Association of the eukaryotic vaginal virome with prophylactic antibiotic exposure and reproductive outcomes in a subfertile population undergoing in vitro fertilisation: a prospective exploratory study.

OBJECTIVE: The objective of this study was to use high-throughput sequencing to describe the vaginal eukaryotic DNA virome in patients undergoing in vitro fertilisation (IVF) to examine associations between the vaginal virome, antibiotic exposure and IVF outcomes. DESIGN: Prospective exploratory study. SETTING: Single academic fertility centre. POPULATION: Subfertile women age 18-43 years undergoing their first IVF cycle with a fresh embryo transfer. METHODS: The primary exposure was prophylactic azithromycin or no azithromycin before IVF. A mid-vaginal swab was obtained at the time of embryo transfer for virome analysis. MAIN OUTCOME MEASURES: The primary outcomes compared between exposure groups were characteristics of vaginal virome and clinical pregnancy rates. Secondary outcomes were virome associations with number of oocytes retrieved, number of blastocysts and implantation rate. RESULTS: Twenty-six women contributed a vaginal swab before embryo transfer. There were no significant differences in IVF outcomes between azithromycin groups. There was no association between viral diversity and clinical pregnancy overall. A higher diversity of herpesviruses and α-papillomaviruses was observed in samples from the azithromycin-treated group compared with the no azithromycin group (P = 0.04). In women that received azithromycin, viral diversity was higher in the group that did not achieve clinical pregnancy compared with those who did (P = 0.06). CONCLUSIONS: We demonstrate that the vaginal eukaryotic virome in women undergoing IVF is associated with antibiotic exposure. Additionally, we demonstrate an inverse trend between viral diversity and pregnancy, with a higher number of viruses detected associated with failure to achieve clinical pregnancy in the azithromycin group. TWEETABLE ABSTRACT: Higher viral diversity is associated with prophylactic antibiotic exposure in subfertile women undergoing IVF.

Liquid domains in vesicles investigated by NMR and fluorescence microscopy.

We use (2)H-NMR, (1)H-MAS NMR, and fluorescence microscopy to detect immiscibility in three particular phospholipid ratios mixed with 30% cholesterol: 2:1 DOPC/DPPC, 1:1 DOPC/DPPC, and 1:2 DOPC/DPPC. Large-scale (>>160 nm) phase separation into liquid-ordered (L(o)) and liquid-crystalline (L(alpha)) phases is observed by both NMR and fluorescence microscopy. By fitting superimposed (2)H-NMR spectra, we quantitatively determine that the L(o) phase is strongly enriched in DPPC and moderately enriched in cholesterol. Tie-lines estimated at different temperatures and membrane compositions are based on both (2)H-NMR observations and a previously published ternary phase diagram. (2)H- and (1)H-MAS NMR techniques probe significantly smaller length scales than microscopy experiments (submicron versus micron-scalp), and complex behavior is observed near the miscibility transition. Fluorescence microscopy of giant unilamellar vesicles shows micrometer-scale domains below the miscibility transition. In contrast, NMR of multilamellar vesicles gives evidence for smaller ( approximately 80 nm) domains just below the miscibility transition, whereas large-scale demixing occurs at a lower temperature, T(low). A transition at T(low) is also evident in fluorescence microscopy measurements of the surface area fraction of ordered phase in giant unilamellar vesicles. Our results reemphasize the complex phase behavior of cholesterol-containing membranes and provide a framework for interpreting (2)H-NMR experiments in similar membranes.

Reduction of ovarian torsion 1 week after embryo transfer in a patient with bilateral hyperstimulated ovaries.

OBJECTIVE: To report a rare case of unilateral ovarian torsion 1 week after embryo transfer in a patient with bilateral hyperstimulated ovaries. DESIGN: Case report and literature review. SETTING: Reproductive Endocrine division in a university teaching hospital. PATIENT(S): Infertility patients undergoing IVF-ET. INTERVENTION(S): Laparoscopic reduction of adnexa 1 week after ET. MAIN OUTCOME MEASURE(S): Successful preservation of the affected adnexa. RESULT(S): Delivery of 3.324 kg male infant with preservation of the affected ovary. CONCLUSION(S): Untwisting of the affected ovary at laparoscopy without aspiration reduction of cystic masses is appropriate. The outcome of the pregnancy (even very early) in patients with torsion of the adnexa may be favorable after a laparoscopic unwinding of the affected adnexa.

