bluuebunny/crossref_metadata_2025 huggingface dataset:
How geographic distance and depth drive ecological variability and isolation of demersal fish communities in an archipelago system (Cape Verde, Eastern Atlantic Ocean)
Authors: Medina Anibal , Brêthes Jean‐Claude , Sévigny Jean‐Marie , Zakardjian Bruno
Published: June 2007

Cape Verde is a tropical oceanic ecosystem, highly fragmented and dispersed, with islands physically isolated by distance and depth. To understand how isolation affects the ecological variability in this archipelago, we conducted a research project on the community structure of the 18 commercially most important demersal fishes. An index of ecological distance based on species relative dominance (Di) is developed from Catch Per Unit Effort, derived from an extensive database of artisanal fisheries. Two ecological measures of distance between islands are calculated: at the species level, ΔDi, and at the community level, ΔD (sum of ΔDi). A physical isolation factor (Idb) combining distance (d) and bathymetry (b) is proposed. Covariance analysis shows that isolation factor is positively correlated with both ΔDi and ΔD, suggesting that Idb can be considered as an ecological isolation factor. The effect of Idb varies with season and species. This effect is stronger in summer (May to November), than in winter (December to April), which appears to be more unstable. Species react differently to Idb, independently of season. A principal component analysis on the monthly (ΔDi) for the 12 islands and the 18 species, complemented by an agglomerative hierarchical clustering, shows a geographic pattern of island organization, according to Idb. Results indicate that the ecological structure of demersal fish communities of Cape Verde archipelago, both in time and space, can be explained by a geographic isolation factor. The analytical approach used here is promising and could be tested in other archipelago systems.
Simvastatin for rats with thioacetamide‐induced liver failure and encephalopathy
Authors: Huang Hui‐Chun , Wang Sun‐Sang , Lee Fa‐Yauh , Chan Cho‐Yu , Chang Full‐Young , Lin Han‐Chieh , Chu Chi‐Jen , Chen Yi‐Chou , Lee Shou‐Dong
Published: June 2007

Background and Aim: Nitric oxide (NO) inhibition aggravates hepatic damage and encephalopathy and increases mortality in rats with thioacetamide (TAA)‐induced acute liver failure. Statins enhance NO synthase expression beyond their lipid‐lowering capability, but the impact on encephalopathy remains unexplored. The aim of this study was to assess the effects of simvastatin on rats with TAA‐induced acute liver damage and hepatic encephalopathy.

Methods: Sprague–Dawley rats received TAA (350 mg/kg/day) or normal saline (NS) by intraperitoneal injection for 3 consecutive days. Two days before injections, each group was divided into three subgroups, taking (i) distilled water; (ii) simvastatin (20 mg/kg/day); or (iii) simvastatin plusNG‐nitro‐l‐arginine methyl ester (L‐NAME, 25 mg/kg/day) by oral gavage for 5 days. On the fifth day, severity of encephalopathy was assessed and plasma levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin and ammonia were measured.

Results: The TAA subgroups showed higher ALT, AST, bilirubin and ammonia levels and lower motor activity counts as compared with the NS subgroups. Among the TAA‐treated subgroups, rats with simvastatin treatment exerted higher motor activity counts and survival rate (P = 0.043), and a trend of lower ALT, AST, bilirubin and ammonia levels than those receiving saline. All rats that underwent simvastatin plus L‐NAME treatment died during or after TAA injections.

Conclusions: Simvastatin improved encephalopathy and survival in TAA‐administered rats. The beneficial effect was offset by L‐NAME, suggesting the role of NO in liver damage and encephalopathy.
A family with juvenile polyposis linked to the BMPR1A locus: Cryptic mutation or closely linked gene?
Authors: Chow Elizabeth , Lipton Lara , Carvajal‐Carmona Luis G , Arthur Gordon , Bhathal Prithi , Kaur Gurjeet , Jaeger Emma , Woodford‐Richens Kelly , Howarth Kimberley , Tomlinson Ian , Macrae Finlay
Published: June 2007

Background and Aim:  Familial juvenile polyposis syndrome (JPS) is a rare autosomal dominant condition in which patients develop hamartomatous gastrointestinal polyps with malignant potential. Pathogenic germline mutations in both the SMAD4 and BMPR1A genes involved in the transforming growth factor β pathway account for 40% of cases of JPS. Genetic heterogeneity remains evident, as the balance of cases is not accounted for by mutations in these genes. The aim of this study was to determine the mutation responsible in a family with juvenile polyposis.

Methods:  An Australian Caucasian family with juvenile polyposis have attended and followed surveillance plans through the Familial Bowel Cancer Clinic, The Royal Melbourne Hospital. A pedigree of the family was constructed with attention to the mixed phenotypic expression of polyps in affected members. Genetic testing for SMAD4 and BMPR1A mutations in germline DNA and linkage analysis to SMAD4, BMPR1A and 15q14 (CRAC1 locus) were performed.

Results:  There were no pathogenic mutations in SMAD4 and BMPR1A. There was no linkage to SMAD4 or 15q14 (CRAC1 locus). Linkage analysis suggested a cryptic BMPR1A mutation or the presence of another gene in close proximity to the BMPR1A locus. Two additional candidate genes in the region of linkage (PTEN and MINPP1) were excluded.

