Laparoscopy or laparotomy for distal tubal surgery? A meta-analysis

Of couples with subfertility, 25% have complete or partial blockage of the fallopian tube. Since the advent of in vitro fertilization (IVF), the role of tubal surgery has diminished. However, this type of surgery continues to be undertaken on selected patients with mild tubal disease, and in those with severe tubal disease, in centres where IVF is not available. This systematic review was undertaken to compare pregnancy outcomes after laparoscopic surgery with that of open microsurgical technique. Studies comparing laparoscopic techniques with conventional microsurgery requiring laparotomy for treatment of distal tubal disease were included. The relevant trials were identified from Cochrane Menstrual Disorders and Subfertility Groups of Specialised Register of Controlled Trials (searched up to July 2005). The following strategies were adapted using the OVID platform, MEDLINE (1966 to July 2005), Cochrane Central Register of Control Trials, CENTRAL, and EMBASE (1980 to July 2005). Outcomes analysed were: 'take home baby' rate, intrauterine pregnancy rate and ectopic pregnancy rate per pregnancy. Subgroup analysis was carried out to compare intrauterine pregnancy rate in the laparoscopy and conventional microsurgery groups according to the extent of tubal damage. Six relevant studies were identified. Overall, no significant difference was observed in the intrauterine pregnancy rate between the two groups, combined OR 1.32 (95% confidence interval [CI], 0.58 - 3.02). For patients with mild tubal disease, there was no significant difference in the intrauterine pregnancy rate between treatment and control group, OR 1.06 (95% CI, 0.42 - 2.70). For patients with severe tubal disease, there was a significantly increased intrauterine pregnancy rate in the laparotomy group, OR 0.34 (95% CI, 0.14 - 0.86). Appropriate patient selection is the main factor affecting outcome in terms of fertility. These data do not indicate a significant difference in pregnancy rates between open and laparoscopic techniques for lesser degrees of tubal damage. Other factors, such as costs and hospital stay, will come into the decision making, and are likely to favour laparoscopic techniques. If a decision is made to open the badly damaged tubes of a patient, then an open microsurgical technique should be employed.

Sm-p80-based DNA vaccine formulation induces potent protective immunity against Schistosoma mansoni

No effective vaccine exists for the human parasitic disease, schistosomiasis. We have targeted a functionally important antigen, Sm-p80 as a vaccine candidate because of its consistent immunogenicity, protective potential and important role in the immune evasion process. In this study we report that a Sm-p80-based DNA vaccine formulation confers 59% reduction in worm burden in mice. Animals immunized with Sm-p80-pcDNA3 exhibited a decrease in egg production by 84%. Sm-p80 DNA elicited strong immune responses that include IgG2A and IgG2B antibody isotypes in vaccinated animals. Splenocytes proliferated in response to Sm-p80 produced appreciably more Th1 response enhancing cytokines (IL-2, IFN-gamma) than Th2 response enhancing cytokines (IL-4, IL-10). These data reinforce the potential of Sm-p80 as an excellent vaccine candidate for schistosomiasis.

Effect of potassium chloride supplementation in drinking water on broiler performance under heat stress conditions

The effect of water supplementation of KCl on performance of heat-stressed Hubbard broilers was evaluated in the present experiment. The 3 experimental treatments (i.e., control, 0.3 and 0.6% KCl) were allocated to 3 replicates of 15 birds each. The control group was kept on dugout tap water, whereas the other 2 groups were supplied water supplemented with 0.3 and 0.6% KCl (wt/vol) by supplementing 3 and 6 g of KCl, respectively, per liter of drinking water. Broilers were provided ad libitum access to feed and water for the experimental period of 7 to 42 d of age and kept in open-sided house. The birds were reared under continuous thermostress (minimum 28.2 +/- 1.02 and maximum 37.5 +/- 0.78 degrees C) environment. Supplementing drinking water with 0.6% KCl reduced panting-phase blood pH to 7.31 and significantly increased live BW gain by 14.5 (P = 0.036) and 7.9% (P = 0.029) at 28 and 42 d of age, respectively, relative to control. An improved (P = 0.04) feed:gain and lowered body temperature were noted in groups supplemented with 0.6% KCl as compared with control and 0.3% KCl. Enhanced physiological adaptation with 0.6% KCl was evidenced by a more favorable pH during the panting phase in the present study. These findings demonstrated a possibility of better broiler live performance through KCl supplementation under conditions of severe heat stress (35 to 38 degrees C).

Barrier agents for adhesion prevention after gynaecological surgery

BACKGROUND

Pelvic adhesion can form as a result of inflammation, endometriosis or surgical trauma. During pelvic surgery, strategies to reduce pelvic adhesion formation may include placing synthetic barrier agents such as oxidised regenerated cellulose, polytetrafluoroethylene or Fibrin sheets between the pelvic structures.

OBJECTIVES

To assess the effect of physical barriers used during pelvic surgery in women of reproductive age on pregnancy rates, pelvic pain, or postoperative adhesion reformation.

SEARCH STRATEGY

We searched the Cochrane Menstrual Disorders and Subfertility Group Trials Register (searched September 2007) which is based on regular searches of MEDLINE, EMBASE, CINAHL, PsycINFO and CENTRAL, plus handsearching of 20 relevant journals and conference proceedings, and searches of several key grey literature sources. In addition, companies were contacted for unpublished trials.

SELECTION CRITERIA

Any randomised controlled trials (RCTs) comparing the use of physical barriers versus no treatment or other physical barriers in the prevention of adhesions in women undergoing gynaecological surgery.

DATA COLLECTION AND ANALYSIS

Review authors assessed trial eligibility and quality.

