bluuebunny/crossref_metadata_2025 huggingface dataset:
Peripheral and central signals in the control of eating in normal, obese and binge-eating human subjects
Authors: Hellström Per M. , Geliebter Allan , Näslund Erik , Schmidt Peter T. , Yahav Eric K. , Hashim Sami A. , Yeomans Martin R.
Published: October 2004

The worldwide increase in the incidence of obesity is a consequence of a positive energy balance, with energy intake exceeding expenditure. The signalling systems that underlie appetite control are complex, and the present review highlights our current understanding of key components of these systems. The pattern of eating in obesity ranges from over-eating associated with binge-eating disorder to the absence of binge-eating. The present review also examines evidence of defects in signalling that differentiate these sub-types. The signalling network underlying hunger, satiety and metabolic status includes the hormonal signals leptin and insulin from energy stores, and cholecystokinin, glucagon-like peptide-1, ghrelin and peptide YY3-36 from the gastrointestinal tract, as well as neuronal influences via the vagus nerve from the digestive tract. This information is routed to specific nuclei of the hypothalamus and brain stem, such as the arcuate nucleus and the solitary tract nucleus respectively, which in turn activate distinct neuronal networks. Of the numerous neuropeptides in the brain, neuropeptide Y, agouti gene-related peptide and orexin stimulate appetite, while melanocortins and α-melanocortin-stimulating hormone are involved in satiety. Of the many gastrointestinal peptides, ghrelin is the only appetite-stimulating hormone, whereas cholecystokinin, glucagon-like peptide-1 and peptide YY3-36 promote satiety. Adipose tissue provides signals about energy storage levels to the brain through leptin, adiponectin and resistin. Binge-eating has been related to a dysfunction in the ghrelin signalling system. Moreover, changes in gastric capacity are observed, and as gastric capacity is increased, so satiety signals arising from gastric and post-gastric cues are reduced. Understanding the host of neuropeptides and peptide hormones through which hunger and satiety operate should lead to novel therapeutic approaches for obesity; potential therapeutic strategies are highlighted.
Genes, the environment and the control of food intake
Authors: de Castro John M.
Published: October 2004

Genes are known to have independent influences on the height and weight of individuals, their overall levels of nutrient intakes and their meal sizes and frequencies. Recent evidence suggests that genes exert multiple and subtle influences on the controls of food intake. There are significant genetic influences on the level and responsiveness of the individual to physiological factors, such as the preprandial stomach contents of nutrients and subjective hunger, and also to environmental and psychological factors such as social facilitation of eating, diurnal rhythms of intake, palatability, cognitive restraint and dietary density. The general model of intake regulation provides an integrated and comprehensive account of how these physiological and environmental factors might fit together to produce the control of intake and body weight.
Insulin-like Growth Factor I Controls Adhesion Strength Mediated by α5β1Integrins in Motile Carcinoma Cells
Authors: Lynch Laura , Vodyanik Pavel I. , Boettiger David , Guvakova Marina A.
Published: October 2004

One of the intriguing questions regarding cell motility concerns the mechanism that makes stationary cells move. Here, we provide the first physical evidence that the onset of breast cancer cell motility in response to insulin-like growth factor I (IGF-I) correlates with lowering of adhesion strength from 2.52 ± 0.20 to 1.52 ± 0.13 μdynes/μm2in cells attached to fibronectin via α5β1integrin. The adhesion strength depends on the dose of IGF-I and time of IGF-I treatment. Weakening of cell-matrix adhesion is blocked significantly (p < 0.01) by the catalytically inactive IGF-I receptor (IGF-IR) and the phosphoinositide 3-kinase (PI-3 kinase) inhibitor LY-294002, but it is unaffected by mitogen-activated protein kinase kinase inhibitor UO-126 and Src kinase inhibitor PP2. Sustained blockade of Rho-associated kinase (ROCK) with Y-27632 down-regulates adhesion strength in stationary, but not in IGF-I-treated, cells. Jasplakinolide, a drug that prevents actin filament disassembly, counteracts the effect of IGF-I on integrin-mediated cell adhesion. In the absence of growth factor signaling, ROCK supports a strong adhesion via α5β1integrin, whereas activation of the IGF-IR kinase reduces cell-matrix adhesion through a PI-3K-dependent, but ROCK-independent, mechanism. We propose that disassembly of the actin filaments via PI-3 kinase pathway contributes to weakening of adhesion strength and induction of cell movement. Understanding how cell adhesion and migration are coordinated has an important application in cancer research, developmental biology, and tissue bioengineering.
Genetic and Environmental Factors Influencing Glutathione Homeostasis inSaccharomyces cerevisiae
Authors: Perrone Gabriel G. , Grant Chris M. , Dawes Ian W.
Published: October 2004

