Superoxide dismutase activity in human follicular fluid after controlled ovarian hyperstimulation in women undergoing in vitro fertilization

OBJECTIVE

To determine the activity of superoxide dismutase (SOD) and the total protein concentration in human preovulatory ovarian follicular fluid (FF) in relation to corresponding serum levels and the fertilization capacity of oocytes.

DESIGN

Prospective, observational study.

SETTING

Academic-based center for reproductive medicine.

PATIENT(S)

Twenty-eight female partners of infertile couples, 13 of whom were smokers, undergoing controlled ovarian hyperstimulation for IVF.

INTERVENTION(S)

Blood and follicular fluid samples were collected 34-36 hours after hCG administration.

MAIN OUTCOME MEASURE(S)

Levels of SOD activity and total protein concentrations.

RESULT(S)

Superoxide dismutase activity was present in all the FF studied and mean levels were statistically significantly higher than in serum. Total protein concentrations in serum were statistically significantly correlated with corresponding concentrations in FF. There was no difference in SOD activity between smokers and nonsmokers. Total protein concentrations in FF were marginally and statistically significantly lower in nonsmokers. Follicular fluid from patients whose oocytes did not become fertilized had a statistically significantly higher level of SOD activity than that from patients whose oocytes did become fertilized.

CONCLUSION(S)

Superoxide dismutase activity is present in FF and is higher than in serum. The degree of SOD activity is variable and seems to be inversely related to the fertilization of oocytes.

How commonly are children hospitalized for dehydration eligible for care in alternative settings?

BACKGROUND

Avoiding unnecessary hospitalization has long been a goal of child health care providers. Managed care practice environments increasingly pressure the practicing pediatrician to avoid hospitalization.

OBJECTIVES

To estimate the proportion of childhood dehydration hospitalizations eligible for care in alternative settings (eg, short-stay treatment and triage units, home nursing) and to assess the type and duration of services that might be required for alternative setting care of children with these illness episodes.

DESIGN

All dehydration hospitalizations for the 198 593 children (aged > 1 month and < 19 years) dwelling in Rochester, NY (Monroe County), between 1991 and 1995 were identified in county-wide hospital discharge computer files. Medical records were reviewed for a random sample of 380 of the hospitalizations. Children with major underlying conditions were excluded from analysis because of higher risk for deterioration, and greater complexity of medical care might render alternative settings inappropriate. Measures included a 4-item score estimating level of dehydration, serum bicarbonate level at presentation, and time to rehydration. Rehydration was defined as a drop in urine-specific gravity to 1.010 or less or reduction of fluid administration to the maintenance rate.

RESULTS

Altogether, 1121 dehydration hospitalizations occurred during the study period. Based on medical record review for a random sample of 380 of these 1121, major underlying problems were present in 27.4% (104) of hospitalizations sampled. Simple, acute gastroenteritis accounted for 75.4% (208) of 276 hospitalizations remaining in the sample. Levels of dehydration for these children were estimated as at least 5% for 51.0% (106) and at least 10% for 16.3% (34) of hospital admissions, and serum bicarbonate levels were 12 mmol/L or less for 26.0% (54). Time from hospital admission to rehydration was no greater than 12 hours for 79.3% (165) and no greater than 24 hours for 94.7% (197). However, hospital stay was generally substantially longer. The time hospitalized following rehydration represented 85.8% of the average inpatient stay. Hospital discharge was heavily concentrated in daytime hours, although the children achieved rehydration at all hours of the day. No deterioration occurred during hospitalizations studied.

CONCLUSION

Nearly all children hospitalized for simple, acute gastroenteritis in Rochester might be eligible for care in alternative settings designed to provide hospital-level care for short periods.

