Dental implant treatment in patients with cancer on high-dose antiresorptive medication: A prospective feasibility study with 2 years follow-up

OBJECTIVES

Dental implant treatment is considered contraindicated in patients with cancer on high-dose antiresorptive medication (HDAR). The aim of this prospective, feasibility study was to evaluate implant treatment in patients with cancer on HDAR, in terms of implant survival, implant success, and oral health-related quality of life (OHLQoL) after 2 years of loading.

MATERIALS AND METHODS

Implants were inserted in three groups of HDAR patients: (1) Previous tooth extraction, no medication-related osteonecrosis of the jaw (MRONJ), (2) Previous MRONJ, now healed, (3) Existing MRONJ, planned surgical resection. Implants were placed without adjunctive bone or soft tissue argumentation. Abutment operation was performed after ≥12 weeks. Prosthetic treatment was initiated ≥14 weeks. Survival and success rate were determined, and OHLQoL was analyzed with OHIP-49 and QLQ-H&N35 questionnaires. Patients were seen for 6 months, 1- and 2 years follow-up.

RESULTS

Twenty-two patients, 39 implants, completed the implant-based prosthetic treatment. Implant-supported crowns and overdentures were fabricated. Thirteen patients (59%) with 23 implants (59%) completed 2 years follow-up. Overall implant survival and success rate after 2 years of loading were 100% and 97.4%, respectively. OHLQoL for the patients increased in all groups after the treatment, a substantial increase was seen in group 3. Two patients developed MRONJ, but not related to the implant treatment.

CONCLUSION

Dental implant treatment, with high survival and success rate and increased post-treatment OHLQoL, is feasible in HDAR patients after 2 years of loading. Caution with general recommendations should be exercised.

Tooth extractions in patients with cancer receiving high-dose antiresorptive medication: a randomized clinical feasibility trial of drug holiday versus drug continuation

OBJECTIVE

Medication-related osteonecrosis of the jaw (MRONJ) is a serious adverse reaction to high-dose antiresorptive medication (AR) in patients with cancer. A temporary discontinuation of AR (drug holiday) has been suggested to potentially reduce the risk of MRONJ after oral surgery. However, no consensus exists. The aim of the present feasibility trial was to evaluate the impact of a high-dose AR drug holiday in connection with surgical tooth extraction on the development of MRONJ and patient-reported health state.

STUDY DESIGN

Patients with cancer receiving high-dose AR were randomized to a drug holiday from 1 month before to 3 months after surgical tooth extraction or drug continuation. Follow-up was scheduled at 1, 3, and 6 months postoperatively. Patient health state was evaluated using the EQ-5D-5L questionnaire.

RESULTS

The study included 23 patients (11 men, 12 women). AR included denosumab (n = 13) and bisphosphonate (n = 10) with median AR durations of 9 and 17.5 months, respectively. Four denosumab patients from the drug holiday group developed MRONJ. Differences in EQ-5D-5L between the treatment groups were found in favor of drug continuation.

CONCLUSIONS

The results indicate that a high-dose AR drug holiday does not prevent development of MRONJ after surgical tooth extraction and that patient-reported health state declines during a drug holiday compared with drug continuation.

Patients report inferior quality of care for knee osteoarthritis prior to assessment for knee replacement surgery - a cross-sectional study of 517 patients in Denmark

