bluuebunny/crossref_metadata_2025 huggingface dataset:
Mechanisms of resistance to imipenem in imipenem‐resistant, ampicillin‐sensitive Enterococcus faecium
Authors: EL AMIN NAGWA , LUND BODIL , TJERNLUND ANNELIE , LUNDBERG CHRISTINA , JALAKAS KIRSTI , WRETLIND BENGT
Published: October 2003

Enterococcus faecium has six penicillin‐binding proteins (PBP), where PBP5 seems to be the main target for β‐lactam antibiotics. The PBP profiles of three imipenem‐resistant, ampicillin‐sensitive E. faecium strains, isolated from the same patient, were studied using biotinylated ampicillin and chemiluminescence detection. Imipenem resistance in these strains was found to be associated with hyperproduction of PBP5 compared to the ampicillin‐ and imipenem‐susceptible strain ATCC 19434. PBP5 in the imipenem‐resistant strains (S1, B2) exhibited a selectively decreased affinity for imipenem. An 854 bp DNA fragment, corresponding to the penicillin‐binding domain of pbp5fm, was studied in the resistant strains and the reference strain. Four amino acid substitutions were observed in the resistant strains compared to the susceptible one. The contribution of these substitutions to the increased production of PBP5 in these strains is unclear since the substitution was observed also in a strain without increased production of PBP5. Our results suggest that the moderate imipenem resistance observed in these strains is associated with increased production of PBP5 with relatively decreased affinity for imipenem, and that evolution of imipenem resistance in E. faecium is dinstinct from that of the other β‐lactams such as ampicillin.
Grass allergen‐specific T‐cells of atopic patients
Authors: WÜRTZEN PETER ADLER
Published: October 2003

The prevalence of atopic diseases has increased dramatically in the Western world over the last 20 years. Further insight into the mechanisms of the allergic reaction may help in the development of new more efficient protocols for the specific treatment of allergic diseases. Until a decade ago the major focus in allergy research was on the IgE reactivity of atopic patients and the description of major allergens responsible for the allergic reactions. More recently, the important role of CD4+ T‐cells in orchestrating the production of IgE and the maturation of eosinophils through the production of IL‐4 (or IL‐13) and IL‐5 has been clearly established. This has led to the characterization of T‐cell responsiveness to numerous major allergens, demonstrating the importance of T‐cells for the allergic response of atopic patients and for the specific treatment of allergic diseases. One of the major objectives of allergy research is the development of improved treatment protocols for specific therapy. In this review our results on the T‐cell reactivity of grass allergic patients to the group 5 major allergen of the grass Phleum pratense (Phl p 5) are discussed in relation to the literature on allergen‐specific T‐cell reactivity and the specific treatment of allergic disease. Our investigations focused on three subjects: 1) Grass allergen‐specific T‐cell reactivity of atopic patients in freshly isolated PBMC cultures, 2) Phl p 5 isoallergen recognition of T‐cell lines (TCL) and clones (TCC) established from PBMC of grass allergic patients, and 3) Identification of T‐cell epitopes on Phl p 5.
Validity of wet‐mount bacterial morphotype identification of vaginal fluid by phase‐contrast microscopy for diagnosis of bacterial vaginosis in family practiceNote
Authors: SCHMIDT H. , HANSEN J. G.
Published: October 2003

The aim of this study was to determine the accuracy of a wet‐mount bacterial morphology scoring (BMS) system and Nugent's Gram stain analysis for the diagnosis of bacterial vaginosis, using Amsel's criteria as the gold standard. The three diagnostic criteria were assessed independently. The BMS diagnosis was based on a scoring system which weighed the number of small bacterial morphotypes regarded as typical of bacterial vaginosis against lactobacillary morphotypes in phase‐contrast microscopy of wet‐mount preparations. Three groups of non‐pregnant women attending either because of vaginal discharge, other genitourinary symptoms, or for a routine check‐up, and a group of pregnant women attending for antenatal care were studied. The diagnostic accuracy was measured by sensitivity, specificity, positive and negative predictive values, and likelihood ratio. The accuracy of the BMS diagnosis was substantially high in all of the examined groups (LR 15.4–20.3). The accuracy of the Gram stain diagnosis was lower (LR 7.6–10.9). In the total material, the accuracy of the BMS diagnosis was higher than that of the Nugent's Gram staining. Intra‐ and inter‐observer reproducibility of all three criteria applied was high. We propose greater routine use of the new BMS diagnosis for point‐of‐care testing in family practice as well as in research and in microbiology laboratories.
Atypical decubital fibroplasia with unusual histologyNote
Authors: FUKUNAGA MASAHARU
Published: October 2003

A case of atypical decubital fibroplasia with unusual histology arising in the buttock of a 68‐year‐old bed‐ridden male in presented. The lesion measuring 5.4 cm in greatest dimension was histologically characterized by a proliferation of fibroblasts with oval to spindle nuclei and dense fibrous stroma with focal hyalinization and calcification. Ganglion‐like fibroblastic cells and multinucleated giant cells of osteoclast type were also observed. There were numerous elastic fibers within and adjacent to the proliferating stromal cells. The proliferating stromal cells were positive for vimentin and collagen type IV but negative for CAM 5.2, epithelial membrane antigen, desmin, α‐smooth muscle actin, muscle actin, HHF35, S‐100 protein and CD34. Ultrastructurally, they were of a fibroblastic nature. The hypercellularity, lack of zones of fibrinoid necrosis, lack of lobulation and the presence of multinucleated giant cells were different from the originally described lesion. This condition represents a variant of atypical decubital fibroplasia. Pathogenic factors of this lesion are considered to be chronically repeated pressure and associated intermittent ischemia. The recognition of the lesion and its distinction from a sarcoma is essential.
Specific primer for AP‐PCR identification of Actinobacillus actinomycetemcomitans
Authors: Avila‐Campos Mario J. , Sacchi Cláudio T. , Whitney Anne M. , Steigerwalt Arnold G. , Mayer Leonard W.
Published: October 2003

