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Background A distal tibia osteochondral allograft is a potential graft option for glenoid reconstruction because the distal tibia may have a similar radius of curvature (ROC) as the glenoid. This study evaluated ROC mismatch as measured on computed tomography (CT) scans between the glenoid, distal tibia, and humeral head. Methods Bilateral CT images were formatted for 10 decedents from the Office of the Medical Investigator database, giving 20 specimens per anatomic location. The ROCs of the glenoid, distal tibia, and humeral head were measured. A statistical model was generated to assess ROC mismatch of randomly paired distal tibias and glenoids. Results The mean ± standard deviation ROC was 2.9 ± 0.25 cm for the glenoid, 2.3 ± 0.21 cm for the distal tibia, and 2.5 ± 0.12 cm for the humeral head. No differences were found in laterality, intraobserver, or interobserver measurements. The least-squares difference in the ROC between the glenoid and tibia was 0.57 cm, glenoid and humerus was 0.40 cm, and humerus and tibia was 0.17 cm. Only 22% of randomly paired distal tibias and glenoids had a difference in ROC of 0.3 cm or less. Conclusion CT measurement of the ROC of the glenoid, distal tibia, and humeral head is reliable and reproducible. The probability of obtaining a random distal tibia allograft with a similar ROC to the glenoid is low. Obtaining ROC measurements of the injured glenoid and the distal tibia allograft specimen before use for glenoid reconstruction may be useful. [ABSTRACT FROM AUTHOR]

Background Adrenal dysfunction is frequently reported in severe acute hepatitis using serum total cortisol. Aims Because 90% of serum cortisol is bound to proteins that are altered during stress, we investigated the effect of decreased cortisol-binding proteins on serum total and free cortisol in severe acute hepatitis. Methods 43 severe and 31 non-severe acute hepatitis and 29 healthy controls were enrolled consecutively and studied prospectively. Baseline (T 0 ) and cosyntropin-stimulated (T 60 ) serum total and free cortisol concentrations were measured. Results T 0 and T 60 serum total cortisol did not differ significantly between severe, non-severe hepatitis and healthy controls. Conversely, serum free cortisol (T 0 p = 0.012; T 60 p < 0.001) concentrations increased from healthy controls to severe hepatitis, accompanied by a decrease in corticosteroid-binding globulin and albumin (all p < 0.001). In acute hepatitis ( n = 74), patients with “low” corticosteroid-binding globulin (<28 mg/L) had higher T 0 serum free cortisol than others (103.1 [61.2–157] vs. 56.6 [43.6–81.9] nmol/L, p = 0.0024). Analysis of covariance showed that at equal concentration of total cortisol, the free cortisol concentration was significantly higher in severe than in non-severe hepatitis ( p < 0.001) or healthy controls ( p < 0.001). Conclusions In severe hepatitis, the decrease in cortisol-binding proteins impairs correct diagnosis of adrenal dysfunction. This could be corrected by measuring or estimating free cortisol. [ABSTRACT FROM AUTHOR]

Importance: The N-methyl-d-aspartic acid receptor hypofunction model of schizophrenia predicts a paradoxical increase in synaptic glutamate release. In vivo measurement of glutamatergic neurotransmission in humans is challenging, but glutamine, the principal metabolite of synaptic glutamate, can be quantified with proton magnetic resonance spectroscopy (1H-MRS). Although a few studies have measured glutamate, glutamine, and glutamine to glutamate ratio, it is not clear which of these 1H-MRS indices of glutamatergic neurotransmission is altered in schizophrenia.Objective: To examine glutamine, glutamate, and glutamine to glutamate ratio in the dorsal anterior cingulate, as well as their relationships with symptoms and cognition in schizophrenia.Design, Setting, and Participants: Cross-sectional design using 3-T 1H-MRS in participants recruited from university-based psychiatric outpatient clinics who underwent neuroimaging at an affiliated research facility. Participants were 84 patients with a DSM-IV-TR diagnosis of schizophrenia and 81 psychiatrically healthy volunteers, matched in age, sex, ethnicity, and occupational level to the head of household of family of origin.Main Outcomes and Measures: Glutamine, glutamate, and glutamine to glutamate ratio. Also symptoms and cognition.Results: Glutamine was increased