Comparison of the efficacy of selecting sperm with normal nuclei by high magnification for intracytoplasmic sperm injection (ICSI) according to age in refractory in vitro fertilization (IVF) cases

PURPOSE

To determine the pregnancy rates according to age in women failing to conceive after three previous embryo transfers or having a husband whose sperm shows a DNA fragmentation index (DFI) > 30% when performing the sperm chromatin structure assay.

METHODS

Women up to age 45 were included and there was no restriction for low egg reserve. Live delivered pregnancy rates were determined according to three age groups: < or =34, 35-38, 39-45. The data were also analyzed in a group comparable to previous publications using high magnification ICSI, i.e., younger women with normal egg reserve. Pregnancy rates following frozen embryo transfer were also evaluated.

RESULTS

Using all 86 in vitro fertilization-embryo transfer (IVF-ET) cycles the live delivered pregnancy rates were 40% (10/25) for women < or = age 34, 24% (6/25) in women age 35-38, and 13.8% in women aged 39-45. Evaluating the younger group with normal egg reserve with > or =3 previous failed IVF-ET cycles the live delivered pregnancy rate per transfer was 38% (16/42). If one adds the additional six live deliveries from subsequent frozen embryo transfer (6 of 17, 35.3%) this group of women had a 52.3% (22/42) live delivered pregnancy rate from one egg retrieval.

CONCLUSIONS

These data were uncontrolled and thus conclusions should be viewed with caution. The results are sufficiently encouraging to warrant a prospective controlled trial and possibly encourage a company to consider commercially manufacturing high magnification microscopes.

A comparison of efficacy of freezing embryos at the 2 pronuclear (2PN) stage vs multi-cell when using a simplified freezing protocol with one-step removal of cryoprotectant

PURPOSE

To compare the efficacy of freezing embryos at the 2 pronuclear stage vs multi-cell stage using a simplified freezing protocol with a one-step removal of the cryoprotectant.

METHODS

A retrospective analysis was performed. Survival, delivered pregnancy and implantation rates were compared in transfers of all embryos frozen at 2 pronuclear stage (2PN) or all embryos frozen at multi-cell stage. The results were further stratified and compared according to the number of high quality embryos transferred.

RESULTS

In all categories despite comparing similar numbers and quality of embryos transferred there was a significantly higher survival rate of 2PN embryos. Significantly higher delivered pregnancy and implantation rates were seen with 2PN vs multi-cell embryos when there was only one or two embryos with > or = 6 blastomeres and < 25% fragmentation, and a trend for higher delivered pregnancy rates when there were three top quality embryos transferred.

CONCLUSIONS

When given the option it is preferable when using this simplified freezing and thawing protocol to freeze at the 2PN stage.

Pregnancy rates per embryo transfer (ET) may be improved by conventional oocyte insemination for male factor rather than intracytoplasmic sperm injection (ICSI)

PURPOSE

To determine if intracytoplasmic sperm injection (ICSI) for mild male factor may create embryos less likely to implant.

METHOD

A retrospective analysis of pregnancy outcome following oocyte fertilization with ICSI vs conventional egg insemination was performed.

RESULTS

Though there were many less cases using conventional oocyte insemination compared to ICSI so that a meaningful comparison of outcome could not be made, the data could suggest the fertilization by ICSI might result in embryos less likely to implant.

CONCLUSIONS

This pilot study should encourage IVF centers to consider conventional oocyte insemination for mild male factor instead of ICSI. Only by evaluating a larger series can it be determined with certainty that fertilization by ICSI may lower the implantation potential of the embryo that is formed.

The effect of blastomere number on embryo survival upon freezing/thawing

PURPOSE

To determine if the blastomere number of embryos at the time of freezing is related to its quality post-thaw.

METHODS

A retrospective cohort analysis of frozen/thawed embryos. Only multi-cell embryos were used for this study. If an embryo was of good quality it would either be transferred or re-frozen.

RESULTS

There did not appear to be any trend for a lower percentage of good quality embryos with fewer numbers of blastomeres.

CONCLUSIONS

Though 4-cell embryos have a markedly lower implantation potential upon fresh embryo transfer compared to 6-8-cell embryos, this is not reflected in their ability to survive freeze-thawing.

Comparison of SNR and CNR for in vivo mouse brain imaging at 3 and 7 T using well matched scanner configurations

Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) for magnetic resonance microimaging were measured using two nearly identical magnetic resonance imaging (MRI) scanners operating at field strengths of 3 and 7 T. Six mice were scanned using two imaging protocols commonly applied for in vivo imaging of small animal brain: RARE and FLASH. An accounting was made of the field dependence of relaxation times as well as a small number of hardware disparities between scanner systems. Standard methods for relaxometry were utilized to measure T1 and T2 for two white matter (WM) and two gray matter (GM) regions in the mouse brain. An average increase in T1 between 3 and 7 T of 28% was observed in the brain. T2 was found to decrease by 27% at 7 T in agreement with theoretical models. The SNR was found to be uniform throughout the mouse brain, increasing at higher field by a factor statistically indistinguishable from the ratio of Larmor frequencies when imaging with either method. The CNR between GM and WM structures was found to adhere to the expected field dependence for the RARE imaging sequence. Improvement in the CNR for the FLASH imaging sequence between 3 and 7 T was observed to be greater than the Larmor ratio, reflecting a greater susceptibility to partial volume effects at the lower SNR values at 3 T. Imaging at 7 T versus 3 T in small animals clearly provides advantages with respect to the CNR, even beyond the Larmor ratio, especially in lower SNR regimes. This careful multifaceted assessment of the benefits of higher static field is instructive for those newly embarking on small animal imaging. Currently the number of 7 T MRI scanners in use for research in human subjects is increasing at a rapid pace with approximately 30 systems deployed worldwide in 2008. The data presented in this article verify that if system performance and radio frequency uniformity is optimized at 7 T, it should be possible to realize the expected improvements in the CNR and SNR compared with MRI at 3 T.

Chinese herbal medicine Huangqi type formulations for nephrotic syndrome

BACKGROUND

At present, there is a lack of safe and effective drugs for nephrotic syndrome (NS). Huangqi type formulations have been used to treat nephrotic syndrome for years in China, however the effects and safety of these formulations have not been systematically reviewed.

OBJECTIVES

To assess the benefits and harms of Huangqi and Huangqi type formulations in treating NS in any age group, either as sole agents or in addition to other drug therapies.

SEARCH STRATEGY

We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, Chinese Biomedicine Database (CBM), CNKI, VIP and reference lists of articles. There was no language restriction. Date of most recent search: June 2006.

SELECTION CRITERIA

All randomised controlled trials (RCTs) assessing the use of Huangqi or Huangqi type formulations in treating NS in adults and children, either as sole agents or in addition to other drug therapies.

DATA COLLECTION AND ANALYSIS

Two authors independently assessed study quality and extracted data. For dichotomous outcomes (remission, side effects and Inefficacy rate), results were expressed as relative risk (RR) and 95% confidence intervals (CI). Continuous outcomes (triglycerides cholesterol, plasma albumin) results were expressed as mean difference (WMD) with 95% CI.

MAIN RESULTS

Three studies were identified (n = 128), all comparing Huangqi type formulations with placebo. Huangqi injection had a positive effect on plasma albumin (WMD 6.90, 95% Cl 3.60 to 10.20) and cholesterol (WMD 2.13, 95% Cl -2.97 to -1.29). Huangqi and red Chinese date reduced some adverse reactions (Cushing's syndrome: RR 0.55, 95% Cl 0.32 to 0.94; hormone reduced syndrome: RR 0.58, 95% Cl 0.39 to 0.85, respiratory tract infection: RR 0.27, 95% Cl 0.08 to 0.88), but no benefit on reducing relapse. Huangqi and Danggui had a positive effect on cholesterol (WMD -0.85, 95% Cl -1.70 to 0.00).

AUTHORS' CONCLUSIONS

Huangqi type formulations may have some positive effects in treating NS by increasing plasma albumin and reducing blood cholesterol, Cushing's syndrome, hormone reduced syndrome and respiratory tract infection. However, limited by the lack of high quality clinical studies, we are unable to recommend Huangqi type formulations for NS. Large, properly randomised, placebo-controlled, double-blind studies are required.

Vitamin A for preventing acute lower respiratory tract infections in children up to seven years of age

BACKGROUND

Vitamin A supplements are effective for preventing diarrhoea. There are theoretical reasons it might also be effective for acute lower respiratory tract infections (LRTIs), also very common in children, especially in low income countries.

OBJECTIVES

To assess the effectiveness and safety of vitamin A for preventing acute LRTIs in children up to seven years of age.

SEARCH STRATEGY

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2007, Issue 2); MEDLINE (1966 to July 2007); EMBASE (1974 to July 2007); and the Chinese Biomedicine Database (CBM) (1976 to July 2007).

SELECTION CRITERIA

Randomised controlled trials (RCTs) that assessed the effectiveness of vitamin A in the prevention of acute LRTI in children up to seven years of age.

DATA COLLECTION AND ANALYSIS

The review authors independently extracted data and assessed trial quality. Study authors were contacted for additional information.

MAIN RESULTS

Most studies found no significant effect of vitamin A on the incidence of acute LRTI, or prevalence of symptoms of acute LRTI. Vitamin A caused an increased incidence of acute LRTI in one study; an increase in cough and fever; and increased symptoms of cough and rapid breathing in two others. Three reported no differences and no protective effect of vitamin A. Two studies reported that vitamin A significantly reduced the incidence of acute LRTI with children with poor nutritional status or weight, but increased it in normal children.

AUTHORS' CONCLUSIONS

This unexpected result is outside our current understanding of the use of vitamin A for preventing acute LRTIs. Accordingly, vitamin A should not be given to all children to prevent acute LRTIs. There is evidence for vitamin A supplements to prevent acute LRTIs in children with low serum retinol or those with a poor nutritional status.

