Maternal self-reported polycystic ovary syndrome with offspring and maternal cardiometabolic outcomes

STUDY QUESTION

Do children born to mothers with polycystic ovary syndrome (PCOS) have an adverse cardiometabolic profile including arterial stiffness at 9 years of age compared to other children?

SUMMARY ANSWER

Children of mothers with PCOS did not have differing cardiometabolic outcomes than children without exposure.

WHAT IS KNOWN ALREADY

While women with PCOS themselves have higher risk of cardiometabolic conditions such as obesity and diabetes, the evidence on intergenerational impact is unclear. Given in utero sequalae of PCOS (e.g. hyperandrogenism, insulin resistance), the increased risk could be to both boys and girls.

STUDY DESIGN, SIZE, DURATION

The Upstate KIDS cohort is a population-based birth cohort established in 2008-2010 to prospectively study the impact of infertility treatment on children's health. After ∼10 years of follow-up, 446 mothers and their 556 children attended clinical visits to measure blood pressure (BP), heart rate, arterial stiffness by pulse wave velocity (PWV), mean arterial pressure, lipids, high-sensitivity C-reactive protein (hsCRP), hemoglobin A1c (HbA1c), and anthropometrics.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Women self-reported ever diagnoses of PCOS ∼4 months after delivery of their children in 2008-2010. Linear regression models applying generalized estimating equations to account for correlation within twins were used to examine associations with each childhood cardiometabolic outcome.

MAIN RESULTS AND THE ROLE OF CHANCE

In this cohort with women oversampled on infertility treatment, ∼14% of women reported a PCOS diagnosis (n = 61). We observed similarities in BP, heart rate, PWV, lipids, hsCRP, HbA1c, and anthropometry (P-values >0.05) among children born to mothers with and without PCOS. Associations did not differ by child sex.

LIMITATIONS, REASONS FOR CAUTION

The sample size of women with PCOS precluded further separation of subgroups (e.g. by hirsutism). The population-based approach relied on self-reported diagnosis of maternal PCOS even though self-report has been found to be valid. Participants were predominantly non-Hispanic White and a high proportion were using fertility treatment due to the original design. Differences in cardiometabolic health may be apparent later in age, such as after puberty.

WIDER IMPLICATIONS OF THE FINDINGS

Our results provide some reassurance that cardiometabolic factors do not differ in children of women with and without self-reported PCOS during pregnancy.

STUDY FUNDING/COMPETING INTEREST(S)

Supported by the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, United States (contracts #HHSN275201200005C, #HHSN267200700019C, #HHSN275201400013C, #HHSN275201300026I/27500004, #HHSN275201300023I/27500017). The authors have no conflicts of interest.

REGISTRATION NUMBER

NCT03106493.

Eco-friendly green synthesis of silver nanoparticles from Aegle marmelos leaf extract and their antimicrobial, antioxidant, anticancer and photocatalytic degradation activity

The present research work, green synthesis of silver nanoparticles (Ag NPs) was synthesized from silver ions using the reducing and capping agents of Aegle marmelos leaf extract. Initially, UV-vis spectrophotometry absorption of the Surface Plasmon Resonance centre at 450 nm was confirmed the formation of Ag NPs. Preliminary phytochemical and FT-IR analysis indicate the identification of secondary metabolised flavonoids that act as the reducing and capping agent of the synthesized Ag NPs. Transmission electron microscope analysis, morphology of Ag NPs shown by transmission electron microscopy is spherical with a size range of ∼30-50 nm. The synthesized Ag NPs were investigate the in-vitro anticancer, antimicrobial and antioxidant activity, results shows the potential activity against the standard drugs. The Ag NPs also revealed the cytotoxicity against MDA-MB-231 human breast cancer cells. The MTT assay shows the IC₅₀ values at 125 ± 4.26 μg/mL of Ag NPs compared to the untreated cells of negative control. The Ag NPs was excellent photocatalyst act as degradation of environmentally polluted Basic Fuchsin dye within 18 min.

