bluuebunny/crossref_metadata_2025 huggingface dataset:
Factors affecting the outcome of laparoscopic ovarian drilling for polycystic ovarian syndrome in women with anovulatory infertility
Authors: Li T. C. , Saravelos H. , Chow M. S. , Chisabingo R. , Cooke I. D.
Published: August 2005

Objective
To describe and analyse the factors affecting the pregnancy rate of laparoscopic ovarian drilling for polycystic ovarian syndrome in women with anovulatory infertility.

Design
A retrospective study.

Setting
A specialist infertility clinic based at a teaching hospital in England.

Population
One hundred and eighteen women, for whom hospital records and follow up data were available, with polycystic ovarian syndrome who underwent laparoscopic ovarian surgery for anovulatory infertility over a five year period, between January 1991 and December 1995.

Main Outcome measures
Ovulation and pregnancy rate.

Results
The cumulative conception rate 12 months after the treatment was 54%. Women who conceived following the surgery had a shorter duration of infertility, were treated with diathermy (rather than laser), had higher pre‐operative luteinising hormone levels, were younger and were more likely to have ultrasonographic evidence of polycystic ovarian disease. Logistic multiple regression analysis showed that the duration of infertility, modality used in treatment (laser or diathermy) and the preoperative levels were the main determinants of the outcome.

Conclusion
Women with polycystic ovarian syndrome respond favourably to laparoscopic ovarian drilling. The success rate in women with infertility duration of less than three years, treated with diathermy, in whom the pre‐operative level was more than 10 IU/L reached 79%.
A comparative study using two dose regimens (200 μg or 400 μg) of vaginal misoprostol for pre‐operative cervical dilatation in first trimester nulliparae
Authors: Fong Y. F. , Singh Kuldip , Prasad R. N. V.
Published: August 2005

Objective
To determine the optimal dosage and dosing interval for the use of misoprostol administered vaginally for pre‐operative cervical dilatation.

Design
Prospective double‐blind randomised study.

Setting
Fertility Control Centre, National University Hospital, Singapore.

Methods
Women were randomly allocated to either the 200 μg or the 400 μg misoprostol group. Vacuum aspiration was performed at either three or four hours after the insertion of misoprostol tablets. Using Hegar's dilatator, degree of cervical dilatation before operation was measured. Other parameters assessed included the amount of additional dilatation required (if it was < Hegar 8), pre‐operative and intra‐operative blood loss, and associated side effects.

Results
For the 200 μg misoprostol group, only seven (23.3%) achieved a dilatation of ≥ 8 mm compared with 29 women (96.7%) in the 400 μg misoprostol group. The odds ratio was 95.3 (95% CI 10.9–830.9) for 400 pg misoprostol for successful pre‐operative cervical dilatation of ≥ 8 mm. The mean cervical dilatation for 400 μg and 200 μg misoprostol was 8.2 mm and 6.4 mm, respectively (P < 0.001). The use of 400 pg misoprostol with an evacuation interval of three hours appears to be the optimal dosage and evacuation time interval. Increasing the time interval beyond three hours did not confer any additional advantage on the rate of successful cervical dilatation but was instead associated with an increase in side effects such as vaginal bleeding, lower abdominal pain and the appearance of products of conception at the cervical os. However, besides vaginal bleeding, no significant differences in the frequency of these side effects were demonstrated.

Conclusion
This first report on the comparison of differing dosages and time intervals to determine the optimal dosage treatment schedule shows that the vaginal application of 400 μg misoprostol for at least three hours is optimal for pre‐operative cervical dilatation before vacuum aspiration in first trimester nulliparae.
The rise in caesarean section rate: the same indications but a lower threshold
Authors: Leitch C. R. , Walker J. J.
Published: August 2005

Objective
To investigate the reasons for the rise in caesarean section rate and note any change in Design A retrospective, descriptive study comparing the years 1962 and 1992.

Setting
A large city centre teaching hospital.

Results
There was an overall increase in the caesarean section rate from 6.8% in 1962 to 18.1% in 1992. No single cause contributed more than 30% towards this increase. The main indications in both years were similar: failure to progress (42.2%vs 36.7%) and fetal indications (18.1%vs 18.9%). The largest relative increases were in the malpresentation group (10.8%vs 16%) and previous caesarean section (4.5%vs 15.2%).

Conclusions
These results suggest that there has been a lowering in the overall threshold concerning the decision to carry out a caesarean section rather than changes in obstetric management. Obstetricians and the women in their care have to decide whether the current balance between risk and benefit is acceptable or whether they wish to alter the underlying philosophy if any significant reduction is to be sustained. indications.
Physiological changes in insulin resistance in human pregnancy: longitudinal study with the hyperinsulinaemic euglycaemic clamp technique
Authors: Stanley Katharine , Fraser Robert , Bruce Christine
Published: August 2005

Objective
To perform measurements of insulin resistance serially in pregnancy and after childbirth in normal women.

Design
Longitudinal study.

Setting
Teaching hospital.

Methods
Ten normal women were studied using the hyperinsulinaemic euglycaemic clamp technique before pregnancy, at 16, 26 and 36 weeks gestation, and 8 weeks after delivery. All women breastfed their infants. Insulin resistance was measured by the glucose infusion rate required to maintain the plasma glucose at 4.5 mmol/l.

