bluuebunny/crossref_metadata_2025 huggingface dataset:
Rapid β-lactam-induced lysis requires successful assembly of the cell division machinery
Authors: Chung Hak Suk , Yao Zhizhong , Goehring Nathan W. , Kishony Roy , Beckwith Jon , Kahne Daniel
Published: December 2009

β-lactam antibiotics inhibit penicillin binding proteins (PBPs) involved in peptidoglycan synthesis. Although inhibition of peptidoglycan biosynthesis is generally thought to induce cell lysis, the pattern and mechanism of cell lysis can vary substantially. β-lactams that inhibit FtsI, the only division specific PBP, block cell division and result in growth as filaments. These filaments ultimately lyse through a poorly understood mechanism. Here we find that one such β-lactam, cephalexin, can, under certain conditions, lead instead to rapid lysis at nascent division sites through a process that requires the complete and ordered assembly of the divisome, the essential machinery involved in cell division. We propose that this assembly process (in which the localization of cell wall hydrolases depends on properly targeted FtsN, which in turn depends on the presence of FtsI) ensures that the biosynthetic machinery to form new septa is in place before the machinery to degrade septated daughter cells is enabled. β-lactams that target FtsI subvert this mechanism by inhibiting FtsI without perturbing the normal assembly of the cell division machinery and the consequent activation of cell wall hydrolases. One seemingly paradoxical implication of our results is that β-lactam therapy may be improved by promoting active cell division.
Nickel-inducible lysis system in
Synechocystis
sp. PCC 6803
Authors: Liu Xinyao , Curtiss Roy
Published: December 2009

We designed and constructed a controllable inducing lysis system in
Synechocystis
sp. PCC 6803 to facilitate extracting lipids for biofuel production. Several bacteriophage-derived lysis genes were integrated into the genome and placed downstream of a nickel-inducible signal transduction system. We applied 3 strategies: (
i
) directly using the phage lysis cassette, (
ii
) constitutively expressing endolysin genes while restricting holin genes, and (
iii
) combining lysis genes from different phages. Significant autolysis was induced in the
Synechocystis
sp. PCC 6803 cells with this system by the addition of NiSO
4
. Our inducible cyanobacterial lysing system eliminates the need for mechanical or chemical cell breakage and could facilitate recovery of biofuel from cyanobacteria.
Label-free cellular manipulation and sorting via biocompatible ferrofluids
Authors: Kose Ayse R. , Fischer Birgit , Mao Leidong , Koser Hur
Published: December 2009

We present a simple microfluidic platform that uses biocompatible ferrofluids for the controlled manipulation and rapid separation of both microparticles and live cells. This low-cost platform exploits differences in particle size, shape, and elasticity to achieve rapid and efficient separation. Using microspheres, we demonstrate size-based separation with 99% separation efficiency and sub-10-μm resolution in <45 s. We also show continuous manipulation and shape-based separation of live red blood cells from sickle cells and bacteria. These initial demonstrations reveal the potential of ferromicrofluidics in significantly reducing incubation times and increasing diagnostic sensitivity in cellular assays through rapid separation and delivery of target cells to sensor arrays.
17-β-Estradiol increases neuronal excitability through MAP kinase-induced calpain activation
Authors: Zadran Sohila , Qin Qingyu , Bi Xiaoning , Zadran Homera , Kim Young , Foy Michael R. , Thompson Richard , Baudry Michel
Published: December 2009

17-β-Estradiol (E2) is a steroid hormone involved in numerous brain functions. E2 regulates synaptic plasticity in part by enhancing NMDA receptor function and spine density in the hippocampus, resulting in increased long-term potentiation and facilitation of learning and memory. As the calcium-dependent neutral protease, calpain, is also involved in these processes, we tested whether E2 could activate calpain and examined the functional consequences of E2-mediated calpain activation in hippocampus. Calpain activity was analyzed by a fluorescence resonance energy transfer (FRET)-based assay that allows both quantitative determination and spatial resolution. E2 rapidly activated calpain in cultured cortical and hippocampal neurons, prominently in dendrites and dendritic spines. E2-induced calpain activation was mediated through mitogen-activated protein kinase (MAPK), as it was completely blocked by MEK inhibitors. It was also calcium-independent, as it was still evident in presence of the calcium chelator, BAPTA-AM. Activation of ERα and ERβ receptors by specific agonists stimulated calpain activity. Finally, the rapid E2-mediated increase in excitability in acute hippocampal slices was prevented by a membrane-permeable calpain inhibitor. Furthermore, E2 treatment of acute hippocampal slices resulted in increased actin polymerization and membrane levels of GluR1 but not GluR2/3 subunits of AMPA receptors; both effects were also blocked by a calpain inhibitor. Our results indicate that E2 rapidly stimulates calpain activity through MAP kinase-mediated phosphorylation, resulting in increased membrane levels of AMPA receptors. These effects could be responsible for E2-mediated increase in neuronal excitability and facilitation of cognitive processes.
Expression of human telomerase reverse transcriptase and correlation with telomerase activity in placentas with and without intrauterine growth retardation
Authors: IZUTSU TOSHIHIKO , IZUTSU NAOKO , IWANE AYAKO , TAKADA ANNA , NAGASAWA TAKAYUKI , KANASUGI TOMONOBU , SUGIYAMA TORU
Published: December 2009

