bluuebunny/crossref_metadata_2025_split huggingface dataset:
Expectant management of spontaneous first‐trimester miscarriage: prospective validation of the ‘2‐week rule’
Authors: Casikar I. , Bignardi T. , Riemke J. , Alhamdan D. , Condous G. 
Published: January 2010

AbstractObjectivesTo assess uptake and success of expectant management of first‐trimester miscarriage for a finite 14‐day period, in order to evaluate our ‘2‐week rule’ of management.MethodsThis was a prospective observational study evaluating our proposed 2‐week rule of expectant management, which is based on the finding that women managed expectantly are most likely to miscarry in the first 14 days and that to wait longer than 2 weeks without intervention does not confer a greater chance of successful resolution. Eligible women diagnosed with first‐trimester miscarriage were offered a choice of expectant management or surgical evacuation under general anesthesia. Inclusion criteria for expectant management were: diagnosis of incomplete miscarriage (heterogeneous tissue, with or without a gestational sac, seen on ultrasound in the uterine cavity and distorting the endometrial midline echo), missed miscarriage (crown–rump length (CRL) ≥ 6 mm with absent fetal heart activity) or empty sac (anembryonic pregnancy) based on transvaginal ultrasonography. Women with complete miscarriage, missed miscarriage at the nuchal translucency scan, molar pregnancy or miscarriage ≥ 3 weeks in duration (missed miscarriage in which the CRL was ≥ 3 weeks smaller than the gestational age based on last menstrual period), or with signs of infection or hemodynamic instability were excluded. Expectant management consisted of weekly ultrasonography for 2 weeks. If after 2 weeks resolution was not complete, surgery was advised.Results1062 consecutive pregnant women underwent transvaginal ultrasound examination. Of these, 38.6% (410/1062) were diagnosed with miscarriage, of whom 241 (59%) were symptomatic at the time of presentation and 282 were eligible for the study. These were offered expectant management and 80% (227/282) took up this option. 11% (24/227) were lost to follow‐up; therefore, complete data were available on 203 women. Overall spontaneous resolution of miscarriage at 2 weeks was observed in 61% (124/203) of women. Rates of spontaneous resolution at 2 weeks according to the type of miscarriage were 71% for incomplete miscarriage, 53% for empty sac and 35% for missed miscarriage. The incidence of unplanned emergency dilatation and curettage due to gynecological infection or hemorrhage was 2.5% (5/203).ConclusionsExpectant management based on the 2‐week rule is a viable and safe option for women with first‐trimester miscarriage. Women with an incomplete miscarriage are apparently the most suitable for expectant management. Copyright © 2010 ISUOG. Published by John Wiley & Sons, Ltd.
Umbilical vein anomaly in fetuses with Down syndrome
Authors: Achiron R. , Gindes L. , Gilboa Y. , Weissmann‐Brenner A. , Berkenstadt M. 
Published: January 2010

AbstractObjectiveTo describe the prevalence of abnormal umbilical vein (UV) anatomy in fetuses with Down syndrome.MethodsThis was a retrospective survey covering a 24‐month period of fetuses with a genetic diagnosis of Down syndrome following a routine early second‐trimester (12–16‐week) detailed fetal anomaly scan at a single academic tertiary referral center. In our unit this exam includes fetal umbilicoportal venous system evaluation.ResultsDuring the study period, 37 fetuses were diagnosed with Down syndrome and had a detailed early anatomy scan. In four (11%) the detailed early anomaly scan revealed that the UV was connected to the hepatic portion of the inferior vena cava (IVC) at a position lower than its usual site. Their average gestational age at diagnosis was 13 + 6 (range, 11 + 6 to 15 + 2) weeks. Three of the four fetuses had a nuchal translucency thickness of 3–4 mm. In one fetus there was an additional finding of significant tricuspid regurgitation and the one with normal nuchal translucency thickness had an atrioventricular septal defect (atrioventricular canal) and umbilical cord hernia. During the same period three of 2500 (0.12%) fetuses with normal karyotype demonstrated similar anomalous insertion of the UV into the IVC, creating a portocaval shunt which had normal ductus venosus‐like Doppler flow in all three cases. The odds ratio for abnormal umbilicoportal venous system in fetuses with Down syndrome compared with the normal population was 107.4 (95% CI, 19.2–637.1).ConclusionsFetuses with Down syndrome demonstrate an increased prevalence of abnormal connection of the UV to the IVC. Copyright © 2010 ISUOG. Published by John Wiley & Sons, Ltd.
Continuous independent quality control for fetal ultrasound biometry provided by the cumulative summation technique
Authors: Balsyte D. , Schäffer L. , Burkhardt T. , Wisser J. , Zimmermann R. , Kurmanavicius J. 
Published: January 2010

