Human papilloma virus (HPV)-E6/E7 and epidermal growth factor receptor (EGF-R) protein levels in cervical cancer and cervical intraepithelial neoplasia (CIN)

BACKGROUND

About 90% of cervical cancers and advanced cervical intraepithelial neoplasia (CIN II/III) are squamous epithelial cells with mRNA for human papillomavirus (HPV)16 and 18 and up-regulated epidermal growth factor receptor (EGF-R). Since presence of proteins rather than mRNA may be truly indicative of active infection or disease progression, establishing reliable methods for quantifying these proteins in cervical biopsies is important.

METHOD

We have established an objective semi-quantitative immunofluorescent antibody assay to reliably assess the levels of HPV-E6/E7 and EGF-R proteins in the cervical biopsies from 12 normal women, five women with CIN I, 15 with CIN II/III and ten with cervical cancer.

RESULTS

HPV-E6/E7 and EGF-R, when present, were specific to para-basal, basal and squamous epithelial cells (negative in stromal cells). Nine of ten women with cervical cancer and 15 (14 CIN II/III; 1 CIN I) of 20 women with CIN were positive for HPV-E6/E7. All 12 controls were HPV-negative. The controls and six women with CIN (four with CIN I) negative for HPV had low levels of EGF-R. The only exception was one woman with cervical cancer negative for HPV, with high levels of EGF-R. Levels of HPV-E6/E7 and EGF-R were significantly higher (P < 0.001 vs. controls) in women with advanced CIN II and III (P< 0.05 vs. controls in CIN I) and cervical cancer. The HPV-E6/E7 and EGF-R levels correlated significantly (r = 18.98; P < 0.001, by linear regression analysis).

CONCLUSION

We have established a highly specific and sensitive semi-quantitative immunofluorescent antibody assay for measuring levels of HPV-E6/E7 proteins and EGF-R in archival cervical biopsies. Our data suggest an association between HPV-E6/E7 and EGF-R.

Cervical motion after adding a posterior pad to the halo vest

Investigators have shown that significant segmental motion occurs in patients immobilized in halo vests. One cadaver study showed that this is decreased with a posterior pad added to the construct. To improve nonoperative care of patients with cervical trauma, segmental cervical motion was evaluated in normal volunteers immobilized in a halo vest with and without a posterior pad. Two commonly used methods to measure sagittal angulation were used. Thirty normal volunteers were placed in halo vests by using positioning pins on the cranium. A sphygmomanometer attached to the posterior uprights of the vest inflated to 40 mm Hg was used as a posterior pad at the greatest visible lordosis. Lateral radiographs of the cervical spine were taken with volunteers in the upright and supine positions with and without the posterior pad inflated. Radiographs were randomly sorted and were each read twice by 3 readers. Measurements of the posterior atlantodental interval, sagittal displacement, and sagittal rotation were recorded using 2 different methods: the Buetti-Bauml method, which uses lines drawn along the posterior vertebral bodies, and the method of White and colleagues, which uses lines drawn along the inferior vertebral bodies. Inflation status of the pad showed no statistically significant difference in any of the measured variables. This was true for both methods of measurement. Application of a posterior pad to the halo vest did not show any change in the segmental motion of the cervical spine in normal volunteers.

Surgery versus radiation therapy for patients with aggressive fibromatosis or desmoid tumors: A comparative review of 22 articles

BACKGROUND

Desmoid tumors (aggressive fibromatoses) are benign neoplasms with high rates of recurrence after surgery. Radiotherapy is sometimes reported to prevent recurrences, but not in all studies. In order to evaluate the effect of radiation, comparative analysis was performed.

METHODS

The authors conducted a MEDLINE search and collected all articles in the English language on the treatment of "desmoid tumor" or "aggressive fibromatosis" from the years 1983-1998. They categorized treatment into three groups: surgery alone (S), surgery with radiotherapy (S + RT), or radiotherapy alone (RT). The S and S + RT groups were each subdivided according to whether margins were free (-), positive (+), or unknown. Each subgroup was divided into cases with primary, recurrent, or unknown tumor.

RESULTS

The local control rates after treatment for cases in the S group with (-) margins, (+) margins, and overall were 72%, 41%, and 61%, respectively. For the S + RT group the local control results were 94%, 75%, and 75%, respectively, significantly different when compared with the results for the S group. For the RT group, the local control was 78%, significantly superior to that of the S group (61%). Cases with primary and recurrent tumors had significantly superior local control rates with S + RT or RT versus S. Radiotherapy complications noted were fibrosis, paresthesias, edema, and fracture.

CONCLUSIONS

RT or S + RT results in significantly better local control than S. Even after dividing the groups into cases with free and positive margins and cases with primary and recurrent tumors, the best local control is achieved with RT or S + RT.

Non-ophthalmologist screening for retinopathy of prematurity

AIM

To determine if a non-ophthalmologist can accurately screen for retinopathy of prematurity (ROP) by evaluating the posterior pole blood vessels of the retina. ROP is a common ocular disorder of premature infants and may require multiple screening examinations by an ophthalmologist to allow for timely intervention. Since there is a strong correlation between posterior pole vascular abnormalities and vision threatening ROP, screening examinations performed by non-ophthalmologist may yield useful clinical information in high risk infants.

METHODS

Infants born at the Medical University of South Carolina who met screening criteria (n = 142) were examined by a single non-ophthalmologist using a direct ophthalmoscope to evaluate the posterior pole blood vessels for abnormalities of the venules and/or arterioles. To determine the accuracy of the non-ophthalmologist's clinical observations, infants were also examined by an ophthalmologist, using an indirect ophthalmoscope, who graded the posterior pole vessels as normal, dilated venules, or dilated and tortuous venules and arterioles (including "plus disease").

RESULTS

There was significant correlation (p <0.001) between the non-ophthalmologist's and ophthalmologist's diagnoses of posterior pole vascular abnormalities. 47 infants had normal posterior pole blood vessels by the non-ophthalmologist examination. Of these, 31 (66%) were considered to have normal vessels and 16 (34%) to have dilated venules by the ophthalmologist. The non-ophthalmologist correctly identified abnormal posterior pole vessels in all 21 infants diagnosed with abnormal arterioles and venules by the ophthalmologist. No infants with clinically important ROP ("prethreshold" or worse) would have failed detection by this screening method.

CONCLUSION

Using a direct ophthalmoscope, a non-ophthalmologist can screen premature infants at risk for ROP by evaluating the posterior pole blood vessels of the retina. While not necessarily recommended for routine clinical practice, this technique may nevertheless be of value to those situations where ophthalmological consultation is unavailable or difficult to obtain.

Levels of transferrin and alpha 2-HS glycoprotein in women with and without endometriosis

The study objective was to test the hypothesis that elevated levels of transferrin and alpha 2-HS glycoprotein occur in the peritoneal environment of patients with endometriosis that may lead to the observed autoimmunity to these proteins. We set up a double sandwich enzyme-linked immunosorbent assay (ELISA) for measuring levels of transferrin and alpha 2-HS glycoprotein in the serum and peritoneal fluid samples from women with (n = 24-60) and without endometriosis (n = 35-49). Serum and peritoneal fluid levels of alpha 2-HS glycoprotein and peritoneal fluid levels of transferrin were significantly elevated in patients with endometriosis, in contrast to the controls. Serum levels of transferrin in patients, however, were significantly less in the patients than in controls. We conclude that transferrin and alpha 2-HS glycoprotein are present at high concentrations in the peritoneal fluids of patients with endometriosis. This may play a significant role in the autoimmune pathophysiology of endometriosis.

Postdural puncture headache in paediatric oncology patients

PURPOSE

Previous studies have not determined the correlation between dural puncture and postural headache in paediatric patients. Furthermore, no studies have evaluated the correlation between atypical headache and dural puncture in the paediatric population. Therefore, we prospectively analyzed the incidence of typical postdural puncture headache (PDPHA) and atypical headache in paediatric oncology patients following dural puncture.

