bluuebunny/crossref_metadata_2025 huggingface dataset:
Scientific basis for the content of routine antenatal care I. Philosophy, recent studies, and power to eliminate or alleviate adverse maternal outcomes
Authors: Villar José , Bergsjø Per
Published: March 2008

Background. Scope and content of antenatal care programs are ritualistic rather than evidence‐based. We wanted to identify elements of antenatal care which are of proven benefit in preventing or ameliorating specific adverse outcomes in the mother: bleeding, anemia, preeclampsia, sepsis and genito‐urinary infection and obstructed labor. Methods. Review of recent literature, especially randomized controlled trials. Results and conclusions. Recent trials indicate that fewer routine visits for low‐risk women do not put pregnancies at increased risk but may lessen patient satisfaction. Bleeding in pregnancy has many causes, none of which can be eliminated through antenatal care. Risk factors can be identified by history‐taking. Counselling and advice on what to do is the best option. Anemia in pregnancy is common, especially in developing countries. Routine iron supplementation is not necessary in well‐nourished populations, but iron and folate should be provided for every pregnant woman in areas of high anemia prevalence; based on circumstantial evidence. Hemoglobin (Hb) determination as a routine test is more important late (around week 30) than early in pregnancy: high Hb is a danger signal. It is uncertain whether early detection of pre‐eclampsia will reduce the incidence of eclampsia. Recent trials do not support routine aspirin to prevent pre‐eclampsia among low risk women, nor is there evidence that anti‐hypertensive treatment of mild pre‐eclampsia will prevent more severe disease, but improved detection and care may still lead to better outcome. As to infections, urine culture and dipstick for leucocyte esterase and nitrite with subsequent treatment of positive cases will reduce the risk of pyelonephritis and appears to be cost‐effective. Serological screening and treatment of syphilis is inexpensive and cost‐effective. Obstructed labor can be anticipated in multiparas based on obstetrical history. Hospital delivery should be secured. Height of nulli‐paras should be recorded where hospital birth is not routine and a discriminatory level for hospital delivery decided locally. External version of breech lie does reduce the incidence of breech births and cesarean delivery.
Fetal breathing recorded by actocardiogram and real ‐ time ultrasonography a comparison
Authors: Malcus Peter , Razvi Khalil , Arulkumaran Sabaratnam , Ratnam Shan S.
Published: March 2008

Background. The aim of the study is to evaluate the ability of fetal actocardiogram to assess fetal breathing movements.

Methods. A descriptive study. Evaluation of the agreement between real‐time ultrasound and actocardiographic assessment of fetal breathing movements. Eleven unselected pregnancies admitted because of various pregnancy complications.

Results. In six cases the breathing pattern recorded by the actocardiogram correlated to the findings with real‐time ultrasonography. In five cases where fetal breathing was observed on the ultrasound screen, the actocardiogram did not either indicate breathing or was of an indecisive appearance. Two cases where no breathing was observed on real‐time ultrasound yielded actocardiograms without patterns typical of breathing, but with activity difficult to distinguish from breathing.

Conclusions. With the paper speed set at 3 cm/min it is possible to detect some types of fetal breathing or the absence of breathing with accuracy on the actocardiogram. However, in cases without deep and regular diaphragmatic excursions it is not possible to evaluate breathing with certainty by the actocardiogram.
Marine n‐3 fatty acid and calcium intake in relation to pregnancy induced hypertension, intrauterine growth retardation, and preterm delivery: A case‐control study
Authors: Kesmodel Ulrik , Olsen Sjúrdur Frodi , Salvig Jannie Dalby
Published: March 2008

Objective. To evaluate whether low intakes in pregnancy of marine n‐3 fatty acids or calcium increase the risk of preeclampsia, pregnancy induced hypertension, intrauterine growth retardation. or preterm delivery and whether high intakes of the above nutrients increase the risk of posuerm delivery.

Design. A case‐control nested in cohort study.

Subjects ami methods. Between 1989 and 1991 a cohort of 9.434 pregnant women was established. Horn ‐three preeclamptics. 179 women with pregnancy induced hypertension. 182 with intrauterine growth retardation. 153 delivering preterm, and 189 delivering postterm together with 256 controls were sampled for this study. Dietary information was obtained retrospectively between six months and 31/2 years after delivery using a semiquantitative food frequency questionnaire, whilst information on potential confounders was obtained from the cohort data base and analyzed by multiple logistic regression. Questions regarding marine n‐3 fatty acids and calcium intake provided the basis for categorization into three and five intake groups respectively.

Results For all live pregnancy outcomes and both nutritional factors, none of the confoun‐der‐adjusted odds ratios comparing higher intake levels with the lowest intake level were significant. Neither were Z2‐tests for trend calculated for each pregnancy outcome statistically significant (p > 0.20). Odds ratios for highest versus lowest intake levels were for n‐3 fatty‐acids 0 79 ((0.27 to 2.34 (95%CI)) for pregnancy induced hypertension. 1.00 (0.34 to 2.95) for intrauterine growth retardation, and 0.99 (0.35 to 2.74) for preterm delivery; for calcium they were 0.92 (0.33 to 2.60) for pregnancy induced hypertension. 0.77 (0.25 to 2.42) for intrauterine growth retardation, and 1.05 (0.36 to 3.10) for preterm delivery. Conclusions No associations could be detected in these data between calcium or fish intake and adverse pregnancy outcome.
Obstetric outcome of natural and assisted conception twin pregnancies is similar
Authors: Ágústsson Thórhallur , Geirsson Reynir T. , Mires Gary
Published: March 2008

Background. The risk of obstetric intervention and adverse fetal or neonatal outcome is considerably higher in multiple gestation than in singleton pregnancy. How assisted conception influences obstetric management and outcome in twin pregnancies has not been evaluated.

