[Impact of an educational video on the representations of electroconvulsive therapy among psychiatrists in Hauts-de-France and Occitanie]

INTRODUCTION

Despite its effectiveness and good tolerance, electro-convulsive therapy (ECT) is under-used in current clinical practice probably because of stigma and the negative image of this treatment. The main objective of this study was to evaluate the impact of an educational video on the representations of ECT among psychiatrists and psychiatric residents in the North and in Occitanie districts of France.

METHOD

We evaluated the representations of ECT through the Questionnaire on Attitudes and Knowledge of ECT (QuAKE) before (T0) and after (T1) viewing a short educational video. Scores at T0 and T1 were compared with a paired t-test. Factors associated with the improvement of the representations were investigated using a logistic regression model.

RESULTS

In all, 195 responses were obtained. The QuAKE score at T1 was significantly better than at T0 (29.4 at T1 vs. 31.5 at T0, P<0.001). The more negative the representations were at T0, the higher the probability of a decrease in the score at T1 (OR=1.07 [1.02-1.13], P=0.003).

DISCUSSION

Our study showed a beneficial effect of a short educational video on psychiatrists' representations of ECT. The wide use of this type of media, allowing information and destigmatization, could considerably optimize access to ECT for patients.

Strontium incorporation into biomimetic carbonated calcium-deficient hydroxyapatite coated carbon cloth: Biocompatibility with human primary osteoblasts

It has already been shown that sono-electrodeposition can be used to coat activated carbon fiber cloth (ACC) with calcium phosphates (CaP) and we recently demonstrated that cathodic polarization at -1 V/Hg/Hg₂SO₄ was the best parameter to obtain a carbonated calcium deficient hydroxyapatite (CDA) coating with optimal uniformity and homogeneity. In the present study, we investigated whether this technique was suitable to dope this carbonated CDA coating by partial substitution with another bivalent cation such as strontium. We show here that a strontium-substituted carbonated CDA coating can be produced and quantitatively controlled up to at least 10 at.%. In this range we demonstrate that the presence of strontium does not modify either the textural or the structural properties of the carbonated CDA. Owing to the well-known effect of both carbonated CDA and strontium in bone formation, the biocompatibility of ACC coated or not with carbonated CDA or with strontium substituted carbonated CDA was tested using primary human osteoblasts. Our data revealed a positive and dose-dependent effect of strontium addition on osteoblast activity and proliferation. In conclusion, we show here that electrodeposition at -1 V is a suitable and easy process to incorporate cations of biological interest into CaP coating.

Leachate flow around a well in MSW landfill: Analysis of field tests using Richards model

During the lifespan of a Municipal Solid Waste landfill, its leachate drainage system may get clogged. Then, as a consequence of rainfall, leachate generation and possibly leachate injection, the moisture content in the landfill increases to the point that a leachate mound could be created. Therefore, pumping the leachate becomes a necessary solution. This paper presents an original analysis of leachate pumping and injection in an instrumented well. The water table level around the well is monitored by nine piezometers which allow the leachate flow behaviour to be captured. A numerical model based on Richards equation and an exponential relationship between saturated hydraulic conductivity and depth is used to analyze the landfill response to pumping and injection. Decreasing permeability with depth appears to have a major influence on the behaviour of the leachate flow. It could have a drastic negative impact on the pumping efficiency with a maximum quasi-stationary pumping rate limited to approximately 1m³/h for the tested well and the radius of influence is less than 20m. The numerical model provides a reasonable description of both pumping and injection tests. However, an anomalous behaviour observed at the transition between pumping and recovery phases is observed. This could be due to a limitation of the Richards model in that it neglects the gas phase behaviour and other double porosity heterogeneous effects.

Abstract P3-13-22: Should modified radical mastectomy be modified? A phase 1 study to evaluate infraradical mastectomy for invasive breast cancer

Background: Surgical procedures in breast cancer have become less aggressive. However, around one in three patients must undergo modified radical mastectomy (MRM). We evaluated if infraradical mastectomy (IFM), which preserves the skin and fat tissues surrounding the breast, is safe. IFM has the potential to preserve neck opening and by the way femininity of patients. Aesthetic results obtained after breast reconstruction are also expected to be improved.

Objective: The primary objective of this phase 1 trial is to evaluate the feasibility and safety of IFM.

Methods: Patients were recruited in two specialized breast clinics. We performed enucleation with a cold knife to the mammary gland after a water-assisted dissection of the periglandular space using a dedicated tool. In a second step we removed the peripheral skin and fat tissue which surrounded the gland to obtain a classical MRM. Fat tissue removed in the second step underwent a careful pathological examination (10 biopsies) in order to evaluate residual invasive or in situ breast cancer and atypical hyperplasia. We also evaluated which is the percentage of tissue and skin removed in the second step with regard to the global surgical specimen because that could be left in the future if the procedure is declared safe.

Results: A total of 35 patients (43 to 80 years old) were prospectively recruited from March 2015 to March 2016. The distribution of tumor type was: pTis 2.9%, pT1 45.7%, pT2 45.7% and pT3 5.7%. Pathological analysis of the periglandular tissue removed in the second step revealed: 0% invasive carcinoma, 1% focal ductal carcinoma in situ (DCIS), and 0% atypical hyperplasia. On average, the weight of an IFM was 37% lower compared to the weight of a MRM. Skin resection was reduced by 48% with IFM. No serious adverse event was observed.

Conclusions: Preliminary results are promising. Our phase 1 trial suggests that the procedure is safe concerning premalignant or malignant disease left after IFM. Moreover, a high quantity of skin and fat tissue is saved by IFM. We are now recruiting a second cohort of patients in order to confirm these results. In addition, we will also quantify the amount of mammary glands left around IFM compared to MRM by performing additional biopsies and quantitative evaluation by pathologists.

Presurgical selection criteria have been modified for the second cohort in order to avoid residual DCIS left after IFM. After this second cohort, we plan to begin a large prospective randomized phase 3 trial with long-term disease-free survival and aesthetic results as the primary endpoints.

