bluuebunny/crossref_metadata_2025 huggingface dataset:
Weighty Matters: Control of Women's Access to Physical Strength
Authors: Brace-Govan Jan
Published: November 2004

This paper gives an account of the social forces exerted to contain women's interest and access to weightlifting, and a muscular strength usually associated with masculinity. Weightlifting can create formidable physical strength but without the visible, physical displays of body building. The significance of weightlifting women's lack of visibility is important and alters the social dynamic of their experience of physical strength. The study relies on in-depth, semi-structured interviews with 16 elite women weightlifters. They recount how disciplined, different and empowered they perceive themselves to be. Drawing together the weightlifting women's illuminative epiphanic moments ( Denzin, 1989 , 1992, 1993) revealed the close association of strength with force and, the social expectation that, not only is powerful physicality used to dominate others, but it is also expected to be male. Women's access to domination is contained through the gendered nature of gym space and a masculine approach to training. Strength training is not only a source of self-identity, but it is also a site of collective experience and enforced norms of affective behaviour. The paper concludes that it is important for women to be supported in their challenge in this arena.
A Tale of Two Ontologies: An Immanent Critique of Critical Realism
Authors: Cruickshank Justin
Published: November 2004

In this article is it argued that critical realism has two mutually exclusive definitions of ontology. Ontology is defined as both a fallible interpretation of reality and as a definitive definition of a reality beyond our knowledge claims. A slippage in meaning occurs from the former to the latter, as critical realists try to justify the claim that their ontology ought to supply the terms of reference for all scientific research. Rather than defend an alternative ontology, it is argued that ontology needs to be defined in terms of fallible interpretations of social reality. This necessitates the revision and replacement of ontological theories in the course of an ongoing critical dialogue about reality, and precludes the use of one fixed ontology to supply the terms of reference for the sciences. 2
Frovatriptan for the Treatment of Cluster Headaches
Authors: Siow HC , Pozo-Rosich P , Silberstein SD
Published: November 2004

Cluster headaches both episodic and chronic are some of the most challenging headaches to treat. Although effective treatments are now available, some patients continue to be unresponsive to standard therapy. We present 17 patients from our practice whom we treated preventively with frovatriptan, a new triptan with a long half-life. The promising results suggest that this medication may be an useful addition to our ammaterium against this painful disorder.
Quantification of Acute Neck Pain Following Whiplash Injury by Computer-Aided Pressure Algesimetry
Authors: Stude P , Nebel K , Lüdecke C , Wiese H , Diener H-C , Keidel M
Published: November 2004

Until now the clinical investigation of cervical pain due to whiplash injury is mainly based on finger palpation. The present study introduces a PC-interactive pressure algesimetry to standardize cervical pain measurement. Pressure pain scores of the splenius and trapezius muscles of 23 patients with an acute cervical syndrome after whiplash injury were compared to those of 24 healthy subjects. The pressure painfulness of neck and shoulder muscles was significantly increased in whiplash patients. The splenii muscles showed an equally increased muscle pain whereas the trapezii muscles showed a left-sided preponderance of painfulness, possibly due to the seat belt position in this group of motor vehicle drivers. The computer-interactive pressure algesimetry enables a standardized and rater-independent quantification of the cervical syndrome with neck and shoulder pain caused by whiplash injury.
Sporadic Hemiplegic Migraine
Authors: Thomsen LL , Olesen J
Published: November 2004

Sporadic hemiplegic migraine (SHM) is defined as migraine attacks associated with some degree of motor weakness/hemiparesis during the aura phase and where no first degree relative (parent, sibling or child) has identical attacks. The present review deals with recent scientific studies according to which: The SHM prevalence is estimated to be 0.005%; SHM patients have clinical symptoms identical to patients with familial hemiplegic migraine (FHM) and significantly different from patients with migraine with typical aura (typical MA); SHM affected had no increased risk of migraine without aura (MO), but a highly increased risk of typical MA compared to the general population; SHM patients only rarely have mutations in the FHM gene CACNA1A; SHM attacks in some cases can be treated with Verapamil. The reviewed data underlie the change in the International Classification of Headache Disorders 2nd edition where SHM became separated from migraine with typical aura or migraine with prolonged aura. All cases with motor weakness should be classified as either FHM or SHM.
Prevalence and Factors Associated with Headache in Patients with Systemic Lupus Erythematosus
Authors: Weder-Cisneros ND , Téllez-Zenteno JF , Cardiel MH , Guibert-Toledano M , Cabiedes J , Velásquez-Paz AL , García-Ramos G , Cantú C
Published: November 2004

