Current status of pesticide effects on environment, human health and it's eco-friendly management as bioremediation: A comprehensive review

Pesticides are either natural or chemically synthesized compounds that are used to control a variety of pests. These chemical compounds are used in a variety of sectors like food, forestry, agriculture and aquaculture. Pesticides shows their toxicity into the living systems. The World Health Organization (WHO) categorizes them based on their detrimental effects, emphasizing the relevance of public health. The usage can be minimized to a least level by using them sparingly with a complete grasp of their categorization, which is beneficial to both human health and the environment. In this review, we have discussed pesticides with respect to their global scenarios, such as worldwide distribution and environmental impacts. Major literature focused on potential uses of pesticides, classification according to their properties and toxicity and their adverse effect on natural system (soil and aquatic), water, plants (growth, metabolism, genotypic and phenotypic changes and impact on plants defense system), human health (genetic alteration, cancer, allergies, and asthma), and preserve food products. We have also described eco-friendly management strategies for pesticides as a green solution, including bacterial degradation, myco-remediation, phytoremediation, and microalgae-based bioremediation. The microbes, using catabolic enzymes for degradation of pesticides and clean-up from the environment. This review shows the importance of finding potent microbes, novel genes, and biotechnological applications for pesticide waste management to create a sustainable environment.

Deciphering Haplotypic Variation and Gene Expression Dynamics Associated with Nutritional and Cooking Quality in Rice

Nutritional quality improvement of rice is the key to ensure global food security. Consequently, enormous efforts have been made to develop genomics and transcriptomics resources for rice. The available omics resources along with the molecular understanding of trait development can be utilized for efficient exploration of genetic resources for breeding programs. In the present study, 80 genes known to regulate the nutritional and cooking quality of rice were extensively studied to understand the haplotypic variability and gene expression dynamics. The haplotypic variability of selected genes were defined using whole-genome re-sequencing data of ~4700 diverse genotypes. The analytical workflow identified 133 deleterious single-nucleotide polymorphisms, which are predicted to affect the gene function. Furthermore, 788 haplotype groups were defined for 80 genes, and the distribution and evolution of these haplotype groups in rice were described. The nucleotide diversity for the selected genes was significantly reduced in cultivated rice as compared with that in wild rice. The utility of the approach was successfully demonstrated by revealing the haplotypic association of chalk5 gene with the varying degree of grain chalkiness. The gene expression atlas was developed for these genes by analyzing RNA-Seq transcriptome profiling data from 102 independent sequence libraries. Subsequently, weighted gene co-expression meta-analyses of 11,726 publicly available RNAseq libraries identified 19 genes as the hub of interactions. The comprehensive analyses of genetic polymorphisms, allelic distribution, and gene expression profiling of key quality traits will help in exploring the most desired haplotype for grain quality improvement. Similarly, the information provided here will be helpful to understand the molecular mechanism involved in the development of nutritional and cooking quality traits in rice.

Understanding the role of SWEET genes in fruit development and abiotic stress in pomegranate (Punica granatum L.)

BACKGROUND

The Sugar Will Eventually Be Exported Transporters (SWEET), consisting of the MtN3 and salvia domain, are sugar transporters having an active role in diverse activities in plants such as pollen nutrition, phloem loading, nectar secretion, reproductive tissue development, and plant-pathogen interaction. The SWEET genes have been characterized only in a few fruit crop species.

METHODS AND RESULTS

In this study, a total of 15 SWEET genes were identified in the pomegranate (Punica granatum) genome. The gene structure, transmembrane (TM) helices, domain architecture, and phylogenetic relationships of these genes were evaluated using computational approaches. Genes were further classified as Semi-SWEETs or SWEETs based on the TM domains. Similarly, pomegranate, Arabidopsis, rice, and soybean SWEETs were studied together to classify into major groups. In addition, analysis of RNAseq transcriptome data was performed to study SWEEET gene expression dynamics in different tissue. The expression suggests that SWEETs are mostly expressed in pomegranate peel. In addition, PgSWEET13 was found to be differentially expressed under high salinity stress in pomegranate. Further, quantitative PCR analysis confirmed the expression of four candidate genes in leaf and stem tissues.

CONCLUSION

The information provided here will help to understand the role of SWEET genes in fruit development and under abiotic stress conditions in pomegranate.

Study of human knowledge and attitude toward urban birds in Faisalabad city, Pakistan

Birds are very valuable indicators of species richness and endemic patterns in a specified ecosystem, which eventually help the scientist to measure the environmental degradation. The aim of present study was to know human knowledge and attitude toward urban birds in Faisalabad city, Pakistan. The study conducted in four consecutive months: November 2019 to February 2020. Population of birds was noted from eight residential towns of Faisalabad city, data were collected through questionnaire. Faisalabad has a reasonably large population of birds and present data show that, there is a significant difference between favorite bird of residential areas and institutions. The pigeon received the most likeness in bird population among residential area residents, while the myna received the least. The most popular bird in Faisalabad institutions was the sparrow, while the least popular bird was the common myna. Bird adaptation percentage of residential areas and institutional areas of Faisalabad was the highest for parrot and sparrow respectively. People in residential areas and institutions, on the other hand, adapted least to common myna. It is concluded that people of the study area like birds and offered food and high population of birds are present in study area.

