O-068 Training of clinicians: How to do it and how to best evaluate it

Training of clinicians: How to do it and how to best evaluate it?

Anis Feki, Tatjana Motrenko, Roy Farquharson

Many countries within Europe and EU do not have a specific national agency that provides the necessary structure or governance for appropriate training in Reproductive Medicine (RM). Therefore, The European Society of Human Reproduction and Embryology (ESHRE) has been the responsible agency for accreditation of RM training alongside its sister organization, the European Board and College of Obstetrics and Gynaecology (EBCOG). Both of these organizations are ultimately responsible to and approved by the Union of European Medical Specialties (UEMS), which represents the European Union (EU) governing body for medical practitioners’ education.

The Reproductive Medicine subspecialist is a specialist in basic obstetrics and gynecology who has undergone theoretical and practical training in the medical and surgical management of infertility, including assisted reproductive techniques (ART). In general, the comprehensive management of these problems includes both diagnostic and therapeutic procedures allied to continuous audit of outcome.

The global aim is to improve the care of patients with disorders of reproductive function. To reach this target, both ESHRE and EBCOG put in place a program that starts with accreditation of training centers in obstetrics and gynecology and more specifically, specialist training centers in reproductive medicine. Fellows must have a structured program of a minimum of 2 years after completing their basic obstetrics and gynecology syllabus and/or obtaining EFOG European Fellow of Obstetrics and Gynecology) diploma for non-European basic training. When a training fellow in RM has completed their logbook, the fellow will finish by assessing an individual’s knowledge and skills by passing an exit-training exam called the EFRM (ESHRE-EBCOG Fellow in Reproductive Medicine) diploma.

The success of and the need for such certification has led ESHRE to structure the training also for reproductive surgeons, embryologists, as well as nurses and midwives. In addition, several countries within the EU already have a national compulsory specialist accreditation system for RM training.

Recent proposals by the EU Commission to build European reference networks across all specialties, including RM may require the recognition of ESHRE/EBCOG–accreditation as an appropriate entry point for consideration of diagnostic and other interventions. Encouraging subspecialists and centers to apply for training accreditation may well prove to be an increasingly attractive option as educational needs across Europe become integrated and formalized through UEMS. ESHRE holds the view that accredited centers/subspecialists for training are beacons of excellence that often go hand in hand with high-quality research.

Studies of the extracytoplasmic function sigma factor PG0162 in Porphyromonas gingivalis

PG0162, annotated as an extracytoplasmic function (ECF) sigma factor in Porphyromonas gingivalis, is composed of 193 amino acids. As previously reported, the PG0162-deficient mutant, P. gingivalis FLL350 showed significant reduction in gingipain activity compared with the parental strain. Because this ECF sigma factor could be involved in the virulence regulation in P. gingivalis, its genetic properties were further characterized. A 5'-RACE analysis showed that the start of transcription of the PG0162 gene occurred from a guanine (G) residue 69 nucleotides upstream of the ATG translation initiation codon. The function of PG0162 as a sigma factor was confirmed in a run-off in vitro transcription assay using the purified rPG0162 and RNAP core enzyme from Escherichia coli with the PG0162 promoter as template. As an appropriate PG0162 inducing environmental signal is unknown, a strain overexpressing the PG0162 gene designated P. gingivalis FLL391 was created. Compared with the wild-type strain, transcriptome analysis of P. gingivalis FLL391 showed that approximately 24% of the genome displayed altered gene expression (260 upregulated genes; 286 downregulated genes). Two other ECF sigma factors (PG0985 and PG1660) were upregulated more than two-fold. The autoregulation of PG0162 was confirmed with the binding of the rPG0162 protein to the PG0162 promoter in electrophoretic mobility shift assay. In addition, the rPG0162 protein also showed the ability to bind to the promoter region of two genes (PG0521 and PG1167) that were most upregulated in P. gingivalis FLL391. Taken together, our data suggest that PG0162 is a sigma factor that may play an important role in the virulence regulatory network in P. gingivalis.

The roles of RgpB and Kgp in late onset gingipain activity in the vimA-defective mutant of Porphyromonas gingivalis W83

Previous studies have shown that VimA, an acetyltransferase, can modulate gingipain biogenesis in Porphyromonas gingivalis. Inactivation of the vimA gene resulted in isogenic mutants that showed a late onset of gingipain activity that only occurred during the stationary growth phase. To further elucidate the role and contribution of the gingipains in this VimA-dependent process, isogenic mutants defective in the gingipain genes in the vimA-deficient genetic background were evaluated. In contrast with the wild-type strain, RgpB and Kgp gingipain activities were absent in exponential phase in the ∆rgpA::tetQ-vimA::ermF mutant. However, these activities increased to 31 and 53%, respectively, of that of the wild-type during stationary phase. In the ∆rgpA::cat-∆kgp::tetQ-vimA::ermF mutant, the RgpB protein was observed in the extracellular fraction but no activity was present even at the stationary growth phase. There was no gingipain activity observed in the ∆rgpB::cat-∆kgp::tetQ-vimA::ermF mutant whereas Kgp activity in ∆rgpA::cat-∆rgpB::tetQ-vimA::ermF mutant was 24% of the wild-type at late stationary phase. In contrast to RgpA, the glycosylation profile of the RgpB catalytic domain from both W83 and P. gingivalis FLL92 (vimA::ermF) showed similarity. Taken together, the results suggest multiple gingipain activation pathways in P. gingivalis. Whereas the maturation pathways for RgpA and RgpB are different, the late-onset gingipain activity in the vimA-defective mutant was due to activation/maturation of RgpB and Kgp. Moreover, unlike RgpA, which is VimA-dependent, the maturation/activation pathways for RgpB and Kgp are interdependent in the absence VimA.

