ASSESSMENT OF NEONATAL AND MATERNAL COMPLICATIONS IN PREGNANT WOMEN WITH GESTATIONAL DIABETES IN THE IRANIAN POPULATION

Context

Gestational diabetes mellitus (GDM) is one of the most common complications during pregnancy. It is also a growing problem worldwide and is associated with many maternal and fetal complications during and after pregnancy.

Objective

This study aimed to investigate the neonatal and maternal complications of gestational diabetes in the Iranian population of pregnant women.

Design

This prospective cohort study was carried out on the health assessment data of pregnant women in the age range of 18-45 years who were referred to health centers affiliated with Mashhad University of Medical Sciences, Mashhad, Iran, from March 2019 to September 2020.

Subjects and Methods

Overall, 2,500 pregnant women with GDM and 7,700 healthy pregnant women were enrolled in the GDM and healthy groups, respectively. Individuals' data were recorded in an electronic health record system (SINA System) and were later collected and analyzed.

Results

Significant between-group differences were observed in terms of cesarean delivery risk, hypertension, fetal macrosomia, preeclampsia, preterm birth, fetal birth weight, and neonatal icterus in GDM and non-GDM groups. However, no significant differences were found in terms of stillbirth, and low birth weight between the two groups. Based on the logistic regression model, GDM significantly increased the risk of cesarean delivery, fetal macrosomia, and neonatal icterus.

Conclusions

The fetal macrosomia leading to the cesarean delivery, and neonatal icterus were determined as the significant complications of GDM in the Iranian population. These results can provide valuable insight into healthcare planning.

Investigation of the Proliferative Potential of FGF21 or FGF19 in Liver-Specific FGFR4-Deficient Mice

Fibroblast growth factor 21 (FGF21) and FGF15/FGF19 belong to the same subgroup of FGFs and are believed to have therapeutic potential in the treatment of type 2 diabetes and associated metabolic dysfunctionalities and pathological conditions. FGF19 has been proposed to induce hyperplasia and liver tumors in FVB mice (named after its susceptibility to Friend leukemia virus B), mediated by the FGF receptor 4 (FGFR4). The goal of this work was to investigate whether FGF21 might also have a potential proliferative effect mediated via FGFR4 using liver-specific Fgfr4 knockout (KO) mice. We conducted a mechanistic 7-day study involving female Fgfr4 fl/fl and Fgfr4 KO mice with a treatment regimen of twice daily or daily subcutaneous injections of FGF21 or FGF19 (positive control), respectively. The Ki-67 liver labeling index (LI) was evaluated by a semi-automated bioimaging analysis. The results showed a statistically significant increase in FGF21- and FGF19-treated Fgfr4 fl/fl mice. Interestingly, in Fgfr4 KO mice, this effect was absent following both treatments of FGF19 and FGF21, indicating that not only the FGFR4 receptor is pivotal for the mediation of hepatocellular proliferation by FGF19 leading finally to liver tumors but it seems also that FGFR4/FGF21 signaling has an impact on the hepatocellular proliferative activity, which does not promote the formation of hepatocellular liver tumors based on the current knowledge.

Pharmacokinetics of novel Fc-engineered monoclonal and multispecific antibodies in cynomolgus monkeys and humanized FcRn transgenic mouse models

Monoclonal antibodies (mAbs) are among the fastest growing and most effective therapies for myriad diseases. Multispecific antibodies are an emerging class of novel therapeutics that can target more than one tumor- or immune-associated modulators per molecule. The combination of different binding affinities and target classes, such as soluble or membrane-bound antigens, within multispecific antibodies confers unique pharmacokinetic (PK) properties. Numerous factors affect an antibody’s PK, with affinity to the neonatal Fc receptor (FcRn) a key determinant of half-life. Recent work has demonstrated the potential for humanized FcRn transgenic mice to predict the PK of mAbs in humans. However, such work has not been extended to multispecific antibodies. We engineered mAbs and multispecific antibodies with various Fc modifications to enhance antibody performance. PK analyses in humanized FcRn transgenic mouse (homozygous Tg32 and Tg276) and non-human primate (NHP) models showed that FcRn-binding mutations improved the plasma half-lives of the engineered mAbs and multispecific antibodies, while glycan engineering to eliminate effector function did not affect the PK compared with wild-type controls. Furthermore, results suggest that the homozygous Tg32 mouse model can replace NHP models to differentiate PK of variants during lead optimization, not only for wild-type mAbs but also for Fc-engineered mAbs and multispecific antibodies. This Tg32-mouse model would enable prediction of half-life and linear clearance of mAbs and multispecific antibodies in NHPs to guide the design of further pharmacology/safety studies in this species. The allometric exponent for clearance scaling from Tg32 mice to NHPs was estimated to be 0.91 for all antibodies.

