bluuebunny/crossref_metadata_2025_split huggingface dataset:
Muscle strength and tibolone: a randomised, double‐blind, placebo‐controlled trial
Authors: Meeuwsen Ingrid B.A.E. , Samson Monique M. , Duursma Sijmen A. , Verhaar Harald J.J. 
Published: December 2003

Objective
To investigate the effects of tibolone, a tissue‐specific compound with a mixed (estrogenic, progestogenic and androgenic) hormonal profile, on skeletal muscle strength in a group of healthy postmenopausal womenDesign
Randomised, parallel group, double‐blind, placebo‐controlled, single‐centre trial conducted between August 1997 and July 1999Participants
Eighty‐five healthy women, between one and 15 years postmenopausal, (mean [SD] age, 54.2 [4.7] years) recruited from local paper advertisements. Participants were randomly assigned to 2.5mg tibolone or to identically appearing placebo pills daily for 12 months, taken orally in the morningMethods
Both maximal handgrip strength, representing upper body strength, and maximal quadriceps strength, representing lower body strength, were measured isometricallyMain outcome measures
Treatment effect estimates (between group differences) in handgrip strength and isometric knee extension at last visitResults
Tibolone significantly (P= 0.04) increased handgrip strength compared with placebo (difference 0.99 kg, [95% CI 0.1–1.9]). No significant treatment effect (P= 0.61) was observed in isometric knee extension strength. Isometric strength adjusted for body mass index resulted in a trend favouring tibolone (P= 0.06). Individual trend analysis showed a significant difference in rate of change throughout the year (6.8% [95% CI 2.1–10.7]) favouring tiboloneConclusions
Administration of tibolone increased handgrip strength in postmenopausal women compared with placebo. A trend indicating a positive effect in isometric knee extension strength adjusted for body mass index was observed. Tibolone seems to mitigate the menopause‐related decline in muscle strength
Can pre‐operative computed tomography predict resectability of ovarian carcinoma at primary laparotomy?
Authors: Byrom J. , Widjaja E. , Redman C.W.E. , Jones P.W. , Tebby S. 
Published: December 2003

Objective
To assess the ability of computed tomography in predicting whether suspected ovarian cancer could be fully excised at primary laparotomy.Design
Retrospective analysis of patient notes and pre‐operative computed tomography scans.Setting
A UK NHS cancer centre.Population
Seventy‐seven women who underwent laparotomy for an ovarian tumour and who had had a pre‐operative computed tomography scan.Methods
Women who had a computed tomography scan before laparotomy for an ovarian tumour were identified. Analysis was undertaken to determine the accuracy of computed tomography in predicting malignancy, stage and residual disease. The computed tomography parameters significantly associated with residual disease were determined by a χ2 analysis. These parameters, in addition to age and CA125, were used to generate a predictive model. This model was further refined by stepwise logistic regression and a clinical scoring index was generated.Main outcome measures
To identify those computed tomography parameters significantly associated with residual disease and to use these with CA125 and age to generate a useful clinical scoring index to predict residual disease in suspected ovarian cancer.Results
Seventy‐seven women underwent a laparotomy for an ovarian tumour and had a pre‐operative computed tomography scan. Fifty‐one of these women had malignant disease and twenty‐five of these women had residual disease remaining. The sensitivity of computed tomography in predicting malignancy was 90% with a specificity of 85% and the overall accuracy of computed tomography for predicting stage of disease was 73% (37/51). The overall sensitivity of computed tomography in predicting residual disease was 88%, the specificity was 92% and the positive predictive value was 85%. The parameters on computed tomography that were significantly (P < 0.05) associated with residual disease were ascites, omental cake, mesenteric disease, paracolic gutter deposits, diaphragmatic deposits and pleural effusion. The predictive model generated was more accurate than computed tomography alone (sensitivity 88%, specificity 98%, positive predictive value 95%). Using stepwise logistic regression enabled the predictive model to be simplified to include mesenteric disease, omental cake, age and CA125 without any change in sensitivity or specificity and this model was used to generate a scoring index.Conclusion
This study shows that prediction of resectability by computed tomography is excellent and is further improved by the generation of a predictive model, which can be used to generate a simple scoring index. This scoring system now needs to be tested prospectively to ensure that its performance remains as good in an independent sample population.
A double‐blind randomised controlled trial of continuous oxygen therapy for compromised fetuses
Authors: Lindow S.W. , Mantel G.D. , Anthony J. , Coetzee E.J. 
Published: December 2003

