Dissecting the clinicopathologic, genomic, and immunophenotypic correlates of KRASG12D-mutated non-small-cell lung cancer.

BACKGROUND: Allele-specific KRAS inhibitors are an emerging class of cancer therapies. KRAS-mutant (KRASMUT) non-small-cell lung cancers (NSCLCs) exhibit heterogeneous outcomes, driven by differences in underlying biology shaped by co-mutations. In contrast to KRASG12C NSCLC, KRASG12D NSCLC is associated with low/never-smoking status and is largely uncharacterized. PATIENTS AND METHODS: Clinicopathologic and genomic information were collected from patients with NSCLCs harboring a KRAS mutation at the Dana-Farber Cancer Institute (DFCI), Memorial Sloan Kettering Cancer Center, MD Anderson Cancer Center, and Imperial College of London. Multiplexed immunofluorescence for CK7, programmed cell death protein 1 (PD-1), programmed death-ligand 1 (PD-L1), Foxp3, and CD8 was carried out on a subset of samples with available tissue at the DFCI. Clinical outcomes to PD-(L)1 inhibition ± chemotherapy were analyzed according to KRAS mutation subtype. RESULTS: Of 2327 patients with KRAS-mutated (KRASMUT) NSCLC, 15% (n = 354) harbored KRASG12D. Compared to KRASnon-G12D NSCLC, KRASG12D NSCLC had a lower pack-year (py) smoking history (median 22.5 py versus 30.0 py, P < 0.0001) and was enriched in never smokers (22% versus 5%, P < 0.0001). KRASG12D had lower PD-L1 tumor proportion score (TPS) (median 1% versus 5%, P < 0.01) and lower tumor mutation burden (TMB) compared to KRASnon-G12D (median 8.4 versus 9.9 mt/Mb, P < 0.0001). Of the samples which underwent multiplexed immunofluorescence, KRASG12D had lower intratumoral and total CD8+PD1+ T cells (P < 0.05). Among 850 patients with advanced KRASMUT NSCLC who received PD-(L)1-based therapies, KRASG12D was associated with a worse objective response rate (ORR) (15.8% versus 28.4%, P = 0.03), progression-free survival (PFS) [hazard ratio (HR) 1.51, 95% confidence interval (CI) 1.45-2.00, P = 0.003], and overall survival (OS; HR 1.45, 1.05-1.99, P = 0.02) to PD-(L)1 inhibition alone but not to chemo-immunotherapy combinations [ORR 30.6% versus 35.7%, P = 0.51; PFS HR 1.28 (95%CI 0.92-1.77), P = 0.13; OS HR 1.36 (95%CI 0.95-1.96), P = 0.09] compared to KRASnon-G12D. CONCLUSIONS: KRASG12D lung cancers harbor distinct clinical, genomic, and immunologic features compared to other KRAS-mutated lung cancers and worse outcomes to PD-(L)1 blockade. Drug development for KRASG12D lung cancers will have to take these differences into account.

Activation of TRPV4 by mechanical, osmotic or pharmaceutical stimulation is anti-inflammatory blocking IL-1ß mediated articular cartilage matrix destruction.

OBJECTIVE: Cartilage health is maintained in response to a range of mechanical stimuli including compressive, shear and tensile strains and associated alterations in osmolality. The osmotic-sensitive ion channel Transient Receptor Potential Vanilloid 4 (TRPV4) is required for mechanotransduction. Mechanical stimuli inhibit interleukin-1ß (IL-1ß) mediated inflammatory signalling, however the mechanism is unclear. This study aims to clarify the role of TRPV4 in this response. DESIGN: TRPV4 activity was modulated glycogen synthase kinase (GSK205 antagonist or GSK1016790 A (GSK101) agonist) in articular chondrocytes and cartilage explants in the presence or absence of IL-1ß, mechanical (10% cyclic tensile strain (CTS), 0.33 Hz, 24hrs) or osmotic loading (200mOsm, 24hrs). Nitric oxide (NO), prostaglandin E2 (PGE2) and sulphated glycosaminoglycan (sGAG) release and cartilage biomechanics were analysed. Alterations in post-translational tubulin modifications and primary cilia length regulation were examined. RESULTS: In isolated chondrocytes, mechanical loading inhibited IL-1ß mediated NO and PGE2 release. This response was inhibited by GSK205. Similarly, osmotic loading was anti-inflammatory in cells and explants, this response was abrogated by TRPV4 inhibition. In explants, GSK101 inhibited IL-1ß mediated NO release and prevented cartilage degradation and loss of mechanical properties. Upon activation, TRPV4 cilia localisation was increased resulting in histone deacetylase 6 (HDAC6)-dependent modulation of soluble tubulin and altered cilia length regulation. CONCLUSION: Mechanical, osmotic or pharmaceutical activation of TRPV4 regulates HDAC6-dependent modulation of ciliary tubulin and is anti-inflammatory. This study reveals for the first time, the potential of TRPV4 manipulation as a novel therapeutic mechanism to supress pro-inflammatory signalling and cartilage degradation.

