bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficiency of endoscopic treatment for vesico‐ureteric reflux in adults
Authors: Arce Jacobo , Angerri Oriol , Caffaratti Jorge , Garat José Maria , Villavicencio Humberto
Published: December 2008

OBJECTIVE

To evaluate the results of our experience with endoscopic management of vesico‐ureteric reflux (VUR) in adults, and to describe factors and complications that might contribute to the failure of the technique.

PATIENTS AND METHODS

Between 1992 and 2006, 21 patients (17 women and four men; mean age 32.1 years, sd 15.6) had endoscopic treatment for VUR (14 unilateral and seven bilateral ureteric units, UU). Patients previously operated for VUR were excluded. The VUR grades were II, III, IV and V in 10, 12, five and one UUs, respectively. The main indication for treatment was a history of repeated episodes of acute pyelonephritis (61%). Complications after surgery were evaluated.

RESULTS

The success rate of the first endoscopic treatment was 69%, and was 81% after the second. Two UUs with grade IV VUR were endoscopically managed for a third time with complete resolution. Only one UU with grade V VUR required open surgery. The success rate for VUR grades II, III and IV after the first treatment was five of eight, 12/12 and one of five, respectively. After the second treatment the success rate increased to seven of eight and two of five for grades II and IV, respectively. There were no complications related to the intervention. Factors related to a failure of technique were duplex ureter and dysfunctional voiding in eight UUs (seven patients).

CONCLUSIONS

The endoscopic management of VUR in previously untreated adult patients is a simple and efficient technique, with low comorbidity.
Does International Fragmentation Occur in Sectors Other Than Machinery?*
Authors: Kimura Fukunari , Hayakawa Kazunobu , Ji Zheng
Published: December 2008

It is well established in the published literature that international fragmentation has dramatically developed in East Asia since the 1990s, particularly in machinery industries, including general machinery, electric machinery, transport equipment and precision machinery. However, how far has international fragmentation developed in sectors other than the machinery sector, such as textiles or chemicals? To answer this question, we empirically investigate whether features of international fragmentation appear in other sectors by examining intraregional trade in East Asia. The results indicate that, although some features of international fragmentation can be observed in some other sectors, particularly in the chemical sector, they are most distinctive in the general/electric machinery sector.
Lewis Growth Model and China's Industrialization*
Authors: Islam Nazrul , Yokota Kazuhiko
Published: December 2008

This paper examines China's industrialization in the light of the Lewis growth model. It begins with a perusal of Lewis's own writings and those of Fei and Ranis to clarify certain assumptions and predictions of the Lewis model. The paper then reviews previous applications of the Lewis model in studying industrialization of other countries, and notes the methodological problems that arise in this regard. In applying the Lewis model to study China's industrialization, the paper focuses on the dynamic relationship between wage and marginal product of labor in the traditional sector. For this purpose, the paper estimates a production function for China's agricultural sector using province level data and compares the estimated marginal product of labor with the corresponding wage of the sector. The results show that the marginal product has been increasing (from below) at a faster pace than the wage, as is predicted by the Lewis model. The results indicate that China as a whole is steadily moving toward the Lewis Turning Point.
Relationship between Managerial Compensation and Business Performance in Japan: New Evidence Using Micro Data*
Authors: Sakawa Hideaki , Watanabel Naoki
Published: December 2008

This paper examines the relationship between the level of managerial compensation and the quality of corporate governance in Japan in the period following the bubble burst of 1991–1995. There are three main findings. First, Japanese firms with weaker governance have greater agency problems in that managerial opportunism extracts higher compensation and the firm performs relatively worse. Second, these agency problems were more severe during the recessionary period of 1994–1995. Finally, governance structures in industries with higher managerial compensation are relatively weaker than in other industries.
A Geocomputational Heuristic for Coverage Maximization in Service Facility Siting
Authors: Murray Alan T , Matisziw Timothy C , Wei Hu , Tong Daoqin
Published: December 2008

Siting service facilities in order to maximize regional coverage is important when budget resources are limited. Various approaches exist for addressing this particular planning problem for discrete or continuous representations of potential facility sites and demand to be served. In cases where both candidate facility sites and service demand are continuous, approaches for maximizing regional coverage have only examined the siting of a single facility. In this article, a geocomputational approach is proposed for addressing multiple facility siting when demand is continuously distributed and facilities may be located anywhere in the region. Emergency warning siren location is used to highlight the developed approach.
Determining Semantic Similarity of Behaviour Using Natural Semantic Metalanguage to Match User Objectives to Available Web Services
Authors: Stock Kristin
Published: December 2008