[Comparison of the aerosol produced by electronic cigarettes with conventional cigarettes and the shisha]

In previous studies of the smoke from regular cigarettes and water pipes, we measured aerosol particle sizes in three streams; S1, inhaled by the smoker, S2, released by the device itself and S3, exhaled by the smoker. We used an electrostatic low-pressure impactor (ELPI), giving particle size distributions in real time and calculated median diameters, D50, and dispersion (σg). This allowed us to predict airway deposition. In addition, the aerosol particle half-life in the air was used as a measure of the risk to others from passive smoking. With the same equipment, we measured the particle sizes and persistence in air of the liquid aerosol generated by e-cigarettes (Cigarettec®) containing water, propylene glycol and flavorings with or without nicotine. Aerosol generation was triggered by a syringe or by the inspiration of volunteer smokers. The D50 data obtained in S1, were 0.65 μm with nicotine and 0.60 μm without nicotine. Deposition in the airways could then be calculated: 26% of the total would deposit, of which 14% would reach the alveoli. These data are close to those found with regular cigarettes. For S3, D50 data were 0.34 μm and 0.29 μm with or without nicotine. The half-life in air of the S3 stream was 11 seconds due to a rapid evaporation. The-e-cigarette aerosol, as measured here, is made of particles bigger than those of cigarette and water pipe aerosols. Their deposition in the lung depends on their fate in the airways, which is unknown. Contrary to tobacco smoke, which has a half-life in air of 19 to 20 minutes, the risk of passive "smoking" exposure from e-cigarettes is modest.

VimA-dependent modulation of the secretome in Porphyromonas gingivalis

The VimA protein of Porphyromonas gingivalis is a multifunctional protein involved in cell surface biogenesis. To further determine if its acetyl coenzyme A (acetyl-CoA) transfer and putative sorting functions can affect the secretome, its role in peptidoglycan biogenesis and effects on the extracellular proteins of P. gingivalis FLL92, a vimA-defective mutant, were evaluated. There were structural and compositional differences in the peptidoglycan of P. gingivalis FLL92 compared with the wild-type strain. Sixty-eight proteins were present only in the extracellular fraction of FLL92. Fifteen proteins present in the extracellular fraction of the parent strain were missing in the vimA-defective mutant. These proteins had protein sorting characteristics that included a C-terminal motif with a common consensus Gly-Gly-CTERM pattern and a polar tail consisting of aromatic amino acid residues. These observations suggest that the VimA protein is likely involved in peptidoglycan synthesis, and corroborates our previous report, which suggests a role in protein sorting.

Porphyromonas gingivalis mutY is involved in the repair of oxidative stress-induced DNA mispairing

The ability for DNA mismatch repair, after oxidative stress-induced DNA damage, is critical for the persistence of Porphyromonas gingivalis in the inflammatory environment of the periodontal pocket. Our previous report demonstrated that, in contrast to other organisms, the repair of oxidative stress-induced DNA damage involving 8-oxo-7,8-dihydroguanine (8-oxoG) may occur by a yet-to-be described mechanism in P. gingivalis. 8-oxoG does not block DNA replication; rather, it mispairs with adenine, which can be repaired by the MutY glycosylase. To determine the function of the P. gingivalis MutY homologue in DNA repair, it was insertionally inactivated using the ermF-ermAM antibiotic cassette and used to create a mutY-deficient mutant (FLL147) by allelic exchange mutagenesis. FLL147 had an increased rate of spontaneous mutation and was more sensitive to hydrogen peroxide compared with the wild-type W83 strain. DNA oligomers containing a site-specific 8-oxoG:A mispair was repaired similarly in both the P. gingivalis mutY-defective mutant and wild-type strains. The P. gingivalis mutY homologue was shown to complement the mutY mutation in Escherichia coli. In a gel mobility shift assay, the purified recombinant MutY is able to bind an oligo containing an 8-oxoG:A mispair. Taken together, MutY may play the expected role in oxidative stress resistance in P. gingivalis. However, there may exist other redundant mechanism(s) for the removal of 8-oxoG:A mismatch in this organism.

regT can modulate gingipain activity and response to oxidative stress in Porphyromonas gingivalis

Recombinant VimA protein can interact with the gingipains and several other proteins that may play a role in its biogenesis in Porphyromonas gingivalis. In silico analysis of PG2096, a hypothetical protein that was shown to interact with VimA, suggests that it may have environmental stress resistance properties. To further evaluate the role(s) of PG2096, the predicted open reading frame was PCR amplified from P. gingivalis W83 and insertionally inactivated using the ermF-ermAM antibiotic-resistance cassette. One randomly chosen PG2096-defective mutant created by allelic exchange and designated FLL205 was further characterized. Under normal growth conditions at 37 °C, Arg-X and Lys-X gingipain activities in FLL205 were reduced by approximately 35 % and 21 %, respectively, compared to the wild-type strain. However, during prolonged growth at an elevated temperature of 42 °C, Arg-X activity was increased by more than 40 % in FLL205 in comparison to the wild-type strain. In addition, the PG2096-defective mutant was more resistant to oxidative stress when treated with 0.25 mM hydrogen peroxide. Taken together these results suggest that the PG2096 gene, designated regT (regulator of gingipain activity at elevated temperatures), may be involved in regulating gingipain activity at elevated temperatures and be important in oxidative stress resistance in P. gingivalis.

