bluuebunny/crossref_metadata_2025 huggingface dataset:
Variability of El Niño–Southern Oscillation–related noise in the equatorial Pacific Ocean
Authors: Wu Renguang , Kirtman Ben P.
Published: December 2009

This study documents the variability of noise in the equatorial Pacific associated with the El Niño and La Niña events based on the ensemble retrospective forecasts of the Climate Forecast System. It is found that the noise (measured by the ensemble spread) in the western equatorial Pacific zonal wind stress is enhanced around and before the peak of El Niño events and weakened around 2–3 months after the peak of El Niño events. The change in the wind stress noise is communicated to the thermocline depth in the eastern equatorial Pacific with about 1 month time lag. The eastern equatorial Pacific SST noise, however, decreases during the decay stages of El Niño events while the corresponding noise in the surface zonal wind and heat flux increases. This decrease in the SST noise is related to the weakening of the SST front and the suppression of the tropical instability waves along the flanks of the equatorial Pacific cold tongue that is associated with the SST warming due to El Niño events. Similar relations are seen during La Niña events except that the changes are in opposite sense. As such, the signal‐to‐noise ratio and, thus, the predictability for the eastern equatorial Pacific SST is relatively high during warm events compared to cold events.
Inflammation, DNA-centered radicals, and oxidative genotoxicity: The role of HOCl produced by myeloperoxidase in carcinogenesis
Authors: Gomez-Mejiba Sandra , Zhai Zili , Ramirez Dario
Published: December 2009

Myeloid cells (macrophages and neutrophils) infiltrate and synthesize myeloperoxidase (MPO) in sites of inflammation, producing gentotoxicity. In RAW 264.7 macrophages, bacterial lipopolysaccharide (LPS) induces superoxide radical anion, nuclear deformation (nuclear protuberances), MPO synthesis, biomolecule oxidation and cell death. “Freezing” LPS-triggered macrophage activation with the nitrone spin trap 5,5-dimethyl-1-pyrroline N-oxide (DMPO) prevented cell activation and death. Oxidation of proteins and genomic DNA was also blocked, with formation of protein- and DNA-DMPO nitrone adducts, as analyzed by immuno-spin trapping with a polyclonal anti-DMPO serum. Interestingly, confocal microscopy analysis of these cells showed that MPO, genomic DNA, and DNA-DMPO nitrone adducts co-localized in the nuclear protuberances. These observations, and the fact that DNA is negatively charged and MPO is a cationic protein, suggest a role for uptaken or newly synthesized MPO in oxidative genotoxicity induced by myeloid cells in sites of inflammation. In order to understand MPO-induced formation of DNA-centered radicals, we studied DNA-DMPO nitrone adducts in calf thymus DNA treated with micromolar concentrations of hypochlorous acid (HOCl) added as a bolus or generated in situ by the MPO/H2O2/Cl- system in the presence of DMPO. We also investigated DNA-DMPO nitrone adducts inside living cells containing MPO. The cell models we used were: i) human leukemia (HL)-60 cells, which overexpress MPO, ii) RAW 264.7 macrophages activated with LPS (1 ng/ml for 24 h), to induce MPO, and iii) A549 human airway epithelial cells pre-loaded with human MPO. When these cells were activated with the phorbol ester PMA, the number of 6-thioguanine-resistant cells with the hypoxanthine-guanine phosphoribosyl transferase (HRPT) mutation increased. This mutation was prevented by each of the following: the NADPH oxidase inhibitor apocynin; the MPO inhibitors salicylhydroxamic acid and 4-aminobenzoic acid hydrazide; the cell-permeable HOCl scavenger resveratrol; and DMPO, which traps DNA-centered radicals and prevents further oxidation. Genomic DNA-centered radicals and further mutagenesis induced by activated myeloid cells in sites of inflammation can be prevented by blocking MPO activity, preventing formation of and/or scavenging HOCl, or trapping DNA-centered radicals. Our findings provide new therapeutic avenues for preventing carcinogenesis induced by infiltration and activation of myeloid cells in sites of inflammation, for example, in the lung exposed to particulate matter. SUPPORTED BY NIEHS 5R00ES015415-03
Highly sensitive silicon microreactor for catalyst testing
Authors: Henriksen Toke R. , Olsen Jakob L. , Vesborg Peter , Chorkendorff Ib , Hansen Ole
Published: December 2009

A novel microfabricated chemical reactor for highly sensitive measurements of catalytic activity and surface kinetics is presented. The reactor is fabricated in a silicon chip and is intended for gas-phase reactions at pressures ranging from 0.1 to 5.0 bar. A high sensitivity is obtained by directing the entire gas flow through the catalyst bed to a mass spectrometer, thus ensuring that nearly all reaction products are present in the analyzed gas flow. Although the device can be employed for testing a wide range of catalysts, the primary aim of the design is to allow characterization of model catalysts which can only be obtained in small quantities. Such measurements are of significant fundamental interest but are challenging because of the low surface areas involved. The relationship between the reaction zone gas flow and the pressure in the reaction zone is investigated experimentally. A corresponding theoretical model is presented, and the gas flow through an on-chip flow-limiting capillary is predicted to be in the intermediate regime. The experimental data for the gas flow are found to be in good agreement with the theoretical model. At typical experimental conditions, the total gas flow through the reaction zone is around 3×1014 molecules s−1, corresponding to a gas residence time in the reaction zone of about 11 s. To demonstrate the operation of the microreactor, CO oxidation on low-area platinum thin film circles is employed as a test reaction. Using temperature ramping, it is found that platinum catalysts with areas as small as 15 μm2 are conveniently characterized with the device.
Direct fabrication of nanopores in a metal foil using focused ion beam with in situ measurements of the penetrating ion beam current
Authors: Nagoshi Kotaro , Honda Junki , Sakaue Hiroyuki , Takahagi Takayuki , Suzuki Hitoshi
Published: December 2009

