bluuebunny/crossref_metadata_2025 huggingface dataset:
Preoperative chemoradiotherapy for rectal cancer: a comparison between intravenous 5‐fluorouracil and oral capecitabine
Authors: Ramani V. S. , Sun Myint A. , Montazeri A. , Wong H.
Published: July 2010

Introduction  Capecitabine provides an attractive alternative to intravenous (IV) 5‐flourouracil (5‐FU) in chemoradiation regimes for rectal cancer by avoiding the need for intravenous access and inpatient stay. We aimed to compare retrospectively the efficacy of concurrent capecitabine with IV 5‐FU in preoperative pelvic chemoradiation schedules for rectal cancer in our centre.

Method  Patients treated from January 2005 to June 2007 were included. Information was collected on patient characteristics; treatment details; pathological response to treatment; recurrence and survival. All statistical analyses were performed using SPSS V17.

Results  All patients had pelvic radiation. Ninety‐nine patients were treated with capecitabine and 97 with 5‐FU. The two groups were well matched for age, sex and TNM stage. There were significantly more PS (performance status) 0 patients in the capecitabine group (51%vs 30%) (P = 0.001). Of the 99 patients in the capecitabine group, 91 (92%) were able to undergo surgery with 84 (93%) achieving R0 resection. In the 5‐FU group, these proportions were 87 (90%) and 70 (80%). The difference in the rate of R0 resection was statistically significant (P = 0.024). The APR rate was 35% in the capecitabine group compared with 47% in the 5‐FU group (P = 0.06). There was no significant difference in pathological complete response (pCR) rates between capecitabine (14%) and 5‐FU(12%). A higher pCR rate (30%) was observed in patients who underwent a brachytherapy boost (P = 0.051). There were three local recurrences in the whole patient group, (capecitabine 1; 5‐FU 2). Thirty‐five patients had distant metastases, 14 in the capecitabine and 21 in the 5‐FU group. There was no significant difference in the risk of recurrence between the two groups. Six patients in each group had grade 3 toxicity with diarrhoea being more common with capecitabine.

Conclusions  Preoperative chemoradiotherapy with capecitabine for rectal cancer is efficacious and comparable to 5‐FU (IV). It is more convenient, is well tolerated and avoids the need for inpatient admission.
Patient‐selected goals in overactive bladder: a placebo controlled randomized double‐blind trial of transdermal oxybutynin for the treatment of urgency and urge incontinence
Authors: Cartwright Rufus , Srikrishna Sushma , Cardozo Linda , Robinson Dudley
Published: July 2010

Study Type – Therapy (RCT) Level of Evidence 1b

What’s k
n
own on the subject? and What does
the study add?

In common with other anticholinergics, transdermal oxybutynin improves symptoms, and disease specific quality of life for patients with urgency incontinence. Achievement of patient selected goals for treatment of overactive bladder has also been demonstrated in uncontrolled studies.

Over a four week period, transdermal oxybutynin improved urinary urgency for patients with overactive bladder, including those without incontinence. However, in comparison to placebo it did not lead to significant achievement of patients’ own therapeutic goals.

OBJECTIVE

To assess patient selected goal improvement with transdermal oxybutynin, in a representative population of adult women with overactive bladder (OAB).

SUBJECTS AND METHODS

Adult women with ≥3 month history of OAB symptoms, with or without urgency urinary incontinence, were recruited from a tertiary referral urogynaecology unit. Participants were allocated to either transdermal oxybutynin 3.9 mg/day or matching placebo patches in a double‐blind, randomized parallel group design, over 4 weeks. Patient‐selected goal achievement was defined as the primary outcome measure. Participants selected their own goals for treatment at baseline, and subsequently scored achievement of these goals on a visual analogue scale. They completed 3‐day bladder diaries incorporating the Patients Perception of Intensity of Urgency Scale (PPIUS) to assess urgency and urgency incontinence episodes. Quality of life was assessed using the King’s Health Questionnaire (KHQ).

RESULTS

A total of 96 women were randomized; 78 (81.3%) participants completed 4 weeks double‐blind treatment. There was no significant difference between mean goal achievement in the transdermal oxybutynin and placebo groups (41.9% (SD 31.3) vs 32.2% (SD 27.3), P= 0.203). Transdermal oxybutynin was associated with significant improvements in urgency episodes (−1.23 episodes/day (SD1.40) vs −0.21 episodes/day (SD 1.58), P= 0.01). Both groups made non‐significantly different improvements in KHQ scores; 18 (38.2%) patients in the transdermal oxybutynin group experienced either erythema or pruritus, with 7 (14.9%) experiencing at least one systemic adverse event.

CONCLUSIONS

In women with OAB, in comparison with placebo, transdermal oxybutynin 3.9 mg/day leads to significant objective improvements in urinary urgency, but with no significant difference observed in achievement of patients’ own goals for therapy, or improvement in disease specific quality of life.
Reduced incidence of blindness in relation to diabetes mellitus in southern Germany?
Authors: Genz J. , Scheer M. , Trautner C. , Zöllner I. , Giani G. , Icks A.
Published: July 2010

Diabet. Med. 27, 1138–1143 (2010)

Aims  We estimated the incidence of blindness in the diabetic and non‐diabetic population in 2008 and compared it with results from 1990–1998 in a neighbouring region.

