bluuebunny/crossref_metadata_2025 huggingface dataset:
Customer satisfaction with order fulfillment in retail supply chains: implications of product type in electronic B2C transactions
Authors: Thirumalai Sriram , Sinha Kingshuk K.
Published: December 2004

This paper focuses on the proverbial “last mile” of the retail supply chain – i.e., delivering products to the end‐customer – and highlights the need for recognizing product type differences in configuring order fulfillment processes in electronic business‐to‐customer (B2C) transactions. The following two questions serve as the motivation for the study: Do customer expectations of order fulfillment processes vary across product types? Should the product type matter in configuring order fulfillment processes? From the studies in the marketing literature, we infer that customer satisfaction assessments are based on customer expectations of order fulfillment processes, and that these expectations systematically vary across the three product types: convenience goods (e.g., groceries, home and office supplies), shopping goods (e.g., ready‐to‐wear men, women, and kids’ apparel), and specialty goods (e.g., desktop and notebook computers, and wedding dresses). In particular, we posit that ceteris paribus, customer satisfaction with order fulfillment will decrease moving along a continuum of product types, from convenience goods to specialty goods. The empirical analysis for this study is based on data collected on dimensions of customer satisfaction with order fulfillment from a sample of 256 firms engaged in electronic B2C transactions. Firms included in our study sample are such that their products can be classified into only one of three product types: convenience, shopping, or specialty goods. In essence, each firm in the study sample is a proxy for one of three product types. The results of the empirical analysis indicate that, on average, customers tend to have higher satisfaction levels with the order fulfillment process of convenience and shopping goods than with the order fulfillment process of specialty goods. We discuss the managerial implications of our results, contributions of the paper to the literature, limitations, and directions for future research.
An Upper Permian permineralized plant assemblage in volcaniclastic tuff from the Xuanwei Formation, Guizhou Province, southern China, and its palaeofloristic significance
Authors: HILTON JASON , SHI-JUN WANG , GALTIER JEAN , GLASSPOOL IAN , STEVENS LIL
Published: December 2004

A new permineralized fossil plant assemblage is described from volcaniclastic tuff collected in the Upper Permian (Wuchiapigian to Changhsingian) Xuanwei Formation at Shanjiaoshu mine, Guizhou Province, China. The assemblage is fragmentary but contains a small sphenopsid strobilus, a partial strobilus of a lepidodendralean lycopsid, pinnae of the filicalean fern Anachoropteris and a filicalean non-laminate fertile pinna rachis, the marattialean ferns Eoangiopteris, Scolecopteris and Psaronius, hooked stems of probable gigantopterid affinity, and two kinds of cardiocarpalean ovules. This represents the first indisputable evidence of Anachoropteris from the Permian of China, and contrasts with previous evidence from Europe and North America that indicates this genus became extinct during earliest Permian times. The assemblage highlights the persistence of plants from wetland communities and mire ecosystems into the Upper Permian of southern China, and adds further support to the presence of the Ameriosinian phytogeographical realm. This represents the first record of a plant assemblage preserved in volcaniclastic sediments from the Upper Permian of southern China, and in combination with other recently discovered plant assemblages in similar deposits in southern China, suggests volcanism to be an important factor in facilitating permineralized plant preservation in this realm. Although the source of the volcanism that produced the tuff is unknown, its age and location are consistent with the Emishan Large Igneous Province (LIP) of southwest China.
Significance of graphite occurrences in the Aracena Metamorphic Belt, Iberian Massif
Authors: CRESPO ELENA , LUQUE JAVIER , FERNÁNDEZ-RODRÍGUEZ CARLOS , RODAS MAGDALENA , DÍAZ-AZPIROZ MANUEL , FERNÁNDEZ-CALIANI JUAN CARLOS , BARRENECHEA JOSÉ F.
Published: December 2004

The significance of syngenetic and epigenetic graphite occurrences from the Variscan high-temperature/low-pressure Aracena Metamorphic Belt is discussed in the framework of the tectono-thermal evolution of this southern zone of the Iberian Massif. Syngenetic graphite is associated with both low- to medium-grade metamorphic rocks (La Umbría series, Precambrian in age) and high-grade, granulite facies rocks (the Precambrian Fuente del Oro series and a Cambrian calc-silicate series). Epigenetic, fluid-deposited occurrences correspond to overgrowths on existing metamorphic graphite grains and vein-type mineralization. Two types of graphitized particles with remarkable differences in reflectance, anisotropy and size can be distinguished in the Precambrian metapelites of the La Umbría series. Large, >150 μm length, platy crystals with high reflectance and anisotropy are interpreted as detrital and are considered indirect evidence of an old orogenic cycle prior to the Cadomian Orogeny, during which metamorphism exceeded greenschist facies. The coexistence of two types of particles explains the scattering of values of the c parameter of graphite determined by XRD (c = 6.72–6.74 Å), and the anomalously high temperatures of the DTA exothermic peak (close to 600 °C) of graphite with respect to that inferred from mineral assemblages in these rocks. The presence of graphite-rich quartzites and gneisses within the Fuente del Oro series and the calc-silicate series is evidence of sedimentation under reducing conditions in a continental shelf. The characteristics of graphite reflect the high-grade metamorphic conditions attained in the southern area of the Aracena Metamorphic Belt. Pervasive flow of fluids related to a major Variscan extensional event resulted in overgrowths on the pre-existing graphite in the gneisses and quartzites of the calc-silicate series, as evidenced by the heterogeneous isotopic composition of graphite single crystals in these rocks. A later stage of graphite precipitation is represented by scarce vein-type occurrences in mafic granulites that document channelled flow of fluids.
The significance of the graptoloid Amphigraptus divergens from the (mid-Rawtheyan) type section of the Ashgill Series, Ordovician
Authors: RICKARDS R. B.
Published: December 2004

