Perifocal edema is a risk factor for preoperative seizures in patients with meningioma WHO grade 2 and 3

BACKGROUND

Patients with intracranial meningiomas frequently suffer from tumor-related seizures prior to resection, impacting patients' quality of life. We aimed to elaborate on incidence and predictors for seizures in a patient cohort with meningiomas WHO grade 2 and 3.

METHODS

We retrospectively searched for patients with meningioma WHO grade 2 and 3 according to the 2021 WHO classification undergoing tumor resection. Clinical, histopathological and imaging findings were collected and correlated with preoperative seizure development. Tumor and edema volumes were quantified.

RESULTS

Ninety-five patients with a mean age of 59.5 ± 16.0 years were included. Most tumors (86/95, 90.5%) were classified as atypical meningioma WHO grade 2. Nine of 95 tumors (9.5%) corresponded to anaplastic meningiomas WHO grade 3, including six patients harboring TERT promoter mutations. Meningiomas were most frequently located at the convexity in 38/95 patients (40.0%). Twenty-eight of 95 patients (29.5%) experienced preoperative seizures. Peritumoral edema was detected in 62/95 patients (65.3%) with a median volume of 9 cm3 (IR: 0-54 cm3). Presence of peritumoral edema but not age, tumor localization, TERT promoter mutation, brain invasion or WHO grading was associated with incidence of preoperative seizures, as confirmed in multivariate analysis (OR: 6.61, 95% CI: 1.18, 58.12, p = *0.049). Postoperative freedom of seizures was achieved in 91/95 patients (95.8%).

CONCLUSIONS

Preoperative seizures were frequently encountered in about every third patient with meningioma WHO grade 2 or 3. Patients presenting with peritumoral edema on preoperative imaging are at particular risk for developing tumor-related seizures. Tumor resection was highly effective in achieving seizure freedom.

Single-centre prospective evaluation of the first 5 years of cystic fibrosis newborn screening in Germany

Background

In 2016, nationwide cystic fibrosis newborn screening (CFNS) was newly implemented in Germany, using an immunoreactive trypsin/pancreatitis-associated protein/DNA screening algorithm that differs from most other nationwide screening programmes.

Methods

We analysed real-life feasibility of the confirmation process with respect to our pre-specified procedural objectives. These included overall accuracy through false-negative and false-positive results, effectiveness of the Bavarian tracking system, and accuracy of Macroduct and Nanoduct sweat conductivity compared with quantitative chloride determination. All consecutive CFNS-positive newborns assigned to our CF centre and born between 1 September 2016 and 31 August 2021 (n=162) were included.

Results

The German CFNS was feasible at our CF centre as all procedural objectives were met. The positive predictive value (PPV) of positive CFNS was low (0.23) and two initially negatively screened children were later diagnosed with CF. The tracking system was highly efficient with a 100% tracking rate. The Macroduct and Nanoduct systems had comparable success rates (93.2% versus 95.9%). Importantly, conductivity via Macroduct was more accurate than via Nanoduct (zero and four false-positive newborns, respectively).

Conclusions

CF confirmation diagnostics of neonates in a certified regional CF centre was well managed in daily routine. The PPV of the German CFNS needs to be improved, e.g. by extending the DNA analysis within the screening algorithm and by increasing the number of variants tested. The Bavarian tracking system can serve as a successful model for other tracking systems. We preferred the Macroduct system because of its more accurate sweat conductivity readings.

Detection of caries lesions using a water-sensitive STIR sequence in dental MRI

In clinical practice, diagnosis of suspected carious lesions is verified by using conventional dental radiography (DR), including panoramic radiography (OPT), bitewing imaging, and dental X-ray. The aim of this study was to evaluate the use of magnetic resonance imaging (MRI) for caries visualization. Fourteen patients with clinically suspected carious lesions, verified by standardized dental examination including DR and OPT, were imaged with 3D isotropic T2-weighted STIR (short tau inversion recovery) and T1 FFE Black bone sequences. Intensities of dental caries, hard tissue and pulp were measured and calculated as aSNR (apparent signal to noise ratio) and aHTMCNR (apparent hard tissue to muscle contrast to noise ratio) in both sequences. Imaging findings were then correlated to clinical examination results. In STIR as well as in T1 FFE black bone images, aSNR and aHTMCNR was significantly higher in carious lesions than in healthy hard tissue (p < 0.001). Using water-sensitive STIR sequence allowed for detecting significantly lower aSNR and aHTMCNR in carious teeth compared to healthy teeth (p = 0.01). The use of MRI for the detection of caries is a promising imaging technique that may complement clinical exams and traditional imaging.

Dorsal column mapping in resection of intramedullary spinal cord tumors: a prospective comparison of two methods and neurological follow-up

PURPOSE

In surgery for intramedullary spinal cord tumors (imSCT), distortion of the anatomy challenges the visual identification of dorsal columns (DC) for midline myelotomy. Dorsal column mapping (DCM) and spinal cord stimulation (SCS) can identify DC neurophysiologically. We compare application and feasibility of both methods.

METHODS

Patients with surgically treated imSCT were prospectively included between 04/2017 and 06/2019. The anatomical midline (AM) was marked. SSEPs at the DC after stimulation of tibial/median nerve with an 8-channel DCM electrode and cortical SSEP phase reversal at C3/C4 after SCS using a bipolar concentric probe were recorded. Procedural and technical aspects were compared. Standardized neurological examinations were performed preoperatively, 1 week postoperatively and after more than 12 months.

RESULTS

The DCM electrode detected the midline in 9/13 patients with handling limitations in the remaining patients. SCS was applicable in all patients with determination of the midline in 9/13. If both recordings could be acquired (6/13), concordance was 100%. If baseline SSEPs were poor, both methods were limited. SCS was less time-consuming (p = 0.001), cheaper, and easier to handle. In 92% of cases, the AM and neurophysiologic midlines were concordant. After myelotomy, 3 patients experienced > 50% reduction in amplitude of SSEPs. Despite early postoperative worsening of DC function, long-term follow-up showed significant recovery and improvement in quality of life.

CONCLUSION

DCM and SCS may help confirm and correct the AM for myelotomy in imSCT, leading to a favorable long-term neurological outcome in this cohort. SCS evolved to be superior concerning applicability, cost-effectiveness, and time expenditure.

Translocator protein (18kDA) (TSPO) marks mesenchymal glioblastoma cell populations characterized by elevated numbers of tumor-associated macrophages

TSPO is a promising novel tracer target for positron-emission tomography (PET) imaging of brain tumors. However, due to the heterogeneity of cell populations that contribute to the TSPO-PET signal, imaging interpretation may be challenging. We therefore evaluated TSPO enrichment/expression in connection with its underlying histopathological and molecular features in gliomas. We analyzed TSPO expression and its regulatory mechanisms in large in silico datasets and by performing direct bisulfite sequencing of the TSPO promotor. In glioblastoma tissue samples of our TSPO-PET imaging study cohort, we dissected the association of TSPO tracer enrichment and protein labeling with the expression of cell lineage markers by immunohistochemistry and fluorescence multiplex stains. Furthermore, we identified relevant TSPO-associated signaling pathways by RNA sequencing.We found that TSPO expression is associated with prognostically unfavorable glioma phenotypes and that TSPO promotor hypermethylation is linked to IDH mutation. Careful histological analysis revealed that TSPO immunohistochemistry correlates with the TSPO-PET signal and that TSPO is expressed by diverse cell populations. While tumor core areas are the major contributor to the overall TSPO signal, TSPO signals in the tumor rim are mainly driven by CD68-positive microglia/macrophages. Molecularly, high TSPO expression marks prognostically unfavorable glioblastoma cell subpopulations characterized by an enrichment of mesenchymal gene sets and higher amounts of tumor-associated macrophages.In conclusion, our study improves the understanding of TSPO as an imaging marker in gliomas by unveiling IDH-dependent differences in TSPO expression/regulation, regional heterogeneity of the TSPO PET signal and functional implications of TSPO in terms of tumor immune cell interactions.

A simple surgical technique for sellar closure after transsphenoidal resection of pituitary adenomas in the context of risk factors for cerebrospinal fluid leaks and meningitis

OBJECTIVE

The transsphenoidal approach is the standard for most pituitary tumors. Despite low morbidity, postoperative CSF fistulas and meningitis are specific complications. Various surgical closure techniques for intraoperative CSF (iCSF) leak and sellar reconstruction have been described. For many years the authors have applied synthetic materials for iCSF leak repair and sellar closure in a standardized fashion in their department. Here they analyze the surgical outcome as well as risk factors for iCSF leak and meningitis.

METHODS

All patients with transsphenoidal resection of a pituitary adenoma performed by the same surgeon between January 2013 and December 2019 were screened retrospectively. A small amount of iCSF flow without a diaphragmatic defect was classified as a minor leak, and obvious CSF flow with or without a diaphragmatic defect was classified as a major leak. In case of iCSF leak, a fibrin- and thrombin-coated sponge was used to cover the diaphragmatic defect and another one was used for the sellar opening. A gelatin sponge was placed in the sphenoid sinus as an abutment. The primary and secondary outcomes were the number of postoperative CSF (pCSF) leaks and meningitis, respectively. Clinical, histological, and perioperative data from medical records were collected to identify risk factors for CSF leak and meningitis.

RESULTS

Of 417 transsphenoidal surgeries, 359 procedures in 348 patients with a median age of 54 years were included. There were 96 iCSF leaks (26.7%; 37.5% major, 62.5% minor). In 3 of 359 cases (0.8%) a pCSF fistula occurred, requiring revision surgery in 2 patients and a lumbar drain in 1 patient. Meningitis occurred in 3 of 359 cases (0.8%). All 3 patients recovered without sequelae after antibiotic therapy. According to univariate analysis, risk factors for iCSF leak were macroadenoma (p = 0.006) and recurrent adenoma (p = 0.032). An iCSF leak was found less often in functioning adenomas (p = 0.025). In multivariate analysis recurrent tumors remained as a risk factor (p = 0.021) for iCSF leak. Patients with iCSF leak were at increased risk for a pCSF leak (p = 0.005). A pCSF leak in turn represented the key risk factor for meningitis (p = 0.033).

