bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy of leflunomide for treatment of immune-mediated polyarthritis in dogs: 14 cases (2006–2008)
Authors: Colopy Sara A. , Baker Theresa A. , Muir Peter
Published: February 2010

Objective—To evaluate efficacy and adverse effects of leflunomide for the treatment of naturally occurring immune-mediated polyarthritis (IMPA) in dogs.

Design—Retrospective case series.

Animals—14 dogs with cytologically confirmed IMPA.

Procedures—Medical records were used to identify dogs with a diagnosis of IMPA that were treated with leflunomide. Signalment, radiographic findings, laboratory data, dosage of leflunomide, treatment duration, treatment response, and occurrence of adverse effects were determined from medical records.

Results—Mean ± SD initial dosage of leflunomide was 3.0 ± 0.5 mg/kg (1.4 ± 0.2 mg/lb) PO once daily. Treatment duration for the initial starting dosage ranged from 1 to 6 weeks. Of the 14 dogs treated with leflunomide, 8 had complete resolution of clinical signs of IMPA initially, 5 had partial response to treatment, and 1 had minimal response to treatment. Adverse effects from treatment with leflunomide were not observed during the treatment period.

Conclusions and Clinical Relevance—Oral administration of leflunomide was a safe and effective alternative to oral administration of corticosteroids for treatment of IMPA in dogs. On the basis of findings in this study, a starting dosage for leflunomide of 3 to 4 mg/kg (1.4 to 1.8 mg/lb) PO once daily for at least 6 weeks before making dose adjustments is recommended. Dose adjustments should be based on cytologic evaluation of synovial fluid and clinical signs of IMPA. Hematologic variables, serum biochemical analysis results, and clinical signs of IMPA should be monitored for evidence of adverse effects to treatment with leflunomide.
Management of mastitis and abscessation of mammary glands secondary to fibroadenomatous hyperplasia in a primiparturient cat
Authors: Burstyn Uri
Published: February 2010

Case Description—A 1-year-old sexually intact female domestic shorthair cat was evaluated because of an 8-week history of pronounced mammary gland hyperplasia that had progressed to mastitis and abscessation of the mammary glands since parturition 7 days earlier. The cat was anorectic, was febrile, and had signs of discomfort. Its kittens were weak and appeared to have difficulty nursing.

Clinical Findings—Physical examination revealed pyrexia, mastitis with abscessation in the 6 caudal mammary glands, skin ulceration over the nipples, and areas of skin necrosis over the abscessed mammary glands. A CBC revealed nonregenerative anemia and leukocytosis with a left shift (2.160 × 109 band cells/L) and toxic changes. Mastitis and incipient septicemia were considered the most likely causes. The history of mammary gland hyperplasia since the second week of pregnancy suggested a diagnosis of fibroadenomatous hyperplasia that predisposed the cat to subsequent mastitis.

Treatment and Outcome—Surgical drainage of the abscessed mammary glands, debridement of necrotic skin, and placement of a Penrose drain resulted in rapid improvement in clinical status. Broad-spectrum antimicrobial treatment (amoxicillin–clavulanic acid) was prescribed, and the cat was discharged from the hospital. Mastitis and fibroadenomatous mammary gland hyperplasia resolved rapidly afterward.

Clinical Relevance—Management of abscessed mammary glands through surgical drainage and drain placement is an option for treatment of cats with complications of fibroadenomatous hyperplasia. In the cat of this report, the treatment approach resulted in rapid resolution of mastitis, was less invasive than mastectomy, and avoided the potential complications of treatment with a progesterone-receptor antagonist.
Fecal egg counts after anthelmintic administration to aged horses and horses with pituitary pars intermedia dysfunction
Authors: McFarlane Dianne , Hale Grace M. , Johnson Eileen M. , Maxwell Lara K.
Published: February 2010

Objective—To determine effects of pituitary pars intermedia dysfunction (Cushing's disease) and age on fecal egg count and time to egg reappearance after anthelmintic treatment in horses residing in similar environments.

Design—Cross-sectional study.

Animals—29 healthy horses (4 to 35 years old) and 13 horses with PPID (13 to 33 years old).

Procedures—Fecal egg counts were performed by use of a modified Wisconsin flotation method at 2-week intervals before and after ivermectin treatment.

Results—Horses with PPID had higher fecal egg counts before and 8, 10, and 12 weeks after ivermectin treatment, compared with counts for site-matched healthy horses. There was no difference in the period for < 90% reduction in fecal egg counts between the 2 groups. Age did not affect fecal egg counts at any time point.