Hesperidin, a citrus flavonoid ameliorates hyperglycemia by regulating key enzymes of carbohydrate metabolism in streptozotocin-induced diabetic rats

The present study investigated the protective effect of hesperidin on carbohydrate metabolizing enzymes in streptozotocin-induced diabetic rats. Hesperidin was administered to streptozotocin-induced (40 mg/kg b.w.) diabetic rats at different dosages of (25, 50, 100 mg/kg b.w.) respectively for 30 days to evaluate its effect on fasting plasma glucose, insulin, glycosylated hemoglobin, hemoglobin, and carbohydrate metabolic enzymes. The plasma glucose levels were significantly reduced in a dose-dependent manner in hesperdin-treated group of rats when compared to the diabetic control rats. In addition, concomitant increase in hemoglobin and insulin levels and a decrease in glycosylated hemoglobin were observed in treated group of rats. The activities of the hepatic key enzymes of carbohydrate metabolism such as hexokinase and glucose-6-phosphate dehydrogenase were significantly increased, whereas glucose-6-phosphatase and fructose-1,6-bisphosphatase were significantly decreased. Furthermore, hesperidin administration prevented the loss in body weight and improved the glycogen content in the hepatic tissue of diabetic animals by reinstating the activities of glycogen synthase and glycogen phosphorylase. These results showed that hesperidin has potential antihyperglycemic activity in streptozotocin-induced diabetic rats. This was further supported by the histological studies of pancreas and liver.

Photocatalytic Activity and Humidity Sensor Studies of Magnetically Reusable FeWO₄-WO₃ Composite Nanoparticles

Different mole ratios of (8:2, 6:4, 4:6 and 2:8) iron tungstate-tungsten trioxide (FeWO₄-WO₃) composite nanoparticles were synthesized by solid state method. The synthesized composite nanoparticles were characterized by powder X-ray diffraction analysis (XRD), field-emission scanning electron microscopy (FE-SEM) with energy dispersive X-ray spectroscopy (EDX), transmission electron microscopy (TEM) and vibrating sample magnetometer (VSM) studies. The crystalline nature and particle size of the samples were characterized by powder X-ray diffraction analysis (XRD). The morphology was confirmed by field-emission scanning electron microscopy (FE-SEM) analysis and transmission electron microscope (TEM). The energy dispersive X-ray spectroscopy (EDX) proved the purity of nanocomposites. Vibrating sample magnetometer reveals that the sample shows paramagnetic property based on the metal present in the prepared nanocomposites at room temperature. The magnetic property is due to the structural defects rather than the impurity phase. Magnetization saturation value (M_s = 398.7 emu/g) of FWWO-46 composite nanoparticles is high enough to be magnetically removed by applying a magnetic field. The composites were subjected to DC conductance measurement as a function of relative humidity in the range of 5-98%, achieved by different water vapour buffers thermostated at room temperature. The sensitivity factor, S_f (R_5%/R_98%) measured at 25 °C revealed that FWWO-46 shows the highest humidity sensitivity factor S_f = 3956, with a response and recovery time of 45 s and 100 s respectively. Photocatalytic degradation of methylene blue (MB) from aqueous solution has been carried out using FeWO₄-WO₃ composite nanoparticles as photocatalyst under Ultraviolet radiation.

Delayed conception in women with low-urinary iodine concentrations: a population-based prospective cohort study

STUDY QUESTION

Is iodine deficiency associated with decreased fecundability?

SUMMARY ANSWER

Moderate to severe iodine deficiency is associated with a 46% decrease in fecundability.

WHAT IS KNOWN ALREADY

Iodine deficiency is common in women of childbearing age but its effect on fecundability has not been investigated.

STUDY DESIGN, SIZE, DURATION

The LIFE Study, a population-based prospective cohort study, enrolled 501 women who had discontinued contraception within 2 months to become pregnant between 2005 and 2009.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Women reported on risk factors for infertility by interview then kept daily journals of relevant information. Women used fertility monitors to time intercourse relative to ovulation then used home digital pregnancy tests to identify pregnancies on the day of expected menstruation. Urine samples for iodine analysis were collected on enrollment.

MAIN RESULTS AND THE ROLE OF CHANCE

Samples were in the deficiency range in 44.3% of participants. The group whose iodine-creatinine ratios were below 50 μg/g (moderate to severe deficiency) had a 46% reduction in fecundity (P = 0.028) compared with the group whose iodine-creatinine ratios were in the adequate range: adjusted fecundability odds ratio of becoming pregnant per cycle, 0.54 (95% confidence interval 0.31-0.94).

LIMITATIONS, REASONS FOR CAUTION

Iodine concentrations vary within individuals over time, so the data must be interpreted by group as we have done; residual confounding is possible.

WIDER IMPLICATIONS OF THE FINDINGS

Significant delays in becoming pregnant occur at iodine concentrations that are common in women in the USA and parts of Europe. Replicating these findings will be important to determine whether improving iodine status could be beneficial in improving fecundability.

