bluuebunny/crossref_metadata_2025 huggingface dataset:
Fetal clavicle length throughout gestation: a nomogram
Authors: Sherer D. M. , Sokolovski M. , Dalloul M. , Khoury‐Collado F. , Osho J. A. , Lamarque M. D. , Abulafia O.
Published: January 2006

Objective

To create a nomogram of fetal clavicle length (CL) throughout gestation.

Methods

Cross‐sectional study of patients between 14 and 42 weeks' gestation. Inclusion criteria consisted of well‐established dates (consistent with early ultrasound), singleton, non‐anomalous fetuses, and intact amniotic membranes. Sonographic measurements included biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), femur length (FL), humerus length (HL) and sonographically estimated fetal weight (SEFW). For every case, the average of three separate measurements of the CL was used. The 5th, 50th and 95th centiles were obtained by least squares regression. Pearson's correlation coefficient and associated P‐values for the relationships between CL and other biometric measurements were calculated. The data were compared to a nomogram of the CL generated in 1985 from the measurement of 85 fetuses.

Results

A total of 623 consecutive patients were studied. In all but three cases, CL was successfully measured. Mean maternal age was 27.7 ± 6.2 years, median gravidity 3 (range, 1–14) and median parity 1 (range, 0‐9). Mean CL (mm) = −75.30 + 32.70*ln(GA) and SD = −0.41 + 0.08328*GA, where ln represents the natural logarithm and GA the gestational age in weeks. Fetal CL correlated significantly and strongly with BPD, HC, AC, HL, FL and the logarithm of SEFW, with Pearson correlation values of 0.973, 0.977, 0.976, 0.979, 0.977 and 0.979, respectively (all P < 0.001). Measurements according to comparable 1985 data were consistently substantially below the present data (smaller CL for any given GA except below 17 weeks' gestation).

Conclusions

We propose a new nomogram of CL, which differs significantly from the previously published nomogram. We suggest that the present data reflect the use of high‐resolution ultrasound technology and propose that these data, based on a large number of fetuses, replace the previous nomogram. We also suggest that the ‘1 mm = 1 week’ rule of thumb should no longer be used, since it can be erroneous by as much as 6 weeks. Copyright © 2006 ISUOG. Published by John Wiley & Sons, Ltd.
Meckel–Grüber syndrome: sonography and pathology
Authors: Ickowicz V. , Eurin D. , Maugey‐Laulom B. , Didier F. , Garel C. , Gubler M. C. , Laquerrière A. , Avni E. F.
Published: January 2006

Objective

To define a specific sonographic pattern for the appearance of the kidneys in fetuses affected by Meckel–Grüber syndrome (MGS).

Methods

This was a retrospective analysis of 30 cases, collected from five centers, with ultrasound features suggestive of MGS. Only fetuses with a confirmed diagnosis of MGS were finally included. Analysis included a detailed evaluation of the sonographic findings and comparison with pathological follow‐up.

Results

Seventeen cases met the pathological criteria for a diagnosis of MGS and were included in the study. In all cases, a typical sonographic pattern was seen: the kidneys were enlarged (mean, + 4.8 SD) and showed unusual corticomedullary differentiation, occurring as early as the first trimester. In most cases, the medullary areas appeared excessively large and mottled due to the presence of multiple small cysts.

Conclusions

The kidneys of fetuses with MGS are enlarged, cystic and have unusual corticomedullary differentiation. These features can be observed as early as the first and early second trimesters. Copyright © 2006 ISUOG. Published by John Wiley & Sons, Ltd.
Effects of breastfeeding on women's health
Authors: Kennedy K.I.
Published: January 2006

Research about the effects of breastfeeding on maternal health has concentrated primarily on breast cancer, bone loss, and maternal depletion. Breastfeeding may provide some protection against breast cancer. Adequate maternal nutrition, a prolonged period of weaning, and adequate child spacing are expected to alleviate any potential bone loss or maternal depletion caused by breastfeeding. Regardless of how one chooses to weigh the relative benefits and risks of breastfeeding to the mother, it seems clear that the programmatic tasks are to see that breastfeeding women are adequately fed and enabled to space their pregnancies.
Breastfeeding in family planning programs: A help or a hindrance?
Authors: Huffman S.L. , Labbok M.H.
Published: January 2006

Breastfeeding is a major contributor to child spacing and reproductive health, and, as such, is a vital women's issue. Further, if breastfeeding levels were to decline, the increase in family planning services that would be required to replace the lost fertility impact would be prohibitive, both in terms of cost and difficulty. This concern places breastfeeding centrally as a family planning policy issue as well. This paper discusses how breastfeeding contributes to child spacing and reduced fertility; the appropriate and timely introduction of complementary family planning methods during breastfeeding; issues and controversies in the support of breastfeeding as a family planning issue in the context of women's concerns, including the concept of exclusive breastfeeding for 6 months, the encouragement and support to maintain breastfeeding after 6 months, and the use of the Lactational Amenorrhea Method (LAM) and other family planning methods in the early postpartum period; and the role of family planning programs in supporting women's informed reproductive health choices.
Breastfeeding as a women's issue: Conclusions and consensus, complementary concerns, and next actions
Authors: Labbok M.H.
Published: January 2006

Twelve themes arose during the conference which, when presented to the group in a summary session, were greeted by general consensus and approval. These themes fall into four categories: women and health care; women and other life choices; women and men; and women and political action. Additional concerns that were not included in the 1‐day conference are outlined, including a discussion of: (1) respect for the reproductive roles of women, the three ‘I's’, and other reproductive health issues; (2) a 7‐stage approach to women's nutrition; (3) the supervisory role of the health care provider versus a role as a creator of self‐efficacy; (4) the cost of breastfeeding; and (5) the impact on the environment. Conclusions and next actions also are presented for consideration.
Improved activity of streptozotocin‐selected insulinoma cells following microencapsulation and transplantation into diabetic mice
Authors: Bloch K. , Vorobeychik M. , Yavrians K. , Azarov D. , Bloch O. , Vardi P.
Published: January 2006

