bluuebunny/crossref_metadata_2025 huggingface dataset:
Defective de novo thymocyte maturation in cyclosporin A (CsA)-induced autoimmunity: expression of costimulatory and activation molecules
Authors: HOMMA M , VAN BREDA VRIESMAN P J C , DAMOISEAUX J G M C
Published: December 2003

Lethally x-irradiated Lewis rats, reconstituted with syngeneic bone marrow and transiently treated with CsA for 4 weeks, will develop an autoimmune disease about 2–3 weeks after cessation of CsA therapy. CsA-induced autoimmunity is a thymus-dependent and T cell-mediated autoimmune disease. CsA is thought to generate autoreactive T cells by interference with negative selection in the thymus; x-irradiation is required to eliminate the peripheral autoregulatory T cell circuit. In this study we re-evaluate the effect of CsA on thymic atrophy and thymocyte maturation. Subsequently we examine the expression of costimulatory and activation molecules (CD2, CD5, CD11a, CD11b, CD25, CD28, CD43, CD54, OX-40, RT-1A, RT-1B and RT-1D) during distinct maturational stages in order to detect possible clues to the observed effects of CsA on thymocyte maturation and selection. The results revealed that CsA blocks maturation of double-positive TCRint to double-positive TCRhigh thymocytes and preferentially inhibits the development of mature CD4 single-positive thymocytes. Furthermore, CsA administration resulted in a reduced expression of the costimulatory CD2 molecule. Although it is a matter of debate whether this defective CD2 expression is involved in the aberrant maturation and selection of thymocytes, it is speculated that reduced costimulation via CD2 may influence differentiation into distinct T cell subsets.
Calcium efflux and influx in f-met-leu-phe (fMLP)-activated human neutrophils are chronologically distinct events
Authors: ANDERSON R , MAHOMED A GOOLAM
Published: December 2003

The kinetics of efflux of calcium mobilized from intracellular stores following activation of human neutrophils with the synthetic chemotactic tripeptide, fMLP (1 μm), as well as that of the subsequent store-operated influx of this cation, has been measured by radiometric procedures using 45Ca. These procedures enabled distinction between net efflux and influx of 45Ca. Preincubation of neutrophils in medium containing 45Ca as the sole source of Ca2+, followed by activation with fMLP, resulted in a rapid efflux of the cation, which coincided with its release from intracellular stores. Efflux terminated at ≈ 30 s after addition of fMLP to neutrophils and resulted in the loss of 42 ± 3% (P < 0.005) of cell-associated 45Ca. Net influx of 45Ca, which was insensitive to the voltage-dependent Ca2+ channel blockading agent, verapamil (20 μm), could only be detected at 30–60 s after the addition of fMLP to neutrophils, and proceeded for about 5 min, resulting in intracellular concentrations of Ca2+ which were 27 ± 3% (P < 0.05) higher than preactivation levels. These results demonstrate that the efflux of cytoplasmic Ca2+ mobilized from intracellular stores during activation of neutrophils by fMLP, and the subsequent influx of extracellular Ca2+ to replete these stores, are chronologically distinct events in fMLP-activated neutrophils.
Characterization of murine monoclonal antibodies against the Ro52 autoantigen
Authors: SCHMITZ M , BACHMANN M , LAÜBINGER J , THIJSSEN J P H , PRUIJN G J M
Published: December 2003

Immunization of BALB/c mice with purified recombinant human Ro52 protein resulted in three anti-Ro52 MoAbs termed 2E7, 4C6 and 4F11. All anti-Ro52 MoAbs specifically reacted with recombinant human Ro52 protein, and also with Ro52 protein in total extracts of all human cell lines analysed, including the epithelial cell line HeLa, the B cell line Raji, the bladder carcinoma cell line RT112, and a fibroblast cell line derived from patients with xeroderma pigmentosum. The anti-Ro52 MoAbs were able to immunoprecipitate the recombinant human Ro52 protein expressed in wheat germ extract, but failed to precipitate hY RNAs from cell extracts. The staining pattern of the MoAbs strongly differed between the RT112 cells and the fibroblast cell line. RT112 cells displayed an intense cytoplasmic staining and in addition distinct fine nuclear speckles. In contrast, in the fibroblast cell line no cytoplasmic staining but only staining of distinct nuclear speckles was observed. Using deletion mutants of Ro52 the epitopes recognized by the anti-Ro52 MoAbs 2E7, 4C6 and 4F11 were partially mapped. All three MoAbs appeared to recognize distinct epitopes, that are located in the regions of Ro52 bordered by amino acids 136–164, 208–363 and 136–190, respectively. These MoAbs can be of great use in studying the cellular processes in which the Ro52 protein is involved.
Endometrial resection after vacuum curettage
Authors: Maia Jr H. , Calmon L. C. , Marques D. , Oliveira M. C. , Coutinho E. M.
Published: December 2003

Objective

To assess the efficacy of suction curettage in removing the functional layers of the endometrium prior to hysteroscopic resection.

Design

Prospective study conducted during 1 year.

Patients

A total of 43 patients aged between 31 and 51 years, with symptoms of menorrhagia.

Setting

Endoscopy unit in a hospital.

Interventions

Hysteroscopy and transvaginal sonography were used in the diagnostic work up. Patients were submitted to vacuum curettage immediately prior to endometrial resection. Postoperative treatment with nomegestrol acetate was used in all cases.

