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To explore the long-term (perceived) consequences of (severe pre-)eclampsia in rural Tanzania.Women were traced for this mixed-methods study 6-7 years after the diagnosis of (severe pre-)eclampsia. Demographic and obstetric characteristics were noted, and blood pressure was recorded. Questionnaires were used to assess physical and mental health. The qualitative part consisted of semi-structured interviews (SSI). A reference group consisted of women without hypertensive disorders of pregnancy.Of 74 patients, 25 (34%) were available for follow-up, and 24 were included. Five (20%) had suffered from (pre-)eclampsia twice. Hypertension was more common after (pre-)eclampsia than in the reference group (29% vs. 13%). Thirteen women (56%) had feelings of anxiety and depression, compared to 30% in the reference group. In SSIs, experiences during the index pregnancy were explored, as well as body functions, reproductive life course and limitations in daily functioning, which were shown to be long-lasting.Women who suffered from (severe pre-)eclampsia may experience long-term sequelae, including hypertension, depression and anxiety. Women lack information about their condition, and some are worried to conceive again. To address their specific needs, a strategy along the continuum of care is needed for women following a complicated pregnancy, starting with a late postnatal care visit 6 weeks after giving birth.Explorer les conséquences à long terme (perçues) de la (sévère pré-) éclampsie en zone rurale, en Tanzanie. MÉTHODES: Les femmes ont été suivies pour cette étude à méthodes mixtes durant 6 à 7 ans après le diagnostic de (sévère pré-) éclampsie. Les caractéristiques démographiques et obstétriques ont été notées et la pression artérielle a été enregistrée. Des questionnaires ont été utilisés pour évaluer la santé physique et mentale. La partie qualitative consistait en des entretiens semi-structurés (ESS). Un groupe de référence était composé de femmes sans troubles hypertensifs de la grossesse. RÉSULTATS: Sur 74 patientes, 25 (34%) étaient disponibles pour le suivi et 24 ont été incluses. Cinq (20%) avaient souffert de (pré-) éclampsie à deux reprises. L'hypertension était plus fréquente après la (pré-) éclampsie que dans le groupe de référence (29% vs 13%). Treize femmes (56%) avaient des sensations d'anxiété et de dépression, contre 30% dans le groupe de référence. Dans les ESS, les expériences au cours de la grossesse indice ont été explorées, ainsi que les fonctions corporelles, le cours de la vie reproductive et les limitations du fonctionnement quotidien, qui se sont révélées durables.Les femmes qui ont souffert de (sévère pré-) éclampsie pourraient éprouver des séquelles à long terme, y compris l'hypertension, la dépression et l'anxiété. Les femmes manquent d'informations sur leur état et certaines ont peur de concevoir à nouveau. Pour répondre à leurs besoins spécifiques, une stratégie tout au long du continuum des soins est nécessaire pour les femmes à la suite d’une grossesse compliquée, en commençant par une visite de soins postnatals tardive six semaines après l'accouchement.

Background The worldwide incidence of birth by Caesarean Section (CS) is rising. Many births after a previous CS are by repeat surgery, either by an elective CS or after a failed trial of labour. Adhesion formation is associated with increased maternal morbidity in patients with repeat CSs. In spite of large-scale studies the relation between the incidence of adhesion formation and CS surgical technique is unclear. This study aims to assess maternal and neonatal morbidity and mortality after repeat CSs in a rural hospital in a low-income country (LIC) and to analyse the effect of surgical technique on the formation of adhesions. Methods A cross-sectional, retrospective medical records study of all women undergoing CS in Ndala Hospital in 2011 and 2012. Results Of the 3966 births, 450 were by CS (11.3%), of which 321 were 1st CS, 80 2nd CS, 36 3rd CS, 12 4th and one 5th CS (71, 18, 8, 3 and 0.2% respectively). Adhesions were considered to be severe in 56% of second CSs and 64% of third CSs. In 2nd CSs, adhesions were not associated with closure of the peritoneum at 1st CS, but were associated with the prior use of a midline skin incision. There was no increase in maternal morbidity when severe adhesions were present. Adverse neonatal outcome was more prevalent when severe adhesions were present, but this was statistically non-significant (16% vs 6%). Conclusions Our results give insight into the practice of repeat CS in our rural hospital. Adhesions after CSs are common and occur more frequently after midline skin incision at 1st CS compared to a transverse incision. Reviewing local data is important to evaluate quality of care and to compare local outcomes to the literature.