Glutathione is an essential metabolite protecting cells against oxidative stress and aging. Here, we show that endogenously synthesized glutathione undergoes intercellular cycling during growth to stationary phase. Genome-wide screening identified ∼270 yeast deletion mutants that overexcrete glutathione, predominantly in the reduced form, and identified a surprising set of functions important for glutathione homeostasis. The highest excretors were affected in late endosome/vacuolar functions. Other functions identified included nitrogen/carbon source signaling, mitochondrial electron transport, ubiquitin/proteasomal processes, transcriptional regulation, ion transport and the cellular integrity pathway. For many mutants the availability of branched chain amino acids and extracellular pH influenced both glutathione homeostasis and cell viability. For all mutants tested, the onset of glutathione excretion occurred when intracellular concentration exceeded the maximal level found in the parental strain; however, in some mutants prolonged excretion led to substantial depletion of intracellular glutathione. These results significantly contribute to understanding mechanisms affecting glutathione homeostasis in eukaryotes and may provide insight into the underlying cause of glutathione depletion in degenerative processes such as Parkinson's disease. The important implications of these data for use of the yeast deletion collection for the study of other phenomena also are discussed.
Cajal Bodies, Nucleoli, and Speckles in the Xenopus Oocyte Nucleus Have a Low-Density, Sponge-like Structure
Authors: Handwerger Korie E. , Cordero Jason A. , Gall Joseph G.
Published: October 2004

Nuclear organelles, unlike many cytoplasmic organelles, lack investing membranes and are thus in direct contact with the surrounding nucleoplasm. Because the properties of the nucleoplasm and nuclear organelles influence the exchange of molecules from one compartment to another, it is important to understand their physical structure. We studied the density of the nucleoplasm and the density and permeability of nucleoli, Cajal bodies (CBs), and speckles in the Xenopus oocyte nucleus or germinal vesicle (GV). Refractive indices were measured by interferometry within intact GVs isolated in oil. The refractive indices were used to estimate protein concentrations for nucleoplasm (0.106 g/cm3), CBs (0.136 g/cm3), speckles (0.162 g/cm3), and the dense fibrillar region of nucleoli (0.215 g/cm3). We determined similar protein concentrations for nuclear organelles isolated in aqueous media, where they are no longer surrounded by nucleoplasm. To examine the permeability of nuclear organelles, we injected fluorescent dextrans of various molecular masses (3–2000 kDa) into the cytoplasm or directly into the GV and measured the extent to which they penetrated the organelles. Together, the interferometry and dextran penetration data show that organelles in the Xenopus GV have a low-density, sponge-like structure that provides access to macromolecules from the nucleoplasm.
Regulation of Endocytosis, Nuclear Translocation, and Signaling of Fibroblast Growth Factor Receptor 1 by E-Cadherin
Authors: Bryant David M. , Wylie Fiona G. , Stow Jennifer L.
Published: October 2004

Fibroblast growth factor (FGF) receptors (FGFRs) signal to modulate diverse cellular functions, including epithelial cell morphogenesis. In epithelial cells, E-cadherin plays a key role in cell-cell adhesion, and its function can be regulated through endocytic trafficking. In this study, we investigated the location, trafficking, and function of FGFR1 and E-cadherin and report a novel mechanism, based on endocytic trafficking, for the coregulation of E-cadherin and signaling from FGFR1. FGF induces the internalization of surface FGFR1 and surface E-cadherin, followed by nuclear translocation of FGFR1. The internalization of both proteins is regulated by common endocytic machinery, resulting in cointernalization of FGFR1 and E-cadherin into early endosomes. By blocking endocytosis, we show that this is a requisite, initial step for the nuclear translocation of FGFR1. Overexpression of E-cadherin blocks both the coendocytosis of E-cadherin and FGFR1, the nuclear translocation of FGFR1 and FGF-induced signaling to the mitogen-activated protein kinase pathway. Furthermore, stabilization of surface adhesive E-cadherin, by overexpressing p120ctn, also blocks internalization and nuclear translocation of FGFR1. These data reveal that conjoint endocytosis and trafficking is a novel mechanism for the coregulation of E-cadherin and FGFR1 during cell signaling and morphogenesis.
Relational patterns of gene expression via non-metric multidimensional scaling analysis
Authors: Taguchi Y.-h. , Oono Y.
Published: October 2004

Motivation: Microarray experiments result in large-scale data sets that require extensive mining and refining to extract useful information. We demonstrate the usefulness of (non-metric) multidimensional scaling (MDS) method in analyzing a large number of genes. Applying MDS to the microarray data is certainly not new, but the existing works are all on small numbers (<100) of points to be analyzed. We have been developing an efficient novel algorithm for non-metric MDS (nMDS) analysis for very large data sets as a maximally unsupervised data mining device. We wish to demonstrate its usefulness in the context of bioinformatics (unraveling relational patterns among genes from time series data in this paper).

Results: The Pearson correlation coefficient with its sign flipped is used to measure the dissimilarity of the gene activities in transcriptional response of cell-cycle-synchronized human fibroblasts to serum. These dissimilarity data have been analyzed with our nMDS algorithm to produce an almost circular relational pattern of the genes. The obtained pattern expresses a temporal order in the data in this example; the temporal expression pattern of the genes rotates along this circular arrangement and is related to the cell cycle. For the data we analyze in this paper we observe the following. If an appropriate preparation procedure is applied to the original data set, linear methods such as the principal component analysis (PCA) could achieve reasonable results, but without data preprocessing linear methods such as PCA cannot achieve a useful picture. Furthermore, even with an appropriate data preprocessing, the outcomes of linear procedures are not as clear-cut as those by nMDS without preprocessing.