Headache is common in systemic lupus erythematosus with reported prevalence as high as 70%. The aims of this study were: to estimate the prevalence and types of headache in a sample of patients with systemic lupus erythematosus comparing it with rheumatoid arthritis, to determine clinical and serological associations. Eighty-one systemic lupus erythematosus and 29 rheumatoid arthritis consecutive patients seen in our outpatient clinic were interviewed. Headache was evaluated using the diagnostic criteria proposed by the International Headache Society. Additional evaluations were carried out in the 81 systemic lupus erythematosus patients including depression, disease activity, lupus damage, function disability, quality of life, and severity degree using a validated scales. We analysed the following autoantibodies: anti-double stranded DNA, anti-nucleosomes, anti-histones, anti-ribosomal P, anti-cardiolipin antibodies, anti-β2-glycoprotein-I (GPI), and antinuclear antibodies. Forty-one per cent of systemic lupus erythematosus and 17% of rheumatoid arthritis patients suffered from headache ( P = 0.02). No significant difference for any primary headache type between the two groups was found. Frequency of headache types in systemic lupus erythematosus patients was: migraine 24%, tensional-type headache 11%, and mixed headache 5%. In systemic lupus erythematosus patients the risk factors associated with headaches were Raynaud's phenomenon (OR 3.6; 95% CI 1.3-9.5; P = 0.009) and β2GPI antibody positivity (OR 4.5; 95% CI 1.2-16.2; p = 0.016). We conclude that headache is more common in systemic lupus erythematosus than in rheumatoid arthritis patients and was independently associated with Raynaud's phenomenon and β2GP-I antibodies.
Rupture of the sphincter ani: the recurrence rate in second delivery
Authors: Elfaghi Ibtesam , Johansson‐Ernste Birgit , Rydhstroem Hakan
Published: November 2004

Background  Injury to the genital tract sustained during childbirth can lead to transient or protracted morbidity. Attention should be paid to avoidable risk factors that can cause this complication.

Aim  To analyse the recurrence, at a later delivery, of trauma to the genital tract, subsequent to perineal laceration of the sphincter ani (third or fourth degree), sustained at an earlier delivery.

Design  A population‐based study.

Setting  In Sweden, 1973–1997 inclusive.

Population  All women with a vaginal, singleton delivery in Sweden.

Methods  The Medical Birth Registry, the National Board of Health and Welfare was used to identify cases of ruptured sphincter ani.

Main outcome measures  OR was calculated with 95% confidence interval. A stratified analysis was performed using the Mantel‐Haenszel technique.

Major end point  Rupture of the sphincter ani (third or fourth degree) at second delivery.

Results  The incidence of anal sphincter rupture increased sixfold during the study period, from 0.5% in 1973 to 3.0% in 1997. Women who had sustained a laceration of this type ran a significantly increased risk of a recurrence at a later delivery. This effect persisted even after stratification for birthweight, year of birth, parity and maternal age (OR 4.74, 95% confidence interval 4.34–5.17). When only fourth degree rupture was considered (rupture of both anal sphincter and rectum), the corresponding figures were 6.52 (95% CI 5.29–8.04). This effect also persisted after stratification for birthweight, year of birth, parity and maternal age. The OR for giving birth a second time, subsequent to a third or fourth degree perineal laceration at first delivery, was 0.68 (95% CI 0.67–0.70).

Conclusion  Our findings suggest that the risk of an anal sphincter rupture at delivery increases five to sevenfold when there has been a similar rupture at a previous delivery. Further study is needed before safe recommendations can be made concerning the subsequent mode of delivery to be adopted, following rupture in the sphincter ani at a previous birth.
Management of genital chlamydial infections at termination of pregnancy services in England and Wales: where are we now?
Authors: LaMontagne D. Scott , Pimenta Jeanne M. , Fenton Kevin A. , Mallinson Harry , Hopwood Jenny
Published: November 2004

Objective  To determine the range of policies and practices related to the management of genital chlamydial infection employed at termination of pregnancy services in England and Wales.

Design  Cross‐sectional descriptive study.

Setting  England and Wales.

Population  Termination of pregnancy providers.

Methods  Survey questionnaire administered to termination of pregnancy providers

Main outcome measures  Policies and practices for the management of genital chlamydial infection in women seeking termination of pregnancy with comparison to the national guidelines of the chief medical officer (CMO) and the Royal College of Obstetricians and Gynaecologists (RCOG).

Results  One hundred and thirty‐eight (48%) practices responded to the survey, with representation across England and Wales. Policies for screening and/or treatment of chlamydial infection existed for 70% of providers. We found three practice patterns for the management of genital chlamydial infection among termination of pregnancy attenders: 70% of providers tested their own attenders prior to termination and treated if necessary; about 25% of providers administered prophylaxis without testing; and a small number of providers (<5%) neither tested nor treated attenders.

Conclusion  These patterns may be the result of differences in the CMO and RCOG guidelines. Given the impact of untreated genital chlamydial infection in women attending for termination, consistent recommendations from the CMO and RCOG may encourage uniform practice for the management of chlamydial infection in this vulnerable population.
Hypoxia induced activin secretion by the fetoplacental unit: differential responses related to gestation
Authors: Loose Jan M. , Miller Suzanne L. , Supramaniam Veena G. , Ward Janelle W. , O'Connor Anne E. , De Krester David M. , Wallace Euan M. , Jenkin Graham
Published: November 2004

Objective  To determine whether activin A levels reflect oxygen availability in basal and hypoxic conditions in the late pregnant fetus and newborn lamb.

Design  In vivo animal experimental study.

Setting  Department of Physiology, Monash University.

Population  Chronically catheterised fetal sheep in late gestation.

Methods  Fetal hypoxia was induced at 125 (n= 4), 135 (n= 4) or 145 days (‘term’; n= 3) gestational age by maternal nitrogen exposure, for 4 hours, during which maternal and fetal arterial, and amniotic fluid samples were collected. Lambs (age one, five and eight days; n= 3) were exposed to 1 hour of hypoxia via nitrogen exposure.

Main outcome measures  Activin A, prostaglandin E2 (PGE2) and cortisol were analysed in plasma and amniotic fluid, and whole blood was used to determine Pao2, Paco2, %O2, lactate and pH.