METHODS

The study population consisted of 66 paediatric patients undergoing 128 consecutive procedures, including 99 lumbar punctures and 29 bone marrow aspirations without concomitant lumbar puncture. Patients were prospectively randomized into four groups: Group I, preteens (< 13 yr) undergoing lumbar puncture, Group II, adolescents (13-21 yr) undergoing lumbar puncture, Group III, preteens undergoing bone marrow aspiration, and Group IV, adolescents undergoing bone marrow aspiration. The presence and description of headache was documented immediately after dural puncture or bone marrow aspiration, and on post-procedure days # 1, 3 and 5 by personnel blinded to the type of procedure.

RESULTS

There was an increase in the incidence of headache (9.1%) after lumbar puncture in patients < 21 yr relative to patients undergoing bone marrow aspiration (P < 0.05). No difference was found between the incidence of typical PDPHA after dural puncture in preteens and adolescents. There was also no difference in the incidence of atypical headache after dural puncture or after bone marrow aspiration among preteens and adolescents.

CONCLUSIONS

Paediatric patients experience an increased incidence of typical postdural puncture headache after dural puncture compared with age-matched patients undergoing bone marrow aspiration only. Atypical headache is relatively common in the paediatric population after dural puncture or bone marrow aspiration.

Morphometric discrimination of melanoma in situ of sun-damaged skin from chronically sun-damaged skin

BACKGROUND

The histologic discrimination of melanoma in situ of sun-damaged skin (MIS) from chronically sun-damaged skin (SDS) can sometimes be difficult using accepted criteria.

OBJECTIVE

We evaluated these entities by means of morphometry and multifactorial analysis.

METHODS

We measured the number and area of melanocyte nuclei, melanocyte nucleoli, stratum spinosum keratinocyte nuclei, and papillary dermal lymphocyte nuclei from hematoxylin-eosin-stained slides representing 38 cases of MIS and 18 cases of SDS matched for age, sex, and site with a high-resolution digital imaging and analysis system.

RESULTS

Multiple logistic regression analysis correctly classified 100% of the cases using the number of melanocytes per 0.5 mm and the maximum melanocyte nuclear area divided by the maximum keratinocyte nuclear area. The strongest results were achieved measuring approximately 1 mm of epidermis.

CONCLUSION

Morphometry and multifactorial analysis can distinguish MIS from SDS. Morphometric analysis of melanocytic proliferations may be useful at the margins of surgical resections.

Levels of antibodies to transferrin and alpha 2-HS glycoprotein in women with and without endometriosis

PROBLEM

To establish an enzyme-linked immunosorbent assay (ELISA) for determining the levels of antibodies to transferrin and alpha 2-HS glycoprotein in the serum of women with and without endometriosis.

METHOD OF STUDY

Serum samples were obtained from 105 normal women, who were randomly selected for a population-based epidemiologic study, and 123 patients with active endometriosis. An ELISA using transferrin and alpha 2-HS glycoprotein as antigens was established.

RESULTS

The levels of antibodies to transferrin and alpha 2-HS glycoprotein in the serum of patients with endometriosis were approximately 21 times higher than those in the serum of control subjects without endometriosis. Only 2% of control subjects had false positive levels of these antibodies, and 5% of patients with endometriosis had false negative levels of these antibodies (specificity, 98.1 and 98.1, respectively, for anti-transferrin and anti-alpha 2-HS glycoprotein; sensitivity, 95 and 96.7, respectively, for anti-transferrin and anti-alpha 2-HS glycoprotein).

CONCLUSIONS

Patients with endometriosis have significantly higher levels of antibodies to transferrin and alpha 2-HS glycoprotein than control subjects. Testing women for antibodies to transferrin and alpha 2-HS glycoprotein will provide a specific noninvasive diagnosis of endometriosis.

The body mass index-mortality relationship in white and African American women

OBJECTIVE

To examine the association of body mass index to all-cause and cardiovascular disease (CVD) mortality in white and African American women.

RESEARCH METHODS AND PROCEDURES

Women who were members of the American Cancer Society Prevention Study I were examined in 1959 to 1960 and then followed 12 years for vital status. Data for this analysis were from 8,142 black and 100,000 white women. Body mass index (BMI) was calculated from reported height and weight. Associations were examined using Cox proportional hazards modeling with some analyses stratified by smoking (current or never) and educational status (less than complete high school or high school graduate).

RESULTS

There was a significant interaction between ethnicity and BMI for both all-cause (p<0.05) and CVD mortality (p<0.001). BMI (as a continuous variable) was associated with all-cause mortality in white women in all four groups defined by smoking and education. In black women with less than a high school education, there were no significant associations between BMI mortality. For high school-educated black women, there was a significant association between BMI and all-cause mortality. Among never smoking women with at least a high school education, models using the lowest BMI as the reference indicated a 40% higher risk of all-cause mortality at a BMI of 35.9 in black women vs. 27.3 in white women.

DISCUSSION

The impact of BMI on mortality was modified by educational level in black women; however, BMI was a less potent risk factor in black women than in white women in the same category of educational status.

Effects of antibodies to transferrin and alpha 2-HS glycoprotein on in vitro sperm motion: implications in infertility associated with endometriosis

PROBLEM

Women with endometriosis have antibodies to endometrial transferrin and alpha 2-HS glycoprotein in their serum and peritoneal fluid. The objective of this study was to determine whether antibodies to transferrin and alpha 2-HS glycoprotein adversely affect sperm motility and survival.

METHOD OF STUDY

Spermatozoa obtained from normal fertile donors and washed free of seminal plasma were incubated with the medium (control), 1:2 and 1:100 dilutions of antitransferrin, 1:4, 1:8 and 1:100 dilutions of anti-alpha 2-HS glycoprotein, and a 1:2 dilution of antialbumin antiserum (negative control). Sperm motion characteristics in 10 microliters aliquots were evaluated at 30 min, 1 hr, 2 hr, 4 hr, and 24 hr using computerized sperm motion analysis. A paired t-test was done to analyze the effects of the various antibodies on sperm motion characteristics.

RESULTS

Antibodies to albumin failed to adversely affect sperm motility in general or the several sperm motion characteristics in particular. In contrast, antibodies to transferrin at the dilution of 1:2 adversely affected the percentage of motile and rapid spermatozoa, progressive and path velocities, straightness, linearity, track speed, and anterior-lateral head displacement (P < 0.001) at all the time intervals, whereas a 1:100 dilution of this antiserum adversely affected these parameters only at 24 hr. Elongation and beat cross-frequency were significantly affected at 4 and 24 hr by a 1:2 dilution of antitransferrin antiserum. The effects of anti-alpha 2-HS glycoprotein were more pronounced than those of antitransferrin, but they were similar. Dilutions of 1:4 and 1:8 were effective at all time intervals, whereas a 1:100 dilution was effective in reducing the track speed and the percentage of rapid cells at 24 hr (P < 0.001).

CONCLUSION

Antibodies to endometrial transferrin and alpha 2-HS glycoprotein present in the peritoneal fluid, and possibly in the oviductal fluid, of patients with endometriosis may adversely affect postcoital sperm motility and sperm survival.

Interobserver reliability of digital and endovaginal ultrasonographic cervical length measurements

OBJECTIVE

Our purpose was to prospectively evaluate the interobserver reliability of digital and endovaginal ultrasonographic cervical length measurements.

STUDY DESIGN

Forty-three women were recruited from our antepartum clinic to participate in this study. Two independent and blinded digital cervical examinations were performed by the first author and a second examiner. Instructions were given to estimate the cervical length in millimeters. After micturition endovaginal ultrasonographic cervical length measurements were performed by two independent, blinded registered diagnostic medical sonographers. Cervical lengths were compared with the Student t test and Pearson's correlation coefficient. A kappa statistic was calculated for interobserver reliability at three levels of agreement +/- 1 mm, +/- 4 mm, and +/- 10 mm. Data are expressed as means +/- SD.