Methods  All newly registered blindness allowance recipients in 2008 were drawn up in a German region (population 4.5 million). We estimated sex‐specific, age‐specific and standardized incidence rates of blindness in the diabetic and the non‐diabetic population and relative and attributable risks as a result of diabetes. A comparison to the data from 1990–1998 was performed using log‐linear Poisson regression.

Results  Four‐hundred and sixty‐eight cases were drawn up (63% female). One‐hundred and twenty‐two (26.1%) had diabetes. Blindness incidence rates (per 100 000 person‐years) standardized to the 2008 German population were: men 9.1 (95% confidence interval 7.8–10.5), women 9.9 (8.8–11.1); diabetic population: men 21.8 (11.6–31.9), women 19.7 (9.2–30.1); non‐diabetic population: men 8.0 (6.6–9.5), women 9.1 (7.9–10.3). Relative risk of blindness, diabetic vs. non‐diabetic population: men 2.7 (1.6–4.5), women 2.2 (1.3–3.8). Attributable risk among exposed: 63% in men, 54% in women. Population attributable risk: 12% in men, 8% in women. Incidences of blindness were significantly lower than in all years of the period 1990–1998 in both the diabetic and the non‐diabetic population.

Conclusions  We found the incidence of blindness to be approximately 2.5‐fold higher in the diabetic compared with the non‐diabetic population. Fifty‐eight per cent of the risk to become blind in diabetic individuals and 9% of the risk to become blind in the entire population were attributable to diabetes. The decrease of the blindness incidence observed during the 1990s may have continued.
Neutrophil Gelatinase‐Associated Lipocalin (NGAL) and Kidney Injury Molecule 1 (KIM1) in patients with diabetic nephropathy: a cross‐sectional study and the effects of lisinopril
Authors: Nielsen S. E. , Schjoedt K. J. , Astrup A. S. , Tarnow L. , Lajer M. , Hansen P. R. , Parving H.‐H. , Rossing P.
Published: July 2010

Diabet. Med. 27, 1144–1150 (2010)

Aims  Our aim was to evaluate the markers of tubulointerstitial damage, neutrophil gelatinase‐associated lipocalin (NGAL) and kidney injury molecule 1 (KIM1) in Type 1 diabetic patients with different levels of albuminuria and in control subjects. In addition, the effect of renoprotective treatment on urinary NGAL was evaluated in diabetic nephropathy.

Methods  This was a cross‐sectional study in 58 normoalbuminuric (u‐albumin < 30mg/24 h), 45 microalbuminuric (30–300 mg/24 h) and 45 macroalbuminuric (> 300 mg/24 h) Type 1 diabetic patients and 55 non‐diabetic control subjects. Furthermore, in a second study, urine‐NGAL was measured in a randomized cross‐over study of 56 Type 1 diabetic patients with diabetic nephropathy treated with lisinopril 20, 40 and 60 mg daily.

Results  Urine‐NGAL levels were [geometric mean (95% CI)]: control subjects 74 (52–104) (pg/mmol creatinine), normoalbuminuric 146 (97–221), microalbuminuric 222 (158–312) and macroalbuminuric group 261 (175–390). Urine‐NGAL increased significantly from the normo‐ to the micro‐ and further to the macroalbuminuric group (P < 0.05). Urine‐NGAL was higher in normoalbuminuric vs. control subjects (P < 0.01). Plasma‐NGAL was significantly higher in the normoalbuminuric and macroalbuminuric groups than in the control group. Urine‐KIM1 was higher in all diabetic groups than in the control group (P < 0.001), with no difference between diabetic groups. During lisinopril treatment,

urine‐NGAL was reduced (95% CI) 17% (11–50) (not significant).

Conclusions  Urine‐NGAL and urine‐KIM1 (u‐KIM1) are elevated in Type 1 diabetic patients, with or without albuminuria, indicating tubular damage at an early stage. Urine‐NGAL increases significantly with increasing albuminuria. The ACE inhibitor lisinopril reduced urine‐NGAL, but this was not statistically significant.
Search and rescue in collapsed structures: engineering and social science aspects
Authors: El‐Tawil Sherif , Aguirre Benigno
Published: July 2010

This paper discusses the social science and engineering dimensions of search and rescue (SAR) in collapsed buildings. First, existing information is presented on factors that influence the behaviour of trapped victims, particularly human, physical, socioeconomic and circumstantial factors. Trapped victims are most often discussed in the context of structural collapse and injuries sustained. Most studies in this area focus on earthquakes as the type of disaster that produces the most extensive structural damage. Second, information is set out on the engineering aspects of urban search and rescue (USAR) in the United States, including the role of structural engineers in USAR operations, training and certification of structural specialists, and safety and general procedures. The use of computational simulation to link the engineering and social science aspects of USAR is discussed. This could supplement training of local SAR groups and USAR teams, allowing them to understand better the collapse process and how voids form in a rubble pile. A preliminary simulation tool developed for this purpose is described.
Effects of seismic intensity and socioeconomic status on injury and displacement after the 2007 Peru earthquake
Authors: Milch Karen , Gorokhovich Yuri , Doocy Shannon
Published: July 2010