Influence of calcium addition on growth of highly purified syntrophic cultures degrading long-chain Fatty acids

Two highly purified syntrophic associations resulting in acetogenesis from stearate (SM) and oleate (OM) were obtained from the sludges of a sewage digestor. In both cases, Methanospirillum hungatei together with short, motile, gram-negative, nonfluorescent rods morphologically similar to Syntrophomonas wolfei were identified by microscopic examination. Besides growing on volatile fatty acids (butyrate through caproate), both cultures grew on oleate (C(18:1)) and numerous even-numbered, saturated long-chain fatty acids (LCFA [decanoate through stearate]). In addition, during growth on LCFA, supplementation of the culture media with calcium chloride was an absolute requirement. The sole difference between the associations was observed when SM and OM cultures were transferred from a stearate to an oleate medium. The SM culture needed 10 days before starting to degrade oleate, whereas the OM culture grew immediately, but the OM culture also grew immediately when transferred to stearate medium. Saturated LCFA degradation occurred in the presence of equinormal amounts of calcium (fatty acid/Ca ratio, 2). On the other hand, OM degradation only took place in the presence of an equimolar amount of calcium (fatty acid/Ca ratio, 1). These observations are discussed by considering the solubility constants of LCFA as calcium salts and the toxicity of the free acids against microorganisms.

In situ determination of the static inductance and resistance of a plasma focus capacitor bank

The static (unloaded) electrical parameters of a capacitor bank are of utmost importance for the purpose of modeling the system as a whole when the capacitor bank is discharged into its dynamic electromagnetic load. Using a physical short circuit across the electromagnetic load is usually technically difficult and is unnecessary. The discharge can be operated at the highest pressure permissible in order to minimize current sheet motion, thus simulating zero dynamic load, to enable bank parameters, static inductance L(0), and resistance r(0) to be obtained using lightly damped sinusoid equations given the bank capacitance C(0). However, for a plasma focus, even at the highest permissible pressure it is found that there is significant residual motion, so that the assumption of a zero dynamic load introduces unacceptable errors into the determination of the circuit parameters. To overcome this problem, the Lee model code is used to fit the computed current trace to the measured current waveform. Hence the dynamics is incorporated into the solution and the capacitor bank parameters are computed using the Lee model code, and more accurate static bank parameters are obtained.

[Particle size in water pipe smoke]

INTRODUCTION

It is a popular perception that narghile (water pipe) smoking is less harmful to the lungs than cigarettes in both active and passive smokers.

METHODS

Using a sinusoidal pump we simulated water pipe smoking in conditions close to users' habits. The particle sizes and concentrations in the smoke streams were measured with an electrical low pressure impactor (ELPI), sorting particle numbers and size into 12 classes ranging from 0.028 to 10 microm in diameter.

RESULTS

Water pipe smoke contains microparticles and nanoparticles. The main inhaled smoke stream (C1) contains particles in a concentration of 3.55 x 10(6) ml(-1) with a median particle diameter (D50) of 0.34microm before bubbling through water. After bubbling, it retains 1.20 x 10(6) ml(-1) particles with a D50 of 0.27 mm, indicating that 2/3 of the particles are retained in the water, the smallest being trapped the less. Compared with C1, the D50 of the side stream smoke (C2) is smaller (0.11mm) while the D50 of the expired stream (C3) is similar (0.25mm).

CONCLUSION

After bubbling, C1 particle sizes are similar to those measured in cigarette smoke but the volumes inhaled by a water pipe smoker are higher allowing prediction of greater deposition in the respiratory tract than with cigarette smoking.

[Particle size in the smoke produced by six different types of cigarette]

INTRODUCTION

For several decades a more peripheral distribution of the broncho-pulmonary pathologies related to tobacco has been observed.

METHODS

The aim of this study is to examine whether changes in the particle size of cigarette smoke as the result of new manufacturing technologies could play a part in the observed epidemiologic changes through a more distal disposition of smoke particles in the airways. Using a smoking machine and a low pressure electrostatic impactor we measured the particle size of the smoke from six different types of cigarette, representing old and new manufacturing techniques. The effect of a filter was assessed by a size analyser measuring the electrical mobility of the particles.

RESULTS

The results show a difference in particle size between the primary smoke inhaled by the smoker, S1 (0.27 +/- 0.03 microm.) and the secondary smoke, S2 inhaled by passive smokers (0.09 +/- 0.01 microm). There is no difference in particle size between the 6 different types of cigarette. Filters dilute the smoke without altering particle size.

CONCLUSION

The recent alterations in the distribution of tobacco related pathologies cannot be explained by changes in particle size in cigarette smoke. The explanation has to sought elsewhere.

