Contractile changes of the clitoral cavernous smooth muscle in female rabbits with experimentally induced overactive bladder

INTRODUCTION: Recently, growing clinical evidence has suggested that sexual dysfunction is more prevalent in women with overactive bladder (OAB). Aims. However, there has been no basic research to clarify the relationship between OAB and female sexual dysfunction. Therefore, we investigated this issue using a rabbit model of OAB. METHODS: Twenty-seven New Zealand white female rabbits were randomly divided into the OAB and control groups. MAIN OUTCOME MEASURES: The contractile responses of clitoral cavernous strips to K(+), phenylephrine (PE), Bay K 8644, and endothelin (ET)-1, and the relaxation responses of acetylcholine (ACh), sodium nitroprusside (SNP), and Y-27632 to PE-induced contraction by measuring isometric tension. Results. The contractile responses to K(+), PE, Bay K 8644, and ET-1 were significantly more increased in the OAB group in a dose-dependant manner than in the control group (P < 0.05), and the responses to ET-1 were more prominent than those to the remaining substances (P < 0.01). The increased contractile responses to ET-1 were blocked by BQ123 (ET(A) receptor antagonist) but not by BQ788 (ET(B) receptor antagonist). Clitoral cavernosal strips from the OAB group were more difficult to relax than those from the control group in terms of ACh- and SNP-induced relaxation (P < 0.05). The Y-27632-induced relaxant responses to PE- and ET-1-induced contraction were less prominent in the OAB group than in the control group. CONCLUSIONS; The results of this study provide evidence that female OAB may deteriorate clitoral engorgement, which is associated with a greater force generation by increased calcium sensitization and subsequently decreased of relaxation. The activation of ET and Rho-kinase system may be crucial to negatively effect the clitoral smooth muscle relaxation in experimentally induced OAB animal model. But whether these vasomotor effects are revived in human clitoris is still debatable.     

Host-parasite interactions during pregnancy.

The point that host defense against infectious disease is exceedingly complex scarcely needs further emphasis. We have tried to show that pregnancy is a state which has the potential for altering any of the many facets of host defense, and in some instances presented evidence that pregnancy does alter resistance to infection. Some diseases are either more severe during pregnancy or more prevalent during pregnancy, suggesting a softening of the host defenses. However, both monocytic and polymorphonuclear leucocyte phagocytic systems seem to be more active during pregnancy. Transferrin is increased in pregnancy. The immune system in pregnancy is either normal or slightly depressed. A number of other factors have been mentioned for which no information exists as to the effect pregnancy has on them. Despite the information reviewed, it is not possible to say that pregnancy has a net positive or negative effect on host defense; the effect, if any, depends ostensibly on the disease entity. That the host defenses may be somewhat enhanced by pregnancy while susceptibility to certain diseases is increased is paradoxical and serves to underscore the fact that our understanding of host defense in pregnancy is abysmally deficient. Probably no concept is made more clear by this paper than the idea that in the area of host defense in pregnancy there is as much space as any researcher may choose to fill.     

Sialates and negative charge on the surface of syncytiotrophoblastic cells of full-term placentae in toxemic patients

In the syncytiotrophoblastic surface of the toxemic full-term placentae, the sialates and their consequent negative charging were studied by both electron microscopic histochemistry (Ferritin method) and Western blot analysis. Evidence is presented showing (1) that the reactions with both the ferritin labelled Limulus Polyphemus Agglutinin (LPA-ferritin), specific to sialates, and the cationized ferritin, specific to a negative charge, decrease in the specimens of toxemic placentae, (2) that the density of sialates in placentae of severe gestational proteinuria or/and hypertension is statistically lower than that of severe gestational edema, and (3) that there is no difference between the blotted bands in normal placentae and toxemic ones regardless of the severity of the toxemia. These results indicate that the reduction of the surface negative charging is demonstrated in toxemic syncytiotrophoblasts and appears to be secondary to the decrease in the amount of sialate.     

Patients with psychiatric disorders in gynecologic practice--a three year follow-up

OBJECTIVE: Patients with depressive disorders are commonly encountered in gynecologic practice. The prevalence rates for depressive disorders have been reported to vary between 10 and 40% among patients consulting their gynecologist. The purpose of the current study was to study health care utilization by patients with a psychiatric disorder in the gynecologic setting during a three-year period after the initial diagnosis of depression and/or anxiety. STUDY DESIGN: In 1998 all scheduled and walk-in patients, at two gynecologic centers in northern Sweden during one month, were screened for prevalence of depression and anxiety disorders using the PRIME-MD system. Medical records for the period 16 December 1998 to 31 December 2001 have been reviewed. RESULTS: Patients diagnosed with any anxiety disorder made significantly more appointments to the gynecologist and were acutely hospitalized more often than control subjects. Both patients with any depressive or any anxiety diagnosis made significantly more visits to health care personnel other than the gynecologist and they received counseling by phone and/or letter significantly more often than patients in the control group. Furthermore, patients with depressive and/or anxiety diagnosis were also referred to other medical specialists more often than controls. CONCLUSION: The present study has indicated that gynecologic patients with depression and anxiety over a three-year follow-up period have an increased health care utilization with more frequent consultations and more frequent referrals.     

