bluuebunny/crossref_metadata_2025 huggingface dataset:
Increased expression of integrin α3β1 in highly brain metastatic subclone of a human non‐small cell lung cancer cell line
Authors: Yoshimasu Tatsuya , Sakurai Teruhisa , Oura Shoji , Hirai Issei , Tanino Hirokazu , Kokawa Yozo , Naito Yasuaki , Okamura Yoshitaka , Ota Ichiro , Tani Naoyuki , Matsuura Nariaki
Published: August 2005

To clarify the roles of integrin and extracellular matrix (ECM) in the process of non‐small cell lung cancer (NSCLC) brain metastasis, we established an in vivo model of brain metastasis of human NSCLC cell line EBC‐1/original in athymic mice, and established highly brain metastatic subclone EBC‐1/brain and highly bone metastatic subclone EBC‐1/bone. Integrin expression of these subclones was evaluated by flow cytometry. In vitro cell attachment, migration and proliferation assays with ECMs were performed using these subclones. Expression of integrin α3 subunit was higher in EBC‐1/brain than in both EBC‐1/original and EBC‐1/bone. In vitro cell attachment, migration, and proliferation assays revealed that EBC‐1/brain had higher affinity and higher reactivity to laminin than EBC‐1/original and EBC‐1/bone. Blocking of integrin α3β1 significantly (P<0.05) decreased brain metastasis by EBC‐1/brain. Interaction of integrin α3β1 and laminin plays important roles in the process of brain metastasis of non‐small cell lung cancer.
Lack of modifying effects of 4‐tert‐octylphenol and benzyl butyl phthalate on 3, 2′‐dimethyl‐4‐aminobiphenyl‐induced prostate carcinogenesis in rats
Authors: Kohno Hiroyuki , Suzuki Rikako , Sugie Shigeyuki , Tsuda Hiroyuki , Tanaka Takuji
Published: August 2005

The modifying effects of dietary feeding of two estrogenic compounds, 4‐tert‐octylphenol (tOP) and benzyl butyl phthalate (BBP), on 3, 2′‐dimethyl‐4‐aminobiphenol (DMAB)‐induced prostatic carcinogenesis were investigated in male F344 rats. We also assessed the effects of the test compounds on the proliferating cell nuclear antigen (PCNA) index in induced neoplasms, prostatic intra‐epithelial neoplasm (PIN), and non‐lesional glands in the prostate. To induce prostatic neoplasms, rats were given subcutaneous injections of DMAB (25 mg/kg body weight) every other week, 10 times in total. They also received the experimental diet containing 10 or 100 ppm tOP and BBP for 40 weeks, starting 1 week after the last dosing of DMAB. DMAB exposure produced prostatic adenocarcinoma with an incidence of 41.2% at the end of the study (week 60). Dietary administration of tOP and BBP did not affect the incidence of prostatic adenocarcinoma: 43.8% in the DMAB→10 ppm tOP group; 25.0% in the DMAB→100 ppm tOP group; 43.8% in the DMAB→10 ppm BBP group; and 43.8% in the DMAB→100 ppm BBP group. The PCNA indices in adenocarcinomas, PIN, and non‐lesional glands in rats treated with DMAB and tOP or BBP were slightly lower than that of the DMAB alone group, but the differences were not statistically significant. These results might suggest that dietary feeding of the estrogenic compounds tOP and BBP did not modulate DMAB‐induced prostatic carcinogenesis in rats.
A novel DNA topoisomerase inhibitor: dehydroebriconic acid, one of the lanostane‐type triterpene acids from Poria cocos
Authors: Mizushina Yoshiyuki , Akihisa Toshihiro , Ukiya Motohiko , Murakami Chikako , Kuriyama Isoko , Xu Xianai , Yoshida Hiromi , Sakaguchi Kengo
Published: August 2005

Traditional Chinese medicinal plants are a treasure house for screening novel inhibitors of DNA polymerases and DNA topoisomerases from mammals; in the present study, nine lanostanetype triterpene acids were found in sclerotium of Poria cocos. Among the nine compounds, only dehydroebriconic acid could potently inhibit DNA topoisomerase II (topo II) activity (IC50=4.6 μM), while the compound moderately inhibited the activities of DNA polymerases α, β, γ, δ, ɛ, η, iota;, κ and λ only from mammals, to similar extents. Another compound, dehydrotrametenonic acid, also showed moderate inhibitory effects against topo II (IC50=37.5 μM) and weak effects against all the polymerases tested. Both compounds showed no inhibitory effect against topo I, higher plant (cauliflower) DNA polymerase I (α‐like polymerase) or II (βlike polymerase), calf thymus terminal deoxynucleotidyl transferase, human immunodeficiency virus type‐1 reverse transcriptase, prokaryotic DNA polymerases such as the Klenow fragment of E. coli DNA polymerase I, Taq DNA polymerase and T4 DNA polymerase, or DNA metabolic enzymes such as T7 RNA polymerase, T4 polynucleotide kinase and bovine deoxyribonu‐clease I. These findings suggest that dehydroebriconic acid and dehydrotrametenonic acid should be designated as topo II‐preferential inhibitors, although they also moderately inhibited all the mammalian DNA polymerases tested. Both dehydrotrametenonic acid and dehydroebriconic acid could prevent the growth of human gastric cancer cells, and their LD50 values were 63.6 and 38.4 μM, respectively. The cells were halted at the G1 phase in the cell cycle. The relation between the structure of triterpene acids and their inhibitory activities is discussed.
Does spatial pattern matter to ecosystem functioning? Insights from biological soil crusts
Authors: MAESTRE F. T. , ESCUDERO A. , MARTINEZ I. , GUERRERO C. , RUBIO A.
Published: August 2005

Theoretical and modelling studies highlight the importance of the spatial patterns of organisms for ecosystem functioning, stability and dynamics. However, there is little empirical evidence as to their importance as drivers of such ecosystem attributes.