Conclusions and Clinical Relevance—For similar environmental conditions, horses with PPID were more likely to have higher fecal egg counts than were healthy horses. Therefore, horses with PPID may need to have a more aggressive parasite prevention program than do healthy horses. Age did not affect fecal egg counts or time to egg reappearance after anthelmintic treatment, which suggested age alone does not likely require special consideration when designing a parasite control program for adult horses.
Norm conditions for real-algebra isomorphisms between uniform algebras
Authors: Shindo Rumi
Published: February 2010

Let A and B be uniform algebras. Suppose that α ≠ 0 and A
1 ⊂ A. Let ρ, τ: A
1 → A and S, T: A
1 → B be mappings. Suppose that ρ(A
1), τ(A
1) and S(A
1), T(A
1) are closed under multiplications and contain expA and expB, respectively. If ‖S(f)T(g) − α‖∞ = ‖ρ(f)τ(g) − α‖∞ for all f, g ∈ A
1, S(e
1)−1 ∈ S(A
1) and S(e
1) ∈ T(A
1) for some e
1 ∈ A
1 with ρ(e
1) = 1, then there exists a real-algebra isomorphism $$
\tilde S
$$: A → B such that $$
\tilde S
$$(ρ(f)) = S(e
1)−1
S(f) for every f ∈ A
1. We also give some applications of this result.
Approximation properties of q-Baskakov operators
Authors: Finta Zoltán , Gupta Vijay
Published: February 2010

We establish direct estimates for the q-Baskakov operator introduced by Aral and Gupta in [2], using the second order Ditzian-Totik modulus of smoothness. Furthermore, we define and study the limit q-Baskakov operator.
An observation on Kannan mappings
Authors: Nakanishi Masato , Suzuki Tomonari
Published: February 2010

In order to observe the condition of Kannan mappings more deeply, we prove a generalization of Kannan’s fixed point theorem.
On totally inert simple groups
Authors: Dixon Martyn , Evans Martin , Tortora Antonio
Published: February 2010

A subgroup H of a group G is inert if |H: H ∩ H
g| is finite for all g ∈ G and a group G is totally inert if every subgroup H of G is inert. We investigate the structure of minimal normal subgroups of totally inert groups and show that infinite locally graded simple groups cannot be totally inert.
Efficient representations of Green’s functions for some elliptic equations with piecewise-constant coefficients
Authors: Melnikov Yuri
Published: February 2010

Convenient for immediate computer implementation equivalents of Green’s functions are obtained for boundary-contact value problems posed for two-dimensional Laplace and Klein-Gordon equations on some regions filled in with piecewise homogeneous isotropic conductive materials. Dirichlet, Neumann and Robin conditions are allowed on the outer boundary of a simply-connected region, while conditions of ideal contact are assumed on interface lines. The objective in this study is to widen the range of effective applicability for the Green’s function version of the boundary integral equation method making the latter usable for equations with piecewise-constant coefficients.
Some properties of epimorphisms of Hilbert algebras
Authors: Buşneag Dumitru , Ghiţă Mircea
Published: February 2010

This paper represents a start in the study of epimorphisms in some categories of Hilbert algebras. Even if we give a complete characterization for such epimorphisms only for implication algebras, the following results will make possible the construction of some examples of epimorphisms which are not surjective functions. Also, we will show that the study of epimorphisms of Hilbert algebras is equivalent with the study of epimorphisms of Hertz algebras.
A procedure to compute prime filtration
Authors: Rauf Asia
Published: February 2010

Let K be a field, S = K[x
1, … x
n] be a polynomial ring in n variables over K and I ⊂ S be an ideal. We give a procedure to compute a prime filtration of S/I. We proceed as in the classical case by constructing an ascending chain of ideals of S starting from I and ending at S. The procedure of this paper is developed and has been implemented in the computer algebra system Singular.
Age and growth in a newly-established invasive population of topmouth gudgeon
Authors: Záhorská Eva , Kováč Vladmir , Katina Stanislav
Published: February 2010

Specimens of invasive topmouth gudgeon, Pseudorasbora parva, from Šúr Pond (Bratislava, Slovakia) were examined to assess age and growth, and to determine whether this recently-established invasive population employs a less specialized ontogenetic trajectory than the specialized form typical of native and/or long-time established populations. Samples were collected in October 2004 (n=143). Standard length (SL) ranged from 18.16 mm to 67.57 mm (mean 32.56 mm), and eviscerated body weight ranged from 0.10 to 5.02 g (mean 0.63 g). Scale caudal diameter ranged from 0.52 to 2.42 mm (mean 1.08 mm). SL at which the scales started to form was estimated to be 1.58 mm. The population was represented with 5 age groups, from 0+ to 4+. Relative to other populations for which comparable data are available the recently-established population of topmouth gudgeon was found to mature at smaller size and at a younger age compared to native and/or long-time established populations (all specimens bigger than 25.0 mm SL, and 94% of specimens from the age group I were already mature).
Far-infrared rays control prostate cancer cells in vitro and in vivo
Authors: Shima Hiroki , Yamamoto Shingo , Qiu Jun , Shincho Mayumi , Hirota Seiichi , Yoshikawa Yoshie , Yoshikawa Reigetsu , Hashimoto-Tamaoki Tomoko
Published: February 2010

We introduce a new effective method to control hormone-refractory prostate cancer cells using an activated rubber/resin form (RB), far-infrared ray (FIR) emitter, with or without sodium butyrate treatment (NaB). The growth of three human prostate cancer cell lines (Du145, PC-3 and LNCaP) was suppressed in vitro and vivo by FIR, and the cells were eradicated with FIR + 3 mM NaB. G1 arrest and apoptotic pathway proteins were induced by FIR with elevated expressions of apoptosis-related transcripts in cDNA microarray. RB reflects and radiates in the wavelengths of about 4 to 25 µm in the FIR that work to suppress the growth of human prostate cancer cells. Accordingly, this technique may be used as a new therapeutic treatment in hormone-refractory prostate cancer.
Phosphorylation is switch of L-type pyruvate kinase allostery
Authors: Faustova Ilona , Kuznetsov Aleksei , Juronen Erkki , Loog Mart , Järv Jaak
Published: February 2010

