Comparison of irrigation protocols for the internal decontamination of dental implants-results of in vitro and in vivo studies

OBJECTIVES

Previous investigations have shown a progressive bacterial colonization of the internal cavities of two-piece dental implants with possible implications for peri-implant bone loss. The aim of the study was to compare different irrigation protocols for the internal decontamination of implants in vitro and in vivo.

MATERIALS AND METHODS

In the in vitro part, 80 samples were obtained 24 h after inoculation with an aliquot of subgingival bacteria from 40 implants as follows: before and after either cleaning with a brush and an irrigation solution (irrigation-brush-irrigation: test) or repeated irrigation alone (irrigation-irrigation: control). In the clinical study, 40 samples from twenty partially edentulous patients contributing each with one implant were collected after removal of abutment and suprastructure with sterile paper points immediately before and after decontamination and subsequently analyzed for total bacterial counts (TBC) by real-time-PCR. Irrigation solutions were chlorhexidine (0.2% (CHX)), H₂ O₂ (10%), alcohol (70%, (ALC)), and NaCl (0.9%). Differences in proportional reduction of TBC between the four irrigation solutions were analyzed.

RESULTS

Irrigation with H₂ O₂ showed the highest effect in both parts of the study (relative TBC reduction in vitro: H₂ O₂ : 87.1%, CHX: 56.9%, ALC: 43.7%, NaCl: 42.7%; in vivo: H₂ O₂ : 51.4%, ALC: 30.4%, NaCl: 26.3%, CHX: 7.1%). The additional use of a brush showed no beneficial effect (p = 0.088). Overall, H₂ O₂ was superior to all other irrigation solutions with regard to relative TBC reduction.

CONCLUSIONS

The present results indicate the potential of an irrigation protocol that includes a 10% H₂ O₂ solution for the internal decontamination of implants. (ClinicalTrials.gov NCT01917305).

Konsiliar- und Liaisonpsychiatrie im Allgemeinkrankenhaus

Somatische Erkrankungen werden häufig von psychischen Symptomen und Verhaltensauffälligkeiten begleitet. Andererseits weisen viele körperliche Beschwerden auch auf das Vorliegen einer larvierten psychischen Erkrankung hin. Aus diesem Grund hat in den letzten Jahren die Bedeutung der Konsiliarpsychiatrie und Psychotherapie am Allgemeinkrankenhaus deutlich zugenommen. Der vorliegende Artikel gibt einen Überblick über die Aufgaben und die Organisation der Konsiliarpsychiatrie am Allgemeinkrankenhaus. Besonderer Aspekt wird auf die Bedeutung der Konsiliarpsychiatrie für die Arbeit des somatisch tätigen Arztes gelegt. Es sollten Probleme, Arbeitsfelder und Chancen der Konsiliarpsychiatrie am Allgemeinkrankenhaus aufgezeigt werden.

RBO Aleph: leveraging novel information sources for protein structure prediction

RBO Aleph is a novel protein structure prediction web server for template-based modeling, protein contact prediction and ab initio structure prediction. The server has a strong emphasis on modeling difficult protein targets for which templates cannot be detected. RBO Aleph's unique features are (i) the use of combined evolutionary and physicochemical information to perform residue–residue contact prediction and (ii) leveraging this contact information effectively in conformational space search. RBO Aleph emerged as one of the leading approaches to ab initio protein structure prediction and contact prediction during the most recent Critical Assessment of Protein Structure Prediction experiment (CASP11, 2014). In addition to RBO Aleph's main focus on ab initio modeling, the server also provides state-of-the-art template-based modeling services. Based on template availability, RBO Aleph switches automatically between template-based modeling and ab initio prediction based on the target protein sequence, facilitating use especially for non-expert users. The RBO Aleph web server offers a range of tools for visualization and data analysis, such as the visualization of predicted models, predicted contacts and the estimated prediction error along the model's backbone. The server is accessible at http://compbio.robotics.tu-berlin.de/rbo_aleph/.

Feasibility of using administrative data to compare hospital performance in the EU

OBJECTIVE

To describe hospitals' organizational arrangements relevant to the abstraction of administrative data, to report on the completeness of administrative data collected and to assess associations between organizational arrangements and completeness of data submission.

DESIGN

A cross-sectional

STUDY DESIGN

utilizing administrative data.

SETTING AND PARTICIPANTS

Randomly selected hospitals from seven European countries (The Czech Republic, France, Germany, Poland, Portugal, Spain, and Turkey).

MAIN OUTCOME MEASURES

Completeness of data submission for four quality indicators: mortality after acute myocardial infarction, stroke and hip fractures and complications after normal delivery.

RESULTS

In general, hospitals were able to produce data on the four indicators required for this research study. A substantial proportion had missing data on one or more data items. The proportion of hospitals that was able to produce more detailed indicators of relevance for quality monitoring and improvement was low and ranged from 40.1% for thrombolysis performed on patients with acute ischemic stroke to 63.8% for hip-fracture operations performed within 48 h after admission for patients aged 65 or older. National factors were strong predictors of data completeness on the studied indicators.

CONCLUSIONS

At present, hospital administrative databases do not seem to be an appropriate source of information for comparison of hospital performance across the countries of the EU. However, given that this is a dynamic field, changes to administrative databases may make this possible in the near future. Such changes could be accelerated by an in-depth comparative analysis of the issues of using administrative data for comparisons of hospital performances in EU countries.

Sperm-egg interaction and functional assessment of springbok, impala and blesbok cauda epididymal spermatozoa using a domestic cattle in vitro fertilization system

The study assesses the possibility to estimate the potential fertility of post-thawed antelope (Antidorcas marsupialis), impala (Aepyceros melampus) and blesbok (Damaliscus dorcus phillipsi) epididymal sperm using homologous and heterologous IVF and the functioning of cattle IVF system to produce antelope embryos. Cauda epididymal sperm were collected from the antelope and cryopreserved under field conditions. In vitro matured domestic cow, blesbok and springbok oocytes were co-incubated in modified-Tyrode Lactate (m-TL) IVF media with springbok, impala and blesbok sperm for heterologous IVF and springbok and blesbok sperm for homologous IVF. A group of presumptive zygotes from each treatment were examined for sperm penetration and male pronuclear formation after 18h and the remainder were cultured and evaluated for embryo cleavage 22h later. The study shows that Modified Tyrode Lactate in vitro fertilization media supports survivability, capacitation and hyperactivation of springbok, impala and blesbok sperm. Springbok, impala and blesbok post-thawed epididymal spermatozoa are capable of fertilizing domestic cow oocytes under conditions that support domestic cattle IVF. Penetration, male pronuclear formation and embryo cleavage did not differ (p>0.05) between cow oocytes inseminated with sperm from springbok, impala or blesbok however these parameters were higher (p<0.05) for oocytes inseminated with bull sperm. Modified Tyrode Lactate IVF media supported homologous fertilization and embryo development in springbok and blesbok however did not support blastocyst development. These findings suggest that cattle provide a useful model for evaluating springbok, impala and blesbok post-thawed cauda epididymal sperm functionality. Domestic cattle embryo culture conditions need to be modified to promote blastosyst development in these antelope species. Such research provides an important tool in assisted reproductive technology development when high biological value material is utilized for wild species recovery plans.

Enriching the captive elephant population genetic pool through artificial insemination with frozen-thawed semen collected in the wild

The first successful AI in an elephant was reported in 1998, using fresh semen. Since then almost 40 calves have been produced through AI in both Asian and African elephants worldwide. Following these successes, with the objective of enriching the captive population with genetic material from the wild, we evaluated the possibility of using frozen-thawed semen collected from wild bulls for AI in captivity. Semen, collected from a 36-yr-old wild African savanna elephant (Loxodonta africana) in South Africa was frozen using the directional freezing technique. This frozen-thawed semen was used for four inseminations over two consecutive days, two before and two after ovulation, in a 26-yr-old female African savanna elephant in Austria. Insemination dose of 1200 × 10(6) cells per AI with 61% motility resulted in pregnancy, which was confirmed through ultrasound examination 75, 110 and 141 days after the AI procedure. This represents the first successful AI using wild bull frozen-thawed semen in elephants. The incorporation of AI with frozen-thawed semen into the assisted reproduction toolbox opens the way to preserve and transport semen between distant individuals in captivity or, as was done in this study, between wild and captive populations, without the need to transport stressed or potentially disease-carrying animals or to remove animals from the wild. In addition, cryopreserved spermatozoa, in combination with AI, are useful methods to extend the reproductive lifespan of individuals beyond their biological lifespan and an important tool for genetic diversity management and phenotype selection in these endangered mammals.

