bluuebunny/crossref_metadata_2025 huggingface dataset:
Renal reabsorption of inorganic phosphorus in pregnancy in relation to the calciotropic hormones
Authors: Weiss Mordechai , Eisenstein Zemach , Ramot Yoram , Lipitz Shlomo , Shulman Adrian , Frenkel Yair
Published: August 2005

Objective
To measure renal reabsorption of inorganic phosphorus and the calciotropic hormones in early

Design
Prospective, cross‐sectional study.

Setting
Endocrine Institute at Assaf Harofeh and E. Wolfson Medical Centers; the Deparment of Obstetrics and Gynaecology, Sheba Medical Centre and Tel Aviv University.

Population
Three groups of healthy women were studied: pregnant women at the end of the first trimester (n= 20), pregnant women at the end of the third trimester (n= 22), and nonpregnant controls (n= 27).

Methods and main outcome measures
The renal tubular maximal phosphorus reabsorption per decilitre of glomerular filtrate (TmP/GFR) was measured in all women. Circulating levels of intact parathyroid hormone, calcitriol (1,25‐dihydroxy vitamin D3) and insulin‐like growth factor I were assayed in part of the women (8.11 of each group).

Results
TmP/GFR was elevated in the first trimester group (mean 0.263 mmol/L) compared with controls (95% CI 0.07–0.46, P= 0.003). Third trimester values did not differ fiom controls. Serum calcitriol in the first trimester group was higher (mean difference 17.68 pg/mL) compared with controls (95% CI 3.89–31.47, P= 0.006) and was higher still (mean difference 20.75 pg/mL) in the third trimester group (95% CI 1.01–40*49, P= 0.042). Serum parathyroid hormone in the first trimester group was lower than in controls or the third trimester group: mean differences were respectively. Parathyroid hormone levels correlated negatively to calcitriol levels in the combined control and first trimester groups (r= ‐0.54, P= 0.022) and negatively to TmP/GFR values in the combined three groups (r= ‐0.68, P= 0.042). First trimester levels of insulin‐like growth factor I were lower than those in controls or in the third trimester: mean differences were 10.24 nmol/L (95% CI 2.05–1 8.43, P= 0.007) and 13.57 nmol/L (95% CI 4.23–22.91, P= 0.003), respectively.

Conclusions
The dominant change in mineral metabolism in pregnancy is a rise in calcitriol which most probably is responsible for the relative suppression of parathyroid hormone and thereby for the rise in TmP/GFR in early pregnancy. All the above support the transfer of minerals to the fetus without compromising maternal bone. The significance of circulating insulin‐like growth factor I remains and late pregnancy. 4.40 pg/mL (95% CI ‐1.40 to 10.15, P= 0.078) and 8.18 pg/mL (95% CI 0.51–15.85, P= 0.019) unclear.
Barbados Low Dose Aspirin Study in Pregnancy (BLASP): a randomised trial for the prevention of pre‐eclampsia and its complications
Authors: Rotchell Y. E. , Cruickshank J. K. , Phillips Gay M. , Griffiths J. , Stewart A. , Farrell B. , Ayers S. , Hennis A. , Grant A. , Duley L. , Collins R.
Published: August 2005

Objective
To determine whether prophylactic, low dose controlled‐release aspirin improves outcome for pregnant women and their babies in Barbados.

Design
Randomised placebo‐controlled trial.

Setting
The Queen Elizabeth Hospital, Barbados.

Population
All women attending antenatal clinics between 12 and 32 weeks of gestation were eligible, if without specific contraindications to aspirin and unlikely to deliver immediately.

Methods
Randomisation was computer‐generated in the antenatal clinic; 1822 women were allocated to receive 75 mg controlled‐release aspirin and 1825 matching placebo.

Main outcome measures
Proteinuric pre‐eclampsia, other pregnancy‐induced hypertension, pregnancy duration, birthweight, stillbirths and neonatal deaths, major neonatal events.

Results
All but three women from each group were followed up successfully. Forty‐four percent were primigravid, and 8% had previous obstetric complications. There were no significant differences between the allocated treatment groups in the incidence of proteinuric pre‐eclampsia (40 [2.2%] of those allocated aspirin, compared with 46 [2.5%] allocated placebo), of preterm delivery (255 [14.0%] vs 270 [14.8%]), of birthweight < 1500 g (32 [1.7%] vs 33 [1.8%]) or of stillbirth and neonatal death (44 [2.4%] vs 38 [2.1%]). Aspirin was not associated with excess risk of maternal orfetal bleeding.

Conclusions The results of this study in Barbados do not support the routine use of low dose aspirin for prevention of pre‐eclampsia or its complications, confirming results of previous large trials in other settings.
A randomised controlled trial of intravenous magnesium sulphate versus placebo in the management of women with severe pre‐eclampsia
Authors: Coetzee E. J. , Dommisse J. , Anthony J.
Published: August 2005

Objective
To determine whether the administration of prophylactic intravenous magnesium sulphate reduces the occurrence of eclempsia in women with severe pre‐eclampsia.

Design
Randomised controlled trial.

Setting
A tertiary referral obstetric unit.

Population
Eight hundred and twenty‐two women with severe pre‐eclampsia requiring termination of pregnancy by induction of labour or caesarean section.

Methods
The women were randomised to receive either placebo (saline) or magnesium sulphate intravenously. The investigators were blinded to the contents of the pre‐mixed solutions.

