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Effect of small doses of aspirin and acetaminophen on total menstrual loss and pain of cramps and headache.

90 women participated in a 4-month study. During the first 2 periods, they took no pain relievers whatsoever; during their last 2 periods they took 2 X 325 mg aspirin, acetaminophen or an identically packaged placebo every 4 h to total 8 tablets during the first 24 h of their periods beginning with spotting. For statistical analysis, periods 1 and 2 were combined and averaged, then compared with periods 3 and 4 combined and averaged. Total menstrual loss in grams, number of days of flow, and pain of cramps and headaches were analyzed by MANOVA for each of the three treatment groups. An ANOVA for each of these variables as well as for daily menstrual loss for the first 3 menstrual days was also performed. The MANOVA for all variables by the three treatment groups failed to show any significant differences. Similarly, ANOVAs for the individual variables failed to indicate significant differences except for the variable pain of cramps (p = 0.0072). The Duncan's Multiple Range Test for pain of cramps showed that the average pain for the placebo group was higher than for either the aspirin or the acetaminophen group, although the means for these two groups were not significantly different. These results indicate that neither aspirin nor acetaminophen in the doses given alter either total menstrual loss or the pattern of loss during the first 3 menstrual days. However, both preparations were found to be more effective than placebo in reducing pain of cramps.

Acetaminophen↗

Modification of stool content by increased bran intake.

Six healthy subjects, four males and two females, were studied for 8 weeks with daily dietary history, 72-hr weekly stool collections, and analysis of stool specimens for fecal weight, water, pH, and total aerobic and anaerobic qualitative and quantitative bacteria. Subjects were studied first for a 3-week control period, followed by 3 weeks of 5.4 g of crude fiber supplementation daily (Kellogg's "All Bran"), and then by a 2-week control period. Analysis of diets revealed that the mean intake of crude fiber rose to at least 10 g/day, and stool volume increased significantly during the high-fiber intake. The stools remained at the same pH, and the same percentages of water and solids were present durin- control and high-fiber-intake periods. Bacteriological analysis revealed no significant differences in qualitative or quantitative counts; however, the ratio of anaerobic to aerobic organisms appeared to increase.

Adult↗

Power spectral analysis of heart period variability in hypertensive patients with left ventricular hypertrophy.

This study aimed to characterize sympathovagal balance by heart period power spectrum analysis in hypertensive patients with echocardiographic evidence of left ventricular hypertrophy. Twenty ambulatory patients (11 men and 9 women), aged 50 +/- 10 years, with established essential hypertension and echocardiographic left ventricular hypertrophy, performed 24-h blood pressure monitoring and electrocardiogram Holter recording on 2 consecutive days. Twenty age- and sex-matched normal subjects comprised the control group. Power spectrum analysis, performed using the fast Fourier transform algorithm, demonstrated lower values of low and high frequency power in hypertensives than in controls, while ultralow and very low frequency power were similar in the two groups. Very low frequency, low frequency, and high frequency power increased during the night in both groups, showing a similar circadian pattern. We found a direct correlation between daytime systolic (r = 0.51; P < .05) and diastolic (r = 0.52; P < .05) blood pressure and left ventricular mass index. Moreover, negative correlations were found between left ventricular mass index and low frequency (r = -0.47; P < .05) and high frequency power (r = -0.47; P < .05). There was a direct correlation between nighttime decrease in systolic blood pressure and nighttime increase in high frequency power (r = 0.45; P < .05). As 24-h low frequency and high frequency power, obtained using the Fourier transform algorithm, both reflect the parasympathetic modulation of heart rate, our results demonstrate that hypertensive patients with left ventricular hypertrophy are characterized by a sympathovagal imbalance with a reduction of vagal tone that is more evident with increasing severity of hypertension.

Blood Pressure↗

Structural studies on the O-antigen of Aeromonas salmonicida.

Lipopolysaccharide from a strain of Aeromonas salmonicida salmonicida was isolated from cells by the aqueous phenol method in 2.3% yield (based on dry weight of bacteria). Hydrolysis of the lipopolysaccharide in 1% acetic acid afforded O-polysaccharide (19% by weight), core-oligosaccharide (12.2%) and lipid A (44.6%). Analysis indicated that 3-deoxy-D-manno-2-octulosonic acid was absent from the lipopolysaccharide and that no low-molecular-weight compounds were released by the mild hydrolysis. The O-polysaccharide had the monosaccharide composition of rhamnose, glucose and N-acetylmannosamine in molar ratio of 1.0:1.58:0.83. 75% of the N-acetylmannosamine residues were substituted at position 4 by O-acetyl groups. Hydrolysis of the methylated polysaccharide proved to be both difficult and dependent on the method of hydrolysis chosen, in all cases a partially methylated disaccharide of rhamnose and N-acetylmannosamine was identified in the hydrolysate. Methylation analysis, periodate oxidation and proton magnetic resonance analysis were used to confirm the structure of the repeating unit as: (formula; see text).

