Thermo-mechanical characterization of electrospun polyurethane/carbon-nanotubes nanofibers: a comparative study

Creating ultrathin, mountable fibers from a wide range of polymeric functional materials has made electrospinning an adequate approach to producing highly flexible and elastic materials. In this paper, electrospinning was utilized to produce thermoplastic polyurethane (TPU) nanofibrous membranes for the purpose of studying their thermal and mechanical properties. Towards a study of the effects of fiber orientation and multi-walled carbon nanotubes (MWCNTs) as a filler on both mechanical and thermal characteristics of electrospun TPU mats, an experimental comparison was held between unidirectional and randomly aligned TPU and TPU/MWCNTs nanofibrous structures. The incorporation of MWCNTs into randomly oriented TPU nanofibers resulted in a significant increase in Young's modulus (E), from 3.9 to 7.5 MPa. On the other hand, for unidirectionally spun fibers, Young's modulus increased from 17.1 to 18.4 MPa upon the addition of MWCNTs. However, dynamic mechanical analysis revealed a different behavior. The randomly oriented specimens exhibited a storage modulus with a significant increase from 180 to 614 MPa for TPU and TPU/MWCNTs mats, respectively, and a slight increase from 119 to 143 MPa for unidirectional TPU and TPU/MWCNTs mats, respectively. Meanwhile, the loss modulus increased with the addition of MWCNTs from 15.7 to 58.9 MPa and from 6.4 to 12 MPa for the random and aligned fibers, respectively. The glass transition values for all the mats fell in the temperature range of - 60 to - 20 °C. The thermal degradation of the membranes was not significantly affected by the addition of MWCNTs, indicating that the mixing of the two constituents did not change the TPU's polymer structure and that the TPU/MWCNTs nanocomposite exhibited stable thermal degradation properties.

The Association between High-risk Behavior and Central Nervous System Injuries: Analysis of Traffic-related Fatalities in a Large Coroner's Series

High-risk behaviors leading to traffic fatalities are often a result of severe traumatic brain and spine injuries. The objective of the study was to analyze patterns of behavior in drivers and motorcyclists that are associated with central nervous system (CNS)-related prehospital deaths that may serve as a basis for future prevention initiatives. Our study group comprised 514 fatalities with severe CNS injuries documented at autopsy. The majority (n = 491) was the result of motor vehicle collisions (MVCs). In this group, male drivers predominated and the majority, 80 per cent, wore seatbelts. Toxicology analysis revealed 53 per cent of drivers with a mean concentration of ethanol above the legal limit. Texting while driving comprised 45 per cent of the study group. Less than 5 per cent of the fatalities were the result of road or weather conditions. In the motorcycle group (n = 23), 100 per cent of the victims were unhelmeted. We report a large autopsy series of CNS-related deaths with analysis of behavioral factors associated with the fatalities. Substance abuse and distracted driving are dominant patterns of high-risk behavior in MVCs and not wearing a motorcycle helmet is deadly for victims of motorcycle crashes.

The effects of capparis spinosa ethanol extracts on humoral immune responses in mice treated with aflatoxin B1

The results of this investigation had demonstrated the production of aflatoxins from Aspergillus flavus and study effects on humoral immune by measuring the concentrations of immunoglobulins IgA, IgG, IgM, IgE and measurement of concentrations of the complements C3, C4 in mice with treated of Aflatoxin B1. The results of qualities analysis HPLC showed the ability of isolation of Aspergillus flavus from chips, macroni, red sun flower, shamia, hazelnut, corn and peanut and isolate from fish to produce aflatoxin with different rate. The isolation of Aspergillus flavus which isolated from peanuts recoded the highest rate of production of aflatoxin B1 which it reached to (213760.28) ppm. 40 male mice were used experimentation they divided into eight groups. Three groups of mice were gave aflatoxin B1 56.3 ppm and after 2 hours treated by ethanolic extracts crude phenol and alkaloid in 250 mg/ ml while the fourth group was given aflatoxin B1 only, while the fifth, sixth and seventh groups were treated with ethanolic extracts only and the eight group was given control groups PBS. The results of study showed a significant increase in concentrations immunoglobulins IgA, IgG, IgM in the mice that dosage of extracts crude after gave aflatoxin B1 56.3 ppm it reached the highest concentration of IgA, IgG, IgM (139. 06, 3223.80, 339.66) mg/ 100 ml respectively compared with positive control that gave aflatoxin only it reached IgA, IgG, IgM (20. 23, 108.66, 25.30) mg/ 100 ml respectively. The results of the study also recoded a significant increase in the IgE concentration of 22 IU in mice that gave the crude extract after giving aflatoxin B1 with concentrations of 56.3 ppm compared to positive control of 2.83 IU. The results of the study showed a significant increase in concentration of complements C3, C4 in mice that dosage ethanolic extracts crude phenols and alkaloid after two hours gave aflatoxin B1. The highest concentration of C3, C4 (279.33, 132.20) mg/ 100 ml respectively in mice that gave crude extract after given aflatoxin B1 in compared with positive control that gave aflatoxin B1 only it reached concentrations C3, C4 (12, 17.50) mg/ 100 ml respectively. We concluded of that caper plant has immune stimulatory effects in mice.

