bluuebunny/crossref_metadata_2025 huggingface dataset:
Evolutionary distributions in adaptive space
Authors: Cohen Yosef
Published: December 2005

An evolutionary distribution (ED), denoted by z(x, t), is a distribution of density of phenotypes over a set of adaptive
traits x. Here x is an n‐dimensional
vector that represents the adaptive space. Evolutionary
interactions among phenotypes occur within an ED and between EDs.
A generic approach to modeling systems of ED is developed. With
it, two cases are analyzed. (1) A predator prey inter‐ED
interactions either with no intra‐ED interactions or with
cannibalism and competition (both intra‐ED interactions). A
predator prey system with no intra‐ED interactions is stable.
Cannibalism destabilizes it and competition strengthens its
stability. (2) Mixed interactions (where phenotypes of one ED both
benefit and are harmed by phenotypes of another ED) produce
complete separation of phenotypes on one ED from the other along
the adaptive trait. Foundational definitions of ED, adaptive
space, and so on are also given. We argue that in evolutionary
context, predator prey models with predator saturation make less
sense than in ecological models. Also, with ED, the dynamics of
population genetics may be reduced to an algebraic problem.
Finally, extensions to the theory are proposed.
A general asymptotic dynamic model for Lipschitzian elastic curved rods
Authors: Vodák Rostislav
Published: December 2005

We study the asymptotic behaviour of solutions to the linear
evolution problem for clamped curved rods with the
small thickness ε under minimal regularity assumptions
on the geometry. In addition, nonconstant density of the curved
rods is considered.
Determination of Mercury in an Assortment of Dietary Supplements Using an Inexpensive Combustion Atomic Absorption Spectrometry Technique
Authors: Levine Keith E. , Levine Michael A. , Weber Frank X. , Hu Ye , Perlmutter Jason , Grohse Peter M.
Published: December 2005

The concentrations of mercury in forty, commercially available dietary supplements, were determined using a new, inexpensive analysis technique. The method involves thermal decomposition, amalgamation, and detection of mercury by atomic
absorption spectrometry with an analysis time of approximately six minutes per sample. The primary cost savings from this approach is that labor‐intensive sample digestion is not required prior to analysis, further automating the analytical procedure. As a result, manufacturers and regulatory agencies concerned with monitoring lot‐to‐lot product quality may find this approach an attractive alternative to the more classical acid‐decomposition, cold vapor atomic absorption methodology. Dietary supplement
samples analyzed included astragalus, calcium, chromium picolinate, echinacea, ephedra, fish oil, ginger, ginkgo biloba, ginseng, goldenseal, guggul, senna, St John′s wort, and yohimbe products. Quality control samples analyzed with the dietary supplements indicated a high level of method accuracy and precision. Ten replicate preparations of a standard reference material (NIST 1573a, tomato leaves) were analyzed, and the
average mercury recovery was 109% (2.0% RSD). The method quantitation limit was 0.3 ng, which corresponded to 1.5 ng/g sample. The highest found mercury concentration (123 ng/g) was measured in a concentrated salmon oil sample.
When taken as directed by an adult, this product would result in an approximate mercury ingestion of 7 μg per week.
Technical Considerations in Remote LIMS Access via the World Wide Web
Authors: Ulma William , Schlabach David M.
Published: December 2005

The increased dependency on the World Wide Web by both laboratories and their customers has led LIMS developers to take advantage of thin‐client web applications that provide both remote data entry and manipulation, along with remote reporting functionality. Use of an LIMS through a web browser allows a person to interact with a distant application, providing both remote administration and real‐time analytical result delivery from virtually anywhere in the world. While there are many benefits of web‐based LIMS applications, some concern must be given to these new methods of system architecture before justifying them as a suitable replacement for their traditional
client‐server systems. Developers and consumers alike must consider the security aspects of introducing a wide area network capable system into a production environment, as well as the concerns of data integrity and usability.
Design and Development of Microcontroller‐Based Clinical ChemistryAnalyser for Measurement of Various Blood Biochemistry Parameters
Authors: Taneja S. R. , Gupta R. C. , Kumar Jagdish , Thariyan K. K. , Verma Sanjeev
Published: December 2005

Clinical chemistry analyser is a high‐performance microcontroller‐based photometric biochemical analyser to measure various blood biochemical parameters such as blood glucose, urea, protein, bilirubin, and so forth, and also to measure and observe
enzyme growth occurred while performing the other biochemical tests such as ALT (alkaline amino transferase), amylase, AST (aspartate amino transferase), and so forth. These tests are of great significance in biochemistry and used for diagnostic purposes and classifying various disorders and diseases such as diabetes, liver malfunctioning, renal diseases, and so forth. An inexpensive clinical chemistry analyser developed by the authors
is described in this paper. This is an open system in which any reagent kit available in the market can be used. The system is based on the principle of absorbance transmittance photometry. System design is based around 80C31 microcontroller with RAM, EPROM, and peripheral interface devices. The developed system incorporates light source, an optical module, interference filters of various wave lengths, peltier device for maintaining required temperature of the mixture in flow cell, peristaltic pump for sample aspiration, graphic LCD display for displaying blood parameters, patients test results and kinetic test graph, 40 columns mini thermal printer, and also 32‐key keyboard for executing various functions. The lab tests conducted on the instrument include versatility of the analyzer, flexibility of the software, and treatment of sample. The prototype was tested and evaluated over 1000 blood samples successfully for seventeen blood parameters. Evaluation was carried out at Government Medical College and Hospital, the Department of Biochemistry. The test results were found to be comparable with other standard
instruments.
Automated Microdosing System for Integration With a Miniaturized High‐pressure Reactor System
Authors: Stoll Norbert , Hawali Ihsan , Thurow Kerstin
Published: December 2005