CONCLUSIONS

Patients with macroadenomas and recurrent adenomas are especially at risk for iCSF leak. An iCSF leak in turn increases the risk for a pCSF leak, which carries the risk for meningitis. The authors' surgical technique leads to a very low rate of pCSF leaks and meningitis without using autologous graft materials. Hence, this technique is safe and improves patient comfort by avoiding the disadvantages of autologous graft harvesting.

Acute Hiccups Detected by Electromyographic Recordings During Resection of a Vestibular Schwannoma

BACKGROUND AND IMPORTANCE

Intraoperative neuromonitoring (IONM) is routinely used to monitor cranial nerve function during resection of vestibular schwannomas. Sudden movements in the surgical field can be a disturbing factor for the surgeon. IONM can help determine the cause of unexpected patient movements.

CLINICAL PRESENTATION

We report the case of a 54-year-old patient who underwent retromastoid craniotomy and resection of a vestibular schwannoma. Toward the end of dissection of the tumor from the lower cranial nerves and brainstem, the patient showed repetitive shoulder elevation. Electroencephalography showed burst suppression, confirming deep sedation and excluding voluntary movements. Free-running electromyography recorded spontaneous, simultaneous, bilateral vocal cord activity that was synchronous with upper body movement. There was simultaneous but smaller activity in the right genioglossus muscle and levator veli palatini, indicative for far-field activity. These IONM findings allowed us to classify the clinical observations as intraoperative hiccups.

CONCLUSION

Hiccups during general anesthesia are rare but should be considered as a differential diagnosis of sudden upper body movement. To the best of our knowledge, this is the first reported case of acute hiccups during resection of a vestibular schwannoma. IONM reliably distinguished it from an increase in intraoperative consciousness or accessory nerve activation resulting in shoulder movements.

Associations of Texture Features of Proton Density Fat Fraction Maps between Lumbar Vertebral Bone Marrow and Paraspinal Musculature

Chemical shift encoding-based water−fat MRI (CSE-MRI)-derived proton density fat fraction (PDFF) has been used for non-invasive assessment of regional body fat distributions. More recently, texture analysis (TA) has been proposed to reveal even more detailed information about the vertebral or muscular composition beyond PDFF. The aim of this study was to investigate associations between vertebral bone marrow and paraspinal muscle texture features derived from CSE-MRI-based PDFF maps in a cohort of healthy subjects. In this study, 44 healthy subjects (13 males, 55 ± 30 years; 31 females, 39 ± 17 years) underwent 3T MRI including a six-echo three-dimensional (3D) spoiled gradient echo sequence used for CSE-MRI at the lumbar spine and the paraspinal musculature. The erector spinae muscles (ES), the psoas muscles (PS), and the vertebral bodies L1-4 (LS) were manually segmented. Mean PDFF values and texture features were extracted for each compartment. Features were compared between males and females using logistic regression analysis adjusted for age and body mass index (BMI). All texture features of ES except for Sum Average were significantly (p < 0.05) different between men and women. The three global texture features (Variance, Skewness, Kurtosis) for PS as well as LS showed a significant difference between male and female subjects (p < 0.05). Mean PDFF measured in PS and ES was significantly higher in females, but no difference was found for the vertebral bone marrow’s PDFF. Partial correlation analysis between the texture features of the spine and the paraspinal muscles revealed a highly significant correlation for Variance(global) (r = 0.61 for ES, r = 0.62 for PS; p < 0.001 respectively). Texture analysis using PDFF maps based on CSE-MRI revealed differences between healthy male and female subjects. Global texture features in the lumbar vertebral bone marrow allowed for differentiation between men and women, when the overall PDFF was not significantly different, indicating that PDFF maps may contain detailed and subtle textural information beyond fat fraction. The observed significant correlation of Variance(global) suggests a metabolic interrelationship between vertebral bone marrow and the paraspinal muscles.

Finite Element Analysis of Osteoporotic and Osteoblastic Vertebrae and Its Association With the Proton Density Fat Fraction From Chemical Shift Encoding-Based Water-Fat MRI - A Preliminary Study

PURPOSE

Osteoporosis is prevalent and entails alterations of vertebral bone and marrow. Yet, the spine is also a common site of metastatic spread. Parameters that can be non-invasively measured and could capture these alterations are the volumetric bone mineral density (vBMD), proton density fat fraction (PDFF) as an estimate of relative fat content, and failure displacement and load from finite element analysis (FEA) for assessment of bone strength. This study's purpose was to investigate if osteoporotic and osteoblastic metastatic changes in lumbar vertebrae can be differentiated based on the abovementioned parameters (vBMD, PDFF, and measures from FEA), and how these parameters correlate with each other.

MATERIALS AND METHODS

Seven patients (3 females, median age: 77.5 years) who received 3-Tesla magnetic resonance imaging (MRI) and multi-detector computed tomography (CT) of the lumbar spine and were diagnosed with either osteoporosis (4 patients) or diffuse osteoblastic metastases (3 patients) were included. Chemical shift encoding-based water-fat MRI (CSE-MRI) was used to extract the PDFF, while vBMD was extracted after automated vertebral body segmentation using CT. Segmentation masks were used for FEA-based failure displacement and failure load calculations. Failure displacement, failure load, and PDFF were compared between patients with osteoporotic vertebrae versus patients with osteoblastic metastases, considering non-fractured vertebrae (L1-L4). Associations between those parameters were assessed using Spearman correlation.

RESULTS

Median vBMD was 59.3 mg/cm³ in osteoporotic patients. Median PDFF was lower in the metastatic compared to the osteoporotic patients (11.9% vs. 43.8%, p=0.032). Median failure displacement and failure load were significantly higher in metastatic compared to osteoporotic patients (0.874 mm vs. 0.348 mm, 29,589 N vs. 3,095 N, p=0.034 each). A strong correlation was noted between PDFF and failure displacement (rho -0.679, p=0.094). A very strong correlation was noted between PDFF and failure load (rho -0.893, p=0.007).

CONCLUSION

PDFF as well as failure displacement and load allowed to distinguish osteoporotic from diffuse osteoblastic vertebrae. Our findings further show strong associations between PDFF and failure displacement and load, thus may indicate complimentary pathophysiological associations derived from two non-invasive techniques (CSE-MRI and CT) that inherently measure different properties of vertebral bone and marrow.

Association of Cervical and Lumbar Paraspinal Muscle Composition Using Texture Analysis of MR-Based Proton Density Fat Fraction Maps

In this study, the associations of cervical and lumbar paraspinal musculature based on a texture analysis of proton density fat fraction (PDFF) maps were investigated to identify gender- and anatomical location-specific structural patterns. Seventy-nine volunteers (25 men, 54 women) participated in the present study (mean age ± standard deviation: men: 43.7 ± 24.6 years; women: 37.1 ± 14.0 years). Using manual segmentations of the PDFF maps, texture analysis was performed and texture features were extracted. A significant difference in the mean PDFF between men and women was observed in the erector spinae muscle (p < 0.0001), whereas the mean PDFF did not significantly differ in the cervical musculature and the psoas muscle (p > 0.05 each). Among others, Variance(global) and Kurtosis(global) showed significantly higher values in men than in women in all included muscle groups (p < 0.001). Not only the mean PDFF values (p < 0.001) but also Variance(global) (p < 0.001), Energy (p < 0.001), Entropy (p = 0.01), Homogeneity (p < 0.001), and Correlation (p = 0.037) differed significantly between the three muscle compartments. The cervical and lumbar paraspinal musculature composition seems to be gender-specific and has anatomical location-specific structural patterns.

Past medical history of tumors other than meningioma is a negative prognostic factor for tumor recurrence in meningiomas WHO grade I

Background

Prognostic markers for meningioma recurrence are needed to guide patient management. Apart from rare hereditary syndromes, the impact of a previous unrelated tumor disease on meningioma recurrence has not been described before.

Methods

We retrospectively searched our database for patients with meningioma WHO grade I and complete resection provided between 2002 and 2016. Demographical, clinical, pathological, and outcome data were recorded. The following covariates were included in the statistical model: age, sex, clinical history of unrelated tumor disease, and localization (skull base vs. convexity). Particular interest was paid to the patients’ past medical history. The study endpoint was date of tumor recurrence on imaging. Prognostic factors were obtained from multivariate proportional hazards models.

Results

Out of 976 meningioma patients diagnosed with a meningioma WHO grade I, 416 patients fulfilled our inclusion criteria. We encountered 305 women and 111 men with a median age of 57 years (range: 21–89 years). Forty-six patients suffered from a tumor other than meningioma, and no TERT mutation was detected in these patients. There were no differences between patients with and without a positive oncological history in terms of age, tumor localization, or mitotic cell count. Clinical history of prior tumors other than meningioma showed the strongest association with meningioma recurrence (p = 0.004, HR = 3.113, CI = 1.431–6.771) both on uni- and multivariate analysis.

Conclusion

Past medical history of tumors other than meningioma might be associated with an increased risk of meningioma recurrence. A detailed pre-surgical history might help to identify patients at risk for early recurrence.

Low-dose MDCT: evaluation of the impact of systematic tube current reduction and sparse sampling on quantitative paraspinal muscle assessment

Background

Wasting disease entities like cachexia or sarcopenia are associated with a decreasing muscle mass and changing muscle composition. For valid and reliable disease detection and monitoring diagnostic techniques offering quantitative musculature assessment are needed. Multi-detector computed tomography (MDCT) is a broadly available imaging modality allowing for muscle composition analysis. A major disadvantage of using MDCT for muscle composition assessment is the radiation exposure. In this study we evaluated the performance of different methods of radiation dose reduction for paravertebral muscle composition assessment.