Precision Medicine in Assisted Conception: A Multicenter Observational Treatment Cohort Study of the Annexin A5 M2 Haplotype as a Biomarker for Antithrombotic Treatment to Improve Pregnancy Outcome

BACKGROUND

Pregnancy failure and placenta mediated pregnancy complications affect >25% of pregnancies. Although there is biological plausibility for a procoagulant mechanism underlying some of these events, antithrombotic intervention trials demonstrate limited benefit, possibly through lack of stratification in heterogeneous patient groups. The ANXA5 M2 haplotype is a possible procoagulant biomarker and was tested pragmatically to determine whether this screening and LMWH treatment normalized the outcome for ANXA5 M2 positive couples. This was a pragmatic study that aimed to measure the effectiveness of a testing (for the M2 haplotype) and treatment (LMWH) pathway in routine clinical practice where there is variation between patients. Such a study in couples with fertility problems can inform choices between treatments; it is then the management protocol which is the subject of the investigation, not the individual treatments.

METHODS

Couples (N=77) with one or both partners ANXA5 M2 positive demonstrated association of this haplotype with adverse IVF outcome. A pragmatic, multicenter, prospective cohort study of ANXA5 M2 haplotype screening, and LWMH treatment following embryo transfer (ET) in 103 IVF couples positive for ANXA5 M2 was performed. They were compared with a group of 1000 contemporaneous randomly selected unscreened and untreated couples undergoing assisted conception, from which 103 matched control couples were derived. The primary outcome measure was live birth incidence. Secondary outcomes were results following embryo transfer (ET) and live birth outcome by gender and M2 carriage, and allelic dose influence.

FINDINGS

The tested and treated cohort of ANXA5 M2 carriers achieved a similar live birth rate (37.9%) per ET cycle compared to both the more fertile comparison group (38.5%), and to the 103 matched controls (33.0%). Significantly more treated male carrier only couples had a live birth versus female M2 only (47.7% vs. 25.0% p=0.045).

INTERPRETATION

Pragmatic ANXA5 M5 screening and treatment with LMWH in couples undergoing IVF is associated with similar outcome to couples with more favorable prognostic factors. The difference in live birth outcome for treated male only carrier couples may be consistent with an additional maternal thrombophilic factor that may adversely affect pregnancy, although other mechanisms are possible. This study suggests that LMWH treatment should be started prior to clinical pregnancy.

Evaluation of Epicillin in a Twice Daily Dosage Regimen in Acute Respiratory and Urinary Tract Infections

Epicillin was administered orally, using a twice daily dosage regimen, to a total of 266 patients suffering from mild to moderate respiratory or urinary tract infections. The dosage used was 500 mg twice daily in respiratory tract infections and 1000 mg twice daily in urinary tract infections.

The incidence of adverse reactions was 10% in this study and with one exception all were mild to moderate in severity.

Epicillin administered on a twice daily basis proved to be efficacious against the common sensitive pathogens responsible for infection of the respiratory and urinary tracts. An excellent response was reported in 49% of the patients, a good response obtained in 46% and a fair response was achieved in 4%.

The advantages of a twice daily dosage regimen are pointed out.

