bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of Sociocultural Context and Parenting Style on Scholastic Achievement among Iranian Adolescents
Authors: Assadi Seyed Mohammad , Zokaei Nayereh , Kaviani Hossein , Mohammadi Mohammad Reza , Ghaeli Padideh , Gohari Mahmood Reza , Van De Vijver Fons J. R.
Published: January 2007

School grades, family demographics and responses to the parental authority questionnaire were assessed in 240 eighth‐grade students in the southern, central and northern parts of Tehran, Iran's capital. The result showed that poorer families with traditional values had more authoritarian attitudes toward parenting than richer families with more modern values. In contrast to the studies conducted in East Asian societies, the current study found that authoritative parenting was the style associated with the highest academic outcome. Tests of mediation and moderation effects showed that the relation between parenting style and academic outcome was independent of sociocultural context.
Biased Mentalizing in Children Aged Seven to 11: Latent Class Confirmation of Response Styles to Social Scenarios and Associations with Psychopathology
Authors: Sharp Carla , Croudace Tim J. , Goodyer Ian M.
Published: January 2007

A new approach to the measurement of mentalizing is introduced. Instead of measuring the presence or absence of mentalizing capacity, the current study aimed at developing a mentalizing task that focuses on investigating biases in mentalizing through the use of ambiguous peer‐related social scenarios. The response consistency of 659 children was investigated in a community sample of children aged seven to 11. Confirmatory latent class analysis allocated children to three groups on the basis of their responses: an overly positive style (OP), a rational/neutral style (R) or an overly negative style (ON). Children classed as OP showed a greater likelihood of being above cut‐off on a population screen for externalizing disorder. Over a two‐year follow‐up period, the children who were classified as R were most likely to remain so whereas the OP and ON children were found to change group. The results are discussed in the context of social‐cognitive research in this age group. Further studies should examine the external validity of the mentalizing task because the results reported here concern only internal construct validity.
Equity, Responsibility and the Cultural Dimension
Authors: GAERTNER WULF , SCHWETTMANN LARS
Published: January 2007

We present questionnaire studies concerning equity judgments based on an axiom that underlies Rawls's difference principle. Our investigation, spanning over a period of fifteen years, was run at German, Austrian and Slovenian universities. We also modified two of our basic scenarios to check for responsibility aspects. Additionally, we included information on socio‐demographic characteristics of respondents in a probit model. Answers depend on cultural environments, but results indicate some convergence over time. Responsibility considerations are important if they can be attributed to particular persons. Although overall explanatory power of demographic attributes is low, we observe significant gender differences.
A Test of Diminishing Marginal Value
Authors: HOROWITZ JOHN , LIST J. , McCONNELL K. E.
Published: January 2007

The notion of diminishing marginal value had a profound impact on the development of neoclassical theory. Early neoclassical scholars had difficulty convincing contemporaries of the new paradigm's value until political economists used the critical assumption of diminishing marginal value to link utility and demand. While diminishing marginal value remains a key component of modern economic intuition, there is little direct verification of this behavioural property. This paper reports experiments on a myriad of subject pools to examine behaviour in both price and exchange settings. We report results from nearly 900 subjects across 19 treatments and find strong evidence of diminishing marginal value.
Photodynamic therapy: update 2006 Part 1: Photochemistry and photobiology
Authors: Calzavara‐Pinton PG , Venturini M , Sala R
Published: January 2007

Photodynamic therapy (PDT) is a two‐step therapeutic technique in which the topical or systemic delivery of photosensitizing drugs is followed by irradiation with visible light. Activated photosensitizers transfer energy to molecular oxygen, generating reactive oxygen species (ROS). The subsequent oxidation of lipids, amino acids and proteins induces cell necrosis and apoptosis. In addition, ROS indirectly stimulate the transcription and release of inflammatory mediators. The photosensitizers are selective, in that they penetrate and accumulate in tumour cells or in the endothelium of newly formed vessels while generally avoiding the surrounding healthy tissue. The mechanisms of penetration through the cell membrane and the pattern of subcellular localization strongly influence the type of cellular effect.

The photobiology and photoimmunology of the haematoporphyrin (Hp) derivative and its purified, lyophilized and concentrated form porfimer sodium have been investigated over the past 30 years. However, interest in PDT in dermatology was not raised until the 1990s with the availability of a simple and effective technique, the topical application of aminolaevulinic acid (ALA) and its methyl ester (methyl aminolaevulinate, MAL) followed by irradiation with broadband red light. At the same time, several new ‘second‐generation’ synthetic sensitizers (e.g. benzoporphyrin derivatives, phthalocyanines, chlorins and porphycenes) became available. These compounds are chemically pure, highly efficient, selective and safe, while offering the advantage that the generalized skin photosensitivity they produce lasts for only a short time. They are currently under clinical evaluation but have not yet been approved for clinical use.

This paper provides an overview of the chemistry of the photosensitizers, the photobiology and photoimmunology of the photodynamic reaction as well as the photophysical characteristics of the light sources available for PDT.
Evaluation of quality of life in patients with toenail onychomycosis by Polish version of an international onychomycosis‐specific questionnaire
Authors: Szepietowski JC , Reich A , Pacan P , Garlowska E , Baran E ,   on behalf of the Polish Onychomycosis Study Group
Published: January 2007

Background  Onychomycosis is the most frequent nail disease, which could impair the patient's quality of life.

