Positive outcome after preimplantation diagnosis of aneuploidy in human embryos

usromosomal abnormalities are responsible for a great deal of embryo wastage, which is reflected, at least partially, in decreased implantation and increased miscarriage in older women. To address this problem the transfer of only chromosomally normal embryos previously selected by preimplantation genetic diagnosis (PGD) has been proposed. We designed a multi-centre in-vitro fertilization (IVF) study to compare controls and a test group that underwent embryo biopsy and PGD for aneuploidy. Patients were matched retrospectively, but blindly, for average maternal age, number of previous IVF cycles, duration of stimulation, oestradiol concentrations on day +1, and average mature follicles. All these parameters were similar in test and control groups. Only embryos classified as normal for those chromosomes were transferred after PGD. The results showed that the rates of fetal heart beat (FHB)/embryo transferred between the control and test groups were similar. However, spontaneous abortions, measured as FHB aborted/FHB detected, decreased after PGD (P < 0.05), and ongoing pregnancies and delivered babies increased (P < 0.05) in the PGD group of patients. Two conclusions were obtained: (i) PGD of aneuploidy reduced embryo loss after implantation; (ii) implantation rates were not significantly improved, but the proportion of ongoing and delivered babies was increased.

The Regenstrief Medical Record System: a quarter century experience

Entrusted with the records for more than 1.5 million patients, the Regenstrief Medical Record System (RMRS) has evolved into a fast and comprehensive data repository used extensively at three hospitals on the Indiana University Medical Center campus and more than 30 Indianapolis clinics. The RMRS routinely captures laboratory results, narrative reports, orders, medications, radiology reports, registration information, nursing assessments, vital signs, EKGs and other clinical data. In this paper, we describe the RMRS data model, file structures and architecture, as well as recent necessary changes to these as we coordinate a collaborative effort among all major Indianapolis hospital systems, improving patient care by capturing city-wide laboratory and encounter data. We believe that our success represents persistent efforts to build interfaces directly to multiple independent instruments and other data collection systems, using medical standards such as HL7, LOINC, and DICOM. Inpatient and outpatient order entry systems, instruments for visit notes and on-line questionnaires that replace hardcopy forms, and intelligent use of coded data entry supplement the RMRS. Physicians happily enter orders, problems, allergies, visit notes, and discharge summaries into our locally developed Gopher order entry system, as we provide them with convenient output forms, choice lists, defaults, templates, reminders, drug interaction information, charge information, and on-line articles and textbooks. To prepare for the future, we have begun wrapping our system in Web browser technology, testing voice dictation and understanding, and employing wireless technology.

Use of noncontingent reinforcement in the treatment of challenging behavior. A review and clinical guide

Recently, noncontingent reinforcement (NCR) has been used to reduce challenging behavior in persons with developmental disabilities. In this context, NCR involves reinforcement on a fixed-time schedule irrespective of behavior. The present article reviews studies involving NCR for the treatment of challenging behavior. Based on this review, a clinical guide for the implementation of NCR is delineated. NCR appears to depend on ensuring that reinforcement matches the function of the challenging behavior. Initially, noncontingent reinforcement should be provided on a continuous basis. The schedule can then be faded from continuous reinforcement to a more appropriate level in a number of ways. NCR can also be combined with additional educationally oriented interventions to promote skill development. Given its ease of implementation and other potential advantages, NCR would appear particularly relevant for applied settings. The clinical guide may offer some assistance to practitioners.

The kin-cohort study for estimating penetrance

A cross-sectional study may be more feasible than a cohort or case-control study for examining the effect of a genetic mutation on cancer penetrance outside of cancer families. The kin-cohort design uses volunteer probands selected from a population with a relatively high frequency of the mutations of interest. By considering the cancer risk in first-degree relatives of mutation-positive and -negative probands as a weighted average of the risk in carriers and noncarriers, with weights calculated assuming a known mode of inheritance, one can infer the penetrance of the mutations. The estimates of penetrance by age 70 years for three specific mutations in the BRCA1 and BRCA2 genes common among Ashkenazi Jews for the first occurrence of breast or ovary cancer is 63%. The kin-cohort design can be a useful tool for quickly estimating penetrance from volunteers in a setting in which the mutation prevalence is relatively high.

