Exercise-induced right ventricular alterations in a rodent model of athletes heart

Funding Acknowledgements

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): János Bolyai Research Scholarship of the Hungarian Academy of Sciences (BO/00837/21) to AO

National Research, Development and Innovation Office (NKFIH) of Hungary (K120277 and K135076 to BM)

Background

Intense sports activity leads to the adaptation of cardiac structure and function, the so-called athlete’s heart. Research over the last years has focused on exercise-induced adaptation of the right ventricle (RV), because the disproportionate load on the RV - when compared with left ventricle - might lead to pathological consequences, such as interstital fibrosis or chamber dilation.

Purpose

We aimed at investigating right ventricular alterations induced by regular aerobic exercise training in a rat model of athlete's heart.

Methods

Young, adult rats were divided into control (Co) and exercised (Ex) groups. Trained rats swam 200 min/day for 12 weeks. In vivo electrophysiological study and in vitro force measurements on isolated permeabilized cardiomyocytes were carried out to investigate electrical and functional alterations, respectively. Molecular biological (qRT-PCR, Western-blot) and histological investigations were applied to reveal underlying mechanisms.

Results

Exercise training was associated with increased RV cardiomyocyte width (12.5±0.1µm Co vs. 13.8±0.2µm Ex, p<0.05) and corresponding hyperphosphorylation of protein kinase B (Akt). RV myofilaments from exercised animals showed increased maximal force development and improved calcium sensitivity. Sarcomere protein investigations revealed marked overall and site-specific hypophosphorylation of troponin I.  We found prolonged QT interval and right ventricular effective refracter period (RVERP: 44.0±1.6ms Co vs. 52.8±2.1ms Ex, p<0.05) along with decreased gene expression of potassium channels. Picrosirius staining did not reveal fibrosis, that was underlied by unchanged protein expression of connective tissue growth factor (CTGF) and gene expression of profibrotic markers. Gene expression of apoptotic markers and fetal gene program did not differ between the groups.

Conclusions

According to our data, regular swim training induced RV hypertrophy, that was associated with functional improvement adn hypophosphorilation of troponin I. Prolonged repolarization without pathological alterations in RV myocardial tissue suggest physiological remodeling after balanced training.

AB0062 ANGIOTENSIN CONVERTING ENZYME ACTIVITY IN ANTI-TNF-TREATED RHEUMATOID ARTHRITIS AND ANKYLOSING SPONDYLITIS PATIENTS

Background

Angiotensin-converting enzyme (ACE) and ACE2 have been implicated in the regulation of vascular physiology. Elevated synovial and decreased or normal ACE or ACE2 levels have been found in rheumatoid arthritis (RA). Very little is known about the effects of tumour necrosis factor α (TNF-α) inhibition on ACE or ACE2 homeostasis.

Objectives

In this study, we assessed the effects of one-year anti-TNF therapy on ACE and ACE2 production in RA and ankylosing spondylitis (AS) in association with other biomarkers.

Methods

Forty patients including 24 RA patients treated with either etanercept (ETN) or certolizumab pegol (CZP) and 16 AS patients treated with ETN were included in a 12-month follow-up study. Serum ACE levels were determined by commercial ELISA, while serum ACE2 activity was assessed using a specific quenched fluorescent substrate. Ultrasonography was performed to determine flow-mediated vasodilation (FMD), common carotid intima-media thickness (ccIMT) and arterial pulse-wave velocity (PWV) in all patients. In addition, CRP, rheumatoid factor (RF) and ACPA were also measured. All assessments were performed at baseline and 6 and 12 months after treatment initiation.

Results

Anti-TNF therapy increased ACE levels in the full cohort, as well as in the RA and AS subsets. ACE2 activity increased in the full cohort, while the ACE/ACE2 ratio increased in the full cohort and in the RA subset (p<0.05). Uni- and multivariable regression analyses determined associations between ACE or ACE/ACE2 ratios at different time points and disease duration, CRP, RF, FMD and IMT (p<0.05). ACE2 activity correlated with CRP. The changes of ACE or ACE2 over 12 months were determined by treatment together with either RF or FMD (p<0.05).

Conclusion

Anti-TNF treatment may increase ACE and ACE2 in the sera of RA and AS patients. ACE and ACE2 may be associated with disease duration, markers of inflammation and vascular pathophysiology. The effects of TNF inhibition on ACE and ACE2 may reflect, in part, the effects of these biologics on the cardiovascular system.