We present a new automated dosing system developed by the Institute for Automation of the University of Rostock, Germany. The new system is designed for the dosing of chemical liquids in the range of 50 μL–2.5 mL. It is integrated into a miniaturized reactor system to be used in the field of combinatorial synthesis. The reactor system can be pressurized up to 150 bar and tempered up to 200°C. A wide range of liquids with different physical properties can be handled with the new dosing system. A detailed description of the new dosing system in terms of function and operation as well as the relevant features and potential benefits is provided.
Validation of Platelet Counting Accuracy With the Celltac F AutomatedHematology Analyzer
Authors: Nagai Yutaka , Kondo Hiroshi , Tatsumi Noriyuki
Published: December 2005

Rapid and accurate analysis of platelet count plays an important role in evaluating hemorrhagic status. Therefore, we evaluated platelet counting performance of a hematology analyzer, Celltac F (MEK‐8222, Nihon Kohden Corporation, Tokyo, Japan), that
features easy use with low reagent consumption and high throughput while occupying minimal space in the clinical laboratory. All blood samples were anticoagulated with dipotassium ethylenediaminetetraacetic acid (EDTA‐2K). The samples were stored
at room temperature (18∘C–22∘C) and tested within 4 hours of phlebotomy. We evaluated the counting ability of the Celltac F hematology analyzer by comparing it with the platelet counts obtained by the flow cytometry method that ISLH and ICSH recommended, and also the manual visual method by Unopette (Becton Dickinson Vacutainer Systems). The ICSH/ISLH reference method is based on the fact that platelets can be stained with monoclonal antibodies to CD41 and/or CD61. The dilution ratio was optimized after the precision, coincidence events, and debris counts were confirmed by the reference method. Good correlation of platelet count between the Celltac F and the ICSH/ISLH reference method (r = 0.99), and the manual visual method (r = 0.93) were obtained. The regressions were y = 0.90x + 9.0 and y = 1.11x + 8.4, respectively. We conclude that the Celltac F hematology analyzer for platelet counting was well suited to the ICSH/ISLH reference method for rapidness and reliability.
The Third Generation of Therapeutic Communities: The Early Development of the TC for Addictions in Europe
Authors: Broekaert Eric , Vandevelde Stijn , Soyez Veerle , Yates Rowdy , Slater Anthony
Published: December 2005

Aims: It is the goal of this study to investigate the first development of the drug-free therapeutic community (TC) in Europe. The paper aims at systemizing information, scattered all over Europe and is the first stage in an ongoing study to record the development of the European TC movement and its influences. Design: After a study of the grey (hidden) literature, TC pioneers and experts per country were contacted to further elaborate the first findings. Subsequently, a preliminary summary of our findings was published in the Newsletter of the European Federation of Therapeutic Communities (EFTC), inviting additional information and corrections. The authors completed the results for this article with relevant first-hand information, obtained through interviews with European pioneers. Findings: The findings are summarized under three topics: chronology, interconnections and European identity. It was found that from 1968 until 1989, a new therapeutic approach arose all over Europe, modeled after Synanon, Daytop and Phoenix House, New York, through Phoenix House, London and Emiliehoeve in the Netherlands. Therapeutic communities were established in Belgium, Finland, Germany, Greece, Ireland, Italy, Norway, Spain, Sweden and Switzerland as well. These communities were closely-knit and interconnected in their reaction against psychiatric and methadone treatment. The European TCs developed an own identity compared to the American ones. Conclusions: The European TCs adapted the model of their American predecessors to their own culture, influenced more by milieu-therapy and social learning. Instead of harsh behaviorism, more emphasis was placed on dialogue and understanding. Professionals occupied a more pivotal role and took over the dominant position of ex-addicts. Research, executed by TC professionals gradually entered the TC. A generic network of TC connections, through which the development evolved, was uncovered, and clear regional trends can be observed.
Co-Morbidity of Infectious and Addictive Diseases in St. Petersburg and the Leningrad Region, Russia
Authors: Krupitsky E.M. , Zvartau E.E. , Lioznov D.A. , Tsoy M.V. , Egorova V.Y. , Belyaeva T.V. , Antonova T.V. , Brazhenko N.A. , Zagdyn Z.M. , Verbitskaya E.V. , Zorina Y. , Karandashova G.F. , Slavina T.Y. , Grinenko A.Y. , Samet J.H. , Woody G.E.
Published: December 2005

