Predicting first-episode psychosis patients who will never relapse over 10 years

BACKGROUND

Although relapse in psychosis is common, a small proportion of patients will not relapse in the long term. We examined the proportion and predictors of patients who never relapsed in the 10 years following complete resolution of positive symptoms from their first psychotic episode.

METHOD

Patients who previously enrolled in a 12-month randomized controlled trial on medication discontinuation and relapse following first-episode psychosis (FEP) were followed up after 10 years. Relapse of positive symptoms was operationalized as a change from a Clinical Global Impression scale positive score of <3 for at least 3 consecutive months to a score of ⩾3 (mild or more severe). Baseline predictors included basic demographics, premorbid functioning, symptoms, functioning, and neurocognitive functioning.

RESULTS

Out of 178 first-episode patients, 37 (21%) never relapsed during the 10-year period. Univariate predictors (p ⩽ 0.1) of patients who never relapsed included a duration of untreated psychosis (DUP) ⩽30 days, diagnosed with non-schizophrenia spectrum disorders, having less severe negative symptoms, and performing better in logical memory immediate recall and verbal fluency tests. A multivariate logistic regression analysis further suggested that the absence of any relapsing episodes was significantly related to better short-term verbal memory, shorter DUP, and non-schizophrenia spectrum disorders.

CONCLUSIONS

Treatment delay and neurocognitive function are potentially modifiable predictors of good long-term prognosis in FEP. These predictors are informative as they can be incorporated into an optimum risk prediction model in the future, which would help with clinical decision making regarding maintenance treatment in FEP.

Effect of paternal age on semen parameters and live birth rate of in-vitro fertilisation treatment: a retrospective analysis

OBJECTIVE

To determine the effect of paternal age on semen parameters and the live birth rate from in-vitro fertilisation (IVF) treatment.

METHODS

We performed a retrospective cohort study of couples undergoing a first IVF cycle between 2004 and 2014 in a tertiary assisted reproduction centre in Hong Kong.

RESULTS

We analysed 3549 cases. Paternal age ≥40 years was negatively correlated with semen volume, progressive motility, total motility and total normal motile count (P<0.005) and positively correlated with sperm concentration (P<0.001). There was no correlation with sperm count, normal morphology, or total motile count. Subgroup analyses in Chinese men only and in men with normal versus abnormal semen parameters showed the same correlations. Paternal age was positively associated with maternal age (P<0.001) and miscarriage (P=0.006), and negatively associated with ongoing pregnancy and live birth (P<0.001). Logistic regression showed that maternal age, total number of oocytes retrieved, and number of embryos transferred were significant factors which independently predicted the likelihood of live birth from IVF (all P<0.001).

CONCLUSION

Paternal age was negatively correlated with some semen parameters, which showed a significant decline after age 40 years. However, paternal age is not predictive of the live birth from IVF treatment.

Preimplantation genetic diagnosis and screening by array comparative genomic hybridisation: experience of more than 100 cases in a single centre

INTRODUCTION

Preimplantation genetic screening has been proposed to improve the in-vitro fertilisation outcome by screening for aneuploid embryos or blastocysts. This study aimed to report the outcome of 133 cycles of preimplantation genetic diagnosis and screening by array comparative genomic hybridisation.

METHODS

This study of case series was conducted in a tertiary assisted reproductive centre in Hong Kong. Patients who underwent preimplantation genetic diagnosis for chromosomal abnormalities or preimplantation genetic screening between 1 April 2012 and 30 June 2015 were included. They underwent in-vitro fertilisation and intracytoplasmic sperm injection. An embryo biopsy was performed on day-3 embryos and the blastomere was subject to array comparative genomic hybridisation. Embryos with normal copy numbers were replaced. The ongoing pregnancy rate, implantation rate, and miscarriage rate were studied.

RESULTS

During the study period, 133 cycles of preimplantation genetic diagnosis for chromosomal abnormalities or preimplantation genetic screening were initiated in 94 patients. Overall, 112 cycles proceeded to embryo biopsy and 65 cycles had embryo transfer. The ongoing pregnancy rate per transfer cycle after preimplantation genetic screening was 50.0% and that after preimplantation genetic diagnosis was 34.9%. The implantation rates after preimplantation genetic screening and diagnosis were 45.7% and 41.1%, respectively and the miscarriage rates were 8.3% and 28.6%, respectively. There were 26 frozen-thawed embryo transfer cycles, in which vitrified and biopsied genetically transferrable embryos were replaced, resulting in an ongoing pregnancy rate of 36.4% in the screening group and 60.0% in the diagnosis group.

CONCLUSIONS

The clinical outcomes of preimplantation genetic diagnosis and screening using comparative genomic hybridisation in our unit were comparable to those reported internationally. Genetically transferrable embryos replaced in a natural cycle may improve the ongoing pregnancy rate and implantation rate when compared with transfer in a stimulated cycle.

Sperm retrieval rate and pregnancy rate in infertile couples undergoing in-vitro fertilisation and testicular sperm extraction for non-obstructive azoospermia in Hong Kong

OBJECTIVE

There are currently no local data on the sperm retrieval and pregnancy rates in in-vitro fertilisation and testicular sperm extraction cycles, especially with regard to the presence of genetic abnormalities. This study aimed to determine the sperm retrieval and pregnancy rates in infertile couples who underwent in-vitro fertilisation and testicular sperm extraction for non-obstructive azoospermia.

METHODS

This retrospective case series was conducted at a tertiary assisted reproduction unit in Hong Kong. Men with non-obstructive azoospermia who underwent in-vitro fertilisation and testicular sperm extraction between January 2001 and December 2013 were included. The main outcome measures were sperm retrieval and pregnancy rates.

RESULTS

During the study period, 89 men with non-obstructive azoospermia underwent in-vitro fertilisation and testicular sperm extraction. Sperm was successfully retrieved in 40 (44.9%) men. There was no statistically significant difference in the sperm retrieval rate of those with karyotypic abnormalities (2/5, 40.0% vs 28/61, 45.9%; P=1.000) and AZFc microdeletion (3/6, 50.0% vs 28/61, 45.9%; P=1.000) compared with those without. Sperms were successfully retrieved in patients who had mosaic Klinefelter syndrome (2/3, 66.7%) but not in the patient with non-mosaic Klinefelter syndrome. No sperms were found in men with AZFa or AZFb microdeletions. Pregnancy test was positive in 15 (16.9%) patients and the clinical pregnancy rate was 13.5% (12/89) per cycle. The clinical pregnancy rate per transfer was 34.3% (12/35).

CONCLUSIONS

The sperm retrieval rate and clinical pregnancy rate per initiated cycle in men undergoing in-vitro fertilisation and testicular sperm extraction in our unit were 44.9% and 13.5%, respectively. No sperms could be retrieved in the presence of AZFa and AZFb microdeletions, but karyotype and AZFc microdeletion abnormalities otherwise did not predict the success of sperm retrieval in couples undergoing in-vitro fertilisation and testicular sperm extraction. Genetic tests are important prior to testicular sperm extraction for patient selection and genetic counselling.

Consensus statements on adherence issues in schizophrenia for Hong Kong

AIM

In view of the clinical importance of the adherence issues in schizophrenia management, a consensus group of experienced local psychiatrists and nurse specialists gathered to outline a number of consensus statements for clinicians to consider enhancing adherence in their patients.