Naturally acquired antibodies to Bacillus anthracis protective antigen in vultures of southern Africa

Sera from 19 wild caught vultures in northern Namibia and 15 (12 wild caught and three captive bred but with minimal histories) in North West Province, South Africa, were examined by an enzyme-linked immunosorbent assay (ELISA) for antibodies to the Bacillus anthracis toxin protective antigen (PA). As assessed from the baseline established with a control group of ten captive reared vultures with well-documented histories, elevated titres were found in 12 of the 19 (63%) wild caught Namibian birds as compared with none of the 15 South African ones. There was a highly significant difference between the Namibian group as a whole and the other groups (P < 0.001) and no significant difference between the South African and control groups (P > 0.05). Numbers in the Namibian group were too small to determine any significances in species-, sex- or age-related differences within the raw data showing elevated titres in four out of six Cape Vultures, Gyps coprotheres, six out of ten White-backed Vultures, Gyps africanus, and one out of three Lappet-faced Vultures, Aegypius tracheliotus, or in five of six males versus three of seven females, and ten of 15 adults versus one of four juveniles. The results are in line with the available data on the incidence of anthrax in northern Namibia and South Africa and the likely contact of the vultures tested with anthrax carcasses. It is not known whether elevated titre indicates infection per se in vultures or absorption of incompletely digested epitopes of the toxin or both. The results are discussed in relation to distances travelled by vultures as determined by new tracking techniques, how serology can reveal anthrax activity in an area and the issue of the role of vultures in transmission of anthrax.

Degradation of the drug diclofenac in water by sonolysis in presence of catalysts

Diclofenac, as one of the most popular antiphlogistics, is produced in great quantities. Nowadays this drug is ubiquitously present in the aquatic environment due to its resistance to biodegradation. Degradation by ultrasonic irradiation is a possibility to eliminate diclofenac from water without the addition of chemicals. The sonolysis of diclofenac in water was investigated at ultrasound frequencies of 24 kHz, 216 kHz, 617 kHz, and 850 kHz and in the presence of various catalysts (TiO2, SiO2, SnO2, and titanosilicate). The degradation of diclofenac by sonolysis of an aqueous solution at 617 kHz followed first-order kinetics. Catalysts, especially TiO2 increased the rate of degradation. Within 30 min of irradiation, the relative concentration of diclofenac decreased from 100% to 16%. By HPLC and GC-MS methods, chlorinated anilines, phenols and carboxylic acid derivatives were detected as a result of the sonolysis. About 35% of organic chlorine was transformed into inorganic chloride. Most of the identified degradation products in the sonolysis of diclofenac were the same compounds that were detected during photo-oxidation experiments with this anti-inflammatory drug.

A phase II study of YM155, a novel survivin suppressant, administered by 168 hour continuous infusion in patients with unresectable stage III or stage IV melanoma

8538

Background: In cell line studies, YM155 showed markedly potent antiproliferative activity against melanoma with 50% growth inhibition (GI50) values ranging from 0.35 nM to 910 nM. In melanoma tumor-bearing mouse xenograft models, YM155 showed significant antitumor activity including regression of tumors, at doses ranging from 1 to 10 mg/kg/day. Methods: Chemotherapy naive patients with unresectable Stage III or IV melanoma were eligible. The primary endpoint was tumor response defined by RECIST criteria. Secondary endpoints included progression-free survival and toxicity. A Simon's two stage minimax design was utilized with the first stage requiring 1 response (N=27) and a total of 2 responses required at the conclusion of stage II (N=29). Patients were considered evaluable if they completed 2 cycles. YM155 was given as a 168-hour (7-day) continuous infusion every three weeks (1 cycle) at a dose of 4.8 mg/m2/day. Results: Enrollment is complete at 34 pts in order to reach 29 evaluable with treatment ongoing. Results are available for the first 26 pts. Median age was 59 y/o, (range 29 - 88) with ECOG PS of 0–1. There is one objective response of intrabdominal lymph nodes based on Investigator assessment at Cycle 2 confirmed at Cycle 4; another patient had a minor response (24% reduction) at Cycle 6 (currently at Cycle 8). Two subjects have shown stable disease after 6 cycles and remain on study. The median number of cycles is 3 (range 1 - 9). Two of 26 pts reported a grade 3 AE considered possibly related to YM155 (chest pain - nos and catheter related thrombosis). Nineteen of 26 pts have discontinued the study (18 PD, 1 withdrew consent). Conclusions: YM155 induced responses in 2 pts and was generally well tolerated. Given this encouraging response as a single agent, studies of YM155 combined with other agents are under consideration.

[Table: see text]

246 IN VITRO PRODUCTION OF SPRINGBOK (ANTIDORCAS MARSUPIALIS) EMBRYOS

The objective of this experiment was to develop in vitro embryo production (IVP) technologies in springbok (Antidorcas marsupialis), a southern African antelope. Springbok, a fairly common species on game farms in parts of South Africa, may be used as a model species for gamete rescue and IVP techniques to be applied to the conservation of other threatened antelope species. Springbok belong to the family bovidae, subfamily antilopinae, tribe antilopini, which comprises about twenty species in genera Gazella, Antilope, Procapra, Antidorcas, Litocranius, and Ammodorcas. In this tribe alone, there are 4 species or subspecies that are critically endangered, 3 that are endangered, and 10 that are considered vulnerable, demonstrating the need for antelope conservation efforts. In addition, our studies contributed to the South African biological resource bank, so that banked springbok semen and embryos might be used in the future for managed genetic contribution to isolated captive or wild populations via assisted reproductive technologies. Oocytes were recovered (3 replicates) from ovaries obtained at supervised culls for management purposes in South Africa, and cultured in defined Gmat or undefined TCM-199 with FCS maturation medium for 28-30 h (Brad et al. 2004 Reprod. Fertil. Dev. 16, 223). Oocytes were fertilized with frozen-thawed springbok epididymal spermatozoa in modified SOF fertilization medium with caffeine (Herrick et al. 2004 Biol. Reprod. 71, 948–958). Eighteen hours after insemination, a randomly selected subset of the zygotes were fixed to determine fertilization success. The remaining zygotes were cultured in G1/G2 media. On Day 7 of culture, embryos were analyzed for development to the morula or blastocyst stage. A total of 259 selected oocytes were collected from 50 females (5.2 selected oocytes/female on average). There was no difference in the percentage of oocytes normally fertilized (2 pronuclei, PN) between oocytes matured in Gmat (n= 43; 12%) and those matured in TCM-199 (n= 42; 10%). There were significantly (P &lt; 0.05) more oocytes penetrated (e2 PN) when matured in TCM (50%) compared to Gmat (23%). There were no differences in embryonic cleavage or morula/blastocyst development (of total oocytes inseminated) between treatments (Gmat,n= 89, 54%, 9.0%; TCM-199, n= 85, 68%, 9.4%, respectively). In both treatments, the average blastocyst grade was 2.125 using the standard bovine grading system (Curtis, Cattle Embryo Transfer Procedure, 1991). In conclusion, in vitro oocyte maturation, fertilization, and embryo culture to the blastocyst stage is possible in springbok. Importantly, blastocysts can be produced in vitro under semi-defined conditions, demonstrating that oocyte maturation without serum does support developmental competence. This is important for the potential international movement of IVP embryos to be used for genetic management in the conservation of antelope species.