Versatile role of silicon in cereals: Health benefits, uptake mechanism, and evolution

Silicon (Si) is an omnipresent and second most abundant element in the soil lithosphere after oxygen. Silicon being a beneficial element imparts several benefits to the plants and animals. In many plant species, including the cereals the uptake of Si from the soil even exceeds the uptake of essential nutrients. Cereals are the monocots which are known to accumulate a high amount of Si, and reaping maximum benefits associated with it. Cereals contribute a high amount of Si to the human diet compared to other food crops. In the present review, we have summarized distribution of the dietary Si in cereals and its role in the animal and human health. The Si derived benefits in cereals, specifically with respect to biotic and abiotic stress tolerance has been described. We have also discussed the molecular mechanism involved in the Si uptake in cereals, evolution of the Si transport mechanism and genetic variation in the Si concentration among different cultivars of the same species. Various genetic mutants deficient in the Si uptake have been developed and many QTLs governing the Si accumulation have been identified in cereals. The existing knowledge about the Si biology and available resources needs to be explored to understand and improve the Si accumulation in crop plants to achieve sustainability in agriculture.

Soybean transporter database: A comprehensive database for identification and exploration of natural variants in soybean transporter genes

Transporters, a class of membrane proteins that facilitate exchange of solutes including diverse molecules and ions across the cellular membrane, are vital component for the survival of all organisms. Understanding plant transporters is important to get insight of the basic cellular processes, physiology, and molecular mechanisms including nutrient uptake, signaling, response to external stress, and many more. In this regard, extensive analysis of transporters predicted in soybean and other plant species was performed. In addition, an integrated database for soybean transporter protein, SoyTD, was developed that will facilitate the identification, classification, and extensive characterization of transporter proteins by integrating expression, gene ontology, conserved domain and motifs, gene structure organization, and chromosomal distribution features. A comprehensive analysis was performed to identify highly confident transporters by integrating various prediction tools. Initially, 7541 transmembrane (TM) proteins were predicted in the soybean genome; out of these, 3306 non-redundant transporter genes carrying two or more transmembrane domains were selected for further analysis. The identified transporter genes were classified according to a standard transporter classification (TC) system. Comparative analysis of transporter genes among 47 plant genomes provided insights into expansion and duplication of transporter genes in land plants. The whole genome resequencing (WGRS) and tissue-specific transcriptome datasets of soybean were integrated to investigate the natural variants and expression profile associated with transporter(s) of interest. Overall, SoyTD provides a comprehensive interface to study genetic and molecular function of soybean transporters. SoyTD is publicly available at http://artemis.cyverse.org/soykb_dev/SoyTD/.

Unexplored nutritive potential of tomato to combat global malnutrition

Tomato, a widely consumed vegetable crop, offers a real potential to combat human nutritional deficiencies. Tomatoes are rich in micronutrients and other bioactive compounds (including vitamins, carotenoids, and minerals) that are known to be essential or beneficial for human health. This review highlights the current state of the art in the molecular understanding of the nutritional aspects, conventional and molecular breeding efforts, and biofortification studies undertaken to improve the nutritional content and quality of tomato. Transcriptomics and metabolomics studies, which offer a deeper understanding of the molecular regulation of the tomato's nutrients, are discussed. The potential uses of the wastes from the tomato processing industry (i.e., the peels and seed extracts) that are particularly rich in oils and proteins are also discussed. Recent advancements with CRISPR/Cas mediated gene-editing technology provide enormous opportunities to enhance the nutritional content of agricultural produces, including tomatoes. In this regard, genome editing efforts with respect to biofortification in the tomato plant are also discussed. The recent technological advancements and knowledge gaps described herein aim to help explore the unexplored nutritional potential of the tomato.

Age and Gender Differences in COVID 19 Morbidity and Mortality in Nepal

Background The global health community has emphasized the importance of reporting epidemiological data by age and sex groups in the COVID-19 pandemic. However, age and sex disaggregated data of COVID-19 cases and deaths are rarely reported. Such data are very crucial for public to make truly informed choices about their own diseases risk and also for governments for public policy response. Objective To assess age and gender difference among COVID-19 cases and deaths in Nepal. Method This is a retrospective study which uses public data on COVID-19 cases and deaths released by Ministry of Health and Population, Government of Nepal from January to November, 2020. The data analysis was carried out using SPPS software version 26. Result Nepal reported 233,452 confirmed cases and 1,566 deaths of COVID-19 from 23 January 2020 to 30 November 2020. We found statistically significant differences on COVID-19 cases by age and gender in Nepal with higher number of cases among males of economically active age groups (20-60 years). Similarly, we found significant difference in COVID-19 mortality with more death occurred among male group compared to female group and with highest number of deaths among the people of above 60 years. Furthermore, we found differences in cases and deaths among provinces. Conclusion The age and gender differences in COVID cases and deaths in Nepal indicates needs of considering age and sex groups seriously while planning for testing, case management and vaccination against COVID-19 infections in Nepal.