We have recently shown that repeated streptozotocin (STZ) treatment induces the selection of insulinoma cells (RINmS) with both improved resistance to diabetogenic toxins and functional activity, compared to parental RINm cells. The aim of the present study was to estimate the potential of RINmS cells to maintain their engineered characteristics during in vivo hyperglycemic conditions. It was found that microencapsulation and transplantation into diabetic mice preserved a three‐fold higher level of insulin content in selected RINmS cells when compared to the parental ones. Retrieval of transplanted encapsulated cells from the peritoneal cavity of diabetic mice had a significantly higher insulin content and a more intense insulin response to secretogogues in selected RINmS cells when compared to retrieved RINm cells. In conclusion, our results show that RINmS cells do not lose their improved functional characteristics after encapsulation and transplantation into diabetic mice.
The effect of p21 antisense oligodeoxynucleotides on the radiosensitivity of nasopharyngeal carcinoma cells with normal p53 function
Authors: Liu Xiu‐Fang , Xia Yun‐Fei , Li Man‐Zhi , Wang Hong‐Mei , He Yu‐Xiang , Zheng Mei‐Lian , Yang Hui‐Ling , Huang Wen‐Lin
Published: January 2006

Objective: p21WAF1/CIP1 is transcriptionally activated by p53 and is required for G1 to S phase progression. p21 plays a critical role in DNA repair after DNA damage. Thus, cells with defective p21 may result in an enhancement of radiation induced apoptosis and improved radiosensitivity. We tested the hypothesis that p21 antisense oligodeoxynucleotides (p21 AS ODNs) can be used to reduce p21 expression level and increase radiosensitivity in CNE‐1‐wtp53 nasopharyngeal carcinoma cell line with normal p53 function.

Methods and materials: The p21 antisense oligodeoxynucleotides (p21 AS ODNs) and the random control oligodeoxynucleotides (p21 RD ODNs) were synthesized. p21 AS ODNs sequence: 5′‐TGTCATGCTGGTCTGCCGCC‐3′; p21 RD ODNs sequence: 5′‐CCGGTGAACGAGCGAGCACA‐3′. p21 AS ODNs and p21 RD ODNs were transfected into CNE‐1‐wtp53 nasopharyngeal carcinoma cell line. The protein expression levels of P21 were evaluated using Western blotting analysis. Cell cycle progression and apoptotic cells were assessed by flow cytometric analysis. The clonogenic survival assay was performed to determine the survival fraction. The parameters D0, Dq, and N for the single‐hit multitarget model and the parameters α, β, α/β, and SF2 for the linear‐quadratic model were calculated. BALB/c nude mice were used to investigate the effect of p21 AS ODNs on the radiosensitivity of nasopharyngeal xenografts in vivo.

Results: p21 AS ODNs were detected mainly in plasma with fluorescence microscopy investigation. P21 protein level dramatically decreased and the amount of apoptotic cells increased in p21 AS ODNs transfected cells than in p21 RD ODNs transfected cells after irradiation. The percentage of G1 arrest decreased in p21 AS ODNs transfected cells 24 h after radiation, then G2 arrest decreased 48 h after radiation. The values of D0, Dq, SF2 decreased and α value increased in p21 AS ODNs transfected cells than in control cells. The inhibition rate in tumor xenografts exposed to X ray of 10 Gy alone was 39.1%, while it was 51.4% in xenografts injected with p21 AS ODNs before exposure to radiation. Unfortunately, there was no significant difference between these two groups (P < 0.05).

Conclusion: p21 Antisense oligodeoxynucleotides led to inhibition of P21 protein expression, loss of G1 arrest, increase of apoptosis in CNE‐1‐wtp53 nasopharyngeal carcinoma cell line in vitro and inhibited tumor growth in vivo. Antisense oligodeoxynucleotides may become a promising strategy to enhance radiosensitivity in nasopharyngeal carcinoma cells with normal p53 function.
Cyclic adenosine 3′,5′‐monophosphate induces differentiation of mouse embryonic stem cells into cardiomyocytes
Authors: Chen Ye , Shao Jian‐Zhong , Xiang Li‐Xin , Guo Jian , Zhou Qing‐Jun , Yao Xing , Dai Li‐Cheng , Lu Yong‐Liang
Published: January 2006

Embryonic stem (ES) cells, derived from blastocyst‐stage of early mammalian embryos, have the potential to differentiate into derivatives of all three embryonic germ layers. Here we reported the first evidence that murine pluripotent ES cells could be induced to differentiate into cardiomyocytes by cyclic adenosine 3′,5′‐monophosphate (cAMP) in vitro. Spontaneously beating of cardiac cell clusters began to be observed within the outgrowths of embryoid bodies (EBs) as early as 2 days after the onset of differentiation. By days 5–8 after induction, a maximum level of cardiomyocyte differentiation could be achieved. Incubation of EBs with cAMP at concentrations ranging from 0.01 mg/L to 1 mg/L resulted in a significant elevation in differentiation rate, reaching a maximum value of 44.0 ± 1.3% at 0.03 mg/L of exposure. At 0.03 mg/L concentration point, an approximately 8.1‐fold increase in cardiomyocyte differentiation was observed in comparison with 5.4 ± 0.9% of untreated controls. The differentiation rate induced by cAMP was shown to be similar to that of RA/DMSO treated controls, indicating that cAMP has the same inducing effect as RA/DMSO. However, no significant co‐inducing effects between cAMP and RA/DMSO were seen. Cardiomyocytes were evident as they expressed cardiac cell specific genes and protein markers including GATA4, Nkx2.5, β‐MHC, atrial natriuretic factor (ANF) and alpha‐actin when analyzed by reverse transcription polymerase chain reaction (RT‐PCR) and immunohistochemical staining. The results from the present study suggested a novel role of cAMP in cardiomyocyte differentiation and provided a new research model for the study of cardiac cell biology.
Mapping nucleolar localization sequences of 1A6/DRIM
Authors: Liu Jiangying , Du Xiaojuan , Ke Yang
Published: January 2006