A through hole with a diameter less than 100 nm was fabricated in an Ag foil using only a focused ion beam (FIB) system and in situ measurements of the penetrating ion beam. During the drilling of the foil by a FIB of Ga+ ions, the transmitted part of the beam was measured with an electrode mounted on the back face of the foil. When the beam current penetrating through the nanopore reached a certain value, irradiation was stopped and the area of the created aperture was measured with a scanning electron microscope. The resulting area was correlated with the current of the penetrating ion beam. This suggests that we can fabricate a nanopore of the desired size by controlling the ion beam via penetrating ion beam measurements. The smallest aperture thus created was circular with diameter of 30 nm.
Seed provenance and fire-related reproductive traits of Pinus pinaster in central Spain
Authors: Gil Luis , López Rosana , García-Mateos Álvaro , González-Doncel Inés
Published: December 2009

Disregarded for centuries, Mediterranean pine forests in Spain have been severely affected by human activities including fires and livestock grazing. As a consequence, reforestation programs were started by the late 1800s, albeit the origin of the seeds was not considered until the late 1960s. In July 2005, a large Pinus pinaster Ait. forest, located in Guadalajara (central Spain), burned down. In this area, we studied fire-related fitness traits in natural stands (zone N) and compared them to those of trees sown with seeds from foreign sources (zone S). Cone production per hectare in zone N doubled that found in zone S. In addition, zone N resulted in more saplings per hectare as well as more small trees bearing cones than zone S. In zone S, trees showed thicker crowns and less fructification resulting in open formations with low intraspecific competition. Whereas in the natural stands the average percentage of serotiny per tree was 32%, in the sown stands only one serotinous cone was found in seven unburned harvested trees. Compared with zone S, the presence of seedlings after springtime was almost nine times higher in zone N in spite of the damaging effects of logging and removal of burnt wood.
Dietary branched chain amino acids ameliorate injury-induced cognitive impairment
Authors: Cole Jeffrey T. , Mitala Christina M. , Kundu Suhali , Verma Ajay , Elkind Jaclynn A. , Nissim Itzhak , Cohen Akiva S.
Published: December 2009

Neurological dysfunction caused by traumatic brain injury results in profound changes in net synaptic efficacy, leading to impaired cognition. Because excitability is directly controlled by the balance of excitatory and inhibitory activity, underlying mechanisms causing these changes were investigated using lateral fluid percussion brain injury in mice. Although injury-induced shifts in net synaptic efficacy were not accompanied by changes in hippocampal glutamate and GABA levels, significant reductions were seen in the concentration of branched chain amino acids (BCAAs), which are key precursors to de novo glutamate synthesis. Dietary consumption of BCAAs restored hippocampal BCAA concentrations to normal, reversed injury-induced shifts in net synaptic efficacy, and led to reinstatement of cognitive performance after concussive brain injury. All brain-injured mice that consumed BCAAs demonstrated cognitive improvement with a simultaneous restoration in net synaptic efficacy. Posttraumatic changes in the expression of cytosolic branched chain aminotransferase, branched chain ketoacid dehydrogenase, glutamate dehydrogenase, and glutamic acid decarboxylase support a perturbation of BCAA and neurotransmitter metabolism. Ex vivo application of BCAAs to hippocampal slices from injured animals restored posttraumatic regional shifts in net synaptic efficacy as measured by field excitatory postsynaptic potentials. These results suggest that dietary BCAA intervention could promote cognitive improvement by restoring hippocampal function after a traumatic brain injury.
Site-directed spin labeling of a genetically encoded unnatural amino acid
Authors: Fleissner Mark R. , Brustad Eric M. , Kálai Tamás , Altenbach Christian , Cascio Duilio , Peters Francis B. , Hideg Kálmán , Peuker Sebastian , Schultz Peter G. , Hubbell Wayne L.
Published: December 2009

The traditional site-directed spin labeling (SDSL) method, which utilizes cysteine residues and sulfhydryl-reactive nitroxide reagents, can be challenging for proteins that contain functionally important native cysteine residues or disulfide bonds. To make SDSL amenable to any protein, we introduce an orthogonal labeling strategy, i.e., one that does not rely on any of the functional groups found in the common 20 amino acids. In this method, the genetically encoded unnatural amino acid
p
-acetyl-L-phenylalanine (
p
-AcPhe) is reacted with a hydroxylamine reagent to generate a nitroxide side chain (K1). The utility of this scheme was demonstrated with seven mutants of T4 lysozyme, each containing a single
p
-AcPhe at a solvent-exposed helix site; the mutants were expressed in amounts qualitatively similar to the wild-type protein. In general, the EPR spectra of the resulting K1 mutants reflect higher nitroxide mobilities than the spectra of analogous mutants containing the more constrained disulfide-linked side chain (R1) commonly used in SDSL. Despite this increased flexibility, site dependence of the EPR spectra suggests that K1 will be a useful sensor of local structure and of conformational changes in solution. Distance measurements between pairs of K1 residues using double electron electron resonance (DEER) spectroscopy indicate that K1 will also be useful for distance mapping.
Angiopoietin‐2 in the perinatal period and the role of intrauterine growth restriction
Authors: MALAMITSI‐PUCHNER ARIADNE , BOUTSIKOU THEODORA , ECONOMOU EMMANUEL , TZONOU ANASTASIA , MAKRAKIS EVANGELOS , NIKOLAOU KONSTANTINOS E. , HASSIAKOS DIMITRIOS
Published: December 2009

