Self-administration of injectable contraceptives: a systematic review.

BACKGROUND: The contraceptive injectable is a safe and effective method that is used worldwide. With the variety of injectable delivery systems, there is potential for administration by the woman herself. Self-administration of the contraceptive injectable is the subject of this systematic review. OBJECTIVES: To assess how effective and safe the contraceptive injectable method is when women themselves perform/administer it, compared with when the usual healthcare providers administer it. SEARCH STRATEGY: We searched PubMed, Popline, Cochrane, CINAHL, and Embase for articles with subject headings or text words related to 'self-administration' and 'contraception'. SELECTION CRITERIA: Studies that compared the administration of the contraceptive injectable by the woman herself versus administration by the healthcare provider were included. Outcomes of interest were continuation rates, safety, and the women's overall satisfaction with the contraceptive provider and method. DATA COLLECTION AND ANALYSIS: We undertook data extraction, descriptive analysis, and assessment of risk of bias. MAIN RESULTS: Three studies met the inclusion criteria. The best available evidence shows that there may be little or no difference in continuation rates when women self-administer contraceptive injections (326 per 1000 women; 95% CI 192-554 per 1000 women) compared with administration by healthcare providers (304 per 1000 women). Safety was not estimable as no serious adverse events were reported in any of the studies. With regards to overall satisfaction towards the provider and the method, the effect of the intervention was uncertain. AUTHORS' CONCLUSIONS: Findings suggest that with appropriate information and training the provision of contraceptive injectables for the woman to self-administer at home can be an option in some contexts. TWEETABLE ABSTRACT: This review assessed the continuation rates and safety of self-administration of the contraceptive injection.

Nuclear and cytoplasmic localization of ß-catenin in the nail-matrix cells and in an onychomatricoma.

ß-catenin plays an important role in hair morphogenesis. Previously, the nuclear and cytoplasmic localizations of ß-catenin were identified in hair-matrix cells. To evaluate ß-catenin expression in the nail matrix, we obtained human nail units. Immunohistochemistry for ß-catenin was used to evaluate sections of normal nail units and of sections from a single case of onychomatricoma. In the nail unit, ß-catenin was expressed in the nucleus and cytoplasm of the suprabasal nail-matrix cells. Of the other epithelial-cell types, only the cell membrane was ß-catenin-positive. In the nail tissue from the onychomatricoma case, ß-catenin was expressed in the nucleus and cytoplasm of the upper epithelial layers. Our result suggests that ß-catenin plays an important role in nail formation. In addition, ß-catenin expression in onychomatricoma supports the presence of nail-matrix cells in this condition. To our knowledge, this is the first report of ß-catenin expression in the nucleus and cytoplasm of the nail matrix.

Inter-Individual Variation in Anti-Parasitic Egg Rejection Behavior: A Test of the Maternal Investment Hypothesis.

Hosts of avian brood parasites may reduce or forego the costs of caring for foreign young by rejecting parasitic eggs from the nest. Yet, many host species accept parasitic eggs and, even among rejecter species, some individuals go on to incubate and hatch them. The factors explaining the variation in egg rejection between species have received much theoretical and empirical attention, but the causes of intraspecific variation in different individuals' propensity for accepting parasitic eggs are less well understood. Here we tested the maternal investment hypothesis, which predicts that hosts with costlier clutches will be more likely to reject parasitic eggs from their nest. We studied variation in the egg rejection responses of American robins (Turdus migratorius), a robust egg-rejecter host of the brood parasitic brown-headed cowbird (Molothrus ater), to 3D-printed cowbird-sized eggs which were painted dark blue, a color known to induce variable and repeatable egg rejection responses in individual robins. Costlier clutch investment was estimated by earlier laying date, larger clutch size, heavier unincubated yolk mass, and variable yolk steroid hormone concentrations. There was no statistical support for most of our predictions. However, we detected more concentrated and greater overall amount of deoxycorticosterone deposited in egg yolks of rejecters relative to acceptors, although this accounted for no more than 14% of variance in the data. Future work should test experimentally the potential physiological linkage between maternal egg yolk steroid investment and egg rejection propensity in this and other host species of avian brood parasites.

