They showed distinct expression

They showed distinct expression WH-4-023 in vitro of V

gamma 9, V delta 2 transcripts and were positive for TCR gamma, but negative for TCR beta by immuno-histochemistry. Targeted inhibition of two oncogenic pathways (AURKA and NOTCH-1) by small-molecular inhibitors induced significant growth arrest in NK-cell lines, thus providing a rationale for clinical trials of these inhibitors in NK-cell malignancies. Leukemia (2011) 25, 348-358; doi:10.1038/leu.2010.255; published online 5 November 2010″
“Introduction: The cyclotron-based (100)Mo(p,2)(99m)Tc transformation has been proposed as a viable alternative to the reactor based (235)U(n,f)(99)Mo ->(99m)Tc strategy for production of (99m)Tc. Despite efforts to theoretically model the amount of ground-state (99g)Tc present at end of bombardment for the (p,2n) reaction, experimental validation has yet to be performed. The co-production of (998)Tc may have important implications in both the subsequent radiopharmaceutical chemistry and patient dosimetry upon injection.

Methods: To determine the extent of (99g)Tc co-production, we have experimentally measured the (100)Mo(p,x)(99)Mo, (99m)Tc, and (99g)Tc excitation functions in the 8-18 MeV range using a combination of natural abundance and 97.42% enriched (100)Mo foils along with gamma-ray spectrometry and ICP-MS. Although

the excitation functions for production of (99)Mo and (99m)Tc have been presented previously CDK inhibitor in the literature, to the best of our knowledge, this work presents the first experimental evaluation of the (100)Mo(p,2n)(99g)Tc excitation function.

Results: From the experimental cross-section measurements, the (99m)Tc production yields and (99m)Tc/(99m+g)Tc nuclei ratio were calculated for various thick target irradiation conditions. Results suggest that TBq quantities of (99m)Tc can be achieved with a (99m)Tc/(99m+g)Tc nuclei ratio that is on par with the current (99)Mo/(99m)Tc generator over standard eluted at a 24-h frequency.


These findings suggest that the cyclotron production of (99m)Tc may be a feasible alternative to the current reactor-based production strategy. (C) 2011 Elsevier Inc. All rights reserved.”
“Introduction: The low-energy beta(-) emitter Tb-161 is very similar to Lu-177 with respect to half-life, beta energy and chemical properties. However, Tb-161 also emits a significant amount of conversion and Auger electrons. Greater therapeutic effect can therefore be expected in comparison to Lu-177. It also emits low-energy photons that are useful for gamma camera imaging.

Methods: The Gd-160(n,gamma)Gd-161 -> Tb-161 production route was used to produce Tb-161 by neutron irradiation of massive Gd-160 targets (up to 40 mg) in nuclear reactors. A semiautomated procedure based on cation exchange chromatography was developed and applied to isolate no carrier added (n.c.a.

Since the ultimate success of long-term management for any condit

Since the ultimate success of long-term management for any condition is based on an understanding of its pathophysiology, and because the pathophysiology of stress urinary incontinence is incompletely defined,

animal models have recently been developed to better understand stress urinary incontinence and develop novel treatment alternatives.

Materials and Methods: Several animal models for urethral dysfunction have emerged in the last few years, including those based on pathophysiological theories of urethral sphincter dysfunction that were designed to simulate maternal birth trauma. Other models have focused on the creation of Selleck Rabusertib a durable model of dysfunction for investigating novel treatments.

Results: Since animals cannot selleck chemicals express intent, these animal models have focused on measuring decreased urethral resistance. The most widely used methods are the sneeze test, the tilt table technique and the leak point pressure test. Newer techniques include abdominal leak point pressure, urethral pressure measurement and retrograde urethral perfusion pressure. In addition to the advantages and disadvantages of each technique, all methods measure the composite contribution to urethral resistance from smooth and striated muscle, urethral closure and connective tissue, although

none measures intent.