Background. Angiopoietin‐2, an angiogenic factor, causing destabilization and postnatal remodeling of blood vessels, is upregulated by hypoxia. We hypothesized that circulating Angiopoietin‐2 levels might differ in intrauterine growth restricted and appropriate for gestational age fetuses and neonates, as the former have restricted growth and development and suffer from in utero hypoxia. Methods. This is a prospective, controlled study, including forty asymmetric, mainly due to hypertension or pre‐eclampsia intrauterine growth restricted (0–9 customized centiles, corrected for gestational age, sex, maternal weight, height, ethnic group, and parity), and 20 appropriate for gestational age (42–82 customized centiles) full‐term infants, as well as their mothers. Blood samples were drawn from mothers, from the doubly clamped umbilical cord (mixed arteriovenous blood, representing fetal state), and from neonates on days 1 (N1) and 4 (N4) of life (representing transition and stabilization to extrauterine life, respectively). Circulating angiopoietin‐2 levels were measured by enzyme immunoassay and the statistical analysis involved t‐test and Pearson correlation. Results. Angiopoietin‐2 levels were significantly higher in intrauterine growth restricted cases only in N4 (p=0.04). No dependence on the mode of delivery and gender was documented. Conclusions. These findings may suggest that intrauterine hypoxia possibly does not upregulate circulating angiopoietin‐2 levels in intrauterine growth restricted fetuses and day 1 neonates; however, increased angiopoietin‐2 on N4, after stabilization to extrauterine life, might signify initiation of catch‐up growth‐related angiogenesis and stimulation of angiogenic factors, granted that angiopoietin‐2 is critically involved in postnatal vascular remodeling.
Is fetal growth impaired after in vitro fertilization?
Authors: AHLBORG LIV , EK SVERKER , FRIDSTRÖM MARGARETA , KUBLICKAS MARIUS , LEIJON MAGNUS , NISELL HENRY
Published: December 2009

Background. The objective was to study fetal growth parameters in in vitro fertilization (IVF) pregnancies and to investigate the relationship between fetal growth and maternal blood pressure. Methods. We examined 64 women, pregnant after in vitro fertilization, with repeated ultrasound examinations measuring biparietal diameter, femur length, and abdominal diameter fetal weight at 24, 30, and 36 weeks of gestation. We calculated deviations in percent from expected values in regards to biparietal diameter, femur length, abdominal diameter, and fetal weight. Blood pressure was measured every second week. Results. Biparietal diameter in the study group was significantly smaller at 24 (−3.3%, 95%CI −4.4 to −2.2) and 30 (−1.4%; 95%CI −2.5% to −0.3) weeks. Femur length differed significantly on all three occasions, at 24 (−6.3%; 95%CI −7.7 to −5.1), 30 (−6.6%; 95%CI −8.0 to −5.3), and 36 (−3.9%; 95%CI; −5.0 to −2.8) weeks. Abdominal diameter demonstrated a significant deviation at 24 weeks (−1.6%; 95%CI −2.8 to −0.4). Fetal weight did not reach significant deviations at any gestational age. There was no correlation between deviation of the individual growth parameters or estimated fetal weight and elevated blood pressure. Conclusion. The growth pattern of in vitro fertilization pregnancies does not seem to differ from spontaneously conceived pregnancies to any appreciable extent. In the present material, no relationship between fetal growth and maternal blood pressure could be observed. We could not show that an impaired fetal growth predates the development of hypertension.
Vascular endothelial growth factor expression is unaltered in placentae and myometrial resistance arteries from pre‐eclamptic patients
Authors: Oh Min‐Jeong , Lee Jae Kwan , Lee Nak Woo , Shin Jung‐Ho , Yeo Min Koo , Kim Aeree , Kim In Sun , Kim Hai‐Joong
Published: December 2009

Background. The purpose of this study is to determine whether there is any difference for vascular endothelial growth factor expression in placentae and myometrial resistance arteries from control and pre‐eclamptic patients to clarify the source of the increased total vascular endothelial growth factor in pre‐eclampsia. Methods. With placentae tissue samples and small pieces of myometrium from the controls (n=10) and pre‐eclampsia patients (n=7), vascular endothelial growth factor immunohistochemistry and mRNA in situ hybridization were performed. We also measured the serum vascular endothelial growth factor levels by competitive enzyme immunoassay at the same time. Results. Vascular endothelial growth factor was identified primarily in syncytiotrophoblast in placental tissue, and it was also identified in smooth muscle cells in the myometrium and perivascular smooth muscle in myometrial resistance arteries. However, there were no differences in vascular endothelial growth factor expression between the groups in the presence of elevated serum levels of total vascular endothelial growth factor in pre‐eclamptic patients (median 18.2 ng/ml versus 4.9 ng/ml). Conclusion. This study suggests that the placenta and perivascular smooth muscle are not the origin of the increased total vascular endothelial growth factor in pre‐eclampsia. To clearly understand the role of vascular endothelial growth factor in pre‐eclampsia, further studies are required to determine the sites of increased vascular endothelial growth factor synthesis.
Performance of Pap smear and human papilloma virus testing in the follow‐up of women with cervical intraepithelial neoplasia grade 1 managed conservatively
Authors: SANTOS ANDRÉ LUIS FERREIRA , FRANÇOISE MAURICETTE DERCHAIN SOPHIE , OTÁVIO SARIAN LUIS , MARTINS MARCOS ROBERTO , MORAIS SIRLEI SIANI , SYRJÄNEN KARI JUHANI
Published: December 2009