Online system for temperature and accumulated dose control in plasma-based ion implantation

Surface treatment optimization requires the control of the ion dose and the workpiece temperature, two parameters that are not trivially measurable in plasma-based ion implantation. A temperature and ion fluence monitoring system has been developed and implemented in a plasma-based ion implanter. It is based on the measurement with a thermopile of the radiation emitted from the back face of a thin copper disk inserted in the stainless steel sample holder. Since the incident ions carry practically all the incident power, the measurement of the Cu disk temperature that increases during implantation can provide an evaluation of the ion fluence in real time. A model has been developed for the deconvolution of the temperature data and has been fitted to the temperature behavior during implantation. A good agreement between the total integrated doses, evaluated with Rutherford backscattering spectroscopy characterization, and the ion fluence calculated by means of this model has been obtained with a discrepancy less than 16%.

HtrA in Porphyromonas gingivalis can regulate growth and gingipain activity under stressful environmental conditions

In several micro-organisms, HtrA, a serine periplasmic protease, is considered an important virulence factor that plays a regulatory role in oxidative and temperature stress. The authors have previously shown that the vimA gene product is an important virulence regulator in Porphyromonas gingivalis. Further, purified recombinant VimA physically interacted with the major gingipains and the HtrA from P. gingivalis. To further evaluate a role for HtrA in the pathogenicity of this organism, a 1.5 kb fragment containing the htrA gene was PCR-amplified from the chromosomal DNA of P. gingivalis W83. This gene was insertionally inactivated using the ermF-ermAM antibiotic-resistance cassette and used to create an htrA-deficient mutant by allelic exchange. In one randomly chosen isogenic mutant designated P. gingivalis FLL203, there was increased sensitivity to hydrogen peroxide. Growth of this mutant at an elevated temperature was more inhibited compared to the wild-type. Further, in contrast to the wild-type, there was a significant decrease in Arg-gingipain activity after heat shock in FLL203. However, the gingipain activity in the mutant returned to normal levels after a further 30 min incubation at room temperature. Collectively, these data suggest that HtrA may play a similar role in oxidative and temperature stress in P. gingivalis as observed in other organisms.

VimA is part of the maturation pathway for the major gingipains of Porphyromonas gingivalis W83

The authors have shown previously that the vimA gene, which is part of the bcp-recA-vimA operon, plays an important role in protease activation in Porphyromonas gingivalis. The gingipain RgpB proenzyme is secreted in the vimA-defective mutant P. gingivalis FLL92. An important question that is raised is whether the vimA gene product could directly interact with the proteases for their activation or regulate a pathway responsible for protease activation. To further study the mechanism(s) of VimA-dependent protease activation, the vimA gene product was further characterized. A 39 kDa protein consistent with the size of the predicted VimA protein was purified. In protein–protein interaction studies, the VimA protein was shown to interact with gingipains RgpA, RgpB and Kgp. Immune sera from mice immunized with P. gingivalis immunoreacted with the purified VimA protein. Taken together, these data suggest an interaction of VimA with the gingipains and further confirm the role of this protein in their regulation or maturation.

Aneurysm of the pancreaticoduodenal arteries with a celiac trunk lesion: current management

OBJECTIVE

We report a ruptured aneurysm of the pancreaticoduodenal arteries without acute or chronic pancreatitis but associated with a median arcuate ligament division that compressed the celiac trunk, an exceptional event, thus far described in only 11 patients. We also conducted a targeted review to seek information about clinical presentation, to hasten diagnosis and assist in therapeutic management.

METHODS

A 54-year-old man with retroperitoneal hemorrhage associated with an arcuate ligament division, documented on computed tomographic scans, underwent diagnostic arteriography and embolization to treat the bleeding aneurysm. In a second elective operation the causative arcuate ligament was sectioned to decompress the celiac artery, to prevent aneurysm recurrence.

RESULTS

Embolization stopped the aneurysmal bleeding, and arteriograms showed that surgical sectioning resolved the celiac trunk stenosis. At 1-year follow-up the patient had no signs of complications or recurrence of disease.

CONCLUSION

Ruptured aneurysm of the pancreaticoduodenal arteries associated with stenosis of the celiac trunk is a surgical emergency. Although a literature review disclosed no significant difference between outcomes after open surgery and radiologic arterial embolization, our experience in this case suggests immediate embolization during arteriography as the most effective treatment. Later, to prevent recurrence, the arcuate ligament should be surgically sectioned and the celiac artery stenosis treated.

Réponse immunitaire à la eCG utilisée dans le traitement de l’induction d’ovulation chez la chèvre et la brebis

In dairy goats and ewes the use of equine Chorionic Gonadotropin (eCG) as a convenient hormone for the induction of ovulation is necessary for out-of-season breeding and artificial insemination (AI). Treatment for induction and synchronization of ovulation consists of a progestagen delivered by vaginal sponge, followed by an eCG injection. In some females, the first injection of eCG induces a humoral response with high concentrations of anti-eCG antibodies in contrast to other females displaying a very low concentration of anti-eCG antibodies. Females eliciting a low response were also poor responders after the following treatments. Conversely, high responders at the first treatment systematically yielded high immune responses upon the following treatment. By a molecular genetic approach using microsatellites we showed that the anti-eCG immune response phenotypes were associated with MHC class II polymorphism. Females with high residual antibody concentrations at the time of eCG injection exhibited a much lower kidding rate than other females did. Lower fertility of these females, inseminated at a fixed time after eCG treatment (43H for goats and 55H for ewes), might be due to the delay in estrus occurrence and the pre ovulatory LH surge. Consequently, under field conditions old females selected for AI are only those with low residual anti-eCG antibody concentrations and old females with high residual antibody concentration are culled from AI breeding because of their low fertility during the previous year. So we have undertaken comparative studies to establish if the anti-eCG immune response is correlated with the global immunity in animals.

