bluuebunny/crossref_metadata_2025 huggingface dataset:
Organizational factors influencing knowledge transfer into practice in Iranian nursing context: A grounded theory approach
Authors: Salsali Mahvash , Cheraghi Mohammad A , Ahmadi Fazlollah
Published: October 2009

Divergence in Iranian nursing organization including academic and clinical settings adversely affects knowledge transfer. Centralized and medical focused nursing with a lack of effective representation at senior or national level was inferred as the main causal conditions. Using grounded theory methodology, in‐depth individual interviews were conducted with 17 participants to better understand their perceptions of the organizational factors influencing knowledge transfer. Organizational factors affecting knowledge transfer can be grouped into two main categories or themes: (i) the dimensions of incompetent organizational content (such as work culture); and (ii) incompetent organizational structure (such as the hierarchy of authority, the expertise and the standardization). The findings showed that there was a range of competing subcultures between management and nursing. The most important basic social problem was inferred as divergence in nursing organization across academic and clinical settings.
Health‐related quality of life among old residents of nursing homes in Norway
Authors: Drageset Jorunn , Natvig Gerd Karin , Eide Geir Egil , Bondevik Margareth , Nortvedt Monica W , Nygaard Harald A
Published: October 2009

This study examined the health‐related quality of life (HRQOL) of nursing home residents (≥ 65 years) using the Short‐Form‐36 Health Survey subscales and how these subscale scores are related to residents' sociodemographic and medical conditions. Residents 95–102 years old reported higher HRQOL than younger respondents. Those with more education reported higher HRQOL. Residents who reported hobbies or special interests had a higher HRQOL score on vitality and mental health variables. Finally, respondents with no comorbid illness scored highest on all HRQOL dimensions, and this was statistically significant for physical functioning and bodily pain. In conclusion, respondents generally reported highly limited physical functioning and slightly limited social functioning. To improve the situation of residents, more attention should be paid to the environment of nursing homes and residents' hobbies and special interests.
Association of polymorphisms of glutamate‐cystein ligase and microsomal triglyceride transfer protein genes in non‐alcoholic fatty liver disease
Authors: Oliveira Claudia Pinto Marques Souza , Stefano José Tadeu , Cavaleiro Ana Mercedes , Zanella Fortes Maria Angela Henriques , Vieira Suzana Maria , Rodrigues Lima Vicência Mara , Santos Telma Eugenio , Santos Virginia Nascimento , De Azevedo Salgado Ana Lucia Farias , Parise Édson Roberto , Ferreira Alves Venâncio Avancini , Carrilho Flair José , Corrêa‐Giannella Maria Lucia
Published: October 2009

Background and Aims:  Although the metabolic risk factors for non‐alcoholic fatty liver disease (NAFLD) progression have been recognized, the role of genetic susceptibility remains a field to be explored. The aim of this study was to examine the frequency of two polymorphisms in Brazilian patients with biopsy‐proven simple steatosis or non‐alcoholic steatohepatitis (NASH): −493 G/T in the MTP gene, which codes the protein responsible for transferring triglycerides to nascent apolipoprotein B, and −129 C/T in the GCLC gene, which codes the catalytic subunit of glutamate‐cystein ligase in the formation of glutathione.

Methods:  One hundred and thirty‐one biopsy‐proven NAFLD patients (n = 45, simple steatosis; n = 86, NASH) and 141 unrelated healthy volunteers were evaluated. Genomic DNA was extracted from peripheral blood cells, and the −129 C/T polymorphism of the GCLC gene was determined by restriction fragment length polymorphism (RFLP). The −493 G/T polymorphism of the MTP gene was determined by direct sequencing of the polymerase chain reaction products.

Results:  The presence of at least one T allele in the −129 C/T polymorphism of the GCLC gene was independently associated with NASH (odds ratio 12.14, 95% confidence interval 2.01–73.35; P = 0.007), whereas, the presence of at least one G allele in the −493 G/T polymorphism of the MTP gene differed slightly between biopsy‐proven NASH and simple steatosis.

Conclusion:  This difference clearly warrants further investigation in larger samples. These two polymorphisms could represent an additional factor for consideration in evaluating the risk of NAFLD progression. Further studies involving a larger population are necessary to confirm this notion.
Ursodeoxycholic acid and artesunate in the treatment of severe falciparum malaria patients with jaundice
Authors: Treeprasertsuk Sombat , Silachamroon Udomsak , Krudsood Srivicha , Huntrup Arun , Suwannakudt Plengsakoon , Vannaphan Suparp , Wilairatana Polrat
Published: October 2009

Background and Aims:  Plasmodium falciparum (PF) infection can lead to severe complications. Ursodeoxycholic acid (UDCA) is increasingly used for the treatment of cholestatic liver diseases. The present study aims to determine the effects of combined UDCA and artesunate compared to placebo and artesunate on the improvement of liver tests in severe PF jaundiced patients.

Methods:  All severe PF jaundiced patients, aged ≥ 15 years and diagnosed as having severe malaria according to WHO 2000 criteria, were enrolled. Patients with evidence of biliary obstruction, other cholestatic liver diseases and those who were pregnant were excluded. Patients were randomized to receive either oral UDCA or placebo for 2 weeks in additional to artesunate. All patients were admitted for at least 14 days to monitor the result of the treatment.

Results:  Seventy‐four severe PF malaria patients with jaundice were enrolled. Both groups had similar demographic and laboratory tests, with the exception being more males in the UDCA group than in the placebo group (P = 0.04). The median of percentage change of total bilirubin and aminotransferase levels at the end of weeks 1, 2, 3 and 4 showed no difference between the two groups. Only the median of percentage change of alkaline phosphatase at the end of week one compared with the baseline values showed less increment in the UDCA group than in the placebo group (P = 0.04). No serious adverse events were seen during the 4 weeks of follow up.

