bluuebunny/crossref_metadata_2025 huggingface dataset:
Impaired vascular function in women with pre‐eclampsia observed with orthogonal polarisation spectral imaging
Authors: Vollebregt Karlijn C. , Boer Kees , Mathura Keshen R. , de Graaff Jurgen C. , Ubbink Dirk Th. , Ince Can
Published: December 2003

Objective To investigate in vivo the function of the microcirculation of the skin in pregnancy and pregnancy complicated with pre‐eclampsia.

Design Case–control study.

Setting Academic Medical Centre.

Participants A group of 10 women with pre‐eclampsia and a healthy control group of 10 pregnant women.

Methods The microcirculation of the skin of the finger at rest and during venous occlusion was studied with laser Doppler fluxmetry and orthogonal polarisation spectral imaging. By inflating a cuff around the upper arm to a pressure of 50mmHg, causing venous occlusion, the local sympathetic veno‐arteriolar reflex was provoked. With laser Doppler fluxmetry the blood flow of the skin at a depth of 1–2mm was measured at rest and during venous occlusion. Orthogonal polarisation spectral imaging was used to assess red blood cell velocity at rest and during venous occlusion of the nutritive capillaries of the skin.

Results Laser Doppler fluxmetry showed no significant difference between the normotensive group and the group with pre‐eclampsia. Using orthogonal polarisation spectral imaging, venous occlusion produced a significantly greater decrease in red blood cell velocity in the control group than in the women with pre‐eclampsia: (84% (81–88)(median and interquartile range) vs 58% (45–88), P=0.0029). No differences in absolute red blood cell velocities were observed between groups either at rest or during venous occlusion.

Conclusion This study shows an impaired local veno‐arteriolar reflex in pre‐eclampsia at the nutritive, but not at the thermoregulatory, level of the microcirculation of the skin.
A randomised placebo‐controlled trial to determine the effect of vitamin E in treatment of primary dysmenorrhoea
Authors: Ziaei S. , Faghihzadeh S. , Sohrabvand F. , Lamyian M. , Emamgholy T.
Published: December 2003

Objective To determine whether vitamin E is effective in the treatment of primary dysmenorrhoea.

Design A randomised placebo‐controlled trial.

Participants One hundred girls, aged 16–18 years old who suffered from primary dysmenorrhoea, among 1000 students attending a public high school in Region 5 in the Greater Tehran Municipality.

Methods Fifty girls were given 500 units of vitamin E (five tablets) per day, and 50 were given five placebo tablets per day. The treatment began two days before the beginning of menstruation and continued through the first three days of bleeding. The severity of pain before and after the treatment was studied. Treatment in both groups was carried out in two consecutive menstrual periods.

Results The severity of pain in the two groups was reduced after treatment, but the reduction was greater in the group treated with vitamin E. These differences were maintained in the second month of therapy.

Conclusion Both placebo and vitamin E are effective in relieving symptoms due to primary dysmenorrhoea, but the effects of vitamin E are more marked.
Pruritus may precede abnormal liver function tests in pregnant women with obstetric cholestasis: a longitudinal analysis
Authors: Kenyon Anna P. , Piercy C. Nelson , Girling J. , Williamson C. , Tribe R.M. , Shennan A.H.
Published: December 2003

Obstetric cholestasis is a liver disorder unique to pregnancy, which typically presents with pruritus. However, pruritus is common in pregnancy and the diagnosis of obstetric cholestasis is confirmed by finding abnormal liver function. We report 10 cases in which pruritus occurred before any abnormality in liver function tests (including total serum bile acids) and discuss the implications of this for clinical practice.
Serum cystatin C reflects glomerular endotheliosis in normal, hypertensive and pre‐eclamptic pregnancies
Authors: Strevens Helena , Wide‐Swensson Dag , Grubb Anders , Hansen Alastair , Horn Thomas , Ingemarsson Ingemar , Larsen Svend , Nyengaard Jens R. , Torffvit Ole , Willner Julian , Olsen Steen
Published: December 2003

Objective
To study the correlation between serum cystatin C levels and renal structural changes in normal, hypertensive and pre‐eclamptic pregnancy to evaluate it as a marker of the degree of renal involvement in pre‐eclampsia.

Design
An observational prospective study.

Setting
University Hospital of Lund, Sweden.

Sample
Thirty‐six women with hypertensive disease in pregnancy and 12 healthy pregnant women in the third trimester recruited from maternal health care centres in the catchment area of the hospital.

Methods
Renal biopsy samples were obtained from all participants and the degree of endotheliosis as well as the mean glomerular volume was evaluated by light microscopy in silver methenamin‐stained sections. Serum cystatin C levels were measured and correlated to the structural changes.

Main outcome measures
Correlation among degree of glomerular endotheliosis, glomerular volume andserum cystatin C.

Results
Serum cystatin C levels differed between the different degrees of endotheliosis, showing a highly significant increasing linear trend. They also correlated significantly with glomerular volume (r = 0.60, P < 0.001). Mean serum urate and creatinine levels also increased with the degree of endotheliosis, but not above the reference interval for normal term pregnancy, even in pre‐eclamptic women.