MAIN RESULTS

Sixteen RCTs were included. Five trials randomised patients while the remainder randomised pelvic organs. Laparoscopy (six trials) and laparotomy (10 trials) were the primary surgical techniques. Indications for surgery included myomectomy (five trials), ovarian surgery (five trials), pelvic adhesions (four trials), endometriosis (one trial), and mixed (one trial). Eleven trials assessed Interceed versus no treatment, two assessed Interceed versus Gore-Tex, one trial assessed Gore-Tex versus no treatment, and one trial assessed Seprafilm versus no treatment. A single trial assessed Fibrin sheet versus no treatment. No studies reported pregnancy or reduction in pain as outcomes. The use of Interceed was associated with reduced incidence of pelvic adhesion formation, both new formation and reformation following laparoscopic surgery or laparotomy. However, this result should be interpreted with caution. Gore-Tex was more effective than no barrier or Interceed in preventing adhesion formation. There was only limited evidence that Seprafilm was effective in preventing adhesion formation following myomectomy and no evidence to support Fibrin sheet.

AUTHORS' CONCLUSIONS

The absorbable adhesion barrier Interceed reduces the incidence of adhesion formation following laparoscopy and laparotomy, but there are insufficient data to support its use to improve pregnancy rates. Gore-Tex may be superior to Interceed in preventing adhesion formation but its usefulness is limited by the need for suturing and later removal. There was no evidence of effectiveness of Seprafilm and Fibrin sheet in preventing adhesion formation.

Laparoscopic entry techniques

BACKGROUND

Laparoscopy is a very common procedure in gynaecology. Complications associated with laparoscopy are often related to entry. The life-threatening complications include injury to the bowel, bladder, major abdominal vessels, and anterior abdominal-wall vessel. Other less serious complications can also occur, such as post-operative infection, subcutaneous emphysema and extraperitoneal insufflation. There is no clear consensus as to the optimal method of entry into the peritoneal cavity.

OBJECTIVES

The objective of this study was to compare the different laparoscopic entry techniques in terms of their influence on intra-operative and post-operative complications.

SEARCH STRATEGY

This review has drawn on the search strategy developed by the Menstrual Disorders and Subfertility Group. In addition MEDLINE and EMBASE were searched through to July, 2007.

SELECTION CRITERIA

Randomised controlled trials were included when one laparoscopic primary-port-entry technique was compared with another.

DATA COLLECTION AND ANALYSIS

Data were extracted independently by the first two authors. Differences of opinion were registered and resolved by the fourth author. Results for each study were expressed as odds ratio (Peto version) with their 95% confidence intervals.

MAIN RESULTS

The 17 included randomised controlled trials concerned 3,040 individuals undergoing laparoscopy. Overall there was no evidence of advantage using any single technique in terms of preventing major complications. However, there were two advantages with direct-trocar entry when compared with Veress-Needle entry, in terms of avoiding extraperitoneal insufflation (OR 0.06, 95%CI 0.02, 0.23) and failed entry (OR 0.22, 95%CI 0.08, 0.56). There was also an advantage with radially expanding access system (STEP) trocar entry when compared with standard trocar entry, in terms of trocar site bleeding (OR 0.06, 95%CI 0.01, 0.46). Finally, there was an advantage of not lifting the abdominal wall before Veress-Needle insertion when compared to lifting in terms of failed entry without an increase in the complication rate (OR 5.17, 95%CI 2.24, 11.90). However, studies were limited to small numbers, excluding many patients with previous abdominal surgery and women with a raised body mass index, who often had unusually high complication rates.

AUTHORS' CONCLUSIONS

On the basis of evidence investigated in this review, there appears to be no evidence of benefit in terms of safety of one technique over another. However, the included studies are small and cannot be used to confirm safety of any particular technique.

Influence of nitrogen and sulfur fertilization on quality of canola (Brassica napus L.) under rainfed conditions

Field experiments were conducted at Cereal Crops Research Institute, Pirsabak, Nowshera, Pakistan, during winter 2003-2004 and 2004-2005 to evaluate the effect of nitrogen and sulfur levels and methods of nitrogen application on canola (Brassica napus L. cv. Bulbul-98) under rainfed conditions. Four levels of S (0, 10, 20, and 30 kg/ha) and three levels of N (40, 60, and 80 kg/ha) and a control treatment with both nutrients at zero level were included in the experiments. Sulfur levels were applied at sowing while N levels were applied by three methods (100% soil application, 90% soil+10% foliar application, and 80% soil +20% foliar application). The experiments were laid out in randomized complete block (RCB) design having four replications. Oil content increased significantly up to 20 kg S/ha but further increase in S level did not enhance oil content. Glucosinolate content increased from 13.6 to 24.6 micromol/g as S rate was increased from 0 to 30 kg/ha. Protein content increased from 22.4% to 23.2% as S rate was increased from 0 to 20 kg/ha. Oil content responded negatively to the increasing N levels. The highest N level resulted in the highest values for protein (23.5%) and glucosinolate (19.9 micromol/g) contents. Methods of N application had no significant impact on any parameters under study.

Influence of Canola Meal-Based Diets Supplemented with Exogenous Enzyme and Digestible Lysine on Performance, Digestibility, Carcass, and Immunity Responses of Broiler Chickens

The response of broiler chickens to 2 levels of endo-1,4-beta xylanase and endo-1,3-beta glucanase combination (with and without), 3 levels of digestible Lys (0.8, 0.9, and 1.0%), and 2 levels of canola meal (CM; 20 and 30%) were evaluated in 2 x 3 x 2 factorial arrangement. A total of 2,448 male Hubbard broiler chicks were fed on practical mash diets having 2,750 kcal of ME.kg(-1) and 19.6% CP from 1 to 42 d of age. The BW gain was significantly reduced when 30% CM was added in the diets during 1 to 21 d. Feed:gain and mortality were also observed to be high. No significant effect of enzyme addition or Lys level was observed on feed intake, BW gain, feed:gain, and mortality during the starter phase. When the data were pooled for 42 d, BW gain and feed:gain were unaffected by enzyme addition or Lys levels. A depression in breast weight was observed due to 30% CM or 0.8 and 0.9% digestible Lys at 43 d. Leg weights were significantly depressed by enzyme addition or increasing digestible Lys to 1.0% of the diets. The AME, nitrogen digestibility, and antibody titers against Newcastle and infectious bursal diseases were also unaffected by the dietary treatments. In conclusion, the 30% CM is not recommended in broiler diets especially during starter phase (1 to 21 d). However, the CM may be used up to 30% of the diets during finishing phase. The digestible Lys can be lowered to 0.8% when amino acids in proportion to digestible Lys follow the ideal AA ratio. The glucanase and xylanase cocktail have no pronounced effect on the growth performance, nutrient digestibility, and carcass characteristics.

