bluuebunny/crossref_metadata_2025 huggingface dataset:
Motherhood in the context of maternal HIV infection
Authors: Sandelowski Margarete , Barroso Julie
Published: December 2003

Metasummary and metasynthesis techniques were used to integrate findings pertaining to motherhood in 56 reports of qualitative studies conducted with HIV‐positive women. Motherhood in the context of maternal HIV infection entailed work directed toward the illness itself and the social consequences of having HIV infection in the service of two primary goals: the protection of children from HIV infection and HIV‐related stigma and the preservation of a positive maternal identity. Motherhood both intensified and mitigated the negative physical and social effects of HIV infection. HIV‐positive mothers engaged in a distinctive kind of maternal practice—virtual motherhood—to resist forces that disrupted their relationships with and ability to care for their children, as well as their identities as mothers. © 2003 Wiley‐Liss, Inc. Res Nurs Health 26:470–482, 2003
Developing risk‐adjusted 30‐day hospital mortality rates
Authors: Tourangeau Ann E. , Tu Jack V.
Published: December 2003

This article describes one risk‐adjustment method useful for minimizing threats to internal validity that stem from the impact on the outcomes under investigation from patients' own characteristics and their associated risks. Mortality is the outcome used to illustrate the risk‐adjustment approach. A two‐step approach to outcomes research is suggested. The first step includes risk‐adjusting outcomes for patient characteristics by developing standard mortality rates. In the second step these risk‐adjusted standard rates can be used as dependent variables in outcomes analytic models. This article focuses on the first step. In the current study risk adjustment resulted in changes in both absolute values and rank ordering of hospital mortality rates compared to crude rates. This procedure is useful for developing risk‐adjusted outcomes with administrative data similar to those used in this study. © 2003 Wiley Periodicals, Inc. Res Nurs Health 26:483–496, 2003
Online Ratings: Fact and Fiction
Authors: Hardy Nedra
Published: December 2003

Northwestern University's experience sheds light on some of the common (mis)perceptions about online student evaluations.
Online Student Ratings: Will Students Respond?
Authors: Johnson Trav D.
Published: December 2003

In this chapter, the author examines important issues related to online reporting of student survey results.
Online Reporting of Results for Online Student Ratings
Authors: Llewellyn Donna C.
Published: December 2003

In this chapter, the author examines important issues related to online reporting of student survey results.
Do Online Ratings of Instruction Make $ense?
Authors: Bothell Timothy W. , Henderson Tom
Published: December 2003

In this chapter, the authors compare the costs of online student ratings of instruction with those of paper‐based systems.
Course Evaluation on the Web: Facilitating Student and Teacher Reflection to Improve Learning
Authors: Tucker Beatrice , Jones Sue , Straker Leon , Cole Joan
Published: December 2003

Course Evaluation on the Web is a dynamic, Web‐based system for student reflection on learning, instructor reflection on teaching, and program management.
Online Collection of Midterm Student Feedback
Authors: Bullock Cheryl Davis
Published: December 2003

Evaluation Online offers a variety of options to faculty who want to solicit formative feedback electronically. Researchers interviewed faculty who have used this system for midterm student evaluation.
Online Evaluations of Teaching: An Examination of Current Practice and Considerations for the Future
Authors: Ballantyne Christina
Published: December 2003

As the World Wide Web becomes an integral part of higher education, universities must determine the viability of using the Internet for their student evaluation systems. This chapter highlights important online‐student‐rating issues raised in this volume and in other research.
Prenatal diagnosis of congenital genu recurvatum following amniocentesis complicated by leakage
Authors: Gorincour G. , Chotel F. , Rudigoz R. C. , Guibal‐Baggio A. L. , Berard J. , Pracros J. P. , Guibaud L.
Published: December 2003

Congenital genu recurvatum (CGR) is an extremely rare condition observed at birth. It is associated with, among other malformations, genetic entities such as the Larsen syndrome. When CGR is isolated, orthopedic treatment will usually lead to a good functional prognosis. We report the first case of isolated CGR diagnosed prenatally and suspected to be a consequence of reduced amniotic fluid volume due to leakage following amniocentesis. The etiology and management options for CGR are briefly discussed. Copyright © 2003 ISUOG. Published by John Wiley & Sons, Ltd.
Single umbilical artery at 11–14 weeks' gestation: relation to chromosomal defects
Authors: Rembouskos G. , Cicero S. , Longo D. , Sacchini C. , Nicolaides K. H.
Published: December 2003

Objective

To determine the possible association between single umbilical artery (SUA) at 11–14 weeks of gestation and the incidence of chromosomal abnormalities.

Methods

Color flow imaging of the fetal pelvis was used to determine the number of umbilical arteries in 717 fetuses immediately before chorionic villus sampling for karyotyping at 11–14 weeks' gestation.

Results

Single umbilical artery (SUA) was diagnosed in 21/634 (3.3%) chromosomally normal fetuses, in 5/44 (11.4%) with trisomy 21, 14/18 (77.8%) with trisomy 18 and 2/21 (9.5%) with other chromosomal defects. In the chromosomally normal group there was no significant difference in median fetal crown–rump length or nuchal translucency (NT) between those with a single and those with two umbilical arteries. In the 42 fetuses with SUA the expected number of cases of trisomy 21, estimated on the basis of maternal age, gestational age and fetal NT, was 4.7, which was not significantly different from the observed 5. The corresponding numbers for trisomy 18 were 2.0 for expected and 14 for observed (Fisher's exact test P = 0.0016).