PROCESS

Prior to the consensus group meeting, three core members drafted eight statements on the issue of adherence in schizophrenia. Using a modified Delphi method, published literature and published guidelines regarding the management of schizophrenia were reviewed by the full panel during the group meeting. After discussion and reflection from each individual member of the consensus group, the eight statements were reworded and electronically voted on anonymously in two steps: acceptance on quality of evidence and practicability in implementation.

RESULTS

After modifications of the original statements, there was very high overall level of agreement and acceptance (reaching international standard) on all the five areas of adherence within the eight statements of the finalised statement.

CONCLUSIONS

The present consensus statements are the first in Hong Kong to address systematically adherence issues in schizophrenia management. They include areas on adherence assessment and definition, treatment strategies in enhancing adherence, and treatment considerations at specific phases of schizophrenia. They are tailored to be of practical utility in the local Hong Kong setting.

Glycodelin in reproductive endocrinology and hormone-related cancer

Glycodelin is an endocrine-regulated glycoprotein that has significant effects on immune cells, apoptosis, reproduction, cell adhesion, differentiation and cancer. In reproduction, glycodelin contributes to capacitation and immunoprotection of spermatozoa, and it modulates sperm-oocyte binding, acrosome reaction and implantation. In endocrine-related cancer, the differentiation inducing effects of glycodelin are accompanied by growth restriction of malignant cells, decreased expression of oncogenes, increased expression of tumour suppressor genes and morphological reversion of the malignant phenotype. This review features these properties and clinical connections, highlighting the role of glycosylation in biological actions.

An analysis of ectopic pregnancies following in vitro fertilisation treatment in a 10-year period

Of clinical pregnancies in our in vitro fertilisation (IVF) programme, 5.4% were ectopic and 0.85% of clinical pregnancies (15% of ectopic pregnancies) were heterotopic. Ectopic pregnancies were more common after IVF/embryotransfer (ET) than frozen embryotransfer (FET). Although there was a suggestion that tubal factors were more common in those with ectopic pregnancies, the difference did not reach statistical significance. No relationship existed with regard to the ovarian stimulation regimen, the dosage/ duration of human menopausal gonadotrophin used, the details of embryo transfer and number of embryos transferred. Patients who develop ectopic pregnancies after IVF can be counselled that they have a good chance of achieving a normal pregnancy with subsequent attempts.

Suicide after discharge from psychiatric inpatient care: a case-control study in Hong Kong

OBJECTIVE

To identify the risk period and the risk factors for suicide in Chinese psychiatric patients after discharge from inpatient psychiatric treatment. The nature of psychiatric aftercare provided to these patients was also explored.

METHOD

A case control study with 73 patients who were discharged from a large psychiatric unit in Hong Kong between January 1996 and December 1999 and had received coroners' verdict of suicide or undetermined death within the same period. Controls were 73 surviving patients discharged from the same unit. They were individually matched for sex, age, psychiatric diagnosis, and date of discharge.

RESULTS

Post-discharge clustering of suicides was observed among the cases. Nearly 80% of them died within 1 year of discharge. The most common principal diagnosis among the cases was schizophrenia and related psychotic disorders. Multivariate analysis showed that suicide was associated with: unemployment (OR = 12.2, 95% CI = 2.1 - 70.4), past suicidal attempts (OR = 3.4, 95% CI = 1.2 - 9.6), maternal mental illness (OR = 13.4, 95% CI = 1.0 - 170.0), and suicidal ideation or attempt before the last admission (OR = 5.0, 95% CI = 1.4 - 18.0). The psychiatric aftercare received by cases and controls were generally similar. However, cases were more likely to have had contact with health care services in the last week before death (OR = 4.0, 95% CI = 1.3 - 11.9).

CONCLUSIONS

Suicidal risk is high in Chinese psychiatric patients soon after discharge. They share some common risk factors for suicide identified in Western studies but several differences are evident: the predominance of schizophrenia in the suicides; the lower prevalence of substance abuse and comorbidity; the low proportion of patients living alone; and the increased clinical contact before death but the less suicidal intent expressed in Chinese patients. It is necessary to consider these socio-cultural factors in assessment of suicidal risk and implementation of suicide prevention strategies in Chinese psychiatric patients.

Identification of novel genes expressed during spermatogenesis in stage-synchronized rat testes by differential display

The molecular mechanism regulating spermatogenesis at different developmental stages remains largely unknown. In a vitamin A-deficiency (VAD) rat model, five distinct histologically defined, stage-synchronized testes: (i) resting spermatogonia and preleptotene spermatocytes at Day 0 of post-vitamin A treatment (PVA); (ii) early pachytene spermatocytes at Day 7 PVA; (iii) late pachytene at Day 15 PVA; (iv) round spermatids at Day 25 PVA; and (v) elongated spermatids at Day 35 PVA were used to study gene expression profiles by mRNA differential display. Twenty-four differentially expressed cDNA fragments were identified and cloned; oligonucleotide sequence analyses indicated that there are 12 novel gene sequences, half of which share no apparent match in current GenBank/EMBL databases. Other 12 VAD clones share sequence homology to membrane channel and transport, transcription and translation, cell cycle and morphogenesis, inducer and transducer, surface or secreted glycoproteins or enzymes, and other miscellaneous molecules. Semi-quantitative RT-PCR analyses against different stages of VAD testes demonstrated: (i) restricted expression of VAD1.2 and 1.3 (novel) on Day 25 PVA when round spermatids form; (ii) escalating pattern of VAD12 (Cx43) in Sertoli cells; and (iii) relative constant levels of VAD4 (A5D3), VAD26.1 (ribonuclease), and VAD27 (GRP8) in spermatogenesis.

Transfer of two embryos instead of three will not compromise pregnancy rate but will reduce multiple pregnancy rate in an assisted reproduction unit

OBJECTIVE

To compare the pregnancy rates and multiple pregnancy rates of cycles initiated in 1998 and in 1999, during which 3 and 2 embryos were advised to be replaced, respectively.

STUDY DESIGN

A retrospective study

RESULTS

There were no differences between 1998 and 1999 in the pregnancy rate per cycle started or per transfer, implantation rate and the multiple pregnancy rates, despite a significantly lower number of embryos replaced in 1999. A significantly higher implantation rate was found in cycles with frozen embryos than those without. Using logistic regression analysis, the chance of pregnancy was significantly improved only by the presence of frozen embryos in the fresh cycles with an odds ratio of 2.0 (95% confidence interval: 1.3-3.0) whereas the chance of multiple pregnancy was significantly increased by replacing 3 embryos instead of 2 (odds ratio: 2.1, 95% confidence interval: 1.1-4.2).