Laparoscopic entry techniques and complications

OBJECTIVE

To identify laparoscopic entry techniques employed by gynecologists in the United Kingdom to determine if the consensus technique is adhered to, and to observe whether entry technique affects complication rate.

METHOD

An anonymous postal questionnaire was sent to gynecologists with an interest in laparoscopic surgery in the United Kingdom.

RESULTS

At total of 568 questionnaires were sent and 345 (60.7%) were returned. Of gynecologists who returned the questionnaire 194 (57%) reported occurrence of a major bowel or vascular complication. In terms of the key elements of the consensus document there was no significant difference in entry technique used between those that reported major injury (vascular, bowel, or both), and those that did not.

CONCLUSIONS

This survey demonstrates the variation in entry techniques used by gynecologists in the United Kingdom. Without a good evidence-base to the contrary no entry technique can be stated as safer than another.

Pain relief in hysterosalpingography

BACKGROUND

Hysterosalpingography (HSG) is a method of testing for tubal patency. Various pharmacological strategies are available that may reduce the pain during the procedure.

OBJECTIVES

To compare the effectiveness of different types of pharmacological interventions for pain relief in women undergoing hysterosalpingography (HSG) for investigation of subfertility.

SEARCH STRATEGY

This review has drawn on the search strategy developed for the Menstrual Disorders and Subfertility Group. In addition MEDLINE and EMBASE were searched up to July 2006.

SELECTION CRITERIA

All randomised controlled trials investigating the pharmacological interventions for pain relief during HSG were investigated.

DATA COLLECTION AND ANALYSIS

Data were extracted independently by the first two authors. Differences of opinion were registered and resolved by the third author. Results for each study were expressed as mean pain score and standard error of the mean with 95% confidence intervals.

MAIN RESULTS

The included eight trials reported on 570 women undergoing HSG.Overall, there was no evidence of benefit of using any analgesia compared with placebo for pain relief during the procedure (standard mean difference (SMD) of -0.05 (95%CI -0.25 to 0.14) or up to 29 minutes after HSG SMD 0.17, (95%CI -1.00 to 1.34)). Four RCTs involving 219 women found evidence of benefit with any analgesia in comparison to placebo for pain relief more than 30 minutes after HSG, with the SMD of -0.82(95%CI-1.18 to -0.45). One RCT involving 91 women compared the effectiveness of opioid analgesics versus non-opioid analgesics and reported no evidence of difference in pain relief at any stage of the procedure. One RCT involving 20 women compared the use of topical analgesia with a paracervical block, with analysis demonstrating more benefit to be gained from using topical analgesia during HSG, with the SMD of -2.03 (95%Cl-3.16 to -0.91).

AUTHORS' CONCLUSIONS

There is little evidence of benefit in terms of pain relief of any of the interventions considered in this study during or immediately after HSG. However, there is limited evidence of pain reduction 30 minutes after the procedure. Further RCTs should consider the role of non steroidal antiinflammatories (NSAIDs) and intrauterine anaesthetic during HSG.

Comparative Bioefficacy of Lysine from l-Lysine Hydrochloride or l-Lysine Sulfate in Basal Diets Containing Graded Levels of Canola Meal for Female Broiler Chickens

A broiler growth assay was conducted to compare the efficacy of l-lysine HCl and l-lysine sulfate at a graded addition of canola meal (CM). A total of 1,440 1-d-old female Hubbard broiler chicks were allotted randomly to 6 dietary treatments each in 4 replicates of 60 birds per pen. The 2 lysine sources (l-lysine HCl and l-lysine sulfate) and the 3 CM levels (10, 15, and 20%) were used in 2 x 3 factorial arrangement in isonitrogenous (19% CP) and equicaloric (2,700 kcal of ME/kg) diets containing 0.96% digestible lysine. The experiment lasted for 42 d, and a single mash diet was used throughout the experiment. The feed intake during the starter phase (1 to 28 d) decreased linearly as the dietary CM level increased with diets containing l-lysine HCl, whereas feed intake increased linearly with increasing dietary CM level with that of lysine sulfate. Gizzard weight as percentage of carcass weight increased linearly (P < or = 0.016) as dietary CM level increased. No significant effect of lysine sources or CM was observed on body weight gain, feed:gain, mortality, carcass weight, breast and thigh yield, and abdominal fat. In conclusion, l-lysine HCl can be replaced with l-lysine sulfate for broiler diets, and CM can be used as up to 20% of the starter (1 to 28 d) and finisher (29 to 42 d) diets without having any adverse effects of broiler performance.

Partial purification and characterization ofGigantocotyle explanatumsomatic antigens

Soluble extracts ofGigantocotyle explanatum, isolated from the liver of buffaloBubalus bubaliswere fractionated on Sephadex G-200 columns. Nine major fractions referred to as F1, F2, F3, F4, F5, F6, F7, F8 and F9 were separated. Each fraction was tested by ELISA for antigenicity using sera fromG. explanatum-infected field buffaloes. Fractions F1 and F2 were highly antigenic, F3, F4, F6 and F7 were moderately antigenic and F5, F8 and F9 were poorly antigenic. Analyses by SDS–PAGE revealed that each fraction comprised several polypeptide(s) in the molecular weight range of <29 to >205 kDa. Results of Western blotting indicated that not all polypeptides which appeared in the SDS–PAGE were antigenic. The antigenic molecules of each fraction were mostly in the low molecular weight range of <14 to >94 kDa with the polypeptides in the range of >14, 14, 18, 21–25 and 34–36 kDa.

Formation of nanostructured, nanocrystalline boron nitride microparticles with diatom-derived 3-D shapes

The first use of diatom frustules as shape-dictating 3-D templates for the syntheses of nanostructured, nanocrystalline micro-particles of a non-oxide ceramic, boron nitride, is demonstrated.

