Similar endometrial development in oocyte donors treated with either high- or standard-dose GnRH antagonist compared to treatment with a GnRH agonist or in natural cycles

BACKGROUND

This descriptive study evaluates the impact on endometrial development of standard and high doses of a GnRH antagonist in stimulated cycles compared with GnRH agonist and natural cycles.

METHODS

Thirty-one oocyte donors were treated with a combination of rFSH and 0.25 mg/day ganirelix (standard dose), 2 mg/day ganirelix (high dose) or 0.6 mg/day buserelin (long protocol). Vaginal progesterone (200 mg/day) was administered in the luteal phase. Endometrial biopsies were performed 2 and 7 days after HCG administration. Additional biopsies were carried out in a subset of 12 subjects, 2 and 7 days following the LH peak of their previous natural cycle. Biopsies were evaluated histologically and by scanning electron microscopy. Gene expression profiles were also studied.

RESULTS

At HCG +2, all the parameters studied were similar in all the groups and comparable to those observed in the natural cycle. At HCG +7, endometrial dating, steroid receptors and the presence of pinopodes were comparable in both GnRH antagonist groups and in the natural cycle. In buserelin group, endometrial dating and pinopode expression suggested an arrested endometrial development. For window of implantation genes, expression patterns were closer to those in the natural cycle following standard- or high-dose ganirelix than after buserelin administration.

CONCLUSION

No relevant alteration was observed in the endometrial development in the early and mid-luteal phases in women undergoing controlled ovarian stimulation for oocyte donation following daily treatment with a standard- or high-dose GnRH antagonist. In addition, the endometrial development after GnRH antagonist mimics the natural endometrium more closely than after GnRH agonist.

Use of confocal immunofluorescence microscopy to localize viral nonstructural proteins and potential sites of replication in pigs experimentally infected with foot-and-mouth disease virus

Replication of foot-and-mouth disease virus in infected pig epithelium has been studied by immunofluorescence labeling of the viral nonstructural protein 3ABC and confocal microscopy. The results were correlated with viral RNA copy numbers in tissue samples from adjacent sites determined by reverse transcription-PCR (RT-PCR). Lesion formation was seen in the tongues and coronary band epithelia of infected pigs 2 days after infection. Viral replication was observed in cells of the epithelium of the tongue and coronary band but not in the associated stromal cells. Infected epithelial cells were present in the stratum spinosum, away from the lesion, with small lesions formed above the basement membrane. Viral replication was markedly reduced in tongue epithelium by day 3 postinfection but remained apparent in the coronary band tissue up to 5 days postinfection. These results were confirmed by the RNA copy number determined by RT-PCR.

60 HISTOLOGICAL COMPARISONS BETWEEN NUCLEAR TRANSFER AND IN VIVO PORCINE EMBRYOS

Due to the high rate of embryonic loss during a nuclear transfer pregnancy, cloning is considered a relatively inefficient process. However, as the only method of producing knockout domestic animals it is considered an invaluable tool for the biotechnical industry. By histologically comparing embryos at significant stages in the porcine pregnancy (Days 10, 12, and 14), factors contributing to embryonic loss may be revealed. Many consider the period between days 10 and 14 to be critical for determining survivability as the embryos must undergo rapid changes to signal for maternal recognition of pregnancy as well as adapt to a changing environment. This study included three gilts per stage of pregnancy and four different experimental groups for each stage studied: nonpregnant animals, in vivo-pregnant animals, nuclear transfer (NT) recipients, and in vitro-manipulated recipients (IVM). IVM embryos were in vitro-produced embryos upon which a mock nuclear transfer has been performed in an effort to account for the variability introduced by the actual technique. Animals either were bred or underwent a surgical embryo transfer on Day 1 of the estrous cycle according to their assigned experimental group. Fifty embryos were transferred per embryo transfer. Embryos were flushed from the uterine horns at time of collection (Day 10, 12, or 14) and preserved in 10% neutral buffered formalin. All embryonic disc diameters and gross morphology were evaluated as parameters for normal development. Embryos were then dehydrated in ethanol, paraffin-imbedded, sectioned, stained with hemotoxylin and eosin, and Day 14 embryos were evaluated for abnormalities such as higher-than-normal nucleoli numbers, increased cytoplasmic vacuoles, and higher than normal numbers of mitotic figures. All results were analyzed using ANOVA. There were significant differences (P < .0001) between diameters of the embryonic disks, with the diameters of the NT embryonic disks being smaller than those of the in vivo controls at all stages studied. Morphologically, the in vivo controls were more developmentally competent than their NT counterparts by the time they reached Day 14 (P = 0.0002) in that most had achieved the more advanced elongated form of growth as opposed to remaining spherical in shape. Significant histological differences in the number of nucleoli per nuclei were also found between in vivo and NT embryos (P = 0.05) as well as between MNT and NT embryos (P = 0.05). Therefore, nuclear transfer embryos develop at a much slower rate than their in vivo counterparts and often exhibit histological abnormalities that could contribute to this slow growth. Due to the apparent increase in nucleoli, it is possible that NT embryos are being arrested at a specific stage in the cell cycle. The authors would like to acknowledge the Research Animal Diagnostic Laboratory for their help in imbedding, sectioning, and staining the embryos; Dr. Duane Keisler for running the hormone assays; and Kristin Whitworth, Melissa Samuel, Aaron Bonk, Jin-Geol Kim, Emily Fergason, David Wax, Tom Cantley, August Rieke, Randy Farrell, and Lacey Griesbaum for all their help.