Natural Semantic Metalanguage specifies a set of semantic primitives identified by linguists since the 1970s as being present in all analysed languages and not capable of further reduction. In this article, the 63 semantic primitives are used to define the semantics of user objectives and web services in the form of semantic explications, which are then compared to determine whether the web services are likely to be helpful in meeting the user objective. The comparison of the user objectives and web services is a two stage process. Firstly, the content is compared by classifying the semantic primitives from the candidate web service and user objective on the basis of whether the primitives are common or similar. On the basis of these classifications, the percentage match and semantic relationship (subset, superset, overlaps, disjoint, identical) are determined. Secondly, the order of the semantic primitives is compared and the edit distance determined as a measure of semantic similarity. The method is tested using two examples: a comparison of spatial relations and a comparison of a user objective and three geospatial web services. The results show that the method is able to determine which concepts are broadly semantically similar and which are not.
The Creation of a National Agricultural Land Use Dataset: Combining Pycnophylactic Interpolation with Dasymetric Mapping Techniques
Authors: Comber Alexis , Proctor Chris , Anthony Steve
Published: December 2008

Agricultural Census data is summarised over spatially coarse reporting units for reasons of farm confidentiality. This is problematic for research at a local level. This article describes an approach combining dasymetric and volume preserving techniques to create a national land use dataset at 1 km2resolution. The results for an English county are compared with contemporaneous aggregated habitat data. The results show that the accurate estimates of local agricultural land use (Arable and Grass) patterns can be estimated when individual 1 km squares are combined into blocks of > 9 squares, thereby providing local estimates of agricultural land use. This in turn allows more detailed modelling of land uses related to specific livestock and cropping activities. The dataset created by this work has been subject to extensive external validation through its incorporation into a number of other national models: nitrate leaching (e.g. MAGPIE, NEAP‐N), waste, and pathogen modelling related to agricultural activity.
A Qualitative Study of Judgments in Race Discrimination Employment Cases
Authors: BROWN ALISON , ERSKINE ANGUS
Published: December 2008

Qualitative methods were used with the aim of identifying any persistent patterns in the written judgments of British employment tribunal cases involving claims of race discrimination that might explain why these claims are relatively unlikely to succeed. The main factors at work appeared to be credibility of the parties and whether the claimant had enough evidence to pass the burden of proof to the respondent. A relatively recent legislative amendment relating to burden of proof appears to be very significant, while other factors highlighted in the literature appear to be less so.
Developing a Performance Measurement System for University Central Administrative Services
Authors: Arena Marika , Arnaboldi Michela , Azzone Giovanni , Carlucci Paola
Published: December 2008

Central administrative services have recently received increasing attention from practitioners and academics due to the challenging need to both manage scarce resources and provide high‐quality services. In this context, performance measurement systems (PMSs) may assume a central role, although an unresolved debate remains on the claimed benefits of accountability and the difficulties that have emerged in defining and managing proper measures. This paper contributes to this debate by presenting the results of a study in which a PMS for central administrative services has been developed and tested through an action research approach drawing on actor network theory. The experiment was carried out in 15 Italian universities and five areas of services were dealt with: student support, research support, accounting, human resources, and logistics and procurement. The highly participative method resulted in a comparable system with a complete set of cost and quality indicators across the participating universities. These data proved to be useful at managerial and policy level, providing insights on the presence of scale effects and on the relative importance of quality dimensions for users of services. Participating in the project encouraged the university staff to use indicators in decision making.
Differential diagnosis of dementia in the field of learning disabilities: a case study
Authors: Bell Dorothy M. , Turnbull Allyson , Bruce Kidd W.
Published: December 2008

Accessible summary

 As people get older, many are not able to move as quickly as they used to and many find it harder to think about how to sort their problems.

 Sometimes people develop what is called dementia. If someone has dementia then you may notice changes in their memory or how they behave.

 There are a few kinds of dementia – one is called Alzheimer’s dementia; another is called vascular dementia; another is called Lewy Body dementia.

 If people have these illnesses they find that gradually they are not as able to do the things they used to. They may forget more things like people’s names or how to make their tea.

 There are other illnesses that can look a bit like these dementia illnesses and sometimes it is hard to tell if someone has a dementia illness or if they have some other illness instead of or as well as the dementia.

 Many of these illnesses can be helped with medicine or with the right sort of support so it is important to sort out just what it is that is making the problem for the person.

 If someone really does have a dementia illness then staff members need to know this so they can help the person. Sometimes this means moving into a different house or having different staff members who understand the difficulties.

 Sometimes it is hard to find the right place for a person to live. This is because if they have dementia, then as they get older they may need more and more help.

 The man in this paper was not able to speak to people but the writer used something called Talking Mats. When there is an important time in their life when they have to choose what they would like to do, Talking Mats is a way to find what a person wants without them speaking, by using pictures.

Assessment for a diagnosis of dementia is hard enough under the best possible conditions. There are possible alternative or concomitant diagnoses, such as depression, to consider. However, when the possible dementia concerns a gentleman with severe learning disabilities and with a severe communication disorder then this assessment becomes even more difficult. Still more complications may arise from practical pressures such as general changes in health and hence of support needs; changes in support staff; what housing options are available at the time; and what options are or may be available in anticipation of future needs. This brief case‐study highlights the difficulties and competing pressures that complicate further just such a differential diagnosis.
Preoperative evaluation of endometrial carcinoma by contrast‐enhanced ultrasonography
Authors: Song Y , Yang J , Liu Z , Shen K
Published: December 2008

Objective  To investigate the potential usefulness of contrast‐enhanced ultrasonography in the preoperative evaluation of endometrial carcinoma and observe its enhancement pattern and time–intensity curve.