Methods. A survey of all twin pregnancies in Iceland and the Tayside Region, Scotland for a four year period, 1990‐93 comparing twins after assisted fertilization with natural conception.

Results. The total number of twin pregnancies was 522, of which 453 were natural conceptions and 69 assisted. The twin rate was 1:75 among natural conceptions, but 1:5 in women having assisted fertilization. Mean gestational age in both groups was 36 weeks. Elective Cesarean section was used more often in the assisted conception group (odds ratio 2.57; p = 0.003). Induction rates did not differ to any significant degree and once labor commenced, no difference was seen between assisted and natural conception twins in the mode of delivery or neonatal short term morbidity. Birthweight, gestational length and perinatal mortality rates by conventional and extended classification were not different.

Conclusion. After allowing for more frequent elective Cesarean section in the obstetric care of the assisted conception pregnancies, there was no major difference in obstetric and neonatal management or outcome between twins resulting from natural and assisted conception.
Factors influencing the reliability of oral contraceptives
Authors: Hansen Torben Høiland , Lundvall Finn
Published: March 2008

Background. The reliability of oral contraceptives (OC) is high but several known factors can potentially induce failures. The dose of estrogen (EE) has been reduced through the years. Interaction with concomitant use of other medicine is wellknown and gastroenteritis can reduce the uptake of EE. To further characterize and quantify these factors we have performed this study.

Methods. Among patients admitted for legal abortion we selected those who had taken OC (only combined preparations; gestagen‐only preparations were excluded) according to the prescription but nevertheless became pregnant. Various parameters were noted. Results. Among 8058 women 70 women were found. Twenty‐nine used three‐phased and 25 used low‐dose OC while the rest used high‐dose, two‐phased or unknown OC (four, five and seven patients respectively). Five patients used other medicine concurrently (salbutamol, astemizol, mianserin, chlorcyclizin, paradryl, carbamazepin, lithium, chlorprotoxin and imip‐ramin). Sixteen patients had symptoms of gastroenteritis at the time of conception. Forty‐nine patients had failure without any known influencing factors. There was no significant difference between the various OC used by the patients compared to sales of them in Denmark. About two‐thirds of the patients wanted to continue with OC as future prevention. Conclusions. Failure of OC is a rare event but can occur in case of concurrent gastroenteritis or use of other medicine but in many cases, however, no definite cause can be determined. The EE‐content of the various OC was not found to have any influence. Although OC‐failure had occurred two‐thirds of the patients wanted to continue the use of OC.
Cytobrush and endocervical curettage in the diagnosis of dysplasia and malignancy of the uterine cervix
Authors: Mogensen Susanne Theil , Bak Martin , Dueholm Margit , Frost Lars , Knoblauch Niels Ole , Præst Jørgen , Svanholm Hans
Published: March 2008

Background. The validity of cytobrush and endocervical curettage combined with colposcop‐ically directed biopsies in the diagnosis of cervical dysplasia and malignancy has not been evaluated in randomized trials. We aimed to elucidate the diagnostic validity of the two methods.

Methods. A prospective, randomized study of 180 consecutive patients. All patients were examined without anesthesia by colposcopically directed biopsies of the ectocervix and randomly assigned to either cytobrush or endocervical curettage. Patients with CIN 1 were investigated with the alternative method three months later. Patients with CIN 2 had a cone biopsy.

Results. One hundred and thirty‐one patients were evaluable. The sensitivity of cytobrush and endocervical curettage combined with colposcopically directed biopsies of the ectocervix was 96% and 84% (p = 0.08), respectively. The specificities of the two investigations were 95% and 88%, respectively (p=0.78). All cytobrush specimens were evaluable but because of a low recovery of endocervical material a diagnosis could not be made in 12%) of the patients examined by endocervical curettage.

Conclusion. The sensitivity of the combined use of cytobrush and biopsies of the ectocervix was equal to or higher than the sensitivity of endocervical curettage and ectocervical biopsies. The specificities of the two investigations were much alike. All cytobrush specimens were evaluable but a diagnosis could not be performed in 12% of the endocervical curettage specimens because of too little endocervical material. Furthermore, cytobrush is less inconvenient to the patient. Therefore, in the follow‐up of patients with cervical dysplasia endocervical curettage may be replaced with cytobrush.
A population study of urinary incontinence and nocturia among women aged 20‐59 years
Authors: Samuelsson Eva , Victor Arne , Tibblin Gösta
Published: March 2008

Background. The aim was to study urinary incontinence (UI) and nocturia in a female population: prevalence, effect on well‐being, wish for treatment and result of treatment in primary health care.