Amphigraptus divergens Lapworth is known to be restricted, in Britain, to the linearis Biozone, and its occurrence in the type Ashgill Series reinforces Rickards' prior independent attribution of that part of the type Ashgill to the linearis Biozone. The thecal structure revealed in this paper allies A. divergens to the dicellograptids rather than the leptograptids, hence it is placed in the family Dicranograptidae. The evolutionary origin of Amphigraptus is almost certainly rooted in Dicellograptus.
Medication prescribing patterns for patients with bipolar I disorder in hospital settings: adherence to published practice guidelines
Authors: Lim Prudence Z , Tunis Sandra L , Edell William S , Jensik Sarah E , Tohen Mauricio
Published: December 2004

Objective:
The purposes of this paper were to examine the medication prescribing patterns for bipolar I disorder in hospital settings and to compare them to recently published expert consensus guidelines for medication treatment of bipolar disorder.   Methods: Data were obtained from the 1996–2000 CQI+SM Outcomes Measurement System, on patients age 18 or older admitted to psychiatric inpatient units from over 100 medical–surgical hospitals. A total of 1864 patients with a primary discharge diagnosis of bipolar I or II disorder were identified from a large cohort of hospitalized patients. Patient characteristics were assessed at hospital admission and medication usage, at discharge. The medication analysis focused on the 1471 individuals with bipolar I mania or bipolar I depression (with or without psychotic features), representing 54% and 25% of admitted bipolar patients, respectively.   Results: At admission, the typical bipolar patient (mean age 57) had experienced a relatively severe and chronic course of illness. The array of psychotropic agents used was broad, with no single prescribing pattern predominant. Only one in three bipolar I (manic or depressed) patients with psychotic features was discharged on medications recommended by expert guidelines as preferred or alternate recommended treatment. Absent psychotic features, this dropped to one in six patients. Surprising was the relatively high use of antidepressants for patients with mania, particularly those without psychotic symptoms.   Conclusions: Results suggest that a substantial proportion of patients with bipolar I disorder are discharged from hospitals on medications not generally recommended by current practice guidelines.
Rapid, continuous cycling and psychiatric co‐morbidity in pediatric bipolar I disorder
Authors: Findling Robert L , Gracious Barbara L , McNamara Nora K , Youngstrom Eric A , Demeter Christine A , Branicky Lisa A , Calabrese Joseph R
Published: December 2004

Objectives:
The primary purpose of this study was to describe the clinical presentation of bipolar I disorder (BP‐I) as it occurs in children and adolescents and to assess whether the manifestations of BP‐I were similar in both age groups.   Method: Ninety youths between the ages of 5 and 17 years meeting full diagnostic symptom criteria for BP‐I were included in this study. The diagnosis of BP‐I was established for these youths based on the results of a semi‐structured diagnostic interview and a clinical assessment by a child and adolescent psychiatrist. The course of a subset of these youngsters’ illnesses was assessed using the Life Charting Method (LCM). Data regarding the clinical presentation, longitudinal history, psychiatric co‐morbidities and parental psychopathology were also obtained.   Results: The clinical presentation of BP‐I was similar in children and adolescents. Youths meeting diagnostic criteria for BP‐I developed an average of approximately 5.8 of the 7 symptoms of mania during periods of elevated or irritable mood. BP‐I was found to be a cyclic disorder characterized by high rates of rapid cycling (50%) with almost no inter‐episode recovery. Almost 75% of these subjects also met diagnostic symptom criteria for a disruptive behavior disorder. High rates of mood disorders were found in fathers.   Conclusions: These data suggest that the presentation of juvenile BP‐I is a cyclic and valid clinical condition with manifestations on a continuum with the later‐onset forms of this illness.
Confusion and dysphoria with low‐dose topiramate in a patient with bipolar disorder
Authors: Andrade Chittaranjan
Published: December 2004

Background:
Topiramate, a newer antiepileptic agent, may benefit several neurological and psychiatric states, including bipolar disorder.   Case report: A physically healthy, stockily built, 47‐year‐old, hypomanic Asian male with a >20‐year history of uneventful use of psychotropic agents received topiramate in a dose that was stepped up to 100 mg/day across 10 days. He developed dysphoria, confusion, word‐finding difficulties, and difficulties in maintaining a train of thought; the symptoms vanished within a week of drug discontinuation, and reappeared 1–2 days after rechallenge at a dose of 25 mg/day.   Conclusion: It appears that, while confusion is usually a dose‐dependent adverse effect of topiramate, certain patients may idiosyncratically develop this adverse effect at very low doses.
Clinical correlates of psychiatric comorbidity in bipolar I patients
Authors: Vieta Eduard , Colom Francesc , Corbella Barbara , Martínez‐Arán Anabel , Reinares María , Benabarre Antonio , Gastó Cristóbal
Published: December 2004