Availability: The FORTRAN source code of the method used in this analysis (pure nMDS) is available at http://www.granular.com/MDS/

Contact:  tag@granular.com

Supplementary information:  http://www.granular.com/MDS/B1_2005.
Inferring pathways from gene lists using a literature-derived network of biological relationships
Authors: Rajagopalan Dilip , Agarwal Pankaj
Published: October 2004

Motivation: A number of omic technologies such as transcriptional profiling, proteomics, literature searches, genetic association, etc. help in the identification of sets of important genes. A subset of these genes may act in a coordinated manner, possibly because they are part of the same biological pathway. Interpreting such gene lists and relating them to pathways is a challenging task. Databases of biological relationships between thousands of mammalian genes can help in deciphering omics data. The relationships between genes can be assembled into a biological network with each protein as a node and each relationship as an edge between two proteins (or nodes). This network may then be searched for subnetworks consisting largely of interesting genes from the omics experiment. The subset of genes in the subnetwork along with the web of relationships between them helps to decipher the underlying pathways. Finding such subnetworks that maximally include all proteins from the query set but few others is the focus for this paper.

Results: We present a heuristic algorithm and a scoring function that work well both on simulated data and on data from known pathways. The scoring function is an extension of a previous study for a single biological experiment. We use a simple set of heuristics that provide a more efficient solution than the simulated annealing method. We find that our method works on reasonably complex curated networks containing ∼9000 biological entities (genes and metabolites), and ∼30 000 biological relationships. We also show that our method can pick up a pathway signal from a query list including a moderate number of genes unrelated to the pathway. In addition, we quantify the sensitivity and specificity of the technique.

Contact:  dilip_rajagopalan@gsk.com
The construction of amino acid substitution matrices for the comparison of proteins with non-standard compositions
Authors: Yu Yi-Kuo , Altschul Stephen F.
Published: October 2004

Motivation: Amino acid substitution matrices play a central role in protein alignment methods. Standard log-odds matrices, such as those of the PAM and BLOSUM series, are constructed from large sets of protein alignments having implicit background amino acid frequencies. However, these matrices frequently are used to compare proteins with markedly different amino acid compositions, such as transmembrane proteins or proteins from organisms with strongly biased nucleotide compositions. It has been argued elsewhere that standard matrices are not ideal for such comparisons and, furthermore, a rationale has been presented for transforming a standard matrix for use in a non-standard compositional context.

Results: This paper presents the mathematical details underlying the compositional adjustment of amino acid or DNA substitution matrices.

Availability: Programs implementing the methods described are available from the authors upon request.

Contact:  altschul@ncbi.nlm.nih.gov
Implementation of a gene expression index calculation method based on the PDNN model
Authors: Nielsen Henrik Bjørn , Gautier Laurent , Knudsen Steen
Published: October 2004

Summary: Gene expression index calculations from Affymetrix GeneChips have been dominated by the Affymetrix MAS, dChip, and RMA methods. A new method to estimate the gene expression value utilizing the probe sequence information named position-dependent nearest-neighbor (PDNN) has been suggested by Zhang et al. (2003). Here we describe an open source implementation of the PDNN method for the statistical language R.

Availability: The package can be downloaded from http://www.bioconductor.org/repository/devel/package/html/affypdnn.html

Contact:  hbjorn@cbs.dtu.dk
Vocabulon: a dictionary model approach for reconstruction and localization of transcription factor binding sites
Authors: Sabatti Chiara , Rohlin Lars , Lange Kenneth , Liao James C.
Published: October 2004

Motivation: Gene expression arrays enable measurements of transcription values for a large number or all genes in the genome. In order to better interpret these resluts and to use them to reconstruct transcription networks, information on location of binding sites for regulatory proteins in the entire genome is needed. In particular, this represents an open problem in Escherichia coli.

Results: We describe the first implementation of dictionary-style models to the study of transcription factors binding sites in an entire genome. Vocabulon's unique feature is that it can both reconstruct binding sites characterized by unknown motifs and impute locations of known binding sites in long sequences by simultaneous search. On one hand, the dictionary model specifies a probability for the entire sequence taking simultaneously into account all the possible binding sites. This greatly reduces the number of false positives. On the other hand, the possibility of refining motif description, as an increasig number of binding sites are identified, augments the sensitivity of the method. We illustrate these properties with examples in E.coli. The results of gene expression arrays are used both to guide the search and corroborate it.

Availability: For copy of the Vocabulon program and other details please contact csabatti@mednet.ucla.edu

Contact:  csabatti@mednet.ucla.edu
MedKit: a helper toolkit for automatic mining of MEDLINE/PubMed citations
Authors: Ding Jing , Berleant Daniel
Published: October 2004

Summary: MEDLINE/PubMed is one of the most important information sources for bioinformatics text mining. However, there remain limitations in working with MEDLINE/PubMed citations. For example, PubMed imposes an upper limit of 10 000 for downloading PMID list or citations; and MEDLINE files are too large for most off-the-shelf XML parsers. We developed a Java package, MedKit, to work-around the limitations, as well as provide other useful functionalities, e.g. random sampling. Its four modules (querier, sampler, fetcher and parser) can work independently, or be pipelined in various combinations. It can be used as a stand-alone GUI application, or integrated into other text-mining systems. Text mining researchers and others may download and use the toolkit free for non-commercial purposes.