Methods. A postal questionnaire was sent to all women aged 20‐59 years who were scheduled for gynecological health examination by midwives in a primary health care district during one year. Questions concerning well‐being were based on the Gothenburg QOL instrument. All women with incontinence were offered treatment by a midwife and a family doctor. Results. Of the included 641 women. 491 (77%) answered the questionnaire. The prevalence of urinary incontinence was 27.7%, 3.5% having daily leakage. Nocturia occurred in 32 women (6.5%). 12 of whom were also incontinent. Self‐assessed health, sleep, fitness and satisfaction with work situation decreased significantly with increased frequency of incontinence. Well‐being was not correlated to type of incontinence. Nocturia correlated to poor health and sleep. About a quarter of the incontinent women started treatment when offered and 80% of those who completed the treatment program were subjectively improved. Wish for treatment was directly correlated to frequency of incontinence but not to type. Conclusions. Urinary incontinence and nocturia affect well‐being in a negative way. Well‐being and wish for treatment correlate to frequency of incontinence but not to type of incontinence. Most women with UI accept it; only about a quarter of incontinent women, or 6‐7% of all women in the studied age group, want treatment. Treatment of female urinary incontinence in primary health care is successful.
Hernias in trocar ports following abdominal laparoscopy
Authors: Lajer Henrik , Widecrantz Steven , Heisterberg Lars
Published: March 2008

Background. With increasing numbers of laparoscopics in gynecologic surgery as well as the use of larger trocars more post‐operative hernias can be expected. Most hernias occur as Richter' hernias without peritoneal lining and contain small or large intestines or omentum. The incidence is around 1%, but rising with increasing size of trocars. About one fourth of hernias are umbilical, the rest located extraumbilical.

Results. The diagnosis is typically based on the presence of vomiting or nausea with an extended and painful abdomen within two weeks of surgery and can be established by a small bowel series. However, the course can be prolonged and ileus can occur up to one year following laparoscopy. In the majority of cases the hernial content was small intestines or omentum.

Conclusions. In order to reduce the frequency of trocar hernias it is recommended to apply small trocars. Fascial closure must be done when trocars of 10 mm or larger have been employed and the surgeon must ensure that peritoneal tissue is not drawn into the trocar canals when removing the probes. Also, umbilical hernias must be ruled out and, if found, closure must include the complete fascial defect. There are several techniques available for fascial closure. It is concluded that all precautions including fascial suturing must be taken to reduce the 1% incidence of post‐laparoscopy hernias.
The behavior of amidolytic factor VII in smoking and non‐smoking pregnant women in relation to their gestational age
Authors: Devies Ingrid E. C. , Ubachs Hans M. H. , van Wersch Jan W. J.
Published: March 2008

Objective. Aim of the study was to assess the behavior of factor VII by commercial amidolytic assay in smoking and non‐smoking pregnant women, and to compare this with the earlier reported factor VII: C levels during pregnancy and to discuss the role of F VII: Am with regard to thromboembolic complication in smoking pregnant women.

Methods. Blood samples were obtained for 75 non‐smoking pregnant women and 109 smoking pregnant women. For the chromogenic determination of F VIFAm a COA‐Set F VII test kit from Kabi Vitrum was used. Correlations were calculated by the Spearman rank method. The Mann‐Whitney‐U test was used for the statistical comparison of the median values of the smoking and non‐smoking groups.

Results. Both the smoking and non‐smoking group displayed a significant increase of F VII: ‐Am with gestational age (r=0.53; p<0.0001 for smokers and r=0.55; p=0.005 for non‐smokers). The median concentration of F VII: Am was significantly higher in stage 3 (226%‐211%) and stage 4 (262%‐230%) in the smoking group.

Conclusion. As elevated F VII: C levels have been described to be a risk factor for thrombotic events, the even higher than normally already enhanced plasma levels of FVII: Am in smoking pregnant women may indicate an additional risk for both thrombosis in the pregnant and for an increased fetal morbidity and even mortality caused by thrombotic processes in the uteroplacental vasculature. The results from the present study might be an extra argument to advise pregnant women not to smoke or to quit smoking during pregnancy.
Umbilical cord blood sampling — a tool for delivery quality control?
Authors: Bulkmans Nicole , Lyrenas Sven , Hallberg Gunilla , Niklasson Frank
Published: March 2008

Background. Regular cord blood analysis post partum is regarded by many as one of the most accurate and objective methods of auditing intrapartum care. Emergency cesarean sections and ventouse deliveries, due to the threat of asphyxia, are examples where post partum acid base data from the umbilical artery ought to be a must. The possibility of having cord blood analyses as a routine at all deliveries was investigated in this study.

Methods. During a two month period blood samples were drawn from both the umbilical artery and vein at all vaginal deliveries and cesarean sections between 8 am and 4 pm. Samples were analysed for a complete acid base status and lactate concentration.

Results. True paired artery‐venous samples for acid base data and lactate concentrations were obtained from 48% of the women. Sampling was especially difficult after emergency cesarean section and vaginal twin deliveries. Lactate analyses gave the same information about the metabolic state of the newborn as did BEecf.

Conclusions. Cord blood acid base data are a superior method of retrospective analyses of CTG‐tracings and partographs within a quality control program relating to intra partum care. However, routines for cord blood sampling must be well established in both the delivery room and in the operating theater to obtain samples from the umbilical artery in cases of threatening intrapartum asphyxia. A graph for easy post partum documentation and interpretation of acid base data is introduced.
Psychological adjustment of infertile women entering IVF treatment: Differentiating aspects and influencing factors
Authors: Bringhenti Franco , Martinelli Franca , Ardenti Rossella , Battista La Sala Giovanni
Published: March 2008

Objective. To evaluate the psychological adjustment of infertile women compared with a control group of mothers and to determine which personal or marital factors influence the amount of emotional disorders in the infertile group.