Autoantibodies to brain components and antibodies to Acinetobacter calcoaceticus are present in bovine spongiform encephalopathy

Bovine spongiform encephalopathy (BSE) is a neurological disorder, predominantly of British cattle, which belongs to the group of transmissible spongiform encephalopathies together with Creutzfeldt-Jakob disease (CJD), kuru, and scrapie. Autoantibodies to brain neurofilaments have been previously described in patients with CJD and kuru and in sheep affected by scrapie. Spongiform-like changes have also been observed in chronic experimental allergic encephalomyelitis, at least in rabbits and guinea pigs, and in these conditions autoantibodies to myelin occur. We report here that animals with BSE have elevated levels of immunoglobulin A autoantibodies to brain components, i.e., neurofilaments (P < 0.001) and myelin (P < 0.001), as well as to Acinetobacter calcoaceticus (P < 0.001), saprophytic microbes found in soil which have sequences cross-reacting with bovine neurofilaments and myelin, but there were no antibody elevations against Agrobacterium tumefaciens or Escherichia coli. The relevance of such mucosal autoantibodies or antibacterial antibodies to the pathology of BSE and its possible link to prions requires further evaluation.

Antitumor activity of thalidomide in refractory multiple myeloma

BACKGROUND

Patients with myeloma who relapse after high-dose chemotherapy have few therapeutic options. Since increased bone marrow vascularity imparts a poor prognosis in myeloma, we evaluated the efficacy of thalidomide, which has antiangiogenic properties, in patients with refractory disease.

METHODS

Eighty-four previously treated patients with refractory myeloma (76 with a relapse after high-dose chemotherapy) received oral thalidomide as a single agent for a median of 80 days (range, 2 to 465). The starting dose was 200 mg daily, and the dose was increased by 200 mg every two weeks until it reached 800 mg per day. Response was assessed on the basis of a reduction of the myeloma protein in serum or Bence Jones protein in urine that lasted for at least six weeks.

RESULTS

The serum or urine levels of paraprotein were reduced by at least 90 percent in eight patients (two had a complete remission), at least 75 percent in six patients, at least 50 percent in seven patients, and at least 25 percent in six patients, for a total rate of response of 32 percent. Reductions in the paraprotein levels were apparent within two months in 78 percent of the patients with a response and were associated with decreased numbers of plasma cells in bone marrow and increased hemoglobin levels. The microvascular density of bone marrow did not change significantly in patients with a response. At least one third of the patients had mild or moderate constipation, weakness or fatigue, or somnolence. More severe adverse effects were infrequent (occurring in less than 10 percent of patients), and hematologic effects were rare. As of the most recent follow-up, 36 patients had died (30 with no response and 6 with a response). After 12 months of follow-up, Kaplan-Meier estimates of the mean (+/-SE) rates of event-free survival and overall survival for all patients were 22+/-5 percent and 58+/-5 percent, respectively.

CONCLUSIONS

Thalidomide is active against advanced myeloma. It can induce marked and durable responses in some patients with multiple myeloma, including those who relapse after high-dose chemotherapy.

MAP kinases in pollen

The male gametophyte of flowering plants has a highly regulated developmental programme to ensure efficient fertilization of the ovule and the faithful transmission of genetic material to the offspring. Cell cycle control mechanisms dictate the formation of the vegetative and generative (sperm) cells, while an increase in transcriptional/translational activity and the accumulation of stored proteins and mRNA is followed by a quiescent state at maturation. A switch to a new developmental programme occurs after the pollen tube lands on the stigma with the formation of the pollen tube, growth through the style, and subsequent fertilization. Apart from the internal control mechanisms involved in this developmental programme, pollen grains must cope with physical changes during development within the anther (desiccation) and subsequently during germination on the stigma (rehydration). The metabolic and structural changes that occur throughout these processes should require signaling mechanisms to co-ordinate the appropriate response, and recent data demonstrate the presence in pollen of an array of molecules belonging to diverse signalling pathways, including mitogen-activated protein (MAP) kinases. The role of MAP kinases in pollen is discussed in the context of the various developmental and physical changes that occur throughout pollen maturation and germination.

