Female reproductive health impacts of Long COVID and associated illnesses including ME/CFS, POTS, and connective tissue disorders: a literature review

Long COVID disproportionately affects premenopausal women, but relatively few studies have examined Long COVID's impact on female reproductive health. We conduct a review of the literature documenting the female reproductive health impacts of Long COVID which may include disruptions to the menstrual cycle, gonadal function, ovarian sufficiency, menopause, and fertility, as well as symptom exacerbation around menstruation. Given limited research, we also review the reproductive health impacts of overlapping and associated illnesses including myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), postural orthostatic tachycardia syndrome (POTS), connective tissue disorders like Ehlers-Danlos syndrome (EDS), and endometriosis, as these illnesses may help to elucidate reproductive health conditions in Long COVID. These associated illnesses, whose patients are 70%-80% women, have increased rates of dysmenorrhea, amenorrhea, oligomenorrhea, dyspareunia, endometriosis, infertility, vulvodynia, intermenstrual bleeding, ovarian cysts, uterine fibroids and bleeding, pelvic congestion syndrome, gynecological surgeries, and adverse pregnancy complications such as preeclampsia, maternal mortality, and premature birth. Additionally, in Long COVID and associated illnesses, symptoms can be impacted by the menstrual cycle, pregnancy, and menopause. We propose priorities for future research and reproductive healthcare in Long COVID based on a review of the literature. These include screening Long COVID patients for comorbid and associated conditions; studying the impacts of the menstrual cycle, pregnancy, and menopause on symptoms and illness progression; uncovering the role of sex differences and sex hormones in Long COVID and associated illnesses; and addressing historical research and healthcare inequities that have contributed to detrimental knowledge gaps for this patient population.

Haemosporidian parasites and incubation period influence plumage coloration in tanagers (Passeriformes: Thraupidae)

Birds are highly visually oriented and use plumage coloration as an important signalling trait in social communication. Hence, males and females may have different patterns of plumage coloration, a phenomenon known as sexual dichromatism. Because males tend to have more complex plumages, sexual dichromatism is usually attributed to female choice. However, plumage coloration is partly condition-dependent; therefore, other selective pressures affecting individuals' success may also drive the evolution of this trait. Here, we used tanagers as model organisms to study the relationships between dichromatism and plumage coloration complexity in tanagers with parasitism by haemosporidians, investment in reproduction and life-history traits. We screened blood samples from 2849 individual birds belonging to 52 tanager species to detect haemosporidian parasites. We used publicly available data for plumage coloration, bird phylogeny and life-history traits to run phylogenetic generalized least-square models of plumage dichromatism and complexity in male and female tanagers. We found that plumage dichromatism was more pronounced in bird species with a higher prevalence of haemosporidian parasites. Lastly, high plumage coloration complexity in female tanagers was associated with a longer incubation period. Our results indicate an association between haemosporidian parasites and plumage coloration suggesting that parasites impact mechanisms of sexual selection, increasing differences between the sexes, and social (non-sexual) selection, driving females to develop more complex coloration.

Local People Standings on Existing Farm Animal Welfare Legislation in the BRIC Countries and the USA. Comparison with Western European Legislation

This study explored the demand for improved farm animal welfare (FAW) legislation in the BRIC countries and the USA. Results are discussed in comparison to Europe. Interviewees ranked their willingness to support or oppose introduction of more FAW-friendly laws in their country. A multinomial logistic regression was fit to the data (p < 0.001), with the parameters "country × gender" (p < 0.001) and "country × age" (p < 0.001) found significant. Americans, Russian women, and older Brazilian men are very supportive. The age effect is also felt in India, where older people are more supportive. Chinese, American men, and younger Indians are less supportive. Russian males are the group that oppose the most, followed by younger Brazilians and Indians. The law and its application vary a lot between countries. Nevertheless, the societal willingness to improve FAW legislation is high in all countries. The willingness is higher in Europe. The different cultural backgrounds, the socio-economic factors, and the social, economic, and environmental sustainability are enough reasons to create barriers to policy harmonization in the global trade of farm animal products.

Host life-history traits predict haemosporidian parasite prevalence in tanagers (Aves: Thraupidae)

Vector-borne parasites are important ecological drivers influencing life-history evolution in birds by increasing host mortality or susceptibility to new diseases. Therefore, understanding why vulnerability to infection varies within a host clade is a crucial task for conservation biology and for understanding macroecological life-history patterns. Here, we studied the relationship of avian life-history traits and climate on the prevalence of Plasmodium and Parahaemoproteus parasites. We sampled 3569 individual birds belonging to 53 species of the family Thraupidae. Individuals were captured from 2007 to 2018 at 92 locations. We created 2 phylogenetic generalized least-squares models with Plasmodium and Parahaemoproteus prevalence as our response variables, and with the following predictor variables: climate PC1, climate PC2, body size, mixed-species flock participation, incubation period, migration, nest height, foraging height, forest cover, and diet. We found that Parahaemoproteus and Plasmodium prevalence was higher in species inhabiting open habitats. Tanager species with longer incubation periods had higher Parahaemoproteus prevalence as well, and we hypothesize that these longer incubation periods overlap with maximum vector abundances, resulting in a higher probability of infection among adult hosts during their incubation period and among chicks. Lastly, we found that Plasmodium prevalence was higher in species without migratory behaviour, with mixed-species flock participation, and with an omnivorous or animal-derived diet. We discuss the consequences of higher infection prevalence in relation to life-history traits in tanagers.

