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Jones GS, Baldwin DR. Lung cancer screening and management. Minerva Med 2015; 106:339-354. [PMID: 26605556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Deaths from lung cancer are greater than for any other type of malignancy. Many people present with advanced stage cancer at diagnosis and survival is limited. Low radiation dose CT (LDCT) screening appears to offer part of the solution to this. The US National Lung Screening Trial (NLST) showed a 20% reduction in cancer related mortality and a 6.7% reduction in all cause mortality in patients who had LDCT compared to chest X-ray. Lung Cancer screening is now being implemented in the US using the NLST screening criteria but many questions remain about the details of the methodology of screening and its cost effectiveness. Many of these questions are being answered by ongoing European trials that are reporting their findings. In this review we objectively analyse current research evidence and explore the issues that need to be resolved before implementation, including technical considerations, selection criteria and effective nodule management protocols. We discuss the potential barriers that will be faced when beginning a national screening programme and possible solutions to them.
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Affiliation(s)
- G S Jones
- Respiratory Medicine Unit, David Evans Centre, University of Nottingham, Nottingham City Hospital Campus,Nottingham, UK -
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Chen X, Tsiang M, Yu F, Hung M, Jones GS, Zeynalzadegan A, Qi X, Jin H, Kim CU, Swaminathan S, Chen JM. Modeling, analysis, and validation of a novel HIV integrase structure provide insights into the binding modes of potent integrase inhibitors. J Mol Biol 2008; 380:504-19. [PMID: 18565342 DOI: 10.1016/j.jmb.2008.04.054] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2008] [Revised: 04/22/2008] [Accepted: 04/23/2008] [Indexed: 11/25/2022]
Abstract
It has been shown that L-731988, a potent integrase inhibitor, targets a conformation of the integrase enzyme formed when complexed to viral DNA, with the 3'-end dinucleotide already cleaved. It has also been shown that diketo acid inhibitors bind to the strand transfer complex of integrase and are competitive with the host target DNA. However, published X-ray structures of HIV integrase do not include the DNA; thus, there is a need to develop a model representing the strand transfer complex. In this study, we have constructed an active-site model of the HIV-1 integrase complexed with viral DNA using the crystal structure of DNA-bound transposase and have identified a binding mode for inhibitors. This proposed binding mechanism for integrase inhibitors involves interaction with a specific Mg(2+) in the active site, accentuated by a hydrophobic interaction in a cavity formed by a flexible loop upon DNA binding. We further validated the integrase active-site model by selectively mutating key residues predicted to play an important role in the binding of inhibitors. Thus, we have a binding model that is applicable to a wide range of potent integrase inhibitors and is consistent with the available resistant mutation data.
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Affiliation(s)
- X Chen
- Gilead Sciences, 333 Lakeside Drive, Foster City, CA 94404, USA
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Santer BD, Wigley TML, Mears C, Wentz FJ, Klein SA, Seidel DJ, Taylor KE, Thorne PW, Wehner MF, Gleckler PJ, Boyle JS, Collins WD, Dixon KW, Doutriaux C, Free M, Fu Q, Hansen JE, Jones GS, Ruedy R, Karl TR, Lanzante JR, Meehl GA, Ramaswamy V, Russell G, Schmidt GA. Amplification of surface temperature trends and variability in the tropical atmosphere. Science 2005; 309:1551-6. [PMID: 16099951 DOI: 10.1126/science.1114867] [Citation(s) in RCA: 226] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The month-to-month variability of tropical temperatures is larger in the troposphere than at Earth's surface. This amplification behavior is similar in a range of observations and climate model simulations and is consistent with basic theory. On multidecadal time scales, tropospheric amplification of surface warming is a robust feature of model simulations, but it occurs in only one observational data set. Other observations show weak, or even negative, amplification. These results suggest either that different physical mechanisms control amplification processes on monthly and decadal time scales, and models fail to capture such behavior; or (more plausibly) that residual errors in several observational data sets used here affect their representation of long-term trends.
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Affiliation(s)
- B D Santer
- Program for Climate Model Diagnosis and Intercomparison, Lawrence Livermore National Laboratory, Livermore, CA 94550, USA.
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Abstract
We report an approach for developing combinatorial fluorescence energy transfer (CFET) tags by tuning the tags' fluorescence emission signatures. The tags can all be excited at a single wavelength and analyzed by a simple optical system. We constructed eight CFET tags with unique fluorescence signatures, detected by a three-color capillary array electrophoresis (CAE) system with 488 nm excitation, using only three fluorescent dyes. A 1',2'-dideoxyribose phosphate spacer was used to separate the donor and acceptor to tune the energy transfer efficiency, generating unique fluorescence signatures. The spacer also served as an electrophoretic mobility tag to tune the mobility of CFET-labeled DNA for multiplex detection of single-nucleotide polymorphisms (SNPs). Six nucleotide variations were identified simultaneously using six CFET tags on synthetic DNA templates and on a PCR product from the retinoblastoma tumor suppressor gene.
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Affiliation(s)
- A K Tong
- Laboratory of DNA Sequencing and Chemical Biology, Columbia Genome Center, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
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Abstract
A comparison of observations with simulations of a coupled ocean-atmosphere general circulation model shows that both natural and anthropogenic factors have contributed significantly to 20th century temperature changes. The model successfully simulates global mean and large-scale land temperature variations, indicating that the climate response on these scales is strongly influenced by external factors. More than 80% of observed multidecadal-scale global mean temperature variations and more than 60% of 10- to 50-year land temperature variations are due to changes in external forcings. Anthropogenic global warming under a standard emissions scenario is predicted to continue at a rate similar to that observed in recent decades.
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Affiliation(s)
- P A Stott
- Met Office, Hadley Centre for Climate Prediction and Research, Bracknell, Berkshire RG12 2SY, UK.
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Abstract
Recognition of the autistic spectrum disorders is becoming more widespread amongst basic scientists, clinicians, and the general population. The term does not imply anything about pathology or aetiology, although it has proved to be a useful concept clinically. From Kanner's classical autism the concept has widened in scope to include milder and more subtle impairments. From a clinical perspective, there are many alternative diagnoses in an individual with autistic-like symptoms, and thorough investigation is necessary to exclude these.
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Affiliation(s)
- G S Jones
- Woodlands Hospital, Cults, Aberdeen, UK.
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Kerdelhué B, Williams RF, Lenoir V, Fardin V, Kolm P, Hodgen GD, Jones GS, Scholler R, Jones HW. Variations in plasma levels of substance P and effects of a specific substance P antagonist of the NK(1) receptor on preovulatory LH and FSH surges and progesterone secretion in the cycling cynomolgus monkey. Neuroendocrinology 2000; 71:228-36. [PMID: 10773742 DOI: 10.1159/000054540] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
These studies investigated the role of substance P (SP) in the regulation of the hypothalamic-pituitary-ovarian axis in cynomolgus monkeys with normal menstrual cycles. Plasma concentrations of SP were determined in blood samples taken every morning in normally menstruating cynomolgus monkeys throughout the menstrual cycle. There was a significant decreasing linear trend of SP during the follicular phase (cycle day -13 to day 0) and a significant inverse relationship between SP plasma values and plasma 17beta-estradiol (E(2)) values from day -13 to day 0 of the adjusted cycle. Correspondingly, SP area under the curve was significantly greater during the follicular phase than the luteal phase. In a second experiment, plasma concentrations of E(2), luteinizing hormone (LH), follicle-stimulating hormone (FSH) and progesterone and length of cycles were measured after five daily intragastric administrations (10 mg/kg) of an NK(1) receptor (SP receptor) antagonist (RPR 100893; 10 mg/kg) initiated after serum E(2) concentrations had exceeded 125 pg/ml. There was a statistically significant reduction in the amplitude (41% of control) and the area under the curve (37% of control) of the preovulatory LH surge. In addition, there was a reduction of the duration of the LH surge (3 +/- 0.1 days in controls vs. 2.1 +/- 0.2 days in treated animals). The present results show for the first time that there are significant variations in plasma levels of SP, with a strong negative correlation with serum levels of E(2) during the follicular phase of the cynomolgus monkey, and that endogenous SP has a potentiating role in the interactive hypothalamo-anterior-pituitary mechanisms which lead to the preovulatory LH and FSH surges during the menstrual cycle in the monkey.