Methods

MDCT scans of eighteen subjects (6 males, age: 71.5±15.9 years, and 12 females, age: 71.0±8.9 years) were retrospectively simulated as if they were acquired at 50%, 10%, 5%, and 3% of the original X-ray tube current or number of projections (i.e., sparse sampling). Images were reconstructed with a statistical iterative reconstruction (SIR) algorithm. Paraspinal muscles (psoas and erector spinae muscles) at the level of L4 were segmented in the original-dose images. Segmentations were superimposed on all low-dose scans and muscle density (MD) extracted.

Results

Sparse sampling derived mean MD showed no significant changes (P=0.57 and P=0.22) down to 5% of the original projections in the erector spinae and psoas muscles, respectively. All virtually reduced tube current series showed significantly different (P>0.05) mean MD in the psoas and erector spinae muscles as compared to the original dose except for the images of 5% of the original tube current in the erector spinae muscle.

Conclusions

Our findings demonstrated the possibility of considerable radiation dose reduction using MDCT scans for assessing the composition of the paravertebral musculature. The sparse sampling approach seems to be promising and a potentially superior technique for dose reduction as compared to tube current reduction.

Regional variation of thigh muscle fat infiltration in patients with neuromuscular diseases compared to healthy controls

Background

Chemical shift encoding-based water-fat magnetic resonance imaging (CSE-MRI) measures a quantitative biomarker: the proton density fat fraction (PDFF). The aim was to assess regional and proximo-distal PDFF variations at the thigh in patients with myotonic dystrophy type 2 (DM2), limb-girdle muscular dystrophy type 2A (LGMD2A), and late-onset Pompe disease (LOPD) as compared to healthy controls.

Methods

Seven patients (n=2 DM2, n=2 LGMD2A, n=3 LOPD) and 20 controls were recruited. A 3D-spoiled gradient echo sequence was used to scan the thigh musculature. Muscles were manually segmented to generate mean muscle PDFF.

Results

In all three disease entities, there was an increase in muscle fat replacement compared to healthy controls. However, within each disease group, there were patients with a shorter time since symptom onset that only showed mild PDFF elevation (range, 10% to 20%) compared to controls (P≤0.05), whereas patients with a longer period since symptom onset showed a more severe grade of fat replacement with a range of 50% to 70% (P<0.01). Increased PDFF of around 5% was observed for vastus medialis, semimembranosus and gracilis muscles in advanced compared to early DM2. LGMD2A_1 showed an early disease stage with predominantly mild PDFF elevations over all muscles and levels (10.9%±7.1%) compared to controls. The quadriceps, gracilis and biceps femoris muscles showed the highest difference between LGMD2A_1 with 5 years since symptom onset (average PDFF 11.1%±6.9%) compared to LGMD2A_2 with 32 years since symptom onset (average PDFF 66.3%±6.3%). For LOPD patients, overall PDFF elevations were observed in all major hip flexors and extensors (range, 25.8% to 30.8%) compared to controls (range, 1.7% to 2.3%, P<0.05). Proximal-to-distal PDFF highly varied within and between diseases and within controls. The intra-reader reliability was high (reproducibility coefficient ≤2.19%).

Conclusions

By quantitatively measuring muscle fat infiltration at the thigh, we identified candidate muscles for disease monitoring due to their gradual PDFF elevation with longer disease duration. Regional variation between proximal, central, and distal muscle PDFF was high and is important to consider when performing longitudinal MRI follow-ups in the clinical setting or in longitudinal studies.

Magnetic Resonance Imaging-Based Robotic Radiosurgery of Arteriovenous Malformations

Objective

CyberKnife offers CT- and MRI-based treatment planning without the need for stereotactically acquired DSA. The literature on CyberKnife treatment of cerebral AVMs is sparse. Here, a large series focusing on cerebral AVMs treated by the frameless CyberKnife stereotactic radiosurgery (SRS) system was analyzed.

Methods

In this retrospective study, patients with cerebral AVMs treated by CyberKnife SRS between 2005 and 2019 were included. Planning was MRI- and CT-based. Conventional DSA was not coregistered to the MRI and CT scans used for treatment planning and was only used as an adjunct. Obliteration dynamics and clinical outcome were analyzed.

Results

215 patients were included. 53.0% received SRS as first treatment; the rest underwent previous surgery, embolization, SRS, or a combination. Most AVMs were classified as Spetzler-Martin grade I to III (54.9%). Hemorrhage before treatment occurred in 46.0%. Patients suffered from headache (28.8%), and seizures (14.0%) in the majority of cases. The median SRS dose was 18 Gy and the median target volume was 2.4 cm³. New neurological deficits occurred in 5.1% after SRS, with all but one patient recovering. The yearly post-SRS hemorrhage incidence was 1.3%. In 152 patients who were followed-up for at least three years, 47.4% showed complete AVM obliteration within this period. Cox regression analysis revealed Spetzler-Martin grade (P = 0.006) to be the only independent predictor of complete obliteration.

Conclusions

Although data on radiotherapy of AVMs is available, this is one of the largest series, focusing exclusively on CyberKnife treatment. Safety and efficacy compared favorably to frame-based systems. Non-invasive treatment planning, with a frameless SRS robotic system might provide higher patient comfort, a less invasive treatment option, and lower radiation exposure.

Local Bone Mineral Density, Subcutaneous and Visceral Adipose Tissue Measurements in Routine Multi Detector Computed Tomography-Which Parameter Predicts Incident Vertebral Fractures Best?

In this case-control study the value of bone mineral density (BMD) at different vertebral levels, subcutaneous adipose tissue (SAT), and visceral adipose tissue (VAT) to identify patients with incident osteoporotic vertebral fractures in routine multi-detector computed tomography (MDCT) exams was assessed.

MATERIAL AND METHODS

Seventeen patients who underwent baseline and follow-up routine contrast-enhanced MDCT and had an incident osteoporotic vertebral fracture at follow-up were included. Seventeen age-, sex- and follow-up duration-matched controls were identified. Trabecular BMD (from Th5 to L5) as well as cross-sectional area of SAT and VAT were extracted.

RESULTS

BMD performed best to differentiate patients with an incident fracture from controls at the levels of Th5 (area under the curve [AUC] = 0.781, p = 0.014), Th7 (AUC = 0.877, p = 0.001), and Th9 (AUC = 0.818, p = 0.005). Applying multivariate logistic regression BMD at Th7 level remained the only significant predictor of incident vertebral fractures (Th5-L5) with an odds ratio of 1.07 per BMD SD decrease. VAT and SAT did not show significant differences between the fracture and control group (p > 0.05).

CONCLUSION

The local BMD measurement appears to be more suitable than standard mean BMD from L1-L3 for fracture risk assessment.

Microvascular decompression for trigeminal neuralgia in the elderly: efficacy and safety

OBJECTIVE

The safety and efficacy of surgical microvascular decompression (MVD) in elderly patients with trigeminal neuralgia (TN) is controversially discussed in the literature. A widespread reluctance to expose this cohort to major intracranial surgery persists. Our aim was to compare the efficacy and safety between older and younger patients with TN.

METHODS

In this cross-sectional study, 139 MVD procedures (103 patients < 70 and 36 patients ≥ 70) were included. Surgical fitness was assessed by the American Society of Anesthesiology (ASA) grade. The pain-free interval was evaluated using Kaplan-Meier analysis only in patients with a recent follow-up visit. Independent risk factors for recurrence in patients with a minimum 12-month follow-up were determined.

RESULTS

Patients ≥ 70 showed a significantly higher number of comorbidities. Pain intensity, affection of trigeminal branches and symptom duration was similar between groups. No significant difference in treatment associated complications and permanent neurological deficits was shown. There was no treatment-related mortality. A tendency towards a lower recurrence rate in patients < 70 did not reach statistical significance (17.6% vs. 28.6%, P = 0.274). Pain-free interval was not different between both cohorts (78.7 vs. 73.5 months, P = 0.391).

CONCLUSION

Despite a higher prevalence of comorbidities in elderly patients, complication rates and neurological deficits after MVD were comparable to younger patients. Rates of immediate and long-term pain relief compared favorably to previous studies and were similar between elderly and younger patients. These data endorse MVD as a safe and effective first-line surgical procedure for elderly patients with TN and neurovascular conflict on MRI.

Prediction of Incidental Osteoporotic Fractures at Vertebral-Specific Level Using 3D Non-Linear Finite Element Parameters Derived from Routine Abdominal MDCT

To investigate whether finite element (FE) analysis of the spine in routine thoracic/abdominal multi-detector computed tomography (MDCT) can predict incidental osteoporotic fractures at vertebral-specific level; Baseline routine thoracic/abdominal MDCT scans of 16 subjects (8(m), mean age: 66.1 ± 8.2 years and 8(f), mean age: 64.3 ± 9.5 years) who sustained incidental osteoporotic vertebral fractures as confirmed in follow-up MDCTs were included in the current study. Thoracic and lumbar vertebrae (T5-L5) were automatically segmented, and bone mineral density (BMD), finite element (FE)-based failure-load, and failure-displacement were determined. These values of individual vertebrae were normalized globally (g), by dividing the absolute value with the average of L1-3 and locally by dividing the absolute value with the average of T5-12 and L1-5 for thoracic and lumbar vertebrae, respectively. Mean-BMD of L1-3 was determined as reference. Receiver operating characteristics (ROC) and area under the curve (AUC) were calculated for different normalized FE (Kload, Kdisplacement,K(load)g, and K(displacement)g) and BMD (KBMD, and K(BMD)g) ratio parameter combinations for identifying incidental fractures. Kload, K(load)g, KBMD, and K(BMD)g showed significantly higher discriminative power compared to standard mean BMD of L1-3 (BMDStandard) (AUC = 0.67 for Kload; 0.64 for K(load)g; 0.64 for KBMD; 0.61 for K(BMD)g vs. 0.54 for BMDStandard). The combination of Kload, Kdisplacement, and KBMD increased the AUC further up to 0.77 (p < 0.001). The combination of FE with BMD measurements derived from routine thoracic/abdominal MDCT allowed an improved prediction of incidental fractures at vertebral-specific level.