Objective
To investigate the effect of chronic oxygen therapy in fetuses with absent end diastolic flow in the umbilical artery assessed by doppler analysis at 24–30 weeks of gestation.Design
A double‐blind, randomised control trial was performed with patients blindly allocated to receive humidified oxygen or humidified air.Setting
A tertiary referral hospital in South Africa.Participants
Thirty‐two women who presented between 24 and 30 weeks of gestation with a confirmed finding of absent end diastolic flow in the umbilical artery.Methods
After randomisation patients were allocated to receive a 40% mixture of humidified oxygen or humidified air from uniform coloured gas cylinders which were marked either ‘a’ or ‘b’ All women received betamethasone from 27 weeks of gestation on a weekly basis. Cardiotocographs were used from 28 weeks of gestation; after 28 weeks of gestation an amniocentesis was considered to confirm fetal maturity. Women were expected to breath the allocated gas continuously apart from meals and visits to the toilet.Main outcome measures
Survival of the fetus was the main outcome measure with secondary outcome measures documenting improvement in the fetal condition in utero.Results
There were 16 women randomised to receive oxygen and 16 to receive air. There were nine survivors in the oxygen group (56.3%) and six in the air group (37.5%) (relative risk 1.5, 95% confidence interval 0.7–3.2). There was a nonsignificant increase in mean birthweight in the oxygen group (858.3 grammes vs 774.4 grammes) and a nonsignificant increase in mean duration of treatment in the oxygen group (12.8 days vs 10.4 days).Conclusion
This study did not demonstrate that chronic oxygen therapy provides any benefits to compromised fetuses between 24 and 30 weeks of gestation. Larger studies with sufficient power are necessary to assess whether oxygen therapy can reduce perinatal mortality by a clinically useful amount in this group of patients.
Knowledge, use and attitudes towards emergency contraceptive pills among swedish women presenting for induced abortion
Authors: Aneblom Gunilla , Larsson Margareta , Odlind Viveca , Tydén Tanja 
Published: December 2003

Objective
To investigate the knowledge, experiences and attitudes towards emergency contraceptive pills (ECP) among women presenting for induced abortion.Design
Survey by self‐administered waiting room questionnaires.Setting
Three large hospitals in the cities of Uppsala, Västerås and Örebro in Sweden.Population
591 Swedish‐speaking women consecutively attending the clinics for an induced abortion during a four‐month period in 2000.Results
The response rate was 88% (n= 518). As many as 43% had a history of one or more previous abortions and 43% were daily smokers. Four out of five women, 83%, were aware of ECP, but only 15 women used it to prevent this pregnancy. Fewer, 38%, knew the recommended timeframes for use and 54% had knowledge of the mode of action. The two most common sources of information about ECP were media and friends. One out of five, 22%, had previously used the method, and at the time of conception, 55% would have taken ECP if it had been available at home, and 52% were positive to having ECP available over the counter.Conclusions
Emergency contraception is well known but is still underused. Lack of awareness of pregnancy risk may be one limiting factor for its use. Making ECP available over the counter may be an important measure towards better availability. Information strategies to the public are needed before ECP will be a widely used back‐up method.
Endothelial cell expression of adhesion molecules is induced by fetal plasma from pregnancies with umbilical placental vascular disease
Authors: Wang Xin , Athayde Neil , Trudinger Brian 
Published: December 2003

