O-252 Next generation sequencing analysis of the seminal microbiome in male partners of women with idiopathic recurrent pregnancy loss: results of a prospective cohort study

Study question

Is there an association between the semen microbiome, seminal reactive oxygen species (ROS) and DNA fragmentation in men with recurrent pregnancy loss (RPL)?

Summary answer

This pilot study outlines the subtle role that microbiota play in influencing ROS and sperm DNA damage for male partners of women with RPL

What is known already

RPL is defined as the loss of two or more consecutive pregnancies. This devastating condition impacts approximately 1% of couples. Paternal causes are not routinely screened for and an underlying cause is not found in up to 50% of cases. Recent studies have reported an association between elevated seminal ROS and sperm DNA fragmentation in the male partner, and RPL. We hypothesised that seminal microbiota contribute to increased ROS and sperm DNA damage. To test this, we investigated the relationship between seminal bacterial composition and ROS levels in men with proven fertility versus men with a history of RPL.

Study design, size, duration

We conducted a prospective, case-control study and recruited participants between November 2018 and March 2020 at Imperial College Healthcare NHS Trust. A total of 109 men participated in the study; 46 men with RPL and 63 men with proven fertility and no history of RPL. Each participant attended for a single study visit which consisted of a full medical history, assessment of testicular volume, height, weight, blood samples and production of a semen sample.

Participants/materials, setting, methods

Routine semen analysis (WHO) and endocrine and lipid profiles were performed for all patients. Semen ROS and DNA fragmentation were performed (luminol and TUNEL methodologies, respectively). ROS were classified as high (>3.77 RLU/s) or low (<3.77 RLU/s). Metataxonomic profiling of samples was performed using Illumina Miseq-based sequencing of the V1-V2 hypervariable regions of bacterial 16S rRNA gene amplicons. Multivariate and univariate modelling was performed to explore associations between metataxonomic profiles, ROS levels and clinical metadata.

Main results and the role of chance

Men with RPL had higher mean semen volume (p = 0.02) and increased prevalence of high ROS (p = 0.02, Fisher's exact) compared with controls; but other clinical characteristics were similar between groups. A total of 3,700,136 high quality sequence reads were generated for the dataset with an average of 33,946 reads/sample. Hierarchical clustering of bacterial genera relative abundances identified 4 distinct microbial signatures characterised by high relative abundance of 1. Streptococcus, 2. Lactobacillus and Gardnerella, 3. polymicrobial (including Prevotella), and 4. Corynebacterium and Finegoldia. Prevalences of these groups were similar in control and RPL groups (p = 0.11). Additionally, no association between the bacterial genera groups and elevated ROS, DNA fragmentation, or clinical factors such as age, ethnicity, or semen volume were observed (chi-square tests). At species taxonomy level relative abundance of L. crispatus was higher in controls compared to RPL, but did not withstand false discovery rate correction for multiple testing (p = 0.006, q = 0.67). Higher relative abundance of Microbacterium was detected in semen samples with high DNA fragmentation (p = 8.7E-4, q = 0.08). This relationship was even stronger within the RPL cohort (p = 2.8E-5, q = 0.002). No significant enrichment of specific taxa was observed between high or low ROS samples however, low ROS was associated with Corynebacterium relative abundance >20%.

Limitations, reasons for caution

More patients are required to enhance statistical power. Duplicate sample collection may establish the robustness of seminal compositions observed. Time since last sexual intercourse samples may affect the analysis. Concomitant analysis of the vaginal microbiome of female partners may improve our understanding of how partners may affect each other’s fertility.

Wider implications of the findings

Our data suggests interactions between microbiota composition, ROS and sperm DNA damage which may be implicated in the pathogenesis of recurrent miscarriage. Further studies are needed to determine if seminal microbiota play causal roles in RPL, and whether interventions modifying the seminal microbiome may modify pregnancy outcomes in affected couples

Trial registration number

not applicable

P–385 The relationship between systemic oestradiol and vaginal microbiota composition in miscarriage and normal pregnancy

Study question

Is there an association between serum oestradiol, vaginal microbial composition and pregnancy outcome in the early first trimester?

