Effects of bradycardia, hypoxemia and early intubation on bronchopulmonary dysplasia in very preterm infants: An observational study

BACKGROUND

Bronchopulmonary dysplasia (BPD) is the most common pulmonary complication in preterm infants.

OBJECTIVES

The study aimed to explore the effects of bradycardia, hypoxemia, and early intubation on BPD in very preterm infants.

METHODS

This is a prospective observational cohort study. Preterm infants with a mean gestational age of 28.67 weeks were recruited from two level III neonatal intensive care units (NICUs) in Taiwan. Continuous electrocardiography was used to monitor heart rates and oxygen saturation (SpO2). Infants were monitored for heart rates of <100 beats per minute and SpO2 levels of <90 % lasting for 30 s. Generalized estimating equations were used to analyze the effects of bradycardia, hypoxemia, and early intubation on BPD in very preterm infants. Model fit was visually assessed using receiver operating characteristic curve analysis.

RESULTS

Bradycardia, hypoxemia, and early intubation significantly increased the odds of BPD among the preterm infants (N = 39) during NICU stay; the odds ratios for bradycardia, hypoxemia, and early intubation for BPD versus non-BPD were 1.058, 1.013, and 29.631, respectively (all p < 0.05). A model combining bradycardia, hypoxemia, and early intubation accurately predicted BPD development (area under the curve = 0.919).

CONCLUSIONS

Bradycardia, hypoxemia, and early intubation significantly increased the odds of BPD among very preterm infants during NICU stay. The model combining bradycardia, hypoxemia, and early intubation accurately predicted BPD development.

Time variation of high-risk groups for liver function deteriorations within fluctuating long-term liver function after hepatic radiotherapy in patients with hepatocellular carcinoma

PURPOSE

The purpose of this study is to find essential risk factors associated with liver function (LF) deteriorations within fluctuating long-term LF and their time-varying effects in patients with hepatocellular carcinoma (HCC) receiving hepatic radiotherapy and to identify high-risk groups for adverse LF deteriorations and their changes over time in facilitating the prevention of hepatic decompensation and the improvement of survival.

MATERIALS AND METHODS

A total of 133 HCC patients treated by hepatic radiotherapy were enrolled. A study design was conducted to convert posttreatment long-term LF with fluctuating levels over time to recurrent LF events using defined upgrades in a grading scale. The hazard ratios (HR) of pretreatment biochemical, demographic, clinical, and dosimetric factors in developing posttreatment LF events were estimated using the Cox model. Methodologies of the counting process approach, robust variance estimation, goodness-of-fit testing based on the Schoenfeld residuals, and time-dependent covariates in survival analysis were employed to handle the correlation within subjects and evaluate the time-varying effects during long-term follow-up.

RESULTS

Baseline LF score before radiotherapy and gender were significant factors. Initial HR in developing LF events was 1.17 (95% CI 1.11-1.23; P < 0.001) for each increase of baseline LF score and kept almost constant over time (HR, 1.00; 95% CI 1.00-1.01; P = 0.065). However, no difference was observed regarding initial hazards for gender (HR, 1.00; 95% CI 0.64-1.56; P = 0.994), but the hazard for women got higher monthly over time compared with men (HR, 1.04; 95% CI 1.01-1.07; P = 0.006).

CONCLUSIONS

High-risk groups for adverse LF deteriorations after hepatic radiotherapy may change over time. Patients with poor baseline LF are vulnerable from the beginning. Women require prevention strategies and careful monitoring for deteriorations at a later stage.

Critical Factors of Dose Distribution in Breast Cancer Tomotherapy With Metallic Port Breast Tissue Expander: Image Correction, Delivery Mode, and Volume Impact

Objectives: Breast reconstruction helps patients enhance their body image after mastectomy. Metallic ports in tissue expanders lead to dose attenuation during radiotherapy. Tissue expander volume shifts the metallic port position, possibly causing various dose alterations. This study aimed to evaluate the impact of the MAGNA-SITE^TM tissue expander volume on tomotherapy. Methods: Boluses and MAGNA-SITE^TM were placed on a Rando phantom to simulate the tissue expander under the pectoralis major. Computed tomography simulation images were transformed through replacing the electron density of (a) metallic artifact region only (Image metallic port) and (b) metallic port and artifact regions (Image Homo). Planning was calculated using fixed-beam and helical-mode techniques. Radiation was delivered with different volumes of the tissue expander. Results: Integrated 997 dose points were calculated. Planning with Image metallic port provided a calculated dose significantly closer to a realistic dose. The percentage of doses achieving the prescribed dose was significantly higher in the helical mode. In layer 2, the 100-mL tissue expander had a significantly lower measurement dose than all other volumes. Volume 150 mL had the highest increase in the measured dose difference from the plan dose at layer 2. Volume 250 mL had the highest percentage of measurement doses passing the 5% dose difference from plan dose. The coldest dose areas were noted in layers 1 and 2, especially in the metallic port–direct image mode. The average dose reduction of the measured cold areas was 6.03 ± 1.94%. Conclusion: Dose distribution was affected by the volume of the metallic port tissue expander. Tomotherapy with proper image heterogeneity correction and helical mode can reduce the attenuation from the metallic port. A tissue expander volume of 150 to 250 mL is suitable. Patients with high risk at the chest wall should be evaluated carefully to avoid underdosing. Radiation oncologists should closely cooperate with plastic surgeons to optimize treatment for each patient.

Half-beam volumetric-modulated arc therapy in adjuvant radiotherapy for gynecological cancers

PURPOSE

The purpose of this study is to introduce half-beam volumetric-modulated arc therapy (HVMAT), an innovative treatment planning technique from our work, for reducing dose to the organs at risk (OAR) during adjuvant radiotherapy for gynecological cancers.

METHODS AND MATERIALS

Seventy-two treatment plans of 36 patients with gynecological cancers receiving adjuvant radiotherapy were assessed. Among them, 36 plans were designed using HVMAT and paired with the other 36 traditional volumetric-modulated arc therapy (VMAT) plans for each patient. The main uniqueness of the HVMAT designs was that it consisted of two opposite-shielded half-beam fields rotated inversely in two coplanar arcs, collocating with the specially-devised avoidance structures to enhance the control of the OAR doses. The dose distributions in HVMAT and VMAT were evaluated and compared using the random effects model.

RESULTS

The ratios of OAR doses in HVMAT compared with VMAT showed a comprehensive OAR dose reduction when using HVMAT (V_20Gy : bladder, 0.92; rectum, 0.95; V_30Gy : bowel, 0.91; femoral heads, 0.66), except for the ilium (V_30Gy : 1.12). The overall mean difference for each OAR across V_40Gy , V_30Gy , V_20Gy , and bowel V_15Gy was statistically significant (almost all p < 0.001). In addition, HVMAT promoted a better conformity index, homogeneity index, D_2% , and V_107% of the planning target volume (all p < 0.001).

CONCLUSIONS

HVMAT is capable of generating deep double-concave dose distributions with the advantage of reducing dose to several OARs simultaneously. It is highly recommended for pelvic irradiation, especially for treating gynecological cancers in adjuvant radiotherapy.