Background. Human telomerase reverse transcriptase has been found in telomerase‐positive tumor tissues, but not in telomerase‐negative nonmalignant somatic cells. Methods. Thirty‐two first‐trimester chorionic villi specimens (Group A), 33 second‐ and third‐trimester placenta specimens without asymmetric intrauterine growth retardation (Group B) and 13 specimens of placenta tissue from cases with intrauterine growth retardation (Group C) were examined for telomerase activity and expression of human telomerase reverse transcriptase by reverse transcription polymerase chain reaction and quantitative reverse transcription polymerase chain reaction. Results. Telomerase activity was detected in 29 of the 32 specimens (90.6%) in Group A, in 20 of the 33 specimens (60.6%) in Group B and none of the 13 specimens (0.0%) in Group C. Human telomerase reverse transcriptase was identified in all 32 specimens of Group A (100%), all 33 specimens of Group B (100%) and 2 of the 13 specimens in Group C (15.4%) by nested reverse transcription polymerase chain reaction. Copy numbers of human telomerase reverse transcriptase were 202.3±73.0 (n=32), 8.8±2.9 (n=33) and 0 (n=13) in Groups A, B, and C, respectively. Significant differences were observed between Groups A and B, Groups A and C, and Groups B and C (p<0.01, p<0.01, and p<0.01, respectively). Conclusions. Our findings indicate that human telomerase reverse transcriptase expression is the rate‐limiting determinant of telomerase activity in chorionic villi during the first trimester. Telomerase activity was not detected in placentas with intrauterine growth retardation, whereas human telomerase reverse transcriptase was expressed in some placentas with intrauterine growth retardation.
Adult granulosa cell tumor of the ovary: 35 cases in a single Korean institute
Authors: KIM Y. M. , JUNG M. H. , KIM K. R. , KIM J. H. , KIM Y. T. , NAM J. H. , MOK J. E.
Published: December 2009

Background. Adult granulosa cell tumor of the ovary is an uncommon neoplasm. The overall prognosis is favorable. The prognostic factors that are related to survival have not been well defined and are discussed in the literature amidst controversy. Methods. Thirty‐five patients diagnosed with adult granulosa cell tumor of the ovary were reviewed retrospectively. Demographic data, pathologic findings, treatments, and survival times were reviewed and analyzed for prognostic significance. Results. Of the 35 cases, there were 30 cases representing stage I tumors, one case at stage II, four cases at stage III, and no cases at stage IV. The mean overall survival time of all patients was 140.3 months. The 5‐ and 10‐year survival rates were 92.0% and 85.8% respectively. The FIGO stage was the only independent prognostic factor. Conclusions. Despite the small number of patients, the study showed that the less advanced stage is the only favorable prognostic factor of significance.
Excretion of lactose in urine as a measure of increased permeability of the lactating breast during inflammation
Authors: FETHERSTON CATHERINE M. , LAI CHING TAT , MITOULAS LEON R. , HARTMANN PETER E.
Published: December 2009

Hypothesis. The increased excretion of lactose in urine will be an accurate predictor of increased breast permeability during inflammation of the breast and therefore could predict whether there is a relationship between the severity and type of symptoms suffered during mastitis and changes in breast permeability. Methods. Twenty‐six mothers were followed prospectively from Day 5 postpartum to the end of their lactation. Milk from each breast, blood, 24‐hour urine samples, and data on breast and systemic pathologies were collected at reference intervals during the first three months postpartum, daily during the occurrence of any breast inflammation and 7 days after resolution of symptoms. Results. The 24‐h excretion of lactose in urine was higher during mastitis (p<0.001), peaking at the commencement of the mastitis and decreasing over time until there was no significant difference at the time of follow‐up when compared to mothers without mastitis (p<0.25). The changes in lactose in urine were consistent with the changes in sodium, chloride, and lactose in milk, confirming milk expressed for sample analysis was representative of milk from the site of inflammation. Increased severity of breast symptoms experienced during mastitis was a significant predictor for an increased excretion of lactose in urine (p<0.022). Conclusions. The use of 24‐h excretion of lactose in urine provided a reliable marker of changes occurring in breast permeability and subsequently has shown that an increasing area of inflammation of the breast was predictive of an increase in breast permeability and associated changes in milk composition.
Ovarian cancer and genetic susceptibility in relation to the BRCA1 and BRCA2 genes. Occurrence, clinical importance and intervention
Authors: SØGAARD MARIE , KRÜGER KJÆR SUSANNE , GAYTHER SIMON
Published: December 2009

