Relationship between sperm viability as determined by flow cytometry and nonreturn rate of dairy bulls

A newly developed flow cytometric method for determination of sperm concentration and viability was tested in an insemination trial with cryopreserved bull sperm to establish the relationship between sperm viability and nonreturn rates. Semen for experimental inseminations was produced from 157 young sires (114 Holstein and 43 Jersey), each contributing 4 experimental semen collections. Straws containing approximately 15 x 10(6) motile sperm before freezing were used in 118,680 experimental inseminations performed by 254 artificial insemination technicians in 6352 Danish herds. Statistical analysis based on 44,946 experimental first inseminations showed that the major part (95.4%) of variation in the 56-day nonreturn rate (NRR56) was residual. Only 0.38% of the total variation in NRR56 was due to bulls and differences between ejaculate within bull. However, bulls were preselected, and a relatively high insemination dose was used. Correlations between sperm viability as assessed by flow cytometry and NRR56 was slightly lower than observed for microscopic assessment of sperm motility. However, flow cytometry makes it possible to achieve an objective and precise determination of sperm viability. It was therefore possible to calculate the effect on NRR56 provided selection of semen is based on the flow cytometric method. Three freezing extenders were used in this experiment, but a significant difference in NRR56 was not observed. Flow cytometric results for 1 extender (Biociphos Plus) indicated poorer sperm survival during postthaw incubation compared with Triladyl extender with whole and with clarified egg yolk.

Quality control in boar semen production by use of the FACSCount AF system

A simple and rapid flow cytometric method has recently been developed for simultaneous determination of sperm concentration and viability in semen from domestic animals. Use of SYBR-14 trade mark in combination with propidium iodide (PI) allows estimation of the proportion of live sperm (viability). An internal standard of fluorescent microspheres (beads) makes it possible to determine the sperm concentration during the same analysis. In the first experiment, the relationship between sperm viability and litter size was investigated. The second experiment explored whether a smaller variation in the number of motile sperm per insemination dose could be obtained using the FACSCount AF flow cytometer than using a spectrophotometer. Results in the first experiment show that sperm viability is closer related to litter size than is the traditionally used motility parameter. Although the flow cytometer is precise and objective, a limited effect on litter size should be anticipated if ejaculates are selected for insemination according to the percentage of viable sperm. However, the present trial used large insemination doses (2.3 x 10(9) motile sperm/dose) which partially compensate for the differences in motility and viability between boars and ejaculates. In the second experiment it was found that variation in the number of motile sperm per insemination dose could be reduced significantly if the FACSCount AF flow cytometer rather than the Corning 254 spectrophotometer was used for determination of sperm concentration in the raw semen. It is concluded that the FACSCount AF flow cytometer is a strong tool for improvement of the quality control in artificial insemination (AI) centres.

Surficial Deposits at Gusev Crater Along Spirit Rover Traverses

The Mars Exploration Rover Spirit has traversed a fairly flat, rock-strewn terrain whose surface is shaped primarily by impact events, although some of the landscape has been altered by eolian processes. Impacts ejected basaltic rocks that probably were part of locally formed lava flows from at least 10 meters depth. Some rocks have been textured and/or partially buried by windblown sediments less than 2 millimeters in diameter that concentrate within shallow, partially filled, circular impact depressions referred to as hollows. The terrain traversed during the 90-sol (martian solar day) nominal mission shows no evidence for an ancient lake in Gusev crater.

Colorectal transport in normal defaecation

OBJECTIVE

Colorectal luminal transport during defaecation can be assessed by means of scintigraphy. However, normal values remain to be established and inter- and intra-subjective variation is unknown. The aim of the study was to describe colorectal transport during normal defaecation by means of a new method for colorectal scintigraphy and to determine inter- and intrasubjective variation.

METHODS

Thirty healthy volunteers (18 men and 12 women, age 22-46 years; median 31) took 2 MBq 111In on two consecutive days (days 0 and 1). On days 1 and 2 an abdominal scintigraphy was done before and after defaecation. Changes in colorectal contents were computed in two ways: firstly, assuming ordered evacuation, the extent of colorectal emptying was computed; secondly, antegrade and retrograde transport within the colorectum was computed for each colorectal segment.

