bluuebunny/crossref_metadata_2025 huggingface dataset:
Activin A, inhibin A, inhibin B and parturition: changes of maternal and cord serum levels according to the mode of delivery
Authors: Florio P. , Benedetto C. , Luisi S. , Santuz M. , Di Carlo C. , Marozio L. , Genazzani A. R. , Petraglia F.
Published: August 2005

Objective
To evaluate whether activin A, inhibin A, and inhibin B levels in maternal and umbilical artery serum change according to the mode of delivery.

Design
Maternal and cord blood specimens were collected at term after spontaneous labour and vaginal delivery, or elective caesarean section.

Setting
Universities of Pisa, Turin, Naples and Udine.

Population
Forty–two healthy pregnant women, at 39–40 weeks of gestation, divided into two subgroups: group 1 vaginal delivery (n= 21), were delivered of 10 female and 11 male infants; group 2 elective caesarean section (n= 21), were delivered of 11 female and 10 male infants.

Main outcome measures
Serum activin A, inhibin A, inhibin B concentrations in maternal and umbilical cord blood.

Results
At vaginal delivery, maternal serum inhibin A and inhibin B levels were lower and activin A levels higher than at elective caesarean section. Maternal levels of activin A, inhibin A and inhibin B were constantly higher than in umbilical arterial blood, independent of the mode of delivery. No significant difference was observed in umbilical arterial serum levels of the three proteins between the two modes of delivery. Umbilical arterial serum activin A and inhibin A concentrations did not show a significant difference between male and female infants in either vaginal or caesarean section, but male infants showed inhibin B levels significantly higher than female, independent of the mode of delivery.

Conclusions
In the presence of active labour, the human placenta secretes larger amounts of activin A and lesser amounts of inhibin A and inhibin B into the maternal circulation. Inhibin–related proteins in the fetal circulation do not show differences according to the mode of delivery, suggesting that they have a different method of production or metabolic rate compared with maternal activin and inhibins.
The possible use of colour flow Doppler in planning treatment in early invasive carcinoma of the cervix
Authors: Cheng Wen‐Fang , Wei Lin‐Hung , Su Yi‐Ning , Cheng Shao‐Pei , Chu Jan‐Show , Lee Chien‐Nan
Published: August 2005

Objective
To investigate the pathological significance of intra‐tumoural blood flow signals detected by colour Doppler ultrasound and their association with angiogenesis in cervical carcinoma.

Design
A prospective cross‐sectional study.

Setting
University hospital.

Population
One hundred and four women with Stage IB‐IIA cervical carcinoma.

Methods
All women underwent radical hysterectomy and pelvic lymph node dissection. Transvaginal colour Doppler ultrasound was performed before surgery to search for arterial blood flow signals within the tumours. Tumours with a measurable intra‐tumoural resistance index were defined as tumour with detectable blood flow and the others as tumour with undetectable blood flow. The microvessel density of the excised tumour was assessed immunohistochemically. The women's clinical and pathologic data were recorded.

Results
There were 60 tumours (58%) exhibiting detectable intra‐tumoural blood flow signals. Tumours with detectable blood flow were larger, had deeper cervical stromal invasion, a higher incidence of parametrial invasion and pelvic lymph node metastases, and a higher microvessel density, when compared with those without detectable blood flow. Cervical cancers with deep cervical stromal invasion, parametrial invasion, and pelvic lymph node metastasis had higher microvessel density than those with superficial stromal invasion, no parametrial invasion, or no lymph node metastasis. Microvessel density correlated well with lymph node metastases and parametrial invasion by multiple regression analysis, while intra‐tumoural blood signals only showed correlation with parametrial invasion. In the prediction of pelvic lymph node metastases and parametrial invasion, colour flow Doppler had a sensitivity of 0.80 and specificity of 0.48 in predicting lymph node metastases, and sensitivity of 0–91 and specificity of 0.57 in predicting parametrial invasion.

Conclusions
The characteristics of blood flow signals in cervical carcinoma detected by colour Doppler ultrasound are associated with tumour angiogenesis and could reflect the likelihood of parametrial invasion and lymph node metastases in cervical carcinoma. The intra‐tumoural blood flow signals might be used as a screening test in predicting parametrial invasion and pelvic lymph node metastases. These findings may be helpful in planning treatment for women with Stage I and II cervical carcinoma.
Cavaterm thermal balloon ablation for the treatment of menorrhagia
Authors: Hawe Jeremy A. , Phillips A. Graham , Chien Patrick F. W. , Erian John , Garry Ray
Published: August 2005

Fifty patients due to undergo endometrial ablation as a treatment of dysfunctional uterine bleeding were recruited to assess the efficacy and safety of a new thermal balloon ablation system (Cavaterm). The patients were followed up for a mean of 14 months (range 6–24): 34 (68%) have complete amen‐orrhoea, 12 (24%) only have spotting, two (4%) are eumenorrhoeic, and two (4%) have had failed treatments. There were no major complications, but two patients have required oral antibiotics for suspected endometritis. Although these preliminary results are encouraging, all patients remain under review to determine long term effect of the procedure. Further evaluation is also underway in the form of a randomised trial against endometrial laser ablation.
Intrinsic duodenal obstruction: trends in management and outcome over 45 years (1951–1995) with relevance to prenatal counselling
Authors: Murshed R. , Nicholls G. , Spitz L.
Published: August 2005

Objective
To investigate the incidence of associated anomalies and document changes and progress in the management and outcome of intrinsic duodenal obstruction (atresia or stenosis) in a large series over a long time period with a view to providing comprehensive data for prenatal counselling.

Design
A retrospective casenote review.

Setting
A quaternary referral centre for paediatxic and neonatal surgery.