Results
There was a progressive increase in insulin resistance in all women as pregnancy progressed. The increase in resistance was most marked between 16 and 26 weeks of gestation, with only minimal progression thereafter. Lactation does not alter insulin resistance.

Conclusion
The timing and extent of changes in insulin resistance are of physiological importance because they affect all classes of maternal and fetal substrates.
Choosing options for ultrasound screening in pregnancy and comparing cost effectiveness: a decision analysis approach
Authors: Roberts Tracy , Mugford Miranda , Piercy James
Published: August 2005

Objective
To compare the cost effectiveness of different programmes of routine antenatal ultrasound screening to detect four key fetal anomalies: serious cardiac anomalies, spina bifida, Down's syndrome and lethal anomalies, using existing evidence.

Design
Decision analysis was used based on the best data currently available, including expert opinion from the Royal College of Obstetricians and Gynaecologists, Working Party and secondary data from the literature, to predict the likely outcomes in terms of malformations detected by each screening programme.

Setting
Results applicable in clinics, hospitals or GP practices delivering antenatal screening.

Main outcome measure
The number of cases with a ‘target’ malformation correctly detected antenatally.

Results
There was substantial overlap between the cost ranges of each screening programme demonstrating considerable uncertainty about the relative economic efficiency of alternative programmes for ultrasound screening. The cheapest, but not the most effective, screening programme consisted of one second trimester ultrasound scan. The cost per target anomaly detected (cost effectiveness) for this programme was in the range £5,000‐£109,000, but in any 1000 women it will also fail to detect between 3.6 and 4.7 target anomalies.

Conclusions
The range of uncertainty in the costs did not allow selection of any one programme as a clear choice for NHS purchasers. The results suggested that the overall allocation of resources for routine ultrasound screening in the UK is not currently economically efficient, but that certain scenarios for ultrasound screening are potentially within the range of cost effectiveness reached by other, possibly competing, screening programmes. The model highlighted the weakness of available evidence and demonstrated the need for more information both about current practice and costs.
Patterns of diagnosis and referral in women consulting for chronic pelvic pain in UK primary care
Authors: Zondervan Krina T. , Yudkin Patricia L. , Vessey Martin P. , Dawes Martin G. , Barlow David H. , Kennedy Stephen H.
Published: August 2005

Objectives
To describe duration of symptoms and patterns of diagnosis and referral in women with chronic pelvic pain.

Design
Retrospective cohort analysis of the MediPlus UK Primary Care Database.

Setting
One hundred and thirty‐six general practices in the UK.

Study group
A cohort of 5051 incident cases of chronic pelvic pain.

Methods
The cohort was followed up from the start of their symptoms in 1992 until the end of the chronic pelvic pain episode or the end of 1995.

Main outcome measures
Duration of symptoms, frequency of diagnoses and referral rates.

Results
A third of women had symptoms persisting for more than two years. Duration of symptoms increased significantly with age (P < 0.001) from a median of 13.7 months in 13–20 year olds to 20.2 months in women over the age of 60. Irritable bowel syndrome and cystitis were the most common diagnoses at all ages. Twenty‐eight percent of women never received a diagnosis during three to four years of follow up after first consultation, and 60% of women had no evidence of a specialist referral. Women aged 21–50 and women whose final diagnosis was endometriosis received the largest number of diagnoses and had the highest referral rates.

Conclusions
The numbers and types of diagnosis given to a woman with chronic pelvic pain and the likelihood of specialist referral depend on her age, as well as on the duration of symptoms. Women seen in secondary care for chronic pelvic pain are a highly selected group and are likely to represent only the tip of the iceberg.
A comparison of fetal behaviour in breech and cephalic presentations at term
Authors: Kean L. H. , Suwanrath C. , Gargari S. S. , Sahota D. S. , James D. K.
Published: August 2005

Objective
To evaluate fetal behaviour in breech and cephalic fetuses at term, using a computerised fetal behaviour program.

Design
An observational study.

Setting
Pregnancy Assessment Centre, University Hospital, Nottingham.

Sample
Twenty‐six breech and 58 cephalic fetuses between 36 and 41 weeks.

Methods
Behaviour (fetal heart rate and activity) was recorded with the use of Doppler ultrasound. The duration of recording was 60 minutes or more in all but four recordings (minimum 49 minutes).

Main outcome measures
Behavioural criteria studied were 1. the relative percentage time spent in low and high variation fetal heart rate patterns; 2. the duration and recurrence of fetal activity; 3. the number of accelerations in low and high fetal heart rate variation; and 4. the number of fetal behavioural state transitions.

Results
Breech fetuses differed from the cephalic group in that they were lighter than the cephalic fetuses (median 3105 g vs 3400 g; P < 0.01) and were born to older mothers (median maternal age 30 years vs 28 years; P < 0.01). No significant differences were found in rates of movement, numbers of accelerations and time exhibiting low and high fetal heart rate variation. However, breech fetuses exhibited significantly more state transitions (median 5.2h vs 3.69h; P= 0.01).

Conclusions
This study shows that breech fetuses are neurologically different from their cephalic counterparts in otherwise healthy pregnancies, and that subtle behavioural differences can be demonstrated in utero using this computerised method.
The influence of 5,10 methylenetetrahydrofolate reductase genotypes on enzyme activity in placental tissue
Authors: Daly Sean F. , Molloy Anne M. , Mills James L. , Less Y. Jack , Conley Mary , Kirke Peadar N. , Weir Donald G. , Scott John M.
Published: August 2005

Objective
To study the effects of heterozygosity and homozygosity for the C677T mutation of the 5,10 methylenetetrahydrofolate reductase (MTHFR) gene on the activity of this enzyme in placental tissue from pregnancies not affected by neural tube defect.

