Corifollitropin alfa for poor responders patients, a prospective randomized study

BACKGROUND

Poor ovarian response remains one of the biggest challenges for reproductive endocrinologists. The introduction of corifollitropin alpha (CFA) offered an alternative option to other gonadotropins for its longer half-life, its more rapid achievement of the threshold and higher FSH levels. We compared two different protocols with CFA, a long agonist and a short antagonist, and a no-CFA protocol.

METHODS

Patients enrolled fulfilled at least two of the followings: AFC < 5, AMH < 1,1 ng/ml, less than three oocytes in a previous cycle, age > 40 years. Ovarian stimulation with an antagonist protocol was performed either with 300 UI rFSH and 150 UI rLH or 300UI HMG. In the long agonist group, after pituitary suppression with triptorelin, CFA was given the 1-2th day of cycle and 300 UI rFSH and 150 UI rLH the 5th day. In the short antagonist group CFA was given the 1-2th day of cycle and 300 UI rFSH and 150 UI rLH the 5th day. The primary objective was the effect on the number of oocytes and MII oocytes. Secondary objective were pregnancy rates, ongoing pregnancies and ongoing pregnancies per intention to treat.

RESULTS

The use of CFA resulted in a shorter lenght of stimulation and a lower number of suspended treatments. Both the CFA protocols were significantly different from the no-CFA group in the number of retrieved oocytes (p < 0,05), with a non-significant difference in favour of the long agonist protocol. Both CFA groups yielded higher pregnancy rates, especially the long protocol, due to the higher number of oocytes retrieved (p < 0,05), as implantation rates did not differ. The cumulative pregnancy rate was also different, due to the higher number of cryopreserved blastocysts (p < 0,02).

CONCLUSIONS

The long agonist protocol with the addition of rFSH and rLH showed the best results in all the parameters. A short antagonist protocol with CFA was less effective, but not significantly, although provided better results compared to the no-CFA group. We suggest that a long agonist protocol with CFA and recombinant gonadotropins might be a valuable option for poor responders.

TRIAL REGISTRATION

The study was approved by the local Ethics Committee (EudraCT2015-002817-31).

Pulmonary edema as a postoperative complication in two obese patients (a horse and a dog)

In this case series, the development and successful treatment of pulmonary edema are described in two obese animals (a horse and a dog) in the postoperative period. This rare but severe complication is normally fairly easy to diagnose, but the cause is usually multifactorial and difficult to determine. Potentially contributing factors are discussed. Both animals responded successfully to therapy and were discharged without further incidents.

Anaphylaxis after intravenous administration of amoxicillin/clavulanic acid in two dogs under general anesthesia

In this case series, the occurrence and successful treatment of anaphylaxis after the intravenous administration of amoxicillin/clavulanic acid are described in two dogs under general anesthesia. Within five to ten minutes after the administration of the antibiotic, a severe hypotension occurred in both dogs, accompanied by labial and periorbital swelling and erythema. Therapy consisted of counteracting the cardiovascular effects of anaphylaxis and preventing further release of inflammatory mediators. Both dogs recovered uneventfully from the drugrelated anaphylaxis.

Paraprostaatcyste met urotheliale aflijning bij een hond

Een geïnfecteerde paraprostaatcyste met oorsprong in het prostaatparenchym werd gediagnosticeerd bij een zeven jaar oude, mannelijke, intacte Amerikaanse staffordshireterriër die aangeboden werd met dysurie. De diagnose werd gesteld aan de hand van de anamnese, het lichamelijk en echografisch onderzoek, het bacteriologisch onderzoek, het uitgebreid histopathologisch onderzoek en een DNA-test. De behandeling bestond uit het chirurgisch verwijderen van een groot deel van de cyste, omentalisatie van het restant gecombineerd met castratie en antibioticumtherapie. Immunohistochemische kleuringen toonden aan dat de cyste een urotheliale aflijning had. Een DNAtest sloot het persisterende-gang-van-Müller-syndroom (PMDS) uit. De cyste had een open verbinding met de urethra en ontstond vermoedelijk uit een embryonaal restant ter hoogte van de prostaat. De hond herstelde vlot van de ingreep maar de dysurie en incontinentie persisteerden. Bij de controle vier maanden postoperatief werd echografisch een nieuwe paraprostaatcyste aangetoond. Uit de echobegeleide punctie bleek de cyste geïnfecteerde urine te bevatten.

JAK2 V617F mutation and PRV-1 overexpression: relevance in the diagnosis of polycythaemia vera and essential thrombocythaemia

In the diagnosis of polycythaemia vera and essential thrombocythaemia, two molecular markers were described in the last decade: the overexpression of the PRV-1 gene and the V617F mutation in the JAK2 gene. In this study we assess their usefulness by comparing our test results with the available clinical data. We show that in the diagnosis of polycythaemia vera the JAK2 mutation screening is crucial, while testing for the PRV-1 overexpression is redundant. On the contrary, in the diagnosis of essential thrombocythaemia (ET), both JAK2 and PRV-1 show their usefulness.

