bluuebunny/crossref_metadata_2025 huggingface dataset:
Pyridine nucleotide cycle and trigonelline (N‐methylnicotinic acid) synthesis in developing leaves and fruits of Coffea arabica
Authors: Zheng Xin‐Qiang , Nagai Chifumi , Ashihara Hiroshi
Published: November 2004

We examined the biosynthesis of trigonelline in leaves and fruits of Arabica coffee (Coffea arabica) plants. [3H]Quinolinic acid, which is an intermediate of de novo pyridine nucleotide synthesis, and [14C]nicotinamide and [14C]nicotinic acid, which are degradation products of NAD, were converted to trigonelline and pyridine nucleotides. These tracer experiments suggest that the pyridine nucleotide cycle, nicotinamide → nicotinic acid → nicotinic acid mononucleotide (NaMN) → nicotinic acid adenine dinucleotide (NaAD) → NAD → nicotinamide mononucleotide (NMN) → nicotinamide, operates in coffee plants, and trigonelline is synthesized from nicotinic acid formed in the cycle. Trigonelline accumulated up to 18 µmol per leaf in developed young leaves, and then decreased with age. Although the biosynthetic activity of trigonelline from exogenously supplied [14C]nicotinamide was observed in aged leaves, the endogenous supply of nicotinamide may be limited, reducing the contents in these leaves. Trigonelline is synthesized and accumulated in fruits during development. The trigonelline synthesis in pericarps is much higher than that in seeds, but its content in seeds is higher than pericaps, so that some of the trigonelline synthesized in the pericarps may be transported to seeds. Trigonelline in seeds may be utilized during germination, as its content decreases. Trigonelline synthesis from [14C]nicotinamide was also found in Theobroma cacao plants, but instead of trigonelline, nicotinic acid‐glucoside was synthesized from [14C]nicotinamide in Camellia sinensis plants.
Rheology of Dead Sea shampoo containing the antidandruff climbazole
Authors: Abu‐Jdayil B. , Mohameed H. A.
Published: November 2004

Synopsis

In this study, the effect of the antidandruff climbazole on the rheology of hair shampoo containing Dead Sea (DS) salt was investigated. The presence of either DS salt or the climbazole led to increase in the shampoo viscosity. An optimum concentration was found where the viscosity of shampoo was maximum. In the absence of DS salt, the viscosity of hair shampoo increased with increasing the climbazole concentration to reach a maximum value at 1.0 wt%. Further addition of climbazole decreased the viscosity of shampoo. Adjusting the pH of the shampoo at 5.5 and 5.0 shifted the optimum climbazole concentration (corresponds to maximum viscosity) to 0.8 wt% and led to increase in the viscosity of shampoo. On the other hand, the addition of climbazole to the shampoo containing DS salt resulted in a decrease in shampoo viscosity. This decrease of shampoo viscosity became more pronounced with increasing the climbazole and/or DS salt concentrations. By controlling the pH of shampoo, an optimum formula of shampoo comprising both climbazole and DS salt and having maximum viscosity was obtained.
Polyelectrolyte‐micelle coacervation: effect of coacervate on the properties of shampoo
Authors: Hiwatari Y. , Yoshida K. , Akutsu T. , Yabu M. , Iwai S.
Published: November 2004

A typical formula for shampoo containing cationic polymers and anionic/amphoteric surfactants exhibits liquid–liquid phase separation under certain conditions when the shampoo is diluted with water upon the actual use in bathroom. The lower dense phase is considered to be an insoluble complex formed with the cationic polymer and mixed surfactants. Generally, this associative liquid–liquid phase separation is called ‘coacervation’ and the phase of complex is called ‘coacervate’. Although it is well known that the usage texture of shampoo is influenced by coacervate, there are only a few reports about their relationship. In this work, we studied the properties of coacervate and its effect on the usage texture of shampoo, particularly focusing on the effect of the cationic polymer structure. We prepared five different model shampoos that contain various cationic polymers and studied the effect of the characteristics of the polymers on the condition of the complex formations, the amount of coacervate, the rheological properties and the adhesive behaviour of coacervate on the surface of damaged hair. It was found that both the structure and the degree of substitution of cationic polymer drastically changed the condition of coacervation. Moreover, the cationic polymers showed remarkable effect on the rheological properties and the adhesive behaviour of the coacervate on the damaged hair. These results implied that we could control the usage texture of shampoo by choosing proper cationic polymers to control coacervation.
20‐O‐β‐D‐Glucopyranosyl‐20 (S)‐protopanaxadiol (compound K) induces expression of hyaluronan synthase 2 gene in transformed human keratinocytes and fibroblasts and increases hyaluronan in hairless mouse skin
Authors: Kim S. , Kang B. Y. , Cho S. Y. , Sung D. S. , Shin E. S. , Chang H. K. , Yeom M. H. , Woo K. S. , Kim D. H. , Sim Y. C. , Lee Y. S.
Published: November 2004