CRISPR/Cas9 generated knockout mice lacking phenylalanine hydroxylase protein as a novel preclinical model for human phenylketonuria

Phenylketonuria (PKU) is an autosomal recessive inborn error of L-phenylalanine (Phe) metabolism. It is caused by a partial or complete deficiency of the enzyme phenylalanine hydroxylase (PAH), which is necessary for conversion of Phe to tyrosine (Tyr). This metabolic error results in buildup of Phe and reduction of Tyr concentration in blood and in the brain, leading to neurological disease and intellectual deficits. Patients exhibit retarded body growth, hypopigmentation, hypocholesterolemia and low levels of neurotransmitters. Here we report first attempt at creating a homozygous Pah knock-out (KO) (Hom) mouse model, which was developed in the C57BL/6 J strain using CRISPR/Cas9 where codon 7 (GAG) in Pah gene was changed to a stop codon TAG. We investigated 2 to 6-month-old, male, Hom mice using comprehensive behavioral and biochemical assays, MRI and histopathology. Age and sex-matched heterozygous Pah-KO (Het) mice were used as control mice, as they exhibit enough PAH enzyme activity to provide Phe and Tyr levels comparable to the wild-type mice. Overall, our findings demonstrate that 6-month-old, male Hom mice completely lack PAH enzyme, exhibit significantly higher blood and brain Phe levels, lower levels of brain Tyr and neurotransmitters along with lower myelin content and have significant behavioral deficit. These mice exhibit phenotypes that closely resemble PKU patients such as retarded body growth, cutaneous hypopigmentation, and hypocholesterolemia when compared to the age- and sex-matched Het mice. Altogether, biochemical, behavioral, and pathologic features of this novel mouse model suggest that it can be used as a reliable translational tool for PKU preclinical research and drug development.

Trypanosoma brucei transferrin receptor: Functional replacement of the GPI anchor with a transmembrane domain

The transferrin receptor of Trypanosoma brucei (TbTfR) is a heterodimer of a glycosylphosphatidylinositol (GPI)-anchored ESAG6 subunit and an ESAG7 subunit. To investigate whether the GPI-anchor is essential for the function of the TbTfR, an ESAG6 with a transmembrane domain instead of a GPI-anchor (ESAG6tmd) was inducibly expressed in bloodstream form trypanosomes. It is shown that the ESAG6tmd is able to dimerise with ESAG7 to form a TbTfR that can bind transferrin. Fractionation experiments clearly demonstrated that the transmembrane-anchored TbTfR is exclusively associated with the membrane fraction. No difference in the uptake of transferrin was observed between trypanosomes inducibly expressing a transmembrane-anchored TbTfR and trypanosomes inducibly expressing a GPI-anchored TbTfR. Differences in glycosylation pattern of ESAG6tmd and native ESAG6 may indicate different intracellular trafficking of transmembrane- and GPI-anchored TbTfRs. The findings suggest that the GPI-anchor is not essential for the function of the TbTfR in bloodstream forms of T. brucei.

Development and Validation of an Image Analysis System for the Measurement of Cell Proliferation in Mammary Glands of Rats

Reliable detection and measurement of cell proliferation are essential in the preclinical assessment of carcinogenic risk of therapeutics. In this context, the assessment of mitogenic potential on mammary glands is crucial in the preclinical safety evaluation of novel insulins. The existing manual counting is time-consuming and subject to operator bias. To standardize the processes, make it faster, and resistant to errors, we developed a semiautomated image analysis system (CEPA software, which is open-source) for counting of proliferating cells in photomicrographs of mammary gland sections of rats labeled with Ki-67. We validated the software and met the predefined targets for specificity, accuracy, and reproducibility. In comparison to manual counting, the respective mean differences in absolute labeling indices (LIs) for CEPA software were 3.12% for user 1 and 3.05% for user 2. The respective regression analysis revealed a good correlation between the CEPA software user and manual counting. Moreover, the CEPA software showed enhanced reproducibility between independent users. The interuser variability is centered around 0 and the absolute difference was about 0.53% LI. Based on validation data, our software has superiority to the manual counting and is a valid and reliable tool for the routine analysis of cell proliferation in mammary glands from rats exposed to insulin analogs.

