Struggling with issues about cardiopulmonary resuscitation (CPR) for end-stage heart failure patients

BACKGROUND

Integrating heart failure and palliative care teams combines unique expertise from both cardiology and palliative care. However, professionals from the two arenas of life-saving cardiology and palliative care may well have different experiences with and approaches to patient care. Little is known how to optimally discuss cardiopulmonary resuscitation with patients and their relatives and what challenges are for healthcare providers.

OBJECTIVE

The aim of this study was to describe the experiences and thoughts of members of an integrated heart failure and palliative care team concerning talking about CPR with end-stage heart failure patients.

METHOD

We used a descriptive qualitative design, conducting group interviews during 2011 with professionals from different disciplines working with heart failure patients over a 1-year period. A qualitative content analysis was performed to examine the interview data.

RESULTS

Professional caregivers in integrated heart failure and palliative homecare are struggling with the issue of CPR of end-stage heart failure patients. They wrestle with the question of whether CPR should be performed at all in these terminally ill patients. They also feel challenged by the actual conversation about CPR with the patients and their relatives. Despite talking them about CPR with patients and relatives is difficult, the study participants described that doing so is important, as it could be the start of a broader end-of-life conversation.

CONCLUSION

Talking with patient and relatives about CPR in end-stage heart failure, as suggested in the current heart failure guidelines, is a challenge in daily clinical practice. It is important to discuss the difficulties within the team and to decide whether, whom, how and when to talk about CPR with individual patients and their relatives.

Effects of person-centred and integrated chronic heart failure and palliative home care. PREFER: a randomized controlled study

AIMS

We evaluated the outcome of person-centred and integrated Palliative advanced home caRE and heart FailurE caRe (PREFER) with regard to patient symptoms, health-related quality of life (HQRL), and hospitalizations compared with usual care.

METHODS AND RESULTS

From January 2011 to October 2012, 36 (26 males, 10 females, mean age 81.9 years) patients with chronic heart failure (NYHA class III-IV) were randomized to PREFER and 36 (25 males, 11 females, mean age 76.6 years) to the control group at a single centre. Prospective assessments were made at 1, 3, and 6 months using the Edmonton Symptom Assessment Scale, Euro Qol, Kansas City Cardiomyopathy Questionnaire, and rehospitalizations. Between-group analysis revealed that patients receiving PREFER had improved HRQL compared with controls (57.6 ± 19.2 vs. 48.5 ± 24.4, age-adjusted P-value = 0.05). Within-group analysis revealed a 26% improvement in the PREFER group for HRQL (P = 0.046) compared with 3% (P = 0.82) in the control group. Nausea was improved in the PREFER group (2.4 ± 2.7 vs. 1.7 ± 1.7, P = 0.02), and total symptom burden, self-efficacy, and quality of life improved by 18% (P = 0.035), 17% (P = 0.041), and 24% (P = 0.047), respectively. NYHA class improved in 11 of the 28 (39%) PREFER patients compared with 3 of the 29 (10%) control patients (P = 0.015). Fifteen rehospitalizations (103 days) occurred in the PREFER group, compared with 53 (305 days) in the control group.

CONCLUSION

Person-centred care combined with active heart failure and palliative care at home has the potential to improve quality of life and morbidity substantially in patients with severe chronic heart failure.

TRIAL REGISTRATION

NCT01304381.

Occupational performance and strategies for managing daily life among the elderly with heart failure

AIM

The aim of this study was to describe experiences of limitations in occupational performance and strategies for managing daily activities among the elderly with chronic heart failure (CHF).

METHODS

Ten participants from primary healthcare with a confirmed diagnosis of CHF were interviewed. The interviews were analysed using qualitative content analysis.

RESULTS

The first theme, "Redefining an active life, aware of one's impaired body", was based on four sub-themes: realizing one's limited activity ability; striving to preserve an active life; focusing on meaningful activities; and changing vs. not changing habits and roles. The second theme, "Planning activities and balancing the degree of effort", was based on three sub-themes: limiting, organizing, and rationalizing activities; adjusting activities to today's ability; and using technology and adapting the environment.

