335 EFFECT OF MEM VITAMINS AND FORSKOLIN ON IN VITRO EMBRYO PRODUCTION AND SOPS-VITRIFICATION ABILITY OF IN VITRO DERIVED PORCINE BLASTOCYSTS

The aims of this study were, first to investigate the effect of minimum essential medium (MEM) vitamins (VITs) during IVM of porcine oocytes on in vitro embryo production of porcine embryos and second, to determine if the addition of VITs during IVM and the chemical delipidation with forskolin improve the vitrification ability of in vitro-derived porcine blastocysts. COCs were divided in two groups and matured in NCSU-23 for 44 h with 0.05% VITs (V group) or without VITs (NV group). Matured oocytes were inseminated with frozen-thawed spermatozoa. Presumptive zygotes were cultured for 16 h to assess IVF parameters (N = 767) or for 6 days (N = 2858) to evaluate the in vitro embryo development (Day 0 = day of IVF). On Day 5, some embryos from NV and V groups were cultured for 24 h with 10 μM forskolin (NVF and VF groups). The remaining embryos were cultured without forskolin (NVNF and VNF groups). On Day 6, embryos from the four experimental groups were assessed for blastocysts formation and some blastocysts (N = 414) were vitrified using superfine open pulled straws (SOPS). Vitrified blastocysts were warmed (one-step dilution method) and cultured for 24 h to assess their viability. Blastocysts with totally or partially reformed blastocoel cavity and normal or excellent morphology were considered viable. Five replicates of a 2 × 2 factorial design were conducted. Data was analyzed with the MIXED procedure. The threshold for significance was set at P < 0.05. Results are expressed as least squares means ± SEM. No differences were observed in the maturation of COCs treated with VITs (92.7 ± 1.3%) and non-treated COCs (94.3 ± 1.3%). The NV and V maturation groups showed similar penetration (83.0 ± 3% and 82.6 ± 3%, respectively) and monospermy (48.9 ± 6%, and 48.3 ± 6%, respectively) rates. The rate of monosermic oocytes related to the total of analyzed oocytes was similar for NV (38.1 ± 3.7%) and V (38.4 ± 3.7%) groups. The values of cleavage rate on Day 2 were similar for NV (66.7 ± 1.5%) and V (69.6 ± 1.6%) embryos. The addition of VITs to IVM medium improved (P < 0.01) up to 10 points the blastocysts formation rate, but the addition of forskolin at Day 5 did not affect this parameter. The V group showed a higher (P < 0.01) blastocysts rate (45.1 ± 2.5%) than the NV group (38.4 ± 2.3%).The addition of VITs did not affect the survival of in vitro-derived blastocysts after SOPS-vitrification on Day 6. However, the blastocysts cultured for 24 h with forskolin showed higher (P < 0.05) viability (44.0 ± 7.9%) after vitrification and warming than those embryos cultured without forskolin (34.1 ± 7.8%). In conclusion, the addition of MEM vitamins to IVM medium improves the blastocysts formation rate and the chemical delipidation with forskolin improve the cryosurvival of SOPS-vitrified porcine in vitro-derived blastocysts. This study was supported by the Seneca foundation of Murcia (GERM 04543/07), MICINN (AGL2009-12091 and RC-2007), and CARM (2I05SU0012).

Aggressive resection of hepatocellular carcinoma with right atrial involvement

Hepatocellular carcinoma with extension into the right heart is a recognized, albeit rare occurrence. Patients who present with tumors extending into the heart have generally been considered inoperable and had limited survival, many sustaining tumor embolism and/or sudden death. Resection has been fraught with intraoperative and perioperative mortality as well as considerable postoperative morbidity. We report an exceptional case of a patient with such a tumor successfully treated with an aggressive surgical approach and review the limited published experience.

Aggressive Resection of Hepatocellular Carcinoma with Right Atrial Involvement

Hepatocellular carcinoma with extension into the right heart is a recognized, albeit rare occurrence. Patients who present with tumors extending into the heart have generally been considered inoperable and had limited survival, many sustaining tumor embolism and/or sudden death. Resection has been fraught with intraoperative and perioperative mortality as well as considerable postoperative morbidity. We report an exceptional case of a patient with such a tumor successfully treated with an aggressive surgical approach and review the limited published experience.

