Bipolar disorder following a stroke involving the left hemisphere

OBJECTIVE

Post-stroke mania has rarely been noted and researched, and reported cases have mostly involved the non-dominant hemisphere. In this paper, we report a case of bipolar disorder secondary to a stroke over the dominant hemisphere.

CLINICAL PICTURE

A 48-year-old, right-handed man had a cerebral infarct over the left temporal region. He became depressed after the stroke, and 4 months later developed a manic episode.

TREATMENT

The patient was treated with haloperidol and lorazepam.

OUTCOME

The symptoms subsided within 2 months after treatment.

CONCLUSIONS

It is premature to consider mania to be a syndrome of the right, or non-dominant, hemisphere. We suggest that further study focusing on specific anatomical regions, rather than laterality, will help to elucidate the interrelationship between mood and brain function.

Insulin-like growth factor II (IGF-II) inhibits insulin-like growth factor binding protein I (IGFBP-1) production in luteinized human granulosa cells with a potency similar to insulin-like growth factor I (IGF-I) and higher than insulin

Insulin-like growth factor binding protein I (IGFBP-I) is produced by human granulosa cells and may be important in follicular development. Production of IGFBP-I in human granulosa cells is under inhibitory control of insulin and insulin-like growth factor-I (IGF-I). It had not been known if IGF-II affected IGFBP-I production in these cells. We examined the effect of IGF-II on IGFBP-I production in human granulosa cells and compared this effect of IGF-II to similar effects of insulin and IGF-I. Human granulosa cells were obtained during in vitro fertilization and plated at a density of 10(5) cells/mL in McCoy 5A tissue culture medium supplemented with 10% fetal calf serum. After 48 h of preincubation at 37 C, 90% humidity, 5% CO2, the medium was removed, and serum-free medium was added. After 24 h of incubation in the serum-free medium, the medium was removed, cells were washed, and new serum-free medium supplemented with various concentrations of insulin, IGF-I, or IGF-II was added. After 24 h of incubation with insulin, IGF-I, or IGF-II, the medium was removed and frozen at-20 C until assayed for IGFBP-I. IGFBP-I was measured using kits from Diagnostic System Laboratories, Webster, Texas. Concentrations of IGFBP-I in the medium were 4.4 +/- 1.7 ng/mL for control cells; 3.0 +/- 0.8, 3.0 +/- 0.7, 3.1 +/- 0.7, 1.8 +/- 0.5, and 1.1 +/- 0.3 ng/mL for 1, 10, 10(2), 10(3), and 10(5) ng/mL insulin respectively; 1.4 +/- 0.6, 2.1 +/- 0.5, 0.3 +/- 0.1, 0.1 +/- 0.02, and 0.01 +/- 0.02 ng/mL for 0.5, 1, 5, 10, and 10(2) ng/mL of IGF-I, respectively; and 2.3 +/- 2.2, 1.2 +/- 0.8, 0.9 +/- 0.3, 0.7 +/- 0.2, and 0.04 +/- 0.02 ng/mL for 0.5, 1, 5, 10, and 10(2) ng/mL of IGF-II, respectively. Concentration of IGFBP-I in the medium collected from cells incubated with hormones was statistically lower than that for control cells starting at 10(3) ng/mL of insulin (P < 0.05), 0.5 ng/mL of IGF-I (P < 0.05) and 1 ng/mL of IGF-II (P < 0.05). Within the range of hormone concentrations tested, the P-values (independent groups t-test) never reached less than 0.01 levels for insulin, but reached this level at 5 ng/mL for both IGF-I and IGF-II. We conclude that IGF-II inhibits IGFBP-I production in luteinized human granulosa cells in a dose-dependent manner and with potency similar to IGF-I and higher than insulin. Further studies are needed to determine the physiological significance of this and other effects of IGF-II in the human ovary in both normal and pathological states.

Use of the silicone tracheal T-tube for tracheostenosis or tracheomalacia

BACKGROUND

Tracheobtenosib and tracheomalacia are trivial diseases. The conventional choice of managements with tracheostomy, either temporary or long-term usage, can only partially resolve the problems of airway obstruction. Silicone tracheal T-tube presents a substitute for it.

