Acute bilateral suppurative parotitis following treatment of acute decompensated heart failure with noninvasive positive-pressure ventilation

We present a case of acute bilateral suppurative parotitis in an elderly patient with acute heart failure who was hospitalized and treated with noninvasive positive-pressure ventilation. In this case, sepsis due to infection occurred, leading to severe illness.

67 Effects of phytohemagglutinin on the culture of isolated bovine blastomeres derived from the 8-cell stage invitro-produced embryos

Monozygotic twin embryos which can efficiently be produced by blastomere separation and aggregation of early cleavage stages of embryos using commercially provided well-of-the-well (WOW) culture dish. Phytohaemagglutinin (PHA) is a plant lectin that binds to and aggregates on the surface of animal cells, but also contains toxicity that causes food poisoning. The present study was conducted to evaluate the toxicity to embryos and the effect to development of isolated blastomeres on PHA-supplemented WOW culture. Embryos were produced using oocytes from ovaries collected at an abattoir by IVM, IVF, and invitro culture (IVC). The tissue culture medium 199 supplemented with 5% calf serum (CS), Brackett-Oliphant solution supplemented with 10mgmL−1 bovine serum albumin, and CR1aa medium containing 5% CS were used for each culture step. For the evaluation of PHA toxicity, 89 embryos that developed to the 5-8-cell stage were obtained at Day 2 after insemination. Each embryo was cultured in a droplet of 5 µL/embryo IVC culture medium supplemented with or without PHA. For the evaluation of PHA to development of isolated blastomeres, 111 of 8-cell stage embryos were obtained 48-54h post-insemination. Zonae pellucidae were removed by exposure to 0.25% pronase. Then, embryos were separated into single blastomeres by gentle pipetting in IVC medium. Each four blastomeres were formed in the shape of a bunch inside the thin cylinder at the tip of the Pasteur pipette by gentle pipetting. Then, each mass of blastomeres in each 60 masses was cultured individually in 5-µL droplets of IVC medium supplemented with or without PHA on the flat surface of a tissue culture dish. On the other hand, each four blastomeres were introduced into a single conical micro-well each having a diameter and depth of ~287µm and 168µm (Dai Nippon Printing). This culture of blastomeres was performed covered with a droplet of 2.5µL well−1 IVC medium supplemented with or without PHA in each 50 or 52 wells. In all of investigations, PHA was used at 50µgmL−1 (Akagi et al. 2011 J. Reprod. Dev. 57). Statistical analysis was performed using Student's t-test and analysis of variance. The blastocyst formation rate (71.1±2.3% vs. 72.7±1.7%), total cell number (120 vs. 122), and inner cell mass cell number (47 vs. 51) at Day 7 after IVF did not differ between PHA-supplemented and PHA-free group in the toxicity test, respectively. In the blastomere culture, the blastocyst formation rate was very low (10.0±5.9% vs. 5.0±2.9%) regardless of the PHA supplementation in drops on the flat surface of a tissue culture dish. On the other hand, blastocyst formation was improved using the WOW culture dish (24.0±3.6% vs. 40.4±7.6%) but there was no difference with or without PHA supplementation. Although nontoxicity of PHA and efficacy of WOW culture for isolated-aggregated blastomeres were confirmed, no improvement of PHA supplementation on development was observed in this study. Subsequently, experiments on the optimum concentration of PHA for aggregation and development of blastomeres in WOW culture are required.

92 Culture method for long-distance transport of bovine embryos derived from IVF before blastulation using microtubes

In vitro-produced (IVP) embryos are more easily damaged by cryopreservation than in vivo-derived embryos. Therefore, transportation of fresh IVP embryos in a manner that can maintain viability is necessary. This study was conducted to determine the preferable culture conditions for transport of embryos at 5 days post-insemination (dpi) in 1.5-mL microtubes. Cumulus-oocyte complexes derived from an abattoir were matured and then inseminated with frozen-thawed semen. Presumptive zygotes were cultured in mCR1aa (CR1)+5% calf serum (CS) until use. In Exp. 1, embryos with 5 blastomeres at 5 dpi were randomly assigned to 1 of 3 groups: 25mM Hepes-CR1aa (H-CR1)+5% CS or 25mM Hepes-M199 (H-M199)+5% CS in air, or CR1 in 5% CO2. Embryos were cultured in microdrops overlaid with liquid paraffin in a petri dish for 48h at 38.5°C. In Exp. 2, the optimal number of embryos to culture per microtube was assessed. Presumptive zygotes were cultured in groups of 20, 40, or 80 in 1mL of CR1 covered with liquid paraffin in microtubes in an incubator at 38.5°C in 5% CO2 until 7 dpi. For Exp. 3, culture of embryos in microtubes in a portable incubator was tested. At 5 dpi, 5-cell embryos (n=17 to 36 per microtube) were statically cultured in 1mL of CR1 or H-CR1 in microtubes in a portable incubator set at 38.5°C for 48h. The CR1 was pre-equilibrated in an incubator in 5% CO2 for 24h before use. Embryos were harvested from microtubes after 48h and were then cultured in microdrops of CR1 overlaid with liquid paraffin in a petri dish in an incubator at 38.5°C in 5% CO2 until 8 dpi. In Exp. 4, embryos (n=29 to 39 five-cell embryos per microtube) were transported in a portable incubator by land for 1000km over a period of 44h using the same conditions as in Exp. 3. Control embryos were statically cultured in microdrops of CR1 in an incubator in 5% CO2. Statistical analyses were carried out by ANOVA (Exp. 1 and 2), t-test (Exp. 3), or Fisher’s exact test (Exp. 4). In Exp. 1, there was no effect (P>0.05) of culture medium on blastocyst development at 7 dpi (27.6±2.3, 25.7±7.2, and 17.3±2.9% for CR1, H-CR1, and H-M199, respectively). In Exp. 2, blastocyst development at 7 dpi was not affected (P>0.05) by the number of presumptive zygotes cultured per microtube (43.6±8.3, 42.4±4.0, and 39.9±2.9% for 20, 40, and 80 presumptive zygotes, respectively). In Exp. 3, blastocyst development at 8 dpi was not affected (P>0.05) by culture medium (60.7±7.4 and 53.1±4.4% for CR1 and H-CR1, respectively); however, the pH of CR1 changed from 7.5 to 8.1 at 48h after culture. In Exp. 4, blastocyst development at 8 dpi was not affected (P>0.05) by transport (57.1, 64.4, and 75.5% for CR1, H-CR1, and control, respectively). These results indicate that IVP embryos harvested at 5 dpi can be transported by portable incubator with no effect on embryo development to the blastocyst stage. This work was supported by grants from the Project of the Bio-oriented Technology Research Advancement Institution, NARO (the special scheme project on advanced research and the development for next-generation technology).

75 Culture of isolated blastomeres supplemented with L-ascorbic acid 2-phosphate in a well-of-the-well culture dish

We have reported monozygotic twin calves that can be produced efficiently by blastomere separation of 2-cell stage embryos and by the use of a commercially provided well-of-the-well culture dish (Hashiyada 2017 J. Reprod. Dev.). The present study was conducted to evaluate the effect of a culture supplement, l-ascorbic acid 2-phosphate (AA-2P), a sustained antioxidant substance that reduces reactive oxygen species. Embryos were produced using oocytes from ovaries collected at an abattoir by in vitro maturation, IVF, and in vitro culture (IVC). TCM199 supplemented with 5% calf serum, Brackett-Oliphant solution supplemented with 10mg mL−1 BSA, and CR1aa containing 5% calf serum were used for each culture step. Two-cell stage embryos were obtained 24 to 27h post-insemination (hpi). Zonae pellucidae were removed by exposure to 0.25% pronase. Then, embryos were separated into each blastomere by gentle pipetting in IVC medium. Each blastomere was introduced into a single conical micro-well of 25 wells, each having a diameter and depth of ~287 and 168µm (Dai Nippon Printing, Tokyo, Japan). Culture of blastomeres in wells was performed covered with a droplet of 2.5 µL/well IVC medium supplemented with 0 (n=212), 250 (n=214), 500 (n=206), and 750 µM (n=204) of AA-2P. The blastocyst formation rate at Day 8 after IVF, the quality of blastocysts assessed by morphological observation, and the cell numbers were compared among each concentration of AA-2P. In addition, the developmental speed to the blastocyst stage was analysed using time-lapse cinematography for 0 and 500 µM of AA-2P (n=40, respectively). Statistical analysis was performed using Fisher’s exact test and ANOVA. The blastocyst formation rate (32-40%), the total cell number (108-114), and inner cell mass cell number (26-28) did not differ among groups. The time to reach the 4-cell stage was significantly shorter in media supplemented with 0 µM (43 hpi) than with 500 µM (52 hpi); however, the time to reach the blastocyst stage did not differ (150 and 155 hpi, respectively). Regarding the proportion of quality grade 1 to 3 blastocysts and the developmental speed to the blastocyst stage, high-quality grade 1 embryos were significantly faster than those of middle and low-quality grade 2 and 3 ones in 0 (145 v. 154 hpi; P<0.05) and 500 µM (150v. 158 hpi; P<0.05) supplemented medium. In this experiment, no effect of AA-2P was observed for the culture of isolated blastomeres from 2-cell stage embryos, although it was suggested that blastomeres with high developmental competence reach the blastocyst stage faster, which might reflect the quality of the embryos.