The Influence of Exogenous Multienzyme Preparation and Graded Levels of Digestible Lysine in Sunflower Meal-Based Diets on the Performance of Young Broiler Chicks Two Weeks Posthatching

The study was conducted to investigate the effect of adding multienzyme preparation (Rovabio Excel AP, Adisseo Asia Pacific Pte Ltd., Singapore) at 2 inclusion levels of sunflower meal (SFM; 20 and 30% of the diets) with 3 levels of digestible Lys (0.8, 0.9, and 1.0%) with and without enzyme in a 2 x 2 x 3 factorial arrangement. Each diet was offered to 4 replicates of 51 one-day-old straight-run Hubbard broiler chicks (n = 2448) in a practical vegetable-based mash diet having 2,750 kcal of ME/kg and 19% CP during 2 wk posthatching (1 to 14 d of age). Feed formulation was based on digestible amino acids, which were calculated from the CP and DM contents of each ingredient using AminoDat 2 (Degussa Corp., Allendale, NJ). The enzyme used in this study was authenticated by the supplier to have minimum level of endo-1,4-beta xylanase (22,000 visco units/g) and endo-1,3(4)-beta glucanase (2,000 AGL units/g) and was added at the rate of 50 mg/kg of finished diet. No significant effect of enzyme or level of SFM was observed on BW gain (BWG), feed intake, or mortality during the experimental period. The BWG and feed:gain for birds fed on 30% SFM with enzyme were comparable to those fed on 20% SFM without enzyme during 1 to 14 d of age. However, enzyme at 20% SFM depressed the BWG (P <or=0.006) and feed conversion ratio (P <or=0.027). A quadratic (P <or=0.036) response of digestible Lys was noted for BWG, whereas it was linear (P <or=0.001) for feed:gain during 1 to 7 and 1 to 14 d. A level of 1.0% digestible Lys was observed best for BWG and feed:gain. For BWG, 0.8 and 0.9% digestible Lys was comparable when it was used at 30% SFM, along with enzyme. In conclusion, enzyme supplementation during 2 wk posthatching has no remarkable effect when used in SFM-based diets. Moreover, digestible Lys may be lowered to 0.8% during the first week but not less than 1.0% during the second week post-hatching.

Techniques for pelvic surgery in subfertility

BACKGROUND

Since the introduction of in-vitro fertilisation (IVF) tubal surgery has been less frequently undertaken as a technique to improve fertility in women with damaged fallopian tubes. There are various surgical techniques that can be used to repair blocked or damaged fallopian tubes.

OBJECTIVES

To evaluate the role of tubal surgery in the management of tubal infertility and to evaluate surgical techniques for the treatment of tubal infertility.

SEARCH STRATEGY

This review has drawn on the search strategy developed for the Menstrual Disorders and Subfertility Group. We identified relevant trials from the Cochrane Menstrual Disorders and Subfertility Group Specialised Register (searched up to July 2005) and Cochrane Central Register of Controlled Trials (CENTRAL). The following databases were searched using the OVID platform: 1. MEDLINE (1966 to July 2005); 2. EMBASE (1980 to July 2005).

SELECTION CRITERIA

All randomised controlled trials investigating the following topics on infertility surgery technique as follows were included.1) The role of infertility surgery versus no treatment.2) The role of infertility surgery versus alternative treatments.3) The role of magnification.4) The role of the CO2 laser at infertility surgery. 5) The role of operative laparoscopy to perform infertility surgery. 6) Any other intervention regarding surgical technique investigated by RCT.

DATA COLLECTION AND ANALYSIS

Data were extracted independently by the first two authors. Differences of opinion were recognised and resolved by consensus. Two by two tables were generated for each trial for the dichotomous outcome of pregnancy and the effects on pregnancy rate of each study is expressed as an odds ratio with 95% confidence intervals.

MAIN RESULTS

Seven randomised control trials were identified. No RCTs comparing infertility surgery versus no treatment or alternative treatments were found. There was no RCT found investigating the use of magnification for tubal surgery. There was no evidence for or against the use of a CO2 laser compared with standard techniques for adhesiolysis (OR for pregnancy 1.07, 95% CI 0.40 to 2.87) or salpingostomy (OR for pregnancy 1.38, 95% CI 0.47 to 4.05) from two RCTs. One RCT randomised women for salpingostomatolysis by laparotomy and laparoscopy using the classic approach or the one suture technique. There was no evidence of benefit or disadvantage when laparoscopy was compared to laparotomy. The OR for bilateral tubal patency was 1.32 (95% CI 0.55 to 3.22) and unilateral tubal patency OR was 0.82 (95% CI 0.29 to 2.29). The pregnancy rate was not reported. There was no evidence of benefit or disadvantage from two RCTs assessing the use of a prosthesis at salpingostomy compared with non-use (combined odds of pregnancy (term) in group using the prosthesis as compared to the control (OR for pregnancy at term 1.17, 95% CI 0.47 to 2.93). There was no evidence of benefit or disadvantage difference in one RCT comparing Cuff versus Bruhat technique for salpingostomy One RCT compared two methods of salpingostomy (OR for pregnancy rate ( intrauterine) 1.02, 95% CI 0.22 to 4.61). One RCT showed no evidence of benefit or disadvantage for the use of thermocoagulation or electrocoagulation at adhesiolysis, odds for pregnancy rate between the two groups OR 0.87 (95% CI 0.51 to 1.46).

AUTHORS' CONCLUSIONS

From these limited data there is no evidence of benefit or disadvantage of tubal surgery versus no treatment or alternative treatments. Likewise there is no evidence of advantage or disadvantage of using microsurgery over standard techniques; laparoscopic approach over laparotomy; the use of CO2 laser; or electrocoagulation over thermocoagulation. Randomised controlled trials should be undertaken to determine the role of tubal surgery versus no treatment or alternative treatments. Randomised controlled trials should be undertaken to determine the role at tubal surgery of magnification, laparoscopic approach, the use of lasers or electrocoagulation.