RESULTS

Median colorectal emptying during normal defaecation was 99% of the rectosigmoid (range: 60% of the rectosigmoid to complete emptying of the rectosigmoid, descending colon, transverse colon and 19% of the caecum/ascending colon). There was no difference between men (median 99% of the rectosigmoid) and women (98% of the rectosigmoid). Day to day variation was large (dispersion=52%) with a trend towards larger defaecation on day 2 than on day 1 (P = 0.09). Large antegrade and retrograde movements of colorectal contents were observed within the colorectum during defaecation. Antegrade transport involved the rectosigmoid (median 99%), the descending colon (median 53%), the transverse colon (median 46%), and the caecum/ascending colon (median 11%). Retrograde transport was mainly from the transverse colon and the descending colon. Colorectal emptying was significantly correlated to the subjective description (P < 0.01) but not to total gastrointestinal or segmental colorectal transit times determined by means of radioopaque markers.

CONCLUSIONS

Colorectal scintigraphy before and after defaecation provides detailed information about colorectal emptying and intracolonic antegrade or retrograde transport during defaecation. Inter- and intraindividual variations are large and antegrade and retrograde transport within the colorectum is common.

Colorectal transport during defecation in patients with lesions of the sacral spinal cord

Normal defecation involves reflexes between the colorectum and sacral spinal cord. Lesions of the conus medullaris or cauda equina interrupt such reflex arches and cause constipation. The aim of the study was to compare colorectal transport during defecation in patients with sacral spinal cord lesions and healthy volunteers. Ten patients with sacral spinal cord lesions (six men and four women, age 21-57 y, median = 36) and 16 healthy volunteers (10 men and six women, age 22-42 y, median = 30) took one or two doses of 111In-labelled polystyrene pellets perorally to mark colorectal contents. Abdominal scintigraphy was performed before and after defecation. Total colorectal emptying and segmental antegrade or retrograde transport was computed. Median colorectal emptying during normal defecation was 81% of the rectosigmoid (range: 53% of the rectosigmoid to complete emptying of the rectosigmoid and 40% of the descending colon) in healthy volunteers and 27% of the rectosigmoid (range: 0-44% of the rectosigmoid) in patients with conal/cauda equina lesions (P < 0.001). Median antegrade transport was 82% (control group) vs 27% (patients) of the rectosigmoid (P < 0.001), 38% vs 4% of the descending colon (P < 0.02), 13% vs 1% of the transverse colon (P = 0.28), and 4% vs 2% of the caecum/ascending colon (P = 0.76). It is concluded that damage to reflex arches between the colorectum and the sacral spinal cord significantly reduces emptying of the rectosigmoid and descending colon during defecation.

Validation of the FACSCount AF system for determination of sperm concentration in boar semen

A flow cytometric method has been developed for rapid determination of sperm concentration in semen from various mammalian species.* All cells containing DNA are stained with SYBR-14 or propidium iodide (PI) and sperm concentration is determined in relation to an internal standard of fluorescent microspheres (beads). Satisfactory staining can be achieved within 2-3 min and the following flow cytometric analysis on the FACSCount AF System rapidly provides the user with a precise and accurate assessment of the sperm concentration. In this study, the FACSCount AF System and Sperm Counting Reagent (BD Biosciences) was compared with microscopic counting using a Bürker-Türk haemocytometer. In addition, sperm concentration was determined using the Corning 254 spectrophotometer which is used routinely by Danish artificial insemination stations for boars. The results show that the agreement between flow cytometry and microscopic counting is very high. The slope for the regression line was 1.12 (SE = 0.03) with an estimated intercept with the Y-axis of 22 x 10(6) sperm/ml (SE = 10 x 10(6) sperm/ml) and an estimated error of the model of 10 x 10(6) sperm/ml. For the spectrophotometer, the slope of the regression line was 1.09 (SE = 0.07) with an estimated intercept of 137 x 10(6) sperm/ml (SE = 25 x 10(6) sperm/ml). The average error made by the spectrophotometer was 55 x 10(6) sperm/ml. In addition, the results obtained using flow cytometry was highly repeatable (CV = 2.7%) in comparison with the spectrophotometric method (CV = 6.3%). These results indicate that the FACSCount AF System is a valuable tool for precise and accurate assessment of sperm concentration in boar semen and that use of this system may lead to production of more uniform insemination doses containing a specific number of sperm per dose.