Background. Conservative management (follow‐up) of cervical intraepithelial neoplasia grade 1 (CIN1) is acceptable, but evidence on performance of follow‐up tools, such as Pap smear and human papilloma virus (HPV) test, is still needed. Methods. A cohort of 78 women with histologically confirmed CIN1, referred because of atypical squamous cell or low‐grade squamous intraepithelial lesion in their Pap smear, was enrolled between August 2000 and September 2002 and was prospectively followed‐up at 6 and 12 months, until September 2003. Follow‐up examinations included Pap test and Hybrid Capture II (HCII) with high‐risk HPV, colposcopy, and cervical biopsies in patients with persistent abnormalities. Odds ratios and performance indicators (with 95% confidence interval) were calculated for HPV and Pap test results in detecting biopsy‐confirmed CIN during the follow‐up. Results. Thirty‐seven (47%) of the women were HPV‐positive at baseline. At first follow‐up visit, 30 women had persistent CIN1 and one woman progressed to CIN2; 15 patients had CIN1 and one patient CIN2 at the second follow‐up visit. Women with persistent CIN1 (or progression) during follow‐up had a significantly higher HPV detection rate and abnormal Pap tests, compared to women with regressive disease. Cytology had a far better sensitivity in detecting CIN than HCII at the first follow‐up visit (81 versus 52%, respectively), whereas both examinations had equivalent sensitivities at the second follow‐up visit (69 and 56%, respectively). Cytology had a superior negative predictive value at the first follow‐up visit and better positive predictive value, in addition, at the second visit. Conclusions. Because cytological abnormalities correlated generally better with the persistence of biopsy‐confirmed CIN1 in this follow‐up protocol, HCII test is the second‐hand option to Pap test, but the use of both Pap and HCII together seems an unnecessary waste of resources.
Reliability of an automatic ultrasound system in the post partum period in measuring urinary retention
Authors: Van Os Adriana F. M. , Van der Linden Paul J. Q.
Published: December 2009

Background. Urinary retention in the post partum period may lead to short‐ and long‐term complications.

Objective. To investigate the reliability of an automatic ultrasound system to measure the volume of the bladder post partum.

Methods. About 85 women, who delivered vaginally were observed 6 hr post partum. When the bladder volume measured by Bladder, Scan™ BVI 3000® was more than 300 ml, it was compared with the bladder volume measured by catheterization.

Results. Ten additional catheterizations were performed by using BladderScan™ BVI 3000®, when compared with the number of estimated catherizations based on clinical indications. Eight women had a residual volume of more than 300 ml, of whom two got an indwelling catheter. Using Bland‐Altman methods, there was no significant difference in volumes measured by BladderScan™ BVI 3000® or by catheterization. Also, there was no significant difference between two observers.

Conclusion. The BladderScan™ BVI 3000® is a reliable and non‐invasive method to recognize urinary retention in the post partum period.
Eclampsia in Scandinavia: incidence, substandard care, and potentially preventable cases
Authors: Beathe Andersgaard Alice , Herbst Andreas , Johansen Marianne , Ivarsson Anna , Ingemarsson Ingemar , Langhoff‐Roos Jens , Henriksen Tore , Straume Bjørn , Øian Pål
Published: December 2009

Background. Description of incidence, clinical signs, symptoms, and consequences of eclampsia in Scandinavia, and assessment of substandard care and potential preventability. Methods. A descriptive cohort study including all women giving birth in a 2‐year period (mid‐1998–mid‐2000) in Scandinavia. Notifications of eclampsia cases were obtained from all obstetric units at 3‐monthly intervals. All patient files were reviewed, and systematic audit was performed to identify potentially preventable cases by using predefined criteria. Main outcome measures. Signs and symptoms preceding the eclamptic seizure, the standard of medical care, maternal and perinatal morbidity, and mortality were all recorded. Potentially preventable cases through improved care and cases eligible for primary prophylactic magnesium sulfate (MgSO4) were estimated. Results. The incidence of eclampsia was 5.0/10 000 maternities (CI = 4.3–5.7/10 000). Eighty‐six percent had a diagnosis of pre‐eclampsia before the seizure. Nine of 10 had at least one physical complaint before the first seizure, severe headache being the most common symptom, occurring in two‐thirds. Most seizures (90%) occurred after admission to hospital. By audit, 89 cases (42%) were classified as having received substandard care. Prophylactic use of magnesium sulfate might have reduced the number of eclampsia cases by 35 (17%). Conclusions. Eclampsia occurred mainly in hospital and the majority of women had symptoms heralding the seizure. In retrospect, nearly half of the cases were found potentially preventable by timely intervention, improved medical care, and systematic use of prophylactic treatment with MgSO4.
Cumulative incidence of previous spontaneous abortion in Sweden in 1983–2003: a register study
Authors: Adolfsson Annsofie , Larsson Per‐Göran
Published: December 2009

Aim. The aim of this study is to find out how common miscarriages are among women who have delivered a child.

