Predictors of recovery of ovarian function during aromatase inhibitor therapy.

BACKGROUND: Aromatase inhibitors (AIs) may cause a rise in estrogen levels due to ovarian function recovery in women with clinical chemotherapy-induced ovarian failure (CIOF). We carried out a prospective registry trial to identify predictors of ovarian function recovery during AI therapy. PATIENTS AND METHODS: Women with hormone receptor (HR)-positive breast cancer who remained amenorrheic and had hormonal levels consistent with ovarian failure after adjuvant chemotherapy were enrolled in a multi-institutional clinical trial of anastrozole. Subjects underwent frequent assessment using an ultrasensitive estradiol assay. Multivariable analysis was used to evaluate clinical and biochemical predictors of ovarian function recovery within 48 weeks. RESULTS: Recovery of ovarian function during AI therapy was observed in 13 of 45 (28.9%) assessable subjects after a median 2.1 months (range 0.6-11.9). Median age at chemotherapy initiation was statistically significantly different between those who regained ovarian function (43 years, range 40-51) and those who remained postmenopausal (49 years, range 44-52; P < 0.0001). CONCLUSIONS: A significant proportion of women with CIOF recover ovarian function during AI therapy, including a woman over age 50 at initiation of chemotherapy. Tamoxifen remains the standard of care for women with CIOF. If an AI is used, patients should be monitored frequently with high-quality estradiol assays. CLINICALTRIALS.GOV: NCT00555477.

Modernizing and Expanding the NASA Space Geodesy Network to Meet Future Geodetic Requirements.

NASA maintains and operates a global network of Very Long Baseline Interferometry (VLBI), Satellite Laser Ranging (SLR), and Global Navigation Satellite System (GNSS) ground stations as part of the NASA Space Geodesy Program. The NASA Space Geodesy Network (NSGN) provides the geodetic products that support Earth observations and the related science requirements as outlined by the US National Research Council (NRC 2010, 2018). The Global Geodetic Observing System (GGOS) and the NRC have set an ambitious goal of improving the Terrestrial Reference Frame (TRF) to have an accuracy of 1 millimeter and stability of 0.1 millimeters per year, an order of magnitude beyond current capabilities. NASA and its partners within GGOS are addressing this challenge by planning and implementing modern geodetic stations co-located at existing and new sites around the world. In 2013, NASA demonstrated the performance of its next-generation systems at the prototype next-generation core site at NASA's Goddard Geophysical and Astronomical Observatory in Greenbelt, Maryland. Implementation of a new broadband VLBI station in Hawaii was completed in 2016. NASA is currently implementing new VLBI and SLR stations in Texas and is planning the replacement of its other aging domestic and international legacy stations. In this article, we describe critical gaps in the current global network and discuss how the new NSGN will expand the global geodetic coverage and ultimately improve the geodetic products. We also describe the characteristics of a modern NSGN site and the capabilities of the next-generation NASA SLR and VLBI systems. Finally, we outline the plans for efficiently operating the NSGN by centralizing and automating the operations of the new geodetic stations.

Frequency of antibiotic resistance among group B Streptococcus isolated from healthy college students.

We report resistant rates to erythromycin and clindamycin among Streptococcus agalactiae (group B Streptococcus) isolated from a random sample of healthy male and nonpregnant female college students. Observed resistance rates were twice as high as those reported among pregnant women from the same geographic area 2 years prior.

The association of kernicterus with bacterial infection in the newborn.

A total population of 29,395 neonates cared for in the six-year period from 1971 to 1976 was reviewed for evidence of autopsy-proven kernicterus. A total of 327 neonates died and 232 were autopsied. The only cases of kernicterus occurred in four near-term infants with antemortem proven sepsis. All four of these infants weighed more than 2,200 gm and were delivered after gestations of either 36 or 37 weeks. These cases of kernicterus occurred during a period when more aggressive management of hyperbilirubinemia in low-birth-weight infants had apparently eliminated immaturity as a predisposing factor in the development of kernicterus, uncovering bacterial infection as the major remaining etiologic co-factor.