Summary answer

In women with a vaginal microbiome deplete of Lactobacillus species at the time of Pregnancy of Uncertain Viability (IPUV), higher serum oestradiol associates with livebirth.

What is known already

During pregnancy, oestradiol mediates vaginal mucosal properties and increases glycogen deposition in epithelial cells which is thought to support colonisation of Lactobacillus species. Low levels of Lactobacillus associates with adverse outcomes such as miscarriage and preterm birth. The direct relationship between systemic oestradiol and the vaginal microbiome has never been studied in pregnancy. However studies have shown a positive correlation between serum oestrone, vaginal glycogen and Lactobacillus abundance in menopausal women.

Study design, size, duration

This was a prospective cohort study where one-hundred women were recruited in early pregnancy at the time of IPUV and donated paired blood and vaginal samples. 40 women had an eventual miscarriage, 58 had a livebirth and two pregnancies were terminated. All 100 women donated one paired serum and vaginal sample at this time point, and 22 women with Lactobacillus depletion at the time of IPUV donated further longitudinal vaginal samples.

Participants/materials, setting, methods

Participants were recruited from an Early Pregnancy Unit and underwent transvaginal ultrasound assessment of their pregnancy. Serum samples were analysed with an immunoassay on a ROCHE COBAS E411 analyser for Oestradiol (pg/ml) and Progesterone (ng/ml). Bacterial DNA was extracted from paired vaginal swabs and sequenced using Illumina MiSeq sequencing of 16S rRNA gene amplicons.

Main results and the role of chance

Lactobacillus dominance of the vagina was associated with higher serum levels of E2 and progesterone compared to depletion (E2=398pg/ml vs 302pg/ml(p = 0.02), P4=23.1ng/ml vs 17ng/ml(p = 0.02)). E2 and P4 were positively correlated (r = 0.6, p < 0.05). At species level, L. crispatus dominance associated with significantly higher levels of E2 compared to high-diversity communities (468pg/ml vs 302pg/ml(p = 0.03) but no such relationship was observed for P4. Both E2 and P4 levels were lower in women who eventually miscarried. However there was no significant difference in the vaginal bacterial composition at genera or species level at this early gestational age (P = 0.08) regardless of per vaginal bleeding. However in women with Lactobacillus depleted microbiota, livebirth was associated with significantly higher E2 levels compared to women suffering miscarriage (212pg/ml in miscarriage vs 395pg/ml in livebirth, p = 0.003) (OR = 22.4 P = 0.004). In 22 women who had Lactobacillus depletion at the time of IPUV (7 with an eventual outcome of miscarriage, and 15 with an eventual outcome of livebirth), longitudinal vaginal bacterial DNA sequencing was performed. In 7/15 women with livebirth, and higher E2 levels, the microbial composition changed to become more Lactobacillus dominant during pregnancy, whereas in those with miscarriage, only 1/7 changed to become Lactobacillus dominant.

Limitations, reasons for caution

In this study, serum oestradiol levels were compared to the local vaginal bacterial environment. The ideal would be to study local vaginal oestradiol, glycogen and the bacterial composition.

Wider implications of the findings: In contrast to previous studies in menopause where low oestrogen levels associate with the vaginal microbial composition, this study uses the high oestradiol environment of early pregnancy to study the mechanistic relationship between oestradiol and vaginal Lactobacillus abundance.

Trial registration number

NA

Accuracy of digitization of bony landmarks for measuring change in scapular attitude

Digitizing bony landmarks is a common technique used to measure scapular position, but it has not been validated against a gold standard. The aim of this study was to determine the accuracy of this technique for four physiological arm movements using optoelectronic markers mounted on scapular bone pins as a gold standard. Eight subjects had bone pins inserted into their lateral scapular spine. Three points were digitized on the scapula with an optoelectronic probe: the medial root of the scapular spine, the posterolateral corner of the acromion, and the inferior angle of the scapula. The four active movements tested in this study were glenohumeral abduction, glenohumeral horizontal adduction, hand behind back, and forward reaching. The three bony landmarks were digitized six times in three different positions for each movement. Data from one subject were rejected secondary to pin loosening. The overall position-specific r.m.s. errors ranged from 2.0° to 12.5°. The full abduction position had considerably higher r.m.s. errors than the other positions (posterior tipping, 12.5°; upward rotation, 7.3°; internal rotation, 12.0°). It appears that the digitization of bony landmarks may be a valid method for measuring changes in scapular attitude with the following caveats: the full abduction position has a high r.m.s. error, and small scapular motions have high percentage errors.

