In vitro fertilisation/intracytoplasmic sperm injection beyond 2020.

Over 8 million babies have been born following IVF (in vitro fertilisation) and other artificial reproductive technology (ART) procedures since Louise Brown's birth 40 years ago. New innovations have added much complexity to both clinical and laboratory procedures over the last four decades. Translation of novel approaches from basic science into clinical practice continues unabated, widening the applicability of ART to new groups of people and helping improve both chances of healthy live birth and patient acceptability. However, the impact of ART on the health of both patients and their offspring continues to cause concern, and many ethical challenges created by new scientific developments in this field attract widely differing opinions. What is undeniable is that there will be a sustained global growth in utilisation of ART and that reproductive tourism will allow many people to access the treatment they desire notwithstanding national regulations that may forbid some approaches. The greatest challenge is to expand access to ART to those living in the less wealthy nations who are equally deserving of its benefits.

Effects of 21 days of bed rest, with or without artificial gravity, on nutritional status of humans.

Spaceflight and bed rest models of microgravity have profound effects on physiological systems, including the cardiovascular, musculoskeletal, and immune systems. These effects can be exacerbated by suboptimal nutrient status, and therefore it is critical to monitor nutritional status when evaluating countermeasures to mitigate negative effects of spaceflight. As part of a larger study to investigate the usefulness of artificial gravity as a countermeasure for musculoskeletal and cardiovascular deficits during bed rest, we tested the hypothesis that artificial gravity would have an effect on some aspects of nutritional status. Dietary intake was recorded daily before, during, and after 21 days of bed rest with artificial gravity (n = 8) or bed rest alone (n = 7). We examined body composition, hematology, general blood chemistry, markers of oxidative damage, and blood levels of selected vitamins and minerals before, during, and after the bed rest period. Several indicators of vitamin status changed in response to diet changes: serum alpha- and gamma-tocopherol and urinary 4-pyridoxic acid decreased (P < 0.001) and plasma beta-carotene increased (P < 0.001) in both groups during bed rest compared with before bed rest. A decrease in hematocrit (P < 0.001) after bed rest was accompanied by a decrease in transferrin (P < 0.001), but transferrin receptors were not changed. These data provide evidence that artificial gravity itself does not negatively affect nutritional status during bed rest. Likewise, artificial gravity has no protective effect on nutritional status during bed rest.

A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults.

BACKGROUND: The incidence and severity of herpes zoster and postherpetic neuralgia increase with age in association with a progressive decline in cell-mediated immunity to varicella-zoster virus (VZV). We tested the hypothesis that vaccination against VZV would decrease the incidence, severity, or both of herpes zoster and postherpetic neuralgia among older adults. METHODS: We enrolled 38,546 adults 60 years of age or older in a randomized, double-blind, placebo-controlled trial of an investigational live attenuated Oka/Merck VZV vaccine ("zoster vaccine"). Herpes zoster was diagnosed according to clinical and laboratory criteria. The pain and discomfort associated with herpes zoster were measured repeatedly for six months. The primary end point was the burden of illness due to herpes zoster, a measure affected by the incidence, severity, and duration of the associated pain and discomfort. The secondary end point was the incidence of postherpetic neuralgia. RESULTS: More than 95 percent of the subjects continued in the study to its completion, with a median of 3.12 years of surveillance for herpes zoster. A total of 957 confirmed cases of herpes zoster (315 among vaccine recipients and 642 among placebo recipients) and 107 cases of postherpetic neuralgia (27 among vaccine recipients and 80 among placebo recipients) were included in the efficacy analysis. The use of the zoster vaccine reduced the burden of illness due to herpes zoster by 61.1 percent (P<0.001), reduced the incidence of postherpetic neuralgia by 66.5 percent (P<0.001), and reduced the incidence of herpes zoster by 51.3 percent (P<0.001). Reactions at the injection site were more frequent among vaccine recipients but were generally mild. CONCLUSIONS: The zoster vaccine markedly reduced morbidity from herpes zoster and postherpetic neuralgia among older adults.

Candida krusei renal cyst infection and measurement of amphotericin B levels in cystic fluid in a patient receiving AmBisome.

Candida krusei is an opportunistic pathogen commonly implicated in urinary tract infections in immunocompromised patients. We present the first case of C. krusei renal cyst infection, occurring in a post-liver and kidney transplant patient with autosomal dominant polycystic kidney disease. Her persistent candiduria and fevers were refractory to prolonged therapy with AmBisome (Fujisawa Pharmaceuticals Co. Ltd., Osaka, Japan). She eventually required bilateral nephrectomies of her native kidneys. Cystic fluid was aspirated from six hemorrhagic and six nonhemorrhagic cysts. Cystic fluid cultures yielded C. krusei. Fluid from the nonhemorrhagic cysts was also analyzed for amphotericin B levels, measured using a bioassay. Free amphotericin B levels in the cysts were lower than the minimal inhibitory concentration for amphotericin B for this organism. We provide the first description of amphotericin B levels in cystic fluid obtained during bilateral nephrectomies.