AIRBORNE MULTISPECTRAL LIDAR DATA FOR LAND-COVER CLASSIFICATION AND LAND/WATER MAPPING USING DIFFERENT SPECTRAL INDEXES

Airborne Light Detection And Ranging (LiDAR) data is widely used in remote sensing applications, such as topographic and landwater mapping. Recently, airborne multispectral LiDAR sensors, which acquire data at different wavelengths, are available, thus allows recording a diversity of intensity values from different land features. In this study, three normalized difference feature indexes (NDFI), for vegetation, water, and built-up area mapping, were evaluated. The NDFIs namely, NDFI<sub>G-NIR</sub>, NDFI<sub>G-MIR</sub>, and NDFI<sub>NIR-MIR</sub> were calculated using data collected at three wavelengths; green: 532 nm, near-infrared (NIR): 1064 nm, and mid-infrared (MIR): 1550 nm by the world’s first airborne multispectral LiDAR sensor “Optech Titan”. The Jenks natural breaks optimization method was used to determine the threshold values for each NDFI, in order to cluster the 3D point data into two classes (water and land or vegetation and built-up area). Two sites at Scarborough, Ontario, Canada were tested to evaluate the performance of the NDFIs for land-water, vegetation, and built-up area mapping. The use of the three NDFIs succeeded to discriminate vegetation from built-up areas with an overall accuracy of 92.51%. Based on the classification results, it is suggested to use NDFI<sub>G-MIR</sub> and NDFI<sub>NIR-MIR</sub> for vegetation and built-up areas extraction, respectively. The clustering results show that the direct use of NDFIs for land-water mapping has low performance. Therefore, the clustered classes, based on the NDFIs, are constrained by the recorded number of returns from different wavelengths, thus the overall accuracy is improved to 96.98%.

[Treatment for Periprosthetic Femoral Fractures after Total Hip Arthroplasty]

PURPOSE OF THE STUDY To give a description of the patient group, risk factors, classification, therapeutic procedures and treatment outcomes in periprosthetic femoral fractures after total hip arthroplasty treated in the Trauma Hospital in Brno. MATERIAL AND METHODS This retrospective study comprised of 51 patients treated for a periprosthetic femoral fracture between 2003 and 2013. This included 19 (37%) intra-operative and 32 (63%) post-operative fractures. According to the Vancouver classification, the types of fractures were as follows: 9 patients A; 21 B1; 9 B2; 6 B3 and 6 with type C. RESULTS Type A fractures were treated conservatively. Although pseudoarthrosis of the greater trochanter occurred, the patients had no clinical problems. The intra-operative type B1 fractures were managed by cerclage tapes in nine patients and the post-operative B1 fractures were treated by plate osteosynthesis in 10 patients and femoral stem reimplantation in two patients. All post-operative type B2 and type B3 fractures were managed by reimplantation of the femoral stem and type C fractures were treated by plate osteosynthesis. Serious complications requiring revision surgery were recorded in five patients; they included plate failure in two B1 fractures, dislocation of a B2 fracture, a dislocation with femoral component rotation in a B3 fracture and failure of the plate in a type C fracture. CONCLUSIONS The treatment of a periprosthetic fracture can affect the patient's life. In view of the fracture type, implant type, general health of the patient and all risk factors, the authors prefer one-stage surgical treatment. The Vancouver classification is a guidleine for the therapeutic plan. Osteosynthesis as a single procedure is indicated only if the femoral component is stable and well fixed. When the stem in B2 and B3 fractures is loose, revision surgery with stem replacement is necessary. Key words: periprosthetic fracture, total hip atrhroplasty, Vancouver classification.

Multicentre study of the clinical relevance of screening IVF patients for carrier status of the annexin A5 M2 haplotype

Thrombophilia and impaired placental vasculature are a major cause of adverse pregnancy outcome. In 2007, a new hereditary factor for obstetric complications and recurrent pregnancy loss (RPL) was identified as a sequence variation in the core promoter of the annexin A5 gene, ANXA5, called the M2 haplotype. M2 carriership has been demonstrated in couples with recurrent miscarriage and its origin is embryonic rather than specifically maternal, confirmed by subsequent papers. The M2 haplotype is the first report of a hereditary factor related to pregnancy pathology caused by embryonic-induced anticoagulation. It has been demonstrated that couples with RPL had equal and significantly increased M2 carriership and that maternal and paternal carriership confers equal risk. Given its importance for patients with RPL, and potentially implantation failure, this study assessed the incidence of carrier status for the M2 ANXA5 haplotype in both the male and female of couples attending five CARE IVF centres. In 314 patients (157 couples), 44% of couples (one or both partners), 24% of females, 26% of males and 37% of couples with unexplained infertility were M2 carriers. This high incidence has provoked further urgent studies on specific patient populations and on the value of post embryo-transfer therapy.

Abstract P1-09-11: Can patient navigation help overcome barriers to breast cancer treatment in patients with health care disparities?

Background: Patient navigation has been demonstrated to aid in adherence to breast cancer screening initiatives. Fewer studies have documented benefit for patients undergoing treatment, and especially among those with barriers to care. Cancer health disparities affecting low-income and minority patients are well documented. Causes of poor outcomes include treatment delays coupled with social and financial barriers. This report examines the impact of patient navigation on adherence to prescribed cancer treatment, including in patients receiving treatment in adjuvant and metastatic breast cancer settings.