Objectives:
To ascertain the clinical implications of psychiatric comorbidity in the course and outcome of bipolar I patients.   Methods: One hundred and twenty‐nine bipolar I outpatients in remission [Young Mania Rating Scale (Y‐MRS)<7, Hamilton Depression Rating Scale (HDRS)<9] were assessed by means of the Structured Clinical Interview for DSM‐III‐R axis I and axis II (SCID‐I and SCID‐II) in order to detect all possible psychiatric comorbid diagnoses. The sample was split according to the presence of psychiatric comorbidity and the groups were compared.   Results: Psychiatric comorbidity was detected in 31% of the sample. A higher number of mixed features, depressive episodes and suicide attempts and a predominance of depressive onset amongst comorbid bipolar patients were the most relevant differences between the two groups.   Conclusions: There is an association between depression, suicidality and comorbidity in bipolar I disorder. As comorbidity had a clear relevance in the course and outcome of bipolar illness, this issue should be specifically assessed in clinical practice.
Effect of ethacrynic acid on sodium pump α isoforms in SH‐SY5Y cells
Authors: Valdes Renee M , Huff Mary O , El‐Masri M Adnan , El‐Mallakh Rif S
Published: December 2004

Background:  Ethacrynic acid (ECA), a diuretic that has several cellular actions, increases expression of the sodium and potassium‐activated adenosine triphosphatase (Na, K‐ATPase or Na pump) in normal lymphocytes, but not in lymphocytes of bipolar patients. While this has been proposed to be important in the pathophysiology of bipolar illness, the response of neural tissues to ECA is unknown.

Methods:  Human neuroblastoma SH−SY5Y cells differentiated with 10‐μM retinoic acid were treated with various ECA concentrations for 3 days, and changes in Na‐pump α‐isoform expression were quantified with densitometric analysis of Western bands.

Results:  Expression of α1 and α3 Na pump isoforms significantly increased with 10−5 M ECA. Cells treated with 10−6 or 10−7 M ECA showed no change in Na‐pump expression, while cells treated with 10−4 M ECA died. The α2 isoform could not be detected in differentiated SH‐SY5Y cells.

Conclusions:  The effect of ECA on α1‐isoform in neural tissue is similar to that observed in lymphocytes. As α3 isoform is not expressed in lymphocytes, however, we conclude that lymphocytes are an incomplete model of neural tissue.
Bipolar depression: criteria for treatment selection, definition of refractoriness, and treatment options
Authors: Yatham Lakshmi N , Calabrese Joseph R , Kusumakar Vivek
Published: December 2004

Objective:  This paper reviews controlled studies of bipolar depression, outlines criteria for choosing treatment, defines refractoriness in bipolar depression, and provides options for treatment of refractory bipolar depression.

Methods:  Controlled studies that examined the efficacy of treatments for acute and long‐term treatment of bipolar depression were located through electronic searches of several databases and by manual crosssearch of references and proceedings of international meetings.

Results:  Lithium comes close to fulfilling the proposed criteria for first‐line treatment for bipolar depression, and those not responding to lithium should be considered to have refractory bipolar depression. Options for such patients include addition of lamotrigine or a second mood stabilizer, or a newer‐generation antidepressant such as a serotonin re‐uptake inhibitor or bupropion, or the atypical antipsychotic olanzapine.

Conclusions:  Although there is a paucity of research in the treatment of refractory bipolar depression, available data could be used for providing rational treatment options for such patients. However, further studies are urgently needed to determine which options are most appropriate for which type of patients.
Assessment of treatment response in mania: commentary and new findings
Authors: Baldessarini Ross J
Published: December 2004

Background:  Assessment of therapeutic interventions in bipolar disorder is complicated by rapid, complex clinical changes, high placebo‐response rates, and varying times to specific levels of clinical recovery that may not be adequately reflected in averaged rating‐scale scores particularly in acute mania, calling for improved methods to evaluate treatment responses. Chengappa et al. (1) propose operational criteria for specific outcomes based on rating‐scale data from two placebo‐controlled trials of olanzapine in mania.

Methods:  These trials and other recent research were considered in commenting on the design, conduct, analysis and interpretation of experimental therapeutic trials in mania and to optimize olanzapine versus placebo contrasts by systematically varying end‐point criteria for mania (YMRS) and depression (HDRS) ratings.

Results:  Olanzapine versus placebo responses were optimally separated at scores of 10 for final paired mania and depression ratings, or 5 for each rating scale considered separately.

Conclusions:  Use of empirically determined end‐points derived from standard rating scales used in experimental therapeutics research in mood disorders can improve both outcome‐assessment and separation of active treatment from placebo responses in acute mania.
Phenotypic spectra of bipolar disorder in responders to lithium versus lamotrigine
Authors: Passmore Michael J , Garnham Julie , Duffy Anne , MacDougall Marsha , Munro Alana , Slaney Claire , Teehan Andrew , Alda Martin
Published: December 2004

Objective:  We conducted a study of clinical presentation and family history in patients responsive to either of two commonly used mood stabilizers, lithium and lamotrigine.

Methods:  The sample included 164 subjects from 21 families of bipolar probands, 14 responders to lithium and seven to lamotrigine. Diagnostic information on first‐degree relatives was obtained in a blind fashion through a combination of direct interviews (SADS‐L) and family history assessments (FH‐RDC).