CONCLUSIONS

Elderly people with CHF are struggling with an ongoing process of occupational adaptation due to periodical physical decline and fluctuating day-to-day ability. This highlights a need for information on strategies from a holistic perspective and client-centred occupational therapy interventions.

Preclinical report on allogeneic uterus transplantation in non-human primates

STUDY QUESTION

Is it possible to perform allogeneic uterus transplantation (UTx) with a donation from a live donor in a non-human primate species and what immunosuppression is needed to prevent rejection?

SUMMARY ANSWER

Allogeneic UTx in the baboon is a donor- and recipient-safe surgical procedure; immunosuppression with induction therapy and a triple protocol should be used.

WHAT IS KNOWN ALREADY

UTx may become a treatment for absolute uterine factor infertility. Autologous UTx models have been developed in non-human primates with reports on long-term survival of the uterine grafts. STUDY DESIGN, SIZEAND DURATION: This experimental study included 18 female baboons as uterus donors and 18 female baboons as uterus recipients. The follow-up time was 5-8 weeks.

PARTICIPANTS/MATERIALS, SETTING AND METHODS

Uterus retrieval was performed with extended hysterectomy including bilateral uterine and internal iliac arteries and ovarian veins. After UTx, with vascular anastomoses unilateral to the internal iliac artery and the external iliac vein, the uterus recipients received one of the following: no immunosuppression (n = 4); monotherapy (oral slow release tacrolimus) (n = 4) or induction therapy (antithymocyte globulin) followed by triple therapy (tacrolimus, mycophenolate, corticosteroids; n = 10). Surgical parameters, survival, immunosuppression and rejection patterns were evaluated.

MAIN RESULTS AND THE ROLE OF CHANCE

The durations of uterus retrieval and recipient surgery were around 3 and 3.5 h, respectively. The total ischemic time was around 3 h. All the recipients and the donors survived the surgery. All the recipients presented rejection to some extent within the first weeks following UTx. In one recipient, the uterus was of normal appearance at the end of the study period. In spite of occasional high (>60 ng/ml) blood levels of tacrolimus, there was no evidence of nephrotoxicity.

LIMITATIONS AND REASONS FOR CAUTION

This initial non-human primate allogeneic UTx study indicates that further research is needed to optimize immunosuppression protocols in order to avoid uterine rejection.

WIDER IMPLICATIONS OF THE FINDINGS

The findings suggest that allogeneic UTx in primate species is feasible but continued work on this issue is needed.

STUDY FUNDING/COMPETING INTEREST(S)

The study was funded by the Swedish Research Council, ALF University of Gothenburg, Hjalmar Svensson Foundation and by Jane and Dan Olsson Research Foundation. The authors do not have any competing interest.

Unequal care for dying patients in Sweden: a comparative registry study of deaths from heart disease and cancer

BACKGROUND

The Swedish Palliative Registry is a nationwide quality registry aimed at facilitating improvement in end-of-life care. The goal is for the registry to list and report quality indicators related to care during the last week of life in all cases expected death in Sweden.

AIM

To examine the quality of care during the last week of life as reported to the registry for patients with heart disease compared to those with cancer.

METHOD

A retrospective registry study.

RESULTS

Patients dying of heart disease compared to those dying from cancer had more shortness of breath, fewer drugs prescribed as needed against the usual symptoms and often died alone. Furthermore, they and their close relatives received less information about the imminence of death and bereavement follow-up was less common. The healthcare personnel were less aware of the heart disease patients' symptoms and less often knew about where they wished to die.

CONCLUSION

Great differences were found in registered end-of-life care suggesting that the care given to patients with heart disease and cancer was unequal even after adjustment for age, sex and setting at the time of death. If our observational findings are confirmed in future studies there is obviously a need for new models for end-of-life management in order to facilitate the provision of equal care to dying patients regardless of diagnosis.