Design  A prospective study.

Setting  Gynaecological department of a college hospital.

Population  A total of 35 women diagnosed with endometrial carcinoma.

Methods  The patients were evaluated with real‐time grey‐scale contrast‐enhanced ultrasonography. In 21 women, the parameters of time–intensity curve were compared between the endometrial lesion and normal myometrium. Findings about the depth of myometrial invasion on sonograms were compared with histological findings.

Main outcome measures  Enhancement pattern, parameters of time‐intensity curve, depth of myometrial invasion detected on sonograms.

Results  In visual evaluation, the brightness of the power Doppler signal and the amount of recognisable vascular areas increased in each tumour after contrast agent administration. Feeding vessels of the tumour were shown in 77.1% (27/35) of women. The other 22.9% (8/35) of women revealed that the signals were first visualised in the central portion of the tumour. The arrival time and peak time of endometrial lesion tended to be shorter than normal myometrium. The tumours started to enhance earlier than or at the same time as myometrium in 90.5% (19/21) of women. The peak intensity, enhancement intensity, and rising rate were higher in endometrial lesion than normal myometrium. There was no myometrial invasion in eight women, inner half myometrial invasion in 19 women and the outer half myometrial invasion in eight women. The corresponding values for ultrasound were 9, 17, and 9. The sensitivity of contrast‐enhanced ultrasonography in detecting deep invasion was 75.0%, while the specificity was 88.9%, and the accuracy was 85.7%. The overall accuracy of assessment of myometrial invasion was 68.6%.

Conclusion  There is some benefit in contrast‐enhanced ultrasonography of endometrial carcinoma. It may provide better information in tumour imaging. Large studies are needed to determine the appropriate use and benefit of this new procedure.
New technologies in contraception
Authors: Rowlands S
Published: December 2008

New technologies in both reversible contraception and sterilisation are described. The review includes recent advances in the development of oral contraception, emergency contraception, injectable contraception, vaginal rings, subdermal implants, transdermal contraception, intrauterine devices, spermicides and barrier methods. It also covers methods of transcervical female sterilisation and more easily reversible male sterilisation. The emphasis is on the technology and its safety and effectiveness. Hormonal delivery systems are described in some detail. Mention is also made of research into vaccines and male hormonal methods, where progress has been disappointing.
Oral nifepidine versus subcutaneous terbutaline tocolysis for external cephalic version: a double‐blind randomised trial
Authors: Collaris R , Tan PC
Published: December 2008

Objective  To evaluate oral nifedipine versus subcutaneous terbutaline tocolysis for external cephalic version (ECV).

Design  A double‐blind randomised trial.

Setting  A university hospital in Malaysia.

Population  Non‐labouring women with a term singleton fetus in breech presentation or transverse lie suitable for elective ECV.

Methods  Participants were randomised to either 10 mg oral nifedipine tablet and subcutaneous saline placebo or oral placebo tablet and 250 microgram bolus terbutaline subcutaneously. Participants and providers were blinded. Ultrasound assessment and cardiotocogram were performed prior to ECV. ECV was commenced 20–30 minutes after treatment. A maximum of two ECV attempts were permitted. Elective caesarean delivery or a repeat ECV attempt at a later date was offered to participants following failed ECV. After successful ECV, management was expectant.

Main outcome measures  Primary outcomes were successful ECV (cephalic presentation immediately after ECV) and caesarean delivery.

Results  Ninety women were randomised: 44 to nifedipine and 46 to terbutaline. Initial ECV success rate was 15/44 (34.1%) versus 24/46 (52.2%) (relative risk [RR] 0.7, 95% CI 0.4–1.1; P= 0.094), and caesarean delivery rate was 34/44 (77.3%) versus 26/46 (56.5%) (RR 1.4, 95% CI 1.01–1.85; numbers needed to treat to benefit 5, 95% CI 2.5–55; P= 0.046) for nifedipine and terbutaline groups, respectively. Neonatal outcome was not different.

Conclusions  Bolus subcutaneous terbutaline tocolysis for ECV compared with oral nifedipine resulted in less caesarean deliveries. ECV success rate was not significantly higher. Larger studies are indicated.
A randomised trial comparing the H Pipelle with the standard Pipelle for endometrial sampling at ‘no‐touch’ (vaginoscopic) hysteroscopy
Authors: Madari S , Al‐Shabibi N , Papalampros P , Papadimitriou A , Magos A
Published: December 2008

Objectives  To evaluate the effectiveness and tolerance of H Pipelle compared with the standard Pipelle as an endometrial biopsy device at outpatient ‘no‐touch’ hysteroscopy.

Design  A prospective randomised trial carried out in an outpatient diagnostic hysteroscopy clinic.

Setting  A large undergraduate teaching hospital.