Conclusion:  Most affected members of this Australian Caucasian family demonstrate a phenotype of mixed polyps: juvenile polyps, adenomas and/or hyperplastic polyps. Cloning of a potentially responsible gene closely linked to the BMPR1A locus or a cryptic mutation in BMPR1A may offer valuable insights into the pathogenesis of JPS.
Prevalence and prognosis of gastric cancer detected by screening in a large Japanese population: Data from a single institute over 30 years
Authors: Miyahara Ryoji , Niwa Yasumasa , Matsuura Tetsuo , Maeda Osamu , Ando Takafumi , Ohmiya Naoki , Itoh Akihiro , Hirooka Yoshiki , Goto Hidemi
Published: June 2007

Background and Aim:  In Japan, screening examination with photofluorography is widely performed to reduce the mortality due to gastric cancer. The possibility of a future decline in gastric cancer cases and changes in its characteristics is suggested. The aim of this study was to examine the usefulness of direct radiology as a general health screening technique and the historical changes of gastric cancer in Japan.

Methods:  This study involved 936 patients with gastric cancer whose carcinomas were detected by direct radiology as part of a general health screening at the Aichi Prefectural Center for Health Care from 1970 to 2000. We studied the prevalence of gastric carcinoma, its prognosis, differences between the two histological types of carcinoma and historical changes.

Results:  The age‐adjusted cancer detection rate slightly decreased. Comparing two histological types, diffuse‐type carcinoma cases relatively increased. Intestinal‐type carcinomas increased in the lower portion of the stomach, whereas diffuse‐type increased in the upper portion. The 5‐year survival rate was 92.7% for intestinal‐type carcinoma and 84.8% for diffuse‐type. Diffuse‐type carcinomas were further progressed than intestinal‐type when detected by direct radiology; however, detection of diffuse‐type improved, so the percentage of early gastric cancer of diffuse type significantly increased, and the survival rate significantly improved, from 70.4% to 90.5%.

Conclusion:  The prevalence of gastric cancer has been decreasing, but the proportion of diffuse‐type carcinoma localized in the upper portion of the stomach has been increasing in Japan.
Ultrasound‐guided liver biopsy in real life: Comparison of same‐day prebiopsy versus real‐time ultrasound approach
Authors: Manolakopoulos Spilios , Triantos Christos , Bethanis Sotirios , Theodoropoulos Jiannis , Vlachogiannakos Jiannis , Cholongitas Evangelos , Sideridis Markos , Barbatis Calipso , Piperopoulos Ploutarchos , Spiliadi Charis , Papadimitriou Nikolaos , Roukounakis Nikolaos , Tzourmakliotis Dimitrios , Avgerinos Alec , Burroughs Andrew
Published: June 2007

Background and Aim:  Currently, an increasing number of liver biopsies are performed by radiologists under real‐time ultrasound control. A routine ultrasound assessment of a puncture site before performing percutaneous biopsy is reported to increase diagnostic yield and decrease complication rates. It is not clear if real‐time ultrasound is superior to marking the puncture site before biopsy as regards reducing biopsy size and avoiding fragmentation and complications. The aim of this study was to compare ultrasound assessment of the puncture site before performing percutaneous liver biopsy with real‐time ultrasound liver biopsy for suspected diffuse liver disease.

Methods:  Consecutive percutaneous liver biopsies (n = 631) for diffuse liver disease were evaluated. Group A consisted of patients who had real‐time guided‐ultrasound biopsy performed by radiologists (241 patients; M/F, 35/106; median age 48 year [range, 17–76]; needle 18 G). Group B patients were assessed by radiologists using ultrasound of the puncture site on the same day that biopsies were performed by experienced gastroenterologists/hepatologists on the ward using the marked site (390 patients; M/F, 276/114; median age 43 year [range, 15–75]; needle 16 G).

Results:  There were no differences in severity of liver disease, establishing a diagnosis (OR, 1.92 [95% CI, 0.84–4.34]; P = 0.12), length of liver biopsy specimens, number of fragments or complications. Two independent variables were significantly associated with a histological diagnosis: longer biopsy length (P < 0001) and fragment number of two or less (P < 0.001).

Conclusion:  Real‐time ultrasound did not improve diagnostic yield or result in fewer complications. Marking the puncture site seems adequate and has the practical advantage that it takes up less of the radiologists' time.
Usefulness of transpapillary bile duct brushing cytology and forceps biopsy for improved diagnosis in patients with biliary strictures
Authors: Kitajima Yasuhiro , Ohara Hirotaka , Nakazawa Takahiro , Ando Tomoaki , Hayashi Kazuki , Takada Hiroki , Tanaka Hajime , Ogawa Kanto , Sano Hitoshi , Togawa Shozo , Naito Itaru , Hirai Masaaki , Ueno Koichiro , Ban Tessin , Miyabe Katuyuki , Yamashita Hiroaki , Yoshimura Norihiro , Akita Shinji , Gotoh Kazuo , Joh Takashi
Published: June 2007

Background and Aim:  Transpapillary bile duct brushing cytology and/or forceps biopsy was performed in the presence of an indwelling guidewire in patients with biliary stricture, and the treatment time, overall diagnosis rate, diagnosis rate of each disease, complications, and influences on subsequent biliary drainage were investigated.

Methods:  After endoscopic retrograde cholangiography, brushing cytology was performed, followed by forceps biopsy. In patients with obstructive jaundice, endoscopic biliary drainage (EBD) was subsequently performed. To investigate the influences of bile duct brushing cytology and forceps biopsy on EBD, patients who underwent subsequent EBD by plastic stent were compared with patients who underwent EBD alone.