Risk of work-related injury in workers with obstructive sleep apnea: A systematic review and meta-analysis

The objective of this study is to elucidate the relationship between obstructive sleep apnea (OSA) and the risk of work-related injuries (WRIs), synthesize the latest clinical evidence and conduct a systematic review and meta-analysis adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA 2020). Observational studies published before April 2020 in PubMed, Cochrane library, PsycINFO, Scopus, Google Scholar and Web of Science were included. Random-effects Mantel-Haenszel meta-analysis was performed. A total of 15 studies with 21,507 participants were included. Prespecified subgroup analyses based on study design and the characteristics of the enrollees were conducted. Overall, workers with OSA had 1.64-fold increased odds of being involved in WRIs compared to their counterparts (OR = 1.64, 95% CI = 1.24-2.16, p = 0.0005). In addition to the professional drivers that have been studied in the past, such a trend also existed in the general working population (OR = 1.68, 95% CI = 1.14-2.49, p = 0.01). We also found that workers with excessive daytime sleepiness (Epworth Sleepiness Scale score >10) had a 1.68-fold increased risk of WRIs compared to those with lower ESS scores (OR = 1.68, 95% CI = 1.22-2.30, p = 0.002). This study verified that OSA workers had a higher risk of WRIs, and such correlations do not show obvious differences in subgroups with different sample sizes, OSA diagnosis methods, job types or definitions of WRI. Based on the association between OSA and WRIs identified in our study, further studies investigating the protective effects of early identification and management of OSA on WRIs are warranted.

Long-term clinical outcomes of patients receiving proton beam therapy for caudate lobe hepatocellular carcinoma

Hepatocellular carcinoma (HCC) located in the caudate lobe (caudate HCC) is rare; however, patients with this type of tumour have poorer prognoses than those with HCC in other segments. Despite many published reports on the clinical usefulness of proton beam therapy (PBT) for HCC, data on the clinical outcomes of patients undergoing PBT for caudate HCC remain scarce. Therefore, the present study aimed to investigate the outcomes of this group of patients. Thirty patients with caudate HCC who underwent definitive PBT between February 2002 and February 2014 were retrospectively analysed. The total irradiation doses ranged from 55 to 77 (median 72.6) Gy relative biological dose. The median follow-up period was 37.5 (range, 3.0-152.0) months. The overall survival (OS) rates at one, three and five years were 86.6%, 62.8% and 46.1%, respectively. According to univariate and multivariate analyses, Child-Pugh A (P < 0.01), having a single tumour (P = 0.02) and a low serum alpha-fetoprotein level (AFP; P < 0.01) were significant factors predicting longer survival. The local control (LC) rates at one, three and five years were 100%, 85.9% and 85.9%, respectively, while the corresponding progression-free survival (PFS) rates were 65%, 27.5% and 22%, respectively. No grade 3 or worse adverse events were observed. PBT is effective and safe for the treatment of caudate HCC, and should therefore be considered a feasible option for intervention in patients with this disease.

Calling nurses to care for burn victims after color-dust explosion

BACKGROUND

Healthcare professionals follow codes of ethics, making them responsible for providing holistic care to all disaster victims. However, this often results in ethical dilemmas due to the need to provide rapid critical care while simultaneously attending to a complex spectrum of patient needs. These dilemmas can cause negative emotions to accumulate over time and impact physiological and psychological health, which can also threaten nurse-patient relationships.

AIM

This study aimed to understand the experience of nurses who cared for burn victims of the color-dust explosion and the meaning of ethical relationships between nurse and patient.

RESEARCH DESIGN

A qualitative descriptive study using a phenomenological approach.

PARTICIPANTS AND RESEARCH CONTEXT

Clinical nurses who provided care to the patients of the Formosa color-dust explosion of 2015 were selected by purposive sampling (N = 12) from a medical center in Taiwan. Data were collected using individual in-depth semi-structured interviews. Audiotaped interviews were transcribed and analyzed using Colaizzi's method.

ETHICAL CONSIDERATIONS

This study was approved by the institutional review board of the study hospital. All participants provided written informed consent.

FINDINGS

Three main themes described the essence of the ethical dilemmas experienced by nurses who cared for the burn-injured patients: (1) the calling must be answered, (2) the calling provoked my feelings, and (3) the calling called out my strengths.

CONCLUSIONS

Healthcare providers should recognize that nurses believed they had an ethical responsibility to care for color-dust explosion burn victims. Understanding the feelings of nurses during the care of patients and encouraging them to differentiate between the self and the other by fostering patient-nurse relationships based on intersubjectivity could help nurses increase self-care and improve patient caregiving.

Meaning of critical traumatic injury for a patient's body and self

BACKGROUND

Patients with a traumatic injury often require intensive care for life-saving treatments. Physical suffering and emotional stress during critical care can be alleviated by ethical caring provided by nurses. The relationship between body and self are fundamentally inseparable. Nurses need to understand the impacts of traumatic injury on a patient's body and self.

AIM

To understand the meaning of traumatic injury for body and self for patients receiving intensive care.

RESEARCH DESIGN

A qualitative descriptive study using Giorgi's phenomenological approach.

PARTICIPANTS AND RESEARCH CONTEXT

Patients receiving intensive care for physical trauma were selected by purposive sampling (N = 15) from a medical center in Taiwan. Individual in-depth, face-to-face audiotaped interviews, guided by semi-structured questions, were used to collect data. Each interview lasted 30-60 min. Audiotaped interviews were transcribed and analyzed.

ETHICAL CONSIDERATIONS

This study was approved by the Institutional Review Board of the medical center.

FINDINGS

The impact of the experience of traumatic injury on participants' body and self was described by three main themes: (1) Searching for the meaning of the injured body, (2) Feeling trapped in the bed, and (3) The carer and the cared-for.

DISCUSSION AND CONCLUSION

The implications of the three themes described in the findings are as follows: Trauma as a source of meaning; Body and self are mutually limiting or mutually enabling; and Ethical relationships. The experience of needing intensive care following a traumatic injury on the body and self was dynamic and mutual. The experience of the injury changed the relationship between body and self, and gave new meaning to life. Nurses play a crucial role in continuity of care by understanding the meaning of a traumatic injury for patient's body and self that facilitates ethical care and recovery from injury.

Capacity of proton beams in preserving normal liver tissue during proton beam therapy for hepatocellular carcinoma

Unirradiated liver volume (ULV) preservation rate is an important factor associated with radiation-induced liver disease (RILD) in patients with hepatocellular carcinoma (HCC) undergoing proton beam therapy (PBT). The purpose of this study is to identify the predictors for ULV preservation and quantify the capacity of proton beams in normal liver sparing during PBT. We reviewed planning data of 92 patients with single intrahepatic HCC tumors undergoing PBT. The potential clinical and planning factors that may affect ULV preservation were involved in multiple linear regression for ULV preservation rate. The significant factors were determined to be predictors and their influences were quantified. The median ULV preservation rate was 62.08%. All the assessed clinical factors showed significant effects on ULV preservation rate: clinical target volume (CTV), P < 0.001; portal vein tumor thrombosis (PVTT), P = 0.010; left lobe tumor, P = 0.010. In contrast, none of the planning factors demonstrated significance. The coefficients of significant factors in multiple linear regression were 60.85 for intercept, -0.02 for CTV, -9.01 for PVTT and 8.31 for left lobe tumors. The capacity of proton beams to spare normal liver tissue during PBT for HCC is mainly affected by clinical factors. The baseline of the ULV preservation rate is 60.85%, decreasing 0.02% with each milliliter of CTV increase and 9.01% for tumors with PVTT, and increasing 8.31% for tumors limited to the left lobe. Further clinical studies should be carried out to correlate our dosimetric findings with clinical outcomes.

Arabidopsis chloroplast J protein DJC75/CRRJ mediates nitrate-promoted seed germination in the dark

BACKGROUND AND AIMS

Nitrate can stimulate seed germination of many plant species in the absence of light; however, the molecular mechanism of nitrate-promoted seed germination in the dark remains largely unclear and no component of this pathway has been identified yet. Here, we show that a plastid J-domain protein, DJC75/CRRJ, in arabidopsis (Arabidopsis thaliana) is important for nitrate-promoted seed germination in the dark.

