Ibuprofen inhibits key genes involved in androgen production in theca-interstitial cells

OBJECTIVE

To study the effects of ibuprofen on androgen production, gene expression, and cell viability in rat theca-interstitial cells exposed to the proinflammatory stimuli interleukin-1β (IL-1β) and lipopolysaccharide (LPS).

DESIGN

Animal study.

SETTING

University-based research laboratory.

PATIENTS/ANIMALS

Theca-interstitial cells were isolated from 30 day old female Sprague Dawley rats.

INTERVENTIONS

Theca cells were cultured with pro-inflammatory media containing IL-1β and LPS and compared with cells cultured in control media.

MAIN OUTCOME MEASURES

Androstenedione quantification was performed on conditioned cell culture medium using liquid chromatography-mass spectrometry. Theca cell viability was assessed using PrestoBlue cell viability assay. The gene expression of Cyp17a1, Cyp11a1, and Hsd3b was analyzed using quantitative polymerase chain reaction.

RESULTS

Both proinflammatory stimuli IL-1β and LPS increased androstenedione concentration in cell culture medium, and these effects were mitigated with ibuprofen. Both inflammatory agents in addition increased the expression of key genes involved in androgen synthesis: Cyp17a1, Cyp11a1, and Hsd3b; the addition of ibuprofen to the culture medium inhibited these effects. Theca cell viability increased with IL-1β and LPS. Ibuprofen inhibited the IL-1β-mediated increase in cell viability but did not reverse the effects of LPS.

CONCLUSIONS

In conclusion, our findings support the hypothesis that many of the alterations induced by inflammatory stimuli in theca-interstitial cells are abrogated by the addition of ibuprofen.

Evidence of profound ovarian suppression on combined hormonal contraception resulting in dramatically different ovarian reserve testing and oocyte retrieval outcomes: case report and review of the literature

Objective

To describe a case report and demonstrate that degree of ovarian suppression with continuous combined hormonal contraception (CHC) may be more profound than previously described and may present similarly as decreased ovarian reserve.

Design

Case report and review of the literature.

Setting

Private practice in vitro fertilization center.

Patient(s)

A 36-year-old single gravida 0 presenting for oocyte cryopreservation on CHC.

Intervention(s)

Discontinuation of vaginal ring combined hormonal contraceptive for 6 months.

Main Outcome Measure(s)

Antral follicle count, antimüllerian hormone, day 3 follicle-stimulating hormone, total oocytes, and mature oocytes retrieved before and after discontinuation of CHC.

Result(s)

After a 6-month break from CHC, our patient’s antimüllerian hormone level increased from undetectable levels to 3.45 ng/mL, day 3 follicle-stimulating hormone level decreased from 14.9 IU/mL–6.17 IU/mL, and antral follicle count improved from 0–28. In addition, the number of oocytes retrieved after a 4-month CHC break and 6-month break increased from 8 to 29, respectively.

Conclusion(s)

In patients on long-term combined continuous hormonal contraception, profound ovarian suppression can result in a clinical picture of diminished ovarian reserve and extremely poor response to high-dose stimulation, which may be reversed by more time off from suppression.

Inflammatory Stimuli Trigger Increased Androgen Production and Shifts in Gene Expression in Theca-Interstitial Cells

Polycystic ovary syndrome (PCOS) is a common reproductive endocrine disorder characterized by theca cell hyperplasia and excessive androgen production. An increasing body of evidence has pointed to a close association between PCOS and low-grade chronic systemic inflammation. However, the mechanistic basis for this linkage is unknown. Therefore, we evaluated the effects of the inflammatory agents lipopolysaccharide (LPS) and IL-1β on rat theca-interstitial cells (TICs). We found that incubation with either LPS or IL-1β elicited a dose-dependent increase in both TIC viability and androgen production. Using RNA sequencing analysis, we found that both of these inflammatory agents also triggered profound and widespread shifts in gene expression. Using a stringent statistical cutoff, LPS and IL-1β elicited differential expression of 5201 and 5953 genes, respectively. Among the genes upregulated by both LPS and IL-1β were key regulatory genes involved in the cholesterol and androgen biosynthesis pathways, including Cyp17a1, Cyp11a1, Hsd3b, and Hmgcr. This provides a molecular explanation for the mechanism of action of inflammatory agents leading to increased androgen production. Gene ontology and pathway analysis revealed that both LPS and IL-1β regulated genes highly enriched for many common functions, including the immune response and apoptosis. However, a large number of genes (n = 2222) were also uniquely regulated by LPS and IL-1β, indicating that these inflammatory mediators have substantial differences in their mechanism of action. Together, these findings highlight the potential molecular mechanisms through which chronic low-grade inflammation contributes to the pathogenesis of androgen excess in PCOS.