Conclusions: We critically reviewed the different models of stress urinary incontinence and urethral dysfunction as well as the different methods of measuring urethral resistance.”
“The serotonergic EGFR inhibitor system regulates processing in components of the vestibular nuclear complex, including the medial vestibular nucleus (MVe) and nucleus prepositus hypoglossi (PH). Recent studies using anterograde and retrograde tracers have shown that vestibular nuclei are targeted by regionally selective projections from the

serotonergic dorsal raphe nucleus. The objective of the present investigation was to determine whether the DRN is targeted by projections from the vestibular nuclear complex in rats using, the anterograde tracer biotinylated dextran amine (BDA). After injection of BDA into PH or the caudal parvicellular division of MVe, labeled fibers and terminals were observed in the ventromedial and lateral subdivisions of DRN. These findings indicate that projections from the vestibular nuclei and PH are organized to modulate processing within specific functional domains of the DRN. (c) 2008 Elsevier Ireland Ltd. All rights reserved.”
“Purpose: Pelvic floor disorders including urinary incontinence, pelvic organ prolapse and fecal incontinence are common problems encountered by the older woman. With the increasing population of older American women urologists and gynecologists can expect to provide evaluation and treatment of these conditions with increasing frequency. These conditions are amenable to medical and surgical therapies.

Data are reviewed demonstrating that heterogeneity in morphologic

Data are reviewed demonstrating that heterogeneity in morphological response of microglia and the expression of TNF alpha and TNF receptors are critical in identifying and characterizing neurotoxic events as they relate to neuroinflammation, neuronal damage and in stimulating neuroprotection. Published by Elsevier Inc.”
“Purpose: We determined the efficacy, safety, adjustability and technical feasibility of the adjustable continence therapy device (Uromedica, Plymouth, Minnesota) for the treatment of recurrent female stress urinary incontinence.

Materials and Methods: Female patients with recurrent stress urinary incontinence were Entinostat enrolled in the study and

a defined set of exclusionary criteria were followed. Baseline and regular followup tests to determine eligibility, and to measure subjective and objective improvement were performed. A trocar was passed fluoroscopically and with digital vaginal guidance to the urethrovesical junction through small incisions between the labia majora and minora. The adjustable continence therapy device was delivered and the balloons were filled with isotonic contrast. PLK inhibitor The injection ports for balloon inflation were placed in a subcutaneous pocket in each labia majora. Device adjustments were performed percutaneously in the clinic postoperatively. An approved investigational device exemption Food and Drug Administration

protocol was followed to record all adverse events.

Results: A total of 162 subjects underwent implantation with I year of data available on 140. Mean Stamey score improved

by 1 grade or more in 76.4% (107 of 140) of subjects. Improvement in the mean incontinence quality of life questionnaire score was noted at 36.5 to 70.7 (p <0.001). Reductions in mean Urogenital Distress Inventory (60.3 to 33.4) and Incontinence Impact Questionnaire (54.4 to 23.4) scores also occurred (p <0.001). Mean provocative pad weight decreased from 49.6 to 11.2 gm (p <0.001). Of the patients 52% (67 of 130) were dry at I year (less than selleck kinase inhibitor 2 gm on provocative pad weight testing) and 80% (102 of 126) were improved (greater than 50% reduction on provocative pad weight testing). Complications occurred in 24.4% (38 of 156) of patients. Explantation was required in 18.3% (28 of 153) of the patients during 1 year. In terms of the complications 96.0% were considered to be mild or moderate.

Conclusions: The Uromedica adjustable continence therapy device is an effective, simple, safe and minimally invasive treatment for recurrent female stress urinary incontinence. It can be easily adjusted percutaneously to enhance efficacy and complications are usually easily manageable. Explantation does not preclude later repeat implantation.”
“Methylmercury (MeHg) is a potent environmental neurotoxin that preferentially targets the developing embryonic nervous system.

DEP significantly suppressed only TNF- and IL-6 release Suppress

DEP significantly suppressed only TNF- and IL-6 release. Suppressed cytokine release may also be produced by reduced cellular cytokine production. Data suggested that decreased cytokine release is not produced by the presence of benzo[a]pyrene (BaP), a polycyclic aromatic hydrocarbon. Comparison of TNF- release after LPS, PMA, or A23817 revealed that suppressive effects of UD are LPS dependent, whereas inhibitory effects of DEP may work across multiple mechanistic pathways. 4-Hydroxytamoxifen November and June Chapel Hill PM exposure stimulated TNF- and IL-8 release before LPS exposure. Fine and coarse

November PM exposure markedly suppressed TNF- release 6 h after LPS stimulation, but appeared to exert a stimulatory effect on IL-8 release 24 h after LPS exposure. June fine and coarse PM suppressed IL-8 release after LPS exposure. Data suggest that seasonal influences on PM composition affect AM inflammatory response before and after bacterial exposure. Overall, delayed or inhibited AM immune responses to LPS after PM exposure suggest human exposure to ambient PM may enhance

pulmonary susceptibility to respiratory infections.”
“BACKGROUND: Transcranial Doppler sonography (TCD) assessment of intracranial blood flow velocity has been suggested to accurately determine intracranial pressure (ICP).

