bluuebunny/crossref_metadata_2025 huggingface dataset:
PENALIZED‐R2CRITERIA FOR MODEL SELECTION*
Authors: TAYLOR LARRY W.
Published: October 2009

It is beneficial to observe that popular model selection criteria for the linear model are equivalent to penalized versions ofR2. Let PR2refer to any one of these model selection criteria. Then PR2serves the dual purpose of selecting the model and summarizing the resulting fit subject to the penalty function. Furthermore, it is straightforward to extend the logic of PR2to instrumental variables estimation and the non‐parametric selection of regressors. For two‐stage least squares estimation, a simulation study investigates the finite‐sample performance of PR2to select the correct model in cases of either strong or weak instruments.
ORIGINAL ARTICLE: ‘My memory’s back!’ Inclusive learning disability research using ethics, oral history and digital storytelling
Authors: Manning Corinne
Published: October 2009

Accessible summary

 This article is about how people with learning disabilities helped to produce a history about Australia’s oldest and largest purpose‐built institution for people with learning disabilities, Kew Cottages.

 The study uses oral history to empower people with learning disabilities to tell their stories in their own words.

 I believe that it is important for oral histories to be accessible for people with learning disabilities. So I used a new form of history‐making, digital storytelling/histories, to produce a DVD using text, sounds and images.

 This research is important for people with learning disabilities because it explains how traditional oral history techniques can be used with new media technology to create collaborative, meaningful and accessible publications.

The following article outlines the methodological approach used to include people with learning disabilities as active participants in an oral history produced in Australia. The history sought to document life inside Kew Cottages, Australia’s oldest and largest specialised institution for people with learning disabilities. This work furthers existing research being conducted with people with learning disabilities in the fields of oral history and life history. The article explores: research ethics, the value of oral history and the positive benefits for inclusive learning disability research using digital storytelling/histories.
Mechanism of skull suture maintenance and interdigitation
Authors: Miura Takashi , Perlyn Chad A. , Kinboshi Masato , Ogihara Naomichi , Kobayashi‐Miura Mikiko , Morriss‐Kay Gillian M. , Shiota Kohei
Published: October 2009

Skull sutures serve as growth centers whose function involves multiple molecular pathways. During periods of brain growth the sutures remain thin and straight, later developing complex fractal interdigitations that provide interlocking strength. The nature of the relationship between the molecular interactions and suture pattern formation is not understood. Here we show that by classifying the molecules involved into two groups, stabilizing factors and substrate molecules, complex molecular networks can be modeled by a simple two‐species reaction–diffusion model that recapitulates all the known behavior of suture pattern formation. This model reproduces the maintenance of thin sutural tissue at early stages, the later modification of the straight suture to form osseous interdigitations, and the formation of fractal structures. Predictions from the model are in good agreement with experimental observations, indicating that the model captures the essential nature of the interdigitation process.
The diagnosis of the cause of the death of Venerina
Authors: Mazzotti Giovanni , Falconi Mirella , Teti Gabriella , Zago Michela , Lanari Marcello , Manzoli Francesco A.
Published: October 2009

Venerina (little Venus) is the name given to a wax model representing a pregnant young woman that was created in Florence (Italy) by Clemente Susini (1754–1814) in 1782. It is currently located in the historic Science Museum of the University of Bologna. The model was constructed so as to enable removal of the thoracic and abdominal walls and various organs, exposing the heart, diaphragm and an opened uterus with a well‐developed fetus. The woman is small, about 145 cm (4′ 9′) tall and of delicate build; she looks like a teenage girl. We know that Clemente Susini worked directly with the cadaver and copied the anatomical preparation exactly. This artist often represented the true structure using a wax mould; the existence of two other versions of this specimen suggests that this model was made in this way. Therefore, Venerina’s body may be a faithful representation of a young woman who died while pregnant. Observation of the body confirms that the organs are normal, except for the heart and great vessels. The walls of both ventricles are of equal thickness and the ventricles themselves of approximately equal size. The arch of the aorta and the enlarged pulmonary trunk are connected by a short duct about 3.5 mm in diameter. If this structure represents an open arterial duct, we can deduce that the two ventricles worked under the same conditions of blood pressure, hence their equal wall thickness. If the young woman died from this congenital disease, the cause of death has been diagnosed on a wax model of her body after more than two centuries.
Functional characteristics of the rat jaw muscles: daily muscle activity and fiber type composition
Authors: Kawai Nobuhiko , Sano Ryota , Korfage Joannes A. M. , Nakamura Saika , Tanaka Eiji , Van Wessel Tim , Langenbach Geerling E. J. , Tanne Kazuo
Published: October 2009