Improving the sensitivity limit of surface plasmon resonance biosensors by detecting mixed interference signals

We demonstrate that the sensitivity limit of intensity-based surface plasmon resonance (SPR) biosensors can be enhanced when we combine the effects of the phase and amplitude contributions instead of detecting the amplitude variation only. Experimental results indicate that an enhancement factor of as much as 20 times is achievable, yet with no compromise in measurement dynamic range. While existing SPR biosensor systems are predominantly based on the angular scheme, which relies on detecting intensity variations associated with amplitude changes only, the proposed scheme may serve as a direct system upgrade approach for these systems. The new measurement scheme may therefore lead to a strong impact in the design of SPR biosensors.

Corticobasal syndrome and primary progressive aphasia as manifestations of LRRK2 gene mutations

BACKGROUND

Mutations in the LRRK2 gene are an important cause of familial and nonfamilial parkinsonism. Despite pleomorphic pathology, LRRK2 mutations are believed to manifest clinically as typical Parkinson disease (PD). However, most genetic screens have been limited to PD clinic populations.

OBJECTIVE

To clinically characterize LRRK2 mutations in cases recruited from a spectrum of neurodegenerative diseases.

METHODS

We screened for the common G2019S mutation and several additional previously reported LRRK2 mutations in 434 individuals. A total of 254 patients recruited from neurodegenerative disease clinics and 180 neurodegenerative disease autopsy cases from the University of Pennsylvania brain bank were evaluated.

RESULTS

Eight cases were found to harbor a LRRK2 mutation. Among patients with a mutation, two presented with cognitive deficits leading to clinical diagnoses of corticobasal syndrome and primary progressive aphasia.

CONCLUSION

The clinical presentation of LRRK2-associated neurodegenerative disease may be more heterogeneous than previously assumed.

Diffusion tensor MR imaging reveals persistent white matter alteration after traumatic brain injury experienced during early childhood

BACKGROUND AND PURPOSE

Diffusion tensor imaging (DTI) can noninvasively quantify white matter (WM) integrity. Although its application in adult traumatic brain injury (TBI) is common, few studies in children have been reported. The purposes of this study were to examine the alteration of fractional anisotropy (FA) in children with TBI experienced during early childhood and to quantify the association between FA and injury severity.

MATERIALS AND METHODS

FA was assessed in 9 children with TBI (age = 7.89 +/- 1.00 years; Glasgow Coma Scale [GCS] = 10.11 +/- 4.68) and a control group of 12 children with orthopedic injuries without central nervous system involvement (age = 7.51 +/- 0.95 years). All of the subjects were at minimum 12 months after injury. We examined group differences in a series of predetermined WM regions of interest with t test analysis. We subsequently conducted a voxel-wise comparison with Spearman partial correlation analysis. Correlations between FA and injury severity were also calculated on a voxel-wise basis.

RESULTS

FA values were significantly reduced in the TBI group in genu of corpus callosum (CC), posterior limb of internal capsule (PLIC), superior longitudinal fasciculus (SLF), superior fronto-occipital fasciculus (SFO), and centrum semiovale (CS). GCS scores were positively correlated with FA in several WM areas including CC, PLIC, SLF, CS, SFO, and inferior fronto-occipital fasciculus (IFO).

CONCLUSION

This DTI study provides evidence that WM integrity remains abnormal in children with moderate-to-severe TBI experienced during early childhood and that injury severity correlated strongly with FA.

1,25-Dihydroxyvitamin D3 targeting of NF-kappaB suppresses high glucose-induced MCP-1 expression in mesangial cells

Macrophages accumulate in kidney glomeruli and interstitium of patients with diabetic nephropathy in response to monocyte chemoattractant protein-1 (MCP-1); a chemokine produced by both tubular epithelial and mesangial cells (MCs). Vitamin D and its analogs have been shown to have renoprotective effects; however, there are few studies involving diabetic nephropathy. We explored mechanisms by which 1,25-dihydroxyvitamin D3 (1,25(OH)2D3) can be renoprotective by measuring MCP-1 expression in MCs. Using a luciferase reporter assay, we found that high glucose (HG)-induced MCP-1 transcription and that this induction is blocked by 1,25(OH)2D3. Electrophoretic mobility shift and chromatin immunoprecipitation assays showed that HG increased the p65/p50 binding to the two NF-kappaB sites within the promoter. This was suppressed by 1,25(OH)2D3, but this decrease was reversed by overexpression of p65. 1,25(OH)2D3 was found to stabilize IkappaBalpha leading to an inhibition of p65 translocation to the nucleus and subsequent reduction of NF-kappaB binding. In primary MCs prepared from vitamin D receptor knockout animals, basal MCP-1 levels were elevated but not affected by 1,25(OH)2D3. The analog paricalcitol inhibited the induction and activity of MCP-1 while ameliorating glomerulosclerosis in streptozotocin-diabetic mice. Our results suggest that 1,25(OH)2D3 might block hyperglycemia-induced renal injury by blunting NF-kappaB activation.