RESULTS

Digital cervical lengths were not different between the two examiners (18.7 +/- 4.8 mm, 20.5 +/- 6.2 mm) nor between the two ultrasonographic measurements (38.6 +/- 6.1 mm, 39.2 +/- 5.4 mm). The digital cervical lengths agreed (+/- 1 mm) 35% of the time (R2 0.10, p = 0.02). The endovaginal ultrasonographic measurements agreed (+/- 1 mm) 74% of the time with a stronger correlation (R2 0.53, p = 0.0001). The kappa statistic for interobserver variability was marginal for both digital and endovaginal cervical length measurements when agreement was defined as +/- 1 mm. Endovaginal ultrasonography was significantly more reliable than digital examination when agreement between examiners was defined as either +/- 4 mm or +/- 10 mm.

CONCLUSION

Although both digital and endovaginal ultrasonographic cervical length measurements show correlation between examiners, endovaginal ultrasonography is significantly more reliable when agreement is defined as > or = +/- 4 mm. Serial cervical length measurements to predict preterm labor will be enhanced by the interobserver reliability of endovaginal ultrasonography.

Prediction equations do not eliminate systematic error in self-reported body mass index

Epidemiological studies of the risks of obesity often use body mass index (BMI) calculated from self-reported height and weight. The purpose of this study was to examine the pattern of reporting error associated with self-reported values of BMI and to evaluate the extent to which linear regression models predict measured BMI from self-reported data and whether these models could compensate for this reporting error. We examined measured and self-reported weight and height on 5079 adults aged 30 years to 64 years from the second National Health and Nutrition Examination Survey. Measured and self-reported BMI (kg/m2) was calculated, and multiple linear regression techniques were used to predict measured BMI from self-reported BMI. The error in self-reported BMI (self-reported BMI minus measured BMI) was not constant but varied systematically with BMI. The correlation between measured BMI and the error in self-reported BMI was -0.37 for men and -0.38 for women. The pattern of reporting error was only weakly associated with self-reported BMI, with the correlation being 0.05 for men and -0.001 for women. Error in predicted BMI (predicted BMI minus measured BMI) also varied systematically with measured BMI, but less consistently with self-reported BMI. More complex models only slightly improved the ability to predict measured BMI compared with self-reported BMI alone. None of the equations were able to eliminate the systematic reporting error in determining measured BMI values from self-reported data. The characteristic pattern of error associated with self-reported BMI is difficult or impossible to correct by the use of linear regression models.

Intrasubject variability of the pressure-transmission ratio in patients with genuine stress incontinence

The aim of the study was to determine the intrasubject variability of the pressure-transmission ratio (PTR) with various cough intensities in subjects with genuine stress incontinence. Thirty-six patients with genuine stress incontinence underwent multichannel urodynamics and had a series of pressure-transmission ratios (PTRs) determined with the urethral transducer placed at the point of the maximal closure pressure. Patients were asked to cough with increasing intensities and three to four different cough-induced PTRs were recorded for each subject. The data were analysed using regression analysis, repeated measures analysis of variance and comparison of variance. The PTRs showed a high degree of variability within subjects. The mean within subject standard deviation was 18.5%. The effect of parity, maximal urethral closure pressure and age were insignificant on the variability. Cough intensities of greater than 90 cmH2O have a lesser degree of variability. The mean PTR across all cough intensities was fairly constant in the 82%-87% range. It was concluded that the PTR in an individual has a high degree of variability independent of cough intensity, and cannot be relied upon as a diagnostic measure in subjects with genuine stress incontinence. However, the PTR for the population as a whole was consistent across all cough intensities.

Dimensions of the pediatric crystalline lens: implications for intraocular lenses in children

As surgeons gain more experience with the implantation of posterior chamber intraocular lenses (IOLs) into the capsular bag in children, the minimum age for which implantation is advised may continue to be lowered. Accurate sizing of an IOL intended for in-the-bag fixation may depend on knowledge of the size of the capsular bag. In order to develop a growth curve for the normal crystalline lens and hence the capsular bag, 50 pediatric autopsy eyes ranging in age from 1 day to 16 years were obtained postmortem and measured within 24 hours after enucleation. Mean crystalline lens diameter was 6.00 mm at birth, 6.80 mm at 2 months, 7.1 mm at 3 months, 7.66 mm at 6 to 9 months, 8.4 mm at 21 months, 8.5 mm at 2 to 5 years, and 9.3 mm at 16 years. The post-lensectomy capsular bag size at each respective age is 1 mm larger. While age was a predictor of crystalline lens size, corneal diameter and globe axial length were better predictors of crystalline lens size. These data and accompanying linear regressions may be helpful in designing appropriate IOLs for pediatric patients.

Can non-ophthalmologists screen for retinopathy of prematurity?

BACKGROUND

Dilation and tortuosity of the posterior pole vessels ("plus disease") is a poor prognostic sign and may indicate the presence of threshold or pre-threshold retinopathy of prematurity (ROP). Because stage 3 ROP appears rarely in the absence of posterior pole vascular abnormalities, we prospectively evaluated the ability of non-ophthalmologists (4th-year medical students, pediatric residents, and nurse practitioners) to identify abnormalities in the retinal blood vessels of infants undergoing examinations for ROP.

METHODS

Fifty infants weighting less than 1600 g at birth were examined between 32 and 40 weeks after conception. Prior to ophthalmological examination, non-ophthalmologist examiners graded posterior pole vessels as normal or abnormal based on ophthalmoscopic appearance. One hundred twenty-one ocular examinations were performed using the teaching mirror of the indirect ophthalmoscope, 179 using the direct ophthalmoscope. The indirect ophthalmoscopy was performed simultaneously by an ophthalmologist who evaluated the posterior pole vessels for abnormalities prior to conducting a peripheral fundus examination on either eye.

RESULTS

Testing sensitivity for the non-ophthalmologist examiners using direct and indirect ophthalmoscopy was 96% and 92%, respectively. Combining the results from direct and indirect ophthalmoscopy, the Clopper-Pearson 95% sensitivity confidence interval for identifying abnormal arterioles and venules was 82% to 99%, with a point estimate of 95%.

CONCLUSION

These data suggest that non-ophthalmologist examiners can detect posterior pole vascular abnormalities in premature infants. If properly trained, they could possibly play a role in screening or follow-up examinations for ROP.

Skin color and cancer mortality among black men in the Charleston Heart Study

The association between skin color and 30-year cancer mortality in a random sample of black men and a peer-nominated group of high socioeconomic status (SES) black men was evaluated in the Charleston Heart Study, a prospective study, begun in 1960, designed to investigate the epidemiology of coronary heart disease in a biracial cohort. Skin color was used as a continuous variable and as a categorical variable, by tertiles, in a Cox proportional hazards regression model. In the high SES group, there was a statistically significant decreasing relationship between skin color and cancer mortality, with those having the lightest skin having the lowest cancer mortality. In the random sample of black men, the relationship between skin color and cancer mortality was not statistically significant; however, the data indicated a slight protective effect among those with the lightest skin color. Because degree of skin reflectance is a measure of black-white admixture, these results may indicate a genetic mechanism underlying the differences in cancer mortality across skin color groups. Skin color is also recognized as a marker for psychosocial factors. Therefore, poor prognosis among those with darker skin color as a result of failure of early detection, inadequate treatment, and a variety of psychosocial stressors represents an alternative explanation of the study findings.