The Russian health care system is organized around specific diseases, with relatively little focus on integration across specialties to address co-morbidities. This organizational structure presents new challenges in the context of the recent epidemics of injection drug use (IDU) and HIV. This paper uses existing and new data to examine the prevalence of reported new cases of drug dependence (heroin) and HIV over time as well as associations between drug dependence and alcoholism, hepatitis B and C, and tuberculosis in the City of St. Petersburg and the Leningrad region. We found a sharp rise in reported cases of IDU beginning in 1991 and continuing until 2002/2003, followed by a sharp rise in newly reported cases of HIV. These rises were followed by a drop in new cases of HIV and drug addiction in 2002/2003 and a drop in the proportion of HIV-positve individuals with IDU as a risk factor. Infection with hepatitis B and C were common, especially among injection drug users (38 and 85%, respectively), but also in alcoholics (7 and 14%). Tuberculosis was more common in alcoholics (53%) than in persons with alcoholism and drug dependence (10%), or with drug dependence alone (4%). Though these data have many limitations, they clearly demonstrate that drug dependence and/or alcoholism, HIV, hepatitis, and tuberculosis frequently co-occur in St. Petersburg and the Leningrad Region. Prevention and treatment services across medical specialties should be integrated to address the wide range of issues that are associated with these co-morbidities.
Parental Anti-Smoking Socialization
Authors: den Exter Blokland Endy A.W. , Hale, III William W. , Meeus Wim , Engels Rutger C.M.E.
Published: December 2005

This longitudinal study of 600 families concentrates on the influence of parental anti-smoking socialization by examining both (a) the effects of eight indicators of anti-smoking socialization on adolescent smoking and (b) the influence of parental smoking on the effectiveness of their anti-smoking socialization. Robust differences between smoking and non-smoking parents demonstrated that both kinds of families hold different norms and attitudes about adolescent smoking and how to deal with it. In terms of effective anti-smoking socialization, it appeared that parental involvement on a more abstract level, such as feeling confident one has influence on the smoking behaviour of one’s child and having knowledge whether one’s child and his or her friends smoke, seemed important in preventing early adolescent smoking, while concrete communication or house rules about smoking were not.
Drugs and Social Exclusion in Ten European Cities
Authors: March Joan Carles , Oviedo-Joekes Eugenia , Romero Manuel
Published: December 2005

Aim: To describe social characteristics seen among socially excluded drug users in 10 cities from 9 European countries, and identify which social exclusion indicators (i.e. housing, employment, education) are most closely linked to intravenous drug use. Design: Cross-sectional survey. Setting: Interviews were held in social services centers, town halls, streets, squares and other usual meeting points of the target population. Participants: The sample comprises 1,879 participants who have used heroin and/or cocaine and certain derivatives (92.3%) over the last year. Males accounted for 69.7% of the sample, and the mean age was 30.19 years. Participants were recruited in 10 cities: Seville and Granada, Spain; Cologne, Germany; Vienna, Austria; Brussels, Belgium; Athens, Greece; Dublin, Ireland; London, England; Lisbon, Portugal, and Perugia, Italy. Measurements: Structured face-to-face questionnaire, conducted by privileged access interviewers. Results: Cannabis, heroin and cocaine are the most widely used substances. In the total sample, 60.2% injected drugs during the last year, 45.9% reported having hepatitis C; 54.9% have been in prison; 14.2% are homeless; 11.3% have a regular job, and 35.2% are involved in illegal activities. Hierarchical logistic regression analysis (injectors and non-injectors) showed that older participants have a greater likelihood of injecting than younger ones. Social exclusion variables associated with intravenous drug use are incarceration, homelessness, irregular employment, and delinquency. Participants who abandoned or were expelled from a drug treatment program are at greater risk of injecting drugs than participants who have never had treatment, are currently in treatment or have been released. Conclusion: Personal, social, and economic conditions are all linked in a process of social exclusion that compounds problem drug misuse. Given the findings of this study, we believe that there is a clear need for specific programs targeting specific groups, i.e., distinct strategies must be set in place, in line with the profile and needs of the patient in each context.
Alcohol and Injury: A Risk Function Analysis from the Emergency Room Collaborative Alcohol Analysis Project (ERCAAP)
Authors: Cherpitel Cheryl J. , Bond Jason , Ye Yu
Published: December 2005

While emergency room (ER) studies have documented a strong association of alcohol and injury, less is known about the level of risk at which various quantities of alcohol or particular patterns of drinking place the individual for injury. Comparative risk function analyses are carried out in ER samples in seven countries that cover sites in 14 studies included in the Emergency Room Collaborative Alcohol Analysis Project (ERCAAP). Risk of injury is analyzed for the mean number of drinks consumed per day and the number of occasions in which 5 or more drinks were consumed at one time (5+) during the last year. All countries showed similar increases in injury risk to an average volume of about 2 drinks per day, with a leveling off of risk at higher average daily volumes, with the exception of Italy. Risk of injury increased to 12 or more 5+ days for the USA, Canada and Mexico, but leveled off after only 3 5+ days for Argentina and Spain. Poland showed increased risk to 30 5+ days. Similar risk curves were found for both males and females, although females were at lower risk of injury in all countries expect Spain and Poland. In low detrimental drinking pattern societies, risk curves showed higher risk for any drinking and any frequency of 5+ but at higher levels of each, risk levels decreased nearly to levels found for abstainers. Risk functions were also consistent across gender and age groups in low detrimental drinking pattern societies, with higher risk for males and those <30. For those countries with high detrimental drinking patterns, injury risk increased with volume and 5+ drinking primarily among males. This ER-based risk function analysis suggests that risk of injury increases proportionally with increased alcohol consumption at lower consumption levels, but a threshold effect is achieved at relatively low levels of mean daily consumption and higher consumption times. Risk may be culturally specific, dependent, in part, on the manner in which alcohol is used in the culture.
Endoscopic Therapy for Oesophageal Cancer
Authors: Ng Enders K.W.
Published: December 2005