Novel Ultrafast Spiral Head MR Angiography Compared to Standard MR and CT Angiography

BACKGROUND AND PURPOSE

Intracranial vessel imaging by time-of-flight MR angiography (TOF-MRA) is one of the most frequently performed investigations in clinical neuroradiology. Particularly in the acute setting, fast imaging is needed for diagnostics, with a sequence ideally depicting even small vessels. The purpose of this study was to compare image and diagnostic quality of a novel ultrashort TOF-MRA sequence accelerated by spiral imaging (TOF-Spiral-short) to a standard TOF-MRA sequence accelerated by compressed sensing (TOF-CS) and to CT angiography (CTA).

METHODS

Forty-one patients (36.6% showing vessel pathologies) who had undergone TOF-CS (acquisition duration: 4 minutes 8 seconds), TOF-Spiral-short (acquisition duration: 51 seconds; spiral imaging [accelerating factor 1.3], decreased field of view [accelerating factor 1.2], and increased voxel size [accelerating factor 3.3]), and CTA were retrospectively evaluated. Assessment of image quality, diagnostic confidence, and quantification of stenosis or aneurysm diameter were performed by two readers.

RESULTS

Image quality at the skull base was slightly reduced with TOF-Spiral-short compared to CTA and TOF-CS (P < .05). Delineation of small intracranial vessels was improved by TOF-Spiral-short compared to CTA (P < .0001). In TOF-Spiral-short, diagnostic confidence was not reduced compared to TOF-CS in patients with vessel pathologies. We observed no significant difference in quantitative pathology assessment between TOF-Spiral-short and the other two modalities. TOF-Spiral-short enabled the correct identification of all vessel pathologies.

CONCLUSIONS

Accelerating TOF-MRA of brain-feeding arteries by a novel ultrashort spiral imaging sequence shows adequate image quality and sufficient diagnostic performance. Thus, TOF-Spiral-short holds potential for fast and reliable diagnostics of vessel pathologies, particularly in the acute setting.

Motor evoked potentials during revascularization in ischemic stroke predict motor pathway ischemia and clinical outcome

OBJECTIVE

The relevance of motor evoked potential (MEP) recovery during mechanical endovascular thrombectomy (MT) in patients with ischemic stroke is unclear. We correlated MEP recovery during MT to symptom improvement and to ischemia in eloquent motor areas on magnetic resonance imaging (MRI) and compared the predictive value of MEPs to visual angiographic reperfusion status, classified by modified Thrombolysis in Cerebral Infarction grading (mTICI).

METHODS

Patients with hemisyndrome and large-vessel occlusion undergoing MT were included (n35, 49% females; 73.9 ± 14.5 years; n31 anterior circulation). MEPs were elicited transcranially and recorded at the abductor pollicis brevis muscle bilaterally throughout the procedure. An MRI was acquired within 7 days after MT.

RESULTS

The median door-to-needle time was 3.5 hours. Median National Institutes of Health Stroke Scale at presentation was 16 (7 - 37). Median Modified Rankin Scale score was 4 at day 7 and 3 months. After MT, MEP-recovery occurred in 21 cases after a median time span of 4.5 min [range 2 - 11 min]. Symptom improvement at day 7 (3 months) was noted in 22 (21) cases. Absence of ischemia on postinterventional MRI was noted in 21 cases, 19 of whom showed MEP-recovery. Stratified for symptom improvement at day 7, sensitivity (specificity) of MEP-recovery was 86% (85%) and of mTICI ≥ 2b was 95% (23%). Stratified for absence of ischemia on postinterventional MRI, sensitivity (specificity) of MEP-recovery was 90% (86%) and of mTICI ≥ 2b was of 95% (21%).

CONCLUSIONS

MEP recovery occurs early after successful endovascular mechanical revascularization and is superior to mTICI grading in predicting postoperative neurological outcome and postoperative motor-pathway ischemia.

SIGNIFICANCE

This is a new, significant and clinically important study since it emphasizes the additional value of MEP monitoring in a field, which has been traditionally unaffiliated with neurophysiological monitoring.

Age- and gender-related variations of cervical muscle composition using chemical shift encoding-based water-fat MRI

PURPOSE

To understand fat distribution patterns and ectopic fat deposition in healthy adults and to provide normative data, encompassing the borders of physiological regional muscle composition. For this purpose chemical shift encoding-based water-fat Magnetic Resonance Imaging (MRI) was used for proton density fat fraction (PDFF) calculations.

MATERIAL AND METHODS

91 volunteers were enrolled (male: n = 28, age = 36.6 ± 11.4 years; female: n = 63, age = 38.5 ± 15.1 years). PDFF values combined for the multifidus, semispinalis and spinalis cervicis muscles at the level of the 3rd cervical vertebral body (C3), the 5th cervical vertebral body (C5) and the first thoracic vertebral body (Th1) were extracted.

RESULTS

The paraspinal musculature at C3 (14.8 ± 10.1 % vs. 19.2 ± 11.0 %; p = 0.029) and Th1 (13.8 ± 7.0 % vs 17.7 ± 7.4 %; p = 0.011) showed significantly lower PDFF values in men compared to women. Partial correlation testing with BMI as control variable revealed highly significant correlations between the paraspinal musculature PDFF at C3 (men: r = 0.504, p = 0.007; women: r = 0.279, p = 0.028), C5 (men: r = 0.450, p = 0.019; women: r = 0.347, p = 0.006) and Th1 (men: r = 0.652, p < 0.0001; women: r = 0.443, p < 0.0001) with age in both genders.

CONCLUSION

The present data suggest gender and age-specific fat deposition patterns of the cervical and the upper cervicothoracic paraspinal muscles and may provide reference values for pathology detection.

A simple method to quantify follicle survival in cryopreserved human ovarian tissue

STUDY QUESTION

Can follicle survival in frozen-thawed human ovarian tissue be quantified in situ using the dye Neutral Red (NR) to stain viable follicles specifically?

SUMMARY ANSWER

A follicle survival rate within ovarian tissue can be calculated using NR followed by histological evaluation and evidence for a consistently high follicle survival in a series of ovarian tissue from 25 Danish girls and women undergoing ovarian tissue cryopreservation (OTC) was obtained.

WHAT IS KNOWN ALREADY

Securing follicle survival in cryopreserved ovarian tissue is crucial for proper quality control when centers wish to implement OTC. The only established technique for validation of follicle survival is xenografting of thawed ovarian tissue to immunodeficient mice. However, this functional test is expensive, time consuming, requires animal facilities and only provides a qualitative-not quantitative-measure for follicle survival.

STUDY DESIGN SIZE, DURATION

Quantification of follicle survival in human ovarian tissue donated from 30 girls and women having tissue cryopreserved for fertility preservation from 2000 to 2015 at the Laboratory of Reproductive Biology in Copenhagen, Denmark.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Cryopreserved ovarian cortex was donated from 25 girls and young women aged 10-36 years (mean age: 25 years) and the average storage time in liquid nitrogen was 9.1 ± 5.6 years, ranging from 1.6 to 17.9 years. In 12 of the cases, the ovarian tissue was collected from the local hospital and in the other 13 cases the ovarian tissue was transported on ice up to 6 h prior to freezing. Donated fresh ovarian surplus tissue was obtained from five women aged 23-34 years (mean age: 27 years). Ovarian tissues were chopped into small fragments and incubated in culture medium containing 50 mg/ml NR for 3-4 h. Fragments of ovarian tissue containing clearly NR-stained follicles were selected for counting, encapsulated in 4% agar and were processed for histology to calculate a follicular survival rate.

MAIN RESULTS AND THE ROLE OF CHANCE

The mean follicle survival rate in the 25 patients after freezing and thawing was 84% ± 11 (mean ±SD), ranging from 50% to 98%. The high follicle survival rate in this clinical series of patients reflects a constant high-quality service performed in our center and confirms the robustness of the slow freezing protocol. No significant association between follicle survival rates and storage time was found using linear regression analysis, suggesting that storage in liquid nitrogen does not affect viability of the tissue. No significant association in follicle survival rates was found between ovarian tissues collected at the local hospital compared to tissues transported on ice prior to freezing, supporting that prolonged cooling does not seem to greatly affect the follicle survival. For the fresh ovarian tissue, the average follicle survival rate was 91% ± 5 (mean ± SD) in five patients, ranging from 81% to 95%.

LIMITATIONS, REASONS FOR CAUTION

Even though the NR staining requires active incorporation of the dye, the test is merely a short in situ test that cannot completely replace the functional value of xenografting studies in which the integrity and developmental potential of the ovarian follicles are assessed.

WIDER IMPLICATIONS OF THE FINDINGS

OTC is now being employed around the world but to date it has been difficult for centers to evaluate the effectiveness of their program and perform proper quality control. NR staining combined with histological evaluation is the first quantitative method to provide a survival rate for follicles in frozen-thawed human ovarian tissue and offer a valuable and easily applicable tool to validate the cryopreservation procedure when implementing OTC or as routine quality control for the overall freezing performance within tissue banking facilities.

STUDY FUNDING/COMPETING INTEREST(S)

The Research Pools of Rigshospitalet, the Danish Cancer Foundation, Dagmar Marshalls Foundation, and the Novo Nordic Foundation are thanked for having funded this study. The authors have no conflicts of interest.