Skeletal muscles have a heterogeneous fiber type composition, which reflects their functional demand. The daily muscle use and the percentage of slow‐type fibers have been shown to be positively correlated in skeletal muscles of larger animals but for smaller animals there is no information. The examination of this relationship in adult rats was the purpose of this study. We hypothesized a positive relationship between the percentage of fatigue‐resistant fibers in each muscle and its total duration of use per day. Fourteen Wistar strain male rats (410–450 g) were used. A radio‐telemetric device was implanted to record muscle activity continuously from the superficial masseter, deep masseter, anterior belly of digastric and anterior temporalis muscles. The degree of daily muscle use was quantified by the total duration of muscle activity per day (duty time) exceeding specified levels of the peak activity (2, 5, 20 and 50%). The fiber type composition of the muscles was examined by the myosin heavy chain content of the fibers by means of immunohistochemical staining. At lower activity levels (exceeding 2 and 5% of the peak activity), the duty time of the anterior belly of digastric muscle was significantly (P < 0.01) longer than those of the other muscles. The anterior belly of digastric muscle also contained the highest percentage of slow‐type fibers (type I fiber and hybrid fiber co‐expressing myosin heavy chain I + IIA) (ca. 11%; P < 0.05). By regression analysis for all four muscles, an inter‐muscular comparison showed a positive relationship between the duty time (exceeding 50% of the peak activity) and the percentage of type IIX fibers (P < 0.05), which demonstrate intermediate physiological properties relative to type IIA and IIB fibers. For the jaw muscles of adult male rats, the variations of fiber type composition and muscle use suggest that the muscle containing the largest amounts of slow‐type fibers (the anterior belly of digastric muscle) is mainly involved in low‐amplitude activities and that the amount of type IIX fibers is positively related to the generation of large muscle forces, validating our hypothesis.
Recurrent acute necrotizing encephalopathy following influenza A in a genetically predisposed family
Authors: GIKA ARTEMIS D , RICH PHILIP , GUPTA SACHIN , NEILSON DEREK E , CLARKE ANTONIA
Published: October 2009

Acute necrotizing encephalopathy (ANE) typically affects young, healthy children who develop rapid‐onset severe encephalopathy triggered by viral infections. This disease is more commonly reported in Japan but occurs worldwide, although it remains under‐recognized in Western countries. An autosomal dominant form, ANE1, was recently identified. We report the details of a 9‐year‐old Caucasian female who experienced recurrent ANE episodes at the ages of 9 months and 9 years. Brain magnetic resonance imaging findings were characteristic of ANE during both episodes, although more extensive in the recent episode, which resulted in severe neurological sequelae; influenza A was identified on bronchoalveolar lavage during this episode. Interestingly, there was evidence of peripheral polyneuropathy during the recent episode, which has not previously been described in sporadic ANE. Both the patient and her mother, who had also had postviral polyneuritis in the past, harbour a mutation in Ran‐binding protein 2 (RANBP2); this occurred de novo in the mother and confers genetic susceptibility to ANE. Our case suggests that recurrent disease and/or an expanded clinical phenotype raises the possibility of ANE1; positive family history, although supportive, is not necessary as the mutation can occur de novo. Increased awareness may lead to earlier recognition and better treatment options.
White matter abnormalities and dystonic motor disorder associated with mutations in the SLC16A2 gene
Authors: GIKA ARTEMIS D , SIDDIQUI ATA , HULSE ANTHONY J , EDWARD SELVAKUMARI , FALLON PENNY , MCENTAGART MERIEL E , JAN WAJANAT , JOSIFOVA DRAGANA , LERMAN‐SAGIE TALLY , DRUMMOND JAMES , THOMPSON EDWARD , REFETOFF SAMUEL , BÖNNEMANN CARSTEN G , JUNGBLUTH HEINZ
Published: October 2009

Aim  Mutations in the SLC16A2 gene have been implicated in Allan–Herndon–Dudley syndrome (AHDS), an X‐linked learning disability* syndrome associated with thyroid function test (TFT) abnormalities. Delayed myelination is a non‐specific finding in individuals with learning disability whose genetic basis is often uncertain. The aim of this study was to describe neuroimaging findings and neurological features in males with SLC16A2 gene mutations.

Method  We reviewed brain magnetic resonance imaging (MRI) findings and neurological features in a cohort of five males aged between 1 year 6 months and 6 years (median 4y) from four families harbouring SLC16A2 gene mutations.

Results  The participants presented aged between 4 and 9 months with initial hypotonia and subsequent spastic paraparesis with dystonic posturing and superimposed paroxysmal dyskinesias. Dystonic cerebral palsy was the most common initial clinical diagnosis, and AHDS was suspected only retrospectively, considering the characteristically abnormal thyroid function tests, with high serum tri‐iodothyronine (T3), as the most consistent finding. Brain MRI showed absent or markedly delayed myelination in all five participants, prompting the suspicion of Pelizaeus–Merzbacher disease in one patient.

Interpretation  Our findings indicate a consistent association between defective neuronal T3 uptake and delayed myelination. SLC16A2 involvement should be considered in males with learning disability, an associated motor or movement disorder, and evidence of delayed myelination on brain MRI. Although dysmorphic features suggestive of AHDS are not always present, T3 measurement is a reliable screening test.
Development of the Hypertonia Assessment Tool (HAT): a discriminative tool for hypertonia in children
Authors: JETHWA ANITA , MINK JONATHAN , MACARTHUR COLIN , KNIGHTS SHANNON , FEHLINGS TARA , FEHLINGS DARCY
Published: October 2009

Aim  The aim of this study was to develop a tool to identify paediatric hypertonia subtypes.

Method  Items generated by experts were subscaled (spasticity, dystonia, rigidity). The tool was administered to 34 children (19 males, 15 females, mean age 8y 2mo, range 2y 5mo–18y 7mo) with hypertonia and cerebral palsy (CP) in Gross Motor Function Classification System (GMFCS) levels: I, n=7; II, n=5; III, n=7 level IV, n=7; and level V, n=8 level. Kuder–Richardson Formula 20 determined internal consistency. To assess reliability, two physicians administered the tool to 25 additional children with CP (15 males, 10 females; mean age 10y 8mo; GMFCS levels I, n=4; II, n=3; III, n=7; IV, n=4; and V, n=7) on two occasions, 2 weeks apart. To evaluate validity, a third physician diagnosed the hypertonia by neurological examination.

