bluuebunny/crossref_metadata_2025 huggingface dataset:
Does Macroeconomic Performance Affect Corporate Governance? Evidence from Turkey
Authors: Ugur Mehmet , Ararat Melsa
Published: July 2006

Recent work on corporate governance has highlighted the effects of corporate governance quality on macroeconomic crises, especially in the context of South‐East Asian economies. However, the possibility of reverse causation from macroeconomic performance to corporate governance has been overlooked. This paper aims to address this issue by examining the relationship between macroeconomic stabilisation and corporate governance reforms in Turkey since the 1999 and 2001 crises. We demonstrate that the prospect of macroeconomic stability has led to extensive corporate governance reforms for two reasons. First, recent return to macroeconomic stability has been underpinned by public governance reforms, which spilled over to the area of corporate governance. We call this the statutory reform effect. Second, macroeconomic stability tended to have a positive effect on firms’ investment in corporate governance quality. We call this the voluntary reform effect. To substantiate these findings, we examine the post‐1999 developments in the following areas: (i) the effectiveness of regulatory authorities; (ii) disclosure and transparency rules; and (iii) the quality of the enforcement regime.
The Impact of Corporate Governance Structures on the Corporate Investment Performance in Turkey
Authors: Orbay Hakan , Yurtoglu B. Burcin
Published: July 2006

In spite of the fact that most research has concentrated on the typical agency problem between managers and dispersed shareholders, in many countries large shareholders are much more frequently observed than firms with dispersed ownership structures. While large shareholders are perceived as a potential solution to the typical agency problem between managers and dispersed shareholders, less research has been done on the costs of large shareholders. One important issue in this literature is that deviations of cash flow rights from voting rights often result in substantial value discounts. In this paper we test for the impact of such deviations on corporate investment performance in Turkey. To measure corporate investment performance we estimate returns on investment relative to company costs of capital, a methodology that overcomes the endogeneity problem, which is known to contaminate results in the empirical corporate governance literature. Consistent with existing studies, we find that the average Turkish listed company has a return on investment which is less than its cost of capital. We also report significantly better investment performance for companies that do not deviate from one share–one vote by using pyramidal ownership structures, dual‐class shares and other devices that enhance the control power of large shareholders beyond their cash flow rights. We also find that business group membership improves the investment performance and relative market valuation of companies.
The use and abuse of hostages in later Anglo‐Saxon England
Authors: Lavelle Ryan
Published: July 2006

This paper explores the use of hostages in political relations in Anglo‐Saxon England, often between different ethnic groups. Although much of the evidence relates to the ninth century when hostages were used as a means of guaranteeing the peace agreements made between King Alfred and his Viking adversaries, consideration will be given here to the use of hostages in the broader context of the late Anglo‐Saxon period. The paper discusses whether the significance of these arrangements lay in their projection of imperial power or in their practicality as a crude political tool whose effectiveness in maintaining an agreement lay in a tangible threat. Both of these aspects of Anglo‐Saxon hostageship are examined, especially with regard to peacemaking, the extent to which it could be successful, and why.
Foraging habitats based on the diet of female northern fur seals (Callorhinus ursinus) on the Pribilof Islands, Alaska
Authors: Zeppelin T. K. , Ream R. R.
Published: July 2006

Scats (fecal samples) collected between 1987 and 2000 on northern fur seal Callorhinus ursinus rookeries of St Paul (n=2968) and St George Islands (n=1203), Alaska, were used to examine the relationship between breeding sites and food habits of adult female seals. On the basis of the frequency of occurrence (FO) and per cent minimum number of individual prey (%MNI) in scats, juvenile walleye pollock Theragra chalcogramma and gonatid squid Gonatopsis borealis/Berryteuthis magister and Gonatus madokai/Gonatus middendorffi were the dominant prey species consumed overall. Other primary prey (FO>5%) included Pacific sand lance Ammodytes hexapteus, Pacific herring Clupea pallasi, northern smoothtongue Leuroglossus schmidti, Atka mackerel Pleurogrammus monopterygius, Pacific salmon (Oncorhynchus spp.) and other squid of the Gonatus genus. We identified five rookery complexes from a cluster analysis of the FO of primary prey in scats. Rookery complexes were separated geographically and each was further defined by characteristic patterns in the representation of prey types typically associated with specific hydrographic domains. Diet differences were observed among rookeries on the north and south side of St George Island and on the east, south and south‐west side of St Paul Island. The rookery clusters observed in this study provide evidence of resource partitioning among adult female northern fur seals and have important implications for fur seal conservation and management.
Copulation behaviour and paternity in shy albatrosses (Thalassarche cauta)
Authors: Abbott C. L. , Double M. C. , Gales R. , Cockburn A.
Published: July 2006