Contains fulltext : 177902.pdf (Publisher’s version ) (Open Access) The purpose of this study is to explore and quantify perceptions and experiences of women with a traumatic childbirth experience in order to identify areas for prevention and to help midwives and obstetricians improve woman-centered care. A retrospective survey was conducted online among 2192 women with a self-reported traumatic childbirth experience. Women were recruited in March 2016 through social media, including specific parent support groups. They filled out a 35-item questionnaire of which the most important items were (1) self-reported attributions of the trauma and how they believe the traumatic experience could have been prevented (2) by the caregivers or (3) by themselves. The responses most frequently given were (1) Lack and/or loss of control (54.6%), Fear for baby's health/life (49.9%), and High intensity of pain/physical discomfort (47.4%); (2) Communicate/explain (39.1%), Listen to me (more) (36.9%), and Support me (more/better) emotionally/practically (29.8%); and (3) Nothing (37.0%), Ask for (26.9%), or Refuse (16.5%) certain interventions. Primiparous participants chose High intensity of pain/physical discomfort, Long duration of delivery, and Discrepancy between expectations and reality more often and Fear for own health/life, A bad outcome, and Delivery went too fast less often than multiparous participants. Women attribute their traumatic childbirth experience primarily to lack and/or loss of control, issues of communication, and practical/emotional support. They believe that in many cases, their trauma could have been reduced or prevented by better communication and support by their caregiver or if they themselves had asked for or refused interventions.

Background: Both induction of labour at 41 weeks and expectant management until 42 weeks are common management strategies in low-risk pregnancy since there is no consensus on the optimal timing of induction in late-term pregnancy for the prevention of adverse outcomes. Our aim was to explore maternal preference for either strategy and the influence on quality of life and maternal anxiety on this preference. Methods: Obstetrical low-risk women with an uncomplicated pregnancy were eligible when they reached a gestational age of 41 weeks. They were asked to fill in questionnaires on quality of life (EQ6D) and anxiety (STAI-state). Reasons of women's preferences for either induction or expectant management were explored in a semi-structured questionnaire containing open ended questions. Results: Of 782 invited women 604 (77.2%) responded. Induction at 41 weeks was preferred by 44.7% (270/604) women, 42.1% (254/604) preferred expectant management until 42 weeks, while 12.2% (74/604) of women did not have a preference. Women preferring induction reported significantly more problems regarding quality of life and were more anxious than women preferring expectant management (p < 0.001). Main reasons for preferring induction of labour were: “safe feeling” (41.2%), “pregnancy taking too long” (35.4%) and “knowing what to expect” (18.6%). For women preferring expectant management, the main reason was “wish to give birth as natural as possible” (80.3%). Conclusion: Women's preference for induction of labour or a policy of expectant management in late-term pregnancy is influenced by anxiety, quality of life problems (induction), the presence of a wish for natural birth (expectant management), and a variety of additional reasons. This variation in preferences and motivations suggests that there is room for shared decision making in the management of late-term pregnancy.

A new model of antenatal care to manage pregnant women with iron deficiency anemia at public health centers in Indonesia has been studied. This study aimed to explore the facilitators and the barriers of this new model introduction by using focus group discussions to nurse-midwives and nurse-midwife coordinators. Training and information booklets, the improved confidence in providing comprehensive care, and adequate support from supervisors were perceived as facilitators of the new model. Financial support and public transportation necessary to reach the optimum treatment according to the new model, limited health insurance coverage, and shortage of staff and iron tablets were the barriers. Similar barriers should be anticipated for further implementation. A lasting support of policy and decision makers therefore is essential.

Background Shared decision-making (SDM) is an important aspect of modern health care. Many studies evaluated different interventions to improve SDM, however, none in an inpatient clinical setting. A tool that has been proven effective in an outpatient department is the three questions intervention. These questions are created for patients to get optimal information from their medical team and to make an informed medical decision. In this study, we evaluated the feasibility and effectiveness of this simple intervention on SDM in the obstetric inpatient department of a university hospital in the Netherlands. Method This is a clinical pilot before and after study, using mixed methods with quantitative and qualitative data collection. The three questions were stated on a card; (i.e. 1) What are my options; 2) What are the possible benefits and harms of those options; 3) How likely are each of those benefits and harms to happen to me?). The study period lasted 6 weeks in which all patients admitted to the obstetric ward were asked to participate in the study. In the first 3 weeks patients did not receive the three questions intervention (pre-intervention group). In the final 3 weeks all patients included received the intervention (intervention group). The main quantitative outcome measure was the level of SDM measured using the SDM-Q9 questionnaire at discharge (range 0–100). In addition, interviews with four patients of the intervention group were conducted and qualitatively analyzed. Results Thirty-three patients were included in the pre-intervention group, 29 patients in the intervention group. The mean score of the SDM-Q9 in the pre-intervention group was 65.5 (SD 22.83) and in the intervention group 63.2 (SD 20.21), a not statistically significant difference. In the interviews, patients reported the three questions to be very useful. They used the questions mainly as a prompt and encouragement to ask more specific questions. Discussion No difference in SDM was found between the two groups, possibly because of a small sample size. Yet the intervention appeared to be feasible and simple to use in an inpatient department. Further studies are needed to evaluate the impact of implementation of these three questions on a larger scale. Electronic supplementary material The online version of this article (10.1186/s12884-018-1921-z) contains supplementary material, which is available to authorized users.