Among four pyruvate kinase isoenzymes, M1, M2, R and L, only M1 is considered as a nonallosteric enzyme. However, here we show that the non-phosphorylated L-type pyruvate kinase (L-PK) is also a non-allosteric enzyme with respect to its substrate phosphoenolpyruvate (PEP). The allosteric catalytic properties of L-PK are switched on through phosphorylation by cAMP-dependent protein kinase. The non-phosphorylated enzyme was produced by expressing the rat L-PK in E. coli, as the bacterium does not have mammalian-type protein kinases. The resulting tetrameric protein was phosphorylated with a stoichiometric ratio of one mole of phosphate per one L-PK monomer. Activity of the phosphorylated enzyme was allosterically regulated by PEP with the Hill coefficient n=2.5. It was observed that allostery was engaged by phosphorylation of the first subunit in the tetrameric enzyme, while further phosphorylation only modulated this effect. The discovered switching between non-allosteric and allosteric forms of L-PK and the possibility of modulating the allostery by phosphorylation are important for understanding of the interrelationship between allostery and the regulatory phosphorylation in general, and may have implication for further analysis of glycolysis regulation in the liver.
Evaluation of antioxidant activity of Melothria maderaspatana in vitro
Authors: Raja Boobalan , Pugalendi Kodukkur
Published: February 2010

In this study, an aqueous extract of leaves from Melothria maderaspatana was tested for in vitro antioxidant activity. Free radical scavenging assays, such as hydroxyl radical, hydrogen peroxide, superoxide anion radical and 2,2-diphenyl-1-picryl hydrazyl (DPPH), 2,2’-azinobis-(3-ethyl-enzothiazoline-6-sulfonic acid) (ABTS) radical scavenging, and reducing power assay, were studied. The extract effectively scavenged hydroxyl radical, hydrogen peroxide and superoxide anion radicals. It also scavenged DPPH and ABTS radicals. Furthermore, it was found to have reducing power. All concentrations of leaf extract exhibited free radical scavenging and antioxidant power, and the preventive effects were in a dose-dependent manner. The antioxidant activities of the above were compared to standard antioxidants such as butylated hydroxytoluene (BHT), ascorbic acid, and α-tocopherol. The results obtained in the present study indicate that the M. maderaspatana extract could be considered a potential source of natural antioxidant.
ROS mediate selenite-induced apoptosis in colon cancer cells
Authors: Králová Věra , Červinka Miroslav , Rudolf Emil
Published: February 2010

Selenite-induced oxidative stress and its relationship to mitochondrial apoptosis was studied in human adenocarcinoma HT-29 cells. It is shown that selenite induces caspase-dependent apoptosis, which is mediated by mitochondria via released cytochrome c, apoptosis-inducing factor (AIF) and Smac/Diablo. Selenite activates stress kinases p38 and JNK while suppressing reduced glutathione (GSH) and thioredoxin reductase (TrxR) levels, transiently inducing heme oxygenase (HO-1) system as well as reducing Akt expression. Pre-treatment of cells with selected antioxidants and stress kinase inhibitors significantly prevented selenite-induced cell death, thereby implicating oxidative stress as a direct (Bax) as well as indirect (via kinases) cause of HT-29 cells demise. These results thus demonstrate for the first time active proapoptotic and anti-survival effects of selenite in colon cancer cells.
Predicting Landscape‐Scale Habitat Distribution for Ruffed GrouseBonasa umbellusUsing Presence‐Only Data
Authors: Blomberg Erik J. , Tefft Brian C. , Endrulat Erik G. , McWilliams Scott R.
Published: February 2010

Ruffed grouseBonasa umbelluspopulations in North America have declined as forests have matured and the extent of early successional forest habitat required by the species has diminished. When wildlife species decline because of habitat loss, determining where to focus habitat management efforts is difficult because both the wildlife population and the required habitat(s) are usually limited in distribution. We adopted a relatively new ecological modeling method, partitioned Mahalanobis D2, which allowed us to predict the distribution of potential ruffed grouse habitat across a landscape of management concern where high quality habitat was uncommon. We used presence data derived from radio‐telemetry locations, and GIS habitat data from publicly available sources to create competing partitioned Mahalanobis D2 models. The competing models identified important habitat variables and predicted ruffed grouse habitat distribution at 1‐ha and 25‐ha scales in southwestern Rhode Island, USA. The 1‐ and 25‐ha models produced comparable overall classification accuracy (83.1% and 81.4%, respectively) but differed substantially in the area of predicted habitat (4,475.5 ha and 10,133.8 ha, respectively). We selected the more conservative 1‐ha model as the ‘best’ model, and expanded it to a larger landscape extent. Once expanded, the model predicted 11,463 ha (15.5% of total land area) of potential ruffed grouse habitat for a 735‐km2landscape in southwestern Rhode Island. This model identified those areas with varying proximities to the following features as likely to contain ruffed grouse habitat: early successional forests, river and stream corridors, mixed conifer forests, conifer forests, shrub wetlands and deciduous forests. Early successional forests were the most consistent component of habitat used by grouse, despite the fact that this habitat type was uncommon in our study area (< 1% of total land area). Our model can be used to identify areas of existing ruffed grouse habitat for management focus.
New Possibilities of Observing Animal Behaviour from a Distance Using Activity Sensors in Gps‐Collars: An Attempt to Calibrate Remotely Collected Activity Data with Direct Behavioural Observations in Red Deer Cervus elaphus
Authors: Löttker Petra , Rummel Anna , Traube Miriam , Stache Anja , Šustr Pavel , Müller Jörg , Heurich Marco
Published: February 2010