STUDY FUNDING/COMPETING INTEREST(S)

This study was funded by the Intramural Research Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, USA. Contracts N01-HD-3-3355; N01-HD-3-3356; N01-HD-3-3358 and HHSN275201100001l/HHSN27500007. None of the authors has any conflict of interest to declare.

Optical, Magnetic and Photocatalytic Activity Studies of Li, Mg and Sr Doped and Undoped Zinc Oxide Nanoparticles

Nanoparticles of Li, Mg and Sr doped and undoped zinc oxide was prepared by simple precipitation method. The structural, optical, and magnetic properties of the samples were investigated by the Powder X-ray Diffraction (XRD), Scanning Electron Microscope (SEM), Transmission Electron Microscope (TEM), Fourier Transform Infrared (FTIR) spectroscopy, Ultra-violet Visible spectroscopy (UV-vis) spectra, Photoluminescence (PL) and Vibrational Sample Magnetometer (VSM). The Powder X-ray diffraction data confirm the formation of hexagonal wurtzite structure of all doped and undoped ZnO. The SEM photograph reveals that the pores availability and particles size in the range of 10 nm-50 nm. FTIR and UV-Visible spectra results confirm the incorporation of the dopant into the ZnO lattice nanostructure. The UV-Visible spectra indicate that the shift of blue region (lower wavelength) due to bandgap widening. Photoluminescence intensity varies with doping due to the increase of oxygen vacancies in prepared ZnO. The pure ZnO exist paramagnetic while doped (Li, Mg and Sr) ZnO exist ferromagnetic property. The photocatalytic activity of the prepared sample also carried out in detail.

Structural, Optical, Morphological and Microbial Studies on SnO₂ Nanoparticles Prepared by Co-Precipitation Method

Nanoparticles of tin oxide (SnO2) powders were prepared by co-precipitation method at 500 °C, 700 °C and 900 °C temperature. The sintered SnO2 nanoparticles, structural, optical, magnetic, morphological properties and microbial activity have been studied. XRD studies reveals that sintered powder which exhibits tetragonal crystal structure and both crystallinity as well as crystal size increase with increase in temperature. The morphological studies reveal randomly arranged grains with compact nature grain size increases with sintering temperature. The compositional analyses of SnO2 nanoparticles have been studied using X-ray photoelectron spectroscopy analysis. The optical band gap values of SnO2 nanoparticles were calculated to be about 4.3 eV in the temperature 500 °C, comparing with that of the bulk SnO2 3.78 eV, by optical absorption measurement. Room temperature M-H curve for pure SnO2 nanoparticles exhibits ferromagnetic behaviour. The tin oxide nanoparticles are acted as potential candidate material for bacterial and fungal activity.

A data-driven search for semen-related phenotypes in conception delay

Sperm count, morphology, and motility have been reported to be predictive of pregnancy, although with equivocal basis prompting some authors to question the prognostic value of semen analysis. To assess the utility of including semen quality data in predicting conception delay or requiring >6 cycles to become pregnant (referred to as conception delay), we utilized novel data-driven analytic techniques in a pre-conception cohort of couples prospectively followed up for time-to-pregnancy. The study cohort comprised 402 (80%) male partners who provided semen samples and had time-to-pregnancy information. Female partners used home pregnancy tests and recorded results in daily journals. Odds ratios (OR), false discovery rates, and 95% confidence intervals (CIs) for conception delay (time-to-pregnancy > 6 cycles) were estimated for 40 semen quality phenotypes comprising 35 semen quality endpoints and 5 closely related fecundity determinants (body mass index, time of contraception, lipids, cotinine and seminal white blood cells). Both traditional and strict sperm phenotype measures were associated with lower odds of conception delay. Specifically, for an increase in percent morphologically normal spermatozoa using traditional methods, we observed a 40% decrease in conception delay (OR = 0.6, 95% CI = 0.50, 0.81; p = 0.0003). Similarly, for an increase in strict criteria, we observed a 30% decrease in odds for conception delay (OR = 0.7, 95% CI = 0.52, 0.83; p = 0.001). On the other hand, an increase in percent coiled tail spermatozoa was associated with a 40% increase in the odds for conception delay (OR = 1.4, 95% CI = 1.12, 1.75; p = 0.003). However, our findings suggest that semen phenotypes have little predictive value of conception delay (area under the curve of 73%). In a multivariate model containing significant semen factors and traditional risk factors (i.e. age, body mass index, cotinine and ever having fathered a pregnancy), there was a modest improvement in prediction of conception delay (16% increase in area under the curve, p < 0.0002).