Results  Basal activin A concentrations in the fetal arterial circulation remained unchanged between 125 days (0.230 [0.10] ng/mL) and term (0.28 [0.10] ng/mL), as did fetal oxygen saturation (59.11% [4.74%] to 52.25% [4.84%]) and pH (7.35 [0.02] to 7.37 [0.02]). Moderate fetal hypoxia (50% fall in fetal arterial %O2) produced a significant increase in circulating activin A (2.05 [0.67] ng/mL) and a significant decrease in pH (7.27 [0.03]) at 125 days of gestation, however, at 135 and 145 days, activin A and pH remained unchanged. Fetal activin A concentration was significantly correlated with pH (P= 0.036) but not %O2 (P= 0.072). Hypoxia in the lambs did not alter circulating activin A.

Conclusions  In response to hypoxia, activin A is increased in the circulation of 125‐day‐old fetuses, but not in older fetuses. Fetal arterial activin A levels sensitively reflect pH but not oxygen saturation, with increasing activin A in conditions of metabolic acidosis.
Incidence of breast abscess in lactating women: report from an Australian cohort
Authors: Amir Lisa H. , Forster Della , McLachlan Helen , Lumley Judith
Published: November 2004

Objectives  To report the incidence of breast abscess in lactating women.

Design  Data were combined from two studies (a randomised controlled trial and a survey) to provide a cohort of women for this report.

Setting  Women were recruited from two hospitals on one site in Melbourne, Victoria, the Royal Women's Hospital (public) (1999–2001) and Frances Perry House (private) (2000–2001).

Participants  A total of 1193 of 1311 (91%) primiparous, English‐speaking women from a diverse range of backgrounds, including those receiving public clinic care, private care and birth centre care.

Methods  A structured telephone interview was conducted on breastfeeding at six months postpartum.

Main outcome measures  Lactational mastitis and breast abscess.

Results  Two hundred and seven women experienced mastitis. Five women developed a breast abscess: 0.4% of women who commenced breastfeeding (95% CI 0.14–0.98); 2.9% of women who took antibiotics for mastitis (95% CI 1.0–6.7).

Conclusion  Although many authors estimate that 11% of women with mastitis develop a breast abscess, the incidence of lactating breast abscesses in Australia appears to be lower than reported in the past. Our estimate is that 3% of women with mastitis will develop a breast abscess.
Prevalence of Mycoplasma genitalium in early pregnancy and relationship between its presence and pregnancy outcome
Authors: Oakeshott Pippa , Hay Phillip , Taylor‐Robinson David , Hay Sima , Dohn Birthe , Kerry Sally , Jensen Jorgen S.
Published: November 2004

Mycoplasma genitalium is associated with cervicitis and pelvic inflammatory disease but little is known about its role in pregnancy. We investigated the prevalence of M. genitalium by polymerase chain reaction assay on urine specimens from 1216 pregnant women (mean age 31years) presenting before 10 weeks of gestation in 32 general practices. The prevalence of M. genitalium was 0.7% (6/915, 95% CI 0.1–1.2). It was more common in women aged <20 years, women of Afro‐Caribbean or black African ethnic origin, women in social classes 3–5 and single women. Only one woman with M. genitalium infection miscarried, and none of those followed up to term had a preterm birth, although the numbers were small. The low prevalence of M. genitalium infection suggests it is unlikely to be an important risk factor in adverse pregnancy outcome in healthy women in the community.
Testing positive for human papillomavirus in routine cervical screening: examination of psychosocial impact
Authors: McCaffery Kirsten , Waller Jo , Forrest Sue , Cadman Louise , Szarewski Anne , Wardle Jane
Published: November 2004

Objective  To examine the psychosocial impact of testing positive for high risk human papillomavirus (HPV) among women attending primary cervical screening.

Design  Cross sectional survey. Measures were taken at baseline and one week after the receipt of HPV and cytology screening results.

Setting  Well women's clinic in London, UK.

Population or Sample  Four hundred and twenty‐eight women aged 20–64 years.

Methods  Postal questionnaire survey.

Main outcome measures  Psychosocial and psychosexual outcomes were anxiety, distress and feelings about current, past and future sexual relationships.

Results  Women with normal cytology who tested positive for HPV (HPV+) were significantly more anxious and distressed than women who were negative (HPV−) using both a state anxiety measure [F(1,267) = 29, P < 0.0001] and a screening specific measure of psychological distress [F(1,267) = 69, P < 0.0001]. Women with an abnormal or unsatisfactory smear result, who tested HPV+, were significantly more distressed than HPV− women with the same smear result [F(1,267) = 8.8, P= 0.002], but there was no significant difference in state anxiety. Irrespective of cytology result, HPV+ women reported feeling significantly worse about their sexual relationships. Approximately one‐third of women who tested positive reported feeling worse about past and future sexual relationships compared with less than 2% of HPV− women.