Citation Format: Coibion M, Lifrange E, Jossa V, Mutijima E, Crevecoeur A, Olivier F, Di Bella J, Jerusalem G. Should modified radical mastectomy be modified? A phase 1 study to evaluate infraradical mastectomy for invasive breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-13-22.

Association between birth route and late-onset sepsis in very preterm neonates

OBJECTIVE

To evaluate the association between birth route and late-onset sepsis (LOS), and coagulase-negative Staphylococcal (CONS)-related LOS in preterm neonates.

STUDY DESIGN

In this observational study, data from 20,038 infants born between 22 and 32 weeks' gestation and admitted to Canadian neonatal intensive care units between 2010 and 2014 were analyzed retrospectively. The impact of birth route on LOS was assessed using univariate analysis and multiple logistic regression.

RESULTS

A total of 8218 neonates were born via vaginal route and 11,820 via cesarean section. Incidence rates of LOS for infants born vaginally and via a cesarean section were 13.1 and 13.2%, respectively, and there was no significant difference in odds of LOS between the groups (adjusted odds ratio (AOR): 0.99; 95% CI 0.87 to 1.12); however, the odds of CONS sepsis were higher in the cesarean group (AOR: 1.15; 95% CI: 1.01 to 1.32).

CONCLUSION

Birth route did not have an impact on LOS, but was associated with CONS-related LOS.

Enquête de fonctionnement des services d’hospitalisation à domicile psychiatriques en France en 2015

Le nombre de lits consacrés à l’hospitalisation à domicile (HAD) est en constante évolution ces dernières années. L’HAD en psychiatrie a pour mission de préparer, raccourcir, prendre le relais, éviter ou remplacer l’hospitalisation classique. Il n’existe, à notre connaissance, pas de données centralisées concernant les différents services d’HAD psychiatrique en France. Notre communication présente les résultats d’une enquête téléphonique, réalisée à partir du service d’HAD psychiatrique du centre hospitalier de Montauban (82). Elle décrit les principaux indicateurs de fonctionnement des différents HAD psychiatriques, contactées, présentes sur le territoire national en 2015. Les indicateurs étudiés sont : l’année de création de la structure, le nombre de place d’hospitalisation, la durée moyenne de séjour, les pathologies principales, la file active moyenne, les critères d’exclusion, la procédure d’activation, la composition des équipes, la couverture horaire et le rayon d’action géographique. Les résultats sont analysés à la recherche de facteurs d’homogénéité ou de disparité.

Recensement des services d’hospitalisation à domicile psychiatriques en France en 2015

L’hospitalisation à domicile (HAD) est une alternative à l’hospitalisation à temps complet classique, dans laquelle des soins intensifs sont effectués au domicile du patient. La circulaire DHOS du 4 février 2004 a, plus particulièrement, défini les modalités de l’HAD en psychiatrie : « elle prépare, raccourcit, prend le relais, évite ou remplace l’hospitalisation classique ». Il est important que l’HAD s’intègre dans l’organisation des soins psychiatriques et du secteur déjà existant. Elle renforce la diversité de l’offre de soin, facilite souvent l’accès au suivi psychiatrique et la continuité du parcours de soins. Les structures d’HAD sont disséminées sur l’ensemble du territoire français et leur nombre s’accroît régulièrement sans que puissent se coordonner les différentes équipes de psychiatrie porteuses de ce projet. En effet, à ce jour, il est difficile de trouver des données centralisées concernant les différents services d’HAD psychiatriques en France. Cette communication présente les résultats d’une enquête téléphonique réalisée en 2015 à partir du service d’HAD psychiatrique du centre hospitalier de Montauban (82). Il présente la répartition et la localisation des services d’HAD psychiatrique en France en 2015. Ce recensement a pour but de donner ainsi une vision simple et globale de l’implantation des structures d’hospitalisation à domicile en psychiatrie, avec le projet ultérieur de faciliter les échanges des pratiques dans ce domaine et peut-être de proposer une coordination nationale.

Syndrome malin des neuroleptiques chez le sujet âgé. Cas clinique et comparaison aux données de la littérature

Mme L., 90 ans, était traitée en 3e intention par rispéridone 0,5 mg puis 1 mg durant 7 jours dans le cadre d’un trouble anxieux généralisé décompensé avec agitation. Une rhabdomyolyse et une cytolyse hépatique ont été découvertes fortuitement, associées à des signes cliniques de syndrome malin des neuroleptiques (SMNL) débutant. Les anomalies cliniques et paracliniques ont été résolutives 7 jours après l’arrêt de la rispéridone.

Nous avons réalisé une revue de la littérature sur le SMNL chez le sujet âgé de plus de 65 ans dans la base de données gratuite de Pubmed entre 1985 et 2014.

Parmi les patients retrouvés, la majorité étaient des hommes âgés de plus de 80 ans. Les pathologies traitées étaient représentées pour moitié par des pathologies neurodégénératives. Les différentes classes d’antipsychotiques étaient représentées, avec notamment : halopéridol, dropéridol, chlorpromazine, trifluopérazine, méthotrimeprazine, loxapine, sulpiride ainsi que risperidone et olanzapine. L’augmentation récente des doses semblait être un facteur favorisant. Les délais d’apparition étaient immédiat (< 48 h), précoce (2 à 15 jours), ou tardif (> 15 jours) dans la plupart des cas. Les signes cardinaux du SMNL étaient présents dans la plupart des cas, associés à une augmentation systématique des CPK. On note 50 % de mortalité.

La spécificité chez le sujet âgé semble être une mortalité plus élevée qu’en population générale. Les facteurs de risque tels les pathologies neurodégénératives sont analysés. Les auteurs interrogent le rapport bénéfice/risque de la prescription des antipsychotiques chez la personne âgée.