THU0531 A PROSPECTIVE STUDY EVALUATING THE ROLE OF 68GA-RGD2 PET/CT ANGIOGENESIS IMAGING IN ASSESSING DISEASE ACTIVITY AND TREATMENT RESPONSE IN RHEUMATOID ARTHRITIS AND ITS COMPARISON WITH DAS28

Background:

PET/CT imaging of synovial angiogenesis using68Ga-RGD (cyclic tripeptide agent targeting αvβ3integrin) to study disease activity in rheumatoid arthritis (RA) has been demonstrated earlier in a few patients. However, post treatment changes in disease activity on68Ga-RGD2PET/CT imaging have not been adequately assessed.

Objectives:

To compare the performance of68Ga-RGD2PET/CT with disease activity score (DAS) 28 in assessing disease activity and treatment response in RA.

Methods:

Thirty patients (24F, 6M) aged 43±12 years with clinically diagnosed RA were prospectively studied. After calculation of DAS28 by a rheumatologist, all 30 patients underwent68Ga-RGD2PET/CT scan. Of these, 27 patients underwent a second68Ga-RGD2PET/CT scan and clinical assessment after at least 3 months of treatment. Total body and regional images of the upper limbs were acquired and interpreted by two nuclear medicine physicians blinded to the clinical findings. Joints showing focally increased tracer uptake compared to the background were considered positive and joints showing uptake equal to or less than background were considered negative. Data of 30 patients were used for inter-observer and inter-modality agreement calculations. Changes in PET parameters and DAS28 were compared in 27 patients to assess treatment response.

Results:

Out of 1560 joints examined in the initial scan, 394 were positive on PET/CT compared to 348 on clinical evaluation. Inter-observer agreement between nuclear medicine physicians was excellent (Cohen’s kappa 0.92, p<0.05) and inter-modality agreement between PET and clinical examination was moderate (Cohen’s kappa 0.55, p<0.05). The DAS28 and SUVmax values (highest and average) of 27 patients showed significant reduction on follow-up compared to the initial evaluation. There was significant correlation between percentage change in DAS28 and percentage change in scan parameters like PET positive joint counts (0.689, p<0.001), average SUVmax (0.712, p<0.001) and highest SUVmax values (0.558, p=0.003) of scan-positive joints in 27 patients. Additional advantages of68Ga-RGD2PET/CT included objective assessment, whole body evaluation of all small and large joints, and greater reproducibility.

Conclusion:

68Ga-RGD2PET/CT is a promising tool for objective assessment of disease activity and treatment response in patients with RA.

Table 1.

Clinical and PET parameters of the patients

ParameterInitial data (n=27)Mean (SD)/Median (IQR)Follow-up data (n=27)Mean (SD)/Median (IQR)TJC(28)10 (5-13)3 (2-4)SJC(28)6 (3-7)1 (0-2)ESR25 (20-41)24 (18-35)PtGA6.0 (5.0-6.0)3.0 (2.0-4.0)DAS28(3)5.14 (0.85)3.74 (0.88)DAS28(4)5.60 (0.90)3.80 (0.96)PET positive Joints12 (7-8)4 (2-9)aSUVmax2.08 (1.68-2.52)1.79 (1.00-2.06)hSUVmax3.45 (2.71-4.70)3.34 (1.95-4.25)

TJC/SJC: tender/swollen joint counts; ESR: erythrocyte sedimentation rate; PtGA: patients global assessment scale; DAS: disease activity score; aSUVmax/hSUVmax: average/highest SUVmax (maximum standardized uptake value); SD: standard deviation; IQR: interquartile range

Figure 1.

68Ga-RGD2PET scan of a 26-year female RA patient on treatment.A.Initial scan shows increased tracer uptake in multiple joints of upper and lower limbs and tendon sheaths of hands and ankle region (arrows); DAS28 was 4.56 (moderate disease activity) and ESR 12 mm/1sthour.B. Follow-up scan after 4 months shows resolution of tracer activity in the previously involved joints with only a mild focus persisting in the left knee joint; DAS28 was 1.73 (clinical remission according to ARA) and ESR 08 mm/1sthour.