On the relations between seen objects and components of potential actions

Accounts of visually directed actions usually assume that their planning begins with an intention to act. This article describes three experiments that challenged this view through the use of a stimulus-response compatibility paradigm with photographs of common graspable objects as stimuli. Participants had to decide as fast as possible whether each object was upright or inverted. Experiments 1 and 2 examined the effect of the irrelevant dimension of left-right object orientation on bimanual and unimanual keypress responses. Experiment 3 examined wrist rotation responses to objects requiring either clockwise or anticlockwise wrist rotations when grasped. The results (a) are consistent with the view that seen objects automatically potentiate components of the actions they afford, (b) show that compatibility effects of an irrelevant stimulus dimension can be obtained across a wide variety of naturally occurring stimuli, and (c) support the view that intentions to act operate on already existing motor representations of the possible actions in a visual scene.

RESEARCH: Perceptions of Risk Associated with Use of Farm Chemicals: Implications for Conservation Initiatives

/ Data were collected from 245 farmers within the Darby Creek hydrologic unit in central Ohio to assess perceptions of risk associated with use of farm chemicals. Farmers were asked to evaluate the level of risk associated with use of agricultural chemicals for water quality, food safety, food quality, health of applicator, health of farm animals, wildlife, beneficial plants, beneficial insects, and human health. Study findings revealed that respondents perceived use of farm chemicals posed little or no threat to any of the assessed items. A composite index was formulated from the responses to the nine items and was titled Perceived Risk. Variance in the Perceived Risk index was regressed against social learning variables. The findings revealed that approximately 32% of the variance was explained by the predictive variables included in the model. It was concluded that the theoretical perspective was somewhat useful for understanding perceptions held about agricultural chemical use at the farm level. The findings are discussed in the context of future conservation and educational-information programs within the study region.KEY WORDS: Risk perception; Risk assessment; Groundwater; Pesticide contamination; Food safety; Environmental quality

On the relations between seen objects and components of potential actions

Accounts of visually directed actions usually assume that their planning begins with an intention to act. This article describes three experiments that challenged this view through the use of a stimulus-response compatibility paradigm with photographs of common graspable objects as stimuli. Participants had to decide as fast as possible whether each object was upright or inverted. Experiments 1 and 2 examined the effect of the irrelevant dimension of left-right object orientation on bimanual and unimanual keypress responses. Experiment 3 examined wrist rotation responses to objects requiring either clockwise or anticlockwise wrist rotations when grasped. The results (a) are consistent with the view that seen objects automatically potentiate components of the actions they afford, (b) show that compatibility effects of an irrelevant stimulus dimension can be obtained across a wide variety of naturally occurring stimuli, and (c) support the view that intentions to act operate on already existing motor representations of the possible actions in a visual scene.

The role of digital imaging and communications in medicine in an evolving healthcare computing environment: the model is the message

The decision to use Digital Imaging and Communications in Medicine (DICOM), Health Level 7 (HL7), a common object broker such as the Common Object Request Brokering Architecture (CORBA) or ActiveX (Microsoft Corp, Redmond, WA) or any other protocol for the transfer of DICOM data depends on the requirements of a particular implementation. The selection of protocol is independent of the information model. Our goal as message standards developers is to design a data interchange infrastructure that will faithfully convey the computer-based patient record and make it available to authorized health care providers when and where it is needed for patient care. DICOM accurately and expressively represents the clinically significant properties of images and the semantics of image-related information. The DICOM data model is small and well-defined. The model can be expressed in Standard Generalized Markup Language (SGML) or Object Management Group Interface Definition Language or other common syntax-and can be implemented using any reliable communications protocol. Therefore our opinion is that the DICOM semantic data model should serve as the basis for a logically equivalent set of specifications in HL7, CORBA, ActiveX, and SGML for the interchange of biomedical images and image-related information.