Scintigraphic assessment of antegrade colonic irrigation through an appendicostomy or a neoappendicostomy

Background

The aim of this study was to evaluate large bowel transport following antegrade colonic irrigation with a new scintigraphic technique.

Methods

Ten patients (eight with severe constipation, two with faecal incontinence; median age 47 (range 41–66) years) treated with antegrade colonic irrigation took 111In-labelled polystyrene pellets to label the bowel contents. 99mTc-labelled diethylenetriamine penta-acetate was mixed with the irrigation fluid to map its distribution within the large bowel. Scintigraphy was performed before and after a standardized irrigation procedure. The large bowel was divided into four segments. Assuming ordered evacuation of the large bowel, the contribution of each colonic segment to total evacuation was expressed as a percentage of original segmental count. The segmental contributions were added to reach a total defaecation score (range 0–400).

Results

The median defaecation score was 350, corresponding to complete emptying of the rectosigmoid, descending colon, transverse colon, and half of the caecum and ascending colon. The retained irrigation fluid was located throughout the large bowel. Back-flow to the ileum was observed in four patients.

Conclusion

This study used a new scintigraphic technique to assess large bowel transport following antegrade colonic irrigation. Antegrade colonic irrigation induces highly effective emptying even in patients with severe constipation.

A randomized controlled trial of shared care versus routine care for patients receiving oral anticoagulant therapy

OBJECTIVES

To evaluate the effect of a shared care programme (SCP), defined as a scheme based on shared responsibility, enhanced information exchange, continues medical education and explicit clinical guidelines, between general practitioners (GPs) and a hospital outpatient clinic (HOC), on oral anticoagulant therapy (OAT).

DESIGN

The study was a 2-year prospective, randomized, controlled trial, preceded by a 1-year period of observation.

SETTING

The HOC, GPs, and OAT patients in the admission area of Aarhus University Hospital, Aarhus County, Denmark, covering 310 300 inhabitants.

SUBJECTS

A total of 207 GPs, including their enlisted patients on OAT, were invited, and 61.4% accepted participation. They were randomized into an intervention group [group-INT: 64 GPs and 453 patients (170 patients on OAT throughout the study period, i.e. full follow-up)], and a control group [group-CON: 63 GPs and 422 patients (173 with full follow-up)]. The remaining 80 GPs served as a nonresponder group (group-NON) of 485 patients (184 with full follow-up).

MAIN OUTCOME MEASURE

Therapeutic control of OAT in terms of time spent by the patients within the therapeutic interval (TI) of an international normalized ratio (INR) between 2.0 and 3.5.

RESULTS

The groups did not differ significantly with regard to age, sex, OAT indication, anticoagulant drug used, or the therapeutic control at baseline. In a comparison based on intention-to-treat principles, the therapeutic control increased statistical significance amongst patients with full follow-up in group-INT compared with group-CON (median time within TI: group INT = 86.6% vs. 80.5%, P = 0.007).

CONCLUSION

An SCP of anticoagulant management is effective in reducing patient time outside the therapeutic INR interval in OAT patients randomly assigned to an SCP, as compared with a control group.

Scintigraphic assessment of colostomy irrigation

OBJECTIVE: This study aims to evaluate colonic transport following colostomy irrigation with a new scintigraphic technique. MATERIALS AND METHODS: To label the bowel contents 19 patients (11 uncomplicated colostomy irrigation, 8 complicated colostomy irrigation) took 111In-labelled polystyrene pellets one and two days before investigation. 99mTc-DTPA was mixed with the irrigation fluid to assess its extent within the bowel. Scintigraphy was performed before and after a standardized washout procedure. The colon was divided into three segments 1: the caecum andascending colon; 2: the transverse colon; 3: the descending and sigmoid colon. Assuming ordered evacuation of the colon, the contribution of each colonic segment to the total evacuation was expressed as a percentage of the original segmental counts. These were added to reach a total defaecation score (range: 0-300). RESULTS: In uncomplicated colostomy irrigation, the median defaecation score was 235 (range: 145-289) corresponding to complete evacuation of the descending and transverse colon and 35% evacuation of the caecum/ascending colon. In complicated colostomy irrigation it was possible to distinguish specific emptying patterns. The retained irrigation fluid reached the caecum in all but one patient. CONCLUSION: Scintigraphy can be used to evaluate colonic emptying following colostomy irrigation.