Acknowledgments:

This study was supported by Indian Council of Medical Research, New Delhi [grant no.3/2/June-2017/PG-Thesis-HRD (23)]

Disclosure of Interests:

None declared

Expanding Avenue of Fast Neutron Mediated Mutagenesis for Crop Improvement

: Fast neutron (FN) radiation mediated mutagenesis is a unique approach among the several induced mutagenesis methods being used in plant science in terms of impacted mutations. The FN mutagenesis usually creates deletions from few bases to several million bases (Mb). A library of random deletion generated using FN mutagenesis lines can provide indispensable resources for the reverse genetic approaches. In this review, information from several efforts made using FN mutagenesis has been compiled to understand the type of induced mutations, frequency, and genetic stability. Concerns regarding the utilization of FN mutagenesis technique for a plant with different level of ploidy and genome complexity are discussed. We have highlighted the utility of next-generation sequencing techniques that can be efficiently utilized for the characterization of mutant lines as well as for the mapping of causal mutations. Pros and cons of mapping by mutation (MutMap), mutant chromosome sequencing (MutChromSeq), exon capture, whole genome sequencing, MutRen-Seq, and different tilling approaches that can be used for the detection of FN-induced mutation has also been discussed. Genomic resources developed using the FN mutagenesis have been catalogued wooing to meaningful utilization of the available resources. The information provided here will be helpful for the efficient exploration for the crop improvement programs and for better understanding of genetic regulations.

Paraneoplastic pemphigus as a first sign of metastatic retroperitoneal inflammatory myofibroblastic tumor: (18)F-FDG PET/CT findings

A 30-year-old female presented with a 3-month history of erosive stomatitis and bullous lesions, along with recurrent episodes of abdominal pain. She was found to have a retroperitoneal lump in left lumbar region. Skin biopsy revealed bullous disorder. CT guided biopsy of the retroperitoneal mass was suggestive of inflammatory myofibroblastic tumor (IMT). She was started on oral steroids and supportive care, and surgery was being planned when she developed respiratory failure. CT chest revealed vertebral metastases. PET/CT for whole body work up revealed a left para-aortic mass along with multiple skeletal metastases. The patient was kept on conservative management. After 3 months, the patient has shown clinical improvement, and an exploratory laparotomy is now being planned for the excision of the tumor, followed by chemotherapy. This case of retroperitoneal IMT is rare in terms of skeletal metastases with paraneoplastic pemphigus.

Genetic Diversity Assessment of Acid Lime (Citrus Aurantifolia Swingle) Landraces of Eastern Nepal Using RAPD Markers

Acid lime (Citrus aurantifolia Swingle) is an important commercial fruit crop, cultivated from terai to high hill landscapes of Nepal. However, production and productivity is very low due to various reasons including infestations by various diseases and pests, lack of diseases and pests resistant and high yielding varieties. In this context, determination of genetic variation at molecular level is fundamental to citrus breeders for the development of elite cultivars with desirable traits. In the present study, Random Amplified Polymorphic DNA (RAPD) marker technique has been employed to assess genetic diversity in 60 acid lime landraces representing different agro-ecological zones of eastern Nepal. Nine selected arbitrary primers generated 79 RAPD fragments of which 75 were polymorphic (94.94%). Phenogram was constructed by NTSYSPC ver. 2.21i using UPGMA cluster analysis based on Jaccard’s similarity coefficient to deduce overall genetic diversity and relationships of the acidlime genotypes under study. Sixty acid lime landraces formed seven clusters and similarity value ranged from 38% to 98% with an average of 72%. Genetic variation at different agro-ecological zones was assessed using Popgene ver. 1.32 and found 47% to 69.6% polymorphism. Shannon’s index and Nei’s gene diversity showed highest level of acid lime diversity in Terai zone (PPB, 69.62%; H, 0.213; I, 0.325) followed by mid-hill zone (PPB, 67.09%; H, 0.208; I, 0.317). The results obtained will be useful to citrus breeders for elite cultivar development. The RAPD-PCR technique is found to be the rapid and effective tool for genetic diversity assessment in acid lime landraces of Nepal. DOI: http://dx.doi.org/10.3126/ijasbt.v2i3.10950  Int J Appl Sci Biotechnol, Vol. 2(3): 315-327  

Assessment of Pesticide Residues in Some Vegetables Grown in Kavrepalanchok and Bhaktapur Districts

Pesticides have wide spread use and their toxic residues have been reported in various environmental matrices. Thus, the determination of pesticide residues in food commodities such as vegetables, cereals, fruits, and other environmental components like soil, water has become increasingly essential requirement for consumers, producers and authorities for food quality control. Therefore, monitoring of residue level and exposure assessment of organophosphate group of pesticides namely dichlorovos and methyl parathion was carried out in 30 winter and summer vegetables supplied in Kathmandu valley. It was found that the MRL value of dichlorovos exceeded in three types of vegetables whereas in case of methyl parathion the MRL value exceeded in two types of vegetables only. The estimated average daily intake (EADI) of dichlorovos exceeded the acceptable daily intake (ADI) in 18 vegetables, whereas, regarding methyl parathion the EADI exceeded the ADI in 10 types of vegetables. Nepal Journal of Science and Technology Vol. 13, No. 2 (2012) 45-50 DOI: http://dx.doi.org/10.3126/njst.v13i2.7713

Relationship between apoptosis and the number of macrophages in eutopic endometrium from women with and without endometriosis

OBJECTIVE

To investigate the relationship between apoptotic cells and macrophages in the eutopic endometrium of women with and without endometriosis.