Main outcome measure
The occurrence of eclampsia in the two groups.

Results
The data of 699 women were evaluated. Fourteen were withdrawn after randomisation. The overall incidence of eclampsia was 1.8%. Of 345 women who received magnesium sulphate, one developed eclampsia (0.3%); in the placebo group, 11/340 women (3.2%) developed eclampsia (relative risk 0.09; 95% confidence interval 0.01–0.69; P= 0.003).

Conclusion
The use of intravenous magnesium sulphate in the management of women with severe pre‐eclampsia significantly reduced the development of eclampsia.
Increase in incidence of gastroschisis in the South West of England in 1995
Authors: Penman David G. , Fisher Ross M. , Noblett Helen R. , Soothill Peter W.
Published: August 2005

Objective
To describe the incidence of gastroschisis and to identify possible aetiological factors.

Design
A retrospective case review study.

Setting
The South West Region of England.

Population
All known cases of gastroschisis were identified from the regional fetal medicine, ultrasound, pathology and neonatal surgery databases. Datasets to be collected were agreed prospectively and included demographic, past medical, family and obstetric information for all pregnancies conceived between January 1987 and December 1995.

Results
In the first eight years the incidence was 1.61 10,000 but in 1995 a highly statistically significant rise to 4.4/ 10,000 was found (P= 0.0009). The increased incidence was not associated with changes in maternal age, proportion of primigravidae, use of tobacco or illicit drugs, conception while taking the oral contraceptive pill, or an increase in the number of teenage pregnancies. The median maternal age at last menstrual period for pregnancies with gastroschisis was 20.4 years which was much younger than the national average of 28 years. Thirty‐seven percent of these conceptions occurred during the first quarter of the year compared with the expected 25%.

Conclusions
The incidence of gastroschisis has risen to a higher level than previously reported which, despite a marked association with young maternal age at conception, is not due to an increase in the teenage pregnancy rate. As the average length of inpatient stay in the neonatal intensive care unit for cases with this malformation is approximately four weeks, the rise has considerable cost implications. The increasing incidence may also offer opportunities to determine the cause of gastroschisis.
Low dose oestrogen prophylaxis for recurrent urinary tract infections in elderly women
Authors: Cardozo Linda , Benness Christopher , Abbott Denise
Published: August 2005

Objective
To assess the efficacy of oral oestriol in the prevention of recurrent Urinary tract infections in elderly women.

Design
Double‐blind, randomised, parallel group, placebo controlled trial

Setting
Urogynaecology Unit at King's College Hospital with some women recruited from the geriatric units of St. Pancras Hospital and Dulwich Hospital, London (UK).

Participants
Seventy‐two postmenopausal women older than 60 years of age (mean 73.2 years) suffering from recurrent urinary tract infections.

Intervention
Oral oestriol (3 mg per day) or placebo for six months.

Main outcome measures
Urinary tract infection rates.

Results
The study was difficult to conduct because of its design and the age of the participants. Oral oestriol (3 mg per day) was not shown to be superior to placebo in the prevention of recurrent urinary tract infections, but both oestriol and placebo improved urinary symptoms during the trial.

Conclusion
The power of the study might have been too low to detect a significant difference between the groups, or oral oestriol(3 mg per day) may have been either the wrong dose or the wrong route of administration for this indication.
Application of a customised birthweight standard in the assessment of perinatal outcome in a high risk population
Authors: de Jong Catharina L. D. , Gardosi Jason , Dekker Gustaaf A. , Colenbrander Gerard J. , van Geijn Herman P.
Published: August 2005

Objective
Physiological as well as pathological variables influence birthweight. The aim of the present study was to examine perinatal outcome in relation to birthweight centiles applying a customised birthweight standard.

Methods
Two hundred and seventeen babies from high risk pregnancies were evaluated and classified as small or not small for gestational age according to two standards: 1. conventional Dutch birthweight centiles and 2. customised centiles which adjust individually for physiological variables like maternal booking weight, height and ethnic origin.

Results
Customisation of the weight standards resulted in identification of an additional group of infants who were small for gestational age, but not by the Dutch standards. These babies were associated with significantly more adverse perinatal events than those who were not small for gestational age as defined by a customised standard.

Conclusions
Adjustment of birthweight centiles for physiological variables significantly improves the identification of infants who have failed to reach the expected birthweight and who are at increased risk for adverse perinatal events.
Lipid peroxidation in cord blood at birth: the effect of labour
Authors: Rogers M. S. , Mongelli J. M. , Tsang K. H. , Wang C. C. , Law K. P.
Published: August 2005

Objective
To determine the effect of labour on free oxygen radical activity in the fetus, as reflected by lipid peroxide levels in umbilical cord arterial blood.

Design
Prospective, observational study.

Setting
Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong.

Methods
Umbilical cord arterial and venous blood samples were collected from singleton term infants delivered by elective caesarean section. Base excess, PO2, pCO2, and pH were measured in both samples and compared to identify double venous samples. Cord arterial acid‐base balance and concentrations of organic hydroperoxides and malondialdehyde were compared with those obtained from normal vaginal deliveries.