241 TIME POINTS FOR IN VITRO MATURATION OF LION (PANTHERA LEO) OOCYTES

The objective of the study was to establish a time point for successful in vitro maturation of lion (Panthera leo) oocytes using a model developed for the domestic cat (Gomez et al. 2003 Theriogenology 60, 239–251). As part of a game reserve management program, one adult free-ranging lioness (6–7 years old) and her 3 sub-adult cubs (18 months old) were chemically immobilized with 500 mg of a combination of tiletamine and zolazepam (Zolatil 100�; Virbac SA, Carras, France) by remote injection (Dan-inject�; Dan-Inject ApS, Borkop, Denmark) and within 20 min euthanized using 8 g sodium pentobarbitone (Euthapent� KruVet, SA). Ovaries collected from the adult and 2 sub-adult females were transported to a laboratory in a flask containing warm (37�C) sterile saline. Within 2 h of collection, all visible follicles were aspirated using a 21G needle attached to a 5-mL syringe. To increase the number of recovered oocytes, ovaries were minced using a scalpel blade in a 60-mm Petri dish containing warm search medium (HEPES-buffered TCM-199, 2.2 mM Ca lactate, 0.36 mM pyruvate, 2 mM glutamine, 1.12 mM cysteine, 0.3% w/v fatty acid-free BSA, and 50 �g mL-1 gentamicin). A total of 33 and 54 oocytes were recovered from the adult and sub-adult females, respectively, and cultured in 35-mm Petri dishes containing 3-mL of maturation medium (sodium bicarbonate-buffered TCM-199, 1 IU mL-1 hCG, 0.5 IU mL-1 eCG, 2.2 mM Ca lactate, 0.36 mM pyruvate, 2 mM glutamine, 1.12 mM cysteine, 0.3% w/v fatty acid-free BSA, and 50 �g mL-1 gentamicin). Petri dishes containing oocytes were enclosed in a sealed plastic bags, filled with a humidified gas mixture of 5% CO2, 5% O2, and 90% N2, and incubated at 38.8�C. After 26, 32, or 38 h of incubation, groups of 29 oocytes were fixed in 3 : 1 ethanol : acetic acid solution and stored at 4�C for 48 h. Fixed oocytes were stained with 1% w/v orcein and visualized with phase-contrast microscopy. Oocytes in telophase I or metaphase II were classified as mature. Each ovary had an average of 22.5 � 3.0 antral follicles, where 8.8 � 2.0 were 2-3 mm, and 13.8 � 1.5 were 1 mm in diameter. There were no CLs present. Out of 87 oocytes recovered, 24.0 � 3.7% had a uniform cytoplasm and &gt;3-4 layers of cumulus cells, 42.2 � 6.0% had a uniform cytoplasm and 2 or less layers of cumulus cells, and 33.8 � 9.7% had no cumulus cells attached. None of the oocytes were mature at 26 h, but at 32 h and 38 h, the percentage of matured oocytes significantly (P &lt; 0.05) increased to 63.9 � 13.9% and 80.4 � 7.1%, respectively. These results indicate that the domestic cat system used herein can be successfully applied for in vitro maturation of lion oocytes. However, unlike oocytes from a domestic cat, lion oocytes required a culture period of 32 to 38 h to reach metaphase II. Further studies are required to confirm these findings and to test fertilization rates of such matured oocytes, and their ability for further development.

217 QUALITY CHANGES IN POST-THAW SPRINGBOK (ANTIDORCAS MARSUPIALIS) EPIDIDYMAL SPERM MAINTAINED IN FERTILIZATION MEDIUM

The availability of gametes from the cropping of excess wildlife species provides the opportunity for the advancement of knowledge into assisted reproductive technology for possible future conservation measures. Little is known about the longevity of springbok (Antidorcas marsupialis) spermatozoa maintained in fertilization medium. The aim of this project was to determine the quality changes of post-thawed springbok spermatozoa incubated in fertilization medium by measuring plasma membrane integrity over time. Testes (n = 12) were obtained from two geographically distinct free-ranging springbok populations in South Africa. Spermatozoa were flushed from the cauda epididymides within three hours of the animals' death. Samples from an individual male were pooled, diluted to 400 × 106 sperm/mL with Biladyl (Minitüb, Tiefenbach, Germany) fraction A (no glycerol) and equilibrated in a water bath for 6 h at 4°C. An equal volume of Biladyl fraction B (containing 12% glycerol) was added to the sample to make a final concentration of 200 × 106 sperm/mL. Samples were loaded into 0.25-mL straws and frozen in liquid nitrogen vapor (5 cm above the liquid nitrogen level) for 20 min after which they were plunged into liquid nitrogen. Straws from each sample were thawed for 20 s at 36°C in a water bath. Thawed spermatozoa (100 μL) was added to 1 mL IVF-TALP medium containing heparin and PHE (Vajta et al. 1996 Theriogenology 45, 683–689) in 2-mL Nunc tubes (AEC, Amersham, South Africa) and incubated at 38.7°C, in humidified 5% CO2 balance air for 30 h. Aliquots were extracted from the incubating spermatozoa to determine plasma membrane integrity at 6-h intervals. Propidium iodide (Sigma, South Africa) at 50 ng/mL (10 min at RT) was used to evaluate membrane integrity under fluorescence microscopy at ×400, with a 450-nm excitation filter, a 510-nm dicroic beam splitter, and a 520-nm barrier filter. Cells with damaged plasma membrane have nuclei that fluorescence red. Eosin/nigrosin was also used to evaluate membrane integrity under ×400 bright-field microscopy. Cells with damaged plasma membrane stain purple-red, whereas the balance of cells remain translucent. The average post-thaw motility of spermatozoa in populations A and B was 69% (n = 6) and 68% (n = 6), respectively. Plasma membrane integrity of post-thawed springbok spermatozoa deceased steadily in IVF-TALP medium over the 30-h period (Table 1). Cryopreserved epididymal sperm derived from free-ranging springbok populations survive in IVF-TALP media and may be useful in future conservation activities where an isolated gene pool requires genetic supplementation through one or more assisted reproduction techniques such as IVF or AI. Further research is required to confirm and extend these findings. Table 1. Percentage plasma membrane integrity of post-thawed springbok sperm over time

195 CHANGES OF BLESBOK AND BLUE WILDEBEEST EPIDIDYMAL SPERM AFTER INCUBATION AT 37°C

Postmortem recovery of epididymal spermatozoa and their preservation in Biological Resource Banks is a convenient source of germplasm, providing a possible future conservation resource for selected endangered wildlife species. It is necessary to gain knowledge of the biology of the gametes of the different species, in order to define effective protocols for cryopreservation and future assisted reproductive technology application. A pilot study on the changes in blue wildebeest (Connochaetes taurinus) and blesbok (Damaliscus dorcas phillipsi) epididymal sperm was carried out in order to provide some insight into the effects of incubation at 37°C. Chemicals were aquired from Sigma (South Africa), except JC-1 (Molecular Probes, Leiden, The Netherlands). Sperm was obtained by flushing the vas deferens and cauda epididymis of 6 adult blue wildebeests and 4 adult blesbok after the breeding season using 1 mL of Biladyl (fraction A; Minitüb, Tiefenbach, Germany). Cells were washed and resuspended in buffered medium (20 mM HEPES, 197 mM NaCl, 10 mM glucose, 2.5 mM KOH). Part of each sample was analyzed and part was incubated for 1 h at 37°C, and then analyzed. Analysis consisted of: motility (% of motile sperm, TM; and % of linear sperm, LM), vitality (fluorescent dye propidium iodide, 7 μM; % of unstained cells noted after 10 min at RT: vital, VIT), mitochondrial status (fluorescent dye JC-1, 7.5 μM; % of cells with orange midpiece noted after 30 min at 37°C: active mitochondria, MIT), and induction of acrosome reaction (15 min at 37°C in buffered medium complemented with 3 mM CaCl; % of intact acrosomes noted in control: splits no ionophore, ACR, and test: splits 1 μM calcimycin, ION). Samples were assessed using phase contrast microscopy (×400; ×200 for motility). Results are showed in Table 1. No significant differences (Wilcoxon Rank Sign test) were detected, possibly due to the low number of samples. However, LM appeared to decrease after incubation. Incubaton may increase the sensitivity of blue wildebeest sperm to ionophore (ION). Motility was least for blesbok, and the decrease of LM after incubation was more apparent. This treatment may induce different physiologycal changes between the species (different LM variation). The rest of the parameters suggest that the treatment did not induce extensive cell damage. Further research must be carried out to confirm these findings. Table 1. Median values for the analyzed parameters Sponsors of this project include Vodacom, Joan St. Leger Lindburgh Charitable Trust, Tony and Lizette Lewis Foundation, Department Science and Technology (South Africa), British Airways, IMV Technologies/CBS (France), NECSA, Zeiss Microscopes, AEC-Amersham, CryoLogic (Australia), Cook Veterinary (Australia), Mazda Wildlife Fund, The Scientific Group, Genaust (Australia), and SCI – Chesapeake Chapter.

