Maternal morbid obesity: financial implications of weight management

The objective of this study was to evaluate health outcomes and costs of pregnancies complicated by extreme maternal obesity (class III obesity, body mass index ≥ 40). We conducted a retrospective case-control descriptive study comparing extremely obese women (cases) and their infants with randomly selected controls. Health outcomes were obtained from the medical records and costs from billing data. Total costs for each mother-infant dyad were calculated. Compared with 85 controls, the 82 cases experienced higher morbidity, higher costs and prolonged hospital stay. However, 26% of cases maintained or lost weight during pregnancy, whereas none of the controls maintained or lost weight during pregnancy. When mother/infant dyads were compared on costs, case subjects who maintained or lost weight experienced lower costs than those who gained weight. Neonatal intensive care consumed 78% of total hospital costs for infants of the obese women who gained weight, but only 48% of costs for infants of obese women who maintained or lost weight. For extremely obese women, weight management during pregnancy was achievable, resulted in healthier neonatal outcomes and reduced perinatal healthcare costs.

260 THE EFFECTS OF L-ARGININE ON CUMULUS CELL INTEGRITY AND MEIOTIC RESUMPTION DURING IN VITRO MATURATION OF BOVINE OOCYTES IN THE PRESENCE OF OVARIAN FOLLICLE HEMI-SECTIONS

Nuclear maturation of the oocytes, characterised by a resumption of meiosis, occurs at the end of the growing phase in preovulatory follicles, after the peak of gonadotropins. The mechanisms and substances involved, by which gonadotropins lead to the final nuclear maturation, are still unknown. The withdrawal of immature oocytes from the follicular environment is sufficient to trigger the spontaneous resumption of meiosis, hindering the study of these events in the in vitro model. However, the co-culture of immature oocytes with hemi-sections (HS) of follicular walls holds the meiosis arrest and is therefore an alternative system for evaluating the role of certain substances in the process of oocyte maturation. Nitric oxide is an important signalling molecule. There is evidence that NO is involved in the mechanisms that hold the meiotic arrest, and also in the events that lead to the resumption of nuclear maturation. Through the action of the NO synthase enzyme, l-arginine releases NO as a by-product. Thus, l-arginine may be considered a natural NO donor. This study tested the possible involvement of NO in the oocyte maturation process in in vitro conditions mimicking the in vivo environment. Different concentrations of l-arginine (2.5, 4, 5, 6, 10, and 50 mM) were added in the culture medium (200 µL of TCM-199/albumin). Groups of 20 cumulus–oocyte complexes were matured for 22 h at 38.5°C with 8 HS from the follicular wall. In addition, two controls (with and without HS) were processed. Membrane integrity of cumulus cells (CC) was evaluated, as well as the nuclear maturation of the oocytes at 22 h of culture, by double staining with Hoechst 33342 (10 µg mL–1) and propidium iodide (10 µg mL–1) and staining with 1% orcein, respectively. The results were assessed through ANOVA, and means were compared by t-test. There was an increase in the proportion of CC with intact membranes (P < 0.05) in cumulus–oocyte complexes supplemented with at least 4 mM l-arginine [39.4 ± 9.8, 34.4 ± 18.1, 33.2 ± 0, 66.7 ± 24.1, 64.3 ± 15.9, 60.6 ± 12.8, 51.9 ± 19.3 (means ± SD) of CC with intact membrane for control with HS, without HS, and 2.5, 4, 5, 6, and 10 mM l-arginine, respectively], but a higher concentration (50 mM) of l-arginine had the opposite effect (20.3%). Similarly, concentrations of 4, 5, and 6 mM l-arginine increased the proportion of oocytes that reached intermediate stages (metaphase I, telophase I) of nuclear maturation when compared with the control with HS (P < 0.05; 72.6 ± 12.5, 74.1 ± 9.5, 67.2 ± 19.3 v. 48.0 ± 11.7) and caused a trend for an increase in the proportion of oocytes at the metaphase-II stage [3.4 ± 4, 7.7 ± 10.9, 14.1 ± 14.4, 19.4 ± 13.4, 22.1 ± 28.2, 6.9 ± 6, 9 ± 0 (means ± SD) for the control with HS and 2.5, 4, 5, 6, 10, and 50 mM l-arginine respectively]. In conclusion, l-arginine improved the integrity of CC and may play a role in the nuclear oocyte maturation process in a dose-response manner. Further investigations are necessary to clarify the role of NO in these cellular processes. Supported by FAPERJ.