Disclosure of Interests

Boglárka Soós: None declared, Miklós Fagyas: None declared, Ágnes Horváth: None declared, Edit Végh: None declared, Anita Pusztai: None declared, Monika Czókolyová: None declared, Alexandra Csongrádi: None declared, Attila Hamar: None declared, Zsófia Pethö: None declared, Nóra Bodnár: None declared, György Kerekes: None declared, Katalin Hodosi: None declared, ​Éva Szekanecz​: None declared, Szilvia Szamosi Speakers bureau: Roche, Sager, Amgen, Sándor Szántó Speakers bureau: AbbVie, Novartis, Lilly, MSD, UCB, Consultant of: AbbVie, Novartis, UCB, Gabriella Szücs Speakers bureau: Roche, Lilly, Actelion, Zoltán Papp: None declared, Zoltán Szekanecz Speakers bureau: AbbVie, Pfizer, Roche, MSD, Novartis, Lilly, Richter, Consultant of: Pfizer, Novartis, Richter, Grant/research support from: Pfizer, UCB

Exercise training induces benign right ventricular hypertrophy along with functional improvement and without pathological processes or arrhythmogenicity in a rodent model of athletes heart

Introduction

Regular sport activity leads to the adaptation of cardiac structure and function, the so-called athlete's heart. Research projects over the last years have focused on exercise-induced adaptation of the right ventricle (RV), because the disproportionate load on the RV - when compared with the left ventricle - might lead to pathological consequences, such as myocardial interstital fibrosis or chamber dilation.

Purpose

We aimed at investigating comprehensively RV alterations induced by regular aerobic exercise training in a rat model of athlete's heart.

Methods

Young, adult rats were divided into control (Co) and exercised (Ex) groups (n=12–12). Exercised rats underwent a 12-week-long swim training program. In vivo electrophysiological study and in vitro cellular force assessments on isolated cardiomyocytes were carried out to investigate electrical and functional RV alterations, respectively. Molecular biological (qRT-PCR, Western-blot) and histological investigations were applied to reveal underlying mechanisms.

Results

Exercise training was associated with increased RV cardiomyocyte diameter (12.5±0.1 μm Co vs. 13.8±0.2 μm Ex, p&lt;0.05), that was associated with hyperphosphorylation of protein kinase B (Akt). RV cardiomyocytes from exercised animals showed improved calcium sensitivity and increased maximal force development, that was associated with hypophosphorylation of troponin I. We found increased length of repolarization as reflected by prolonged QT interval and ventricular effective refracter period (VERP: 44.0±1.6 ms Co vs. 52.8±2.1 ms Ex, p&lt;0.05) along with decreased gene expression of potassium channels (Kcnd2, Kcnj2). We could not induce ventricular arrhythmia by programmed stimulation. Picrosirius staining did not reveal fibrosis, that was associated with unchanged protein expression of connective tissue growth factor (CTGF) and gene expression of profibrotic markers (such as TGF-β). Gene expression of apoptotic markers (Bax, Bcl-2) and fetal gene program (such as β-MHC) did not differ between groups.

Conclusions

According to our data, regular swim training induced RV hypertrophy, that was associated with functional improvement (improved calcium sensitivity and maximal force), hypophosphorylation of troponin I and prolonged repolarization without characteristic pathological alterations or arrhythmogenicity of RV myocardial tissue.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Research, Development and Innovation Office of Hungary

Sex-related differences in cardiac and myofilament function in rats with pressure-overload induced left ventricular hypertrophy

Introduction

Recent findings indicate that sex is a major determinant of left ventricular (LV) structure in pressure overload (PO)-induced LV myocardial hypertrophy (LVH). However, data are scare regarding sex-related differences in LV function in case of PO-evoked LVH.

Aim

Hence, in the present study we aimed at comprehensively investigating sex-related functional differences on the global cardiac level and also on the myofilament level in PO-induced LVH.

Method

Abdominal aortic banding (AB) was carried out to induce chronic PO for 6 or 12 weeks in male and female rats. Age- and sex-matched sham-operated animals served as controls. The development of LVH was followed by serial echocardiography. The extent of cardiomyocyte hypertrophy and myocardial fibrosis were evaluated by histology. Cardiac function was assessed by pressure-volume analysis. Force measurement was carried out in permeabilized cardiomyocytes to compute myofilament function.

Results

At week 6, robust myocardial hypertrophy, concentric LV geometry and moderate interstitial fibrosis were detected in both male and female AB rats. This early stage of PO-induced LVH was associated with increased LV contractility (slope of end-systolic pressure-volume relationship [ESPVR, mmHg/μl]: 3.09±0.18 Male-AB-wk6 vs. 1.79±0.22 Male-Sham-wk6 P&lt;0.05; 3.68±0.77 Female-AB-wk6 vs. 1.87±0.21 Female-Sham-wk6 P&lt;0.05) and enhanced myofilament Ca2+ sensitivity in both sexes (pCa50: 5.86±0.01 Male-AB-wk6 vs. 5.73±0.02 Male-Sham-wk6 P&lt;0.05; 5.94±0.03 Female-AB-wk6 vs. 5.73±0.01 Female-Sham-wk6 P&lt;0.05). At week 6, the augmented LV contractility effectively counterbalanced the increased afterload in both male and female AB groups. Hence, ventricular-arterial coupling (VAC) was maintained and LV systolic function was preserved in the AB groups in both sexes. In contrast, at week 12, marked sex differences could be observed. At this later stage, LVH was characterized by eccentric remodeling and intensified collagen accumulation in male AB rats. The initial LV contractility augmentation (slope of ESPVR, mmHg/μl: 1.74±0.13 Male-AB-wk12 vs. 1.31±0.17 Male-Sham-wk12 n.s.) as well as the enhanced myofilament Ca2+ sensitivity (pCa50: 5.78±0.02 Male-AB-wk12 vs. 5.75±0.01 Male-Sham-wk12 n.s.) diminished, leading to impaired VAC and reduced LV systolic function. On the contrary, in female AB rats, cardiac contractility (ESPVR, mmHg/ μl: 3.97±0.50 Female-AB-wk12 vs. 2.08±0.17 Female-Sham-wk12 P&lt;0.05) and myofilament Ca2+ sensitivity (pCa50:5.85±0.02 Female-AB-wk12 vs. 5.78±0.01 Female-Sham-wk12 P&lt;0.05) remained increased, resulting in adequate VAC and preserved LV systolic function at late-stage of PO-induced LVH as well.