We evaluated the relationships between different biological soil crust attributes (spatial pattern, cover and diversity) and ecosystem functioning in two semiarid areas differing in the developmental stage of these crusts.

We found a significant direct relationship between spatial pattern and both soil bulk density and respiration (surrogates of ecosystem infiltration and nutrient cycling, respectively) at one of our study sites. However, the strength of such a relationship was lower than that found between attributes such as cover and evenness and the same ecosystem functioning surrogates.

Our results represent, to our knowledge, some of the first empirical evidence linking the spatial pattern of a community and ecosystem functioning. They also suggest that the importance of spatial pattern as a driver of ecosystem functioning may depend on community attributes such as cover and diversity, and that its importance may be lower than that of these attributes.
Climate‐ and crop‐responsive emission factors significantly alter estimates of current and future nitrous oxide emissions from fertilizer use
Authors: Flynn Helen C. , Smith Jo , Smith Keith A. , Wright Jim , Smith Pete , Massheder Jon
Published: August 2005

The current Intergovernmental Panel on Climate Change (IPCC) default methodology (tier 1) for calculating nitrous oxide (N2O) emissions from nitrogen applied to agricultural soils takes no account of either crop type or climatic conditions. As a result, the methodology omits factors that are crucial in determining current emissions, and has no mechanism to assess the potential impact of future climate and land‐use change. Scotland is used as a case study to illustrate the development of a new methodology, which retains the simple structure of the IPCC tier 1 methodology, but incorporates crop‐ and climate‐dependent emission factors (EFs). It also includes a factor to account for the effect of soil compaction because of trampling by grazing animals. These factors are based on recent field studies in Scotland and elsewhere in the UK. Under current conditions, the new methodology produces significantly higher estimates of annual N2O emissions than the IPCC default methodology, almost entirely because of the increased contribution of grazed pasture. Total emissions from applied fertilizer and N deposited by grazing animals are estimated at 10 662 t N2O‐N yr−1 using the newly derived EFs, as opposed to 6 796 t N2O‐N yr−1 using the IPCC default EFs. On a spatial basis, emission levels are closer to those calculated using field observations and detailed soil modelling than to estimates made using the IPCC default methodology. This can be illustrated by parts of the western Ayrshire basin, which have previously been calculated to emit 8–9 kg N2O‐N ha−1 yr−1 and are estimated here as 6.25–8.75 kg N2O‐N ha−1 yr−1, while the IPCC default methodology gives a maximum emission level of only 3.75 kg N2O‐N ha−1 yr−1 for the whole area. The new methodology is also applied in conjunction with scenarios for future climate‐ and land‐use patterns, to assess how these emissions may change in the future. The results suggest that by 2080, Scottish N2O emissions may increase by up to 14%, depending on the climate scenario, if fertilizer and land management practices remain unchanged. Reductions in agricultural land use, however, have the potential to mitigate these increases and, depending on the replacement land use, may even reduce emissions to below current levels.
Characterizing interannual variations in global fire calendar using data from Earth observing satellites
Authors: Carmona‐Moreno César , Belward Alan , Malingreau Jean‐Paul , Hartley Andrew , Garcia‐Alegre Maria , Antonovskiy Mikhail , Buchshtaber Victor , Pivovarov Victor
Published: August 2005

Daily global observations from the Advanced Very High‐Resolution Radiometers on the series of meteorological satellites operated by the National Oceanic and Atmospheric Administration between 1982 and 1999 were used to generate a new weekly global burnt surface product at a resolution of 8 km. Comparison with independently available information on fire locations and timing suggest that while the time‐series cannot yet be used to make accurate and quantitative estimates of global burnt area it does provide a reliable estimate of changes in location and season of burning on the global scale. This time‐series was used to characterize fire activity in both northern and southern hemispheres on the basis of average seasonal cycle and interannual variability. Fire seasonality and fire distribution data sets have been combined to provide gridded maps at 0.5° resolution documenting the probability of fire occurring in any given season for any location. A multiannual variogram constructed from 17 years of observations shows good agreement between the spatial–temporal behavior in fire activity and the ‘El Niño’ Southern Oscillation events, showing highly likely connections between both phenomena.
Alfred Russel Wallace, past and future
Authors: Smith Charles H.
Published: August 2005

The naturalist Alfred Russel Wallace (1823–1913) has for many years been standing in the shadow of his more famed co‐discoverer of the principle of natural selection, Charles Darwin. Despite outward similarities between the two men's formulation of the principle, Wallace had fit his appreciation of natural selection into views on evolution that were quite different from Darwin's. A closer examination of what Wallace had in mind suggests a model of process in which natural selection per se acts as the negative feedback mechanism (actually, a ‘state‐space’) in the relation between population and environment, and environmental engagement as made possible by the resulting selection of traits acts as the positive feedback part of the cycle. Thus, it may be better to contextualize adaptive structures as entropy‐relaying biogeochemical facilitators that only ‘generate a potential for evolution’ than to portray them as the end results of evolution. This systems point of view better lends itself to appreciations of the biogeographical context of evolution than does the tree‐thinking of a more conventional style of speciation‐focused Darwinism, which sometimes confuses process with result.
Leakage of cardiac troponin I in aortic valve stenosis
Authors: KUPARI M. , ERIKSSON S. , TURTO H. , LOMMI J. , PETTERSSON K.
Published: August 2005

Objective.  Degeneration and death of cardiomyocytes contribute to the genesis of heart failure (HF) in aortic valve stenosis (AS). We studied whether the ongoing myocyte damage in AS can be detected from circulating cardiac troponin I (cTnI) concentrations.