Knowing what an animal is doing where and when is crucial for understanding habitat use as well as for detecting deviations from the norm, e.g. the animal's responses to disturbances or predators. While an animal's position can quite easily be assigned using VHF‐ or GPS‐telemetry, determining its behaviour from a distance is still limited. A new generation of GPS‐collars, equipped with a dual‐axis acceleration sensor allows insights into the animal activity by continuously (5‐minute intervals) delivering x‐ and y‐values on a scale from 0 to 255. However, until now it has not been possible to tell which activity values can be attributed to which kind of behaviour. Therefore, the overall aim of our study was to find a method to distinguish different behavioural categories from these activity values. We used four captive red deer Cervus elaphus (one male and three females) and equipped them with GPS‐collars while simultaneously observing their behaviour. Values for different behavioural categories were compared statistically using ANOVA with ‘individual’ as random effect and Tukey's follow‐up test. Threshold values between the categories were determined by recursive partitioning and were assured by 5,000 bootstraps. While the difference between feeding and slow locomotion was significant in the x‐ but not in the y‐values, each of these two categories differed significantly from resting and fast locomotion. Specific thresholds were established between the three categories resting, feeding with slow locomotion and fast locomotion. Subsequent comparison of the behaviour determined by these threshold values with observed behaviour revealed a high percentage of correctly assigned behaviour (93%). Taken together, this preliminary study demonstrates the potential of dual‐axis acceleration sensors in GPS‐collars for estimating the activity of wild‐living red deer. However, further observations of activity on more individuals of each age and sex class should be performed to take into account inter‐individual variability and to improve the predictive power of the threshold values.
Internal Validation of Predictive Logistic Regression Models for Decision‐Making in Wildlife Management
Authors: Gude Justin A. , Mitchell Michael S. , Ausband David E. , Sime Carolyn A. , Bangs Edward E.
Published: February 2010

Predictive logistic regression models are commonly used to make informed decisions related to wildlife management and conservation, such as predicting favourable wildlife habitat for land conservation objectives and predicting vital rates for use in population models. Frequently, models are developed for use in the same population from which sample data were obtained, and thus, they are intended for internal use within the same population. Before predictions from logistic regression models are used to make management decisions, predictive ability should be validated. We describe a process for conducting an internal model validation, and we illustrate the process of internal validation using logistic regression models for predicting the number of successfully breeding wolf packs in six areas in the US northern Rocky Mountains. We start by defining the major components of accuracy for binary predictions as calibration and discrimination, and we describe methods for quantifying the calibration and discrimination abilities of a logistic regression model. We also describe methods for correcting problems of calibration and future predictive accuracy in a logistic regression model. We then show how bootstrap simulations can be used to obtain unbiased estimates of prediction accuracy when models are calibrated and evaluated within the same population from which they were developed. We also show how bootstrapping can be used to assess coverage rates and recalibrate the endpoints of confidence intervals for predictions from a logistic regression model, to achieve nominal coverage rates. Using the data on successfully breeding wolf packs in the northern Rocky Mountains, we validate that predictions from a model developed with data specific to each of six analysis areas are better calibrated to each population than a global model developed using all data simultaneously. We then use shrinkage of model coefficients to improve calibration and future predictive accuracy for the area‐specific model, and recalibrate confidence interval endpoints to provide better coverage properties. Following this validation, managers can be confident that logistic regression predictions will be reliable in this situation, and thus that management decisions will be based on accurate predictions.
Effects of Prey Size on Scat Analysis to Determine River Otter Lontra canadensis Diet
Authors: Crimmins Shawn M. , Roberts Nathan M. , Hamilton David A.
Published: February 2010

We conducted a controlled feeding trial using two captive river otters Lontra canadensis to determine how prey size may introduce bias into frequency of occurrence analysis using otter scats. Otters were fed specific prey across a range of sizes. We then collected all scats deposited by the otters to determine how many defecation events occurred to remove the prey item from the digestive system. We found a strong, positive relationship between prey item size and the number of scats required to excrete the item. We then examined how the results, of an actual river otter feeding habits study using frequency of occurrence analysis of scats, could be biased towards an over‐representation of larger prey items by using a correction factor for prey item size developed from our feeding trials. Frequency of occurrence suggested a strong preference for mid‐range size of prey items and a strong avoidance of smaller prey items. Our corrected results indicated that otters exhibit little preferential feeding based on prey item size in the Missouri Ozarks. Our results suggest that bias associated with frequency of occurrence analyses may severely limit the robustness of inferences that can be made from such analyses.
Using PIT‐Tag Technology to Target Supplementary Feeding Studies
Authors: Newey Scott , Allison Peter , Thirgood Simon J. , Smith A. Adam , Graham Isla M.
Published: February 2010

