Ulmus minor bark hydro-alcoholic extract ameliorates histological parameters and testosterone level in an experimental model of PCOS rats.

OBJECTIVE: Polycystic ovary syndrome (PCOS) is a common and multifactorial disease associated with female factor infertility. Ulmus minor bark (UMB) is one of the medicinal plants used in Persian folklore as a fertility enhancer. In the current study, we aimed to elucidate the effect of UMB hydro-alcoholic extract on histological parameters and testosterone condition in an experimental model of PCOS rats. METHODS: Thirty female rats were randomly divided into five groups: (1) control, (2) vehicle, (3) PCOS/50 mg [6 mg/kg dehydroepiandrosterone (DHEA) + 50 mg/kg UMB hydro-alcoholic extract], (4) PCOS/150 mg (6 mg/kg DHEA + 150 mg/kg UMB hydro-alcoholic extract), and (5) PCOS (6 mg/kg DHEA). All interventions were performed for 21 days. Afterwards, stereological analysis was done for determination of ovarian volume and follicle number. The serum level of testosterone was measured by ELISA kit. RESULTS: UMB hydro-alcoholic extract improved the total number of the corpus luteum in the treatment groups when compared to the PCOS group (p<0.05). PCOS/150 mg and PCOS/50 mg groups showed significantly lower total number of the primordial, primary, and secondary follicles as well as testosterone level compared to the PCOS group (p<0.05). The total number of antral follicles and volume of ovary did not differ significantly between groups. CONCLUSION: UMB extract may be an effective and good alternative in improving PCOS histo-logical and testosterone disturbances although further studies are warranted to confirm the safety of UMB plant in human.

Hyperthermia versus busulfan: Finding the effective method in animal model of azoospermia induction.

Animal models of azoospermia are very applicable when evaluating new treatment methods for research purposes. The present study aimed to compare azoospermia induction in mice using busulfan or hyperthermia. To do this, about 36 adult male mice (28-30 g) were included into three experimental groups randomly (n = 12): control, busulfan (injected by a single dose of 40 mg/kg busulfan intraperitoneally) and hyperthermia (exposure to a temperature of 43°C every other day for 5 weeks). Animals were preserved for 35 and 70 days following interventions and then were sacrificed for further evaluations. After 35 days, busulfan and hyperthermia groups revealed a significant decrease in the sperm count and weight of testis compared to the control group (p < .0001). In addition, after 70 days, sperm count and weight of testis in group busulfan showed a significant increase compared to group hyperthermia (p < .01). No significant difference was observed regarding the mortality of mice between busulfan and hyperthermia groups. In group busulfan, degenerative changes in the germinal epithelium were detected in some tubules, although in group hyperthermia, degenerative changes and complete depletion of all tubules were observed. Continuous hyperthermia is a more effective method in the induction of as animal model of azoospermia compared to the busulfan.

Clinical Applications of Assisted Oocyte Activation in Couples with Various Reproductive Problems: A Systematic Review.

ICSI may face fertilization failure, prompting the use of assisted oocyte activation (AOA) techniques. While AOA is implemented in infertility clinics, its target patients and definitive application remain uncertain. This systematic review adheres to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to assess reproductive outcomes in ICSI-AOA cycles compared to conventional ICSI and evaluate AOA effectiveness in various infertility disorders. A literature search encompassed PubMed, Web of Science, EMBASE, and Scopus databases until December 2023 for relevant English studies. Included studies compared ICSI-AOA with conventional ICSI in couples with prior fertilization failure, utilizing diverse AOA methods. Control groups consisted of sibling oocytes, previous cycles of the same couples, or couples undergoing conventional ICSI. Evaluated outcomes included fertilization, cleavage, embryo quality, implantation, pregnancy, and live birth rates. Article screening and data extraction were performed by two authors, with risk of bias assessed by another investigator. Out of 3088 initially identified articles, 30 studies were included, focusing on fertilization failure (n = 10), female infertility (n = 3), PLCζ defects (n = 4), poor sperm quality (n = 4), Globozoospermia (n = 4), and surgically retrieved sperm (n = 8). Most studies concluded that AOA could overcome fertilization failure, but success rates varied based on sperm-related or oocyte-related factors in ICSI-AOA cycles. Due to differences in patient inclusion criteria and sample sizes, most studies were not sufficiently similar for pooled analysis, limiting robust conclusions. There is insufficient evidence, particularly from randomized controlled trials (RCTs), to determine the efficacy or safety of ICSI-AOA as a treatment strategy. Registration number is PROSPERO, CRD42024551221.