METHODS

We present 5 patients with tracheostenosis or tracheomalacia managed with nine procedures of long silicone Montgomery T-tube prothesis between 1984 and 1994 in VGH-Taipei. The primary diagnosis included tracheal injury (2), postintubation tracheal stenosis (2), and stenosis due to endotracheal tuberculosis (1). Three patients received a long segmental T-tube for permanent endotracheal stenting and the other two patients used T-tube insertion for temporary stenting of the trachea for 7 and 11 months, respectively, with satisfactory results.

RESULTS

All patients got immediate benefit from the prothesis in respiration with simple postoperative care. Two patients with temporary T-tube placement had it successfully removed in 7 and 11 months, respectively. Placement of the T-tube for subglottic stenosis also protected the function of phonation. The tracheal T-tube restored airway patency reliably with good long-term results and could be the preferred management of chronic upper airway obstructive disease not amenable to surgical repair. The most common complication was airway obstruction caused by either granulations or sticky mucoid substance. Three patients and six tubes (60%) developed granulation obstruction and the average duration of granuloma formation was 7.7 months. Laser phototherapy or surgical intervention, such as tracheoplasty, with change of the T-tube was carried out for granuloma obstruction.

CONCLUSIONS

T-tube is a good endoprothesis for tracheostenosis and tracheomalacia with minimal complication for cases of long tracheostenosis or complex tracheal injury.

Prevalence of stroke in Kinmen

BACKGROUND AND PURPOSE

Stroke is the second most common cause of death in Taiwan. We studied its prevalence, risk factors, and mortality in a rural Chinese population.

METHODS

A door-to-door survey of stroke was conducted in two Kinmen Island townships with a total population of 26105 people. Our target population (n = 5061) consisted of all the registered residents in these townships who were aged > or = 50 years on August 1, 1993. All participants were given a standardized neurological examination and a questionnaire.

RESULTS

The participation rate was 77.4% (n = 3915). Ninety-six cases of completed stroke were identified. Eighty-nine patients had one, 6 patients had two, and 1 patient had three episodes of stroke. The prevalence of stroke in persons aged > or = 50 years was 24.5 per 1000 (95% confidence interval, 19.7 to 29.3 per 1000). Prevalence increased with age. Statistically significant risk factors associated with stroke included hypertension, diabetes mellitus, and irregular heartbeats. Of the stroke survivors, 59% were independent in activities of daily living and 71% could walk independently.

CONCLUSIONS

Compared with other countries, Taiwan has a moderately high prevalence of stroke. The risk factors for stroke in this rural region of a developing country are similar to those in developed countries. Most stroke survivors here perform their daily activities independently without outside assistance.

Prevascularized bone graft cultured in sintered porous beta-Ca2P2O7 with 5 wt% Na4P2O7.10H2O addition ceramic chamber

Autogenous bone transfer is an important part of reconstructive plastic surgery. Presently available techniques have the disadvantages of limitation of available donor site, loss of donor tissue and the possibility of donor defect or deformity. In the present study, a vascularized bone graft was created and cultured in the groin area of the New Zealand rabbit. The cylindrical ceramic chambers, 15 mm in length, 6 mm in outer diameter and 3 mm in inner diameter, were prepared by the addition of sintered porous beta-Ca2P2O7 with 5 wt% Na4P2O7.10H2O. In the first group, the chambers impregnated with autogenous bone fragments and allogenous demineralized bone matrix with volume ratio 1:1 were cultured in the rabbit's groin area with saphenous vessels passing through. In the second group, the chambers were treated by the same procedures as the first group but without saphenous vessels passing through. In the third group, the chambers were not impregnated, and were cultured in the groin area with saphenous vessels. After 2, 4, 6, 8 and 12 wk of operation, the animals were killed with an overdose of intravenous pentobarbital. The viability of the osseous tissue in the chamber was evaluated by histological examination, microangiograms and fluorochrome incorporation for the three groups. The autogenous bone chips could survive and retain their osteogenic properties while packed into the sintered porous beta-Ca2P2O7 (with 5 wt% Na4P2O7.10H2O addition) ceramic chamber and implanted in the rabbit groin area up to 12wk. However, even at the longest time periods, considerable amounts of dead bone were present in the chambers. In addition, we observed bone resorption in the three groups up to 12 wk, which might be attributed to lack of physiological stress. There were significant differences in new bone formation and osseous cell viability among the three groups. The prevascularized vessels and autogenous bone chips were both necessary for the formation of new bone and osteogenic property in the chamber under these heterotopic circumstances. The biodegradable ceramic used in this study was gradually absorbed and dissolved in the physiological environment. However, the degradation debris of the ceramic caused no injury to the new bone formation. These findings support the concept of creating a preformed vascularized bone graft to reconstruct segmental bone defects.