Effects of 24-hour and 36-hour sleep deprivation on smooth pursuit and saccadic eye movements

Sleep restrictions and sleep deprivation have become common in modern society, as many people report daily sleep below the recommended 8 hours per night. This study aimed to examine the effects of sleep deprivation on oculomotor performance by recording smooth pursuit and saccadic eye movements after 24 and 36 hours of sleep deprivation. Another objective was to determine whether detected changes in oculomotor performance followed fluctuations according to a circadian rhythm and/or subjective Visuo-Analogue sleepiness Scale scores. Oculomotor responses were recorded from 18 subjects using electronystagmography, and comprised measurements of accuracy (i.e., the percentage of time the eye movement velocity was within the target velocity boundaries), velocity and latency. Continuous EEG recordings were used to validate that subjects had remained awake throughout the 36-hour period. Our findings showed that sleep deprivation deteriorated smooth pursuit gain, smooth pursuit accuracy and saccade velocity. Additionally, the ratio between saccade velocity and saccade amplitude was significantly decreased by sleep deprivation. However, as the length of sleep deprivation increased, only smooth pursuit gain deteriorated further, whereas there were signs of improvement in smooth pursuit accuracy measurements. The latter observation suggests that smooth pursuit accuracy might be affected by the circadian rhythm of alertness. Surprisingly, high subjective scores of sleepiness correlated in most cases with better saccade performance, especially after 36 hours of sleep deprivation, suggesting that awareness of sleepiness might make subjects perform better during saccade assessments. To conclude, oculomotor function clearly decreased after sleep deprivation, but the performance deteriorations were complex and not necessarily correlated with subjectively felt sleepiness.

Effects of proprioceptive vibratory stimulation on body movement at 24 and 36h of sleep deprivation

OBJECTIVE

To investigate whether postural stability and adaptation differed after a normal night of sleep, after 24h (24 SDep) and 36h (36 SDep) of sleep deprivation while subjected to repeated balance perturbations. Also, to determine whether there was any correlation between subjective alertness scores and objective posturographic measurements. Lastly, to investigate the effects of vision on the stability during sleep deprivation.

METHODS

Body movements at five locations were recorded in 18 subjects (mean age 23.8years) using a 3D movement measurement system while subjected with eyes open and closed to vibratory proprioceptive calf stimulation after a normal night of sleep, 24 and 36 SDep.

RESULTS

The clearest sleep deprivation effect was reduced ability to adapt head, shoulder and hip movements, both with eyes open and eyes closed. Additionally, several near falls occurred after being subjected to balance perturbations for 2-3min while sleep deprived. Unexpectedly, postural performance did not continue to deteriorate between 24 and 36h of sleep deprivation, but showed some signs of improvement. Subjective scores of sleepiness correlated poorly with actual changes in postural control performance.

CONCLUSIONS

Sleep deprivation might affect postural stability through reduced adaptation ability and lapses in attention. Subjective alertness might not be an accurate indicator of the physiological effects of sleep deprivation.

SIGNIFICANCE

Sleep deprivation could increase the risk of accidents in attention demanding tasks. There is a need for objective evaluation methods to determine actual performance capacity during sleep deprivation.

SEM analysis of sealant penetration in posterior approximal enamel carious lesions in vivo

PURPOSE

To study the microstructure of sealant penetration in the enamel of in vivo sealed approximal noncavitated incipient caries lesions with and without a preceding bonding step.

MATERIALS AND METHODS

A total of 26 proximal noncavitated caries lesions were sealed in vivo, using a sealant in 13 premolars with orthodontic indication of extraction. Each tooth was randomly assigned to mesial or distal surface application of a sealant in the lesion area and in surrounding sound enamel, with or without a bonding system. Four groups were analyzed: a nonbonding group in the lesion area (NBL); a nonbonding group in sound enamel (NBS); a bonding group in the lesion area (BL) and a bonding group in sound enamel (BS). The premolars were extracted after two weeks. All sealed areas were cut and demineralized with 37% hydrochloric acid for 24 h. For each group, the resin tags were observed and measured by scanning electron microscopy.