DESIGN

Retrospective analysis of archival uterine endometrial biopsy specimens.

SETTING

Institute for the Study and Treatment of Endometriosis, and university-based pathology and research laboratories.

PATIENT(S)

Fifty-one women with endometriosis and 24 healthy control subjects without endometriosis.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

The number of TUNEL+ (terminal deoxynucleotide transferase [TdT]-mediated deoxyuridine triphospate [dUTP] nick end-labeling-positive) (apoptotic) cells and CD68+ (CD68 positive) (macrophages).

RESULT(S)

Apoptotic cells and macrophage numbers were positively correlated in the eutopic endometrium of women with and without endometriosis. However, the number of apoptotic cells and the macrophage content in the endometrium of women with endometriosis was significantly reduced compared with that of healthy control subjects without endometriosis. Differences between apoptosis and macrophage numbers between the two populations were observed predominantly during the early proliferative phase of the menstrual cycle.

CONCLUSION(S)

The reduction in apoptosis described for endometrial cells in women with endometriosis may be related to reduced macrophage trafficking into the eutopic endomtrium during the early-proliferative phase of the menstrual cycle.

Retroperitoneal subpancreatic ectopic pregnancy following in vitro fertilization in a patient with previous bilateral salpingectomy: how did it get there?

An unusual case of retroperitoneal ectopic pregnancy is reported. The patient, a 34 year old nulligravida, underwent IVF/ET following bilateral salpingectomy. A small, degenerating, intrauterine gestational sac suggested failing intrauterine pregnancy. There was no intraperitoneal free fluid. On Day 41 after ET, the patient was hospitalized because of acute epigastric pains. A pseudocyst of the head of pancreas was demonstrated by CT scan. A day later, exploratory laparotomy, because of a precipitous drop in the hemoglobin, revealed a massive retroperitoneal hematoma and an embryo in the gestational sac attached to the head of pancreas and major blood vessels. The patient did well following surgery. The mechanisms of retroperitoneal embryo migration are discussed and literature is reviewed.

Apoptosis in endometrial glandular and stromal cells in women with and without endometriosis

BACKGROUND

The aetiology of endometriosis is unknown. Ectopic dissemination of the endometrial cells gives origin to endometriotic lesions, but occurs in women with and without endometriosis. It has been suggested that increased ectopic cell survival facilitates their implantation. The objectives of this study were to evaluate endometrial apoptosis in women with endometriosis according to: (i) cyclic changes, (ii) glandular and stromal contribution, and (iii) stage of the disease.

METHODS

The subjects were women undergoing diagnostic laparoscopy and endometrial biopsies for suspected endometriosis. Spontaneous apoptosis was evaluated using TdT-mediated dUTP-biotin nick end-labelling (TUNEL) assay. Apoptotic cells per 10 mm(2) (apoptotic index) in an area of 10-50 mm(2) in 5 microm endometrial tissue sections were counted and location of these cells was recorded.

RESULTS

The apoptotic index in glandular epithelium was lower in endometriosis than controls (26.0 +/- 5.5 versus 51.2 +/- 9.7, P = 0.03) but not in the stroma (36.3 +/- 6.4 versus 48.4 +/- 11.3, NS). In controls, apoptosis was highest during the late secretory/menstrual and early proliferative phases and cyclic variability was apparent. In endometriosis, this cyclic variability was lost. There was a trend toward decreased apoptosis with increasing stage of the disease, but the differences lacked statistical significance.

CONCLUSIONS

Spontaneous apoptosis is decreased in the endometrial glands in women with endometriosis, especially during late secretory/menstrual and early proliferative phases of the cycle. This may indicate increased viability of endometrial cells shed during menses, facilitating their ectopic survival and implantation.