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Affiliation(s)
- B Kerdelhué
- Laboratoire de Neurobiologie Cellulaire et Moléculaire, CNRS E.P. 1591, Faculté de Pharmacie, Paris, France.
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Montgomery TR, Aiello F, Adelman RD, Wasylyshyn N, Andrews MC, Brazelton TB, Jones GS, Jones HW. The psychological status at school age of children conceived by in-vitro fertilization. Hum Reprod 1999; 14:2162-5. [PMID: 10438444 DOI: 10.1093/humrep/14.8.2162] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This study assessed the behavioural and psychological profiles of children conceived by in-vitro fertilization (IVF) who are now at school age. A total of 743 IVF children born at one institution and now of school age, over 4 years old, were surveyed with Achenbach questionnaires. Follow-up telephone interviews were conducted with non-responders. The results from the study group were compared to the questionnaire control group using one-tailed t-test with statistical significance set less than 0.05. There was an 84% overall response rate. Sixty-seven per cent returned questionnaires. An additional 17% completed a telephone interview. The study group had no statistically significant increase in the rate of behavioural or psychological problems compared with the control group. There were no statistically significant differences within the study group related to sex or to multiple gestation IVF births. This large group of school-age IVF children has normal psychological development with no identified adverse effect of their status as IVF children. Determining the role, if any, of IVF in the very small number of children with behavioural and psychological problems will require additional study.
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Affiliation(s)
- T R Montgomery
- Department of Pediatrics, Eastern Virginia Medical School, Children's Hospital of the King's Daughters, Norfolk, VA 23507, USA
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Moaddel R, Sharma A, Huseni T, Jones GS, Hanson RN, Loring RH. Novel biotinylated phenylarsonous acids as bifunctional reagents for spatially close thiols: studies on reduced antibodies and the agonist binding site of reduced Torpedo nicotinic receptors. Bioconjug Chem 1999; 10:629-37. [PMID: 10411461 DOI: 10.1021/bc9801575] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We synthesized three novel organoarsenicals as prototype bifunctional reagents for spatially close thiols, N-(4-arsenosophenyl) hexahydro-2-oxo-(3aS,4S,6aR)-1H-thieno[3, 4-d]imidazole-4-pentamide (1), 2-[4-[(4-arsenosophenyl)amino]-1, 4-dioxobutyl] hydrazide, (3aS,4S,6aR)-hexahydro-2-oxo- 1H-thieno[3, 4-d] imidazole-4-pentanoic acid (2), and [4-[[12-[[5-[(3aS,4S, 6aR)-hexahydro-2-oxo-1H-thieno[3, 4-d]imidazol-4-yl]-1-oxopentyl]amino]-1-oxododecyl]amino]phe nyl]-arso nous acid (3) containing both biotin and arsenic with intervening varying length spacers extending from 2 to 15 A beyond biotin bound to streptavidin. Conceptually, the arsenical group can form a stable, covalent ring structure with appropriately spaced thiols and thereby anchor the reagent to a macromolecule, while biotin allows for the detection of the reagent-macromolecule complex via avidin binding. Because the alpha-subunits of all characterized nicotinic receptors contain an easily reducible disulfide bond between adjacent cysteine residues, the reduced alpha-subunit is an attractive site for labeling. Compounds 1-3 all simultaneously bound streptavidin and dithiols, and all three decreased the number of [125I]alpha-bungarotoxin-binding sites in reduced Torpedo nicotinic receptors (IC50s 10-300 nM). Moreover, arsenylation of the receptors prevented their reoxidation with dithio-bis(nitrobenzoic acid), was reversible with 2,3-dimercaptopropanesulfonic acid, and protected the receptor from irreversible alkylation by bromoacetylcholine. However, in no case did 1-3 allow simultaneous binding to reduced nicotinic receptors and to [125I]streptavidin, although 3 alone allowed simultaneous labeling of a spatially close dithiol located in reduced antibodies.
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Affiliation(s)
- R Moaddel
- Department of Pharmaceutical Sciences, Northeastern University, Boston, Massachusetts 02115, USA
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Mohyi DL, Kerdelhué B, Lenoir V, Kolm P, Jones HW, Jones GS. Plasma substance-P and substance-K and gonadal steroids in relation to the gonadotropin surge in normal human reproductive cycles. J Assist Reprod Genet 1998; 15:547-51. [PMID: 9822983 PMCID: PMC3454922 DOI: 10.1023/a:1022534204239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE This study was designed to examine changes in peripheral plasma substance-P and -K levels, their association with follicle-stimulating hormone and luteinizing hormone release in normal reproductive cycles in humans, and their correlation with plasma estradiol and progesterone. METHODS Fourteen healthy, normally menstruating women underwent daily blood sampling (cycle day 4, 4-14 days) for measurement of estradiol, progesterone, luteinizing hormone, and follicle-stimulating hormone, substances-P and -K, and daily transvaginal ultrasounds assessing follicular growth and documentation of ovulation. RESULTS Estradiol peaked on day 13, luteinizing hormone and follicle-stimulating hormone peaked on day 14, and progesterone began an exponential increase on about day 13. CONCLUSIONS In contrast to other experimental designs using in vitro or in vivo rat or monkey tissue, peripheral levels of substances-P (P = 0.8391) and -K (P = 0.3205) reflected no modulation related to midcycle gonadotropin release in cycling woman.
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Affiliation(s)
- D L Mohyi
- Jones Institute for Reproductive Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia, USA
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Carcillo JA, Korzekwa KR, Jones GS, Parise RA, Gillespie DG, Whalen MJ, Kochanek PM, Branch RA, Kost CK. The cytochrome P450 suicide inhibitor, 1-aminobenzotriazole, sensitizes rats to zymosan-induced toxicity. Res Commun Mol Pathol Pharmacol 1998; 102:57-68. [PMID: 9920346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Reduction in whole body cytochrome P450 (CYP 450) activity is evident in humans who develop trauma and sepsis-induced multiple organ failure (MOF). It is not known whether this has any deleterious or protective effect. Intraperitoneal injection of zymosan, the cell wall of Saccharomycoses A, induces dose-dependent inflammation with concomitant MOF in rats. High dose intraperitoneal zymosan (100 mg/100 g body weight) causes mortality and organomegaly in rats; low dose zymosan (20 mg/100 g body weight) does not. To study a role for CYP 450 in zymosan-induced toxicity, we examined the effect of the non-specific CYP 450 suicide inhibitor 1-aminobenzotriazole (1-ABT)(80 mg/kg/d), on rats treated with low dose zymosan. The 90% reduction in CYP 450 content achieved by this dose of 1-ABT was associated with 58% mortality in rats treated with low dose zymosan, in contrast to no mortality in rats treated with low dose zymosan alone (p < 0.01). In survivors, liver and lung organomegaly (p < 0.01), and polymorphonuclear leukocyte accumulation in the liver (p < 0.01) were increased after zymosan administration in rats treated with 1-ABT compared to those without 1-ABT. There was no effect of treatment with 1-ABT on the increased urinary excretion of nitric oxide byproducts observed after zymosan administration. These observations are consistent with the hypothesis that the CYP 450 enzyme system is an endogenous protectant in this experimental model of inflammation-induced MOF.