Availability:  http://metnetdb.gdcb.iastate.edu/medkit

Contact:  berleant@iastate.edu
Genomic Basis for Cell-Wall Diversity in Plants. A Comparative Approach to Gene Families in Rice and Arabidopsis
Authors: Yokoyama Ryusuke , Nishitani Kazuhiko
Published: October 2004

Monocotyledons and dicotyledons are distinct, not only in their body plans and developmental patterns, but also in the structural features of their cell walls. The recent completion of the rice (Oryza sativa) genomic sequence and publication of the sequence data, together with the completed database of the Arabidopsis thaliana genome, provide the first opportunity to compare the full complement of cell-wall-related genes from the two distinct classes of flowering plants. We made this comparison by exploiting the fact that Arabidopsis and rice have type I and type II walls, respectively, and therefore represent the two extremes in terms of the structural features of plant cell walls. In this review article, we classify all cell-wall-related genes into 32 gene families, and generate their phylogenetic trees. Using these data, we can phylogenetically compare individual genes of particular interest between Arabidopsis and rice. This comparative genome approach shows that the differences in wall architecture in the two plant groups actually mirror the diversity of the individual gene families involved in the cell-wall dynamics of the respective plant species. This study also identifies putative rice orthologs of genes with well-defined functions in Arabidopsis and other plant species.
Caesarean delivery and outcome in very low birthweight infants
Authors: Paul David A , Sciscione Anthony , Leef Kathleen H , Stefano John L
Published: October 2004

Objective

To determine the relationship between mode of delivery, intraventricular haemorrhage (IVH), and mortality in very low birthweight (VLBW) infants.

Study design

A historical cohort study of infants admitted to a single level III neonatal intensive care unit during a five‐year period. Infants < 1500 g born by caesarean delivery (n = 400) were compared to those born by vaginal delivery (n = 305).

Results

After controlling for potential confounding variables including: gestational age, fetal presentation, and multiple birth, caesarean delivery was not associated with a decreased odds of IVH (odds ratio 1.2, 95% CI 0.7–2.0), severe IVH (1.9, 0.9–4.0), or mortality (1.2, 0.6–2.4).

Conclusions

In our population of very low birthweight infants, caesarean delivery is not associated with a decreased risk for mortality or intraventricular haemorrhage.
Risk factors for preterm delivery in patients demonstrating sonographic evidence of premature dilation of the internal os, prolapse of the membranes in the endocervical canal and shortening of the distal cervical segment by second trimester ultrasound
Authors: Benham Brady N , Balducci James , Atlas Robert O , Rust Orion A
Published: October 2004

Objective

To investigate the outcomes and risk factors associated with the second trimester sonographic findings of premature dilation of the internal cervical os, prolapse of the membranes into the endocervical canal and shortening of the distal segment.

Study design

Retrospective chart review to identify patients who met the following criteria: (i) gestational age between 16 and 24 weeks; (ii) a vaginal probe ultrasound documenting dilatation of the internal os, prolapsed membranes into the endocervical canal but not extending beyond the external os, and a shortened distal cervix; and (iii) no evidence of increased uterine activity.

Methods

Sonographic measurements obtained included: (i) the width of the internal os dilation; (ii) the depth of membranes prolapsed into endocervix (funneling); (iii) the distal cervical length;and (iv) the total cervical length. Patients were stratified into two groups according to gestational age at delivery: the preterm group (< 34 weeks) and the near‐term group (≥ 34 weeks).

Results

Thirty‐seven patients had complete records for analysis and their pregnancies resulted in 47 live births. Eighteen patients were stratified to the near term group and 19 were stratified to the preterm group. There were no stillborn infants and 10 neonatal deaths. Ten patients received cerclage and seven patients delivered at < 34 weeks gestational age. Risk factors found to be significant for preterm delivery included a gestational age at diagnosis of ≥ 20 weeks gestation (p = 0.03), dilatation of the internal os > 1.3 cm (p = 0.04), and a composite Benham score ≥ 1.0 (p = 0.02).

Conclusions

The sonographic findings of premature dilatation of the internal os, prolapse of the membranes into the endocervical canal and shortening of the distal cervix are associated with a high rate of delivery < 34 weeks (51%) and neonatal death (27%).
Higher order multiple pregnancies in New South Wales 1990–1999
Authors: Roberts Christine L , Raynes‐Greenow Camille H , Algert Charles S , Peat Brian
Published: October 2004

Objective

To examine higher order multiple pregnancy and birth rates in NSW, and to describe trends in the characteristics and management of these births.

Design

Cross‐sectional analytic study.

Setting

New South Wales, Australia.

Population

Two hundred and ninety‐one women who gave birth to triplets, quadruplets or quintuplets (880 babies) from 1 January 1990 to 31 December 1999.

Methods

Data were obtained from the NSW Midwives Data Collection and rates over time were calculated.

Main outcome measures

Higher order multiple birth and pregnancy rates (≥ 20 weeks), place of birth, mode of delivery, fetal death rates and Apgar scores.

Results

There was no significant change in the number or rate of higher order multiple births in NSW during the 1990s with an average annual rate of 10.3/10,000 births or 3.5/10,000 pregnancies ≥ 20 weeks. Among women with higher order multiple pregnancies, those aged ≥ 35 years increased from 19% in 1990 to 47% in 1999. There was also a trend towards delivery in a perinatal centre from 56% to 70%, and vaginal birth from 18% to 28%. There were no significant changes in infant outcomes.

