Randomized trial of conservative laparoscopic treatment and methotrexate administration in ectopic pregnancy and subsequent fertility

Methotrexate treatment was compared to laparoscopic salpingotomy for conservative management of ectopic pregnancy in a prospective randomized study. One hundred patients were randomized into two groups using random numbers. Inclusion criteria were an ectopic pregnancy visualized by ultrasound with a pre-therapeutic score <13 as assessed by the following six criteria, graded from 1 to 3: gestational age, human chorionic gonadotrophin (HCG) concentration, progesterone concentration, abdominal pain, haemoperitoneal volume and diameter of the haematosalpinx. The treatments were either 1 mg/kg of methotrexate injected transvaginally into the ectopic pregnancy without anaesthesia or administered i.m. when the pregnancy could not safely or easily be punctured (group 1), or laparoscopic salpingotomy (group 2). Success was defined as the return to normal (<10 mIU/ml) of HCG concentrations. Treatment was successful for 45 of 51 patients in group 1 (88.2%) and 47 of 49 in group 2 (95.9%). Medical treatment was significantly (P < 0.05) associated with shorter postoperative stay (24 compared with 46 h), but HCG returned to normal more quickly after laparoscopic treatment (13 compared with 29 days). Spontaneous reproductive performance was similar in both groups, but overall intrauterine pregnancy was higher, and repeat ectopic pregnancy lower, after methotrexate treatment. In selected cases of ectopic pregnancy, with a pre-therapeutic score <13, methotrexate treatment appeared as safe and efficient as conservative treatment by laparoscopy and was associated with improved subsequent fertility.     

Should we apply assisted reproduction technology to women without limitations of age?

The decline of female fertility with increasing age is due to a physiological diminution of the ovarian reserve of follicles. Hence, a reliable evaluation of the ovarian reserve before performing assisted reproductive technology in aged women provides them and the physician with information about the actual probabilities of pregnancy. Patients aged over 38 years should be accepted in assisted reproduction programs only after confirmation of a healthy ovarian reserve. Patients aged more than 42 years, even in case of a normal ovarian reserve assessment, should be only accepted in selected cases. After 42 years until 46 of age, techniques of in vitro fertilization with oocyte donation may represent an alternative chance of pregnancy to aged women.     

Mastery and performance goals predict epistemic and relational conflict regulation.

The present research examines whether mastery and performance goals predict different ways of reacting to a sociocognitive conflict with another person over materials to be learned, an issue not yet addressed by the achievement goal literature. Results from 2 studies showed that mastery goals predicted epistemic conflict regulation (a conflict regulation strategy focused on the attempt to integrate both points of view), whereas performance goals predicted relational conflict regulation (a conflict regulation strategy focused on the evaluation and affirmation of self-competence). Study 1 shows these links via direct self-report measures of conflict regulation. Study 2 shows the same links using the amount of competence reported for the self and for the other as subtle measures of conflict regulation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Magnetic resonance imaging of the fetus: a study of 20 cases performed without curarization

Twenty patients underwent magnetic resonance imaging (MRI) at a mean gestational age of 32 weeks. There were 12 patients with suspected fetal brain abnormality and four with intrauterine growth retardation (IUGR), while the remaining four cases were studied for other reasons. The MRI examinations were performed on a 0.5 Tesla machine, with surface coils. One minute acquisition time T1 sequences were used. All the studies were performed without fetal curarization, and only under maternal sedation using flunitrazepam given per os 1 h before MRI examination. Three examinations were incomplete because of fetal movement artefacts. In the remaining cases, MRI allowed the examination of fetal brain anatomy. In five cases, it helped to differentiate isolated hydrocephalus and corpus callosum agenesis. Sub-ependymal nodules were depicted in a case of fetal tuberous sclerosis. One suspected arachnoid cyst was proved to be an ultrasound artefact. Decreased fetal fat on MR images was correlated with low birth weight in cases of IUGR. Due to its better spatial resolution, ultrasonography was more accurate for the diagnosis of facial and lumbar anomalies. Fetal MRI may be performed without curarization. Surface coils allow the detailed analysis of brain parenchyma, and thus MRI is especially useful in the difficult prenatal diagnosis of fetal brain abnormalities.     

