First trimester termination of pregnancy: methods in comparison between two European university hospitals.

PURPOSE OF INVESTIGATION: To compare methods, epidemiological features, and legislations of first trimester termination of pregnancy in two European Union University Hospital: Szeged, Hungary, (UHS) and Rome, Italy (UHR). MATERIALS AND METHODS: The study included 195 women in UHS and 197 women in UHR undergoing a termination of pregnancy, The method used in UHR was electric vacuum aspiration, while in UHS it is chosen according to the patients' features. RESULTS: Mean gestational week at the time of interruption was 8.21 ± 0.12 SD for UHS and 9.00 ± 0.08 SD for UHR (p = 0.000 1). Previous artificial termination of pregnancy was 0.40 ± 0.05 SD for UHR, and 0.77 ± 0.07 SD for UHS (p = 0.0001). Foreign women were 32.5% in UHR and 0.5% in UHS. Incidence of side effects was 1% for UHS and 0.5% for UHR. Parity was 2.54 ± 0.12 SD for UHR and 3.00 ± 0.14 SD for UHS (p = 0.01). CONCLUSIONS: The methods for interruption resulted safe and effective. Antibiotic prophylaxis, routinely provided in UHR, turned out to be effective to pre- vent post-operative infections. Cervical priming with Laminaria is safe, but patient's hospitalization is required. Different legislations may account for some epidemiological differences between the two hospitals.

Optimization of two-photon wave function in parametric down conversion by adaptive optics control of the pump radiation.

We present an efficient method for optimizing the spatial profile of entangled-photon wave function produced in a spontaneous parametric down conversion process. A deformable mirror that modifies a wavefront of a 404 nm CW diode laser pump interacting with a nonlinear ß-barium borate type-I crystal effectively controls the profile of the joint biphoton function. The use of a feedback signal extracted from the biphoton coincidence rate is used to achieve the optimal wavefront shape. The optimization of the two-photon coupling into two, single spatial modes for correlated detection is used for a practical demonstration of this physical principle.

The Combined therapy myo-inositol plus D-Chiro-inositol, in a physiological ratio, reduces the cardiovascular risk by improving the lipid profile in PCOS patients.

BACKGROUND: Women with Polycystic Ovarian Syndrome (PCOS) present several factors that increase the cardiovascular risk, such as insulin resistance and dyslipidemia. Myo-inositol and D-chiro-inositol have been shown to improve insulin resistance, hyperandrogenism and to induce ovulation in PCOS women. However, their effects on dyslipidemia are less clear. The aim of the present study was to evaluate whether the combined therapy myo-inositol plus D-chiro-inositol (in a in a physiological ratio of 40:1) improve the metabolic profile, therefore, reducing cardiovascular risk in PCOS patients. PATIENTS AND METHODS: Twenty obese PCOS patients [BMI 33.7 ± 6 kg/m2 (mean ± SD)] were recruited. The lipid profile was assessed by measuring total cholesterol, LDL, HDL and triglycerides before and after 6 months treatment with the combined therapy. Secondary end points included changes in BMI, waist-hip ratio, percentage of body fat, HOMA-IR and blood pressure. RESULTS: The combined therapy myo-inositol and D-chiro-inositol improved LDL levels (3.50 ± 0.8 mmol/L versus, 3 ± 1.2 mmol/L p < 0.05), HDL (1.1 mmol/L ± 0.3 versus 1.6 mmol/L ± 0.4 p < 0.05) and triglycerides (2.3 ± 1.5 mmol/L versus 1.75 ± 1.9 mmol/L p < 0.05). Furthermore, significant improvements in HOMA-IR were also observed. CONCLUSIONS: The combined therapy myo-inositol plus D-chiro-inositol is able to improve the metabolic profile of PCOS women, therefore, reducing the cardiovascular risk.

Hereditary haemorragic teleangectasia and pregnancy: case report.

We report an uncommon case of a 38-years-old pregnant woman affected by HHT (Hereditary haemorrhagic telangiectasia; Osler-Weber-Rendu syndrome) who underwent to a caesarean section (CS) without any complication. The patient at 36th weeks+1 day pregnancy referred to the Emergency Obstetric Unit due to a intercostals pain on left side. On third day after admission the woman started travailing and physicians decided to perform the CS. Considering that no AVMs was found at MRI, a continuous spinal anaesthesia was planned. On postpartum day 4 the patient was discharged. This represents the only case published in the literature. Women with HHT, especially those with arteriovenous malformations (AVM), are at high risk in pregnancy due to physiological haemodynamic changes pregnancy associated. Early screening of patients with HHT for the presence of spinal cord or cerebral AVMs is recommended to optimise perioperative anaesthetic management and to avoid severe complications.