Design
Placental tissue was genotyped for the C677T variants of MTHFR. Total enzyme activity and residual activity after heating to 46°C for 5 minutes was then measured.

Setting
A teaching hospital.

Sample
Placental samples (n= 200), one from each of 200 uncomplicated term deliveries.

Main outcome measures
Total and residual enzyme activity for MTHFR.

Results
Placentae heterozygous for the C677T mutation of the MTHFR gene had significantly lower total enzyme activity than those without the mutation; the lowest activity occurred in homozygotes for the mutation. The same pattern was seen in relation to enzyme activity after heating.

Conclusion
This study demonstrates that reduced enzyme activity is associated with the C677T variant of MTHFX in placental tissue. This is an important metabolic step in folic acid metabolism and pro‐
5,10 methylenetetrahydrofolate reductase polymorphism in black South African women with pre‐eclampsia
Authors: Chikosi A.B. , Moodley J. , Pegoraro R. J. , Lanning P.A. , Rom L.
Published: August 2005

The polymorphic C677T mutation in the gene encoding 5,10 methylenetetrahydrofolate reductase has been shown to be a risk factor for pre‐eclampsia in Japanese and European women when inherited as a homozygous trait. We attempted to verify these findings in a black African population with a high incidence of pre‐eclampsia. No difference in frequency of the T‐allele was observed in 105 women with pre‐eclampsia, compared with 110 healthy pregnant normotensive women. Only one woman with pre‐eclampsia was TT homozygous, suggesting that methylenetetrahydrofolate reductase polymorphism is not an important factor in the pathogenesis of pre‐eclampsia in black South African women.
Use of the disutility ratio in prenatal screening for Down's syndrome
Authors: van der Meulen Jan H. P. , Mol Ben W. J. , Pajkrt Eva , van Lith Jan M. M. , Voorn Wim
Published: August 2005

Objective
To assess the value of the triple test incorporating individual differences in parental evaluation of outcomes of pregnancy.

Design
Decision analysis.

Sample
Monte Carlo simulation of triple test results in 25,000 women with a normal pregnancy and 25,000 women with a pregnancy affected by Down's syndrome.

Methods
A decision model was developed for women who were 16 weeks pregnant. Three strategies were evaluated: 1. no prenatal testing; 2. amniocentesis; and 3. the triple test followed by amniocentesis if the risk of a pregnancy with Down's syndrome, based on maternal age and the triple test results (post‐test risk), was above the woman's threshold risk for amniocentesis.

Main outcome measures
The outcomes considered were: 1. birth of a child without Down's syndrome; 2. birth of a child with Down's syndrome; and 3. pregnancy loss, either spontaneously, or as a result of termination. The values of these pregnancy outcomes were expressed on a disutility scale in units of ‘lost pregnancy equivalents’. The birth of a normal child brings no disutility. The disutility of the birth of a child with Down's syndrome is consequently specified by the ratio of the expected parental distress after the birth of a child with Down's syndrome to the expected parental distress after the loss of the pregnancy (disutility ratio).

Results
The value of the triple test depends strongly on maternal age as well as on the individual evaluation of the outcome of pregnancy. The triple test is of considerable value for all women > 38 years; its value for women between 27 and 38 years depends on the disutility ratio, and it is of little value for women c 27 years.

Conclusion
The value of the triple test depends on the parental evaluation of outcome of pregnancy for a large group of pregnant women. The disutility ratio, as introduced in this study, might be an instrument to elicit these values for individual women in clinical practice.
Fetal ultrasound biometry: 2. Abdomen and femur length reference values
Authors: Kurmanavicius Juozas , Wright Eileen M. , Royston Patrick , Zimmermann Roland , Huch Renate , Huch Albert , Wisser Joseph
Published: August 2005

Objective
To create reliable reference ranges and calculate Z scores for fetal abdomen and femur ultrasound biometry using a large sample size which is evenly distributed from 12 to 42 weeks of pregnancy.

Design
A prospective, cross‐sectional study.

Setting
Obstetric clinics (outpatient and delivery units) at the University Hospital of Zurich.

Sample
The study data were obtained from 6557 pregnant women.

Methods
Only the first ultrasound examination between 12 and 42 weeks of each fetus with certainly established gestational age was used for analysis. No exclusions were made on the grounds of small‐for‐date birthweight, prematurity or other events several weeks after the examination. Separate regression models were fitted to estimate the mean and standard deviation at each gestational age for each parameter.

Results
A total of 5807 mean abdominal diameters and abdominal circumferences were derived from fetal transverse and anterio‐posterior fetal abdominal diameter measurements. Fetal femur length was measured in 5860 instances. The charts, tables and regression formulae of the biometrical measurements are presented. A comparison of our charts with others showed no significant difference. Only Merz's1 centiles for abdominal biometry were lower and for femur length higher than ours. An application to calculate 2 scores was developed using Excel (Microsoft Corporation, USA); the macros are presented in detail in the Figure 6 footnote.

