The Impact of a Machine Learning Early Warning Score on Hospital Mortality: A Multicenter Clinical Intervention Trial

OBJECTIVES

To determine the impact of a machine learning early warning risk score, electronic Cardiac Arrest Risk Triage (eCART), on mortality for elevated-risk adult inpatients.

DESIGN

A pragmatic pre- and post-intervention study conducted over the same 10-month period in 2 consecutive years.

SETTING

Four-hospital community-academic health system.

PATIENTS

All adult patients admitted to a medical-surgical ward.

INTERVENTIONS

During the baseline period, clinicians were blinded to eCART scores. During the intervention period, scores were presented to providers. Scores greater than or equal to 95th percentile were designated high risk prompting a physician assessment for ICU admission. Scores between the 89th and 95th percentiles were designated intermediate risk, triggering a nurse-directed workflow that included measuring vital signs every 2 hours and contacting a physician to review the treatment plan.

MEASUREMENTS AND MAIN RESULTS

The primary outcome was all-cause inhospital mortality. Secondary measures included vital sign assessment within 2 hours, ICU transfer rate, and time to ICU transfer. A total of 60,261 patients were admitted during the study period, of which 6,681 (11.1%) met inclusion criteria (baseline period n = 3,191, intervention period n = 3,490). The intervention period was associated with a significant decrease in hospital mortality for the main cohort (8.8% vs 13.9%; p < 0.0001; adjusted odds ratio [OR], 0.60 [95% CI, 0.52-0.71]). A significant decrease in mortality was also seen for the average-risk cohort not subject to the intervention (0.49% vs 0.26%; p < 0.05; adjusted OR, 0.53 [95% CI, 0.41-0.74]). In subgroup analysis, the benefit was seen in both high- (17.9% vs 23.9%; p = 0.001) and intermediate-risk (2.0% vs 4.0 %; p = 0.005) patients. The intervention period was also associated with a significant increase in ICU transfers, decrease in time to ICU transfer, and increase in vital sign reassessment within 2 hours.

CONCLUSIONS

Implementation of a machine learning early warning score-driven protocol was associated with reduced inhospital mortality, likely driven by earlier and more frequent ICU transfer.

149 Emergency Clot Retrieval and Stenting for Posterior Circulation Stroke

The current literature regarding the morphology and presentations of strokes due to basilar artery stenosis/occlusion is limited. This pathology is a rare cause of stroke and its management is not clearly decided in guidelines or published literature. Moreover, posterior circulation strokes are reported to be more devastating than anterior circulation. We present a case of a 68-year-old male who presented in an acute setting with reduced consciousness, myoclonic jerks, weakness and nausea due to a stroke from an occluded mid-segment basilar artery. MRI showed evidence of left cerebellar and right occipital infarcts. Emergent cerebral angiography was performed, and he was immediately treated by thrombectomy and stenting (Stryker Wingspan stent). The patient made a full recovery within one week and remained well at follow-up 3 months post-procedure. Emergency recanalization of basilar artery strokes, by clot retrieval and stenting, should be considered as a treatment option.

148 Acute Renal Infarcts from Spontaneous Intra-Renal Dissection

Spontaneous renal artery dissection and acute renal infarcts are rare occurrences and often misdiagnosed in clinical practice. We present four male patients, between 30-50 years of age, who have no underlying cardiac conditions, hypertension, or diabetes mellitus. They presented with abdominal/loin/flank pain due to spontaneous renal artery dissection and were all treated with endovascular stenting. Two patients had renal artery fibromuscular dysplasia, confirmed by CT angiogram, a rare pathology which is reported in literature to mostly affect women. All four patients recovered fully from the operation, with no post-operative complications noted. These patients were post-operatively managed medically with anti-platelet therapy for two years and did not experience any post-procedural complications at their 24-month follow up. Classically visceral artery dissection can be managed by anti-platelet therapy alone, however fibromuscular dysplasia can cause spontaneous dissection with renal infarcts and this requires urgent treatment with endovascular stents. Further research is needed on the post-procedural medical management guidelines.

Symptomatic hepatic hydrothorax successfully treated with transjugular intrahepatic portosystemic shunt (TIPS)–role of titration of portosystemic gradient reduction to avoid post‐TIPS encephalopathy

Key Clinical Message

We describe a challenging case of hepatic hydrothorax secondary to nonalcoholic steatohepatitis cirrhosis. Our management involved successfully treating the hydrothorax with a transjugular intrahepatic porto-systemic shunt but having to manage the subsequent complication of hepatic encephalopathy. We conclude with a review of the available literature.

Endovascular treatment of isolated systemic arterial supply to normal lung with coil and glue embolisation

Surgery is the standard treatment for the extremely rare pathology of isolated anomalous systemic arterial supply to normal lung (ISSNL). We describe our experience with this anomaly in a 29-year-old male presenting with recurrent haemoptysis that was successfully treated with a combination of metallic coils and cyanoacrylate glue. In addition to contributing to the extremely limited data on endovascular therapeutic options in ISSNL, we also intend to raise the awareness among endovascular therapists of the need to be cautious ofand preserve the radiculomedullary/pial branches arising from an anomalous artery before embolising it.

