PRECISION: the Belgian molecular profiling program of metastatic cancer for clinical decision and treatment assignment

PRECISION is an initiative from the Belgian Society of Medical Oncology (BSMO) in collaboration with several stakeholders, encompassing four programs that aim to boost genomic and clinical knowledge with the ultimate goal to offer patients with metastatic solid tumors molecularly guided treatments. The PRECISION 1 study has led to the creation of a clinico-genomic database. The Belgian Approach for Local Laboratory Extensive Tumor Testing (BALLETT) and GeNeo studies will increase the number of patients with advanced cancer that have comprehensive genotyping of their cancer. The PRECISION 2 project consists of investigator-initiated phase II studies aiming to provide access to a targeted drug for patients whose tumors harbor actionable mutations in case the matched drug is not available through reimbursement or clinical trials in Belgium.

Long-term survival of pig-to-rhesus macaque renal xenografts is dependent on CD4 T cell depletion

The shortage of available organs remains the greatest barrier to expanding access to transplant. Despite advances in genetic editing and immunosuppression, survival in experimental models of kidney xenotransplant has generally been limited to <100 days. We found that pretransplant selection of recipients with low titers of anti-pig antibodies significantly improved survival in a pig-to-rhesus macaque kidney transplant model (6 days vs median survival time 235 days). Immunosuppression included transient pan-T cell depletion and an anti-CD154-based maintenance regimen. Selective depletion of CD4⁺ T cells but not CD8⁺ T cells resulted in long-term survival (median survival time >400 days vs 6 days). These studies suggested that CD4⁺ T cells may have a more prominent role in xenograft rejection compared with CD8⁺ T cells. Although animals that received selective depletion of CD8⁺ T cells showed signs of early cellular rejection (marked CD4⁺ infiltrates), animals receiving selective CD4⁺ depletion exhibited normal biopsy results until late, when signs of chronic antibody rejection were present. In vitro study results suggested that rhesus CD4⁺ T cells required the presence of SLA class II to mount an effective proliferative response. The combination of low pretransplant anti-pig antibody and CD4 depletion resulted in consistent, long-term xenograft survival.

Clinical and electrophysiological investigation of spastic muscle overactivity in patients with disorders of consciousness following severe brain injury

OBJECTIVE

The clinical and electrophysiological profile of spastic muscle overactivity (SMO) is poorly documented in patients with disorders of consciousness (DOC) following severe cortical and subcortical injury. We aim at investigating the link between the clinical observations of SMO and the electrophysiological spastic over-reactivity in patients with prolonged DOC.

METHODS

We prospectively enrolled adult patients with DOC at least 3 months post traumatic or non-traumatic brain injury. The spastic profile was investigated using the Modified Ashworth Scale and the Hmax/Mmax ratio. T1 MRI data and impact of medication were analyzed as well.

RESULTS

21 patients were included (mean age: 41 ± 11 years; time since injury: 4 ± 5 years; 9 women; 10 traumatic etiologies). Eighteen patients presented signs of SMO and 11 had an increased ratio. Eight patients presented signs of SMO but no increased ratio. We did not find any significant correlation between the ratio and the MAS score for each limb (all ps > 0.05). The presence of medication was not significantly associated with a reduction in MAS scores or Hmax/Mmax ratios.

CONCLUSIONS

In this preliminary study, the Hmax/Mmax ratio does not seem to reflect the clinical MAS scores in patients with DOC. This supports the fact they do not only present spasticity but other forms of SMO and contracture.

SIGNIFICANCE

Patients with DOC are still in need of optimized tools to evaluate their spastic profile and therapeutic approaches should be adapted accordingly.

Physical therapy in patients with disorders of consciousness: Impact on spasticity and muscle contracture

BACKGROUND

Spasticity is a frequent complication after severe brain injury, which may prevent the rehabilitation process and worsen the patients' quality of life.

OBJECTIVES

In this study, we investigated the correlation between spasticity, muscle contracture, and the frequency of physical therapy (PT) in subacute and chronic patients with disorders of consciousness (DOC).