Earthquakes are a major cause of displacement, particularly in developing countries. Models of injury and displacement can be applied to assist governments and aid organisations in effectively targeting preparedness and relief efforts. A stratified cluster survey was conducted in January 2008 to evaluate risk factors for injury and displacement following the 15 August 2007 earthquake in southern Peru. In statistical modelling, seismic intensity, distance to rupture, living conditions, and educational attainment collectively explained 54.9 per cent of the variability in displacement rates across clusters. Living conditions was a particularly significant predictor of injury and displacement, indicating a strong relationship between risk and socioeconomic status. Contrary to expectations, urban, periurban, and rural clusters did not exhibit significantly different injury and displacement rates. Proxies of socioeconomic status, particularly the living conditions index score, proved relevant in explaining displacement, likely due to unmeasured aspects of housing construction practices and building materials.
Tilting at Windmills or Contested Norms? Dissident Proxy Initiatives in Canada
Authors: Bates Kimberly , Hennessy Dean
Published: July 2010

Manuscript Type: Empirical

Research Question/Issue: Do shareholder activists influence standards of legitimacy with Dissident proxy initiatives? What are the antecedents and consequences of Dissident proxy initiatives?

Research Findings/Insights: We use a longitudinal Canadian sample to evaluate the dynamics of Dissident proxy initiatives. Firms with lower legitimacy are more likely to receive governance‐ and performance‐oriented Dissident proxy initiatives. Firms with higher legitimacy were more likely to settle proxy initiatives of all types, and avoid publishing activist shareholders' concerns to all shareholders, but this relationship did not hold for governance‐oriented proposals. Firms that received more governance‐ and performance‐oriented proposals subsequently had lower legitimacy.

Theoretical/Academic Implications: Dissident proxy initiatives are legitimation contests, where shareholders contest the legitimacy of corporate management's conduct. The dynamics that produce proposals and management responses are consistent with the predictions of institutional theories of legitimacy, institutional entrepreneurship, and legitimation contests. Because the ownership structure of Canadian corporations makes passage unlikely, they resemble a ritual for influencing legitimacy of a wide variety of practices.

Practitioner/Policy Implications: Management's response to Dissident proxy initiatives makes a statement about the legitimacy of their conduct. Settling proxies may enable management to contribute to the acceptance or rejections of emerging practices. Management should consider whether attempts to decouple adoption of some practices from core operations are wise in the long term. Shareholder activists should consider whether management is seeking to ceremonially adopt policies demanded in dissident proxies.
Random-Weight Particle Filtering of Continuous Time Processes
Authors: Fearnhead Paul , Papaspiliopoulos Omiros , Roberts Gareth O. , Stuart Andrew
Published: July 2010

It is possible to implement importance sampling, and particle filter algorithms, where the importance sampling weight is random. Such random-weight algorithms have been shown to be efficient for inference for a class of diffusion models, as they enable inference without any (time discretization) approximation of the underlying diffusion model. One difficulty of implementing such random-weight algorithms is the requirement to have weights that are positive with probability 1. We show how Wald’s identity for martingales can be used to ensure positive weights. We apply this idea to analysis of diffusion models from high frequency data. For a class of diffusion models we show how to implement a particle filter, which uses all the information in the data, but whose computational cost is independent of the frequency of the data. We use the Wald identity to implement a random-weight particle filter for these models which avoids time discretization error.
A Flexible Model for Estimating Price Dynamics in On-Line Auctions
Authors: Jank Wolfgang , Shmueli Galit , Zhang Shu
Published: July 2010

The path that the price takes during an on-line auction plays an important role in understanding and forecasting on-line auctions. Price dynamics, such as the price velocity or its acceleration, capture the speed at which auction information changes. The ability to estimate price dynamics accurately is especially important in realtime price forecasting, where bidders and sellers must make quick decisions or react to changes in market conditions. Existing models for estimating price paths from observed bid data suffer from issues of non-monotonicity, high variability or computational inefficiency. We propose a flexible two-parameter beta model which adequately captures a wide range of auction price paths. The model is computationally efficient and has several properties that make it especially advantageous in the on-line auction context. We compare the beta model with non-parametric and parametric alternatives empirically, when used in a variety of forecasting models. Using bidding data from eBay auctions, we find that the beta model leads to fast and high accuracy price predictions. This behaviour is consistent across various forecasting models and data sets. The implication for practice is the usefulness of the beta model for obtaining accurate and realtime bidding and selling decisions in on-line markets.
Reducing Responsibility: An Evidentialist Account of Epistemic Blame
Authors: Dougherty Trent
Published: July 2010

Abstract: This paper argues that instances of what are typically called ‘epistemic irresponsibility’ are better understood as instances of moral or prudenial failure. This hypothesis covers the data and is simpler than postulating a new sui generis form of normativitiy. The irresponsibility alleged is that embeded in charges of ‘You should have known better!’ However, I argue, either there is some interest at stake in knowing or there is not. If there is not, then there is no irresponsibility. If there is, it is either the inquirer's interests—in which case it is a prudential shortcoming—or someone else's interests are at stake—in which case it is a moral shortcoming. In no case, I argue, is there any need to postulate a form of normativity in epistemology other than the traditional epistemological norm that one's attitudes should fit the evidence one has.
Cascade of genetic algorithm and decision tree for cancer classification on gene expression data
Authors: Yeh Jinn‐Yi , Wu Tai‐Hsi
Published: July 2010