Transthoracic surgery for oesophageal cancer is associated with a high incidence of respiratory complications. Recent development of minimally invasive oesophagectomy by the use of video-assisted thoracoscopic approach may have a potential to minimize morbidity and mortality. While results from earlier series were equivocal, recent reports have shown an encouraging trend. This article serves to review the recent literature evidence in relation to the surgical approach, safety, efficacy and potential problems of such a highly complex minimally invasive operation.
Laparoscopic-Endoscopic Rendezvous Resection of Upper Gastrointestinal Tumors
Authors: Schubert D. , Kuhn R. , Nestler G. , Kahl S. , Ebert M.P. , Malfertheiner P. , Lippert H. , Pross M.
Published: December 2005

Background: Endoscopic and laparoscopic local resection of gastric tumors has increasingly been performed in recent years. This article describes the technical considerations and early results of laparoscopic-endoscopic rendezvous resection of gastric lesions. Patients and Methods: Rendezvous resection was performed in 26 patients with submucosal gastric tumors (n = 22) and early gastric cancer (n = 4). Laparoscopic wedge resection (LWR) was performed in 16 patients with anterior wall tumors and laparoscopic intragastric resection (LIR) in 7 patients with posterior wall tumors. Conversion to open surgery was carried out in 3 cases. Results: Operation times were 53 min (range 35–115) for LWR and 83 min (range 56–130) for LIR, respectively. In submucosal lesions the mean tumor size was 36 mm (range 16–47) and in early gastric cancer 17.3 mm (range 16–20). Rendezvous resection was performed with curative intent and clear resection margins in all patients without lymphatic or vessel permeation. Postoperative complications occurred in 2 patients. After a mean follow-up of 22.8 months (range 2–71), no local recurrence or metastatic disease and no tumor-related death were observed. Conclusions: When selected properly, the laparoscopic-endoscopic approach is considered to be curative and safe for resection of localized gastric tumors.
Laparoscopic Gastrectomy for Cancer
Authors: Etoh Tsuyoshi , Shiraishi Norio , Kitano Seigo
Published: December 2005

There are three procedures for the management of early gastric cancer (EGC): laparoscopic wedge resection (LWR), intragastric mucosal resection (IGMR), and laparoscopic gastrectomy. LWR or IGMR can be applied to treat EGC without the risk of lymph node metastasis. However, owing to the recent technical advances in endoscopic mucosal resection for EGC, the use of laparoscopic local resection for these lesions has gradually decreased. On the other hand, laparoscopic gastrectomy with lymph node dissection, such as laparoscopy-assisted distal gastrectomy, is widely accepted for the treatment of EGC with the risk of lymph node metastasis. To establish the acceptability of laparoscopic gastrectomy with D2 lymph node dissection against advanced gastric cancers, safe techniques and new instruments must be developed. The following advantages of laparoscopic surgery for the treatment of gastric cancer have been well demonstrated: clinical course after operation, pulmonary function, immune response. In the future, laparoscopic surgeons have to design and implement education and training systems for standard laparoscopic procedures, evaluate clinical outcomes by multicentric randomized control trial studies, and clarify the oncological aspects of laparoscopic surgery in basic studies.
Current Status of Laparoscopic Therapy of Cholecystolithiasis and Common Bile Duct Stones
Authors: Shamiyeh Andreas , Wayand Wolfgang
Published: December 2005

Background: Laparoscopic cholecystectomy (LC) is the standard operation for gallstone disease. The aim of this review was to scrutinize the advantages and benefits of this minimal invasive technique compared to the conventional operation according to the available literature. Regarding the evidence-based medicine criteria, the current status of laparoscopy in the treatment of cholecystolithiasis, cholecystitis and common bile duct stones has been worked out. Methods: A Medline, PubMed, Cochrane search. Results: Ten randomized controlled trials (RCTs) are available comparing laparoscopic versus open cholecystectomy. The superiority of LC in less postoperative pain, shorter recovery and hospital stay is stated. Operation time was longer in the first years of LC. 3 RCTs deal with acute cholecystitis: one paper could not find any significant advantage of LC over conventional cholecystectomy, the other two found benefits in recovery, hospital stay and postoperative pain. The range of conversion is between 5 and 7% in elective cases and increases up to 27% for acute cholecystitis. With a rate of more than 90% in Europe, the standard procedure for common bile duct stones is ‘therapeutic splitting’ with endoscopy and retrograde cholangiopancreatography preoperatively followed by LC. Laparoscopic bile duct clearance is effective and safe in experienced hands, however, the only proven benefit is a slightly shorter hospital stay. Conclusion: The laparoscopic approach is preferred in elective cholecystectomy and acute cholecystitis. The minimal invasive technique has proven to be effective, gentle and safe. The main benefits are evident within the first postoperative days.
Current Status of Laparoscopic Therapy of Colorectal Cancer
Authors: Bruch H.-P. , Esnaashari H. , Schwandner O.
Published: December 2005

