High concentration of thrombomodulin in plasma is associated with hemorrhage: a prospective study in patients receiving long-term anticoagulant treatment

BACKGROUND

The aim of this study was to prospectively test whether the risk of bleeding complications in 212 consecutive outpatients treated with oral anticoagulants could be predicted by levels of endothelium-derived hemostatic variables.

METHODS AND RESULTS

All bleeding complications were recorded during 5 years of follow-up; serious bleeding was defined as intracranial bleeding or hemorrhage causing death or necessitating hospitalization. The relationships of bleeding complications and plasma concentrations of tissue plasminogen activator, von Willebrand factor, and thrombomodulin, plasminogen activator inhibitor activity, and other possible risk factors were studied. Twenty-two patients suffered from bleeding complications during anticoagulant treatment; in 14 patients, these were serious. We found that the numbers both of serious hemorrhages and of total hemorrhages were significantly associated with increased levels of thrombomodulin. The number of bleeding episodes increased exponentially through quartiles one to four of the thrombomodulin distribution.

CONCLUSIONS

Thrombomodulin concentrations in plasma are related to the risk of hemorrhage in patients treated with oral anticoagulants.

In vitro marginal leakage around Class II resin composite restorations with glass-ceramic inserts

The aim of the study was to evaluate in vitro the marginal seal in Class II resin composite restorations reinforced with glass-ceramic inserts. Forty Class II cavities, with the gingival margins located at the cementoenamel junction, were restored with Palfique Estelite light-cured resin composite and one of two different bonding agents, All Bond 2 and Tokuso Light Bond, with or without the inclusion of glass-ceramic inserts. The extent of dye penetration along the tooth-restoration interface was measured under an optical microscope. The marginal seal of composite restorations placed with All Bond 2 was significantly better than that of restorations placed with Tokuso Light Bond. There was significantly less microleakage in All Bond 2 restorations without glass-ceramic inserts than in All Bond 2 restorations containing glass-ceramic inserts. No significant difference in marginal seal was demonstrated between Tokuso Light Bond restorations with glass-ceramic inserts and those without inserts.

The transcription factor C/EBP-beta and its role in ovarian function; evidence for direct involvement in the ovulatory process

Gonadotropins are responsible for maturation of the ovarian follicle and the oocyte. Ovulation is the ultimate step in this process and involves disintegration of the follicular wall and subsequent release of an oocyte into the oviduct. These events are triggered by a surge of luteinizing hormone (LH). Genes expressed in the ovary, that respond to LH, are likely to be involved in the biochemical pathways that regulate ovulation. The transcription factor C/EBP-beta is induced promptly in the ovary, as a response to an ovulatory dose of gonadotropins. We used an ex vivo perfusion system to demonstrate that a specific reduction in ovarian C/EBP-beta expression inhibits ovulation. In such ovaries the oocytes appeared to be entrapped within the follicle. We have found a correlation between the expression level of the activating isoform of C/EBP-beta and the number of oocytes ovulated in response to gonadotropins. Since a reduction in C/EBP-beta expression does not affect the level of the ovulatory mediator prostaglandin endoperoxide synthase-2 (PGS-2), these findings support the view of C/EBP-beta as an important factor in the ovulatory process and highlight a C/EBP-beta-dependent and PGS-2-independent pathway that takes part in regulation of ovulation.

E-cadherin expression in human epithelial ovarian cancer and normal ovary

The ovarian surface epithelium (OSE) is the origin of the majority of human ovarian cancers. These adenocarcinomas are characterized by initial local growth followed by spreading into the peritoneal cavity at later stages of tumor progression. The cell-adhesion molecule E-cadherin (E-cad) plays an important role in maintaining tissue integrity. Disappearance or impaired function of E-cad have often been associated with tumor formation and invasion in vivo and in vitro. The cell-specific expression of E-cad was investigated in normal human ovaries (n = 12), in benign (n = 5) and borderline (n = 4) ovarian epithelial tumors and in adenocarcinomas of different stages and histological grades (n = 18), by immunohistochemistry and immunoblotting. An ovarian cancer cell line (NIH-OVCAR3) was used as a reference. The epithelial origin of the cells was confirmed with cytokeratin (AE1/AE3) staining. In normal ovaries, the expression of E-cad was limited to inclusion cysts or deep clefts lined with OSE, whereas no staining of the OSE could be demonstrated at the surface of the ovary. In contrast, benign and borderline tumors uniformly expressed E-cad. This was observed in malignant tumors of all stages despite their degree of differentiation. E-cad was also present in metastasis from such tumors. The cell-specific expression of E-cad in inclusion cysts of normal ovaries and in epithelial layers of borderline tumors indicates a role for E-cad in the early events of the progression to a malignant phenotype. E-cad was not downregulated in later stages of ovarian cancer progression.