Background and purpose - Clinical care pathways for knee osteoarthritis (OA) are not always in line with clinical guidelines. We investigated (1) the patient-perceived quality of OA management, (2) which physiotherapist-delivered treatments patients with knee OA have attempted, and (3) patients' expected subsequent treatment, at the time of referral to an orthopedic surgeon.Patients and methods - This cross-sectional study included all patients with scheduled first-time appointments for knee OA at an orthopedic outpatient clinic from April 2017 to February 2018. Postal questionnaires included the 16-item OsteoArthritis Quality Indicator (OA-QI) questionnaire and questions about physiotherapist-delivered treatment for knee OA.Results - 517 of 627 (82%) eligible patients responded. Responders' (63% female) mean age was 67 years. The mean pass rate for the 16 independent quality indicators was 32% (8-74%). Sub-grouped into 4 categories, pass rates for independent quality indicators ranged from 16-52% regarding information, 9-50% regarding pain and functional assessment, 8-35% regarding referrals, and 16-74% regarding pharmacological treatment. While half of responders felt informed of physical activity benefits, only one-third had consulted a physiotherapist during the past year. Commonest physiotherapist-delivered treatments were exercise therapy for 22% and participation in the Good Life with osteoArthritis in Denmark (GLA:D) program for12% of responding patients. 65% expected surgery as subsequent treatment.Interpretation - Patients with knee OA are undertreated in primary care in Denmark; however, our findings may only reflect healthcare settings that are comparably organized. Our results call for better structure and uniform pathways for primary care knee OA treatment before referral to an orthopedic surgeon.

Acute hypoxia induces upregulation of microRNA-210 expression in glioblastoma spheroids

AIM

Tumor hypoxia and presence of tumor stem cells are related to therapeutic resistance and tumorigenicity in glioblastomas. The aim of the present study was therefore to identify microRNAs deregulated in acute hypoxia and to identify possible associated changes in stem cell markers.

MATERIALS & METHODS

Glioblastoma spheroid cultures were grown in either 2 or 21% oxygen. Subsequently, miRNA profiling was performed and expression of ten stem cell markers was examined.

RESULTS

MiRNA-210 was significantly upregulated in hypoxia in patient-derived spheroids. The stem cell markers displayed a complex regulatory pattern.

CONCLUSION

MiRNA-210 appears to be upregulated in hypoxia in immature glioblastoma cells. This miRNA may represent a therapeutic target although it is not clear from the results whether this miRNA may be related to specific cancer stem cell functions.

Abstract P4-08-08: Cross Reactivity of Clinically Validated Anti-HER2 Antibodies

Background: Human epidermal growth factor receptor (HER-) 2 belongs to the family of epidermal growth factor receptors (EGFRs) with homology to HER1, HER3 and HER4. HER2 is over-expressed in approximately 20% of invasive human breast cancers (Wolff, Hammond et al. 2007). Over-expression of HER2 is associated with a poor prognosis; however, the protein can be targeted by anti-HER2 therapy (trastuzumab, Herceptin®) (Slamon, Leyland-Jones et al. 2001). Trastuzumab therapy is offered only to patients whose tumors over-express HER2 protein and/or show amplification of the HER2 gene. Accordingly, the expression level of HER2 protein and/or amplification of the HER2 gene are determined routinely in all newly diagnosed breast cancers. Essential to this testing of HER2 expression at the protein level is the availability of specific antibody-based test systems.

Aim: The aim of the present study was to investigate the specificity of three clinically approved commercially available anti-HER2 antibodies towards members of the EGFR-family.

Methods: We studied the antibody used in the Herceptest™ (Dako), the PATHWAY® antibody (Ventana Medical Systems, Inc.) and the Oracle™ antibody (Leica Microsystems). Antibody specificity was investigated by manually performed immunohistochemistry (IHC) and in competitive ELISAs. For IHC, Chinese Hamster Ovary (CHO) cells were transiently transfected with the intracellular domain of respectively HER1, HER2, HER3 and HER4 and all three antibodies were applied to sections of formalin-fixed paraffin-embedded (FFPE) transfected cells. In ELISA, cross reactivity towards HER1 and HER4 was tested with peptides corresponding to the C-terminal part of HER1 and HER4.

