Fetal fibronectin in the cervicovaginal fluid of women with threatened preterm labour as a predictor of delivery before 34 weeks' gestation

Fetal fibronectin (fFN) is an extracellular matrix protein found at the junction between fetal and maternal tissue. It has been hypothesized that fFN is released into cervicovaginal fluid prior to the onset of preterm labour and during episodes of threatened preterm labour (TPL). In the present study fFN was present in the cervicovaginal fluid of 31% (11/36) of patients with TPL. The presence of fFN was found to be predictive of delivery prior to 34 weeks' gestation in 36 patients presenting with TPL and intact membranes (sensitivity 100%, specificity 81%). Eleven patients had a positive fFN assay and 5 delivered before 34 weeks (positive predictive value (PPV) 46%). Twenty-five patients had a negative fFN result and none were delivered before 34 weeks (negative predictive value (NPV) 100%). Patients presenting with TPL who are fFN positive would be ideal candidates for intervention trials of tocolytics. It may be possible to delay or avoid immediate tocolysis and interhospital transfer in patients with a negative fFN immunoassay.

Post-traumatic stress symptoms in children and parents following a school-based fatality

In 1991 the roof blew off a Swindon Primary School. One child was killed. Two years later 19 of her classmates were interviewed. The parent who collected the child from school that day was also interviewed. Recalled levels of post-traumatic stress syndrome (PTSD) symptoms were assessed in both parent and child in the month following the incident. The children's symptom levels at 2 years were also assessed. Parents and children recalled significant post-traumatic stress reactions at 1 month. The level of symptoms in parents did not correlate with that of their own children.

Cumulative pregnancy rates and pregnancy outcome after in-vitro fertilization: > 5000 cycles at one centre

Cumulative pregnancy rates and pregnancy outcome analysis are useful methods for advising an infertile couple of the probability of in-vitro fertilization (IVF) success. All 5209 IVF cycles in 2391 couples at University Hospital, London, Ontario, Canada, over 10 years were studied. Cumulative pregnancy rates were estimated using life table analysis. The Cox proportional hazards model was used to estimate the influence of covariates. Oocyte retrieval and embryo transfer were achieved in 84 and 64% of cycles initiated respectively. There were 644 intra-uterine and 24 ectopic pregnancies (13%/cycle initiated, 15%/oocyte retrieval and 20%/embryo transfer). Cumulative pregnancy rates following six cycles were: tubal 55%, idiopathic 65%, endometriosis 60%, multifactorial 63% and male 40%. There were 68 spontaneous abortions (10.6%) and three induced abortions for congenital anomalies. The multiple gestation rate was 22%. Caesarean section and preterm delivery rates were 35 and 20% respectively, due in part to the high proportion of multiple gestations. Of 15 deliveries which resulted in stillbirths and/or neonatal deaths, 12 were multiple gestations; 18 pregnancies (3.3%) were complicated by congenital malformations. No increases in congenital malformations or spontaneous abortions were identified. Cumulative pregnancy rates were lower in cases of male infertility. Success rates did not decline with successive IVF cycles. IVF is an evolving infertility treatment.

Classification of ductal carcinoma in situ by image analysis of calcifications from digital mammograms

There is evidence to suggest that non-comedo cases of ductal carcinoma in situ (DCIS) may have a lower risk of progressing to invasive disease than comedo DCIS and may be managed with less radical treatment. Most cases of DCIS present as calcifications on the mammogram and, due to differences in the tumour architecture, comedo calcifications often have a characteristic linear or branching appearance. In this study, computer methods were developed to identify the comedo cases using the imaging features of individual calcifications and of calcification clusters. Classifier performance was measured using the area under the receiver operating characteristic (ROC) curve and was optimized by systematic testing of many different combinations of these features. On a test-set of 42 cases the computer achieved a ROC curve area of 0.91 using six combined cluster features. These results are encouraging given the observed overlap in appearance between the comedo and non-comedo cases.

Confounding variables affecting in vitro fertilization success: a decade of experience

PURPOSE

To evaluate etiology of infertility, female age, ovarian response and stimulation protocol in affecting in vitro fertilization (IVF) success.

METHODS

Retrospective analysis was used. Computer records of all 5209 cycles initiated in 2391 couples from February 1, 1984 to December 31, 1993 were analyzed.