Objective
To test the hypothesis that local production with spill into the fetal circulation of factor(s) injurious to endothelium is responsible for the vascular pathology present when the umbilical artery Doppler study is abnormal. Expression of adhesion molecules is a feature of endothelial cell activation.Design
Case–control study.Setting
University teaching hospital.Samples
Fetal plasma was collected from 27 normal pregnancies, 39 pregnancies with umbilical placental vascular disease defined by abnormal umbilical artery Doppler and 11 pregnancies with pre‐eclampsia and normal umbilical artery Doppler.Methods
Isolated and cultured human umbilical vein endothelial cells from normal pregnancies were incubated with fetal plasma from three study groups. mRNA expression of intercellular cell adhesion molecule‐1 (ICAM‐1), vascular cell adhesion molecule‐1 (VCAM‐1) and platelet‐endothelial cell adhesion molecule‐1 (PECAM‐1) were assessed by reverse transcription‐polymerase chain reaction. To confirm the occurrence of this in vivo, we measured the levels of soluble fractions of sICAM‐1, sVCAM‐1 and sPECAM‐1 in the fetal circulation in the fetal plasma used for endothelial cell incubation.Results
The mRNA expression of ICAM‐1 [median 1.1 (interquartile range 0.5–1.9) vs 0.7 (0.3–1.2), P < 0.05] and PECAM‐1 [2.1 (1.2–3.0) vs 1.5 (0.7–2.1), P < 0.05] was significantly higher following incubation with fetal plasma from umbilical placental vascular disease compared with the normal group. There was no difference in the expression of VCAM‐1 [1.2 (0.9–1.8) vs 1.1 (0.8–1.6), ns]. The group with maternal pre‐eclampsia and normal umbilical artery Doppler did not differ from the normal group. In the umbilical placental vascular disease group, the results were similar in the presence or absence of pre‐eclampsia. For soluble fractions of the adhesion molecules released into the fetal circulation, we found the levels (ng/mL) of sICAM‐1 [median 248.5 (interquartile range 197.3–315.7) vs 174.2 (144.5–212.9), P < 0.05] and sPECAM‐1 [9.3 (6.2–11.1) vs 6.1 (5.4–7.7), P < 0.05] in fetal plasma to be significantly increased in the presence of umbilical placental vascular disease compared with the normal.Conclusions
Vascular disease in the fetal umbilical placental circulation is associated with an elevation in mRNA expression by endothelial cells of ICAM‐1 and PECAM‐1. Our study provides evidence for endothelial cell activation and dysfunction in umbilical placental vascular disease. We speculate that the plasma factor(s) affecting the vessels of the umbilical villous tree is locally released by the trophoblast. The occurrence of the maternal syndrome of pre‐eclampsia appears to be independent of this.
The effect of body mass index on three methods of fetal weight estimation
Authors: Farrell Tom , Holmes Rob , Stone Peter 
Published: December 2003

Objective
To assess agreement between three methods of estimation of fetal weight and determine the influence of maternal obesity.Design
Prospective observational study.Setting
A tertiary referral teaching hospital.Population
Unselected women attending for induction of labour.Method
Maternal, clinical and ultrasonic estimations of fetal weight were made prior to induction of labour in 96 consenting women. The estimations of fetal weight were performed independently by the three methods.Main outcome measure
Bland and Altman plots to show limits of agreement, and intraclass correlation coefficients.Results
Variable levels of accuracy were obtained for maternal, clinical and ultrasound estimates of fetal weight. Ultrasound estimation of fetal weight performed equally best for women of high and low body mass index (BMI). For women of low BMI, the intraclass correlation coefficient (ICC) was 0.90 (95% CI 0.83–0.94) and 0.87 (95% CI 0.77–0.93) for women with high BMI. Despite this, the limits of agreement for ultrasound were in the order of −700 to +500 g. Both maternal and clinical estimation of fetal weight under‐estimated true fetal weight in women with low BMI and over‐estimated the true fetal weight in women with high BMI. The largest observed mean difference was obtained with clinical palpation in both low and high BMI women.Conclusion
The accuracy of ultrasound estimation of fetal weight was better than maternal and clinical estimation of fetal weight and was not influenced significantly by maternal BMI.
Factors associated with maternal mortality in rural Guinea‐Bissau. A longitudinal population‐based study
Authors: Høj L. , Da Silva D. , Hedegaard K. , Sandström A. , Aaby P. 
Published: December 2003