Unexplained recurrent pregnancy loss and unexplained infertility: twins in disguise

STUDY QUESTION

Is B-cell CLL/lymphoma 6 (BCL6) endometrial expression, a surrogate biomarker of endometriosis, elevated in women with unexplained recurrent pregnancy loss (uRPL) and unexplained infertility (UI) compared to fertile subjects?

SUMMARY ANSWER

Endometrial BCL6 expression is elevated to a similar degree in women with uRPL and UI compared to fertile controls.

WHAT IS KNOWN ALREADY

Endometriosis has been linked to the genesis of endometrial progesterone resistance and to specific nuclear proteins, including endometrial BCL6. BCL6 overexpression (immune histologic score > 1.4) has been strongly associated with poor reproductive outcomes in IVF cycles in women with UI. Our previous data have demonstrated an accuracy of 94% for diagnosing endometriosis, and BCL6 protein is elevated in the decidua of women with uRPL.

STUDY DESIGN SIZE DURATION

In this case-control study, at a tertiary university teaching hospital, 110 samples (control n = 28; uRPL n = 29; UI n = 53) from pathological archives were analyzed. Timed endometrial biopsies were obtained between 2 January 2002 and 31 December 2016.

PARTICIPANTS/MATERIALS SETTING METHOD

LH-timed endometrial biopsies were obtained from women with UI, uRPL (two or more consecutive losses) and normal fertile subjects during the mid-secretory phase of the menstrual cycle. Endometrial BCL6 protein levels were compared in women with UI and uRPL and fertile controls using western blot analysis and immunohistochemistry (HSCORE).

MAIN RESULTS AND THE ROLE OF CHANCE

The mean age of the uRPL group was significantly higher than the others [mean (SD)] control = 32.7 (2.6); uRPL = 35.8 (3.7); UI = 32.7 (4.4); P = 0.002, ANOVA]. Seventy-nine percent of women in both subfertile groups (uRPL and UI, 65 out of 82) displayed elevated BCL6 protein levels. From these, a subset of cases with abnormal BCL6 went to laparoscopy and endometriosis was found in 9 out of 11 cases of uRPL and in 20 out of 21 cases of UI. Median BCL6 HSCORE for controls versus uRPL and UI was significantly different [median (interquartile); control = 0.3 (0.02 to 0.5); uRPL = 3 (1.9 to 3.6); UI = 2.9 (1.6 to 3.1); P < 0.0001, Kruskal-Wallis]. A significant trend in the association between the degree of infertility (fertile, uRPL and UI) and the HSCORE level (negative, medium and high) was found (P < 0.001; x 2 for trend). Western blot of representative samples from each group demonstrated similar findings based on protein levels in the whole endometrium. After running ANCOVA analysis for age difference, the BCL6 difference among groups was still significant (P-value < 0.0001).

LIMITATIONS REASONS FOR CAUTION

We studied subjects with two consecutive pregnancy losses rather than the definition adopted in Europe of three losses. The findings may lack external validity in other clinical settings (e.g. low prevalence of endometriosis).

WIDER IMPLICATIONS OF THE FINDINGS

Based on the data presented here, we postulate that the degree of BCL6 expression may represent a continuum of progesterone resistance and response to inflammation that occurs in women with endometriosis, yielding different degrees of infertility, from uRPL to UI.