Results:  The samples for cytology were collected successfully in all cases, and the sensitivity for malignancy/benignity, specificity, and accuracy were 71.6%, 100%, and 75.0%, respectively. The biopsy sampling was successful in 51 patients, and samples applicable to the evaluation were collected in all 51 patients. The sensitivity for malignancy/benignity, specificity, and accuracy were 65.2%, 100%, and 68.6%, respectively. Combination of the two procedures increased the sensitivity and accuracy to 73.5% and 76.6%, respectively. The time required for cytology and biopsy was 11.7 min, which is relatively short. Cytology and biopsy did not affect drainage. Regarding accidents, bile duct perforation occurred during biopsy in one patient (1.9%), but was rapidly improved by endoscopic biliary drainage.

Conclusions:  Transpapillary brushing cytology and forceps biopsy could be performed in a short time. The diagnosis rate was high, and the incidence of complication was low, having no influence on subsequent biliary drainage.
Developmental status of young infants with congenital heart disease
Authors: HIROSE YUKIMI , ICHIDA FUKIKO , OSHIMA YOSHIHIRO
Published: June 2007

Background: Developmental status of young infants with congenital heart disease (CHD) is associated with physical and psychosocial factors. With the aim of obtaining basic data to perform developmental support, the study was conducted to examine the development and associated factors among these infants.

Methods: The Japanese Denver Developmental Screening Test was performed in 75 infants at 3–5 months of age, and a questionnaire was sent to their mothers about recognition of their child’s development. Infants with and without developmental delay were compared using the characteristics of diagnosis of heart disease, symptoms and surgery, the state of growth of infants, and recognition of a child’s development by its mother. To specify more adequate factors, a multiple logistic regression analysis was conducted.

Results: Of 75 infants, 14 (18.7%) had developmental delay. Weight gain of standard weight–2SD, Kaup index, and recognition of a child’s development by mothers were associated with delayed development. In particular, infants gaining weight at <10 g/day were significantly more delayed than those gaining weight at >20 g/day. In addition, infants whose mothers recognized developmental delay were significantly delayed compared to those not recognized.

Conclusions: Developmental status of young infants with CHD was found to be strongly associated with growth. In particular, weight gain <10 g/day appeared to be the critical point for delayed development, as well as mothers’ recognition of their child’s development.
SUCCESSFUL MANAGEMENT OF METASTASIS‐INDUCED PANCREATITIS BY ENDOSCOPIC PANCREATIC DUCT STENTING IN A CASE OF LARGE CELL LUNG CANCER
Authors: Oku Takatomi , Maeda Masahiro , Wada Yuko , Waga Eriko , Sahara Shin , Nagamachi Yasuhiro , Fujita Miri , Suzuki Yasuhiro , Nagashima Kazuo , Niitsu Yoshiro
Published: June 2007

The prognosis for patients with metastasis‐induced acute pancreatitis (MIAP) is extremely poor. Although chemotherapy has been shown to improve overall survival in patients with MIAP, as well as in patients with small cell lung cancer, it is poorly tolerated by patients with severe pancreatitis. Furthermore, patients with a history of chemotherapy often develop multidrug‐resistant tumors. Here we report a first case of MIAP that was successfully managed by endoscopic pancreatic duct stenting. A 54‐year‐old man with pancreatic metastasis from large cell lung cancer developed acute pancreatitis approximately three times per month, despite a continuous conventional therapy for pancreatitis. As his disease was refractory to chemotherapy, he underwent endoscopic pancreatic duct stenting. The procedure was successful in controlling his pancreatitis, and he survived 7 months after the onset of a first acute pancreatitis. Our experience with this case suggests pancreatic duct stenting as one therapeutic method for MIAP.
ENDOSCOPIC MUCOSAL RESECTION OF A SOLITARY GASTRIC PLASMACYTOMA
Authors: Roost Jennifer , Mai Hugh , Banerjee Subhas , Longacre Teri , Van Dam Jacques
Published: June 2007

Gastrointestinal plasmacytoma typically occurs in the setting of a systemic plasma cell neoplasm such as multiple myeloma or plasma cell leukemia. Rarely, a solitary plasmacytoma is identified. Surgical excision of early, isolated plasmacytomas is usually curative. We report on endoscopic excision of a solitary gastrointestinal plasmacytoma.
AORTO‐DUODENAL FISTULA: MULTIDETECTOR COMPUTED TOMOGRAPHY AND GASTRODUODENOSCOPY FINDINGS OF A RARE CAUSE OF UPPER GASTROINTESTINAL HEMORRHAGE
Authors: De Filippo Massimo , Sverzellati Nicola , Albini Alessandra , Rabaiotti Enrico , Cavestro Martina , Quinto Salvatore , Zompatori Maurizio
Published: June 2007

An aorto‐enteric fistula is a serious complication of abdominal aortic aneurysm. Acute upper gastrointestinal bleeding may be a life‐threatening condition that calls for immediate diagnosis and action. Morbidity and mortality remain high despite progress in diagnosis and therapeutic procedures. In the literature, the aorto‐enteric fistula diagnostic suspicion by multidetector computed tomography scan is assumed on the basis of the interruption of the aortic wall, with the presence of duodenal gas situated to tightened contact with the aorta. We report a patient with an aorto‐duodenal fistula associated with inflammatory abdominal aortic aneurysm detected by gastro‐duodenoscopy and multidetector computed tomography scan, with gas found in the lumen of the abdominal aorta, between the aneurysm wall and the thrombus.
NEW ARGON PLASMA COAGULATION METHOD FOR SUPERFICIAL ESOPHAGEAL CARCINOMAS: ARGON PLASMA COAGULATION‐SUBEPITHELIAL ABLATION
Authors: Kawada Kenro , Kawano Tatsuyuki , Momma Kumiko , Fujiwara Junko , Nagai Kagami , Nishikage Tetsurou , Nakajima Yasuaki , Ogiya Kazuo , Tanaka Koji , Haruki Shigeo , Iwai Takehisa
Published: June 2007