77 Monozygotic Twin Calves Production by Blastomere Separation Technique with Commercial Well-of-the-Well Culture Dish

Monozygotic twin bovine embryos can be produced by blastomere separation of 2-cell embryos and commercial well-of-the-well (WOW) culture dish (Hashiyada et al. 2016 Reprod. Fertil. Dev. 28, 178) obtaining 60% and 48% of blastocyst formation and monozygotic blastocyst pairs, respectively. The present study was conducted to evaluate the fertility of blastocysts derived from this production system in Japanese Black beef cattle. Embryos were produced using oocytes collected by ovum pick-up technique. TCM-199 supplemented with 5% calf serum (CS), Brackett-Oliphant solution supplemented with 10 mg mL−1 BSA, and CR1aa containing 5% CS, were used for each culture step: in vitro maturation, fertilization, and culture (IVM,IVF, and IVC). Two-cell stage embryos were obtained 24 to 27 h post-insemination. Zonae pellucidae were removed by exposure to 0.25% pronase. Then, embryos were separated into blastomeres by gentle pipetting in IVC medium. Each blastomere was introduced into a single conical microwell of 25 wells, each having a diameter and depth of ~287 μm and 168 μm (Dai Nippon Printing, Tokyo, Japan). Blastomeres in wells were cultured covered with a droplet of 2.5 μL of IVC medium/well. The developed blastocysts in pairs on 7 days post-insemination were used for transfer. Single embryos of monozygotic twin embryos were transferred to Japanese Black cattle with a generally small body frame to produce twin calves from a set of recipients. Twin embryos were transferred in pairs to unilateral of uterus of non-lactating Holstein cows. Pregnancy and twin pregnancy were determined at 30 days of gestation by ultrasonography and were reconfirmed at 60 days with detection of fetal loss. Statistical significance was analysed by Fisher’s exact test. There was no significant difference in pregnancy rate or twin pregnancy rate between single embryo transfer (7/14, 50% and 2/7, 28.6%) and twin embryo transfer (9/21, 42.9% and 4/21, 19%). In either transfer method, fetal loss was not observed in diagnosis carried out at 60 days by ultrasonography. To date, 2 pairs of twin calves have been obtained from twin pregnant cows by twin embryo transfer within the normal range of gestation length (286 and 288 days) and birth weight (31-40 kg). These results indicate that blastocysts developed from blastomeres separated from 2-cell embryos by culturing with commercial WOW culture dish had fertility similar to that of intact embryos derived from standard in vitro culture and further demonstrate the possibility of production of normal twin calves.

164 The Origin of Oocyte, In Vitro-Matured Oocyte With/Without Super-Stimulation, and In Vivo-Matured Oocyte Influence the Timing of Cleavage in Early Embryo and Oxygen Consumption of Blastocyst After IVF in Japanese Black Cow

It has been reported that in vitro- and in vivo-matured oocyte obtained from fully growth follicles have high developmental competence. Furthermore, the timing of cleavage in early embryo after IVF affect pregnancy success after embryo transfer. It is still unknown whether origin of oocyte affects the timing of cleavage. In this study, we examined the influence of oocyte origin on cleavage timing of early embryo after IVF. Japanese Black cows were used as donors. Oocytes derived from non-stimulation follicles (control: CON), fully grown follicles after super-stimulation treatment (SST) and follicles just before ovulation after ovulation-induction treatment (in vivo-matured oocyte: VIVO) were obtained by ovum pick-up (OPU). In the CON group, OPU was conducted on arbitrary days except oestrus. In SST group, dominant follicles were aspirated and a CIDR was inserted into the vagina on Day 0, and then FSH was injected twice a day from the evening of Day 1 to the morning of Day 5 with decreasing doses in total 20 AU. In the evening of Day 4, prostaglandin F2α (0.5 mg of cloprostenol) was administered. On Day 6, SST oocytes were collected after CIDR withdrawl. In the VIVO group, the treatment was carried out as SST until prostaglandin F2α administration, and then CIDR withdrawal and administration of gonadotropin-releasing hormone (GnRH, 0.2 mg of fertirelin acetate) performed on the evening of Day 4 and morning of Day 5, respectively. The VIVO oocytes were collected at 25 to 26 h after GnRH. The CON and SST oocytes were inseminated after 20 to 22 h of IVM, and VIVO oocytes were inseminated at 30 h after GnRH, with 3 × 106 sperm mL−1, respectively. After 6 h of IVF, presumptive zygotes were individually cultured for 168 h, using a well-of-the-well dish (Dai-Nippon-Print, Japan) and were observed by time-lapse cinematography (CCM-4MZS; Astec, Japan) to analyse the cleavage timing of embryos. Oxygen consumption (O2) was measured in blastocysts on 168 hpi with a scaning electrochemical microscopy system (HV-405SP; Hokuto Denko, Japan). Statistical analysis was carried out by Steel-Dwass test for the timing of cleavage and Tukey-Kramer test for O2. In CON (n = 15), SST (n = 25), and VIVO (n = 36), the time of first cleavage was 27.5, 29.1, and 26.1 hpi, that of second cleavage was 38.9, 40.3, and 36.0 hpi, and that of third cleavage was 48.5, 46.1, and 45.9 hpi, respectively. These cleavage times were shorter in VIVO than in CON and SST (P < 0.01). The time interval between first and second cleavage (2nd cell cycle) was shorter in VIVO (10.1; P < 0.01) than CON (11.4) and SST (11.2). The time interval between second and third (3rd cell cycle) were shorter (P < 0.01) in SST (9.4) than in VIVO (10.1), and in VIVO than in CON (10.2), respectively. Consumption of O2 was lower (P < 0.01) in CON (0.61 × 10−14 mol s−1) than in SST (0.94 × 10−14 mol s−1) and VIVO (0.94 × 10−14 mol s−1). These results suggest that the origin of oocyte influences the length of cell cycle and O2 consumption of blastocyst producted in vitro.

14 ENHANCEMENT OF THE EARLY RECOVERY OF OVARY AND UTERUS FUNCTIONS BY TREATMENT OF eCG AND POVIDONE-IODINE IN POSTPARTUM JAPANESE BLACK CATTLE

The aim of this study was to evaluate the effect of administration of eCG and intrauterine infusion of povidone-iodine to promote the early recovery of ovary and uterus functions in early stage after delivery on postpartum beef cows. Thirty-three postpartum Japanese Black cows without retention of placenta were used for this investigation. After delivery, cows nursed colostrums to calves for several hours in a pen, and then were separated from calves and returned into a barn managed in a group. In experimental group (n = 14), on Day 10 (Day 0 = day of parturition), an intramuscular administration of 500 IU of eCG and infusion of 30 mL of 2% povidone-iodine into the uterus body were conducted. The untreated cows delivered in the same period were compared as a control group (n = 19). Cows were inseminated artificially using commercial Japanese Black frozen–thawed semen when standing oestrus was detected until Day 90. Pregnancy diagnosis was performed 30 days after insemination by ultrasonography. For all of the experimental group and 8 cows in the control group, the diameter of follicles >8 mm and the diameter of cross-section between endometrium in uterus of the implanted side at the point of ~2 cm from bifurcation of the uterus were measured using an ultrasound scanning machine connected to a 7.5-MHz convex probe. This monitoring was carried out every 10 days from Day 10 until the day of first oestrus (= insemination) or until Day 80 for non-returned oestrus cows. Data were analysed using Fisher’s exact test and ANOVA. The ratio of returned oestrus by Day 90 was 100% (14/14) in experimental group and 89.5% (17/19) in control group. The first oestrus day postpartum in the experimental group and the control group was the almost same: 52.9 ± 12.1 (24–88) days and 57.2 ± 19.9 (29–78) days, respectively. The conception rate until Day 90 tended to be higher (P = 0.07) in the experimental group (78.6%, 11/14) than in the control group (47.4%, 9/19). The days inseminated to cows that were conceived, was almost same between the experimental group (57.5 ± 18.6, 24–87 d) and the control group (55.4 ± 12.9, 36–78 d). The ratio of cows observed follicles more than 8 mm, was higher in the experimental group than control group on Day 50 (90.9% v. 50.0%; P = 0.09) and Day 60 (66.7% v. 0%; P < 0.05), respectively. The diameter of uterus tended to be lesser in the experimental group than in the control group on Day 30 (16.9 ± 2.8 mm v. 19.2 ± 2.8 mm; P = 0.09), and that regressed linearly to Day 30 in the experimental group however that was prolonged until Day 40 (16.4 ± 1.7 mm) in the control group. These results indicate that administration of eCG and uterus infusion of povidone-iodine at an early stage postpartum may promote the early recovery of ovary and uterus functions in beef cows. This research was supported by a grant from the Research Program of MAFF, (REP1004) Development of Innovative Technology for Animal Reproduction.

