Can we predict adolescent cannabis use? A Bayesian semi-parametric approach to project future trends

Despite its decrease in many Western countries, cannabis remains the most used illicit substance among adolescents. This study aims to summarize cannabis consumption during the last two decades and project trends among 15-year-olds in the 2021-22 HBSC survey. A Bayesian semi-parametric hierarchical model was adopted to estimate the trend of cannabis consumption using data of about 287,000 adolescents from the 2001/2002 to the 2017/2018 HBSC wave and the 38 countries that met the inclusion criteria. Data show an overall decline in most countries for both boys and girls. However, in 22 countries of 38 cannabis use is expected to increase again in our projection. The discussion of these findings should take into account cultural, policy, social factors and unpredictable events such as the Covid-19 pandemic, that can significantly impact future trends leading to discrepancies between the projected and observed values. However, these discrepancies can provide insight into understanding the potential impact of preventive strategies and the underlying processes responsible for changes in cannabis use over time.

Giving Breath to Motor Neurons: Noninvasive Mechanical Ventilation Slows Disease Progression in Amyotrophic Lateral Sclerosis

OBJECTIVE

Noninvasive mechanical ventilation (NIMV) improves amyotrophic lateral sclerosis (ALS) quality of life and survival. However, data about its effect on disease progression are still lacking. Here, we test whether NIMV use changed the rate of functional decline among ALS patients.

METHODS

In this retrospective observational study, we included 448 ALS patients followed up at the ALS Center in Turin, Italy, who underwent NIMV during the disease course. The primary outcome was the change in functional decline after NIMV initiation adjusting for covariates. Functional decline was based on the nonrespiratory items of the Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS-R).

RESULTS

NIMV initiation resulted in a slower functional decline (mean improvement = 0.16 points per month, 95% confidence interval = 0.12-0.19, p < 0.001), with consistent effects observed across various demographic factors, including sex, age at diagnosis, and disease duration before NIMV initiation. This finding was replicated using the PRO-ACT (Pooled Resource Open-Access ALS Clinical Trials) dataset. The favorable impact of NIMV on ALSFRS-R progression was evident independently of disease stages. Notably, NIMV benefits were not dose-dependent but were particularly prominent for nighttime respiratory support.

INTERPRETATION

NIMV significantly influences the rate of motor progression in ALS, and this effect is not determined by the nonlinearity of ALSFRS-R trajectory. The functional decline slowed following NIMV initiation, independently of the site of disease onset or disease severity at the time of NIMV initiation. Our findings underscore the importance of timely NIMV initiation for all ALS patients and highlight the need to consider NIMV-induced slowing of disease progression when evaluating clinical trial outcomes. ANN NEUROL 2024;95:817-822.

Effects of Levetiracetam and Lacosamide on survival and seizure control in IDH-wild type glioblastoma during temozolomide plus radiation adjuvant therapy

Introduction

There are no clear indications for the best choice of anti-seizure medications to control brain tumor related epilepsy. In vitro studies have shown an antitumoral effect of Levetiracetam and Lacosamide on glioblastoma IDH-wild type.

Research question

This study investigates whether the use of levetiracetam and/or lacosamide impacts survival rates. The secondary aim was to evaluate the efficacy of both ASMs in controlling seizures.

Materials and methods

In this observational retrospective single-cohort study, patients underwent chemoradiation protocol after GBM surgery. They were grouped as follows: (1) use of levetiracetam, (2) use of lacosamide, (3) simultaneous use of levetiracetam and lacosamide, (4) no ASM usage. Survival curves were plotted using the Kaplan-Meier method coupled with a log-rank test for difference assesments. To evaluate the pharmacological efficacy of post-operative seizure control, a negative binomial regression was conducted.

Results

The study included 272 patients, 174 of which underwent adjuvant chemoradiation treatment. Patients without ASM therapy had a non-significant longer median OS (compared to the other groups (log-rank = 0.37). The IRR of seizure relapse was 2.57 (p = 0.007) times higher in lacosamide users, and MGMT promoter methylation demonstrated a protective effect against postoperative seizure onset (p = 0.05), regardless of the aforementioned confounding factors.

Discussion and conclusions

In patients diagnosed with GBM IDH-WT undergoing chemoradiation therapy, the use of levetiracetam or lacosamide for controlling BTRE does not seem to modify survival. Lacosamide users exhibited a higher IRR of postoperative seizures compared to levetiracetam users, and MGMT promoter methylation appears to be a protective factor.

Risk Behaviors among Migrant Adolescents in Italy

Adolescence is a critical period for engaging in health risk behaviors. Migrant adolescents may face unique challenges due to acculturation stress. This study aims to monitor substance use and problem gambling among migrant adolescents living in Italy. Data from the 2017/18 Health Behavior in School-Aged Children survey in Italy were analyzed. The 18,794 participants included 15-year-olds, categorized as native or migrants, with ethnic backgrounds from Western, Eastern European, or non-Western/non-European countries. Girls had higher smoking rates, while boys exhibited higher prevalence of alcohol-related risk behaviors, cannabis use, and gambling. Boys from Eastern European countries displayed a greater risk of drunkenness (OR: 1.58, 95% CI: 1.06-2.37), particularly in the first generation, while those from Western countries showed a higher risk of multiple substance use (OR: 1.44, 95% CI: 1.05-1.96). Girls from Eastern European and non-Western/non-European countries had a lower risk of alcohol consumption (OR: 0.50, 95% CI: 0.29-0.85; OR: 0.55, 95% CI: 0.33-0.91, respectively). Finally, boys, especially those from Eastern European and non-Western/non-European countries, had a significantly higher risk of problem gambling (OR: 1.83, 95% CI: 1.04-3.22; OR: 2.10, 95% CI: 1.29-3.42, respectively). This disparity was more pronounced in the first generation, possibly due to acculturation challenges and socio-economic factors. Risk behaviors in adolescents are influenced by complex interplays of gender, cultural factors, and migration generation. Preventive strategies should consider these factors to effectively address substance use and gambling in this heterogeneous population.

Who Stays, Who Moves on and the Host Population: A Picture of Adolescents' Perceived Well-Being and Risk Behaviours

The study aims to evaluate the health profile of first- and second-generation Romanian immigrants living in Italy compared to their adolescent peers in the country of origin (Romania) and the host population (Italian-borns). Analyses were performed on the 2013/2014 Health Behaviour in School-aged Children (HBSC) survey data. Romanian natives showed lower levels of health complaints and higher life satisfaction than Romanian migrants, who were similar to the host population, especially the second-generation ones. A comparable prevalence of being bullied was registered among Romanians, both native and immigrant, with significantly lower levels among Italian natives. Bullying others showed the second-generation migrants share a similar prevalence with the host population. The prevalence of liking school a lot was three times higher among the Romanian natives than among their peers living in Italy. Thanks to the HBSC data, this study is the first to examine the health of adolescent migrants from both the perspective of the host country and the population of origin. The results highlight the need for a more nuanced approach to studying immigrant populations, taking into account both the host country's perspective and the health patterns of the population of origin.

Suicide spectrum among young people during the COVID-19 pandemic: A systematic review and meta-analysis

BACKGROUND

There are concerns that suicidal behaviors are arising among adolescents. The COVID-19 pandemic could have worsened the picture, however, studies on this topic reported contrasting results. This work aimed to summarise findings from the worldwide emerging literature on the rates of suicidality among young people during the COVID-19 pandemic.