Epsilon 4 allele of apolipoprotein E increases risk of Alzheimer's disease in a Chinese population

We examined the apolipoprotein E genotype in 56 Chinese patients with late-onset sporadic Alzheimer's disease (AD) and 57 Chinese control subjects of similar age. The frequency of epsilon 4 in the AD group was significantly higher than that in the control group (23.2% versus 7.9%, p = 0.003). The odds ratio for AD in individuals with either one or two epsilon 4 was 2.96 (95% CI 1.11 to 8.03). The linear trend for AD in proportion to alleles of epsilon 4 was also significant (chi 2 = 8.2, p = 0.004). Our results support the association between epsilon 4 and AD in the Chinese.

Continuous Cell Line from Pupal Ovary of Perina nuda (Lepidoptera: Lymantriidae) That Is Permissive to Nuclear Polyhedrosis Virus from P. nuda

A continuous cell line, designated NTU-PN-HH, was established from the pupal ovary of Perina nuda Fabricius (Lepidoptera: Lymantriidae). The cells have been through more than 300 passages during 4 years in TNM-FH medium supplemented with 10% FBS, at a constant temperature of 28&deg;C. The cell line consists of four major morphologic types: polymorphic cells, spindle-shaped cells, round cells, and squamous cells. The characterization of this cell line showed that NTU-PN-HH is a newly established cell line. It is the first cell line that is permissive to PnNPV (P. nuda multiple nuclear polyhedrosis virus).

Monitoring of plasma clozapine levels and its metabolites in refractory schizophrenic patients

Plasma concentrations of clozapine and its metabolites desmethylclozapine and clozapine N-oxide were measured in 61 patients with refractory schizophrenia. Before the initiation of clozapine, each patient was given haloperidol (HL) up to 60 mg/day for at least 4 weeks without improvement. Patients were then given a fixed dose of clozapine 400 mg/day. Patients were assessed with the Brief Psychiatric Rating Scale (BPRS) at baseline before HL therapy, at the end of HL at 6 weeks, before clozapine, and after 6 weeks of clozapine therapy. Clozapine and its metabolites were measured by high-performance liquid chromatography with ultraviolet detection. The mean plasma concentrations of clozapine, desmethylclozapine, and clozapine N-oxide were 598 +/- 314, 281 +/- 140, and 90 +/- 29 ng/ml, respectively. The mean decrease in the total BPRS scores from baseline clozapine to the 6-week treatment period was 11 +/- 4. Clinical improvement was noted to occur in most patients with clozapine plasma levels > 300 ng/ml. Improvement diminished in patients with clozapine plasma levels > 700 ng/ml. The most common adverse effects were sedation and hypersalivation. Significant correlations between plasma clozapine concentrations and adverse side effects were not found.

Treatment of dentin hypersensitivity by Nd:YAG laser

Our previous study indicated that dentin surface irradiated with an Nd:YAG laser at an energy output of 30 mJ, 10 pulses/sec (pps), for 2 min resulted in a melted surface and a closure of exposed dentinal tubules orifices, but without dentin surface cracking. The purpose of this study is to evaluate the effectiveness of the Nd:YAG laser in the treatment of dentin hypersensitivity. Thirty subjects participated in this study and were followed for 3 months. Two sites of dentin hypersensitivity in a patient were treated; one received Nd:YAG laser treatment and the other served as control. Dentin hypersensitivity was assessed by mechanical and thermal stimulus. Pulpal vitality was measured using an electrical stimulus. The Nd:YAG laser treatment reduced dentin hypersensitivity to air by 65% and to mechanical stimulus by 72% over 3 months. All teeth remained vital after laser treatment, without adverse reactions or complications. In conclusion, the Nd:YAG laser can be used to reduce dentin hypersensitivity without detrimental pulpal effects.