Life as a clinical director: an insight.

The clinical director (CD) is responsible for delivering high-quality patient-focused clinically effective healthcare services, which support the core principles of patient safety, and also serves as a conduit transmitting the trust's vision and objectives to clinical staff. The CD has to have a strategy to ensure that this is delivered without compromising patient care. He/she has to speak for all staff and ensure that the directorate strategy is aligned with the vision and strategy of the trust. In the opposite direction, the CD acts as a conduit through implementation of the departmental vision and strategy. To achieve these objectives, the CD works in close collaboration with the divisional triumvirate (executive [senior management team], divisional team [mid-level], directorate/departmental team), service manager, specialty leads, and senior nurses in addition to frontline consultant radiologists to ensure planning and delivery of robust clinical services within their areas and the entire trust. The role of the CD inherently requires "out-of-the-box" strategies, innovation, and influential communication skills for continuous service improvement and effective patient management pathways and flow. The CD ensures that appropriate medical workforce is available in the department to deliver high-quality care and maximise clinical efficiencies through effective deployment of available resources.

An Information Theory Approach to Identifying a Representative Subset of Hydro-Climatic Simulations for Impact Modeling Studies.

Uncertainties in hydro-climatic projections are (in part) related to various components of the production chain. An ensemble of numerous projections is usually considered to characterize the overall uncertainty; however in practice a small set of scenario combinations are constructed to provide users with a subset that is manageable for decision-making. Since projections are unavoidably uncertain, and multiple projections are typically informationally redundant to a considerable extent, it would be helpful to identify an informationally representative subset in a large model ensemble. Here a framework rooted in the information theoretic Maximum Information Minimum Redundancy concept is proposed for identifying a representative subset from an available ensemble of hydro-climatic projections. We analyze an ensemble of 16 precipitation and temperature projections for Sweden, and use these as inputs to the HBV hydrological model to project river discharge until the mid of this century. Representative subsets are judged in terms of different statistical properties of three essential climate variables (precipitation, temperature and discharge), whilst we further assess the sensitivity of the optimized subset for different seasons and future periods. Our results indicate that a quarter to a third of the available set of projections can represent more than 80% of the total information of hydro-climatic changes. We find that the representative subsets are sensitive to the regional hydro-climatic characteristics and the choice of variables, seasons and periods of interest. Therefore we recommend that any selection process should not be solely driven by climatic variables but, rather, should also consider variables of the impact model.

Radiographic Anatomy of the Neck-Shaft Angle of Femur in Nepalese People: Correlation with its Clinical Implication.

Background Neck-shaft angle (NSA) is one of the prominent features in the proximal femur which is an important determinant of fracture of femoral neck. Present study evaluating the value of neck-shaft angle has relied heavily on radiographs. As knowledge of neck-shaft angle is important to orthopaedic surgeons, there is need to elucidate whether there is significant variation of this angle among the two different genders and various age groups of both right and left femora of Nepalese population. Objective To ascertain the value of neck-shaft angle in the Nepalese population by means of a radiographic study and to correlate the values with regard to right neck-shaft angle/ left neck-shaft angle side (RNSA/LNSA), gender and three different age group. Method Normal pelvic radiographs of 148 patients seen at department of orthopedic and radiology, College of Medical Sciences- Teaching Hospital (COMS-TH), Bharatpur, Chitwan from the month of February 2017 to June 2017 were divided into two different gender and three different age groups (21-40 years, 41-60 years and Above 60 years) and their neck-shaft angle of both right and left sides were recorded. Result The average of RNSA and LNSA were found to be 132.96±6.05° and 131.54±13.66° respectively for male and 134±6.57° and 132.98±6.23° respectively for female. In total the average RNSA and LNSA were 133.51±6.32° and 132.26±10.61° respectively. Similarly, the average RNSA and LNSA for three different age groups (21-40 years, 41-60 years and Above 60 years) were found to be 133.76±6.44°, 133.69±6.36° and 132.50±6.06° and the 133.35±6.29°, 132.47±5.85° and 128.84±21.98° respectively. Conclusion The average neck-shaft angle recorded here shows no significant difference in both RNSA and LNSA in males except for a small and significant difference in LNSA in female of three different age groups.