METHODS

A systematic review and meta-analysis were performed, searching five electronic databases for studies published from January 1, 2020 until July 27, 2022. Studies reporting rates for each of the three considered outcomes (suicide, suicidal behaviors, and suicidal ideation) among young people under 19 years old during the COVID-19 pandemic were included. Random-effects meta-analyses were conducted, and the intra-study risk of bias was assessed. When pre-COVID-19 data were available, incidence rate ratio (IRR) and prevalence ratio (PR) estimates were calculated between the two periods. All the analyses were performed according to the setting explored: general population, emergency department (ED), and psychiatric services. The review protocol was registered on PROSPERO (CRD42022308014).

FINDINGS

Forty-seven observational studies were selected for more than 65 million subjects. The results of the meta-analysis showed a pooled annual incidence rate of suicides of 4.9 cases/100,000 during 2020, accounting for a non-statistically significant increase of 10% compared to 2019 (IRR 1.10, 95% CI: 0.94-1.29). The suicidal behaviors pooled prevalence during the COVID-19 pandemic was higher in the psychiatric setting (25%; 95% CI: 17-36%) than in the general population (3%; 1-13%) and ED (1%; 0-9%). The pooled rate of suicidal ideation was 17% in the general population (11-25%), 36% in psychiatric setting (20-56%) and 2% in ED (0-12%). The heterogeneity level was over 97% for both outcomes in all settings considered. The comparison between before and during COVID-19 periods highlighted a non-statistically significant upward trend in suicidal behaviors among the general population and in ED setting. The only significant increase was found for suicidal ideation in psychiatric setting among studies conducted in 2021 (PR 1.15; 95% CI: 1.04-1.27), not observed exploring 2020 alone.

INTERPRETATION

During the pandemic, suicide spectrum issues seemed to follow the known pattern described in previous studies, with higher rates of suicidal ideation than of suicidal behaviors and suicide events. Governments and other stakeholders should be mindful that youth may have unique risks at the outset of large disasters like the COVID-19 pandemic and proactive steps are necessary to address the needs of youth to mitigate those risks.

FUNDING

The present study was funded by the University of Torino (CHAL_RILO_21_01).

Risk behaviors among migrant adolescents in Italy

Background

Over the last decade, the student population migrated to Italy has quadrupled, but studies on their potentially harmful behaviors such as substance use are still scarce. The aim of this research is to monitor risk behaviors among migrant adolescents in Italy and provide appropriate indications for the definition of targeted policies and interventions.

Methods

A representative sample of 15 year-old adolescents was drawn from the 2018 Italian Health Behavior in School-aged Children (HBSC) survey data. Smoking habits, alcohol consumption and drunkenness were investigated and differences with Italian peers were assessed.

Findings

Results were based on more than 18,500 students, of which 16% were migrants: 32.7% from Western countries (We), 32.5% from Eastern European countries (Ee), and 34.8% from non-Western/non-European countries (nW). Compared with natives, students from nW countries showed a lower risk of smoking habits (OR: 0.72, 95%CI: 0.58-0.89) and weekly alcohol consumption (OR:0.57, 95%CI:0.43-0.75), whereas drunkenness was more prevalent among Ee migrants (OR: 1.42, 95%CI: 1.10-1.83). Overall, both migrant and Italian girls showed a lower risk of unhealthy behaviors than boys.

Conclusions

Compared to the native counterparts, migrant adolescents showed differences in substance use according to their ethnic background. We observed two different immigration patterns: the Western immigrants, who came from countries with higher affluence and share similar risk behaviors with native peers, and non-Western immigrants, who came from less affluent countries and seemed to maintain the risk behaviors of their culture of origin.

Key messages

Suicidality among children and adolescents “in the COVID-19 era”: a worldwide metanalytic picture

Background

The impact of the COVID-19 pandemic on adolescent suicidality is still controversial. The present systematic review and meta analysis aim to summarise findings from emerging literature about prevalences of the main suicidal outcomes among children and adolescents under 19 years old, and to compare them with the pre-pandemic period.

Methods

Five databases (PubMed, Embase, Scopus, CINAHL and Web of Science) were systematically searched for studies published in English from January 1st, 2020 until November 3rd, 2021, reporting prevalence for suicidal ideation (SI), suicidal behaviors (SB) and suicide (S) in the general population aged <19 during the COVID-19 pandemic. Single-study prevalence data were pooled using random-effects meta-analysis. If studies reported prevalence estimates for both pre- and during-pandemic periods, prevalence ratio (PR) comparing the two periods has been computed and pooled.

Results

Sixteen observational studies were selected: 10 about SI, 9 about SB and 3 about S. During the pandemic, prevalence of SI among adolescents was 21% (95% CI 12-34%) while prevalence of SB was 3% (95% CI 1-10%). Comparing pre- and during- pandemic prevalences, a significant overall increase in SB was observed (PR 1.35; 95% CI 1.06-1.72) while the prevalence rates of SI remained substantially steady (PR 0.95; 95% CI 0.64-1.39). A narrative review on the population-based data on suicide rates suggested an escalating trend since Summer 2020, after an initial stability of the phenomenon.

Conclusions

During the COVID-19 pandemic SB showed a 35% increase and suicides rates escalated after a initial stability. School closures might be involved, representing an initial protective factor for suicidality, while after the reopenings we could have assisted to a suicide rebound, especially among the most vulnerable young people.

Key messages

• The topic of suicidality among young people is still affected by a cultural stigma that hampers the development of both academic research, early detection and preventive policies.

• The increase in suicidal behaviors among youths after the COVID-19 outbreak highlights a major public health issue that requires adequate supporting policies to control and prevent this phenomenon.

The impact of conscientious objection on voluntary abortion in Italy in the last two decades

Background

Italian Law 194/1978 legalized voluntary abortion during the first 90 days of pregnancy. Healthcare professionals can claim conscientious objection (CO), but regional governments must guarantee women's rights. In recent years, international human rights authorities argued that access to safe abortion was limited in Italy due to widespread CO.

Methods

An ecological study was conducted using 1997-2019 ministerial data on the number of gynecologists registered as conscientious objectors, the proportion of abortions performed timely (within 14 days of the request), and within 8-10 weeks of pregnancy. The extra workload for non-objecting gynecologists was calculated as the ratio between the workload for non-objectors and the (theoretical) workload for each gynecologist on duty. The correlation between the extra workload for non-objectors and the proportion of abortions performed within 14 days of the request or beyond 21, as well as the correlation between waiting time and gestational age at the time of the procedure. Data were analyzed for Italy and stratified for its 21 Regions.

Results

CO among gynecologists turned out to be stable around an average of 70% (median 69%, IQR 64-71%) in the last decades, with 62% of abortions performed within 14 days and 82% of procedures performed by the 10th week of pregnancy. In 13 regions (statistically significant in 5) the increase in workload for non-objectors was inversely correlated with abortions performed within 14 days, and directly correlated with those performed later than 21 days. In all regions (statistically significant in 18) a direct correlation was found between procedures performed timely and those performed within 8 weeks of pregnancy.

Conclusions

Data from the last 20 years confirm previous findings and CO still seems to have a strong impact on women's right to access safe and timely abortion in Italy. More efforts are needed to narrow the gap between the provisions of the law and its implementation.

