bluuebunny/crossref_metadata_2025 huggingface dataset:
Changed pattern in the use of episiotomy in Sweden
Authors: Röckner G. , Fianu‐Jonasson A.
Published: August 2005

Objective
To study changes in the use of episiotomy since 1989, controlling for variables such as severe tears, epidural anaesthesia, duration of the second stage of labour, instrumental deliveries, birthweight and maternal position at delivery.

Design
Retrospective study. Data were obtained from original birth records and questionnaires.

Setting
Huddinge University Hospital and all labour wards (n= 62) in Sweden.

Population
10,661 women who were delivered vaginally (4575 nulliparae, 6086 multiparae) between 1992 and 1994, and 3366 nulliparae delivered in all Swedish hospitals during the month of March 1995.

Main outcome measures
Episiotomy rates, severe tears and instrumental deliveries.

Results
The rate of episiotomy was 1 % and of severe tears 0.6% among multiparae delivered vaginally (including instrumental deliveries) at Huddinge University Hospital between 1992 and 1994. The rate of episiotomy was 6.6% and of severe tears 2.3% among nulliparae. Vacuum extraction and epidural anaesthesia were more commonly associated with episiotomy. Factors significantly associated with severe tears were infant birthweight ≥ 4000 g, vacuum extraction and episiotomy. In all Swedish labour wards in 1995 the mean incidence of episiotomy in nulliparae was 24.5%, a significant decrease from 33.7% in 1989. Wide variations occurred between hospitals (4%‐50%).

Conclusion
The use of episiotomy was much reduced at Huddinge University Hospital, with a consistently low rate of severe tears. This supports the growing evidence for individualised and restrictive use of episiotomy at childbirth.
The effect of ovariectomy and oestrogen replacement on small artery biomechanics in the rat
Authors: Acs Nandor , Széksics Béla , Nádasy György L. , Várbíró Szaboles , Kakucs Réka , Monos Emil
Published: August 2005

Objective
To determine the effects of oestrogen deficiency and hormone replacement therapy on the biomechanical properties of a small artery.

Sample
Thirty non‐pregnant female Sprague‐Dawley rats.

Methods
Twenty animals were pharmacologically ovariectomised by triptorelin and received either oestradiol propionate or its vehicle. Ten other animals received only the vehicle for the same period of time (control group). After 12 weeks of treatment, cylindrical segments of the saphenous artery were isolated and cannulated at both ends. Pressure‐diameter curves were recorded from segments in normal Krebs‐Ringer, using norepinephrine, and then with papaverine. The vessel segment close to the examined one was histologically evaluated. Serum levels of oestradiol and cortisol were determined.

Main outcome measures
Biomechanical parameters based on the pressure‐diameter curves.

Results
Pharmacological ovariectomy decreased the passive diameter of the arteries and oestrogen replacement therapy prevented this. Decreased reactivity to norepinephrine was also restored by oestrogen treatment. Pressure induced myogenic tone was decreased significantly by oophorectomy and increased after oestradiol treatment. No significant changes were found in wall thickness, distensibility, elastic modulus or tangential stress. No significant histological alterations were seen in the vessel wall. Oestradiol levels were significantly decreased in the castrated animals compared with the other two groups.

Conclusions
These results suggest that oestrogen deficiency decreases and oestrogen replacement increases the passive diameter of small peripheral arteries, and that oestrogen enhances the reactivity of vascular smooth muscle. These responses may provide the background mechanisms for the increased incidence of arterial hypertension and hot flushes during the menopause and the ability of oestrogen substitution to prevent them.
Modified Joel‐Cohen technique for caesarean delivery
Authors: Wallin Gunnar , Fall Ole
Published: August 2005

Objective
To investigate whether a series of changes in the current caesarean section operative routine, based on new knowledge, would be beneficial.

Design
A prospective controlled trial.

Setting
Labour ward with approximately 3000 deliveries annually in a suburban area of Gothenburg, Sweden.

Participants
Seventy‐two pregnant women scheduled for delivery by caesarean section were randomised to either modified Joel‐Cohen technique (n= 36) or Pfannenstiel technique (n= 36).

Main outcome measures
Blood loss during surgery and operating time.

Results
based on new knowledge, would be beneficial. The median estimated intra‐operative blood loss was 250 mL in the modified Joel‐Cohen group and 400 mL in the Pfannenstiel group (P= 0.026). The proportion of women with 2 300 mL was 16/36 in the modified Joel‐Cohen group vs 28/36 in the Pfannenstiel group (OR 0.229,95% CI 0.082–0.637). Median operating time was 20 min in the modified Joel‐Cohen group compared with 28 min in the Pfannenstiel group (P < 0.001). The proportion of women with 2 25 min was 1/36 in the modified Joel‐Cohen group vs 33/36 in the Pfannenstiel group (OR 0.003, 95% CI Conclusions We conclude that the modified Joel‐Cohen technique of caesarean delivery reduced intra 0.000–0.026).

Conclusions
We conclude that the modified Joel‐Cohen technique of caesarean delivery reduced intra‐operative blood loss and operating time compared with the Pfannenstiel technique.
Changes in anal anatomy following vaginal delivery revealed by anal endosonography
Authors: Frudinger Andrea , Halligan Steve , Bartram Clive I. , Spencer John A. D. , Kamm Michael A.
Published: August 2005

Objective
To investigate changes in anal canal anatomy following vaginal delivery in women without apparent sphincter injury.

Design
Prospective controlled observational study.

Setting
District general hospital.

Population
Consecutive parous and nulliparous women attending a gynaecology outpatient clinic.