STUDY FUNDING/COMPETING INTERESTS

This study was supported by NICHD/NIH R01 HD067721 (SLY and BAL), by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior: Grant 99999.003035/2015-08 (BAL) and by CAPES/PROAP (RFS). Two authors (BAL, SLY) have licensed intellectual property for the detection of endometriosis. Dr Bruce Lessey is an unpaid scientific Advisor for CiceroDx. The other authors report no conflict of interest.

Evolution of larval competitiveness and associated life-history traits in response to host shifts in a seed beetle

Resource competition is frequently strong among parasites that feed within small discrete resource patches, such as seeds or fruits. The properties of a host can influence the behavioural, morphological and life-history traits of associated parasites, including traits that mediate competition within the host. For seed parasites, host size may be an especially important determinant of competitive ability. Using the seed beetle, Callosobruchus maculatus, we performed replicated, reciprocal host shifts to examine the role of seed size in determining larval competitiveness and associated traits. Populations ancestrally associated with either a small host (mung bean) or a large one (cowpea) were switched to each other's host for 36 generations. Compared to control lines (those remaining on the ancestral host), lines switched from the small host to the large host evolved greater tolerance of co-occurring larvae within seeds (indicated by an increase in the frequency of small seeds yielding two adults), smaller egg size and higher fecundity. Each change occurred in the direction predicted by the traits of populations already adapted to cowpea. However, we did not observe the expected decline in adult mass following the shift to the larger host. Moreover, lines switched from the large host (cowpea) to the small host (mung bean) did not evolve the predicted increase in larval competitiveness or egg size, but did exhibit the predicted increase in body mass. Our results thus provide mixed support for the hypothesis that host size determines the evolution of competition-related traits of seed beetles. Evolutionary responses to the two host shifts were consistent among replicate lines, but the evolution of larval competition was asymmetric, with larval competitiveness evolving as predicted in one direction of host shift, but not the reverse. Nevertheless, our results indicate that switching hosts is sufficient to produce repeatable and rapid changes in the competition strategy and fitness-related traits of insect populations.

Foraging mode affects the evolution of egg size in generalist predators embedded in complex food webs

Ecological networks incorporate myriad biotic interactions that determine the selection pressures experienced by the embedded populations. We argue that within food webs, the negative scaling of abundance with body mass and foraging theory predict that the selective advantages of larger egg size should be smaller for sit-and-wait than active-hunting generalist predators, leading to the evolution of a difference in egg size between them. Because body mass usually scales negatively with predator abundance and constrains predation rate, slightly increasing egg mass should simultaneously allow offspring to feed on more prey and escape from more predators. However, the benefits of larger offspring would be relatively smaller for sit-and-wait predators because (i) due to their lower mobility, encounters with other predators are less common, and (ii) they usually employ a set of alternative hunting strategies that help to subdue relatively larger prey. On the other hand, for active predators, which need to confront prey as they find them, body-size differences may be more important in subduing prey. This difference in benefits should lead to the evolution of larger egg sizes in active-hunting relative to sit-and-wait predators. This prediction was confirmed by a phylogenetically controlled analysis of 268 spider species, supporting the view that the structure of ecological networks may serve to predict relevant selective pressures acting on key life history traits.

The effect of inbreeding on natural selection in a seed-feeding beetle

Little is known about how inbreeding alters selection on ecologically relevant traits. Inbreeding could affect selection by changing the distribution of traits and/or fitness, or by changing the causal effect of traits on fitness. Here, I test whether selection on egg size varies with the degree of inbreeding in the seed-feeding beetle, Stator limbatus. There was strong directional selection favoring large eggs for both inbred and outbred beetles; offspring from smaller eggs had lower survivorship on a resistant host. Inbreeding treatment had no effect on the magnitude of selection on egg size; all selection coefficients were between ~0.078 and 0.096, regardless of treatment. However, inbreeding depression declined with egg size; this is because the difference in fitness between inbreds and outbreds did not change, but average fitness increased, with egg size. A consequence of this is that populations that differ in mean egg size should experience different magnitudes of inbreeding depression (all else being equal) and thus should differ in the magnitude of selection on traits that affect mating, simply as a consequence of variation in egg size. Also, maternal traits (such as egg size) that mediate stressfulness of the environment for offspring can mediate the severity of inbreeding depression.