Routinely collected registration data are an efficient source for conducting research. In particular, they are useful for studies with rare outcomes, as these require large sample sizes, which are difficult to obtain through targeted data collection. Registration data are often used to compare severe, adverse maternal and perinatal outcomes in different birth settings. However, registration data are primarily recorded for purposes other than research, such as supporting care processes. Subsequently, if these data are used for scientific studies, the analyses are, by definition, ‘secondary’ and therefore are likely to have more limitations compared to prospectively and purposely collected research data. We want to show how some of these limitations can lead to erroneous conclusions, using the Dutch perinatal register as an example. This may help researchers to avoid some of the pitfalls of using register based data and help service users, professionals and policy makers to recognise these limitations when interpreting study findings. This article is protected by copyright. All rights reserved.

Contains fulltext : 117640.pdf (Publisher’s version ) (Open Access) OBJECTIVES: To test the hypothesis that low risk women at the onset of labour with planned home birth have a higher rate of severe acute maternal morbidity than women with planned hospital birth, and to compare the rate of postpartum haemorrhage and manual removal of placenta. DESIGN: Cohort study using a linked dataset. SETTING: Information on all cases of severe acute maternal morbidity in the Netherlands collected by the national study into ethnic determinants of maternal morbidity in the netherlands (LEMMoN study), 1 August 2004 to 1 August 2006, merged with data from the Netherlands perinatal register of all births occurring during the same period. PARTICIPANTS: 146 752 low risk women in primary care at the onset of labour. MAIN OUTCOME MEASURES: Severe acute maternal morbidity (admission to an intensive care unit, eclampsia, blood transfusion of four or more packed cells, and other serious events), postpartum haemorrhage, and manual removal of placenta. RESULTS: Overall, 92 333 (62.9%) women had a planned home birth and 54 419 (37.1%) a planned hospital birth. The rate of severe acute maternal morbidity among planned primary care births was 2.0 per 1000 births. For nulliparous women the rate for planned home versus planned hospital birth was 2.3 versus 3.1 per 1000 births (adjusted odds ratio 0.77, 95% confidence interval 0.56 to 1.06), relative risk reduction 25.7% (95% confidence interval -0.1% to 53.5%), the rate of postpartum haemorrhage was 43.1 versus 43.3 (0.92, 0.85 to 1.00 and 0.5%, -6.8% to 7.9%), and the rate of manual removal of placenta was 29.0 versus 29.8 (0.91, 0.83 to 1.00 and 2.8%, -6.1% to 11.8%). For parous women the rate of severe acute maternal morbidity for planned home versus planned hospital birth was 1.0 versus 2.3 per 1000 births (0.43, 0.29 to 0.63 and 58.3%, 33.2% to 87.5%), the rate of postpartum haemorrhage was 19.6 versus 37.6 (0.50, 0.46 to 0.55 and 47.9%, 41.2% to 54.7%), and the rate of manual removal of placenta was 8.5 versus 19.6 (0.41, 0.36 to 0.47 and 56.9%, 47.9% to 66.3%). CONCLUSIONS: Low risk women in primary care at the onset of labour with planned home birth had lower rates of severe acute maternal morbidity, postpartum haemorrhage, and manual removal of placenta than those with planned hospital birth. For parous women these differences were statistically significant. Absolute risks were small in both groups. There was no evidence that planned home birth among low risk women leads to an increased risk of severe adverse maternal outcomes in a maternity care system with well trained midwives and a good referral and transportation system.

Iron oxide-based catalysts supported on titania and zirconia have been investigated as alternatives for the currently used bulk iron oxide dehydrogenation catalysts. The present study focuses on titania-supported catalysts. Catalyst samples were prepared by pore-volume impregnation of commercially available pre-shaped support bodies with solutions of various iron precursor compounds. Transmission electron microscopy (TEM) and temperature-programmed reduction (TPR) revealed that the best microscopic distribution is achieved with ammonium iron citrate. X-ray diffraction (XRD) showed a difference between the investigated supports: on rutile TiO2, iron was present as hematite (Fe2O3), whereas on anatase, pseudobrookite (Fe2TiO5) was formed. When testing the catalytic activity in but-1-ene dehydrogenation, rapid deactivation was observed which could not be prevented by using a catalyst containing potassium. Without potassium, deactivation is attributed to the formation of ilmenite, FeTiO3. With potassium, the iron oxide phase reacts with both potassium and TiO2, which diminishes the activity which initially was present in catalysts without potassium. When a more inert support is used, viz. ZrO2, no solid state reaction is observed, and a stable catalyst is obtained.

Please cite this paper as: van Dillen J, Mesman J, Zwart J, Bloemenkamp K, van Roosmalen J. Introducing maternal morbidity audit in the Netherlands. BJOG 2010;117:416–421. Objective To describe the panel audit process and to identify substandard care in selected women from a nationwide prospective cohort study into severe acute maternal morbidity (SAMM) in the Netherlands. Design Prospective audit of selected women with SAMM. Setting Eight audit meetings held throughout the Netherlands. Population All pregnant women in the Netherlands. Methods Before each meeting, SAMM details of selected women were sent to all panel members for individual assessment by completing an audit form. During a subsequent plenary meeting, findings were discussed and substandard care factors as judged by the majority of assessors were scored. Main outcome measures Incidence of substandard care and recommendations for improving the quality of care. Results Substandard care was identified in 53 of 67 women (79%). Specific recommendations were formulated concerning the procedure of audit and concerning local as well as national management guidelines. Conclusion Our findings reflect SAMM in the Netherlands and substandard care is present in four out of five women. Ongoing audit of women with SAMM is promoted both at local and national level.