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Affiliation(s)
- J A Carcillo
- Center for Clinical Pharmacology, Dept of Anesthesiology and Critical Care Medicine, University of Pittsburgh School of Medicine, PA, USA
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Kerdelhué B, Gordon K, Williams R, Lenoir V, Fardin V, Chevalier P, Garret C, Duval P, Kolm P, Hodgen G, Jones H, Jones GS. Stimulatory effect of a specific substance P antagonist (RPR 100893) of the human NK1 receptor on the estradiol-induced LH and FSH surges in the ovariectomized cynomolgus monkey. J Neurosci Res 1997; 50:94-103. [PMID: 9379497 DOI: 10.1002/(sici)1097-4547(19971001)50:1<94::aid-jnr10>3.0.co;2-a] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Utilizing a human NK1 receptor antagonist (RPR 100893), the present in vivo study was designed to test the hypothesis that endogenous substance P (SP) modulates the action of 17beta-estradiol in inducing luteinizing hormone (LH) and follicle stimulating hormone (FSH) surges in ovariectomized cynomolgus monkey. Plasma concentrations of LH and FSH as well as NK1 receptor antagonist and SP were measured during the development of the negative and positive feedback phases which follow a single administration of estradiol benzoate (50 microg/kg) to long-term ovariectomized monkeys. Daily administration by gastric intubation of 1 mg/kg or 10 mg/kg of the NK1 receptor antagonist (RPR 100893) leads to detectable levels of the antagonist in the blood of treated animals for at least 6 hr after its administration. These levels are in agreement with the experimentally determined IC50 value of the antagonist. The most striking finding of this study is that LH and FSH releases are enhanced during the descending arm of the estradiol benzoate-induced LH and FSH surges, which suggests that endogenous SP normally has an inhibitory role during this time. The enhancement of LH release is approximately 50%, regardless of the amount of the NK1 antagonist used. However, the enhanced FSH release is more important. Furthermore, blockade of the NK1 receptor with the smaller dose of the antagonist leads to a small, but significant, increase in plasma levels of SP, indicating that blockade of SP receptors leads to an increased release of SP. Collectively, these results further substantiate the link which exists between the ovarian steroid 17beta-estradiol and SP systems. Also, for the first time, these results demonstrate an inhibitory involvement of the human NK1 receptor in the 17beta-estradiol-induced pseudo-ovulatory gonadotropin surges in the ovariectomized monkey.
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Affiliation(s)
- B Kerdelhué
- Laboratoire de Neuroendocrinologie, Faculté de Pharmacie, Paris, France
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Kerdelhué B, Lenoir V, Kolm P, Seltman HJ, Jones HW, Jones GS. ACTH, beta-endorphin, substance P, and corticotrophin releasing hormone in plasma and follicular fluid in hormonally stimulated menstrual cycles for in-vitro fertilization in the human. Hum Reprod 1997; 12:231-5. [PMID: 9070701 DOI: 10.1093/humrep/12.2.231] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Changes in plasma concentrations of ACTH, beta-endorphin (beta-EP) and cortisol have been found to be associated during the human menstrual cycle. Changes in hypothalamic levels of gonadotrophin releasing hormone (GnRH), beta-EP and substance P (SP) have also been associated with the oestrous cycle in the rat. Therefore, an attempt was made to measure the activity of the corticotrophic axis and SP by measuring blood and follicular fluid concentrations of ACTH, beta-EP, SP and corticotrophin releasing hormone (CRH) during the hormonal ovarian stimulation phase for in-vitro fertilization (IVF), in a series of 19 patients. At the plasma level, there was no significant change over treatment days in ACTH (P = 0.1550), beta-EP (P = 0.1137), or SP concentrations (P = 0.5625). CRH was not detectable over treatment days. In addition, there was no significant change in neuropeptide over treatment days between those women who became pregnant and those who did not (P = 0.17 for all). In the follicular fluid, ACTH was not detectable, beta-EP concentration was three times higher than in the plasma, CRH was detectable, and SP concentration was similar to that of plasma. There was no apparent correlation, however, between beta-EP or SP concentrations in the plasma and follicular fluid from a given patient. In conclusion, the absence of changes in the activity of the corticotrophic axis during the hormonal ovarian stimulation suggests that there was no major stress component associated with the stimulation phase of IVF or the occurrence of a pregnancy.
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Affiliation(s)
- B Kerdelhué
- Laboratoire de Neuroendocrinologie, Faculté des Sciences Pharmaceutiques et Biologiques, Université Rene Descartes, Paris V, France
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Jones GS. Book reviewsNuclear Medicine Annual 1995. Ed. by FreemanL M, pp.x+288, 1995 (Raven Press, New York), $129.00 ISBN 0781702852. Br J Radiol 1996. [DOI: 10.1259/0007-1285-69-819-289-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Xie Y, McHugh T, McKay J, Jones GS, Loring RH. Evidence that a nereistoxin metabolite, and not nereistoxin itself, reduces neuronal nicotinic receptors: studies in the whole chick ciliary ganglion, on isolated neurons and immunoprecipitated receptors. J Pharmacol Exp Ther 1996; 276:169-77. [PMID: 8558427 DOI: 10.1163/2211730x96x00090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Nereistoxin (100 microM, 2-10 min) blocks nicotinic receptors in the intact chick ciliary ganglion. This effect mimics blockade by the reducing agent dithiothreitol (2 mM, 20 min), which is not reversed until oxidation with dithiobisnitrobenzoic acid (1 mM, 5 min). After treating intact ganglia with either nereistoxin or dithiothreitol, the affinity alkylating agent bromoacetylcholine causes irreversible blockade that cannot be reversed by dithiobisnitrobenzoic acid. These data suggest that nereistoxin, or a metabolite, acts to reduce nicotinic receptors, although nereistoxin differs from dithiothreitol in that agonists only partially protect against nereistoxin reduction. In studies on chick retina, we previously proposed that a metabolite of nereistoxin (such as dihydronereistoxin) is the actual reducing agent for neuronal nicotinic receptors. Current findings in chick ciliary ganglion supporting this hypothesis include: 1) changing pH alters the minimal nereistoxin concentration needed for blockade in intact ganglia, but has little effect on the minimal concentration needed for dithiothreitol, 2) application of a quaternary analog of nereistoxin has little effect on intact ganglion, but a quaternary analog of dihydronereistoxin blocks nicotinic receptors by reduction, 3) nereistoxin weakly oxidizes rather than reduces immunoprecipitated receptors from chick brain and 4) in whole-cell patch-clamp studies, nereistoxin clearly does not reduce receptors on chick ciliary neurons, although dihydronereistoxin mimics receptor blockade by dithiothreitol, and requires oxidation by dithiobisnitrobenzoic acid for reactivation. Together, these data suggest that nereistoxin is not a direct reducing agent for neuronal nicotinic receptors.
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Affiliation(s)
- Y Xie
- Department of Pharmaceutical Sciences, Northeastern University, Boston, Massachusetts, USA
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Jackson EK, Koehler M, Mi Z, Dubey RK, Tofovic SP, Carcillo JA, Jones GS. Possible role of adenosine deaminase in vaso-occlusive diseases. J Hypertens 1996; 14:19-29. [PMID: 12013490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
OBJECTIVE To describe several emerging concepts regarding the biosynthesis, metabolism and biological roles of adenosine and to illustrate the possible significance of these ideas to vascular biology by proposing a hypothesis pertaining to the role of erythrocyte-derived adenosine deaminase in vaso-occlusive diseases associated with damaged erythrocytes. MULTIPLE PATHWAYS FOR ADENOSINE FORMATION Three pathways of adenosine biosynthesis have been well established: the intracellular ATP pathway, the extracellular ATP pathway and the transmethylation pathway. A fourth pathway that has received relatively little attention, but could be particularly important in vascular smooth muscle, is the cyclic AMP-adenosine pathway. This pathway involves the extracellular or intracellular metabolism, or both, of cyclic AMP to AMP and hence to adenosine. Our recent experiments in cultured vascular smooth muscle cells, isolated vascular beds and intact animals support the existence of the cyclic AMP-adenosine pathway. Together these four pathways of adenosine formation should assure pharmacologically active levels of vascular adenosine. ANTIVASO-OCCLUSIVE ACTIONS OF ADENOSINE: The overall pharmacologic profile of adenosine suggests that this nucleoside functions to protect vascular beds from vaso-occlusive events. In this regard, some well known effects of adenosine include vasodilation, release of nitric oxide from vascular endothelial cells and inhibition of platelet aggregation, platelet adhesion, neutrophil-endothelial interactions, renin release and noradrenergic neurotransmission. Moreover, studies indicate that adenosine also releases nitric oxide from cultured vascular smooth muscle cells and inhibits vascular smooth muscle cell growth. Thus, any condition that reduces the levels of adenosine in the blood vessel wall or blood vessel-blood interface might predispose toward vaso-occlusive events. DAMAGE TO ERYTHROCYTES REDUCES ADENOSINE LEVELS Adenosine deaminase rapidly metabolizes adenosine to inosine, which lacks antivaso-occlusive properties. Because erythrocytes are generously endowed with adenosine deaminase, any condition that damages erythrocytes will cause leakage of adenosine deaminase from erythrocytes directly onto the blood vessel wall, thus diminishing local vascular levels of adenosine. Experiments using dimethyl sulfoxide-induced hemolysis have confirmed the hypothesis that erythrocyte-derived adenosine deaminase can reduce adenosine levels in vivo. HYPOTHESIS THE ROLE OF ERYTHROCYTE-DERIVED ADENOSINE DEAMINASE IN VASO-OCCLUSIVE DISEASES: Because multiple biosynthetic pathways maintain pharmacologically active levels of adenosine within the blood vessel wall and adenosine exerts a number of antivaso-occlusive effects, release of adenosine deaminase from erythrocytes may increase the risk for vaso-occlusive events.