[An unusual thoracic opacity]

We report a case of a paraspinal meningocele in a 37-year-old man with no other clinical manifestation. The diagnosis was established on the basis of the computed tomography and magnetic resonance imaging features.

[Ultrasonographic diagnosis and prenatal management of fetal ovarian cysts]

OBJECTIVE OF THE STUDY

To evaluate the outcome of fetal ovarian cysts in relation to their ultrasonic appearance and size. To define, on that basis, the contribution of intrauterine aspiration.

MATERIAL AND METHODS

Retrospective study of all ovarian fetal cysts detected by prenatal ultrasound examination (n = 25) during a 4 year period. All these cysts were followed during pregnancy and after delivery until spontaneous or surgical resolution.

RESULTS

At the time of prenatal sonographic detection at the mean gestational age of 32 1/2 weeks, the mean cyst diameter was 43+/-17 mm and 36% of all these cysts were already complicated (fluid-debris level, septa or finding of a retracting clot). Among the 16 non-complicated cysts (echolucent and thin-walled) 44% became twisted during the perinatal period irrespective of the size or the time of discovery. At birth, all these complicated cysts underwent surgical treatment and needed oophorectomy or adnexectomy. Surgery was therefore performed in a total of 56% of neonates. The pathologic reports confirm in all cases the benign follicular or follicular lutein nature of the cysts.

CONCLUSION

Due to this high rate of mechanical complications, cyst decompression may be considered at the time of diagnosis in case of an anechoic fetal ovarian cyst. The safety and efficacy of this approach, on the cases reported in the literature seem encouraging. Although, a prospective randomized evaluation is needed.

Implications of recent advances in reproductive physiology for reproductive management of goats

The control of reproduction in goats is interesting for technical reasons (synchronization of kiddings, adjustment to forage availability or to economy), and for genetic reasons (identification and dissemination of improved genotypes). The use of short-light rhythms leads to markedly increased production of semen per buck and prevents occurrence of a 'resting' season. Recent identification of a bulbourethral lipase in goat spermatozoa opens new perspectives in sperm preservation. Light plus 'short day' treatments also allow induction of out-of-season oestrous cycles and ovulations leading to enhanced fertility. Repeated use of eCG provokes the production of antibodies, delays the timing of ovulation and causes a reduction in fertility after fixed-time artificial insemination. All steps of embryo production, freezing and transfer are now controlled and allow the attainment of satisfactory numbers of kids born per donor female, which are compatible with the development of the technique for exchanging genotypes between countries. In vitro production of embryos allows high development rates to be achieved after in vitro maturation and fertilization of oocytes, and will ensure the production of synchronous populations of one-cell zygotes at the stage required by new biotechnologies.

[Idiopathic granulomatous mastitis. Review of the literature illustrated by 4 cases]

INTRODUCTION

Idiopathic granulomatous mastitis (IGM) was described as a specific entity in 1972 by Kessler and Wolloch. Despite the 120 cases reported in the international literature, this pathology remains quite unknown.

MATERIAL AND METHODS

Four cases of idiopathic granulomatous mastitis are reported in this article in order to outline the main clinical features of this affection. Data in the literature were used to discuss diagnostic and therapeutic particularities.

DISCUSSION

The histologic findings of a non-caseating granulomatous inflammation, centered on breast lobules, composed of epithelioid cells and multinucleated giant cells, allow establishing the diagnosis of granulomatous mastitis (GM). The main presenting symptom of GM is a single inflammatory mass of the breast; the diagnosis is thus often mistaken for breast carcinoma (more than 50% of the reported cases). Radiologic and cytologic findings alone do not enable reaching certain diagnosis because they cannot resolve the differential diagnosis of inflammatory process and malignancy. The diagnosis of IGM can be established after the etiological work up remains negative. A course of oral corticosteroid therapy, non-steroidian anti-inflammatory drugs, or colchicine can be used in order to shrink the breast mass, allowing more conservative surgery. Local excision is of limited benefit as there is a strong tendency for recurrence.

CONCLUSION

Different therapeutic options of IGM are explained by its clinical variability. A more pragmatic therapeutic approach would be enabled by a new classification based on course and severity.

Humoral immune response to equine chorionic gonadotropin in ewes: association with major histocompatibility complex and interference with subsequent fertility

In dairy ewes, the use of eCG as a convenient hormone for the induction of ovulation is necessary for out-of-season breeding and artificial insemination (AI). In this report we show the presence of anti-eCG antibodies in plasma of treated ewes. The major histocompatibility complex (MHC) was involved in the individual variability of the humoral immune responses to eCG. We found significant associations between the anti-eCG response phenotype and some MHC class II alleles. The low immune response phenotype was associated with one MHC class II allele only in Lacaune ewes, and the high immune response phenotype was associated with one MHC class II allele both in Manech and in Lacaune ewes. In herds, the impact of residual anti-eCG antibodies on subsequent fertility after AI seems minimal because of an indirect elimination of high-responder ewes from AI breeding. Therefore, the true magnitude of the association between residual anti-eCG antibody concentration and fertility has been underestimated. An additional experiment without any high-responder female elimination showed a significant correlation between high residual antibody concentrations and lower lambing rate after AI at a fixed time, possibly because of a delayed preovulatory LH surge. The results suggest that anti-eCG antibody concentration is one risk factor for infertility after AI.