Contains fulltext : 171449.pdf (Publisher’s version ) (Open Access) BACKGROUND: Preterm birth is a major cause of neonatal mortality, especially in low and middle income countries. Antenatal corticosteroid therapy for foetal maturation could have a significant impact and therefore is often referred to as an important strategy to reduce neonatal mortality. A recently conducted large multinational trial showed that antenatal corticosteroids can have adverse effects in low income countries, but this is likely to depend on the specific setting. In our hospital preterm birth is only recognized in patients with severe maternal disease, due to physician-initiated delivery. Spontaneous preterm births are rarely seen in the hospital and often take place in the community or while on the road to a health facility. OBJECTIVE: To investigate the effects of antenatal corticosteroid therapy in a rural hospital in Tanzania. METHODS: A secondary analysis of a retrospective medical records study of women with severe pre-eclampsia and eclampsia performed in Ndala Hospital between July 2011 and December 2012. We used data on gestational age, birth weight, Apgar score, time between admission and birth, use of corticosteroids and maternal and foetal survival. Ethical clearance was obtained from the directorate of research and publications of the University of Dodoma (ref. UDOM/DRP/346). RESULTS: Thirty-six women with forty live foetuses were analysed. Twelve women (13 neonates) were given corticosteroids and could be compared to 24 women (27 neonates) who did not get corticosteroids. The incidence of fresh stillbirths (antenatal death) was 20 %. The 13 neonates who received corticosteroids had significantly smaller birth weight, longer interval between admission and delivery and poorer outcomes (stillbirth and neonatal death). An analysis of 24 neonates with a birth weight between 1.5 and 2.5 kg showed a trend toward better outcome in neonates who did not receive antenatal corticosteroid therapy. CONCLUSION: Small retrospective studies as these have a low level of evidence, but this study helped to gain more knowledge of local conditions affecting the effectiveness of antenatal corticosteroid therapy in our setting of a small rural hospital. Reliability of estimating gestational age, epidemiology of preterm birth, exposure to infections, foetal monitoring and quality of neonatal care are likely to influence the effect of antenatal corticosteroid therapy. Further larger prospective studies should be conducted to determine the exact preconditions of antenatal corticosteroid therapy in low-income countries. Until that time, the WHO precautions seem reasonable and audits and small observational studies like ours can help in assessing whether a specific hospital is suited for antenatal corticosteroid therapy.

The p53 protein is mutated in 50% of all human tumors and plays a key role in apoptosis, cell cycle, and the expression of several genes. We investigated if p53 mutations influence the herpes simplex virus thymidine kinase (HSV-tk)/ganciclovir (GCV)-induced bystander effect (BE). Additionally, we studied some of the underlying mechanisms. GCV sensitivity and BE were studied in a human ovarian carcinoma cell line transfected with an empty vector (A2780/cmv) or a vector containing a p53 hotspot mutation at codon 175 (A2780/m175) or 248 (A2780/m248). In addition, expression levels of two nucleoside analogue transporters, multidrug resistance-related protein 4 and 5 (MRP4/MRP5), were determined. Finally, differences in gap junctional intercellular communication (GJIC) were studied by determining connexin 43 (Cx43) expression and by modulating GJIC with 18-alpha-glycyrrhetinic acid. Our results showed that compared to A2780/cmv, GCV sensitivity was significantly decreased in A2780/m175 and A2780/m248. Additionally, a significant BE (relative increase in cell kill) was found in A2780/cmv and A2780/m248. In contrast, an increased survival was observed in A2780/m175. No MRP4 or MRP5 expression was detected. However, all A2780 cell lines expressed Cx43. Modulating the GJIC significantly decreased the BE in A2780/cmv and A2780/ m248. In conclusion, HSV-tk/GCV-induced BE is influenced by p53 mutations. Differences in GJIC could be one of the underlying mechanisms.

In rats, the relationship between [F-18]FHPG accumulation and HSVtk expression was studied with PET and autoradiography. [F-18]FHPG distribution closely corresponded with HSVtk immunohistochemical staining. ROI analysis of tracer uptake 2 hours p.i. and Patlak graphical analysis were applied to quantify the PET data. For both analysis methods, the [F-18]FHPG PET signal correlated well with the fraction of HSVtk expressing cells implanted, but showed a plateau when plotted against HSVtk protein levels. This might be due to rate limiting [F-18]FHPG membrane transport. (C) 2003 Elsevier Inc. All rights reserved.