Novel approaches in myeloma therapy

High-dose melphalan (200 mg/m2) followed by one or more autologous peripheral blood stem cell transplantations is a safe and effective treatment regimen for multiple myeloma. This treatment regimen is as effective as standard therapy for myeloma in older (>65 years) patients and in patients with renal failure. However, advanced age (>50 years), duration of prior standard therapy (> 12 months), and a low CD34 mobilization potential (<20 x 10(6)/kg) are associated with a higher incidence of cytogenetic myelodysplasia. Future efforts directed at curing multiple myeloma should incorporate the best remission induction regimens presently available and should use consolidation/maintenance treatment (eg, idiotype/dendritic cell vaccination and dexamethasone/cyclophosphamide/etoposide/cisplatin combination chemotherapy) to enhance sustained complete remission. Other options to improve the treatment of myeloma include novel adjunctive therapies that target the myeloma cell microenvironment (eg, bisphosphonates, thalidomide, other antiangiogenesis agents) and allogeneic transplantation techniques to induce a graft-versus-myeloma effect.

Identification of New Hot Bands in the Blue and Green Band Systems of FeH

A particularly rich region of the electronic spectrum of FeH from 525 to 545 nm was investigated using the techniques of dispersed and undispersed laser-induced fluorescence. Analysis has led to the discovery that several different electronic transitions are embedded in this region; the (0, 0) and (1, 1) bands of the e(6)Pi-a(6)Delta (green) system, the (0, 2) band of the g(6)Phi-X(4)Delta (intercombination) system, the (0, 1) band of the g(6)Phi-a(6)Delta (blue) system, and the (0, 0) band of the g(6)Phi-b(6)Pi system. Seventy-five lines were assigned in the (0, 1) band of the g(6)Phi-a(6)Delta transition. These, with the assignment of an additional 14 lines in the 583 nm region to the (0, 1) band of the e(6)Pi-a(6)Delta transition, led to the extension of the known term values to higher J values for the Omega = 9/2, 7/2, and 5/2 spin components of the v = 1 level of the a(6)Delta state and the novel characterization of the a(6)Delta(3/2) (v = 1) and g(6)Phi(5/2) (v = 0) components. A further 73 lines were assigned to the first four subbands of the (1, 1) band of the e(6)Pi-a(6)Delta transition and term values for the lowest four spin components of the v = 1 level of the e(6)Pi state were determined. This provides the first experimental measurement of a vibrational interval in one of the higher lying electronic states of FeH. The interval does not appear to vary strongly between the spin components (DeltaG(1/2) = 1717, 1713, 1710 cm(-1) for Omega = 7/2, 5/2, 3/2, respectively). Remarkably few of the hot-band transitions assigned in this work could be identified in the complex, high-temperature spectrum of FeH recorded by P. McCormack and S. O'Connor [Astron. Astrophys. Suppl. 26, 373-380 (1976)]. Copyright 1999 Academic Press.

Pharmacological profile of ZD1611, a novel, orally active endothelin ETA receptor antagonist

The endothelins (ETs), potent vasoconstrictor peptides, have been implicated in the pathogenesis of various cardiovascular disorders. In the present study, we describe the novel, potent, orally active, selective ET(A) receptor antagonist ZD1611 [3-(4-[3-(3-methoxy-5-methylpyrazin-2-ylsulfamoyl)-2-pyridyl ]phenyl)- 2,2-dimethylpropanoic acid]. ZD1611 competitively inhibited (125)I-labeled ET-1 binding at human cloned ET(A) and ET(B) receptors with pIC(50) values of 8.6 +/- 0.1 and 5.6 +/- 0.1, respectively, showing 1000-fold selectivity for the ET(A) receptor. ZD1611 caused a parallel rightward shift of the concentration response curve to ET-1 in the rat isolated aorta yielding a concentration of antagonist that caused a 2-fold rightward shift in the ET-1-response curve (pA(2)) of 7.5 +/- 0.3. When administered i. v. to anesthetized rats and dogs, ZD1611 caused dose-related rightward shifts of partial dose-response curves to the precursor of ET-1, big ET-1. Threshold doses for significant antagonist activity were determined as 0.1 mg/kg and 0.3 mg/kg in the rat and dog, respectively. Importantly, ZD1611 was able to reverse an established big ET-1-induced pressor response in pithed rats in the presence of continuous big ET-1 infusion. Failure of ZD1611 to inhibit the BQ3020 (ET(B)-selective)-induced depressor response in pithed rats indicated a lack of activity at the endothelial ET(B) receptor. ZD1611 was orally active in the rat at 0.3 mg/kg and had a duration of action of more than 7 h, and, in the dog, a dose of 0.6 mg/kg p.o. was active for at least 6 h. In conclusion, these data demonstrate that ZD1611 is a potent and orally active, selective ET(A) receptor antagonist with a long duration of action which may be of therapeutic use.