EEG-Monitored ECT: A Comparison of Seizure Duration under Anesthesia with Etomidate and Thiopentone

Electroencephalogram-monitored electroconvulsive therapy (ECT) was carried out in 20 depressed inpatients. Before treatment, patients were randomly allocated to treatment using etomidate (Hypnomidat) (n = 10) or thiopentone (n = 10) for anesthesia. The groups were matched for sex, age, weight, and type and severity of depression. The seizure duration (seconds) was measured by electroencephalography (EEG), and the electrical energy (Joules, J) was determined for each treatment. A ratio of seizure duration:electrical energy (s/J) was computed. Both seizure duration and seizure duration:electrical energy were greater in the etomidate group than in the thiopentone group, whereas electrical energy did not differ significantly. The number of treatments in the etomidate group did not differ from that in the thiopentone group, as may be expected, perhaps because of the small size.

First Report of Aspergillus Vine Canker of Table Grapes Caused by Aspergillus niger

A vine canker was first observed in the San Joaquin Valley, CA, in fall 1989, on exceptionally vigorous 1-year-old cv. Redglobe vines (Vitis vinifera) when vines were trained up the stakes. Since 1989, the same canker symptoms have been observed in Tulare, Kern, Fresno, and Riverside (Coachella Valley, CA) counties on cv. Redglobe, Crimson Seedless, Chardonnay, and Grenache vines. In affected vineyards, the disease resulted in the retraining of 2 to 6.1% of vines the following spring, using a shoot originating from below the canker. In a sample of 54 infected vines collected in 1997, 65% of cankers were found at the branching (crotch) of the vine, 24% along the shoot, or both (11%). All infections started through wounds caused by removing lateral shoots or leaves when the vine was topped to form cordons or possibly through growth cracks that occur on rapidly growing 1-year-old shoots. The first symptoms usually appear in August as red pinhead-size drops of sap on the surface of discolored tissue. By October to November, the canopies of vines girdled by the canker prematurely display fall colors and are very distinct from healthy vines. The trunk is slightly swollen and spongy where the canker occurs. Internal canker tissue is discolored and dead. Black spores are abundant within the canker, on the surface of the canker, or both. Callous tissue is often associated with the canker as the vine attempts to repair the damage with new tissue. Canker length can range from 3.5 to 26.5 cm (average 7.0 cm) and can affect the shoot's cross section from 0.4 cm to completely girdling the shoot (up to 9.0 cm in circumference). Isolations from cankers or black sporulation inside the canker on acidified potato dextrose agar (APDA) consistently yielded Aspergillus niger van Tiegh. Six well-matured current-season canes of cv. Redglobe in an experimental vineyard at Kearney Agricultural Center were inoculated by inserting a 7-mm plug of mycelium from actively growing cultures on APDA in a cut made with a 7-mm cork borer or by brushing spores of the culture over the surface of six canes wounded with a sterile razor. Six canes were inoculated with a 7-mm plug of APDA and used as noninoculated controls. Inoculated sites were sealed with Parafilm to avoid dehydration. Inoculation of grapevines with A. niger resulted in cankers similar to those observed in commercial vineyards 5 months after inoculation. Cankers ranged from 2.4 to 4.2 cm for mycelial-plug inoculation (100% of canes infected) and 2.3 to 7.3 cm for spore-brushing inoculation (67% infected). Noninoculated control canes were not infected. In another experiment, inoculation of 10 canes each with A. niger on 17 May, 10 June, 2 July, 21 July, and 16 August resulted in 50, 60, 90, 90, and 100% canker formation, respectively, 5 to 8 months after inoculation, suggesting summer inoculations were more effective than spring inoculations. Reisolation from infected canes on APDA revealed A. niger. Aspergillus species in section Nigri have been reported to be among the pathogens involved in the bunch rot complex (1,2), but to our knowledge, this is the first report of A. niger causing a serious canker of vigorously growing grape vines. References: (1) W. B. Hewitt. Berry rots and raisin molds. Pages 26-28 in: Compendium of Grape Diseases. R. C. Pearson and A. C. Gohen, eds. The American Phytopathological Society, St. Paul, MN, 1994. (2) W. R. Jarvis and J. A. Traquair. Plant Dis. 68:718, 1984.