Design. Cross‐sectional questionnaire study with a group of infertile women and a group of mothers attending a routine gynecological examination.

Setting. Infertile women and mothers received the questionnaires after a psychological or medical examination respectively, at a Sterility Center in a Department of Obstetrics and Gynaecology.

Participants. One hundred and twenty‐two infertile women, entering an IVF program, and 57 mothers attending a routine care visit.

Main outcome measures. Stressful events, self‐esteem, job and marital satisfaction, care and control measures of intimate bond, state‐trait anxiety, depression, psychophysiological symptoms and global emotional factor scores.

Results. The organic infertile group was higher than mothers on satisfaction with their relationship with their husbands, perception of care and state‐anxiety. The emotional factor scores of infertile women, controlled for stressful events, were influenced by a) number of IVF‐cycles and availability for adoption, b) job position, job satisfaction and self‐esteem, c) personality dimensions. State and trait anxiety scores were influenced by the level of global marital satisfaction.

Conclusions. Infertile women, entering an IVF treatment program, do not necessarily show signs of psychological maladjustment. Their level of state‐anxiety can be considered a situational response to the treatment stress. The infertility condition and its treatment can be effectively dealt with by women having a good personality disposition, a high level of self‐esteem, who are satisfied with their job and relationship with their husband, and who are willing to adopt a child as a last solution for their maternal need.
The prevalence and severity of climacteric symptoms and the use of different treatment regimens in a Swedish population
Authors: Stadberg Elisabeth , Mattsson Lars‐Åke , Milsom Ian
Published: March 2008

Objectives. To determine (i) the prevalence and severity of climacteric symptoms, and (ii) the prevalence of treatment for climacteric complaints, in a population based, random sample of Swedish women aged 46–62 years.

Material and methods. A random sample of 5990 women from the birth cohorts 1946 1942 1938 1934 and 1930. resident in the city of Göteborg, was obtained from the population register. The women were invited by letter to complete a questionnaire concerning general health, reproductive history, climacteric symptoms (severity graded on a scale 0,1,2,3) and the treatment of climacteric complaints. The overall response rate was 76%.

Results. The prevalence of climacteric symptoms was as follows: vasomotor symptoms 53%, depression irritability 57%. sleeping disturbance 52%, muscle/joint pain 57%, loss of libido 37”, and vaginal dryness 21%. Hormone replacement therapy (HRT) with medium potency estrogens was currently being used by 13.4% and 7.7% were using low potency estrogens. Medium potency estrogens had previously been used by 14% and 6% had used low potency estrogens. HRT was reported to be effective against the most common climacteric complaints in 70%‐90%. Non‐hormonal treatment regimens had been used by 45% of the women and 31–63%. reported a positive effect on climacteric symptoms.

Conclusions. Although the majority of peri‐ and postmenopausal women reported suffering from climacteric complaints only 21% were current users of estrogens. Non‐hormonal treatment modalities had been used by 45% of the women and were reported to have a good effect on climacteric symptoms in 45% compared to up to 90% of the HRT users.
Intrauterine administration of levonorgestrel 5 and 10 μg/24 hours in perimenopausal hormone replacement therapy
Authors: Wollter‐Svensson Lars‐Olof , Stadberg Elisabeth , Andersson Kerstin , Mattsson Lars‐Åke , Odlind Viveca , Persson Ingemar
Published: March 2008

Objective. To investigate the clinical effects especially with regard to histopathology and bleeding patterns by levonorgestrel (5‐ or 10 ug/24 h) released from an intrauterine system (IUS) in combination with estradiol valerate (2 mg) given daily or transdermal estradiol (50 μg/24 h) in perimenopausal women.

Design. A prospective randomized single blind comparison during twelve months.

Subjects. One hundred and twelve perimenopausal women with vaso‐motor symptoms. Outcome measures. Histopathological assessment of the endometrium, ultrasonographic measurement of endometrial thickness, bleeding patterns, and acceptability.

Results. A total of 108 women started the study and 12 discontinued. The most common reason for discontinuation was frequent bleeding (six women). Thus, 96 (89%) women were followed for twelve months. In both the 5‐ and 10 ug levonorgestrel IUS groups the endometrium in all women but one was non‐proliferative after twelve months and no case of hyperplasia was found. Irregular bleeding was reported during the first months of treatment but decreased after six months. At the end of the study 62% in the 5 μg‐ and 61% in the 10 μg group were amenorrhoic. The effects on bleeding patterns did not differ between the two levonorgestrel dosages.

Conclusion. Continuous combined HRT was well accepted in perimenopausal women when the progestogen was given in an IUS. IUS's releasing 5‐ or 10 μg/24 h levonorgestrel seemed to minimize the progestogenic side effects and proved to be sufficient for effective prevention of endometrial stimulation by estrogen treatment in HRT in perimenopausal women.
Pelvic floor findings in urinary incontinence results of conditioning using vaginal cones
Authors: Fischer Wolfgang , Linde Astrid
Published: March 2008

Background. Conservative treatment of urinary incontinence (UI) may be more reliable if it is associated with improved testing of pelvic floor function. The results of cone training in patients and healthy controls are compared.