Effects of nicotine on sperm attachment and penetration of zona-free hamster eggs

A previous study from this laboratory showed that nicotine in vitro has deleterious effects on sperm motion characteristics. This study was conducted to evaluate the effects of nicotine on the ability of human spermatozoa to attach and penetrate zona-free hamster eggs. Spermatozoa from fertile donors, washed free of seminal plasma, were incubated with medium (control) and 0.1, 1, 5, and 10 mM concentrations of nicotine (concentrations estimated to approximate residual concentrations of nicotine in the testes of heavy smokers) for 18 h at 37 degrees C in a humid 5% carbon dioxide incubator. The sperm preparations were then mixed with enzymatically denuded hamster eggs and incubated for 3 h at 37 degrees C. The oocytes were examined by phase-contrast microscopy to enumerate the rates of sperm attachment and penetration. The data were analyzed by a paired t test and repeated measures analysis of variance using the arcsine transformation of the percentages. The percentages of eggs with attached spermatozoa significantly declined in a dose-dependent manner, the highest inhibition being at 10 mM (F = 24). The rate of sperm penetration was even more significantly decreased with the increase in nicotine concentrations in the following order: 10 mM (F = 56) > 5 mM (F = 30) > 1 mM (F = 44) > 0.1 mM (F = 12). Nicotine concentrations of 0.1 mM and above negatively affected sperm penetration of zona-free hamster eggs.

The predictive value of posterior pole vessels in retinopathy of prematurity

Dilation and tortuosity of the posterior pole vessels "(plus disease)" is a sign of poor prognosis and may be associated with threshold or prethreshold retinopathy of prematurity (ROP). We have found that normal posterior pole vessels are a reliable marker for the absence of stage 3 ROP. One hundred thirty-two consecutive premature infants weighing less than 1600 g at birth underwent ROP examinations between 32 and 40 weeks' postconceptional age. The status of the posterior pole vessels was compared to peripheral retinal pathology. Vascular findings in the posterior pole were graded 0, 1, 2, or 3, with 0 representing normal arterioles and venules and 3 representing plus disease. The remainder of the fundus examination was recorded using the international Classification of ROP, then converted to a severity scale based on zone and stage of ROP. For each infant, only one examination representing the most severe stage of ROP reached prior to treatment or spontaneous regression was used for data analysis. There was a highly significant Spearman's rank correlation (rs = 0.65) between the posterior pole vascular abnormalities and the severity of ROP in the retinal periphery. Clinically important ROP was not found in any patient with normal posterior pole vessels (grade 0) and stage 3 disease was usually associated with both venous and arterial vascular abnormalities (grades 2 or 3). When ocular examination of premature infants is difficult because of poor dilation of the pupil, hazy media, or medical instability, normal appearance of the posterior pole vessels can be a reassuring finding if it is necessary to postpone complete fundus examination in infants at risk for ROP.

The effect of nicotine on in vitro sperm motion characteristics

PURPOSE AND STUDY PLAN: Men who are habitual smokers tend to have poor semen quality. We studied the effect of nicotine on sperm motility in vitro. Spermatozoa from 13 normal fertile nonsmoking donors, washed free of seminal plasma, were treated with medium alone (control); and, 10 mM, 5 mM, 1 mM and 0.1 mM nicotine (concentrations estimated to approximate residual concentrations of nicotine in the testes of heavy smokers). Computerized sperm motion analysis (CASA) was done at 2, 4, 6 and 24 h after incubation.

RESULTS

Sperm motility, beat/cross frequency, linearity and maximum anterior lateral head displacement (ALH max.) were significantly decreased across nominal dosages (P < 0.001 by repeated measures analysis of variance). Of the concentrations tested, 0.1 mM had no effect; 1 mM significantly decreased sperm motility (P = 0.003) and linearity (P = 0.02); 5 mM decreased the beat frequency (P = 0.001) and linearity (0.02); and 10 mM markedly decreased motility (P = 0.0001), beat frequency (P = 0.0002), linearity (P = 0.02) and ALH max. (P = 0.02). The interactions between dose and time were insignificant.

CONCLUSION

Nicotine at concentrations of > or = 1 mM significantly decreased sperm motion characteristics after different periods of incubation, whereas 0.1 mM concentration had the least effect.

Kinin, a mediator of diabetes-induced glomerular hyperfiltration

Renal kallikrein is increased in diabetic patients and streptozotocin (STZ)-induced diabetic rats with hyperfiltration. Chronic inhibition of renal kallikrein reduces glomerular filtration rate (GFR) and renal plasma flow (RPF) in hyperfiltering STZ-induced diabetic rats. To investigate whether these actions of kallikrein and its inhibition are kinin-mediated, we used a B2-kinin receptor antagonist (BKA). In STZ-induced diabetic rats with hyperfiltration, renal kallikrein excretion rate was significantly increased (P < or = 0.01), and kinin excretion rate was increased 57%, as compared with control rats. Left kidney GFR and RPF were measured before and during a 40-min infusion of BKA (0.5 micrograms.kg-1.min-1) or vehicle. Infusion of the kinin receptor antagonist reduced the GFR and RPF significantly. GFR was reduced by 18%, from an average baseline value of 2.07 +/- 0.11 to 1.70 +/- 0.06 ml/min, P < or = 0.001 (means +/- SE). RPF was reduced by 25%, from 6.74 +/- 0.38 to 5.06 +/- 0.17 ml/min, P < or = 0.001. Total renal vascular resistance was significantly increased during BKA infusion, P < or = 0.001. Vehicle infusion for the same period had no significant effect on GFR, RPF, or renal vascular resistance. These findings further support the hypothesis that increased renal production of kinins contributes to the renal vasodilation of diabetes.

Black women have smaller abdominal girths than white women of the same relative weight

Anthropometric measurements were compared in 312 white and 242 black women (mean age 54) who were participants in the Charleston Heart Study. Body mass index (BMI) was greater in black women (27.8 kg/m2) than in white women (24.7 kg/m2) as were body circumferences. However, when the girth measurements were adjusted for BMI, some racial differences were reversed. Age, smoking and BMI-adjusted abdominal girth was smaller in the black women than in the white women (88.9 cm vs 92.2 cm). The ratio of abdomen to midarm circumference was larger in white women than black women (3.24 vs 3.09), and could be interpreted to indicate a less central fat pattern in the black women. This conclusion should be viewed with caution since circumference measurements, though often used in epidemiologic research, do not differentiate between subcutaneous fat and visceral fat.

Insulin-like growth factor I produces renal hyperfiltration by a kinin-mediated mechanism

Insulin-like growth factor-I (IGF-I) infusion into rats and humans reduces renal vascular resistance and raises glomerular filtration rate (GFR) and renal plasma flow (RPF). To investigate whether kinins mediate the renal vasodilatory effects of IGF-I, we infused rats with IGF-I alone or in the presence of a B2 kinin receptor antagonist. Left kidney GFR, RPF, and kinin excretion were measured during infusion of vehicle and subsequently during 60-min infusion of IGF-I or IGF-I plus kinin antagonist. IGF-I was given as a bolus (150 micrograms/kg body wt), followed by infusion at a rate of 8.3 micrograms.kg-1 x min-1 for 60 min. The kinin antagonist was infused at a dose of 1 microgram.kg-1 x min-1 for 60 min before the start of IGF-I infusion. GFR and RPF increased significantly after IGF-I infusion was begun, from baseline levels of 1.70 +/- 0.12 and 6.21 +/- 0.34 to 2.12 +/- 0.11 and 7.91 +/- 0.29 ml/min, respectively, at 20 min (P < 0.001). This effect was maintained throughout 60 min of infusion. The increase in GFR and RPF was associated with a marked rise in urinary kinin excretion, from a baseline of 8.51 +/- 6.7 to 24.7 +/- 6.7 pg/min at 20 min and 40.3 +/- 10.4 pg/min at 40 min (P < 0.001). Pretreatment with the kinin receptor antagonist blocked the rise in GFR and RPF in response to IGF-I. These data suggest that the renal vasodilatory effect of IGF-I is mediated by kinins.