Conclusion

A SUA at 11–14 weeks' gestation has a high association with trisomy 18 and other chromosomal defects. Copyright © 2003 ISUOG. Published by John Wiley & Sons, Ltd.
Relationship between placental blood flow resistance and precordial venous Doppler indices
Authors: Baschat A. A.
Published: December 2003

Objective

To characterize the relationship between placental blood flow resistance and precordial venous Doppler indices in normal fetuses.

Methods

This was a prospective cross‐sectional Doppler study of uncomplicated pregnancies. Umbilical artery (UA), inferior vena cava (IVC) and ductus venosus (DV) were examined. Multiple indices were calculated for each vein and correlated with the UA pulsatility index (PI) and gestational age (GA). In addition, an arteriovenous ratio (AV ratio) between the UA PI and multiple venous indices was calculated and related to GA.

Results

In the 237 patients studied all venous indices showed a linear relationship with the UA PI. All venous indices except the IVC preload index (PLI) had a significant positive correlation with the UA PI. Seven AV ratios were calculated and each had a linear negative relationship with GA. The relationship between UA PI and IVC pulsatility index for veins (PIV) and DV PIV remained constant throughout gestation. The AV ratio that utilized the IVC PLI and DV systolic/a‐wave ratio showed a significant decline with GA.

Conclusion

Placental blood flow resistance least influences the IVC PLI while the converse is true for the PIV in both veins. A differential effect of placental afterload on various venous indices needs to be accounted for in situations of elevated placental blood flow resistance. AV Doppler ratios may be useful for this purpose. Copyright © 2003 ISUOG. Published by John Wiley & Sons, Ltd.
Oscillations of cerebrovascular resistance throughout the menstrual cycle in healthy women
Authors: Krejza J. , Siemkowicz J. , Sawicka M. , Szylak A. , Kochanowicz J. , Mariak Z. , Lewko J. , Spektor V. , Babikian V. , Bert R.
Published: December 2003

Objectives

Increased concentration of endogenous estrogen during a typical menstrual cycle has been shown to correlate with augmentation of blood flow through the internal carotid arteries (ICAs), which may be related to changes in vascular resistance within the brain. In this study we investigated the effects of endogenous estrogen and progesterone on cerebrovascular impedance in young healthy women.

Methods

The blood flow in the ICA and the common (CCA) and external (ECA) carotid arteries was studied with duplex Doppler sonography. The resistance index (RI) was determined and correlated with plasma 17β‐estradiol concentration in 14 young healthy women throughout their menstrual cycle.

Results

The concentration of 17β‐estradiol increased in the follicular phase of the cycle and reached a peak on day 14, whereas concentration of progesterone remained low. Along with an increase in estrogen concentration, the ICA RI had decreased from its initial level on average by 9.2% on day 13 and by 6.7% on day 14 (P < 0.05). In contrast, the trend of the ECA RI was to increase during the peak of estrogen concentration. There were no significant changes in the CCA RI or in the systolic blood pressure, heart rate, hematocrit and hemoglobin concentration through the menstrual cycle.

Conclusions

Estrogen‐related augmentation of blood flow through the ICA is caused mainly by decreased cerebrovascular impedance, as shown by a decrease in the ICA RI. These changes in RI suggest that estrogen influences cerebral impedance mainly by altering the resistance of cerebral microvasculature. Copyright © 2003 ISUOG. Published by John Wiley & Sons, Ltd.
Ultrasound prediction of risk of spontaneous miscarriage in live embryos from assisted conceptions
Authors: Choong S. , Rombauts L. , Ugoni A. , Meagher S.
Published: December 2003

Objective

An accurate method to predict subsequent miscarriage in live embryos has not yet been established. This pilot study aimed to determine the most discriminatory ultrasound‐based model for predicting spontaneous miscarriage after embryonic life was first detected in assisted conceptions. A method for estimating individual risk of miscarriage was developed.

Methods

This was a prospective cross‐sectional survey of 322 live singleton embryos in women from an assisted reproductive technology program. Mean sac diameter (MSD), crown–rump length (CRL), embryonic heart rate (EHR), maternal age and gestational age at the first transvaginal scan detecting embryonic life (between 42 and 62 days) were observed. These variables were included in a multivariate model for predicting spontaneous miscarriage occurring prior to 20 weeks. MSD, CRL and MSD minus CRL were assessed in univariate logistic regression analyses. The global diagnostic accuracy of each model was compared directly using receiver–operating characteristics (ROC) curves.

Results

The multivariate model demonstrated the best ROC curve for predicting miscarriage (ROC area 0.87; 95% CI, 0.80–0.95). The separate univariate analyses had less diagnostic accuracy. In particular, MSD − CRL had a significantly smaller ROC area (0.65) than did the multivariate model (P < 0.01).