143 EFFECT OF FSH OR EPIDERMAL-GROWTH-FACTOR-LIKE PEPTIDE SUPPLEMENTATION TO MATURATION MEDIUM ON DEVELOPMENTAL COMPETENCE OF BOVINE OOCYTES DERIVED FROM FULLY DEVELOPED FOLLICLES INDUCED BY SUPER-STIMULATION

Bovine oocytes obtained by ovum-pick-up (OPU) following follicle growth treatment (FGT) have improved quality and competence (Imai et al. 2008 Reprod. Fertil. Dev. 20, 182). However, the effect of the presence of FSH or epidermal growth factor (EGF) like peptide during in vitro maturation (IVM) on the developmental competence of FGT oocytes has not been well known. This study was undertaken to examine the developmental competence of FGT oocytes following IVM in the presence of FSH (recombinant human FSH) or EGF-like peptide (amphiregulin; Areg) and IVF. Japanese Black cows (n = 17) were used as donors. Five days after arbitrary OPU (opu group), follicles ≥8 mm in diameter were aspirated again, a controlled internal drug release (CIDR) was inserted into the vagina, and then pFSH was injected twice a day from the evening of Day 6 to the morning of Day 10 with decreasing doses (total of 20 AU; 4, 4, 3, 3, 2, 2, 1, 1 AU/day). On the evening of Day 8, PGF2α (0.5 mg of cloprostenol) was administered. On Day 11, oocytes were aspirated from follicles with ≥5 mm in diameter of the treated donors by OPU (fgt group). The cumulus-oocyte complexes (COC) were cultured in the absence (opu-cont and fgt-cont groups) or presence of 0.1 IU mL−1 FSH (opu-fsh and fgt-fsh groups) or 100 ng mL−1 Areg (opu-areg and fgt-areg groups) in IVM medium (mTCM199 containing 5 mg mL−1 BSA) for 20 to 22 h (1 COC/5 µL, total of 162–171 COC per group), and then co-cultured with 3 × 106 sperm/mL for 6 h. The presumptive zygotes were continued to culture in mCR1aa supplemented with 5% newborn calf serum for 216 h (1 zygote/5 µL) using micro-well culture dishes (Dai-Nippon-Print). When repeating this opu-fgt session in the same cow, an interval at least for 50 days was kept, and the session was performed 28 times. Statistical analysis was carried out by Mann-Whitney’s U-test (between opu and fgt groups) or Steel-Dwass test after Kruskal-Wallis test (among all groups). The number of follicles ≥5 mm increased in the fgt than opu group (17.8 v. 2.9; P < 0.01). The number of COC collected was not different between the opu and fgt groups (23.1 v. 19.6; P > 0.05). The blastocyst formation rate was higher in the fgt than opu group (36.9 v. 23.1%; P < 0.01). Within 6 groups, the blastocyst formation rate was higher in the fgt-fsh (43.3%; P < 0.01) and fgt-areg (39.5%; P < 0.05) groups than the opu-cont (16.3%) group. The rate in the fgt-fsh group was also higher than that in the opu-fsh group (43.3 v. 18.7%; P < 0.01). These results suggested that FGT improved the developmental competence of bovine oocytes, probably through improving the ability of the COC to react against FSH/Areg.

194 EFFECT OF CORPUS LUTEUM PRESENCE FOR THE DURATION OF FOLLICULAR GROWTH ON BOVINE OOCYTE DEVELOPMENTAL COMPETENCE

It has been reported that follicular wave control is effective to increase bovine oocyte (OC) quality of ovum pickup (Imai et al. 2008 Reprod. Fertil. Dev. 20, 182). However, the effect on the bovine OC developmental competence to the presence of corpus luteum (CL) for the duration of follicular growth (FG) is not known. This study was conducted to examine the developmental competence of OC after stimulation of FG with and without CL. Japanese Black cows (n = 4/session) were synchronised in oestrus (Day 0; D0) with prostaglandin F2α (PGF2α; 0.5 mg cloprostenol). On Day 9, cows were removed follicles (FL) ≥ 8 mm in diameter and CIDR were inserted. Cows in the PGF2α treatment group (PG) were administered PGF2α (0.75 mg cloprostenol) for regression of the CL; the PGF2α non-treatment group (non-PG) were not administered PGF2α for the presence of CL. The cows received 20 mg of FSH twice a day from the evening of Day 10 to the morning of Day 14 in decreasing doses. Oocytes were collected from FL ≥ 5 mm by OPU on Day 15. Collected OC were classified as follows: Grade 1, several layers of cumulus cells (CC) and homogeneous OC cytoplasm; Grade 2, 1 to 3 layers of CC; Grade 3, denuded OC; Grade 4, expanded CC or degenerated OC. The OC that were classified as Grade 1 to 3 were matured in vitro for 20–22 h and then inseminated with 3 × 106 sperm mL–1 for 6 h. Then presumptive zygotes were cultured in 5% newborn calf serum + CR1aa for 216 h in micro-well culture dishes (Dai, Nippon, Japan). Cows were assigned to groups of 4 with each pair placed into 1 of the treatments, and groups switched at ≥40 days of interval for crossover trials. To compare the quality of OC derived from CL ipsilateral FL and CL contralateral FL, the OC were subdivided in CL ipsilateral group (ipsi-CL) and CL contralateral group (contra-CL) in the non-PG. In addition, half of the data from PG were regarded as unilateral ovary (regression CL group; reg-CL). Statistical analysis was carried by Student’s t-test, Tukey’s test, Fisher’s exact probability test, and chi-squared test. Part of data was log-transformed. At OPU, all cows in the non-PG group had an observed CL, and the average diameter of the CL was 16 ± 0.1 mm in the long axis and short; all cows in the PG were observed to not have a CL. In PG and non-PG, there were no significant differences in the number of FL ≥ 5 mm, the rate of cleavage, or the rate of blastocyst (BL) formation (17 ± 2.0 v. 20.8 ± 2.6, 82.7 ± 5.6% v. 86.1 ± 3.9% and 53.4 ± 5.9% v. 62.1 ± 4.7%, respectively). The number of BL tended to increase in non-PG cows compared with PG cows (10.0 ± 1.2 v. 7.8 ± 0.9; P = 0.078). The number of BL rated as Code 1 or 2 (IETS code) was higher in non-PG cows than in PG cows (76 v. 46; P < 0.01). In ipsi-CL, contra-CL, and reg-CL, statistical differences were observed between the rate of Grade 1 to 2 OC and groups; the rate of Grade 1 to 2 OC was higher in ipsi-CL (93.8 v. 79.0 v. 86.7; P < 0.01). These results suggested that the presence of CL for the duration of FG did not affect the rate of cleavage and BL formation but may have improved efficiency of embryo production by increasing quality of OC and BL.

96 EFFICIENT PRODUCTION OF MONOZYGOTIC TWIN BOVINE EMBRYOS USING BLASTOMERE SEPARATION TECHNIQUE WITH COMMERCIAL WELL OF THE WELL CULTURE DISH

