significantly reduced in PGE1 groups compared with control groups at 72 hours (MD: −0.07 mg/dL, 95% CI: −0.11 to −0.04 mg/dL; P < .001; 4 trials combined). We also meta-analyzed the postprocedure cystatin C (CysC) at 24 and 48 hours with 2 trials. There were lower postprocedure CysC levels in PGE1 groups than those in control groups (MD: −0.18 mg/L, 95% CI: −0.33 to −0.03 mg/L; P = .02 at 24 hours and MD: −0.14 mg/L, 95% CI: −0.23 to −0.06 mg/L; P = .001 at 48 hours).Conclusions:PGE1 provides effective nephroprotection against CI-AKI and may act as a part of effective prophylactic pharmacological regimens.

Can uterocervical angles successfully predict induction of labor in nulliparous women?

PurposeInduction of labor is a common practice in obstetrics. In recent years, a newer ultrasonographic parameter called the uterocervical angle (UCA) has been identified as a predictive tool for births. Our purpose is to investigate the role of UCA in predicting successful induction of labor. MethodsThe nulliparous term pregnancies (n:150) were grouped into successful/failed inductions of labor based on their progress into the active phase of labor after the administration of prostaglandin E2 (dinoprostone). The pre-induction cervical length (CL) and UCA were compared in the two groups. The study population was further grouped according to their modes of delivery and pre-induction UCAs were compared among the subgroups. ResultsThe mean UCAs were not significant among the successful induction and failed induction groups (105.46 ± 20.54 degrees in the successful group and 110.57 ± 13.46 degrees in the failed group). However, UCAs significantly varied among the modes of delivery subgroups. The median UCA was significantly higher in patients who delivered vaginally after a successful induction of labor than in patients who delivered via cesarean section. The median UCA value was lowest in patients who had a successful induction of labor but ended up having a cesarean section (Fig. 2). Further, the duration of the active phase of labor negatively correlated with the UCA but not the CL (rho=-0.23, p = 0.02). There was also a negative correlation between the CL and the UCA in patients who delivered vaginally after successful induction of labor (rho= −0.21, p = 0.03). ConclusionThe UCA is a promising ultrasonographic marker in obstetrics. Although the pre-induction UCA did not predict the outcome of labor induction, patients with broader pre-induction UCAs were prone to have a shorter duration of active phase. The pre-induction CL and UCA are inversely corraleted in nulliparous women who delivered vaginally after a successful induction of labor.

Effects of Prostaglandin E1 on Patients Undergoing Major Gastrointestinal Surgery.

The aim of this study was to investigate the clinical effects of prostaglandin E1 (PGE1) in patients who underwent surgery for gastrointestinal (GI) trauma, perforation, or obstruction. PGE1 is thought to enhance intestinal blood supply and reduce GI complications during the postoperative period. The medical records of 889 patients undergoing major GI surgery were reviewed retrospectively. Propensity score matching was performed to adjust for any baseline differences. Clinical outcomes, including early GI function recovery, postoperative complications, and length of hospital stay, were evaluated in all patients. In 278 paired patients, selected nutritional, immunologic, and inflammatory variables were compared based on PGE1 administration. After propensity score 1:1 matching, the baseline characteristics were similar for both groups. PGE1 was associated with prompt postoperative GI function recovery, including first bowel movement [2.6 ± 0.9 vs 3.1 ± 1.0 days after surgery in patients with and without PGE1 treatment, risk ratio 0.51, 95% confidence interval (CI) 0.41-0.65, P < 0.001] and first feeding within postoperative day 3 [179 (64.39%) vs 152 (54.68%); risk ratio 0.61, 95% CI 0.42-0.90, P = 0.012]. A lower overall postoperative complication rate, including infectious complications [45 (16.2%) vs 68 (24.5%); odds ratio 0.60, 95% CI 0.39-0.91, P = 0.010] and major complications [23 (8.3%) vs 48 (17.3%); odds ratio 0.43, 95% CI 0.26-0.73, P = 0.001], was noted in patients with PGE1 treatment than in patients without PGE1 treatment. Furthermore, the immunologic and inflammatory variable C-reactive protein on postoperative day 3 was reduced by PGE1 treatment (52.5 ± 36.4 vs 89.6 ± 42.4 mg/L; P = 0.037, t test). PGE1 is associated with beneficial clinical effects, such as prompt postoperative GI function recovery and reduced overall postoperative complications after emergency GI surgery, which may be attributed to a reduced inflammatory response.