A prospective, randomized, double-blind, placebo-controlled multi-centre study on the efficacy and safety of sublingual immunotherapy (SLIT) in children with seasonal allergic rhinoconjunctivitis to grass pollen

BACKGROUND

Especially in childhood, sublingual immunotherapy (SLIT) could offer advantages over subcutaneous therapy. However, limited data on its efficacy is available.

METHODS

In four German centres 97 children (age 3-14 years) with allergic rhinoconjunctivitis to grass pollen were enrolled in a prospective, double-blind trial comparing SLIT (Pangramin SLIT; ALK-SCHERAX, 0.5 microg major allergens, three times per week, 32 months) with placebo. Primary endpoint was a multiple symptom-medication score for changes in seasonal diary entries between the first and third year of the study (SLIT n=39; placebo n=38).

RESULTS

The multiple symptom-medication score was significantly reduced by SLIT to 77.3% of the placebo group (P=0.0498). The subsequent analysis of the single endpoints did not reveal significant differences for symptom scores in favour of SLIT (85.1% of placebo group; P=0.22). However, the medication score improved significantly (67.1% of placebo group; P=0.0025). Furthermore, secondary endpoints assessing in vivo immune responses did not differ significantly between the groups. However, retrospective analysis showed some inhomogeneity for clinical and in vitro parameters at the beginning of the study. Allergic side effects with possible relation to the study drug were reported in both groups (SLIT 49%, placebo 27%, P=0.026).

CONCLUSION

Our study indicates that SLIT had a positive effect on the reduction of a multiple symptom-medication score, mainly by significantly reducing rescue medication use, but had no significant effect on symptoms alone in children with rhinoconjunctivitis to grass pollen compared with a placebo.

211QUALITY CHANGES IN BLUE WILDEBEEST (CONNOCHAETES TAURINUS) EPIDIDYMAL SPERMATOZOA MAINTAINED AT 4°C

Wildlife management in southern Africa often involves the harvesting of animals on ranches and reserves, providing unique opportunities to collect and assess the quality of epididymal spermatozoa for possible future conservation actions. The black wildebeest (Connochaetes gnu) is facing renewed threats to its survival, including the production of fertile hybrids from crossing with the more common blue wildebeest (Connochaetes taurinus). The close relationship between the two wildebeest species allows for the blue wildebeest to be used as a model to assess epididymal sperm quality over time while maintained at 4°C. Field conditions often preclude the immediate availability of liquid nitrogen, necessitating the development of alternative short-term storage methods. All chemicals were provided by Sigma (South Africa) unless otherwise stated. Testes were harvested from 6 blue wildebeest bulls at a local game farm, Savannah, and kept at 5°C during transportation to the lab. Epididymides were dissected out and spermatozoa were flushed out of the cauda epididymis using 1mL of Tris-citrate egg yolk extender (Fraction A, Biladyl, Minitub, Germany), followed by storage at 4°C and assessment at 12h intervals. At each interval, an aliquot was removed, washed with a modified buffered HEPES solution (20mM HEPES, 355mM sucrose, 10mM glucose, 2.5mM KOH;; 400mOsm/kg, pH 7; Sigma) and visually assessed with a phase contrast microscope (×200, at 37°C) to determine the percentage of motile (MS) and progressive motile (PS) spermatozoa. In addition, plasma membrane integrity (PMI) was assessed with eosin-nigrosin staining and active mitochondrial status (MIT) assessed with an epifluorescent microscope (×400) using the fluorescent probe JC-1 (Molecular Probes, The Netherlands;; 7.5μM; 30min at 37°C). Resilience to hypo-osmotic shock was also evaluated by incubating the sample in a modified hypo-osmotic medium (100mOsmkg−1; 15min RT), and staining with PI to assess plasma membrane integrity (HOSPMI). A summary of results is presented in the table 1. The MS, MIT and HOSPMI did not decrease significantly during the 48h storage period. The only parameters that showed a significant decrease were PS and PMI (P&lt;0.01, Kruskall-Wallis test). However, PMI showed a slow but steady decrease (13%), whereas PS underwent a significant drop (52%). In conclusion, epididymal spermatozoa from the blue wildebeest, kept at 4°C for 48h, may still be useful for some assisted-reproduction techniques. The use of spermatozoa from a common but closely related wildebeest species allows for the development of assisted-reproduction techniques that may one day aid the conservation of threatened wildebeest species. Additional research is needed to confirm these findings and to test the effect of longer storage times on spermatozoa of this species as well as closely related endangered species. Table 1 Parameters measured during the 12-h time periods (mean±SD)

208EFFECT OF REFRIGERATION AND CRYOPRESERVATION ON THE QUALITY OF LION EPIDIDYMAL SPERMATOZOA

Epididymal spermatozoa from harvested wild animals is potentially useful for conservation purposes, as it can be used for subsequent artificial insemination or stored in Biological Resource Banks for future use. The potential of sperm banking is of particular interest for use in lion (Panthera leo) populations maintained in small National Parks, as translocation of males to effect gene-flow is often problematic, resulting in the translocated lion being killed by resident pride males. We measured the change in sperm quality over time during cool storage (at 4°C) and after thawing of samples cryopreserved at −196°C. Also, we present a correlation between sperm plasma membrane integrity and mitochondrial activity as measured by fluorescent analysis. The testes from a pride lion were removed and transported to the laboratory (at 4°C) within 6h. The epididymides were removed and both cauda epididymides were flushed with 1mL of Tris-citrate egg yolk extender (Fraction A, Biladyl, Minitub, Germany). The sample containing 2930×106 cells mL−1 was washed (20mM HEPES, 355mM sucrose, 10mM glucose, 2.5mM KOH;; 400mOsm/kg, pH 7; Sigma, South Africa) and after centrifugation (5min. at 600g), the pellet was resuspended in 0.5mL of washing solution (with 197mM NaCl instead of sucrose). One aliquot of spermatozoa was kept at 4°C and evaluated at 24h intervals for 7 days. A second aliquot of the sperm sample was extended in Tris-citrate egg yolk extender with glycerol (Fraction B, Biladyl), frozen in liquid nitrogen (LN) vapor and stored in LN. The frozen sample was later thawed and evaluated as for the cooled samples. Percentages of motile (MS) and progressive (PS) spermatozoa were assessed using a phase contrast microscope (×200; stage at 37°C). Sperm plasma membrane damage was assessed by determining the percentage of cells exhibiting red fluoresence after staining with propidium iodide (PI, 50ng/mL; 10min RT). Spermatozoa that did not stain red in PI were classified as plasma membrane intact (PMI). Resilience to hypo-osmotic shock and plasma membrane integrity were evaluated by incubating a portion of the sample in a 100mOsm/kg solution (10nM glucose, 20nM HEPES, 30nM NaCl) containing PI for 15min at room temperature. The percentage of sperm cells with active mitochondria (MIT) was determined by counting spermatozoa showing orange fluoresence over the mid-piece after staining with JC-1(7.5 uM Sigma) for 30min at 37°C. At collection, MS was 15% and did not show a significant decrease during the 7-day storage period. Initially, PS was 10% and dropped to 5% after 7 days, with values fluctuating during the storage period. Both PMI and HOSPMI were 80% on Day 1, gradually decreasing to 75% on Day 7 of storage. PMI and MIT showed a highly significant correlation (r=0.88; P=0.003; n=8). In frozen-thawed sperm samples, MS fell from a pre-freeze value of 15% to 5% after thawing. Similarly, PS fell from 10% in pre-freeze to 3% in frozen-thawed samples. Likewise, PMI, HOSPMI and MIT values were 80% and 45%, 87% and 45% and 89% and 49%, respectively. Our study showed that lion sperm PMI and MIT remained high after 7 days at 4°C. MS and PS, although low, did not vary during this same period. PI and JC-1 showed a significant correlation, suggesting that both might be affected by the same deleterious factors. Although PMI, HOSPMI and MIT values decreased approximately 40% after freezing, we feel that such sperm samples could be used for in vitro embryo production, if not by IVF, by ICSI. Of course, additional studies are needed to validate our suggestion.