Abstract: Cancer classification, through gene expression data analysis, has produced remarkable results, and has indicated that gene expression assays could significantly aid in the development of efficient cancer diagnosis and classification platforms. However, cancer classification, based on DNA array data, remains a difficult problem. The main challenge is the overwhelming number of genes relative to the number of training samples, which implies that there are a large number of irrelevant genes to be dealt with. Another challenge is from the presence of noise inherent in the data set. It makes accurate classification of data more difficult when the sample size is small. We apply genetic algorithms (GAs) with an initial solution provided by t statistics, called t‐GA, for selecting a group of relevant genes from cancer microarray data. The decision‐tree‐based cancer classifier is built on the basis of these selected genes. The performance of this approach is evaluated by comparing it to other gene selection methods using publicly available gene expression data sets. Experimental results indicate that t‐GA has the best performance among the different gene selection methods. The Z‐score figure also shows that some genes are consistently preferentially chosen by t‐GA in each data set.
A study on non‐invasive detection of blood glucose concentration from human palm perspiration by using artificial neural networks
Authors: Saraoğlu Hamdi Melih , Koçan Mehmet
Published: July 2010

Abstract: In this paper the relationship between blood glucose concentration and palm perspiration rate is studied as a non‐invasive method. A glucose concentration range from 83 mg/dl to 116.5 mg/dl is examined. An artificial neural network (ANN) trained by the Levenberg–Marquardt algorithm is developed to detect the performance indices based on the one‐ and two‐input variables. A data set for 72 volunteers is used for this study. Data of 36 volunteers are used for training the ANN and data of 36 volunteers were reserved for testing. Results of the study are acceptable with an error of 8.38% for the Elman neural network and 8.77% for the multilayer neural network. Therefore, the palm perspiration rate may be used as a good indicator for detecting glucose concentration in blood. This non‐invasive method has advantages such as time saving, cost etc. over other methods and it is painless. The results of clinical experiments, follow‐up methods and other applications are presented.
Management of minor acute cutaneous wounds: importance of wound healing in a moist environment
Authors: Korting HC , Schöllmann C , White RJ
Published: July 2010

Moist wound care has been established as standard therapy for chronic wounds with impaired healing. Healing in acute wounds, in particular in minor superficial acute wounds – which indeed are much more numerous than chronic wounds – is often taken for granted because it is assumed that in those wounds normal phases of wound healing should run per se without any problems. But minor wounds such as small cuts, scraps or abrasions also need proper care to prevent complications, in particular infections. Local wound care with minor wounds consists of thorough cleansing with potable tap water or normal saline followed by the application of an appropriate dressing corresponding to the principles of moist wound treatment. In the treatment of smaller superficial wounds, it appears advisable to limit the choice of dressing to just a few products that fulfil the principles of moist wound management and are easy to use. Hydroactive colloid gels combining the attributes of hydrocolloids and hydrogels thus being appropriate for dry and exuding wounds appear especially suitable for this purpose – although there is still a lack of data from systematic studies on the effectiveness of these preparations.
Circumscribed palmo‐plantar hypokeratosis: a disease of desquamation? Immunohistological study of five cases and literature review
Authors: Kanitakis J , Lora V , Chouvet B , Zambruno G , Haftek M , Faure M
Published: July 2010

Background  Circumscribed palmoplantar hypokeratosis (CPH) is a recently recognized, rarely reported dermatosis that shows characteristic clinicopathological features; however, its pathogenesis remains unknown.

Objective  The aim of this study was to get further insight into the pathogenesis of CPH.

Methods  An immunohistological study was performed on five cases of CPH to investigate the expression of several epidermal proliferation and differentiation proteins, with emphasis on those involved in corneocyte desquamation [including corneodesmosin, kallikrein 5 and lympho‐epithelial Kazal type inhibitor (LEKTI)].

Results  In three of five cases, a decreased expression of LEKTI, corneodesmosin and filaggrin was found, along with an increased expression of kallikrein 5 and keratin 6. The expression of several other antigens (including involucrin, Ki67, p63, CD138/syndecan I, EGF‐R) did not present a consistently different pattern as compared with the unaffected epidermis.

Conclusion  The immunohistopathologic features of CPH suggest that an altered (accelerated) corneocyte desquamation process could be the main pathological mechanism underlying the development of lesions.
Annual Research Review: Epigenetic mechanisms and environmental shaping of the brain during sensitive periods of development
Authors: Roth Tania L. , David Sweatt J.
Published: July 2010

Experiences during early development profoundly affect development of the central nervous system (CNS) to impart either risk for or resilience to later psychopathology. Work in the developmental neuroscience field is providing compelling data that epigenetic marking of the genome may underlie aspects of this process. Experiments in rodents continue to show that experiences during sensitive periods of development influence DNA methylation patterns of several genes. These experience‐induced DNA methylation patterns represent stable epigenetic modifications that alter gene transcription throughout the lifespan and promote specific behavioral outcomes. We discuss the relevance of these findings to humans, and also briefly discuss these findings in the broader contexts of cognition and psychiatric disorder. We conclude by discussing the implications of these observations for future research.
Structure of the seminal receptacle and sperm storage in the Japanese pygmy squid
Authors: Sato N. , Kasugai T. , Ikeda Y. , Munehara H.
Published: July 2010