METHODS

109 patients with subacute and chronic disorders of consciousness (Vegetative state/Unresponsive wakefulness syndrome - VS/UWS; minimally conscious state - MCS and patients who emerged from MCS - EMCS) were included in the study (39 female; mean age: 40±13.5y; 60 with traumatic etiology; 35 VS/UWS, 68 MCS, 6 EMCS; time since insult: 38±42months). The number of PT sessions (i.e., 20 to 30 minutes of conventional stretching of the four limbs) was collected based on patients' medical record and varied between 0 to 6 times per week (low PT = 0-3 and high PT = 4-6 sessions per week). Spasticity was measured with the Modified Ashworth Scale (MAS) on every segment for both upper (UL) and lower limbs (LL). The presence of muscle contracture was assessed in every joint. We tested the relationship between spasticity and muscle contracture with the frequency of PT as well as other potential confounders such as time since injury or anti-spastic medication intake.

RESULTS

We identified a negative correlation between the frequency of PT and MAS scores as well as the presence of muscle contracture. We also identified that patients who received less than four sessions per week were more likely to be spastic and suffer from muscle contracture than patients receiving 4 sessions or more. When separating subacute (3 to 12 months post-insult) and chronic (>12months post-insult) patients, these negative correlations were only observed in chronic patients. A logit regression model showed that frequency of PT influenced spasticity, whereas neither time since insult nor medication had a significant impact on the presence of spasticity. On the other hand, PT, time since injury and medication seemed to be associated with the presence of muscle contracture.

CONCLUSION

Our results suggest that, in subacute and chronic patients with DOC, PT could have an impact on patients' spasticity and muscles contractures. Beside PT, other factors such as time since onset and medication seem to influence the development of muscle contractures. These findings support the need for frequent PT sessions and regular re-evaluation of the overall spastic treatment for patients with DOC.

Ethnic disparities and morbidity in the Province of Antwerp, Belgium

OBJECTIVE

This study aims to identify geographical disparities in perinatal mortality and morbidity in the province of Antwerp, Belgium. We performed a retrospective cohort study from an existing database. Data included from 1 January , 2000 to 31 December, 2009 and including all deliveries in the Province of Antwerp, Belgium. Collected outcome measures : fetal death, early and late neonatal death, preterm birth, low birth weight. Outcomes were analyzed according to postal code of the pregnant women's address.

RESULTS

A total of 167.246 deliveries in sixty postal codes were analyzed and statistically significant differences (p<0.001) between postal codes for all outcome measures except for early and late neonatal death were detected. Generally postal codes tend to have either high or low prevalences for all perinatal outcomes and two postal code zones had a significantly worse perinatal outcome on all fields. Major differences in perinatal outcome exist within the well-defined area of the relatively small province of Antwerp, Belgium.

CONCLUSION

Perinatal outcome is strongly influenced by maternal postal code even within a relatively affluent European region demonstrating persistent health inequalities and suggesting further research is necessary to explain these differences and create interventions to diminish inequalities.

Pregnant after assisted reproduction: a risk pregnancy is born! 18-years perinatal outcome results from a population-based registry in Flanders, Belgium

BACKGROUND

Although the increased risk for perinatal morbidity and mortality of babies born after ART is largely attributed to a higher rate of multiple gestations, a significantly worse perinatal outcome for singleton pregnancies following ART compared to pregnancies after natural conception has been reported as well. Most studies only include IVF/ICSI pregnancies; studies describing the perinatal outcome of pregnancies after non-IVF assisted reproduction are scarce.

METHODS AND MATERIALS

Population-based cohort study with three exposure groups: a study group of pregnancies (1) after ovarian stimulation (OS), with or without artificial insemination (AI), (2) after IFV or ICSI and (3) a naturally conceived (NC) comparison group. Data from the regional registry of all hospital deliveries in the Dutch-speaking part of Belgium during an 18-years period from January 1993 until December 2010 were used. The perinatal outcome parameters were prematurity, low birth weight, perinatal mortality and morbidity including neonatal intracranial bleeding and need for intubation. Logistic regression analysis was used including mode of conception, female age, foetal sex, parity and year of delivery.