Conclusions
We have presented centile charts, tables and formulae for fetal abdominal diameter and circumference and femur length derived from a large and minimally selected sample size in a carefully designed cross‐sectional study. Complete tables and regression formulae to calculate reference ranges and Z scores are presented to use in computer‐aided evaluation of fetal ultrasound biometry.
Colposcopy and treatment of cervical intra‐epithelial neoplasia: are national standards achievable?
Authors: Semple David , Saha Arabinda , Maresh Michael
Published: August 2005

Objective
To assess whether consensus based national standards for colposcopy and treatment of cervical intra‐epithelial neoplasia are achievable in practice.

Design
Identification of 100 consecutive cases of first assessment colposcopy from each gynaecological unit in the former North West region from 1 January 1994 and follow up of their outcome after one year.

Setting
All 19 gynaecological colposcopy clinics in the former North West region.

Sample
In one hospital data were available on only 39 women and therefore information was analysed on 1839 women.

Main outcome measures
Waiting times for colposcopy, different modalities of treatment used for pre‐malignant conditions of the cervix and type of anaesthesia used for treatments. With regard to follow up, time of occurrence, whether or not colposcopy was performed and efficacy of treatment as judged by cervical cytology.

Results
Waiting times for colposcopy varied in the individual hospitals studied, but overall 56% of patients were seen within eight weeks. Diathermy loop excision was the most popular treatment modality accounting for 44% of cases. At six months after treatment, 9.98% of patients had a smear of mild dyskaryosis or worse. Colposcopy, as well as cytology, was used at the first follow up visit in 43% of cases.

Conclusion
At a local level individual hospitals can identify areas where improvements in the service they provide need to be made. The practicality of the current guidelines in today's health service needs questioning.
A controlled comparison of ovarian response to controlled stimulation in first generation Asian women compared with white Caucasians undergoing in vitro fertilisation
Authors: Lashen H. , Afnan M. , Sharif K.
Published: August 2005

Objective
To compare ovarian response to controlled stimulation among Asian women from the Indian sub‐continent and white Caucasian women undergoing in vitro fertilisation (IVF).

Design
Nested case‐control study.

Setting
Assisted Conception Unit, Birmingham Women's Hospital.

Sample
One hundred and eight first generation Asian patients (born in the Indian sub‐continent) and 216 white Caucasian controls, all of whom received IVF treatment in the period 1994 to 1997, were selected for the study. The two groups were matched for age to within one year, early follicular phase follicle stimulating hormone, indication for treatment, gonadotrophin dose and year of treatment. The outcome of treatment was not known when the controls were selected.

Results
There was no statistically significant difference between the two groups in the duration of stimulation, egg number, number of embryos produced, fertilisation rate, clinical pregnancy rate, miscarriage rate, cycle cancellation rate and implantation rate.

Conclusion
Under the same IVF protocol Asian women's response to controlled ovarian stimulation and IVF outcome are comparable to their white Caucasian peers.
Perioperative ultrasonography of lymph nodes in patients with gynaecological malignancy
Authors: Helin Hanna‐Leena , Penttinen Jorma , Kirkinen Pertti
Published: August 2005

Objective
To examine the accuracy of perioperative ultrasonography in detecting pelvic and para‐aortic lymph nodes, and to compare the ultrasonographic findings with those observed in histology.

Participants
Forty women with gynaecological malignancy were examined by ultrasonography during their operations before surgical exploration of the lymph nodes; 182 specimens were taken for histological analysis.

Main outcome measures
Ultrasonographic findings were compared with histological diagnoses of lymph node biopsies.

Results
Suspicious lymph nodes (diameter > 5 mm) were found in 31 lymph node regions. Seventeen histologically malignant lymph nodes were found. The sensitivity, specificity, and accuracy of finding metastatic lymph nodes by ultrasonography were 7 1 %, 88%, and 87%, respectively. The frequency of false negative ultrasonographic findings was 29%.

Conclusions
Perioperative ultrasonographic examination can be of use in localising pelvic and para‐aortic lymph nodes, especially in laparoscopic operations, where tactile palpation of the retroperitoneal space is not possible. The negative predictive value of the method is high, but the relatively poor sensitivity limits its diagnostic value.
Effects of corticotrophin releasing hormone on contractile activity of myometrium from pregnant women
Authors: Simpkin James C. , Kermani Faiz , Palmer Anna M. , Campa Juan S. , Tribe Rachel M. , Linton Elizabeth A. , Poston Lucilla
Published: August 2005

Objective
To determine whether corticotrophin releasing hormone plays a role in the regulation of tone in tern nonlabouring human myometrium.

Setting
A teaching hospital research laboratory.

Sample
Thirty‐seven women undergoing elective nonlabour caesarean section under regional anaesthesia.

Methods
Human corticotrophin releasing hormone (1, 10, 100 nmol/L) was added to strips of term, nonlabouring myometrium mounted in an organ bath, and the effect on spontaneous, oxytocin (1 nmol/L) or prostaglandin F2α (100 nmol/L) stimulated contractions determined. Cyclic adenosine monophosphate (CAMP) content of the tissue was also determined by enzyme immunoassay.

Results
Corticotrophin releasing hormone did not affect myometrial tension development in any of the experimental protocols. cAMP increased transiently after addition of corticotrophin releasing hormone (166.7 ± 12.7% at 1 minute) but this was not reflected by any change in tension.