Leukocyte subpopulations in the human uterine cervical stroma at early and term pregnancy

Leukocyte subsets were detected by immunohistochemical methods in cervical tissue in either the first trimester or at term pregnancy. In tissue obtained during first trimester lower total numbers of leukocytes were observed in comparison with late pregnancy (2.7 cells/0.04 mm2 versus 5.5 cells/0.04 mm2). The major subgroup of leukocytes present in early pregnancy was T-lymphocytes. The majority of these cells were of the suppressor/cytotoxic subtype. Neutrophils were present at about 1/5th of the density of T-lymphocytes. Very few macrophages were observed at this stage. At term pregnancy, neutrophils were present in significantly higher numbers than during first trimester with no difference between tissue obtained before or during active labour. Macrophages were present at about 10-fold higher density than during early pregnancy. In conclusion, tissue-bound leukocytes are present in the human cervix at a higher density in late pregnancy compared to first trimester. The increased densities of neutrophils and macrophages at this stage indicate a role for these cells during cervical ripening.

Evidence for nitric oxide mediation of contractile activity in isolated strips of the human Fallopian tube

Endogenously produced nitric oxide (NO) induces relaxation in smooth muscle in various organs. The purpose of this study was to investigate whether a NO-mediated relaxation system exists in the human Fallopian tube. To study contractility, the isthmic portion of the tube was obtained from 23 fertile women during operations due to benign non-tubal diseases. Tubal smooth muscle strips were mounted in tissue chambers containing HEPES buffer and connected to a Grass transducer for the isometric registration of contractile activity. By adding L-arginine (the substrate for NO synthesis) or N-nitro-L-arginine methyl ester (L-NAME; an inhibitor of NO synthesis) to the tissue chambers, changes in tubal contractility were monitored. The addition of L-NAME caused increased tubal contractility, while L-arginine, after an initial transient increase in tonus, caused relaxation of the strips. Using immunohistochemistry, NO synthase, the enzyme that catalyses the production of NO from L-arginine, was identified in tubal tissue cells. These results indicate that a NO-dependent relaxation system exists in the Fallopian tube and that NO may play a role as a mediator of tubal contractility.

Localisation of mRNA for interleukin-1 receptor and interleukin-1 receptor antagonist in the rat ovary

Interleukin-1 (IL-1) is a multifunctional cytokine with profound effects on ovarian function. The effects of IL-1 on ovarian steroidogenesis have been demonstrated in several species. IL-1 mRNA levels are increased in the thecal layer of the ovulating follicle and IL-1 beta has been shown to induce ovulations in vitro. In this study we have investigated the presence and distribution of the mRNAs for type I IL-1 receptor (IL-1RtI) and for the naturally occurring IL-1 receptor antagonist (IL-1ra) in ovaries of adult cycling rats, to elucidate the target cells for IL-1 action. We have demonstrated the presence of mRNA for both substance by in situ hybridisation and reverse transcription PCR. mRNA for IL-1RtI was not found in primordial follicles but was abundant in the granulosa and thecal layer in developing follicles with stronger signals in the granulosa layer. In the preovulatory and ovulatory follicles, there was a further increase in the signal for IL-1RtI mRNA in the thecal layer compared with the granulosa layer. Corpora lutea were weakly positive at all stages and atretic follicles were largely negative. No mRNA was detected in oocytes of any stage mRNA for IL-1ra showed a similar distribution to that of IL-1RtI. The changes in distribution suggest an action of IL-1 on rat granulosa cells during follicular development and on thecal cells during ovulation.