Endovascular exclusion of aberrant splenic artery aneurysm with covered stent

The splenic artery arising from the superior mesenteric artery is an uncommon anatomical variant. This aberrant origin may rarely be associated with an aneurysm. Previous cases have been managed with surgery and combined surgical/endovascular or endovascular techniques, with the latter involving occlusion of the aneurysm with coils. We report a case of aberrant splenic artery aneurysm that was excluded with a balloon-mounted covered stent, and discuss the technical issues encountered in using this approach. A follow-up computed tomography performed six months after the covered stent placement showed persistent exclusion with marked shrinkage of the aneurysm sac.

Endovascular revascularisation of popliteal artery occlusions: two complex cases

Peripheral vascular disease-related occlusions of the arteries are complex lesions that can be treated surgically or through endovascular means in symptomatic patients. In this case report, we describe two interesting cases of popliteal occlusion that were revascularised using advanced endovascular techniques to salvage the limb. The first case was a chronic popliteal artery occlusion that required atypical arterial access along with embolisation due to earlier attempted intervention to revascularise the artery. The second case was an acute embolic occlusion that was excluded from the circulation primarily rather than through the typical approach of thrombolysis or mechanical thrombectomy.

Chronic adrenaline treatment fails to down-regulate the Del301-303-alpha2B-adrenoceptor in neuronal cells

BACKGROUND AND PURPOSE

A polymorphism of the human alpha(2B)-adrenoceptor (Del(301-303)-alpha(2B)-adrenoceptor) has been described, and this receptor exhibits reduced G-protein-coupled receptor kinase (GRK) phosphorylation and impaired short-term desensitization. Expression of the Del(301-303)-alpha(2B)-adrenoceptor also is associated with an increased risk for myocardial infarction in humans. Recent evidence from our laboratory suggests a quantitative relationship between cellular GRK3 expression levels and the sensitivity of the alpha(2B)-adrenoceptor to agonist-induced down-regulation. Therefore, the present study was undertaken to study agonist-induced down-regulation of the wild-type (WT)- and Del(301-303)-alpha(2B)-adrenoceptor in a neuronal cell model.

EXPERIMENTAL APPROACH

Haemagglutinin (HA) epitope-tagged WT- and Del(301-303)-alpha(2B)-adrenoceptor containing plasmids were constructed and the receptors were stably or transiently transfected in neuroblastoma/glioma hybrid NG108 cells. The expression levels in stable transfects were approximately 50 fmol x mg(-1). These cells were used to examine agonist-induced down-regulation and phosphorylation of the WT- and Del(301-303)-alpha(2B)-adrenoceptor.

KEY RESULTS

The Del(301-303)-alpha(2B)-adrenoceptor, compared with the WT-alpha(2B-)adrenoceptor, displayed reduced adrenaline-stimulated (20 microM) phosphorylation and did not down-regulate in response to adrenaline (20-1000 microM). Using immunofluorescence labelling, we observed that transiently transfected WT-alpha(2B)-adrenoceptors internalized upon adrenaline treatment whereas the Del(301-303)-alpha(2B)-adrenoceptor did not. Finally, we determined the effect of adrenaline on the Del(301-303)-alpha(2B)-adrenoceptor in cells stably over-expressing GRK3 3-fold. In spite of the GRK3 over-expression, 20-1000 microM ADR failed to down-regulate or to increase phosphorylation of the Del(301-303)-alpha(2B)-adrenoceptor in these cells.

CONCLUSIONS AND IMPLICATIONS

The results suggest that the 301-303 deletion mutation of the alpha(2B)-adrenoceptor eliminates agonist-induced down-regulation, an effect that cannot be overcome by increasing agonist concentration or by modest GRK3 over-expression.

Ultrasonography for detection of early pregnancy following embryo transfer in unknown breed of Bos indicus cows

Real time, B mode ultrasound was used from Days 18 to 64 to detect and monitor the conceptus in 30 unknown breeds of Bos indicus recipients following embryo transfer. The embryonic vesicle was first visible within the uterus between Days 18 and 20 (mean +/- SD 18.5 +/- 0.7d) d). The embryo proper was detected at Day 19.5 +/- 0.7. The heartbeats were detected at Day 22.6 +/- 0.9. The average day of first detection of the allantois, the C - shaped embryo and the amnion was 23.1 +/- 0.8, 23.8 +/- 1.4 and 25.1 +/- 1.4 d, respectively. The fore limb, the limb buds, the spinal cord and the optic area were observed on Days 32.7 +/- 1.3, 32.9 +/- 1.3, 33.0 +/- 1.5 and 33.6 +/- 1.4, respectively. Fetal movements could be detected at Day 50.7 +/- 1.0. Ribs and vertebrae were detected on Day 60.9 +/- 1.7. The mean length of the embryo proper was 4.5 +/- 0.8 mm. on Day 19. At Day 60 it was 52.5 +/- 7.0 mm. The growth of the embryo proper increased steadily until Day 39, growing rapidly thereafter. Embryonic death was detected in one recipient on Day 32. The echogenic area started increasing and recipient appeared in estrus on Day 40. Sixteen recipients exhibited estrus on Days 22 to 24. An increase in intrauterine fluid was observed on Days 18 to 24.