in the schizophrenia group (P = .01) as well as the glutamine to glutamate ratio (P = .007) but not glutamate (P = .89). Glutamine levels were positively correlated with severity of psychotic symptoms (P = .02). Choline was also increased in schizophrenia (P = .002).Conclusions and Relevance: Elevated glutamine, which was directly related to psychotic symptoms, is consistent with increased glutamatergic synaptic release in schizophrenia, as predicted by the N-methyl-d-aspartic acid receptor hypofunction model. Further understanding the underlying mechanism of glutamatergic dysfunction in schizophrenia may lead to new pharmacological strategies to treat psychosis. [ABSTRACT FROM AUTHOR]

IMPORTANCE The N-methyl-D-aspartic acid receptor hypofunction model of schizophrenia predicts a paradoxical increase in synaptic glutamate release. In vivo measurement of glutamatergic neurotransmission in humans is challenging, but glutamine, the principal metabolite of synaptic glutamate, can be quantified with proton magnetic resonance spectroscopy (¹H-MRS). Although a few studies have measured glutamate, glutamine, and glutamine to glutamate ratio, it is not clear which of these ¹H-MRS indices of glutamatergic neurotransmission is altered in schizophrenia. OBJECTIVE To examine glutamine, glutamate, and glutamine to glutamate ratio in the dorsal anterior cingulate, as well as their relationships with symptoms and cognition in schizophrenia. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional design using 3-T ¹H-MRS in participants recruited from university-based psychiatric outpatient clinics who underwent neuroimaging at an affiliated research facility. Participants were 84 patients with a DSM-IV-TR diagnosis of schizophrenia and 81 psychiatrically healthy volunteers, matched in age, sex, ethnicity, and occupational level to the head of household of family of origin. MAIN OUTCOMES AND MEASURES Glutamine, glutamate, and glutamine to glutamate ratio. Also symptoms and cognition. RESULTS Glutamine was increased in the schizophrenia group (P = .01) as well as the glutamine to glutamate ratio (P = .007) but not glutamate (P = .89). Glutamine levels were positively correlated with severity of psychotic symptoms (P = .02). Choline was also increased in schizophrenia (P = .002). CONCLUSIONS AND RELEVANCE Elevated glutamine, which was directly related to psychotic symptoms, is consistent with increased glutamatergic synaptic release in schizophrenia, as predicted by the N-methyl-D-aspartic acid receptor hypofunction model. Further understanding the underlying mechanism of glutamatergic dysfunction in schizophrenia may lead to new pharmacological strategies to treat psychosis. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to determine whether Libman-Sacks endocarditis is a pathogenic factor for cerebrovascular disease (CVD) in systemic lupus erythematosus (SLE). Background: A cardioembolic pathogenesis of SLE CVD manifested as: 1) neuropsychiatric systemic lupus erythematosus (NPSLE), including stroke and transient ischemic attacks (TIA); 2) neurocognitive dysfunction; and 3) magnetic resonance imaging of focal brain lesions has not been established. Methods: A 6-year study of 30 patients with acute NPSLE (27 women, 38 ± 12 years of age), 46 age- and sex-matched SLE controls without NPSLE (42 women, 36 ± 12 years of age), and 26 age- and sex-matched healthy controls (22 women, 34 ± 11 years of age) who underwent clinical and laboratory evaluations, transesophageal echocardiography, carotid duplex ultrasound, transcranial Doppler ultrasound, neurocognitive testing, and brain magnetic resonance imaging/magnetic resonance angiography. Patients with NPSLE were re-evaluated after 4.5 months of therapy. All patients were followed clinically for a median of 52 months. Results: Libman-Sacks vegetations (87%), cerebromicroembolism (27% with 2.5 times more events per hour), neurocognitive dysfunction (60%), and cerebral infarcts (47%) were more common in NPSLE than in SLE (28%, 20%, 33%, and 0%) and healthy controls (8%, 0%, 4%, and 0%, respectively) (all p ≤ 0.009). Patients with vegetations had 3 times more cerebromicroemboli per hour, lower cerebral blood flow, more strokes/TIA and overall NPSLE events, neurocognitive dysfunction, cerebral infarcts, and brain lesion load than those without (all p ≤ 0.01). Libman-Sacks vegetations were independent risk factors of NPSLE (odds ratio [OR]: 13.4; p < 0.001), neurocognitive dysfunction (OR: 8.0; p = 0.01), brain lesions (OR: 5.6; p = 0.004), and all 3 outcomes combined (OR: 7.5; p < 0.001). Follow-up re-evaluations in 18 of 23 (78%) surviving patients with NPSLE demonstrated improvement of vegetations, microembolism, brain perfusion, neurocognitive dysfunction, and lesion load (all p ≤ 0.04). Finally, patients with vegetations had reduced event-free survival time to stroke/TIA, cognitive disability, or death (p = 0.007). Conclusions: The presence of Libman-Sacks endocarditis in patients with SLE was associated with a higher risk for embolic CVD. This suggests that Libman-Sacks endocarditis may be a source of cerebral emboli. [Copyright &y& Elsevier]

Abstract: Endometrial cancer is the most common malignancy of the female genital tract, and the incidence and mortality rates from this disease are increasing. Although endometrial carcinoma has been regarded as a tissue-specific disease mediated by female sex steroid pathways, considerable evidence implicates a role for an inflammatory response in the development and propagation of endometrial cancer. We hypothesized that if specific patterns of cytokine expression were found to be predictive of adverse outcome, then selective receptor targeting may be a therapeutic option. This study was therefore undertaken to determine the relationship between cytokine production in primary cell culture and clinical outcome in endometrial adenocarcinoma. Fresh endometrial tissues were fractionated into epithelial and stromal fractions and cultured. After 6–7 days, supernatants were collected and cells enumerated. Batched aliquots were assayed using ELISA kits specific for CSF-1, GMCSF, G-CSF, TNF-α, IL-6, IL-8, and VEGF. Data were compared using ANOVA, Fisher''s exact, and log rank tests. Increased epithelial VEGF production was observed more often in tumors with Type 2 variants (p = 0.039) and when GPR30 receptor expression was high (p = 0.038). Although increased stromal VEGF production was detected more often in grade 3 endometrioid tumors (p = 0.050), when EGFR expression was high (p = 0.003), and/or when ER/PR expression was low (p = 0.048), VEGF production did not correlated with overall survival (OS). Increased epithelial CSF-1 and TNF-α production, respectively, were observed more often in tumors with deep myometrial invasion (p = 0.014) and advanced stage (p = 0.018). Increased CSF-1 (89.5% vs. 42.9%, p = 0.032), TNF-α (88.9% vs. 42.9%, p = 0.032, and IL-6 (92.3% vs. 61.5%, p = 0.052) also correlated with low OS. In Cox multivariate models, CSF-1 was an independent predictor of low survival when stratified by grade (p = 0.046) and histology (p = 0.050), and TNF-α, when stratified by histology (p = 0.037). In this study, high CSF-1, TNF-α, and IL-6 production rates identified patients at greatest risk for death, and may signify patients likely to benefit from receptor-specific therapy. [Copyright &y& Elsevier]

This study investigated differences in visual perception and visual-motor based school functions in children with and without congenital hemiplegia. Twenty children with hemiplegia (9 right; 11 left) and 37 control children ages 4-10 years were compared using the Developmental Test of Visual Perception, Motor-Free Visual Perceptual Test-Revised and School Function Assessment subtests (Using Materials, Written Work). Children with hemiplegia attained significantly lower scores than controls on all measures by one-way ANOVAs. Children with left hemiplegia scored significantly lower on motor-free visual tests. Regression analyses identified visual measures predictive of school performance. Results will assist school-based therapists working with this population. [ABSTRACT FROM AUTHOR]

Background: Recently published evidence has identified thinner central corneal thickness (CCT) as a strong predictive factor for the conversion from ocular hypertension (OHT) to primary open-angle glaucoma (POAG). The association between CCT and development of normal-tension glaucoma (NTG), however, is less clear. Accordingly, we designed this cross-sectional study to further explore the relationship between CCT and NTG. Patients and methods: All patients with a clinical diagnosis of NTG and NTG suspect (NTGS) who were seen from September 2002 through May 2003 at the Albuquerque VA Medical Center eye clinic were identified retrospectively. After eligible subjects were categorized into no, mild, moderate, and