Methods
All women were examined using anal endosonography, and parous subjects without apparent sphincter injury compared with age‐matched nulliparous controls to determine any differences in general anal canal morphology.

Main outcome measures
Individual anal canal components were measured at defined levels and subjects compared with controls.

Results
Twenty‐one of 54 parous women had no anal sphincter scar. Compared with nulliparous women, they had significant anterior sphincter thinning (mean 3.7 mm vs 4.6 mm, P < 0.01) in association with lateral external sphincter thickening (mean 7.0 mm vs 4.4 mm, P < 0.01), and longitudinal muscle thickening (mean 2.8 mm vs 2.1 mm, P < 0.01).

Conclusions
Specific changes in anal morphology have been demonstrated following vaginal delivery in women without apparent sphincter injury.
Epidemiological characteristics of women with high grade CIN who do and do not have human papillomavirus
Authors: Tabrizi Sepehr N. , Fairley Christopher K. , Chen Shujun , Borg Anthony J. , Baghurst Peter , Quit Michael A. , Garland Suzanne M.
Published: August 2005

Objective
Human papillomavirus infection is an important aetiological agent associated with the devel‐ opment of cervical neoplasia. However, even with the most sensitive methods of detection, human papillomavirus DNA has been detected in only 90% of cases of cervical cancer and between 80%‐90% of cases of dysplasia. This study aimed to determine if there are epidemiological differences between women who are positive or negative for human papillomavirus. with high grade cervical intraepithelial neoplasia (CIN).

Design
Four hundred and sixty women with CIN 11 and 111 lesions were studied. To ensure optimal detection of human papillomavirus DNA, two specimens (i.e. tampon and cervical biopsy) were collected from each woman and tested by three techniques: L1 ‐polymerase chain reaction, E6–PCR and low stringency Southern blotting. A detailed questionnaire was completed and blood sample collected for determination of serum levels of beta‐carotene, vitamin A and E from each patient. Human leucocyte antigen (HLA)‐DQB 1 alleles were also compared between the groups of women who were positive or negative for human papillomavirus.

Results
Overall, human papillomavirus DNA analysis was positive in 411 women (89%). Age, number of sexual partners in the last 12 months, past pregnancy and marital status werc associated with human papillomavirus detection in the crude analysis. However, in the adjusted analysis no cpidemi‐ ological features remained significantly differcnt between the human papillomavirus positive and negative patients. Moreover, examination of vitamin A, E and beta‐carotene levels did not show a significant difference between the two groups of patients. However, in the HLA‐DQBI allele profile a significantly higher proportion of women who were negative for human papillomavirus had DQB1 *0201, *0603 and *0604 (P= 0.05.0.001,0.03, respectively).

Conclusion
We did not find a significant differcnce in epidemiological factors between women with human papillomavirus positive and negative high grade CIN. However differences between the frequency of thrcc HLA DQB1 alleles suggest that women with these allele profiles have a higher chance of clearing human papillomavirus, without affecting their chance of developing dysplasia.
Colposuspension after previous failed incontinence surgery: a prospective observational study
Authors: Cardozo Linda , Hextall Andrew , Bailey Jane , Boos Kelvin
Published: August 2005

Objective
To evaluate the outcome of colposuspension for genuine stress incontinence in women who had previously undergone bladder neck surgery.

Design
Prospective observational study.

Setting
Tertiary referral urogynaecology unit.

Participants
Fifty‐two consecutive women with recurrent genuine stress incontinence operated on one surgeon.

Main outcome measures
Subjective and objective cure of stress incontinence. Complications one surgeon.

Results
The mean age of the women was 51 years (range 28–72) and weight 72.7 kg (range 53–112). Sixty‐five continence procedures had been performed previously, with 13 women (25%) having had more than one operation. Nine months post‐operatively the subjective cure rate was 80% and objective cure rate 78%. Intraoperative complications were few but included two bladder injuries and one rectus muscle tear which required repair. Seven women (13%) developed voiding difficulties which required clean intermittent self‐catheterisation, but only one needed to continue this for six months. None of the women developed detrusor instability.

Conclusions
In this setting colposuspension after previous bladder neck surgery offers a high rate of success. However, long term follow up is needed to see if this effect is maintained.
Follow up of women with simple ovarian cysts detected by transvaginal sonography in the Tokyo metropolitan area
Authors: Sasaki H. , Oda M. , Ohmura M. , Akiyama M. , Liu C. , Tsugane S. , Terashima Y. , Tanaka T.
Published: August 2005

Objective
To investigate the management of women with asymptomatic ovarian masses, to determine the appropriate duration of follow up, and to identify diagnostic indicators of growing cysts.

Design
Review of women's hospital records.

Setting
Tokyo Metropolitan Cancer Detection Center, Japan.

Population
Two hundred and twenty‐five pre‐ and postmenopausal women with a diagnosis of ovarian cyst ≥6 cm in diameter and normal serum level of CA125, diagnosed between 1 October 1990 and 25 December 1991.

Main outcome measure
Change in size of cyst as shown by ultrasound.

Results
Seventy‐five months after initial diagnosis, 29 (13%) of the masses had progressed, 31 (14%) had persisted, and 165 (73%) had regressed. One hundred and nine masses (48%) had regressed within six months of the initial diagnosis. In univariate analysis transvaginal ultrasonographic assessment of morphology findings, cyst diameter, carcinoembyronic antigen (CEA) and CA 19.9 were associated with the prognosis of the cyst. Multivariate regression analysis demonstrated that only the initial serum CA19‐9 level and serum CEA level were significant predictors of ovarian masses that regressed (P for trend = 0.004 and 0.02, respectively).