Ginsenosides, the major active ingredient of ginseng, show a variety of biomedical efficacies such as anti‐aging, anti‐oxidation and anti‐inflammatory activities. To understand the effects of 20‐O‐β‐D‐glucopyranosyl‐20 (S)‐protopanaxadiol (compound K), one of the major metabolites of ginsenosides on the skin, we assessed the expression level of approximately 100 transcripts in compound K‐treated HaCaT cells using cDNA microarray analysis. Compound K treatment induced differential expression of 40 genes, which have been reported to be involved in the organization of the structure of the extracellular matrix as well as defense responses in human skin cells. One of the most interesting findings is a two‐fold increase in hyaluronan synthase2 (HAS2) gene expression by compound K. We found that change in expression of HAS2 gene represents a specific response of HaCaT cells to compound K because hyaluronan synthase 1,3 was not changed by treatment with compound K. We also demonstrated that the compound K effectively induced hyaluronan synthesis in human skin cells and hairless mouse skin. A human clinical study indicated that topical application of compound K containing oil‐in‐water emulsion showed improvement of xerosis, wrinkle and fine lines in the aged skin. We concluded that compound K has anti‐aging effects by the induction of HAS2 gene expression and following hyaluronan synthase.
Reconstructed human epidermis as an efficient tool in the evaluation of the effects of UV irradiation and of the photoprotective capacities of a sunblock
Authors: Mavon A. , Gélis C. , Vicendo P.
Published: November 2004

Solar or UVA (ultraviolet A) irradiation of the skin causes biological damage, including apoptosis, which is evident in the form of sunburn cells and the overexpression of p53. These two parameters, as well as the measurement of cellular viability, were used to evaluate the effects of UV irradiation on a reconstructed human epidermis (RHE) model, with and without the photoprotection of a broad spectrum sunblock. Reconstructed epidermis models were irradiated by solar spectrum (420 mJ cm–2) or UVA (20 J cm–2). In the absence of irradiation, and with irradiation doses of 420 mJ cm–2 and 20 J cm–2, viability was estimated at 95, 12 and 70% respectively. Sunburn cells per cm were evaluated at 0, 41 and 22, respectively under these same conditions. The apoptotic response was studied through the expression of p53, which increased at first and was then followed by a specific cleavage, 24 h after irradiation at 420 mJ cm–2. However, in the presence of a broad spectrum sunblock preparation (a combination of OMC, MBTBP, TiO2 and ZnO) and after irradiation at 420 mJ cm–2 and 20 J cm–2, viability increased to 40 and 85% respectively. The number of sunburn cells (SBC) per cm fell to 12 and nine respectively. The photoprotection provided by the sunblock limited the increase in the expression of p53 and resulted in the total disappearance of the cleavage. This study shows that human reconstructed epidermis is a valid skin model for use in the evaluation of the effects of solar and UVA irradiation, as well as in the testing of the efficacy of sunfilters.
High spatial resolution study of human skin using synchrotron infrared microscopy: application to the penetration of external agents
Authors: Gross N. , Marull S. , Fromageot C. , Lebel M. , Baret J.‐M. , Barbier A. , Ortega J.‐M. , Dumas P.
Published: November 2004

Human skin sections were studied using synchrotron‐powered infrared microscopy. The superior lateral resolution achieved with this technique (diffraction‐limited spot sizes) allows the detailed analysis of the biocomposition of the skin layers. It is shown that highly organized lipids are present in the stratum corneum, as evidenced by a slight frequency difference in the symmetric stretch mode of the methylene groups. Biochemical images were generated showing the precise location of the lipids, proteins and collagen across the skin section. More enhanced images were generated using a statistical approach (fuzzy C‐means clustering). Penetration of two external agents (cyanophenol and a cosmetic compound, ethylhexyl methoxycinnamate) was studied. The penetration pathway across the stratum corneum is favored at locations of lower lipid concentration. Both compounds penetrated into the epidermis, but neither of them induced a change in the protein secondary structure. It was shown that hair follicle is a favored penetration pathway for these agents.
Development of effects of plant extracts on the activity and expression of UVA‐induced MMPs (matrix metalloproteases)
Authors: Lee D.‐H. , Lee B.‐C. , Yoon E.‐J. , Lee K.‐E. , Park S.‐M. , Pyo H.‐B. , Choe T.‐B.
Published: November 2004

The effects of several natural products on in vitro MMP‐1 activity and UVA‐induced MMP‐1 synthesis in human dermal fibroblast (HDF) cultures were studied with the aim of developing novel anti‐aging agents from natural sources. We measured MMP‐1 activities by fluorescence assay using gelatin as substrates. In addition, UVA‐induced MMP‐1 expression was analyzed by enzyme‐linked immunosorbent assay (ELISA) and gelatin‐based zymography in HDF cultures, and RT‐PCR techniques were used. The results showed a strong inhibitory effect of the extracts of Dicentra spectabilis and of the flower buds of Tussilago farfara. In a concentration of 0.05% (w/v), the extracts of the flower buds of Tussilago farfara and of Dicentra spectabilis inhibited MMP‐1 activity by 92 and 87% respectively. At 0.1% (w/v), the extracts of the flower buds of Tussilago farfara and of Dicentra spectabilis suppressed the UVA‐induced expression of MMP‐1 by an amount similar to that with Vitamin C 200 μm. These results suggest that the extracts of Dicentra spectabilis and of the flower buds of Tussilago farfara effectively protect skin from UV‐induced photoaging. Therefore, the extracts are thought to have potential as effective raw materials for anti‐aging cosmetics.
Comparison of age‐related changes in wrinkling and sagging of the skin in Caucasian females and in Japanese females
Authors: Tsukahara K. , Fujimura T. , Yoshida Y. , Kitahara T. , Hotta M. , Moriwaki S. , Witt P. S. , Simion F. A. , Takema Y.
Published: November 2004