Conclusions:  In severe PF malaria patients with jaundice, combined therapy with UDCA and artesunate is safe, but does not significantly improve liver tests compared to placebo and artesunate.
Secreted protein acidic and rich in cysteine (SPARC) gene polymorphism association with hepatocellular carcinoma in Italian patients
Authors: Segat Ludovica , Milanese Michele , Pirulli Doroti , Trevisiol Chiara , Lupo Francesco , Salizzoni Mauro , Amoroso Antonio , Crovella Sergio
Published: October 2009

Background and Aim:  Hepatocellular carcinoma (HCC) is a multifactorial disease driven by both genetic and epigenetic factors. Infection, inflammation and the immune response against hepatitis B virus and hepatitis C virus have been shown to play an important role in increasing cancer risk and promoting tumor development. In order to investigate the genetic component influencing HCC development, we analyzed 50 single nucleotide polymorphisms (SNP) spanning 34 different genes in 230 Italian patients affected by HCC and 230 controls.

Methods:  Genes were selected on the basis of their known biological function and their possible involvement in the progression or in the susceptibility to HCC was considered. SNP genotyping was performed using allelic‐specific fluorescent probes.

Results:  For most SNP, no differences were identified between HCC patients and controls, with the exception of rs2304052, localized on the secreted protein acidic and rich in cysteine (SPARC) gene, which was significantly associated to the disease. The C allele was significantly more frequent in the HCC patients than in the healthy controls (23% vs 10%, corrected P < 0.001), as well as the CC genotype (13% vs 1%, corrected P < 0.001).

Conclusion:  Since the presence of the rs2304052 C allele is associated with an increased risk (odds ratio: 2.76) of developing hepatocarcinoma, our results allowed us to identify a SNP in the SPARC gene correlating to HCC susceptibility.
Diagnosis of obscure gastrointestinal hemorrhage with capsule endoscopy in combination with multiple‐detector computed tomography
Authors: Zhang Bing‐Ling , Jiang Ling‐Ling , Chen Chun‐Xiao , Zhong Bai‐Shu , Li You‐Ming
Published: October 2009

Aim:  To demonstrate the clinical efficacy of combination capsule endoscopy (CE) and multiple‐detector computed tomography (MDCT) diagnostic imaging in the identification of gastrointestinal hemorrhages.

Methods:  In the present study, 123 patients with gastrointestinal hemorrhages of obscure origin (GHOO) were examined with CE in combination with MDCT. The results were compared with findings of surgical pathology.

Results:  Of the 123 patients, 57.72% (71/123) of the patients exhibited positive CE findings compared with 30.08% (37/123) on MDCT alone (P < 0.01). When used in combination, 65.85% (81/123) of patients scored positively. The detection rate due to the combination of diagnostic imaging was significantly higher than that of MDCT alone (P < 0.01), but was not significantly higher than that of CE alone (P > 0.05). Integrating the two diagnostic platforms improved the diagnosis of stromal tumors, hemangioma, Crohn's disease, vascular anomaly, Meckel's diverticulum, and ancylostomiasis. There was no significant difference in the positive detection rate between CE and MDCT when confirmed by surgical pathology.

Conclusion:  The contribution of CE is critical in the diagnosis of GHOO, given the fact that there is a significant difference in the detection rate between CE and MDCT, but there is no significant difference in the rate between CE plus MDCT and CE alone.
Laparoscopic nephrectomy in patients with renal vein and/or inferior vena cava anomalies: Video presentation
Authors: Habuchi Tomonori , Narita Shintaro , Tsuchiya Norihiko , Kumazawa Teruaki , Horikawa Yohei , Sato Shigeru
Published: October 2009

Abstract:  Laparoscopic nephrectomy is a standard surgery for the treatment of many types of renal tumor, renal pelvic tumor, and benign disease. Renal vein and inferior vena cava anomalies are not uncommon, having been detected at an incidence of 2–17%. With the increasing number of patients undergoing laparoscopic nephrectomy, surgeons have more opportunities to encounter major anomalies of the renal vein and inferior vena cava. This video presents images of the management of the renal pedicle in laparoscopic nephrectomy in cases where there were anomalies of the renal vein and inferior vena cava.

Patient 1 had left renal tumor with the left inferior vena cava, patient 2 had left ureteral tumor with double inferior vena cava, patient 3 had left renal tumor with double inferior vena cava and a circumaortic renal vein, patient 4 had left renal tumor with a retro‐aortic renal vein, and patient 5 had left renal tumor with a circumaortic renal vein. Multiple renal arteries were present in patients 3, 4, and 5.

In laparoscopic nephrectomy complicated by anomalies of the renal vein and inferior vena cava, (i) surgical staff should be alert for the potential presence of aberrant veins and multiple renal arteries that may not be visualized in preoperative imaging. (ii) An anterior transperitoneal approach is well‐suited in the understanding of positional relationships of vessels and anatomical landmarks in cases of vascular anomalies. (iii) With recent advances in diagnostic imaging modalities, such as multislice computed tomography (CT) and 3‐D CT, it has become easier to identify the major arterial and venous anomalies. However, intraoperative observation and assessment remain important and mandatory in the management of smaller anomalous vessels accompanied by major anomalies.
Impact of troponin 1 on long‐term mortality after emergency orthopaedic surgery in older patients
Authors: Chong C. , Lam Q. , Ryan J. , Sinnappu R. , Lim W. K.
Published: October 2009

Objectives:  To determine the association between post‐operative troponin rises and longer term (2‐year) mortality after emergency orthopaedic surgery in patients over 60 years of age.