Conclusions

The most discriminatory test for predicting spontaneous miscarriage in live embryos was a multivariate model, which allows estimation of individual risk levels. Copyright © 2003 ISUOG. Published by John Wiley & Sons, Ltd.
Late onset microcephaly: failure of prenatal diagnosis
Authors: Schwärzler P. , Homfray T. , Bernard J.‐P. , Bland J. M. , Ville Y.
Published: December 2003

We present a case of recurrent primary developmental microcephaly of late onset, the prenatal diagnosis of which could not be achieved despite performing targeted serial ultrasound scans that revealed no obvious fetal abnormality. Serial scans for head measurements and detailed examination of the brain anatomy by both transabdominal and transvaginal sonography including color and power Doppler assessment revealed no obvious brain abnormality. Frontal lobe distance and thalamic frontal lobe distance at 36 weeks were on the 30th and 50th centiles, respectively. Growth velocity remained on the 50th centile up to 36 weeks; between 36 and 38 weeks measurements were between the 35th and 40th centiles. The infant was delivered by Cesarean section at 38 weeks on parental request. On examination after birth the head circumference was on the 9th centile, but the facies was that of a microcephalic child with a sloping forehead and neurologically he was severely abnormal. The adequacy of the normal reference ranges used is reviewed: the use of sex‐specific growth charts at 38 weeks would have demonstrated the biparietal diameter and the head circumference to be on the 20th and 15th centiles, respectively, rather than just below the 40th centile. However, even sex‐specific charts may not allow the recognition of a substantial number of affected fetuses. Copyright © 2003 ISUOG. Published by John Wiley & Sons, Ltd.
Ultrasound examination at 37 weeks' gestation in the prediction of pregnancy outcome: the value of cervical assessment
Authors: Ramanathan G. , Yu C. , Osei E. , Nicolaides K. H.
Published: December 2003

Objective

To examine the potential value of routine measurement of cervical length in singleton low‐risk pregnancies at 37 weeks of gestation in the prediction of onset and outcome of labor.

Methods

Cervical length was measured by transvaginal sonography at 37 weeks in 1571 singleton low‐risk pregnancies. Outcome measures were gestation at spontaneous onset of labor, post‐term delivery, duration of labor and mode of delivery.

Results

The median cervical length at 37 weeks was 30 mm and there was a significant association between cervical length and gestation at delivery, which increased from a mean of 38 weeks for cervical length of 10 mm to 41 weeks for cervical length of 35 mm. The incidence of delivery after 40 weeks and 10 days was 296 (18.8%) and the incidence increased with cervical length at 37 weeks from 0% to 6%, 35% and 68% for respective cervical lengths of < 20, 21–30, 31–40 and 41–50 mm. In the pregnancies with spontaneous onset of labor the incidence of Cesarean section for failure to progress increased from 3.6% to 6.0%, 6.4% and 11.8% for cervical lengths of < 20, 21–30, 31–40 and 41–50 mm, respectively. In the pregnancies requiring induction for post‐term the incidence of Cesarean section for failed induction or failure to progress increased from 7.5% to 20.1% to 25.0% for cervical lengths of 21–30, 31–40 and 41–50 mm, respectively.

Conclusion

Measurement of cervical length at 37 weeks can define the likelihood of spontaneous delivery before 40 weeks and 10 days and the risk of Cesarean section in those requiring induction for prolonged pregnancy. Copyright © 2003 ISUOG. Published by John Wiley & Sons, Ltd.
Prenatal diagnosis of a cleidocranial dysplasia‐like phenotype associated with a de novo balanced t(2q;6q)(q36;q16) translocation
Authors: Winer N. , Le Caignec C. , Quere M. P. , David A. , Boceno M. , Aubron F. , Joubert M. , Boog G. , Philippe H. J. , Rival J. M.
Published: December 2003

Cleidocranial dysplasia (CCD) is a congenital disorder of bone development characterized by persistently open or delayed closure of cranial sutures and wormian bones, hypoplastic and/or aplastic clavicles, wide pubic symphysis, dental anomalies and short stature. The condition is inherited as an autosomal‐dominant trait and the human CBFA1 gene has been identified as the CCD gene. We describe a prenatal form of the skeletal disorder that included clavicular hypoplasia, absence of ossification of the cranial parietal bones and very poor ossification of the frontal and pubic bones. Growth restriction affecting only the long bones was also noted. The fetal karyotype revealed an apparently de novo balanced t(2q;6q)(q36;q16) translocation. This particular form of skeletal disorder associated with the absence of family history and an apparently de novo balanced translocation led the parents to opt for termination of the pregnancy. Copyright © 2003 ISUOG. Published by John Wiley & Sons, Ltd.
Endoanal sonography in assessment of fecal incontinence following obstetric trauma
Authors: Martínez Hernández Magro P. , Villanueva Sáenz E. , Jaime Zavala M. , Sandoval Munro R. D. , Rocha Ramírez J. L.
Published: December 2003

Objectives

Fecal incontinence is a common, incapacitating and largely unrecognized medical problem and can be caused by various factors. Obstetric trauma is the most common cause of fecal incontinence secondary to trauma. We aimed to analyze the role of endoanal ultrasound in assessment of this type of fecal incontinence, and report the functional results of surgical treatment.

Methods

We reviewed the records of all 22 patients with fecal incontinence secondary to obstetric trauma who were evaluated by endoanal ultrasound and underwent surgical management in our department from April to 1997 to April 2002. Pre‐ and postoperative evaluation of the degree of incontinence was done using the incontinence score of Jorge and Wexner.

Results

The patients had a median age of 43 (range, 29–68) years. All had vaginal deliveries, five of which (22.7%) were instrumental. Most of the patients had total fecal incontinence (solids) with preoperative incontinence score values of 15–20 (median, 18). Endoanal ultrasound confirmed structural defects in the anterior external anal sphincter alone in 16 (72.7%) patients, and both anterior external and internal sphincter defects in six (27.3%) patients. A thinned perineal body was present in all patients. All patients received surgical treatment with overlapping sphincteroplasty and there was improvement of continence in 19 (86.4%) patients with postoperative incontinence score values between 4 and 0 (median, 2).