Population
lbo hundred and seventy‐five infants born with duodenal obstruction between 1951 and 1995.

Methods
For analysis of management and outcome data, the series was divided into three groups, each admitted over 15 year periods: Group A, 1951–1965; Group B, 1966–1980; Group C, 1981–1995.

Main outcome measures
Primary: associated anomalies, complication rates and survival. Secondary: age at diagnosis, duration of hospital stay.

Results
There were 136 males and 139 females. Seventeen of 30 cases (57%) presenting between 1991 and 1995 were diagnosed prenatally on ultrasound scan. The median age at diagnosis for atresia was 3–5 days (Group A); 2.2 days (Group B) and 1.8 days (Group C). The median age at diagnosis for incomplete obstruction was five days. Associated anomalies included Down's syndrome (n= 82, 30%); Down's plus cardiac malformation (n= 38, 14%); isolated cardiac (n= 64, 23%); and gastrointestinal problems (n= 116, 42%). Overall complication rates fell from 51% (Group A) to 18% (Group C) and survival increased from 51% to 95%. Median hospital stay also decreased from 35 days to 18 days.

Conclusions
These data confirm a progressive improvement in the outcome of intrinsic duodenal obstruction over the past 45 years. It is important to note that they only relate to infants born with duodenal atresia and do not take into account possible ‘hidden’ mortality resulting from spontaneous abortion or termination.
Magnetocardiography in the diagnosis of fetal arrhythmia
Authors: van Leeuwen P. , Halier B. , Bader W. , Geissler J. , Trowitzsch E. , Grönemeyer D. H. W.
Published: August 2005

Objective
To examine the possible use of magnetocardiography in the diagnosis of fetal arrhythmias.

Design
Investigation of routinely examined pregnant women, as well as women referred because of arrhythmias or other reasons.

Participants
Sixty‐three women between the 13th and 42nd week of pregnancy.

Methods
Recording of 189 fetal magnetocardiograms, of which 173 traces (92%) demonstrated sufficient fetal signal strength to permit evaluation. After digital subtraction of the maternal artefact, all fetal complexes were identified and the recording was examined for arrhythmic events.

Results
Short bradycardic episodes, not associated with any pathological condition, were found in 26% of all recordings, usually in mid‐pregnancy. In 12 cases, isolated extrasystoles of no clinical importance could be identified. There were nine traces which revealed multiple arrhythmias including ventricular and supraventricular ectopic beats, bigeminy and trigeminy, sino‐atrial block and atrio‐ventricular conduction disturbances. Furthermore, two cases with tachycardia were found.

Conclusion
Magnetocardiography offers a simple noninvasive method for examination of the fetal cardiac electrophysiological signal. It may thus be useful in the identification and classification of clinically relevant arrhythmia and aid in decisions concerning treatment.
Does an inflatable obstetric belt facilitate spontaneous vaginal delivery in nulliparae with epidural analgesia?
Authors: Cox Joanne , Cotzias Christina S. , Siakpere Obukohwo , Osuagwu Fiona I. , Holmes Emma P. , Paterson‐Brown Sara
Published: August 2005

Objective
To assess whether an inflatable obstetric belt, synchronised to apply uniform fundal pressure during a uterine contraction, reduces operative delivery rates when used in the second stage of labour.

Design
Randomised controlled trial.

Methods
Five hundred nulliparae with a singleton cephalic pregnancy at term and with an epidural in labour were recruited during the first stage and randomised at full dilatation. Standard care involved one hour passive second stage and one hour active pushing after which instrumental delivery was performed if delivery was not imminent. Those randomised to the belt group, in addition to standard care, had the inflatable obstetric belt for the whole second stage of labour.

Main outcome measure
Mode of delivery.

Results
One hundred and eleven of the 260 women in the belt group (42.7%) compared with 94 of the 240 in the control group (39.2%) had a spontaneous vertex delivery (P= 0.423). The lift‐out instrumental delivery rate was similar between the two groups: 108 belts (41.5%), compared with 101 controls (42.1%) (P= 0.902), whereas rotational instrumental deliveries in the belt group were 26 belts (10%) compared with 36 controls (15%) (P= 0.09). Fifteen women (5.8%) in the belt group and nine women (34%) in the control group had a caesarean section in the second stage (P= 0.292). An intact perineum was more likely in the belt group (16.5% compared with 9–6%, P= 0.022) as was a third degree tear (6.5% compared with 0.4%, P= 0.001).

Conclusion
The inflatable obstetric belt did not significantly reduce operative delivery rates when used in this clinical setting in the second stage of labour.
Second trimester prenatal screening for Down's syndrome using alpha‐fetoprotein and free beta hCG: a seven year review
Authors: Spencer Kevin
Published: August 2005

Objective
To determine the value and impact over a seven year period of a second trimester screening programme for trisomy 21 and trisomy 18, using the two maternal serum markers alpha‐fetoprotein and free beta human chorionic gonadotrophin.

Design
Retrospective review.

Setting
A biochemical screening laboratory serving three health districts with three antenatal clinics in both teaching and nonteaching hospitals.

Population
67,904 pregnancies in women of all ages screened between 14 and 22 weeks of gestation between 1 April 1991 and 31 March 1998.

Methods
All women booked into three major antenatal clinics were offered biochemical screening. Women at increased risk of trisomy 21 or trisomy 18 (≥ 1 in 250 at term) were offered an invasive diagnostic procedure. Follow up of the outcome of all pregnancies was performed.

Main outcome measures
Detection rate for trisomy 21 and trisomy 18, false positive rates, uptake of screening, uptake of amniocentesis in women identified at increased risk, prevalence of trisomy 21 at birth, detection and false positive rates by maternal age, fetal loss rate after amniocentesis, report turn around time, and identification of other anomalies.