Results

Suction curettage was effective in thinning the endometrium prior to endometrial resection. The visualization of the uterine cavity was not adversely affected by this procedure. The amenorrhea rate was 60% in the patients treated postoperatively with nomegestrol acetate. There were two treatment failures in this group.

Conclusion

Suction curettage is an effective technique for mechanically preparing the endometrium prior to hysteroscopic resection. There was no increased risk for fluid overload in these patients.
Histological results of salpingectomy for ectopic pregnancy: a series of 344 tubal pregnancies
Authors: Dubuisson J.‐B. , Chapron C. , Morice P. , Vacher‐Lavenue M.‐C.
Published: December 2003

Objective

To find out if knowledge of the type, location and extent of histological lesions to the tube might influence the choices for surgical treatment of ectopic pregnancy (EP).

Design

Retrospective clinical study.

Setting

Department of Gynaecological Surgery, Clinique Universitaire Baudelocque, CHU Cochin Port‐Royal, Paris, France.

Subjects

Histological study of 344 cases of laparoscopic salpingectomy for EP.

Results

The EP was in a proximal location in 14.8% of cases (51 patients) and in a distal location in 85.2% of cases (293 patients). The tube was histologically normal in 17.7% of cases (61 patients). The rate of histologically normal tubes was significantly greater in patients with no past history of tubal problems (28.9%, 22 patients vs. 14.5%, 39 patients; P = 0.0004). In 32.3% of cases (111 patients) tube pathology was bifocal. The rate of bifocal tubal pathologies was significantly greater in cases of proximal EP (45.1%, 23 patients vs. 30%, 88 patients; P = 0.03). Proximal pathology is less often isolated than distal pathology (4.5%, 19 patients, vs. 44.5%, 153 patients).

Conclusions

Laparoscopic surgical treatment needs to be more radical (salpingectomy) when the EP is proximal and when the patient presents a past history of tubal surgery and/or infection.
Modified atmosphere packaging of a mixed prepared vegetable salad dish
Authors: Lee Kwang Soo , Park In Soo , Lee Dong Sun
Published: December 2003

The aim of this study was to design a modified atmosphere package for a mixed vegetable salad consisting of 75 g of cut carrot, 55 g of cut cucumber, 20 g of sliced garlic and 50 g of whole green pepper. Respiration data of all the components were combined with film permeability data to predict package atmospheres and design optimal packages for experimental testing for improved shelf‐life of the produce. The optimal package avoided minimum O2 and maximum CO2 tolerance limits, and chilling injury temperatures for any component. A pouch form package made of 27 mm low density polyethylene developed a modified atmosphere of 2.0–2.1% O2 and 5.5–5.7% CO2, which was beneficial for all components and provided better quality retention than other test packages.
Detoxication of rapeseed meal by Rhizopus Oligosporus sp‐T3: A first step towards rapeseed protein concentrate
Authors: Rozan P. , Villaum C. , Bau H. M. , Schwertz A. , Nicolas J. P. , Méjean L.
Published: December 2003

To obtain proteins from OO rapeseed meal for use in human food, a first step was realized by fermentation with Rhizopus oligosporus spT3. The meal's fermentation during 40 h resulted in degradation of 84% of carbohydrates, 30% of lignin and other polyphenolic components indigestible by nonruminants, and 47% of total glucosinolates which are responsible for goitre. The fermentation improves the nutritional quality of rapeseed meal by degrading undesirable factors.
The effect of sugars on the extrusion of maize grits: II. Starch conversion
Authors: Fan Jintian , Mitchell J. R. , Blanshard J. M. V
Published: December 2003

Differential scanning calorimetry (DSC), X‐ray diffraction and rheological studies have revealed that the conversion of A‐type starch during the extrusion of mixtures of maize grits with sugars depends on sugar type and concentration. Sugars inhibited the starch conversion (fructose more than sucrose) by reducing the specific mechanical energy input. Addition of sugars led to changes in the packing of amylose–lipid complexes in the extrudate from an E‐type to V‐type. It is postulated that the complexes pack initially in the less stable E‐form and then rearrange to the more stable V‐form, a process which is accelerated by the addition of sugars because of the enhanced molecular mobility resulting from the reduction in the glass transition temperature. This rearrangement is also seen when extrudates containing no sugar are equilibrated at ambient temperature at moisture contents between 14.5% and 18% (w.b.).
The effects of particle size, connective tissue and cooking regime upon properties of washed mechanically recovered broiler meat
Authors: Kijowski Jacek , Richardson R. Ian
Published: December 2003

Mechanically recovered meat (MRM) from broilers was washed with water, with or without prior chopping and with or without sieving to remove connective tissue. The resultant protein extract was mixed with salt and cooked in a one‐step (directly to 80°C) or two‐step (to 55°C and then to 80°C) cooking regime, to form gels. Washing broiler MRM gave stronger gels with lower cooking loss and expressible moisture than unwashed broiler MRM. These washed gels were also lighter in colour and less red. The best products were produced when some of the collagen had been removed by sieving, but not if the samples had Wrst been chopped, even though the total protein and dry matter contents were also reduced. A two‐step cooking procedure enhanced gel strength. Evidence of a more porous, but dense, structure of washed broiler MRM subjected to a two‐step cooking treatment was given by scanning electron microscopy and these differences could be related to the changes in gel strength and water holding.
Simple procedures to remove mimosine from young leaves, pods and seeds of Leucaena leucocephala used as food
Authors: Soedarjo Muchdar , Borthakur Dulal
Published: December 2003