Conclusions
This study suggests that despite high maternal plasma concentrations of corticotrophin releasing hormone in pregnancy at term, this peptide is unlikely to play a direct role in the control of myometrial contractility in nonlabouring myometrium.
Is the provision of information leaflets before colposcopy beneficial? A prospective randomised study
Authors: Howells R. E. J. , Dunn P. D. J. , Isasi T. , Chenoy R. , Calvert E. , Jones P. W. , Shroff J. Foden , Redman C. W. E.
Published: August 2005

Objective
To assess the usefulness of a leaflet distributed to women before colposcopy designed to reduce their anxiety and psychosexual by providing information.

Design
Prospective randomised study.

Setting
Colposcopy clinic of a large district general hospital.

Sample
Two hundred consecutive women undergoing colposcopy for the first time for a cervical cytological abnormality of severity no greater than moderate dyskaryosis.

Methods
Women were randomised into one of two groups (leaflet or control). Those in the leaflet group were sent an information leaflet prior to attending the clinic. In the colposcopy clinic all the women completed a Statenrait Anxiety Inventory (StAVTrAI) and a modified psychosexual questionnaire before undergoing colposcopy. This was repeated at the six‐month follow up visit. Women in the leaflet group also completed a further questionnaire on the leaflet.

Main outcome measures
Differences of anxiety and psychosexual scores between leaflet and control groups.

Results
The leaflet was well received. There were no statistical differences in StAI and TrAI scores between the study group and the control group at either visit, although in the whole study population StAI and TrAI scores were reduced at the second visit. The leaflet group had significantly more psychosexual problems but by the second visit, the scores had improved and the two groups were similar. When the mean differences in anxiety and psychosexual scores at the initial and second visits were compared between the groups, the reduction in negative sexual feelings and deterioration of TrAI scores experienced by the leaflet group was significant.

Conclusions
This study suggests that the provision of sending an information leaflet prior to colposcopy is not beneficial in isolation. Other approaches need to be considered.
Fetal heart rate variability changes during brief repeated umbilical cord occlusion in near term fetal sheep
Authors: Westgate Jenny A. , Bennet Laura , Gunn Alistair J.
Published: August 2005

Objective
To determine whether changes in fetal heart rate variation during repeated umbilical cord occlusions reflect evolving cardiovascular compromise in near term fetal sheep.

Design
Fetal heart rate variation, fetal mean arterial pressure, electroencephalogram (EEG) and acid‐base status were measured during one minute umbilical cord occlusions, repeated either every five minutes (1 : 5 group) or every 2.5 minutes (1 : 2.5 group) for four hours or until mean arterial pressure fell below 20 mmHg for two successive occlusions.

Sample
Fourteen chronically instrumented fetal sheep, mean gestation 126.3 (2.6) days.

Results
Cord occlusion caused variable decelerations with initial sustained hypertension. In the 1:5 occlusion group mean arterial pressure remained elevated throughout, with little change in acid‐base status (pH = 7.34 (0.07), base deficit = 1.3 (3.9) after 4 hours) and no significant change in fetal heart rate variation. In contrast, in the 1:2.5 group from the third occlusion there was progressive hypotension during occlusions, severe progressive metabolic acidaemia (pH 6.92 (0.1), base deficit 17.0 mmol/L (4.7) after the last occlusion) and marked EEG suppression (P < 0.01). Fetal heart rate variation increased with the onset of occlusions (P < 0.05) and then progressively fell with continued occlusions. During the last 30 minutes of occlusions, fetal heart rate variation was severely suppressed in four, but increased in two fetuses, while all six fetuses developed overshoot‐instability of fetal heart rate and mean arterial pressure following each occlusion.

Conclusions
Acute progressive asphyxia was typically associated with an immediate, transient increase in fetal heart rate variation. Subsequently variation became suppressed in only two‐thirds of fetuses during terminal acidaemia and hypotension. Fetal heart rate overshoot‐instability may be a useful marker of fetal decompensation following variable decelerations.
Oral contraceptive use and risk of endometriosis
Authors:   Italian Endometriosis Study Group
Published: August 2005

Objective
To analyse the association between use of oral contraception and risk of pelvic endometriosis.

Design
We compared use of oral contraception in women with and without endometriosis.

Participants
Eligible for the study were women with primary or secondary infertility (n= 393) or chronic pelvic pain (n= 424). requiring laparoscopy, consecutively observed between September 1995 and January 1996 in 15 obstetrics and gynaecology departments in Italy.

Results
Out of the 817 women included in the study, 345 had a diagnosis of endometriosis; 164 (47.5%) women with endometriosis and 139 (29.4%) without the disease reported ever using oral contraception. In comparison with never users the estimated odds ratios (OR) of endometriosis were 1.8 (95% CI 1.0–3.3) in current users and 1.6 (95% CI 1.1–2.4) in exusers. No clear relation emerged between duration of oral contraceptive use and risk of endometriosis. In comparison with never users, the OR was 1.8 (95% CI 1.1–3.0) for women reporting their last use of oral contraception < 5 years before interview and 1.5 (95% CI 0.9–2.5) for those reporting their last use >5 years before interview.

Conclusions
The study suggests that oral contraception is associated with an increased risk of endometriosis but this finding is based on a selected population and cannot generalised to all women with endometriosis.
The Burch colposuspension for recurrent urinary stress incontinence following retropubic continence surgery
Authors: Maher Christopher , Dwyer Peter , Carey Marcus , Gilmour Donna
Published: August 2005

Objective
To evaluate the Burch colposuspension with Cherney incision in women with recurrent urinary stress incontinence after retropubic continence surgery.