Conclusions

Endoanal sonography is an accurate method for assessing sphincter anatomy, delineating both internal and external anal sphincters. Surgical treatment of sphincter defects is associated with good outcome. Copyright © 2003 ISUOG. Published by John Wiley & Sons, Ltd.
Results of endosonographic imaging of the anal sphincter 2–7 days after primary repair of third‐ or fourth‐degree obstetric sphincter tears
Authors: Starck M. , Bohe M. , Valentin L.
Published: December 2003

Objectives

To describe the endosonographic image of the anal sphincter 2–7 days after delivery in women who had undergone a primary repair of an obstetric sphincter tear.

Methods

Forty‐eight women who had suffered a third‐ or fourth‐degree sphincter tear at delivery and had undergone primary sphincter repair were examined with endoanal sonography 2–7 days after delivery. A score from 0 to 16 was used to describe the extent of the endosonographic defects, a score of 0 indicating no defect and a score of 16 a defect > 180° involving the whole length and depth of the sphincter. Clinical information was retrieved from the delivery and operation records after the analysis of the ultrasound images and the classification of the sonographic defects had been completed.

Results

Clinically, 34 (71%) women had a partial third‐degree tear, 11 (23%) had a total third‐degree tear, and three (6%) had a fourth‐degree tear. Forty‐three (90%; 95% CI, 77–97%) women had sonographic defects, all hypoechoic. Twenty‐three (54%) sonographic defects were confined to the proximal part of the anal canal and involved less than half of the length of the anal canal. Thirty (63%) defects were confined to the external sphincter. Five of nine women (56%) with an endosonographic sphincter defect score ≥ 8 had undergone primary sphincter repair by a doctor in training vs. 9 of 39 women (23%) with an endosonographic sphincter score < 8 (P = 0.05), despite the fact that 86% (12/14) of the tears sutured by doctors in training were clinically partial third‐degree tears vs. 65% (22/34) of those sutured by specialists (P = 0.15). Five (15%) of 34 women with a clinical partial third‐degree tear had an endosonographic sphincter score ≥ 8 vs. four (29%) of 14 with a clinical total third‐ or fourth‐degree sphincter tear (P = 0.26).

Conclusions

Most women (90%) with a clinical third‐ or fourth‐degree obstetric sphincter tear have endosonographic sphincter defects if they are examined 2–7 days after primary repair. The extent of the endosonographic defects seems to be determined mainly by the surgical experience of the doctor performing the repair, and not by the clinical degree of the tear. Copyright © 2003 ISUOG. Published by John Wiley & Sons, Ltd.
Uterine artery blood flow velocity waveforms during uterine contractions
Authors: Li H. , Gudmundsson S. , Olofsson P.
Published: December 2003

Objective

No quantitative or qualitative Doppler velocimetry classification of vascular flow resistance covering all stages of forward and reversed flows exists. The objective of this study was to characterize uterine artery (UtA) flow velocity waveforms (FVWs) obtained during an oxytocin challenge test (OCT) and compare them to FVWs in spontaneous normal labor.

Methods

Uterine artery Doppler velocimetry was performed during and between uterine contractions in 61 high‐risk pregnancies subjected to an OCT and in 20 normal pregnancies undergoing spontaneous labor. FVWs were classified relative to the presence of forward/absent/reversed flow during systole and diastole, and the time‐averaged flow velocity over the heart cycle.

Results

Eleven different FVW classes were identified. No relationship between FVWs recorded during uterine inertia and contractions was found (P ≥ 0.2). In both groups, only forward FVWs were recorded between contractions, whereas during contractions flow reversal was more common in the OCT group (P ≤ 0.002). In cases of predominantly reversed flow, a reciprocal relationship to FVW classes recorded in the contralateral artery was found.

Conclusions

UtA FVW patterns recorded during uterine contractions were not predicted by flow patterns recorded during uterine inertia. Reversal of flow direction was more common during oxytocin‐induced uterine contractions than during spontaneous contractions. In cases of predominantly reversed flow, domains of the uterus may be supplied by blood from the contralateral UtA. These observations give new insights into the circulatory dynamics of the uterus during labor, and also point to a possible vasoconstrictory effect in the UtAs of oxytocin at high concentrations. Copyright © 2003 ISUOG. Published by John Wiley & Sons, Ltd.
First‐trimester reversed end‐diastolic flow in the umbilical artery is not always an ominous sign
Authors: Bellver J. , Lara C. , Rossal L. P. , Remohí J. , Pellicer A. , Serra V.
Published: December 2003

We report five cases of first‐trimester reversed end‐diastolic flow in the umbilical artery. Diagnoses were performed between 8 and 12 gestational weeks. All but one case appeared as a transient early finding. Second‐trimester fetal demise occurred in two cases. One case delivered at 32 weeks with severe growth restriction but recovered well. The other two cases had a good pregnancy outcome. Our experience suggests that this early Doppler finding is not always an ominous sign. Copyright © 2003 ISUOG. Published by John Wiley & Sons, Ltd.
The reliability of virtual organ computer‐aided analysis (VOCAL) for the semiquantification of ovarian, endometrial and subendometrial perfusion
Authors: Raine‐Fenning N. J. , Campbell B. K. , Clewes J. S. , Kendall N. R. , Johnson I. R.
Published: December 2003

Objectives

Three‐dimensional power Doppler angiography (3D‐PDA) has been largely used for the subjective assessment of vascular patterns but semiquantification of the power Doppler signal is now possible. We examined the intraobserver and interobserver reliability of the semiquantification of ovarian, endometrial and subendometrial blood flow using 3D‐PDA, virtual organ computer‐aided analysis (VOCAL™) and shell‐imaging.

