Folic acid prevents neural tube defects: International comparison of awareness among obstetricians/gynecologists and urologists

AIM

It has been suggested that periconceptional intake of folic acid prevents risks of having fetuses afflicted with neural tube defects. We aim to internationally investigate knowledge of the role of folic acid and attitudes toward the life-style of young women of child-bearing age among obstetricians/gynecologists and urologists.

METHODS

A questionnaire was sent to obstetricians/gynecologists and urologists residing in Japan, South Korea, Taiwan, North America, Europe, Australia and New Zealand by post or e-mail. The investigation was conducted between December 2002 and November 2004.

RESULTS

A mean of 91% of obstetricians/gynecologists and 56% of urologists are aware of the role of folic acid, where Asian urologists knew less compared to those of North America, Europe, Australia and New Zealand. A majority of doctors always, or occasionally, recommend folic acid supplements or multivitamins, well-balanced meals, and the cessation of smoking and drinking. An average of 85% of doctors believes information on folic acid should be disseminated to young women.

CONCLUSIONS

A majority of obstetricians/gynecologists and urologists know the importance of periconceptional folic acid in reducing the risk of neural tube defects and have been advising young women to improve their lifestyle.

Comparison of Recurrence Rates after Anterior Colporrhaphy for Cystocele Using Three Different Surgical Techniques

AIMS

To compare the recurrence rates after anterior colporrhaphy for cystocele using three different surgical techniques: standard plicating, purse-string, and rolling anterior colporrhaphy.

METHODS

A retrospective chart review of women undergoing anterior colporrhaphy for cystocele with or without concomitant operations between 1988 and 2000 was conducted. Women were assessed by vaginal examination pre- and postoperatively at 6 weeks and over 2 years. Grades of cystocele were assessed by Baden-Walker halfway grading system. chi(2) tests and ANOVAs were performed for categorical and continuous variables, respectively. Cox regressions were used to calculate recurrent rates.

RESULTS

Among the studied 363 women, 296, 33, and 34 underwent standard plicating, purse-string and rolling techniques, respectively. There was no significant difference in age, parity, menopausal status, or mean length of follow-up among the three groups. The purse-string group revealed a significantly higher risk of recurrence than the standard plicating group (hazard ratio: 2.67; 95% CI: 1.05-6.08). The severity of cystocele was another key role of determining the prognosis for recurrences (grades 3 & 4 relative to grade 1, hazard ratio: 3.35; 95% CI: 1.34-8.38).

CONCLUSION

Our study showed that standard plicating and rolling technique provided similar anatomic cure rates. However, the purse-string technique was less effective in restoring vaginal anatomy than standard plicating anterior colporrhaphy.

Prediction of the functional class of metal-binding proteins from sequence derived physicochemical properties by support vector machine approach

Metal-binding proteins play important roles in structural stability, signaling, regulation, transport, immune response, metabolism control, and metal homeostasis. Because of their functional and sequence diversity, it is desirable to explore additional methods for predicting metal-binding proteins irrespective of sequence similarity. This work explores support vector machines (SVM) as such a method. SVM prediction systems were developed by using 53,333 metal-binding and 147,347 non-metal-binding proteins, and evaluated by an independent set of 31,448 metal-binding and 79,051 non-metal-binding proteins. The computed prediction accuracy is 86.3%, 81.6%, 83.5%, 94.0%, 81.2%, 85.4%, 77.6%, 90.4%, 90.9%, 74.9% and 78.1% for calcium-binding, cobalt-binding, copper-binding, iron-binding, magnesium-binding, manganese-binding, nickel-binding, potassium-binding, sodium-binding, zinc-binding, and all metal-binding proteins respectively. The accuracy for the non-member proteins of each class is 88.2%, 99.9%, 98.1%, 91.4%, 87.9%, 94.5%, 99.2%, 99.9%, 99.9%, 98.0%, and 88.0% respectively. Comparable accuracies were obtained by using a different SVM kernel function. Our method predicts 67% of the 87 metal-binding proteins non-homologous to any protein in the Swissprot database and 85.3% of the 333 proteins of known metal-binding domains as metal-binding. These suggest the usefulness of SVM for facilitating the prediction of metal-binding proteins. Our software can be accessed at the SVMProt server http://jing.cz3.nus.edu.sg/cgi-bin/svmprot.cgi.