Metformin-induced increases in GDF15 are important for suppressing appetite and promoting weight loss

Metformin is the most commonly prescribed medication for type 2 diabetes, owing to its glucose-lowering effects, which are mediated through the suppression of hepatic glucose production (reviewed in refs. ^1-3). However, in addition to its effects on the liver, metformin reduces appetite and in preclinical models exerts beneficial effects on ageing and a number of diverse diseases (for example, cognitive disorders, cancer, cardiovascular disease) through mechanisms that are not fully understood^1-3. Given the high concentration of metformin in the liver and its many beneficial effects beyond glycemic control, we reasoned that metformin may increase the secretion of a hepatocyte-derived endocrine factor that communicates with the central nervous system⁴. Here we show, using unbiased transcriptomics of mouse hepatocytes and analysis of proteins in human serum, that metformin induces expression and secretion of growth differentiating factor 15 (GDF15). In primary mouse hepatocytes, metformin stimulates the secretion of GDF15 by increasing the expression of activating transcription factor 4 (ATF4) and C/EBP homologous protein (CHOP; also known as DDIT3). In wild-type mice fed a high-fat diet, oral administration of metformin increases serum GDF15 and reduces food intake, body mass, fasting insulin and glucose intolerance; these effects are eliminated in GDF15 null mice. An increase in serum GDF15 is also associated with weight loss in patients with type 2 diabetes who take metformin. Although further studies will be required to determine the tissue source(s) of GDF15 produced in response to metformin in vivo, our data indicate that the therapeutic benefits of metformin on appetite, body mass and serum insulin depend on GDF15.

Antibody Fc engineering for enhanced neonatal Fc receptor binding and prolonged circulation half-life

The neonatal Fc receptor (FcRn) promotes antibody recycling through rescue from normal lysosomal degradation. The binding interaction is pH-dependent with high affinity at low pH, but not under physiological pH conditions. Here, we combined rational design and saturation mutagenesis to generate novel antibody variants with prolonged half-life and acceptable development profiles. First, a panel of saturation point mutations was created at 11 key FcRn-interacting sites on the Fc region of an antibody. Multiple variants with slower FcRn dissociation kinetics than the wildtype (WT) antibody at pH 6.0 were successfully identified. The mutations were further combined and characterized for pH-dependent FcRn binding properties, thermal stability and the FcγRIIIa and rheumatoid factor binding. The most promising variants, YD (M252Y/T256D), DQ (T256D/T307Q) and DW (T256D/T307W), exhibited significantly improved binding to FcRn at pH 6.0 and retained similar binding properties as WT at pH 7.4. The pharmacokinetics in human FcRn transgenic mice and cynomolgus monkeys demonstrated that these properties translated to significantly prolonged plasma elimination half-life compared to the WT control. The novel variants exhibited thermal stability and binding to FcγRIIIa in the range comparable to clinically validated YTE and LS variants, and showed no enhanced binding to rheumatoid factor compared to the WT control. These engineered Fc mutants are promising new variants that are widely applicable to therapeutic antibodies, to extend their circulation half-life with obvious benefits of increased efficacy, and reduced dose and administration frequency.