Reduced osmolarity oral rehydration solution for treating cholera

BACKGROUND

Oral rehydration solution (ORS) is used to treat dehydration caused by diarrheal diseases including cholera. Reduced osmolarity formulations are safe and more effective than standard ORS for treating non-cholera diarrhea. As cholera causes rapid electrolyte loss, it is important to know if these benefits are similar for people with cholera.

OBJECTIVES

To compare the safety and efficacy of reduced osmolarity oral rehydration solution (ORS) with standard ORS for treating diarrhea due to cholera.

SEARCH STRATEGY

We searched the Cochrane Infectious Disease Group Specialized Register (January 2004), CENTRAL (The Cochrane Library Issue 1, 2004), MEDLINE (1966 to January 2004), EMBASE (1974 to January 2004), and LILACS (1982 to January 2004). We also contacted organizations and searched reference lists.

SELECTION CRITERIA

Randomized controlled trials comparing reduced osmolarity ORS with standard ORS for treating adults and children with acute diarrhea due to cholera.

DATA COLLECTION AND ANALYSIS

Two reviewers independently applied eligibility criteria, assessed trial quality, and extracted data. We pooled binary data using relative risks (RR), continuous data using weighted mean difference (WMD) or the standardized mean difference (SMD), and presented the results with 95% confidence intervals (CI).

MAIN RESULTS

For glucose-based reduced osmolarity ORS, seven trials (718 participants) met the inclusion criteria. Biochemical hyponatremia (serum sodium < 130 mmol/L) was more common with reduced osmolarity ORS (RR 1.67, CI 1.09 to 2.57; 465 participants, 4 trials); for severe biochemical hyponatremia (serum sodium < 125 mmol/L) this was not significant (RR 1.58, CI 0.62 to 4.04; 465 participants, 4 trials). No trials reported symptomatic hyponatremia or death. We found no statistically significant difference in the need for unscheduled intravenous infusion. Analyses separating children and adults showed no obvious trends. Two trials also examined rice-based ORS. In the reduced osmolarity group, duration of diarrhea was shorter (WMD -16.85 hours, CI -21.22 to -12.48; 102 participants, 2 trials).

REVIEWERS' CONCLUSIONS

In people with cholera, reduced osmolarity ORS is associated with biochemical hyponatremia when compared with standard ORS, although there are similar benefits in terms of other outcomes. Although this risk does not appear to be accompanied by serious consequences, the total patient experience in existing trials is small. Under wider practice conditions, especially where patient monitoring is difficult, caution is warranted.

Quality of Life in Patients Treated with First-Line Antiretroviral Therapy Containing Nevirapine And/Or Efavirenz

Objective

To assess whether differences in safety profiles between nevirapine (NVP) and efavirenz (EFV), as observed in the 2NN study, translated into differences in ‘health related quality of life’ (HRQoL).

Design

A sub-study of the 2NN study, with antiretro-viral-naive patients randomly allocated to NVP (once or twice daily), EFV or NVP+EFV, in addition to stavudine and lamivudine.

Methods

Comparing differences in changes of HRQoL over 48 weeks as measured with the Medical Outcomes Study HIV Health Survey (MOS-HIV) questionnaire, using analysis of variance.