MDM2 restrains estrogen-mediated AKT activation by promoting TBK1-dependent HPIP degradation

Restoration of p53 tumor suppressor function through inhibition of its interaction and/or enzymatic activity of its E3 ligase, MDM2, is a promising therapeutic approach to treat cancer. However, because the MDM2 targetome extends beyond p53, MDM2 inhibition may also cause unwanted activation of oncogenic pathways. Accordingly, we identified the microtubule-associated HPIP, a positive regulator of oncogenic AKT signaling, as a novel MDM2 substrate. MDM2-dependent HPIP degradation occurs in breast cancer cells on its phosphorylation by the estrogen-activated kinase TBK1. Importantly, decreasing Mdm2 gene dosage in mouse mammary epithelial cells potentiates estrogen-dependent AKT activation owing to HPIP stabilization. In addition, we identified HPIP as a novel p53 transcriptional target, and pharmacological inhibition of MDM2 causes p53-dependent increase in HPIP transcription and also prevents HPIP degradation by turning off TBK1 activity. Our data indicate that p53 reactivation through MDM2 inhibition may result in ectopic AKT oncogenic activity by maintaining HPIP protein levels.

Review and prospect of emerging contaminants in waste--key issues and challenges linked to their presence in waste treatment schemes: general aspects and focus on nanoparticles

The presence in waste of emerging pollutants (EPs), whose behaviours and effects are not well understood, may present unexpected health and environmental risks and risks for the treatment processes themselves. EP may include substances that are newly detected in the environment, substances already identified as risky and whose use in items is prohibited (but which may be present in old or imported product waste) or substances already known but whose recent use in products can cause problems during their future treatment as waste. Several scientific studies have been conducted to assess the presence of EP in waste, but they are mostly dedicated to a single category of substance or one particular waste treatment. In the absence of a comprehensive review focused on the impact of the presence of EP on waste treatment schemes, the authors present a review of the key issues associated with the treatment of waste containing emerging pollutants. This review presents the typologies of emerging pollutants that are potentially present in waste along with the major challenges for each treatment scheme (recycling, composting, digestion, incineration, landfilling and wastewater treatment). All conventional treatment processes are affected by these new pollutants, and they were almost never originally designed to consider these substances. In addition to these general aspects, a comprehensive review of available data, projects and future R&D needs related to the impact of nanoparticles on waste treatment is presented as a case study.

The clinical variability of maternally inherited diabetes and deafness is associated with the degree of heteroplasmy in blood leukocytes

CONTEXT

Maternally inherited diabetes and deafness (MIDD) is a rare form of diabetes with a matrilineal transmission, sensorineural hearing loss, and macular pattern dystrophy due to an A to G transition at position 3243 of mitochondrial DNA (mtDNA) (m.3243A>G). The phenotypic heterogeneity of MIDD may be the consequence of different levels of mutated mtDNA among mitochondria in a given tissue.

OBJECTIVE

The aim of the present study was thus to ascertain the correlation between the severity of the phenotype in patients with MIDD and the level of heteroplasmy in the blood leukocytes.

PARTICIPANTS

The GEDIAM prospective multicenter register was initiated in 1995. Eighty-nine Europid patients from this register, with MIDD and the mtDNA 3243A>G mutation, were included. Patients with MELAS (mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes) or with mitochondrial diabetes related to other mutations or to deletions of mtDNA were excluded.

RESULTS

A significant negative correlation was found between levels of heteroplasmy and age of the patients at the time of sampling for molecular analysis, age at the diagnosis of diabetes, and body mass index. After adjustment for age at sampling for molecular study and gender, the correlation between heteroplasmy levels and age at the diagnosis of diabetes was no more significant. The two other correlations remained significant. A significant positive correlation between levels of heteroplasmy and HbA(1c) was also found and remained significant after adjustment for age at molecular sampling and gender.

CONCLUSIONS

These results support the hypothesis that heteroplasmy levels are at least one of the determinants of the severity of the phenotype in MIDD.

Injury of the axillary artery after a proximal humeral fracture: a case report and overview of the literature

A traumatic lesion of the axillary artery after a proximal humeral fracture is very uncommon. The clinical presentation can be very misleading and therefore it is mandatory to have a high index of suspicion and, as presented in this case report, to check the pulsations in different positions. Open repair remains the golden standard for most surgeons, but, in selected cases, an endovascular approach is feasible. The functional outcome is mostly determined by the associated trauma, especially the injury to the nervous structures.

Retinal and renal complications in patients with a mutation of mitochondrial DNA at position 3,243 (maternally inherited diabetes and deafness). A case-control study

AIMS/HYPOTHESIS

We assessed the prevalence and determinants of retinal and renal complications in patients with maternally inherited diabetes and deafness (MIDD).

METHODS

This was a multicentre prospective study comparing the prevalence of retinopathy and renal disease in 74 patients with MIDD and 134 control patients matched for sex, age and clinical presentation at onset of diabetes, duration of diabetes and current treatment. Comparisons were adjusted for HbA(1c) and hypertension.

RESULTS

In MIDD patients, HbA(1c) (7.6 +/- 1.6 vs 8.5 +/- 2.0%, p < 0.002), systolic blood pressure (126.6 +/- 16.2 vs 133.1 +/- 17.3 mmHg, p < 0.007) and prevalence of hypertension (33.8 vs 64.2%, p < 0.0001) were lower than in control patients. Prevalence of diabetic retinopathy was 3.7-fold lower in MIDD patients (6/74, 8 vs 40/134, 29.6%, p < 0.0001). Differences between groups remained significant after adjustment for hypertension, systolic blood pressure and HbA(1c). In MIDD, urinary albumin excretion (314.8 vs 80.1 mg/24 h, p = 0.035) and creatinine plasma levels (103.5 vs 82.2 micromol/l, p = 0.0178) were higher and GFR was lower. Impaired renal function (GFR <60 ml/min) was four- to sixfold more frequent in MIDD. Differences between MIDD and control diabetic patients further increased when adjusted for HbA(1c) and systolic blood pressure (p < 0.0001). Adjustment for treatment with an ACE inhibitor or angiotensin II receptor antagonist did not modify the results.