The Nordic countries have the highest incidences of ovarian cancer in the world (around 15 cases per 100,000 women). We have conducted a review of the recent literature with focus on the Nordic countries, on genetic susceptibility to ovarian cancer, and the clinical implications in relation to the BRCA1 and BRCA2 genes. One of the strongest risk factors for ovarian cancer is a family history of ovarian and/or early‐onset breast cancer. It is thought that germline mutations in BRCA1/2 might be responsible for as much as 10% of all ovarian cancer cases and all families containing either multiple case, site‐specific ovarian cancer cases or breast and ovarian cancers together. Data from several international studies suggest that the lifetime risk of ovarian cancer in a BRCA1 mutation carrier can vary from 18 to 56% and from 14 to 27% in a BRCA2 carrier, depending on the presence/absence of a family history of the disease. Genetic evaluation and testing is used in many countries to identify families with BRCA1/2 mutations. Once a mutation has been identified, genetic counseling and testing can be offered to unaffected family members. Prophylactic oophorectomy in unaffected mutation carriers will eliminate the risk of ovarian cancer, although there is a slight residual risk of peritoneal cancer. During oophorectomy, the Fallopian tube should also be removed. If a woman does not want prophylactic oophorectomy, then tubal ligation or oral contraceptive use can be considered as these have been shown to reduce ovarian cancer risk also in mutation carriers.
Helping parents to tell their children about the use of donor insemination (DI) and determining their opinions about open‐identity sperm donors
Authors: LEEB‐LUNDBERG SARA , KJELLBERG SVANTE , SYDSJÖ GUNILLA
Published: December 2009

Objective. To look at the level of compliance with Swedish law whether or not parents intend to tell their child about donor insemination. We also wanted to look at the parents’ attitudes towards open‐identity sperm donors and at relationships within the family. Method. All parents who were treated and gave birth to a child through donor insemination from 1997 to 2003 were included in the study. Sixteen of 20 couples (80%) were willing to take part in an interview, where the men and women were interviewed separately. The children of these couples had an average age of 2.9 years. Results. Three of the 16 couples had told their child about donor insemination and 9 couples intended to tell the child when he/she was older. Thus 12 couples (75%) had disclosed or planned to inform their child in the future. Fourteen of 16 couples had told others about the donor insemination. The majority (20 of 31 individuals) had a positive attitude towards open‐identity for sperm donors and 21 of 31 would have chosen an open‐identity sperm donor if they had had the choice between that and an anonymous donor. All the parents felt they had an equal relationship with their child. Conclusion. Couples who conceived a child through donor insemination are open about the donor insemination, both to other people in their surroundings and in their intention to tell the child. These families seem to be functioning well with relaxed attitudes towards the donor insemination process.
Randomized study on the effect of adding oxytocin to ethacridine lactate or misoprostol for second‐trimester termination of pregnancy
Authors: Kelekci Sefa , Erdemoglu Evrim , İnan İsmet
Published: December 2009

Objective. To compare effectiveness of misoprostol and ethacridine lactate with or without oxytocin in second‐trimester medical abortions.

Subjects and methods. A randomized prospective study. A total of 388 women with genetic indications for termination of pregnancy at 13–24 weeks of gestation were recruited. Group I (n=85) were treated with extra‐amniotic ethacridine lactate, 10 ml instilled per gestational week, to a maximum of 200 ml. Group II (n=93) were treated with misoprostol administered intravaginally (200 μg), followed by 100 μg of oral misoprostol 4 hourly for 24 h. Group III (n=102) were treated with a combination of ethacrine lactate and oxytocin. An initial dose of 6 mU/min oxytocin was given, followed by additional 6 mU/min doses every 20 min. Group IV (n=96) were treated with a combination of misoprostol and oxytocin administered in a similar way as in group III. The main outcome measures were time to induce abortion, side effects, and failure/success rates.

Results. The mean time to induce abortion was 14.2±3.6, 13.2±3.4, 10.8±2.6, and 9.9±2.4 h in groups I, II, III, and IV, respectively (p<0.001). Addition of oxytocin to ethacridine lactate did not decrease the risk of prolongation of induction beyond 24 h but use of oxytocin with misoprostol did reduce the risk of induction beyond 24 h (OR: 0.46, 95%CI: 0.21–1, p<0.05). The occurrence of minor side effects was similar in all groups.

Conclusion. Addition of oxytocin to ethacridine lactate or misoprostol significantly decreases the length of time to induce abortion without supplementary side effects.
Miniconization procedure with C‐LETZ conization electrode for treatment of cervical intraepithelial neoplasia: A Swedish study
Authors: MINTS MIRIAM , GABERI VERA , ANDERSSON SONIA
Published: December 2009

Background. Since 1989 large loop excision of the transformation zone (LLETZ) has become the treatment of choice for cervical intraepithelial neoplasia in many colposcopy clinics. This method has limitations however, in that the resection margins of the cone produced by LLETZ cannot give conclusive histological reassurance, because of thermal injury in 5–30% of the specimens. Furthermore, LLETZ are often taken in several sections, which makes the histopathological examination unnecessarily difficult. As a new and single treatment without these limitations, conization with the contoured loop excision of the transformation zone (C‐LETZ) electrode was investigated in the present study. Material and methods. One hundred and seventy‐four patients with CIN were treated with the C‐LETZ electrode during 12 months at the Gynaecological Department, Karolinska University Hospital, Huddinge. The inclusion criteria were a histological diagnosis of CIN II–III, or persistent CIN I. Results. Eighty‐six per cent of the patients had a complete excision according to histological findings, and 12% had an incomplete excision. The frequency of incomplete excisions increased with the severity of the CIN but were found in all groups of patients: 1 (3%) in CIN I, 5 (12%) in CIN II, and 12 (17%) in CIN III. The resection margins and histological diagnoses were certain in 98% of the cases. A cure rate of 90% was observed. Conclusions. Miniconization with the C‐LETZ electrode makes it possible to individualize the size of the minicones and produce the minicones as one‐piece specimens for histopathological assessment. Our findings confirm that this method is a reproducible, safe, and economical way to treat CIN with a low rate of morbidity in a hospital outpatient setting.
Term prediction with ultrasound: Evaluation of a new dating curve for biparietal diameter measurements
Authors: BACKE BJØRN , NAKLING JAKOB
Published: December 2009