Intelligence quotient in childhood acute lymphoblastic leukemia after prophylactic treatment in central nervous system with 18 Gy cranial irradiation and intrathecal methotrexate

The purpose of this study is to evaluate whether central nervous system prophylactic treatment (CNSP) with cranial irradiation therapy (CrRT) 18 Gy and intrathecal methotrexate would decline the intelligence quotient (IQ) scores of children with acute lymphoblastic leukemia (ALL). In protocol TCL 842, children with ALL received CrRT 18 Gy in 12 fractions, and 5 concomitant doses of intrathecal methotrexate 15 mg/m2/dose with 15 mg as the maximum, for CNSP after remission achieved. The first IQ test was performed immediately after CNSP. Those who had no CNS relapse for more than 5 years after CNSP had a second IQ test. For children between 3 and 6 years old, the Stanford-Binet (S-B) IV test was used, and for older children, the Wechsler Intelligence Scale for Children-Revised (WISC-R) was used. Fourteen consecutive children at our hospital were enrolled. There were 7 boys and 7 girls. The age at diagnosis ranged from 3 to 9 years old. Two of them were in the high-risk group, eight in the intermediate-risk group, and four in the standard-risk group. The IQ scores of all patients fell within the average range. In the first IQ tests, the mean IQ score was 104.29 (range 83-124, S.D. 14.55). In the second IQ tests, the mean IQ score was 100.93 (range 85-128, S.D. 11.57). Statistically, there was no significant difference between the first and second IQ scores (paired t-test, two-tailed P = 0.4232; one-tailed P = 0.2116). Our findings suggested that CNSP used in protocol TCL 842 did not reduce IQ scores of children with ALL 5 years after CNSP.

Insulin receptor mediates inhibitory effect of insulin, but not of insulin-like growth factor (IGF)-I, on IGF binding protein 1 (IGFBP-1) production in human granulosa cells

Insulin-like growth factor binding proteins (IGFBPs) may participate in regulating ovarian function by modifying effects of insulin-like growth factors (IGFs) or by directly affecting ovarian steroidogenesis in both normal and pathological circumstances. The latter include hyperinsulinemic insulin resistant states, such as polycystic ovary syndrome. We examined regulation of IGFBP-1 production in human granulosa cells by insulin and IGF-I. The cells were obtained during in vitro fertilization, plated in McCoy-5A tissue culture medium supplemented with 10% fetal calf serum (10(5) cells/0.5 mL), and incubated at 37 C, 90% humidity, 5% CO2 for 48 h. After additional 24 h incubation without fetal calf serum, 1, 10, or 100 ng/mL of insulin or IGF-I were added with or without 2 h preincubation with 10 micrograms/mL monoclonal anti insulin receptor antibody IR-47-9. After 48 h incubation with insulin or IGF-I, the medium was collected and IGFBP-1 and progesterone concentrations were measured, using kits from Diagnostic Systems Laboratories, Webster, TX. Progesterone concentration ranged between 50-100 ng/mL/10(5) cells, without consistent stimulatory effect of either insulin or IGF-I. Control cells produced 7.0 +/- 1.7 ng/mL of IGFBP-1. Incubation with 1 or 10 ng/mL of insulin resulted in culture medium IGFBP-1 concentrations of 7.1 +/- 1.3 ng/mL and 5.4 +/- 0.7 ng/mL, respectively (P = NS). Incubation with 100 ng/mL of insulin reduced IGFBP-1 culture medium concentration to 1.6 +/- 0.3 ng/mL (P < 0.01, compared with controls). 1, 10, and 100 ng/mL of IGF-I inhibited IGFBP-1 concentrations in the conditioned culture medium to 1.3 +/- 0.3 ng/mL, 0.4 +/- 0.1 ng/mL and 0.3 +/- 0.1 ng/mL, respectively (P < 0.01, compared with controls). Preincubation with antiinsulin receptor antibody IR-47-9 alleviated inhibitory effect of insulin, but not of IGF-I on IGFBP-1 production. After preincubation with IR-47-9, IGFBP-1 culture medium concentrations were 5.9 +/- 0.8 ng/mL, 4.9 +/- 1.2 ng/mL, and 4.8 +/- 1.3 ng/mL for 1, 10, and 100 ng/mL of insulin, respectively. The latter number was significantly higher than IGFBP-1 concentration in the medium collected from cells incubated with 100 ng/mL of insulin without IR-47-9 (1.6 +/- 0.3 ng/mL, P < 0.01) and not significantly different from the control cells. For cells preincubated with IR-47-9 and then incubated with 1, 10, or 100 ng/mL of IGF-I, the IGFBP-1 conditioned culture medium concentrations were 1.7 +/- 0.1 ng/mL, 0.5 +/- 0.2 ng/mL, and 0.3 +/- 0.1 ng/mL, respectively. None of these were significantly different from the IGFBP-1 concentrations in the medium collected from cells incubated with the respective concentrations of IGF-I without preincubation with IR-47-9. We conclude that 1) both insulin and IGF-I inhibit IGFBP-1 production by cultured human granulosa cells; 2) IGF-I is a more potent inhibitor of IGFBP-1 production than insulin; 3) in the range of hormone concentrations tested, insulin exerts its inhibitory effect on IGFBP-1 production via insulin receptor, while IGF-I appears to exert its effect via another receptor.