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Affiliation(s)
- E K Jackson
- Center for Clinical Pharmacology, University of Pittsburgh Medical Center, Pennsylvania 15213-2582, USA
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Schoolcraft WB, Schlenker T, Jones GS, Jones HW. In vitro fertilization in women age 40 and older: the impact of assisted hatching. J Assist Reprod Genet 1995; 12:581-4. [PMID: 8580653 DOI: 10.1007/bf02212578] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
PURPOSE To assess the impact of assisted hatching on in vitro fertilization (IVF) outcome in women age 40 and older. METHODS A retrospective analysis was performed to compare 28 cycles of IVF without assisted hatching to 38 cycles of IVF with assisted hatching. All patients in both groups were age 40 or older and the mean age was similar. RESULTS The delivery rate per oocyte retrieval was significantly higher in the assisted hatching group (18/38; 48%) compared to the nonhatched controls (3/28; 11%, P = 0.0003). The implantation rate of hatched embryos (40/175; 22%) was clearly enhanced, compared to the nonhatched embryos (7/126; 6%, P < 0.001). The fertilization rate, number of oocytes and the number of embryos per patient were comparable in the two groups. CONCLUSIONS Assisted hatching dramatically improves embryonic implantation and term pregnancy rates in women age 40 and older undergoing IVF.
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Affiliation(s)
- W B Schoolcraft
- Center for Reproductive Medicine, Englewood, Colorado 80110, USA
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Kerdelhué B, Jones GS, Gordon K, Seltman H, Lenoir V, Mélik Parsadaniantz S, Williams RF, Hodgen GD. Activation of the hypothalamo-anterior pituitary corticotropin-releasing hormone, adrenocorticotropin hormone and beta-endorphin systems during the estradiol 17 beta-induced plasma LH surge in the ovariectomized monkey. J Neurosci Res 1995; 42:228-35. [PMID: 8568923 DOI: 10.1002/jnr.490420210] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The present work describes time-dependent changes in the content of corticotropin-releasing hormone (CRH), adrenocorticotropin (ACTH), and beta-endorphin (beta-EP) in the hypothalamus (HT) and anterior pituitary (AP) and in the concentration of ACTH and beta-EP in the plasma during the 17 beta estradiol (E2) benzoate (E2B)-induced luteinizing hormone (LH) surge in ovariectomized cynomolgus monkeys. Monkeys were euthanized at 0, 30, 48, 72, and 96 hr post-E2B. HT and AP were rapidly dissected, extracted in 2 N acetic acid containing 1 mM phenylmethane sulfonyl fluoride at 4 degrees C, and centrifuged at 18,000g for 30 min. Peptide concentrations were measured in the supernatant by specific radioimmunoassays (RIAs). In the HT, there were significant (P < 0.05) decreases in ACTH and beta-EP content by 30 hr post-E2B and a significant (P < 0.05) decrease in HT CRH content 48 hr post-E2B. Thereafter, CRH, ACTH, and beta-EP content increased up to 72 hr post-E2B. In the AP, there was an almost linear decrease in the CRH content through 48 hr post-E2B followed by a marked 20-fold (P < 0.01) increase in the AP CRH content at 72 hr post-E2B, which corresponds to the time of the descending arm of the LH surge. The patterns of ACTH and beta-EP content were very similar in the AP, while that of CRH differed markedly. In contrast, in the HT CRH, ACTH, and beta-EP profiles were very similar. Significant (P < 0.05) increases in circulating levels of ACTH, beta-EP, and cortisol were evident at 30 hr (all 3 hormones), 48 hr (beta-EP and cortisol), and 72 hr (cortisol) post-E2B, which corresponds with the time of decreased hypothalamic content of CRH, ACTH, and beta-EP. These results suggest that there maybe a marked activation of the hypothalamo-anterior pituitary-adrenal axis during the negative and positive feedback phases of the E2B-induced LH surge in the ovariectomized monkey.
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Affiliation(s)
- B Kerdelhué
- Laboratoire de Neurobiologie de la Reproduction, CNRS, Jouy-en-Josas, France
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Abstract
OBJECTIVE To access the effect of augmenting IVF with assisted hatching in the treatment of poor-prognosis patients. DESIGN Thirty-three poor-prognosis IVF patients were treated with assisted hatching and were compared with 43 control subjects without assisted hatching. SETTING Center for Reproductive Medicine, Swedish Medical Center, Englewood, Colorado. PARTICIPANTS Seventy-six women undergoing IVF with a poor prognosis for pregnancy. Poor prognosis was defined as Elevated day 3 FSH level; age > or = 39 years; and multiple prior IVF failures. MAIN OUTCOME MEASURES Pregnancy and implantation rates per embryo. RESULTS The incidence of ongoing pregnancy in the assisted hatching group was 64% compared with 19% in the control group. Implantation rate per embryo transferred was 33% in the assisted hatching group versus 6.5% in the control group. CONCLUSIONS These results demonstrate that assisted hatching, when applied to poor-prognosis patients, improves embryonic implantation and pregnancy rates.
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Affiliation(s)
- W B Schoolcraft
- Center for Reproductive Medicine, Swedish Medical Center, Englewood, Colorado 80110
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21
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Abstract
An In vitro comparison of the corrosion response of 316LVM stainless steel and MP35N (a CoNiCrMo alloy) electrodes under conditions appropriate to applications in functional electrical stimulation (FES) was made. Electrodes of both alloys were subjected to a cathodic 40 microC/cm2 charge injection protocol and the potential transient response was recorded over a 96 h period. The transient responses were compared with potentiodynamic polarization data used to establish the quasiequilibrium response of the alloys in the carbonate and phosphate-buffered saline electrolyte used in the study. The MP35N electrodes exhibited extensive pitting corrosion during charge injection, whereas little corrosion was observed on 316LVM electrodes. An explanation for the susceptibility of MP35N to corrosion during charge injection is found in the potentiodynamic polarization data, which reveal a breakdown potential (critical pitting potential) of 0.45 V (SCE) for MP35N compared with 1.05 V (SCE) for 316LVM. Factors that may influence corrosion response during charge injection from alloys exhibiting active-passive behavior are discussed.