Background. In Norway, routine ultrasound examination with assessment of gestational age was included in the standard antenatal care program in 1985. Until presently, a dating chart introduced in 1983 has been used throughout the country. New national normal values are now developed. The aim of the study was to compare the performance of the two sets of normal values; both are based on measurement of fetal biparietal diameter in the second trimester. Material and method. We analyzed a cohort of 11,238 singleton deliveries with spontaneous onset of labor. All had reliable last menstrual period and all had a routine ultrasound examination in the second trimester with measurement of fetal biparietal diameter. We calculated the expected day of delivery both according to the old (method A) and the new (method B) reference values. Results. The prediction error (the difference between observed and expected day of delivery) for the last menstrual period method was −0.1 days, for method A −3.5 days, and for method B −0.7 days. The prediction error for method A increased up to 7 days when ultrasound measurements were obtained in gestational week 14–15. Conclusion. The old ultrasound method leads to a systematic underestimation of fetal age, and the prediction error increases notably when the ultrasound measurements are performed in the early second trimester. Gestational age is more precisely assessed with the new reference values.
The effect of accelerated rehabilitation on recovery after surgery for ovarian malignancy
Authors: MARX CHARLOTTE , RASMUSSEN TINA , JAKOBSEN DORTHE HJORT , OTTOSEN CHRISTIAN , LUNDVALL LENE , OTTESEN BENT , CALLESEN TORBEN , KEHLET HENRIK
Published: December 2009

Background. In patients undergoing colonic surgery the postoperative hospital stay has been reduced from 8–12 days to 2–4 days with multimodal rehabilitation programs. The aim of this study was to evaluate the postoperative outcome after surgery for ovarian malignancy with conventional care compared to fast‐track multimodal rehabilitation. Methods. Seventy‐two consecutive patients receiving conventional care (group 1) were compared with 69 consecutive patients receiving multimodal, fast‐track rehabilitation with a planned care program including continuous epidural analgesia, early oral feeding and mobilization (group 2) in the same department. Outcome was postoperative hospital stay and morbidity during the first postoperative month. Results. Median age was 63 years (group 1) and 62 years (group 2). Median postoperative hospital stay was reduced from 6 days in group 1 (mean 7.3) to 5 days in group 2 (mean 5.4) (p<0.05). There was no difference in the overall complication rate, although severe medical complications were reduced in group 2 (14% versus 2%; p<0.01). Readmission rate was 10% in group 1 and 3% in group 2 (p>0.05). Conclusions. The concept of fast‐track multimodal rehabilitation appears to be beneficial in patients operated for ovarian malignancy, as hospital stay and medical morbidity are reduced.
A population‐based study of Swedish gynecologists’ experiences of working in abortion care
Authors: HAMMARSTEDT META , LALOS ANN , WULFF MARIANNE
Published: December 2009

Background. Legal abortion is a recurrent part of gynecologists’ work. The aim of the study was to describe Swedish gynecologists’ clinical and emotional experiences when working in abortion care. Further aims were to elucidate their perception of women's motives for having an abortion as well as looking for possible demographic and gender differences. Methods. A questionnaire comprising both structured and semi‐structured questions was sent to a random sample of 269 Swedish gynecologists. The response rate was 85%. Results. The female gynecologists were younger (27–59 years) and more numerous than the males (33–66 years). Almost all believed that gynecologists should be involved in abortion care, and half were opposed to the privilege of refusing to work with termination of pregnancy. The gynecologists supported the shift from surgical to medical abortions but not to their being managed in primary healthcare. A few gynecologists (n=42) had considered changing their job because of termination of pregnancy being part of their work. Misgivings occurred sometimes in connection with surgical and late abortions (n=60 and n=108 respectively). Few gynecologists (n=33) had felt inadequate when encountering abortion patients and more than half thought that working with termination of pregnancy was a positive experience. The gynecologists believed that continuing professional development and ongoing guidance of termination of pregnancy matters were important. Conclusions. In general, Swedish gynecologists have no doubts about taking part in and performing termination of pregnancy. Their clinical and emotional experience, as expressed in this study, as well as their perception of women's motives for abortions, indicate that they have gained deep insights and developed their professionalism in their work with termination of pregnancy.
Pelvic girdle pain in pregnancy: The impact on function
Authors: ROBINSON HILDE STENDAL , ESKILD ANNE , HEIBERG ELI , EBERHARD‐GRAN MALIN
Published: December 2009