Abstract. We used arbitrarily‐primed polymerase chain reaction (AP‐PCR) to design and construct a specific primer pair for the identification of Actinobacillus actinomycetemcomitans. We analyzed 25 DNA samples of A. actinomycetemcomitans isolated from patients with localized juvenile periodontitis. From 90 AP‐PCR primers screened, one amplification product was selected, cloned in pCR II vector, and sequenced. The sequence was used to design a single pair of specific primers. The sequence was compared with GenBank entries using BLAST and showed no significant matches. PCR amplification using the new primer pair AA1416 produced a characteristic 3.5‐Kb band in all A. actinomycetemcomitans DNAs tested. Primer pair AA16S produced no or different amplicon profiles using DNA samples from bacterial species other than A. actino‐mycetemcomitans. Our results show that this single primer pair AA1416 can be used in PCR to identify A. actinomycetemcomitans isolates and differentiate them typing from other periodontal bacteria. These approaches appear promising in facilitating laboratory identification and taxonomy of putative periodontopathogens.
Repeated local metronidazole‐ therapy as adjunct to scaling and root planing in maintenance patients
Authors: Bernimoulin J.‐P.
Published: October 2003

Abstract. The purpose of this investigation was to evaluate the effect of local antibiotic therapy with metronidazole adjunctively to scaling and root planing (SRP) versus mechanical treatment alone. 30 maintenance‐patients were included in this single‐blind study. The subjects had to comply with the following criteria: 2 non‐adjacent sites with a probing depth ≥6 mm with bleeding on probing in separate quadrants, no periodontal therapy within the last 3 months, and no antibiotic therapy within the last 6 months. After randomization, the study sites were assigned to one of the following 2 treatments: SRP plus subgingival application of metronidazole 25% dental gel (Elyzol®) 5× during 10 days (test site) or SRP alone (control site). Subgingival microbiological samples were taken prior to, and 21 days and 3 months after scaling. The samples were analyzed with a commercial chair‐side ELISA (Evalusite®) for Porphyromonas gingivalis, Prevotella intermedia and Actinobacillus actinomycetemcomitans. Probing pocket depth (PPD), attachment level (AL) and bleeding on probing (BOP) were recorded at baseline and 3 months later. PPD reduction and AL‐gain were statistically significant (p<0.001) after both treatments. However, there were no statistically significant differences between them. The same observation was made for BOP. P. gingivalis was reduced significantly after both treatments without statistically significant differences. P. intermedia was reduced significantly only after SRP. A. actinomycetemcomitans was not reduced significantly after either treatment. In conclusion, the repeated local application of metronidazole as an adjunct to SRP and the mechanical treatment alone showed similar clinical and microbiological effects without statistically significant differences with the exception of P. intermedia.
Expansion of the Fraction of Th1 Cells in Women with Preeclampsia: Inverse Correlation between the Percentage of Th1 Cells and the Plasma Level of PAI‐2
Authors: OHKUCHI AKIHIDE , MINAKAMI HISANORI , AOYA TOSHIO , HAGA TORU , KIMURA HIROKAZU , SUZUKI MITSUAKI , SATO IKUO
Published: October 2003

PROBLEM: The fractions of Th1 cells and Tc1 cells may be increased in preeclamptic women compared with healthy pregnant women.  METHOD OF STUDY: Eleven healthy non‐pregnant women, nine healthy pregnant women (34.1±3.1 weeks of gestation), and 10 women with preeclampsia (32.0±5.4 weeks) were studied. The fractions of Th1 cells, Th2 cells, Tc1 cells, and Tc2 cells in the peripheral blood mononuclear cells were determined using a three‐color flow cytometric technique. The concentrations of plasma plasminogen activator inhibitor‐2 (PAI‐2) were simultaneously determined.  RESULTS: The fraction of Th1 cells was significantly larger in women with preeclampsia (18.7±5.2%) than in normal pregnant women (11.0±5.7%), and it increased with a decrease in the PAI‐2 level (r=−0.706, P=0.002), which was significantly lower in preeclamptic women (83.4±46.8 ng/mL) than in normal pregnant women (225.3±82.0 ng/mL). The fraction of Tc1 cells increased with increases in the fraction of Th1 cells (r=0.657, P<0.001) and the ratio of Th1‐to‐Th2 cells (r=0.535, P=0.002). The ratio of Tc1‐to‐Tc2 cells also increased with an increase in the ratio of Th1‐to‐Th2 cells (r=0.394, P=0.031).  CONCLUSIONS: The fraction of Th1 cells appears to be expanded in women with preeclampsia compared with healthy pregnant women.
The Differential Effect of Injecting Estradiol‐17β, Testosterone, and Hydrocortisone During the Immune Adaptive Period on the Fertility of Female Mice
Authors: CHAPMAN JOHN C. , MIN SOOHONG , MICHAEL SANDRA D. , KUNAPORN SAICHOL , SHAH SAUREEN , KAIKI‐ASTARA ANASTASIA
Published: October 2003