A door-to-door survey of Parkinson's disease in a Chinese population in Kinmen

BACKGROUND

Most published studies have shown lower prevalence rates of Parkinson's disease (PD) in Asian and black African than in Western countries, leading to the hypothesis that Asians and blacks might be protected from PD.

OBJECTIVE

To investigate the prevalence of PD in a Chinese population.

DESIGN

Community-based survey.

SETTING

Registered residents 50 years of age or older (N = 5061) on the islet of Kinmen located off the southeastern coast of China [corrected].

METHOD

Single-phase door-to-door survey by neurologists. All participants were administered a questionnaire and received motor examinations of the Unified Parkinson's Disease Rating Scale.

RESULTS

The participation rate was 96% (N = 3915) among 4158 contacted individuals. Twenty-three cases of PD were identified, including three cases with dementia. The crude prevalence rate of PD was 587 (95% confidence interval (CI), 373 to 884) per 100,000 persons 50 years of age or older. Assuming no case of PD among individuals under 50 years of age, the prevalence rate was 119 (95% CI, 80 to 169) per 100,000 for the total population.

CONCLUSIONS

The prevalence rates of PD in Kinmen were much higher than those reported from mainland China, but slightly lower than those reported from more developed countries. The present findings suggest that, instead of genetic factors, differences in case-ascertainment, life expectancy, and the length of survival with PD may be more important contributors to the variations in observed PD prevalence rates.

Acute disseminated encephalomyelitis in middle-aged or elderly patients

Acute disseminated encephalomyelitis (ADEM) in middle-aged or elderly adults is rarely reported. We present here three ADEM patients of these age groups, who manifested behavioral changes, mutism or psychosis. Single clinical episodes, widespread encephalopathic disturbances and magnetic resonance imaging (MRI) findings favored the diagnosis of ADEM. However, no obvious preceding infections could be discovered. Two of them had traveled to mainland China prior to admission to psychiatric wards. All three patients had fair-to-good recovery after steroid treatment. A review of the literature showed that clinical and neuroimage findings of ADEM in the elderly group did not differ from those in the younger group. However, ADEM has rarely been reported in older age groups, probably due to: (1) differences between the elderly and young people in susceptibility or immune response to infectious agents, and (2) lack of a sensitive tool to examine patients prior to the wide-spread use of MRI. We suggest ADEM as one of the possible etiologies of acute or subacute onset of psychosis in adult patients, especially in those with a history of traveling.