Effective analysis of rotundone at below-threshold levels in red and white wines using solid-phase microextraction gas chromatography/tandem mass spectrometry.

Rotundone is an oxygenated sesquiterpene belonging to the family of guaianes, giving the 'peppery' aroma to white and black pepper and to red wines. Here we describe a novel, convenient protocol for the synthesis of rotundone, starting from a commercially available compound and requiring only two reaction steps, and an improved, faster method of GC separation (30 min) with selective quantisation of rotundone using tandem mass spectrometry in multiple reaction monitoring (MRM) mode with d(5)-rotundone as internal standard. With limits of detection (LODs) of 1.5 ng/L in white wine and 2.0 ng/L in red wine, intraday repeatability CV values of 6% and 5% at 50 ng/L and 500 ng/L and interday repeatability CV values of 13% and 6% at 50 ng/L and 500 ng/L, respectively, the improved protocol provides the desired sensitivity and selectivity for routine analysis of rotundone in both white and red wines. Initial application of this method highlighted the presence of unexpectedly high concentrations of rotundone, thus explaining the origin of the distinctive peppery aroma in Schioppettino and Vespolina red wines and in Gruener Veltliner white wines.

Stomatological approach to Sjögren's syndrome: diagnosis, management and therapeutical timing.

Sjögren's syndrome is a chronic multisystem autoimmune disease characterized by the exocrine glands inflammation, with subsequent hypofunction. More frequently lachrymal and salivary glands are interested with subsequent xerophthalmia and xerostomia. Sjögren's syndrome can be present in an idiopathic type or in association with other autoimmune diseases as rheumatoid arthritis, systemic lupus erythematosus, schlerodermia, etc. It interests mainly the women (with a ratio F:M=9:1) with an age between 40 and 60 years old. The disease prevalence varies from 0.4% to 4.8%. The glandular lesions determine in the time a volume reduction and a secretum quality alteration. The most frequent oral manifestations are xerostomia, that allows the establishment of caries, gingivitises, periodontal disease and oral candidiasis. The aim of this work was to perform a thorough review of the literature on Sjögren's syndrome, illustrating the most internationally accredited diagnostic criteria, the patient's management and therapeutical approach in the odontostomatological discipline. The Authors conclude that it doesn't exist a resolutive treatment of the disease. The therapy is only palliative, and is turned to the treatment of xerostomia and xerophthalmia, through systemic and aspecific sialogogues drugs. From the odontostomatological point of view, particularly useful results the domiciliary and professional oral hygiene to contrast the xerostomia effect on the oral structures.

Treatment of hirsutism with myo-inositol: a prospective clinical study.

The aim of this study was to evaluate the effects of myo-inositol treatment in hirsute women; changes in lipid pattern and insulin sensitivity were also considered. Forty-six hirsute women were enrolled at the first Institute of Obstetrics and Gynecology and evaluated at baseline and after receiving myo-inositol therapy for 6 months. Body mass index (BMI), hirsutism, serum concentrations of total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, triglycerides, apolipoprotein B, lipoprotein(a), serum adrenal and ovarian androgens, fasting glucose and insulin concentrations were evaluated. No changes in BMI were observed. The hirsutism decreased after therapy (P < 0.001). Total androgens, FSH and LH concentrations decreased while oestradiol concentrations increased. There was a slight non-significant decrease in total cholesterol concentrations, an increase in HDL cholesterol concentrations and a decrease in LDL cholesterol concentrations. No significant changes were observed in serum triglyceride, apolipoprotein B and lipoprotein(a) concentrations. Insulin resistance (P < 0.01), analysed by homeostasis model assessment, was reduced significantly after therapy. Administration of oral myo-inositol significantly reduced hirsutism and hyperandrogenism and ameliorated the abnormal metabolic profile of women with hirsutism.

The efficacy and safety of a single dose of polyhexamethylene biguanide gynaecologic solution versus a seven-dose regimen of vaginal clindamycin cream in patients with bacterial vaginosis.