Self-expanding nitinol stents in recanalisation of long-length superficial femoral artery occlusions in patients with critical limb ischaemia

INTRODUCTION

This study aims to evaluate our experience with self-expanding nitinol stent- enabled recanalisation of long-length occlusions (30 cm or more) of the superficial femoral artery (SFA).

METHODS

573 patients underwent 842 lower limb interventions from August 2006 to December 2008. A retrospective review of patients undergoing recanalisation of long-length SFA occlusions with self-expanding nitinol stents and an evaluation of their patency and impact on limb salvage, were done.

RESULTS

22 patients (mean age 62.5 years, male: female ratio 11:11) underwent 22 long-length SFA stenting procedures. The spectrum of critical limb ischaemia included rest pain (five), ulcer (six) and gangrene (11). Length of occlusions varied from 30 cm to 45 cm (average length 36.4 cm). Five patients had stents placed through the ipsilateral popliteal artery approach, and the rest had stents placed through the femoral artery approach. All patients were followed up over an average duration of 12 months. One patient died due to associated medical conditions during this period. Six out of 21 (28.6 percent) of the stents thrombosed completely on one year follow-up. Of these, two patients underwent amputation, one patient had a bypass, and the stent in two patients were recanalised with balloon angioplasty. All remaining patent stents showed varying degrees of stenoses at one year. The overall limb salvage rate at one year following stent placement was 81 percent.

CONCLUSION

Our experience showed the beneficial result of long-length SFA stent placement with good limb salvage outcome. Repeat interventions may be required to maintain the patency of stents in these patients.

Renal vascular injuries following nephron-sparing surgery and their endovascular management

INTRODUCTION

This study aims to describe renal vascular injuries following nephron-sparing surgery and the efficacy of transcatheter embolisation in management of these complications.

METHODS

A retrospective review was performed on 96 patients who underwent nephron-sparing surgery from 2001 to 2005. Selective angiography was performed on all patients referred for significant postoperative haematuria and internal bleeding, followed by embolisation where indicated. Patient presentation, type of vascular injury, embolisation technique and treatment outcome were reviewed in each case. Efficacy of embolisation in preservation of renal function was assessed.

RESULTS

Seven arterial lesions were identified in four patients (three male and one female; age range 47-70 years). Three patients developed pseudoaneurysms (mean size 2.1 cm, range 1.5-3 cm). One patient revealed four separate areas of active contrast extravasations. All patients were successfully treated with coil embolisation with complete symptomatic relief within one to three days. Renal function was preserved in all patients over a follow-up period of 90 days.

CONCLUSION

Renal arterial injuries, especially pseudoaneurysms, are an important though uncommon cause of haematuria following nephron-sparing surgery. Coil embolisation is an effective treatment for management of these iatrogenic injuries.

An effective chromatographic separation of chicken red blood cell coproporphyrinogen oxidase and uroporphyrinogen decarboxylase, two enzymes in heme biosynthesis

Of the heme biosynthetic pathway enzymes, coproporphyrinogen oxidase is one of the least understood. Substrate recognition studies [Prepr. Biochem. Biotech.1997, 27, 47, J. Org. Chem.1999, 64, 464] have been done using chicken blood hemolysates (CBH) as the source of this enzyme. However, the enzyme uroporphyrinogen decarboxylase is also present in these preparations and separation of these two enzymes from CBH had not yet been achieved. Thus, a substrate ligand column was developed by covalently linking coproporphyrin-III to a sepharose resin following a similar procedure previously used for the purification of uroporphyrinogen decarboxylase [Int. J. Biochem.1992, 24, 105]. The ligand-resin chromatography step rapidly separates coproporphyrinogen oxidase from uroporphyrinogen decarboxylase as well as the majority of the hemoglobin.

Atypical manifestation of dural arteriovenous fistula

A case of secondary dural arteriovenous fistula presenting as infantile stroke, in a fifteen month old boy, is reported. The initial impression on CT scan in this case was misleading, due to the atypical appearance of the pathological periventricular blood vessels, interpreted as periventricular calcification.