AbstractObjectiveTo apply the cumulative summation (CUSUM) technique for an evaluation of the learning process of sonographic fetal weight estimation at term in combination with the z‐scores of biometry determinants and to assess the time of appearance and sources of errors.MethodsLearning curve (LC‐CUSUM) and double CUSUM charts for systematic error detection based on absolute and signed mean percentage error were generated to retrospectively estimate the longitudinal accuracy of sonographic fetal weight estimation conducted by three trainees and one experienced examiner. For LC‐CUSUM analysis an examination was considered to be a failure when there was an absolute error in birth weight estimation ≥ 15%. Fetal biometry measurements (head circumference, abdominal circumference (AC) and femur length (FL)) from 227 routine ultrasound scans of one examiner were separately transformed into z‐scores and double CUSUM charts were generated to assess the systematic errors for each determinant.ResultsThe LC‐CUSUM charts revealed that different numbers of scans are required for different examiners to achieve competence in estimating birth weight. AC and FL deviated most significantly from expected values (P < 0.05). The double CUSUM charts revealed exact periods of systematic errors in the measurement of biometry determinants, clearly reflecting errors of fetal weight estimation.ConclusionsThe use of CUSUM techniques in the analysis of sonographic data allows observation of the development of an examiner's skill and maintenance of competence. The CUSUM technique not only allows the reasons for impaired fetal weight estimation to be revealed but also allows determination of the exact time when inaccurate measurements start to occur. We suggest that CUSUM charts should be implemented in routine clinical practice as a measure of objective quality evaluation of sonographic fetal biometry. Copyright © 2010 ISUOG. Published by John Wiley & Sons, Ltd.
Three‐dimensional ultrasound in the diagnosis of Müllerian duct anomalies and concordance with magnetic resonance imaging
Authors: Bermejo C. , Martínez Ten P. , Cantarero R. , Diaz D. , Pérez Pedregosa J. , Barrón E. , Labrador E. , Ruiz López L. 
Published: January 2010

AbstractObjectivesTo demonstrate the value of three‐dimensional (3D) ultrasound in the diagnosis of uterine malformations and its concordance with magnetic resonance imaging (MRI).MethodsThis study included 286 women diagnosed with uterine malformation by 3D ultrasound, having been referred to our clinics on suspicion of uterine malformation following clinical and/or conventional two‐dimensional ultrasound examination. With the exception of three with intact hymen, patients underwent both bimanual examination and speculoscopy before and/or after sonography. MRI was performed in 65 cases. We analyzed the diagnostic concordance between the techniques in the study of uterine malformations.ResultsUsing 3D ultrasound we diagnosed: one case with uterine agenesis; 10 with unicornuate uterus, four of which also underwent MRI; six with didelphic uterus, one of which had MRI; 45 with bicornuate uterus, 12 of which had MRI; 125 with septate uterus (18 with two cervices), 42 of which had MRI (six with two cervices); 96 with arcuate uterus, three of which had MRI; and three with diethylstilbestrol (DES) iatrogenic uterine malformations, all of which had MRI. Among the 65 which underwent MRI, the diagnosis was: four cases with unicornuate uterus, 10 with bicornuate uterus (two with two cervices), 45 with septate uterus (five with two cervices), three with arcuate uterus and three with DES‐related uterine malformations. The concordance between 3D ultrasound and MRI was very good (kappa index, 0.880 (95% CI, 0.769–0.993)). Discrepancies in diagnosis between the two techniques occurred in four cases. There was very good concordance in the diagnosis of associated findings (kappa index, 0.878 (95% CI, 0.775–0.980)), this analysis identifying differences in two cases.ConclusionsThere is a high degree of concordance between 3D ultrasound and MRI in the diagnosis of uterine malformations, the relationship between cavity and fundus being visualized equally well with both techniques. 3D ultrasound should be complemented by careful gynecological exploration in order to identify any alterations in the cervix. Copyright © 2010 ISUOG. Published by John Wiley & Sons, Ltd.
Invasive growth of Saccharomyces cerevisiae depends on environmental triggers: a quantitative model
Authors: Zupan Jure , Raspor Peter 
Published: January 2010