Results
Cord arterial blood samples, obtained from cases of uncomplicated labour followed by spontaneous vaginal delivery, had significantly higher lipid peroxide concentrations than those delivered following elective caesarean section. This was most marked for malondialdehyde with a median value increased by 105%, whilst organic hydroperoxide was increased by only 27%. Of the acid‐base parameters, base excess was increased by 78%, with only minimal changes in pH, PCO2, and PO2. These differences remained highly significant after including other pregnancy characteristics in multivariate analysis.

Conclusion
The findings indicate that high levels of free oxygen radical activity in the fetus are a function of the labour process, as are changes in acid‐base balance.
Development and validation of the menorrhagia outcomes questionnaire
Authors: Lamping Donna L. , Rowe Pamela , Clarke Aileen , Black Nick , Lessof Leila
Published: August 2005

Objective
To develop and evaluate the acceptability, reliability and validity of a short, patient‐based questionnaire for assessing the outcomes of surgical treatment for menorrhagia due to benign disease.

Design
A psychometric study by postal survey.

Setting
Five hospitals in southeast England.

Sample
One hundred and eleven women undergoing hysterectomy for menorrhagia due to benign disease.

Methods
Data from a long research questionnaire used in the North West Thames Hysterectomy Study were analysed using standard psychometric methods to identify the subset of items which were the most scientifically sound indicators of outcome. The Menorrhagia Outcomes questionnaire is a 26–item questionnaire which covers symptoms, post‐operative complications, quality of life, and women's satisfaction with outcome. The questionnaire was field tested for acceptability, reliability and validity by postal survey.

Results
The Menorrhagia Outcomes Questionnaire was found to be highly acceptable to women and showed excellent internal consistency, test‐retest reliability, criterion and construct validity.

Conclusion
The Menorrhagia Outcomes Questionnaire is a practical and scientifically sound measure of outcome from the woman's perspective following surgical treatment for menorrhagia due to benign disease. It takes less than five minutes to complete, is appropriate for use with different surgical treatments for menorrhagia (eg. hysterectomy, endometrial resection, laser ablation) and is feasible for routine monitoring of large numbers of women by postal survey. Most importantly, this questionnaire has been shown to perform well from a scientific point view, having met standard psychometric criteria for reliability and validity.
Puerperal thromboprophylaxis: comparison of the anti‐Xa activity of enoxaparin and unfractionated heparin
Authors: Gibson Janice L. , Ekevall Klara , Walker Isobel , Greer Ian A.
Published: August 2005

Low molecular weight heparins are used extensively for thromboprophylaxis. The aim of this study was to compare the activity of the low molecular weight heparin, enoxaparin, 20 mg and 40 mg, given once per day with unfractionated heparin, 7500iu given twice per day, in terms of their anti‐Xa activity in puerperal women following caesarean section and with an additional risk factor for venous thromboembolism. Seventeen women were randomised to receive one of the three treatments. The anti‐Xa activity associated with each treatment was measured prior to treatment and at 2, 4, 6, 12 and 24 hours. The mean anti‐Xa values of the groups receiving enoxaparin, 20mg and 40mg, were significantly higher than those of the group receiving unfractionated heparin. There was no difference between the two enoxaparin groups in terms of the anti‐Xa activity profiles. This study suggests that the use of enoxaparin is superior to unfractionated heparin in terms of anti‐Xa activity.
Expression of endothelin‐1 in amniotic fluid embolism and possible pathophysiological mechanism
Authors: Khong T. Y.
Published: August 2005

Since endothelin is a potent vasoconstrictor and bronchoconstrictor, endothelin‐1 expression in the lung was investigated using immunohistological techniques in two cases of amniotic fluid embolism. Intense expression of endothelin‐1 was observed in amniotic squames while weaker staining was seen in alveolar epithelium, bronchiolar epithelium and intraalveolar macrophages and focally in vascular endothelium. Endothelin‐1 may play a role in the early and transient haemodynamic alteration of pulmonary hypertension in amniotic fluid embolism.
Sonographic prediction of malignancy in adnexal masses using an artificial neural network
Authors: Tailor Anil , Jurkovic Davor , Bourne Thomas H. , Collins William P. , Campbell Stuart
Published: August 2005

Objective
To generate a neural network algorithm which computes a probability of malignancy score for pre‐operative discrimination between malignant and benign adnexal tumours.

Design
A retrospective analysis of previously collected data. Information from 75% of the study group was used to train an artificial neural network and the remainder was used for validation.

Setting
The Gynaecological Ultrasound Research Unit at King's College Hospital, London.

Population
Sixty‐seven women with known adnexal mass who had been examined using transvaginal B‐mode ultrasonography and colour Doppler imaging with pulse spectral analysis immediately before surgery. The excised masses were classified histologically as benign (n= 52) or malignant (n= 19, of which three were borderline.

Methods
The variables that were put into the artificial neural network were: age, menopausal status, maximum tumour diameter, tumour volume, locularity, the presence of papillary projections, the presence of random echogenecity, the presence of analysable blood flow velocity waveforms, the peak systolic velocity, time‐averaged maximum velocity, the pulsatility index, and resistance index. Histological classification, categorised as benign or malignant, was the output result.

