In vitro and in vivo antitumor activity of a methanol extract of Dregea volubilis leaves with its antioxidant effect.

CONTEXT: In India, Dregea volubilis (L.f.) Benth. ex Hook.f. (Asclepediaceae), a large twining shrub with a woody vine, is used to treat tumors traditionally. OBJECTIVE: This study evaluated the in vitro and in vivo antitumor activity of the methanol extract of Dregea volubilis leaves (MEDV) and elucidated its possible mechanism of action. MATERIALS AND METHODS: In vitro antitumor activity of MEDV was evaluated against Ehrlich ascites carcinoma (EAC) cell-line. In vivo antitumor and antioxidant activity of MEDV at three dose levels (50, 100, and 200 mg/kg) were determined against EAC tumor-bearing mice. After 24 h of EAC inoculation, the extract was administered for 9 consecutive days. After the administration of the last dose on the 9th day followed by 18 h fasting, mice from all groups were sacrificed to determine antitumor activity and hematological profiles along with liver related biochemical parameters like lipid peroxidation, antioxidant enzymatic activity, etc. RESULTS: For in vitro antitumor activity, IC(50) value of MEDV for EAC tumor cells was 85.51 ± 4.07 µg/ml. The MEDV showed a decrease in tumor volume, packed cell volume and viable cell count and an increase in the non-viable cell count of the EAC tumor-bearing mice (p < 0.001). Hematological profile reverted near to normal level in extract treated mice. MEDV decreased the hepatic lipid peroxidation level and enhanced superoxide dismutase and catalase level in tumor-bearing mice (p < 0.001). DISCUSSION AND CONCLUSION: MEDV exhibited in vitro and in vivo antitumor activity in EAC tumor-bearing mice mediated through augmenting antioxidant defense system.

The measurement properties of the menorrhagia multi-attribute quality-of-life scale: a psychometric analysis.

Menorrhagia, or heavy menstrual bleeding (HMB), is a common gynaecological condition. As the aim of treatment is to improve women's wellbeing and quality of life (QoL), it is necessary to have effective ways to measure this. This study investigated the reliability and validity of the menorrhagia multi-attribute scale (MMAS), a menorrhagia-specific QoL instrument. Participants (n = 431) completed the MMAS and a battery of other tests as part of the baseline assessment of the ECLIPSE (Effectiveness and Cost-effectiveness of Levonorgestrel-containing Intrauterine system in Primary care against Standard trEatment for menorrhagia) trial. Analyses of their responses suggest that the MMAS has good measurement properties and is therefore an appropriate condition-specific instrument to measure the outcome of treatment for HMB.

Inhalation of expiratory droplets in aircraft cabins.

UNLABELLED: Airliner cabins have high occupant density and long exposure time, so the risk of airborne infection transmission could be high if one or more passengers are infected with an airborne infectious disease. The droplets exhaled by an infected passenger may contain infectious agents. This study developed a method to predict the amount of expiratory droplets inhaled by the passengers in an airliner cabin for any flight duration. The spatial and temporal distribution of expiratory droplets for the first 3 min after the exhalation from the index passenger was obtained using the computational fluid dynamics simulations. The perfectly mixed model was used for beyond 3 min after the exhalation. For multiple exhalations, the droplet concentration in a zone can be obtained by adding the droplet concentrations for all the exhalations until the current time with a time shift via the superposition method. These methods were used to determine the amount of droplets inhaled by the susceptible passengers over a 4-h flight under three common scenarios. The method, if coupled with information on the viability and the amount of infectious agent in the droplet, can aid in evaluating the infection risk. PRACTICAL IMPLICATIONS: The distribution of the infectious agents contained in the expiratory droplets of an infected occupant in an indoor environment is transient and non-uniform. The risk of infection can thus vary with time and space. The investigations developed methods to predict the spatial and temporal distribution of expiratory droplets, and the inhalation of these droplets in an aircraft cabin. The methods can be used in other indoor environments to assess the relative risk of infection in different zones, and suitable measures to control the spread of infection can be adopted. Appropriate treatment can be implemented for the zone identified as high-risk zones.

Flow dynamics and characterization of a cough.