Methods

3D‐PDA was used to acquire 20 ovarian and 20 endometrial volumes from 40 different patients at various stages of in vitro fertilization treatment. VOCAL was then used to delineate the 3D areas of interest and the ‘histogram facility’ employed to generate three indices of vascularity: the vascular index, the flow index and the vascularization flow index. Intraobserver and interobserver reliability was assessed by two‐way, mixed, intraclass correlation coefficients (ICCs) and general linear modeling was used to examine for differences in the mean values between each observer.

Results

The intraobserver reliability for both observers was extremely high and there were no differences in reliability between the observers for measurements of both volume and vascularity within the ovary or endometrium and its shells. With the exception of the outside subendometrial shell volumes, there were no significant differences between the two observers in the mean values obtained for either endometrial or ovarian volume and vascularity measurements. The interobserver reliability of measurements was equally high throughout with all measurements obtaining a mean ICC of above 0.985.

Conclusions

3D‐PDA and shell‐imaging offer a reliable, practical and non‐invasive method for the assessment of ovarian, endometrial and subendometrial blood flow. Future work should concentrate upon confirming the reliability of data acquisition and the validity of the technique before its predictive value can be truly tested in prospective clinical studies. Copyright © 2003 ISUOG. Published by John Wiley & Sons, Ltd.
Umbilical cord edema associated with patent urachus
Authors: Schiesser M. , Lapaire O. , Holzgreve W. , Tercanli S.
Published: December 2003

Umbilical cord anomalies can often be detected prenatally by ultrasound, but a definitive prenatal diagnosis is not always possible. We present a case with increasing edema of the Wharton's jelly followed by the development of pseudocysts in the proximal umbilical cord due to a patent urachus. The first abnormal findings were detected by ultrasound in the 14th week of gestation. Differential diagnoses and their influence on surveillance and birth management are discussed. Copyright © 2003 ISUOG. Published by John Wiley & Sons, Ltd.
Fetal subcutaneous tissue thickness (SCTT) in healthy and gestational diabetic pregnancies
Authors: Larciprete G. , Valensise H. , Vasapollo B. , Novelli G. P. , Parretti E. , Altomare F. , Di Pierro G. , Menghini S. , Barbati G. , Mello G. , Arduini D.
Published: December 2003

Objective

To determine reference values of fetal subcutaneous tissue thickness (SCTT) throughout gestation in a healthy population and to compare them with those from a population of pregnant women with gestational diabetes under standard therapy.

Methods

Three hundred and three women recruited from a high‐risk pregnancy clinic were classified as being healthy (n = 218) or as having gestational diabetes (n = 85) on the basis of a negative or positive oral glucose tolerance test, respectively. They were enrolled into the cross‐sectional study at 20 weeks' gestation. Ultrasound examinations were performed approximately every 3 weeks until delivery at term. The mid‐arm fat mass and lean mass (MAFM, MALM), the mid‐thigh fat mass and lean mass (MTFM, MTLM), the abdominal fat mass (AFM) and the subscapular fat mass (SSFM) were evaluated. Time‐specific reference ranges were constructed from the 218 healthy women and a conventional Student's t‐test was performed to compare SCTT values between the two study groups throughout gestation.

Results

Normal ranges, including 5th, 50th and 95th centiles of the distribution, were generated for each SCTT parameter obtained in each of the two groups of women. Significant differences were found between the two study groups at 37–40 weeks' gestation for MTFM, at 20–22 and 26–28 weeks for MTLM, at 31–34 and 35–37 weeks for MAFM, at 26–28 and 38–40 weeks for SSFM, and at 39–40 weeks for AFM, the mean residual values always being greater in gestational diabetic women than they were in the group of healthy pregnant women.

Conclusions

We provide gestational age‐specific reference values for fetal SCTT. Fetal fat mass values, particularly in late gestation, are greater in women with gestational diabetes compared with healthy women. The reference values may have a role in assessing the influence of maternal metabolic control on fetal state. Copyright © 2003 ISUOG. Published by John Wiley & Sons, Ltd.
Sonographic assessment of the cervix before, during and after a uterine contraction is effective in predicting the course of labor
Authors: Saito M. , Kozuma S. , Kikuchi A. , Sakai M. , Fujii T. , Unno N. , Okai T. , Taketani Y.
Published: December 2003

Objective

To investigate whether the degree of change in cervical length during a uterine contraction is predictive of subsequent progression of labor.

Methods

The subjects were 73 uncomplicated parturient women at term. We observed the cervix before, during and after a uterine contraction by transvaginal ultrasound in the first stage of labor and determined the degree of cervical shortening during the contraction relative to the cervical length before contraction. We related the degree of cervical shortening to labor patterns at the time of the ultrasound examination, which were retrospectively determined by reviewing the partogram.

Results

The cervix was shortened in length by about 50% on average during a uterine contraction in the normal course of labor. The degree of cervical shortening was significantly greater in the normal latent and active phases than it was in the prolonged latent phase, protracted active phase and false labor, whereas there were no differences between the former two phases nor between the latter three phases. Nulliparous and parous women exhibited almost the same degree of shortening in the normal latent and active phases.

Conclusions

Real‐time ultrasound observation of the cervix during uterine contraction could help differentiate inefficient uterine contractions from normal ones and thus predict the subsequent course of labor. Copyright © 2003 ISUOG. Published by John Wiley & Sons, Ltd.
Assessment of para‐aortic lymph nodes by intraoperative sonography in gynecological malignancies: a preliminary report
Authors: Ryo E. , Nagasaka T. , Yasugi T. , Kozuma S. , Taketani Y.
Published: December 2003

Objective

To investigate the usefulness of intraoperative sonography for the assessment of para‐aortic lymph nodes in gynecological malignancies.