The effect of boiling and soaking in water on the mimosine and protein contents of young leaves, pods and seeds of the tropical leguminous tree Leucaena leucocephala (leucaena) was investigated. It was observed that the soluble protein content in leucaena tissue was overestimated because of the presence of mimosine. A more accurate method of determining the soluble protein content in leucaena tissue containing mimosine was developed and used in this study. It was found that boiling removed mimosine from young leaves, pods and seeds of leucaena but it also reduced the amount of soluble protein significantly. Soaking in water for 24 h eliminated 97% of mimosine from young leaves, pods and split seeds of leucaena, and up to 20% of mimosine from the whole young seeds without significantly reducing the soluble protein content.
Temperature and pressure effects on supercritical CO2 extraction of tomato seed oil
Authors: Roy Bhupesh C. , Goto Motonobu , Hirose Tsutomu
Published: December 2003

Tomato seed oil was extracted with supercritical carbon dioxide in a semibatch‐flow extractor within the temperature range 313–343 K and the pressure range 10.8–24.5MPa. The extraction rates increased with pressure, but decreased with temperature increase because of the variation in solvent density and resultant differences in oil solubility. The fatty acid composition of the extracted oil was similar to that of soybean oil.
Dynamic supercritical CO2 extraction for removal of cholesterol from anhydrous milk fat
Authors: Huber W. , Molero A. , Pereyra C. , Martínez de la Ossa E.
Published: December 2003

The feasibility of different extraction techniques for the selective removal of cholesterol from anhydrous milk fat (AMF) by supercritical carbon dioxide has been studied. A dynamic extraction system was used to determine both the experimental solubility of anhydrous milk fat in the supercritical solvent and the selectivity of cholesterol over anhydrous milk fat at 40–70°C and 8–40MPa at various stages during extraction. In addition, adsorbents were used for the selective removal of cholesterol from anhydrous milk fat. The results indicate that a direct extraction alone or with several separators in series are not practical, but a selective removal of 97% of the cholesterol from the extracted anhydrous milk fat is possible by using an adsorbent with recovery of solvent and cholesterol. A schematic industrial countercurrent process for the removal of cholesterol and the fractionation of milk fat is proposed.
Asparagus responds to controlled atmospheres in warm conditions
Authors: Lill Ross E. , Corrigan Virginia K.
Published: December 2003

Asparagus spears held in warm conditions (20°C) for 4 days in controlled atmospheres (CA) ranging from 5 to 10% oxygen with 5–15% carbon dioxide had significantly longer residual shelf‐life (≈4.5 days) in air than did check spears (2.6 days). This response was also reflected in sensory characteristics, with lower off‐flavour ratings and higher flavour and acceptability ratings for CA‐treated than for check spears. The level of response was similar across the range of atmospheres tested. Tests using plastic films differing in permeability demonstrated that modified atmosphere technology can be used to obtain the improvement in spear quality, but the gas permeability of the films tested was too low to provide a commercially useful pack. The potential for microperforated films for this application is discussed.
Comparison of high pressure treatment and thermal pasteurization effects on the quality and shelf life of guava puree
Authors: Yen Gow‐Chin , Lin Hsin‐Tang
Published: December 2003

The effects of high pressures and thermal pasteurization on the survival of microorganisms, enzyme inactivation and quality changes of guava puree during storage at 4°C were investigated and compared with untreated samples. After treatment at a pressure of 600MPa and 25°C for 15 min, the microorganisms in guava puree were inactivated to less than 10 cfu mL−1 and the product exhibited no change in colour, pectin, cloud and ascorbic acid content as compared with fresh samples. The inactivation of enzymes in guava puree by thermal pasteurization was greater than by high pressures. The microbial count in guava puree reduced to 200 cfu mL−1 and the product showed marked changes in viscosity, turbidity and colour when heated at 88–90°C for 24s. The content of pectin, cloud and ascorbic acid as well as colour in untreated and high pressurized (400MPa) guava puree gradually decreased, whereas these changes were not observed in pasteurized (88–90°C) and high pressurized (6000MPa) puree during storage at 4°C for 60 days. The guava puree treated at 600MPa and 25°C for 15 min retained good quality similar to the freshly extracted puree after storage at 4°C for 40 days.
Direct appositional (no flap) closure of deep anal fistula
Authors: Thomson W. H. F. , Fowler A. L.
Published: December 2003

Objective  After sphincter‐sparing core fistulectomy for deep anal fistula most surgeons advance a rectal mucosal flap to reinforce closure of the internal opening. Our own method having for many years been simple appositional closure the resulting series presented an opportunity for comparison.

Patients and methods  From November 1987 to January 2001, 44 patients underwent 46 core fistulectomies with flap‐less direct appositional closure in our unit. Records were kept prospectively. Twenty‐six fistulae (in 28 patients) appeared healed at two to five months follow‐up and the patients had been discharged. A full review was mounted in May 2001, when 16 of the healed patients could be contacted and questionnaires completed. Two patients were excluded from the study.

Results  The procedure failed in 16 patients initially and was found to have done so in two more at long‐term follow‐up (41% overall). Three patients had died and five could not be traced.