Monozygotic twin embryos can be produced using the technique of blastomere separation and well of the well (WOW) dish having handmade micro-wells by the needle depression (Tagawa et al. 2008). We have recently reported that developed commercial WOW dish enhances embryo competence in individual culture (Sugimura et al. 2010). The present study was conducted to evaluate the availability of commercial WOW dish for production of monozygotic twin embryos in bovine. Embryos were produced using oocytes from ovaries collected at an abattoir by IVM, IVF, and IVC. For each culture, TCM-199 supplemented with 5% calf serum (CS), Brackett-Oliphant solution supplemented with 10 mg mL–1 BSA, and CR1aa containing 5% CS were used. To evaluate the adaptability of dishes on culture of isolated blastomeres from different cell stage, 2- (n = 63), 4- (n = 94), 8- (n = 137), and 10- to 14- (n = 116) cell stages were obtained on 24–27 h, 30–36 h, 48–54 h, and 48–54 h from the beginning of fertilization, respectively. The zona pellucida was removed by exposure of 0.25% pronase, followed by gentle pipetting by inspiration and expiration in the IVC medium. Then, two halves separated from the original number of blastomeres were randomly allocated to the conical micro-wells of commercial dish (Dai Nippon Printing, Tokyo, Japan) or created micro-wells by pressing the bottom of the dish with an eyeleteer (control). The approximate diameter and depth of each 25 wells in a commercial dish was 287 and 168 μm, and each 20 wells in the control were 800 and 600 μm. The blastomeres were cultured in wells covered with a droplet of 2.5 μL well–1 IVC medium until Day 8 (IVF = Day 0). Expanded blastocysts (n = 28) derived from tetra-blastomeres of 8-cell stage were stained to determine the number of the inner cell mass (ICM) and trophectoderm (TE) in each group. Statistical significance of the blastocyst formation rates and the number of cells were analysed by the chi-square test and the Student’s t-test, respectively. In the 2-cell stage, blastocyst formation rate in commercial dish tended to be higher than that in the control (60.0% v. 46.1%). The rate of monozygotic blastocyst pairs in commercial dish was higher compared with the control (48.0% v. 26.3%, P < 0.05). In the 4-cell stage, rates of blastocyst formation (50.0% v. 33.0%, P < 0.05) and the pairs (39.5% v. 12.5%, P < 0.01) in the commercial dish, both were higher compared with the control. In the 8-cell stage, there were no differences between two groups in rates of blastocyst formation (53.1% v. 59.0%) and the pairs (41.8% v. 48.7%), similarly in the 10- to 14-cell stage (47.9% v. 56.8% and 36.2% v. 40.9%, respectively). The ICM, TE, and total cell numbers were not different between the commercial and the control dish (28.0 ± 3.2 v. 26.0 ± 3.8, 64.6 ± 4.3 v. 76.0 ± 7.9, and 92.6 ± 6.2 v. 102.0 ± 11.0, respectively). These results indicate that separated blastomeres could be developed to blastocysts efficiently and stably regardless of embryo cell stage with a commercial WOW culture dish.

Protection against biohazards in animal laboratories

An outline of the animal facilities known as the "Quarters for Experimentally Infected Animals" of the Research Institute for Microbial Diseases, Osaka University, is presented as one example of the approaches used for protecting against biohazards in animal laboratories. The quarters are contained in a 2-story building which is in the form of small cubicles for housing the experimentally infected animals. Each cubicle is equipped with specially designed cabinet compartments in which the animal cages are placed. The anterior surface of the compartments consists of an outward inclining door. Vigorous air-mixing between compartments and the interiors of the cubicles can be avoided by this arrangement. The air for ventilation is sucked through a gap between the edge of the door and the wall of each compartment and the collected air is finally filtered through Cambridge "Aerosolve" and "Absolute" filters before being exhausted into the atmosphere. In the central corridor connecting each cubicle the air pressure is maintained at a higher level than that in the cubicle but lower than that outdoors. Thus, the air stream is always kept flowing from the outside to the inside of the cubicle and from the inside of the cubicle to the compartments but never vice versa. Each cubicle is equipped with an individual, pass-through autoclave. All soiled materials are sterilized before being removed from the cubicle. The drained water from each cubicle is chlorinated in a tank by chloride of lime. In these facilities experimentally infected animals can be handled with little danger of accidental contamination of personnel, other animals, or the external environment. The authors emphasize the importance of complete adherence to the rules in such animal facilities.

235 DEVELOPMENT OF IN VIVO-MATURED OOCYTES COLLECTED FROM JAPANESE BLACK CATTLE STIMULATED WITH DIFFERENT DURATIONS OF FOLLICULAR GROWTH

We demonstrated that in vivo-matured oocytes (mOC) collected by ovum-pick up (OPU) from cows after stimulation of follicular growth (FG) are suitable for producing good quality blastocysts (BL). However, it is not known whether duration of FG affects developmental competence of mOC. The purpose of this study was to examine development of mOC after stimulation with different duration of FG. Japanese black donor cows (n = 4 per each group), were treated with a CIDR at Day 0. Follicle of diameter >8 mm were removed on Day 5. A total 20 AU of FSH was administrated to cows twice daily with decreasing doses from the evening of Day 6 to the morning of Day 10. In the conventional group (48PG), a administration of PGF2α (0.75 mg of cloprostenol), CIDR withdrawal, and administration of GnRH (0.2 mg of fertirelin acetate) were performed on the evening of Day 8, morning of Day 9, and morning of Day 10, respectively. In the experimental group (72PG), administration of PGF2a, CIDR withdrawal, and administration of GnRH were performed on the evening of Day 9, the morning of Day 10, and the morning of Day 11, respectively. The mOC were collected from follicles >5 mm by OPU at 25 to 26 h following GnRH administration. Collected mOC were inseminated with 3 × 106 sperm mL–1 in BO solution on 30 h after GnRH. After 6 h of IVF, presumptive zygotes were cultured for 168 h in 5% CS + CR1aa, using a micro-well culture dish (Dai-Nippon-Print) and time-lapse cinematography (CCM-1.4MZS; Astec) for individual embryo observation. The kinetics of early embryo was analysis by CCM-1.4 software. To assess the quality of BL, prognostic factors were used as follows: (1) less than 27 hpi (hours post-insemination) at the first cleavage (1st CD), (2) 2 blastomeres at the end of 1st CD, and (3) absence of multiple fragments at the end of the 1st CD (Sugimura et al. 2012 PLoS ONE 7, e36627; Imai et al. 2014 Reprod. Fertil. Dev. 26, 182). Data were analysed by Student's t-test or chi-square test. The number of mOC were 12.5 ± 4.7 and 10.3 ± 2.7 (means ± s.e.) oocytes per session in 48PG and 72PG. There was no significant difference in cleavage rate or BL formation rate (97.5 ± 1.5 v. 98.2 ± 1.8%, 66.3 ± 8.2 v. 66.8 ± 3.5%, respectively). The time for 1st CD was shorter in 48PG (26.1 ± 0.3 v. 27.8 ± 0.4; P < 0.01), and the rate of 1st CD less than 27 hpi was superior in 48PG compared with 72PG (74.3 v. 42.9%; P < 0.05). However, the rate of 2 blastomeres and absence of multiple fragments were not different between 48PG and 72PG. The number of BL tended to decrease in 72PG compared with 48PG (28.6 v. 48.6%; P = 0.087). These results indicate that duration of FG did not affect the rate of cleavage and BL formation. However, extension of duration of FG might reduce the quality of BL.

Properties of Agents that Effectively Entrap Liquid Lipids

A droplet of an oil-in-water emulsion of methyl linoleate in a saccharide or protein solution that contained with a surfactant, a stabilizer, or both was dehydrated by drying equipment for a single droplet that resembled a spray drier. The lipid exposed on the surface of dehydated samples was extracted and measured by gas chromatography. Gum arabic or gelatin without additives resulted in little lipid being exposed; they were good entrapping agents. Little lipid was exposed with a pullulan solution containing lecithin, sugar ester, carboxymethylcellulose, or sodium caseinate but much was exposed with a maltodextrin solution containing any of the surfactants tested. When both the surfactant lecithin and the stabilizer xanthan gum were added to the emulsion prepared in a maltodextrin solution, lipid was not detected. The results suggested that effective entrapping agents of liquid lipids cause much emulsification, stabilize the emulsion (that is, they cause the continuous phase to be very viscous), and create a dehydrated matrix of fine, dense network layers.

75 DETECTION OF EMBRYONIC DEATH BY MONITORING OVARIAN STEROIDS BALANCE AND ULTRASONOGRAPHY IN JAPANESE BLACK CATTLE

In beef cattle, 20 to 44% embryonic loss occurs during the early stages of pregnancy (Humblot et al. 2001). However, the mechanism of early and late embryonic death is not clear. We investigated occurrence of embryonic death by monitoring ovarian hormones dynamics and checking for the presence of the conceptus after artificial insemination or embryo transfer in beef cattle. Twenty Japanese black females were inseminated (AI) and 12 females were transferred with 1 embryo (ET). Blood samples were collected on Days 21, 24, 28, 38, 48, 58, and 68 post-oestrus (oestrus = Day 0) and then stored at –30°C. Progesterone (P4) and oestradiol (E2) plasma concentrations were analysed using a chemiluminescent immunoassay. On each day of blood sampling, ovaries and presence of a conceptus in the uterus were monitored by ultrasonography. At Day 24 post-oestrus, the presence of the fetus was detected in 8 females (AI, n = 6; ET, n = 2), whereas only 3 females were confirmed to be pregnant at Day 28 and Day 38 post-oestrus. No embryo loss was seen at later stages of pregnancy (Days 48, 58, and 68 post-oestrus). At Day 21 post-oestrus, the conceptus could not be detected by ultrasonography but the E2/P4 ratio provided indication on the pregnancy status of the females that were classified as pregnant (n = 8) or not pregnant (n = 24) at day 24 post-oestrus (1.7 ± 2.2 versus 28.0 ± 34.2 respectively; mean ± s.d.). In the nonpregnant females compared with the pregnant ones at Day 24 post-oestrus, P4 declined below 1 ng mL–1 (0.6 ± 0.2 ng mL–1 v. 8.6 ± 3.9 ng mL–1), whereas E2 blood level remained stable (15.7 ± 21.9 v. 18.1 ± 1.1 pg mL–1). The decrease in P4 levels led to an increase in E2/P4 ratio (1.3 to 37.3 on Day 24). Our study suggests that a large proportion of embryo loss (75%) occurs before Day 24, whereas an additional 16% loss was seen between Day 24 and Day 28 post-oestrus. This embryo loss was shown to be associated with the altered balance of ovarian hormones.