A comparison of the effects of cholesterol on CHD mortality in black and white women: twenty-eight years of follow-up in the Charleston Heart Study

The relationship between cholesterol and 28-year CHD mortality in women was evaluated in the Charleston Heart Study. Linear, quadratic, and cubic models were investigated using Cox proportional hazards regression analysis. In white women, the linear, quadratic, and cubic terms for cholesterol were significant suggesting an asymmetric J-shaped relationship. In black women, only the linear term in all three models was statistically significant suggesting an increasing CHD mortality rate with increasing cholesterol level. The lack of consistency of results by different statistical analyses in black women make conclusions concerning the nature of the relationship between cholesterol and CHD mortality less strong in black women than in white women. Compared with women having a cholesterol value equal to the mean of the group (241 mg/dl), white women having a cholesterol value one standard deviation above the mean (s = 52.5 mg/dl) had a 60% higher CHD mortality rate (hazard ratio = 1.6, 95% CI: 1.2-2.1). In black women, the estimated hazard ratio for a one standard deviation (s = 47.8 mg/dl) increase in cholesterol is 1.4 (95% CI: 1.03-1.8). The results suggest that the relationship of cholesterol to CHD mortality is different in white and black women. The relationship in white women appears to be curvilinear and represented by an asymmetric curve while the relationship in black women is not curvilinear and the overall pattern of association, while possibly linear, is equivocal.

Body mass index and body girths as predictors of mortality in black and white women

BACKGROUND

The high prevalence of obesity in black women has been hypothesized to contribute to higher rates of coronary heart disease and total mortality. Investigators have recently refined the study of obesity by differentiating anatomic patterns of the physical location of adipose tissue on the body. We examined fat patterning as a predictor of mortality in black women.

METHODS

Body mass index (BMI) and body girths were examined as predictors of all-cause and coronary heart disease mortality during 25 to 28 years of follow-up in black and white women in the Charleston Heart Study.

RESULTS

The BMI was associated with all-cause and coronary heart disease mortality in white, but not black, women. After controlling for differences in BMI, the risk of all-cause mortality was greater in white women with larger chest and abdominal girths, while midarm girths were inversely associated with mortality. The hazard at the 85th percentile relative to the 15th percentile of abdomen/midarm ratio was 1.44 in models that included BMI, education, and smoking as covariates. In black women, the girths were not predictive of either all-cause or coronary heart disease mortality.

CONCLUSIONS

The failure of BMI and fat patterning to predict mortality in black women challenges previously held assumptions regarding the role of overweight in the higher mortality experienced by black women.

Body mass index and body girths as predictors of mortality in black and white men

Anthropometric measurements collected from black and white men in the 1960 (n = 946) and 1963 (n = 456) examinations of the Charleston Heart Study cohort (Charleston County, South Carolina) were examined as predictors of all cause and coronary heart disease mortality. Anthropometric measurements included body mass index, chest girth (at the third intercostal space), abdominal girth (at the umbilicus) and midarm circumference. Vital status of 98 percent of the cohort was determined through 1988. Body mass index was not associated with mortality in the white men; however, it was predictive of all cause and coronary heart disease mortality in the black men. Analyses conducted separately in the lower and upper range of body mass index in black men showed the adjusted relative hazard at the 50th versus the 10th percentile of body mass index was 0.54 for all cause mortality, but was not significant for coronary heart disease mortality; whereas the adjusted relative hazard for the 90th relative to the 50th percentile was 1.7 for coronary heart disease deaths, but not significant for deaths from all causes. The circumference measurements were not predictive of all cause or coronary heart disease mortality in the white men. In the black men, the adjusted relative hazard ratios for all cause mortality for the 85th relative to the 15th percentiles were 0.22 for midarm circumference and 2.0 for abdominal circumference.

Intrafamilial phenotypic expression of autosomal dominant polycystic kidney disease

It has been suggested that the clinical expression of autosomal dominant polycystic kidney disease (ADPKD) is uniform among individuals of a given family. To test this hypothesis, intrafamilial variations in ages at onset of first symptoms, types of first symptoms, serum creatinine concentrations, and renal sizes were evaluated in 131 patients with ADPKD from 36 unrelated families. These parameters were compared in younger and older affected relatives in the same family at a single time, due to difficulties of following them longitudinally. Because the natural course of the disease is to progress with age, it was presumed that disease progression in a given family was nonuniform if older individuals had lower serum creatinine concentrations, and/or smaller kidneys than their affected younger relatives, or if relatives of similar ages had different serum creatinine concentrations and/or kidney sizes. Nonuniform progression was suggested in 38% of affected relatives by serum creatinine concentrations and in 53% by kidney sizes. Ages at onset of first symptoms and types of first symptoms were also different in patients from the same families. These data indicate that phenotypic expression of ADPKD may differ considerably among patients who belong to the same families.

Evidence for renal kinins as mediators of amino acid-induced hyperperfusion and hyperfiltration in the rat

This study examined the role of tissue kallikrein and kinins in renal vasodilation produced by infusion of amino acids (AA). In rats fed a 9% protein diet for 2 wk, intravenous infusion of a 10% AA solution over 60-90 min reduced total renal vascular resistance and increased glomerular filtration rate (GFR) by 25-40% and renal plasma flow (RPF) by 23-30% from baseline. This was associated with a two- to threefold increase in urinary kinin excretion rate. Acute treatment of rats with aprotinin, a kallikrein inhibitor, resulted in deposition of immunoreactive aprotinin in kallikrein-containing connecting tubule cells and inhibited renal kallikrein activity by 90%. A protinin pretreatment abolished the rise in urinary kinins and prevented significant increases in GFR and RPF in response to AA. In a second group of rats pretreated with a B2 kinin receptor antagonist, [DArg Hyp3, Thi5,8 D Phe7]bradykinin, AA infusion raised urinary kinins identically as in untreated controls, but GFR and RPF responses were absent. Aprotinin or the kinin antagonist produced no consistent change in renal function in rats that were not infused with AA.AA-induced increases in kinins were not associated with an increase in renal kallikrein activity. Notably, tissue active kallikrein level fell 50% in AA-infused rats. These studies provide evidence that kinins generated in the kidney participate in mediating renal vasodilation during acute infusion of AA.

Factors associated with the frequency of after-hours in-person patient consultations

In this study, 901 after-hours calls to 26 second- and third-year family practice residents in a university based program were audited to determine patient and physician characteristics associated with after-hours rates of in-person consultation. In-person consultation frequency averaged 25.5%, but ranged from 9% to 53% among physicians (P = .02). Male patients were seen more frequently than female patients (P = .008) Younger patients were seen more frequently than older patients (P = .01). Calls for trauma, obstetrics, and respiratory complaints were more likely to result in in-person consultations than were calls for other problems (P less than .00001). Categorical modeling analysis, used for adjustment, confirmed differences in consultation frequencies both among physicians and due to the nature of the caller's complaint. Neither the time of the call, the patient's race, nor the physician's sex, marital status, level of training, distance lived from the family practice center, or personality type as measured by the Myers-Briggs Type Indicator were associated with the frequency of consultation. Additional research is needed to determine the factors responsible for physician differences in after-hours in-person consultation frequency.