Prévalence de la dénutrition et évaluation de l’efficacité d’une prise en charge nutritionnelle précoce chez les patients hospitalisés atteints du COVID-19

Introduction et but de l’étude

L’infection par le SARS-Cov2 (COVID-19) s’associe à un risque majeur de dénutrition. Cependant, les données nutritionnelles chez les patients atteints de COVID-19 sont limitées. Nos objectifs étaient :

– d’évaluer la prévalence de la dénutrition chez les patients hospitalisés pour COVID-19 à j0 puis à j30 post-hospitalisation ;

– d’étudier les liens entre dénutrition et gravité de la maladie à l’admission ;

– d’étudier l’impact de la dénutrition sur une évolution défavorable de la maladie (transfert vers une unité de soins intensifs (USI) ou décès) ;

– d’évaluer l’impact d’une prise en charge nutritionnelle précoce.

Matériel et méthodes

Tous les patients hospitalisés pour COVID-19 dans le service de médecine interne du CHU Pitié-Salpêtrière ont été inclus du 21 mars au 24 avril 2020 (n = 114, 60,5 % d’hommes, âge : 59,9 ± 15,9 ans). L’état nutritionnel de ces patients a été défini en utilisant les critères de la Haute Autorité de santé (HAS) 2019. Les caractéristiques cliniques, radiologiques et biologiques des patients atteints de COVID-19 ont été comparées en fonction de leur statut nutritionnel. Une régression logistique a été utilisée pour évaluer les associations entre les paramètres nutritionnels et l’évolution défavorable de la maladie. Une prise en charge nutritionnelle précoce selon la perte de poids et d’appétit des patients (consistant à une alimentation enrichie, une prévention du syndrome de renutrition inappropriée, des compléments nutritionnels oraux CNO et/ou une nutrition entérale NE), a été mise en place dès l’admission. À j30 post-hospitalisation, les données nutritionnelles cliniques, biologiques, anthropométriques, ont été collectées afin d’étudier l’évolution de l’état nutritionnel.

Résultats et analyse statistique

La prévalence globale de la dénutrition à j0 était de 44,6 % (14,2 % de dénutrition modérée, 30,4 % de dénutrition sévère). Celle-ci atteignait 66,7 % chez les patients provenant d’un service de réanimation. Une hypoalbuminémie initiale était associée à un risque plus élevé de transfert en unité de soins intensifs (pour 10 g/L d’albumine, OR [IC95 %] : 0,31 [0,1 ; 0,7] ; p < 0,01) et ce, indépendamment de l’âge et de la CRP. Après prise en charge nutritionnelle (69 % de CNO et 2,6 % de NE), la prévalence de la dénutrition à j30 post-hospitalisation était de 20,6 % (15,2 % de dénutrition modérée et 5,4 % de dénutrition sévère). À j30, on observait une masse musculaire basse selon impédancemétrie et une fonction musculaire altérée selon Handgrip chez 29,3 % des patients par rapport aux normes HAS.

Conclusion

La COVID-19 en service de médecine est associée à une forte prévalence de la dénutrition, encore plus marquée chez les patients provenant d’une USI. L’hypoalbuminémie à l’admission est associée à une évolution défavorable de la maladie, et ce indépendamment de la CRP et de l’âge. Un dépistage et une prise en charge nutritionnelle globale est possible (malgré les difficultés de recueil de données anthropométriques et de mise en place de la stratégie nutritionnelle liées aux mesures barrière), nécessaire et efficace chez ces patients, de manière précoce, ainsi que dans le suivi.

In vivo assessment of body composition and growth potential of modern broiler using dual-energy X-ray absorptiometry

Context Genetic improvements in modern strains have led to continuous increments in broiler growth rates, which, as a consequence, have resulted in higher economic returns for broiler producers over the last decades. Aim The present study was conducted to characterise the potential growth of the body and feathers of Cobb 500, Hubbard Flex and Ross 308 male and female broilers, as well as to assess the changes in chemical composition that occur up to 16 weeks of age. Methods Birds were fed isoenergetic diets divided in four phases and formulated to marginally exceed the nutritional requirements of the strains throughout the growing period. They were maintained in a controlled environment so as not to limit growth. A dual energy X-ray absorptiometry (DXA) scanner was used to follow the in vivo body composition of 12 broilers of each strain and sex (total of 72 broilers), and the feather weight and composition was determined in four birds of each strain and sex selected at intervals during the growing period (total of 288 broilers) through comparative slaughter with later chemical analysis. Key results Parameters of Gompertz growth curve to describe the strains were estimated for body and feather weight as well as for the growth of their chemical components. Conclusion Differences in the growth rates between strains were evident, indicating the possible differences in selection methods used by geneticists in the different breeding companies. These genetic parameters would explain part of the variation on broiler´s performance which impacts on the way they should be fed and housed during growth. Implications The accurate description of genetic growth potential is useful information to be associated with factorial models that predict nutritional and feed intake requirements of birds. The main advantage of DXA technology is to decrease the variation of body deposition on the Gompertz model, resulting from the use of the same bird throughout its life. Despite the speed of obtaining chemical values of the body, the method is unsuitable for measuring the growth of feathers, which is also important data to be collected and related to the broiler strains.