Methods. The numbers of deliveries and miscarriages were extracted from the Swedish Medical Birth Register between 1983 and 2003. Linear regression was performed in order to investigate whether the increasing mean age of mothers or differences in pregnancy identification methods could explain the increased frequency of miscarriage.

Results. The reported number of miscarriages increased each year during the 21‐year period, with a marked increase between 1991 and 1993 and only a slight increase during the final 10 years. For primiparous women, the frequency of reported miscarriages per delivery increased from 8.6% in 1983 to 13.9% in 2003. The corresponding figures for 2‐parous women showed an increase from 14.5% to 21.3% respectively. Women aged 30–34 years had an odds ratio of 1.43 (95% CI 1.40–1.45) to suffer spontaneous abortion compared to the age group 25–29 years. Linear regression showed that an increase in mean age at delivery could only partly explain the increase in the frequency of reported miscarriages. A possible explanation could be differences in methods of identifying early pregnancy.

Conclusion. Of all women who deliver a child, nearly 20% have experienced previous miscarriage. The increased mean age of women could only explain a small portion of the seen increase in miscarriage. The marked increase from 1991 to 1993 is interesting. Possible reasons for the increase are discussed.
Effect of oral hormone replacement therapy on plasma homocysteine levels
Authors: GUIMARÃES DANIELA AMORIM MELGAÇO , CARDOSO JARBAS , DUSSE LUCI MARIA SANT'ANA , FRANCO ROMERSON MARTINS , DE A. FRANCO HILTON , ALVIM TÚLIO CÉSAR , DA SILVA TEIXEIRA GEORGE , DAS GRAÇAS CARVALHO MARIA , PAULA FERNANDES ANA
Published: December 2009

Background. Various inherited or acquired conditions can lead to mild or severe hyperhomocysteinemia, which has toxic effects on the vascular endothelium. It has been reported that hormone replacement therapy is associated with decreased homocysteine plasma levels, but this is still a controversial issue. Purpose. To compare homocysteine plasma levels in women before and after 3 months of oral hormone replacement therapy. Methods. Twenty‐four women were selected to take part in the study. Blood samples were collected immediately before hormone replacement therapy (cyclic association of 2 mg of estradiol valerate and 1 mg of cyproterone acetate) and three months after the beginning of hormone replacement therapy. Samples collected before hormone replacement therapy were used as controls. Plasma homocysteine levels and the presence of C677T mutation in the methylene tetrahydrofolate reductase gene were evaluated in all participants. Results. The methylene tetrahydrofolate reductase gene mutation was detected in 8 women (33.3%) in heterozygosis, in 3 (12.5%) in homozygosis, and 13 women (54.2%) did not present the mutation. No significant differences were observed in homocysteine levels before and after three months of oral hormone replacement therapy, regardless of the C677T genotype. Conclusions. The results obtained indicate that homocysteine plasma levels are not affected after three months of oral hormone replacement therapy.
Depression and anxiety during pregnancy and six months postpartum: a follow‐up study
Authors: Andersson Liselott , Sundström‐Poromaa Inger , Wulff Marianne , Åström Monica , Bixo Marie
Published: December 2009

Aims. To investigate the relationship between antenatal and postpartum depression and anxiety and to explore associated maternal characteristics. Methods. From a population‐based sample of 1,555 women attending two obstetric clinics in Sweden, all women with an antenatal psychiatric diagnosis (n=220) and a random selection of healthy women (n=500) were contacted for a second assessment three to six months postpartum. The Primary Care Evaluation of Mental Disorders was used for evaluation on both occasions. Results. Fewer cases of depressive and/or anxiety disorders were prevalent postpartum compared with the second trimester screening. Depression and/or anxiety were prevalent in 16.5% of postpartal women versus 29.2% of pregnant women. There was a significant shift from a majority of subthreshold diagnoses during pregnancy to full Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) diagnoses during the postpartum period. A history of previous psychiatric disorder, living single, and obesity were significantly associated with a new‐onset postpartum psychiatric disorder. The absence of a previous psychiatric disorder was significantly associated with a postpartum recovery of depression or anxiety. Conclusions. Depression and anxiety appear to be less common postpartum than during pregnancy.
Morbidity related to maternal group B streptococcal infections
Authors: Muller Anouk E. , Oostvogel Paul M. , Steegers Eric A.P. , Joep Dörr P.
Published: December 2009

Group B streptococcus is known to be a leading cause of neonatal infection, but less appreciated is the fact that it causes maternal infection also. Maternal group B streptococcal infections during pregnancy and delivery threaten not only the mother, but the child as well. Postpartum infection, such as mastitis, bacteremia, sepsis, meningitis, endometritis, and wound infections are hazards to the mother. We describe the various maternal group B streptococcal infections, their characteristics, associated neonatal morbidity, and prevention and treatment strategies during pregnancy, delivery, and in the postpartum period.
Combining HPV and MIB‐1 tests reduces the number of colposcopies in women with equivocal cytology
Authors: WENSVEEN C.W.M. , KAGIE M.J. , VELDHUIZEN R.W. , TRIMBOS J.B.M.Z. , BOON M.E.
Published: December 2009

