Microsomal epoxide hydrolase polymorphism and risk of spontaneous abortion

Fibrinopeptide B (M(r) 1552.58) was employed as a calibration compound for matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) post-source decay (PSD) fragment ion analysis in the negative mode. Experiments were performed by using both continuous and delayed extraction, with the maximum reflectron voltages being 30 and 21 kV, respectively. For comparison, a common positive ion PSD calibrant, ACTH(18-39) (M(r) 2466.7), was also employed with positive ion calibration constants being applied to negative ion spectra. Using fibrinopeptide B as the calibrant, the negative ion PSD results for angiotensin II (M(r) 1046.2), renin substrate tetradecapeptide (horse) (M(r) 1759.0), and the custom-synthesized peptide (K2G4)2 (M(r) 987.1) showed a factor of 1.5-2 improvement in absolute mass accuracy. Typical absolute mass-to-charge ratio accuracies were within +/- 1 Thompson and were achieved even when the peptide being analyzed was more massive than fibrinopeptide B. In addition, both calibrants showed increased accuracy when experiments were conducted in the delayed extraction mode. Other advantages of using fibrinopeptide B are its moderate cost and the ability to perform calibration and sample analysis for negative ion PSD under the same instrumental conditions.     

Cocaine and tobacco use and the risk of spontaneous abortion

BACKGROUND: Cigarette smoking and cocaine use may be risk factors for spontaneous abortion, but data supporting such a link are limited. METHODS: We studied the associations between cocaine and tobacco use and spontaneous abortion among pregnant adolescents and women (age range, 14 to 40 years) who sought care at an inner-city emergency department. A total of 400 adolescents and women had spontaneous abortions either at study entry or during follow-up (which lasted until 22 weeks' gestation), and 570 adolescents and women remained pregnant past 22 weeks' gestation. Cocaine use was measured at base line by self-reports and analysis of urine and hair samples. Cigarette smoking was measured by self-reports and urine analysis. RESULTS: The adolescents and women in both groups were predominantly black and of lower socioeconomic status. Among those who had spontaneous abortions, 28.9 percent used cocaine on the basis of hair analysis and 34.6 percent smoked on the basis of a urine cotinine assay, as compared with 20.5 percent and 21.8 percent, respectively, of the adolescents and women who did not have spontaneous abortions. The presence of cocaine in hair samples was independently associated with an increase in the occurrence of spontaneous abortion (odds ratio, 1.4; 95 percent confidence interval, 1.0 to 2.1) after adjustment for demographic and drug-use variables. However, the use of cocaine as measured by self-reports and by urine analysis was not. The presence of cotinine in urine was also independently associated with an increased risk of spontaneous abortion (odds ratio, 1.8; 95 percent confidence interval, 1.3 to 2.6). Twenty-four percent of the risk of spontaneous abortion could be related to cocaine or tobacco use. CONCLUSIONS: Cocaine and tobacco use were common in our study population and were associated with a significant risk of spontaneous abortion.     

Intravenous immunoglobulin therapy for recurrent spontaneous abortion: a meta-analysis

The aim of this paper was to identify the mechanism/s responsible of the antimetastatic effect of a single low dose of cyclophosphamide (Cy), previously demonstrated by us in the rat lymphoma LTACB. No direct cytotoxic antimetastatic activity of Cy could be proved. In vitro treatment of L-TACB cells with mafosfamide did not alter their invasiveness or their motility. The adoptive transfer of splenocytes from Cy-treated tumor-bearing rats, together with L-TACB cells inhibited their metastatic growth. The single low dose Cy treatment of T-immunodeficient nude mice did not show the antimetastatic effect on L-TACB observed in immunocompetent mice. An inhibition of the metastatic ability due to immunomodulation by Cy is proposed.     