Population  Sixty women investigated for abnormal menstruation in an outpatient diagnostic hysteroscopy clinic.

Methods  Prospective randomised trial comparing the H Pipelle with the standard Pipelle de Cornier.

Main outcome measures  Adequacy of the biopsy specimens and women’s experience.

Results  Ninety‐three percent (H Pipelle) and 87% (Pipelle) of the biopsy specimens were judged to be adequate for histological diagnosis (P > 0.05). However, obtaining endometrial sampling with the H Pipelle was significantly quicker (median times: 39 seconds [H Pipelle] and 102 seconds [Pipelle], P < 0.0001) and less painful (median visual analogue scale score: 1 [H Pipelle] and 5 [Pipelle], P = 0.011).

Conclusions  The H Pipelle not only makes it possible to perform hysteroscopy and endometrial biopsy with minimal instrumentation but is also associated with a shorter biopsy time and less discomfort than the standard Pipelle without any loss of biopsy adequacy.
Blood oxygenation level dependent functional magnetic resonance imaging: current and potential uses in obstetrics and gynaecology
Authors: Vincent K , Moore J , Kennedy S , Tracey I
Published: December 2008

Blood‐oxygenation‐level‐dependent functional magnetic resonance imaging is a noninvasive technique that has become increasingly popular in the neurosciences. It measures the proportion of oxygenated haemoglobin in specific areas of the brain, mirroring blood flow and therefore function. Here we review how the findings from functional studies impact on areas of gynaecological practice as diverse as chronic pain, continence, and premenstrual dysphoric disorder. Finally we review some of the more novel applications of the technique, such as imaging of pelvic floor function and the effects of hypoxia on the fetus.
Minimal access surgery in adolescent gynaecology
Authors: Pandis GK , Michala L , Creighton SM , Cutner AS
Published: December 2008

The benefits of a minimally invasive approach are now well documented in adult women, and thus surgeons have embraced the notion of expanding such expertise in adolescence with measured enthusiasm and a great sense of responsibility. Faster recovery is likely to have a positive impact on schooling, while less adhesion formation may reduce future fertility issues. Gynaecologists performing minimally invasive procedures in adolescents ought to be aware of the steep learning curve required for achieving proficiency with complex laparoscopic surgery. In the group of rare congenital anomalies and advanced endometriosis, the best surgical results can only be achieved after careful preoperative planning by a multidisciplinary team
Policies for manual removal of placenta at vaginal delivery: variations in timing within Europe
Authors: Deneux‐Tharaux C , Macfarlane A , Winter C , Zhang W‐H , Alexander S , Bouvier‐Colle M‐H ,   the EUPHRATES Group
Published: December 2008

The length of the third stage of labour is a potential modifiable risk factor for postpartum haemorrhage at vaginal delivery, but there is no definitive evidence that early intervention to remove the placenta manually will prevent postpartum haemorrhage. We report a wide variation between countries in Europe in policies about the timing of manual removal of placenta. Two groups of countries with clearly divergent policies were identified. A randomised controlled trial is needed to provide definitive evidence on the risks and benefits of manual removal of placenta at different timings after vaginal delivery.
Assessment of forceps blade orientations during their placement using an instrumented childbirth simulator
Authors: Dupuis O , Moreau R , Pham MT , Redarce T
Published: December 2008

This paper aims to highlight the benefits of simulator training in obstetric manipulations such as forceps blade placement. The BirthSIM simulator is used to mimic operative vaginal deliveries. To characterise forceps blade placement, we studied the curvature of forceps path. The orientation of the forceps blades are studied in the quaternion unit space to ensure time‐independent analysis. The results showed progress for all novices in forceps blade placement. Simulator training helps them to develop their self‐confidence and acquire experience before working in the delivery room.
In vivo magnetic resonance spectroscopy of gynaecological tumours at 3.0 Tesla
Authors: Booth SJ , Pickles MD , Turnbull LW
Published: December 2008

Background  Magnetic resonance spectroscopy (MRS) uses the same hardware as MR imaging and allows us to analyse the biochemistry of tissues in vivo. Published data for gynaecological lesions are limited and are largely based on MRS carried out at the lower magnetic field strength of 1.5 Tesla (T).

Objective  The purpose of this study was to determine whether in vivo proton MRS could be performed at the higher magnetic field strength of 3 T to characterise the spectra of a variety of benign and malignant gynaecological lesions.

Design  Prospective, non‐randomised study.

Setting  MRI department within a tertiary referral centre for gynaecological cancers.

Sample  All women with a pelvic mass under going 3T MRI.

Methods  We carried out MRS on nonrandomised women undergoing routine 3 T MRI within our MRI department during investigation for gynaecological lesions from February 2006 to April 2008. Only those women for whom histopathological data were available were included.

Main outcome measures  The presence of choline detected by in vivo 3T MRS.