Results  The internal consistency of the spasticity items was moderate (α=0.58), and dystonia was high (α=0.79). Item reduction eliminated seven of the 14 original items. The agreement of the spasticity and rigidity subscales was adequate (prevalence‐adjusted bias‐adjusted kappa [PABAK] ranging from moderate [0.57] to excellent [1.0]) for validity, test–retest reliability, and interrater reliability. For dystonia agreement was lower, with PABAK ranging from fair (0.30) to good (0.65). Eighty‐seven per cent had spasticity and 78% had dystonia.

Interpretation  The Hypertonia Assessment Tool has good reliability and validity for identifying spasticity and the absence of rigidity, and moderate findings for dystonia.
Relationship between neuromuscular body functions and upper extremity activity in children with cerebral palsy
Authors: BRÆNDVIK SIRI M , ELVRUM ANN‐KRISTIN G , VEREIJKEN BEATRIX , ROELEVELD KARIN
Published: October 2009

Aim  Our aim was to investigate the relationship between the dimensions of neuromuscular body function and elbow, forearm, and hand activity in the upper extremities in children/adolescents with spastic cerebral palsy (CP), within the framework of the World Health Organization International Classification of Functioning, Disability and Health.

Method  Twenty‐three participants (10 males, 13 females, mean age 13y, SD 3y, range 8–18y) with spastic CP (21 with hemiplegia, two with diplegia) at Manual Ability Classification System levels I to III participated in the study. Neuromuscular body function measures were (1) muscle strength in the elbow, forearm, and grip, (2) muscle tone in elbow flexors and forearm supinators, (3) active supination range and elbow extension range, and (4) force control at submaximal level in elbow flexion. Activity measures were actual use of the affected hand in bimanual activities (Assisting Hand Assessment) and instructed use of the affected hand (Melbourne Assessment of Unilateral Upper Limb Function).

Results  Nearly all the neuromuscular body function variables were significantly correlated with activity. The combination of active supination range and strength explained 74% of the variance in actual use, and the combination of active supination range and force control explained 74% of the variance in instructed use.

Interpretation  In high‐functioning children and adolescents with CP, limited active supination range and difficulties in generating and modulating force are strongly related to limitations in hand activity. Further studies are needed to establish cause and effect in this relationship.
Mode of delivery and the risk of delivery‐related perinatal death among twins at term: a retrospective cohort study of 8073 births
Authors: Smith Gordon C.S. , Shah Imran , White Ian R. , Pell Jill P. , Dobbie Richard
Published: October 2009

Objective  To determine the risk of perinatal death among twins born at term in relation to mode of delivery.

Design  Retrospective cohort study.

Setting  Scotland 1985–2001.

Population  All twin births at or after 36 weeks of gestation, excluding antepartum stillbirths and perinatal deaths due to congenital abnormality (n= 8073).

Methods  The outcome of first and second twins was compared using McNemar's test and the outcome of twin pairs in relation to mode of delivery was compared using exact logistic regression.

Main outcome measures  Intrapartum stillbirth or neonatal death of either twin.

Results  Overall, there were six deaths of first twins and 30 deaths of second twins (OR for second twin 5.00, 95% CI 2.00–14.70). The odds ratio for death of the second twin due to intrapartum anoxia was 21 (95% CI 3.4–868.5). The associations were similar for twins delivered following induction of labour and for sex discordant twins. However, there was no association between birth order and the risk of death among 1472 deliveries by planned caesarean section. There was death of either twin among 2 of 1472 (0.14%) deliveries by planned caesarean section and 34 of 6601 (0.52%) deliveries by other means (P= 0.05, odds ratio for planned caesarean section 0.26 [95% CI 0.03–1.03]). The association was similar when adjusted for potential confounders. Assuming causality, we estimate that 264 caesarean deliveries (95% CI 158–808) would be required to prevent each death.

Conclusion  Planned caesarean section may reduce the risk of perinatal death of twins at term by approximately 75% compared with attempting vaginal birth. This is principally due to reducing the risk of death of the second twin due to intrapartum anoxia.
A randomised double blind trial comparing misoprostol or placebo in the management of early miscarriage
Authors: Blohm F. , Fridén B.E. , Milsom I. , Platz‐Christensen J.J. , Nielsen S.
Published: October 2009

Objectives  To study if misoprostol 400 μg, administered vaginally, increased the successful resolution of early miscarriage compared with placebo.

Design  Randomised, double blind placebo controlled study.

Setting  Sahlgrenska University Hospital, Göteborg, Sweden.

Sample  One hundred and twenty‐six women seeking medical attention for early miscarriage.

Method  Women with a non‐viable, first trimester miscarriage were randomised to vaginal administration of misoprostol 400 μg or placebo.

Main outcome measures  Main outcome measure was the proportion of successful complete resolution of miscarriage. Secondary outcomes were incidence of infection, bleeding, gastrointestinal side effects, pain, use of analgesics and length of sick leave between groups.

Results  Sixty‐four patients were randomised to misoprostol and 62 to placebo. Eighty‐one percent in the misoprostol and 52% in the placebo group had a complete miscarriage within one week of the primary visit (RR 1.57; 95% CI 1.20–2.06). Patients in the misoprostol group reported more pain as assessed on a visual analogue scale (60.4 [31.0] vs 43.8 [37.1] mm; P < 0.007) and required analgesics more often (83%vs 61%, RR 1.35; 95% CI 1.08–1.70). There were no significant differences in the occurrence of gastrointestinal side effects, infection, reduction in haemoglobin or sick leave between the groups.