RESULTS

Data on 1 079 814 births were studied: 1 039 415 singletons (19 896 IVF/ICSI, 20 469 OS and 999 050 NC) and 39 041 twins (9 353 IVF/ICSI, 4812 OS and 24 876 NC) were available for analysis. IVF/ICSI singletons had a significantly worse outcome when compared to OS and NC for almost all investigated perinatal parameters. Non-IVF/OS singletons were also significantly disadvantaged for prematurity and low birth weight when compared to NC. The outcome of twin pregnancies was similar for the three groups unless only unlike-sex twins were studied separately. Among this subgroup, IVF/ICSI carried a higher risk for low birth weight when compared to NC. OS unlike-sex twins were at increased risk for low birth weight, intra uterine death and perinatal mortality when compared to NC.

CONCLUSION

According to our results all ART pregnancies, whether due to IVF/ICSI or non-IVF treatment, have to be considered as risk pregnancies, irrespective of the number of foetuses.

LIMITATIONS OF THE STUDY

Although our logistic regression analysis included co-variables with a potential impact on perinatal outcome such as mode of conception, female age, foetal sex, parity and year of delivery, we couldn't correct for other prominent confounders such as the use of fresh or frozen embryos, use of homologous or donor gametes, smoking, obesity, socio-economic status, occupation exposures and pre-existing disease.

Photon counting spectral CT component analysis of coronary artery atherosclerotic plaque samples

OBJECTIVE

To evaluate the capabilities of photon counting spectral CT to differentiate components of coronary atherosclerotic plaque based on differences in spectral attenuation and iodine-based contrast agent concentration.

METHODS

10 calcified and 13 lipid-rich non-calcified histologically demonstrated atheromatous plaques from post-mortem human coronary arteries were scanned with a photon counting spectral CT scanner. Individual photons were counted and classified in one of six energy bins from 25 to 70 keV. Based on a maximum likelihood approach, maps of photoelectric absorption (PA), Compton scattering (CS) and iodine concentration (IC) were reconstructed. Intensity measurements were performed on each map in the vessel wall, the surrounding perivascular fat and the lipid-rich and the calcified plaques. PA and CS values are expressed relative to pure water values. A comparison between these different elements was performed using Kruskal-Wallis tests with pairwise post hoc Mann-Whitney U-tests and Sidak p-value adjustments.

RESULTS

RESULTS for vessel wall, surrounding perivascular fat and lipid-rich and calcified plaques were, respectively, 1.19 ± 0.09, 0.73 ± 0.05, 1.08 ± 0.14 and 17.79 ± 6.70 for PA; 0.96 ± 0.02, 0.83 ± 0.02, 0.91 ± 0.03 and 2.53 ± 0.63 for CS; and 83.3 ± 10.1, 37.6 ± 8.1, 55.2 ± 14.0 and 4.9 ± 20.0 mmol l(-1) for IC, with a significant difference between all tissues for PA, CS and IC (p < 0.012).

CONCLUSION

This study demonstrates the capability of energy-sensitive photon counting spectral CT to differentiate between calcifications and iodine-infused regions of human coronary artery atherosclerotic plaque samples by analysing differences in spectral attenuation and iodine-based contrast agent concentration.

ADVANCES IN KNOWLEDGE

Photon counting spectral CT is a promising technique to identify plaque components by analysing differences in iodine-based contrast agent concentration, photoelectric attenuation and Compton scattering.

Pregnancy at late premenopausal age: outcome of pregnancies at 45 years and older in Flanders, Belgium

To describe the obstetric outcome in women at ages ≥ 45. A retrospective cohort study on a large existing database covering all deliveries in the Flanders region, Belgium, was performed, comparing obstetric outcomes at age 25, 35, 40 and 45 or older, for the period 2005-2010. In the period studied, 421 women gave birth at maternal age ≥ 45 vs 3,405, 15,206, 22,586 at ages 40, 35 and 25, respectively. With advancing maternal age, a significant linear increase for low birth weight (< 2,500 g) and preterm delivery (< 37, < 35 weeks and < 29 weeks), maternal hypertension and diabetes, both primary and secondary caesarean section, was noted. Between ages 40 and ≥ 45, both fetal and early neonatal death demonstrated a significant rise from 4.9/1,000 and 1.8/1,000 to 26/1,000 and 9.5/1,000, respectively. With advancing maternal age, a gradual but not statistically significant decline in the proportion of male fetuses was noted, from 51.6% at 25, to 47.2% in the oldest group. Multivariate analysis confirmed advanced maternal age to be a significant factor in low birth weight, preterm delivery, hypertension, diabetes, caesarean section and perinatal mortality. In Flanders, mothers at age 45 and older have a significantly increased risk for low birth weight, preterm delivery, hypertension, diabetes, caesarean section and perinatal mortality.