In the Netherlands, Streptococcus suis is a rare cause of meningitis. Over the past few years, the number of reported cases worldwide has increased. The bacterium is mainly isolated in pigs, but humans can also become infected.At the Emergency Department, a 60-year-old man presented with headache, confusion, fever and nuchal rigidity. He worked at a meat factory. Laboratory testing showed abnormalities linked to bacterial meningitis. S. suis was cultured from blood and cerebrospinal fluid. The patient was treated with dexamethasone, ceftriaxone and later benzylpenicillin intravenously. He recovered well, but had bilateral perceptive hearing loss as a sequela.Particularly people who are in close contact with pigs have an increased risk of S. suis infection. S. suis meningitis can be very severe and lead to serious complications and even death. Rapid diagnosis and adequate treatment are critical. Permanent hearing loss is the most frequent sequela.

To describe the panel audit process and to identify substandard care in selected women from a nationwide prospective cohort study into severe acute maternal morbidity (SAMM) in the Netherlands.Prospective audit of selected women with SAMM.Eight audit meetings held throughout the Netherlands.All pregnant women in the Netherlands.Before each meeting, SAMM details of selected women were sent to all panel members for individual assessment by completing an audit form. During a subsequent plenary meeting, findings were discussed and substandard care factors as judged by the majority of assessors were scored.Incidence of substandard care and recommendations for improving the quality of care.Substandard care was identified in 53 of 67 women (79%). Specific recommendations were formulated concerning the procedure of audit and concerning local as well as national management guidelines.Our findings reflect SAMM in the Netherlands and substandard care is present in four out of five women. Ongoing audit of women with SAMM is promoted both at local and national level.

Sepsis is a major cause of maternal death worldwide. Little is known on the incidence of severe maternal morbidity related to sepsis. In this review, we focus on new findings concerning epidemiology, etiology and outcome of maternal sepsis in low-income as well as high-income countries.It is estimated that puerperal sepsis causes at least 75,000 maternal deaths every year, mostly in low-income countries. Studies from high-income countries report incidence of maternal morbidity due to sepsis of 0.1-0.6 per 1000 deliveries. The causative microorganisms are generally polymicrobial with beta-haemolytic streptococci group A (GAS) often being the cause of severe cases of puerperal fever. The single most important risk factor for postpartum infection seems to be caesarean section, and prophylactic antibiotics during the procedure substantially reduce the infection risk. Improvements in service provision as promoted through the Surviving Sepsis Campaign can reduce the overall risk of mortality and morbidity from maternal sepsis in high-income as well as in low-income countries.Maternal sepsis is an infrequent, but important complication of pregnancy, childbirth and puerperium, resulting in significant maternal morbidity and mortality worldwide. Improved outcome is possible through improved service provision.

Iron oxide catalysts supported on magnesium oxide have been prepared by impregnation of a preshaped magnesium oxide support to incipient wetness with poorly crystallizing organometallic complexes. As organometallic complexes ammonium iron(III) citrate and ammonium iron(III) EDTA have been used. After impregnation the iron has appeared to be homogeneously distributed throughout the magnesium oxide support bodies. Upon calcination in air, the precursors decompose to form magnesium ferrite at temperatures as low as ca. 800 K. Calcination in air at 973 K results in the formation of small MgFe2O4 crystallites with a typical size of ca. 200 A, as determined by X-ray diffraction and electron microscopy.

The catalytic behaviour of iron oxide catalysts supported on magnesium oxide in the non-oxidative dehydrogenation of but-1-ene to buta-1,3-diene has been studied. Under dehydrogenation conditions the magnesium ferrite phase of the fresh catalyst was found to be reduced to FeO in the bulk of the ferrite particles, where FeO is strongly stabilized by the formation of a solid solution with MgO. At the surface of the particles magnesium ferrite is reduced to Fe3O4. In the reduced state a catalyst containing ca. 3 wt.% Fe shows a but-1-ene conversion of 26% combined with a buta-1,3-diene selectivity of 65% at 873 K. The activation energy for dehydrogenation was found to be 47 kcal mol–1.The (unpromoted) catalyst gradually deactivates owing to carbon deposition. Under dehydrogenation conditions the catalyst surface is completely covered by a layer of amorphous carbon within 20 h.

The reduction behaviour of iron oxide supported on magnesium oxide has been studied using temperature-programmed reduction (TPR), X-ray diffraction (XRD), and high-field magnetic measurements. The catalysts, containing 1–6 wt.% Fe, were prepared by incipient-wetness impregnation of a preshaped magnesium oxide support with organometallic complexes, such as, ammonium iron(III) citrate and ammonium iron(III) EDTA. In the fresh calcined catalyst the iron oxide is present as magnesium ferrite, MgFe2O4. With TPR two broad reduction peaks, reflecting the sequential reduction of Fe3+via Fe2+ to Fe0, were observed. High-field magnetic measurements enabled us to describe the reduction behaviour in detail. In the first reduction step, proceeding at ca. 630 K, MgFe2O4 is reduced to FeO partly via Fe3O4. A second reduction step at 750 K results in the formation of metallic iron. Part of the metallic iron has been found to be present in the form of superparamagnetic particles within the MgO support.