CONCLUSION

Patients should be advised to have 2 embryos replaced without jeopardizing the pregnancy rates in the fresh cycles. The risk of multiple pregnancy is significantly increased when 3 embryos are transferred instead of 2.

pRb-expressing adenovirus Ad5-Rb attenuates the p53-induced apoptosis in cervical cancer cell lines

The retinoblastoma protein (pRb), the gene product of the first reported tumour suppressor gene, is functionally inactivated by the E7 protein of high-risk human papillomavirus (HPV) found in most human cervical cancers. We have, in this study, constructed an adenoviral vector expressing wild-type pRb (Ad5-Rb) and used the constructed Ad5-Rb to transfect the osteosarcoma cell line Saos-2, and three cervical cancer cell lines HeLa, SiHa and C-33A. Our results showed that pRb caused G1 arrest in Saos-2 cells after transfection with Ad5-Rb. The number of colonies formed by the Ad5-Rb-transfected Saos-2 cells in soft agar was also found to be significantly lower (P<0.05) than those transfected with the adenoviral control expressing Escherichia coli beta-galactosidase (Ad5-LacZ). The transfection of Ad5-Rb caused an increase in the population of SiHa and C-33A cells in the G1 phase from 53.0 and 52.9% to 72.4 and 64.3%, respectively, but not in the HeLa cells. However, Ad5-Rb did not show any inhibitory effect on the growth of SiHa, HeLa and C-33A cells, and inhibition of colony formation in soft agar was not observed either. In contrast, flow cytometric analysis showed that Ad5-p53, a p53-expressing adenovirus, induced apoptosis, i.e. the appearance of sub-G1 peak, in all three tested cervical cancer cell lines. Nevertheless, the Ad5-p53-induced apoptosis was partially inhibited when Ad5-Rb was added simultaneously. These findings suggested that pRb may not be a good candidate for cervical cancer gene therapy. Our data also showed that the use of full-length pRb in combination with TP53 might not be a suitable strategy for cancer gene therapy.

Temporal effect of human oviductal cell and its derived embryotrophic factors on mouse embryo development

Mouse embryos at different stages of development were cocultured with human oviduct cells or cultured in the presence of oviduct-derived embryotrophic factor-1, -2, and -3 (ETF-1, -2, and -3) for various amounts of time within the preimplantation period. Cocultures that included the period from 48 to 72 h post-hCG stimulated cell division and increased the cell numbers in the inner cell mass (ICM) of the exposed blastocyst. Exposure of embryos to oviductal cells from 96 to 120 h post-hCG increased the cell number in the trophectoderm (TE), blastocyst size, hatching rate, attachment, and in vitro spreading of the blastocyst. ETF-1 and ETF-2 affected embryos between 48 and 72 h post-hCG by increasing the number of cells in the ICM. In contrast, ETF-3 had a more profound effect on embryos that were exposed from 96 to 120 h post-hCG, where it mostly affected the development of TE cells, leading to higher hatching rate. Human oviductal cells improved mouse embryo development partly by the production of high molecular weight embryotrophic factors. These factors had differential effects on mouse embryo development.

Quantification of transforming growth factor beta1 (TGFbeta1) mRNA expression in mouse preimplantation embryos and determination of TGFbeta receptor (type I and type II) expression in mouse embryos and reproductive tract

We hypothesized that transforming growth factor beta1 (TGFbeta(1)) and its receptors play a role in the interaction between the preimplantation embryo and the reproductive tract. To investigate this hypothesis, TGFbeta 1 mRNA in mouse embryos was quantified by competitive reverse transcription-polymerase chain reaction using an RNA mimic. TGFbeta 1 was first detected in the unfertilized oocyte, disappeared after fertilization and was expressed again at the 2-cell stage (4410 +/- 1330 transcripts/embryo). Its expression increased gradually, peaked at the 8-cell stage (58 600 +/- 17 300 transcripts/embryo) and declined rapidly after the morula stage reaching a concentration of 1520 +/- 546 transcripts/embryo at the blastocyst stage. The mRNA levels of TGFbeta 1 at the 8-cell and morula stages were significantly higher than that at other cell stages (P < 0.05). The expression of TGF receptors in embryos and in the reproductive tract was also investigated. Both TGFbeta(1) type I (ALK-5) and type II TGFbeta receptors were detected in embryos from 1-cell to blastocyst stage by immunohistochemistry. Northern hybridization and immunohistochemistry showed a constant expression of both TGFbeta receptors in the oviduct from day 1 to day 4 of pregnancy, whilst in the uterus there was a marked increase in the expression of TGFbeta type I receptor on day 3. Expression of TGFbeta type II receptor in the uterus remained unaltered throughout the study period. This study has shown that preimplantation mouse embryos produce TGFbeta(1) and that both the embryos and the reproductive tract are responsive to TGFbeta(1) in the preimplantation period.

Establishment and characterization of an immortalized human oviductal cell line

Human oviductal cells stimulate embryo development in vitro partly by the production of embryotrophic glycoproteins. The identity of these glycoproteins is not yet known mainly because oviductal samples are limited and that the cultured parental oviductal cells cannot produce sufficient amount of embryotrophic factors for characterization. In this study, human oviductal epithelial cells (OE) were immortalized by HPV 16 E6/E7 open reading frame (ORF) by retroviral expression. The characteristics of this immortalized cell line (OE-E6/E7) were compared to the parental OE. HPV 16 E6/E7 DNA was found only in OE-E6/E7 but not in OE. Human oviduct-specific glycoprotein, estrogen receptors, and cytokeratin were found in both cell types. Both OE and OE-E6/E7 possessed telomerase activities but the former had much lower activity. OE-E6/E7 also produced glycoproteins with chromatographic behavior similar to the embryotrophic glycoproteins derived from OE. These results showed that OE-E6/E7 retained a number of characteristics of OE. The development of preimplantation mouse embryo was significantly better after coculture with OE-E6/E7 when compared to medium alone culture in term of blastulation rates (52% vs. 32%) and blastocyst diameter (113.0 +/- 2.07 microm vs. 83.9 +/- 5.23 microm). This immortalized cell line can be used as a continuous and stable in vitro system for the study of the oviductal embryotrophic activity. Mol. Reprod. Dev. 59: 400-409, 2001.

Mitomycin C and cisplatin enhanced the antitumor activity of p53-expressing adenovirus in cervical cancer cells

This study investigated the enhanced antitumor activity of Ad5-p53 in combination with mitomycin C (MMC) or cisplatin (DDP) in cervical cancer cell lines SiHa and C-33A. MMC and DDP inhibited the growth of SiHa and C-33A cells in a dose-dependent manner, and the combination of MMC or DDP with Ad5-p53 showed a stronger growth inhibition than those treated with either Ad5-p53, MMC, or DDP alone. As evidenced by the formation of the approximately 200 bp DNA ladder and the appearance of sub-G1 peak, both MMC and DDP induced apoptosis in cervical cancer cells. Western blot analysis of p53 showed that MMC/DDP did not induce the increase of p53 protein in SiHa cells nor the increase of the cellular and nuclear p53 protein in Ad5-p53 transfected Saos-2 cells. Taken together, these results suggested that the combination of Ad5-p53 and MMC/DDP may serve as an effective therapeutic regime for human cervical cancer treatment.

A comparative study of raw and prepared semen samples from two consecutive days

OBJECTIVE

To study and compare raw and prepared semen samples from two consecutive days by conventional sperm parameters, various motility characteristics of spermatozoa determined by computer-aided sperm analysis and calcium ionophore-induced acrosome reaction.

STUDY DESIGN

Semen samples of male partners in couples undergoing 81 cycles of double intrauterine insemination were studied. The first sample was produced after abstinence of 2-7 days and the second, 24 hours after the first. Both samples were processed by isolate sperm separation medium.