DISC1 regulates N-methyl-D-aspartate receptor dynamics: abnormalities induced by a Disc1 mutation modelling a translocation linked to major mental illness

The neuromodulatory gene DISC1 is disrupted by a t(1;11) translocation that is highly penetrant for schizophrenia and affective disorders, but how this translocation affects DISC1 function is incompletely understood. N-methyl-D-aspartate receptors (NMDAR) play a central role in synaptic plasticity and cognition, and are implicated in the pathophysiology of schizophrenia through genetic and functional studies. We show that the NMDAR subunit GluN2B complexes with DISC1-associated trafficking factor TRAK1, while DISC1 interacts with the GluN1 subunit and regulates dendritic NMDAR motility in cultured mouse neurons. Moreover, in the first mutant mouse that models DISC1 disruption by the translocation, the pool of NMDAR transport vesicles and surface/synaptic NMDAR expression are increased. Since NMDAR cell surface/synaptic expression is tightly regulated to ensure correct function, these changes in the mutant mouse are likely to affect NMDAR signalling and synaptic plasticity. Consistent with these observations, RNASeq analysis of the translocation carrier-derived human neurons indicates abnormalities of excitatory synapses and vesicle dynamics. RNASeq analysis of the human neurons also identifies many differentially expressed genes previously highlighted as putative schizophrenia and/or depression risk factors through large-scale genome-wide association and copy number variant studies, indicating that the translocation triggers common disease pathways that are shared with unrelated psychiatric patients. Altogether, our findings suggest that translocation-induced disease mechanisms are likely to be relevant to mental illness in general, and that such disease mechanisms include altered NMDAR dynamics and excitatory synapse function. This could contribute to the cognitive disorders displayed by translocation carriers.

Knowledge and management of fever among Moroccan parents

Parents often have misperceptions about childhood fever, and little information is available about the home management of feverish children in Morocco. In this study of the perceptions, knowledge and practices of families regarding children's fever, the parents of 264 febrile children aged 0-16 years were interviewed in a paediatric emergency department in Rabat in 2011. Only 3.5% of parents knew the correct temperature definition for fever, 54.4% determined their children's fever using a thermometer, and the preferred site was rectal. Most of them (96.8%) considered that fever was a very serious condition, which could lead to side-effects such as brain damage (28.9%), seizures (18.8%) paralysis (19.5%), dyspnoea (14.8%) and coma (14.8%). Paracetamol was used by 85.9% and traditional treatments by 45.1%. Knowledge about the correct definition of fever was significantly associated with parents' profession, educational level and receipt of previous information and advice from health professionals.

[Anaesthetic implications in a pregnant patient with an extreme thrombocytopenia due to a May-Hegglin anomaly: general o regional anaesthesia?]

The May-Hegglin anomaly is an inherited disorder, so uncommon that the incidence is still unknown. It is characterized by macro-thrombocytopenia with normal platelet function and cytoplasmic inclusion bodies in granulocytes. The case is reported of a 28-year-old primiparous patient who had an urgent caesarean section due to failed induction of labour. The patient had no history of abnormal bleeding. Other causes of thrombocytopenia or platelet dysfunction, such as preeclampsia, HELLP syndrome, or placental abruption, were ruled out. The platelet count prior to surgery was 20,900/mm(3) with normal platelet function. General anaesthesia was performed. No excessive bleeding occurred and a platelet transfusion was not needed.

[Neonatal liver abscess after umbilical venous catheter]

INTRODUCTION

The use of an umbilical venous catheter (UVC) is common practice in neonatal units and is subjected to strict rules of insertion and monitoring to detect potential complications. Hepatic abscess is one of these rare complications.

OBSERVATION

We report the observation of a 15-day-old female newborn admitted for a hepatic abscess. The patient had been hospitalized at birth in a neonatal intensive care unit. With the appearance of hemodynamic instability on the 4th day of life, a nosocomial infection was suspected and was treated with ceftazidime, vancomycin and amikacin. Later, as the need for O(2) increased and plasma C-reactive protein (CRP) was 190 mg/L, the patient received imipenem and vancomycin, while an abdominal ultrasound examination showed a hepatic abscess. A triple antibiotic treatment was initiated with imipenem, vancomycin, and metronidazole, while the initial examination showed a clinically stable patient with a CRP at 208 mg/L. Abdominal ultrasounds showed a hepatic abscess measuring 53.4×24.9 mm on day 21 and 51.4 mg/L CRP. Then the abscess dimensions decreased to 35.7×14 mm. The antibiotic therapy was maintained for 4 weeks.

CONCLUSION

Hepatic abscess should be suspected in neonates with UVC with sepsis and persistent signs of inflammation in spite of adequate antibiotic treatment.