Background. The aim of this study was to determine the prevalence of self‐reported pelvic girdle pain in pregnancy and study the impact on function, the use of crutches, and waking up at night, according to location of pain. Methods. A population‐based questionnaire study was performed among all women 18–40 years in two communities in Norway in 1998–99. A total of 1,817 women with a prior delivery constituted the study sample. Pelvic girdle pain was grouped into five categories: pain in anterior pelvis, in posterior pelvis, in anterior and unilateral posterior pelvis, in anterior and bilateral posterior pelvis (a complete pelvic girdle syndrome), and pelvic pain with no information on location. Results. A total of 46% (843/1,817) reported pelvic girdle pain in pregnancy at one location or more. Nineteen percent reported pain in anterior pelvis only, 14% in posterior pelvis only, 4% in anterior and unilateral posterior pelvis, and 5% reported a complete pelvic girdle syndrome. A total of 7% of all pregnant women used crutches during pregnancy and 15% reported waking up at night frequently due to pelvic girdle pain. A complete pelvic girdle syndrome, as compared to pain in the anterior pelvis only, was strongly associated with the use of crutches (adjusted odds ratio (OR) 4.3; 95% confidence interval (CI) 2.5–7.4) and with waking up at night due to pain (OR 4.6; 95% CI 2.7–7.2). Conclusion. Pain related to the pelvic joints is common among pregnant women in Norway and may cause serious functional problems.
Antioxidant protection during the menstrual cycle: the effects of estradiol on ascorbic–dehydroascorbic acid plasma levels and total antioxidant plasma status in eumenorrhoic women during the menstrual cycle
Authors: Michos Constantinos , Kiortsis Demetrios N. , Evangelou Angelos , Karkabounas Spyridon
Published: December 2009

Background. Estrogens, apart from their classic role as steroid hormones, also possess significant antioxidant properties. The present study was undertaken to assess the antioxidant potential of the female during the various menstrual phases and to investigate the correlation between ascorbic acid, dehydroascorbic acid plasma levels, total antioxidant plasma status, and estradiol levels. Design and methods. Thirteen eumenorrhoic women were studied. Ascorbic acid and dehydroascorbic acid plasma levels, total antioxidant plasma status, estradiol, progesterone, luteinizing hormone, and follicle‐stimulating hormone during time of menstruation, midfollicular phase, time of ovulation, and midluteal phase were determined. Ascorbic–dehydroascorbic acid ratio was also calculated. Results. A progressive significant rise in ascorbic acid plasma levels (p<0.01), ascorbic–dehydroascorbic acid ratio (p<0.001), and total antioxidant plasma status (p<0.05) from menstruation to ovulation was observed. Moreover, a significant decrease in dehydroascorbic acid was found at the same phases (p<0.05). Changes of estradiol levels during the menstrual cycle correlated positively with the changes of ascorbic acid levels and total antioxidant plasma status (p<0.05). Furthermore, estradiol levels correlated positively with ascorbic acid levels (p<0.05, r<0.5), ascorbic–dehydroascorbic acid ratio (p<0.05, r<0.5), and total antioxidant plasma status (p<0.05, r<0.8) in all menstrual phases. Conclusions. An elevated antioxidant protection during ovulation and the midluteal phase appears to be present in eumenorrhoic women. Moreover we observed a cyclic variation in the antioxidant parameters we assayed in the females in the present study, which could be due to cyclic changes in estradiol levels.
Cosmetic results of lower midline abdominal incision: Donati stitches versus a continuous intracutaneous suture in a randomized clinical trial
Authors: de Waard Judith , Trimbos Baptist , Peters Lex
Published: December 2009

Background. The objective of this study was to compare the cosmetic outcome of two different closing techniques for lower midline abdominal incisions: a continuous intracutaneous suture versus interrupted Donati stitches.Methods. Eighty patients undergoing gynecological surgery through a lower midline abdominal incision were randomized. The cosmetic outcome of the scar was assessed by independent observers and the patients at 8 days and 4–6 months after the operation using visual analog scales and a validated scoring system for hypertrophy, width, color, and cross‐hatching. Patients also completed a visual analog scale for postoperative pain on both occasions. The accumulated data were statistically evaluated using two‐sided χ2, Student's t, or Mann–Whitney tests with a confidence interval of 95%. Results. Closing a lower midline abdominal laparotomy wound with an absorbable intracutaneous suture did not take more time than using Donati stitches. Laparotomy scores were only significantly better in the intracutaneous group at the first assessment, one week after the operation. The cosmetic visual analog scale scores by both independent observers and patients were slightly better in the intracutaneous group but the difference was not statistically significant. There was also no significant difference between visual analog scale scores for pain felt around the scar. Conclusions. This study shows that in the opinion of both independent observers and patients, scar cosmetics are not significantly different when using Donati skin sutures or an intracutaneous suture to close a lower midline laparotomy wound. The two methods do not differ either in time‐consuming aspects or postoperative pain perception.
The joint effect of vaginal Ureaplasma urealyticum and bacterial vaginosis on adverse pregnancy outcomes
Authors: Vogel Ida , Thorsen Poul , Hogan Vijaya K. , Schieve Laura A. , Jacobsson Bo , Ferre Cynthia D.
Published: December 2009