RESULTS

Semen volume, sperm concentration and total motile spermatozoa were significantly reduced in day 2 raw and prepared samples, whereas normal morphology, motility characteristics and percentage of acrosome-reacted spermatozoa increased significantly in day 2 inseminated samples as compared to day 1. Oligospermic, asthenospermic and teratozoospermic samples showed a significant improvement in concentration, various motility characteristics and normal morphology of spermatozoa in day 2 samples as compared to day 1.

CONCLUSION

Men with normal samples showed improvements in normal morphology and acrosome-reacted spermatozoa, whereas those with subnormal semen samples from day 1 showed a significant improvement in concentration, various spermatozoal velocities and normal morphology on day 2.

The incidence of cytoplasmic fragmentation in mouse embryos in vitro is not affected by inhibition of caspase activity

OBJECTIVE

To investigate the relationship between cytoplasmic fragmentation and caspase activity in the mouse embryo.

DESIGN

Experimental laboratory study.

SETTING

University gynacology unit.

ANIMAL(S)

One-cell zygote of mouse (MF1 x BALB/c).

INTERVENTION(S)

Mouse embryos were treated with caspase inhibitors: benzyloxycarbonyl-Val-Ala-Asp fluoromethylketone (z-VAD-fmk) and benzyloxycarbonyl-Asp-glu-Val-Asp-fluoromethyl ketone (Z-DEVD-fmk).

MAIN OUTCOME MEASURE(S)

Morphological development of the embryo, proportion of fragmented embryos, caspase-3-like activity, DNA breakage, and phosphatidylserine exposure in blastomeres.

RESULT(S)

The proportion of embryo reaching two-cell, three- to four-cell, and morula stage at 48, 72, and 96 hours after hCG administration, respectively, were comparable between the control embryos and those treated with either z-VAD-fmk or z-DEVD-fmk, at three concentrations (10 microM, 50 microM, and 200 microM). Although the inhibitors suppressed the caspase-3-like activity in the embryo fragment before compaction and decreased DNA breakages, there was no statistically significant difference in the percentage of fragmented embryo between the control and those treated with caspase inhibitors. The inhibitors did not affect the incidence of phosphatidylserine exposure in the blastomere of the treated embryos.

CONCLUSION(S)

Cytoplasmic fragmentation in precompaction mouse embryos is not a consequence of caspase-related apoptosis.

A comparative study of gene expression in murine embryos developed in vivo, cultured in vitro, and cocultured with human oviductal cells using messenger ribonucleic acid differential display

The objectives of this study were to compare the mRNA expression patterns in early mouse embryos in different culture conditions by differential display reverse transcription-polymerase chain reaction (DDRT-PCR). Embryos developed in vivo, cultured in vitro, and cocultured with human oviductal epithelial cells were studied at the 2-cell, 4-cell, 8-cell/morula, and blastocyst stages. Messenger RNA profiles were displayed by DDRT-PCR using downstream T11VV (V = A, C, or G) and upstream decamer primers. Total cDNA banding patterns were highly conserved in the three groups studied. Some fragments are unique in different culture conditions. Thirteen out of the 40 selected differentially expressed clones were characterized. The DNA sequence analyses of these clones displayed high sequence homology with cDNA sequences in the mouse expressed sequence tag database. Using semiquantitative RT-PCR, we confirmed differential expression of these DD amplicons in the three groups of embryos. The temporal expression of some of the selected DD amplicons during preimplantation development were studied in the three groups of embryos. In conclusion, DDRT-PCR is an effective tool for contrasting gene expression patterns and characterizing mRNA transcripts in mouse embryo.

In vitro fertilization and embryo transfer during natural cycles

OBJECTIVE

To report the results of in vitro fertilization and embryo transfer (IVF/ET) performed during natural cycles.

STUDY DESIGN

A prospective clinical study.

RESULTS

Thirty-two cycles were started in 19 patients who had regular ovulatory cycles and tubal factors or unexplained infertility only as the cause of infertility. Egg collection was performed in 12 cycles, and four pregnancies resulted from ET in eight cycles. The pregnancy rates were 12.5% per cycle initiated, 33.3% per retrieval cycle and 50% per transfer.

CONCLUSION

Natural cycle IVF/ET offers a low-cost alternative to patients with infertility.

HMG is as good as recombinant human FSH in terms of oocyte and embryo quality: a prospective randomized trial

Previous studies have demonstrated that the use of recombinant human follicle stimulating hormone (rhFSH) for ovarian stimulation may be associated with a better outcome than human menopausal gonadotrophin (HMG), probably due to the absence of LH, higher FSH bioactivity and better quality of oocytes and embryos when rhFSH is used. Very few studies have examined the effects of different gonadotrophins on oocyte and embryo quality. In this prospective study, 40 women undergoing ovarian stimulation for intracytoplasmic sperm injection were randomized to receive a standard protocol of either HMG or rhFSH in down-regulated cycles. Prior to microinjection, each denuded oocyte was videotaped to assess nuclear maturity, morphology of zona pellucida, oocyte and polar body and the zona thickness, and diameters of oocyte and ooplasma. Fertilization and subsequent embryo development of each oocyte were followed. The embryologists were blind to the type of gonadotrophin each patient had received for stimulation. No significant differences were found between the two groups with regard to the demographic data, the ovarian responses and pregnancy/implantation rates. The percentage of metaphase II oocytes in the HMG and rhFSH groups were similar (86.9 versus 87.4% respectively). All other parameters assessing oocyte and embryo quality were also comparable between the two groups.

Human oviductal cells reduce the incidence of apoptosis in cocultured mouse embryos

OBJECTIVE

To investigate the effect of human oviductal cell coculture on the incidence of apoptosis in mouse embryos.

DESIGN

Experimental laboratory study.

SETTING

University gynecology unit.

PATIENT(S)

Fallopian tubes were obtained from patients undergoing hysterectomy.

INTERVENTION(S)

Mouse embryos were cocultured with human oviductal cells.

MAIN OUTCOME MEASURE(S)

Blastocyst development, allocation of inner cell mass (ICM) and trophectoderm (TE) in blastocyst, and apoptosis in embryos.

RESULT(S)

Oviductal cells significantly enhanced the blastulation (38%) and hatching rate (22%) of the cocultured zygotes. The corresponding values in medium alone culture were 21% and 9%, respectively. The cocultured embryos also had higher blastomere count at blastocyst stage (P<0. 005). This was due to increase in both the cell count of ICM (P<0. 05) and TE (P<0.001). Coculture reduced the incidence of apoptosis in the cultured morula and blastocyst from 38% and 48% to 16% (P<0. 001) and 27% (P<0.05), respectively. The number of apoptotic blastomeres per morula (1.5 +/- 0.6; P<0.005) and blastocyst (2.3 +/- 0.7; P<0.005) after coculture was also significantly lower than that of the corresponding control (morula, 2.1 +/- 0.8; blastocyst, 3.5 +/- 1.1).

CONCLUSION(S)

Human oviductal cells improved mouse embryo development partly by decreasing the incidence of apoptosis.

Comparison of two dosages of recombinant human follicle-stimulating hormone in Chinese women undergoing controlled ovarian stimulation: prospective randomised double-blind study

OBJECTIVE

To compare two dosages of recombinant human follicle-stimulating hormone for controlled ovarian stimulation.

DESIGN

Prospective, randomised double-blind study.

SETTING

Tertiary assisted reproduction unit, Hong Kong.