The negative effect of repeated equine chorionic gonadotropin treatment on subsequent fertility in Alpine goats is due to a humoral immune response involving the major histocompatibility complex

In dairy goats, the use of eCG as a convenient hormone for the induction of ovulation is necessary for out-of-season breeding and artificial insemination. However, repeated eCG treatments are followed by decreased fertility in goats inseminated at a fixed time after treatment. In this report, we show the presence of anti-eCG antibodies in plasma of treated goats. A 500 IU eCG injection induces a humoral response, with variable concentrations of anti-eCG antibody being produced in individual goats. The analysis of successive anti-eCG immune responses over several years has demonstrated the existence of different populations of goats, defined as low, medium, and high responders. By the use of two caprine microsatellites located inside (OLADRB) and outside (BM1258) the major histocompatibility complex (MHC), a significant association (p < 0.05) between the anti-eCG antibody response and some MHC-DRB alleles was found. Goats with high antibody concentrations at the time of eCG injection (> 2.5 microg/ml) exhibited a much lower kidding rate than did other females (41.3% vs. 66.7%). Lower fertility of these goats, inseminated at a fixed time after eCG treatment, might be due to the observed delay in estrus occurrence and the preovulatory LH surge.

International collaborative calibration of a preparation of equine chorionic gonadotrophin (eCG NZY-01) proposed as a new standard

A batch of partially purified equine chorionic gonadotrophin (eCG NZY-01) was freeze-dried in vials of 500 iu and characterized in a large number of in vivo and in vitro assays. These assays were performed in eight laboratories in seven countries (Argentina, Belgium, England, France, Germany, Holland and USA). Four of these laboratories were in universities or government research organizations and four were those of pharmaceutical companies. Good correlation between in vivo and in vitro assays was found for unknown samples and for commercial preparations from different sources when performed against eCG NZY-01 as the standard. This result suggests that, in contrast to the WHO IRP2 international standard, the eCG NZY-01 preparation contains all eCG isoforms in proportions roughly similar to those found in serum and commercial preparations. The consistency of the data when using eCG NZY-01 as the reference in all types of in vivo and in vitro assays validates the wide use of in vitro assays which are cheaper, quicker and ethically preferable to in vivo assays. Vials of 500 iu eCG NZY-01 are available to researchers and manufacturers.

Immobilized metal ion affinity capillary electrophoresis of proteins--a model for affinity capillary electrophoresis using soluble polymer-supported ligands

An affinity capillary electrophoresis method has been developed that employs small ligands covalently bound to a replaceable soluble polymer matrix. The metal chelate iminodiacetate-Cu(II) coupled to polyethylene glycol was used as a model system and the interactions of different model proteins, namely ribonucleases, cytochromes c, chymotrypsin, and kallikrein, were investigated. The method allowed for easy determination of dissociation constants using a modified Langmuir adsorption isotherm equation which is applicable to interactions with fast on/off kinetics. It is shown that the general rules for protein interaction with matrix-bound metal chelates established for immobilized metal ion affinity chromatography (IMAC) are maintained in immobilized metal ion affinity capillary electrophoresis (IMACE). In contrast to gel electrophoresis, IMACE allowed for using similar conditions as in IMAC, especially regarding the high salt concentrations, usually employed with the latter technique. The usefulness of the method for quantification of low-affinity interactions and studying protein surface structure and structure/function relationship using the metal affinity is demonstrated.

Extracellular matrix analogs as carriers for growth factors: in vitro fibroblast behavior

Repair of connective tissue involves interactions between growth factors (GFs) and extracellular matrix (ECM) molecules. On the other hand, biological biomaterials could be used to carry and deliver GFs to stimulate wound healing. In the present study, fibroblasts were cultivated in a serum-free culture medium onto collagen (type I), hyaluronic acid, chondroitin sulfate, fibronectin, or fibrin. FGF, EGF, or PDGF was incorporated within those substrates. Using immuno- and radiolabeling assays, the distribution of GFs within the ECM analogs was relatively uniform and GFs retained in substrates were dependent on the substrates. Fibroblast replication was determined by the incorporation of [3H]-thymidine and compared to control groups. On collagen or chondroitin sulfate, the incorporation of GFs did not significantly improve cell proliferation. On hyaluronic acid, the incorporation of FGF and PDGF enhanced cell replication at 48 h. The incorporation of PDGF in fibronectin enhanced cell replication. On fibrin, the incorporation of PDGF, EGF, and FGF significantly enhanced cell replication. However, cell replication on FGF-incorporated fibrin was higher by 48 h than that on fibrin in the presence of FGF-supplemented culture medium. Fibrin sustains the biological activity of GFs, FGF in particular, and can be a carrier for GF that stimulates cell replication.