The effects of proprioceptive or strength training on the neuromuscular function of the ACL reconstructed knee: a randomized clinical trial

OBJECTIVES

The purpose of this study was to determine the effects of a proprioceptive training program (PT) vs. a strength training (ST) program on neuromuscular function after anterior cruciate ligament (ACL) reconstruction. The second purpose was to establish the determinants of functional ability for the operated limb.

METHODS

Ten participants with unilateral ACL reconstructions were randomly assigned to one of the following 12-week training protocols: (1) isotonic ST, and (2) PT. The outcome measures were: (1) peak torque time of the hamstring muscles (PeakTT), (2) average concentric and eccentric torques of the quadriceps and hamstring muscles, (3) one-legged single hop for distance (SLHD), (4) one-legged time hop (TH), and (5) subjective scores.

RESULTS

: There was a significant group by time interaction effect for PeakTT (P = 0.017). The PT group demonstrated greater percent change in isokinetic torques than the ST group at the end of the 12 weeks (P < or = 0.05). Participants in both groups demonstrated similar significant gains in functional ability and subjective scores (P < or = 0.014). Quadriceps strength is a determinant of functional ability for the operated limb (R2 = 0.72).

CONCLUSIONS

: Both training protocols influenced PeakTT. The beneficial effects of ST on PeakTT appear to be load-dependent, while sufficient practice may be crucial in maintaining PeakTT improvements induced by PT. Proprioceptive training alone can induce isokinetic strength gains. Restoring and increasing quadriceps strength is essential to maximize functional ability of the operated knee joint.

Helping children to the other side of silence: a study of the impact of the stay safe programme on Irish children's disclosures of sexual victimization

OBJECTIVE

This study aimed to evaluate the effectiveness of a school based safety skills program--The Stay Safe Programme--in facilitating the disclosure of sexual abuse among sexually victimized children and adolescents in Dublin.

METHOD

A Cohort of 145 children who had participated in the Stay Safe Programme prior to their referral to a sexual abuse assessment unit were compared with a cohort of 443 children who had not participated in the prevention program on a range of disclosure related variables abstracted from case notes.

RESULTS

More Stay Safe participants, particularly female adolescents, made disclosures of suspected sexual abuse than non-participants. A higher rate of initial disclosure to teachers was made by Stay Safe participants and more teachers in schools participating in the Stay Safe Programme initiated referrals for evaluation of suspected child sexual abuse. Following assessment a higher rate of confirmed abuse occurred among Stay Safe participants and for these confirmed cases more Stay Safe participants made purposeful disclosures and in significantly more cases referral was due to the child telling someone about the abuse. These differences in disclosure between program participants and non-participants were unrelated to demographic factors or characteristics of the abuse.

CONCLUSIONS

The Stay Safe Programme was an effective secondary prevention intervention deserving widespread implementation.

Evaluation of the effectiveness of the stay safe primary prevention programme for child sexual abuse

OBJECTIVE

This child abuse prevention study aimed to evaluate the effectiveness of the Stay Safe Programme in training unscreened 7 and 10 year old children in personal safety skills. Subsidiary aims were to evaluate the program's impact on children's self-esteem and parents' and teachers' knowledge and attitudes of relevance to child abuse and protection.

METHOD

Changes in safety knowledge and skills and self-esteem of 339 children who participated in the Stay Safe Programme were compared with those of 388 waiting list controls. Children in the training group were also followed up at 3 months. In addition, the knowledge and attitudes of parents and teachers of children who completed the program were evaluated before and after the program and 5 month follow-up data were collected from teachers only.

