Two mifepristone doses and two intervals of misoprostol administration for termination of early pregnancy: a randomised factorial controlled equivalence trial

OBJECTIVE

To compare the efficacy of 100 mg and 200 mg of mifepristone and 24- and 48-hour intervals to administration of 800 microg vaginal misoprostol for termination of early pregnancy.

DESIGN

Placebo-controlled, randomized, equivalence trial, stratified by centre.

SETTING

13 departments of obstetrics and gynecology in nine countries.

POPULATION

2,181 women with 63 days or less gestation requesting medical abortion.

METHODS

Two-sided 95% CI for the risk differences of failure to complete abortion were calculated and compared with 5% equivalence margin between two doses of mifepristone and two intervals to misoprostol administration. Proportions of women with adverse effects were compared between the regimens using standard testes for proportions.

OUTCOME MEASURES

Rates of complete abortion without surgical intervention and adverse effects associated with the regimens.

RESULTS

Efficacy outcome was analysed for 2,126 women (97.5%) excluding 55 lost to follow up. Both mifepristone doses were found to be similar in efficacy. The rate of complete abortion was 92.0% for women assigned 100 mg of mifepristone and 93.2% for women assigned 200 mg of mifepristone (difference 1.2%, 95% CI: -1.0 to 3.5). Equivalence was also evident for the two intervals of administration: the rate of complete abortion was 93.5% for 24-hour interval and 91.7% for the 48-hour interval (difference -1.8%, 95% CI: -4.0 to 0.5). Interaction between doses and interval to misoprostol administration was not significant (P = 0.92). Adverse effects related to treatments did not differ between the groups.

CONCLUSIONS

Both the 100 and 200 mg doses of mifepristone and the 24- and 48-hour intervals have a similar efficacy to achieve complete abortion in early pregnancy when mifepristone is followed by 800 micrograms of vaginally administered misoprostol.

Identification and characterization of a novel benzo[a]pyrene-derived DNA adduct

The aim of this study was to generate and identify a novel benzo[a]pyrene (BP)-derived DNA adduct found both in vitro and in vivo. To date, the majority of studies have focused on N(2)-[10 beta(7 beta,8a,9a-trihydroxy-7,8,9,10-tetrahydrobenzo[a]pyrene)yl]-deoxyguanosine (anti-BPDE-dG), the major adduct generated following bioactivation of BP. However, a second adduct is also formed following bioactivation of BP which has been speculated to result from further metabolism of 9-OH-BP. In order to identify this second reaction pathway, the ultimate DNA binding species, and the DNA base involved, we have synthesized and characterized a dG-derived DNA adduct arising from further bioactivation of 9-OH-BP in the presence of rat liver microsomes. Analysis of the adducted nucleotides was conducted using both the (32)P-postlabeling assay and capillary electrophoresis-mass spectrometry (CE-MS).

Changing prevalence of antibody to Dengue virus in paired sera in the two years following an epidemic in Taiwan

To elucidate the epidemic pattern of a dengue outbreak in southern Taiwan during 1987-8, antibody prevalence rates were investigated in paired sera collected in both epidemic (Kaohsiung) and non-epidemic (Tainan) areas. In Kaohsiung, the IgG prevalence rate in 1989 was significantly higher (9.23%) than that in 1988 (5.29%) suggesting that new infections continuously appeared after the first bleeding in 1988. Although IgG antibody persisted in most infected blood samples, waning of antibody occurred in 6/355 (1.69%) of Kaohsiung sera. IgM antibody was only detected in Kaohsiung sera, suggesting that Tainan was not involved in the outbreak. Because IgG antibody was present in some samples collected in 1989, but not in 1988, from the non-epidemic area, sporadic infections perhaps occurred. Additionally, 4/355 (1.13%) of Kaohsiung sera showed IgM antibody positive in both 1988 and 1989. In turn, secondary infections may have occurred because of circulation of multiple-types of the virus. The possible relationship between low levels of dengue haemorrhagic fever (DHF) and the loss of IgG antibodies over time is also discussed.

[Value of CA125 (carbon hydrate tumor-associated antigen) and endometrial antibodies for the detections of endometriosis]

Levels of CA125 and endometrial antibodies (EMAb) in serum and peritoneal fluid were determined in 42 cases, including 28 cases of endometriosis as trial group and 14 infertile patients without endometriosis as controls. Results showed that the levels of CA125 and EMAb in peritoneal fluid were higher significantly than in serum, but no difference were found between two groups. Serum EMAb levels were significantly higher in the trial group than in the controls. There was no significant difference in the levels of serum CA125 between two groups. The positive rate of serum CA125 and EMAb were 71.43% and 82.14% respectively. The sensitivity of CA125 and EMAb measurements in the diagnosis of endometriosis were 71.43% and 82.14%, and the specificity were 57.21% and 57.14% respectively.