Infertility treatment and children's longitudinal growth between birth and 3 years of age

STUDY QUESTION

Does early childhood growth from birth through to 3 years of age differ by mode of conception?

SUMMARY ANSWER

Findings suggest early childhood growth was comparable for children irrespective of infertility treatment, but twins conceived with ovulation induction with or without intrauterine insemination (OI/IUI) were slightly smaller than twins conceived without treatment.

WHAT IS KNOWN ALREADY

Although studies have found that babies conceived with infertility treatment are born lighter and earlier than infants conceived without treatment, little research especially for non-assisted reproductive technology (ART) treatments has focused on their continued growth during early childhood.

STUDY DESIGN, SIZE, DURATION

Upstate KIDS recruited infants born (2008-2010) to resident upstate New York mothers. Infants were sampled based on birth certificate indication of infertility treatment; specifically, for every singleton conceived by infertility treatment, three singletons without infertility treatment were recruited and matched on region of birth. All multiple births irrespective of treatment were also recruited. Children were prospectively followed, returning questionnaires every 4-6 months until 3 years of age. In total, 3905 singletons, 1129 sets of multiples (96% of whom were twins) enrolled into the study. Analyses included 3440 (88%) singletons (969 conceived with treatment; specifically, 433 with ART and 535 with OI/IUI) and 991 (88%) sets of multiples (439 conceived with treatment; specifically 233 with ART and 206 with OI/IUI) with growth data available.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Mothers reported infertility treatment use at baseline and children's height and weight from pediatric visits. Self-reported use of ART was previously verified by linkage with the US Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) database. Mixed linear models with cubic splines accounting for age and age-gender interactions were used to estimate mean differences in growth from birth to 3 years by infertility treatment status and adjusting for maternal age, race, education, private insurance, smoking status during pregnancy, maternal pre-pregnancy and paternal body mass indices (BMI).

MAIN RESULTS AND THE ROLE OF CHANCE

Compared with singletons conceived without treatment (n = 2471), singletons conceived by infertility treatment (433 by assisted reproductive technologies (ART), 535 by OI/IUI and 1 unknown specific type) did not differ in growth. Compared with twins not conceived with treatment (n = 1076), twins conceived with OI/IUI (n = 368) weighed slightly less over follow-up (122 g). They were also proportionally smaller for their length (-0.17 weight-for-length z-score units). No differences in mean size over the 3 years were observed for twins conceived by ART, though some evidence of rapid weight gain from birth to 4 months (adjusted OR 1.08; 95% CI: 1.00-1.16) suggestive of catch up growth was observed.

LIMITATIONS, REASONS FOR CAUTION

Participants from upstate New York may not be representative of US infants. Although accounted for in statistical analysis, attrition during follow-up may have limited power to detect small differences.

WIDER IMPLICATIONS OF THE FINDINGS

This study is the first to prospectively track the growth of children conceived with and without infertility treatment in the USA, including a substantial number of twins. Our findings are similar to what was previously observed in the ART literature outside of the states.

STUDY FUNDING/COMPETING INTERESTS

Supported by the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD; contracts #HHSN275201200005C, #HHSN267200700019C). Authors have no competing interests to declare.

TRIAL REGISTRATION NUMBER

Not applicable.

Paternal exposures to environmental chemicals and time-to-pregnancy: overview of results from the LIFE study

Published findings from the Longitudinal Investigation of Fertility and the Environment (LIFE) Study regarding the relation between environmental chemicals and couple fecundity, as measured by time-to-pregnancy (TTP), are reviewed with a particular focus on role of the male partner. The LIFE Study recruited 501 couples from 16 counties in two U.S. states upon discontinuing contraception for purposes of becoming pregnant. Upon enrollment, couples provided a blood and urine sample for the quantification of persistent and non-persistent environmental chemicals, respectively, and then completed daily journals until pregnant or up to one year of trying. Female partners used fertility monitors to aid the timing of intercourse relative to ovulation, and digital home pregnancy test kits on the day of expected menses. Chemical classes included: metals, persistent organic pollutants, environmental phenols, and phthalates that were quantified using inductively coupled plasma mass spectrometry or isotope dilution high-resolution or tandem mass spectrometry. Time-to-pregnancy (TTP) was defined as the number of prospectively observed menstrual cycles required for pregnancy. Fecundability odds ratios (FORs) and 95% confidence intervals (CIs) were estimated for each chemical and partner after adjusting for potential confounders and accounting for right censoring and time off contraception. FORs < 1 are suggestive of diminished fecundity or a longer TTP. Significant reductions (ranging from 17-31%) in couple fecundity were observed for male partners' concentration of lead (0.83; 0.70, 0.98), 2,2',4,4'-tetrahydroxybenzophenone (0.69; 0.49, 0.97), monobenzyl (0.80; 0.67, 0.97), and monomethyl (0.81; 0.70, 0.94) phthalates after adjusting for the female partners' concentrations. Seven PCB congeners quantified in men's serum were associated with a 17-29% reduction in couple fecundity. Our findings underscore the importance of a couple-based exposure design, inclusive of the male partner, when assessing couple-dependent outcomes such as TTP to avoid misinterpretation of results based only upon the female partner.

