Classic indicators and diel dissolved oxygen versus trend analysis in assessing eutrophication of potable-water reservoirs

Potable source-water reservoirs are the main water supplies in many urbanizing regions, yet their long-term responses to cultural eutrophication are poorly documented in comparison with natural lakes, creating major management uncertainties. Here, long-term discrete data (June 2006-June 2018) for classical eutrophication water quality indicators, continuous depth-profile data for dissolved oxygen (DO), and an enhanced hybrid statistical trend analysis model were used to evaluate the eutrophication status of a potable source-water reservoir. Based on classical indicators (nitrogen, N and phosphorus, P concentrations and ratios; phytoplankton biomass as chlorophyll a, chl a; and trophic state indices), the reservoir was eutrophic to hypereutrophic and stoichiometrically imbalanced. Anoxia/hypoxia occurred for 7-8 months annually systemwide, even throughout the water column for days to weeks in some years; and elevated total ammonia (up to ~900 μg tNH₃ L^-1 ) in surface waters from late summer/fall through late winter/early spring suggested substantial internal legacy nutrient loading. These surprising DO and tNH₃ phenomena may characterize many reservoirs in urbanizing areas, and the associated cascade of negative impacts may increasingly affect them under global warming. Total organic carbon (TOC), seasonally influenced by phytoplankton biomass, commonly exceeded 6 mg L^-1 , which is problematic for potable-water treatment, and significantly trended up over time. Wet-year inflow dilution influenced an apparent decreasing trend in nutrients within the hypereutrophic upper reservoir, which receives most tributary inputs. Nevertheless, significant reservoirwide trends (increasing total phosphorus [TP], phytoplankton chl a, TOC) and mid- and/or lower region trends (increasing total nitrogen [TN], tNH₃ , decreasing TN:TP ratios) suggest that water quality degradation from eutrophication has worsened over time. These findings support broadly applicable recommendations to strengthen protection of potable source-water reservoirs in urbanizing watersheds: (1) protective numeric water quality criteria are needed for TOC as well as TN, TP, and chl a; (2) continuous diel data capture more realistic DO conditions than traditional sampling, and can provide important insights for water treatment managers; and (3) assessment of reservoir eutrophication status to track management progress over time should emphasize classic indicators equally as statistical trends, which are highly sensitive to short-term meteorological forcing.

Three-dimensional visualisation of the feto-placental vasculature in humans and rodents

Adequate development of the feto-placental circulation is critical for placental exchange function and healthy fetal growth. Understanding the structure of this circulation and how it informs fetal outcomes is important both in the human placenta, and the rodent, a purported comparative experimental model. Vascular casting and micro-CT imaging approaches enable detailed quantification of the complex vascular relationships in the feto-circulation, and provide detailed data to parameterise in silico models. Here, to assist researchers to apply these technically challenging methods we provide detailed approaches to cast and image; 1) human placentas at the cotyledon-level, and 2) whole rodent placentas.

Utility of the ACE Inhibitor Captopril in Mitigating Radiation-associated Pulmonary Toxicity in Lung Cancer: Results From NRG Oncology RTOG 0123

OBJECTIVES

The primary objective of NRG Oncology Radiation Therapy Oncology Group 0123 was to test the ability of the angiotensin-converting enzyme inhibitor captopril to alter the incidence of pulmonary damage after radiation therapy for lung cancer; secondary objectives included analyzing pulmonary cytokine expression, quality of life, and the long-term effects of captopril.

MATERIALS AND METHODS

Eligible patients included stage II-IIIB non-small cell lung cancer, stage I central non-small cell lung cancer, or limited-stage small cell. Patients who met eligibility for randomization at the end of radiotherapy received either captopril or standard care for 1 year. The captopril was to be escalated to 50 mg three times a day. Primary endpoint was incidence of grade 2+ radiation-induced pulmonary toxicity in the first year.

RESULTS

Eighty-one patients were accrued between June 2003 and August 2007. Given the low accrual rate, the study was closed early. No significant safety issues were encountered. Eight patients were ineligible for registration or withdrew consent before randomization and 40 patients were not randomized postradiation. Major reasons for nonrandomization included patients' refusal and physician preference. Of the 33 randomized patients, 20 were analyzable (13 observation, 7 captopril). The incidence of grade 2+ pulmonary toxicity attributable to radiation therapy was 23% (3/13) in the observation arm and 14% (1/7) in the captopril arm.

CONCLUSIONS

Despite significant resources and multiple amendments, NRG Oncology Radiation Therapy Oncology Group 0123 was unable to test the hypothesis that captopril mitigates radiation-induced pulmonary toxicity. It did show the safety of such an approach and the use of newer angiotensin-converting enzyme inhibitors started during radiotherapy may solve the accrual problems.

IFPA meeting 2015 workshop report IV: placenta and obesity; stem cells of the feto-maternal interface; placental immunobiology and infection

Workshops are an important part of the IFPA annual meeting as they allow for discussion of specialised topics. At the 2015 IFPA annual meeting there were 12 themed workshops, three of which are summarized in this report. These workshops related to various aspects of placental biology and collectively covered areas of obesity and the placenta, stem cells of the feto-maternal interface, and placental immunobiology and infection.

Stem Cells and Pregnancy Disorders: From Pathological Mechanisms to Therapeutic Horizons

Blastocyst implantation, placental development, and fetal growth are all dependent on the interactions between the developing placenta and the decidualized endometrium. Adult stem cell populations resident in both the placenta and endometrium play key roles in directing cell fate and tissue organization throughout pregnancy. As we begin to understand how these stem cell populations contribute to successful pregnancies, we can begin to ask what roles they play in the pathogenesis of pregnancy disorders from implantation failure and miscarriage through fetal growth restriction and preeclampsia. Furthermore, as our understanding of the therapeutic applications of stem cells in other organs rapidly expands, can we make stem cell therapies a clinical reality in obstetric medicine? This review aims to summarize our current understanding of the role reproductive stem cells play in pregnancy success, and how they may help us better understand the underlying pathogenesis of pregnancy disorders to offer novel therapeutic solutions in the future.