Outcome of fetal pyelectasis diagnosed antenatally

Renal pelvis dilatation is a common anomaly detected at the 20-week anomaly scan. The aim of this study was to evaluate the postnatal outcome of fetal pyelectasis in an unselected obstetric population. This was a retrospective study of fetal pyelectasis detected at midtrimester anomaly scan. Fetal pyelectasis was classified as mild if the anteroposterior renal pelvis diameter measured >5 mm-< or= 7 mm, moderate >7-< or = 10 mm and severe as >10 mm. Persistant fetal pyelectasis was defined as >7 mm in the third trimester.

RESULTS

During the study period fetal pyelectasis was identified in 74 women. 6 were excluded, as case records were not available. Mild pyelectasis was identified in 38/67(56.7%), moderate pyelectasis in 20/67(29.8%) and severe pyelectasis in 9/67(13.4%). None of the infants in the mild pyelectasis subgroup required surgery. 3/29(10%) in the moderate and severe pyelectasis subgroup required postnatal surgery. Of the 38 with mild fetal pyelectasis 13.1% had a positive postnatal diagnosis out of which 7.9% had vesico-ureteric reflux, 2.6% renal dysplasia and 2.6% pelvi-ureteric junction (PUJ) stenoses.

CONCLUSION

74% of pregnancies in the mild pyelectasis subgroup demonstrated spontaneous resolution. However persistent mild pyelectasis may lead to postnatal morbidity and should be followed up.

Analysis of potential antigens of protoscoleces isolated from pulmonary and hepatic hydatid cysts of Bubalus bubalis

The aqueous soluble proteins of the protoscoleces of Echinococcus granulosus isolated from the pulmonary and hepatic hydatid cysts of Bubalus bubalis were partially purified on Sephadex G-200 column. The isolated fractions were tested for their antigenicity by immunodot using the sera collected from experimentally infected puppies during the prepatent period of infection. Six protein profiles (F1-F6) were recovered from both the isolates but the polypeptide recovery of each fraction of the two isolates were some what different, particularly protein concentration of F5 in the liver isolate was greater than the lung isolate. Contrary to this, the concentration of F1 polypeptides of the lung origin protoscoleces is greater as compared to that of the liver. In addition, some antigenic dissimilarity has also been observed in the two isolates. A weak IgG response against F1, F2 and F6 polypeptides was observed in the 4th day post infection (p.i.) sera. With the age of infection the response against these antigens increased as revealed by the intensity of the spot in immunodot analysis. Our studies show that the differences in the elution profile and antigenic profile of the lung and liver isolates, as revealed by gel filtration and immunodot analysis, might be either due to the influence of the microhabitat or these may be two different strains. Further studies are certainly required in this direction.

Analysis of excretory-secretory and somatic antigens of Gastrothylax crumenifer

The excretory/secretory (ES) metabolic products released by Gastrothylax crumenifer (Trematoda: Digenea) during in vitro incubations and the somatic extract of the adult parasite were analysed using polyacrylamide gel electro-phoresis (PAGE). Immunogenicity of ES and somatic extracts were evaluated by immunoblotting and ELISA using sera raised against ES and somatic antigens in rabbits. The electropherograms of ES and somatic extracts have been resolved into 38 and 41 polypeptides, respectively. The apparent molecular weights of these polypeptides range from <29 to > 205 kDa. A total of 14 polypeptides were found to be common to both of the samples. The analysis of immunoblot results revealed 22 and 27 antigenic polypeptides in ES and somatic extracts respectively. Only 11 and 13 antigenic polypeptides were found specific to ES and tissue extract respectively. The molecular weights of these specific polypeptides were calculated to be <14.4, 16, 20, 25, 33, 42, 119, 125 and > 205 kDa for metabolic products and <14.4, 25, 30, 35, 78, 84 and > 205 kDa for the tissue extracts, respectively. Analysis of ELISA results revealed that a dilution of up to 1:3200 of the test sera could react with the ES product. Further, when the ES antigens were allowed to react with antisomatic extracts in hyperimmune sera the titre of IgG increased up to a dilution of 1:12800. The potential importance of these antigens in the immunodiagnosis of amphistomiasis is discussed.

Partial purification and characterization of Gastrothylax crumenifer somatic antigens

The soluble extracts of Gastrothylax crumenifer isolated from the rumen of buffalo (Bubalus bubalis) were fractionated on a Sephadex G-200 column. A total of eight major fractions (F1, F2, F3, F4, F5, F6, F7, and F8) were separated from the whole homogenate of G. crumenifer, and each of these fractions was tested for their antigenicity by ELISA against rabbit hyperimmune sera. It was observed that F1, F2, F3 and F4 were highly antigenic, F6 and F7 were moderately antigenic and F5 and F8 were poorly antigenic. The individual fractions analysed after SDS-PAGE and Western blotting indicated that the antigenic fractions of G. crumenifer are of low molecular weight, in the range of <14-50kDa, and predominant antigenic components which were evident in most of the Sephadex profiles were of Mr 15, 18, 19, 23-24 and 28-32kDa.

Cost effectiveness evaluation of the Ministry of Health Malaysia dialysis programme

We determine the cost effectiveness of centre and home haemodialysis (HD), continuous ambulatory peritoneal dialysis (CAPD) and intermittent peritoneal dialysis (IPD) treatment in the Ministry of Health (MOH) programme. The viewpoint taken for this evaluation is that of MOH. Cost categories identified were capital cost, dialysis operational cost, medical cost and general hospital cost. Cost estimates were mostly based on actual resource utilisation. Life years saved were estimated based on Dialysis Registry data on 2480 HD and 732 CAPD patients. Overall, the cost-effectiveness ratio (CER) of centre HD was RM21620/life year saved. Those of home HD, CAPD and IPD were RM23375, RM30469 and RM36016 respectively. Sensitivity analyses did not change the ranking of the CER. We conclude the MOH dialysis programme was cost-effective, and among the various dialysis modalities centre HD was the most cost-effective.