Conclusions  Treatment with 400 μg misoprostol administered vaginally increased the success rate of resolvement of uncomplicated early miscarriages compared with placebo. However, women who received misoprostol experienced more pain and required more analgesics than those who did not.
Modulation of cytokine production by dydrogesterone in lymphocytes from women with recurrent miscarriage
Authors: Raghupathy Raj , Al Mutawa Esraa , Makhseed Ma'asoumah , Azizieh Fawaz , Szekeres‐Bartho Julia
Published: October 2009

Objective  To examine the effects of dydrogesterone on the production of Th1 and Th2 cytokines by lymphocytes from women undergoing unexplained recurrent spontaneous miscarriage (RSM).

Design  Controlled prospective, clinical study conducted in a maternity hospital and a university‐based immunology laboratory.

Setting  Faculty of Medicine, Kuwait University and Kuwait Maternity Hospital.

Sample  Thirty women with unexplained RSM.

Methods  Peripheral blood mononuclear cells (PBMC) from women with unexplained RSM were isolated from venous blood by density gradient sedimentation and stimulated with phytohaemagglutinin (PHA). Culture supernatants assayed for interferon (IFN)‐γ, tumour necrosis factor (TNF)‐α, interleukin (IL)‐4, IL‐6 and IL‐10 by ELISA. Levels of the progesterone‐induced blocking factor (PIBF) were also measured.

Main outcome measures  Cytokine production in the presence and absence of progesterone and dydrogesterone.

Results  Dydrogesterone significantly inhibited the production of the Th1 cytokines IFN‐γ (P= 0.0001) and TNF‐α (P= 0.005) and induced an increase in the levels of the Th2 cytokines IL‐4 (P= 0.03) and IL‐6 (P= 0.017) resulting in a substantial shift in the ratio of Th1/Th2 cytokines. The effect of dydrogesterone was blocked by the addition of the progesterone‐receptor antagonist mifepristone, indicating that dydrogesterone was acting via the progesterone receptor. Dydrogesterone induced the production of PIBF.

Conclusion  Dydrogesterone inhibits the production of the Th1 cytokines IFN‐γ and TNF‐α from lymphocytes and up‐regulates the production of the Th2 cytokines IL‐4 and IL‐6, inducing a Th1 to Th2 cytokine shift.
Obstetric management of a woman's first delivery and the implications for pelvic floor surgery in later life
Authors: Uma Ramalingam , Libby Gillian , Murphy Deirdre J.
Published: October 2009

Objective  To determine the influence of intrapartum care during a first delivery on the risk of pelvic floor surgery in later life.

Design  Nested case–control study with record linkage of a historical cohort and a current morbidity database.

Setting  Hospital births in Dundee 1952–1966.

Population  The 7556 primiparous women from the Walker cohort.

Methods  The cases (n= 352) were women who delivered a first singleton baby at term (≥37 weeks) and subsequently had pelvic floor surgery. Controls (n= 1403) were women who delivered their first baby during the same time period and did not undergo surgery. Univariate and multivariate logistic regression analyses were performed taking account of demographic, anthropometric and obstetric factors.

Main outcome measure  Pelvic floor surgery.

Results  Caesarean section was associated with a reduced risk of pelvic floor surgery compared with spontaneous vaginal delivery (odds ratio 0.16, 95% CI 0.05–0.55). Forceps delivery and infant birthweight >4.0 kg were not identified as significant risk factors (OR 0.94, 95% CI 0.71, 1.25, and OR 0.94, 95% CI 0.50, 1.75, respectively). Episiotomy and prolonged labour (>12 hours) may be associated risk factors but were of borderline significance (OR 1.46, 95% CI 0.99, 2.10, and OR 1.51, 95% CI 1.00, 2.27).

Conclusion  Caesarean section in a first pregnancy appears to protect against pelvic floor surgery in later life.
Breastfeeding expectations versus reality: a clusterrandomised controlled trial
Authors: Lavender Tina , Baker Lisa , Smyth Rebecca , Collins Stuart , Spofforth Anne , Dey Paola
Published: October 2009

Objective  To evaluate the affect of an antenatal educational breastfeeding intervention on women's breastfeeding duration.

Design  Cluster randomised controlled trial. Unit of randomisation: electoral ward. The primary outcome was the proportion that fulfilled their antenatal breastfeeding expectation. Secondary outcomes were the number of women breastfeeding on discharge and at four months. Data were collected using a series of questionnaires and diaries.

Setting  Teaching hospital in North West of England.

Participants  Women who expressed a desire to breastfeed at the start of their pregnancy.

Methods  Women were allocated to either routine antenatal education or an additional single educational group session supervised by a lactation specialist and attended by midwives from their locality.

Main outcome measure  The proportion of women who fulfilled their expectation of breastfeeding.

Result  One thousand three hundred and twelve women were randomised, with 1249 (95%) women available for analysis. There was no difference between the groups in the proportion of women who attained their expected duration of breastfeeding (OR 1.2; 95% CI 0.89–1.6; χ2= 1.4, df= 1, P= 0.2; mean cluster size 156, design effect 1.6). There were no differences between the groups in the uptake of breastfeeding on discharge (OR = 1.2; 95% CI 0.8–1.7; χ2= 1.1, df= 1, P= 0.3; mean cluster size 163, design effect = 2.0) or exclusively at four months (OR = 1.1; 95% CI 0.6–1.8; χ2= 0.07, df= 1, P= 0.8; mean cluster size 156, design effect 1.6).