Elective induction of labour increases caesarean section rate in low risk multiparous women

The aim of this study was to compare the risk of secondary caesarean section in induced versus spontaneous labour in the second delivery of low risk women who had a vaginal delivery in their first pregnancy. The data were retrospective cohort from an existing regional database, comparing term (between 37 and 42 gestational weeks) second deliveries in cephalic position in women who had previously given vaginal birth. Diabetes, hypertension and multiple pregnancy were excluded as were those with a birth weight less than 2500 g or more than 4500 g. The difference was not significant when induction was performed after 41 weeks. The results showed a total number of 29693 deliveries were included, 21243 in spontaneous labour and 8450 after induction of labour. In the spontaneous group 312 (1.5%) underwent secondary caesarean section, as compared to 237 (2.8%) in the induced group, p < 0.001, OR 1.93 (95% confidence interval 1.63-2.29). It was concluded that elective induction of labour in low risk women who have previously given vaginal birth is associated with an almost doubled rate of secondary caesarean section if performed before 41 weeks.

Foetal monitoring during labour: practice versus theory in a region-wide analysis

PURPOSE

To evaluate cardiotocography (CTG) alone versus CTG and ST-analysis (STAN) in daily obstetric practice in a complete region.

METHODS

Prospective registration in the region of Flanders in combination with standard registration of perinatal outcome.

RESULTS

Of 62,606 term deliveries registered, 57,141 (91.3%) were available for complete analysis. In 50,748 (88.8%) CTG alone and in 6,393 (11.6%) CTG+STAN was used. STAN was used significantly more in case of hypertension, diabetes and induction of labour and was associated both in univariate and multivariate analysis with significantly more secondary caesarean section for suspected foetal distress, instrumental vaginal delivery, low Apgar score and need for neonatal intensive care. There was no difference in perinatal death or asphyxia.

CONCLUSION

ST-analysis versus CTG results in more caesarean sections, instrumental vaginal deliveries and neonatal intensive care. This can not be explained solely by its use in more complicated cases as in multivariate analysis including hypertension, diabetes and induction of labour ST analysis persists as a significant factor. We hypothesise that this could be explained by less well trained users not adhering to STAN-guidelines.

Pregnancy outcome of Moroccan and Turkish women in Belgium

OBJECTIVE

To compare perinatal outcome in women from Turkish and Moroccan descent versus autochthonous women in Belgium.

METHODS

Retrospective cohort study, data from an existing database, coupled with sociodemographic data from birth certificates.

RESULTS

There were more teenage pregnancies in the Moroccan and Turkish group, Moroccan women delivered more frequently after age 40 but Turkish women less frequently. In Moroccan and Turkish women the level of education was lower, they had less hypertension, fewer pregnancies after artificial reproductive technology and preterm deliveries, more diabetes and more grand multiparity. Moroccan women demonstrated more HIV infection. Planned cesarean section was less frequent in the Moroccan and Turkish group, and there was no difference for secondary cesarean section. Belgian women had more induction of labor, instrumental vaginal delivery and epidural anesthesia. There were more babies with low birth weight in both the Moroccan and Turkish group. Moroccan woman had more babies with a birth weight above 4500 g. Total perinatal death rate was higher for Moroccan women while there was no difference between Belgian and Turkish babies.

CONCLUSION

Moroccan women demonstrated higher rates of HIV infection and perinatal mortality, while in both Turkish and Moroccon women diabetes was higher and hypertension less frequent. Belgian women underwent more interventions during pregnancy.