We investigated the mating system of shy albatrosses Thalassarche cauta by combining behavioural observations during the pre‐laying period with genetic paternity analysis. Genetic data on the mating systems of several procellariiform seabirds have recently become available, but data on the reproductive behaviour of these species are rarely obtained. Our main aims were to describe the copulatory behaviour of this species and identify how males achieve within‐pair and extra‐pair paternity (EPP). Most copulations occurred on the nest, were unforced and were within‐pair. Females controlled the success of copulations and were observed soliciting extra‐pair matings. Within‐pair and extra‐pair copulations were behaviourally similar. A low frequency (7–10%, n=29 chicks) of EPP was detected despite male use of frequent copulation as a paternity guard. The pre‐laying foraging exodus of female shy albatrosses differed from that in other albatrosses: it was relatively short in length, lasting c. 2 days, and within‐pair copulations occurred after the female's return 2 days before laying. This may reflect the close proximity of feeding grounds to the breeding colony.
Review article: The impact of obesity on reproduction in women with polycystic ovary syndrome
Authors: Pasquali R , Gambineri A , Pagotto U
Published: July 2006

The polycystic ovary syndrome (PCOS) is one of the most common causes of infertility due to anovulation in women. The clinical features of PCOS are heterogeneous and may change throughout the lifespan, starting from adolescence to postmenopausal age. This is largely dependent on the influence of obesity and metabolic alterations, including an insulin‐resistant state and the metabolic syndrome, which consistently affect most women with PCOS. Obesity does in fact have profound effects on both the pathophysiology and the clinical manifestation of PCOS, by different mechanisms leading to androgen excess and increased free androgen availability and to alterations of granulosa cell function and follicle development. Notably, simple obesity per se represents a functional hyperandrogenic state. These mechanisms involve early hormonal and metabolic factors during intrauterine life, leptin, insulin and the insulin growth factor system and, potentially, the endocannabinoid system. Compared with normal weight women with PCOS, those with obesity are characterised by a worsened hyperandrogenic and metabolic state, poorer menses and ovulatory performance and, ultimately, poorer pregnancy rates. The importance of obesity in the pathogenesis of PCOS is emphasised by the efficacy of lifestyle intervention and weight loss, not only on metabolic alterations but also on hyperandrogenism, ovulation and fertility. The increasing prevalence of obesity among adolescent and young women with PCOS may partly depend on the increasing worldwide epidemic of obesity, although this hypothesis should be supported by long‐term prospective epidemiological trials. This may have great relevance in preventive medicine and offer the opportunity to expand our still limited knowledge of the genetic and environmental background favouring the development of the PCOS.
Third‐trimester fetal MRI in isolated 10‐ to 12‐mm ventriculomegaly: is it worth it?
Authors: Salomon LJ , Ouahba J , Delezoide A‐L , Vuillard E , Oury J‐F , Sebag G , Garel C
Published: July 2006

Objective  The justification for magnetic resonance imaging (MRI) in isolated mild ventriculomegaly remains controversial. This study was undertaken to evaluate the contribution of third‐trimester MRI in isolated 10‐ to 12‐mm fetal ventriculomegaly.

Design  Observational prospective cohort study.

Setting  Universitary prenatal reference centre.

Population  From February 2000 to May 2005, we prospectively collected data concerning fetuses referred to us for cerebral MRI following detection of ventriculomegaly by ultrasound scan (n= 310).

Methods  Among these, we identified and analysed those cases in which ventriculomegaly was isolated and did not exceed 12 mm in ultrasound examinations prior to MRI scan (n= 185).

Main outcome measure  Cases in which MRI provided additional information that was likely to have an impact on prenatal management were detailed.

Results  During the study period, 310 MRI were performed because of fetal ventriculomegaly. Hundred and eighty‐five were suspected to be isolated 10‐ to 12‐mm ventriculomegalies in ultrasound scan and formed our database. MRI confirmed the 10‐ to 12‐mm isolated fetal ventriculomegaly in 106 cases (57.3%) and found other abnormalities in 5 (4.7%) of these 106 cases. MRI found ventricular measurement to be less than 10 mm in 43 cases (23.3%) and more than 12 mm in 36 cases (19.4%). Among these 36 fetuses with ventricle size more than 12 mm, 6 (16.7%) had other abnormalities, whereas MRI did not find other abnormalities in the 43 cases with ventricle size below 10 mm.

Conclusion  Before advantages of MRI to ultrasound examination can be demonstrated, it seems reasonable that MRI should remain an investigational tool, restricted to selected clinical situations in which the results are expected to modify case management. Where ultrasound scan suspects isolated ventriculomegaly of 10 to 12 mm, our data suggest that when the finding is confirmed with MRI this could be expected in around 5% of cases. Therefore, the policy of routine MRI in such cases should depend on prenatal centres’ priorities.
Incidence of upper genital tract occlusion following microwave endometrial ablation (MEA™)
Authors: Tawfeek S , Sholapurkar S , Sharp N
Published: July 2006

The aim of the study was to determine the incidence of occlusion of the upper genital tract following microwave endometrial ablation (MEA™) in women treated for therapy‐resistant menorrhagia. A total of 35 women were recruited between January 1997 and January 2005, Royal United Hospital Bath, to have interval hysterosalpingogram (HSG) post‐MEA. After a successful MEA, either with general or local anaesthesia, 35 HSGs were performed 3 or more months later. Complete occlusion of the upper genital tract was found in 30 women (85.7%) and incomplete occlusion with tubal patency persisted in 5 (14.3%).
Differential effect of nerve growth factor on dopaminergic neurotoxin‐induced apoptosis
Authors: Hirata Yoko , Meguro Tomotaka , Kiuchi Kazutoshi
Published: July 2006