Molecular and endocrine factors involved in future dominant follicle dynamics during the induction of luteolysis in Bos indicus cows

The growth profiles of the future dominant follicle (DF) and subordinate follicle (SF) and the gene expression of the granulosa cells during luteolysis induction in Bos indicus cows were evaluated. Forty cows were synchronized with a progesterone and estradiol based protocol. After synchronization, cows with a corpus luteum (CL) were evaluated by ultrasonography every 12 h, beginning at eight days post ovulation. Cows identified with a follicle of at least 6.0 mm in diameter in the second wave were split into two groups (BD-before follicular deviation and AD-after follicular deviation. In the BD group cows received 500 μg of cloprostenol (a synthetic analogue of prostaglandin F2α) when the DF reached a mean diameter of 7.0 mm (6.5–7.5 mm). In the AD group, cows received 500 μg of cloprostenol when the DF reached a mean diameter of 8.0 mm (7.5–8.5 mm). Cows in both groups were submitted to aspiration of the DF at 96 and 72 h after prostaglandin was given. Follicular aspirations were performed to quantify IGF1R, LHR and PAPPA transcripts in the granulosa cells. The diameter of the DF at the moment of prostaglandin administration (P = 0.001) and the growth rate of the SF (P = 0.05) were greater in the AD group. There was greater abundance of LHR transcripts in BD cows (P = 0.04). The remaining variables tested were similar between the experimental groups (P > 0.05). In conclusion, the induction of luteolysis before follicular deviation does not interfere with dominant follicle dynamics. However, it causes granulosa cell LHR down regulation.

A Case of Nonocclusive Mesenteric Ischemia Treated by Continuous Intravenous Administration of Prostaglandin E&lt;sub&gt;1&lt;/sub&gt;

A Case of Nonocclusive Mesenteric Ischemia Treated by Continuous Intravenous Administration of Prostaglandin E&lt;sub&gt;1&lt;/sub&gt;

A study on prostaglandin E1 therapy in critical limb ischaemia patients to evaluate the improvement in vascularity

Background: Diffuse peripheral arterial disease or peripheral occlusive vascular disease (POVD) involving the lower limb is a debilitating illness with high incidence of morbidity and mortality. The objective of this study was to assess the improvement of ulcer healing and improvement of the level of amputation in patients with diffuse peripheral arterial disease after administration of prostaglandin E1.Methods: From June 2013 to November 2014, a total of 45 patients having critical limb ischaemia (Fontaine’s grade III and IV) not suitable for angioplasty and stenting or bypass procedures received different courses of Prostaglandin E1 (PGE1). 20 patients (44.44%) received 6 full courses of PGE1, 3 patients (6.66%) received 5 courses, 5 patients (11.11%) received 4 courses, 4 patients (8.8%) received 3 courses, 4 patients (8.8%) received 2 courses and 9 patients (20%) received one course. PGE1 was administered through intravenous infusion (Alprastodil 100mcg) over 10 hours a day for 5 days in one month (1course). They were followed up for 3 years till June 2017.The improvement in level of amputation, ulcer healing and complications were assessed.Results: 14 patients (31.1%) did not require amputation of limbs/ toes, 24 patients (53.3%) have the same amputated status while 7 patients (15.6%) required higher amputation. This study justifies the role of PGE1 therapy in improving the peripheral arterial pulsations and thereby augmenting ulcer healing and improving the level of amputation.Conclusions: After diagnosing a patient with advanced CLI where angioplasty and stenting or bypass procedures are not possible, aggressive treatment for the non-healing ulcer, amputation of gangrenous limbs or toes and starting the PGE1 therapy early not only arrest the progression of POVD but even reverses it to some extent.

Outpatient cervical ripening in a district general hospital: a five-year retrospective cohort study

The number of women undergoing induction of labour has risen steadily in recent years. Outpatient induction is becoming more common in the UK in response to the required increase in resources, although evidence supporting its safety is lacking. We reviewed the notes of low-risk women presenting for outpatient cervical ripening using prostaglandins over a five-year period, and compared our neonatal and maternal outcomes to local and national data. Of the 502 eligible women, 400 underwent outpatient treatment. Most women returned early, in labour. There were no foetal, neonatal or maternal deaths, and our neonatal morbidity compared favourably with local rates. Mode of delivery and major maternal complication rates were comparable to national maternity indicators. We conclude that outpatient cervical ripening following careful case selection does not appear to increase neonatal or maternal mortality or morbidity. It offers patients an alternative to traditional inpatient induction and may improve allocation of hospital resources.Impact statementWe present a retrospective cohort study of neonatal and maternal outcomes in 502 women selected for outpatient cervical ripening for postmaturity at Bedford Hospital over the five-year period from 2010 to 2015.This study was conceived following a previous publication in this journal from Bedford Hospital in 2002 by Neale et al., which described the outcomes of 100 women who underwent outpatient cervical ripening. Our conclusions compare the results from the two studies.Out of our combined sample of 602 women, 491 were discharged home following administration of prostaglandins. This represents the largest sample size in the published literature on outpatient induction of labour, which was first undertaken in our unit in 1998 and is now widely practiced within the UK.Several publications, including the 2013 Cochrane review by Kelly et al. and a recent large survey of practice (Sharp et al. 2016) have highlighted the paucity of available data regarding the safety of this procedure as an outpatient. We therefore hope that the results of our study will be of interest to many maternity units who currently undertake or are considering to provide the facility for outpatient cervical ripening as a prelude to induction of labour.