To examine the mechanism of sperm storage in Idiosepius paradoxus, here we describe aspects of the mating behavior of I. paradoxus and the morphology of the spermatozoa and the seminal receptacle after copulation. The seminal receptacle is located in the ventral portion of the buccal membrane surrounding the buccal mass, and opens inside the buccal membrane. It branches into approximately six sacs, similar in appearance to a bunch of bananas, and its wall consists of cuboidal ciliated epithelial cells (with oval nuclei) surrounded by a connective tissue. Multiple vacuoles are distributed in the bottom region of each sac. These histological and morphological characteristics differ from previous reports for loliginid squids and cuttlefish. In all except one receptacle observed in this study, sperm were stored near the bottom of each sac, and each sperm was facing the sac bottom. We observed spermatozoa in the entrance of the seminal receptacle in only one squid. These results suggest that spermatozoa were actively moving, and that sperm actively swam to the seminal receptacle. The volume of sperm in the seminal receptacles of the squid that had copulated eight times was the same as that in the squid that had copulated 29 times, which suggests that the seminal receptacle was filled after approximately eight copulation events. A squid that had copulated nine times retained a significant number of sperm in the seminal receptacle after spawning, suggesting that all of the sperm in the receptacle was not depleted after one spawning event.
Risk factors for incomplete healing of the uterine incision after caesarean section
Authors: Vikhareva Osser O , Valentin L
Published: July 2010

Please cite this paper as: Vikhareva Osser O, Valentin L. Risk factors for incomplete healing of the uterine incision after caesarean section. BJOG 2010;117:1119–1126.

Objective  To determine which factors increase the risk of large caesarean scar defects as assessed by transvaginal ultrasound.

Design  Observational cross‐sectional study.

Setting  University Hospital.

Population  One hundred and eight women who had undergone one caesarean section.

Methods  Transvaginal ultrasound examination of the scar in the uterus 6–9 months after the caesarean. Published ultrasound definitions of large scar defects were used. Clinical information was obtained from medical records after all ultrasound images had been evaluated.

Main outcome measures  Factors increasing the risk of large caesarean scar defects.

Results  Twenty‐two (20%) women had a large caesarean scar defect. The odds of a large defect increased with cervical dilatation at caesarean (0 cm, 1–4 cm, 5–7 cm, 8 cm or more; odds ratio [OR] 4.4 [95% CI 0.7–28.5]; 26.5 [4.3–161.8]; and 32.4 [6.1–171.0]; P < 0.001), station of the presenting part at caesarean below pelvic inlet (OR 14.1 [4.6–43.1]; P < 0.001), duration of labour at caesarean (0 hour, 1–4 hours, 5–9 hours, 10 hours or more; OR 2.0 [0.2–23.8]; 13.0 [2.2–76.6]; and 33.1 [6.6–166.9]; P < 0.001), oxytocin augmentation (OR 6.3, [2.3–17.3]; P < 0.001), retroflexed uterus at ultrasound examination (OR 2.9 [1.0–8.3]; P = 0.047). According to multivariate logistic regression no variable added information to cervical dilatation or the station of the presenting fetal part at caesarean.

Conclusions  Caesarean in advanced labour is associated with increased risk of incomplete healing of the uterine incision as determined by transvaginal ultrasound.
Reduced birthweight in short or primiparous mothers: physiological or pathological?
Authors: Zhang X , Mumford SL , Cnattingius S , Schisterman EF , Kramer MS
Published: July 2010

Please cite this paper as: Zhang X, Mumford S, Cnattingius S, Schisterman E, Kramer M. Reduced birthweight in short or primiparous mothers: physiological or pathological?. BJOG 2010;117:1248–1254.

Objective  Customisation of birthweight‐for‐gestational‐age standards for maternal characteristics assumes that variation in birth weight as a result of those characteristics is physiological, rather than pathological. Maternal height and parity are among the characteristics widely assumed to be physiological. Our objective was to test that assumption by using an association with perinatal mortality as evidence of a pathological effect.

Design  Population‐based cohort study.

Setting  Sweden.

Population  A total of 952 630 singletons born at ≥28 weeks of gestation in the period 1992–2001.

Methods  We compared perinatal mortality among mothers of short stature (<160 cm) versus those of normal height (≥160 cm), and primiparous versus multiparous mothers, using an internal reference of estimated fetal weight for gestational age. The total effects of maternal height and parity were estimated, as well as the effects of height and parity independent of birthweight (controlled direct effects). All analyses were based on fetuses at risk, using marginal structural Cox models for the estimation of total and controlled direct effects.

Main outcome measures  Perinatal mortality, stillbirth, and early neonatal mortality.

Results  The estimated total effect (HR; 95% CI) of short stature on perinatal death among short mothers was 1.2 (95% CI 1.1–1.3) compared with women of normal height; the effect of short stature independent of birthweight (controlled direct effect) was 0.8 (95% CI 0.6–1.0) among small‐for‐gestational‐age (SGA) births, but 1.1 (95% CI 1.0–1.3) among non‐SGA births. Similar results were observed for primiparous mothers.

Conclusions  The effect of maternal short stature or primiparity on perinatal mortality is partly mediated through SGA birth. Thus, birthweight differences resulting from these maternal characteristics appear not only to be physiological, but also to have an important pathological component.
The relationship between urethral mobility and parity
Authors: Dickie KJ , Shek KL , Dietz HP
Published: July 2010

Please cite this paper as: Dickie K, Shek K, Dietz H. The relationship between urethral mobility and parity. BJOG 2010;117:1220–1224.