Results
A variant of the back propagation method was selected to train the network. The overall architecture of the network with the best performance contained an input layer with four variables (age, time‐averaged maximum velocity, papillary projection score and maximum tumour diameter), a hidden layer with three units and an output layer with one. The sensitivity and specificity at the optimum diagnostic decision value for the artificial neural network output (0.45) were 100% (95% CI 78.2%–100%) and 98.1% (95% CI 89.5%–100%), respectively. These values were significantly better than those obtained from the independent use of the resistance index, pulsatility index, time‐averaged maximum velocity or peak systolic velocity at their optimum decision values (P < 0.01).

Conclusion
Artificial neural networks may be used on clinical and ultrasound derived end‐points to accurately predict ovarian malignancy. There is a need for a prospective evaluation of this technique using a larger number of patients.
Assessment of maternal mortality and late maternal mortality among a cohort of pregnant women in Bamako, Mali
Authors: Etard Jean‐François , Kodio Belco , Traoré Sidy
Published: August 2005

Objective
Few prospective studies have been undertaken of maternal mortality in sub‐Saharan Africa. National statistics are inadequate, and data from hospitals are often the only source of information available. Reported maternal mortality ratios may therefore show large variations within the same country, as in Mali. This study was designed to produce an estimate of the maternal mortality ratio for the population of Bamako.

Design
Prospective cohort study.

Setting
Bankoni (population 59,000), a district of Bamako (population 700,000).

Population
5782 pregnant women identified during quarterly household visits.

Methods
After enrolment, two follow up visits, at six weeks and one year after delivery, were performed to collect information on the pregnancy, its outcome, the method of delivery, the puerperium and the first year after birth. Detailed inquiries on deaths were undertaken in the community, the maternity units and the reference hospital.

Main outcome measures
Maternal mortality ratio, late maternal mortality, likely cause of death.

Results
Complete data at follow up were available on 4717 women (82%) (4653 single and 64 twin pregnancies). Most of the women had antenatal care were and delivered in a district maternity hospital. There were 4580 live births (96%). Fifteen maternal deaths were recorded, yielding an overall maternal mortality ratio of 327 per 100,000 live births. Hypertensive disorders and haemorrhage were the main causes of death. Five more deaths occurred within 42 days or one year after delivery.

Conclusions
This study gave an estimate of the maternal mortality ratio for the population of Bamako, and stressed the need of better emergency obstetric care and the importance of late maternal mortality.
Amniotic fluid concentrations of Interleukin‐1β, Interleukin‐6 and TNF‐α in chorioamnionitis before 32 weeks of gestation: histological associations and neonatal outcome
Authors: Baud Olivier , Emilie Dominique , Pelletier Eric , Lacaze‐Masmonteil Thierry , Zupan Véronique , Fernandez Hervé , Dehan Michel , Frydman René , Ville Yves
Published: August 2005

Objectives
To test the association between cytokine levels in the amniotic fluid and (i) the vascular invasion phase of intrauterine infection, (ii) the occurrence of periventricular leukomalacia; to assess the correlation between C‐reactive protein levels, a recognised biological marker of inflammation in maternal serum and cytokine levels in the amniotic fluid.

Design
Prospective clinical study.

Setting
Fetal medicine unit and neonatal intensive care unit, Antoine Beclere Hospital, Clamart, France.

Sample
Thirty‐one pregnancies complicated by chorioamnionitis leading to birth before 32 weeks of gestation.

Methods
Interleukin 1‐β, Interleukin 6 and TNF‐α prospectively measured in the amniotic fluid. Histological examination of the placenta. Ultrasound examination and magnetic resonance imaging of the brains of the newborn infants performed within the first week of life.

Main outcome measures
The occurrence of periventricular leukomalacia was assessed by trans fontanellar ultrasound and magnetic resonance imaging.

Results
There was a significant positive correlation between the occurrence of histological chorioamnionitis, vascular extension of infection of the membranes, maternal inflammatory syndrome and neonatal sepsis. A strong association was found between maternal serum C‐reactive protein concentrations and cytokine levels in the amniotic fluid. Interleukin‐1β was the best predictor of vascular extension of chorioamnionitis, and TNF‐α was the best predictor of the development of severe early neonatal infection. There was no association betwecn the amniotic fluid levels of cytokines and the development of periventricular leukomalacia.

Conclusions
These data suggest that IL‐1β, IL‐6 and TNF‐α are produced in relation to intrauterine inflammation and infection, but cannot be directly implicated in the development of fetal cerebral white matter lesions.
Ovarian and uterine characteristics after total body irradiation in childhood and adolescence: response to sex steroid replacement
Authors: Bath Louise E. , Critchley Hilary O. D. , Chambers Sarah E. , Anderson Richard A. , Kelnar Christopher J. H. , Wallace W. Hamish B.
Published: August 2005

Objective
To study the effect of total body irradiation (14.4 Gray) in childhood and adolescence on ovarian and uterine characteristics, and to investigate the response to physiological sex steroid serum concentrations.

Design
All long term post‐pubertal female survivors of total body irradiation who had been treated in paediatric centres in Scotland were identified. Their ovarian and uterine characteristics were studied.

Setting
Recruitment was from follow up oncology clinics.

Sample
Nine women were identified, eight of whom were assessed and five progressed to detailed investigation. A control population of 12 women treated for acute leukaemia, but not treated with total body irradiation, and five healthy women with no history of childhood malignancy were recruited as controls.

Methods
Ovarian function was determined by measurement of serum gonadotrophins and sex steroids. Uterine response to physiological sex steroid replacement was investigated in women with ovarian failure, and to endogenous sex steroid production in women with ovarian function by ultrasound scan. The physiological sex steroid replacement was achieved with transdermal oestradiol patches and self administered vaginal progesterone pessaries.