Results  Eighty‐seven women underwent MRS, 57 of whom had newly diagnosed neoplasms. MRS data for 39 of these new women (18 were excluded because of technical errors or missing data) were used to detect the presence of choline, an indicator of basement membrane turnover. Overall, choline was present in 13 of the 14 ovarian cancers, 8 of the 11 cervical tumours and all 4 of the uterine cancers. There was no statistical significant difference between choline levels in various lesion types (P= 0.735) or between benign and malignant disease (P= 0.550).

Conclusions  In vivo MRS can be performed at 3 T to provide biochemical information on pelvic lesions. The way in which this information can be utilised is less clear but may be incorporated into monitoring tissue response in cancer treatments.
Novel developments on cervical length screening and progesterone for preventing preterm birth
Authors: Berghella V
Published: December 2008

Cervical length (CL) measured by transvaginal ultrasound is an effective screening test for the prevention of preterm birth (PTB). The criteria for an effective screening test are all met by CL. It studies an important condition (PTB); it is safe and acceptable by >99% of women; it recognises an early asymptomatic phase that precedes PTB by many weeks; it has a well‐described technique, is reproducible, is predictive of PTB in all populations studies so far; and, perhaps most importantly, it has been shown that ‘early’ treatment is effective in prevention. These two interventions, effective only in specific populations, are ultrasound‐indicated cerclage and vaginal progesterone.
Preimplantation genetic diagnosis as a source of human embryonic stem cells for disease research and drug discovery
Authors: Stephenson EL , Mason C , Braude PR
Published: December 2008

Embryos surplus to therapeutic requirements following preimplantation genetic diagnosis can be used to derive human embryonic stem cell (hESC) lines carrying mutations significant to human disease. These cells provide a powerful in vitro tool for modelling disease progression in a number of cell types as well as having the potential to revolutionise drug discovery. Robust and reproducible directed differentiation protocols are needed to maximise the potential of these cells. In this review, we explore the current use of hESC and induced pluripotent stem cells in disease‐specific research and discuss the use of stem cell technology in drug discovery and toxicity testing.
Instrumental requirements for minimal invasive fetal surgery
Authors: Klaritsch P , Albert K , Van Mieghem T , Gucciardo L , Done’ E , Bynens B , Deprest J
Published: December 2008

Minimal invasive intrauterine interventions have gained their place in fetal medicine. Interventions on the placenta, umbilical cord, fetal membranes or on the fetus require special endoscopes with their respective sheaths, cannulas and additional instruments. Instruments for fetal therapy are purpose designed for the procedure of interest and most gynaecologists are therefore not familiar with them. We review the currently available instrumentation used during operations for complicated monochorionic multiple pregnancies, congenital diaphragmatic hernia, amniotic band syndrome, urinary tract obstruction and hydrothorax.
Efficacy and safety of transvaginal mesh kits in the treatment of prolapse of the vaginal apex: a systematic review
Authors: Feiner B , Jelovsek JE , Maher C
Published: December 2008

Background Vaginal mesh kits are being used to surgically treat apical vaginal prolapse; however, their safety and efficacy are currently unknown.

Objectives To summarise success and complication rates for commonly used vaginal mesh kits in the treatment of apical prolapse.

Search strategy MEDLINE and other scientific databases were queried for primary research addressing the use of vaginal mesh kits for apical prolapse published between 1950 and 2007, including abstracts presented in major scientific meetings.

Selection criteria Studies describing the use of mesh to support either the anterior or posterior compartment alone, for incontinence or fistula repair or not addressing the vaginal apex were excluded.

Data collection and analysis Identified studies were grouped by the mesh kit and complications categorised using the Dindo classification system. Weighted averages and confidence intervals were calculated on objective success, follow‐up length and complications.

Main results Thirty studies totalling 2653 women met inclusion criteria. Objective success rates (95% CI) were Apogee™ (American Medical Systems Inc., Minnetonka, MN, USA) 95% (95–96), Prolift™ (Ethicon Women’s Health and Urology, Somerville, NJ, USA) 87% (86–87) and posterior intravaginal slingplasty 88% (87–89). Reoperations not requiring anaesthesia (Dindo IIIa) occurred in 0.4–2.3% and requiring anaesthesia (Dindo IIIb) in 1.5–6.0%, with a follow up between 26 and 78 weeks. Mesh erosion was the most commonly reported complication occurring in 4.6–10.7%.

Author’s conclusions Overall objective success using transvaginal mesh kits in restoring apical vaginal prolapse is high. However, an increasing number of women require surgical intervention for mesh‐related complications based on limited data quality and short follow up. Further research addressing functional outcomes and the impact of these procedures on women’s symptoms and quality of life is mandatory.
Fertility‐sparing treatment in young women with endometrial cancer or atypical complex hyperplasia: a prospective single‐institution experience of 21 cases
Authors: Signorelli M , Caspani G , Bonazzi C , Chiappa V , Perego P , Mangioni C
Published: December 2008