Design
A retrospective review.

Participants
All 53 women had recurrent urinary stress incontinence after retropubic continence surgery with an average of 2.1 (range 1–5) previous failed continence procedures per woman.

Main outcome measures
Subjective and objective success rates and complications including detrusor instability, voiding difficulties and genital prolapse.

Results
Forty‐seven women (89%) had no or occasional (< one episode per week) stress or urge incontinence. One woman had persistent stress incontinence and five urge incontinence. Forty‐two women (80%) rated their surgery as being highly successful and 38 women (72%) had no urinary leakage due to genuine stress incontinence or detrusor instability on repeat urodynamic evaluation. Three women (6%) developed de novo detrusor instability post‐operatively. Two women (4%) had voiding difficulties post‐operatively that necessitated the use of intermittent self‐catheterisation for at least four months. The median length of follow up was nine months (4–72). In 39 women (73%), marked retropubic fibrosis was found at the time of surgery.

Conclusions
Marked retropubic fibrosis should be expected in women with recurrent stress inconti‐ nence after retropubic continence surgery. The Burch colposuspension with the assistance of the Cherney incision and sharp dissection of retropubic fibrosis is an effective and safe procedure for women with this condition.
Relationship of serum levels of endogenous relaxin to cervical size in the second trimester and to cervical ripening at term
Authors: Eppel W. , Kucera E. , Bieglmayer C.
Published: August 2005

Objective
To assess whether cervical size in the early second trimester and cervical ripening at term may be related to serum levels of endogenous relaxin, 17R‐oestradiol or progesterone.

Design
A cross‐sectional study investigating the relationship between hormone concentrations and cervical parameters as measured by ultrasound and Bishop score, respectively.

Participants
Uncomplicated human pregnancies with normal fetal outcome, 72 women in the second trimester and 40 women at term.

Methods
Vaginal ultrasound and palpation were used to estimate cervical parameters. Hormones were analysed either by dissociation‐enhanced fluoroimmunoassay (relaxin) or by automated electrochemiluminescent immunoassays.

Results
Cervical length and diameter correlated positively during mid‐gestation and negatively at term. During mid‐gestation, but not at term, relaxin was significantly associated with cervical length and volume, and with progesterone. Bishop score only correlated inversely with progesterone at term.

Conclusion
Corpus luteum function is reflected by progesterone and relaxin in the early second trimester. An impact of relaxin on cervical growth, previously demonstrated by animal models and in vitro experiments, was confirmed during human mid‐gestation. In contrast to many other species, human cervical ripening was not associated with endogenous relaxin at term, but with decreased progesterone.
Are high levels of oestradiol after implants associated with features of dependence?
Authors: O'Leary A. , Bowen‐Simpkins P. , Tejura H. , Rajesh U.
Published: August 2005

Objective
To determine whether features of dependence develop in women receiving oestradiol implants, and if so, whether these features are related to serum oestradiol levels.

Design
A questionnaire survey of women attending for implants over a six month period.

Setting
An implant clinic in a district general hospital.

Main outcome measures
Psychological symptoms and their relationship to serum oestradiol levels.

Results
Women with serum oestradiol levels below 500 pmol/L were generally asymptomatic of psychological symptoms.

Conclusion
Serum oestradiol levels of women receiving implants should be kept in the range of 300–500, pmol/L. Higher levels appear to be associated with the development of psychological symptoms which could be classified as features of dependence.
The treatment of hypertriglyceridaemia in menopausal women with transdermal oestradiol therapy
Authors: Bhathena R. K. , Anklesaria B. S. , Ganatra A. M.
Published: August 2005

The objective of this study was to evaluate the effect of transdermal oestradiol on serum triglycerides in menopausal women with pre–existing mild to moderate hypertriglyceridaemia. Forty–four women, who had had a hysterectomy and who had been maintained on 50 μg unopposed oestradiol for six months, were divided into two groups: those with normal baseline triglyceride concentrations (0.4–2 mmol/L) (n= 34) and those with raised baseline readings (> 2–4 mmol/L) (n= 10). There was a significant reduction in the concentrations of serum triglycerides in both groups [‐9.6% (P 0.001) and −17% (P <0.001), respectively]. Transdermal oestradiol therapy may be a useful treatment option in menopausal women with pre–existing hypertriglyceridaemia. There is a need to conduct large, prospective, controlled trials using transdermal oestradiol to treat hypertriglyceridaemia in menopausal women.
Analysis of Integration in Nursing Science and Practice
Authors: Whittemore Robin
Published: August 2005

Purpose:

To clarify the definition of integration and to identify universal aspects of the experience of integration related to healing, health, and nursing care.

Design:

An integrative review concept analysis method was used. Relevant reports were identified by a computer‐assisted search using the keyword integration in CINAHL from 1966 to 2004 and by reviewing the reference lists of retrieved reports. The final sample included 56 reports; 36 were empirical and 20 were theoretical.

Methods:

Data were extracted from primary sources on the definition of integration, aspects of the process, antecedents, consequences, and facilitators. Data display matrices were used and were iteratively compared to derive a process model of integration related to health.