Conclusion  Simple appositional closure after core fistulectomy for deep anal fistula seems inferior to methods using flap reinforcement.
Pre‐operative radiotherapy for rectal carcinoma? Has the case really been made for short course pre‐operative radiotherapy if surgical standards for rectal carcinoma are optimal?
Authors: Hermanek P. , Heald R. J.
Published: December 2003

Recent publications on early results of the Dutch trial on pre‐operative radiotherapy combined with total mesorectal excision (TME) for resectable rectal cancer have initiated a major swing towards routine radiotherapy of this type. However, detailed analysis of the data so far published shows 23.3% microscopic margin involvement and 23.9% macroscopically poor specimens in a sample group. Since only mobile tumours were selected these figures are too high to validate the claim that the whole series represents ‘standardized TME surgery’. The role of pre‐operative radiotherapy for resectable rectal cancer undergoing optimal surgery therefore remains open. It may be expected that in future the individual indication for pre‐operative radiotherapy will be based on the findings of pre‐operative modern fine slice high resolution magnetic resonance imaging (MRI).
Quality of life in patients with chronic anal fissure
Authors: Griffin N. , Acheson A. G. , Tung P. , Sheard C. , Glazebrook C. , Scholefield J. H.
Published: December 2003

Objective  Little is known about the quality of life in patients with the distressing symptoms of chronic anal fissure. This was a prospective study assessing the physical and mental health of fissure patients before and after topical treatment.

Patients and methods  New patients attending the fissure clinic were recruited prospectively into the study over a 2‐month period. On first appointment, patients were given 2 questionnaires to complete: the Short‐Form 36 Health Survey (SF‐36) and a general questionnaire recording patients' demographic details, previous treatment, site and duration of fissure and symptoms on a visual analogue scale (VAS). Following an 8‐week course of topical treatment, patients repeated the SF‐36 and symptoms were again recorded on a VAS. Healing of fissure was noted.

Results  Fifty‐four patients entered the study, of which 39 returned for follow‐up; 16 male, 23 female; mean age 38.6 years (range 17–80 years). Median duration of fissure was 6 months (3 months – 10 years). Higher VAS ratings for fissure pain were associated with worse scores for all aspects of health‐related quality of life, including mental health (P < 0.001), bodily pain (P < 0.001), vitality (P < 0.006) and social functioning (P < 0.001). Compared to age and gender matched norms for the SF‐36, fissure patients had more bodily pain (P < 0.001, Wilcoxon) and poorer health perceptions (P < 0.02, Wilcoxon). Gender did not affect any of the SF‐36 subscales. However, females did report significantly more bleeding (P = 0.05). On follow‐up, healing was complete in 27 patients (69%). Symptoms of pain, bleeding and irritation were all significantly reduced in this group. Repeating the SF‐36 showed an improvement in bodily pain, role‐physical functioning and vitality (P < 0.05).

Conclusion  Successful nonsurgical treatment of chronic anal fissure leads to symptomatic improvement and beneficially affects health‐related quality of life.
Joint Effects of Group Efficacy and Gender Diversity on Group Cohesion and Performance
Authors: Lee Cynthia , Farh Jiing‐Lih
Published: December 2003

Cette étude s’intéresse aux facteurs de l’efficience de groupe et à la conjonction de l’efficience de groupe et de la mixité sur las relation entre l’efficience et les résultats du groupe. On a constitué 45 groupes d’étudiants de 1° cycle (N= 260) devant réaliser en classe deux projets en commun. Il est apparu que la performance antérieure et l’auto‐efficience étaient toutes deux positivement corrélées à l’efficience de groupe. De plus, l’interaction de la mixité et de l’efficience de groupe entretenait une liaison positive avec l’efficacité de groupe (qualité du projet et cohésion du groupe). En particulier, la mixité facilitait la relation entre l’efficacité et l’efficience de groupe. Une discussion porte sur les implications de cette recherche.

This study examined the sources of group efficacy and the joint roles of group efficacy and gender diversity on the relationship between group efficacy and group outcomes. We used 45 project groups (260 undergraduate students) designed to complete two in‐class group projects. We found that past performance and self‐efficacy were both positively related to group efficacy. Further, the interaction of gender diversity and group efficacy was positively related to group effectiveness (project grade and group cohesion). Specifically, mixed gender groups facilitated the relationship between group efficacy and group effectiveness. Implications of the study are discussed.
Appreciating Stockbroking: Constructing Conceptions to Make Sense of Performance
Authors: Blomberg Jesper
Published: December 2003

ABSTRACT  The performance of individual stockbrokers differs. This paper aims to make sense of these differences. In a study of 14 stockbrokers, the high performing brokers described their working life in a systematically different way, compared to the low performing brokers. The brokers gave different and conflicting accounts of what, from an outsider's viewpoint, seemed to be very similar work and working conditions. The brokers’ different accounts are interpreted and reconstructed into two opposing conceptions of stockbrokers’ world of working. In an ideal typical sense these two conceptions make sense of, and maybe even explain the stockbrokers’ different levels of performance.
Edith Penrose's (1959) Contributions to the Resource‐based View of Strategic Management
Authors: Kor Yasemin Y. , Mahoney Joseph T.
Published: December 2003

ABSTRACT We argue thatRugman and Verbeke (2002) underestimate the importance ofPenrose's (1959) contributions to the modern resource‐based view of the firm. In particular, we take issue withRugman and Verbeke's (2002) arguments concerningPenrose's (1959) contributions to our knowledge of: (1) thecreationof competitive advantage, (2)sustainingcompetitive advantage, (3) isolating mechanisms, and (4) competitive advantage and economic rents. In our response, we show thatPenrose (1959) has bothdirectlyand indirectly influenced the modern resource‐based view of strategic management.
Artists' Books
Authors: Peixoto Tania
Published: December 2003