RESULTS

The lesion areas showed a very irregular resin network with twisted and curved tags in contrast to the sound enamel where a regular etching pattern was observed. The length of resin tags in microns for each group (mean +/-SD) was: NBG-L = 4.19 +/- 1.59; NBG-S = 5.49 +/- 2.49; BG-L = 4.57 +/- 1.99; and BG-S = 4.21 +/- 1.87. The differences between the groups were not statistically significant (p = 0.34).

CONCLUSION

The use of a bonding system prior to the application of a pit and fissure sealant on both lesion and sound enamel areas does not increase the resin penetration length under non-contaminated conditions.

Effects of 24-hour and 36-hour sleep deprivation on smooth pursuit and saccadic eye movements

Sleep restrictions and sleep deprivation have become common in modern society, as many people report daily sleep below the recommended 8 hours per night. This study aimed to examine the effects of sleep deprivation on oculomotor performance by recording smooth pursuit and saccadic eye movements after 24 and 36 hours of sleep deprivation. Another objective was to determine whether detected changes in oculomotor performance followed fluctuations according to a circadian rhythm and/or subjective Visuo-Analogue sleepiness Scale scores. Oculomotor responses were recorded from 18 subjects using electronystagmography, and comprised measurements of accuracy (i.e., the percentage of time the eye movement velocity was within the target velocity boundaries), velocity and latency. Continuous EEG recordings were used to validate that subjects had remained awake throughout the 36-hour period. Our findings showed that sleep deprivation deteriorated smooth pursuit gain, smooth pursuit accuracy and saccade velocity. Additionally, the ratio between saccade velocity and saccade amplitude was significantly decreased by sleep deprivation. However, as the length of sleep deprivation increased, only smooth pursuit gain deteriorated further, whereas there were signs of improvement in smooth pursuit accuracy measurements. The latter observation suggests that smooth pursuit accuracy might be affected by the circadian rhythm of alertness. Surprisingly, high subjective scores of sleepiness correlated in most cases with better saccade performance, especially after 36 hours of sleep deprivation, suggesting that awareness of sleepiness might make subjects perform better during saccade assessments. To conclude, oculomotor function clearly decreased after sleep deprivation, but the performance deteriorations were complex and not necessarily correlated with subjectively felt sleepiness.

Pegfilgrastim can be effectively administered the same day as chemotherapy to prevent neutropenia-related complications

19571

Background: Pegfilgrastim has been proven to reduce neutropenia-related complications of chemotherapy. However, the administration of pegfilgrastim 24 hours after chemotherapy treatment often poses an inconvenience for the patients and care givers. Methods: A retrospective chart review of the patients who received pegfilgrastim the same day as chemotherapy was done at a rural oncology practice, where some patients travel more than 100 miles each way for treatment. Incidence of febrile neutropenia (FN), defined as ANC = 500 and temperature =101° F; hospitalization for FN; dose-delay; dose-reduction (= 15% reduction in the planned dose); ANC recovery (ANC=1,500 on the day of next treatment), Grade III/IV neutropenia one week after chemotherapy and empiric use of prophylactic antibiotics was recorded. Results: Between 11/05 and 11/06, 243 doses of pegfilgrastim were given the same day as chemotherapy to 48 patients. M/F=14/34; Age(median): 61.2 yrs (range: 27–88 yrs).The diagnoses were NSCLC=13 (Stage II, III, IV: 2, 2 and 9, respectively); Breast Ca=11 (stage II, III, IV: 4, 6 and 1, respectively); Diffuse large B-cell lymphoma (DLBCL)= 6 (stage III, IV: 4, 2); Follicular lymphoma=3 (stage IV: 3); SCLC=3 (stage IV: 3); Ovarian Ca=2 (stage III, IV: 1, 1); and others=10. Twenty five different chemotherapy regimens were administered (Q3 wk. regimens: 19, Q2 wk. regimens: 4 and others=2). No patient had FN or hospitalization for FN. ANC recovery was sub- optimal twice (ANC of 880 and 1,010 on the day of next treatment). Dose was delayed only once due to neutropenia (ANC=880), patient with ANC of 1,010 received treatment as scheduled. Three patients needed dose-reduction of more than 15% (all had DLBCL). Grade III/IV neutropenia after one week of treatment (CBC was available after 235 treatments) was observed in 52 (0.2%) patients, 23 patients had had AC and 25 patients had had CHOP. Empiric prophylactic antibiotics were not given to any patient. Conclusions: Pegfilgrastim can be effectively given the same day as chemotherapy to ameliorate neutropenia-related complications. Same-day administration of pegfilgrastim could improve the quality of life of patients and may reduce the health care costs. Large prospective trials should be done to address this issue.

