Fertility patients' views about frozen embryo disposition: results of a multi-institutional U.S. survey.

OBJECTIVE: To describe fertility patients' preferences for disposition of cryopreserved embryos and determine factors important to these preferences. DESIGN: Cross-sectional survey conducted between June 2006 and July 2007. SETTING: Nine geographically diverse U.S. fertility clinics. PATIENT(S): 1020 fertility patients with cryopreserved embryos. INTERVENTION(S): Self-administered questionnaire. MAIN OUTCOME MEASURE(S): Likelihood of selecting each of five conventional embryo disposition options: store for reproduction, thaw and discard, donate to another couple, freeze indefinitely, and donate for research; likelihood of selecting each of two alternative options identified in previous research: placement of embryos in the woman's body at an infertile time, or a disposal ceremony; importance of each of 26 considerations to disposition decisions; and views on the embryo's moral status. RESULT(S): We found that 54% of respondents with cryopreserved embryos were very likely to use them for reproduction, 21% were very likely to donate for research, 7% or fewer were very likely to choose any other option. Respondents who ascribed high importance to concerns about the health or well-being of the embryo, fetus, or future child were more likely to thaw and discard embryos or freeze them indefinitely. CONCLUSION(S): Fertility patients frequently prefer disposition options that are not available to them or find the available options unacceptable. Restructuring and standardizing the informed consent process and ensuring availability of all disposition options may benefit patients, facilitate disposition decisions, and address problems of long-term storage.

Knee joint injury and repair modeled by membrane systems.

Tissue reparative processes following tissue injury are modeled by a basic membrane system, dealing only with objects, non-active membranes, and non-deterministic evolution rules. At the biological level, tissue repair is regulated by multiple interactions between cells and macromolecules, the latter acting as signals. Such signals modify cell behavior including proliferation, migration, differentiation, and phagocytosis. The signaling components themselves are produced and removed by the resident cell population, and this set of events may provide additional stimuli for altering cell activities. In this paper we have focused on modeling the biology of events following an injury to the knee joint, and have used hyaluronan (a polymer produced by cartilage and synovial cells) as an example for a signaling component in the healing process. The intrinsic non-determinism of the model is a key feature, which allows a mathematical description of the repair responses as well as a possibility for either functional restoration or chronic degeneration, leading to arthritis.

Image analysis of aggrecan degradation in articular cartilage with formalin-fixed samples.

Many studies in arthritis research require an evaluation of the cellular responses within the joint and the ensuing matrix degradation in articular cartilage. The early histochemical/histological scale of Mankin have opened new approaches to evaluating cartilage structure. Histological methods now include in situ hybridization for cell-specific gene expression and immunohistochemistry for the spatial organization of cartilage proteins and their processed forms. This chapter details of a method for immunohistochemical analysis of aggrecan degradation in articular cartilage samples which have been prepared by standard methods of formalin fixation and paraffin embedding. The procedure focuses on the application of antibodies (e.g., anti-ADAMTS4, anti-MT4MMP) which detect some of the proteinases most likely involved, and anti-NITEGE which detects the terminal product of the aggrecanase-mediated cleavage of aggrecan at Glu392-Ala393 (bovine, human, dog, rat, pig, sheep, horse, mouse) or Glu393-Ala394 (chick).

Inducible nitric oxide synthase expression by peritoneal macrophages in endometriosis-associated infertility.

OBJECTIVE: Determine whether peritoneal macrophages from women with endometriosis-associated infertility express more inducible nitric oxide synthase (NOS2) and produce more NO than fertile controls. DESIGN: Unblinded clinical study. PATIENT(S): Nine infertile women with endometriosis and nine normal fertile women undergoing laparoscopy. INTERVENTION(S): Peritoneal fluid and macrophages were collected. Cells were also cultured with the NOS2 inducers interferon-alpha (IFN-alpha) or IFN-gamma plus lipopolysaccharide (LPS). MAIN OUTCOME MEASURE(S): Peritoneal fluid NO levels, peritoneal macrophage NOS activity, and peritoneal macrophage NOS2 protein expression. RESULT(S): NOS enzyme activity was higher in peritoneal macrophages from endometriosis patients. Immunoblots demonstrated NOS2 protein only in peritoneal macrophages from women with endometriosis. Peritoneal fluid NO concentration was similar in the two groups, but total peritoneal fluid NO content was higher in endometriosis patients. After 3 days' culture, peritoneal macrophages from women with endometriosis produced more NO in response to IFN-alpha or IFN-gamma plus LPS than controls. CONCLUSION(S): Peritoneal macrophages from women with endometriosis-associated infertility express higher levels of NOS2, have higher NOS enzyme activity, and produce more NO in response to immune stimulation in vitro. As high levels of NO adversely affect sperm, embryos, implantation, and oviductal function, reducing peritoneal fluid NO production or blocking NO effects may improve fertility in women with endometriosis.