Cell-specific localization of nitric oxide synthases (NOS) in the rat ovary during follicular development, ovulation and luteal formation

Nitric oxide (NO) has emerged as one of several important intraovarian regulatory factors. In particular, NO has been implicated in the processes of ovulation and atresia-related apoptosis. The aim of the present study was to investigate the presence and distribution of the NO-generating nitric oxide synthase (NOS) enzymes in the ovary during follicular development, ovulation and luteal formation of the equine chorionic gonadotrophin (ECG)/human chorionic gonadotrophin (HCG)-primed rat. NADPH diaphorase activity was used as a histochemical marker for NOS within the ovary. Diaphorase reactivity was most abundant in the stroma (S) of the ovary and in the theca (T) layer of the follicle. In luteinized ovaries, weaker diaphorase reactivity was present within the corpora lutea (CL). Two different isoforms of NOS, the constitutively expressed endothelial NOS (eNOS) and the inducible isoform of NOS (iNOS), were immunolocalized in ovaries of immature rats and in ECG/HCG-primed rats during the periovulatory period from HCG injection until 2 days after ovulation. In addition, ovarian concentrations of eNOS and iNOS were quantified by immunoblotting. Immunoblotting with a monoclonal anti-eNOS antibody demonstrated the presence of eNOS mainly in the residual ovary (ROV) during the periovulatory period. In luteinized ovaries, higher concentrations of eNOS were seen in CL, while those in the ROV at this stage were lower than in the periovulatory ovary. Immature ovaries contained diminutive amounts of eNOS, detectable mostly in the ROV compartment. In contrast, iNOS was barely detectable during follicular development to the preovulatory stage. A slight elevation of iNOS was observed in the granulosa cells at 6 h after the HCG injection. The levels of iNOS during the luteal phase were also low. Immunohistochemical analysis using polyclonal eNOS and iNOS antibodies revealed the localization of these two isoforms primarily in the S and the T of the periovulatory ovary. In luteinized ovaries, positive immunoreactivity was also seen within the CL. With a monoclonal antibody against eNOS, intense immunoreactivity was observed in the S, T and within CL. There was a particularly strong staining in blood vessels. These data demonstrate the presence of an intraovarian NO-generating system. The localization of this system to the S, T and CL suggests a role for NO in the ovulatory process and in the regulation of CL function.

Increased levels of plasma thrombomodulin are associated with vascular and all-cause mortality in patients on long-term anticoagulant treatment

BACKGROUND

The aim of the study was to test if plasma levels of thrombomodulin could predict mortality in 209 patients on long-term anticoagulant treatment followed up for 3.8 years.

METHODS AND RESULTS

The thrombomodulin level was 60.9 +/- 29.8 micrograms.l-1 for all 45 patients who died and 60.5 +/- 30.5 micrograms.l-1 for the 38 vascular deaths, compared to 52.3 +/- 20.7 micrograms.l-1 for the 164 survivors. We found that, in Cox regression analyses, all-cause (P = 0.025) and vascular mortality (P = 0.042) was significantly and independently associated with increased levels of thrombomodulin.

CONCLUSIONS

The level of plasma thrombomodulin can predict all-cause and vascular mortality in patients on long-term anticoagulant treatment.

Reducing the risk of sensitivity and pulpal complications after the placement of crowns and fixed partial dentures

Sensitivity after cementation of a crown with glass-ionomer cement is often attributed to an adverse effect on the pulp by the luting agent. Most permanent restorative materials in common use today do not tend to irritate the pulp; the main cause of pulpal damage is infection, the bacteria originating in the smear layer or deep in the dental tubules, inaccessible to caries-excavating procedures. A poorly fitting provisional crown may expose cut dentin to the oral fluids, and mechanical trauma caused by frictional heat during preparation may also damage the pulp. The following precautions are recommended during precementation procedures to reduce the risk of an inflammatory response in the pulp: (1) The provisional crown should be well fitting, covering cervical dentin but not impinging on the periodontal tissues. The permanent crown should be cemented as soon as possible. (2) The superficial smear layer should be removed and the dentinal surface should be treated with an antibacterial solution before the provisional crown is placed. (3) To decrease dentinal permeability under the provisional crown, the dentinal surface should be covered with a liner that can be easily removed before final cementation. (4) to ensure optimal mircomechanical bonding, the dentinal surface should be thoroughly cleaned, and the dentin should be kept moist until cementation. (5) The occlusion should be carefully checked before cementation of the crown.