Miscibility critical pressures in monolayers of ternary lipid mixtures.

When phospholipids are mixed with cholesterol in a monolayer at an air-water interface, coexisting 2-dimensional liquid phases can be observed if the surface pressure, pi, is lower than the miscibility critical pressure, pi(c). Ternary mixtures of two phospholipid species with dihydrocholesterol have been reported to have critical pressures that are linearly proportional to the relative composition of the phospholipids. However, we report here that, if the acyl chains of the two phospholipids differ significantly in length or unsaturation, the behavior is markedly different. In this case, the critical pressure of the ternary mixture can be remarkably high, exceeding the critical pressures of the corresponding binary mixtures. High critical pressures are also seen in binary mixtures of phospholipid and dihydrocholesterol when the two acyl chains of the phospholipid differ sufficiently in length. Using regular solution theory, we interpret the elevated critical pressures of these mixtures as an attractive interaction between the phospholipid components.

Urinary incontinence: occurrence, knowledge, and attitudes among women aged 55 and older in a rural Midwestern setting.

OBJECTIVE: To examine the occurrence, attitudes, and knowledge of urinary incontinence (UI) among older women in a rural setting. DESIGN: Client questionnaire. SETTINGS AND SUBJECTS: A randomly selected sample of community-dwelling women aged 55 years and older living in a rural midwestern state. INSTRUMENT: Participants completed several instruments, including an Incontinence Survey that queried primarily demographic data, an Incontinence Quiz that queried knowledge and attitudes toward UI, and specific questions related to its clinical and psychosocial consequences. METHODS: The questionnaire was mailed to 300 women whose names had been randomly selected from a seniors' group mailing list. MAIN OUTCOME MEASURE: The prevalence of UI among a group of community-dwelling older women as well as attitudes and knowledge concerning incontinence. RESULTS: One hundred twenty women returned the questionnaire, providing a response rate of 40%. Three of the 120 respondents were excluded because they did not answer the question pertaining to UI status. Of the 117 who did respond, 79 (67.5%) reported UI. Most of the respondents with incontinence categorized their UI as minor (81.9%), and 88% denied that incontinence had a significant impact on their lifestyle. Thirty-seven percent of the incontinent women sought treatment. When questioned about UI, over half of the 117 respondents incorrectly indicated that incontinence is a normal result of advanced age. Almost one third of the respondents incorrectly believe that most people become incontinent by the time they reach the age of 85. CONCLUSIONS: Misconceptions concerning the causes of and the availability of treatment for incontinence among community-dwelling women may have an impact on their decision to seek care for this typically remediable condition.

The influence of polymer molecular weight in lamellar gels based on PEG-lipids.

We report x-ray scattering, rheological, and freeze-fracture and polarizing microscopy studies of a liquid crystalline hydrogel called Lalpha,g. The hydrogel, found in DMPC, pentanol, water, and PEG-DMPE mixtures, differs from traditional hydrogels, which require high MW polymer, are disordered, and gel only at polymer concentrations exceeding an "overlap" concentration. In contrast, the Lalpha,g uses very low-molecular-weight polymer-lipids (1212, 2689, and 5817 g/mole), shows lamellar order, and requires a lower PEG-DMPE concentration to gel as water concentration increases. Significantly, the Lalpha,g contains fluid membranes, unlike Lbeta' gels, which gel via chain ordering. A recent model of gelation in Lalpha phases predicts that polymer-lipids both promote and stabilize defects; these defects, resisting shear in all directions, then produce elasticity. We compare our observations to this model, with particular attention to the dependence of gelation on the PEG MW used. We also use x-ray lineshape analysis of scattering from samples spanning the fluid-gel transition to obtain the elasticity coefficients kappa and B; this analysis demonstrates that although B in particular depends strongly on PEG-DMPE concentration, gelation is uncorrelated to changes in membrane elasticity.