Argon plasma coagulation (APC) has been introduced to the field of therapeutic endoscopy and is now widely used. A new ablation technique is herein proposed for the treatment of superficial esophageal carcinomas. According to this technique, after the initial ablation, we exfoliate the epithelium and then perform a second ablation (APC‐subepithelial ablation). APC is applied at a power/gas setting of 60 W and 2l min in the esophagus. The APC applicator is inserted through the working channel of the endoscope, and a transparent hood is then set at the tip of the endoscope. At first, lines are traced around the tumor. Next, the initial ablation is made in a uniform manner. A transparent hood is then attached to the ablated tumor and, thereafter, the epithelium is easily exfoliated. The muscularis mucosae are preserved. We next identify any remaining non‐uniform ablation areas and then a second ablation is made on those areas. To obtain a complete eradication of the mucosal and submucosal tissue, the endoscopic appearance of brownish subepithelial tissue following the secondary argon plasma irradiation after epithelial exfoliation with initial argon plasma irradiation is needed. The secondary ablation could thus safely ablate at the esophageal gland level. The procedure is minimally invasive and easy to apply. A total of 48 patients with superficial esophageal squamous cell carcinoma were treated between February 2000 and April 2006 (median follow up 46 months). One hundred and sixty one sessions were performed with no major complications (no bleeding, no perforation, and no stenosis). The technique is thus considered to be safe.
BLACK ESOPHAGUS: A CASE SERIES
Authors: Forman Robin , Gopal Kavitha , Huysman AnnMarie , Zanchi Antonella , Cohen Seth
Published: June 2007

Black esophagus is a rare endoscopic finding. While the etiology remains unknown, it occurs in elderly patients and/or those with comorbid conditions, particularly vascular disorders. It usually involves the distal third of the esophagus. The most common presenting symptom is acute esophageal bleeding. The natural history of the disease is that of spontaneous resolution. The differential diagnosis includes acute necrotizing esophagitis, melanosis, pseudo‐melanosis, melanoma, acanthosis nigricans, and caustic substance (lye) ingestion. Some associated conditions include ischemia, prolonged hypotension, hyperglycemia, hypersensitivity to antibiotics, herpetic infection, aortic dissection, and anti‐cardiolipin antibodies. The pathogenesis of black esophagus is not fully understood, but it is hypothesized that low systemic perfusion plays a dominant role. The present report describes three women diagnosed during esophagogastroduodenoscopy with black esophagus. Two of our patients presented with hypertensive emergencies, an association not reported in the literature. One of the patients described developed Gram‐negative bacteremia after esophagogastroduodenoscopy, an unreported sequelae of black esophagus.
DIFFUSE WHITE DEPOSITS OF THE DUODENUM MAY SUGGEST DELAYED GLUCOSE ABSORPTION
Authors: Urita Yoshihisa , Domon Kaoru , Ishihara Susumu , Nanami Makie , Yanagisawa Taketo , Okubo Ryo , Sawa Tomoka , Watanabe Toshiyasu , Akimoto Tatsuo , Kato Hirohito , Hara Noriko , Honda Yoshiko , Nagai Yoko , Nakanishi Kazushige , Shimada Nagato , Sugimoto Motonobu , Miki Kazumasa
Published: June 2007

Background:  The aim of the present study was to evaluate the relationship between white deposits observed in the duodenum and malabsorption of nutrients.

Methods:  132 consecutive subjects presenting with diagnostic upper endoscopy were recruited in this study. 13C‐acetate was given intraduodenally in 65 patients and 13C‐glucose in 67 patients. At the end of endoscopy, the tip of the endoscope was placed in the second part of the duodenum and 20 mL water containing 100 mg 13C‐substrate was sprayed onto the duodenal mucosa. Breath samples were taken at baseline and at 10 min intervals.

Results:  There were no significant differences between 13CO2 excretion and the grade of white deposits after giving intraduodenal 13C‐acetate. A delay in the 13CO2 excretion curve in patients with a body mass index of more than 26 was noted after giving 13C‐glucose and there was a significant delay in 13CO2 excretion in the ‘diffuse’ group as compared with the other two groups. The mean values of 13CO2 were significantly lower in obese patients than in non‐obese subjects.

Conclusion:  Results from the duodenal infusion study using stable isotopes demonstrate a close association between diffuse white deposits on the duodenal mucosa and delayed glucose absorption.
Sonographic femur length to trunk cross area ratio: Prediction of fetal outcome in 30 cases in which micromelia was suspected
Authors: Arahori Hitomi , Tamura Arihiro , Wasada Kenshi , Shimoya Kouichiro , Wada Kazuko , Murata Yuji , Ozono Keiichi
Published: June 2007

Aim:  The purpose of the present study was to investigate the potential value of fetal routine sonographic biometry in evaluating micromelias.

Methods:  Thirty fetuses had a presumptive diagnosis of micromelia from antepartum ultrasound examinations during the period between 1 April 1996 and 31 March 2005. The postnatal clinical features, final diagnoses and outcomes were examined to retrospectively compare these cases with biometric parameters obtained from routine antepartum ultrasound examinations.

Results:  Final diagnoses included skeletal dysplasia (16), small‐for‐dates (SFD) infant without any abnormalities (seven), chromosomal abnormality (three), pyruvate dehydrogenase complex deficiency (one), Marden–Walker syndrome (one), and suspected Freeman–Sheldon syndrome (one). One turned out to be a healthy infant. All cases were divided on the basis of the final diagnoses into three groups: skeletal dysplasia (16 fetuses), SFD and healthy infant (eight fetuses) and others (six fetuses). The ratios of femur length (FL) to mean FL at a given gestational age (%FL) and of FL to biparietal diameter (FL/BPD) were significantly lower in the skeletal dysplasia group than those in the other groups. Moreover, in the skeletal dysplasia group, when the lethal cases were excluded, the ratio of FL to fetal trunk cross area (FL/FTA) was significantly lower than that in the other groups.