Colorectal symptoms in patients with neurological diseases

Several neurological diseases cause constipation or faecal incontinence restricting social activities and influencing quality of life. As several new treatment modalities have become available within the last few years, doctors treating patients with neurological diseases should be aware of the symptoms and have a basic knowledge of relevant treatment options. Constipation and faecal incontinence are common symptoms in patients with traumatic spinal cord injuries, spina bifida, multiple sclerosis, diabetic polyneuropathy, Parkinson's disease, stroke, and cerebral palsy. New treatment modalities are: prokinetic agents, enemas administered through the enema continence catheter or through an appendicostomy, and biofeed-back. Sacral nerve stimulation is still mostly at an experimental level and colostomy should be restricted to the few patients with most severe problems resistant to other therapy.

Changes in circulating blood volume after infusion of hydroxyethyl starch 6% in critically ill patients

BACKGROUND

The cardiovascular response to a volume challenge with hydroxyethyl starch (HES) (200/0.5) 6% depends on the relation between the volume of HES 6% infused and the expansion of the blood volume in critically ill patients. However, only relatively limited data exist on the plasma expanding effect of infusion of HES 6% in critically ill patients. The purpose of the study was to evaluate the variation in the expansion of the circulating blood volume (CBV) in critically ill patients after infusion of 500 ml of colloid (HES (200/0.5) 6%) using the carbon monoxide method.

METHODS

In 20 consecutive patients admitted to the ICU requiring mechanical ventilation and volume expansion, 500 ml of HES (200/0.5) 6% was infused. The CBV was measured immediately before the infusion, 10 min after completing the infusion and then hourly for 8 h.

RESULTS

The median volume expansion immediately after infusion was 470 ml (range 270 ml to 840 ml). The corresponding values after 4 h and 8 h were 265 ml (range -30 ml to 460 ml) and 120 ml (range -210 ml to 360 ml), respectively. The increase in CBV was only statistically significant for 4 h. The coefficient of variation of the method for estimation of CBV was 3.6%.

CONCLUSIONS

The large interindividual variation of the volume expansion after infusion of HES 6% in critically ill patients illustrates one of the difficulties in optimizing colloid therapy and interpretating the changes in hemodynamic variables after a colloid challenge.

Effects of indomethacin on Salmonella typhimurium- and cholera toxin-induced fluid accumulation in the porcine small intestine

The effect of the cyclooxygenase and prostaglandin E2 (PGE2) synthesis inhibitor, indomethacin, on the secretory responses induced by Salmonella serotype Typhimurium (ST) and cholera toxin (CT), in the porcine small intestine was investigated. ST (10(10) colony-forming units) and CT (56 micrograms) were instilled in tied-off intestinal loops in young anaesthetized pigs receiving intravenous indomethacin in a total dose of 7.5 mg/kg, or saline. The accumulated fluid in the loops and the luminal content of endogenous secretagogues PGE2 and 5-hydroxytryptamine (5-HT) were measured. ST induced fluid accumulation in the jejunum, whereas CT induced fluid accumulation in the jejunum and ileum. Indomethacin had no effect on the secretory responses. Indomethacin had a significant effect on the luminal content of PGE2 in jejunal ST and CT loops, whereas no effect of indomethacin was observed on the luminal content of 5-HT in ST and CT loops. In ST and CT loops, an increased content of PGE2 and 5-HT compared with test loops infused with Ringer's solution was observed. These results indicate that the porcine jejunal secretory response to ST and CT does not involve prostaglandins although indomethacin has an influence on the luminal release of PGE2 but not of 5-HT.