Human 1A6/downregulated in metastasis (DRIM) is a nucleolar protein with multiple HEAT‐repeat motifs (Huntington, elongation factor 3, a subunit of protein phosphatase 2A, target of rapamycin). The yeast homologue to 1A6/DRIM, Utp20, is part of the small subunit processome and functions in 18S RNA processing. In the present study, we utilized the green fluorescent protein as the fusion protein marker to investigate the sequence responsible for 1A6/DRIM accumulation in nucleolus. Deletion sequence analysis demonstrated that a single region located between amino acids 2744 and 2761 at the C‐terminus of 1A6/DRIM is capable of nucleolar accumulation. Two basic amino acid clusters within this region are essential for nucleolar accumulation. The sequences required for nucleolar accumulation overlaps the putative nuclear localization signal of 1A6/DRIM.
Artemisia annua L. (Asteraceae) trichome‐specific cDNAs reveal CYP71AV1, a cytochrome P450 with a key role in the biosynthesis of the antimalarial sesquiterpene lactone artemisinin
Authors: Teoh Keat H. , Polichuk Devin R. , Reed Darwin W. , Nowak Goska , Covello Patrick S.
Published: January 2006

Artemisinin, a sesquiterpene lactone endoperoxide derived from the plant Artemisia annua, forms the basis of the most important treatments of malaria in use today. In an effort to elucidate the biosynthesis of artemisinin, an expressed sequence tag approach to identifying the relevant biosynthetic genes was undertaken using isolated glandular trichomes as a source of mRNA. A cDNA clone encoding a cytochrome P450 designated CYP71AV1 was characterized by expression in Saccharomyces cerevisiae and shown to catalyze the oxidation of the proposed biosynthetic intermediates amorpha‐4,11‐diene, artemisinic alcohol and artemisinic aldehyde. The identification of the CYP71AV1 gene should allow for the engineering of semi‐synthetic production of artemisinin in appropriate plant or microbial hosts.
Regulation of p90RSK phosphorylation by SARS‐CoV infection in Vero E6 cells
Authors: Mizutani Tetsuya , Fukushi Shuetsu , Saijo Masayuki , Kurane Ichiro , Morikawa Shigeru
Published: January 2006

The 90 kDa ribosomal S6 kinases (p90RSKs) are a family of broadly expressed serine/threonine kinases with two kinase domains activated by extracellular signal‐regulated protein kinase in response to many growth factors. Our recent study demonstrated that severe acute respiratory syndrome (SARS)‐coronavirus (CoV) infection of monkey kidney Vero E6 cells induces phosphorylation and dephosphorylation of signaling pathways, resulting in apoptosis. In the present study, we investigated the phosphorylation status of p90RSK, which is a well‐known substrate of these signaling pathways, in SARS‐CoV‐infected cells. Vero E6 mainly expressed p90RSK1 and showed weak expression of p90RSK2. In the absence of viral infection, Ser221 in the N‐terminal kinase domain was phosphorylated constitutively, whereas both Thr573 in the C‐terminal kinase domain and Ser380 between the two kinase domains were not phosphorylated in confluent cells. Ser380, which has been reported to be involved in autophosphorylation by activation of the C‐terminal kinase domain, was phosphorylated in confluent SARS‐CoV‐infected cells, and this phosphorylation was inhibited by SB203580, which is an inhibitor of p38 mitogen‐activated protein kinases (MAPK). Phosphorylation of Thr573 was not upregulated in SARS‐CoV‐infected cells. Thus, in virus‐infected cells, phosphorylation of Thr573 was not necessary to induce phosphorylation of Ser380. On the other hand, Both Thr573 and Ser380 were phosphorylated by treatment with epidermal growth factor (EGF) in the absence of p38 MAPK activation. Ser220 was constitutively phosphorylated despite infection. These results indicated that phosphorylation status of p90RSK by SARS‐CoV infection is different from that by stimulation of EGF. This is the first detailed report regarding regulation of p90RSK phosphorylation by virus infection.
Expression cloning screen for modifiers of amyloid precursor protein shedding
Authors: Schöbel Susanne , Neumann Stephanie , Seed Brian , Lichtenthaler Stefan F.
Published: January 2006

Ectodomain shedding of the amyloid precursor protein (APP) is a key regulatory step in the generation of the amyloid β peptide (Aβ), which is thought to provoke the pathogenesis of Alzheimer's disease. To better understand the cellular processes that regulate ectodomain shedding of APP we used human embryonic kidney 293 cells and applied a sib‐selection expression cloning approach. In addition to a known activator of APP shedding – protein kinase A – the following cDNAs were identified: the endocytic proteins endophilin A1 and A3, the metabotropic glutamate receptor 3 (mGluR3), palmitoyl‐protein thioesterase 1 (PPT1), Numb‐like and the kinase MEKK2. Endophilins A1 and A3, as well as mGluR3 activated APP shedding relatively specifically. They had little or no effect on the shedding of the unrelated membrane proteins TNF receptor 2 and P‐selectin glycoprotein ligand‐1. In contrast, MEKK2 and PKA also increased shedding of TNF receptor 2, suggesting that these kinases contribute to a general program regulating ectodomain shedding. The strongest activator of APP shedding, endophilin A3, reduced the rate of APP endocytosis and specifically increased APP shedding by the protease α‐secretase, as measured in an antibody uptake assay and by immunoblot analysis. This suggests that endophilin A3 is a novel modulator of APP trafficking affecting access of APP to α‐secretase. In summary, this study shows that expression cloning is a suitable way to identify proteins controlling ectodomain shedding of membrane proteins.
Spatial and temporal variability of Holocene temperature in the North Atlantic region
Authors: Kaplan Michael R. , Wolfe Alexander P.
Published: January 2006