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Affiliation(s)
- S F Cogan
- EIC Laboratories, Norwood, Massachusetts 02062
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22
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Zardiackas LD, Teasdall RD, Black RJ, Jones GS, St John KR, Dillon LD, Hughes JL. Torsional properties of healed canine diaphyseal defects grafted with a fibrillar collagen and hydroxyapatite/tricalcium phosphate composite. J Appl Biomater 1994; 5:277-83. [PMID: 8580534 DOI: 10.1002/jab.770050402] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The need for alternatives to autogenous bone grafts is widely recognized. This study compared the torsional strength of canine femora 1 year after grafting with one of three forms of a collagen/hydroxyapatite/tricalcium phosphate bone grafting material (COLLAGRAFTTM), autogenous bone, or no graft. The groups were compared to each other and to the unoperated contralateral femora. Results of torsional testing were evaluated for torsional strength, torsional displacement, total energy to fracture and White fracture mode. Data analysis showed lower torsional strength of the operated vs. unoperated femora with the exception of morsellized COLLAGRAFTTM material, which had higher strength. However, the only difference in the operated groups was that the morsellized COLLAGRAFTTM had greater strength than several groups including the autogenous bone group. There was no difference found in angular displacement between any of the groups. However, there was a difference in the energy to fracture in both strip forms of the COLLAGRAFTTM. The final conclusion is that in this model, grafting with COLLAGRAFTTM provided torsional properties at one year postoperatively at least equivalent to autogenous bone.
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Affiliation(s)
- L D Zardiackas
- Department of Orthopaedic Surgery, University of Mississippi Medical Center, Jackson 39216, USA
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Abstract
The synthesis and biodistribution is described for a new 99mTc-labeled fatty acid. The requisite diaminodithiol (N2S2) ligand, 9,10-bis[N-(2'-methyl-2'-mercapto)propyl] aminooctadecanoic acid, was prepared in nine steps from ethyl oleate and characterized by fast atom bombardment mass spectrometry and elemental analysis of its nickell(II) complex. The radiolabeling procedure provided a liposoluble 99mTc-labeled complex (99mTc-11) which was administered intravenously to rats concomitantly with 15-(p-[125I]-iodophenyl) pentadecanoic acid (IPPA). The myocardial profile of 99mTc-11 was inferior to that of IPPA.
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Affiliation(s)
- G S Jones
- Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA
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Affiliation(s)
- D E Matthews
- Department of Orthopedic Surgery, University of Mississippi Medical Center, Jackson 49216-4505
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25
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Abstract
A series of phosphoranilidohydrazones of 5-nitro-2-furaldehyde was synthesized and evaluated for antibacterial activity. The series was prepared to examine the applicability of phosphoramidic hydrazones as carriers for the antibacterial nitrofuran moiety. Designed as analogues of nitrofurantoin, members of the series were chosen according to the Topliss approach to analogue design. The title compounds were devoid of gram-negative activity but possessed moderate antistaphylococcal activity. The most potent members of the series were equipotent with nitrofurantoin against Staphylococcus aureus. The relationship between structure and antistaphylococcal activity is discussed.
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Affiliation(s)
- G S Jones
- Department of Pharmaceutical Sciences, Bouve College of Pharmacy and Health Sciences, Northeastern University, Boston, MA 02115
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Abstract
Twelve patients with flexion contractures of the elbow were managed by arthroscopic release of the proximal capsule and debridement of the olecranon fossa. Postoperatively the mean flexion contracture improved from 38 to 3 degrees with supination improving from 45 to 84 degrees and pronation improving from 80 to 88 degrees. All patients reported a decrease in pain level as well as improvement in motion. There was one severe complication in this series, in which a patient sustained a permanent posterior interosseous nerve palsy. Arthroscopic limited capsular release appears to be satisfactory management modality for flexion contracture of the elbow.
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Affiliation(s)
- G S Jones
- Mississippi Sports Medicine & Orthopaedic Center, Jackson
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Elmaleh DR, Kizuka H, Hanson RN, Jones GS, Herman LW, Strauss HW. Structure-localization relationships of 11C-labeled phentermine derivatives: effect of aromatic substitution. Appl Radiat Isot 1993; 44:821-9. [PMID: 8485509 DOI: 10.1016/0969-8043(93)90023-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A series of phentermine analogs, including the unsubstituted, the para-F, -Cl, -Br and -I, and the meta-CF3 derivatives, were labeled by [11C]methylation and evaluated in rats to determine the structure-localization relationships for this class of regional cerebral blood flow imaging agents. All the phentermines were well-localized in the brain; however, only the para-substituted agents were well-retained. Localization in the nontarget tissue was affected by the lipophilicity of the substituent. Comparison with the radioiodinated analogs showed virtually identical results, which suggests that the compounds were not significantly metabolized. The agent with the best biodistribution characteristics was the N-[11C]methyl-p-iodophentermine, with the p-bromo analog almost equivalent.
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Affiliation(s)
- D R Elmaleh
- Department of Radiology, Massachusetts General Hospital, Boston, 02114
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28
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Kerdelhué B, Jones GS, Gordon K, Seltman H, Lenoir V, Millar RP, Williams RF, Hodgen GD. Hypothalamo-anterior pituitary gonadotropin-releasing hormone and substance-P systems during the 17 beta-estradiol-induced plasma luteinizing hormone surge in the ovariectomized female monkey. Endocrinology 1993; 132:1151-7. [PMID: 7679971 DOI: 10.1210/endo.132.3.7679971] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The present study examined the effects of 17 beta-estradiol benzoate (E2B) on the hypothalamic (HT) and anterior pituitary (AP) content of GnRH precursor (pro-GnRH-GAP), GnRH, GnRH-associated peptide (GAP), and substance-P (SP) during the various phases of the E2B-induced LH surge in cynomolgus monkeys. Changes in GnRH and GnRH-associated peptide (GAP) at both hypothalamic and AP levels were closely related at all times after E2B treatment. However, the pattern of change in the AP was very different from that in the HT. In the HT, pro-GnRH-GAP levels did not change significantly throughout the experimental period. In the AP, the pro-GnRH-GAP increased 48 h post-E2B treatment, the time of initiation of the LH surge. An 8-fold increase in AP GnRH occurred 30 h post-E2B treatment. There were no significant changes in the HT content of SP at any time after E2B treatment. However, there was a depletion of AP content by 48 h post-E2B, the time of the LH surge. These results demonstrate that E2 activates and deactivates in a coordinated manner the GnRH and SP systems of the HT-AP complex during initiation of the E2-induced LH surge. The observation that more significant changes occur in the AP than in the HT suggests that an important component of the E2 effect in inducing the LH surge may be directly at the AP level. This action involves changes in the contents of GnRH and SP in the AP.
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Affiliation(s)
- B Kerdelhué
- Laboratoire de Neurobiologie de la Reproduction, CNRS-INRA, Jouy-en-Josas, France
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29
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Loring RH, Dou YM, Lane W, Jones GS, Stevenson KJ. Aromatic trivalent arsenicals: covalent yet reversible reagents for the agonist binding site of nicotinic receptors. Brain Res Mol Brain Res 1992; 15:113-20. [PMID: 1331657 DOI: 10.1016/0169-328x(92)90158-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The agonist binding site of nicotinic acetylcholine receptors (AChRs) includes a disulfide bond that is easily reduced with dithiothreitol to a pair of thiols, and can be then either reoxidized with dithiobis(nitrobenzoic acid) (DTNB) or irreversibly alkylated with bromoacetylcholine (BAC). Aromatic trivalent arsenicals form stable complexes with pairs of appropriately-spaced thiols, but not single thiols. Furthermore, once complexed in proteins, trivalent arsenicals can be removed with dimercaptans, such as 2,3-dimercaptopropanesulfonic acid (DMPS). In an effort to develop reagents that will covalently, yet reversibly label AChRs, we investigated the effects of two model arsenicals, p-aminophenyldichloroarsine (APA) and 4-bromoacetyl-aminophenylarsenoxide (BAPA) on two types of nicotinic receptors: AChRs from Torpedo electroplax and neuronal receptors from chick retina. APA and BAPA significantly decrease the number of 125I-alpha-bungarotoxin binding sites in reduced Torpedo AChRs. Furthermore, arsenylation of neuronal and Torpedo receptors with APA or BAPA (1) prevents reoxidation with DTNB, (2) is reversible with DMPS, and (3) protects against irreversible alkylation by BAC. In Torpedo receptors, the EC50 of protection against BAC alkylation with APA or BAPA is approximately 30 nM. APA arsenylation of Torpedo receptors persists up to 20 h, but can be reversed at any time with DMPS. These results suggest that heterobifunctional arsenicals could anchor labeling groups in the agonist binding site in order to map the agonist binding site, quantitate receptors, or purify and reconstitute functional receptors.