Conclusion
Serum cystatin C may be used as a marker, not only for impaired renal function, but also for the degree of glomerular endotheliosis and increase in glomerular volume in pregnancy. It may be of value in the monitoring of pregnancies complicated by pre‐eclampsia.
Recent trends in breech delivery in the Netherlands
Authors: Molkenboer Jan F.M. , Bouckaert Peter X.J.M. , Roumen Frans J.M.E.
Published: December 2003

The effect of publication of the results of the Term Breech Trial in October 2000 on the mode of delivery of babies in breech presentation in the Netherlands was subject of this study. The results showed an immediate amplifying impact on top of the already existing trend of rising caesarean section rates for term singleton breech presentations. The willingness of obstetricians in the Netherlands to adopt the conclusions of the Term Breech Trial so quickly originate from scientific, legal, psychological and emotional sources. The same amplifying impact applied for all non‐term breeches and breeches from multiple gestations, but not for babies in other than breech presentation.
Microvascular dysfunction: a link between pre‐eclampsia and maternal coronary heart disease
Authors: Ramsay Jane E. , Stewart Frances , Greer Ian A. , Sattar Naveed
Published: December 2003

Epidemiological studies have recently demonstrated a relationship between pre‐eclampsia and coronary heart disease. Insulin resistance has been implicated as a common factor. We have demonstrated, for the first time, using laser Doppler imaging in vivo, impaired microvascular function in women 15–25 years following a pregnancy complicated by pre‐eclampsia. Thus, microvascular dysfunction, which is associated with insulin resistance, may be a predisposing vascular mechanism for both coronary heart disease and pre‐eclampsia. Pregnancies complicated by pre‐eclampsia may identify women at risk of vascular disease in later life and may provide the opportunity for lifestyle and risk factor modification to alter maternal vascular disease risk.
The differential expression of oestrogen receptors, progesterone receptors, Bcl‐2 and Ki67 in endometrial polyps
Authors: Taylor Lydia J. , Jackson Tracy L. , Reid Janet G. , Duffy Sean R.G.
Published: December 2003

Objective
To obtain a greater understanding of the pathogenesis of endometrial polyps and to gain insight into which factors play a pivotal role in their growth.

Design
Retrospective analysis of archived paraffin‐embedded specimens.

Setting
St James's University Hospital.

Sample
Thirty secretory phase endometrial samples, 10 secretory phase endometrial polyps, 8 proliferative phase endometrial samples and 10 proliferative phase endometrial polyps.

Methods
Immunohistochemistry was used to characterise the expression of oestrogen and progesterone receptors, Bcl‐2 and Ki67 in cycling endometrium and phase‐matched endometrial polyps. Patterns of expression were compared between the polyps and the endometrium.

Main outcome measure
The expression of oestrogen receptors, progesterone receptors, Bcl‐2 and Ki67.

Results
Three significant differences were found between the endometrium and the polyps. Polyps taken from the proliferative phase of the cycle displayed significantly elevated expression of Bcl‐2 and weak or no expression of progesterone receptors. Secretory phase polyps displayed an elevated expression of oestrogen receptors.

Conclusion
A localised increase in Bcl‐2 expression and consequential decline or cessation of apoptosis is an important mechanism underlying the pathogenesis of endometrial polyps. Elevated Bcl‐2 expression results in failure of the polyp tissue from undergoing normal cyclical apoptosis during the late secretory phase. This may mean the polyp is not shed along with the rest of the endometrium during menstruation.
A randomised trial comparing local versus general anaesthesia for microwave endometrial ablation
Authors: Wallage S. , Cooper K.G. , Graham W.J. , Parkin D.E.
Published: December 2003

Objective
To compare the acceptability of microwave endometrial ablation using a local anaesthesia/sedation regime or general anaesthesia. To compare recovery following treatment with each type of anaesthetic.

Design
Prospective randomised controlled trial with follow up of women who declined randomisation.

Setting
The gynaecology department of a large teaching hospital in the UK.

Population
All women referred for microwave endometrial ablation at the Aberdeen Royal Infirmary between July 1999 and September 2000 without a medical reason to favour one or other type of anaesthetic.

Methods
191 women were equally randomised to undergo microwave endometrial ablation under general or local anaesthesia. Details were also collected for women not randomised because of an anaesthetic preference. All procedures were undertaken in an operating theatre.

Main outcome measures
Data collected by questionnaire including the woman's view of treatment acceptability, operative details and post‐operative recovery.

Results
Sixty‐nine percent of eligible women would consider treatment under local anaesthesia. Ninety‐one percent of microwave endometrial ablation procedures that started under local anaesthesia were completed without conversion to general anaesthesia. Anaesthetic type and allocation by randomisation or preference made no significant difference to the proportion of women describing treatment as totally or generally acceptable at two weeks. Neither parity nor cavity size predicted acceptability. Women allocated general anaesthesia were more likely to describe the procedure as totally acceptable and to choose the same anaesthetic again. There was no significant difference between anaesthetic groups regarding post‐operative pain, nausea or recovery time.