Objective  Urethral mobility is associated with stress urinary incontinence (SUI) and urodynamic stress incontinence, and this is particularly true for mid‐urethral mobility. The purpose of this study was to determine whether there is a significant relationship between segmental urethral mobility and vaginal parity in women undergoing urodynamic testing for prolapse or lower urinary tract symptoms.

Design  Retrospective study.

Setting  Tertiary referral service for multichannel urodynamic testing.

Population  Women undergoing urodynamic testing for lower urinary tract symptoms or pelvic organ prolapse.

Methods  The stored 3D translabial ultrasound volume data sets of 648 women were assessed. Measurements were performed using post‐processing software in volumes obtained at rest and on maximal Valsalva manoeuvre. Analysis was based on a co‐ordinate system using the dorsocaudal margin of the pubic symphysis. The urethral length was traced and divided into five equal segments. Mobility vectors are determined by the formula √[(yV − yR)2 + (xV − xR)2], where V indicates Valsalva and R indicates rest, with ‘x’ as the vertical distance and ‘y’ as the horizontal distance from the dorsocaudal margin of the pubic symphysis.

Main outcome measures  Mobility vector lengths.

Results  The distal urethra is consistently the least mobile part of the organ, regardless of parity. Vaginal childbirth seems to increase urethral mobility by about 20% for all urethral segments (all P ≤ 0.009). The first vaginal delivery showed the greatest effect, particularly on mid‐urethral mobility.

Conclusions  There is a significant association between urethral mobility and vaginal delivery in women seen for symptoms of pelvic floor dysfunction, affecting all segments of the urethra equally. Most of this effect seems to result from the first vaginal birth.
The multidisciplinary colposcopy meeting: recommendations for future service provision and an analysis of clinical decision making
Authors: Palmer JE , Wales K , Ellis K , Dudding N , Smith J , Tidy JA
Published: July 2010

Please cite this paper as: Palmer J, Wales K, Ellis K, Dudding N, Smith J, Tidy J. The multidisciplinary colposcopy meeting: recommendations for future service provision and an analysis of clinical decision making. BJOG 2010;117:1060–1066.

Objective  In 2004 the NHS Cervical Screening Programme (NHSCSP) recommended that multidisciplinary meetings should be incorporated into patient management. No data has been provided since then regarding its functionality or benefits. We aim to address this issue.

Design  Retrospective review.

Setting  Jessop Wing colposcopy multidisciplinary meeting (MDM), Sheffield, UK.

Population  All women referred to the MDM from September 2003 to September 2009.

Methods  Retrospective review of the colposcopy database (Sept 2003–Sept 2009), cross‐referenced with multidisciplinary team (MDT) letters, patient notes and the hospital results reporting system. Baseline statistics were used for data analysis.

Main outcome measures  Indications for MDT referral; concordance rates from cytopathology and histopathology review; concordance rates between MDT treatment decisions and final patient management.

Results  A total of 535 cases were discussed at 62 MDT meetings during the allocated study period. Discrepancy between referral cytology and cervix punch biopsy was the most common referral (49%). Cytology and histology review concurred with the initial reports in 75.8 and 97.8% of cases, respectively; the MDT decision was concordant with the final patient management in 97% of cases. The main reason for discordance (67%) resulted from patient factors.

Conclusions  When significant discrepancies exist between colposcopy, cytology and histopathology, then MDT discussion seems pertinent as MDT discussion can lead to the avoidance of over‐treatment. To improve timeliness of treatment, MDT meetings should occur at least monthly. The results of each case discussion should be recorded in the patient case notes, the minutes of each meeting should be circulated to all MDT members and a letter describing MDT recommendations must be sent to the colposcopist responsible for patient care.
Audiocardiography in the cardiovascular evaluation of the morbidly obese
Authors: McCullough Peter A. , Zerka Melissa , Heimbach Esther , Musialcyzk Maria , Spring Thomas , DeJong Adam , Jafri Syed S. , Coleman Catherine , Washington Tamika , Raheem Shaheena , Vanhecke Thomas , Zalesin Kerstyn C.
Published: July 2010

Morbid obesity is believed to limit cardiovascular auscultation. We compared audiocardiography to senior attending physicians using conventional stethoscopes in 190 individuals with morbid obesity. Overall, there were 128 (67·4%) women and 62 (32·6%) men with mean ages of 44·9 ± 12·3 and 51·3 ± 10·8 , respectively (P = 0·001). The overall body mass index (BMI) was 47·3 ± 8·5 kg m−2. Of those with an S3 by audiocardiography (n = 7), one had a history of coronary artery disease (CAD), none had a history of heart failure, and one had a left ventricular ejection fraction (LVEF) <45%. The mean LVEF was 58·6 ± 9·9 versus 61·6 ± 5·3 for those with and without an S3 by audiocardiography (P = 0·16). By contrast, of those (n = 6) with an S3 by stethoscope, one had a history of CAD, two had histories of heart failure, and 3 had LVEF < 45%. The mean LVEF of those with and without S3 by stethoscope was 53·7 ± 2·3 and 61·6 ± 5·5%, respectively (P = 0·02). There were 40 (21·1%) patients with an S4 (S4 strength >5) identified by acoustic cardiography while there were 42 (22·1%) heard by the stethoscope and it was heard with both methods in nine patients (21·4% concordance). There were no significant correlations between BMI or peak oxygen consumption and S3 or S4 strength by audiocardiography. Acoustic cardiography performed with an electronic device was not helpful in assisting the cardiovascular examination of the morbidly obese. These data suggest the careful clinical exam with attention to traditional cardiac auscultation using a stethoscope in a quiet room should remain the gold standard.
What Entices the Stork? Fertility, Education and Family Payments*
Authors: DAY CREINA , DOWRICK STEVE
Published: July 2010