Background. In this study the MIB‐1 immunostaining pattern as an index of cellular proliferation was analyzed in smears diagnosed as borderline dyskaryosis in order to establish whether the combination of human papillomavirus testing and MIB‐1 staining could resolve equivocal cytology. Methods. Conventional Pap smears of 108 women diagnosed as borderline dyskaryosis were stained with MIB‐1 and the proliferation index was assessed. These women were evaluated by colposcopy, histological sampling, and human papillomavirus, semi‐quantitative evaluated by hybrid Capture II test. Results. All 64 human papillomavirus‐ and MIB‐1‐negative women had no underlying high‐grade cervical intraepithelial neoplasia or cervical cancer. Forty of the 104 women with normal histology or cervical intraepithelial neoplasia I were positive for human papillomavirus, compared to only one positive MIB‐1 test (i.e. proliferation index of more than 35%). Conclusions. Adding a MIB‐1‐test in human papillomavirus‐positive women with equivocal cytology might reduce the number of colposcopies needed to predict ≥ cervical intraepithelial neoplasia II. With this approach only four instead of 43 human papillomavirus‐positive women would have been referred for colposcopy.
Extremely preterm cesarean delivery: a clinical study
Authors: HÖGBERG U. , Håkansson S. , SERENIUS F. , HOLMGREN P.Å.
Published: December 2009

Objectives. To describe indications for cesarean section for extremely preterm delivery, peri‐ and postoperative complications and perinatal outcome. Design. A case‐referent study with clinical follow‐up. Setting. A tertiary perinatal center. Population. All deliveries at gestational age <28 weeks at Umeå University Hospital in 1997–2003. For preterm cesarean section referents were women with elective first‐time term cesarean section. Methods. Indications for cesarean section delivery were assessed. Peri‐ and postoperative complications, asphyxia, and infant survival at discharge were described. Results. The cesarean section rate was 75%, in one third the operation was considered as difficult. Indications for extremely preterm abdominal delivery were severe disease during pregnancy and delivery complications. Six out of ten cesarean sections were performed on fetal indication. Nonisthmic incision was performed in 20% of cases. No major postoperative complications and few minor postoperative complications were noted. Irrespective of mode of delivery, few of the infants had severe asphyxia. Conclusion. In balancing the risks of complications related to the surgical procedure against the purported benefits of the infant, this study adds support to the argument to deliver even extremely preterm infants by cesarean section.
Two regimens of vaginal misoprostol in second trimester termination of pregnancy – a prospective randomised trial
Authors: KUMAR BHATTACHARYYA SUBIR , MUKHERJI JOYDEB , SANKAR KAMILYA GOURI , RAY SAILESH , HAZRA AVIJIT
Published: December 2009

Background. The search continues for a safe, effective, and cheap method for mid‐trimester termination of pregnancy. Misoprostol is a strong contender in this respect. The dose schedule of misoprostol is still not fixed. The objective of our present study was to compare the efficacy and adverse events of 2 dose regimens of vaginal misoprostol for second trimester termination. Method. A prospective, randomised, controlled trial was undertaken in 138 women at 14–20 weeks gestation, in a teaching hospital. Subjects were randomised to receive either regime A: 400 µg of intravaginal misoprostol every 3 h, or regime B: loading dose of 600 µg, followed by 200 µg every 3 h. The main outcome measure was the success rate at 48 h, total dose required, induction‐abortion interval, and adverse events. Data was analysed by Student's t‐test, Mann–Whitney U‐test, the chi‐squared test or Fisher's exact test, using Statistica 6.0 software. Results. There was no significant difference in the success rates at 24 and 48 h (Regime A: 97.18 and 98.59%; Regime B: 95.45 and 95.45%), and in mean induction‐abortion interval (12.97 versus 12.13 h). However, mean misoprostol requirement was significantly higher for Regime A (1701.4 versus 1269.7 µg). The incidence of fever was significantly less in Regime B (32.4 versus 14.9%). Conclusion. Use of vaginal misoprostol for second trimester abortion had comparable efficacy with less drug requirement for the 600 µg loading dose followed by 200 µg 3‐hourly regime compared to the 400 µg 3‐hourly regime.
Dual–Dual Action? Combining Venlafaxine and Mirtazapine in the Treatment of Depression
Authors: Malhi Gin S. , Ng Felicity , Berk Michael
Published: December 2009

Objective: Venlafaxine and mirtazapine in combination are increasingly used in clinical practice to treat treatment-refractory depression. Putative efficacy for this combination of antidepressants, beyond that of monotherapy, stems from their synergistic actions. This paper describes a prospective case series that examined the efficacy of the venlafaxine–mirtazapine combination in the treatment of depressed patients who had failed at least one antidepressant trial.

Method: Twenty-two depressed patients with major depression were treated with venlafaxine and mirtazapine in combination for an average of just under 8weeks. Baseline ratings on the 17-item Hamilton Depression Rating Scale (HAM-D17), Montgomery–Åsberg Depression Rating Scale (MADRS) and the Clinical Global Impression–Severity Scale (CGI-S) were repeated at end-point, determined by the naturalistic termination of the depressive treatment episode or the discontinuation of the combination treatment due to adverse effects. The length of treatment until end-point was documented for each patient. Descriptive statistics were used on the collated data.