Two-dimensional biosensor arrays based on surface plasmon resonance phase imaging

We present a biosensor design based on capturing the two-dimensional (2D) phase image of surface plasmon resonance (SPR). This 2D SPR imaging technique may enable parallel label-free detection of multiple analytes and is compatible with the microarray chip platform. This system uses our previously reported differential phase measurement approach, in which 2D phase maps obtained from the signal (P) and reference (S) polarizations are compared pixel by pixel. This technique greatly improves detection resolution as the subtraction step can eliminate measurement fluctuations caused by external disturbances as they essentially appear in both channels. Unlike conventional angular SPR systems, in which illumination from a range of angles must be used, phase measurement requires illumination from only one angle, thus making it well suited for 2D measurement. Also, phase-stepping introduced from a moving mirror provides the necessary modulation for accurate detection of the phase. In light of the rapidly increasing need for fast real-time detection, quantification, and identification of a range of proteins for various biomedical applications, our 2D SPR phase imaging technique should hold a promising future in the medical device market.

A novel transcript of the LMO2 gene, LMO2-c, is regulated by GATA-1 and PU.1 and encodes an antagonist of LMO2

Ectopic expression of LIM-only protein 2 (LMO2) in T-cells, as a result of chromosomal translocations or retroviral insertion, plays an important role in the onset of T-cell leukemias. Two transcripts of LMO2 gene (LMO2-a and LMO2-b) have been reported to encode a same 158-amino-acid protein. We have previously reported a novel transcript of human LMO2 gene (LMO2-c) encoding a 151-amino-acid protein, and defined its promoter region. In the present study, we investigated the regulation of the LMO2-c expression and the functions of LMO2-c. We found that LMO2-c expression is regulated by the cooperation of two essential hematopoietic transcription factors GATA-1 and PU.1 in various hematopoietic cell lines, suggesting an important functional role for LMO2-c in the hematopoietic system. More importantly, we demonstrated that LMO2-c acts as an antagonist of LMO2-a/b binding to its partners, therefore blocking the transactivation of LMO2-a/b on its target genes. These findings provide novel evidence to the functions of LMO2 gene in the hematopoietic system and leukemia.

Preventive treatment of intrauterine device-induced menstrual blood loss with tranexamic acid in Chinese women

OBJECTIVES

To investigate whether tranexamic acid (Transamin) therapy reduces the amount of menstrual blood loss (MBL) and occurrence of menorrhagia after intrauterine device (IUD) insertion.

METHODS

Some 175 Chinese women attending for IUD insertion were equally assigned into 2 Transamin groups (1,000 and 500 mg, twice daily) and a placebo group. Their MBL was recorded with a pictorial chart in 3 subsequent menstrual cycles after insertion, while the MBL of 64 patients, collecting used sanitary towels, was also measured by an alkaline hematin method.

RESULTS

A significant decline in post-insertion MBL and occurrence of menorrhagia was found in the 2 Transamin groups compared with the placebo group (p<0.05), whereas the difference in the results from the pictorial chart score was not statistically significant between the 1 g group and placebo group.

CONCLUSION

Transamin treatment with a generally recommended dosage can effectively reduce the amount of IUD-induced MBL and prevent menorrhagia in Chinese women. A lower dosage than recommended (50% of recommended dosage) may have a similar preventive effect.

Increased glycophorin A somatic cell variant frequency in arsenic-exposed patients of Guizhou, China

Exposure to arsenic through domestic burning arsenic-containing coal causes various tumors in a population of Guizhou, China. The glycophorin A (GPA) assay is a human mutation assay detecting somatic variation in erythrocytes expressing the MN blood type, and was used to assess genotoxicity of arsenic-exposed patients. Peripheral blood was collected from 18 adult healthy subjects and 40 arsenic-exposed patients in heparin-treated tubes. Erythrocytes were isolated, fixed in formalin and immuno-labeled with fluorescent antibodies against GPA, followed by flow cytometry analysis. Arsenic exposure increased the variant frequency (expressed as the number of variant red cells per 10(6) erythrocytes): NN, 3.7 in healthy subjects versus 21.2 in arsenic-exposed patients; N phi, 12.6 versus 33.1; MM, 13.1 versus 110; and M phi, 5.2 versus 20.3. The total GPA variant frequency was increased about five-fold (34.7 in healthy subjects versus 185 in arsenosis patients). Furthermore, the variant frequency was significantly higher in skin tumor-bearing patients: NN, 19.4 in arsenic-exposed non-tumor patients versus 31.5 in tumor-bearing patients; N phi, 29.5 versus 54.5; MM, 102 versus 159; M phi, 15.9 versus 45.1. Total GPA variant frequency in arsenic-exposed patients bearing skin tumors was significantly increased compared to patients without skin tumors (167 versus 290). The relationship between arsenic exposure history and GPA variant frequency was less evident. These data demonstrate that arsenic exposure is associated with mutations at the GPA locus, an effect exaggerated in patients bearing arsenic-induced skin tumors. The variant frequency of GPA could be a useful biomarker for arsenic exposure and arsenic carcinogenesis.