Conclusions

The increases in higher order multiple pregnancies observed in Australia in the 1980s, and into the 1990s in other countries, have not persisted in NSW, suggesting that guidelines for limiting the number of embryos/oocytes transferred in assisted reproductive technologies have been widely adopted.
The loss rates for invasive prenatal testing in a specialised obstetric ultrasound practice
Authors: Scott Fergus , Peters Helen , Boogert Tom , Robertson Robert , Anderson John , McLennan Andrew , Kesby Greg , Edelman David
Published: October 2004

Objectives

To establish the spontaneous miscarriage rate and compare it with the procedure related miscarriage rate for amniocentesis and chorionic villus sampling (CVS) by experienced operators.

Design

Retrospective audit over a two‐year period of all patients having a consultation for prenatal diagnosis before 12 weeks gestation.

Setting

A specialised obstetric and gynaecological ultrasound practice.

Population

A total of 2366 patients, mostly over 35 years of age.

Methods

Between 1 July 1995 and 30 June 1997, all patients having a prenatal consultation decided between amniocentesis, CVS or no invasive testing. The CVS was performed either transabdominally or transcervically, depending on the position of the uterus and placenta.

Main outcome measures

Delivery, termination of pregnancy for chromosomal abnormality or miscarriage.

Results

Over the two‐year period, 2366 patients had a prenatal consultation and outcome data were available for all but 53 patients. After consultation, 346 patients decided not to have any prenatal testing and 29 (8.4%) of these had a spontaneous miscarriage. Amniocentesis was requested by 839 patients; however 10 miscarried before the scheduled procedure. After the amniocentesis, there were 13 terminations for chromosomal abnormality and three miscarriages. CVS was requested by 1128 patients; however, 23 miscarried before the scheduled procedure. Transabdominal CVS was performed in 665 patients, transcervical in 416 and in 24 cases the documentation of the method used was unclear. Eleven patients miscarried after the transabdominal CVS (1.65%) compared with nine patients miscarrying after the transcervical CVS (2.16%), which was not statistically significant (p = 0.27).

Conclusion

In the group studied, the spontaneous miscarriage rate from nine weeks gestation is very high (8.4%). The procedure‐related loss rate from amniocentesis was less than 1 in 280. Transabdominal CVS appears to have a lower fetal loss rate than transcervical CVS, but much larger numbers are needed to prove this.
A prospective observational study on the accuracy of patient self‐testing of urine at an antenatal clinic
Authors: Goh Judith TW , Krause Hannah
Published: October 2004

This study was performed to assess whether assigning dipstick self‐testing of urine to antenatal women maintained accuracy and clinical relevance of the results. A total of 212 women were recruited from the routine antenatal clinic for the assessment of accuracy of self‐testing of urine. The women's results were compared to that of the one nurse who routinely performs dipstick testing at the antenatal clinic.

Analysis of the results indicates that women tended to over estimate proteinuria.
Update on intrapartum fetal pulse oximetry
Authors: East Christine E , Colditz Paul B , Begg Lisa M , Brennecke Shaun P
Published: October 2004

This article examines the current status of fetal pulse oximetry (FPO) as a means of intrapartum assessment of fetal wellbeing.

FPO has been developed to a stage where it is a safe and accurate indicator of intrapartum fetal oxygenation. In general, sliding the FPO sensor along the examiner's fingers and through the cervix, to lie alongside the fetal cheek or temple is easy. The recent publication of a randomized controlled trial (RCT) of FPO versus conventional intrapartum monitoring has validated its use to reduce caesarean section rates for nonreassuring fetal status. An Australian multicentre RCT is currently underway. Maternal satisfaction rates with FPO are high.

FPO may be used during labour when the electronic fetal heart rate trace is nonreassuring or when conventional monitoring is unreliable, such as with fetal arrhythmias. If the fetal oxygen saturation (FSpO2) values are < 30%, prompt obstetric intervention is indicated, such as fetal scalp blood sampling or delivery. FSpO2 monitoring should not form the sole basis of intrapartum fetal welfare assessment. Rather, the whole clinical picture should be considered.
Ascertaining women's choice of title during pregnancy and childbirth
Authors: Denning Angela S , Tuttle Lynette K , Bryant Valerie J , Walker Susan P , Higgins John R
Published: October 2004

Methods

A questionnaire was administered to 958 women attending the antenatal clinic at Mercy Hospital for Women, Melbourne, to ascertain their choice of title during pregnancy. Midwifery, nursing and medical staff (376 in total) were also invited to respond to a similar questionnaire.

Results

The response rate was 73.6% from the survey of all women who were overwhelmingly in favour of being called ‘patient’ as their first choice (34%), followed by ‘other’ (20%) and then ‘mother’ (19%). Virtually all women requesting ‘other’ wished to be called by their name. Women wishing to be called ‘patient’ for first choice did not significantly differ from the remainder of the study group in age, gestation, number of previous pregnancies, or number of children. When women from the Family Birth Centre (FBC) were analysed as a separate group, they had a clear preference to be called ‘other’ (unanimously, by their name) than the general antenatal population (odds ratio (OR) 5.1; 95% confidence interval (CI) 3.1, 8.3; p < 0.0001). The staff survey, with a response rate of 84%, also demonstrated that ‘patient’ was the most popular first choice for patient title. Medical staff were significantly more likely to choose ‘patient’ (OR 4.2, 95% CI 2.3, 7.7; p < 0.0001), though the term ‘patient’ was the preferred choice of all staff.
Prothrombin G20210A mutation is not associated with recurrent miscarriages
Authors: Chua Boon Ghee , Burrows Robert F
Published: October 2004

Objective

To assess the association between prothrombin G20210A mutation and recurrent miscarriages.