Birth weight for gestational age among Flemish twin population

OBJECTIVE

The aim of this study was to develop birth weight references for twins. Mean birth weights of individual twins are lower than those of singletons, hence singleton birth weight curves may not be suitable to assess twin birth weights.

STUDY DESIGN

Twin birth weight curves were developed according to gestational age, gender, parity and mode of -conception. The curves are based on population-based data of 40,494 twins born in Flanders, Belgium between 1987 and 2007.

RESULTS

A different growth potential was found comparing the birth weights of twins and singletons. Twins deviate from the singleton curve from 30 weeks gestational age on.

CONCLUSION

Our study underlines that singleton birth weight curves differ from twin birth weight curves. We developed specific twin birth weight curves can be used in clinical practice in order to follow growth patterns of twins in utero.

Understanding rising caesarean section trends: relevance of inductions and prelabour obstetric interventions at term

AIMS

Single center 10-years audit on the relation between labour ward management and caesarean section rate, with special emphasis on the impact of reduced induction rate and the use of strict criteria for the diagnosis of onset of spontaneous labour and the indication for induction of labour.

METHODS

Retrospective classification of all deliveries between 1st January 2001 and 31st December 2010 in Ziekenhuis Oost Limburg, Genk Belgium, into the 10- group classification according to Robson. Numbers and rate of caesarean sections were defined for primiparous and multiparous women in spontaneous labour (groups 1 and 3 respectively), after induced labour (groups 2 and 4 respectively), with caesarean scar uterus (group 5) or with other gestational complications (groups 6 to 10). For these groups, a 10-years evolution was evaluated.

RESULTS

In a total of 19.675 deliveries, the overall caesarean section rate increased from 20% (380/1937) in 2001 to 25% (534/2121) in 2007 (p < 0.001), and decreased again to 20% in 2010 (415/2068) (p < 0.001). The increase of caesarean sections before 2007 was associated with an increase of inductions in singleton cephalic pregnancies at term from 28.5% (410/1437) in 2003 to 35.9% (551/1536) in 2006 (p < 0.001). The decrease of caesarean sections after 2007 occurred both in induced labours, as a direct consequence of rationalised reduction of induction rate, and in spontaneous labours, following introduction of strict criteria for diagnosis of labour. Despite a similar caesarean section rate of 20% in 2001 and 2010, the 6.6% (136/2068) repeat caesarean section rate in 2010 was higher than 4.2% (81/1937) in 2001 (p = 0.001).

CONCLUSION

This single centre audit illustrates that increased induction rate is associated with increased caesarean section rate. This evolution can be reverted through a rationalised management aiming for reduction of induced labours and improved diagnosis of labour.

Epidural analgesia for low risk labour determines the rate of instrumental deliveries but not that of caesarean sections

We analysed retrospectively the link between the incidence of epidural analgesia and the frequency distribution of instrumental delivery, caesarean section, labour induction and parity in a selected group of women with a low risk labour profile in all (85) obstetric units in Flanders (Northern Belgium). A group of 104 932 women with presumed low risk labour profile was subjected to analysis. The main outcome measures were the incidence of obstetric intervention in each obstetric unit in relation to the extent of their use of epidural analgesia. There was a wide variation in the rate of epidural analgesia (3-75%), labour induction 'for convenience' (4-48%) and instrumental delivery (4-50%) among the Flemish obstetric units. The incidence of instrumental delivery in a given unit was greatly influenced by the rate of epidural analgesia and labour induction for convenience (P < 0.001). However, the incidence of caesarean section in a given unit was not determined by either the rates of epidural, labour induction, attempted instrumental delivery or the size of the unit.

Investigating the variations in survival rates for very preterm infants in 10 European regions: the MOSAIC birth cohort

OBJECTIVE

To investigate the variation in the survival rate and the mortality rates for very preterm infants across Europe.

DESIGN

A prospective birth cohort of very preterm infants for 10 geographically defined European regions during 2003, followed to discharge home from hospital.

PARTICIPANTS

All deliveries from 22 + 0 to 31 + 6 weeks' gestation.

MAIN OUTCOME MEASURE

All outcomes of pregnancy by gestational age group, including termination of pregnancy for congenital anomalies and other reasons, antepartum stillbirth, intrapartum stillbirth, labour ward death, death after admission to a neonatal intensive care unit (NICU) and survival to discharge.