Objective
To assess demographic and obstetric risk factors for pregnancy‐related death in a multiethnic rural population in a developing country.Design
A prospective survey of women in the fertile age‐range.Setting
Rural Guinea‐Bissau.Population
More than 15,000 women living in 100 clusters were visited at six‐monthly intervals over a period of more than six years. A total of 10,931 pregnancies were registered prospectively; 85 of these pregnancies resulted in maternal or late maternal death.Main outcome measure
Maternal mortality ratio.Method
In the rural areas of Guinea‐Bissau, we conducted a prospective survey of women in the fertile age range. More than 15,000 women living in 100 clusters were visited at 6‐monthly intervals over a period of more than six years. An analysis of demographic, environmental and obstetric risk factors for maternal death was performed based on 10,931 prospectively registered pregnancies; 85 of these pregnancies resulted in maternal or late maternal death.Results
In the adjusted model maternal mortality ratio increased with increasing distance from the regional hospital (OR>25 km= 7.4 [95% CI: 1.6–132]). Multiple pregnancy was found to increase the risk of maternal death (OR = 3.4 [95% CI: 1.3–7.5]). The risk of subsequent maternal death was increased if the fetus was stillborn (OR = 5.3 [95% CI: 2.8–9.4]). Women living in the region of Gabu had higher mortality than those living in Biombo (OR = 2.5 [95% CI: 1.3–5.1]). No category of age or parity were associated with an increased risk of maternal mortality. Predictive values did not exceed 3% for any of the significant risk factors.Conclusions
For the purpose of reducing maternal mortality, the screening approach of antenatal care is of limited value. Age and parity should not be used routinely as selection criteria for transfer of otherwise healthy pregnant women to higher‐level health institutions. Twin pregnancy seems to be the only operational risk factor identified in this study. Stillbirth is associated with an increased risk of maternal death. Regional differences must be studied further. The distance to emergency obstetric care (EOC) may determine the outcome of a complicated delivery.
Does fetal tracheal fluid flow during fetal breathing movements change before the onset of labour?
Authors: Kalache K.D. , Chaoui R. , Marks B. , Wauer R. , Bollmann Rainer 
Published: December 2003

Objective
To examine changes in intra‐tracheal fluid flow parameters during fetal breathing movements throughout the second half of pregnancy in the normally developing human fetus.Design
Prospective cross‐sectional study.Setting
Fetal medicine unit at the Charité University Hospital in Berlin.Methods
Assessment of tracheal fluid flow was attempted in 340 healthy fetuses (GA 20–40 weeks) in which fetal breathing movements were seen by B‐mode scan. Colour Doppler was applied to visualise the tracheal fluid flow, followed by spectral Doppler to record the velocity waveforms. The records of 53 fetuses divided into five gestational age groups (20–23, 24–27, 28–31, 32–35 and 36–40 weeks of gestation) containing 40 or more continuous breathing cycles (inspiration and expiration) were considered for analysis. Only regular breathing phases were examined and the volume obtained by integration of the tracheal fluid flow displaced during fetal breathing movements was calculated.Results
The intra‐tracheal flow volume moved during inspiration (Vi) and expiration (Ve) increased until 36 weeks of gestation after which there was a flattening until term. This suggests either a reduction of lung liquid production or a diminished lung liquid volume. The median difference between Vi and Ve was positive in the first four age groups and negative in the last one suggesting that, in mature fetuses, the effect of fetal breathing movements no longer results in an influx.Conclusions
Our data demonstrate a modification in fetal behaviour that manifests itself during the last four weeks before birth and has the potential to reduce lung liquid volume.
Preventing anxiety and depression in gynaecological cancer: a randomised controlled trial
Authors: Petersen Rodney W. , Quinlivan Julie A. 
Published: December 2003

Objective
To examine the effect of counselling and relaxation intervention on psychological symptoms in patients with gynaecological cancer between the post‐operative period and the six‐week review.Design
Randomised controlled trial.Participants
Fifty‐three patients with gynaecological cancer.Setting
Three Australian tertiary referral hospitals.Methods
Fifty‐three patients were randomised to control or intervention and completed the baseline Hospital Anxiety and Depression Scale (HADS) and General Health Questionnaire‐28 (GHQ‐28) questionnaires. The intervention consisted of a relaxation and counselling session performed by a senior doctor. Follow up questionnaires were completed at six weeks. Demographic and tumour data were collated independently.Results
Complete data were available on 50 patients. There were no significant differences in demographic, social support or tumour characteristics between the two groups. Multivariate analysis determined that only the intervention and baseline score were significant predictors of outcome. The intervention was associated with a significant reduction in total HADS score (P= 0.002). The reduction was seen in both anxiety and moderate depression subscales (P= 0.001 and P= 0.02). The intervention was also associated with a significant reduction in total GHQ‐28 score and in three of the four subscale scores (somatisation, anxiety and personality development; all P < 0.02). However, no significant difference was found in the fourth subscale of major depression.Conclusion
A relaxation and counselling intervention performed by a treating doctor reduces psychological symptoms in women with a new diagnosis of gynaecological cancer.
Relationship between total homocysteine and folate levels in pregnant women and their newborn babies according to maternal serum levels of vitamin B12
Authors: Guerra‐Shinohara Elvira M. , Paiva Adriana A. , Rondó Patrıacute;cia H.C. , Yamasaki Kátia , Terzi Carolina A. , D'Almeida Vânia 
Published: December 2003