Introduction of intraoperative neuromonitoring does not necessarily improve overall long-term outcome in elective aneurysm clipping

OBJECTIVE

Intraoperative neuromonitoring (IOM), particularly of somatosensory-evoked potentials (SSEPs) and motor-evoked potentials (MEPs), evolved as standard of care in a variety of neurosurgical procedures. Case series report a positive impact of IOM for elective microsurgical clipping of unruptured intracranial aneurysms (ECUIA), whereas systematic evaluation of its predictive value is lacking. Therefore, the authors analyzed the neurological outcome of patients undergoing ECUIA before and after IOM introduction to this procedure.

METHODS

The dates of inclusion in the study were 2007-2014. In this period, ECUIA procedures before (n = 136, NIOM-group; 2007-2010) and after introduction of IOM (n = 138, IOM-group; 2011-2014) were included. The cutoff value for SSEP/MEP abnormality was chosen as an amplitude reduction ≥ 50%. SSEP/MEP changes were correlated with neurological outcome. IOM-undetectable deficits (bulbar, vision, ataxia) were not included in risk stratification.

RESULTS

There was no significant difference in sex distribution, follow-up period, subarachnoid hemorrhage risk factors, aneurysm diameter, complexity, and location. Age was higher in the IOM-group (57 vs 54 years, p = 0.012). In the IOM group, there were 18 new postoperative deficits (13.0%, 5.8% permanent), 9 hemisyndromes, 2 comas, 4 bulbar symptoms, and 3 visual deficits. In the NIOM group there were 18 new deficits (13.2%; 7.3% permanent, including 7 hemisyndromes). The groups did not significantly differ in the number or nature of postoperative deficits, nor in their recovery rate. In the IOM group, SSEPs and MEPs were available in 99% of cases. Significant changes were noted in 18 cases, 4 of which exhibited postoperative hemisyndrome, and 1 suffered from prolonged comatose state (5 true-positive cases). Twelve patients showed no new detectable deficits (false positives), however 2 of these cases showed asymptomatic infarction. Five patients with new hemisyndrome and 1 comatose patient did not show significant SSEP/MEP alterations (false negatives). Overall sensitivity of SSEP/MEP monitoring was 45.5%, specificity 89.8%, positive predictive value 27.8%, and negative predictive value 95.0%.

CONCLUSIONS

The assumed positive impact of introducing SSEP/MEP monitoring on overall neurological outcome in ECUIA did not reach significance. This study suggests that from a medicolegal point of view, IOM is not stringently required in all neurovascular procedures. However, future studies should carefully address high-risk patients with complex procedures who might benefit more clearly from IOM than others.

Long-Term Functional Outcome of Symptomatic Unruptured Intracranial Aneurysms in an Interdisciplinary Treatment Concept

OBJECTIVE

In symptomatic unruptured intracranial aneurysms (UIAs), data on long-term functional outcome are sparse in the literature, even in the light of modern interdisciplinary treatment decisions. We therefore analyzed our in-house database for prognostic factors and long-term outcome of neurologic symptoms after microsurgical/endovascular treatment.

METHODS

Patients treated between 2000 and 2016 after interdisciplinary vascular board decision were included. UIAs were categorized as symptomatic in cases of cranial nerve or brainstem compression. Symptoms were categorized as mild/severe. Long-term development of symptoms after treatment was assessed in a standardized and independent fashion.

RESULTS

Of 98 symptomatic UIAs (microsurgery/endovascular 43/55), 84 patients presented with cranial nerve (NII-VI) compression and 14 patients with brainstem compression symptoms. Permanent morbidity occurred in 9% of patients. Of 119 symptoms (mild/severe 71/48), 60.4% recovered (full/partial 22%/39%) and 29% stabilized by the time of last follow-up; median follow-up was 19.5 months. Symptom recovery was higher in the long-term compared with that at discharge (P = 0.002). Optic nerve compression symptoms were less likely to improve compared with abducens nerve palsies and brainstem compression. Prognostic factors for recovery were duration and severity of symptoms, treatment modality (microsurgery) and absence of ischemia in the multivariate analysis.

CONCLUSIONS

This recent study presents for the first time a detailed analysis of relevant prognostic factors for long-term recovery of cranial nerve/brainstem compression symptoms in an interdisciplinary treatment concept, which was excellent in most patients, with lowest recovery rates in optic nerve compression. Symptom recovery was remarkably higher in the long-term compared with recovery at discharge.

Dynamic changes of estradiol and progesterone concentrations during in vitro oocyte maturation in cattle

Two culture techniques, an open system using 1.0-ml medium and a covered system using 50-mul droplets of medium covered by paraffin oil, used for in vitro bovine follicular oocyte maturation were compared. Estradiol-17beta (E2) was added to Ham's F-10 medium together with other supplementations. In the absence of oocytes, E2 concentration remained unchanged in the 1.0-ml open system, but it decreased gradually in the 50-mul covered system. In the presence of oocytes, E2 increased significantly in the 1.0-ml open system, but this increase could not be detected in the 50-mul covered system. Progesterone (P4) concentration increased in both systems, but it was much higher in the 1.0-ml culture than in the 50-mul culture. The two culture systems allowed an identical nuclear oocyte maturation rate of 88.6 vs 87.0%, a sperm penetration rate of 54.3 vs 59.6%, and a polyspermy rate of 6.8 vs 11.6% for 1.0-ml and 50-mul systems, respectively. The cleavage rate, however, differed significantly (78.3 vs 41.7% for 1.0-ml and 50-mul systems, respectively). It is concluded that diffusion of steroids into the paraffin oil occurs and may affect the cleavage rate but not the maturation or penetration rate.

Ovarian function and morphology in the mare after multiple follicular punctures

REASONS FOR PERFORMING STUDY

In the mare, ultrasound-guided transvaginal oocyte recovery and transfer might offer a way to circumvent the demanding procedures of in vitro embryo production. Before clinical application, the possible consequences for subsequent fertility have to be considered.

OBJECTIVES

To examine ovarian function and morphology in mares after repeated follicular punctures.

METHODS

A total of 14-26 follicular puncture sessions were conducted on each of 4 Norwegian pony mares over a period of 8 years. The ovaries of these mares were recovered by bilateral ovariectomy or at post mortem and subjected to macroscopic inspection and histology. For comparison, ovaries were collected from 7 nonaspirated control mares and processed for histology.

RESULTS

In all experimental mares, ovarian function, defined as the ability regularly to ovulate preovulatory follicles and develop corpora lutea, remained normal during their last breeding season. Gross examination and histology showed that normal follicular and corpus luteum development was accompanied by the formation of condensed reparative fibrosis and normal local haemosiderosis of the ovarian stroma in all experimental mares. In one mare, an ovary contained several foci of chronic apostematous oophoritis, while a cystic structure lined with a single layer of epithelial-like cells and surrounded by a cartilaginous capsule was present in the other ovary.

CONCLUSIONS AND POTENTIAL RELEVANCE

Repeated follicular aspirations do not hamper future folliculogenesis, ovulation and corpus luteum formation. However, ovarian puncture induces reparative fibrosis in the ovarian stroma and involves a risk of inducing abscess formation within the ovarian tissue which may impair fertility.

Antibiotic treatment interruption of suspected lower respiratory tract infections based on a single procalcitonin measurement at hospital admission--a randomized trial

Recent studies have suggested that procalcitonin (PCT) is a safe marker for the discrimination between bacterial and viral infection, and that PCT-guided treatment may lead to substantial reductions in antibiotic use. The present objective was to evaluate the effect of a single PCT measurement on antibiotic use in suspected lower respiratory tract infections (LRTIs) in a Danish hospital setting. In a randomized, controlled intervention study, 223 adult patients admitted to the hospital because of suspicion of LRTI were included with 210 patients available for analysis. Patients were randomized to either PCT-guided treatment or standard treatment. Antibiotic treatment duration in the PCT group was based on the serum PCT value at admission. The cut-off point for recommending antibiotic treatment was PCT > or =0.25 microg/L. Physicians could overrule treatment guidelines. The mean duration of hospital stay was 5.9 days in the PCT group vs. 6.7 days in the control group (p 0.22). The mean duration of antibiotic treatment during hospitalization in the PCT group was 5.1 days on average, as compared to 6.8 days in the control group (p 0.007). In a subgroup analysis of chronic obstructive pulmonary disease patients, the mean length of stay was reduced from 7.1 days in the control group to 4.8 days in the PCT group (p 0.009). It was concluded that the determination of a single PCT value at admission in patients with suspected LRTIs can lead to a reduction in the duration of antibiotic treatment by 25% without compromising outcome. No effect on the length of hospital stay was found.