METHODS

The expression of DJC75 during imbibition in the dark was investigated. The seed germination rate of mutants defective in DJC75 was determined in the presence of nitrate when light cues for seed germination were eliminated by the treatment of imbibed seeds with a pulse of far-red light to inactivate phytochrome B (phyB), or by assaying germination in the dark with seeds harbouring the phyB mutation. The germination rates of mutants defective in CRRL, a J-like protein related to DJC75, and in two chloroplast Hsp70s were also measured in the presence of nitrate in darkness.

KEY RESULTS

DJC75 was expressed during seed imbibition in the absence of light. Mutants defective in DJC75 showed seed germination defects in the presence of nitrate when light cues for seed germination were eliminated. Mutants defective in CRRL and in two chloroplast Hsp70s also exhibited similar seed germination defects. Upregulation of gibberellin biosynthetic gene GA3ox1 expression by nitrate in imbibed phyB mutant seeds was diminished when DJC75 was knocked out.

CONCLUSIONS

Our data suggest that plastid J-domain protein DJC75 regulates nitrate-promoted seed germination in the dark by upregulation of expression of the gibberellin biosynthetic gene GA3ox1 through an unknown mechanism and that DJC75 may work in concert with chloroplast Hsp70s to regulate nitrate-promoted seed germination. DJC75 is the first pathway component identified for nitrate-promoted seed germination in the dark.

Radiation Dose in the Uterine Perforation by Tandem in 3-Dimensional Cervical Cancer Brachytherapy

Cervical cancer patients may sometimes experience different types of uterine perforation by a tandem during brachytherapy. The purpose of this study was to address possibly different management strategies regarding different tandem positions from a dosimetry aspect by evaluating radiation doses delivered to organs-at-risk (OAR) in order to help medical professionals handle different types of uterine perforation. Images and dosimetry data in cervical cancer brachytherapy with uterine perforation were reviewed. Uterine perforation was classified into anterior and posterior perforation according to their tandem positions. Radiation doses received by OAR, including D_2cc and D_1cc of the bladder, rectum, and sigmoid colon, were statistically compared with nonperforation. The doses of high-risk clinical target volume (HR-CTV) of cervical tumor and bilateral point A were also compared in order to assure that the plans had not compromised the treatment efficacy. A total of 21 applications were assessed, including 5 with anterior perforation, 4 with posterior perforation, and 12 without perforation. In anterior perforation, the bladder was the only organ that received a significantly increased dose about 30% at D_2cc and D_1cc. However, in posterior perforation, multiple OAR received significantly excessive doses: approximately 30% for the bladder, 37% for the rectum, and 100% for the sigmoid colon. The OAR dose assessment was based on a statistically equivalent cervical tumor dose. Different management strategies are possible for anterior vs posterior perforation during brachytherapy due to different detrimental extents on OAR dosimetry. The bladder warrants more attention in anterior perforation, without compromising target coverage in treatment planning. On the other hand, repositioning may be considered in posterior perforation due to relatively massive OAR detriments. This concept is a new one and is given for the first time.

Tangent-based volumetric modulated arc therapy for advanced left breast cancer

PURPOSE

To introduce the benefits of tangent-based volumetric modulated arc therapy (TVMAT), an innovative radiotherapy planning technique, compared with traditional volumetric modulated arc therapy (VMAT) for advanced left breast cancer needing nodal irradiation.

MATERIALS AND METHODS

Twenty-three patients with advanced left breast cancer who had received modified radical mastectomy (MRM) and needed adjuvant radiotherapy including nodal irradiation were assessed. Among 23 radiotherapy treatment plans, 17 plans were designed by using TVMAT technique and 6 plans were designed by using traditional VMAT. The main difference of TVMAT from VMAT was that the area of avoidance sector within specific degrees of angle that had no monitor unit (MU) delivery was used in the arc planning, including a total of 5 sectors in 5 partial arcs. The dosimetries of planning target volume (PTV), right breast, bilateral lungs, and heart between TVMAT and VMAT were compared.

RESULTS

The conformity index (CI) and homogeneity index (HI) of PTV between two groups were statistically equivalent (CI: 0.98 ± 0.02 and 0.98 ± 0.03, P = 0.431; HI: 0.12 ± 0.03 and 0.11 ± 0.05, P = 0.177), which indicated that the treatment efficacy of the plans regarding TVMAT was compatible with VMAT. However, all neighboring organs at risk (OAR) showed a great percentage of reduction in mean doses (right breast: 53.1%, right lung: 37.7%, left lung: 8.8%, heart: 21.2%) and low dose parameters (V10: right breast: 72.3%, right lung: 86.1%, left lung: 12.5%, heart: 25.1%; V5: right breast: 56.5%, right lung: 28.3%, left lung: 12.7%, heart: 18.2%) by using TVMAT.

CONCLUSION

TVMAT greatly decreases the radiation doses delivered to the OAR with maintained therapeutic efficacy. It is highly recommended for treating breast cancer, especially for difficult cases with left side disease needing nodal irradiation.

Quantitative analysis of respiration-induced motion of each liver segment with helical computed tomography and 4-dimensional computed tomography

Background

To analyze the respiratory-induced motion of each liver segment using helical computed tomography (helical CT) and 4-dimensional computed tomography (4DCT), and to establish the individual segment expansion margin of internal target volume (ITV) to facilitate target delineation of tumors in different liver segments.

Methods

Twenty patients who received radiotherapy with CT-simulation scanning of the whole liver in both helical CT and 10-phase-gated 4DCT were investigated, including 2 patients with esophagus cancer, 4 with lung cancer, 10 with breast cancer, 2 with liver cancer, 1 with thymoma, and 1 with gastric diffuse large B-cell lymphoma (DLBCL). For each patient, 9 representative points were drawn on the helical CT images of liver segments 1, 2, 3, 4a, 4b, 5, 6, 7, and 8, respectively, and adaptively deformed to 2 phases of the 4DCT images at the end of inspiration (phase 0 CT) and expiration (phase 50 CT) in the treatment planning system. Using the amplitude of each point between phase 0 CT and phase 50 CT, we established quantitative data for the respiration-induced motion of each liver segment in 3-dimensional directions. Moreover, using the amplitude between the original helical CT and both 4DCT images, we rendered the individual segment expansion margin of ITV for hepatic target delineation to cover more than 95% of each tumor.

Results

The average amplitude (mean ± standard deviation) was 0.6 ± 3.0 mm in the left-right (LR) direction, 2.3 ± 2.4 mm in the anterior-posterior (AP) direction, and 5.7 ± 3.4 mm in the superior-inferior (SI) direction, respectively. All of the segments moved posteriorly and superiorly during expiration. Segment 7 had the largest amplitude in the SI direction, at 8.6 ± 3.4 mm. Otherwise, the segments over the lateral side, including segments 2, 3, 6, and 7, had greater excursion in the SI direction compared to the medial segments. To cover more than 95% of each tumor, the required expansion margin of ITV in the LR, AP, and SI directions were at least 2.5 mm, 2.5 mm, and 5.0 mm on average, respectively, with variations between different segments.

Conclusions

The greatest excursion occurred in liver segment 7, followed by the segments over the lateral side in the SI direction. The individual segment expansion margin of ITV is required to delineate targets for each segment and direction.

Effects of Aromatherapy Massage on Pregnant Women's Stress and Immune Function: A Longitudinal, Prospective, Randomized Controlled Trial

OBJECTIVES

This study's aims are to examine the effects of aromatherapy massage on women's stress and immune function during pregnancy.

METHODS

This longitudinal, prospective, randomized controlled trial recruited 52 healthy pregnant women from a prenatal clinic in Taipei using convenience sampling. The participants were randomly assigned to the intervention (n = 24) or control (n = 28) group using Clinstat block randomization. The intervention group received 70 min of aromatherapy massage with 2% lavender essential oil every other week (10 times in total) for 20 weeks; the control group received only routine prenatal care. In both groups, participants' salivary cortisol and immunoglobulin A (IgA) levels were collected before and after the intervention group received aromatherapy massage (every month from 16 to 36 weeks gestation) and were analyzed using enzyme-linked immunosorbent assay.