Methods: This Patient Navigation project (supported by an Avon Foundation grant) was initiated at our public safety net hospital to test whether there was sufficient benefit to warrant a larger randomized trial. Health care coverage included 58% Medicaid, 7% uninsured or undocumented. This study was conducted over a 4 month period with new medical oncology practice patients. Those deemed to be at high risk for non-adherence received navigated care. Navigator duties included care coordination, appointment reminders, patient education materials, translation services, and transportation arrangement. Data collected prospectively included patient characteristics, cancer type, time from referral to first RT, and compliance with visits; this was compared with usual care controls during the 4 month period.

Results: Patient Navigation Program patient characteristics: N = 52 patients (42% breast cancer, 12% prostate cancer, 10% lung cancer and 36% with other cancers). Mean age = 55; 48% Black, 38% Hispanic, 8% Asian, 6% White. The table below gives the results of percentage of adherence to visits (and time to first RT) for all patients in the study receiving navigated care, for just the patients with breast cancer receiving navigated care, and for the usual care control (no navigated care).

Table 1. NAVIGATED CARE: ALL PATIENTS (N = 52)NAVIGATED CARE: BREAST CANCER (n = 22)USUAL CARE GROUPPhysician Visits (Medical Oncology)(141 Visits) 90% (95% CI: 84%-95%)(56 Visits) 91% (95% CI: 80%-97%)(2021 Visits) 79% (95% CI: 77%-81%)Chemotherapy Treatment(107 Treatments) 95% (95% CI: 89%-99%)(30 Treatments) 97% (95% CI: 83%-99%)(1656 Treatments) 86% (95% CI: 84%-88%)Time to first RT32 Days (n = 25)35 Days (n = 8)30 Days

Conclusions: This Patient Navigation Program is associated with observed improvements in adherence to chemotherapy and in follow up physician visits. No impact on time to first RT was shown. These results document that a Patient Navigation Program can help overcome barriers to good cancer care.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-09-11.

The association between high-risk behavior and central nervous system injuries: analysis of traffic-related fatalities in a large coroner's series

High-risk behaviors leading to traffic fatalities are often a result of severe traumatic brain and spine injuries. The objective of the study was to analyze patterns of behavior in drivers and motorcyclists that are associated with central nervous system (CNS)-related prehospital deaths that may serve as a basis for future prevention initiatives. Our study group comprised 514 fatalities with severe CNS injuries documented at autopsy. The majority (n = 491) was the result of motor vehicle collisions (MVCs). In this group, male drivers predominated and the majority, 80 per cent, wore seatbelts. Toxicology analysis revealed 53 per cent of drivers with a mean concentration of ethanol above the legal limit. Texting while driving comprised 45 per cent of the study group. Less than 5 per cent of the fatalities were the result of road or weather conditions. In the motorcycle group (n = 23), 100 per cent of the victims were unhelmeted. We report a large autopsy series of CNS-related deaths with analysis of behavioral factors associated with the fatalities. Substance abuse and distracted driving are dominant patterns of high-risk behavior in MVCs and not wearing a motorcycle helmet is deadly for victims of motorcycle crashes.

Dextran sodium sulfate inhibition of real-time polymerase chain reaction amplification: a poly-A purification solution

BACKGROUND

Dextran sulfate sodium (DSS) induces experimental colitis and promotes colitis-associated cancer in rodents. Here we document potent inhibition of real-time quantitative polymerase chain reaction (qPCR) using cDNA from DSS-exposed mouse tissues, which complicates gene expression analysis.

METHODS

We characterize DSS inhibition of qPCR in-vitro and in a wide array of murine tissues following ingestion of DSS. We examine different approaches to RNA purification prior to cDNA synthesis in order to optimize real-time polymerase chain reaction amplification and gene expression analysis.

RESULTS

DSS inhibits qPCR amplification of cDNA between 1 and 10 nM. Orally administered DSS interferes with qPCR amplification of cDNA derived from multiple tissues. Poly-A purification of DSS-exposed RNA allows reliable and cost-effective gene expression analysis in DSS-exposed tissue.

CONCLUSIONS

DSS is a potent inhibitor of real-time qPCR amplification and interferes with tissue-specific gene expression analysis in DSS-exposed mice. Poly-A purification of tissue-derived RNA results in reliable and cost-effective gene expression analysis in DSS-exposed mice.

Risk factor investigation for cardiovascular health through WHO STEPS approach in Ardabil, Iran

Objectives:

Reliable evidence is the keystone for any noncommunicable disease (NCD) prevention plan to be initiated. In this study we carried out a risk factor investigation based on the WHO Stepwise approach to Surveillance (STEPS).

Methods:

The study was conducted on 1000 adults between 15 and 64 years of age living in Ardabil province, north-west Iran during 2006, based on the WHO STEPS approach to surveillance of risk factors for NCD. At this stage only the first and second steps were carried out. Data were collected through standard questionnaires and methods analyzed using STATA version 8 statistical software package.