Egyedek közti variáció az antiparazitikus tojás-diszkriminációban: az anyai befektetés hipotézis tesztelése Kivonat A költésparazita madárfajok gazdái csökkenthetik vagy megszüntethetik az idegen fióka nevelésének költségeit úgy, hogy eltávolítják a fészekbol a paraziták tojásait. Ennek ellenére több gazdafaj is elfogadja a parazita tojásokat, sot az elutasító gazdafajok körében is akadnak olyan egyedek, amelyek elfogadják és kikeltik az idegen tojást. Bár az eddigi elméleti és kísérleti kutatások nagy hangsúlyt fektettek a különbözo gazdafajok közti, költésparazita tojások diszkriminacióját befolyásoló tényezok feltárására, a parazita tojások elfogadásának gazdafajon belüli varianciája kevésbé tisztázott. Jelen kutatásunkban az anyai befektetés hipotézisét vizsgáltuk, melynek értelmében azok az egyedek, amelyek több energiát fektetnek fészekaljukba, nagyobb valószínuséggel távolítják el a költésparazita tojásait a fészekbol. A vándorrigónak (Turdus migratorius) a parazita tojást elutasító viselkedését vizsgáltuk meg a költésparazita barnafeju gulyajáró (Molothrus ater) tojásához hasonló méretu, de sötétkék színu, 3 D nyomtatóval készített mutojásokat használva. A költési periódusban korábban letojt, több tojásból álló, nagyobb inkubálatlan tömegu és változatos szteroid hormonkoncentrácijú sárga szíku tojásokkal rendelkezo fészekaljakat tekintettük a magasabb anyai befektetésu fészekaljaknak. Feltevéseink nagyrészét statisztikai eredményeink nem támasztották alá. Mindezek ellenére, a parazita tojásokat elfogadó egyedekéhez képest, az idegen tojást elutasító egyedek tojásai sárga szíkanyagában nagyobb koncentrációban és mennyiségben volt jelen a dezoxikortikoszteron, bár ez az adatainkra jellemzo varianciának csupán 14%-át magyarázta. További kísérletes vizsgálatok szükségesek ahhoz, hogy feltárhassuk az esetleges fiziológiás kapcsolatot az anyai tojas szteroid hormone befektetés és a parazita tojások elutasításának gyakorisága között ennél a gazdafajnál, és más költésparazita gazdáknál egyaránt. Translated kindly by Attila Marton, Debrecen University.

Dicynthaurin: an antimicrobial peptide from hemocytes of the solitary tunicate, Halocynthia aurantium.

We isolated a novel antimicrobial peptide, dicynthaurin, from hemocytes of a tunicate, Halocynthia aurantium. The native peptide had a mass of approximately 6.2 kDa and was composed of two 30-residue monomers without sequence homology to any previously identified peptides (ILQKAVLDCLKAAGSSLSKAAITAIYNKIT). Most cynthaurin molecules were C-terminally amidated and were linked covalently by a single cystine disulfide bond. When performed in membrane-mimetic environments, circular dichroism studies of dicynthaurin revealed largely alpha-helical conformations. Dicynthaurin's broad-spectrum activity encompassed Gram-positive (Micrococcus luteus, Staphylococcus aureus, Listeria monocytogenes) and Gram-negative bacteria (Escherichia coli, Pseudomonas aeruginosa), but not Candida albicans, a fungus. Although dicynthaurin was purified from a marine invertebrate, its antimicrobial activity was optimal at NaCl concentrations below 100 mM. This suggests that the antimicrobial actions of this molecule may take place intracellularly (e.g., within a phagosome) rather than extracellularly.

Effects of maternal hypertension in very-low-birth-weight infants.