Conclusion
Simple ovarian cysts in patients with a normal level of CA125 have a low risk for ovarian cancer. Vaginal ultrasound at six months will identify regression of most simple cysts. CA19‐9 and CEA at the initial diagnosis are useful parameters to predict future regression of ovarian cysts.
The white coat effect in hypertensive pregnancy: much ado about nothing?
Authors: Brown Mark A. , Robinson Arlene , Jones Mike
Published: August 2005

Objectives
To determine the prevalence of white coat hypertension and white coat effect among hypertensive pregnant women and to assess whether the presence of a significant white coat effect was associated with adverse pregnancy outcome when clinical management was based upon standard sphygmomanometric blood pressure recordings.

Design
Prospective blinded studies assessing the presence of a white coat effect.

Setting
Antenatal ward and pregnancy day assessment unit of St George Hospital, a teaching hospital in Sydney, Australia.

Population
One hundred and twenty‐one hypertensive pregnant women in the second half of their pregnancy admitted to hospital or the day assessment unit for management of their hypertensive disorders.

Methods
Routine sphygmomanometric blood pressures were recorded by midwives in the ward or day assessment unit and awake blood pressure recordings were averaged. These blood pressures were compared with average awake blood pressures recorded by ambulatory blood pressure monitor (ABPM) (Spacelabs 90207, Seattle, Washington, USA). White coat hypertension was defined as an average sphygmomanometer blood pressure ≥ 140 mmHg systolic and/or ≥ 90 mmHg diastolic with awake ABPM average blood pressure within the normal range for ABPM‐derived blood pressures in pregnancy, according to gestation. White coat effect was the difference between average sphygmomanometer blood pressure and average awake ABPM‐derived blood pressure. All clinical management was based upon routine sphygmomanometer recordings and clinicians were blinded to ABPM data.

Main outcome measures
Prevalence of white coat hypertension and white coat effect; maternal and fetal outcomes in those with and without a white coat effect of ≥ 20 mmHg systolic and/or ≥ 10 mmHg diastolic.

Results
Systolic and diastolic white coat hypertension were present in only 3.2% and 4.2% of the group, respectively. A systolic white coat effect ≥ 20 mmHg was found in only 4.2% but 20.2% (26% for day assessment unit patients vs 15% for inpatients; P= 0.17) had a diastolic white coat effect 10 mmHg. There was no difference in maternal or fetal outcomes between women with and with out a white coat effect.

Conclusions
White coat hypertension is an infrequent occurrence in mildly hypertensive pregnant women. Although a white coat effect is present more often, this is associated with clinical outcomes similar to women who do not exhibit this phenomenon. Using ABPM to identify a white coat effect in women presenting with hypertension in the second half of their pregnancy does not appear to be clinically useful.
Medical termination of pregnancy at 63 to 83 days gestation
Authors: Gouk Elaine V. , Lincoln Karen , Khair Anu , Haslock Joanne , Knight June , Cruickshank Derek J.
Published: August 2005

Objective
To assess the efficacy of a medical regimen for the termination of pregnancy within the gestational age range of 63 to 83 days.

Design
Prospective observational study.

Setting
Gynaecology department within a district general hospital.

Population
Women attending t0068e pregnancy advisory clinic between June 1996 and December 1997.

Methods
The medical regimen used was mifepristone 200 mg orally followed after 36 to 48 h by misoprostol 800 μg administered vaginally.

Main outcome measures
The success rate of the medical termination of pregnancy regimen, where success was defined as achieving complete abortion without the need for secondary intervention by either surgical or repeat medical means.

Results
Primary medical termination of pregnancy was chosen by 253 (80.8%) of the 313 women and was successful in 239 (94.5%). Repeat medical treatment achieved completion of the abortion in a further three women (1.2%) and surgical evacuation of the uterus was required in 10 (4.0%). One woman declined further intervention after failed medical treatment but subsequently miscarried.

Conclusions
The combination of mifepristone and misoprostol is effective for the termination of pregnancy for gestations of 63 to 83 days.
The effect of compression therapy on venous haemodynamics in pregnant women
Authors: Büchtemann Alexandra S. , Steins Anke , Volkert Birgit , Hahn Martin , Klyscz Thomas , Jünger Michael
Published: August 2005

Objective
To study the influence of compression on the haemodynamics o the deep venous system in pregnancy.

Design
A prospective, observational study

Setting
The phlebological unit of the department of dermatology at a university hospital.

Population
Fifteen pregnant women with no previous signs of chronic venous insufficiency.

Methods
Parameters of the venous pump function were assessed by strain‐gauge plethysmography. Blood flow velocity, flow volume and vessel diameter in the superficial femoral vein were measured by duplex sonography. All examinations were performed with and without applied compression stockings (25–32 mmHg) at two different stages of gestation and after delivery. In addition, subjective symptoms were graded.

Results
Venous pump function improved and refilling time lengthened significantly when compression was used during gestation and postnatally. Duplex sonography showed an increase in blood flow velocity and flow volume in the superficial femoral vein with applied compression; the vessel diameter increased slightly. Subjective symptoms of the leg, graded on an arbitrary scale, were reduced by regular compression therapy.

Conclusion
Our results indicate that compression improves the clinical symptoms of venous congestion and the venous haemodynamics of the legs during pregnancy and in the postpartum period. Thus, the regular use of compression during pregnancy and the puerperium may reduce the incidence of thromboembolic events.
Maternal peripheral blood leukocytes in normal and pre‐eclamptic pregnancies
Authors: von Dadelszen Peter , Wilkins Thurl , Redman Christopher W. G.
Published: August 2005

Objective
To analyse activation of maternal peripheral blood leukocytes by flow cytometric measurements of intracellular free‐ionised calcium of lymphocytes, granulocytes, and monocytes, separately.

