[Prelabour Rupture of Membranes at Term: In- or Outpatient Management? A Survey in Birth Institutions in the German-Speaking Part of Switzerland]. / Vorzeitiger spontaner Blasensprung am Termin: Hospitalisation oder ambulantes Management? Eine Erhebung in Deutschschweizer Geburtsinstitutionen.

Approximately 8-10% of pregnant women experience prelabour rupture of membranes at term (tPROM). The ideal timing to induce labour as a means to shorten the time interval to birth and thus to reduce maternal and neonatal risk of infection is a controversial topic. A distinction is made between an active and an expectant approach. There is little evidence comparing in- and outpatient management in the expectant approach. The goal of this investigation was to determine the current management approach in birth institutions in the German-speaking part of Switzerland. In this cross-sectional study, a self-designed online questionnaire was distributed to obstetricians and midwives in leading positions at all obstetric institutions in Switzerland. Outcome measures were: the currently offered approach at tPROM, experience with outpatient expectant management and the willingness to introduce outpatient management as an option for pregnant women. From a total of n=85 Swiss German birth institutions, n=47 (55%) responded to the questionnaire. 53% (n=25) provide outpatient expectant management. The women's satisfaction was seen as a decisive advantage. The respondents furthermore ascribed advantages for maternal outcome but no advantage for fetal outcome. 73% (n=16) of respondents working in institutions that hospitalize exclusively stated their willingness to introduce outpatient management provided that there was evidence of maternal and fetal outcome and that expectant mothers were satisfied. The number of birth institutions offering outpatient management is surprisingly high. In future studies examining general management at tPROM, the question of outpatient management should be included. Even though this survey seems to justify outpatient management under strict quality control conditions, prospective studies to assess safety issues are urgently needed.

[Traumatic abruption of the placenta with disseminated intravascular coagulation]. / Traumatische plazentalösung mit disseminierter intravasaler gerinnung.

Trauma in pregnancy is infrequent and a systematic primary strategy constitutes a real challenge for the interdisciplinary team. With a high fetal mortality rate and a substantial maternal mortality rate traumatic placental abruption is a severe emergency which every anesthetist should be aware of. After hemodynamic stabilization of the mother and control of the viability of the fetus the therapy of traumatic placental abruption consists mostly of an immediate caesarean section. Coagulopathy by depletion of coagulation factors as well as disseminated intravascular coagulation (DIC) have to be expected and consequently a massive blood loss must be anticipated. Thrombelastography provides assistance for fast differential diagnosis and goal-directed treatment of the disturbed sections of the coagulation cascade.

[Antibiotics: drug and food interactions]. / Antibiothérapie: interactions médicamenteuses et alimentaires.

Antibiotics are widely prescribed in medical practice. Many of them induce or are subject to interactions that may diminish their anti-infectious efficiency or elicit toxic effects. Food intake can influence the effectiveness of an antibiotic. Certain antibiotics can lower the effectiveness of oral contraception. Oral anticoagulation can be influenced to a great extent by antibiotics and controls are necessary. Interactions are also possible via enzymatic induction or inhibition of cytochromes. The use of an interaction list with substrates of cytochromes enables to anticipate. Every new prescription should consider a possible drug or food interaction.

Occurrence of exercise dependence in a college-aged population.

Students (n = 257) were evaluated for scope and commitment to physical activity by use of self-reported data that assessed amount of activity per week and the obligatory or pathological nature of their activity patterns. Exhibiting atypical activity patterns, 21.8% of the students in the sample exercised 360 or more minutes per week and demonstrated at least one exercise "dependent" response pattern to queries about obligatory or pathological exercise. Although clinicians and educators should promote the many advantages of regular participation in physical activity, they should acknowledge that, for some, it may have undesirable consequences that occur at a frequency parallel to other age-related negative behaviors.

Elevation in erythroblast count in maternal blood before the onset of preeclampsia.

OBJECTIVE: We recently showed that both maternal and fetal erythroblast counts are elevated in the peripheral blood of pregnant women with preeclampsia. The purpose of this study was to examine whether this elevation actually occurs before the clinical onset of the disorder. STUDY DESIGN: Erythroblasts were enriched and enumerated in 97 maternal blood samples obtained in the second trimester, and results were subsequently correlated with pregnancy outcomes. RESULTS: Significantly higher quantities of erythroblasts (mean, 6041.7 vs 928.9; P =.008) were detected in blood samples obtained from women who later acquired preeclampsia (n = 15) than in blood samples from the control cohort (n = 72). Intrauterine growth restriction (n = 10) was not accompanied by a similar rise in erythroblast count. CONCLUSION: Because a large proportion of the erythroblasts in maternal blood are fetal, our data suggest that fetal-maternal cell traffic is affected early in pregnancies that are later complicated by preeclampsia but not in those affected only by intrauterine growth restriction.

Dissection of a nuclear localization signal.