OBJECTIVE: At the present the clinical treatment of choice of bacterial vaginosis (BV) is the use of systemic or local metronidazole or clindamycin. Aim of the study was to evaluate the efficacy and tolerability of a single dose of gynaecologic solution, Polyhexamethylene Biguanide (PHMB), Monogin, in the treatment of BV in comparison to a 7-days treatment with clindamycin vaginal cream. STUDY DESIGN: This multicenter, randomized, single-blind, parallel-group study enrolled 740 patients with BV infections. Treatment consisted of either a single intravaginal dose of PHMB or 7 daily doses of Clindamycin. Efficacy and safety were assessed 21-30 days after the start of treatment. The efficacy endpoints were Investigator Cure, Clinical Cure (a composite of all 4 Amsel's criteria and investigator Cure), Nugent Cure (Nugent score < 4), and therapeutic cure (a composite of clinical cure and Nugent Cure). Resolution of individual Amsel's criteria was also evaluated. Any adverse event of the treatment has been monitored throughout the study. RESULTS: No significant differences has been reported in cure rates between the PHMB and Clindamycin treatment groups in Investigator Cure (P = 0.702), Clinical Cure (P = 0.945), Nugent Cure (P = 0.788), or Therapeutic Cure (P = 0.572). Results were also similar for 3 of 4 and 2 of 4 Amsel's criteria and for each individual Amsel's criterion (all P-values > 0.200). Ninety-five percent confidence intervals for each endpoint were consistent with equivalence between the 2 products. There was no significant difference between the treatment groups in the incidence of treatment-emergent adverse events (P = 0.386). CONCLUSIONS: A single dose, of PHMB gynaecologic solution (Monogin) is equivalent in safety and efficacy to a 7-dose regimen of Clindamycin vaginal cream in the treatment of bacterial vaginosis. Futhermore the compliance as been reported to be higher for the single-dose treatment with PHMB than with 7-days treatment with Clindamycin.

Odontostomatological approach to the pregnant patient.

Pregnancy is a condition characterized by various physiological modifications (placentary and ovarian hormones release) that influence various organic districts, including the oral district. In this review were re-examined the rules about the execution of dental services with the relative indications and contraindications during the different phases of pregnancy, the use of the ionizing radiations and the pharmacologic therapy during pregnancy, considering the metabolic, anatomical haemodinamic modifications to which the gestant is exposed during this condition and considering the various parameters related to it: the pharmacokinetic modifications, the drug toxicity based on its teratogenic potential, indications, side effects and specific effects of drugs administrated, the toxicological aspects of dental amalgams and the use of the local anaesthetics during pregnancy. The authors conclude that pregnancy is not a contraindication for the dental treatment and existing an increase of oral diseases, the woman must be exposed to more frequent controls.

Spinodal of supercooled polarizable water.

We develop a series of molecular dynamics computer simulations of liquid water, performed with a polarizable potential model, to calculate the spinodal line and the curve of maximum density inside the metastable supercooled region. After analyzing the structural properties, the liquid spinodal line is followed down to T=210K . A monotonic decrease is found in the explored region. The curve of maximum density bends on approaching the spinodal line. These results, in agreement with similar studies on nonpolarizable models of water, are consistent with the existence of a second critical point for water.

Beneficial effects of low doses of ethinyl-estradiol on the lipid profile in postmenopausal women.

The purpose of this study was to investigate the beneficial effects of low doses of ethinyl-estradiol on the lipid profile in postmenopausal women. One hundred and five patients (mean age [+/-S D] 42.9 +/- 5.0 years) who underwent a hysterectomy and bilateral salpingo-oophorectomy were included in the study. For the present study serum levels of total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, triglycerides, apolipoprotein B (apoB), and lipoprotein(a) [Lp(a)] were investigated. When all patients were considered together (Table 1), EE2 therapy significantly increased serum levels of total cholesterol, HDL cholesterol and LDL cholesterol. The ratio of HDL to LDL cholesterol, Lp(a) and triglyceride concentrations did not change significantly from the baseline value. Although our study was not randomized or controlled with a placebo, the beneficial metabolic effects of ethinyl-estradiol on lipid patterns should be considered in patients needing hormonal replacement therapy in postmenopause.

Cascade radical reaction of 2-alkynyl-substituted aryl radicals with aryl isothiocyanates: a novel entry to benzothieno[2,3-b]quinolines through alpha-(Arylsulfanyl)imidoyl radicals.

The novel cascade radical reaction of 2-(phenylalkynyl)aryl radicals with 4-Y-phenyl isothiocyanates (Y = H, OMe, Me, Cl, CN) provides a useful one-pot protocol for the production of 8-Y-substituted (12) and/or 9-Y-substituted benzothieno[2,3-b]quinolines (11). The whole process entails primary formation of an alpha-(2-alkynylarylsulfanyl)imidoyl radical that undergoes smooth 5-exo-dig cyclization onto the alkynyl triple bond. The derived 1-phenylvinyl radical then exhibits six-membered cyclization onto the isothiocyanate ring, to give 11, and/or five-membered ipso-cyclization to an azaspiro intermediate, whose eventual rearrangement affords 12. The overall findings clearly showed that the relative proportion of the outcoming isomeric benzothienoquinolines 11 and 12 can be markedly affected by the nature of the original isothiocyanate substituent. Moreover, the findings also furnished the first chemical evidence that enhancing the electrophilic power of the employed radical can properly enhance the reactivity of aryl radicals toward isothiocyanates.