Books reviewed in this article:

Cris Cheek and Kirsten Lavers, (eds) The Millennium Collection

Inventory: Losing Finding Collecting
Artists' Books
Authors: Peixoto Tania
Published: December 2003

Books reviewed in this article:

John Bently, Concerning the Poetry of Lost Things (Harrow)

Thomas A Clark, Distance and Proximity

Telfer Stokes, Become

Bart van der Leck, Het Vlas (The Flax Flower) Hans Christian Andersen
Beyond Regionalism
Authors: Bechhoefer William
Published: December 2003

Book reviewed in this article:

David Robson, Geoffrey Bawa: The Complete Works
Enhancing the Learning and Retention of Biblical Languages for Adult Students
Authors: Morse MaryKate
Published: December 2003

Abstract.  Finding ways to reduce students’ anxiety and maximize the value of learning Greek and Hebrew is a continual challenge for biblical language teachers. Some language teachers use technology tools such as web sites or CDs with audio lessons to improve the experience. Though these tools are helpful, this paper explores the value gained from understanding first how students learn and then how technology tools best support that learning. Developments in cognitive psychology and neuroscience offer many insights concerning adult learning and retention. After a presentation of key insights, several ideas are suggested for enhancing the learning and retention experience of biblical language students.
Can Communicative Methods Enhance Ancient Language Acquisition?
Authors: Overland Paul
Published: December 2003

Abstract.  For several years the field of Second Language Acquisition has benefited from methods associated with communicative language learning. However, these benefits have largely been overlooked when teaching ancient languages, likely because the objective for ancient languages is literacy, not oral fluency. This article outlines an experiment that capitalized on communicative language methods to accelerate literacy for beginning students of Biblical Hebrew. (Digital images associated with this essay may be found at:〈http://www.wabashcenter.wabash.edu/journal/overland.html〉
Effects at age nine of maternal smoking in pregnancy: experimental and observational findings
Authors: MacArthur Christine , Knox E. George , Lancashire Robert J.
Published: December 2003

Objectives To compare long term outcomes of a randomised controlled trial of anti‐smoking education in pregnancy and to examine the same outcomes according to maternal pregnancy smoking behaviour.

Design Follow up of the population included in the randomised controlled trial nine years later and of ex‐smokers and non‐smokers within the same hospital population.

Setting A maternity hospital in Birmingham with follow up of children in schools and mothers at home.

Population 1218 smokers recruited to the trial; also 191 ex‐smokers at booking and 414 non‐smokers throughout pregnancy.

Methods Children were assessed individually by psychologists in schools, and mothers interviewed at home to obtain additional information relevant to cognitive development and growth. Information on smoking during pregnancy was obtained from mothers and obstetric data from computerised case‐notes, both recorded immediately following delivery.

Main outcome measures Height, weight, IQ and neurological soft signs at 9.4 years.

Results Differences in birthweight and length between the intervention and control groups were confirmed but no intervention–control differences were found at age 9.4 for weight, height, IQ or neurological soft signs. Differences were found for height and IQ according to mothers pregnancy smoking behaviour, but smoking did not remain an independent predictor after taking account of confounding factors. Alternative classifications of smoking behaviour, taking account of the gestation at stopping and mean cigarette consumption throughout pregnancy likewise showed no effect.

Conclusions The well established early hazards of smoking during pregnancy seem to be resolved by later childhood, with no evidence of direct long term effects on growth or cognitive functioning.
A comparison of oral and vaginal misoprostol for induction of labour at term: a randomised trial
Authors: Kwon Janice S. , Davies Gregory A.L. , Mackenzie V. Paul
Published: December 2003

Objective To compare the efficacy of oral with vaginal misoprostol for induction of labour at term.

Design Randomised trial.

Setting Tertiary Care hospital.

Participants One hundred and sixty‐seven women requiring induction of labour.

Methods The women were randomised to receive 50 μg of misoprostol orally or vaginally every 6 h until the cervix was favourable for amniotomy, spontaneous rupture of membranes, or active labour occurred. Sample size was calculated with a two‐tailed alpha of 0.05 and a power of 95% to detect a 5 h difference in induction‐to‐delivery time. Student's t test was used for comparison of normally distributed continuous variables and the Mann‐Whitney U test was used for non‐Gaussian distributed continuous variables. Fisher's exact and χ2 tests were used for comparison of categorical variables. The main outcome measure was induction to delivery time.

Results The median induction to delivery time was significantly shorter with vaginal misoprostol (15.7 h range 4.3‐55.7), compared with oral misoprostol (23.0 h range 3.2‐141.7, P=0.0013). The median number of doses was also significantly less in the vaginal misoprostol group, 1 (range 1‐3), compared with the oral group, 2 (range 1‐8), (P<0.0001). The significant differences in outcome held true when nulliparous and multiparous women were analysed separately. There were no differences between the two routes of administration with respect to rates of hyperstimulation or neonatal asphyxia. There were more caesarean sections in the vaginal misoprostol group, but the difference was not statistically significant.