Methods. Voluntary contractions of pelvic floor muscles in 16 women with genuine stress incontinence, 14 with mixed stress/urge incontinence, and eight healthy controls were assessed by digital transvaginal palpation, manometry, and inspection using the so‐called speculum‐lift test. In addition, the capability to hold vaginal cones was investigated. All examinations were done before and after four‐week cone training (Femcon® 20–70 g).

Results. Prior to cone training, no pelvic floor response was recordable from eight women (27%) by palpation and from seven women (23%) by inspection. After training, contractions were restored in all women. The best post‐training results were obtained by palpation (27 positive responses), followed by manometry (25 women, 83%), and speculum‐lift test (13 women, 43%). The capability to hold vaginal cones was also improved. Initial weights in 15 UI patients (50%) were lower (cone No. 1–2) than in eight healthy women (cone No. 5). Average contractility increased from 5 to 9.7 mmHg in patients and from 17.5 to 23.1 mmHg in healthy women. Twenty‐four patients (80%) were cured (57%>) or improved (23%). Twenty‐six asked for continuation of cone training.

Conclusions. Pelvic floor conditioning with vaginal cones is a good alternative to poor acceptance or insufficient availability of conventional exercises.
Immunohistochemical analysis of insulin‐like growth factor I, insulin‐like growth factor I receptor and insulin‐like growth factor II in endometriotic tissue and endometrium
Authors: Chang Shiuh Y. , Ho Yat‐Sen
Published: March 2008

Background. The purpose of this study was to investigate unprecedentedly immunohistochemical localization of insulin‐like growth factor I, insulin‐like growth factor I receptor and insulin‐like growth factor II in endometriotic tissue, and to compare staining intensity with that of endometrium obtained simultaneously.

Methods. Endometriotic and corresponding endometrial tissue samples were obtained during operative laparoscopy from eighteen infertile patients for the problem of infertility. Semiquantitative scoring was used for analysis of results.

Results. It was demonstrated that insulin‐like growth factor I and insulin‐like growth factor I receptor were present in both endometriotic and endometrial tissues. In contrast, there was little insulin‐like growth factor II present in either ectopic or eutopic endometrial tissue. For insulin‐like growth factor I and insulin‐like growth factor I receptor, the immunostaining score was similar between ectopic and eutopic endometrial tissues. There was no significant difference in immunostaining score between glandular epithelium and stromal cells. Conclusions, insulin‐like growth factor I and insulin‐like growth factor I receptor could be demonstrated immunohistochemically in both endometriotic and endometrial tissues.
Conservative management of twin pregnancies with one dead fetus: is it safe?
Authors: Zorlu C. Gürkan , Yalçin Hakan R. , Claglar Turhan , Gökmen Oya
Published: March 2008

Background. Fetal death in one of the twins is unusual and the management issue of such a condition is not straightforward.

Methods. We reviewed the outcomes of nine twin pregnancies with one dead fetus in whom follow‐up period exceeded 3 weeks.

Results. The twinning frequency was 8.9 per thousand deliveries and the frequency of subsequent antepartum death of one fetus was found to be 3.8%. The preterm birth rate was 45.5%and the survival rate was 90.1%. The perinatal mortality rate was 12%. Maternal clotting disorder was observed in one patient and treated successfully with heparin. Conclusions. We suggest that these patients are best managed conservatively unless further hazard to the fetus or mother appears.
Three‐year follow‐up of the use of a levonorgestrel‐releasing intrauterine system in hormone replacement therapy
Authors: Suhonen Satu , Holmström Teddy , Lähteenmäki Pekka
Published: March 2008

Background. The efficacy of a levonorgestrel‐releasing intrauterine system in opposing endometrial proliferation and in preventing bleeding was studied in peri‐ and postmenopausal women receiving estrogen replacement therapy.

Methods. This was an open, non‐controlled follow‐up study of the use of a levonorgestrel‐releasing intrauterine system during continuous estrogen replacement therapy carried out by using oral, transdermal or subdermal estradiol. The efficacy of the progestin therapy was evaluated by transvaginal ultrasonography and by examination of endometrial biopsy samples taken 20 months (mean, range 17–22; first evaluation) and 34 months (mean, range 31–38 months; second evaluation) after insertion of the levonorgestrel‐releasing intrauterine system, and by studying patterns of bleeding. Twenty‐five women participated in the first evaluation, and 29 in the second.

Results. Seventy‐six percent of the women were amenorrheic at the first evaluation, and 79% at the second evaluation. Others had spotting for 1–2 days monthly or less often. The mean time until amenorrhea was reached was 6 months (range 2–13 months) after insertion of the levonorgestrel‐releasing intrauterine system. The median endometrial thickness assessed by ultrasound was 2 mm at both evaluations. No signs of proliferation were observed in any of the endometrial samples.

Conclusions. Local progestin delivery via a levonorgestrel‐releasing intrauterine system was effective in suppressing the endometrium and in eliminating bleeding in women receiving estrogen replacement therapy, and the intrauterine progestin therapy was also well accepted.
Evaluation of induced abortion as a risk factor for ectopic pregnancy: A case‐control study
Authors: Skjeldestad Finn Egil , Atrash Hani K.
Published: March 2008

Objective. To assess the risk of ectopic pregnancy after one or more induced abortions. Design. Population‐based case‐control study.