AbstractIn this contribution, the influence of various physicochemical factors on Saccharomyces cerevisiae invasive growth is examined quantitatively. Agar‐invasion assays are generally applied for in vitro studies on S. cerevisiae invasiveness, the phenomenon observed as a putative virulence trait in this clinically more and more concerning yeast. However, qualitative agar‐invasion assays, used until now, strongly limit the feasibility and interpretation of analyses and therefore needed to be improved. Besides, knowledge in this field concerning the physiology of invasive growth, influenced by stress conditions related to the human alimentary tract and food, is poor and should be expanded. For this purpose, a quantitative agar‐invasion assay, presented in our previous work, was applied in this contribution to clarify the significance of the stress factors controlling the adhesion and invasion of the yeast in greater detail. Ten virulent and non‐virulent S. cerevisiae strains were assayed at various temperatures, pH values, nutrient starvation, modified atmosphere, and different concentrations of NaCl, CaCl2 and preservatives. With the use of specific parameters, like a relative invasion, eight invasive growth models were hypothesized, which enabled intelligible interpretation of the results. A strong preference for invasive growth (meaning high relative invasion) was observed when the strains were grown on nitrogen‐ and glucose‐depleted media. A significant increase in the invasion of the strains was also determined at temperatures typical for human fever (37–39 °C). On the other hand, a strong repressive effect on invasion was found in the presence of salts, anoxia and some preservatives. Copyright © 2010 John Wiley & Sons, Ltd.
Lymph Node Ratio Versus Number of Affected Lymph Nodes as Predictors of Survival for Resected Pancreatic Adenocarcinoma
Authors: Bhatti Imran , Peacock Oliver , Awan Altaf K. , Semeraro David , Larvin Michael , Hall Richard I. 
Published: January 2010

AbstractBackgroundThe objective of this study was to compare the prognostic significance of the lymph node ratio (LNR) with the absolute number of affected lymph nodes for resected pancreatic ductal adenocarcinoma.MethodsData were collected from 84 patients who had undergone pancreatoduodenectomy for pancreatic ductal adenocarcinoma over a 10‐year period. Patients were categorized into four groups according to the absolute LNR (0, 0–0.199, 0.2–0.299, ≥0.3). Kaplan‐Meier and Cox proportional hazard models were used to evaluate the prognostic effect.ResultsAn LNR of ≥0.2 (median survival 8.1 vs. 35.7 months with LNR < 0.2; p < 0.001) and ≥0.3 (median survival 5.9 vs. 29.6 months with LNR < 0.3; p < 0.001), tumor size (p < 0.017), positive resection margin (p < 0.001), and nodal involvement (p < 0.001) were found to be significant prognostic markers following univariate analysis. Following multivariate analysis, only LNR at both levels [≥0.2 (p = 0.05; HR 1.8) and LNR of ≥0.3 (p = 0.01; HR 2.7)] were independent predictors of a poor outcome. The number of lymph nodes examined had no effect on overall survival in either node‐positive patients (p = 0.339) or node‐negative patients (p = 0.473).ConclusionsThe LNR represents a stronger independent prognostic indicator than the absolute number of affected lymph nodes in patients with resected pancreatic ductal adenocarcinoma.
Hunter syndrome in an 11‐year old girl on enzyme replacement therapy with idursulfase: brain magnetic resonance imaging features and evolution
Authors: Manara Renzo , Rampazzo Angelica , Cananzi Mara , Salviati Leonardo , Mardari Rodica , Drigo Paola , Tomanin Rosella , Gasparotto Nicoletta , Priante Elena , Scarpa Maurizio 
Published: January 2010