Signs and symptoms associated with early pregnancy loss: findings from a population-based preconception cohort

STUDY QUESTION

What is the relationship between signs and symptoms of early pregnancy and pregnancy loss <20 weeks' gestation?

SUMMARY ANSWER

Vaginal bleeding is associated with increased incidence of early pregnancy loss, with more severe bleeding and bleeding accompanied by lower abdominal cramping associated with greater incidence of loss; conversely, vomiting is associated with decreased incidence of early pregnancy loss, even in the setting of vaginal bleeding, while nausea alone is not.

WHAT IS KNOWN ALREADY

Two previous cohort studies with preconception enrollment suggested that bleeding is associated with loss while nausea is inversely associated with loss though these studies were limited by small study size and reporting after loss ascertainment. No prior preconception cohort study has examined multiple signs and symptoms in relation to pregnancy loss.

STUDY DESIGN, SIZE, DURATION

Population-based preconception cohort of 501 couples discontinuing contraception to try for pregnancy in 16 counties in Michigan and Texas, USA. Participants were followed daily until positive home pregnancy test or 12 months of trying without an hCG pregnancy; women who became pregnant were followed daily from 2 to 7 weeks post-conception.

PARTICIPANTS, SETTING, METHODS

Three hundred and forty-seven women had a positive home pregnancy test denoting hCG pregnancy. Three hundred and forty-one women remained after excluding ineligible pregnancies. Women recorded daily from 2 to 7 weeks post-conception their signs and symptoms, including vaginal bleeding (none, spotting, light, moderate and heavy), lower abdominal cramping, nausea and vomiting. Pregnancy losses were ascertained by a subsequent negative home pregnancy test, clinical confirmation or onset of menses, depending on gestational age at loss; time-to-loss was measured in days post-conception. Cumulative incidence functions and 95% confidence intervals (CIs) were constructed for each sign or symptom, and hazard ratios (HRs) and 95% CIs for presence compared with absence of signs or symptoms were estimated using Cox proportional hazard models.

MAIN RESULTS AND THE ROLE OF CHANCE

Women experienced lower abdominal cramping (85%), nausea (48%), vomiting (46%) and light/moderate/heavy vaginal bleeding (24%) during early pregnancy. Ninety-five (28%) women experienced a loss. Cumulative incidence of pregnancy loss varied by symptomatology: 19% for vomiting, 27% for lower abdominal cramping, 35% for nausea only, 52% for vaginal bleeding, 81% for vaginal bleeding with lower abdominal cramping. Incidence of pregnancy loss was increased among women with vaginal bleeding (HR: 3.62, 95% CI: 2.29-5.74) and among women with vaginal bleeding and lower abdominal cramping (HR: 5.03, 95% CI: 2.07-12.20). Incidence of pregnancy loss was decreased for women with vomiting (HR: 0.51, 95% CI: 0.30-0.86). In the setting of vaginal bleeding with lower abdominal cramping, vomiting reduced the incidence of pregnancy loss (HR: 0.24, 95% CI: 0.11-0.56).

LIMITATIONS, REASONS FOR CAUTION

There were few losses beyond 14 weeks gestation; thus, the precision of our findings related to losses occurring after the first trimester is limited.

WIDER IMPLICATIONS OF THE FINDINGS

By using sensitive home pregnancy tests, we are able to document and characterize the cumulative incidence of the earliest pregnancy losses, which constitute the majority of losses. The use of daily, prospective capture of signs and symptoms relative to ascertainment of pregnancy loss minimizes potential biases associated with reporting after rather than before a loss, which could potentially distort the relationship between signs and symptoms and pregnancy loss. The findings of our study suggest that it may be useful to develop prognostic models for pregnancy loss based on signs and symptoms.

STUDY FUNDING/COMPETING INTERESTS

This study was supported by the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health (contract numbers N01-HD-3-3355; N01-HD-3-3356; N01-HD-3-3358). The authors have no conflict of interest to declare.