Both rotenone and manganese are possible neurotoxins for a wide variety of cell and neuronal types including dopaminergic neurons and induce apoptosis in various cells. Neurotrophic factors have the potential for therapeutic development when used to prevent Parkinson's disease. In this paper, we focused on the differences between rotenone and manganese as toxins, and characterized the influence of neurotrophic factors on toxin‐induced apoptosis in PC12 cells. There were distinct differences in intracellular mechanisms between rotenone‐ and manganese‐induced apoptosis such as the production of reactive oxygen species, the response to antioxidants, and the activation of the c‐Jun N‐terminal kinase (JNK) and p38 mitogen‐activated protein kinase (MAPK). Nerve growth factor (NGF) almost completely prevented rotenone‐induced but not manganese‐induced caspase activation and DNA fragmentation. The differential effect of NGF was found to be mainly due to the down‐regulation of the Trk tyrosine kinase receptor by manganese but not by rotenone. Prevention of rotenone‐induced apoptosis by NGF was attenuated by the phosphatidylinositol 3‐kinase (PI 3‐kinase) inhibitor, LY294002, but not MAPK kinase (MEK) inhibitors, PD98059 or U0126. These results demonstrate that the potential neurotoxins for dopaminergic cells exert their toxic effect by activation of different signaling pathways of apoptosis and that NGF prevents rotenone‐induced apoptosis through the activation of the PI 3‐kinase pathway not MAPK pathway.
The antinociceptive activity of Muntingia calabura aqueous extract and the involvement of l‐arginine/nitric oxide/cyclic guanosine monophosphate pathway in its observed activity in mice
Authors: Zakaria Zainul Amiruddin , Sulaiman Mohd Roslan , Jais Abdul Manan Mat , Somchit Muhammad Nazrul , Jayaraman Kogilla Vani , Balakhrisnan Ganesh , Abdullah Fatimah Corazon
Published: July 2006

The present study was carried out to investigate on the possible involvement of l‐arginine/nitric oxide/cyclic guanosine monophosphate (l‐arginine/NO/cGMP) pathway in the aqueous extract of Muntingia calabura (AEMC) leaves antinociception in mice assessed by abdominal constriction test. The AEMC, obtained by soaking the dried leaves in distilled water (DH2O) (1 : 2; w/v) for 24 h, was prepared in concentrations of 10%, 50% and 100% that were approximately equivalent to doses of 27, 135 and 270 mg/kg, and administered subcutaneously (s.c.) 5 min after pre‐treatment (s.c.) of mice with DH2O, l‐arginine (20 mg/kg), NG‐monomethyl‐l‐arginine acetate (l‐NMMA; 20 mg/kg), NG‐nitro‐l‐arginine methyl esters (l‐NAME; 20 mg/kg), methylene blue (MB) (20 mg/kg), respectively. The AEMC was found to exhibit a concentration‐dependent antinociception after pre‐challenge with DH2O. Interestingly, pre‐treatment with l‐arginine was found to block significantly (P < 0.05) the AEMC antinociception but only at the highest concentration (100%) of AEMC used. On the other hand, pre‐treatment with l‐NAME was found to significantly (P < 0.05) enhance the low concentration but inhibit the high concentration AEMC antinociception. MB was found to significantly (P < 0.05) enhance AEMC antinociception at all concentrations used. Except for the higher concentration of AEMC used, co‐treatment with l‐NAME was found to insignificantly and significantly (P < 0.05) reverse the l‐arginine effect when given alone or with low concentration AEMC, respectively. In addition, co‐treatment with MB significantly (P < 0.05) reversed the l‐arginine effect when given alone or with 10% concentration AEMC but failed to affect the activity of the rest of concentrations used. As a conclusion, this study has demonstrated the involvement of l‐arginine/NO/cGMP pathway in AEMC antinociception.
Reduced nestling growth of East African StonechatsSaxicola torquata axillarisin the presence of a predator
Authors: SCHEUERLEIN ALEXANDER , GWINNER EBERHARD
Published: July 2006

We investigated nestling growth of tropical East African StonechatsSaxicola torquata axillaristo evaluate the effects of nest predation, predator presence and food availability. We provided some Stonechat pairs with supplemental food, while others in a similar habitat served as a control. Concomitantly, we assessed the presence of Fiscal ShrikesLanius collarisin supplemental fed and unsupplemented territories. Fiscal Shrikes prey on adult Stonechats and nestlings. We found that nestling growth was considerably reduced in Stonechat pairs that shared their territory with a Shrike. This effect was greater in nestlings of pairs that did not receive supplemental food. The reduction in nestling growth rates was significantly correlated with a reduced rate of visiting by the parents. Behavioural observations further suggested that parents reduced their feeding visits to the nest presumably to minimize their own predation risk, rather than predation risk of their brood. Our experiments show that the lower reproductive investment in tropical Stonechats can be attributed to risk‐sensitive behaviour of the parents, especially when food is in limited supply.
Breeding biology of the Red Kite Milvus milvus in Corsica
Authors: MOUGEOT FRANÇOIS , BRETAGNOLLE VINCENT
Published: July 2006