Design and setting.  A cross‐sectional cohort study in a university hospital.

Subjects and methods.  We examined 131 adult patients undergoing echocardiography and cardiac catheterization for isolated AS. Blood was sampled from the aortic root and, in a subset of 49 patients, also from the coronary sinus for the determination of cTnI using a sensitive immunoanalysis.

Results.  Seventy‐three patients (56%) had detectable aortic cTnI (≥5 ng L−1) with 30 of them (23% of the total group) having cTnI above the reference limit in healthy subjects (>14 ng L−1). Patients with detectable cTnI had a higher prevalence of HF than those with undetectable cTnI (42% vs. 19%, P = 0.004). Plasma cTnI rose from the aorta to the coronary sinus by ≥5 ng L−1 in 13 of 49 patients with AS (27%) versus in none of 12 control patients free of structural heart disease (P = 0.044). AS patients with transcardiac cTnI gradients ≥5 ng L−1 had lower left ventricular (LV) ejection fractions than AS patients with gradients <5 ng L−1 (mean ± SD, 52 ± 14% vs. 61 ± 11%; P = 0.011).

Conclusions.  Detectable circulating cTnI is not uncommon in AS and shows a moderate association with the presence of HF. Leakage of cTnI into the coronary sinus associates with impairment of LV systolic function. Monitoring cTnI could provide a means to expose incipient clinical deterioration in AS.
A positive outcome in patient with massive acute pulmonary embolism and right atrial mobile thrombus fragmented during thrombolysis: a serial echocardiographic examination
Authors: LICHODZIEJEWSKA B. , JANKOWSKI K. , KURNICKA K. , CIURZYNSKI M. , LISZEWSKA‐PFEJFER D.
Published: August 2005

The case report presents a patient with acute, massive pulmonary embolism diagnosed by transthoracic echocardiography, with the mobile thrombus visualized in the right atrium. During the thrombolytic therapy the thrombus was fragmented and migrated to the pulmonary artery, with a rapid transient worsening of the clinical status of the patient. The continuation of thrombolysis led to the gradual improvement of the patient condition. In this case report the importance of serial echocardiographic examinations in revealing right heart masses, the right ventricle overloading and the effectiveness of treatment is shown.
Inequalities in birth outcomes in Russia: evidence from Tula oblast
Authors: Danishevski Kirill , Balabanova Dina , McKee Martin , Nolte Ellen , Schwalbe Nina , Vasilieva Natalia
Published: August 2005

This paper describes pregnancy outcomes and identifies their determinants in a Russian region, in the year 2000. It includes all births and perinatal deaths recorded as occurring in Tula oblast. The socio‐economic correlates of adverse outcomes are explored using logistic regression; outcomes and their determinants are compared with other countries. Perinatal mortality in Tula in 2000 was 16.8/1000 births. The frequencies of low birthweight, low ponderal index and preterm birth were higher in Tula than in other industrialised countries. Mean birthweight increased with increasing education and was higher in married than in single mothers, and higher in ethnic Russians than in others. Survival in the perinatal period was substantially lower at all birthweights than in Sweden, which has the lowest neonatal mortality rate in Europe. There are wide inequalities in fetal development in Russia, especially in relation to maternal education, and the adverse outcomes appear to reflect a combination of adverse fetal development (implying the need for policies that improve the health of prospective mothers) and poor survival (implying the need for more effective care for newborn infants).
Relationship of primary mitochondrial respiratory chain dysfunction to fiber type abnormalities in skeletal muscle
Authors: Enns GM , Hoppel CL , DeArmond SJ , Schelley S , Bass N , Weisiger K , Horoupian D , Packman S
Published: August 2005

Variation in the size and relative proportion of type 1 and type 2 muscle fibers can occur in a number of conditions, including structural myopathies, neuropathies, and various syndromes. In most cases, the pathogenesis of such fiber type changes is unknown and the etiology is heterogeneous. Skeletal muscle mitochondrial respiratory chain analysis was performed in 10 children aged 3 weeks to 5 years with abnormalities in muscle fiber type, size, and proportion. Five children were classified as having definite, four as probable, and one as possible mitochondrial disease. Type 1 fiber predominance was the most common histological finding (six of 10). On light microscopy, four cases had subtle concomitants of a mitochondriopathy, including mildly increased glycogen, lipid, and/or succinate dehydrogenase staining, and one case had more prominent evidence of underlying mitochondrial disease with marked subsarcolemmal staining. Most cases (nine of 10) had abnormal mitochondrial morphology on electron microscopy. All were found to have mitochondrial electron transport chain (ETC) abnormalities and met diagnostic criteria for mitochondrial disease. We did not ascertain any patients who had isolated fiber type abnormalities and normal respiratory chain analysis during the period of study. We conclude that mitochondrial ETC disorders may represent an etiology of at least a subset of muscle fiber type abnormalities. To establish an etiologic diagnosis and to determine the frequency of such changes in mitochondrial disease, we suggest analysis of ETC function in individuals with fiber type changes in skeletal muscle, even in the absence of light histological features suggestive of mitochondrial disorders.
Attention deficit hyperactivity disorder: The family and social context
Authors: Neophytou Koula , Webber Ruth
Published: August 2005