Realization of Vertically Aligned, Ultrahigh Aspect Ratio InAsSb Nanowires on Graphite

The monolithic integration of InAs(1-x)Sb(x) semiconductor nanowires on graphitic substrates holds enormous promise for cost-effective, high-performance, and flexible devices in optoelectronics and high-speed electronics. However, the growth of InAs(1-x)Sb(x) nanowires with high aspect ratio essential for device applications is extremely challenging due to Sb-induced suppression of axial growth and enhancement in radial growth. We report the realization of high quality, vertically aligned, nontapered and ultrahigh aspect ratio InAs(1-x)Sb(x) nanowires with Sb composition (xSb(%)) up to ∼12% grown by indium-droplet assisted molecular beam epitaxy on graphite substrate. Low temperature photoluminescence measurements show that the InAs(1-x)Sb(x) nanowires exhibit bright band-to-band related emission with a distinct redshift as a function of Sb composition providing further confirmation of successful Sb incorporation in as-grown nanowires. This study reveals that the graphite substrate is a more favorable platform for InAs(1-x)Sb(x) nanowires that could lead to hybrid heterostructures possessing potential device applications in optoelectronics.

Successive time to pregnancy among women experiencing pregnancy loss

STUDY QUESTION

Is time to pregnancy (TTP) similar across successive pregnancy attempts among women experiencing pregnancy loss?

SUMMARY ANSWER

TTP after a loss may be longer compared with TTP before a loss.

WHAT IS KNOWN ALREADY

Two pregnancy cohort studies have reported that TTP is similar across pregnancy attempts in fertile women. However, this has not been investigated among women experiencing pregnancy losses.

STUDY DESIGN, SIZE, DURATION

Data for this analysis come from the Longitudinal Investigation of Fertility and the Environment Study, a population-based, preconception cohort of couples attempting pregnancy. During 2005-2009, recruitment was targeted to 16 counties in Michigan and Texas with reported exposures to persistent environmental chemicals. A total of 501 couples were recruited and followed for up to 12 months of pregnancy attempts allowing for continued participation of women with pregnancy losses until censoring.

PARTICIPANTS, SETTING, METHODS

We assessed TTP among 70 couples recruited upon discontinuing contraception for purposes of becoming pregnant and experiencing ≥1 prospectively observed pregnancy losses during 12 months of trying. There were 61 couples who contributed two pregnancy attempts and 9 who contributed three. Women were instructed in the use of urine-based home fertility monitors to time intercourse relative to ovulation and recorded their bleeding patterns in daily journals. TTP was defined as the number of menstrual cycles taken to achieve pregnancy. Women were also instructed in the use of home digital pregnancy tests and asked to begin pregnancy testing on the day of expected menses. Women recorded the results of their pregnancy tests in a daily journal with a single positive pregnancy test result indicating an hCG-confirmed pregnancy. Pregnancy losses were ascertained from a subsequent recorded negative pregnancy test or clinically confirmed loss. We estimated fecundability odds ratios (FORs) comparing subsequent to first TTP using discrete Cox models with robust standard errors, accounting for cycles off contraception before study entry and adjusting for maternal age, body mass index, reproductive history and time-varying cigarette, alcohol and caffeine usage while trying.

MAIN RESULTS AND THE ROLE OF CHANCE

The mean female age was 30.3 ± 4.3 years; 21% had a prior pregnancy loss before study entry. Of the second and third attempts, 59 and 43%, respectively, were longer compared with the first attempt. FORs <1 suggest reduced fecundability or a longer TTP when comparing the second with the first attempt (0.42, 95% confidence interval (CI): 0.28, 0.65), and similarly for the third relative to the first attempt (0.64, 95% CI: 0.18, 2.36). TTP in the second attempt was a median of 1 cycle longer (interquartile range: 0, 3 cycles) compared with TTP in the first attempt.

LIMITATIONS, REASONS FOR CAUTION

As this is the first study to investigate successive TTP exclusively among women experiencing pregnancy loss, our findings await corroboration since most losses occurred early in gestation. As such, the generalizability of our findings for all pregnancy losses awaits further research. We also had limited power to detect a reduction in fecundability for the third compared with first pregnancy attempt.

WIDER IMPLICATIONS OF THE FINDINGS

Unlike fertile women, TTP in women experiencing early pregnancy losses may trend towards longer subsequent attempts. If the findings are corroborated, women experiencing losses may benefit from counselling regarding trying times.