Results
Overall, 87% (67,904/78,501) of women underwent screening. The rate of detection of trisomy 21 was 75% (80/107; 95% CI 66 to 83) with a 5.1% false positive rate (3466/67,904; CI 4.9 to 5.3%). In women under 30 years of age the detection rate was 60% (18/30; CI 41 to 77) with a 2.6% false positive rate (956/36,371; CI 2.5 to 2.8). The rate of detection of trisomy 18 was 57% (8/14; CI 29 to 82) with a 0.7% false positive rate (475/67,904; CI 0.64 to 0.76). Uptake of amniocentesis was 83% (2912/3508). Women were 3–3 times more likely to refuse amniocentesis if the risk was close to the cutoff (1 in 250) than if the risk was ≥ 1 in 50. Fetal loss within 28 days of amniocentesis was 0.9% (25/2912). Prenatal screening identified 84 other anomalies in addition to 41 cases of impending fetal death.

Conclusion
Second trimester prenatal screening for trisomy 21 and trisomy 18 using a simple two marker approach incorporating free beta hCG can achieve high detection rates over a long period of time. Health authorities who still have not introduced trisomy 21 screening should be encouraged by what can be achieved and should consider making such screening available to all women. Established second trimester detection rates of 75% for a 5% false positive rate will be the benchmark by which first trimester screening using nuchal translucency, PAPP–A and free beta hCG will be judged.
Teenage pregnancies and risk of late fetal death and infant mortality
Authors: Olausson Petra Otterblad , Cnattingius Sven , Haglund Bengt
Published: August 2005

Objective
To estimate the effect of low maternal age on late fetal death and infant mortality and to estimate the extent of any increase in infant mortality attributable to higher rates of preterm birth among teenagers.

Design
Population‐based cohort study.

Setting
Births recorded in the nationwide Swedish Medical Birth Registry.

Population
All single births to nulliparous women aged 13–24 years (n= 320,174) during 1973–1989.

Methods
Using information recorded in the medical birth registry, linked to a national education register, the effect of low maternal age on adverse outcomes was estimated using logistic regression analysis.

Main outcome measures
Late fetal death, neonatal and postneonatal mortality and preterm birth.

Results
Compared with mothers aged 2CL24 years, adjusted risks of neonatal and postneonatal mortality were significantly increased among mothers aged 13–15 years (odds ratios = 2.7 and 2.6, respectively) and among those aged 16–17 years (odds ratios = 1.4 and 2.0, respectively), while mothers aged 18–19 years had a significant increase in risk of postneonatal mortality only (odds ratio = 1.4). Rates of very preterm birth (≤ 32 weeks), according to maternal age, were: 13–15 years, 5.9%; 16–17 years, 2.5%; 18–19 years, 1.7%; and 20–24 years, 1.1%. The high rates of very preterm birth among young teenagers almost entirely explained the increased risk of neonatal mortality in this group.

Conclusions
The increased risks of neonatal and postneonatal mortality among young teenagers may be related to biological immaturity. The increase in risk of neonatal mortality is largely explained by increased rates of very preterm birth.
Effects of tocolytic treatment with ritodrine on cardiovascular autonomic regulation
Authors: Vesalainen Risto K. , Ekholm Eeva M. K. , Jartti Thomas T. , Tahvanainen Kari U. O. , Kaila Timo J. , Erkkola Risto U.
Published: August 2005

Objective
To study the acute effects of tocolytic treatment with intravenous ritodrine on cardiovascular autonomic regulation.

Design
Validated methods to assess cardiovascular autonomic nervous function—heart rate and blood pressure variability and vagal cardiac baroreflex sensitivity—were measured before and during ritodrine infusion.

Setting
Turku University Central Hospital, Turku, Finland.

Sample
Twelve pregnant women admitted to hospital for threatened preterm labour.

Methods
Electrocardiogram and continuous noninvasive finger blood pressure signals were recorded in each woman, resting in a supine position. Autoregressive spectrum analysis was used to quantify short term heart rate and blood pressure variability. Vagal cardiac baroreflex sensitivity was measured as the bradycardia response to an intravenous bolus injection of phenylephrine.

Main outcome measures
Vagal cardiac baroreflex sensitivity and spectrum analysis indices of short term heart rate and blood pressure variability.

Results
Ritodrine significantly decreased vagal cardiac baroreflex sensitivity as well as total (0.00–0.40 Hz), low frequency (0.04–0.15 Hz) and high frequency (0.15–4.40 Hz) power bands of the heart rate variability spectrum. Ritodrine significantly increased mean heart rate and the low frequency power band of the systolic blood pressure Variability spectrum.

Conclusions
In pregnant women with threatened preterm labour intravenous administration of ritodrine decreases vagal cardiac baroreflex sensitivity and vagal modulation of heart rate, and increases sympathetically mediated blood pressure variability. Decreased baroreflex sensitivity and heart rate variability are known to be associated with a poor prognosis in some patient groups, so the effects of ritodrine tocolysis may be unfavourable in women with impaired circulatory homeostasis.
Maternal and fetal angiotensinogen gene allele sharing in pre‐eclampsia
Authors: Morgan L. , Crawshaw S. , Baker P. N. , Pipkin F. Broughton , Kalsheker N.
Published: August 2005

Objective
To compare the angiotensinogen genotypes in normotensive and pre‐eclamptic pregnancies in maternal and fetal samples.

Design
Prospective observational study.

Setting
University Hospital, Queen's Medical Centre, Nottingham.

Population
Forty‐three women with pre‐eclampsia and 84 normotensive pregnant women. Fetal samples were available for genotyping from 96% of the pregnancies.