Bacillus amyloliquefaciens CECT 5940 alone or in combination with antibiotic growth promoters improves performance in broilers under enteric pathogen challenge

A study was conducted to investigate the effects of Bacillus amyloliquefaciens CECT 5940 as a direct-fed microbial (DFM) alone or in association with bacitracin methylene disalicylate (BMD) in broilers under enteric pathogen challenge. A total of 1,530-day-old male Cobb500 chicks were randomly assigned to 5 treatments, with 9 replicate pens with 34 birds each. Treatments included positive control (PC, basal diet without additives or challenge); negative control (NC, basal diet without additive and challenged birds); NC + 0.05 g/kg BMD; NC + 1 g/kg DFM (10⁶ CFU B. amyloliquefaciens CECT 5940/g of feed); and NC + 0.05 g/kg BMD + 1 g/kg DFM. The challenge consisted of oral gavage with Eimeria maxima and Clostridium perfringens inoculum. Body weight gain (BWG), feed intake (FI), and feed conversion ratio (FCR) were evaluated on days 21, 35, and 42. Ileal and cecal content were collected on days 21 and 28 for C. perfringens enumeration by real-time PCR assay and the intestinal health was evaluated by scores. Uniformity (UN), carcass (CY), and breast meat yields (BMY) were evaluated on day 42. After 14 and 21 d post-inoculation, birds in the challenged groups had significant lower FI and BWG compared to the PC group (P < 0.05). However, the groups receiving DFM, BMD, or its combination presented better FCR, CY, BMY, UN, and lower incidence of footpad lesion and litter quality visual scores, compared to the NC group without feed additives (P < 0.05). Mortality was not affected by treatments (P > 0.05). Broilers fed DFM, BMD, or its combination presented lower C. perfringens in ileal content at 21 and 28 d compared to NC group without additives (P < 0.05) and also maintained gut health by keeping the frequency of ballooning, abnormal content, and swollen mucosa comparable to the PC group (P > 0.05). The study indicates that Bacillus amyloliquefaciens CECT 5940 is effective as BMD to provide similar performance and gut health in challenged broilers.

Growth performance and carcass yield of broiler chickens in response to carbohydrases and its association with phytase

ABSTRACT An experiment was conducted to evaluate broiler chicken performance and carcass yield in response to carbohydrase supplementation (Xylanase and Betaglucanase; XB) and association of carbohydrase and phytase (PHY). A total of 1,920 day-old male broiler chicks (Cobb 500) were distributed in a completely randomized design with 8 treatments and 8 replicates each, allocated in 64 pens with 30 chicks each. The treatments were: Positive Control (PC); Negative Control (NC): reduced ME [-120kcal/kg (Starter) and -170kcal/kg (Finisher)]; NC + XB [50g/ton]; NC + XB [100g/ton]; NC + XB [150g/ton]; NC + XB [50g/ton] + PHY [100g/ton]; NC + XB [100g/ton] + PHY [100g/ton]; NC + XB [150g/ton] + PHY [100g/ton]. The inclusion of XB (150) and XB (50, 100, and 150) associated with phytase increased feed intake than positive control when considering the total rearing phase. The feed conversion ratio of all broilers fed diets with energy reduction were worse than positive control, even with the addition of enzymes, and did not differ between them. There was no significant effect of treatments on carcass parameters.

Nitrogen maintenance requirements and potential for nitrogen retention of pullets in growth phase

Experiments were conducted to estimate daily N maintenance requirements (NMRs) and the genetic potential for daily N retention (NR_max T) of pullets in growth phase. Three nitrogen balance trials were conducted, and a total of 48 Hy-line W-36 pullets were used in each trial in age periods (starter: 14-28, grower: 56-70 and developer: 98-112 days). The treatments consisted of six graded levels of nitrogen in the diets (L1 = 8, L2 = 16, L3 = 24, L4 = 32, L5 = 40 and L6 = 48 g N/kg of feed), formulated using the dilution technique. The regression analyses between nitrogen intake and nitrogen excretion were performed to fit the exponential function and to determine the NMR. The daily NMRs that were estimated at 294, 331 and 355 mg/BW_kg ^0.67 for the initial, grower and developer periods, respectively, were applied for further calculation of NR_max T as the threshold value of the function between N intake and daily N balance. The NR_max T was estimated by a statistical procedure following several iteration steps by the Levenberg-Marquardt algorithm until the sum of the squares of the residual was minimized. The NR_max T was estimated at 3,200, 2,633 and 1,826 mg/BW_kg ^0.67 for starter, grower and developer periods respectively. The determined model parameters were the precondition for modelling of the amino acid requirement based on an exponential N-utilization model and depended on performance and dietary amino acid efficiency. This procedure will be further developed and applied in the subsequent study.

Optimal in-feed amino acid ratio for laying hens based on deletion method

A total of 56 Hy‐line W‐36 hens from 28 to 30 weeks were used on nitrogen balance (NB) trial to estimate daily N maintenance requirements (NMR) and the genetic potential for daily N retention (NR_maxT). The treatments consisted of six graded levels of nitrogen in the diets (N1 = 8; N2 = 16; N3 = 24; N4 = 32; N5 = 40; and N6 = 48 g N/kg of feed), formulated using the dilution technique. The regression analyses between nitrogen intake and excretion were performed to fit the exponential function and to determine the NMR = 292 mg/BW_kg^0.67, which was applied for further calculation of NR_maxT = 1,883 mg/BW_kg^0.67. A second NB trial was conducted, and a total of 96 Hy‐line W‐36 hens were used in the same period to estimate the ideal amino acid ratio (IAAR). Twelve treatments with eight replicates and one bird per cage were used. A balanced diet (BD) was formulated to meet the IAAR and the requirement of other nutrients for pullets. The limiting diets were formulated diluting BD with cornstarch and refilled with synthetic AAs and other feed ingredients, except for the AA under study. In each trial, the data of nitrogen intake, excretion, deposition and retention were obtained in a NB trial. The IAAR determined by Goettingen approach was Lys 100, Met+Cys 88, Trp 21, Thr 69, Arg 109, Val 90, Ile 75, Leu 127, Phe+Tir 110, Gly+Ser 73 and His 29%. The IAAR determined by Louvain approach was Lys 100, Met+Cys 88, Trp 21, Thr 69, Arg 104, Val 91, Ile 78, Leu 121, Phe+Tir 119, Gly+Ser 77 and His 29%.