The involvement of the Toll-like receptor family in ovulation

INTRODUCTION: Ovulation is similar to an inflammatory response and is associated with increased production of prostaglandins as well as local growth regulatory factors. However, the expression and function of innate immune cell-related genes in non-immune cells within the ovary has been reported recently and provides a novel and important regulatory system during ovulation. DISCUSSION: Several members of the Toll-like receptor (TLR) surveillance system are expressed in granulosa cells and cumulus cells. These receptors can be activated by pathogens as well as endogenous ligands leading to the induction and release of potent cytokines and chemokines from cumulus cells. CONCLUSION: These inflammatory factors exert potent effects on cumulus cell-oocyte expansion, ovulation, transport and fertilization indicating that ovulation is a more complex immune-inflammatory process than previously recognized.     

Survival of younger cervical carcinoma patients treated by radical radiotherapy in the west of Scotland 1964-1984

Between 1964 and 1984, 2011 patients in the West of Scotland were treated by radical radiotherapy for carcinoma of cervix. In keeping with the rise in incidence amongst younger patients nationally, the number of women aged less than 35 years seen during the 20-year period has doubled. Younger women (aged less than 35 or less than 45) have a better prognosis mainly because more present with earlier disease. Stage for stage there has been no change in survival of women of all ages treated by identical radiotherapy during this period. The rise in mortality of younger patients from carcinoma of cervix may be due to the increased incidence of the condition rather than a more virulent form of the disease.     

Patients with psychiatric disorders in gynecologic practice—a three year follow-up

Objective.?Patients with depressive disorders are commonly encountered in gynecologic practice. The prevalence rates for depressive disorders have been reported to vary between 10 and 40% among patients consulting their gynecologist. The purpose of the current study was to study health care utilization by patients with a psychiatric disorder in the gynecologic setting during a three-year period after the initial diagnosis of depression and/or anxiety.

Study design.?In 1998 all scheduled and walk-in patients, at two gynecologic centers in northern Sweden during one month, were screened for prevalence of depression and anxiety disorders using the PRIME-MD system. Medical records for the period 16 December 1998 to 31 December 2001 have been reviewed.

Results.?Patients diagnosed with any anxiety disorder made significantly more appointments to the gynecologist and were acutely hospitalized more often than control subjects. Both patients with any depressive or any anxiety diagnosis made significantly more visits to health care personnel other than the gynecologist and they received counseling by phone and/or letter significantly more often than patients in the control group. Furthermore, patients with depressive and/or anxiety diagnosis were also referred to other medical specialists more often than controls.

Conclusion.?The present study has indicated that gynecologic patients with depression and anxiety over a three-year follow-up period have an increased health care utilization with more frequent consultations and more frequent referrals.     

妊娠滋养细胞肿瘤临床分期与预后评分系统应用及其争议

国际妇产科联盟(FIGO)于2000年审定并通过了妊娠滋养细胞肿瘤的临床分期及预后评分标准,该文主要介绍了其分期、预后评分系统及在临床中的应用价值,以及该分期、预后评分系统在临床应用中存在争议的问题。     

A comparative study of methods of oxytocin administration for induction of labour

Summary. Equipment has become available for the automatic infusion of oxytocin in a closed loop system for the induction of labour. This system was compared with manual administration of oxytocin by peristaltic infusion pump, the dosage being based on data derived from an intrauterine catheter or by clinical assessment of uterine activity. A total of 121 patients classified according to parity and cervical score were allocated to an automatic infusion system (AIS) or a peristaltic infusion pump system. Patient characteristics were similar in both groups. Labour was significantly longer in those induced by automatic infusion system particularly in nulliparae and patients with poor cervical scores. In 53.3% of the nulliparae with poor cervical scores the automatic infusion system proved inadequate to effect vaginal delivery. Neonatal outcome was similar in both groups. Automatic infusion of oxytocin by the present system increased the length of induced labour and had no statistically significant effect on neonatal outcome, conferring no advantage over a more traditional method of oxytocin administration.     