Conclusion  The provision of a single educational group session supervised by a lactation specialist, and attended by midwives and women, failed to promote the uptake of breastfeeding. Public health interventions, which encourage positive attitudes to breastfeeding within the family and wider community, should be developed and evaluated.
Neonatal death following termination of pregnancy
Authors: Vadeyar Shantala , Johnston Tracey A. , Sidebotham Mary , Sands Jean
Published: October 2009

The aim of this study was to look at neonatal death following termination of pregnancy in 31 cases over a six‐year period in our region and to determine why this was occurring. We have highlighted two main areas of concern: failure to perform feticide in keeping with RCOG advice, and classification and registration below the clinical limit of viability. In these circumstances, appropriate counselling of the family and an antenatal plan for the postnatal care of the dying infant made prior to delivery are essential. We question the rationale of the existing classification and registration requirements below the clinical limit of viability.
Primary mode of delivery and subsequent pregnancy
Authors: Mollison J. , Porter M. , Campbell D. , Bhattacharya S.
Published: October 2009

Objective  To investigate the relationship between primary mode of delivery and subsequent pregnancy and to compare the findings with a previous study conducted on an earlier cohort from the same population.

Design  Population cohort.

Setting  Aberdeen City, Scotland.

Population  Women who delivered their first singleton child in Aberdeen Maternity Hospital between 1980 and 1997.

Methods  Population‐based data relating to the index and next pregnancy event, if any, were obtained from the Aberdeen Maternity Neonatal Databank. Subsequent pregnancy was compared across the three modes of delivery groups using log rank tests and Cox proportional hazards regression models.

Main outcome measure  First subsequent pregnancy following index delivery.

Results  Women who delivered by caesarean section (CS) were less likely to have a subsequent pregnancy compared with those who had a spontaneous vaginal delivery (SVD), hazard ratio = 0.91 (95% CI 0.87, 0.95). This confirmed the findings of a previous study conducted on an earlier cohort of the same population. The median time to next pregnancy following CS was 36.3 months, 31.8 months following instrumental vaginal delivery (IVD) and 30.4 months following SVD. In contrast to the earlier study where women who had an instrumental delivery were found to be an intermediate group, we found no difference in subsequent pregnancy following IVD compared with SVD, HR = 1.0 (95% CI 0.96, 1.03).

Conclusions  Following an initial delivery by CS, fewer women went on to have another pregnancy compared with SVD. The incidence of subsequent pregnancy is similar following instrumental and SVD.
Domestic violence risk during and after pregnancy: findings from a British longitudinal study
Authors: Bowen Erica , Heron Jon , Waylen Andrea , Wolke Dieter ,   and the ALSPAC study team
Published: October 2009

Objective  The objectives of this study were to examine the rates of domestic violence reported during and after pregnancy and to assess the importance of family adversity.

Design  Prospective longitudinal cohort study.

Setting  Bristol Avon, Southwest England.

Population  Seven thousand five hundred and ninety‐one pregnant women with due dates between 1.4.91 and 31.12.92.

Methods  Questionnaires administered at 18 weeks of gestation and 8 weeks, 8 months, 21 months and 33 months postpartum.

Main outcome measures  The experience of emotional or physical cruelty by an intimate partner at each time point.

Results  Fewer women reported domestic violence victimisation during pregnancy than they did postpartum (18 weeks of gestation: 1% physical cruelty, 4.8% emotional cruelty, 5.1% any victimisation; 33 months postpartum: 2.9% physical, 10.8% emotional, 11% any victimisation). Women who reported being victimised during pregnancy also reported significantly higher levels of social adversity during pregnancy. The number of social adversities reported during pregnancy also predicted postpartum victimisation. Women who reported only one adversity during pregnancy were 2.73 (95% CI, 2.16–3.45) times more likely to report physical victimisation at 33 months postpartum. Women who reported 5 adversities during pregnancy were 14.69 (95% CI, 7.35–29.37) times more likely to report such victimisation at 33 months postpartum. For emotional cruelty, women who reported only one adversity during pregnancy were 2.10 (95% CI 1.80–2.46) times more likely to report emotional victimisation at 33 months postpartum and 6.10 (95% CI 3.51–10.59) times more likely to report such victimisation when five or more adversities were present during pregnancy.

Conclusions  Levels of social adversity reported in pregnancy are important predictors of concurrent and future victimisation. Screening for social adversity factors could help identify women at high risk for future domestic violence.
Specific PGF2α receptor (FP) antagonism and human uterine contractility in vitro
Authors: Friel Anne M. , O'Reilly Michael W. , Sexton Donal J. , Morrison John J.
Published: October 2009

Objective  PGF2α acts through its receptor, FP, as an important smooth muscle contractile agent. The aim of this study was to investigate the effects of specific FP antagonism, using the novel‐specific FP non‐competitive antagonist THG113.31, on spontaneous and agonist‐elicited contractions in pregnant and non‐pregnant human myometrium in vitro.

Design  Scientific study.

Setting  University hospital and laboratories.

Population  Women undergoing caesarean section or hysterectomy.

Methods  Biopsies of human myometrium were obtained at elective caesarean section (n= 22) and from hysterectomy specimens from premenopausal women (n= 8). Dissected strips were mounted in tissue baths under physiological conditions. The effects of THG113.31 on spontaneous and oxytocin‐induced contractions, in pregnant myometrium, and on phenylephrine‐induced contractions, in non‐pregnant myometrium, were measured. The effects of PGF2α on spontaneous contractions, in pregnant tissue, in the presence and absence of THG113.31, were investigated. The integrals of contractile activity measured were compared with those from simultaneously run control experiments. The pD2 and mean maximal effect observed for THG113.31, and for PGF2α in the presence and absence of THG113.31, were calculated.