Main outcome measures
Determination of ovarian function and uterine response to physiological sex steroid serum concentrations.

Results
Six of eight women treated with total body irradiation had ovarian failure; preservation of function was seen in two girls treated pre‐pubertally who had biochemical evidence of incipient ovarian failure. Four women with ovarian failure had reduced uterine volume, undetectable blood supply and absent endometrium at baseline assessment; after three months of physiological sex steroid replacement treatment uterine blood supply and endometrial response were not significantly different from controls; uterine volume improved but remained significantly smaller than controls and correlated with age at total body irradiation.

Conclusions
Ovarian failure after total body irradiation is common and risk relates to age at treatment. Physiological sex steroid replacement improved uterine measures and these women may benefit from assisted reproductive technology.
Serum markers for Down's syndrome in women who have had in vitro fertilisation: implications for antenatal screening
Authors: Wald N. J. , White N. , Morris J. K. , Huttly W. J. , Canick J. A.
Published: August 2005

To examine the Down's syndrome screening positive rate among in vitro fertilisation (IVF) pregnancies, we measured second trimester serum marker levels in singleton IVF pregnancies (cases) and in five non–IVF pregnancies (controls) matched to each case for gestational age, age of mother, and duration of storage of the serum sample. There were 151 IVF pregnancies in which alpha fetoprotein, unconjugated oestriol (uE3), free β–human chorionic gonadotrophin (hCG) and total hCG were measured, 104 IVF pregnancies in which free α‐hCG was measured, and 39 IVF pregnancies in which inhibin A was measured. Median uE3 levels were 6% lower (P= 0.003), median free β–hCG 9% higher (P= 0.024), and median total hCG 14% higher (P= 0.026) in IVF pregnancies compared with controls. The screen positive rate in the IVF pregnancies (28%) was about twice as high as that in controls (17%). High hCG levels may be explained by progesterone remaining high in IVF pregnancies. The low uE3 levels remain unexplained. In Down's syndrome screening in IVF pregnancies hCG and uE3 values should be adjusted to avoid the high screen positive rate.
Pregnancy complications in women with recurrent miscarriage associated with antiphospholipid antibodies treated with low dose aspirin and heparin
Authors: Backos M. , Rai R. , Baxter N. , Chilcott I. T. , Cohen H. , Regan L.
Published: August 2005

Objective
To study the obstetric course of women with a history of recurrent miscarriage associated with antiphospholipid antibodies, lupus anticoagulant and anticardiolipin antibodies, treated with low dose aspirin and low dose heparin.

Design
Prospective observational study.

Setting
University based tertiary referral clinic.

Population
One hundred and fifty pregnant women with a history of recurrent miscarriage associated with persistently positive tests for antiphospholipid antibodies.

Methods
Lupus anticoagulant was detected using the dilute Russell's viper venom time together with a platelet neutralisation procedure. IgG and IgM anticardiolipin antibodies were detected using a standardised enzyme linked immunosorbent assay. An IgG anticardiolipin level ≥5 per litre units and an IgM anticardiolipin level ≥3 per litre units was considered positive. Aspirin (75 mg daily) was commenced at the time of a positive pregnancy test and heparin (5000 units subcutaneously 12 hourly, or enoxaparin 20 mg daily) was started when fetal heart activity was demonstrated on ultrasound. Treatment was stopped at the time of miscarriage or at 34 weeks of gestation.

Results
One hundred and seven pregnancies (71%) resulted in a live birth. Forty‐one pregnancies (27%) miscarried, the majority in the first trimester. One woman had a stillbirth, and one a premature baby who died in the neonatal period. One pregnancy was terminated for a fetal anomaly. Gestational hypertension complicated 17% (18/108) of ongoing pregnancies and antepartum haemorrhage 7% (8/108). Twenty‐six babies (24%) were delivered before 37 weeks of gestation. Fifty women (46%) were delivered by caesarean section. The median birthweight of all live born infants was 3069 g (range 5314300); however 15% (16/108) of the infants were small for gestational age.

Conclusion
Combination treatment with aspirin and heparin leads to a high live birth rate among women with recurrent miscarriage and antiphospholipid antibodies. However, successful pregnancies are prone to a high risk of complications during all trimesters. Close antenatal surveillance and planned delivery of these pregnancies in a unit with specialist obstetric and neonatal intensive care facilities are indicated.
The changes in magnetic resonance properties of the fetal lungs: a first result and a potential tool for the non‐invasive in utero demonstration of fetal lung maturation
Authors: Duncan Keith R. , Gowland Penny A. , Freeman Alan , Moore Rachel , Baker Philip N. , Johnson Ian R.
Published: August 2005

Objective
To measure magnetic resonance parameters T1 and T2 of the fetal lungs and investigate the relationship of these parameters to changes in volume and gestation.

Design
Prospective cross‐sectional study.

Setting
Large teaching hospital in Nottingham and the Magnetic Resonance Centre at the University of Nottingham.

Population
Normal pregnancies from 20 weeks to term.

Methods
T1, T2, and lung volume were measured in the fetus using echo‐planar magnetic resonance imaging.

Main outcome measures
The relationship of T1 and T2 to gestational age and lung volume.

