bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rectal analgesia for the relief of perineal pain after childbirth: a randomised controlled trial of diclofenac suppositories
Authors: Dodd Jodie M. , Hedayati Hedyeh , Pearce Elizabeth , Hotham Neil , Crowther Caroline A. 
Published: September 2004

Objective  To evaluate rectal diclofenac in the relief of perineal pain after trauma during childbirth.Design  A randomised, double‐blind trial.Setting  Delivery Suite, Women's and Children's Hospital, South Australia.Population  Women with a second‐degree (or greater) perineal tear or episiotomy.Methods  Women were randomly allocated to either diclofenac or placebo suppositories (Anusol), using a computer‐generated randomisation schedule with stratification for parity and mode of birth. Treatment packs contained two × 100 mg diclofenac or two placebo suppositories, the first being inserted when suturing was complete, and the second 12–24 hours after birth. Women were asked to complete questionnaires at 24 and 48 hours after birth relating to their degree of perineal pain using the validated Short Form McGill Pain Questionnaire.Main outcome measures  Pain scores at 24 and 48 hours after birth.Results  A total of 133 women were recruited, with 67 randomised to diclofenac suppositories and 66 to placebo. Women in the diclofenac group were significantly less likely to experience pain at 24 hours while walking (RR 0.8; 95% CI 0.6 to 1.0), sitting (RR 0.8; 95% CI 0.6 to 1.0), passing urine (RR 0.6; 95% CI 0.4 to 1.0) and on opening their bowels (RR 0.6; 95% CI 0.2 to 0.9) compared with those women who received placebo. These differences were not sustained 48 hours after birth.Conclusions  The use of rectal non‐steroidal anti‐inflammatory drug suppositories is a simple, effective and safe method of reducing the pain experienced by women following perineal trauma within the first 24 hours after childbirth.
Informed consent for elective and emergency surgery: questionnaire study
Authors: Akkad Andrea , Jackson Clare , Kenyon Sara , Dixon‐Woods Mary , Taub Nick , Habiba Marwan 
Published: September 2004

Objectives  To evaluate women's experience of giving consent to obstetric and gynaecological surgery and to examine differences between those undergoing elective and emergency procedures.Design  A prospective questionnaire study.Setting  A large teaching hospital.Population  1006 consecutive patients undergoing elective or emergency surgery in obstetrics and gynaecology.Methods  Questionnaires were administered to women who had given consent to surgery following the introduction of national guidelines and consent form. Differences in responses between elective and emergency patients were assessed using frequencies, single and multivariable analyses.Main outcome measures  Patients' experience and recall of the consent process, their overall satisfaction and their views on what is important for adequate consent.Results  There were significant differences between patients undergoing elective or emergency surgery. Patients undergoing emergency surgery were less likely to have read (OR 0.22) or understood (OR 0.40) the consent form, and were more likely to report feeling frightened by signing it (OR 2.52). They were more likely to report they felt they had no choice about signing the consent form (OR 2.11), and that they would have signed regardless of its content (OR 3.14). Overall, significantly more patients undergoing elective (80%) or emergency (63%) surgery reported satisfaction with the consent process. Patients were more likely to report satisfaction if they read (OR 1.80) and agreed with (OR 3.49) the consent form, and if someone checked that they understood (OR 3.09).Conclusion  Patients' needs may not be adequately addressed by current guidelines for consent to treatment, particularly in emergency circumstances. The introduction of more complex forms and procedures appears to conflict with patients' need for personal communication and advocacy. The implications on the ethical and legal standing of consent are considerable.
Hysterectomy improves quality of life and decreases psychiatric symptoms: a prospective and randomised comparison of total versus subtotal hysterectomy
Authors: Thakar Ranee , Ayers Susan , Georgakapolou Alexandra , Clarkson Peter , Stanton Stuart , Manyonda Isaac 
Published: September 2004