[Labor pain worries future fathers more than the mothers]

OBJECTIVE

To evaluate the concerns of the future father about labor pain and another 9 items which could be important to the well-being of the mother during delivery. To investigate any possible differences in opinion between the future father and mother.

PATIENTS AND METHODS

An anonymous and voluntary questionnaire was offered to the father and the pregnant patient during the last month of pregnancy. They had to answer the questionnaire separately, scoring 10 items in a 0-10 point ordinal scale, according to their concerns and the importance for the good development of the delivery (0= not concerned about/insignificant to 10=concerned about/great importance). The items included were: 1) esthetic aftermath, 2) embarassment, 3) continous information, 4) walking during labor, 5) drinking during labor, 6) companionship, 7) labor pain, 8) keeping composure, 9) kindness, 10) room comfortability. Data on age, education, parity and nationality were recorded.

RESULTS

A total of 147 questionnaires were completed, 99 by mothers, and 48 by fathers. Pain was the most important concern for the future fathers scoring a mean (SD) of 8.15 (2), while continuous information 7.71 (2.5), kindness 7.9 (2.1), and companionship 8.21 (2.3) were more important than pain for mothers. A statistically significant difference was found between fathers and mothers regarding labor pain (P=.001), walking during labor (P=.003), and drinking during labor (P=.009).

CONCLUSIONS

The result of our study suggests that increasing the presence of the father during the delivery process, and taking care of the emotional aspects and the quality of the information given could be very important for the perception of satisfaction.

[Diffuse arterial calcified elastopathy. A case report]

Diffuse arterial calcified elastopathy is a very rare and little known hereditary disease, characterized by diffuse calcifications of the arterial wall. It seems common in North Africa and in the Caucasian region. Its incidence appears to be underestimated in Morocco. Clinical pattern is dominated by renovascular hypertension often associated with symptoms of heart failure. Risk of sudden death from myocardial infarction is particularly important. Thus, the diagnosis of diffuse arterial calcified elastopathy must always be suspected in front of an apparently unexplained heart failure or renovascular hypertension occurring in an infant. We report a case of diffuse arterial calcified elastopathy discovered in a neonatal intensive care unit, during management of a cardiogenic shock in a 3-months old infant. This observation demonstrates the importance of systematic measurement of the arterial tension, family screening and the impact of the ultrasound in the detection of vascular calcifications. Treatment remains essentially symptomatic.

[Pseudosarcoidotic ganglionic mediastinal tuberculosis]

INTRODUCTION

The aetiological inquiry in the presence of systemic granulomatosis should consider some uncommon forms of tuberculosis infections. For instance, Poncet's tuberculous rheumatism is a rare entity subject to controversy.

CASE REPORT

A 32-year-old man presenting febrile polyarthritis associated with spontaneously vanishing erythematous papular skin rash. The tests revealed a biological inflammatory syndrome and mediastinal lymph nodes. The biopsies showed cutaneous and mediastinal adenoid granulomatosis. The cutaneous lesions resolved spontaneously. The culture of the ganglionic sample was positive. The evolution was favourable under treatment and the articular pain disappeared within a few days.

CONCLUSION

Poncet's tuberculous rheumatism may underly evolving visceral tuberculosis. It's presence requires a search for tuberculosis when systemic granulomatosis with cutaneous and articular involvement may simulate sarcoidosis.

[Oesophageal duplication with neonatal revelation. About 2 cases]

Oesophageal duplication is a rare form of digestive duplication. This congenital malformation can be asymptomatic or manifest itself through respiratory signs due to airway compression. We report 2 cases of oesophageal duplication discovered in the neonatal period.

CASE REPORT

In both cases, symptoms were dominated by respiratory distress and vomiting. Diagnosis was confirmed by oesophageal contrast X-rays, which revealed a total tubular form in the 1st case and a cystic form in the 2nd case.

CONCLUSION

Oesophageal duplication is a rare abnormality of benign nature, which can be revealed in neonatal period by a noisy compression picture. Diagnosis of this anomaly should trigger a search for other digestive duplications, as well as associated malformations, in particular vertebral.