Results

The 2NN study enrolled 1216 patients. No validated questionnaires were available for 244 patients, and 55 patients had no HRQoL data at all, leaving 917 patients eligible for this sub-study. A total of 471 (51%) had HRQoL measurements both at baseline and week 48. The majority (69%) of patients without HRQoL measurements did, however, complete the study. The change in the physical health score (PHS) was 3.9 for NVP, 3.4 for EFV and 2.4 for NVP+EFV ( P=0.712). For the mental health score (MHS) these values were 6.1, 7.0 and 3.9, respectively ( P=0.098). A baseline plasma HIV-1 RNA concentration (pVL) ≥100 000 copies/ml and a decline in pVL (per log10) were independently associated with an increase of PHS. An increase of MHS was only associated with pVL decline. Patients experiencing an adverse event during follow-up had a comparable change in PHS but a significantly smaller change in MHS, compared with those without an adverse event.

Conclusions

First-line ART containing NVP and/or EFV leads to an improvement in HRQoL. The gain in HRQoL was similar for NVP and EFV, but slightly lower for the combination of these drugs.

Studies of quantitative parameters of virus excretion and transmission in pigs and cattle experimentally infected with foot-and-mouth disease virus

Foot-and-mouth disease virus (FMDV) can be spread by a variety of mechanisms and the rate of spread, the incubation period and the severity of disease depend on a multitude of parameters, including the strain of virus, the dose received, the route of introduction, the animal species and the husbandry conditions. More knowledge with regard to these parameters is urgently needed to improve resource-efficient disease control. This report describes detailed studies of FMDV load, excretion and transmission in pigs infected with FMDV O UKG 2001, O TAW 1997 and C Noville virus and in cattle infected with the O UKG 2001 virus to facilitate use of a "FMDV load framework" for the assessment of transmission risks. Virus replicated rapidly in pigs and cattle exposed by direct contact. The mean incubation period was around 3-4 days for cattle-to-cattle and 1-3 days for pig-to-pig transmission, depending on the intensity of contact. The results confirmed that a strong relation exists between dose and length of incubation period. Clinical disease was severe in pigs but relatively mild in inoculated cattle; contact infection of cattle appeared to increase the severity of lesions. FMDV RNA was recovered in nasal and mouth swabs from inoculated animals soon after they developed a viraemia and probably reflected the early production and excretion of virus. FMDV RNA in nasal and mouth swabs from contact animals could be detected several days before they showed other signs of infection, indicating the possibility of detecting exposed animals during the incubation period. FMDV RNA could also be detected in swab samples after the viraemic phase. This may have represented background environmental virus that had been trapped in the respiratory tract and mouth. Alternatively, it may have indicated a somewhat slower clearance or half-life of viral RNA or an extended low level of FMDV replication at these sites. The pattern of FMDV RNA concentrations in pigs was closely similar to that in cattle, but the amounts of FMDV RNA were higher.

Demographic profile of the elderly population in Dublin accident and emergency hospital catchment areas

The Dublin metropolitan area is now divided into a number of clearly defined accident and emergency (A & E) catchment areas since the closing of the smaller inner city hospitals and the opening of newer hospitals on the periphery of the city. We examined the demographic profile of the elderly population in Dublin city and county served by each of the new catchment areas. Whilst the elderly population make up 9.9% (105,188) of the Dublin population (1996 census) they make up over 20% of the A & E attendances and up to over 40% of the A & E admissions in major Dublin hospitals. There is a wide variation in the percentage elderly population in each hospital catchment area with inner more settled city areas having a much higher percentage elderly population over those hospital catchment areas that serve newer housing areas. We also looked at the level of deprivation. Combining the two most deprived levels St James's Hospital had the largest absolute number and the highest percentage of deprived elderly 12,736 (51.1%) followed by the Mater 6,919 (32.9%), Beaumont 5371 (31.5%), James Connolly 2,983 (38.1%), Tallaght 2012 (22.3%) and St Vincent's Hospital 1987 (7.7%). Hospitals with high numbers of elderly and serving deprived catchment areas face particular resource problems in meeting the needs of the population that they serve. A significant increase in the provision of publicly funded community facilities and long stay accommodation is required to meet the needs of the large number of deprived elderly in the inner city area. Failure to respond to these demographic challenges will have a profound effect on the ability of hospital emergency services to meet the increasing pressures posed by the high volume of acutely sick economically deprived elderly presenting to hospital accident and emergency departments.