CONCLUSIONS/INTERPRETATION

This study indicates that diabetic retinopathy is less prevalent in MIDD than in control diabetes. This suggests that retinal alterations due to mitochondrial disease may have a protective role. By contrast, nephropathy is far more frequent in MIDD, suggesting the presence of a specific renal disease independent of diabetic nephropathy.

[Assessment of compliance with ARV treatment in Africa]

This study was conducted in health facilities in the capitals of five sub-Saharan African countries (Cotonou, Benin; Bangui, Central African Republic; Libreville, Gabon; Yaoundé, Cameroon; and Casablanca, Morocco). The purpose was to investigate factors promoting and impeding compliance with antiretroviral therapy (ART) and cotrimoxazole (CTX) prophylaxis in adult patients. Patients were interviewed immediately after follow-up examination to identify the problems that they encountered and the solutions that they proposed to improve compliance. Compliance was assessed based on three measurement modalities, i.e. skipping medication during the four days prior to attendance, counting the number of remaining tablets, and attendance assiduity. Compliance scores varied according to measurement modality from 65% to 90%. All patients underlined the impact of treatment on their daily life and the difficulty of following the prescribed regimen properly. Impeding factors for compliance were treatment-related hunger, lack of information, out-of-pocket expenses (including laboratory tests, transportation, and loss of income), side effects, long waiting time at the treatment centers, and fear stigma and discrimination. Efforts to increase access to treatment can only be successful if accompanied by measures to promote compliance.

195 CHANGES OF BLESBOK AND BLUE WILDEBEEST EPIDIDYMAL SPERM AFTER INCUBATION AT 37°C

Postmortem recovery of epididymal spermatozoa and their preservation in Biological Resource Banks is a convenient source of germplasm, providing a possible future conservation resource for selected endangered wildlife species. It is necessary to gain knowledge of the biology of the gametes of the different species, in order to define effective protocols for cryopreservation and future assisted reproductive technology application. A pilot study on the changes in blue wildebeest (Connochaetes taurinus) and blesbok (Damaliscus dorcas phillipsi) epididymal sperm was carried out in order to provide some insight into the effects of incubation at 37°C. Chemicals were aquired from Sigma (South Africa), except JC-1 (Molecular Probes, Leiden, The Netherlands). Sperm was obtained by flushing the vas deferens and cauda epididymis of 6 adult blue wildebeests and 4 adult blesbok after the breeding season using 1 mL of Biladyl (fraction A; Minitüb, Tiefenbach, Germany). Cells were washed and resuspended in buffered medium (20 mM HEPES, 197 mM NaCl, 10 mM glucose, 2.5 mM KOH). Part of each sample was analyzed and part was incubated for 1 h at 37°C, and then analyzed. Analysis consisted of: motility (% of motile sperm, TM; and % of linear sperm, LM), vitality (fluorescent dye propidium iodide, 7 μM; % of unstained cells noted after 10 min at RT: vital, VIT), mitochondrial status (fluorescent dye JC-1, 7.5 μM; % of cells with orange midpiece noted after 30 min at 37°C: active mitochondria, MIT), and induction of acrosome reaction (15 min at 37°C in buffered medium complemented with 3 mM CaCl; % of intact acrosomes noted in control: splits no ionophore, ACR, and test: splits 1 μM calcimycin, ION). Samples were assessed using phase contrast microscopy (×400; ×200 for motility). Results are showed in Table 1. No significant differences (Wilcoxon Rank Sign test) were detected, possibly due to the low number of samples. However, LM appeared to decrease after incubation. Incubaton may increase the sensitivity of blue wildebeest sperm to ionophore (ION). Motility was least for blesbok, and the decrease of LM after incubation was more apparent. This treatment may induce different physiologycal changes between the species (different LM variation). The rest of the parameters suggest that the treatment did not induce extensive cell damage. Further research must be carried out to confirm these findings. Table 1. Median values for the analyzed parameters Sponsors of this project include Vodacom, Joan St. Leger Lindburgh Charitable Trust, Tony and Lizette Lewis Foundation, Department Science and Technology (South Africa), British Airways, IMV Technologies/CBS (France), NECSA, Zeiss Microscopes, AEC-Amersham, CryoLogic (Australia), Cook Veterinary (Australia), Mazda Wildlife Fund, The Scientific Group, Genaust (Australia), and SCI – Chesapeake Chapter.

Heterogeneity of diabetes phenotype in patients with 3243 bp mutation of mitochondrial DNA (Maternally Inherited Diabetes and Deafness or MIDD)

OBJECTIVE

In patients with maternally inherited diabetes and deafness (MIDD), due to 3 243 A > G mutation of mitochondrial DNA (mtDNA), diabetes may present with variable phenotypes.

OBJECTIVE

To ascertain the existence of two distinct phenotypes, MIDD1 and MIDD2, in a series of patients with MIDD.

DESIGN

Multicenter prospective study.

PATIENTS

77 patients with diabetes and the mtDNA 3243 mutation and 139 control patients with type 1 (T1D) or type 2 (T2D) diabetes, matched according to initial presentation of diabetes, age at onset, sex, and duration of diabetes (24 T1D and 115 T2D, including 55 treated with insulin).

MEASUREMENTS

Anthropometric characteristics (height, body weight, body mass index [BMI], sex), family history of diabetes, and characteristics of diabetes (age at onset, treatment, hemoglobin A1c [HbA1c]), extrapancreatic manifestations.