Isolation and characterisation of a novel trophoblast side-population from first trimester placentae

The placenta is responsible for all nutrient and gas exchange between mother and baby during pregnancy. The differentiation of specialised placental epithelial cells called trophoblasts is essential for placental function, but we understand little about how these populations arise. Mouse trophoblast stem cells have allowed us to understand many of the factors that regulate murine trophoblast lineage development, but the human placenta is anatomically very different from the mouse, and it is imperative to isolate a human trophoblast stem cell to understand human placental development. Here we have developed a novel methodology to isolate a Hoechst side-population of trophoblasts from early gestation placentae and compared their transcriptome to differentiated trophoblast populations (cytotrophoblasts and extravillous trophoblasts) using microarray technology. Side-population trophoblasts clustered as a transcriptomically distinct population but were more closely related to cytotrophoblasts than extravillous trophoblasts. Side-population trophoblasts up-regulated a number of genes characteristic of trophectoderm and murine trophoblast stem cells in comparison to cytotrophoblasts or extravillous trophoblasts and could be distinguished from both of these more mature populations by a unique set of 22 up-regulated genes, which were enriched for morphogenesis and organ development and the regulation of growth functions. Cells expressing two of these genes (LAMA2 and COL6A3) were distributed throughout the cytotrophoblast layer at the trophoblast/mesenchymal interface. Comparisons to previously published trophoblast progenitor populations suggest that the side-population trophoblasts isolated in this work are a novel human trophoblast population. Future work will determine whether these cells exhibit functional progenitor/stem cell attributes.

IL-1 beta but not the NALP3 inflammasome is an important determinant of endothelial cell responses to necrotic/dangerous trophoblastic debris

INTRODUCTION

Necrotic but not apoptotic trophoblastic debris can induce endothelial cell activation but the mechanism by which endothelial cells distinguish apoptotic from necrotic debris is unclear. The NALP3 inflammasome is a pattern recognition receptor that macrophages employ to recognise "danger signals" in necrotic cell corpses. In this study, we hypothesized that endothelial cells can identify and respond to necrotic trophoblastic debris via the NALP3 inflammasome.

METHODS

The effect of trophoblastic debris on endothelial expression of NALP3 inflammasome components was investigated using qRT-PCR, immunoassays and fluorescent caspase 1 activity assay. IL-1β in was quantified by ELISA. Endothelial cell activation was measured by cell surface ICAM expression and monocytes adhesion assay.

RESULTS

The NALP3 inflammasome was expressed in resting vascular endothelial cells and is involved in endothelial response to danger signals. However, exposure to necrotic trophoblastic debris did not significantly alter the expression of any of the three components of the NALP3 inflammasome at the mRNA level, nor was caspase-1 activation increased. Conditioned media from endothelial cells exposed to necrotic trophoblastic debris contained elevated levels of IL-1β which was derived from the necrotic debris and which contributed to endothelial cell activation.

DISCUSSION

Necrotic trophoblastic debris induced endothelial cell activation through the IL-1β/IL-1R pathway. However, the NALP3 inflammasome in endothelial cells was not involved in this process.

Multiscale modelling of the feto-placental vasculature

The placenta provides all the nutrients required for the fetus through pregnancy. It develops dynamically, and, to avoid rejection of the fetus, there is no mixing of fetal and maternal blood; rather, the branched placental villi 'bathe' in blood supplied from the uterine arteries. Within the villi, the feto-placental vasculature also develops a complex branching structure in order to maximize exchange between the placental and maternal circulations. To understand the development of the placenta, we must translate functional information across spatial scales including the interaction between macro- and micro-scale haemodynamics and account for the effects of a dynamically and rapidly changing structure through the time course of pregnancy. Here, we present steps towards an anatomically based and multiscale approach to modelling the feto-placental circulation. We assess the effect of the location of cord insertion on feto-placental blood flow resistance and flow heterogeneity and show that, although cord insertion does not appear to directly influence feto-placental resistance, the heterogeneity of flow in the placenta is predicted to increase from a 19.4% coefficient of variation with central cord insertion to 23.3% when the cord is inserted 2 cm from the edge of the placenta. Model geometries with spheroidal and ellipsoidal shapes, but the same volume, showed no significant differences in flow resistance or heterogeneity, implying that normal asymmetry in shape does not affect placental efficiency. However, the size and number of small capillary vessels is predicted to have a large effect on feto-placental resistance and flow heterogeneity. Using this new model as an example, we highlight the importance of taking an integrated multi-disciplinary and multiscale approach to understand development of the placenta.

The relationship between TGFβ, low oxygen and the outgrowth of extravillous trophoblasts from anchoring villi during the first trimester of pregnancy

BACKGROUND

During the first trimester of human pregnancy, specialised placental cells called extravillous trophoblasts (EVTs) grow out from anchoring villi, invade the maternal decidua and remodel the uterine spiral arteries. Inadequate EVT invasion is associated with pregnancy complications including intrauterine growth restriction (IUGR) and pre-eclampsia. During early pregnancy, the placenta exists in a physiologically normal low oxygen environment, which may regulate EVT outgrowth. One potential oxygen responsive regulator of EVTs is the transforming growth factor-beta (TGFβ) family of cytokines. This work aimed to determine the role of TGFβ1, β2 and β3 in regulating EVT outgrowth in the low oxygen environment of early pregnancy.

RESULTS

Using a quantitative high-throughput first trimester villous explant model of EVT outgrowth we demonstrated no significant difference in the frequency of EVT outgrowth between explants treated with TGFβ1, β2 or β3. However, explants treated with TGFβ2, but not β1 or β3, produced EVT outgrowths with a significantly smaller area in comparison to untreated controls (p=0.03). When explants were cultured in 1.5% oxygen, TGFβ2, but not β1 or β3, in the conditioned medium of explants that produced EVT outgrowth was significantly reduced in comparison to 8% oxygen (p<0.05). There was no significant difference in the concentration of TGFβ2 or TGFβ3 from isolated primary EVTs cultured in 1.5% or 8% oxygen.

CONCLUSIONS

TGFβ2 inhibits EVT outgrowth expansion from first trimester anchoring villi. As TGFβ2 secretion from anchoring villi is down-regulated in low oxygen, these findings suggest that the low oxygen environment in early pregnancy may be important to allow EVT outgrowth expansion and promote adequate placentation.

The impact of concurrent granulocyte-macrophage colony-stimulating factor on quality of life in head and neck cancer patients: results of the randomized, placebo-controlled Radiation Therapy Oncology Group 9901 trial

PURPOSE

The Radiation Therapy Oncology Group (RTOG) conducted a randomized, placebo-controlled trial evaluating the efficacy of GM-CSF in reducing mucosal injury and symptom burden from curative radiotherapy for head and neck (H&N) cancer.