UNLABELLED: Airborne disease transmission has always been a topic of wide interests in various fields for decades. Cough is found to be one of the prime sources of airborne diseases as it has high velocity and large quantity of droplets. To understand and characterize the flow dynamics of a cough can help to control the airborne disease transmission. This study has measured flow dynamics of coughs with human subjects. The flow rate variation of a cough with time can be represented as a combination of gamma-probability-distribution functions. The variables needed to define the gamma-probability-distribution functions can be represented by some medical parameters. A robust multiple linear regression analysis indicated that these medical parameters can be obtained from the physiological details of a person. However, the jet direction and mouth opening area during a cough seemed not related to the physiological parameters of the human subjects. Combining the flow characteristics reported in this study with appropriate virus and droplet distribution information, the infectious source strength by coughing can be evaluated. PRACTICAL IMPLICATIONS: There is a clear need for the scientific community to accurately predict and control the transmission of airborne diseases. Transportation of airborne viruses is often predicted using Computational Fluid Dynamics (CFD) simulations. CFD simulations are inexpensive but need accurate source boundary conditions for the precise prediction of disease transmission. Cough is found to be the prime source for generating infectious viruses. The present study was designed to develop an accurate source model to define thermo-fluid boundary conditions for a cough. The model can aid in accurately predicting the disease transmission in various indoor environments, such as aircraft cabins, office spaces and hospitals.

Involvement of atrial natriuretic peptide in abrogated cardioprotective effect of ischemic preconditioning in ovariectomized rat heart.

BACKGROUND: Nitric oxide (NO) is an effective mediator of ischemic preconditioning (IPC)-induced cardioprotection. Atrial natriuretic peptide (ANP) is downregulated after ovariectomy, which results in reduction in the level of NO. The present study deals with the investigation of the role of ANP in abrogated cardioprotective effect of IPC in the ovariectomized rat heart. METHODS: Heart was isolated from ovariectomized rat and mounted on Langendorff's apparatus, subjected to 30 min of ischemia and 120 min of reperfusion. IPC was given by four cycles of 5 min of ischemia and 5 min of reperfusion with Krebs-Henseleit solution. The myocardial infract size was estimated employing triphenyltetrazolium chloride stain, and coronary effluent was analyzed for creatine kinase-MB (CK-MB) and lactate dehydrogenase (LDH) release to consider the degree of myocardial injury. The cardiac release of NO was estimated by measuring the level of nitrite in coronary effluent. RESULTS: IPC-mediated cardioprotection was significantly attenuated in ovariectomized rat as compared to normal rat, which was restored by perfusion with ANP. However, this observed cardioprotection was significantly attenuated by perfusion with L-NAME, an endothelial nitric oxide synthase inhibitor, and Glibenclamide, a KATP channel blocker, alone or in combination noted in terms of increase in myocardial infract size, release of CK-MB and LDH, and also decrease in release of NO. CONCLUSION: Thus, it is suggested that ANP restores the attenuated cardioprotective effect of IPC in the ovariectomized rat heart which may be due to increase in the availability of NO and consequent increase activation of mitochondrial KATP channels.

The feasibility, success and patient satisfaction associated with outpatient hysteroscopic sterilisation.