Physicians' experiences of palliative care for heart failure patients

BACKGROUND

Although heart disease is the single most common cause of death knowledge about palliative care for this group of patients is deficient.

AIM

The aim of this study was to describe physicians' experiences of palliative care for heart failure patients.

METHODS

Fifteen physicians at a medical geriatrics clinic were interviewed. The interviews were analysed using thematic content analysis.

RESULTS

The results show that the physicians are confronted with patients with an unpredictable disease trajectory, including patients with severe symptoms, uncertainty about anticipating the course of dying and encountering close relative's anxiety and frustration. The physicians face difficult situations regarding whether to continue or withdraw care and medical treatment which means deciding concerning 'active' medical treatment, cardio pulmonary resuscitation and an implantable cardioverter-defibrillator (ICD). The physicians acknowledge the necessity for better structured follow-ups and cooperation with outpatient settings. They recognize that there is a lack of follow-ups and continuity of care and treatment at the hospital, involving their passing on or retaining responsibility for the patients' medical care.

CONCLUSION

From the physicians' view clarification of who is principally responsible for the patient's medical care, being involved throughout the disease trajectory and cooperating more closely with palliative care services are necessary to further improve the way in which care is delivered to patients dying of heart failure.

Cyclosporine A exposure during pregnancy in mice: effects on reproductive performance in mothers and offspring

BACKGROUND

Pregnancies after organ transplantation and under immunosuppressive treatment are associated with slightly elevated risks for obstetric and post-natal complications but can usually be managed well. However, little is known about the effects of intrauterine exposure (IUE) to immunosuppressants in the growing and adult offspring. One major issue is the potentially negative effects of immunosuppressive medication on reproduction. This study investigates the effect of exposure during pregnancy to the most commonly used immunosuppressant in organ transplantation, cyclosporine A (CsA), on the reproductive outcome in mothers and offspring.

METHODS

Female C57CBA-F1 mice received 0, 10, 20 or 30 mg/kg bodyweight of CsA daily by subcutaneous mini-osmotic pumps during mating and pregnancy. Blood concentrations of CsA, implantation rates, resorption rates and fetal weights were analysed. In addition, female and male mice exposed to CsA in utero were mated to unexposed partners and pregnancy outcomes were analysed.

RESULTS

Direct maternal exposure to CsA at high doses reduced implantation rates and fetal survival. IUE to CsA reduced adolescent growth but did not affect fertility, although a reduction in birthweight was seen in offspring of females exposed to CsA in utero.

CONCLUSIONS

CsA exposure during pregnancy correlates with impaired reproductive outcome, but offspring fertility is not affected. The cause of reduction in adolescent weight gain and low birthweight in offspring of females exposed to CsA in utero need further investigation.

Fatigue in elderly with chronic heart failure: an under-recognized symptom

In this secondary analysis of interviews with people with chronic heart failure, we examine living with fatigue in terms of obstacles and opportunities on personal, systemic and societal levels. On a personal level, people report that their bodies force them to rest, and to give in to and make space in their lives for fatigue. The need for rest is strong, but resting and inactivity are also regarded as dangerous. The healthcare system provides assistance through home care and technical equipment. However, society imposes obstacles, such as a lack of services in the immediate surroundings that prevent living well. In conclusion, people with chronic heart failure can manage their lives on a personal level by means of selection, optimization and compensation, and the healthcare system can provide further support; however, on a societal level there is lack of resources for those suffering from fatigue due to chronic heart failure.

Being a close relative of a person with severe, chronic heart failure in palliative advanced home care -- a comfort but also a strain

Within previous research on family care of terminally ill people, studies have only rarely been carried out concerning heart failure care. This study aims to illuminate meanings of being a close relative of a person with severe, chronic heart failure (CHF) in palliative advanced home care (PAHC). Narrative interviews were conducted with three close relatives, tape-recorded, transcribed verbatim and a phenomenological-hermeneutic method was used to interpret the text. Meanings of being a close relative is to follow the life-threatening ups and downs, the person with CHF is going through. This means being on primary call, always on standby to mediate security and pleasure. In the deepest downs it is also to call for the back-up call i.e. the PAHC team, trusting their ability to show up on time to alleviate in the worst downs i.e. ease suffering. This study reveals that to be the close relative that the ill person is dependent on 24 hours a day is both a comfort and a strain.

