25-Hydroxyvitamin D and 1,25-dihydroxyvitamin D of D2 and D3 origin in maternal and umbilical cord serum after vitamin D2 supplementation in human pregnancy.

Serum concentrations of 25-hydroxyvitamin D (25-OHD) and 1,25-dihydroxyvitamin D [1,25-(OH)2D] of vitamin D2 and D3 origin were determined separately in 10 women before vitamin intake in early pregnancy, and repeated in maternal and cord serum obtained at delivery after 20 to 30 wk of vitamin D2 supplementation in a dose of 400 IU/day. Before supplementation 25-OHD2 and 1,25-(OH)D2D2 were present in just traceable or nondetectable concentrations, but the levels increased in all to a mean +/- 1 SD of 7.3 +/- 3.7 ng/ml and 37.2 +/- 18.1 pg/ml, respectively (p less than 0.0025), by the time of delivery. At delivery the total 25-OHD and 1,25-(OH)2D levels were always lower in the cord than in the maternal serum (30.7 +/- 14.2 versus 20.1 +/- 9.1 ng/ml, and 90.1 +/- 31.2 versus 37.3 +/- 11.6 pg/ml, p less than 0.0025). The paired concentrations of 25-OHD were closely related (r = 0.89, p less than 0.0005), while the association for 1,25-(OH)2D was not statistically significant (r = 0.53, p less than .01). The 25-OHD of D2 and D3 origin accounted for a similar proportion of the total 25-OHD in the maternal and cord serum (ratio of 25-OHD2 to 25-OHD3: 0.40 +/- 0.28 versus 0.45 +/- 0.29, p = NS), as did the respective 1,25-(OH)2D metabolites [ratio of 1,25-(OH)2D2 to 1,25-(OH)2D3: 0.73 +/- 0.35 versus 0.90 +/- 0.50, p = NS].(ABSTRACT TRUNCATED AT 250 WORDS)

Cyclic variation in the expression of Fc gamma receptors in human endometrium.

Cyclic variations of Fc gamma receptors (FcR) in human endometrium were studied in specimens from the fundal part, the lower part of the uterine cavity and from the endocervix obtained in the proliferative, ovulatory and early and late secretory phase. The three classes of FcR were studied using monoclonal antibodies (mAb) and indirect immunohistochemistry with avidin-biotin-peroxidase complexes. FcRI, FcRII and FcRIII were expressed on stomal cells throughout the cycle. In the late secretory phase some of the stromal cells had morphology comparable to predecidual cells. These cells express FcRIII only. FcRIII only were expressed on the glandular epithelium in all phases of the cycle. The endothelium was negative in the midcycle and positive early and late in the cycle for FcRI and FcRIII, although weak for FcRIII late in the cycle. FcRII was not expressed on the endothelium. Apparently the FcR activity in the endometrium does not vary during the menstrual cycle, except for small variation in the expression on the endothelium and the presence of FcRIII on positive predecidual cells. No differences in FcR expression were found in specimens taken from different parts of the uterine cavity.

Systemic and mucosal antibody responses to group B streptococci following immunization of the colonic-rectal mucosa.

The cervico-vaginal mucosa is poorly designed for inducing a mucosal immune response, but it can effect such a response evoked at other mucosal sites. This study was undertaken to determine whether colonic-rectal immunization with group B streptococci (GBS) might induce a local cervico-vaginal immune response. Mice were immunized with either fragmented GBS rectally, whole GBS rectally, or whole GBS subcutaneously. Cholera toxin (CT) was used as an adjuvant for the rectal immunizations. Following colonic-rectal immunization with whole GBS, the mean anti-GBS IgA antibody level in vaginal secretions was 735 kU/ml, with individual values reaching 3480 kU/ml. Corresponding levels of IgA antibodies never exceeded 10 kU/ml in serum and intestinal secretions, or 90 kU/g in feces. In vaginal secretions IgA antibodies to GBS also constituted a much larger fraction of total IgA than in serum, intestinal secretions and feces. Immunizations with fragmented GBS produced much lower IgA responses. Anti-GBS IgA response at the inductive site in the colon-rectum was not significant, as opposed to a strong anti-CT IgA response. Except in serum, the anti-GBS IgG responses to colonic-rectal immunizations were generally low, or absent. The results may provide a basis for the development of mucosal vaccines against GBS-infection.