Aeromonas↗

[Chemical studies on polysaccharide of Achyeanthes bidentata].

A peptide-polysaccharide, ABAB showing immunological activity was isolated from Achyeanthes bidentata Bl. It was shown to be homogeneous by HPLC and optical rotation analysis. Its molecular weight was estimated to be 2.3 x 10(4). It composed of D-glucuronic acid, D-galactose, D-galacturonic acid, L-arabinose and L-rhamnose in molar ratio of 12:2:3:1:1. Reduction of carboxyl groups, methylation analysis, periodate oxidation, Smith degradation and IR analysis showed that ABAB possesses a main chain composed of (1----4)-D-glucuronic acid and (1----4)-D-galacturonic acid residues. The non-reducing terminal residues in the side chains were L-arabinose and L-rhamnose. ABAB contained 24.1% of peptides composed of glycine, glutamic acid, aspartic acid and serine.

Drugs, Chinese Herbal↗

Gold therapy in rheumatoid arthritis. Interim report of the Canadian multicenter prospective trial comparing sodium aurothiomalate and auranofin.

One hundred and twelve patients with classical or definite rheumatoid arthritis (RA) were randomly assigned to receive either sodium aurothiomalate (GSTM) or auranofin (AF). Monthly clinical assessments (morning stiffness, grip strength, articular index, pain, quality of life) and concurrent hematological, biochemical, and urine studies were performed to monitor the efficacy/toxicity (E/T) ratio. Ninety-two patients have completed 3 months; 65, 6 months; 47, 9 months; and 30, 12 months. The groups were numerically balanced at each time period. Analysis of the 0-6 month period suggests that both drugs were equally and significantly beneficial after 3 months and that this was maintained at 6 months. Toxicity was as frequent in both groups but more serious in the GSTM group. The main side effects were gastrointestinal (diarrhea) in the AF group and mucocutaneous in the GSTM group. Half of the withdrawals (14 in each group) were because of side effects in the GSTM group and for inadequate therapeutic efficacy in the AF group. This study suggests that after 6 months of treatment the E/T ratio of AF is greater than or equal to that of GSTM. These conclusions will need to be confirmed during the ongoing longer observation period. A significant clinical difference between the 2 drugs is that in a given patient treated with GSTM, the onset of toxicity coincides with a good therapeutic effect. This relationship does not appear to exist during AF treatment.

Arthritis, Rheumatoid↗

Continuous collection of pulse oximetry data: a new, inexpensive, portable computerized method.

The availability of reliable pulse oximetry equipment has led to interest in identifying patterns of hypoxaemia in the postoperative period. Methods for the computerized collection and analysis of pulse oximetry data have been described, but these require continuous use of a relatively powerful computer system throughout both the monitoring (data collection) and analysis periods. We have designed a technique which uses a small, portable and relatively inexpensive computer unit for data collection, after which the data may be transferred to a more powerful computer for analysis. Appropriate programming and choice of software have produced a relatively "user friendly" system which can be operated successfully even with minimal computing experience. The unit has the potential to be modified to form the basis of a "medical advice system" which could be used for the "intelligent" monitoring of high risk patients.

Humans↗

Delayed childbearing in Canada: trends and factors.

"Using period and cohort birth order statistics, an overview of the phenomenon of delayed childbearing in Canada is presented. Data employed in the period analysis were mainly from the years 1944 to 1985, while women born between the years 1935 and 1960 were the subjects of the cohort analysis. An examination of selected indices, namely, age-specific first-birth fertility rates, median ages of women at first-order birth and cumulative first-order birth rates shows that there is an overall trend for women to postpone the initiation of childbearing until late twenties or early thirties.... The results indicate that work experience, education, occupation and year of marriage are important variables influencing age at first birth and first-birth interval." (SUMMARY IN FRE AND ITA)

Age Factors↗

Evidence against transmission of Hodgkin's disease in high schools.