RESULTS

There were 644 intrauterine, 24 solely ectopic and 7 heterotopic pregnancies. Pregnancy rates increased with number of embryos transferred with a significant increase still found between transfer of three or four embryos. Multiple gestations also increased in association with an increasing number of embryos transferred. Pregnancy rates per cycle did not decline with repeated cycles. Reduced pregnancy rates were associated with a primary diagnosis of male infertility. Covariates associated with a better pregnancy rate were younger age of the female partner or higher peak preovulatory serum estradiol. Routine administration of GnRH-agonist was associated with a reduced cycle cancellation rate, an increase in oocytes retrieved and an improved pregnancy rate.

CONCLUSIONS

Couples with male infertility and increased female age should be counselled regarding the reduced prognosis for success.

Antiviral effect of cyclopentenone prostaglandins on vesicular stomatitis virus replication

Prostaglandins are potentially useful antiviral agents, however their mechanism of action is unclear. Recent evidence suggests that RNA transcription of vesicular stomatitis virus (VSV) is inhibited by prostaglandins (Bader and Ankel, J. Gen. Virol. 71, 2823-2832, 1990). Prostaglandins are known to have multiple effects on cells which may or may not be related to their antiviral action. We examined the effects of prostaglandins on cells and on VSV RNA polymerase in vitro to seek the mechanism of antiviral action. Actinomycin D inhibited cellular RNA synthesis but failed to block the antiviral activity of prostaglandins on VSV. Thus induction of host cell RNA transcription is not involved in the antiviral action. Neither modulation of the cellular glutathione level by prostaglandins nor formation of prostaglandin-glutathione conjugates was required for the antiviral action. The relative inhibition of VSV RNA polymerase in vitro by prostaglandins with different structures correlated to inhibition of VSV replication in infected cells. This result indicates that the same step in VSV replication is inhibited by prostaglandins both in the in vitro RNA polymerase assay and in the infected cell.

Health service costs of coronary angioplasty and coronary artery bypass surgery: the Randomised Intervention Treatment of Angina (RITA) trial

For some patients with coronary artery disease, percutaneous transluminal coronary angioplasty (PTCA) is an alternative to coronary artery bypass grafting (CABG). We report comparative health service costs of these interventions within the Randomised Intervention Treatment of Angina (RITA) trial. Medications were costed at published UK prices; other resource use was costed with a set of unit costs estimated at two recruiting centres to the RITA trial, one in London and one outside. Over 2-year follow-up of 1011 patients, the estimated mean additional cost for those randomised to CABG compared with PTCA was 1050 pounds (95% CI 621 pounds-1479 pounds), with unit costs from the non-London centre, and 1823 pounds (1202 pounds-2444 pounds), with unit costs from the London centre. The initial average cost of treating a patient randomised to PTCA is about 52% of that of CABG, but after 2 years this increased to about 80% because of the greater need for subsequent interventions. The balance of advantage between PTCA and CABG may change after several years: funding has been obtained to continue RITA follow-up for 10 years. However, on the basis of patients' status at 2 years, the cost advantages of PTCA cannot be ignored. Further research is necessary to assess whether the advantage of PTCA in terms of cost is translated into one of cost-effectiveness.

Sequence and characterization of the Escherichia coli genome between the ndk and gcpE genes

The region of the chromosome immediately upstream of the Escherichia coli gene gcpE has been cloned and sequenced. This region contains two functional open reading frames, orf 384 and orf 337, encoding proteins of 43,082 and 36,189 Da, respectively. Sequencing analysis (this paper) and the isolation of a DNA fragment containing a functional promoter (Talukder, A.A., Yanai, S., and Yamada, M. (1994) Biosci. Biotech. Biochem. 58, 117-120) indicate that orf 337 is in an operon with gcpE. The gene orf 384 is immediately downstream of the gene ndk, which encodes nucleoside diphosphate kinase.

The protection of laboratory animals: a response to Stephenson

This paper clarifies certain issues raised by Wendell Stephenson (The Journal of Medicine and Philosophy 18: 375-388, 1993) about research programs and animal care practices at the Oregon Regional Primate Research Center. It also responds to Stephenson's critique of the National Institute of Health's Guide for the Care and Use of Laboratory Animals. It identifies utilitarianism as the ethical theory underlying Stephenson's critique. Arguing that such an ethical theory is unworkable in addressing concerns about biomedical research and the use of animals, the paper defends the Guide's reliance on a wider tradition of ethical theories.