Results: In IHC experiments, all three antibodies stained cells transfected with HER2. Binding of the antibodies to HER2 was confirmed bycompetitive ELISA. However, in IHC experiments the PATHWAY® and the Oracle™ antibodies also stained cells transfected with HER4. Competitive ELISAs confirmed binding of the PATHWAY® antibody to HER4, whereas binding of the Oracle™ antibody to HER4 could not be confirmed in a competitive ELISA. None of the antibodies cross reacted with HER1 and HER3 homologous to the HER2 binding site of the antibodies.

Conclusions: Two out of three clinically validated anti-HER2 antibodies were shown to cross react with HER4 in FFPE cells. As determination of HER2 over-expression and/or amplification guides therapy with trastuzumab, a valid test result by the use of specific antibodies is crucial to ensure proper personalized therapy with HER2-targeted therapy. These results warrant further investigation of anti-HER2 antibodies and of the procedures for clinical determination of HER2 protein expression. References:

Slamon DJ et al. (2001) J Med 344:783 Wolff AC et al. (2007) J Clin Oncol 25:118

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P4-08-08.

Phenotypic and functional markers for 1alpha,25-dihydroxyvitamin D(3)-modified regulatory dendritic cells

The clinical use of dendritic cells (DCs) to induce antigen-specific immune tolerance has been hampered by the lack of a widely acknowledged method for generating human regulatory DCs but even more so by the non-existence of reliable markers. Thus, we set out to find reliable markers that can be measured with simple methods to identify regulatory DCs that are applicable for future clinical studies. Human DCs were generated from peripheral blood monocytes in the presence of 1alpha,25-dihydroxyvitamin D(3) (VD3), which gave rise to a phenotype that resembles immature DCs, with the exception of high CD14 and reduced CD1a on the cell surface. These VD3-treated DCs exert a long-lasting inefficient T cell stimulation and induce T cell hyporesponsiveness with regulatory potential. Importantly, such VD3-treated DCs were readily distinguishable from untreated DCs by low levels of interleukin-23 secretion and low expression of miR-155 upon exposure to maturation stimuli. Furthermore, VD3-treated DCs showed over-expression of miR-378. All these features can be used as robust markers for quality control of VD3-treated regulatory DCs in future clinical studies.

Changes of periodontal parameters following apical surgery: a prospective clinical study of three incision techniques

AIM

To evaluate periodontal changes following apical surgery, and to relate changes to the type of incision and to the type of restoration present at the gingival margin (GM).

METHODOLOGY

Periodontal parameters [probing depth (PD), level of GM and clinical attachment, plaque and bleeding indices] were recorded at baseline and 1 year following apical surgery. The periodontal changes were calculated and assessed with respect to the incision technique (intrasulcular incision, papilla base incision and submarginal incision), as well as to the presence and type of a restoration margin in contact with the gingiva.

RESULTS

One hundred and eighty-four teeth could be evaluated. No significant differences between the three incision techniques were found regarding changes in PDs and plaque index over time. However, significant differences between the intrasulcular and submarginal incisions were found for changes in levels of GM and clinical attachment. For example, with the intrasulcular incision, there was a mean recession of 0.42 mm at buccal sites, whereas using the submarginal incision there was a gain of 0.05 mm. No statistically significant influence could be demonstrated for the presence and type of restoration margins, or the smoking habit of the patient.

CONCLUSION

The type of incision was found to affect changes significantly in periodontal parameters within an observation period of 1 year following apical surgery, whereas the restoration margin and smoking habit did not prove to have any significant effect.

Randomized clinical trial of effect of synbiotics, neomycin and mechanical bowel preparation on intestinal barrier function in patients undergoing colectomy

BACKGROUND

The aim of this study was to investigate whether it is possible to modulate gut microflora and preserve intestinal barrier function during elective colorectal surgery by using combinations of oral antibiotics, synbiotics and mechanical bowel preparation (MBP).