Key messages

• A high proportion of objecting staff makes it difficult to guarantee women’s rights to access timely and safe abortion.

• Effective organizational strategies and a proper legal framework are needed to cope with the high percentage of conscientious objectors among health professionals.

Temporal trends of suicidality among adolescents in the last decade in Piedmont, Northwestern Italy

Background

Over the last decade, trends of suicidality among adolescents remain unclear. We conducted a cross-sectional study using surveillance data collected over the past 10 years in the Piedmont region, Italy, to explore temporal trends in suicidality among hospitalized adolescents.

Methods

This was a retrospective study over an 11-year period of time. The target cohort was adolescents aged 13-19 discharged from inpatient/day-hospital care with at least one suicidality-related ICD9-CM code (i.e., suicidal ideation-SI, suicidal risk-SR and suspected suicide-SS) between 2011 and 2021 in Piedmont (Northwestern Italy). Social-economic related data is available from Census 2011. Yearly incidence rates (IR) were calculated based on the overall hospitals’ catchment population and by sex. Poisson regression model was estimated to evaluate the trend over time and the association with sex, and a potential effect of the COVID-19 pandemic. A non-linear trend was allowed by modelling natural splines.

Results

We included 490 adolescents (median age: 15 years, IQR: 13-16), 380 girls and 110 boys, with ICD9-CM codes for SI (264; 53.9%), SR (142; 29%), SS (90; 18.4%) at first discharge. Girls showed a higher risk of repeated inpatient care than boys (19.2% vs 7.3%, p < 0.01). Since 2013, yearly suicidality IRs started increasing linearly in boys (+1.7/100,000 per year, 95%CI: 0.7-2.8). Apparently, suicidality IRs increasing in girls were observed since 2011 (+5.8/100,000 per year, 95%CI 2.8-8.9) and were significantly higher than in boys (p < 0.001).

Conclusions

Suicidality among young inpatients increased in Piedmont during the last decade. Females seemed to be more affected than males. Further research is needed to better understand gender-related risk factors for suicidality.

Key messages

• There has been an increase in the number of adolescents reporting suicidal ideation in the last decade, especially in girls.

• Intervention strategies are urgently needed to reverse a potentially alarming trend in suicidality among young people.

Headless spermatozoa in fertile men

Headless or unucleated spermatozoa were evaluated in semen specimens of 52 fertile men in order to investigate the frequency and the percentage of this morphological abnormality and to estimate the probable correlation of the abnormality with other semen parameters, since there are no available data. The only sperm parameter which correlated with the number of headless spermatozoa was the number of micro round-headed spermatozoa (r= + 0.4432, P<0.001). It is concluded that the high frequency of headless or unucleated spermatozoa in the semen specimens of fertile men, albeit in low percentage, does not seem to have any biological significance. Moreover headless and round-headed spermatozoa could be the outcome of the same pathogenetic mechanism.

Increased levels of human placental growth hormone in the amniotic fluid of pregnancies affected by Down syndrome

OBJECTIVE

To evaluate the concentrations of human placental growth hormone (hPGH) in amniotic fluid (AF) at gestational mid-trimester in normal pregnancies and in pregnancies complicated by Down's syndrome.

DESIGN

AF samples from 21 women with Down's syndrome pregnancies were analyzed retrospectively. About 47 AF samples from women with singleton, uncomplicated pregnancies, who gave birth to healthy neonates with birth weight appropriate for gestational age were used as controls. All AF samples were obtained during amniocentesis for fetal karyotyping at 16-23 weeks' gestation. hPGH levels were measured by a solid phase immunoradiometric assay using two different epitopes.

RESULTS

The mean hPGH values in the AF of the Down's syndrome-affected pregnancies were significantly higher (P<0.05) compared to those of normal pregnancies, at 16-23 weeks' gestation: mean-value+/-SD in the AF was 1.96+/-1.35 microg/l vs. 0.82+/-0.67 microg/l.

CONCLUSIONS

Higher hPGH levels in AF were found in pregnancies affected by Down's syndrome as compared to normal pregnancies at gestational mid-trimester. hPGH was detected in all AF samples, and it provides evidence that this pregnancy-specific hormone enters the fetal compartment and is not limited to the maternal circulation. The physiological role and effect of hPGH on fetal growth in normal and pathological pregnancies needs further investigation.

Hydrops fetalis, thickened placenta and other sonographic findings in a low-level trisomy 21 mosaicism: a case report

We report a case of trisomy 21 mosaicism detected upon amniocentesis in a 36-year-old woman. Ultrasound examination at 23 weeks' gestation showed a fetus with hydrops, pulmonary hypoplasia, oligohydramnios, thickened placenta, and intrauterine growth retardation. Cytogenetic analysis revealed low-percentage (6%) mosaicism for trisomy 21. Hydrops fetalis and thickened placenta are uncommon findings in fetuses affected by trisomy 21 mosaicism. A short review of the literature is given regarding the sonographic findings associated with trisomy 21 mosaicism, and the genetic counseling in such cases.

A stillborn fetus with amniotic band syndrome and elevated levels of alpha-fetoprotein plus beta-human chorionic gonadotropin: a case report

Amniotic band syndrome is an uncommon, congenital fetal abnormality with multiple disfiguring and disabling manifestations. A wide spectrum of clinical deformities are encountered and range from simple ring constrictions to major craniofacial and visceral defects. We report a case of constriction amniotic bands involving upper extremities and intrauterine fetal death due to strangulation of umbilical cord. Abnormally elevated levels of alpha-fetoprotein and beta-chorionic gonadotropin were detected at 17 weeks' gestation. They were probably caused by the loss of cutaneous integrity of the fetus (alpha-fetoprotein), and by the placental attempt to counteract the fetal growth restriction and hypoxia, due to the strangulation of umbilical cord by the amniotic bands (beta-chorionic gonadotropin).

Intraabdominal umbilical vein dilatation and term delivery. A case report and review of the literature

Dilatation of the fetal umbilical vein is a rare, most commonly isolated finding. Approximately 100 cases have been reported in the literature that describe different management approaches, especially regarding the time of delivery. We present a new case of umbilical vein dilatation diagnosed at 23 weeks' gestation as an isolated sonographic finding, in a fetus with short umbilical cord, delivered at 38 weeks' gestation. The clinical and sonographic features as well as the management options of this uncommon condition are shortly discussed.

Medically assisted human reproduction: the Greek view

Medically assisted human reproduction is a controversial issue that has attracted heated debate over the last two decades. In December 2002 the Greek Parliament passed a law with major social and scientific impact: the Medically Assisted Human Reproduction Act 3089/02. This law establishes the parameters of so-called surrogate motherhood, protects the anonymity of semen donors and sets the legal framework through which a woman's artificial fertilization after her husband's death is allowed. This article aims to discuss the legal ramifications of medically assisted human reproduction and especially the moral and social issues concerning the introduction of surrogate motherhood in Greece.

A randomized comparison between intravaginal misoprostol and prostaglandin E2 for labor induction

OBJECTIVE

The aim of this randomized study was to compare the effectiveness, safety, and side effects of 6 h vaginal misoprostol versus vaginal prostaglandin E(2) (PGE(2)) for labor induction.

STUDY DESIGN

Fifty microgram of misoprostol was given intravaginally in the misoprostol group (204 women), and 3 mg PGE(2) was given intravaginally in the PGE(2) group (211 women). In both groups, the dose was repeated every 6 h for a maximum of three doses, until active labor was achieved. Artificial rupture of membranes and oxytocin infusion was used during labor in both groups where it was indicated.