Comparison of cytological 'jet-wash' specimens and histology in endometrial carcinoma.

Jet-washing of the uterine cavity for cytological examination has been performed in 200 patients. The results were compared with the histological diagnoses obtained by curettage. In 24 patients with endometrial carcinoma, both methods showed one specimen to be 'not adequate' while the other showed malignancy. A combination of jet-wash and curettage gave a diagnosis in 96% of patients while curettage alone gave a diagnosis in 82%, and cytology alone in 90%. The method is simple and may be of special value in postmenopausal patients.

Infant death rates and animal-shed delivery in remote rural areas of Nepal.

This article outlines a community-based retrospective study in a remote area of Nepal and describes local birth practices and their impact on infant mortality. Data collection was carried out in two steps, a household survey from September to October 1996 and a qualitative research phase. Data collected include socio-economic background, reproductive history, birth practices and child survival. Among 3007 live-born children, 660 (22%) died before their first birthday. In keeping with local customs, approximately half of the children were delivered in an animal shed and the other half in the home. Children born in an animal shed were at significantly higher risk of dying than were those born in the home even after adjusting for socio-economic status and biological variables. The association was stronger in the neonatal period (OR = 2.8, 95% CI 1.9-4.1) than during the post-neonatal period (OR= 1.3, 95% CI 1.02-1.6). The preparation of the delivery place was inadequate and thereby facilitated infection of both the newborn and the mother. Traditional norms and animal-shed delivery practices are common in the Jumla community. The reasons addressed for giving birth in the animal shed included (1) Household Deity's anger if delivery takes place in the home and (2) easy to clean the shed following the birth.

Homocysteine and methylmalonic acid levels in pregnant Nepali women. Should cobalamin supplementation be considered?

OBJECTIVE: The aim of this study was to investigate homocysteine and methylmalonic acid levels as markers of functional cobalamin and folate status in pregnant Nepali women. DESIGN: Cross-sectional study. SETTING: Patan Hospital, Kathmandu, Nepal. SUBJECTS: A sub-sample (n=382) of all pregnant women (n=2856) coming for their first antenatal visit in a 12 month period, 1994-1995. The selection of the sub-sample was based on maternal haematocrit values, categorised into three groups: severely, moderately and non-anaemic women. As serum levels of total homocysteine (s-tHcy) and methylmalonic acid (s-MMA) were similar in the three groups, pooled data are presented. Women who had already received micronutrient supplementation (n=54) were excluded. The remaining women (n=328) were included in the statistical analysis. RESULTS: Overall mean values (+/-s.d.) of s-tHcy and s-MMA were 9.5 (+/-4.2) micromol/l and 0.39 (+/-0.32) micromol/l, respectively. Elevated s-tHcy (>7.5 micromol/l) was found in 68% of the women, while 61% had elevated s-MMA (>0.26 micromol/l). Low s-cobalamin values (<150 pmol/l) were observed in 49% of the women, while only 7% had low s-folate values (< or =4.5 nmol/l). s-tHcy was significantly correlated with s-MMA (r=0.28, P<0.001), s-cobalamin (r=-0.30, P<0.001) and s-folate (r=-0.24, P<0.001). s-MMA was significantly associated with s-cobalamin (r=-0.40, P<0.001), but not with s-folate. CONCLUSIONS: Functional cobalamin deficiency was very common in the study population, while functional folate deficiency was rather uncommon. We suggest considering cobalamin supplementation to pregnant Nepali women. SPONSORSHIP: The Norwegian Research Council and the Norwegian Universities Committee for Development, Research and Education.

Pregnancy outcome in Norway after Chernobyl.