Reproductive characteristics of cloned heifers derived from adult somatic cells

This study examined the onset of puberty, follicular dynamics, reproductive hormone profiles, and ability to maintain pregnancy in cloned heifers produced by somatic cell nuclear transfer. Four adult somatic cell-cloned heifers, derived from a 13-yr-old Holstein cow, were compared to 4 individual age- and weight-matched heifers produced by artificial insemination (AI). From 7 to 9 mo of age, jugular venous blood samples were collected twice weekly, and from 10 to 11 or 12 mo of age, blood sampling was carried out every other day. After the heifers reached puberty (defined as the first of 3 consecutive blood samples with peripheral plasma progesterone concentrations of >1 ng/ml), ultrasound examination of ovaries and jugular plasma sample collection were carried out daily for 1 estrous cycle. Cloned heifers reached puberty later than controls (mean +/- SEM, 314.7 +/- 9.6 vs. 272 +/- 4.4 days and 336.7 +/- 13 vs. 302.8 +/- 4.5 kg for clones and controls, respectively; P < 0.05). However, cloned and control heifers were not different in estrous cycle length, ovulatory follicle diameter, number of follicular waves, or profiles of hormonal changes (LH, FSH, estradiol, and progesterone). Three of the 4 clones and all 4 control heifers became pregnant after AI. These results demonstrate that clones from an aged adult have normal reproductive development.

Tubercular endophthalmitis simulating retinoblastoma

PURPOSE

To report a case of tubercular endophthalmitis simulating retinoblastoma.

METHODS

Case report. An 8-year-old female presented with a history of complete loss of vision and a white pupillary reflex in the left eye of 3 month's duration.

RESULTS

Retinoblastoma could not be excluded on the basis of clinical examination and relevant investigational studies. In the left eye, a computed tomography (CT) scan demonstrated a large vitreous mass with foci of calcification. Enucleation in the left eye was performed, and histopathological examination revealed a chronic granulomatous endophthalmitis and acid-fast bacilli consistent with tubercular pathology.

CONCLUSION

This case illustrates that tubercular endophthalmitis with leukocoria and a vitreous mass containing focal calcification may simulate retinoblastoma.

In vitro cultivation of human islets from expanded ductal tissue

A major obstacle to successful islet transplantation for both type 1 and 2 diabetes is an inadequate supply of insulin-producing tissue. This need for transplantable human islets has stimulated efforts to expand existing pancreatic islets and/or grow new ones. To test the hypothesis that human adult duct tissue could be expanded and differentiated in vitro to form islet cells, digested pancreatic tissue that is normally discarded from eight human islet isolations was cultured under conditions that allowed expansion of the ductal cells as a monolayer whereupon the cells were overlaid with a thin layer of Matrigel. With this manipulation, the monolayer of epithelial cells formed three-dimensional structures of ductal cysts from which 50-to 150- micrometer diameter islet-like clusters of pancreatic endocrine cells budded. Over 3-4 weeks culture the insulin content per flask increased 10- to 15-fold as the DNA content increased up to 7-fold. The cultivated human islet buds were shown by immunofluorescence to consist of cytokeratin 19-positive duct cells and hormone-positive islet cells. Double staining of insulin and non-beta cell hormones in occasional cells indicated immature cells still in the process of differentiation. Insulin secretion studies were done over 24 h in culture. Compared with their basal secretion at 5 mM glucose, cysts/cultivated human islet buds exposed to stimulatory 20 mM glucose had a 2.3-fold increase in secreted insulin. Thus, duct tissue from human pancreas can be expanded in culture and then be directed to differentiate into glucose responsive islet tissue in vitro. This approach may provide a potential new source of pancreatic islet cells for transplantation.

Disposable contact lenses in penetrating keratoplasty

PURPOSE

To evaluate the therapeutic efficacy of disposable contact lenses in management of complications after keratoplasty.

METHODS

Twenty-eight patients with various post keratoplasty complications were fit with disposable contact lenses (45% Vifilcon A and 55% water content). Indications for lens use included persistent epithelial defects, wound leak, graft edema, dry eye and protection of normal corneal epithelium.

RESULTS

Success was obtained with the therapeutic use of disposable lenses in 20 of the 28 cases. The best results were seen in maintenance and restoration of healthy ocular surface and small wound leaks. Stromal graft edema with no epithelial involvement was the major area of therapeutic failure.

CONCLUSIONS

Disposable contact lenses are an attractive low cost option in the management of complications after keratoplasty. They are particularly useful in maintaining a healthy ocular surface, providing symptomatic relief and avoiding resurgery in patients with small wound leaks.

Intralenticular foreign bodies: report of eight cases and review of management

PURPOSE

The management of intralenticular foreign bodies (ILFBs) with or without cataract has varied from time to time in the last century. We evaluated the surgical removal of the ILFBs with cataract extraction as a single-stage procedure.

METHODS

Eight consecutive cases with intralenticular foreign bodies presenting to the trauma centre at our institute, were included in the study. Planned ILFB removal with cataract extraction and IOL implantation as a single-stage procedure was done in all the patients. They were followed up from 2 months to 2 years after the surgery.