We compared age‐related changes in wrinkles in eight areas of facial skin (forehead, glabella, upper eyelid, corner of the eye, lower eyelid, nasolabial groove, cheek, and corner of the mouth) and sagging in the subzygomatic area of Caucasian females and of Japanese females. The subjects studied included 85 healthy Caucasian females (aged 20–69 years) living in Cincinnati in the U.S. and 70 Japanese females (aged 20–69 years) living in Tokyo. Photos of the face in frontal and in oblique 45 views were analyzed. Wrinkles in the face and sagging in the subzygomatic area were graded on Japanese photoscales, respectively, by the same experi‐enced observer. The wrinkle score increased with age in all eight areas of the face examined in Caucasian females as well as in Japanese females. In the group aged 20–29 years, the wrinkle score in each area was significantly higher in Caucasian females than in Japanese females. The wrinkle scores in the forehead, glabella, upper eyelid, and corner of the eyes were similar at advanced ages between the two groups, while the wrinkle scores in lower areas of the face (lower eyelid, nasolabial groove, cheek, and corner of the mouth) were markedly higher in Caucasian females than in Japanese females in each age group, and reached an upper limit at advanced ages in Caucasian females. The sagging score also increased with age in Caucasian females as well as in Japanese females. The sagging score was significantly higher in Caucasian females than in Japanese females in the groups aged 40 years or more. These results suggest more marked wrinkle formation in all areas of the face in younger age groups of Caucasian females living in North America than in Japanese females living in Tokyo. In particular, Caucasian females showed marked age‐related wrinkle formation in the lower areas of the face, probably due to sagging in the subzygomatic area, which suggests a higher susceptibility to sagging in the subzygomatic area of Caucasian females.
Maternal Intrusiveness, Maternal Warmth, and Mother–Toddler Relationship Outcomes: Variations Across Low‐Income Ethnic and Acculturation Groups
Authors: Ispa Jean M. , Fine Mark A. , Halgunseth Linda C. , Harper Scott , Robinson JoAnn , Boyce Lisa , Brooks‐Gunn Jeanne , Brady‐Smith Christy
Published: November 2004

The present study investigated the extent to which maternal intrusiveness and warmth during play, observed in 579 European American, 412 African American, and 110 more and 131 less acculturated Mexican American low‐income families when children were approximately 15 months old, predicted 3 dimensions of the mother–toddler relationship 10 months later. Intrusiveness predicted increases in later child negativity in all 4 groups. Among African Americans only, this association was moderated by maternal warmth. Intrusiveness predicted negative change in child engagement with mothers only in European American families. Finally, near‐significant trends suggested that intrusiveness predicted later decreased dyadic mutuality in European American and more acculturated Mexican American families, but not in African American or less acculturated Mexican American families.
Development of Mutual Responsiveness Between Parents and Their Young Children
Authors: Kochanska Grazyna , Aksan Nazan
Published: November 2004

This comprehensive study of mutual responsiveness examined 102 mothers and 102 fathers interacting with their children at 7 and 15 months. Responsiveness was studied from developmental and individual differences perspectives, and assessed using macroscopic ratings and microscopic event coding. The latter captured parents' reactions to children's negative, positive, and physical bids, and children's reactions to parents' social‐interactive bids, mood regulation attempts, and influence attempts. Responsiveness depended on bid type and child age, and reflected developmental changes in children, parents, and relationships. Mothers were more responsive than fathers; children were equally responsive to both parents and coherent in their responsiveness. Ratings revealed dyadic mutuality and longitudinal continuity of responsiveness. Parent–child responsiveness from 7 to 15 months was consistent with assumptions of a parent‐driven process.
Parenting Stress, Infant Emotion Regulation, Maternal Sensitivity, and the Cognitive Development of Triplets: A Model for Parent and Child Influences in a Unique Ecology
Authors: Feldman Ruth , Eidelman Arthur I. , Rotenberg Noa
Published: November 2004

To examine the development of triplets, 23 sets of triplets were matched with 23 sets of twins and 23 singletons (N=138). Maternal sensitivity was observed at newborn, 3, 6, and 12 months, and infants' cognitive and symbolic skills at 1 year. Triplets received lower maternal sensitivity across infancy and exhibited poorer cognitive competencies compared with singletons and twins. The most medically compromised triplet showed the lowest regulation, received lower maternal sensitivity, and demonstrated the weakest outcomes compared with siblings. Structural modeling charted three levels of influence on cognitive outcomes: direct, indirect, and contextual. The triplet ecology provides a context for assessing the relations among infant inborn dispositions, the rearing environment, and the role of exclusive parenting in development.
Is a Picture Worth a Thousand Words? The Flexible Nature of Modality Dominance in Young Children
Authors: Napolitano Amanda C. , Sloutsky Vladimir M.
Published: November 2004