Objective. To examine associations of vaginal Ureaplasma urealyticum (UU) and bacterial vaginosis (BV) with preterm delivery (PTD), small for gestational age (SGA), and low birth weight (LBW). Material and methods. A population‐based, prospective cohort study of 2,927 pregnancies. After exclusion of multiples and antibiotic use sample size was 2,662. BV (Amsel's criteria) and UU (culture) were assessed in week 17. Gestational age was determined by last menstrual period, confirmed by ultrasound measurement in 97.5%. SGA infants were calculated from intrauterine fetal growth measurements. Results. There was no increased risk for spontaneous PTD among women with BV only (crude odds ratio 1.0, 95% CI 0.4–2.7), among women with UU only (1.3, 0.8–2.0), nor among women with UU + BV (0.9, 0.4–2.3) compared to women without UU and BV. However, there was a threefold increased risk of a LBW birth in women with UU + BV (3.1, 1.8–5.4), a twofold risk of a LBW birth among women with UU only (1.9, 1.3–2.9), but no increased risk among women with BV only (0.8, 0.3–2.2). Similarly, women with UU + BV had over a twofold increased risk of an SGA birth (2.3, 1.3–4.0), women with UU only had a 70% increase (1.7, 1.1–2.5), whereas a nonsignificant increase was found in women with BV only (1.3, 0.6–2.9). Adjustment by established confounders (smoking, previous PTD, previous LBW, and Escherichia coli) did not affect risk estimates. Conclusion. This analysis suggests that UU is independently associated with fetal growth and LBW and that BV with UU may enhance the risk of these outcomes.
Placement of probes in electrostimulation and biofeedback training in pelvic floor dysfunction
Authors: Voorham‐van der Zalm Petra J. , Pelger Rob C. M. , van Heeswijk‐Faase Ingrid C. , Elzevier Henk W. , Ouwerkerk Theo J. , Verhoef John , Lycklama à Nijeholt Guus A. B.
Published: December 2009

Background. We examined the positioning of five commonly used probes in electrostimulation and biofeedback training.

Materials and methods. Ultrasound and MRI were used to evaluate the position of these probes in two multiparous women, in reference to pelvic floor anatomy.

Results. From caudal to cranial we identified the anal external sphincter, puborectal muscle, and levator group. Positioning of probes varied considerably: the recording plates are situated from 1 cm caudal to 6 cm cranial of the puborectal muscle. Most probes stretched, due to a relatively large diameter, the vagina wall, anal external sphincter, or puborectal muscle beyond physiological proportions. On straining, all probes were pushed upwards into the rectum.

Conclusion. The positioning of all examined probes varied considerably. Hence it is not likely that these probes give a reliable and uniform registration of muscular activity of the pelvic floor function or are all optimal for electrostimulation.
Estrogens are potentially the only steroids with an antioxidant role in pregnancy: in vitro evidence
Authors: Reyes Miguel R. , Sifuentes‐Alvarez Antonio , Lazalde Brissia
Published: December 2009

Background. Pregnancy is a condition that favors oxidative stress by reactive oxygen species. Oxidative stress is involved in the etiopathogenesis of disorders of pregnancy such as pre‐eclampsia. An antioxidant effect of estrogens has been described and a putative role of them as antioxidants has been proposed. The aim of this work was to evaluate in vitro the antioxidant properties of dehydroepiandrosterone sulfate, estradiol, estriol, progesterone, and testosterone, five steroid hormones present in the maternofetal circulation. Methods. The antioxidant properties of the hormones were evaluated by two methods: 1. their antioxidant effect on the auto‐oxidation of linoeic acid, a hydrogen atom transfer reaction; 2. diphenylpicrylhydrazil‐scavenging capacity, a single electron transfer reaction. Results. Of the five hormones tested, only estradiol and estriol at 10 μM concentration exerted a strong antioxidant effect of 81.73 and 70.97% respectively on linoleic acid auto‐oxidation, at the end‐point of the reaction. Likewise, only these two hormones showed radical‐scavenging activity on diphenylpicrylhydrazil, noticeable only at supraphysiological concentrations of 1 mM. Conclusions. Estradiol and estriol could play a role as antioxidants for maternofetal autoprotection in addition to their hormonal activity, but this role could be preferentially exerted by estriol due to its higher concentrations exhibited during pregnancy. In vivo studies are necessary to shed light on this issue.
Satisfying parents’ preferences with regard to various models of postnatal care is cost‐minimizing
Authors: ELLBERG LOTTA , HÖGBERG ULF , LUNDMAN BERIT , LINDHOLM LARS
Published: December 2009

Background. This study describes three options for postnatal care in Sweden and contains a cost analysis of the options in various combinations. The aim of the study was to calculate the cost of a postnatal care model according to new parents’ preferences. Methods. Staff costs were calculated for various models of postnatal care, comprising the maternity ward, the family suite, and/or the early discharge program. One of the models was based on answers from 342 parents who specified their preferences with regard to postnatal care in the event of another birth. Results. Comparing costs for five different models of postnatal care showed that the proportion of mothers receiving care at the maternity ward crucially influences the total costs. The staff costs differed significantly between the models, ranging from US$448 000 to US$778 000 per 1500 mother‐child dyads. Main outcome measures Cost calculation of various care models and parents’ preferences for postnatal care. Conclusions. Because the parents’ preferences with regard to postnatal care created one of the most cost‐minimizing care models in the study, it would be possible to better meet parent's desires and, at the same time, reduce costs, without increasing risks in comparison with the early discharge program.
Spontaneous abortion: A prospective cohort study of younger women from the general population in Denmark. Validation, occurrence and risk determinants
Authors: BUSS L. , TOLSTRUP J. , MUNK C. , BERGHOLT T. , OTTESEN B. , GRØNBÆK M. , KJAER S.K.
Published: December 2009