Conclusion  The findings suggest that testing positive for HPV may have an adverse psychosocial impact, with increased anxiety, distress and concern about sexual relationships. Psychosocial outcomes of HPV testing need further investigation and must be considered alongside clinical and economic decisions to include HPV testing in routine cervical screening.
Ex vivo analysis of HIV‐1 co‐receptors at the endocervical mucosa of women using oral contraceptives
Authors: Prakash Manyu , Patterson Steve , Gotch Frances , Kapembwa Moses S.
Published: November 2004

Combined oral contraceptives may alter the microenvironment of the female genital tract and, thus, influence susceptibility of endocervical cells to HIV‐1 transmission. The mechanism for this effect is unknown but might involve combined oral contraceptive up‐regulation of chemokine receptors on CD4+ endocervical cells. We measured chemokine co‐receptor (CCR5 and CXCR4) expression on cervical intraepithelial CD4+ T lymphocytes, macrophages and dendritic cells using flow cytometry in 32 healthy women, 16 of whom were combined oral contraceptive users and 16 non‐users. All women tested negative for sexually transmitted infections. Combined oral contraceptive users showed a higher proportion of CCR5+ CD4+ T lymphocytes compared with combined oral contraceptive non‐users (P < 0.05). However, expression of both co‐receptors on cervical intraepithelial macrophages and dendritic cells was no different between the two groups. Up‐regulation of CCR5 on cervical intraepithelial CD4+ T lymphocytes offers a potential explanation by which women receiving combined oral contraceptives may be at increased risk of HIV transmission.
Risks of induction of labour in women with a uterine scar from previous low transverse caesarean section
Authors: Locatelli Anna , Regalia Anna Laura , Ghidini Alessandro , Ciriello Elena , Biffi Anna , Pezzullo John C.
Published: November 2004

Objective  Recent studies have shown that among women with uterine scars from previous caesarean section of any type, induction of labour is associated with increased risk of uterine rupture compared with spontaneous labour. We have assessed the risk of uterine rupture in a cohort of women with a previous low transverse caesarean section in whom induction and management of labour were performed according to a strict protocol.

Design  Cohort study.

Setting  University Hospital.

Population  All women with a singleton pregnancy and a previous low transverse caesarean section requiring induction of labour from 1/1/1992 to 12/30/2001 (n= 310) were compared with a control cohort during the same study period constituted of women with a previous low transverse caesarean section in spontaneous labour (n= 1011).

Methods  Clinical characteristics and rate of uterine rupture of women with previous caesarean section undergoing induction of labour were compared with those of women with previous caesarean section in spontaneous labour.

Main outcome measure  Incidence of uterine rupture.

Results  Uterine rupture occurred in 0.3% in the previous caesarean section—induction group versus 0.3% in the previous caesarean section—spontaneous labour group (P= 0.9). Logistic regression analysis showed no significant difference in the rate of uterine rupture between the induction and spontaneous labour group (P= 0.67) after controlling for maternal age, parity, duration of labour, gestational age at delivery and birthweight.

Conclusion  Among women with a previous low transverse caesarean section, induction of labour is not associated with significantly higher rates of uterine rupture compared with spontaneous labour, provided a consistent protocol with strict criteria for intervention is adopted.
Women's perceived experiences of abuse in the health care system: their relationship to childhood abuse
Authors: Swahnberg Katarina , Wijma Barbro , Wingren Gun , Hilden Malene , Schei Berit
Published: November 2004

Objectives  The aim of this study was to determine whether there was an association between any lifetime experiences of emotional, physical and/or sexual abuse and perceived abuse in the health care system. Furthermore, we wanted to ascertain if adult victims of perceived abuse in the health care system reported exposure to childhood emotional, physical and/or sexual abuse more often than non‐victims did.

Design  A cross sectional questionnaire study. The first hypothesis was tested in the total sample, and the second hypothesis in a case–control analysis. The cases were those women who reported perceived experiences of abuse in the health care system as adults. Exposure was defined as experience of emotional, physical and/or sexual abuse in childhood.

Settings  Three Swedish gynaecological clinics.

Sample  A total of 2439 gynaecology patients (response rate 81%).

Methods  Postal questionnaire.

Main outcome measure  Associations between experiences of emotional, physical and/or sexual abuse, and perceived abuse in the health care system; all operationalised in The NorVold Abuse Questionnaire (NorAQ).

Results  A general association was found between lifetime experiences of emotional, physical and/or sexual abuse and perceived abuse in the health care system. Adult victims of abuse in the health care system reported experiences of emotional, physical and/or sexual abuse in childhood more often than non‐victims did. These findings also held after adjustment for age and educational level.

Conclusions  We found associations between experiences of any lifetime abuse and perceived abuse in the health care system. Adult victimisation in the health care system was associated with childhood exposure to emotional, physical and/or sexual abuse. These associations call for attention and need to be further investigated.
What do they know?: a content analysis of women's perceptions of trial information
Authors: Kenyon Sara , Dixon‐Woods Mary
Published: November 2004

Objective  To examine interpretations of study information by women participating in ORACLE, a trial of antibiotics in preterm labour.

Design  Questionnaire survey sent to women recruited to the ORACLE trial.

Setting  United Kingdom.

Population  A questionnaire was sent to 3074 ORACLE participants in a purposively selected sample of 55 collaborating maternity units, chosen to reflect a range of regions and of district general and teaching hospitals.

Methods  Content analysis was applied to verbatim text provided in response to an open question. Responses were also compared with a framework based on key points about the purpose of ORACLE. Closed questions were analysed using descriptive statistics.

Main outcome measures  Participants' interpretations of the purpose of the study.