Design
Case‐control study.

Setting
High risk pregnancy service in a regional centre.

Material
Samples from 10 women with Pre‐eclampsia, 10 appropriately‐matched women with normal pregnancy, nine multigravid normal women at mid‐gestation selected as being least likely to demonstrate any tendencies towards Pre‐eclampsia, and 11 healthy nonpregnant women of reproductive age were studied.

Methods
Using flow cytometry, intracellular free ionised calcium ([Ca2+]i) was estimated by loading the cells with Fluo‐3 and measuring the changes in fluorescence intensity induced by free ionised calcium. After the basal levels were measured, the response of phagocytes to stimulation with n‐formylmethionyl‐leucyl‐phenylalanine (fMLP) was determined.

Main outcome measures
Basal [Ca2+]i of peripheral blood leukocytes.

Results
Median basal [Ca2+]i was significantly increased in all three subsets of leukocytes—lymphocytes, granulocytes and monocytes in Pre‐eclampsia—compared with the three control groups. Samples from both groups of women with normal pregnancy did not differ from those from nonpregnant women. The peak responses of monocytes to stimulation with 10 nmol fMLP were greater in samples from pre‐eclamptic women, giving evidence of priming.

Conclusions
Peripheral blood leukocytes are activated in Pre‐eclampsia in terms of basal changes in the intracellular second messenger—free ionised calcium. Peripheral blood monocytes are primed to give greater responses after stimulation with fMLP.
Second trimester maternal serum β human chorionic gonadotrophin and pregnancy outome
Authors: Mikic Taita Stojilkovic , Johnson Pam
Published: August 2005

The aim of this prospective, controlled study was to examine the relation between second trimester maternal serum β human chorionic gonadotrophin (HCG) and birthweight. The study population con sisted of 192 women with maternal serum βHCG ≥ 3.5 multiple of the median and a control group with the same number of women with maternal serum βHCG ≥ 2.0 multiple of the median. There was no difference in birthweight and other pregnancy outcomes between the two groups. When used prospectively, elevated βHCG in the mid‐trimester is not a predictor for intrauterine growth restriction or other pregnancy complications.
Administration of low‐dose aspirin to mothers with small for gestational age fetuses and abnormal umbilical Doppler studies to increase birthweight: a randomised double‐blind controlled trial
Authors: McCowan Lesley M. E. , Harding Jane , Roberts Alistair , Barker Sarah , Ford Cassandra , Stewart Alistair
Published: August 2005

Objective
To determine whether antenatal treatment (for ≥= 14 days) with 100 mg aspirin daily, given to mothers with small for gestational age fetuses and abnormal umbilical Doppler, will increase birthweight.

Design
Randomised, double‐blind placebo controlled trial.

Setting
A tertiary referral centre.

Participants
Ninety‐nine women, of whom 65 were treated for ≥= 14 days (32 with aspirin and 33 with placebo) and comprised the study group. The entry criteria were: singleton pregnancy with ultrasound evidence of a small for gestational age fetus (abdominal circumference < 10%); previous anatomy scan <20 weeks and no evidence of fetal abnormality; gestation between 24 and 36 weeks; umbilical artery Doppler resistance index > 95% for gestation; no previous aspirin treatment in pregnancy; and no contra‐indication to aspirin treatment.

Results
The mean duration of treatment was 30 days for aspirin treated, and 29 for placebo. No difference was found in birthweight or other measures of fetal growth or newborn morbidity between those treated with aspirin or placebo. Compliance, assessed by thromboxane B2 analysis, showed almost complete suppression of thromboxane B, in aspirin treated women.

Conclusion
Low‐dose aspirin did not increase birthweight in pregnancies where the fetus has abnormal umbilical Doppler and is thought to be small for gestational age.
Prevention of postmenopausal bone loss at lumbar spine and upper femur with tibolone: a two‐year randomised controlled trial
Authors: Beardsworth S. A. , Kearney C. E. , Purdie D. W.
Published: August 2005

Objective
To examine the effects of tibolone on bone mineral density and its concurrent safety and subject acceptability.

Design
Prospective randomised controlled study.

Setting
Centre for Metabolic Bone Disease, Hull.

Population
Forty‐seven healthy post‐menopausal women aged 50–57 years with normal bone mineral density at lumbar spine.

Methods
Bone mineral density was assessed every 24 weeks at lumbar spine and proximal femur using dual energy X‐ray absorptiometry.

Results
The bone mineral density of the tibolone treated subjects tended to increase while those of the controls tended to fall. The higher densities in the tibolone group were significant at lumbar spine from week 24 (P= 0.002) and at the trochanter from week 72 (P= 0.014). The lower bone densities in the controls were significant at Ward's Triangle and femoral neck at week 96 (P < 0.0001), and at lumbar spine from week 24 onwards (P < 0.05). Between‐treatment analysis indicated that, by the 96th week, the bone densities at all sites in the tibolone group were significantly different from those in the control group. At the lumbar spine the differences were highly significant throughout the study (P < 0.0004). Four women receiving tibolone withdrew from the study due to unacceptable adverse events. Two women withdrew from the control group. There was no significant difference between the groups in the number of subjects suffering adverse experiences. Vaginal bleeding occurred in seven women, all from the tibolone treated group, resulting in one withdrawal from the study.

Conclusion
Tibolone is thus an effective and well‐tolerated alternative to oestrogen in the prevention of osteoporosis with its beneficial effects being most apparent at the lumbar spine.
Microwave endometrial ablation: development, clinical trials and outcomes at three years
Authors: Hodgson David A. , Feldberg Ian B. , Sharp Nicholas , Cronin Nigel , Evans Martyn , Hirschowitz Lynn
Published: August 2005

Objective
To describe the introduction of microwave endometrial ablation to clinical practice, and to report the outcomes three years after endometrial ablation.