Objective. To assess the occurrence of spontaneous abortion, comparing two different data sources. To estimate the rate of spontaneous abortion over a 2‐year period, and examine potential predictors of the risk for incident spontaneous abortion. Methods. We used interview data from a population‐based prospective cohort study comprising 11,088 women and data from a linkage of the cohort with the Hospital Discharge Register to compare spontaneous abortions as reported in the interview with those identified in the register. Based on interview data, we estimated the rate of spontaneous abortion during the two‐year follow‐up. Finally, risk determinants for incident spontaneous abortion were analyzed by means of logistic regression. Results. A total of 654 spontaneous abortions before enrolment in the study were reported by the women compared to 531 abortions found in the register. More than 80% of the spontaneous abortions identified from both sources were recorded in the same year. During follow‐up a total of 20.9% of pregnancies intended to be carried to term ended as a spontaneous abortion. In the risk factor analysis, we found that previous spontaneous abortion, being single, never having used oral contraceptives, and use of intrauterine device were associated with increased risk of subsequent spontaneous abortion. In addition, it was indicated that a short interpregnancy interval following a spontaneous abortion may confer an increased risk of abortion in the subsequent pregnancy. Conclusion. We found a high rate of spontaneous abortion in the present study and an acceptable agreement between information obtained by interview and register information. More than 25% of the spontaneous abortions were only reported by the women, and this could not be explained by erroneously reported induced abortions, and may be early, nonhospitalized abortions. We confirm that number of previous spontaneous abortions is a strong determinant, and our data may also indicate a role of previous contraceptive habits. A role of the length of interpregnancy interval in the risk of spontaneous abortion cannot be ruled out.
Intravaginal electrical stimulation: a randomized, double‐blind study on the treatment of mixed urinary incontinence
Authors: Amaro João L. , Gameiro Mônica O. , Kawano Paulo R. , Padovani Carlos R.
Published: December 2009

Background. The aim of this study was to compare effective and sham intravaginal electrical stimulation (IES) in treating mixed urinary incontinence.

Methods. Between January 2001 and February 2002, 40 women were randomly distributed, in a double‐blind study, into two groups: group G1 (n=20), effective IES, and group G2 (n = 20), sham IES, with follow up at one month. Different parameters was studied: 1. clinical questionnaire; 2. body mass index; 3. 60‐min pad test; 4. urodynamic study. The protocol of IES consisted of three 20‐min sessions per week over a seven‐week period. The Dualpex Uro 996 used a frequency of 4 Hz.

Results. There was no statistically significant difference in the demographic data of both groups. The number of micturitions per 24 h after treatment was reduced significantly in both groups. Urge incontinence was reduced to 15% in G1 and 31.5% in G2; there was no significant difference between the groups. In the analog wetness and discomfort sensation evaluations were reduced significantly in both groups. The pretreatment urodynamic study showed no statistical difference in urodynamic parameters between the groups. Ten percent of the women presented involuntary detrusor contractions. In the 60‐min pad test, there was a significant reduction in both groups. In regards to satisfaction level, after treatment, 80% of G1 patients and 65% of G2 patients were satisfied. There was no statistically significant difference between the groups.

Conclusion. Significant improvement was provided by effective and sham electrostimulation, questioning the effectiveness of electrostimulation as a monotherapy.
Intrauterine pressure, ischemia markers, and experienced pain during administration of a vasopressin V1a receptor antagonist in spontaneous and vasopressin‐induced dysmenorrhea
Authors: LIEDMAN RAGNER , GRANT LEE , IGIDBASHIAN SARAH , JAMES IAN , MCLEOD ALISON , SKILLERN LAURENCE , ÅKERLUND MATS
Published: December 2009

Background. A model to study the effect of vasopressin V1a antagonist in dysmenorrhea. Methods. A double‐blind, randomized, placebo‐controlled, cross‐over trial was performed. Eight patients with primary dysmenorrhea and eight tubal‐ligated, healthy subjects participated on days 1–2 of two consecutive menstruations. At each menstruation a bolus injection of 10 pmol/kg of vasopressin was administered before and during infusion of either 300 μg/min of atosiban or placebo. Intrauterine pressure was measured as area under the curve throughout the experiments. Ischemia markers in plasma and pain recorded by a visual analog scale were measured before and after each vasopressin injection as well as before and after the start of either atosiban or placebo infusion. Results. Vasopressin injections elevated area under the curve in both healthy volunteers and dysmenorrhea subjects. The vasopressin‐induced rise in area under the curve was lower during atosiban administration than during infusion of placebo in both groups. None of the ischemia markers differed between or within groups at vasopressin injections or atosiban/placebo infusions. In subjects with dysmenorrhea the increase in pain following the administration of vasopressin was significantly lower during atosiban than during placebo infusion. Healthy volunteers experienced only slight discomfort after the vasopressin injections. Conclusions. Atosiban reduces vasopressin‐induced intrauterine pressure in both healthy volunteers and dysmenorrheics, and reported pain in subjects with dysmenorrhea. The ischemia markers are not a useful biomarker index in women with dysmenorrhea. The dysmenorrhea pain evoked by vasopressin correlated poorly with area under the curve, which may suggest that the effect is mediated by more than one V1a‐like receptor. We conclude that this model with recordings in healthy women is useful in the evaluation of drug candidates for primary dysmenorrhea.
The comparison of vessels in elective and spontaneous abortion decidua in first trimester pregnancies: importance of vascular changes in early pregnancy losses
Authors: GUN BANU DOGAN , NUMANOGLU GAMZE , OZDAMAR SUKRU OGUZ
Published: December 2009

Background. To determine whether adequate trophoblastic migration and maternal placental perfusion occurs in cases of early pregnancy loss, we compared vessels in elective abortion decidua with those in spontaneous abortion decidua.