Conclusions Compared with oral misoprostol, vaginal misoprostol for induction of labour at term results in a shorter induction‐to‐delivery time, with fewer doses required per patient. Vaginal misoprostol may be associated with higher rates of caesarean section than oral misoprostol.
The frequency of significant pathology in women attending a general gynaecological service for postcoital bleeding
Authors: Rosenthal Adam N. , Panoskaltsis Theo , Smith Trudy , Soutter W.P.
Published: December 2003

Objectives To document the frequency of pathology in women who complain of postcoital bleeding. To determine whether negative cervical cytology excludes serious pathology in women with postcoital bleeding. To determine whether postcoital bleeding increases the risk of serious pathology in women with an abnormal smear.

Design A retrospective study.

Setting A university teaching hospital.

Population 314 women with postcoital bleeding seen in the gynaecology service from first January 1988 to 31 December 1994.

Methods Women were identified from the computerised records of the colposcopy service and copies of correspondence, which was routinely retained on computer. The latter was searched for the text strings coital and intercourse.

Main outcome measure Histopathological diagnosis.

Results Twelve women (4%) had invasive cancer: 10 were cervical or vaginal cancers and two endometrial cancers. Eight of the 10 cervical or vaginal cancers were clinically apparent. Four women of these 10 had had a normal smear before being referred for further investigation of postcoital bleeding. Two of these cancers were visible only with the aid of the colposcope. Thus, 0.6% of women attending a gynaecology service with postcoital bleeding, a normal looking cervix and a normal smear had invasive cancer of the cervix. Cervical intraepithelial neoplasia were found in 54 women (17.%) and 15 women (5%) had cervical polyps. Nineteen of the 63 women (30%) with significant pathology had a normal or inflammatory cervical smear. No explanation for the postcoital bleeding was found in 155 women (49 %).

Conclusions Although invasive cancer is rare in women with postcoital bleeding, it is much commoner than in the general population. It seems likely that cervical intraepithelial neoplasia is also associated with postcoital bleeding, perhaps because the fragile cervical epithelium becomes detached during intercourse. Postcoital bleeding should continue to be regarded as an indication of high risk for invasive cervical cancer and for cervical intraepithelial neoplasia. Prompt referral to a colposcopy clinic is indicated, but most women with postcoital bleeding will have no serious abnormality.
Medical education with the Internet: a pilot training programme in reproductive medicine
Authors: Jenkins J.M. , Cook J. , Edwards J. , Draycott T. , Cahill D.J.
Published: December 2003

Following a detailed information technology survey in the South West Deanery, an Internet educational programme in reproductive medicine was constructed, delivered and assessed. The course followed a problem‐based approach using case studies, using an education website and electronic mail (e‐mail) to communicate between trainees and trainers. Independent evaluation revealed a high level of satisfaction for both trainees and trainers with an increase in trainees’ confidence to deal with patients following the course. This study suggests that the Internet may be used effectively to deliver postgraduate medical education, if the training programme is designed appropriately to computer infrastructure and the computer literacy of the users.
Non‐surgical treatment of uterovaginal prolapse using double vaginal rings
Authors: Singh K. , Reid W.M.N.
Published: December 2003

A new technique of using double vaginal ring pessaries to treat uterovaginal prolapse in a group of elderly women is described. Eighteen women with a mean age of 82 years and advanced Stage III or IV uterovaginal prolapse had double vaginal rings inserted. All of them previously had used single vaginal ring pessaries or had undergone pelvic floor repair surgery. Double ring pessaries were successful in 13 of the 18 women. They are a useful treatment of advanced prolapse in women unsuitable for surgery.
Oestrogen deficiency causes DNA damage in uterine leiomyoma cells: a possible mechanism for shrinkage of fibroids by GnRH agonists
Authors: Cheng Ya‐Min , Chou Cheng‐Yang , Huang Soon‐Cen , Lin Hui‐Chuan
Published: December 2003

Objective
To examine whether gonadotrophin‐releasing hormone agonist or oestradiol can directly affect DNA in leiomyoma cells.

Design
In vitro explant culture of leiomyoma cells.

Setting
University research group.

Sample
Leiomyoma cells were cultured from the specimens of four premenopausal women at myomectomy.

Methods
The presence of gonadotrophin‐releasing hormone receptor in leiomyoma cells was determined by reverse transcriptase–olymerase chain reaction. Leiomyoma cells were treated with gonadotrophin‐releasing hormone agonist or cultured in different concentrations of oestrogen, progesterone or fetal calf serum for one, four or seven days.

Main outcome measures
Cell number, expression of proliferating cell nuclear antigen, and DNA damage after one, four or seven days of treatment.

Results
Gonadotrophin‐releasing hormone receptor messenger ribonucleic acid was detected on cultured leiomyoma cells. Leiomyoma cell growth was not affected by the addition of gonadotrophin‐releasing hormone agonist or progesterone, but increased with oestrogen or fetal calf serum supplementation. Overexpression of proliferating cell nuclear antigen was prevented in cultures added with oestrogen or fetal calf serum, but not related to gonadotrophin‐releasing hormone agonist treatment. Significant decreases in DNA damage as indicated by decreased comet number were found in the leiomyoma cultures treated with oestrogen or fetal calf serum for four and seven days but not with gonadotrophin‐releasing hormone agonist or progesterone. Furthermore, 5% fetal calf serum supplementation was more growth supporting and more significantly reduced the comet number than 250 pM 17 β‐oestradiol.