Vaginal sacrospinous colpopexy and laparoscopic sacral colpopexy for vaginal vault prolapse

BACKGROUND

Vaginal sacrospinous colpopexy (VSC) and laparoscopic sacral colpopexy (LSC) both correct vault prolapse. The present study compares the perioperative course and long-term results of VSC and LSC.

METHODS

This retrospective study of post-hysterectomy vault prolapse involved 111 patients operated with either VSC (n=51) or LSC (n=60). The median time for the postoperative follow-up visit was 33.6 (range: 13-60) months for the LSC group and 38.4 (range: 7-108) months for the VSC group. Prolapse grade as well as the patient's satisfaction was recorded at the follow-up visit.

RESULTS

Operation time was significantly shorter in the VSC group (median: 62 min) compared to the LSC group (median: 129 min). The rate of perioperative complications was low in both groups. There were 3 laparotomies in the LSC group, due to perioperative complications. The inpatients days were similar, with 3.7 days (1-18) and 4.0 days (2-21) in the VSC and the LSC group, respectively. Surgery for the recurrence of vault prolapse at any time before the follow-up visit did not occur in the VSC group, but occurred in 7 patients in the LSC group. At the follow-up visit, there was no recurrence of vault prolapse in either group. The subjective success rate was 82% in the VSC and 78% in the LSC group.

CONCLUSIONS

This study indicates that VSC and LSC are two equally effective surgical procedures to correct vaginal vault prolapse, but the LSC technique requires a longer operating time.

Uterine transplantation: a future possibility to treat women with uterus factor infertility?

Uterine transplantation is developed as a possible future treatment for patients with absolute uterus factor infertility. Patients with the Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome, patients having had hysterectomy for benign or malignant uterine/cervical diseases and patients with intrauterine adhesions are the major groups of patients, who could benefit from this procedure. There has been one attempt to transplant a human uterus, which however failed. Since then, several uterine transplantation animal models have been developed to examine various aspects of the uterus transplantation procedure and to optimize it for human use. In a mouse model, normal pregnancy rate and offspring were seen after syngeneic uterus transplantation. The tolerance for cold ischemia from the time the uterus is taken out from the donor until placed in the recipient is around 24 h, as shown in a mouse uterine transplantation model and on human uterine tissue. The rejection pattern of the transplanted uterus was tested in an allogeneic mouse model with signs of rejection after 5 to 10 days. High doses of cyclosporin A (CyA) could partly suppress rejection but pregnancies have not yet been achieved in allogeneic uterus transplants in any species. In the sheep and pig models, the vascular anastomosis technique and the tolerability to cold ischemia have been evaluated. Normal offspring have been delivered in the sheep model after autotransplantation and presently allogeneic uterine transplants in sheep treated with corticosteroids and CyA are tested. Initial studies on uterus transplantation is also now conducted in primates. It is predicted that uterus transplantation may reach a clinical stage within 2-3 years, in the event of a continuous high research activity within this field.

