Proteases associated with gynecological tumors

Proteases are involved in the invasion and metastasis of tumours by destruction of the basal membrane and connective tissue. As levels in malignant tissue have both prognostic and therapeutic implications, we examined 318 frozen samples from malignant tumours and comparable non-malignant tissue looking for urokinase plasminogen activator (uPA), tissue plasminogen activator (tPA), and plasminogen activator inhibitor-1 (PAI-1) levels with ELISA, as well as cathepsin D with RIA. Oestrogen receptor (ER) levels, progesterone receptor (PrgR) levels and epidermal growth factor receptors (EGFR) were measured by biochemical methods at the same time. Significantly raised levels of uPA, PAI-1 and cathepsin D were found in malignant tissue, with PAI-1 particularly high in carcinoma of the cervix. Significantly raised tPA levels were found in breast cancer tissue with a more favourable clinical prognosis, with a positive correlation between tPA and ER. No correlation could be shown between uPA, PAI-1 and cathepsin D with other prognostic factors for breast cancer. It could be that routine, uncomplicated estimation of tumour-associated proteases such as uPA, tPA, PAI-1 and cathepsin D will provide an independent prognostic marker for therapeutic decisions with regard to gynaecological tumours and breast cancer.

Biochemical and immunohistochemical detection of the epidermal growth-factor receptor (EGF-R) in breast-tumor specimens

Analyses of the level of expression of the epidermal growth factor receptor (EGF-R) of breast cancer tumors may add independent information about the prognosis of individual patients. Furthermore, the use of monoclonal antibodies directed against EGF-R as therapeutic tools (e.g., Mab 425) requires a reliable evaluation of the individual EGF-R content. Various analytical methods have been published, including (Scarff RW and Torloni H: World Health Organization, Geneva, 1968), biochemical detection of EGF-R by a radiolabeled physiologic ligand [I-125]EGF, (Early Breast Cancer Trialists' Collaborative Group: Lancet 329: 1-15, 1992) biochemical analyses of EGF-R content with a monoclonal antibody, and (McGuire WL and Clark GM: N Engl J Med 326: 1756-1761, 1992) immunohistochemical EGF-R detection. We measured the EGF-R content in membrane pellets derived from routine processing for evaluation of estrogen (ER, ER-EIA) and progesterone receptor (PgR; PgR-EIA) in 185 breast cancers and 18 benign breast samples, using a single-point saturation assay (RBA). Simultaneously, ER (ER-ICA), PgR (PgR-ICA), and EGF-R immunohistochemistry was performed on frozen sections of the same tumors. Various cell lines and normal skin tissue samples served as EGF-R positive or negative controls. The results of the two different EGF-R analyzing methods were compared with other biological characteristics of the tumors. 37% of the tumors were EGF-R positive. There was an inverse correlation between the ER or PgR and the EGF-R content. EGF-R overexpression correlated with high tumor grade. Analyses of EGF-R content in membrane pellets of breast cancer samples by single point saturation assay as well as the evaluation of tumor sections by immunohistochemistry can be performed routinely. The results obtained with both analytical methods did not differ significantly. but the immunohistochemistry proved to be more difficult to perform and to interpret. Thus, we prefer to perform both analytical methods simultaneously to provide information potentially useful for clinical management of individual cancer patients.

Comparison of a single vs. a four intradermal sterile water injection for relief of lower back pain for women in labour: a randomised controlled trial

OBJECTIVE

sterile water injections are a simple, safe, effective, non-pharmacological technique for relieving back pain in labour, however the number of injections required to achieve optimal analgesia is unknown. The objective of this trial was to evaluate the degree and duration of analgesia provided by a single injection of sterile water, compared to four injections.

DESIGN

randomised controlled non-inferiority trial.

PARTICIPANTS AND SETTING

three hundred and five women in labour at term, requesting analgesia for back pain were recruited from two metropolitan hospitals in Brisbane, Australia.

INTERVENTION

participants were randomly assigned to receive either one (n=147) or four (n=158) sterile water injections.

OUTCOME MEASURES

difference in self-reported pain measured using a visual analogue scale (VAS) between baseline and 30 mins post-intervention. The clinically acceptable margin of difference was defined as ≤ 1 cm on the VAS between the single injection compared to four injection technique. Secondary outcomes include VAS score on injection and 10, 60, 90 and 120 mins post-intervention, analgesia use, mode of birth and maternal satisfaction.

FINDINGS

the mean difference in the pre and post (30 mins) injection scores between two groups was -1.48 cm (95% CI -2.10, -0.86) in favour of the FI technique, however the injection pain associated with the FI was significantly greater than that of the SI technique (p<0.001). There were no significant differences between the two groups in terms of other analgesic use, mode of birth or maternal satisfaction.

CONCLUSION

the four injection technique was associated with increased level of analgesia at 30 mins post-intervention compared to the single injection, but also a greater degree of injection pain.

Mode of anaesthetic for category 1 caesarean sections and neonatal outcomes

BACKGROUND

Birth by emergency caesarean section (CS) is common and often considered urgent (category 1). In the UK, over half of all category 1 CS are performed under general anaesthesia (GA). In this setting, little is known about the effect of the mode of anaesthesia on the neonate.

METHODS

A retrospective cohort study was performed using routinely collected de-identified data from Mater Health Services, Brisbane, Australia. The data set included 533 term babies born by category 1 CS for presumed fetal compromise between 2008 and 2011. Bivariate and multivariate analyses were undertaken.