Conclusions
Microwave endometrial ablation under local anaesthesia was acceptable to the majority of women referred for treatment. There was no recovery advantage from local anaesthesia and almost 1 in 10 women who starting treatment under local anaesthesia needed a general anaesthetic because of discomfort. The incidence of post‐operative pain and nausea means that treatment with this local anaesthetic/sedation regime remains a day case rather than an outpatient procedure.
The cost of microwave endometrial ablation under different anaesthetic and clinical settings
Authors: Seymour Janelle , Wallage Sarah , Graham Wendy , Parkin David , Cooper Kevin
Published: December 2003

Objective
To compare the costs of microwave endometrial ablation under local anaesthetic and general anaesthetic in an operating theatre and to estimate the cost of performing treatment under local anaesthetic in a dedicated clinic setting.

Design
The costing study was undertaken alongside a randomised controlled trial comparing the acceptability of microwave endometrial ablation using local versus general anaesthetic in a theatre setting.

Setting
Department of Gynaecology, Aberdeen Royal Infirmary, Scotland.

Sample
One hundred and twenty‐seven women undergoing microwave endometrial ablation who had been randomly allocated to general or local anaesthetic.

Methods
Health and non‐health service resource use was recorded prospectively. Data on resource use were combined with unit costs estimated using standardised methods to determine the cost per patient for microwave endometrial ablation under local or general anaesthetic in theatre. A model was developed to estimate the health service cost of microwave endometrial ablation under local anaesthetic in a clinic setting.

Main outcome measures
Health and non‐health service costs.

Results
There was little difference in cost when treatments were performed under local or general anaesthetic in theatre. The median health and non‐health cost of microwave endometrial ablation was £440 and £120, respectively, under general anaesthetic and £428 and £125 per women under local anaesthetic. The health service cost of microwave endometrial ablation using local anaesthetic in a clinic setting was estimated to be £432 per treatment; however, this varied from £389 to £491 in the sensitivity analysis.

Conclusion
There are minimal cost savings to the patient or health service from using local rather than general anaesthetic for microwave endometrial ablation in a theatre setting. Cost modelling suggests that in a clinic setting microwave endometrial ablation has a similar cost to theatre based treatment once re‐admissions for treatment under general anaesthetic are considered. Sensitivity analysis indicated that these findings were sensitive to assumptions in the model.
Risk factors for stress, urge or mixed urinary incontinence in Italy
Authors: Parazzini Fabio , Chiaffarino Francesca , Lavezzari Maurizio , Giambanco Vincenzo ,   on behalf of VIVA Study Group,   A list of VIVA members is provided on page 932
Published: December 2003

Objective
To assess risk factors for different type of urinary incontinence—stress, urge or mixed—and overactive bladder without urinary incontinence.

Design
Case–control study.

Setting
Gynaecology clinics.

Population
Women attending first level gynaecological centres.

Methods
Cases were 1062 women with urinary incontinence or overactive bladder aged 40 years or more (mean age 62.3 years, range 40–88) consecutively observed in first level gynaecological centres. Controls were 1143 women (mean age 58 years, range 40–86) observed in the same centre after the identification of the cases, without any symptoms related to urinary incontinence or overactive bladder.

Main outcome measures
Determinants of different types of urinary incontinence and overactive bladder.

Results
The risk of urinary incontinence was lower in more educated patients and increased with body mass index (BMI). The number of vaginal births was associated with the risk of stress and mixed urinary incontinence, but not urge urinary incontinence and overactive bladder. In comparison with nulliparae, the odds ratios (OR) for stress and mixed urinary incontinence were 5.4 (95% confidence interval [CI] 1.9–15.0) and 1.6 (95% CI 1.0–2.6), respectively, for women reporting one or two vaginal birth and 5.1 (95% CI 1.8–14.5) and 2.2 (95% CI 1.3–3.7), respectively, for three or more. A history of operative vaginal delivery was directly associated with the risk of stress and mixed urinary incontinence and increased the risk of urge urinary incontinence and of overactive bladder, but the latter ORs were not statistically significant. When compared with women with no birth, a history of caesarean section increased the risk of stress urinary incontinence. A history of hysterectomy, recurrent urinary infection and perineal trauma increased the risk of all types of urinary incontinence.

Conclusions
Vaginal births increased the risk of stress and mixed urinary incontinence, but not of urge urinary incontinence and overactive bladder. The risk of all types of urinary incontinence was increased in women with higher BMI, with a history of hysterectomy, urinary infection and perineal traumas. These factors were not related to the risk of overactive bladder.
Myometrial and placental artery reactivity alone cannot explain reduced placental perfusion in pre‐eclampsia and intrauterine growth restriction
Authors: Ong Stephen S. , Moore Rachel J. , Warren Averil Y. , Crocker Ian P. , Fulford Jon , Tyler Damian J. , Gowland Penny A. , Baker Philip N.
Published: December 2003

Objectives
(1) To investigate a possible association between myometrial and placental artery vasoreactivity and perfusion at the basal and chorionic plates, respectively. (2) To confirm that myometrial arteries from women with pre‐eclampsia and intrauterine growth restriction exhibit an attenuated endothelium‐dependent vasodilatory response.

Methods
Women with normal pregnancy, pre‐eclampsia and intrauterine growth restriction had a magnetic resonance scan to assess placental perfusion using a technique called intravoxel incoherent motion. At delivery, myometrial and chorionic plate placental arteries were assessed on a wire myograph. Vessels were pre‐constricted with the thromboxane mimetic U46619 and dilated with incremental doses of bradykinin.