Acute and chronic responses of human renal kallikrein and kinins to dietary protein

Glomerular filtration rate (GFR; creatinine clearance) and renal excretion rates of active kallikrein, prokallikrein, and kinins were measured in seven normal male subjects after a week on a constant low (40 g/day)-protein diet (LP) and during a subsequent week when only protein content was increased to 140 g/day (HP). Renal kinin excretion increased from 19.7 +/- 1.2 micrograms/day on day 7 of LP to 26.0 +/- 2.5 on day 1 of HP (P less than 0.002), and this higher rate persisted during HP. Active kallikrein excretion increased from 105 +/- 16 to 171 +/- 40 micrograms/day on day 2 of HP (P less than 0.006). Prokallikrein excretion did not increase significantly until day 4 of HP, 52 +/- 16 vs. 96 +/- 38 micrograms/day (P less than 0.03). The increases in active kallikrein and kinin excretion preceded an increase in GFR, which went from 117 +/- 6.8 ml/min on LP to 130 +/- 10 ml/min on day 5 of HP (P less than 0.003). At the end of the LP diet, acute ingestion of 40 g of a casein solution produced an increase in kinin excretion after 2 h (586 +/- 64 vs. 402 +/- 33 pg/min, P less than 0.001) and further to 640 +/- 74 pg/min at 3 h (P less than 0.001). This was accompanied by an increase in GFR at 3 h (154 +/- 18 vs. 132 +/- 10 ml/min, P less than 0.05). Kinin excretion rate correlated directly with GFR during both chronic (r = 0.87) and acute (r = 0.77) studies.(ABSTRACT TRUNCATED AT 250 WORDS)

Predictors of physical disability in elderly blacks and whites of the Charleston Heart Study

During the 1984/85 recall of the Charleston Heart Study Cohort, physical function data were obtained for 247 white males, 376 white females, 123 black males, 247 black females and 71 high socioeconomic status (SES) black males over 60 years of age. Black females had the highest prevalence of physical disability (55.8%), followed by white females (43.2%), black males (39.0%) and white males (25.8%) and high SES black males (22.3%). Physical disability was 1.5-2.5 times as prevalent among individuals with a history of cardiovascular disease (CVD) than those without such a history. Among individuals without a current history of CVD univariate analyses showed the following as significant (lower 95% CI greater than 1.0) predictors of physical disability: elevated systolic blood pressure in white females, black males, and black females; elevated cholesterol in black females; obesity in black females; and low educational level in white females. Regression analyses indicated that obesity in 1960 accounted for 10.9 and 2.9% respectively of the variability in physical disability scores in 1985 for black females and white females.

Variability in islet cell antibody determination: a quantitative assessment

The source of variability in the outcome of islet cell antibody (ICA) determinations due to pancreas and serum were independently assessed with a quantitative assay. The effect of choice of pancreatic substrate and serum specimen was assessed by testing for parallelism among twenty-five dilution curves of five sera from diabetic subjects and five pancreata. The five by five format allowed for five tests of pancreatic variability (one serum against five pancreata) and five tests of serum variability (one pancreas against five sera). Analyses of variance and covariance of these dilution curves indicate that test outcome is affected by both the sera (5 tests, p values 10(-6) to 10(-7) and the pancreas (5 tests, p values 10(-3) to 10(-5)). The data support heterogeneity among islet cell antibody isotypes and raise the possibility of diversity of islet cell antigens. Antigenic diversity of pancreatic substrates may interfere with inter- and intra-laboratory comparisons of islet cell antibody determinations. The strong effect of pancreas type on ICA outcome infers possible heterogeneity of the islet cell antigen(s) capable of reacting with human islet cell antibodies.

Endometrial antigens involved in the autoimmunity of endometriosis

Serum and peritoneal fluid from five fertile women without endometriosis and serum (n = 23) and peritoneal fluid (n = 12) from infertile women with endometriosis were tested for the presence of antibodies against endometrial tissue antigens by a Western blot analysis. Antigens with molecular weights (MW) of 19, 31, 38, and 42 kd reacted with antibodies in the serum and peritoneal fluid from both fertile and infertile women. Antibodies in 20 of 23 (87%) sera and all 12 (100%) peritoneal fluid samples from endometriosis patients reacted against endometrial antigens with molecular weights (MW) of 26 kd and/or 34 kd. Serum from 10 patients (43%) and peritoneal fluid from 6 patients (50%) also had antibodies to an endometrial antigen with MW of 21.5 kd. Reactivity to other endometrial antigens with MW 16, 24, 48, and 75 kd was also noted in patients with endometriosis. Antibodies in the serum and peritoneal fluid from fertile women failed to react against these antigens. It is concluded that the humoral and local endometrial autoimmunity detected in patients with endometriosis is primarily directed against antigens with MW of 26 and 34 kd.

Studies on sperm survival and motility in the presence of cytotoxic sperm antibodies

The effect of cytotoxic sperm antibodies and native complement in the serum and secretions from 40 fertile and 93 infertile couples on in vitro sperm survival and motion characteristics was studied. Sperm survival in vitro was unaffected by sera from fertile and infertile subjects without cytotoxic sperm antibodies and from infertile men with antibodies to control but not to autologous sperm. Sperm survival was reduced (P less than .001) by sera from infertile men with antibodies to autologous sperm or to antologous and control sperm and from women with cytotoxic antibodies to sperm from both. Sera from fertile couples without sperm antibodies enhanced sperm swimming speed and motility index (P less than .0001). Sera from infertile women with or without cytotoxic sperm antibodies did not affect sperm motility. Sperm survival and motility were reduced by seminal plasma from infertile men with cytotoxic antibodies to autologous and/or control sperm. Seminal plasma from fertile men enhanced sperm survival. Cervical mucus from infertile women with antibodies to autoimmune husbands' sperm or to husbands' and control sperm inhibited sperm motion, whereas cervical mucus from infertile women without sperm antibodies and women with antibodies to control sperm failed to have any effect. It is concluded that cytotoxic sperm antibodies developed through exposure to sperm antigens in autoimmune infertile men decrease in vitro sperm survival and/or motility.

The effect of physician personality on laboratory test ordering for hypertensive patients

Laboratory tests are responsible for a large percentage of health care expenses in the United States. In a retrospective study of the outpatient test ordering by residents for hypertensive patients between the years 1980 and 1986 at the Department of Family Medicine at the Medical University of South Carolina, we found great variability in laboratory test ordering as well as an association between personality as measured by the Myers-Briggs Type Indicator (MBTI) and test ordering. Introverts ordered more than extroverts, and intuitives ordered more than sensors. This association was confirmed by a multiple regression analysis controlling for potential confounders of test ordering, such as severity of disease, the presence of coexisting diabetes mellitus, the demographic characteristics of the patient population, and the number of initial evaluations for hypertension. Elucidation of a relationship between resident personality and laboratory test ordering has important implications for planning intervention strategies to reduce excessive laboratory test ordering in ambulatory care.

A computerized postcoital test sperm motility: comparison with clinical postcoital test and correlations with sperm antibodies

Sixty-five infertile women had a conventional postcoital test (PCT), a computerized postcoital test (cPCT), and sperm antibody testing. Twenty-four women had good cervical mucus and good PCT sperm motility (group 1), 23 had poor cervical mucus and poor PCT sperm motility (group 2), and 18 had good cervical mucus but poor PCT sperm motility (group 3). The percentage of motile sperm, mean linearity, and the motility index of sperm by cPCT also were decreased in groups 2 and 3 (p less than 0.001) in contrast to group 1. A reduced PCT sperm count was significantly associated with positive titers of antibodies to autologous sperm in the husbands' serum, whereas a reduced PCT motility correlated with high titers of cytotoxic antibodies to husbands' sperm in the wives' serum and cervical mucus. An increased percentage of vibratory sperm at PCT correlated with elevated titers of cytotoxic antibodies to husbands' sperm in the wives' serum and cervical mucus, and hemagglutinating (r = 0.44; p less than 0.001) and immunofluorescent IgA antibodies to husbands' sperm (r = 0.47; p less than 0.001) in the cervical mucus. Mean swimming speed of sperm by cPCT correlated inversely with cytotoxic and hemagglutinating antibody titers to husbands' sperm, and immunobead-binding IgM and immunofluorescent IgG, IgA, and IgM (r = 0.52; p less than 0.001) antibodies to sperm in the seminal plasma. Motility indices correlated inversely with cytotoxic antibody titers to husbands' sperm in the wives' serum, and hemagglutinating antibody titers to husbands' sperm in cervical mucus. The predictive values of PCT and cPCT for the presence of cytotoxic and immunofluorescent IgA antibodies to autoimmune husbands' sperm were 76% and 71%, respectively, in the serum and 85% and 75%, respectively, in the cervical mucus of the wives. The predictive value of PCT and cPCT for immunobead-binding and immunofluorescent IgM antibodies to sperm in the wives' serum was 71%. Computerized PCT measures more sperm characteristics than PCT, although it is in general agreement with PCT.