Results:  The probands differed with respect to clinical course (episodic in the lithium group, rapid cycling in the lamotrigine group), and comorbidity (panic attacks and substance abuse in the lamotrigine group). The relatives of lithium responders had significantly higher risk of bipolar disorder while relatives of lamotrigine responders had higher prevalence of schizoaffective disorder, major depression and panic attacks.

Conclusions:  These findings suggest that lithium‐ and lamotrigine‐responsive patients differ with respect to course of illness, comorbidity and family history and may represent distinct subtypes of bipolar disorder.
The oxytocin antagonist atosiban versus the β‐agonist terbutaline in the treatment of preterm labor
Authors:   THE EUROPEAN ATOSIBAN STUDY GROUP (, )
Published: December 2004

Objective. To compare the efficacy and safety of atosiban and terbutaline for the inhibition of preterm labor.

Methods. Two hundred and forty‐nine women diagnosed with preterm labor at 23–33 weeks of gestation were enrolled of whom 245 women received treatment, 116 with atosiban and 129 with terbutaline. At randomization, women were stratified by gestational age (≤28 weeks and >28 weeks). Atosiban (iv bolus dose of 6.75 mg, then 300 μg/min for 3 h and 100 μg/min thereafter) and terbutaline (5–20 μg/min) were administered by iv infusion for 13–18 h. Re‐treatment with study drug or an alternative tocolytic agent was allowed. Tocolytic effectiveness was assessed in terms of the number of women undelivered after 48 hours and 7 days and efficacy and tolerability in terms of the number of women remaining undelivered and not requiring alternative tocolytic therapy after 48 hours and 7 days of starting therapy. Safety was assessed in terms of maternal side effects and neonatal morbidity.

Results. Tocolytic effectiveness at 48 hours was 86.1% vs 85.3%; p=0.783, and after 7 days it was 76.5% vs 67.4%; p=0.067, in the atosiban and terbutaline groups, respectively. Tocolytic efficacy and tolerability after 48 hours was 72.2% vs 68.2%; p=0.51 and after 7 days was 55.6% vs 43.4%; p=0.08 in the atosiban and terbutaline groups, respectively. Overall, there were fewer clinically important adverse events with atosiban than with terbutaline.

Conclusions. The efficacy of atosiban in the inhibition of preterm labor was shown to be comparable to terbutaline. Atosiban had a superior safety profile compared with terbutaline in terms of maternal and fetal adverse events, and comparable infant outcomes.
Occurrence of gestational diabetes mellitus and the value of different screening indicators for the oral glucose tolerance test
Authors: ÖStlund Ingrid , Hanson Ulf
Published: December 2004

Background. The objective of the present study was to determine prevalence of gestational diabetes mellitus (GDM) in terms of impaired glucose tolerance (IGT) and diabetes mellitus (DM), and the value of traditional anamnestic risk factors for predicting outcome of the oral glucose tolerance test (OGTT).

Methods. A prospective population‐based study in a defined geographic area in Sweden. All pregnant nondiabetic women (n = 4918) attending maternal health care from July 1994 to June 1996 were offered a 75g OGTT in gestational weeks 28–32. Traditional anamnestic risk factors, as well as results of the OGTT in terms of fasting‐B‐glucose and 2h‐B‐glucose, were registered.

Results. 3616 (73.5%) women agreed to perform the OGTT. Sixty‐one (1.7%) of those had GDM [47 (1.3%) had impaired glucose tolerance and 14 (0.4%) had diabetes mellitus]. 15.8% fulfilled traditional risk factor criteria. Traditional anamnestic risk factors as an indicator to perform an OGTT identified 29/61 GDM women and 9/14 women with DM. Among primiparas, 4/21 with gestational diabetes mellitus were detected.

Conclusion. Using traditional risk factors as an indicator to perform an OGTT gives a low sensitivity to detect GDM and even DM especially among primiparas.
Nausea and vomiting associate with increasing maternal androgen levels in otherwise uncomplicated pregnancies
Authors: Carlsen Sven Magnus , Vanky Eszter , Jacobsen Geir
Published: December 2004

Background. The objective of the present study was to investigate the hypothesis that maternal androgen levels associate with nausea and vomiting in otherwise uncomplicated pregnancies.

Methods. One hundred and twenty‐nine women with uncomplicated pregnancies, reported nausea and vomiting in weeks 17, 25, 33, 37, and when admitted for delivery. Maternal levels of androstenedione, dehydroepiandrosterone sulfate (DHEAS), testosterone, and sex hormone binding globulin (SHBG) were measured and the free testosterone index calculated in weeks 17 and 33 of pregnancy.

Results. Maternal levels of androstenedione and DHEAS associated positively with nausea and vomiting in week 17. In week 33, testosterone and DHEAS associated positively with nausea and vomiting, as well as androstenedione. A calculated emesis score associated positively with increasing average levels of both androstenedione and testosterone during pregnancy, as well as the free testosterone index.

Conclusions. Nausea and vomiting associate with increasing maternal androgen levels during otherwise uncomplicated pregnancies. Whether androgens are causally related to emesis gravidarum remains unknown.
Plasma YKL‐40, as a prognostic tumor marker in recurrent ovarian cancer
Authors: Dehn Hannah , HØgdall Estrid V. S. , Johansen Julia S. , JØrgensen Morten , Price Paul A. , Engelholm Svend A. A. , HØgdall Claus K.
Published: December 2004

Background. YKL‐40, a member of family 18 glycosyl hydrolases, is secreted by cancer cells. The function of YKL‐40 in cancer diseases is unknown, but it is a growth factor of connective tissue cells and probably has a role in inflammation and remodeling of the extracellular matrix, a process also involved in metastatic malignant diseases. High serum YKL‐40 has been associated with poor prognosis for patients with colorectal and recurrent breast cancer.