Design
A clinical trial using prototype microwave endometrial ablation equipment.

Setting
District general hospital.

Population
Forty‐three women with completed families and with failed medical management for men‐orrhagia were treated with microwave endometrial ablation between October 1994 and April 1995.

Main outcome measures
A statement of perceived menstrual loss and satisfaction supported by a menstrual symptom questionnaire score. Dysmenorrhoea was graded as a measure of described severity. Treatment time.

Results
Forty‐three women had a total of 46 treatments. Mean treatment time: n= 43, was 141 seconds (50–310). Amenorrhoea: n= 16; 37.2%. Very light periods/discharge: n= 11; 25.6%. Improved periods and woman satisfied: n= 9; 20.9%. Improved periods and woman not satisfied: n= 1; 2.3%. Overall satisfaction at three years is 83.7%. Moderate (55.8%) or severe (27.9%) dysmenorrhoea pre‐operatively had improved to 11.6% and 6.8% respectively at three years. Three re‐treatments and four hysterectomies will be discussed.

Conclusions
Microwave endometrial ablation is a new treatment for dysfunctional uterine bleeding using the application of microwave energy to the endometrium. This results in a rapid but restricted depth of intrauterine heating avoiding hysteroscopic fluid, operative haemorrhage and earthing risks. The technique is simple to learn and perform. Women report a high level of satisfaction three years after microwave endometrial ablation.
Expression of macrophage inflammatory protein‐1α (MIP‐1α) in human endometrium throughout the menstrual cycle
Authors: Akiyama Minoru , Okabe Hidetoshi , Takakura Kenji , Fujiyama Yoshihide , Noda Yoichi
Published: August 2005

Objective
To investigate the distribution and the role of macrophage inflammatory protein‐la (MIP‐ 1α) in human endometrium during cyclic changes.

Setting
Department of Obstetrics and Gynaecology, Shiga University of Medical Science and University Hospital.

Materials
Eighteen endometrial tissue specimens surgically resected or biopsied from women with normal menstrual cycles, without hormonal disorder or endometrial diseases.

Methods
By immunohistochemistry, using monoclonalantibodies (lambda delta 78 for MIP‐la and CR3/43 for human leukocyte antigen‐DR (HLA‐DR)).

Results
Immunoreactivity for anti‐MIP‐lα was distributed diffusely in epithelial cells throughout the proliferative and secretory phases but was absent during menstruation due to degenerative or necrotic changes. HLA‐DR was expressed in epithelial cells only in the late secretory phase and was not expressed in stromal cells.

Conclusion
Immunohistochemicalanalysis showed the presence of MIP‐ lα in the endometrial epithelium. Expression of HLA‐DR in epithelial cells was observed only in the late secretory phase, suggesting that accumulation of MIP‐lα in epithelium occurred by self production and not via a receptor mediated pathway. MIP‐lα was released from the denuded epithelium during menstruation and appeared to contribute to the accumulation of monocytes/macrophages into the endometrial cavity. MIP‐la has a number of biological effects other than monocytic chemotaxis, and some of these effects may be exerted in the endometrial tissue.
Women's attitudes to urodynamics: a questionnaire survey
Authors: Gorton Emma , Stanton Stuart
Published: August 2005

Objective
To obtain a measure of how well women tolerate urodynamic investigations and to determine

Design
Prospective questionnaire survey

Setting
A teaching hospital tertiary referral centre urodynamic laboratory.

Participants
Three hundred and twenty‐four women attending for urodynamic investigations on 33 1 occasions. Questionnaires were returned from 297 women (9 1.7%) with six women returning two questionnaires.

Results
Urodynamic investigations were well tolerated by most women, with 45% feeling that the procedure was not as bad as they expected. Moderate or severe anxiety about the test was experienced by 42% and 40% felt moderately or severely embarrassed. Pain was noted by 27% of women during investigation, and by 13% after investigation. Overall distress from the procedure was less in older women and in those who had been referred from a specialist urogynaecology clinic. Distress was higher when difficulties were encountered during the investigation and in women who had investigations other than a standard cystometrogram. Women were likely to find the test less distressing when they felt they had been given adequate information about the test.

Conclusions
Although urodynamic investigations are generally well tolerated, there is a significant minority of women who find the test embarrassing, painful and distressing. how well they thought the test was explained.
A randomised comparison of the effects of oral versus transdermal 17β‐oestradiol, each combined with sequential oral norethisterone acetate, on serum lipoprotein levels
Authors: Spencer Chris , Crook David , Ross David , Cooper Alison , Whitehead Malcolm , Stevenson John
Published: August 2005

Objective
To investigate the effects of oral versus, transdermal 17β‐oestradiol, given in both cases with sequential addition of oral norethisterone acetate, on serum lipid and lipoprotein levels in postmenopausal women.

Design
Open, randomised, parallel groups study.

Setting
University Clinical Research Group.

Population
Sixty‐four postmenopausal women with climacteric complaints who were otherwise healthy were screened. Of these, 58 fulfilled the entry criteria.

Methods
Fifty‐eight postmenopausal women were randomised to receive either oral 17β‐oestradiol/oestriol (Trisequens) or transdermal 17β‐oestradiol (Estrapak) together with cyclical addition of norethisterone acetate for 48 weeks.