RESULTS

In 13 cases (17%, MIDD1), diabetes presented as insulin-dependent from the onset, with ketoacidosis in 6 cases. In 64 cases (83%, MIDD2), diabetes resembled T2D, and was treated with diet in 12 cases, oral hypoglycemic agents in 21 cases, or insulin in 31 cases. Compared with patients with MIDD2, patients with MIDD1 were characterized by lower age at onset of first manifestation of MIDD (25.4 +/- 9.6 vs 33.7 +/- 13.2 Years, P<0.0005), lower body weight (49.1 +/- 7.4 vs 56.3 +/- 10.9 kg, P<0.0025), lower BMI (18.2 +/- 2.3 vs 20.9 +/- 3.6 kg/m2, P<0.0005), and higher HbA1c levels (9.5 +/- 2.0 vs 7.5 +/- 1.6%, P<0.0005). Frequency of family history of diabetes and of extrapancreatic manifestations was the same in both MIDD subtypes. No difference was found within the MIDD2 subtype when comparing patients treated with or without insulin. Compared with matched controls, patients with MIDD had a lower BMI (MIDD1/T1D 18.2 +/- 2.3 vs 24.0 +/- 3.6 kg/m2 and MIDD2/T2D 20.9 +/- 3.6 vs 30.2 +/- 5.9 kg/m2, P<0.0025). Lastly, male patients with MIDD had a shorter height than controls (MIDD1/T1D: 166.1 +/- 3.2 vs 177.3 +/- 6.6 cm and MIDD2/T2D: 168.4 +/- 7.2 vs 173.6 +/- 6.6 cm P<0.025).

CONCLUSIONS

These results confirm the existence of two different phenotypes in MIDD, MIDD1 and MIDD2, which may be related to the severity of the mitochondrial disease. The role of other genetic and/or environmental factors in the variable phenotype of MIDD remains to be elucidated.

211QUALITY CHANGES IN BLUE WILDEBEEST (CONNOCHAETES TAURINUS) EPIDIDYMAL SPERMATOZOA MAINTAINED AT 4°C

Wildlife management in southern Africa often involves the harvesting of animals on ranches and reserves, providing unique opportunities to collect and assess the quality of epididymal spermatozoa for possible future conservation actions. The black wildebeest (Connochaetes gnu) is facing renewed threats to its survival, including the production of fertile hybrids from crossing with the more common blue wildebeest (Connochaetes taurinus). The close relationship between the two wildebeest species allows for the blue wildebeest to be used as a model to assess epididymal sperm quality over time while maintained at 4°C. Field conditions often preclude the immediate availability of liquid nitrogen, necessitating the development of alternative short-term storage methods. All chemicals were provided by Sigma (South Africa) unless otherwise stated. Testes were harvested from 6 blue wildebeest bulls at a local game farm, Savannah, and kept at 5°C during transportation to the lab. Epididymides were dissected out and spermatozoa were flushed out of the cauda epididymis using 1mL of Tris-citrate egg yolk extender (Fraction A, Biladyl, Minitub, Germany), followed by storage at 4°C and assessment at 12h intervals. At each interval, an aliquot was removed, washed with a modified buffered HEPES solution (20mM HEPES, 355mM sucrose, 10mM glucose, 2.5mM KOH;; 400mOsm/kg, pH 7; Sigma) and visually assessed with a phase contrast microscope (×200, at 37°C) to determine the percentage of motile (MS) and progressive motile (PS) spermatozoa. In addition, plasma membrane integrity (PMI) was assessed with eosin-nigrosin staining and active mitochondrial status (MIT) assessed with an epifluorescent microscope (×400) using the fluorescent probe JC-1 (Molecular Probes, The Netherlands;; 7.5μM; 30min at 37°C). Resilience to hypo-osmotic shock was also evaluated by incubating the sample in a modified hypo-osmotic medium (100mOsmkg−1; 15min RT), and staining with PI to assess plasma membrane integrity (HOSPMI). A summary of results is presented in the table 1. The MS, MIT and HOSPMI did not decrease significantly during the 48h storage period. The only parameters that showed a significant decrease were PS and PMI (P&lt;0.01, Kruskall-Wallis test). However, PMI showed a slow but steady decrease (13%), whereas PS underwent a significant drop (52%). In conclusion, epididymal spermatozoa from the blue wildebeest, kept at 4°C for 48h, may still be useful for some assisted-reproduction techniques. The use of spermatozoa from a common but closely related wildebeest species allows for the development of assisted-reproduction techniques that may one day aid the conservation of threatened wildebeest species. Additional research is needed to confirm these findings and to test the effect of longer storage times on spermatozoa of this species as well as closely related endangered species. Table 1 Parameters measured during the 12-h time periods (mean±SD)

208EFFECT OF REFRIGERATION AND CRYOPRESERVATION ON THE QUALITY OF LION EPIDIDYMAL SPERMATOZOA

Epididymal spermatozoa from harvested wild animals is potentially useful for conservation purposes, as it can be used for subsequent artificial insemination or stored in Biological Resource Banks for future use. The potential of sperm banking is of particular interest for use in lion (Panthera leo) populations maintained in small National Parks, as translocation of males to effect gene-flow is often problematic, resulting in the translocated lion being killed by resident pride males. We measured the change in sperm quality over time during cool storage (at 4°C) and after thawing of samples cryopreserved at −196°C. Also, we present a correlation between sperm plasma membrane integrity and mitochondrial activity as measured by fluorescent analysis. The testes from a pride lion were removed and transported to the laboratory (at 4°C) within 6h. The epididymides were removed and both cauda epididymides were flushed with 1mL of Tris-citrate egg yolk extender (Fraction A, Biladyl, Minitub, Germany). The sample containing 2930×106 cells mL−1 was washed (20mM HEPES, 355mM sucrose, 10mM glucose, 2.5mM KOH;; 400mOsm/kg, pH 7; Sigma, South Africa) and after centrifugation (5min. at 600g), the pellet was resuspended in 0.5mL of washing solution (with 197mM NaCl instead of sucrose). One aliquot of spermatozoa was kept at 4°C and evaluated at 24h intervals for 7 days. A second aliquot of the sperm sample was extended in Tris-citrate egg yolk extender with glycerol (Fraction B, Biladyl), frozen in liquid nitrogen (LN) vapor and stored in LN. The frozen sample was later thawed and evaluated as for the cooled samples. Percentages of motile (MS) and progressive (PS) spermatozoa were assessed using a phase contrast microscope (×200; stage at 37°C). Sperm plasma membrane damage was assessed by determining the percentage of cells exhibiting red fluoresence after staining with propidium iodide (PI, 50ng/mL; 10min RT). Spermatozoa that did not stain red in PI were classified as plasma membrane intact (PMI). Resilience to hypo-osmotic shock and plasma membrane integrity were evaluated by incubating a portion of the sample in a 100mOsm/kg solution (10nM glucose, 20nM HEPES, 30nM NaCl) containing PI for 15min at room temperature. The percentage of sperm cells with active mitochondria (MIT) was determined by counting spermatozoa showing orange fluoresence over the mid-piece after staining with JC-1(7.5 uM Sigma) for 30min at 37°C. At collection, MS was 15% and did not show a significant decrease during the 7-day storage period. Initially, PS was 10% and dropped to 5% after 7 days, with values fluctuating during the storage period. Both PMI and HOSPMI were 80% on Day 1, gradually decreasing to 75% on Day 7 of storage. PMI and MIT showed a highly significant correlation (r=0.88; P=0.003; n=8). In frozen-thawed sperm samples, MS fell from a pre-freeze value of 15% to 5% after thawing. Similarly, PS fell from 10% in pre-freeze to 3% in frozen-thawed samples. Likewise, PMI, HOSPMI and MIT values were 80% and 45%, 87% and 45% and 89% and 49%, respectively. Our study showed that lion sperm PMI and MIT remained high after 7 days at 4°C. MS and PS, although low, did not vary during this same period. PI and JC-1 showed a significant correlation, suggesting that both might be affected by the same deleterious factors. Although PMI, HOSPMI and MIT values decreased approximately 40% after freezing, we feel that such sperm samples could be used for in vitro embryo production, if not by IVF, by ICSI. Of course, additional studies are needed to validate our suggestion.