Results:

29.0% of men and 2.6% of women were current daily tobacco smokers. The mean number of manufactured cigarettes smoked per day was 18.9 among current daily smokers. Smoking was most prevalent among men of low-income families and those of lower education. The mean body mass index (BMI) was 26.6 kg/m², and was significantly correlated with systolic blood pressure. 58.9% were overweight or obese; 18.0% had raised blood pressure and 3.7% had isolated systolic hypertension. The mean number of servings of fruit consumed per day was 1.1; 33.1% had low levels of activity. Combined risk factor analysis showed that 4.1% of participants were in the low-risk group (up to 5.1% among men and 3.2% among women). Those in the high-risk group comprised 25.6% in the 25- to 44-year age group and 49.7% in the 45- to 64-year age group. Mean BMI increased by age in both sexes at least at the first three decades of adult life.

Conclusion:

Based on observed status of risk for cardiovascular health, burden of cardiovascular diseases is expected to increase if an effective prevention strategy is not undertaken.

Twin pregnancy with a complete hydatidiform mole and co-existing fetus following in-vitro fertilization: case report

Hydatidiform mole with a co-existing live fetus is a rare event. We report the case of a 41 year old Caucasian woman who attended for in-vitro fertilization. Three embryos, containing two apparently normal pronuclei, were transferred into the uterus. A twin pregnancy with a live fetus and a complete mole ensued. The pregnancy was managed conservatively until 28 weeks gestation when, following an episode of major antepartum haemorrhage, a live female infant was delivered by Caesarean section. The mole, weighing over 1.7 kg, was successfully evacuated. Following delivery, serum human chorionic gonadotrophin concentrations returned to baseline and remain within the normal range at 24 months. Both mother and daughter are well on assessment 24 months later.

Pharmacokinetics and stability of the ch14.18-interleukin-2 fusion protein in mice

The fusion protein formed from ch14.18 and interleukin-2 (ch14.18-IL-2), shown to exhibit antitumor efficacy in mouse models, consists of IL-2 genetically linked to each heavy chain of the ch14.18 chimeric anti-GD2 monoclonal antibody. The purpose of this study was to determine the pharmacokinetics of ch14.18-IL-2 in mice and assess its stability in murine serum. Following i.v. injection, the fusion protein was found to have a terminal half-life of 4.1 h. Detection of IL-2 following injection of the ch14.18-IL-2 fusion protein showed a similar half-life, indicating that the fusion protein prolongs the circulatory half-life of IL-2. Detection of human IgG1 following injection of ch14.18-IL-2 showed a terminal half-life of 26.9 h. These data suggested that the native fusion protein is being altered in vivo, resulting in a somewhat rapid loss of detectable IL-2, despite prolonged circulation of its immunoglobulin components. In vitro incubation of the ch14.18-IL-2 fusion protein in pooled mouse serum at 37 degrees C for 48 h resulted in a loss of its IL-2 component, as detected in enzyme-linked immunosorbent assay systems and in proliferation assays. Polyacrylamide gel electrophoresis and Western blot analysis of the fusion protein incubated in mouse serum at 37 degrees C indicated that the ch14.18-IL-2 is cleaved, resulting in a loss of the 67-kDa band (representing the IL-2 linked to the IgG1 heavy chain) and the detection of a band of more than 50 kDa, slightly heavier than the IgG1 heavy chain itself. This suggests that the fusion protein is being cleaved in vitro within the IL-2 portion of the molecule. These studies show that (1) ch14.18-IL-2 prolongs the circulatory half-life of IL-2 (compared to that of soluble IL-2) and (2) the in vivo clearance of the fusion protein occurs more rapidly than the clearance of the ch14.18 antibody itself, possibly reflecting in vivo cleavage within the IL-2 portion of the molecule, resulting in loss of IL-2 activity.

Local side effects of subcutaneous and intramuscular urinary gonadotropins for ovarian stimulation in in vitro fertilization: a prospective, randomized study

OBJECTIVE

To compare the incidence and severity of local side effects of urinary-derived gonadotropins administered s.c. and i.m..

DESIGN

Prospective randomized study of women undergoing IVF treatment.

SETTING

Tertiary referral center for assisted reproduction.

PATIENT(S)

A total of 71 patients were randomized to receive gonadotropins by the s.c. (n = 41) or i.m. (n = 30) route.

INTERVENTION(S)

One cycle of IVF with gonadotropins administered either s.c. or i.m. for ovarian stimulation.

MAIN OUTCOME MEASURE(S)

Incidence and severity of local side effects, such as redness, itching, swelling, pain, and bruising.

