A multi-centre, open label, randomised, parallel-group, superiority Trial to compare the efficacy of URsodeoxycholic acid with RIFampicin in the management of women with severe early onset Intrahepatic Cholestasis of pregnancy: the TURRIFIC randomised trial

Published online: 12 January 2021BACKGROUND: Severe early onset (less than 34 weeks gestation) intrahepatic cholestasis of pregnancy (ICP) affects 0.1% of pregnant women in Australia and is associated with a 3-fold increased risk of stillbirth, fetal hypoxia and compromise, spontaneous preterm birth, as well as increased frequencies of pre-eclampsia and gestational diabetes. ICP is often familial and overlaps with other cholestatic disorders. Treatment options for ICP are not well established, although there are limited data to support the use of ursodeoxycholic acid (UDCA) to relieve pruritus, the main symptom. Rifampicin, a widely used antibiotic including in pregnant women, is effective in reducing pruritus in non-pregnancy cholestasis and has been used as a supplement to UDCA in severe ICP. Many women with ICP are electively delivered preterm, although there are no randomised data to support this approach. METHODS: We have initiated an international multicentre randomised clinical trial to compare the clinical efficacy of rifampicin tablets (300 mg bd) with that of UDCA tablets (up to 2000 mg daily) in reducing pruritus in women with ICP, using visual pruritus scores as a measuring tool. DISCUSSION: Our study will be the first to examine the outcomes of treatment specifically in the severe early onset form of ICP, comparing "standard" UDCA therapy with rifampicin, and so be able to provide for the first-time high-quality evidence for use of rifampicin in severe ICP. It will also allow an assessment of feasibility of a future trial to test whether elective early delivery in severe ICP is beneficial.William M. Hague ... Suzette Coat ... Jodie Dodd, Maria Fuller ... Teck Yee Khong ... Jennie Louise ... Philippa Middleton, Ben W. Mol ... Michael Stark ... et al

Evidence-based pathology: umbilical cord coiling

The generation of a pathology test result must be based on criteria that are proven to be acceptably reproducible and clinically relevant to be evidence-based. This review de-constructs the umbilical cord coiling index to illustrate how it can stray from being evidence-based. Publications related to umbilical cord coiling were retrieved and analysed with regard to how the umbilical coiling index was calculated, abnormal coiling was defined and reference ranges were constructed. Errors and other influences that can occur with the measurement of the length of the umbilical cord or of the number of coils can compromise the generation of the coiling index. Definitions of abnormal coiling are not consistent in the literature. Reference ranges defining hypocoiling or hypercoiling have not taken those potential errors or the possible effect of gestational age into account. Even the way numerical test results in anatomical pathology are generated, as illustrated by the umbilical coiling index, warrants a critical analysis into its evidence base to ensure that they are reproducible or free from errors.T.Y. Khon

О ВАРИАЦИОННОСТИ ОПЕРАТОРНОГО УРАВНЕНИЯ С ПРОИЗВОДНОЙ ЧЕТВЕРТОГО ПОРЯДКА ПО ВРЕМЕНИ

The problem of existence of a Hamiltonian action for an operator equation with the fourth time derivative is investigated.Исследован вопрос о существовании действия по Гамильтону для операторного уравнения с производной четвертого порядка по времени

О косвенной представимости операторного уравнения с производной четвертого порядка по времени в форме уравнений Гамильтона-Остроградского

The problem of indirect representability of an operator equation with the fourth time derivative in the form of Hamilton-Ostrogradskii equations is investigated. For this purpose, necessary and sufficient conditions for the indirect representability of the considered equation in the form of the Lagrange- Ostrogradskii equation are obtained and the Hamilton-Ostrogradskii action is constructed.Исследована косвенная представимость операторного уравнения с производной четвертого порядка по времени в форме уравнений Гамильтона-Остроградского. Для этого получены необходимые и достаточные условия косвенной представимости рассматриваемого уравнения в форме уравнения Лагранжа-Остроградского и построено действие по Гамильтону-Остроградскому

Об условиях потенциальности для одного операторного уравнения с производной четвертого порядка по времени

The problem of the existence of a direct variational formulation of an operator equation with the fourth time derivative is investigated.Исследован вопрос о существовании прямой вариационной формулировки операторного уравнения с производной четвертого порядка по времени

Improving soft peaty soil by grouted stone columns Punggol waterway project, Singapore

14th Asian Regional Conference on Soil Mechanics and Geotechnical Engineering