OBJECTIVE: To determine the feasibility and patient satisfaction of female sterilisation using the Essure system in an outpatient hysteroscopy clinic without conscious sedation or general anaesthesia. DESIGN: Prospective cohort study. SETTING: Outpatient hysteroscopy clinic in a large teaching hospital. POPULATION: Women undergoing outpatient hysteroscopic sterilisation using the Essure system for permanent fertility control. METHODS: Demographic and procedural data were prospectively collected from 112 consecutive women undergoing outpatient hysteroscopic sterilisation without sedation or general anaesthesia. A hysterosalpingogram (HSG) was performed routinely in all women 3 months after the procedure to confirm bilateral tubal occlusion. Postal questionnaires were sent at this time enquiring about patient satisfaction and experience with the outpatient procedure. Multivariable logistic regression was used to identify factors independently predictive of successful completion of the procedure. MAIN OUTCOME MEASURES: Technical feasibility, predictive factors for technical success (operator, body mass index, uterine size, axis, menstrual phase and cervical stenosis), complications, tubal occlusion on HSG, patient satisfaction and procedure-related experience. RESULTS: Successful bilateral tubal placement of the Essure microinserts was achieved in 103/112 (92%, 95% CI 85-96%) women. Nonsecretory phase of the menstrual cycle (P = 0.04) and a clinically normal-sized uterus (P = 0.003) were independently predictive for successful completion of the outpatient procedure on multivariable modelling. There were no major procedure-related complications recorded, but transient vasovagal reactions occurred in 5/112 (5%) women. Of the original cohort of 112 women with successful procedures, 84 women were 3 months postprocedure and had undergone a HSG. Bilateral tubal occlusion was confirmed in 83/84 (99%, 95% CI 94-100%) women at 3 months and in 100% at 6 months. Seventy-six of 84 (91%) had returned the questionnaires, and 70/73 (96%, 95% CI 88-99%) were satisfied with their overall experience of the procedure including radiological follow up, with most reporting being 'very satisfied' (64/73, 88%, 95% CI 78-94%). CONCLUSIONS: Outpatient hysteroscopic sterilisation using the Essure system without sedation or general anaesthesia is a successful and safe procedure associated with high rates of patient satisfaction. If practical, women should be scheduled to have their procedures in the proliferative phase of the menstrual cycle to optimise successful placement of Essure devices, especially if the uterus is clinically enlarged.

The effectiveness of gynaecology teaching associates in teaching pelvic examination to medical students: a randomised controlled trial.

OBJECTIVES: To assess whether teaching female pelvic examinations using gynaecological teaching associates (GTAs); women who are trained to give instruction and feedback on gynaecological examination technique, improves the competence, confidence and communication skills of medical students compared to conventional teaching. STUDY DESIGN: Randomised controlled trial. SETTING: Ten University of Birmingham (UoB) affiliated teaching hospitals in the UK. POPULATION: 492 final year medical students. METHODS: GTA teaching of gynaecological examination compared with conventional pelvic manikin based teaching at the start of a five week clinical placement in obstetrics and gynaecology (O&G). MAIN OUTCOME MEASURES: Student's perception of their confidence was measured on a 10cm visual analogue scale (VAS). Domains of competence were measured by a senior clinical examiner using a standardised assessment tool which utilised 10cm VAS and by a GTA using a four point Likert scale. Assessors were blinded to the allocated teaching intervention. RESULTS: 407/492 (83%) students completed both the intervention and outcome assessment. Self-reported confidence was higher in students taught by GTAs compared with those taught on manikins (median score GTA 6.3; vs. conventional 5.8; p=0.03). Competence was also higher in those taught by GTAs when assessed by an examiner (median global score GTA 7.1 vs. conventional 6.0; p<0.001) and by a GTA (p<0.001). CONCLUSIONS: GTA teaching of female pelvic examination at the start of undergraduate medical student O&G clinical placements improves their confidence and competence compared with conventional pelvic manikin based teaching. GTAs should be introduced into undergraduate medical curricula to teach pelvic examination.

Uterine artery embolization for symptomatic uterine fibroids.