We conducted a prospective study of conservative treatment in 21 young nulliparous women with grade (G)1 endometrial cancer stage IA (11) or atypical complex hyperplasia (10). All were treated with a low‐dose cyclic natural progestin therapy (200 mg/day from day 14–25) and encouraged to attempt pregnancy immediately. No adverse therapy‐related effects were recorded. Overall response rate to progestin therapy was 57%. Nine women conceived (43%). There were 13 pregnancies, of which 13 were spontaneous and 8 were in women with persistent disease or partial response to hormonal treatment. Three additional complete responses were observed after delivery. Only women with known primary infertility or severe polycystic ovary syndrome showed inadequate pregnancy rate. Fifteen women underwent definitive surgery after enrolment (median 27 months, range 3–56 months). All 21 women are alive and disease free after a median follow up of 98 months.
The impact of viewing a hysteroscopy on a screen on the patient’s experience: a randomised trial
Authors: Ogden J , Heinrich M , Potter C , Kent A , Jones S
Published: December 2008

Background  The introduction of patient screens for outpatient procedures is becoming increasingly common. To date, the impact on the patient of viewing the screen remains unknown.

Objectives  To explore how viewing the screen during a hysteroscopy procedure affects the patient’s experience.

Setting  The outpatient clinics at the Royal Surrey Hospital in Guildford and the Royal Infirmary in Bradford.

Design  A randomised control trial.

Sample  Women undergoing a hysteroscopy procedure were randomly allocated to see the screen (n = 81) or not to see the screen (n = 76).

Methods  A quantitative study with measures taken before and after the intervention.

Main outcome measures  Pain perception, mood, illness cognitions, communication.

Results  Seeing the screen or not had no impact on several measures of pain perception, mood, illness cognitions or communication. However, women who did not see the screen were more optimistic about the effectiveness of their treatment and felt that the health professional was more receptive to them during the consultation compared with those who saw the screen. After controlling for the use of a local anaesthetic, those who did not see the screen also reported a greater decrease in anxiety after the procedure. However, those who saw the screen described pain more positively (i.e. in terms of comfort, reassurance or encouragement) compared with those who did not see the screen.

Conclusion  Viewing the screen does not benefit the patient and may interfere with the patient–physician interaction.
The feasibility of a less invasive method to assess endometrial maturation—comparison of simultaneously obtained uterine secretion and tissue biopsy
Authors: van der Gaast MH , Macklon NS , Beier‐Hellwig K , Krusche CA , Fauser BCJM , Beier HM , Classen‐Linke I
Published: December 2008

Objective  To compare the assessment of endometrial maturation parameters in endometrial secretion samples obtained by a novel minimally invasive technique with those assessed in tissue biopsies.

Design  Prospective study.

Setting  University Hospital.

Population  Healthy female volunteers attending a gynaecological outpatient clinic.

Methods  Endometrial secretion fluid and tissue sampling 5 days after a spontaneous ovulation assessed with ultrasound.

Main outcome measures  Progesterone (P) receptor, Ki‐67 expression and the Noyes criteria were used to date endometrial biopsies. In the endometrial fluid samples, glycodelin A (GdA), leukaemia inhibitory factor (LIF) and P levels were analysed, and protein content and electrophoresis patterns were determined.

Results  All data were correlated to estradiol (E2) and P serum concentrations. The dating according to histology and immunohistochemical staining patterns correlated significantly with GdA levels (r = 0.376, P =0.048) in endometrial fluid samples as well with serum levels of E2 (r = 0.568, P =0.001) and P (r = 0.408, P =0.023). No correlation was observed between tissue dating and LIF levels and protein content in endometrial fluid samples.

Conclusions  The measurement of GdA in endometrial secretion samples may provide a less invasive method for assessing endometrial maturation in potential conception cycles without disrupting implantation.
Proteomic biomarkers for the diagnosis and risk stratification of polycystic ovary syndrome: a systematic review
Authors: Atiomo W , Khalid S , Parameshweran S , Houda M , Layfield R
Published: December 2008

Background  The exact causes of polycystic ovary syndrome (PCOS) are uncertain, and treatment could be improved. Discovery‐based approaches like ‘proteomics’ may result in faster insights into the causes of PCOS and improved treatment.

Objectives  To identify the number and nature of proteomic biomarkers found in PCOS so far and to identify their diagnostic and therapeutic potential.

Search strategy  All published studies on proteomic biomarkers in women with PCOS identified through the MEDLINE (1966–2008), EMBASE (1980–2008) and the ISI web of knowledge (v4.2) databases.

Selection criteria  The terms ‘polycystic ovary syndrome’ and ‘proteomic’, ‘proteomics’, ‘proteomic biomarker’ or ‘proteomics biomarker’ without any limits/restrictions were used.

Data collection and analysis  Original data were abstracted where available and summarised on a separate Microsoft Excel (2007) database for analysis.

Main results  Seventeen articles were identified, of which 6 original papers and 1 review article contained original data. Tissues investigated included serum, omental biopsies, ovarian biopsies, follicular fluid and T lymphocytes. Sample sizes ranged from 3 to 30 women. One hundred and forty‐eight biomarkers were identified. The biomarkers were involved in many pathways, for example the regulation of fibrinolysis and thrombosis, insulin resistance, immunity/inflammation and the antioxidant pathway. Eleven groups of biomarkers appeared to be independently validated. The individual sensitivities for the diagnosis of PCOS were reported for 11 named biomarkers and ranged from 57 to 100%.