Granulocyte-macrophage colony-stimulating factor: presence in human follicular fluid, protein secretion and mRNA expression by ovarian cells

In recent years it has become evident that a leukocyte-cytokine network contributes to the paracrine regulation of ovarian function. The objectives of this study were to examine the presence of a potent lympho-haemopoietic cytokine, granulocyte-macrophage colony-stimulating factor (GM-CSF), in tissues and fluids from human ovaries. In a prospective study, follicular fluid and plasma were collected from naturally cycling women and women undergoing hyperstimulation for in-vitro fertilization (IVF). Granulosa-lutein cells were collected at the time of oocyte recovery for IVF and corpora lutea were collected at the time of hysterectomy for non-ovarian reasons. Culture supernatants from ovarian cell and tissue cultures were harvested on completion of a 48 h incubation. Immunoactive GM-CSF was measured by enzyme-linked immunosorbent assay, and was found to be present at statistically significantly higher levels in follicular fluid (8.9 +/- 0.7 pg/ml) and plasma (11.3 +/- 0.8 pg/ml) of women undergoing hyperstimulation compared to follicular fluid (5.3 +/- 0.3 pg/ml) and plasma (7.1 +/- 0.5 pg/ml) from naturally cycling women. Immunoactive GM-CSF was also detected in culture supernatants of granulosa-lutein cells (47.6 pg/10(5) cells), early luteal phase corpora lutea (0.52 pg/microgram DNA) and mid-luteal phase corpora lutea (0.98 pg/microgram DNA). Furthermore, transcripts for GM-CSF, and both the alpha and beta subunits of the GM-CSF receptor, were detected by reverse transcription polymerase chain reaction (RT-PCR) in granulosa-lutein cell culture preparations and corpora lutea collected during the early, mid- and late luteal phase of the menstrual cycle. These results show that GM-CSF is expressed and secreted by cells within the human ovary, and, together with the finding of expression of mRNA for GM-CSF receptor, suggest a role for GM-CSF in the local regulation of ovarian events.

The human preovulatory follicle is a source of the chemotactic cytokine interleukin-8

Mammalian ovulation has several similarities to local inflammatory reactions, involving participation of leukocytes and inflammatory mediators. In response to a preovulatory luteinizing hormone surge, there is an influx of leukocytes into the preovulatory follicle and uncharacterized chemotactic activity towards these cells has previously been reported in follicular fluid of several species, including the human. In the present study, we have investigated the presence and local production of interleukin-8 (IL-8), a potent leukocyte-chemotactic and neutrophil-activating cytokine, in the human preovulatory follicle. Immunoreactive IL-8 was present in the follicular fluid in all of 12 in-vitro fertilization (IVF) patients investigated. IL-8 concentrations in follicular fluid (1269 +/- 245 pg/ml) were approximately 30-fold higher than in plasma (41 +/- 14 pg/ml). Isolated granulosa cells in culture secreted large amounts of IL-8 protein. Basal secretion of IL-8 was dose-dependently enhanced by the presence of fetal calf serum and was further stimulated by the addition of the ovulation-associated cytokine IL-1 beta. Messenger RNA for IL-8 was detected by reverse transcription/polymerase chain reaction (RT-PCR) in all tested samples of granulosa cells of IVF patients (n = 8) and in all biopsies from preovulatory follicle walls obtained in natural cycles (n = 6). This is the first demonstration of IL-8 in the mammalian ovary. Local production, combined with high follicular fluid concentrations, suggests that this cytokine plays a role in cyclic ovarian events, such as ovulation.

Inhibition of nitric oxide: effects on interleukin-1 beta-enhanced ovulation rate, steroid hormones, and ovarian leukocyte distribution at ovulation in the rat