In-vitro uptake and metabolism of [3H] corticosterone by mammary glands from pregnant, lactating, and post-lactational rats and by parametrial adipose tissue from lactating rats.

The study was designed to determine the influence of the physiological state on the in-vitro uptake and metabolism of glucocorticoid hormone by the mammary gland. [3H] Corticosterone was accordingly incubated with minced mammary glands from pregnant, lactating and post-lactational rats. The total uptake of [3H] corticosteroid was obtained from the concentration of radioactivity by the tissue and the specific activity of the steroid substrate. The extent of 21-acylation was determined as the percentage of the radioactivity in the chromatographed tissue extracts attributable to 21-acyl-[3H] corticosterone. The results indicated that the uptake of [3H] corticosteroid increased with advancing pregnancy, attained a high plateau level during lactation, and steadily declined during the post-lactational period. The extent of 21-acylation of [3H] corticosterone varied from 10 to 40%, fluctuating widely in all physiological states, particularly during the post-lactational period. It was inferred that the stromal elements, presumably the adipocytes, of the mammary gland can also acylate the corticosteroid hormone, a view which gained experimental support from similar studies with minced parametrial adipose tissue from lactating rats.

Increased CD38 expression is associated with favorable prognosis in adult acute leukemia.

CD38 is expressed in acute lymphoblastic leukemia (ALL) and acute myelogenous leukemia (AML) blasts and its prognostic significance is unknown. We investigated CD38 expression in 304 AML and 138 ALL patients. CD38 was lower in AML-M3 compared to other FAB subtypes (5% vs. 41%; P < 0.001), but was similar among ALL subtypes (56.6%; P = 0.69). Ph + ALL and AML with t(15; 17) patients showed lower CD38 expression than the other cytogenetic groups. Overall survival favored AML and ALL patients with higher CD38 levels. Multivariate analysis revealed CD38 expression to be an independent outcome predictor in AML, but not in ALL.

Safety belt use during pregnancy.

OBJECTIVE: To evaluate the importance of prenatal education on the proper use of seat belts during pregnancy. METHODS: Three hundred fifty pregnant women were provided surveys at their first prenatal visit and then again at 28-32 weeks' gestation. The surveys assessed the actual use and placement of seat belts before and during pregnancy and knowledge about the use of restraint systems during pregnancy. In addition, the women were surveyed with respect to the information provided to them regarding seat belt use. RESULTS: Two hundred ninety-eight women returned both surveys, 68% of whom reported using seat belt in a manner currently recommended. Nearly 20% stated that they rarely or never used seat belts during their pregnancy. Women who reported receiving information regarding seat belt use from their prenatal provider were significantly more likely both to use their belts (83% versus 65%; P < .001) and to identify proper belt placement (77% versus 57%; P < .001) compared with those who did not receive information, respectively. CONCLUSIONS: Despite current recommendations and laws regarding seat belt use during pregnancy, one-third of women report either not using seat belts or using them improperly during pregnancy. Prenatal care providers can substantially influence the proper use of seat belts by discussing their correct use during pregnancy.

Pelvic fluid collections following hysterectomy and their relation to febrile morbidity.

OBJECTIVE: To determine the incidence of pelvic fluid collections after hysterectomy, detected by transvaginal sonography and pelvic examination, and to correlate these findings with postoperative febrile morbidity. METHODS: Thirty-eight women, aged 26-65, were studied by pelvic examination and transvaginal sonography 1-5 days after vaginal or abdominal hysterectomy. The sonographer was unaware of the patient's clinical course before the examination and was not involved in clinical decision making. The results of the study were not made available to the treating physician. RESULTS: Transvaginal sonography revealed a sonolucent mass consistent with a fluid collection above the vaginal cuff ranging in size from 3.9-74.7 cm3 in 13 of 38 patients (34.2%). Only one of the 13 fluid collections was evident on pelvic examination performed before ultrasound. Nine of 13 women (69.2%) with fluid collections developed febrile morbidity, compared to three of 25 (12%) who did not have fluid collections (P = .006, Fisher exact test). Cuff cellulitis was clinically diagnosed in seven of the 13 women (53.8%) with fluid collections, compared to none of 25 women without fluid collections (P < .001, Fisher exact test). CONCLUSIONS: Pelvic fluid collections are common after hysterectomy. Women who develop post-hysterectomy fluid collections appear to be at increased risk for the development of febrile morbidity and cuff cellulitis. Transvaginal sonography may facilitate the diagnosis of post-hysterectomy pelvic fluid collections, which are not readily detected by pelvic examination.