Methods:  One hundred and two patients were recruited in 2006 and had inpatient troponin 1 measurements. These patients were followed up by a telephone call annually for complications.

Results:  At 2 years, 29.4% (30/102) of patients had died. Twenty‐five patients (25/54 or 49.3%) with a troponin rise were dead at 2 years compared with five patients without a troponin rise (5/48 or 10.4%), which was significantly different P < 0.0001. Patients with a higher troponin level (>0.1 µg/L) were more likely to be dead at 2 years compared with those with a lower level of troponin. However, when adjusted for other comorbidities the association between troponin elevation and death at 2 years did not persist. Using Cox regression multivariate analysis, only one factor, sustaining an in‐hospital cardiac event odds ratio 4.3 (95% confidence interval 1.8–10.3, P = 0.001), was associated with 2 years all‐cause mortality . Furthermore, patients who sustained a symptomatic troponin rise (P < 0.0001) or asymptomatic troponin rise (P = 0.004) were more likely to have died at 2 years compared with those with no troponin rise. Three factors were significantly associated with a cardiac event during the second year: (i) post‐operative troponin rise (P = 0.05); (ii) pre‐morbid atrial fibrillation (P = 0.04); and (iii) post‐operative renal failure (P < 0.001).

Conclusion:  Elevated post‐operative troponin levels are predictive of 1‐year but not 2‐year mortality in older patients undergoing emergency orthopaedic surgery.
Daily rhythms and sex differences in vasoactive intestinal polypeptide, VIPR2 receptor and arginine vasopressin mRNA in the suprachiasmatic nucleus of a diurnal rodent, Arvicanthis niloticus
Authors: Mahoney M. M. , Ramanathan C. , Hagenauer M. H. , Thompson R. C. , Smale L. , Lee T.
Published: October 2009

Diurnal and nocturnal animals differ with respect to the time of day at which the ovulatory surge in luteinizing hormone occurs. In some species this is regulated by the suprachiasmatic nucleus (SCN), the primary circadian clock, via cells that contain vasoactive intestinal polypeptide (VIP) and vasopressin (AVP). Here, we evaluated the hypothesis that chronotype differences in the timing of the luteinizing hormone surge are associated with rhythms in expression of the genes that encode these neuropeptides. Diurnal grass rats (Arvicanthis niloticus) were housed in a 12/12‐h light–dark cycle and killed at one of six times of day (Zeitgeber time 1, 5, 9, 13, 17, 21; ZT 0 = lights‐on). In‐situ hybridization was used to compare levels of vip, avp and VIP receptor mRNA (vipr2) in the SCN of intact females, ovariectomized females, ovariectomized females given estradiol and intact males. We found a sex difference in vip rhythms with a peak occurring at ZT 13 in males and ZT 5 in intact females. In all groups avp mRNA rhythms peaked during the day, from ZT 5 to ZT 9, and had a trough in the dark at ZT 21. There was a modest rhythm and sex difference in the pattern of vipr2. Most importantly, the patterns of each of these SCN rhythms relative to the light–dark cycle resembled those seen in nocturnal rodents. Chronotype differences in timing of neuroendocrine events associated with ovulation are thus likely to be generated downstream of the SCN.
Fasting biases brain reward systems towards high‐calorie foods
Authors: Goldstone Anthony P. , Prechtl de Hernandez Christina G. , Beaver John D. , Muhammed Kinan , Croese Charlotte , Bell Gabriel , Durighel Giuliana , Hughes Emer , Waldman Adam D. , Frost Gary , Bell Jimmy D.
Published: October 2009

Nutritional state (e.g. fasted vs. fed) and different food stimuli (e.g. high‐calorie vs. low‐calorie, or appetizing vs. bland foods) are both recognized to change activity in brain reward systems. Using functional magnetic resonance imaging, we have studied the interaction between nutritional state and different food stimuli on brain food reward systems. We examined how blood oxygen level‐dependent activity within a priori regions of interest varied while viewing pictures of high‐calorie and low‐calorie foods. Pictures of non‐food household objects were included as control stimuli. During scanning, subjects rated the appeal of each picture. Twenty non‐obese healthy adults [body mass index 22.1 ± 0.5 kg/m2 (mean ± SEM), age range 19–35 years, 10 male] were scanned on two separate mornings between 11:00 and 12:00 h, once after eating a filling breakfast (‘fed’: 1.6 ± 0.1 h since breakfast), and once after an overnight fast but skipping breakfast (‘fasted’: 15.9 ± 0.3 h since supper) in a randomized cross‐over design. Fasting selectively increased activation to pictures of high‐calorie over low‐calorie foods in the ventral striatum, amygdala, anterior insula, and medial and lateral orbitofrontal cortex (OFC). Furthermore, fasting enhanced the subjective appeal of high‐calorie more than low‐calorie foods, and the change in appeal bias towards high‐calorie foods was positively correlated with medial and lateral OFC activation. These results demonstrate an interaction between homeostatic and hedonic aspects of feeding behaviour, with fasting biasing brain reward systems towards high‐calorie foods.
Inhibitory effect of kisspeptins on insulin secretion from isolated mouse islets
Authors: Vikman J. , Ahrén B.
Published: October 2009