Exposure to environmental and mainstream tobacco smoke and risk of spontaneous abortion

The present nationwide, multicenter clinical study was carried out in 26 departments of surgery to define the incidence and attendant mortality of intestinal infarction following abdominal aortic surgery, and to identify patients at risk of it. The data consist of 1752 patients who underwent abdominal aortic reconstruction during 1991-1993 as recorded in the Finnish national vascular registry (FINNVASC). Among the 1752 operations, 27 patients treated at 14 different hospitals had intestinal ischemia, and the complete patient records of all 27 cases were reanalyzed. The incidence of bowel infarction was 1.2%. Among patients operated on for a ruptured aneurysm it was 3.1%, whereas 1.0% of patients with nonruptured aneurysm and 0.6% of those operated on for aortoiliac occlusive disease developed intestinal infarction. In 14 patients (67%) the lesion affected the left colon. The overall 30-day mortality rate was 13% but reached 67% among those with intestinal infarction. We conclude that acute intestinal ischemia with bowel infarction is an infrequent but serious complication of abdominal aortic surgery. It is mainly related to surgery due to aneurysmal disease, and patients with occlusive aortoiliac disease present ischemic complications in the intestines less often. Hypotensive patients being treated for ruptured aneurysm are at greatest risk of intestinal ischemia.     

Endometriosis and spontaneous abortion rate: a cohort study in infertile women

Oxidative stress is believed to play an important role in the development of vascular complications associated with diabetes mellitus. In this study, we examined the efficacy of long-term treatment with the antioxidant, N-acetylcysteine, in preventing the development of defective endothelium-dependent relaxation in streptozotocin-induced, Sprague-Dawley diabetic rats. At 48 h after injection of streptozotocin, a portion of diabetic rats received 250 mg/L N-acetylcysteine in drinking water for a total duration of 8 weeks. Oral administration did not alter the increase in blood glucose or the reduction in serum insulin but did modestly reduce total glycosylated hemoglobin. In precontracted thoracic aortic rings suspended in isolated tissue baths, endothelium-dependent relaxation to acetylcholine was impaired in diabetic rings compared with control rings. Endothelium-independent relaxation to nitroglycerin was unaltered. Long-term oral administration of N-acetylcysteine did not alter responses to nitroglycerin but completely prevented the defective relaxation to acetylcholine. These studies indicate a dissociation between glycemic control and correction of endothelial dysfunction and suggest that long-term exposure to reactive oxygen subsequent to diabetes rather than hyperglycemia per se is responsible for the development of endothelial dysfunction in diabetes mellitus.     

Proactive risk management: effective communication

Communication is the most powerful tool in clinical practice. Repeatedly, research has shown that good communication skills result in better clinical outcomes, a greater propensity to follow clinical recommendations and reduced risk of clinical negligence and complaints. In using a proactive approach to communication, healthcare professionals must become increasingly sensitized to the stresses associated with illness and hospitalization and must learn the importance of good listening and effective communication to ensure high quality patient care. A study by Lester and Smith (1993) demonstrated that time-limited, negative communications by doctors is associated with increased litigious intentions among patients, even when outcomes were neither adverse nor negligent. The qualities of caring and concern exhibited by doctors make a difference in healthcare outcomes.     

Management of spontaneous abortion in family practices and hospitals

The results of a greenhouse experiment on the translocation rate of 134Cs from potato leaves to tubers were compared with calculations of the radioecological model ECOSYS-87 and other literature values. The 134Cs activities applied at three development stages (three pinnate leaves fully developed, onset of flowering, onset of yellowing) to leaves of the plant were taken as starting points for the model to calculate the activity in the tubers at harvest. The default yield in the model was replaced by the experimentally obtained values. The translocation rate measured in the greenhouse experiment was 4 to 14 times higher than the calculations of the model. Some possible reasons for such a high translocation rate, compared with the literature data, are discussed. Based on these comparisons, it is concluded that maximal translocation occurs at the growth stage of flowering of a crop and that the development stage of a crop might be a stronger parameter to describe the time dependency of translocation than the usually applied parameter 'days before harvest'.     