EURADOS trial performance test for neutron personal dosimetry

This paper reports on the results of a neutron trial performance test sponsored by the European Commission and organised by EURADOS. As anticipated, neutron dosimetry results were very dependent on the dosemeter type and the dose calculation algorithm. Fast neutron fields were generally well measured, but particular problems were noted in the determination of intermediate energy fields and large incident angles, demonstrating the difficulties of neutron personal dosimetry. Of particular concern from a radiological protection point of view was the large number of results underestimating personal dose equivalent. A considerable over-response was noted in a few cases.

EURADOS trial performance test for photon dosimetry

Within the framework of the EURADOS Action entitled Harmonisation and Dosimetric Quality Assurance in Individual Monitoring for External Radiation, trial performance tests for whole-body and extremity personal dosemeters were carried out. Photon, beta and neutron dosemeters were considered. This paper summarises the results of the whole-body photon dosemeter test. Twenty-six dosimetry services from all EU Member States and Switzerland participated. Twelve different radiation fields were used to simulate various workplace irradiation fields. Dose values from 0.4 mSv to 80 mSv were chosen. From 312 single results, 26 fell outside the limits of the trumpet curve and 32 were outside the range 1/1.5 to 1.5. Most outliers resulted from high energy R-F irradiations without electronic equilibrium. These fields are not routinely encountered by many of the participating dosimetry services. If the results for this field are excluded, most participating services satisfied the evaluation criteria.

Harmonisation and dosimetric quality assurance in individual monitoring for external radiation

The current situation amongst Member States is that there are widely differing national requirements for dosimetric services and for dosemeter performance. It is clear that with the free movement of workers within the European Union (EU) and the requirements for individual dosimetry given in Council Directive 96/29 EURATOM, a degree of harmonisation of requirements and procedures of EU Member States would be desirable. A EURADOS action group, made up of members from each of the EU Member States plus Switzerland, was set up with the overall objectives of consolidating within the EU the quality of individual monitoring using personal dosemeters and assisting movement towards harmonised procedures. An outline of the work of the action group is given and the term 'harmonisation' is discussed.

Endocrine disrupting compounds: effect of octylphenol on reproduction over three generations

With the growing concern that environmental chemicals might impair human and animal fertility, it is important to investigate the possible influence of these substances on sexual differentiation and genital development of mammals. Many of these substances are suspected to interfere with endocrine processes, and exposure during critical periods of prenatal development might affect reproductive performance over several generations. Alkylphenols and their metabolites are lipophilic substances exerting apparent estrogenic action in in vitro and in vivo testing systems. With the widespread industrial use of alkylphenols, these are disseminated in the environment with sewage sludge, and domestic animals and humans are likely to be exposed via the food chain. Using the pig as an in vivo model, we studied the effect of intrauterine exposure to tertiary octylphenol (OP) on essential reproductive parameters over 3 generations. Sows were treated daily from D 23 to 85 of pregnancy with either 0, 10 or 1000 micrograms OP/kg body weight. Treatment with OP extended pregnancy length and induced basal cell proliferation in the cervical epithelium of the parental generation. In F1 offspring of sows treated with the low dosage of OP, onset of puberty was accelerated. Furthermore, when F1 gilts and F1 boars originating from sows treated with high dosages of OP were bred, the litter size was reduced. The results of the present study are compared with previous reports on estrogenicity of OP, and the usefulness of in vivo animal or embryo models for the evaluation of possible consequences of human exposure to endocrine disrupting compounds is discussed. Furthermore, possible consequences of exposure to endocrine disrupting compounds for the embryo transfer industry are addressed.