Recombinant human osteogenic protein 1 in the rat mandibular augmentation model: differences in morphology of the newly formed bone are dependent on the type of carrier

Recombinant human osteogenic protein 1 (rhOP1), also known as bone morphogenetic protein 7, was investigated in a newly developed experimental model, the rat lateral mandibular augmentation model. Algipore and Bio-Oss Block were applied as carrier materials. Extensive induction of newly formed bone was demonstrated on the test side containing rhOP1 and did not occur on the control side without rhOP1. The interstitial bone formation was limited to the augmented area and was not observed in the surrounding masseter muscle. The morphology of the newly formed bone differed in both carrier systems, which may be an important characteristic for the clinical indication of carrier systems in combination with bone morphogenetic proteins.

Recombinant human osteogenic protein-1 induces dentin formation: an experimental study in miniature swine

It was the aim of the present study to investigate the induction of dentin formation by recombinant human osteogenic protein-1 (hOP-1). In 4 adult miniature pigs a total of 16 teeth with artificially exposed dental pulps were capped with 3 mg of a complex of recombinant hOP-1 in collagen matrix (2.5 micrograms/mg), collagen matrix alone, or calcium hydroxide paste. Teeth were removed in block section after a healing period of 5 weeks. Decalcified sections were processed for light microscopy and histomorphometric analysis. In hOP-1 treated teeth substantial amounts of hard tissue formation (osteodentin and tubular dentin) had consistently led to a complete bridging of the defects. Less dentin formation was seen after calcium hydroxide application. In control defects collagen matrix alone failed to form complete dentin bridges. Recombinant human osteogenic protein-1 in a collagen carrier matrix appeared to be suitable as a bio-active capping agent for surgically exposed dental pulps.

A practical strategy to increase participation and reduce challenging behavior during leisure skills programming

The effects of prompting, reinforcer sampling, and assistance on participation and challenging behavior of two adults with severe disabilities were examined under three conditions during a leisure program. For baseline, leisure materials were absent, but there was opportunity for social interaction. Next, leisure materials were provided, but participants were neither prompted nor assisted to use these materials. During intervention, participants sampled the materials and were assisted to use each item during a 5-minute prompting sequence. A reversal design demonstrated that the prompting sequence was associated with increased participation and reduced challenging behavior. These improvements were maintained as the frequency of the prompting sequence was reduced from four times to once per session.

Treatment-related chromosome abnormalities in human embryos

Mosaicism was studied in good quality embryos from four different centres in order to assess the effects of follicular induction and exposure to laboratory conditions on chromosomal status. The donated embryos were fully biopsied and analysed by fluorescence in-situ hybridization using probes for chromosomes X, Y, 13, 18 and 21, simultaneously. The number of abnormal cells present indicated the division at which mosaicism first occurred (4/4 cells at first division, 2/4 cells at second, 2/8 at third). The rate of mosaicism in embryos from different centres varied greatly (P < 0.001). Most of the mosaic embryos were obtained before 1991. In one clinic increased mosaicism was found in embryos obtained before 1991 when compared to embryos obtained thereafter. The results suggest that certain culture conditions and/or hormonal stimulation protocols may induce chromosomal abnormalities and partly explain differences in pregnancy rates between in-vitro fertilization centres.

Chromosome 13 poly(ADP-ribose) polymerase polymorphisms and lung cancer risk

A 193 base pair repeat polymorphism in the human poly(ADP-ribose) polymerase (PADPRP) pseudogene found on chromosome 13 has been associated with lung cancer, endemic Burkitt lymphoma, B-cell lymphoma, breast cancer and colorectal carcinoma. We investigated the frequency of the PADPRP genetic polymorphism in a hospital-based case-control study of lung cancer for 54 cases and 47 controls. There was a statistically significant difference in allelic frequency between Caucasians and African Americans (p<0.001). For African Americans, the odds ratio for lung cancer and the 'B' allele was 2.38 (95% C.I.=0.73, 7.69) and for Caucasians 0.44 (95% C.I.=0.11, 1.77). The results for the African Americans, however, were not in Hardy-Weinberg equilibrium, although the Caucasians were. Thus, this study, albeit small, does not find that the PADPRP pseudogene duplicated region located on chromosome 13 is a risk factor for lung cancer.