Objective  The present study was undertaken to evaluate the impact of toenail onychomycosis on quality of life among Polish population.

Patients and methods  Three thousand nine‐hundred and four (3904: 2269 females and 1635 males) individuals fulfilled an international onychomycosis‐specific quality‐of‐life questionnaire consisting of statements regarding social, emotional and symptoms problems. All patients had toenail onychomycosis confirmed by the positive direct microscopic examination and/or by the positive mycologic culture. Seven hundred and sixty‐seven patients simultaneously had fingernail onychomycosis. All patients were divided into subgroups according to sex, age, education level, place of living, type of onychomycosis, number of involved toenails, fingernails involvement, duration of illness and previously used antimycotic therapy.

Results  Most of the patients demonstrated significantly reduced quality of life. The degree of life impairment varied between analysed subgroups. Patients with more advanced toenail onychomycosis and with fingernail involvement were more seriously affected. Both social and emotional impairments were more pronounced in female than in male patients, although there were no differences according to symptoms. Moreover, patients with better educational level and people living in towns or cities were more emotionally and socially affected by onychomycosis, although people living in the country or with poorer education level presented with significantly more severe symptoms.

Conclusions  Toenail onychomycosis is still a serious medical problem, which can significantly reduce the patient's quality of life.
Combination of 308‐nm xenon chloride excimer laser and topical calcipotriol in vitiligo
Authors: Goldinger SM , Dummer R , Schmid P , Burg G , Seifert B , Läuchli S
Published: January 2007

Background   A large variety of therapeutic agents are being used for the treatment of vitiligo, but treatment remains a challenge. Recently, monochromatic phototherapies such as 311‐nm narrowband ultraviolet B therapy and 308‐nm xenon chloride excimer laser have been reported to be an effective and safe therapeutic option in children and adult patients with vitiligo. Single reports stipulate that the addition of topically applied calcipotriol to phototherapy increases its effectiveness.

Objective  The purpose of the present pilot study was to determine if the addition of topical calcipotriol increases the efficacy of the 308‐nm xenon chloride excimer in the treatment of vitiligo.

Methods  Ten patients with vitiligo with essentially bilateral symmetrical lesions were enrolled in this prospective right/left comparative, single‐blinded trial conducted over a 15‐month period. All patients received 308‐nm XeCl excimer laser therapy three times weekly. Calcipotriol ointment (Daivonex®) was applied to lesions on one side of the body twice daily.

Results  After 24 treatments (8 weeks), nine patients were evaluated. Eight patients showed evidence of repigmentation on both body sides, with no significant difference between the body side treated with calcipotriol and excimer laser and the side treated with excimer laser alone. The mean repigmentation rate was 22.4% (1– 37%).

Conclusion  The addition of calcipotriol ointment to 308‐nm xenon chloride excimer laser phototherapy does not significantly enhance its efficacy. Small additive effects must be investigated in a larger trial.
Photodynamic therapy: update 2006 Part 2: Clinical results
Authors: Calzavara‐Pinton PG , Venturini M , Sala R
Published: January 2007

In several randomized, controlled studies, the application of a standard preparation containing methyl‐aminolevulinate (MAL; Metvix®, Galderma, F), followed by red light irradiation proved effective and well tolerated in the treatment of actinic keratosis and basal cell carcinoma, and has now been approved for clinical use in European countries. A brand name aminolevulinic acid (ALA) solution (Levulan Kerastick®, Dusa Pharmaceuticals Inc., Wilmington, MA) plus blue light exposure has been approved for the treatment of actinic keratosis in the USA. Randomized and controlled studies have shown that MAL as well as ALA are also effective in the treatment of Bowen's disease. In addition, a large and growing number of open studies or case reports have evaluated its use in the treatment of a broad range of other neoplastic, inflammatory and infectious skin diseases. However, efficacy and definite advantages over standard therapies remain to be clarified because the experimental design of these studies was often poor, the number of enrolled patients was generally low, and the follow‐up was shorter than 12 months. However, these studies have suggested a few possible clinical applications worthy of further investigation. A growing number of laboratory and clinical findings suggest that several new synthetic sensitizers, besides ALA and MAL, may be helpful in the treatment of non‐melanoma skin cancers, melanoma metastasis, and selected inflammatory and infective skin diseases. These compounds are deliverable intravenously, have short half‐lives both in the blood and skin, and are highly efficient. However, they are as of yet not approved for clinical use.
Infectious complications and managements for surgical site infections in genital Paget's disease
Authors: Yamasaki O , Asagoe K , Otsuka M , Oono T , Iwatsuki K
Published: January 2007

Background  Extramammary Paget's disease is an intra‐epidermal carcinoma that occurs preferentially in genital areas. Patients with genital Paget's disease (GPD) sometimes develop severe post‐surgical infections because of this anatomical disadvantage.

Objective  To study perioperative micro‐organisms and surgical site infection (SSI) in GPD.

Methods  We examined micro‐organisms isolated from preoperative lesions, necrotic sites and infected wounds in 60 adult patients with GPD who underwent surgery at our hospital between November 1990 and December 2005. Based on the obtained microbiological data, we assessed the incidence, risk factors and treatment of SSI.