Postlaparoscopic small bowel obstruction secondary to unrecognized nodular endometriosis of the terminal ileum

Small bowel involvement by endometriosis occurs in about 0.5% of patients, but nodular endometriosis involving the entire wall of the terminal ileum is extremely rare. Endometriotic nodules protruding into the intestinal lumen may lead to chronic, partial, or acute complete small bowel obstruction and associated clinical changes. If obstruction is partial, preoperative diagnosis is difficult and seldom suspected, and no reliable diagnostic tests are available. At laparoscopic surgery, performed typically for associated pelvic endometriosis, bowel lesions may easily be overlooked, especially in women with abdominal adhesions from earlier surgery. Surgical injury, tension tears, or postoperative edema may contribute in such cases to the development of acute, complete small bowel obstruction, which may be difficult to differentiate from postoperative ileus. The patient may deteriorate rapidly and develop abdominal sepsis and multiple organ failure with high risk of mortality. Because of increased production of tumor necrosis factor-alpha by autologous monocytes, endometriosis may predispose to development of severe sepsis and septic shock. (J Am Assoc Gynecol Laparosc 8(1):161-166, 2001)

Open laparoscopy: 29-year experience

OBJECTIVE

To describe the safety and efficacy of open laparoscopy as a method of access to the abdominal cavity for laparoscopic surgery.

METHODS

We reviewed retrospectively all cases of open laparoscopy we did between August 1970 and June 1999.

RESULTS

Twenty-seven (0.5%) of 5284 patients who had open laparoscopies during the study years developed complications related to primary access. Twenty-one had minor wound infections, four had minor hematomas, one developed an umbilical hernia that required reoperation, and one had an inadvertent injury to the small bowel that was repaired intraoperatively without adverse outcome. Access to the abdominal cavity was generally secured in 3-10 minutes.

CONCLUSION

Open laparoscopy was associated with no method failure or life-threatening complications. Minor and medium risk complications occurred at a rate of 0.5%. Open laparoscopy is a safe, effective method of accessing the abdominal cavity.

Intracytoplasmic sperm injection into zona-free human oocytes results in normal fertilization and blastocyst development

Zona-free human oocytes are frequently encountered in in-vitro fertilization (IVF) laboratories. The oocytes escape out of the zona pellucida, following zona fracture, which can occur during oocyte retrieval or manipulation, but occasionally may be the result of increased zona fragility. Some of the zona-free oocytes are mature and morphologically healthy; nevertheless, all are typically discarded. In this report, we demonstrate that zona-free oocytes can be fertilized normally using intracytoplasmic sperm injection (ICSI) and can subsequently develop without zona to the blastocyst stage in vitro. We therefore suggest that those mature and morphologically normal zona-free oocytes may be rescued, fertilized with ICSI and then cultured to the blastocyst stage for subsequent transfer or cryopreservation.

Cytolysis of eutopic and ectopic endometrial cells by peripheral blood monocytes and peritoneal macrophages in women with endometriosis

OBJECTIVE

To compare the ability of peripheral blood monocytes (PBM) and peritoneal macrophages (PM) to mediate the in vitro cytolysis of endometrial cells from eutopic and ectopic endometrium in women with endometriosis.

DESIGN

Prospective study of immune function.

SETTING

Institute for the Study and Treatment of Endometriosis and university-based research laboratories.

PATIENT(S)

Twenty-four women with endometriosis (15 in stage I/II, 9 in stage III/IV) and 4 patients treated with GnRH agonists.

INTERVENTION(S)

Peritoneal fluid and peripheral blood were sampled and eutopic and ectopic endometrium were biopsied during diagnostic laparoscopy.

MAIN OUTCOME MEASURE(S)

Lysis of autologous endometrial cells.

RESULT(S)

Peripheral blood monocytes were significantly more cytolytic than peritoneal macrophages against autologous uterine endometrial cells. However, PBM and PM displayed a similar degree of cytolysis against a hepatoma cell line. Ectopic endometrial cells were significantly more resistant to cytolysis by autologous PBMC than were matched eutopic endometrial cells, and were completely resistant to cytolysis by autologous PM.

CONCLUSION(S)

The reduced capacity of PM from women with endometriosis to mediate the destruction of endometrial cells coupled with the increased resistance of ectopic endometrial cells to macrophage-mediated cytolysis may facilitate the survival of these cells within the peritoneal cavity of women with endometriosis.

Spontaneous apoptosis of endometrial tissue is impaired in women with endometriosis

OBJECTIVE

To evaluate spontaneous apoptosis in single-cell suspensions of eutopic and ectopic endometrium from women with endometriosis and in eutopic endometrium from fertile controls without endometriosis.

DESIGN

Paired specimens of eutopic and ectopic endometrial tissue from patients with endometriosis and eutopic endometrium from controls were assessed for spontaneous apoptosis.

SETTING

Institute for the Study and Treatment of Endometriosis and university-based research laboratories.

PATIENT(S)

Fertile controls (n = 10) and women with untreated endometriosis (n = 16).

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Spontaneous apoptosis assessed with an ELISA-based cell death detection kit.