Gelatinases and their tissue inhibitors during human ovulation: increased expression of tissue inhibitor of matrix metalloproteinase-1

Remodelling of the extracellular matrix (ECM) of the follicular wall by matrix metalloproteinases (MMPs) and tissue inhibitors of matrix metalloproteinases (TIMPs) has been suggested to be crucial in ovulation. To investigate the expression of the gelatinases, MMP-2 and MMP-9, together with their inhibitors, TIMP-2 and TIMP-1, in the perifollicular ovarian stroma from women just before and during ovulation, we obtained biopsies of the stroma adjacent to the leading follicle. Laparoscopic surgery was performed either before the LH peak or at any of three intervals after ovulation triggering by hCG. Immunoblotting, immunohistochemistry and quantitative RT-PCR were performed. All four proteins were expressed by immunoblots, with no detectable changes in the expression of MMP-2, MMP-9 and TIMP-2. Scattered immunostaining for MMP-9 and TIMP-2 was seen, and MMP-2 was demonstrated in a concentric layer. A significant increase in TIMP-1 protein and mRNA was seen during the three ovulatory phases, and a strong and patchy immunostaining for TIMP-1 was shown. This is the first study that has demonstrated an ovulation-associated expression of these ECM-remodelling enzymes around the human follicle at ovulation. The increased expression of TIMP-1 may reflect a specific temporal inhibition of collagenolysis and thereby a time-dependent regulation of ECM breakdown in areas surrounding the apex of the follicle.

Rejection of the transplanted uterus is suppressed by cyclosporine A in a semi-allogeneic mouse model

BACKGROUND

A mouse uterus transplantation model has previously been developed for studies of various aspects of uterine transplantation, which in the future may be used as treatment for uterine infertility. The aim of the study was to evaluate the effect of the immunosuppressant cyclosporine A (CyA) on the rejection of the allotransplanted uterus in the mouse.

METHODS

C57BL/6 mice were recipients of uteri from F1 hybrids (C57BL/6 x CBA/ca). Transplanted mice received vehicle (control, n=5), 10 or 20 mg/kg/day of CyA (CyA10, n=5 and CyA20, n=5). Untreated F1 hybrids with syngeneic transplants (n=3) were negative controls. On day 10 post-transplantation, the grafted uteri were examined, and biopsies were taken for histology and quantification of T cells.

RESULTS

Histology analysis revealed necrosis of the uterine transplants in controls and to a lesser extent in the CyA groups. Apoptosis and inflammation was prominent in grafts from the CyA10 group but suppressed in the CyA20 group. A similar increase of CD4+ cells was seen in all groups, whereas the number of CD8+ cells was higher (P < 0.05) in the two allogeneic groups receiving CyA compared with the allogeneic vehicle group.

CONCLUSIONS

CyA treatment clearly delays the progress of rejection of grafted uteri but is insufficient to suppress T cell infiltration. Interestingly, the number of CD8+ cells was higher in groups receiving CyA, possibly reflecting a CyA-dependent depression of activation-induced cell death (AICD) of cytotoxic T cells.

Safety and efficacy of atorvastatin in patients with severe renal dysfunction

OBJECTIVE

To investigate the efficacy and safety of a daily dose of 10 mg of atorvastatin in patients with chronic kidney disease (CKD) stages 4 and 5 and a glomerular filtration rate of <30 ml/min.

MATERIAL AND METHODS

This was an open, prospective, randomized study. A total of 143 patients were included: 73 were controls and 70 were prescribed 10 mg/day of atorvastatin. As efficacy variables, total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol and triglyceride levels were determined at the start of the study and at 1, 3, 6, 12, 18, 24, 30 and 36 months.

RESULTS

The follow-up period was a mean of 20+/-14.4 months (range 1-36 months) for those on atorvastatin versus 22+/-12.7 months (range 0.5-36 months) for the controls. Compared with baseline values, patients treated with atorvastatin had significantly lower concentrations of total cholesterol at Month 36 (5.8 vs 4.4 mmol/l; -23%; p<0.001), of LDL cholesterol at Month 36 (3.6 vs 2.2 mmol/l; -35%; p<0.001) and of triglycerides at Months 24 (2.5 vs 1.9 mmol/l) and 36 (2.5 vs 1.8 mmol/l). The controls had significantly reduced levels of total cholesterol at Month 36 (p<0.21) and of LDL cholesterol at Months 30 and 36. Compared with the controls, the atorvastatin group had lower levels of total cholesterol and LDL cholesterol at Months 1-30. Fifteen patients (21%) stopped taking their medication as they could not tolerate the side-effects, the most frequent complaints being gastrointestinal discomfort and headache.