Results  The colonized organisms found in preoperative GPD were Enterobacteriaceae (27.6%), methicillin‐sensitive Staphylococcus aureus (MSSA) (22.4%) and coagulase‐negative staphylococci (CNS) (15.5%), among others. In the postoperative necrotic sites, the frequency of MSSA isolation was reduced to 9.4%, while Pseudomonas aeruginosa and methicillin‐resistant S. aureus (MRSA) both increased in frequency from 3.4% and 0% upon preoperative examination to 18.8% and 9.4%, respectively. The incidence of SSI was 15%. In 7 of 9 SSIs, MRSA and/or P. aeruginosa were isolated.

Conclusion  We have successfully identified a number of perioperative micro‐organisms in GPD. The present observations may be extremely useful in choosing appropriate antimicrobial agents for use in the surgical treatment of GPD.
The increase in tryptase‐ and chymase‐positive mast cells is associated with partial inactivation of chymase and increase in protease inhibitors in basal cell carcinoma
Authors: Diaconu N‐C , Kaminska R , Naukkarinen A , Harvima RJ , Harvima IT
Published: January 2007

Background  In basal cell carcinoma (BCC), mast cells accumulate in the peritumoral stroma. The serine proteinases tryptase and chymase are the major mediators in mast cell granules and they may exert their enzymatic activity in the BCC lesion by inducing matrix remodeling and epithelial cell detachment.

Objective  To analyse the numbers of mast cells showing tryptase enzyme activity, chymase enzyme activity and chymase immunoreactivity as well as the presence of chymase inhibitors α1‐antichymotrypsin (α1‐AC), α1‐proteinase inhibitor (α1‐PI) and squamous cell carcinoma antigen‐2 (SCCA‐2) in BCC.

Methods  Eleven biopsies were taken from the lesion and healthy‐looking skin of 10 patients with superficial spreading BCC. The frozen biopsies were analysed enzyme‐ and immunohistochemically, and a sequential double‐staining method was applied.

Results  In the BCC lesion, the number of mast cells with tryptase activity and chymase immunoreactivity was significantly increased by 2.2‐ to 2.3‐fold. Practically all tryptase‐immunopositive cells contained tryptase activity although occasional tryptase‐immunopositive cells (about 1% of total) revealed no activity. However, the ratio of cells with chymase activity to those with chymase immunoreactivity was significantly decreased from 49 ± 19% in the healthy skin to 33 ± 19% in the BCC lesion. Instead, the percentage of mast cells displaying α1‐AC or α1‐PI immunoreactivity was significantly increased by 1.7‐fold in the BCC lesion. SCCA‐2 expression was strongly increased in the malignant BCC epithelium but mostly in the suprabasal layers.

Conclusions  Tryptase‐ and chymase‐positive mast cells (MCTC) increased in the BCC lesion. However, chymase is partially inactivated, possibly by the effective chymase inhibitors α1‐AC and α1‐PI. SCCA‐2 increased in BCC, but was localized mostly to the suprabasal layers, and thus it seems not to be crucial in inhibiting chymase.
Allergy to peanut oil – clinically relevant?
Authors: Ring J , Möhrenschlager M
Published: January 2007

The increasing prevalence of food allergies (especially allergy to peanuts) has led to a discussion of how safe topical preparations containing peanut oil are with respect to allergy.

The major allergens from peanuts are proteins that have been characterized at a molecular level and cloned. Clinical signs of peanut allergy symptoms can be observed on the skin (urticaria), or in the gastrointestinal and/or respiratory tract culminating in cardiovascular symptoms and anaphylactic reactions. In most cases, symptoms are elicited by oral uptake; rarely, a contact urticaria has been described. In vegetable oils, the contents of protein differ depending on the production process: crude oils contain approximately 100 times more proteins than refined oils. This has clear‐cut implications for allergic individuals. Quantitative data are available regarding elicitation of symptoms in allergic individuals with a threshold dose of 0.1–1 mg peanut allergen in oral provocation tests. There are anecdotal reports of adverse reactions after topical use of peanut oils. In one epidemiological trial, an association between topical use of skin care products containing peanut oil and the development of peanut allergy was observed; however, the data reflect a retrospective analysis without specifying skin care products containing peanut oil and also without analysing the quantity of topicals used. In contrast, oral tolerance was prevented and allergic sensitization was enhanced in a mouse model using high concentrations of peanut protein. So far, no reliable data are available regarding doses required to induce sensitization against peanut allergen via the epidermal route. A possible induction of sensitization against peanut proteins through contact with the skin via skin care products and the respective protein concentrations is a matter of speculation. Patients with atopic diseases, namely eczema, need appropriate skin care because of the disturbed skin barrier function. The benefit of avoiding damage to skin barrier functions of atopic individuals by the use of peanut protein‐containing skin care products seems to outweigh possible risks of sensitization and/or allergy induction against substances contained in those products containing refined peanut oil.
Effect of incorporation of dairy products in chevon nuggets
Authors: BAGCHI ANGSHUMAN , CHAKRABORTY RUNU , RAYCHAUDHURI UTPAL
Published: January 2007