Small concentrations of alamethicin induce a cubic phase in bulk phosphatidylethanolamine mixtures.

Under normal conditions, excess water dispersions of liquid crystalline 1,2-dielaidoyl-sn-glycero-3- phosphoethanolamine (DEPE) are known to convert from a liquid crystalline lamellar (L alpha) to inverse hexagonal (HII) phase at about 60 degrees Celsius. The nonlamellar phase behavior of lipid systems is also known to depend on the monolayer spontaneous curvature. The single-channel activity of alamethicin in black lipid bilayer membranes has been shown to be dependent upon the lipid composition of the membrane. Since the monolayer spontaneous curvature properties (e.g., the monolayer spontaneous curvature, curvature coefficients and bilayer thickness) vary with lipid composition, the single-channel activity of alamethicin presumably also correlates with the monolayer spontaneous curvature properties. Accordingly, we reasoned that if alamethicin couples to the curvature properties of a lipid film, then the curvature properties must, in turn, be perturbed by the presence of alamethicin and that this perturbation should be observable in the lipid phase behavior. Here X-ray diffraction and NMR are used to show that the presence of as little as 1% alamethicin introduces a large region of cubic phase into the thermal phase diagram. This suggests that perturbation of the nonlamellar phase behavior of a lipid system may be a method to survey different channel-forming molecules for possible behavior that indicates that the ion channel is sensitive to the monolayer spontaneous curvature properties.

Regulation of the Immune Response by Eicosanoids: Pharmacology and Clinical Effects of Prostaglandin E in Aspirin-Sensitive Syndromes.

Immunomodulatory effects of prostaglandin E(2) (PGE(2)) have been documented both in vitro and in vivo. Our previous studies have examined the effects of intravenously administered PGE(2) in mast-cell-mediated diseases, including aspirin-sensitive asthma and systemic mast-cell-activation syndrome. The basis for investigations of these particular diseases has been the hypothesis that the inhibition of cyclooxygenase removes one of its products, PGE(2), that provides a critical restraint on the activation of the mast cell. Based on the beneficial effects of PGE(2) found in these studies, we have extended our investigations to an evaluation of misoprostol, the orally available analog of PGE(1). Our preliminary studies with this drug are consistent with an inhibition of mast cell activation by misoprostol, an effect observed at doses higher than currently recommended for gastric protection. The findings from these initial trials have led to the development of ex vivo whole-blood assays that assess the pharmacodynamics of misoprostol's immunomodulatory actions, which support the concept of employing higher doses to obtain sustained systemic effects. To extend these results, we have undertaken double-blinded, placebo-controlled clinical investigations to examine the effects of the higher doses of misoprostol (300--600 &mgr;g QID) given chronically in aspirin-sensitive asthma and systemic mast cell activation. Although still ongoing, our studies have confirmed by a variety of clinical evaluations that the higher doses of misoprostol can be tolerated by many patients and appear to be safe. Based on our findings and those of others, further investigation of the therapeutic usefulness of this drug or other PGE analogs in allergic and immunologic diseases appears warranted.

Probability of alamethicin conductance states varies with nonlamellar tendency of bilayer phospholipids.

With few exceptions, membrane lipids are usually regarded as a kind of filler or passive solvent for membrane proteins. Yet, cells exquisitely control membrane composition. Many phospholipids found in plasma membrane bilayers favor packing into inverted hexagonal bulk phases. It was suggested that the strain of forcing such lipids into a bilayer may affect membrane protein function, such as the operation of transmembrane channels. To investigate this, we have inserted the peptide alamethicin into bilayer membranes composed of lipids of empirically determined inverted hexagonal phase "spontaneous radii" Ro, which will have expectably different degrees of strain when forced into bilayer form. We observe a correlation between measured Ro and the relative probabilities of different conductance states. States of higher conductance are more probable in dioleoylphosphatidylethanolamine, the lipid of highest curvature, 1/Ro, than in dioleoylphosphatidylcholine, the lipid of lowest curvature.