Methods
Maternal and fetal DNA was genotyped at angiotensinogen codon 235 and at a dinucleotide repeat polymorphism in the 3′ flanking region of the gene. Angiotensinogen and renin concentrations were measured in maternal plasma by radioimmunoassay.

Results
In contrast to earlier studies, no association was demonstrated between the angiotensinogen 235 Thr variant and pre‐eclampsia. Normotensive pregnant women homozygous for this variant had significantly lower plasma angiotensinogen concentrations (median 2.2 ng AI/mL; IQR 1.8–3.0) than women homozygous for the 235 Met allele (3.6 ng AI/mL; IQR 2.5–4.1; P= 0.04). In pre‐eclamptic pregnancies, 79% (11/14) of mothers heterozygous for the dinucleotide repeat allele designated A9 transmitted this allele to the fetus, more frequently than would be expected by chance (P= 0.02). The A9 allele was associated with low plasma angiotensinogen concentrations (P= 0.001) and high renin concentrations (P= 0.02) in normotensive women.

Conclusions
There is no evidence that the angiotensinogen 235 Thr allele is associated with pre‐eclampsia in the Nottingham population. The angiotensinogen 235 Thr allele is associated with low plasma angiotensinogen concentrations in normotensive pregnant women, in contrast to the high levels associated with this variant in non‐pregnant women, suggesting that regulation of angiotensinogen expression in normal pregnancy may differ significantly from that in the non‐pregnant state. There is preliminary evidence that maternal‐fetal transmission of an angiotensinogen allele associated with low plasma angiotensinogen concentrations is associated with pre‐eclampsia. Impaired generation of angiotensin II at the maternal‐fetal interface may be a factor in the pathogenesis of pre‐eclampsia.
The reasons for termination of pregnancy in the third trimester
Authors: Dommergues Marc , Benachi Alexandra , Benifla Jean‐Louis , des Noëttes Richard , Dumez Yyves
Published: August 2005

Objective
To analyse the process in making decisions leading to termination of pregnancy in the third trimester and to evaluate the maternal morbidity associated with this procedure.

Design
Retrospective study.

Setting
The Maternité Port Royal University Hospital, Paris, France.

Population
A consecutive series of 956 terminations of pregnancy performed for fetal anomalies in singleton pregnancies, 305 of which were in the third trimester and 651 in the second.

Main outcome measures
Indications for termination of pregnancy; process leading to late termination of pregnancy; maternal morbidity.

Results
One hundred and thirteen (37%) third trimester terminations of pregnancy were associated with false negative resulted from the results of earlier screening tests. In 15 terminations (15%), the decision was postponed, although the poor fetal prognosis was established earlier. In 55 (18%) the diagnosis was not possible earlier than the third trimester, and in 122 (40%) the diagnosis was possible earlier but the poor prognosis for the fetus was not established until the third trimester. Maternal morbidity due to termination of pregnancy was similar in the second and third trimester.

Conclusion
One‐third of late terminations of pregnancy could have been avoided by more efficient screening in the second trimester. However, because fetal prognosis is not always clear when a malformation is diagnosed, postponing the decision until fetal development allows more thorough evaluation and may avoid unnecessary termination of pregnancy in the second trimester. This could be the main beneficial aspect of not setting a limit to the gestational age for performing termination of pregnancy. To analyse the process in making decisions leading to termination of pregnancy in the third trimester and to evaluate the maternal morbidity associated with this procedure. The Maternit6 Port Royal University Hospital, Paris, France.
The effect of indomethacin tocolysis in preterm labour on perinatal outcome: a randomised placebo‐controlled trial
Authors: Panter Katerine R. , Hannah Mary E. , Amankwah Kofi S. , Ohlsson Arne , Jefferies Ann L. , Farine Dan
Published: August 2005

Objective
To determine whether indomethacin tocolysis in preterm labour is associated with a better perinatal outcome than placebo.

Design
A randomised placebo‐controlled trial.

Setting
Two university teaching hospitals with level three neonatal intensive care units.

Population
Women in preterm labour with intact membranes between 23 and 30 weeks of gestation.

Methods
Random allocation to tocolysis with indomethacin (50 mg followed by 25 mg 6 hourly for 48 hours) or placebo in a double‐blind fashion.

Main outcome measures
The primary outcome, perinatal mortality or severe neonatal morbidity, was defined as perinatal death, necrotising enterocolitis, bronchopulmonary dysplasia, intraventricular haemorrhage or pen‐ventricular leucomalacia. Data were analysed using odds ratios (OR) and 95% confidence intervals (95% CI).

Results
Between March 1995 and February 1996, 34 women (39 babies) were recruited. The baseline characteristics of the two groups were similar. No patient was lost to follow up. In the indomethacin group, gestation was prolonged by > 48 hours in 13/16 (81%) of women vs 10/18 (56%) in the placebo group. The incidence of perinatal mortality or severe neonatal morbidity was not significantly different between the groups, but occurred in twice as many babies in the indomethacin group as in the placebo group d/l9 (32%) vs 3/20 (15%) OR (95% CI) 2.62 (0.44–18.8). There was one perinatal death, of a baby delivered at 24 weeks of gestation. This occurred in the indomethacin group.