OBJECTIVE: We attempted to validate this method in patients with communicating cerebrospinal fluid 5-Fluoracil mouse systems using predetermined pressure levels.

METHODS: Ten patients underwent a lumbar check details infusion test, applying 4 to 5 preset ICP levels. On each level, the pulsatility index (PI) in the middle cerebral artery was determined by measuring the blood flow velocity using TCD. ICP was simultaneously measured with an intraparenchymal sensor. ICP and PI were compared using correlation analysis. For further understanding

of the ICP-PI relationship, a mathematical model of the intracranial dynamics was simulated using a computer.

RESULTS: The ICP-PI regression equation was based on data from 8 patients. For 2 patients, no audible Doppler signal was obtained. The equation was ICP = 23*PI + 14 (R(2) = 0.22, P < .01, N = 35). The 95% confidence interval for a mean ICP of 20 mm Hg was -3.8 to 43.8 mm Hg. Individually, the regression coefficients varied from 42 to 90 and the offsets from -32 to +3. The mathematical simulations suggest that variations in vessel compliance, autoregulation, and arterial pressure have a serious effect on the ICP-PI relationship.

CONCLUSIONS: The in vivo results show that PI is not a reliable predictor of ICP. Mathematical simulations indicate that this is caused by variations in physiological parameters.”
“Acetaminophen (APAP)-induced hepatotoxicity accounts for nearly half of acute liver failure cases in the United States. The doses that produce hepatotoxicity vary considerably and many risk factors have been proposed, including liver inflammation from viral hepatitis.

In contrast, dose-dependent increases in rCBV were most pronounce

In contrast, dose-dependent increases in rCBV were most pronounced in limbic regions, such that responses seen at see more 0.1 mg/kg nicotine in accumbens, hippocampus, amygdala, and several other limbic areas were not seen following 0.3 mg/kg nicotine. Finally, whereas profound tolerance was observed in many cortical regions after the second of two paired nicotine injections at either 0.1 or 0.3 mg/kg, subcortical limbic structures showed only a weak trend for tolerance. Lack of rCBV changes in animals receiving nicotine methiodide,

a quaternary nicotine analog that does not cross the blood-brain barrier, supports a direct neuronal effect of nicotine rather than an action on the vasculature. These data provide pharmacodynamic insight into the regional heterogeneity of nicotine tachyphylaxis development, which may be relevant to behavioral and

neurobiological mechanisms associated with repeated tobacco consumption. Neuropsychopharmacology AS1842856 (2011) 36, 2498-2512; doi:10.1038/npp.2011.139; published online 27 July 2011″
“Alcoholism and alcohol use disorders are characterized by several months to decades of heavy and problematic drinking, interspersed with periods of abstinence and relapse to heavy drinking. This alcohol-drinking phenotype was modeled using macaque monkeys to explore neuronal adaptations in the striatum, a brain region controlling habitual behaviors. Prolonged drinking with repeated abstinence narrowed the variability in daily intake, increased the amount find more of ethanol consumed in bouts, and led to higher blood ethanol concentrations more than twice the legal intoxication limit. After :the final abstinence period of this extensive drinking protocol, we found a selective increase in dendritic spine density and enhanced glutamatergic transmission in the putamen, but not in the caudate nucleus. Intrinsic

excitability of medium-sized spiny neurons was also enhanced in the putamen of alcohol-drinking monkeys in comparison with non-drinkers, and GABAeric transmission was selectively suppressed in the putamen of heavy drinkers. These morphological and physiological changes indicate a shift in the balance of inhibitory/excitatory transmission that biases the circuit toward an enduring increase in synaptic activation of putamen output as a consequence of prolonged heavy drinking/relapse. The resultant potential for increased putamen activation may underlie an alcohol-drinking phenotype of regulated drinking and sustained intoxication. Neuropsychopharmacology (2011) 36, 2513-2528; doi:10.1038/npp.2011.140; published online 27 July 2011″
“Genetic variation in AKTI may be associated with sensitivity to the psychotomimetic effects of cannabis as well as with increased risk for psychotic disorder following cannabis use. Investigation of the effect of this interaction on relevant intermediate phenotypes for psychosis, such as cognition, may help to clarify the underlying mechanism.