BACKGROUND: Uterine fibroids cause heavy and prolonged bleeding, pain, pressure symptoms and subfertility but are mostly benign. The traditional method of treatment has been surgery as long term medical therapies have not shown to be effective. Uterine artery embolization (UAE - complete occlusion of both the uterine arteries with particulate emboli) has been reported to be an effective and safe alternative in the treatment of menorrhagia and other fibroid-related symptoms in women not desiring future fertility, but thus far this evidence is based on case controlled studies and case reports. OBJECTIVES: To review the benefits and/or harms from randomised controlled trials (RCTs) of uterine artery embolization (UAE) versus other interventions for symptomatic uterine fibroids. SEARCH STRATEGY: We searched the Cochrane Menstrual Disorders & Subfertility Group Trials register (searched 10 August 2005), the Cochrane Central Register of Controlled Trials (CENTRAL) on the Cochrane Library, Issue 3, 2004), MEDLINE (January 1966 to November 2005) and EMBASE (January 1980 to November 2005). We also contacted authors of potential ongoing studies. SELECTION CRITERIA: RCTs of UAE versus any medical or surgical therapy for symptomatic uterine fibroids. DATA COLLECTION AND ANALYSIS: Two of the authors (AS and JKG) assessed the trials and extracted the data independently. They also contacted the investigators of eligible RCTs for unpublished data. MAIN RESULTS: Three trials were included in this review. Two RCTs compared UAE with abdominal hysterectomy in 234 women. Although the follow-up period was intended for two years, the available published results was only for six months follow-up. The second trial included 63 women comparing UAE with myomectomy in women who wished to preserve their fertility. The minimum follow-up reported was six months with a mean of 17 (+/- 9.3) months. The clinical success rate measured by improvement in fibroid-related symptoms e.g. menstrual loss was at least 85% in the UAE group from both trials. The mean dominant fibroid volume decreased by 30 to 46% in two trials. UAE significantly reduces length of hospital stay compared to surgery for either hysterectomy or myomectomy. Women undergoing UAE resumed routine activities sooner than those undergoing surgery. UAE was associated with a higher rate of minor post procedural complications such as vaginal discharge, post puncture haematoma and post embolization syndrome (pain, fever, nausea, vomiting), as well as higher unscheduled visits and readmission rates after discharge, compared with hysterectomy. There were no major complication differences between the two groups. Three women in the myomectomy trial had elevated FSH levels post UAE indicating possible ovarian dysfunction. AUTHORS' CONCLUSIONS: UAE offers an advantage over hysterectomy with regards to a shorter hospital stay and a quicker return to routine activities. There is no evidence of benefit of UAE compared to surgery (hysterectomy / myomectomy) for satisfaction. The higher minor complications rate after discharge in the UAE group as well as the unscheduled visits and readmission rates require more longer term follow-up trials to comment on its effectiveness and safety profile. There is currently an ongoing trial (REST, U. K.) and EMMY trial yet to report on the long term follow up, the results of which are awaited with interest.

The Gupta-Frank clamp for salpingo-oophorectomy at vaginal hysterectomy.

BACKGROUND: When performing a vaginal hysterectomy, removal of the tubes and ovaries can be either necessary or desirable. We describe our experience with a new instrument called the Gupta-Frank clamp for performing vaginal salpingo-oophorectomy at the time of vaginal hysterectomy. INSTRUMENT: The stainless steel Gupta-Frank clamp is 260 mm long, and its shanks are curved to avoid impedance from the vaginal walls. The 70-mm jaws have a smooth curve, which allows both the round and infundibulopelvic ligaments to be incorporated into a single clamp bite. Each jaw has three serrated grooves, which interlock with the corresponding jaw grooves to give a 6-mm-wide atraumatic nonslip area. EXPERIENCE: We have used this instrument in 18 women undergoing bilateral salpingo-oophorectomy at the time of vaginal hysterectomy. A single clamp bite on each side was sufficient to accomplish salpingo-oophorectomy in all cases. There were no major complications. CONCLUSION: Salpingo-oophorectomy performed vaginally at the time of vaginal hysterectomy with the Gupta-Frank clamp is feasible and is accomplished easily and safely.

Purification and properties of levanase from Rhodotorula sp.

Levanase, a slime dissolving enzyme of Rhodotorula sp., was purified to approx. 26-fold by ammonium sulphate precipitation, DEAE and gel filtration (Sephacryl S-200) chromatography. The molecular mass of the enzyme was 39 kDa. The purified levanase showed maximum activity at pH 6.0 and 40 degrees C. Enzyme was quite stable at 4 degrees C and at pH 5.5 to 6.5. Hg2+ at a level of 10 mM completely inhibited the levanase activity, while 2-mercaptoethanol at the same concentration showed a 2.93-times increase in activity. In addition to levan, the enzyme also showed substrate specificity towards inulin.

Effect of paper quality on the response rate to a postal survey: a randomised controlled trial. ISRCTN 32032031.