A survey in Greater Boston identified 1577 new cases of histologically diagnosed Hodgkin's disease between 1959 and 1973. Of these cases, 448 were of ages such that the patients might have attended high school during 1960-73. For 96 per cent of these persons high-school attendance was ascertained. First of all, we studied Hodgkin's disease at high schools in two time periods. The 13 high schools with cases present in 1960-64 were matched with 26 schools that had no cases in this period, and we compared these two groups for the occurrence of Hodgkin's disease during 1965-69. The proportion of "exposed" high schools that had cases diagnosed in the second period was 0.62, and that for the matched high schools was 0.65. We performed this two-time-period analysis for 25 additional combinations of time periods; in none of them did we find a statistically significant positive result. Secondly, we studied the risk of Hodgkin's disease among persons who had attended high school at the same time as a diagnosed case. We followed these "exposed" persons through 1973 and observed 12 cases among them, whereas the expected number of cases was 13.9. Thirdly, we evaluated the extent to which members of all possible pairs of cases had attended the same or nearby high schools at the same time. We found no excess of classmate pairs than might have occurred by chance alone. These data suggest that there is no transmission of an etiologic agent for Hodgkin's disease at high schools.

Adult↗

Structures of O-linked oligosaccharides present in the proteoglycans secreted by human mammary epithelial cells.

The structures of O-glycosidically linked oligosaccharides present in the heparan sulfate and chondroitin sulfate proteoglycans isolated from the culture medium of a normal (HBL-100) and a malignant (MDA-MB-231) human mammary epithelial cell line have been determined. Both proteoglycan types from the two cell lines contain a series of O-linked oligosaccharides ranging in size from di- to hexasaccharide. Cells were grown in the presence of either [3H]glucosamine or [3H]galactose and Na2 35SO4, and the proteoglycans were isolated as described (Gowda, D. C., Bhavanandan, V. P., and Davidson, E. A. (1986) J. Biol. Chem. 261, 4926-4934). The O-linked oligosaccharides were released from the proteoglycans by alkaline borohydride treatment and purified by a combination of gel filtration and high voltage paper electrophoresis. The structures of two neutral and seven acidic oligosaccharides were established based on sugar composition, the results of periodate oxidation, sequential exoglycosidase treatment, and methylation analysis. Periodate oxidation, taking advantage of tritium label at specific positions of constituent sugars, proved to be a valuable tool in establishing the structure of isomeric components in the mixture. The structures of the oligosaccharides were assigned as follows: (Formula: see text) The oligosaccharide containing both sialic acid and ester sulfate is novel and has not been reported previously.

Adenocarcinoma↗

A profile of the female cycle length.

"This study suggests some points of view about the menstrual cycle length. In the first part aggregate indicators of cycle characteristics are computed for various types of data aggregations.... In the second part, the period analysis and the consequent estimated spectral density functions are applied to the basal body temperature series." Data are for 1,798 women in London, England. (SUMMARY IN ITA)

Biology↗

Surgical treatment of hilar bile duct carcinoma: experience with 25 consecutive hepatectomies.

To evaluate our recent surgical policy regarding hilar bile duct carcinoma, we evaluated 62 cases treated between 1976 and 1993, and 25 cases treated between 1994 and 2000. In the late period we used percutaneous transhepatic portal vein embolization (PTPE) before extended right hepatectomy; S4a + S5 + S1 hepatectomy for elderly patients and those with poor liver function; and routine total caudate lobectomy including the paracaval portion and resection of the inferior portion of the medial segment (S4a). Sixty-five (74.7%) of the 87 patients underwent hepatectomy: 40 in the early period and 25 in the late period. Bile duct resection alone was performed in 22 patients, all in the early period. Resection was curative in 54.8% in the early period and 88.0% in the late period. The 3- and 5-year survival rates in the early period were 27.1% and 20.2%, respectively, as compared to 59.9% and 49.9% in the late period. Analysis of the 25 hepatectomies in the late period revealed improved survival times compared to patients treated by PTPE with extended right hepatectomy. No complications occurred after extended left hepatectomy or S4a + S5 + S1 hepatectomy, but four patients (16%) who underwent extended right hepatectomy plus PTPE died postoperatively. Our policy has resulted in improved outcome in patients with hilar bile duct carcinoma.

Adult↗

[Carotid sinus syndrome: diagnosis, treatment and complications].