advanced visual field loss groups, analysis of variance (ANOVA) and regression analyses were used to determine group differences for several IOP variables, several systemic variables, and CCT. Additional analyses were completed after eligible subjects were recategorized into thin, intermediate, and thick CCT groups. Results: Eighty-four eyes in 84 NTGS subjects and 56 eyes in 56 NTG subjects were studied. Mean CCT was significantly thicker in the no field loss group (NTGS) when compared with all 3 groups with glaucomatous visual field loss (NTG). In multivariate regression analysis, the association between CCT and the presence of NTG-related visual field loss was robust and independent. Conversely, no relationship was found between CCT and severity of NTG-related visual field loss. Conclusions: In eyes characterized by statistically normal intraocular pressure (IOP) measurements as measured by Goldmann applanation tonometry, we found a significant relationship between CCT and the presence, but not severity, of glaucomatous visual field loss. A prospective study is required to further explore and confirm these relationships. [Copyright &y& Elsevier]

Abstract: Background: Although the ability of central corneal thickness (CCT) to predict development of primary open-angle glaucoma has become increasingly well recognized, the ability of CCT to predict severity of glaucoma remains uncertain. This study was designed to expand the available knowledge about the relationship between CCT and glaucoma severity. Methods: Retrospective identification of all patients with a clinical diagnosis of either primary open angle glaucoma (POAG) or ocular hypertension who were seen from September 2002 through May 2003 at the Albuquerque VA Medical Center eye clinic was completed. Eligible subjects were segregated into no, mild, moderate, or advanced visual field loss groups based on Advanced Glaucoma Intervention Study (AGIS) visual field scoring criteria. Following statistical analyses comparing the visual field groups, the sample was divided into thin, intermediate, and thick CCT groups, and further analysis was performed. Results: Mean CCT was significantly higher in the no field loss group compared with all 3 groups with glaucomatous visual field loss. Mean CCT was not statistically different, however, between the mild, moderate, and advanced visual field loss groups. In linear regression analyses, no significant relationship was found between CCT and severity of visual field loss. Conclusions: Although CCT was associated strongly with development of POAG-related visual field loss, CCT was not associated with severity of visual field loss in this study. These findings suggest that glaucoma patients with thinner corneas are just as likely to have advanced levels of field loss as glaucoma patients with thicker corneas. Prospective studies are needed to validate these findings. [Copyright &y& Elsevier]

Objective: This survey was performed to examine the inclusion and extent of abortion education in US medical schools. Study design: A 3-item confidential survey requesting information about abortion education throughout the 4 years of medical school was mailed to the OB-GYN clerkship directors of the 126 accredited US medical schools. Results: Seventy-eight surveys were returned, for a response rate of 62%. Overall, 17% of clerkship directors reported no formal education about abortion either in the preclinical or clinical years. In the third-year OB-GYN rotation, 23% reported no formal education whereas 32% offered a lecture specifically about abortion. While 45% of third-year rotations offered a clinical experience, participation was generally low. About half of schools offered a fourth-year reproductive health elective, but few students participated. Conclusion: Abortion education is limited in US medical schools. As an integral part of women's reproductive health services, abortion education deserves a place in the curricula of all medical schools. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to assess sexual function in women after surgery for stress urinary incontinence and/or pelvic organ prolapse (UI/POP) at 3 and 6 months with the Pelvic Organ Prolapse Urinary Incontinence Sexual Questionnaire (PISQ). Study design: Of 269 eligible women participating in a trial of prophylactic antibiotic use with suprapubic catheters, 102 (37.9%) agreed to participate in a sexual function study. Women underwent a variety of anti-incontinence and reconstructive surgeries. Sexual function and urinary incontinence were assessed preoperatively and at 3 and 6 months postoperatively with the PISQ and Incontinence Impact Questionnaires (IIQ-7). Paired t tests compared changes over time. Logistic regression compared worsening PISQ vs other variables. Generalized McNemar's test compared individual questions pre- and postoperatively. Significance was set at P < .05. Results: Mean age was 47.1 (23 to 85) years, and 64% of women were premenopausal. Seventy-five (74%) women completed questionnaires at 3 or 6 months. Sexual function scores declined after surgery despite improvement in IIQ-7 scores (PISQ - 86 vs 78, P < .001; IIQ-7 = 52 vs 13, P < .001). Behavioral Emotive domain scores worsened at 3 to 6 months compared with pre- operative scores, while the Physical domain improved (all P < .001). Worsening PISQ scores were independent of age, type of surgery, hysterectomy, complications, or hormonal status (logistic regression, all P < .05). Conclusion: Sexual function scores in women after surgery for UI/POP do not improve despite improvement of incontinence at 3 to 6 months after surgery. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to determine if antibiotic prophylaxis with nitrofurantoin monohydrate macrocrystals (study drug) after pelvic organ prolapse and/or urinary incontinence surgery with suprapubic catheterization (SPC) decreases urinary tract infection (UTI) compared with placebo in a randomized, double-blind, multicenter trial. Study design: Six centers participated in this study. After a negative preoperative urine culture, history, surgical and postoperative course, urine culture and symptoms at SPC removal, and at 6 to 8 weeks postoperative, any other UTI and adherence were recorded. To demonstrate a 50% decrease in the bacteruria rate from 20%, with 80% power and α of 0.05, 438 patients were required. Data were evaluated with Student t test and Fisher exact test. Results: Of 449 patients enrolled, 211 randomized to study drug, and 224 randomized to placebo. No pre- or perioperative differences existed between groups (all P > .05). Antibiotic prophylaxis decreased positive urine cultures compared with placebo (46% vs 61%, P = .002), symptomatic UTI at SPC removal (7.2% vs 19.8%, P = .001), and any other symptomatic UTI 6 to 8 weeks postoperatively (18.9% vs 32.6%, P = .002). Antibiotic prophlylaxis did not decrease symptomatic UTI at the 6- to 8-week postoperative visit (1.8% vs 5.4%, P = .10). [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to compare intraoperative and postoperative complications of abdominal hysterectomy for the enlarged, myomatous uterus with vaginal hysterectomy with morcellation.Study Design: Medical records of 139 patients who underwent vaginal hysterectomy with morcellation and 244 patients who underwent total abdominal hysterectomy for an enlarged, myomatous uterus between August 1990 and July 2001 were reviewed. Uterine weights of >982 g were excluded because this was the largest uterus removed vaginally, which left 208 evaluable cases of total abdominal hysterectomy. The perioperative and postoperative course of the two groups was compared. The Student t test was used for continuous variables, and the Fisher exact test was used for binary or categoric data.Results: There were no significant differences between the two groups in surgical or anesthetic risk factors (P>.05). Operative time was similar between the groups (P>.05). Length of hospital stay was increased significantly with total abdominal hysterectomy (mean, 3.9 days vs 2.6 days; P<.001). Perioperative complications were increased with the abdominal route (10% vs 25%, P<.001).Conclusion: In this large series, uterine morcellation at the time of vaginal hysterectomy is safe and facilitates the removal of moderately enlarged and well-supported uteri and is associated with decreased hospital stay and perioperative morbidity rate compared with the abdominal route. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to compare gestational trophoblastic disease incidence rates with the use of population-based data.Study Design: All incident cases between 1973 and 1997 and live birth, pregnancy, and women at risk were tabulated with the use of data that were derived from the New Mexico Tumor Registry and Vital Records and Health Statistics Annual Reports. Statistical methods included trends analyses, odds ratios, and Poisson regression.Results: Of 939 total cases, 312 non-Hispanic white women, 399 Hispanic white women, 201 American Indian women, and 27 other women were affected. Age-adjusted incidence rates were significantly higher for American Indian women (11.16%) compared with non-Hispanic (3.57%) or Hispanic white women (5.32%); the probability value was <.001. When live birth (1:438 women) and pregnancy (1:486 women) denominators were considered, American Indian women alone were at increased risk, and the ratio increased by 56% over 25 years. American Indian women were also at increased risk for partial mole (relative risk, 4.03; 95% CI, 2.57-6.31), invasive mole (relative risk, 26.7; 95% CI, 7.81-93.14), and choriocarcinoma (relative risk, 6.29; 95% CI, 1.81-22.66) variants.Conclusion: American Indians are at increased risk relative to the other predominant ethnic groups in New Mexico. Age-adjusted standardization provided a reproducible measurement that may be applicable across other registries. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The purpose of this study was to compare gestational trophoblastic disease incidence rates with the use of population-based data. STUDY DESIGN: All incident cases between 1973 and 1997 and live birth, pregnancy, and women at risk were tabulated with the use of data that were derived from the New Mexico Tumor Registry and Vital Records and Health Statistics Annual Reports. Statistical methods included trends analyses, odds ratios, and Poisson regression. RESULTS: Of 939 total cases, 312 non-Hispanic white women, 399 Hispanic white women, 201 American Indian women, and 27 other women were affected. Age-adjusted incidence rates were significantly higher for American Indian women (11.16%) compared with non-Hispanic (3.57%) or Hispanic white women (5.32%); the probability value was <.001. When live birth (1:438 women) and pregnancy (1:486 women) denominators were considered, American Indian women alone were at increased risk, and the ratio increased by 56% over 25 years. American Indian women were also at increased risk for partial mole (relative risk, 4.03; 95% CI, 2.57-6.31), invasive mole (relative risk, 26.7; 95% CI, 7.81-93.14), and choriocarcinoma (relative risk, 6.29; 95% CI, 1.81-22.66) variants. CONCLUSION: American Indians are at increased risk relative to the other predominant ethnic groups in New Mexico. Age-adjusted standardization provided a reproducible measurement that may be applicable across other registries. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to determine whether the concurrent administration of oxytocin with sustained-release dinoprostone results in shorter induction times when compared with oxytocin after the removal of the dinoprostone insert.Study Design: Women with singleton pregnancies at > or = 36 weeks, vertex presentations, reactive nonstress tests, no prior uterine scar, intact membranes, and Bishop scores of < or = 6 were randomly assigned to receive oxytocin either immediately after placement of a sustained-release dinoprostone insert (immediate) or 30 minutes after its removal (delayed). The primary outcome was the time interval from induction to delivery.Results: Seventy-one patients were enrolled (immediate, 34 patients; delayed, 37 patients). There were no differences between treatment groups in non-reassuring fetal heart tracings, excess uterine activity, and epidural use. The mean time from dinoprostone placement until delivery was 544 minutes, shorter in the immediate group (972 vs 1516 minutes; P =.001). The proportion of deliveries within 24 hours was higher (90% vs 53%; P =.002) in the immediate group. Cesarean delivery rates were similar between the immediate and delayed groups (16% vs 13%; P =.73). No adverse maternal or neonatal outcomes were observed with concurrent therapy.Conclusion: Oxytocin that is administered concurrently with sustained-release dinoprostone significantly shortens induction-to-delivery times and results in a higher proportion of vaginal deliveries of < or = 24 hours with no apparent adverse effects. [ABSTRACT FROM AUTHOR]

Examines the development of an instrument to evaluate sexual function in women suffering from pelvic organ prolapse and urinary incontinence. Fabrication of the Pelvic Organ Prolapse-Urinary Incontinence Sexual Function Questionnaire; Validity of questions about urogynecological and sexual problems.