Laparoscopic colorectal resections offer several benefits postoperatively, including minimal impairment of gastrointestinal and pulmonary function, less immunosuppression, shorter hospital stay and improved reconvalescence. Since the introduction of laparoscopic surgery for the therapy of curable colorectal cancer, some concern was voiced in terms of oncologic radicality, the issue of port-site metastases and tumor cell distribution. However, the clinical reality has demonstrated that oncologic radicality is equivalent to open surgery, and the incidence of port-site metastases is not increased when compared to wound recurrence at the laparotomy site. Focusing on colon and rectum, various indications of laparoscopic-endoscopic ‘rendezvous’ procedures exist including laparoscopic-assisted endoscopic transluminal resection, endoscopic-assisted wedge or anatomical resections, and, finally, intraoperative tumor location by colonoscopy to achieve oncologic resection margins in laparoscopic curative resections. In terms of colorectal curative resections, long-term results provide level I evidence that laparoscopic surgery for colon cancer is oncologically adequate and can be performed with equivalent morbidity and mortality rates when compared to conventional surgery. In terms of rectal cancer, no level I evidence is available. However, short-term data from experienced centers do not report inferior oncologic outcome particularly related to laparoscopic total mesorectal excision.
Laparoscopic Total Mesorectal Excision for Rectal Cancer Surgery
Authors: Marescaux Jacques , Rubino Francesco , Leroy Joel
Published: December 2005

The introduction of total mesorectal excision in the early 1980s has improved local control and survival in patients with rectal cancer. Laparoscopic resections for colonic malignancies are gaining acceptance in the light of the recent evidence of oncologic adequacy from randomized clinical trials. Technical difficulties and the difference in the natural history of the disease have excluded rectal cancer from major clinical trials comparing laparoscopic to conventional rectal surgery. This review examined the feasibility, safety and oncologic outcomes of reported laparoscopic total mesorectal excision for surgical treatment of operable rectal cancer.
p16 Gene Methylation in Colorectal Tumors: Correlation with Clinicopathological Features and Prognostic Value
Authors: Sanz-Casla M.T. , Maestro M.L. , Vidaurreta M. , Maestro C. , Arroyo M. , Cerdán J.
Published: December 2005

Background: Methylation of the CpG islands in the p16 gene promoter region is an important transcription repression mechanism that has been identified as an alternative mechanism for inactivating specific genes in cancer. Given that, DNA methylation is a common event in colorectal cancer. Materials and Methods: The aim of this study was to establish the methylation status of the p16 gene in 104 patients with colorectal carcinoma and evaluate its prognostic value. DNA was bisulfite-modified and analyzed for p16 promoter methylation by methylation-specific PCR. Results: Methylation of thep16 gene was determined in 18.3% of our patient population (19/104). The methylated state did not correlate with any clinicopathological factors. During a median follow-up period of 72 months, the overall survival rate for patients with gene methylation was 75% and without gene methylation it was 61% (p = 0.09). Conclusions: Although not statistically significant, this difference indicates a clinically valuable tendency.
Placental Lesions in a Case of DiGeorge Sequence
Authors: Fulcheri E. , Gualco M. , Delfino F. , Pantarotto M.F.
Published: December 2005

This work describes some placental alterations found in a partial form of DiGeorge sequence, namely, hypoplasia of a cord artery with internal calcification of an extensive endoluminal thrombosis, and widespread calcification of microthrombi in the arteries of the second and third order villous branches. Hypoplasia of a cord artery is a relatively rare event, and is also associated with malformations of the gastroenteric and cardiovascular system, as sometimes described in the DiGeorge sequence. Interesting placental alterations are reported and their likely physiopathologic basis and pathogenic correlation discussed in order to give a better and more comprehensive picture of the DiGeorge sequence in which the correlated placental alterations are not sufficiently known.
Massive Feto-Maternal Hemorrhage: Diagnosis by Cardiotocography, Doppler Ultrasonography and ST Waveform Analysis of Fetal Electrocardiography
Authors: Malcus Peter , Björklund Lars J. , Lilja Monica , Teleman Pia , Laurini Ricardo
Published: December 2005

A 34-year-old healthy gravida 2 para 1 presented after an uncomplicated pregnancy at term with a 2-day history of diminished fetal movements. Fetal anemia was suspected by fetal heart rate monitoring and Doppler estimation of the fetal peak blood flow velocity of the middle cerebral artery. We were also fortunate to register pathological ST waveform changes of the fetal ECG indicating fetal hypoxia. The diagnosis of a massive feto-maternal hemorrhage was confirmed by an extremely high fraction of erythrocytes containing fetal hemoglobin in maternal blood and, after delivery, by placental histology.
Prenatal Diagnosis of Hypochondroplasia: Three-Dimensional Multislice Computed Tomography Findings and Molecular Analysis
Authors: Bonnefoy O. , Delbosc J.M. , Maugey-Laulom B. , Lacombe D. , Gaye D. , Diard F.
Published: December 2005

We report the first case of sporadic hypochondroplasia diagnosed in utero by computed tomography (CT) three-dimensional (3D) imaging and molecular analysis at 38 weeks’ gestation. Prenatal sonographic examinations performed at 32 and 35 weeks’ gestation revealed a rhizomelic shortness of the long bones (femur and humerus) with macrocephaly. Based on these findings, a nonlethal form of skeletal dysplasia was suspected and a multislice CT imaging with 3D reconstruction was performed depicting skeletal abnormalities which suggested hypochondroplasia. The prenatal diagnosis was confirmed by DNA mutation analysis of the fibroblast growth receptor 3 gene.
Sonographic Cervical Length Measurement before Labor Induction in Term Nulliparous Women
Authors: Daskalakis George , Thomakos Nikolaos , Hatziioannou Leonardos , Mesogitis Spyros , Papantoniou Nikolaos , Antsaklis Aris
Published: December 2005