Active corpus luteum function at pre-, peri- and postimplantation is essential for a viable pregnancy

Luteal-phase estrogen and progesterone concentrations were measured every other day and used to monitor the corpus luteum activity. The patterns of estrogen and progesterone concentrations were compared relative to the day of endogenous human chorionic gonadotropin (hCG) detection (defined as the day of implantation). The relationship between estrogen and progesterone and hCG concentrations was studied in 71 viable pregnancies, 12 clinical abortions, five preclinical abortions and 84 non-pregnant cycles after IVF/ET. Although all patients received luteal-phase progesterone support (25-50 mg/ml), low late luteal-phase progesterone concentrations of < 30 ng/ml from day + 11 to day + 15 were found in 64 patients (17% of viable pregnancies, 33.3% of clinical abortions, 60% of preclinical abortions and 53.6% of non-pregnant cycles) day + 1 was the day of retrieval). Implantation always occurred before or on day + 13 and 86% of pregnant cycles implanted on day + 8 to day + 11. Viable pregnancies had significantly higher mean progesterone concentrations on day + 3 to day + 7 (pre-implantation) and on day + 9 to day + 15 (postimplantation) than those of non-pregnant cycles or abortions. On the day of implantation, the mean +/- standard of deviation of estrogen (pg/ml) and progesterone (ng/ml) levels for viable pregnancies, clinical abortion and preclinical abortions were 314 +/- 210, 40.5 +/- 25; 226.7 +/- 246, 48.7 +/- 31; and 39.6 +/- 24.5, 28.6 +/- 24.5, respectively. On the same day, 73.2% of viable pregnancies, 41.7% of clinical abortions, and 20% preclinical abortions had a progesterone concentration > 30 ng/ml; 73.2% of viable pregnancies, 41.7% of clinical abortions and 20% of preclinical abortions had an estrogen concentration > 100 pg/ml. Although not precluding implantation completely, late luteal-phase hormonal deficiencies may impair endometrial growth and might ultimately lead to failure or abnormal implantation. A viable pregnancy requires not only a functional corpus luteum in the early luteal phase to develop a receptive endometrium, but also a responsive corpus luteum in the late luteal phase to support pregnancy. The time of implantation is critical. Implantation that occurs before the demise of the corpus luteum will facilitate a normal pregnancy.

Performance on a smell screening test (the MODSIT): a study of 510 predominantly illiterate Chinese subjects

The 12-item Modular Smell Identification Test (MODSIT) was administered to 239 male and 271 female Chinese subjects whose age ranged from 50 to 92 years (68.3 +/- 10.9) and whose education ranged from 0 to 20 years (2.5 +/- 4.3). Every participant was examined by a physician and was found to be free of dementia, stroke, and Parkinson's disease. Different from the standard procedures, only one-third of each odor pad was used for each subject, the four odor choices were presented orally for the majority of subjects, and they were not forced to make a selection when they could not detect or identify the odor. The average level of performance was 46% correct. The score was negatively associated with age, positively associated with education and with performance on a dementia screening test, and corroborated with subjects' report of smell deterioration in recent years. Nonsmokers and women performed better than smokers and men. The 12-item MODSIT had an internal consistency reliability of 0.73 and a 7-month retest stability of 0.57 with different examiners. The MODSIT is satisfactory for group studies, even when administered with suboptimal procedures such as those used in the present study.

Day 3 estradiol serum concentrations as prognosticators of ovarian stimulation response and pregnancy outcome in patients undergoing in vitro fertilization

OBJECTIVE

To test the hypothesis that elevated E2 levels on day 3 of IVF cycles without GnRH agonist (GnRH-a) are associated with reduced oocyte numbers and pregnancy rates (PRs).

DESIGN

Day 3 levels of E2 and FSH were obtained from patients undergoing controlled ovarian hyperstimulation without GnRH analogue for IVF.

PATIENTS

Five hundred ninety-two consecutive IVF cycles.

RESULTS

Patients were grouped according to their day 3 E2 levels (< 30, 31 to 45, 46 to 60, 61 to 75, and > 75 pg/mL [conversion factor to SI unit, 3.671]). The ongoing PR per retrieval for patients with E2 levels < 30 pg/mL was significantly higher than for patients with E2 levels 31 to 75 pg/mL. There were no pregnancies if the E2 level was > 75 pg/mL. The mean number of oocytes per retrieval was significantly lower in patients from the E2 groups with E2 > 60 pg/mL compared with patients in groups with E2 < 60 pg/mL. Day 3 FSH and E2 levels also were evaluated simultaneously. In patients with the lowest levels of FSH and E2, the PR was the highest. No pregnancies occurred if the FSH level was > 17 mIU/mL (conversion factor to SI unit, 1.00) and the E2 level was > 45 pg/mL on day 3.