Results
Pre‐constricted myometrial arteries from women with pre‐eclampsia or intrauterine growth restriction exhibited an attenuated vasodilatory response to bradykinin, compared with normal pregnancy (P < 0.0001). Pre‐constricted placental arteries exhibited a minimal vasodilatory response in all three groups of women (P = 0.10). Maximal constrictor and vasodilatory responses of myometrial arteries were not associated with the perfusing fraction at the basal plate. Maximal constrictor and vasodilatory responses of chorionic plate placental arteries were not associated with the perfusing fraction at the chorionic plate.

Conclusion
We confirm that myometrial arteries from women with pre‐eclampsia or intrauterine growth restriction exhibit an attenuated endothelium‐dependent vasodilatory response. Apart from vasoreactivity of small arteries, other factors may be involved in the control of placental perfusion.
The usefulness of ultrasound assessment of amniotic fluid in predicting adverse outcome in prolonged pregnancy: a prospective blinded observational study
Authors: Morris J.M. , Thompson K. , Smithey J. , Gaffney G. , Cooke I. , Chamberlain P. , Hope P. , Altman D. , MacKenzie I.Z.
Published: December 2003

Objective
To determine whether a single ultrasound scan at or beyond 40 weeks of gestation to detect a single deepest pool of amniotic fluid <2 cm and amniotic fluid index (AFI) <5 cm is clinically useful in the prediction of subsequent adverse pregnancy outcome.

Design
A prospective double blind cohort study.

Setting
A university teaching hospital delivering approximately 6000 women annually.

Population
One thousand and five hundred and eighty‐four pregnant women at or beyond 40 weeks of gestation.

Methods
Ultrasound assessment of liquor to detect the single deepest pool of amniotic fluid and derive the AFI at or after 40 weeks of gestation.

Main outcome measures
Perinatal death, meconium aspiration, birth asphyxia, intervention in labour for fetal distress, a cord arterial pH <7 and admission to the neonatal unit.

Results
An AFI <5 cm but not a single deepest pool <2 cm was significantly associated with birth asphyxia or meconium aspiration. An AFI <5 cm was also significantly associated with caesarean section for fetal distress in labour, a cord arterial pH <7 at delivery and low Apgar scores. Despite there being a statistically significant association with adverse outcomes the sensitivity of AFI was low at 28.6%, 12% and 11.5% for major adverse outcome, fetal distress in labour or admission to the neonatal unit, respectively.

Conclusions
The AFI is superior to a measure of the single deepest pool as an assessment of the fetus at or after 40 weeks but has a poor sensitivity for adverse pregnancy outcome. Routine use is likely to lead to increased obstetric intervention without improvement in perinatal outcomes.
WHO multinational study of three misoprostol regimens after mifepristone for early medical abortion. I: Efficacy
Authors: von Hertzen Helena , Honkanen Helena , Piaggio Gilda , Bartfai György , Erdenetungalag Radnaabazar , Gemzell‐Danielsson Kristina , Gopalan Sarala , Horga Mihai , Jerve Fridtjof , Mittal Suneeta , Ngoc Nguyen Thi Nhu , Peregoudov Alexandre , Prasad R.N.V. , Pretnar‐Darovec Alenka , Shah Rashmi S. , Song Si , Tang Oi Shan , Wu Shang Chun ,   For WHO Research Group on Post‐Ovulatory Methods for Fertility Regulation,   The collaborators are listed on page 817
Published: December 2003

Objectives
To compare the efficacy of oral and vaginal administration of misoprostol after a single oral dose of 200 mg of mifepristone and to investigate whether the efficacy can be improved and the duration of bleeding shortened by continuing oral misoprostol for one week.

Design
Double blind, randomised controlled trial.

Setting
Fifteen gynaecological clinics in 11 countries.

Population
A total of 2219 healthy pregnant women requesting medical abortion with ≤63 days of amenorrhoea.

Methods
Mifepristone 200 mg administered orally on day one, followed by 0.8 mg misoprostol either orally or vaginally on day three. The oral group and one of the vaginal groups continued with 0.4 mg of oral misoprostol twice daily for seven days.

Main outcome measures
Complete abortion was the main outcome. Secondary outcomes were side effects, timing of expulsion and duration of bleeding.

Results
The crude complete abortion rate was 92.3% in the oral plus continued oral misoprostol group, in the vaginal‐only group it was 93.5%, and it was 94.7% in the vaginal group that continued with oral misoprostol, when considering undetermined cases as failures. Among women with amenorrhoea length ≥57 days, the risk of failure of complete abortion was almost three times higher in the oral plus continued oral misoprostol group (RR = 2.8, 95% CI 1.3 to 5.8), and over two times higher in the vaginal‐only group (RR = 2.2, 95% CI 1.0 to 4.7), when compared with the vaginal plus continued oral misoprostol group. Among women with amenorrhoea length <57 days, the differences were not significant. Timing of expulsions and duration of bleeding were similar in the three groups.