The role of food in limiting or regulating populations of mammalian herbivores remains a central question in ecology with great relevance to wildlife and livestock management. Supplementary feeding studies have been widely used to assess the potentially limiting role of food availability, and supplementary feeding is also a common management technique. In both contexts there is an assumption that all individuals in the target population have access to food. There are, however, questions as to whether supplementary feed reaches the target population and how benefits are translated into individual and population level effects. We describe and use a technique using Passive Induced Transponder (PIT) tags to monitor individual use of supplementary feed in wild mountain hare Lepus timidus populations and test the assumption that supplementary feed reaches the target population. Over the course of one winter only 50% of the target hare population used supplementary feed and there was considerable individual variation in the time spent feeding among those individuals that fed. Neither age, sex nor an index of body condition were significant in explaining which individuals visited feeding stations or how long individuals spent feeding. The method and results described here suggest that, at least for the mountain hare, the central assumption that all target individuals have access to and use supplementary feed is invalid. Great care is thus needed in designing and interpreting the results of supplementary feeding studies or management programmes that include supplementary feeding.
Behavioural Responses of GPS‐Collared Female Red Deer Cervus elaphus to Driven Hunts
Authors: Sunde Peter , Olesen Carsten R. , Madsen Torben L. , Haugaard Lars
Published: February 2010

Precise knowledge of how game species react to different hunting practices is a prerequisite for sound management of intensively hunted populations. We compared behavioural and spatial behaviour of five GPS‐collared female red deer Cervus elaphus in Denmark before, during and after exposure to 21 driven hunts (2–5 times each). In 53% of all hunts, deer left their normal home ranges within 24 hours, moving on average 4 km and remaining away for an average of six days. Compared to pre‐hunt values, deer moved longer distances per unit time on the day of the hunt and during the following two nights. Diurnal activity (based on motion sensors) did not increase significantly on the hunting day, but was lower than normal the day after the hunt. Nocturnal activity was equal before and after hunts. Deer spent 96% of their time in (safer) forest habitats by day and 43% by night before and after hunts. No induced responses were conditional on distance to the hunters (0–1.5 km), hunt duration (1.3–6.4 hours) or the time elapsed since previous hunts (4 to >30 days). The inclination of deer to flee from areas following hunts might complicate attempts to optimise harvesting policies in landscapes with many landowners within a typical flight range.
Evaluation of preoperative criteria used to predict lymph node metastasis in endometrial cancer
Authors: HAN SEUNG‐SU , LEE SANG HOON , KIM DONG HO , KIM JAE WEON , PARK NOH‐HYUN , KANG SOON‐BEOM , SONG YONG SANG
Published: February 2010

Objective.To evaluate whether we could accurately predict lymph node (LN) metastasis with preoperative tests in endometrial cancer.Design.Retrospective study.Setting.Seoul National University Hospital, South Korea.Population.Three hundred patients with endometrial cancer who underwent surgical staging including lymphadenectomy between January 1999 and July 2007.Methods.We reviewed the medical records of 300 patients with endometrial cancer. The preoperative factors used to predict LN metastasis were as follows: old age (≥55 years), serum CA‐125 level [level ≥ 20 U/mL (if age < 50 years), level ≥ 28 U/mL (if age ≥ 50 years)], non‐endometrioid histologic type and Grade 3, metastatic LN assessed by pelvic MRI or CT, and deep myometrial invasion assessed by pelvic MRI only. Logistic regression analysis was used to determine the significant predictive factors.Main outcome measures.Sensitivity/specificity and false positive/negative rates.Results.Thirty patients had LN metastasis. Although LN evaluation by pelvic MRI or CT and high CA‐125 level were the significant independent predictors for LN metastasis, the sensitivity/specificity and false positive/negative rates for LN metastasis by these two combined preoperative tests were 86.7%/71.4% and 68.7%/2.7%, respectively. However, the sensitivity/specificity and false positive/negative rates for LN metastasis by six combined preoperative tests were 100%/28.9% and 84.6%/0%, respectively.Conclusions.The six combined preoperative tests are useful in selecting patients without LN metastasis in endometrial cancer. Lymphadenectomy could be avoided in about 29% of patients with endometrial cancer who have no LN metastasis by using six combined preoperative tests.
Pelvic exenteration for gynecological malignancies: an analysis of 15 cases operated on at a single institution
Authors: MÄENPÄÄ JOHANNA U , KANGASNIEMI KATRI , LUUKKAALA TIINA
Published: February 2010