The ovulatory process resembles an inflammatory reaction with an infiltration of leukocytes, production of inflammatory mediators such as cytokines, and a general edema and hyperemia. Nitric oxide (NO), a potent vasodilator and the main mediator of macrophage tumoricidal and bacteriocidal activities, is known to participate in inflammatory reactions and has been shown to mediate the interleukin-1 beta (IL-1 beta)-directed tissue-remodeling events within the ovary. The regulation by NO of ovulation rate, leukocyte distribution, and steroid release in the rat ovary was investigated through use of a combination of in vivo and in vitro models of ovulation and a competitive inhibitor, N-omega-nitro-L-arginine methyl ester (L-NAME), of the NO synthase (NOS) enzyme. Subcutaneous L-NAME (1.5 x 10(-4) mol/kg) administration significantly reduced the in vivo ovulation rate of eCG/hCG-primed rats (L-NAME-treated: 10.6 +/- 1.8 [mean +/- SEM] oocytes per ovary [O/O], 11.0 +/- 1.2 rupture sites per ovary [RS/O]; saline-treated: 18.0 +/- 1.8 O/O, 19.4 +/- 1.1 RS/O; p < 0.01) at 20 h post-hCG. These results were reflected in vitro, where addition of L-NAME (3.5 x 10(-5) mol/L) to LH (0.1 microgram/ml)-perfused ovaries decreased ovulation rate from 8.2 +/- 1.6 to 2.7 +/- 1 ovulations per ovary (p < 0.05) and simultaneously decreased nitrite accumulation at the completion of perfusions from 16.5 +/- 1.9 to 4.1 +/- 0.5 nmol/ml (p < 0.001). The addition of L-NAME to LH+IL-1 beta (4 ng/ml)-perfused ovaries decreased ovulation rate from 15.2 +/- 2.4 to 0.8 +/- 0.8 ovulations per ovary (p < 0.001) and simultaneously decreased nitrite accumulation at 22 h from 22.8 +/- 2.2 to 1.9 +/- 0.6 nmol/ml (p < 0.001). Studies analyzing and manipulating perfusion flow rate indicated that the L-NAME effects on ovulation rate are primarily due to a reduction in flow rate resulting from inhibition of NO, which may be a consequence of the known vasoconstrictor effects of NOS inhibitors. The observed reduction of in vivo ovulation rate by NO inhibition at 20 h post-hCG was associated with a significant reduction in thecal MCA149+ neutrophils at 12 h post-hCG, the expected time of ovulation (L-NAME-treated: 98.4 +/- 9.2 cells per thecal area; saline-treated: 211.5 +/- 11.5 cells per thecal area; p < 0.001), while ED1+ monocytes/macrophages underwent similar but nonsignificant changes. Plasma (20 h post-hCG) and perfusate progesterone were not different with L-NAME treatment, while perfusate estradiol levels were markedly reduced upon addition of L-NAME, suggesting a role for NO in ovulation but not in the process of luteinization. In summary, deprivation of NO by use of the competitive inhibitor, L-NAME, led to fewer ovulations, reduced accumulation of nitrite, a decreased neutrophil count in the theca of preovulatory follicles, and reduced estradiol secretion, while progesterone release remained unaffected. The NO pathway may therefore play an important role in the regulation of ovulation and the mediation of IL-1 beta's pro-ovulatory effects. There are likely to be primarily vascular effects, but also a nonvascular component, to the NO regulation of ovulation, with both components indirectly affecting ovulatory leukocyte distribution and steroid secretion.

Regulation of the inducible form of prostaglandin endoperoxide synthase in the perfused rat ovary

The regulation of the two isoforms of prostaglandin endoperoxide synthase (PGS-1 and PGS-2) and prostaglandin synthesis by luteinizing hormone (LH)/3-isobutyl-1-methylxanthine (IBMX) and progesterone was examined in granulosa cells and residual ovarian tissue of rat ovaries perfused in vitro. The endogenous progesterone synthesis was blocked by an inhibitor of 3 beta-dehydroxysteroid-dehydrogenase, compound A (CA), previously shown to reversibly inhibit ovulation in the in vitro perfused rat ovary. Preovulatory ovaries were perfused for 7 h, and soluble extracts from granulosa cells and residual ovarian tissue were obtained for immunoblotting and determination of the tissue contents of PGS-1/PGS-2. The tissue concentrations of prostaglandins (PGE2, PGF2 alpha and 6-keto-PGF1 alpha) were measured. The ovaries were perfused with medium alone (control) or medium containing LH (0.1 microgram/ml) and IBMX (0.2 mM), LH+IBMX+CA (10 micrograms/ml) or LH+IBMX+CA+progesterone (10 micrograms/ml). PGE2, PGF2 alpha and 6-keto-PGF1 alpha tissue concentrations were increased by LH+IBMX, with highest values detected for PGE2. The addition of CA alone or CA in combination with exogenous progesterone, did not change the values of prostaglandins increased by LH+IBMX. The content of PGS-1 was only marginally changed in both granulosa cells and residual ovarian tissue in the different treatment groups, compared to the control group. In contrast, PGS-2 was markedly increased by LH+IBMX, especially in the granulosa cells. The addition of CA, in combination with LH+IBMX, resulted in a small decrease of PGS-2, and progesterone further decreased its content. In the residual ovarian tissue, only minor changes of PGS-2 were detected. These results demonstrate that LH and progesterone selectively regulate the expression of PGS-2 in rat granulosa cells, whereas the hormonal regulation of PGS-1 is less pronounced. Progesterone inhibits PGS-2 in granulosa cells but has negligible effects on the total ovarian synthesis of prostaglandins during the ovulatory period.