PROBLEM: Female mice injected with estradiol‐17β (E2) and testosterone during the immune adaptive period are infertile as adults. Study 1 examined the effect of the day of injection of E2 and testosterone on the incidence of infertility in two strains of mice. Study 2 examined the effect of hydrocortisone on E2‐induced infertility. 
METHOD OF STUDY: Study 1: Neonatal (C57BL/6J×A/J)F1 B6A and (C3H/HeJ×129J)F1 C31 female mice were injected from 0 to 3 and from 3 to 6 days of age with either 20 μg E2 or 20 μg testosterone. Animals were tested for fertility by mating with fertile males. Study 2: Neonatal B6A females were injected with 20 μg E2 with/without 1000 μg hydrocortisone on days 1, 3, 5, 7, and 10. At adulthood, ovaries were examined for the presence of corpora lutea (CLs). 
RESULTS: Study 1: The incidence of E2‐induced infertility in adult B6A and C31 females decreased over three consecutive matings. In contrast, the incidence of testosterone‐induced infertility in adult B6A and C31 females increased. E2 caused the highest incidence of infertility in C31 females when injected prior to 3 days of age. In B6A mice, E2 caused the highest incidence of infertility when injected after 3 days of age. Study 2: When hydrocortisone was injected with E2, 90% of the B6A females had ovaries with CLs at 100 days of age. Without hydrocortisone, only 16% of the B6A females injected with E2 had ovaries with CLs. 
CONCLUSION: Study 1: The incidence of infertility caused by injections of E2 is dependent on the strain of mice and the day(s) injected. The incidence of infertility caused by injections of testosterone is independent of the strain of mice. Study 2: Hydrocortisone prevents E2‐induced infertility. 
It is proposed that injections of E2 during the immune adaptive period alter T‐cell maturation, which contributes to E2‐induced infertility.
Different Antiphospholipid Antibody Specificities are Found in Association with Early Repeated Pregnancy Loss Versus Recurrent IVF‐Failure Patients
Authors: MATSUBAYASHI HIDEHIKO , SUGI TOSHITAKA , ARAI TADASHI , KONDO AKANE , SUZUKI TAKAHIRO , IZUMI SHUN‐ICHIRO , MAKINO TSUNEHISA , McINTYRE JOHN A.
Published: October 2003

PROBLEM: Patients having in vitro fertilization and embryo transfer (IVF‐ET) failures show an increased incidence of antiphospholipid (aPL) antibodies; but controversy exists whether aPL can induce IVF‐failure. This study was designed to compare aPL specificities between recurrent IVF‐failure patients versus repeated early pregnancy loss (RPL) patients. 
METHOD OF STUDY: Anticardiolipin (aCL), lupus anticoagulant (LA), antiphosphatidylserine (aPS), antiphosphatidylethanolamine (aPE), and antinuclear antibodies (ANA) were measured in 74 recurrent IVF‐ET failure patients and compared with 273 early RPL patients (<10 weeks). 
RESULTS: An increased incidence of IgG‐aPE and ANA was observed for both groups in comparison with controls. Patients with recurrent IVF‐ET failure showed a significantly higher prevalence of IgG‐aPS (P=0.02) and IgG‐aCL (P=0.02) when compared with early RPL patients or controls.  CONCLUSIONS: IgG‐aPS and IgG‐aCL may be responsible for some IVF‐failures. Additional studies are needed to clarify the pathogenic role of IgG‐aPS and IgG‐aCL on IVF‐ET failure.
Expression of Integrin Receptors on Peripheral Lymphocytes: Correlation with Endometrial Receptivity1
Authors: REDDY VENKATA RAMI K. , GUPTA SADHANA M. , MEHERJI PERVIN K.
Published: October 2003

PROBLEM: To investigate the expression of integrin (ITG) cell adhesion molecules on peripheral blood lymphocytes (PBL) and their correlation with endometrial cell ITG expression in fertile and infertile women during peak uterine receptive period (day 19/20).  METHOD OF STUDY: Surface marker expression and quantification of α6, α4 and β3 ITG subunits was done by immunohistochemistry, indirect immunofluroscence and cell‐enzyme‐linked immunosorbent assay methods using endometrial cells and PBL obtained from fertile and infertile (unexplained infertility) women.  RESULTS: The expression of ITGs was significantly (P<0.001) decreased in the endometrial cells of infertile women compared to normal fertile women. These results correlated well with the data obtained using PBL‐ITG expression.  CONCLUSIONS: If these preliminary data are consistent in a larger group of patients, the expression of α4 and β3‐ITG subunits on PBL may be used as clinical markers to assess endometrial receptivity in infertile women. Moreover, frequent blood sampling is advantageous over repeated endometrial biopsies as the former approach is easier, non‐traumatic and avoids intra‐uterine infections.
Suppression of Natural Killer Cell Function and Production of Soluble ICAM‐1: Endometrial Stroma Versus Melanoma
Authors: VIGANÒ PAOLA , DI BLASIO ANNA MARIA , SOMIGLIANA EDGARDO , COZZOLINO SABRINA , CANDIANI MASSIMO , VIGNALI MARIO
Published: October 2003