RESULTS

The mean interval from the institution of labor induction to delivery was 11.3 +/- 8.6 h for the misoprostol group, and 15.7 +/- 9.3 h for PGE(2 )group (P < 0.05). In the misoprostol group, oxytocin was used less frequently, but there was a higher prevalence of tachysystole. No statistically significant differences were observed between the two groups as regard abnormal patterns of fetal heart rate, the mode of delivery, and the need for neonatal intervention.

CONCLUSION

In conclusion, the intravaginal administration of 50 mug misoprostol at 6 h interval (maximum three doses) is comparable in safety, but more effective for induction of labor than 3 mg intravaginal PGE(2).

Increased human placental growth hormone at midtrimester pregnancies may be an index of intrauterine growth retardation related to preeclampsia

OBJECTIVE

To evaluate the relationship between maternal serum and amniotic fluid levels of human Placental Growth Hormone (hPGH) with the fetal intrauterine growth retardation (IUGR) related to preeclampsia.

DESIGN

We analyzed samples in pairs of serum and amniotic fluid retrospectively from 25 women, who manifested preeclampsia and IUGR in the late second or the third trimester of gestation. The samples were obtained at 16-22 weeks' gestation during amniocentesis for fetal karyotyping. At this time, there was no clinical or sonographic evidence of preeclampsia or IUGR, respectively. Sixty-two serum samples were used as controls which were obtained at 16-22 weeks' gestation from women with singleton, uncomplicated pregnancies, with normal outcome, and appropriate for gestational age neonatal birth weight. Forty-seven amniotic fluid samples were also used as controls which were obtained at 16-22 weeks' gestation from the women that were included in the control group who underwent an amniocentesis. hPGH levels were measured by a solid phase immunoradiometric assay.

RESULTS

The mean hPGH values in the serum and the amniotic fluid of the IUGR related to preeclampsia affected pregnancies were significantly higher (P<0.05) than those of the normal pregnancies at 16-22 weeks' gestation: mean+/-SD in the serum was 13.16+/-10.52 ng/ml vs. 4.39+/-2.23 ng/ml; mean+/-SD in the amniotic fluid 2.49+/-1.6 ng/ml vs. 0.82+/-0.67 ng/ml.

CONCLUSION

hPGH levels in maternal serum and amniotic fluid were found to be higher at 16-22 weeks' gestation in pregnancies that will be complicated subsequently by IUGR related to preeclampsia. Our findings suggest that the evaluation of the changes of hPGH levels at midtrimester should be further investigated for the possibility to provide a potential predictive index of IUGR and preeclampsia.

Changes in maternal plasma levels of VEGF, bFGF, TGF-beta1, ET-1 and sKL during uncomplicated pregnancy, hypertensive pregnancy and gestational diabetes

BACKGROUND

Vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), transforming growth factor-beta1 (TGF-beta1), endothelin-1 (ET-1) and soluble c-kit ligand (sKL) are cytokines involved in embryogenesis.

MATERIALS AND METHODS

Maternal plasma cytokines were measured with ELISA during the three trimesters of gestation and on the day of delivery in 93 pregnant women and 18 age-matched non-pregnant control women.

RESULTS

The VEGF and bFGF levels increased during the first trimester and declined thereafter, but they remained above the controls' values until delivery. The TGF-beta1 levels increased during the first trimester and remained unchanged thereafter. On the contrary, the ET-1 levels decreased and remained low until delivery. VEGF, bFGF, TGF-beta1 and ET-1 were increased in hypertensive pregnancy. Except for ET-1, these cytokines were also increased in gestational diabetes. No changes in plasma sKL were documented.

CONCLUSION

All the aforementioned cytokines play a role in uncomplicated pregnancy, whereas hypertensive pregnancy is causatively-related with increased ET-1.

A case report of recurrent anencephaly and literature review

Anencephaly is a rare congenital anomaly in which the forebrain, meninges, vault of the skull, and scalp all fail to form. We report a case of a 32-year-old gravida 2 woman with an anencephalic fetus detected at the 21st gestational week. She had a history of an intrauterine fetal death of an anencephalic fetus at the 20th gestational week two years before. We present the case and briefly review the literature.

Prenatal diagnosis of hypochondroplasia: Report of two cases

Hypochondroplasia (HCH) is an autosomal dominant skeletal dysplasia characterized by short extremities, short stature and lumbar lordosis, usually exhibiting a phenotype similar to but milder than achondroplasia (ACH). Mutations in the fibroblast growth factor receptor 3 (FGFR3) gene are present in a significant proportion of HCH patients. Reports of prenatal diagnosis of HCH are very rare and the phenotype/genotype correlation in these patients is poor. Here we present two sporadic cases with second trimester ultrasound findings consistent with a diagnosis of a non-lethal skeletal dysplasia. Ultrasound evaluation after 23 weeks of gestation showed a decreased rate of development of the femora (femur length <fifth centile), while biparietal diameter, abdominal circumference, and foot length were within normal limits. Femur length/foot and femur length/abdominal circumference ratios were <0.87 and <0.18, respectively. Prenatal cytogenetic and molecular genetic analysis was performed. Karyotype was normal and FGFR3 G380R mutation characteristic of ACH was excluded in both fetuses. Molecular genetic analysis carried out retrospectively revealed that both fetuses were heterozygous for the C1620A mutation resulting in N540K substitution in FGFR3, the most common mutation in HCH. We conclude that the combination of ultrasound and molecular genetic approach is helpful for establishing an accurate diagnosis of HCH in utero and subsequently for appropriate genetic counseling and perinatal management.

Contraception during perimenopause

Perimenopause marks the transition from normal ovulation to anovulation and ultimately to permanent loss of ovarian function. Fecundity, the average monthly probability of conception, declines by half as early as the mid-forties, however women during the perimenopause still need effective contraception. Issues arising at this period such as menstrual cycle abnormalities, vasomotor instability, the need for osteoporosis and cardiovascular disease prevention, as well as the increased risk of gynecological cancer, should be taken into consideration before the initiation of a specific method of contraception. Various contraceptive options may be offered to perimenopausal women, including oral contraceptives, tubal ligation, intrauterine devices, barrier methods, hormonal injectables and implants. Recently, new methods of contraception have been introduced presenting high efficacy rates and minor side-effects, such as the monthly injectable system, the contraceptive vaginal ring and the transdermal contraceptive system. However, these new methods have to be further tested in perimenopausal women, and more definite data are required to confirm their advantages as effective contraceptive alternatives in this specific age group. The use of the various contraceptive methods during perimenopause holds special benefits and risks that should be carefully balanced, after a thorough consultation and according to each woman's contraceptive needs.