214USE OF FLOURESCENT PROBES TO ACCESS EPIDIDYMAL SPERMATOZOA OF THE BLUE WILDEBEEST CONNOCHAETES TAURINUS AND IMPALA ANTELOPE AEPYCEROS MELAMPUS MELAMPUS

Sperm quality assessment may be a useful tool not only for evaluating the reproductive health of free-ranging populations, but also for selecting individuals for future assisted-reproduction technology programs. The aim of this study was to assess the functionality of epididymal spermatozoa collected from blue wildebeest (Connochaetes taurinus) and impala (Aepyceros melampus melampus) during the non-breeding season, using the fluorescent probes, propidium ioide (PI;; Sigma, South Africa) and JC-1 (Molecular Probes, The Netherlands). Six blue wildebeest and eight impala were harvested as part of a wildlife management program on a game ranch in South Africa. Testes were removed and transported to the laboratory within 6 hours while being maintained at 4°C. The cauda epididymides were removed and flushed with 1mL of Tris-citrate egg yolk extender (fraction A, Biladyl;; Minitüb, Germany). The sperm sample was diluted 1:4 in HEPES washing medium (Sigma;; 20mM HEPES, 355mM sucrose, 10mM glucose, 2.5mM KOH;; 400mOsm/kg, pH 7), and centrifuged for 5min at 600g, followed by re-suspending the pellet in 0.1mL of HEPES saline medium (Sigma;; as for washing medium, except 197mM NaCl instead of sucrose). The percentage of motile (MS) and progressively motile (PS) spermatozoa were determined using phase contrast microscopy (×200, 37°C). Sperm plasma membrane integrity and mitochondrial status were assessed using fluorescence microscopy (×400, 450–490nm excitation filter, 510nm dichroic-beam splitter, 520nm barrier filter) after staining with PI (50ngmL−1; 10min, RT) and JC-1 (7.5μM; 30min, 37°C), respectively. Spermatozoa with damaged plasma membranes showed a red fluorescence and spermatozoa with active and inactive mitochondria (MIT) fluoresced orange and green, respectively. Spearman correlation coefficients were calculated between spermatozoa with intact plasma membranes (IPM) and MIT, and with motility (Statistica™ package). A summary of the results is shown in the table 1. Although samples were not collected during the breeding season, sperm quality appeared to be good for the blue wildebeest, but less so for the impala. In general, impala results were more varied. Significant correlations were found for impala (n=8, P&lt;0.05) MS-IPM: 0.75; IPM-MIT: 0.83, and for blue wildebeest (n=6, P&lt;0.05), MS-IPM: 0.84; IPM-MIT: 0.81, and for pooled data (n=14, P&lt;0.01), MS-IPM: 0.93; MS-MIT: 0.87; PS-IPM: 0.67; PS-MIT: 0.66; IPM-MIT: 0.95. These correlations suggest a relationship of functional parameters to sperm motility. Both membrane integrity and mitochondrial status are important for sperm flagellar activity. The correlation between IPM and MIT indicates a relationship or the effect of common factors. In conclusion, sperm collected from blue wildebeest and impala during the non-breeding season appear functional, a fact that may be useful for future conservation programs based on assisted reproduction technology or for assessing the reproductive health status of free-ranging wildlife populations. The fluorescent probes PI and JC-1 appear useful for assessing sperm quality in these two species and should be considered for further sperm quality assessment studies in other antelope species. Table 1 Results of the analyses, showing mean±SD (max.–min.)

57EMBRYO DEVELOPMENT FOLLOWING INTERSPECIES NUCLEAR TRANSFER OF AFRICAN BUFFALO (SYNCERUS CAFFER), BONTEBOK (DAMALISCUS DORCUS DORCUS) AND ELAND (TAUROTRAGUS ORYX) SOMATIC CELLS INTO BOVINE CYTOPLASTS

Wildlife conservation requires traditional as well as innovative conservation strategies in order to preserve gene and species diversity. Interspecies nuclear transfer has the potential to conserve genes from critically endangered wildlife species where few or no oocytes are available from the endangered species, and where representative cell lines have been established for the wildlife population while numbers were still abundant. The purpose of this study was to investigate the developmental ability of embryos reconstructed with transfer of somatic cells from the African buffalo (Syncerus caffer), bontebok (Damaliscus dorcus dorcus) and eland (Taurotragus oryx) to enucleated domestic cattle (Bos taurus) oocytes. Skin tissue from the three wildlife species were collected by surgically removing approx. 1.0×1.0cm ear skin notches from animals immobilized with a combination of etorphine hydrochloride (M99; South Africa) and azaperone (Stressnil, South Africa). The biopsies were placed into physiological saline and transported to the laboratory at 4°C within 2h, cleaned with chlorohexidine gluconate and sliced finely in Minimal Essential Medium supplemented with 10% fetal calf serum. The resultant tissue explants were treated as previously described (Baumgarten and Harley 1995 Comp. Biochem. Physiol. 110B, 37–46) and actively growing fibroblast cultures made available for the nuclear transfer process. Nuclear transfer was performed using the HMC technique (Vajta et al., 2003 Biol. Reprod. 68, 571–578) using slaughterhouse-derived bovine oocytes. Culture was performed in SOFaaci (Vajta et al., 2003 Biol. Reprod. 68, 571–578) medium supplemented with 5% cattle serum using WOWs (Vajta et al., Mol. Reprod. Dev. 50, 185–191). Two identical replicates were made with somatic cells of each species. After successful reconstruction, 57, 42 and 48 nuclear transferred and activated buffalo, bontebok and eland embryos were cultured, respectively. All except for 2 buffalo embryos cleaved; 22 (39%) developed to or over the 8-cell stage, and 2 (3.5%) of them to the blastocyst stage. All but 3 bontebok embryos cleaved, 17 (40%) developed to or over the 8-cell stage, but none of them reached the compacted morula or blastocyst stage. Sixteen (33%) of the eland embryos developed to or over the 8-cell stage with one (2%) reaching the blastocyst stage. In conclusion, buffalo, bontebok and eland embryos developed from reconstruction using their respective somatic cells combined with bovine cytoplasts, however, in vitro developmental ability to the blastocyst stage was limited. Additional basic research that establishes the regulative mechanisms involved with early preimplantation development together with optimising nuclear transfer techniques may have the potential to one day play a role in the conservation of critically endangered wildlife species.

209FUNCTIONAL ASSESSMENT OF WHITE RHINOCEROS CERATHOTERIUM SIMUM EPIDIDYMAL SPERMATOZOA BEFORE AND AFTER CRYOPRESERVATION