Results  A response rate of 61% was achieved, and 1462 participants provided written answers to a specific question on why the study was being carried out. Content analysis suggested that the information leaflet was highly valued as a source of information about the trial. There was evidence that women's interpretations of the purpose of the trial were not identical to those that the investigators intended. Of the five key points about the trial described in the information leaflet, 400 (27%) participants reported one key point, 550 (38%) two key points, 229 (16%) three key points and 23 (1.5%) four key points. None reported five key points and it was not possible to classify 46 responses (3%). Vague, confused understanding or poor recall were evident in 204 (14%) of responses.

Conclusion  Although the ORACLE trial was run as a model of good practice at the time, this study suggests that it may not be possible to demonstrate full understanding of trial purpose and design by all participants. Emphasis should be on the provision of full information that involves consumers in its design and evaluation.
Trends in the cause of late fetal death, 1982–2000
Authors: Bell Ruth , Parker Louise , MacPhail Sheila , Wright Chris
Published: November 2004

Background  Progress in reducing late fetal deaths has slowed in recent years, despite changes in intrapartum and antepartum care.

Objectives  To describe recent trends in cause‐specific fetal death rates.

Design  Retrospective cohort study.

Setting  North of England.

Population/Sample  3,386 late fetal deaths (≥28 weeks of gestation and at least 500 g), occuring between 1982 and 2000.

Methods  Data on deaths were obtained from the Northern Perinatal Mortality Survey. Data on live births were obtained from national birth registration statistics. Rate ratios (RR) and 95% confidence intervals (CI) for fetal deaths in 1991–2000 compared with 1982–1990 were calculated.

Main outcome measures  Cause‐specific late fetal death rates per 10,000 total births.

Results  Mortality in singletons declined from 51.5 per 10,000 births in 1982–1990 to 42.0 in 1991–2000 (RR 0.82, 95% CI 0.76–0.87). There was a greater decline in multiples, from 197.9 to 128.0 per 10,000 (RR 0.65, 95% CI 0.51–0.83). In singletons, the largest reductions occurred in intrapartum‐related deaths, and deaths due to congenital anomalies, antepartum haemorrhage and pre‐eclampsia. There was little change in the rate of unexplained antepartum death occurring at term (RR 0.97, 95% CI 0.84–1.11) or preterm (RR 0.94, 95% CI 0.82–1.07), these accounting for about half of all late fetal deaths. Unexplained antepartum deaths declined in multiple births and in singletons of birthweight <1500 g.

Conclusions  While late fetal mortality due to many specific causes has declined, unexplained antepartum death rates have remained largely unchanged. Improved identification of deaths due to growth restriction and infection, which may otherwise be classified as unexplained, is important. Further investigation of the underlying aetiologies of genuinely unexplained deaths is needed.
The use of levonorgestrel‐releasing intrauterine system for treatment of menorrhagia in women with inherited bleeding disorders
Authors: Kingman C.E.C. , Kadir R.A. , Lee C.A. , Economides D.L.
Published: November 2004

Background  The levonorgestrel‐releasing intrauterine system (LNG‐IUS) is used commonly by gynaecologists as a contraceptive and to treat menorrhagia. However, its efficacy has not been examined in women with inherited bleeding disorders.

Design  A prospective pilot study.

Setting  A teaching hospital in north London with a designated haemophilia centre.

Population  Female patients with a known inherited bleeding disorder.

Methods  Sixteen women with subjective and objective menorrhagia caused by inherited bleeding disorders (13 von Willebrand's Disease, two factor XI deficiency and one Hermansky–Pudlak syndrome), who had previously undergone unsuccessful medical treatment were followed up for nine months after LNG‐IUS insertion. Bleeding was measured by pictorial chart and haemoglobin concentration.

Main outcome measure 

Results  All women reported that their periods were improved, pictorial chart scores were lower and 56% became amenorrhoeic. None reported side effects.

Conclusion  The LNG‐IUS is well tolerated and effective and improves quality of life.
Ignorance of electrosurgery among obstetricians and gynaecologists
Authors: Mayooran Zorana , Pearce Scott , Tsaltas Jim , Rombauts Luk , Brown T. Ian H. , Lawrence Anthony S. , Fraser Kym , Healy David L.
Published: November 2004

Objective  The purpose of this study was to assess the level of skill of laparoscopic surgeons in electrosurgery.

Design  Subjects were asked to complete a practical diathermy station and a written test of electrosurgical knowledge.

Setting  Tests were held in teaching and non‐teaching hospitals.

Sample  Twenty specialists in obstetrics and gynaecology were randomly selected and tested on the Monash University gynaecological laparoscopic pelvi‐trainer. Twelve candidates were consultants with 9–28 years of practice in operative laparoscopy, and 8 were registrars with up to six years of practice in operative laparoscopy. Seven consultants and one registrar were from rural Australia, and three consultants were from New Zealand.

Methods  Candidates were marked with checklist criteria resulting in a pass/fail score, as well as a weighted scoring system. We retested 11 candidates one year later with the same stations.

Main outcome measures  No improvement in electrosurgery skill in one year of obstetric and gynaecological practice.

Results  No candidate successfully completed the written electrosurgery station in the initial test. A slight improvement in the pass rate to 18% was observed in the second test. The pass rate of the diathermy station dropped from 50% to 36% in the second test.