RESULTS

The pregnant women in the intervention group had lower salivary cortisol (p < 0.001) and higher IgA (p < 0.001) levels immediately after aromatherapy massage than those in the control group, which did not receive massage treatment. Comparing the long-term effects of aromatherapy massage on salivary IgA levels between groups at different times, the study found that the pretest salivary IgA levels at 32 (p = 0.002) and 36 (p < 0.001) weeks gestational age (GA) were significantly higher than the pretest IgA at 16 weeks GA (baseline).

CONCLUSIONS

This study presented evidence that aromatherapy massage could significantly decrease stress and enhance immune function in pregnant women. The findings can guide clinicians or midwives in providing aromatherapy massage to women throughout the pregnancy.

Prostatic urethral angle might be a predictor of treatment efficacy of α-blockers in men with lower urinary tract symptoms

Purpose

We investigated the association of the prostatic urethral angle (PUA) with peak urinary flow rate (Q_max) and the severity of lower urinary tract symptoms (LUTS) on the aging male. We also evaluated the effect of the PUA on the treatment efficacy of tamsulosin on men with LUTS.

Materials and methods

The records were obtained from a prospective database for first-visit male patients with LUTS in the outpatient department of our institution. These patients underwent a detailed physical examination and taking of medical history. A transrectal ultrasound was performed on these patients. The prostate size, length of intravesical prostatic protrusion (IPP), PUA, and International Prostate Symptom Score (IPSS) of the patients were evaluated. Uroflowmetry and a bladder scan for residual urine were also performed on every patient. Tamsulosin 0.2 mg per day was prescribed. The IPSS and uroflowmetry were reevaluated after they had received treatment for 3 months.

Results

A total of 178 patients were included, and 149 of them completed this cohort study. The mean PUA was 48.32°±13.74°. The mean prostate volume was 39.19±20.87 mL, and the mean IPP was 5.67±7.85 mm. On multivariate linear regression analysis, the PUA was independently associated with the IPSS (P<0.001), Q_max (P=0.004), post-treatment IPSS change (P=0.032), and post-treatment Q_max change (P<0.001). However, the prostate volume and IPP were not associated with these clinical items.

Conclusion

The PUA is significantly associated with Q_max and IPSS in men with LUTS. The PUA is also inversely correlated with changes in Q_max and IPSS after tamsulosin treatment. Namely, the PUA might be a predictor for the treatment efficacy of α-blockers in aging men with LUTS.

Effects of Hg, CH(3)-Hg, and Temperature on the Expression of Mercury Resistance Genes in Environmental Bacteria

Twenty different bacterial isolates obtained from a mercury-contaminated site in Oak Ridge, Tenn., were grown on plate count agar amended with 25 mug of Hg or 3 mug of CH(3)-Hg (R-Hg) per ml. The total cellular RNA was extracted from each isolate by an acid-guanidine-thiocyanate-phenol-chloroform method. The transcripts of merA and merB were detected and quantitated by Northern (RNA) hybridization. A qualitative assay of mercuric reductase was used to confirm the enzyme activity. Low temperature (4 degrees C) with the presence of Hg (25 mug/ml) significantly increased the net merA transcripts of mid-log-phase cells of six environmental isolates. The net merA transcript production by 18 of the isolates increased when they were grown on 50% plate count broth with 15 mug of Hg per ml, but only 8 isolates showed increased production of merB transcripts. The MICs of Hg and R-Hg for 10 methyl mercury-resistant isolates ranged from 45 to 110 mug of Hg and 0.6 to 4.5 mug of R-Hg per ml. R-Hg was able to induce the expression of merB in 70% of methyl mercury-resistant strains.

Rapid method for direct extraction of mRNA from seeded soils

A protocol for direct extraction of mRNA from soil samples was developed. Soil samples (10 g) were washed twice with 120 mM phosphate buffer (pH 5.2). The lysis of cells, fixation of RNA, and hydrolysis of DNA were achieved by vigorously shaking the washed soil in a 4 M guanidine thiocyanate solution containing 25 mM sodium citrate, 0.5% sarcosyl, and 0.1 M 2-mercaptoethanol. The pH of the homogenized mixture was adjusted with 2 M sodium acetate (pH 4.0); the mRNA was then extracted with phenol and chloroform. Total RNA was precipitated with isopropanol. This method extracts up to 17 mug of total RNA per g (wet weight) of soil containing 8.0 x 10 cells of Pseudomonas aeruginosa PU21, and mRNA has been detected in 160-ng total RNA fractions. This method has been used for the detection of mRNA transcribed from specific biodegradative genes, including the nah and mer operons, in contaminated soils. This extraction method can be completed within a few hours and has tremendous potential for ecological studies of in situ gene expression among soil microbiotas.

Schwannoma of the auricle

OBJECTIVES

We report an extremely rare case of schwannoma of the auricle.

METHODOLOGY

A case report and review of the world literature concerning schwannoma of the auricle are presented.

RESULTS

Schwannoma is a benign, encapsulated, slow-growing neoplasm. Approximately 25-45% of all schwannomas occur in the head and neck, whereas schwannomas of the external ear are extremely uncommon, with only nine cases reported in the English literature since the first report in 1977. In this report, we describe the case of a 47-year-old male patient who presented with a 2-year history of a slow-growing mass in the left auricle, which was managed by wide surgical excision. We believe this case to be the second case of schwannoma of the auricle reported.

CONCLUSIONS

To our knowledge, this is the second report in the world literature of auricle schwannoma. Schwannoma should be considered in the evaluation of any tumour of the auricle.

Is planned surgery important in sinonasal inverted papilloma?

OBJECTIVE

To evaluate which clinical characteristics of inverted papilloma (IP) can result easily in misdiagnosis by clinicians and to determine the recurrence rate of inverted papilloma depending on diagnosis confirmation pre-operatively, intra-operatively or post-operatively.

PATIENTS AND METHODS

Fifty-one patients were treated for IP and 47 patients attended regular post-operative follow-up appointments for at least one year (mean: 54 months).

RESULTS

The patients were assigned to 3 groups: group Ia, in which IP was not confirmed until the post-operative pathology findings; group Ib, in which IP was confirmed during the operation; and group II, in which IP was confirmed before the operation. There were nineteen (37%) patients in group Ia, nine patients (18%) in group Ib and twenty-three patients (45%) in group II. The recurrence rates for groups Ia, Ib and II were 33%, 11% and 5% respectively.

CONCLUSIONS

The initial presentation of bilateral sinonasal disease can easily lead the doctor into the misdiagnosis of IP. Bony erosion, remodelling, and a widening of the natural orifice of the sinuses on a CT scan are useful signs indicating IP. The correct diagnosis prior to surgery is a determinant of outcome. The use of frozen sections should, however, improve outcome as well. In this study we highlight the high prevalence and relatively low control rate of misdiagnosed IP (pathology undetermined pre-operatively) and hope to remind clinicians that early recognition of the tumour is most beneficial to patients.

Hydroxychavicol, a novel betel leaf component, inhibits platelet aggregation by suppression of cyclooxygenase, thromboxane production and calcium mobilization

BACKGROUND AND PURPOSE

Platelet hyperactivity is important in the pathogenesis of cardiovascular diseases. Betel leaf (PBL) is consumed by 200-600 million betel quid chewers in the world. Hydroxychavicol (HC), a betel leaf component, was tested for its antiplatelet effect.

EXPERIMENTAL APPROACH

We tested the effect of HC on platelet aggregation, thromboxane B(2) (TXB(2)) and reactive oxygen species (ROS) production, cyclooxygenase (COX) activity, ex vivo platelet aggregation and mouse bleeding time and platelet plug formation in vivo. The pharmacokinetics of HC in rats was also assessed.