The efficacy and tolerability of iron protein succinylate in the treatment of iron-deficiency anemia in pregnancy

The aim of this study was to evaluate the efficacy and tolerability of iron protein succinylate in the treatment of iron-deficiency anemia in pregnancy. One hundred and thirty anemic pregnant women were studied. Inclusion criteria were iron-deficiency type of anemia, and hemoglobin levels below of 11.5, 10.9 and 10.3 g/dl for the three trimesters of pregnancy, respectively. Twenty-five women who presented pregnancy-related complications were excluded during treatment. The remaining 105 were treated with 1600-mg iron protein succinylate per os daily for a period of four months. A group of anemia-related clinical signs and symptoms, and hematological parameters were recorded at the beginning of treatment, as well as two and four months later. They included epidermis and mucosal paleness, skin and nail lesions, glossitis, heart pulse, sickness, anorexia, apathy, ataxia, polypnea, insomnia, nervousness, paresthesias and other neurological symptoms; the hematological parameters included Hgb, hct, RBCs, WBCs, MCV, MCH, MCHC, PLTs, serum Fe and ferritin. Possible side or adverse effects were considered during treatment. The majority of symptoms and signs of anemia were gradually improved. There was a statistically significant increase in the means of Hgb, hct, WBCs, MCV, MCH, PLTs and serum ferritin (p < 0.05). Anemia was effectively treated in 100/105 (95.2%) women, but not in five patients (4.8%) who displayed poor compliance to the therapeutic protocol. There were transient and mild side-effects in seven (6.6%) treated women, namely diarrhea, epigastralgia, vomiting, and nausea, which however, did not necessitate discontinuation of the therapeutic protocol. Iron protein succinylate is an effective and well tolerated treatment of iron-deficiency anemia in pregnancy.

Benign struma ovarii complicating pregnancy: a case report and review of the literature

INTRODUCTION

Struma ovarii is a type of mature ovarian teratoma consisting mainly of thyroid tissue. The rarity of this tumor in pregnancy and the risk of malignancy make difficult the diagnosis and the management.

CASE REPORT

We report a case of benign struma ovarii initially detected as an ovarian mass at the first trimester of pregnancy.

Effects of doxycycline, metronidazole and their combination on Candida species colonization of the human oropharynx, intestinal lumen and vagina

The present study reports about the effect of doxycycline and/or metronidazole on colonization by Candida organisms of the human gastrointestinal (GI), oropharyngeal tract and vagina. Treatment with doxycycline or metronidazole for 10 days increased, but not significantly, the GI, oropharyngeal or vaginal colonization by Candida species. The combination of doxycycline and metronidazole, used for the same period, caused a significant increase of 2.5 log10 CFU/g of stools (mean) colonization by Candida. Likewise, 2 out of 9 patients treated with the combination had substantially increased colonization of their vagina by Candida species. This effect, however, could not be expressed statistically due to the semiquantitative nature of the vaginal cultures. In contrast, the combination did not increase oropharyngeal colonization. In conclusion, doxycycline and metronidazole as monotherapies, did not increase significantly Candida colonization in the cavities examined. The combination of doxycycline and metronidazole had a substantial effect, increasing the GI and vaginal colonization by Candida organisms.

Reduced expression of corticotropin-releasing hormone receptor type-1 alpha in human preeclamptic and growth-restricted placentas

Placentally derived CRH seems to play a major role in the mechanisms controlling human pregnancy and parturition, via activation of specific receptors widespread in reproductive tissues. In the human placenta, CRH seems to modulate vasodilation, prostaglandin production, and ACTH secretion. It has also been suggested that CRH might act as a placental clock, determining the length of gestation. In addition, maternal plasma CRH concentrations are further elevated in pregnancies associated with abnormal placental function, such as preeclampsia and intrauterine growth retardation (IUGR). In this study, we sought to investigate the expression of CRH-R1 alpha levels in placentas from women who have undergone normal deliveries (control group) and patients who have been diagnosed as having preeclampsia or IUGR. Results showed that placental CRH-R1 alpha mRNA levels (as shown by quantitative RT-PCR) and protein levels (shown by Western blotting analysis) were significantly (P < 0.05) reduced in all of the complicated pregnancies. In contrast, levels of the angiotensin II receptor were elevated in preeclampsia and reduced in IUGR subjects, as shown by RT-PCR and Western blotting analysis. These findings might suggest that changes in receptor expression may contribute toward dysregulation of the dynamic balance controlling vascular resistance.

Bcl-2 and Bax expression in human endometriotic and adenomyotic tissues

OBJECTIVE

To determine the Bcl-2 and Bax expressions in endometriotic and adenomyotic tissues. In addition, to evaluate the Bcl-2/Bax status during the menstrual cycle in these tissues.

METHODS

A total of 56 women were retrospectively recruited from a University hospital setting. A total of 25 had endometriosis and 31 adenomyosis. Tissue samples were collected during gynaecological surgery and confirmed by histology to have endometriosis or adenomyosis. Bcl-2 and Bax expressions were investigated on 56 formalin-fixed and paraffin-embedded tissue by immunohistochemical staining and electron microscopy.

RESULTS

The difference of Bcl-2-positive protein between endometriosis and adenomyosis was not significant. No significant difference was found between Bcl-2 expression and the proliferative and secretory phase of the cycle in women with endometriosis, but this comparison was highly significant (P<0.001) in women with adenomyosis. The difference of Bax-positive protein between endometriosis and adenomyosis was not significant. In addition, no significant differences were found between the various phases of the cycle. We have found a stronger inverse correlation between the expression of Bcl-2 and Bax in endometriosis than in adenomyosis.

CONCLUSIONS

Our results suggest that the pathogenesis of ovarian endometriosis may be different from that of adenomyosis and the persistence of Bcl-2 and Bax expressions during both phases of the cycle in ovarian endometriotic tissues may have important implications for the survival and proliferation of the ectopic endometrial tissue.

In vitro optical characterization and discrimination of female breast tissue during near infrared femtosecond laser pulses propagation

Ultrashort infrared laser pulses were transmitted through excised female breast tissue. The resulted signal was recorded by a streak camera with a time resolution of the order of a few ps. Experimental data of the temporal spread of the ultrashort pulse during the transmission through the tissue have been analyzed using the Patterson analytical expression derived from the diffusion theory. This resulted in the calculation of the absorption and reduced scattering coefficients, which are related to the optical characteristics of each type of tissue. The goal of the study was to use the theoretical values of the coefficients to discriminate different kinds of tissue.

Detection of interleukin-6, interleukin-8, and interleukin-11 in plasma from women with spontaneous abortion

OBJECTIVE

To investigate the role of IL-6, IL-8, and IL-11 in the immune-regulatory mechanisms involved in the spontaneous abortion of the first trimester of pregnancy.

STUDY DESIGN

Plasma levels of IL-6, IL-8, and IL-11 were determined in 68 women who had a spontaneous abortion of unknown aetiology during the first trimester of pregnancy. They were compared with the corresponding levels of 73 age-matched pregnant women who had an uneventful pregnancy, and 52 age-matched non-pregnant women. All enrolled women presented without any severe disease, syndrome or recent infection. Cytokine levels were measured by a sensitive sandwich enzyme-linked immunoassay.

RESULTS

The women with spontaneous abortion had significantly decreased plasma levels of IL-6, IL-8 and IL-11 compared to those with normal pregnancies (P<0.05). The non-pregnant women had no detectable cytokine levels.

CONCLUSIONS

The reduced plasma levels of IL-6, IL-8 and IL-11 in women with spontaneous abortion may be related to the underlying aetiopathogenetic mechanisms, however, there is no sufficient evidence for their use as predictive markers of pregnancy outcome.

