215 AN IMPROVED SYSTEM FOR THE IN VITRO PRODUCTION OF PORCINE EMBRYOS

A reliable in vitro system for the production of porcine embryos (IVP) is important for use in basic research and in the reproductive technologies. Despite recent developments, blastocyst rates remain low compared with those obtained for most domestic species. Here, we report a porcine IVP system, based largely on our ovine and bovine systems (Walker et al. 1996 Biol. Reprod. 55, 703–708; Kelly et al. 2007 Reprod. Dom. Anim. 42, 577–582), that gives blastocyst development rates higher than previously reported. Abattoir-sourced ovaries were collected into PBS, and cumulus–oocyte complexes (COC) were aspirated (from 3- to 6-mm follicles) into HEPES–TCM-199 supplemented with 0.4% BSA. The COC (up to 30/well) were matured in 600 μL of maturation medium (TCM-199, 20% (vol/vol) porcine follicular fluid, FSH, LH, epidermal growth factor, cysteamine, and estradiol) for 42 h at 38.6°C in humidified 5% CO2. After 42 h, excess cumulus cells were removed and the COC were placed into modified Tris medium supplemented with BSA and caffeine (500 μL well–1). Sperm from pooled semen were washed in HEPES SOF supplemented with BSA, caffeine, and heparin and incubated for 45 min. Sperm were then centrifuged and the pellet was resuspended; a concentration of 5 × 105 sperm mL–1 was used. Oocytes and sperm were co-cultured for 6 h, cumulus cells were removed, and presumptive zygotes were placed into 600 μL of culture medium (SOF, BSA, and amino acids). Zygotes were cultured in 5% CO2:5% O2:90% N2, and cleavage and embryo development to Day 6 were assessed. Separate studies were conducted with COC from mature sows and from prepubertal gilts. In the latter, COC were exposed to ±dbcAMP for the first 22 h of the maturation period. Blastocyst rates in the sow were similar to those routinely produced in sheep and cows in our laboratory. Cleavage rates, mean blastocyst cell numbers, and incidence of polyspermy (assessed to be 10 to 12% in prepubertal gilts) were improvements on those generally reported (see Nagai et al. 2006 Front. Biosci. 11, 2565–2573 and Gil et al. 2010 Reprod. Dom. Anim. 45, 40–48 for general reviews). Observations indicate that the use of dbcAMP to regulate oocyte maturation had a negative effect on most parameters. Although blastocyst cell numbers are indicative of blastocyst quality, the significance of these findings can be validated only by transfer studies to determine embryo viability. Table 1.Development rates for in vitro-fertilised oocytes derived from sow and prepubertal gilts1 This work was partly supported by the Australian Cooperative Research Centre for an Internationally Competitive Pork Industry.

Asymmetric breast uptake of radioiodine in a patient with thyroid malignancy: metastases or not?

Various physiological processes can cause potentially misleading appearances in radioiodine whole body scans; proper understanding of the causes of these can therefore obviate diagnostic errors. Whole-body radioiodine scintigraphy with I131 or I123 is an accurate form of imaging used for management of differentiated thyroid carcinoma. Following thyroidectomy, any residual thyroid tissue or metastatic disease is ablated with high dose I131 and diagnostic images are acquired, demonstrating residual thyroid tissue and metastatic disease. However, atypical physiological uptake of I131 can simulate metastases.

Application of mobile phone technology for managing chemotherapy-associated side-effects

BACKGROUND

Novel mobile phone technology linked to a server that communicates patients' symptoms to healthcare professionals has been adapted to register the side- effects of chemotherapy and provide advice on management of toxicity. We report a feasibility study to examine the utility of home monitoring of patients' symptoms via a mobile phone.

METHODS

Six colon cancer patients receiving adjuvant chemotherapy, entered symptom data onto user friendly screens on a mobile phone twice daily. This 'real time' self assessment of nausea, vomiting, mucositis, diarrhoea and hand-foot syndrome and measurement of temperature was sent via a secured connection to a remote computer. In the event of moderate or severe symptoms (generating amber and red alerts respectively), the nurse was immediately alerted by the computer, via a pager. The nurse then contacted the patient to reinforce the automatic advice sent to the patient on their phone and to assess the patient using clinical algorithms.

RESULTS

The patient used the mobile phones during the first two cycles of chemotherapy. The data were successfully analysed by the server software and alerts were generated alerting the study nurses to patients' symptoms at the appropriate time. There were 91 alerts-54 red and 37 amber; 54% (29/54) of the red alerts were data delay and transmission problems which were swiftly rectified. The remaining red alerts were managed appropriately by the study nurses. Both patients and staff felt confident in this approach to symptom management.

CONCLUSIONS

This study demonstrates that the technology for monitoring patients' symptoms worked well. The patients felt secure in the knowledge that their symptoms were being closely monitored and that they were participating effectively in their own care management.