Conclusions
For amenorrhoea length ≥57 days, vaginal misoprostol is more effective than oral when continued with 0.4 mg oral misoprostol twice daily for seven days. Misoprostol continuation improved the efficacy in this amenorrhoea group compared with a single dose of vaginal misoprostol on day three, but it did not shorten the duration of bleeding. No differences in efficacy were observed when amenorrhoea length was <57 days.
Sexual psychophysiology and effects of sildenafil citrate in oestrogenised women with acquired genital arousal disorder and impaired orgasm: a randomised controlled trial
Authors: Basson Rosemary , Brotto Lori A.
Published: December 2003

ObjectiveSome postmenopausal women lose genital sexual responsivity despite preserved subjective sexual arousal from non‐genital stimuli. When oestrogen replacement is without benefit, both the underlying pathophysiology and management of this acquired genital female sexual arousal disorder are unclear. We aimed to study the effect of sildenafil on sexual arousal and orgasmic functioning of such women. Secondly, we aimed to explore the concordance between a detailed historical assessment of genital response in real life, with laboratory vaginal photoplethysmographic assessment of genital vasocongestion.

DesignSession one consisted of a semi‐structured clinical interview to assess real life sexual arousal. Session two employed vaginal pulse amplitude and self‐report questionnaire assessment of erotica‐induced sexual arousal. Sessions three and four were a randomised, double‐blind, placebo‐controlled crossover administration of sildenafil on orgasm latency, intensity, perception of genital congestion and subjective arousal to eroticaplusclitoral vibrostimulation.

SettingUniversity associated Sexual Medicine Clinic and Psychophysiology Laboratory.

SampleVolunteer sample of 34 oestrogenised postmenopausal women with acquired genital female sexual arousal disorder and impaired orgasm.

MethodsSildenafil (50 mg) or placebo administered over two laboratory sessions.

Main outcome measuresOrgasm latency and intensity during drug sessions; subjective and psychophysiological sexual arousal during photoplethysmography session.

ResultsThe erotic video significantly increased subjective sexual arousal in all women. Vaginal pulse amplitude responses varied from robust to absent. Although across all women, sildenafil improved neither arousal nor orgasm, subsequent analyses comparing highversuslow vaginal pulse amplitude responders revealed significantly reduced latency to orgasm, and increased subjective sexual arousal and perception of genital arousal in the latter group of women.

ConclusionThe data suggest that oestrogenised postmenopausal women with genital female sexual arousal disorder and orgasmic impairment based only on clinical assessment do not benefit from sildenafil. However, the photoplethysmograph had predictive value—those women showing low vaginal pulse amplitude response benefited from sildenafil compared with women with a higher response. Thus, oestrogenised women diagnosed with acquired genital female sexual arousal disorder may be a heterogeneous group and the photoplethysmograph might be useful in their further characterisation.
The burden of disease from neonatal mortality: a review of South Asia and Sub‐Saharan Africa
Authors: Hyder Adnan A. , Wali Salman A. , McGuckin Jeffery
Published: December 2003

Objective
To assess the burden of neonatal mortality in two developing regions.

Design
Review of secondary data collated through literature review.

Setting
Community and facility based studies and national health surveys.

Population
Neonatal (<28 days) population of South Asia and Sub‐Saharan Africa.

Methods
Data on neonatal mortality were gathered from peer‐reviewed literature, reports of the Demographic and Health Surveys and websites of country‐based organisations. The base year for this study is 1995. For each country, a weighted mean neonatal mortality rate was calculated and the total number of neonatal deaths estimated. Country data were summarised over each region to estimate annual regional neonatal deaths and rates. The burden of disease from neonatal mortality was determined using a summary measure of health—healthy life years.

Main outcome measures
Numbers of deaths and healthy life years (HeaLYs).

Results
Neonatal mortality rate for South Asia ranged from 41.9 to 56.9 per 1000 live births for 1995. Sri Lanka was an exception with a neonatal mortality rate between 16.3 and 18.6 per 1000 live births. The estimated regional neonatal mortality rate for South Asia was 46.27 per 1000 live births for 1995. There was a significant lack of data from Sub‐Saharan Africa, resulting in highly variable neonatal mortality rates, ranging from 13 per 1000 live births in Kenya to 108 per 1000 live births in Senegal. The mean regional neonatal mortality for Sub‐Saharan Africa for 1995 was estimated at 38.8 per 1000 live births.

Conclusion
The burden of neonatal mortality in only these two regions of the developing world represents more than 2 million annual deaths. A call for greater investments in neonatal research and health programs is a logical extension to this review of evidence.
The incidence of sterilisation in the UK
Authors: Rowlands Sam , Hannaford Philip
Published: December 2003

Objective
To estimate incidence rates for tubal occlusion and vasectomy, and to examine how these vary with age, geographical area and time.

Design
Search of patient files for operation codes in the years 1992–1999 and calculation of person time.

Population and setting
General Practice Research Database.

Methods
Patient files of women aged 20–54 years and men aged 20–64 years were searched for sterilisation operation codes. Annual incidence rates in five year aged bands were calculated for sterilisation operations for both sexes. Figures were examined according to National Health Service Region and population density category of the general practices. The relationship between year of operation and mean age at operation was also examined.

Main outcome measures
Incidence rates by year, age group and geographical area.