The adaptive significance of maternal effects

Recently, the adaptive significance of maternal effects has been increasingly recognized. No longer are maternal effects relegated as simple `troublesome sources of environmental resemblance' that confound our ability to estimate accurately the genetic basis of traits of interest. Rather, it has become evident that many maternal effects have been shaped by the action of natural selection to act as a mechanism for adaptive phenotypic response to environmental heterogeneity. Consequently, maternal experience is translated into variation in offspring fitness.

Inbreeding depression in two seed-feeding beetles, Callosobruchus maculatus and Stator limbatus (Coleoptera: Chrysomelidae)

Inbreeding depression is well documented in insects but the degree to which inbreeding depression varies among populations within species, and among traits within populations, is poorly studied in insects other than Drosophila. Inbreeding depression was examined in two long-term laboratory colonies of the seed beetle, Callosobruchus maculatus (Fabricius), which are used frequently as models for experiments in ecology, evolution and behaviour. Inbreeding depression in these laboratory colonies are compared with one recently field-collected population of a different seed beetle, Stator limbatus Horn. Inbreeding reduced embryogenesis, egg hatch and larval survival in both species, such that eggs produced by sib matings were >17% less likely to produce an adult offspring. Inbred larvae also took 4-6% longer to develop to emergence in both species. Inbreeding depression varied among the measured traits but did not differ between the two populations of C. maculatus for any trait, despite the large geographic distance between source populations (western Africa vs. southern India). Inbreeding depression was similar in magnitude between C. maculatus and S. limbatus. This study demonstrates that these laboratory populations of C. maculatus harbour substantial genetic loads, similar to the genetic load of populations of S. limbatus recently collected from the field.

Selection on body size and sexual size dimorphism differs between host species in a seed-feeding beetle

Sexual size dimorphism varies substantially among populations and species but we have little understanding of the sources of selection generating this variation. We used path analysis to study how oviposition host affects selection on body size in a seed-feeding beetle (Stator limbatus) in which males contribute large ejaculates (nuptial gifts) to females. Females use nutrients in these ejaculates for egg production. Male body size, which affects ejaculate size, affects female fecundity and is thus under fecundity selection similar in magnitude to the fecundity selection on female body size. We show that when eggs are laid on a host on which larval mortality is low (seeds of Acacia greggii) fecundity predicts fitness very well and fecundity selection is the major source of selection on both male and female adult size. In contrast, when eggs are laid on a host on which larval mortality is high (seeds of Parkinsonia florida) fecundity poorly predicts fitness such that fecundity selection is relaxed on both male and female size. However, because egg size affects larval mortality on this poor host (P. florida) there is selection on female size via the female size --> egg size --> fitness path; this selection via egg size offsets the reduction in fecundity selection on female, but not male, body size. Thus, differences in host suitability (due to differences in larval mortality) affect the relative importance of two sources of selection on adult body size; fecundity selection on both male and female body size is lower on the poor quality host (P. florida) relative to the high quality host (A. greggii) whereas selection on female body size via effects of egg size on offspring survival (body size --> egg size --> fitness) is greater on the poor quality host relative to the high quality host. Because selection via the egg size path affects only females the difference in larval survival between hosts shifts the relative magnitude of selection on female vs. male size. Researchers working on other study systems should be alerted to the possible importance of subtle, but consequential, indirect selection on their study organisms.