Results
Linear regression demonstrated a significant relationship (P < 0.001) between gestational age and lung volume, T1 and T2. There was also a significant relationship between lung volume and T1 and T2 (P < 0.001).

Conclusions
Relaxation time measurements give additional information to lung volume estimation in the assessment of lung physiology in utero. We have demonstrated the progressive changes which take place in the fetal lungs between 20 weeks and term. The physiological changes which can be demonstrated with this non‐invasive technique may have an important application in the demonstration of fetal lung maturity in a prospective non‐invasive manner.
Indicators of quality of antenatal care: a pilot study
Authors: Vause Sarah , Maresh Michael
Published: August 2005

Objective
To pilot a list of indicators of quality of antenatal care across a range of maternity care settings. For each indicator to determine what is achieved in current clinical practice, to facilitate the setting of audit standards and calculation of appropriate sample sizes for audit.

Design
A multicentre retrospective observational study.

Setting
Nine maternity units in the United Kingdom.

Population
20, 771 women with a singleton pregnancy, who were delivered between 1 August 1994 and 31 July 1995.

Results
Nine of the eleven suggested indicators were successfully piloted. Two indicators require further development. In seven of the nine hospitals external cephalic version was not commonly performed. There were wide variations in the proportions of women screened for asymptomatic bacteriauria. Screening of women from ethnic minorities for haemoglobinopathy was more likely in hospitals with a large proportion of non‐Caucasian women. A large number of Rhesus negative women did not have a Rhesus antibody check performed after 28 weeks of gestation and did not receive anti‐D immunoglobulin after a potentially sensitising event during pregnancy. As a result of the study appropriate sample sizes for future audit could be calculated.

Conclusions
Measuring the extent to which evidence‐based interventions are used in routine clinical practice provides a more detailed picture of the strengths and weaknesses in an antenatal service than traditional outcomes such as perinatal mortality rates. Awareness of an appropriate sample size should prevent waste of time and resources on inconclusive audits.
Misoprostol dose‐related shivering and pyrexia in the third stage of labour
Authors: Lumbiganon Pisake , Hofmeyr Justus , Gülmezoglu A. Metin , Pinol Alain , Villar José ,   For the WHO Collaborative Trial of Misoprostol in the Management of the Third Stage of Labour
Published: August 2005

Objective
To select the misoprostol dose to be used in a large multicentre randomised trial comparing misoprostol with oxytocin in the routine management of the third stage of labour.

Design
Randomised pilot trial, double‐blinded with the use of double placebos.

Setting
Two of the nine hospitals that will participate in the main multicentre trial. The hospitals were

Population
Women during second stage of labour about to be delivered vaginally.

Methods
located in Johannesburg, South Africa and Khon Kaen, Thailand. The trial had three arms: misoprostol 400 μg versus misoprostol 600 μg versus intramuscular oxytocin 10 IU. Each group received an injection and three tablets immediately after the birth of the baby.

Main outcome measures
Shivering and pyrexia rates were the main outcome measures. Data on other side effects and characteristics of the third stage of labour were also collected. Side effects were noted as none, mild, moderate or severe.

Results
Both shivering and pyrexia (temperature > 38°C) were most common in the 600 μg misoprostol group (28% and 7.5% for shivering and pyrexia, respectively) compared with 400 μg misoprostol (19% and 2%), and the oxytocin group (12.5% and 3%). The increase in shivering in the misoprostol 600 pg group was due primarily to a higher rate of moderate shivering. None of the women had a temperature > 40°C. There were no increases in severe side effects and other adverse events in the misoprostol 600 μg group.

Conclusions
When used in the management of the third stage of labour oral misoprostol is associated with an increase in the rate of moderate shivering and pyrexia which seems to be dose‐related. Based on the results of this pilot trial, the Steering Committee has decided to use 600 μg misoprostol in the main trial, comparing it with oxytocin, in order to achieve higher effectiveness.
Controlled trial of fundal height measurement plotted on customised antenatal growth charts
Authors: Gardosi Jason , Francis Andre
Published: August 2005

Objective
The purpose of this study was to evaluate the effect of a policy of standard antenatal care which included plotting fundal height measurements on customised antenatal charts in the community.

Design
Prospective, non‐randomised, controlled, population‐based study.

Population
Two defined and separate referral areas from community to teaching hospital, with similar delivery rates and socioeconomic characteristics. A total of 1272 consecutively booked women with singleton pregnancies and dating ultrasound scans before 22 weeks of gestation.

Intervention
In the study area customised fundal height charts were issued to each mother at the routine hospital booking scan, on which regular fundal height measurements were to be plotted by community midwives. The charts adjusted limits according to maternal characteristics including height, weight, parity and ethnic group. Usual management in the control area included fundal height assessment by abdominal palpation and recording on a standard co‐operation card.

Outcome measures
Antenatal detection of small and large for gestational age babies; number of antenatal investigations for fetal growth in each group.

Results
The study group had a significantly higher antenatal detection rate of small for gestational age babies (48%vs 29%, odds ratio 2.2, 95% confidence interval 1.145) and large for gestational age babies (46%vs 24%, OR 2.6, CI 1.3–5.5). There was no increase in the study group in the overall number of scans per pregnancy done in the ultrasound department (1.2 vs 1.3, P= 0.14), but a slight decrease in repeat (two or more) third trimester scans (OR 0.8, CI 0.6–11.0, P= 0.08). Women in the study group had significantly fewer referrals for investigation in a pregnancy assessment centre (OR 0.7, CI 0.5–0.9; P= 0.01) and fewer admissions to the antenatal ward (OR 0.6, CI 0.4–0.7, P= 0.001). There were no differences in perinatal outcome.