Pregnancy outcome has been studied in terms of legal abortions, early spontaneous abortions and total number of pregnancies (in an ad hoc study covering 6 counties) as well as various perinatal health problems (on the basis of routinely recorded data for epidemiological surveillance from the Medical Birth Registry of Norway). Apparently, no effects were observed in terms of an increased occurrence of legal abortions, while spontaneous abortions increased from 7.2% of all pregnancies during the last 12 months before the accident to 8.3% after the accident [corrected]. At the same time, the total number of pregnancies somewhat decreased. Based on monthly measurements in each municipality of external and internal (food-based) doses, dose-response associations were assessed for a number of perinatal health problems. No associations were observed.

PIP: The effects of Chernobyl on pregnancy outcome were investigated in Norway in terms of legal abortions, early spontaneous abortions, total pregnancies, and perinatal health problems (cataracts, microcephaly, low birth weight, and perinatal mortality). The epidemiological results showed that there were no serious gross changes in pregnancy outcome in Norway after Chernobyl in 1986. Anxiety may have led to the temporary decrease in pregnancies. The statistically significant difference in spontaneous abortions between 19867 and 1987, particularly in the months following Chernobyl, may be related but causation cannot be determined based on the present data; i.e., dietary changes due to anxiety may also be related. Further analyses will be conducted with data spanning 5 years after Chernobyl. The Central Bureau of Statistics provided data on legal abortions as reported by hospitals to county medical officers. Spontaneous abortions (16 weeks) are based on ad hoc notifications from hospitals in 5 counties: Aust-Agder, Hordaland, Oppland, Troms, and Trondelag. Compulsory notification of births is recorded in the Medial birth Registry and includes congenital malformations and other perinatal health problems. The National Institute of Radiation Hygiene recorded data after the accident on indoor gamma rates, radiocesium (Cs 134) soil samples, and municipality specific average food-based dose equivalents of Cs 134 and 137 in meat and meat supplies. The total external and internal dose is provided for May 1986-April 1989. Food-based doses remained at an elevated level for an extended period of time. Infant exposure was considered form the 2nd month of gestation. Legal abortions, induced or spontaneous, were not impacted by Chernobyl, but the effect may have been delayed to the 3rd or 4th quarter with a 1.0% increase. However, at Haukeland Hospital in Bergen, the highest abortion rates were 19.1% in 1985-86 and 19.2% in 1986-87. Pregnancies temporarily decreased in the 3rd and 4th quarters following the accident in a period usually reflecting annual increases. Cataract occurrences increased the year after the accident with 8 observed and 3.8 expected, but the P value was insignificant (P=.74). Microcephaly followed a similar pattern. Birth 2500 gms had observed values of 2726 vs. 2639.2 expected, an insignificant P value of .99. Observed perinatal deaths of 634 were less than the 718.8 expected.

Anaemia in pregnancy: possible causes and risk factors in Nepali women.

OBJECTIVE: The aim of this study was to investigate the importance of nutritional deficiencies and infections in the development of anaemia in pregnant Nepali women. DESIGN: Case-control study. SETTING: Patan Hospital, Kathmandu, Nepal. SUBJECTS: A sub-sample (n=479) of all pregnant women (n=2856) coming for their first antenatal visit in a 12 month period, 1994-1995. Women who had already received any micronutrient supplementation (n=82), and those whose serum samples showed macroscopic haemolysis (n=7) were excluded. The remaining women (n=390) were included in the statistical analysis. They were divided into three groups; a non-anaemic control group, haematocrit (Hct)>33% (n=82), and two case-groups: moderately anaemic, Hct 25-33% (n=254), and severely anaemic, Hct<25% (n=54). RESULTS: We found high prevalences of nutritional deficiencies and intestinal infections, both among cases and controls. The prevalence of low s-ferritin was high, especially among the severely anaemic women (55.6%). In a multiple logistic regression model, the presence of low s-vitamin A, elevated s-C-reactive protein or hookworm infection was associated with a significantly increased risk of severe anaemia. The adjusted odds ratios (95% CI) were 8.38 (1.99, 35.30), 4.91 (1.22, 19.67) and 5.43 (1.20, 24.61), respectively. CONCLUSIONS: In addition to the present routine iron and folate supplementation to pregnant Nepali women, vitamin A supplementation needs to be considered. Prevention and treatment of infections should, together with dietary advice, be emphasized more strongly in the antenatal care. SPONSORSHIP: The Norwegian Research Council and the Norwegian Universities Committee for Development, Research and Education. European Journal of Clinical Nutrition (2000) 54, 3-8

Primary 9 + 0 cilia in the embryonic and the adult human heart.