The breeding biology of the Red Kite Milvus milvus is still little known in the southern part of its range (Mediterranean), despite recent conservation concerns and major declines in most insular populations (Sicily, Sardinia and Balearics). We report here on the breeding biology of the Red Kite in Corsica in 1996–99 and on recent population trends there. In a 42‐km2 study area located in the northwest of the island (Balagne region), breeding density was locally high (1.17–1.78 breeding pairs/km2). Breeding dispersion ranged from loosely colonial to dispersed, with average nearest‐neighbour distance of 444 ± 316 m (range 50–2000) (all data as means ± sd). Kites established breeding territories in January–February, and 92.4% of territorial pairs laid a clutch (n = 238). Laying took place between February and May (mean lay date: 27 March ± 16 days, n = 147). Clutch size averaged 2.44 ± 0.71 (1–5 eggs, n = 96), hatching success 66.9% and fledging success 78.6%. Productivity averaged 1.33 ± 0.88 young per breeding attempt (n = 221) and 1.65 ± 0.65 young per successful breeding attempt (n = 173). Overall breeding success was 51.4 ± 38.0% (n = 88). We describe the growth of young (wing, weight, tarsus and bill) and show a marked seasonal decline in clutch size and breeding performance, with pairs laying earlier producing larger clutches and being more successful than later breeding pairs. Unlike most other insular Mediterranean Red Kite populations that have recently declined, the breeding population in the northwest of Corsica, which accounts for c. 25% of the whole island population, increased from 25 to 35 pairs in 1989 to a maximum of 80–90 pairs in 1997. This increase was probably related to the lack of persecution and a local increase in abundance of Rabbits Oryctolagus cuniculus, following their introduction in the late 1970s, which provided an important feeding resource for Kites. Finally, we compare our results with those from other Red Kite populations studied in Europe. We found that there is a latitudinal gradient in laying date and productivity across Western Europe populations, but no evidence of an insular syndrome in the Corsican population.
Variation in Chemotherapy Utilization in Ovarian Cancer: The Relative Contribution of Geography
Authors: Polsky Daniel , Armstrong Katrina A. , Randall Thomas C. , Ross Richard N. , Even‐Shoshan Orit , Rosenbaum Paul R. , Silber Jeffrey H.
Published: July 2006

Objective. This study investigates geographic variation in chemotherapy utilization for ovarian cancer in both absolute and relative terms and examines area characteristics associated with this variation.

Data Sources. Surveillance, Epidemiology, and End Results (SEER) Medicare data from 1990 to 2001 for Medicare patients over 65 with a diagnosis of ovarian cancer between 1990 and 1999. Chemotherapy within a year of diagnosis was identified by Medicare billing codes. The hospital referral region (HRR) represents the geographic unit of analysis.

Study Design. A logit model predicting the probability of receiving chemotherapy by each of the 39 HRRs. Control variables included medical characteristics (patient age, stage, year of diagnosis, and comorbidities) and socioeconomic characteristics (race, income, and education). The variation among HRRs was tested by the χ2 statistic, and the relative contribution was measured by the ω statistic. HHR market characteristic are then used to explain HRR‐level variation.

Principal Findings. The average chemotherapy rate was 56.6 percent, with a range by HRR from 33 percent to 67 percent. There were large and significant differences in chemotherapy use between HRRs, reflected by a χ2 for HRR of 146 (df=38, p<.001). HRR‐level variation in chemotherapy use can be partially explained by higher chemotherapy rates in HRRs with a higher percentage of hospitals with oncology services. However, an ω analysis indicates that, by about 15 to one, the variation between patients in use of chemotherapy reflects variations in patient characteristics rather than unexplained variation among HRRs.

Conclusions. While absolute levels of chemotherapy variation between geographic areas are large and statistically significant, this analysis suggests that the role of geography in determining who gets chemotherapy is small relative to individual medical characteristics. Nevertheless, while variation by medical characteristics can be medically justified, the same cannot be said for geographic variation. Our finding that density of oncology hospitals predicts chemotherapy use suggests that provider supply is positively correlated with geographic variation.
Analyzing Multiple Informant Data from an Evaluation of the Health Disparities Collaboratives
Authors: James O'Malley A. , Landon Bruce E. , Guadagnoli Edward
Published: July 2006

Objective. To use multivariate regression methods to analyze simultaneously data obtained from multiple respondents or data sources (informants) at health centers.

Data Source. Surveys of executive directors, medical directors, and providers from 65 community health centers (176 informants) who participated in an evaluation of the Health Disparities Collaboratives.

Study Design. Cross‐sectional survey of staff at the health centers during 2003–2004.

Statistical Methods. In order to illustrate this method, we analyze the association between informants' assessments of the culture of the center and participation in the collaborative, and the association between computer availability and the effort made by management to improve the quality of the care and services at their center. Multivariate regression models are used to pool information across informants while accounting for informant‐specific effects and retaining informants in the analysis even if the data from some of them are missing. The results are compared with those obtained by traditional methods that use data from a single informant or average over informants' ratings.

Findings. In both the Collaborative participation and quality improvement efforts analyses, the multivariate regression multiple informants' analysis found significant effects and differences between informants that traditional methods failed to find. Participating centers emphasized developmental (entrepreneurship, innovation, risk‐taking) and rational culture. The effect of hierarchical culture (stability and bureaucracy) on participation depended on the informant; executive directors and medical providers were the most discrepant. In centers that participated in the Collaborative, the availability of computers was positively associated with the effort that management made toward improving quality.