Outcome assessment of the Ministry of Health Malaysia dialysis programme

We describe the outcomes on haemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) provided by the Ministry of Health (MOH). The assessment was based on data from the Malaysian Dialysis Registry on 2480 HD and 732 CAPD patients who commenced dialysis between 1980 and 1996. Young patients (age < 40) have remarkable long term survival (life expectancies of 16 years on HD, 18 years on CAPD). Adjusting for background mortality, relative survival of older patients was as good as younger ones. Diabetics did poorly. 52% of HD and 26% of CAPD patients were employed in 1996. 71% of HD patients scored 10(normal) on QL index (a measure of quality of life) while 60% of CAPD patients have similar score. Differences in rehabilitation and QL index scores by age, gender and diabetes were also observed. Outcomes of dialysis in the MOH programme are reassuring.

Effects of lead on the male reproductive system in mice

The effect of environmental lead on the male reproductive system has been a major area of concern for several years. Lead toxicity to the male reproductive system of sexually mature male CF-1 mice was investigated by administering two concentrations of lead (0.25% and 0.5%) via drinking water for 6 wk. The low lead dose significantly reduced the number of sperm within the epididymis, while the high dose reduced both the sperm count and percentage of motile sperm and increased the percentage of abnormal sperm within the epididymis. There was no significant effect on testis weight; however, the high-dose treatment significantly decreased the epididymis and seminal vesicle weights as well as overall body weight gain. Plasma luteinizing hormone (LH), follicle-stimulating hormone (FSH), and testosterone (T) levels were not affected by lead administration indicating that in adult male CF-1 mice, lead targets testicular spermatogenesis and sperm within the epididymis to produce reproductive toxicity rather than acting at other sites within the hypothalamic-pituitary-testicular axis.

Coproantigens: early detection and suitability of an immunodiagnostic method for echinococcosis in dogs

In the present study immunodiagnostic tests for Echinococcus granulosus-specific coproantigens have been evaluated. The techniques are based on polyclonal antisera collected from dogs experimentally infected with E. granulosus protoscoleces. ELISA, Countercurrent immunoelectrophoresis (CCIEP) and Immunodot were evaluated for their application in coprodiagnosis. The level of coproantigens was detectable on day 7 post-infection and reached a maximum level on day 56 as detected by ELISA. Very high O.D values were obtained when faecal samples of 7-8 weeks post-infection were used. Besides this, immunodot and CCIEP were also tested and the 4th week post-infection samples gave significant reactions. It is evident from the results that ELISA was more sensitive and detected the coproantigens as early as the first week post-infection whereas immunodot and CCIEP detected coproantigens later. The latter methods are rapid, cost-effective and can be used to diagnose suspect cases of echinococcosis under field conditions. Thus, it is suggested that future studies should be aimed at early detection of echinococcosis by a rapid and cost-effective immunodot test.

The anti-stress activity of a gem-containing Unani formulation against diverse stressors

Drugs of mineral origin, especially gems, are extensively used in Tibb-e-Unani (Unani Medicine), both as single drugs and as compound formulations. But such drugs have not yet been adequately studied scientifically. Jawahir Mohra (JM) is one such, as yet unstudied, anti-stress Unani preparation, containing a few herbal and animal ingredients also. Therefore in the present study, a modified JM preparation was investigated for its anti-stress activity against physical, chemical and metabolic stimuli. The non-gem complement (NGC) of JM was also studied for action against physical stress. In albino rats stressed by swimming and subsequently tested for motor function by Rota rod (muscle coordination), activity wheel (forced motor activity) and photoactometer (spontaneous motor activity), JM treatment for 7 days produced a striking and significant increase in activity. The NGC also increased the activity significantly which was however less than JM. JM also produced a striking increase in cold swimming endurance and in the latency of post-anoxia convulsions, while pentylentetrazol (PTZ)-induced defecation and urination in an open field arena under continuous stimulation by intense light and sound was significantly decreased. Therefore, the present investigation indicates that the gem-containing Unani compound JM has significant anti-stress activity of a non-specific type against diverse stressors. This could be due to adaptogenic activity of the preparation. The study also shows that the gems in JM contribute significantly to its anti-stress activity.

Human platelet Fc receptors: binding kinetics of Fc derivatives to the receptors

Human platelets are known to carry Fc receptors (Fc R), but the binding characteristics between ligands and Fc gamma R has not been well elucidated. In this study, we investigated the binding kinetics of IgG Fc fragments (Fc) to Fc R, the association and dissociation characteristics of the ligands to and from Fc gamma R using enzymatically modified Fc fragment derivatives. Approximately 60 minutes and 90 minutes were needed at 37 degrees C and 22 degrees C, respectively, for complete saturation of the Fc binding sites with horseradish peroxidase-conjugated Fc (HPO-Fc). Heat aggregated IgG (HAG) had a greater affinity for the Fc gamma R than Fc monomers. Additional binding of HAG was observed even after the binding sites were saturated with Fc monomers. This could be explained by different binding sites available only for immune complexes or by the partial dissociation of binding sites saturated with Fc by HAG. Further, we noted partial dissociation of HPO-Fc, when HAG was added after saturation of the binding sites with HPO-Fc. In a subsequent experiment, we compared the relative affinities of chemically or enzymatically modified Fc derivatives for Fc gamma R. HAG, which was used as a model for CIC, had a greater affinity for platelet Fc gamma R than IgG monomer and Fc derivatives. Pepsin-digestion of Fc caused a total loss of its affinity for the Fc gamma R, whereas b-mercaptoethanol-treated Fc fragments demonstrated substantial binding to the Fc gamma R. These results indicate that the pepsin digestion affects the Fc portion and causes a disruption in the area of the Fc which is essential for the recognition by the platelet Fc gamma R. On the other hand, cleavage of disulfide bridges by beta-mercaptoethanol resulted in a marked increase in affinity for the Fc gamma R. On the other hand, enzymatic cleavage of the carbohydrate moieties of Fc did not alter the affinity of Fc fragments for the Fc gamma R, indicating that the carbohydrates play an insignificant role or are not involved in their binding to the Fc gamma R.