Controlled ovarian hyperstimulation adversely affects implantation following in vitro fertilization-embryo transfer

PURPOSE

Our purpose was to determine if controlled ovarian hyperstimulation adversely affects implantation.

METHODS

A retrospective comparison of pregnancy rates (PRs) and implantation rates was made between oocyte recipients versus their donors, who shared half of the retrieved oocytes, and regular patients undergoing in vitro fertilization-embryo transfer (IVF-ET) who were not sharing eggs.

RESULTS

Higher implantation rates (39.0 vs 22.5%; P < 0.05) were found in recipients compared to donors in the stimulated cycle. However, no differences were seen in PRs or implantation rates in frozen ET cycles. The data for standard IVF patients were almost-identical to those for donors.

CONCLUSIONS

Superior implantation rates and PRs in oocyte recipients versus donors were not related to better oocyte quality for recipients because of egg sharing or to a better uterine environment because of similar results with frozen ET in all three groups. An adverse effect of the hyperstimulation regimen best explains the difference.

Altered phenotypic characteristics of T47d human breast cancer cells after prolonged growth in estrogen-deficient medium

T47D human breast cancer cells were cultured in estrogen-deficient media for up to 32 months and the resulting cell line (L(hE(-))) exhibited unique phenotypic and genotypic characteristics. Compared to low passage (L) cells, the L(hE(-)) cells exhibited a significantly higher rate of proliferation, unique morphological features, advanced ploidy status and 5- to 10-fold higher levels of the estrogen receptor (ER) as determined by ligand binding and Western blot analysis. Sequence analysis of the DNA binding domain of the ER revealed a C-->A transversion which resulted in a H513N amino acid change. Treatment of L cells with 10 n m 17beta-estradiol (E2) resulted in a greater than two-fold increase in cell proliferation which was inhibited by tamoxifen, 4'-hydroxytamoxifen, ICI 164,384 and ICI 182,780. In contrast, 10 n m E2 caused a 70% decrease in growth of L(hE(-)) cells and this antimitogenic activity was blocked by ICI 164,384 and ICI 182,780 but not by tamoxifen or 4'-hydroxytamoxifen. L(hE(-)) cells were E2-responsive in transient transfection studies using a plasmid containing an estrogen-responsive element derived from the vitellogenin A2 gene promoter. These data show that the phenotypic and genotypic characteristics of L(hE(-)) T47D cells resemble those described for ER-negative cell lines stably transfected with the ER.

Forming collaborative relationships

No more separate assessments--the Collaborative History and Physical form facilitates communication between nurses and physicians while it decreases duplication of data and increases patient satisfaction.

MAP kinase activation by hypoosmotic stress of tobacco cell suspensions: towards the oxidative burst response?