RESULTS

ILFBs were removed with Kelman-Mcpherson forceps in seven cases and in one it was expressed with the nucleus during extra capsular cataract extraction. Co-existent posterior capsular tears were seen in two eyes, of which only one needed a localized vitrectomy. Posterior chamber intraocular lens implantation was possible without any complication in all the cases. Postoperative uveitis seen in three cases was easily controlled with periocular steroids. Best corrected visual acuity at last examination was 6/9 or better in 7 cases and 6/12 in one case with posterior capsular opacification.

CONCLUSIONS

Timing and necessity of ILFB removal may be adjusted according to the foreign body characteristics and associated ocular trauma, choosing, as far as possible, the least traumatic procedure. Use of forceps rather than magnets is safer for the removal of the ILFB. Co-existent posterior capsular tears need to be anticipated and dealt with when encountered.

Developmental competence of juvenile calf oocytes in vitro and in vivo: influence of donor animal variation and repeated gonadotropin stimulation

Juvenile calf oocytes represent an untapped source of germ plasm for reproduction. Reports on the developmental competence of calf oocytes have been controversial. In this research, oocytes were recovered after gonadotropin stimulation from Holstein calves (N = 10) at 2-3 mo of age (2-mo cycle) and again at 4-5 mo of age (4-mo cycle). The in vitro developmental competence was measured, and prestimulation follicle numbers (for 2-mo cycle) and poststimulation follicle numbers (both cycles) were obtained. The number of antral follicles doubled after stimulation (23.4 +/- 6.1 vs. 55.1 +/- 16.1) for the 2-mo cycle and for the 4-mo cycle (47.4 +/- 12.4). The number of follicles observed prior to stimulation in the 2-mo cycle was found to be highly correlated with the poststimulation oocyte recovery for both collection cycles (r = 0.95, 2-mo cycle; r = 0.81, 4-mo cycle). The majority (90-96%) of recovered oocytes were found to be usable for in vitro maturation and fertilization; of these, 41-42% cleaved and 10-11% developed to morulae or blastocysts. Eighty-four in vitro-produced embryos were transferred to synchronized recipients and resulted in 11 pregnancies, leading to 7 live (4 males, 3 females) and 2 dead (one male, one female) calves at full term. No significant differences were observed between the 2-mo and 4-mo collection cycles; however, 73% of the total pregnancies resulted from the 2-mo cycle. All pregnancies resulted from embryos of high-responding donors. The high correlation between the number of follicles prior to stimulation and the poststimulation response suggests the possibility of screening calves prior to stimulation for routine embryo production.

The homeodomain protein IDX-1 increases after an early burst of proliferation during pancreatic regeneration

Islet duodenal homeobox 1 (IDX-1/PF-1/STF-1/PDX-1), a homeodomain protein that transactivates the insulin promoter, has been shown by targeted gene ablation to be required for pancreatic development. After 90% pancreatectomy (Px), the adult pancreas regenerates in a process recapitulating embryonic development, starting with a burst of proliferation in the epithelium of the common pancreatic duct. In this model, IDX-1 mRNA was detected by semiquantitative reverse transcription-polymerase chain reaction in total RNA from isolated common pancreatic ducts at levels 10% of those of isolated islets. The IDX-1 mRNA levels were not significantly different for common pancreatic ducts of Px, sham Px, and unoperated rats and did not change with time after surgery. By immunoblot analysis, IDX-1 protein was only faintly detected in these ducts 1 and 7 days after Px or sham Px but was easily detected at 2 and 3 days after Px. Similarly, IDX-1 immunostaining was barely detectable in sham or unoperated ducts but was strong in ducts at 2-3 days after Px. The increase of IDX-1 immunostaining followed that of BrdU incorporation (proliferation). These results indicate a posttranscriptional regulation of the IDX-1 expression in ducts. In addition, islets isolated 3-7 d after Px showed higher IDX-1 protein expression than control islets. Thus, in pancreatic regeneration IDX-1 is upregulated in newly divided ductal cells as well as in islets. The timing of enhanced expression of IDX-1 implies that IDX-1 is not important in the initiation of regeneration but may be involved in the differentiation of ductal cells to beta-cells.

Rapid sexing of bovine preimplantation embryos using polymerase chain reaction: production of calves with predetermined sex under field conditions

Two to four blastomere size biopsies were obtained from each 6-day-old embryo of zebu and crossbred cattle for sex determination. The sex of the embryos was determined with a set of bovine Y-chromosome specific primer pairs by using polymerase chain reaction. Thirty two biopsied embryos after their sex was determined, when transferred fresh to synchronized recipients, resulted in 56.2% pregnancy rate. Sixteen healthy calves were born at full term, while 2 heifers aborted at mid-term from fresh embryo transfer. Simultaneously, 44 biopsied embryos which were kept frozen, were thawed at a later date and transferred to the previously synchronized recipients, thereby leading to 24 pregnancies (54.5%). Twenty-three healthy calves were born at full term, while 1 heifer aborted at mid-term from frozen-thawed embryo transfer. The pregnancy rates from both fresh and frozen-thawed biopsied embryos were comparable with that of controls (P > 0.05). Except for a single misidentification of a male calf as a female by our PCR assay (2.6%), the phenotypic sex of all the live born calves as well as the aborted fetuses was correctly matched with the PCR detection.