“Rationale Cognitive impairment in schizophrenia is partic

“Rationale Cognitive impairment in schizophrenia is particularly evident in the domains of attention and executive functions. Atypical antipsychotics are somewhat more effective than conventional antipsychotics in improving cognitive functioning in these patients.

Objective The aim of this study was to compare the effects of conventional and atypical antipsychotics in a model of attentional performance

deficit of schizophrenia induced by blockade of N-methyl-D-aspartate (NMDA) receptors in the medial prefrontal cortex.

Materials and methods Attentional performance was assessed using the five-choice serial reaction time task. The task provides indices of attentional functioning (% Sorafenib correct responses), executive control (measured by anticipatory and perseverative responding), decision time (measured by correct response latency), and omissions. Haloperidol and clozapine were given intraperitoneally (IP) to animals that had received vehicle or a competitive NMDA receptor antagonist, 3-(R)-2-carboxypiperazin-4-propyl-1-phosphonic acid (CPP), directly into the medial prefrontal cortex.

Results Fifty nanograms/side

of CPP reduced accuracy (% correct responses) and increased anticipatory and perseverative responding. Haloperidol (0.03 mg/kg IP) reduced the CPP-induced anticipatory and perseverative overresponding but not the impairment in accuracy. In contrast, clozapine (2.5 mg/kg IP) reversed BAY 1895344 ic50 the decrease in accuracy and impulsivity (anticipatory responding) but not perseverative NSC23766 datasheet overresponding. CPP increased decision time and omissions, but these effects were not affected by either haloperidol or clozapine.

Conclusions The effects on “”impulsivity”" and “”compulsive perseveration”" in a rat model of attentional and executive

deficit of schizophrenia might differentiate conventional and atypical antipsychotics. Antagonistic activity at 5-HT2A receptors may best explain the facilitatory effects of clozapine on cognition.”
“Intracerebral hemorrhage is a devastating disease, and no specific therapy has been proven to reduce mortality in a randomized controlled trial. However, management in a neuroscience intensive care unit does appear to improve outcomes, suggesting that many available therapies do in fact provide benefit. In the acute phase of intracerebral hemorrhage care, strategies aimed at minimizing ongoing bleeding include reversal of anticoagulation and modest blood pressure reduction. In addition, the monitoring and regulation of glucose levels, temperature, and, in selected cases, intracranial pressure are recommended by many groups. Selected patients may benefit from hematoma evacuation or external ventricular drainage.

We explore the influence of categories on perception through one

We explore the influence of categories on perception through one such phenomenon, the perceptual magnet effect, selleck inhibitor in which discriminability between vowels is reduced near prototypical vowel sounds. We present a Bayesian model to explain why this reduced discriminability might occur: It arises as a consequence of optimally solving the statistical

problem of perception in noise. In the optimal solution to this problem, listeners’ perception is biased toward phonetic category means because they use knowledge of these categories to guide their inferences about speakers’ target productions. Simulations show that model predictions closely correspond to previously published human data, and novel experimental results provide evidence for the predicted link between perceptual warping and noise. The model unifies several previous accounts of the perceptual magnet effect and provides a framework for exploring categorical effects in other domains.”
“Background: Atherosclerotic occlusive disease of the proximal vertebral artery is an important cause of cerebrovascular ischemic events with a significant associated morbidity and mortality. Endovascular treatment has emerged as a promising tool of the therapeutic armamentarium, MK-8776 concentration along with medical therapy and surgical reconstruction. Our objective was to systemically review the pertinent evidence on the endovascular

management of proximal vertebral artery disease and perform an analysis of the published outcomes.

Methods: A systematic review of the literature identified all studies reporting percutaneous transluminal angioplasty or stenting, or both, for proximal vertebral artery stenosis. Web-based search engines were searched using the Medical Subject Headings terms “”vertebral artery,”" “”angioplasty,”" and “”stents”" in all possible science combinations. Studies comprising a series of at least five patients were considered for analysis. Periprocedural transient ischemic attack and stroke and death from any cause <= 30 days of treatment were defined as the primary outcome end points.