METHODS

Ninety-two patients were randomly assigned to one of four groups. Group 1 had MBP only, group 2 had neomycin + MBP, group 3 had synbiotics + neomycin + MBP, and group 4 had synbiotics + neomycin but no MBP. Changes in gut microflora were assessed by culturing nasogastric aspirates and polymerase chain reaction-denaturing gradient gel electrophoresis of faecal samples. Intestinal barrier function was determined by microbiological confirmation of bacterial translocation and measurement of intestinal permeability. The inflammatory response was monitored by measurement of serum C-reactive protein and interleukin 6, and septic morbidity was recorded prospectively.

RESULTS

Four patients were excluded owing to protocol violation, leaving 24 patients in group 1, 22 in group 2, 20 in group 3 and 22 in group 4 for analysis. There was a significant decrease in Enterobacteriaceae in group 3 compared with the other groups. Group 3 had a significantly lower incidence of translocation after bowel mobilization (P < 0.001). There was no significant difference between the groups in intestinal permeability, inflammatory response or septic morbidity.

CONCLUSION

The combination of MBP, neomycin and synbiotics reduces the prevalence of faecal Enterobacteriaceae and bacterial translocation; however, this was not associated with a reduction in inflammatory response or septic morbidity in this study. Larger trials are needed before a change in practice can be recommended.

Dentine-bonded resin composite (Retroplast) for root-end filling: a prospective clinical and radiographic study with a mean follow-up period of 8 years

AIM

To evaluate treatment outcome after using a resin composite (Retroplast, RP) in combination with a dentine-bonding agent (GLUMA) as root-end filling material after 1 year as well as after more than 5 years (final examination). Also, the influence of various pre-, intra- and postoperative factors on the treatment outcome was studied.

METHODOLOGY

All patients (87) undergoing root-end resection consecutively treated by root-end filling with RP on an incisor, canine, pre-molar, or first molar (87 teeth, 118 roots) were initially enrolled in the study. RP was applied on the entire resected surface that was prepared to a slightly concave shape and after conditioning with EDTA and GLUMA. The treatment outcome involving subjective, clinical and radiographic parameters was evaluated after 1 year and at the final examination. A total of 27 patients (36 roots) were excluded from the study because of unavailability of follow-up (19) and extraction of the operated tooth for reasons other than failed surgery (8). Consequently, 60 patients (82 roots) were included in the final material. The mean follow-up period at the final examination was 8 years (range: 6.5-9 years).

RESULTS

The radiographic evaluation at the final examination revealed that 77%, 5%, 7% and 11% of the treated roots were characterized by complete, incomplete, uncertain and unsatisfactory healing, respectively. A total of 95% of the roots classified as completely healed at the 1-year control were also completely healed at the final examination. Two roots (5%) showing complete healing at the 1-year control revealed unsatisfactory healing at the final examination because of displaced or lost RP-filling. Moreover, 60% of the roots with uncertain healing at the 1-year control demonstrated complete or incomplete healing at the final examination. The classification according to subjective, clinical and radiographic parameters revealed that 78% of the teeth were characterized by a successful treatment outcome at the final examination. Evaluation of the influence of various pre-, intra- and postoperative factors on the treatment outcome revealed that the radiographic classification at the final examination was exclusively influenced by the radiographic classification at the 1-year control (P < 0.001).

CONCLUSIONS

The present long-term study indicates that RP can be used for root-end filling with a successful treatment outcome.

Haemostatic agents used in periradicular surgery: an experimental study of their efficacy and tissue reactions

AIM

To evaluate the haemostatic efficacy and the histologic tissue responses after the application of different haemostatic agents used in periradicular surgery.

METHODOLOGY

The study was conducted in the calvarium of six rabbits. Standardized bone defects (diameter 4 mm) were trephined, and different haemostatic agents were applied and compared with control defects: bone wax (left for 10 min), Stasis (ferric sulphate, left for 5 s), Expasyl (aluminium chloride, left for 2 min and left permanently in situ), and a combination of Expasyl (2 min) and Stasis (5 s). The sites were photographed before the application and after the removal of the haemostatic agents. Three independent examiners judged the initial and final bleeding (on the photographs) using a bleeding score for each site and treatment. The results were compared using Wilcoxon's signed rank test. For the histologic analysis, three animals were killed after 3 weeks and three animals after 12 weeks. Transverse, nondecalcified sections were stained with combined basic fuchsin and toluidine blue for descriptive histology.