Conclusion

The initially augmented LV contractility and enhanced myofilament Ca2+ sensitivity declines in male but not in female AB rats at later time points. Hence, characteristically different alterations occur in LV systolic function between the two sexes in late-stage of PO-evoked LVH.

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): NVKP_16-1-2016-0017.

Levosimendan in Acute and Advanced Heart Failure: an Expert Perspective on Posology and Therapeutic Application

Levosimendan, a calcium sensitizer and potassium channel-opener, is widely appreciated by many specialist heart failure practitioners for its effects on systemic and pulmonary hemodynamics and for the relief of symptoms of acute heart failure. The drug’s impact on mortality in large randomized controlled trials has been inconsistent or inconclusive but, in contrast to conventional inotropes, there have been no indications of worsened survival and some signals of improved heart failure-related quality of life. For this reason, levosimendan has been proposed as a safer inodilator option than traditional agents in settings, such as advanced heart failure. Positive effects of levosimendan on renal function have also been described. At the HEART FAILURE 2018 congress of the Heart Failure Association of the European Society of Cardiology, safe and effective use levosimendan in acute and advanced heart failure was examined in a series of expert tutorials. The proceedings of those tutorials are summarized in this review, with special reference to advanced heart failure and heart failure with concomitant renal dysfunction. Meta-analysis of clinical trials data is supportive of a renal-protective effect of levosimendan, while physiological observations suggest that this effect is exerted at least in part via organ-specific effects that may include selective vasodilation of glomerular afferent arterioles and increased renal blood flow, with no compromise of renal oxygenation. These lines of evidence require further investigation and their clinical significance needs to be evaluated in specifically designed prospective trials.

Dose-dependent electrophysiological effects of the myosin activator omecamtiv mecarbil in canine ventricular cardiomyocytes

Omecamtiv mecarbil (OM) is a myosin activator agent recently developed for treatment of heart failure. Although its action on extending systolic ejection time and increasing left ventricular ejection fraction is well documented, no data is available regarding its possible side-effects on cardiac ion channels. Therefore, the present study was designed to investigate the effects of OM on action potential morphology and the underlying ion currents in isolated canine ventricular myocytes using sharp microelectrodes, conventional patch clamp, and action potential voltage clamp techniques. OM displayed a concentration-dependent action on action potential configuration: 1 μM OM had no effect, while action potential duration and phase-1 repolarization were reduced and the plateau potential was depressed progressively at higher concentrations (10 - 100 μM; P < 0.05 compared to control). Accordingly, OM (10 μM) decreased the density of the transient outward K⁺ current (I_to), the L-type Ca²⁺ current (I_Ca) and the rapid delayed rectifier K⁺ current (I_Kr), but failed to modify the inward rectifier K⁺ current (I_K1). It is concluded, that although the therapeutic concentrations of OM are not likely to influence cardiac ion currents significantly, alterations of the major cardiac ion currents can be anticipated at concentrations above those clinically tolerated.

The novel cardiac myosin activator omecamtiv mecarbil increases the calcium sensitivity of force production in isolated cardiomyocytes and skeletal muscle fibres of the rat

BACKGROUND AND PURPOSE

Omecamtiv mecarbil (OM) is a novel cardiac myosin activator drug for inotropic support in systolic heart failure. Here we have assessed the concentration-dependent mechanical effects of OM in permeabilized cardiomyocyte-sized preparations and single skeletal muscle fibres of Wistar-Kyoto rats under isometric conditions.

EXPERIMENTAL APPROACHES

Ca²⁺ -dependent active force production (F_active ), its Ca²⁺ sensitivity (pCa₅₀ ), the kinetic characteristics of Ca²⁺ -regulated activation and relaxation, and Ca²⁺ -independent passive force (F_passive ) were monitored in Triton X-100-skinned preparations with and without OM (3nM-10 μM).

KEY RESULTS

In permeabilized cardiomyocytes, OM increased the Ca²⁺ sensitivity of force production (ΔpCa₅₀ : 0.11 or 0.34 at 0.1 or 1 μM respectively). The concentration-response relationship of the Ca²⁺ sensitization was bell-shaped, with maximal effects at 0.3-1 μM OM (EC₅₀ : 0.08 ± 0.01 μM). The kinetics of force development and relaxation slowed progressively with increasing OM concentration. Moreover, OM increased F_passive in the cardiomyocytes with an apparent EC₅₀ value of 0.26 ± 0.11 μM. OM-evoked effects in the diaphragm muscle fibres with intrinsically slow kinetics were largely similar to those in cardiomyocytes, while they were less apparent in muscle fibres with fast kinetics.