Comparison of 20-minute pad test versus 1-hour pad test in women with stress urinary incontinence

OBJECTIVES

To compare the sensitivity of the 20-minute pad test with that of the 1-hour pad test in women with stress urinary incontinence.

METHODS

From January to March 2005, 100 women with stress urinary incontinence who underwent a urodynamic study were enrolled. Each patient underwent a 1-hour pad test before the urodynamic study. The infusion of 250 mL water into the bladder in the 20-minute pad test was performed after the urodynamic study. The results of the two tests in each patient were analyzed and compared using Pearson's chi-square or the Wilcoxon signed-rank test.

RESULTS

The mean age of the 100 women was 53.3 +/- 12.1 years, with a mean parity of 2.9 +/- 1.5. In the 100 patients, the 20-minute pad test had better sensitivity than the 1-hour pad test (46% versus 34%, P <0.001). In the quantitative study, the two pad tests had fair agreement, and the pad weight results for the 1-hour pad test had significantly larger amounts than those for the 20-minute pad test (P = 0.002).

CONCLUSIONS

The 20-minute pad test had better sensitivity than the 1-hour pad test in women with stress urinary incontinence.

Modulation spectroscopy study of the effects of growth interruptions on the interfaces of GaAsSb/GaAs multiple quantum wells

The effects of growth interruption times combined with Sb exposure of GaAsSb/GaAs multiple quantum wells (MQWs) have been investigated by using phototransmittance (PT), contactless electroreflectance (CER) and wavelength modulated surface photovoltage spectroscopy (WMSPS). The features originated from different portions of the samples, including interband transitions of MQWs, interfaces and GaAs, are observed and identified through a detailed comparison of the obtained spectra and theoretical calculation. A red-shift of the interband transitions and a broader lineshape of the fundamental transition are observed from samples grown under Sb exposure compared to the reference sample grown without interruption. The results can be interpreted in terms of both increases in Sb content and mixing of Sb in the GaAs interface layers. An additional feature has been observed below the GaAs region in the samples with Sb treatment. The probable origin of this additional feature is discussed.

Prediction of MHC-binding peptides of flexible lengths from sequence-derived structural and physicochemical properties

Peptide binding to MHC is critical for antigen recognition by T-cells. To facilitate vaccine design, computational methods have been developed for predicting MHC-binding peptides, which achieve impressive prediction accuracies of 70-90% for binders and 40-80% for non-binders. These methods have been developed for peptides of fixed lengths, for a limited number of alleles, trained from small number of non-binders, and in some cases based straightforwardly on sequence. These limit prediction coverage and accuracy particularly for non-binders. It is desirable to explore methods that predict binders of flexible lengths from sequence-derived physicochemical properties and trained from diverse sets of non-binders. This work explores support vector machines (SVM) as such a method for developing prediction systems of 18 MHC class I and 12 class II alleles by using 4208-3252 binders and 234,333-168,793 non-binders, and evaluated by an independent set of 545-476 binders and 110,564-84,430 non-binders. Binder accuracies are 86-99% for 25 and 70-80% for 5 alleles, non-binder accuracies are 96-99% for 30 alleles. Binder accuracies are comparable and non-binder accuracies substantially improved against other results. Our method correctly predicts 73.3% of the 15 newly-published epitopes in the last 4 months of 2005. Of the 251 recently-published HLA-A*0201 non-epitopes predicted as binders by other methods, 63 are predicted as binders by our method. Screening of HIV-1 genome shows that, compared to other methods, a comparable percentage (75-100%) of its known epitopes is correctly predicted, while a lower percentage (0.01-5% for 24 and 5-8% for 6 alleles) of its constituent peptides are predicted as binders. Our software can be accessed at .