Objective  To conduct a prospective and concurrent evaluation of changes in health status and quality of life and psychological outcome measures over one year in women randomised to total or subtotal abdominal hysterectomy. The concurrent evaluation was the impact of total versus subtotal hysterectomy on bladder, bowel and sexual function.Design  Prospective, randomised, double‐blind study.Setting  A large UK Teaching Hospital (St George's Hospital, London) and a large District General Hospital (Mayday University Hospital, Croydon).Methods  Sample  Two hundred and seventy‐nine women undergoing hysterectomy for benign disease were randomly allocated to total hysterectomy (n= 146) or subtotal hysterectomy (n= 133).Main outcome measures  Quality of life assessment using the Short‐Form‐36 health survey (SF‐36) and psychological outcome measures using the General Health Questionnaire‐28 (GHQ‐28) before the operation and 6 and 12 months after.Results  Quality of life and psychological symptoms were similar in the two groups at baseline. Following surgery, quality of life improved in six of the eight domains, with no significant difference between the groups, with the exception of emotions which showed a greater improvement in subtotal hysterectomy women between baseline and 12 months. When this difference was examined further by looking at change in the GHQ subscales, there were no significant differences between total and subtotal hysterectomy women in the amount of change in anxiety, depression, somatic symptoms or social dysfunction, between baseline and post‐operative measurements. All women showed an improvement in psychological symptoms following both operations.Conclusion  Hysterectomy, whether total or subtotal, may improve quality of life and psychological outcome.
Higher order repeat caesarean sections: how safe are five or more?
Authors: Rashid Mumtaz , Rashid Rabia S. 
Published: September 2004

Objective  To determine the maternal morbidity and mortality associated with multiple repeat caesarean sections.Design  Retrospective study.Setting  Security Forces Hospital serving Ministry of Interior and Security Forces personnel in Riyadh, Kingdom of Saudi Arabia.Population  Three hundred and eight case records undergoing between fifth and ninth caesarean section (mean 7) were studied and compared with a control group of 306 patients undergoing third or fourth caesarean section during the period January 1994–December 2002.Main outcome measure  Operative and post‐operative complications and difficulties.Results  Five or more caesarean sections were associated with a longer operating time as well as an increased rate of severe adhesions. Blood transfusion rate was similar in the two groups but a drop of pre‐operative to post‐operative haemoglobin was significantly higher in the study group compared with the controls. There was no significant difference in the Apgar score of the baby, neonatal admission rate, incidence of caesarean hysterectomy, uterine scar rupture, placenta praevia, placenta accreta, bladder injury, incidence of postpartum pyrexia, wound infection and urinary tract infection between the two groups. There was no maternal death in the study group but one mother died in the control group.Conclusion  The higher order (5–9) repeat caesarean sections carry no specific additional risk for the mother or the baby when compared with the lower order (3 or 4) repeat caesarean sections.
A cost–utility analysis of microwave and thermal balloon endometrial ablation techniques for the treatment of heavy menstrual bleeding
Authors: Garside Ruth , Stein Ken , Wyatt Katrina , Round Ali , Pitt Martin 
Published: September 2004

Objective  To assess the cost effectiveness of the second‐generation surgical treatments for heavy menstrual bleeding (microwave and thermal balloon endometrial ablation) compared with existing endometrial ablation techniques (transcervical resection and rollerball, alone or in combination) and hysterectomy.Design  A state transition (Markov) cost–utility economic model.Population   Women with heavy menstrual bleeding.Methods  A Markov model was developed using spreadsheet software. Transition probabilities, costs and quality of life data were obtained from a systematic review of effectiveness undertaken by the authors, from published sources, and expert opinion. Cost data were obtained from the literature and from a NHS trust hospital. Indirect comparison of thermal balloon endometrial ablation versus microwave endometrial ablation or either second‐generation endometrial ablation method versus hysterectomy, and comparison of second‐generation versus first‐generation techniques were carried out from the perspective of health service payers. The effects of uncertainty were explored through extensive one‐way sensitivity analyses and Monte Carlo simulation.Main outcome measures  Incremental cost effectiveness ratios based on cost per quality adjusted life year (QALY) gained, and cost effectiveness acceptability curves.Results  Compared with first‐generation techniques, both microwave and thermal balloon endometrial ablation cost less and accrued more QALYs. Hysterectomy was more expensive, but accrued more QALYs than all endometrial ablation methods. Baseline results showed that differences between microwave endometrial ablation and thermal balloon endometrial ablation were slight. Sensitivity analyses showed that small changes in values may have a marked effect on cost effectiveness. Probabilistic simulation highlighted the uncertainty in comparisons between different endometrial ablation options, particularly between second‐generation techniques.Conclusions  Despite limitations in available data, the analysis suggests that second‐generation techniques are likely to be more cost effective than first‐generation techniques in most cases. Hysterectomy, where a woman finds this option acceptable, continues to be a very cost effective procedure compared with all endometrial ablation methods.
Planned caesarean section decreases the risk of adverse perinatal outcome due to both labour and delivery complications in the Term Breech Trial
Authors: Su Min , Hannah Walter J. , Willan Andrew , Ross Susan , Hannah Mary E. 
Published: September 2004