METHODS

Eligible patients with H&N cancer receiving radiation encompassing ≥50 % of the oral cavity or oropharynx received subcutaneous GM-CSF or placebo. Quality of life (QoL) was assessed using the RTOG-modified University of Washington H&N Symptom Questionnaire at baseline 4, 13, 26, and 48 weeks from radiation initiation.

RESULTS

Of 125 eligible patients, 114 were evaluable for QoL (58 GM-CSF, 56 placebo). Patient demographics, clinical characteristics, and baseline symptom scores were well balanced between the treatment arms. At the end of the acute period (13 weeks), patients in both arms reported negative change in total symptom score indicating increase in symptom burden relative to baseline (mean -18.4 GM-CSF, -20.8 placebo). There was no difference in change in total symptom score (p > 0.05) or change in mucous, pain, eating, or activity domain scores (p > 0.01) between patients in the GM-CSF and placebo arms. Analysis limited to patients treated per protocol or with an acceptable protocol deviation also found no difference in change in total symptom score (p > 0.05) or change in domain scores (p > 0.01) between treatment arms. Provider assessment of acute mucositis during treatment did not correlate with patient-reported mucous domain and total symptom scores (p > 0.05).

CONCLUSION

GM-CSF administered concurrently during head and neck radiation does not appear to significantly improve patient-reported QoL symptom burden.

Single-fraction radiotherapy versus multifraction radiotherapy for palliation of painful vertebral bone metastases-equivalent efficacy, less toxicity, more convenient: a subset analysis of Radiation Therapy Oncology Group trial 97-14

BACKGROUND

The Radiation Therapy Oncology Group (RTOG) trial 97-14 revealed no difference between radiation delivered for painful bone metastases at a dose of 8 gray (Gy) in 1 fraction (single-fraction radiotherapy [SFRT]) and 30 Gy in 10 fractions (multifraction radiotherapy [MFRT]) in pain relief or narcotic use 3 months after randomization. SFRT for painful vertebral bone metastases (PVBM) has not been well accepted, possibly because of concerns about efficacy and toxicity. In the current study, the authors evaluated the subset of patients that was treated specifically for patients with PVBM.

METHODS

PVBM included the cervical, thoracic, and/or lumbar spine regions. Among patients with PVBM, differences in retreatment rates and in pain relief, narcotic use, and toxicity 3 months after randomization were evaluated.

RESULTS

Of 909 eligible patients, 235 (26%) had PVBM. Patients with and without PVBM differed in terms of the percentage of men (55% vs 47%, respectively; P = .03) and the proportion of patients with multiple painful sites (57% vs 38%, respectively; P < .01). Among those with PVBM, more patients who received MFRT had multiple sites treated (65% vs 49% for MFRT vs SFRT, respectively; P = .02). There were no statistically significant treatment differences in terms of pain relief (62% vs 70% for MFRT vs SFRT, respectively; P = .59) or freedom from narcotic use (24% vs 27%, respectively; P = .76) at 3 months. Significant differences in acute grade 2 through 4 toxicity (20% vs 10% for MFRT vs SFRT, respectively; P = .01) and acute grade 2 through 4 gastrointestinal toxicity (14% vs 6%, respectively; P = .01) were observed at 3 months, with lower toxicities seen in the patients treated with SFRT. Late toxicity was rare. No myelopathy was recorded. SFRT produced higher 3-year retreatment rates (5% vs 15%; P = .01).

CONCLUSIONS

Results for the subset of patients with PVBM in the RTOG 94-17 randomized controlled trial were comparable to those for the entire population. SFRT produced less acute toxicity and a higher rate of retreatment than MFRT. SFRT and MFRT resulted in comparable pain relief and narcotic use at 3 months.

Impact of sildenafil on marital and sexual adjustment in patients and their wives after radiotherapy and short-term androgen suppression for prostate cancer: analysis of RTOG 0215

PURPOSE

The Radiation Therapy Oncology Group (RTOG) 0215 investigated the efficacy of sildenafil in improving erectile dysfunction following radiotherapy and neoadjuvant/concurrent androgen deprivation therapy among prostate cancer patients and found a significant improvement on drug but only in 21% of study participants. This paper reports on a secondary aim to investigate the effect of sildenafil on overall sexual and marital adjustment among both patients and their wives.

METHODS

RTOG 0215 was a placebo-controlled, double-blind, crossover trial of sildenafil. Participation of wives was optional. Twenty-four married heterosexual couples (33% of heterosexual couples in study) completed the Sexual Adjustment Questionnaire and Locke's Marital Adjustment Test. Treatment differences in mean change scores were evaluated by paired t-tests, and the proportion of patients achieving a clinically meaningful change was evaluated using chi-square tests. Spearman's correlation coefficients were used to determine the association of adjustment between patients and wives.

RESULTS

There was no significant change in either sexual or marital adjustment for patients. For wives, there was a trend for improvement in sexual adjustment but no significant change in marital adjustment. Change in marital adjustment between patients and wives was weakly related (r(s) = 0.15, p = 0.48), and for sexual adjustment, there was a moderate, but nonsignificant relationship (r(s) = 0.40, p = 0.09).

CONCLUSIONS

Larger studies are warranted to further examine possible differences in sexual experiences and treatment needs between prostate cancer patients and their wives, as well as to assess predictors of sildenafil response.

Human placentation from nidation to 5 weeks of gestation. Part II: Tools to model the crucial first days

Human pregnancy is unusual with respect to monthly spontaneous decidualisation as well as the degree of placental invasion and interaction with the decidualised endometrial stroma. This review covers in vivo animal models and in vitro cell culture models that have been used to study the earliest stages of human implantation and placentation from nidation to 5 weeks of gestation. The field has expanded rapidly in recent years due to the generation of human embryonic stem cell lines and the ability of some scientists to culture human blastocysts. These models have enabled researchers to begin to elucidate the interactions involved in human blastocyst apposition, adhesion and implantation. However, we still understand very little about the differentiation processes involved in the formation of the placenta. Continued improvements to current models, including the potential isolation of a human trophoblast stem cell, will significantly enhance our ability to define the molecular and structural events occurring during human implantation and early placental development.