A comparative study of methods of oxytocin administration for induction of labour

Equipment has become available for the automatic infusion of oxytocin in a closed loop system for the induction of labour. This system was compared with manual administration of oxytocin by peristaltic infusion pump, the dosage being based on data derived from an intrauterine catheter or by clinical assessment of uterine activity. A total of 121 patients classified according to parity and cervical score were allocated to an automatic infusion system (AIS) or a peristaltic infusion pump system. Patient characteristics were similar in both groups. Labour was significantly longer in those induced by automatic infusion system particularly in nulliparae and patients with poor cervical scores. In 53.3% of the nulliparae with poor cervical scores the automatic infusion system proved inadequate to effect vaginal delivery. Neonatal outcome was similar in both groups. Automatic infusion of oxytocin by the present system increased the length of induced labour and had no statistically significant effect on neonatal outcome, conferring no advantage over a more traditional method of oxytocin administration.     

U.S. national trends in labor induction, 1989-1998

OBJECTIVE: To examine the epidemiology of labor induction in the United States. STUDY DESIGN: We used U.S. natality data from 1989 to 1998 and examined the rate of labor induction by year, geographic region, maternal characteristics and pregnancy complications. RESULTS: Between 1990 and 1998, the rate of labor induction increased from 9.5% to 19.4% of all births nationwide. However, the induction rate varied widely by state. White race, higher education and early initiation of prenatal care were associated with a higher rate of induction. For all gestational ages, a significantly increased induction rate occurred during the study period. The increase for clinically indicated induction was significantly slower than the overall increase, suggesting that elective induction has risen much more rapidly. CONCLUSION: The rate of induction of labor more than doubled in the U.S. nationwide in the decade from 1989 to 1998. The increased use of labor induction may be attributable to both clinically indicated and elective induction.     

The immune system and aging: a review

The concept of immunosenescence reflects age-related changes in immune responses, both cellular and serological, affecting the process of generating specific responses to foreign and self-antigens. The decline of the immune system with age is reflected in the increased susceptibility to infectious diseases, poorer response to vaccination, increased prevalence of cancer, autoimmune and other chronic diseases. Both innate and adaptive immune responses are affected by the aging process; however, the adaptive response seems to be more affected by the age-related changes in the immune system. Additionally, aged individuals tend to present a chronic low-grade inflammatory state that has been implicated in the pathogenesis of many age-related diseases (atherosclerosis, Alzheimer's disease, osteoporosis and diabetes). However, some individuals arrive to advanced ages without any major health problems, referred to as healthy aging. The immune system dysfunction seems to be somehow mitigated in this population, probably due to genetic and environmental factors yet to be described. In this review, an attempt is made to summarize the current knowledge on how the immune system is affected by the aging process.     

IVF results: optimize not maximize

The desire to improve in vitro fertilization (IVF) results has led clinicians to replace more than 1 embryo in the uterus. As a result, multiple births have increased over the last 2 decades to epidemic proportions, exposing the field of assisted conception to justified criticism. This review aims to ensure that physicians involved in the field of fertility treatment are aware of the risks and complications related to multiple pregnancies, and to explore possible strategies such as blastocyst culture, preimplantation genetic screening, and embryo cryopreservation, which can help to control and reverse the tide of multiple pregnancies without reducing the good success rate that modern IVF treatment enjoys. A brief overview of the respective UK legislative system is also presented.     

Estimation of fetal lung volume using enhanced 3-dimensional ultrasound: a new method and first result

Objective To measure fetal lung volume using a computer based, enhanced, 3-dimensional ultrasound imaging system.
Design An observational study.
Setting The Fetal Medicine Unit at Guys Hospital, London.
Participants Twenty healthy women with a singleton pregnancy between 24 and 36 weeks of gestation were scanned on one occasion during pregnancy using an ultrasound based 3-dimensional imaging system. All delivered at term with weights above the 10th centile for gestation.
Results Total lung volume increased exponentially with gestational age. Right lung volume measured consistently greater than left lung volume.
Conclusions The use of this new enhanced 3-dimensional imaging system allows for estimations of fetal lung volume. Preliminary data confirm that fetal lung volume, measured by a computerised 3-dimensional ultrasound imaging system increased exponentially with gestational age. The use of this system has obvious application in the further study of lung growth in utero and possible clinical application in disease states where fetal lung growth may be impaired.     

Investigating the relationship between affluence and elective caesarean sections

The proportion of women delivering by caesarean section has increased dramatically in England and many westernised countries. It has been suggested that one important reason for this increase is the growing proportion of women opting for elective caesareans for lifestyle reasons, a trend that is, it is argued, most common among the affluent. We investigated the hypothesis that affluent women are more likely to deliver by elective caesarean section. Logistic regression modelling was used to analyse data from half a million women who delivered in English NHS hospitals between 1996 and 2000. We found that women living in the most affluent areas of England were significantly more likely to have an elective caesarean section than their deprived counterparts.     