RESULT(S)

Spontaneous apoptosis (monitored by absorbance) of eutopic endometrium from patients with endometriosis and fertile controls was 0.63 +/- 0.1 and 1.43 +/- 0.11, respectively. Among patients with endometriosis, spontaneous apoptosis of ectopic endometrium was 0.26 +/- 0.06. Decreased apoptosis of ectopic versus eutopic endometrium was observed independent of cycle phase.

CONCLUSION(S)

The susceptibility of endometrial tissue to spontaneous apoptosis is significantly lower in women with endometriosis than in fertile controls. We suggest that decreased susceptibility of endometrial tissue to apoptosis contributes to the etiology or pathogenesis of endometriosis.

Embryo implantation during menstruation in the absence of adequate estradiol and progesterone support, with subsequent normal response to ovulation induction and superfetation

OBJECTIVE

To report an unusual case of embryo implantation and superfetation.

DESIGN

Retrospective case analysis.

SETTING

Oak Brook Fertility Center.

PATIENT(S)

A 41-year-old woman underwent two consecutive ovarian stimulation cycles interrupted by a normal menstrual period. Ovulation and implantation occurred during both cycles. The first embryo conceived developed normally until term; the second failed to develop.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Retrospective analysis of stored blood samples for serum E2, P, and beta-hCG levels.

RESULT(S)

Rising beta-hCG levels during menstruation indicated normal embryonic implantation in the absence of adequate E2 and P support. During subsequent ovarian stimulation, there was a normal follicular and E2 response and normal ovulation in spite of the ongoing pregnancy. The second embryo, conceived during the second cycle of stimulation, implanted but failed to develop.

CONCLUSION(S)

This unusual case indicates that E2, P, and endometrial thickness requirements for successful implantation may not always be as critical as postulated previously. The absence of a decidual response might have facilitated superfetation.

Subcutaneous estradiol pellets for endometrial preparation in donor oocyte recipients with a poor endometrial response

PURPOSE

The purpose of this study was to evaluate the clinical effectiveness of subcutaneous estradiol pellets in donor oocyte recipients with an inadequate endometrial response.

METHODS

The subjects were 13 women with ovarian failure and a maximal endometrial thickness < 10 mm on standard estrogen regimens, as demonstrated during mock and/or prior oocyte donation cycles. They underwent pellet implantation (100-250 mg of estradiol) 6-13 weeks before oocyte donation.

RESULTS

maximal (mean +/- SD) endometrial thickness was 8.7 +/- 1.5 mm on standard regimens, in contrast to 11.7 +/- 1.8 mm on pellets, while estradiol levels were 674 +/- 844 and 815 +/- 706 pg/ml, respectively. The estradiol:estrone ratio on pellets was > 1. There was 1 pregnancy with early loss during 10 cycles on other estrogen regimens and 12 pregnancies during 19 cycles on pellets. The pregnancy and implantation rates were, respectively, 63 and 27% on pellets and 41 and 14% on standard regimens in historical controls.

CONCLUSIONS

We conclude that estradiol pellets after a single administration provide constant estradiol levels extending into the first trimester of pregnancy, a physiologic estradiol:estrone ratio, and a better endometrial response than standard estrogen regimens. Implantation and pregnancy rates are higher. This approach may be especially suitable for recipients with a poor endometrial response.

Changing trends in the diagnosis of endometriosis: a comparative study of women with pelvic endometriosis presenting with chronic pelvic pain or infertility

OBJECTIVE

To compare demographic, epidemiologic, and medical data and to evaluate diagnostic trends in women with endometriosis and chronic pelvic pain symptoms or endometriosis and infertility.

DESIGN

Retrospective analysis.

SETTING

Institute for the Study and Treatment of Endometriosis.

PATIENT(S)

Six hundred ninety-three consecutive patients with endometriosis and chronic pelvic pain (n = 357) or endometriosis and infertility (n = 336).

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Demographic and epidemiologic parameters, diagnostic trends.

RESULT(S)

Women with pelvic symptoms were younger, had less formal education, more frequent family history, and higher frequency and intensity of pelvic complaints. Mean ages at first symptom and diagnosis were lower in the pain group, but stage of endometriosis at first diagnosis was more advanced. The mean "diagnostic delay" was longer in the pelvic pain than in the infertile group (6.35 versus 3.13 years), but it decreased during three consecutive 5-year intervals in both groups, and there was also a gradual decrease in the frequency of advanced endometriosis at the time of first diagnosis.

CONCLUSION(S)

Demographic and epidemiologic parameters in women with endometriosis differ, depending whether chronic pelvic pain or infertility are the presenting symptoms. In the pain group, diagnostic delay is longer and endometriosis at diagnostic laparoscopy more advanced, indicating progressiveness of the disease. During the last 15 years, diagnostic delay steadily decreased and the frequency of advanced endometriosis at first diagnosis declined.