RESULTS

Overall the proportion of this very preterm cohort who survived to discharge from neonatal care was 89.5%, varying from 93.2% to 74.8% across the regions. Less than 2% of infants <24 weeks' gestation and approximately half of the infants from 24 to 27 weeks' gestation survived to discharge home from the NICU. However large variations were seen in the timing of the deaths by region. Among all fetuses alive at onset of labour of 24-27 weeks' gestation, between 84.0% and 98.9% were born alive and between 64.6% and 97.8% were admitted to the NICU. For babies <24 weeks' gestation, between 0% and 79.6% of babies alive at onset of labour were admitted to neonatal intensive care.

CONCLUSIONS

There are wide variations in the survival rates to discharge from neonatal intensive care for very preterm deliveries and in the timing of death across the MOSAIC regions. In order to directly compare international statistics for mortality in very preterm infants, data collection needs to be standardised. We believe that the standard point of comparison should be using all those infants alive at the onset of labour as the denominator for comparisons of mortality rates for very preterm infants analysing the cohort by gestational age band.

Somali women and their pregnancy outcomes postmigration: data from six receiving countries

Objective

This study aimed to investigate pregnancy outcomes in Somali-born women compared with those women born in each of the six receiving countries: Australia, Belgium, Canada, Finland, Norway and Sweden.

Design

Meta-analyses of routinely collected data on confinements and births.

Setting

National or regional perinatal datasets spanning 3–6 years between 1997 and 2004 from six countries.

Sample

A total of 10 431 Somali-born women and 2 168 891 receiving country-born women.

Methods

Meta-analyses to compare outcomes for Somali-born and receiving country-born women across the six countries.

Main outcome measures

Events of labour (induction, epidural use and proportion of women using no analgesia), mode of birth (spontaneous vaginal birth, operative vaginal birth and caesarean section) and infant outcomes (preterm birth, birthweight, Apgar at 5 minutes, stillbirths and neonatal deaths).

Results

Compared with receiving country-born women, Somali-born women were less likely to give birth preterm (pooled OR 0.72, 95% CI 0.64–0.81) or to have infants of low birthweight (pooled OR 0.89, 95% CI 0.82–0.98), but there was an excess of caesarean sections, particularly in first births (pooled OR 1.41, 95% CI 1.25–1.59) and an excess of stillbirths (pooled OR 1.86, 95% CI 1.38–2.51).

Conclusions

This analysis has identified a number of disparities in outcomes between Somali-born women and their receiving country counterparts. The disparities are not readily explained and they raise concerns about the provision of maternity care for Somali women postmigration. Review of maternity care practices followed by implementation and careful evaluation of strategies to improve both care and outcomes for Somali women is needed.

Restoring a functional beta-cell mass in diabetes

Type 1 and type 2 diabetes have often been presented as disease forms that profoundly differ in the presence and pathogenic significance of a reduced beta-cell mass. We review evidence indicating that the beta-cell mass in type 1 diabetes is usually not decreased by at least 90% at clinical onset, and remains often detectable for years after diagnosis at age above 15 years. Clinical and experimental evidence also exists for a reduced beta-cell mass in type 2 diabetes where it can be the cause for and/or the consequence of dysregulated beta-cell functions. With beta-cell mass defined as number of beta-cells, these views face the limitation of insufficient data and methods for human organs. Because beta-cells can occur under different phenotypes that vary with age and with environmental conditions, we propose to use the term functional beta-cell mass as an assessment of a beta-cell population by the number of beta-cells and their phenotype or functional state. Assays exist to measure functional beta-cell mass in isolated preparations. We selected a glucose-clamp test to evaluate functional beta-cell mass in type 1 patients at clinical onset and in type 1 recipients following intraportal islet cell transplantation. Comparison of the data with those in non-diabetic controls helps targeting and monitoring of therapeutic interventions.

Preeclampsia and birthweight by gestational age in singleton pregnancies in Flanders, Belgium: a prospective study

PURPOSE

Recent studies have questioned the relationship between low birthweight and hypertension in pregnancy, especially in term pregnancies. We aimed to analyse the influence of chronic hypertension, preeclampsia, gestational hypertension and superimposed preeclampsia on birth weight in singleton pregnancies at different gestational ages.