Conclusion  The study found ignorance of electrosurgery/diathermy among gynaecological surgeons. One year later, skills were no better.
Gene expression profile of long‐lived Ames dwarf mice and Little mice
Authors: Amador‐Noguez Daniel , Yagi Kazuo , Venable Susan , Darlington Gretchen
Published: November 2004

Ames dwarf mice (Prop1df/df) and Little mice (Ghrhrlit/lit) are used as models of delayed aging and show significant increases in lifespan (50% and 25%, respectively) when compared with their wild‐type siblings. To gain further insight into the molecular basis for the extended longevity of these mice, we used oligonucleotide microarrays to measure levels of expression of over 14 000 RNA transcripts in liver during normal aging at 3, 6, 12 and 24 months. We found that the Prop1df/df and Ghrhrlit/lit genotypes produce dramatic alterations in gene expression, which are predominantly maintained at all ages. We found 1125 genes to be significantly affected by the Prop1df/df genotype and 1152 genes were significantly affected by the Ghrhrlit/lit genotype; 547 genes were present in both gene lists and showed parallel changes in gene expression, suggesting common mechanisms for the extended longevity in these mutants. Some of the functional gene classes most affected in these mutants included: amino acid metabolism, TCA cycle, mitochondrial electron transport, fatty acid, cholesterol and steroid metabolism, xenobiotic metabolism and oxidant metabolism. We found that the Prop1df/df genotype, and to a minor extent the Ghrhrlit/lit genotype, also produced complex alterations in age‐dependent changes in gene expression as compared with wild‐type mice. In some cases these alterations reflected a partial delay or deceleration of age‐related changes in gene expression as seen in wild‐type mice but they also introduced age‐related changes that are unique for each of these mutants and not present in wild‐type mice.
Lipophilic regulator of a developmental switch in Caenorhabditis elegans
Authors: Gill Matthew S. , Held Jason M. , Fisher Alfred L. , Gibson Bradford W. , Lithgow Gordon J.
Published: November 2004

In Caenorhabditis elegans, the decision to develop into a reproductive adult or arrest as a dauer larva is influenced by multiple pathways including insulin‐like and transforming growth factor β (TGFβ)‐like signalling pathways. It has been proposed that lipophilic hormones act downstream of these pathways to regulate dauer formation. One likely target for such a hormone is DAF‐12, an orphan nuclear hormone receptor that mediates these developmental decisions and also influences adult lifespan. In order to find lipophilic hormones we have generated lipophilic extracts from mass cultures of C. elegans and shown that they rescue the dauer constitutive phenotype of class 1 daf‐2 insulin signalling mutants and the TGFβ signalling mutant daf‐7. These extracts are also able to rescue the lethal dauer phenotype of daf‐9 mutants, which lack a P450 steroid hydroxylase thought to be involved in the synthesis of the DAF‐12 ligand; extracts, however, have no effect on a DAF‐12 ligand binding domain mutant that is predicted to be ligand insensitive. The production of this hormone appears to be DAF‐9 dependent as extracts from a daf‐9;daf‐12 double mutant do not exhibit this activity. Preliminary fractionation of the lipophilic extracts shows that the activity is hydrophobic with some polar properties, consistent with a small lipophilic hormone. We propose that the dauer rescuing activity is a hormone synthesized by DAF‐9 that acts through DAF‐12.
Aging activates adipogenic and suppresses osteogenic programs in mesenchymal marrow stroma/stem cells: the role of PPAR‐γ2 transcription factor and TGF‐β/BMP signaling pathways
Authors: Moerman Elena J. , Teng Kui , Lipschitz David A. , Lecka‐Czernik Beata
Published: November 2004

Osteoblasts and adipocytes originate from a common progenitor, which arises from bone marrow mesenchymal stroma/stem cells (mMSC). Aging causes a decrease in the number of bone‐forming osteoblasts and an increase in the number of marrow adipocytes. Here, we demonstrate that, during aging, the status of mMSC changes with respect to both their intrinsic differentiation potential and production of signaling molecules, which contributes to the formation of a specific marrow microenvironment necessary for maintenance of bone homeostasis. Aging causes a decrease in the commitment of mMSC to the osteoblast lineage and an increase in the commitment to the adipocyte lineage. This is reflected by changes in the expression of phenotype‐specific gene markers. The expression of osteoblast‐specific transcription factors, Runx2 and Dlx5, and osteoblast markers, collagen and osteocalcin, is decreased in aged mMSC. Conversely, the expression of adipocyte‐specific transcription factor PPAR‐γ2, shown previously to regulate osteoblast development and bone formation negatively and to regulate marrow adipocyte differentiation positively, is increased, as is a gene marker of adipocyte phenotype, fatty acid binding protein aP2. Furthermore, production of an endogeneous PPAR‐γ activator(s) that stimulates adipocyte differentiation and production of autocrine/paracrine factor(s) that suppresses the osteoblastic phenotype are also increased. In addition, expression of different components of TGF‐β and BMP2/4 signaling pathways is altered, suggesting that activities of these two cytokines essential for bone homeostasis change with aging.
Accumulation of mutations and somatic selection in aging neural stem/progenitor cells
Authors: Bailey Kimberly J. , Maslov Alexander Y. , Pruitt Steven C.
Published: November 2004