CONCLUSIONS

For patients undergoing IVF without GnRH analogue, oocyte numbers and PRs decrease with increasing levels of day 3 E2. Combining day 3 FSH and E2 improved the prognostic ability of either of these hormones used alone.

Direct autocorrelation measurements of mid-infrared picosecond pulses by quantum-well devices

We report the direct autocorrelation of ultrashort mid-infrared laser pulses, using an unbiased GaAsy/GaAlAs quantum-well device as a nonlinear photovoltaic medium. Using this method, we autocorrelate ultrashort (3-ps) low-energy (~500-nJ) pulses of 10.6-microm light. This approach should permit the autocorrelation of subpicosecond infrared pulses.

Variability of day 3 follicle-stimulating hormone levels in eumenorrheic women

OBJECTIVE

To assess the intercycle variability of early follicular follicle-stimulating hormone (FSH) and estradiol (E2) levels in eumenorrheic women according to age.

STUDY DESIGN

Forty-eight female volunteers with regular menstrual cycles were studied. Serum samples were obtained on cycle day 3 in multiple cycles over a one-year period. Serum was also obtained on consecutive cycle days 2, 3 or 4 in a single cycle in 20 participants. All samples were assayed for FSH and E2 by radioimmunoassay.

RESULTS

In women under 40 years of age, all initial day 3 FSH levels were < 20 mIU/mL, and 15% of subjects had a subsequently elevated day 3 FSH level (> or = 20 mIU/mL) within the year. In eight women 40-44 years of age, 75% had an initial day 3 FSH level < 20 mIU/mL, but half of them subsequently had an elevated level, > 20 mIU/mL, within the year. Between cycle days 2, 3 and 4, FSH (coefficient of variation [CV] = 14.8%, 95% confidence interval (CI) = 11.4-18.3%) varied less than E2 (CV = 31.1%, 95% CI = 21.5-40.6%).

CONCLUSION

A single day 3 FSH level < 20 mIU/mL is highly predictive of all subsequent values within a year and occurred only in women under 40. An FSH level drawn on cycle day 2 or 4 will probably be within 18% of the day 3 value, but the E2 level may vary by up to 40%.

Endometriosis: a stage by stage analysis--the role of in vitro fertilization

OBJECTIVE

To investigate the impact of endometriosis stage on IVF.

PATIENTS

A retrospective study of 214 patients diagnosed with endometriosis who underwent 360 cycles of IVF at The New York Hospital-Cornell Medical Center. Meanwhile, 111 pure mechanical (tubal) infertility patients treated in 160 cycles at the same time were designated as the control group for comparison.

MAIN OUTCOME MEASURES

Patient's hormone and semen profiles, hormonal response and outcome to stimulation, as well as the outcome of pregnancy, abortion, and delivery rate were analyzed.

RESULTS

No differences in the pregnancy outcome between the endometriosis and control groups were noted when compared among the subgroups of pure endometriosis, endometriosis plus tubal factor, endometriosis plus others (primarily endometriosis plus male factor), and control. Comparing the outcomes in pure endometriosis cases by staging, we could not find any discrepancies in terms of pregnancy rates (PRs) according to the severity of the disease. The addition of GnRH analogur down-regulation to gonadotropin stimulation resulted in an increase in PR. A relatively high delivery rate (38.9% per cycle, 41.9% per retrieval, and 43.2% per transfer) was achieved when the pure endometriosis patients were treated with concomitant leuprolide acetate down-regulation and gonadotropin.

CONCLUSION

We have observed that pregnancy outcome in patients with endometriosis was not different than the outcome for patients with mechanical (tubal) infertility. There were no differences in PRs by stage of endometriosis.