Author’s conclusions  Proteomic biomarker discovery in PCOS offers great potential. Current challenges include reproducibility and data analysis. The establishment of a PCOS‐specific biomarker data bank and international consensus on the framework of systematic reviews in this field are required.
Digital colposcopy: ready for use? An overview of literature
Authors: Louwers JA , Kocken M , ter Harmsel WA , Verheijen RHM
Published: December 2008

The aims of this review were to summarise the various methods of digital colposcopy and to provide an overview of their efficacy. We conducted a literature search and focused on papers that described a technique for colposcopy, other than conventional colposcopy, and compared this with conventional colposcopy and/or histology and included digitalisation of the process. All papers have been classified in one of the following categories: digital imaging and telecolposcopy, spectroscopy, computerised colposcopy, optical coherence tomography and confocal microcolposcopy. Among the most promising developments is spectroscopy, allowing a more or less automated analysis and interpretation of the colposcopic image.
The limits and rewards of political opportunism: How electoral timing affects the outcome of currency crises
Authors: WALTER STEFANIE
Published: December 2008

Politicians are often assumed to be opportunistic. This article examines both whether there is a limit to this opportunism and whether voters reward policy makers for opportunistic behaviour. By looking at currency crisis situations, the article presents a graphic rational opportunistic political business cycle model in which incumbents face a tradeoff between their wish to signal competence and the economic constraints imposed by the crisis. It analyses how electoral incentives affect policy makers' management of currency crises and how this management in turn affects the subsequent election outcome. The empirical results of probit models with selection using a sample of 122 crises in 48 industrial and developing countries between 1983 and 2003 confirm the model's prediction that under certain circumstances some types of policy makers do indeed have incentives to deviate from optimal policy in the run‐up to elections – and that voters reward this behaviour by re‐electing policy makers who follow such strategies. However, there is a limit to the readiness to manipulate: when speculative pressure is too severe, incumbents no longer manipulate policy but implement the least painful policy option instead.
Hemoglobin Control, ESA Resistance, and Regular Low‐Dose IV Iron Therapy: A Review of the Evidence
Authors: Singh Ajay
Published: December 2008

Anemia management in hemodialysis patients has progressed following the introduction of erythropoiesis‐stimulating agents (ESAs) and intravenous (IV) iron. However, maintaining a stable hemoglobin (Hb) level can be challenging. Patient comorbidities and variable dosage administrations of ESA therapy can lead to great variability in Hb concentrations over time. Fluctuating Hb levels is associated with increased complications. This article reviews factors that affect Hb control, with a focus on management practices (e.g., regular low‐dose administration of IV iron) that can help improve anemia management.
Attraction of male winterform pear psylla to female‐produced volatiles and to female extracts and evidence of male–male repellency
Authors: Guédot Christelle , Horton David R. , Landolt Peter J.
Published: December 2008

Pear psylla, Cacopsylla pyricola (Förster) (Homoptera: Psyllidae), is a major pest of commercial pears in North America and Europe. Olfactometer trials have shown that males of both the summer and winter morphotype are attracted to female‐infested host material. Additional work with the summer morphotype has shown that males are attracted to females even in the absence of the host plant, which is evidence that female C. pyricola produce a volatile sex attractant. Here, we describe similar results with the winterform, confirming for this morphotype that the female psylla rather than the infested host material is the source of the attractant. Male winterforms displayed attraction to odors from live females in the absence of the host plant, freshly killed females, and female whole body extracts. The female whole body extracts were at least as attractive as a comparable number of live females, suggesting that we were successful at extracting the components of the attractant with this procedure. All previous olfactometer trials with C. pyricola used the insect as the attractant source; the current study is the first to demonstrate that volatile chemicals isolated from the female insect were attractive to male conspecifics. Winterform males were also assayed to odors produced by conspecific males. We found that male psylla avoided volatile odors from live males, freshly killed males, or whole body extracts of males. To our knowledge, these results are the first indication that males of any member of the Psyllidae avoid odors associated with conspecific males.
Misclassification and the use of register‐based indicators for depression
Authors: Thielen K. , Nygaard E. , Andersen I. , Rugulies R. , Heinesen E. , Bech P. , Bültmann U. , Diderichsen F.
Published: December 2008

Objective:  To study the degree to which depression indicators based on register data on hospital and antidepressant treatment suffer from differential misclassification with respect to gender, age and social group.

Method:  Data on 7378 persons were obtained by linking a cross‐sectional survey of Danish adults aged 40 and 50 years with population‐based registers. Misclassification was analysed by comparing survey data to register data on major depression using the method proposed by Rothman and Greenland.

Results:  Differential misclassification was found. Adjustment for misclassification reduced women’s odds ratios from 2.18 to 1.00 for hospital treatment and from 1.70 to 1.10 for antidepressants. For the lower social group, the corresponding odds ratios increased from 1.18 to 3.52, and from 1.35 to 2.32 respectively, whereas odds ratios with respect to age remained almost unchanged.