Conclusions. The multiple informants model provided the most precise estimates and alerts users to differential effects across informants. Because different informants may have different insights or experiences, it is important that differences among informants be measured and ultimately understood by health services researchers.
Mechanisms regulating cytotrophoblast invasion in normal pregnancy and pre‐eclampsia
Authors: LYALL Fiona
Published: July 2006

The placental bed underlies the placenta and includes the decidua basalis and underlying myometrium containing the uterine spiral arteries. For successful human haemochorial placentation, the placental bed spiral arteries must undergo considerable alterations. These physiological modifications are thought to be brought about by the interaction of invasive cytotrophoblast with the spiral artery vessel wall. Failure of spiral artery transformation is thought to play an important role in the sequence of events that gives rise to pre‐eclampsia. The mechanisms that control human trophoblast invasion in normal, let alone abnormal pregnancy, are still poorly understood. Much of the information on the early physiological changes within the placental bed comes from studies on intact hysterectomy specimens.1 Details of such events in late pregnancy and in pregnancies complicated by pre‐eclampsia and fetal growth restriction are principally derived from the study of placental bed biopsies taken at Caesarean section. The methods of sampling the placental bed have been reviewed elsewhere.2 Many investigators have relied on in vitro models of trophoblast invasion. In vitro models can be extremely useful in dissecting out some of these processes but may be open to artefacts. The mechanisms underlying normal and failed trophoblast invasion appear to be complex. In this manuscript the mechanisms that control the invasion of trophoblast into the decidua and myometrium are reviewed. Along with this is a review of the purported mechanisms underlying failed spiral artery transformation. Particular emphasis has been placed on topics that have been best studied.
Leptin and leptin receptor levels in pregnant women with hyperemesis gravidarum
Authors: AKA Nurettin , ATALAY Sacide , SAYHARMAN Sema , KILIÇ Düzgün , KÖSE Gültekin , KÜÇÜKÖZKAN Tuncay
Published: July 2006

Objective:  To investigate the association between the leptin, leptin receptor and hormone levels and hyperemesis gravidarum, and to determine whether these two parameters may be early markers for hyperemesis gravidarum.

Methods:  The study group consisted of 18 pregnant women with hyperemesis gravidarum and the control group consisted of 18 healthy pregnant women. Demographic characteristics were recorded and body mass index (BMI) values were calculated for all the pregnant women. Serum leptin, leptin receptor, insulin, cortisol, thyroid hormone and human chorionic gonadotrophin (hCG) levels were measured.

Results:  When the two groups were compared with respect to leptin levels, the group with hyperemesis gravidarum was found to have significantly higher leptin levels (P = 0.037). No intergroup differences were observed in serum cortisol, insulin, hCG, thyroid hormone levels or BMI values. In the group with hyperemesis gravidarum, an inverse correlation was detected between cortisol and leptin (r = –0.762, P < 0.01), and hCG and thyroid‐stimulating hormone (r = –0.503, P < 0.05), whereas a significant correlation was detected between insulin and leptin (r = 0.538, P < 0.05), leptin and BMI (r = 0.711, P < 0.01), and between TT3 and hCG (r = 0.605, P < 0.01).

Conclusion:  It was concluded that leptin could play a role in, and be defined as, a marker of hyperemesis gravidarum.
Obstetric management of the next pregnancy after an unexplained stillbirth: An anonymous postal survey of Australian obstetricians
Authors: ROBSON Stephen , THOMPSON Jane , ELLWOOD David
Published: July 2006

Background:  Women who have an unexplained stillbirth are more likely to be delivered early, by induced labour or Caesarean section, in their next pregnancy. It is unclear whether these birth outcomes result from characteristics of the next pregnancy, or represent management strategies of obstetricians.

Aim:  To investigate obstetricians’ management strategies in the next pregnancy after an unexplained stillbirth.

Methods:  Anonymous postal survey of Australian obstetricians. Respondents were given a clinical scenario regarding a previous unexplained stillbirth and were asked about management.

Results:  The response rate was 69%. Tests of ‘fetal well‐being’ were undertaken by the majority of respondents. Additional third trimester ultrasound surveillance was recommended by 87% of respondents, regular cardiotograph monitoring by 72% and formal fetal movement charting by 39%. Elective induction of labour (in the absence of any other obstetric indication) was recommended by 93% of respondents, and elective Caesarean delivery by 35%.

Conclusions:  The tendency for subsequent pregnancies after an unexplained stillbirth to be delivered earlier, and more often by Caesarean section, may be due in part to altered management strategies, not solely as a result of complications of the pregnancy itself.
Recurrence after treatment for high‐grade dysplasia: Should we modify our post‐treatment surveillance protocols?
Authors: CARTER Jonathan , SIM Janie , LAND Russell , DALRYMPLE Christopher , ABDEL‐HADI Mohammed , PATHER Selvan
Published: July 2006

A cohort of women, having undergone an excisional procedure for high‐grade cervical dysplasia, was studied to identify those patients who developed recurrent high‐grade cervical dysplasia post‐treatment. We have confirmed that recurrent histologically confirmed high‐grade cervical dysplasia is uncommon after complete excision and appears not to occur within the first 6 months post‐treatment. Post‐treatment surveillance protocols should incorporate these findings.
Vigorous exercise and birth outcomes in a sample of recreational exercisers: A prospective study across pregnancy
Authors: DUNCOMBE Dianne , SKOUTERIS Helen , WERTHEIM Eleanor H. , KELLY Leanne , FRASER Virginia , PAXTON Susan J.
Published: July 2006

Objective:  This study examined the question of whether vigorous exercise undertaken by recreational exercisers across pregnancy, defined in two ways, were associated with reduced infant birthweight and gestational age at birth.