Age-related histopathological and biochemical testicular damages were ameliorated by vitamin C administration.

INTRODUCTION AND OBJECTIVES: Aging is an irreversible process associated with decreased biological functions that can lead to the reduction of reproductive organs capacities in males and females. Paternal age is a significant predictor of offspring health and development. So, the aim of this study was to evaluate the effects of vitamin C on histopathological and biochemical testicular changes following aging process with a focus on stereological methods. MATERIAL AND METHODS: For this study, 48 adult male NMRI mice were divided into two control and experimental groups. Mice in experimental group were supplemented with vitamin C (150mg/kg) including 24-h interval by oral gavage for 33 weeks. Same regime was performed for animals in control group except that vitamin C was replaced by water. Then, right testes were extracted for stereological and left testes were used for molecular analyses on weeks 8, 12, and 33. RESULTS: Our findings showed low semen quality, decreased level of serum Luteinizing hormone (LH), Follicle-stimulating hormone (FSH), and testosterone along with increased reactive oxygen species (ROS) production and higher apoptotic gene expression following aging. Stereological studies showed that the volume of testes, the length of seminiferous tubules, and the number of spermatogenic and none-spermatogenic cells decreased significantly during aging. Also, vitamin C consumption for 33 weeks significantly improved biochemical and histological indices. The impact of aging on male reproduction seems to be inevitable worldwide. Therefore, the use of protective and preventive remedies conserving male fecundity is very important and based on our results, vitamin C is a beneficial candidate for improving age-related testicular changes due to aging process.

Late anti-apoptotic effect of K(ATP) channel opening in skeletal muscle.

Necrosis and apoptosis caused by ischaemia-reperfusion (IR) result in myocyte death and atrophy. ATP-sensitive K(+) (K(ATP) ) channels activation increases tissue tolerance of IR-injury. Thus, in the present study, we evaluated the effects of K(ATP) channel activation on skeletal muscle apoptosis after IR. Male Wistar rats were treated with 40 mg/kg, i.p., diazoxide (a K(ATP) channel opener) or 5 mg/kg, i.p., glibenclamide (a K(ATP) channel inhibitor) 30 min before the induction of 3 h ischaemia, followed by 6, 24 or 48 h reperfusion. At the end of the reperfusion period, the gastrocnemius muscle was removed for the analysis of tissue malondialdehyde content, superoxide dismutase (SOD) and catalase (CAT) activity, Bax and Bcl-2 protein expression, histological damage and the number of apoptotic nuclei. Ischaemia-reperfusion increased malondialdehyde content (P < 0.01) and Bax expression (P < 0.01) and induced severe histological damage, in addition to decreasing CAT and SOD activity (P < 0.01 and P < 0.05, respectively) and Bcl-2 expression (P < 0.01). Diazoxide reversed the effects of IR on tissue damage, MDA content, SOD and CAT activity (after 6 and 24 h reperfusion; P < 0.05) and Bax and Bcl-2 expression (after 24 and 48 h reperfusion; P < 0.01). In contrast, glibenclamide pretreatment had no effect. The number of apoptotic nuclei in the IR and glibenclamide-pretreated groups increased significantly (P < 0.001 vs Sham). In contrast, diazoxide pretreatment decreased the number of apoptotic nuclei compared with the IR group (P < 0.01). The results of the present study suggest that the K(ATP) channel activator diazoxide attenuates lipid peroxidation during the first hour of reperfusion and modulates apoptotic pathways at later time points.

Impaired spermatogenesis caused by busulfan is partially ameliorated by treatment with conditioned medium of adipose tissue derived mesenchymal stem cells.