Complex genetic architecture of population differences in adult lifespan of a beetle: nonadditive inheritance, gender differences, body size and a large maternal effect

Evolutionary responses to selection can be complicated when there is substantial nonadditivity, which limits our ability to extrapolate from simple models of selection to population differentiation and speciation. Studies of Drosophila melanogaster indicate that lifespan and the rate of senescence are influenced by many genes that have environment- and sex-specific effects. These studies also demonstrate that interactions among alleles (dominance) and loci (epistasis) are common, with the degree of interaction differing between the sexes and among environments. However, little is known about the genetic architecture of lifespan or mortality rates for organisms other than D. melanogaster. We studied genetic architecture of differences in lifespan and shapes of mortality curves between two populations of the seed beetle, Callosobruchus maculatus (South India and Burkina Faso populations). These two populations differ in various traits (such as body size and adult lifespan) that have likely evolved via host-specific selection. We found that the genetic architecture of lifespan differences between populations differs substantially between males and females; there was a large maternal effect on male lifespan (but not on female lifespan), and substantial dominance of long-life alleles in females (but not males). The large maternal effect in males was genetically based (there was no significant cytoplasmic effect) likely due to population differences in maternal effects genes that influence lifespan of progeny. Rearing host did not affect the genetic architecture of lifespan, and there was no evidence that genes on the Y-chromosome influence the population differences in lifespan. Epistatic interactions among loci were detectable for the mortality rate of both males and females, but were detectable for lifespan only after controlling for body size variation among lines. The detection of epistasis, dominance, and sex-specific genetic effects on C. maculatus lifespan is consistent with results from line cross and quantitative trait locus studies of D. melanogaster.

Genetic architecture of population differences in oviposition behaviour of the seed beetle Callosobruchus maculatus

Few studies have examined the genetic architecture of population differences in behaviour and its implications for population differentiation and adaptation. Even fewer have examined whether differences in genetic architecture depend on the environment in which organisms are reared or tested. We examined the genetic basis of differences in oviposition preference and egg dispersion between Asian (SI) and African (BF) populations of the seed beetle, Callosobruchus maculatus. We reared and tested females on each of two host legumes (cowpea and mung bean). The two populations differed in mean oviposition preference (BF females preferred cowpea seeds more strongly than did SI females) and egg dispersion (SI females distributed eggs more uniformly among seeds than did BF females). Observations of hybrid and backcross individuals indicated that only the population difference in oviposition preference could be explained by complete additivity, whereas substantial dominance and epistasis contributed to the differences in egg dispersion. Both rearing host and test host affected the relative magnitude of population differences in egg dispersion and the composite genetic effects. Our results thus demonstrate that the relative influence of epistasis and dominance on the behaviour of hybrids depends on the behaviour measured and that different aspects of insect oviposition are under different genetic control. In addition, the observed effect of rearing host and oviposition host on the relative importance of dominance and epistasis indicates that the genetic basis of population differences depends on the environment in which genes are expressed.

Evolutionary genetics of lifespan and mortality rates in two populations of the seed beetle, Callosobruchus maculatus

The age at which individuals die varies substantially within and between species, but we still have little understanding of why there is such variation in life expectancy. We examined sex-specific and genetic variation in adult lifespan and the shape of mortality curves both within and between two populations of the seed beetle, Callosobruchus maculatus, that differ in a suite of life history characters associated with adaptation to different host species. Mean adult lifespan and the shape of the logistic mortality curves differed substantially between males and females (males had lower initial mortality rates, but a faster increase in the rate of mortality with increasing age) and between populations (they differed in the rate of increase in mortality with age). Larger individuals lived longer than smaller individuals, both because they had lower initial mortality rates and a slower increase in the rate of mortality with increasing age. However, differences in body size were not adequate to explain the differences in mortality between the sexes or populations. Both lifespan and mortality rates were genetically variable within populations and genetic variance/covariance matrices for lifespan differed between the populations and sexes. This study thus demonstrated substantial genetic variation in lifespan and mortality rates within and between populations of C. maculatus.

