[Microalbuminuria in clinical practice].
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Albuminuria↗
Biomedical subjects
A Herman
Publications and source records attributed to A Herman.
Effect of increased ppGpp concentration on DNA replication of different replicons in Escherichia coli.
The plasmids harbouring the relA gene under an inducible promoter allowed us to increase the guanosine 5'-diphosphate-3'-diphosphate (ppGpp) concentration in Escherichia coli cells without any starvation and thus, to directly investigate the effect of ppGpp on DNA replication. We studied all types of replicons which were investigated previously in amino acid-starved bacteria and found that ColE1, oriC, lambda plasmid and pSC101 but not RK2 replicons are sensitive to high ppGpp level. To our knowledge, this paper presents the first direct evidence that replication of most, but not all, replicons is dependent on ppGpp concentration and thus, is under stringent control.
DNA Replication↗
Ovarian function following abdominal hysterectomy with and without unilateral oophorectomy.
There is no consensus concerning optimal adnexal surgery during abdominal hysterectomy, when continued hormonal function is desired, associated with reduced sequelae in the future. The aim of the study was to compare residual ovarian function following abdominal hysterectomy with preservation of one or both ovaries, in a prospective randomized study. Forty patients were allocated randomly and sequentially into two groups: those undergoing abdominal hysterectomy with unilateral oophorectomy, and those undergoing abdominal hysterectomy only. Ovarian function was evaluated by measuring FSH, TLH and E2 before, and 1 week, 1 month, 3 months and 6 months after the operation. Thirty-five percent of the patients undergoing abdominal hysterectomy with unilateral oophorectomy demonstrated impaired ovarian function 6 months after the operation. None of the patients with both preserved ovaries showed impaired ovarian function 6 months later. Therefore, when continued ovarian function following abdominal hysterectomy is desired, preservation of both ovaries seems to be more beneficial.
Adult↗
First trimester embryo reduction: a medical solution to an iatrogenic problem.
The incidence of multiple pregnancies is increasing, mainly as a consequence of the widespread use of various infertility protocols. Since such gestations present a high risk of feto-maternal morbidity and mortality, selective first trimester fetocide remains one of the few reasonable options. We reviewed the literature dealing with the outcome of 804 multiple pregnancies following the use of transcervical, transvaginal or transabdominal approaches. Questions relating to dealing with technical failure, method of fetocide and procedural improvements are examined. In a comparison of the variables: miscarriage, preterm delivery, perinatal and neonatal loss rates, the transvaginal approach fares better, but statistical significance (P < 0.001) is achieved only for preterm delivery. We speculated that this might be attributable to the very early gestational age at which the procedure is usually performed. However, the transabdominal approach offers better results when post-manipulation maternal morbidity is considered, i.e. infection and vaginal bleeding. Since each option offers different advantages and disadvantages, additional experience and larger population samples are required to further clarify this important issue.
Female↗
Uterine fluid human decidua-associated protein 200 and implantation after embryo transfer.
Uterine fluid samples from 109 patients undergoing in-vitro fertilization and embryo transfer were obtained so as to examine the relationship between the uterine fluid concentration of human decidua-associated protein (hDP) 200 and the implantation rate. The sampling was performed on the day of embryo transfer with a Wallace catheter, used for the testing of cervical patency before embryo replacement. The implantation rate, as well as the pregnancy rate, demonstrated a significantly positive correlation with the concentration of hDP 200 in the uterine fluid, measured just before embryo transfer. These results indicate that hDP 200, identified as a rheumatoid factor secreted by the endometrium, may be involved in the implantation process.
Decidua↗
Follow up and outcome of isthmic pregnancy located in a previous caesarean section scar.
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Adult↗
Renal hemodynamics and blood flow autoregulation during acute cyclooxygenase inhibition in male rats.
After the acute inhibition of prostanoid synthesis, adjustments of renal hemodynamics may not be characterized immediately. Therefore, time-related effects of indomethacin on hemodynamics and renal blood flow (RBF) autoregulation were studied in anesthetized euvolemic male rats injected intravenously with vehicle, indomethacin (3, 4, or 5 mg/kg body wt), or meclofenamate (4 or 5 mg/kg body wt). Hemodynamics and RBF autoregulation were not influenced by vehicle injection, nor by time (n = 6). In contrast, mean arterial pressure (MAP) decreased significantly from 117 +/- 4 to 103 +/- 3 mmHg, and RBF progressively and significantly increased from 8.00 +/- 0.34 to 9.17 +/- 0.50 ml/min in the 3 mg/kg body wt indomethacin group (n = 8). Treatment with the higher doses of indomethacin (n = 9) or meclofenamate (n = 6) did not change RBF, while MAP decreased by 15 mmHg. A time-dependent significant enhancement of RBF autoregulatory efficiency was found in the drug-treated rats. Changes in renal function and reductions of prostanoid excretion in urine, of plasma renin activity, or serum aldosterone were similar in the nonsteroidal antiinflammatory drug groups. In conclusion, our findings demonstrate important time-related adjustments of renal hemodynamics in male rats treated with indomethacin, especially with the lower dose (3 mg/kg body wt iv). The factor(s) responsible for the hemodynamic changes remains unknown.