This paper presents the different ways of incorporating various coprecipitates obtained from milk in chevon nuggets. The chevon was obtained from a rare but popular breed called Black Bengal goat. Milk coprecipitates of varying composition were in the formulations. Emulsion stability, yield, moisture and protein contents were not affected significantly, whereas shear force, pH, various organoleptic properties were found to be affected significantly. This method may potentially lead to the development of new emulsion‐based nuggets.
Effects of fat on the properties of halloumi cheese
Authors: THEOPHILOU PANAYIOTA , WILBEY R ANDREW
Published: January 2007

Halloumi cheese was produced from 11 bovine milks with fat contents of 1.61–4.04%, giving a range of 32–53% fat in dry matter (FDM) in the cheeses. Starter culture and/or microparticulated whey protein (Simplesse

®

100(E)) was also added to selected batches of milk. Hardness decreased with increasing FDM, with increase in moisture and with lower pH. On sensory evaluation, there was an increase in preference score with FDM (R2 = 0.8). Inclusion of microparticulated whey protein may have had a fat mimetic effect, as preference scores otherwise decreased with increasing protein levels (R2 = 0.75).
Water mobility during renneting and acid coagulation of casein solutions: a differentiated low‐resolution nuclear magnetic resonance analysis
Authors: HINRICHS RUTH , BULCA SELDA , KULOZIK ULRICH
Published: January 2007

Changes in water mobility during renneting and fermentation (acidification) of casein micelle solutions measured by nuclear magnetic resonance (NMR) are presented. Casein solutions (native and ultra‐high temperature or UHT‐treated) were renneted and fermented directly in the NMR instrument to detect changes in water mobility due to the induced structural changes online. The data were analysed using a newly developed method capable of differentiating several fractions of water in terms of their mobility according to the T2 relaxation times in four distinct ranges, that is, immobile, weakly mobile, mobile and very mobile. Whereas obvious changes in the water mobility take place during acidification, no changes in the water mobility during renneting were observed. This is explained by proposing a model building on different mechanisms of coagulation between acidification and renneting.
Mexican Queso Chihuahua: rheology of fresh cheese†
Authors: VAN HEKKEN DIANE L , TUNICK MICHAEL H , TOMASULA PEGGY M , CORRAL FRANCISCO J MOLINA , GARDEA ALFONSO A
Published: January 2007

Rheological properties of fresh Queso Chihuahua made from raw milk (RM) or pasteurized milk (PM) were characterized using texture profile, torsion and small amplitude oscillatory shear analyses. Although the rheological properties varied significantly among the different brands with overlapping ranges for the individual RM and PM cheese brands, overall the PM cheeses were harder, chewier and more cohesive but had lower viscoelastic values than the RM cheeses. Establishing the rheological properties of Mexican Queso Chihuahua increases our understanding of the quality traits of Hispanic‐style cheeses and provides a foundation for maintaining the traditional texture of the cheese.
Development of an Oriental‐style dairy product coagulated by microcapsules containing probiotics and filtrates from fermented rice
Authors: SU LIEH‐CHI , LIN CHIN‐WEN , CHEN MING‐JU
Published: January 2007

The objectives of this study were to microencapsulate both probiotics and culture filtrates by spray drying to maintain enzyme activity and probiotic viability during storage. Thus, probiotics and culture filtrates from lao‐chao were microencapsulated by spray drying with various outlet air temperatures, and the milk‐clotting activity, survival of probiotics and physical properties of the microcapsules were determined. The end purpose was to create easy‐to‐use probiotic Kou Woan Loa cultures. In the near future, manufacturing probiotic Kou Woan Loa could be carried out by simply mixing milk with 5% microcapsules and waiting for 1 h for coagulation, which would be time saving and convenient. The present study has shown that microencapsulation of Lactobacillus acidophilus BCRC 14079, Bifidobacterium longum BCRC 14605 and culture filtrates from lao‐chao by spray drying could provide a good protection for both milk‐clotting enzymes and probiotics. The average of microcapsules size and density was 10 µm and 1.68 g/cm3, respectively. An increase in the microencapsulation efficiency of microcapsules and lower water activity was found when the outlet air temperature was raised. However, the survival of L. acidophilus and B. longum was reduced as the outlet air temperature increased. The numbers of probiotics were maintained above the recommended therapeutic minimum (107 cfu/g) throughout storage.
Property changes and cholesterol‐lowering effects in evening primrose oil‐enriched and cholesterol‐reduced yogurt
Authors: LEE SU‐JEONG , HWANG JI‐HYUN , LEE SEONG , AHN JOUNGJWA , KWAK HAE‐SOO
Published: January 2007