STUDY FUNDING/COMPETING INTERESTS

This research was supported by the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (contracts N01-HD-3-3355, N01-HD-3-3356 and NOH-HD-3-3358). K.J.S. was supported by an Intramural Research Training Award from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Division of Intramural Population Health Research. The authors have no conflicts of interest to declare.

Preconception stress increases the risk of infertility: results from a couple-based prospective cohort study--the LIFE study

STUDY QUESTION

Are women's stress levels prospectively associated with fecundity and infertility?

SUMMARY ANSWER

Higher levels of stress as measured by salivary alpha-amylase are associated with a longer time-to-pregnancy (TTP) and an increased risk of infertility.

WHAT IS KNOWN ALREADY

Data suggest that stress and reproduction are interrelated; however, the directionality of that association is unclear.

STUDY DESIGN, SIZE, DURATION

In 2005-2009, we enrolled 501 couples in a prospective cohort study with preconception enrollment at two research sites (Michigan and Texas, USA). Couples were followed for up to 12 months as they tried to conceive and through pregnancy if it occurred. A total of 401 (80%) couples completed the study protocol and 373 (93%) had complete data available for this analysis.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Enrolled women collected saliva the morning following enrollment and then the morning following their first observed study menses for the measurement of cortisol and alpha-amylase, which are biomarkers of stress. TTP was measured in cycles. Covariate data were captured on both a baseline questionnaire and daily journals.

MAIN RESULTS AND THE ROLE OF CHANCE

Among the 401 (80%) women who completed the protocol, 347 (87%) became pregnant and 54 (13%) did not. After adjustment for female age, race, income, and use of alcohol, caffeine and cigarettes while trying to conceive, women in the highest tertile of alpha-amylase exhibited a 29% reduction in fecundity (longer TTP) compared with women in the lowest tertile [fecundability odds ratios (FORs) = 0.71; 95% confidence interval (CI) = (0.51, 1.00); P < 0.05]. This reduction in fecundity translated into a >2-fold increased risk of infertility among these women [relative risk (RR) = 2.07; 95% CI = (1.04, 4.11)]. In contrast, we found no association between salivary cortisol and fecundability.

LIMITATIONS, REASONS FOR CAUTION

Due to fiscal and logistical concerns, we were unable to collect repeated saliva samples and perceived stress questionnaire data throughout the duration of follow-up. Therefore, we were unable to examine whether stress levels increased as women continued to fail to get pregnant. Our ability to control for potential confounders using time-varying data from the daily journals, however, minimizes residual confounding.

WIDER IMPLICATIONS OF THE FINDINGS

This is the first US study to demonstrate a prospective association between salivary stress biomarkers and TTP, and the first in the world to observe an association with infertility.

STUDY FUNDING/COMPETING INTEREST(S)

This study was supported by the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (contracts #N01-HD-3-3355, N01-HD-3-3356, N01-HD-3358). There are no conflicts of interest to declare.

TRIAL REGISTRATION NUMBER

Not applicable.

Rational scale-up of a baculovirus-insect cell batch process based on medium nutritional depth

We have developed a serum-free cell culture process utilizing a recombinant baculovirus (AcNPV) expression vector to infect Trichoplusia ni insect cells for the production of the human lysosomal enzyme, glucocerebrosidase. The enzyme, which is harvested as a secreted protein in this process, can serve as a replacement therapy for the genetic deficiency Gaucher disease. In the course of pilot scale-up of a batch glucocerebrosidase process from 25-mL working volume shaker flask units to 25-L working volume stirred bioreactor units, a semi-empirical model was developed for the rational determination of scaleable process parameters, including host cell density at infection, multiplicity of infection (MOI), and harvest time. A key assumption of the model is that maximum protein production is limited by the serum-free medium's nutritional capacity, which can, in turn, be determined from the growth of uninfected cells. For the host cell/medium combination used in this study, the nutritional limit was determined to be 1.3 x 10(7) to 1.7 x 10(7) viable-cell-days/mL. Based on this, the model predicts that optimal protein expression is consistent with a 4-day batch process where the host cell density at the time of infection is 1.5 x 10(6) to 2.0 x 10(6) cells/mL and the MOI is 0.09-0.3. These parameters were empirically confirmed to give the highest achievable batch product yield, first in shaker flasks and then at larger scales. The low MOI allows at least one population doubling to take place post viral addition, so that the effective infected cell density producing product generally exceeds 4 x 10(6) cells/mL. It was also interesting to note that this process consistently achieved the same level of maximum protein production at the 25-L bioreactor scale in 4 days compared to 5 days at the shaker flask scale. This may be attributable to better control of the culture environment in the bioreactor. Unlike some other lepidopteran insect cells, such as Sf-9, T. ni cells were found to produce significant levels of the inhibitory metabolites ammonia and lactate. Our results suggest that reduction and/or removal of inhibitory metabolites might be beneficial for infection of high-density cultures of these cells and might also facilitate application of more sophisticated culture strategies, including fed-batch. (c) 1996 John Wiley & Sons, Inc.