GABA(B) receptor-mediated increase of neurosteroids by gamma-hydroxybutyric acid

Among the pharmacological actions of gamma-hydroxybutyric acid (GHB), some may involve GABA(A) receptor-mediated mechanisms. GHB, however, fails to directly interact with sites for agonists and modulators on the GABA(A) receptor complex. We hypothesized that, in vivo, GHB may interfere with GABA(A) receptor function by altering the brain concentrations of the neurosteroids 3 alpha-hydroxy-5 alpha-pregnan-20-one (allopregnanolone, AP) and 3 alpha,21-dihydroxy-5 alpha-pregnan-20-one (allotetrahydrodeoxycorticosterone, THDOC), positive allosteric modulators of GABA-gated chloride currents. In male Wistar rats, GHB dose-dependently (75-1000 mg/kg, i.p.) increased AP, THDOC and their precursors pregnenolone and progesterone in brain cortex and hippocampus. The increases of AP (4-5 fold) and THDOC (3-4 fold) elicited by 300 mg/kg GHB peaked between 30 and 90 min and abated by 180 min. The selective GABA(B) receptor antagonist SCH 50911 (50 mg/kg, i.p.) prevented the action of GHB, while the GABA(B) receptor agonist baclofen (5-10 mg/kg) mimicked it. NCS-382 (50 mg/kg, i.p.), the purported selective antagonist of the GHB receptor, failed to antagonize GHB, but at 300 mg/kg increased brain cortical neurosteroids to the same extent as 300 mg/kg GHB; coadministration of GHB and NCS-382, however, failed to yield an additive effect. These results strongly suggest that GHB, via a GABA(B) receptor-mediated mechanism, increases the brain concentrations of neurosteroids, whose properties as amplifiers of the GABA-gated chloride conductances may play a role in the GABA(A) receptor-mediated pharmacological actions of GHB.

GABA(B) receptor inhibition causes locomotor stimulation in mice

The present study investigated the effect of the administration of the GABA(B) receptor antagonists, SCH 50911 [(2S)(+)-5,5-dimethyl-2-morpholineacetic acid], CGP 46381 [(3-aminopropyl)(cyclohexylmethyl)phosphinic acid] and CGP 52432 (3-[[(3,4-dichlorophenyl)methyl]amino]propyl]diethoxymethyl)phosphinic acid), on spontaneous locomotor activity in mice. All drugs were acutely administered at the doses of 10 and 30 mg/kg (i.p.). The dose of 30 mg/kg of all drugs resulted in a significant stimulation of locomotor activity. The locomotor stimulation elicited by SCH 50911 was completely blocked by haloperidol (0.1 mg/kg, i.p.), suggesting that hyperactivity induced by blockade of the GABA(B) receptor is mediated by enhanced dopamine release. These results suggest the existence of a GABA(B) receptor-mediated tonic inhibition of dopamine neurons.

The cannabinoid receptor antagonist SR 141716 prevents acquisition of drinking behavior in alcohol-preferring rats

The cannabinoid CB(1) receptor antagonist, N-piperidino-5-(4-chlorophenyl)-1-(2,4-dichlorophenyl)-4-methyl-3-pyrazole-carboxamide) (SR 141716); 0.3-3 mg/kg, i.p., twice daily for 10 days), prevented the acquisition of alcohol drinking behavior in rats genetically selected for alcohol preference (Sardinian alcohol-preferring (sP) rats), having the free choice between alcohol (10%, v/v) and water. The results suggest that activation of cannabinoid CB(1) receptors is essential for the acquisition of alcohol drinking behavior in animals with a genetically determined alcohol preference.

Role of GABA(B) receptors in the sedative/hypnotic effect of gamma-hydroxybutyric acid

The present study was aimed at identifying the receptor systems involved in the mediation of the sedative/hypnotic effect of gamma-hydroxybutyric acid (GHB) in DBA mice. Administration of the putative antagonist of the GHB binding site, 6,7,8,9-tetrahydro-5-hydroxy-5H-benzocyclohept-6-ylideneacetic acid (NCS-382; 50-500 mg/kg, i.p.), significantly increased the duration of loss of righting reflex induced by GHB (1000 mg/kg, i.p.). In contrast, the GABA(B) receptor antagonists, (2S)(+)-5,5-dimethyl-2-morpholineacetic acid (SCH 50911; 25-100 mg/kg, i.p.) and (3-aminopropyl)(cyclohexylmethyl)phosphinic acid (CGP 46381; 12.5-150 mg/kg, i.p.), completely prevented the sedative/hypnotic effect of GHB. SCH 50911 (100 and 300 mg/kg, i.p.) was also capable to readily reverse the sedative/hypnotic effect of GHB (1000 mg/kg, i.p.) in mice that had lost the righting reflex. SCH 50911 (100 mg/kg, i.p.) also completely abolished the sedative/hypnotic effect of the GABA(B) receptor agonist, baclofen. These results indicate that the sedative/hypnotic effect of GHB is mediated by the stimulation of GABA(B) receptors and add further support to the hypothesis that the GABA(B) receptor constitutes a central site of action of GHB.