Objective
To determine total homocysteine and folate levels in pregnant women according to vitamin B12 (B12) levels, and to analyse the impact of maternal B12 levels on the nutritional status of their newborn babies.Design
Cross sectional observational study.Setting
Two public hospitals in Jundiai City, São Paulo, Brazil.Sample
Sixty‐nine pregnant women and their respective newborn babies at the time of delivery.Methods
Maternal blood was collected up to 8 hours before delivery. Umbilical cord blood was collected after the expulsion of the placenta. Total homocysteine was measured by high perfomance liquid chromatography, folate by ion capture methodology and B12 by enzyme immunoassay.Main outcome measures
Relationship between low maternal vitamin B12 levels and total homocysteine and folate levels in pregnant women and new born babies.Results
There was a significant correlation between maternal and neonatal B12 levels, but not between maternal B12 and neonatal red blood cell (RBC) folate. There was a weak correlation between maternal B12 levels and neonatal serum folate. However, there were significant correlations between maternal and neonatal total homocysteine levels and between neonatal B12 and neonatal total homocysteine levels. Mean (±SD) umbilical cord blood B12, RBC folate, serum folate and total homocysteine levels were 1.7 ± 0.8, 1.8 ± 0.8, 2.2 ± 0.8 and 0.9 ± 0.3 times higher than maternal B12, RBC folate, serum folate and total homocysteine values, respectively.Conclusions
These data suggest that pregnant women with low B12 levels are unable to provide the necessary amount of B12 to their fetuses. The clinical consequences could be the presence of neurological abnormalities as well as the lack of utilisation of homocysteine for methionine transformation.
Altered vascular function in healthy normotensive pregnant women with bilateral uterine artery notches
Authors: Brodszki J. , Länne T. , Stale H. , Batra S. , Maršál K. 
Published: December 2003

Objectives
To assess endothelial function and vascular mechanical properties in normotensive pregnant women with high resistance in the uteroplacental circulation.Design
Cross‐sectional prospective study.Setting
Doppler ultrasound laboratory at university department of obstetrics and gynaecology referral centre for high risk pregnancies.Participants
Forty‐two caucasian normotensive pregnant women: 23 with uncomplicated pregnancies and 19 with bilateral uterine artery notches.Methods
Flow‐mediated dilatation of the brachial artery was measured by ultrasonography at 25 gestational weeks. Concentrations of nitrite and nitrate in the plasma were established at 25 and 32 gestational weeks. The elastic properties of the common carotid artery, abdominal aorta and popliteal artery were measured with an ultrasonic echo‐tracking system.Results
Flow‐mediated dilatation at two minutes after cuff deflation was significantly lower in the bilateral notch group compared with the control group, 8.3% and 13.7%, respectively (P= 0.0007). The ability to sustain vasodilatation was reduced in the bilateral notch group (P= 0.02). Lower values of nitrite and nitrate in the plasma were found at 32 gestational weeks in the bilateral notch group than in the control group (mean 24.76 μM/L (SD 5.6) and 30.93 μM/L (8.2), respectively; P= 0.008). Nitrite and nitrate levels tended to be lower in the bilateral notch group even at 25 gestational weeks (29.45 μM/L (8.3) and 35.73 μM/L (11.0) in the bilateral notch and control group, respectively; P= 0.09). There was no difference in aortic, carotid or popliteal elasticity between the two groups.Conclusions
Healthy normotensive pregnant women with bilateral uterine artery notches show impaired endothelial function, but no differences in vascular mechanical properties.