The high integration and differentiation potential of autologous neural stem cell transplantation compared with allogeneic transplantation in adult rat hippocampus

Cell therapy is thought to have a central role in restorative therapy, which aims to restore function to the damaged nervous system. The purpose of this study was to establish an autologous neural stem cell (NSC) transplantation model using adult rats and to compare survival, migration, and differentiation between this system and allogeneic NSC transplantation. Furthermore, we compared the immunologic response of the host tissue between autologous and allogeneic transplantation. NSCs were removed from the subventricular zone of adult Fischer 344 rats using stereotactic methods. NSCs were expanded and microinjected into normal hippocampus in the autologous brain. Allogeneic NSC (derived from adult Wistar rats) transplantation was performed using the same procedure, and hippocampal sections were analyzed immunohistologically 3 weeks post-transplantation. The cell survival and migration rate were higher for autologous transplantation than for allogeneic transplantation, and the neuronal differentiation rate in the autologous transplanted cells far exceeded that of allogeneic transplantation. Furthermore, there was less astrocyte and microglia reactivity in the host tissue of the autologous transplantation compared with allogeneic transplantation. These findings demonstrate that immunoreactivity of the host tissue strongly influences cell transplantation in the CNS as the autologous transplantation did not induce host tissue immunoreactivity; the microenvironment was essentially maintained in an optimal condition for the transplanted cells.

Fertilization by intracytoplasmic sperm injection (ICSI) does not impair subsequent pregnancy outcome following frozen embryo transfer (ET) as determined by a large retrospective analysis

PURPOSE

To determine if fertilization by intracytoplasmic sperm injection (ICSI) adversely affects pregnancy outcome following frozen embryo transfer (ET).

METHODS

Retrospective analysis of frozen ETs where the oocytes were fertilized by conventional insemination vs ICSI was carried out.

RESULTS

No difference in pregnancy outcome was found in women up to age 42. There was a non-significant trend for lower pregnancy rates in women age 43 and older.

CONCLUSIONS

In the largest series to date by far these data convincingly show that fertilization by ICSI does not impair outcome following frozen ET.

A comparison of luteal phase support in graduated estradiol/progesterone replacement cycles using intramuscular progesterone alone versus combination with vaginal suppositories on outcome following frozen embryo transfer

PURPOSE

To compare pregnancy outcome following frozen embryo transfer according to type of progesterone (P) support given in the luteal phase.

METHODS

Retrospective cohort analysis of frozen embryo transfer (ET) cycles in which ovulation was suppressed by graduated estradiol in the follicular phase. Two P regimens in the luteal phase were compared: P vaginal suppositories and intramuscular P vs intramuscular alone.

RESULTS

The clinical and viable pregnancy rates were significantly higher for the women receiving only intramuscular P (57.6% and 43.7%) vs those receiving combined therapy (45.9% and 35.6%, respectively). The implantation rates were not significantly different (22.6% vs 19.5%).

CONCLUSION

The increased pregnancy rates with intramuscular P may have been related to a higher number of embryos transferred (3.69 vs 3.26). Nevertheless, intramuscular P alone is at least as effective, if not more effective, than combined therapy for frozen embryo transfers.

A comparison of in vitro fertilization outcome by culture media used for developing cleavage-stage embryos

PURPOSE

To determine whether removing glucose and phosphate from media used for developing cleavage-stage embryos improves outcome following transfer of fresh or frozen embryos. Furthermore the study would evaluate the efficacy of adding nonessential amino acids and glutamate to media.

METHODS

Embryo development was rotated on a weekly basis in human tubal fluid (HTF), versus two media relatively devoid of glucose and phosphate (e.g., P1), with one having the addition of essential amino acids and glutamate (Quinn's Advantage Medium).

RESULTS

For fresh cycles, the implantation rate was significantly higher for Quinn's. There was less fragmentation with P1 and Quinn's. For frozen cycles, the viable pregnancy, implantation rates and embryo quality were higher for Quinn's and P1 than HTF.

CONCLUSION

Removal of glucose and phosphate for day-2 embryos improves in vitro fertilization outcome after embryo transfer. It is not clear if adding certain non-essential amino acids and glutamate provides further improvement.

Evidence using a shared oocyte pool that the sperm rather than the oocyte in some cases may be responsible for the production of embryos with a high percentage of fragmented blastomeres--case report

PURPOSE

Hypothesis--a sperm defect rather than an oocyte problem may occasionally be responsible for blastomere fragmentation.

METHODS

The morphology of embryos in pairs of women producing embryos from a common pool of oocytes but fertilized by two different sperm sources was performed to see if a pair could be detected where one woman produced embryos with very little blastomere fragmentation vs the other woman having embryos with extensive fragmentation.

RESULTS

An oocyte donor was identified who produced 49 oocytes resulting in 17 embryos for the infertile donor to evaluate and 13 for the recipient. Almost all of the donor embryos showed extensive fragmentation vs very little for the recipient embryos.

CONCLUSION

The sperm, in some cases at least, may be the etiologic factor for blastomere fragmentation.