Frequent resistance of clinical group B streptococci isolates to clindamycin and erythromycin.

OBJECTIVE: To determine both the frequency of reported penicillin allergy in parturients and the frequency of resistance in vitro of clinical isolates of group B streptococci to clindamycin and erythromycin. METHODS: One hundred clinical isolates of group B streptococci were tested to determine the frequency of resistance to clindamycin, erythromycin, penicillin G, vancomycin, and cefazolin. The frequency of beta-lactam allergy and reported allergic reaction also were recorded for all consecutive laboring women during the 4-month study. RESULTS: The frequency of group B streptococcal resistance to clindamycin was 15% and to erythromycin was 16%. No isolates were resistant to penicillin G, vancomycin, or cefazolin. Twelve percent of the 963 women who delivered during the study reported a penicillin allergy, but only 30% of those could describe their allergic reaction. CONCLUSION: In vitro resistance of group B streptococci to clindamycin and erythromycin occurred frequently in this population. Whereas the importance of this finding in vivo is uncertain, it raises concern about the possibility of inadequate prophylaxis using currently recommended alternatives in penicillin-allergic patients. Artful questioning of women reporting penicillin allergy may lessen the likelihood of using these less desirable agents in the setting of intrapartum antimicrobial prophylaxis.

Maternal and transplacental pharmacokinetics of cefazolin.

OBJECTIVE: To evaluate the intrapartum pharmacokinetics of cefazolin, including delivery to amniotic fluid (AF) and fetal compartments, and to ascertain that adequate cefazolin concentrations are attained to exceed the mean concentration inhibiting 90% (MIC(90)) of group B streptococcus strains. METHODS: Cefazolin (1 g) was administered intravenously at five separate time intervals (0.5, 1, 2, 4, and 6 hours) before elective cesarean at term to 26 women with intact membranes and with no significant infections or cardiovascular, liver, or renal disease. Samples of maternal blood, cord blood, and AF were obtained at the time of delivery. Exact collection times relative to cefazolin infusion were noted. Amniotic fluid contaminated with blood or meconium was excluded. Cefazolin concentration was measured by high-pressure liquid chromatography. RESULTS: All maternal and cord plasma cefazolin levels, except one, were above the MIC(90) for Streptococcus agalactiae (group B streptococcus). For AF, all cefazolin levels, except two, were above the MIC(90). CONCLUSIONS: Cefazolin concentrations greater than or equal to the MIC(90) for group B streptococcus were attained in nearly all maternal, fetal, and AF samples. This information, together with the knowledge that there is rare resistance of group B streptococcus to cefazolin, supports the use of cefazolin as a better alternative than clindamycin or erythromycin for group B streptococcus prophylaxis in patients with a nonanaphylactic penicillin allergy.

Oral trovafloxacin compared with intravenous cefoxitin in the prevention of bacterial infection after elective vaginal or abdominal hysterectomy for nonmalignant disease. Trovafloxacin Surgical Group.

BACKGROUND: Trovafloxacin is a new fourth-generation fluoroquinolone whose pharmacokinetics and in vitro activity suggest that it is well suited for antibiotic prophylaxis in elective hysterectomy. METHODS: In a randomized, double-blind, multicenter study, parallel groups of women 18 years of age or older received either 200 mg trovafloxacin by mouth and intravenous (i.v.) placebo or 2 g cefoxitin by i.v. infusion and placebo by mouth before elective vaginal or abdominal hysterectomy for nonmalignant disease. RESULTS: In the 103 and 97 patients in the trovafloxacin and cefoxitin groups, respectively, who were evaluable for efficacy, the prophylactic success rates at hospital discharge (96% in both groups) and 30 +/- 6 days after hysterectomy (88% and 91% in the trovafloxacin and cefoxitin groups, respectively) were statistically equivalent. Both antibiotics were well tolerated. CONCLUSION: A single oral 200 mg dose of trovafloxacin is as effective and safe as a standard cefoxitin parenteral regimen in the prevention of primary bacterial infection after elective vaginal or abdominal hysterectomy for nonmalignant disease.