The early Holocene climate of the North Atlantic region was influenced by two boundary conditions that were fundamentally different from the present: the presence of the decaying Laurentide Ice Sheet (LIS) and higher than present summer solar insolation. In order to assess spatial and temporal patterns of Holocene climate evolution across this region, we collated quantitative paleotemperature records at sub-millennial resolution and synthesized their temporal variability using principal components analysis (PCA). The analysis reveals considerable spatial variability, most notably in the time-transgressive expression of the Holocene thermal maximum (HTM). Most of the region, but especially areas peripheral to the Labrador Sea and hence closest to the locus of LIS disintegration, experienced maximum Holocene temperatures that lagged peak summer insolation by 1000–3000 years. Many sites from the northeastern North Atlantic sector, including the Nordic Seas and Scandinavia, either warmed in phase with maximum summer insolation (11,000–9000 years ago) or were less strongly lagged than the Baffin Bay–Labrador Sea region. These spatially complex patterns of Holocene climate development, which are defined by the PCA, resulted from the interplay between final decay of the LIS and solar insolation forcing.
Rodent paleofaunas as indicators of climatic change in Europe during the last 125,000 years
Authors: Hernández Fernández Manuel
Published: January 2006

This paper presents a quantitative reconstruction of the European late Pleistocene paleoclimate based on 72 rodent assemblages of five sequences from France, Germany and Bulgaria, covering the last interglacial–glacial cycle. They show a pattern of severe changes in temperature, with reduced precipitation during the coldest periods. A tentative correlation between the isotopic and palynological records and the paleotemperature changes is shown. These changes are consistent with variations in atmospheric circulation patterns in response to an expanding–retracting Fennoscandian ice-sheet. They can be attributed to the enhancement–weakening of the Scandinavian-Polar anticyclone and its associated dry winds, the south–north shifting of the North Atlantic Polar Front, and the varying supply of moist air from the Atlantic. Qualitative paleoenvironmental analysis shows broadleaved-deciduous forests in France and Bulgaria during most of the studied period. Taiga and tundra appeared in eastern France during the lower Würm. The German sequence indicates the presence of coniferous forests. These results are broadly consistent with other paleobiological records (mammalian, avian and insect faunas, isotopic record in dental tissue, palynology). The main discrepancies with the paleoclimate inferred from the palynological record are found during the coldest periods and are probably due to the interaction between vegetation, climate, and atmospheric CO2 levels.
Mental health care in Madrid
Authors: Ferre Navarete F. , Palanca I.
Published: January 2006

Aim

To describe principles and characteristics of mental health care in Madrid.

Method

Based on existing data, service provision, number of professionals working in services, funding arrangements, pathways intocare, user/carer involvement and specific issues are reported.

Results

In Madrid, mental health services are organized into 11 zones/areas, divided into 36 districts, where there is a mental healthoutpatient service with a multi-disciplinary team. Home treatment and psychosocial rehabilitation services have been developed. Specialist programmes exist for vulnerable client groups, including Children and Adolescents, Addiction/Alcohol and Older People. The Madrid Mental Health Plan (2003–2008) is regarded as the key driver in implementing service improvement and increased mental health and well-being in Madrid. It has a meant global budget increase of more than 10% for mental health services. Results of the first 2 years are: an increase in mental health staff employed (17%), four new hospitalization units, 50% increase in places for children and adolescents Day Hospitals, 62 new beds in long care residential units, development of specific programmes for the homeless and gender-based violence, a significant investment in information systems (450 new computers) and development of best practice and operational guidelines. Mental health system was put to the test with Madrid's March 11th terrorist attack. A Special Mental Health Plan for Affected people was developed.

Discussion

Unlike some European countries, public mental health service is the main heath care provider. There are no voluntary agenciescollaborating with mental health care. Continuity of care and coordination between all mental health resources is essential in service delivery. Increased demand of care for minor psychiatric disorders, children and adolescent mental health care, and implementation of rehabilitation and residential facilities for chronic patients are outstanding challenges similar to those in other European capitals. Overall, the mental health system had successfully coped with last year's increased care demand after March 11th terrorist attack in Madrid.
Mental health care in Rome
Authors: Gaddini A. , Ascoli M. , Biscaglia L.
Published: January 2006

Aim

To describe principles and characteristics of mental health care in Rome.

Method

Based on existing data, service provision, number of professionals working in services, funding arrangements, pathways tocare, user/carer involvement and specific issues are reported.

Results

After the Italian psychiatric reform of 1978, an extensive network of community-based services has been set up in Romeproviding prevention, care and rehabilitation in mental health. A number of small public acute/emergency inpatient units inside general hospitals was created (median length of stay in 2002 = 8 days) to accomplish the shift from a hospital-based to a community-based psychiatric system of care. Some private structures provide inpatient assistance for less acute conditions (median length of stay in 2002 = 28 days), whilst the large Roman psychiatric hospital was closed in 1999.

Discussion

Whilst various issues of mental health care in Rome overlap with those in other European capitals, there also are some specific problems and features. During the last two decades, the mental health system in Rome has been successfully converted to a community-based one. Present issues concern a qualitative approach, with an increasing need to foresee adequate evaluation, especially considering mental health patients' satisfaction with services and economic outcomes.
Measuring Shrinkage in the Welfare State: Forms of Privatization in a Canadian Health-Care Sector
Authors: Gildiner Alina
Published: January 2006

Abstract.There is a discussion in the literature about whether, to what extent, and in what ways the welfare state is retrenching or otherwise changing. Both the health policy literature and the broader policy studies literature have tended to focus on economic measures of privatization. This study tests the adequacy of the measures of public-private change proposed by Stoddart and Labelle (1984) by using them to track and analyze the sequence of policy changes in automobile legislation, workers' compensation and health that transformed Ontario's rehabilitation health sector from being almost entirely public in 1990 to being almost entirely private a decade later. It suggests adding what is called “allocative decision-making power” to indicators used to assess public-private change in order to more adequately capture transformations.