Methods

The assessment of para‐aortic lymph node swelling by computed tomography (CT), palpation during surgery and intraoperative sonography was performed in 43 women with a gynecological malignancy. The sensitivity, specificity and predictive values of each technique for assessment of node metastasis were examined in the 33 women who underwent para‐aortic lymphadenectomy. For each of the three assessment techniques, the number of para‐aortic lymphadenectomies that would have been performed and the number of women who would have had missed metastasis were evaluated assuming a para‐aortic lymphadenectomy would be performed only when swollen nodes were detected.

Results

Para‐aortic nodes were assessed to be swollen by CT, palpation, and intraoperative sonography, respectively, in one, six and 10 of 43 women in total, and in one, six and nine of the 33 women who underwent para‐aortic lymphadenectomy. The sensitivity and negative predictive value of intraoperative sonography were 100%, while the specificity and positive predictive value of CT were 100%. If para‐aortic lymphadenectomy had been performed only when swollen nodes were detected by intraoperative sonography, the number performed would have decreased from 33 to nine without missing lymph‐node metastasis.

Conclusion

Intraoperative sonography has potential for the assessment of para‐aortic lymph nodes in gynecological malignancies. Copyright © 2003 ISUOG. Published by John Wiley & Sons, Ltd.
Design and methodology of the COACH study: a multicenter randomised Coordinating study evaluating Outcomes of Advising and Counselling in Heart failure
Authors: Jaarsma Tiny , van der Wal Martje H.L. , Hogenhuis Jochem , Lesman Ivonne , Luttik Marie‐Louise A. , Veeger Nic J.G.M. , van Veldhuisen Dirk J.
Published: December 2003

Background:

While there are data to support the use of comprehensive non‐pharmacological intervention programs in patients with heart failure (HF), other studies have not confirmed these positive findings. Substantial differences in the type and intensity of disease management programs make it impossible to draw definitive conclusions about the effectiveness, optimal timing and frequency of interventions.

Aims:

1. To determine the effectiveness of two interventions (basic support vs. intensive support) compared to ‘care as usual’ in HF patients, on time to first major event (HF readmission or death), quality of life and costs. 2. To investigate the role of underlying mechanisms (knowledge, beliefs, self‐care behaviour, compliance) on the effectiveness of the two interventions.

Methods:

This is a randomised controlled trial in which 1050 patients with heart failure will be randomised into three treatment arms: care as usual, basic education and support or intensive education and support. Outcomes of this study are; time to first major event (HF hospitalisation or death), quality of life (Minnesota Living with HF Questionnaire, RAND36 and Ladder of Life) and costs. Data will be collected during initial admission and then 1, 6, 12, and 18 months after discharge. In addition, data on knowledge, beliefs, self‐care behaviour and compliance will be collected.

Results:

The study started in January 2002 and results are expected at the end of 2005.

Conclusions:

This study will help health care providers in future to make rational and informed choices about which components of a HF management program should be expanded and which components can possibly be deleted.
Suppression of cytokines and nitric oxide production, and protection against lethal endotoxemia and viral myocarditis by a new NF‐κB inhibitor
Authors: Matsumori Akira , Nunokawa Youichi , Yamaki Akira , Yamamoto Kanjo , Hwang Myung‐Woo , Miyamoto Tadashi , Hara Masatake , Nishio Ryosuke , Kitaura‐Inenaga Katsura , Ono Koh
Published: December 2003

Background:

Nuclear factor kappa B (NF‐κB) is activated by several factors, which increase the inflammatory response, and this activation, in turn, leads to the expression of several genes such as cytokines, and may play an important role in cardiovascular diseases.

Aims:

The aim of the study is to examine the effect of SUN C8079, a newly synthesized NF‐κB inhibitor in vitro and in vivo.

Methods:

We examined the effects of SUN C8079 on the transcriptional responses of NF‐κB, on activation of NF‐κB in electrophoretic mobility shift assay, and on the gene expressions of tumor necrosis factor (TNF)‐α and iNOS. We also studied effects of SUN C8079 on lethal endotoxemia and viral myocarditis in mice.

Results:

SUN C8079 inhibited the lipopolysaccharide (LPS)‐induced expression of the genes of TNF‐α and iNOS by inhibiting the activation of NF‐κB in vitro. SUN C8079 inhibited the systemic release of TNF‐α and improved mortality in LPS‐treated mice. In addition to protecting mice against lethal endotoxemia, SUN C8079 prevented the development of myocarditis due to the encephalomyocarditis virus (EMCV), and inhibited the expressions of proinflammatory cytokines and the iNOS gene in cardiac tissues.