Islet hormone secretion is regulated by a variety of factors, and many of these signal through G protein‐coupled receptors (GPCRs). A novel islet GPCR is GPR54, which couples to the Gq isoform of G proteins, which in turn signal through the phospholipase C pathway. Ligands for GPR54 are kisspeptins, which are peptides encoded in the KISS1 gene and also expressed in islet β‐cells. The KISS1 gene encodes a hydrophobic 145‐amino acid protein that is cleaved into a 54‐amino acid protein, kisspeptin‐54 or KP54. Shorter kisspeptins also exist, such as kisspeptin‐10 (KP10) and kisspeptin‐13 (KP13). The involvement of GPR54 and kisspeptins in the regulation of islet function is not known. To address this problem, we incubated isolated mouse islets in the presence of KP13 and KP54 for 60 min and measured insulin secretion. We found that both KP13 and KP54 at 10 nM, 100 nM and 1μM inhibited insulin secretion in the presence of 2.8 mM glucose. However, by increasing the glucose concentration, this inhibitory action of the kisspeptins vanished. Thus, at 11.1 mM glucose, KP13 and KP54 inhibited insulin secretion only at high doses, and at 16.7 mM they no longer inhibited insulin secretion in any of the doses. We conclude that kisspeptins inhibit insulin secretion at glucose concentrations below 11.1 mM. This suggests that kisspeptins are regulating insulin secretion at physiological concentrations of glucose. The mechanisms by which kisspeptins regulate islet function and insulin secretion are unknown and will be further investigated.
Beneficial effects of K‐ATP channel openers in diabetes: an update on mechanisms and clinical experiences
Authors: Grill V. , Radtke M. , Qvigstad E. , Kollind M. , Björklund A.
Published: October 2009

Stresses associated with the diabetic state participate in the demise of β‐cells and therapies that eliminate or reduce such stresses are much needed. K‐ATP channel openers, of which diazoxide is the most studied, are potentially useful because experimental studies show that they can counteract chronic over‐stimulation of β‐cells and protect against toxic conditions, including relative hypoxia. Several mechanisms may underlie the beneficial effects of diazoxide; these may include both indirect (counteracting over‐stimulation) and direct mitochondrial effects.

Side effects of diazoxide have limited its use in human trials. We have tested lower doses than previously of diazoxide and thereby largely eliminated side effects. In this setting, we demonstrate positive effects on β‐cell function in type 2 diabetic patients who were simultaneously treated with bedtime insulin. However, such effects were absent in insulin‐naïve patients. In newly diagnosed type 1 diabetic patients, a 6‐month intervention with diazoxide failed to result in better preservation of β‐cell function. K‐ATP channel openers have a potential to improve β‐cell function in subgroups of type 2 diabetes patients. Analogues of diazoxide with more potency in relation to side effects would heighten the possibilities for K‐ATP channel openers to be of therapeutic use in type 1 diabetes.
Pdx1 and other factors that regulate pancreatic β‐cell survival
Authors: Fujimoto K. , Polonsky K. S.
Published: October 2009

A progressive reduction in β‐cell mass occurs in the evolution of diabetes. Thus understanding the mechanisms responsible for this reduction in β‐cell mass is important for understanding the pathogenesis of diabetes and in developing novel approaches to prevention and treatment. Pancreatic duodenal homeobox 1 (Pdx1) is a transcription factor that plays a central role in pancreatic β‐cell function and survival. Complete deficiency of Pdx1 is associated with pancreatic agenesis, and partial deficiency leads to severe β‐cell dysfunction, and increases β‐cell death and diabetes both in rodent and human. Chronic hyperglycaemia and dyslipidaemia, which are major features of type 2 diabetes, cause β‐cell dysfunction via reduced Pdx1 expression. Inhibition of insulin/insulin‐like growth factor (Igf) signalling followed by reduced Pdx1 expression is a common pathway induced by the majority of the mechanisms in apoptotic β‐cells. Although the report so far paid little attention to non‐apoptotic β‐cell death (autophagy and necrosis), we expect these are also involved in the pathogenesis of diabetes. The potential role of Pdx1 in non‐apoptotic β‐cell death should also be considered in future studies in diabetes, and in attempts to develop novel agents that target this process for prevention and treatment of the disorder.
MEY = MSY
Authors: Christensen Villy
Published: October 2009

It has been generally accepted for more than half a century that the fishing sector stood to gain from managing fisheries at the effort level producing maximum economic yield (MEY) rather than at the higher effort level producing maximum sustainable yield (MSY). However, the acceptance is built on evaluating only the revenue and cost structure for the fishing fleet, not for the overall fishing sector including processing, distribution and marketing of fish products. Considering these links of the fish value chain moves the MEY‐level closer to, but slightly below the MSY‐level. For society as a whole, this means that MSY is the more appropriate target reference level.
The Liberal Peace at Home and Abroad: Northern Ireland and Liberal Internationalism
Authors: Mac Ginty Roger
Published: October 2009

Northern Ireland, we are told, holds positive lessons for other societies emerging from violent conflict. As Britain is one of the leading proponents of liberal internationalism, this article considers whether the liberal internationalism pushed with so much enthusiasm abroad through British foreign policy has been applied with diligence at home—in the Northern Ireland peace process. The findings suggest that Northern Ireland is by no means a poster child for liberal internationalism. Instead, British government handling of the Northern Ireland peace process shows serious deviations from the liberal internationalist canon. This article argues that liberal peace-lite has been tolerated and facilitated at home, while a stricter variant is often expected in overseas contexts.
INCENSE AND INSENSIBILITY: AUSTIN ON THE ‘NON‐SERIOUSNESS’ OF POETRY
Authors: De Gaynesford Maximilian
Published: October 2009