Busulfan (BSU) is a chemotherapeutic drug that can cause subfertility or sterility in males. We investigated the effects of adipose tissue-derived mesenchymal stem cells (AT-MSC) conditioned medium (CM) (AT-MSC-CM) on histopathological and molecular characteristics of mouse testes exposed to BSU using stereology. We used adult male mice divided randomly into five groups: control, Dulbecco's modified Eagle's medium (DMEM), dimethyl sulfoxide (DMSO), BSU, and BSU + CM. Thirty-five days following BSU injection, sperm and testis tissues were harvested for stereological and molecular studies. The BSU group exhibited significantly reduced testis volume, interstitium and tubules compared to the other groups, although the volume of the testis remained unchanged for BSU and CM groups. The number of testis cells was reduced in the BSU group compared to the other groups. The CM group exhibited a significantly increased number of testis cells compared to the BSU group. Sperm count and motility, and length density of seminiferous tubules were increased in CM group compared to the BSU group. AT-MSC-CM exhibited ameliorative effects on histopathologic changes of mouse testes exposed to BSU.

A Novel De Novo Chromosomal Insertion, 46 XX, ins(7:13)(p14; q14.2q21.1) is Related to the Embryo Development Arrest Following Assisted Reproductive Technique.

BACKGROUND: Infertility is a problem affecting a large number of couples in the world. One of the causes of infertility can be chromosomal rearrangements such as insertions. In this case report study, the outcome of two intra-cytoplasmic sperm injection (ICSI) cycles of an infertile woman with de novo chromosomal insertion is explained. CASE PRESENTATION: A couple with a 10-year history of infertility referred to our infertility clinic. The husband had a daughter in his first previous marriage. The wife had a 7 and a 10 year history of infertility in the first and second marriages, respectively. In the first marriage, she reported a history of 2 failed intra-uterine insemination (IUI) cycles. In the second marriage, she had a history of 1 spontaneous abortion at 12 weeks of pregnancy, 4 failed IUI cycles, and 1 failed ICSI cycle. The couple was subjected to ICSI cycles twice and failed due to embryo development arrest. The couple referred for karyotyping. The husband showed a normal male karyotype. In comparison, the wife revealed an abnormal female karyotype with two rearrangements: chromosome 13 with an interstitial deletion between bands q14.2 and q21.1, and a derivative chromosome 7 containing this segment of chromosome 7 as an insertion onto short arm at the p14 position. CONCLUSION: To the best of our knowledge, this is the first report of insertion 46 XX, ins(7:13)(p14; q14.2q21.1) which is associated with the embryo development arrest following assisted reproductive technique.

Ameliorating effects of curcumin-loaded superparamagnetic iron oxide nanoparticles (SPIONs) on the mouse testis exposed to the transient hyperthermia: A molecular and stereological study.

BACKGROUND: Testicular hyperthermia can have negative effects on male fertility. Despite reported therapeutic benefits of curcumin, several factors often limit its application such as low water solubility and instable structure. Curcumin-loaded superparamagnetic iron oxide nanoparticles (SPIONs) were designed to solve its limitation of use. In the present study, we evaluated the effect of curcumin-loaded SPIONs on transient testicular hyperthermia in mouse. MATERIALS AND METHOD: A total of 18 adult male NMRI mice were divided into three groups (n = 6): I. Controls (Cont), II. Scrotal hyperthermia (Hyp), III. Scrotal hyperthermia + curcumin-loaded iron particles (240 µL) (Hyp + Cur). After seventy days, the animals were sacrificed and used for further molecular and stereological evaluations. RESULTS: Sperm count, motility and viability significantly decreased in group hyp as compared to cont group. Furthermore, Sperm DNA fragmentation and cell apoptosis in testes increased remarkably in group hyp, compared with group cont. Stereological study showed a reduction in number of spermatogenic and Leydig cells, as well as reduced weight and volume of testes in hyp group. Degenerative appearance of testes exposed to hyperthermia was also observed. In addition, higher mRNA expression of inflammatory cytokines (IL1-α, IL6, and TNF-α) was detected in group hyp compared to cont group. However, curcumin-loaded SPIONs alleviated all of the pathologic changes in the Hyp + Cur group compared to the hyp group. CONCLUSION: Here, we used nanoparticle form of curcumin in testicular hyperthermia model and showed its ameliorating effects on testes damages caused by heat stress, which can be an appropriate method to overcome the problems that limit curcumin application in cases with increased intra testicular temperature.

Effect of Artificial Oocyte Activation on Intra-Cytoplasmic Sperm Injection Outcomes in Patients with Lower Percentage of Sperm Containing Phospholipase Cζ: A Randomized Clinical Trial.