METHODS

Between January 1, 2001 and December 31, 2002 data on hypertension (subdivided in chronic hypertension, preeclampsia, gestational hypertension, superimposed preeclampsia and eclampsia) were collected prospectively for all deliveries in the region of Flanders, Belgium. Multiple pregnancies and patients with diabetes were excluded from analysis. Multiple linear regression was performed to construct a model for the prediction of birthweight and to determine the contribution of hypertension.

RESULTS

Hypertension was diagnosed in 5,284 of 111,007 (4.8%) singleton pregnancies, and of these 647 had chronic hypertension (0.6% of the total group), 2,253 (2%) gestational hypertension, 2,244 (2%) preeclampsia and 140 (0.1%) superimposed preeclampsia. Birthweight less than 2,500 g was most frequent in the preeclamptic group and less frequent in case of gestational hypertension, but in all hypertensive groups it was statistically more frequent compared to the normotensive pregnancies. Before 26 weeks' gestational age the presence of any kind of hypertension did not influence birthweight. From 26 weeks on preeclampsia contributed to a lower birthweight. Gestational hypertension resulted in a lower birthweight between 28 and 34 weeks, but not before or after this period. Superimposed preeclampsia only had an effect between 32 and 34 weeks and chronic hypertension only marginally contributed to birthweight. A relation with both a high birthweight (> 4000 g) and birthweight < 2500 g was found in term gestational hypertension and preeclampsia.

CONCLUSION

At an early gestational age (less then 26 weeks) hypertension is not a significant factor influencing birthweight. Uncomplicated chronic hypertension is not an important factor determining birthweight but preeclampsia is. Gestational hypertension influences birthweight in a limited period between 28 and 34 weeks of gestational age. When hypertensive pregnancies reach term they tend to result both in more babies weighing < 2,500 g and > 4,000 g.

Nutrient sensing in pancreatic β cells suppresses mitochondrial superoxide generation and its contribution to apoptosis

Excessively high glucose concentrations have been shown to damage tissues through stimulation of mitochondrial superoxide generation. This effect has therefore been considered as a potential cause for dysfunction and death of pancreatic β cells in diabetes. We have examined whether the rate of glucose metabolism in isolated rat β cells is correlated with their formation of oxygen radicals. It was found that high rates of glucose metabolism did not stimulate the formation of superoxide and H2O2 but suppressed it. The higher rates of superoxide production in β cells with lower mitochondrial metabolic activity contributed to the susceptibility of these cells to apoptosis.

326 OPTIMIZING FREQUENCY OF FSH APPLICATION FOR SUPEROVULATORY TREATMENT IN CATTLE

The aim of the study was to examine the influence of the application frequency of Pluset® (Calier, Spain) and Folltropin® (Vetrepharm, London, Ontario, Canada) on the results of embryo recovery in Simmental cattle. Moreover, pulsatility of LH concentrations in plasma should be studied before and after application of Pluset. FSH was given in a treatment of eight or four injections on four consecutive days starting between Days 9 and 13 of the estrous cycle. Luteolysis was induced by application of 500 μg Estrumate® (Essex Tierarznei, Munich, Germany), applied 72 and 84 h after the first FSH injection. Embryo recovery was performed non-surgically on Day 7 of the following estrous cycle. Heifers received either a total amount of 500 IU Pluset according to the International Standard for human urine FSH and LH (P1: 8 injections, n = 20; P2: 4 injections, n = 54) or 200 mg Folltropin according to NIH bFSH-B1 (F1: 8 injections, n = 117; F2: 4 injections, n = 60). Cows received either 550 IU Pluset (P3: 8 injections, n = 54; P4: 4 injections, n = 183) or 260 mg Folltropin (F3: 8 injections, n = 36; F4: 4 injections, n = 159). Altogether 8 heifers were bled throughout 8 h every 10 min on Days 9 and 12 (before and during stimulation with FSH). The samples were analyzed for LH by ECLIA (intra-assay coefficient of variation (VK) 6.4%, inter-assay VK 8.9%). The evaluation of the data was carried out with the procedure ‘GLM’ of the statistics software package SAS (SAS Institute, Inc., Cary, NC, USA) and PULSAR analysis. As a post hoc test Student's t-test was used. Significance was set at P = 0.05. Results of embryo recovery are shown in the table. Number of LH pulses in 8 h (LSM ± SE) was 2.3 ± 0.4 on Day 9 and 0.6 ± 0.4 on Day 12 (P < 0.05). We conclude that four injections of both FSH products can lead to results comparable with those reached with eight injections in a 12 hours interval. Therefore, the effort for superovulatory treatments can be reduced. However, it has to be considered that the portion of transferable embryos was reduced, partly significantly, after four FSH injections. This result was independent of the drug used. Table 1. Results of embryo recovery