PROBLEM: It has been suggested that specific mechanisms commonly used by different cellular systems to evade immunologic recognition are involved in the development of endometriosis. To gain insight into this aspect, we looked at the relationship between two of these mechanisms in endometrial stroma and the melanoma system for which the ability to create an environment of immune privilege has been well established.  METHOD OF STUDY: Media conditioned by endometrial stromal cultures and malignant melanoma A375 were examined to test their effects on peripheral blood mononuclear cell‐mediated cytotoxicity directed against K562 target. Moreover, these media were tested for the concentration of the soluble form of intercellular adhesion molecule‐1 (sICAM‐1), which has been suggested as a marker for spreading potential.  RESULTS: Media conditioned by endometrial stromal cultures exerted a significant suppressive effect on cell cytotoxicity when compared with those derived from malignant melanoma Moreover, the constitutive release of sICAM‐1 was significantly higher in supernatants from endometrial stromal than in melanoma cells.  CONCLUSIONS: These results indicate that two specific properties suggested to be involved in the ability of tumor cells to evade the immune system are more pronounced in the endometrium than in a malignant melanoma. Since the properties evaluated have been previously demonstrated to be even more notable in endometrial samples derived from endometriosis patients, a role of these mechanisms in the development of the disease may be hypothesized.
Herbal Medicines, Sairei‐to and Tokishakuyaku‐san, Differently Modulate the Release of Cytokines from Decidual Versus Peripheral Blood Mononuclear Cells
Authors: FUJII TOMOYUKI , KANAI TAKAO , KOUZUMA SHIRO , MIKI AKINORI , HYODO HIRONOBU , YAMASHITA TAKAHIRO , UNNO NOBUYA , TAKETANI YUJI , BABA KAZUNORI
Published: October 2003

PROBLEM AND METHOD OF STUDY: We have shown that Tokishakuyaku‐san (Toki) and Sairei‐to (Sai) enhance T helper‐1 (Th1) cytokine release from peripheral blood mononuclear cells (PBMCs); thereby, they could be a therapeutic means in the treatment of autoimmunity related recurrent abortion in which T helper‐2 (Th2) polarization is exaggerated, the condition purported to benefit from these herbal medicines. However, an open question is whether these medicines might enhance Th1 cytokine release in decidual tissues and thereby stimulate the killer activity, thus, working counterproductively by accelerating maternal alloimmune reactions toward fetal tissues. To address this, we examined the effects of these medicines on the release of cytokines from decidual mononuclear cells (DMCs) in comparison with PBMCs on the assumption that they might act differently on these cell types. The effects of these medicines were investigated as related to human leukocyte antigen (HLA)‐G, a nonclassical HLA class I antigen expressed on trophoblasts and a putative crucial player involved in fetomaternal immune interplay.  RESULTS: Regarding Th1 cytokines, Toki marginally increased the release of tumor necrosis factor (TNF)‐α, but not interferon (IFN)‐γ from DMCs while Sai did not affect the release of both. Both Toki and Sai were without effect in modulating the release of interleukin (IL)‐4, a member of Th2 cytokines. Interestingly, the presence of HLA‐G reduced the release of Th1 cytokines from DMCs regardless of the addition of Toki, Sai or none. These findings are in sharp contrast with PBMCs on which these medicines seem to act so as to enhance Th1 polarization and attenuate Th2 polarization.  CONCLUSION: Differential effects of Toki and Sai on the release of Th1/Th2 cytokines between DMCs and PBMCs may afford the rationale of these medicines in the treatment of autoimmunity‐related recurrent abortion.
Cytotoxic Effects of Soluble Factor in Preeclamptic Sera on Human Trophoblasts
Authors: FUKUSHIMA KOTARO , TSUKIMORI KIYOMI , KOBAYASHI HIROAKI , KOMATSU HAJIME , NAKANO HITOO , NISHIJIMA HITOSHI , SEKI HIROYUKI , TAKEDA SATORU
Published: October 2003

Evidence indicating abnormal biological behavior of trophoblasts has been seen in preeclamptic patients, but the mechanism is still unknown. We have previously shown that endothelial injury and neutrophil activation are induced by certain factors in preeclamptic sera. We investigated the effect of sera from eight preeclamptic and 11 normal pregnant women on cellular proliferation and viability of trophoblasts using 3H‐thymidine incorporation and the trypan‐blue dye exclusion test, respectively. Five of eight preeclamptic sera, but none of the normal pregnant sera, inhibited 3H‐thymidine incorporation. The trypan‐blue test revealed the sera reduced cellular viability. Gel permeation showed that the greatest growth‐inhibitory activity corresponded to a molecular weight of 50 kDa. The serum‐mixing test revealed this permeation and inhibitory preeclamptic sera suppressed the growth‐promoting activity of normal pregnant sera in a dose‐dependent manner. These results suggested the presence of certain factors in some preeclamptic sera that can affect cellular behavior of human trophoblasts.
Women's choice in the gender and ethnicity of her obstetrician and gynaecologist
Authors: Ekeroma Alec , Harillal Mahesh
Published: October 2003

Objective: To ascertain women's preferences in the gender and ethnicity of her obstetrician or gynaecologist and to determine whether there were differences in preferences among different ethnic and age groups.

Study design: A simple 11‐item questionnaire was placed at the antenatal and gynaecological clinics provided by South Auckland Health. The questionnaire was voluntary and 848 women completed the questionnaire over a 4‐month period.

Results: Half of the women preferred a woman doctor and the other half had no preference. There was a 6% increase in preference for a woman doctor where an examination was required. Of the women who preferred a female doctor, 45% would change their preference if a chaperone were present. There was no disproportionate increase in preference for a woman doctor by the patient's ethnicity or age group. Most of the women did not think the ethnicity of her doctor mattered; however, 18% preferred the ethnicity of her doctor be similar to hers. There were more European women who preferred a European doctor and fewer Maori women would prefer a Maori doctor. Of the 9% of women who did not prefer a doctor of the same ethnicity to hers, Pacific Island women were over‐represented.