Phenotypic characteristics of dengue 2 virus persistently infected in a C6/36 clone of Aedes albopictus cells

A C6/36 cell culture persistently infected by dengue 2 virus was established and retained for over 20 weeks. No CPE was observed at any stage of infection. However, some giant cells up to 2- or 3-fold the diameter of normal cells appeared in the established culture. Extracellular virus titers fluctuated with a periodic tendency while the antigen level remained constant, suggesting some viral particles evolved into noninfectious defective interfering particles. Plaque size tended to change during the passage of cultures. The passage 8 virus mainly produced plaques relatively smaller than those produced by the passage 1 virus. Nevertheless, the plaque sizes produced by the passages 18 virus were somewhat mosaic. A temperature-sensitive mutant was detected in the virus released from passages 8 and 18. In addition, passages 8 and 18 produced the lowest virus titers. When persistently infected viruses were grown in Vero cells at 37 degrees, at passage 1 there was a high titer which decreased 5 days postinoculation, whereas at passages 8 and 18 titers were undetectable until 4 days postinoculation. It seems that dengue 2 virus persistently infected in C6/36 cells could have been genetically altered. This will be tested by nucleic acid analysis of the viruses.

Detection of dengue virus antigens in cultured cells by using protein A-gold-silver staining (pAgs) method

A protein A-gold-silver (pAgs) staining was developed to detect dengue virus antigens in cultured cells. The method can be carried out in either newly-subcultured or monolayered cells. Dengue virus-inoculated C6/36 clone of Aedes albopictus cells and human endothelial cells appeared brown-yellowish color on the peripheral membrane of the infected cells. In many cases, the infected C6/36 cells appeared darker than that of the infected endothelial cells. The positive results from the inoculated C6/36 cells usually appeared as early as 2 days post-inoculation for types 1, 2, and 4 of dengue viruses and 3 days for the dengue 3 virus. The same batch of specimens detected by direct immunofluorescence antibody test (DFA) showed positive 4 days post-inoculation for the types 2, 3, and 4 of dengue viruses and 6 days for the dengue 1 virus. The result also showed that all pAgs-positive specimens were also DFA-positive, but not vice versa. It suggested that pAgs is not only sensitive but also specific for dengue virus detection from inoculated cultured cells.

Detection of IgM antibodies from cerebrospinal fluid and sera of dengue fever patients

During the dengue epidemic from late 1987 to 1989, 6 specimens of cerebrospinal fluid (CSF) and sera for IgM detection were collected from 4 cases virologically confirmed dengue patients who had neural symptoms. Another 20 serum specimens, which had been diagnosed as dengue infection either virologically or serologically, were sent to the laboratory from Kaohsiung Medical College Hospital. All these specimens were also taken to detect the existence of IgM. The results showed that IgM could be detected from 14 out of 20 serum specimens. One of the positive specimens showed IgM can last up to 252 days after onset of illness. In addition, IgM was detected from both CSF and sera of all four dengue patients with neural symptoms. The IgM titer in CSF (less than or equal to 1:20) was always lower than that in serum (greater than or equal to 1:80). Two cases with sequentially collected specimens showed the fading of IgM titer in CSF. As a matter of fact, it became undetectable about a month after onset of illness, which is apparently different from the situation in serum.

Comparison of four different dosages of injectable bromocriptine retard for puerperal ablactation

The clinical efficacy, tolerance and effect on plasma prolactin levels of four different dosages of intramuscular bromocriptine retard were compared. 108 Chinese puerperas with a mean body weight of 58 kg, who chose not to breast-feed following vaginal delivery, were randomized into four equal groups. The patients in each group were given intramuscular bromocriptine retard: 20, 30, 40 or 50 mg. The injection was well tolerated by all, except for two patients who developed small haematomas at the site of the injection and 2 patients who complained of dizziness. Ablactation occurred in 100% of the patients in the 40 mg group, but was successful in only 92 and 91% of the patients in the 20 and 30 mg groups, respectively. There were two cases of suboptimal response in the 50 mg group, despite marked reduction in plasma prolactin levels. Both these patients had developed moderate breast engorgement before they received the injection. The difference in response among the four groups was not statistically significant. We recommend that the injection be given prior to the development of breast engorgement.