A new look at an old task: advantages and uses of sickness-conditioned learning in day-old chicks.

In sickness-conditioned learning, animals become ill after sampling a new substance and develop an aversion that is expressed as avoidance of that substance in subsequent presentations. We examined the parameters of a one-trial, nongustatory, sickness-conditioned learning task in day-old chicks. Chicks pecked a bead and were made ill by i.p. injection of lithium chloride (LiCl). Both 0.5 and 1.0 M LiCl (0.1 ml) produced reliable avoidance at test. Chicks injected with LiCl between 15 and 45 min after training avoided the bead at test, whereas those injected within 5 or 10 min or more than 45 min after training did not. Avoidance was present until 24 h posttraining and absent after 48 h. Therefore, robust learning of the sickness-conditioned learning task occurs in one trial without the need for gustatory cues, and memory for the task lasts at least 24 h. Uses of this task to study memory formation in the day-old chick are discussed.

Evaluation and treatment of the gravida and fetus following trauma during pregnancy.

The management of trauma during pregnancy requires an interdisciplinary team approach involving surgeons, emergency medicine physicians, and obstetricians. Management principles are similar to those utilized in nonpregnant patients, but a number of unique circumstances must be considered, including physiologic changes of pregnancy, diagnosis and management of abruptio placentae and fetomaternal hemorrhage, and the management of traumatic cardiac arrest during pregnancy. The routine use of cardiotocography, Kleihauer-Betke assay, and perimortem cesarean section are discussed as new principles in the management of trauma during pregnancy.

Motor vehicle crashes, pregnancy loss and preterm labor.

Trauma during pregnancy is remarkably common, and is greatly underestimated in terms of its contribution to both maternal and perinatal morbidity and mortality. Motor vehicle crashes, falls, assaults, including domestic violence, are all important mechanisms of injury, and clinical algorithms have been developed to manage the injured pregnant women. Focus on recognition and management of the most common injuries seen in pregnant women, namely abruptio placentae and uterine rupture are addressed through hemodynamic stabilization and continuous fetal and uterine contraction monitoring in the women injured beyond 24 weeks' gestation.

Repair of the traumatically ruptured gravid uterus. A report of two cases resulting in viable pregnancies.

In two cases of traumatic rupture of the unscarred, pregnant uterus, careful repair was able to preserve fertility even after extensive damage. Because of the extreme variations in the presentation of this uncommon problem, a high index of suspicion may be necessary to save the woman's life in cases of fetal demise after a serious car accident.

Abdominal wall Actinomyces abscess associated with an intrauterine device. A case report.

An abdominal wall Actinomyces abscess occurred in a woman with an intrauterine device. Contributing factors were local trauma, spread from surrounding colonized body sites and symbiotic growth of other anaerobes. The diagnosis was based on the histologic finding of the sulfur granule. Special studies may be needed to distinguish this condition from other, similar ones (Nocardia, botryomycosis).

Abruptio placentae after auto accidents. A case-control study.