Developed economies, experiencing concomitant declining fertility and rising educational attainment, have introduced policies to boost fertility. We model substitution of bought‐in services for parental time in the rearing and education of children in an economy where technological progress leads households to choose fewer, but better educated, children. We analyse the effects on fertility and education of a baby bonus, paid maternity leave and child‐care subsidies. We establish conditions under which either maternity or child‐care benefits are more efficacious in raising fertility, and we establish that a lump sum baby bonus will increase fertility only if the bonus increases faster than income per capita. Policies that stimulate fertility also raise parental investment in education per child.
Role of mitochondria in contraction and pacemaking in the mouse uterus
Authors: Gravina FS , Parkington HC , Kerr KP , De Oliveira RB , Jobling P , Coleman HA , Sandow SL , Davies MM , Imtiaz MS , Van Helden DF
Published: July 2010

BACKGROUND AND PURPOSEUterine spontaneous contraction and pacemaking are poorly understood. This study investigates the role of the mitochondrial Ca2+store in uterine activity.

EXPERIMENTAL APPROACHWe investigated the effects of mitochondrial and sarco‐endoplasmic reticulum (SER) inhibitors on contraction, membrane potential (Vm) and cytosolic Ca2+concentration ([Ca2+]c) in longitudinal smooth muscle of the mouse uterus.

KEY RESULTSThe mitochondrial agents rotenone, carbonylcyanide‐3‐chlorophenylhydrazone (CCCP), 7‐chloro‐5‐(2‐chlorophenyl)‐1,5‐dihydro‐4,1‐benzothiazepin‐2(3H)‐one (CGP37157) and kaempferol decreased the force of contractions. The ATP synthase inhibitor oligomycin had no significant effect. The effects of these agents were compared with those of SER inhibitors cyclopiazonic acid (CPA), 2‐amino ethoxyphenylborate (2‐APB) and caffeine. All agents, except CPA and oligomycin, decreased contractile force. CPA and CCCP transiently increased contraction frequency, which returned to control levels, whereas rotenone, CGP37157, kaempferol and 2‐APB decreased frequency and caffeine had no significant effect. Application of the mitochondrial agents when CPA functionally inhibited stores did not change contraction frequency but, with the exception of kaempferol, decreased force. CCCP caused depolarization and maintained increase in [Ca2+]cor depolarization/transient hyperpolarization and transient increase in [Ca2+]cfor oestrus and di‐oestrus tissues respectively. Rotenone caused hyperpolarization and maintained increase in [Ca2+]c. CGP37157 and kaempferol caused hyperpolarization but no measurable change in [Ca2+]c. Application of a range of K+channel blockers indicated a role of Ca2+‐activated K+(KCa) channels in the CCCP‐ and CGP37157‐induced actions.

CONCLUSIONS AND IMPLICATIONSMitochondria have a modulatory role on uterine contractions, with mitochondrial inhibition reducing contraction amplitude and pacemaker frequency by changes in Vm, [Ca2+]cand/or Ca2+influx.
Predictors of a sustained virological response in patients with genotype 4 chronic hepatitis C
Authors: Gad Rita Raafat , Males Sylvia , El Makhzangy Hesham , Shouman Soheir , Hasan Aboubakr , Attala Mohamed , El Hoseiny Mostafa , Zalata Khaled , Abdel‐Hamid Mohamed , Fontanet Arnaud , Mohamed Mostafa K. , Esmat Gamal
Published: July 2010

Objectives: To determine the clinical, biological, virological and histological predictive factors associated with a sustained virological response (SVR) to combined interferon therapy among Egyptian patients infected by genotype 4 hepatitis C virus (HCV).

Patients and Methods: Individual data from 250 patients with genotype 4 chronic hepatitis C, treated with different regimens of combined interferon, were analysed. The primary end point was SVR defined as undetectable HCV RNA by polymerase chain reaction (PCR) 24 weeks after the end of treatment. Multivariate logistic regression analysis was performed to select the independent prognostic parameters associated with SVR.

Results: A sustained virological response was achieved among 137/250 (54.8%) patients. Baseline factors independently and negatively associated with SVR were serum α‐fetoprotein (AFP) level (above 0.3 upper limit of normal) [odds ratio (OR)=0.5, 95% confidence interval (CI): 0.2–0.8], severe fibrosis (Metavir score >F2) (OR=0.4, 95% CI: 0.2–0.8), presence of steatosis (OR=0.5, 95% CI: 0.3–0.97) and standard interferon treatment (OR=0.4, 95% CI: 0.2–0.8).