Genital tuberculosis can present as disseminated ovarian carcinoma with ascites and raised Ca-125: a case report

In women with an adnexal mass, ascites and elevated Ca-125 levels, ovarian carcinoma must be ruled out. However, several other conditions, including genital tuberculosis, may present similarly. A 41-year-old woman with weight loss, ascites and elevated levels of Ca-125 was evaluated for ovarian cancer. Computerized tomography revealed an adnexal mass, ascites and lymph nodes on the peritoneal surface. Paracentesis of the ascitic fluid revealed a lymphocytic exudate but failed to show any malignant cells. At laparotomy, frozen sections of tissue biopsies were negative for malignancy; however, a total hysterectomy plus adnexectomy was performed. Postoperatively histologic examination revealed typical features of genital tuberculosis. Antituberculosis treatment was effectively given to the patient. Serum levels of Ca-125 were undetectable 12 weeks after treatment. In conclusion, genital tuberculosis can be misdiagnosed and confused with ovarian cancer. Intraperitoneal tuberculosis should be considered in the differential diagnosis in cases in which ovarian cancer is suspected, even when malignancy-associated risk factors are present.

Microsatellite analysis provides efficient confirmation of fetal trophoblast isolation from maternal circulation

Fetal trophoblasts can be found in maternal circulation from an early stage of pregnancy and thus provide a potential source of DNA for non-invasive prenatal diagnosis. We have developed a two-step method for trophoblast isolation between the 8th and 12th week of pregnancy. Blood was sampled from 14 women undergoing termination of pregnancy or spontaneous abortion. Immunomagnetic beads precoated with HLA class I and II, and with anti-cytokeratin-18 monoclonal antibodies, were used to remove CD8+ and other maternal cells, and to select for fetal trophoblasts, respectively. Microsatellite analysis was performed on DNA extracted from the isolated, maternal, paternal and placental cells after PCR amplification. Recovery of the trophoblasts was confirmed in 13/14 cases (93%) by the identification of an identical microsatellite pattern for fetal and placental cells. Further evidence was the presence of heterozygous alleles of both maternal and paternal origin. The correct prediction of gender in all five male fetuses was an additional confirmation of trophoblast recovery. We conclude that trophoblasts can be effectively isolated from maternal blood in the first trimester, and by using polymorphic microsatellite markers to confirm sample purity, this method has potential future application in prenatal diagnosis.

Erythropoietin in the treatment of iron deficiency anemia during pregnancy

The aim of this study was to investigate the efficacy of recombinant human erythropoietin (rHuEPO) combined with parenteral iron, in the treatment of moderate and severe iron deficiency anemia during pregnancy. Twenty-six pregnant women, who had been ineffectively treated with iron supplementation alone for at least 8 weeks, were enrolled. They met the following criteria for inclusion in the study: hemoglobin (Hb) concentration <8.5 g/dl, evidence of iron deficiency anemia, and absence of other pregnancy complications, or severe systemic diseases. The treatment protocol comprised of a combination therapy with 150 IU/kg rHuEPO subcutaneously three times per week and 100 mg parenteral iron daily, for a total period of 4 weeks. Nineteen out of 26 women (73%) showed a quick response, with Hb reaching normal levels within the first 2 weeks of treatment. They displayed an average of 3.17 g/dl increase in Hb concentration during the total period of therapy, with 3.0 g/dl increase within the first 2 weeks. In 5 women (19.2%) there was no significant increase in Hb levels, while in 2 women (7.6%) a further decline in Hb concentration was observed, that necessitated a blood transfusion. In conclusion, rHuEPO combined with parenteral iron is an effective treatment for moderate and severe iron deficiency anemia during pregnancy, with minimal adverse or side effects. It may serve as an alternative to blood transfusion, or in cases of resistant anemia that are not effectively treated by iron supplementation alone. However, further studies are needed to investigate the poor response observed in about 25% of treated patients.

Plasma carnitine levels of pregnant adolescents in labor

STUDY OBJECTIVE

To determine the concentration of plasma carnitine (total, free, and acylcarnitine) during the delivery of uncomplicated pregnancies of adolescent women. To investigate the relationship between maternal and neonatal levels of carnitine and to compare these carnitine levels between pregnant and nonpregnant adolescents.

DESIGN

Samples of maternal and umbilical blood were taken at the time of delivery and examined for the determination of the carnitine-total, free, and acylcarnitine-concentration by the use of an enzymatic-radioisotope method. Twenty-two cases of uncomplicated adolescent pregnancies with a normal labor and without perinatal complications were examined. The plasma level of carnitine was also examined in 17 healthy nonpregnant adolescent women, which constituted the control group.

RESULTS

The concentrations of plasma carnitine in adolescent pregnancies at the time of delivery were calculated at 19.6 +/- 2.15 microMol/L (total), 12.62 +/- 1.31 microMol/L (free), and 6.98 +/- 1.55 microMol/L (acylcarnitine). The corresponding mean values in umbilical plasma were 30.31 +/- 2.06 microMol/L, 22.39 +/- 1.64 microMol/L, and 7.92 +/-.96 mucroMol/L. There is a statistically significant difference between the mean values in maternal and umbilical plasma (P <.0001 for total and free carnitine and P <.012 for acylcarnitine). The correlations between adolescent pregnant women and their infants as regards total, free, and acylcarnitine were 0.137, 0.018, and 0.33, respectively. Neither of these parameters was statistically significant. The corresponding mean values of carnitine in nonpregnant adolescent women were statistically significantly higher than in adolescent pregnant women (total carnitine: 41.61 +/- 3.09 microMol/L, free: 31.39 +/- 2.81 microMol/L, acylcarnitine: 10.22 +/- 1.88 microMol/L, P <.0001).

CONCLUSIONS

The concentration of plasma carnitine at the end of adolescent pregnancy is low compared to the levels of umbilical carnitine at birth and that found in nonpregnant adolescent women. It may not have an obvious impact on the utilization of fatty acids in an uncomplicated full-term pregnancy; however, it suggests the potential risk for neonatal fatty-acid oxidation in a preterm or complicated pregnancy.

Cycle and age-related changes in corticotropin-releasing hormone levels in human endometrium and ovaries

Corticotropin-releasing hormone (CRH) is synthesized in most female reproductive tissues such as the ovaries and the uterus. In the non-pregnant uterus, it is mainly produced by epithelial cells of the endometrium. Recent in vitro experimental findings show that endometrial CRH is under the positive control of progesterone, participating in the decidualization process of endometrial stroma and the progression of blastocyst implantation. CRH is also produced in the thecal compartment of the human ovary, controlling ovarian steroid hormone biosynthesis. In the present study we compared the concentration of immunoreactive CRH (ir-CRH) in biopsies from proliferative and secretory human endometria, and from pre- and postmenopausal human ovaries. We found that the concentration of ir-CRH was significantly higher in the secretory (92 +/- 8 pg/mg protein; n = 10) than the proliferative (75 +/- 9 pg/mg protein; n = 12; p < 0.05) endometria. This observation supports the experimental in vitro findings associating endometrial CRH in intrauterine phenomena of the secretory phase of the menstrual cycle (decidualization and implantation). Additionally, we have shown that the concentration of ir-CRH was significantly higher in the premenopausal (125 +/- 12 pg/mg protein; n = 14) than the postmenopausal (100 +/- 12 pg/mg protein; n = 12; p < 0.05) ovaries, suggesting that ovarian CRH is related to normal ovarian function during the reproductive lifespan.