RESULTS

The most efficient haemorrhage control was provided by Expasyl in combination with Stasis and by Expasyl alone, whereas bone wax had the weakest bleeding reduction effect. The histologic analysis after 3 weeks demonstrated an inflammatory and foreign body tissue response towards all haemostatic agents. At 12 weeks, this tissue response was less pronounced but still present in sites treated with bone wax or Expasyl. In general, the inflammatory tissue reactions were limited to the bone defects, and never extended into the surrounding tissues.

CONCLUSIONS

Expasyl alone or in combination with Stasis appeared to be the most efficient of tested agents to control the bleeding within the bony defects created in a rabbit calvarium model.

A prospective, randomized, comparative clinical study of resin composite and glass ionomer cement for retrograde root filling

OBJECTIVE

To compare the clinical and radiographic treatment outcome of retrograde root filling with either dentin-bonded resin composite (Retroplast, RP) or glass ionomer cement (Chelon-Silver, CS).

STUDY DESIGN

A prospective, randomized clinical study of 134 consecutive patients with indication of retrograde root filling of an incisor, canine, premolar, or first molar. Either RP or CS was chosen at random as retrograde filling material. Either material was applied onto the entire resection surface after prepared slightly concave. This preparation technique makes a sealing of the entire resection surface possible and prevents marginal contraction gaps during polymerization. A total of 122 patients were available for 1-year follow-up.

RESULTS

After 1 year the proportion of successful cases was significantly higher in the RP group (73%) than in the CS group (31%) (p<0.001). Doubtful healing with a need for a longer observation period was seen in 17% of the RP cases and 19% of the CS cases. The proportion of failures in the RP group (10%) was significantly lower than that in the CS group (50%) (p<0.001). Most of the unsuccessful CS cases failed due to loosening of the retrograde filling.

CONCLUSIONS

Dentin-bonded RP applied onto the entire, slightly concave resection surface is a predictable apical sealant characterized by a high success rate. In contrast, retrograde root filling with CS results in an unacceptably high failure rate due to insufficient bonding strength to the concave resection surface.

Inhibitory effects of 1alpha,25-dihydroxyvitamin D(3) on the G(1)-S phase-controlling machinery

The nuclear hormone 1alpha,25-dihydroxyvitamin D(3) induces cell cycle arrest, differentiation, or apoptosis depending on target cell type and state. Although the antiproliferative effect of 1alpha,25-dihydroxyvitamin D(3) has been known for years, the molecular basis of the cell cycle blockade by 1alpha,25-dihydroxyvitamin D(3) remains largely unknown. Here we have investigated the mechanisms underlying the G(1) arrest induced upon 1alpha,25-dihydroxyvitamin D(3) treatment of the human breast cancer cell line MCF-7. Twenty-four-hour exposure of exponentially growing MCF-7 cells to 1alpha,25-dihydroxyvitamin D(3) impeded proliferation by preventing S phase entry, an effect that correlated with appearance of the growth-suppressing, hypophosphorylated form of the retinoblastoma protein (pRb), and modulation of cyclin-dependent kinase (cdk) activities of cdk-4, -6, and -2. Time course immunochemical and biochemical analyses of the cellular and molecular effects of 1alpha,25-dihydroxyvitamin D(3) treatment for up to 6 d revealed a dynamic chain of events, preventing activation of cyclin D1/cdk4, and loss of cyclin D3, which collectively lead to repression of the E2F transcription factors and thus negatively affected cyclin A protein expression. While the observed 10-fold inhibition of cyclin D1/cdk 4-associated kinase activity appeared independent of cdk inhibitors, the activity of cdk 2 decreased about 20-fold, reflecting joint effects of the lower abundance of its cyclin partners and a significant increase of the cdk inhibitor p21(CIP1/WAF1), which blocked the remaining cyclin A(E)/cdk 2 complexes. Together with a rapid down-modulation of the c-Myc oncoprotein in response to 1alpha,25-dihydroxyvitamin D(3), these results demonstrate that 1alpha,25-dihydroxyvitamin D(3) inhibits cell proliferation by targeting several key regulators governing the G(1)/S transition.