Genetic architecture of adaptive differentiation in evolving host races of the soapberry bug, Jadera haematoloma

To explore genetic architecture and adaptive evolution, we conducted environmental and genetic experiments with two recently (ca. 100 generations) diverged, geographically adjacent races of the soapberry bug. One race occurs on a native host plant species, the other on an introduced host. We focused on three traits: length of the mouthparts, body size and development time. The first experiment was an environmental manipulation, comparing individuals of each population reared on one or the other host species ('cross-rearing') and estimating three evolutionary rates for each trait. The first rate, 'evolutionary path' compares ancestral-derived populations when both were reared on the introduced host. The second, 'current ecological contrast' compares populations with each reared on its natal host. The third, 'evolved tradeoff' compares the two races when reared on the native host. Differences among these rates are striking and informative. For example, development time, which appears to be relatively undifferentiated phenotypically, has actually evolved very rapidly via countergradient selection. The pattern differs for each trait, and clear developmental tradeoffs have evolved as quickly as adaptation to the new host in each. The second experiment was a two-generation 'line cross' study. With joint-scaling analyses, we compared purebred, hybrid and backcrossed individuals to describe genetic architecture. Additive genetic variance for mouthpart length was consistently large (ca. 60%), but the interaction of dominance, maternal effects and epistasis was important in the other traits. Rearing host strongly affected genetic architecture. There was no clear relationship between genetic architecture and rate of evolution. Selection has produced both additive and nonadditive differentiation between the host races with surprising speed, consistent with theoretical predictions about evolution in fitness-associated traits.

Evolutionary ecology of progeny size in arthropods

Most models of optimal progeny size assume that there is a trade-off between progeny size and number, and that progeny fitness increases with increasing investment per young. We find that both assumptions are supported by empirical studies but that the trade-off is less apparent when organisms are iteroparous, use adult-acquired resources for reproduction, or provide parental care. We then review patterns of variation in progeny size among species, among populations within species, among individuals within populations, and among progeny produced by a single female. We argue that much of the variation in progeny size among species, and among populations within species, is likely due to variation in natural selection. However, few studies have manipulated progeny environments and demonstrated that the relationship between progeny size and fitness actually differs among environments, and fewer still have demonstrated why selection favors different sized progeny in different environments. We argue that much of the variation in progeny size among females within populations, and among progeny produced by a single female, is probably nonadaptive. However, some species of arthropods exhibit plasticity in progeny size in response to several environmental factors, and much of this plasticity is likely adaptive. We conclude that advances in theory have substantially outpaced empirical data. We hope that this review will stimulate researchers to examine the specific factors that result in variation in selection on progeny size within and among populations, and how this variation in selection influences the evolution of the patterns we observe.

Genetic variation in paternal investment in a seed beetle

Males of many species invest resources in their offspring. For paternal investment to evolve, it must exhibit heritable variation. Using a standard half-sibling quantitative genetic design, we investigated whether genetic variation in male ejaculate size, a trait that affects female fecundity and copulation duration, are present in the seed beetle Callosobruchus maculatus. Ejaculate size was estimated as the amount of weight lost by males during mating. Dams, but not sires, had significant effects on their sons' absolute ejaculate size (both replicates) and relative ejaculate size (proportion of body weight; one replicate only), explaining 21-25% of the variance in absolute ejaculate size and 8-16% of the variance in relative ejaculate size. These results suggest either a large maternal effect on ejaculate size or sex-linkage of loci that affect the variation in ejaculate size. The proportion of phenotypic variance explained by sex- linkage (assuming no maternal effects) was 42 and 49% (ejaculate size) and 17 and 31% (relative ejaculate size) in the two replicates. These results indicate that male paternal investment can respond to selection, and that it may be able to do so especially rapidly because sex-linked traits have the potential to evolve much more quickly than autosomal traits. There were only weak negative correlations between ejaculate size and mating duration, contrary to what we predicted. There was additive genetic variation in female copulation duration, but not in male copulation duration, suggesting that copulation duration is under female control. Copyright 1998 The Association for the Study of Animal Behaviour.