Objective  To determine if the decreased risk of adverse perinatal outcome, with a policy of planned caesarean, in the Term Breech Trial, was due to a reduction of problems of labour, problems of delivery or unrelated problems.Design  Secondary analysis of data from the Term Breech Trial, a randomised controlled trial of planned caesarean versus planned vaginal birth for the singleton fetus in frank or complete breech presentation at term.Setting  Women were recruited from 121 centres in 26 countries.Population  Women who were enrolled in the Term Breech Trial.Methods  Adverse perinatal outcome was classified as due to labour, due to delivery, due to neither labour nor delivery or unexplained by an experienced obstetrician who was masked to allocation group. The risk of an adverse outcome in each category was compared according to intention to treat and also by actual method of delivery.Main outcome measures  Adverse perinatal outcome (excluding lethal congenital anomalies) that was due to labour, due to delivery, due to neither labour nor delivery or unexplained.Results  Planned caesarean was associated with a lower risk of adverse outcome due to both labour (RR 0.14, 95% CI 0.04–0.45, P < 0.001) and delivery (RR 0.37, 95% CI 0.16–0.87, P= 0.03), compared with planned vaginal birth. Prelabour caesarean and caesarean during early labour were associated with the lowest risk and vaginal birth was associated with the highest risk of adverse outcome due to both labour (0%, 0.4% and 2.2%, respectively) and delivery (0.2%, 0% and 3.1%, respectively).Conclusions  Planned caesarean decreases the risk of adverse perinatal outcome due to both problems of labour and problems of delivery for the singleton fetus in breech presentation at term, compared with planned vaginal birth.
A randomised double‐blind comparison of epidural fentanyl versus fentanyl and bupivicaine for pain relief in the second stage of labour
Authors: Lindow S.W. , Dhillon A.R. , Husaini S.W. , Russell I.F. 
Published: September 2004

Objectives  To compare the effectiveness of two different methods for epidural analgesia in the second stage of labour—fentanyl alone versus the usual mixture of bupivicaine and fentanyl.Design  A double‐blind, randomised, controlled trial.Setting  An English maternity hospital.Sample  Eighty nulliparous women in the second stage of labour.Methods  After successful institution of epidural analgesia with a continuous infusion of bupivicaine/fentanyl mixture in the first stage of labour, the patients were randomised at full dilatation to receive either continuation of the same solution or a change to a fentanyl‐only solution given at the same rate.Main outcome measures  Mode of delivery, duration of the second stage and quality of analgesia.Results  There was no difference in the number of instrumental deliveries (30%vs 27.5%) or the duration of the second stage (141 vs 147 minutes) between the bupivicaine/fentanyl and fentanyl groups, respectively. The bupivicaine/fentanyl group demonstrated a lower need for rescue epidural analgesia (1 vs 6, RR 0.2, 95% CI 0.02–1.3) and significantly fewer high pain scores (11 vs 20, RR 0.6, 95% CI 0.3–1.0).Conclusion  Second stage epidural analgesia with fentanyl did not alter delivery outcomes or labour duration but resulted in poorer analgesia.
Domestic violence: prevalence and association with gynaecological symptoms
Authors: John R. , Johnson J.K. , Kukreja S. , Found M. , Lindow S.W. 
Published: September 2004