Control of oocyte maturation in cows--biological factors

Since bovine in vitro fertilization became possible in the early 80s, a lot of effort has been done to clarify the mechanisms of what seems more and more one of the crucial steps in this procedure, being oocyte maturation. Undoubtedly, many biological factors act together to prepare the immature oocyte for a successful development to a competent embryo after fertilization. Defects in oocyte maturation can possibly be caused by an inadequate nuclear or cytoplasmic maturation or even by a failure of both. There is a general agreement upon the fact that the origin of the oocyte can play an important role. Oocytes derived from very small follicles show a lower rate of maturation and lower blastocyst development with currently used maturation protocols. Parthenogenetic activation of small size follicle derived oocytes suggests that their poor development was not caused by fertilization problems but more likely by intrinsic oocyte factors. Similar developmental rates achieved through nuclear transfer and parthenogenetic activation suggests that the nucleus of the incompetent oocyte may not be the sole reason for a poor development. Another important factor appears to be the donor animal age. The younger the donor animal, the more impaired is its oocyte's developmental competence in most of the embryo IVP systems. Treatment with exogeneous gonadotropins can be beneficial in young donors on the oocyte cleavage rates but does not always increase the final blastocyst outcome. This review briefly documents some of the biological factors and their possible effects on the developmental capacities of the bovine oocyte in vitro.

Comparison of various maturation treatments on in vitro maturation of goat oocytes and their early embryonic development and cell numbers

In the present study, comparison of 2 different culture media (Ham's F-12 and M-199) for supporting in vitro maturation of goat oocytes, and their subsequent embryonic development was evaluated in the presence or absence of sera (estrous goat serum, EGS and fetal calf serum, FCS) and hormones (FSH, 0.5 ug/ml, LH, 5 ug/ml and estradiol, 1 ug/ml). Neither medium (Ham's F-12 or M-199) when supplemented with EGS and hormones showed any notable changes in the maturation rate nor in cleavage and blastocyst development. The mean cell number for blastocysts was also significantly low (P < 0.05). However, Ham's F-12 medium supplemented with FCS and hormones showed a considerable increase in the maturation rate, but subsequent embryonic development was not appreciably increased. However, maturation, cleavage and blastocyst development rates of oocytes matured in M-199 medium in combination with 10% FCS and hormones were significantly higher (P < 0.05). Mean cell number per blastocyst was also significantly increased in this latter treatment compared with that of the other groups (P < 0.05). The results thus indicated that both the culture medium and serum have a marked effect on maturation and subsequent embryonic development. Further, the results also showed that the combination of M-199 with FSH, LH and E2 supplemented with 10% FCS was the most efficacious medium for in vitro maturation and subsequent embryonic development of the media, sera and hormone combinations studied.

Morphological development, cell number, and allocation of cells to trophectoderm and inner cell mass of in vitro fertilized and parthenogenetically developed buffalo embryos: the effect of IGF-I

The morphology and number of cells in the trophectoderm (TE) and inner cell mass (ICM) of buffalo blastocysts derived from in vitro fertilization and cultured in the presence or absence of insulin-like growth factor-I (IGF-I) were analyzed by differential fluorochrome staining technique. The total cell number (TCN), TE number, and ICM cell number were significantly higher in blastocysts developed in vitro in the presence of IGF-I as compared to blastocysts developed without IGF-I (P < 0.01). It was observed that the buffalo blastocyst took 5-9 days postfertilization to develop in vitro. In order to correlate the time required for blastocyst development and the allocation of cells to TE and ICM, blastocysts were designated as fast (developing on or before day 7) or slow (developing after day 7). The TCN, TE, and ICM cells of fast-developing blastocysts cultured in the presence of IGF-I were significantly higher than slow-developing blastocysts (P < 0.01). The blastocysts developed on day 6 had a mean total cell number 118.6 +/- 21.4, which significantly decreased to 85.6 +/- 17.4, 62.0 +/- 14.5, and 17.0 +/- 4.0 on days 7, 8, and 9, respectively (P < 0.05). Normal development of buffalo embryo showed that, on average, embryos reached compact morula stage at the earliest between days 4.5-5.5. Blastocysts developed, at the earliest, between days 5.0-6.0, and it took them, on average, 6.5 days to hatch from the zona pellucida. TCN, TE, and ICM increased three times from morula to blastocyst; however, the proportion of ICM to TCN remained the same, in both embryonic stages. TE approximately doubled in hatched blastocysts, as compared to unhatched blastocysts (P < 0.05). However, ICM cells were decreased. The time required for development of parthenogenetic blastocysts was observed to be greater as compared to in vitro fertilized (IVF) blastocysts. The total cell number of parthenogenetic blastocysts was 100.8 +/- 11.3, including 59.2 +/- 8.4 cells of TE and 42.1 +/- 6.9 cells of ICM.