214USE OF FLOURESCENT PROBES TO ACCESS EPIDIDYMAL SPERMATOZOA OF THE BLUE WILDEBEEST CONNOCHAETES TAURINUS AND IMPALA ANTELOPE AEPYCEROS MELAMPUS MELAMPUS

Sperm quality assessment may be a useful tool not only for evaluating the reproductive health of free-ranging populations, but also for selecting individuals for future assisted-reproduction technology programs. The aim of this study was to assess the functionality of epididymal spermatozoa collected from blue wildebeest (Connochaetes taurinus) and impala (Aepyceros melampus melampus) during the non-breeding season, using the fluorescent probes, propidium ioide (PI;; Sigma, South Africa) and JC-1 (Molecular Probes, The Netherlands). Six blue wildebeest and eight impala were harvested as part of a wildlife management program on a game ranch in South Africa. Testes were removed and transported to the laboratory within 6 hours while being maintained at 4°C. The cauda epididymides were removed and flushed with 1mL of Tris-citrate egg yolk extender (fraction A, Biladyl;; Minitüb, Germany). The sperm sample was diluted 1:4 in HEPES washing medium (Sigma;; 20mM HEPES, 355mM sucrose, 10mM glucose, 2.5mM KOH;; 400mOsm/kg, pH 7), and centrifuged for 5min at 600g, followed by re-suspending the pellet in 0.1mL of HEPES saline medium (Sigma;; as for washing medium, except 197mM NaCl instead of sucrose). The percentage of motile (MS) and progressively motile (PS) spermatozoa were determined using phase contrast microscopy (×200, 37°C). Sperm plasma membrane integrity and mitochondrial status were assessed using fluorescence microscopy (×400, 450–490nm excitation filter, 510nm dichroic-beam splitter, 520nm barrier filter) after staining with PI (50ngmL−1; 10min, RT) and JC-1 (7.5μM; 30min, 37°C), respectively. Spermatozoa with damaged plasma membranes showed a red fluorescence and spermatozoa with active and inactive mitochondria (MIT) fluoresced orange and green, respectively. Spearman correlation coefficients were calculated between spermatozoa with intact plasma membranes (IPM) and MIT, and with motility (Statistica™ package). A summary of the results is shown in the table 1. Although samples were not collected during the breeding season, sperm quality appeared to be good for the blue wildebeest, but less so for the impala. In general, impala results were more varied. Significant correlations were found for impala (n=8, P&lt;0.05) MS-IPM: 0.75; IPM-MIT: 0.83, and for blue wildebeest (n=6, P&lt;0.05), MS-IPM: 0.84; IPM-MIT: 0.81, and for pooled data (n=14, P&lt;0.01), MS-IPM: 0.93; MS-MIT: 0.87; PS-IPM: 0.67; PS-MIT: 0.66; IPM-MIT: 0.95. These correlations suggest a relationship of functional parameters to sperm motility. Both membrane integrity and mitochondrial status are important for sperm flagellar activity. The correlation between IPM and MIT indicates a relationship or the effect of common factors. In conclusion, sperm collected from blue wildebeest and impala during the non-breeding season appear functional, a fact that may be useful for future conservation programs based on assisted reproduction technology or for assessing the reproductive health status of free-ranging wildlife populations. The fluorescent probes PI and JC-1 appear useful for assessing sperm quality in these two species and should be considered for further sperm quality assessment studies in other antelope species. Table 1 Results of the analyses, showing mean±SD (max.–min.)