Conclusion
There is no evidence that indomethacin tocolysis is beneficial, and further trials are needed to assess the impact of indomethacin tocolysis in preterm labour.
Lower urinary tract symptoms and their impact on women with anorexia nervosa
Authors: Boos Kelvin , Hextall Andrew , Cardozo Linda , Toozs‐Hobson Philip , Anders Kate , Treasure Janet
Published: August 2005

Anorexia nervosa is a condition which is associated with extremely low body weight and endocrine problems including persistent anovulation and a hypo‐oestrogenic state. As the lower urinary tract is oestrogen sensitive, it is possible that women suffering from anorexia nervosa may experience similar distressing urinary problems. Of 29 anorexic women assessed, the majority had significant irritative urinary symptoms of which frequency, urgency and nocturia were the most common. These symptoms also had an unfavorable impact on their quality of life.
Twin mothers, pregnancy hypertension and pre‐eclampsia
Authors: Thornton J. G. , Macdonald A. M.
Published: August 2005

Objective
To estimate the maternal genetic contribution to the hypertensive diseases of pregnancy.

Design
A cohort study of female twins with information on hypertensive diseases of pregnancy obtained by questionnaire screening, and verification of diagnosis from hospital or general practitioner records.

Setting
A volunteer twin registry in the UK with recruitment through the media without reference to pregnancies or disease status.

Population
Adult female, same‐sex twin pairs who completed a pregnancy history questionnaire and consented to record inspection.

Main outcome measure
Self‐reported and hospital‐validated diagnosis of non‐proteinuric pregnancy hypertension and of pregnancy hypertension with proteinuria (pre‐eclampsia).

Results
Self‐reported pre‐eclampsia had a heritability of 0.221 and non‐proteinuric hypertension of 0.198. However, none of the pairs who were self‐reported as concordant for pre‐eclampsia were confirmed from hospital records. Using hospital records, the heritability of pre‐eclampsia was 0 and 0.375 for non‐proteinuric hypertension. Using a model treating pre‐eclampsia as a separate disease from non‐proteinuric hypertension, and assuming that the next pair identified was both monozygotic and concordant for pre‐eclampsia, the estimated heritability of pre‐eclampsia remained 0 (95% CI 0–0.49). Using a threshold model in which non‐proteinuric hypertension is treated as a mild form of pre‐eclampsia, heritability is estimated at 0.247 (95% CI 0.23–4.454).

Conclusion
Neither non‐proteinuric hypertension nor pre‐eclampsia are inherited in simple Mendelian fashion. The genetic contribution to multi‐factorial inheritance is smaller than hitherto believed.
Randomised, double‐blind, placebo controlled pilot study assessing nitroglycerin as a tocolytic
Authors: Smith Graeme N. , Walker Mark C. , McGrath Michael J.
Published: August 2005

Thirty‐three women in preterm labour were randomised in a double‐blind fashion to receive either transdermal nitroglycerin (n= 17) or placebo (n= 16). Both groups had significant (P < 0.001) change in the cervix prior to randomisation. The primary outcome measure was delivery within 48 hours of randomisation. Fewer women randomised to nitroglycerin treatment (6/17) were delivered within 48 hours, compared with the placebo treatment (10/16) (RR 0.56, 95% CI 0–27 to 1.19). This pilot study lends support to two case series published that suggest that transdermal nitroglycerin may be promising as a safe, effective means for tocolysis.
Recurrent pain after hysterectomy and bilateral salpingo‐oophorectomy for endometriosis: evaluation of laparoscopic excision of residual endometriosis
Authors: Clayton R. D. , Hawe J. A. , Love J. C. , Wilkinson N. , Garry R.
Published: August 2005

Endometriosis can represent with a variety of symptoms including pelvic pain, dyspareunia and pain with defaecation, up to several years after hysterectomy and bilateral salpingo‐oophorectomy. This may occur when all endometriotic tissue is not excised at the time of the initial procedure. Although excision of endometriosis at this time would be preferable, we have found laparoscopic excision of residual endometriosis to be effective in relieving endometriosis associated pain.
Association of cerebral perfusion pressure with headache in women with pre‐eclampsia
Authors: Belfort Michael A. , Saade George R. , Grunewald Charlotta , Dildy Gary A. , Abedejos Pauline , Herd J. Allan , Nisell Henry
Published: August 2005

Objective
To study estimated cerebral perfusion pressure and its relation to headache and scotomata in women with pre‐eclampsia.

Design
Prospective, observational study.

Setting
University teaching hospitals.

Population
Seventy‐nine pre‐eclamptic women with (n= 42) and without (n= 37) headache. Patients with scotomata were also studied separately.

Methods
Transcranial Doppler ultrasound was used to estimate the resistance index, pulsatility index, and estimated cerebral perfusion pressure in the middle cerebral artery. eCPP data were plotted on the same axes as the mean (and 5th and 95th% prediction limits) eCPP data from 63 normal pregnant women followed longitudinally through pregnancy. Data outside of the 95% prediction limits were regarded as abnormal. Data from the pre‐eclamptic women were also expressed in terms of the number of standard deviations from the mean value established for normal pregnancy (multiples of the standard deviation: MOS). All studies were prior to labour, under similar conditions, and before volume expansion or treatment. Analysis of data was performed using Student's t test, Mann‐Whitney U test, ANOVA, and Fisher's exact test with two‐tailed P < 0.05, and receiver operating characteristic curve analysis with a one‐tailed P < 0.05.

Main outcome measures
Resistance index, pulsatility index, and eCPP.

Results
Pre‐eclamptic women with headache were much more likely to have abnormal eCPP (34/42; 88%) than those without headache (18/37; 49%), P= 0.004, OR 4.5 (95% CI 1.5 to 13.9). There were no differences in terms of MOS in the resistance index or pulsatility index between the two groups, but estimated perfusion pressure, expressed as multiples of the standard deviation in the group with headache, was significantly higher than in the women without. Headache was noted in both over‐perfusion and under‐perfusion states. Only women with headache had scotomata, and their presence was not related to the severity of the headache or any difference in resistance indices or eCPP.