EURADOS trial performance test for personal dosemeters for external beta radiation

On the initiative of the European Dosimetry Group (EURADOS) action group 'Harmonisation and Dosimetric Quality Assurance in Individual Monitoring for External Radiation' a trial performance test for whole-body and extremity personal dosemeters broadly representative of those in use in the EU was accomplished. This paper deals with the part of the performance test concerned with exposure to beta radiation. Fifteen dosimetric services participated with whole-body dosemeters intended to measure beta doses (Hp(0.07)) of which 13 used thermoluminescent (TL) detectors and two used photographic films. Eight services participated with extremity dosemeters which all used TL detectors. A description is given of the irradiation set-up, the characteristics of the irradiation fields, the calibration quantity applied and the performance criteria used for the evaluation of the results. The paper discusses in detail the results obtained from the exercise. In particular, based on the replies to a questionnaire issued to each participant, the results are analysed in relation to important design characteristics of the dosemeters taking part in the test.

GM-CSF regulates bleomycin-induced pulmonary fibrosis via a prostaglandin-dependent mechanism

To characterize the role of GM-CSF in pulmonary fibrosis, we have studied bleomycin-induced fibrosis in wild-type mice vs mice with a targeted deletion of the GM-CSF gene (GM-CSF-/- mice). Without GM-CSF, pulmonary fibrosis was worse both histologically and quantitatively. These changes were not related to enhanced recruitment of inflammatory cells because wild-type and GM-CSF-/- mice recruited equivalent numbers of cells to the lung following bleomycin. Interestingly, recruitment of eosinophils was absent in GM-CSF-/- mice. We investigated whether the enhanced fibrotic response in GM-CSF-/- animals was due to a deficiency in an endogenous down-regulator of fibrogenesis. Analysis of whole lung homogenates from saline- or bleomycin-treated mice revealed that GM-CSF-/- animals had reduced levels of PGE2. Additionally, alveolar macrophages were harvested from wild-type and GM-CSF-/- mice that had been exposed to bleomycin. Although bleomycin treatment impaired the ability of alveolar macrophages from wild-type mice to synthesize PGE2, alveolar macrophages from GM-CSF-/- mice exhibited a significantly greater defect in PGE2 synthesis than did wild-type cells. Exogenous addition of GM-CSF to alveolar macrophages reversed the PGE2 synthesis defect in vitro. Administration of the PG synthesis inhibitor, indomethacin, to wild-type mice during the fibrogenic phase postbleomycin worsened the severity of fibrosis, implying a causal role for PGE2 deficiency in the evolution of the fibrotic lesion. These data demonstrate that GM-CSF deficiency results in enhanced fibrogenesis in bleomycin-induced pulmonary fibrosis and indicate that one mechanism for this effect is impaired production of the potent antifibrotic eicosanoid, PGE2.

Antiemetic efficacy of combination therapy with granisetron plus prednisolone plus the dopamine D2 antagonist metopimazine during multiple cycles of moderately emetogenic chemotherapy in patients refractory to previous antiemetic therapy

Effective antiemetic treatment of patients who have previously experienced chemotherapy-induced nausea and vomiting is difficult. The aim of this study was to evaluate the antiemetic efficacy of a single intravenous dose of granisetron plus a 3-day oral treatment with prednisolone 25 mg once a day plus metopimazine 30 mg four times a day in patients refractory to previous antiemetic treatment with granisetron or with prednisolone plus metopimazine. The study population was made up of 25 consecutive women with stage I or II breast cancer, who were treated with multiple cycles of adjuvant cyclophosphamide, fluorouracil plus methotrexate or cyclophosphamide, epirubicin plus fluorouracil given i.v. every 3 weeks. Patients received the three-drug combination of antiemetics during a total of 113 cycles of chemotherapy. No emetic episodes were reported in 88.9% cycles on day 1, in 94.7% cycles on days 2 through 5 and in 85.8% cycles on days 1 through 5 after chemotherapy. No nausea was reported in 43.4% cycles on day 1, in 49.6% cycles on days 2 through 5 and in 34.5% cycles on days 1 through 5. Nineteen patients (76.0%) completed the scheduled nine cycles of chemotherapy, 1 being withdrawn because of > or =5 emetic episodes and 5, because they were not satisfied with the antiemetic treatment. The treatment was well tolerated. In conclusion, granisetron plus prednisolone plus metopimazine is a highly effective antiemetic treatment in patients receiving moderately emetogenic chemotherapy refractory to antiemetic therapy with granisetron or prednisolone plus metopimazine.