Cardiovascular properties of LF 2.0254, a new potent vasoselective calcium channel blocker with a slow onset of action

The effects of LF 2.0254, a new 1,4-dihydropyridine derivative, were studied in rabbit aorta stimulated by various contractile agents and in isolated guinea pig atria. LF 2.0254 inhibited in a time-dependent fashion K(+)- and CA2(+)-induced contractions of rabbit aorta with respective IC50 of 2.7 nM and 1.7 nM. An action of LF 2.0254 at the voltage operated calcium channel was consistent with the finding that LF 2.0254 antagonized 45Ca2(+)-uptake induced by depolarisation of smooth muscle, and since contractile responses evoked by (-) norepinephrine and the calcium ionophore A23187 were insensitive to the drug. In isolated paced left atria and spontaneously beating right atria of guinea pig, LF 2.0254 added for 60 min at 1 microM only slightly decreased the contractile force and beating rate. In anesthetized open-thorax dogs, LF 2.0254 (1 to 100 micrograms/kg, iv) dose-dependently lowered systemic blood pressure and increased cardiac output with a slower onset of action than nifedipine. LF 2.0254 and nifedipine decreased total peripheral, coronary, femoral and vertebral resistance. In marked contrast to nifedipine, LF 2.0254 induced only a slight decrease in left ventricular dP/dt. In conscious hypertensive dogs LF 2.0254 (0.1 and 0.3 mg/kg per os) decreased blood pressure and concomitantly increased heart rate and plasma renin activity. It is concluded that LF 2.0254 differ markedly from nifedipine in its more gradual onset of action and greater selectivity for the vasculature with respect to the myocardium.

[Vasodilator effects of LF 2.0254, a new 1,4-dihydropyridine. Comparison with nifedipine]

LF 2.0254 is a new 1.4 dihydropyridine that relaxes vascular smooth muscles by blockade of calcium entry mediated by depolarisation. In rabbit aortas contracted by KCl (15 to 55 mM) or CaCl2 (2 mM), LF 2.0254 differs markedly from nifedipine and nicardipine because of its slow onset of action, the inhibitory effect increasing with the duration of tissular contact. LF 2.0254 has only slight negative chronotropic and inotropic effects on isolated guinea-pig atria as well as in anesthetized dogs after intravenous administration. Furthermore, in open-chest anesthetized dogs, LF 2.0254 decreases mean arterial blood pressure and since cardiac output is maintained total peripheral resistance is decreased. LF 2.0254 administered orally to perinephritic hypertensive dogs (0.1 and 0.3 mg/kg) and to spontaneously hypertensive rats (0.3 to 10 mg/kg) induces a more pronounced and long-lasting hypotensive action than nifedipine. In conclusion, these results suggest that LF 2.0254 could be useful in the treatment of hypertension associated or not with cardiac insufficiency.

Clinical efficacy of levamisole in the treatment of primary nephrosis in children

The purpose of the study was to evaluate the efficacy and the toxicity of levamisole given for 1 year to 16 children suffering from minimal change primary nephrosis who were relapsing frequently. The overall results showed that under levamisole the relapse rate decreased by 55% and the steroid requirements by 50%. After cessation of levamisole administration, most children (11/16) relapsed again. A second course of levamisole treatment reduced the relapse rate significantly once again. At the dosage of 2.5 mg/kg given every other day for 1 year or more, no side effects of levamisole does not cure nephrosis but reduces the incidence of relapses for the period it is administered. It also reduces the steroid requirements without any important side effects.

Comparative antihypertensive effects of nifedipine and nicardipine in adult and aged spontaneously hypertensive rats

Effects of two dihydropyridine derivatives, nifedipine and nicardipine, on systolic blood pressure and heart rate in adult (4- to 5-month-old) spontaneously hypertensive rats (SHR) were studied in comparison with those in aged (11- to 12-month-old) SHR. Both calcium channel blockers induced similar dose-dependent hypotensive effects in 4- to 5-month- and 11- to 12-month-old SHR. The maximal hypotensive action of both calcium channel blockers was delayed in aged SHR compared to adult SHR. Nicardipine induced a similar reflex tachycardia in adult and aged SHR. In contrast to nicardipine there was no increase in heart rate after administration of nifedipine in aged SHR at same hypotensive effects. It is concluded that nifedipine and nicardipine are potent antihypertensive agents in aged SHR which differently affect heart rate.

Modification of the basic side chain in tamoxifen: effects on microsomal metabolism and in vitro biological activity

The effect of reducing the basicity of the side chain in tamoxifen (1) on in vitro microsomal metabolism and biological potency has been investigated. The N-methyl-N-(2,2,2-trifluoroethyl) analogue 10 and its 4-hydroxy derivative 18 have been synthesised. The side chain of 10 was not metabolised detectably by rat liver microsomes but a small amount of 18 was formed; there was no evidence of metabolic switching. The lack of metabolism of 10 is unlikely to reflect steric effects since the N,N-diethyl analogue 9 had a metabolism profile similar to that of tamoxifen, but could reflect the reduction in the basicity of the side chain. Compounds 10 and 18 had relative binding affinities (RBA) to oestrogen receptors in rat uterine cytosol and MCF-7 whole cells approximately 5 times lower than the values for tamoxifen (1) and 4-hydroxytamoxifen (3), respectively. Also 10 was similarly less potent than 1 as an inhibitor of the growth of MCF-7 cells in culture although antioestrogenicity was maintained. There was no evidence for improved cell penetration by 10 relative to 1. Of the N-acyl analogues (15-17) of tamoxifen synthesised, the N-trifluoroacetyl analogue 15 had a very low RBA. The N-acetyl (16) and N-formyl (17) analogues had RBA values comparable to that of 1 in cell cytosol or whole cell systems, but did not inhibit growth of MCF-7 cells. Thus, although metabolism of the side-chain in tamoxifen can be inhibited, reduction of biological potency results.