Development of sustainability indicators by communities in China: a case study of Chongming County, Shanghai

Public participation as a means of identifying sustainability indicators for Chongming County, Shanghai, China was evaluated by an international group drawing on established best practice. An initial 'long list' of 86 sustainability indicators, based on previous indicator systems developed in China, was identified. This 'long list' was reduced via consultations with local academics and local-government officers from Shanghai City and Chongming County to a 'short list' of 17 indicators. This short-list was subjected to further community consultation involving 159 local-government officers, teachers, students (aged 12-14 years), farmers and workers. Data from the consultations indicated differences in the understanding of sustainable development among the different sectors. By combining the data from the different sectors it was possible to identify a consensus around 4 core and 7 additional indicators. These are proposed as indicators which could be used to steer local activities directed towards sustainable development. The list of indicators produced by the people of Chongming Island was compared to local indicator systems in Europe. In comparison with European lists the Chongming list was found to have a greater emphasis on economic development but a similar level of concern for environmental matters. This study has special significance as it reports on the implementation of a process involving local resident participation in the process of sustainable development in China.

Evidence that the adverse effect of controlled ovarian hyperstimulation on successful pregnancy outcome following embryo transfer may be related to premature trophoblast invasion

PURPOSE

To determine if premature trophoblast invasion may be a contributing factor to lower fecundity associated with controlled ovarian hyperstimulation (COH) and in vitro fertilization (IVF).

METHODS

Blood samples were obtained three-five days after ET to measure expression by lymphocytes of a 34 kDa protein known as the progesterone-induced blocking factor (PIBF) using an immunocytochemistry technique. Clinical and viable pregnancy rates were determined according to whether PIBF was detected or not.

RESULTS

Progesterone-induced blocking factor was positive in 14 of 67 (21%). Clinical pregnancy rates following fresh ET were 7.1% for those positive for PIBF versus 43.4% for those negative for PIBF.

CONCLUSIONS

Progesterone-induced blocking factor production requires allogeneic induction of progesterone receptors in gamma/delta T-cells. This suggests early detection of PIBF may be related to premature trophoblast invasion possibly into an endometrium not yet prepared for the trophoblast, thus possibly leading to early immune rejection of the fetus.

Association between protease-specific proteolytic cleavage of brevican and synaptic loss in the dentate gyrus of kainate-treated rats

Proteolytic fragments generated by ADAMTS (a disintegrin and metalloprotease with thrombospondin motifs)-mediated cleavage of the aggregating chondroitin sulfate proteoglycan, brevican, have been identified, but not localized in the CNS. The purpose of this study, using kainate-induced CNS lesion, was to examine the spatial and quantitative relationship between ADAMTS1 and 4 mRNA expression and ADAMTS-mediated cleavage of brevican (as determined by the abundance of the neo-epitope QEAVESE at the C-terminal of the cleaved brevican G1 domain). In untreated rats, in situ hybridization and reverse transcriptase polymerase chain reaction indicated that ADAMTS4 expression was higher than ADAMTS1 and was localized to hippocampus, temporal lobe and other areas of cortex, striatum and hypothalamus. ADAMTS4 mRNA expression in these regions correlated with the presence of the QEAVESE neo-epitope, which was concentrated in perineuronal nets and in neuropil. In rats that seized after kainate, there was a dramatic elevation in ADAMTS1 and ADAMTS4 transcript that correlated and co-localized with a robust elevation in an extractable, 55-kDa fragment of brevican in temporal lobe and hippocampus. This fragment consisted, at least in part, of the ADAMTS-cleaved epitope G1-QEAVESE. The kainate-induced elevation in this ADAMTS-cleaved fragment was localized to amygdaloid and thalamic nuclei, hippocampus, caudate-putamen, cingulate cortex, and the outer molecular layer of the dentate gyrus where it was accompanied by a robust elevation in ADAMTS1 and 4 mRNA and a 28% decline in synaptic density 5 days after kainate.Thus, complexes of extracellular matrix proteins that exist in perineuronal nets and in the neuropil are cleaved by specific matrix-degrading proteases at early time points during excitotoxic neurodegeneration. The observed ADAMTS-induced cleavage of brevican in the dentate outer molecular layer is closely associated with diminished synaptic density, and may, therefore, contribute to synaptic loss and/or reorganization in this region.

Effect of transferring frozen-thawed embryos resulting from fertilization of immature oocytes matured one day in culture prior to intracytoplasmic sperm injection (ICSI) on implantation rates

PURPOSE

To evaluate whether it is efficacious to allow immature (metaphase I or germinal vesicle stage) oocytes to incubate one more day and then perform ICSI.

METHOD

A retrospective study of frozen embryo transfers (ET) of deselected frozen embryos was performed to see if inclusion of a higher percentage of embryos derived from in vitro maturation of oocytes resulted in lower implantation rates.

RESULTS

The implantation rate following transfer of frozen-thawed embryos, where embryos derived from immature oocytes constituted < or = 40% of the embryos (group 1) was similar to group 2 with > 40% (11.3% vs 9.8%). However, group 1 had a 10.2% implantation rate for viable (past first trimester) sacs vs only 4.3% for group 2.

CONCLUSIONS

Pregnancies from transfer of frozen-thawed embryos derived from in vitro cultured immature oocytes are as likely to implant as the other deselected frozen-thawed embryos.