Conclusion: This is the first study of this nature in New Zealand and the findings on preference for a female doctor are similar to those from other countries. The results of the present study did not show any difference in preference by women from the ethnicities studied and by age group. The use of a chaperone where a male doctor suggests an examination will reassure nearly half of those women who preferred a female doctor. Although most women did not think the ethnicity of her doctor mattered, there were distinct differences by ethnicity with more European women preferring a European doctor and fewer Maori women preferring a Maori doctor. A qualitative study is needed to ascertain reasons for these differences in preference.
Hysteroscopy under general anaesthesia, a near painless procedure
Authors: Tong Stephen , Zachariah Rebecca , Chua Boon Ghee , Vollenhoven Beverley
Published: October 2003

Anecdotally, hysteroscopy and curettage under general anaesthesia causes crampy postoperative pain. A randomised, double‐blind trial to investigate whether intrauterine lignocaine could decrease such pain was initiated by us. At an interim analysis, the results of the study found that almost half of all women studied so far (n = 53) were completely painfree from the moment they awoke with no difference between placebo and treatment groups. Of the remainder, most rated pain as either ‘mild’, or less. For most women, hysteroscopy, dilatation and curettage causes either none or very little pain postoperatively.
Ultrasound detection of the Essure permanent birth control device: A case series
Authors: Teoh Mark , Meagher Simon , Kovacs Gabor
Published: October 2003

Background:  The current recommendation to check the position of the Essure permanent birth control (PBC) micro‐insert device after its insertion is by abdominal X‐ray 3 months after insertion. We propose that ultrasound imaging is more suited for this purpose and gives reassurance much earlier. The sonographic appearance of the micro‐inserts and the reliability of this modality in localising the devices is described in the present study.

Objective:  To ascertain the appearance of the Essure PBC device at transvaginal and transabdominal ultrasound scanning and to determine the reliability of this approach in localising the contraceptive device.

Study population and methods:  All patients who had the Essure PBC procedure between June 2002 and January 2003 at our centre were offered an ultrasound scan to check device position.

Results:  The micro‐inserts were easily distinguished by their echogenic coil‐like appearance within each uterine cornua extending into the proximal fallopian tube. Of the 15 patients examined, 14 pairs of devices were seen: one device was malpositioned in the lower part of the uterus. In one patient, only one device was seen in the correct position but the other device was not identified and presumably expelled after a notably difficult insertion.

Discussion:  Ultrasound appears to be well suited for micro‐insert localisation. An early post insertion ultrasound scan is recommended to reassure about correct positioning of device and may potentially alleviate patient anxiety, or diagnose malposition early.
Role of fertility treatments in multiple pregnancy at National Women's Hospital from 1996 to 2001
Authors: Bolton Patricia , Yamashita Yoshiki , Farquhar Cynthia M
Published: October 2003

Objective: To determine the influence of fertility treatments on multiple pregnancy rates.

Study Design: A retrospective audit of women with multiple pregnancies from 1996 to 2001 at National Women's Hospital (NWH), Auckland, New Zealand was conducted. Information was collected regarding the demographics, fertility treatment, outcome of the pregnancy and complications experienced by women discharged with multiple births as an discharge diagnosis.

Results: For the years 1996–2001 there were 1136 multiple births at NWH. Of these births, 201 (18%) were conceived following fertility treatment. Seventeen percent of twin births and 44% of triplet births were conceived following fertility treatment. There was a statistically significant increase in the number of births conceived following fertility treatment, from 9% in 1996 to 24% in 2001, although the proportion of births that were multiple overall did not change (2% in 1996 and 2.3% in 2001). Sixty‐three percent of all fertility conceived multiple births were following in vitro fertilization/intracytoplasmic sperm injection treatment. Sixty percent of these women had two embryos transferred and 31% had three embryos transferred. Ovulation induction with follicle‐stimulating hormone accounted for 19% of all fertility conceived multiple births. Nineteen percent of fertility conceived multiple births followed clomiphene treatment alone.

Conclusions: The proportion of multiple pregnancies as a result of fertility treatments has increased over the 6 years studied.
Should obstetricians support a ‘term cephalic trial’?
Authors: Robson Stephen , Ellwood David
Published: October 2003

Recent analyses of the published data suggest that the risks of elective Caesarean delivery in an uncomplicated pregnancy may not outweigh the benefits of vaginal birth by as much as has been supposed. Indeed, this balance may be so close that the place of elective Caesarean delivery of a term cephalic baby might be considered as a worthwhile subject of a randomised controlled trial. We discuss the potential consequences of such a trial and what effect it could have on obstetric practice.
Replacement of one selected embryo is just as successful as two embryo transfer, without the risk of twin pregnancy
Authors: Kovacs Gab , MacLachlan Vivien , Rombauts Luk , Healy David , Howlett Donna
Published: October 2003

The transition of in vitro fertilization from research to standard clinical practice has, to a great extent, been as a result of the use of controlled ovarian hyper stimulation. A disadvantage of the availability of multiple embryos has been the replacement of several embryos leading to an epidemic of multiple pregnancies. This retrospective review of 2606 fresh embryo transfers between 2001 and 2003, where either one or two selected embryos were replaced from an available cohort of at least four, shows that single embryo transfers have a similar pregnancy rate without the risk of multiple pregnancy.
Prevention, Promotion or Just Survival? A Consumer's Perspective
Authors: Ellis Gaynor
Published: October 2003

Objective: Drawing on recent Australian research into the lives of people experiencing major mental illness, this paper presents a consumer perspective on the failure of current mental health policy and practice in addressing the broader social determinants of health that impact upon and influence consumer recovery. Despite this, some basic ‘grassroots’ achievements by consumer and service providers in a regional city, almost devoid of nontreatment services, are detailed as examples of what is possible at a local level.