Conclusion:

These findings suggest that the activation of NF‐κB plays an important role in the pathogenesis of endotoxemia and viral myocarditis, and that the NF‐κB inhibitor, SUN C8079, may be therapeutic in these disorders.
Screening for cervical cancer in developing countries
Authors: Cronjé H.S.
Published: December 2003

Cervical cancer is the most common malignancy amongst females in developing countries, mainly due to a lack of precursor screening. This absence of screening is the result of inherent disadvantages of the Pap smear: high cost, low sensitivity, the need for a laboratory with high human expertise and a complex screening program logistic system. The prerequisites for screening in a developing country include a screening method that is affordable, which can be effectively applied once in a lifetime at the age of 30–35 years, provide an immediate result and thereby allowing for on‐site treatment of positive cases. None of the current screening methods comply with these prerequisites. More research is necessary into different combinations of tests, which improve sensitivity. On‐site human papillomavirus (HPV) identification, alone or in combination with other tests, is promising. Another promising development is immunization against HPV infection, either as a preventative measure or for stimulating immunity in infected women.
The Nurse’s Role in the Assessment and Treatment of Bipolar Disorder
Authors: Tugrul Karen
Published: December 2003

The prevalence of bipolar disorder is underestimated, and the condition is often misdiagnosed as depression. Because bipolar disorder does not appear to respond to standard treatments for depression, misdiagnosed patients may suffer increased morbidity and mortality. Nurses have the ability to significantly impact the successful care of these patients by recognizing and assessing bipolar disorder, managing treatment with appropriate mood stabilizers and therapies, and educating patients and their families. Bipolar disorder diagnosis, the consequences of misdiagnosis and mismanagement, lifestyle factors that may increase the risk for episode recurrence, and useful interventions are discussed.
Surgical management of acute ear canal separation in a cat
Authors: Clarke S.P.
Published: December 2003

A 5-year-old cat presented with haemorrhagic left aural discharge, 2 days following a road traffic accident. Otoscopic examination identified disruption of the external ear canal at the auricular/annular cartilage junction. This was managed by total ear canal ablation and lateral bulla osteotomy. Left sided facial nerve deficits were present following surgery. Eighteen months postoperatively there were no auricular problems, however facial nerve deficits persisted.

There are no previous reports describing management of acute separation at the auricular/annular cartilage junction of the external ear in the cat or dog. This case report describes the presentation, diagnosis and surgical management of an acute ear canal separation at the auricular/annular junction of the external ear canal in a cat.
From supply chain to demand chain: the role of lead time reduction in improving demand chain performance
Authors: de Treville Suzanne , Shapiro Roy D , Hameri Ari‐Pekka
Published: December 2003

To improve demand chain performance, is it better for parties in a supply chain to focus first on lead time reduction, or instead concentrate on improving the transfer of demand information upstream in the chain? Even though the theory of supply and demand chain management suggests that lead time reduction is an antecedent to the use of market mediation (i.e., adjusting production to fit actual customer demand as it materializes) [Harvard Business Rev. 75 (2) (1997) 105] to reduce transaction uncertainty in the chain, which can be conceptualized as the primary goal of supply chain management [J. Operat. Manage. 11 (3) (1993) 289], demand chain parties often are observed in practice to begin with information transfer improvement, ignoring the problem of long lead times. In this paper, we propose a framework for prioritizing lead time reduction in a demand chain improvement project, using a typology of demand chains to identify and recommend trajectories to achieve desirable levels of market mediation performance.
The deployment of temporary production workers in assembly operations: a case study of the hidden costs of learning and forgetting
Authors: Stratman Jeff K. , Roth Aleda V. , Gilland Wendell G.
Published: December 2003

The dynamics of workforce skill levels has a considerable impact on plant‐level performance that is commonly overlooked by managers of manufacturing operations. In this study, we present a discrete event simulation model inspired by and validated in an actual manufacturing setting that includes short product life cycles, mid‐volume production quantities, and a production environment consisting of assembly, inspection and testing.

The effect of worker skill dynamics is analyzed using a factorial experimental design that contrasts the use of temporary versus permanent workers on manufacturing cost performance. The manufacturing costs assessed include labor, inspection and testing. The cost of reworking a defect is captured as an increase in the labor consumption. Materials costs are not assessed. At the core of the analysis, it is assumed that temporary workers have relatively less skill and therefore have higher average production times, higher average defect rates associated with their assembly activity, and lower rates of learning. In addition, the variance of the production time is higher for the temporary workers. Despite these indicators of performance problems, temporary workers may be used because of the considerably lower wage rate compared to permanent employees.

Our in‐depth case analyses shows that assigning skilled permanent workers to upstream build operations was superior to other policies deploying temporary workers, regardless of lot size or product complexity. Attesting to the importance of the labor mix component of manufacturing strategy, workforce deployment policies tended to dominate product switching frequency (a proxy variable for lot size and product mix) in impacting costs.
Bone marrow‐derived cells contribute to lung regeneration after elastase‐induced pulmonary emphysema
Authors: Ishizawa Kota , Kubo Hiroshi , Yamada Mitsuhiro , Kobayashi Seiichi , Numasaki Muneo , Ueda Shinsaku , Suzuki Takashi , Sasaki Hidetada
Published: December 2003

All‐trans retinoic acid (ATRA) is known to reverse the anatomic and physiologic signs of pulmonary emphysema. However, the origin of the progenitor cells involved in this lung regeneration remains unclear. Recently, it was shown that bone marrow could be the source of progenitor cells for several cell types. Mice with elastase‐induced emphysema were treated with ATRA, granulocyte colony‐stimulating factor (G‐CSF), or a combination of both. ATRA or G‐CSF promoted lung regeneration and increased bone marrow‐derived cell (BMC) numbers in alveoli. Combined treatment of both had an additive effect, which indicated that BMC mobilization might be important in lung regeneration.
Role of the PLA2‐independent peroxiredoxin VI activity in the survival of immortalized fibroblasts exposed to cytotoxic oxidative stress
Authors: Salmon Michel , Dedessus Le Moutier Jérémie , Wenders Frédéric , Chiarizia Sophie , Eliaers François , Remacle José , Royer Véronique , Pascal Thierry , Toussaint Olivier
Published: December 2003