Phase 2 results from Radiation Therapy Oncology Group Study 0537: a phase 2/3 study comparing acupuncture-like transcutaneous electrical nerve stimulation versus pilocarpine in treating early radiation-induced xerostomia

BACKGROUND

In this phase 2 component of a multi-institutional, phase 2/3, randomized trial, the authors assessed the feasibility and preliminary efficacy of acupuncture-like transcutaneous electrical nerve stimulation (ALTENS) in reducing radiation-induced xerostomia.

METHODS

Patients with cancer of the head and neck who were 3 to 24 months from completing radiotherapy with or without chemotherapy (RT ± C) and who were experiencing xerostomia symptoms with basal whole saliva production ≥0.1 mL per minute and were without recurrence were eligible. Patients received twice weekly ALTENS sessions (24 sessions over 12 weeks) using a proprietary electrical stimulation unit. The primary study objective was to assess the feasibility of ALTENS treatment. Patients were considered compliant if 19 of 24 ALTENS sessions were delivered, and the targeted compliance rate was 85%. Secondary objectives measured treatment-related toxicities and the effect of ALTENS on overall radiation-induced xerostomia burden using the University of Michigan Xerostomia-Related Quality of Life Scale (XeQOLS).

RESULTS

Of 48 accrued patients, 47 were evaluable. The median age was 60 years, 84% of patients were men, 70% completed RT ± C for >12 months, and 21% had previously received pilocarpine. Thirty-four patients completed all 24 ALTENS sessions, 9 patients completed 20 to 23 sessions, and 1 patient completed 19 sessions, representing a 94% total compliance rate. Six-month XeQOLS scores were available for 35 patients and indicated that 30 patients (86%) achieved a positive treatment response with a mean ± standard deviation reduction of 35.9% ± 36.1%. Five patients developed grade 1 or 2 gastrointestinal toxicity, and 1 had a grade 1 pain event.

CONCLUSIONS

The current results indicated that ALTENS treatment for radiation-induced xerostomia can be delivered uniformly in a cooperative, multicenter setting and produces possible beneficial treatment response. Given these results, the phase 3 component of this study was initiated.

Validation of a Predictive Model for Survival in Patients With Advanced Cancer: Secondary Analysis of RTOG 9714

Background

The objective of this study was to validate a simple predictive model for survival of patients with advanced cancer.

Methods

Previous studies with training and validation datasets developed a model predicting survival of patients referred for palliative radiotherapy using three readily available factors: primary cancer site, site of metastases and Karnofsky performance score (KPS). This predictive model was used in the current study, where each factor was assigned a value proportional to its prognostic weight and the sum of the weighted scores for each patient was survival prediction score (SPS). Patients were also classified according to their number of risk factors (NRF). Three risk groups were established. The Radiation Therapy and Oncology Group (RTOG) 9714 data was used to provide an additional external validation set comprised of patients treated among multiple institutions with appropriate statistical tests.

Results

The RTOG external validation set comprised of 908 patients treated at 66 different radiation facilities from 1998 to 2002. The SPS method classified all patients into the low-risk group. Based on the NRF, two distinct risk groups with significantly different survival estimates were identified. The ability to predict survival was similar to that of the training and previous validation datasets for both the SPS and NRF methods.

Conclusions

The three variable NRF model is preferred because of its relative simplicity.

Randomized, double-blinded, placebo-controlled crossover trial of treating erectile dysfunction with sildenafil after radiotherapy and short-term androgen deprivation therapy: results of RTOG 0215

INTRODUCTION

Erectile dysfunction (ED) may be the most commonly observed adverse event (AE) associated with the combination of radiation therapy (RT) and androgen deprivation therapy (ADT). A significant number of men are trying phosphodiesterase type 5 inhibitors (PDE5s) such as sildenafil to treat ED, yet sildenafil studies to date shed little light on the response to ED after ADT.

AIM

The purpose of this trial was to evaluate sildenafil in the treatment of ED in prostate cancer patients previously treated with external beam RT and neoadjuvant and concurrent ADT.

METHODS

  In this randomized, double-blinded crossover trial, eligible patients received RT/ADT for intermediate risk prostate cancer and currently had ED as defined by the International Index of Erectile Function (IIEF). Patients were randomized to 12 weeks of sildenafil or placebo followed by 1 week of no treatment then 12 weeks of the alternative. Treatment differences were evaluated using a marginal model for binary crossover data.

MAIN OUTCOME MEASURES

The primary end point was improved erectile function, as measured by the IIEF.

RESULTS

The study accrued 115 patients and 61 (55%) completed all three IIEF assessments. Sildenafil effect was significant (P = 0.009) with a difference in probabilities of erectile response of 0.17 (95% confidence interval: 0.06, 0.29), and 0.21 (0.06, 0.38) for patients receiving ≤ 120 days of ADT. However, as few as 21% of patients had a treatment-specific response, only improving during sildenafil but not during the placebo phase.

CONCLUSIONS

This is the first controlled trial to suggest a positive sildenafil response for ED treatment in patients previously treated with RT/ADT, however, only a minority of patients responded to treatment. ADT duration may be associated with response and requires further study. The overall low response rate suggests the need for study of additional or preventative strategies for ED after RT/ADT for prostate cancer.

RTOG physician and research associate attitudes, beliefs and practices regarding clinical trials: implications for improving patient recruitment

PURPOSE

Timely recruitment and retention of human subjects remains a leading problem in oncology clinical trials even among the national oncology clinical trial cooperative groups. The Radiation Therapy Oncology Group (RTOG) developed an exploratory survey to assess member attitudes, beliefs, and practices (ABPs) towards clinical trials that might influence patient accrual to clinical trials.

METHODS

The survey was developed using Survey Monkey(c) and emailed to principal investigators (PIs) and research associates (RAs) at 267 RTOG member institutions. Survey items were selected based on a review of the literature. PI and RA responses were matched by institution to determine whether responses varied due to job responsibilities and/or institutional practices. Principal component analysis was used to achieve variable reduction in further describing respondents' ABPs.

RESULTS

PIs and RAs reported similar recruitment concerns [kappa=0.55, 95% CI (0.51, 0.60)]. Five components related to recruitment concerns were identified: presentation of trials to patients, barriers and recruitment risks, staff involvement, access for underrepresented populations, and familial involvement (patient). Nearly one of four (24%) respondents perceived that patients did not understand what randomization means. Staff issues included nearly a third of respondents not having a formal mechanism at their institution for eligibility screening, and similarly, about one of three respondents felt that unrepresented patient populations would benefit from translated consent forms.