Attention deficit hyperactivity disorder (ADHD) is a common diagnosis among school‐aged children and needs to be understood within the context of cultural expectations. A qualitative study was conducted to explore the effects on mothers of boys diagnosed with ADHD. Family members were interviewed five times, at 3‐month intervals. The boys’ teachers were interviewed twice. Convenience sampling was used to choose three couples (and other family members), who had a son, aged 9, diagnosed with ADHD. This paper focuses on the results of interviews with mothers and target boys. Thematic analysis of transcribed interviews yielded several themes, including parental stress, societal expectations, parental confidence and side‐effects of medication. Mothers reported that parenting a child diagnosed with ADHD has a significant social, emotional and personal impact. Results indicate that while medication overall had positive outcomes, there were some side‐effects for the boys, including negative reactions to the ADHD diagnosis.
Radiotherapy in the management of vaginal intraepithelial neoplasia after hysterectomy
Authors: WOODMAN CIARAN B. , MOULD JOHN J. , JORDAN JOSEPH A.
Published: August 2005

Summary. Intravaginal radium was used to treat 11 patients who were found to have vaginal intraepithelial neoplasia (VAIN) following hysterectomy for cervical intraepithelial neoplasia. All were discovered by cytological follow‐up, were colposcopically assessed and diagnosis was confirmed by histological examination before treatment. Nine of 10 patients questioned continue to enjoy satisfactory sexual intercourse after treatment but 6 of 8 premenopausal patients subsequently became oestrogen deficient and required hormone replacement therapy. No other significant morbidity has been observed. All remain cytologically and colposcopically free of disease after a median follow‐up of 26 months. We conclude that radiotherapy is an effective treatment of VAIN following hysterectomy.
Gestational‐age‐dependent concentrations of polyamines, their conjugates and metabolites in urine and amniotic fluid
Authors: VAN DEN BERG GITA A. , KINGMA ANNEKE W. , VISSER GERARD H. A. , MUSKIET FRITS A. J.
Published: August 2005

Summary. The metabolism and fate of polyamines during cell proliferation, differentiation, and cell loss were investigated by measuring the concentration of polyamines, their conjugates and some of their metabolites in amniotic fluid of 24 subjects, and in urine of 85 women during pregnancy. The increase of putrescine and spermine in acid‐hydrolysed urines during pregnancy appeared to be almost completely due to increases in monoacetylated putrescine and Nl,N12 diacetylated spermine, respectively. The latter two were the quantitatively most important polyamines in amniotic fluid. In urine, monoacetylated putrescine showed the highest levels at the end of pregnancy, whereas N1,N12 diacetylated spermine reached the highest values at about 32 weeks gestation. It was impossible to establish whether extracellular monoacetylated putrescine is linked either to cell growth or cell loss. The appearance of Nl,N12 diacetylated spermine is probably due to cell loss and dependent on the degree of differentiation during fetal development. The decline and eventual disappearance of urinary Nl,N12 diacetylated spermine during the first 2 years after birth may be coherent with maturation of the FAD‐dependent polyamine oxidase activity.
Fetomaternal macrotransfusion in the Yorkshire region. 1. Prevalence and obstetric factors
Authors: LI T. C. , BROMHAM D. R. , BALMER B. M.
Published: August 2005

Summary. The prevalence of fetomaternal macrotransfusion (FMMT), defined as fetomaternal haemorrhage (FMH) ≥10 ml, was calculated in a series of 15 724 postpartum Kleihauer tests recorded in six hospitals. The mean prevalence in this retrospective survey, the largest published to date, was 0.83% (SEM 0.22) but values varied according to the technique used to quantify the volume of FMH. A number of obstetric factors that have been suggested as influencing the occurrence and extent of FMMT were examined. The frequencies of these factors in cases with FMMT were compared with those in a control group without FMMT selected from the same population. Manual removal of the placenta (P<0.0001) and fetal distress in labour (P<0.0001) occurred significantly more frequently in the case group. We are unable to confirm previous reports that other obstetric factors may influence the occurrence and extent of FMMT.
The prognostic and therapeutic value of second‐look laparotomy in advanced ovarian cancer
Authors: BERTELSEN KAMMA , HANSEN MOGENS KERN , PEDERSEN POUL HJORTKÆR , LARSEN GORM , NYLAND MOGENS , JACOBSEN MARIANNE , ANDERSEN JØRN ERIK
Published: August 2005

Summary. Of 267 patients with ovarian cancer FIGO stages III and IV, 157 underwent second‐look laparotomy after combination chemotherapy consisting of cis‐platinum and cyclophosphamide with and without doxorubicin. At second‐look operation 45% had macroscopic tumour, 15% microscopic tumour, and 40% complete pathological response. Survival 3 years after second look was: complete pathological response 74%; microscopic disease 24%; visible tumour <1 cm 28%; visible tumour >1 cm 17%; negative cytology 59%; and positive cytology 18%. Of the patients with macroscopic tumour, 29% had all visible tumour removed at second look. Three‐year survival for these patients was about 45%.
Association between hormonal and haemorheological changes during the menstrual cycle in healthy women
Authors: SOLERTE SEBASTIANO B. , FIORAVANTI MARISA , SPINILLO ARSENIO , FERRARI ETTORE , GUASCHINO SECONDO
Published: August 2005