Follicular dynamics in Mangalarga mares

Ovarian follicular activity was studied by ultrasonography during 17 oestrous cycles in 9 Mangalarga mares during the second half of the ovulatory season. Sixteen oestrous cycles were considered normal and one 3-wave cycle showing a prolonged luteal phase was considered atypical. Daily ultrasonographic examinations were performed and the compiled data on follicular dynamics were studied retrospectively. One major wave of follicular growth was observed in 13 of the 16 normal cycles (81.25%), whereas 2 major waves occurred in 3 cycles (18.75%). The mean (+/- s.d.) days of emergence of the primary wave of follicular development in cycles containing one or 2 waves were Day 6.0 +/- 2.3 and Day 11.0 +/- 1.0, respectively. The secondary wave of follicular development in 2-wave cycles emerged on Day 0.0 +/- 3.6. The day of wave divergence for primary waves of follicular development in cycles which exhibited one or 2 major waves were Day 12.2 +/- 3.5 and Day 17.3 +/- 3.0, respectively. Divergence of secondary waves occurred in only one of the 3 cycles which exhibited 2 major follicular waves (Day 7). The mean (+/- s.d.) maximum diameters of the dominant follicle in the primary wave of oestrous cycles exhibiting one and 2 major waves were 39.0 +/- 3.9 mm and 34.7 +/- 2.5 mm, respectively. The mean (+/- s.d.) maximum diameter of the dominant follicle present in the secondary wave was 34.3 +/- 11.0 mm. The mean (+/- s.d.) lengths of the interovulatory intervals for cycles containing one and 2 major waves were 19.4 +/- 2.2 and 23.3 +/- 2.5 days, respectively. These data indicate that most Mangalarga mares show one major follicular wave during the oestrous cycle but a small percentage of mares show 2 major waves.

Innervation pattern of malformative cortical vessels in Sturge-Weber disease: an histochemical, immunohistochemical, and ultrastructural study

OBJECTIVE

This study was undertaken to elucidate the pattern of vascular innervation in areas of pial angiomatosis in Sturge-Weber disease (SWD) and eventually correlating it with the pathophysiology of the disease, namely its chronic ischemic changes.

METHODS

We processed part of a surgical specimen resected from a 3-year-old female patient who underwent functional hemispherectomy for SWD and characterized the pattern of innervation of the malformative cortical vessels using histochemical, immunohistochemical, and ultrastructural techniques.

RESULTS

Cortical vessels were observed to be supplied with numerous varicose nerve fibers containing immunoreactivity for neuropeptide tyrosine and the catecholamine-synthesizing enzyme, tyrosine, tyrosine hydroxylase. In contrast, no nerve fibers containing acetylcholinesterase activity and immunoreactivity for Substance P, a calcitonin gene-related peptide and vasoactive intestinal peptide, were detected. Ultrastructural studies revealed the presence of numerous axon varicosities at the adventitial-medial border. Neuropeptide tyrosine immunoreactivity was localized in large granular vesicles in nerve varicosities that also contained numerous small granular vesicles.

CONCLUSION

These results demonstrate that nerve supplying cortical vessels in SWD are arranged in a distribution pattern similar to the one observed in human normal cortical veins and suggest that these abnormal vessels are innervated only with noradrenergic sympathetic nerve fibers. This represents a clear difference from the pattern of innervation observed in both normal cortical arteries and veins, and is the consequence of the anatomic and functional dysangiogenic process characteristic of the affected cortical areas in SWD.

Mechanisms underlying degeneration of cryopreserved vascular homografts

OBJECTIVE

To analyze the mechanism(s) underlying homograft degeneration, we designed an experimental model in which the behavior of cryopreserved autografts and homografts, as well as fresh autografts, implanted in the same animal was compared.