When presented simultaneously with equally discriminable, but unfamiliar, visual and auditory stimuli, 4‐year‐olds exhibited auditory dominance, processing only auditory information (Sloutsky & Napolitano, 2003). The current study examined factors underlying auditory dominance. In 6 experiments, 4‐year‐olds (N=181) were presented with auditory and visual compounds in which (a) the complexity and familiarity of stimuli were systematically varied (Experiments 1–5) and (b) participants were explicitly instructed to attend to a particular modality (Experiment 6). Results indicate that auditory dominance is a special case of flexible modality dominance, which may stem from automatic pulls on attention. Theoretical implications of these results for understanding the development of attention and cross‐modal processing, as well as linguistic and conceptual development, are discussed.
The Rule of Law and Its Predicament
Authors: HASEBE YASUO
Published: November 2004

Abstract.  The purpose of this paper is to assess the validity of the Razian conception of the rule of law by subjecting it to the acid test of Michel Troper's “realist theory of interpretation.” The author argues that, in light of the Wittgensteinian view of rule‐following, a serious indeterminacy can be seen as inherent in both this conception of the rule of law and Troper's theory of interpretation.
On Non‐parametric Testing, the Uniform Behaviour of the t‐test, and Related Problems
Authors: Romano Joseph P.
Published: November 2004

Abstract.  In this article, we revisit some problems in non‐parametric hypothesis testing. First, we extend the classical result of Bahadur & Savage [Ann. Math. Statist. 25 (1956) 1115] to other testing problems, and we answer a conjecture of theirs. Other examples considered are testing whether or not the mean is rational, testing goodness‐of‐fit, and equivalence testing. Next, we discuss the uniform behaviour of the classical t‐test. For most non‐parametric models, the Bahadur–Savage result yields that the size of the t‐test is one for every sample size. Even if we restrict attention to the family of symmetric distributions supported on a fixed compact set, the t‐test is not even uniformly asymptotically level α. However, the convergence of the rejection probability is established uniformly over a large family with a very weak uniform integrability type of condition. Furthermore, under such a restriction, the t‐test possesses an asymptotic maximin optimality property.
Nation Speaking Unto Nation? Newspapers and National Identity in the Devolved UK
Authors: Rosie Michael , MacInnes John , Petersoo Pille , Condor Susan , Kennedy James , Rosie M.J. , MacInnes J. , Petersoo P. , Condor S. , Kennedy J.
Published: November 2004

There are two problems with the existing account of the relationship between newspapers and national identity in the UK. The first is that although it is widely assumed that the mass media are central to the reproduction and evolution of national identity this has never been empirically demonstrated. The second is that exactly what comprises the relevant ‘national’ context in the UK is unclear. Content analysis of 2,500 sampled articles, together with qualitative comparison of different editions of the same newspaper titles and interviews with editors and journalists are used to show the extent and nature of ‘national’ frames of reference in newspapers in England and Scotland. Paradoxically, devolution may have reduced the spatial diversity of news stories in the press in England and Scotland.
The Trouble with ‘Inclusion’: A Case Study of the Faith Zone at the Millennium Dome
Authors: Gilliat-Ray Sophie
Published: November 2004

Some sociologists of religion would argue that there has been a move away from ‘religion’, in terms of institutionalised dogmas and established corporate ways of believing, towards ‘spiritualities of life’ where the emphasis lies on the personal, the individual and the experiential ( Heelas, 2002 ; Wuthnow, 2001 ). Given the evidence for the apparent popularity of spirituality in contemporary Western society, it is surprising that between 1996 and 2000, the Zone concerned with religion at the Millennium Dome in Greenwich was re-named from ‘The Spirit Zone’ to ‘The Faith Zone’. A range of political, economic and religious interests lay behind the Zone's re-naming, and both the name (and the content) changed to reflect ‘religion’ rather than ‘spirituality’. The process of constructing the Zone thus moved in a diametrically opposite direction to some of the trends associated with religious belief in modern Britain. An investigation of the dynamics behind the construction of the Faith Zone at the Dome provides an opportunity to evaluate what ‘counted’ as religion ( Beckford, 2003 ) at a specific time and context in British society. The paper also shows that behind the Labour Government rhetoric of ‘inclusion’, various dimensions of spiritual belief and activity in Britain are excluded from the public sphere. When it comes to religion, taken-for-granted criteria operate – resulting in the prioritisation of the official, the ‘representative’, the ‘respectable’, and ‘the unified’ over the unofficial, the deviant, the private, and the contested. This paper looks at the struggles and the conditions associated with the idea and the policy of inclusion in relation to religion in modern Britain, using the Faith Zone at the Dome as a case study.
Middle Class Fractions, Childcare and the ‘Relational’ and ‘Normative’ Aspects of Class Practices
Authors: Ball Stephen J. , Vincent Carol , Kemp Sophie , Pietikainen Soile
Published: November 2004

The emphasis in class research remains on the structural aspects of class, class processes are neglected. This paper focuses upon some relational and normative aspects of class through an examination of social divisions produced and constructed within middle class families' choices of childcare. Working with data from two contrasting settings in London (Battersea and Stoke Newington) three issues are addressed in the paper; the extent to which childcare arrangements both substantively and structurally position children differently within long term educational careers; the ways in which the use of choice in a market system of child care and education, works to produce patterns of social closure that quietly discriminate via the collectivist criterion of class and racial membership; and the ways in which child care choices also point-up and perpetuate subtle distinctions and tensions of values and lifestyle within the middle class, between class factions. Concepts drawn from the work of Bourdieu are deployed throughout.
Establishing Self and Meaning in Low Back Pain Narratives
Authors: Ong Bie Nio , Hooper Helen , Dunn Kate , Croft Peter
Published: November 2004