An 82-year-old postmenopausal woman presented with severe clinical hyperandrogenism related to testosterone overproduction, possibly as a result of a mucinous cystadenoma. The cystadenoma was successfully removed in toto. The patient was discharged in good health. Plasma testosterone levels normalised 6 weeks after surgery. Ovarian mucinous cystadenomas are a rare cause ofhyperandrogenism.

Reducing child and maternal mortality are important UN Millennium Development Goals. The AIDS epidemic, which is targeted in another Millennium Development Goal, has a negative influence on child and maternal health. Although on a mondial level, the influence of HIV/AIDS on child and maternal mortality appears to be slight, HIV/AIDS constitutes a significant factor in Sub-Saharan Africa. In the Netherlands, the introduction of aggressive antiretroviral therapy has reduced the chance of vertical transmission to1%. In low-wage countries, financial means and political commitment for similar handling are lacking. Possible strategies for the prevention of vertical transmission for these countries are as follows: multivitamin supplements during pregnancy, prophylaxis against opportune infections with cotrimoxazol, a vaginal douche with chlorhexidine for cases where the membranes have ruptured more than 4 hours previously, and a single dose of nevirapine.

Our study focused on the influence of herpes simplex virus thymidine kinase (HSV-tk) expression and ganciclovir (GCV) treatment on the sensitivity of C6 glioma cells to frequently used chemotherapeutic drugs, i.e. adriamycin (ADR), cisplatin (CDDP), 5-fluorouracil (5-FU), and methotrexate (MTX). Transfection with HSV-tk revealed an increased sensitivity to GCV and CDDP and a decreased sensitivity to ADR and MTX. No significant differences were found in sensitivity to 5-FU. Combined treatment in a HSV-tk negative cell line revealed an additive effect when GCV was combined with ADR, whereas an antagonistic effect was found when GCV was combined with CDDP, 5-FU, or MTX. Comparable results were obtained in an HSV-tk positive cell line, apart from CDDP, which showed an additive effect. In conclusion, both HSV-tk transfection and subsequent GCV treatment can influence the sensitivity of tumor cells to various chemotherapeutic drugs in an antagonistic manner. Therefore, combining HSV-tk/GCV gene therapy with chemotherapy might not always be beneficial.

This paper focuses on the influence of chemoresistance on the herpes simplex virus (HSV-tk)/ganciclovir (GCV)-induced bystander effect (BE), as studied in a human small cell lung cancer (SCLC) cell line (GLC4) and its sublines with in vitro acquired resistance to adriamycin (GLC4/ADR), mitoxantrone (GLC4/MITO) and cisplatin (GLC4/CDDP). Chemoresistance for adriamycin, mitoxantrone and cisplatin significantly changed GCV sensitivity. A significant BE was found in all GLC4 cell lines. Compared to the parental GLC4 cell line, the BE was significantly higher only for the GLC4/ADR cell line. No expression of the nucleoside transporters MRP4 and MRP5 was detected. In all cell lines expression of connexin 43 was found, but modulation of gap junctional intercellular communication (GJIC) by 18-alpha-glycyrrhetinic acid did not significantly change the BE in any of the GLC4 cell lines. In conclusion, chemoresistance can influence the HSV-tk/GCV-induced BE, which seems not to be related to differences in MRP4/MRP5 expression or to differences in GJIC.

In a pregnant woman presenting with vaginal bleeding and a vaginal tumour, vaginal metastasis ofa trophoblast tumour from a mola pregnancy was diagnosed.

Favourable pharmacokinetics of the prodrug are essential for successful HSVtk/ganciclovir (GCV) suicide gene therapy. [F-18] FHPG PET might be a suitable technique to assess the pharmacokinetics of the prodrug GCV noninvasively, provided that [F-18] FHPG mimics the behaviour of GCV. Since membrane transport is an important aspect of the pharmacokinetics of the prodrug, we investigated the cellular uptake mechanism of [F-18] FHPG in an HSVtk expressing C6 rat glioma cell line and in tumour- bearing rats. The nucleoside transport inhibitors dipyridamol, NBMPR and 2- chloroadenosine did not significantly affect the [F-18] FHPG uptake in vitro. Thymidine and uridine significantly decreased [F-18] FHPG uptake by 84 and 58%, respectively, but an enzyme assay revealed that this decline was due to inhibition of the HSVtk enzyme rather than membrane transport. Nucleobase transport inhibitors, thymine and adenine, caused a 58 and 55% decline in tracer uptake, respectively. In vivo, the ratio of [F-18] FHPG uptake in C6tk and C6 tumours decreased from 3.070.5 to 1.070.2 after infusion of adenine. Thus, in our tumour model, [F-18] FHPG transport exclusively occurred via purine nucleobase transport. In this respect, FHPG does not resemble GCV, which is predominantly taken up via the nucleoside transporter, but rather acyclovir, which is also taken up via the purine nucleobase carrier.

A 42-year-old pregnant Namibian woman presented with an abnormal position of the foetus due to intra-abdominal pregnancy.