Conclusion:  Differential misclassification should be considered when register‐based information about hospital and antidepressant treatment are used as depression indicators.
Brain functional changes during placebo lead‐in and changes in specific symptoms during pharmacotherapy for major depression
Authors: Hunter A. M. , Ravikumar S. , Cook I. A. , Leuchter A. F.
Published: December 2008

Objective:  Brain functional changes during placebo lead‐in have been associated with antidepressant response in clinical trials for major depressive disorder (MDD); however, the relationship between such non‐pharmacodynamic changes in brain function and changes in specific symptoms is unknown.

Method:  Fifty‐eight adults with MDD completed a 1‐week single‐blind placebo lead‐in preceding 8 weeks of double‐blind randomized treatment with fluoxetine or venlafaxine (n = 30) or placebo (n = 28). Brain functional change during lead‐in was assessed using quantitative electroencephalographic (qEEG) prefrontal theta‐band cordance. Symptoms were assessed using the Symptom Checklist‐90‐Revised (SCL‐90‐R).

Results:  The multiple regression model examining the qEEG parameter in relation to SCL‐90‐R subscales was significant [F(9,9) = 4.27, P = 0.021, R2 = 0.81] in females, with a significant association for the interpersonal sensitivity subscale (beta coefficient = 1.94, P = 0.001).

Conclusion:  Prefrontal neurophysiologic change during placebo lead‐in may indicate subsequent antidepressant‐related improvement in symptoms of interpersonal sensitivity.
Participation of the secreted dipeptidyl and tripeptidyl aminopeptidases in asaccharolytic growth of Porphyromonas gingivalis
Authors: Oda H. , Saiki K. , Tonosaki M. , Yajima A. , Konishi K.
Published: December 2008

Background and Objective:  Porphyromonas gingivalis secretes gingipains, endopeptidases essential for the asaccharolytic growth of this bacterium. P. gingivalis also secretes dipeptidyl aminopeptidases (DPPIV and DPP‐7) and a tripeptidyl aminopeptidase (PTP‐A), although their role in asaccharolytic growth is unclear. The present study was carried out to elucidate the role of these dipeptidyl/tripeptidyl aminopeptidases on the asaccharolytic growth of P. gingivalis.

Material and Methods:  Knockout mutants for the DPPIV (dpp), dpp7 and/or PTP‐A genes were constructed. Brain–heart infusion medium supplemented with sterile hemin and menadione (BHIHM) was used as a complex medium, and the minimal medium used was GA, in which the sole energy source was a mixture of immunoglobulin G and bovine serum albumin. Growth of P. gingivalis was monitored by measuring the optical density of the culture.

Results:  All knockout mutants for DPPIV, dpp7 and PTP‐A grew as well as strain W83 in BHIHM. In GA, growth of single‐knockout and double‐knockout mutants was similar to that of W83, whereas growth of a triple‐knockout mutant (83‐47A) was reduced. We purified recombinant DPPIV and recombinant PTP‐A from recombinant Escherichia coli overproducers, and purified DPP‐7 from the triple‐knockout mutant 83‐4A. GA supplemented with the three purified dipeptidyl/tripeptidyl aminopeptidases supported the growth of 83‐47A.

Conclusion:  DPPIV, DPP‐7 and PTP‐A contribute to the normal growth of P. gingivalis by cleaving substrate peptides into short‐chain polypeptides that are efficient energy sources for P. gingivalis.
Post‐ischemic brain damage: the endocannabinoid system in the mechanisms of neuronal death
Authors: Pellegrini‐Giampietro Domenico E. , Mannaioni Guido , Bagetta Giacinto
Published: December 2008

An emerging body of evidence supports a key role for the endocannabinoid system in numerous physiological and pathological mechanisms of the central nervous system. In the recent past, many experimental studies have examined the putative protective or toxic effects of drugs interacting with cannabinoid receptors or have measured the brain levels of endocannabinoids inin vitroandin vivomodels of cerebral ischemia. The results of these studies have been rather conflicting in supporting either a beneficial or a detrimental role for the endocannabinoid system in post‐ischemic neuronal death, in that cannabinoid receptor agonists and antagonists have both been demonstrated to produce either protective or toxic responses in ischemia, depending on a number of factors. Among these, the dose of the administered drug and the specific endocannabinoid that accumulates in each particular model appear to be of particular importance. Other mechanisms that have been put forward to explain these discrepant results are the effects of cannabinoid receptor activation on the modulation of excitatory and inhibitory transmission, the vasodilatory and hypothermic effects of cannabinoids, and their activation of cytoprotective signaling pathways. Alternative mechanisms that appear to be independent from cannabinoid receptor activation have also been suggested. Endocannabinoids probably participate in the mechanisms that are triggered by the initial ischemic stimulus and lead to delayed neuronal death. However, further information is needed before pharmacological modulation of the endocannabinoid system may prove useful for therapeutic intervention in stroke and related ischemic syndromes.