No significant financial relationships to disclose.

Changes in multi-segmented body movements and EMG activity while standing on firm and foam support surfaces

Postural control ensures stability during both static posture and locomotion by initiating corrective adjustments in body movement. This is particularly important when the conditions of the support surface change. We investigated the effects of standing on a compliant foam surface using 12 normal subjects (mean age 26 years) in terms of: linear movements at the head, shoulder, hip and knee; EMG activity of the tibialis anterior and gastrocnemius muscles and torques towards the support surface. As subjects repeated the trials with eyes open or closed, we were also able to determine the effects of vision on multi-segmented body movements during standing upon different support surface conditions. As expected, EMG activity, torque variance values and body movements at all measured positions increased significantly when standing on foam compared with the firm surface. Linear knee and hip movements increased more, relative to shoulder and head movements while standing on foam. Vision stabilized the head and shoulder movements more than hip and knee movements while standing on foam support surface. Moreover, vision significantly reduced the tibialis anterior EMG activity and torque variance during the trials involving foam. In conclusion, the foam support surface increased corrective muscle and torque activity, and changed the firm-surface multi-segmented body movement pattern. Vision improved the ability of postural control to handle compliant surface conditions. Several essential features of postural control have been found from recording movements from multiple points on the body, synchronized with recording torque and EMG.

Chondrocyte-alginate bioconstructs: An nuclear magnetic resonance relaxation study

Proton nuclear magnetic resonance (NMR) relaxometry can give informations about hydrogel scaffold properties. As these properties can be modified with culture time and conditions according to scaffold biodegradability and new tissue biosynthesis, the aim of this research was to test the efficiency of this noninvasive NMR technique in the follow-up of 3D cultures for tissue engineering. The distributions of proton relaxation times T1 and T2 have been measured on cylindrical gel samples of different types of alginate, in the presence or absence of hyaluronate, in gels or bioconstructs with encapsulated chondrocytes cultured for 30 days in normal or reduced weight conditions. It was found that T2 increases with the mannuronate/guluronate ratio in alginate samples and with the presence of hyaluronate. The distributions of both T1 and T2 result wider for bioconstructs cultured in normal gravity than for those cultured in reduced weight conditions. Neither cell growing nor collagen production but only GAG neosynthesis have been demonstrated in our experimental conditions. In conclusion, T2 is sensitive to the gel properties (possibly to the rigidity of macromolecular components). The homogeneity of bioconstructs can be monitored by the distribution of T1 and T2. We propose that nonspatially resolved NMR relaxometry can efficiently be used in monitoring tissue development in a biodegradable scaffold for tissue engineering.

Cervical muscle afferents play a dominant role over vestibular afferents during bilateral vibration of neck muscles