Main outcome measures  Changes in contractility.

Results  THG113.31 exerted a potent relaxant effect in both spontaneous and oxytocin‐induced contractility in pregnant tissue (P < 0.001), and phenylephrine‐induced contractility in non‐pregnant tissue (P < 0.001), compared with control experiments. PGF2α exerted a significant contractile effect on spontaneous contractions in pregnant tissue and this effect was not significantly attenuated by THG113.31 (P > 0.05).

Conclusion  THG113.31 exerted a significant relaxant effect on human spontaneous and oxytocin‐induced contractility but did not alter PGF2α‐elicited contractility. These data raise questions about the exact mechanism of effect of THG113.31 and its interaction with FP. The uterorelaxant potency of THG113.31 in human myometrium in vitro indicates that it may be of limited use as a tocolytic compound.
Factors related to breast abscess after delivery: a population‐based study
Authors: Kvist Linda J. , Rydhstroem Hakan
Published: October 2009

Objective  To investigate whether there are underlying factors, other than breastfeeding behaviours, which may contribute to the development of breast abscess during the year following delivery.

Design  A population‐based study.

Setting  In Sweden.

Population  The 1,454,068 singleton deliveries during 1987–2000.

Methods  Data retrieval from two national patient registers: the Medical Birth Registry and the National Discharge Register. Stratified Mantel–Haenszel analysis.

Main outcome measures  Odds ratios with 95% confidence intervals for possible risk factors for breast abscess in the year following delivery.

Results  During the year following delivery 1401 women had surgery because of a breast abscess. This gives a rate of 0.1%. Sixty‐five percent of cases occurred between three and eight weeks postpartum. An annual increase in the odds ratio (OR) was found between 1993 and 1999. Lowest risk was found among mothers who were ≤24 years and a significantly increased risk among mothers ≥30 years. There was a 3.6‐fold increased risk for breast abscess associated with primiparity and OR for post‐maturity (>41 weeks) was 5.

Conclusion  Primiparous women appear to be at a greater risk for the development of breast abscess during lactation than multiparous women. Mothers over the age of 30 years and those who give birth post‐maturely are also at a significantly increased risk. Primiparous women and women over 30 years could be targeted for extra information in preparation for parenthood classes about how to avoid over distension of the breasts during breastfeeding. Further research is needed to understand the role of post‐maturity and to investigate why some women recover spontaneously from inflammatory processes of the breast.
PALLIATIVE CARE, PUBLIC HEALTH AND JUSTICE: SETTING PRIORITIES IN RESOURCE POOR COUNTRIES
Authors: BLINDERMAN CRAIG
Published: October 2009

Many countries have not considered palliative care a public health problem. With limited resources, disease‐oriented therapies and prevention measures take priority. In this paper, I intend to describe the moral framework for considering palliative care as a public health priority in resource‐poor countries. A distributive theory of justice for health care should consider integrative palliative care as morally required as it contributes to improving normal functioning and preserving opportunities for the individual. For patients requiring terminal care, we are guided less by principles of justice and more by the duty to relieve suffering and society's commitment to protecting the professional's obligation to uphold principles of beneficence, compassion and non‐abandonment. A fair deliberation process is necessary to allow these strong moral commitments to serve as reasons when setting priorities in resource poor countries.
2‐Methylhopanoids are maximally produced in akinetes of Nostoc punctiforme: geobiological implications
Authors: DOUGHTY D. M. , HUNTER R. C. , SUMMONS R. E. , NEWMAN D. K.
Published: October 2009

2‐Methylhopanes, molecular fossils of 2‐methylbacteriohopanepolyol (2‐MeBHP) lipids, have been proposed as biomarkers for cyanobacteria, and by extension, oxygenic photosynthesis. However, the robustness of this interpretation is unclear, as 2‐methylhopanoids occur in organisms besides cyanobacteria and their physiological functions are unknown. As a first step toward understanding the role of 2‐MeBHP in cyanobacteria, we examined the expression and intercellular localization of hopanoids in the three cell types of Nostoc punctiforme: vegetative cells, akinetes, and heterocysts. Cultures in which N. punctiforme had differentiated into akinetes contained approximately 10‐fold higher concentrations of 2‐methylhopanoids than did cultures that contained only vegetative cells. In contrast, 2‐methylhopanoids were only present at very low concentrations in heterocysts. Hopanoid production initially increased threefold in cells starved of nitrogen but returned to levels consistent with vegetative cells within 2 weeks. Vegetative and akinete cell types were separated into cytoplasmic, thylakoid, and outer membrane fractions; the increase in hopanoid expression observed in akinetes was due to a 34‐fold enrichment of hopanoid content in their outer membrane relative to vegetative cells. Akinetes formed in response either to low light or phosphorus limitation, exhibited the same 2‐methylhopanoid localization and concentration, demonstrating that 2‐methylhopanoids are associated with the akinete cell type per se. Because akinetes are resting cells that are not photosynthetically active, 2‐methylhopanoids cannot be functionally linked to oxygenic photosynthesis in N. punctiforme.
The impact of powered and manual toothbrushing on incipient gingival recession
Authors: McCracken Giles I. , Heasman Lynne , Stacey Fiona , Swan Moira , Steen Nick , De Jager Marko , Heasman Peter A.
Published: October 2009

Aim: To compare clinical effects of manual and powered toothbrushes on sites of localized gingival recession over 12 months. To evaluate patterns and the extent of toothbrush bristle wear.