What is at stake when J. L. Austin calls poetry ‘non‐serious’, and sidelines it in his speech act theory? (I). Standard explanations polarize sharply along party lines: poets (e.g. Geoffrey Hill) and critics (e.g. Christopher Ricks) are incensed, while philosophers (e.g. P. F. Strawson; John Searle) deny cause (II). Neither line is consistent with Austin's remarks, whose allusions to Plato, Aristotle and Frege are insufficiently noted (III). What Austin thinks is at stake is confusion, which he corrects apparently to the advantage of poets (IV). But what is actually at stake is the possibility of commitment and poetic integrity. We should reject what Austin offers (V).1
PHILOSOPHY AND LITERATURE: YESTERDAY, TODAY AND TOMORROW
Authors: Warner Martin
Published: October 2009

Plato's rhetorical gesture invoking a ‘quarrel’ between philosophy and poetry points to a deep problem in our conception of rational discourse, often obscured or displaced in the history of philosophy's relations with imaginative literature, especially with respect to analytic philosophy in the first half of the twentieth century. Recent developments have helped focus attention on the overlap between philosophy and literature, which the contemporary retreat from philosophy's ‘narrative turn’ does little to undermine. Further work in the philosophy of language, the logic of the imagination, and the relations between dialectic and rhetoric promise to throw light on that ancient problem.
Preventing Homelessness due to Domestic Violence: Providing a Safe Space or Closing the Door to New Possibilities?
Authors: Netto Gina , Pawson Hal , Sharp Cathy
Published: October 2009

Domestic violence has been recognized as a major contributory factor to homelessness in the UK and elsewhere, with women more likely to be affected. In the UK and other countries undergoing welfare reform, moves toward ‘active citizenship’ increase the complexity of the relationship between states and citizens and open up new strategies for both. However, analysts have noted some strategies can create new forms of inequality, including gender‐based ones. This article considers the impact of prevention‐centred homelessness policy responses to domestic violence, with specific reference to the ‘Sanctuary’ model. Sanctuary schemes support women facing homelessness due to domestic violence to remain in their current residence, protected against attack from outside the home. Drawing on analysis of the literature and empirical work, we compare the experiences of women who have used traditional forms of support and Sanctuary services. We argue that while the model has the potential to provide greater autonomy to some women in these circumstances, it is not appropriate for all. Increased emphasis on Sanctuary schemes could make it more difficult for women who might prefer to move. We conclude that more attention needs to be paid to addressing the origin of women's homelessness due to domestic violence.
Chronic and acute stress, gender, and serotonin transporter gene–environment interactions predicting depression symptoms in youth
Authors: Hammen Constance , Brennan Patricia A. , Keenan‐Miller Danielle , Hazel Nicholas A. , Najman Jake M.
Published: October 2009

Background:  Many recent studies of serotonin transporter gene by environment effects predicting depression have used stress assessments with undefined or poor psychometric methods, possibly contributing to wide variation in findings. The present study attempted to distinguish between effects of acute and chronic stress to predict depressive symptoms at age 20 among 346 youth varying in polymorphisms of the 5HTT gene who had been assessed at ages 15 and 20.

Methods:  Interview measures assessed major acute life events between 15 and 19, and multiple interviews and questionnaires with youths and their parents at youth age 15 provided an index of chronic family stress. Lg alleles were reclassified as S.

Results:  Chronic family stress at age 15 predicted higher depression scores at 20 among those with one or two S alleles, and the effects of genetic moderation were significant only for females. Gene–environment interactions with acute stress were nonsignificant.

Conclusions:  Careful measurement and separation of the effects of chronic and acute stress, and gender, are encouraged in the study of mechanisms of the stress–depression association.
Social functioning and communication in children with cerebral palsy: association with disease characteristics and personal and environmental factors
Authors: VOORMAN JEANINE M , DALLMEIJER ANNET J , VAN ECK MIRJAM , SCHUENGEL CARLO , BECHER JULES G
Published: October 2009

Aim  The objective of this longitudinal study was to describe the course of social functioning and communication in children with cerebral palsy (CP) over a 3‐year period, its difference with the normative course, and its relationship with disease characteristics and personal and environmental factors.

Method  Participants in this study were 110 children with CP (70 males, 40 females) with a mean age of 11 years and 3 months (SD 1y 8mo). Social functioning and communication were measured with the Vineland Adaptive Behavior Scales. Comparisons were made with normative data; data were analysed with generalized estimating equations. According to the Gross Motor Function Classification System (GMFCS), 50 of the 110 children were categorized as GMFCS level I, 16 as level II, 13 as level III, 13 as level IV, and 18 as level V.

Results  The course of social functioning over a 3‐year period showed an increase in restrictions in children with CP (p<0.001). Restrictions in communication increased more in children with the most severe forms of CP (p<0.001). In addition to disease characteristics (GMFCS category, presence of epilepsy, and speech problems), personal factors (externalizing behaviour problems) and environmental factors (having no siblings, low parental level of education, and parental stress) were associated with greater restrictions in social functioning and communication.

Interpretation  The results indicate that it is important to focus not only on the medical treatment of children with CP, but also on their behavioural problems and social circumstances, and to support the parents so that social functioning and communication in these children may be improved.
Survival of individuals with cerebral palsy receiving continuous intrathecal baclofen treatment: a matched‐cohort study
Authors: KRACH LINDA E , KRIEL ROBERT L , DAY STEVEN M , STRAUSS DAVID J
Published: October 2009

Aim  To determine whether intrathecal baclofen (ITB) changes mortality risk in persons with cerebral palsy (CP).