Conclusions: The third National Mental Health Strategy requires a focus on the provision of greater community support for consumers, including increased support for consumer initiatives, the non-government sector, and rehabilitation programs. Mental health policy and practice needs to address the social determinants of health.
Stability within the Chaos: The Koori Kids Mental Health Network
Authors: Mushin David , Potter Carol , Booth Anne , Geoghegan Kaye , Krupinska Ola , Paul Campbell , Wyatt Nareida
Published: October 2003

Introduction: The Koori (Aboriginal term for Indigenous people from South Eastern Australia) Kids Mental Health Network is a child, adolescent and family psychiatric service based at the Victorian Aboriginal Health Service, a community health service which is controlled by the Victorian Koori community and based in Melbourne. The Koori Kids Mental Health Network is a collaborating group of Indigenous mental health workers from the Victorian Aboriginal Health Service and other health services together with a network of non-Indigenous workers from mainstream child and adolescent mental health services.

Method: This article is a distillation of a 3-hour workshop involving seven members of the Koori Kids Mental Health Network. It comprised an introduction regarding the development of the Network, a section on the process by which Indigenous and mainstream workers have developed their working relationships and fostered each other's development according to the needs of Indigenous families, and a section on the nature of the service provided to these patients.

Results: A child and adolescent psychiatric service, relevant to the needs of the Victorian Aboriginal community, has developed through the collaborative functioning of mainstream and aboriginal mental health workers. It has been critical for the development of such a service that it be coordinated by an Aboriginal mental health worker and located within a health service administered by the Aboriginal community. The workshop enabled presentation and discussion of material leading to an understanding of the Service and its development.
Ageing is associated with reduced basal and stimulated release of nitric oxide by the coronary endothelium
Authors: AMRANI M. , GOODWIN A. T. , GRAY C. C. , YACOUB M. H.
Published: October 2003

The ageing process is known to be associated with biochemical and functional changes in the heart. In an attempt to determine whether the ability of the coronary endothelium to secrete nitric oxide (NO) both at rest and in response to pharmacological stimulation is age dependent, we studied four groups of rats of different ages (1, 5, 15 and 26 months, respectively). Basal release of NO by endothelium as assessed by response of coronary flow to l‐monomethylarginine, an inhibitor of NO synthase, was higher in the younger age groups. Similarly, the response of coronary flow to 5‐hydroxytryptamine, a selective probe of endothelial capacity to secrete NO, was diminished in the older animals. This was confirmed by direct measurement of NO by chemiluminescence in the coronary effluent. In contrast, the response to glyceryl trinitrate appeared to be unaltered by age. It is concluded that in rats, basal and stimulated release of nitric oxide by the coronary endothelium deteriorates with age.
Neuronally mediated anion secretion induced by short‐chain fatty acids in the rat distal small intestine
Authors: DIENER M. , VUJICIC Z. , SCHARRER E.
Published: October 2003

The short‐chain fatty acids acetate, propionate and butyrate induced a concentration‐dependent increase of short‐circuit current (Isc) in the rat distal small intestine in vitro. They were ineffective in the proximal small intestine. The increase of Isc in the distal small intestine was dependent on the presence of Cl‐ and HCO‐3 ions. It was blocked by the inhibitor of the Na+‐K+‐Cl‐‐cotransporter, bumetanide, and by the Cl‐ channel blocker, 5‐nitro‐2‐(3‐phenylpropylamino)‐benzoate, indicating that short‐chain fatty acids evoke an anion secretion. The secretion induced by propionate was blocked by the neurotoxin, tetrodotoxin, and inhibited by the muscarinic antagonists, atropine. In contrast, indomethacin, a cyclooxygenase inhibitor, or nordihydroguaiaretic acid, a lipoxygenase inhibitor, were ineffective. These results indicate that short‐chain fatty acids stimulate chemosensitive neurones in the rat small intestine in a region‐specific manner, which induce anion secretion by the release of mainly acetylcholine.
Effect of a new inhibitor of lipid peroxidation on kidney function after ischaemia‐reperfusion. A study on rat and rabbit kidneys
Authors: SØRENSEN V. , NILSSON U. , PETTERSSON S. , SCHERSTÉN T. , SJÖQVIST P. O. , SVENSSON L. , JONSSON O.
Published: October 2003

Lipid peroxidation of mitochondrial and cell membrane structures is the final step in the oxygen radical‐induced damage observed at reperfusion of kidneys after ischaemia. We compared the ability of an indeno‐indol compound (code name H290/51) with that of α‐tocopherol to inhibit lipid peroxidation in reoxygenated isolated rat renal tissue in vitro measured as production of TBARS (thiobarbituric acid reactive substances). H290/51 was 100 times more efficient than α‐tocopherol. Treatment of rats in vivo with H290/51 in a dosage giving a plasma concentration of 500 nmol L‐1 inhibited TBARS production measured in vitro by 80%. Treatment of rabbits with H290/51 almost completely inhibited radical production at reperfusion after 60 min of ischaemia measured with spin trap technique using OXANOH (2‐ethyl‐3‐hydroxy‐2,4,4‐trimethyloxazolidine) as a spin trap. Furthermore, such pretreatment significantly improved kidney function and survival of rabbits subjected to 60 min of ischaemia to the left kidney and contralateral nephrectomy. These studies stress the importance of inhibiting lipid peroxidation to prevent the ischaemia‐reperfusion damage and furthermore suggest a role for treatment with antioxidants like H290/51 in clinical practice, e.g. at reconstructive renal surgery and transplantation.
Metabotropic glutamate receptors in hippocampal long‐term potentiation and learning and memory
Authors: RIEDEL G. , REYMANN K. G.
Published: October 2003