Résumé.Assiste-t-on au déclin de l'État-providence ou à sa transformation? Quelle est l'ampleur du phénomène? Ce sont des questions qui ont été maintes fois examinées. Or, les analyses des politiques de santé ainsi que les études plus générales des politiques publiques ont tendance à se concentrer sur les mesures économiques de privatisation. La présente étude vise à tester la pertinence des mesures du changement public-privé proposées par Stoddart et Labelle (1984) en les appliquant à la série des changements de politiques en matière de réglementation automobile, d'indemnisation des travailleurs et de santé qui ont fait passer le secteur de la réadaptation du système de santé ontarien d'un statut presque entièrement public en 1990 à un statut presque entièrement privé une décennie plus tard. Cette étude propose d'ajouter la mesure de ce qu'on appelle “ la capacité à prendre des décisions d'allocation ” aux indicateurs traditionnels d'évaluation de l'équilibre public-privé, afin de mieux décrire les processus de changement.
External Constraints on Female Political Participation
Authors: MAEDA YUKIO
Published: January 2006

This article examines the gender gap in political participation in Japan. Although previous studies indicate that women may face several external constraints on political participation, this idea has not been tested systematically. Using the Japanese component of the Asia-Europe Survey, the article demonstrates that work experience and age have very different impacts on participation across the sexes. It argues that men and women encounter very different working conditions and family circumstances at certain stages of their lives, which create a gender gap in political participation.
Exploring the Low Levels of Women's Representation in Japanese Local Government
Authors: BOCHEL CATHERINE , BOCHEL HUGH
Published: January 2006

Although women have consistently outvoted men in elections in Japan since the 1970s, the country has a relatively poor record in terms of women being elected to representative bodies. In recent years, there have been increases, particularly in the number of women in the House of Representatives and the House of Councillors, but at the local level the rate of change has been slower.

As in other states, a number of propositions have been put forward to explain the low numbers of women in local assemblies. Drawing upon a variety of sources, including the developing literature and interviews with women councillors and others, this article seeks to identify the variety of factors that have contributed to holding down levels of female representation in local government in Japan. It examines these in the context of recent changes and considers the extent to which there is the prospect for further change.
An Evaluation of Japan's Current Energy Policy in the Context of the Azadegan Oil Field Agreement Signed in 2004
Authors: SHAOUL RAQUEL
Published: January 2006

In 2004, a government-backed Japanese consortium signed an agreement with the government of Iran to develop the major Azadegan oil field. Not only has the project been given the go-ahead despite numerous political obstacles and poor prospects attributed it, but the agreement also appears to be in conflict with Japan's energy policy, materializing from the mid 1980s to date. Consequently it is important to evaluate Azadegan in terms of Japan's evolving oil policy. Three alternative arguments are proposed to evaluate the quality of policy change: Japan–Iran's ‘special relationship’, bureaucratic factors in the energy policy-making process, and the rise of China. The conclusion emerging from this article is that the rise of China and the growing competition between Tokyo and Beijing in the Middle East and elsewhere are the primary factors in Japan's decision to conclude the Azadegan oil deal. The Azadegan case study therefore sets a new precedent for Japanese energy policy which emphasizes the political and strategic rather than economic factors leading this policy formulation.
Structure and Measurement of Life Satisfaction in Asian Countries: An Exploratory Analysis
Authors: JAGODZINSKI WOLFGANG
Published: January 2006

The relationship between specific and global measures of life satisfaction or happiness is usually seen as an asymmetric bottom-up relationship. Domain satisfaction and general satisfaction are independently measured and the typical question is whether the former has an impact on the latter or to what extent the former contributes to the latter. This paper, in contrast, investigates whether general life satisfaction can be statisti-cally derived from domain-specific satisfaction. It is suggested to conceptualize life satisfaction as a second-order factor, which is only indirectly related to observable variables. In the first part of the empirical analysis, it is shown that such a model fits the data of the first AsiaBarometer quite well. The factor models for the Asian countries under investigation are not equivalent but strikingly similar. The four first-order factors refer to satisfaction with (1) the family, (2) social status and social health, (3) economic status, and (4) collective goods. These factors load highly on a second-order factor, which is called general life satisfaction.

The results suggest the calculation of a specifically weighted factor score for each country and to base the further analyses on these scores. In the second part of the empirical investigation, it is demonstrated, however, that simple unweighted indices, which are calculated under the assumption of meaning equivalence, are very highly correlated with the country-specific factor scores. The further analysis is therefore based on an unweighted index.

In the last part of the empirical study, the reliability and validity of the life satisfaction index is examined and compared with the validity of a single indicator of overall happiness. Similar variables are used in many international surveys. Index and indicator are moderately correlated. It is shown that the life satisfaction index on average correlates higher with well-established determinants of happiness than the single item. This is particularly true for the pooled international data set, which includes the data from all participating countries. Accordingly, indices seem to be more reliable and valid measures of general life satisfaction, and may be better suited for comparative analyses at least for the countries under investigation.
Constitutional hypotension, does it exist?
Authors: Pechère-Bertschi  , Nussberger  , Burnier
Published: January 2006

L’hypotension orthostatique, souvent sévère, est une manifestation bien reconnue dans les dysautonomies associées à des neuropathies, ou d’autres affections systémiques (diabète). Par contre, les symptômes orthostatiques à type de pré-syncope, associés à une chute relativement modeste de la pression artérielle à l’orthostatisme, sont une entité mal connue, et font non rarement l’objet de consultations. Récemment a été reconnu le syndrome de tachycardie orthostatique ajoutant à ce tableau, une tachycardie posturale et une augmentation des catécholamines plasmatiques. Nous passons en revue dans cette article les différentes causes d’hypotension orthostatique, neurogène ou non, et nous évoquons quelques mécanismes physiopathologiques ayant trait à l’homéostasie sodique rénale dans l’hypotension. En particulier, des altérations de l’homéostasie sodique rénale pourraient contribuer à engendrer et maintenir ce syndrome, et pourraient être partiellement corrigées par l’apport de sel. Enfin, nous faisons le point sur les modalités thérapeutiques.
Molecular genetics of human hypertension
Authors: Ferrari
Published: January 2006