Hypoosmotic stress activates a phosphorylation-dependent oxidative burst. In-gel kinase assays were performed to characterize the protein kinases that could be implicated in osmoregulation and in the activation of the oxidative burst. Hypoosmotic stress activated several kinases among which 50 and 46 kDa proteins displayed mitogen-activated protein kinase (MAP kinase) properties. They phosphorylated myelin basic protein in the absence of calcium, were recognized by antibodies directed against human MAP kinases, and were phosphorylated on tyrosine. Immunoprecipitation with an antibody directed against the tobacco MAP kinase Ntf4 showed that at least one of the activated kinases would be Ntf4-like. Apigenin, a MAP kinase and cyclin-dependent kinase inhibitor which prevents the hypoosmotically induced oxidative burst (Cazale et al. 1998; Plant Physiol. 116, 659-669), inhibited these kinases in vitro suggesting that they may play a role in the activation of the oxidative burst. Like the oxidative response, activation of the kinases depended on extracellular calcium influx and protein kinases sensitive to staurosporine and 6-DMAP. However, kinase activation did not depend on effluxes through anion channels or on the oxidative burst. Two-dimensional in-gel kinase assays revealed the presence of three protein kinases with an apparent molecular mass of 50 kDa and one of 46 kDa, all four being activated by hypoosmotic stress. The same kinases were also activated by oligogalacturonides and salicylic acid, underlying the importance of these MAP kinases as common components of different signaling pathways triggered by different extracellular stimuli.

Five year results of LINAC radiosurgery for arteriovenous malformations: outcome for large AVMS

PURPOSE

For radiosurgery of large arteriovenous malformations (AVMs), the optimal relationship of dose and volume to obliteration, complications, and hemorrhage is not well defined. Multivariate analysis was performed to assess the relationship of multiple AVM and treatment factors to the outcome of AVMs significantly larger than previously reported in the literature.

METHODS AND MATERIALS

73 patients with intracranial AVMs underwent LINAC radiosurgery. Over 50% of the AVMs were larger than 3 cm in diameter and the median and mean treatment volumes were 8.4 cc and 15.3 cc, respectively (range 0.4-143.4 cc). Minimum AVM treatment doses varied between 1000-2200 cGy (median: 1600 cGy).

RESULTS

The obliteration rates for treatment volumes < 4 cc, 4-13.9 cc, and > or = 14 cc were 67%, 58%, and 23%, respectively. AVM obliteration was significantly associated with higher minimum treatment dose and negatively associated with a history of prior embolization with particulate materials. No AVM receiving < 1400 cGy was obliterated. The incidence of post-radiosurgical imaging abnormalities and clinical complications rose with increasing treatment volume. For treatment volumes > 14 cc receiving > or = 1600 cGy, the incidence of post-radiosurgical MRI T2 abnormalities was 72% and the incidence of radiation necrosis requiring resection was 22%. The rate of post-radiosurgical hemorrhage was 2.7% per person-year for AVMs with treatment volumes < 14 cc and 7.5% per person-year for AVMs > or = 14 cc.

CONCLUSION

As AVM size increases, the dose-volume range for the optimal balance between successful obliteration and the risk of complications and post-radiosurgical hemorrhage narrows.

Simple steps to keep yourself safe

With increasing incidences of violence in the patient's environment, home health staff are at great risk in and outside of the client's home. This article addresses the practical steps and precautions needed to predict violent incidents and provides suggestions for implementing simple self-protection techniques when encountering situations in which violence is escalating.

Therapeutic approaches to the management of common baldness

Common baldness or androgenetic alopecia is a universal problem, having affected both sexes of all races to different extents for as long as mankind has existed. The progressive androgen dependent hair loss follows specific patterns and is a physiological process, which may take on disease quality due to psychosocial compontents. These should be taken into consideration when discussing the several treatment options available, particularly as a cure cannot be offered. Cosmetic measures range from back-combing over perms to hairpieces and wigs. Medical therapies include systemic antiandrogens and topical minoxidil; surgical options comprise follicular transplantation, scalp reduction and rotation. Before starting treatment, however, careful consideration should be given to the differential diagnosis which includes drug-induced hair thinning, anagen effluvium, diffuse alopecia areata, metabolic disturbances, nutritional deficiencies and acute as well as chronic telogen effluvium.