OBJECTIVE: To determine the effects of mild vs severe maternal hypertension on the neonatal morbidity of very-low-birth-weight infants. DESIGN: Cohort case-control study. SETTING: Tertiary care center neonatal intensive care unit. PATIENTS: Thirty-nine infants born to mothers with maternal hypertension (blood pressure > or = 140/90 mm Hg on 2 occasions during pregnancy) among 267 very-low-birth-weight infants (< or = 1250 g) admitted to the special care nursery between January 1, 1991, and December 31, 1992. Each infant was matched for gestational age and survival to 2 control infants born to normotensive mothers. The cohort included 11 infants of mothers with mild hypertension, 28 with severe hypertension, and 78 controls. MAIN OUTCOME MEASURES: Late and variable decelerations, incidence of small size for gestational age, respiratory distress syndrome, intraventricular hemorrhage, patent ductus arteriosus, apnea, ventilator therapy, oxygen requirement, and bronchopulmonary dysplasia. RESULTS: The mild and severe maternal hypertension groups had significantly lower birth weights and more infants small for gestational age than did controls. The incidence of respiratory distress syndrome, however, was significantly lower in infants of mothers with mild hypertension than in those with mothers with severe hypertension. Those in the mild group had fever days of ventilatory therapy and lower oxygen requirements than both the infants in the severe group and control infants. The incidence of apnea in the mild hypertension group was significantly lower than that in the severe hypertension group. CONCLUSIONS: Although mothers with both mild and severe hypertension have an increased incidence of infants small for gestational age, the infants born to mothers with mild hypertension had less respiratory distress syndrome, apnea, ventilator therapy, oxygen requirements, and bronchopulmonary dysplasia when compared with very-low-birth-weight infants born to mothers with severe hypertension.

Alterations in irregular and fractal heart rate behavior in growth restricted fetuses.

OBJECTIVES: To determine whether irregularity, and short- and long-term fractal correlation reflecting smoothness of heart rate behavior are changed in intrauterine growth restricted fetuses. STUDY DESIGN: Fetal heart rate data of 192 normal fetuses and 86 intrauterine growth restricted fetuses between 31 and 42 weeks of gestation were studied. Approximate entropy to quantify irregularity, and short-term (< or =80 beats, alpha1) and long-term (>80 beats, alpha2) fractal scaling exponents to quantify the short- and long-term fractal correlation were calculated. RESULTS: In the intrauterine growth restricted fetuses, the approximate entropy was significantly lower (P<0.001). The alpha2 value was significantly higher (P=0.0001) than in the normal fetuses, which performed better (F=34.2, P<0.0001) than other heart rate variability indexes in differentiating the intrauterine growth restricted fetuses from the normal fetuses in stepwise discriminant analysis. CONCLUSIONS: Compared to normal fetuses, intrauterine growth restricted fetuses show a difference in that the irregularity of the fetal heart is decreased. A more apparent difference is that the long-term fractal correlation of the fetal heart is increased and the fetal heart is smoother in the long-term scale.

Management of posteriorly dislocated intraocular lens using pars plana vitrectomy.

In order to evaluate the results of pars plana vitrectomy (PPV) for the treatment of posteriorly dislocated intraocular lens (PC-IOL), we retrospectively examined and analyzed the hospital records of patients who had undergone PPV to exchange or reposition a PC-IOL dislocated into the vitreous cavity. Of 20 eyes in 20 patients, IOL exchange was performed in 6 eyes, and IOL repositioning in 14 eyes. Posteriorly dislocated IOL occurred in 14 eyes during or within 2 days, and in 6 eyes 6 months after the IOL implantation. Thirteen eyes were surgically treated early after the occurrence, within 3 days, while 7 eyes were treated later, between 5 to 7 days. Compared with preoperative best-corrected visual acuity, the final visual acuity improved more than 2 lines in 12 eyes. With no significant difference on the statistics, earlier visual rehabilitation seemed to be shown in late-treated patients than in early-treated. Accordingly, a posterior dislocation of IOL can be successfully treated with PPV, and barring any serious complications such as retinal detachment, there is no need for surgery immediately following the occurrence.

Nosocomial respiratory syncytial virus infection in a newborn nursery.

Respiratory syncytial virus (RSV) has been recognized as a major nosocomial hazard on pediatric wards, but symptomatic RSV infection is uncommon during the first four weeks of life. We report here four cases of neonatal RSV infection in a special-care newborn nursery and two of them probably acquired the infection nosocomially. By rapid diagnosis using immunofluorescent technique and early implementation of infection control measures, we were able to prevent further spread of RSV infection.

Hypogastric arterial-vaginal fistula following multiple surgeries and pelvic radiotherapy.