Conclusions
Headache in women with pre‐eclampsia is strongly associated with the presence of abnormal cerebral perfusion pressure. This information may be of use in clinical management.
A feasibility study of adolescent sex education: medical students as peer educators in Edinburgh schools
Authors: Jobanputra James , Clack Alice R. , Cheeseman Giles J. , Glasier Anna , Riley Simon C.
Published: August 2005

Objectives
To determine the feasibility of medical students being involved in sex education in secondary schools, as lesson leaders in peer group discussions.

Design
1. Questionnaires and interviews to determine pupil and professional opinions about the present sex education provision and the possible involvement of medical students. 2. A pilot scheme in one school involving medical students as peer educators.

Setting
Six central Edinburgh secondary schools; local sex education services; Edinburgh University.

Sample
1. Thirty schoolteachers and 205 pupils returned questionnaires. From this, 18 teachers and 12 pupil groups (six to eight pupils each) were interviewed. 2. Pilot scheme involved three sessions with three groups of six to eight pupils per session. Twenty‐nine returns for the evaluative (pupil) questionnaire were received.

Main outcome measures
Questionnaire analysis; anecdotal evidence from interviews; evaluative questionnaire given to pupils participating in pilot study.

Results
Ninety‐four percent of teachers and 93% of pupils were in favour of medical student involvement in schools. Teachers identified large class size and lack of resources for small group work as factors limiting the effectiveness of present sex education. Pupils identified teacher embarrassment in certain issues as a barrier to communication, and 89% found communication to be easier with medical students.

Conclusions
Response to the idea of medical student involvement was very favourable from all parties involved, and a continuation of the study has been integrated as an options course into the Edinburgh University undergraduate medical curriculum.
A randomised, controlled study of uterine exteriorization and repair at caesarean section
Authors: Wahab M. A. , Karantzis P. , Eccersley P. S. , Russell I. F. , Thompson J. W. , Lindow S. W.
Published: August 2005

Objective
To determine the surgical and anaesthetic benefits and problems associated with the practice of routine exteriorisation of the uterus to facilitate repair at caesarean section.

Design
A randomised controlled study of women undergoing caesarean section. After establishment of anaesthesia, women were randomised to either exteriorisation and uterine repair or suture of the uterus in the abdomen.

Setting
A maternity hospital in the United Kingdom.

Main outcome measures
Peri‐operative haemoglobin change, duration of operation, maternal morbidity and length of hospital stay. Intra‐operative pain, nausea, vomiting, pulling or tugging sensations were secondary outcome measures.

Results
Three hundred and sixteen women were randomised, of whom 288 were subsequently analysed (139 women in whom the uterus was exteriorised and 149 where the uterus was not exteriorised). Exteriorisation of the uterus, an elective caesarean section and a spinal or general anaesthesia each had a statistically significant association with reduced blood loss (P < 0.05) There were no statistically significant differences between the two groups with regard to intra‐operative complications or pain, nor were there any statistically significant difference in post‐operative wound sepsis, pyrexia, deep vein thrombosis, blood transfusion or length of hospital stay.

Conclusion
With effective anaesthesia, exteriorisation of the uterus for repair following caesarean delivery is not associated with significant problems and is associated with less blood loss.
D‐Dimer and Inflammatory Markers as Predictors of Functional Decline in Men and Women with and without Peripheral Arterial Disease
Authors: McDermott Mary M. , Ferrucci Luigi , Liu Kiang , Criqui Michael H. , Greenland Philip , Green David , Guralnik Jack M. , Ridker Paul M. , Taylor Lloyd M. , Rifai Nader , Tian Lu , Zheng Jane , Pearce William H. , Schneider Joseph R. , Vonesh Ed
Published: August 2005

Objectives: To determine whether higher circulating levels of inflammatory and thrombotic markers are associated with greater decline in lower extremity performance.

Design: Prospective cohort.

Setting: Academic medical center.

Participants: Three hundred thirty‐seven men and women with lower extremity peripheral arterial disease (PAD) and 215 without PAD.

Measurements: Objective measures of leg function, including the 6‐minute walk and Short Physical Performance Battery (SPPB), were obtained at baseline and annually for 3 years. D‐dimer, high‐sensitivity C‐reactive protein, serum amyloid A, and fibrinogen levels were measured at baseline. Participants were categorized into one of three groups, ranging from low to high levels of inflammation, depending on the number of individual blood factors in the lowest and highest tertiles for each corresponding blood factor.

Results: Adjusting for age, sex, race, ankle brachial index, comorbidities, and other confounders, greater inflammation was associated with greater decline in the SPPB (P=.008). Results were similar when repeated in participants with and without PAD separately (P for trend=.04 for participants with PAD and .07 for participants without PAD). In fully adjusted analyses, there were no significant associations between inflammation group and decline in 6‐minute walk performance.

Conclusion: Higher baseline levels of inflammatory markers and D‐dimer were associated with greater decline in the SPPB at 3‐year follow‐up in persons with and without PAD.
Protective Influences of Families for Children Adopted From the Former Soviet Union
Authors: McGuinness Teena M. , Ryan Rebecca , Robinson Cheryl Broadus
Published: August 2005

Purpose:

To (a) characterize the total competence of 9‐ to 12‐year old children adopted from the former Soviet Union who have resided in the United States at least 5 years, and (b) evaluate risks and protective influences of adoptive families and their relationships to competence.

Design:

Longitudinal, descriptive study.

Methods:

In the previously reported phase, the families of 105 internationally adopted children and their families from 23 U.S. states were assessed via telephone interviews and postal survey. In this phase, 3.5 years later, 46 of the families from 16 states were located and reassessed. Measures included: Total Competence scale of the Child Behavior Checklist (CBCL), Family Environment Scale (FES), and demographic information. Multivariate regression analysis was conducted to determine which risk and protective factors contributed to competence scores of the adopted children.