RESULTS

Compared with waiting-list controls, trained children showed significant improvements in safety knowledge and skills and these gains were maintained at follow-up. The greatest gains were made by 7 year olds. Children who participated in the program also showed significant improvements in self-esteem which were maintained at 3 months follow-up but only the 7 year olds in the training group made significantly larger gains in self-esteem than their control group counterparts. Children with a higher socioeconomic status benefited more from the program than less privileged children. Both parents and teachers showed significant improvements in knowledge and attitudes concerning protection over the course of the program and for teachers, these gains were maintained at follow-up.

CONCLUSION

The findings suggest that the Stay Safe Programme was effective in training children in safety skills and so may usefully be used as a primary prevention intervention for child abuse.

Behavioral validation of the Childhood Anxiety Sensitivity Index in children

Examined the construct validity of the Childhood Anxiety Sensitivity Index (CASI) in young children through the use of a behavioral challenge task. Elementary-school children completed the CASI as well as self-report measures of state and trait anxiety and subjective fear prior to and immediately following a stair-stepping task designed to increase physiological arousal. Results indicate that the CASI was a significant predictor of the degree of state anxiety and subjective fear reported in response to the challenge task, even after controlling for pretask levels of state anxiety and fear, respectively. Additionally, the CASI predicted changes in fear experienced in response to the challenge task. The findings lend support to the validity of the CASI in preadolescent children and suggest that the CASI possesses unique clinical utility relative to measures of trait anxiety. However, results of this study must be interpreted cautiously, because a large portion of the variance in response to arousal was left unaccounted for by the CASI and the overall model.

Comparison of midazolam with propofol for sedation in outpatient bronchoscopy

We have compared sedation for fibreoptic bronchoscopy provided by incremental doses of midazolam with that provided by a computer-controlled infusion of propofol. These two methods were compared in terms of operator and patient acceptability, anxiolysis, effects on systolic arterial pressure and oxygen saturation. Tests were made also of memory and motor reactions, before and 60 min after the end of the procedure. Acceptability to operators and patients was high in both groups. There were no significant differences between the groups in systemic arterial pressure or anxiolysis. Oxygen saturation decreased in both groups (propofol group median 83% (range 69-95%); midazolam group median 86% (range 77-95%)) (ns). The median recovery time was 5 min (range 5-10 min) in the propofol group and 10 min (range 5-40 min) in the midazolam group (P < 0.01). Memory and motor reaction times 60 min after the end of the procedure did not differ from baseline in the propofol group, but were significantly impaired in the midazolam group.

An outbreak of isoniazid resistant tuberculosis in Glasgow 1981-1988

An increase in the number of patients attending the Victoria Infirmary, Glasgow with isoniazid resistant tuberculosis, prompted a survey of the incidence of the condition in Glasgow. There was a clustering of cases among the homeless and/or alcoholic population of the city, particularly between the years 1982 and 1986. This suggests an outbreak of isoniazid resistance among that population, probably spread from a single, but unidentified source.

Controlled-release theophylline in the treatment of nocturnal asthma

A total of 104 asthmatic patients with symptoms of asthma and/or a 'morning dip' in the peak expiratory flow rate (PEFR) who were receiving multiple therapies, including inhaled or oral steroids, were treated in addition once nightly with controlled-release theophylline in an 8-week double-blind, placebo-controlled cross-over study. Theophylline produced an improvement in symptoms of cough, wheeze, sleep disturbance and PEFR in the 73 completing patients compared to run-in and placebo treatment. Theophylline also produced an improvement in the forced expiratory volume in 1 s and forced vital capacity relative to baseline, and in the difference between actual and predicted PEFR values. Nausea was the most frequent side-effect but both patients' and investigator's global impressions of the effect of study medication were in favour of theophylline.