Objective: The purpose of the study was to determine if transvaginal sonographic measurement of the cervical length is a useful method to predict successful labor induction in nulliparas. Methods: 137 women who were scheduled for medically indicated induction of labor had a transvaginal sonographic measurement of the cervical length before labor induction. Inclusion criteria were: (1) singleton pregnancy; (2) gestational age between 37–42 weeks; (3) live fetus in cephalic presentation; (4) intact membranes; (5) no vaginal bleeding; (6) no previous history of uterine surgery; (7) nulliparous women, and (8) no allergy or asthma in response to prostaglandins. Induction of labor was performed within 6 h of the ultrasonographic examination, by inserting 2 mg of dinoprostone in the posterior vaginal fornix, repeated if needed every 6 h for up to three doses. When the cervix became favorable and no regular contractions were observed, amniotomy and oxytocin augmentation, starting at 1 mIU/min and increasing 1 mIU every 30 min as necessary, was performed. Results: All women were Caucasians and the mean age was 24.3 years (range 19–37 years). The mean cervical length was 28 mm (range 11–39 mm). The Bishop score was ≤5 in 101 women and >5 in the 36 others. Vaginal delivery occurred in 92 women (67.1%), and the vast majority of them (89 women; 96.7%) gave birth within 24 h of induction. Forty-five women (32.8%) had a cesarean section. The Bishop score was not predictive of the mode of delivery. Thirty-six of 101 women (35.6%) with a Bishop score ≤5 delivered by cesarean section, compared to 9 of 36 women with a Bishop score >5 (25%) (p = NS). Women with a cervical length <27 mm were more likely to deliver vaginally. Using this cutoff value the sensitivity of a successful labor induction was 76% and the specificity was 75.5%. Conclusions: Transvaginal sonographic measurement of cervical length is a good predictor of a successful labor induction at term in nulliparas.
Fetal Lung Growth in Congenital Diaphragmatic Hernia
Authors: Bargy F. , Beaudoin S. , Barbet P.
Published: December 2005

Background: In spite of significant therapeutic progress, the prognosis of congenital diaphragmatic hernia (CDH) remains pejorative in those forms in which the liver is herniated into the chest. The severity of this malformation relies on the pulmonary hypoplasia due to lung compression by the herniated viscera in the thoracic cavity, particularly the liver. This impaired growth concerns the whole pulmonary tissue, i.e. both the vessels and the alveoli. For the clinician, it is mandatory to know the evolution pattern of the lesions, to define the best time to treat them. Aim and Method: The aim of this work was to study the pulmonary lesions along the gestation in fetuses affected byCDH. This morphological study was carried out on 134 human fetuses aged from 22 to 40 weeks of gestation. Anatomical and histological analysis focused on lung weight, alveolar count and wall thickness of the distal vessels. Results: The results indicate that the pulmonary lesions worsen as the pregnancy continues, particularly beyond 30 weeks of gestation. Conclusion:Such an anatomical study should bring to the clinicians useful data to enhance the management of the patients.
Evaluation Levels of Cytokines in Amniotic Fluid of Women with Intrauterine Infection in the Early Second Trimester
Authors: Suzuki Yoshikatsu , Yamamoto Tamao , Kojima Kazuhisa , Tanemura Mitsuyo , Tateyama Hisashi , Suzumori Kaoru
Published: December 2005

Amniotic fluid was obtained from 180 patients by amniocentesis at 16–22 weeks of gestation and assayed for the levels of interleukin (IL)-6, IL-8, leukocyte elastase (LE), and glucose. Ten of cases had clinical symptoms, such as uterine contraction, genital bleeding, and cervical ripening, and the other 170 were assessed for fetal chromosomal features. Four of the ten cases with uterine contraction developed abortion, while 10 of those screened had findings of fetal chromosomal anomalies, and 7 cases then underwent induced abortion artificially. In the cases of abortion, levels of IL-6, IL-8 and LE were higher than in the samples from the 160 pregnant women without clinical symptoms and a normal karyotype, while glucose in amniotic fluid was lower. Of 6 cases with clinical symptoms, but not developing abortion, 4 developed preterm labor, and in these IL-6 and IL-8 also were significantly elevated, with LE being slight high compared to normal. The results suggest that IL-6, IL-8, LE, and glucose in amniotic fluid at early second trimester can be used as markers of severe infection in the uterus, and with the first two being particularly sensitive.
Hemodynamic Analysis of Cephalothoracopagus by the Color Doppler Method
Authors: Iura Toshihiko , Makinoda Satoru , Sasakura Chihaya , Hirosaki Natsuko , Inoue Hirokazu , Waseda Tomoo , Watanabe Yukio
Published: December 2005

In a case of cephalothoracopagus, the umbilical artery (UA) was observed with color Doppler method, and the findings were compared with the hemodynamics of 46 normal fetuses. The patient was a 25-year-old primigravida who had appeared for routine prenatal visits since her 6th week of pregnancy. At a later time, the patient was examined after an interval of 4 weeks. Although an ultrasonography was also conducted, unfortunately, any findings of cephalothoracopagus were not detected. In the 25th week of gestation, we hospitalized her for marked polyhydramnios (amniotic fluid index: 280 mm), at which time an ultrasound examination revealed cephalothoracopagus. In the UA, the Vmax was 30.3 cm/s (normal fetus at 25–28 weeks: 33.5 ± 3.9 cm/s). The UA hemodynamics fell below the normal range. At 26 weeks, the UA Vmax was 56.5 cm/sec, a level which significantly exceeded the normal range. The patient underwent a cesarean section at 27 weeks of gestation; the indication was fetal distress. This is caused by the condition in which the fetal heart beats decreases to 90 beats per minute 3 times during a 10-min period as measured on the cardiotocograms. She delivered a 1,392-gram female with an Apgar score of 2 points (respiratory 1 point and heart rate 1 point). The infant was a cephalothoracopagus, with one head, two hearts, four upper limbs, and four lower limbs. The neonate died from circulatory failure 56 min after birth.
Prenatal Diagnosis of Trisomy 9
Authors: Nakagawa Miki , Hashimoto Kazumasa , Ohira Hiroki , Hamanaka Takuro , Ozaki Mamoru , Suehara Noriyuki
Published: December 2005