CONCLUSIONS

Findings of this survey inform RTOG strategies for addressing opportunities for improvement, including clinician/patient education and a best practices tool box that in the future would include successful mechanisms for eligibility screening and recruitment.

The regulation of trophoblast differentiation by oxygen in the first trimester of pregnancy

In the first trimester of human pregnancy villous cytotrophoblasts are able to differentiate to form either the overlying syncytiotrophoblast layer or, in anchoring villi, extravillous trophoblasts which grow out from the villi and invade into the maternal decidua, acting to both physically attach the placenta to the decidua, and modify the maternal spiral arteries to sustain pregnancy. During the first 10-12 weeks of gestation, extravillous trophoblast plugs block the spiral arteries and prevent maternal blood flow entering the intervillous space, thereby creating an environment of physiological hypoxia in which placental and fetal development occur. As extravillous trophoblasts migrate away from the villus they differentiate from a proliferative to an invasive phenotype. The hypoxic environment of the first trimester is believed to play an important role in the regulation of trophoblast differentiation. However, there is currently a large body of conflicting experimental evidence concerning this topic. This review examines the experimental evidence to date on the role of oxygen in trophoblast differentiation.

Temperature sensitivity of the keratin cytoskeleton and delayed spreading of keratinocyte lines derived from EBS patients

Point mutations in the keratin intermediate filament genes for keratin 5 or keratin 14 are known to cause hereditary skin blistering disorders such as epidermolysis bullosa simplex, in which epidermal keratinocytes are extremely fragile and the skin blisters on mild trauma. We show that in 2 phenotypically diverse cases of epidermolysis bullosa simplex, the keratin mutations result in a thermoinstability of the intermediate filament cytoskeleton which can be reproducibly demonstrated even in the presence of tissue culture-induced keratins and in conditions where filament fragility is not otherwise obvious. SV40-T antigen and HPV16 (E6--E7) immortalised keratinocyte cell lines were examined, established from control and epidermolysis bullosa simplex-affected individuals with either severe (Dowling-Meara) or mild (Weber-Cockayne) forms of the disease. In standard tissue culture conditions no significant and consistent abnormality of the keratin cytoskeleton could be demonstrated. However after thermal stress a reduced stability of the keratin filaments was demonstrable in the epidermolysis bullosa simplex cell lines, with filaments breaking into aggregates similar to those seen in skin from EBS patients. These aggregates were maximal at 15 minutes after heat shock and the filament network structure was substantially reversed by 60 minutes. Differences were also seen in the cells during respreading after replating: cells containing mutant keratins were slower to respread than controls and fine aggregates were seen at the cell margins in the Dowling-Meara derived cell line. Such delays in restoring the normal intermediate filament network after physiological processes involving cytoskeleton remodelling may render the cells vulnerable to cytolysis in vivo if physically challenged during this time window. The steady reduction in the mitotic index of the epidermis during the first few years of life could then explain the clinical improvement which is frequently observed in growing children.

An ultrastructural study of ependymal cell differentiation during lizard (Gallotia galloti) midbrain development

Ependymal cell differentiation was examined in the lizard Gallotia galloti from E31 to adult. From E31 to E34 only one type of cell could be identified making up the pseudostratified columnar neuroepithelium but by E35 to E37 three types of ependymal cell were present. The first type was a narrow, elongated, columnar cell containing rough endoplasmic reticulum filled with an amorphous ground substance similar to that of astrocytes. The second type was broader with the nucleus close to the ventricular surface with numerous lipid droplets of varying sizes in the cytoplasm. The third type had an irregularly shaped apical nucleus and a broad basal process probably extending to the pial surface. The process contained numerous microtubules, glycogen granules and a few filaments. From E38 to hatching the ependyma showed marked regional variation. Much of it was formed by a single layer of moderately dark cuboidal cells but parts were made up of a low columnar epithelium in which the cells had elongated nuclei, frequently indented on the ventricular side. Cilia were common and often cells had cytoplasmic protrusions into the ventricle. Lipid was present in the form of small apical droplets or a large basal droplet. Ependymal cells in the region of the sulcus limitans were packed with lipid as were cells of the adjacent subventricular layer. In the adult the ependymal lining varied from cuboidal to low columnar with nuclear chromatin usually arranged in a reticulated pattern. Two types of ependymal process extending to the pia could be identified. One type was packed with microfilaments whilst the other contained a core of microtubules and scattered glycogen granules. Lipid was still present in the cells of the sulcus limitans.

An ultrastructural study of the development of oligodendrocytes in the midbrain of the lizard

Oligodendrocyte development was investigated in the midbrain of the lizard Gallotia galloti using the electron microscope. Oligodendroblasts, which had a pale cytoplasm containing numerous microtubules in the perikaryon and processes, were present from E35. Active oligodendrocytes had a pale nucleus, usually containing a nucleolus, and an electron-dense cytoplasm with long parallel stacks of rough endoplasmic reticulum. These were present from E37 to hatching which coincides with the period of rapid myelination. The three types of oligodendrocyte (light, medium and dark) first classified by Mori & Leblond (1970) in the rat could be identified in the lizard. Light oligodendrocytes were present at all ages from E37 to adult. Medium oligodendrocytes first appeared at E40 and dark oligodendrocytes were present at all ages from hatching onwards.

An ultrastructural study of the development of astrocytes in the midbrain of the lizard

Astrocyte development was investigated electron microscopically in the midbrain of the lizard Gallotia galloti from E32 to adult. At E32 only very immature (early) glioblasts were present in the midbrain and similar cells could be found until hatching. From E34 two other types of glioblast could be identified--dark glioblasts which had a slightly greater amount of cytoplasm than early glioblasts and light glioblasts, in which cytoplasmic organelles were more abundant. Both dark and light glioblasts were present in very small numbers in the adults. Astroblasts, which could be identified by the characteristic appearance of their rough endoplasmic reticulum, first appeared at E35, at which stage a few very immature astrocytes containing small quantities of gliofilaments were also present. With increasing age the quantity of gliofilaments in astrocyte cytoplasm increased. Astrocytes in the adult white matter contained very large amounts of gliofilaments whereas those in grey matter contained many fewer gliofilaments and had glycogen granules in their cytoplasm which were rarely present in mature fibrous astrocytes.