BACKGROUND: Artificial oocyte activation (AOA) is a specialized method in assisted reproductive technique (ART). According to increasing concern about using AOA, it is necessary to evaluate sperm-borne oocyte activating factors (SOAFs) including phospholipase C zeta (PLCζ). In this study, PLCζ before AOA was evaluated first and then the impact of AOA on pre-implantation embryo development was investigated. METHODS: This prospective clinical trial enrolled couples subjected to ICSI. By evaluating PLCζ, semen samples were categorized into two groups; I (Control) and II (PLCζ deficient). Retrieved oocytes from partners were put into three categories: control group (Injected with sperm from group I, n=113), group without AOA (Injected with sperm from group II and no exposure to AOA, n=106), and group AOA (Injected with sperm from group II and exposure to AOA, n=114). Finally, fertilization results were compared via Kruskal-Wallis followed by Dunn's multiple comparison test. The p<0.05 was considered statistically significant. RESULTS: Fertilization rate was significantly lower in the group without AOA compared to control group (41.9±6.3 vs. 78.1±4.7, p<0.001). AOA improved fertilization rate in group AOA compared to the group without AOA (69.5±3.9 vs. 41.9±6.3, p<0.01); however, cleavage (91.7±2.8, 90.9±4.6, and 95.2±3.4, respectively) and embryo quality (2.5±0.1, 2.3±0.2, and 2.4±0.2, respectively) scores were not substantially different between groups of control, with and without AOA. CONCLUSION: We showed that PLCζ can be considered as a good biomarker in evaluation of oocyte activation capability. Further studies are required to establish the best use of PLCζ as a biomarker in clinics.

Vitamin C restores ovarian follicular reservation in a mouse model of aging.

Ovarian aging is related to the reduction of oocyte quality and ovarian follicles reservation leading to infertility. Vitamin C is a natural antioxidant which may counteract with adverse effects of aging in the ovary. The aim of this study was to evaluate the possible effect of vitamin C on NMRI mice ovarian aging according to the stereological study. In this experimental study, 36 adult female mice (25-30 g) were divided into two groups: control and vitamin C. Vitamin C (150 mg/kg/day) were administered by oral gavage for 33 weeks. Six animals of each group were sacrificed on week 8, 12, and 33, and right ovary samples were extracted for stereology analysis. Our data showed that the total volume of ovary, cortex, medulla and corpus luteum were significantly increased in vitamin C group in comparison to the control groups (P≤0.05). In addition, the total number of primordial, primary, secondary, and antral follicles as well as granulosa cells were improved in vitamin C group in compared to the control groups (P≤0.05). No significant difference was observed in total volume of oocytes in antral follicles between control and vitamin C groups. Our data showed that vitamin C could notably compensate undesirable effects of ovarian aging in a mouse model.

The Effect of Prenatal Exposure to 2.4 GHz Radio Frequency on the Histology and Expression of the osteocalcin and RUNX2 Gene of the Forelimb in an NMRI Mouse.

Introduction: Today the use of electromagnetic waves has dramatically increased in modern industrial societies. This study aimed to investigate the effect of prenatal exposure to 2.4 GHz wireless frequency on forelimb development in an NMRI mouse in vivo. Methods: A total of 21 female mice weighing 25-30 g were included in the present study. They were randomly assigned to 3 groups, namely control (n=7), sham (n=7), and experimental (n=7). After mating, the experimental group was exposed to 2.4 GHz radio frequency at a distance of 20-30 cm from the device, 4 h/d until the delivery. The sham group was placed at a distance of 20-30 cm from the device every day without exposure to electromagnetic waves, and the control group had a pregnancy period without any stress and electromagnetic wave exposure. After giving birth, the forelimbs were isolated from the infants and examined by stereological studies and RT-PCR for the evaluation of osteocalcin and RUNX2 gene expression. Results: Although, at first glance, there was no macroscopic teratogen effect in forelimbs in all groups, via a stereological method, we showed that bone and cartilage volume decreased in the experimental group compared to the other groups. We also found that the experimental group had lower expression of the osteocalcin and RUNX2 gene than the control and sham groups did. However, there were no significant differences between the control and sham groups in terms of bone and cartilage volume and gene expression. Conclusion: Although teratogen effect of prenatal exposure to 2.4 GHz radio frequency on forelimbs was not demonstrated macroscopically, further studies showed negative effects on the forelimb bone, cartilage volume, and gene expression.