The effect of electrical field strength on activation and development of cloned caprine embryos

The activation procedure used in nuclear transfer (NT) is one of the critical factors affecting the efficiency of animal cloning. The purpose of this study was to compare the effect of two electrical field strengths (EFS) for activation on the developmental competence of caprine NT embryos reconstructed from ear skin fibroblasts of adult Alpine does. The NT embryos were obtained by transfer of the quiescent fibroblasts at the fourth passage into the enucleated metaphase II (M II) oocytes. Four to five hours after electrical fusion, the NT-embryos were activated by EFS either at 1.67 or at 2.33 kV/cm and immediately incubated in 6-DMAP (2 mM) for 4 h. The cleavage rate of the NT-embryos activated with 2.33 kV/cm was greater than that activated with 1.67 kV/cm after in vitro culture for 18 h (65.6% versus 19.6%, p < 0.001). No pregnancy was found in 14 recipient does after transferring 51 NT embryos at 1-2 cell stages activated with 1.67 kV/cm. In contrast, two of the seven recipients were pregnant and gave birth to three kids after transferring 61 NT embryos at 1-2 cell stages activated by 2.33 kV/cm. The birth weights of three cloned kids were within the normal range of Alpine goats. However, one kid died 1h after birth while the remaining two are still healthy. DNA analysis by polymerase chain reaction (single-strand conformation polymorphism, SSCP) confirmed that the three kids were genetically identical to the nuclear donor.

Hepatitis B post-partum e antigen clearance in hepatitis B carrier mothers: Correlation with viral characteristics

BACKGROUND

The purpose of the present paper was to correlate hepatitis B virus (HBV) genotype, e antigen titer, HBV-DNA level and precore/basal core promoter mutations with post-partum e antigen clearance in hepatitis B e antigen (HBeAg)-positive carrier mothers.

METHODS

A total of 40 consecutive HBeAg-positive carrier mothers were studied from January 2002 to January 2003. The blood samples were taken at delivery, 3-4 months and at 1 year after delivery, and the follow-up period was until 1 year after delivery. All sera were assayed for HBeAg, HBV-DNA level, HBV genotype and precore/basal core promoter mutations. The correlation between HBV characteristics and post-partum e antigen clearance was analyzed by Mann-Whitney, Pearson chi2 and multiple logistic regression tests.

RESULTS

The mean age of the 40 HBeAg-positive carrier mothers was 29.9 +/- 5.3 years with a mean parity of 1.4 +/- 0.7. Five of them (group I) had post-partum e antigen clearance, which persisted thereafter, whereas the remaining 35 carrier mothers (group II) had persistent positivity of HBeAg during the follow-up period. The prepartum comparisons of HBV characteristics between groups I and II were comparable in terms of demographics and distributions of HBV genotype and precore/basal core promoter mutations. In contrast, group I carrier mothers had lower HBeAg titer and HBV-DNA level than group II carrier mothers (1:80 vs 1:4000, P = 0.02, and 3.75 x 10(5) vs 3 x 10(8) copies/mL, P = 0.028, respectively).

CONCLUSIONS

Post-partum e antigen clearance in HBeAg-positive carrier mothers is closely associated with prepartum low HBeAg titer or HBV-DNA level.

Prediction of the functional class of lipid binding proteins from sequence-derived properties irrespective of sequence similarity

Lipid binding proteins play important roles in signaling, regulation, membrane trafficking, immune response, lipid metabolism, and transport. Because of their functional and sequence diversity, it is desirable to explore additional methods for predicting lipid binding proteins irrespective of sequence similarity. This work explores the use of support vector machines (SVMs) as such a method. SVM prediction systems are developed using 14,776 lipid binding and 133,441 nonlipid binding proteins and are evaluated by an independent set of 6,768 lipid binding and 64,761 nonlipid binding proteins. The computed prediction accuracy is 78.9, 79.5, 82.2, 79.5, 84.4, 76.6, 90.6, 79.0, and 89.9% for lipid degradation, lipid metabolism, lipid synthesis, lipid transport, lipid binding, lipopolysaccharide biosynthesis, lipoprotein, lipoyl, and all lipid binding proteins, respectively. The accuracy for the nonmember proteins of each class is 99.9, 99.2, 99.6, 99.8, 99.9, 99.8, 98.5, 99.9, and 97.0%, respectively. Comparable accuracies are obtained when homologous proteins are considered as one, or by using a different SVM kernel function. Our method predicts 86.8% of the 76 lipid binding proteins nonhomologous to any protein in the Swiss-Prot database and 89.0% of the 73 known lipid binding domains as lipid binding. These findings suggest the usefulness of SVMs for facilitating the prediction of lipid binding proteins. Our software can be accessed at the SVMProt server (http://jing.cz3.nus.edu.sg/cgi-bin/svmprot.cgi).