CONCLUSIONS AND IMPLICATIONS

OM acted as a Ca²⁺ -sensitizing agent with a downstream mechanism of action in both cardiomyocytes and diaphragm muscle fibres. The mechanism of action of OM is connected to slowed activation-relaxation kinetics and at higher OM concentrations increased F_passive production.

Myeloperoxidase evokes substantial vasomotor responses in isolated skeletal muscle arterioles of the rat

Aims

Myeloperoxidase (MPO) catalyses the formation of a wide variety of oxidants, including hypochlorous acid (HOCl), and contributes to cardiovascular disease progression. We hypothesized that during its action MPO evokes substantial vasomotor responses.

Methods

Following exposure to MPO (1.92 mU mL⁻¹) in the presence of increasing concentrations of hydrogen peroxide (H₂O₂), changes in arteriolar diameter of isolated gracilis skeletal muscle arterioles (SMAs) and coronary arterioles (CAs) and in the isometric force in basilar arteries (BAs) of the rat were monitored.

Results

Myeloperoxidase increased vascular tone to different degrees in CAs, SMAs and BAs. The mechanism of increased vasoconstriction was studied in detail in SMAs. MPO-evoked vasoconstrictions were prevented by the MPO inhibitor 4-aminobenzhydrazide (50 μm), by endothelium removal in the SMAs. Surprisingly, the HOCl scavenger L-methionine (100 μm), the thromboxane A2 (TXA2) antagonist SQ-29548 (1 μm) or the non-specific cyclooxygenase (COX) antagonist indomethacin (1 μm) converted the MPO-evoked vasoconstrictions to pronounced vasodilations in SMAs, not seen in the presence of H₂O₂. In contrast to noradrenaline-induced vasoconstrictions, the MPO-evoked vasoconstrictions were not accompanied by significant increases in arteriolar [Ca²⁺] levels in SMAs.

Conclusion

These data showed that H₂O₂-derived HOCl to be a potent vasoconstrictor upon MPO application. HOCl activated the COX pathway, causing the synthesis and release of a TXA2-like substance to increase the Ca²⁺ sensitivity of the contractile apparatus in vascular smooth muscle cells and thereby to augment H₂O₂-evoked vasoconstrictions. Nevertheless, inhibition of the HOCl–COX–TXA2 pathway unmasked the effects of additional MPO-derived radicals with a marked vasodilatory potential in SMAs.

Evolutionary origins of the placental expression of chromosome 19 cluster galectins and their complex dysregulation in preeclampsia

INTRODUCTION

The dysregulation of maternal-fetal immune tolerance is one of the proposed mechanisms leading to preeclampsia. Galectins are key regulator proteins of the immune response in vertebrates and maternal-fetal immune tolerance in eutherian mammals. Previously we found that three genes in a Chr19 cluster encoding for human placental galectin-13 (PP13), galectin-14 and galectin-16 emerged during primate evolution and may confer immune tolerance to the semi-allogeneic fetus.

MATERIALS AND METHODS

This study involved various methodologies for gene and protein expression profiling, genomic DNA methylation analyses, functional assays on differentiating trophoblasts including gene silencing, luciferase reporter and methylation assays. These methods were applied on placental specimens, umbilical cord blood cells, primary trophoblasts and BeWo cells. Genomic DNA sequences were analyzed for transposable elements, transcription factor binding sites and evolutionary conservation.

RESULTS AND DISCUSSION

The villous trophoblastic expression of Chr19 cluster galectin genes is developmentally regulated by DNA methylation and induced by key transcription factors of villous placental development during trophoblast fusion and differentiation. This latter mechanism arose via the co-option of binding sites for these transcription factors through promoter evolution and the insertion of an anthropoid-specific L1PREC2 transposable element into the 5' untranslated region of an ancestral gene followed by gene duplication events. Among placental Chr19 cluster galectin genes, the expression of LGALS13 and LGALS14 is down-regulated in preterm severe preeclampsia associated with SGA. We reveal that this phenomenon is partly originated from the dysregulated expression of key transcription factors controlling trophoblastic functions and galectin gene expression. In addition, the differential DNA methylation of these genes was also observed in preterm preeclampsia irrespective of SGA.

CONCLUSIONS

These findings reveal the evolutionary origins of the placental expression of Chr19 cluster galectins. The complex dysregulation of these genes in preeclampsia may alter immune tolerance mechanisms at the maternal-fetal interface.

Structure-activity relationships of vanilloid receptor agonists for arteriolar TRPV1

BACKGROUND AND PURPOSE

The transient receptor potential vanilloid 1 (TRPV1) plays a role in the activation of sensory neurons by various painful stimuli and is a therapeutic target. However, functional TRPV1 that affect microvascular diameter are also expressed in peripheral arteries and we attempted to characterize this receptor.