Methods. We studied all women who had a histologically verified ectopic pregnancy in one Norwegian county between January 1, 1987, and December 31, 1990. We identified population‐based control sets of women among participants in the second Norwegian fertility study (1988–1989). Gravida women 20–39 years of age, who were not using contraceptives and had become spontaneously pregnant, were eligible for analysis. The final analyses included 174 women with ectopic pregnancy, 115 pregnant control women and 227 nonpregnant control women.

Statistical methods. Chi‐square test and unconditional logistic regression. Results. Fifty‐three (30.5%) of women with ectopic pregnancy, 18 (15.7%) of pregnant control women and 51 (22.5%) of nonpregnant control women had had one or more previous induced abortions. The adjusted odds ratio of ectopic pregnancy among women with one previous induced abortion was 1.3 (95% confidence interval; 0.9 to 1.8) and 1.2 (95% CI; 0.8 to 1.7) compared with pregnant and nonpregnant control women, respectively. Among women who had two or more induced abortions, the adjusted odds ratio of ectopic pregnancy was 0.2 (95%< CI; 0.04 to 0.9) compared with pregnant control women and 1.8 (95% CI; 0.4 to 7.8) compared with nonpregnant control women. When we used the outcome of the most recent pregnancy, birth as reference, we found no association between an outcome of induced abortion and subsequent ectopic pregnancy regardless of whether the control women were pregnant.

Conclusion. We found no association between induced abortion and subsequent ectopic pregnancy. Women who had induced abortions were characterized as having several other risk factors for ectopic pregnancy.
The problem of skipped generation and subclinical disease in familial breast‐ovarian cancer
Authors: Dørum Anne , Abeler Vera M. , Heimdal Ketil , Tropé Claes , Møller Pål
Published: March 2008

Background. The major gene for inherited breast ovarian cancer families shows high penetrance in female carriers. Daughters of living unaffected women in these families are supposed to have a low risk of cancer. Linkage analyses may be used to determine the probability that such families are linked to BRCA1 and, subsequently, to identify mutation carriers in such families. Linkage analyses are dependent upon correct diagnoses of all family members. Methods. We report one breast‐ovarian cancer family, prospectively observed, in which a mother and her daughter contracted ovarian and breast cancer almost simultaneously. Linkage analyses indicated that they both had the same BRCA1 mutation. The mother's sister had a possible premalignant lesion at oophorectomy.

Discussion. We discuss the problems raised by the pathological classification of possible premalignant lesions, that linkage analyses are sensitive to misclassification of diagnoses, and probability for skipped generation.
Laparoscopic management of adnexal mass during pregnancy
Authors: Yuen Pong Mo , Chang Allan M. Z.
Published: March 2008

Background. To assess the use of laparoscopy in the management of persistent adnexal mass during the second trimester of pregnancy.

Subjects. Six consecutive pregnant women undergoing laparoscopic surgery for persistent adnexal masses in the second trimester.

Results. Laparoscopic removal of an adnexal mass was successfully performed in all patients. The median operating time was 37.5 minutes. There were no intra‐ and post‐operative complications. Tocolytic therapy was not required and no patients developed uterine contractions. All patients delivered normal infants vaginally at term without complications. Conclusion. With attention to the surgical technique, laparoscopic removal of persistent adnexal mass during the second trimester of pregnancy is safe and carries the same benefits over laparotomy as in non‐pregnant women.
Malignant tumors of the ovary or the breast in association with infertility: a report of thirteen cases
Authors: Unkila‐Kallio Leila , Leminen Arto , Tiitinen Aila , Lehtovirta Pentti , Wahlstrom Torsten , Ylikorkala Olavi
Published: March 2008

Background. Many questions have been raised recently about the relationship between infertility, fertility drugs and cancer. This prompted us to evaluate our patients having ovarian or breast cancer with a known history of infertility.

Methods. We report thirteen women who had been examined and/or treated for infertility before the occurrence of malignant tumors of the ovary or the breast at an age under 50 years in 1990–1995 in our unit.

Results. Mean age of the patients was 35 years (s.d. 5.9 years, range 28–47 years). Of the 11 ovarian tumors, one was a malignant teratoma, two were granulosa cell tumors and eight epithelial ovarian cancers. Ten women had received either clomiphene citrate alone or together with gonadotrophins, one had used only gonadotrophins, and in two patients ovarian cancer was detected during an infertility work‐up but before any treatment. Four women had used clomiphene for more than twelve cycles. Two patients had ductal breast cancer. Conclusions. Our patients emphasize the need for follow‐up and long‐term prospective studies in infertile women who have been evaluated or treated for infertility.
2007 – An Excellent Year for Molecules and a Look Forward to 2008
Authors: McPhee Derek , Lin Shu-Kun
Published: March 2008

As already anticipated in August 2007 [1], the year that just concluded proved to be a truly outstanding one for MDPI's flagship journal Molecules.[...]
Poly(3‐alkylthiophene)s as anticorrosive additive for paints: Influence of the main chain stereoregularity
Authors: Iribarren José I. , Ocampo Cintia , Armelin Elaine , Liesa Francisco , Alemán Carlos
Published: March 2008