Do quantitative and qualitative shear wave elastography have a role in evaluating musculoskeletal soft tissue masses?

OBJECTIVES: To determine if quantitative and qualitative shear wave elastography have roles in evaluating musculoskeletal masses. METHODS: 105 consecutive patients, prospectively referred for biopsy within a specialist sarcoma centre, underwent B-mode, quantitative (m/s) and qualitative (colour map) shear wave elastography. Reference was histology from subsequent biopsy or excision where possible. Statistical modelling was performed to test elastography data and/or B-mode imaging in predicting malignancy. RESULTS: Of 105 masses, 39 were malignant and 6 had no histology but benign characteristics at 12 months. Radiologist agreement for B-mode and elastography was moderate to excellent Kw 0.52-0.64; PABAKw 0.85-0.90). B-Mode imaging had 78.8% specificity, 76.9% sensitivity for malignancy. Quantitatively, adjusting for age, B-mode and lesion volume there was no statistically significant association between longitudinal velocity and malignancy (OR [95% CI] 0.40[0.10, 1.60], p=0.193), but some evidence that higher transverse velocity was associated with decreased odds of malignancy (0.28[0.06, 1.28], p=0.101). Qualitatively malignant masses tended to be towards the blue spectrum (lower velocities); 39.5% (17/43) of predominantly blue masses were malignant, compared to 14.3% (1/7) of red lesions. CONCLUSIONS: Quantitatively and qualitatively there is no statistically significant association between shear wave velocity and malignancy. There is no clear additional role to B-mode imaging currently. KEY POINTS: • Correlation between shear wave velocity and soft tissue malignancy was statistically insignificant • B-mode ultrasound is 76.9 % sensitive and 78.8 % specific • Statistical models show elastography does not significantly add to lesion assessment.

Cardio-metabolic Risk Profile in Women with Previous History of Pre-Eclampsia.

INTRODUCTION: Preeclampsia is one of the leading causes of maternal and neonatal morbidity and mortality. However there is growing evidence that there are differences during the post partum period between subjects with prior preeclampsia and prior uncomplicated pregnancy and women with a history of preeclampsia are more likely to develop cardiovascular disease later in life. The aim of our study was to assess the cardio- metabolic risk profile in women with previous history of pre-eclampsia and to their counterparts who had normal pregnancy. METHODS & MATERIAL: In a hospital based case-control study, 50 women aged 20-45 years who had history of preeclampsia and equal numbers of age matched women who had normal pregnancy were included. Apart from routine anthropometric and biochemical parameters, they were assessed for insulin resistance, Hs CRP (High sensitive C reactive protein) and flow mediated vasodilatation (FMD). RESULTS: Significant difference was noted with regard to BMI and waist circumference, systolic and diastolic blood pressures, and HOMA-IR which were higher and HDL and FMD were lower in women the previous preeclampsia than women with normal pregnancy. The prevalence of various cardio-metabolic risk factors increased in with increase in duration from index pregnancy. CONCLUSION: Women with previous history of preeclampsia had adverse cardio-metabolic profile than those who had normal pregnancy. They had higher insulin resistance and endothelial dysfunction. They also have high prevalence of chronic metabolic disorders with increased duration since index pregnancy.

Mapping QTLs for opaque2 modifiers influencing the tryptophan content in quality protein maize using genomic and candidate gene-based SSRs of lysine and tryptophan metabolic pathway.

KEY MESSAGE: The mapping analysis resulted in identification of five significant QTLs for opaque2 modifiers influencing the tryptophan content in quality protein maize using functional and genomic SSR markers. Quality protein maize (QPM) was developed by selecting genetic modifiers that convert opaque2 mutant containing high lysine and tryptophan. There are several unlinked opaque2 modifier loci (Opm) in QPM whose location, nature and mode of action are not clear. To identify these Opm QTLs, we developed a population of 218 F2:3 individuals from a cross between VQL2 and VQL8, two isogenic QPM inbreds significantly differing in tryptophan content. Based on the data of the F2:3 population, five significant QTLs on chromosomes 5, 7 and 9 with LOD values more than 2.5 were identified and together explained 38.6 % of the total phenotypic variance (R (2)). The Wx1 gene which has influence on the amino acid composition of the maize endosperm was mapped on chromosome 9 near the marker phi022 and also validated by bulk analysis. The QTL near the SSR marker ZmASK3, developed from the aspartate kinase 2 gene of the lysine pathway, mapped on chromosome 5 and had LOD of 2.7 with R (2) of 5.1 %. On chromosome 9, the QTL between the loci umc1430 and bnlg1401 had an LOD of 4.5 with R (2) of 9.1 %, whereas the QTL between the loci bnlg1401 and phi022 had an LOD of 4.2 with R (2) of 8.4 %. The third QTL was observed to be close to the marker umc2207 with an LOD of 4.8 and R (2) of 8.4 %. The identified QTLs will be very useful in the marker-assisted back-cross breeding and transgressive breeding for the development of QPM maize.