Pain narratives encounter the problem of verbalising private and internalised experiences. Words appear to fall short of giving meaning to the feelings and impact of pain. In this paper we report on how people describe their low back pain and the way in which they claim to present this to clinicians. In the research interviews they need to establish themselves as believable narrators and provide accounts of how they legitimise their pain in clinical encounters. As a result, the interviews provide complex and layered narratives of pain and its representation.
Disposition and Determinism – Genetic Diagnostics in Risk Society
Authors: Lemke Thomas
Published: November 2004

This article investigates the relationship between genetic determinism and the discourse of risk by making use of an elaboration of the concept of governmentality developed by Michel Foucault. After a short outline of the theoretical profile of the employed risk analysis, the main part of the text distinguishes three core level of analysis. With a view to illustrating several aspects of a ‘genetic governmentality’ the increasing social impact of genetic information is examined from the angle of truth programs, power strategies and technologies of the self.
THE LEWIS MODEL AFTER 50 YEARS
Authors: KIRKPATRICK COLIN , BARRIENTOS ARMANDO
Published: November 2004

We reassess the contribution of Sir Arthur Lewis's 1954 paper entitled ‘Economic Development with Unlimited Supplies of Labour’ to our understanding of economic development, and to the establishment of development economics as an academic discipline. We argue that Lewis's key insight into the structural dualism characterizing developing countries mapped out a new and distinctive field for development economics and policy. The paper has had a profound impact over the last 50 years and continues to yield valuable lessons for understanding the nature of economic transformation.
Topiramate Inhibits Trigeminovascular Neurons in the Cat
Authors: Storer RJ , Goadsby PJ
Published: November 2004

To facilitate understanding the action of antimigraine preventives the effect of topiramate on trigeminocervical activation in the cat was examined. Animals ( n = 7) were anaesthetized and physiologically monitored. The superior sagittal sinus (SSS) was stimulated to produce a model of trigeminovascular nociceptive activation. Cumulative dose-response curves were constructed for the effect of topiramate at doses of 3, 5, 10, 30 and 50 mg/kg on SSS-evoked firing of trigeminocervical neurons. Topiramate reduced SSS evoked firing in a dose-dependent fashion. The maximum effect was seen over 30 min for the cohort taken together. At 3 mg/kg firing was reduced by 36 ± 13% (mean ± SEM) after 15 min. At 5 and 50 mg/kg firing was reduced by 59 ± 6% and 65 ± 14%, respectively, after 30 min. Inhibition of the trigeminocervical complex directly, or neurons that modulate sensory input, are plausible mechanisms for the action of preventives in migraine.
Sumatriptan (5-HT1B/1D-agonist) Causes a Transient Allodynia
Authors: Linde M , Elam M , Lundblad L , Olausson H , Dahlöf CGH
Published: November 2004

Unpleasant sensory symptoms are commonly reported in association with the use of 5-HT1B/1D-agonists, i.e. triptans. In particular, pain/pressure symptoms from the chest and neck have restricted the use of triptans in the acute treatment of migraine. The cause of these triptan induced side-effects is still unidentified. We have now tested the hypothesis that sumatriptan influences the perception of tactile and thermal stimuli in humans in a randomized, double-blind, placebo-controlled cross-over study. Two groups were tested; one consisted of 12 (mean age 41.2 years, 10 women) subjects with migraine and a history of cutaneous allodynia in association with sumatriptan treatment. Twelve healthy subjects (mean age 38.7 years, 10 women) without migraine served as control group. During pain- and medication-free intervals tactile directional sensibility, perception of dynamic touch (brush) and thermal sensory and pain thresholds were studied on the dorsal side of the left hand. Measurements were performed before, 20, and 40 min after injection of 6 mg sumatriptan or saline. Twenty minutes after injection, sumatriptan caused a significant placebo-subtracted increase in brush-evoked feeling of unpleasantness in both groups ( P < 0.01), an increase in brush-evoked pain in migraineurs only ( P = 0.021), a reduction of heat pain threshold in all participants pooled ( P = 0.031), and a reduction of cold pain threshold in controls only ( P = 0.013). At 40 min after injection, no differences remained significant. There were no changes in ratings of brush intensity, tactile directional sensibility or cold or warm sensation thresholds. Thus, sumatriptan may cause a short-lasting allodynia in response to light dynamic touch and a reduction of heat and cold pain thresholds. This could explain at least some of the temporary sensory side-effects of triptans and warrants consideration in the interpretation of studies on migraine-induced allodynia.
Clinical Implications of Migraine in Systemic Lupus Erythematosus: Relation to Cumulative Organ Damage
Authors: Appenzeller S , Costallat LTL
Published: November 2004