Main outcome measures
Serum levels of total cholesterol, triglycerides, high density lipoproteins (HDL), low density lipoproteins (LDL), very low density lipoproteins (VLDL), apolipoproteins, and lipoprotein(a) at baseline, and after 46 weeks (oestrogen‐alone phase), and 48 weeks (oestrogen‐progestogen phase) of treatment.

Results
Oral oestradiol therapy did not affect serum total cholesterol levels during the oestrogen‐alone phase, but during the combined phase there was a 5% fall (P < 0.05) due to a 7% decrease in LDL cholesterol levels (P < 0.01). Oral therapy also increased serum triglyceride levels by 9.4% during the oestrogen‐alone phase (P < 0.05). During the combined phase of transdermal therapy, there was a 19% fall in serum triglyceride levels (P < 0.05) and a 6%, fall in HDL levels (P < 0.05). Oral oestradiol reduced lipoprotein(a) levels by 31% during the oestrogen‐alone phase and by 37% with norethisterone acetate addition (P < 0.05). Transdermal therapy had no significant effect on lipoprotein(a).

Conclusions
Other than a minor fall in HDL, in women receiving transdermal 17β‐oestradiol, co‐administration of oral progestogen in general improved, rather than worsened, this serum lipoprotein profile.
Long term effects of tibolone on the genital tract in postmenopausal women
Authors: Morris E. P. , Wilson P. O. G. , Robinson J. , Rymer J. M.
Published: August 2005

Objectives
To assess the effects of six years tibolone therapy on the genital tract in postmenopausal women against matched voluntary controls.

Design
Prospective, non‐randomised, open label study of the efficacy of tibolone.

Methods
Symptoms were assessed by questionnaires every six months. Assessment of genital tract cellular activity comprised annual vaginal smear and endometrial biopsy/smear in the tibolone group (n= 58) and vaginal smear alone in the control group (n= 55). As a recent protocol addition, transvaginal ultrasound assessment of endometrial thickness was performed in all women who gave consent. endometrial biopsy was performed in control women if the endometrial thickness was > 5 mm. Karyopyknotic index and maturation index were calculated from the vaginal smears.

Results
The rate of amenorrhoea between six months and six years treatment was 90% in the tibolone group compared with 91% in the controls (P was not significant). There was improvement in reported vaginal symptomatology in the treatment group but not in the controls. Median endometrial thickness increased slightly in the tibolone treated group (3.2 mm tibolone vs 2.5 mm control; P < 0.05). There were no cases of cytologically proven endometrial stimulation in asymptomatic women in either group. Both vaginal karyopyknotic index and maturation index increased significantly in the tibolone treated group over six years, but not in the control group.

Conclusions
Tibolone is effective at maintaining an inactive endometrium while providing oestrogenisation of the lower genital tract over a six year period.
Human papillomavirus type 16 and 18 detection in the management of mild dyskaryosis
Authors: Cruickshank Margaret E. , Buchan Suzanne , Melvin William T. , Kitchener Henry C.
Published: August 2005

Objective
To determine if semi‐quantitative human papillomavirus (HPV) types 16 and 18 detection by polymerase chain reaction can increase the sensitivity and specificity of repeat cytology alone for underlying high grade cervical intraepithelial neoplasia (CIN).

Design
Prospective randomised study of immediate treatment and surveillance.

Setting
A dedicated colposcopy clinic serving a regional population.

Sample
Three hundred and four women with smears reported as mild dyskaryosis.

Methods
Repeat cytology, HPV 16 and 18 tests, and colposcopy were performed at study entry. Women were randomised to either immediate treatment or surveillance with repeated tests at 6 and 12 months. Unless all study smears were negative, women were treated at study exit by large loop excision of the transformation zone.

Main outcome measures
Sensitivity and specificity of HPV testing for types 16 and 18 in conjunction with cytology for high grade CIN.

Results
Combining repeat cytology with HPV 16 and 18 testing had a sensitivity of 94% and a specificity of 26%., a positive predictive value of 71%, and a negative predictive value of 71%, for underlying high grade CIN. If used to secondary screen in conjunction with repeat cytology for mild dyskaryosis, 88% of women would have been referred for colposcopy on the basis of either test being positive.

Conclusion
Combining repeat cytology and HPV 16 and 18 detection would result in the majority of women being referred for immediate colposcopy. Taken with an overall default rate of 17%, immediate referral of all women with mild dyskaryosis for colposcopic assessment still appears to be a more effective clinical strategy.
Guided Health Imagery for Smoking Cessation and Long‐Term Abstinence
Authors: Wynd Christine A.
Published: August 2005

Purpose:

To examine the effectiveness of guided imagery for immediate smoking cessation and long‐term abstinence in adult smokers.

Design:

A repeated measures design was used with 71 smokers recruited from a hospital outpatient clinic, 38 in the intervention group, and 33 in the control group.

Methods:

Both study groups received educational and counseling sessions in their homes. The intervention group was provided with additional instruction in the use of guided imagery and was encouraged to practice this imagery at least once per day with a 20‐minute audiotaped exercise for reinforcement. The repeated measures included smoking rates (cigarettes per day) that were measured and confirmed through corroborating friends and family.

Findings:

At 24‐months after the intervention, smoking abstinence rates were significantly higher for the guided health imagery intervention group (26% abstinence rate versus 12% abstinence rate for the placebo‐control group).

Conclusions:

Guided imagery was an effective intervention for long‐term smoking cessation and abstinence in adult smokers.
Utility of a Standardized Nursing Terminology to Evaluate Dosage and Tailoring of an HIV/AIDS Adherence Intervention
Authors: Bakken Suzanne , Holzemer William L. , Portillo Carmen J. , Grimes Richard , Welch Jennifer , Wantland Dean
Published: August 2005

Purpose:

To illustrate the utility of a standardized nursing terminology to calculate the dosage of the Client Adherence Profiling‐Intervention Tailoring (CAP‐IT) and to determine the extent to which a tailored intervention was delivered to 117 persons with HIV/AIDS who participated in the experimental arm of a randomized controlled trial (RCT).