Post-menopausal vertebral osteoporosis: can dual energy X-ray absorptiometry forearm bone density substitute for axial measurements?

This study compared measurements of BMD using dual energy X-ray absorptiometry (DXA) at three sites in the nondominant forearm (ultradistal, distal one-third and a mid-region between these two), the lumbar spine (L1-L4) and the proximal femur (femoral neck, trochanter and Ward's triangle) for the evaluation of vertebral osteoporosis. Studies were performed on 100 normal women aged 29-69 yr (average 52 yr) and 63 osteoporotic women age 48-75 yr (average 66 yr) using the Hologic QDR-1000. Precision values of < 1% were obtained in both normal and osteoporotic women at both forearm and axial sites. Z-scores for the osteoporotics [Z = (mean BMD normal--mean abnormal)/S.D.] were--2.02 lumbar spine, -1.96 femoral neck, -1.79 ultradistal forearm, -1.73 mid region and -1.66 distal one-third forearm. Receiver operating characteristic curves showed that the lumbar spine and femoral neck equally discriminated between normals and osteoporotics with a 95% area under each curve, significantly greater values than those for the forearm which were 87% ultradistal, 89% mid forearm and 86% distal one-third forearm. Fracture thresholds, defined as the 90th centile of BMD for osteoporotic patients, were 1 S.D. below the normal mean for lumbar spine and femoral neck but equal to the mean for ultradistal, 0.6 S.D. below mean for mid region and 0.3 S.D. below mean for distal one-third region. We conclude that for the discrimination of normals and osteoporotic women the three forearm sites are comparable. However, both lumbar spine and proximal femur BMD are superior to all forearm sites.

Eighth survey of staffing in cardiology in the United Kingdom 1992

The Eighth Survey of Staffing in Cardiology was conducted with an index date of 30 September 1992. The total number of cardiologists in England and Wales, defined as individuals trained in the specialty and spending at least 40% of their professional time working in it, was 358. Of these 11 were part time, defined as six sessions or less, giving a number in whole time (or near whole time) equivalents of 352.5. The number of individuals increased from 1991 by 18 (5.3%). There were 71 cardiologists in Scotland and Northern Ireland, making a total for the United Kingdom of 429 individuals (423.5 whole time equivalents), which is 7.3 per million population. A total of 44 Districts serving 8.8 million people have no resident cardiologist. There has been little improvement since the 1991 survey. An additional 34 Districts with populations greater than 250,000 have only one cardiologist: we have clear evidence of inadequate provision of care in most of these, a situation that is inevitable within the resources provided. A wider threat to the provision of a satisfactory level of cardiological care throughout the United Kingdom will follow from changes in the organisation of the National Health Service and in the new requirements for training of future cardiologists because these changes will make major new demands on consultant time which cannot be met within existing resources. A crisis will be averted only if a rapid and major expansion of the consultant grade can be achieved.

Elastin degradation in the aorta of Watanabe hereditary hyperlipidemic rabbits

The Watanabe hereditary hyperlipidemic (WHHL) rabbit is an animal model that resembles humans with familial hyperlipidemia. In the thoracic aortae, there is also morphologic evidence of marked destruction of medial lamellar elastin fibers. Herein is provided the chemical evidence of elastolytic degradation. The levels of lysyl oxidase (L.Ox.), soluble elastin (SE) and insoluble elastin (IE) were estimated in thoracic aortae samples from New Zealand white (NZW) and WHHL rabbits at 6 months of age or 5 WHHL rabbits at 2.5 years of age. Enzyme-linked immunosorption assays (ELISA) were used in the L.Ox. and SE measurements. IE was measured following alkali extraction of aortae. There was a decrease in IE in thoracic aortae from Watanabe rabbits compared to NZW controls at 6 months of age (P < 0.1), and a further loss of IE in aortae from 2.5-year-old WHHL rabbits relative to the values at 6 months (P < 0.05). Average values for IE were: 130 mg/g for 6-month-old NZW, 100 mg/g for 6-month-old WHHL, and 60 mg/g for 2.5-year-old WHHL rabbits. Moreover, SE was only observed in aorta extracts from the older WHHL rabbits, a sign of elastolytic damage. There was also a five- to sixfold decrease in L.Ox. in the older vs. younger rabbits.