PARTICIPANTS

Forty subfertile Chinese women aged 24 to 38 years undergoing in vitro fertilisation. Entry criteria included good physical and mental health, and a body mass index between 18 and 29 kg/m2. Exclusion criteria were subfertility caused by an endocrine abnormality, polycystic ovarian syndrome, or absent ovarian function; previous assisted reproduction treatment in which fewer than three oocytes were retrieved; prior hospitalisation due to severe ovarian hyperstimulation syndrome; chronic cardiovascular, hepatic, renal, or pulmonary disease; alcohol or drug abuse; and the administration of investigational drugs within the previous 3 months.

INTERVENTION

Injection of recombinant follicle-stimulating hormone, 100 IU/d or 200 IU/d.

MAIN OUTCOME MEASURES

The number of oocytes, total dose of drug used, and pregnancy rates.

RESULTS

Compared with the 20 women receiving 200 IU/d, the 20 who received 100 IU/d had a significantly lower median number of oocytes retrieved and median total dose of drug used (7.5 versus 15.0 [P<0.001] and 1200 IU versus 2000 IU [P<0.001], respectively). The pregnancy rates in the fresh cycles were similar (20%) in both groups, but the cumulative pregnancy rates in the 100 IU/d and 200 IU/d groups were 20.0% and 45.0% per stimulated cycle, respectively. The incidence of ovarian hyperstimulation syndrome in the 100 IU/d and 200 IU/d groups was 5.0% and 20.0%, respectively.

CONCLUSIONS

Use of 100 IU/d of recombinant follicle-stimulating hormone requires a lower total dose but results in the harvest of half the number of oocytes compared with when a dosage of 200 IU/d is used.

Suppression subtractive hybridization identifies genes expressed in oviduct during mouse preimplantation period

Fertilization and development of mouse embryos occur in the ampullae of oviduct. Various growth factors and embryotrophic factors produced by the oviductal cells have been demonstrated to enhance embryo development in vitro. As a step towards understanding the genetic changes of mouse oviduct during mouse embryos preimplantation period, we adopted suppression subtractive hybridization (SSH) to establish four subtracted cDNA libraries to identify (1) oviduct-expressing genes, and (2) genes that may support embryo development in vivo. Using this method, we isolated 82, 88, 99, and 109 clones from four mouse libraries prepared from 0 (day 0), 24 (day 1), 48 (day 2), and 72 h (day 3) post-human chorionic gonadotropin (hCG) treated mice. Reverse dot-blot analysis confirmed that 25 (day 0), 24 (day 1), 40 (day 2), and 29 (day 3) clones were highly expressed in mouse oviduct when compared to other tissues. DNA sequence analysis identified genes encoding mouse oviduct-specific glycoprotein (MOGP), actin-binding protein 280, and several viral genes. Northern analysis confirmed that the genes were mainly expressed in oviduct, with some viral genes also expressed in uterus. About 9% of these oviduct expressing clones (11/118) were novel. We further demonstrated that one of the novel clones ODEG0-17 was expressed in the oviduct during early embryo preimplantation period and rarely in other tissues by RT-PCR. Our results show that SSH is a powerful method applicable to identifying tissue-specific transcripts on fertilization and development.

Deletions within the azoospermia factor subregions of the Y chromosome in Hong Kong Chinese men with severe male-factor infertility: controlled clinical study

OBJECTIVE

To determine the patterns and the prevalence of microdeletions in the azoospermia factor subregions of the Y chromosome in Hong Kong Chinese men with severe male-factor infertility.

DESIGN

Controlled clinical study.

SETTING

Reproductive centre of a university teaching hospital, Hong Kong.

PARTICIPANTS

Fifty-eight men with severe male-factor infertility who participated in the in vitro fertilisation programme from May 1998 through March 1999, and 46 male volunteers with proven fertility.

MAIN OUTCOME MEASURES

Polymerase chain reaction analysis of DNA from peripheral blood lymphocytes using six loci spanning the AZFa, AZFb, and AZFc subregions of the Y chromosome. RESULTS. No microdeletions were detected in the fertile controls or in patients with obstructive azoospermia. Deletions within the AZFc subregion were found in 9% (4/44) of men with non-obstructive azoospermia or severe oligospermia. Neither AZFa nor AZFb deletions were detected in any participants.

CONCLUSION

Deletions within the azoospermia factor subregions of the Y chromosome are associated with severe male-factor infertility in Hong Kong Chinese men.

Laboratory aspects of assisted reproduction

A number of advances have been made concerning the laboratory aspects of assisted reproduction. Intracytoplasmic sperm injection has revolutionised the treatment of male infertility. With the development of better embryo culture media, blastocyst transfer is now possible and is likely to reduce high-order multiple pregnancy in assisted reproduction treatment. Pre-implantation genetic diagnosis has become an alternative to prenatal diagnosis. The recent use of molecular biology techniques to detect small genetic defects in men with severe male-factor infertility has provided information for the better counselling of these patients. Other techniques that are being developed are likely to have a tremendous impact on assisted reproduction treatment. These include in vitro maturation, follicle culture, and oocyte/ovarian tissue cryopreservation. The current status of the developments in the laboratory aspects of assisted reproduction is reviewed in this article.

The effect of ageing on female fertility in an assisted reproduction programme in Hong Kong: retrospective study

OBJECTIVE

To analyse the effect of ageing on female fertility in an in vitro fertilisation programme in Hong Kong.

DESIGN

Retrospective study.

SETTING

University teaching hospital, Hong Kong.

PATIENTS

Seven hundred and seventy-one women in whom 1336 cycles of in vitro fertilisation were initiated between 1 January 1986 and 31 December 1995.

MAIN OUTCOME MEASURES

Patient age and indications for treatment; hormonal response; and the number of cancelled cycles, oocytes retrieved, oocytes fertilised, cleaving embryos, embryos transferred, and clinical pregnancies.

RESULTS

Compared with women aged <or =30 years (n=193), women aged > or =36 years (n=398) had a significantly higher cycle cancellation rate (19.3% versus 10.4%), fewer oocytes retrieved per retrieval cycle (6.6 versus 9.0), fewer oocytes fertilised per retrieval cycle (5.0 versus 7.0), fewer cleaving embryos per retrieval cycle (4.8 versus 6.8), and lower serum oestradiol level (9735 [standard deviation, 5681] pmol/L versus 10 708 [5916] pmol/L) despite a larger amount of human menopausal gonadotrophin having been used (all variables, P<0.01; Chi squared test). The clinical pregnancy rate per initiated cycle (range, 7.5%-13.0%) decreased with advancing age (P<0.01; Chi squared test).

CONCLUSION

Ageing has a significant deleterious effect on women's reproductive capability. Women should be encouraged to seek early medical advice and treatment for subfertility.

Effects of human follicular fluid on the capacitation and motility of human spermatozoa

OBJECTIVE

To investigate the capacitation and motility kinetics of spermatozoa treated with human follicular fluid (FF).

DESIGN

Controlled, experimental laboratory study.

SETTING

University-based gynecology unit.

PATIENT(S)

Human FF was collected from women undergoing assisted reproductive treatment. Semen samples were obtained from men visiting subfertility clinics.

INTERVENTION(S)

Spermatozoa were incubated with human FF under various experimental conditions. Spermatozoa incubated with Earle's balanced salt solution were used as the control.