AbstractMucopolysaccharidosis type II (MPS‐II, Hunter disease) is a X‐linked recessive disorder. Affected females are extremely rare, mostly due to skewed X chromosome inactivation. A few papers outline MPS‐II brain magnetic resonance imaging (MRI) “gestalt” in males, but neuroradiological reports on females are still lacking. We present an 11‐year‐old girl affected by the severe form of MPS‐II who was followed up over a time span of 8 years, focusing on clinical and brain MRI evolution. In the last 2.5 years, the patient has been treated with enzyme replacement therapy (ERT) with idursulfase (Elaprase™, Shire Human Genetic Therapies AB, Sweden). On brain and cervical MRI examination, abnormalities in our patient did not differ from those detected in male patients: J‐shaped pituitary sella, enlargement of perivascular spaces, brain atrophy, mild T2‐hyperintensity in the paratrigonal white matter, diffuse platyspondylia, and mild odontoid dysplasia with odontoid cup. Brain atrophy progressed despite ERT introduction, whereas perivascular space enlargement did not change significantly before and after ERT. Cognitive impairment worsened independently from the course of white matter abnormality. Despite a profound knowledge of genetic and biochemical aspects in MPS‐II, neuroradiology is still poorly characterized, especially in female patients. Spinal and brain involvement and its natural course and evolution after ERT introduction still need to be clarified.
Soil erodibility, microbial biomass, and physical–chemical property changes during long‐term natural vegetation restoration: a case study in the Loess Plateau, China
Authors: Zhu Bingbing , Li Zhanbin , Li Peng , Liu Guobin , Xue Sha 
Published: January 2010

AbstractSoil erodibility (Kfactor) is an important index for measuring soil susceptibility to water erosion, and an essential parameter that is needed for the prediction of soil erosion. Field investigation and laboratory analysis were conducted to study the changes of soil characteristics during long‐term vegetation restoration in the hilly gullied loess area. The soil erodibilityKvalues were calculated using the EPIC model and the physico‐chemical properties as well as microbial characteristics were evaluated along a chronosequence of natural vegetation recovery (0–50 years) in abandoned land in the Zhifanggou Watershed of Ansai County, northwestern Shaanxi Province, China. The results showed that natural vegetation recovery following abandonment resulted in improvement of the soil properties and structure and these improving effects were closely related to the date of abandonment. Specifically, theKvalue of the surface layer (0–20 cm) was significantly reduced with time, while the total organic carbon, total nitrogen and soil microbial biomass C, microbial N and microbial P and the water‐stable aggregate increased quickly. During the first 10 years of abandonment, these changes occurred relatively quickly due to a significant increase in soil organic matter, after which they gradually fluctuated for approximately 20 years, reaching their uttermost or minimum levels finally. However, these values differed greatly underPlatycladus orientalisforest, which suggests that soil rehabilitation is a long‐term task that requires several generations to complete.
Comparative Evaluation of Physicochemical Properties of Jatropha Seed Oil from Malaysia, Indonesia and Thailand
Authors: Emil A. , Yaakob Zahira , Satheesh Kumar M. N. , Jahim J. M. , Salimon J. 
Published: January 2010

AbstractThe jatropha oil was extracted from the jatropha seeds collected from different origins viz., Malaysia, Indonesia and Thailand. The physicochemical properties such as density, viscosity, percentage free fatty acid (FFA), iodine value, saponification value and peroxide value of the extracted jatropha seed oil were evaluated. The evaluation of fatty acid composition using gas chromatography (GC) revealed that, oleic (42.4–48.8%) and linoleic acid (28.8–34.6%) are the dominant fatty acids present in the jatropha seed oil. The saturated fatty acids such as palmitic and stearic acid lie in the range 13.25–14.5 and 7–7.7%, respectively. The observed major triacylglycerol (TAG) composition was OOL (22.94–25.75%) and OLL (15.52–20.77%).
Influence of risk of neurological impairment and procedure invasiveness on health professionals’ management of procedural pain in neonates
Authors: Stevens Bonnie , McGrath Patrick , Ballantyne Marilyn , Yamada Janet , Dupuis Annie , Gibbins Sharyn , Franck Linda , Finley G. Allen , Howlett Alexandra , Johnston Celeste , O'Brien Karel , Ohlsson Arne 
Published: January 2010