The malaria parasite Plasmodium relictum in the endemic avifauna of eastern Cuba

Island populations are vulnerable to introduced pathogens, as evidenced by extinction or population decline of several endemic Hawaiian birds caused by the malaria parasite, Plasmodium relictum (order Haemosporida). We analyzed blood samples from 363 birds caught near Guantánamo Bay, Cuba, for the presence of haemosporidian infections. We characterized parasite lineages by determining nucleotide variation of the parasite's mitochondrial cyt b gene. Fifty-nine individuals were infected, and we identified 7 lineages of haemosporidian parasites. Fifty individuals were infected by 6 Haemoproteus sp. lineages, including a newly characterized lineage of Haem. (Parahaemoproteus) sp. CUH01. Nine individuals carried the P. relictum lineage GRW4, including 5 endemic Cuban Grassquits (Tiaris canorus) and 1 migratory Cape May Warbler (Setophaga tigrina). A sequence of the merozoite surface protein gene from one Cuban Grassquit infected with GRW4 matched that of the Hawaiian haplotype Pr9. Our results indicate that resident and migratory Cuban birds are infected with a malaria lineage that has severely affected populations of several endemic Hawaiian birds. We suggest GRW4 may be associated with the lack of several bird species on Cuba that are ubiquitous elsewhere in the West Indies. From the standpoint of avian conservation in the Caribbean Basin, it will be important to determine the distribution of haemosporidian parasites, especially P. relictum GRW4, in Cuba as well as the pathogenicity of this lineage in species that occur and are absent from Cuba.

Prevalence of bovine milk pathogens in Azorean pastures: mobile versus fixed milking machines

The aims of the present study were (1) to evaluate the influence of using mobile (n=47) or fixed (n=45) milking machines in Azorean herds on the apparent prevalence of several milk pathogens in bulk tank milk (BTM) and (2) to determine whether separated subclinical mastitic cows can serve, in real time, as predictors of milk pathogen prevalence for the remaining animals at the herd level. The use of a mobile or fixed milking machine influenced (P≤0.05) the prevalence of Staphylococcus aureus (72.3 per cent; n=34 v 51.1 per cent; n=23, respectively) and Klebsiella species (46.8 per cent; n=22 v 26.7 per cent; n=12, respectively). S aureus (95 per cent CI OR 1.1 to 6.0) and Klebsiella species (95 per cent CI OR 1.0 to 5.8) were 2.5 times more likely to increase in the BTM of herds using mobile milking machines. The prevalence of coagulase-negative staphylococci (100 per cent; n=92), Escherichia coli (75.0 per cent), Corynebacterium bovis (57.6 per cent), Enterococcus species (55.4 per cent), Streptococcus dysgalactiae (51.1 per cent), Streptococcus uberis (41.3 per cent), Actinomyces pyogenes or Peptostreptococcus indolicus (41.3 per cent) and Streptococcus agalactiae (32.6 per cent) in BTM remained similar among the herds. κ coefficients were always <0.70, indicating intra-herd disagreement of the prevalence of milk pathogens between BTM and separated milking cows. Milking hygiene should be improved in pastures, focusing specifically on herds that use a mobile milking machine. The segregated cows at milking time are not good predictors of milk pathogens in BTM.

Description of a model to optimise the feeding of amino acids to growing pullets

1. A nutrition model is described that may be used to optimise the amino acid nutrition of laying-type pullets prior to the onset of lay. It is not a method of optimising lifetime laying performance. 2. The potential growth and composition of the body, feathers, ovary and oviduct are described from hatching to the age at which sexual maturity is attained, from which the daily amino acid and energy requirements for the average individual in the population can be calculated. 3. There are two parts to the approach used, the first being a description of the model itself and the second being a description of how the required information was gathered. A number of assumptions made in developing the model are discussed. 4. The rates of maturing of the body, feather-free body and body protein of the DeKalb pullets used were shown to be constant at 0.017/d and those of feathers at 0.02/d. These are considerably slower than those of the oviduct and ovary (0.139 and 0.084/d respectively). The ovary attained a higher mature weight (78.4 vs. 58.7 g) than the oviduct. 5. The age at which the growth of the reproductive organs is initiated in the model is defined by the user. The daily amount of threonine required to meet the requirements for maintenance and potential growth of the developing tissues and organs is calculated for each day of the growing period from hatching to the age at which the first egg is laid. A method of calculating the required daily concentration of threonine in the feed is described, from which a feeding programme may be derived. 6. For the model to produce an optimum economic feeding programme for a population of laying-type pullets, more information than is available from this study is required. These issues are discussed in the paper.