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Affiliation(s)
- R H Loring
- Department of Pharmaceutical Sciences, Northeastern University, Boston, MA 02115
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30
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Xie Y, Jones GS, Loring RH. Effects of oxidizing and reducing analogs of acetylcholine on neuronal nicotinic receptors. Mol Pharmacol 1992; 42:356-63. [PMID: 1301068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The synthesis and pharmacological characterization of dithiobisacetylcholine and dithiobis-N,N-dimethyl-4-acetylpiperazinium (two oxidizing analogs of acetylcholine), as well as those of their reduced counterparts, are described. Both the oxidizing and reducing analogs stimulate nicotinic receptors in the chick retina and block the binding of 125I-labeled neuronal bungarotoxin to retinal homogenates (IC50 values of 2 x 10(-6) to 6 x 10(-5) M). Both oxidizing compounds reverse the physiological effects of reduction by dithiothreitol on nicotinic function in intact chick retina, when applied for 2 sec (EC50 values of about 10(-5) M). This effect is selective, insofar as neither agent alters the effects of dithiothreitol treatment on receptors for N-methyl-D-aspartate. Reoxidation takes place at the disulfide located near the nicotinic receptor agonist binding site, inasmuch as reoxidation by these agents prevents affinity alkylation by bromoacetylcholine, and occupation by the competitive antagonist d-tubocurarine prevents reoxidation. Unlike thiocholine, a weak agonist with a free sulfhydryl that, paradoxically, is reported to oxidize nicotinic receptors in electroplax, the reduced forms, mercaptoacetylcholine and N,N-dimethylamino-4-mercaptoacetylpiperazinium, have no direct redox effects on retinal receptors, but they do protect the receptors against reduction by dithiothreitol.
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Affiliation(s)
- Y Xie
- Department of Pharmaceutical Sciences, College of Pharmacy and Allied Health Professions, Northeastern University, Boston, Massachusetts 02115
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31
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Shahmanesh M, Drake S, White D, Horton A, Evans J, Jones GS. Persistent alveolar increased permeability to 99mTc DTPA in patients with advanced HIV infection. Thorax 1992; 47:575-6. [PMID: 1412109 PMCID: PMC463881 DOI: 10.1136/thx.47.7.575-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Jones GS, Bylund DB, Hanson RN. Synthesis and binding to beta-adrenergic receptors of p-aminobenzyl analogues of practolol and atenolol. J Pharm Sci 1992; 81:397-8. [PMID: 1354250 DOI: 10.1002/jps.2600810422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The p-aminobenzyl analogues (8a and 8b, respectively) of the cardioselective beta-adrenergic receptor antagonists practolol and atenolol were prepared from the corresponding phenoxymethyloxiranes in 30 and 13% yields, respectively. The dissociation constants for the beta-adrenergic receptor were measured in membrane preparations of rat heart and lung. In membranes from the heart (which contain mostly beta 1-adrenergic receptors), the affinities of the derivatives and parent compounds were similar. By contrast, in membranes from the lung (which contain mostly beta 2-adrenergic receptors), the derivatives were more potent than the parent compounds. Thus, the cardioselectivities of the p-aminobenzyl analogues 8a and 8b were about one-sixth those of the respective parents.
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Affiliation(s)
- G S Jones
- Section of Medicinal Chemistry, College of Pharmacy and Allied Health Professions, Northeastern University, Boston, MA 02115
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Abstract
The aim of this study was to determine the prevalence of late-onset congenital adrenal hyperplasia (LOCAH) in a group of hyperandrogenic women presenting with menstrual disturbances and/or infertility. Thirty-five women were evaluated by basal hormonal profiles and underwent ACTH stimulation testing. In this study, 17.1% of women showed evidence of partial 21-OH deficiency (21-OHD), and 5.7% 3 beta-HSD deficiency. Neither basal hormonal levels nor clinical characteristics distinguished women with LOCAH from other hyperandrogenic women. And although the mean basal 17-OH progesterone (17-OHP) level in women with 21-OHD (152 +/- 66 ng/dl) was significantly higher than levels in other hirsute women, 4 of 6 (67%) women with 21-OHD had normal 17-OHP levels. Thus, to identify all affected individuals with partial 21-OHD, our data suggest that hyperandrogenic women with basal unsuppressed 17-OHP levels greater than 100 ng/dl should undergo dynamic testing. With regard to partial 3 beta-HSD deficiency, basal DHEA-S levels greater than the 95th percentile of other hirsute women may be used to screen for this deficiency. In conclusion, LOCAH due to partial steroid enzyme deficiencies are a frequent occurrence in women who present with symptoms of hyperandrogenism and ACTH stimulation remains an important tool in making the diagnosis of enzyme deficiencies.
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Affiliation(s)
- D K Hassíakos
- Jones Institute for Reproductive Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia 23507
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Jones GS. Luteal phase defect: a review of pathophysiology. Curr Opin Obstet Gynecol 1991; 3:641-8. [PMID: 1958796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Corpus luteum function depends on normal granulosa and theca cell components, which in turn are stimulated by an adequate luteinizing hormone (LH) surge in both duration and amplitude of pulses with LH residual pulses of adequate amplitude during the 14-day luteal span. The granulosa component must be competent to 1) synergize with thecal androgen production for increased estrogen production, 2) develop LH receptors for progesterone production, and 3) mature the egg cytoplasmically. The theca component must be capable of inducing angiogenesis factor to increase follicular blood supply and must be responsive to an LH pulse and human chorionic gonadotropin for corpus luteum rescue. The corpus luteum defect with a normal 14-day span is related either to an inadequate granulosa cell or to an inadequate LH surge, but a fairly normal LH pulse and theca cell response. The short luteal phase defect is related to a poor LH surge and an absent or extremely poor LH pulse. Diagnostic studies have indicated that the endometrial biopsy is the most efficient diagnostic method. Severe luteal defects can be diagnosed by a progesterone assay if the entire cycle is assayed, but single or even multiple progesterone assays are unreliable. The etiology is multifactorial and usually is related to the hypothalamic-pituitary factors influencing the LH surge, rather than to ovarian factors. Factors may vary from cycle to cycle, making it important to determine that the defect is repetitive. The specific etiology is often difficult to determine; substitution progesterone therapy is the most satisfactory treatment.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- G S Jones
- Jones Institute for Reproductive Medicine, Eastern Virginia Medical School, Norfolk
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Toner JP, Philput CB, Jones GS, Muasher SJ. Basal follicle-stimulating hormone level is a better predictor of in vitro fertilization performance than age. Fertil Steril 1991; 55:784-91. [PMID: 1901282 DOI: 10.1016/s0015-0282(16)54249-6] [Citation(s) in RCA: 362] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A study of 1,478 consecutive in vitro fertilization (IVF) cycles was made to determine if basal follicle-stimulating hormone (FSH) levels and age were independent predictors of IVF performance. Regression analyses indicated independent contributions of both basal FSH and age in predicting cancellation rate, peak estradiol, number of oocytes retrieved, fertilized, and transferred, and total and ongoing pregnancy rates. Miscarriage rate was unrelated to both age and basal FSH. Follicle-stimulating hormone level was a better predictor than age for all outcome variables examined and remained a significant predictor after accounting for age, etiology of infertility, and semen quality. The combined use of age and basal FSH in counseling patients improves the accuracy of prognosis, and may provide an index of functional ovarian reserve ("ovarian age").
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Affiliation(s)
- J P Toner
- Jones Institute for Reproductive Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk 23507
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Muasher SJ, Kruithoff C, Simonetti S, Oehninger S, Acosta AA, Jones GS. Controlled preparation of the endometrium with exogenous steroids for the transfer of frozen-thawed pre-embryos in patients with anovulatory or irregular cycles. Hum Reprod 1991; 6:443-5. [PMID: 1955555 DOI: 10.1093/oxfordjournals.humrep.a137355] [Citation(s) in RCA: 55] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
We have reported a 36% pregnancy rate (eight of 22 transfers) with the transfer of cryopreserved-thawed embryos in patients with anovulatory or irregular cycles following a protocol using pituitary suppression with leuprolide acetate after preparation of the endometrium with transdermal E2 and i.m. P. This protocol is simple, easy to follow, and safe and could be used in future for all patients with cryopreserved pre-embryos.