The influence of the main chain stereoregularity on the properties of poly(3‐decylthiophene‐2,5‐diyl) as anticorrosive additive of conventional organic coatings have been examined. For this purpose a small concentration (0.3% w/w) of regiorandom and regioregular conducting polymers were added to alkyd, epoxy, and polyurethane paints typically used in marine environments. The Young's modulus and the elongation at break of the alkyd and epoxy coatings modified with the regiorandom conducting polymer were significantly better than those of the films generated with the original paints, evidencing a very favorable interaction between the additive and the resins. On the other hand, the anticorrosive properties imparted by the modified paints are better when the conducting polymer is regiorandom than when it is regioregular, although even the degree of protection provided by all the modified coatings was higher than that of the original ones. © 2008 Wiley Periodicals, Inc. J Appl Polym Sci, 2008
Solid‐phase microextraction and ion chromatographic analysis of anions based on polypyrrole electrode
Authors: Şahin Yücel , Ercan Betül , Şahin Mutlu
Published: March 2008

The polypyrrole (PPy) film was used for the selective extraction of trace levels of chloride, nitrite, and nitrate ions by solid phase micro‐extraction (SPME). PPy film was electrochemically prepared from aqueous solutions of pyrrole and LiClO4 under N2 atmosphere at constant potential of +0.80 V (versus Ag/AgCl). The anion uptake and release properties of the PPy film electrodes were examined under both open circuit and controlled potential conditions for prospective applications in electrochemically controlled solid‐phase microextraction (EC‐SPME). Applied positive and negative potentials facilitated the extraction and desorption of anions, respectively. Ions were desorbed into sample aliquot and were determined by ion chromatography (IC). The effect of uptake/release parameters, potential, time, pH of the uptake solution, on EC‐SPME of anions was investigated. The method was validated using a standard reference material and tested for the determination of the ions in water samples. © 2008 Wiley Periodicals, Inc. J Appl Polym Sci, 2008
Impact of impregnation chemical on surface glossiness of synthetic, acrylic, polyurethane, and water‐based varnishes
Authors: Keskin Hakan , Atar Musa
Published: March 2008

This study was performed to determine the effects of impregnation chemical on surface glossiness of some varnishes. For this purpose, the test samples prepared from Oriental beech, European oak, Scotch pine, Oriental spruce, and Uludag fir woods according to ASTM D 358 were impregnated with Imersol‐Aqua according to ASTM D 1413 and producer's definition by short‐term (S), medium‐term (M), and long‐term (L) of dipping methods and coated by synthetic (Sv), acrylic (Ac), water‐based (Wb), and polyurethane (Pu) varnishes according to ASTM D 3023. After the varnishing process, the surface glossiness parallel to fibers was determined according to TS 4318. Consequently, among the nonimpregnated wood samples, surface glossiness parallel to fibers was found to be the highest in Oriental spruce and the lowest in European oak. As for the period of dipping, the highest surface glossiness was obtained in medium‐term dipping and the lowest in long‐term dipping. As for the varnish types, the surface glossiness was found to be the highest in polyurathane varnish and the lowest in water‐based varnish. Considering the interaction of wood type, period of impregnation, and type of varnish, surface glossiness was the highest in Uludag fir, long‐term dipping, and polyurathane varnish (103.9 gloss) and the lowest in Oriental beech, long‐term dipping, and water‐based varnish (67.78 gloss). In consequence, in the massive constructions and furniture elements the surface glossiness parallel to fibers after the impregnation with Imersol‐Aqua is of great concern, long‐term impregnation of Uludag fir materials could be recommended. © 2008 Wiley Periodicals, Inc. J Appl Polym Sci, 2008
Hydrophobic properties of new epoxy‐silica hybrids
Authors: Cardiano Paola
Published: March 2008

New products to be employed as coatings for construction materials have been synthesized. Room temperature blending of poly(bisphenolA‐co‐epichlorohydrin), glycidyl endcapped (DGEBA) and 3‐aminopropyl‐methyldiethoxysilane (AMTS), as well as of DGEBA, (3‐glycidyloxypropyl)trimethoxysilane (GLYTS) and AMTS, in CHCl3, employing different stoichiometric ratios, leads to transparent and crack free solids. The extent of epoxy cleavage during the hardening reaction and the hydrolysis of the Si(OR)x groups have been followed by 13C NMR spectroscopy in solution; the solids have been characterized by means of Raman, FTIR, and TG‐DTA studies. The hydrophobic properties of the resulting solids have been investigated by contact angle measurements on coated glass slides, and have been tailored by adding to the above mixtures two fluorine‐containing comonomers, namely glycidyl‐2,2,3,3,4,4,5,5,6,6,7,7,8,8,9,9‐hexadecafluorononyl ether (GLY16F) and 3,3,3‐trifluoropropyl‐trimethoxysilane (TFP‐TMS). Preliminary tests to evaluate the efficacy of the above products, as construction materials coatings, have been carried out by means of mercury intrusion porosimetry and water absorption by the wicking method. © 2008 Wiley Periodicals, Inc. J Appl Polym Sci, 2008
Effect of β‐nucleating agents on crystallization and melting behavior of isotactic polypropylene
Authors: Xiao Wenchang , Wu Peiyi , Feng Jiachun
Published: March 2008