KEY RESULTS

HC inhibited arachidonic acid (AA) and collagen-induced platelet aggregation and TXB(2) production. HC inhibited the thrombin-induced TXB(2) production, but not platelet aggregation. SQ29548, suppressed collagen- and thrombin-induced TXB(2) production, but not thrombin-induced platelet aggregation. HC also suppressed COX-1/COX-2 enzyme activity and the AA-induced ROS production and Ca(2+) mobilization. HC further inhibited the ex vivo platelet aggregation of platelet-rich plasma (>100 nmole/mouse) and prolonged platelet plug formation (>300 nmole/mouse) in mesenteric microvessels, but showed little effect on bleeding time in mouse tail. Moreover, pharmacokinetics analysis found that more than 99% of HC was metabolized within 3 min of administration in Sprague-Dawley rats in vivo.

CONCLUSIONS AND IMPLICATIONS

HC is a potent COX-1/COX-2 inhibitor, ROS scavenger and inhibits platelet calcium signaling, TXB(2) production and aggregation. HC could be a potential therapeutic agent for prevention and treatment of atherosclerosis and other cardiovascular diseases through its anti-inflammatory and antiplatelet effects, without effects on haemostatic functions.

A biomarker for the identification of swine fecal pollution in water, using the STII toxin gene from enterotoxigenic Escherichia coli

This research developed a PCR method to identify swine fecal pollution in water, using a portion of the STII toxin gene from enterotoxigenic Escherichia coli as the target sequence. This method showed the gene to have a wide-spread geographical distribution and temporal stability; and the primers demonstrated high specificity, sensitivity, and reliability. A total of 110 DNA extracts from different animal fecal and human sewage samples were screened using the primers and no positives resulted. Centrifugation and filtration methods for concentrating E. coli seeded into stream, ocean, secondary effluent, and dairy lagoon waters resulted in detection limits at the femtogram and attogram levels. E. coli with the biomarker seeded into stream, ocean, and secondary effluent waters remained stable for approximately 2 weeks for all water types. Of the farm lagoon and waste samples tested, 94% were positive for the STII trait, regardless of the number of E. coli screened and 100% were positive when > or =35 E. coli isolates were screened. As the PCR product of the target sequence yielded a single band, the method is applicable to dot blot detection methodology, yielding great accuracy in determining the presence of swine fecal sources.

A biomarker for the identification of cattle fecal pollution in water using the LTIIa toxin gene from enterotoxigenic Escherichia coli

This research describes a method based on PCR to identify cattle fecal pollution in water using a portion of the heat labile toxin IIA (LTIIa) gene from enterotoxigenic Escherichia coli (ETEC). We describe the development of the primers and target. DNA extracts (221) from different animal fecal and human sewage samples were screened and showed no cross-reactivity. Minimum detection limits using centrifugation and filtration methods to concentrate E. coli seeded into stream, ocean, and secondary effluent waters were found to be at femtogram and attogram levels, respectively. Stability of the biomarker in stream, ocean, and secondary effluent waters was 2-4 weeks for all water types. Finally, 33 farm lagoon and waste samples were collected and 31 tested to validate the method; 93% were positive for the LTIIa trait when >1,000 E. coli were screened and 100% positive when >10(5) E. coli were screened. Prevalence of the toxin gene in the E. coli population affected the outcome of the analyses. The cow biomarker can be used in watershed studies to identify cattle waste with great accuracy if the appropriate numbers of E. coli are screened.

Preparation of double-encapsulated microcapsules for mitigating drug loss and extending release

The double-encapsulated microcapsules were prepared by the non-solvent addition, phase-separation method to form core material and, encapsulated with the O/W emulsion non-solvent addition method to increase drug loading and regulate drug release rate. The drug used was theophylline, which is water-soluble. Dichloromethane and n-hexane were used as the solvent and non-solvent, respectively. This study investigated how various core material and microcapsule EC/TH ratios affect the drug loss, particle size, surface morphology and release rate. The drug loss of the double-encapsuLated microcapsules was 12.8% less than that of microcapsules prepared by the O/W emulsion non-solvent addition method alone. The particle size of these double-encapsulated microcapsules decreased as the concentration of EC polymer was increased in the second encapsulation process. The roughness of their surface was also in proportion to the concentration of polymer solution used in the second encapsulation process. The dissolution study showed that the T20 of the double-encapsulated microcapsules ranged from 2-35.4 h, while that of the O/W emulsion non-solvent addition method microcapsules was from 2.7-7.7 h. The greater the level of EC in the polymer solution, the slower the release rate of the drug from the microcapsules when the EC was not over the critical amount.

Ion transport and morphological changes of mitochondria in brown adipocytes of warm- and cold-acclimatized obese Zucker rats

Brown adipose tissue plays the dominant role in response to cold acclimatization through its capacity to produce heat. To demonstrate the cellular function for thermogenesis induced by cold acclimation in the brown adipose tissue of obese Zucker rats, we examined the changes for the area as well as the Na, K, Cl, and Ca concentrations in the mitochondria of brown adipocytes after the warm (25 degrees C, WG) and the cold acclimations (10 degrees C, CG). Moreover, the respiratory quotients (RQs) of these rats were measured. After the acclimations, the RQ in the CG was decreased and the oxygen consumption increased. A morphometric analysis of electron micrographs of brown adipocytes from the two groups of rats showed a marked increase in the area of the mitochondria in the CG. An electron probe X-ray microanalysis showed an increase in the Ca concentration and decreases in the Na and K concentrations in the matrix of the mitochondria of the cells in the CG. These results suggest that the reduction in the RQ of obese Zucker rats acclimated to cold is the consequence of the metabolism of a large quantity of lipid in the brown adipocytes. Our data also indicate that the observed change in the mitochondrial area and the increase for Ca in the mitochondria were associated with the cold-induced thermogenesis in brown adipocytes of obese Zucker rats.

Disruption of Plasmodium falciparum chitinase markedly impairs parasite invasion of mosquito midgut

To initiate invasion of the mosquito midgut, Plasmodium ookinetes secrete chitinolytic activity to penetrate the peritrophic matrix surrounding the blood meal. While ookinetes of the avian malaria parasite Plasmodium gallinaceum appear to secrete products of two chitinase genes, to date only one chitinase gene, PfCHT1, has been identified in the nearly completed Plasmodium falciparum strain 3D7 genome database. To test the hypothesis that the single identified chitinase of P. falciparum is necessary for ookinete invasion, the PfCHT1 gene was disrupted 39 bp upstream of the stop codon. PfCHT1-disrupted parasites had normal gametocytogenesis, exflagellation, and ookinete formation but were markedly impaired in their ability to form oocysts in Anopheles freeborni midguts. Confocal microscopy demonstrated that the truncated PfCHT1 protein was present in mutant ookinetes but that the concentration of mutant PfCHT1 within the apical end of the ookinetes was substantially reduced. These data suggest that full-length PfCHT1 is essential for intracellular trafficking and secretion and that the PfCHT1 gene product is necessary for ookinetes to invade the mosquito midgut.

Pregnancy after intentional cryopreservation of percutaneous sperm aspiration specimens and intracytoplasmic sperm injection. A report of two cases

BACKGROUND

Microsurgical epididymal sperm aspiration (MESA) and percutaneous epididymal sperm aspiration (PESA) are two methods of obtaining spermatozoa from patients with irreparable obstructive azoospermia. Intentionally using frozen-thawed spermatozoa obtained from MESA had been reported to be successful. With minimal invasiveness, intentionally cryopreserved PESA specimens and intracytoplasmic sperm injection (ICSI) were carried out in two cases.

CASES

Two cases of irreparable obstructive azoospermia received PESA, and the spermatozoa were cryopreserved intentionally. Successful ICSI was performed later, utilizing frozen-thawed spermatozoa.