Findings:

Between Time 1 (mean age of children, 7.7 years) and Time 2 (mean age of children, 11 years), average scores on the Total Competence scale of the CBCL did not change significantly, despite impending challenges of early adolescence. Subdomain scores on the FES were more positive than norms. Results from the regression analysis showed that, of the risk and protective factors considered, only birth weight and the cohesion subscale of the FES were statistically significant in explaining variation in the competence score of the CBCL.

Conclusions:

Families continued to face challenges, but findings were consistent with other studies showing that, despite early adversities, these adopted children generally fared well developmentally with protective family environments of major importance.
Photoluminescence of Rare‐Earth‐Doped Ca‐α‐SiAlON Phosphors: Composition and Concentration Dependence
Authors: Xie Rong‐Jun , Hirosaki Naoto , Mitomo Mamoru , Suehiro Takayuki , Xu Xin , Tanaka Hidehiko
Published: August 2005

Rare‐earth‐doped Ca‐α‐SiAlON phosphors, with the compositions of (Ca1−3/2xREx)m/2Si12−m−nAlm+nOnN16−n (RE=Ce, Sm, and Dy, 0.5≤m=2n≤3.0), were prepared by sintering at 1700°C for 2 h under 10 atm N2. The concentration of rare earths varied from 3 to 30 at.% with respect to Ca. The photoluminescence (PL) properties were investigated as functions of the composition of the host matrix (i.e., m) and the concentration of rare earths (i.e., x). The results show that the emission properties can be optimized by tailoring m and x. The Ce3+ luminescence originating from the 4f–5d interconfigurational transitions is greatly affected by the environment surrounding the Ce3+ ions, which differs from the Sm3+ or Dy3+ luminescence arising from the 4f–4f intraconfigurational transitions. X‐ray diffraction and scanning electron microscopy were used to explain the composition and concentration dependence of PL properties.
Stability of Channeled Ni–YSZ Cermets Produced from Self‐Assembled NiO–YSZ Directionally Solidified Eutectics
Authors: Laguna‐Bercero Miguel A. , Larrea Ángel , Merino Rosa I. , Peña José I. , Orera Víctor M.
Published: August 2005

Channeled yttria‐stabilized cubic phase of the zirconia (Ni–YSZ) cermets are produced by reduction of laser‐assisted directionally solidified NiO–YSZ lamellar eutectics. The material is formed by ∼400 nm wide alternating lamellae of 40% porous Ni and YSZ, which serve as parallel channels for gas flow and electronic transport and for oxygen ion diffusion. The low‐energy interfaces formed between the metallic Ni particles and the YSZ prevent particle coarsening and impart long‐term stability to the anode at operating temperatures. The electrical conductivity and the pore size distribution present no degradation after 300 h at 900°C under a H2/N2 atmosphere. This stability is indicative of an improvement in comparison with conventional Ni–YSZ anodes for solid oxide fuel cells.
Atomic Resolution Imaging of Au Nanocluster Dispersed in TiO2, SrTiO3, and MgO
Authors: Wang C. M. , Shutthanandan V. , Zhang Y. , Thevuthasan S. , Duscher G.
Published: August 2005

Gold nanoclusters dispersed in single crystal TiO2, MgO, and SrTiO3 have been prepared by ion implantation at 300–975 K and subsequent annealing at 1275 K for 10 h. High‐resolution transmission electron microscopy and high‐angle annular dark field (HAADF) imaging in aberration corrected scanning transmission electron microscope (STEM) have been used to characterize the microstructure of the gold nanoclusters dispersed materials. STEM‐HAADF imaging with atomic resolution has directly revealed for all three materials that Au atoms partially occupy cation lattice positions. Cavities up to several tens of nanometers were observed in MgO and SrTiO3. The cavities and gold clusters are spatially associated in MgO and SrTiO3, indicating a strong interaction between the Au cluster and cavities. For MgO and SrTiO3, the faceting planes appear to be the same for both nanometer‐sized cavity and the Au cluster, demonstrating that both the surface energy and the interfacial energy between Au cluster and the matrix are lowest on these planes.
Dielectric and Pyroelectric Properties of 〈111〉‐Oriented Fe‐Doped 0.62Pb(Mg1/3Nb2/3)O3–0.38PbTiO3 Single Crystals
Authors: Wan Xinming , Zhao Xiangyong , Luo Haosu , Chan H. L. W. , Choy C. L.
Published: August 2005

Fe‐doped 0.62Pb(Mg1/3Nb2/3)O3–0.38PbTiO3 (PMN–0.38PT) single crystals were grown by a modified Bridgman technique. Two kinds of single crystals with different iron ion molar ratios, (i) 0.2 mol% and (ii) 1.0 mol%, were obtained. The effect of doping iron ions on the dielectric and pyroelectric properties of the 〈111〉‐oriented PMN–0.38PT single crystals was examined. The temperature of the permittivity maximum (Tm) exhibits no dispersion behavior and decreases with increasing doping concentration. The dielectric loss of the 0.2 mol% Fe‐doped PMN–0.38PT single crystal is much lower than that of the high dopant content crystal (1.0 mol%) and undoped crystal, which makes it possess excellent pyroelectric performance. By a dynamic method, the measured pyroelectric coefficient and detectivity figure of merit (FD) of 0.2 mol% Fe‐doped PMN–0.38PT single crystal are 439 μC/m2·K and 56.3 μPa−1/2, respectively, both better than those of widely used pyroelectric single crystal LiTaO3. The results imply that the single crystal is a promising candidate for infrared detectors and other pyroelectric applications. The mechanism of doping effect was also discussed based on the principles of crystal chemistry.
Particulate‐Reinforced Precursor‐Derived Si–C–N Ceramics: Optimization of Pyrolysis Atmosphere and Schedules
Authors: Lee Sea‐Hoon , Weinmann Markus , Aldinger Fritz
Published: August 2005