RESULT(S)

Pain was the most common side effect, with 55.3% and 70.1% of i.m. and s.c. injections, respectively, resulting in pain. There were no statistically significant differences in the incidence of itching or bruising after i.m. and s.c. injections. Although there was a higher incidence of redness and swelling in the s.c. group compared with the i.m. group, most cases were classified as mild.

CONCLUSION(S)

There was a significantly higher incidence of some local side effects after s.c. gonadotropin administration but most of these were mild and well tolerated by patients.

A prospective randomized study to assess the clinical efficacy of gonadotrophins administered subcutaneously and intramuscularly

The purpose of this study was to compare the clinical efficacy of gonadotrophins administered s.c. or i.m., in a prospective randomized study of women undergoing in-vitro fertilization (IVF) treatment at a tertiary referral centre. In all, 71 patients undergoing a total of 162 IVF treatment cycles were randomized to receive either s.c. (n = 41) or i.m. (n = 30) administration of gonadotrophins. Up to three cycles of IVF were assessed for each patient. The main outcome measures were the number of oocytes retrieved, the total amount of gonadotrophins used, the number of follicles recruited and the cumulative pregnancy and live birth rates. The mean number of oocytes retrieved was 10.5 for each group. The number of days of stimulation was significantly shorter for the s.c. group (11.7 +/- 1.9 days, mean +/- SD) than the i.m. group (12.6 +/- 2.3 days). The cumulative conception and live birth rates after three cycles of treatment were similar between the two groups. Our results suggest that the clinical efficacy of s.c. and i.m. administration of gonadotrophins is comparable. Both routes are well tolerated by patients.

Success of intrauterine insemination using cryopreserved donor sperm is related to the age of the woman and the number of preovulatory follicles

OBJECTIVE

Our objective was to assess parameters associated with a successful outcome of intrauterine insemination (IUI) using cryopreserved donor sperm.

DESIGN

We analyzed 750 consecutive donor IUI cycles undertaken by 363 women in an assisted conception clinic. The main outcome measure was clinical pregnancy.

RESULTS

IUI was performed in 94.7% of the 750 IUI treatment cycles commenced and 180 clinical pregnancies occurred. The clinical pregnancy rate per cycle was 26.4%. The rate was significantly related to the patient's age (30.5% for age < or = 35 years and 18.1% for age > 35 years; P < 0.006) and whether there was one or more than one preovulatory follicles [20.9, 34.4, and 31.5% for one, two, and three or four follicles with a mean diameter of 14 or more mm at the time of human chorionic gonadotropin (hCG) administration; P = 0.006]. Two to four preovulatory follicles were present in 12.6% of the natural cycles, 43.6% of clomiphene citrate or tamoxifen, and 59.9% of gonadotropin stimulated cycles. The difference in the number of preovulatory follicles between stimulated and unstimulated cycles was highly significant (P < 0.0001). Pregnancy rates were 29.9% in gonadotropin-stimulated cycles, 23.6% in clomiphene citrate- or tamoxifen-stimulated cycles, 23.6% in clomiphene and 20.1% in unstimulated cycles. The difference in pregnancy rates between gonadotropin-stimulated and natural cycles was significant (P = 0.038). Cycle fecundity rates were not significantly affected by the number of previous treatment cycles, duration of infertility, gravidity and parity of the patient, presence of a spontaneous luteinizing hormone (LH) surge before the administration of hCG, or number of motile sperm in the insemination specimen.

CONCLUSIONS

Success of IUI using cryopreserved donor sperm is related to the age of the women and whether there is one or more than one preovulatory follicles.

Transvaginal three-dimensional ultrasound: accuracy of follicular volume measurements

OBJECTIVES

To evaluate the accuracy of three-dimensional (3-D) ultrasound (US) follicular volume measurements.

DESIGN

Prospective clinical study.

SETTING

A tertiary referral center for assisted reproduction.

PATIENTS

Twenty-five patients undergoing ovarian stimulation for IVF-ET using the long protocol of GnRH agonist.

INTERVENTION

Transvaginal two-dimensional (2-D) and 3-D ovarian scan performed immediately before US-directed follicle aspiration.

MAIN OUTCOME MEASURES

The volume of follicular fluid aspirated was compared with the corresponding volume of the follicle measured by 3-D US and with the conventional 2-D US volume measurement calculated using the formula pi/6 (D1 x D2 x D3). Limits of agreement and 95% confidence intervals were calculated and systematic bias between the methods was analyzed.

RESULTS

The limits of agreement between the volume of follicular aspirate and follicular volume determined by US were +0.96 to -0.43 mL for 3-D measurements and +3.47 to -2.42 mL for 2-D measurements.