EXPERIMENTAL APPROACH

Sensory TRPV1 activation was measured in rats by use of an eye wiping assay. Arteriolar TRPV1-mediated smooth muscle specific responses (arteriolar diameter, changes in intracellular Ca(2+)) were determined in isolated, pressurized skeletal muscle arterioles obtained from the rat and wild-type or TRPV1(-/-) mice and in canine isolated smooth muscle cells. The vascular pharmacology of the TRPV1 agonists (potency, efficacy, kinetics of action and receptor desensitization) was determined in rat isolated skeletal muscle arteries.

KEY RESULTS

Capsaicin evoked a constrictor response in isolated arteries similar to that mediated by noradrenaline, this was absent in arteries from TRPV1 knockout mice and competitively inhibited by TRPV1 antagonist AMG9810. Capsaicin increased intracellular Ca(2+) in the arteriolar wall and in isolated smooth muscle cells. The TRPV1 agonists evoked similar vascular constrictions (MSK-195 and JYL-79) or were without effect (resiniferatoxin and JYL-273), although all increased the number of responses (sensory activation) in the eye wiping assay. Maximal doses of all agonists induced complete desensitization (tachyphylaxis) of arteriolar TRPV1 (with the exception of capsaicin). Responses to the partial agonist JYL-1511 suggested 10% TRPV1 activation is sufficient to evoke vascular tachyphylaxis without sensory activation.

CONCLUSIONS AND IMPLICATIONS

Arteriolar TRPV1 have different pharmacological properties from those located on sensory neurons in the rat.

Microarray profiling reveals that placental transcriptomes of early-onset HELLP syndrome and preeclampsia are similar

BACKGROUND

The involvement of the placenta in the pathogenesis of preeclampsia and HELLP syndrome is well established, and placental lesions are also similar in these two syndromes. Here we aimed to examine the placental transcriptome and to identify candidate biomarkers in early-onset preeclampsia and HELLP syndrome.

METHODS

Placental specimens were obtained at C-sections from women with early-onset preeclampsia and HELLP syndrome, and from controls who delivered preterm or at term. After histopathological examination, fresh-frozen placental specimens were used for microarray profiling and validation by qRT-PCR. Differential expression was analysed using log-linear models while adjusting for gestational age. Gene ontology and pathway analyses were used to interpret gene expression changes. Tissue microarrays were constructed from paraffin-embedded placental specimens and immunostained.

RESULTS

Placental gene expression was gestational age-dependent among preterm and term controls. Out of the 350 differentially expressed genes in preeclampsia and 554 genes in HELLP syndrome, 224 genes (including LEP, CGB, LHB, INHA, SIGLEC6, PAPPA2, TREM1, and FLT1) changed in the same direction (elevated or reduced) in both syndromes. Many of these encode proteins that have been implicated as biomarkers for preeclampsia. Enrichment analyses revealed similar biological processes, cellular compartments and biological pathways enriched in early-onset preeclampsia and HELLP syndrome; however, some processes and pathways (e.g., cytokine-cytokine receptor interaction) were over-represented only in HELLP syndrome.

CONCLUSION

High-throughput transcriptional and tissue microarray expression profiling revealed that placental transcriptomes of early-onset preeclampsia and HELLP syndrome largely overlap, underlying a potential common cause and pathophysiologic processes in these syndromes. However, gene expression changes may also suggest a more severe placental pathology and pronounced inflammatory response in HELLP syndrome than in preeclampsia.

Natural radioactivity in the soils of some eastern counties of Hungary

Soil samples were collected from six East-Hungarian counties at 98 different sites and the radionuclides (238)U, (226)Ra, (232)Th and (40)K were determined in these samples by gamma spectrometry. The means and ranges of the activity concentrations obtained for the above isotopes were 33.3 (6-68), 29.7 (10-61), 32.1 (9-56) and 418 (218-670) Bq kg(-1) (dry mass), respectively. Significant differences between certain counties were revealed. (226)Ra/(238)U activity ratio <1 was found at near-river sites lying on the plain terrain. The results were compared with those of the only nationwide survey published for Hungary till now. The mean activity concentrations obtained in this work for the East-Hungarian counties were slightly lower than those resulted for the whole country in the nationwide survey. Its main reason is possibly the different average geological character of the two areas. The computed mean terrestrial absorbed dose rate in air in the East-Hungarian region is 41.0 nGy h(-1).

Lean birds in the city: body size and condition of house sparrows along the urbanization gradient

1. Urbanized habitats differ from natural ones in several ecological features, including climate, food availability, strength of predation and competition. Although the effects of urbanization on avian community composition are well known, there is much less information about how individual birds are affected by these human-generated habitat differences. 2. In this study we investigated the relationships between the morphological characteristics and the degree of habitat urbanization in house sparrows, Passer domesticus (Linne 1758) . We collected data for more than 1000 non-breeding adult birds in Hungary between 1997 and 2006, from seven sites including farmlands, suburban areas and city centres. 3. We found that the body mass, tarsus length and body condition of free-living sparrows differed among the sites: birds in more urbanized habitats were consistently smaller and in worse condition than birds in more rural habitats. A composite measure of habitat urbanization (based on building density, road density and vegetation cover) explained over 75% of variance between sites in the studied traits, after we controlled for the effects of sex, year, season and time of capture. 4. The difference in body mass between rural and urban sparrows was significant when birds were kept in aviaries under identical conditions, with constant ad libitum food availability. It is therefore unlikely that the reduced body size and condition of urban sparrows are a consequence of reduced access to food for adults (e.g. due to strong competition), or their short-term responses to high food predictability (e.g. by strategic mass regulation). 5. We suggest that habitat differences in nestling development or adaptive divergence of sparrow populations due to distinct environmental conditions (such as differing predation pressure) may account for the differences along the urbanization gradient.