131 CHARACTERISTICS OF PREGNANCIES AND OFFSPRING FOLLOWING TRANSFER OF BOVINE IN VIVO EMBRYOS ASSESSED BY NANORESPIROMETRY

It has been speculated whether the metabolism of the pre-implantation embryo may be reflected on the pregnancy and characteristics of the newborn animal. The present study investigated whether respiration rates of individual embryos were correlated with gestation length, type of parturition, birth weight, sex, and viability of the offspring. In-vivo embryos (n = 47) were recovered on day 7 from 11 superovulated and inseminated Holstein-Friesian cows and embryonic respiration rates were measured individually by nanorespirometry. The embryos were classified according to morphological quality (I, II, III), stage of development, and diameter and were subsequently transferred individually (n = 43) to synchronized recipients. Gestation length of the recipients (n = 22) was calculated and the type of parturition (no assistance, light traction, heavy traction, or caesarean section) recorded. Sex, weight, and condition of the calves at birth (weak, normal, or very active) were also assessed. Results were evaluated by chi-square analysis and using a linear mixed model. The pregnancy rate was 60% (26/43), and the respiration rates of individual embryos influenced gestation length as well as the interaction of weight at birth and type of parturition (P < 0.05). Embryos with higher respiration rates tended to be associated with a slightly more difficult type of parturition, which was not affected by sex. When embryos were divided into two even-sized categories according to their respiration rates (high v. low), low embryonic respiration rates were associated with low birth weight in 73% of the newborn calves (Table 1). Neither sex nor condition of the calves was directly affected by the embryonic respiration rates. The diameter and morphology of the embryo affected birth weight (P < 0.05), with quality I embryos associated with heavier calves when compared to quality III embryos. Furthermore, light traction was more frequently used to retrieve heavier animals (P < 0.05), and male calves were 3.2 kg heavier than females (P < 0.05). These results suggest that the metabolism of the embryo might affect the weight of the newborn animal and consequently the type of parturition. However, birth weight is highly influenced by the recipients and season, and thus a more accurate correlation is likely to be established when the weight of the postpubertal offspring is considered. Table 1. Birth weight of newborn calves according to respiratory category of bovine in-vivo embryos

Respiration rates correlate with mRNA expression of G6PD and GLUT1 genes in individual bovine in vitro-produced blastocysts

Quantification of embryo respiration is a promising procedure to assess embryonic metabolism and possibly select viable embryos. At the blastocyst stage, ATP is produced by glycolysis and oxidative phosphorylation, processes that require uptake of oxygen and glucose, which is regulated by the expression of GLUT1 and G6PD. The purpose of the present study was to investigate the relationship between respiration rates and relative abundances of G6PD and GLUT1 transcripts in individual bovine blastocysts produced in vitro. Respiration rates of 104 bovine in vitro-produced blastocysts were measured individually using the nanorespirometer technology. Real-time RT-PCR was employed to determine the relative abundance of G6PD and GLUT1 mRNA in individual embryos. The mean respiration rates were similar for male and female blastocysts of the same developmental stage, but the sex ratio was skewed towards males. GLUT1 expression was down-regulated in female versus male embryos. In contrast, a approximately 1.8-fold increase in the expression of G6PD mRNA was observed in female blastocysts when compared to male blastocysts, indicating that dosage compensation for this gene had not yet occurred. Both GLUT1 and G6PD expression levels were affected by morphological quality and stage of development. Expression of GLUT1 and G6PD mRNAs was correlated with respiration rates, indicating that, in metabolically active blastocysts, uptake of oxygen and glucose are jointly increased. These findings suggest that expression of genes for oxidative phosphorylation and glycolysis are both involved in oxygen demanding ATP production.

Investigation of respiration of individual bovine embryos produced in vivo and in vitro and correlation with viability following transfer

BACKGROUND

Quantification of oxygen consumption by individual preimplantation embryos has the potential to improve embryo selection. This study investigated whether respiration rates of individual embryos are useful indicators of embryo viability. The effect of the Nanorespirometer on embryo viability was also evaluated.

METHODS

The respiration rates of individual day 7 bovine in vivo- (n=44) and in vitro-produced (n=156) embryos were measured using the Nanorespirometer. In vivo-produced embryos were individually transferred to recipients.

RESULTS

The respiration rates of in vivo-produced embryos increased with increasing morphological quality and stage of development (P < 0.05). Pregnancy rates on days 35 and 60 were 65 and 60%, respectively. The mean respiration rate did not differ significantly between embryos producing and not producing a pregnancy, but the transfer of embryos with respiration rates <0.78 nl/h, between 0.78 and 1.10 nl/h, and >1.10 nl/h resulted in 48, 100 and 25% pregnancy rate, respectively. The mean respiration rate of in vitro-produced embryos was higher than that of in vivo-produced embryos because of differences in the morphological quality and stage of development.

CONCLUSION

The Nanorespirometer does not adversely influence embryo viability, but the sample size was too small to confirm the significance of the correlation observed between respiration rates and viability.

Effect of Days Post-Partum, Breed and Ovum Pick-Up Scheme on Bovine Oocyte Recovery and Embryo Development

The objective of this study was to investigate (i) the effect of two different ovum pick-up (OPU) schemes (once vs twice weekly aspirations) on oocyte recovery rate, quality and subsequent in vitro embryo development, (ii) the influence of days post-partum on oocyte recovery and (iii) possible differences in OPU results from two different herds. In group A, OPU was performed twice weekly in two Holstein Friesian (HF) and three Danish Red and White (DRW) cows from a private herd. In the research herd, two groups of eight HF cows were investigated: group B (OPU once weekly) and group C (OPU twice weekly). The collected oocytes were subsequently submitted to in vitro embryo production. More oocytes were recovered from the private herd when compared with the research herd. In the research herd, the twice weekly scheme aspirated more oocytes than the once weekly scheme. The quality of the retrieved oocytes was significantly different between groups B and C but not between groups A and C, and HF cows yielded higher quality oocytes than DRW cows (p = 0.029). Oocytes from group C showed higher level of embryonic development than group B oocytes. No differences in blastocyst rates were observed between groups A and C. Session affected the number of retrieved oocytes and subsequent developmental rates, with these being lower in the first compared with the last sessions. Finally, there was no significant effect of days post-partum in the number and quality of the retrieved oocytes, likely because of the small group size and high variation between sessions.

132 DIFFERENCES IN RESPIRATION RATES BETWEEN IN VIVO- AND IN VITRO-PRODUCED BOVINE EMBRYOS

In vitro-produced (IVP) bovine embryos differ (e.g. morphology and physiology) from their in vivo counterparts. Oxygen consumption is an indicator of the overall metabolic activity of a single embryo. Therefore, the aim of this study was to determine and compare respiration rates of in vivo- and in vitro-produced bovine day 7 embryos. Diameters of these two embryo types were also compared. In vivo embryos (n = 28) were recovered from 8 superovulated Holstein Frisian cows on day 7 following AI, while IVP embryos (n = 160; Holm et al. 1999 Theriogenology 52, 683-700) were used on day 7 after fertilization. Embryos were measured (outer diameter) and morphologically evaluated (Quality 1 to 4, IETS Manual, 1998). Only transferable in vivo embryos were used (i.e. excluding Quality 4). Respiration rates were measured on each embryo by Nanorespirometer technology (Lopes et al. 2005 Reprod. Fertil. Develop. 17, 151). Data were analyzed using Proc Mixed, and values are presented as mean � SEM. Values with different superscripts differ significantly (P < 0.05). The average respiration rates were 0.82 � 0.06a nL/h for in vivo vs. 1.37 � 0.06b nL/h for IVP embryos. The average respiration rates for the different morphological qualities were as follows (nL/h, numbers in brackets): IVP: 2.1 � 0.08a (38), 1.37 � 0.07b (55), 1.08 � 0.07c (48) and 0.62 � 0.11d (19) for Quality 1, 2, 3, and 4, respectively. In vivo: 1.17 � 0.21b,c,e (6), 0.80 � 0.15c,d,e (12), and 0.64 � 0.16d,f (10) for Quality 1, 2, and 3, respectively. The average diameter (mm) of in vivo and IVP embryos was 0.157 � 0.002a and 0.176 � 0.002b, respectively. Respiration rates were directly related to embryo diameter; larger embryos were associated with higher respiration rates (y = 17.55 � 1.32 nL/h � mm, n = 188). Respiration rates of in vivo embryos were significantly lower than those of IVP embryos, regardless of quality. This difference could reflect an effect of the culture conditions on IVP embryos because media components affect embryo metabolism. Moreover, the different ages (day 7 for IVP vs. approximately Day 6.5 for in vivo embryos, because in vivo embryos are less than 7 days after fertilization at recovery) and stages (IVP: up to expanded blastocyst stage; in vivo: morula or early blastocyst stage) could have influenced the results and also partly explain the smaller diameter of the in vivo embryos. Finally, respiration rates decreased proportionately to the morphological quality within embryo type, indicating that morphological differences are reflected at the physiological level. In conclusion, this study further outlines metabolic differences between in vivo and IVP bovine embryos. Whether such differences are a manifestation of metabolic stress associated to the separation from the natural environment or reflect suboptimal culture conditions is yet to be determined. ASL is supported by FCT, Portugal.

Respiration rates of individual bovine in vitro-produced embryos measured with a novel, non-invasive and highly sensitive microsensor system

Oxygen consumption is a useful parameter for evaluating embryo quality, since it provides a valuable indication of overall metabolic activity. Over the years, several approaches have been used to measure the respiration rates of individual embryos, but a convincing method has not yet been reported. In this study, we introduce and have validated a novel high resolution microsensor technology to determine the respiration rates of individual embryos at different developmental stages. We have employed this technology to investigate the correlation between respiration rate and embryo morphology, diameter and sex. Following morphological evaluation, individual respiration rates of day 3 (n= 18) and day 7 (n= 60) bovinein vitro-produced embryos were determined. Of the measured embryos, 64 were lysed for sex diagnosis by PCR. Average respiration rates of day 7 embryos (1.30 ± 0.064 nl/h) were 3.4-fold higher than day 3 embryos (0.38 ± 0.011 nl/h). On day 7, the average respiration rate of quality 1 blastocysts was significantly higher than the respiration rates of the lower qualities. For both day 3 and day 7 embryos, respiration rates were directly influenced by embryo diameter but did not differ between sexes. These results have demonstrated that the novel microsensor technology can be used to accurately and rapidly (8 min) measure the respiration rates of individual embryos at different developmental stages. Respiration rates were only in partial agreement with embryo morphology, suggesting a slight discrepancy between these two methods in assessing embryo quality. It is likely that a combined assessment of embryo respiration and morphology would improve embryo classification and subsequent selection.

Embryo technology: implications for fertility in cattle

During the past thirty years, basic and experimental studies on classical (superovulation; non-surgical recovery and transfer of cattle embryos) and advanced embryo technologies (in vitro embryo production; cloning by somatic cell nuclear transfer) have generated structural and functional information on oocyte development and quality, fertilisation and conceptus development. This information has provided new insight, not only into these technologies per se but also into the factors contributing to fertility in cattle. It is now known that the peripheral and follicular endocrine profiles have a profound influence on the subsequent developmental competence of the embryo. It is also well established that manipulation of the oocytes or embryos may adversely affect embryonic and foetal development, leading to the so-called 'large offspring syndrome'. Information from such studies has alerted scientists to the importance of epigenetics in cattle reproduction.