Method  Records were reviewed for all persons with CP who were managed with ITB for hypertonicity at a specialty hospital in Minnesota between May 1993 and August 2007. A comparison cohort was randomly selected from clients of the California Department of Developmental Services who were initially evaluated between 1987 and 1990 and were matched to those with ITB for age, sex, Gross Motor Function Classification System (GMFCS) level, presence or absence of epilepsy, and feeding‐tube use. Survival probabilities were estimated using the Kaplan–Meier method, and differences were tested via log‐rank.

Results  Three hundred and fifty‐nine persons with CP (202 males, 157 females) receiving ITB for hypertonicity (mean age 12y 8mo, SD 7y 9mo, range 3y 1mo to 39y 9mo) were matched to 349 persons without ITB pumps (195 males, 154 females; mean age 12y 7mo, SD 8y 4mo, range 2y 7mo to 40y). The proportion of patients at different GMFCS levels in the ITB and in the non‐ITB cohorts, respectively, was as follows: level II 3% and 3%, level III 16% and 16%, level IV 38% and 37%, and level V 43% and 44%. Survival at 8 years of follow‐up was 92% (SD 1.9%) in the ITB cohort and 82% (SD 2.4%) in the non‐ITB cohort (p<0.001). After adjustment to account for recent trends in improved survival in CP, 8‐year survival in the non‐ITB cohort was 88%, which was not significantly different from the ITB cohort (p=0.073).

Interpretation  ITB therapy does not increase mortality in individuals with CP and may suggest an increase in life expectancy.
Unusual presentation of Bartholin's gland duct cysts: anterior expansions
Authors: Rouzier Roman , Azarian Madeleine , Plantier Françoise , Constancis Elisabeth , Haddad Bassam , Paniel Bernard‐Jean
Published: October 2009

The medical records of 32 patients who underwent surgery for a vulvar mucinous cyst located between the urethral meatus and the fourchette were reviewed. Nineteen (59%) patients had been referred to our centre because of cyst recurrence after incision or excision. The majority of the cysts were lined by a single layer of tall columnar cells with zones of squamous metaplasia. Subacute or chronic bartholinitis was demonstrated in 94% of the cases demonstrating that these cysts were anterior expansions of Bartholin's gland duct cysts. No ipsilateral recurrence was observed after cyst and gland excision.
The benefits and risks of inducing labour in patients with prior caesarean delivery: a systematic review
Authors: McDonagh Marian S. , Osterweil Patricia , Guise Jeanne‐Marie
Published: October 2009

Objective  To evaluate the risks and benefits of inducing labour in women with a prior caesarean delivery.

Design  Systematic review.

Sample  Pregnant women with prior caesarean delivery.

Methods  Studies were identified using MEDLINE, EMBASE, HealthSTAR, Cochrane Database of Systematic Reviews, Cochrane Controlled Trials Register, Database of Abstracts of Reviews of Effectiveness, reference lists and experts.

Main outcome measures  All studies reporting data for outcomes in women with induced labours and prior caesarean were eligible. Methodologic quality was evaluated using the criteria of the U.S. Preventive Services Task Force and the NHS Centre for Reviews and Dissemination. We assigned studies good, fair or poor rating.

Results  We reviewed 162 full text articles, identified 14 fair‐quality studies, and found no good‐quality studies. Compared with spontaneous labour, induction was more likely to result in caesarean delivery. Of women undergoing spontaneous labour, 20% had a caesarean (range 11–35%) compared with 32% receiving oxytocin (range 18–44%). In studies of PGE2, spontaneous labour resulted in caesarean delivery in 24% (range 18–51%) compared with 48% with PGE2 (range 28–51%). There was a non‐significant increase in uterine ruptures among those induced compared with spontaneous labours. There were no maternal deaths; other maternal complications were infrequently reported. Only four studies reported on infant deaths; other infant outcomes were inadequately reported.

Conclusion  Women with a history of caesarean attempting trial of labour who require induction have a higher rate of caesarean delivery and have a slightly elevated risk of rupture compared with similar women with spontaneous labour. More consideration is needed for potential confounders: dose, reasons for induction and appropriate comparison groups.
Randomised comparative trial of the levonorgestrel intrauterine system and mefenamic acid for the treatment of idiopathic menorrhagia: a multiple analysis using total menstrual fluid loss, menstrual blood loss and pictorial blood loss assessment charts
Authors: Reid Peter C. , Virtanen‐Kari Susanna
Published: October 2009

Objective  To compare the efficacy and tolerability of the levonorgestrel intrauterine system (LNG IUS) with mefenamic acid in the management of objective idiopathic menorrhagia.

Design  Phase III, Single centre, open, randomised, comparative, parallel group study.

Setting  District General Hospital in the United Kingdom.

Population  Fifty‐one women with objective menorrhagia.

Methods  Twenty‐five women randomised to receive the LNG IUS and 26 to oral mefenamic acid for six cycles.

Main outcome measures  Change from baseline in menstrual blood loss (MBL), total menstrual fluid loss (TMFL) and pictorial blood loss assessment chart (PBAC) score at the third and sixth cycle of treatment.

Results  After six cycles the median menstrual blood loss was 5 mL in the LNG IUS group and 100 mL in the mefenamic acid group (P < 0.001). Median TMFL was 27 mL in the LNG IUS group and 157 mL in the mefenamic acid group (P < 0.001). Median PBAC score was 25 in the LNG IUS group and 159 in the mefenamic acid group. Changes in menstrual blood loss correlated strongly to changes in TMFL (r= 0.88) but PBAC correlated less well to blood loss and total fluid loss (r= 0.53 and r= 0.58).