141 SUPERIORITY OF FEMALE EMBRYO PRODUCTION SYSTEM BY IN VIVO-MATURED OOCYTE AND X-SORTED SPERM IN BROWN SWISS COWS

Embryo transfer using a female embryo is an effective tool for offspring production on dairy industry; however, embryo production by embryo recovery (ER) using X-sorted semen is not sufficient because non-fertilized oocytes are recovered frequently. In Holstein cows, we developed a system for high blastocyst production that was performed by IVF using X-sorted sperm and in vivo-matured oocytes obtained by ovum pickup (OPU) after superstimulation. The purpose of this study was to adjust this system to Brown Swiss cows, comparing between ER and embryo production from oocytes derived from OPU with or without superstimulation. In the ER group, cows (n = 10) received a CIDR (Day 0) and 2 mg of oestradiol-benzoate on Day 1. A total of 30 Armour Units of FSH were injected into cows twice a day, with decreasing doses from the evening of Day 5 to the morning of Day 9. On the evening of Day 7 or 8, 0.75 mg of prostaglandin F2α (cloprostenol) was injected. The CIDR was removed on Day 8 or 9 and 0.2 mg of gonadotropin-releasing hormone (GnRH; fertirelin acetate) were injected on Day 9 or 10. At oestrus, AI was carried out twice, 12 h apart, with a total of 4 straws of X-sorted semen per cow. In the OPU group, cows (n = 7) were subjected to OPU without any pretreatment, collected immature oocytes were in vivo matured for 20 to 22 h, followed by IVF using X-sorted sperm for 6 h; then, presumptive zygotes were in vitro cultured (IVC) for 9 days. In the in vivo-matured oocyte group (matured group), a CIDR was inserted (Day 0) in cows (n = 4), all follicles larger than 8 mm were removed on Day 5. Administration of FSH, prostaglandin F2α, and GnRH, as well as withdrawal of CIDR, were performed as in the ER group. In vivo-matured oocytes were collected from follicles larger than 5 mm by OPU at 25 to 26 h following GnRH injection; collected oocytes with expanded cumulus cells were fertilized with X-sorted sperm 30 h after GnRH. After 6 h of IVF, presumptive zygotes were transferred to in vitro culture, as in the OPU group. Data were compared among 3 groups; the ER group was analysed for number of CL, collected embryos, and normal embryos, against the number of aspirated follicles, collected oocytes used for IVF, and formed blastocysts in the OPU and matured groups, respectively, by Tukey-kramer test after ANOVA. There were no differences between the number of CL in the ER group and the number of follicles in the OPU and matured groups (16.4 ± 5.3 v. 31.6 ± 22.7 v. 18.5 ± 4.7, mean ± s.d., respectively). Also the number of collected embryos in the ER group and number of oocytes for IVF in the OPU and matured groups (12.8 ± 7.6 v. 14.9 ± 11.8 v. 17.8 ± 7.7, respectively) was similar. However, the number of blastocysts in the matured group (13.0 ± 5.9; P < 0.01) was higher than that in the OPU group (3.0 ± 2.2) and in the ER group (2.8 ± 3.7). For female embryo production in Brown Swiss cows using X-sorted sperm, the system of IVF with in vivo matured oocytes obtained by OPU is more effective than ER or OPU without pretreatment.

A mechanical coil insertion system for endovascular coil embolization of intracranial aneurysms

Like other fields of medicine, robotics and mechanization might be introduced into endovascular coil embolization of intracranial aneurysms for effective treatment. We have already reported that coil insertion force could be smaller and more stable when the coil delivery wire is driven mechanically at a constant speed. Another background is the difficulty in synchronizing operators' minds and hands when two operators control the microcatheter and the coil respectively. We have therefore developed a mechanical coil insertion system enabling a single operator to insert coils at a fixed speed while controlling the microcatheter. Using our new system, the operator manipulated the microcatheter with both hands and drove the coil using foot switches simultaneously. A delivery wire force sensor previously reported was used concurrently, allowing the operator to detect excessive stress on the wire. In vitro coil embolization was performed using three methods: simple mechanical advance of the coil; simple mechanical advance of the coil with microcatheter control; and driving (forward and backward) of the coil using foot switches in addition to microcatheter control. The system worked without any problems, and did not interfere with any procedures. In experimental coil embolization, delivery wire control using the foot switches as well as microcatheter manipulation helped to achieve successful insertion of coils. This system could offer the possibility of developing safer and more efficient coil embolization. Although we aim at total mechanization and automation of procedures in the future, microcatheter manipulation and synchronized delivery wire control are still indispensable using this system.

159 RELATIONSHIP BETWEEN CLEAVAGE PATTERNS OF FIRST CELL CYCLE AND POST-TRANSFER VIABILITY IN BOVINE EMBRYOS OBTAINED BY OVUM PICKUP AND IN VITRO FERTILIZATION

More than 300 000 embryos have been transferred all over the world (Stroud 2010 IETS Newsl. 27(4), 11–21). We have reported that embryos that showed the abnormal cleavage pattern at the first cell division can develop to the blastocyst stage (Somfai et al. 2010 J. Reprod. Dev. 56, 200–207). However, we have limited knowledge about the consequences of the pattern of first embryonic cleavage on their post-transfer developmental competence. The present study was conducted to determine the developmental competence of bovine blastocysts showing different cleavage patterns at their first cell division. Cumulus–oocyte complexes were collected by ovum pickup from Japanese Black cows and were subjected to in vitro maturation and IVF as reported previously (Imai et al. 2006 J. Reprod. Dev. 52, S19–S29 suppl). Inseminated oocytes were cultured in CR1aa medium supplemented with 5% calf serum covered by mineral oil at 38.5°C in 5% CO2 in air with micro-droplets or 5% CO2, 5% O2 and 90% N2. The kinetics of embryo development were analysed by time-lapse cinematography for 168 h after IVF by using a Cultured Cell Monitoring System (CCM-M1.4ZS, Astec, Fukuoka, Japan). A total of 673 photographs of each embryo were taken (1 photograph in every 15 min) during in vitro culture. Image stacks were analysed by the CCM-M1.4 software. Embryos were classified in 5 groups according to the pattern of first cleavage as normal cleavage (NC), direct cleavage from 1 cell to 3 to 4 blastomeres (3–4BL), unequal blastomeres (UB), multiple fragments (MF) and protrusion formation (PT). Blastocysts developing from each group were transferred into the ipsilateral uterine horn of each synchronized recipient on Day 7 or 8 after oestrus. Data on conception at Day 60, abortion and delivery were then recorded. Data were analysed by chi-square test and Student's t-test. In total, 43 embryos were transferred, 17 conceptions (39.5%) were established and 16 recipients (94.1%) were delivered. Only 1 abortion was detected at Day 223 in the NC group. The highest conception rate was observed in the NC group (55%, n = 20) and the 3–4BL (n = 12), UB (n = 6) and PT (n = 3) groups showed similar conception rates of 33.3% (1 implanted embryo belonged to 2 classes in UB and PT) and none of the embryos derived from the MF group (n = 3) could cause conception. There was a significant difference (P < 0.05) in conception rates between the NC group and totals of each of the other cleavage groups. No significant difference was found in gestation lengths and birth weights between the NC group (282.2 ± 4.4 days, 30.6 ± 3.8 kg, respectively) and totals of each of the other cleavage groups (282.8 ± 5.3 days, 30.3 ± 1.9 kg, respectively). These results indicate that embryos showing abnormal cleavage patterns at first cell division can develop to normal calves with normal gestation lengths and birth weights; however, their post-transfer viability is lower than for NC embryos. This work was supported by the Research and Development Program for New Bio-industry Initiatives.