Identification of a novel stress resistance mechanism in Campylobacter jejuni

AIM

To study stress resistance mechanisms in Campylobacter spp.

METHODS AND RESULTS

Campylobacter strains were grown to the appropriate phase in Brucella broth. The cells were diluted into either cell-free spent medium (obtained by filtration of a grown culture) or a freshly prepared medium and the pH reduced to 4.5, a lethal pH value. At suitable time intervals survivors were enumerated on Campylobacter blood free selective agar base. The cell-free spent medium from mid-exponential and stationary phase had a protective effect on acid and thermal stress in Campylobacter jejuni CI 120, a natural isolate. The protective effect of the extracellular compound was not significantly inactivated by boiling, but was inactivated by proteinase.

CONCLUSIONS

The present study suggests that a protein (or proteins) accumulated by C. jejuni CI 120 during growth may play an active role in the induction of stress responses and that this protein is heat stable.

SIGNIFICANCE AND IMPACT OF THE STUDY

The results indicate that C. jejuni CI 120, a natural isolate, has the ability to use extracellular signalling mechanisms to induce tolerance to stress factors. This is a major advancement in the understanding of the physiological basis for survival of C. jejuni in the environment.

Patients' health-related quality-of-life and health state values for motor neurone disease/amyotrophic lateral sclerosis

Motor neurone disease (MND) has a severe impact on patient quality of life, especially in later stages of the disease. This study assesses the health-related quality of life (HRQL) of MND patients, and for the first time elicits health state values from patients for their present health state. A structured interview was conducted with 77 patients. Patients completed a disease specific health status measure (ALSAQ-40), a generic health status measure (EuroQol EQ-5D), a visual analogue scale (VAS) and a standard gamble (SG) exercise. The ALSAQ-40 was sensitive to disease severity. Patients' mean VAS rating of their own health ranged from 0.74 for stage 1 (early) disease severity (n = 15), to 0.37 for stage 4 (late stage) disease severity (n = 19). Utilities elicited via SG varied from a mean of 0.79 for stage 1 disease severity to a mean of 0.45 for stage 4 disease severity. The EQ-5D derived single index ranged from a mean of 0.63 for stage 1 disease severity to a mean of -0.01 for stage 4 disease severity. This study demonstrates that it is feasible and practical to obtain health state values from MND patients and it provides evidence that patients place a high value on their HRQL, even in cases where health status is very poor.

Comparison of the effects of two intrathecal anaesthetic techniques for transurethral prostatectomy on haemodynamic and pulmonary function

BACKGROUND AND OBJECTIVE

Transurethral prostatectomy is routinely performed under spinal anaesthesia. This technique can cause hypotension, which is particularly undesirable in the elderly. The objective was to compare spinal anaesthesia for transurethral prostatectomy using hyperbaric bupivacaine 15 mg (control group) and hyperbaric bupivacaine 10 mg (limiting spread by maintaining the upright position for 15 min) and fentanyl 25 microg (fentanyl group) in terms of haemodynamic and pulmonary function.

METHODS

Thirty ASA I-III patients were randomly selected and underwent spinal anaesthesia with either hyperbaric bupivacaine 15 mg (immediately positioned supine) or hyperbaric bupivacaine 10 mg (upright for 15 min) and fentanyl 25 microg.

RESULTS

The greatest changes in mean arterial pressure (P = 0.9), ephedrine requirements (P = 0.8) and mean maximum change in forced vital capacity (P = 0.5) were similar in both groups.

CONCLUSIONS

The addition of fentanyl 25 microg to bupivacaine 10 mg and limiting the spread of the block does not improve either haemodynamic or pulmonary function compared with bupivacaine 15 mg in patients undergoing transurethral prostatectomy.

A Scandinavian adaptation of the Multi-Clinic Smell and Taste Questionnaire: evaluation of questions about olfaction

OBJECTIVE

A Scandinavian adaptation of the Multi-Clinic Smell and Taste Questionnaire (MCSTQ-Sc) was evaluated with respect to comprehension and test-retest reliability for responses to questions about olfactory dysfunction (abnormal sensitivity, parosmia and phantosmia) and related questions about medical history and consequences of olfactory dysfunction.

MATERIAL AND METHODS

Comprehension was evaluated in a first study in 20 patients with chief complaints of olfactory dysfunction by comparing questionnaire- and interview-based responses. Test-retest reliability was evaluated in a second study in 30 other patients with olfactory complaints.