Methods:  A prospective approach was implemented. A total of 148 pregnant women participated. Average intensity duration and frequency of vigorous exercise reported were examined and compared with two existing definitions of vigorous exercise. Participants completed questionnaires (including retrospective reports on 3 months prepregnancy) and an exercise diary at 16–23 weeks pregnancy, 24–31 weeks pregnancy and 32–38 weeks pregnancy, and at 7 to 14 days post‐partum a birth outcomes questionnaire was completed.

Results:  There were no significant differences between exercise groups for birthweight and gestational age at birth.

Conclusions:  There was no evidence that the intensity duration and frequency of vigorous exercise were associated with significant reductions in mean birth outcomes for the infants of women who participated in the study. Replication in a large, more diverse sample is recommended.
Perinatal outcome of pregnancies after inadvertent exposure to gonadotrophin‐releasing hormone analogue
Authors: TAN Heng Hao , YEONG Cheng Toh , LOH Kia Ee Sheila
Published: July 2006

Background:  The use of gonadotrophin‐releasing hormone agonists (GnRHa) in in vitro fertilisation (IVF) cycles is accepted as standard practice. However, the safety profile of this drug with inadvertent exposure in pregnancy is still in question.

Aim:  To evaluate the pregnancy outcomes in a group of infertile patients who conceive spontaneously while undergoing IVF with unrecognised daily exposure to GnRHa during the downregulation regime.

Methods:  A review of all women undergoing planned treatment cycles in our IVF centre, comprising of a total of 1949 fresh and 154 frozen embryo cycles from January 1996 to December 2001. All spontaneous pregnancies were recorded and case records reviewed.

Outcome measure:  Course and clinical outcome of pregnancies.

Results:  Nine spontaneous pregnancies were recorded (0.43%). The median duration of inadvertent exposure to subcutaneous leuprolide acetate was 22 days (range 21–25). The median age of the patients was 35 years (range 28–39) and the median duration of infertility was 3.5 years (range 1.5–8). Nine pregnancies resulted in miscarriages. Seven pregnancies progressed to term and resulted in singleton live births with no apparent evidence of fetal abnormalities or aneuploidies. One pregnancy was complicated by parvovirus infection at 19 weeks gestation with transient fetal hydrops. The pregnancy outcomes appear favourable even when compared to those conceived through the completed IVF cycles within the same cohort.

Conclusion:  Our experience reaffirms current evidence from earlier studies that accidental exposure to GnRHa in early pregnancy is safe. However, we believe that contraception prior to GnRHa is still prudent pending definitive data.
Longitudinal ultrasound assessment of fetal presentation: A review of 1010 consecutive cases
Authors: FOX Alice J. Sophia , CHAPMAN Michael G.
Published: July 2006

Background:  Abnormal presentation (detected in the early third trimester) causes concern for pregnant women and their carers. Definitive ultrasound‐based data on the risk of persistence of abnormal presentation is lacking to allow appropriate counselling. Comparison of pregnancy outcome was made on the basis of maternal age at delivery.

Methods:  Notes of 1010 women (426 primigravidae, 584 multigravidae), with singleton pregnancies, confined between 1997 and 2005 were reviewed to extract: (i) the gestation based on 18–20‐week ultrasound in conjunction with the patient's recorded last menstrual period, and (ii) the presentation of each antenatal visit from 28+ weeks until delivery. Previous obstetric history, maternal age, mode of delivery, birthweight and outcomes were also documented.

Results:  At 28–30 weeks, 216 babies presented abnormally. By 38+ weeks, 54 persisted as either a breech or a transverse lie. Thus, an abnormal presentation in the early trimester carries a 22.2% chance of persisting at term. Continuance of abnormal presentation at each subsequent week of the third trimester increased the risk of a Caesarean delivery at term. Conversely, in only six cases, a cephalic presentation at 28–30 weeks converted to a breech or other presentation during the third trimester – a risk of 0.75%.

Conclusion:  These statistics provide a useful tool in advising women of the chances of abnormal presentation at term based on the presentation at various stages of the third trimester, and prepare them for the potential requirement of a Caesarean section.
Case report of failed tubal occlusion using Essure™ pbc (permanent birth control) hysteroscopic sterilisation procedure
Authors: KARTHIGASU Krishnan A. , Garry Ray , Hart Roger
Published: July 2006

The device previously known as STOP, now called the Essure™ pbc device, is a dynamic expanding microinsert, placed in the proximal section of the fallopian tube, occluding the tube. Initial reports about the device are promising with occlusion of the tubes in 100% with no reported pregnancies and a high rate of safety and patient acceptability. This report documents the first reported failure of tubal occlusion of an appropriately placed Essure™ pbc device.
Visual cognitive function in dementia of Alzheimer’s type: a comparison of visual event‐related potentials and Stroop test
Authors: ITO Kentaro , TOMIYA Norichika , IIMORI Makio , YOSHIHAMA Jun , MATSUDA Hiroshi
Published: July 2006

Background:  Many published studies on dementia of Alzheimer’s type (DAT) have utilized event‐related potentials (ERP) and the Stroop test. However, most of this research has performed these analyses separately. Therefore, in the present research, these two examinations were carried out together following the same paradigm in order to clarify the characteristics of visual dysfunction in DAT patients.