The present study was carried out to investigate the changes in chemical and sensory properties and the cholesterol‐lowering effect of evening primrose oil (EPO) addition to cholesterol‐reduced yogurt. The rate of cholesterol removal reached 93.5% by β‐cyclodextrin in yogurt before EPO addition. pH, viscosity and microbial counts decreased with amounts of EPO added. The thiobarbituric acid value of cholesterol‐reduced and EPO‐enriched yogurt increased proportionally to length of storage period and amount of EPO addition, and it was significantly different between the EPO‐enriched groups than in unenriched groups in all storage periods. The production of short‐chain free fatty acids (FFA) increased with longer periods of storage. From 6 days’ storage, the amounts of short‐chain FFA in 6 and 10% EPO‐enriched groups were significantly different from other groups. Most sensory scores of 2% EPO‐enriched group were not significantly different from those of the control, whereas 6 and 10% EPO addition showed an adverse effect on sensory analysis. In blood analysis, the total cholesterol increase after 8 weeks’ feeding was dramatically lowered to 39.2% in the 10% EPO‐enriched group from 57.7% in the control. In addition, the concentration of blood triglyceride increased in the control, whereas it decreased in the 10% EPO‐enriched group. The above results indicated that EPO addition resulted in a profound lowering effect in blood lipids, although it adversely affected some sensory properties.
Queso Chihuahua: effects of seasonality of cheesemilk on rheology†
Authors: TUNICK MICHAEL H , VAN HEKKEN DIANE L , CALL JEFFREY , MOLINA‐CORRAL F JAVIER , GARDEA ALFONSO A
Published: January 2007

Fresh semihard raw milk (RM) and pasteurized milk (PM) cheeses made by Mennonite communities in Chihuahua, Mexico were sampled in early winter, mid‐spring and late summer and evaluated during storage to determine if rheological properties were affected by the season the cheese was produced. Seasonal effects were observed in the rheology of the RM cheeses, which underwent more extensive proteolysis than the PM cheeses. The rheological properties of the PM cheeses and the composition of all cheeses were consistent throughout the year. The texture of the RM cheese is affected by season, whereas the variability in texture and composition of PM cheese is minimal, allowing for the manufacture of a uniform product.
Optimizing cholesterol removal from cream using β‐cyclodextrin cross‐linked with adipic acid
Authors: HAN EUN‐MI , KIM SONG‐HEE , AHN JOUNGJWA , KWAK HAE‐SOO
Published: January 2007

The present study was carried out to optimize the different conditions for cross‐linked β‐cyclodextrin (β‐CD) using adipic acid on cholesterol removal in cream. Different factors were β‐CD concentration, mixing temperature, mixing time and mixing speed. Cross‐linked β‐CD was prepared with adipic acid. When the cream was treated with 10% cross‐linked β‐CD, cholesterol removal was the highest at 90.7%, which was not significantly different from treatments with 15% and 20% cross‐linked β‐CD. Cholesterol removal was significantly influenced by mixing temperature, mixing time and mixing speed. After cholesterol removal from cream, the used cross‐linked β‐CD was washed for cholesterol dissociation and reused. For recycling study, the cholesterol removal in first trial was 91.5%, which was mostly same as that using new cross‐linked β‐CD. However, after 10 repeated trials using the same sample, only 83.4% of the cholesterol was removed from cream. Therefore, the present study indicated that the optimum conditions for cholesterol removal using cross‐linked β‐CD were 10%β‐CD addition, 30 min mixing with 1400 r.p.m. speed at 40°C with over 90% cholesterol removal. In addition, recycled β‐CD cross‐linked with adipic acid showed a similarly high recycling efficiency to unused β‐CD of about 90% up to the seventh trial.
Correlation study between standard plate count and flow cytometry for determination of raw milk total bacterial count
Authors: CASSOLI LAERTE DAGHER , MACHADO PAULO FERNANDO , DE OLIVEIRA RODRIGUES ANA CAROLINA , COLDEBELLA ARLEI
Published: January 2007

Milk samples were collected in the dry season (n = 155) and in the rainy season (n = 68) to establish a correlation between electronic flow cytometry and standard plate count for the determination of total bacterial count of raw milk. Results were expressed in individual bacterial count (ibc) and colony forming unit (cfu) for electronic flow cytometry (Bactocount) and standard plate count, respectively. The accuracy of Bactocount, denoted by the residual standard deviation (s(y,x)), was 0.309 log cfu/mL. The predictive interval of estimated values was broad and it is suggested that total bacterial count should be expressed in ibc without transformation to cfu.
The importance of chlamydial infections in obstetrics and gynaecology: An update
Authors: CURRIE Marian J. , BOWDEN Francis J.
Published: January 2007

Chlamydia is now the most common notifiable infectious disease in many countries, a fact that has serious ramifications for the reproductive health of women. This review highlights the epidemiology, pathophysiology, clinical features and reproductive sequelae of the infection. Current screening and management methods are outlined. Obstetricians and gynaecologists are ideally placed to play a major role in the primary prevention of this significant sexually transmitted infection.
Proteomic analysis and characterisation of human cervico‐vaginal fluid proteins
Authors: DI QUINZIO Megan K. W. , OLIVA Karen , HOLDSWORTH Sarah J. , AYHAN Mustafa , WALKER Susan P. , RICE Gregory E. , GEORGIOU Harry M. , PERMEZEL Michael
Published: January 2007

Aim:  Cervico‐vaginal fluid (CVF) may provide insight into the biochemical pathways of human reproduction and parturition. The aim of this study was to establish a 2‐D electrophoretic map of human CVF in healthy, pregnant women at term.

Methods:  CVF was collected, concentrated and processed by routine 2‐D polyacrylamide gel electrophoresis using pH 4–7‐immobilised pH gradient strips and 8–16% gradient polyacrylamide gels. Imaged gels were analysed, yielding more than 400 proteins. A total of 157 proteins were common to all gels with a subgroup of the most abundant proteins being excised and characterised either by MALDI or by electrospray ion‐trap mass spectrometry.