London bombings July 2005: The immediate pre-hospital medical response

On July 7th 2005 a series of terrorist bombs exploded in London. The transport system was targeted and at least 54 passengers were killed and around 700 injured. This paper describes the immediate pre-hospital medical response to the four scenes. From the perspective of the London Helicopter Emergency Medical Service the deployment, difficulties on scene and the initial lessons learned are discussed.

Carers' perceptions of pain in people with dementia: a grounded theory approach

The purpose of this Grounded Theory based study was to add to the limited understanding about the perception and observation of pain by the formal and informal carers of people with dementia. Thirty-one carers talked about how they know when their person with dementia has pain. Findings showed there is no one set of signs or behaviours that indicate pain in all people with dementia. However, a common pain assessment process amongst carers involved being able to detect deviation from normal behaviours based upon their intimate knowledge of what is normal for their person. A central hypothesis was thus generated from the data that considered that effective pain assessment for people with dementia is dependent on carers having an intimate knowledge of the individual's normal state of being with dementia. Implications for nursing practice are discussed.

How common is attention-deficit/hyperactivity disorder? Towards resolution of the controversy: results from a population-based study

Attention-deficit/hyperactivity disorder (AD/HD) is a common behavioral disorder among children, yet there is uncertainty about many aspects of AD/HD, including its precise frequency of occurrence, presence of comorbid conditions, long-term outcomes and the impact of treatment on long-term outcome. The objectives of the studies described in this paper were to address these important questions about AD/HD. The study subjects were from a population-based birth cohort, and included all children born in Rochester, Minnesota, from 1976 to 1982, who remained in the community after the age of 5 y (n = 5718). Complete medical and school records were available for all members of the birth cohort, including detailed information about AD/HD symptoms, psychometric test and questionnaire results, medical and non-medical treatments, and long-term academic and psychosocial outcomes. This information was used to identify 375 subjects from the birth cohort with AD/HD, based on well-defined research criteria. The estimated cumulative incidence of AD/HD at the age of 19y was 7.5% (95% confidence interval 6.5-8.4). Data from these 375 subjects with AD/HD will be used in ongoing studies of this disorder.

Estimation of the differential pressure at renal artery stenoses

Atherosclerotic disease of the renal artery can lead to reduction in arterial caliber and ultimately to conditions including renovascular hypertension. Renal artery stenosis is conventionally assessed, using angiography, according to the severity of the stenosis. However, the severity of a stenosis is not a reliable indicator of functional significance, or associated differential pressure, of a stenosis. A methodology is proposed for estimation of the renal artery differential pressure (RADP) from MR imaging. Realistic computational fluid dynamics (CFD) models are constructed from MR angiography (MRA) and phase-contrast (PC) MR. The CFD model is constructed in a semiautomated manner from the MR images using the Isosurface Deformable Model (IDM) for surface reconstruction and a Marching Front algorithm for construction of the volumetric CFD mesh. Validation of RADP estimation was performed in a realistic physical flow-through model. Under steady flow, the CFD estimate of the differential pressure across a stenosis in the physical flow-through model differed by an average of 5.5 mmHg from transducer measurements of the pressure differential, for differential pressures less than 60 mmHg. These results demonstrate that accurate estimates of differential pressure at stenoses may be possible based only on structural and flow images.

Efficacy and safety of valdecoxib in treating the signs and symptoms of rheumatoid arthritis: a randomized, controlled comparison with placebo and naproxen

OBJECTIVE

To compare the efficacy of the COX-2 specific inhibitor valdecoxib with the conventional NSAID naproxen and placebo in treating rheumatoid arthritis (RA).

METHODS

This multi-centre, randomized, double-blind, placebo-controlled trial compared the efficacy and safety of valdecoxib 10 mg (n=209), 20 mg (n=212) or 40 mg once daily (q.d.) (n=221) with naproxen 500 mg b.i.d. (n=226) or placebo (n=222), in treating the signs and symptoms of RA. Efficacy was assessed by the number of patients responding to treatment according to the American College of Rheumatology-Responder Index (ACR-20).

RESULTS

ACR-20 response was recorded for all randomized patients who received a single dose of study medication (above). Valdecoxib, at all administered doses, produced significant improvements in the ACR-20 Responder Index at weeks 2, 6 and 12 compared with placebo (P<or=0.01). Valdecoxib and naproxen did not differ in terms of ACR-20 response rate and the three doses of valdecoxib were similar to one another. All three doses of valdecoxib were well tolerated.

CONCLUSIONS

Single daily doses of valdecoxib 10, 20 and 40 mg demonstrated efficacy that was superior to placebo and similar to naproxen in treating the signs and symptoms of RA. All three doses provided similar levels of efficacy.