158 RELATIONSHIP BETWEEN FOURTH CELL CYCLE DURATION AND POST-TRANSFER VIABILITY IN IN VITRO-FERTILIZED BOVINE EMBRYOS

In cattle, the prediction of embryonic viability after embryo transfer is an important research target. A previous study has indicated that the duration of the fourth cell cycle at the time of maternal-zygotic transition, which is involved in in vitro embryonic development, may be an indicator of blastocyst formation; this study showed that embryos with a short fourth cell cycle have a better potential of developing into blastocysts than those with a long fourth cell cycle (Lequarre et al. 2003 Biol. Reprod. 69, 1707–1713). However, the relationship between the fourth cell cycle duration and post-transfer viability of embryos is unclear. The aim of the present study was to examine the effect of the fourth cell cycle duration on embryo development after embryo transfer. Twenty-five IVF bovine embryos were cultured in well-of-the-well culture dishes contained 125 μ of CR1aa supplemented with 5% calf serum at 38.5°C in 5% O2 and 5% CO2 for 168 h after insemination. In vitro development of the embryos was monitored using time-lapse cinematography (Sugimura et al. 2010 Biol. Reprod. 83, 970–978). We found that 61% of the blastocysts had a long fourth cell cycle (41.5 ± 5.9 h), which is commonly referred to as the lag phase, whereas the remaining embryos had a short fourth cell cycle (7.4 ± 4.5 h). All the embryos with a short fourth cell cycle exhibited a lag phase in the next cell cycle (32.9 ± 6.6 h). Moreover, embryos with a short fourth cell cycle were found to have a higher blastocyst rate (75.8%) than those with a long fourth cell cycle (48.1%; Student's t-test, P < 0.01). However, embryonic cell number, apoptosis incidence, chromosomal abnormality and O2 consumption were found to be identical between the 2 groups (Student's t-test, P > 0.05). Real-time reverse-transcription PCR results of the individual blastocysts showed that the relative expression of 5 genes related to pregnancy reorganization, placentation and fetal growth—namely, CDX2, IFN-τ, PLAC8, AKR1B1 and IGF2R—did not differ between the 2 groups (Student's t-test, P > 0.05). Furthermore, blastocysts derived from embryos with long (n = 30) and short (n = 19) fourth cell cycles were transferred into 49 recipient cows; we did not observe any difference between the long and short fourth cell cycles on the rates of pregnancy (long vs short fourth cell cycle, 30.0 vs 52.6%) and delivery (long vs short fourth cell cycle, 30.0 vs 47.4%; Yates' corrected chi-square test, P > 0.10). These results show that blastocysts derived from embryos with either long or short fourth cell cycles have identical developmental competence after embryo transfer. Therefore, the fourth cell cycle duration during maternal-zygotic transition appears to be unavailable as the indicator of post-transfer viability of IVF bovine embryos. This work was supported by the Research and Developmental Program for New Bio-Industry Initiatives.

Efficacy and safety of dutasteride on prostate cancer risk reduction in Asian men: the results from the REDUCE study

OBJECTIVE

A post hoc analysis of Asian men in the REDUCE study was conducted to investigate whether the outcomes were in line with those of the overall population.

METHODS

REDUCE was a 4-year international, multicenter, randomized, double-blind, placebo-controlled, parallel-group study. Inclusion criteria were men between 50 and 75 years of age, a serum prostate-specific antigen level of 2.5-10.0 ng/ml (50-60 years) or 3.0-10.0 ng/ml (>60 years), and a single, negative prostate biopsy (6-12 cores) within 6 months before enrollment. The primary endpoint was biopsy-detectable prostate cancer. This post hoc analysis included subjects who were recorded as Asian.

RESULTS

A total of 134 Asians, including 57 Japanese, were randomized to the study treatment. During the study period, the incidence of prostate cancer in the placebo and dutasteride groups was 19.6% (11/56) and 9.3% (5/54), respectively (relative risk reduction, 54%; 95% confidence intervals, -27 to 83%, P = 0.12), in the Asian subpopulation. Fewer tumors with the Gleason scores of 7-10 and 8-10 were detected among dutasteride-treated men. Although the incidences of drug-related sexual adverse events were higher in the dutasteride group, only in rare occasions did they lead to drug discontinuation.

CONCLUSIONS

The incidence of prostate cancer in the dutasteride group was lower than that in the placebo group, although the difference was not significant. These results paralleled those for the overall population and support the value of dutasteride for prostate cancer risk reduction in Asian men with an increased risk of prostate cancer.

Low-dose dobutamine radionuclide ventriculography for prediction of myocardial viability: quantitative analysis of regional left ventricular function

BACKGROUND

It is important to distinguish viable myocardium from necrotic tissue in order to decide upon therapy in patients with ischemic heart disease.

HYPOTHESIS

We verified the hypothesis that quantitative analysis of regional left ventricular function using low-dose dobutamine radionuclide ventriculography (RNV) can sensitively predict myocardial viability and compared its usefulness with thallium-201 (201Tl) single-photon emission computed tomography (201Tl-SPECT).

METHODS

Radionuclide ventriculography at rest and during low-dose dobutamine infusion (5 micrograms/kg/min), 201Tl-SPECT, and coronary angiography were performed in 51 subjects with severe ischemia-related stenosis of coronary arteries and 3 subjects without coronary artery disease. 201Tl uptake was assessed as normal (control), low perfusion (LP), or defect. We compared the response of regional function to dobutamine with the regional 201Tl uptake. The accuracy of both methods for identifying viable myocardium was investigated in 17 patients who underwent successful coronary revascularization, with a resulting improvement in wall motion.

RESULTS

The increase in regional ejection fraction (delta r-EF) in response to dobutamine was significantly greater in the control (12 +/- 6%) and LP (16 +/- 11%) regions than in the defect (5 +/- 10%) regions. The increase in one-third regional ejection fraction (delta r-1/3EF) was also significantly higher in the control (14 +/- 7%) and LP (10 +/- 8%) regions than in the defect regions (5 +/- 6%). We defined myocardial viability as a delta r-EF > 5% or a delta r-1/3EF > 2%. The sensitivity and specificity of the delta r-EF for identification of myocardial viability were 91.4 and 55.5%, respectively. The sensitivity and specificity of the delta r-1/3EF were 91.4 and 66.6%, respectively; the corresponding values for 201Tl SPECT were 74.2 and 77.8%.

CONCLUSION

Low-dose dobutamine RNV with quantitative analysis of regional left ventricular function was more sensitive for identification of viable myocardium than 201Tl-SPECT.

Esophageal atresia with double tracheoesophageal fistula--a case report and review of the literature

Esophageal atresia with double tracheoesophageal fistula (TEF) is a very rare anomaly, and the accurate preoperative diagnosis of proximal TEF is very difficult. This paper describes a baby girl who presented with esophageal atresia with double, proximal, and distal TEF. The distal TEF was diagnosed before operation, whereas the proximal TEF was found intraoperatively. Overlooking the presence of proximal TEF can lead to increased morbidity and mortality due to severe respiratory infection and the necessity of a second operation. Great care must therefore be taken to not overlook the presence of proximal TEF in patients with this anomaly.

Comparison of metabolic effects of pioglitazone, metformin, and glimepiride over 1 year in Japanese patients with newly diagnosed Type 2 diabetes

AIMS

To compare the metabolic effects of pioglitazone, metformin, and glimepiride in the treatment of Japanese patients with newly diagnosed Type 2 diabetes.

METHODS

A total of 114 patients with Type 2 diabetes who had never used oral hypoglycaemic drugs were studied for 12 months. Patients were randomly assigned to pioglitazone (30-45 mg/day, n = 38), metformin (750 mg/day, n = 39), or glimepiride (1.0-2.0 mg/day, n = 37). The effect of treatment on fasting plasma glucose (FPG), glycated haemoglobin (HbA(1c)), 1,5-anhydroglucitol (1,5AG), total cholesterol, high-density lipoprotein (HDL)-cholesterol, triglycerides, free fatty acids (FFA), and fasting plasma insulin levels was monitored monthly. Body weight and safety data were also collected.

RESULTS

Eight patients withdrew from the study (three in the pioglitazone group, two in the metformin group, and three in the glimepiride group). The rate of reduction of HbA(1c) was fastest in patients receiving glimepiride and slowest in patients receiving pioglitazone. Although there were no significant differences among the three groups in HbA(1c) levels at the end of the study, patients taking pioglitazone had relatively lower FPG and 1,5AG levels than patients taking the other two drugs. These results suggest that pioglitazone acts predominantly on nocturnal metabolism rather than at mealtimes. FFA were reduced significantly in those taking pioglitazone (542.2 microEq/l vs. 237.3 microEq/l; P < 0.01) before a decrease in HbA(1c) was apparent. The change in FFA levels correlated with the change in HbA(1c) (r = 0.409, P < 0.01). There were no significant differences in other lipid parameters among the groups.

CONCLUSIONS

Pioglitazone, metformin, and glimepiride are equally effective in reducing blood glucose in patients with newly diagnosed Type 2 diabetes. However, their specific characteristics, such as the rapid action on blood glucose levels of glimepiride and the favourable action on FPG and FFA of pioglitazone, should be considered when choosing an appropriate agent.

Usefulness of troglitazone administration to obese hyperglycaemic patients with near-normoglycaemia

AIMS

We assessed the effectiveness of 400 mg/day of troglitazone administered to hyperglycaemic patients with near-normoglycaemia who were obese and who had hyperinsulinaemia.