Suppression of revertant fibers in mdx mice by expression of a functional dystrophin.

Duchenne muscular dystrophy (DMD) is characterized by progressive muscle degeneration that results from the absence of dystrophin. Despite null mutations in the dystrophin gene, many DMD patients display a low percentage of dystrophin-positive fibers. These "revertant fibers" are also present in the dystrophin-deficient mdx mouse and are believed to result from alternative splicing or second mutation events that bypass the mutation and restore an open reading frame. However, it is unclear what role dystrophin and the dystrophic pathology might play in revertant fiber formation and accumulation. We have analyzed the role of dystrophin expression and the dystrophic pathology in this process by monitoring revertant fibers in transgenic mdx mice that express truncated dystrophins. We found that newborn transgenic mice displayed approximately the same number of revertant fibers as newborn mdx mice, indicating that expression of a functional dystrophin does not suppress the initiation of revertant fiber formation. Surprisingly, when the transgene encoded a functional dystrophin, revertant fibers were not detected in adult or old mdx mice. In contrast, adult transgenic mice expressing a non-functional dystrophin accumulated increasing numbers of revertant fibers, similar to mdx mice, suggesting that positive selection is required for the persistence of revertant fibers. Finally, we provide evidence that the loss of revertant dystrophin in transgenic mdx muscle fibers overexpressing a functional dystrophin results from displacement of the revertant protein by the transgene-encoded dystrophin.

Assembly of the dystrophin-associated protein complex does not require the dystrophin COOH-terminal domain.

Dystrophin is a multidomain protein that links the actin cytoskeleton to laminin in the extracellular matrix through the dystrophin associated protein (DAP) complex. The COOH-terminal domain of dystrophin binds to two components of the DAP complex, syntrophin and dystrobrevin. To understand the role of syntrophin and dystrobrevin, we previously generated a series of transgenic mouse lines expressing dystrophins with deletions throughout the COOH-terminal domain. Each of these mice had normal muscle function and displayed normal localization of syntrophin and dystrobrevin. Since syntrophin and dystrobrevin bind to each other as well as to dystrophin, we have now generated a transgenic mouse deleted for the entire dystrophin COOH-terminal domain. Unexpectedly, this truncated dystrophin supported normal muscle function and assembly of the DAP complex. These results demonstrate that syntrophin and dystrobrevin functionally associate with the DAP complex in the absence of a direct link to dystrophin. We also observed that the DAP complexes in these different transgenic mouse strains were not identical. Instead, the DAP complexes contained varying ratios of syntrophin and dystrobrevin isoforms. These results suggest that alternative splicing of the dystrophin gene, which naturally generates COOH-terminal deletions in dystrophin, may function to regulate the isoform composition of the DAP complex.

Interactions between beta 2-syntrophin and a family of microtubule-associated serine/threonine kinases.

A screen for proteins that interact with beta 2-syntrophin led to the isolation of MAST205 (microtubule-associated serine/threonine kinase-205 kD) and a newly identified homologue, SAST (syntrophin-associated serine/threonine kinase). Binding studies showed that beta 2-syntrophin and MAST205/SAST associated via a PDZ-PDZ domain interaction. MAST205 colocalized with beta 2-syntrophin and utrophin at neuromuscular junctions. SAST colocalized with syntrophin in cerebral vasculature, spermatic acrosomes and neuronal processes. SAST and syntrophin were highly associated with purified microtubules and microtubule-associated proteins, whereas utrophin and dystrophin were only partially associated with microtubules. Our data suggest that MAST205 and SAST link the dystrophin/utrophin network with microtubule filaments via the syntrophins.

Viscoelastic relaxation of bilayer lipid membranes: II. Temperature dependence of relaxation time.

Recent studies have demonstrated the high frequency exponential relaxation of a viscoelastic modulus of lipid membranes. It is shown that the temperature dependence of the relaxation time can be extracted from published data on the relevant modulus for solvent-free bilayer lipid membranes of glycerol monoöleate. The relaxation is fastest close to the membrane transition temperature, where the time scale is approximately 20 mus. Possible causes of the transitional minimum of this time scale are discussed.

Viscoelastic relaxation of bilayer lipid membranes. Frequency-dependent tension and membrane viscosity.