Phenobarbital pretreatment alters the localization of CCl4-induced changes in rat liver microsomal fatty acids

Phenobarbital treatment induces an isozyme(s) of liver microsomal cytochrome P450 susceptible to CCl4 and enhances the latter's lethality. We have now studied phenobarbital's effect on the specificity of phosphatidyl fatty acid changes in rat liver microsomes. Male Sprague-Dawley rats were pretreated with three daily ip doses of phenobarbital (50 mg/kg) or saline and then orally dosed with CCl4 (2.5 ml/kg). Liver microsomes were prepared 7.5 to 180 min after CCl4 treatment, the lipid fraction was extracted, diene conjugate content was determined, and phospholipids were separated by HPLC for fatty acid content determination. Protein, phospholipid, and phosphatidyl fatty acid residue loss occurred early (7.5 to 30 min) and in some cases later (60 to 180 min) in both pretreated groups, suggesting that two phases of CCl4-mediated injury occurred. Phenobarbital pretreatment accelerated the CCl4-induced formation of diene conjugates in the microsomal lipids. In studies on the separated phospholipids, phenobarbital alone altered microsomal fatty acid content, primarily decreasing arachidonic acid in favor of linoleate, particularly in phosphatidylserine. During the early phase of CCl4 injury, phenobarbital pretreatment shifted the major loss of arachidonic acid from phosphatidylserine to phosphatidylethanolamine. During the later phase, arachidonic acid loss was still prominent, but the most extensive CCl4-induced changes in fatty acids occurred in the neutral lipid fraction, regardless of pretreatment. These changes included loss of neutral lipid linoleic and docosahexanoic acids associated with an increase in palmitic acid. These data demonstrate that phenobarbital pretreatment is associated with a shift in the predominant phospholipid locus from phosphatidylserine to phosphatidylethanolamine for the early CCl4-induced fatty acid changes in rat liver microsomes.

NADPH-dependent and -independent loss of cytochrome P-450 in control and phenobarbital-induced rat hepatic microsomes incubated with carbon tetrachloride

Carbon tetrachloride-mediated loss of cytochrome P-450 has been compared in hepatic microsomes from untreated and phenobarbital-treated rats. At concentrations of carbon tetrachloride greater than 2.5 mM, a direct effect (i.e., NADPH- independent) on cytochrome P-450 was observed. This apparently arose from the "solvent" properties of carbon tetrachloride as this effect could be duplicated with the physically similar alkyl halide 1,2-dibromo-3-chloropropane. NADPH-dependent loss of cytochrome P-450 occurred at lower concentrations with maximal response occurring at 2.5-5.0 mM. Residual cytochrome P-450 at these concentrations was similar in untreated and phenobarbital-treated microsomes. Mixed-function oxidase activities in phenobarbital-treated microsomes were reduced to levels below those of uninduced controls. The 52-kDa polypeptide(s) in untreated microsomes and that specifically induced in phenobarbital-treated microsomes were susceptible to NADPH-dependent carbon tetrachloride incubation. These data suggest that the susceptibility of specific forms of cytochrome P-450 to carbon tetrachloride can be duplicated in in vitro incubation. Furthermore, data on the direct action of carbon tetrachloride suggest that this route of damage must be taken into consideration when concentrations of carbon tetrachloride of 2.5 mM or greater are used in in vitro incubation systems.

Alterations in hepatocyte plasma membrane in carbon tetrachloride poisoning. Freeze-fracture analysis of gap junction and electron spin resonance analysis of lipid fluidity

The plasmalemma of the livers of rats treated with carbon tetrachloride (CCl4) were examined by freeze-fracture and electron spin resonance probe techniques. The rodents received by mouth either mineral oil alone (0 to 4.5 hours before sacrifice) or CCl4 in mineral oil (1:1) (2.5 ml of CCl4/kg, 0 to 3 hours before sacrifice). Rats were anesthetized with ether and livers were perfused in situ with saline either at ambient temperature or at 4 degrees C. After perfusion, livers were fixed in situ and processed for freeze-fracture and electron microscopy. Hepatocytes were isolated and incubated with 12-doxylstearic acid and subjected to electron spin resonance analysis. Electron microscopy revealed greater than a 2.5-fold increase in the individual mean gap junction size when rats were treated with mineral oil alone for 4.5 hours and the livers were processed at room temperature. The mean gap junction size in rats dosed with CCl4 for 0.5 hours before sacrifice equalled those of the group treated with mineral oil for 4.5 hours. Increases in gap junction size with CCl4 were progressive with time; by 3 hours, a 3.5-fold increase over controls was observed (p less than 0.05). When livers were perfused with iced saline, rats treated with mineral oil for 1.5 hours had a slight decrease (not significant) in mean gap junction size as compared to controls, while the size in rats treated for the same amount of time with CCl4 increased almost 5-fold over controls (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Paired cisternae of endoplasmic reticulum in developing ovarian oocytes of the golden hamster

Paired cisternae of rough endoplasmic reticulum linked together by two parallel structures exhibiting periodic striations have been observed in the cytoplasm of small pre-antrum oocytes in the golden hamster. They are present only in oocytes from animals older than 3 weeks of age. Two or more such pairs may be associated with one another, and similar structures have been observed in contact with the nuclear envelope. The peak incidence of the paired membranes coincides with a sharp increase in rough endoplasmic reticulum as the oocyte commences rapid growth. A suggested role for the paired membranes in production of new endoplasmic reticulum is discussed.

Unusual arrangements of endoplasmic reticulum in large oocytes of the golden hamster

Endoplasmic reticulum complexes consisting of up to twenty layers of rough cisternae interleaved with rounded vesicles of semismooth membrane have been observed in large oocytes of the hamster in animals older than 3 weeks of age. The appearance of the complexes varies with the mode of tissue preparation. The possible function of the complexes is discussed.

Comparison of in vivo 31P-MR spectra of the brain, liver, and kidney of adult and infant animals

In vivo 31P-magnetic resonance spectroscopy (MRS) was used to determine the phosphorus metabolite levels in the brain and kidney of infant rabbits and adult rats and in the liver of infant rabbits and adult and infant rats. For 31P-MRS of the brain, a surface, radiofrequency coil was placed on the anterosuperior region of the head; for 31P-MRS of the liver and kidney, a radiofrequency coil was chronically implanted either between the hepatic lobes or around the kidney. 31P-MR spectra were found to show large variations in the levels of the phosphorus metabolites depending on the species, the organ, and the age of the animal. The phosphate monoester (MP)/adenosine triphosphate (ATP) ratio was significantly higher and the phosphocreatine (PCr)/ATP ratio was significantly lower in the brains of infant rabbits than in the brains of adult rats. Comparison of these data with data reported for humans and other animals suggests that these differences are due mainly to differences in age and not to differences among species. The phosphodiester (PD)/ATP ratio was found to be significantly higher in the livers of infant rabbits than in the livers of adult and infant rats - a difference more likely related to the species than to age. The kidneys of the infant rabbits showed a higher PCr/ATP radio than the kidneys of the adult rats, but this difference might be due to the influence of PCr in the surrounding muscle.