Methods: A longitudinal, single‐blind, randomized, parallel group clinical trial compared the effects of one manual and one powered toothbrush on incipient lesions of localized gingival recession. Toothbrush wear was evaluated concurrently by wear index and wear rating.

Results: Sixty patients were recruited and randomized to two groups with 52 (26 per group) attending the final visit at month 12. There were no differences between groups for full‐mouth plaque index, pocket depth or bleeding on probing at baseline and month 12. There were no differences at target sites for clinical attachment level, pocket depth, bleeding on probing, plaque index, width of keratinized gingiva or maximal height of recession. There were no differences between the wear of the brushes as measured by wear index or wear rating.

Conclusion: There was no progression of gingival recession in subjects using either toothbrush over 12 months. There was no difference in the overall wear of the powered and manual toothbrushes over successive 3‐month periods.
Partial least squares path modelling for relations between baseline factors and treatment outcomes in periodontal regeneration
Authors: Tu Yu‐Kang , Gilthorpe Mark S. , D' Aiuto Francesco , Woolston Andrew , Clerehugh Valerie
Published: October 2009

Background:Some clinical outcome variables in periodontal research are mathematically coupled, and it is not feasible to include all the mathematically coupled variables in an ordinary least squares (OLS) regression analysis. The simplest solution to this problem is to drop at least one of the mathematically coupled variables. However, this solution is not satisfactory when the mathematically coupled variables have distinctive clinical implications.

Material and Methods:Partial least squares (PLS) methods were used to analyse data from a study on guided tissue regeneration. Relationships between characteristics of baseline lesions and treatment outcomes after 1 year were analysed using PLS, and the results were compared with those from OLS regression.

Results:PLS analysis suggested that there were multiple dimensions in the characteristics of baseline lesion: vertical dimension was positively associated with probing pocket depth (PPD) reduction and clinical attachment level (CAL) gain, whilst horizontal dimension was negatively associated with the outcome. Baseline gingival recession had a negative association with PPD reduction but a small positive one with CAL gain.

Conclusion:PLS analysis provides new insights into the relationships between baseline characteristics of infrabony defects and periodontal treatment outcomes. The hypothesis of multiple dimensions in baseline lesions needs to be validated by further analysis of different datasets.
Low prevalence of subgingival viruses in periodontitis patients
Authors: Nibali Luigi , Atkinson Claire , Griffiths Paul , Darbar Ulpee , Rakmanee Thanasak , Suvan Jeanie , Donos Nikos
Published: October 2009

Background: Viruses such as Human Cytomegalovirus (HCMV) and Epstein–Barr virus (EBV) have been proposed to be periodontal pathogens. The aim of this study was to analyse the presence of herpesvirus DNA in subgingival plaque samples of patients with different forms of periodontitis and in healthy periodontia.

Materials and Methods: A total of 140 ethnically mixed (prevalently Caucasian) subjects took part in the study. Sixteen were affected by localized aggressive periodontitis (LAgP), 64 by generalized aggressive periodontitis (GAgP), 20 by chronic periodontitis (CP) and 40 were periodontally healthy. Polymerase chain reaction (PCR) analyses were performed to detect HCMV and EBV. Sera were tested for anti‐HCMV and EBV IgG antibodies. PCRs for herpes simplex (HSV) and varicella zoster virus (VZV) were performed in subgingival samples from a subset of 20 AgP subjects.

Results: HCMV DNA was not detected in any plaque samples. EBV DNA was detected in four LAgP (25%), two GAgP (3%) subjects and four healthy individuals (10%). HSV DNA and VZV DNA were not detected in the subset of studied individuals.

Conclusions: This study challenges the previously reported high prevalence of herpesvirus DNA in subgingival samples from periodontitis patients and so questions whether they act as pathogens in such patients.
The gingival biotype assessed by experienced and inexperienced clinicians
Authors: Eghbali Aryan , De Rouck Tim , De Bruyn Hugo , Cosyn Jan
Published: October 2009

Aim: A recent cluster analysis has identified three gingival biotypes among 100 periodontally healthy subjects based on different combinations of morphometric data related to maxillary front teeth and surrounding soft tissues. Patients with a thin‐scalloped biotype are considered at risk because they have been associated with a compromised soft tissue response following surgical and/or restorative therapy. Hence, an accurate identification of these high‐risk patients is warranted. The purpose of the present study was to evaluate the precision of simple visual inspection as a method to identify the gingival biotype by experienced and inexperienced clinicians.

Material and Methods:

Fifteen clinicians (five Restorative Dentists, five Periodontists and five Students) were invited to assess the gingival biotype (thin‐scalloped, thick‐flat, thick‐scalloped) of 100 periodontally healthy subjects based on clinical slides. Cluster analysis on these subjects was used as the gold standard and the accuracy in identifying the gingival biotype was determined using percentile agreement and κ statistics. Intra‐ and inter‐examiner reliability were also calculated.

Results:

The gingival biotype was accurately identified only in about half of the cases irrespective of the clinician's experience. The thick‐flat biotype was mostly recognized especially by experienced clinicians (70% of the cases). Nearly half of the thin‐scalloped cases were misclassified. The intra‐examiner repeatability was fair to substantial (κ: 0.328–0.670) and the inter‐examiner reproducibility was slight to moderate (κ: 0.127–0.547).