Variation of indoor radon progeny concentration and its role in dose assessment

Instantaneous measurements of equilibrium equivalent concentration of radon (EEC(Rn)) were taken over a period of 1 year in 2004 in a typical house at Amritsar city, located in the northwest part of India. A method based on absolute beta counting subsequent to grab aerosol sampling was used. During that year, EEC(Rn) varied between 1.56B qm(-3) and 22.77B qm(-3) with average value of 8.76Bb qm(-3). EEC(Rn) decreased with the transition from winter to summer and vice versa, having a negative correlation with outdoor temperature. The use of mechanical ventilation, under normal living conditions during summer, caused an extra decrease in the concentrations. The variations with temperature and mechanical ventilation are discussed. Some major issues related to the uncertainties in dose calculations caused by the lack of knowledge of equilibrium factor and ignoring the effect of life style on the radon and its progeny concentrations are discussed.

Analysis of perioperative morbidity according to whether the uterine cavity is opened or remains closed during abdominal myomectomy--results of 423 abdominal myomectomy cases

For women who desire pregnancy or who wish to retain their uterus, myomectomy is the standard approach for the treatment of fibroids. Abdominal myomectomy seems to be the best choice when there are large subserosal or intramural fibroids (> 5-7 cm), or submucosal fibroids > 3 cm or when multiple fibroids (> 3) are to be removed. When submucosal myomas are present or multiple fibroids are to be removed, opening the uterine cavity during the surgical procedure is more likely to happen. There is lack of published evidence about whether there is any difference in perioperative morbidity and management of those cases where the uterine cavity is opened during the surgical procedure compared with those where the uterine cavity remains closed.

METHODS

We undertook a retrospective review of 423 abdominal myomectomies via either an opened or closed uterine cavity. As a primary outcome we assessed the overall perioperative morbidity rate and as a secondary outcome we compared the necessity of pre and postoperative transfusions, intraoperative bleeding, febrile morbidity, unintended surgical interventions, life-threatening events, need for relaparotomies and duration of hospital stay between the opened and non opened uterine cavity groups.

RESULTS

The overall perioperative morbidity rate was significantly higher in those cases where the uterine cavity was opened during surgery; however the difference was caused only by the increased risk of intraoperative bleeding. All the other variables, such as febrile morbidity, number of relaparotomies, unintended surgical procedures and life-threatening events did not differ between the two groups.

CONCLUSION

Although there is an increased risk of intraoperative bleeding it seems that entering the uterine cavity during abdominal myomectomy can be considered as safe a procedure as in those cases where the uterine cavity remains closed.

Spinal anesthesia for cesarean section in a woman with Kartagener’s syndrome and a twin pregnancy

Kartagener's syndrome is an inherited disease characterized by a triad of symptoms: bronchiectasis, situs inversus and sinusitis resulting from defective cilial motility. There are few reports in the literature regarding the optimum anesthetic technique in patients with Kartagener's syndrome. The main anesthetic considerations are related to the respiratory system and increased risk of infection. We report the case of a woman with Kartagener's syndrome and a twin pregnancy conceived by in-vitro fertilization-embryo transfer, who underwent cesarean section under spinal anesthesia. Despite recurrent pulmonary problems, the twin pregnancy resulted in a successful outcome. This was facilitated by a close working relationship between the obstetrician, anesthesiologist and patient.

Chlamydia trachomatis infection, Fallopian tube damage and a mannose-binding lectin codon 54 gene polymorphism

BACKGROUND

Mannose-binding lectin (MBL), a component of the innate immune system, provides a first-line defense against invading microorganisms. Polymorphisms in the MBL gene have been associated with increased risk of infection. Chlamydia trachomatis genital tract infections are a major cause of Fallopian tube occlusion. Our objective was to test whether an MBL codon 54 polymorphism might contribute to development of C. trachomatis-associated tubal damage.

METHODS

In a case-control study, 97 women with occluded and 104 women with patent Fallopian tubes were tested for a history of chlamydial infection by serology and for their MBL codon 54 genotype by PCR and restriction fragment length polymorphism analysis. Clinical data were blinded to those performing all laboratory analyses.

RESULTS

Women with tubal occlusion who also had a positive chlamydial serology had the highest rate of variant MBL B allele carriage (P<0.001). Among women who were chlamydial antibody negative, allele B carriage was also more frequent in those with blocked, as opposed to patent, Fallopian tubes (P<0.01).

CONCLUSIONS

Wild-type allele A homozygosity is protective against, while carriage of the variant allele B is a risk factor for, Fallopian tube occlusion in women who are seropositive or seronegative for C. trachomatis.