RESULTS

The area under the plasma glucose curve in oral glucose tolerance tests (OGTT) significantly decreased from 39.8 +/- 19.4-20.5 +/- 10.2 mg/dL. h and the area under the insulin-response curve from 31.8 +/- 22.5-12.2 +/- 5.7 microU/ml x h 4 months after the start of treatment. The level of HbA1c significantly improved from 6.6 +/- 0.2 to 6.3 +/- 0.2% (p < 0.05) by 1 month after administration, and that of serum 1,5-anhydroglucitol (1,5-AG) from 12.6 +/- 1.1-18.3 +/- 2.5 micro/ml (p < 0.05). In some cases, recovery of the first-phase insulin secretion was observed.

CONCLUSIONS

These findings suggest that the administration of this insulin sensitizer is useful in the treatment of obese Japanese subjects with borderline or mild diabetics accompanied by hyperinsulinaemia.

Effects of omega-3 fatty acids in rat allogenic small intestinal transplantation

The aim of this study was to estimate the effect of omega-3 fatty acids on the recipient and graft immune response after rat allogenic small intestinal transplantation. Seven-week-old Lewis rats were randomly assigned to one of three groups according to the diet received: an FO group (fish oil supplemented), an SB group (soy bean oil supplemented) or a control group (normal rat chow). The recipient Lewis rats were each given their respective group diet for 12 days, and then, on the 19th day of gestation, a 2 cm jejunum from the donor fetal Fischer rat was transplanted into the abdominal wall of the recipient rats using a non-vascular anastomotic technique. The recipient rats were killed on day 2 after transplantation, and the recipient plasma IL-2, IFN-gamma and IL-1 beta levels were determined. In addition, the histological findings of the graft were analyzed. The cytokine levels of the FO group were significantly lower than the other two groups. In order to determine the grade of rejection, the morphological findings were blindly graded on a scale of 0-4. The mean grade of the FO group was also significantly lower than the other two groups. Omega-3 fatty acids are therefore considered to have an immunosuppressive effect on rat allogenic small intestinal transplantation based on the recipient plasma IL-1 beta, TNF and IL-2 levels and the histological findings of the grafts.

Retarded gastric acid secretion in rats infected with larval Taenia taeniaeformis

The influence of hepatic larval Taenia taeniaeformis infection on gastric acid secretory activity and gastric mucosal integrity was investigated. After 12 weeks of infection with 2,000 T. taeniaeformis eggs, the gastric pH values of control and infected rats were 4.1+/-0.6 (mean +/- SD) and 8.4+/-0.2, respectively. There was no difference in the basal acid secretion between control (1.7+/-0.7 micro Eq.H(+)/15 min) and infected (1.9+/-0.3) rats. However, infected rats failed to respond to histamine stimulation, the maximum acid output level being 2.8+/-0.4 in the infected rats, compared to 12.9+/-3.3 in control rats. Larval T. taeniaeformis infection resulted in the suppression of gastric acid secretion leading to hypergastrinemia.

[KRP-297, MCC-555]

KRP-297 and MCC-555, which are being developed in Japan as thiazolidinediones, uniquely bind and activate peroxisome proliferator-activated receptors(PPAR). KRP-297, unlike other thiazolidinediones, effects on not only PPAR gamma but also PPAR alpha. Furthermore, this compound acts directly on basal glucose uptake in the rat skeletal muscle. KRP-297 decreased plasma glucose and insulin levels, and also blood triglyceride and free fatty acid in diabetic animal models. MCC-555 has significant antidiabetic properties yet its binding affinity for PPAR gamma is less than 1/10 that of BRL 49653. Thus, it is regarded now as a PPAR gamma modulator rather than agonist, depending on cell type. At present, clinical phase II studies of both drugs are under way.

Post-load glucose measurements in oral glucose tolerance tests correlate well with 1,5-anhydroglucitol, an indicator of overall glycaemic state, in subjects with impaired glucose tolerance

Using both cross-sectional and longitudinal methods, we investigated the relationship between post-load serum glucose concentration in a 75 g oral glucose tolerance test (OGTT) and overall glycaemic state in subjects with impaired glucose tolerance (IGT). Glycaemic state was assessed by measuring glycated haemoglobin (HbA1c) and the serum concentration of 1,5-anhydroglucitol (1,5-AG). In the cross-sectional study, the concentration of 1,5-AG, while remaining within a normal range, was reduced to a degree proportional to the post-load glycaemic level. Although the correlation between HbA1c and post-load plasma glucose was relatively weak (r=0.281, P<0.001), a significant inverse correlation (r=-0.824, P<0.0001) was found between 1,5-AG and mean post-load plasma glucose concentration in 211 subjects with IGT. Fasting plasma glucose (r=-0.539, P<0.0001) and 2 h plasma glucose (r=-0.621, P<0.0001) were correlated with 1,5-AG less strongly than was post-load glycaemia. Both 1,5-AG and HbA1c were correlated weakly but significantly with the fasting insulin concentration. In the longitudinal study we measured 1,5-AG and mean post-load plasma glucose with an OGTT once yearly for 10 years in 15 subjects with IGT. Strong inverse correlations were seen between 1,5-AG and mean post-load plasma glucose in each subject (range of r values among subjects of -0.584 to -0.978). These findings suggest a close relationship between post-load plasma glucose concentration measured by OGTT and overall glycaemic state in subjects with IGT.

The efficacy of predeposited autologous blood transfusions in general pediatric surgery

Allogeneic blood transfusions are associated with a risk of infection, immunological reactions, immunosuppression, and the induction of antibodies in blood cells. We report our results of giving predeposited autologous blood transfusions (PABT) to children when it was anticipated that transfusions would be required for an elective operation. Autologous blood was collected for deposit from 16 patients ranging in age from 1 to 11 years old (mean 5.6 years old, mode 4 years old), and weighing from 9.7 to 42 kg (mean 20.8kg). They included 12 patients with pectus excavatum (funnel chest) and 4 patients with choledochal cyst (CBD). Blood was collected once from 2 patients and twice from the other 14 patients, then centrifuged and stored in a freezer at -80 degrees C. Between 7 and 14 ml/kg was collected at one time, the total mean volume of predeposited blood being 21.0 +/- 3.3 ml/kg for the children operated on for funnel chest, and 16.2 +/- 4.5 ml/ kg for those operated on for CBD. None of the patients required allogeneic transfusions and no complications occurred. PABT was found to be a safe and effective means for elective general pediatric surgical procedures for avoidance of allogeneic blood transfusion.

Outcome of fetal cystic hygroma and experience of intrauterine treatment

OBJECTIVE

To review our cases of fetal cystic hygroma and to examine the prognostic factors with the goal of establishing criteria for the intrauterine treatment for cystic hygroma.

PATIENTS AND METHODS

Thirty-one cases of fetal cystic hygroma were managed by us from January 1988 to December 1997, and 21 cases were available for analysis. Three prognostic factors, namely chromosomal abnormality, structural anomaly and hydrops fetalis, were evaluated. We treated 2 cases of cystic hygroma associated with hydrops fetalis in utero using OK-432 injection under ultrasound guidance.

RESULTS

The fetuses without any of the prognostic factors listed above showed a good prognosis throughout the fetal and neonatal periods. However, in this group, 2 infants with large tumors died of hemorrhage from the tumor at 6 months and 3 years of age, respectively. Cases with hydrops fetalis without chromosomal abnormalities or structural anomalies (5 cases) resulted in either intrauterine fetal death (IUFD, 2 cases) or early perinatal neonatal death (early PND, 3 cases). The cause of early PND was circulatory failure. Most of the hydrops cases with either a chromosomal abnormality or structural anomaly resulted in IUFD before 22 weeks of gestation. The size of the cyst decreased in 1 of 2 cases treated in utero.

CONCLUSIONS

The fetal cases of cystic hygroma showing hydrops fetalis without chromosomal abnormalities or structural anomalies are considered to be possible candidates for intrauterine therapy. Those with very large cystic hygroma without any of the three prognostic factors are also thought to be candidates for fetal treatment. Based on our clinical experience, sclerotherapy using OK-432 is considered to be a treatment option in selected cases with fetal cystic hygroma.

Manganese intoxication during intermittent parenteral nutrition: report of two cases

BACKGROUND AND METHODS

The administration of trace elements is thought to be needed in patients receiving long-term parenteral nutrition. Recently, manganese intoxication or deposition was documented in such patients. We report two cases of manganese intoxication during intermittent parenteral nutrition including manganese. Manganese had been administered for 4 years at a frequency of one or two times per week in one case and for 5 years at a frequency of one or two times per month in the other case. Both cases showed mild symptoms with headache and dizziness. One case had mild hepatic dysfunction and the other did not. The whole-blood manganese level increased in one case, but not in the other case. T1-weighted magnetic resonance images revealed symmetrical high-intensity areas in basal ganglia and thalamus in both cases. After the administration of manganese was stopped, these symptoms all disappeared and the magnetic resonance images abnormalities gradually improved in both patients. Mild long-term manganese intoxication is thus considered to occur regardless of the frequency of using a manganese supplement.