RESULTS

Data from the two studies suggest that the vast majority of the questions evaluated from the MCSTQ-Sc are comprehensible and generate responses with very good reliability. Distinct exceptions were poor agreement between the questionnaire- and interview-based responses for questions about the number of cigarettes smoked and the pleasantness and typical episode length of phantosmia; the test-retest reliability regarding the nostril side of phantosmia also showed poor agreement. The results suggest the importance of probing these areas further in the clinical interview.

CONCLUSION

The findings imply that, with a few caveats, the MCSTQ-Sc is a useful tool for the clinical assessment of olfactory dysfunction and its consequences.

Patients' expectations of recovery following stroke: a qualitative study

PURPOSE

Patients and carers frequently express disappointment with the extent of recovery achieved at the point of discharge from physiotherapy. Research has suggested that high expectations of recovery may be encouraged by physiotherapists. This study examined the information exchanged between physiotherapists and patients in relation to recovery following stroke in order to explore this issue.

METHODS

The study comprised in-depth longitudinal case studies of 16 patients with a first incident stroke. Qualitative interviews were conducted with patients and their physiotherapists to explore their understandings and expectations of recovery and of physiotherapy at three time points. Patients were assessed for deficits of movement, function and mood at the same three stages and observations of out-patient sessions were also conducted. Qualitative data were analysed using thematic analysis. The assessment data were analysed using descriptive and comparative statistics.

RESULTS

Data indicated deficits of movement improved significantly between the first and third assessments. The qualitative data showed that physiotherapists did not encourage over-optimistic expectations of recovery through the verbal information they provided to patients. Nevertheless patients did maintain high expectations of recovery throughout the three-month post-stroke period.

CONCLUSION

Improved communication strategies, informed by an evidence base of recovery, should be used to encourage realistic expectations of physiotherapy without destroying the process of active participation and skill acquisition.

Clinical presentation of inhalational anthrax following bioterrorism exposure: report of 2 surviving patients

The use of anthrax as a weapon of biological terrorism has moved from theory to reality in recent weeks. Following processing of a letter containing anthrax spores that had been mailed to a US senator, 5 cases of inhalational anthrax have occurred among postal workers employed at a major postal facility in Washington, DC. This report details the clinical presentation, diagnostic workup, and initial therapy of 2 of these patients. The clinical course is in some ways different from what has been described as the classic pattern for inhalational anthrax. One patient developed low-grade fever, chills, cough, and malaise 3 days prior to admission, and then progressive dyspnea and cough productive of blood-tinged sputum on the day of admission. The other patient developed progressively worsening headache of 3 days' duration, along with nausea, chills, and night sweats, but no respiratory symptoms, on the day of admission. Both patients had abnormal findings on chest radiographs. Non-contrast-enhanced computed tomography of the chest showing mediastinal adenopathy led to a presumptive diagnosis of inhalational anthrax in both cases. The diagnoses were confirmed by blood cultures and polymerase chain reaction testing. Treatment with antibiotics, including intravenous ciprofloxacin, rifampin, and clindamycin, and supportive therapy appears to have slowed the progression of inhalational anthrax and has resulted to date in survival.

Characterization of protein C receptor expression in monocytes

Many sequelae associated with endotoxaemic-induced shock result from excessive production of the cytokine mediators, tumour necrosis factor alpha (TNF-alpha), interleukin 1 (IL-1) and IL-6 from lipopolysaccharide (LPS)-activated monocytes. Protein C (PC)/activated protein C (APC) has potent cytokine-modifying properties and is protective in animal models and human clinical trials of sepsis. The precise mechanism by which this anti-inflammatory response is achieved remains unknown; however, the recently described endothelial protein C receptor (EPCR) appears to be essential for this function. The pivotal role that monocytes play in the pathophysiology of septic shock led us to investigate the possible expression of a protein C receptor on the monocyte membrane. We used similarity algorithms to screen human sequence databases for paralogues of the EPCR but found none. However, using reverse transcription-polymerase chain reaction (RT-PCR), we detected an mRNA transcribed in primary human monocytes and THP1 cells that was identical to human EPCR mRNA. We also used immunocytochemical analysis to demonstrate the expression of a protein C receptor on the surface of monocytes encoded by the same gene as EPCR. These results confirm a new member of the protein C pathway involving primary monocytes. Further characterization will be necessary to compare and contrast its biological properties with those of EPCR.