Cytotoxic sperm antibodies and in vitro fertilization of mature oocytes: a preliminary report

The fertilization rates of mature oocytes during in vitro fertilization and embryo transfer (IVF-ET) using fetal cord serum-supplemented insemination media were greater than or equal to 57% for five infertile couples without sperm antibodies (group 1). But they were less than or equal to 50% for four of nine infertile couples (group 2) with cytotoxic sperm antibodies in both partners (n = 6) or the husband alone (n = 3). Two women in group 1 were successful in achieving normal, full-term pregnancies with the delivery of normal infants (chi2 = 4.2, P less than 0.05, by chi-square analysis). One of them consistently tested negative for sperm antibodies, while her husband was previously treated with antibiotics for infection and transient sperm antibodies in the seminal plasma. Subsequently, antibody titers in the husband were in the normal range when the successful IVF-ET was performed. One woman in group 2, with antibodies to her autoimmune husband's sperm but not control sperm and with a long-standing poor postcoital test sperm motility, conceived through artificial insemination with donor sperm (AID) after failing to conceive with her husband through IVF-ET. These data suggest that the presence of cytotoxic sperm antibodies in the serum and/or secretions of both partners reduces the rates of fertilization of mature oocytes in spite of using fetal cord serum in the IVF media. Pregnancy achievement is impaired in this group.

Sperm and seminal plasma antigens from autoimmune men induce immunological infertility

Adult male rabbits were immunized with normal saline (controls), sperm extracts from 2 autoimmune men, seminal plasmas from the same autoimmune men, sperm extract from a fertile nonautoimmune man, and seminal plasma from the same fertile nonautoimmune man. All the sperm donors were free from infections. Rabbits immunized with fertile men's sperm extract and seminal plasma had significantly elevated postimmunization hemagglutinating but not cytotoxic sperm antibodies and reproduced normally. Rabbits immunized with autoimmune men's sperm and seminal plasma antigens developed high titers of cytotoxic and hemagglutinating sperm antibodies in their serum and seminal plasma and their reproduction was markedly reduced. Their sera and seminal plasma reduced motility of sperm from a normal donor. The immune responses were confirmed by electron microscopic immunocytochemistry. This technique revealed membrane-bound endogenous IgG on sperm from only those rabbits immunized with sperm extracts from autoimmune men. These antisera reacted against a protein in the 58,000 D range; antisera to fertile man's sperm extract reacted against three proteins with molecular weights of 15,000, 18,400, 25,000, and 44,000 D, as judged by Western blot. Rabbit antisera to seminal plasma from autoimmune men reacted against several proteins; additionally, it detected two proteins with 43,000 and 68,000 molecular weight detected by antiserum to fertile man's seminal plasma. Sperm and seminal plasma antigens from autoimmune men are different in their elicited immunogenic responses from those of fertile nonautoimmune men. These responses are relevant to infertility.

Sperm antibodies and human leukocyte antigens in couples with early spontaneous abortions

Twenty-six couples with two or more early spontaneous abortions and 53 couples with recently proven fertility (control group) were typed for human leukocyte antigens (HLA) of A and B loci and screened for the presence of cytotoxic and hemagglutinating antibodies to sperm. Eighteen other couples with two or more abortions were tested for sperm antibodies alone. Both partners in 24 of 44 (54%) aborting couples were positive (titers of greater than or equal to 32), whereas the control group had sperm antibodies in the negative range (titers of 0 to 16; P less than .0001). Thirty-one husbands (70%) and 24 wives (54%) were positive for sperm antibodies in the study group. Sharing of HLA-A and/or -B antigens between partners was similar in the control and study groups. Fourteen of 26 (54%) couples with two or more abortions did not share HLA-A and/or -B antigens, in contrast to 14 of 53 (26%) in the control fertile group (P less than .02). Antigenic frequencies of HLA-B7 singly and in combination with HLA-B35 were increased in females in the aborting but not in the fertile control group (P less than .001). The combined incidence of HLA-B7, -B8, and -B35 in both partners was significantly higher in the aborting couples as contrasted with the control group. It is suggested that the presence of sperm antibodies is associated with early pregnancy wastage. Histocompatibility antigens B7 and B35 may play a role through their association with sperm antibodies and early spontaneous abortions.

Time-related changes in the plasma concentrations of prolactin, gonadotropins, sex hormone-binding globulin, and certain steroid hormones in female runners after a long-distance race

Running is associated with an increase in plasma concentrations of certain anterior pituitary hormones and adrenal steroids. This study reports such increases after a marathon race. Six trained female runners, 26 to 42 years old, participated in a marathon race. Fasting (resting) blood samples were collected a few weeks before the race (baseline) and immediately (0 hour), 1 hour, and 4 hours after the run. The data were analyzed with the use of two-way analyses of variance (F-test), paired t-test, and Page's test. At 0 hour, compared with baseline, significant increases were observed in the plasma concentrations of testosterone (T), dehydroepiandrosterone sulfate (DHEA-S), cortisol (F), free T index (T/SHBG), and prolactin (PRL). At 1 hour, levels of these steroid hormones and PRL declined, some significantly. At 4 hours, levels of all hormones except DHEA-S returned to baseline. No significant changes were observed in concentrations of follicle-stimulating hormone (FSH), luteinizing hormone (LH), and sex hormone-binding globulin (SHBG), as evaluated by F-test. Running-associated changes in plasma hormonal concentrations revert to baseline in four hours, although DHEA-S may take a little longer.

A computerized sperm motion analysis [published erraturm appears in Fertil Steril 1986 Nov;46(5):980]

Semen samples from 35 fertile men and husbands of 32 infertile couples were evaluated with the use of a rapid computerized sperm motion analysis (CSA). The counts and percentages of motile sperm measured by routine semen analysis (RSA) and CSA were comparable in both groups. In CSA, mean values of swimming speed (microns per second), linearity, and motility index of sperm in the fertile men were significantly higher than those in the infertile group. At 3 hours, the number of sperm moving at a speed of 21 to 30 microns/second were higher in the infertile group than in the fertile group. In contrast, the number of sperm moving at a speed of 31 to 50 microns/second and higher was increased in the fertile group over the infertile group. Good correlations were obtained between RSA and CSA sperm counts and percentages of progressively motile sperm. Sperm counts, percent motility, indices of motility, and mean sperm speed obtained by two observers with the use of CSA correlated well. It seems that the sperm speed and the motility index remain unaltered in repeat semen analyses of fertile men. It is concluded that a computerized analysis of sperm swimming speed is a reliable and rapid mode for evaluating semen samples and offers more discriminatory sperm motion characteristics than the RSA.

Leukocyte migration inhibitory factor (LIF) to sperm from autoimmune men in infertile couples

Leukocyte migration inhibitory factor (LIF) is produced by lymphocytes with receptors specific to sensitizing antigens. This principle was used to detect possible antigenic differences between sperm of autoimmune and nonautoimmune men. Sixteen fertile and 91 infertile couples were screened for cytotoxic and hemagglutinating antibodies to sperm from their husbands and controls. Their lymphocytes were tested for the production of LIF to sperm extracts and seminal plasma from the husbands and controls by a direct leukocyte migration inhibition assay. Twenty-nine of 35 men producing LIF to sperm and/or seminal plasma were positive for sperm antibodies (p = 0.0004, vs sperm antibody-negative controls). Twenty-three of 29 wives with LIF production had sperm-autoimmune husbands (p = 0.04). Leukocyte migration was significantly inhibited in sperm-autoimmune men by autologous sperm extracts and seminal plasma in contrast to control sperm extracts and seminal plasma (p = 0.0006 and 0.001, respectively). The wives of autoimmune men had significantly higher LIF responses to their husbands' sperm extracts than to other antigens (p = 0.02). Men with cytotoxic antibodies in their seminal plasma produced LIF to autologous sperm (p = 0.001). It is suggested that certain sperm and seminal plasma antigens of autoimmune men may lead to specific humoral and cell-mediated immune responses in both partners.

