Immunomodulatory effects of hydroxychloroquine on Th1/Th2 balance in women with repeated implantation failure.

BACKGROUND: Cellular immune abnormalities such as the imbalance between T-helper (Th) 1 and Th2 cytokines have been implicated as potentially modifiable causes of idiopathic repeated implantation failures (RIF). The purpose of this study was to investigate the effects of hydroxychloroquine on IL-10 and TNF-α secretion, expression of T-bet and GATA-3 transcription factors and cellular localization of TNF-α, IFN-γ, IL-10 and IL-4 in endometrial cells in women with RIF. MATERIALS AND METHODS: A total of 17 women with a history of RIF and elevated TNFα/IL-10 ratio (TNFα/IL-10> = 30.6) were included in the study. The serum levels of TNFα and IL-10, the expression of transcription factors related to Th1 and Th2 cells and the immune-reactivity of TNFα, IFN-γ as Th1 related cytokines and IL-10, IL-4 as Th2 related cytokines in endometrial tissues were evaluated by ELISA, real-time PCR, and fluorescent immunohistochemistry respectively. All, evaluations were done both before and after treatment with hydroxychloroquine (400 mg/orally per day). RESULTS: Hydroxychloroquine treatment significantly decreased (p < 0.0001) serum level of TNF-α and significantly increased serum level of IL-10 (p < 0.0001). T-bet, the Th1 transcription factor, expression was down-regulated and GATA-3, the Th2 transcription factor, expression was up-regulated. IL-10 and IL-4 fluorescent immunoreactivities significantly increased (p < 0.05 and p < 0.001 respectively) and TNFα and IFN-γ fluorescent immunoreactivities significantly decreased (p < 0.05) in endometrial tissue in women with RIF after treatment in comparison with before treatment. CONCLUSION: Hydroxychloroquine administration in women with RIF With a high TNF-α/IL-10 ratio during the implantation window can decrease this ratio and seems to be an effective therapeutic strategy in RIF caused by cellular immune abnormalities through a shift in Th2 responses.

Evaluation of Self-Perceived Changes in Gastrointestinal Symptoms During Ramadan Fasting.

Little is known regarding the effects of Ramadan fasting on common gastrointestinal symptoms. The aim of this study was to assess the alterations of these symptoms in a healthy Iranian adult population during Ramadan. In a cross-sectional study, self-administered questionnaires were used to evaluate the alterations in seven groups of gastrointestinal symptoms (esophageal symptoms, dyspeptic symptoms, bloating and abdominal distension, constipation, diarrhea, abdominal pain, and nausea) after Ramadan. A total of 900 individuals participated in the study. Almost 87 % of participants reported to fast for at least 2 weeks during Ramadan. After adjusting for potential confounders, we found no relationship between alteration in frequency of gastrointestinal symptoms and Ramadan fasting, except for constipation which increased significantly after Ramadan fasting (odds ratio 1.99, 95 % confidence interval 1.05-3.80, P < 0.05). In addition, those who fasted for at least 2 weeks reported to experience severe or very severe constipation-related symptoms three times more in comparison with those who fasted for less than 2 weeks (P < 0.05). There was no relationship between severity of other gastrointestinal symptoms and Ramadan fasting. We found that Ramadan fasting does not increase frequency and severity of common gastrointestinal symptoms in the general population except for constipation that may be experienced more frequently and severely among those who fast for 2 weeks or more.

Interactions between natural and electrically evoked saccades. III. Is the nonstationarity the result of an integrator not instantaneously reset?

In the monkey, fixed-vector saccades evoked by superior colliculus (SC) stimulation when the animal fixates can be dramatically modified if the stimulation is applied during or immediately after an initial natural saccade. The vector is then deviated in the direction opposite to the displacement just accomplished as if it were compensating for part of the preceding trajectory. Recently, it was suggested that the amplitude of the compensatory deviation is related to the amplitude of the initial saccade linearly, and that the ratio between the two decreases exponentially as stimulation is applied later. These two findings (spatial linearity and temporal nonstationarity) were invoked as evidence for the noninstantaneous resetting of a feedback integrator. Such an integrator is included in most models of saccade generation for the specific purpose of terminating a saccade when it has reached its intended goal. However, the hypothesis of a feedback integrator in the process of being reset implies that the exponential decay of the compensatory deviation is temporally linked to the end of the initial saccade. We analyzed the time course of this decay in stimulation experiments performed at 24 SC sites in two monkeys. The results show that if the start of the exponential decay of compensation is assumed to be linked to the end of the initial saccade, then the relation between the amount of compensatory deviation and the amplitude of the initial saccade is not linear. On the other hand, it is possible to show a linear relation if the measurements of compensatory deviation are made in terms of delay of stimulation from the saccade beginning. We conclude that stimulating the SC just after a visually guided saccade does not seem to test the properties of a feedback integrator. Whether such an integrator is or is not resettable is not likely to be decided by this approach. Conversely, as the nonstationarity of compensation is linked to the beginning of the saccade, the nonstationarity seems to represent a property of an event occurring at saccade onset. We suggest that this event, close to the input of the oculomotor apparatus, is the summation of the visual signal with a damped signal of eye position or displacement.