Results
The average annual incidence of sterilisation in the eight year period was 4.75 per 1000 person years at risk for women aged 20–54 and 4.48 per 1000 person years at risk for men aged 20–64. For women, there was a statistically significant 30% decrease in incidence of tubal occlusion over the study period. There was no change in vasectomy rates over time. About one‐third of all vasectomies in the UK are estimated to be performed outside hospital and community clinic settings. The rates of sterilisation in both sexes were much lower in Greater London than elsewhere in the UK.

Conclusions
The popularity of tubal occlusion appears to be on the decline. Since 1996, the UK has been one of very few countries in which sterilisation incidence in men is greater than that in women.
Low plasma volume following pregnancy complicated by pre‐eclampsia predisposes for hypertensive disease in a next pregnancy
Authors: Aardenburg Robert , Spaanderman Marc E.A. , Ekhart Timo H. , van Eijndhoven Hugo W. , van der Heijden Olivier W.H. , Peeters Louis L.H.
Published: December 2003

Objective
A large number of women with a history of pre‐eclampsia/HELLP have a low plasma volume at least six months postpartum. The objective of this study was to determine whether a low plasma volume in formerly pre‐eclamptic women and HELLP patients is associated with an increased risk for recurrent hypertensive complications in a next pregnancy.

Design
Prospective observational study.

Setting
Tertiary obstetric centre.

Sample
Formerly pre‐eclamptic women and controls.

Methods
In 316 women with a history of pre‐eclampsia and/or HELLP, we measured, plasma volume along with haemodynamic, metabolic and haemostatic variables at least six months postpartum. A group of 22 healthy parous controls was used as a reference. After standardising plasma volume for body mass index, women were subdivided into normotensive and normal plasma volume (n = 199), normotensive and low plasma volume (n = 76) and hypertensive (n = 41) subgroups, which were compared for demography, clinical parameters and course of a next pregnancy.

Main outcome measures
Recurrent hypertensive disease of pregnancy.

Results
Relative to the normal plasma volume subgroup, normotensive women in the low plasma volume subgroup have a higher body mass index, a lower total vascular compliance and a shorter estimated systemic circulation time. They have a higher HOMA index and higher fasting triglyceride levels. In normotensive and hypertensive former patients alike, low plasma volume is associated with a higher recurrence of hypertensive complications in a next pregnancy compared with normotensive women with normal plasma volume.

Conclusion
Low plasma volume in normotensive women with a history of pre‐eclampsia and/or HELLP is associated with overweight, reduced vascular compliance and insulin resistance and a predisposition for recurrent pre‐eclampsia and HELLP syndrome in a next pregnancy.
Can enquiries into severe acute maternal morbidity act as a surrogate for maternal death enquiries?
Authors: Pattinson R.C. , Buchmann E. , Mantel G. , Schoon M. , Rees H.
Published: December 2003

Objective
To assess whether severe acute maternal morbidity (SAMM, ‘near misses’) can be used as a surrogate of an analysis of maternal deaths to describe the pattern of severe maternal disease and avoidable factors related to it.

Design
Prospective, descriptive study.

Setting
A SAMM and maternal mortality audit was conducted in three clearly defined geographical areas, consisting of rural and urban settings in South Africa.

Population
Indigent black African pregnant women.

Method
Cases of SAMM and maternal deaths were collected in the areas and a comparison was made of the disease profiles and avoidable factors, missed opportunities and substandard care.

Main outcome measures
The proportion of primary obstetric causes and avoidable factors in women with SAMM and maternal deaths, and the mortality indices of the primary obstetric causes of death and organ system dysfunction.

Results
A total of 423 women with SAMM and 128 maternal deaths were collected over two years. Demographic factors were similar between the groups except that significantly more maternal deaths had not attended any antenatal care. The primary obstetric causes of SAMM and maternal death did not correlate. The four most common causes of SAMM were complications of hypertension (27.2%), postpartum haemorrhage (18.0%), antepartum haemorrhage (12.8%) and abortion (11.3%), whereas the four most common causes of maternal death were non‐pregnancy related sepsis (26.6%), complications of hypertension (23.4%), pre‐existing medical disease (14.1%) and abortion (10.9%). The types of avoidable factors were similar between both groups although administrative factors occurred significantly more frequently in the maternal death group as did poor problem identification and monitoring.

Conclusion
Review of SAMM gives a different disease pattern to that obtained from maternal death audits. However, in diagnosing inadequacies in the health system, similar information was obtained.
Seasonal cycle of body composition and energy of brown trout (Salmo trutta) in a temperate zone lake
Authors: Berg O. K. , Thronæs E. , Bremset G.
Published: December 2003

Abstract – Seasonal changes in protein and fat were investigated in brown trout (Salmo trutta L.) of a stunted population from a small, temperate zone lake. The lake was ice‐covered during winter (about 200 days), and hypolimnic water temperature during winter was about 4°C. During winter there was an increase in specific fat, in particular among the larger sized fish, while there was a general decrease in specific protein content among both small (<5 winters) and large (age 5 or older) trout. During winter (end of October to mid‐May) an average trout gained 32 kJ of fat, but protein energy content decreased by 14 kJ, yielding a net energy increase of 18 kJ or a daily energy gain of 0.09 kJ  ·  day−1. During the ice‐free season (mid‐May to the end of October) the trout increased mainly in protein content with daily energy gains of about 1.4 kJ  ·  day−1, a value about 14 times higher than the corresponding winter value. Trout living in lakes may store considerable amounts of fat during wintertime in contrast to the depletion of fat reserves found among stream‐living trout in the same area, which face lower water temperatures in the winter period.Note
The dry‐season diet of freshwater fishes in monsoonal tropical rivers of Cape York Peninsula, Australia
Authors: Pusey B. J. , Arthington A. H. , Read M. G.
Published: December 2003