Biological Resource Banks represent a potentially valuable tool for species conservation. It is, however, necessary to understand the species-specific cryopreservation process and its consequences for spermatozoa to aid in the development of assisted reproduction as a future conservation tool. The aim of this study was to assess the in vitro functionality of white rhinoceros Cerathoterium simum epididymal spermatozoa both before and after cryopreservation. Testes from a harvested white rhino bull were removed and transported at 5°C to the laboratory within 4h. The cauda epididymis was dissected out and flushed with 2mL of Tris-citrate egg yolk extender (fraction A, Biladyl, Minitüb, Germany). A 0.1mL aliquot was removed for analysis and the balance (9mL; 2mL fraction A+7mL sperm sample) mixed with an additional 27.2mL of Tris-citrate egg yolk with glycerol (fraction B, Bidadyl). The extended sample was allowed to cool to 4°C over a 6-h period before an additional 29.2mL of cooled fraction B were added (final sperm concentration=150×106mL−1). Sperm samples were loaded into 0.25-mL straws and frozen over LN2 vapor (4cm for 20min) for later assessment. Sperm straws were thawed by placing the straws in water at 37°C for 30s. Pre-freeze and post-thaw evaluations were carried out in the same manner. Media used included: HEPES for washing (20mM HEPES, 355mM sucrose, 10mM glucose, 2.5mM KOH) and HEPES saline (197mM NaCl, instead of sucrose). An aliquot was diluted with HEPES (washing) and centrifuged for 5min at 600×g; the pellet was resuspended in HEPES saline. Sperm motility (total motility %, TM;; and progressive motility %, PM) was assessed using phase contrast microscopy (×200; 37°C). Sperm plasma membrane status was assessed using the fluorescent dye, propidium iodide (50ngmL−1 in HEPES saline;; 10min, RT). Percentage of cells with plasma membranes intact (unstained;; PMI) was recorded. Mitochondrial status was assessed with the fluorescent dye, JC-1 (7.5μM in HEPES saline;; 30min, 37°C). The % of cells with an orange-stained midpiece was recorded (active mitochondria;; MIT). Resilience to hypoosmotic shock (HOS test) was assessed by diluting a sample in 100mOsm/kg HEPES saline (1:20; 15min, RT). An aliquot was stained with PI to assess plasma membrane status (HOSPMI), and the rest was fixed with formaldehyde, and % coiled tails (positive endosmosis;; HOST) was estimated using phase contrast microscopy (×400). Evaluations of PMI, MIT and HOSPMI were performed using fluorescence microscopy (×400, 450–490nm excitation filter). The results indicated that quality was good pre-freezing (TM: 60%; PMI: 86%; MIT: 100%), except for a PM value of 15%. After thawing, although there was a drop in TM (30%), there was no decrease in PM (20%). Our in vitro functional assessment indicated a loss of quality between the pre-freeze and post-thaw evaluations, but PMI and MIT maintained their pre-thaw levels (60% and 72%, respectively). The HOS test, which indicates plasma membrane integrity, decreased from the pre-freeze level (91%) to a post-thaw value of 70%. HOSTPMI was 72% pre-freeze, and decreased to 54% post-thaw. In conclusion, epididymal spermatozoa from the white rhino may retain its functionality after cryopreservation in a commerically available cryo-extender (Bidadyl). The use of assisted reproduction techniques could someday play a role in the management and conservation of the white rhinoceros and related species.

27BIRTH OF AFRICA'S FIRST NUCLEAR-TRANSFERRED ANIMAL PRODUCED WITH HANDMADE CLONING

Cloning technology has the potential to stimulate the development of the animal biotechnology industry in southern Africa, as well as provide conservationists with an additional tool to possibly assist with conserving critically endangered wildlife species sometime in the future. The aim of this study was to determine whether cloning could produce blastocysts and possibly live progeny in a field-type laboratory without micromanipulators and CO2 incubator. Approx. 1×1-cm ear skin notches were surgically removed from a physically immobilized 9-year-old Holstein cow, a former South African milk production record holder. The tissues were placed into physiological saline and transported to the laboratory at 4°C within 2h, cleaned with chlorohexidine gluconate and sliced finely in Minimal Essential Medium supplemented with 10% fetal calf serum. The resultant tissue explants were treated as previously described (Bartels et al., 2003 Theriogenology 59, 387) and actively growing fibroblast cultures were made available for the nuclear transfer process. Bovine oocytes from slaughterhouse-derived ovaries were collected and matured for 21h in modified TCM-199 medium supplemented with 15% cattle serum, 10IUmL−1 eCG and 15IUmL−1 hCG. Nuclear transfer was performed using the HMC technique (Vajta et al., 2003 Biol. Reprod. 68, 571–578). At 21h after the start of maturation, cumulus cells and zonae pellucidae were removed and oocytes were randomly bisected by hand. Cytoplasts were selected using Hoechst staining and a fluorescent microscope. After a two-step fusion, reconstructed embryos were activated with calcium ionophore and dimethylaminopurine. Culture was performed in SOFaaci medium supplemented with 5% cattle serum using WOWs (Vajta et al., Mol. Reprod. Dev. 50, 185–191). All incubations including culture of donor cells were performed in the submarine incubator system (SIS; Vajta et al., 1997 Theriogenology 48, 1379–1385). In two consecutive experiments, 6 blastocysts were produced from 52 reconstructed embryos. On Day 7, 5 blastocysts were selected for transfer into 3 previously synchronized recipients. All three recipients became pregnant, but two of the recipients aborted at six and seven months, respectively. Post-mortem examination on the first aborted fetus did not reveal any identifiable etiology, but coincided with 6 abortions from natural pregnancies during a heat wave, while the organism Brucella abortis was isolated from the second aborted fetus. The third pregnancy went to term, and a healthy calf, weighing 27kg, was delivered by Caesarean section. The three-month-old calf is being raised by a surrogate Jersey cow under standard dairy conditions and is expected to join the dairy in eighteen months’ time. The birth of ‘Futhi’, meaning ‘replicate’ in Zulu, is Africa’s first cloned animal and signifies an important milestone in the development of animal biotechnology in Africa.

203TIMING OF IN VITRO OOCYTE MATURATION IN SPRINGBOK (ANTIDORCAS MARSUPIALIS), BLACK WILDEBEEST (CONNECHAETES GNU), BLESBOK (DAMALISCUS DORCUS PHILLIPSI), AND REEDBUCK (REDUNCA ARUNDINUM)

With an increased need for genetic diversity within populations, assisted reproductive technology is becoming an important tool for banking semen and embryos, with the possibility of future AI or embryo transfer between distant populations. Previous research has demonstrated that the broad approach of applying bovine IVM/F/C protocols to African antelope is inefficient for embryo production. The purpose of this study was to determine the timing of oocyte maturation (to telophase or metaphase II) in vitro in springbok (Antidorcas marsupialis; n=84), black wildebeest (Connechaetes gnu; n=18), blesbok (Damaliscus dorcus phillipsi; n=9), and reedbuck (Redunca arundinum; n=1). Ovaries were collected within 4h of death from culled animals on game reserves in South Africa, placed into warm SOF-HEPES, sliced and cumulus-oocyte complexes (COCs) collected. Complexes were placed into GMat medium supplemented with 0.01UmL−1 each FSH and LH, 50ngmL−1 EGF, and 1.0% (v/v) PSA (100U penicillin mL−1, 100μg streptomycin mL−1, 0.25ng amphotercin mL−1). Oocytes were removed from medium after 16, 20, 24, 28 or 32h of maturation in 5% CO2 in air at 39°C. After removal, complexes were denuded with hyaluronidase, mounted on a slide and placed into 3:1 (ethanol:glacial acetic acid) fixative until time of analysis. Oocytes were stained with aceto-orcein, and nuclear maturation was evaluated with a phase contrast microscope. As shown in the Table 1, in springbok (n=311), the percentage of mature oocytes peaked at 28h of maturation and was not different (P&lt;0.05) from oocytes matured for 32h. Fewer springbok oocytes were mature at 16, 20 and 24h. Black Wildebeest (n=88) oocytes were mature by 24h, with no additional increase in maturation at 28 or 32h. Blesbok oocytes (n=42) were not mature at 16 or 20h, and there was no difference (P&gt;0.05) in the percentage of oocytes mature at 24 or 28h. Observational data in reedbuck (n=10) indicated that no oocytes were mature at 20 or 24h, but 25.0% were mature at 28h. The low occurrence of mature oocytes at 28h in blesbok and reedbuck suggests that additional time points should be examined later in maturation. This study demonstrates that oocytes of these species can be successfully matured in vitro, but the rate of maturation and thus the optimal time of insemination for IVF is species specific. Table 1 Timing of in vitro oocyte nuclear maturation to telophase or metaphase II in springbok, black wildebeest and blesbok

The importance of the intrathecal infusion test in the diagnosis of normal pressure hydrocephalus

The intrathecal infusion test is a reliable method in diagnosing normal pressure hydrocephalus. Between May 1982 and January 2000 we investigated 300 patients suspected of having normal pressure hydrocephalus (NPH) by carrying out an intrathecal infusion test in a constant flow technique. The resistance to cerebrospinal fluid outflow (R(out)) in the intrathecal infusion test was the main criterion of grouping patients into those with normal pressure hydrocephalus or those with cerebral atrophy. A further differentiation into early stage and late stage was made by measuring the compliance (C(p)) - this being the secondary criterion. In 162 patients (54%) the diagnosis of NPH could be confirmed. Of these, 154 patients (95%) underwent a shunt operation. Graduation of NPH and cerebral atrophy following the results of the infusion test at an early stage and an advanced stage allow the conclusion of prognostic evaluations about the course of disease to be made. Patients with NPH in an early stage report in the follow up an improvement of their symptoms after a shunt operation in 65 percent of cases, and those with advanced stage NPH, in 50 percent of cases. The computer aided infusion test allows a reliable differentiation between patients with NPH and those with cerebral atrophy.