Results: At baseline, mean scores were 28.8 (SD=3.8) for HAM-D17, 30.1 (SD=5.8) for MADRS, and 4.5 (SD=0.5) for CGI-S, reflecting a cohort at the moderate to severe end of the spectrum. At end-point, mean absolute scores were 10.2 (SD=4.7) for HAM-D17, 10.8 (SD=4.6) for MADRS, and 2.3 (SD=0.6) for CGI-S. Mean change from baseline was 18.6 (SD=6.4) for HAM-D17, 19.3 (SD=6.8) for MADRS, and 2.3 (SD=0.6) for CGI-S. Mean duration of treatment was approximately 8weeks, producing a response rate of 81.8% and a remission rate of 27.3%. Only one patient was unable to tolerate the combination although nearly half (10) had significant side-effects during treatment.

Conclusion: This study demonstrates relatively high response and remission rates that are encouraging and contribute to the efficacy database for this antidepressant combination. Further studies using randomized controlled designs are needed.
Social Distance Towards People with Mental Illness in Southwestern Nigeria
Authors: Adewuya Abiodun O. , Makanjuola Roger O. A.
Published: December 2009

Objective: Recent research findings have challenged earlier claims that stigmatizing attitudes towards the mentally ill are less evident in non-Western cultures. A knowledge base of the attitude of the community towards the mentally ill is needed before embarking on an active anti-stigma programme in sub-Saharan Africa. The aim of the present study was to assess the lay public's attitude (social distance) towards people with mental illness in southwestern Nigeria and examine the factors correlating with such an attitude.

Method: A cross-sectional survey was carried out in which respondents (n=2078) selected from three different communities in southwestern Nigeria completed questionnaires detailing sociodemographic variables, familiarity with mental illness, perceived causation of mental illness, perceived personal attributes of mental illness and perceived prognosis of mental illness. Their preferred social distance towards people with mental illness was measured with a modified version of the Bogardus Social Distance Scale.

Results: The level of desired social distance towards the mentally ill was seen to increase with the level of intimacy required in the relationship, with 14.5% of the participants categorized as having low social distance, 24.6% as having moderate social distance and 60.9% as having high social distance towards the mentally ill. The independent correlates of high social distance towards the mentally ill included having never cared for the mentally ill (odds ratio (OR)=3.31, 95% confidence interval (CI)=2.14–5.21), age over 50 years (OR=1.93, 95%CI=1.59–2.33), perceived supernatural causation of mental illness (OR=1.82, 95%CI=1.51–2.18) and perceived ‘dangerousness’ stereotype of the mentally ill (OR=1.54, 95%CI=1.28–1.85).

Conclusions: There is emerging evidence of a high level of social distance and stigmatization of mental illness in sub-Saharan Africa. There is need to incorporate anti-stigma educational programmes into the mental health policies of countries in sub-Saharan Africa. Such policy should include community education regarding the causation, manifestation, treatment and prognosis of mental illness.
Factors Encouraging Medical Students to a Career in Psychiatry: Qualitative Analysis
Authors: Wigney Tessa , Parker Gordon
Published: December 2009

Objective: Declining interest in psychiatry is an urgent public health issue and has been the subject of many studies. The purpose of the present paper was to survey the attitudes of senior medical students in order to explore reasons why psychiatry might be regarded as an attractive option as a career.

Method: Thirty-three students from an Australian university were asked during a written examination to consider why a psychiatric career might be an attractive choice for medical recruits. Key themes were identified and qualitatively analysed from the open-ended responses to the question: ‘On the basis of your clinical experience, consider why a psychiatric career is an attractive choice these days.’

Results: Thematic analysis indicated that the factors influencing decisions to specialize as a psychiatrist weighted financial and lifestyle advantages. The main drawcard profile was of challenging work that affords a good lifestyle and stimulating research opportunities. Other themes such as rewarding patient interaction, holistic care and variety were also raised.

Conclusion: Concern that the Australian psychiatric profession is failing to attract sufficient numbers of high-quality recruits is growing. While the majority of essays analysed in this account suggested that the students perceived psychiatry as an adequate career that affords the benefits of a balanced lifestyle, the constraining nature of the survey question compelled examinees to provide positive responses. Despite this bias, the responses are nonetheless revealing and contribute to understanding of the factors that may influence trainees to enter the field. On the whole, it would appear that the discipline is currently not exciting keen passions in medical students.
Comprehensive Description of Adolescents Admitted to a Public Psychiatric Inpatient Unit and their Families
Authors: John Tonge Bruce , Catherine Hughes Georgina , Marie Pullen Jill , Beaufoy Jeanette , Gold Stanley
Published: December 2009

Objective: Adolescents accessing inpatient psychiatric services typically have severe and complex disturbance. The aim of the present study was to provide a comprehensive description of an adolescent inpatient sample by examining their psychiatric diagnosis, symptomatology and functioning and associated parental mental health, family functioning and cultural and socioeconomic factors. Few studies have described all these factors and existing studies have reported varying results.

Methods: Participants were 88 adolescents (37 male) aged 12–18 years (mean=15.4 years) consecutively recruited through a small number of case clinicians from a regional metropolitan public inpatient unit over a 5 year period. Adolescents and parents participated in clinical interviews and completed psychometric measures. Case clinicians provided diagnostic information.