CONCLUSIONS

The true volume of ovarian follicles, within the clinically useful range for IVF-ET cycles, is measured more accurately by a 3-D US system than by 2-D US techniques.

Assessment of uterine artery blood flow on the day of human chorionic gonadotropin administration by transvaginal color Doppler ultrasound in an in vitro fertilization program

OBJECTIVE

To assess whether measurement of uterine artery blood flow impedance (the pulsatility index) as determined by transvaginal color Doppler ultrasound on the day of hCG administration in patients undergoing IVF can predict pregnancy and implantation rates.

DESIGN

Prospective observational study of women undergoing IVF.

SETTING

A tertiary referral center for assisted reproduction.

PATIENTS

One hundred thirty-five patients undergoing 139 IVF cycles.

INTERVENTION

Transvaginal color Doppler assessment of uterine artery pulsatility index on the day of administration of hCG.

MAIN OUTCOME MEASURES

Mean pulsatility index of the left and right uterine arteries, pregnancy rate, and embryo implantation rate.

RESULTS

The patients were grouped into pregnant and nonpregnant groups and according to whether the pulsatility index was low (1.00 to 1.99), medium (2.00 to 2.99), or high (> or = 3.00). The pregnancy rates were 13.8%, 34.7%, and 14.3% for the low, medium, and high pulsatility index groups, respectively, and were not significantly different. The implantation rates for the same groups were 10.7%, 16.3%, and 5.4%, respectively. The implantation rate for all the patients with pulsatility index < 3.00 (and especially 2.00 to 2.99) was significantly higher than the high pulsatility index group.

CONCLUSIONS

The study suggests that the measurement of uterine artery pulsatility index on the day of hCG predicts subsequent implantation rates. It may allow the administration of hCG to be deferred until uterine artery pulsatility index falls to < 3.00, which may result in improved implantation rates.

Ovarian stromal blood flow in women with polycystic ovaries--a possible new marker for diagnosis?

Blood flow changes in the ovarian stroma of women embarking on in-vitro fertilization treatment were assessed on day 2 or 3 of the menstrual cycle using colour and pulsed Doppler ultrasound. Women were divided into three groups: group 1, 63 women with regular, ovulatory menstrual cycles and normal ovaries on ultrasound scan; group 2, 13 women similar to group 1 but with polycystic ovaries (PCO) on ultrasound scan; and group 3, 12 women with biochemical evidence of previous anovulatory cycles and/or oligomenorrhoea and/or elevated serum luteinizing hormone concentrations (> 10 IU/l) in the early follicular phase together with PCO on ultrasound scan. A subjective assessment of the intensity and quantity of coloured areas in the ovarian stroma appeared to be greater in both groups 2 and 3 compared with group 1. Mean (SEM) ovarian stromal peak systolic blood flow velocity (Vmax) was 16.88 (1.79) and 16.89 (2.36) cm/s in groups 2 and 3 respectively. These velocities were significantly greater than the mean (SEM) ovarian stromal Vmax of group 1; 8.74 (0.68) cm/s (P < 0.001). Mean (SEM) ovarian stromal time averaged maximum velocity (TAMX) was 10.55 (0.91) and 10.89 (1.80) cm/s in groups 2 and 3 respectively, both significantly greater than mean ovarian stromal TAMX of group 1, (P < 0.001). There was no significant difference in pulsatility index (PI) between the three groups. There thus appears to be significantly greater ovarian stromal blood flow velocity in women with polycystic ovaries as detected by colour and pulsed Doppler ultrasound. Increased ovarian stromal blood velocity may be a new parameter to assist in the ultrasound diagnosis of PCO.(ABSTRACT TRUNCATED AT 250 WORDS)

Long-term treatment of essential hypertension with Nadolol and Hydrochlorothiazide: a two-year follow-up

After 3 weeks of placebo administration, thirty-two mildly or moderately hypertensive patients were treated with hydrochlorothiazide (HCZ) for 3 weeks, then with HCZ plus nadolol, a new beta-adrenergic blocker, for 2 years. The dose of HCZ was 50 mg once daily for all except two patients, who received 50 mg twice a day. The dose of nadolol ranged from 40 mg to 240 mg, once daily. The average supine blood pressure decreased from 182/110 mm Hg at the end of the placebo period to 170/104 mm Hg at the end of treatment with HCZ alone. Nadolol was added to the regimen, and the average supine blood pressure decreased further to 132/88 mm Hg at the end of 3 months of combined therapy. It remained essentially unchanged for the duration of the 2-year study, and no increases in the dosage of either drug were needed. Side-effects were mild, and none required a change in dosage. A once-daily dose of nadolol combined with HCZ appears to be safe and effective therapy for the long-term treatment of mild or moderate essential hypertension.