Pregnancy-related mortality in the United States, 1987-1990

OBJECTIVE

To use data from the Centers for Disease Control and Prevention's (CDC) Pregnancy-Related Mortality Surveillance System to examine trends in pregnancy-related mortality and risk factors for pregnancy-related death.

METHODS

In collaboration with ACOG and state health departments, the Pregnancy-Related Mortality Surveillance System has collected information on all deaths caused by pregnancy since 1979. Multiple data sources were used, including national death files, state health departments, maternal mortality review committees, individuals, and the media. As part of the initiation of the Pregnancy-Related Mortality Surveillance System in 1987, CDC staff contacted state health department personnel and encouraged them to identify and report pregnancy-related deaths. Data were reviewed and coded by experienced clinicians. Pregnancy-related mortality ratios (pregnancy-related deaths per 100,000 live births) were calculated.

RESULTS

After decreasing annually after 1979, the reported pregnancy-related mortality ratio increased from 7.2 in 1987 to 10.0 in 1990. This increase occurred among women of all races. A higher risk of pregnancy-related death was found with increasing maternal age, increasing live-birth order, no prenatal care, and among unmarried women. The leading causes of pregnancy-related death were hemorrhage, embolism, and hypertensive disorders of pregnancy. During the periods 1979-1986 and 1987-1990, the cause-specific pregnancy-related mortality ratios decreased for deaths due to hemorrhage and anesthesia, whereas pregnancy-related mortality ratios due to cardiomyopathy and infection increased. The leading causes of death varied according to the outcome of the pregnancy.

CONCLUSION

Increased efforts to identify pregnancy-related deaths have contributed to an increase in the reported pregnancy-related mortality ratio. More than half of such deaths, however, are probably still unreported. Adequate surveillance of pregnancy-related mortality and morbidity is necessary for interpreting trends, identifying high-risk groups, and developing effective interventions.

Preliminary experience with human oocyte cryopreservation using 1,2-propanediol and sucrose

Feasibility of cryopreservation of mature human oocytes using 1, 2-propanediol and sucrose was studied initially utilizing 1 and 2 day old unfertilized oocytes. Of these 285 aged oocytes 55% survived thawing, and 41% of 128 oocytes inseminated by single sperm intracytoplasmic injection (ICSI) fertilized normally. Limited embryonic development occurred in 51% of these embryos (n = 27) observed for the next 4 days. Cryosurvival of fresh donated oocytes (n = 81) was poorer (n = 20; 24.7%), while fertilization (n = 13; 65%) and embryo development (100%) was good prior to uterine transfer on day 3. Eight oocyte recipient cycles were undertaken, in which cryopreserved donated oocytes were thawed and inseminated by ICSI. Five of these cycles reached embryo transfer, and three pregnancies were initiated though none went successfully to term. Oocyte cryopreservation will ultimately facilitate oocyte donation procedures; however, cryosurvival of fresh frozen oocytes must be improved to at least the degree observed with aged unfertilized oocytes.

Cloning of the alpha and beta ovine thyroid hormone receptor cDNAs

Thyroid hormones modulate critical responses in a variety of tissues during development. While the mechanisms underlying many of these responses are uncertain, specific thyroid hormone nuclear receptor proteins likely play key roles in these processes. Many studies investigating the perinatal role of thyroid hormones in maturation have focused on events occurring in the developing rodent. However, the ovine fetus also serves as a useful model for human fetal thyroid system function. To extend the utility of the ovine model, the cDNAs representing the ovine family of nuclear thyroid receptors have been cloned, sequenced, and used to characterize mRNA species in ovine brain.