A previous study showed that vibratory stimulation of neck muscles in humans induced short-latency electromyographic (EMG) activation of lower leg muscles, producing postural reactions at the feet. These findings indicated that cervical proprioception contributes to stabilization of stance through rapidly integrated pathways. However, as vibration may excite both proprioceptive and vestibular afferents, and because of the proximity of neck muscles to the vestibular apparatus, neck muscle vibration could also have activated the vestibular system thereby contributing to the effect observed. To investigate any possible contribution of vestibular stimulation, vibratory stimuli were applied bilaterally and separately to the splenius muscles of the neck and the planum mastoideum overlying the vestibular organs. Ten normal subjects, with eyes closed, were exposed to vibratory stimulation of two different amplitudes and frequencies. Responses were assessed by EMG activity recorded from tibialis anterior and gastrocnemius muscles of both legs and by changes in center of pressure as measured by a force platform. Results indicated that vibration induced reproducible EMG and postural responses in the anteroposterior direction, particularly on cessation of vibration. EMG and postural responses were considerably lower and less consistent with mastoid vibration compared with neck muscles vibration. Previous reports suggest that vibratory stimulation could propagate to the vestibular organs and generate a vestibular-induced postural activation. However, our findings indicate that cervical muscles afferents play a dominant role over vestibular afferents when vibration is directed towards the neck muscles.

Morbidity of laparoscopic surgery for complicated appendicitis: an international study

BACKGROUND

Although laparoscopic appendectomy has some advantages over open appendectomy, some reports do show more postoperative intraabdominal abscesses.

METHODS

A retrospective review of complicated appendicitis managed surgically by eight surgical groups from six countries was undertaken. Among 3,433 patients with appendicitis, 1,017 (29.5%) had complicated appendicitis, which included perforated or gangrenous appendicitis with or without localized or disseminated peritonitis. There were 74 preoperative abscesses (7.4%) and 5 small bowel obstructions.

RESULTS

One patient died. There were 29 postoperative intraabdominal abscesses (2.8%) and 112 mostly minor complications. Conversion to laparotomy was necessary for 28 patients (2.7%). The surgical time ranged from 32 to 132 min (mean, 62 min), and the hospital stay ranged from 1 to 18 days (mean, 3.5 days).

CONCLUSIONS

The morbidity rates, particularly for intraabdominal abscesses, were less for laparoscopic appendectomy in complicated appendicitis than those reported in the literature for open appendectomy, whereas operating times and hospital stays were similar.

Infrared imaging microscopy of bone: illustrations from a mouse model of Fabry disease

Bone is a complex tissue whose composition and properties vary with age, sex, diet, tissue type, health and disease. In this review, we demonstrate how infrared spectroscopy and infrared spectroscopic imaging can be applied to the study of these variations. A specific example of mice with Fabry disease (a lipid storage disease) is presented in which it is demonstrated that the bones of these young animals, while showing typical spatial variation in mineral content, mineral crystal size, and collagen maturity, do not differ from the bones of age- and sex-matched wild type animals.

NMR relaxometry and imaging of water absorbed in biodegradable polymer scaffolds

Porous substrates made of poly(3-hydroxybutyrate-3-hydroxyvalerate) (PHBHV) were prepared by a particulate leaching method. After removing the salt by extraction in water, proton nuclear magnetic resonance (NMR) relaxometry and imaging were performed on sets of PHBHV substrates immersed in phosphate-buffered solution during 3 months at different time points. Polarized optical microscopy studies were performed on thin sections, 25 and 5 mum, of the PHBHV samples. The results of NMR relaxometry showed two (1)H nuclei populations, well distinguishable on the free induction decay (FID), due to the different decay time constants, a factor of 10(2) apart. Thus, it was possible to separate the two populations, giving separate distributions of T(1) relaxation times. One population could be associated with water protons in the pores and the other to macromolecular protons. The distributions of T(1) and T(2) of the water proton shifted to lower values with increasing immersion time to a constant value after 30 days. The results obtained by NMR imaging showed an initial increase in the apparent porosity, reaching a plateau after 25 days of immersion. This increase is attributed mainly to the absorption of water in the microporosity as supported by the results of the relaxometry measurements and shown by scanning electron microscopy. The average porosity measured by NMR imaging at the plateau, 78+/-3%, is slightly higher than that determined by optical microscopy, 73+/-9%, which may be due to the fact that the latter method did not resolve the microporosity. Overall, the results suggest that at early stages after immersing the scaffolds in the aqueous medium, first 30 days approximately, NMR imaging could underestimate the porosity of the substrate.