Der Blutdruck variiert in der Allgemeinbevölkerung entlang eines Continuums und wird durch zahlreiche Mechanismen reguliert, die eine Vielzahl von Genen und Umweltfaktoren involvieren. Epidemiologische Studien haben gezeigt, daß die Blutdruckvariabilität im gleichen Verhältnis sowohl genetischen Determinaten wie auch Umweltfaktoren zugeschrieben werden kann. In den letzten Jahren wurde die molekulare Basis von drei autosomal-vererbten Formen von schwerer Hypertonie klarifiziert: a) der Glukokortikoid-hemmbare Aldosteronismus (GHA), b) das Liddle Syndrom und c) das Syndrom des Apparenten Mineralokortikoid Exzeß (AME). Der GHA ist die Folge einer Expression eines chimären Gens, welches aus der Fusion des Promoters der 11beta-Hydroxylase mit der kodierenden Region des Enzyms Aldosteron-Synthase resultiert. Die Expression dieses chimären Gens in der Zona fasciculata der Nebennierenrinde steht unter der Kontrolle des ACTH und kann deshalb durch Gabe von Glukokortikoiden wie Dexamethason gehemmt werden. Mutationen der beta- oder gamma-Untereinheit des epithelialen Natrium-Kanals im distalen Nierentubulus verursachen das Liddle Syndrom. Die erhöhte Aktivität des Kanals infolge Mutationen führt zur vermehrten Natrium-Reabsorption. Diese wird durch Gabe von Amilorid oder Triamteren, nicht aber Spironolacton supprimiert. Das AME wird durch Mutationen des Enzyms 11beta-Hydroxysteroid Dehydrogenase Typ 2 hervorgerufen. Dieses Enzym wandelt das aktiv wirkende Kortisol zur Rezeptor-inaktiven Ketoform Kortison um, und schützt somit den nicht-spezifischen Mineralokortikoidrezeptor vor einer Stimulation durch endogene Glukokortikoide. Mit Ausnahme dieser seltenen genetischen Defekte des erweiterten Renin-Angiotensin-Systems existiert eine Vielzahl von potentiellen Genen, die das Risiko einer Hypertonie in einer gegebenen Umgebung erhöhen. Der Zusammenhang zwischen dem Angiotensinogen Gen und der familiären Hypertonie wurde anhand mehrerer Studien dokumentiert. Eine Variante des Angiotensinogen-Gens korreliert mit erhöhten Werten an Plasma-Angiotensinogen und wird häufiger bei Hypertonikern als bei Normotonikern gefunden. Der Zusammenhang zwischen dem Angiotensinogen-Genotyp, dem intermediären Phänotyp (erhöhtes Plasma-Angiotensinogen) und dem fernen Phänotyp (erhöhter Blutdruck) wird durch eine solche Beobachtung deutlich dargestellt. Der Nachweis dieser Gene, zusammen mit anderen informativen genetischen Markern wird erlauben, nach genetischen Verbindungen zwischen arterieller Hypertonie und einem bestimmten Chromosomen-Lokus zu suchen. Thanks to clinical curiosity, biochemical studies and, more recently, advances in molecular genetics, the non-entity called «essential hypertension» is shrinking. Richard D. Gordon Nature Genetics 1995
Diabetes and pregnancy
Authors: Schäfer-Graf  , Vetter
Published: January 2006

Glukosestoffwechselstörungen in der Schwangerschaft lassen sich unterteilen in den präexistenten Typ I Diabetes (Inzidenz 0.8%) und den Gestationsdiabetes (3–5%). Die Komplikationen für die Kinder leiten sich aus dem Hyperinsulinismus des Feten ab, der eine Reaktion auf ein erhöhtes Glukoseangebot bei mütterlicher Hyperglykämie darstellt. Für die Geburtshilfe bedeutsam ist das übermäßige Wachstum des Feten, seine Reifehemmung und entsprechende Anpassungstörungen nach der Geburt. Frauen mit Typ I Diabetes sollten schon präkonzeptionell intensiv im Hinblick auf eine Schwangerschaft betreut werden. Zur Senkung von Fehlbildungs- und Abortrate ist eine präkonzeptionelle Optimierung der Stoffwechselsituation unabdingbar. Untersuchungsbefunde bezüglich diabetischer Retinopathie und Nephropathie sollten vorliegen. Die Betreuung während der Schwangerschaft erfordert eine enge interdisziplinäre Kooperation von Diabetologen und Geburtsmedizinern. Die angestrebten Blutzuckerwerte liegen niedriger als außerhalb der Schwangerschaft. Der Gestationsdiabetes wird durch einen Screeningtest mit 50 g Glukose, dem bei positivem Ausfall ein 75 g oGTT folgt, diagnostiziert. In den meisten Fällen ist eine konservative Therapie mit Diät und Bewegungstherapie ausreichend. Frauen nach Schwangerschaften mit Gestationsdiabetes sollten auf ihr erhöhtes Risiko, einen Diabetes zu entwickeln, hingewiesen und entsprechend betreut werden.
Urologic problems during pregnancy
Authors: Sulser  , John  , Zimmermann
Published: January 2006