The regulated process of protein import into the nucleus of a eukaryotic cell is mediated by specific nuclear localization signals (NLSs) that are recognized by protein import receptors. This study seeks to decipher the energetic details of NLS recognition by the receptor importin alpha through quantitative analysis of variant NLSs. The relative importance of each residue in two monopartite NLS sequences was determined using an alanine scanning approach. These measurements yield an energetic definition of a monopartite NLS sequence where a required lysine residue is followed by two other basic residues in the sequence K(K/R)X(K/R). In addition, the energetic contributions of the second basic cluster in a bipartite NLS ( approximately 3 kcal/mol) as well as the energy of inhibition of the importin alpha importin beta-binding domain ( approximately 3 kcal/mol) were also measured. These data allow the generation of an energetic scale of nuclear localization sequences based on a peptide's affinity for the importin alpha-importin beta complex. On this scale, a functional NLS has a binding constant of approximately 10 nm, whereas a nonfunctional NLS has a 100-fold weaker affinity of 1 microm. Further correlation between the current in vitro data and in vivo function will provide the foundation for a comprehensive quantitative model of protein import.

Structural requirements for the specific recognition of an m7G mRNA cap.

7-Methylguanosine (m(7)G), also known as the mRNA "cap", is used as a molecular tag in eukaryotic cells to mark the 5' end of messenger RNAs. The mRNA cap is required for several key events in gene expression in which the m(7)G moiety is specifically recognized by cellular proteins. The configurations of the m(7)G-binding pockets of a cellular (eIF4E) and a viral (VP39) cap-binding protein have been determined by X-ray crystallography. The binding energy has been hypothesized to result from a pi-pi stacking interaction between aromatic residues sandwiching the m(7)G base in addition to hydrogen bonds between the base and acidic protein side chains. To further understand the structural requirements for the specific recognition of an m(7)G mRNA cap, we determined the effects of amino acid substitutions in eIF4E and VP39 cap-binding sites on their affinity for m(7)GDP. The requirements for residues suggested to pi-pi stack and hydrogen bond with the m(7)G base were examined in each protein by measuring their affinities for m(7)GDP by fluorimetry. The results suggest that both eIF4E and VP39 require a complicated pattern of both orientation and identity of the stacking aromatic residues to permit the selective binding of m(7)GDP.

Quantitative analysis of nuclear localization signal (NLS)-importin alpha interaction through fluorescence depolarization. Evidence for auto-inhibitory regulation of NLS binding.

We have developed a quantitative in vitro steady-state fluorescence depolarization assay to measure the interaction of a nuclear localization signal (NLS) substrate with its receptors. This assay relies on the change in fluorescence depolarization of an NLS fused to the green fluorescent protein upon binding to receptor. No binding is observed in the absence of a functional NLS, and binding affinities measured correlate with previous in vivo studies of NLS function. We have used this assay to test an auto-inhibitory model for the interaction of an NLS with the NLS receptor complex. This model suggests that NLS binding to importin alpha is modulated by an auto-inhibitory sequence within the N terminus of importin alpha, which is displaced by importin beta binding. Consistent with this model, NLS substrates bind tightly to an N-terminally truncated importin alpha lacking the auto-inhibitory domain (K(d) approximately 10 nm), but measurable binding to full-length importin alpha is only observed upon addition of importin beta. Our quantitative results support the auto-inhibitory model and suggest a mechanism for a switch between a cytoplasmic, high affinity and a nuclear, low affinity NLS receptor. This predicted mode of interaction would facilitate binding of substrate in the cytoplasm and its subsequent release into the nucleus.

Age dependency of ABO histo-blood group antibodies: reexamination of an old dogma.

Current textbooks for transfusion medicine state that anti-A and/or anti-B (anti-A/B) agglutination titers--and thus the respective antibody concentrations--reach their maximum in individuals 5 to 10 years old and then gradually decline with the increasing age of the individual. This statement is largely based on a study by Thomsen and Kettel that dates to 1929. In the present article, ABO antibodies in sera of 175 healthy persons aged 61 to 97 years, as well as sera of 170 newborn infants and children aged 0 to 17 years, were analyzed. Microhemagglutination tests were performed with all sera and complemented by ABO enzyme-linked immunosorbent assays to measure the immunoglobulin class (IgM, IgG, and IgA) of the anti-A/B. As in a previous study using sera of persons aged 20 to 67 years, individual differences exceeded age-related changes for all variables. Median values of IgG and IgA anti-A/B were elevated in elderly persons of blood group O, whereas no significant changes were observed in other variables. In particular, the decrease in agglutination titers with the increasing age of the individuals was far less pronounced than previously described; even in sera of persons aged 90 to 97 years, median agglutination titers of 128 were found. Results in the sera of children confirm previously reported data that agglutination titers and IgM anti-A/B reached adult levels at the age of 5 to 10 years.