Non-destructive analysis of the protein conformational structure of human pituitary adenomas using reflectance FT-IR microspectroscopy

Reflectance Fourier-transform infrared microspectroscopy was used to determine the secondary structure and composition of the different human pituitary adenomas. Non-functioning pituitary adenomas exhibited similar protein secondary structure and conformational composition, but active pituitary adenomas revealed different behavior. The differences in secondary structure for the different human pituitary adenomas might possibly be due to the different protein conformations of the proliferated adenoma tissues and various hormones shared.

Mechanical properties and histological evaluation of sintered beta-Ca2P2O7 with Na4P2O7.10H2O addition

The ultimate goal of implantation of biomaterials in the skeleton is to reach full integration of the non-living implant with the living bone. The biomaterial can be used much as a bone graft, resorbing or dissolving as bone growth occurs, and the end result is a new remoulded bone. Calcium pyrophosphate, Ca2P2O7, is one of the intermediate products of bone mineralization. beta-Dicalcium pyrophosphate (beta-DCP) doped with certain amounts of Na4P2O7.10H2O was prepared as the developed material. Na4P2O7.10H2O was used as a liquid-phase additive to improve the sintering process and promote physiological bioresorbability. Compressive strength and four-point bending strength were measured by the Bionix test system 858. The mechanical strength of the sintered beta-DCP increased with the addition of Na4P2O7.10H2O up to 5 wt%, but thereafter decreased. The microstructure and crystal structure were analysed by the techniques of SEM, EPMA, TEM and XRD. The relationship between the mechanical strength of the sintered bioceramics and the Na4P2O7.10H2O dopant was examined in terms of the presence of NaCa(PO3)3, grain growth and abnormal grain coalescence while the dopant increased. Preliminary in vivo evaluation was studied by rabbit femur condyle implantation. There was no inflammation or any toxic sign during the experimental period. The histological section of intraosseous implantation revealed that the new bone deposited directly on the surface of the material in the fourth week after operation. The implant gradually decreased in volume and was replaced by the surrounding regenerated bone in the rabbit condyle in vivo environment. The results led us to conclude that the developed material has great potential as a biodegradable bone substitute.

Cloning and promoter mapping of mouse kappa opioid receptor gene

We have isolated mouse kappa opioid receptor (KOR) genomic clones containing the complete 5'-untranslated region, a portion of the 3'-untranslated region, and its coding region. The mouse KOR gene spans at least 16 kb and contains at least 4 exons. Exon I encodes the major portion of 5'-untranslated sequence and transcription initiation is determined, by primer extension experiments, to reside at 3 major sites, located at 334, 340, and 716 nucleotides upstream from the translation initiation codon. No typical TATA or CAAT boxes can be identified within an approximately 1-kb upstream region. Exon II contains 271 nucleotides, including 14 nucleotides of 5'-untranslated sequence. Exon III contains 353 nucleotides and exon IV begins at amino acid position #204 and encodes the rest of the 3'-end sequence of the cloned cDNA. Based upon Northern blot analysis, KOR transcript is estimated to be approximately 6 kb in length.

Endometrial thickness appears to be a significant factor in embryo implantation in in-vitro fertilization

To evaluate the role of endometrial thickness and pattern in in-vitro fertilization (IVF), these parameters were prospectively measured in 516 cycles of IVF with embryo transfer at our clinic. Pregnancy and embryo implantation rates were assessed for each mm of endometrial thickness and for each of three endometrial patterns. Embryo implantation, clinical and ongoing pregnancy rates were significantly higher in the patients with an endometrial thickness > 9 mm (24.4, 48.6 and 42.2% respectively) compared with those of < 9 mm (14.3, 16.0 and 11.7% respectively; P < 0.005). Endometrial thickness was negatively influenced by age and positively influenced by oestradiol concentration. The majority of patients (69.8%) exhibited a 'ring' endometrial pattern. Embryo implantation and clinical pregnancy (statistically significant), as well as ongoing pregnancy rates (not statistically significant), were lower in patients exhibiting the 'solid' pattern. Endometrial thickness is independent of pattern in its effect on pregnancy outcome. In conclusion, endometrial thickness > 9 mm as well as ring and intermediate endometrial patterns denoted a more favourable prognosis for pregnancy in IVF but thinner endometrium and those exhibiting a solid configuration had an acceptable pregnancy outcome.