Cytokines in the ovary: pathophysiology and potential for pharmacological intervention

The ovary and testis are sites for interaction between the endocrine and immune system via leukocytes and their secreted products, the cytokines. There are convincing data available to show that the gonads are sites of cytokine action and production. In the ovary, cytokines and leukocytes are intimately involved in follicular development, ovulation, and luteal function. A variety of clinical situations may be due to cytokine action in the gonads, and therapeutic manipulation of the immune system may affect reproductive function.

Contraction gaps in Class II restorations with self-cured and light-cured resin composites

PURPOSE

To evaluate in vitro the cervical gap formation in composite restorations in which an increment of autopolymerizing composite was interposed between the light-cured filling material and the dentin bonding system. Two different self-cured materials and two different adhesives were used and compared.

MATERIALS AND METHODS

In 40 Class II cavity preparations with the gingival margins in dentin or cementum, an increment of either of two different autopolymerizing composites, Palfique or Bisfil 2B, was interposed between the light-cured filling material (Palfique Estelite) and either of two different dentin bonding systems, All-Bond and Superbond D (20 restorations each). The specimens were immersed in toluidine blue dye. A section was taken from each specimen and examined under an optical microscope. The extent of dye penetration was measured. The specimens were then stored in water for 1-4 months and replicas of the sections were examined by SEM.

RESULTS

Good marginal adaptation was observed for All-Bond/Bisfil 2B in all the restorations. All-Bond/Palfique showed good adaptation in 7 out of 10 cases, the failures occurring between bonding agent and composite. Superbond D/Palfique and Superbond D/Bisfil 2B showed marginal gap formation in 8 out of 10 and in all the restorations respectively. In the latter, four gaps occurred between bonding agent and dentin. As a consequence, a very significant difference (P<0.001) was found between All-Bond and Superbond treatments; no significant difference was found between Bisfil 2B and Palfique in each group treated with either All-Bond or Superbond. After 1-4 months storage in water, hygroscopic expansion of the restorative materials reduced the total number of gaps and the efficacy of the treatments was no more significantly different.

Methodology and characterization of an in vitro perfusion model for the mouse ovary

Perfusion of intact ovaries in vitro has proved to be a suitable model for the study of ovarian events, such as ovulation and corpus luteum function, with advantages over cell culture systems of preserved three-dimensional structure with intact intercellular communication. This methodology has been described for several larger experimental animals. Development of genetically manipulated mouse strains and the larger availability of recombinant proteins and monoclonal antibodies in this species prompted the development of a mouse ovary perfusion system. In the present study, we describe the methodology for perfusion of mouse ovaries in vitro and characterize the model with respect to steroidogenesis, ovulatory efficiency and morphology. Swiss mice (30-45 g) were synchronized with a single injection of a GnRH agonist and laparotomy was performed on the morning of pro-oestrus. The right ovary and its vasculature, after cannulation on the arterial side, were surgically isolated and transferred to a recirculating perfusion system, and were perfused for 20 h. The ultrastructure of the ovaries after 20 h of perfusion was examined by transmission electron microscopy, which showed well-preserved cellular organelles and nuclei and distinct tight junctions between endothelial cells. Unstimulated ovaries did not ovulate and secreted small quantities of progesterone. After addition of hCG (50 iu) or ovine LH (0.1 microgram ml-1), ovulations were observed in all perfused ovaries (2.6 +/- 0.5 and 2.0 +/- 0.3 ovulations per treated ovary, respectively). There was a distinct rise in progesterone output after hormone addition. When a phosphodiesterase inhibitor, isobutylmethylxanthine (0.2 mumol l-1), was added in combination with LH, the ovulation rate (7.4 +/- 1.2) was similar to that in vivo and progesterone secretion was further increased compared with other treatments. Since the mouse has become a very important experimental animal in medical research and we have the ability to genetically manipulate this species, this methodology for perfusing mouse ovaries in vitro may be a useful tool in future studies of ovarian physiology.