A patient with recurrent sigmoid colon cancer developed an arterial-vaginal fistula after multiple surgeries and postoperative radiotherapy. Angiography revealed a fistula between the hypogastric artery and vaginal wall. Gelfoam and coil embolization controlled the hemorrhage and she recovered without incident. This case illustrates development of malignant fistula and intervention with embolization in a patient with multiple surgeries and postoperative irradiation in the pelvis.

Effects of maternal preeclampsia on brain-stem auditory evoked response in very low birth weight infants.

OBJECTIVE: Because stress in utero may enhance neuromotor maturation, we hypothesized that infants born to mothers with preeclampsia would have a shorter absolute latency V and interpeak latency I-V period (brain-stem conduction time) of brain-stem auditory evoked response (BAER) than infants born to normotensive mothers. STUDY DESIGN: A retrospective cohort study was performed to assess the effects of maternal preeclampsia on BAER of very low birth weight infants. The cohort consisted of 24 infants with a birth weight less than 1251 gm born to mothers with preeclampsia, and 48 infants born to normotensive mothers, matched for birth date within 2 months, gestational age, and chronologic age at the time of the BAER test. The BAER test was completed before discharge, with the infant in a quiet state and the use of a 30 dB stimulus. RESULTS: The mean latencies of wave V were shortened bilaterally (left 8.60 +/- 0.6 msec vs 9.02 +/- 0.6 msec, p < 0.008; right 8.61 +/- 0.6 msec vs 8.96 +/- 0.6 msec, p < 0.033, and the interpeak latency of I-V was significantly shortened compared with the control subjects on the left (left 4.91 +/- 0.5 msec vs 5.38 +/- 0.6 msec, p < 0.003; right 5.17 +/- 0.5 msec vs 5.37 +/- 0.6 msec, not significant). CONCLUSION: These results suggest that the intrauterine stress of maternal preeclampsia accelerates the maturation of the auditory nerve and brain-stem auditory pathway in very low birth weight infants.

Gram-Negative Bacteria in Refrigerated Catfish Fillets Treated with Lactic Culture and Lactic Acid †.

Catfish fillets were treated with combinations of lactic culture ( Lactococcus lactis spp. cremoris ATCC 19257) and lactic acid using a meat tumbler. Fillets were placed individually in Ziploc bags and stored at 4 or 10°C. Counts of gram-negative bacteria on crystal violet tetrazolium chloride agar (CVT), the pH, and the sensory quality of fillets were evaluated after 0, 3, 6, and 9 days of storage time. The combination of 2.5% lactic culture and either 2% lactic acid dip (5 min) or 3% lactic acid dip (1 or 5 min) effectively (P < 0.05) inhibited counts for 9 days. The most effective treatment combination was 2.5% lactic culture incubated for 48 h and 3% lactic acid dip. The pH of samples treated with lactic culture and lactic acid ranged from 5.6 to 6.1 for 9 days at 4 or 10°C Lactic culture and lactic acid combinations extended the refrigerated shelf life of catfish for an additional 3 days at 4 and 10°C and reduced CVT counts by two log cycles over untreated fish. The combination of lactic culture and lactic acid were generally preferred for flavor and odor compared to controls after 6 and 9 days of storage, respectively.

Magnesium is a cerebrovasodilator in newborn piglets.

We tested the hypothesis that, in newborn piglets, magnesium results in a dose-dependent prostanoid-mediated cerebrovasodilation. Pial arterioles (50-200 microns in diameter) were serially measured, and cortical subarachnoid cerebrospinal fluid (CSF) was collected for radioimmunoassay of 6-ketoprostaglandin F1 alpha (6-keto-PGF1 alpha, hydrolysis product of prostacyclin) and thromboxane B2 (TxB2, metabolite of thromboxane A2) before and after CSF containing 1.2, 2.4, 4.8, and 9.6 mM MgCl2 was suffused over the parietal cortex under a closed cranial window in twelve 2- to 4-day-old piglets. Magnesium suffusion resulted (P < 0.05) in a dose-dependent pial arteriolar vasodilation. The increase in vessel diameter was greater (P < 0.001) with 2.4, 4.8, and 9.6 mM than with 1.2 mM concentration of magnesium. The increase in vessel diameter with 9.6 mM was also greater (P < 0.001) than with the 2.4 mM concentration of magnesium. Magnesium suffusion did not result in changes in cortical CSF prostanoid concentrations. The effect of intravenous indomethacin (5 mg/kg) on cyclooxygenase inhibition in the pial arterioles was confirmed by a 24 +/- 3% decrease in vessel diameter at the baseline (1.2 mM) magnesium concentration. In contrast, cyclooxygenase inhibition with intravenous indomethacin did not attenuate the magnesium-induced cerebrovasodilation. We conclude that in new born piglets magnesium suffusion over the parietal cortex results in a dose-dependent cerebrovasodilation that is most likely not mediated by prostanoids.

