Effectiveness of nifedipine tocolysis to facilitate external cephalic version: a systematic review.

BACKGROUND: The success rates of external cephalic version (ECV) are improved with the use of betamimetic tocolytics, but these drugs are associated with maternal side effects. OBJECTIVES: To critically evaluate the effectiveness and advantages, if any, of nifedipine as a tocolytic for ECV. SEARCH STRATEGY: We searched PubMed, OVID [Medline, all evidence-based medicine (EBM) reviews], Embase, the Cochrane clinical trials register and references therein. SELECTION CRITERIA: Randomised trials comparing nifedipine with placebo or another tocolytic agent among women with a singleton, term breech or transverse presentation. DATA COLLECTION AND ANALYSIS: Two reviewers evaluated search results and extracted data from eligible studies using a standard data extraction form. Primary outcomes were success rates of ECV and cephalic presentation at delivery. Pooled relative risks and 95% confidence intervals were calculated for comparable studies, and where similar outcomes were assessed. MAIN RESULTS: Three trials met the inclusion criteria. Two trials (n = 176) compared nifedipine with terbutaline and found lower rates of successful ECV among women receiving nifedipine, pooled risk ratio = 0.67 (95% CI 0.48-0.93, P = 0.016). One trial (n = 320) comparing nifedipine with placebo did not find any significant difference in ECV success rates (41.6% nifedipine versus 37.2% placebo, P = 0.43). Although minor side effects were slightly higher with nifedipine compared with placebo, there was no significant difference in the rate of adverse maternal or neonatal outcomes or maternal satisfaction between the nifedipine and terbutaline groups, and women in both groups showed a similar preference for oral administration (62% nifedipine and 71% terbutaline). AUTHORS' CONCLUSIONS: This review found no evidence to support the use of nifedipine for tocolysis to facilitate external cephalic version.

The Ess1 prolyl isomerase is linked to chromatin remodeling complexes and the general transcription machinery.

The Ess1/Pin1 peptidyl-prolyl isomerase (PPIase) is thought to control mitosis by binding to cell cycle regulatory proteins and altering their activity. Here we isolate temperature-sensitive ess1 mutants and identify six multicopy suppressors that rescue their mitotic-lethal phenotype. None are cell cycle regulators. Instead, five encode proteins involved in transcription that bind DNA, modify chromatin structure or are regulatory subunits of RNA polymerase II. A sixth suppressor, cyclophilin A, is a member of a distinct family of PPIases that are targets of immuno suppressive drugs. We show that the expression of some but not all genes is decreased in ess1 mutants, and that Ess1 interacts with the C-terminal domain (CTD) of RNA polymerase II in vitro and in vivo. The results forge a strong link between PPIases and the transcription machinery and suggest a new model for how Ess1/Pin1 controls mitosis. In this model, Ess1 binds and isomerizes the CTD of RNA polymerase II, thus altering its interaction with proteins required for transcription of essential cell cycle genes.

Serotonin-dependent collagenase transcription in myometrial cells requires extended AP-1 site.

Primary cultures of uterine smooth muscle cells from post-partum rats express interstitial collagenase in response to serotonin and the serotonin-dependent production of interleukin-1 (IL-1) [Wilcox, B.D., Dumin, J.A. and Jeffrey, J.J. Serotonin regulation of interleukin-1 messenger RNA in rat uterine smooth muscle cells. Relationship to the production of interstitial collagenase J. Biol. Chem., 269, (1994a), 29658]. Transient transfections of these cells indicate that rat collagenase transcription is regulated via a proximal consensus AP-1 site within an extended palindrome. Mutation of either the AP-1 site or extended palindrome (EP) decreases promoter activity to approximately 30% of the wild-type. Electrophoretic mobility shift assays reveal the binding of smooth muscle cell nuclear proteins to the AP-1 EP. This binding is barely detectable after mutation of the EP and is completely eliminated by mutation of the AP-1 heptamer. Competition experiments demonstrate that binding to the AP-1 EP is specific and of higher affinity than binding to oligonucleotides containing a mutated EP. Binding to the AP-1 EP is higher when smooth muscle cells are cultured in the presence of serotonin than in its absence. Although IL-1 is required for collagenase transcription, binding to the AP-1 EP appears to be IL-1-independent. FosB, Fra-2, c-Jun, JunB and, most abundantly, JunD bind the AP-1 EP in the absence and presence of serotonin. In contrast, Fra-1 expression and binding are serotonin-dependent suggesting that the activation of Fra-1 may be a key component of collagenase transcriptional activation.