Sexual selection and the fitness consequences of male body size in the seed beetle Stator limbatus

We examined sexual selection on male body size in a laboratory population of the seed beetle, Stator limbatus, and the fitness consequences to females of mating with larger males. Large males produced larger ejaculates than small males. Both males and females lost body weight as a consequence of breeding, and large males lost more weight than small males. The amount of weight lost by males correlated as highly with female fecundity as did the amount of weight lost by females. Similarly, male and female body weight correlated equally highly with female fecundity. These results indicate that males make substantial contributions to female fecundity, probably through nutrients transferred in their ejaculate. As a consequence, fecundity selection should favour large body size in both males and females. We found no preference for large males when virgin females were presented with only one male, but when presented with two males simultaneously, females were more likely to mate with the larger male. This result is consistent with relative female choice or male-male competition, although no indications of male-male competition were observed. Females that mated with small males re-mated sooner than females that first mated with large males. Females that first mated with a non-virgin male were also more likely to re-mate than females that first mated with a virgin male, suggesting that females re-mate to obtain additional sperm or nutrients and not just as a form of mate choice. In addition to the possible benefits from mate choice and male-male competition, large males gain a mating advantage through reduced sperm competition. This large male advantage, combined with fecundity selection on males as well as females, may account for males being larger than females in this species.Copyright 1998 The Association for the Study of Animal Behaviour.

Preservation of pulmonary function by an outer membrane protein F vaccine. A study in rats with chronic pulmonary infection caused by Pseudomonas aeruginosa

This study investigated the ability of a protein F vaccine to reduce macroscopic evidence of lung damage and preserve pulmonary function in immunized animals in a rat model of chronic pulmonary infection caused by Pseudomonas aeruginosa. Other membrane protein F of P aeruginosa was purified by extraction from polyacrylamide gels of cell envelope proteins of the PAO1 immunotype 7 strain. Rats were immunized intramuscularly with either 25 micrograms of the purified protein F or bovine serum albumin on days 0 and 14 and then challenged on day 28 via intratracheal inoculation of agar beads containing cells of an immunotype 3 clinical isolate of P aeruginosa. Also, included was a noninfected control group which received only sterile agar beads. On day 35, the lungs were excised, pulmonary compliance measured, and the lungs examined macroscopically for the presence and severity of lesions. The protein F-immunized rats had a significant (p < 0.01) reduction in the number of severe pulmonary lesions as compared with bovine serum albumin-immunized rats. Lung compliance (CL) was significantly (p < 0.001) reduced in rats which were immunized with bovine serum albumin (n = 17, CL = 0.12 +/- 0.008), whereas CL of protein F-immunized rats (n = 12, CL = 0.17 +/- 0.006) was similar to that of noninfected control rats (n = 5, CL = 0.15 +/- 0.008). This study demonstrated that a protein F vaccine has the ability to decrease macroscopic lung lesions from infection and preserve pulmonary function in actively immunized rats upon subsequent challenge with P aeruginosa in this model of chronic lung infection.

Determination of indwelling ureteral stent patency: comparison of standard contrast and nuclear cystography, and lasix renography

OBJECTIVE

Because of the difficulty in determining patency of Double-J ureteral catheters, a study was devised at Madigan Army Medical Center to determine the best method to demonstrate stented ureteral patency.

METHODS

Forty-two patients requiring Double-J ureteral stenting for various clinical reasons were the study group. Outpatients underwent contrast retrograde cystography, nuclear cystography, and diuretic renography every four to six weeks during the stent duration or just prior to stent removal if the stents were indwelling for less than four weeks. In addition, four weeks after stent removal diuretic renography alone was done to evaluate for possible delayed obstructive effect of the ureteral stenting.

RESULTS

A total of 53 stents and 42 patients were evaluated. Seventy-seven sets of studies were obtained. In only four instances did all three imaging methods agree on the obstruction. In the remaining 73 sets of data, at least one imaging technique indicated stented ureteral patency. The contrast retrograde cystogram was positive for reflux 52 times (71%). Nuclear cystography showed patency 54 times (74%) and an unobstructed diuretic renogram was obtained 59 times (81%). In addition, five of the six diuretic renograms accomplished with patients in the supine position only and which showed obstruction were repeated with patients in the upright position, and they showed unobstructed function. The overall sensitivity for diuretic renography was 89 percent when the diuretic renogram was done with patients in the supine and upright positions.

CONCLUSIONS

Diuretic renography is the most sensitive test for detecting stented ureteral patency. This test needs to be performed with patients in both the supine and upright positions.