Ethylene glycol ethers and risks of spontaneous abortion and subfertility

Potential reproductive effects from occupational exposures to ethylene glycol ethers (EGE) are of concern since these organic solvents have been used widely in industry, and their reproductive toxicity has been well documented in animal studies. For determination of whether occupational exposure to EGE was associated with increased risks of spontaneous abortion and subfertility (i.e., taking more than 1 year of unprotected intercourse to conceive), a retrospective cohort study was conducted among workers at two semiconductor manufacturing plants in the eastern United States in 1980-1989 as part of a larger evaluation of reproductive health. Reproductive and occupational histories were obtained from interviews of semiconductor manufacturing workers and spouses. Assessment of potential exposure to mixtures containing EGE (none, low, medium, and high) was based on reported processes and company records. There were 1,150 pregnancies to semiconductor manufacturers, 561 to female employees and 589 to wives of male employees. Among female manufacturers, potential exposure to mixtures containing EGE was associated with increased risks of spontaneous abortion (relative risk in the high exposure group = 2.8; 95% confidence interval (CI) 1.4-5.6) and subfertility (odds ratio in the high exposure group = 4.6; 95% CI 1.6-13.3). Both of these risks exhibited a dose-response relation with potential EGE exposure (p for trend = 0.02). Among spouses of male manufacturers potentially exposed to mixtures containing EGE, there was no increased risk of spontaneous abortion, but there was a nonsignificant increased risk of subfertility (odds ratio in the high exposure group = 1.7; 95% CI 0.7-4.3).     

Delayed delivery of surviving triplet after fetal reduction and spontaneous abortion

In multiple pregnancies, survival of remaining fetuses after premature death and delivery of one fetus is uncommon. We report a case of a triplet pregnancy that was reduced to twins at the 14th gestational week and then had preterm premature rupture of membranes and intrauterine fetal death of one twin at the 17th gestational week. To save the surviving fetus, delivery of the dead fetus and ligation of the umbilical cord at the cervical level were performed. We also performed McDonald cervical cerclage to keep the placenta of the dead fetus as well as that of the surviving one in the uterine cavity. After a series of aggressive procedures, including immediate administration of tocolytic agents, and antibiotic prophylaxis to prevent infection and preterm labor, the surviving fetus was delivered vaginally 73 days later due to intractable uterine contractions. After a 10-week hospital stay, the infant boy, weighing 2,500 g, was discharged without any sequelae. To our knowledge, this was the longest interval between deliveries in a triplet pregnancy reported in Taiwan. With adequate intensive management, a satisfactory outcome of the fetus and mother in such cases is possible.     

A cytogenetic study of 514 Chinese couples with recurrent spontaneous abortion

OBJECTIVE: To study the role of chromosomal aberration in the causation of recurrent spontaneous abortion (RSA) in Chinese population. METHODS: A total of 514 Chinese couples with 2 or more spontaneous abortions at less than 24 weeks of gestation were included. For each proband, a minimum of 13 metaphases were analyzed by G-banding. Additional cells (usually 50-100 cells) were screened when mosaicism was suspected. Chi 2 test was used to compare the number and frequency of couples with and without balanced translocation with respect to whether liveborn was present or absent. Chi 2 test for trend was used to show whether a correlation existed between the occurrence of balanced translocation and the number of spontaneous abortions at ascertainment. RESULTS: The overall incidence of chromosome anomaly was 51 out of 514 (9.92%). Chi 2 test for trend analysis showed that the chance of one member of a couple being a balanced carrier increased with the number of spontaneous abortions. The chance of finding translocation in couples with liveborn was higher than that in couples without liveborn, but the difference was not statistically significant. We also found that pericentric inversion 9 did not play an important role in the causation of recurrent abortion. CONCLUSIONS: Cytogenetic analysis is indicated in couples with 2 or more spontaneous abortions and the chance of finding chromosomal aberration increases with the number of abortions at the time of ascertainment.     

The development of a national plan for disaster mental health.