One randomized controlled trial comparing angioplasty and stenting of the proximal vertebral artery and medical therapy was identified. No comparative studies of endovascular treatment and open surgical repair were found. Forty-two selected studies reported endovascular treatment (angioplasty or stenting, or both) of 1117 vertebral arteries in 1099 patients. The weighted mean technical success rate was 97% (range, 36%-100%). Periprocedural transient ischemic attack occurred in 17 patients (1.5%). The combined stroke and death rate was 1.1%. Recurrent symptoms of vertebrobasilar insufficiency developed in 65 of 967 patients (8%) within a reported follow-up of 6 to 54 months. Restenosis developed in 183 of 789 patients (23%) who underwent follow-up imaging (range, 0%-58%).

“Background: Recurrent spontaneous abortion (RSA) refers t

“Background: Recurrent spontaneous abortion (RSA) refers to 2 or more consecutive pregnancy losses, and RSA with unknown causes is called unexplained recurrent spontaneous abortion (URSA). Tim-3, a subtype of the T-cell immunoglobulin domain and mucin domain (Tim) protein family, might

be an important regulatory molecule that plays a pivotal role in selleck compound URSA, which might be triggered mostly by Th1/Th2 immune deviation. To understand the etiology and pathogenesis of URSA in Han Chinese women, we investigated the association between polymorphisms of rs10053538 and rs10515746 in the promoter of Tim-3 and the risk of URSA in Han Chinese women.

Methods: One hundred and forty-eight women with RSA resulting in still birth were enrolled in the URSA group. We performed tests to rule out congenital reproductive system malformation, reproductive system tumor, endocrine dyscrasia, and chromosome abnormalities. One hundred and fifty-three women with normal pregnancy leading to live birth were selected H 89 concentration at random to comprise the control group. All women

included in this study were genetically unrelated Han Chinese women. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and allele-specific polymerase chain reaction (AS-PCR) were used to determine polymorphisms of rs10053538 and rs10515746, respectively, in all subjects. PCR products were chosen at random for sequencing.

Results: No significant statistical difference was found between the distribution frequency of the GT + TT genotype and T allele on the rs10053538 locus in the URSA group or the control group (10.1% vs. 11.8%, Chi(2) = 0.205, P = 0.651; 5.1% vs. 6.5%, Chi(2) = 0.592, P = 0.441; respectively). Neither was there

a significant difference between the distribution frequency of the GT + TT genotype and T allele on the rs10515746 locus in the groups (6.8% vs. 3.9%, Chi(2) 1.201, P = 0.273; 3.4% vs. 2.0%, Chi(2) = 1.169, P = 0.280; respectively).

Conclusions: The present study suggested that these polymorphisms of rs10053538 or rs10515746 in the Tim-3 promoter may not be associated with URSA in Han Chinese women.”
“Mesotocin (MT) is a neurohypophysis hormone in non-mammalian vertebrates including chickens, and homologous of oxytocin (OT) in mammals. Oxytocin (OT) is a well known reproductive hormone in mammals, but the physiological WH-4-023 roles of MT in chickens have not been clarified well. OT is thought to regulate feeding behavior because central and peripheral injections of OT inhibit feeding behavior in mammals. In avian, on the other hand, the effect of MT on feeding regulation has not yet been clarified. Therefore, the present study was carried out to examine whether MT is related to the regulation of feeding in chicks (Gallus gallus). Intracerebroventricular (ICV) injection of MT significantly decreased food intake in chicks while intraperitoneal injection had no effect.