Surface oxidation occurred during pyrolysis of SiC particulate‐reinforced composites (PRCs) with a precursor‐derived Si–C–N matrix. In contrast, such an oxidation was not observed in pure Si–C–N ceramics. The present investigation discusses the possible reasons for this, and reports on the influence of such an oxidation on the microstructure and the mechanical and thermal properties of PRCs by the precursor‐impregnation and pyrolysis method. The high‐temperature mass stability of the PRCs in Ar deteriorated owing to the decomposition of SiO2 formed by oxidation. The effects of the pyrolysis schedule on the processing and mechanical properties of PRCs are also investigated.
Sintering Kinetics at Constant Rates of Heating: Effect of Al2O3 on the Initial Sintering Stage of Fine Zirconia Powder
Authors: Matsui Koji , Ohmichi Nobukatsu , Ohgai Michiharu , Enomoto Naoya , Hojo Junichi
Published: August 2005

The sinterabilities of fine zirconia powders including 5 mass% Y2O3 were investigated, with emphasis on the effect of Al2O3 at the initial sintering stage. The shrinkage of powder compact was measured under constant rates of heating (CRH). The powder compact including a small amount of Al2O3 increased the densification rate with elevating temperature. The activation energies at the initial stage of sintering were determined by analyzing the densification curves. The activation energy of powder compact including Al2O3 was lower than that of a powder compact without Al2O3. The diffusion mechanisms at the initial sintering stage were determined using the new analytical equation applied for CRH techniques. This analysis exhibited that Al2O3 included in a powder compact changed the diffusion mechanism from grain boundary to volume diffusions (VD). Therefore, it is concluded that the effect of Al2O3 enhanced the densification rate because of decrease in the activation energy of VD at the initial sintering stage.
Histologic and histomorphometric analysis of three types of dental implants following 18 months of occlusal loading: a preliminary study in baboons
Authors: Watzak Georg , Zechner Werner , Ulm Christian , Tangl Stefan , Tepper Gabor , Watzek Georg
Published: August 2005

Abstract: The purpose of this study was to determine the percentage of ‘bone area’ (BA) and ‘bone‐to‐implant contact’ (BIC) of dental implants with different designs and surface modifications after functional loading. Three types of dental implants with fixed partial dentures were placed in the posterior jaws of adult baboons (commercially pure titanium (CpTi) screws, grit‐blasted acid‐etched (GBAE) screws, and titanium plasma‐sprayed (TPS) cylinders), three of the same design per quadrant. After 18 months of functional loading, all implants investigated were successfully integrated in the jawbone and histologic and histomorphometric analyses were carried out. Statistical evaluation was performed with a mixed model with data given as least‐square means and standard errors of the mean (SEM). Histologically, direct BIC without connective tissue interposed between implant surfaces and peri‐implant bone was seen. Analysis of BA within 1 mm around implants showed significant differences between CpTi (50.5%) and TPS (39.7%) (±2.72 SEM; P<0.01) in the maxilla. To account for the different implant designs, absolute BIC was calculated. Significant differences were found between CpTi (23.9 mm) and TPS (15.1 mm) and between GBAE (27.2 mm) and TPS (15.1 mm) (±1.05 SEM; P<0.01) in the maxilla and between GBAE (26.5 mm) and TPS (19.6 mm) (±1.42 SEM; P<0.01) in the mandible. Overall, the data indicate that, in the maxilla, screw‐shaped implants showed more absolute BIC than cylindrical implants, which had less maxillary than mandibular absolute BIC after 18 months of functional loading.
Ultraviolette Strahlung – Quellen, Spektren, Umwelteinflüsse
Authors: Hölzle Erhard , Hönigsmann Herbert
Published: August 2005

Die UV‐Strahlung in unserer Umwelt ist Teil der elektromagnetischen Strahlung, die von der Sonne ausgeht. Sie wird als optische Strahlung bezeichnet und umfasst an der Erdoberfläche den Bereich von 290 bis 4 000 nm. Die UV‐Strahlung wird aufgrund internationaler Konventionen in kurzwelliges UV‐C (200 – 280 nm), mittelwelliges UV‐B (280 – 320 nm) und langwelliges UV‐A (320 – 400 nm) eingeteilt. Die Sonnenstrahlung, welche an einem definierten Ort zu einer definierten Zeit auf die Erdoberfläche auftritt, wird als Globalstrahlung bezeichnet. Sie wird bei ihrem Durchtritt durch die Erdatmosphäre quantitativ und qualitativ verändert. Neben atmosphärischen Bedingungen, wie Ozonschicht und Luftverschmutzung, spielen geographische Breite, Höhenlage, Jahreszeit, Tageszeit, Bevölkungsgrad und der Einfluss von indirekter Strahlung durch Streuung in der Atmosphäre und Reflektion vom Untergrund eine Rolle bei der Modifikation der Globalstrahlung, welche schließlich die biologisch wirksame Strahlung darstellt. Die Strahlungsverteilung an der Körperoberfläche variiert mit dem Einfallswinkel der Sonnenstrahlung und der Körperstellung. Die kumulative UV‐Exposition wird hauptsächlich durch berufliche Tätigkeit im Freien und das Freizeitverhalten bestimmt sowie durch die Anwendung von Solarien und phototherapeutischen Maßnahmen zusätzlich erhöht.