In this article, the author provides a history of the development of the national plan for disaster mental health, discusses its present state, and provides some suggestions for the future of theory, research, and practice in the field. The focus is on the provision of mental health services in the emergency phase of a disaster, rather than on the long-term follow-up. Consequently, the focus is on the American Red Cross's disaster mental health program and, to a lesser extent, the American Psychological Association's Disaster Response Network. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationship between decidual leukocyte infiltration and spontaneous abortion in a murine model of early fetal resorption

The cardiovascular effects of KRN2391, N-cyano-N'-(2-nitroxyethyl)-3-pyridine carboximidamide monomethanesulfonate, were compared with those of cromakalim and nitroglycerin in anesthetized dogs. KRN2391 (3-30 micrograms/kg, i.v.), cromakalim (3-30 micrograms/kg, i.v.) and nitroglycerin (1-10 micrograms/kg, i.v.) produced a dose-related decrease of the mean blood pressure with concomitant increase in heart rate. The increase in heart rate caused by cromakalim was lower than that caused by KRN2391 and nitroglycerin. Left ventricular end-diastolic pressure was decreased by all doses of KRN2391 and nitroglycerin. Cromakalim at 3 and 10 micrograms/kg decreased this end-diastolic pressure but increased it at 30 micrograms/kg. Left ventricular dP/dt was increased by KRN2391 and nitroglycerin but was decreased by cromakalim. KRN2391 and cromakalim produced a dose-dependent increase in aortic and coronary blood flow. Nitroglycerin showed biphasic changes in aortic and coronary blood flow, i.e., an initial increase followed by a decrease. At equipotent hypotensive doses, the increase in coronary blood flow induced by KRN2391 was greater than that by cromakalim and nitroglycerin, and total peripheral and coronary vascular resistances were decreased by KRN2391 and cromakalim. Nitroglycerin showed biphasic changes in total peripheral and coronary vascular resistances, i.e., these resistance showed an initial decrease followed by an increase. The relative decrease of coronary vascular resistance compared to the total peripheral vascular resistance was greater for KRN2391 than for cromakalim and nitroglycerin. The changes in hemodynamic parameters caused by KRN2391 were inhibited by pretreatment with glibenclamide (5 mg/kg, i.v.). These results suggest that the hemodynamic profile of KRN2391 is closer to that of cromakalim than to that of nitroglycerin, but that the selectivity for the coronary vascular bed is higher for KRN2391 than for cromakalim. In addition, it is considered that, compared with KRN2391 and nitroglycerin, cromakalim has a low selectivity for the vasculature vs the myocardium.     

Participative development calls for a participative concept of communication

The most common approach to health communication, characterized by a top-down, one way flow of information through which individuals and communities are provided with solutions to their problems, is increasingly in question. The belief that the main goal of health communication programmes is to disseminate carefully worded messages to community target groups in order to trigger individual behaviour change is increasingly questioned in terms of both effectiveness and appropriateness. An alternative belief is that the aim of these programmes should be to involve both community members and health workers in critical analysis of health problems and potential solutions in order to develop strategies for action. This article describes two contrasting models of communication, the "information-dissemination for individual change model" and the "participatory, problem solving for action model". The two models are discussed in terms of the communication process, levels of programme intervention, communication activities and communication materials and an argument is given for the participatory model with examples of successful programmes that have adopted this approach.     

Buying safety: the economics of reproductive risk and abortion in Egypt

This article examines the economics of abortion safety in Egypt. Under Egyptian law induced abortion is restricted to cases in which two physicians certify that the pregnancy presents a danger to the health or life of the mother. Despite this legal restriction, the available data indicate that abortion is quite widely practiced. Multifaceted strands of legal, religious, economic, and health care policy influence both discourse about and access to abortion in Egypt. Interviews with 18 Egyptian women who sought to terminate their pregnancies revealed a wide range of abortion methods that varied in both safety and cost. Three levels of safety were identified: (1) indigenous (wasfa baladi) methods were potentially the least safe; (2) biomedical abortions at clandestine clinics appeared safer than indigenous methods, but were not without risk: and (3) biomedical abortions administered by private gynecologists, were the most safe. Safety is expensive. Wealthy women can literally buy safety, while poor women's lack of financial resources put their lives at great risk.     