Conclusions:  FL/FTA appears to be a useful parameter to help differentiate fetuses with non‐lethal skeletal dysplasia from anatomically normal fetuses either with constitutionally short limbs or with intrauterine growth restriction (IUGR).
Prospective study of intramuscular ergometrine compared with intramuscular oxytocin for prevention of postpartum hemorrhage
Authors: Saito Keisuke , Haruki Atsushi , Ishikawa Hiroshi , Takahashi Tsuneo , Nagase Hiromi , Koyama Makiko , Endo Masaya , Hirahara Fumiki
Published: June 2007

Aim:  To compare the efficacy and safety of intramuscular oxytocin with intramuscular ergometrine in the management of postpartum hemorrhage during the third stage of labor.

Methods:  Women who had been pregnant for more than 35 weeks and delivered cephalic singletons vaginally without predelivery administration of oxytocics were included. The cases considered to be at high risk were excluded, such as those who had uterine fibroids, a previous cesarean section, previous postpartum hemorrhage, or severe anemia. Five units of oxytocin or 0.2 mg of methylergometrine were administered intramuscularly immediately after delivery of the baby.

Results:  Compared with intramuscular ergometrine, the use of intramuscular oxytocin was associated with a significant reduction in mean total postpartum blood loss (288.16 g vs 354.42 g, P = 0.004), frequency of postpartum hemorrhage (≥500 mL: 10.9% vs 20.32%, relative risk [RR] = 0.54, 95% confidence interval [CI] = 0.32–0.91), and need for therapeutic oxytocics (5.13% vs 12.3%, RR = 0.42, 95% CI = 0.19–0.91). There were no differences between the groups in terms of the mean duration of the third stage, the mean level of hemoglobin on the second postpartum day, and the frequency of postpartum hemorrhage (≥1000 mL), or manual removal of placenta. Few side‐effects were found, with no significant differences between the groups.

Conclusions:  The routine use of intramuscular oxytocin is more effective than the use of intramuscular ergometrine for prevention of postpartum hemorrhage in the third stage of labor.
Impact of advanced maternal age on neonatal survival of twin small‐for‐gestational‐age subtypes
Authors: Kristensen Sibylle , Salihu Hamisu M. , Keith Louis G. , Kirby Russell S. , Pass Mary A. B. , Fowler Karen B.
Published: June 2007

Aim:  We examined the impact of advanced maternal age (>40 years old) on the survival of twin small‐for‐gestational‐age (SGA) infants, that is, infants who were smaller in size than was expected for the baby's sex, genetic heritage, and gestational age.

Methods:  The present study was a retrospective cohort study on twin live births in the USA from 1995 to 1998 inclusive. Two categories of SGA babies were defined: discordant (when only one of a twin pair was SGA) and concordant (when both were SGA). Otherwise, the twin pair was appropriate‐for‐gestational‐age (AGA) concordant.

Results:  192 195 twin pairs were analyzed. The incidence of SGA discordance and concordance was 11.8% and 3.9%, respectively. The occurrence of both SGA subtypes tended to decrease with increasing maternal age. The unadjusted risk for neonatal mortality increased when both twins were affected (15.8: 22.8 and 56.6 per 1000 among AGA concordant, SGA discordant and SGA concordant twins; P‐value for trend < 0.0001). Using maternal‐age‐specific AGA babies as reference, the adjusted risk for neonatal mortality climbed progressively with advancing maternal age in a dose‐dependent pattern, being lowest among teenagers and highest in mothers aged ≥40 years.

Conclusions:  SGA discordance and concordance declined with advancing maternal age. In contrast, neonatal mortality of both SGA subtypes worsened with the increase in maternal age compared with that of the age‐specific AGA infants. These findings are potentially useful to care providers in counseling older women, a group that is progressively increasing in size and is most susceptible to twining.
Maternal positioning and fetal positioning in utero
Authors: Matsuo Koji , Shimoya Koichiro , Ushioda Norichika , Kimura Tadashi
Published: June 2007

Aim:  Approximately two‐thirds of term vertex fetuses are in the left occiput position in utero. However, little is understood about the physiology of maternal–fetal positioning during pregnancy. It was hypothesized that fetal left occiput positioning is affected by maternal positioning. The present study was designed to investigate the relationship between maternal positioning in late pregnancy and fetal positioning in utero.

Methods:  A prospective cohort study was conducted at Ueda Hospital, Kobe, Japan. Eligible women were limited to low‐risk pregnancies ending in spontaneous vaginal delivery with singleton vertex fetuses. Information obtained from the mother included the preference of positioning during sleep in the second half of pregnancy. Fetal information recorded after delivery included fetal positioning.

Results:  Eighty‐one (50.6%) of 160 evaluated women preferred left lateral positioning while 70 (43.8%) women preferred right lateral positioning in the second half of pregnancy. Seventy‐seven (51.7%) of 149 evaluated fetuses were in the left occiput position while 72 (48.3%) fetuses were in the right occiput position in utero. Maternal left lateral positioning with fetal left occiput position in utero was the predominant positioning (41 of 149, 27.5%). However, there was no statistical relationship between maternal positioning and fetal occiput positioning in utero.