Control of essential hypertension with captopril, an angiotensin converting enzyme inhibitor

1 Captopril, an orally active angiotensin converting enzyme inhibitor, was compared with hydrochlorothiazide (HCT) in the treatment of mild and moderate essential hypertension. 2 Twenty outpatients received no antihypertensive therapy for 2 weeks, after which they were given placebo for 8 weeks. Since their diastolic blood pressure remained above 100 mm Hg, they were then randomized to receive either captopril (twelve patients) or HCT (eight patients) for a 4-week titration period. If the supine diastolic blood pressure (SDBP) was normalized, (less than or equal to 90 mm Hg) by the end of titration period, the established regimen was continued for an 8-week maintenance period; if not, the alternate drug was added in increasing doses for up to 4 weeks and the combined therapy was maintained for the remaining 4 weeks. 3 After the first 4 weeks of therapy, both groups showed a statistically significant decrease in both systolic and diastolic blood pressure. Normalization of SDBP occurred in 75% of patients treated with captopril alone, and the addition of HCT produced normalization in the remainder. HCT alone resulted in normalization of SDBP in 50% of patients and the blood pressure of the remaining patients was normalized after the addition of captopril. 4 Captopril given orally, either alone or in conjunction with HCT, is an effective agent for the control of mild and moderate essential hypertension. 5 In our series the main side effects encountered were vertigo and dizziness, transient eosinophilia, a rise of BUN and or/a rise of SGPT or SGOT.

Nadolol and propranolol in the treatment of hypertension: a double-blind comparison

Nadolol and propranolol were compared in seventy-five hypertensive patients in a double-blind randomized study conducted at Ain-Shams Hospital. After an initial wash-out period of 5 weeks, including 3 weeks of placebo administration, forty-five patients were given nadolol once daily and thirty patients received propranolol four times per day for 12 weeks, followed by a tapering-off period of 2 weeks. Both beta-blocking agents were effective in controlling hypertension with final daily doses ranging from 80 to 320 mg. Of statistical significance, however, were the better responses of supine systolic blood pressure elicited by nadolol. The only adverse reactions that occurred in this series were slight weight gains in two patients treated with nadolol and moderate dizziness in one patient treated with propranolol. Nadolol was proved to be a safe antihypertensive drug, at least comparable to propranolol in efficacy, with the advantages of a once-daily dose and a lack of direct depressant action on the heart.

Long-term treatment of essential hypertension using nadolol and hydrochlorothiazide combined

1 The stepped care approach for the treatment of hypertension was adopted in a study at Ain Shams Hospital using hydrochlorothiazide (HCT) and a new beta-blocker, nadolol. Sixty mild to moderately hypertensive patients were studied for 20 weeks (2 weeks no antihypertendive the therapy, 3 weeks placebo, 3 weeks HCT, 4 weeks nadolol + HCT dose titration and 8 weeks nadolol + HCT maintenance). The dose of HCT was 50 mg once daily throughout the study except for six patients who had their HCT dose increased to 100 mg daily during maintenance. The dose of nadolol ranged from 40-240 mg daily. 2 No patient on HCT monotherapy achieved full control of his supine diastolic blood pressure (SDBP less than 90 mm Hg). On combined therapy, 55 patients (91.7%) showed a full response, whereas the remaining five patients a good or adequate response. 3 Thirty-two of these patients agreed to continue in the study for a further 21 months (totalling 2 yr of therapy). To date, 15 of them have completed a total of 10 months, 7 have completed 11 months and 10 have completed 12 months. The delta percentage decrease in supine BP continued to be 28.0 and 19.5 for systolic and diastolic BPs respectively. 4 No significant changes in funduscopies, chest X-rays, ECGs, or full laboratory investigations were noted. A few side-effects of mild nature occurred. None necessitated discontinuation of therapy. 5 Combined therapy with nadolol and HCT is a safe and effective method of controlling hypertension over extended periods.

Effectiveness of the nitroblue tetrazolium test in demonstrating reduced bactericidal activity of polymorphonuclear neutrophils in schistosomal hepatosplenomegaly and ascites

The nitroblue tetrazolium (NBT) test was carried out on blood from ten normal individuals and 20 schistosomal patients, ten of whom had hepatosplenomegaly and ten hepatosplenomegaly and ascites. The test revealed defective neutrophils in patients who had hepatosplenomegaly accompained by ascites. The phagocytic and bactericidal effects from five of each of the two groups of patients; results substantiated tose obtained by the NBT screening test. The NBT screening test thus proved useful in detecting acquired defective function of neutrophils in a helminthic parasitic disease that is accompanied by frequent bacterial infections.