Hormone therapy of spontaneous abortion. Our experience with treatment with Gravibinan

The results of the treatment of 151 pregnancies with threatened and/or habitual abortions by using high hormonal dosages (Gravibinan "Alkaloid") are presented. Eight pregnancies were in primigravidas, the remaining 143 patients having previously had 47 interruptions of pregnancy, 66 deliveries, and 313 spontaneous abortions. Disregarding artificial abortions in 379 previous pregnancies there were 313 or 82.5 per cent spontaneous abortions. The treatment was performed by i. m. applications of Gravibinan, during the first week every two days, during the following two weeks every three days, and until the accomplished 16 weeks of pregnancy every five days. Besides hormonal therapy, all patients were on bed rest; in the following course of pregnancy tocolysis and in the case of opened cervix the cerclage cervicis were performed. The vitality of the ovum and the fetus, as well as the efficacy of the treatment were evaluated by clinical findings, HCG and estriol urinary eliminations, and by ultrasonography. Out of 151 treated pregnancies, 21 (13.91%) resulted in early abotion, 17 (11.26%) in mid-trimester abortion, 6 (3.97%) in pre-term, and 107 (70.86%) in term deliveries. There were two (1.77%) perinatally dead premature infants. HCG urinary eliminations were significantly lower in pregnancies resulting is missed abortion or first-trimenon miscarriage, whereas no difference was established between pregnancies resulting in delivery or mid-trimester abortion. The authors recommend hormonal treatment in early threatening and/or habitual abortions by administering high dosages of estrogens and gestagens. Such a treatment stimulates secretory transformation of the endometrium at the beginning of pregnancy, and this allows early placentation and the uterine growth with a simultaneous quiescence of the myometrium, which, in turn, makes the growth of the ovum possible. The authors stress the importance of a complex procedure in the establishment of the etiology and in the treatment of spontaneous and/or habiutal abortion.     

Induced abortion as an independent risk factor for breast cancer: a comprehensive review and meta-analysis

Effects of continuous feeding flavonoids (flavone, flavanone, and tangeretin) on drug-metabolizing enzymes in rat liver were investigated to ascertain how long feeding is required to reach maximal induction and to determine whether maximal induction is maintained for a long period of feeding. In the first experiment rats received a diet containing 10 mmol flavonoid/kg dry matter for 4, 8, 16, or 32 d. The second experiment was designed to examine the time course for induction during the first 4 d. The kinetics of induction depended on the chemical structure of the flavonoid and was different from one enzyme to another. Flavone increased P450 1A and P450 2B apoproteins and stimulated many enzyme activities. A significant increase of P450 1A1/2 proteins, ethoxyresorufin O-deethylase (EROD), and methoxyresorufin O-demethylase (MROD) activities occurred as early as 6 h after the first administration, and a gradual increase was observed up to 4 d of feeding. P450 2B1/2 proteins and pentoxyresorufin O-depentylase (PROD) activity were also increased but after a lag period when compared with P450 1A1/2 proteins. EROD and MROD activities declined after 4 d, whereas PROD activity remained steady during 32 d of flavone feeding. Glutathione transferase (GST) and p-nitrophenol UDP-glucuronosyl transferase (UGT) activities were also increased. The maximal induction was reached by 4 d of feeding for UGT and after a longer duration of feeding (16 d) for GST. Flavanone treatment induced mostly P450 2B1/2 proteins and PROD, GST, and UGT activites. After 4 d of feeding, P450 2B1/2 proteins and PROD activity declined whereas GST and UGT activities remained steady. Tangeretin treatment produced changes similar to flavone but of lesser magnitude and after a longer delay.