Conclusions: Among genotype 4 chronic hepatitis C patients, severe fibrosis, severe steatosis, treatment with standard interferon and a high serum AFP level were all negatively associated with SVR. Pretreatment serum AFP level should be considered in the routine assessment of factors predictive of a treatment response.
Treatment for Mechanical Valve Thrombosis in the Right Heart: Combined Pharmacological and Mechanical Thrombolysis
Authors: Aoyagi Shigeaki , Fukunaga Shuji , Teshima Hideki
Published: July 2010

We report clinical results of combined pharmacological and mechanical thrombolysis for mechanical prosthetic valve thrombosis (PVT) in the right heart. Between January 1992 and December 2008, combined thrombolysis, which consisted of an intravenous infusion of urokinase together with mechanical disruption of thrombus in a prosthetic valve by temporarily increasing the cardiac pacing rate, was performed in three patients with four cases of mechanical PVT in the right heart. The prosthetic valve in all three patients was a bileaflet mechanical valve, and was located in the tricuspid position in two patients and in the pulmonary position in the remaining patient. PVT was diagnosed by echocardiography and cineradiography. Thrombolysis was successful in all four cases in the three patients, and no hemorrhagic complications or clinically symptomatic pulmonary embolisms were observed. Mechanical disruption of thrombus using a pacemaker appears to be an effective adjunctive modality to thrombolysis with fibrinolytic agents for PVT in the right heart. Combined pharmacological and mechanical thrombolysis may improve success rates and reduce the time required for thrombolysis of PVT.
Conversion to Sirolimus in Renal Transplant Recipients: A Single‐Center Experience
Authors: Yelken Berna , Caliskan Yasar , Ozkan Oktay , Gorgulu Numan , Yazici Halil , Turkmen Aydin , Sever Mehmet S.
Published: July 2010

Maintenance immunosuppression with calcineurin inhibitors (CNI) following renal transplantation is associated with nephrotoxicity and accelerated graft loss. Sirolimus (SRL) is a nonnephrotoxic immunosuppressive agent. We retrospectively analyzed our experience with kidney transplant recipients who were converted from CNI to SRL. A total of 58 renal transplant recipients were converted from CNI to SRL. SRL was started at a dose of 0.075 mg/kg and, at the same time, CNI dose was reduced by 50% daily for 3 days. SRL trough levels were targeted between 8 and 12 ng/mL. When target trough levels were achieved, CNI was withdrawn. The main indications for switching were posttransplant malignancies (n = 32) and chronic allograft nephropathy (CAN) (n = 10). The mean time from transplantation to conversion was 84 ± 71 months. Mean serum creatinine level was 1.63 ±  0.52 mg/dL before conversion. Serum creatinine levels at the 1, 3, 6 months, and 1, 2, 3 years after conversion were 1.64 ± 0.58 mg/dL (P = 0.67), 1.52 ± 0.53 mg/dL (P =  0.414), 1.62 ± 0.62 mg/dL (P = 0.734), and 1.48 ±  0.58 mg/dL (P = 0.065), 1.58 ± 0.53 mg/dL (P = 0.854), 1.88 ± 0.77 mg/dL (P = 0.083), respectively. Daily proteinuria levels increased from 0.04 ± 0.11 g/day at baseline to 0.55 ± 1.33 g/day (P = 0.037) after conversion, in the responders group. In the nonresponders group, baseline proteinuria was 0.13 ± 0.25 g/day, and increased to 1.44 ± 2.44 g/day after conversion (P = 0.008). SRL was discontinued in 16 patients (31%) because of the occurrence of severe side effects. The proportion of patients remaining on SRL therapy over time was 43.1% at 1 year, 15.5% at 2 years after conversion, and 10.3% at 3 years after conversion. SRL conversion may be very useful in patients suffering from neoplasia; however, frequent side effects related with this intervention should be considered, and routine conversion from CNI to SRL to reduce nephrotoxicity should be discouraged.
Capsule Thickness Correlates With Vascular Density and Blood Flow Within Foreign‐Body Capsules Surrounding Surgically Implanted Subcutaneous Devices
Authors: Bartoli Carlo R. , Nadar Menaka M. , Godleski John J.
Published: July 2010

Medical devices implanted in subcutaneous tissue elicit wound‐healing events that encapsulate the device. To investigate the foreign‐body response to devices of clinically relevant size, we studied the relationship between capsule thickness, vascular density, and blood flow within the capsule. In nine canines, we implanted 40 subcutaneous devices (polysulfone n = 14, titanium n = 17, silicone‐coated n = 9). Devices and surrounding tissue structures were harvested at 208 ± 142 (mean ± standard deviation) days after implantation. Tissues were processed for histological analysis with light microscopy. Foreign‐body capsule (FBC) thickness and vascular density were determined. A subset of five animals was instrumented via thoracotomy for microsphere injections and reference blood sampling. In these animals, regional blood flow was determined in mL/min/g of tissue in the FBC to examine the relationship between capsule thickness and blood flow. One‐way analysis of variance and linear regression analyses were performed. The FBC thickness was 0.92 ±  0.67 mm for all devices studied and was not influenced by device material. Capsule thickness correlated with vascular density for all devices (R2 = 0.85, P < 0.0001) and for each device material (polysulfone R2 = 0.85, P < 0.0001; silicone R2 = 0.95, P < 0.0001; titanium R2 = 0.87, P < 0.0001). Capsule thickness correlated modestly with blood flow for all devices studied (R2 = 0.59, P < 0.0001) and for each device material (polysulfone R2 = 0.77, P < 0.001; silicone R2 = 0.65, P = 0.10; titanium R2 = 0.52, P = 0.03). Capsule thickness, vascular density, and blood flow were similar within individual animals but variable across animals. Material type did not influence the thickness of FBCs surrounding devices of clinically relevant size. Capsule thickness correlated strongly with vascular density and modestly with blood flow within the capsule. Individual animals exhibited variable foreign‐body responses.