CONCLUSION

PESA and ICSI are promising methods for these patients. The major advantages are minimal invasiveness and flexibility for further treatment.

Prenatal diagnosis of meconium peritonitis in a twin pregnancy after intracytoplasmic sperm injection. A case report

BACKGROUND

Meconium peritonitis occurring in pregnancies following artificial reproductive techniques (ART) is rare. We report the first case of meconium peritonitis following intracytoplasmic sperm injection (ICSI).

CASE

A 37-year-old woman attended our in vitro fertilization (IVF) program because her husband suffered from hypospermatogenetic azoospermia due to cancer surgery and radiotherapy. The patient achieved a twin pregnancy through ICSI from testicular sperm extraction at our IVF center. Meconium peritonitis, fetal ascites, polyhydramnios, bowel dilatation, hydrocele and intraabdominal calcification were noted in one of the twins on ultrasound at 30 weeks' gestation. Cesarean section due to breech presentation in labor was performed at 36 weeks' gestation. A normal female and male infant with a distended abdomen were delivered. Emergency laparotomy was performed on the male twin because of dyspnea. A 0.2-cm perforation was found in the terminal ileum. Ileotomy was performed and closed after 27 days.

CONCLUSION

Prenatal diagnosis of meconium peritonitis is possible through careful ultrasonographic examination, and early surgical intervention and intensive postoperative support are required to improve the prognosis.

Methotrexate for cesarean scar pregnancy after in vitro fertilization and embryo transfer. A case report

BACKGROUND

Cesarean scar pregnancy is an exceedingly rare occurrence. We present the first case of cesarean scar pregnancy following in vitro fertilization-embryo transfer (IVF-ET).

CASE

A 40-year-old woman with a history of a previous cesarean section presented with five years of unexplained infertility. The patient complained of abdominal pain 16 days after embryo transfer. Ultrasonography revealed a gestational sac with cardiac activity located outside the lower segment of the uterus. Dilatation and curettage was performed due to misdiagnosis of inevitable abortion. Two weeks later, repeated sonography demonstrated a sacculus, 4.07 x 4.07 cm, within the uterine isthmus with only 7.1 mm of thickness separating the sac from the urinary bladder. Normal cervical length without ballooning was noted. Cesarean scar pregnancy was diagnosed. Local injection of methotrexate (MTX) under ultrasound guidance was performed. Plasma beta-hCG levels declined from 23,328 to 8 mlU/mL within two months.

CONCLUSION

For women with cesarean scar pregnancy who desire fertility, conservative treatment using MTX is an excellent choice.

The preparation and drug-release behaviour of CTA/EC and PMS/EC composite microcapsules

A cellulose triacetate (CTA) and three different molecular weights of poly(alpha-methyl styrene) (PMS) were used as co-wall materials to prepare composite microcapsules with ethylcellulose (EC). A non-solvent-addition phase-separation method was used. The core material was theophylline (TH) and the solvent-non-solvent pair was dichloromethane-n-hexane, and the drug-release rates of the microcapsules prepared from these two types of co-wall materials were compared. The effects of their phase-separation range on the properties of the microcapsules, such as particle size, release rate and the morphology of the microcapsules are also discussed. The release rate of microcapsules was also affected by the compatibility of the co-wall materials and the EC. The dissolution studies indicated that the drug-release time of CTA/EC and PMS/EC composite microcapsules was sustained to 10 and 3.5 times, respectively, in comparison with that for pure EC microcapsules.

Constituents from the leaves of Aristolochia elegans

One new biphenyl ether, aristogin C (1), and two new porphyrins, aristophylls A (2) and B (3), as well as 11 known compounds, were isolated from the leaves of Aristolochia elegans. Their structures were elucidated according to the spectroscopic (NMR and MS) analyses or by comparison with literature values.

In vitro maturation and fertilization of immature oocytes: a comparative study of fertilization techniques

PURPOSE

Our purpose was to investigate the factors influencing maturation and fertilization of immature oocytes.

METHODS

Immature oocytes were obtained from women undergoing cesarean section. They were cultured in the maturation medium either with or without cumulus cells. After maturation to metaphase II, they were randomly fertilized by in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI).

RESULTS

After incubation for 48 hr, 441 oocytes (42.8%) reached metaphase II. Among them, 56.6% of cumulus-enclosed oocytes, but only 29.2% of denuded oocytes, reached metaphase II. Of the 289 cumulus-enclosed oocytes, the fertilization rates by IVF and ICSI were 56.3 and 84.1%, respectively (P < 0.01). Of the 152 denuded oocytes, the fertilization rates by IVF and ICSI were 39.5 and 84.5%, respectively (P < 0.01). The cleavage rates, however, were similar.

CONCLUSIONS

Cumulus cells are beneficial in the maturation of human oocytes in vitro and that ICSI increases the fertilization rate for the in vitro matured oocytes. The developmental potential of the fertilized oocytes, however, is similar irrespective of the fertilization method or the presence or absence of cumulus cells.

Phenolic compounds from tournefortia sarmentosa

Three new isoprenylbenzenes, tournefolins A (1), B (2), and C (3), and two new 2-ethoxy-4,5-dihydroxybenzoyl compounds, 4 and 5, together with the known compounds, salicylic acid and allantoin, were isolated from the stems of Tournefortia sarmentosa. The structures of new compounds were elucidated as 2-(4beta-methyltetrahydrofuran-2alpha-yl)-5-(4beta-methyltetrahydrofu ran-2beta-yl)-1,4-dihydroxybenzene (1), methyl 5-(5-hydroxy-2-methoxyphenyl)-3-furoate (2), methyl 5-(2, 5-dihydroxyphenyl)-3-furoate (3), 2-ethoxy-4,5-dihydroxybenzaldehyde (4), and 2-ethoxy-4,5-dihydroxybenzoic acid (5), on the basis of spectral and chemical methods. The relative configuration of 1 was determined by single-crystal X-ray crystallography.

Percutaneous epididymal sperm aspiration in psychogenic anejaculation during IVF. A report of two cases

BACKGROUND

Psychogenic anejaculation on the day of oocyte retrieval is uncommon in in vitro fertilization (IVF) programs. Before the use of intracytoplasmic sperm injection (ICSI), either the cycle had to be canceled or a sperm donor recruited.

CASES

Two couples were enrolled for IVF. On the day of oocyte retrieval, the male partners developed psychogenic anejaculation.

CONCLUSION

In cases of psychogenic anejaculation during IVF, percutaneous epididymal sperm aspiration can be utilized to obtain sperm for ICSI.

Potential use of repeated fluorescence in situ hybridization in the same human blastomeres for preimplantation genetic diagnosis

OBJECTIVE

To assess the feasibility of repeated fluorescence in situ hybridization (FISH) procedures in the same nucleus of a human blastomere.

DESIGN

Three consecutive FISH procedures were performed in the same human blastomere by using direct label fluorescence CEP and WCP probes (Vysis).

SETTING

Hospital-based private IVF program.

PATIENT(S)

Twenty-eight infertile couples who underwent conventional IVF in our center.

INTERVENTION(S)

Embryos from oocytes with three pronuclei after in vitro insemination were used in this study.

MAIN OUTCOME MEASURE(S)

The rates of nuclear loss, present signals, and absent signal were examined.

RESULT(S)

In group 1, the rates of presence of signals were 94% after the first FISH, 92% after the second FISH, and 88% after the third FISH. In group 2, the rates of presence of signals were 96% after the first FISH, 93% after the second FISH, and 87% after the third FISH. There was no statistically significant difference in the rates of nuclear loss, present signals, and absent signal between three consecutive FISH procedures and between CEP and WCP probes.