Two-year, blinded, randomized, controlled trial of treatment of active rheumatoid arthritis with leflunomide compared with methotrexate. Utilization of Leflunomide in the Treatment of Rheumatoid Arthritis Trial Investigator Group

OBJECTIVE

Three 6-12-month, double-blind, randomized, controlled trials have shown leflunomide (LEF; 20 mg/day, loading dose 100 mg x 3 days) to be effective and safe for the treatment of rheumatoid arthritis (RA). This analysis of the North American trial assessed whether the clinical benefit evident at month 12 was sustained over 24 months of treatment with LEF as compared with the efficacy and safety of methotrexate (MTX), an equivalent disease-modifying antirheumatic drug, at 24 months.

METHODS

The year-2 cohort, comprising patients continuing into the second year of treatment with > or = 1 dose of study medication and > or = 1 followup visit after week 52, consisted of 235 patients (LEF n = 98; placebo n = 36; MTX n = 101). The mean (+/- SD) maintenance dose of LEF was 19.6 +/- 1.99 mg/day in year 2 and that of MTX was 12.6 +/- 4.69 mg/week. Statistical analyses used an intent-to-treat (ITT) approach. Statistical comparisons of the active treatments only were prospectively defined in the protocol.

RESULTS

In total, 85% and 79% of LEF and MTX patients, respectively, who entered year 2 completed 24 months of treatment. From month 12 to month 24, the American College of Rheumatology improvement response rates of > or = 20% (LEF 79% versus MTX 67%; P = 0.049), > or = 50% (LEF 56% versus MTX 43%; P = 0.053), and > or = 70% (LEF 26% versus MTX 20%; P = 0.361) were sustained in both of the active treatment groups. The mean change in total Sharp radiologic damage scores at year 2 compared with year 1 and baseline (LEF 1.6 versus MTX 1.2) showed statistically equivalent sustained retardation of radiographic progression in the active treatment groups. Maximal improvements evident at 6 months in the Health Assessment Questionnaire (HAQ) disability index (HAQ DI) and the physical component score of the Medical Outcomes Survey 36-item short form were sustained over 12 months and 24 months; improvement in the HAQ DI with LEF4(-0.60) was statistically significantly superior to that with MTX (-0.37) at 24 months (P = 0.005). Over 24 months in the ITT cohort, serious treatment-related adverse events were reported in 1.6% of the LEF-treated patients and 3.7% of the MTX-treated patients. Frequently reported adverse events included upper respiratory tract infections, diarrhea, nausea and vomiting, rash, reversible alopecia, and transient liver enzyme elevations.

CONCLUSION

The safety and efficacy of LEF and MTX were maintained over the second year of this 2-year trial. Both active treatments retarded radiographic progression over 24 months. LEF was statistically significantly superior to MTX in improving physical function as measured by the HAQ DI over 24 months of treatment. Results indicate that LEF is a safe and effective initial treatment for active RA, with clinical benefit sustained over 2 years of treatment without evidence of new or increased toxicity.

A randomized, double-blind, crossover clinical trial of diclofenac plus misoprostol versus acetaminophen in patients with osteoarthritis of the hip or knee

OBJECTIVE

To perform a randomized, double-blind, crossover clinical trial of diclofenac + misoprostol versus acetaminophen in ambulatory patients with osteoarthritis of the hip or knee.

METHODS

Patients in 12 ambulatory care settings were eligible if they were age >40 years and if they had Kellgren/Lawrence radiographic grade 2-4 osteoarthritis of the knee or hip and a score of > or =30 mm on a 100-mm visual analog pain scale. Patients were randomized to one of two groups, 75 mg diclofenac + 200 microg misoprostol twice daily or 1,000 mg acetaminophen 4 times daily (each for 6 weeks), and were then crossed over to the other treatment for 6 weeks. A placebo was included in each treatment regimen to enable double blinding. The primary outcome measures were the Western Ontario and McMaster Universities Osteoarthritis Index and the visual analog pain scale of the Multidimensional Health Assessment Questionnaire. Safety was assessed using a standard form to review adverse events.

RESULTS

We enrolled 227 patients, of whom 218 provided data for the first treatment period and 181 provided data for both treatment periods. Significantly higher levels of improvement in the primary outcomes were seen for diclofenac + misoprostol than for acetaminophen (P < 0.001). Adverse events were more common when patients took diclofenac + misoprostol (P = 0.046). Diclofenac + misoprostol was rated as "better" or "much better" by 57% of the 174 patients who provided such ratings for both treatment periods, while acetaminophen was rated as "better" or "much better" by 20% of these patients, and 22% reported no difference (P < 0.001). Differences favoring diclofenac + misoprostol over acetaminophen were greater in patients with more severe osteoarthritis according to baseline pain scores, radiographs, or number of involved joints.

CONCLUSION

Patients with osteoarthritis of the hip or knee had significantly greater improvements in pain scores over 6 weeks with diclofenac + misoprostol than with acetaminophen, although patients with mild osteoarthritis had similar improvements with both drugs. Acetaminophen was associated with fewer adverse events.