The aim of this study was to determine the clinical implications of migraine in systemic lupus erythematosus (SLE) using the cumulative organ damage scores (SLICC-DI). Eighty SLE, 40 rheumatoid arthritis (RA) patients and 40 controls (non SLE, nor RA out-patients), all women, were included. Migraine was defined according to the International Headache Society (IHS) criteria for neuropsychiatric SLE. Disease activity was measured by MEX-SLEDAI and cumulative organ damage by SLICC-DI. Statistics were obtained by Chi-square and Fischer's exact tests. ANOVA was used for comparing means. Migraine was identified in 42.5% of SLE patients, compared to 12.5% of RA patients ( P < 0.05) and 10.0% ( P < 0.05) in the control group. In the SLE group, a significant association between migraine and Raynaud's phenomenon ( P = 0.003, OR = 10.1; 95%CI 2.9-35) and antiphospholipid antibodies ( P = 0.0012; OR = 7.5; 95%CI 2.5-22.9) was noted. SLE patients with active migraine had higher MEX-SLEDAI scores than SLE patients without migraine. SLE patients with past history of migraine had significantly higher SLICC scores than SLE patients without migraine. History of migraine was associated with greater organ damage. Active migraine was associated with higher disease activity, antiphospholipid antibodies and worsening of Raynaud's phenomenon. The increased cumulative organ damage in SLE patients with past history of migraine justifies the routine evaluation of migraine in clinical practice.
The validity of transvaginal ultrasound measurement of endometrial thickness: a comparison of ultrasound measurement with direct anatomical measurement
Authors: Saha Tapash K. , Amer Saad A.K.S. , Biss Judith , Thakare Hemlata , Williams Susan , Farrell Tom , Calvert John
Published: November 2004

Objectives  To compare transvaginal ultrasound measurements of endometrial thickness with direct anatomical measurements and consider the implications of these findings on clinical practice.

Design  Prospective observational study using two modalities blinded to each other's findings.

Setting  Singleton Hospital, Swansea, a medium‐sized District General Hospital.

Sample  Forty‐seven women admitted for hysterectomy.

Methods  All women underwent transvaginal ultrasound scan to measure the endometrial thickness within 16 hours of surgery. Anatomical measurement of the fresh specimen was carried out immediately after surgery.

Main outcome measures  Agreement between ultrasound and anatomical measurements of the endometrial thickness.

Results  No ultrasound measurement was possible in 15% of patients. When both values were obtained, transvaginal ultrasound measurements were >2 mm different from the ruler measurement in 13/40 (33%) with an obvious tendency of the ultrasound scan to over‐estimate the endometrial thickness. The mean difference between the two measurements was −0.8 mm (limits of agreement −7.1 to +5.5 mm). The discrepancy was greater in women with endometrial thickness ≤5 mm (−1.6 mm, limits of agreement −5.7 to +2.6 mm) compared with that in women with endometrial thickness >5 mm (−0.2 mm, limits of agreement −7.6 to +7.2 mm). Kappa statistics showed good agreement between the two measurements in discriminating between thin and thick endometrium in 77% (κ= 0.55). Transvaginal ultrasound misdiagnosed a thick endometrium as thin in 3/40 (8%) and misdiagnosed a thin endometrium as thick in 6/40 (15%).

Conclusions  Transvaginal ultrasonography is of limited value as a screening test for abnormal endometrium in patients with postmenopausal bleeding if the only parameter of normality is an endometrial thickness of 5 mm or less.
Research jobs: how good is the training?
Authors: Hawkins Emma
Published: November 2004

Objectives  To determine if a period in a research job improves confidence in research skills and to assess the quality of research training.

Design and setting  A questionnaire was designed and piloted to assess the content, structure and process of research training.

Population/Sample  All individuals who had passed MRCOG in the five years prior to 1999 and were residents of England or Wales.

Methods  Confidence scores were compared between those with and those without research experience. The availability and value of differing strategies for research training were compared.

Main outcome measures  Confidence in research skills and attitudes to training.

Results  Of the 532 usable questionnaires returned, 226 respondents had done or were doing research and these individuals had higher confidence on a variety of research skills than those with no experience of a formal research job. Confidence was patchy with less than 50% feeling confident at assessing bias in a case‐controlled study, understanding the statistics used in a paper or assessing the power of a study. Of those who had done research, 50% or less felt their training had been good or excellent in any area. Self‐directed learning and discussion with peers were felt to be the most useful strategies for research training. Short intensive courses were not available for many respondents, but were felt to be useful.

Conclusion  The high levels of dissatisfaction with the training in key skills required for research suggests that there is a need for a system for recognition of research posts. Reform of training in the research job should build on the current strength of encouraging self‐directed learning.
The relationship between delivery mode and mortality in very low birthweight singleton vertex‐presenting infants
Authors: Riskin Arieh , Riskin‐Mashiah Shlomit , Lusky Ayala , Reichman Brian ,   In collaboration with the Israel Neonatal Network
Published: November 2004

Objective  To investigate the factors associated with caesarean delivery and the relationship between mode of delivery and mortality in singleton vertex‐presenting very low birthweight (≤1500 g) live born infants.

Design  Observational population‐based study.

Setting  Data collected from all 28 neonatal departments comprise the Israel National Very Low Birth Weight Infant Database.

Population  2955 singleton vertex‐presenting very low birthweight infants registered in the database from 1995 to 2000, and born at 24–34 weeks of gestation.

Methods  The demographic, obstetric and perinatal factors associated with caesarean delivery and subsequent mortality were studied. The independent effect of the mode of delivery on mortality was tested by multiple logistic regression.

Main outcome measure  Mortality was defined as death prior to discharge.