We analyzed retrospectively the outcome of 15 patients treated with pelvic exenteration (nine total and six anterior) for gynecological cancer (six vaginal, four endometrial, three cervical, one vulvar, and one ovarian) from 1987 through 2008. Four operations were for primary tumors and 11 for recurrences. Eight patients had received prior radiotherapy. Median operation time was 310 (range 180–520) min, and median blood loss was 2,500 (range 600– 8,000) mL. Thirteen patients had altogether 59 postoperative complications, 25 (42%) early and 34 (58%) late. One patient each died of complications during the early and late postoperative phases, respectively. Both had received previous radiotherapy. By 31 January 2009, six patients had died, while five and four patients were alive with or without disease, respectively. Only one pelvic recurrence was found. The median progression‐free survival was 8.9 months. Although pelvic exenteration was not totally devoid of mortality, the procedure provided a good local control, with mostly manageable complications.
Does physical activity in leisure time early in pregnancy reduce the incidence of preeclampsia or gestational hypertension?
Authors: VOLLEBREGT KARLIJN C. , WOLF HANS , BOER KEES , VAN DER WAL MARCEL F. , VRIJKOTTE TANJA G.M. , BONSEL GOUKE J.
Published: February 2010

Objective. Assessment of the association of physical activity in leisure time with preeclampsia and gestational hypertension in nulliparous women. Design. Population based prospective cohort study. Setting. Amsterdam, The Netherlands. Population. All pregnant women in Amsterdam between January 2003 and March 2004 who were nulliparous with a singleton pregnancy and who delivered after 24 weeks. Design. At their first prenatal care visit, women were invited to fill out a questionnaire with sociodemographic and psychosocial variables. Physical activity in leisure time in the past week was measured using questions about walking, cycling, playing sports and other activities in leisure time. The amount of minutes and intensity of each activity was studied using four categories: no, low, moderate or high activity. By using multivariate logistic regression, we adjusted for sociodemographic and medical confounders. Main outcome measures. Incidence of preeclampsia and gestational hypertension. Results. A total of 12,377 women were invited with a response rate of 67%; 3,679 nulliparous women were included. The incidence of preeclampsia and gestational hypertension was 3.5% and 4.4%, respectively. The amount of time or intensity of physical activity in leisure time was not associated with a difference in risk of preeclampsia or gestational hypertension. Conclusion. Physical activity in leisure time early in pregnancy does not reduce the incidence of preeclampsia or gestational hypertension in an unselected population of nulliparous women.
Successful implementation of evidence‐based routines in Ukrainian maternities
Authors: BERGLUND ANNA , LEFEVRE‐CHOLAY HELENE , BACCI ALBERTA , BLYUMINA ANNA , LINDMARK GUNILLA
Published: February 2010

Objective. To describe the process of change and assess compliance and effect on maternal and infant outcome when the WHO package Effective Perinatal Care (EPC) was implemented at maternities in Ukraine. Design. Intervention study comparing outcomes before and during 2.5 years after training. Setting. Three maternities in Donetsk, Lutsk and Lviv 2003–2006. Population. Baseline data were collected for 652, 742 and 302 deliveries and 420, 381 and 135 infants, respectively, in Donetsk, Lutsk and Lviv. Follow‐up data included 4,561, 9,865 and 7,227 deliveries and 3,829, 8,658 and 6,401 infants. Methods. Staff training on evidence‐based guideline. Main outcome measures. Interventions during labor, maternal outcomes and hypothermia in the infants. Results: EPC procedures were successfully implemented and adherence to the protocols was excellent. For most variables, the change occurred during the first three months but was well sustained. The use of partogram increased fourfold in Donetsk and from 0% to 60% in Lviv. Induction and augmentation of labor decreased to less than 1% and less than 5%, respectively. Cesarean section rate dropped significantly in two of the maternities. The proportion of hypothermic infants decreased from 60% (Donetsk), 85% (Lutsk) and 77% (Lviv) to 1% in all three maternities during the first three months and was stable throughout the study period. Admission to Neonatal Intensive Care Unit decreased significantly in two of the maternities and there was no effect on early neonatal mortality. Conclusions: The process of education and change was well anchored in the organization, and implementation of new procedures was quick and successful.
Reproductive health in lesbian and bisexual women in Sweden
Authors: MOEGELIN LENA , NILSSON BO , HELSTRÖM LOTTIE
Published: February 2010

Objective. Previous international studies have elucidated signs of poor physical and mental health in women who have sex with women (WSW) and an avoidance of preventive healthcare. When the first Nordic gynecological clinic for WSW was started in Stockholm in 1999, an opportunity to compile information about their physical and psychological health and social situation arose. Design. Retrospective descriptive. Setting and sample. A total of 706 women: 264 patients attending a WSW clinic and 442 women attending the regular gynecological clinic. Methods. Questionnaires. Response rate: WSW 77%, comparison group 40%. Main outcome measures. Possible differences in mental and reproductive health and attendance of preventive healthcare by WSW and heterosexual women. Results. Having had a male sexual partner was reported by 82.3% of the WSW, 39.5% in the last five years and 4.9% in the last year. One‐fifth of WSW had been pregnant, and one in ten had given birth. Equally, many had experience of induced abortion. WSW had less experience of gynecological examination and Papanicolaou smear screening. More than one‐fifth of WSW had at some time had sexually transmitted infections (STI) and 12.6% reported a history of cervical atypia. WSW remembered dissatisfaction with their sexual lives during their youth and had more frequently sought professional help for their sexuality. Conclusion. WSW attend gynecological examinations to a lesser extent than heterosexual women. The fact that WSW reported having been affected by STI and cervical cell atypia underlines the opinion that they should be advised to attend the same gynecological check‐ups and cervical screening programs as heterosexual women.
Tension‐free vaginal tape – a suitable procedure for patients with recurrent stress urinary incontinence
Authors: ALA‐NISSILÄ SEIJA , HAARALA MERVI , MÄKINEN JUHA
Published: February 2010