Indicators of fetal growth and infectious disease in childhood--a birth cohort with hospitalization as outcome

We evaluated the association between indicators of fetal growth and hospitalization with infectious disease during childhood in a cohort of 10,400 newborns. The cohort was based on children born to mothers who at about 36 weeks of gestation attended the midwife centres in Odense and Aalborg, Denmark for a routine examination. Women were recruited to the study from April 1984 to April 1987. After linkage with the National Hospital Registry, the first hospitalization with infectious disease from 6 months up to 12 years of age was identified. The cumulative incidence of hospitalization with infectious disease during follow-up was 18.9%. Preterm birth was associated with an increased risk of being hospitalized with infections during childhood (incidence rate ratio: 1.67, 95% CI: 1.33-2.10); low birth weight had a similar association, but only in preterm birth. Reduced birth length related to the head was correlated with an increased risk of hospitalization with infections. The effect of gestational age was mainly seen in the period close to the time of birth, but the children who were short at birth appeared to remain at increased risk throughout the age interval under analysis. In conclusion, the study suggests that preterm birth was the main factor underlying the association between low birth weight and the increased risk of hospitalization with infectious disease during childhood. However, it could not explain the increased risk in children who were short at birth.

Evolution of the Shanghai city region 1978-1998: an analysis of indicators

Building on a description of the present situation in Shanghai, a series of ten regionally relevant indicators are identified and described. Using data from 1978-1998, relationships between these economic, social and environmental indicators are explored using correlation and regression analysis. The analysis indicated that, in Shanghai, conflict between economy and environment existed throughout the research period and the evolution of the city region system seems to lack regularity. The key elements affecting trends in the development of the Shanghai city region are Gross Domestic Product, Total Investment and Urban Living Area per Head. The city region system seemed more sustainable, indicated by an improvement in environmental quality and relative lower investment growth rate, when the annual change rate of Gross Domestic Product was less than 7-8%.

Cumulative probability of pregnancy following IVF with ICSI and fresh or frozen embryo transfer

The authors studied the cumulative probability of pregnancy for up to 4 consecutive embryo transfer (ET) cycles with ICSI performed for male factor. Transfers could be either fresh or frozen. The clinical pregnancy rate (PR) for the first 4 cycles were similar [44% (61/366); 31% (44/138); 45% (14/31); 44% (4/9)]. Delivery rates were also similar. There was a lower PR on the second retrieval vs. the first retrieval (47% vs. 29%), but this may be related to most of the second retrievals occurring in the second transfer cycle (67%, 31/55); this may be explained by women who were poor responders and required another retrieval without a frozen ET. The majority of transfers in cycle 1 were fresh, whereas cycles 2-4 used primarily frozen-thawed embryos. These data should be helpful for patients requiring IVF with ICSI in deciding to continue with more IVF cycles or consider other

Model-based analysis of dynamics in vergence adaptation

We previously proposed a model to study the dynamics of disparity vergence responses. This model was based on known physiology and consisted of pulse and step neural control processes feeding a linear second-order oculomotor plant. Here, we apply a slightly modified version of that model to analyze the influence of short-term adaptation on vergence dynamics. This analysis showed that, unlike normal vergence responses, adapted responses could not be accurately simulated without a delay between the step and pulse components. Through simulations of normal vergence and adapted vergence responses, we found a strong correlation between delay of the step signal and the size of the movement overshoot. This correlation suggests a strong interaction between neural process generating the pulse and step motor control signals.

[Intact-bridge tympanomastoidectomy procedure: a reasonable option in the surgery of chronic otitis media and mastoiditis with cholesteatoma and/or granulation tissue]

OBJECTIVE

To study and evaluate a surgical option for the treatment of otitis media and mastoiditis with cholesteatoma and/or granulation tissue.

METHODS

The procedure is called intact-bridge tympanomastoidectomy (IBM). There are some modifications for the treatment of patients suffered from chronic otitis media and mastoiditis with cholesteatoma and/or granulation tissue. The features of IBM include: 1. the aditus, mastoid and attic opened and the intractable pathological tissues eradicated thoroughly. 2. the posterior tympanal space opened through the facial recess if necessary. 3. a widened middle ear space by lowering bony bridge established. 4. the adults blocked. 5. immediate or staging tympanoplasties conducted according to the conditions of mucosa in the tympanum.

RESULTS

The modified IBM procedure was performed on 62 ears from 61 cases. The follow-up has been 12-38 months and more than two years in 51 ears. The dry ear was obtained within 5-13 weeks with an average of 6 weeks. In 24.2% of ears the air-bone gap(ABG) was 20dB HL or less and within 21-30 dB HL in 41.9% of ears, the ABG over 31 dB HL was 16.1%.

CONCLUSION

Our results indicate that IBM procedure fulfills the desired purposes of both open- and close-cavity techniques, the thorough eradication of diseased tissue allow to get a dry ear and restoration of hearing. IBM, therefore, is a reasonable choice for the surgery of otitis media and mastoiditis with cholesteatoma and/or granulation tissue.