149 INTRAUTERINE CULTURE OF IN VITRO PRODUCED BOVINE EMBRYOS AND RECOVERY OF THE EMBRYOS AT DAYS 12 - 14

For stem cell production and detailed morphological analysis 12–14-day-old bovine embryos are suitable. However, it has been proven to be difficult to extend the in vitro culture period beyond Days 8–9, and it was the aim of the present experiment to examine whether it might be possible to culture 6–7-day-old in vitro-produced (IVP) embryos for a period of 5–7 days in the uterine horns of heifers. The IVP embryos were produced by standard procedures. Briefly, IVM took place in DMEM medium supplemented with 5% serum, EGF, and eCG/hCG, and IVF was carried out in TALP medium under 5% CO2 in humidified air and at 38.5°C. IVC took place in SOFaaci supplemented with 10% serum under 5% CO2, 5% O2 and 90% N2 at 38.5°C .The embryos were cultured in vitro to Days 6–7 post insemination, when morulas and blastocysts of excellent quality were placed in HEPES-buffered TCM199 with 10% serum, loaded in numbers of 10–30 into 0.25 mL straws, and then transported to the place of transfer in a portable incubator at 38.5°C. The embryos were transferred nonsurgically to the mid or distal part of the uterine horns of 28 dairy heifers which were heat synchronized with injections of cloprostenol (Estrumat Vet, Schering-Plough, Farum, Denmark) to a cycle stage of embryo age +1 day. In 16 heifers, embryos were transferred into both sides and for the remaining ones only into the horn ipsilateral to the ovary bearing the corpus luteum. After 5–7 days, the heifers were flushed nonsurgically by standard method, using a flushing catheter of large caliber (Minitab® 18 G) and slow infusion and evacuation of the fluid. The differences in recovering rate among horns were identified by Fisher's Exact test. Data are given as LS means ± SEM values and statistical differences assigned at the P < 0.05 level. In 6 of the 28 heifers no embryos were obtained; in these 6 cases, the quality of the transferred embryos, the transfer procedure, the heifers, and the flushing procedures did not differ in any obvious way from those of the successful flushings, which numbered 22 (79%). The mean embryo recovery rate was 40 ± 3% with a variation from 7% to 93%. There was a minor but not statistically significant difference between the overall recovery rate of embryos from the ipsi- versus contralateral horn, respectively (44 ± 5% vs. 38 ± 6%). In only 4 of the 16 heifers where transfer occurred to both horns was the recovery rate higher in contralateral side, compared to 9 heifers where the highest recovery rate was seen in the ipsilateral side. The oldest elongated embryos were in one occasion damaged and in another tangled, making it difficult to isolate the individual embryo; apart from that, all of the embryos seemed of excellent quality making it possible to isolate the embryonic discs. It can be concluded that it is possible to culture in vitro produced Day 6–7 bovine blastocysts in the uterus of synchronized heifers and to achieve an acceptable recovery of Day 12–14 embryos.

39 CHROMOSOME ABNORMALITIES IN BOVINE NUCLEAR TRANSFER EMBRYOS PRODUCED BY 'HANDMADE CLONING'

Embryos produced by nuclear transfer using somatic cells as donors exhibit a lower developmental competence compared to in vivo developed and IVM/IVF/IVC embryos. The so-called handmade somatic cell nuclear transfer (HSCNT or handmade cloning) that was recently presented (Vajta et al. 2003 Biol. Reprod. 68, 571–578) has, however, improved the reconstructed embryo and subsequent blastocyst rate. Further, the high total cell number (n = 216) and the high ratio of cells allocated to the inner cell mass (35%) as well as the initial pregnancy rate of 48% on Day 28 following nonsurgical transfer of HSCNT embryos indicated a high average quality. But still the pregnancy loss of HSCNT embryos was high and resulted in a birth rate of 8%. The aim of this study was to estimate the chromosomal variation in HSCNT embryos using fluorescent in situ hybridization (FISH) and to evaluate this as an additional parameter of embryo quality. Nuclei from 49 Day 7 HSCNT embryos from five independent trials were isolated by hypotonic treatment and fixed. Then the nuclei were hybridized with differentially labelled cJAB8 and p33E39 probes that hybridize specifically to the centromeric region of chromosome 6 and 7 (Viuff et al. 2000 Biol. Reprod. 63, 1143–1148). A total of 6715 nuclei were analyzed for chromosomal abnormalities, and the percentage of nuclei with false negative scores represented 1.8%. Only 4.1% of the embryos (2 of 49) had a completely normal diploid composition, while the remaining 47 embryos exhibited different types of mixoploidy. Of the 47 mixoploid embryos, 87% contained more than one type of chromosomal variation with diploid/triploid/tetraploid being the most frequent constitution (43% of the 47 mixoploid embryos). No pure polyploid embryos were observed. The percentages of HSCNT embryos in the groups of 0%, 1–25%, and 26–100% polyploid cells were 4.1%, 67.5%, and 28.6%, respectively. This is significantly higher than the corresponding figures produced and analyzed by comparable methodology of bovine IVM/IVF/IVC embryos (Viuff et al. 1999 Biol. Reprod. 60, 1273–1278). However, 71.4% of the HSCNT embryos contained less than 25% polyploid cells; this low level may not have compromised the developmental competence of these embryos.

181 Oct-4: A POTENTIAL MARKER FOR PLURIPOTENCY IN CATTLE

The POU (Pit-Oct-Unc) domain transcription factor Oct-4 is one of the most acknowledged markers for pluripotency in murine and primate embryonic cells. At the blastocyst stage, expression of Oct-4 has been shown to remain high in the inner cell mass (ICM) while being rapidly down regulated in the trophectoderm (TE). Furthermore, in these species, expression of Oct-4 is maintained in pluripotent derivatives of the ICM and in embryonic stem (ES) cells, but lost upon differentiation. In the bovine embryo, a marker with similar qualities has long been sought. The aim of this study was to investigate, using a commercially available antibody for immunohistochemistry (IHC), whether Oct-4 might serve this role. In vitro produced (IVP) embryos were transferred to synchronized recipients at Day 6 post insemination (p.i) and flushed at Day 12; in vivo-derived embryos were flushed at Day 14. Day 8 IVP embryos (n = 20) were fixed and processed for IHC in paraffin sections together with Day 12 (n = 18) and Day 14 (n = 3) embryos. From Day 8 IVP embryos, outgrowth colonies (OCs) were formed by intact blastocyst culture on mouse SNL feeder cells. OCs were photographed using a stereomicroscope on Days 12, 14, and 16 p.i., and were examined for Oct-4 expression by in situ IHC at Day 16 p.i. (n = 94). From isolated embryonic discs of Day 12 embryos, OCs were derived by similar culture and were either processed for IHC on paraffin sections at Days 16, 18, and 20 p.i. (n = 9) or used for establishment of ES-like cell lines. Of colonies formed, representative specimens from each of the initial 5 passages (n = 18) were examined for Oct-4 expression either in paraffin sections or in situ. In Day 8 embryos, Oct-4 expression was demonstrated in all nuclei of both ICM and TE cells except for presumptive apoptotic ones. Approximately one-fifth of the OCs presented a substantial amount of Oct-4 positive cells of putative ICM, but also of TE origin. Apparently, the formation of Oct-4 positive OCs was favored by initial attachment of the embryonic pole to the feeder cells. In Day 12 and 14 embryos, specific and exclusive Oct-4 staining of nuclei of the complete epiblast, but not the hypoblast and the TE, was revealed. All OCs derived from Day 12 embryonic discs showed specific staining for Oct-4 in nuclei of putative epiblast origin only. On subsequent culture of these isolated epiblast derivatives, loss of Oct-4 staining from colonies was observed by passage 3. This study has, for the first time, shown expression of Oct-4 to be limited to pluripotent cells of bovine Day 12 and 14 embryos. Compared with murine and primate embryos, down-regulation of Oct-4 expression in bovine TE cells appears to be delayed. Findings indicate that Oct-4 may be used as a marker for pluripotency in bovine ES-like cells, although TE derivatives may maintain Oct-4 expression when isolated from Day 8 embryos.