Conclusion
Cell growth, proliferating cell nuclear antigen expression and DNA damage are dependent on oestrogen or fetal calf serum, but independent of gonadotrophin‐releasing hormone agonist or progesterone. Our findings suggest that gonadotrophin‐releasing hormone agonist‐induced leiomyoma shrinkage may be due in part to a mechanism involving DNA damage, and support the hypothesis that gonadotrophin‐releasing hormone agonist exerts its action indirectly through oestrogen action on the tumour level.
The Ipswich childbirth study: one year follow up of alternative methods used in perineal repair
Authors: Grant Adrian , Gordon Beverley , Mackrodat Carolyn , Fern Elizabeth , Truesdale Ann , Ayers Sarah
Published: December 2003

Objective To assess the long term implications of four alternative approaches to postpartum perineal repair.

Design A stratified randomised controlled trial using a 2x2 factorial design.

Setting Original recruitment at the Maternity Unit at Ipswich Hospital NHS Trust, a district general hospital, between 1992 and 1994.

Sample Seven hundred and ninety three women who had participated in the Ipswich Childbirth Study – a trial among women who had required repair of episiotomy or first or second degree tears – at least one year previously.

Methods Self‐completed postal follow up at least one year after recruitment to trial comparing 1. two‐stage repair leaving the skin unsutured with standard three‐stage repair, and 2. polyglactin 910 with chromic catgut as suture material for the repair.

Main outcome measures Failure to resume pain‐free intercourse; persistent perineal pain; perineum feeling different; resuturing; time to resume pain‐free intercourse; and dyspareunia.

Results Fewer women allocated two‐stage repair reported that the perineum felt different (30% versus 40%; RR 0.75; 95% CI 0.61 to 0.91; 2P<0.01); otherwise there were no clear differences between the two methods. Women allocated polyglactin 910 were less likely to have dyspareunia (8% versus 13%; RR 0.59, 95% CI 0.39 to 0.91; 2P= 0.02) and less likely to fail to resume pain‐free intercourse (8% versus 14%; RR 0.57, 95% CI 0.38 to 0.87; 2P<0.01).

Conclusion Two‐stage repair of perineal trauma leaving the skin unsutured appears to reduce the likelihood of the perineum feeling different from before delivery, in addition to less pain and dyspareunia initially; there were no apparent disadvantages. Polyglactin 910 reduces dyspareunia long term, indicating that the short term benefits of this material over chromic catgut persist.
Randomised, double‐blind, placebo‐controlled trial of corticosteroids for the treatment of hyperemesis gravidarum
Authors: Nelson‐Piercy Catherine , Fayers Peter , de Swiet Michael
Published: December 2003

Objective To assess the efficacy of corticosteroids in the treatment of severe hyperemesis gravidarum refractory to conventional management.

Design Multicentre, double‐blind, randomised, placebo‐controlled trial.

Setting Inpatient gynaecology wards in eight collaborating centres.

Population Twenty‐five women with severe hyperemesis of which 24 completed the one‐ week study period.

Methods Twenty‐five women were randomised to receive either 40 mg prednisolone daily in two divided oral doses, or equivalent placebo tablets. If, after three days, a woman was still vomiting, medication was changed to the equivalent intravenous alternative (hydrocortisone 100mg twice daily or normal saline injections)

Main outcome measures Frequency of vomiting and the dependence on intravenous fluid replacement therapy after one week of treatment.

Results There was a non‐significant trend towards improved nausea and vomiting and reduced dependence on intravenous fluids. However, steroid therapy led to an improved sense of wellbeing (P= 0.021), improved appetite (P= 0.039) and increased weight gain (P= 0.025) compared with placebo. There was no difference in pregnancy outcome between the treatment and placebo groups.

Conclusions This study supports a beneficial role for steroids in severe hyperemesis, but did not validate the hypothesis that they lead to rapid and complete remission of symptoms. The study was not large enough to demonstrate a significant improvement in the primary outcome measures.
Is maternal underweight really a risk factor for adverse pregnancy outcome? A population‐based study in London
Authors: Sebire NJ , Jolly M , Harris J , Regan L , Robinson S
Published: December 2003

Objective To determine the maternal and fetal risk of adverse outcome during pregnancy in relation to low maternal body mass index in an unselected population.

Design Retrospective analysis.

Methods Information for the years between 1988 and 1997 was extracted from a validated maternity database, including all but one of the maternity units in the North West Thames Region; 215,105 completed singleton pregnancies were studied. Comparison of pregnancy outcome was made on the basis of maternal body mass index at booking. There were 176,923 with a normal weight body mass index (= 20 < 25). There were 38,182 with an underweight body mass index (< 20). Comparisons included antenatal complications (e.g. gestational diabetes, pre‐eclampsia); intervention in labour, maternal morbidities (e.g. infection, postpartum haemorrhage, pulmonary thromboembolism); and neonatal outcome (admitted to special care baby unit at 24 hour of age, gestation at delivery, birthweight, stillbirth). Data are presented as percentages of outcomes in the normal and underweight groups with adjusted odds ratios and confidence intervals according to body mass index group.

Results In the underweight group only antenatal anaemia, preterm delivery and birthweight below the 5th centile were more frequent than in women of normal body mass index. The prevalence of certain complications, including development of gestational diabetes mellitus, pre‐eclampsia, obstetric intervention and postpartum haemorrhage, were significantly lower in those with low body mass index.