Peroxiredoxin VI (PrxVI) is a bifunctional enzyme with non‐selenium glutathione peroxidase and Ca2+‐independent acidic phospholipase A2 activities. We demonstrate that transfection‐mediated PrxVI overexpression protects immortalized human WI‐38 and murine NIH3T3 fibroblasts against cytotoxic doses of tert‐butylhydroperoxide and H2O2. Mutants for either glutathione peroxidase or phospholipase A2 activity show that glutathione peroxidase but not phospholipase A2 activity is required to promote cell survival after stress. Also, ectopic PrxVI overexpression does not protect telomerase‐stabilized WI‐38 fibroblasts against stress‐induced premature senescence.
Bacillus subtilis YxaG is a novel Fe‐containing quercetin 2,3‐dioxygenase
Authors: Bowater Laura , Fairhurst Shirley A , Just Victoria J , Bornemann Stephen
Published: December 2003

The Bacillus subtilis genome contains genes for three hypothetical proteins belonging to the bicupin family, two of which we have previously shown to be Mn(II)‐dependent oxalate decarboxylases. We have now shown that the third, YxaG, exhibits quercetin 2,3‐dioxygenase activity and that it contains Fe ions. This contrasts with the eukaryotic enzyme which contains a Cu ion. YxaG is the first prokaryotic carbon monoxide‐forming enzyme that utilises a flavonol to be characterised and is only the second example of a prokaryotic dioxygenolytic carbon monoxide‐forming enzyme known to contain a cofactor. It is proposed to rename the B. subtilis gene qdoI.
β1,3‐N‐Acetylglucosaminyltransferase‐7 (β3Gn‐T7) acts efficiently on keratan sulfate‐related glycans
Authors: Seko Akira , Yamashita Katsuko
Published: December 2003

β1,3‐N‐Acetylglucosaminyltransferase‐7 (β3Gn‐T7) has been identified as an anti‐migration factor for a lung cancer cell line but its enzymatic activity has not yet been characterized. Here we show that β3Gn‐T7 efficiently acts on keratan sulfate‐related glycans including Galβ1→4(SO3
−→6)GlcNAcβ1→3Galβ1→4(SO3
−→6)GlcNAc (L2L2), while lacto‐N‐tetraose and lacto‐N‐neo‐tetraose were poor substrates. Moreover, we found that among the other five β3Gn‐Ts and i antigen‐producing β3Gn‐T (iGn‐T), β3Gn‐T2 and iGn‐T act well on L2L2, although these specific activities were lower than those for a tetraantennary N‐glycan. These results indicate that β3Gn‐T7 is the one that most efficiently elongates L2L2 and may be involved in the biosynthesis of keratan sulfate.
Structural characteristics and refolding of in vivo aggregated hyperthermophilic archaeon proteins
Authors: Umetsu Mitsuo , Tsumoto Kouhei , Ashish Kumar , Nitta Shigeki , Tanaka Yoshikazu , Adschiri Tadafumi , Kumagai Izumi
Published: December 2003

Several recombinant proteins in inclusion bodies expressed in Escherichia coli have been measured by Fourier transform infrared and solid‐state nuclear magnetic resonance spectra to provide the secondary structural characteristics of the proteins from hyperthermophilic archaeon Pyrococcus horikoshii OT3 (hyperthermophilic proteins) in inclusion bodies. The β‐strand‐rich single chain Fv fragment (scFv) and α‐helix‐rich interleukin (IL)‐4 lost part of the native‐like secondary structure in inclusion bodies, while the inclusion bodies composed of the hyperthermophilic proteins of which the native form is α‐helix rich, are predominated by α‐helix structure. Further, the secondary structure of the recombinant proteins solubilized from inclusion bodies by detergent or denaturant was observed by circular dichroism (CD) spectra. The solubilization induced the denaturation of the secondary structure for scFv and IL‐4, whereas the solubilized hyperthermophilic proteins have retained the α‐helix structure with the CD properties resembling those of their native forms. This indicates that the hyperthermophilic proteins form native‐like secondary structure in inclusion bodies. Refolding of several hyperthermophilic proteins from in vivo aggregated form without complete denaturation could be accomplished by solubilization with lower concentration (e.g. 2 M) of guanidine hydrochloride and removal of the denaturant via stepwise dialysis. This supports the existence of proteins with native‐like structure in inclusion bodies and suggests that non‐native association between the secondary structure elements leads to in vivo aggregation. We propose a refolding procedure on the basis of the structural properties of the aggregated archaeon proteins.
Oxidative refolding of lysozyme in trifluoroethanol (TFE) and ethylene glycol: interfering role of preexisting α‐helical structure and intermolecular hydrophobic interactions
Authors: Prabha C.Ratna , Mohan Rao Ch.
Published: December 2003

The oxidative refolding of equilibrium intermediates of lysozyme stabilized in trifluoroethanol (TFE) and ethylene glycol was monitored. Equilibrium intermediates of disulfide reduced lysozyme in TFE are known to contain considerable amounts of α‐helical structure and resemble the early intermediate in the oxidative refolding of lysozyme. We find that the intermediates in TFE do not proceed to folding; they form aggregates. However, interestingly, intermediates in ethylene glycol refold to the native state with improved folding yield. Secondary structure of these intermediates was monitored by far‐UV circular dichroism. Our results indicate that formation of α‐helical structure prior to oxidative refolding does not help the process in the case of lysozyme. Interfering with intermolecular hydrophobic interactions in the unfolded state is more productive.