Objective. To evaluate the efficacy of the tension‐free vaginal tape operation (TVT) in patients with and without previous anti‐incontinence surgery. Design. Prospective follow‐up study. Setting. University hospital in Finland. Population. A total of 130 women who had a TVT procedure from August 1998 to December 2002. Main outcome measures. Subjective cure, complications and voiding symptoms. Methods. Sixty women with recurrent (group A) and 70 women with primary stress urinary incontinence (SUI) (group B) were compared. One follow‐up visit took place two months postoperatively and a questionnaire‐based evaluation was carried out three years after operation. Further information was collected a mean of eight years after the operation. Results. There was no difference in the transient postoperative retention rate (17 vs. 19%, p = 0.78) and number of complications (20 vs. 13%, p = 0.29) between group A and group B. At two months after operation, 85% of patients in group A and 94% in group B were cured of SUI and were satisfied with the operative result (p = 0.096). The satisfaction rates at three years were 86 and 91% in groups A and B, respectively, and cure rate of SUI was 93% in both groups. At follow‐up, 20% of the patients in group A and 5.7% in group B (p = 0.013) had de novo urge symptoms and the rate of voiding difficulties increased especially in group B women over time. Conclusions. TVT results in the same cure and complication rates when performed for primary SUI and recurrent SUI. The procedure is effective and associated with a low and acceptable level of complications. It is well suited to treat also recurrent SUI.
The market lifecycle of duloxetine for urinary incontinence in Norway
Authors: HUNSKAAR STEINAR , WELLE‐NILSEN LINA KRISTIN
Published: February 2010

Objective. To investigate the epidemiology of prescriptions for duloxetine for the treatment of stress urinary incontinence during its entire lifecycle in Norway (October 2004–May 2007), including the persistence of use of the drug and the prescribers. Design and setting. Observational study in Norway. Sample. All prescriptions on duloxetine filled in Norwegian pharmacies. Methods. Data from the Norwegian Prescription Database. Main outcome measure. Patient's age, unique identification, date of dispensing, data on specialty of the prescribing doctor, and number of packages purchased. Persistence of use of duloxetine was analyzed by grouping the months of first prescription filled into quarters of a year, from the fourth quarter of 2004 to the third quarter of 2007. Results. A total of 3,024 filled prescriptions were recorded of which 2,903 (96%) could be further analyzed, corresponding to 37 users per 100,000 women in the population. Each patient filled a mean of 3.4 prescriptions. The persistence of use was very low from the second quarter itself, and after 1 year only 12.5% of the patients still purchased the drug. Most prescriptions were written by GPs and gynecologists. A prescription database like ours consists of dispensed prescriptions and not drugs taken. We believe that these biases are of little importance for the main results. Conclusions. Analyses from the national prescription database show that duloxetine had a low uptake on the market and a low persistence rate among the patients during its full lifecycle on the Norwegian market.
Epidural analgesia during labor among immigrant women in Sweden
Authors: EKÉUS CECILIA , CNATTINGIUS SVEN , HJERN ANDERS
Published: February 2010

Objective. To investigate differences in the use of epidural analgesia (EDA) during labor between native Swedish and immigrant women and whether such possible differences could be explained by other maternal factors or birthweight. Design. Population‐based register study. Setting. Nationwide study in Sweden. Population. A total of 455,274 primiparous women, who gave birth to a singleton infant at 37–41 completed gestational weeks during 1992–2005. Of the 72,086 (16%) immigrants, data on 31,148 women from the eight most common countries of origin were analyzed to test our hypotheses. Methods. Register study with perinatal data from the Medical Birth Register and socio‐demographic variables from national income and population registers. Main outcome measure. Use of EDA during vaginal delivery. Results. Compared with native Swedish women, EDA was more often used by women from Chile, odds ratio (OR) 1.39 (95% confidence interval (CI) 1.23–1.57); Iran, OR 1.38 (1.26–1.53); Poland, OR 1.22 (1.08–1.37) and Finland, OR 1.10 (1.03–1.17) after adjustments for perinatal and socio‐demographic confounders, while EDA was less often used among women from Somalia, OR 0.57 (0.46–0.70); Iraq, OR 0.71 (0.64–0.78); Turkey, OR 0.77(0.69–0.86) and Yugoslavia, OR 0.85 (0.79–0.91). Having a native Swedish partner increased the use of EDA in immigrant women. Conclusion. EDA use during labor varies more by maternal country of origin than by socio‐economic factors. This suggests that expectations of care from the country of origin continue to influence the use of EDA after immigration to Sweden.
Serum tetranectin is a significant prognostic marker in ovarian cancer patients
Authors: BEGUM FARAH DIBA , HØGDALL ESTRID , CHRISTENSEN IB JARLE , KJAER SUSANNE KRÜGER , BLAAKAER JAN , CHRISTENSEN LISE , HØGDALL CLAUS
Published: February 2010