PEARLS: Program for Energetic Analysis of Receptor−Ligand System

Analysis of the energetics of small molecule ligand-protein, ligand-nucleic acid, and protein-nucleic acid interactions facilitates the quantitative understanding of molecular interactions that regulate the function and conformation of proteins. It has also been extensively used for ranking potential new ligands in virtual drug screening. We developed a Web-based software, PEARLS (Program for Energetic Analysis of Ligand-Receptor Systems), for computing interaction energies of ligand-protein, ligand-nucleic acid, protein-nucleic acid, and ligand-protein-nucleic acid complexes from their 3D structures. AMBER molecular force field, Morse potential, and empirical energy functions are used to compute the van der Waals, electrostatic, hydrogen bond, metal-ligand bonding, and water-mediated hydrogen bond energies between the binding molecules. The change in the solvation free energy of molecular binding is estimated by using an empirical solvation free energy model. Contribution from ligand conformational entropy change is also estimated by a simple model. The computed free energy for a number of PDB ligand-receptor complexes were studied and compared to experimental binding affinity. A substantial degree of correlation between the computed free energy and experimental binding affinity was found, which suggests that PEARLS may be useful in facilitating energetic analysis of ligand-protein, ligand-nucleic acid, and protein-nucleic acid interactions. PEARLS can be accessed at http://ang.cz3.nus.edu.sg/cgi-bin/prog/rune.pl.

Comparisons of urodynamic characteristics between female patients with overactive bladder and overactive bladder plus stress urinary incontinence

OBJECTIVES

To determine and compare the urodynamic characteristics in patients with overactive bladder (OAB) and patients with OAB plus stress urinary incontinence (OAB+SUI).

METHODS

A total of 120 patients (60 each in OAB and OAB+SUI groups) who underwent urodynamic study between January and April 2003 were recruited. A detailed history, physical examination, and multichannel urodynamic data, including uroflowmetry, filling and voiding cystometry, stress urethral pressure profile, and 20-minute pad test were obtained for each patient. The urodynamic findings of each patient were analyzed and the results compared between the two groups.

RESULTS

The median age of both groups was 51 years (interquartile range 43 to 64) with a parity of 3 (interquartile range 2 to 4); 54% (n = 65) were menopausal. The urodynamic parameters of bladder storage function showed premature filling sensation with decreased bladder capacity. Additionally, 60 (50%) had genuine stress incontinence, 3 (3%) had idiopathic detrusor overactivity, 11 (9%) mixed type incontinence, and 12 (11%) had voiding dysfunction. Among the urodynamic parameters between the two groups, first desire, strong desire, urgency, functional urethral length, maximal urethral pressure, maximal urethral closure pressure, pad test, and percentage of genuine stress incontinence in the OAB+SUI group were significantly lower statistically than those in the OAB group (P <0.03); the differences in age, parity, and percentage of menopausal status were also statistically significant (P <0.03).

CONCLUSIONS

Our data showed that patients in the OAB+SUI group had more impaired urodynamic parameters than those in the OAB group. Age, parity, and menopausal status were contributory factors.

Prediction of transporter family from protein sequence by support vector machine approach

Transporters play key roles in cellular transport and metabolic processes, and in facilitating drug delivery and excretion. These proteins are classified into families based on the transporter classification (TC) system. Determination of the TC family of transporters facilitates the study of their cellular and pharmacological functions. Methods for predicting TC family without sequence alignments or clustering are particularly useful for studying novel transporters whose function cannot be determined by sequence similarity. This work explores the use of a machine learning method, support vector machines (SVMs), for predicting the family of transporters from their sequence without the use of sequence similarity. A total of 10,636 transporters in 13 TC subclasses, 1914 transporters in eight TC families, and 168,341 nontransporter proteins are used to train and test the SVM prediction system. Testing results by using a separate set of 4351 transporters and 83,151 nontransporter proteins show that the overall accuracy for predicting members of these TC subclasses and families is 83.4% and 88.0%, respectively, and that of nonmembers is 99.3% and 96.6%, respectively. The accuracies for predicting members and nonmembers of individual TC subclasses are in the range of 70.7-96.1% and 97.6-99.9%, respectively, and those of individual TC families are in the range of 60.6-97.1% and 91.5-99.4%, respectively. A further test by using 26,139 transmembrane proteins outside each of the 13 TC subclasses shows that 90.4-99.6% of these are correctly predicted. Our study suggests that the SVM is potentially useful for facilitating functional study of transporters irrespective of sequence similarity.