Glutamate receptors have been identified as important interfaces in learning and memory paradigms as well as in mechanisms of synaptic plasticity, such as long‐term potentiation (LTP) and long‐term depression (LTD), which are believed to be the underlying cellular basis of at least some forms of learning. Although investigations of G‐protein‐coupled receptors have a long history, those depending on ligand‐binding of glutamate have only been discovered recently, and this is the reason why our knowledge about metabotropic glutamate receptors (mGluRs) is at present very limited. However, the development of relatively specific antagonists and agonists has enabled the analysis of the role of mGluRs in synaptic plasticity, mostly studied on the models of LTP and LTD. Among others, we have been able to demonstrate that activation of mGluRs is essential for induction and maintenance of long‐lasting hippocampal LTP in vitro and in vivo. The work conducted by several groups, including ours, has now provided compelling evidence that mGluR activation is an important step in the cellular cascades leading to memory formation in vertebrates. This led us to assume, given that the hippocampus plays a prominent role in spatial rather than discrimination learning, that mGluRs may participate in the processing of spatial information via hippocampal mechanisms, and may thus be similarly important as N‐methyl‐d‐aspartate receptors. This article surveys the literature dealing with mGluRs in hippocampal LTP and learning and memory. We will demonstrate that, although the understanding of cellular mechanisms of neuronal plasticity and of the pharmacology of learning and memory has advanced, the missing link to prove that LTP is a substrate for some forms of learning still remains unsolved. Nevertheless, it appears reasonable to argue that mGluRs in LTP and learning may share some, but not all features, and it will be an interesting approach for further analysis to address the unresolved issues.
Skeletal muscle buffering capacity is higher in the superficial vastus than in the soleus of spontaneously running rats
Authors: WESTON A. R. , WILSON G. R. , NOAKES T. D. , MYBURGH K. H.
Published: October 2003

Skeletal muscle buffering capacity (βmtitr) was determined in soleus (type I) and superficial vastus (type II) muscles of 16 Long–Evans rats with differing levels of spontaneous activity and in 11 sedentary control rats. βmtitr was 24% higher (P<0.001) in superficial vastus muscle than in soleus muscle (268±50 vs. 216±30 μmol H+ g muscle dry wt‐1 pH unit‐1) (mean±SD). There was no relationship between βmtitr and mean weekly running distance amongst spontaneously running rats, nor was βmtitr any greater in these rats than in a group of sedentary control rats. Protein to wet wt ratio was 31% higher (P<0.0001) in the superficial vastus muscle when compared with soleus muscle (22.04±3.74 vs. 16.77±3.00 mg protein, 100 mg wet wt muscle‐1), but there was no relationship between protein to wet wt ratio and running distance. Initial muscle homogenate pH (pHi) was lower in superficial vastus muscle compared with soleus muscle (6.36±0.25 vs. 6.63±0.16). Running rats had a significantly lower pHi in both soleus and superficial vastus than sedentary controls. There was an exponential relationship between weekly running distance and pHi in both the superficial vastus muscle (r=‐0.86, P<0.001) and the soleus muscle (r=‐0.73, P<0.01). Citrate synthase activity correlated with weekly running distance in superficial vastus muscle (r=0.66, P<0.01) but not in soleus muscle. The results confirm a higher βmtitr in the type II superficial vastus muscle when compared with the predominantly type I soleus muscle. We suggest that this may be partly the result of a higher protein concentration in type II muscle. Future studies measuring βmtitr in mixed muscle (e.g. human vastus lateralis) should report fibre type composition.
Effect of C‐peptide administration on whole body glucose utilization in STZ‐induced diabetic rats
Authors: WU W. , OSHIDA Y. , YANG W‐P. , LI L. , OHSAWA I. , SATO J. , IWAO S. , JOHANSSON B‐L. , WAHREN J. , SATO Y.
Published: October 2003

Recent studies suggest that C‐peptide stimulates glucose transport in isolated skeletal muscle. In order to determine the effect of C‐peptide on whole body glucose utilization, streptozotocin (60 mg kg‐1) (STZ)‐induced diabetic and normal rats were studied using the euglycaemic clamp procedure and continuous infusion of somatostatin (1.0 μg kg‐1 min‐1) in pentobarbital‐anaesthetized rats. Plasma insulin levels during the 6.0‐ and 30.0‐mU kg‐1 min‐1 insulin infusions rose to 70–90 μU mL‐1 and 500–700 μU mL‐1, respectively. Blood glucose concentrations were clamped at 7.5–7.9 mmol L‐1 in the diabetic rats and at basal levels or 7.7 mmol L‐1 in the non‐diabetic (normal) rats. Biosynthetic human C‐peptide (0.5 nmol kg‐1 min‐1) was infused in 12 diabetic and 11 normal rats, resulting in concentrations of 26–41 nmol L‐1. The metabolic clearance rate of glucose (MCR) for the diabetic rats receiving C‐peptide (12.0±1.0 mL kg‐1 min‐1) was significantly (P<0.01) higher than that in the diabetic rats given saline (6.3±0.7 mL kg‐1 min‐1) or a randomly scrambled C‐peptide (7.8±1.3 mL kg‐1 min‐1) at low‐dose insulin infusion but not at the high‐dose insulin infusion. In normal rats C‐peptide did not significantly increase the MCR for glucose. These results thus demonstrate that C‐peptide has the capacity to increase glucose utilization in STZ‐induced diabetic rats.
Intracerebroventricular angiotensin II increases tolerance to blood loss in conscious sheep
Authors: ULLMAN J. E. , HJELMQVIST H. , RUNDGREN M.
Published: October 2003