The effect of Bay K 8644 on angiotensin II-induced contractions of rabbit aortic strips

The effect of Bay K 8644 on contractile responses to angiotensin II (AII) was investigated in rabbit aorta. Bay K 8644 alone did not elicit contraction while contractile responses to AII were enhanced at low concentrations (10(-8), 3 X 10(-8), 10(-7) M) and depressed at a higher concentration (10(-6) M). The potentiating effect was always observed and increased after treatment by phentolamine. These findings suggest that Bay K 8644 activates calcium channels operated by angiotensin receptors.

Aromatase, 17 beta-hydroxysteroid dehydrogenase and intratissular sex hormone concentrations in cancerous and normal glandular breast tissue in postmenopausal women

In a study of the origin of estrogens in patients with breast cancer, the concentrations of estrogens and their androgen precursors, and aromatase and 17 beta-hydroxysteroid dehydrogenase (E2DH) activities were determined in normal glandular and cancerous breast tissue. The correlation between tissue estrogens, precursor concentrations, enzyme activities and plasma levels and/or receptor status were calculated. In both normal glandular and carcinomatous breast tissue, the concentrations of androstenedione (A), dehydroepiandrosterone (DHEA), 5 androstene-3 beta, 17 beta-diol (5-Adiol), estrone (E1), estradiol (E2) and progesterone (P) were significantly higher than plasma concentrations. While testosterone (T) concentrations were similar, dehydroepiandrosterone (DHCA) and estrone sulphate (E1S) concentrations were lower in tissue than in plasma. In carcinomatous tissue androgen concentrations were lower, but estrogen concentrations were higher than in glandular breast tissue. Estradiol (E2) concentration was positively correlated with the receptor concentration with the mean E2 concentration corresponding to an estimated receptor occupancy of about 25%, probably sufficient for a submaximal biological response. Aromatase and E2DH (E2----E1) activities were observed in all breast cancer and glandular breast tissues, activities being higher in carcinoma than in glandular breast tissues; nevertheless, aromatase activity accounts probably only for a small fraction of tissue estrogen concentration. E2DH, but not aromatase activity, was significantly higher in estrogen receptor positive than in estrogen receptor negative tissues and was negatively correlated with tissue dehydroepiandrosterone (DHEA) and its sulphate (DHEAS) concentration; the latter two steroids are non competitive inhibitors of E2DH which inactivates E2 to E1. This effect of DHEA(S) may constitute a mechanism by which these androgens stimulate cancer growth and a rationale (besides suppression of estrogen precursors) for medical or surgical adrenalectomy in hormone sensitive metastatic mammary cancer. E2DH activity might constitute an additional marker of hormone dependency of mammary cancer.

A new method for evaluating the inhibitory potency of antiestrogens on breast cancer cell lines

Breast cancer cell lines in monolayer culture are helpful in evaluating the potential antitumor activity of antiestrogens. A new method has been developed to rapidly measure the inhibitory potency of a given compound without any cell harvest and counting. Cells are incubated in 96-multiwell culture dishes in the absence or presence of an antiestrogen at 3 concentrations. At the end of incubation, cells are fixed with ethanol and colored with hematoxylin. The intensity of the coloration, which is measured with a multiscan spectrophotometer, gives an accurate evaluation of the cell number and, thereby, an estimate of the inhibitory potency of the antiestrogen. Addition of estradiol to the culture allows to evaluate the antagonistic effect of this hormone towards the inhibition of the antiestrogen. Because of its rapidity and low cost, our method should offer a new dimension in the in vitro screening of antiestrogens and probably most other antineoplastic drugs.

Comparison of the effects of nifedipine, diltiazem and verapamil on the mechanical activity of rabbit papillary muscles induced by barium chloride

Isolated rabbit papillary muscles that do not present pacemaker activity under physiological conditions develop a spontaneous activity in the presence of 2 mmol/l BaCl2. Ba-induced contractions were unaffected by high concentrations of the Na antagonist procainamide (10(-5) mol/l). Tetrodotoxin (10(-5) mol/l), a specific blocker of the fast Na current, only slightly increased the amplitude of contractions. In contrast, the calcium entry blockers nifedipine, diltiazem, and verapamil strongly depressed the mechanical activity in a time- and dose-dependent manner. The concentrations that decreased the amplitude and frequency of contractions by 50% were determined. The order of potency was nifedipine much greater than diltiazem greater than or equal to verapamil. Ba-induced automaticity is a particularly useful model on which the potency of calcium entry blockers could be assessed.

Trifluoperazine antagonizes postsynaptic alpha 1-but not alpha 2-adrenoceptor-mediated pressor responses in the rat

The specificity of the alpha-adrenergic blockade by trifluoperazine was tested in pithed rats. Trifluoperazine reduced the pressor effects of (-)-noradrenaline. The log dose-response curve to methoxamine, an alpha 1-agonist, was shifted to the right whereas the vasopressor responses to BHT-920, an alpha 2-agonist, were unaffected by trifluoperazine. It was concluded that trifluoperazine acts as a peripheral vascular alpha 1-antagonist in the rat.

A new method for the preparation of beta-amylase from sweet potato

A simple method for the preparation of sweet potato beta-amylase by thymol amylose adsorption is described. The method is far more efficient and gives higher recovery of the enzyme. The crystalline enzyme thus obtained is found to be homogeneous by gel chromatography, polyacrylamide gel electrophoresis.