The importance of the intrathecal infusion test in the diagnostic of normal-pressure hydrocephalus

OBJECTIVE

The intrathecal infusion test is a reliable method for diagnosing normal-pressure hydrocephalus (NPH).

METHODS

Between May 1982 and January 1997, we investigated 200 patients suspected of having NPH by carrying out an intrathecal infusion test with a constant-flow technique. The resistance to cerebrospinal fluid outflow in the intrathecal infusion test was the main criterion for grouping patients into those with NPH or those with cerebral atrophy. A further differentiation into early stage and advanced stage was made by measuring the compliance, this being the secondary criterion.

RESULTS

In 107 patients (54%), the diagnosis of NPH could be confirmed. Of these, 102 patients (95%) underwent a shunt operation. Graduation of NPH and cerebral atrophy following the results of the infusion test at an early stage and an advanced stage allows prognostic evaluations about the course of disease to be made. Patients with NPH at an early stage reported an improvement of their symptoms in the follow-up after a shunt operation in 65% of cases, while 50% of those with advanced-stage NPH reported improvement.

CONCLUSION

The computer- aided infusion test allows a reliable differentiation between patients with NPH and those with cerebral atrophy.

The ICP-dependency of resistance to cerebrospinal fluid outflow: a new mathematical method for CSF-parameter calculation in a model with H-TX rats

The international The simultaneous measurement of the resistance and compliance during a single investigation minimizes the patients exertion. In contrast to the classical method it is not necessary that the ICP reaches a plateau. Our mathematical method diverges with t he description of a pressure dependent slope of the function for the resistance from the static examination models. We proved our mathematical method by the use of a dynamic infusion test in 10 H-Tx rats without hydrocephalus and five hydrocephalic H-Tx rats. For that we are able to take the non linearity of the CSF resorption into consideration.

[The importance of neuronavigation in endoscopic operations in neurosurgery]

Intracranial endoscopy as minimal invasive surgery for the treatment of hydrocephalus and intracranial cysts cannot be disregarded after 10 years of clinical practicing. The advantages are low traumatization of brain tissue and good visual control of the operation field. Neuronavigation qualifies as a method of increased operation safety for lesions which are deep seated or difficult to access. A combination of both systems partially neutralizes the respective disadvantages. On the one hand, the neuronavigation ensures the endoscopic approach up to the intracranial caverns and especially supports the endoscopy in cases of bad vision or pathologic anatomy. Endoscopy, on the other hand, enables the surgeon to recognize discrepancies and mistakes of the neuronavigation due to optical control. Increased expenses and time and staff requirements are counterbalanced by the increased cumulated operation safety. An advantageous side-effect of the combination of neuronavigation and intracranial endoscopy is the high learning potential for assistants. For all these reasons the application of neuronavigation in intracranial endoscopy is considered very important and strongly recommended.

Computer-assisted image analysis-derived intermediate endpoints

The development of prostatic lesions undergoes a slow progression. To establish efficacy of chemopreventive intervention it is therefore necessary to define surrogate endpoint biomarkers. Such biomarkers should be sensitive in their ability to indicate response. They should be objective, ie, the result of measurement, and numerically defined so that a statistical validation of response is possible. They should be able to indicate not only a halt of progression of a lesion, but also a reversal of progression. The spatial and statistical distribution of nuclear chromatin in the secretory and luminal cells in prostatic intraepithelial neoplastic lesions has been shown to be well defined. It can be represented by a set of features. These have been used to define a progression curve along which progression or regression of a lesion can be assessed. One could define a fixed endpoint, or one might choose to accept a statistically significant regression along the progression curve as criterion for chemopreventive efficacy. Expected difficulties could arise from lesion heterogeneity, as it would affect the sampling, and from multifocal lesions of differing progressions. Lesion heterogeneity thus limits the precision with which regression could be detected. These problems might be partially overcome by observations taken in histologically normal appearing regions of the prostate. The nuclear chromatin pattern of secretory cell nuclei measured in such tissue regions from prostates harboring intraepithelial or malignant lesions has been shown to exhibit distinctive changes from the chromatin pattern seen in secretory cell nuclei from prostates free from any such lesions. These changes appear to be expressed in the tissue up to a substantial distance from a lesion. The expression of changes in the nuclear chromatin suggests the existence of an intraepithelial preneoplastic lesion that can be detected by biomarkers, but which is not apparent from visual microscopic inspection. Since chemoprevention might be expected to be most effective at the earliest stages of lesion development, the assessment of such early alterations is seen as highly relevant to efforts to validate the efficacy of chemopreventive intervention.

Predictive value of inflammatory and coagulation parameters in the course of severe ulcerative colitis

Alterations in markers of coagulation have been found in patients with inflammatory bowel disease. Our aim was to study the predictive value of coagulation and inflammatory parameters in the course of severe ulcerative colitis. Twenty-seven patients were included. The disease course was followed for one year. Sensitivity, specificity, negative predictive value, positive predictive value, and likelihood ratio, as well as the clinical predictive value of laboratory variables were calculated. Inflammatory variables, such as ESR, CRP, and leukocyte and platelet count showed poor diagnostic accuracy. Several coagulation parameters, such as fibrinogen and fibrin(ogen) degradation products, were increased in patients with active ulcerative colitis, whereas coagulation factor XIII was decreased. No significant relationship between clinical course and coagulation parameters was demonstrated, though both inflammatory and coagulation parameters were useful in the assessment of disease activity in patients with active ulcerative colitis.

Phase 3 study comparing methotrexate and tacrolimus with methotrexate and cyclosporine for prophylaxis of acute graft-versus-host disease after marrow transplantation from unrelated donors

After the transplantation of unmodified marrow from human leukocyte antigen-matched unrelated donors receiving cyclosporine (CSP) and methotrexate (MTX), the incidence of acute graft-versus-host disease (GVHD) is greater than 75%. Tacrolimus is a macrolide compound that, in previous preclinical and clinical studies, was effective in combination with MTX for the prevention of acute GVHD. Between March 1995 and September 1996, 180 patients were randomized in a phase 3, open-label, multicenter study to determine whether tacrolimus combined with a short course of MTX (n = 90), more than CSP and a short course of MTX (n = 90), would reduce the incidence of acute GVHD after marrow transplantation from unrelated donors. There was a significant trend toward decreased severity of acute GVHD across all grades (P =.005). Based on the Kaplan-Meier estimate, the probability of grade II-IV acute GVHD in the tacrolimus group (56%) was significantly lower than in the CSP group (74%; P =.0002). Use of glucocorticoids for the management of GVHD was significantly lower with tacrolimus than with CSP (65% vs 81%, respectively; P =. 019). The number of patients requiring dialysis in the first 100 days was similar (tacrolimus, 9; CSP, 8). Overall and relapse-free survival rates for the tacrolimus and CSP arms at 2 years was 54% versus 50% (P =.46) and 47% versus 42% (P =.58), respectively. The combination of tacrolimus and MTX after unrelated donor marrow transplantation significantly decreased the risk for acute GVHD than did the combination of CSP and MTX, with no significant increase in toxicity, infections, or leukemia relapse.