Results: In contrast to previous studies, adolescents were from a cross-section of socioeconomic backgrounds. Results showed a high rate of comorbid Axis I diagnoses with depressive disorders the most common principal diagnosis. Two-thirds of adolescents experienced clinical levels of internalizing problems. Clinical levels of thought disturbance and externalizing problems were reported for most adolescents, although adolescents self-reported fewer of these symptoms. Educational and social difficulties were common. A salient result was the high level of family dysfunction reported by multiple informants. Most parents reported minimal personality or psychological disturbance but results contradicted other studies and may reflect response bias. In a preliminary finding, non-English-speaking background and low socioeconomic status were associated with a psychosis-related principal diagnosis.

Conclusion: Findings indicate the multiplicity of issues facing adolescent inpatients including psychiatric symptoms, impaired personal and family functioning and family cultural and background factors. Treatment that focuses on only some of these factors may have limited effectiveness.
Comparison of Insulin Resistance, Metabolic Syndrome and Adiponectin in Overweight Bipolar Patients Taking Sodium Valproate and Controls
Authors: Elmslie Jane L. , Porter Richard J. , Joyce Peter R. , Hunt Penelope J. , Shand Brett I. , Scott Russell S.
Published: December 2009

Objective: Metabolic abnormalities in patients with bipolar disorder may be secondary to obesity, aspects of the disorder or its treatment. To investigate this further, the purpose the present study was to compare insulin resistance, components of the metabolic syndrome and adiponectin levels in a group of overweight bipolar patients taking sodium valproate and a group of non-psychiatric control subjects.

Methods: Data were collected from 60 overweight bipolar patients who had experienced clinically significant weight gain thought to be related to sodium valproate treatment and from 60 control subjects without psychiatric illness matched for age, gender, body mass index and ethnicity.

Results: The frequency of the metabolic syndrome was high in both groups (50% and 32%, respectively), although not significantly different between groups (p = 0.06). Similar frequencies of insulin resistance (HOMA-IR), abdominal obesity, hypertriglyceridaemia, hypertension and fasting hyperglycaemia were found in both groups. High-density lipoprotein cholesterol levels were lower in patients (p = 0.006), while adiponectin was unexpectedly higher than in control subjects (9.6±5.9 µg mL−1 vs 7.4±4.3 µg mL−1, p = 0.03). The frequencies of insulin resistance (HOMA-IR), the metabolic syndrome and its individual components were not significantly different in patients taking atypical antipsychotic medication and patients not on these medications.

Conclusions: Frequencies of insulin resistance and the metabolic syndrome were similar in bipolar patients taking sodium valproate and matched control subjects, but dyslipidaemia was more frequent. Adiponectin levels were higher in patients. Further research is required to clarify the reasons for these findings.
Shyness Programme: Longer Term Benefits, Cost-Effectiveness, and Acceptability
Authors: Titov Nickolai , Andrews Gavin , Johnston Luke , Schwencke Genevieve , Choi Isabella
Published: December 2009

Objective: In two randomized controlled trials Titov et al. demonstrated significant benefit from an Internet- and email-based treatment programme for social phobia: the Shyness programme. Data are presented about the longer term outcomes (6 months after treatment), cost-effectiveness relative to face-to-face treatment, and the acceptability of the programme to participants.

Method: Participants completed outcome and acceptability questionnaires at 6 months after treatment. Repeated measures analyses of variance were calculated using an intention-to-treat design. Cost-effectiveness in years lived with disability averted were calculated based on between-group effect sizes.

Results: A total of 59% of treatment group participants completed the 6 month follow-up questionnaires. Between post-treatment and 6 month follow up participants continued to make improvements in symptoms of social phobia, while maintaining improvements in mood, psychological distress, and disability. At 6 month follow up the mean within-group effect size (Cohen's d) for the two social phobia measures increased from 1.2 to 1.4. Cost-effectiveness in years lived with disability (YLD) averted was calculated as one-quarter that of face-to-face group treatment, or $AUD1495 for one YLD gained, compared to $AUD5686/YLD gained. Participants rated the Internet treatment to be as effective and helpful as face-to-face treatment.

Conclusions: The present results confirm the reliability of the short-term findings reported in the first two Shyness programmes. The procedure appears to be very cost-effective, and acceptable to participants. These data provide further support for the development of Internet-based virtual clinics for common mental disorders.
Relapse of Successfully Treated Anxiety and Fear: Theoretical Issues and Recommendations for Clinical Practice
Authors: Boschen Mark J. , Neumann David L. , Waters Allison M.
Published: December 2009

Despite the existence of effective interventions for anxiety disorders, relapse – or the return of fear – presents a significant problem for patients and clinicians in the longer term. The present paper draws on the experimental and clinical behavioural literature, reviewing the mechanisms by which the return of fear can occur. The aim of the paper was to generate a list of treatment recommendations for clinicians aimed at reducing relapse in successfully treated anxiety disorders. Clinical and experimental literature on the mechanisms of renewal, reinstatement, spontaneous recovery and reacquisition are reviewed. These are linked with the clinical and experimental literature on the return of fear in successfully treated anxiety. A list of recommendations to assist in reducing the probability of relapse in successfully treated anxiety is presented. This list includes methods for use in behavioural (exposure) treatment of anxiety disorders that aim to enhance clinical outcomes. Despite the significant problem of relapse in successfully treated anxiety, there are methods available to reduce the probability of relapse through return of fear. Clinicians engaging in treatment of anxiety disorders should be mindful of these methods to ensure optimal patient outcome.