Conclusions  Both the LNG IUS and mefenamic acid significantly decreased menstrual blood loss, TMFL and PBAC scores. The LNG IUS produced greater reductions in all parameters than mefenamic acid. Comparison of the different measurements suggests that TMFL assessment may be an easier and a more relevant measure of symptom severity than menstrual blood loss.
Non‐invasive intrapartum fetal ECG: preliminary report
Authors: Taylor Myles J.O. , Thomas Matthew J. , Smith Mark J. , Oseku‐Afful Salome , Fisk Nicholas M. , Green Andrew R. , Paterson‐Brown Sara , Gardiner Helena M.
Published: October 2009

Objectives  To obtain fetal heart rate, detailed fetal electrocardiography (fECG) signals and uterine contractions during labour using a single device.

Design  Prospective observational study.

Setting  Delivery suite at a tertiary referral hospital, London, UK.

Population  Fifteen patients at median gestation of 39 weeks (range 24–41) were recruited at median cervical dilatation of 4.0 cm (range 0–10) of whom 8/15 (53%) had intact amniotic membranes.

Methods  Using 12 abdominally sited electrodes, we recorded the composite abdominal signal in pregnancies intrapartum. The recorded data were analysed off‐line using a blind signal separation technique.

Main outcome measures  Success of signal separation and fECG time intervals.

Results  Successful fECG signal acquisition was achieved in 12/15 (80%) patients and an averaged fECG waveform acquired. In these patients, P and QRS waves were seen in all cases, and T waves in 11/12 (92%). True beat‐to‐beat heart rate (HR) was displayed and measures of its variability obtained. The mother's ECG and uterine electrical activity, shown to match tocographically recorded uterine contractions, were also separated and displayed. Failure to acquire fECG in three cases was attributed to excessive abdominal muscular activity and electrical interference.

Conclusions  This study demonstrates a non‐invasive technique that displays detailed intrapartum fECG waveforms, HR variability, maternal ECG and uterine contractions simultaneously, all in a single device and which avoids the potential risks of invasive monitoring with a fetal scalp electrode.
Socio‐economic position across the life course and hysterectomy in three British cohorts: a cross‐cohort comparative study
Authors: Cooper Rachel , Lawlor Debbie A. , Hardy Rebecca , Ebrahim Shah , Leon David A. , Wadsworth Michael E.J. , Kuh Diana
Published: October 2009

Objective  To examine the association between indicators of lifetime socio‐economic position and rates of hysterectomy in three British cohorts.

Design  Cross‐cohort comparative study.

Setting  Two cohorts: England, Scotland and Wales. Third cohort: Aberdeen, Scotland.

Population  Three thousand two hundred and eight women born between 1919 and 1940, participating in the British Women's Heart and Health Study (BWHHS); 1394 women from the MRC National Survey of Health and Development (NSHD), followed up since birth in 1946; 3208 women born between 1950 and 1955, participating in the Aberdeen Children of the 1950s study, all with complete information on lifetime socio‐economic position and hysterectomy status.

Methods  Relative indices of inequality were derived for markers of socio‐economic position in childhood and adulthood. Cox's regression models were used to test the association between these markers and hysterectomy.

Main outcome measure  Self‐reported hysterectomy with or without oophorectomy.

Results  Adverse socio‐economic position in childhood and as indicated by educational status was associated with reduced rates of hysterectomy in the oldest of the three cohorts (BWHHS), whereas conversely in the NSHD and Aberdeen cohorts it was associated with increased rates of hysterectomy. The unadjusted hazards ratios for hysterectomy comparing worst to best socio‐economic position for father's social class were 0.73 (0.56, 0.96) for women from the BWHHS, 1.77 (1.19, 2.65) for those from the NSHD and 2.06 (1.46, 2.89) for those from the Aberdeen cohort. Associations between markers of adult socio‐economic position and hysterectomy tended to be weaker in all three cohorts and often did not reach conventional levels of statistical significance.

Conclusions  Our results show that hysterectomy rates are influenced by childhood socio‐economic position and educational attainment, but that the nature of this association varies across these three British cohorts born in different decades of the 20th century. That there were no consistent or strong associations between adult SEP and hysterectomy rates suggest that social factors influencing rates of hysterectomy are likely to be those experienced or which develop in early life rather than those which develop later.
Recreational drugs and fetal gastroschisis: maternal hair analysis in the peri‐conceptional period and during pregnancy
Authors: Morrison John J. , Chitty Lynn S. , Peebles Donald , Rodeck Charles H.
Published: October 2009

Objective  To objectively measure individual recreational drug groups in maternal hair samples timed for the period of conception and different stages of pregnancy in expectant mothers with a diagnosis of fetal gastroschisis.

Design  Prospective observational study.

Setting  Tertiary level Fetal Medicine Unit in a University teaching hospital.

Population  Pregnant women with a diagnosis of fetal gastroschisis (n= 22) and a control group of women (n= 25) with a normal fetus.

Methods  Hair samples were cut from the vertex of the head of expectant mothers with a diagnosis of fetal gastroschisis and a matched control group in whom the fetus was normal. The samples were analysed by enzyme‐linked immunosorbent assay (ELISA) for individual drug groups. Confirmatory tests using gas chromatography with mass spectrometry (GCMS) were used.

Main outcome measures  Presence of recreational drug compounds in hair samples.

Results  In the group with fetal gastroschisis there were four proven positive cases for recreational drug abuse (18%) and there were none in the control group.