[Pulmonary actinomycosis in a child]

Pulmonary actinomycosis is a rare bacteriological disease, characterized by local suppuration and an extensive fibro-inflammatory process, with a possible pseudotumoral outcome. We report on a case in a 15-year-old boy, admitted in our department for prolonged pleuropneumopathy. Clinical and radiological findings were not contributive. The diagnosis of actinomycosis was obtained by pathology after surgical resection. This disease can mimic on lung X-rays a number of disorders, such as pulmonary tuberculoma, invasive tuberculosis or lung carcinoma. Pleuropulmonary actinomycosis is a rare intrathoracic infection during childhood, of which poor outcome and tough diagnosis lead usually to a surgical attitude given a picture of recurrent pulmonary abnormality. When the diagnosis is established, the treatment is medical.

[Surgical treatment of pulmonary hydatid cysts in childhood]

OBJECTIVES

To analyse the radioclinical forms of pulmonary hydatid cyst in children, and to evaluate the results of surgical treatment.

PATIENTS AND METHODS

During a period of 4 years (2002-2005), 26 surgical procedures were performed for pulmonary hydatid cyst in 23 children (16 boys and 7 girls, mean age 13, 5 years). Symptoms were chest pain (87%), broncho-pulmonary infection (32%) and hemoptysis (22%). Chest x-ray showed a non-complicated cyst in 62% of cases. The CT scan was performed in 15 cases (65%), mainly for complicated forms. Abdominal echography for all patients showed 3 hepatic localisations of hydatid cyst. All the patients underwent surgical treatment by thoracotomy.

RESULTS

In a total of 34 cysts, 21 were uncomplicated, 13 complicated (intra-bronchial rupture: 11 cases, pleural rupture: 2 cases). Cystectomy or pericystectomy were performed in 91% of cases, segmentectomy in 6% and a lobectomy in 3%. Decortication was done in the 2 pleural-ruptured cases. There was no mortality. One lower left lobe atelectasis was observed post-operatively.

CONCLUSION

Conservative surgical techniques for pulmonary hydatid cysts in children are preferred to parenchyma resection. In our practice the treatment of bilateral hydatidosis in 2 times decreases the complication rate.

Intracellular Positioning of Isoforms Explains an Unusually Large Adenylate Kinase Gene Family in the Parasite Trypanosoma brucei

Adenylate kinases occur classically as cytoplasmic and mitochondrial enzymes, but the expression of seven adenylate kinases in the flagellated protozoan parasite Trypanosoma brucei (order, Kinetoplastida; family, Trypanosomatidae) easily exceeds the number of isoforms previously observed within a single cell and raises questions as to their location and function. We show that a requirement to target adenylate kinase into glycosomes, which are unique kinetoplastid-specific microbodies of the peroxisome class in which many reactions of carbohydrate metabolism are compartmentalized, and two different flagellar structures as well as cytoplasm and mitochondrion explains the expansion of this gene family in trypanosomes. The three isoforms that are selectively built into either the flagellar axoneme or the extra-axonemal paraflagellar rod, which is essential for motility, all contain long N-terminal extensions. Biochemical analysis of the only short form trypanosome adenylate kinase revealed that this enzyme catalyzes phosphotransfer of gamma-phosphate from ATP to AMP, CMP, and UMP acceptors; its high activity and specificity toward CMP is likely to reflect an adaptation to very low intracellular cytidine nucleotide pools. Analysis of some of the phosphotransfer network using RNA interference suggests considerable complexity within the homeostasis of cellular energetics. The anchoring of specific adenylate kinases within two distinct flagellar structures provides a paradigm for metabolic organization and efficiency in other flagellates.

Cervical ripening with oral misoprostol at term

OBJECTIVES

To determine the efficacy of 200 microg single dose oral misoprostol as a cervical priming agent at term.

METHODS

In this double-blind randomized trial, 156 pregnant women requiring induction of labor with gestational age of 37-42 weeks and Bishop score < or =5, were randomized to receive either 200 microg of misoprostol or a placebo, orally. Labor was induced with intravenous oxytocin infusion 12 h after oral medication if the patient did not go into labor. The primary outcome was the change in the Bishop score 12 h after oral medication. The secondary outcomes were the timings starting from the drug administration to the onset of uterine activity, interval between oral medication and delivery, oxytocin need for induction, mode of delivery, frequency of side effects, and neonatal and maternal outcome. The chi-square or Fisher exact test, Student's t-test, and Mann-Whitney U-test were used for analysis of the data.