Conclusions
Serial measurement of fundal height plotted on customised charts leads to increased antenatal detection of small and large babies. This is accompanied by fewer investigations, which is likely to represent increased confidence in the community to recognise normal fetal growth. With adjustments for physiological variables, fundal height measurements appear to be a cost effective screening method which can result in substantial improvements in the antenatal assessment of fetal growth.
Paracervical anaesthesia in outpatient hysteroscopy: a randomised double‐blind placebo‐controlled trial
Authors: Lau W. C. , Lo W. K. , Tam W. H. , Yuen P. M.
Published: August 2005

Objective
To evaluate the efficacy and safety of paracervical anaesthesia in reducing pain during outpatient hysteroscopy and endometrial biopsy.

Design
Prospective, randomised, placebo‐controlled, double‐blind study.

Population
One hundred women undergoing outpatient hysteroscopy and endometrial biopsy for abnormal uterine bleeding.

Interventions
Paracervical block using 10 mL of either 2% lignocaine or normal saline before the procedure.

Main outcome measures
Evaluation of pain at different stages of hysteroscopy using a visual analogue scale together with blood pressure and heart rate monitoring.

Results
Compared with placebo, paracervical anaesthesia significantly reduced the pain only at the time of insertion of the hysteroscope, but not at the subsequent stages of the procedure. However, paracervical injection of lignocaine resulted in a higher incidence of bradycardia and hypotension.

Conclusions
Paracervical anaesthesia not only fails to reduce pain during outpatient hysteroscopy and endometrial biopsy, but also carries a risk of inducing bradycardia and hypotension, which is probably a result of inadvertent intravascular injection.
Neutrophil function in women with pre‐eclampsia
Authors: Crocker I. P. , Wellings R. P. , Fletcher J. , Baker P. N.
Published: August 2005

ObjectiveTo investigate the function of neutrophils in normal pregnancy and pre‐eclampsia.

DesignBaseline levels and activated responses of peripheral blood neutrophils were measured in response to the physiological agonists, n‐formyl‐met‐leu‐phe (fMLP) and zymosan activated serum.

SampleNeutrophils of 16 pre‐eclamptic, 17 normal pregnant (third trimester) and 15 nonpregnant age‐matched control women were calculated.

SettingAntenatal Clinic, City Hospital, Nottingham.

MethodsNeutrophil superoxide anion production was determined by lucigenin‐enhanced chemilumi‐nescence; the release of secondary granule lactoferrin by ELISA; and the expression of cell surface adhesion molecules CD1 1b, CD 18 and L‐selectin (CD62L) by flow cytometric analysis.

ResultsSuperoxide anion generation was reduced in the pregnant group compared with nonpregnant controls [fMLP by 51 % (P= 0.03) and zymosan activated serum by 56% (P= > 0.01)] but pre‐eclamptic measurements did not show a similar reduction. There were no differences between the three study groups in the plasma levels of lactofenin, or in the stimulated expression and release of CD1 Ib and CD18, or lactoferrin and L‐selectin. The base‐line levels for the production of superoxide anions; the expression of CD11b or CD 18 or L‐selectin; and the release of lactofemn showed no significant differences.

ConclusionsCirculating neutrophils in pregnancy and pre‐eclampsia are neither activated nor primedin vivo, however the release of reactive oxygen species is diminished in normal pregnancy. In comparison, an elevation of reactive oxygen generation in pre‐eclampsia may highlight a role for neutrophils in the oxidative stress and pathophysiology of this disease.
Geriatrics Training and Education for Nongeriatrician Faculty: The Dean's Faculty Scholars in Aging Program
Authors: Eleazer G. Paul , Laditka Sarah B. , Roberts Ellen , Hirth Victor A. , Wieland Darryl
Published: August 2005

The University of South Carolina School of Medicine in Columbia implemented the Dean's Faculty Scholars in Aging (DFSA) Program in 2001 to strengthen the knowledge of geriatrics of nongeriatrician faculty members. The primary indicator of strengthening physicians' geriatrics knowledge was the development of new educational experiences by physicians in the DFSA Program. Twenty‐six nongeriatrician faculty in seven departments were recruited to participate as scholars. Most scholars were in key educational positions, including assistant deans, department chairs, and clerkship and residency directors. Scholars received special training to develop geriatrics educational experiences based on their medical specialty and interests. Training encouraged cross‐departmental collaboration. Scholars also had access to resources, including professional geriatric educators. Funds were available to support development of educational experiences and for a small amount of salary support. Since the program was implemented, 36 new geriatric experiences have been developed, 29 of the 36 were implemented, and 11 of the 36 were evaluated. Experiences included an elective for residents in the care of older patients in the emergency room and a required hospice rotation in the psychiatry clerkship for third‐year medical students. All scholars developed a geriatrics educational experience, and most implemented one. This suggests that scholars demonstrated successful progress in geriatrics training.
A Conceptual Model of Cognitive Deficits in Chronic Heart Failure
Authors: Bennett Susan J. , Sauvé Mary Jane , Shaw Rose Mary
Published: August 2005

Purpose:

To describe a conceptual model to guide studies of cognitive deficits among patients with heart failure.