Objective  To determine the prevalence of domestic violence in a population of women attending a gynaecology outpatient clinic in the United Kingdom and also to investigate whether women who reported domestic violence were more likely to complain of certain gynaecological symptoms.Design  Questionnaire survey.Setting  A gynaecology outpatient clinic in a North of England Hospital.Sample  Nine hundred and twenty consecutive clinic attenders.Methods  Anonymous confidential questionnaire given to women.Main outcome measures  Disclosure of a past history of domestic violence and gynaecological complaints.Results  Nine hundred and twenty consecutive women were included and 825 questionnaires were returned (90% response rate). The prevalence of physical abuse was 21% (171/825). Thirty‐four (4%) had experienced violence in the past year. Domestic violence is three times less common in women over 50 years old. Ex‐husbands (32%) and ex‐boyfriends (29%) were the main perpetrators. Forty‐eight percent women who had experienced physical violence also had forced sexual activity. Of the 15 presenting symptoms reported by the women, lower abdominal pain, dysmenorrhoea, dyspareunia, smear abnormalities, cancer worries and bowel symptoms were significantly more common complaints in the group who reported domestic violence. The women with domestic violence also had significantly more consultations; however, the duration of their symptoms was not significantly different.Conclusion  The prevalence of domestic violence in a cohort of women who attended the gynaecology outpatient clinic in a North of England Hospital was 21%. Women who are subjected to domestic violence tend to have more consultations and are more likely to complain of certain symptoms.
Is aging programed?
Authors: Austad Steven N. 
Published: September 2004

SummaryDevelopment and morphogenesis may easily be thought of as programed, in the sense that they result from a sequence of cellular and molecular events designed by natural selection to produce a given adult phenotype. Aging, except in exceptional cases such as the rapid decay and death of Pacific salmon, is not design but decay. The decay of senescence is not due to natural selection's designing hand, but to its absence. The empirical difference between programed and nonprogramed senescence becomes evident when comparing the stereotypical steps leading to death in salmon contrasted with the lack of such stereotypy in most organisms such as humans and mice. Understanding the distinction between programed development and nonprogramed senescence helps focus attention on the phenotypic performance of adults, which is the focus of natural selection, and therefore be attentive to any unwanted pleiotropic side‐effects of genetic or environmental treatments which retard aging.
Altered cholesterologenic and lipogenic transcriptional profile in livers of aging Snell dwarf (Pit1dw/dwJ) mice
Authors: Boylston William H. , Gerstner Arpad , DeFord James H. , Madsen Mark , Flurkey Kevin , Harrison David E. , Papaconstantinou John 
Published: September 2004

SummarySeveral murine models demonstrate that mammalian longevity can be increased by single gene mutations affecting endocrine signalling, particularly via the GH/IGF‐1 axis. In this study, we identify age‐independent patterns of hepatic gene expression characteristic of long‐lived Snell (Pit1dw/dwJ) dwarf mice. Comparative microarray analysis of young and aged male livers was performed to discover specific genes differentially expressed between Pit1dw/dwJ and control mice. Further examination by real‐time RT‐PCR confirmed that transcripts encoding HMG‐CoA synthase‐1, HMG‐CoA reductase, farnesyl diphosphate synthase, isopentenyl pyrophosphate isomerase, mevalonate decarboxylase, squalene epoxidase, lanosterol demethylase, malic enzyme and apolipoprotein A‐IV were significantly decreased in both male and female Pit1dw/dwJ livers at 3–5 and 24–28 months of age. In contrast, transcripts encoding the β3‐adrenergic receptor, lipoprotein lipase, PPARγ and a very low‐density lipoprotein receptor homologue were increased significantly in dwarf livers relative to age‐matched controls. These studies reveal enduring transcriptional changes characteristic of Pit1dw/dwJ dwarf mice that involve genes regulating cholesterol biosynthesis, fatty acid metabolism and lipoprotein homeostasis. Linked to global energy metabolism, this stable shift in hepatic gene expression may contribute to longevity determination by influencing particular metabolic functions often compartmentalized within the mitochondrion and peroxisome; further this metabolic shift may also parallel many transcriptional changes induced by caloric restriction.
coq7/clk‐1 regulates mitochondrial respiration and the generation of reactive oxygen species via coenzyme Q
Authors: Nakai Daisuke , Shimizu Takahiko , Nojiri Hidetoshi , Uchiyama Satoshi , Koike Hideo , Takahashi Mayumi , Hirokawa Katsuiku , Shirasawa Takuji 
Published: September 2004