Fetal trisomy 9, especially its nonmosaic form, is a rare chromosomal abnormality and there are only 8 cases reported to have been sonographically detected in the prenatal period. We report a case of nonmosaic fetal trisomy 9, mimicking trisomy 13 on sonographic findings at 32 weeks’ gestation. Although the incidence of trisomy 9 is rare, diagnosing trisomy 9 is important because the sonographic features are similar to those of trisomies 13 and 18, and cannot to be identified by routine fluorescencein situ hybridization. Because nonmosaic trisomy 9 is universally lethal, correct diagnosis and appropriate counseling is essential in patient care and clinical management.
Amiodarone in Treatment of Fetal Supraventricular Tachycardia
Authors: Pradhan Mandakini , Manisha  , Singh Renu , Kapoor Aditya
Published: December 2005

We report a case of nonimmune hydrops fetalis detected at 32 weeks of gestation. Fetal heart rate was 300 beats per minute. Ultrasound and fetal Doppler echocardiography showed it to be due to supraventricular tachycardia (SVT). Following failed maternal therapy with digoxin alone, amiodarone with digoxin was used. Conversion to sinus rhythm and resolution of hydrops followed this treatment. Since there is no ideal treatment protocol for these cases at present, we reviewed reports of transplacental treatment of SVT.
Heterotopic Trigeminal Pregnancy in Infertile Women after Ovulation Stimulation and Embolisation of a Uterine Myoma
Authors: Müller Vranješ A. , Popović Z. , Vlahović I. , Habek D. , Kasač Z.
Published: December 2005

Heterotopic pregnancy is a simultaneous occurrence of intra-uterine pregnancy and ectopic pregnancy. The incidence of ectopic pregnancy has increased as a consequence of assisted reproduction and ovulation stimulation agents. In this report, we describe the case of a 34-year-old nulliparous woman who became pregnant after ovulation induction with clomiphene. According to her gynaecologic history, she had embolisation of a uterine myoma. The report presents a case of ectopic and twin intra-uterine pregnancy. After total laparoscopic salpingectomy, she had normal intra-uterine pregnancy.
Ballantyne Syndrome: A Case Report
Authors: Paternoster Delia M. , Manganelli Francesca , Minucci Daria , Nanhornguè Kimta Ngaradoumbe , Memmo Alessia , Bertoldini Margherita , Nicolini Umberto
Published: December 2005

Ballantyne syndrome (also called mirror syndrome or triple edema) describes the unusual association of fetal and placental hydrops with maternal preeclampsia. This is a case report illustrating a 37-year-old patient who was referred to our clinics at 28 weeks of gestation (wg) because of fetal hydrothorax. On examination, the woman did not show signs of preeclampsia. The fetal ultrasound examination revealed bulky hydrothorax, generalized subcutaneous edema, placental edema, and polyhydramnios. It was not possible to find the cause of the fetal hydrops. At 29 weeks and 4 days of gestation, the fetal hydrothorax was removed by two pleuro-amniotic shunts, but at the moment of our intervention anasarca was already present. In the following 3 days, despite observing bed rest, the mother developed edema of hands and face, while blood pressure remained normal. At 30 wg the patient underwent cesarean section because fetal movements ceased and the fetal heart rate monitoring showed loss of variability and decelerations. Before dying, the neonate lived for 20 days in a state of deep hypotension.
Abruptio Placentae during Fetal Myelomeningocele Repair
Authors: Barini Ricardo , Barreto Maria Weber G. , Cursino Kleber , Zambelli Herder , Prando Adilson , Sbragia Lourenço
Published: December 2005

Myelomeningocele (MM) is a congenital neural tube defect with serious consequences, including hydrocephaly. An important hope for intrauterine repair is that hydrocephaly may be prevented by reversing the Arnold-Chiari malformation. Three medical centers in the United States are doing trials with this objective. We describe an intrauterine correction of MM in a Brazilian research center of fetal medicine, which resulted in abruptio placentae and fetal death, to illustrate factors that influence fetal-maternal risks during this surgical procedure.
Cardiac Circumference Measurement: Possible Screening Tool in Early Pregnancy for Anomalous Cardiac Development
Authors: Guariglia Lorenzo , Rosati Paolo , Bartolozzi Francesco
Published: December 2005