CONCLUSION

Although the medication caused no severe adverse events, we recommend caution when using atorvastatin for severe CKD patients until further evidence of its safety and efficacy is verified.

Collagens in the human ovary and their changes in the perifollicular stroma during ovulation

BACKGROUND

Remodeling of the collagens around the follicle is a major event in ovulation. The aim of the present study was to investigate the distribution of collagen I, III, and IV in the human ovary.

METHODS

Biopsies of the perifollicular stroma were obtained at sterilization during the preovulatory phase (follicle size >14 mm) or at any of three intervals (12-18 h after human chorionic gonadotrophin: early ovulatory phase; >18-24 h: late ovulatory phase; 44-77 h: postovulatory phase) after human chorionic gonadotrophin. Excised dominant follicles and whole ovarian sections were also obtained. Immunohistochemistry using antibodies against collagen I, III, IV, vimentin, and CD 45 was performed.

RESULTS AND CONCLUSIONS

Collagens I and III were distributed in concentric layers in the capsular stroma with bundles of collagens connecting these layers to form a mesh. Collagen I was present in larger quantities in the outer layers and collagen III showed the inverse distribution. In the theca, collagen I was present in the externa and collagen III in the entire layer. The staining intensity of collagens I and III in the perifollicular stroma decreased from the preovulatory stage. Collagen IV was present in the basal lamina separating granulosa and theca cells. This study shows that collagen I and III are abundant in and around the ovulating human follicle with typical patterns of distribution. Collagen IV is present in the basal membrane that separates the granulosa from the theca cells. Taking into account the abundance of collagens in the follicular wall and their specific localization, major site-directed degradation of collagens seems to be necessary for follicular rupture to occur.

Rejection patterns in allogeneic uterus transplantation in the mouse

BACKGROUND

Transplantation of the uterus in the mouse has been developed as a model system for research towards human uterine transplantation. Previous studies in a mouse model have demonstrated that a syngeneic uterus transplant can give rise to normal offspring. The aim of this study was to characterize the time course of rejection in a fully allogeneic mouse uterus transplantation model.

METHODS

Uteri of BALB/c mice were transplanted to a heterotopic position in C57BL/6 recipients, whose native uteri were left in situ. The blood flow of the uteri, their gross appearance and general histology and the density of T-lymphocytes were examined on postoperative days 2-28.

RESULTS

Macroscopic signs of rejection were apparent from day 5. At the light microscopy level, minimal inflammatory changes were seen from day 5 and massive inflammation was seen from day 10 to day 15. At day 28, necrosis and fibrosis were seen. The density of T-lymphocytes (CD3(+)) was increased in the grafted uterus from day 2 in the myometrium and from day 5 in the endometrium. Blood flow in the grafted uteri was reduced from day 15.

CONCLUSION

A murine model to study rejection of allogeneic uterus transplants was characterized. Signs of rejection were seen from day 2 to day 5 and severe rejection was seen from day 10 to day 15. The data will be useful in future studies on immunosuppressants in this model.

Short-term ischaemic storage of human uterine myometrium--basic studies towards uterine transplantation

BACKGROUND

Transplantation of the uterus has been suggested as a possible future treatment of absolute uterine infertility. The tolerability of human uterine tissue to cold ischaemic storage was tested in the present study.

METHODS

Small tissue samples of human uteri were subjected to cold (4 degrees C) ischaemia (6 and 24 h) in Ringer acetate (RIN), the intracellular-like University of Wisconsin solution (UW) or the extracellular-like Perfadex solution (PER). The ability of myometrial strips to contract, histology by light and electron microscopy as well as tissue concentrations of glutathione, ATP and protein were used as parameters to detect cold ischaemic injuries.