Aim of the study. The purpose of the present study was to examine the prognostic value of plasma YKL‐40 in patients presenting with recurring ovarian cancer.

Methods. YKL‐40 was determined by ELISA in plasma samples from 73 patients with relapse of ovarian cancer shortly before start of second‐line chemotherapy. The endpoint used was death because of ovarian cancer.

Results. Plasma YKL‐40 was increased in ovarian cancer patients (median 94 µg/L, range 20–1970 µg/L) compared with age‐matched controls (33 µg/L, range 20–130 µg/L) (p < 0.001). Fifty‐five per cent of the patients had a plasma YKL‐40 level above the upper normal 95th percentile of controls. Patients with high plasma YKL‐40 (i.e. > 130 µg/L or > 160 µg/L) at the time of relapse had significantly shorter survival than patients with normal levels (respectively p = 0.007 and p = 0.004). Plasma YKL‐40 proved to be an independent prognostic factor in a multivariate Cox analysis (YKL‐40 > 160 µg/L; HR = 2.27) (p = 0.006), including serum CA‐125 and clinical/histological parameters.

Conclusion. High plasma YKL‐40 is related to short survival in patients with recurrent ovarian cancer.
Personality factors and emotional responses to pregnancy among IVF couples in early pregnancy: a comparative study
Authors: Hjelmstedt Anna , Widström Ann‐Marie , Wramsby Håkan , Matthiesen Ann‐Sofi , Collins Aila
Published: December 2004

Background. Little is known as to whether negative experiences associated with infertility and IVF treatment persist after successful treatment. The aim of the study was to compare couples who have conceived after IVF and couples who have conceived naturally regarding personality factors and emotional responses to pregnancy.

Methods. Fifty‐seven women pregnant after IVF and 55 male partners and 43 women who had conceived naturally and 39 male partners were recruited from university IVF clinics and antenatal clinics in Stockholm. The subjects were interviewed about their socio‐demographic background. They completed scales of personality traits, anxiety, emotional responses to pregnancy, marital adjustment and reactions to recalled infertility while in pregnancy week 13 (range 11–17).

Results. The results showed that the IVF women had more muscular tension and were more anxious about loosing the pregnancy than the control women. The IVF women with high infertility distress were more anxious about loosing the pregnancy and less ambivalent than the women with lower distress. The IVF men had more somatic anxiety, indirect aggression, guilt, and were more detached and more anxious about loosing the pregnancy and less ambivalent than the control men. The IVF men with high infertility distress were more anxious about the baby not being normal than the men with lower infertility distress.

Conclusions. The women and men who had conceived after IVF differed on a number of personality dimensions and emotional responses to the pregnancy from that of the women and the men who had conceived naturally. The results suggest that IVF couples may need additional emotional support in early pregnancy.
Effects of treatment with gonadotropin releasing hormone agonist on the uterine leiomyomata structure
Authors: Bozzini Nilo , Rodrigues Consuelo J. , Petti Domingos A. , Bevilacqua Ruy G. , GonÇalves Sergio P. , Pinotti José Aristodemo
Published: December 2004

Objective. Our aim was to study the effects of the gonadotropin releasing hormone agonist on the uterine leiomyoma of infertile women.

Material and methods. Sixty‐seven nulliparous women (aged 24–39 years) with uterine leiomyomas, underwent ultrasonographic study of leiomioma volume, and were divided in two groups. Thirty‐one had nodes greater than 300 cm3 and were treated with goserelin 3.6 mg every 28 days for 6 months (group I); the other 36 patients did not receive medication (group II or control group). Sixteen patients from group I had ≤ 36% (median) reduction of the leiomyoma volume (subgroup Ia) and the other 15 women had reduction > 36% (subgroup Ib). All women underwent myomectomy.

Results. The group with the greater leiomyoma reduction after treatment with goserelin (group Ib) showed a significantly lower percentage of ER+ when compared with group Ia and the control group. Group Ib had a significantly higher percentage of PR+ in relation to the control group, but not to group Ia. The number of blood vessels, AgNOR dots, and cells, and the amount of collagen were not different between the three groups studied. Leiomyomata reduction correlated negatively with the percentage ER+ cells, but positively with the PR+ cells, amount of collagen and number of blood vessels. No correlation was found between the number of AgNOR dots and cellularity.

Conclusion. Our data strengthen the hypothesis that the uterine leiomyoma response to steroid hormones results from the presence of specific hormone receptors, and progesterone receptors may also play a role in the development of leiomyoma.
Subdermal progestin implant (Nestorone®) in the treatment of endometriosis: clinical response to various doses
Authors: Ylänen Kaija , Laatikainen Timo , Lähteenmäki Pekka , Moo‐Young Alfred J.
Published: December 2004

Objective. To evaluate the efficacy of three different doses of Nestorone® progestin administered by implants for relief of pain, as well as bleeding patterns and symptoms in women with endometriosis.

Design. An open clinical study without a control group.

Patients. Twenty‐one women in whom endometriosis was diagnosed and treated at laparoscopy or at laparotomy.