CONCLUSIONS

Patients should be carefully monitored when receiving long-term parenteral nutrition including manganese, even when the manganese dose is small and the frequency of receiving a manganese supplement is low.

The influence of traditional Chinese herbal drugs on serum 1, 5-anhydroglucitol levels

The serum concentration of 1,5-anhydroglucitol (1,5-AG), a polyol which originates mainly in the diet, is used in Japan as a new marker for glycemia. To evaluate the potential interference of 1, 5-AG measurements by traditional Chinese medicines (Kampo), we examined the 1,5-AG content in 32 types of concentrated dosage forms of Kampo using high performance liquid chromatography (HPLC). The 32 types of Kampo were the most frequently used in Japan, two of which, Ninjin-yoei-to (7030 microg/g dry weight) and Kami-kihi-to (6700 microg/g dry weight), contained large amounts of 1,5-AG. Six others contained small amounts of 1,5-AG. Both Ninjin-yoei-to and Kami-kihi-to contain the same ingredient, Polygalae radix, which is a crude form of polygalitol (1,5-AG). To confirm the effects of these Kampo medicines on the serum levels of 1,5-AG, we administered Ninjin-yoei-to (7.5 g/day) for 8 weeks to 18 patients with Type 2 diabetes mellitus (Type 2 DM). The serum level of 1,5-AG increased from 9.8+/-8.9 to 28.1+/-17.5 microg/ml by week 8. Hemoglobin A1c (HbA1c) had not changed by week 8. Thus, an abnormal serum 1,5-AG level may be present in patients taking Kampo which contains Polygalae radix.

The validity of bioelectrical impedance phase angle for nutritional assessment in children

BACKGROUND/PURPOSE

Bioelectrical impedance analysis (BIA) is a quick and noninvasive method for estimating body composition. Many prediction equations have been reported recently using bioelectrical impedance to calculate fat free mass (FFM) and fat mass (FM). These equations are based on the assumption that the composition and density of FFM are stable. In children, the composition and density of FFM vary according to age and clinical state, so the use of these equations is limited. However, phase angle is directly determined from resistance (Rz) and reactance (Xc) without equations and reflects body cell mass. The authors, therefore, investigated the validity of phase angle for nutritional assessment in children.

METHODS

Bioelectrical impedance analysis and anthropometric measurements were performed in 81 patients, including 71 well-nourished and 10 malnourished children.

RESULTS

Phase angle correlated with body weight (R = 0.818) and arm muscle circumference (r = 0.901) in well-nourished children. Malnourished patients showed lower phase angle than that of well-nourished children.

CONCLUSION

Bioelectrical impedance phase angle is a useful parameter for nutritional assessment in children.

Transport of 1,5-anhydro-D-glucitol into insulinoma cells by a glucose-sensitive transport system

The uptake of 1,5-anhydro-D-glucitol (1,5-AG) occurs by passive mechanisms in cells or tissues that have passive glucose transporters. It is known that serum 1,5-AG concentrations are reduced in patients with diabetes mellitus. To elucidate the metabolism of this substance and its physiological role in pancreatic beta-cells, we assayed 1,5-AG transport in the insulinoma-derived cell lines, RINr and MIN6. Both cell lines showed an insulin-insensitive, concentration-dependent uptake of 1,5-AG with a saturation time of approximately 120 min, and most of the 1,5-AG in the cytoplasm was in the free form. A biphasic saturation curve was obtained using a wide range of 1,5-AG concentrations, suggesting that accumulation was mediated by a high affinity and a low affinity transporter. The high affinity transporter had a K(m) of 10.4 in RINr cells and 13.0 mM in MIN6 cells, and the low affinity transporter had a K(m)100 times, being much higher than the physiological concentrations of 1,5-AG. These results indicate that the 1,5-AG carrier system in insulinoma cells is distinct from that in either the somatic cells or renal tubular cells. These findings also suggest that a unique 1,5-AG transport system is present in pancreatic beta-cells.

[Troglitazone]

There are good responders to troglitazone in whom sulfonylurea had failed to improve glycemia. The anti-diabetic effect of this agent seems to be partially composed of prolonged action. The action on different adipose tissue depots of troglitazone may be involved in this slow action. Significant decrease in fasting plasma glucose occurred. The effect may be related to reducing nocturnal hepatic glucose output by the drug. The efficacy of troglitazone is dependent on the levels of circulating insulin. Recent reports demonstrate the good therapeutic power of troglitazone in combination with a sulfonylurea or metformin, or insulin. Thus, we got a new approach of oral therapy to patients with type 2 diabetes in sulfonylurea failure before entering the insulin treatment. Because of low frequency of hypoglycemia, we can safely continue to use this drug in patients with euglycemia by the therapy for preventing return to hyperglycemia.

"Gut-feeling" or evidence-based approaches in the evaluation and treatment of human short-bowel syndrome

Short bowel syndrome is the malabsorptive state that often follows extensive resection of the small intestine. Long-term survival without parenteral nutrition depends on the process of intestinal adaptation, through which the remaining small bowel gradually increases its absorptive capacity. The process of intestinal adaptation is almost exclusively luminal nutrient dependent. To date the clinical management of short bowel patients is mostly based on a 'trial and error' regimen because human data and randomised trials using trophic substances are lacking due to the small number of patients annually present in pediatric surgical centres. We evaluate here the currently available as well as some more recently developed methods of measuring intestinal absorption and adaptation in short bowel patients. New techniques such as measurements of (1) intestinal permeability and carbohydrate absorption using the sugar absorption test, (2) gastrointestinal hormone production of gastrin, cholecystokinin and peptide YY, (3) transmural potential difference of the gastrointestinal tract using electrophysiology and (4) mucosal enzyme expression of lactase and sucrase-isomaltase using immunohistochemistry were evaluated. These new techniques are promising in monitoring the process of adaptation of the remaining intestine and evaluating the effect of therapeutic interventions in patients with short bowel syndrome.

Fetal stabilization for antenatally diagnosed diaphragmatic hernia

BACKGROUND/PURPOSE

Infants with congenital diaphragmatic hernia have pulmonary hypoplasia resulting in persistent pulmonary hypertension of neonates (PPHN), which is the main contributor to both high mortality and morbidity. The pulmonary artery bed in patients with congenital diaphragmatic hernia (CDH) is underdeveloped and is very sensitive to slight stimuli. It is, therefore, vital to avoid any factors that might increase pulmonary vascular resistance during the perinatal treatment of these patients. Recently, fetal anesthesia for perinatal stabilization in patients with CDH has been reported. However, the efficacy of this method remains controversial. The aim of this study is to analyze the benefits of fetal stabilization using fetal anesthesia in patients with CDH.

METHODS

The authors have seen 9 cases of antenatally diagnosed CDH and attempted fetal stabilization. The indication for fetal stabilization was a lung thoracic ratio of less than 0.2, without any severe associated anomalies. The protocol for fetal stabilization was (1) monitoring the fetal respiratory movement and heart beat by ultrasonography, (2) the administration of morphine (20 to 30 mg) and diazepam (5 mg) to the mother, (3) the confirmation of any interruptions in fetal movement followed by a cesarean section, (4) pancuronimum (0.5 mg) was given through the umbilical vessels, (5) intubation before clamping of the umbilical cord, and (6) high-frequency oscillatory ventilation (HFO) without bagging.

RESULTS

The lung-thratic ratio (LTR) was between 0.06 to 0.17 (average, 0.10+/-0.04). Operation was performed in 7 of 9 patients at between 2.5 and 27 hours after birth. The overall survival rate was 66.7% (6 of 9). All of the patients who underwent operation within 5 hours after birth survived.

CONCLUSIONS

Perinatal stabilization using fetal anesthesia was found to be effective in preventing PPHN and shortening the period of preoperative stabilization. It also improved the survival rate of patients with severe CDH.

Complications in neonates with short bowel syndrome and long-term parenteral nutrition

BACKGROUND

Because of advances in parenteral nutrition (PN), the prognosis for patients with short bowel syndrome (SBS) has recently shown great improvement. Even infants with a small bowel measuring only 20 cm either with or without an ileocoecal valve can now survive. However, because of the increased periods of PN, severe complications associated with PN have been observed.

PATIENTS AND METHODS

We analyzed 17 patients with SBS treated by long-term PN to investigate the complications of PN, particularly hepatic dysfunction, micronutrient deficiency, and intoxication.

RESULTS

Eleven of 17 patients (64.7%) had hepatic dysfunction, mostly cholestasis. The main causes of hepatic dysfunction were loss of enteral feeding and infections. Regarding the complications of the micronutrients, zinc and copper deficiencies have been observed less often because of trace element supplements. However, manganese deposition, especially in the basal ganglia, was recognized in one patient.

CONCLUSIONS

We therefore need to pay more attention to these problems when treating this disease in order to improve the overall prognosis significantly.