Conservation implications of complex population structure: lessons from the loggerhead turtle (Caretta caretta)

Complex population structure can result from either sex-biased gene flow or population overlap during migrations. Loggerhead turtles (Caretta caretta) have both traits, providing an instructive case history for wildlife management. Based on surveys of maternally inherited mtDNA, pelagic post-hatchlings show no population structure across the northern Atlantic (phi(ST) < 0.001, P = 0.919), subadults in coastal habitat show low structure among locations (phi(ST) = 0.01, P < 0.005), and nesting colonies along the southeastern coast of the United States have strong structure (phi(ST) = 0.42, P < 0.001). Thus the level of population structure increases through progressive life history stages. In contrast, a survey of biparentally inherited microsatellite DNA shows no significant population structure: R(ST) < 0.001; F(ST) = 0.002 (P > 0.05) across the same nesting colonies. These results indicate that loggerhead females home faithfully to their natal nesting colony, but males provide an avenue of gene flow between regional nesting colonies, probably via opportunistic mating in migratory corridors. As a result, all breeding populations in the southeastern United States have similar levels of microsatellite diversity (H(E) = 0.70-0.89), whereas mtDNA haplotype diversity varies dramatically (h = 0.00-0.66). Under a conventional interpretation of the nuclear DNA data, the entire southeastern United States would be regarded as a single management unit, yet the mtDNA data indicate multiple isolated populations. This complex population structure mandates a different management strategy at each life stage. Perturbations to pelagic juveniles will have a diffuse impact on Atlantic nesting colonies, mortality of subadults will have a more focused impact on nearby breeding populations, and disturbances to adults will have pinpoint impact on corresponding breeding populations. These findings demonstrate that surveys of multiple life stages are desirable to resolve management units in migratory marine species.

Atrial flutter ablation with a new radiofrequency catheter

OBJECTIVE

To assess the performance of a new radiofrequency catheter, specially designed for inferior vena cava-tricuspid annulus (IVC-TA) isthmus ablation, in the treatment of atrial flutter.

PATIENTS

IVC-TA isthmus ablation was performed in thirteen patients, eleven men and two women, aged 60 +/- 12, with a diagnosis of typical atrial flutter, symptomatic despite anti-arrhythmic therapy. The flutter was present for more than one year in seven patients and was paroxysmal in the remainder. The echocardiogram showed atrial enlargement in six patients. Atrial flutter was an isolated phenomenon in seven patients and in the remainder was associated with arterial hypertension (two patients), ischemic heart disease (two patients) and dilated cardiomyopathy (two patients).

METHODS

In the electrophysiologic study four diagnostic catheters were used, including one duodecapolar for mapping the tricuspid annulus. In the patients who presented with sinus rhythm, atrial flutter was induced with programmed atrial stimulation, and then the atrial activation circuit was mapped. To demonstrate the entrainment phenomenon the IVC-TA isthmus was over-stimulated, to prove that this was the slow zone of the circuit. The radiofrequency energy was applied in the IVC-TA isthmus with the Medtronic Cosio-Fluttr ablation catheter, for 60 sec per application, with temperature control and with a maximum energy output of 50 W. Criteria for success were not only the disappearance of the atrial flutter during the application of radiofrequency energy, but also the demonstration of bi-directional IVC-TA isthmus block.

RESULTS

The primary success rate was 100%. The mean procedure time was 110 +/- 22 min, mean fluoroscopy time was 23 +/- 4 min and the number of radiofrequency energy pulses was 9 +/- 3. There were no complications. The patients were followed for a mean time of 8 +/- 4 months and atrial flutter recurred in only one patient (8%).

CONCLUSIONS

Atrial flutter ablation with the new Medtronic Cosio-Fluttr catheter, specially designed for the application of radiofrequency at the IVC-TA isthmus, is a safe procedure and has a high success rate. It simplifies ablation, decreasing the number of radiofrequency energy pulses, without using long sheaths and keeping short procedure and fluoroscopy times.

[Deciding about pacing mode in sinus node dysfunction: should carotid sinus massage be performed and in which circumstances?]

OBJECTIVE

To state the incidence of carotid sinus syndrome (CSS) with atrioventricular node manifestation in patients with sinus node dysfunction (SND) and indication for a definitive pacemaker (PM), we propose a new protocol between atrial pacing AAI and double chamber DDD.

POPULATION AND METHODS

69 patients (PTS) (male 71%), median age 65 +/- 10 years, with SND (normal PQ and no intraventricular conduction defect), that had a PM implant following the protocol that included carotid sinus massage for the pacing decision, were followed prospectively between December 1995 and November 1999. During the protocol we implanted DDD PM in PTS with Wenckebach less than 130 or Wenckebach equal/over 130 and CSS. At least, in PTS with Wenckebach equal/over 130 and no CSS we implanted AAI PM. The follow-up was between 4 months and 4 years, with clinical evaluation in the first and fourth months and then half yearly, with carotid sinus massage in the first evaluation.

RESULTS

About 1/4 of the 69 patients followed had SND without carotid sinus syndrome, or atrioventricular node repercussion; the SND involved the atrioventricular node in 56% of the patients, and there was a relation between the SND and carotid sinus syndrome in 18.8%. The follow-up revealed, in all patients, a complete remission of the symptoms, and when we repeated the carotid sinus massage in the first evaluation, there was a response like in the surgery room, in all patients.

CONCLUSIONS

There is a significant number of patients with SND and carotid sinus syndrome. The carotid sinus massage performed in the surgery room does not influence the test sensitivity and specificity in the diagnosis of carotid sinus syndrome. The authors think that carotid sinus massage should be considered in the protocol that defines the pacing mode, in patients with SND, and that influence the choice of pacemaker in 18.8% of patients.

Relationship between semantic paraphasias and related nonverbal factors

Word-finding deficits are a common problem in aphasic patients. One hypothesis suggests that the difficulty that patients experience in naming objects or pictures is related to a disruption in the ability to access the lexicon. Another hypothesis suggests that these problems are caused by a disruption of the mental dictionary and the semantic representations contained in it. The main purpose of this study is to assess whether nonverbal factors such as the ability to distinguish between similar attributes of objects is related to word-use problems in aphasia. 14 adults with left hemisphere cerebrovascular accidents and some word use deficit were administered the first 30 items of the Boston Naming Test and the Conceptual Matching subtest of the Detroit Test of Learning Aptitude. Errors on the Conceptual Matching subtest correlated significantly with the number of semantic paraphasias.