Nieren- und Harnwegserkrankungen in der Schwangerschaft erfordern oftmals die interdisziplinäre Kooperation von Geburtshelfern und Urologen. Oberstes Prinzip jeglicher Abklärung und Behandlung ist der Schutz der Mutter und ihres Kindes. Neben den entzündlichen Erkrankungen, die bei aufsteigendem Infekt eine akute Pyelonephritis verursachen können, sind es vor allem die schwangerschaftsbedingte Hydronephrose und in geringerem Umfang die Steinerkrankung in der Schwangerschaft, welche die aktive Mithilfe der Urologie erfordern. Während bei den entzündlichen Erkrankungen der gezielte antibiotische Einsatz im Vordergrund steht, bieten sich bei Versagen der konservativen Maßnahmen bei der Hydronephrose und der Steinerkrankung endourologische Therapieoptionen an, welche dank der Ultrasonographie ohne ionisierende Strahlung sicher zur Anwendung gebracht werden können. Auf diese Weise gelingt es in den meisten Fällen, die Schwangerschaft regulär zu Ende zu bringen und die weitere Abklärung und Behandlung in die nachgeburtliche Phase zu verlagern.
Pregnancy and gastrointestinal disorders
Authors: Merger  , Schölmerich
Published: January 2006

Abdominelle Beschwerden in der Schwangerschaft können vielfältige Ursachen haben (Tab. 1). Von Bedeutung sind insbesondere gynäkologische, urologische und gastroenterologische Erkrankungen. Übelkeit und Erbrechen, bei Nichtschwangeren «klassische» Symptome gastrointestinaler Erkrankungen, sind bei Schwangeren in der Regel Zeichen einer normal verlaufenden Schwangerschaft. Ösophageale Refluxbeschwerden oder Obstipation, die in der überwiegenden Mehrzahl der Schwangerschaft vorkommen, sind auf ähnliche Weise unvermeidliche Begleiterscheinungen, die auf die hormonellen Veränderungen und die veränderten Raumverhältnisse in der Bauchhöhle zurückzuführen sind. Schwerwiegende gastrointestinale Erkrankungen in der Schwangerschaft sind selten, können jedoch häufig gerade in den Prodromalstadien schwer von essentiell harmlosen Schwangerschaftsbegleiterscheinungen zu unterscheiden sein. Bei begründetem Verdacht kann der Einsatz auch belastender oder invasiver diagnostischer Methoden gerechtfertigt sein. Die rechtzeitige Erkennung der seltenen Fälle, in denen rasches Handeln geboten ist, kann für Mutter und Fetus von entscheidender Bedeutung für das Überleben sein.
Pharmacotherapy in pregnancy
Authors: Paulus
Published: January 2006

Zwischen 1958 und 1961 wurden rund 10000 Kinder mit schweren Gliedmaßendefekten geboren, deren Mütter das Schlafmittel Thalidomid eingenommen hatten. Seit dieser Katastrophe herrscht bei pharmazeutischer Industrie, Ärzten und Patientinnen berechtigte Vorsicht, häufig jedoch auch irrationale Panik im Hinblick auf den Einsatz von Arzneimitteln in der Schwangerschaft. Nach statistischen Erhebungen nehmen 15–50% aller Schwangeren Medikamente im ersten Schwangerschaftsdrittel ein, oft noch in Unkenntnis der Schwangerschaft, was angesichts der sensiblen Phase der Organogenese in den ersten drei Schwangerschaftsmonaten besonders fatale Auswirkungen haben kann. Nach Thalidomid wurden weitere teratogene Arzneimittel wie Kumarin-Derivate (z.B. Warfarin), Vita-min A und seine Derivate (z.B. Isotretinoin), Folsäureantagonisten oder Antikonvulsiva wie Hydantoin oder Valproinsäure entdeckt. Eine Vielzahl anderer Wirkstoffe gilt als potentiell embryo-/fetotoxisch, wobei der Effekt dieser Pharmaka vor allem von Dosis und Expositionszeit abhängt. Bei zahlreichen Präparaten liegen Kasuistiken über Fehlbildungen vor, jedoch fehlen Studien mit statistischer Aussagekraft. Die pharmazeutische Industrie zieht sich auf eine juristisch sichere Position zurück, indem sie bei den meisten Präparaten in der Fachinformation unter der Rubrik «Schwangerschaft» «kontraindiziert» oder zumindest «strenge Indikationsstellung» vermerkt. Ein therapeutischer Nihilismus bei chronisch kranken Schwangeren kann jedoch z.B. im Falle von Epilepsie, Hypertonie oder Asthma bronchiale zu dramatischen Verschlechterungen der Grunderkrankung und damit zu einer erheblichen Gefährdung der fetalen Entwicklung führen. Andererseits werden durch unzureichende Aufklärung von Patientinnen und medizinischem Fachpersonal über die realen Risiken einer bereits erfolgten medikamentösen Therapie in der Frühgravidität zahlreiche Schwangerschaftsabbrüche ohne fundierte Indikation durchgeführt. Grundsätzlich sind altbewährte Präparate neuen Wirkstoffen vorzuziehen. Ist jedoch eine Exposition mit einem unzureichend erprobten Wirkstoff in Unkenntnis der Gravidität erfolgt, sollten ausgewiesene Beratungszentren für Reproduktionstoxikologie mit entsprechenden Datenregistern etabliert und konsultiert werden.
Hemorrhagic disorders in pregnancy
Authors: Ludwig
Published: January 2006

Es gibt geburtshilfliche Notfälle mit akuten Hämostasestörungen, welche auf eine disseminierte intravasale Gerinnung zurückzuführen sind. Der Schwerpunkt der vorliegenden Übersicht liegt jedoch auf solchen Blutstillungsdefekten, welche bereits vor der Schwangerschaft bestehen, weil sie meistens kongenital oder gelegentlich erworben sind, wie z.B. die Immunothrombozytopenie (ITP). Die wichtigsten hämorrhagischen Diathesen, nämlich die ITP, die v. Willebrand’sche Defekt-Koagulopathie und die Problematik bei Hämophilie A und B Trägerinnen werden im Zusammenhang mit der Schwangerschaft erörtert. Dabei muß die mögliche Beeinträchtigung der Hämostase des Feten und Neugeborenen berücksichtigt werden. Über die selteneren Formen wird nur tabellarisch informiert. In welchem Maße plasmatische Koagulationsdefekte durch die vermehrte Synthese oder Aktivierung der verschiedenen Faktoren in der Schwangerschaft kompensiert werden, geht aus einer Synopse durchschnittlich erhobener Blutgerinnungs-Parameter hervor. Das wichtigste Element ist Sorgfalt in der Erhebung der Anamnese. In der Regel ergeben sich Hinweise auf das Vorliegen einer hämorrhagischen Diathese.
Meningitis (I) – differential diagnosis; aseptic and chronic meningitis
Authors: Leib  , Täuber
Published: January 2006