Study design

A literature review was performed in Medline identifying articles from 1966 to December 2000. Articles meeting inclusion criteria were systematically reviewed and included in a meta‐analysis.

Results

Six trials, all case‐controlled, were identified. These trials included 323 women with recurrent pregnancy loss. The odds ratio (OR) for heterozygous prothrombin mutation was 1.9 (95% confidence interval (CI) 0.98–4.14), and for homozygous prothrombin mutation was 3.76 (95% CI 0.75–18.77). The OR for prothrombin mutation and primary recurrent abortion was 2.19 (95% CI 0.61–7.89) and for prothrombin mutation and secondary recurrent abortion was 1.29 (95% CI 0.2–8.36).

Conclusion

There is no evidence to support an association of prothrombin G20210A mutation with recurrent miscarriages.
Factors associated with pregnancy or miscarriage after clomiphene therapy in WHO Group II anovulatory women: a study conducted at Fertility Plus, National Women's Hospital, Auckland
Authors: Milsom Stella R , Gibson Gillian , Buckingham Karen , Gunn Alistair J
Published: October 2004

Objectives

The present study was designed to determine whether clinical and endocrine characteristics assessed on initial screening of normogonadotropic oligo/amenorrhoeic infertile patients could predict ovulation and then conception and successful live birth or miscarriage.

Study design

Retrospective cohort study.

Setting

Outpatient clinic.

Population

Eighty‐two consecutive women receiving clomiphene citrate (CC) therapy from 1993 to 1998.

Results

A cumulative conception rate of 67% was reached after six or more CC‐induced cycles. Patients with failure of ovulation after a full course of CC had more severe oligomenorrhoea (p < 0.001) and greater BMI (p < 0.05) at initial screening. There was no relationship with levels of LH or androgens. In contrast, among women who ovulated in response to CC, conception was associated with less frequent periods, and higher basal levels of LH, free testosterone and androstenedione. Conceptions with subsequent miscarriage were associated with intermediate levels of LH and numbers of spontaneous periods between non‐conception and live births.

Conclusions

These observations are consistent with the hypothesis that failure of ovulation after CC is related to different factors (overweight and severe oligomenorrhoea) from those that predispose to non‐conception (low basal LH and androgen levels and mild oligomenorrhoea).
Trends in labour and birth interventions among low‐risk women in New South Wales
Authors: Roberts Christine L , Algert Charles S , Douglas Ian , Tracy Sally K , Peat Brian
Published: October 2004

Objective

To examine recent trends in obstetric intervention rates among women at low‐risk of poor pregnancy outcome.

Design

Cross‐sectional analytic study.

Setting and Population

A population of 336,189 women categorised as low‐risk of a poor pregnancy outcome who gave birth to a live singleton in NSW from 1 January 1990 to 31 December 1997.

Main outcome measures

Obstetric intervention rates including oxytocin induction and augmentation of labour, epidural analgesia, instrumental births, caesarean section and episiotomy.

Methods

Trends over time were assessed by fitting trend‐lines to numbers of births or by trends in proportions. Unconditional logistic regression was used to assess the impact of epidural analgesia on instrumental birth over time.

Results

Rates of operative births did not rise despite increases in maternal age and use of epidural analgesia. Instrumental births declined over time from 26% to 22% among primiparas and 5% to 4% among multiparas. There was also a shift to vacuum extraction rather than forceps. Although instrumental birth was strongly associated with epidural analgesia, the strength of the association declined over the study period, for primiparas from an adjusted odds ratio of 7.2 to 5.2 and for multiparas from 13.2 to 10.3.

Conclusions

Increased use of epidural analgesia for labour has been a feature of the management of birth at term during the 1990s. The decline in the strength of association between epidural analgesia and instrumental birth may reflect improved epidural techniques and management of epidural labour, and recognition of the adverse maternal outcomes associated with forceps and vacuum births.
Late antenatal carriage of group B Streptococcus by New Zealand women
Authors: Grimwood Keith , Stone Peter R , Gosling Isobelle A , Green Robyn , Darlow Brian A , Lennon Diana R , Martin Diana R
Published: October 2004

Objectives

To determine in New Zealand women the prevalence of group B Streptococcus (GBS) carriage late in pregnancy and to identify GBS colonisation risk factors, antibiotic susceptibility and serotype distribution.

Design

Prospective, observational study.

Setting

Community and hospital antenatal clinics in Wellington and Auckland during 1998–1999.

Sample

Convenience sample of 240 women between 35–37 weeks gestation.

Methods

Sociodemographic data, obstetric details and anogenital swabs were collected from each subject. Swabs were inoculated into selective media. GBS isolates underwent serotyping and antibiotic susceptibility testing.