MAIN OUTCOME MEASURE(S)

Chlortetracycline staining patterns and sperm motility parameters.

RESULT(S)

The rate of capacitation in the human FF-treated spermatozoa was significantly higher than that in the control spermatozoa after 1 hour and 3 hours of treatment. The percentage of acrosome-reacted spermatozoa also was significantly higher after human FF treatment than after control treatment. These effects of human FF were dose-dependent. Human FF-treated spermatozoa maintained their velocities at the zero-hour level for 5 hours, whereas the velocities of the control spermatozoa decreased significantly after 1 hour. Human FF treatment significantly increased the beat cross-frequency above the rate at zero hour for 5 hours. The hyperactivation of the human FF-treated spermatozoa remained stable for 3 hours, whereas that of the control spermatozoa decreased significantly after 1 hour of incubation. Significantly more human FF-treated spermatozoa underwent hyperactivation than did control spermatozoa after 1 hour and 3 hours of treatment. The effects of human FF on beat cross-frequency and hyperactivation were dose-dependent.

CONCLUSION(S)

Human FF promotes capacitation and the acrosome reaction within a short period. It also stimulates or maintains various sperm motility parameters.

Adverse effects of hydrosalpinx fluid on sperm motility and survival

The negative impact of hydrosalpinx on IVF outcome is well recognized but some reports indicate that tubal infertility with hydrosalpinx is a heterogeneous entity and may have different effects on the outcome. The embryotoxic effects of hydrosalpinx fluid (HF) have been documented in mouse but not human embryos. This study examined the effects of HF on sperm motility and survival after various periods of incubation. Fifteen infertile patients with hydrosalpinx shown on ultrasound monitoring during ovarian stimulation underwent aspiration of HF after egg collection. Electrolytes, glucose and pyruvate concentrations were within the physiological ranges found in normal human tubal fluid. Sperm motility and velocities remained unchanged after 5 h of incubation with various concentrations of HF but the percentage of motile spermatozoa was significantly reduced after 24 h of incubation. Both 50 and 100% HF were potentially cytotoxic (survival indices <85%). The detrimental effect seemed to be dependent on the concentrations of HF. Low osmolarity, low lactate concentrations or the protein content may be responsible for the loss of sperm motility. A human sperm survival test using HF may be useful in selecting appropriate treatment options for patients with hydrosalpinx undergoing IVF treatment or tubal surgery.

Human oviductal cells produce a factor(s) that maintains the motility of human spermatozoa in vitro

OBJECTIVE

To characterize in part the factor(s) in conditioned medium (CM) that maintains sperm motility after human oviductal cell culture.

DESIGN

Controlled, experimental, laboratory study.

SETTING

University-based gynecology unit.

PATIENT(S)

Fallopian tubes were obtained from patients who underwent tubal ligation or hysterectomy. Semen with normal sperm parameters was obtained from men who visited subfertility clinics.

INTERVENTION(S)

Spermatozoa were incubated with CM and their motility was evaluated by a computer-aided sperm analysis system.

MAIN OUTCOME MEASURE(S)

Curvilinear velocity, straight-line velocity, average path velocity, linearity, amplitude of lateral head displacement, beat cross-frequency, and percentage of spermatozoa that exhibited hyperactivation.

RESULT(S)

Compared with their baseline motility (0 hour), spermatozoa incubated with CM maintained various motility parameters for a longer period than did control spermatozoa. All the motility parameters of the CM-treated spermatozoa were higher than those of the control spermatozoa at the same time point. This effect of CM was dose-dependent and increased with the duration of incubation. The effect was stable at 56 degrees C but was not observed after 100 degrees C heat treatment. Trypsin, but not proteinase K, abolished the effect. A fraction with a molecular weight of <3 kd in the CM was responsible for the observed effect.

CONCLUSION(S)

Human oviductal cells produce a peptide(s) that maintains sperm motility.

High serum oestradiol concentrations in fresh IVF cycles do not impair implantation and pregnancy rates in subsequent frozen-thawed embryo transfer cycles

High oestradiol concentrations may be detrimental to the success of in-vitro fertilization (IVF) treatment. A total of 1122 women aged <40 years who were undergoing their first IVF cycle were evaluated retrospectively. Serum oestradiol concentrations on the day of human chorionic gonadotrophin (HCG) administration were categorized into three groups: group A <10 000 pmol/l; group B 10 000-20 000 pmol/l and group C >20 000 pmol/l. In fresh cycles, group A had significantly lower pregnancy rates per transfer (16.2 versus 23.7% respectively, P = 0.005, chi(2)) and implantation rates (8.7 versus 11.7% respectively, P = 0.037, chi(2)), when compared with group B. The pregnancy rate per transfer in group C was significantly lower than that in group B (12.1 versus 23.7%, P = 0.049, chi(2)) and group C had the lowest implantation rate (6.4%). In frozen-thawed embryo transfer cycles, implantation rates in groups A, B and C were similar (7.5, 8.1 and 9.6% respectively) and the pregnancy rates were also comparable in all groups. In conclusion, high serum oestradiol concentrations in fresh IVF cycles may adversely affect implantation and pregnancy rates. Embryo quality seemed unaffected as excess embryos from different groups had similar implantation and pregnancy rates in frozen-thawed embryo transfer cycles. The reduced implantation was probably due to an adverse endometrial environment resulting from high serum oestradiol concentrations.

Changes in p21WAF1, pRb, Mdm-2, Bax and Bcl-2 expression in cervical cancer cell lines transfected with a p53 expressing adenovirus

The aim of this study was to provide some insights into the molecular mechanisms involved in p53-dependent apoptosis and growth arrest. Changes in the levels of p53 protein and proteins regulated by p53 were studied in relation to events of the cell cycle and apoptosis in cervical cancer cell lines upon transfection with a p53 expressing adenovirus (Ad5-p53). The post-transfection level of p53 protein in SiHa cells was found to be unchanged during the 24-48 h period. In contrast, the level of p21WAF1 protein was shown to increase to its highest level at 24 h, and decreased gradually up to 48 h after the Ad5-p53 transfection. We further noted that the increase of p21WAF1 was accompanied by G1 arrest at 24 h and the decrease of p21WAF1 was associated with apoptosis at 36-48 h after transfection. An anti-p21WAF1 antibody cross-reactive protein band of approximately 14 kDa was observed in HeLa and C-33A cells when these cells were committed to apoptosis upon Ad5-p53 transfection. In SiHa cells, phosphorylation of pRb was inhibited during the early stage of Ad5-p53 transfection. This was followed by the cleavage of pRb. However, Ad5-p53 transfection did not change the levels of Bax and Bcl-2 proteins. Our results suggested that, Bax and Bcl-2 may not be important for the apoptosis of these cells, whereas cleavage of Rb, and the decrease of p21WAF1 could play important roles in p53-dependent apoptosis.

Effects of human follicular fluid on spermatozoa that have been cocultured with human oviductal cells

OBJECTIVE

To investigate the sequential effects of human oviductal cells and human follicular fluid (hFF) on various sperm functions.

DESIGN

Laboratory experimental study.

SETTING

University gynecology unit.

PATIENT(S)

Fallopian tubes were from patients undergoing tubal ligation or hysterectomy. Semen was from men attending the subfertility clinics.

