Early provision of intrauterine contraception as part of abortion care-5-year results of a randomised controlled trial

STUDY QUESTION: Can the incidence of subsequent termination of pregnancy (TOP) be reduced by providing intrauterine contraception as part of the abortion service? SUMMARY ANSWER: Provision of an intrauterine device (IUD) as part of TOP services reduced the need for subsequent TOP but the effect was limited to the first 3 years of the 5-year follow-up. WHAT IS KNOWN ALREADY: An IUD is highly effective in preventing subsequent TOP. Prompt initiation of IUD use leads to a higher usage rate during follow-up, as compliance with post-TOP IUD insertion visits is low. STUDY DESIGN, SIZE, DURATION: The objective of this randomised controlled trial was to assess the effect of early comprehensive provision of intrauterine contraception after TOP, with primary outcome being the incidence of subsequent TOP during the 5 years of follow-up after the index abortion. This study was conducted at a tertiary care centre between 18 October 2010 and 21 January 2013. Altogether, 748 women undergoing a first trimester TOP were recruited and randomised into two groups. The intervention group (n = 375) was provided with an IUD during surgical TOP or 1-4 weeks following medical TOP at the hospital providing the abortion care. Women in the control group (n = 373) were advised to contact primary health care for follow-up and IUD insertion. Subsequent TOPs during the 5-year follow-up were identified from the Finnish Register on induced abortions. PARTICIPANTS/MATERIALS, SETTING, METHODS: The inclusion criteria were age >= 18 years, duration of gestation MAIN RESULTS AND THE ROLE OF CHANCE: The overall numbers of subsequent TOPs were 50 in the intervention and 72 in the control group (26.7 versus 38.6/1000 years of follow-up, P = 0.027), and those of requested TOPs, including TOPs and early pregnancy failures, were 58 and 76, respectively (30.9 versus 40.8/1000, P = 0.080). Altogether 40 (10.7%) women in the intervention and 63 (16.9%) in the control group underwent one or several subsequent TOPs (hazard ratio 1.67 [95% CI 1.13 to 2.49], P = 0.011). The number of TOPs was reduced by the intervention during years 0-3 (22.2 versus 46.5/1000, P = 0.035), but not during years 4-5 (33.3 versus 26.8/1000, P = 0.631). LIMITATIONS, REASONS FOR CAUTION: Both medical and surgical TOP were used. This may be seen as a limitation, but it also reflects the contemporary practice of abortion care. The immediate post-TOP care was provided by two different organizations, allowing us to compare two different ways of contraceptive service provision following TOP. WIDER IMPLICATIONS OF THE FINDINGS: Providing TOP and IUD insertion comprehensively in the same heath care unit leads to significantly higher rates of attendance, IUD use and a significantly lower risk of subsequent TOP.Peer reviewe

Through diffusion experiments to study the diffusion and sorption of HTO, 36Cl, 133Ba and 134Cs in crystalline rock

The spent nuclear fuel in Finland will be deposited in crystalline granitic rock in Olkiluoto, Finland. As a part of the safety assessment of the repository, series of extensive in-situ sorption and diffusion experiments and supplementary laboratory work has been done in the Olkiluoto site. Through Diffusion Experiment in a laboratory (TDElab) aims to provide applicable data for the ongoing in-situ experiment in Olkiluoto. This laboratory scale experiment resembles the in-situ experiment and aims to gain information on possible effects in values of distribution coefficients, effective diffusion coefficient and porosity that are caused by differences in laboratory and in-situ conditions. The through diffusion and sorption of tracer solution with known activities of HTO, 36Cl, 133Ba and 134Cs were studied in a decimeter scale sample of veined gneiss, which is one of the main rock types in Olkiluoto. The measured breakthrough curves were modeled taking into account the porosity of the rock and diffusion and sorption of the radionuclides using Time-Domain Random Walk (TDRW) simulations. The porosities of 0.7–0.8% were determined for the rock and effective diffusion coefficients of (3.5 ± 1.0) × 10−13 m2/s and (3.0 ± 1.0) × 10−13 m2/s were determined for HTO and 36Cl, respectively. The porosity and effective diffusion coefficients were found to be in agreement with previous results for veined gneiss. Furthermore, distribution coefficients of (1.0 ± 0.3) × 10−4 m3/kg and (2.0 ± 0.5) × 10−3 m3/kg were determined for 133Ba and 134Cs, respectively, using information about the effective diffusion coefficient determined for HTO. The distribution coefficients were found to be significantly smaller than the ones determined for crushed rock in previous studies and slightly smaller than the ones from previous in-diffusion experiments.Peer reviewe