Differential cleavage and developmental rates and their correlation with cell numbers and sex ratios in buffalo embryos generated in vitro

In vitro matured and fertilized buffalo oocytes were co-cultured with buffalo oviductal epithelial cells (BOEC) in CRlaa medium. Cleaved embryos were separated according to the time of completion of first cleavage (i.e., before 30 h and after 30 h post insemination) and cultured for 5 to 10 d and allowed to develop to the blastocyst stage. Zygotes cleaving before 30 h were termed fast-cleaving while those cleaving after 30 h were termed slow-cleaving. The results indicated that fast-cleaving embryos are more likely to develop into blastocysts (25%) than slow-cleaving embryos (7.8%). The quality and viability of fast-cleaving and fast-developing blastocysts was found to be better than that of slow-cleaving, slow-developing blastocysts as judged by cell numbers (67.7 +/- 3.7 vs 35.2 +/- 2.1). However, the mitotic index was not different between the 2 groups. The sex of fast-developing and slow-developing blastocysts was determined via the polymerase chain reaction (PCR) to correlate the rate of embryonic development with the sex ratio of the embryos. Embryos produced by Bull 293 and Bull M-82, irrespective of their being fast or slow-developing, gave rise to more females and males, respectively. From these results, we suggest that there may be a sire effect on sex ratio of in vitro produced buffalo embryos.

Follicular dynamics in water buffalo superovulated in presence or absence of a dominant follicle

The ovaries of 12 buffalo were examined daily by ultrasound beginning at Day 3 of the estrous cycle, followed by superovulation between Days 10 and 13 of the cycle. The buffalo were divided into 2 groups on the basis of the presence (dominant, n = 7) or absence (nondominant, n = 5) of a dominant follicle at the start of superovulation. Daily ultrasonographic observations of the ovaries were recorded on a videotape and were used to assess the progression of both the large (dominant) follicle and the next-to-the-large (subdominant) follicle as well as the numbers of follicles in the small (4 to 6 mm), medium (7 to 10 mm), and large (>10 mm) size categories, before and during the superovulation treatment. A greater number of small size (P < 0.05) follicles was available before the start of the superovulatory treatment in the buffalo superovulated in the absence of a dominant follicle. The turnover of follicles from medium to large size classes also occurred sooner (P < 0.01), and was of higher magnitude (P < 0.01) during treatment in buffalo of the nondominant follicle group. The number of corpora lutea at palpation per rectum was higher (P < 0.05) in buffalo of the nondominant than the dominant group (4.6 +/- 0.6 vs 2.7 +/- 0.5). However, there was no significant difference among the groups in the means of serum progesterone concentration (3.6 +/- 1.3 vs 2.2 +/- 0.6 ng/ml), total number of embryos (2.0 +/- 0.6 vs 1.1 +/- 0.7), transferable embryos (1.6 +/- 0.5 vs 1.0 +/- 0.6) and unfertilized ova recovered (0.4 +/- 0.2 vs 0) on Day 6. It is concluded that in buffalo, the superovulatory response could possibly be improved by ultrasongraphic observation of the status of follicular dominance prior to treatment.

Seasonal variation in follicular dynamics of superovulated Indian water buffalo

The ovaries of 5 buffalo were examined daily by ultrasound beginning at Day 3 of the estrous cycle, followed by superovulation between Days 11 and 13 of the cycle in both the wet cool and dry hot seasons. Daily ultrasonographic observations of the ovaries were recorded on a videotape and were used to assess the progression of both the large (dominant) and the next to the large (sub-dominant) follicles as well as the numbers of follicles in the small (4 to 6 mm), medium (7 to 10 mm) and large (> 10 mm) size categories in the 2 seasons before and during the superovulation treatment. Greater numbers of small (P < 0.05) and medium size follicles (P < 0.01) were available before the start of the superovulatory treatment in the buffalo during the dry hot season. The turnover of follicles from medium to large size classes also occurred sooner (P < 0.01) and was of higher magnitude (P < 0.05) during the treatment in the dry hot season. However, the number of corpora lutea at palpation per rectum (2.8 +/- 0.7 vs 2.2 +/- 0.6), the serum progesterone concentration (1.6 +/- 0.3 vs 1.4 +/- 0.1 ng/ml), and the yield of embryos on Day 6 (0.2 +/- 0.2 vs 0.6 +/- 0.2) did not differ significantly between the dry hot and the wet cool season. None of the embryos recovered during the dry hot season were transferable, which remains unexplained.