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Affiliation(s)
- S J Muasher
- Howard and Georgeanna Jones Institute for Reproductive Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk 23507
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Brzyski RG, Jones GS, Jones HW, Oehninger S, Muasher SJ. Alterations in luteal phase progesterone and estradiol production after leuprolide acetate therapy before ovarian stimulation for in vitro fertilization. Fertil Steril 1991; 55:119-24. [PMID: 1898886 DOI: 10.1016/s0015-0282(16)54070-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The impact of pituitary suppression with a gonadotropin-releasing hormone agonist (GnRH-a) on the luteal phase of in vitro fertilization (IVF) cycles was examined in 21 women who underwent identical stimulation regimens with and without leuprolide acetate pretreatment. The areas under the serum progesterone curves, measured over the 1st 10 days of the luteal phase, were significantly greater in the GnRH-a cycles compared with the non-GnRHa cycles, but when calculated per oocyte retrieved were similar in GnRH-a and non-GnRH-a cycles. In contrast, the areas under the luteal phase serum estradiol curves were significantly less in the GnRH-a cycles. These data suggest that GnRH-a treatment is accompanied by potentially beneficial alterations in the systemic steroidal milieu of the luteal phase of IVF cycles.
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Affiliation(s)
- R G Brzyski
- Howard and Georgeanna Jones Institute for Reproductive Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk
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Edelstein MC, Brzyski RG, Jones GS, Muasher SJ. Ovarian stimulation for in vitro fertilization in low-responder patients using pulsatile intravenous follicle stimulating hormone. J In Vitro Fert Embryo Transf 1990; 7:275-9. [PMID: 2123917 DOI: 10.1007/bf01129534] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
There is a subset of patients who fail to respond adequately to exogenous gonadotropin stimulation for in vitro fertilization (IVF). In this study, six such low-responder patients who had inadequate stimulations with high-dose intramuscular (im) follicle stimulating hormone (FSH) were treated in a subsequent cycle with pulsatile intravenous (iv) FSH. A paired analysis was performed to compare the cycles using high-dose im FSH with those using pulsatile iv FSH. Trough serum FSH levels were significantly higher with pulsatile iv FSH. No significant difference was noted in the stimulation characteristics or the number or quality of oocytes retrieved and embryos transferred. No pregnancies occurred in either group. While pulsatile iv administration of gonadotropin increases serum FSH levels, it does not appear to have a major impact on follicular stimulation or outcome in low-responder patients undergoing IVF.
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Affiliation(s)
- M C Edelstein
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk 23507
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39
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Abstract
To determine the role of oxygen radicals in the killing of Mycobacterium tuberculosis by neutrophils, the effects of free-radical inhibitors and enzymes, catalase, superoxide dismutase, taurine, deferoxamine, and histidine were evaluated. Changes in the viability of M. tuberculosis were determined by agar plate colony counts and a radiometric assay. No impairment in killing was seen with any of the inhibitors or enzymes. Patients with chronic granulomatous disease (CGD) have a defect in the NADPH oxidase pathway, causing their neutrophils to be unable to generate oxygen radicals. If these radicals are involved in killing, then CGD neutrophils should be less effective killers of M. tuberculosis than normal neutrophils. There was no evidence by either measure of M. tuberculosis viability that CGD neutrophils were less bactericidal than normal neutrophils. Killing by normal neutrophils was also effective in the absence of serum. These results lead to the conclusion that the mechanism by which M. tuberculosis is killed by neutrophils is independent of the oxygen metabolic burst.
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Affiliation(s)
- G S Jones
- Department of Medicine, University of Illinois, Chicago
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Affiliation(s)
- G S Jones
- Howard and Georgeanna Jones Institute for Reproductive Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk 23507
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Edelstein MC, Brzyski RG, Jones GS, Oehninger S, Sieg SM, Muasher SJ. Ovarian stimulation for in vitro fertilization using pure follicle-stimulating hormone with and without gonadotropin-releasing hormone agonist in high-responder patients. J In Vitro Fert Embryo Transf 1990; 7:172-6. [PMID: 2116488 DOI: 10.1007/bf01135684] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
There is a distinct pattern of response to gonadotropin stimulation in some patients marked by high peak estradiol (E2) levels, multifollicular ovarian response, and elevated basal luteinizing hormone (LH)/follicle-stimulating hormone (FSH) ratios. We reviewed the stimulation profiles of five such high-responder patients who failed to conceive during in vitro fertilization with ovarian stimulation using pure FSH. All patients had baseline LH/FSH greater than 1.5 and peak E2 greater than 800 pg/ml. One cycle was canceled prior to hCG administration because of marked ovarian response (E2 greater than 2500 pg/ml, multiple small follicles). In a subsequent cycle, all patients were pretreated with the gonadotropin releasing-hormone agonist (GnRHa) leuprolide acetate for 10-14 days prior to initiation of FSH for ovarian stimulation. Leuprolide was continued until the day of hCG administration. During cycles using GnRHa, there was a statistically significant decrease (P less than 0.05) in serum FSH on day 3 (less than 5 vs 8.3 mIU/ml), serum E2 on day 3 (14.6 vs 34.6 pg/ml), and peak serum E2 (1197.6 vs 1923.0 pg/ml). Patients during cycles with GnRHa had a greater number of preovulatory (8.6 vs 3.0) and total (12.4 vs 6.0) oocytes retrieved (P less than 0.05). The fertilization rate of preovulatory oocytes was also higher during cycles using GnRHa (83 vs 64%). Two pregnancies occurred in the cycles pretreated with GnRHa. These preliminary data indicate that in high-responder patients, a combination of GnRHa and pure FSH results in lower E2 levels during the stimulation cycle and a greater number of total and mature oocytes retrieved and fertilized.
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Affiliation(s)
- M C Edelstein
- Jones Institute for Reproductive Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk 23507
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Karande VC, Scott RT, Jones GS, Muasher SJ. Non-functional ovarian cysts do not affect ipsilateral or contralateral ovarian performance during in-vitro fertilization. Hum Reprod 1990; 5:431-3. [PMID: 2113931 DOI: 10.1093/oxfordjournals.humrep.a137117] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Reports on the significance of ovarian cystic structures during in-vitro fertilization (IVF) have been conflicting. This study examined the effect of such structures on ovarian performance during IVF. Twenty-one patients with one or more cystic structures of 20-50 mm in diameter, detected on day 6 of the menstrual cycle, were compared to 35 non-cystic controls. Differences (cyst versus non-cyst) included basal oestradiol (E2) levels (40 +/- 4.8 versus 29 +/- 2.0 pg/ml; P less than 0.01), ampoules of gonadotrophins administered (24 +/- 2 versus 16 +/- 1; P less than 0.001) and peak E2 concentrations (415 +/- 45 versus 744 +/- 88 pg/ml; P less than 0.05). There were no differences in the number of follicles aspirated or oocytes retrieved. In 19 patients with unilateral structures, the ipsilateral ovary produced fewer follicles (2.5 +/- 0.5 versus 3.9 +/- 0.6; P less than 0.05); however, there were no differences in the number or maturity of oocytes recovered. Since the numbers of oocytes recovered were equivalent in the presence or absence of ovarian cystic structures, their presence is not an indication to cancel an IVF cycle.