Findings:

A wide range of primary sources indicated that integration is an important aspect of healing or recovery from illness. Integration is defined as a complex person‐environment interaction whereby new life experiences (i.e., illness) are assimilated into the self and activities of daily living, thereby contributing to overall life balance.

Conclusions:

Results of this analysis indicate the importance of the concept of integration to the science and practice of nursing. The process of integration appears to be a significant phase that occurs between a diagnosis of illness and subsequent physical and emotional healing.
The Effect of Two Models of Supervision on Selected Outcomes
Authors: Uys Leana R. , Minnaar Ansie , Simpson Barbara , Reid Steve
Published: August 2005

Purpose:

To evaluate the effect of training in two different supervisory models on the supervision itself, the quality of care, and job satisfaction of nurses in different service settings in a district health service (DHS) in South Africa.

Design:

As part of a larger health systems study, the results of supervision training were evaluated. The quantitative study was done in three health districts in South Africa.

Methods:

The modified matrix (MM) model of supervision was taught and implemented in District A, the Centre for Health and Social Studies (CHESS) model in District B, and the control was District C. Checklists based on direct observation and record reviews were used to measure quality of care (quality of hand‐over between shifts, nursing records, management of chronic diseases, and implementation of universal precautions). Questionnaires were used to measure perception of supervision and patient satisfaction. Chi‐square analysis was done.

Findings and conclusions:

Supervision ratings before and after the interventions differed significantly in the total sample, but not by district. In the district with the MM model, care for people with chronic diseases improved significantly, but other measures did not. The supervision training had some influence, but more measures of effectiveness of supervision training are needed.
Comparative evaluation of implant designs: influence of diameter, length, and taper on strains in the alveolar crest
Authors: Petrie Cynthia S. , Williams John L.
Published: August 2005

Objectives: Our aim was to analyze and compare systematically the relative and interactive effects of implant diameter, length, and taper on calculated crestal bone strains.

Material and methods: Three‐dimensional finite‐element models were created of a 20‐mm premolar section of the mandible with a single endosseous implant embedded in high‐ or low‐density cancellous bone. Oblique (200‐N vertical and 40‐N horizontal) occlusal loading was applied. Cortical and cancellous bone were modeled as transversely isotropic and linearly elastic. Perfect bonding was assumed at all interfaces. A two‐level factorial statistical design was used to determine the main and interactive effects of four implant design variables on maximum shear strains in the crestal alveolar bone: diameter, length of tapered segment, length of untapered segment, and taper. Implant diameter ranged from 3.5 to 6 mm, total implant length from 5.75 to 23.5 mm, and taper from 0 to 14°, resulting in 16 implant designs.

Results: Increasing implant diameter resulted in as much as a 3.5‐fold reduction in crestal strain, increasing length caused as much as a 1.65‐fold reduction, whereas taper increased crestal strain, especially in narrow and short implants, where it increased 1.65‐fold. Diameter, length, and taper have to be considered together because of their interactive effects on crestal bone strain.

Conclusion: If the objective is to minimize peri‐implant strain in the crestal alveolar bone, a wide and relatively long, untapered implant appears to be the most favorable choice. Narrow, short implants with taper in the crestal region should be avoided, especially in low‐density bone.
Novel Sialic Acid Transporter of
Haemophilus influenzae
Authors: Allen Simon , Zaleski Anthony , Johnston Jason W. , Gibson Bradford W. , Apicella Michael A.
Published: August 2005

Nontypeable
Haemophilus influenzae
is an opportunistic pathogen and a common cause of otitis media in children and of chronic bronchitis and pneumonia in patients with chronic obstructive pulmonary disease. The lipooligosaccharides, a major component of the outer membrane of
H. influenzae
, play an important role in microbial virulence and pathogenicity.
N
-Acetylneuraminic acid (sialic acid) can be incorporated into the lipooligosaccharides as a terminal nonreducing sugar. Although much of the pathway of sialic acid incorporation into lipooligosaccharides is understood, the transporter responsible for
N
-acetylneuraminic acid uptake in
H. influenzae
has yet to be characterized. In this paper we demonstrate that this transporter is a novel sugar transporter of the tripartite ATP-independent periplasmic transporter family. In the absence of this transporter,
H. influenzae
cannot incorporate sialic acid into its lipooligosaccharides, making the organism unable to survive when exposed to human serum and causing reduced viability in biofilm growth.
Microarray-Based Detection of
Salmonella enterica
Serovar Typhimurium Transposon Mutants That Cannot Survive in Macrophages and Mice
Authors: Chan Kaman , Kim Charles C. , Falkow Stanley
Published: August 2005