Intracerebroventricular (i.c.v.) infusion of hypertonic NaCl improves the tolerance to haemorrhage in sheep. Since i.c.v. angiotensin II (ANG II) shares many of the effects of hypertonic NaCl on fluid balance control and blood pressure, we aimed to determine whether i.c.v. ANG II would also be effective in that regard. Six adult conscious ewes were bled from the jugular vein until the mean arterial pressure suddenly dropped to between 45 and 50 mmHg, during an i.c.v. infusion of ANG II (2 pmol kg‐1 min‐1) which commenced 30 min prior to start of blood removal and continued until end of retransfusion about 80 min after haemorrhage. A corresponding haemorrhage in the same animals during an i.c.v. infusion of 0.9% NaCl served as controls. Significantly more blood had to be withdrawn to induce hypotension when ANG II was given i.c.v. (22.3±1.8 vs. 12.6±1.2 mL kg‐1). The degree of hypotension and the recovery rate of the blood pressure did not differ between the experiments. The increased tolerance to blood loss by ANG II i.c.v. was accompanied by a reinforced elevation of the systemic vascular resistance and a larger decline of the cardiac output. The plasma norepinephrine concentration was significantly increased immediately after haemorrhage during i.c.v. ANG II, but not in control experiments. The overall vasopressin response to the hypotensive blood loss was not affected by ANG II, but high plasma levels were obtained already during the non‐hypotensive stage of haemorrhage. The i.c.v. infusion of ANG II caused a significant lowering of the plasma protein concentration before start of bleeding and accentuated the haemodilution caused by the haemorrhage. We conclude that central administration of ANG II increases the tolerance to haemorrhage in sheep but with concomitant haemodynamic changes which appear unfavourable regarding cardiac load and tissue perfusion.
The fade of gastrin‐stimulated gastric acid secretion in the rat is due to depletion of releasable mucosal histamine
Authors: RØNNING K. , SANDVIK A. K. , WALDUM H. L.
Published: October 2003

The present study examines the applicability of the isolated, acid‐secreting vascularly perfused rat stomach for long‐term physiological and pharmacological studies. The model was used to study the fade of acid secretion during gastrin stimulation. The stomachs were stimulated by exogenous gastrin or histamine alone or in succession. Acid secretion and venous histamine concentrations were measured. Gastrin and histamine potently stimulated acid output, histamine‐stimulated acid secretion was sustained for 300 min while gastrin‐stimulated secretion peaked at 120 min and declined towards basal output at 300 min. Stomachs rendered tachyphylactic to gastrin could be re‐stimulated by exogenous histamine. Venous histamine output during gastrin stimulation decreased in parallel to acid secretion. Thus, the acid‐secreting, isolated vascularly perfused rat stomach can be used for physiological and pharmacological studies with histamine as stimulant for at least 300 min. The present results strongly indicate that the effect of gastrin on acid secretion is mediated by histamine, and that fade of acid secretion during stimulation with gastrin is due to depletion of releasable mucosal histamine.
Differentiated effects of vasodilators on myogenic reactivity during partial inhibition of myogenic tone in pressurized skeletal muscle small arteries of the rat
Authors: BÜLOW A.
Published: October 2003

Myogenic tone and reactivity were studied in isolated, cannulated and pressurized small branches of the femoral artery of the rat. Myogenic tone developed spontaneously under control conditions (1.5 mm Ca2+), reducing the diameter at 80 mmHg to 64±6% of the ‘max 80’, i.e. the diameter in Ca2+ free solution, which was 221±23 μm (mean±SD, n=18). The calcium channel blockers verapamil and diltiazem, dose‐dependently, decreased this myogenic tone with pIC50 values of 6.9±0.2 (n=7) and 6.6±0.1 (n=6), respectively. Myogenic reactivity was demonstrated under control conditions as a sustained decrease in diameter, by 5±3% of max 80 (after an initial, transient distension), in response to a step increase in transmural pressure from 80 to 140 mmHg. This response to the pressure increase was markedly inhibited when myogenic tone had been reduced by 50% with verapamil or diltiazem resulting, in fact, in an increased steady state diameter by 2±1 and 1±1% at 140 compared with 80 mmHg. However, if myogenic tone was reduced to the same extent by low extracellular Ca2+ (∼0.3 mm) the vessels constricted by 6±1% in response to the pressure increase, an effect comparable to that in control Ca2+. Moreover, 50% reductions in myogenic tone by ACh (∼0.1 μm) or pinacidil (∼0.3 μm) were associated with significantly enhanced reactivity; steady state diameter decreased by as much as 11±4 and 15±5% of max 80. These results suggest that voltage dependent l‐type Ca2+ channels are involved both in myogenic tone and in the myogenic response to a rise in vascular transmural pressure in skeletal muscle arteries. Partial inhibition of myogenic tone by other pharmacological routes do not necessarily interfere with myogenic reactivity since the response was, in fact, enhanced in the presence of ACh or pinacidil.