The immobilisation of the rhodium/anthranilic acid complex onto fishbone carbon nanofibres (CNFs) was executed by means of the following steps: 1) surface oxidation of the fibres, 2) conversion of the oxygen-containing surface groups into acid chloride groups, 3) attachment of anthranilic acid and 4) complexation of rhodium by the attached anthranilic acid. The immobilisation process was followed and the resulting surface species were characterised by IR, X-ray absorption fine structure (XAFS) and X-ray photoelectron spectroscopy (XPS), and by molecular modelling. Anthranilic acid bonds to the CNFs by an amide linkage to the carboxyl groups that are present after surface oxidation of the fibres. The immobilised anthranilic acid coordinates to rhodium through the nitrogen atom and the carboxyl group. The assynthesised RhIII complex itself is not active in the liquid-phase hydrogenation of cyclohexene. Reduction with sodium borohydride yields small particles (d = 1.5-2 nm) of rhodium metal that are highly active. The results indicate that different activation procedures for the immobilised Rh/anthranilic acid system should be applied, such as reduction with a milder reducing agent or direct complexation of the rhodium in the RhI state.

Despite the development of new therapeutic strategies, cancer remains incurable in most patients with advanced disease. A recent potential improvement in therapeutic strategies is the concept of suicide gene therapy. After transfection with a suicide gene, cells can convert a harmless prodrug into its toxic metabolite, resulting in selective elimination of these cells. One of the most frequently studied therapeutic strategies is based on transfection with the herpes simplex virus thymidine kinase gene (HSV-tk), followed by ganciclovir administration. Despite promising results in vitro and in vivo, the antitumor effect in clinical trials remains poor, due to very low transfection efficiency. However, high percentages of transfected cells are not mandatory for complete eradication of a tumor in vivo. Transfected tumor cells appear to be capable of inducing the death of neighboring untransfected cells. This cell kill is called the "bystander effect". Various attempts have been made to increase this effect. A substantial bystander effect could overcome the limitations of low transfection efficiency and result in an enhanced and possibly clinically worthwhile antitumor effect in patients. This review is focused on the HSV-tk/GCV system and gives an overview of current knowledge on the bystander effect in vitro and in vivo. In addition, theories concerning its mechanisms and possible approaches to augment this effect are discussed. Finally, we give an overview of clinical trials using suicide gene therapy.

Carbon nanofibres of the fishbone and parallel types were surface-oxidised by several methods. The untreated and oxidised fibres were studied with infrared spectroscopy, thermogravimetric analysis and X-ray photoelectron spectroscopy (XPS). Oxidation in a mixture of concentrated nitric and sulfuric acids proved to be the most effective method for creating oxygen-containing surface groups. This treatment results not only in the formation of carboxy and carboxyic anhydride groups, but also in the generation of ether-type oxygen groups between graphitic layers that are puckered at their edges. The IR spectroscopic data clearly show that the formation of oxygen-containing surface groups occurs at defect sites on the carbon nanofibres and that oxidation proceeds via carbonyl groups and other oxides to carboxy and carboxyic anhydride groups. Owing to the presence of defects, the two types of fibre have similar surface reactivities. With parallel nanofibres, in contrast to fishbone fibres, the macroscopic structure was severely affected by treatment with HNO(3)/H(2)SO(4). The HNO(3)/H(2)SO(4)-treated fibres are highly wettable by water.

KEYWORDS:carbon ¥carbon nanofibres ¥IR spectroscopy ¥nanostructures¥surface analysisCarbon nanofibres (CNFs) that are obtained by catalytic decom-position of carbon-containing gases over small metal particlesare a promising catalyst support material for liquid-phasereactions. The fibres are mechanically strong and can withstandthe forces executed on them by stirring the reaction medium.Furthermore, the skeins of fibres possess a mesoporous macro-structure, decreasing the chance of encountering diffusionlimitation during catalytic reactions in the liquid phase. Thestructure of the CNFs can be tuned by changing the growthconditions and their hydrophobicity can be altered by surfaceoxidation. Moreover, carbon nanofibres are very pure. No othertypes of carbon, such as carbon onions, fullerenes or amorphouscarbon, are formed and no heteroatoms such as sulfur areincorporated during synthesis. They are chemically inert and canbe used in strongly acidic or basic environments. Finally, whengrown in a fluidised bed reactor, carbon nanofibres can beobtained at low cost, making an application as catalyst supportmaterial possible.

Carbon nanofibres of the fishbone and parallel types were surface-oxidised by several methods. The untreated and oxidised fibres were studied with infrared spectroscopy, thermogravimetric analysis and X-ray photoelectron spectroscopy (XPS). Oxidation in a mixture of concentrated nitric and sulfuric acids proved to be the most effective method for creating oxygen-containing surface groups. This treatment results not only in the formation of carboxy and carboxyic anhydride groups, but also in the generation of ether-type oxygen groups between graphitic layers that are puckered at their edges. The IR spectroscopic data clearly show that the formation of oxygen-containing surface groups occurs at defect sites on the carbon nanofibres and that oxidation proceeds via carbonyl groups and other oxides to carboxy and carboxyic anhydride groups. Owing to the presence of defects, the two types of fibre have similar surface reactivities. With parallel nanofibres, in contrast to fishbone fibres, the macroscopic structure was severely affected by treatment with HNO(3)/H(2)SO(4). The HNO(3)/H(2)SO(4)-treated fibres are highly wettable by water.