Typhoid perforation treated with and without metronidazole along with chloramphenicol, gentamycin

Forty cases of typhoid ileal perforation were treated surgically in three years. Chloramphenicol and gentamycin were given to 20 patients, while the remaining 20, received Metronidazole additionally. The mortality rate was 60 percent in the first and 40 percent in the second group.

Characterization of human platelet IgG Fc receptor associated with membrane glycoprotein

Human platelets express IgG Fc receptors (Fc gamma R). Previously we reported that circulating immune complexes (CIC) inhibited fibrinogen binding to platelet glycoprotein IIb/IIIa complex (GPIIb/IIIa) and that isolated Fc gamma R were recognized by monoclonal antibodies (mAb's) to GPIIb and GPIIIa (J.Lab. Clin. Med. 117:209-217, 1991). In this study, we further characterized the properties of the Fc gamma R and the activity associated with GPIIb/IIIa. Binding of Fc portion of human IgG (Fc) to the platelet Fc gamma R associated with GPIIb/IIIa complex, unlike fibrinogen receptor, did not require divalent cations. The Fc gamma R bound to immobilized immune complex were recognized by mAb's to GPIIb, GPIIIa, GPIIb/IIIa. Preincubation of platelet extract with fibrinogen inhibited the binding of heat-aggregated IgG (HAG) to the extract. Flow cytometry of whole platelets revealed inhibition of mAb binding to GPIIb/IIIa, when platelets were incubated with Fc fragments or HAG. Using platelet extract coated to microtiter plates, similar findings were noted with Fc and HAG. The dissociation of GPIIb/IIIa complex by incubating platelet extract at 37 degrees C in the presence of EDTA caused a marked decrease in the binding of GPIIb and GPIIIa to the immobilized immune complex. Activation of intact platelets with ADP resulted in an increased binding of HAG to the platelets, indicating that an augmented Fc gamma R activity is associated with the activation of GPIIb/IIIa. These results suggest a close relationship of the Fc gamma R activity to the fibrinogen binding site (GPIIb/IIIa complex).

Urinary erythrocyte morphology as a diagnostic aid in haematuria

The value of urinary erythrocyte morphology in diagnosing glomerular and nonglomerular haematuria was studied using phase contrast microscopy in 105 patients with significant haematuria. Fifty-eight (93.6%) out of 62 patients with glomerulonephritis had dysmorphic erythrocytes and 40 (93.1%) out of the 43 patients with nonglomerular disease had isomorphic erythrocytes in the urine. A mixed picture of glomerular and nonglomerular haematuria was seen in 5 patients. The sensitivity was 93.6%, the specificity was 97.7% and the positive predictive value was 98.3% for glomerulonephritis in patients with dysmorphic haematuria. The positive predictive value for a nonglomerular source of bleeding was 96.7% with isomorphic haematuria. It is concluded that phase contrast microscopic examination of erythrocytes in urine is a simple, inexpensive and noninvasive technique that reliably distinguishes between glomerular and nonglomerular bleeding in patients.

Cerebral ornithine decarboxylase levels following gestational exposure to cocaine

The pre- and postnatal developmental course of cerebral ornithine decarboxylase (ODC) has been studied in infant rats after treatment of pregnant dams with cocaine. Levels of cocaine attained in brains and serum of embryos were not initially increased over corresponding maternal values, but were more persistent. However, cocaine was not longer detectable in these tissues 4 days after administration. The cerebral ODC level of treated pups was initially depressed and subsequently elevated relative to control values. These changes were apparent at times when cocaine was not detected in the developing brain. Results indicate that a transient exposure to cocaine in utero may lead to prolonged developmental abnormality.

Gestational exposure to phencyclidine (PCP) in rats decreases PCP binding sites in term fetal brain

Pregnant Sprague-Dawley rats were treated with 5 mg/kg body weight of phencyclidine (PCP) injected at 1 ml/kg subcutaneously on three consecutive days at four different stages of gestation. Within 10-30 min after treatment, dams showed some lack of motor coordination and became lethargic. On gestational day 21, all rats were killed by decapitation and brains were dissected and stored from mother and fetus for neurochemical analysis. PCP, dopamine and muscarinic cholinergic receptor binding was measured in membranes prepared from maternal and fetal whole brain. Neurotransmitter concentrations were also measured in the fetal brain homogenates. There was a significant decrease in PCP binding sites in fetal but not maternal brains after maternal PCP injection at gestational days 12-14, 15-17 and 18-20, but not at 9-11 days. Dopamine and muscarinic cholinergic receptor binding was not significantly altered in fetal or maternal brain when compared with vehicle control animals. The whole brain dopamine, 3,4-dihydroxyphenylacetic acid, serotonin, and 5-hydroxyindoleacetic acid concentrations did not show significant change in any group studied. These data indicate that gestational exposure to PCP decreases high affinity binding of PCP in term fetal brain at doses which do not alter maternal PCP receptor binding.

Toxic effects of phencyclidine on developing chick embryo brain

We studied the effects of Phencyclidine (PCP, Angel Dust) on the developing chick embryo brain. In Group-1, the eggs were injected with PCP on the 7th day of incubation and the embryo brains were studied on the 10th day. In Group-2, eggs were injected twice; first on the 7th day and then on the 10th day of incubation. Group-2 brains were then studied on the 16th day of incubation. PCP significantly depressed the development of embryo brains. Cerebral hemisphere weight, total protein and total DNA were significantly lower on day 10 of incubation in Group-1. Similar results were observed in Group-2. Concomitantly, the concentration of brain serotonin at day 10 was also significantly reduced when PCP was injected into the eggs on the 7th day of incubation. Since serotonin has been reported to influence development of the chick embryo brain, the present finding of the effect of PCP on brain development might be a secondary phenomenon. The possible implications of the effects of PCP on human brain development are also discussed.