Primary 9 + 0 cilia have been found in the embryonic and the adult human heart. Proximally the cilia show the typical 9 + 0 filament arrangement. Rearrangement of the filaments occur in their distal regions. The cilia are usually found in deep invaginations of the cell membrane, but can also be found in a superficial position. Close connections are frequently found between cilia and thin cytoplasmic extensions from neighbouring cells.

Ultrastructural studies on the formation of myoflilaments and myofibrils in the human embryonic and adult hypertrophied heart.

The myofibrillogenesis in the human embryonic heart is described. The synthesis of thin filaments, which are the first to appear, takes place in close proximity to smooth surfaced SR tubules. Z-band material is closely related to the thin filaments and appears first as irregularly distributed patches in the filamenteous mass. Further cellular differentiation includes an organization of the thin filaments/Z-band material. The synthesis of thick filaments, which follows that of the thin filaments, takes place in ribosome rich areas of the cell. They are rapidly incorporated into the strings of organized thin filaments/Z-band material. The periodic binding sites on both kinds of filaments are believed to play an important role in the precise ordering of the filaments. The formation of myofilaments in the adult hypertrophied human heart is also described. The similarities between this process and that observed in the embryonic heart are striking, and we believe it to be the same process.

The effect of male occupational exposure in infertile couples in Norway.

The objective of the study was to assess whether reduced semen quality in infertile couples is associated with occupational exposures known to be hazardous to fertility. Results of the first semen analysis were linked to occupational exposure data from a self-administered questionnaire. Reduced semen quality was found in men exposed to electromagnetic fields (odds ratio, 3.22; confidence interval, 1.46 to 7.09). A tendency toward reduced semen quality was seen in commuters (OR, 1.52; CI, 0.89 to 2.59), shift workers (OR, 1.46; CI, 0.89 to 2.40), and men exposed to heavy metals (OR, 1.47; CI, 0.76 to 2.87). In general, the impact of occupational exposure on semen quality in infertile couples in Norway seemed to be minor. However, occupational exposure mapping is still important in individual infertility investigations.

A comparative study of labor induced by oral prostaglandin E2 and buccal tablets of demoxytocin.

A comparative study of the efficacy of oral prostaglandin E2 and buccal tablets of demoxytocin for induction of labor in overdue pregnancies was made in groups of randomly selected patients. Labor was successfully induced in 95.7% of the women in the prostaglandin group and 92.1% of the women in the demoxytocin group. Although the operative delivery rate was low in both groups, it was significantly higher for the demoxytocin group. A low rate of perinatal distress was recorded and there were no serious side effects in either group. The time from start of induction until delivery, as well as the time from amniotomy until delivery, were compared for primiparae and multiparae separately. No significant differences were found. The blood loss during the third stage of labor was lower in the prostaglandin group. We find oral induction of labor in overdue pregnancies effective, safe and convenient.

Seasonal variation in risk of anemia among pregnant Nepali women.

OBJECTIVE: We aimed to investigate whether there is any seasonal variation in risk of anemia among pregnant Nepali women. METHODS: We studied the hematocrit values in pregnant women (n=5495) attending Patan Hospital, Kathmandu for the first antenatal visit in the 2-year period from January 1994 until December 1995. In a sub-sample of subjects (n=2706), additional information was obtained through interviews and clinical examinations. Logistic regression models were used to analyze data. RESULTS: Mean hematocrit values recorded in the monsoon period were significantly lower than hematocrit values recorded in the winter. The prevalence of moderate (hematocrit 25-33%) and severe (hematocrit<25%) anemia was highest in September. CONCLUSIONS: We found a clear seasonal variation in risk of anemia, which was associated with rainfall and temperature. The monsoon seems to be a period when interventions may give the most beneficial effects.

Follow-up after torsion of the spermatic cord.