Conclusions  The incidence of recreational drug use in the peri‐conceptional period and the first trimester by expectant mothers with a diagnosis of fetal gastroschisis is 18%. This association may be linked to the recent increase in the incidence of gastroschisis among younger mothers.
Customised birthweight centiles predict SGA pregnancies with perinatal morbidity
Authors: McCowan Lesley M.E. , Harding Jane E. , Stewart Alistair W.
Published: October 2009

Objectives  To determine the following: (1) the proportion of babies reclassified as small or appropriately grown using customised and population centiles; and (2) the relative risks of perinatal morbidity, including abnormal umbilical Doppler studies, in babies classified as small for gestational age (SGA) and appropriate for gestational age (non‐SGA) using the two centile calculations.

Design  Cohort study in SGA and general hospital populations.

Setting  National Women's Hospital, Auckland, NZ.

Population  A cohort of SGA pregnancies (n= 374) and a general obstetric population (n= 12,879).

Methods  Pregnancy outcomes were compared between ‘non‐SGA both’ (≥10th% by population and customised centiles) and those who were ‘SGA both’ (<10th% by population and customised centiles), ‘SGA customised only’ (SGA by customised but non‐SGA by population centiles) and ‘SGA population only’ (SGA by population but non‐SGA by customised centiles).

Main outcome measures  Maternal and newborn morbidity and perinatal death.

Results  In the SGA cohort 271 (72%) babies were ‘SGA both’, 27 (7%) were ‘SGA customised only’, 32 (9%) were ‘population SGA only’ and 44 (12%) were ‘non‐SGA both’. In the general obstetric population 863 (6.7%) babies were ‘SGA both’, 445 (3.5%) were ‘customised SGA only’, 285 (2.2%) were ‘population SGA only’ and 11,286 (88%) were ‘non‐SGA both’. Perinatal death and newborn morbidity including nursery admission and long hospital stay were increased and comparable between ‘SGA both’ and ‘customised SGA only’ in both study populations. Newborn morbidity was low and comparable between ‘population SGA only’ and ‘non‐SGA both’. No perinatal deaths occurred in ‘population SGA only’ babies. Abnormal Doppler studies were more common in ‘SGA both’ or ‘customised SGA only’ but not in ‘population SGA only’ groups compared with ‘non‐SGA both’.

Conclusions  Customised birthweight centiles identified small babies at risk of morbidity and mortality. Use of customised centiles is likely to detect more babies at risk of perinatal morbidity and mortality than would be detected by population centiles.
Central amylin expression and its induction in rat dams
Authors: Dobolyi Arpád
Published: October 2009

Amylin, or islet amyloid polypeptide, is known as a satiating signal expressed in pancreatic β‐cells but not in the brain. In this study, regulations of postpartum mRNA expressions were investigated in the preoptic area of the hypothalamus. mRNA levels of lactating dams and mothers whose pups were removed immediately after delivery were compared in microarray experiments. There were 20 genes identified with significantly increased and 14 with decreased expression 9 days postpartum. Amylin mRNA level demonstrated the largest change, a 25.7 times increase. Quantitative RT‐PCR measurements validated the increase in the mRNA level of amylin in the preoptic area of lactating dams while the expression level of other members of the calcitonin gene‐related peptide family did not change. In situ hybridization histochemistry for amylin further verified its induction in lactating mothers and demonstrated the distribution of amylin mRNA in the medial preoptic nucleus, parts of the medial preoptic area, and the ventral part of the bed nucleus of the stria terminalis but nowhere else in the rat brain. Immunolabeling verified the postpartum induction of amylin in the preoptic area at the peptide level, as well. The results suggest that amylin may play a part in maternal regulations.
Amyloid precursor protein 695 associates with assembled NR2A‐ and NR2B‐containing NMDA receptors to result in the enhancement of their cell surface delivery
Authors: Cousins Sarah L. , Hoey Sarah E. A. , Anne Stephenson F. , Perkinton Michael S.
Published: October 2009

This is a study of the interaction between the two NMDA neurotransmitter receptor subtypes, NR1/NR2A and NR1/NR2B, and amyloid precursor protein (APP) 695, the major APP variant expressed in neurones. APP695 co‐immunoprecipitated with assembled NR1‐1a/NR2A and NR1‐1a/NR2B NMDA receptors following expression in mammalian cells. Single NR1‐1a, NR1‐2a, NR1‐4bc‐Myc, or NR2 subunit transfections revealed that co‐association of APP695 with assembled NMDA receptors was mediated via the NR1 subunit; it was independent of the NR1 C1, C2, and C2′ cassettes and, the use of an NR1‐2ac‐Myc‐trafficking mutant suggested that interaction between the two proteins occurs in the endoplasmic reticulum. The use of antibodies directed against extracellular and intracellular NR2 subunit epitopes for immunoprecipitations suggested that APP/NMDA receptor association was mediated via N‐terminal domains. Anti‐APP antibodies immunoprecipitated NR1, NR2A, and NR2B immunoreactive bands from detergent extracts of mammalian brain; reciprocally, anti‐NR1 or anti‐NR2A antibodies co‐immunoprecipitated APP immunoreactivity. Immune pellets from brain were sensitive to endoglycosidase H suggesting that, as for heterologous expression, APP and NMDA receptor association occurs in the endoplasmic reticulum. Co‐expression of APP695 in mammalian cells resulted in enhanced cell surface expression of both NR1‐1a/NR2A and NR1‐1a/NR2B NMDA receptors with no increase in total subunit expression. These findings are further evidence for a role of APP in intracellular trafficking mechanisms. Further, they provide a link between two major brain proteins that have both been implicated in Alzheimer’s disease.