Results  Caesarean delivery rate was 51.7%. Caesarean delivery was directly associated with increasing maternal age and gestational age, small for gestational age infants, maternal hypertensive disorders and antepartum haemorrhage, and was inversely related to premature labour and prolonged rupture of membranes. Factors associated with increased survival were increasing gestational age, antenatal corticosteroid therapy, maternal hypertensive disorders and no amnionitis. Mortality rate prior to discharge was lower after caesarean delivery (13.2%vs 21.8%), but in the multivariate analysis, adjusting for the other risk factors associated with mortality, delivery mode had no effect on infant survival (OR 1.00, 95% CI 0.74–1.33). In a subgroup with amnionitis, a protective effect of caesarean delivery was found.

Conclusions  Caesarean delivery did not enhance survival of vertex‐presenting singleton very low birthweight babies. Caesarean delivery cannot be routinely recommended, unless there are other obstetric indications.
A qualitative study of conceptions and attitudes regarding maternal mortality among traditional birth attendants in rural Guatemala
Authors: Rööst Mattias , Johnsdotter Sara , Liljestrand Jerker , Essén Birgitta
Published: November 2004

Objective  To explore conceptions of obstetric emergency care among traditional birth attendants in rural Guatemala, elucidating social and cultural factors.

Study design  Qualitative in‐depth interview study.

Setting  Rural Guatemala.

Sample  Thirteen traditional birth attendants from 11 villages around San Miguel Ixtahuacán, Guatemala.

Method  Interviews with semi‐structured, thematic, open‐ended questions. Interview topics were: traditional birth attendants' experiences and conceptions as to the causes of complications, attitudes towards hospital care and referral of obstetric complications.

Main outcome measures  Conceptions of obstetric complications, hospital referrals and maternal mortality among traditional birth attendants.

Results  Pregnant women rather than traditional birth attendants appear to make the decision on how to handle a complication, based on moralistically and fatalistically influenced thoughts about the nature of complications, in combination with a fear of caesarean section, maltreatment and discrimination at a hospital level. There is a discrepancy between what traditional birth attendants consider appropriate in cases of complications, and the actions they implement to handle them.

Conclusion  Parameters in the referral system, such as logistics and socio‐economic factors, are sometimes subordinated to cultural values by the target group. To have an impact on maternal mortality, bilateral culture‐sensitive education should be included in maternal health programs.
Unadjusted and customised weight centiles in the identification of growth restriction among stillborn infants
Authors: Lyon Vivian , Howatson Allan , Khan Khalid S. , Owen Philip
Published: November 2004

The study aims to compare the utility of unadjusted with customised weight standards in the identification of intrauterine growth restriction (IUGR) among unexplained stillborn infants undergoing postmortem examination. Unadjusted and customised birthweight centiles were determined for 51 unexplained stillborn infants undergoing perinatal autopsy. Unadjusted centiles were calculated from an ultrasonically derived fetal weight standard. Customised centiles were calculated from an online calculator which adjusts the standard to account for important physiological variables. IUGR was defined as moderate or severe according to brain/liver ratios of >3 and >5, respectively. The relationship between the weight centiles and abnormal brain/liver weight ratios was explored. Neither unadjusted nor customised standards identify stillborn infants with brain/liver ratios >3:1. Both unadjusted and customised weight standards identify stillborn infants with brain/liver ratios >5 equally well with high sensitivity (95%) but low specificities (63% and 66%, respectively). Customising weight standards to account for physiological variables does not identify growth restricted stillborn infants more usefully than an unadjusted fetal weight standard.
Carbohydrate solution intake during labour just before the start of the second stage: a double‐blind study on metabolic effects and clinical outcome
Authors: Scheepers H.C.J. , de Jong P.A. , Essed G.G.M. , Kanhai H.H.H.
Published: November 2004

Objective  To study the effects of oral carbohydrate ingestion on clinical outcome and on maternal and fetal metabolism.

Design  Prospective, double‐blind, randomised study.

Setting  Leyenburg Hospital, The Hague, The Netherlands.

Population  Two hundred and two nulliparous women.

Methods  In labour, at 8 to 10 cm of cervical dilatation, the women were asked to drink a solution containing either 25 g carbohydrates or placebo. In a subgroup of 28 women, metabolic parameters were measured.

Main outcome measures  Number of instrumental deliveries, fetal and maternal glucose, free fatty acids, lactate, pH, Pco2, base excess/deficit and β‐hydroxybutyrate.

Results  Drinking a carbohydrate‐enriched solution just before starting the second stage of labour did not reduce instrumental delivery rate (RR 1.1, 95% CI 0.9–1.3). Caesarean section rate was lower in the carbohydrate group, but the difference did not reach statistical significance (1%vs 7%, RR 0.2, 95% CI 0.02–1.2). In the carbohydrate group, maternal free fatty acids decreased and the lactate increased. In the umbilical cord there was a positive venous–arterial lactate difference in the carbohydrate group and a negative one in the placebo group, but the differences in pH and base deficit were comparable.

Conclusion  Intake of carbohydrates just before the second stage does not reduce instrumental delivery rate. The venous–arterial difference in the umbilical cord suggested lactate transport to the fetal circulation but did not result in fetal acidaemia.
The role of clinical follow up in early stage cervical cancer in South Wales
Authors: Lim K.C.K. , Howells R.E.J. , Evans A.S.
Published: November 2004

Objective  To assess the effectiveness of clinical follow up after primary surgery for early stage cervical cancer.