Leukocyte migration inhibitory factor (LIF) to sperm from autoimmune men in infertile couples

Leukocyte migration inhibitory factor (LIF) is produced by lymphocytes with receptors specific to sensitizing antigens. This principle was used to detect possible antigenic differences between sperm of autoimmune and nonautoimmune men. Sixteen fertile and 91 infertile couples were screened for cytotoxic and hemagglutinating antibodies to sperm from their husbands and controls. Their lymphocytes were tested for the production of LIF to sperm extracts and seminal plasma from the husbands and controls by a direct leukocyte migration inhibition assay. Twenty-nine of 35 men producing LIF to sperm and/or seminal plasma were positive for sperm antibodies (p = 0.0004, vs sperm antibody-negative controls). Twenty-three of 29 wives with LIF production had sperm-autoimmune husbands (p = 0.04). Leukocyte migration was significantly inhibited in sperm-autoimmune men by autologous sperm extracts and seminal plasma in contrast to control sperm extracts and seminal plasma (p = 0.0006 and 0.001, respectively). The wives of autoimmune men had significantly higher LIF responses to their husbands' sperm extracts than to other antigens (p = 0.02). Men with cytotoxic antibodies in their seminal plasma produced LIF to autologous sperm (p = 0.001). It is suggested that certain sperm and seminal plasma antigens of autoimmune men may lead to specific humoral and cell-mediated immune responses in both partners.

Cytotoxic sperm antibodies inhibit sperm penetration of zona-free hamster eggs

Zona-free hamster egg sperm penetration assay was used to study the effects of cytotoxic sperm antibodies on egg penetration by the sperm of fertile and infertile men. Twenty-nine fertile and 9 infertile men did not have significant cytotoxic sperm antibodies in their serum and seminal plasma; 7 infertile men were positive for these antibodies in serum and seminal plasma. Two others were positive in sera, and 14 were positive in seminal plasma. Sperm from 18 of 23 (78%) infertile men with sperm antibodies had poor egg penetration (less than or equal to 20%) compared with only 6 of 38 (16%) nonautoimmune men (P less than 0.0001). Sperm from nonautoimmune fertile men were coated with seminal plasma and serum of autoimmune men and serum of isoimmune women, resulting in a significant decrease in hamster egg penetration. Sixteen of 21 (76%) seminal plasma samples with cytotoxic sperm antibodies reduced the control sperm penetration of hamster eggs by greater than or equal to 50%. Coating of sperm from fertile men with serum and seminal plasma samples from non-sperm-immune fertile and infertile subjects did not alter their penetration of hamster eggs. Coating of sperm from autoimmune men with cytotoxic antibody-positive autologous seminal plasma samples resulted in a significant decrease of egg penetration. The inhibitory effect of antibody-positive seminal plasma samples on egg penetration by control sperm was abrogated when the samples were preabsorbed with sperm. It is concluded that cytotoxic sperm antibodies, especially those in seminal plasma, inhibit hamster egg penetration by autologous and control sperm. This may explain in part the incidence of infertility associated with sperm antibodies.

Performance of male nursing students on the MMPI, fantasy, and self-esteem inventories

The field of nursing in the past has been considered a stereotypically feminine vocation, but in recent years an increasing number of men have begun to enter. The present study shows the present day men entering the nursing profession as possessing adequate self-concept, level of ego strength, self-esteem, and male sexuality. They are comparable to other men in the various areas of personality explored and have less need to rely upon fantasy in their everyday functions than control peers in this study.

Physiological integrity of human sperm in the presence of Ureaplasma urealyticum

Several species of Mycoplasma have been isolated from the human genital tract, the most common being M. hominis and Ureaplasma urealyticum. A causal relationship between such infections and sperm dysfunction and infertility has yet to be established. It was the purpose of this study to examine the effects of U. urealyticum infection on the function of sperm as assessed by seminal fluid analysis (SFA), in vitro penetration of bovine cervical mucus (BCMP), and the hamster sperm penetration assay (SPA). No significant differences were noted in the SFA of infected and uninfected samples, either fresh or frozen, fertile or infertile. In addition, no differences were noted in the BCMP or SPA. In sperm from U. urealyticum-infected individuals the basic physiological mechanisms underlying mucus penetration and ovum fertilization seem intact.

Anti-sperm antibodies, detected by agglutination, immobilization, microcytotoxicity and immunobead-binding assays

To determine the reliability of tests currently utilized in the detection of sperm-reactive antibodies, sera were provided as unknowns and studied without knowledge of the clinical histories. Four laboratories performed tray agglutination tests (TAT), three complement-dependent immobilization (SIT), and single laboratories sperm cytotoxicity (SCT), passive haemagglutination (PHA) and immunobead binding (IBB). Most investigators demonstrated an excellent correlation between duplicate sample results. Nearly all of the female sera were free of anti-sperm antibodies and positive results did not appear in greater frequency in women with unexplained infertility as compared with other categories. For the male sera, the highest incidence of anti-sperm antibodies in the infertile group (21% positive for sperm-reactive IgGs) was obtained by immunobead binding. The GAT and TAT results gave 7 and 12% positives, except for lower results in one laboratory. Sperm-reactive antibodies were detected most commonly in vasectomized men, with all assays except SCT and PHA. Of the newer techniques studied, IBB results correlated well with TAT, GAT and SIT, while SCT and PHA did not, suggesting that a different group of antibodies, perhaps directed against other sperm-associated antigens, was being detected by the latter procedures. In this light, emphasis was placed on the need to validate whether results of particular methodologies correlated with impaired sperm function and to develop methods that provided evidence for this premise, either on the basis of clinical criteria or altered gamete interaction in vitro.

Females' isoimmunity to sperm is associated with sperm autoimmunity in their husbands

One hundred twenty-five fertile couples and 334 infertile couples were tested for the presence of cytotoxic and hemagglutinating antibodies to sperm. Elevated titers of sperm antibodies were absent in both partners of fertile couples. Of 79 infertile males with levels of sperm antibodies in the previously established negative range, 97% had wives who also had low titers of sperm antibodies. Of 255 infertile males positive for serum hemagglutinating antibodies, 56% had wives whose serum contained significant circulating hemagglutinating antibodies, while 93 of 202 (46%) males with significant cytotoxic antibody titers had wives whose serum contained elevated cytotoxic antibody titers. The females developed elevated titers of sperm antibodies in the serum and cervical mucus if their husbands had significant titers of hemagglutinating and cytotoxic sperm antibodies in the serum and seminal plasma samples. Females' isoimmunity to sperm was significantly associated with their husbands' autoimmunity to sperm and infertility.

Immunofluorescence in skin specimens from three different biopsy sites in patients with scleroderma

Immunofluorescence (IF) data from three different biopsy sites (nailfold, forearm, buttock) were studied in 18 patients with scleroderma (SD, systemic sclerosis) and the results compared with those obtained from 10 normal controls (NC) and 7 patients with systemic lupus erythematosus (SLE). Immunoglobulin (Ig) deposits were detected by direct IF technique at the dermo-epidermal junction (DEJ) in 8/14 nailfolds, 6/15 forearms and in none of the buttock specimens of SD patients. Epidermal nuclear staining was present in 6/14 nailfolds, and in 6/15 forearms and buttocks. The most prominent finding was the observation of multiple Ig deposits in the cuticle of 9/14 patients with SD. NC group was negative in all sites for epidermal nuclear staining and the only DEJ deposit occurred in the forearm of one subject. In conclusion, this study demonstrates that Ig deposits in SD, both at the DEJ and in the epidermal nuclei, occur more often than previously reported and are especially frequent in the nailfold & cuticle area.