Conservative management of extra-uterine pregnancy

Expectant management was studied in 35 patients representing 4.9% of all ectopic pregnancies during an 8 year period. Laparoscopy was performed in a first period to define the inclusion criteria: hematosalpinx < or = 2 cm and hemoperitoneum < or = 50 ml. In a second period, inclusion criteria used a predictive pretherapeutic score < or = 11 with a sonographic visualization of the ectopic pregnancy. This score involved six criteria graded on a scale from 1 to 3: gestational age, hCG and P level, existence of abdominal pain, size of hemoperitoneum and diameter of hematosalpinx assessed sonographically. The patients were on out-patients basis. Success rate was 85.7% (30/35 patients). When the pretherapeutic score was < or = 11 and the initial hCG level < 1,000 mUl/ml the success rate increased to 96%. Thirteen patients (87%) had patent tubes evaluated by hysterosalpingography on the side of the ectopic pregnancy. Twelve patients delivered one miscarriage occurred and none ectopic pregnancy was observed. Expectant management is a useful form of treatment for ectopic pregnancy in selected cases.     

Communication Patterns in Construction at Construction Manager Level

The procurement process of construction projects has been affected by developments in the field of Information Technology, as well as by the need to cope with growing technological challenges stemming from the integration of multiple building systems into tall and complex buildings. Furthermore, since the procurement phases are undertaken simultaneously, project complexity is increased, and increased integration among them is therefore required. These constraints have made the management of complex construction projects less of an architectural and engineering issue and more of a managerial one. In turn, this has led to an increasing use of the “construction management” concept in the procurement process. This study focused on communications in construction management procurement of building and residential projects in Israel. Communications between the construction manager and the design team were found to be vital in ensuring adherence to project objectives. Communication means were classified as “formal”—written technical information, and as “informal”—verbal communications. Construction managers in Israel still use informal communications in 50% of their interactions with their project counterparts. The study concludes that design capabilities should be one of the essential qualifications required of a construction management firm. In addition to the more traditional responsibilities, such as planning, scheduling, and coordination, the scope of the construction manager’s professional duties should emphasize the aspect of quality management.     

Identification of polypeptides of the carbon metabolism machinery on the two-dimensional protein map of Saccharomyces cerevisiae. Location of 23 additional polypeptides

Using a modification of the basic two-dimensional polyacrylamide gel electrophoresis technique, we have undertaken a systematic identification of the polypeptides of the protein map of Saccharomyces cerevisiae corresponding to components of the carbon metabolism machinery. To the previous location of nine glycolytic enzyme polypeptides on the yeast protein map we add the location of 23 polypeptides. Ten of them were identified as corresponding to cytoplasmic enzymes of the carbon metabolism machinery and 13 were characterized as mitochondrial proteins. The criteria used to establish the identification of these polypeptides spots include migration with purified proteins, immunodetection, overproduction by plasmid–carrying strains and physiological behaviour.     

Enumeration of <Emphasis Type="Italic">Listeria monocytogenes</Emphasis> at Low Contamination Levels in Several Food Matrices Using a Membrane Filtration Method

For the enumeration of Listeria monocytogenes in cold-smoked salmon, a sensitive enumeration method, based on membrane filtration followed by transfer of the filter on a selective medium, has been recently developed. An evaluation of this method was performed with several categories of foods likely to be contaminated with L. monocytogenes. The results obtained with the technique were compared with those from the reference EN ISO 11290-2 method and found to provide more precise results in the enumeration of L. monocytogenes from both artificially and naturally contaminated products. In most cases, the filtration method enabled a greater quantity of food to be examined (from around 0.5 to 14 g, instead of 0.01 to 0.1 g with the reference EN ISO 11290-2 method), thus greatly improving the sensitivity of the enumeration.