Conclusion:  More women prefer the left lateral position during the second half of pregnancy. More fetuses are in the left occiput in utero during the late stage of pregnancy. However, no statistical relationship was observed between maternal and fetal positioning.
Pattern of lymph node metastasis and the optimal extent of pelvic lymphadenectomy in FIGO stage IB cervical cancer
Authors: Lee Jong‐Min , Lee Kwang‐Beom , Lee Seon‐Kyung , Park Chan‐Yong
Published: June 2007

Aim:  To evaluate the distribution pattern of lymph node metastasis and to determine the optimal extent of pelvic lymphadenectomy (LA) in FIGO stage IB cervical cancer.

Methods:  The medical records of 187 patients with FIGO stage IB cervical cancer from March 1996 to December 2002 were reviewed retrospectively. The distribution pattern and risk factors of lymph node metastases were analyzed in 31 patients with lymph node metastases confirmed surgically. One hundred patients, who underwent type III hysterectomy with pelvic LA but did not receive any adjuvant treatment, were analyzed to evaluate whether the extent of LA affected the prognosis of FIGO stage IB cervical cancer. Type I LA included the external iliac nodes, hypogastric nodes, obturator nodes, and parametrial nodes. Type II LA included the pelvic nodes described in type I LA, the common iliac nodes, gluteal nodes, deep inguinal nodes and sometimes the presacral nodes.

Results:  Solitary lymph node metastasis confined to one node group was seen in the obturator, external iliac or hypogastric lymph nodes. All patients with lymph node metastases at multiple sites had metastasis in at least one of these lymph‐node groups. There was no significant difference in disease‐free survival and overall survival in patients without pathologic high‐risk factors according to the type of pelvic LA.

Conclusion:  The extent of LA should be adjusted to reduce complications and not to affect adversely the prognosis of FIGO stage IB cervical cancer patients without pathologic high‐risk factors.
Ovarian endometriosis associated with ovarian cancer and endometrial–endocervical polyps
Authors: Kontoravdis Antonios , Augoulea Areti , Lambrinoudaki Irene , Christodoulakos George , Tzortziotis Dimitrios , Grammatikakis Ioannis , Kontoravdis Nikolaos , Creatsas George
Published: June 2007

Aim:  To determine the prevalence of ovarian cancer and endometrial polyps in women with moderate and severe ovarian endometriosis.

Methods:  A retrospective analysis of 667 cases of moderate and severe endometriosis laparoscopically and histologically confirmed during the period 1997–2004.

Results:  One hundred and ninety‐three (29%) of cases were American Fertility Society (AFS) stage III (moderate endometriosis) and 473 (71%) were AFS stage IV (severe endometriosis). Ovarian cancer was diagnosed in 13 cases (2.0%), while an endometrial or endocervical polyp was identified in 35 cases (5.3%). The incidence of endometrial polyps in the group with moderate endometriosis tended to be higher (15/193, 7.8%) than in the group with severe endometriosis (20/473, 4.2%), and the same results were obtained in the ovarian cancer group (moderate: 6/193, 3.1%; severe: 7/473, 1.5%). However, neither of the two differences was statistically significant.

Conclusions:  Ovarian endometriosis may be associated with an increased incidence of both ovarian cancer and endometrial polyps. Careful evaluation for coexistent pathology should be undertaken in women with symptomatic endometriosis.
Routine prophylactic application of Monsel's solution after loop electrosurgical excision procedure of the cervix: Is it necessary?
Authors: Kietpeerakool Chumnan , Srisomboon Jatupol , Suprasert Prapaporn , Cheewakriangkrai Chalong , Charoenkwan Kittipat , Siriaree Sitthicha
Published: June 2007

Aim:  To determine the benefit of an immediate application of Monsel's solution after loop electrosurgical excision procedure (LEEP) of the cervix for preventing postoperative bleeding.

Methods:  This randomized controlled trial was conducted at Chiang Mai University Hospital, Chang Mai, Thailand. Women who were scheduled for LEEP were approached for participation in the study. The primary endpoint was the duration of uncomplicated vaginal bleeding. Secondary endpoints were the incidence of persistent vaginal bleeding, and postoperative complications including severe early bleeding, severe delayed bleeding and infection.

Results:  Between October 2004 and May 2006, 285 women with an abnormal Pap‐smear, who had undergone LEEP, were randomly allocated to the Monsel's group (n = 140) or control group (n = 145). The baseline outcomes were similar between the two groups. In the Monsel's group, the duration of uncomplicated vaginal bleeding was significantly shorter (P < 0.001) and the occurrence of persistent vaginal bleeding was significantly lower (P = 0.014) than in the control group. The occurrence of severe complications that required treatment, including bleeding and infection, was not significantly different between the two groups (P = 0.379).

Conclusion:  An application of Monsel's solution after LEEP appears to reduce the duration of postoperative vaginal bleeding, but does not significantly prevent severe complications. Such practice may not be necessary if adequate hemostasis is achieved using electrical cauterization.
Hysteroscopy after uterine fibroid embolization in women of fertile age
Authors: Mara Michal , Fucikova Zuzana , Kuzel David , Maskova Jana , Dundr Pavel , Zizka Zdenek
Published: June 2007

Aim:  Uterine artery embolization for fibroids is a controversial issue for women with incomplete reproductive plans. Ovarian failure and uterine infection are the most dreaded complications of this procedure. The purpose of the present study was to assess the types and the frequency of intrauterine abnormalities and the histological features of the endometrium after embolization.

Methods:  Uterine artery embolization was performed on 51 women (average age 34.5 years) with intramural fibroid/s larger than 4 cm. Hysteroscopy and endometrial biopsy was performed from 3 to 9 months later in the luteal phase of the cycle.