Abstract – Fish assemblages in three rivers of eastern Cape York Peninsula, northern Australia, were sampled during the early part of the monsoonal dry season, and the diet of 23 species was quantified. Spatial variation (between‐river) in diet was, in general, not pronounced. Sufficient specimens were collected to enable examination of ontogenetic changes in the diet of four species. Interspecific and ontogenetic variation in diet were most strongly related to differences in body size and mouth gape, with larger species or age classes feeding on fish and large aquatic invertebrates. Other gradients upon which dietary differences were arranged included gradients in detritivory and reliance on terrestrial invertebrates. Significant trophic separation was evident in the fauna despite aquatic invertebrates being the most important food item in most species. Seven, and possibly eight, trophic groups were recognized. Notable features of the trophic organization were the prevalence of omnivory and piscivory and relatively small representation by detritivores. Planktivores were essentially absent. Much of the observed trophic structure within the fishes of Cape York Peninsula could be ascribed to the effects of phylogenetic determinants of body size, morphology and foraging mode. The trophic structure within rivers of eastern Cape York Peninsula is compared to other aquatic systems in tropical northern Australia.Note
Life‐history of the flagfin shiner, Pteronotropis signipinnis, from a blackwater stream in southeastern Mississippi
Authors: Albanese B.
Published: December 2003

Abstract – Flagfin shiners, Pteronotropis signipinnis, were collected from Sweetwater Creek, a second‐order blackwater stream in southeastern Mississippi, during each month of 1996. Analysis of length frequency histograms indicated a life span of 1 to 2 years. Sex ratio was not different from a 1:1 ratio. Adult males were larger and more heavily pigmented near the abdomen than females. Females were reproductive from April to mid‐August. All females attained sexual maturity by 27 mm SL and produced multiple clutches of ova. Clutch size varied from 12 to 101 ova and was correlated with SL. Mean mature oocyte diameter was 0.88 mm (range 0.76–0.96). Despite the relationship between clutch size and body size, P. signipinnis may be selected to invest in early reproduction rather than growth. This idea is supported by the small size at maturity in this species and is consistent with an opportunistic life‐history strategy.Note
γδ T cell receptor repertoire in blood and colonic mucosa of rhesus macaques
Authors: Rakasz Eva , MacDougall Alex V. , Zayas Maria T. , Helgelund Jody L. , Ruckward Tracy J. , Hatfield Glen , Dykhuizen Marta , Mitchen Jacque L. , Evans Peter S. , Pauza C. David
Published: December 2003

Although their precise roles are not well defined, γδ T lymphocytes are recognized as regular components of immune responses. These cells express a limited T cell receptor repertoire and they can be stimulated by soluble ligands without conventional processing and presentation by major histocompatibility antigens. Progress in this area has been limited by the substantial differences between murine and human γδ T cells and the lack of knowledge about these cells in nonhuman primates. We used molecular analysis of T cell receptor diversity to characterize γδ T cell populations from peripheral blood and colon of rhesus macaques (Macaca mulatta). The γδ T cell receptor diversity was limited and distinct for these tissue compartments, particularly in the TCRGV2 family. Furthermore, the TCRDV1+ subset of peripheral blood γδ T cells showed signs of progressive oligoclonalization as a function of age. Similar observations have been reported for human tissue samples and our results validate rhesus macaques as an appropriate animal model for studying primate γδ T cell populations.
Reactivity of human T‐lymphocyte‐specific antibodies with peripheral blood mononuclear cells and spleen of Aotus azarae ssp. boliviensis (owl monkey)
Authors: Langermans Jan A.M. , Vervenne Richard A.W. , Hersbach Jeroen , Thomas Alan W.
Published: December 2003

Aotus monkeys offer one of the few models that can be used for the evaluation of the immunogenicity and efficacy of new vaccine candidates against the human malarias, Plasmodium falciparum and Plasmodium vivax. However, the tools available for evaluation of the immune responses in these New World primates are still limited. In the present study, a previously selected set of monoclonal antibodies that were raised against human T cell determinants and were reactive with at least one other primate species was investigated for its reactivity with Aotus lymphocytes using FACS analysis, indirect immunofluorescence (IFA) and immunohistochemistry. From a panel of 19 mAb, six were found to react consistently with Aotus lymphocytes using FACS analysis. Further evaluation of the mAb using IFA confirmed these findings. Analysis of the selected mAb on spleen sections of Aotus monkeys identified one anti‐CD4 and one anti‐CD8 mAb that can be used for immunohistochemical studies. The set of mAb identified in this study can be used for the detection of various T lymphocyte markers in peripheral blood and in tissues of Aotus monkeys. Together with data published by others, mAb are now identified for detection of six different markers of Aotus T lymphocytes. These mAb are very valuable for the characterisation of immune responses after vaccination and infection in the Aotus malaria models.
Seasonal variations in daily sperm production rate of rhesus and bonnet monkeys
Authors: Gupta G. , Maikhuri J.P. , Setty B.S. , Dhar J.D.
Published: December 2003