Reaction of neprilysin (neutral endopeptidase) and thermolysin with cyclic peptides

The reaction of neprilysin and thermolysin with a series of cyclic beta-turn peptides, varying in length from 6 to 14 residues, has been studied. All of the cyclic peptides bind to neprilysin with their affinity increasing from 113 microM for the 6-membered ring to 17 microM for the 14-membered ring. The 6-membered cyclic peptide was not hydrolyzed. However, kcat increased from 1.5 min-1 for the 8-membered cyclic peptide to 148 min-1 for the 14-membered cyclic peptide. With thermolysin binding of the 6- or 8-membered cyclic peptides was not detected. The Km values for the 10-, 12-, and 14-membered cyclic peptides were all in the 100 microM range. With thermolysin, kcat increased from 7 min-1 for the 10-membered cyclic peptide to 27,000 min-1 for the 14-membered cyclic peptide. Cyclic peptides were all cleaved at N-terminally directed sites. Modeling of the binding of a cyclic peptide, structurally similar to the 12-membered cyclic beta-turn peptide described above, into the active site of thermolysin shows that only half of the substrate makes contact with the enzyme and that only residues on one side of the peptide could fit into the active site. From these studies it is concluded that key factors which influence catalysis include not only peptide sequence, but the flexibility of the peptide and the orientation of the S'1 residue in a cyclic peptide.

Transdentinal stimulation of reparative dentine formation by osteogenic protein-1 in monkeys

Recombinant human osteogenic protein-1 (OP-1) when applied to freshly cut dentine stimulated significantly more reparative dentine than calcium hydroxide paste in permanent monkey teeth. The response to OP-1 was dependent upon the concentration applied to the tooth as a cavity liner as well as the thickness of the residual dentine. The response to calcium hydroxide was similarly dependent upon the thickness of the residual dentine. These data suggest that dental pulps contain cells, including perhaps mature odontoblasts, responsive to OP-1. Therefore OP-1 may be useful in the therapeutic induction of reparative dentine formation.

V-sis induces Egr-1 expression by a pathway mediated by c-Ha-Ras

The early growth response gene, Egr-1, is up-regulated transiently by mitogens and many other stimuli in all cells tested. Using NIH3T3 cells conditionally expressing v-sis from a metallothionein promoter, we show that the addition of Zn2+ stimulates the production of PDGF-B (v-sis) and elicits the expression of Egr-1 in a dose-dependent and time-regulated manner. The signal is likely independent of protein kinase C, but depends on tyrosine kinase and other kinase activities and is mediated by c-Ha-Ras since the presence of dominant-negative mutants of Ras and Raf abrogates the induction of Egr-1 expression by Zn2+. Transiently activated Ras expression in NIH3T3 cells also stimulates the transient expression of Egr-1, but cells that constitutively express Ras do not have elevated levels of Egr-1. Transient assays also demonstrated that Zn2+ or activated Ras expression stimulate the activity of a 950 bp Egr-1 promoter-reporter gene construct and this is abrogated in the presence of mutant Ras and Raf. The accumulated data show that Egr-1 gene expression is regulated by multiple mechanisms, as would be needed for putative roles in cell proliferation, in suppression of transformation and in differentiation.

Effect of vanadate on reproductive efficiency in normal and streptozocin-treated diabetic rats

The effects of oral vanadate treatment on the reproductive efficiency of normal and diabetic female rats were studied. Vanadate treatment in a dose-dependent manner reduced both the conception rate and the ability to carry pregnancy to term compared with a control group. These effects were more severe in diabetic groups as compared with nondiabetic groups. At the 0.25 mg/mL vanadate dose, the conception rate was reduced by 13% and 33% for the nondiabetic group and the diabetic group, respectively. At the 0.50 mg/mL dose, this rate decreased by 20% and 47% for the nondiabetic and diabetic groups, respectively. With an identical oral vanadate regimen of 0.25 mg/mL, the ability to sustain pregnancy to term was reduced by 30% and 90% for the nondiabetic and diabetic groups, respectively, and by 84% and 100% for these groups at a dose of 0.50 mg/mL. Although the blood vanadate concentrations were an order of magnitude higher in diabetic animals treated with vanadate than in nondiabetic animals under an identical vanadate treatment, oral vanadate treatments had no measurable effects in ameliorating hyperglycemia in these diabetic pregnant animals. In conclusion, vanadate is ineffective in normalizing blood glucose in pregnant diabetic rats, and it impairs reproductive capacity and the ability to sustain pregnancy to term in both nondiabetic and diabetic animals.