Reduction of ovulation rate in the rat by administration of a neutrophil-depleting monoclonal antibody

To investigate the effect of systemic neutrophil depletion on ovulation rate, rats were synchronised with eCG and hCG, and concurrently were administered neutrophil-specific, cytotoxic RP-3 monoclonal antibody (mAb), or an irrelevant, class-matched mAb. Neutrophils in the peripheral blood and in the thecal-luteal area of corpora lutea were detected by immunohistochemical analysis with the neutrophil-specific mAb MCA149 and were found to be reduced in number by 70% and 38% respectively following RP-3 treatment compared to the control group. Ovulation rate, as assessed by counting the number of oocytes in the ampullary region of the oviduct 20 h after hCG administration, was found to be reduced by 27% in the neutrophil-depleted rats. This result provides further evidence that neutrophilic granulocytes play an active role in ovulation in the rat.

Endothelial haemostatic factors may be associated with mortality in patients on long-term anticoagulant treatment

The aim of the present study was to test if long-term mortality could be predicted by endothelial derived haemostatic variables in a population with high morbidity due to thromboembolic disease. Plasma samples were drawn from 212 out-patients treated with oral anticoagulants, at the beginning of the study, and analyzed for mass concentration of tissue plasminogen activator (tPA) and its inhibitor (PAI-1), and von Willebrand factor. In the course of 3.8-year follow-up 45 patients died, including 38 vascular deaths. We found that all-cause mortality was significantly associated with increased levels of vWF and tPA. For vascular mortality there was a significant association with all three haemostatic variables (tPA, PAI-1, vWF). For vWF there was a 3-fold increase in total and vascular mortality in the highest quartile compared to the lowest quartile. There were 27 vascular deaths in the group of patients with a tPA-value above the median compared to 11 in those with a tPA below the median. In multivariate Cox regression analysis (including: age, sex, smoking habits, body mass index, diabetes mellitus, hypertension, tPA, PAI-1, and vWF), vWF and smoking were independently significantly associated with all-cause mortality, and tPA and age with vascular mortality. Endothelial derived haemostatic variables are predictors of total and vascular mortality in patients treated with oral anticoagulants.

Microleakage in Class 2 composite resin restorations

Using the dye penetration method, the effect on the microleakage of class 2 resin restorations of two dentin bonding systems that use 10% citric acid-containing dentin conditions was studied. These results were then compared to the results obtained when the manufacturer's conditioner was replaced by a mild surface-active detergent containing 0.2% EDTA and 1% NaF. The cavities that were treated with the 0.2% EDTA-containing conditioner in place of the manufacturer's conditioner showed similar results: Neither of the two bonding systems could totally prevent cervical gap formation.

Distribution of leukocyte subtypes in the sheep ovary after laser drilling

The distribution of leukocyte subtypes in the sheep ovary following laser drilling of the ovarian capsule was examined to understand a possible mechanism by which this treatment promotes ovulation in polycystic ovarian syndrome. Ovaries were removed from sheep at different time-points following laparoscopic laser drilling and immunohistochemical detection of leukocyte subtypes, using specific monoclonal antibodies; standard histological staining was performed. Migration of leukocytes into the laser-drilled site was observed as early as 6 h after laser drilling and the total number of leukocytes in the site was found to increase up to the 12th day after surgery. In the earlier period, polymorphonuclear leukocytes were the dominant leukocyte subtypes, while macrophages and lymphocytes were the major cellular components on the 12th day and later. These results show that the tissue changes in the ovary following laser drilling are consistent with a local inflammatory reaction. The prolonged appearance of numerous macrophages following the acute inflammatory phase could lead to the secretion of cytokines and other substances suggested to be important in promoting ovulation. These data indicate that part of the effectiveness of the laser drilling in polycystic ovarian syndrome may be attributable to the secretory products of these leukocytes.