Daily sperm production (DSP) rate was estimated in adult male rhesus and bonnet monkeys to evaluate seasonal changes in the gametogenic activity of the testes. Three monkeys of each species were castrated during breeding and non‐breeding seasons and DSP rate was estimated by enumerating the homogenization‐resistant spermatid nuclei of steps 13 and 14. Results indicated a significant reduction in the DSP rate per testis during the non‐breeding season in two species, along with a marked decline in the testis weight. However, the gametogenic capacity of seminiferous tubules did not appear to be markedly affected during non‐breeding season, as the DSP rate per gram parenchyma of testis was only marginally reduced. The seasonal changes in DSP were much more pronounced in the rhesus than in the bonnet monkey. The feasibility of circanual rhythm in DSP of sub‐human primates to form a baseline for the study of reproductive function in male is discussed.
Mechanisms of protection induced by live attenuated simian immunodeficiency virus
Authors: Silvera Peter , Wade‐Evans Alison , Rud Erling , Hull Robin , Silvera Kirsty , Sangster Rebecca , Almond Neil , Stott Jim
Published: December 2003

In this study, we investigated whether a type of retroviral interference might be one mechanism that mediates the powerful protection induced by live attenuated SIVC8. Our results show that retroviral interference could be demonstrated between SIV and SHIV‐HXBc2 in human T‐cell lines chronically infected with either SIVC8 or SIVJ5. Lymphocytes from macaques infected with live attenuated SIVC8 were significantly less sensitive (P<0.05) to in vitro infection by virulent SIVJ5 and SHIV‐HXBc2 than were lymphocytes from naïve controls. However, this significant difference in the sensitivity of lymphocytes to virus infection was not observed for more efficiently replicating viruses such as SHIVSF33 and SIVsm3. Virus growth was significantly enhanced (P<0.01) by depletion of CD8+ T‐cells, suggesting a role for these cells in the control of SIV replication, both in vitro and in vivo. We found that levels of the β‐chemokines regulated upon activation, normal T‐cell expressed and secreted, macrophage inflammatory protein‐1α and macrophage inflammatory protein‐1β did not correlate with inhibition of virus replication. Taken together, our findings do not support the hypothesis that retroviral interference is the mechanism by which live attenuated SIVC8 induces protection.
Prevalence of hepatitis B virus infections in nonhuman primates
Authors: Heckel Jens‐Ove , Rietschel Wolfram , Hufert Frank T.
Published: December 2003

The aim of this study was to determine the prevalence of hepatitis B virus (HBV) infection in nonhuman primates. Serum samples from Europe, Thailand and Vietnam were analyzed. Sera obtained from 262 apes and 454 monkeys were tested for HBV infection serologically and for HBV DNA using nested PCR (nPCR). A total number of 198 ape sera and all but one (Cercopithecus aethiops) of the 4543 monkey sera had no serological signs of HBV infection. Among the 64 of 262 (24.4%) seropositive ape sera, we found, as in humans, different stages of HBV infection: very early HBV infection, active infection with high level of infectivity, virus carriers with low infectivity, and passed HBV infection. In the cases with passed infection, 47.8% harbored HBV DNA in the presence of protective antibodies to the HBV surface antigen (HBsAb). This indicates HBV persistence in apes despite immune control. In contrast to apes, in monkeys HBV infection is a very rare event.
Identification of primitive hematopoietic progenitor cells in the rhesus macaque
Authors: Rosenzweig Michael , Marks Douglas F. , DeMaria Mary Ann , Connole Michelle , Johnson R. Paul
Published: December 2003

The close phylogenetic relationship of macaques to humans has resulted in their widespread use as a preclinical model for bone marrow transplantation and stem cell gene therapy. To facilitate further use of this model, we undertook analysis of hematopoietic cells using multiparametric flow cytometric analysis. Rhesus CD34+CD38− cells displayed a number of characteristics of primitive hematopoietic cells, including low forward and orthogonal scatter and the lack of expression of lineage‐specific markers or human lymphocyte antigen‐DR. Four‐color flow cytometric analysis demonstrated that rhesus CD34+CD38− cells were heterogenous with respect to Thy‐1 expression and were CD59dim. Quantitative limiting dilution long‐term culture‐initiating cell (LTC‐IC) analysis demonstrated that CD34+CD38− cells were approximately 150‐fold enriched for LTC‐IC as compared with unfractionated bone marrow, and occurred at a frequency similar to that previously reported in humans. Thus, as in humans, the CD34+38− population of rhesus macaque bone marrow is enriched for primitive, multipotent hematopoietic progenitor cells.
BROKEN SYMMETRY AND JOSEPHSON-LIKE TUNNELLING IN QUANTUM HALL BILAYERS
Authors: GIRVIN S. M.
Published: December 2003

I review recent novel experimental and theoretical advances in the physics of quantum Hall effect bilayers. Of particular interest is a broken symmetry state which optimises correlations by putting the electrons into a coherent superposition of the two different layers.