Continuous electrocardiostimulation was applied in 33 patients with the carotid sinus syndrome. Neither fatal outcomes nor complications occurred in the hospital period. Analysis of complications in the late-term period (follow-up from one to 22 months) allowed the conclusion that physiological stimulation of the heart (in the AAI regimen) is the optimal method for the treatment of the cardioinhibitory form of the syndrome. The management of the mixed form is still disputable.

Adult↗

Stillbirths in the United States, 1981-2000: an age, period, and cohort analysis.

OBJECTIVES: We examined age, period, and cohort (APC) effects on temporal trends in stillbirths among Black and White women in the United States. METHODS: We conducted a cohort study of Black and White women who delivered a singleton live-born or stillborn infant during 1981 through 2000. We analyzed stillbirth rates at 20 or more weeks of gestation within 7 age groups, 4 periods, and 10 "central" birth cohorts after adjusting for confounders. RESULTS: In both racial groups, women younger than 20 years or 35 years or older were at increased risk of stillbirth; risks decreased over successive periods in all age groups. Birth cohort had no impact on stillbirth trends among Blacks and only a small, nonsignificant effect among Whites. Analyses of various APC combinations showed that Blacks were at a 1.2- to 2.9-fold increased risk for stillbirth relative to Whites. Attributable fractions for stillbirth because of age, period, and cohort effects were 16.5%, 24.9%, and 0.1%, respectively, among Black women and 14.5%, 36.2%, and 2.1%, respectively, among White women. CONCLUSIONS: Strong effects of age and period were observed in stillbirth trends, but these factors do not explain the persistent stillbirth disparity between Black and White women.

Adolescent↗

The impact of unstable angina guidelines in the triage of emergency department patients with possible acute coronary syndrome.

OBJECTIVE: The primary aim of this study is to determine whether implementing the Agency for Health Care Policy and Research (AHCPR) Unstable Angina Practice Guideline improves emergency physician's decision making in patients with symptoms of possible acute coronary syndrome (ACS), including those for whom the diagnosis of unstable angina is uncertain. METHODS: The authors conducted a prospective guideline implementation trial with pre-post design in the emergency departments of 1 university hospital and 1 university-affiliated community teaching hospital from January 2000 to May 2001. They enrolled 1140 adults who presented with chest pain or other symptoms of possible ACS. The intervention included the following: 1) physician training in use of the AHCPR risk groups, 2) algorithm for risk stratification, and 3) group feedback. To determine how accurately physicians interpreted the guideline algorithm, the authors compared their risk ratings with actual guideline risk groups. RESULTS: No significant difference in physician triage decisions was observed between baseline and intervention periods. Analysis of physician's risk ratings during the intervention period revealed low overall concordance with actual guideline risk groups (kappa = 0.31); however, physician's risk ratings showed superior discrimination in identifying patients with confirmed ACS (receiver operating characteristic [ROC] area .81 v. .74, P = 0.008). Strict adherence to guideline recommendations would have resulted in hospitalizing 9% more non-ACS patients without lowering the rate of missed ACS. CONCLUSION: Implementation of the AHCPR guideline did not improve triage decisions in emergency department patients with possible ACS. Assessing physician triage solely based on concordance with the AHCPR guideline may not accurately reflect the quality of patient care.

Adult↗

No improvement in long-term liver transplant graft survival in the last decade: an analysis of the UNOS data.

We analyzed change in outcomes during two successive 5-year periods (period I = 1992-1996 vs period II = 1997-2002) among 35 186 deceased adult liver transplant recipients reported to the United Network for Organ Sharing (UNOS) Registry. The 5-year graft survival was 67.4% in the first period and 67.5% in the second, though the 1-year survival had improved from 81.0 to 83.5%. Comparison of blended survival rates during the two study periods showed decreased long-term graft survival in period II, explicable by an increased number of hepatitis C virus cirrhosis (HCV) patients and an increase in patients with HCV antibodies (HCVab) during this later period. Analysis wherein these patients with HCV were excluded revealed the same long-term graft survival during both periods. Non-HCV patients who had HCVab also had worse 5-year graft survival. We conclude that hepatitis C prevented improved outcomes during period II and that improved, more effective, treatment for hepatitis C virus would have great positive impact on overall survival of liver transplant recipients.

Follow-Up Studies↗

[A study of the Edinburgh Postnatal Depression Scale (EPDS) on 859 mothers: detection of mothers at risk for postpartum depression].