Results:  Twenty‐one proteins were successfully identified, yielding 15 different proteins. These included blood transport proteins (albumin and transthyretin); a structural protein (β‐actin); proteins involved in fatty acid metabolism (fatty acid‐binding protein and acetyl‐CoA‐binding protein); a calcium‐binding protein (annexin III); an anti‐inflammatory cytokine (interleukin‐1 receptor antagonist); proteinase inhibitors (α‐1‐antitrypsin, monocyte/neutrophil elastase inhibitor, squamous cell carcinoma antigen‐1 and cystatin A); and enzymes involved in oxidative stress defence (thioredoxin, peroxiredoxin 2, glutathione S‐transferase P and copper,zinc superoxide dismutase).

Conclusion:  CVF is a complex body fluid consisting of both endogenous and environmental proteins. The putative role of some of these proteins in the human reproductive tract is discussed.
Sleep duration and quality in healthy nulliparous and multiparous women across pregnancy and post‐partum
Authors: SIGNAL T. Leigh , GANDER Philippa H. , SANGALLI Michel R. , TRAVIER Noémie , FIRESTONE Ridvan T. , TUOHY Jeremy F.
Published: January 2007

Background:  Longitudinal studies of sleep during normal pregnancy and post‐partum are rare, and interpretation of the findings is often hampered by methodological issues. Consequentially, there is still limited information on what constitutes normal sleep quality and quantity across pregnancy and early post‐partum, for both nulliparous and multiparous women.

Aims:  To quantify the change and variability in sleep duration and quality across pregnancy and post‐partum for healthy nulliparous and multiparous women.

Methods:  Nineteen women (eight nulliparous and 11 multiparous) wore an actigraph and completed a sleep diary to objectively measure sleep for seven nights during the second trimester, one week prior to delivery, and at one and six weeks post‐partum. Mixed model analysis of variance and logistic regression were used to investigate changes in sleep across this timeframe.

Results:  The largest changes in sleep occurred in the first week post‐partum (1.5 h less sleep than during pregnancy, three times more sleep episodes in 24 h, 70% of women regularly napping during the day, and greatest day‐to‐day variability in sleep). Compared to multiparas, nulliparas generally had less efficient sleep, spent more time in bed and had greater wake after sleep onset in the second trimester, and spent less time in bed and had fewer sleep episodes a day at one week post‐partum.

Conclusions:  These changes should be used to inform women about the extent of change in sleep, particularly early post‐partum, and to help health‐care providers identify women experiencing severe sleep loss and disruption and discuss possible coping strategies with them.
Misoprostol for termination of mid‐trimester post‐Caesarean pregnancy
Authors: BHATTACHARJEE Nabendu , GANGULY Rajendra Prasad , SAHA Shyama Prasad
Published: January 2007

Objective:  To evaluate the efficacy and safety of PGE1 analogue, misoprostol, for inducing abortion or labour during mid‐trimester in women who have had a prior Caesarean section (one or more).

Study design:  Women who had to undergo termination of pregnancy between 13 and 26 weeks of gestation for various indications and who had at least one previous Caesarean section were studied over a period of two and a half years. The standard regimen for misoprostol in all the cases was 400 µg up to 20 weeks of gestation and 200 µg for pregnancies longer than 20 weeks, either vaginally or sublingually every six hours (up to maximum 24 h). A contemporaneous cohort of women undergoing the same procedure for similar indications but without scarred uteri served as control.

Results:  Eighty women in the study group underwent termination procedures for unwanted pregnancy, missed abortion, fetal anomaly or fetal death. The median induction–abortion interval was 16.4 h (10–21 h) and did not differ much from that in women without previous Caesarean delivery (median: 15.6 h; range 9.6–20 h), P > 0.05. Misoprostol was found to be safe in our cohort of post‐Caesarean women and there was no case of scar rupture or dehiscence. No significant differences in rates of incomplete abortions, blood loss or sepsis were detected in the study group compared to the control group.

Conclusion:  The use of misoprostol for mid‐trimester pregnancy termination is not contraindicated in women with Caesarean scar and is effective and comparable with those in women without scarred uteri.
The effects of acupuncture during labour on nulliparous women: A randomised controlled trial
Authors: HANTOUSHZADEH Sedigheh , ALHUSSEINI Navid , LEBASCHI Amir Hussein
Published: January 2007

Background:  Acupuncture is as an ancient system of diagnosis and treatment. It is regarded as a complementary tool for pain management.

Aims:  To assess the effects of acupuncture on nulliparous women during labour with respect to pain, labour duration and maternal acceptability.

Methods:  One hundred and forty‐four healthy nulliparous women in active phase were randomised into the study and control group, receiving real and minimal acupuncture, respectively. Visual analogue scale was used to assess pain. Objectives were to evaluate acupuncture effect on pain and labour duration and patients’ willingness to receive acupuncture for subsequent pregnancies.

Results:  Visual analogue scale pain score in the study group was lower after two hours. Active phase duration and the oxytocin units administered were lower in the study group. Study group patients had greater willingness to receive acupuncture again. No adverse effects were detected.