Computed tomography interpretations with a low-cost workstation: a timing study.

An ergonomically simple prototype workstation with two 900 x 1,100-pixel monitors capable of displaying eight full-resolution computed tomography (CT) images in 0.2 seconds, was compared with film for interpretation of computed tomographic images of the chest and abdomen. The hardware platform for this workstation cost less than $11,500 in 1993. A repeated-measures experiment was used to generate average interpretation times of 6.17 minutes for the workstation and 6.03 minutes for the film, including loading and unloading films, with three of the four subjects averaging about a minute longer for each workstation interpretation. All dictated reports were of clinically acceptable accuracy. All radiologists stated that workstations based on this design would be an acceptable clinical tool. However, observation suggested human working-memory strain among infrequent CT readers that could indicate the need for additional training. These data suggest that low-cost workstations can have practical application in interpretation of digital medical images such as CT, with the possibility of small increases in interpretation time.

Histocompatibility antigens in Alzheimer's disease. A preliminary study.

A preliminary study of Alzheimer's disease showed an apparent excess of the antigen A2 in patients who presented the disease before the age of 60, whereas those with onset after 64 showed different frequencies of the antigens A1 and A3 when compared with the local population. There was no abnormality in the distribution of B locus antigens. The findings are briefly discussed.

Monolayer destruction by leukocytes from patients with multiple sclerosis.

Separated lymphoid cells from patients suffering from multiple sclerosis (MS) were co-cultivated with various cell lines. Over 80% of such co-cultivations showed destruction of the tissue-culture monolayers, whereas less than 5% of "normal" blood co-cultivation behaved in the same manner. Because of the possible involvement of virus in the aetiology of MS, many positive co-cultivations were 1) examined electron-microscopically, but no virus particles were seen; and 2) tested for measles and herpes viruses using immunofluorescent techniques, but these also proved negative. Leukocytes from stroke patients showed monolayer destruction in about 50% of cases. Granulocyte contamination was high in the stroke blood samples. Reduction of granulocyte numbers to "normal" levels completely abrogated the effect in the stroke samples, but had no effect on the MS co-cultivations. Monolayer destruction by MS leukocytes also appeared not to be due to lymphotoxin.

Histocompatibility antigens in Alzheimer's disease. A preliminary study.

A preliminary study of Alzheimer's disease showed an apparent excess of the antigen A2 in patients who presented the disease before the age of 60, whereas those with onset after 64 showed different frequencies of the antigens A1 and A3 when compared with the local population. There was no abnormality in the distribution of B locus antigens. The findings are briefly discussed.

T lymphocytes in patients with Down's syndrome.

Individuals with Down's syndrome (DS) are thought to have abnormalities in their immune system, and a tendency to infection and malignancy. Studies to quantify the number of T lymphocytes in the peripheral blood of 82 unselected institutionalized patients (50 DS, 27 controls matched for sex and age, 2 chronic lymphocytic leukemic, 2 acute leukemic, and 1 Hodgkin's disease) were conducted. The numbers of circulating T cells in DS patients did not differ significantly from the control group, and were in the upper limits of normality. Number of "avid" T cells, however, were significantly higher in the DS than in the control group. The blastogenic response of the T cells to mitogen was significantly depressed. The data did not exclude the existence of qualitative abnormalities. Except for DS patients with congenital heart disease, those older than 15 years were not more prone to upper respiratory infections than other institutionalized mentally retarded patients.