Summary coq7/clk‐1 was isolated from a long‐lived mutant of Caenorhabditis elegans, and shows sluggish behaviours and an extended lifespan. In C. elegans and Saccharomyces cerevisiae, coq7/clk‐1 is required for the biosynthesis of coenzyme Q (CoQ), an essential co‐factor in mitochondrial respiration. The clk‐1 mutant contains dietary CoQ8 from Escherichia coli and demethoxyubiquinone 9 (DMQ9) instead of CoQ9. In a previous study, we generated COQ7‐deficient mice by targeted disruption of the coq7 gene and reported that mouse coq7/clk‐1 is also essential for CoQ synthesis, maintenance of mitochondrial integrity and neurogenesis. In the present study, we rescued COQ7‐deficient mice from embryonic lethality and established a mouse model with decreased CoQ level by transgene expression of COQ7/CLK‐1. A biochemical analysis showed a concomitant decrease in CoQ9, mitochondrial respiratory enzyme activity and the generation of reactive oxygen species (ROS) in the mitochondria of CoQ‐insufficient mice. This implied that the depressed activity of respiratory enzymes and the depressed production of ROS may play a physiological role in the control of lifespan in mammalian species and of C. elegans.
Molecular analyses of mtDNA deletion mutations in microdissected skeletal muscle fibers from aged rhesus monkeys
Authors: Gokey Nolan G. , Cao Zhengjin , Pak Jeong W. , Lee Damian , McKiernan Susan H. , McKenzie Debbie , Weindruch Richard , Aiken Judd M. 
Published: September 2004

SummaryMitochondrial DNA (mtDNA) deletion mutations co‐localize with electron transport system (ETS) abnormalities in rhesus monkey skeletal muscle fibers. Using laser capture microdissection in conjunction with PCR and DNA sequence analysis, mitochondrial genomes from single sections of ETS abnormal fibers were characterized. All ETS abnormal fibers contained mtDNA deletion mutations. Deletions were large, removing 20–78% of the genome, with some to nearly all of the functional genes lost. In one‐third of the deleted genomes, the light strand origin was deleted, whereas the heavy strand origin of replication was conserved in all fibers. A majority (27/39) of the deletion mutations had direct repeat sequences at their breakpoints and most (36/39) had one breakpoint within or in close proximity to the cytochrome b gene. Several pieces of evidence support the clonality of the mtDNA deletion mutation within an ETS abnormal region of a fiber: (a) only single, smaller than wild‐type, PCR products were obtained from each ETS abnormal region; (b) the amplification of mtDNA from two regions of the same ETS abnormal fiber identified identical deletion mutations, and (c) a polymorphism was observed at nucleotide position 16103 (A and G) in the wild‐type mtDNA of one animal (sequence analysis of an ETS abnormal region revealed that mtDNA deletion mutations contained only A or G at this position). Species‐specific differences in the regions of the genomes lost as well as the presence of direct repeat sequences at the breakpoints suggest mechanistic differences in deletion mutation formation between rodents and primates.
The M3 muscarinic receptor i3 domain confers oxidative stress protection on calcium regulation in transfected COS‐7 cells
Authors: Joseph James A. , Fisher Derek R. , Carey Amanda , Szprengiel Aleksandra 
Published: September 2004

SummaryEvidence suggests that muscarinic receptors (MAChRs) are involved in various aspects of neuronal and vascular functioning, and that there is selective oxidative stress sensitivity (OSS) among MAChR subtypes. COS‐7 cells transfected with M1, M2 and M4 subtypes show greater OSS than the M1 and M3 subtypes, as seen by the decreased ability of cells to extrude or sequester calcium (Ca2+) following exposure to dopamine (DA) or Aβ 25–35, and depolarization by oxotremorine. We sought to determine which receptor domain may be responsible for the differential vulnerability to OS between ‘OS‐sensitive’ (M1) and ‘non‐sensitive’ (M3) subtypes. Comparison of the amino acid sequences of each receptor has shown that the third cytoplasmic loop (i3 loop) is the domain with the most variability between the two subtypes. Therefore, mutations were made by either deleting or exchanging the i3 loop of M1 and M3 receptors. Experiments revealed that deletions of the i3 loop increased DA sensitivity (a lower percentage of cells showing recovery of [Ca2+]i following depolarization) in both receptors. Chimerics of M1 in which the i3 loop of the M3 was exchanged with the i3 loop of the M1 (M1M3i3) showed that DA sensitivity was reduced (a greater percentage of cells showing increases in calcium clearance) following depolarization. The M3 chimerics containing the M1 i3 loop (M3M1i3) offered no protection against DA‐induced decrements in calcium buffering. Results suggest that the longer i3 loop of the M3 may decrease OSS, possibly playing a role in targeting antioxidants to specific receptor sites that impart OSS.