Prediction of functional class of novel plant proteins by a statistical learning method

In plant genomes, the function of a substantial percentage of the putative protein-coding open reading frames (ORFs) is unknown. These ORFs have no significant sequence similarity to known proteins, which complicates the task of functional study of these proteins. Efforts are being made to explore methods that are complementary to, or may be used in combination with, sequence alignment and clustering methods. A web-based protein functional class prediction software, SVMProt, has shown some capability for predicting functional class of distantly related proteins. Here the usefulness of SVMProt for functional study of novel plant proteins is evaluated. To test SVMProt, 49 plant proteins (without a sequence homolog in the Swiss-Prot protein database, not in the SVMProt training set, and with functional indications provided in the literature) were selected from a comprehensive search of MEDLINE abstracts and Swiss-Prot databases in 1999-2004. These represent unique proteins the function of which, at present, cannot be confidently predicted by sequence alignment and clustering methods. The predicted functional class of 31 proteins was consistent, and that of four other proteins was weakly consistent, with published functions. Overall, the functional class of 71.4% of these proteins was consistent, or weakly consistent, with functional indications described in the literature. SVMProt shows a certain level of ability to provide useful hints about the functions of novel plant proteins with no similarity to known proteins.

Integration of high-risk human papillomavirus DNA correlates with HLA genotype aberration and reduced HLA class I molecule expression in human cervical carcinoma

In human cervical cancer (CC), local immunity against this human papilloma virus (HPV)-associated neoplasia has been signified. To stratify the possibility of HPV integration on HLA mutations, we measured the genotypic and phenotypic integrity of all available HLA class I loci in 30 cases of CC. Paired normal and cancer genomic DNA was analyzed with DNA typing trays, including 57 subtypes of HLA-A, 120 subtypes of HLA-B, and 60 subtypes of HLA-C. We demonstrated significant mutations of HLA genotype with reduced HLA molecule expression in CC. HPV coincide in > 70% cases of aberrant HLA genes. Southern blot analysis revealed the presence of HPV DNA within the mutated HLA foci. Our study reveals a plausible role of HPV integration in the contexts of aberrant HLA genotypes in CC cells. Disruptions of the HLA genes can be possible tactics of HPV to attain the potential carcinogenetic purposes, and thus the cancer immune escape.

Up-regulation of inhibitory natural killer receptors CD94/NKG2A with suppressed intracellular perforin expression of tumor-infiltrating CD8+ T lymphocytes in human cervical carcinoma

Inhibitory signals that govern the cytolytic functions of CD8(+) T lymphocytes have been linked to the expression of natural killer cell receptors (NKRs) on CTLs. There is limited knowledge about the induction of inhibitory NKR (iNKR) expression in vivo. Up-regulation of iNKRs has been linked to the modulation of the virus- and/or tumor-specific immune responses in animal models. In the present study, we directly examined the expression of various NKRs on tumor-infiltrating lymphocytes (TILs) derived from human cervical cancer. We found that in human cervical cancer, the percentage expression of immunoglobulin-like NKR(+)CD8(+) T lymphocytes were similar in gated CD8(+)-autologous TILs and peripheral blood mononuclear cells. On the contrary, cervical cancer-infiltrating CD8(+) T lymphocytes expressed up-regulated C-type lectin NKRs CD94/NKG2A compared with either peripheral blood CD8(+) T cells or normal cervix-infiltrating CD8(+) T lymphocytes. Dual NKR coexpression analyses showed that CD94 and NKG2A were mainly expressed on CD56(-)CD161(-)CD8(+) TILs within the cancer milieu. Immunohistochemical study showed that cervical cancer cells expressed abundant interleukin 15 (IL-15) and transforming growth factor-beta (TGF-beta). In kinetic coculture assay, cervical cancer cells can promote the expression of CD94/NKG2A on CD8(+) T lymphocytes. The cancer-derived effects can be reversed by addition of rIL-15Ralpha/Fc and anti-TGF-beta antibody. Functional analyses illustrated that intracellular perforin expression of CD8(+) T cells was minimal upon up-regulation of CD94/NKG2A. Kinetic cytotoxicity assays showed that up-regulated expressions of CD94/NKG2A restrain CD8(+) T lymphocyte cytotoxicity. Our study strongly indicated that cervical cancer cells could promote the expression of iNKRs via an IL-15- and possibly TGF-beta-mediated mechanism and abrogate the antitumor cytotoxicity of TILs.