Summary. Blood rheology was studied in 15 healthy women throughout a normal menstrual cycle. Significant increases in fibrinogen, blood and plasma viscosity, and a reduction of erythrocyte filtrability were demonstrated during the follicular and ovulatory phase in comparison with mid‐ and late luteal phase of the menstrual cycle. Positive correlations were found between oestradiol levels and the haemorheological variables. Our data suggest that ovarian hormonal activity influences haemorheology and blood flow in healthy women.
Magnesium supplementation in pregnancy. A double‐blind study
Authors: SPÄTLING LUDWIG , SPÄTLING GABRIELE
Published: August 2005

Summary. The effect of magnesium supplementation in pregnancy was studied in 568 women who were treated with 15 mmol magnesiumaspartate‐hydrochloride per day or aspartic acid as placebo given orally during pregnancy from 16 weeks. Allocation to the two groups was performed according to the women's birthdates. Magnesium supplementation during pregnancy was associated with significantly fewer maternal hospitalizations, a reduction in preterm delivery, and less frequent referral of the newborn to the neonatal intensive care unit. The results suggest that magnesium supplementation during pregnancy has a significant influence on fetal and maternal morbidity both before and after delivery.
References ranges and sources of variation for indices of pulsed Doppler flow velocity waveforms from the uteroplacental and fetal circulation
Authors: PEARCE J. M. , CAMPBELL S. , COHEN‐OVERBEEK T. , HACKETT G. , HERNANDEZ J. , ROYSTON J. P.
Published: August 2005

Summary. Variation in indices used to characterize the maximum frequency outline of waveforms obtained from the uteroplacental and fetal circulations by duplex Doppler ultrasound was studied between observers, over a 24‐h period and before and after a meal. No significant differences were found. Reference ranges were derived for three indices, the A/B ratio, the resistance index and the pulsatility index, for waveforms from the fetal descending aorta, umbilical artery, and the placental and maternal sides of the uteroplacental circulation. Indices from waveforms from the uteroplacental circulation demonstrated a fall from 16 to 24 weeks gestation with no change thereafter. The umbilical artery indices demonstrated a continuing fall with increasing gestation but the A/B ratio and resistance index from the fetal descending aorta did not change with gestation. The pulsatility index from the aorta demonstrated a gentle rise.
Helminth infestations in Asian women attending an antenatal clinic in England
Authors: CONSTANTINE G. , ARUNDELL L. , FINN K. , O'CONNOR A. , LUESLEY D. M. , LOWE P.
Published: August 2005

Summary. Asian women attending an antenatal clinic in England were studied to determine the infestation rates with intestinal helminths. An overall rate of 9% was found, rising to 18% in those women resident for less than 7 years. Indians had a carriage rate of 3%, Pakistanis 7.3% and Bangladeshis 45%. Species detected were hookworm, whipworm (Trichuris trichiura), dwarf tapeworm (Hymenolepis nana) and roundworm (Ascaris lumbricoides).
A clinical and urodynamic study comparing the Stamey bladder neck suspension and suburethral sling procedures in the treatment of genuine stress incontinence
Authors: HILTON PAUL
Published: August 2005

Summary. Twenty women with urodynamically proven genuine stress incontinence were randomly allocated to treatment by suburethral sling or Stamey endoscopic bladder neck suspension. Urodynamic assessment was performed before and 3 months after surgery; clinical follow‐up is reported up to 2 years. Blood loss was greater, and there were significantly more postoperative complications associated with the sling procedures. The subjective and objective cure rates at 3 months and 2 years were not significantly different between the two procedures. No significant changes in the resting urethral pressure profile were evident, although with both procedures, cure was associated with an enhancement in pressure transmission ratios in the proximal urethra. Detrusor instability occurring for the first time after operation was associated with both procedures; the sling, in addition, induced a significant degree of outflow obstruction, although this was not evident after the Stamey procedure.
Lipoprotein and apolipoprotein levels in postmenopausal women on continuous oestrogen/ progestogen therapy
Authors: FARISH ELIZABETH , FLETCHER COLIN D. , DAGEN MORAG M. , HART DAVID M. , AL‐AZZAWI FAROUK , PARKIN DAVID E. , HOWIE CATHERINE A.
Published: August 2005

Levels of serum lipoproteins and apolipoproteins were monitored for 48 weeks in two groups of women taking part in a doubleblind trial of continuous oestrogen/progestogen with and without oestriol. There were no differences between the effects of the two treatments on the substances measured. Triglycerides did not change and there was a transient fall in very low density lipoprotein cholesterol. Low density lipoprotein cholesterol fell over the first 24 weeks but rose thereafter to pretreatment levels. There was a decrease in high density lipoprotein (HDL) cholesterol due to a transient fall in HDL2 cholesterol and a gradual decrease in HDL3 cholesterol. Consequently, the only change in lipid levels present after 48 weeks was a decrease in HDL3 cholesterol, the clinical significance of which is uncertain. There was, however, an increase in apoprotein B levels and decreases in apoprotein AI and All levels. These alterations in apoprotein levels may be unfavourable, since apoprotein B levels have been positively correlated and apoprotein AI and All levels negatively correlated with coronary heart disease.
A longitudinal study of circulating progesterone, oestradiol, hCG and hPL during pregnancy in type 1 diabetic mothers
Authors: STEWART M. O. , WHITTAKER P. G. , LIND T. , PERSSON B. , HANSON U.
Published: August 2005