The postpartum is a high-risk period for the occurrence of anxious and depressive episodes. Indeed, during the first few days after delivery, mothers can present postpartum blues symptomatology: fatigue, anxiety, disordered sleeping and a changing mood. Postpartum depression is characterised by a changing mood, anxiety, irritability, depression, panic and obsessional phenomena. It occurs in approximately 10 to 20% mothers. The exact prevalence depending on the criteria used for detection. The first symptoms usually appear between the fourth and sixth week postpartum. However, postpartum depression can start from the moment of birth, or may result from depression evolving continuously since pregnancy. We can add that the intensity of postpartum blues is a risk factor that can perturb maternal development. So it is important for health professionals to dispose of predictive tools. This study is a validation of the French version of the EPDS. The aims of the study were to evaluate the postpartum depression predictive value at 3 days postpartum and to determine a cut-off score for major depression. Subjects participating in this study were met in 3 obstetrical clinics in, or in the vicinity of, Toulouse. Mothers with psychological problems, under treatment for psychological problems or mothers whose babies present serious health problems were excluded from the study. The EPDS was presented to 859 mothers (mean age=30.3; SD=4.5) met at one of the clinics at 3 days postpartum (period 1). They had an EPDS mean score of 6.4 (SD=4.6); 258 (30%) mothers had an EPDS score 9. 82.6% of these mothers experienced a natural childbirth and 17.3% a caesarean section; 51.5% gave birth to their first child, 36.2% to their second child and 12.3% to their third or more. All subjects were given a second EPDS with written instructions to complete the scale during the period 4 to 6 weeks postpartum and return it for analysis (period 2). Between the 4 to 6 weeks postpartum period, 722 mothers replied again to the EPDS. 131 mothers had an EPDS score 11 (mean age=30.3; SD=4.8). They had an EPDS mean score of 13.6 (SD=3.3). Mothers with probable depression were interviewed and assessed, using the Mini (Mini Neuropsychiatric Interview, Lecrubier et al. 1997), the SIGH-D (Structured Interview Guide for the Hamilton Depression Scale) and the BDI (Beck Depression Inventory) in order to diagnose a major depressive episode. They had a HDRS mean score of 13.7 (SD=5.1) and a BDI mean score of 13.6 (SD=5). At 3 days postpartum, we observed that 258 mothers (30%) had an EPDS scores 9 and 164 mothers (19%) had an EPDS scores 11. Between 4 and 6 weeks postpartum, we observed 18.1% of postpartum depression (EPDS 11) and 16.8% (EPDS 12) of major postpartum depression. The analysis of the sensitivity and the specificity at 3 days postpartum provides a cut-off score of 9 (Sensibility: 0.88) (Specificity: 0.50) as predictive of postpartum depression, for this cut-off score, the type I error is low (5.8%) but the type II error is more higher (18.9%). The analysis of the sensitivity and the specificity between 4 and 6 weeks postpartum provides a cut-off score of 12 (Sensibility: 0.91) (Sensibility: 0.74) for the detection of major postpartum depression. Factor analysis shows at 3 days postpartum that the internal structure of the scale is composed of two subscales. The first factor F1 "anxiety" accounts 28% of the variance and the second factor F2 "depression" accounts 20% of the variance. Between 4 and 6 weeks postpartum, factor analysis suggests an unidimensional model in the evaluation of postpartum depression which is better than a two factor model. This factor accounts 40% of the variance. The scale has a good predictive value, and we can observe a significant correlation with the EPDS periods 1 and 2 (r=0.56; p<0.05). This result shows that the depressive mothers mood intensity predicts a future depressive risk. Furthermore, correlations between EPDS and BDI (r=0.68; p<0.05) and EPDS and HDRS (r=0.67; p<0.05) show a good convergent validity. The reliability study confirms the good internal consistency of the EPDS, at 3 days postpartum and in the postpartum depression -symptomatology evaluation (Cronbach's Alpha>0.80). In conclusion, this scale demonstrates good validity and is fast and easy use in obstetrical services, allowing early detection of women who risk to develop postpartum depression and, in the first week of postpartum, of mothers who suffer from a major postpartum depression. The use of the EPDS for an early screening of the risk of postnatal depression which is essential considering the consequences that postnatal depression can have on the development of the infant, on the quality of the relationship within the couple and on other social relationships. Mothers at risk for postnatal depression should be controlled and surveyed by the health professionals in obstetrical clinics.

Adult↗