Bone mass density in post-menopausal women.

OBJECTIVES: To evaluate the effect of age, years since menopause and body weight on bone mass density (BMD) in 283 patients. METHODS: Bone mass density was assessed by bone computerized mineralometry at two sites of the forearm. RESULTS: The mean distal BMD and ultra BMD in the postmenopausal group were negatively correlated with age (P < 0.001, r = -0.48 and P < 0.001, r = -0.50, respectively) and years since menopause (P < 0.001, r = -0.32 and P < 0.001, r = -0.33, respectively). When body-mass index was regressed against distal and ultra distal BMD, positive correlations were found (P = 0.008 and P = 0.007). CONCLUSIONS: From our data, forearm computerized mineralometry seems to be a reliable method for the evaluation of the effects of age and body-mass index on bone mass.

Efficacy and tolerability of brodimoprim at two different dosage schedules in the treatment of acute uncomplicated bacterial cystitis: comparative study vs. pefloxacin.

In an open study, 172 male and female adult patients with acute uncomplicated bacterial cystitis were randomly allocated to three treatment groups. Two groups received brodimoprim 200 mg tablets as follows: a single dose of two 200 mg tablets on day 1, followed by one tablet per day on days 2 and 3 (58 patients); or a single daily dose of two tablets, for 2 days (63 patients). The third group received a single dose of pefloxacin, as two 400 mg tablets, for 1 day (51 patients). Complete urinalysis, sediment and urine culture examinations were carried out before treatment and 10 days after the last dose. Evaluation also comprised, at the time of enrolment and 48 h after the last dose, measurement of corporal temperature and assessment of symptoms (dysuria, pollakiuria, strangury, suprapubic pain, burning sensation during urination and urgency) on a 4-point scale. The eradication rate for the pathogen concerned was 98.3% and 96.7% in the groups receiving brodimoprim for 3 and 2 days, respectively, and 92.8% in the pefloxacin group (between-group comparison n.s.). There was significant regression of symptoms (P < 0.001) in the three groups (between-groups comparison n.s.). Mainly gastrointestinal adverse events occurred in 3 patients receiving brodimoprim for 2 days and in 4 patients from each of the other two groups.

Nausea, vomiting and thyroid function before and after induced abortion in normal pregnancy.

Thyroid function in early pregnancy has been reported to be slightly different from that in second or third trimester. We assessed thyroid function before and after induced abortion in normal pregnant women. A significant increase in serum Free T4 and a decrease in serum TSH were observed before abortion and these changes, apart from the contemporary significance of serum hCG-beta, were especially marked in pregnant women with nausea and vomiting. On the other hand, an increased level of Free T4 and a reduced level of TSH returned to the normal ranges 7-10 days after induced abortion. Furthermore, serum hCG-beta was significantly reduced. These results suggest that, in normal early pregnancy, thyroid function may be related to serum hCG-beta concentration and its increased level, which induces gestational emesis.

PIP: At the Institutes of Gynecology and Obstetrics of the University of Rome (La Sapienza), Italy, serum levels of free thyroxine (FT4), FT3, thyroid stimulating hormone (TSH), and the beta subunit of human chorionic gonadotropin (hCG-beta) were compared before and 7-10 days after induced abortion in 19 normal women in their first trimester of pregnancy. The women were divided into those with nausea and vomiting (7) and those without these symptoms (12). The aim was to distinguish slight transient hyperthyroidism associated with nausea and vomiting in normal early pregnancy with pre-existing thyrotoxicosis or hyperemesis gravidarum. In both groups of women, serum hCG-beta levels were significantly lower 7-10 days after the induced abortion than before (p 0.01) while serum TSH levels were significantly higher (p 0.02). The serum levels of FT4 were higher before than after abortion in both groups of women, but were significantly so in women with nausea and vomiting (p 0.001). After induced abortion, serum levels of FT4 and TSH returned to normal levels. Earlier research found that hCG peaks at 10-13 weeks gestation and decreases to a stable level by 20 weeks gestation and that hCG is associated with thyroid hormone levels. This study's findings support those of earlier research since women in the nausea and vomiting group had higher levels of FT4 and hCG-beta and lower levels of TSH before the induced abortion than after it. Perhaps, hCG physiologically activates the thyroid gland in early pregnancy, which may in turn induce vomiting during early pregnancy.