RESULTS

There were no significant differences in maternal characteristics or indications of induction. The Bishop score 12 h after oral medication significantly improved in the misoprostol group compared with the control group [55 (70%)>8 vs. 4 (5%)>8; P<0.001]. The induction rate was significantly reduced in the misoprostol group (P<0.001). The interval between oral medication and the onset of uterine activity was significantly shorter in the misoprostol group (P<0.001). The interval between oral medication and delivery was also significantly shorter in the misoprostol group (P<0.001). The cesarean delivery rate was significantly lower in the misoprostol group (P<0.001). There were no differences between the groups with respect to the incidence of tachysystole, hyperstimulation, adverse neonatal or maternal outcome.

CONCLUSIONS

Oral administration of 200 microg single dose of misoprostol is an effective agent not only for cervical priming but also for induction of labor at term. Furthermore, it reduces the rate of cesarean deliveries.

Identification of a developmentally regulated iron superoxide dismutase of Trypanosoma brucei

An iron superoxide dismutase (FeSOD) gene of the protozoan parasite Trypanosoma brucei has been cloned and its gene product functionally characterized. The gene encodes a protein of 198 residues which shows 80% identity with FeSODs from other trypanosomatids. Inhibitor studies with purified recombinant FeSOD expressed in Escherichia coli confirmed that the enzyme is an iron-containing SOD. The FeSOD is developmentally regulated in the parasite, expression being lowest in the cell-cycle-arrested, short stumpy bloodstream forms. Differential expression of the FeSOD protein contrasts with only minor quantitative changes in the FeSOD mRNA, indicating post-transcriptional regulation of the enzyme. As the level of FeSOD increases during differentiation of cell-cycle-arrested short stumpy into dividing procyclic forms, it is suggested that the enzyme is only required in proliferating stages of the parasite for the elimination of superoxide radicals which are released during the generation of the iron-tyrosyl free-radical centre in the small subunit of ribonucleotide reductase.

Trypanosoma evansi: demonstration of a transferrin receptor derived from expression site-associated genes 6 and 7

In Trypanosoma brucei, uptake of host transferrin is mediated by a heterodimeric, glycosylphosphatidylinositol-anchored receptor derived from the 2 expression site-associated genes 6 and 7 (ESAG6 and ESAG7). By using specific antibodies, it is shown here that T. evansi, a trypanosome species transmitted mechanically by biting flies, also expresses a transferrin receptor composed of ESAG6 and ESAG7. The cellular uptake of transferrin in T. evansi is completely inhibited with anti-T. brucei (ESAG6/7 heterodimer) antibodies. The demonstration of a functional ESAG6/7 transferrin receptor in T. evansi supports further its close relationship to T. brucei.

Studies on the recycling of the transferrin receptor in Trypanosoma brucei using an inducible gene expression system

Uptake of host transferrin in bloodstream forms of Trypanosoma brucei is mediated by a heterodimeric, glycosylphosphatidylinositol-anchored receptor. After endocytosis, transferrin is delivered to lysosomes where it is proteolytically degraded. Whether the heterodimeric transferrin receptor is returned to mediate several cycles in ligand uptake is undefined. By using an inducible gene expression system we provide evidence for recycling of the transferrin receptor in bloodstream forms of T. brucei. The metabolic half-life of the transferrin receptor in bloodstream-form trypanosomes is determined to be 7 h which is comparable to the half-lives of recycling receptors in mammalian cells. The cycling time of the trypanosomal transferrin receptor is calculated to be 11 min. By means of the half-life and the cycling time, we calculated that each receptor is recycled 60 times before being degraded on average.