Mitral valve repair or replacement is generally not necessary at

Mitral valve repair or replacement is generally not necessary at the time of anomalous origin of the left coronary artery from the pulmonary artery repair. Significant residual mitral regurgitation is present in some patients and can usually be managed surgically at a later date depending on its degree of severity.”
“Cochlin (encoded by COCH) constitutes 70% of non-collagenous protein in the inner ear, and the expression of cochlin is highly specific to the inner

ear. Eleven missense mutation and one in-frame deletion have been reported in the COCH gene, causing hereditary progressive sensorineural hearing loss and vestibular dysfunction, DFNA9. These data imply that cochlin should bear an essential and crucial role in the inner ear function. However, the role of cochlin has not been fully AZD1080 clarified. We have investigated the spatiotemporal expression of cochlin in the inner ear of rats during postnatal development to better understand the functional role of cochlin. By immunohistochemistry, cochlin expression was faint in the cochlea and vestibule on the 6th day after birth (DAB6). At DAB70, strong expression of cochlin was detected in the Spiral limbus and spiral ligament within the cochlea, and in the stromata of the maculae of otolithic Organs and crista ampullaris within the vestibule. Immunoreactivity for

cochlin increased during the postnatal development. Western blot analysis also showed an increase in the expression of cochlin isoforms. Furthermore, the dominant isoform of cochlin expressed changed from p63s to p40s between DAB24 find more and DAB70. These results suggest that the expression of cochlin may be related to the maturation of inner ear function, and the change in isoforms of cochlin expressed will provide important insight into the understanding of both cochlin function and formation of cochlin isoforms.

This is the first to report about the spatiotemporal expression of cochlin in the developing rat inner ear. (C) 2008 Elsevier Ireland Ltd. All rights reserved.”
“Objective: At the severe end of the spectrum of infants with pulmonary atresia and intact ventricular septum, the likelihood of significant right ventricle to coronary artery MX69 solubility dmso connections increases. Our purpose is to present the first series of right ventricle to coronary artery connections ligated off bypass before right ventricular decompression and to evaluate the consequences of this approach.

Methods: From 1988 to 2007, 19 patients with pulmonary atresia and intact ventricular septum had a total of 69 right ventricle to coronary artery connections identified preoperatively, and 10 more were located intraoperatively. Of these, 71 were judged large enough to warrant off-pump direct ligation. Preoperative diagnosis was by transthoracic echocardiography and angiography. Transesophageal and surface echocardiography were used for intraoperative location.

Neurobehavioral testing and histopathologic examination were perf

Neurobehavioral testing and histopathologic examination were performed after reperfusion. In Experiment 2, the expression of the TREK1 in the spinal cord was assessed by immunohistochemistry. Western blot and real-time polymerase chain reaction. In Experiment 3, Amiloride, a blocker of stretch-sensitive channels, was administered intraperitoneally immediately prior to each isoflurane preconditioning. Iso group showed a significant reductions in motor deficit index as well as increases in the number of normal neurons compared with the Con group. The expression of TREK1 protein and the level of mRNA after ischemia were higher XAV 939 in the rats of the Iso group than those in the Con group. Amiloride

pretreatment abolished the protective effects of Iso preconditioning. These finding indicate that isoflurane preconditioning had a neuroprotective effect against spinal cord PND-1186 ic50 ischemia reperfusion injury. These effects may be mediated through the TREK1 pathway. (C) 2012 Elsevier Ireland Ltd. All rights reserved.”
“The recombination rate in Newcastle disease virus

(NDV) was as high as 10% in RDP analysis with full-length NDV genome sequences available in GenBank. We found that two NDV strains, China/Guangxi09/2003 and NDV/03/018, previously reported as recombinants, failed to show any evidence of recombination upon complete genome resequencing. Furthermore, we were able to reproduce artificial recombination by amplification of the M gene in a mixed sample of strains LaSota and ZJ1. It appears that the recombination of NDV is not as common as has been reported. NDV sequences in GenBank should be analyzed with caution Selleck AZD7762 during bioinformatic analyses for natural recombination events.”
“The study of transcription has witnessed an explosion of quantitative effort both experimentally

and theoretically In this article we highlight some of the exciting recent experimental efforts in the study of transcription with an eye to the demands that such experiments put on theoretical models of transcription From a modeling perspective, we focus on two broad classes of models the so-called thermodynamic models that use statistical mechanics to reckon the level of gene expression as probabilities of promoter occupancy, and rate-equation treatments that focus on the temporal evolution of the activity of a given promoter and that make it possible to compute the distributions of messenger RNA and proteins We consider several appealing case studies to illustrate how quantitative models have been used to dissect transcriptional regulation”
“The aim of this study was to investigate the frequency of recall and the content of dreams during pregnancy, as well as their correlation with socio-demographic, obstetric and physician-patients relationship variables, emotional state and duration of labour.