Rhodotorula glutinis meningitis: a case report and review of literature.

Rhodotorula is ubiquitous saprophytic yeast belonging to phylum Basidiomycota. These encapsulated basidiomycetes are being increasingly recognised as important emerging human pathogens. There are scanty reports of meningitis caused by Rhodurorula spp in HIV infected patients. We present one such case of meningitis by Rhodutorula glutinis in HIV-infected patient. The patient also had a past history of abdominal tuberculosis. The diagnosis of Rhodotorula was confirmed by Gram staining and culture of the cerebrospinal fluid (CSF). Contamination was ruled out by repeated culturing of CSF from the same patient. Therapy with Amphotericin B showed good results. Patient was discharged from the hospital. However, in the seventh month of follow-up patient was readmitted with complaints of fever, breathlessness, altered sensorium, vomiting and succumbed to his illness. This time the CSF cultures remained negative for Rhodotorula, acid fast bacilli and other pyogenic organisms. Our last 11-year retrospective analysis of 8197 specimens received for mycological work-up showed that this is the first report of R. glutinis isolation from our institute.

Impact of deforestation on known malaria vectors in Sonitpur district of Assam, India.

BACKGROUND & OBJECTIVES: An alarming rate of deforestation has been reported from Sonitpur district of Assam, India therefore, a study was initiated during 2009 using remote sensing (RS) to assess deforested areas in the district and to study the impact on malaria vectors in order to formulate appropriate control strategy. METHODS: RS imageries of 2000 and 2009 were used to assess deforested areas in the selected district. Entomological data were collected in four surveys during 2009-2011. The data were analyzed statistically using test of single proportions (χ 2 ) and pair-wise comparison. Vector incrimination was done using enzyme-linked immunosorbent assay (ELISA) and entomological inoculation rate (EIR) was calculated to estimate transmission intensity. RESULTS: The deforested areas were identified in north-western parts of Sonitpur district falling in Dhekiajuli Primary Health Centre (PHC). The forest cover of the PHC decreased >50% during 2000-2009. Five species of anopheline vectors were collected. Anopheles minimus sensu lato (s.l.) was collected least abundantly while An. culicifacies s.l. prevailed most abundantly and significant difference was observed between proportions of the collected vector species. Pair-wise comparison between An. culicifacies s.l. and An. minimus s.l. was also found statistically significant indicating that An. culicifacies s.l. is establishing its population in deforested areas. An. culicifacies s.l. was found ELISA positive and EIR was measured as 4.8 during transmission season. CONCLUSION: An. culicifacies s.l. replaced An. minimus s.l., the vector of malaria in northeast India and was found ELISA positive, therefore could have possible role in malaria transmission in the deforested areas of the district.

A prospective double blind study comparing the effects of oxytocin and human chorionic gonadotrophin as trigger for ovulation.

This study was undertaken to compare the effect of oxytocin and human chorionic gonadotrophin (hCG) on ovulation and conception. A total of 100 women with anovulatory infertility were allocated into two equal groups to take clomiphene citrate plus hCG or clomiphene citrate plus oxytocin. The size and number of follicles by transvaginal sonography determined the administration of hCG or oxytocin. The serum progesterone concentration was measured to provide evidence for ovulation. The ovulation and pregnancy rate of the two groups were compared. There was no significant difference between the groups with respect to mean number of follicles, mean follicular size and rate of ovulation in three cycles. The rate of pregnancy was higher in the oxytocin group compared with the hCG group (12% vs 4%) but it failed to reach statistical difference (p = 0.140). Mild pain was the only side-effect observed in the two groups. Oxytocin was found to be a viable alternative to hCG for triggering ovulation in infertile patients.

Retrospective Comparative Analysis of Clinical and Functional Outcome After Arthroscopic Bankart Repair using All-Suture Anchor and Metal Anchor.