Pharmacodynamics & toxicological profile of PartySmart, a herbal preparation for alcohol hangover in Wistar rats

BACKGROUND & OBJECTIVE

PartySmart is a herbal preparation intended for the management of alcohol hangover and other related toxic effects in clinical situation. The present study was designed to investigate the pharmacodynamics and oral toxicity of PartySmart, a herbal formulation in rats.

METHODS

Effect of PartySmart on blood acetaldehyde and alcohol levels was evaluated at doses of 125, 250 and 500 mg/kg b.wt. in rats. Acute toxicity study was conducted with PartySmart at a limit test dose of 2000 mg/kg b.wt., p.o. In repeated dose 90 day study, PartySmart was administered at doses of 500 and 1000 mg/kg b.wt. once-a-day, orally throughout the study period.

RESULTS

PartySmart dose-dependently decreased blood ethanol and acetaldehyde levels as compared to control. PartySmart at a dose of 500 mg/kg b.wt. significantly reduced the area under curve (AUC) of ethanol and acetaldehyde levels. It increased the hepatic alcohol dehydrogenase (ADH) at 500 mg/kg b.wt. and aldehyde dehydrogenase (ALDH) activities at doses of 250 and 500 mg/kg b.w. significantly. Acute toxicity study showed no clinical signs and pre-terminal deaths. The LD(50) of PartySmart was found to be greater than 2000 mg/kg b.wt. No significant differences in PartySmart-treated groups were observed on body weight, food intake, haematological and clinical chemistry, and organ weight ratios as compared to control group in the repeated dose study. Histopathological examination of all target organs showed no evidence of lesions attributing to drug toxicity.

INTERPRETATION & CONCLUSION

PartySmart enhanced acetaldehyde metabolism by increasing ADH and ALDH activity without any side effects. These findings indicate that PartySmart may exert beneficial role in the management of alcohol hangover without any toxicity.

NR4A1, 2, 3--an orphan nuclear hormone receptor family involved in cell apoptosis and carcinogenesis

Three members of the NR4A1/Nur77/ NGFIB orphan nuclear hormone receptor subfamily (NR4A1, NR4A2, and NR4A3) belong to the steroid nuclear hormone receptor superfamily. They share similar structural features and have no known natural ligand. They constitute immediate early genes that are induced by serum, growth factors and receptor engagement and are thus implicated in cell mitogenic responses. These nuclear receptors are transcription factors that exert their functions through activation and subsequent induction of the downstream pathways. They have been shown to play a role in complex pathways of cell survival and apoptosis. Although the expression of these genes have been shown to be pro-survival, it has also been reported that NR4A1 expression can cause apoptosis. These two opposite effects apparently result from distinct mechanisms: either transcriptional activation of genes responsible for cell survival or cell apoptosis, or translocation into the cytoplasm where they target the mitochondria and cause cell apoptosis via Bcl-2 binding. The latter mechanism constitutes a new paradigm of cellular apoptosis. In vitro functional studies using over-expression (gain of function) or gene inactivation (loss of function) type assays, combined with transgenic or knockout animal data in vivo, have revealed these effects and their physiological roles, including thymocyte development for NR4A1/3 and pro-survival in CNS for NR4A2. Recent studies have also suggested an important role of these receptors in cell transformation and tumorigenicity via both their anti-apoptotic and pro-apoptotic functions. In particular, the recent identification of a functional ligand for NR4A1 suggests that these members could potentially serve as drug targets for disease indications such as cancer. While many aspects of these receptors have been previously reviewed, this article focuses on new experimentation and discovery of their apoptotic and carcinogenic roles, and discusses their potential roles as therapeutic targets.

Anaesthetic implications of uterine artery embolisation in management of massive obstetric haemorrhage

The latest triennial report on maternal deaths has recommended the consideration of uterine artery embolisation in management of cases of massive obstetric haemorrhage. We have been using interventional radiology to manage both expected and unanticipated postpartum bleeding in our centre. Three case reports are presented to highlight the value of this technique and issues relating to the anaesthetic and postoperative management of these patients are discussed.