An air pollution model for use in epidemiological studies: evaluation with measured levels of nitrogen dioxide and benzene

The aim of the study was to evaluate the predictions derived from the Danish Operational Street Pollution Model (OSPM) when the input data are obtained by simple methods that could be used in large-scale epidemiological studies. The model calculations were thus compared with passive sampler measurements of nitrogen dioxide and benzene at 103 street locations in Copenhagen, Denmark, and at 101 locations in rural areas. Data on traffic and street configuration were collected by means of a simple registration scheme in which forms were filled out by local municipal authorities. Meteorological data were derived from routine measurements at Copenhagen airport, and data on background air pollution were based on a simple empirical model. Differences in air pollution levels between rural areas and Copenhagen and differences in nitrogen dioxide concentrations at various locations in Copenhagen were well reproduced by the OSPM. The correlation coefficients (r) between the measured and the predicted half-year average concentrations of nitrogen dioxide in Copenhagen were between 0.75 and 0.80 for various degrees of precision of the input data for the model. The results indicate that the OSPM used with the presented methods for generation of input data might be useful in assessing long-term exposure to air pollutants in epidemiological studies.

[Traumatic tricuspid valve insufficiency]

We report a case of tricuspid insufficiency in connection with blunt chest trauma. The patient was involved in a car accident. The central venous catheter showed a right ventricular pressure curve, suggestive of a tricuspid valve insufficiency. A transoesophageal echocardiographic examination supported this by revealing a papillary muscle rupture. This kind of injury has been seen more frequently during the last 35 years, partly because of better diagnostic procedures and a better understanding of the pathology. The decelerating force in the right ventricular chamber produces a regurgitation thereby initiating rupture of the papillary muscle and/or the chordae tendinae. In a literature study twelve out of thirteen patients were involved in car accidents. Some of them had a dominant V-wave in the venous pulse curve, but no clinical observation is directly diagnostic. Therefore, cardiac lesions should be kept in mind whenever there is a history of blunt chest trauma. The best diagnostic approach is echocardiography.

[Acute water intoxication caused by intranasal desmopression--Minirin]

Desmopressin is used for the treatment of nocturnal enuresis. Side effects reported with intranasal desmopressin are transient headache, nausea, abdominal cramps and water intoxication with hyponatremia and grand mal seizure. We report a case of water intoxication with low serum sodium and grand mal seizure in a healthy child treated for enuresis with desmopressin. The child experienced abdominal cramps and nausea prior to the convulsions. A computerised tomography scan of the brain gave the suspicion of increased intracranial pressure ICP. The child recovered fully. We therefore recommend that parents and child are fully informed about the administration and the risk of desmopressin. If a child on desmopressin treatment experiences abdominal cramps, nausea or headache the drug should be discontinued and a physician contacted for control of serum sodium. Temporary withdrawal of desmopressin should also be considered in cases of acute illness influencing water balance.