Excretion of urinary N-telopeptides reflects changes in bone turnover during ovarian suppression and indicates individually variable estradiol threshold for bone loss

OBJECTIVE

To evaluate the effectiveness of N-telopeptides and E2 in monitoring bone turnover during GnRH agonist- (GnRH-a) or danazol-induced hypoestrogenism.

DESIGN

Comparative, nonrandomized prospective study.

SETTING

Institute for the Study and Treatment of Endometriosis.

PATIENT(S)

Premenopausal women undergoing ovarian suppression with GnRH-a (n = 16) or danazol (n = 9).

INTERVENTION(S)

Serum and urine samples were collected and bone mineral density was measured before, during, and after treatment.

MAIN OUTCOME MEASURE(S)

N-telopeptide excretion, serum E2, and bone mineral density at L1 to L4 and femoral neck.

RESULT(S)

During treatment in the GnRH-a group, mean E2 levels were 53% below and N-telopeptides were 38% above the mean baseline. At 1 month post-treatment, L1 to L4 bone mineral density decreased by 3.85%. In the danazol group, E2, N-telopeptides and L1 to L4 bone mineral density changed nonsignificantly in the opposite direction with the mean 1.25% increase in L1 to L4 at 1 month post-treatment. In combined groups, L1 to L4 bone mineral density better correlated with other measures than femoral neck bone mineral density. N-telopeptide excretion was more predictive of L1 to L4 change, with correlation the highest between N-telopeptides at month 4 and bone mineral density at month 1 afterward, while E2 appeared more predictive of the less reliable femoral neck bone mineral density. Individual exceptions to the model of an E2 threshold for bone loss were observed. Also noted were high correlation between on-therapy levels of E2 and N-telopeptides, as well as the presence of a 1-month time lag between E2 and N-telopeptide changes.

CONCLUSION(S)

Bone density decreases during GnRH-a and may slightly increase during danazol treatment. However, E2 threshold for bone loss varies individually. N-telopeptides predict changes in bone mineral density at L1 to L4 better than E2.

Decrease in the size of ovarian endometriomas during ovarian suppression in stage IV endometriosis. Role of preoperative medical treatment

OBJECTIVE

To evaluate the effect of hormonal suppression on the size of ovarian endometriomas and to develop a predictive model for changes in the size of these lesions.

STUDY DESIGN

The study consisted of 80 women of reproductive age with the diagnosis of stage IV pelvic endometriosis, according to the revised American Fertility Society (rAFS) classification, and included 48 women with endometriomas > or = 3 cm. After the initial laparoscopic and sonographic evaluation, ovarian suppression was achieved with either danazol or a gonadotropin-releasing hormone agonist (GnRH-a) for six months. In all patients, pretreatment and posttreatment pelvic sonograms were performed, and at the end of treatment residual disease was evaluated and resected by laparotomy or laparoscopy. Seven of 80 women with endometriomas > or = 3 cm had serial sonograms during the course of therapy. Serial pelvic sonograms in this subgroup were used to develop a statistical model for predicting the size of endometriomas after treatment. The model was then tested in another subgroup of 41 women with endometriomas > or = 3 cm.

RESULTS

At the end of treatment, there was a significant decrease in the r-AFS score in both the danazol and GnRH-a groups. Medical treatment facilitated surgical resection of residual disease and preservation of ovarian tissue. There was no difference in this respect between danazol and GnRH-a. Endometriomas decreased by 51% in both treatment groups. The predictive model, when tested on 41 patients, underestimated the actual change by 11%, but the difference was within the 95% confidence limits.

CONCLUSION

This study documented, for the first time, that ovarian endometriomas decrease in size during hormonal suppression. Both danazol and GnRH-a were equally effective.

Spontaneous and induced synthesis of cytokines by peripheral blood monocytes in patients with endometriosis

OBJECTIVE

To investigate the capacity of peripheral blood monocytes (PBM) from women with endometriosis to secrete tumor necrosis factor-alpha (TNF-alpha), interleukin (IL) IL-6, IL-8, and IL-10.

DESIGN

Peripheral blood monocytes were cultured in the presence and absence of lipopolysaccharide for 24 hours before assessment of cytokines in supernatants by enzyme immunoassay.

SETTING

Institute for the Study and Treatment of Endometriosis and university-based research laboratories.

PATIENTS AND PARTICIPANTS

Fertile controls, n - 10; women with endometriosis, n = 20.

INTERVENTIONS

None.

RESULTS

Basal synthesis of TNF-alpha, IL-6, and IL-8 and the lipopolysaccharide-stimulated synthesis of TNF-alpha by PBM from women with endometriosis was significantly greater in comparison to that of fertile controls. Endometriosis had no effect on the basal or stimulated synthesis of IL-10.

CONCLUSIONS

These data show that endometriosis is associated with increased basal and stimulated synthesis and secretion of several different cytokines by PBM. Each of the cytokines found to be affected has the capacity to play a role in the symptomatology or pathogenesis of the disease.