Photon correlation spectroscopy has been used to study capillary waves on black lipid membranes of glycerol monooleate at temperatures above the lipid transition. For the first time the tension and viscosity of solvent-free bilayers have been observed to display a frequency dependence. The variations of both parameters can be accounted for by a Maxwell viscoelastic fluid model having a relaxation time of 37 microseconds. The equilibrium (omega = 0) tension is compatible with literature values. The present results do not suffice to precisely define the specific molecular processes involved, but relaxation times similar to the present are associated with certain phenomena in phospholipid vesicles. Bilayers containing hydrocarbon solvent do not show such relaxation, presumably due to their weaker intermolecular interactions.

Phase transitions in monoglyceride bilayers. A light scattering study.

Thermotropic phase transitions in single planar bilayers of glycerol mono-oleate have been investigated using quasi-elastic light scattering from thermally excited membrane fluctuations. In certain cases both spectroscopic and intensity information were derived from the observations. For solvent-free bilayers transitional changes were observed in several membrane parameters: in tension, viscosity and thickness, in a combination of lipid orientational order parameter and dielectric anisotropy, and in the lateral compression modulus. These changes, particularly those in membrane thickness and in the anisotropy/order combination, were clearly indicative of a chain-melting transition in the lipid molecules. The chain-melting transition temperature was identified as 16.6 +/- 0.03 degrees C (delta T 1/2 = 1.5 degrees C). The other changes tended to cluster around 12.5 and 16.6 degrees C, suggesting that a two-stage transition was involved. Analysis of pretransitional fluctuations in membrane viscosity, based on a Landau approach, suggested that at the transition the membrane was close to a critical point (T = 12.7 degrees C). Less information was accessible for membranes containing n-decane within their structure. In this case, the change in membrane tension was much smaller than in the solvent-free case and the transition was considerably broadened. These effects accord with an increase in 'interactive volume' within the bilayer due to solvent inclusion.

Photon correlation spectroscopy as a probe of planar lipid bilayer phase transitions.

Photon correlation spectroscopy has been applied to study phase transitions of planar bilayer membranes. The membrane tension and one specific membrane viscosity are probed. Difficulties arising in the measurement of the temperature dependence of these properties are discussed and a servo-control system to overcome them is described. Typical data are presented for monoglyceride bilayers. Membranes incorporating cholesterol display effects below the lipid transition temperature which are interpreted in terms of separation within the membrane into cholesterol-rich fluid regions and regions of lipid in the gel phase. Some of the cholesterol-rich regions are apparently of macroscopic extent.

Epidemic measles and rubella in air force recruits: impact of immunization.

The safety of attenuated viral vaccines against measles and rubella and their efficacy in controlling a massive outbreak of these two diseases in air force recruits at Lackland Air Force Base, Texas, were studied. Recorded cases of measles declined from a high of 1,345 in 1976 to a low of 227 in 1979. Similarly, rubella cases declined from a peak before the immunization program of 1,361 in 1977 to a low of 67 in 1979. A controlled study of morbidity related to immunization revealed that there is less immediate local morbidity from immunizations against measles and rubella than with other routine immunizations. Recruits who received the attenuated viral vaccines reported fever, myalgias, and diarrhea only slightly more frequently than did recruits in the concurrent control group. The present data indicate that measles and rubella, increasingly consequential diseases among young adults, can be safely and effectively controlled with attenuated viral vaccines.

Measles pneumonia in young adults. An analysis of 106 cases.

Measles occurred in 3,220 Air Force recruits between January 1976 and July 1979 and was complicated by pneumonia in 106 cases (3.3 percent). Although no deaths occurred, the illness was characterized as clinically severe with high fever and prolonged hospitalization (mean, 14.5 days). Bacterial superinfection as documented by transtracheal aspiration occurred in 35 cases (30.3 percent) and was caused by Hemophilus influenzae (18), Hemophilus parainfluenzae (two), Neisseria meningitidis (nine), Streptococcus pneumoniae (three), Streptococcus pyogenes (two) and Moraxella kingae (one). Clinical evidence of bronchospasm was present in 18 patients (17 percent) and required bronchodilators in six. Other complications included liver function abnormalities (31 percent), otitis media (29 percent) and sinusitis (25 percent). Measles pneumonia in adolescents is clinically severe with a generally benign outcome.

Necrotizing fasciitis associated with Haemophilus aphrophilus. Report of a case.

Necrotizing fasciitis, a serious infection requiring prompt antibiotic and surgical therapy, previously has not been associated with Haemophilus aphrophilus. We report a case of necrotizing fasciitis associated with methylphenidate abuse from which H aphrophilus was isolated. Surgical and antibiotic therapy based on in vitro susceptibility testing resulted in eradication of the infection.