Comparison of the severity of illness scoring systems for critically ill cirrhotic patients with renal failure

BACKGROUND

Mortality rates of cirrhotic patients with renal failure admitted to the medical intensive care unit (ICU) are high. End-stage liver disease is frequently complicated by disturbances of renal function. This investigation is aimed to compare the predicting ability of acute physiology, age, chronic health evaluation II and III (APACHE II and III), sequential organ failure assessment (SOFA), and Child-Pugh scoring systems, obtained on the first day of ICU admission, for hospital mortality in critically ill cirrhotic patients with renal failure.

METHODS

Sixty-seven patients with liver cirrhosis and renal failure were admitted to ICU from April 2001-March 2002. Information considered necessary for computing the Child-Pugh, SOFA, APACHE II and APACHE III score on the first day of ICU admission was prospectively collected.

RESULTS

The overall hospital mortality rate was 86.6%. Liver disease was most commonly attributed to hepatitis B viral infection. The development of renal failure was associated with a history of gastrointestinal bleeding. Goodness-of-fit was good for SOFA, APACHE II and APACHE III scores. The APACHE III and SOFA models reported good areas under receiver operating characteristic curve (0.878 +/- 0.050 and 0.868 +/- 0.051, respectively).

CONCLUSION

Renal failure is common in critically ill patients with cirrhosis. The prognosis for cirrhotic patients with renal failure is poor. APACHE III and SOFA showed excellent discrimination power in this group of patients. They are superior to APACHE II and Child-Pugh scores in this homogenous group of patients.

Dyspeptic symptoms and water load test in patients with functional dyspepsia and reflux disease

OBJECTIVE

Hypersensitivity to gastric distension has been reported in functional dyspepsia (FD). The aim of this study was to assess the perception to gastric distension and its relationship to specific symptoms using the water load test (WLT) in FD and gastroesophageal reflux disease (GERD).

MATERIAL AND METHODS

A 5-min WLT was used to evaluate sensitivity of gastric distension in 47 FD and 61 GERD subjects, and 49 healthy controls (HC). A visual analogue scale (VAS) measuring symptom severity was obtained from all subjects and its relationship with the maximal ingested volume was determined. The maximal ingested volume was registered and the subjective symptoms were assessed at baseline and 30 min after the WLT.

RESULTS

The maximal ingested volume by HC was 597 +/- 33 ml, which was statistically greater than that of FD (422 +/- 22 ml, p < 0.001) and GERD (504 +/- 23 ml, p < 0.02) subjects. The maximal ingested volume did not differ significantly between FD and GERD. The maximal ingested volume correlated well with nausea (r = -0.49, p < 0.01) and fullness (r = -0.33, p < 0.05) in FD. Male subjects ingested more water than females in the HC (p < 0.01) and GERD groups (p < 0.05), but not in FD (p = NS).

CONCLUSIONS

Both FD and GERD subjects have altered perception to gastric fullness induced by the WLT compared to healthy controls. Good correlations have been observed between the WLT and dyspeptic symptoms such as early satiety and postprandial fullness, but not in GERD.

MoViES: molecular vibrations evaluation server for analysis of fluctuational dynamics of proteins and nucleic acids

Analysis of vibrational motions and thermal fluctuational dynamics is a widely used approach for studying structural, dynamic and functional properties of proteins and nucleic acids. Development of a freely accessible web server for computation of vibrational and thermal fluctuational dynamics of biomolecules is thus useful for facilitating the relevant studies. We have developed a computer program for computing vibrational normal modes and thermal fluctuational properties of proteins and nucleic acids and applied it in several studies. In our program, vibrational normal modes are computed by using modified AMBER molecular mechanics force fields, and thermal fluctuational properties are computed by means of a self-consistent harmonic approximation method. A web version of our program, MoViES (Molecular Vibrations Evaluation Server), was set up to facilitate the use of our program to study vibrational dynamics of proteins and nucleic acids. This software was tested on selected proteins, which show that the computed normal modes and thermal fluctuational bond disruption probabilities are consistent with experimental findings and other normal mode computations. MoViES can be accessed at http://ang.cz3.nus.edu.sg/cgi-bin/prog/norm.pl.