Localization of the apex of the vagina: implications for radiation therapy planning.

PURPOSE: To evaluate (a) the displacement of the vaginal apex by a rod during radiation therapy simulation for gynecologic malignancy and (b) apical localization with implanted radiopaque markers. MATERIALS AND METHODS: Metallic markers were implanted in the cervix or vaginal cuff in nine patients with cervical or endometrial carcinoma who underwent irradiation. In all but one patient, radiographs were obtained with and then without the vaginal rod. Displacement of the markers relative to bone landmarks was measured. The total displacement was the square root of the sum of the squares of displacement in each axial direction. RESULTS: All patients showed displacement of the cervical markers by the vaginal rod (mean total displacement, 1.9 cm; range, 0.6-3.6 cm). The greatest displacement was cephalic (mean, 1.5 cm; range, 0.5-2.4 cm). Anteroposterior displacement occurred in all patients but was not as predictable as cephalic displacement. Displacement was anterior in five of the eight patients, posterior in three patients, and lateral in four patients. CONCLUSION: Displacement of the vaginal apex and/or cervix with placement of the vaginal rod during simulation was marked in all patients. Use of implanted cervical markers to localize the vaginal apex or the cervix during simulation is more accurate than use of a vaginal rod.

Intestinal variant of ovarian endodermal sinus tumor.

A case of ovarian endodermal sinus tumor (EST) with exclusive intestinal differentiation in a 28-year-old black woman is reported. The tumor cells form irregular glands with focal early Paneth cell differentiation resembling intestinal Luberkuhn's crypts. Clinical and pathological features as well as immunohistochemical findings are described.

Alteration of Ca2+ release channel function in sarcoplasmic reticulum of pressure-overload-induced hypertrophic rat heart.

The effects of pressure-overload left ventricular hypertrophy on the Ca2+ release channel in sarcoplasmic reticulum (SR) were studied by [3H]ryanodine binding and 45Ca2+ flux measurements. The density of Ca2+ release channel in left ventricle determined by equilibrium [3H]ryanodine binding to whole homogenates was significantly lower in hypertrophy than sham (Bmax: 0.47 +/- 0.04 v 0.72 +/- 0.10 pmol/mg protein), whereas total number of Ca2+ release channels in whole left ventricle was similar in the two groups. Ryanodine binding to SR vesicles isolated by differential centrifugation was also similar in the two groups, but the SR yield was less in the hypertrophied left ventricle. The Ca2+ release channels in hypertrophied left ventricles showed a significantly increased sensitivity to Ca2+ release agonists (e.g. caffeine and doxorubicin), as characterized by the effects of these agonists on ryanodine binding to whole homogenates and Ca2+ release from isolated SR. These results indicate that pressure-overload left ventricular hypertrophy is associated with both qualitative and quantitative changes in Ca2+ release channel function.

ECP level in nasopharyngeal secretions and serum from children with respiratory virus infections and asthmatic children.

Infection with respiratory virus has been shown to exacerbate asthma in humans. However, the role of a respiratory virus in the pathogenesis of chronic asthma and/or wheezing in young children has not been clearly defined. It has also been debated whether virus-induced wheezing in young children is one entity and allergic asthma another, or whether they are different expressions of the same disease. The present study was done to compare ECP concentrations in nasopharyngeal secretions and serum from 32 nonasthmatic wheezing children with viral infections (RSV in 15 children; influenza B virus in 17 children detected by immunofluorescence antibody technique), 8 asthmatic children without viral infections, and 13 normal children as the controls to understand the role of eosinophil inflammation. The geometric mean of ECP in nasopharyngeal secretions was significantly higher in asthmatic children than in children with virus-induced wheezing (p < 0.05). ECP levels of nasopharyngeal secretions from children with the virus-induced wheezing were significantly greater than those of the controls. However, there were no significant differences in ECP levels in serum among subjects.