Serum progesterone, oestradiol, human chorionic gonadotrophin (hCG) and human placental lactogen (hPL) were determined serially throughout 27 pregnancies in insulin‐dependent diabetic patients from Newcastle (UK), 15 such patients from Stockholm (Sweden) and in 69 normal women having uncomplicated pregnancies. Mean progesterone, oestradiol and hCG concentrations were somewhat higher in the diabetic women during the third trimester but hPL values were not different from normal. The increased hormone concentrations did not relate to the increased birthweights or placental weights in the diabetic women. It is suggested that the usual physiological endocrine changes during normal pregnancy are relatively undisturbed by insulin‐dependent diabetes or the degree of diabetes control achieved.
Outcome of pregnancies complicated by severe hypertension and delivered before 34 weeks; stepwise logistic regression analysis of prognostic factors
Authors: DERHAM R. J. , HAWKINS D. F. , ELDER M. G. , VRIES L. S. DE , ABER V. R.
Published: August 2005

The outcome is described for 106 patients with severe hypertension in pregnancy requiring delivery between 26 and 34 weeks. Management was with methyldopa, hydralazine when required and delivery by caesarean section when indicated. Most patients were delivered for cardiotocographic fetal distress or unstable maternal blood pressure. Eighty‐five babies (80%) survived and were well at follow‐up at 1 year; the perinatal mortality was 123/1000 total births. One patient had postpartum eclampsia, one had pulmonary oedema and one had transient renal failure, but all mothers left hospital well. Stepwise logistic regression analysis showed that the primary positive factor for survival of a healthy baby was gestational age, which was strongly correlated with birthweight. The need for caesarean section as an emergency, hypotension after parenteral hydralazine, intrauterine growth retardation, and severe proteinuria were adverse factors. Intraventricular haemorrhage had a major adverse effect on neonatal survival; it was predisposed to by prolonged maternal hypertension and by low gestational age.
A comparison of three methods of assessing interobserver variation applied to measurement of the symphysis‐fundal height
Authors: BAILEY SUSAN M. , SARMANDAL PURNIMA , GRANT JOHN M.
Published: August 2005

This study assesses the inter‐observer variation of symphysis‐fundal height measurements by three methods—the coefficient of variation, the correlation coefficient and the limits of agreement. The coefficient of variation was 4% and the correlation coefficient 0·959, yet the limits of agreement were very wide. Applying these limits to centile charts of symphysis‐fundal height shows that the fundal height cannot be measured by different observers with sufficient agreement to separate small fundal heights from those which are not small, and this severely limits the usefulness of measurement of the symphysis‐fundal height as a screening test for intrauterine growth retardation. We conclude that inter‐observer variation should be assessed by the method of limits of agreement, and not by calculating the coefficient of variation or the correlation coefficient.
Maternal perception of sound‐provoked fetal movements in low‐risk pregnancies during the third trimester
Authors: NYMAN M. , WESTGREN M.
Published: August 2005

Summary. Maternal perception of fetal movements after vibroacoustic stimulation (Servox) was studied longitudinally on 456 occasions in 90 low‐risk pregnancies after 28 weeks gestation until delivery. A positive response to sound stimulation, recorded as a fetal movement by the mother, occurred on 444 (97%) occasions. Of the 12 negative responses eight occurred before 33 weeks showing a positive correlation with decreasing maturity. All the pregnancies had good outcomes. The low rate of false‐positive tests (3%) adds support to the suggestion that this rapid test could play a role in the assessment of fetal well‐being.
Plasma beta‐endorphin concentrations during suckling in lactating women
Authors: FRANCESCHINI ROBERTO , VENTURINI PIER LUIGI , CATALDI ANGELO , BARRECA TOMMASO , RAGNI NICOLA , ROLANDI ERMANNO
Published: August 2005

Summary. Beta‐endorphin appears to be involved in the hormonal response to suckling in some animals. The peripheral secretory patterns of β‐endorphin, prolactin and cortisol were investigated in serial venous blood samples taken during suckling from eight healthy women who were breast‐feeding on the third or fourth day of the puerperium. Plasma levels of prolactin and β‐endorphin increased significantly during suckling reaching a peak after 20 min, levels of cortisol remained unaffected. It is suggested that the increased β‐endorphin derives from an extra‐hypophyseal source.
The Stamey operation for correction of genuine stress incontinence in the elderly woman
Authors: PEATTIE A. B. , STANTON S. L.
Published: August 2005

Summary. Forty‐four elderly women underwent the Stamey procedure for urethral sphincter incompetence; six had coincidental detrusor instability. All had pre‐ and postoperative urodynamic assessment. At follow‐up, 15 patients continued to complain of stress incontinence and 11 of urge incontinence. Overall, 27 patients still had objective evidence of genuine stress incontinence, and 15 had evidence of detrusor instability. Although the operation has minimal operative and postoperative morbidity, we do not consider its success rate satisfactory for use in the elderly.
Effects of bilateral oophorectomy on lipoprotein metabolism
Authors: FARISH E. , FLETCHER C. D. , HART D. M. , SMITH M. L.
Published: August 2005

Summary.The effects of surgical menopause on lipoprotein levels and their dme course were studied in 31 premenopausal women who were undergoing hysterectomy and bilateral oophorectomy for non‐malignant conditions. Lipoprotein levels were measured beforc oophorectomy and afterwards at 6 and 12 weeks, then at intervals of 3 months for 18 months. Low density lipoprotein (LDL) cholesterol levels rose significantly (P<0.05) in the 6 weeks after operation from a mean of 3.57 (SD 0.66) mmol/1 to 4.21 (SD 0.84) mmol/1 with no significant changes thereafter. There were no significant changes in cholesterol in the other density fractions or in triglyceride levels. High density lipoprotein (HDL) subfractions were measured in 10 of the women to assess any change in the relative amounts of cholesterol carried on HDL2 and HDL3, since the protective effect of HDL is believed to be conferred by the HDL2 fraction only. No significant change was found in either fraction. The increase in LDL cholesterol would be expected to result in an appreciable increase in the risk of developing coronary heart disease, but cannot wholly account for the increase in cardiovascular disease associated with oophorectomy.
The availability of epidural anaesthesia and analgesia in obstetrics
Authors: HIBBARD B. M. , SCOTT D. B.
Published: August 2005