A rejoinder to "Exercise Programs for Patients with Post-Polio Syndrome: a case report"--a short communication

This communication is in response to the article by Michael T Gross and Charles P Schuch entitled "Exercise Programs for Patients with Post-Polio Syndrome: A Case Report" published in the January 1989 issue of Physical Therapy. The investigators examined the effects of a rigorous isokinetic training program on peak torque of the knee flexor and extensor muscles of a post-polio patient. The literature on post-polio syndrome, however, does not support the use of either conventional muscle strengthening regimens or rigorous isokinetic exercise programs in the management of post-polio syndrome. In addition, based on the observation that there was no appreciable increase in muscle strength in either the affected or the apparently unaffected leg, the investigators concluded that their rigorous exercise program was not deleterious. The lack of a normal training response, however, is consistent with bilateral muscle fatigue secondary to overuse rather than muscle weakness secondary to disuse. This result is consistent with the need for a balance between rest and low-intensity exercise, which will help to maintain or enhance function while slowing rather than hastening further deterioration. We hope that this rejoinder clarifies some of the misconceptions that may arise from the Gross and Schuch article and that physical therapists consider very carefully the rationale for any type of exercise program for post-polio patients.

Psoas abscess due to retroperitoneal tuberculous lymphadenopathy

A case of psoas abscess occurring during treatment of tuberculous lymphadenopathy is described. There was no evidence of a bony origin for this abscess. It appears likely that it arose from involved glands on the posterior abdominal wall.

Allo-anti-P1 in a P1-positive person

An allo-anti-P1 antibody is reported in an elderly Caucasian male with P1+ red cells. There was no suggestion that the antibody was causing haemolysis. The case suggests that a slight structural variation may exist in the patient's B antigen giving a serological false-positive response when typed with reagent anti-P1, or that the patient's anti-P1 is directed against a determinant absent in the patient's own antigen structure.

Factors influencing the occurrence of a late reaction to allergen challenge in atopic asthmatics

Thirty extrinsic asthmatics were challenged by inhalation with Dermatophagoides pteronyssinus extract. In twenty-four an immediate reaction was observed and in sixteen this was followed by a late reaction. Those with late reactions tended to have more severe asthma but did not report greater sensitivity to housedust mite. The occurrence of a late reaction was not related to the degree of airways obstruction before challenge or to the intensity of the immediate reaction. Patients in whom the early reaction was induced by a low dose of inhaled antigen were those most likely to develop a late response. Results of histamine challenge testing suggested that this greater sensitivity of the airway might in part be due to greater non-specific bronchial reactivity.

Site of airflow obstruction in immediate and late reactions to bronchial challenge with Dermatophagoides pteronyssinus

The density dependence of maximum flow in ten atopic asthmatics was assessed by response to breathing a helium-oxygen mixture. They were then subjected to bronchial challenge by Dermatophagoides pteronyssinus and density dependence re-assessed during early and late bronchial reactions. There was considerable individual variation in the density dependence before challenge and in the change in density dependence during induced bronchospasm. However, for any given individual the results were similar during early and late reactions. This suggests that the major site of airflow obstruction may vary from one asthmatic to another but that when antigen challenge is followed by a dual early and late reaction the site of obstruction is similar at each stage.

Pulmonary embolism--a long-term follow-up

Fifty-three patients without pre-existing cardiac or pulmonary disease were reviewed 5 to 9 years after angiographically proved pulmonary embolism. Ten of the 42 (24%) with an initial predisposing factor for embolism had died, including 6 from a previously diagnosed medical condition. In this group there was no significant residual disability among survivors and no late recurrence of embolism. By comparison, there were 6 deaths among the 11 in whom no predisposing factor was identified (55%), including 3 from neoplasm and 2 from recurrent embolism with cardiac failure.

The identification of a predisposing factor at the time of embolism was associated with a significantly better long-term prognosis.

Medical care for the homeless--some experience in Glasgow

The experience of running a medical clinic using voluntary help for the homeless is described. As a group they have limited access to normal medical channels despite high morbidity. In particular psychiatric illness, most frequently related to alcohol abuse, infestation, respiratory disease and problems due to poor foot care present commonly. No major administrative problems were encountered. The effects of such special arrangements for the homeless are assessed.