A comparison of the immunogenicity of the native and denatured forms of a protein

The effect of heat denaturation on the physicochemical and immunological properties of a model protein, ovalbumin, and its formaldehyde/lysine-treated form was investigated. Polyacrylamide gel electrophoresis and gel filtration showed that heat denaturation converted ovalbumin to high Mr polymers, whereas formaldehyde/lysine-treated ovalbumin remained monomeric with only a small proportion forming oligomers. NMR analysis demonstrated that non-denatured structures could easily be differentiated from the denatured structures. Intraperitoneal immunization of rabbits and mice showed that both native and denatured forms of ovalbumin induced an immune response, but denatured forms of ovalbumin were found to be less immunogenic and to have a lower epitope density than native ovalbumin. Analysis of the antisera in crossed immunoelectrophoresis showed that they were specific for either native or denatured forms of ovalbumin. These findings were further investigated by ELISA and immunoaffinity chromatography, and the high specificity and low cross-reactivity was confirmed. We conclude that the immunogenic epitopes on denatured ovalbumin are different from those on ovalbumin, and that these epitopes reflect a continuum of denatured conformations.

Tissue reaction and material characteristics of four bone substitutes

The aim of the present study was to qualitatively and quantitatively compare the tissue reactions around four different bone substitutes used in orthopedic and craniofacial surgery. Cylinders of two bovine bone substitutes (Endobon and Bio-Oss) and two coral-derived bone substitutes (Pro Osteon 500 and Interpore 500 HA/CC) were implanted into 5-mm bur holes in rabbit tibiae. There was no difference in the amount of newly formed bone around the four biomaterials. Interpore 500 HA/CC resorbed completely, whereas the other three biomaterials did not undergo any detectable biodegradation. Bio-Oss was osseointegrated to a higher degree than the other biomaterials. Material characteristics obtained by diffuse reflectance infrared Fourier transform spectrometry analysis and energy-dispersive spectrometry did not explain the differences in biologic behavior.

[Traumatic hip dislocation with "spontaneous" reposition and re-luxation]

A case of traumatic hip dislocation with spontaneous reduction of the hip joint is presented. The patient was involved in a car accident, and characterized as multitraumatized. On admission to the Emergency Department there were no clinical signs of traumatic hip-dislocation, but because of the severity of the trauma an X-ray of the pelvis was performed and a fracture of the acetabulum diagnosed. The patient was taken to the operating theatre for surgery of several fractures of both upper and lower extremities. This was followed by control X-rays including both anterior-posterior and lateral views of the right hip. This demonstrated that the right hip was now dislocated. The dislocation was reduced. CT showed a larger fracture of the acetabulum, and this was treated with osteosynthesis. Patients with an unstable hip due to trauma, should as a general rule have the hip X-rayed in two planes. It is further suggested that in cases of severely traumatized patients X-ray of the pelvis should be routinely performed.

Intrauterine fertilization capsules--a clinical trial

Treatment of 26 women with tubal infertility was attempted using intrauterine capsules loaded with oocytes and spermatozoa. The stimulation protocol was as used for in vitro fertilization and embryo transfer and consisted of short-term use of Buserelin, human menopausal gonadotropin, and human chorionic gonadotropin. Oocytes were collected by ultrasonically guided transvaginal aspiration, and spermatozoa were prepared by swim-up technique. The gametes were placed in agar capsules 4 hr after oocyte collection, and the capsules were introduced to the uterine fundus using an insertion tube and piston from an intrauterine device. Six complete capsules and parts of two other capsules were expelled. None of the women became pregnant, compared with a pregnancy rate of 21% per aspiration following in vitro fertilization and embryo transfer during the same period.

Absence of monoacylglycerol pathway for triacylglycerol synthesis in goat mammary gland

Both subcellular fractions of lactating goat mammary gland and dispersed lactating goat mammary-gland cells were able to incorporate [U-3H]2-O-hexadecylglycerol into monoalkyl-monoacylglycerol. However, the incorporation of [U-3H]2-O-hexadecylglycerol into monoalkyl-monoacylglycerol by dispersed cells was not accompanied by incorporation of fatty acid synthesized de novo or added radiolabelled fatty acid. The result therefore shows that an active monoacylglycerol pathway does not exist in goat mammary gland.