Interventions. The patients were randomly allocated to one of three groups receiving a daily dose of either 150 µg, 200 µg or 400 µg Nestorone® for two to four implants inserted subcutaneously for 7 months. After removal of the implants the follow‐up period was 6 months. Six patients in the 150 µg group, seven in the 200 µg group and five in the 400 µg group completed the study.

Measurements. Records of bleeding and registered side‐effects and endometriosis‐related symptoms were kept by the patients. Ovarian status was evaluated by vaginal ultrasonography. Serum concentrations of Nestorone® and of lipids were measured.

Results. Pelvic pain decreased significantly in response to the treatment in all groups but returned to pretreatment levels during the post‐treatment period. Bleeding and spotting was the most common side‐effect followed by hypoestrogenic and psychic symptoms, with no significant difference among the groups. No significant changes in the serum levels of total, HDL or LDL cholesterol were found. One patient during the treatment period and four patients during the follow ups underwent surgical procedures.

Conclusion. All three doses of Nestorone® effectively alleviated endometriosis‐related pain. While the Nestorone® implant provides an interesting option for the treatment of endometriosis‐related pain, its role needs to be assessed in comparative trials.
Hormone replacement therapy and risk of breast cancer: the role of progestins
Authors: Stahlberg Claudia , Pedersen Anette Tønnes , Lynge Elsebeth , Ottesen Bent
Published: December 2004

Epidemiological studies have shown an increased risk of breast cancer associated with the use of hormone replacement therapy (HRT). This notion is mostly based on studies from the USA. During the last decades unopposed estrogen treatment has been used to a lesser extent, whereas the combined estrogen‐progestin treatment regimen is now prescribed worldwide. In the USA the predominant compounds are conjugated estrogens and medroxyprogesterone‐acetate, whereas oestradiol combined with testosterone‐like progestins is commonly used in Europe. These differences are mainly the result of traditions. Recent studies originating from both the USA and Europe suggest that the combined treatment regimens with estrogen and progestin increase the risk of breast cancer beyond the risk following the use of unopposed estrogen. At present it is not known if progestins with different androgenecity influence the risk of breast cancer to a varying degree.

This review focuses on studies published after the latest meta‐analysis in 1997, with special attention given to the type of progestin used and the treatment mode, i.e. cyclical or continuous regimen.
Effects of epidural analgesia during labor on pelvic floor function after vaginal delivery
Authors: Sartore Andrea , Pregazzi Roberto , Bortoli Paolo , Grimaldi Eva , Ricci Giuseppe , Guaschino Secondo
Published: December 2004

Background. Aims of this study were to determine the rate of symptoms related to perineal trauma (anal and stress urinary incontinence) and to assess pelvic floor muscle function in women who underwent epidural analgesia.

Methods. Comparative design comprising 70 matched pairs of primiparous mothers. Each woman was questioned about urogynecologic symptoms and examined by digital test, vaginal perineometry and uroflowmetric stop test score 3 months after vaginal delivery. Urogenital prolapse was defined in accordance with the Baden and Walker's ‘Halfway System Classification’. Statistical analysis was performed using Fisher's exact test to compare the two groups and simple logistic regression models to estimate the odds ratios of every variable considered in respect of the control population.

Results. No significant difference was found in the incidence of stress urinary incontinence, anal incontinence and vaginal prolapse in the two study groups. No significant differences were found between the study groups with regard to the digital test, vaginal manometry and urine stream interruption test.

Conclusions. Use of epidural analgesia is not associated with symptoms related to perineal trauma and pelvic floor muscle weakness.
Dinoprostone versus misoprostol: a randomized study of nulliparous women undergoing induction of labor
Authors: Lokugamage Amali U. , Forsyth Sophie F. , Sullivan Keith R. , El Refaey Hazem , Rodeck Charles H.
Published: December 2004

Background. The objectives of the study were to compare the efficacy and safety of intravaginal misoprostol and intravaginal dinoprostone for induction of labor and to quantify the clinical response to suspicious cardiotocographic (CTG) readings.

Methods. One hundred and ninety‐one patients were randomized to receive either 50 µg misoprostol initially then a further identical dose 6 h later or 2 mg dinoprostone initially followed by 1 mg 6 h later, over a period of 24 h. If not in labor after 24 h, then both arms of the study would thereafter receive dinoprostone alone as per hospital protocol.

Results. The induction to delivery interval (1047 vs. 1355 min, p = 0.01), delivery within 12 h (35.4% vs. 18.9%, p = 0.02) and delivery within 24 h (83.3% vs. 63.3%, p = 0.01) were all shorter in the misoprostol arm. There were no differences in rates of oxytocin augmentation ( p = 0.47), tachysystole ( p = 0.32) and hyperstimulation syndrome ( p = 0.82). There was an increase in the median number of times a doctor was called to advise on a suspicious CTG in the misoprostol group (1 vs. 2 occasions, p = 0.052), but there was no difference in neonatal outcome.

Conclusions. Intravaginal misoprostol led to a shorter, more efficient labor, and although there was more anxiety related to the CTG, there was no increase in neonatal adverse effects.
A comparison of three methods to evaluate maximum bladder capacity: cystometry, uroflowmetry and a 24‐h voiding diary in women with urinary incontinence
Authors: Ertberg Pia , Møller Lars Alling , Lose Gunnar
Published: December 2004

Background. Maximum bladder capacity (MBC) is an important parameter in the evaluation of lower urinary tract function. Yet, there is no consensus on how to measure MBC. The aim of this study was to compare estimates of the maximum bladder capacity (MBC) using cystometry, uroflowmetry, and a 24‐h voiding diary in women with urinary incontinence.