Procedure of bidirectional selective outbreeding for production of two rat lines differing in sensitivity to the sedative/hypnotic effect of gamma-hydroxybutyric acid

The exogenous administration of gamma-hydroxybutyric acid (GHB), a constituent of the mammalian brain where it likely functions as a neurotransmitter or a neuromodulator, exerts a number of pharmacological effects, including sedation and hypnosis. The present paper describes a procedure for selective breeding of two rat lines which markedly differ in sensitivity to the sedative/hypnotic effect of GHB. Selective breeding originated from Wistar rats showing opposite sensitivity to the sedative/hypnotic effect of 1 g/kg GHB (i.p.). 'Sensitive' Wistar rats, defined as those individuals displaying values of r = sleep time/onset greater than the upper 15th percentile, were mated to generate the GHB-sensitive (GHB-S) line; conversely, 'resistant' Wistar rats (r-values lower than the lower 15th percentile) were mated to generate the GHB-resistant (GHB-R) line. Upper and lower 15th percentiles were also used to establish the selection cut-offs and criteria for rats of subsequent generations. Specifically, r-values of GHB-S rats were required to be r > or =8 on two separate tests with GHB; r-values of GHB-R rats were required to be r < or =2 on two separate tests with GHB. In each of the three generations produced to date, GHB-S rats showed significantly shorter onset, longer sleep times and greater r-scores than GHB-R rats. The selective breeding of GHB-S and GHB-R rats: (a) suggests that sensitivity to GHB is under genetic control, and (b) may constitute a unique model for investigation of the physiological function of GHB.

Selective breeding of two rat lines differing in sensitivity to GHB and baclofen

Two Wistar-derived rat lines, one sensitive (GHB-S) and the other resistant (GHB-R) to the anesthetic effect of gamma-hydroxybutyric acid (GHB), have been selectively bred. GHB-S and GHB-R rats were also sensitive and resistant, respectively, to the anesthetic effect of baclofen, the prototype GABA(B) receptor agonist, suggesting that they may be useful to elucidate not only the role of endogenous GHB but also that of GABA(B) receptors in sleep and anesthesia.

Determination of the human salivary peptides histatins 1, 3, 5 and statherin by high-performance liquid chromatography and by diode-array detection

A reversed-phase high-performance liquid chromatography (HPLC) method with diode-array detection for the quantification of several human salivary peptides is described. Sample pretreatment consisted of the acidification of whole saliva by phosphate buffer. This treatment produced precipitation of mucins, alpha-amylases and other high-molecular-mass salivary proteins, simultaneous inhibition of intrinsic protease activities and reduction of sample viscosity. Direct HPLC analysis by diode-array detection of the resulting acidic sample allowed one to quantify histatin 1, histatin 3, histatin 5, statherin, as well as uric acid, in normal subjects. Moreover, the groups of peaks pertaining to proline-rich proteins and cystatins were tentatively identified. The method can be useful in assessing the concentration of salivary peptides from normal subjects and from patients suffering oral and/or periodontal diseases.

Itchy dermatitis from Gynaikothrips ficorum March in a family group

This study reports on the occurrence of an itchy dermatitis in all 4 adult members of a family, 2 men and 2 women, following infestation in the family environment with Gynaikothrips ficorum. The skin manifestations and the environmental study are described.

Efficacy of teicoplanin and imipenem on respiratory infections in high risk patients

The efficacy of teicoplanin and imipenem was assayed on microorganisms, mainly hospital opportunistic organisms, resistant to common therapy, isolated from bronchoaspirates of high risk hospitalized patients. Imipenem has shown remarkable activity against all isolated microorganisms with sensitivities ranging from 91.93% against Acinetobacter calcoaceticus to 75.86% against Pseudomonas sp. Teicoplanin has shown excellent activity against Staphylococcus aureus (sensitivity 83.66%).

Evidence from two classic irritation tests for an anti-inflammatory action of a natural extract, Echinacina B

The roots of Echinacea angustifolia (fam. Compositae) were used to obtain an antiphlogistic, immunostimulating and skin repairing extract. On the basis of these potential actions, the extract is used in cosmetic preparations. The aim of this study was to evaluate the anti-inflammatory activity of the extract using different irritation tests. The irritation reaction was induced by application of 0.015 ml of 0.25% croton oil in water to the ears of mice. The raw extract (Echinacina B), topically applied, inhibited oedema both at the maximum (6 hr) and in the decreasing phase (18 hr), and this effect was directly proportional to the doses used. Echinacina B was found to be more potent than the positive control, benzidamine, a topical non-steroidal anti-inflammatory drug. In addition, the extract given iv 1 hr before injection of 0.05 ml of 1% carrageenan into the hind paws of rats inhibited oedema in the histaminic and in the later phases of the phlogistic process. These data show the qualitative value of irritation tests for studying the anti-inflammatory action of a natural plant extract.