Cervical muscle afferents play a dominant role over vestibular afferents during bilateral vibration of neck muscles

A previous study showed that vibratory stimulation of neck muscles in humans induced short-latency electromyographic (EMG) activation of lower leg muscles, producing postural reactions at the feet. These findings indicated that cervical proprioception contributes to stabilization of stance through rapidly integrated pathways. However, as vibration may excite both proprioceptive and vestibular afferents, and because of the proximity of neck muscles to the vestibular apparatus, neck muscle vibration could also have activated the vestibular system thereby contributing to the effect observed. To investigate any possible contribution of vestibular stimulation, vibratory stimuli were applied bilaterally and separately to the splenius muscles of the neck and the planum mastoideum overlying the vestibular organs. Ten normal subjects, with eyes closed, were exposed to vibratory stimulation of two different amplitudes and frequencies. Responses were assessed by EMG activity recorded from tibialis anterior and gastrocnemius muscles of both legs and by changes in center of pressure as measured by a force platform. Results indicated that vibration induced reproducible EMG and postural responses in the anteroposterior direction, particularly on cessation of vibration. EMG and postural responses were considerably lower and less consistent with mastoid vibration compared with neck muscles vibration. Previous reports suggest that vibratory stimulation could propagate to the vestibular organs and generate a vestibular-induced postural activation. However, our findings indicate that cervical muscles afferents play a dominant role over vestibular afferents when vibration is directed towards the neck muscles.

Antiphospholipid antibody tests: spreading the net

OBJECTIVE

To examine the hypothesis that testing for new antiphospholipid antibody specificities may help to identify the antiphospholipid syndrome (APS) in patients with systemic lupus erythematosus (SLE) with thrombosis who are repeatedly negative for anticardiolipin antibodies (aCL) and/or lupus anticoagulant (LA).

METHODS

Three groups of patients with SLE were studied: (a) SLE/APS (n = 56): 51 female, mean (SD) age 46 (11) years, fulfilling 1999 Sapporo criteria for the APS; (b) SLE/thrombosis (n = 56): 53 female, age 42.6 (12) years, all with a history of thrombosis and persistently negative for aCL and/or LA; (c) SLE only (n = 56): 53 female, age 40 (11) years, without a history of thrombotic events. aCL and LA were retested in all samples. All patients were tested for anti-beta(2)-glycoprotein I (anti-beta(2)GPI) and antiprothrombin antibodies (aPT) by coating prothrombin on irradiated plates or using phosphatidylserine-prothrombin complex as the antigen (aPS-PT).

RESULTS

Anti-beta(2)GPI were only present in patients from the SLE/APS group, all of whom were also positive for aCL. aPT and aPS-PT were also more commonly found in SLE/APS than in SLE/thrombosis or SLE only groups (54% v 5%, p<0.0001 or v 16%, p<0.0001 for aPT and 63% v 2%, p<0.0001 or v 11%, p<0.0001 for aPS-PT, respectively). No differences were found between SLE/thrombosis and SLE only groups (p = 1.5 for beta(2)GPI, p = 0.1 for aPT, and p = 0.1 for aPS-PT).

CONCLUSION

Testing for aPT in patients with SLE with thrombosis, but persistently negative for aCL and LA, may be helpful in some selected cases. Anti-beta(2)GPI are not present in patients who are negative for aCL.

Myocardial Preservation Using Celsior: Clinical Results in High-Risk Cardiac Transplantation

Graft failure during the first few days posttransplantation remains one of the main unresolved complications. The objective of this study was to evaluate the influence of Celsior preservation solution on the incidence of early graft failure in high-risk cardiac transplant recipients. A retrospective study was carried out evaluating the cardiac transplants in 179 heart recipients. The patients were divided into 2 groups: (1) Celsior preservation solution (n = 37), and (2) Control solution (n = 142). To evaluate the efficacy of the Celsior solution, a subgroup of transplants from older donors or with ischemia times greater than 4 hours was compared with the other cases. The incidence of early graft failure was lower among the Celsior subgroups with longer ischemia times or of older donors compared with the control groups. We conclude that preservation with Celsior solution in cardiac transplantation is safe and effective. It even has advantages to reduce early graft failure compared with conventional solutions, a benefit that may be more evident in subgroups at high risk for myocardial dysfunction.