Methods. Elective abortion decidua at 5–11 weeks (n=40) were compared with spontaneous abortion decidua at 5–12 weeks (n=25). Also normal late secretory endometrial biopsy specimens (n=10) were examined. The cross‐sections of veins and arteries were counted in 25 elective and 15 spontaneous abortion materials. The number of the veins that contain trophoblastic fragments and the number of the spiral arteries converted by trophoblasts were determined. Statistical significance by Mann–Whitney U and Spearman's correlation test was p<0.05.

Results. All sets of decidua had dilated veins, but no secretory endometrium did. The ratio of converted spiral arteries to nonconverted arteries was much more in elective abortion decidua (113/938, 12.04%) than in spontaneous abortion decidua (11/511, 2.15%) (p<0.001).

Conclusions. The presence of converted arteries, dilated veins, and intravenous trophoblastic fragments in decidual specimens were evidence of intervillous circulation and placental perfusion by maternal circulation in the first trimester. Also the insufficient conversion of the arteries in spontaneous abortions might be responsible for many cases of early pregnancy loss.
Impact of prepregnant body mass index and maternal weight gain on the risk of pregnancy complications in Japanese women
Authors: WATABA KOYA , MIZUTANI TAKAHIRO , WASADA KENSHI , MORINE MIKIO , SUGIYAMA TAKASHI , SUEHARA NORIYUKI
Published: December 2009

Background. To analyze the association of pregnancy complications with prepregnant body mass index and weight gain during pregnancy in Japanese women. Methods. A retrospective cohort study was conducted with 21,718 Japanese women with a singleton pregnancy. Pregnant women were grouped by prepregnant body mass index and evaluated for association with pregnancy complications using multivariate logistic regression analysis. The women in each body mass index group were then divided into groups by weight gain during pregnancy using intervals of 0.05 kg/week to analyze the relationship between the weight gain and pregnancy complications by multivariate logistic regression association analysis. Results. In both nulliparous and parous women, the least pregnancy complications were found among women with medium prepregnant body mass indexes (18–23.9). Significant risks of pregnancy complications were associated with low (<18) and high (≥24) prepregnant body mass indexes, particularly high prepregnant body mass indexes. In nulliparous women, the optimal weight gain was 0.25–0.4 kg/week for low (<18) prepregnant body mass index, 0.20–0.30 kg/week for medium (18–23.9) prepregnant body mass index, and ≥0.05 kg/week for high (≥24) prepregnant body mass index. In parous women, the corresponding values were ≥0.20, 0.20–0.30, and 0.05–0.30 kg/week. Conclusions. Japanese women with prepregnant body mass indexes from 18 to 23.9 are least associated with pregnancy complications, although there is a broad range of prepregnant body mass indexes associated with few pregnancy complications. Optimal weight gain is roughly inversely related to prepregnant body mass index.
If nuchal translucency screening is combined with first‐trimester serum screening the need for fetal karyotyping decreases
Authors: Marsk Anna , Grunewald Charlotta , Saltvedt Sissel , Valentin Lil , Almström Harald
Published: December 2009

Background. This case–control study was performed to evaluate whether adding first‐trimester maternal serum testing to nuchal translucency measurement would improve the antenatal detection of Down's syndrome and decrease the number of women offered fetal karyotyping. Methods. In the Swedish Nuchal Translucency Trial (the NUPP trial), 39,572 pregnant women were randomized to a routine scan at 12–14 gestational weeks including nuchal translucency screening for Down's syndrome, or a routine scan at 16–18 gestational weeks. From the early scan group 47 pregnancies with Down's syndrome were identified and for each case three controls were chosen. Of the 189 women asked to participate, 31 cases and 108 controls with a singleton pregnancy and frozen serum from 8–14 gestational weeks available for analysis accepted participation. Maternal sera were analyzed for free beta human chorionic gonadotrophin and pregnancy‐associated plasma protein A. The risk for Down's syndrome was calculated using combinations of maternal age, crown–rump length, nuchal translucency, and biochemistry. A risk ≥1/250 was considered increased and an indication for fetal karyotyping. Results. Risk calculated on the basis of maternal age alone would have identified 21 of the 31 Down's syndrome cases by karyotyping 61 of the 139 fetuses. Maternal age and nuchal translucency would have identified 29 cases by karyotyping 51 fetuses. Maternal age, nuchal translucency, and biochemistry would also have identified 29 cases by karyotyping 37 fetuses. Conclusions. By adding first trimester biochemistry to nuchal translucency measurement the detection rate of fetuses with Down's syndrome seems to remain unchanged whereas the antenatal risk group to be offered fetal karyotyping decreases.