Introduction: Both knotted all suture anchors and metal anchors are used for arthroscopic Bankart repair. We retrospectively evaluated and compared clinical and functional outcomes after arthroscopic Bankart repair using the knotted all-suture anchors and knotted metal anchors. Materials and methods: In a retrospective cohort analysis, patients who underwent arthroscopic Bankart repair without any concomitant additional lesion repair using either all-suture anchors or metal anchors, between January 2015 and May 2018 were identified. Their pre- and post-operative functional and clinical outcomes were compared using Rowe and WOSI scores. The recurrence rate in the two groups was also compared. Results: A total of 41 patients in all suture anchors group and 47 in the metal anchors group were identified as per inclusion and exclusion criteria. The demographic profile of both groups was comparable. There was no significant difference in clinical and functional outcome between the two suture anchor groups as per Rowe (pre-operative 40.13+6.51 vs 38.09+6.24 and post-operative 2 years 93.28+7.09 vs 92.55+9.2) and WOSI (pre-operative 943.05+216.64 vs 977.55+165.46 and post-operative 2 years 278.21+227.56 vs 270.94+186.25) scores. There was a significant improvement in both the groups between preoperative and post-operative ROWE and WOSI scores at 6 months and 2 years follow-up as compared to pre-operative scores (p<0.001). Re-dislocation rates were also comparable (4.8% vs 6.3%). Conclusion: All-suture anchors showed comparable clinical and functional results as the metal anchors for arthroscopic Bankart repair at two-year follow-up.

Superparamagnetic state by linear and non-linear AC magnetic susceptibility in Mn0.5Zn0.5Fe2O4 ferrites nanoparticles.

The Mn0.5Zn0.5Fe2O4 nanoparticles has been synthesized using citrate-gel-precursor method. The direct mixing of nitrates and acetates yields homogeneous nanoparticles. Phase formation and crystal structure of the synthesized powder were examined through the X-ray diffraction (XRD). Fourier transform infrared (FTIR) spectra of the sample confirm the spinel structure. The average particle size was determined by transmission electron microscopy (TEM) and field emission scanning electron microscopy (FESEM). The average particle size is found to be about 13 nm. Superparamagnetic-like nature of the nanoparticles of Mn0.5Zn0.5Fe2O4 has been revealed through various dc and linear and non-linear ac magnetization measurements. However, the nanoparticles do not behave like ideal non-interacting superparamagnets. The magnetic particle size is found to be about 8 nm with saturation magnetization about 18.1 emu/g. The blocking temperature (T(B)) of the nanoparticle assembly is found to be about 150 K as observed from dc and ac magnetization measurements. The frequency dependence of the blocking temperature (T(B)) is found to follow Vogel-Fulcher law. The associated characteristic time tau0 is found to be 10(-5) s. This value is different from that generally found for non-interacting superparamagnetic (SPM) systems (tau0 = 10(-9)-10(-10) s).

Effects of Heterologous Bovine Seminal Plasma-Supplemented Egg Yolk-Based Extender on Cryosurvivability of Pantja Buck Semen.

The present study was conducted to observe the effects of removal of seminal plasma of Pantja buck semen and supplementation of bovine seminal plasma (BSP) in the extender before cryopreservation. In a preliminary experiment, different levels of BSP were supplemented (1, 3, 5, 7, and 9% v/v) in egg yolk (7.5% egg yolk)-tris (EYT) extender and used for cryopreservation of Pantja buck semen. Results in terms of motility, viability, plasma membrane integrity, acrosome integrity, and lipid peroxidation showed that 5% BSP was suitable for maintaining Pantja buck semen quality during cryopreservation. In the final experiment, pooled semen from four Pantja bucks was split into three aliquots (I, II, and III). Aliquot I was directly diluted in EYT extender and grouped as the control (C); aliquot II and III were washed separately with TALP solution and diluted as D1 (Washed semen with EYT extender) and D2 (Washed semen with EYT extender containing 5% BSP), respectively. Seminal attributes (sperm individual motility, viability, plasma membrane integrity, acrosome integrity, and total morphological abnormalities) were assessed at the postdilution, postequilibration, and post-thawing stages. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), malondialdehyde (MDA) concentration, and glutathione peroxidase (GSH-Px) activity were measured at post-thaw. Washed semen significantly improved (p < 0.05) seminal parameters at post-thaw compared with unwashed semen (control). A significant difference (p < 0.05) was observed in seminal attributes between freezing stages and between dilution groups. Significantly higher (p < 0.05) post-thaw sperm motility, viability, plasma membrane integrity, acrosome integrity, and GSH-Px activity, and significantly lower (p < 0.05) MDA concentration and extracellular release of enzymes (ALT, AST) were observed in group D2 compared with control and D1. The results of the present study demonstrated that cryopreservation of washed Pantja buck semen diluted with 5% BSP-supplemented EYT extender can improve post-thaw semen quality.