Design  Retrospective analysis of clinical follow up after radical hysterectomy and node dissection for early stage cervical cancer.

Setting  Gynaecological Oncology Cancer Centre.

Sample  Two hundred and ninety‐one patients who underwent surgery for cervical cancer.

Methods  Follow up data were collected retrospectively from hand‐searched patients notes, as well as a computerised database (Information System for Clinical Organisation [ISCO]). The data were analysed using the SPSS for windows (SPSS, Chicago, Illinois) statistics package, using χ2, Kaplan–Meier life tables and Cox Linear regression analysis.

Main outcome measures  To determine whether routine follow up was useful for detecting early recurrent disease.

Results  Two hundred and ninety‐one patients treated by radical hysterectomy and node dissections were followed up. The cumulative five‐year survival for all cases in our series was 80% and 53/291 patients (18.2%) were found to have recurrent disease. The median period from surgery to recurrence was 17.6 months (3.0–60.0). Seven patients with recurrence were detected at a routine follow up examination, and two out of seven of the patients were asymptomatic. Detection of the recurrence on routine follow up was not an independent prognostic factor for survival when compared with age, stage and whether the patient received post‐operative adjuvant therapy.

Conclusions  Routine follow up in patients following radical hysterectomy and node dissection for early stage cervical cancer is not a sensitive way of detecting recurrent disease, as a high proportion of patients were symptomatic at the time of detection. As there are other reasons for follow up, we propose alternative methods of structuring the programme.
Infant cortisol response after prolonged antenatal prednisolone treatment
Authors: Miller N.M. , Williamson C. , Fisk N.M. , Glover V.
Published: November 2004

Prednisolone is widely used to treat medical conditions in pregnancy, despite the lack of long term safety studies on infants. Animal studies have shown that antenatal glucocorticoid treatment can cause in utero growth restriction and up‐regulation of the offsprings' hypathalamic–pituitary–adrenal axis. We recruited women treated antenatally with prednisolone, and followed 12 of the infants up to four months, using routine infant vaccinations as a stressor. Birthweights were similar to controls (n= 289, uncomplicated, singleton term pregnancies), as were infants' baseline and stress‐induced cortisol levels. Mothers rated their infants as less difficult and more adaptable than controls. This study provides initial reassurance about the safety of prednisolone in pregnancy.
Laparoscopic surgery following abdominal wall reconstruction: description of a novel method for safe entry
Authors: Tsahalina Efthalia , Crawford Robin
Published: November 2004

We rport a technique for safe laparoscopic access for gynaecological surgery in women who have had their abdominal wall reconstructed by plastic surgery. The abdominal wall incisions for placement of the trocars are made in the abdominoplasty scars and are cosmetically acceptable. In a limited series there appears to be no excess morbidity.
Do maternity care provider groups have different attitudes towards birth?
Authors: Reime Birgit , Klein Michael C. , Kelly Ann , Duxbury Nancy , Saxell Lee , Liston Robert , Prompers Frédérique Josephine Petra Maria , Entjes Robert Stefan Willem , Wong Victor
Published: November 2004

Objective  To compare family physicians', obstetricians' and midwives' self‐reported practices, attitudes and beliefs about central issues in childbirth.

Design  Mail‐out questionnaire.

Setting/Population  All registered midwives in the province, and a sample of family physicians and obstetricians in a maternity care teaching hospital. Response rates: 91% (n= 50), 69% (n= 97) and 89% (n= 34), respectively.

Methods  A postal survey.

Main outcome measures  Twenty‐three five‐point Likert scale items (strongly agree to strongly disagree) addressing attitudes toward routine electronic fetal monitoring, induction of labour, epidural analgesia, episiotomy, doulas, vaginal birth after caesarean section (VBACs), birth centres, provision educational material, birth plans and caesarean section.

Results  Cluster analysis identified three distinct clusters based on similar response to the questions. The ‘MW’ cluster consisted of 100% of midwives and 26% of the family physicians. The ‘OB’ cluster was composed of 79% of the obstetricians and 16% of the family physicians. The ‘FP’ cluster was composed of 58% the family physicians and 21% the obstetricians. Members of the ‘OB’ cluster more strongly believed that women had the right to request a caesarean section without maternal/fetal indications (P < 0.001), that epidurals early in labour were not associated with development of fetal malpositions (P < 0.001) and that increasing caesarean rates were a sign of improvement in obstetrics (P < 0.001). The ‘OB’ cluster members were more likely to say they would induce women as soon as possible after 41 3/7 weeks of gestation (P < 0.001) and were least likely to encourage the use of birth plans (P < 0.001). The ‘MW’ cluster's views were the opposite of the ‘OBs’ while the ‘FP’ cluster's views fell between the ‘MW’ and ‘OB’ clusters.

Conclusions  In our environment, obstetricians were the most attached to technology and interventions including caesarean section and inductions, midwives the least, while family physicians fell in the middle. While generalisations can be problematic, obstetricians and midwives generally follow a defined and different approach to maternity care. Family physicians are heterogeneous, sometimes practising more like midwives and sometimes more like obstetricians.