Cellular composition of primary cultures of human granulosa-lutein cells and the effect of cytokines on cell proliferation

The cellular composition of cells collected from the follicular fluid obtained during the IVF procedure and cultured in vitro was examined, as well as the effects of two cytokines, interleukin-2 (IL-2) and tumour necrosis factor-alpha (TNF alpha), on the proliferation of individual cell types. After 48 h in culture, most of the cells were granulosa-lutein cells exhibiting positive staining against 3-beta-hydroxysteroid dehydrogenase (3 beta-HSD). About one-third of the total cell population stained positive with monoclonal antibodies against specific antigen sites on lymphohaemopoietic cells, including B-lymphocytes, T-lymphocytes, natural killer cells, monocytes and macrophages. During this 48-h period, IL-2 and TNF alpha significantly (P < 0.05) increased the proportion of leukocyte common antigen (LCA)-positive cells and monocytes. At the end of 144 h in culture, although LCA-positive cells and monocytes were still present, there were fewer. The main targets for the proliferative effects of IL-2 and TNF alpha in this culture system during the first 48 h are leukocytes rather than steroid-producing cells. Thus, any observed effects from the addition of cytokines in this system may be due to indirect effects of cytokine-activated leukocytes on granulosa-lutein cells.

Interleukin-1β inhibits luteinizing hormone-induced plasminogen activator activity in rat preovulatory folliclesin vitro

The effects of interleukin-1β (IL-1β) and tumour necrosis factor-α (TNFα) on ovulation-associated plasminogen activator (PA) activity were investigated using preovulatory follicles excised 48h after equine chorionic gonadotrophin (16IU)-priming of immature rats. Follicles were incubated for 6 and 14h with a single dose of LH (1 μg/ml) only, or various cytokine doses in the presence or absence of LH. PA activity in follicular homogenates was determined by a radioactively labelled fibrin-coated plate method and secreted levels of the ovulatory mediators progesterone (P) and prostaglandin E (PGE) were measured by radioimmunoassay. LH induced timedependent rises in PA (2.5-fold over control at 6h and fourfold over control at 14h), while IL-1β and TNFα alone had no effect over either time period. LH and cytokine coincubations over 14h revealed that IL-1β dosedependently inhibited the LH-induced increase in PA activity, up to 85%. The effects of TNFα on LH-induced PA activity were not significant. Both IL-1β and TNFα increased P and PGE secretion time- and dose-dependently. In summary, IL-1β dose-dependently inhibits the LH-induced increase in PA activity in rat preovulatory folliclesin vitro while, as with TNFα, increasing P and PGE synthesis. This study, shows that the earlier reported pro-ovulatory action of IL-1β is not likely to be mediated by activation of the PA-system and suggests that IL-1β may mediate a regulatory loop controlling the extent and distribution of LH-induced PA activity in rat preovulatory follicles.

Effects of tumour necrosis factor alpha (TNF alpha) on ovulation in the rat ovary

The effects of tumour necrosis factor alpha (TNF alpha) on ovulation rate, ovarian secretion of steroids, and on tissue concentrations of the ovulatory mediators plasminogen activator (PA) and prostaglandins were examined in rat ovaries perfused in vitro for 20 h. Unstimulated control ovaries did not ovulate whereas luteinizing hormone (LH; 100 ng mL-1) induced ovulations in all ovaries (2.6 +/- 0.7). TNF alpha (40 ng mL-1) induced ovulations in 3 of 5 ovaries (0.8 +/- 0.4). When TNF alpha was added concomitantly with LH, the LH-induced ovulation rate was increased four-fold (10.6 +/- 1.3). This effect was not seen when TNF alpha was added 5 h after LH (3.2 +/- 0.6). More progesterone was released when TNF alpha was combined with LH by comparison with LH alone. Tissue concentrations of prostaglandin F2 alpha (PGF2 alpha) and PGE were increased by the addition of TNF alpha when compared with the control group, but did not exceed those observed in the LH group, when TNF alpha was combined with LH. PA activity in the tissue was unaffected by TNF alpha and the LH-induced increase in PA activity was inhibited when TNF alpha was combined with LH. The results demonstrate that the proinflammatory cytokine TNF alpha promotes ovulations in the rat ovary.