Results

Two hundred and forty women (9% Maori, 11% Pacific) aged 15–41 years were recruited. Fifty‐two (22%; 95% CI 17, 27) were colonised by GBS. Carriage was independently associated with younger age (59%≤ 30 years; adjusted OR 3.25; 95% CI 1.53, 6.95) and least social deprivation (57% NZ Dep 96 score ≤ 3; adjusted OR 1.22; 95% CI 1.06, 1.39). All GBS isolates were penicillin‐susceptible, but resistance to clindamycin (15%) and erythromycin (7.5%) was detected and associated with serotype V strains. Predominant serotypes were: III (29%), Ia (21%), Ib (20%) and V (20%).

Conclusions

Approximately 20% of New Zealand women carry GBS late in pregnancy, with young age a major risk factor. Increased risk in the socially advantaged, development of resistance to erythromycin and clindamycin, and emergence of new GBS serotypes are findings with important implications for prevention strategies requiring further confirmation.
Aboriginal teenage pregnancies compared with non‐Aboriginal in South Australia 1995–1999
Authors: Westenberg Leontine , van der Klis Karin AM , Chan Annabelle , Dekker Gustaaf , Keane Rosemary J
Published: October 2004

Objective

To compare pregnancy characteristics and outcomes between Aboriginal and non‐Aboriginal teenagers.

Design, setting and population

A retrospective cohort study using the perinatal data collection for South Australian births in 1995–1999: 449 Aboriginal and 4625 non‐Aboriginal teenagers.

Methods

Comparison of socio‐demographic and clinical characteristics, using relative risks.

Main outcome measures

Rates of pregnancy, smoking during pregnancy, induction, delivery method, preterm and small‐for‐gestational‐age births and perinatal mortality.

Results

Aboriginal teenagers have a pregnancy rate more than twice as high as non‐Aboriginal, but a smaller proportion of pregnancies are terminated. They have pregnancies earlier, are more likely to be single, to smoke during pregnancy, to have few antenatal visits, to give birth in a country hospital and to have infections and anaemia. They have lower induction and analgesia rates, but a higher caesarean section rate. Their babies are more likely to be small‐for‐gestational‐age and preterm, to have a congenital abnormality, to require special and intensive nursery care and stay longer in hospital. While their perinatal mortality rate has halved since a decade ago, their neonatal death rate is still twice that of non‐Aboriginal births.

Conclusions

Aboriginal teenagers need special attention. Support in particular is needed for Aboriginal health workers in preconceptional counselling and health promotion programs that build the capacity of the community, eg concerning proper nutrition during pregnancy, smoking cessation, breastfeeding, SIDS prevention, support for early and regular attendance for antenatal care in friendly and culturally appropriate environments. Outreach services and sexual health services for young Aboriginal people also need expansion.
A prospective study of the short‐term outcomes of hysterectomy with and without oophorectomy
Authors: Farquhar CM , Sadler L , Harvey S , McDougall J , Yazdi G , Meuli K
Published: October 2004

Objective

To determine the symptom profile and satisfaction rate for women undergoing hysterectomy with and without oophorectomy.

Study design

Women under 46 years of age who underwent hysterectomy with (n = 266) and without oophorectomy (n = 57) were followed for six months.

Results

Satisfaction was high at six months. In‐hospital complication rates were 28% in Group 1 and 39% in Group 2 (p = 0.11). Pelvic pain was reported in more than half the women at six weeks. A reduction in constipation, diarrhoea, abdominal and pelvic pain, and depression was reported at six months. Quality of sexual function in women did not improve. New symptoms of pelvic pain or depression were present at six months in more than 16% to 37% of the women. Regrets about loss of fertility were increased at six months.

Conclusions

Although levels of satisfaction with the procedure of hysterectomy were high, new symptoms and regrets about the loss of fertility were commonly reported.
The benefits and problems associated with minimal access surgery
Authors: Garry Ray
Published: October 2004

The place of minimal access surgery (MAS) in current gynaecological practice remains controversial. As a consequence, MAS techniques have been subject to a significant amount of prospective, evidence‐based assessment. The ultimate results of these comparative trials will undoubtedly have a profound impact on the future direction of our speciality. It is timely, therefore, to review the currently available data.

Evidence from 2195 patients in 23 randomised clinical trials of five different treatment modalities (ectopic, ovarian cysts, myomectomy, colposuspension and hysterectomy) clearly demonstrates that uncomplicated MAS procedures produce patient‐friendly benefits, at least in the short term. No matter what operation is performed, the laparoscopic approach is associated with less pain, shorter hospital stay and shorter recovery. These immediate patient‐orientated benefits are a generic consequence of replacing the manoeuvres of open surgery through laparotomy incisions with minimal access. These benefits must be offset against significant disadvantages.

Minimal access surgery procedures always require the use of expensive, high technology equipment and usually take longer to perform. Such procedures may be more costly than current open procedures and costs will, in part, be dependent on the amount of disposable equipment employed.

Patients undergoing MAS procedures may be at risk of new and/or increased risk of traditional complications. The longer‐term results of most MAS procedures have not yet been determined.