Results:  Despite all women having no major symptoms prior to hysteroscopy, only 19 (37%) had completely normal hysteroscopic findings. There was intrauterine protrusion of fibroid/s in 19 cases (37%), yellowish coloration of the endometrium in 14 (28%), intrauterine or cervical adhesions in seven (14%), and communication between the myoma and the uterine cavity in five cases (10%). A normal, functional endometrium was histologically verified in 44 women of 49 (90%) who could be evaluated. Regressive changes (necrosis or hyalinization) of leiomyoma or of indefinite origin were found in 17 patients and embolization particles in five, including one patient with microspheres inside the endometrial vessel. No case of Asherman syndrome or endometrial atrophy was observed.

Conclusion:  The frequency of abnormal hysteroscopic findings after embolization is surprisingly high. The clinical significance, reversibility, and impact on fertility of abnormal hysteroscopic findings after embolization remain unclear. Regardless, hysteroscopy should be strongly recommended to all patients after uterine fibroid embolization, prior to conception.
Clinical applications of anxiety, social support, stressors, and self‐esteem measured during pregnancy and postpartum for screening postpartum depression in Thai women
Authors: Liabsuetrakul Tippawan , Vittayanont Arnont , Pitanupong Jarurin
Published: June 2007

Aim:  To assess the clinical applications of anxiety, social support, stressors and self‐esteem as well as the Postpartum Depression Risk Scale (PDRS), measured during pregnancy and postpartum, for screening postpartum depression.

Methods:  A questionnaire regarding anxiety, social support, stressors and self‐esteem was administered to 400 women during 36–40 weeks of gestation and 6–8 weeks postpartum prospectively, using factor analysis. The enrolled women were interviewed 6–8 weeks postpartum by psychiatrists using a diagnostic system of the Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition (DSM‐IV), for diagnosis of postpartum depression. Multiple logistic regression was used to identify the significant predictors for postpartum depression and then developed to be the PDRS and tested for clinical benefit.

Results:  Of 400 enrolled women, 40 (10%) were diagnosed with minor or major postpartum depression. After factor analysis, 10 items of anxiety, 10 items of social support, four items of stressors and five items of self‐esteem were identified, with a standardized reliability coefficient of 0.85, 0.82, 0.81 and 0.82 during pregnancy and of 0.84, 0.82, 0.85 and 0.84 during the postpartum period, respectively. During pregnancy, a significant predictor was anxiety about postpartum depression, but postpartum significant predictors were anxiety and social support, which were generated to be PDRS. The clinical benefit of PDRS as a measure was better postpartum than during pregnancy.

Conclusions:  Anxiety and social support were identified as the predictors of postpartum depression. The development of the PDRS is clinically beneficial and useful during pregnancy and postpartum for the screening of postpartum depression in Thai women.
Virilization in pregnancy due to a borderline mucinous ovarian tumor
Authors: Pather Selvan , Atkinson Kenneth , Wang Iris , Russell Peter , Kesby Greg , Carter Jonathan
Published: June 2007

Virilization in pregnancy due to borderline mucinous ovarian tumors is very rare. A case of a 28‐year‐old patient who was noted at 28 weeks' gestation to have marked virilization with raised serum androgens, ascites and a large complex right adnexal mass is presented. Delivery was carried out by cesarean section and at surgery a large tumor was noted in the right ovary. Histology revealed a borderline mucinous ovarian tumor with stromal luteinization, but there was no evidence of stromal invasion. Serum androgens returned to normal levels following surgery and the maternal virilization had resolved at the 6‐week postnatal visit. Stromal changes in borderline mucinous ovarian tumors may result in virilization due to androgen production; surgical removal is associated with an excellent clinical outcome.
Peptide YY producing strumal carcinoid of the ovary as the cause of severe constipation with contralateral epithelial ovarian cancer
Authors: Kawano Kouichiro , Ushijima Kimio , Fujimoto Takefumi , Komai Kan , Kamura Toshiharu
Published: June 2007

Primary ovarian carcinoid tumors are rare. It has been reported that constipation was a presenting symptom in some patients with ovarian carcinoid. A case of strumal carcinoid of the ovary with contralateral clear cell adenocarcinoma of the ovary discovered with a complaint of constipation is described. Constipation was dramatically improved by resectioning the tumor. The tumor cells were positive for peptide YY (PYY) in the carcinoid component, but not in any other components. The present case could provide evidence of the correlation between constipation and PYY that has been reported elsewhere. Interestingly, the constipation caused by PYY also helped in discovering epithelial ovarian cancer.
Non‐puerperal inversion of the uterus caused by leiomyosarcoma: A case report and clinical management
Authors: Buyukkurt Selim , Vardar Mehmet Ali , Zeren Handan , Ozgunen Fatma Tuncay
Published: June 2007

Uterine inversion is a rare complication of the postpartum period, but it is an even rarer complication of the non‐puerperal period. A 49‐year‐old nulliparous woman was admitted to the hospital with the following complaints: abnormal vaginal bleeding, pain, anuria and a mass protruding from the vulva. The mass was removed by twisting and a laparotomy was required for massive bleeding due to the inversion. The diagnosis of complete inversion was made during the laparotomy. Total abdominal hysterectomy and bilateral salpingo‐oophorectomy was performed and the pathological examination revealed a leiomyosarcoma. Uterine inversion in the non‐puerperal period is an extremely rare event and it should be kept in mind that the cause of the inversion may be a malignant disease, like leiomyosarcoma.
Incremental model for fatigue crack growth based on a displacement partitioning hypothesis of mode I elastic–plastic displacement fields
Authors: POMMIER S. , HAMAM R.
Published: June 2007