Lessons learned from a multidisciplinary heart failure clinic for older women: a randomised controlled trial.

BACKGROUND: many heart failure disease management programs are primarily conducted in the male population. An approach incorporating disciplines such as physiotherapy, occupational therapy, social work, dietary and pharmacy in a standardized clinical pathway merits further investigation in older women with HF. METHODS: in this randomized controlled trial, female patients in the intervention group received the multidisciplinary clinical pathway consisting of a series of 12 visits over a 6-week period in an outpatient clinic. RESULTS: ninety-one community dwelling female patients aged 63 to 89 were randomized. Comparison of change between the two groups from baseline in the Minnesota Living with Heart Failure Questionnaire score did not show a difference (P<0.470). There was also no difference between the two groups in functional outcome as measured by change from baseline by the Physical Self-Maintenance Scale (P<0.321). The treatment group had significantly more hospitalizations, and cardiologist visits during the study period (P < 0.0001). CONCLUSION: It is feasible to conduct a randomized study in a frail community-based older female population and to test a complex multidisciplinary pathway. Future studies should provide insight into the optimal intensity and duration of heart failure management programs with optimal targeting.

Oligoasthenoteratozoospermic (OAT) men display altered phospholipase C ζ (PLCζ) localization and a lower percentage of sperm cells expressing PLCζ and post-acrosomal sheath WW domain-binding protein (PAWP).

Oligoasthenoteratozoospermia (OAT) is demonstrated to be one of the most common causes of male subfertility. Phospholipase C ζ (PLCζ), a sperm-specific protein, is considered to be one of the sperm-borne oocyte activating factors (SOAFs), which play a vital role in fertilization. The post-acrosomal sheath WW domain-binding protein (PAWP) is another candidate for SOAF. The aim of this study was to compare the PLCζ localization patterns and percentage of PLCζ- and PAWP-positive sperm cells in patients with OAT and fertile men with normozoospermia. A total of 40 men included in this study were classified into two groups: OAT (n = 25) and control group (n = 15). Semen samples were collected and analyzed using conventional semen analysis according to the World Health Organization guidelines. The percentage of PLCζ- and PAWP-positive sperm cells and localization patterns of PLCζ were evaluated using immunofluorescence staining. The mean percentage of sperm cells expressing PAWP and PLCζ was significantly lower in OAT compared to control group (52.8 ± 4.2 vs. 76.8 ± 5 and 63.4 ± 3.5 vs. 86.7 ± 2.1, respectively). In addition, statistically significant differences were found with regard to the PLCζ localization patterns, including equatorial, acrosomal + equatorial, and equatorial + post-acrosomal pattern, between the two groups (p < 0.01). The present study showed a lower percentage of sperm cells expressing PLCζ and PAWP, as well as altered localization patterns of PLCζ in men with OAT. Given the role of PLCζ and PAWP in fertilization, as two major candidates for SOAFs, our findings indicate that PLCζ and PAWP impairments may be one of the possible etiologies of decreased fertility in OAT.

Phospholipase C zeta parameters in sperm from polymorphic teratozoospermic men.

Teratozoospermia is a disorder associated with high abnormal sperm morphology which affects fertility in males. In recent years, it has been described that biomarker-based sperm quality evaluation can alleviate male infertility treatment. Phospholipase C zeta (PLCζ) is a sperm-specific factor which appears to be a predicting biomarker for fertilization potential of males. Following fertilization, PLCζ enters into oocyte cytoplasm and induces oocyte activation, a fundamental stage in initiation of embryo development. Currently, PLCζ parameters, including localization patterns, the proportion of PLCζ-expressing sperm and the expression level, are not defined in polymorphic teratozoospermic men. This study aimed to evaluate PLCζ parameters in polymorphic teratozoospermic men, and compare these parameters with fertile normozoospermic men. Semen samples from thirteen normozoospermic fertile men and twenty-three polymorphic teratozoospermic men were included in this study and evaluated using western blotting and immunofluorescence analyses. Our data indicated significantly lower expression of PLCζ in polymorphic teratozoospermic men, as compared with control men; however, there was no significant difference in localization patterns and the proportion of PLCζ-expressing sperm between polymorphic teratozoospermic patients and control men. Collectively, findings from the present study demonstrated that polymorphic teratozoospermic men did not show abnormal localization patterns or the absence of PLCζ, as compared to the control men; nonetheless, lower expression of PLCζ, considering its role in oocyte activation, might be one of the possible causes of infertility in these patients.