Summary. This survey analyses the provision of obstetric epidural services on national and regional bases and also by size of obstetric unit. Epidural anaesthesia and analgesia in obstetrics is not readily available to all women who wish for it, or in whom it is recommended on medical grounds, in spite of the recommendations of the Social Services Committee and other advisory bodies. Deficiencies in the provision of facilities are obvious but further analysis at a local level is required to determine the reasons and the remedies.
The relative risks of caesarean section (intrapartum and elective) and vaginal delivery: a detailed analysis to exclude the effects of medical disorders and other acute pre‐existing physiological disturbances
Authors: LILFORD R. J. , VAN COEVERDEN DE GROOT H. A. , MOORE P. J. , BINGHAM P.
Published: August 2005

Objective–To compare maternal mortalities attributable to vaginal delivery, elective caesarean section (CS) and intrapartum CS.

Design–The number of deaths associated with each method of delivery was ascertained among unselected and among low‐risk women by detailed retrospective review of the casenotes of women who died after delivery. The frequency of each method of delivery throughout the study period was ascertained from the computer database and enhanced by analysis of the case‐notes of unselected groups of women.

Setting–The Peninsula Maternity Services (Cape Town) during the years 1975–1986 inclusive. Subjects–A total of 108 maternal deaths arising from 263 075 maternities provided accurate information. The relative frequency of vaginal and abdominal delivery was determined from the computer database. The ratio of elective CS to emergency prepartum CS to intrapartum CS was obtained by review of the first 200 operations in the years 1975, 1977, 1979, 1982 and 1984.

Main outcome measures–(i) Mortality rates associated with the different methods of delivery in unselected women and in women who were healthy before surgery: (ii) mortality rates apparently attributable to the method of delivery.

Results–The overall relative risk of mortality associated with caesarean section compared with vaginal delivery was 7 decreasing to 5 after the exclusion of women with medical or lifethreatening antenatal complications (eg, haemorrhage, hypertension). The relative risk associated with intrapartum compared with elective sections was 2.3 decreasing to 1.4 after the exclusion of women with medical disorders or life‐threatening complications. The relative risk of maternal mortality which was apparently attributable to intrapartum compared with elective sections was 1 .7. However, the 95% confidence intervals of these values, even from this large data‐set, are wide. Nevertheless, these rates arc in broad agreement with an approximation derived from the British confidential enquiries into maternal deaths.

Conclusion–The attributable relative mortalities of caesarean section compared with vaginal delivery and of intrapartum compared with elective caesarean section are lower than the overall relative mortalities of these modes of delivery and are approximately 5:1 and 1.5:1 respectively. These data are crucially important in the decision to recommend elective caesarean section compared with trial of labour.
Hormone implants and tachyphylaxis
Authors: GARNETT T. , STUDD J. W. W. , HENDERSON A. , WATSON N. , SAVVAS M. , LEATHER A.
Published: August 2005

Summary. The serum oestradiol levels of 1388 women treated with hormone implants at a menopause clinic were reviewed in 1988. Thirty eight (3%) were found to be above 1750 pmol/1. Of these 38 women with supra physiological oestradiol levels 23 had started therapy for menopausal symptoms and 15 for the premenstrual syndrome (PMS). Of the 23 women treated for menopausal symptoms 11 had a history of psychiatric referral for depression and nine had undergone a surgical menopause. Nine of the 15 women with PMS had a history of psychiatric referral for depressive symptoms. We conclude that the women who attain supraphysiological levels of oestradiol on implant therapy have a high frequency of psychopathology or surgical menopause and may require higher oestradiol levels for adequate control of symptoms.
The effect of established and gestational diabetes on pregnancy outcome
Authors: JOHNSTONE FRANK D. , NASRAT AMR A. , PRESCOTT ROBIN J.
Published: August 2005

Objective–To study thc prevalence and type of glucose intolerance in pregnancy and the effect of different types on perinatal mortality and fetal size.

Design–A prospective case‐control study with data collectcd by patient interview and examination of all available records during a 16‐months period between 1984 and 1986. Setting–A large maternily hospital in Kuwait where diabetes in pregnancy is common. Subjects–Thc cases were a consecutivc sample of 731 women, delivered during thc study period, recorded in the labour ward register as being diabetic or having abnormal glucosc tolerance, thc control group was formed from the next woman in the regisler (provided she was not known to be diabetic).

Main outcome measures–Type of diabetes followed the WHO classification, with subdivision depending on level of fasting plasma glucose. Type of perinatal death was examined in detail and birthweight ccntilc calculatcd.

Results–Of the 731 cases, 22% were established diabeties, most werc treated with oral hypoglycacmic drugs bcfore pregnancy and insulin during pregnancy. Of those discovered during pregnancy, 43% were classified as gestational diabetes and the remainder as impaired glucose tolerance. Overall, 50% of cases were treated with insulin. Established diabeties had a perinatal mortality rate nearly four timcs greater than non diabeties (RR, 3.7, 95% CI 2.6 to 6.4) and for gestalional diabeties RR was 2.0 95% CI l.2 to 3.7). Unexplained deaths were particularly common, both in established diabeties (RR, 18.4, 95% CI 3.9 to 85.7) and in gestational diabeties (RR, 13.4, 95% (CI 2.9 to 61.6). Cases with impaired glucose tolerance had no stillbirths and had a lower perinatal loss than the controls, though this was not statistically significant. Heavier babies were seen in all case groups compared with controls, though the impaired glucose tolerance group had lower birthweights than the other two case groups.