The mode I displacement field in the near crack tip region is assumed to be depicted by its partition into an elastic field and a plastic field. Then, each part of the displacement field is also assumed to be the product of a reference field, a function of space coordinates only, and of an intensity factor, function of the loading conditions. This assumption, classical in fracture mechanics, enables one to work at the global scale since fracture criteria can be formulated as a function of the stress intensity factors only. In the present case, the intensity factor of the plastic part of the displacement field measures crack tip plastic flow rate at the global scale. On the basis of these hypotheses, the energy balance equation and the second law of thermodynamics are written at the global scale, i.e. the scale of the K‐dominance area. This enables one to establish a yield criterion and a plastic flow rule for the crack tip region. Then, assuming a relation between plastic flow in the crack tip region and fatigue crack growth allows an incremental model for fatigue crack growth to be built. A few examples are given to show the versatility of the model and its ability to reproduce memory effects associated with crack tip plasticity.
PGD2 DP1 receptor protects brain from ischemia‐reperfusion injury
Authors: Saleem Sofiyan , Zhuang Hean , De Brum‐Fernandes Artur J. , Maruyama Takayuki , Narumiya Shuh , Doré Sylvain
Published: June 2007

Prostaglandin D2 is the most abundant prostaglandin in the brain. It has long been described as a modulator of the neuroinflammatory process, but little is known regarding the role of its Gαs‐coupled receptor, DP1. Therefore, in this study, the effect of the DP1 receptor on the outcome of cerebral ischemia in wildtype (WT) and DP1 knockout (DP1–/–) C57Bl/6 mice was investigated. Ischemia‐reperfusion injury was produced by a 90‐min occlusion of the right middle cerebral artery followed by a 4‐day reperfusion. Infarct size was 49.0 ± 11.0% larger in DP1–/– mice (n = 11; P < 0.01) than in WT mice (n = 9 per group). However, no differences were detected in the relative cerebral blood flow (CBF) or any of the physiological parameters measured (n = 5 per group) or in the large blood vessel anatomy (n = 3 per group). To further address whether the DP1 protective role in the brain could be extended to neurons, mouse primary corticostriatal neuronal cultures were exposed to the DP1‐selective agonist, BW245C, which provided dose‐dependent protection against excitotoxicity induced by glutamate. Protection was significant at a dose as low as 0.05 µm. The results indicate that the DP1 receptor is neuroprotective in both in vivo and in vitro paradigms. Development of drugs to stimulate the DP1 receptor in brain could provide a new therapeutic strategy against cerebral ischemia and potentially other neurological conditions.
Processing acoustic change and novelty in newborn infants
Authors: Kushnerenko Elena , Winkler István , Horváth János , Näätänen Risto , Pavlov Ivan , Fellman Vineta , Huotilainen Minna
Published: June 2007

Research on event‐related potential (ERP) correlates of auditory deviance‐detection in newborns provided inconsistent results; temporal and topographic ERP characteristics differed widely across studies and individual infants. Robust and reliable ERP responses were, however, obtained to sounds (termed ‘novel’ sounds), which cover a wide range of frequencies and widely differ from the context provided by a repeating sound [Kushnerenko et al., (2002) NeuroReport, 13, 1843–1848]. The question we investigated here is whether this effect can be attributed to novelty per se or to acoustic characteristics of the ‘novel’ sounds, such as their wide frequency spectrum and high signal energy compared with the repeated tones. We also asked how sensitivity to these stimulus aspects changes with development. Twelve newborns and 11 adults were tested in four different oddball conditions, each including a ‘standard’ sound presented with the probability of 0.8 and two types of infrequent ‘deviant’ sounds (0.1 probability, each). Deviants were (i) ‘novel’ sounds (diverse environmental noises); (ii) white‐noise segments, or harmonic tones of (iii) a higher pitch, or (iv) higher intensity. In newborns, white‐noise deviants elicited the largest response in all latency ranges, whereas in adults, this phenomenon was not found. Thus, newborns appear to be especially sensitive to sounds having a wide frequency spectrum. On the other hand, the pattern of results found for the late discriminative ERP response indicates that newborns may also be able to detect novelty in acoustic stimulation, although with a longer latency than adults, as shown by the ERP response. Results are discussed in terms of developmental refinement of the initially broadly tuned neonate auditory system.
Sensory learning‐induced enhancement of inhibitory synaptic transmission in the barrel cortex of the mouse
Authors: Tokarski Krzysztof , Urban‐Ciecko Joanna , Kossut Malgorzata , Hess Grzegorz
Published: June 2007

In adult mice, repetitive pairing of stimulation of mystacial vibrissae with an electrical shock to the tail induces expansion of the cortical representation of stimulated vibrissae accompanied by elevation of the GABAergic markers. Here, we show that this associative learning paradigm results in a selective increase in the frequency of spontaneous inhibitory postsynaptic currents in layer IV excitatory neurons located within the barrel representing stimulated vibrissae, evident 24 h after the end of training. The mean amplitude of spontaneous inhibitory postsynaptic potentials recorded from excitatory neurons was unchanged. Recordings from layer IV excitatory and fast spiking neurons showed that the training induced changes neither in the mean frequency nor it the mean amplitude of spontaneous excitatory postsynaptic currents. On the other hand, the mean amplitude of field potentials evoked by the stimulation of layer VI and recorded in layer IV was significantly reduced. These data indicate that aversive training results in a selective and long‐lasting enhancement of GABAergic transmission within the cortical representation of stimulated vibrissae, which may result in a decrease in layer VI‐evoked field responses.