Methods:  Subjects included 30 normal adults, 10 normal elderly and 10 DAT patients. A visual categorically deviant paradigm was utilized during ERP measurement. The target stimulus was red and non‐target stimuli were blue, yellow and green. The stimuli were displayed as square figures. During the Stroop test, the subjects read color names from word cards, named colors from color cards, and the text color of a printed color word. Reading times and differences in reading times were measured for each task.

Results:  Regarding ERP, the normal elderly and DAT groups displayed increased latencies and decreased amplitudes compared to the normal adult group. The normal elderly and DAT groups displayed no significant differences in N100 latencies and amplitudes. However, for P300, the DAT group displayed significantly decreased amplitudes in comparison to the normal elderly group. On the Stroop test, the normal elderly and DAT groups displayed significantly extended differences in reading times compared to the normal adult group. No significant differences were observed between the normal elderly and DAT groups.

Conclusion:  Age‐related changes were observed in the latency of ERP and the increase of the Stroop effect. Characteristic changes in DAT were indicated by latencies and amplitudes of P300, but were not indicated by the Stroop test. Characteristic abnormalities in the stimulation evaluation process were observed for DAT; however, changes other than those related to aging were not apparent in the selection process reaction.
Psychotropic drug prescriptions in hospitalized elderly psychiatric patients: comparison with adult psychiatric patients
Authors: ZULLINO Daniele F. , REYNAUD Gilbert , DE MENDONÇA LIMA Carlos Augusto , BAUMANN Pierre
Published: July 2006

Background:  Drug prescriptions were studied in two samples of inpatients that differentiated by their ages (patients 18–64 years vs elderly patients >64 years), in order to compare the use of psychotropic and non‐psychiatric drugs, and the proportion of newer versus classical antidepressants or antipsychotics.

Methods:  Drug prescriptions were recorded on a reference day in May 2000 in two hospitals that differed in the age categories of the patients who were admitted. The total costs per patient were compared, as well as the proportion of those due to a somatic medication.

Results:  The prescriptions of 61 adult patients and of 82 psychogeriatric patients were assessed. The mean number of prescribed somatic drugs per patient was higher in elderly patients (P < 0.001), which was again reflected in a higher mean number of all drugs jointly (P < 0.001). Prescription of benzodiazepines was lower in elderly patients than in the adult patients (P < 0.001), even when used as an add‐on treatment with antidepressants (P < 0.001). The pharmacological treatment of adult patients was significantly less expensive (9.3 ± 7.2 Swiss Francs/patient) than that of the psychogeriatric patients (14.1 ± 9.5 Swiss Francs/patient; P = 0.009), who had a higher need for somatic comedications.

Conclusions:  This survey confirms the large impact of local traditions on the prescription habits of clinicians, with the exception of the prescription of benzodiazepines, regarding which psychiatrists of psychogeriatric patients seem to be less enthusiastic.
Genetic Biomarkers for Migraine
Authors: De Vries Boukje , Haan Joost , Frants Rune R. , Van den Maagdenberg Arn M.J.M. , Ferrari Michel D.
Published: July 2006

Biomarkers are physical signs or laboratory measurements that occur in association with a pathological process and have putative diagnostic and/or prognostic utility. In migraine, clinical, radiological, and biochemical biomarkers might be helpful to improve diagnosis, get insight in pathophysiology, and facilitate treatment choices. Genetic biomarkers are defined as genetic variations (mutations or polymorphisms) that can predict disease susceptibility, disease outcome, or treatment response. As yet, only a few genetic biomarkers for migraine are available. Mutations in 3 different genes responsible for familial hemiplegic migraine, a monogenetic subtype of migraine with aura, and the MTHFR C677T polymorphism in common forms of migraine are clear examples. Many positive findings from linkage studies and association studies in common forms of migraine have not been replicated, and are therefore of less clinical use. In this review, we will discuss genetic biomarkers in migraine.
Neuronal Signal Substances as Biomarkers of Migraine
Authors: Edvinsson Lars
Published: July 2006

Of the sensory nervous system associated signal substances it is only calcitonin generelated peptide (CGRP) that is reliably associated with the degree of pain in the acute attacks of primary headaches. The treatment with triptans alleviates both the pain and the associated CGRP release, putatively via a presynaptic effect on the sensory nerves. The studies of opoids and other sensory neuropeptides are inconsistent and require further analysis. Initial positive data on endothelin and its receptors have turned out negative. Nitric oxide mechanisms are still debated both in terms of initiation of attacks and for the treatment.
Imaging Findings of Migraine
Authors: Cutrer F. Michael , Black David F.
Published: July 2006