RESULTS

Contractile ability and response to prostaglandin F(2alpha) (PGF(2alpha)) was better preserved after 6 h cold ischaemia in UW and PER in comparison with the other groups. Histological examination did not reveal any major changes after 6 and 24 h cold ischaemic storage in UW and PER solutions, while specimens stored in RIN for 24 h displayed degenerative changes on the electron microscopy level. UW and PER preserved ATP concentrations significantly better than RIN. Myometrium stored in UW contained more total glutathione but also a larger proportion of oxidized glutathione than specimens stored in RIN and PER. Protein concentrations did not change with storage time in any of the solutions.

CONCLUSIONS

The results show that human uterine myometrial tissue is resistant towards cold ischaemia for at least 6 h if stored in UW and PER solutions.

Wnt-signalling pathway in ovarian epithelial tumours: increased expression of beta-catenin and GSK3beta

Beta-catenin is involved in both cell–cell adhesion and in transcriptional regulation by the Wingless/Wnt signalling pathway. Alterations of components of this pathway have been suggested to play a central role in tumorigenesis. The present study investigated, by immunohistochemistry and immunoblotting, the protein expression and localisation of β-catenin, adenomatous polyposis coli (APC), glycogen synthase kinase 3β (GSK3β) and lymphocyte enhancer factor-1 (Lef-1) in normal human ovaries and in epithelial ovarian tumours in vivo and in vitro. Immortalised human ovarian surface epithelium and ovarian cancer cell cells (OVCAR-3) expressed β-catenin, APC, GSK3β and Lef-1. Nuclear staining of β-catenin and Lef-1 were demonstrated only in OVCAR-3 cells. There were significant increases of β-catenin and GSK3β, while APC was reduced in ovarian cancer compared to the normal ovary. Beta-catenin and Lef-1 were coimmunoprecipitated in ovarian tumours, but not in the normal ovary. Nuclear localisation of β-catenin or Lef-1 could not be demonstrated in the normal ovary or in the ovarian tumours. The absence of nuclear localisation of β-catenin could be due to an increased binding to the cadherin–α-catenin cell adhesion complex. In fact, we have earlier reported an increased expression of E-cadherin in ovarian adenocarcinomas. In summary, this study demonstrates an increase in the expression of components of the Wingless/Wnt pathway in malignant ovarian tumours. The increase suggests a role for this signalling pathway in cell transformation and in tumour progression. However, it remains to be demonstrated whether it is an increased participation of β-catenin in transcriptional regulation, or in the stabilisation of cellular integrity, or both, that is the crucial event in ovarian tumorigenesis.

Pregnancy in transplanted mouse uterus after long-term cold ischaemic preservation

BACKGROUND

The aim of this study was to evaluate the viability of the transplanted murine uterus after cold ischaemic preservation.

METHODS

Uteri of mice (6-8 weeks old) were isolated and kept at 4 degrees C in vitro for 24 or 48 h in 0.154 mol/l NaCl or University of Wisconsin (UW) solution. Viability was evaluated by assessment of morphology and contractility in vitro. Furthermore, uteri were transplanted by vascular anastomoses to syngeneic recipients after 24 or 48 h cold ischaemic preservation in UW solution and morphology, blood flow and capacity to implant transferred blastocysts were assessed 2 weeks later.

RESULTS

Uteri that had been preserved for 24 h exhibited normal morphology but after 48 h preservation minimal degenerative changes were seen. Spontaneous contractions occurred in uteri after 24 h as well as 48 h cold ischaemic preservation and prostaglandin F(2alpha)-stimulated responses were preserved. Blood flow and morphology were normal 2 weeks after transplantation in uteri preserved for 24 h, while grafts preserved for 48 h had a decreased blood flow and morphology showed total necrosis of the transplants. Transplanted uteri that had been preserved for 24 h developed pregnancies (in five out of six animals) after embryo transfer, with offspring showing normal weight and growth trajectory.

CONCLUSIONS

This study shows for the first time that the mouse uterus tolerates cold ischaemic preservation and that pregnancies can be carried in transplanted uteri that have been preserved for 24 h.