DNA microarrays provide an opportunity to combine the principles of signature-tagged mutagenesis (STM) with microarray technology to identify potentially important bacterial virulence genes. The scope of DNA microarrays allows for less laborious screening on a much larger scale than possible by STM alone. We have adapted a microarray-based transposon tracking strategy for use with a
Salmonella enterica
serovar Typhimurium cDNA microarray in order to identify genes important for survival and replication in RAW 264.7 mouse macrophage-like cells or in the spleens of BALB/cJ mice. A 50,000-CFU transposon library of
S. enterica
serovar Typhimurium strain SL1344 was serially passaged in cultured macrophages or intraperitoneally inoculated into BALB/cJ mice. The bacterial genomic DNA was isolated and processed for analysis on the microarray. The novel application of this approach to identify mutants unable to survive in cultured cells resulted in the identification of components of
Salmonella
pathogenicity island 2 (SPI2), which is known to be critical for intracellular survival and replication. In addition, array results indicated that a number of SPI1-associated genes, currently not associated with intracellular survival, are negatively selected. However, of the SPI1-associated mutants individually tested for intracellular survival, only a
sirA
mutant exhibited reduced numbers relative to those of wild-type bacteria. Of the mutants unable to survive in mice, significant proportions are either components of the SPI2 pathogenicity island or involved in lipopolysaccharide synthesis. This observation is in agreement with results obtained in the original
S. enterica
serovar Typhimurium STM screen, illustrating the utility of this approach for the high-throughput identification of virulence factors important for survival in the host.
Fetuin-A, a Hepatocyte-Specific Protein That BindsPlasmodium bergheiThrombospondin-Related Adhesive Protein: a Potential Role in Infectivity
Authors: Jethwaney Deepa , Lepore Timothy , Hassan Saria , Mello Kerrianne , Rangarajan Radha , Jahnen-Dechent Willi , Wirth Dyann , Sultan Ali A.
Published: August 2005

Malaria infection is initiated when the insect vector injectsPlasmodiumsporozoites into a susceptible vertebrate host. Sporozoites rapidly leave the circulatory system to invade hepatocytes, where further development generates the parasite form that invades and multiplies within erythrocytes. Previous experiments have shown that the thrombospondin-related adhesive protein (TRAP) plays an important role in sporozoite infectivity for hepatocytes. TRAP, a typical type-1 transmembrane protein, has a long extracellular region, which contains two adhesive domains, an A-domain and a thrombospondin repeat. We have generated recombinant proteins of the TRAP adhesive domains. These TRAP fragments show direct interaction with hepatocytes and inhibit sporozoite invasion in vitro. When the recombinant TRAP A-domain was used for immunoprecipitation against hepatocyte membrane fractions, it bound to α2-Heremans-Schmid glycoprotein/fetuin-A, a hepatocyte-specific protein associated with the extracellular matrix. When the soluble sporozoite protein fraction was immunoprecipitated on a fetuin-A-adsorbed protein A column, TRAP bound this ligand. Importantly, anti-fetuin-A antibodies inhibited invasion of hepatocytes by sporozoites. Further, onset of malaria infection was delayed in fetuin-A-deficient mice compared to that in wild-type C57BL/6 mice when they were challenged withPlasmodium bergheisporozoites. These data demonstrate that the extracellular region of TRAP interacts with fetuin-A on hepatocyte membranes and that this interaction enhances the parasite's ability to invade hepatocytes.
Synthesis of Melanin Pigment by
Candida albicans
In Vitro and during Infection
Authors: Morris-Jones Rachael , Gomez Beatriz L. , Diez Soraya , Uran Martha , Morris-Jones Stephen D. , Casadevall Arturo , Nosanchuk Joshua D. , Hamilton Andrew J.
Published: August 2005

Melanins are implicated in the pathogenesis of several important human diseases. This study confirmed the presence of melanin particles in
Candida albicans
in vitro and during infection. Dark particles were isolated from the digestion of
C. albicans
cultures and from infected tissue, as established by electron microscopy and immunofluorescence techniques.
Apparent receptor-mediated activation of Ca2+-dependent conductive Cl−transport by shark-derived polyaminosterols
Authors: Chernova Marina N. , Vandorpe David H. , Clark Jeffrey S. , Williams Jon I. , Zasloff Michael A. , Jiang Lianwei , Alper Seth L.
Published: August 2005

The shark liver antimicrobial polyaminosterol squalamine is an angiogenesis inhibitor under clinical investigation as an anti-cancer agent and as a treatment for the choroidal neovascularization associated with macular degeneration of the retina. The related polyaminosterol MSI-1436 is an appetite suppressant that decreases systemic insulin resistance. However, the mechanisms of action of these polyaminosterols are unknown. We report effects of MSI-1436 on Xenopus oocytes consistent with the existence of a receptor for polyaminosterols. MSI-1436 activates bidirectional, trans-chloride-independent Cl-flux in Xenopus oocytes. At least part of this DIDS-sensitive Cl−flux is conductive, as measured using two-electrode voltage-clamp and on-cell patch-clamp techniques. MSI-1436 also elevates cytosolic Ca2+concentration ([Ca2+]) and increases bidirectional45Ca2+flux. Activation of Cl−flux and elevation of cytosolic [Ca2+] by MSI-1436 both are accelerated by lowering bath Ca2+and are not acutely inhibited by extracellular EGTA. Elevation of cytosolic [Ca2+] by MSI-1436 requires heparin-sensitive intracellular Ca2+stores. Although injected EGTA abolishes the increased conductive Cl−flux, that Cl−flux is not dependent on heparin-sensitive stores. In low-bath Ca2+conditions, several structurally related polyaminosterols act as strong agonists or weak agonists of conductive Cl−flux in oocytes. Weak agonist polyaminosterols antagonize the strong agonist, MSI-1436, but upon addition of the conductive Cl−transport inhibitor DIDS, they are converted into strong agonists. Together, these properties operationally define a polyaminosterol receptor at or near the surface of the Xenopus oocyte, provide an initial description of receptor signaling, and suggest routes toward further understanding of a novel class of appetite suppressants and angiogenesis inhibitors.