Current concepts in the management and prevention of tuberculosis in adults

After a steady decline in incidence during most of this century, tuberculosis case rates stabilized in the mid-1980s, and since then have steadily increased. Several factors may have been responsible for the increase, including the influx of immigrants from endemic areas and the appearance of AIDS. This review outlines the current recommendations for treatment of tuberculosis in the otherwise normal patient, then discusses special problems which may affect treatment, including primary drug failure and relapse, pregnancy and lactation, extrapulmonary disease, AIDS, renal failure, and liver disease. The appearance and significance of multiple-drug-resistant tuberculosis (MDRT) in AIDS victims is discussed, and current recommendations for screening patients for the presence of tuberculosis are reviewed.

Cavitary lung disease. How to read the radiographic patterns

Many disorders and abnormalities are accompanied by cavitary lesions of the lung, including various diseases that may destroy or replace lung tissue. The most common causes of cavitary lung disease are primary and metastatic neoplasms, granulomas, and necrotizing pulmonary infections. These diseases often have radiographic patterns, clinical signs, and symptoms that are characteristic and may suggest a diagnosis.

A solitary testicular relapse of a rhabdomyosarcoma in an adult

A case of recurrent rhabdomyosarcoma in an adult is reported. The primary disease at presentation was in the maxillary sinus with metastatic spread to regional lymph nodes. A complete response (CR) and a 14-month disease-free interval (DFI) were obtained with combination therapy. The sole site of relapse was an intratesticular mass. Management implications are discussed.

Seminal vesicle abscess: the use of computerized coaxial tomography for diagnosis and therapy

Seminal vesicle abscesses are extremely rare and worthy of report. Computerized tomography easily verifies the diagnosis and simplifies the treatment of transurethral incision and drainage.

Protrusive positioners

Techniques were described for fabricating maxillary and mandibular protrusive positioners for treatment of disk-condyle derangements. Treatment time with the splints varies from 4 to 12 months depending on the age of the patient, the degree of existing symptoms, and patient motivation. At the end of the treatment period and after removal of the splints, the patient may have (1) no pain or internal derangement, (2) no pain but internal derangement with or without reduction, or (3) pain and internal derangement with or without reduction. If dental treatment is required, patients in the first two categories can be treated at a physiologically acceptable treatment position with existing treatment modalities. For patients in the third category, definitive, irreversible stabilization should be reevaluated. For these patients a mandibular cast splint can be changed to an interim splint by replacing the self-polymerizing resin with Isosit (Ivoclar-Vivadent, Schaan, Liechtenstein) or heat-processed acrylic resin.

Provisional restorations for altered occlusions

A method for fabricating provisional restorations with specific criteria has been outlined and offers the following advantages: Altered occlusion can be restored. Select steps can be delegated to auxiliary personnel. Commercial laboratory fees are eliminated. It is inexpensive. The restorations are durable and esthetic. Restorations are readily modified intraorally. This flexible procedure is used for short or long spans, and/or for segmented treatment. Casts of acceptable anterior provisional restorations can provide a template for developing anterior guidance in the final restorations.

Incidence and identification of phospholipase C-producing bacteria in fresh and spoiled homogenized milk

Bacteria which produced phospholipase C were isolated from 13 of 34 fresh and 15 of 35 spoiled samples of homogenized milk. No single off flavor was assigned consistently to samples with phospholipase producers, but 75% of them were bitter. Pseudomonads constituted 62% of the isolates. Other phospholipase C-producing genera and their numbers were Acinetobacter, two; Alcaligenes, three; Bacillus, two; Citrobacter, one; Enterobacter, three; and Flavobacterium, two. Two unidentified yeasts also were isolated.

Lecithin agar for detection of microbial phospholipases

Lecithin agar was developed on which phospholipase C produced turbid zones and phospholipase A produced clear zones. Reactions on lecithin agar agreed 74% of the time with reactions in egg yolk broth. On lecithin agar, interpretation was easier, phospholipase A was detectable, and opaque zones were visible 1 or 2 days earlier than on egg yolk agar. All constituents of the medium can be autoclaved.