Human papillomavirus infection of non-melanoma skin cancers in immunocompetent hosts

Human papilloma viruses (HPVs) consist of more than 70 different types and are known to be associated with numerous malignant tumors, including carcinomas of the mucosal and cutaneous epithelium. Non-melanoma skin carcinoma (NMSC) is the most frequently occurring malignancy worldwide in the Caucasian population. Most studies examining the involvement of papillomaviruses in the development of cutaneous carcinomas have been performed on lesions from patients with epidermodysplasia verruciformis or from immunosuppressed patients. Our specimens were obtained from 108 immunocompetent patients with benign and malignant skin lesions, and HPVs were detected in 27%. HPV 8 and HPV 18 were the most frequent types (62 and 48%, respectively). Our results suggest that HPVs, particularly the oncogenic potential of certain types such as HPV 8, 18, and 5 could contribute to the development of NMSCs.

Cervical cancer screening in Greece

The aim of this study was to describe the state of the art in cervical cancer screening in Greece by presenting the two regionally organised screening programmes that currently operate in the country. Both programmes were initiated in 1991 and are partly funded by the European Union. The Ormylia screening programme covers the population of Halkidiki (Northern Greece), a predominantly rural area. The second programme covers the regions of Messinia and Ilia (Southern Greece). Both programmes are targeted at women aged 25-64 years of age and a Papanicolaou (Pap) smear test is recommended every 2-3 years. Electoral and municipal registries are used to identify the target population and personal invitations are sent to the eligible women in the screening programme. The Ormylia programme is based at the Centre 'Our Lady Who Loves Mankind', whereas mobile units are used by the Messinia and Ilia programme. Slide reading for the Ormylia programme is performed in the cytology laboratory of Alexandra Hospital in Athens and epidemiological support is provided by the Department of Hygiene and Epidemiology (Medical School, University of Athens). A specifically designed database is used for data recording. Over 80% of the target population in the region have already been screened. Communication of results is by means of a personal letter upon a negative result and in person upon a suspicious result. Quality assurance in both programmes is based on the European protocol. These two programmes are the sole organised cervical cancer screening activities in Greece in the absence of a national programme. They employ well-trained personnel, they use modern equipment and have strict quality assurance procedures.

Nitric oxide production by pre-implantation embryos in response to embryotoxic factors

In this report, we examined whether nitric oxide (NO) is involved in early embryo death. We have chosen various experimentally defined embryotoxic stimuli in mice and determined their ability to induce NO production by 2-cell stage embryos. The embryotoxic factors used were interferon-gamma (IFN-gamma), tumor necrosis factor-alpha (TNF-alpha), lipopolysaccharide (LPS), 5-Azacytidine (5-AzaC) and the murine embryotoxic antibody DF4. We showed that in all cases the embryotoxic stimuli induced NO production by early stage embryos that correlated with the induction of the inducible and/or endothelial isoforms of NO synthase. This study was also extended to the human system where sera from women who aborted were tested for their ability to act embryotoxically by inducing NO in early mouse embryos and mature murine placenta. The results obtained confirmed the embryotoxic character of NO found in these particular sera leading to the hypothesis that NO plays a potential role in early embryo death.

Detection of herpes simplex virus (HSV) in aborted material using the polymerase chain reaction technique

OBJECTIVE

To investigate the contribution of HSV to the aetiopathogenesis of spontaneous abortion.

DESIGN

A hospital-based, case-control study.

SETTING

Department of Obstetrics and Gynecology, University Hospital and Laboratory of Clinical Virology, Medical School, University of Crete, Heraklion, Crete, Greece.

POPULATION AND METHODS

Abortion material from 102 cases of women with spontaneous abortion was analysed for the presence of HSV DNA applying the PCR technique. Serological assays were used for the detection of specific IgM and IgG antibodies in the maternal sera of 90 pregnant women with successful outcome of their pregnancy while 70 non-pregnant women at reproductive age were also examined as control.

RESULTS

The HSV genome was detected by PCR amplification in 3 cases of spontaneous abortion, 2 of them exhibited serological markers of virus reactivation while the 3rd showed a past infection. There were no obvious clinical manifestations indicating a current herpes infection. Both groups of pregnant women, either with spontaneous abortion or with a successful outcome of pregnancy, displayed serological markers of HSV reactivation at higher rates compared with non-pregnant women (chi2, p < 0.05).

CONCLUSIONS

Using the PCR technique we were able to detect the HSV genome in gestational tissues of spontaneous abortions, even in cases without any clinical symptoms or seropositivity for a primary infection. Serological assays were not very useful for the elucidation of the role of HSV in inducing spontaneous abortions, although they indicate that the state of pregnancy predisposes to HSV reactivation. However, the detection of HSV in 3 out of a total number of 102 cases does not support HSV infection as a major abortion-related factor.

Cytological diagnosis of malignant mixed müllerian tumor of the uterus in ascitic fluid

The malignant mixed Mullerian tumour (MMMT) is a rare and aggressive neoplasm of the uterus, seen in postmenopausal women. In this case, an uncommon neoplasm was diagnosed cytologically in the ascitic fluid of a woman 58 years old and was confirmed histologically after hysterectomy and bilateral adnexectomy.

Detection and clinical correlations of ras gene mutations in human ovarian tumors

In epithelial ovarian neoplasms K-ras codon 12 gene mutations show a wide variation fluctuating between 4-39% in invasive carcinomas and 20-48% in borderline malignant tumors. In this study, we showed the pattern of point mutations in codon 12 of the K-ras, H-ras and N-ras genes, using polymerase chain reaction restriction fragment length polymorphism analysis in 74 tissue specimens of Greek patients with epithelial ovarian tumors. K-ras and H-ras gene mutations were detected in 11/48 (23%) and 3/48 (6%) cases with primary invasive ovarian carcinomas, respectively, while N-ras gene mutations were not found. No mutation of K-, H- and N-ras genes was detected in 23 ovarian cystadenomas. In 1 out of 3 borderline ovarian tumors (33%) we found an H-ras gene mutation. The prevalence of mutations in K-ras gene was 1/8 (13%) in mucinous, 7/29 (24%) in serous, 1/3 (33%) in endometrioid and 2/8 (25%) in clear-cell adenocarcinomas and in H-ras gene 1/8 (13%) in mucinous and 2/29 (7%) in serous adenocarcinomas. Analysis of the results revealed no significant correlation between ras gene mutations and clinicopathological parameters or clinical outcome of this primary invasive ovarian carcinoma population. Our present data suggest that ras gene mutations in invasive ovarian carcinomas occur in 29% of Greek patients and are not associated with the differentiation of the epithelial cells or the response of patients to adjuvant platinum-based chemotherapy.

Th1- and Th2-type lymphokine-assisted induction and release of chemokine receptors from primary human trophoblast cells

Chemokine receptors (CCRs) have been demonstrated to facilitate the entry of HIV in different cell types of infected individuals, including CD4(+) T cells and dendritic cells. The natural or inducible expression of CCRs on trophoblast cells could provide a valid mechanism for the in utero transmission of HIV from mother to fetus. Because of the rapid turnover of these receptors, we attempted to define the natural and inducible expression of surface CCR3 and CXCR4 on primary human trophoblasts during short periods of cell culture. In the absence of any external stimulus the expression of CCR3 and CXCR4 varied from 1% to 24%. Kinetic experiments show that the levels of both CCR3 and CXCR4 reach a peak of expression after 6 h of culture, whereas by 24 h they have almost disappeared. In the presence of IFN-gamma, CCR3 is showing an increasing pattern of expression after 4 h of incubation, reaching highest levels after 24 h of culture, whereas CXCR4 is kept at lower levels as compared with nontreated cells. Furthermore, in the presence of IL-4, CCR3 expression declines from 2 to 8 h of culture to increase again at 24 h, where 50% of the cell population is expressing the receptors. Under the IL-4 stimulus, CXCR4 shows a peak of expression at 8 h of culture. An interesting feature of this study is that we were able to detect soluble CCR activity in the culture supernatants of trophoblast cells, which followed an inverse pattern of this of surface expression. Thus, the inability of many laboratories to detect high levels of CCRs in placentae of HIV infected mothers may be due on these fast turnover of these receptors, which by the assaying time have either been released in the culture medium or been internalized to the cell.