Monoclonal antibody against a human sperm protein recognizes multiple epitopes on rabbit and human sperm and blocks sperm function

A monoclonal antibody was raised against a human sperm protein of apparent molecular size of 40 kDa. Of the 6 hybridoma clones selected for study, one clone (B-12) was chosen for further investigations. The antibody secreted by the clone agglutinated human and rabbit spermatozoa in vitro. The antibody belonged to IgM class. In indirect immunofluorescence studies this antibody reacted to acrosome of living human and rabbit spermatozoa. On fixed sperm of the same species it recognized midpiece and parts of tail along with the acrosome. Mouse, hamster, guinea pig, monkey and rat sperm showed similar localization. Interaction between rabbit sperm and oocyte was inhibited in vitro by this antibody. On western blots of human and rabbit sperm extracts the antibody recognized more than one epitope.

In vitro maturation, fertilization and development of follicular oocytes from buffalo (Bubalus bubalis)

Cumulus-oocyte complexes, 5596, were cultured for 24 h in either TCM-199 or Ham's F-10 with or without gonadotrophins and supplemented with either 20% buffalo oestrous serum (BES) or fetal calf serum (FCS). The maturation rates of oocytes cultured in TCM-199 or Ham's F-10 medium supplemented with 20% BES were 47.4 +/- 17.8 and 44.8 +/- 25.6, respectively. Addition of luteinizing hormone (LH) (5 micrograms ml-1) significantly improved the maturation rate in the Ham's F-10 medium supplemented with 20% BES (76.8 +/- 18.3), but follicle-stimulating hormone (FSH) (0.5 micrograms ml-1) and oestradiol (1 microgram ml-1) failed to synergize with LH (71.7 +/- 19.5). In the TCM-199 system, LH failed to enhance the maturation rate but the addition of FSH and oestradiol significantly enhanced the proportion of mature oocytes (42.7 +/- 1.4 and 81.7 +/- 14.5, respectively; P less than 0.05). Frozen-thawed spermatozoa prepared in Bracket and Oliphant (BO) medium and treated with 5 mmol caffeine 1(-1) + 10 micrograms heparin showed a higher fertilization rate (29.8%) than those treated in Hepes-Talp and treated with 10 micrograms heparin ml-1 (19.6%). Fertilization rate was significantly improved when fresh ejaculated spermatozoa treated with 5 mmol caffeine 1-1 and 10 micrograms heparin in BO medium (50%) was used. Rate of cleavage and development were also higher when in vitro fertilization was carried out with fresh ejaculated spermatozoa treated with caffeine and heparin (34.1 and 36.8%, respectively) than with frozen-thawed spermatozoa (27.0 and 22.0%, respectively). Development rate was enhanced when fertilized ova were cultured in ligated rabbit oviduct (28.0%) than when co-cultured on oviductal cell monolayers (8.2%). The results indicate that oocytes cultured in medium supplemented with BES and gonadotrophins reveal high rates of maturation and development to the blastocyst stage after fertilization with fresh ejaculated spermatozoa.

Use of Chronogest implants and Folltropin for estrus synchronization and superovulation in goats

Six Barbari goats each were assigned randomly to treatments 1,2 or 3, comprising im injections of FSH (folltropin) at 12, 14 or 16 mg dose level respectively. Estrus was synchronized with intravaginal sponge impregnated with flugestone acetate (30 mg; chronogest) inserted for 12 days and cloprostenol (125 micrograms) im at the insertion as well as at removal of sponge. FSH treatment started 48 hr before the sponge removal as 4-day declining dose scheme. Estrus could be effectively synchronized in all goats under the study, with significant difference (P less than 0.05) in the onset of estrus between the treatment groups. All goats were administered with 750 IU hCG i.v. at estrus. Recording of ovarian response and embryo recovery was done 45 hr after the onset of estrus. The prime aim of superovulation was effectively achieved in Barbari goats with the use of chronogest implants and folltropin. There was no difference (P greater than 0.05) between the treatment groups in recovery of transferable embryos, however, 14 mg folltropin appeared to be near optimal dose. There was no adverse effect on the quality of recovered embryos with high doses of folltropin.

Superovulation and embryo recovery in rabbits (Oryctolagus cuniculus) using different doses of pregnant mare serum gonadotrophin (PMSG)

Present investigation was conducted to study the ovarian response and embryo recovery using different PMSG dose levels. Six rabbits each were assigned randomly to treatment 1 (PMSG 50 IU + hCG 100 IU), treatment 2 (PMSG 75 IU + hCG 100 IU) and the control group (no hormone administered). PMSG injection (im) was followed 68 hr later by natural mating to a fertile rabbit buck and human chorionic gonadotrophin (hCG) injection iv post coitum. Embryos were recovered 96 hr post coitum by a modified surgical method. Mean number of ovulations in the control group differed significantly from treatment 1 and 2, but no significant difference was observed between treatments 1 and 2. Mean embryo recovery percentage was lowest in treatment 2 and highest in the control group. The higher dose PMSG (treatment 2) was observed to be more disturbing in terms of recovery of embryos as well as their morphology.