BACKGROUND: Response rates to surveys are declining and this threatens the validity and generalisability of their findings. We wanted to determine whether paper quality influences the response rate to postal surveys METHODS: A postal questionnaire was sent to all members of the British Society of Gynaecological Endoscopy (BSGE). Recipients were randomised to receiving the questionnaire printed on standard quality paper or high quality paper. RESULTS: The response rate for the recipients of high quality paper was 43/195 (22%) and 57/194 (29%) for standard quality paper (relative rate of response 0.75, 95% CI 0.33-1.05, p = 0.1 CONCLUSION: The use of high quality paper did not increase response rates to a questionnaire survey of gynaecologists affiliated to an endoscopic society.

Management of apparently isolated fetal ventriculomegaly.

Early ultrasound examination can provide accurate antenatal diagnosis of many fetal congenital abnormalities but it is often difficult to translate this into prognosis because of the variable functional effects of similar anatomical changes. In the case of isolated fetal ventriculomegaly it is the prognosis that parents require in order to choose between continuing with the pregnancy or termination. The outcome for antenatally diagnosed ventriculomegaly seems to be worse than that reported in the neurosurgical literature for children treated with congenital hydrocephalus. Follow-up is available for 276 cases with apparently isolated ventriculomegaly who did not undergo termination of pregnancy. One hundred ninety-four (70 per cent) survived and of these 114 (59 per cent) had normal developmental quotient to follow-up. Intrapartum cephalocentesis to aid vaginal delivery is almost invariably associated with fetal/neonatal death. A favorable outcome of normal mental development is present in cases with borderline, stable (nonprogressive) isolated ventriculomegaly or cases in which ventriculomegaly has resolved in utero. Fetal surgery would seem to offer no benefit. The outcome is much worse when other associated congenital anomalies are present.

N-Substituted indanamines as potential hypoglycemic agents.

A number of indanamines substituted at the terminal amino nitrogen with various aliphatic, alicyclic, heterocyclic, and aromatic ring systems were synthesized and screened for hypoglycemic activity. None was found to possess significant activity compared to tolbutamide.

Should we use prostaglandins, tents or progesterone antagonists for cervical ripening before first trimester abortion?

Sixty-four women requesting first trimester termination of pregnancy were recruited into a comparative cohort study comparing the cervical ripening properties of a mechanical dilator (Lamicel; n = 17), prostaglandin, antiprogesterone and placebo control (n = 15), gemeprost; n = 17) and mifepristone; n = 15). Compared to the placebo group, all 3 active agents dilated the cervix (p < 0.02) and they significantly reduced the force required to dilate it to 8 mm Hegar (p < 0.001). Although Lamicel insertion resulted in the largest pre-operative cervical dilatation all agents are effective. Therefore the cervical priming agent of choice should be the most convenient to use and the one with least side-effects. The oral antiprogesterone, Mifepristone, is the easiest to administer and has less side effects.

PIP: Obstetrician-gynecologists at St. James's University Hospital in Leeds, England, compared various cervical ripening agents in 64 18-39 year old women presenting for first trimester abortion. The women either received oral administration of a placebo or RU-486 or had a laminaria tent or gemeprost vaginal suppository inserted into the endocervical canal or the posterior fornix, respectively. All cervical ripening agents dilated the cervix better than the placebo (p .02). They also greatly diminished the force needed (50-65%) to dilate the cervix to 8 mm Hegar (p .001). The laminaria tent resulted in greater initial cervical dilatation than gemeprost or RU-486, regardless of parity (p .05), but the total force was not significantly different between the 3 groups. 71% of the women who received the gemeprost vaginal suppository had pelvic pain and regular painful uterine contractions. The pain was so intense in 33.3% of them (20% of all gemeprost patients) that health workers had to inject opiate analgesia intramuscularly. 81% of laminaria tent patients experienced menstrual type pains. A significantly lower percentage of RU-486 patients (33%) suffered mild pelvic discomfort than the gemeprost (p = .03) and laminaria tent groups (p = .001). None of the women in the placebo, laminaria tent, and RU-486 groups received analgesia. 40-41% of women in the 3 treatment groups experienced preoperative vaginal bleeding. Since RU-486 patients suffered minimal side effects and insertion of laminaria tents is inconvenient and potentially damaging (e.g. iatrogenic complications of fistulas, dumb belling, and tent fracture), the physicians concluded that RU-486 is the easiest cervical priming agent to administer and is as effective as the other agents.