Evaluation of PAWP and PLC? Expression in Infertile Men with Previous ICSI Fertilization Failure.

PURPOSE: The aim of this study was to evaluate postacrosomal sheet WW domain binding protein (PAWP) and phospholipase C ? (PLC?) protein expression in patients with fertilization failure. MATERIALS AND METHODS: Semen samples were collected from 15 fertile men (control group) and 15 patients with previous fertilization failure following ICSI (FF group) and were analyzed according to World Health Organization (WHO) criteria. The mean percentages of PAWP and PLC? positive sperm and the total level of PAWP and PLC? proteins were assessed using immunofluorescence staining. RESULTS: A significantly lower level and lower percentage of PAWP positive sperm in patients with fertilization failure was found compared to the control group (P = 0.01 and P = 0.03, respectively). The mean percentage ofPLC? positive sperm and level of PLC? protein were significantly lower in FF group compared to the control group (P = 0.0003 and P = 0.04, respectively). Significant positive correlations was observed between PAWP and PLC? positive sperms (r = 0.4, P = 0.008) and also total level of expression of PLC? and PAWP proteins (r = 0.4, P = 0.02) in all participants in the study. CONCLUSION: This is the first study that evaluates two main candidates for sperm-borne oocyte activating factors (SOAFs) simultaneously in patients with fertilization failure. Considering lower expression of PAWP and PLC? proteins in such patients, it seems like both factors might have the potential to be considered as SOAFs and diagnostic markers for the oocyte activation ability.

Gender differences in dementia risk factors.

BACKGROUND: With the aging of the population, dementia has become an important health concern in most countries. There is a growing body of literature on the importance of cardiovascular risk factors in the development of Alzheimer's disease (AD), vascular dementia, and mixed dementia (AD with cerebrovascular disease). OBJECTIVE: This article reviews the role of major risk factors in dementia between both sexes. METHODS: The MEDLINE, PubMed, and HealthSTAR databases were searched between 1966 and January 2007 for English-language articles on the risk factors for dementia. RESULTS: The distribution and prevalence of major risk factors between the sexes and age groups are varied. Female sex has been associated with increased risk of the development of AD. In women aged >75 years, rates of hypertension, hyperlipidemia, and diabetes are higher than in similarly aged men. Apolipoprotein E epsilon 4 genotype status appears to have a greater deleterious effect on gross hippocampal pathology and memory performance in women compared with men. Midlife hypertension and hypercholesterolemia in both sexes predict a higher risk of developing AD in later life. Diabetes is increasing in frequency to a greater extent in women than in men, and is associated with a substantial risk for cognitive impairment. Dementia in women (probably) and in men (possibly) is influenced by obesity in the middle of life. CONCLUSIONS: It remains critical that large prospective clinical trials be designed to assess the effect of optimum management of vascular risk factors on cognitive functioning and dementia as the primary outcome, and include women and men in numbers adequate for assessment of gender effects.

In vitro development of embryos from experimentally Kerack-addicted Mice.

BACKGROUND: Prenatal drug exposure, as a common public health concern, is associated with an increased risk of adverse effects on early embryo development. OBJECTIVE: To investigate the in vitro development of - embryo from experimentally Kerack-addicted mice. MATERIALS AND METHODS: Twenty-five female mice were studied in five groups: control, vehicle, and three experimental groups of Kerack-dependent mice (I, II, and III) which received different doses of Kerack for 14 days. After the establishment of addiction model (7 days), experimental groups I, II, and III were given Kerack intraperitoneally at the doses of 5, 35, and 70 mg/kg, twice a day for a period of 7 days, respectively. The vehicle group received normal saline and lemon juice whilst the control group just received water and food. Morulae were obtained through oviduct flashing. The survived embryos were cultured in T6+ 5mg/ml bovine serum albumin. The developmental rates up to hatched stage daily and embryo quality (differential staining and Tunnel staining) were also assessed. RESULTS: The developmental potential of embryos obtained from the addicted mother was significantly decreased in comparison with control group. There was a significant reduction in the rate of blastocyst formation in the high dose Kerack dependent group. However, in addicted mice there was reduction in the total cell number (40.92% vs. 65.08% in control) and, inner cell mass percentage (17.17% vs. 26.15% in control) while apoptotic cells numbers were increased (7.17 vs. 1.46 in control) (p<0.05). CONCLUSION: The Kerack addiction during pregnancy retards preimplantation development and induces apoptosis.