These potential benefits and disadvantages of MAS require that each procedure is carefully and individually assessed. This paper seeks to review the current evidence.
A survey of entry techniques and complications of members of the Australian gynaecological endoscopy society (AGES)
Authors: Kaloo Philip , Cooper Michael , Molloy David
Published: October 2004

Objective

To identify various aspects of laparoscopic entry technique and visceral injury experienced by members of the Australian Gynaecological Endoscopy Society (AGES).

Design

A retrospective mailed survey.

Sample

All members of the Australian Gynaecological Endoscopy Society (AGES).

Main outcome measures

Numbers of bowel and major retroperitoneal vascular injuries experienced, entry techniques utilised, alternative entry sites.

Results

Of the respondents, 73% use a Veress needle entry. In subjects with an increased risk of peri‐umbilical adhesions 83% of respondents use an alternate site of entry, 66% of which use Palmer's point. Sixtyfour per cent of respondents had experienced one or more bowel injuries, 21% had experienced major retroperitoneal vascular injury, 33% of respondents had no plan in place for the management of vascular injury and 51% of respondents would alter their clinical practice if accepted entry technique guidelines were available.

Conclusions

The majority of respondents use the Veress needle method of entry, have had at least one entry‐related bowel injury and use Palmer's point as an alternative entry site in high‐risk subjects. The majority of subjects would alter their clincal practice if accepted entry technique guidelines were available.
An Australasian survey of the management of hydrosalpinges in women due to undergo in vitro fertilisation
Authors: Johnson Neil P , Norris Julie
Published: October 2004

Objective

To ascertain current practice of surgical interventions for women with hydrosalpinges prior to in vitro fertilisation and to compare this with a subsequent systematic review of the literature.

Design

Survey.

Setting

Specialists in Australasian IVF clinics.

Methods

Questionnaire sent to all specialists in Australasian IVF clinics via the clinical directors of these units.

Results

There were 79 respondents from 33 fertility clinics. Although only 66% expressed a belief that there was convincing evidence of an improvement in pregnancy outcomes from surgical treatment for hydrosalpinges prior to in vitro fertilisation, 94% currently offer surgical treatment for hydrosalpinges prior to in vitro fertilisation, 32% always and 62% only in selected cases. Of the 74 respondents offering surgery, all but three expressed a preference for the laparoscopic approach. Of those offering surgery, 89% performed unilateral or bilateral salpingectomy depending whether unilateral or bilateral hydrosalpinges were present, 5% routine bilateral salpingectomy, 14% proximal tubal occlusion with clips, 24% salpingostomy, 7% ultrasound‐guided needle aspiration of hydrosalpinges at the time of egg collection.

Conclusions

The diverse practice among Australasian fertility specialists reflects the apparent conflict in the literature prior to this survey. A Cochrane Review has now demonstrated the efficacy of laparoscopic salpingectomy in improving the odds of live birth for women with hydrosalpinges due to undergo in vitro fertilisation. It will be interesting to review whether this leads to greater uniformity of practice in the coming years.
IVF and tubal pathology — not all bad news
Authors: Johnson Neil P , Sadler Lynn , Merrilees Margaret
Published: October 2004

Objectives

In light of evidence that hydrosalpinges compromise the chance of success of in vitro fertilisation (IVF), the aim of this study was to analyse the results of IVF treatment at our clinic in relation to the cause for infertility and to make inferences concerning the impact of mild tubal disease on IVF outcome.

Design

Retrospective observational study.

Setting

Tertiary fertility clinic in New Zealand.

Population

Nine hundred and six consecutive cycles among 639 couples receiving IVF treatment in the six‐year period 1995‐2000 inclusive.

Methods

Data extraction from the clinic database.

Results

The clinical pregnancy rate of 17.5% per ovarian stimulation cycle and 23.9% per embryo transfer for the cycles of couples with tubal disease as the only cause for infertility was not significantly different from the clinical pregnancy rate of 15.4% per ovarian stimulation cycle and 24.1% per embryo transfer for all other couples undergoing IVF.

In the cycles of women with tubal disease, the clinical pregnancy rate of 6.6% per ovarian stimulation cycle where other causes for infertility were also present, was significantly lower than the clinical pregnancy rate of 17.5% where tubal factor alone was present.

In the cycles of couples with multiple causes for infertility, where the overall pregnancy rate was 10.9% per ovarian stimulation cycle, there was no significant difference in pregnancy rate between those whose multiple causes included tubal disease (6.6% per ovarian stimulation cycle) and those whose multiple causes did not include tubal disease (17.5% per ovarian stimulation cycle).

Conclusion

The overall population of women with tubal disease as the sole cause for infertility (including women with hydrosalpinges and those with non‐hydrosalpinx tubal disease) does not have an overall reduced likelihood of success at IVF. This suggests that non‐hydrosalpinx tubal disease does not compromise the chance of success from IVF. Surgical treatment prior to IVF for the milder forms of tubal disease is not warranted.
Immediate and associated complications of hysterectomy for benign disease
Authors: Tamizian O , Gilby J , Symonds IM , Cust MP , Arulkumaran S
Published: October 2004

Abdominal and vaginal hysterectomy are common operations for benign gynaecological conditions. Though safe operations, they are not without complications. Good medical practice requires that patients be fully counselled regarding risks involved in undergoing medical interventions. This can only be done by regular review of local practice and comparison with national and international standards. We have reviewed 502 case notes of patients who have undergone a hysterectomy for benign conditions over an 18‐month period.