295 COMPARISON OF TWO METHODS TO AVOID MOVEMENT OF BOVINE OOCYTES DURING IN VITRO MATURATION

Development of two-photon laser scanning microscopy (TPLSM) has made it possible to conduct several recordings over time of early stage embryos without compromising viability. To use TPLSM to study structures within the oocyte it is necessary to remove at least part of the cumulus cells to prevent emitted light from being blocked. Aspiration of cumulus oocyte complexes (COC) through a denudation pipette creates a “window” through which the emitted light can escape and be recorded. To allow repeated recordings of the same location within an object it is important to avoid movement of the object. Gelatine (Gel) and poly-l-lysine (PLL) have previously been used to promote adhesion of cells in culture. The aim of our study was to develop a method to avoid movement during IVM of partially denuded COCs without compromising oocyte viability. Previous experiments in our lab showed that partial denudation of COC had no effect on embryo development (unpublished). Bovine COCs were obtained from abattoir ovaries. In the control group COCs were placed in non-treated dishes. In the experimental groups, they were placed in Gel- or PLL-coated dishes, either intact or partially denuded, where the length of cumulus cell “tails” was shortened to around 200 μm on each side of the oocyte. The coated dishes were prepared 24 h prior to IVM with 200 μL of 0.1% Gel (Sigma, Copenhagen, Denmark, G2500) or 200 μL 0.01% PLL (Sigma, P-4832). Partial denudation of COCs was performed with a 127–129 μm diameter denudation pipette. Standard procedures were used for IVM (23 h in DMEM with 5% serum and eCG/hCG), IVF (23 h in TALP), and IVC (SOF with 10% serum); IVM and IVF were incubated at 38.5°C in 5% CO2 in air, and IVC at 5% CO2 in 5% O2. The study was based on a total of 1151 oocytes and 3 replicates. Day 8 blastocyst (BL) rates, BL kinetics, and morphology were used as endpoints to assess oocyte maturation. Kinetics/morphology were graded by a scoring system: hatched/excellent 3, expanded/good 2, non-expanded/poor 1. COCs placed in Gel- or PLL-coated dishes did not move during handling of the dishes. The BL rates in the Gel group were 37%, 25%, and 17%, and in the PLL group 24%, 21%, and 12%, for the control, intact, and partially denuded COCs, respectively. In the Gel group the BL rates showed a decreasing trend (P < 0.0036), whereas in only the PLL group the BL rates from the partially denuded COC differed from the control and the intact COCs (P < 0.008). No significant differences were seen between blastocyst kinetics (Gel/PLL 1.9/1.9, 1.8/1.9, 1.6/1.7) or morphology (Gel/PLL 2.2/2.4, 2.0/2.5, 2.2/2.1) in the control, intact or partially denuded groups. Fisher's exact test used. We conclude that it is possible to avoid movement of COCs during IVM without compromising oocyte maturation in dishes coated with Gel or PLL, if the cumulus layer is intact. The BL rates are compromised if COCs are partially denuded and the “cumulus tails” shortened before IVM in Gel or PLL coated dishes, whereas kinetics and morphology are unaffected. This research was funded by the Danish Research Agency, no. 23-023-0133.

Somatic cell amplification of early pregnancy factors in the fallopian tube

This essay is concerned with the function of ovarian somatic cells, especially those of the cumulus oophorus, that are shed with the oocyte at the time of ovulation. Once dissociated from the surface of the oocyte(s), they remain in its close vicinity or that of the zygote(s) throughout the tubal sojourn. Most such follicular cells are not moribund or dead but continue to be synthetically active, although showing ultrastructural modification. Their secretions may include steroid hormones, prostaglandins and diverse peptides, molecules that would be presented locally to the endosalpinx. The cell suspension represents a potential route of amplification of early pregnancy signals from the embryo to influence the pattern of ovarian steroid secretion and perhaps that of folliculogenesis. Bearing in mind the relatively low concentration of hormones generated by the somatic cell suspension, vascular counter-current transfer of information is postulated from the Fallopian tube to the ipsilateral ovary. Molecular techniques are being applied as a means of examining endosalpingeal responses in four different experimental models in which the numbers and presumptive activity of suspended follicular cells are varied in pigs with spontaneous oestrous cycles. Because these animals ovulate on both ovaries, epithelial activity can be compared and contrasted between the two sides. In a final model, attempts are being made to generate early pregnancy responses in the absence of embryos by transplanting zygote-programmed cumulus cells from a mated donor into the Fallopian tube of an unmated recipient.

2 CORRELATION BETWEEN OXYGEN RESPIRATION RATES AND MORPHOLOGY, SEX, DIAMETER AND DEVELOPMENTAL STAGE OF SINGLE BOVINE IVP-EMBRYOS

A simple, non-invasive, rapid and sensitive oxygen microsensor system was developed to investigate correlations between oxygen respiration rates of individual bovine embryos and their morphology, sex, diameter and developmental stage. Bovine IVP-embryos (n = 78; Holm et al. Theriogenology 52, 683–700) were analysed around the 8-cell stage (Day 3; n = 18) and at various blastocyst stages (Day 7; n = 60). Each embryo was morphologically evaluated, its outer diameter measured and was then loaded into a glass tube (i.d. 0.68 mm, length 3 mm). After 1 h, oxygen concentration gradients generated by the embryo’s respiration were measured over app. 8 min with an oxygen microelectrode (www.unisense.com). Five embryos were measured in one round together with an empty tube as control. The procedure was repeated twice for each embryo with app. 1 h interval. Individual respiration rates in nL O2/embryo/h (nL/h) were calculated from these gradients. The measurements were performed at 38.5°C under constant flow of humidified 5% CO2 in air (app. 19% O2). After this, 64 embryos (14 Day 3; 50 Day 7) were lysed for sex diagnosis by PCR. Values are given as mean ± SD. The sensitivity of the oxygen measurement system was high (controls: 0.034 ± 0.035 nL/h, n = 15) and its repeatability from 1st to 2nd measurement was 99.7 ± 9.8% (n = 71). The average embryo respiration rate was 0.39 ± 0.05 nLl/h on Day 3 (n = 18) and 1.31 ± 0.52 nLl/h on Day 7 (n = 60). For Day 7 embryos, the respiration rates varied according to their morphological quality, being 1.87 ± 0.46a (n = 18), 1.17 ± 0.32b (n = 23), 0.95 ± 0.27b,c (n = 14) and 0.72 ± 0.24c (n = 4) nL/h for quality 1, 2, 3, and 4 embryos, respectively (Proc Mixed,a,b,c: P < 0.05; values with different superscripts differ significantly). The sex ratio (male:female) was 9:5 (Day 3) and 32:18 (Day 7), and on Day 7 this ratio varied between qualities: 11:2, 12:8, 8:4, and 1:3 for quality 1, 2, 3, and 4, respectively. The average respiration rate on day 3 was the same for males and females, as it was on day 7 (1.22 ± 0.43 nL/h (females) and 1.31 ± 0.58 nL/h (males), P > 0.05). There was a correlation between embryo diameter and respiration rate (r2 = 0.65, n = 74), which was even stronger for Day 7 male embryos (r2 = 0.72, n = 32). In conclusion, a highly reliable, repeatable and sensitive system was established for measuring respiration rates in single bovine embryos, even at early developmental stages. The respiration rate was lower on day 3 compared to Day 7 embryos, and it was correlated with the morphological embryo quality on Day 7. Oxygen consumption could be a valuable supplementary indicator of embryo viability, especially in difficult evaluations (e.g. quality 2 and 3 after IVP). It remains to be demonstrated if such measurements can also reveal quality differences already at Day 3, which would be of interest in, e.g. the human field. ASL is supported by FCT, Portugal.

206 FOLLICULAR GROWTH SUBSEQUENT TO FOLLICULAR ASPIRATION IN THE MARE

Follicle aspiration has previously been used in mares as a research tool to remove growing and atretic follicles, in order to study follicular growth. The aim of the present study was to (1) evaluate the fate of the aspirated follicles, and (2) determine the point of selection of the dominant follicle subsequent to follicular aspiration. In six Standardbred mares, all follicles larger than 9 mm were removed by transvaginal ultrasound-guided aspiration (Day 0). Subsequent to follicular aspiration, the growth of follicles larger than 1 mm was monitored daily by ultrasonography from Day 0 to Day 7. Aspirated follicles were monitored to establish whether they refilled and continued to grow, or luteinized. The experiment was conducted in six replicates in each mare. On Day 1 after aspiration the largest and second largest follicles were 10.4 ± 0.8 mm (mean ± SEM) and 7.8 ± 0.6 mm, respectively. On Day 7 the largest follicle and the second largest follicle were 25.7 ± 1.2 mm and 18.6 ± 1.2 mm, respectively. In 10/209 follicles, the follicular cavity refilled subsequent to aspiration with non-echogenic fluid and the follicle diameter increased during the following 7 days. Four of the ten aspirated and refilled follicles grew to become the largest follicles, whereas the remaining six follicles did not reach dominance. A further three aspirated follicles grew and ovulated on Day 5. In one case, an aspirated follicle refilled and continued to grow after an oocyte had been recovered. However, from these preliminary results, the growth pattern of the aspirated follicle can not be predicted on the basis of whether or not the oocyte was removed during the aspiration session. Preliminary results of this study indicate that follicular selection for dominance as determined by follicular size difference may already have occurred on Day 1 after aspiration. Furthermore, follicles that refill with fluid and continue to grow after aspiration may pose a problem when follicular growth and selection are studied. This research was funded by the Danish Research Agency, project no. 23-02-0133.

Combined ACTH and glucocorticoid treatment improves survival and organ maturation in premature newborn calves

Glucocorticoids play an important role in prenatal organ maturation in many species. In humans, maternal treatment with synthetic glucocorticoids improves neonatal adaptation of prematurely born infants. In cows, pre-term calf survival is improved following a single maternal glucocorticoid administration. We hypothesized that stimulation of endogenous cortisol secretion by adrenocorticotropin (ACTH) treatment combined with maternal dexamethasone treatment, would be even more efficient in stimulating organ maturation in the prematurely delivered calf. Three groups of premature calves were delivered by caesarian section at 90% of gestation length from dams which were either untreated or injected with dexamethasone before delivery, combined with either prenatal or postnatal ACTH treatment to the calf. During the first 24h after birth, thermoregulation, blood chemistry, liver values and organ weights were recorded. In the untreated calves, survival was significantly correlated with blood oxygenation, sodium and calcium levels at the moment of birth. There were marked maturational effects of the treatments on body temperature regulation, blood acid-base status, oxygenation, glucose, insulin, IGF-1 levels, weight of the heart, liver, gastrointestinal tract and thymus weight. For many of the measured metabolic, endocrine and organ weight parameters, the intrauterine ACTH treatment was associated with improved values relative to the postnatal ACTH treatment, which appeared to have no immediate effect on calf viability. In conclusion, the premature calf delivered by caesarian section at 90% of gestation length showed blood chemistry, metabolic, endocrine and organ growth characteristics that indicated severe prematurity. However, the maturation of organ function in newborn premature calves following maternal glucocorticoid injections was further enhanced if is was preceded by intra-fetal injections of ACTH.