The influence of long-term administration of conjugated estrogens and antiandrogens to serum leptin levels in women with polycystic ovary syndrome

It is well known that a strong exponential relationship exists between leptin levels and body mass index (BMI). The different serum leptin levels, however, that are observed for each BMI value, suggest that other factors, as well, interfere with leptin secretion. This study was designed in order to estimate serum leptin levels in patients with polycystic ovary syndrome (PCOS), before and after long-term treatment with conjugated estrogens and antiandrogens. Sixteen women with PCOS were included in the study. They were divided into two groups: the first group comprised 11 non-obese women (BMI 21.6 +/- 0.5 kg/m2), aged 23.5 +/- 1.1 years; the second consisted of five obese women (BMI 28.9 +/- 1.5 kg/m2), aged 22.8 +/- 1.9 years. Blood samples for leptin measurement were drawn before and 2, 4, 6, 9 and 12 months after administration of conjugated estrogens and antiandrogens. Our results showed that obese women exhibited higher serum leptin levels in all blood samples. Moreover, the administration of conjugated estrogens and antiandrogens caused an increase in serum leptin levels in the 2nd, 4th, 6th and 9th month in both groups of women. Finally, leptin concentrations during the 12th month of the treatment returned to basic levels in both groups of women with PCOS. Our results support the view that BMI is the main variable that influences serum leptin levels, and that the effect of conjugated estrogens and antiandrogens on serum leptin concentrations is poor.

L-carnitine levels in the seminal plasma of fertile and infertile men: correlation with sperm quality

OBJECTIVE

To confirm the presence of L-carnitine in human seminal plasma, to show differences between L-carnitine concentrations in fertile and infertile subjects, and to show potential relationships between L-carnitine and semen quality.

STUDY DESIGN

Seminal plasma from 101 men obtained by masturbation was examined for the presence of L-carnitine. Semen samples were divided as follows: (a) in eight groups according to the etiology of fertility, (b) in two groups on the basis of normal or abnormal spermiogram, (c) correlation of the amount of L-carnitine in seminal plasma with values of the spermiogram.

RESULTS

We found the following: (1) L-carnitine levels differ significantly between controls and the patient groups (P < .0001) (2) The group with normal spermiogram has a mean value for L-carnitine of 478.4 while the abnormal one comes to 100.58. This difference is statistically significant (P < .0001). (3) There is a statistically significant, positive correlation between L-carnitine and the number of spermatozoa, the percentage of motile spermatozoa, and the percentage of normal forms (P < .0001).

CONCLUSION

These findings suggest that determination of seminal carnitine values might provide the physician with an additional means of evaluating the infertile male.

Soluble IL-6 receptor levels in the seminal plasma of infertile patients with accessory gland infection

The aim of this study was to confirm the presence of soluble interleukin-6 receptor (SIL-6R) in seminal plasma, to show eventual differences between SIL-6R concentrations in fertile and infertile men, and to evaluate the possible value of measuring these substances for the diagnosis of male accessory gland infection. SIL-6R levels were determined by "sandwich" enzyme immunoassay in the seminal plasma of 82 men divided into 7 groups according to the etiological diagnosis of fertility. The levels of SIL-6R in the seminal plasma of men with infection of the accessory genital glands were statistically significantly different in comparison with other groups (p < .001). The results suggest that urogenital infections may lead to elevated levels of SIL-6R in the seminal plasma. This measurement of SIL-6R in semen may provide clinically useful information for the diagnosis of male accessory gland infection.

Corticotrophin-releasing hormone (CRH) interacts with inflammatory prostaglandins and interleukins and affects the decidualization of human endometrial stroma

The hypothalamic neuropeptide, corticotrophin-releasing hormone (CRH), which is also produced by human endometrium, has been shown to induce its decidualization in vitro. This process, induced mainly by progesterone, has characteristics of an aseptic inflammatory reaction, and is modulated by locally produced pro-inflammatory factors. In humans, prostaglandin E(2) (PGE(2)) enhances while interleukin (IL)-1 inhibits the decidualizing effect of progesterone. The aim of the present work was to test the hypothesis that CRH might affect the decidualization of human endometrium interacting with these factors. Therefore, we studied its effects on the production of pro-inflammatory interleukins IL-1, IL-6 and of PGE(2) from human endometrial stromal cells in primary culture. The results strongly suggest that CRH decidualizes stromal cells, as judged by the appearance of cytokeratins and the production of prolactin, two established markers of decidualization. In parallel to its effect on decidualization, CRH also decreased the production of PGE(2), while it increased the production of IL-1 and IL-6. Exposure of endometrial stromal cells to IL-6 also caused decidualization. The data presented here suggest that endometrial CRH regulates the production of local modulators of decidualization, i.e. PGE(2), IL-1 and IL-6. We postulate that, through the regulation of these factors, CRH acts as a local fine-tuner of decidualization initiated by progesterone.

Disposition of pesticides and toxicants in the human reproductive system in cases of acute poisoning

The aim of this study was to estimate the penetration of some of the pesticides and toxicant substances in the human reproductive system. This knowledge is valuable because of the possible adverse influence of these substances on the human reproduction system and the development of the foetus during pregnancy. The existing data is mainly concerned with the results of experimental studies on animals or epidemiological studies. Here we report data concerning the disposition of several toxic xenobiotics (pesticides and solvents) in the tissues of the human reproductive system as well as in other organs and glands. Data was collected from cases of acute poisonings and derived mostly from autopsy materials. Xenobiotics were found to penetrate sampled tissues such as the testes, ovaries, epididymis, uterus, thyroid gland, as well as other human tissues. Further studies will clarify and confirm peculiarities of the penetration of a wide range of substances in various body tissues and will be the base of the estimation of the role of these toxicants in human reproductive ability and the outcome of pregnancy in humans.

Factors that may predispose to rupture of tubal ectopic pregnancy

OBJECTIVE

The purpose of our study was to evaluate factors that may predispose to rupture of tubal ectopic pregnancy. The study included 99 cases of ectopic pregnancies that were treated during the 5-year period 1992-1996.

RESULTS

It was found that: (1) tubal rupture is encountered more often in women with no history of ectopic pregnancy and in those who have full-term pregnancy, suggesting that ectopic pregnancy is less suspected in these women; (2) tubal rupture is encountered less often in lower age ectopic pregnancy; and (3) serum beta-hCG level does not predict tubal rupture.

CONCLUSIONS

Rupture of the tube is more often observed in women with a history of ectopic pregnancy and in women with full-term pregnancy. Such observations suggest that ectopic pregnancy is less suspect in these cases.