Please cite this paper as: van Dillen J, Mesman J, Zwart J, Bloemenkamp K, van Roosmalen J. Introducing maternal morbidity audit in the Netherlands. BJOG 2010;117:416–421. Objective To describe the panel audit process and to identify substandard care in selected women from a nationwide prospective cohort study into severe acute maternal morbidity (SAMM) in the Netherlands. Design Prospective audit of selected women with SAMM. Setting Eight audit meetings held throughout the Netherlands. Population All pregnant women in the Netherlands. Methods Before each meeting, SAMM details of selected women were sent to all panel members for individual assessment by completing an audit form. During a subsequent plenary meeting, findings were discussed and substandard care factors as judged by the majority of assessors were scored. Main outcome measures Incidence of substandard care and recommendations for improving the quality of care. Results Substandard care was identified in 53 of 67 women (79%). Specific recommendations were formulated concerning the procedure of audit and concerning local as well as national management guidelines. Conclusion Our findings reflect SAMM in the Netherlands and substandard care is present in four out of five women. Ongoing audit of women with SAMM is promoted both at local and national level.

A randomized 14-day study in vivo compared the response of Plasmodium falciparum malaria to amodiaquine (35 mg/kg) and sulfadoxine-pyrimethamine (sulfadoxine, 25 mg/kg) in symptomatic outpatients at 2 sites in northern and western Kenya during 1993. Of the 239 patients recruited, 181 (76%) completed the study [84 (46%) on amodiaquine and 97 (54%) on sulfadoxine-pyrimethamine]. There were no significant differences in the parasitological, clinical or haematological responses between the 2 drug groups in both areas, with 18.5% resistance to amodiaquine versus 9.5% for sulfadoxine-pyrimethamine in the north and 35.1% against amodiaquine versus 34.5% for sulfadoxine-pyrimethamine in the west. In both sites defervescence was significantly more rapid with amodiaquine (P < 0.05) and true clinical failure (symptomatic illness with recurrent parasitaemia) was unusual (9%). As high-level resistance to chloroquine is widespread, both drugs are valuable alternatives. However, the significantly higher levels of resistance in the west may be a sign of the increased drug pressure in this holoendemic area and send an important warning concerning resistance to sulfadoxine-pyrimethamine.

To investigate the anchoring of precious metals onto carbon fibrils Pd/C-fibril samples were investigated in both the precursor and the reduced state by X-ray absorption fine structure (XAFS) spectroscopy. Analysis of the XAFS data of the freshly prepared catalyst showed a palladium–tetraamine complex in interaction with carbon. The proposed model involves [Pd(NH3)4]2+ coordinated to the carbon fibril surface, most probably stabilised by the carboxylic groups (through O–H bridging and charge balance) and the π-electron system of the support. After insitu reduction, analysis pointed to small palladium particles of ca. 15 A present on the fibrils with a significant Pd–C interaction.

The acidity of synthetic Zn and Mg saponites exchanged with H+, Al3+, Na+ and K+ has been studied using DRIFTS of adsorbed pyridine and TPD–TG measurements of adsorbed n-propylamine. The characterisation with IR of adsorbed pyridine revealed the presence of a large amount of Lewis acid sites owing to coordinatively unsaturated metal atoms at the edges of the clay platelets. Hardly any Bronsted sites were observed. However, with TPD–TG measurements of n-propylamine it was possible to quantify the number of Bronsted acid sites. In the H+ exchanged clays with high Si/Al ratios the amine/Al molar ratio was found to be near unity. At lower Si/Al ratios the number of acid sites increased non-linearly with the Al content. This study demonstrates that pyridine is a useful probe for determining Lewis acidity. However, to study the Bronsted acidity of H+ exchanged synthetic saponites, reliable quantitative information can only be obtained using n-propylamine.

Two commercial preshaped magnesium oxides, viz. pellet-shaped magnesium oxide (Englhard, Mg-0601) and spherical magnesium oxide (Sud-Chemie, T-4403), have been evaluated for use as carrier material in supported dehydrogenation catalysts. The influences of temperature and steam atmosphere on the textures of the support materials have been studied.The texture of the pellet-shaped support has been found to be well controlled by thermal treatment in air. Upon thermal treatment the B.E.T. surface area of this magnesium oxide decreases, while the average pore radius increases. Typically, a B.E.T. surface area of 6 m2 g–1 and an average pore radius of 1000 A is obtained upon treatment at 1173 K. Spherical magnesium oxide (Sud-Chemie, T-4403) has a very low surface area of 0.18 m2 g–1 and an average pore radius of 40 000 A. Calcination in air at temperatures up to 1473 K does not affect the texture. In 4.8 bar of steam at 423 K both magnesium oxides react completely to magnesium hydroxide. This is accompanied by a drastic increase of the B.E.T. surface area and a decrease of the mechanical strength. At 973 K and a steam pressure of 1 bar no reaction with water is observed.