METHODS

A cryopreserved homograft was implanted in the aorta of 14 sheep. The excised aortic autologous segment was then subjected to cryopreservation, and 1 to 8 weeks later it was implanted 1 to 2 cm below the cryopreserved homograft. The intermediate segment of the native aorta, the fresh autograft, was dissected at this point. Animals were put to death at different times and the implanted segments were harvested together with a portion of native aorta. Histologic and immunohistochemical analyses, as well as cell viability assessments, were then performed on the explanted segments. Similar studies were also conducted on fragments of cryopreserved autografts and homografts before implantation.

RESULTS

With the exception of a partial loss of the endothelium, cryopreserved specimens retained cell viability and morphologic integrity before implantation. Explanted cryopreserved homografts showed profound changes affecting all strata, as well as a decline in cell viability. Lymphocyte infiltrates were found up to 12 months after implantation. Endothelium was always absent in cryopreserved homografts. However, a reendothelialization of the cryopreserved autografts was observed. After an initial period of neuronal degeneration, reenervation of the cryopreserved autograft segment occurred 6 to 12 months after the operation. Findings regarding the fresh autografts were similar to those of the cryopreserved autografts.

CONCLUSION

Our results suggest that the immunologic reaction rather than the cryopreservation process is responsible for the degenerative process occurring in cryopreserved homografts.

Seasonal rhythm of semen characteristics of a Brazilian breed ("Mangalarga") stallion

An attempt has been made to define semen seasonality in a horse in the Southern Hemisphere. Repeated measurements of three variables in the semen were made for 36 months (Jan/90-Dec/92) in a 21-year old "Mangalarga" stallion living under natural photoperiod and temperature conditions in a farm situated in São José do Rio Pardo, São Paulo, Brazil (latitude 21 degrees) 36'S; longitude 46 degrees 53' W). The horse fed on natural pasture and a nutritionally balanced feed twice a day (11:00 and 17:00 h). Water and mineral supplement were available ad libitum. Semen was collected almost daily by an artificial vagina and showed annual changes in volume of ejaculate, sperm motility, and sperm concentration. Spectral and rhythmometric analyses of the semen data were performed according to the fast Fourier transform (FFT) and cosinor techniques (tau = 365 days). Statistically significant annual rhythms for semen volume, motility, and concentration of sperm were present. Acrophases occurred in the spring (October) for ejaculate volume and in autumn (May) for sperm concentration and motility.

Chronobiological characterization of the first estrous cycle in Brasileiro de Hipismo mares during the postpartum period

This study was conducted on 32 mares during the first 30 d of the postpartum period to characterize the first estrous cycle, assessing ovarian cyclicity by determining plasma progesterone concentration and by transrectal palpation. The total pregnancy rate of the breeding season was 81.25%. The present results show that the incidence of estrus occurring at the beginning of the breeding season were early, long and anovulatory. The mares that did not become pregnant ovulated on average 14.5 d post partum, and those that became pregnant ovulated at 19.6 d post partum (P<0.05). On the basis of clinical and hormonal data, we divided the animals into 4 groups, all presenting signs of estrus: Group 1, animals that did not ovulate (n=7) and that presented basal P(4) levels (0.01-2.34 ng/ml) during the first 30 postpartum days; Group 2, animals that ovulated and did not become pregnant (n=13); Group 3, animals that ovulated and became pregnant (n=8). Maximal P(4) levels ranged from 4.40 to 13.50 ng/ml (Group 2) and from 3.70 to 20.50 ng/ml (Group 3). Group 4 were animals that presented high plasma P(4) levels before any clinical sign of ovulation (n=3). The absence of pregnancy could not be attributed to a failure of the corpus luteum, since the groups of mares that became pregnant exhibited similar plasma P(4) levels as the group of nonpregnant mares. Our findings demonstrated that mares exhibited differences in the timing of the first postpartum estrus, the duration of the first postpartum estrus and the timing of the first postpartum ovulation according to the month of the breeding season in which foaling occurs under tropical conditions. Furthermore, our results indicate that the foal heat may be used since its utilization did not affect the total pregnancy rate of the breeding season.