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Introduction: We undertook this study to compare the analgesic efficacy of 0.1% bupivacaine and 0.1% ropivacaine with fentanyl using patient controlled epidural analgesia. Materials and methods: 60 parturients of ⩾ 36 weeks of gestation with cephalic presentation in spontaneous labour with cervical dilatation ⩽ 5cms and baseline pain score of ⩽ 30 on visual analogue scale (VAS), were enrolled in the study. Group I received 10 ml bolus of 0.1% bupivacaine with fentanyl 2μg/ml while Group II received 10 ml bolus of 0.1% ropivacaine with fentanyl 2μg/ml followed by patient controlled epidural analgesia (PCEA) using PCA pump. The primary outcome measured was analgesic efficacy using VAS. Results: VAS scores during first and second hour were found to be significantly lower in Group 1 as compared to Group 2 (Figure 1) with a significant difference from their respective baselines. Group II showed a statistically higher total drug consumption and number of boluses used (62.33 ± 26.6 vs 48.47 ± 16.7 and1.40 ± 0.8 vs 2.00 ± 0.8 respectively) as compared to group I (Table 2) (Figure 3). The motor block showed a statistically significant difference at 4th, 5th and 6th hours between the two groups (Figure 4). Conclusion: The present study demonstrated that 0.1% ropivacaine or 0.1% bupivacaine with fentanyl 2μg/ml used during labour analgesia by PCEA were equally effective for controlling the labour pain with more total drug consumption and less motor blockade associated with 0.1% ropivacaine as compared to 0.1% bupivacaine. [ABSTRACT FROM AUTHOR]

Antilipidemic drugs are routinely detected in effluent and surface waters downstream of wastewater treatment plants. A mixture exposure study with nine environmentally relevant antilipidemic drugs was performed with zebrafish (Danio rerio , ZF) and fathead minnow (Pimephales promelas , FHM) embryos to investigate the effects on sensitive embryologic stages. Zebrafish embryos were exposed nominally to: (a) 0.005 μM, (b) 0.05 μM, or (c) 0.5 μM of each drug in the mixture. Fathead minnow embryos were exposed nominally to: (a) 0.0005 μM, (b) 0.005 μM, or (c) 0.05 μM of each drug in the mixture. Several of the individual drug concentrations were within ranges previously found in the environment. Multiple metrics demonstrate that (a) exposure of ZF and FHM embryos to antilipidemic drugs during embryonic development results in lethal and sublethal effects, (b) ZF were more sensitive than FHM based on median lethal concentration (LC 50 0.02 μM and 0.05 μM, respectively), but FHM exhibited more severe abnormal sublethal morphologies than zebrafish embryos, and (c) the sublethal effects differed between the two species. This model identified novel specific endpoints for assessing sensitive, sublethal effects of pharmaceuticals in the environment. Abnormal myofiber birefringence pattern, hemorrhage, and heart rate are not included in standard evaluations but each of these metrics demonstrated a dose-dependent response in this study. Results demonstrate risk to fish development with potential repercussions at the population level, especially if environmental concentrations increase. • Antilipidemic exposure caused lethal and sublethal effects in fish embryos. • Zebrafish embryos had lower median lethal concentration than fathead minnow embryos. • Fathead minnow embryos exhibit more severe abnormal morphologies than zebrafish. • Sublethal effects differed between the two species. • Antilipidemics may pose a significant threat to aquatic wildlife inhabiting contaminated ecosystems. [ABSTRACT FROM AUTHOR]

Review of the literature regarding prognostic value of CpG island methylator phenotype (CIMP) among colorectal cancer (CRC) patients showed CIMP to be associated with worse disease-free survival and overall survival. Future research into CIMP's most appropriate operational definition and its action mechanism would be of vital importance in helping us put past study results into proper perspective.Background Divergent findings regarding the prognostic value of CpG island methylator phenotype (CIMP) in colorectal cancer (CRC) patients exist in current literature. We aim to review data from published studies in order to examine the association between CIMP and CRC prognosis. Materials and methods A comprehensive search for studies reporting disease-free survival (DFS), overall survival (OS), or cancer-specific mortality of CRC patients stratified by CIMP is carried out. Study findings are summarized descriptively and quantitatively, using adjusted hazard ratios (HRs) as summary statistics. Results Thirty-three studies reporting survival in 10 635 patients are included for review. Nineteen studies provide data suitable for meta-analysis. The definition of CIMP regarding gene panel, marker threshold, and laboratory method varies across studies. Pooled analysis shows that CIMP is significantly associated with shorter DFS (pooled HR estimate 1.45; 95% confidence interval (CI) 1.07–1.97, Q = 3.95, I2 = 0%) and OS (pooled HR estimate 1.43; 95% CI 1.18–1.73, Q = 4.03, I2 = 0%) among CRC patients irrespective of microsatellite instability (MSI) status. Subgroup analysis of microsatellite stable (MSS) CRC patients also shows significant association between shorter OS (pooled HR estimate 1.37; 95% CI 1.12–1.68, Q = 4.45, I2 = 33%) and CIMP. Seven studies have explored CIMP's value as a predictive factor on stage II and III CRC patient's DFS after receiving adjuvant 5-fluorouracil (5-FU) therapy: of these, four studies showed that adjuvant chemotherapy conferred a DFS benefit among CIMP(+) patients, one concluded to the contrary, and two found no significant correlation. Insufficient data was present for statistical synthesis of CIMP's predictive value among CRC patients receiving adjuvant 5-FU therapy. Conclusion CIMP is independently associated with significantly worse prognosis in CRC patients. However, CIMP's value as a predictive factor in assessing whether adjuvant 5-FU therapy will confer additional survival benefit to CRC patients remained to be determined through future prospective randomized studies. [ABSTRACT FROM AUTHOR]