The time-course of the induction of reparative dentine formation in monkeys by recombinant human osteogenic protein-1

Recombinant human osteogenic protein-1 (hOP-1, BMP-7) induces cartilage and bone formation when implanted in extra- and intraskeletal sites in vivo. rOP-1 also preserves pulp vitality and stimulates reparative dentine formation when placed on partially amputated vital dental pulp tissue. The amount of dentine formed in 6 weeks was earlier found to be proportional to the total amount of rOP-1/carrier placed on the pulp and the capacity of the pulp to respond to rOP-1 appeared to be independent of the amount of coronal pulp removed. This reparative dentine was not completely mineralized after 6 weeks healing. Experiments were now made to determine the capacity of hOP-1 to preserve the vitality of and induce reparative dentine in vital radicular pulps. The extent of tissue mineralization present after 1, 2, 4 and 6 months' healing time in permanent monkey teeth was assessed. Radicular pulp vitality was maintained, reparative dentine formed, and mineralization was nearly 75% complete after 1 month and more than 95% after 4 months. The effects of irrigating the exposed pulps with EDTA, sodium hypochlorite or saline were also compared. Significantly more sodium hypochlorite-treated pulps became non-vital and the root canals of all the non-vital teeth contained bacteria at the time of sacrifice.

Localization of connexin43 in rat kidney

The localization of connexin43 (Cx 43) in rat kidney was investigated by the indirect immunofluorescence technique with polyclonal antisera raised against Cx 43. Cx 43 is a gap junction protein expressed in a variety of tissues. The typically punctuated gap junction immunofluorescence (GJI) was observed in the renal arterial and arteriolar system. In the renal artery the GJI was concentrated in the media. In the juxtamedullary nephrons, the GJI is particularly abundant in the vascular bundles. There is abundant GJI in the extraglomerular mesangium while in the afferent arteriole GJI appears decreased. Abundant GJI was observed in the inner medullary collecting ducts and pelvic epithelium. The localization of Cx 43 immunofluorescence observed in this study is only in partial agreement with the results of ultrastructural investigations on the distribution of gap junctions in the kidney. An extensive tight junctional system has been demonstrated in the collecting duct system. However, gap junctions have been reported to be absent. Further studies to resolve this discrepancy are required.

Measurement of chloride concentration in microvolume samples of sweat

Measuring sweat Cl concentration requires multiple steps. Following pilocarpine iontophoresis we compared Cl concentrations of sweat obtained on gauze pads to microvolumes (5 microL) collected into capillary tubes (N = 111). Chloride concentrations obtained by these two methods correlated significantly (r = 0.95; P < 0.001), indicating that Cl concentration can be measured accurately and easily on small volumes.

Use of chromosome microdissection, the polymerase chain reaction, and dot blot hybridization to analyze double minute chromosomes

The potential usefulness of chromosome microdissection, the polymerase chain reaction (PCR), and dot blot hybridization as a quick screening method for determining the genetic composition of double minute chromosomes (DMs) was evaluated. DMs or abnormally banding regions (ABRs) were microdissected from multidrug-resistant hamster cell lines and amplified with PCR using primers specific for the hamster multidrug-resistance (MDR) gene, pgp 1. The microdissected-PCR-amplified products were shown to (a) hybridize to a 32P-labeled pCHP1 probe for the hamster MDR gene by using dot blot or Southern blot analysis and also (b) hybridize back to the chromosome region from which they were originally dissected by using fluorescent in situ hybridization. Microdissected/PCR-amplified DMs were also shown to hybridize to ABRs. When microdissected DMs and ABRs were amplified using hamster specific Alu primers, the resulting material was shown to hybridize with probes for hamster MDR and Alu. These results suggest that the DMs contained in these MDR hamster cell lines contain Alu-like sequences and the chromosome microdissection-PCR-hybridization approach might be used as a quick screening method for identifying genes amplified in DMs and ABRs in cell lines and human tumor samples.