Tacrolimus vs. cyclosporine immunosuppression: results in advanced-stage disease compared with historical controls treated exclusively with cyclosporine

A phase HI comparative trial of tacrolimus- vs. cyclosporine-based graft-vs.-host disease (GVHD) prophylaxis for human leukocyte antigen (HLA)-identical sibling bone marrow transplantation showed less GVHD but poorer survival in the tacrolimus arm. To test the comparability of the two treatment arms with respect to baseline survival prognosis, a matched control study using exclusively cyclosporine-treated patients from the International Bone Marrow Transplant Registry (IBMTR) database was performed. Controls were matched (2:1) based on age (within 5 years), disease, and pretransplant disease status. Two-year survival for tacrolimus-treated clinical trial patients was similar to that of their cyclosporine-treated matched controls (27 and 24%, respectively), and 2-year survival of the cyclosporine-treated clinical trial patients was similar to that of their cyclosporine-treated matched IBMTR controls (42 and 45%, respectively). Consistent with the clinical trial results, the cyclosporine-treated IBMTR controls matched to the tacrolimus group had significantly poorer 2-year survival than the cyclosporine-treated IBMTR controls matched to the cyclosporine group (24 and 45%, respectively; p < 0.01). No significant difference was seen in GVHD between the cyclosporine-treated clinical trial patients and their matched controls; however, the tacrolimus-treated clinical trial patients had significantly less GVHD than their cyclosporine-treated IBMTR controls (p < 0.01). These results support the hypothesis that the survival difference in the phase III trial resulted from an imbalance in the underlying risk factors for death in the two groups rather than from the randomized immunosuppressive regimen.

In vitro maturation and fertilization of oocytes recovered from free-ranging Burchell's zebra (Equus burchelli) and Hartmann's zebra (Equus zebra hartmannae)

A noninvasive repeatable method to harvest oocytes for in vitro fertilization (IVF) could potentially be used to assist reproduction in endangered equid species. The objectives of this study were to evaluate a specific transvaginal ultrasound-guided oocyte recovery procedure for use in zebra mares and the general applicability of IVF procedures in zebra. Ovaries were collected from Burchell's zebra (Equus burchelli) and Hartmann's zebra (Equus zebra hartmannae) mares at routine culling for Expt. I. Of the 144 oocytes recovered from these ovaries, 70% were of excellent quality. No significant difference in oocyte quality was found between the two zebra species. Zona drilling was performed on in vitro-matured oocytes prior to IVF. Epididymal sperm from culled Burchell's zebra stallions were used for IVF. The sperm either were exposed to calcium ionophore or were not treated and served as a control. In vitro fertilized oocytes were then co-cultured with zebra granulosa cells (ZGC) or with bovine oviduct cells (BOC) for up to 8 days. Overall, a 38% cleavage rate was obtained with 16% of sperm-exposed oocytes developing to the morula or blastocyst stage. All of the embryos that developed to at least the morula stage were cultured on BOC; whereas, none of those cultured on ZGC reached the morula stage during the same interval. Cleavage rates of oocytes inseminated with ionophore-treated or with control sperm were not significantly different, suggesting that ionophore treatment of epididymal sperm for IVF in these zebra species may be redundant. In Expt. II, 10 transvaginal ultrasound-guided oocyte aspiration procedures on five captive Burchell's zebra mares recovered a total of 33 oocytes (6.6 oocytes/female) of which 94% were considered viable. This approach may be an attractive means of producing gametes for assisted reproduction in endangered species. Furthermore, results from this study indicate that IVF may become a means of producing offspring from zebra and other equid species in the future.

Rapid in vitro assay for predicting response to fluorouracil in patients with metastatic breast cancer

PURPOSE

To determine if a rapid 3H-uridine uptake assay using breast tumor cells from biopsy specimens could predict clinical response to fluorouracil (5FU) in patients with metastatic breast cancer.

PATIENTS AND METHODS

A double-blind prospective study was conducted of 60 patients with measurable, metastatic breast cancer who had failed to respond to at least one prior chemotherapy regimen. Patients received 5FU 300 mg/m2/d by continuous infusion and were monitored for response. Tumor cells from biopsy specimens were grown in microwells and exposed for 3 days to 0.1, 1.0, 10.0, and 100.00 micrograms/mL of 5FU on strips coated with drug and extracellular matrix. Cells were pulsed with 3H-uridine overnight. Incorporated radioactivity was compared for wells with and without drug. Results were available 4 days from specimen submission.

RESULTS

Of 45 eligible patients, 11 (24%) were not assessable in vitro. Nine patients were assessable in vitro, but not clinically. Of the remaining 25 patients, who were assessable both clinically and in vitro, there was one complete response (CR), five partial responses (PRs), five cases of stable disease, and 14 cases of progressive disease, for an objective response rate of 24%. Response in vitro was significantly correlated with clinical response (P = .002). Of six clinical responders, five also responded in vitro, for an assay sensitivity of 83%. Of 19 nonresponders, 17 were nonresponders in vitro, for a specificity of 89%. The positive predictive value of the test was 71% (five of seven), and the negative predictive value was 94% (17 of 18).

CONCLUSION

Results of an in vitro assay were significantly correlated with clinical response in patients with metastatic breast cancer treated with continuous infusion 5FU.

Unrestricted principal components analysis of brain electrical activity: issues of data dimensionality, artifact, and utility

Principal components analysis (PCA) was performed on the 1536 spectral and 2944 evoked potential (EP) variables generated by neurophysiologic paradigms including flash VER, click AER, and eyes open and closed spectral EEG from 202 healthy subjects aged 30 to 80. In each case data dimensionality of 1500 to 3000 was substantially reduced using PCA by magnitudes of 20 to over 200. Just 20 PCA factors accounted for 70% to 85% of the variance. Visual inspection of the topographic distribution of factor loading scores revealed complex loadings across multiple data dimensions (time-space and frequency-space). Forty-two non-artifactual factors were successful in classifying age, gender, and a separate group of 60 demented patients by linear discriminant analysis. Discrimination of age and gender primarily involved EP derived factors, whereas dementia primarily involved EEG derived factors. Thirty-eight artifactual factors were identified which, alone, could not discriminate age but were relatively successful in discriminating gender and dementia. The need to parsimoniously develop real neurophysiologic measures and to objectively exclude artifact are discussed. Unrestricted PCA is suggested as a step in this direction.

Quantified neurophysiology with mapping: statistical inference, exploratory and confirmatory data analysis

Topographic mapping of brain electrical activity has become a commonly used method in the clinical as well as research laboratory. To enhance analytic power and accuracy, mapping applications often involve statistical paradigms for the detection of abnormality or difference. Because mapping studies involve many measurements and variables, the appearance of a large data dimensionality may be created. If abnormality is sought by statistical mapping procedures and if the many variables are uncorrelated, certain positive findings could be attributable to chance. To protect against this undesirable possibility we advocate the replication of initial findings on independent data sets. Statistical difference attributable to chance will not replicate, whereas real difference will reproduce. Clinical studies must, therefore, provide for repeat measurements and research studies must involve analysis of second populations. Furthermore, Principal Components Analysis can be employed to demonstrate that variables derived from mapping studies are highly intercorrelated and data dimensionality substantially less than the total number of variables initially created. This reduces the likelihood of capitalization on chance. The need to constrain alpha levels is not necessary when dimensionality is low and/or a second data set is available. When only one data set is available in research applications, techniques such as the Bonferroni correction, the "leave-one-out" method, and Descriptive Data Analysis (DDA) are available. These techniques are discussed, clinical and research examples are given, and differences between Exploratory (EDA) and Confirmatory Data Analysis (EDA) are reviewed.

Value of CSF lactate in the differential diagnosis between bacterial meningitis and other diseases with meningeal involvement

Lactate concentrations in the cerebrospinal fluid of 104 patients were determined by the Monotest Lactate Kit. Lactate values were found higher in cases of bacterial meningitis than in patients not suffering from acute CNS disorders. Elevated lactate levels were also found in patients suffering from aseptic meningitis, septicemia, CNS trauma and cerebrovascular accidents, seizures and diabetes mellitus. The highest levels were found in cases of bacterial meningitis, but there was considerable overlapping between the groups. CSF lactate thus appears to have limited diagnostic value in the differential diagnosis between bacterial meningitis and other diseases with meningeal involvement.

Value of pleural lactate in the differential diagnosis between empyema and non-bacterial pleural effusions

Lactate concentrations in the pleural fluid of 50 patients were determined by the Monotest Lactate Kit. Lactate values were found higher in bacterial pleural infections than in cases of hydrothorax. Elevated levels were also found in most cases of histologically confirmed cases of pleural neoplasms and in some cases of non-bacterial pleuritis exsudativa . The highest levels were found in cases of empyema, but there was considerable overlapping between the groups. Pleural lactate thus appears to have little diagnostic value in the differential diagnosis between empyema and non-bacterial pleural effusions.