Conclusions–Type 2 diabetes was found to be common, most cascs being diagnosed in pregnancy. Under the conditions found in Kuwait. diabetes, in the sense of a raised fasling glucose, is accompanicd by a high rate of perinatal loss from unexplained stillbirth. This applies whether the condition was present before pregnancy or was discovered during pregnancy. Fetal macrosomia was also common in both situations. Impaired glucose tolerance, where fasting levels remain normal, does not appear to increase fetal loss, but may be associated with fetal macrosomia. As these women age they are likely to develop overt diabetes in the non‐pregnant state, and subsequently to develop serious complications of this disease. Improving glycaemic control. both during pregnancy and subsequently, should be a priority.
Five years with continuous combined oestrogen/ progestogen therapy. Effects on calcium metabolism, lipoproteins, and bleeding pattern
Authors: CHRISTIANSEN CLAUS , RIIS BENTE JUEL
Published: August 2005

Objective–To study the effect of long‐term continuous combined oestrogen/progestogen therapy on calcium metabolism, lipoproteins, and bleeding pattern in early postmenopausal women.

Design–A prospective, open, controlled study. After initial examinations, control examinations were performed every three months for the first two years and every year for the following three (two) years, with determinations of bone mass, serum lipoproteins, and bleeding pattern.

Setting– Out‐patient research clinic at The Department of Clinical Chemistry, Glostrup Hospital, Denmark.

Participants–Eighteen healthy women between 6 months and 3 years after a natural menopause, entered in a trial of continuous long‐term hormone replacement therapy and a comparison group of 19 age‐matched untreated women.

Intervention–The treated group received 2 mg of 17β‐oestradiol combined with 1 mg of norethisterone acetate orally each day continuously for 5 years with a 3 month therapyfree interval after the first 2 years. The women were investigated before treatment, then every 3 months for the first 2 years and every year for the next 3 years for determinations of bone mass, serum lipoproteins and bleeding patterns. The comparison group was followed‐up in parallel for the first 4 years. Forearm bone mass was measured with single photon absorptiometry. Blood and urine samples were taken in the morning after an overnight fast and tobacco abstinence.

Main outcome measures–The effects of hormone therapy on bone mineral content in the forearm, on serum and urine indices of calcium metabolism, on serum levels of total, high (HDL‐C) and low (LDL‐C) density lipoprotein cholesterol, and bleeding pattern.

Results–Bone mineral content in the forearm was stable during the 5 years of treatment, whereas it declined significantly averaging 10% after 4 years in the comparison group. The biochemical estimates of bone turnover decreased to premenopausal level in the hormone group, whereas they remained at a high level in the comparison group. In the hormone group total cholesterol and LDL‐C decreased by 20% whereas HDL‐C was virtually unchanged. The treatment was associated with minor irregular bleeding in nine women during the first 6 months of treatment, after which no bleeding was experienced.

Conclusion–Continuous combined oestrogen/progestogen therapy can keep early postmenopausal women free of bleeding episodes for a period of 5 years, after the first 6 months in which spotting occurs in 25%. The therapy prevented bone loss completely. The changes in serum lipoproteins were concordant with a lipid profile associated with a decreased risk of coronary heart disease.
Carbon dioxide laser treatment for vulval papillomatosis (vulvodynia)
Authors: SHAFT M. T. , FINN C. , LUESLEY D. M. , JORDAN J. A. , ROLLASON T. P.
Published: August 2005

Summary. Genital papillomatosis accompanied by distressing vulval symptoms is often termed vulvodynia. Common presenting symptoms are vulvar burning, pruritus and dyspareunia. Sixteen patients with vulval papillomatosis (vulvodynia) have been treated by carbon dioxide laser therapy over a 4‐year period. Initial responses at 6 weeks appeared encouraging but with follow‐up it became apparent that the relapse rate was high, with a mean symptom‐free interval of 4–6 months. Of the 16 patients treated, only three remain symptom free. In view of our findings, we recommend that laser therapy should not be offered as a primary procedure, if at all, for patients with vulval papillomatosis.
The use of Histoacryl for episiotomy repair
Authors: ADONI AMIRAM , ANTEBY EYAL
Published: August 2005

Summary. Histoacryl‐tissue adhcsive (B. Braun Melsungen AG W. Germany) was used in place of skin sutures (2/0 chromic catgut, Ethicon Ltd, Edinburgh, Scotland) for episiotomy repair in a group of 20 women. This group was compared with two groups of women undergoing first and repeat episiotomy. Variables analysed included pain in the episiotomy site, pain while walking, sitting, sleeping, lying down, breast‐feeding, micturating and defaecating. The Histoacryl group was superior with regard to all the variables. This simple, new method can reduce pain and inconvenience for patients, especially following the first delivery.
Serum bile acids in normal pregnancy
Authors: CARTER JONATHAN
Published: August 2005

Summary. Serum bile acid levels were measured in a longitudinal study of 56 women throughout normal pregnancy. Postprandial levels of serum bile acids were measured at each visit. Mean serum bile acid levels increased significantly from 5.3 (2 SD 3.4) μmol/l at 16 weeks to 6.5 (2 SD 3.7) μmol/l at term (P < 0.005).