RNA secondary structure prediction based on free energy and phylogenetic analysis

We describe a computational method for the prediction of RNA secondary structure that uses a combination of free energy and comparative sequence analysis strategies. Using a homology-based sequence alignment as a starting point, all favorable pairings with respect to the Turner energy function are identified. Each potentially paired region within a multiple sequence alignment is scored using a function that combines both predicted free energy and sequence covariation with optimized weightings. High scoring regions are ranked and sequentially incorporated to define a growing secondary structure. Using a single set of optimized parameters, it is possible to accurately predict the foldings of several test RNAs defined previously by extensive phylogenetic and experimental data (including tRNA, 5 S rRNA, SRP RNA, tmRNA, and 16 S rRNA). The algorithm correctly predicts approximately 80% of the secondary structure. A range of parameters have been tested to define the minimal sequence information content required to accurately predict secondary structure and to assess the importance of individual terms in the prediction scheme. This analysis indicates that prediction accuracy most strongly depends upon covariational information and only weakly on the energetic terms. However, relatively few sequences prove sufficient to provide the covariational information required for an accurate prediction. Secondary structures can be accurately defined by alignments with as few as five sequences and predictions improve only moderately with the inclusion of additional sequences.

Iron deficiency anaemia and adverse dietary habits in hospitalised children

AIMS

To determine the prevalence of iron deficiency anaemia in children hospitalised with acute illness and the frequency of adverse dietary habits in the children with iron deficiency anaemia.

METHODS

This was a prospective study of all children, aged 9 to 23 months resident in metropolitan Auckland who were hospitalised at Starship Children's Hospital, from July to October 1997, with an acute medical illness and had a full blood count performed. Iron deficiency anaemia was defined as haemoglobin <110 g/L, red cell distribution width >14.5% and either serum ferritin <10 microg/L or transferrin saturation <10%. Ethnicity and dietary habits of the children were determined by interviewing parents.

RESULTS

During the study period 284 children, aged 9 to 23 months were admitted, of whom 206 (73%) had a full blood count performed. Sixty (29%) of these 206 children had iron deficiency anaemia. A larger proportion of Pacific Islands (P) compared to Maori (M) or European children (E) had iron deficiency anaemia. (P vs M:43% vs 21%, p=0.01; P vs E:43% vs 14%, p<0.001; M vs E 21% vs 14%, P=0.27). Sixty-nine percent of the children with iron deficiency anaemia had a dietary factor (early introduction of cows milk, late introduction of meat or regular consumption of tea) likely to have contributed to their iron deficiency.

CONCLUSIONS

Iron deficiency is prevalent in Auckland children aged 9 to 23 months, hospitalised with an acute illness. The prevalence varies with ethnicity. Adverse dietary habits are present in 69% of the children with iron deficiency anaemia.

Cyclical variations in the abundance of leptin receptors, but not in circulating leptin, correlate with NPY expression during the oestrous cycle

We have demonstrated previously that pharmacological doses of oestradiol decreased leptin receptor expression in the hypothalamus. We therefore analysed leptin receptor expression during the oestrous cycle in the rat, to establish if acute changes in oestradiol affect leptin receptor expression under physiological conditions. Radioactive in situ hybridization histochemistry was used to measure the gene expression under investigation. Total leptin receptor transcript levels were lowest in pro-oestrus in the choroid plexus, these changes correspond inversely with levels of circulating oestradiol in the rat 4-day oestrous cycle. In contrast full-length leptin receptor levels in both arcuate and ventromedial nuclei did not correspond to the levels of total leptin receptor in the same areas of the hypothalamus or serum levels of oestradiol. Full-length leptin receptor expression in the arcuate nucleus was negatively correlated with neuropeptide Y (NPY) expression (r = 0.447, p < 0. 05) in the same nucleus. Arcuate nucleus NPY expression did not correlate significantly with the expression of total leptin receptors in the arcuate nucleus (r = 0.080) or serum leptin levels (r = 0.251). Our results demonstrate that leptin receptor expression is regulated during the oestrous cycle. The unchanged serum leptin levels during the oestrous cycle together with the correlation between the expression of leptin-RL and NPY provide circumstantial evidence that regulation of leptin receptor abundance in the hypothalamus governs the biological actions of leptin.