57EMBRYO DEVELOPMENT FOLLOWING INTERSPECIES NUCLEAR TRANSFER OF AFRICAN BUFFALO (SYNCERUS CAFFER), BONTEBOK (DAMALISCUS DORCUS DORCUS) AND ELAND (TAUROTRAGUS ORYX) SOMATIC CELLS INTO BOVINE CYTOPLASTS

Wildlife conservation requires traditional as well as innovative conservation strategies in order to preserve gene and species diversity. Interspecies nuclear transfer has the potential to conserve genes from critically endangered wildlife species where few or no oocytes are available from the endangered species, and where representative cell lines have been established for the wildlife population while numbers were still abundant. The purpose of this study was to investigate the developmental ability of embryos reconstructed with transfer of somatic cells from the African buffalo (Syncerus caffer), bontebok (Damaliscus dorcus dorcus) and eland (Taurotragus oryx) to enucleated domestic cattle (Bos taurus) oocytes. Skin tissue from the three wildlife species were collected by surgically removing approx. 1.0×1.0cm ear skin notches from animals immobilized with a combination of etorphine hydrochloride (M99; South Africa) and azaperone (Stressnil, South Africa). The biopsies were placed into physiological saline and transported to the laboratory at 4°C within 2h, cleaned with chlorohexidine gluconate and sliced finely in Minimal Essential Medium supplemented with 10% fetal calf serum. The resultant tissue explants were treated as previously described (Baumgarten and Harley 1995 Comp. Biochem. Physiol. 110B, 37–46) and actively growing fibroblast cultures made available for the nuclear transfer process. Nuclear transfer was performed using the HMC technique (Vajta et al., 2003 Biol. Reprod. 68, 571–578) using slaughterhouse-derived bovine oocytes. Culture was performed in SOFaaci (Vajta et al., 2003 Biol. Reprod. 68, 571–578) medium supplemented with 5% cattle serum using WOWs (Vajta et al., Mol. Reprod. Dev. 50, 185–191). Two identical replicates were made with somatic cells of each species. After successful reconstruction, 57, 42 and 48 nuclear transferred and activated buffalo, bontebok and eland embryos were cultured, respectively. All except for 2 buffalo embryos cleaved; 22 (39%) developed to or over the 8-cell stage, and 2 (3.5%) of them to the blastocyst stage. All but 3 bontebok embryos cleaved, 17 (40%) developed to or over the 8-cell stage, but none of them reached the compacted morula or blastocyst stage. Sixteen (33%) of the eland embryos developed to or over the 8-cell stage with one (2%) reaching the blastocyst stage. In conclusion, buffalo, bontebok and eland embryos developed from reconstruction using their respective somatic cells combined with bovine cytoplasts, however, in vitro developmental ability to the blastocyst stage was limited. Additional basic research that establishes the regulative mechanisms involved with early preimplantation development together with optimising nuclear transfer techniques may have the potential to one day play a role in the conservation of critically endangered wildlife species.

209FUNCTIONAL ASSESSMENT OF WHITE RHINOCEROS CERATHOTERIUM SIMUM EPIDIDYMAL SPERMATOZOA BEFORE AND AFTER CRYOPRESERVATION

Biological Resource Banks represent a potentially valuable tool for species conservation. It is, however, necessary to understand the species-specific cryopreservation process and its consequences for spermatozoa to aid in the development of assisted reproduction as a future conservation tool. The aim of this study was to assess the in vitro functionality of white rhinoceros Cerathoterium simum epididymal spermatozoa both before and after cryopreservation. Testes from a harvested white rhino bull were removed and transported at 5°C to the laboratory within 4h. The cauda epididymis was dissected out and flushed with 2mL of Tris-citrate egg yolk extender (fraction A, Biladyl, Minitüb, Germany). A 0.1mL aliquot was removed for analysis and the balance (9mL; 2mL fraction A+7mL sperm sample) mixed with an additional 27.2mL of Tris-citrate egg yolk with glycerol (fraction B, Bidadyl). The extended sample was allowed to cool to 4°C over a 6-h period before an additional 29.2mL of cooled fraction B were added (final sperm concentration=150×106mL−1). Sperm samples were loaded into 0.25-mL straws and frozen over LN2 vapor (4cm for 20min) for later assessment. Sperm straws were thawed by placing the straws in water at 37°C for 30s. Pre-freeze and post-thaw evaluations were carried out in the same manner. Media used included: HEPES for washing (20mM HEPES, 355mM sucrose, 10mM glucose, 2.5mM KOH) and HEPES saline (197mM NaCl, instead of sucrose). An aliquot was diluted with HEPES (washing) and centrifuged for 5min at 600×g; the pellet was resuspended in HEPES saline. Sperm motility (total motility %, TM;; and progressive motility %, PM) was assessed using phase contrast microscopy (×200; 37°C). Sperm plasma membrane status was assessed using the fluorescent dye, propidium iodide (50ngmL−1 in HEPES saline;; 10min, RT). Percentage of cells with plasma membranes intact (unstained;; PMI) was recorded. Mitochondrial status was assessed with the fluorescent dye, JC-1 (7.5μM in HEPES saline;; 30min, 37°C). The % of cells with an orange-stained midpiece was recorded (active mitochondria;; MIT). Resilience to hypoosmotic shock (HOS test) was assessed by diluting a sample in 100mOsm/kg HEPES saline (1:20; 15min, RT). An aliquot was stained with PI to assess plasma membrane status (HOSPMI), and the rest was fixed with formaldehyde, and % coiled tails (positive endosmosis;; HOST) was estimated using phase contrast microscopy (×400). Evaluations of PMI, MIT and HOSPMI were performed using fluorescence microscopy (×400, 450–490nm excitation filter). The results indicated that quality was good pre-freezing (TM: 60%; PMI: 86%; MIT: 100%), except for a PM value of 15%. After thawing, although there was a drop in TM (30%), there was no decrease in PM (20%). Our in vitro functional assessment indicated a loss of quality between the pre-freeze and post-thaw evaluations, but PMI and MIT maintained their pre-thaw levels (60% and 72%, respectively). The HOS test, which indicates plasma membrane integrity, decreased from the pre-freeze level (91%) to a post-thaw value of 70%. HOSTPMI was 72% pre-freeze, and decreased to 54% post-thaw. In conclusion, epididymal spermatozoa from the white rhino may retain its functionality after cryopreservation in a commerically available cryo-extender (Bidadyl). The use of assisted reproduction techniques could someday play a role in the management and conservation of the white rhinoceros and related species.