Conclusions:  Acupuncture could reduce pain experience, active phase duration and oxytocin units. Patients were satisfied and no adverse effects were noted.
Labour and perinatal outcome in women at term with one previous lower‐segment Caesarean: A review of 1000 consecutive cases
Authors: TAN Peng Chiong , SUBRAMANIAM Revathy Nadesan , OMAR Siti Zawiah
Published: January 2007

Objective:  To compare the outcome in 1000 women at term with one lower transverse Caesarean that was suitable for a trial of labour.

Methods:  One thousand consecutive women with one previous scar suitable for a trial of labour delivering in our centre from June 2002 to December 2005 were identified from the labour ward register. Data were retrieved from patients’ charts, and neonatal admissions were determined.

Results:  In the study, 76.8% of women underwent a trial of labour, with a 71.2% vaginal birth rate. Hospital stay was shorter with a trial of labour. The three perinatal deaths (0.4%; P = 1.0) occurred in the trial of labour group. Compared to elective repeat Caesareans, successful vaginal births after trial of labour were associated with less neonatal admission, reduced blood transfusion requirement and shorter hospital stay; emergency Caesarean deliveries after a trial of labour were associated with more neonatal admissions and operative complications.

Conclusions:  Trial of labour was associated with a shorter hospital stay. A successful trial of labour after one Caesarean was associated with the best outcome underscoring the importance of patient selection for a trial of labour.
Women with gestational diabetes mellitus in the ACHOIS trial: Risk factors for shoulder dystocia
Authors: ATHUKORALA Chaturica , CROWTHER Caroline A. , WILLSON Kristyn ,   Australian Carbohydrate Intolerance Study in Pregnant Women (ACHOIS) Trial Group
Published: January 2007

Background:  Gestational diabetes mellitus (GDM) is associated with increased risk of fetal macrosomia and shoulder dystocia. However, not all women with GDM and fetal macrosomia have shoulder dystocia.

Aims:  To identify the risk factors for shoulder dystocia in women with gestational diabetes using data from women recruited into the routine care group of the ACHOIS trial.

Methods:  A secondary analysis was performed on data collected from women enrolled in the ACHOIS trial. Bivariate analyses were performed using the Fisher exact test. Variables found to be significantly associated with shoulder dystocia and previously identified risk factors were used as explanatory variables in multivariate analyses.

Results:  A positive relationship was found between the severity of maternal fasting hyperglycaemia and the risk of shoulder dystocia, with a 1 mmol increase in fasting oral glucose‐tolerance test leading to a relative risk (RR) of 2.09 (95% CI 1.03–4.25). Shoulder dystocia occurred more often in births requiring operative vaginal delivery (RR 9.58, 95% CI 3.70–24.81, P < 0.001). Macrosomic and large‐for‐gestational‐age infants were more likely to have births complicated by shoulder dystocia (RR 6.27, 95% CI 2.33–16.88, P < 0.001 and RR 4.57, 95% CI 1.74–12.01, P < 0.005, respectively). Fetal macrosomia was the only variable to maintain its significance in all multivariate analyses.

Conclusions:  Fetal macrosomia is the strongest independent risk factor for shoulder dystocia. Effective preventative strategies are needed.
Patterns of antenatal corticosteroid prescribing 1998–2004
Authors: POLYAKOV Alex , COHEN Saul , BAUM Marita , TRICKEY Donna , JOLLEY Damien , WALLACE Euan M.
Published: January 2007

Background:  The administration of antenatal corticosteroids to women at risk of preterm birth is an important component of care for such women. However, inevitably, attempts to maximise the number of women who receive corticosteroids ahead of preterm birth will also expose women perceived at risk who subsequently deliver at term. These women have not been previously quantified.

Aims:  To describe antenatal corticosteroid prescribing practices at a single institution over a seven‐year period.

Methods:  Interrogation of an electronic birthing outcome system supplemented by hand‐searching of medical records, recording all women birthing before 34 weeks and all women with a hospital admission before 34 weeks but birthing after 34 weeks. The number of women receiving antenatal corticosteroids in each of these groups was recorded, and trends between groups and over time were analysed using logistic regression.

Results:  While the total number of women receiving antenatal corticosteroids in our institution has risen over the last seven years, the proportion of women receiving antenatal corticosteroids who deliver between 24 and 35 weeks has increased inconsistently and modestly (average increase 12% per year (95% CI: 6–19%, P < 0.001). In contrast, the number of women receiving antenatal corticosteroids who subsequently deliver after 34 weeks has increased consistently, with an average increase rate of 21% per year (95% CI: 16–25%, P < 0.001).

Conclusions:  Increasing numbers of women birthing after 34 weeks in our hospital are receiving antenatal corticosteroids before 34 weeks. The long‐term implications of this are not currently clear.
Clinical and histological significance of atypical glandular cell on Pap smear
Authors: BEHTASH Nadereh , NAZARI Zeinab , FAKHREJAHANI Farhad , KHAFAF Alireza , AZAR Elham Ghayouri
Published: January 2007

Background:  Atypical glandular cell (AGC) on Pap smear is uncommon but may represent a variety of benign and malignant lesions.

Aim:  The aim of this study was to evaluate the association between AGC on Pap smear and significant pathological finding to tailor management protocols.

Methods:  Between 2002 and 2005, 60 women with AGC on Pap smears were referred to our colposcopy clinic. Forty‐one women underwent colposcopy‐directed biopsy, endocervical curettage, endometrial sampling and cervical conisation to determine the cytological and histological correlations of AGC on Pap smears.