Meningitis ist die häufigste und schwerste Infektion des zentralen Nervensystems. Entzündlicher Befall der Hirnhäute führt zur Pleozytose des Liquors und zur klassischen Symptom-Triade mit Kopfschmerz, Fieber und Meningismus. Krankheitssymptome entwickeln sich innert Stunden bis Tage als akute Meningitis und über Tage bis Wochen als chronische Meningitis. Patienten mit aseptischer Meningitis zeigen in der Liquoruntersuchung eine vorwiegend lymphozytäre Pleozytose, ohne daß ein bakterieller Erreger nachgewiesen werden kann. Obwohl Enteroviren die häufigste Ursache der aseptischen Meningitis sind, können auch nicht-virale Erreger und nicht-infektöse Agenzien das Krankheitsbild verursachen. Symptome und Liquorpleozytose, welche über mehr als 4 Wochen anhalten, definieren die chronische Meningitis. Die Diagnose basiert auf dem Krankheitsverlauf, der Syptomatik, der Liquoruntersuchung und gegebenenfalls auf neuroradiologische Verfahren. Die Differentialdiagnose ist breit und der vorherrschende Zelltyp im Liquor kann Hinweise auf die Ätiologie vermitteln. Die Wahl der empirischen Therapie («blinden Antibiose») der chronischen und der aseptischen Meningitis orientiert sich primär an den erhobenen Befunden, sowie den anamnestischen Risikofaktoren. Oft ist eine definitive Diagnose nicht, oder nur verzögert möglich, weshalb bei Krankheitsbildern mit einem möglicherweise fatalen Verlauf mit einer empirischen Therapie gegen den wahrscheinlichsten Erreger begonnen werden muß.
Meningitis (II) – acute bacterial meningitis
Authors: Leib  , Täuber
Published: January 2006

Die akute bakterielle Meningitis ist ein medizinischer Notfall, insbesondere bei Patienten mit rasch progredientem Krankheitsbild und Bewußtseinstrübung. Die Liquoruntersuchung zeigt bei der bakteriellen Meningitis eine entzündliche Reaktion mit vorwiegend polymorphonukleären Zellen. Die häufigsten bakteriellen Meningitis-Erreger sind Streptococcus pneumoniae, Neisseria meningitis, Listeria monocytogenes, Gruppe B Streptokokken (Streptococcus agalactiae), Haemophilus influenzae und Enterobacteriaceae. Infektion mit spezifischen Meningitis-Erregern ist abhängig vom Alter und von prädisponierenden Faktoren. Die Behandlung hat zwei Hauptziele: Die Eradikation des Infektionserregers und die Behandlung der zentralnervösen und systemischen Komplikationen. Die empirische («blinde») antibiotische Therapie muß unverzüglich begonnen werden, da die Prognose der Erkrankung maßgeblich vom Zeitpunkt des Therapiebeginns bestimmt ist. Blutkulturen sollten stets vor Beginn der Antibiotikatherapie abgenommen werden. Die Wahl der empirisch verabreichten Antibiotika ist primär vom Alter des Patienten abhängig und wird anhand der Resultate der Gram-Färbung des Liquors und dem Vorhandensein von spezifischen Risikofaktoren angepaßt. Zu Beginn wählt man eine Antibiotikatherapie, welche alle wahrscheinlichen Erreger abdeckt und engt anschließend das Wirkungsspektrum wenn möglich ein.
Diagnosis and therapy of brain abscesses
Authors: Nau  , Behnke-Mursch
Published: January 2006

Die verursachenden Erreger von Hirnabszessen variieren in Abhängigkeit von der Grunderkrankung. Typisch sind Mischinfektionen aus Aerobiern und Anaerobiern. Hirnabszesse entwickeln sich meist subakut. Sensibelster Entzündungsparameter im Blut ist das C-reaktive Protein (bei 80–90% der Patien-ten erhöht). Die entscheidende diagnostische Maßnahme ist das kraniale CT ohne und mit Kontrastmittel (KM). Die rasche Kultur von Abszeßinhalt durch Punktion, Drainage oder Abszeßexzision ist entscheidend für die Erregeridentifikation. Eine alleinige Chemotherapie zur Abszeßbehandlung wird nur angewandt, wenn 1. multiple, tief gelegene und/oder sehr kleine Abszesse vorliegen oder 2. sich der Patient in einem so schlechten Allgemeinzustand befindet, daß ihm ein invasiver Eingriff nicht zugemutet werden kann oder 3. eine Hirnphlegmone und kein abgekapselter Abszeß vorliegt. Gebräuchliche operative Verfahren sind die Abszeßaspiration (meist nach stereotaktischer Abszeßpunktion), die offene Kraniotomie mit Abszeßexzision und die offene Abszeßevakuation ohne Kapselentfernung. Für die ungezielte Chemotherapie vor Erregernachweis bevorzugen wir die Kombination von Cefotaxim (3×2–4 g/d i.v.) mit Metronidazol (3–4×0,5 g/d i.v.). Kortikosteroide sind indiziert, wenn der Prozeß raumfordernd ist und eine Herniation droht oder multiple Abszesse vorliegen, die nur teilweise operativ angehbar sind, oder Hirnregionen mit besonderer Ödemneigung betroffen sind.