203TIMING OF IN VITRO OOCYTE MATURATION IN SPRINGBOK (ANTIDORCAS MARSUPIALIS), BLACK WILDEBEEST (CONNECHAETES GNU), BLESBOK (DAMALISCUS DORCUS PHILLIPSI), AND REEDBUCK (REDUNCA ARUNDINUM)

With an increased need for genetic diversity within populations, assisted reproductive technology is becoming an important tool for banking semen and embryos, with the possibility of future AI or embryo transfer between distant populations. Previous research has demonstrated that the broad approach of applying bovine IVM/F/C protocols to African antelope is inefficient for embryo production. The purpose of this study was to determine the timing of oocyte maturation (to telophase or metaphase II) in vitro in springbok (Antidorcas marsupialis; n=84), black wildebeest (Connechaetes gnu; n=18), blesbok (Damaliscus dorcus phillipsi; n=9), and reedbuck (Redunca arundinum; n=1). Ovaries were collected within 4h of death from culled animals on game reserves in South Africa, placed into warm SOF-HEPES, sliced and cumulus-oocyte complexes (COCs) collected. Complexes were placed into GMat medium supplemented with 0.01UmL−1 each FSH and LH, 50ngmL−1 EGF, and 1.0% (v/v) PSA (100U penicillin mL−1, 100μg streptomycin mL−1, 0.25ng amphotercin mL−1). Oocytes were removed from medium after 16, 20, 24, 28 or 32h of maturation in 5% CO2 in air at 39°C. After removal, complexes were denuded with hyaluronidase, mounted on a slide and placed into 3:1 (ethanol:glacial acetic acid) fixative until time of analysis. Oocytes were stained with aceto-orcein, and nuclear maturation was evaluated with a phase contrast microscope. As shown in the Table 1, in springbok (n=311), the percentage of mature oocytes peaked at 28h of maturation and was not different (P&lt;0.05) from oocytes matured for 32h. Fewer springbok oocytes were mature at 16, 20 and 24h. Black Wildebeest (n=88) oocytes were mature by 24h, with no additional increase in maturation at 28 or 32h. Blesbok oocytes (n=42) were not mature at 16 or 20h, and there was no difference (P&gt;0.05) in the percentage of oocytes mature at 24 or 28h. Observational data in reedbuck (n=10) indicated that no oocytes were mature at 20 or 24h, but 25.0% were mature at 28h. The low occurrence of mature oocytes at 28h in blesbok and reedbuck suggests that additional time points should be examined later in maturation. This study demonstrates that oocytes of these species can be successfully matured in vitro, but the rate of maturation and thus the optimal time of insemination for IVF is species specific. Table 1 Timing of in vitro oocyte nuclear maturation to telophase or metaphase II in springbok, black wildebeest and blesbok

Laparoscopic removal of a chronically retained gauze

This case report presents a 49-year-old man with a history of referred right thoracic pain due to a gauze pad, left in the abdomen 22 years earlier following a surgical intervention for gastric perforation. This subphrenic encapsulated aseptic granuloma surrounding a gauze has been removed laparoscopically. The gauze had decomposed into a semi-liquid material consisting of hundreds of small particles and could not be removed in one piece; a basket was used. As one does not know whether the gauze and its surrounding tissue has infected or become malignant, it might be better to remove it as a whole with its capsule.

Maternally inherited diabetes and deafness: a multicenter study

BACKGROUND

Maternally inherited diabetes and deafness (MIDD), which is seen in 0.5% to 2.8% of patients with type 2 diabetes mellitus, is related to a point mutation at position 3243 of mitochondrial (mt) DNA. Its clinical description is incomplete.

OBJECTIVE

To study the clinical presentation and complications of diabetes in patients with MIDD and to identify clinical characteristics that may help select diabetic patients for mtDNA mutation screening.

DESIGN

Multicenter prospective descriptive study.

SETTING

16 French departments of internal medicine, diabetes and metabolic diseases, or both.

PATIENTS

54 patients with type 2 diabetes mellitus and the mtDNA 3243 mutation.

MEASUREMENTS

Characteristics of diabetes, metabolic control (glycosylated hemoglobin level), complications of diabetes, and involvement of other organs.

RESULTS

On average, patients with MIDD were young at diabetes onset and presented with a normal or low body mass index. None were obese. Seventy-three percent of probands had a maternal family history of diabetes. Diabetes was non-insulin-dependent at onset in 87% of patients; however, 46% of patients had non-insulin-dependent disease at onset but progressed to insulin therapy after a mean duration of approximately 10 years. Neurosensory hearing loss was present in almost all patients. Eighty-six percent of patients who received an ophthalmologic examination had macular pattern dystrophy (a specific retinal lesion). Forty-three percent of patients had myopathy, 15% had cardiomyopathy, and 18% (9 of 51) had neuropsychiatric symptoms. Although the prevalence of diabetic retinopathy was 8% among patients who received an ophthalmologic examination, lower than expected after a mean 12-year duration of diabetes, prevalence of kidney disease was 28%. This suggests that a specific renal involvement was the result of mitochondrial disease.

CONCLUSIONS

Maternally inherited diabetes and deafness has a specific clinical profile that may help identify diabetic patients for mtDNA testing.

[The treatment of sterility due to retrograde ejaculation, using implantation of a pericervical sphincter prosthesis. Apropos of a case]

The authors report the case of a 26 year old man consulting for primary sterility due to retrograde ejaculation, which was associated with urinary incontinence secondary to repeated surgery to the bladder neck for neurogenic bladder in a patient with incomplete spina bifida. Pericervical implantation of an AMS 800 artificial sphincter restored perfect continence and normal ejaculation followed by a pregnancy for his wife.

[Calcium channel blockers and dysthymic disorders. Recent data]

The authors review the use of the calcium antagonists in the treatment of dysthymic disorders. Verapamil is mainly studied, but present researches focus on drugs with specific action on the CNS, particularly nimodipine. Their most constant therapeutic efficiency concerns hypomanic states; but their effect when prescribed alone remains inconstant on the manic states of bipolar disorders; in a preventive purpose, alone, or associated with lithium, their efficiency is real but inconstant. Their particular interest in dysthymic disorders is due to their absence of cognitive perturbations contrary to neuroleptics, and their less side-effects than lithium.