Genomic instability within somatic stem cells may lead to the accumulation of mutations and contribute to cancer or other age‐related phenotypes. However, determining the frequency of mutations that differ among individual stem cells is difficult from whole tissue samples because each event is diluted in the total population of both stem cells and differentiated tissue. Here the ability to expand neural stem/progenitor cells clonally permitted measurement of genomic alterations derived from a single initial cell. C57Bl/6 × DBA/2 hybrid mice were used and PCR analysis with strain‐specific primers was performed to detect loss of heterozygosity on nine different chromosomes for each neurosphere. The frequency with which changes occurred in neurospheres derived from 2‐month‐ and 2‐year‐old mice was compared. In 15 neurospheres derived from young animals both parental chromosomes were present for all nine chromosome pairs. In contrast, 16/17 neurospheres from old animals demonstrated loss of heterozygosity (LOH) on one or more chromosomes and seven exhibited a complete deletion of at least one chromosomal region. For chromosomes 9 and 19 there is a significant bias in the allele that is lost where in each case the C57Bl/6 allele is retained in 6/6 neurospheres exhibiting LOH. These data suggest that aging leads to a substantial mutational load within the neural stem cell compartment which can be expected to affect the normal function of these cells. Furthermore, the retention of specific alleles for chromosomes 9 and 19 suggests that a subset of mutational events lead to an allele‐specific survival advantage within the neural stem cell compartment.
The G/C915 polymorphism of transforming growth factor β1 is associated with human longevity: a study in Italian centenarians
Authors: Carrieri Giuseppina , Marzi Erika , Olivieri Fabiola , Marchegiani Francesca , Cavallone Luca , Cardelli Maurizio , Giovagnetti Simona , Stecconi Rosalia , Molendini Cinzia , Trapassi Chiara , De Benedictis Giovanna , Kletsas Dimitri , Franceschi Claudio
Published: November 2004

Sequence variations in a variety of pro‐ or anti‐inflammatory cytokine genes have been found to influence successful aging and longevity. Because of the role played by the transforming growth factor β1 (TGF‐β1) cytokine in inflammation and regulation of immune responses, the variability of the TGF‐β1 gene may affect longevity by playing a role in inflamm‐aging. Two polymorphisms, G/A−800 and C/T−509, located in the 5′ region, and two missense polymorphisms, T/C869 and G/C915 which change (Leu > Pro)10 and (Arg > Pro)25, respectively, located in the signal peptide, were analysed in 419 subjects from Northern and Central Italy, including 172 centenarians and 247 younger controls. In addition, the effects of the TGF‐β1 genetic variability on plasma levels of the biologically active form (naturally processed) of this cytokine were studied in 143 randomly selected subjects, including 73 centenarians. Significant differences were found at the +915 site as far as the C allele and GC genotype were concerned, both of them being lower in centenarians than in young controls (P = 0.034 and 0.028, respectively), but none of the other tested genetic variants was significantly different between centenarians and controls. Moreover, a particular haplotype combination (G−800/C−509/C869/C915) was notably lower in centenarians than in younger individuals (P = 0.007). Finally, active TGF‐β1 plasma levels were significantly increased in the elderly group, but no relationship with TGF‐β1 genotypes was observed. These results suggest that, at least in this population, the variability of the TGF‐β1 gene influences longevity and that the age‐related increase in plasma levels of active TGF‐β1 seems not to be genetically regulated.
Age‐dependent expression of glucocorticoid‐ and mineralocorticoid receptors on neural precursor cell populations in the adult murine hippocampus
Authors: Garcia Ana , Steiner Barbara , Kronenberg Golo , Bick‐Sander Anika , Kempermann Gerd
Published: November 2004

Steroid hormones are regulators of adult hippocampal neurogenesis and are central to hypotheses regarding adult neurogenesis in age‐related and psychiatric disturbances associated with altered hippocampal plasticity – most notably dementias and major depression. Using immunohistochemistry, we examined the expression of glucocorticoid (GR) and mineralocorticoid (MR) receptors during adult hippocampal neurogenesis. In young mice only 27% of dividing cells in the subgranular zone expressed GR, whereas 4 weeks after division 87% had become positive for GR and MR. GR was expressed by 50% of the radial glia‐like type‐1 and type‐2a progenitor cells, whereas MR was expressed only by mature calbindin‐positive granule cells. Doublecortin‐positive neuronal progenitor cells (type‐2b) and early postmitotic calretinin‐positive neurons were devoid of GR and MR expression. Fifty per cent of the intermediate type‐3 cells showed GR expression, possibly reflecting cells terminating maturation. Thus, all subpopulations of dividing precursor cells showed an identical receptor profile (50% GR, no MR), except for type‐2b cells, which expressed neither receptor. There was also no overlap between calretinin and GR early postnatally (P8) or after physical activity or exposure to an enriched environment, both of which are potent neurogenic stimuli. In contrast, in old age calretinin‐positive young neurons became GR and MR positive, suggesting increased steroid sensitivity. Age also increased the expression of GR in type‐1 and type‐2a precursor cells. Other intermediates were so rare in old age that they could not be studied. This course and variability of receptor expression in aging might help to explain differential vulnerability of adult neural precursor cells to corticoid‐mediated influences.
Ischemia‐induced neurogenesis is preserved but reduced in the aged rodent brain
Authors: Jin Kunlin , Minami Manabu , Xie Lin , Sun Yunjuan , Mao Xiao Ou , Wang Yaoming , Simon Roger P. , Greenberg David A.
Published: November 2004