Mannose-binding lectin (MBL) codon 54 gene polymorphism protects against development of pre-eclampsia, HELLP syndrome and pre-eclampsia-associated intrauterine growth restriction

Insufficient invasion of the spiral arteries by trophoblast cells is associated with the etiology of pre-eclampsia, the syndrome of hemolysis, elevated liver enzymes and low platelet counts (HELLP) and pre-eclampsia-associated intrauterine growth restriction (IUGR). Mannose-binding lectin (MBL) is a component of the innate immune system. MBL-mediated activation of the complement cascade is an important event in the destruction of invading trophoblasts. The gene coding for MBL is polymorphic, and variant alleles result in greatly reduced circulating MBL levels. The aim of this study was to test the association between an MBL polymorphism and pre-eclampsia, HELLP syndrome and IUGR. DNA was extracted from buccal swabs of 51 women with pre-eclampsia, 81 women with HELLP syndrome and 184 healthy pregnant controls. Aliquots were tested for a single nucleotide MBL gene polymorphism at codon 54 by PCR and endonuclease digestion. Homozygosity for the wild-type allele was more frequent in patients with pre-eclampsia (P = 0.04) and HELLP syndrome (P = 0.02) when compared with controls. The presence of the variant allele was more prevalent among controls than in women with pre-eclampsia (P = 0.02) or HELLP syndrome (P = 0.028). Twenty-two (55%) patients with pre-eclampsia and 43 (53%) women with HELLP syndrome delivered an IUGR neonate. MBL-54 heterozygosity was more frequent in controls (27.2%) than in pre-eclamptic women (4.5%, P = 0.025) and those with HELLP syndrome (11.7%, P = 0.05) who delivered an IUGR neonate. Genotype frequencies of neonates born to mothers in all study groups were similar. Carriage of the MBL codon 54 polymorphism protects against pre-eclampsia, HELLP syndrome and IUGR and implies that an MBL-mediated event might be involved in the pathogenesis of these disorders.

Novel mutation in OTC gene causes neonatal death in twin brothers

Ornithine transcarbamylase (OTC) deficiency is the most common inborn error of the urea cycle. OTC locus is located in the short arm of X-chromosome. Authors report a case of a woman who gave birth to monozygotic male twins who later died because of severe neonatal-onset hyperammonaemic encephalopathy caused by a novel mutation of OTC gene. Post-mortem liver biopsy was taken from the second twin; afterwards, blood was drawn from the mother for examination. DNA sequence data showed that the mother was a carrier of the same novel mutation that was previously detected in the case of her son. In OTC deficiency, detection of female carriers is important for genetic counselling and eventual prenatal diagnosis.

High frequency of methylenetetrahydrofolate reductase 677TT genotype in Hungarian HELLP syndrome patients determined by quantitative real-time PCR

Our aim was to determine the methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism in hypertensive disorders during pregnancy. We conducted our experiments on isolated DNA samples of 73 healthy pregnant, 101 severe pre-eclamptic and 63 HELLP syndrome women in this study. The MTHFR C677T polymorphism was determined by quantitative real-time PCR method. A significantly higher number of the TT genotype (25.4%) was found in the HELLP syndrome group compared to the healthy (8.2%) and severe pre-eclamptics group (8.9%) (P=0.03). The frequency of the mutant T allele was found to be 45.2% of HELLP syndrome, whereas it was 32.2% of the healthy pregnant (P=0.03) and 30.2% (P=0.008) of the severe pre-eclamptic patients. In the HELLP group a high frequency of eclampsia was observed (12.6%) and among them 75% had the MTHFR C677T mutation.

Correlation between first polar body morphology and further embryo development

First polar body (PB) morphology of human oocytes can indicate further embryo development and viability. However, controversial data have been published in this topic. Our retrospective study analyses the fertilization and further development of oocytes in relation to different morphological features of the first PB. The morphology of 3387 MII oocytes from 522 in vitro fertilization (IVF) treatments were assessed before intracytoplasmic sperm injection (ICSI). Oocytes were classified according to their first PB morphology. Assessment of fertilization and embryonic development (cell number, embryo grade, amount of anuclear fragmentation and presence of multinucleated blastomeres) was performed 16-20 and 42-48 hours after ICSI. Our results show that fertilization rate and embryo quality is influenced by PB morphology, while speed of development is not affected by the morphology of the first PB. Contrary to previous findings, our results suggest that oocytes with a fragmented PB had a higher developmental ability than those with an intact PB. However, we observed a lower viability of oocytes with a large PB. Since there are contradictions in this and previous observations, an extensive study is needed with standard hormonal stimulation protocol and oocyte evaluation criteria.

Congenital heart diseases in twin pregnancies

OBJECTIVE

To find connection between the type of congenital heart malformations and twin pregnancies.

METHOD

Retrospective analysis of data of fetal cardiology database between 1 January 1996 and 30 November 2003.