Two kinds of β‐nucleating agents, named a rare earth complex (WBG) and a N,N′‐dicyclohexylterephthalamide (TMB5), were introduced into isotactic polypropylene (iPP), and their effect on crystallization and melting behavior of iPP was comparatively investigated. Wide angle X‐ray diffraction measurements revealed that both the two additives were highly effective in inducing β modification. At their respective optimum concentrations of 0.08 wt % for WBG and 0.06 wt % for TMB5, the relative amount of β‐form calculated by Turner‐Jones equation both exceeds 92%. However, the isothermal crystallization kinetics investigated by differential scanning calorimetry demonstrated that WBG had more pronounced effect than TMB5 in accelerating the overall crystallization rate. The Lauritzen–Hoffman theory analysis also revealed that WBG was more effective not only in increasing the nucleus number but also in accelerating the growth rate of crystallization. After completing isothermal crystallization process, the subsequent melting behavior examination suggested that the addition of WBG expanded the upper limit temperature of forming β modification, and therefore was more effective in delaying the β‐α transformation than TMB5. © 2008 Wiley Periodicals, Inc. J Appl Polym Sci, 2008
Tracking change in a human‐dominated landscape: developing conservation guidelines using freshwater fish
Authors: Carey Michael P. , Mather Martha E.
Published: March 2008

To conserve biodiversity in a human‐dominated landscape, a science‐based inventory and monitoring plan is needed that quantifies existing resources, isolates drivers that maintain natural communities, determines harmful stressors, and links ecological drivers and human stressors. A tactical approach is proposed for conservation planning using freshwater fish at the Cape Cod National Seashore.

Freshwater fish are well studied and occur across environmental gradients. The lentic systems at the national park are relatively pristine yet are enveloped by a region of high population density. Using fish community data, three steps were taken for tracking anthropogenic impacts in a human dominated landscape. First, fish and potential drivers were sampled intensively along a gradient to determine which fish metrics reflect natural communities and which abiotic and biotic factors structure them. Second, emerging and existing regional human threats were identified. Third, these human threats were linked to the potential drivers that maintain natural communities to identify the most informative metrics to monitor and track change.

Fish communities, water quality, habitat, and food resources were sampled concurrently in 18 ponds in 1999 and 2000. Three common fish species explained 98% of variation in numbers across systems. Based on ecological relationships, pH, depth, vegetation, prey, and community complexity were determined to maintain biodiversity of freshwater fish communities.

The primary human threats here included: development‐related, land‐use changes; non‐point source pollution; eutrophication from septic systems; and introduced species that are a byproduct of high human visitation. These are common threats in many rapidly urbanized areas and are likely to have relevance to many sites.

To track the impact of emerging threats to freshwater ponds related to increased human population, monitoring changes in water quality, vegetated habitat, fish diversity, and trophic interactions are recommended.

Copyright © 2008 John Wiley & Sons, Ltd.
Hierarchical summarization of large documents
Authors: Yang Christopher C. , Wang Fu Lee
Published: March 2008

Many automatic text summarization models have been developed in the last decades. Related research in information science has shown that human abstractors extract sentences for summaries based on the hierarchical structure of documents; however, the existing automatic summarization models do not take into account the human abstractor's behavior of sentence extraction and only consider the document as a sequence of sentences during the process of extraction of sentences as a summary. In general, a document exhibits a well‐defined hierarchical structure that can be described as fractals—mathematical objects with a high degree of redundancy. In this article, we introduce the fractal summarization model based on the fractal theory. The important information is captured from the source document by exploring the hierarchical structure and salient features of the document. A condensed version of the document that is informatively close to the source document is produced iteratively using the contractive transformation in the fractal theory. The fractal summarization model is the first attempt to apply fractal theory to document summarization. It significantly improves the divergence of information coverage of summary and the precision of summary. User evaluations have been conducted. Results have indicated that fractal summarization is promising and outperforms current summarization techniques that do not consider the hierarchical structure of documents.
Comparison of SHF and SSF processes from steam‐exploded wheat straw for ethanol production by xylose‐fermenting and robust glucose‐fermenting Saccharomyces cerevisiae strains
Authors: Tomás‐Pejó Elia , Oliva Jose M. , Ballesteros Mercedes , Olsson Lisbeth
Published: March 2008

In this study, bioethanol production from steam‐exploded wheat straw using different process configurations was evaluated using two Saccharomyces cerevisiae strains, F12 and Red Star. The strain F12 has been engineerically modified to allow xylose consumption as cereal straw contain considerable amounts of pentoses. Red Star is a robust hexose‐fermenting strain used for industrial fuel ethanol fermentations and it was used for comparative purposes. The highest ethanol concentration, 23.7 g/L, was reached using the whole slurry (10%, w/v) and the recombinant strain (F12) in an SSF process, it showed an ethanol yield on consumed sugars of 0.43 g/g and a volumetric ethanol productivity of 0.7 g/L h for the first 3 h. Ethanol concentrations obtained in SSF processes were in all cases higher than those from SHF at the same conditions. Furthermore, using the whole slurry, final ethanol concentration was improved in all tests due to the increase of potential fermentable sugars in the fermentation broth. Inhibitory compounds present in the pretreated wheat straw caused a significantly negative effect on the fermentation rate. However, it was found that the inhibitors furfural and HMF were completely metabolized by the yeast during SSF by metabolic redox reactions. An often encountered problem during xylose fermentation is considerable xylitol production that occurs due to metabolic redox imbalance. However, in our work this redox imbalance was counteracted by the detoxification reactions and no xylitol was produced. Biotechnol. Bioeng. 2008;100: 1122–1131. © 2008 Wiley Periodicals, Inc.