Myocardial architecture, texture and left ventricular heterogeneity in the pulsed Doppler tissue imaging pattern

The regional contribution for the global ventricular functional performance is complex and heterogeneous, the myocardial texture could reflect this particular aspect, during the phases of myocardial contraction and relaxation. The objective of our clinical study was to evaluate the relationship between the segmental myocardial velocity pattern by Doppler tissue imaging and the ultrasound characteristics of the left ventricular myocardium analysed by computerized ultrasound densitometry with the calculation of its intensity (dB), in a population of 22 subjects without clinical history of cardiovascular pathology, 50% female gender, mean age 43 +/- 11 years (19-66 years). In the methodology of study, the left ventricular myocardium was divided in 16 segments, according with the transthoracic echocardiographic recommendations of the American Society of Echocardiography (A.S.E.). During one cardiac cycle interval, the ultrasound characteristics of the left ventricular myocardium were evaluated continuously and in a quantitative manner, applying the computerized ultrasound densitometry method on the gray scale images of the ventricular myocardium, with the sample size identical to the myocardial wall thickness. The peak (Vmax-cm/sec) and mean (Vm-cm/sec) pulsed Doppler tissue imaging velocities, individuals, segmental and a total velocities, contraction and relaxation velocities of the left ventricular myocardium were obtained immediately after the computerized ultrasound densitometry analysis. Ultrasound densitometry and Doppler tissue imaging data were obtained in a total number of 352 left ventricular myocardial segments. Using the multiple linear correlation matrix analysis, the ultrasound intensity registered inverse significant correlation's with the Doppler tissue imaging Vmax and Vm for the systolic "s" wave in the total segments and each one of them (r = -0.66; p = 0.001; interval 2-18 cm/sec; r = -0.52 to -0.70) and with the early diastolic "e" wave (r = -0.42; p = 0.01; interval 2-19 cm/sec; r = -0.35 to -0.55). Direct correlation's were obtained for the computerized ultrasound densitometry intensity and Doppler tissue imaging Vmax and Vm of the late diastolic "a" wave in the total number of the left ventricular myocardial wall segments and in each one of them (r = 0.51; p = 0.01; interval 1-17 cm/sec; r = 0.42 a 0.66). We conclude that in our study and under physiological conditions of myocardial performance, a direct correlation was obtained between the ultrasound characteristics of the ventricular myocardial imaging and its velocities of contraction and relaxation. These facts reflect the close relationship between left ventricular myocardial structure and function, analyzed by the new ultrasound Doppler technologies.

Spontaneous ovarian hyperstimulation and primary hypothyroidism with a naturally conceived pregnancy

BACKGROUND

Ovarian hyperstimulation syndrome, not related to ovulation induction, is rare. A MEDLINE search from 1987 to 1997 using the key words "spontaneous ovarian stimulation," "pregnancy," and "hypothyroidism" revealed only five cases: three associated with pregnancies and two with primary hypothyroidism.

CASE

A 25-year-old white gravida 2, para 1, at 11-12 weeks' gestation presented with mild distension of a nontender abdomen, myxedematous facies, and large bilateral, multilobulated ovarian cysts. Conception had occurred spontaneously. Thyroid stimulating hormone was elevated, and free triiodothyronine and free thyroxine were low. Hypothyroidism, associated with spontaneous ovarian hyperstimulation syndrome, was diagnosed, and oral levothyroxine (0.10 mg/day) was started. With TSH still elevated at 21 weeks, levothyroxine was increased to 0.20 mg/day, and by 24 weeks, TSH and ovarian size were normal. Vaginal delivery of a 1120 g male infant occurred at 28 weeks.

CONCLUSION

A case of naturally conceived pregnancy associated with spontaneous ovarian hyperstimulation and primary hypothyroidism is reported.

Bartter's syndrome and pregnancy

Bartter's syndrome is a rare renal tubular disorder and few cases are reported associated with pregnancy. We describe a case of long standing disease with a good obstetric outcome in which the main concern was to maintain normal potassium serum levels.

Alpha3beta1-integrin as a critical mediator of the hepatic differentiation response to the extracellular matrix

The extracellular matrix (ECM) promotes the differentiation of many cell types, and ECM remodeling in the liver has been implicated in embryonic development, tissue injury, and oncogenesis. Integrins are heterodimeric ECM receptors that play critical roles in transducing the composition of the ECM in the cell environment. We previously showed that mouse H2.35 cells, a conditionally transformed, liver-derived cell line, assume a more differentiated hepatocyte morphology and enhanced liver-specific gene expression when the cells are cultured on gelatinous ECM substrata. Here we show that H2. 35 cells express relatively high levels of alpha3beta1-integrins, similar to that previously shown for immature hepatocytes, transformed hepatocytes, and biliary cells. However, the cell morphological responses that depend on alpha3beta1-integrin have not been defined. We found that transfecting H2.35 cells with antisense RNA construct directed to alpha3-subunit messenger RNA perturbs the initial cell attachment to laminin and collagen, and strongly inhibits cell morphological, proliferative, and gene expression responses to a collagen gel substratum. In situ hybridization to mouse embryo tissues demonstrates the presence of alpha3-subunit messenger RNAs in newly formed hepatocytes. We suggest that alpha3beta1-integrins are important for immature and transformed hepatocytes to respond morphologically to the extracellular matrix.

Cardiac consequences of renal transplantation changes in left ventricular morphology

OBJECTIVE

The aim of this study was to characterize changes in left ventricular morphology and function by conventional echocardiography in a pediatric population after renal transplantation (RT).