INTERVENTION(S)

Spermatozoa were treated with [1] 6 hours in Earle's balanced salt solution (EBSS-BSA; control); [2] 5 hours in EBSS-BSA and 1 hour with hFF (hFF); [3] 5 hours with oviductal cells and 1 hour in EBSS-BSA (coculture); and [4] 5 hours with oviductal cells and 1 hour with hFF (sequential).

MAIN OUTCOME MEASURE(S)

Motility, acrosome reaction, zona binding, and oocyte fusion.

RESULT(S)

Groups II and III spermatozoa had similar motility and were better than that of group I. Group IV displayed higher motility parameters than the other groups. Human follicular fluid induced acrosome reaction. The incidence of acrosome reaction in group IV was significantly lower than that in group II. Group III did not affect the acrosome reaction. Spermatozoa in groups II-IV had lower zona binding capacity than those in group I. Human follicular fluid stimulated oocyte penetration, whereas oviductal cells suppressed this effect of hFF.

CONCLUSION(S)

Oviductal cells maintained the fertilizing capacity of spermatozoa, whereas hFF facilitated the fertilization process of oviductal spermatozoa.

How good are accident and emergency doctors in the evaluation of psychiatric patients?

The aim of this study was to find out the agreement between psychiatrists and emergency department (ED) doctors in the diagnosis and treatment of psychiatric emergencies. All patients presenting with a psychiatric complaint and who were subsequently referred to the psychiatrist were included. A standard form was used to collect demographic data, provisional diagnoses and initial treatment by ED doctors, diagnoses by psychiatrists, and compatibility of ED diagnoses and treatment as judged by consulting psychiatrists. The mean age of the 223 patients enrolled was 36.5 years and the distribution between males and females was roughly equal. The most frequent presentations were aggressive behaviour (27.9%), depressive mood (13.5%) and suicidal idea (12.1%). Schizophrenia (39%) was the most common diagnosis followed by depression (20%) and adjustment disorders (9.5%). The agreements between psychiatrists and ED doctors in diagnosis and treatment were 61.4% and 89.5% respectively. Schizophrenia and bipolar disorders were least likely to be mis-classified. It is concluded that ED doctors were deficient in the diagnosis of psychiatric conditions especially in the less common diagnostic categories.

Separation of bovine serum albumin and its monoclonal antibody from their immunocomplexes by sodium dodecyl sulfate-capillary gel electrophoresis and its application in capillary electrophoresis-based immunoassay

A non-competitive immunoassay was performed by sodium dodecyl sulfate-capillary gel electrophoresis with UV detection using bovine serum albumin (BSA) and monoclonal anti-BSA. BSA, anti-BSA and their immunocomplexes were well resolved under non-denaturing conditions. A linear calibration curve was obtained and can be used for the quantification of anti-BSA. The limit of detection of anti-BSA was 0.1 microM under the present conditions. Compared with capillary zone electrophoresis, we believed that this method has the potential to be used as a more general format for performing capillary electrophoresis-based immunoassay of medium- and large-sized analytes.

Maternal serum alpha-fetoprotein and human chorionic gonadotrophin in pregnancies conceived after intracytoplasmic sperm injection and conventional in-vitro fertilization

Data in the Caucasian population suggest that maternal serum alpha-fetoprotein (AFP) and unconjugated oestriol concentrations are reduced and human chorionic gonadotrophin (HCG) concentrations are elevated in pregnancies conceived after in-vitro fertilization (IVF), leading to a higher than expected Down's syndrome screen-positive rate. There are no previous reports on the serum marker values in pregnancies conceived after intracytoplasmic injection (ICSI). Between 1996 and 1998, we measured maternal serum total HCG and AFP concentrations between 15 and 20 weeks gestation in 42 in-vitro fertilization (IVF) pregnancies and 23 ICSI pregnancies with known normal outcome. The results were compared with that of 2799 naturally occurring singleton pregnancies who were known to have a normal outcome. Median AFP multiple of the median (MOM) in ICSI pregnancies was significantly reduced to 0.76 compared with both that of the controls and that of the IVF pregnancies. For the IVF pregnancies, median HCG MOM was elevated to 1.15, and median AFP MOM was reduced to 0.88 compared with the controls, but these differences were not statistically significant. In both the IVF and ICSI pregnancies the changes might result in a falsely high Down's syndrome risk. In particular, the reduced AFP concentration in ICSI pregnancies was substantial. If this preliminary finding is substantiated by other series, the appropriate adjustment needs to be made to allow for valid interpretation of the screen result and to avoid an unnecessarily high false positive rate.

Noncompetitive immunoassays using protein G affinity capillary chromatography and capillary electrophoresis with laser-induced fluorescence detection

A new and simple approach to perform immunoassay using protein G affinity capillary chromatography and laser-induced fluorescence detection was described. A noncompetitive assay for monoclonal anti-bovine serum albumin (BSA) was used to test the performance of the system. Fluorescein isothiocyanate labeled BSA was used as a tracer to determine anti-BSA in pM level. Capillaries with inner diameter of 150 microns were packed with recombinant protein G-bound perfusive support. The packed capillary was used to capture the immunocomplexes, which were subsequently desorbed by 100 mM glycine (pH 9.0). Open tube capillary electrophoresis-based immunoassay (CEIA) for anti-BSA was also performed. Using standard samples, calibration curves for anti-BSA was established in both assays. Compared with CEIA, this system improved the concentration sensitivity for about 100-fold due to the pre-concentration of immunocomplex in the protein G column, while the mass sensitivity was similar in the two methods.

Differential expression of gap-junction gene connexin 31 in seminiferous epithelium of rat testes

Spermatogenesis, a tightly regulated developmental process of male germ cells in testis, is associated with temporal and spatial expression of certain gap-junction connexins. Our findings by RT-PCR indicate that the Cx31 gene is expressed in testis tissue of adult and postnatal rats. During the postnatal spermatogenic process, the Cx31-specific signal became detectable at 15 dpp and onward by in situ hybridization, and apparently localized in the basal compartment of seminiferous epithelium where active spermatogonia and early primary spermatocytes reside. No signal was found in the luminal region. In adult testes, spermatids of elongation phase were also Cx31 positive. Immunohistochemical analysis with mouse anti-Cx31 antibody gave a similar staining pattern, providing further evidence that the gap-junction protein is abundant in the basal seminiferous epithelium, in accordance with the cellular distribution of Cx31 mRNA. These results represent the first demonstration of Cx31 expression at both transcriptional and protein levels in the seminiferous epithelium of rat testes. Thus, Cx31 may play a role in cell-cell communication during spermatogenesis.

Use of capillary electrophoresis-based competitive immunoassay for a large molecule

A systematic study on the optimization of capillary electrophoresis-based immunoassay (CEIA) was performed using bovine serum albumin (BSA) and monoclonal anti-BSA. The immunocomplex could not be resolved from free BSA or anti-BSA with UV detection. When fluorescein isothiocyanate-labeled BSA (FITC-BSA) was used as tracer, the free and bound FITC-BSA were well separated giving definite peaks with laser induced fluorescence detection. The factors affecting the separation of the free and bound FITC-BSA, including voltage, pH and ionic strength of the running buffer, were systematically analyzed. Competitive CEIAs were demonstrated in uncoated and coated capillaries with whole or Fab fragment of the antibody. The coefficient of variation for the quantification of BSA in coated capillary was less than that in uncoated capillary. This study demonstrated that competitive CEIA could be applied to quantify high-molecular-mass protein in biological fluids.