Persistence of phencyclidine in fetal brain

Phencyclidine residues were found in the brains of rat pups of mothers dosed with this drug during pregnancy. These levels were significant at times after dosing when maternal levels of phencyclidine in serum or brain were low or undetectable. The persistence of this compound in fetal serum was also not prolonged. Maternal ingestion of PCP for a relatively brief time may result in an extended exposure of the developing nervous system.

Abuse of phencyclidine (PCP) a laboratory experience

Emergency Room patients at Riverside General Hospital who are found by the attending physician to have depressed sensorium and altered personality are routinely subjected to urine tests for various drugs of abuse including phencyclidine (PCP). The findings of the laboratory analysis of these patients are presented in this paper. The toxicology laboratory of this hospital performs screening procedures for various drugs on urine specimens by thin layer chromatography. Drugs detected are confirmed by gas chromatography and a homogeneous enzyme immunoassay technique. In 1981, 1.6% of the urine specimens of patients in the above-mentioned category were found to be positive for PCP. This percentage increased sharply during 1982 (5.8%) and 1983 (5.6%). During 1984 and 1985 the percentage dropped to 4.2% and 4.6%. It is implied from data that the abuse of this drug in this area has leveled off. The data also indicated that PCP is predominantly used by young adults with ages ranging from 21 to 30 years. The abuse of this drug in people over 40 years of age is comparatively very small. Among users of this drug, 67.5% are men and 32.5% are women. Out of 68 women found to be abusing PCP, 5 delivered their babies in this hospital. PCP was detected in the urine specimens of each of these babies. Four out of the five infants showed withdrawal symptoms such as extreme irritability, jitteriness, hyperactivity with high pitched cries and a poor ability to take food.

The effects of exogenous nutrients on growth of chick embryo brain

The effect of an early addition of exogenous nutrients on brain growth has been investigated in chick embryo. The nutrients were introduced onto chorioallantoic membrane at day 6 or 7 of embryonal life, and the cerebral hemispheres examined at the end of neuronal proliferation for the following parameters: weight, DNA content (index of cell number) and protein content. L-Tryptophan produced significant inhibition, probably by creating amino acid imbalance and interference with the transport of other amino acids. D-Tryptophan (slower transport) was inactive. 5-Methyltryptophan produced significant inhibition, probably by causing deficiency of tryptophan utilization and of production of serotonin, which is a growth factor for early brain. Glycine stimulated brain growth, probably by conversion to glucose which is the main energy source for the embryo in this period. Brain weight and DNA were found to be significantly correlated with blood glucose level. It is concluded that, within genetic limits, early brain growth might be manipulated in both directions (inhibition or stimulation) by addition of proper nutrients during sensitive period of neuronal proliferation.

The effect of progesterone on brain and body growth of chick embryos

It has been suggested that in the embryo hormonal steroids may act also as control factors for the growth of neural systems. In the present work progesterone was introduced onto the chorioallantoic membrane of the chick embryo on day 7 or days 7 and 10 of incubation. The embryo, dissected at day 10, showed significant increases in body weight and cerebral hemispheres weight. The response at day 13 was less pronounced; male embryos responded to progesterone more than the female embryos. Progesterone is a precursor to other corticosteroids, but corticosterone itself had a significant harmful effect on embryonal growth. Several possible explanations of these results have been offered. It appears that progesterone itself promotes the growth of the early embryo, but the effect depends on its age and sex.

Correlations between neonatal body weight and adolescent brain development in rats

Correlations between neonatal body weight, and body weight and several brain parameters at 30 days of age were studied in normal rats. At 30 days ('adolescence') cortex has already reached its final thickness and the rat exhibits long-term memory. Brain parameters included cerebral weight, DNA, protein and cholesterol contents and densities, as well as cortical and cerebral dimensions (cerebral sections). As expected, most of these parameters in 30-day-old animals were significantly correlated with each other. Unexpectedly, neonatal body weight was also significantly correlated with cholesterol content and density at 30 days, as well as with cortical and cerebral dimensions at 30 days. Thus, statistically, neonatal body weight already predetermines the extent of neuronal (cerebral) development at adolescence (30 days). This finding also makes it possible to make at birth statistical predictions about future brain development without having to sacrifice neonatal animals.

Effects of undernutrition and protein malnutrition on brain chemistry of rats

The present study was undertaken to assess the effects of different degrees of nutritional restrictions during fetal life, suckling, and after weaning on the chemical composition of the brain. At 42 days of age, the rats were killed, and the brains were processed for analyses. The rats exposed to severe protein malnutrition after weaning had lower brain weights than those on controls. The brain seems to be resistant to the effects of moderate protein malnutrition imposed during suckling or after weaning. Thus, the brain is either resistant to the effects of mild nutritional deficiency imposed during suckling, or brain composition is very responsive to nutritional rehabilitation initiated after weaning. The effects of severe undernutrition during suckling were not, however, reversed when adequate nutrition was initiated after weaning. The suckling period seems to be critical during development, as the process of myelination was lowered and the levels of electrolytes were irreversibly disturbed. The brains of the rats born to the mothers protein malnourished during gestation were not significantly different from those of controls. The brain seems to be either preferentially protected from the effects of malnutrition imposed during fetal development, or the brain component are very responsive to nutritional rehabilitation initiated immediately after birth. It is suggested that the mother's nutritional status during gestation does not significantly affect the development of the brain. When the young were born to and nursed by protein-malnourished mothers, the growth and the maturation of the brain in such animals were similar to those in rats moderately undernourished during suckling. Growth and maturation of the brain are affected by a lowered level of protein in the diet. Moderate undernutrition imposed during suckling is not important, but the effect is maximum when undernutrition is severe during this period. The suckling period is therefore, comparatively more critical during development.

Surdo-cardiac syndrome: incidence among children in schools for the deaf

This is a report on a survey of 1126 deaf children in three schools for the deaf in the Province of Ontario. One case of the surdo-cardiac syndrome previously reported is included. There were four other children who had a history of syncope but no prolongation of the Q-T interval on the ECG. It is possible that these may represent a variant of the syndrome. Five more children had a prolonged Q-T interval but no fainting spells.