Patient anxiety and experiences associated with an outpatient "one-stop" "see and treat" hysteroscopy clinic.

BACKGROUND: "One-stop" outpatient hysteroscopy clinics have become well established for the investigation and treatment of women with abnormal uterine bleeding. However, the advantages of these clinics may be offset by patient factors such as anxiety, pain, and dissatisfaction. This study aimed to establish patients' views and experiences of outpatient service delivery in the context of a one-stop diagnostic and therapeutic hysteroscopy clinic, to determine the amount of anxiety experienced by these women and compare this with other settings, and to determine any predictors for patient preferences. METHODS: The 20-item State-Trait Anxiety Inventory was given to 240 women attending a one-stop hysteroscopy clinic: to 73 consecutive women before their appointment in a general gynecology clinic and to 36 consecutive women attending a chronic pelvic pain clinic. The results were compared with published data for the normal female population, for women awaiting major surgery, and for women awaiting a colposcopy clinic appointment. In addition, a questionnaire designed to ascertain patients' views and experiences was used. Logistic regression analysis was used to delineate the predictive values of diagnostic or therapeutic hysteroscopy, and to determine their effect on the preference of patients to have the procedure performed under general anesthesia in the future. RESULTS: Women attending the hysteroscopy clinic in this study reported significantly higher levels of anxiety than those attending the general gynecology clinic (median, 45 vs 39; p = 0.004), but the levels of anxiety were comparable with those of women attending the chronic pelvic pain clinic (median, 45 vs 46; p = 0.8). As compared with the data from the normal female population (mean, 35.7) and those reported for women awaiting major surgery (mean, 41.2), the levels of anxiety experienced before outpatient hysteroscopy clinic treatment were found to be higher (mean, 45.7). Only women awaiting colposcopy (6-item mean score, 51.1 +/- 13.3) experienced significantly higher anxiety scores than the women awaiting outpatient hysteroscopy (6-item mean score, 47.3 +/- 13.9; p = 0.002). Despite their anxiety, most women are satisfied with the outpatient hysteroscopy "see and treat" service. High levels of anxiety, particularly concerning pain but not operative intervention, were significant predictors of patients desiring a future procedure to be performed under general anesthesia. CONCLUSIONS: Outpatient hysteroscopy is associated with significant anxiety, which increases the likelihood of intolerance for the outpatient procedure. However, among those undergoing operative therapeutic procedures, dissatisfaction was not associated with the outpatient setting.

Position for women during second stage of labour.

BACKGROUND: For centuries, there has been controversy around whether being upright (sitting, birthing stools, chairs, squatting) or lying down have advantages for women delivering their babies. OBJECTIVES: To assess the benefits and risks of the use of different positions during the second stage of labour (i.e. from full dilatation of the cervix). SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register (16 April 2003). SELECTION CRITERIA: Trials that used randomised or quasi-randomised allocation and appropriate follow up and compared various positions assumed by pregnant women during the second stage of labour. DATA COLLECTION AND ANALYSIS: We independently assessed the trials for inclusion and extracted the data. MAIN RESULTS: Results should be interpreted with caution as the methodological quality of the 19 included trials (5764 participants) was variable. Use of any upright or lateral position, compared with supine or lithotomy positions, was associated with: reduced duration of second stage of labour (10 trials: mean 4.29 minutes, 95% confidence interval (CI) 2.95 to 5.64 minutes) - this was largely due to a considerable reduction in women allocated to the use of the birth cushion; a small reduction in assisted deliveries (18 trials: relative risk (RR) 0.84, 95% CI 0.73 to 0.98); a reduction in episiotomies (12 trials: RR 0.84, 95% CI 0.79 to 0.91); an increase in second degree perineal tears (11 trials: RR 1.23, 95% CI 1.09 to 1.39); increased estimated blood loss greater than 500 ml (11 trials: RR 1.68, 95% CI 1.32 to 2.15); reduced reporting of severe pain during second stage of labour (1 trial: RR 0.73, 95% CI 0.60 to 0.90); fewer abnormal fetal heart rate patterns (1 trial: RR 0.31, 95% CI 0.08 to 0.98). REVIEWER'S CONCLUSIONS: The tentative findings of this review suggest several possible benefits for upright posture, with the possibility of increased risk of blood loss greater than 500 ml. Women should be encouraged to give birth in the position they find most comfortable. Until such time as the benefits and risks of various delivery positions are estimated with greater certainty, when methodologically stringent trials' data are available, women should be allowed to make informed choices about the birth positions in which they might wish to assume for delivery of their babies.