Methods:

The intervention nurse assigned nursing diagnoses from the Home Health Care Classification (HHCC) based upon CAP scores. During the IT phase of CAP‐IT, the nurse delivered and documented a tailored set of nursing interventions associated with the CAP and assigned nursing diagnoses. Hierarchical linear regression was used to evaluate the extent to which the number of interventions and intervention times were tailored to client needs.

Results:

Linear regression models that included CAP scores and nursing diagnoses as predictor variables explained 53.2% of the variance in total number of interventions and 58.9% of the variance in intervention time.

Conclusions:

The use of the standardized nursing terminology enabled calculation of the intervention dose and documentation that a tailored intervention was delivered.
Temperature Dependence of the Cation Distribution in Nickel Aluminate Spinel from Thermodynamics and X‐Rays
Authors: Han Yong Sheng , Li Jian Bao , Ning Xiao Shan , Chi Bo
Published: August 2005

The single crystal NiAl2O4 was prepared by a solid‐state reaction. The change of its cation distribution with temperature was calculated by a modified thermodynamic equation by including a new parameter δ, which is a characteristic of nonconfiguration entropy. The calculated results showed that the degree of inversion for NiAl2O4 decreases with temperature, although the temperature dependence of cation distribution is very weak. This result was supported by X‐ray diffraction measurement.
Proton‐Conductive Membranes Doped with Orthophosphoric Acid Based on Inorganic–Organic Hybrid Materials
Authors: Huang Sheng Jian , Lee Hoi Kwan , Lee Yong Su , Kang Won Ho
Published: August 2005

A series of proton‐conductive inorganic–organic hybrid membranes doped with phosphoric acid (H3PO4) have been prepared by the sol–gel process with 3‐glycidoxypropyltrimethoxysilane (GPTMS), 3‐aminopropyltriethoxysilane (APTES), and tetraethoxysilane (TEOS) as precursors. High proton conductivity of 3.0 × 10−3 S/cm with a composition of 50TEOS–30GPTMS–20APTES–50H3PO4 was obtained at 120°C under 50% relative humidity (RH). The differential thermal analysis curve showed that thermal stability of membrane is significantly enhanced by the presence of an SiO2 framework up to 250°C. X‐ray ray diffraction revealed that the gels were amorphous. Infrared spectra showed a good complexation of H3PO4 in the matrix. The porous hybrid membrane, characterized by scanning electron microscopy, shows humidity‐dependent conduction, and the conductivity under 75% relative humidity was significantly improved by addition of APTES due to the increase in the concentration of the defective site in the hybrid matrix.
Ultraviolette Strahlung – Immunantwort
Authors: Schwarz Thomas
Published: August 2005

Ultraviolette (UV) Strahlung übt eine Vielzahl biologischer Effekte aus, darunter Induktion von Hautkrebs, vorzeitige Hautalterung und Unterdrückung des Immunsystems. Die immunsuppressiven Effekte von UV‐Strahlung sind von großer biologischer und klinischer Relevanz, da sie zur Photokarzinogenese beitragen. Daher ist die Kenntnis der der Immunsuppression zugrunde liegenden Mechanismen von großer Wichtigkeit. UV‐Strahlung unterdrückt das Immunsystem in mehrfacher Weise. Sie inhibiert die Präsentation von Antigenen, stimuliert die Freisetzung immunsuppressiver Zytokine und induziert T‐Lymphozyten vom regulatorischen Typ. Eine wesentliche molekulare Zielstruktur bei der UV‐induzierten Immunsuppression ist der UV‐induzierte DNA‐Schaden. Die weitere Aufklärung der Mechanismen der UV‐induzierten Immunsuppression wird nicht nur zu einem besseren Verständnis der physiologischen und pathologischen Effekte von UV‐Strahlung führen, sondern auch einen Beitrag zur Entwicklung neuer protektiver Strategien beitragen.
Cl−secretion in ATP‐treated renal epithelial C7–MDCK cells is mediated by activation of P2Y1 receptors, phospholipase A2 and protein kinase A
Authors: Akimova A. Olga , Bourcier Nathalie , Taurin Sebastien , Bundey Richard A. , Grygorczyk Konrad , Gekle Michael , Insel Paul A. , Dulin Nickolai O. , Orlov Sergei N.
Published: August 2005

This study examines the mechanism of P2Y‐induced Cl− secretion in monolayers of C7–Madin–Darby canine kidney (MDCK) cells triggered by basolateral application of ATP and measured as transcellular short current (ISC). Both ATP‐induced arachidonic acid (AA) synthesis and ISC in ATP‐treated cells were abolished by the phosholipase A2 (PLA2) inhibitor, AACOCF3. The cyclo‐oxygenase inhibitor indomethacin decreased ISC and cAMP production in ATP‐treated cells with an IC50 of ∼0.3 μm. ATP led to rapid activation of cAMP‐dependent protein kinase A (PKA), as estimated by phosphorylation of a vasodilator‐stimulated phosphoprotein. PKA activity and ISC evoked by ATP, as well as by prostaglandin E1 (PGE1), were diminished in the presence of the PKA inhibitor H‐89 or an adenovirus‐mediated expression of PKA‐inhibitor protein, PKI. In contrast, indomethacin completely blocked the increment of PKA and ISC triggered by ATP and AA, but did not affect PKA activation and ISC detected with PGE1. The kinetics of [Ca2+]i elevation in ATP‐ and thapsigargin‐treated cells were similar and suppressed by the Cai2+ chelator BAPTA. Neither baseline nor maximal increment of ATP‐induced ISC was affected by thapsigargin and BAPTA. Real‐time PCR showed that C7 cells express more mRNA for P2Y1 and P2Y2 than for other P2Y receptor subtypes. The rank order of potency (2MeSATP > ATP > ADP ≫ UTP) indicates that P2Y1 rather than P2Y2 receptors contribute to PKA and ISC activation. Viewed collectively, these data show that Cl− secretion in C7–MDCK monolayers treated with basolateral ATP is triggered by P2Y1 receptors and is mediated by subsequent [Ca2+]i‐independent activation of PLA2 and PKA.
Adaptive H∞ Control Using Backstepping Design and Neural Networks
Authors: Niu Yugang , Lam James , Wang Xingyu , Ho Daniel W. C.
Published: August 2005