Objective: In this study, cardiac circumference (CC), measured by transvaginal sonography, was analyzed to determine the growth during the early stage of pregnancy and its relationship to abdominal circumference and femur length (FL). Methods: Biometric measurements, including CC, were obtained in 1,182 euploid fetuses at 9–16 weeks’ gestation. The CC measurements were related to gestational age (GA), abdominal circumference, and FL. The corresponding 95% confidence intervals were calculated. Results: A linear growth function was observed between CC (mm) and GA (days) (r2 = 0.601; p < 0.0001; y = 0.573 GA – 24.185). Similarly, a good correlation is described with a linear function between CC (mm) and abdominal circumference (mm) (r2 = 0.70; p < 0.0001; y = 0.343 AC + 3.696) and between CC (mm) and FL (mm) (r2 = 0.626; p < 0.0001; y = 1.335 FL + 14.444). The regression analysis that best correlates the dependent variable CC (mm) with the independent variables, GA (days), abdominal circumference (mm), and FL (mm), is: y = 0.137 GA + 0.235 AC + 0.199 FL – 3.303 (r2 = 0.708; p < 0.0001). Conclusion: Our results provide normative data of the growth of the CC in early pregnancy. The good correlation described between CC and abdominal circumference and FL suggests that cardiac measurements in early pregnancy alone, or related to other fetal biometric parameters, could be used as a screening tool to identify fetuses at risk for abnormal heart development.
A Folate-Dependent Metabolite in Amniotic Fluid from Pregnancies with Normal or Trisomy 21 Chromosomes
Authors: Baggot Paddy Jim , Eliseo Anna Jane Y. , Kalamarides Jeremy A. , Shoemaker James D.
Published: December 2005

Introduction: Previous studies have given conflicting results as to whether or not folate metabolism is altered in Down syndrome. Folate is necessary to facilitate metabolism of one-carbon units. Folate accepts one-carbon units from one-carbon unit donors, including formiminoglutamate (FIGLU). Folate deficiency leads to accumulation of FIGLU and impairment of one-carbon unit metabolism. FIGLU is a functional measure of folate deficiency. Materials and Methods: Archived anonymized amniotic fluid specimens were obtained from normal pregnancies and those with Down syndrome. Gas liquid chromatography/mass spectrometry was used to quantitate FIGLU, which is elevated in folate deficiency. A tetra-deuterated FIGLU was used as a standard, and single-ion monitoring was performed. Nonparametric statistical analysis was performed with the Mann-Whitney U test. Results: FIGLU was significantly lower in pregnancies with Down syndrome. The median FIGLU level was 0.9 µmol/l in amniotic fluid from fetuses with Down syndrome. The median FIGLU level was 1.3 in amniotic fluid from control fetuses. This difference was statistically significant (p = 0.009). No statistically significant differences were found with histidine or glutamate. Discussion: There was no evidence of folate deficiency. FIGLU was decreased, not increased. Decreased FIGLU might result from accelerated activity of one or more genes on chromosome 21, by a gene dosage effect. Genes which might explain the reduced FIGLU include one which degrades FIGLU (glutamate formiminotransferase-cyclodeaminase), one which participates in purine synthesis, and one which degrades homocysteine (cystathionine-β-synthase).
A Journey across the Wall of Varicose Veins: What Physicians Do Not Often See with the Naked Eye
Authors: Renno W.M. , Saleh F. , Wali M.
Published: December 2005

Objective: To examine varicose veins (VVs) from inside out in order to help surgeons and general practitioners better understand the pathogenesis of the disease and improve their management. Material and Methods: A comprehensive examination of the wall of VVs was performed using transmission electron microscopy. The ultrastructural morphology of the collagen, elastin and smooth muscle content of the wall was analyzed in a sample of 10 patients (4 male and 6 female) and 10 matched controls aged between 37 and 50 years. Results: Analysis of the tunica media revealed that the smooth muscle cells were significantly separated from each other by a marked increase in amorphous and fibrous tissue in which many of the collagen and elastin fibers lost their normal structural arrangement. The cells contained a large number of membrane-bound intracellular vesicles and cytoplasmic vacuoles. The collagen fibers were smaller and thinner than what is commonly seen in normal veins, and they were widely separated from each other. A light electron-lucent center was observed in the middle of the fibers. Similar changes were also seen in the intima and were associated with irregular plaque-like intimal thickening. Conclusion: Our study revealed a significant separation among smooth muscle cells in the wall of VVs, and the presence of an abnormal amorphous extracellular matrix and intracytoplasmic vacuoles could reflect ‘unusual’ possible secretory and phagocytic roles of smooth muscle cells. This could provide an important explanation for the abnormal contractile function of these cells in VVs.
Caries Prevalence and Treatment Needs of 12-Year-Old Children in the Islamic Republic of Iran
Authors: Momeni Anahita , Mardi Medya , Pieper Klaus
Published: December 2005

Objective: To assess the prevalence of dental caries and treatment needs of 12-year-old children living in Teheran and a rural area surrounding Esfahan. Subjects and Methods: A total of 1,102 pupils were examined clinically for caries according to WHO criteria. One calibrated dentist examined all children. Results: Of the children studied, 63.8% had sound permanent dentition, 9.9% had filled teeth and 26.3% needed treatment. The mean DMFT value found was 0.77 (DFS: 1.19). The D component was 58.7%, the M component 3.4% and the F component 37.9%. The levels of caries experience varied according to the child’s residence. The teeth of children living in the rural area (mean DMFT: 0.38) were significantly less affected than those of children living in Teheran (mean DMFT: 1.1). In the capital city of Teheran, considerable differences related to social status were observed. The lowest DMFT values (0.74) were found in southern Teheran where the poorest people live. The highest caries experience was found in the middle-class social stratum. Conclusion: The results indicate that caries prevalence among 12-year-old children in the Islamic Republic of Iran is as low as in the developed countries of central Europe.