The adult mammalian brain retains the capacity for neurogenesis, by which new neurons may be generated to replace those lost through physiological or pathological processes. However, neurogenesis diminishes with aging, and this casts doubt on its feasibility as a therapeutic target for cell replacement therapy in stroke and neurodegenerative disorders, which disproportionately affect the aged brain. In previous studies, neurogenesis was stimulated by cerebral ischemia in young rodents, and the neurogenesis response of the aged rodent brain to physiological stimuli, such as hormonal manipulation and growth factors, was preserved. To investigate the effect of aging on ischemia‐induced neurogenesis, transient (60 min) middle cerebral artery occlusion was induced in young adult (3‐month) and aged (24‐month) rats, who were also given bromodeoxyuridine to label newborn cells. As found in prior studies, basal neurogenesis in control, nonischemic rats was reduced with aging. Ischemia failed to stimulate neurogenesis in the dentate gyrus (DG) subgranular zone (SGZ), in contrast to results obtained previously after more prolonged (90–120 min) middle cerebral artery occlusion, but increased the number of BrdU‐labeled cells in the forebrain subventricular zone (SVZ). This effect was less prominent in aged than in young adult rats, with fold‐stimulation of BrdU incorporation reduced by ∼20% and the total number of cells generated diminished by ∼50%. BrdU‐labeled cells in SVZ coexpressed neuronal lineage markers, consistent with newborn neurons. We conclude that ischemia‐induced neurogenesis occurs in the aged brain, and that measures designed to augment this phenomenon might have therapeutic applications.
Neural stem cells as therapeutic agents for age‐related brain repair
Authors: Bernal Giovanna M. , Peterson Daniel A.
Published: November 2004

Neurogenesis occurs in two germinal centres of the adult brain and persists with increasing age, although at a reduced level. This observation, that the mature brain can support neurogenesis, has given rise to the hope that neural stem cells could be used to repair the brain by repopulating regions suffering from neuronal loss as a result of injury or disease. The aging brain is vulnerable to mild cognitive impairment, increasing incidence of stroke, and a variety of neurodegenerative diseases. However, most studies to date have focused on the young adult brain, and relatively little information is available about the regulation of neurogenesis in the aged brain or the potential of using neural stem cells to repair the aged brain. This review summarizes the current state of knowledge on neurogenesis in the young adult brain and discusses the information available on age‐related changes in neurogenesis. Possible therapeutic strategies using neural stem cells for repair of the aging brain are considered.
Ellipsometry analysis of the in vitro adsorption of tea polyphenols onto salivary pellicles
Authors: Joiner Andrew , Muller Dries , Elofsson Ulla M. , Arnebrant Thomas
Published: November 2004

The adsorption of components from black tea and of purified tea polyphenols onto a whole unstimulated salivary pellicle‐like protein layer, formed in vitro on hydroxyapatite discs, was studied by in situ ellipsometry. It was found that components from black tea and the purified polyphenols epicatechin‐3‐gallate (ECG), epigallocatechin‐3‐gallate (EGCG) and theaflavin readily adsorbed onto the pellicle. Further investigations showed that under the experimental conditions of this study, no black tea‐ or purified polyphenol‐modified pellicles were eluted by either phosphate buffer or sodium dodecyl sulphate rinses. Therefore, black tea and its polyphenol components are indicated to have a profound effect on in vitro pellicle modification. Similar effects were observed for tannic acid.
Dental trait anxiety and pain sensitivity as predictors of expected and experienced pain in stressful dental procedures
Authors: Klages Ulrich , Ulusoy Özlem , Kianifard Simin , Wehrbein Heinrich
Published: November 2004

A prevailing hypothesis suggests that exaggerated pain expectations in dentally anxious and pain‐sensitive patients might usually be disconfirmed by a lower level of pain experienced during treatment. The present study was conducted to investigate whether this contention also holds during stressful dental procedures. Patients reporting high and low levels of dental fear and of pain sensitivity were compared in their expected and experienced pain and in the concordance between the two measures. Participants were 97 patients undergoing extraction and root canal treatment. The measuring instruments used were the Dental Anxiety Scale (DAS), the Pain Sensitivity Index (PSI), affective and sensory pain descriptor scales, and a numerical pain‐intensity scale. The results demonstrated that patients, in general, expected more pain than they subsequently experienced. Subjects with a high DAS score both expected and experienced more pain than those with a low DAS score. Within the group of subjects with a high DAS score, those indicating high pain sensitivity expected and experienced more pain than their counterparts; additionally, only those reporting low pain sensitivity disconfirmed their high pain expectancies. The results suggest that during stressful dental procedures, patients indicating dental anxiety and pain sensitivity above median levels are especially at risk of stabilizing exaggerated pain expectations and dental fear.
Immunoexpression of extracellular matrix proteins in human salivary gland development
Authors: Furuse Cristiane , Cury Patrícia Ramos , De Araújo Ney Soares , De Araújo Vera Cavalcanti
Published: November 2004

Immunoexpression of the extracellular matrix (ECM) proteins laminin, fibronectin, tenascin and types I, III and IV collagen was analyzed in the major and minor salivary glands of seven human fetuses at different gestational ages. The results showed the presence and localization of laminin, collagen IV and fibronectin around glandular structures at all stages of development. Tenascin was only detectable around excretory ducts. In the earliest stages of development, type I and type III collagen were presented as fine fibers delineating the glandular structures and delimiting the extension of the future lobule. As glandular development proceeded, the lobule was gradually filled with collagens and glandular tissue.