Organizing Framework:

The conceptual framework of cognitive deficits in chronic heart failure is based on theoretical and empirical literature about (a) the pathophysiology of heart failure, (b) the pathophysiology of cognitive deficits, and (c) health‐related quality of life. Other variables that may cause or contribute to cognitive deficits include age, the relative contributions of multiple comorbid conditions, hypertension, and depressive symptoms. Covariates that might influence cognitive deficits (medications, gender, and education) are also included in the model. The most prominent cognitive deficits are believed to occur in domains of attention, working memory, memory, learning, executive function, and psychomotor speed. The main outcome variable is health‐related quality of life, which is believed to be influenced by circulatory insufficiency and cognitive deficits.

Conclusions:

The conceptual model described in this paper is a framework for testing cognitive deficits that occur in heart failure. After validation through empirical testing, the model may be useful in developing interventions for patients with heart failure whose care is complicated by cognitive deficits.
Fabrication and Characterization of Ceramic Foams Based on Silicon Carbide Matrix and Hollow Alumino‐Silicate Spheres
Authors: Ozcivici Engin , Singh Raman P.
Published: August 2005

Closed‐cell foams were fabricated by incorporating two different grades of hollow alumino‐silicate spheres (cenospheres) into a silicon carbide matrix. The matrix was formed by the pyrolysis of a preceramic polymer, and multiple polymer infiltration and pyrolysis (PIP) cycles were employed to minimize the open voids in the material. The physical, mechanical and thermal properties of the fabricated foams were characterized as functions of the number of reinfiltration cycles. The open‐ and closed‐void volume fractions were determined by measurements of bulk and skeletal densities. Mechanical properties, including strength and modulus, were evaluated using four‐point bend and compression tests. Finally, thermal properties of the material, including the coefficient of thermal expansion and the thermal conductivity, were determined using dilatometry and the laser‐flash technique, respectively. This processing technique results in closed‐cell syntactic foams with minimal porosity (∼2–4%), reasonable mechanical strength (∼30 MPa) and very low thermal conductivity (≤1 W/m·K). In this manner, this process can be used for the low‐cost and net‐shape fabrication of closed‐cell silicon carbide‐based syntactic foams for high‐temperature applications.
Effects of splinted prosthesis supported a wide implant or two implants: a three‐dimensional finite element analysis
Authors: Huang Heng‐Li , Huang Jehn‐Shyun , Ko Ching‐Chang , Hsu Jui‐Ting , Chang Chih‐Han , Chen Michael Y. C.
Published: August 2005

Objectives: Three‐dimensional finite element (FE) models of splinted prosthetic crowns were studied and stress analyses were evaluated with different types of implant support, including standard, wide or two implant(s) for partial, posterior edentulous restorations.

Material and methods: The FE models were constructed based on a cadaver mandible containing the 2nd premolar and the 1st molar. The crowns of these two teeth were modeled as connected and disconnected to mimic the splinted and non‐splinted designs, respectively. One standard implant was placed at the premolar region, while three types of implant support, one at a time (the standard implant, wide implant and two implants), were used to support the molar crown. A 100 N oblique load was applied to the buccal cusp on each crown. The FE simulation was validated experimentally via strain gauge measurement.

Results: The experimental data were well correlated with the FE predictions (r2=0.97). When compared with the standard implant used in the molar area, the wide implant and two implants reduced the peak stress in crestal bone by 29–37% for both splinted and non‐splinted cases. Inserting the standard implant into both the premolar and molar area, the bone stresses were identical for splinted and non‐splinted designs. However, splinting the adjacent crowns has shown to decrease the bone stresses at the premolar region by 25%, while the wide implant or two implants were placed at the molar region.

Conclusion: The biomechanical advantages of using the wide implant or two implants are almost identical. The benefit of load sharing by the splinted crowns is notable only when the implants on the premolar and molar regions have different supporting ability.
An evaluation of resonance frequency analysis for the determination of the primary stability of orthodontic palatal implants. A study in human cadavers
Authors: Gedrange T. , Hietschold V. , Mai R. , Wolf P. , Nicklisch M. , Harzer W.
Published: August 2005

Background: The primary stability of short orthodontic implants is important for anchorage.

Methods: For this study 14 cadaveric human heads were used. The stability of orthodontic implants (Straumann) with lengths of 4 and 6 mm and different localization (palatal suture or paramedially) were evaluated. The implants with length of 6 mm were only placed in the suture and primary stability was non‐invasively determined with the resonance frequency (Osstell®). The invasive method for the analysis of the morphometric parameters of the implant/bone contact was carried out by means of histological and radiological examinations.

Results: The 6 mm implants have significant better primary stability in the palatal suture as 4 mm implants paramedially (P<0.05). No differences were found between 6 and 4 mm implants in the palatal suture and between 4 mm implants in palatal suture to paramedially. The histological and radiological results demonstrate the ability to measure the implant stability by investigation of the bone offer and density around the implant. Bone structure, especially the pore size in the trabecular bone and the precision of placement may influence the stability.

Conclusion: This study shows that the short implant gives sufficient bone fixation, independently of placement. The quality of implantation and bone structure are more important than the length of the orthodontic implant.