The purpose of this study was to determine whether vitamin C supplementation reduces the incidence of upper respiratory tract infections (URTIs), and attempt to explain the variability in URTIs among marathon runners and sedentary subjects. Marathon runners (n=44) and sedentary subjects (n=48) were randomly assigned either 1,000 mg vitamin C or a placebo daily for two months prior to and one month following a marathon race. Baseline (pre-supplementation) plasma vitamin C concentrations were higher among the vitamin C treated runners (VR, n=30) and placebo treated runners (PR, n=14) (78.5±2.7 and 84.0±3.6 mmol/L, respectively) compared to vitamin C treated sedentary (VS, n=23) and placebo treated sedentary (PS, n=25) subjects (61.1±4.7 and 52.8±5.0 mmol/L, respectively). Vitamin C concentrations increased with supplementation (81.0±2.1 mmol/L for VR and 72.6±2.9 mmol/L for VS). No treatment differences were found for URTI incidence (33.3%, 42.9%, 43.5%, and 32.0% among VR, PR, VS, and PS, respectively). Multiple logistic regression revealed the following factors to be significantly related to an increased risk of URTIs: (1) faster training pace, (2) greater number of marathons run, (3) shorter distance for the longest run of the week, and (4) female gender. The data indicate that vitamin C supplementation of 1,000 mg/day did not decrease the incidence of URTIs in marathon runners. Training and gender were more influential than vitamin C supplementation in explaining the incidence of URTIs. [ABSTRACT FROM AUTHOR]

Objective: Our purpose was to create a model for predicting amnionitis and rapid delivery in preterm labor patients by use of amniotic fluid interleukin-6 and clinical parameters.Study Design: Amniotic fluid was cultured and analyzed, and a clinical score (incorporating gestational age, amniotic fluid Gram stain, glucose, leukocyte esterase, and maternal serum C-reactive protein) was determined in 111 patients diagnosed with preterm labor. Statistical analysis involved t tests, chi2, logarithmic regression, and multivariate regression analysis (P < or = .05).Results: The incidence of positive amniotic fluid cultures was 8.7% (9 of 103 patients). Patients with positive cultures of the amniotic fluid had a shorter delivery interval (4.8 +/- 7.5 vs 28.9 +/- 25.4 days, P < .001). Patients with elevated amniotic fluid interleukin-6 (> or = 7586 pg/ml) were more likely to have a positive amniotic fluid culture (relative risk = 8.8, 95% confidence interval = 1.6 to 47.4, P < .001) and to be delivered within 2 days (relative risk = 16.8, 95% confidence interval = 4.5 to 62.7, P < .001). Stepwise multivariate regression analysis yielded a model using interleukin-6, cervical dilatation, and gestational age (r2 = 0.63, P < .001) with a specificity of 100% for predicting delivery within 2 days of amniocentesis.Conclusions: A mathematical model using maternal amniotic fluid interleukin-6 seems to be a useful clinical tool for quantifying the interval to preterm birth for patients in preterm labor. [ABSTRACT FROM AUTHOR]

Abstract: OBJECTIVE: Our purpose was to investigate the safety and efficacy of a synthetic intracervical hygroscopic dilator, Dilapan (Gynotech, Inc., Middlesex, N.J.), on ripening the cervix before medically indicated induction of labor. STUDY DESIGN: Two hundred forty patients with a Bishop score of ≤4 were prospectively randomized to receive either preinduction synthetic hygroscopic dilators (n = 112) or no pretreatment (n = 128) before oxytocin induction. RESULTS: Compared with controls, the dilator group exhibited a significant change in median Bishop score, but there was no significant difference in length of labor (dilator 18.8 ± 12.8 hours vs control 21.7 ± 14.8 hours) or in the cesarean section rate (dilator 41/112 [36.6%] vs control 49/128 [38.3%]). Relative proportions of nulliparous and multiparous patients, infant weights, and cervical dilation at the time of cesarean section were not significantly different between groups. No adverse maternal or fetal effects could be attributed to use of the device. CONCLUSIONS: Preinduction cervical ripening with hygroscopic dilators does not shorten the length of labor or lower the cesarean section rate in patients undergoing induction of labor. (Am J Obstet Gynecol 1996;175:145-9.) [Copyright &y& Elsevier]