Changing patterns of cerium reactivity in developing ovarian oocytes of the hamster

In developing ovarian oocytes of 2-day-old, 12-day-old and adult hamsters, oxidative enzyme activity as demonstrated by the cerium technique is strongest at 12 days and occurs principally in those oocytes which have begun rapid growth. The reaction is associated with the outer mitochondrial membrane, nearby cytoplasm, endoplasmic reticulum and nuclear envelope. Once antrum formation has begun and the mitochondria have reached the dormant (storage) stage, cerium reactivity ceases. In adults, reaction occurs at the same stages of oocyte development but is weaker and limited to the mitochondria and their immediate vicinity.

Age-dependent alterations in the physicochemical properties of rat liver microsomes

Aging results in a significant decline in liver drug metabolism which is largely attributable to changes in the microsomal mixed function oxidase system. For example, the mixed function oxidase system in the livers of senescent rats is characterized by: (1) a reduced cytochrome P-450 content; (2) a decline in the specific activity of NADPH-cytochrome c (P-450) reductase; and (3) a slower rate of ethylmorphine N-demethylation in comparison to young adult animals. Since several factors intrinsic to the microsomes may influence the efficacy of the mixed function oxidase system, e.g. the phospholipid and cholesterol contents, the saturation index of the fatty acids and the fluidity of the membranes, we conducted a physicochemical analysis of liver microsomes isolated from young adult (3-4 months), mature (12-16 months) and senescent (25-27 months) male Fischer rats. Although the microsomal cholesterol content did not change appreciably between maturity and senescence, there was a marked decline in the total phospholipid content. This resulted in a significant increase in the cholesterol/phospholipid ratio, 0.49 to 0.65 between 16 and 27 months of age. The age-related changes in the total phospholipid content were largely reflected in each of the major fractions, i.e. phosphatidylcholine, phosphatidylinositol and phosphatidylethanolamine + phosphatidylserine. Small increases in the relative percentages of highly unsaturated fatty acid species were offset by similar decreases in the more frequent and more saturated species as a function of increased age. As a result, the net change in the fatty acid saturation index was probably minimal. However, the increase in the cholesterol/phospholipid ratio most likely contributes to the significant decline in the order parameter of microsomes isolated from old rats which, in turn, may impair the functional capacity of the hepatic mixed function oxidase system.

Nurse-doctor communication: A study on interprofessional communication

The health team is an ingenious concept, often defined as a group of people coming together and pooling their resources for the benefit of the patient. One immediately gets the impression of an interacting network of hospital staff, each sharing the belief that no one person can provide totally for any patient’s complex physical and mental needs.

Enzyme studies on TPPase-reactive cytoplasmic structures observed in early meiotic prophase I of the hamster oocyte

Ovaries of immature and adult hamsters were incubated in medium containing thiamine pyrophosphate (TPP) to determine the age at which TPPase-reactive cytoplasmic structures first appear in the germ cells, and at what age the structures cease to be present. The structures were found only in oocytes from animals 8-15 days of age. They occur in predictyate germ cells in polyovular follicles and in very early dictyate oocytes in unilaminar follicles. The TPPase-reactive structures were never observed in atretic oocytes, in unilaminar follicles of adult animals, nor in multilaminar follicles of animals at any age. Ovaries of 8-12-day-old animals and adults were then incubated in media in which one of the following substrates was substituted for TPP: uridine diphosphate (UDP), inosine diphosphate (IDP), and adenosine monophosphate (AMP). Half of the samples in each experiment were incubated in medium containing the inhibitor L-p-bromotetramisole. beta-Glycerophosphate was used in control incubations, or the substrate was omitted entirely. The cytoplasmic structures were found to be reactive after incubation in UDP-containing media, but not after incubation in media containing AMP. With IDP as substrate, reactions were atypical and confined to peripheral regions of the cytoplasm. Other sites of enzyme activity after incubation with the various substrates (cell membranes, zona pellucida, endoplasmic reticulum and Golgi apparatus) are also described and discussed.

Intake of phosphatase-active plasma membrane into the cytoplasm of oocytes from sexually immature hamsters

When thiamine pyrophosphate is used as substrate, heavily stained complexly branching cytoplasmic structures are seen in developing oocytes of the hamster between 8 and 12 days after birth. This coincides with the onset of the dictyate stage of first meiotic prophase. The structures appear to arise from the oocyte plasma membrane in two ways: (1) by proliferation and infolding of the membrane, and (2) by membrane being pushed into the cytoplasm by invaginating follicle cell processes. This appears to be followed by proliferation of the invaginated plasma membrane within the oocyte cytoplasm. Incubations with ATP or beta-glycerophosphate, with and without the inhibitor L-p-bromotetramisole, indicate that the staining is not due to the action of either ATPase or alkaline phosphatases. The origin and possible developmental significance of the reactive structures are discussed.

The phospholipids of the hepatic endoplasmic reticulum. Structural change in liver injury

Endoplasmic-reticulum phospholipids were measured during the first hour after carbon tetrachloride administration to male Sprague-Dawley rats and compared with carbon tetrachloride challenge of microsomes from control animals in vitro. The extracted lipids were separated by high-pressure liquid chromatography. No significant differences in the abundance of phosphatidylserine, phosphatidylethanolamine, phosphatidylinositol or phosphatidylcholine were found after either treatment when compared with untreated controls. Diene conjugate formation in each separated phospholipid was determined by measuring A(232) and expressed on the basis of lipid phosphorus. Phosphatidylserine was peroxidized 6-fold greater than in controls after challenge in vivo, reaching maximal change after 15min, whereas the other phospholipids showed little or no alteration. Fatty acid composition analysis was performed by g.l.c. after transesterification of individual phospholipids. Phosphatidylserine revealed two types of response: an abrupt decrease in relative abundance of oleic acid (C(18:1)) and linoleic acid (C(18:2)) without further loss and a slower, linear decrease in arachidonic acid (C(20:4)) over the first hour. Similar changes were not seen in other phospholipids. In the ;in vitro' model, the relative amounts of the phospholipids do not change. The extent of peroxidation was greater in all the phospholipids than found in vivo, with phosphatidylserine peroxidized to the greatest extent. These data suggest that carbon tetrachloride injury in vivo produces an early peroxidative event and that a specific phospholipid (phosphatidylserine) is selectively modified, although maintaining its relative concentration in the membrane. Dissection of this process in vitro will require refinement of existing systems to reduce the non-specific changes associated with the model system.