CONCLUSION(S)

Six or more chromosomes of a single blastomere may be examined with use of this repeated FISH procedure, which may be important for preimplantation genetic diagnosis.

Feasibility study of repeated fluorescent in-situ hybridization in the same human blastomeres for preimplantation genetic diagnosis

In order to increase the number of chromosomes examined in each blastomere, we have developed a repeated fluorescent in-situ hybridization (FISH) procedure by which six or more chromosomes can be analysed per blastomere of a human embryo. Three consecutive FISH procedures with directly-labelled fluorescent Vysis DNA probes were carried out for examination of chromosomes X, Y, 11, 13, 18 and 21 in the same blastomeres (n = 126) and lymphocytes (n = 164). Based on the initial number of nuclei, the percentages of nuclear loss and presence of signals were 3 and 92% respectively in blastomeres; 6 and 91% respectively in lymphocytes after the first FISH; 7 and 87% respectively in blastomeres and 10 and 86% respectively in lymphocytes, after the second FISH. These percentages were 13 and 78% respectively in blastomeres and 14 and 81% respectively in lymphocytes after the third FISH. The FISH procedure was repeated successfully in a couple for preimplantation genetic diagnosis of chromosomal aneuploidies in biopsied blastomeres of their embryos in our clinic. In conclusion, it is feasible to carry out repeated FISH procedures in the same blastomeres. Six or more chromosomes of a single blastomere may be examined using this procedure.

Influence of glass-ceramic thickness on Hertzian and bulk fracture mechanisms

PURPOSE

The objective of this study was to test the hypothesis that bulk fracture of glass-ceramic disks of variable thickness originates at the inner, resin-bonded surface and is dominant over Hertzian fracture at the lower range of thickness values.

MATERIALS AND METHODS

Eight groups of seven glass-ceramic disks (Dicor, Dentsply), 12 mm in diameter with thicknesses ranging from 0.4 to 2.4 mm, were cast, cerammed (to produce approximately 55 vol% of tetrasilicic fluormica crystals), air abraded, etched, and silane coated according to the manufacturer's instructions. The disks were bonded to an epoxy die substrate (with an elastic modulus comparable to that of dentin) using a light-activated resin cement. The bonded samples were supported on a flat surface and loaded at the top center of each disk until crack initiation occurred. All disks exhibited an initial crack within the bonded surface. Three randomly selected samples for each thickness were loaded beyond the point of crack initiation until Hertzian failure occurred.

RESULTS

Although the crack-initiation force increased with increasing thickness, the failure stress approached a maximum level at a thickness of approximately 1.6 mm. These results suggest that the estimated maximum occlusal load for each patient should be used to select the minimum thickness of ceramic crowns rather than using the arbitrary traditional selection of a 1.5-mm thickness.

CONCLUSIONS

The authors conclude that bulk fracture is initiated within the bonded surface of a glass-ceramic specimen (for samples 0.4 to 2.4 mm in thickness) when the glass-ceramic is supported by a substrate with an elastic modulus similar to that of dentin. Furthermore, a Hertzian failure mechanism is unlikely to cause bulk fracture for these conditions.

Quantification of poliovirus in seawater and sewage by competitive reverse transcriptase--polymerase chain reaction

Reverse transcriptase-polymerase chain reaction (RT-PCR) has been used extensively to detect enteric viruses in environmental samples. Advantages of RT-PCR include its high detection sensitivity and rapid turn-around time. However, unlike traditional cell culture, RT-PCR has not provided quantitation and infectivity information. In this study, we have developed a quantitative RT-PCR method that can be used to determine the amount of poliovirus RNA in environmental samples. An RNA internal standard for poliovirus RT-PCR was designed and obtained through genetic engineering. Serial dilutions of RNA internal standard templates were amplified with a 5'-carboxyfluorescein-labeled poliovirus downstream primer and a nonlabeled poliovirus upstream primer in the RT-PCR. The fluorescent light intensity of labeled RT-PCR products was quantified using an ABI DNA sequencer with GeneScan software. The internal standard was coamplified with poliovirus in the RT-PCR, allowing for enumeration of the poliovirus RNA present in the seawater and sewage samples. This method, using a cloned internal standard and specified primers in the PCR, may be applied to quantify other microorganisms in environmental samples. Although quantitative RT-PCR has begun to be used more extensively for detecting pathogens in clinical samples, the complex nature of many environmental samples has limited the sample range of the effectiveness of quantitative RT-PCR.

Pregnancy after immature oocyte donation and intracytoplasmic sperm injection

OBJECTIVE

To report a case of pregnancy from in vitro-matured primary oocytes fertilized by ICSI. The pregnancy occurred in a woman who was in an oocyte donation program; the woman's husband had normal sperm parameters.

DESIGN

Case report.

SETTING

Private general hospital affiliated with a university hospital.

PATIENT(S)

A recipient with premature ovarian failure, a recipient's husband with normal sperm, and a pregnant woman who donated her oocytes.

INTERVENTION(S)

Aspiration of immature oocytes during cesarean section, in vitro culture for maturation, ICSI of matured oocytes, coculture of fertilized oocytes.

MAIN OUTCOME MEASURE(S)

Fertilization of oocytes by ICSI, and cleavage of embryos by Vero cell coculture.

RESULT(S)

Two of seven immature oocytes became metaphase II oocytes, and both were fertilized by ICSI. The two zygotes were cocultured on Vero cells to become grade 1 two-cell embryos. Pregnancy was obtained after transfer.

CONCLUSION(S)

More studies are necessary to clarify whether ICSI can increase the fertilization rate of in vitro-matured primary oocytes, and to clarify the role of coculture in fertilization.

Outcome of in-vitro culture of fresh and frozen-thawed human testicular spermatozoa

The effect of in-vitro culture on the motility and morphology of fresh and frozen-thawed human testicular spermatozoa obtained from obstructive azoospermic patients and on the motility of testicular spermatozoa obtained from non-obstructive azoospermic patients was evaluated. The outcome of intracytoplasmic sperm injection (ICSI) with fresh and frozen-thawed human testicular spermatozoa was studied. The results showed that significant improvement of sperm morphology and motility was observed in culture of fresh (n = 17) and frozen-thawed (n = 15) testicular sperm samples obtained from patients with obstructive azoospermia. The motility of cultured testicular spermatozoa reached a peak at 72 h without the need for special media. In six of 20 samples obtained from patients with non-obstructive azoospermia, improvement of sperm motility was observed. When only non-motile testicular spermatozoa were cultured, they all remained non-motile (n = 9). In patients with obstructive azoospermia, fertilization rates of 80 and 81% were obtained using ICSI with fresh and frozen-thawed testicular spermatozoa respectively. Clinical pregnancies were observed in four out of nine patients with fresh testicular spermatozoa and two out of five patients after using frozen-thawed spermatozoa. When fresh testicular spermatozoa obtained from patients with non-obstructive azoospermia were used for ICSI, the fertilization rate was 68% and two out of seven patients achieved clinical pregnancies. In conclusion, the morphology and motility of fresh and frozen-thawed testicular spermatozoa in patients with obstructive azoospermia can be significantly improved after in-vitro culture. The outcome of in-vitro culture of testicular spermatozoa in patients with non-obstructive azoospermia is unpredictable. In-vitro culture of non-motile testicular spermatozoa is not successful so far. The outcome of ICSI with fresh and with frozen-thawed testicular spermatozoa was similar.

High fertilization rate obtained after intracytoplasmic sperm injection with 100% nonmotile spermatozoa selected by using a simple modified hypo-osmotic swelling test

OBJECTIVE

To report a high fertilization rate after intracytoplasmic sperm injection (ICSI) in patients with 100% nonmotile spermatozoa selected by a simple modified hypo-osmotic swelling test.

DESIGN

Clinical study.

SETTING

Hospital-based IVF center.

PATIENT(S)

Three couples with infertility due to asthenospermia.