Detection of Trypanosoma brucei gambiense in sleeping sickness suspects by PCR amplification of expression-site-associated genes 6 and 7

We have developed a sensitive and specific method to identify Trypanosoma brucei ssp. using PCR to amplify conserved expression-site-associated gene 6 and 7 DNA target sequences. Amplification of 10% of the DNA in a single trypanosome produced sufficient PCR product to be visible as a band in an agarose gel stained with ethidium bromide. We analysed 59 blood samples of serologically positive cases of sleeping sickness by PCR, and directed parasitological examination of tissue fluids. The PCR test detected 87% of the parasitologically positive cases, with a specificity of 97%. In 5 cases, the parasite was demonstrated by the PCR test 4-6 months prior to parasitological detection. This result shows the potential of the assay in early diagnosis of actual T. b. gambiense infections in apparently aparasitaemic sleeping sickness patients.

Antigen-antibody system associated with non-A, non-B hepatitis detected by indirect immunofluorescence

Ten chimpanzees were infected with non-A, non-B hepatitis by inoculation of patient serum or serum from a chimpanzee previously inoculated with patient serum. Convalescent serum from one of them reacted, in indirect immunofluorescent tests, with some of the hepatocyte nuclei in sections of autologous liver biopsy specimens and specimens from eight of the other chimpanzees. Serum from a convalescent patient reacted in the same way. These positive sera did not react with liver sections from uninfected chimpanzees. No reaction with positive liver sections was given by serum from chimpanzees which were uninfected or had antibodies to hepatitis A or B antigens. These control results suggest that the antigen-antibody system detected has specificity for non-A, non-B hepatitis.

[Waardenburg's syndrome. Four cases in an Iranian family (author's transl)]

4 cases of Waardenburg's syndrome in an Iranian family are presented and discussed. The patients, a 34-year-old father with his 6-month-old and 3-year-old sons and 2-year-old daughter, show symptoms of this syndrome in varying degrees of expression except for deafness.

Potentiation of coxsackievirus B3 infection in adult mice pretreated with a gold salt

In mice treated with sodium aurothiomalate (myocrisin), prior to infection with Coxsackievirus B3, 90% of the animals died by the 11th day postinfection (p.i.). A mortality of 10% was noted in mice receiving myocrisin only, and no deaths occurred in animals infected with virus alone. The highest amount of virus was recovered from the pancreas of myocrisin-treated mice on day 3 p.i. This was over 500-fold higher than the virus titer found in the pancreas of mice infected with virus only. Generally the titer of virus present in different organs was higher at every point in drug-treated animals as compared to intact mice infected with the virus. A high and persistent viremia was present in myocrisin-treated mice; in contrast a low viremia followed by virus clearance from the blood was observed in intact mice infected with the virus. The antibody response was studied in intact and myocrisin-treated mice infected with the virus. In both groups, no neutralizing antibodies were detected on days 1, 2, and 3 p.i. On day 7 after infection, the titers of antibodies were 1:16 and 1:12 in intact and myocrisin-treated mice, respectively. Administration of hyperimmune anti-Coxsackievirus B3 serum 6 hours after infection protrected in myocrisin-treated group of mice against lethal disease. The results of these studies suggest that (1) antibodies alone may not be sufficient to limit the spread and persistence of virus in natural infections and (2) in the absence of any apparent histopathological differences the increased multiplication of Coxsackievirus B3 could be the cause of death in myocrisin-treated mice.

Interaction of coxsackievirus B-3 and peritoneal exudate cells of adult mice treated with cyclophosphamide

Interaction of coxsackievirus B-3 with peritoneal exudate cells (p.e.c.) of adult mice treated with cyclophosphamide (CP) and of normal untreated mice were examined. The measurement of virus concentration in the supernates and the infective center assay of the virus-treated p.e.c. showed no significant differences in viral uptake between the p.e.c. of mice treated with CP for 1 and 24 hours, and the cells of normal untreated mice. However, a significant decrease in viral uptake was found in p.e.c. of mice collected 72 hours after treatment with CP. This relationship in viral uptake between the CP-treated and normal p.e.c. was reversed when the cells were exposed to antimacrophage serum (AMS). The p.e.c. from normal mice exposed to AMS inactivated significantly less virus than similar cells treated with normal rabbit serum. The peritoneal cell-free fluid of mice treated with CP and coxsackievirus B-3 for 24 hours, contained less virus than the fluid from mice injected with virus alone. It is therefore concluded that the reduction in viral uptake by the p.e.c. derived from mice 72 hours after CP-treatment may contribute to the severity of infection in CP-treated mice.