MATERIAL AND METHODS

This study includes 21 children, 11 female and 10 male, aged 11.8 +/-2.6 years at the time of renal transplantation. Eleven were on regular hemodialysis treatment and two on continuous peritoneal dialysis for 31.8 +/- 31.6 months; eight were transplanted without prior dialysis. Eight children were hypertensive before RT and nine (seven de novo) after RT. The patients were analysed in a prospective follow-up study with echocardiography immediately before and 30.2 +/- 15 months after successful renal transplantation. We measured the following echocardiographic parameters: Left ventricular end diastolic (LVED) and end systolic diameter (LVES), left atrial dimension (LAD), septal thickness (IVST), posterior wall thickness (PWT), shortening fraction (SF) and left ventricular index mass (LVIM). The paired Student's test, Fisher exact test and Pearson's correlation were used for statistical analysis. We analyzed the echocardiographic changes in the total group and separately in the subgroups with and without prior hemodialysis, as well as the influence of the duration of dialysis, anemia and hypertension.

RESULTS

1. After renal transplantation we found a decrease in the LVED LVES, LAD, IVST and PWT measurements (p < 0.05). There was a negligible increase in SF. The LVIM decreased from 139 g/m2 to 104 g/m2, representing a 21% reduction of the initial value, but this reduction was not of statistically significant. 2. The findings were similar in the hemodialysis group-LVIM decreased from 167.6 g/m2 to 94.9 g/m2, representing a 35% reduction in the initial value. 3. In the non dialysis group LVED, LVES, LAD and SVT decreased and LVIM showed a minor increase. There was a negligible increase in SF. 4. We found an increased LVIM in children with prior hemodialysis before RT, especially if dialysis lasted for more than two years. 5. Amelioration of hematocrit correlated with reduction of LVIM. 6. Regression of LV hypertrophy after RT was not dependent on blood pressure levels.

CONCLUSIONS

Renal transplantation resulted in a tendency towards normalization of the echocardiographic parameters analysed: Contractility, as assessed by shortening fraction, was normal in this population. Although cardiac hypertrophy and dilation is reversible after RT, it would seem that children may benefit from an earlier transplantation.

[Gaucher's disease in pregnancy]

A case of Gaucher's disease associated with pregnancy is reported. Although clinical symptoms were not present, portal hypertension was detected by ultrasound in the 13th week of pregnancy. Maternal anemia implied the use of erythropoietin from the 33rd week onwards. Good perinatal and maternal outcomes were achieved and there were no hemorrhagic complications.

Major histocompatibility complex binding affinity of an antigenic determinant is crucial for the differential secretion of interleukin 4/5 or interferon gamma by T cells

Differential activation of CD4+ T-cell precursors in vivo leads to the development of effectors with unique patterns of lymphokine secretion. To investigate whether the differential pattern of lymphokine secretion is influenced by factors associated with either the display and/or recognition of the ligand, we have used a set of ligands with various class II binding affinities but unchanged T-cell specificity. The ligand that exhibited approximately 10,000-fold higher binding to I-Au considerably increased the frequency of interferon gamma-producing but not interleukin (IL) 4- or IL-5-secreting cells in vivo. Using an established ligand-specific, CD4+ T-cell clone secreting only IL-4, we also demonstrated that stimulation with the highest affinity ligand resulted in interferon gamma production in vitro. In contrast, ligands that demonstrated relatively lower class II binding induced only IL-4 secretion. These data suggest that the major histocompatibility complex binding affinity of antigenic determinants, leading to differential interactions at the T cell-antigen-presenting cell interface, can be crucial for the differential development of cytokine patterns in T cells.

Development of 124 sequence-tagged sites and cytogenetic localization of 217 cosmids for human chromosome 10

A total of 124 new chromosome 10-specific sequence-tagged sites (STSs) were derived from two sources: (1) DNA sequences obtained from anonymous clones in new libraries enriched for human chromosome 10 inserts, and (2) published sequences of genes and other loci already known to map to chromosome 10. Libraries were constructed from a somatic cell hybrid carrying human chromosomes 10 and Y. A cosmid library was made from total DNA of the hybrid and probed with labeled total human DNA to identify clones with human DNA inserts. Two hundred seventeen cosmids were mapped to regions of human chromosome 10 by fluorescence in situ hybridization. Twenty-five cosmids represent probes that have been placed on the genetic map previously. One hundred ninety-two cosmids represent new probes that have not been mapped previously. Cosmids carrying inserts with CA repeats were identified by hybridization with a labeled poly(dC-dA)-poly(dG-dT) probe and subcloned to yield microsatellite STS markers. Two small insert plasmid libraries were made, the first by subcloning inserts from a chromosome 10-enriched lambda phage library (LL10NS01) and the second by cloning Alu element-mediated PCR products amplified from hybrid DNA. STSs were generated from the DNA sequences of clone inserts. Chromosome 10-specific STSs were distinguished from Y chromosome STSs by one or both of the following criteria: (1) successful PCR amplification from a template consisting of DNA from another chromosome 10-containing cell line, NA10926B, or (2) FISH localization to chromosome 10 of the source cosmid or of YACs isolated by PCR screening with the STS. These libraries were the source of 90 new chromosome 10-specific STSs, 42 of which contain CA repeats.