OBJECTIVE: To compare accident and injury characteristics in pregnant women with and without abruptio placentae involved in auto accidents (AAs). STUDY DESIGN: A retrospective, case-control study involving 12 pregnant women (16-39 weeks) with a diagnosis of abruptio placentae after AAs and 12 control subjects matched for gestational age (+/- 2 weeks) involved in AAs without abruptio placentae from 1988 through 1997. Numerous variables were compared, including restraint system use, estimated speed of the collision, injury severity score (ISS), clinical findings and patient position in the vehicle. Patient complaints and physical examination on admission were also recorded, and obstetric and neonatal outcomes were compared. Statistical analysis was performed using the independent sample t, Mann-Whitney and Fisher's exact tests, when appropriate. RESULTS: There was no significant difference in the frequency of unrestrained subjects or position in the vehicle between cases and controls. Estimated speed of the vehicle at the time of collision was significantly higher in the abruptio placentae group (> 30 mph, 92% vs. 50%, P = .03), as was the mean ISS code (20 [SD 12.71] vs. 4 [SD 5.13], P < .001). Abdominal pain and vaginal bleeding were seen more frequently in women with abruptio placentae as compared to controls (58% vs. 25% and 33% vs. 0, respectively). Patients with abruptio placentae had a higher incidence of preterm delivery (mean gestational age at delivery = 29 weeks [SD 7.99] vs. 36 weeks [SD 7.21], P = .008) and stillbirth (57% vs. 0%, P = .002) and lower mean birth weight (1,924 g [SD 931] vs. 3,069 g [SD 450], P = .003). There was no significant difference in cesarean section rates between the groups (58% vs. 30%, P = .23). There was no difference in the two groups in placental location on ultrasonography. CONCLUSION: Pregnant women who were involved in severe accidents (i.e., higher speed or ISS) were more likely to suffer abruptio placentae. In severe accidents, proper restraints were frequently not used. Because of the severity of these accidents, current restraint systems may not be sufficient to prevent abruptio placentae even with proper restraint use. Efforts toward designing new restraint systems for pregnant women should be encouraged.

Investigations of crashes involving pregnant occupants.

Case reports of 16 crashes involving pregnant occupants are presented that illustrate the main conclusions of a crash-investigation program that includes 42 crashes investigated to date. Some unusual cases that are exceptions to the overall trends are also described. The study indicates a strong association between adverse fetal outcome and both crash severity and maternal injury. Proper restraint use, with and without airbag deployment, generally leads to acceptable fetal outcomes in lower severity crashes, while it does not affect fetal outcome in high-severity crashes. Compared to properly restrained pregnant occupants, improperly restrained occupants have a higher risk of adverse fetal outcome in lower severity crashes, which comprise the majority of all motor-vehicle collisions.

The role of socioeconomic status in adolescent literature.

This article attempts to establish that socioeconomic status (SES) plays an important role in the lives of adolescents and is reflected in adolescent literature. The emphasis on SES in four adolescent novels: The Outsiders by S.E. Hinton, To Kill a Mockingbird by Harper Lee, The Catcher in the Rye by J. D. Salinger, and The Pigman by Paul Zindel suggests that both the authors and their young readers are aware of its influence in today's society. Three areas which are greatly affected by SES are examined: adolescents' self-esteem, how it affects characterization and subsequently the degree to which adolescents identify with a literary character, and how it functions as a learning device, enabling authors to infuse their own moral values into the minds of their audiences.

Characterization of ovine utero-placental interface tensile failure.

Data on the strength of the utero-placental interface (UPI) would help improve understanding of the mechanisms of placental abruption (premature separation of the placenta from the uterus) during motor-vehicle crashes involving pregnant occupants. An ovine model was selected for study because like the human, its placenta has a villous attachment structure. Uteri with intact placentas were obtained from three sheep as by-products of another research study. The samples were harvested between 102 and 119 days of the 145-day gestational period. Rectangular specimens with areas measuring 15 mm × 5 mm were cut through the thickness of the placenta and uterus. Each subject provided eight samples, of which four were tested at a nominal strain rate of 0.10 strains/sec and the remainder was tested at a nominal strain rate of 1.0 strains/sec. Sutures were used to secure the uterine side of the specimens to the test fixture, while mechanical clamps were used to attach the placenta side. A FARO arm scanner recorded the initial geometry of the tissue, and a random dot pattern applied to the placenta and uterus tissue allowed visualization of displacement. For the structure of the UPI, mean tensile failure strain and standard deviations are 0.37 (0.11) and 0.37 (0.18) for the 0.10 and 1.0 strain rates, respectively (p-value = 0.970) while the associated failure stresses are 6.5 (1.37) and 15.0 (5.08) kPa, (p-value = 0.064). The results from sheep UPI testing provide the first estimate of the human UPI structural failure tolerance.