Objective. To evaluate the prognostic value of preoperative serum tetranectin (TN) in Danish ovarian cancer (OvCa) patients. Design. Population‐based, multidisciplinary Danish case‐control study of OvCa. Participants. A total of 445 primary OvCa patients diagnosed at one of the gynecological departments in 18 regional hospitals around Denmark during the period 1994–1999. Methods. Serum levels of TN were evaluated preoperatively and tested for possible association with prognosis. Main outcome measures. Disease specific survival. Results. During the observation period (median 45.9 months, range 0.2–121) 278 OvCa‐related deaths were seen. Univariate analysis of TN and CA125 demonstrated a significant association with survival using the Cox proportional hazards model, when stratified for adjuvant treatment (TN: p < 0.0001, hazard ratio = 0.44; 95% confidence interval 0.33–0.60 and CA125: p < 0.0001, hazard ratio = 1.19; 95% confidence interval 1.11–1.27). Disease specific survival curves for patients with tumors in the early stages showed no significant association with survival, neither for TN (p = 0.68) nor for CA125 (p = 0.07). For the stage III group, a significant association with survival was found for TN (p = 0.027), but not for CA125 (p = 0.37). Multivariate Cox analysis identified TN, age, residual tumor, International Federation of Gynecology and Obstetrics stage and grade but not serum CA125 as independent prognostic variables. Conclusion. Preoperative serum TN is a useful prognostic indicator of advanced stage for patients with OvCa.
Time to focus on the public health aspects of preterm delivery
Authors: MORKEN NILS‐HALVDAN
Published: February 2010

Preterm delivery is a leading cause of child death and results in substantial emotional and economic costs for both the involved family and for society. It increases later disease risk in both the mother and in her preterm delivered child. The proportion of preterm delivery is increasing in several populations. Public health interventions have so far been the only beneficial initiative in prevention and treatment of preterm delivery and there is a need for both larger research studies and an approach that centers more on this complicated condition as a public health problem. The public health and population focus is an important fundament for proper use of new molecular biology techniques that in the future may increase our understanding of the pathophysiological pathways of preterm delivery and result in causal treatment modalities that are applicable to the clinical setting.
Factor Structures of the Neurocognitive Assessments and Familial Analysis in First-Episode Schizophrenia Patients, Their Relatives and Controls
Authors: Wang Qiang , Vassos Evangelos , Deng Wei , Ma Xiaohong , Hu Xun , Murray Robin M. , Collier David A. , Li Tao
Published: February 2010

Objectives: Schizophrenia patients have a wide range of cognitive deficits. To explore the structure of these deficits and index their psychometric properties in order to define the major separable factors, exploratory factor analysis (EFA) was performed on a series of neuropsychological test results in a sample of Han Chinese first-episode schizophrenia patients, their relatives and controls without mental illness.

Methods: The factors derived from the composite sample were tested with confirmatory factor analysis (CFA) in each of the subsamples. The heritability of each factor was estimated by using the mixed linear model in order to determine whether the common factor scores describe the familiarity of the data.

Results: A six-factor model of general mental activity, sort and shift, attention and anti-interference, logical memory, reasoning and problem-solving/executive function, and visual reproduction were extracted and confirmed on EFA and CFA. There was a hierarchy in cognitive performance deficits in relatives depending on their relatedness to probands. Patients performed more poorly than siblings/offspring in general mental activity, sort and shift, attention and anti-interference, logical memory, planning and problem-solving, but not in visual reproduction. The logical memory domain was found to be significantly heritable (h2=0.34), and reasoning and problem-solving had a marginal heritability of around 0.19.

Conclusions: Generalized cognitive deficit accounts for the majority of the overall variance of cognitive deficits in schizophrenia. Estimates of heritability were modest. The present results also support the hypothesis that neurocognitive deficits of schizophrenia are familial and could serve as endophenotypes, especially logical memory, which is the most heritable.
Longer Term Effect of Randomized, Controlled Group Cognitive Behavioural Therapy for Internet Addiction in Adolescent Students in Shanghai
Authors: Du Ya-song , Jiang Wenqing , Vance Alasdair
Published: February 2010

Objective: The aim of the present study was to evaluate the therapeutic effectiveness of group cognitive behavioural therapy (CBT) for Internet addiction in adolescents.

Method: A total of 56 patients, who met Beard's diagnostic criteria for Internet addiction, aged 12–17 years, were divided randomly into an active treatment group (n = 32) and a clinical control group (n = 24). Participants in the active treatment group were treated with an eight-session multimodal school-based group CBT while participants in the clinical control group received no intervention. Internet use, time management, emotional, cognitive and behavioural measures were assessed for both groups at baseline, immediately after the intervention and at 6 month follow up by investigators blind to the participants’ group status.

Results: Internet use decreased in both groups while only the multimodal school-based group CBT evinced improved time management skills and better emotional, cognitive and behavioural symptoms.

Conclusions: Multimodal school-based group CBT is effective for adolescents with Internet addiction, particularly in improving emotional state and regulation ability, behavioural and self-management style.