Increasingly sophisticated neuroimaging techniques have allowed researchers to begin to define functional and anatomical characteristics of migraine. This paper reviews current knowledge and techniques employed. Assessing present‐day knowledge limitations it concludes that with parallel advances in the technology of imaging and the pathophysiologic understanding of migraine, a reliable biomarker may be discovered in the future.
Successful Treatment of Hypnic Headache with Topiramate: A Case Report
Authors: Guido Marco , Specchio Luigi Maria
Published: July 2006

Hypnic headache is a rare cause of benign headache in the elderly. This is a clinical report of a 67‐year‐old housewife, suffering from hypnic headache, in which topiramate yielded a successful prophylactic effect at 100 mg/day.
Differential Glutamate Dehydrogenase (GDH) Activity Profile in Patients with Temporal Lobe Epilepsy
Authors: Malthankar‐Phatak Gauri H. , De Lanerolle Nihal , Eid Tore , Spencer Dennis D. , Behar Kevin L. , Spencer Susan S. , Kim Jung H. , Lai James C. K.
Published: July 2006

Summary:  Purpose: Pathophysiologic mechanisms underlying temporal lobe epilepsy (TLE) are still poorly understood. One major hypothesis links alterations in energy metabolism to glutamate excitotoxicity associated with seizures in TLE. The purpose of this study was to determine whether changes in the activities of enzymes critical in energy and neurotransmitter metabolism contributed to the alterations in metabolic status leading to the excitotoxic effects of glutamate.

Methods: Activities of four key enzymes involved in energy metabolism and glutamate cycling in the brain [aspartate aminotransferase (AAT), citrate synthase (CS), glutamate dehydrogenase (GDH), and lactate dehydrogenase (LDH)] were measured in anterolateral temporal neocortical and hippocampal tissues obtained from three different groups of medically intractable epilepsy patients having either mesial, paradoxical, or mass lesion–associated temporal lobe epilepsy (MTLE, PTLE, MaTLE), respectively.

Results: We found that GDH activity was significantly decreased in the temporal cortex mainly in the MTLE group. A similar trend was recognized in the hippocampus of the MTLE. In all three patient groups, GDH activity was considerably lower, and AAT and LDH activities were higher in cortex of MTLE as compared with the corresponding activities in hippocampus (p < 0.05). In the MTLE cortex and hippocampus, GDH activities were negatively correlated with the duration since the first intractable seizure.

Conclusions: Our results support the hypothesis suggesting major alteration in GDH activity mainly in the MTLE group. It is proposed that significant alterations in the enzyme activities may be contributing to decreased metabolism of glutamate, leading to its accumulation.
Remote Memory in Temporal Lobe Epilepsy
Authors: Voltzenlogel Virginie , Després Olivier , Vignal Jean‐Pierre , Steinhoff Bernhard J. , Kehrli Pierre , Manning Lilianne
Published: July 2006

Summary:  Purpose: The present study aims at characterizing remote memory in patients with temporal lobe epilepsy (TLE); it also considers the impact of its most important variables (lateralization of the lesion, duration of epilepsy, age at onset, and seizure frequency) on remote memory.

Methods: We examined the performance of 38 patients with unilateral TLE (19 right TLE and 19 left TLE) and 35 healthy subjects on six remote memory tasks. Memory for personal events was assessed by using the Autobiographical Memory Interview and the Modified Crovitz Test. Memory for public events was evaluated by means of photographs of famous faces and famous scenes, questions about famous events, and the Dead/Alive Test.

Results: Both right‐TLE and left‐TLE groups had impaired memory for autobiographic episodes and public events relative to normal subjects. In contrast, personal semantic memory was preserved. In addition, an effect of laterality was recorded, with right‐TLE patients obtaining significantly better scores than left‐TLE patients on every test. Duration of epilepsy, age at onset, and seizure frequency did not influence performance on remote memory measures.

Conclusions: The comprehensive neuropsychological study of 38 TLE patients showed that this neurologic condition affects remote memory systems differently. We discuss the different factors that could account for this pattern of performance on the bases of both functional brain organization and memory theories.
Speech Preservation during Language‐dominant, Left Temporal Lobe Seizures: Report of a Rare, Potentially Misleading Finding
Authors: Kaiboriboon Kitti , Parent Jack M. , Barbaro Nicholas M. , Walker John A. , Garcia Paul A.
Published: July 2006

Summary:  Purpose: To evaluate the prevalence and mechanism of ictal speech in patients with language‐dominant, left temporal lobe seizures.

Methods: We retrospectively reviewed the video‐EEG telemetry records for the presence of ictal speech in 96 patients with surgically proven left temporal lobe epilepsy and studied the seizure‐propagation patterns in three patients who required intracranial EEG recordings for seizure localization.

Results: Ictal speech preservation was observed in five patients. One patient's seizures demonstrated rapid propagation of the ictal discharges to the contralateral temporal area where the seizure evolved, resembling a nondominant temporal lobe seizure. The other two patients had ictal discharges that remained confined to the inferomesial temporal areas, sparing language cortex.

Conclusions: Preservation of speech in complex partial seizures of language‐dominant, left temporal lobe origin is rare. Based on intracranial EEG recordings, the likely mechanism underlying this potentially misleading clinical finding is the preservation of language areas due to limited seizure‐propagation patterns.