Woman's position during second stage of labour.

BACKGROUND: For centuries, there has been controversy around whether being upright (sitting, birthing stools, chairs, squatting) or lying down have advantages for women delivering their babies. OBJECTIVES: The objective of this review was to assess the benefits and risks of the use of different positions during the second stage of labour (i. e. from full dilatation of the cervix). SEARCH STRATEGY: Relevant trials are identified from the register of trials maintained by the Cochrane Pregnancy and Childbirth Group, and from the Cochrane Controlled Trials Register. SELECTION CRITERIA: Trials were included which compared various positions assumed by pregnant women during the second stage of labour. Randomised and quasi-randomised trials with appropriate follow-up were included. DATA COLLECTION AND ANALYSIS: Trials were independently assessed for inclusion, and data extracted, by the two authors. Disagreements would have been resolved by consensus with an editor. Meta-analysis of data is performed using the RevMan software. MAIN RESULTS: Results should be interpreted with caution as the methodological quality of the 18 trials was variable. Use of any upright or lateral position, compared with supine or lithotomy positions, was associated with: 1. Reduced duration of second stage of labour (12 trials - mean 5.4 minutes, 95% confidence interval (CI) 3.9 - 6.9 minutes). This was largely due to a considerable reduction in women allocated to use of the birth cushion. 2. A small reduction in assisted deliveries (17 trials - odds ratio (OR) 0.82, 95% CI 0.69 - 0.98). 3. A reduction in episiotomies (11 trials - OR 0.73, 95% CI 0.64 - 0.84). 4. A smaller increase in second degree perineal tears (10 trials - OR 1.30, 95% CI 1.09 - 1.54). 5. Increased estimated risk of blood loss > 500ml (10 trials - OR 1.76, 95% CI 1.34 - 3.32). 6. Reduced reporting of severe pain during second stage of labour (1 trial - OR 0.59, 95% CI 0.41 - 0.83). 7. Fewer abnormal fetal heart rate patterns (1 trial - OR 0.31, 95% CI 0.11 - 0.91). REVIEWER'S CONCLUSIONS: The tentative findings of this review suggest several possible benefits for upright posture, with the possibility of increased risk of blood loss > 500ml. Women should be encouraged to give birth in the position they find most comfortable. Until such time the benefits and risks of various delivery positions are estimated with greater certainty when methodologically stringent trials data are available, then women should be allowed to make informed choices about the birth positions in which they might wish to assume for delivery of their babies.

Rapid spectrophotometric determination of trace copper impurity in N,N'-di(2-butyl)-p-phenylenediamine.

The trace copper is separated from the matrix by extraction of the latter (an antioxidant of N-alkylated p-phenylenediamine type) from ammoniacal medium and then determined spectrophotometrically.

Polarography of molybdenum in aspartic acid solution.

The polarographic behaviour of Mo(VI) in solutions of aspartic acid is reported. In 0.01M acid, two waves are obtained, but at pH 4 only one, and they are diffusion controlled. The determination is possible in the presence of Ni, Cr(VI), W(VI), Mn(II), Co(II), Cu(II) or Th, with an accuracy of 2% in the range 10(-5)-10(-3)M.

Phospholipase A production by isolates of Salmonella species.

The incidence of intra- and extra-cellular phospholipase-A production by Salmonella isolates from human, poultry and environmental material was investigated. Nearly 17 per cent (15/90) of the strains tested produced phospholipase A. Phospholipase production was encountered in S. typhi, S. paratyphi A, S. typhimurium, S. seftenberg, S. bareilly, S. weltevredeen, S. newport, S. adelaide, S. alachua and S. gallinarum. Maximum (10/15) phospholipase producers were isolated from the human material. Phospholipase positive human isolates exhibited a high incidence of simultaneous multiple drug resistance, enterotoxigenicity and cell surface hydrophobicity.