Results:  The mean age of the patients was 46.9 ± 11.5 years (range, 23–80 years). Of these patients 13 patients (31.7%) were postmenopause and 28 patients (68.2%) were in reproductive age. We found eight (19.5%) significant pathological findings including four (9.7%) high‐grade squamous intraepithelial lesion, one (2.4%) adenocarcinoma of uterus, one (2.4%) adenocarcinoma of cervix, one (2.4%) squamous cell carcinoma of cervix and one (2.4%) papillary serous tumour of ovary.

Conclusion:  AGC on Pap smear was associated with a clinically significant diagnosis in approximately 20% of our cases. The women with a diagnosis of AGC on cervicovaginal smear are needed to be evaluated at least with colposcopy, endocervical and endometrial curettage. Clinicians should be careful about the significance of AGC on Pap smears.
Endometrial cells as a predictor of uterine cancer
Authors: HEARD Adrian R. , RODER David M. , SHORNE Lesley , KENNY Bernadette , PRIEST Kevin R.
Published: January 2007

Background:  With the recent cervix screening national guidelines recommending against reporting of benign endometrial cells, we examined South Australian data to see what impact this would have on detecting uterine cancers.

Aims:  To test whether benign endometrial cells detected in cervical cytology testing confer an increased risk of uterine cancer, and to ascertain what percentage of uterine cancers will be missed in cervical screening programs if these cells are not reported.

Methods:  The study was a retrospective cohort design of 1585 women with shed endometrial cells, each matched with three women without shed cells. All were linked with cancer registry data to check for uterine cancer diagnosis. Cox proportional hazards regression was used to check for any increase in cancer risk with shed endometrial cells. Using the calculated relative risks for uterine cancer diagnosis, we estimated the number of uterine cancers in South Australia associated with benign endometrial cells.

Results:  The presence of benign endometrial cells in a cervical cytology test increases the risk of uterine cancer sixfold. However, screening women with benign cells would involve a major increase in pathology work for only an 18% increase in uterine cancers detected.

Conclusions:  Until cytology systems have a higher sensitivity in detecting which benign endometrial cells are associated with uterine cancer, pathology laboratories are unlikely to be required to report these cells on tests. Inability to adjust for symptomatic status may have reduced the relevance of the results in this study.
Alternative cervical cancer prevention in low‐resource settings: Experiences of visual inspection by acetic acid with single‐visit approach in the first five provinces of Thailand
Authors: PALANUWONG Buncha
Published: January 2007

Background:  After the confirmation of its safety, acceptability and feasibility in a cervical cancer prevention demonstration project in 2002, a visual inspection by acetic acid (VIA) followed by an effective treatment using cryotherapy as a single‐visit approach (SVA) was recently introduced in five provinces having low Pap smear screening rates, in Thailand. The effectiveness of a screening program is usually associated with a high level of coverage; however, in low‐resource settings such a high coverage is still hard to attain by the conventional Pap smear approach.

Aims:  To evaluate whether VIA/SVA can increase women's access to the prevention services in low‐resource provinces of Thailand.

Methods:  A cross‐sectional study was conducted by analysing electronic screening records of the provinces. A χ2 test was used in the comparisons of screening coverage between the year before and the first year of VIA/SVA implementation during 1998–2005.

Results:  This comparative study, which included 88 554 screening visits totally, shows a significant increase in the screening coverage of five provinces after the VIA/SVA implementation (P < 0.001). As a result of the large substitution of VIA/SVA for Pap smears, the costs of screening were lowered by as much as $US362 300 (66.8%) in the first year.

Conclusion:  VIA/SVA has provided good screening coverage and lowered the financial burden in five low‐resource provinces of Thailand. Therefore, it is promisingly competitive as a potential alternative means of cervical cancer prevention in low‐resource areas.
Achieving quality assurance standards in colposcopy practice: A teaching hospital experience
Authors: NOOH Ahmed , BABBURI Padma , HOWELL Robert
Published: January 2007

Objective:  To assess the performance of the colposcopy service of the teaching hospitals of Cardiff and Vale Trust, University of Wales, Cardiff, South Wales, UK by determining if patients attending colposcopy clinic had been managed in accordance with the local departmental, regional and national (National Health Service Cervical Screening Programme) guidelines with the ultimate purpose of identifying areas for improvement in patients’ care.

Methods:  We retrospectively analysed the case notes of 426 women who attended the colposcopy clinic over a three‐month period in 2005.

Results:  This study has shown that five of the national standards have been achieved. These relate to availability of cytology report at the time of colposcopic assessment, recording of colposcopist's impression as to the nature of the cervical lesion, suitability of biopsy samples for histological analysis, primary haemorrhage as a complication of large loop excision of transformation zone treatment and inpatient admission following this treatment. However, other five unmet standards relate to recording of visibility of squamocolumnar junction, predictability of high‐grade lesion, taking a biopsy from a high‐grade lesion as suggested by smear, recording consent of treatment, and number of treatments performed as an outpatient.

Conclusion:  Our findings should lead to changes in the structure and functioning of the colposcopy clinic that would improve the detection of significant disease and the timeliness of diagnosis and the speed with which results are communicated.