Phorbol regulation of topoisomerases I and II in human leukemia cells. Studies in an additional cell pair sensitive or resistant to phorbol-induced differentiation

We previously reported (Zwelling et al., Cancer Res 50: 7116-7122, 1990) that etoposide-induced DNA cleavage and mRNA coding for topoisomerase II are reduced in HL-60 cells induced to differentiate by phorbol ester. Reduction of etoposide-induced cleavage and topoisomerase II message did not occur in the derived cell line 1E3 (which is resistant to phorbol-induced differentiation), implying that topoisomerase II activity may be related to the state of cell differentiation. We have extended these studies using a new phorbol sensitive/resistant cell pair, S (sensitive) and PET (phorbol ester tolerant). Phorbol ester exposure not only reduced etoposide-induced DNA cleavage and topoisomerase II mRNA in S cells but also decreased the amount of immunoreactive topoisomerase II enzyme in whole S cells. However, immunoreactive topoisomerase II extracted from the nuclei of phorbol-treated S cells was not reduced compared with that from the nuclei of untreated S cells. This suggests that topoisomerase II contained in nuclear extracts is not always representative of the total cellular enzyme. Dramatic decreases in the amount, activity, or gene expression of topoisomerase II were not observed after phorbol treatment of the resistant PET cells; this is consistent with the potential involvement of topoisomerase II in monocytoid differentiation. Levels of topoisomerase I enzyme and mRNA fell in both S and PET cells after phorbol treatment; therefore, the genes for topoisomerases I and II did not appear to be regulated coordinately.

Further characterization of an amsacrine-resistant line of HL-60 human leukemia cells and its topoisomerase II. Effects of ATP concentration, anion concentration, and the three-dimensional structure of the DNA target

The characterization of type II topoisomerases from amsacrine-sensitive (HL-60) and amsacrine-resistant (HL-60/AMSA) human leukemia cells was extended. The intercalator resistance and etoposide sensitivity of the HL-60/AMSA cells themselves were confirmed, and the stability of this pharmacologic phenotype over many hundreds of cell generations was demonstrated. Prolonging exposure of HL-60/AMSA cells to amsacrine did not alter their sensitivity relative to that of HL-60 cells. Improved methods of immunoblotting allowed clear demonstration that the topoisomerase II within these cells exhibited sensitivity and resistance characteristics that mirrored those of the cells and the isolated enzymes themselves. Additional biochemical characterization of the type II topoisomerases indicated that both enzymes relaxed supercoiled DNA in a distributive fashion and that the ATP concentrations at which optimal catalytic activity of the two enzymes was exhibited were identical. The enzymes differed, however, in their activity optima in buffers of various type and ionic strength. Furthermore, the inability of the HL-60/AMSA enzyme to exhibit enhanced DNA cleavage in the presence of amsacrine could be overcome if the DNA target molecule contained a bend cloned into its polylinker region. By contrast, a bend in a DNA plasmid containing no polylinker was resistant to amsacrine-enhanced cleavage in the presence of HL-60/AMSA topoisomerase II, as was a plasmid containing a polylinker with no bend. This suggests that an unusual DNA conformation (a bend) in a specific DNA context (a polylinker) may be a favored site for topoisomerase II action. It also suggests a mechanism by which the sites and extent of topoisomerase II activity can be controlled in cells.

[Tuberculosis infection level and tuberculin conversion after intradermal BCG in school children of Botucatu, São Paulo, Brazil in 1969]

Procurou-se determinar, no 2.° semestre de 1969, o nível de infecção tuberculosa nos escolares da sede municipal de Botucatu, nas idades de 7 a 15 anos (exclusive) e o efeito do BCG intradérmico e da própria prova em si na viragem tuberculínica. Utilizamos PPD RT23 com 2UT (0,04 mcg) de acordo com a recomendação do Serviço Nacional de Tuberculose. A prevalência desta infecção se situou em torno de 6%, a qual, embora aparentemente baixa, ainda sugere ser a tuberculose problema de Saúde Pública local, com necessidade de melhor controle. Não houve diferença estatística significante entre os níveis encontrados nos grupos bases (A + B) e o controle, C, mas em relação aos atributos considerados, ela predominou na faixa etária de 11 a 15 anos, nos não brancos e no sexo masculino, com aumento significante de nível entre as provas realizadas num período de 90 dias. Não houve diferença significativa para os resultados encontrados entre a primeira e segunda provas realizadas no grupo B o que, entretanto se apresentou evidente no grupo A, após a utilização do BCG intradérmico, sugerindo forte estímulo alérgico para o mesmo. Os resultados foram encaminhados ao Dispensário Regional de Tuberculose para as necessárias medidas de controle.

[Tuberculosis infection and the use of oral and intradermal BCG in school children of Laranjal Paulista, São Paulo, Brazil]

Foi pesquisado no 2.° semestre de 1969, o índice de infecção tuberculosa nos escolares de nível primário da sede municipal de Laranjal Paulista, SP, com faixa etária de 7 a 15 anos. Utilizou-se PPD RT23 com 2UT (0,04 mcg) de acordo com a 2.ª recomendação do Serviço Nacional de Tuberculose, sendo encontrado nível de 8% de reatores fortes o que sugere necessidade de intensificação local do controle da tuberculose. Houve diferenças significativas a 5% quanto à cor e grupo etário, predominando nos "não brancos" e nos de 11 a 15 anos, o mesmo não ocorrendo, entretanto, quanto ao sexo. Os reatores e seus conviventes foram encaminhados ao Dispensário de Tuberculose. Foi também pesquisada a viragem tuberculínica pelo BCG oral e intradérmico, comparados com grupo controle, encontrando-se resultados significantes. O resultado verificado no grupo que tomou BCG por via intradérmica foi quase duas vezes maior que os observados no grupo de BCG oral. Não houve diferenças quanto ao sexo e grupo etário, mas o grupo "não branco" mostrou-se mais reativo. Não foram definidas estatisticamente as reações pós-vacinais e a expectativa populacional foi considerada dentro da esperada para atividades desse tipo.