Fifty-two patients were examined 4-10 1/2 years after operation for torsion of the spermatic cord. The testicular salvage rate was 56%. Loss of testicular tissue was correlated to preoperative duration of symptoms. Serum testosterone concentration was found to be within the reference range. FSH was elevated in patients with the longest duration of symptoms (> 24 h), suggesting an impairment of testicular function in these patients. There were two our of 13 patients with a severe oligo-azoospermia, both had a previous orchiopexy for undescended contralateral testis.

Breech delivery.

Perinatal mortality in 700 cases of breech delivery was studied retrospectively and results were compared with those of controls. Cases were matched with those of cephalic presentation for maternal age and parity, foetal gestational age, and birthweight. The perinatal mortality was more than twice as high in the breech group. The difference remained significant after intrauterine foetal death and malformations were excluded. Neonatal death was most frequently caused by the respiratory distress syndrome and prematurity, and in the breech group also by intracranial haemorrhage. The difference in perinatal mortality was more pronounced in the low weight and low gestational age groups. At term the differences in mortality between the two groups were small. Neonatal distress assessed as low Apgar score and the need for special care was far more frequent for the breech group. Special care in premature breech deliveries and a liberal use of caesarean section in recommended. Delivery before the 36th week of gestation should be performed by caesarean section.

Fertility, motility and penetration in cervical mucus of freeze-preserved human spermatozoa.

PIP: The aim of this investigation was to study the influence of freezing and thawing of semen on motility, penetration ability in cervical mucus and fertilizing capacity of spermatozoa. A total of 65 ejaculates was frozen and thawed. 50 specimens came from 7 heterologous insemination donors and 15 from homologous donors. Fresh ejaculates were studied and frozen immediately. After dilution in a progective medium the mixture was preserved in sealed plastic straws and cooled in liquid nitrogen. Storage time varied from 1 day to 5 weeks. Thawing was done in a water bath at 37 degrees C. The postthaw, otility, penetration ability and duration of motility in cervical mucus of spermatozoa were reduced by the freeze-preservation procedure. However in some of the samples spermatozoa had an unchanged penetration ability of cervical mucus. The women who were inseminated belonged to the sterility groups of the clinic but were apparently were performed in 14 women and 15 homologous inseminations in 4 women. No conceptions occurred after using semen preserved at 196 degrees C. Later the 14 women who had received heterologous insemination with freeze preserved semen were inseminated with fresh semen from the same donors and 8 conceptions occurred. From these results and reports by others it is concluded that postthaw mobility is a poor prediction of fertility. For fresh donor semen there is a significant correlation between conception rate and furation of sperm motility in postthaw specimens may explain in part the reduced fertility. Sperm density of the sample influenced motility recovery. Semen samples of law sperm density are not suitable for freeze preserving. Undetected damage to spermatozoa during freezing and thawing is thought to cause the discrepancy between fertility and the results of the tests. The fertilizing capacity of freeze-preserved semen was more reduced than expected.^ieng

[The P-pill for men--when will it be available?]. / Den mannlige p-pillen--når kommer den?

Although the development of a hormonal contraceptive for men has proved to be more of a challenge than oral contraception for women, several experimental prototypes already satisfy many of the criteria that must be met. Steroid regimes are more effective in Asians than in men of other ethnic backgrounds. They are inexpensive, and the effect is reversible.GnRH analogues are promising, but further research is needed and is being carried out. Androgens must be used as a supplement to all hormonal strategies in order to maintain normal sexual function. The impact of androgens on lipid metabolism and prostate physiology must be clarified. Lack of funding is the greatest barrier to further research and the development of a hormonal contraceptive for men.

Comparison of the risk of ectopic pregnancy with the use of IUD or minipill.

PIP: Among those experiencing ectopic pregnancies, a % of minipill users and increasing % OF IUD users have been found. Between 1973-7, the number of IUD and minipill users in a designated region were calculated in order to compare the risk of ectopic pregnancy. The incidence of ectopic pregnancy in the IUD group was almost double, and significantly higher than that of the minipill group. Of 66 ectopic pregnancies in women with IUDs, 7 were ovarian, compared to no ovarian pregnancies in the minipill group and the group using neither of these contraceptive methods. The present results indicate a higher risk of ectopic pregnancy related to the use of the IUD compared with the use of the minipill.^ieng