Conclusion Low maternal body mass index is associated with increased prevalence of some pregnancy complications, notably preterm delivery and low birthweight, but overall the outcome is favourable and several adverse outcomes are less common in this group of women.
Age at menarche and age at menopause in relation to hepatocellular carcinoma in women
Authors: Mucci Lorelei A. , Kuper Hannah E. , Tamimi Rulla , Lagiou Pagona , Spanos Evangelos , Trichopoulos Dimitrios
Published: December 2003

Objectives
To assess whether age at menarche, age at menopause, parity, and selected blood hormones are associated with risk of hepatocellular carcinoma among women.

Design
Case–control.

Sample and setting
Data collected from 50 cases of hepatocellular carcinoma among women and 62 female controls with minor trauma or surgical conditions who attended one of three hospitals in Athens, Greece between 1995 and 1998.

Methods
Researchers collected information on Reproductive variables and assayed sera samples for blood hormone levels and for chronic infection with Hepatitis B and C viruses.

Results
Individuals with hepatocellular carcinoma had a lower mean age at menarche and a significantly higher mean age at menopause. After adjusting for potential confounding, age at menopause remained an important and significant predictor, increasing the risk of hepatocellular carcinoma 24% for each later year of menopause (P < 0.001). For each year that menarche was delayed, risk of hepatocellular carcinoma declined 21% (P= 0.100). Mean levels of insulin‐like growth factor‐1 and its binding protein were significantly reduced in cases compared with controls, while levels of oestradiol, testosterone and sex hormone binding globulin were somewhat higher among the cases.

Conclusions
This study provides indirect, but converging evidence that steroid hormones in general, and oestrogens in particular, play an important role in the aetiology of hepatocellular carcinoma among women.
Oxytocics reverse the tocolytic effect of glyceryl trinitrate on the human uterus
Authors: Lau L.C. , Adaikan P.G. , Arulkumaran S. , Ng S.C.
Published: December 2003

Objectives To investigate the effect of glyceryl trinitrate on isolated human pregnant uterine strips and whether the uterine relaxation induced by glyceryl trinitrate could be reversed by oxytocics used in current clinical practice.

Design In vitro pharmacological study.

Setting Department of Obstetrics & Gynaecology, National University of Singapore, National University Hospital.

Participants Eighteen women who delivered by caesarean section at term.

Methods Myometrial strips were preloaded with an initial tension of 1.5g in organ baths containing Krebs‐Henseleit solution which was aerated with oxygen in 5% carbon dioxide and maintained at 37°C, pH 7.4. The effect of glyceryl trinitrate was studied in strips displaying regular spontaneous contractions. The ability of oxytocin, ergometrine or prostaglandin F2α to stimulate uterine contractions was assessed in strips where uterine activity was significantly inhibited by glyceryl trinitrate.

Results Glyceryl trinitrate reduced the amplitude and frequency of spontaneous uterine contractions in a concentration‐dependent manner, although the sensitivity of the myometrial strips varied considerably from one specimen to another. The concentration of glyceryl trinitrate producing complete inhibition of myometrial contractions ranged from 44‐705μM. In the presence of glyceryl trinitrate which markedly depressed spontaneous contractions, oxytocin (20mU/mL), ergometrine (6.15μM) and prostaglandin F2α (6.15μM) were capable of reversing the uterine activity to either higher than or the untreated level of contractility.

Conclusions This study demonstrates that glyceryl trinitrate is a potent uterine relaxant in vitro and that the tocolytic effect could be reversed with ease by oxytocics.
An economic evaluation of single dose systemic methotrexate and laparoscopic surgery for the treatment of unruptured ectopic pregnancy
Authors: Sowter Martin C. , Farquhar Cindy M. , Gudex Guy
Published: December 2003

Objective To compare the direct and indirect costs of single dose systemic methotrexate with laparoscopic surgery for the treatment of unruptured ectopic pregnancy.

Design A cost minimisation study undertaken alongside a randomised trial.

Setting Departments of Obstetrics and Gynaecology in three hospitals in Auckland, New Zealand.

Participants Sixty‐two women with an ectopic pregnancy randomised to treatment with either a single dose of methotrexate (50mg/m2) or laparoscopic surgery.

Main outcome measures Direct and indirect costs based on the results of the randomised trial.

Results Direct costs per case were significantly lower in the methotrexate group (mean $NZ 1470) than in the laparoscopy group (mean $NZ 3083) with a mean difference of $NZ 1613 (95% CI $NZ 1166 ‐ $NZ 2061). These significant differences existed under a wide range of alternative assumptions about unit costs. The difference in direct costs in favour of methotrexate was greatest for women presenting with low pretreatment serum β‐hCG concentrations. Mean indirect costs were also significantly lower in the methotrexate group (mean $NZ 1141) than in the laparoscopy group (mean $NZ 1899) with a mean difference of $NZ 758 (95% CI $NZ 277 ‐ $NZ 1240). For women presenting with pretreatment serum β‐hCG concentrations of over 1500 IU/L this difference in indirect costs is lost due to the prolonged follow up required and a higher rate of surgical intervention in women receiving methotrexate.

Conclusion This economic evaluation shows that treating suitable women with an ectopic pregnancy using systemic methotrexate therapy results in a significant reduction in direct costs. The indirect costs borne by the woman and her carers are only likely to be reduced in women with pretreatment serum β‐hCG concentrations under 1500 IU/L.