Conclusions:

Simple visual inspection may not be considered a valuable method to identify the gingival biotype as nearly half of the high‐risk patients are overlooked.
Primary cutaneous myxoid spindle cell squamous cell carcinoma: a clinicopathologic study and review of the literature
Authors: Yang Aparche , Hanley Andrew , Velazquez Elsa F. , Cassarino David S.
Published: October 2009

Mucocutaneous squamous cell carcinoma (SCC) may rarely exhibit intracellular mucin production. Extracellular mucin production is an even rarer finding in SCC that is not well documented in the literature. Here, we report six cases of primary cutaneous and mucocutaneous SCC with prominent extracellular stromal mucin deposition and an epithelial spindle cell component. We propose the term ‘yxoid spindle cell SCC’ (MSC SCC) to describe the histologic characteristics of these six cases. We also propose a set of histologic and immunohistochemical findings for distinguishing MSC SCC from primary cutaneous and metastatic spindle cell neoplasms including other sarcomatoid carcinomas, myxoid sarcomas and the spindle cell variant of atypical fibroxanthoma (AFX). The criteria can also help discern MSC SCC from spindle cell melanomas, which may rarely show a prominent myxoid stroma. Given the small numbers of cases reported to date, the presence of prominent myxoid stroma in primary cutaneous spindle cell SCC has unknown prognostic significance at this time.

Yang A, Hanley A, Velazquez EF, Cassarino DS. Primary cutaneous myxoid spindle cell squamous cell carcinoma: a clinicopathologic study and review of the literature.
Analyses of amino acid sequences in hypervariable region‐1 of hepatitis C virus (HCV) in sera from chimpanzees infected three times with the same HCV strain
Authors: Sugitani M. , Nishimura S. , Mizuno K. , Shikata T.
Published: October 2009

Background  To investigate whether or not the same strain of hepatitis C virus (HCV) can twice re‐infect the same chimpanzee, we analyzed nucleic and amino acid sequences in HCV hypervariable region‐1 (HVR1). Two chimpanzees were inoculated, three times each, with the same HCV strain during the 1983–1991. After each inoculation, chimpanzees developed acute hepatitis C, and then recovered.

Methods  Using sera, HVR1 cloning and antibody to HVR1 major clone measurement were performed.

Results  Clones from the first inoculum were divisible into major and minor types. Clones from the second and third inocula, as well as all post‐inoculation sera, were essentially identical to the major type. Titers of antibody to HVR1 major clone were consistently low in pre‐ and post‐inoculation sera.

Conclusions  Both chimpanzees were re‐infected twice with the same strain of HCV. The sequences from the second and third infections were similar to the major sequences in the first inoculum.
ORIGINAL ARTICLE: PD‐1 but not CTLA‐4 Blockage Abrogates the Protective Effect of Regulatory T Cells in a Pregnancy Murine Model
Authors: Wafula Paul Ojiambo , Teles Ana , Schumacher Anne , Pohl Kerstin , Yagita Hideo , Volk Hans‐Dieter , Zenclussen Ana Claudia
Published: October 2009

Problem  Regulatory T cells (Treg) play an important role in fetal protection. They expand during normal pregnancy and protect paternal/fetal antigens from rejection by maternal effector cells. Accordingly, the transfer of Treg obtained from BALB/c‐mated CBA/J females prevents abortion in DBA/2J‐mated animals. The actual mechanism through which Treg mediate their protective effect is still inconclusive. Cytotoxic T lymphocyte antigen‐4 (CTLA‐4) and Programmed cell death 1 (PD‐1) are some of known Treg‐associated molecules; however, their role in Treg‐mediated fetal protection in murine model has not been investigated.

Method of study  Treg obtained from normal pregnant animals (NP; CBA/J × BALB/c) on day 14 were adoptively transferred into abortion‐prone mice (AP; CBA/J × DBA/2J) intravenously on day 2 of pregnancy. An amount of 250 μg of either anti‐PD‐1 or anti‐CTLA‐4 mAb were injected intraperitoneally on days 0, 3, 6 and 9 of pregnancy. Controls received Treg + IgG or Treg + PBS. NP or AP treated with PBS served as additional controls.

Results  Blocking PD‐1 abrogated the protective effect of Treg, resulting in a higher median abortion rate in comparison with the Treg/isotype‐treated control while CTLA‐4 blockage did not interfere with the protective effect of Treg. This was associated with a diminished number of vascular endothelial growth factor‐A+ cells, previously reported as stimulators of lymphocyte extravasation in preterm labor.

Conclusion  Our data suggest PD‐1 as an important mediator in Treg‐induced fetal protection in the CBA/J × DBA/2J murine model.
ORIGINAL ARTICLE: Pre‐Eclampsia, Placental Abruption and Increased Risk of Atopic Sensitization in Male Adolescent Offspring
Authors: Keski‐Nisula Leea , Heinonen Seppo , Remes Sami , Pekkanen Juha
Published: October 2009

Problem  The aim of this study was to investigate maternal pre‐eclampsia (PE), placental abruption (PA) and atopy among offspring.

Method of study  Obstetric data was recorded from 378 women who were included into the Caesarean delivery birth cohort during 1990–1992. When their children were 15–17 years old skin prick tests (SPTs) and inhalant allergen‐specific (IAS) immunoglobulin E (IgE) were determined among offspring.

Results  Adolescents whose mothers had either PE or PA at the time of delivery had more atopy and especially more severe atopy as measured by the incidence of SPTs positive for ≥5 allergens (RR: 4.28, 95% CI: 1.54–11.92; P < 0.005) and elevated IAS IgE levels (≥1.0 kU/L) (RR: 4.27, 95% CI: 1.08–16.99; P < 0.039). This increased risk was particularly observed in male adolescents.

Conclusion  Maternal PE and PA were associated with an increased risk of severe atopy, especially in male adolescent offspring.