Survival of younger cervical carcinoma patients treated by radical radiotherapy in the West of Scotland 1964–1984

Summary. Between 1964 and 1984, 2011 patients in the West of Scotland were treated by radical radiotherapy for carcinoma of cervix. In keeping with the rise in incidence amongst younger patients nationally, the number of women aged <35 years seen during the 20-year period has doubled. Younger women (aged <35 or <45) have a better prognosis mainly because more present with earlier disease. Stage for stage there has been no change in survival of women of all ages treated by identical radiotherapy during this period. The rise in mortality of younger patients from carcinoma of cervix may be due to the increased incidence of the condition rather than a more virulent form of the disease.     

Certified nurse midwife-attended births: trends in Washington State, 1995-2004

Nationwide, the proportion of certified nurse-midwife (CNM)-attended births has increased steadily. We examined trends in CNM-attended singleton spontaneous vaginal births between 1995 and 2004 in Washington State by site of birth, payer source, and hospital birth volume. CNMs were more likely than other providers to care for women at risk for adverse outcomes based on several sociodemographic indicators. The increased rate of CNM-attended births occurred primarily in hospitals and among both Medicaid- and privately-funded births. The rate of CNM-attended births doubled in hospitals with high birth volumes. We recommend future research designed to understand these trends.     

Antigens of the HLA system in women with vulvar lichen sclerosus. Association with HLA-B21

The cause of vulvar lichen sclerosus (VLS) is unknown. An autoimmune origin has been suggested. The HLA system is responsible for the synthesis of major histocompatibility antigens and is considered a genetic marker of the risk of or resistance to some diseases. Recently, the association between some antigens of the HLA system and diseases of proven autoimmune origin has been reported. A possible association between antigens of the HLA system and VLS has been investigated by others, with contradictory results. Here we report the results of HLA typing in 68 women with histologically proven VLS. The following antigens were tested: A1, A2, A3, A9-11, A28, A29, A32, B5, B7, B8, B12-B18, B21, B22, B27, B35, B40, Cw1-4, Dr1-5 and Dr7. The results were compared with the frequency of HLA antigens in about 2,000 controls. Patients affected by VLS showed an increased frequency of HLA-B21 (22.06% vs. 9.56%, P less than .001), HLA-Dr5 (55.38% vs. 40.92%, P less than .025) and HLA-Dr7 (38.46% vs. 25.19%, P less than .025). After correction for the number of antigens tested (44) the difference in HLA-B21 frequency was significant at the P less than .05 level. This finding gives further support to the suggestion that an immune system disorder is involved in the origin of VLS.     

Vitrifikation

After more than three decades of in vitro fertilization (IVF), the multistep procedure that includes stimulation, embryo culture, and ultrasound-guided embryo transfer has proceeded to a highly sophisticated technique with more reliable and consistent outcome data than before. In contrast, cryopreservation has taken a backseat because the results achieved with slow-freezing protocols were low, less reliable, and inconsistent and especially for oocytes it provided an unacceptably low outcome. That changed dramatically with the introduction of vitrification in 1985. Vitrification protocols appear to be safe, relatively simple for the practitioner by their easy assimilation into an IVF laboratory, potentially faster, and inexpensive. Vitrification has now replaced slow-freezing protocols for oocytes and embryos. For example, for the blastocyst stage, vitrification is effective in achieving high implantation and pregnancy rates as seen with fresh embryo transfers. With the increased use of vitrification in human-assisted reproduction, higher levels of clinical efficiency, utilization, and universal acceptance are to be expected.     

Do obstetric intranatal interventions make birth safer?

Summary. Impartial analyses of the evidence from official statistics, national surveys and specific studies consistently find that perinatal mortality is much higher, when obstetric intranatal interventions are used, as in consultant hospitals, than when they are little used, as in unattached general practitioner maternity units and at home. The conclusion holds even after allowance has been made for the higher predelivery risk status of hospital births as a result of the booking and transfer policies. It holds even more strongly for births at high than at low predicted risk. It follows that the increased use of interventions, implied by increased hospitalization, could not have been the cause of the decline in the national perinatal mortality rate over the last 50 years and analysis of results by different methods confirms that the latter would have declined more in the absence of the former. Data are presented which point to the deleterious effect of interventions on the incidence of low birthweight and short gestation and their associated mortality. Also presented are data supporting the alternative explanation of the decline in perinatal mortality, namely the improvement in the health status of mothers built up over several generations. The organization of the maternity service stands indicted by the evidence. Despite the beliefs of those responsible, it has not promoted, and cannot promote, the objective of reducing perinatal mortality.