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Affiliation(s)
- V C Karande
- Jones Institute for Reproductive Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk 23507
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Karande VC, Jones GS, Veeck LL, Muasher SJ. High-dose follicle-stimulating hormone stimulation at the onset of the menstrual cycle does not improve the in vitro fertilization outcome in low-responder patients. Fertil Steril 1990; 53:486-9. [PMID: 2106455 DOI: 10.1016/s0015-0282(16)53345-7] [Citation(s) in RCA: 96] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In an attempt to improve their outcome with in vitro fertilization (IVF), 34 low-responder patients were stimulated with six ampules of follicle-stimulating hormone (FSH) daily starting on day 1 (n = 17) or day 2 (n = 17) of their menstrual cycles. The stimulated cycles showed a mean peak estradiol of 443 +/- 173 pg/mL, mean days of human chorionic gonadotropin of 7.6 +/- 1.4, 2.67 +/- 1.5 preovulatory oocytes per retrieval, and 2.56 +/- 1.3 oocytes per transfer. Three clinical pregnancies resulted after 25 embryo transfer cycles (12%). With paired analysis, we compared 8 patient cycles with prior six ampules of FSH stimulation starting on day 3; all parameters examined showed no significant differences. In a comparison of 22 patient cycles with prior 4 ampules of FSH stimulation on cycle day 3, no significant differences in any parameters were observed except in the higher number of ampules used in the present study. We conclude that high-dose FSH stimulation at the onset of the menstrual cycle does not improve the IVF outcome in low-responder patients.
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Affiliation(s)
- V C Karande
- Howard and Georgeanna Jones Institute for Reproductive Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk 23507
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Edelstein MC, Brzyski RG, Jones GS, Simonetti S, Muasher SJ. Equivalency of human menopausal gonadotropin and follicle-stimulating hormone stimulation after gonadotropin-releasing hormone agonist suppression. Fertil Steril 1990; 53:103-6. [PMID: 2104806 DOI: 10.1016/s0015-0282(16)53224-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
This study compares the use of human menopausal gonadotropin (hMG) versus follicle-stimulating hormone (FSH), after gonadotropin-releasing hormone agonist (GnRH-a) suppression for in vitro fertilization. Thirty-seven patients were randomized to ovarian stimulation with either hMG or pure FSH. The GnRH-a leuprolide acetate was administered to all patients beginning in the midluteal phase of the prior cycle and continuing until the day of human chorionic gonadotropin (hCG) administration. There were no significant differences between hMG and FSH cycles with regard to the day of hCG administration, mean peak estradiol levels, number of ampules of medication used, and number of oocytes aspirated, embryos transferred, or pregnancies. We conclude that there is no significant difference between hMG and FSH stimulation when used in conjunction with GnRH-a.
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Affiliation(s)
- M C Edelstein
- Howard and Georgeanna Jones Institute for Reproductive Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk 23507
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Coddington CC, Hassiakos DK, Harrison HC, Brzyski RG, Jones GS. Effect of a gonadotropin-releasing hormone analogue on the glucose metabolism in a diabetic patient. Gynecol Obstet Invest 1990; 30:246-8. [PMID: 2127036 DOI: 10.1159/000293279] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
We report a case of an insulin-dependent diabetic female who received leuprolide acetate and Depo-Lurpon for the treatment of endometriosis. Their use was associated with hyperglycemia and a deterioration in glucose control that necessitated changes in insulin dosage.
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Affiliation(s)
- C C Coddington
- Department of Obstetrics and Gynecology, Jones Institute for Reproductive Medicine, Eastern Virginia Medical School, Norfolk
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Hofmann GE, Toner JP, Muasher SJ, Jones GS. High-dose follicle-stimulating hormone (FSH) ovarian stimulation in low-responder patients for in vitro fertilization. J In Vitro Fert Embryo Transf 1989; 6:285-9. [PMID: 2517294 DOI: 10.1007/bf01139183] [Citation(s) in RCA: 55] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Follicle-stimulating hormone (FSH) was used in high doses (6 ampoules/day:6FSH) for ovarian hyperstimulation for in vitro fertilization in women with a previous poor response to stimulation with the equivalent of "4FSH." Luteinizing hormone levels did not differ between stimulations, but both FSH and estradiol levels were higher in the 6FSH compared to the 4FSH cycle. There were fewer cancellations in the 6FSH cycle, but similar numbers of preovulatory oocytes were retrieved, fertilized, and transferred. The pregnancy rates per attempt and retrieval were higher in the 6FSH cycle. We conclude that raising and maintaining FSH levels during stimulation in low responders reduced cancellations and may improve in vitro fertilization outcome.
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Affiliation(s)
- G E Hofmann
- Jones Institute for Reproductive Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk 23507
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47
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Abstract
A standard FSH/hMG stimulation protocol applied to all patients does not yield optimum results. In the Norfolk program it has been found that the determination of FSH/LH ratio on day 3 of the menstrual cycle provides a predictive signal of the likelihood of a good or bad response to a standard protocol. If the FSH is high in relation to LH, the patient will likely be a low responder and/or approaching the menopause. A regime of high-dose pure FSH seems to improve the number of eggs in this group and therefore the pregnancy rate. On the other hand, if the FSH/LH ratio is very low, that is, the patient has a high LH, the patient is generally a high responder and produces many eggs, but in some instances the quality of eggs is suspect, and the pregnancy rate is low in a particular subset of high responders. The use of GnRHa and/or minimal stimulation with FSH or hMG seems to improve the pregnancy rate.
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Affiliation(s)
- G S Jones
- Jones Institute for Reproductive Medicine, Eastern Virginia Medical School, Norfolk 23507
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Brzyski RG, Jones GS, Oehninger S, Acosta AA, Kruithoff CH, Muasher SJ. Impact of leuprolide acetate on the response to follicular stimulation for in vitro fertilization in patients with normal basal gonadotropin levels. J In Vitro Fert Embryo Transf 1989; 6:290-3. [PMID: 2517295 DOI: 10.1007/bf01139184] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Fifteen women with normal basal gonadotropin levels and adequate responses to conventional gonadotropin stimulation for in vitro fertilization (IVF) were pretreated with leuprolide acetate (LA) beginning in the midluteal phase prior to a repeat IVF attempt. A significantly longer duration of stimulation requiring a significantly higher total dosage of gonadotropins was observed in LA cycles. The number of preovulatory oocytes retrieved and preembryos transferred was significantly higher in LA cycles. Six of 15 women (40%) had cryopreservation of supernumerary preembryos in LA cycles, versus none in non-LA cycles; 22% of preovulatory oocytes aspirated in LA cycles were available for cryopreservation for future transfer. Five pregnancies occurred in the 15 LA cycles. IVF patients with normal basal gonadotropin levels and normal responses to conventional gonadotropin stimulation benefit from LA pretreatment.
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Affiliation(s)
- R G Brzyski
- Howard and Georgeanna Jones Institute for Reproductive Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk 23507
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Droesch K, Muasher SJ, Brzyski RG, Jones GS, Simonetti S, Liu HC, Rosenwaks Z. Value of suppression with a gonadotropin-releasing hormone agonist prior to gonadotropin stimulation for in vitro fertilization. Int J Gynaecol Obstet 1989. [DOI: 10.1016/0020-7292(89)90223-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Oehninger S, Brzyski RG, Muasher SJ, Acosta AA, Jones GS. In-vitro fertilization and embryo transfer in patients with endometriosis: impact of a gonadotrophin releasing hormone agonist. Hum Reprod 1989; 4:541-4. [PMID: 2507576 DOI: 10.1093/oxfordjournals.humrep.a136941] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
In this study, in-vitro fertilization (IVF) cycles were examined in patients with endometriosis who received gonadotrophin releasing hormone agonist (GnRHa) therapy in an effort to improve their response to stimulation. Twelve patients treated with an identical gonadotrophin stimulation protocol, with and without GnRHa, were evaluated using paired analysis. In the GnRHa cycles, the total number of oocytes retrieved and transferred per cycle was higher than in the control cycles. In addition, use of the agonist lowered the cancellation rate from 33 to 0%, while a trend towards better pregnancy results was observed. When analysed according to the stage of the disease, the patients with stage III or IV endometriosis had a more dramatic improvement with GnRHa. These data suggest that GnRHa therapy may be beneficial in some patients with endometriosis undergoing IVF.
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Affiliation(s)
- S Oehninger
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk 23507
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