Differential TCR signaling regulates apoptosis and immunopathology during antigen responses in vivo.

Clonal selection theories postulate that lymphocyte fate is regulated by antigen receptor specificity. However, lymphocyte apoptosis is induced through nonantigen-specific receptors such as Fas (CD95/APO-1) or TNFR. We define a selective TCR that controls apoptosis by Fas or TNFR stimulation. Variant ligands can deliver this "competence to die" signal without the full TCR signals necessary for cytokine synthesis. These partial agonists regulate T cell deletion in vivo even when Fas or TNF is provided by T cells of unrelated specificity, but they do not cause the liver necrosis that is associated with T cell elimination by the full agonist. Thus, selective signaling ligands regulate T cell deletion and immune damage in vivo and may be important for peripheral T cell tolerance.

Analysis of induced sputum to examine the effects of inhaled corticosteroid on airway inflammation in children with asthma.

BACKGROUND: Analysis of induced sputum can be performed safely in children with asthma and is useful for both cellular and biochemical markers of inflammation. Glucocorticosteroid inhalation has become the first line therapy for chronic asthma by suppressing airway inflammation, which produces the decrease of bronchial hyperreactivity and reduces the number of eosinophil in bronchial submucosa. OBJECTIVE: To determine the characteristics of the inflammatory cells and their markers in sputum and to examine the pharmacokinetic effects of glucocorticoid within 3 hours after inhalation therapy on FEV1 and sputum inflammatory indices in children with clinically defined chronic asthma. METHODS: Thirty subjects with asthma included 14 current symptomatic asthmatics and 14 normal controls inhaled 4.5% hypertonic saline for 10 minutes by nebulizer. The expectorated sputum were collected from all asthmatics before and 3 hours after corticosteroid inhalation for children with asthma and were reduced by dithiotreitol. Total cell counts and differentials were determined. ECP was measured by CAP system. Interleukin-5, GM-CSF and albumin were measured by double sandwich ELISA. RESULTS: The mean eosinophil percentage and ECP in induced sputum of asthmatics were significantly higher than that of controls. The induced sputum samples obtained after glucocorticoid inhalation showed a significant reduction in mean eosinophil percentage, but FEV1, IL-5, GM-CSF, albumin, and ECP values were not significantly decreased. CONCLUSION: The present results in induced sputum may be interpreted to reflect direct steroid action on airways and lack of effect on bone marrow effectors at 3 hours after glucocorticoid inhalation.

cDNA cloning and antibacterial activities of cecropin D-like peptides from Agrius convolvuli.

We have characterized full-length cDNAs encoding two isoforms of agriusin, cecropin D-like antibacterial peptide, present in the hemolymph of the immunized Agrius convolvuli larvae. The cloned cDNAs of agriusins 1 and 2 contain 331 and 329 bp, respectively. The nucleotide sequencing of cDNAs showed that they encode 62 amino acids, whose mature portion was deduced to consist of 38 amino acid residues with over 94% sequence identity. In the sequence homology search, mature agriusin 1 showed over 86 and 71% amino acid sequence homology with bactericidin 4 from Manduca sexta and cecropin D from Hyalophora cecropia, respectively. Since it was demonstrated from the deduced amino acid sequences that the C-terminal residues of agriusins are followed by a Gly residue, two types of synthetic agriusin 1 (syn-agriusin 1 amide and acid) were prepared to verify if natural agriusin 1 is C-terminally amidated. From acid-urea PAGE and reversed phase HPLC profiles to compare two synthetic peptides, we could confirm that the C-terminal amino acid residue of natural agriusin 1, like several cecropins so far identified, is amidated. Finally, our antibacterial assay performed with two syn-agriusins 1 revealed that there is little difference between antibacterial activities of both peptides against Gram-positive and Gram-negative bacteria.