The influence of obesity in the sexual life of women in menopause. A case control study.

It seemed important to us to investigate sexuality during the post-menopausal and senile period to evaluate whether changes in sexual behaviour are related with endocrine-functional alterations brought on by menopause, or whether social-economic and environmental factors represent the principal cause. Thus 1,500 questionnaires were distributed to women aged from 50 to 87. Of the 1,500 questionnaires distributed, only 713 (47.53%) were returned completely filled-in. All women had been classified for age, civil status and life environment. Our statistic analysis does not seem to have singled out those factors that influence sexual activity in women of advanced age but shows only how age, indifferently from civil status and life environment, represents the most important factor. At the same age other factors, probably attached to psychological features and way of life and thus difficult to define and even less qualifiable, may be of influence, explaining a further percentage of control of those answers not explainable by age.

Parkinsonian serum carries complement-dependent toxicity for rat mesencephalic dopaminergic neurons in culture.

The presence of antibodies recognizing specific epitopes of dopaminergic neurons in serum of patients suffering of Parkinson's Disease (PD) as well as their capability to induce neuronal damage was investigated utilizing serum-free dissociated mesencephalic-striatal co-cultures. High affinity dopamine (DA) and GABA uptakes were assessed as specific, functional markers of dopaminergic and GABAergic cell viability, respectively. Heat-inactivated serum samples from 18 and 13 patients suffering from idiopathic and vascular parkinsonism, respectively and from 18 neurologic controls, were added to co-cultures on day 4 in vitro. Twenty four hours later, reconstituted rabbit complement was added for 60 min and uptake parameters as well as immunocytochemical staining for tyrosine hydroxylase (TH)-containing cells were subsequently assessed. DA, but not GABA, uptake was significantly decreased only when complement was added to cultures containing serum samples from 14 out of 18 patients with idiopathic parkinsonism and 3 out of 13 patients with vascular parkinsonism (Fisher test, P < 0.01). Complement addition to cultures containing serum samples from seropositive parkinsonian patients significantly reduced immunocytochemical staining of TH-containing cells. Seropositive and seronegative patients did not differ in demographic and clinical features. These results suggest that a complement-dependent humoral immune response occurs mainly in idiopathic parkinsonian patients, but its clinical relevance remains to be established.

CA-125 and uterine leiomyomas.

CA-125, in the past considered as marker of ovarian neoplasms, has been proven to be useful successively in several obstetric-gynecologic physiopathologic conditions (Endometriosis, beginning pregnancy, PID), united by the common characteristic of peritoneal involvement. Such evidence has suggested us to search possible correlations with uterine leiomyomatosis disease, which for its frequency has the character of a social disease. Our findings would justify the clinical use of this marker in the first screening of fibromiomas, but above all, its diagnostic utility in evolutive aspects of such pathology.

Interaction of ganglioside GM1 with the B subunit of cholera toxin modulates intracellular free calcium in sensory neurons.

The B subunit of cholera toxin, which binds specifically to GM1 ganglioside on cell surfaces, has previously been shown to modulate intracellular calcium levels and growth in several cell types. To explore a role for such changes in calcium in the growth regulatory function of cell-associated GM1 in neurons, dissociated neurons from chicken embryonic day 8 dorsal root ganglia were exposed to the B subunit. To enhance sensitivity to B subunit, some neurons were also enriched with added GM1 (100 microM) and then exposed to B subunit. Incubation of naive cultures with 1 microgram/ml of the B subunit was sufficient to produce modest increases in intracellular free calcium above basal levels in a minor percentage of cells for at least 5 min, as measured by fura-2 fluorescence imaging. Pretreatment of the cells with GM1 for 48 hr increased even further the elevations in intracellular free calcium and the percentage of responding neurons observed after B subunit exposure. These increases in intracellular calcium required the presence of external Ca2+, but were not inhibited by calcium channel blockers. Such changes in calcium were accompanied by fine alterations in morphology affecting mostly the branching of neurites and were more pronounced in the presence of GM1. However, the morphological changes did not result in altered neurofilament protein expression. Immunogold electron microscopy using anti-choleragenoid depicted extensive aggregations of immunoreactive gold particles on neuronal surfaces, which were more extensive in cells treated with GM1. The results demonstrate that cell incorporated GM1 may modulate calcium fluxes, perhaps accounting for the growth regulatory functions of GM1 in both neuronal and other cell types.