Effects of human oviductal cell coculture on various functional parameters of human spermatozoa

OBJECTIVE

To investigate the effect of human oviductal cells on various sperm functions in vitro.

DESIGN

Controlled experimental laboratory study.

SETTING

University gynecology unit.

PATIENT(S)

Women undergoing tubal ligation or hysterectomy and men who were visiting our subfertility clinics.

INTERVENTION(S)

Coculture of oviductal cells with human spermatozoa in vitro; sperm functions were determined after coculture.

MAIN OUTCOME MEASURE(S)

Capacitation, acrosome reaction, zona binding, and oocyte fusion.

RESULT(S)

Oviductal cells and conditioned medium induced more spermatozoa to capacitate than did control medium. Although there was no difference in the spontaneous acrosome reaction between any of the groups, the coculture group had a lower percentage of acrosome-reacted spermatozoa after calcium ionophore challenge than did the control and conditioned medium groups. Coculture and conditioned medium treatment reduced the number of spermatozoa bound to the zona pellucida. The penetration rate and penetration index of the control spermatozoa in the zona-free hamster oocyte penetration test were significantly higher than that of the cocultured or conditioned medium-treated spermatozoa.

CONCLUSION(S)

Human oviductal cells promoted capacitation, stabilized the acrosome, and suppressed binding to the zona pellucida and fusion with the oocyte in vitro.

Use of physical restraints on elderly patients: an exploratory study of the perceptions of nurses in Hong Kong

A qualitative study was designed to explore nurses' perceptions of the use of physical restraints on elderly patients in Hong Kong. Content analysis of semi-structured interviews with 20 registered nurses working in medical and geriatric settings of two regional hospitals revealed that although nurses generally had mixed feelings about the use of physical restraints on elderly patients, they did not question this 'routine' practice and their knowledge about the consequences and alternatives to the use of restraint was limited. It was found that nurses had an overriding concern in ensuring elderly patients' physical safety and using restraints therefore provided them with a sense of security. The deleterious impact of restraint on the care received by elderly patients was largely unrecognized. Implications for practice and future studies are discussed in the light of these findings.

Glycoproteins present in human follicular fluid that inhibit the zona-binding capacity of spermatozoa

Previous studies have suggested that human follicular fluid contains factors that reduce the zona-binding capacity of spermatozoa. The present study provides further evidence of the existence of such factors. Using the hemizona binding assay (HZA), we have shown that the inhibitory effect of human follicular fluid on the zona-binding capacity of spermatozoa is concentration-dependent, an inhibitory effect being detected when the concentration of human follicular fluid was > or = 10%. A 1% concentration of human follicular fluid did not possess this inhibitory activity. Heating human follicular fluid at 56 degrees C for 30 min did not affect its inhibitory properties; treatment with proteinase-K abolished such inhibition. Human follicular fluid was fractionated sequentially by concanavalin-A affinity chromatography, Mono Q ion-exchange chromatography and Superose-12 gel filtration. The zona binding inhibitory activity resided in the fraction which bound to the lectin and Mono Q column and contained molecules with native molecular weights of 32 and 192 kDa. Sodium dodecyl sulphate-polyacrylamide gel electrophoresis analysis suggested that the 192 kDa glycoprotein was a tetramer, while the 32 kDa glycoprotein remained as a single molecular species under denaturing conditions. We conclude that two glycoproteins were responsible for the zona binding inhibitory activity of human follicular fluid. The physiological role of these factors remains unclear.

Partial purification of embryotrophic factors from human oviductal cells

Embryotrophic factors from human oviductal cells were partially purified by liquid chromatographic methods. The conditioned medium from human oviductal cell culture was fractionated successively by concanavalin A (Con-A) affinity chromatography, ion-exchange chromatography and gel filtration. The presence of the embryotrophic activity in the eluates was determined by the stimulatory effects on the development of mouse embryos in vitro. The fraction that did not bind to the lectin Con-A possessed no embryotrophic activity. Ion-exchange chromatography separated the glycoproteins that bound to Con-A into five fractions. Three of them significantly enhanced blastulation as well as conceptus formation. Gel filtration further separated these embryotrophic fractions into five fractions. Three of them with molecular weights of 154 +/- 1, 164 +/- 0.2 and 207 +/- 0.3 kDa significantly stimulated blastulation of mouse embryos. The results of this study demonstrated that several embryotrophic factors with different biochemical properties contributed to the embryotrophic effect of the human oviductal cell/mouse embryo co-culture system.

Molecular characterization of seven Chinese isolates of infectious bursal disease virus: classical, very virulent, and variant strains

Seven infectious bursal disease virus (IBDV) strains isolated from China have been characterized in this study, including a classical strain CJ801, an attenuated strain GZ911, a variant strain GZ902, and four very virulent strains G9201, G9302, F9502, and HK46. With the use of reverse transcription-polymerase chain reaction, the full-length VP2 genes were amplified and the hypervariable regions were sequenced. Protein sequences of the hypervariable region (a.a. 143-382) of the field isolates confirmed their identities. CJ801 has the highest identity to the classical strains STC and 52/70. GZ902 has the highest identity to the American variant strains A, E, and GLS, and they share unique amino acid residue at positions 249K and 254S, which are not present in standard serotype 1 strains. Attenuated strain GZ911, like other cell culture-adapted strains, has substitutions at positions 279(D to N) and 284 (A to T) as well as in the serine-rich heptapeptide region. Hence, these substitutions may take an important role in the reduced virulence of these strains. The four very virulent strains have the highest identity to the European very virulent strain UK661 and Japanese strain OKYM. These strains share unique amino acid residues at positions 222A, 256I, and 294I, which are not present in other less virulent strains. The very virulent strains isolated in Guangdong (G9201, G9303) and Fujian (F9502) Provinces have one to five amino acid substitutions at the two hydrophilic domains of VP2 comparing with UK661 and OKYM, indicating that new very virulent strains are evolving. Phylogenetic analysis suggests that Chinese very virulent IBDVs and European very virulent strains are derived from similar origin.

A prospective randomized control study to compare the effect of serum and a commercial serum substitute (Plasmanate) on the outcome of assisted reproduction program

OBJECTIVES

To compare the effect of supplementation of serum and Plasmanate, a commercial serum substitute, to culture medium on the IVF outcome.

METHODS

One hundred eighty-nine subfertile couples were prospective randomized into the serum and the Plasmanate group during their IVF treatment. In vitro experiment was also performed to determine the fraction of Plasmanate that might affect embryo development.

RESULTS

The pregnancy rate were similar in both groups. The fertilization rate, the number of gestational sacs and good quality spare embryos suitable for cryopreservation were higher in the serum group than the Plasmanate group. However, these differences did not reach statistical significance. Significantly more embryos in the former cleaved to more than 4 cells at the time of transfer than the latter (p < 0.05). Ultrafiltration study showed that this inhibitory effect resided in the low molecular weight fraction (< 30-KD) of Plasmanate.

CONCLUSION

Serum is slightly better than Plasmanate as a protein supplement. However, Plasmanate may still be used for short term embryo culture in assisted reproduction.