A comparison of normal limits arising in nerve conduction studies

A detailed study has been carried out on the influence of various factors, including sex of the patient and side examined, on normal values in peripheral nerve conduction studied. Patients were selected from three clinics, thereby enabling comparisons not only to be made within clinics but also between clinics.

Differentiation of endoplasmic reticulum in the developing oocyte of the golden hamster (Mesocricetus auratus)

The differentiation of the endoplasmic reticulum (ER) in the developing oocyte of the golden hamster is accompanied by changes in susceptibility to impregnation with a zinc iodide-osmium tetroxide (ZnOs) mixture. The staining of two of the three categories of oocyte ER is first seen at or about the time when rapid oocyte growth is initiated. Staining reaches a peak before antrum formation, then declines. A third category of ER remains unstained at all stages. Aberrant reactivity to ZnOs is seen on oocytes which become atretic, and differs with the stage of oocyte development at which atresia occurs. Relationships between the three categories are described, and an attempt made to relate changes in form and distribution to developmental processes. The frequent contact/continuity between ER and mitochondria is discussed with regard to its possible role in lipid metabolism.

Cytochemistry of the Golgi apparatus in developing ovarian germ cells of the Syrian hamster

A cytochemical study of the Golgi apparatus in the developing oocyte of the golden hamster was carried out using the TPPase, AcPase and zinc iodide-osmium tetroxide (ZnOs) techniques. Tissue from both immature and sexually mature animals was investigated. Peak TPPase activity was found in pre-growth oocytes in ovaries from sexually mature adults. Some activity was also present in SER in the peripheral cytoplasm of growing oocytes. AcPase activity was found only after the onset of oocyte growth. It was present in Golgi cisternae and associated vesicles and in some profiles of peripheral SER. No structures corresponding to GERL were identified. Strong staining with ZnOs was seen, at all stages studied, in certain Golgi vesicles and short tubules but not in the cisternae unless the oocyte was atretic. Weaker ZnOs staining was characteristic of ER throughout the oocyte. With all techniques there was a falling off of reactivity as oocyte size increased. Within a single oocyte some Golgi bodies were negative while others were positive, with both TPPase and AcPase techniques. This suggests that two or more functional types of this organelle are present within the developing oocytes.

Analysis of the phospholipid of the nuclear envelope and endoplasmic reticulum of liver cells by high pressure liquid chromatography

A method is described for the separation and analysis of phospholipids from rat-liver nuclear envelope and endoplasmic reticulum. The procedure employs a liquid environment, to which antioxidants can be added, and results in separation of NL, PE, PI, PS, and PC in 99% purity in 12 min; analytical columns and a radial compression system may be employed. The procedure results in phospholipids with a large proportion of highly unsaturated fatty acids; some differences in fatty acid distributions were found when nuclear envelope phospholipid fractions were compared with the corresponding fractions from endoplasmic reticulum.

Phosphorus standards for the electron probe X-ray microanalysis of ultrathin tissue sections

Phosphorus-containing standards for use during quantitative electron probe X-rays microanalysis of ultrathin tissue sections can be quickly and simply prepared using organo-phosphorus compounds which are soluble in Spurr's epoxy resin mixture. Trials of five such compounds (one solid, the rest liquid) are described.

The possible role of the frontal and sub-parietal gland systems of the pentastomid Reighardia sternae (Diesing, 1864) in the evasion of the host immune response

The frontal and sub-parietal glands of the pentastomid Reighardia sternae elaborate lamellate secretion which is poured on to the cuticle. The entire surface of the cuticle, including the mouth, hook pits and reproductive apertures, is coated with secretion. Electron microscope studies indicate that the glands are continuously active, which implies a turnover of surface membranes. The postulated function of these membranes is to protect certain vital areas of the host--parasite interface, notably the pores of ion-transporting cells, from the host immune response. The available evidence suggests that pentastomids do evoke a strong immune response but since most are long-lived they must circumvent it. We believe the surface membrane system to be instrumental in this. Studies on another pentastomid, Porocephalus crotali in rats have shown that an immune response stimulated by a primary infection will kill subsequent infections and that the surface membranes are strongly immunogenic. Obvious parallels between this situation and that of schistosome infections in mammals are discussed. An alternative explantation of concomitant immunity is proposed.

Some observations on egg production and autoreinfection of Reighardia sternae (Diesing, 1864), a pentastomid parasite of the herring gull

Egg production by Reighardia sternae, implanted at various stages of maturity into the interclavicular air sacs of captive gulls, is described. Females produce only 2900 eggs per lifetime over a short patent period of 1-3 days. The problem of a direct life-cycle in relation to this unusually low fecundity is discussed, and speculation is advanced concerning a possible parasitic behavioural trait which could facilitate direct transmission. The hazards of the latter are also offset by auto-reinfection.

An experimental investigation of a direct life-cycle in Reighardia sternae (Diesing, 1864), a pentastomid parasite of the herring gull (Larus argentatus)

A direct life-cycle in Reighardia sternae, a cephalobaenid pentastomid of gulls was investigated: the work was prompted by a report of eggs and larvae recovered from the stomach and intestine of a naturally infected gull. Infective pentastomid eggs were obtained by surgically transplanting maturing female Reighardia, taken from freshly shot wild gulls, into captive recipients. Faecal material from birds thus artificially infected was collected daily and examined for eggs. Eggs were force fed to 33 hand-reared (from eggs or nestlings) juvenile gulls which were selected at random and sacrificed at intervals thereafter and examined for pentastomids. One hour after infection, primary larvae appear in the body cavity where they moult immediately. They grow steadily and by 27-35 days are sexually differentiated, and by 66 days have copulated. Fertilized females take a further 116 days to produce eggs by which time they are 7-6 cm long. The complex migrations undertaken by developing larvae in the gull, and the problems of the mechanism of direct transmission, are discussed.