Delayed childbearing and maternal mortality

OBJECTIVES

To assess the maternal age trend in pregnant women in Flanders, Belgium, and examine the impact of maternal age on maternal mortality.

STUDY DESIGN

Retrospective analysis of a population based regional perinatal database during one decade.

RESULTS

Between 1991 and 2000 a significant increase in maternal age was found, in primiparous as well as in multiparous women. The maternal mortality ratio was 5.8, and strongly related to maternal age, with a relative risk of 7.0 (95% CI: 3.0-16.2) from the age of 35 on, and of 30.0 (95% CI: 11.4-80.6) in women aged 40 years or beyond.

CONCLUSIONS

These data call for further research and action to facilitate career and reproduction, and for special care for older pregnant women.

Gestodene: clinical experience with an innovative progestogen used in a combination oral contraceptive preparation

The contraceptive efficacy, tolerance, and safety of a new monophasic oral contraceptive that combines 75 mcg gestodene (delta-15- levonorgestrel) and 30 mcg ethinyl estradiol were studied in 75 women (944 cycles) currently at risk for pregnancy. 20 women were nulliparous. No woman became pregnant during the trial, nor were vital signs of body weight affected by the drug. Cycle control was excellent, with no bleeding irregularities in 92% of the cycles. Serious complications did not occur. The low incidence of side effects, e.g. headache (9%) and breast tenderness (8%), indicated that the gestodene combination was well-tolerated. In a subgroup of 10 women, no changes in routine laboratory tests could be demonstrated after 12 cycles of treatment.

The effects of thyroxine or a GnRH analogue on thyroid hormone deiodination in the olfactory epithelium and retina of rainbow trout, Oncorhynchus mykiss, and sockeye salmon, Oncorhynchus nerka

Using low (0.5nM) substrate levels we determined the activities of thyroxine (T4) outer-ring deiodination (ORD), T4 inner-ring deiodination (T4IRD) and 3,5,3(')-triiodothyronine (T3) IRD activities in the olfactory epithelium (OLF) and retina (RET) of laboratory-held immature 1-year-old rainbow trout and immature 2.5-year-old sockeye salmon. In both species all three deiodination activities were detected in OLF and RET. For OLF, no particular pathway predominated and activities were similar to those of brain. For RET, T3IRD activity was greater than T4ORD activity and in sockeye RET T3IRD activity exceeded that of liver. Trout immersion for 6 weeks in 100ppm T4 increased plasma T4 levels 3-fold and plasma T3 levels by 50% and caused the anticipated autoregulatory responses in brain and liver deiodination ( downward arrow T4ORD, upward arrow T4IRD, and upward arrow T3IRD); OLF deiodination and RET T4ORD activity were unaltered but RET T4IRD and T3IRD activities increased dramatically. Two injections of a GnRH analogue (20 microgkg(-1)) into sockeye increased plasma T3 levels but not T4 levels and decreased RET T4IRD and T3IRD activities without changing liver, brain, or OLF deiodination. We conclude that in salmonids the main TH deiodination pathways occur in OLF but show no regulation by T4 or GnRH. In contrast, T3IRD activity predominates in RET and can be regulated by T4 and GnRH, suggesting that for RET plasma may be the major T3 source. These findings have implications for thyroidal regulation of sensory functions during salmonid diadromous migrations.