RESULTS

The outcomes of 81 babies born by GA CS were compared with 452 by CS under regional anaesthesia (RA). Compared with a category 1 CS under RA, the decision-to-delivery interval for a GA CS was almost eight minutes faster (24.7 vs 32.6 minutes; P < 0.001). When adjusted for confounders, babies born by category 1 GA CS were significantly more likely to have an Apgar score < 7 at five minutes (aOR 6.89; 95%CI 1.79-26.55; P = 0.005), to require Neopuff or bag/mask ventilation for > 60 seconds (aOR 2.34; 95%CI 1.13-4.84; P = 0.022) and to be admitted to a neonatal intensive care nursery (aOR 2.24; 95%CI 1.16-4.31; P = 0.016).

CONCLUSIONS

General anaesthesia was associated with short-term neonatal morbidity of term babies born by category 1 CS for presumed fetal compromise, despite enabling a more rapid delivery of the baby. These data should help inform the discussion between anaesthetist and obstetrician, in balancing the risks and benefits of the mode of anaesthesia.

Criteria for solid recovered fuels as a substitute for fossil fuels--a review

The waste treatment, particularly the thermal treatment of waste has changed fundamentally in the last 20 years, i.e. from facilities solely dedicated to the thermal treatment of waste to facilities, which in addition to that ensure the safe plant operation and fulfill very ambitious criteria regarding emission reduction, resource recovery and energy efficiency as well. Therefore this contributes to the economic use of raw materials and due to the energy recovered from waste also to the energy provision. The development described had the consequence that waste and solid recovered fuels (SRF) has to be evaluated based on fuel criteria as well. Fossil fuels - coal, crude oil, natural gas etc. have been extensively investigated due to their application in plants for energy conversion and also due to their use in the primary industry. Thereby depending on the respective processes, criteria on fuel technical properties can be derived. The methods for engineering analysis of regular fuels (fossil fuels) can be transferred only partially to SRF. For this reason methods are being developed or adapted to current analytical methods for the characterization of SRF. In this paper the possibilities of the energetic utilization of SRF and the characterization of SRF before and during the energetic utilization will be discussed.

Term stillbirth in older women

Increasing numbers of women are choosing to delay pregnancy. Pregnancy in older women is associated with increased risks, of which stillbirth is one of the most devastating. This retrospective cohort study reviewed the obstetric outcomes in women aged 40 and above over an 11-year period to determine whether maternal age is an independent risk factor for term stillbirth. The study shows that advanced maternal age is an independent risk factor for term stillbirth (odds ratio 2.42, 95% confidence interval 1.04-5.62).

Recent cessation of smoking and its effect on pregnancy outcomes

BACKGROUND

Smoking in pregnancy is associated with a range of adverse pregnancy outcomes.

AIM

To compare adverse pregnancy outcomes for women according to smoking status at the first antenatal visit in an Australian setting.

METHODS

A retrospective study using routinely collected data of all births between 1997 and 2006 at the Mater Mothers' Hospital Brisbane (MMH). Analysis was undertaken using multivariate logistic regression. The following comparisons were undertaken: (i) smokers versus non-smokers; (ii) recent quitters (quit within the last 12 months) versus smokers; and (iii) recent quitters versus non-smokers. Primary outcome measures were small for gestational age (SGA) <10th customised centile and preterm birth (PTB) <37 weeks.

RESULTS

Between 1997 and 2006, 40,193 women birthed at the MMH. Of these 30,524 (75.9%), for which adequate data were available, were included in the study. The smoking rate at booking was 15.4%. Compared to non-smokers (n = 25,814), women who were smoking at the first visit (n = 4710) were at increased risk of SGA (aOR = 2.26, 95%CI = 2.08-2.47) and PTB (aOR = 1.42, 95%CI = 1.27-1.59). In the subset (7801 births) used for comparisons two and three, compared to smokers (n = 1434), recent quitters (n = 945) were at a decreased risk of SGA (aOR = 0.43, 95%CI = 0.33-0.57) but not PTB (aOR = 0.92. 95%CI = 0.69-1.23). Outcomes for recent quitters and non-smokers (n = 5422) appeared similar.

CONCLUSION

This study confirms the increased risk of continued smoking in pregnancy. Women who quit prior to or during early pregnancy appear to have similar risk to that of non-smokers.

Midwifery group practice and mode of birth

BACKGROUND

Midwifery-led models of care, specifically Midwifery Group Practices (MGPs), have been promoted as one way to address the increasing caesarean rate. Whilst women report a high level of satisfaction, and experience lower rates of induction and epidural analgesia, a Cochrane review reported no differences in mode of birth.

METHOD

A retrospective cohort study was performed using routinely collected de-identified data of all term births between 2006 and 2010. Outcomes for 1545 women under MGP model were compared with 13,880 women cared for in all other models. Primary outcome measure was unassisted vaginal birth. Predictors investigated were model of care, induction and epidural analgesia. Both bivariate analysis and multivariate logistic regression analysis was undertaken (controlling for important confounders) with adjusted odds ratios (aOR) and 95% confidence intervals (CI) presented.

FINDINGS

Significant differences were demonstrated in the demographic and clinical characteristics of the groups. Compared with those in other models of care, women in MGP care had similar rates of induction but significantly fewer received epidural analgesia (28.4% vs 33.5%; p<0.001). There was no difference in the mode of birth. When adjusted for confounders, women in MGP care were no more or less likely to have an unassisted vaginal birth (aOR 1.07; 95% CI 0.92-1.24; p=0.397), birth assisted by instrument (aOR 1.02; 95% CI 0.86-1.21; p=0.852) or emergency caesarean section (aOR 0.89; 95% CI 0.74-1.06; p=0.193). However, in the subgroup of women who did not receive epidural analgesia, women in MGP care had an increased likelihood of an unassisted vaginal birth (aOR 1.29; 95% CI 1.06-1.58; p=0.013).

CONCLUSION

Women in MGP care are no more or less likely to have an unassisted vaginal birth.