Methods. From 1 January 1998 to 31 December 1998 a retrospective review comprising 60 incontinent women in whom cystometry, uroflowmetry, and a 24‐h voiding diary were performed were evaluated.

Results. Median age was 55 years (range: 34–90 years). In women with detrusor instability (DI), MBC was significantly higher when measured using a voiding diary (median: 400 ml) as compared with cystometry (median: 215 ml) (p = 0.017). A ‘Bland–Altman plot’ demonstrated poor agreement between MBC in women with DI measured using a voiding diary and cystometry, respectively. The cystometric MBC was significantly higher in women with a stable detrusor (373 ml) as compared with women with DI (215 ml) (p = 0.0027). However, in women with or without DI there were no differences between MBC measured either using a voiding diary (400 vs. 360 mL) or by uroflowmetry (260 vs. 254 ml), respectively.

Conclusions. A low cystometric MBC in women with DI may be an ‘artefact’ caused by the cystometric procedure (catherization and filling). The question is which measure of MBC is the best for clinical and scientific purposes.
Cigarette, alcohol, and caffeine consumption: risk factors for spontaneous abortion
Authors: Rasch Vibeke
Published: December 2004

Objective. To study the association between cigarette, alcohol, and caffeine consumption and the occurrence of spontaneous abortion.

Methods. The study population consisted of 330 women with spontaneous abortion and 1168 pregnant women receiving antenatal care. A case‐control design was utilized; cases were defined as women with a spontaneous abortion in gestational week 6–16 and controls as women with a live fetus in gestational week 6–16. The variables studied comprise age, parity, occupational situation, cigarette, alcohol, and caffeine consumption. The association between cigarette, alcohol, and caffeine consumption was studied using logistic regression analyzes while controlling for confounding variables. In addition stratified analyzes of the association between caffeine consumption and spontaneous abortion on the basis of cigarette and alcohol consumption were performed.

Results. Women who had given birth twice or more previously had increased odds ratio (OR), 1.78 (1.27–2.49), whereas women who were students had decreased OR, 0.55 (0.34–0.91) for having spontaneous abortions. Regarding lifestyle factors, the adjusted ORs among women who consumed 5 units or more alcohol per week or 375 mg or more caffeine per day were 4.84 (2.87–8.16) and 2.21 (1.53–3.18), respectively. Women who smoked 10–19 cigarettes and 20 or more cigarettes per day did not have significantly increased ORs for having spontaneous abortions, after adjusting for other risk factors.

Conclusion. Consumption of 5 or more units alcohol per week and 375 mg or more caffeine per day during pregnancy may increase the risk of spontaneous abortion.
Randomized trial in multiparous patients: investigating a single vs. two‐dose regimen of intravaginal misoprostol for induction of labor
Authors: Lokugamage Amali U. , Forsyth Sophie F. , Sullivan Keith R. , El Refaey Hazem , Rodeck Charles H.
Published: December 2004

Background. Multiparous patients have a higher risk of hyperstimulation and uterine rupture than nulliparous patients. The minimum possible dose of uterotonic drug should be used in induction of labor for multiparous patients to avoid excessive uterine activity, which could increase both maternal and fetal risks.

Methods. One hundred and four women were randomized to either a single dose of 50 µg of intravaginal misoprostol in 24 h, or two consecutive doses of intravaginal 50 µg misoprostol 6 h apart.

Results. The mean induction to delivery interval (789 min [95% CI: 637–941] vs. 576 min [95% CI: 484–667], p = 0.018) and delivery rate within 12 h (63% vs. 83%, p = 0.035) were higher in the two‐dose group. The oxytocin augmentation rate (14% vs. 2%, p = 0.03) was higher in the single‐dose group. There was a higher rate of clinician input related to suspicious cardiotocographic readings in the single‐dose arm ( p = 0.04). There was no statistical difference ( p > 0.05) between the one‐ and two‐dose regimens with respect to the rates of tachysystole (21% vs. 15%), hyperstimulation (3.9% vs. 0%), and meconium staining at delivery (9.8% vs. 13.2%).

Conclusions. The two‐dose regimen was most efficient, but both regimens were well tolerated by the fetuses.
Plasminogen activator inhibitor type 1 (PAI1) and platelet glycoprotein IIIa (PGIIIa) polymorphisms in Black South Africans with pre‐eclampsia
Authors: Pegoraro Rosemary J. , Hira Bavna , Rom Lee , Moodley Jack
Published: December 2004

Background. Association of fibrin abnormalities with pre‐eclampsia prompted this study to examine whether polymorphisms in the plasminogen activator inhibitor Type 1 and platelet glycoprotein IIIa genes constitute risk factors for this condition.

Methods. A group of 151 Black Zulu‐speaking pre‐eclamptics was examined for 4G/5G plasminogen activator inhibitor Type 1 and PlA1/A2 platelet glycoprotein IIIa polymorphic alleles using standard techniques. Results were compared with those found in 217 ethnically matched healthy normotensive pregnant women who had normal full‐term gestations.