In this paper, the adaptive H∞ control problem based on the neural network technique is studied for a class of strict-feedback nonlinear systems with mismatching nonlinear uncertainties that may not be linearly parametrized. By combining the backstepping technique with H∞ control design, an adaptive neural controller is synthesized to attenuate the effect of approximation errors and guarantee an H∞ tracking performance for the closed-loop system. In this work, the structural property of the system is utilized to synthesize the controller such that the singularity problem of the controller usually encountered in feedback linearization design is avoided. A numerical simulation illustrating the H∞ control performance of the closed-loop system is provided.
Robust Adaptive Control Scheme for Discrete-Time System With Actuator Failures
Authors: Fei Juntao , Chen Shuhao , Tao Gang , Joshi Suresh M.
Published: August 2005

A robust adaptive control approach using output feedback for output tracking is developed for discrete-time linear time-invariant systems with uncertain failures of redundant actuators in the presence of the unmodeled dynamics and bounded output disturbance. Such actuator failures are characterized by some unknown inputs stuck at some unknown fixed values at unknown time instants. Technical issues such as plant-model output matching, adaptive controller structure, adaptive parameter update laws, stability and tracking analysis, and robustness of system performance are solved for the discrete-time adaptive actuator failure compensation problem. A case study is conducted for adaptive compensation of rudder servomechanism failures of a Boeing 747 dynamic model presented in discrete time, verifying the desired adaptive system performance in the presence of uncertain actuator failures.
Impact Isolation Limiting Performance Analysis for Three-Component Models
Authors: Balandin Dmitry V. , Bolotnik Nikolai N. , Pilkey Walter D. , Purtsezov Sergey V.
Published: August 2005

For the crashworthiness analysis of transport vehicles a three-component system that consists of a base, a container, and an object to be protected, connected by shock isolators, can be utilized as a model. An approach for a limiting performance analysis of shock isolation for such a model is proposed. This approach involves the reduction of the optimal control problem for the three-component system to an auxiliary optimal control problem for a two-component system. A detailed description of the technique for the determination of the absolute minimum of the performance index and construction of the optimal control is presented. A proposition that provides a mathematical substantiation for this technique is stated and proven. Example problems included in the paper demonstrate the effectiveness of the proposed technique.
Down Regulation of Virulence Factors of
Pseudomonas aeruginosa
by Salicylic Acid Attenuates Its Virulence on
Arabidopsis thaliana
and
Caenorhabditis elegans
Authors: Prithiviraj B. , Bais H. P. , Weir T. , Suresh B. , Najarro E. H. , Dayakar B. V. , Schweizer H. P. , Vivanco J. M.
Published: August 2005

Salicylic acid (SA) is a phenolic metabolite produced by plants and is known to play an important role in several physiological processes, such as the induction of plant defense responses against pathogen attack. Here, using the
Arabidopsis thaliana
-
Pseudomonas aeruginosa
pathosystem, we provide evidence that SA acts directly on the pathogen, down regulating fitness and virulence factor production of the bacteria.
Pseudomonas aeruginosa
PA14 showed reduced attachment and biofilm formation on the roots of the
Arabidopsis
mutants
lox2
and
cpr5
-
2
, which produce elevated amounts of SA, as well as on wild-type
Arabidopsis
plants primed with exogenous SA, a treatment known to enhance endogenous SA concentration. Salicylic acid at a concentration that did not inhibit PA14 growth was sufficient to significantly affect the ability of the bacteria to attach and form biofilm communities on abiotic surfaces. Furthermore, SA down regulated three known virulence factors of PA14: pyocyanin, protease, and elastase. Interestingly,
P. aeruginosa
produced more pyocyanin when infiltrated into leaves of the
Arabidopsis
transgenic line
NahG
, which accumulates less SA than wild-type plants. This finding suggests that endogenous SA plays a role in down regulating the synthesis and secretion of pyocyanin in vivo. To further test if SA directly affects the virulence of
P. aeruginosa
, we used the
Caenorhabiditis elegans
-
P. aeruginosa
infection model. The addition of SA to
P. aeruginosa
lawns significantly diminished the bacterium's ability to kill the worms, without affecting the accumulation of bacteria inside the nematodes' guts, suggesting that SA negatively affects factors that influence the virulence of
P. aeruginosa
. We employed microarray technology to identify SA target genes. These analyses showed that SA treatment affected expression of 331 genes. It selectively repressed transcription of exoproteins and other virulence factors, while it had no effect on expression of housekeeping genes. Our results indicate that in addition to its role as a signal molecule in plant defense responses, SA works as an anti-infective compound by affecting the physiology of
P. aeruginosa
and ultimately attenuating its virulence.