Impact of radical hysterectomy for cervical cancer on urodynamic findings

To elucidate the impact of radical hysterectomy upon the urodynamic findings of patients with cervical cancer, 20 patients with cervical cancer at stage IB to IIA who underwent radical hysterectomy were recruited. Each patient underwent a 20-min pad test and urodynamic study prior to and 3 months after radical hysterectomy. ANOVA, Bonferroni test and paired t -test were utilized for analysis. The mean age of the 20 patients was 50.2+/-8.7 years with a mean parity of 3.5+/-1.5. Four (20%) of the 20 cases revealed normal urodynamic findings preoperatively, and the urodynamic findings became abnormal after surgery. Comparing the urodynamic parameters of both bladder voiding and storage functions pre- and post-surgery, we found significant impairments postoperatively in all 20 cases. Our data demonstrate that abnormal urodynamic findings may pre-exist for some patients with cervical cancer prior to surgical treatment. These findings may worsen, and/or additional abnormal states may arise subsequent to radical hysterectomy.

Sertoli-Leydig cell tumor of the ovary

Sertoli-Leydig cell tumors of the ovary are rare diseases that occur primarily in young women. The majority of these tumors are unilaterally localized, and conservative surgery is sufficient. However, these tumors exhibit a variety of histological patterns, which are significant prognostic factors. To date, no standard therapy exists. Here we report 4 cases of Sertoli-Leydig cell tumors of the ovary. One patient whose tumor was a poorly differentiated Sertoli-Leydig cell tumor with mesenchymal heterologous elements received adjuvant chemotherapy postoperatively but died of disease 2.5 years after surgery. The other 3 patients remained free of disease during follow-up. Conservative surgery is an appropriate treatment for young patients with Sertoli-Leydig cell tumors. Those who have poor prognostic factors may need adjuvant chemotherapy with a combination of bleomycin, etoposide and cisplatin.

Sequential Assessment of Urodynamic Findings before and after Tension-Free Vaginal Tape (TVT) Operation for Female Genuine Stress Incontinence

OBJECTIVES

To sequentially compare the urodynamic findings in patients with genuine stress incontinence (GSI) before and after tension-free vaginal tape (TVT) operation.

PATIENTS AND METHODS

Between January 2001 and January 2002, 24 consecutive patients with GSI who completed multi-channel urodynamic study and 20-minute pad test before operation and at 3, 6, and 12 months after operation were enrolled. The sequential urodynamic findings of each case were compared and analyzed.

RESULTS

The mean age of the 24 patients was 60.6+/-10.7 years with the parity of 3.5+/-1.4. No statistical differences in voiding and storage functions before and after TVT operation were noted. In contrast, significant changes of stress urethral pressure profile (sUPP) including maximal urethral pressure, maximal urethral closure pressure, functional urethral length, urethral closure area and continence area were observed at 6 and 12 months postoperatively ( p<0.03 ). The median pad weight test decreased from 72g (range 10-220) to 0g 3 months after operation and remained unchanged at 6 and 12 months postoperatively.

CONCLUSIONS

This prospective study demonstrates that TVT operation, if done properly, does not significantly impair voiding and storage functions. The significantly increased sUPP parameters may contribute, at least in part, to the high cure rate of TVT operation.

Transfer function analysis of heart rate variability in response to water intake: correlation with gastric myoelectrical activity

We utilized transfer function analysis of heart rate variability (HRV) and respiration to investigate the effect of water intake on gastric myoelectrical activity and its relationship to vagal activity. The electrogastrography (EGG) and HRV were recorded simultaneously before and after drinking 500 ml of water in 10 healthy subjects. We observed good linearity between lung volumes and HRV signals at a ventilatory rate between 0.2 and 0.4 Hz before and after water intake. The EGG power of 3 cycles/min increased remarkably after the water intake. We found that there was a significant increase in the magnitude of the respiration-HRV transfer function after water intake (P < 0.05). The EGG 3 cycles/min power was positively correlated with the transfer magnitude throughout the study (r = 0.54, P = 0.01). These results confirm that transfer function analysis of HRV sensitively identifies subtle changes in the respiratory sinus arrhythmia that occurs with water intake. The present findings suggest that transfer function analysis of HRV and respiration after water intake can be used to evaluate vagal nervous activity in the human gut.