Evaluation of in-hospital management of fracture risk in older patients: a chart review study of tertiary prevention.

Hip fractures are associated with considerable morbidity and mortality in the elderly. Both fall prevention strategies and bone integrity/osteoporosis assessment should be addressed in this population. This study's goal was to evaluate the management of potential re-fracture risk after a hip fracture in an acute care setting. This was a retrospective chart review of patients who were admitted with a hip fracture over the course of one year to the Ottawa Hospital, Civic Campus, Ottawa, Canada. The charts of 147 patients with hip fractures met the inclusion criteria. Use of sedatives on admission was significant (24.5%). Fifty (34%) had some form of osteoporosis management ordered during their hospital stay. The medication recommendations consisted of only 14% being prescribed Vitamin D and 15.6% being prescribed calcium supplementation. Merely 7 (4.8%) patients of the total sample were prescribed bisphosphonates at time of discharge. This study documents a significant care gap in re-fracture management at the time of acute hospitalization after an acute hip fracture. Interventions are required to increase the awareness that this problem is not being addressed at the time of hospitalization and that on discharge, patients will need follow-up by the treating community physician.

A Call for Collaboration: Improving Cardiogeriatric Care.

With the population aging, there is an exponential increase in the prevalence of cardiovascular disease (CVD). Congestive heart failure (CHF) is considered the "poster child" of the blend of CVD, multimorbidity, and frailty in the aging population. Traditionally, from the cardiologist's point of view, the top multimorbidities in CHF are hypertension, ischemic heart disease, hyperlipidemia, anemia, and diabetes. However, the care of these patients is confounded by common geriatric conditions (multimorbidity, dementia, medication intolerance, frailty) contributing to functional disability, reduced quality of life, and increased hospitalization. Given a 3-fold increase in the number of patients with CHF within the next couple of decades, we must act now. We need to address complex care coordination and integrated disease management as part of the continuum of care, including advance directives and patient preferences. Research and educational curricula must address clinical practice guidelines appropriate for the frail elderly with multimorbidities. Improved care of the older patient with cardiac disease is dependent on a new model of collaboration and teamwork between primary care physician, geriatrician, and cardiologist to accommodate the fundamental heterogeneity of aging and the patients' choices. Collaborative cardiogeriatric clinics have started. The goal of these clinics is to provide integrated care and education for older patients and their caregivers, with the objective of improving quality of life and function. These clinics are also designed to build educational capacity for medical trainees and provide an ongoing research environment. This prototype of a sustainable model will be used to assess methods by which cardiogeriatric clinics could be introduced into standard clinical medical practice.

Perspectives from Geriatric In-patients with Heart Failure, and their Caregivers, on Gaps in Care Quality.

BACKGROUND: Evidence indicates that care experiences for complex HF patients could be improved by simple organizational and process changes, rather than complex clinical mechanisms. This survey identifies care gaps and recommends simple changes. METHODS: The study utilized both quantitative and qualitative methods at The Ottawa Hospital, Geriatric Medical Unit during a three-month period. RESULTS: Nineteen patients (average age 85, 12 female) surveyed. Twelve participants lived alone. Fourteen lived in own home. Four patients had formal home-care services. Fifteen relied on family. Gaps were identified in in-patient practice, discharge plan, and discharge summary implementation feedback. Only five participants had seen cardiologist or specialist. Half of patients did not know if they were on a special HF diet. Participants did not recall receiving information on life expectancy but were comfortable discussing EoL care and dying. HF-specific management recommendations were mentioned in only 37% of discharge summaries to PCPs. CONCLUSION: The results provide the starting point for a quality assurance and process re-engineering program in GMU. Organization change is needed to develop and integrate a cardiogeriatric clinical framework to allow the cardiologist, geriatrician, and PCP to actively work as a team with the patient/caregiver to develop the optimal care plan pre- and post-discharge.