AbstractObjectives: To describe how (i) risk of neurological impairment (NI) and (ii) procedure invasiveness influence health professionals’ assessment and management of procedural pain in neonates in the Neonatal Intensive Care Unit (NICU).Design: Prospective observational study.Setting: Three tertiary level NICUs in Canada.Participants: 114 neonates, 25–40 weeks gestational age (GA) undergoing painful procedures.Main Outcome Measures: Physical and behavioural pain indicators and pharmacological and nonpharmacological pain interventions.Results: 114 neonates at high (Cohort A, n = 35), moderate (Cohort B, n = 25) and low (Cohort C, n = 54) risk of NI were observed during 254 painful procedures performed by 147 health professionals. Physical pain indicators were used more frequently by health professionals to assess pain with Cohorts A and B than C (p < .05). Behavioural pain indicators were used similarly across Cohorts. Nonpharmacological interventions were implemented most frequently for pain management. Physical interventions were used with 84% of procedures across Cohorts; particularly for the most invasive procedures. Infants with the highest NI risk (Cohort A) received the most behavioural interventions (p < .05) irrespective of procedural invasiveness. Pharmacological interventions were implemented with 23.2% of procedures; Cohort B received pharmacological interventions most frequently (Cohort B > A, B > C, p < .05) and for increasingly invasive procedures (p < .05).Conclusions: Health professionals use multidimensional indicators to assess neonatal pain. Nonpharmacological interventions dominate pain management. NI risk status and procedure invasiveness are important contextual factors in neonatal pain assessment and management.
Effects of eccentric jaw exercise on temporal summation in jaw‐closing muscles of healthy subjects
Authors: Torisu Tetsurou , Wang Kelun , Svensson Peter , De Laat Antoon , Tanaka Mihoko , Shimada Akiko , Ikoma Akiko , Murata Hiroshi , Arendt‐Nielsen Lars 
Published: January 2010

AbstractEccentric jaw exercises has been known to cause muscle soreness but no studies have so far examined to what extent temporal summation mechanisms within the exercised muscles are changed. The purpose of the present study was to investigate the effects of an eccentric biting exercise on the temporal summation, mechanical pressure sensitivity and jaw muscle activity.A total of 15 healthy men participated in a two‐session‐experiment: In one session, they performed 30 min controlled eccentric jaw exercise and the other session served as a no‐exercise control. Soreness sensations at rest and during maximal biting, pressure pain thresholds (PPTs) and electromyographic (EMG) activity during maximal jaw biting were recorded before (baseline), immediately after (Post‐task), and 1 day after the exercise (1‐day‐after). The temporal summation ratio using intra‐muscular electrical stimulation of the masseter was investigated at baseline and at 1‐day‐after. The eccentric jaw exercise was associated with significant increases in soreness sensation and decreased PPTs at Post‐task and at 1‐day‐after. The EMG activity and biting force did not change. The summation ratio was significantly decreased at 1‐day‐after in both sessions. The present findings demonstrate that eccentric jaw exercise does not induce detectable changes in temporal summation. However, the summation ratio may have clinical utility to differentiate the location of sensitization.
The effect of referral for brief intervention for alcohol misuse on repetition of deliberate self-harm: an exploratory randomized controlled trial
Authors: Crawford M. J. , Csipke E. , Brown A. , Reid S. , Nilsen K. , Redhead J. , Touquet R. 
Published: January 2010

BackgroundReferral for brief intervention among people who misuse alcohol is reported to be effective but its impact among those who present to services following deliberate self-harm (DSH) has not been examined.MethodConsecutive patients who presented to an Emergency Department (ED) following an episode of DSH were screened for alcohol misuse. Those found to be misusing alcohol were randomly assigned to brief intervention plus a health information leaflet or to a health information leaflet alone. The primary outcome was whether the patient reattended an ED following a further episode of DSH during the subsequent 6 months. Secondary outcomes were alcohol consumption, mental health and satisfaction with care measured 3 and 6 months after randomization.ResultsOne hundred and three people took part in the study. Follow-up data on our primary outcome were obtained for all subjects and on 63% for secondary outcomes. Half those referred for brief intervention received it. Repetition of DSH was strongly associated with baseline alcohol consumption, but not influenced by treatment allocation. There was a non-significant trend towards the number of units of alcohol consumed per drinking day being lower among those randomized to brief intervention.ConclusionsReferral for brief intervention for alcohol misuse following an episode of DSH may not influence the likelihood of repetition of self-harm. Longer-term interventions may be needed to help people who deliberately harm themselves and have evidence of concurrent alcohol misuse.