Assessment of equivalence on multiple endpoints

Some clinical trials aim to demonstrate therapeutic equivalence on multiple primary endpoints. For example, therapeutic equivalence studies of agents for the treatment of osteoarthritis use several primary endpoints including investigator's global assessment of disease activity, patient's global assessment of response to therapy, and pain. In this paper, thoughts on simultaneous equivalence assessment on three endpoints are presented. As pointed out by Berger and Hsu (1996), the conventional intersection-union test can be conservative. Simulation and computation are conducted to provide an insight on the conservativeness. We also provide a method to lower the confidence level and at the same time maintain the type I error when endpoints have normal distributions and are independent. If, in a particular analysis, the goal is to demonstrate equivalence on as many endpoints as possible, a step-up procedure can be used for selecting those endpoints for which equivalence may be demonstrated. This step-up procedure at the same time controls experimentwise error rate. The techniques are illustrated by a data example.

Pregnancy/implantation rates as related to age following transfer of frozen embryos produced by ICSI

A study has suggested that one drawback of ICSI is that if these embryos are cryopreserved they have lower implantation rates after thawing and transfer as compared to other frozen embryos derived from conventional oocyte insemination. Other studies have not shown such adverse effects on pregnancy rates following frozen embryo transfer (ET) of embryos formed by ICSI. The study presented here evaluated the largest number of frozen ET cycles of embryos following ICSI, which were compared to couples having frozen ET with embryos formed by conventional insemination. In women age 39 and younger, the clinical, viable, pregnancy rates and implantation rates were very similar. Similar rates were reached for the older group. These data convincingly demonstrate that fertilization by ICSI does not adversely effect the implanting capacity of frozen-thawed embryos.

Transforming growth factor-beta repression of matrix metalloproteinase-1 in dermal fibroblasts involves Smad3

Enhanced production of matrix metalloproteinase-1 (MMP-1, collagenase-1) is implicated in pathological tissue destruction. Transforming growth factor-beta (TGF-beta) prevents cytokine-induced MMP-1 gene expression in fibroblasts. In these studies, we examined the hypothesis that repression of MMP-1 may be mediated through the Smad signaling pathway. The results showed that Smad3 and Smad4, but not Smad1 or Smad2, mimicked the inhibitory effect of TGF-beta and abrogated interleukin-1beta (IL-1beta)-induced stimulation of MMP-1 promoter activity and NFkappaB-specific gene transcription in dermal fibroblasts. Experiments with truncation mutants indicated that both MH1 and MH2 domains of Smad3 were necessary for inhibitory activity. Dominant negative mutants of Smad3 or Smad4 and antagonistic Smad7, which disrupts ligand-induced Smad3 phosphorylation, abrogated the repression of MMP-1 transcription by TGF-beta. Similar results were obtained using immunoblot and Northern analysis. Furthermore, TGF-beta failed to repress MMP-1 promoter activity in Smad3-deficient murine embryonic fibroblasts. These results implicated cellular Smads in mediating the inhibitory effects of TGF-beta. Overexpression of the transcriptional co-activator p300, but not its histone acetyltransferase (HAT)-deficient mutant, was able to relieve repression of MMP-1 gene expression, suggesting that Smad-dependent inhibition may be due to increased competition between Smad proteins and IL-1beta signaling pathways for limiting amounts of cellular p300. Together, these results demonstrate that MMP-1 is a target for negative regulation by TGF-beta through cellular Smad3 and Smad4. Smad-mediated repression of MMP-1 gene expression may be important for preventing excessive matrix degradation induced by inflammatory cytokines; disruption of Smad signaling, as occurs in certain cancer cells, may thus be causally linked to uncontrolled tissue destruction mediated through MMP-1.

Intravascular local gene transfer mediated by protein-coated metallic stent

OBJECTIVE

To assess the feasibility, efficiency and selectivity of adenovirus-mediated gene transfer to local arterial wall by protein-coated metallic stent.

METHODS

A replication-defective recombinant adenovirus carrying the Lac Z reporter gene for nuclear-specific beta-galactosidase (Ad-beta gal) was used in this study. The coating for metallic stent was made by immersing it in a gelatin solution containing crosslinker. The coated stents were mounted on a 4.0 or 3.0 mm percutaneous transluminal coronary angioplasty (PTCA) balloon and submersed into a high-titer Ad-beta gal viral stock (2 x 10(10) pfu/ml) for 3 min, and then implanted into the carotid arteries in 4 mini-swines and into the left anterior descending branch of the coronary artery in 2 mini-swines via 8F large lumen guiding catheters. The animals were sacrificed 7 (n = 4), 14 (n = 1) and 21 (n = 1) days after implantation, respectively. The beta-galactosidase expression was assessed by X-gal staining.

RESULTS

The results showed that the expression of transgene was detected in all animal. In 1 of carotid artery with an intact intima, the beta-gal expression was limited to endothelial cells. In vessels with denuded endothelium, gene expression was found in the sub-intima, media and adventitia. The transfection efficiency of medial smooth muscle cells was 38.6%. In 2 animals sacrificed 7 days after transfection, a microscopic examination of X-gal-stained samples did not show evidence of transfection in remote organs and arterial segments adjacent to the treated arterial site.

CONCLUSIONS

Adenovirus-mediated arterial gene transfer to endothelial, smooth muscle cells and adventitia by protein-coated metallic stent is feasible. The transfection efficiency is higher. The coated stent may act as a good carrier of adenovirus-mediated gene transfer and have a potential to prevent restenosis following PTCA.