Endovascular repair of abdominal aortic aneurysm does not improve early survival versus open repair in patients younger than 60 years.

OBJECTIVES: Multiple randomised trials have demonstrated lower perioperative mortality after endovascular aneurysm repair (EVAR) compared to open surgical repair for infrarenal abdominal aortic aneurysms (AAAs). However, in these trials the mortality advantage for EVAR is being lost within 2 years of repair and the patients evaluated are relatively older with no study specifically comparing EVAR and open repair for patients younger than 60 years of age. DESIGN: A retrospective analysis of prospectively collected data. MATERIALS AND METHODS: Patients younger than 60 years of age who underwent EVAR and open surgical repair for elective infrarenal AAA were identified from the 2007-09 National Surgical Quality Improvement Program (NSQIP) - a prospective database maintained at 237 centres across the United States. Univariate and multivariate analyses were performed. RESULTS: Of the 651 patients, 369 (56.7%) underwent EVAR and 282 (43.3%) underwent open repair. Thirty-day mortality for EVAR and open repair were 1.1% and 0.4%, respectively. This was not significantly different on univariate (P = 0.22) as well as multivariate (P = 0.69) analysis after controlling for other co-morbidities. On multivariate analysis, body mass index, history of stroke and bleeding disorder prior to surgery were associated with a higher 30-day mortality after AAA repair (combined open and EVAR). CONCLUSIONS: These contemporary results demonstrate that the 30-day mortality rate after open repair is similar to that after EVAR in patients younger than 60 years with infrarenal AAA.

A randomized, double-blind, placebo-controlled trial to evaluate efficacy and tolerability of an optimized botanical combination in the management of patients with primary hypercholesterolemia and mixed dyslipidemia.

This study compared the efficacy and tolerability of an optimized botanical combination containing policosanol, tomato extract, orally bioavailable grape procyanidins and Oenothera biennis oil against placebo in the management of patients with primary hypercholesterolemia and mixed dyslipidemia. Such a combination is endowed with biological properties targeted to cholesterol control and vasoprotection. This randomized, double-blind, parallel-group trial consisted of a 6 week treatment period following 4 week baseline period, and a 2 week post-treatment follow-up. At baseline, both the groups were comparable to each other. Both the active treatment and the placebo group included 30 patients (active treatment: mean age 46.80 ± 7.43 years, nine males; placebo: mean age 45.50 ± 6.76 years, eight males). Significant reductions in the LDL-cholesterol (LDL-C; -17.33% from baseline, p < 0.001) and total cholesterol (TC; -13.38% from baseline, p < 0.0001) values over the treatment period were observed with the tested product. The treatment also resulted in reductions in C-reactive protein (CRP), malondialdehyde (MDA) and superoxide dismutase (SOD) values, which are indices of oxidative stress. This rational combination of different compounds is effective and safe in lowering the elevated LDL-C and TC values. It is also effective in the modulation of the oxidation indices values; however, a further long term study in a larger population would be needed in order to confirm these preliminary findings.

A prospective double blind trial investigating impact of vaginal pH on efficacy of prostaglandin gel for cervical ripening and course of labour.

This prospective, double blind investigation was carried out to see the effect of vaginal pH on the efficacy of prostaglandin gel (PGE2) for cervical ripening and course of labour. A total of 45 pregnant women with indications for induction of labour were allocated to two groups: a low vaginal pH (≤5.5, n = 20) and high vaginal pH (>5.5, n = 25) group. All women received prostaglandin E2 gel (0.5 mg in 2.5 ml) intravaginally with repeated dosing if needed, 6 h apart, maximum of three doses. Bishop's score change over 18 h differed significantly between the two groups (p = 0.037). There was no significant difference between the groups with respect to time to onset of labour (9.65±6.29 vs 6.76±3.94, p = 0.066), time to active labour (15.38±9.49 vs 14.30±5.85, p = 0.664), time to complete cervical dilation (18.27±13.85 vs 18.34±6.45; p = 0.984), and time to overall delivery (21.52±9.66 vs 19.39±6.45, p = 0.381).