RESULTS

In single pregnancies 455 and in twin pregnancies 31 severe congenital heart malformations were diagnosed prenatally. In monozygotic twin pregnancies 36% of heart malformations were pulmonary stenosis and 45% endocardial fibroelastosis, which is significantly higher than in single pregnancies. In dizygotic twin pregnancies Ebstein malformation was significantly more frequent than in single pregnancies. With the exception of Ebstein malformation in dichorionic and dizygotic twin pregnancies the cardiac malformations were similar to the ones in single pregnancies.

CONCLUSIONS

The twin pregnancy alone can be considered as indication for fetal echocardiography. The type of congenital heart malformations detected in monochorial twin pregnancies was different from those found in single, dizygotic or dichorionic twin pregnancies. Chorionicity seems to be more important than zygosity.

Rare case of exomphalos complicated with umbilical cord teratoma in a fetus with trisomy 13

An exomphalos containing unusual solid and cystic mass was diagnosed during a routine ultrasound examination in the 17th week of gestation. Further investigations were planned but the pregnancy was terminated. The fetopathological examination revealed an umbilical cord teratoma. Although this entity is very rare it should be emphasized as a possible differential diagnosis when cystic lesion of the cord is detected. Large teratomas associated with abdominal wall defect may have poor fetal outcome and can be associated with structural and chromosomal abnormalities. In our case trisomy 13 was diagnosed.

Nerve-sparing radical hysterectomy for stage IA2-IIB cervical cancer: 5-year survival of 501 consecutive cases

OBJECTIVE

The purpose of this study was to assess the 5-year survival and morbidity in cases with radical hysterectomy and pelvic lymphadenectomy with pre- and postoperative irradiation performed to treat Stage IA2-IIB cervical cancer.

METHODS

During a 10(1/2)-year period between July 1990 and December 2000, 501 consecutive radical hysterectomies with bilateral pelvic lymphadenectomy were performed by the same gynecological surgeon in Stage IA2, IB, IIA and IIB cervical cancer. The patients were treated by pre- and postoperative irradiation as well.

RESULTS

Apart from recurrence, perioperative complications were minimal with no long-term morbidity. The absolute 5-year survival rates for the patients in Stage IA2, IB1, IB2, IIA and IIB were 94.4%, 90.7%, 84.1%, 71.1%, and 55.4%, respectively. The respective 5-year survival rates for patients without or with lymph node metastasis were 94.5% and 33.3% in Stage IB2, 81.7% and 48.7% in Stage IIA and 70.2% and 36.5% in Stage IIB, respectively.

CONCLUSIONS

Nerve-sparing radical hysterectomy with pelvic lymph node dissection and pre- and postoperative irradiation remains the treatment of choice for most patients with early-stage and even Stage IIB cervical cancer. The radicalism and extent of lymph node dissection and parametrial resection should be individualized and tailored to tumor- and patient-related risk factors.

Organochlorine contamination and physiological responses in nestling tree swallows in Point Pelee National Park, Canada

Point Pelee National Park in southwestern Ontario, Canada--a major migratory route and vital breeding area for many birds--has localized areas of organochlorine (OC) contamination from the 1950s and 1960s. During 2002, we investigated the effect of tissue OC contaminant levels on the physiology and growth of nestling tree swallows (Tachycineta bicolor). Polychlorinated biphenyl (PCB) contamination in the nestlings positively correlated with hepatic ethoxy-, benzyloxy-, and pentoxyresorufin-o-dealkylase enzyme activities and liver size. Despite detectable physiologic changes associated with body burdens of PCBs, reproductive success of breeding pairs was not affected. Hatching date was negatively correlated with PCB levels, alkoxyresorufin-O-dealkylase (alkROD) activities, liver size, and serum protein levels. alkROD activities were largely dependent on hatching date because insect prey contaminated with PCBs were only abundant during a limited period of time during the breeding season.

I. Hypogastric artery ligation for intractable pelvic hemorrhage

OBJECTIVE

To assess the outcomes of bilateral hypogastric (internal iliac) ligation performed to control intractable pelvic hemorrhage and avoid hysterectomy.

METHODS

A review of indications and outcomes for 117 cases of bilateral hypogastric artery ligation over 15 years (1990-2004).

RESULTS

Apart from a slight lesion to the hypogastric vein, no complications were observed. Hemorrhage was effectively controlled in all 37 obstetric cases. In 13 of these cases, the uterus was preserved even when there was cervical pregnancy, placenta previa, placental abruption, uterine atony, and uterine rupture, and 4 women were delivered of mature infants. Hemorrhage was effectively controlled in 41 of 80 gynecologic cases. Prophylactic reduction of pelvic blood flow was the indication for the procedure in 39 cases, 5 of whom involving Jehovah's Witnesses adverse to blood transfusion. The uterus was preserved in only a few of the 41 controlled cases, but one woman (so far) was delivered of a mature infant.

CONCLUSION

Hypogastric artery ligation was found to be indicated if (1) life-threatening pelvic hemorrhage could not be controlled by conservative methods; (2) prophylactic reduction of pelvic blood flow was needed to prevent anticipated hemorrhage; and (3) preservation of reproductive function was desired. The procedure was found to be safe and usually effective and should be taught during obstetric and gynecologic training.