Use of BODIPY-Cholesterol (TF-Chol) for Visualizing Lysosomal Cholesterol Accumulation

Dipyrromethene difluoride-cholesterol (TopFluor-Cholesterol, TF-Chol) is a widely used cholesterol analogue due to its excellent fluorescence properties and considerable similarity with natural cholesterol in terms of membrane partitioning. However, the suitability of TF-Chol for detecting lysosomal cholesterol deposition has recently been questioned. Here, we highlight the fact that the method of lipid delivery and the analysis of time-point both affect the membrane distribution and labeling pattern of TF-Chol, similarly as with radiolabeled cholesterol. Lysosomal sterol accumulation characteristic to a lysosomal storage disease is most readily detected when the probe is introduced via the physiological route, i.e. as a sterol fatty acid ester in low-density lipoprotein particles. When administered to cells from solvent, lysosomal sterol sequestration becomes evident after an overnight equilibration between membranes.Non peer reviewe

Europium-based high-temperature superconductors studied by x-ray diffraction and 151Eu Mössbauer spectroscopy

Isotropic powders and magnetically aligned crystallites of EuBa2Cu3O7−δ (1:2:3) and europium-doped Bi2Sr2CaCu2O8 (2:2:1:2) were studied by means of x-ray diffraction and Eu151 Mössbauer spectroscopy. The degree of crystallite orientation of the samples and the values of the lattice constants were determined by x-ray diffraction. The Mössbauer spectra were analyzed considering the full hyperfine Hamiltonian of the nuclear states of the 21.5-keV γ transition. The Mössbauer hyperfine parameters obtained from the superconducting and semiconducting phases are presented. A small change is seen in the Eu151 isomer shift when the oxygen deficiency δ of the 1:2:3 compound is varied. The shift can be explained by a decrease in the s-electron density due to lattice expansion. The changes in the oxidation state of the copper atoms with varying δ were determined from the Mössbauer data: The Cu(2) atoms retain their oxidation state, whereas the Cu(1) atoms adjust their valence according to the value of δ. In the 2:2:1:2 samples, the Eu concentration clearly affected the value of the electric-field gradient at the Eu nucleus. Using a standard procedure, magnetically aligned 2:2:1:2 samples were prepared. The preferred direction of the crystal c axis changed from parallel to perpendicular alignment with the external magnetic field, when the Eu concentration exceeded 20% of the Ca atoms.Peer reviewe

Amputations and socioeconomic position among persons with diabetes mellitus, a population-based register study

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Enzymatic Oxidation of Cholesterol : Properties and Functional Effects of Cholestenone in Cell Membranes

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New computational methods for efficient utilisation of public data

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PNPLA3 mediates hepatocyte triacylglycerol remodeling

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PNPLA3 mediates hepatocyte triacylglycerol remodeling

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Seipin Facilitates Triglyceride Flow to Lipid Droplet and Counteracts Droplet Ripening via Endoplasmic Reticulum Contact

Seipin is an oligomeric integral endoplasmic reticulum (ER) protein involved in lipid droplet (LD) biogenesis. To study the role of seipin in LD formation, we relocalized it to the nuclear envelope and found that LDs formed at these new seipin-defined sites. The sites were characterized by uniform seipin-mediated ER-LD necks. At low seipin content, LDs only grew at seipin sites, and tiny, growth-incompetent LDs appeared in a Rab18-dependent manner. When seipin was removed from ER-LD contacts within 1 h, no lipid metabolic defects were observed, but LDs became heterogeneous in size. Studies in seipin-ablated cells and model membranes revealed that this heterogeneity arises via a biophysical ripening process, with triglycerides partitioning from smaller to larger LDs through droplet-bilayer contacts. These results suggest that seipin supports the formation of structurally uniform ER-LD contacts and facilitates the delivery of triglycerides from ER to LDs. This counteracts ripening-induced shrinkage of small LDs.Peer reviewe