INTERVENTION(S)

The hypo-osmotic swelling test with 150-mOsm NaCl solution was used to select viable spermatozoa before ICSI. Three patients provided semen samples and one of these three also had a testicular biopsy.

MAIN OUTCOME MEASURE(S)

Selection of viable spermatozoa using the hypo-osmotic swelling test with 150-mOsm NaCl solution for ICSI.

RESULT(S)

No motile spermatozoa were found in three ejaculated semen samples and one testicular biopsy. Fifty-seven metaphase-II oocytes were injected with hypo-osmotic swelling test-positive ejaculated or testicular spermatozoa. Fifty-five (96.5%) of these oocytes were intact after injection. Forty-two (76.4%) of 55 oocytes showed two pronuclei, and 40 of the 42 fertilized oocytes cleaved. One patient had all embryos cryopreserved because of the risk of hyperstimulation; two other patients had embryos transferred. One ongoing pregnancy resulted.

CONCLUSION

This hypo-osmotic swelling test with 150-mOsm NaCl solution is a simple and efficient method for selection of viable spermatozoa. A high fertilization rate can be obtained using ICSI with viable spermatozoa selected by using this hypo-osmotic swelling test.

Establishment of an optimal hypo-osmotic swelling test by examining single spermatozoa in four different hypo-osmotic solutions

In order to find an optimal hypo-osmotic swelling test (HOST) and to identify viable sperm cells from patients with asthenozoospermia for intracytoplasmic sperm injection (ICSI), we tested single motile and non-motile spermatozoa in four hypo-osmotic solutions by micromanipulation. The four solutions were: A, H2O; B, 50 mOsm NaCl; C, 150 mOsm NaCl and D, 150 mOsm sodium citrate and fructose. Eosin Y staining was then carried out for evaluation of viability of the spermatozoa after HOST. Using motile spermatozoa, no statistical difference was found in HOST-positive spermatozoa between these four solutions. There were more viable sperm cells after HOST in solutions C and D, as noted by Eosin Y staining. After non-motile spermatozoa were incubated for 1 min in the four solutions, HOST with solution C gave the best results for identification of viable sperm cells compared to the other three solutions. When motile spermatozoa were incubated in solution C or solution D for 30 min, the result of HOST with solution C (10.8% dead spermatozoa) was superior to that of solution D (49.1% dead spermatozoa). In conclusion, the HOST protocol using 150 mOsm NaCl (solution C) for 1 min yielded the best results for selection of viable spermatozoa. This procedure should be used for selection of viable spermatozoa for ICSI in patients with 100% non-motile spermatozoa.

Comparison of PCR-generated fragments of the mce gene from Mycobacterium tuberculosis, M. avium, M. intracellulare, and M. scrofulaceum

Nineteen strains representing 13 species of mycobacteria were tested for the ability to serve as PCR templates for the production of a 293-bp fragment of the mycobacterial mce gene. The mce gene is a virulence factor recently sequenced from Mycobacterium tuberculosis. PCR products were obtained for only the species of the Mycobacterium tuberculosis complex (MTC) and the Mycobacterium avium-M. intracellulare-M. scrofulaceum complex. The fragment was sequenced from M. tuberculosis (one strain), M. avium (three strains), M. intracellulare (two strains), and M. scrofulaceum (two strains). Sequence comparisons suggest that the fragments from each of the species are regions that code for a similar product. One of the M. scrofulaceum strains yielded a sequence whose most probable reading frame was truncated by an amber stop codon caused by a single nuclei acid difference from the other sequences. The amino acid sequences from the non-MTC sequences cluster together, displaying fewer differences from each other than from the M. tuberculosis sequence and the truncated M. scrofulaceum sequence. Principal component analysis of the distance matrix displays the clustering of the M. avium and M. intracellulare sequences into single-species clusters. It is concluded that at least one open reading frame of the mce gene is found, although it is discernibly different, in pathogenic mycobacteria other than the MTC.

Analysis of sewage effluent for human immunodeficiency virus (HIV) using infectivity assay and reverse transcriptase polymerase chain reaction

Environmental survival of human immunodeficiency virus type 1 (HIV-1) is an important public health concern. Survival of HIV in waste water is of particular interest to those who work at treatment facilities and to the general public who have contact with rivers or ocean water receiving treated sewage effluent. Other researchers have reported that HIV can be detected in waste water. Their studies, however, detected homologous nucleic acid sequences but did not attempt to determine infectivity. The current study tested primary and secondary effluent from a major metropolitan sewage agency for the presence of HIV-1 using reverse transcriptase polymerase chain reaction (RT-PCR), HIV-1 p24 antigen enzyme-linked immunosorbent assay, and infectivity testing. For RT-PCR, primers SK38/SK39 and M667/AA55 were used to identify HIV-1 RNA sequences from concentrated and extracted sewage samples. Infectivity assays employed donor peripheral blood mononuclear cells (PBMCs) stimulated with phytohemagglutinin. Coxsackievirus B4, echovirus 7, and poliovirus 1, enteroviruses normally present in sewage, were tested for replication in PBMCs. Poliovirus 1 was found to infect the PBMCs. To eliminate other enteroviruses that may also infect the PBMCs and interfere with HIV-1 testing, concentrated sewage was treated with human immunoglobulin (free of HIV antibodies) and poliovirus antisera before infectivity assays were performed. All treated sewage samples tested negative for HIV-1 by all methods used. HIV-1 seeded into sewage, however, remained infectious in the assay, indicating that the sewage water sample did not interfere with HIV infectivity nor was it toxic to the PBMCs.

Analysis of viral RNA persistence in seawater by reverse transcriptase-PCR

It is important to determine the stability of naked viral RNA in seawater, since false-positive results can occur when reverse transcriptase-PCR (RT-PCR) is used to detect viruses if the RT-PCR amplifies free RNA instead of RNA from intact viruses. An acid guanidinium thiocyanate-phenol-chloroform method was used to extract total RNA from a filtered poliovirus cell culture suspension. The sensitivity of detection in this viral RNA study was 600 fg when RT-PCR was used. The extracted total RNA was seeded into filtered and unfiltered seawater, and the resulting preparations were incubated at 4 degrees C and at room temperature (23 +/- 1 degrees C). Our results showed that the seeded RNA was more stable in filtered seawater than in unfiltered seawater at both temperatures. The viral RNA could not be detected by the RT-PCR after 2 days of incubation in unfiltered seawater and after 28 days of incubation in filter-sterilized seawater. Therefore, because of the relatively short life of viral RNA in natural water, the detection of virus in environmental samples by the RT-PCR was mainly due to the presence of well-protected viral particles and not due to the presence of naked viral RNA.

Multiplex PCR for detection of the heat-labile toxin gene and shiga-like toxin I and II genes in Escherichia coli isolated from natural waters

A triplex PCR method was developed to simultaneously amplify a heat-labile toxin sequence (LT) of 258 bp, a shiga-like toxin I sequence (SLT I) of 130 bp, and a shiga-like toxin II sequence (SLT II) of 346 bp from toxigenic strains of Escherichia coli. This method was used to screen 377 environmental E. coli isolates from marine waters or estuaries located in Southern California and North Carolina for enterotoxigenic or enterohemorrhagic E. coli strains. Of the 377 E. coli screened, one isolate was found to belong to the enterotoxigenic group, since it contained a LT homologous sequence, and one isolate was found to belong to the enterohemorrhagic group, since it contained a SLT I homologous sequence. None was found to contain SLT II homologous sequences. The pathogenicity of the positive environmental E. coli isolates was confirmed by standard bioassays with Y-1 adrenal cells and Vero cells to confirm toxin production. Our results suggest that toxigenic E. coli occurs infrequently in environmental waters and that there is a low public health risk from toxigenic E. coli in coastal waters.