Results. Pre‐eclamptic patients had a slightly higher frequency of the 4G plasminogen activator inhibitor Type 1 allele (15%) compared with the controls (12%); this was reflected also in the heterozygote frequency (28% and 22%) for the patients and the controls, respectively. These differences were not significant. Only 2% of this population was found to be homozygous for the 4G allele. No differences were observed in the platelet glycoprotein IIIa polymorphism genotype and allele frequency distribution between the patients and the controls.

Conclusions. Neither the 4G allele of the plasminogen activator inhibitor Type 1 nor the PlA2 allele of the platelet glycoprotein IIIa have any significant role as risk factors in the patho‐etiology of pre‐eclampsia in Black South Africans, although these genes cannot yet be excluded as contributory to this disorder. It is possible that the underlying causes of pre‐eclampsia may vary between different ethnic populations.
Clinical symptoms after anal sphincter rupture: a retrospective study
Authors: Wagenius Johanna , Laurin Jan
Published: December 2004

Background. To evaluate the current anal sphincter function, the frequency of urinary incontinence and of dyspareunia in patients with earlier anal sphincter rupture following vaginal delivery.

Design. Retrospective case–control study between 1994 and 1999 at the Central Hospital of Helsingborg, Sweden.

Participants. Two hundred and eighteen women with a history of obstetric anal sphincter rupture and 436 matched controls.

Methods. Postal questionnaire regarding anal incontinence, urinary incontinence, dyspareunia and lifestyle alterations. Obstetric data were collected from hospital records.

Results. Of the 654 women included, 534 (82%) responded at a median follow up of 4 ears. Anal incontinence was significantly more common among patients with sphincter rupture. Sixty‐one (33%) reported incontinence of flatus and 39 (21%) incontinence of liquid stools compared with 53 (15%) and 26 (7%) in the control group. Dyspareunia was reported by 26 (14%) patients and 20 (6%) controls. The symptoms of dyspareunia seemed to decrease with time. There was no significant difference in urinary incontinence between the two groups. A third of the women in the case group claimed that their problems with anal incontinence affected their daily lives, but only a few had asked for medical assistance.

Conclusions. Anal sphincter rupture is strongly associated with anal incontinence and dyspareunia several years postpartum. The complaints affect the daily lives of these women to a great extent.
Histopathological changes in ovary and endometrium after tubal ligation: a rat model
Authors: Duran Bulent , Demirkoprulu Nihal , Guvenal Tevfik , Arici Sema , Tuncer Ersin , Cetin Meral , Timuroglu Timucin
Published: December 2004

Background. To evaluate the histopathological effects of tubal ligation on ovary and endometrium in a rat model.

Methods. Twenty‐four female Wistar albino rats weighing 220–260 g were used. The rats were assigned randomly into tubal ligation and control groups. While tubal ligation was applied to the first group of rats, only a laparotomy was performed in the second group. Six weeks later, a second laparotomy was performed and uterine horns and ovaries of the rats in the two groups were excised for histopathological assessment. A pathologist blinded to the groups made histopathological examination including quantification of endometrial phases, presence of endometrial inflammation and counting the number of tertiary follicles and corpora lutea in each ovary.

Results. We found no significant difference between tubal ligation and control groups related to the number of tertiary follicles and corpora lutea (p > 0.05). However, in the tubal ligation group, endometrial inflammatory infiltration was significantly higher than in the control group (p < 0.05).

Conclusion. Tubal ligation does not affect ovarian histology as an indicator of ovarian function. However, endometrial inflammation may occur after tubal ligation and lead to menstrual irregularities as an early complication.
Influence of leptin and the TNF system on insulin resistance in pregnancy and their effect on anthropometric parameters of newborns
Authors: Melczer Zsolt , Bánhidy Ferenc , Csömör Sándor , Tóth Péter , Kovács Margit , Winkler Gábor , Cseh Károly
Published: December 2004

Background.  We studied the contribution of the tumor necrosis factor system and leptin to insulin resistance during the course of normal pregnancy.

Methods.  Forty‐five healthy pregnant women (15 in the 1st, 15 in the 2nd2 and 15 in the 3rd3 trimester) and 25 age‐matched healthy nonpregnant women as controls. Twenty‐three newborns delivered by women followed in the 2nd and 3rd trimesters were also investigated.

Fasting serum immunoreactive tumor necrosis factor‐α, soluble tumor necrosis factor receptor‐1, soluble tumor necrosis factor receptor‐2, leptin (by enzyme‐linked immunoassay) and C‐peptide (by radioimmunoassay) concentrations in the patients and controls were measured. Body weight, length and head circumference of the newborns were analyzed in connection with the measured maternal parameters.

Results.  Significantly elevated tumor necrosis factor‐α, tumor necrosis factor receptor‐1 and ‐2, leptin, and C‐peptide levels were found in the 3rd3 trimester as compared with the 1st1 and 2nd2 trimesters and with the nonpregnant controls. Tumor necrosis factor‐α, tumor necrosis factor receptor‐2, C‐peptide, leptin concentrations and body mass index were found to be in a significant positive linear correlation with each other. Significant negative linear correlations were calculated among maternal serum C‐peptide, tumor necrosis factor‐α and leptin concentrations and the head circumference of the newborns.

Conclusions.  In conclusion, increased tumor necrosis factor‐α and leptin levels may contribute to insulin resistance in late pregnancy. Tumor necrosis factor‐α and leptin may be regulators of intrauterine bone development of newborns.