Aldosterone↗
Changes in uterine artery Doppler flow velocity waveforms during the third stage of labor.
Transabdominal Doppler velocity waveform measurements of the uterine arteries during the third stage of labor were performed upon 25 patients with uncomplicated vaginal deliveries and 5 with prolonged third stage in order to further assess third-stage mechanisms. Based on Doppler flow measurements, three phases of the third stage of labor were observed: (1) a latent phase with a systolic/diastolic ratio (S/D) and a pulsatility index (PI) of 2.14 +/- 0.49 and 0.89 +/- 0.17, respectively; (2) a contraction and detachment phase with an S/D and PI of 2.53 +/- 0.53 and 1.28 +/- 0.37, respectively, and (3) an expulsion phase with an S/D and PI of 2.20 +/- 0.34 and 0.91 +/- 0.20, respectively (p < 0.05). During the third stage of labor, it was shown that uterine contractions squeezed the uterine vessels as they traversed the myometrium, leading to an increase in the extrinsic resistance, which was reflected by high resistance flow. Following placental separation and changes in the placental-site wall, there was slight uterine relaxation resulting in decreased uterine vessel resistance. This observation encourages the authors to continue investigating the contribution of ultrasound and Doppler flow for studies of the postpartum period.
Adult↗
Improved techniques for first-trimester fetal reduction using simultaneous abdominal and transvaginal ultrasonographic guidance. Preliminary report.
Simultaneous transabdominal injection of potassium chloride (KCl) assisted by transvaginal ultrasonographic guidance was evaluated in 5 patients who conceived due to various assisted reproductive techniques and ovarian stimulation. All 5 underwent first-trimester fetal reduction for multiplicity of high-order pregnancies. Four sets of triplets were reduced to twin, and 1 twin pregnancy was reduced to a singleton. Less than 2 ml of 2 mEq/ml KCl per fetus was needed for each case. No fetal or maternal complications nor technical failure attributable to the procedure were recorded. All pregnancies were delivered > or = 35 weeks of gestation. Transabdominal fetal reduction using simultaneous transvaginal ultrasonographic guidance for selective feticide combines the benefits of both the transabdominal and transvaginal approaches, mainly in selected cases in which some experts prefer the abdominal route, but find it technically difficult to practice. Further experience is needed to confirm our encouraging preliminary results before drawing any definitive conclusions.
Abdomen↗
The level of human decidua-associated protein hDP-200, in uterine fluid and serum.
Prospective uterine fluid sampling in 140 patients was performed using a Wallace catheter. The levels of human decidua-associated protein (hDP)-200 in the uterine fluid and in the serum, and the total protein concentration in the uterine fluid were determined. Uterine fluid volumes were scored during the hysteroscopy and no correlation was found with the phase of the menstrual cycle. The total protein concentration in the uterine fluid did not vary significantly during the menstrual cycle. The hDP-200 levels in uterine fluid were significantly higher than those in the serum, although considerable individual variation in the level of uterine fluid hDP-200 was found.
Body Fluids↗
The mechanism of the stringent control of lambda plasmid DNA replication.
Lambda plasmid DNA replication is inhibited in amino acid-starved wild type Escherichia coli strains (stringent response) but not in amino acid-starved relA mutants (relaxed response). This replication is perpetuated by the replication complex containing the lambda O protein (which is protected from proteases by other elements of the complex) and inherited by one of two daughter copies after a replication round. Since a fraction of stable lambda O protein was observed in relA- and relA+ strains, and negative regulation by the lambda Cro repressor does not seem to be important in the stringent or relaxed response of lambda plasmid replication to amino acid starvation, the inhibition of lambda plasmid replication in amino acid-starved wild type strains was investigated. lambda plasmids were unable to replicate in amino acid-starved relA- bacteria treated with rifampicin. Moreover, transcription from pR, which produces mRNA for replication protein synthesis and serves as transcriptional activation of ori lambda, was significantly decreased during the stringent response as well as in non-starved cells containing increased levels of ppGpp. However, it was little or totally not affected by the relaxed response. The replacement of pR with plac (which is known to be uninhibited by ppGpp) in a lambda plasmid resulted in its DNA replication during relaxed and stringent responses as well as during overproduction of ppGpp in unstarved bacteria. We conclude that ppGpp-mediated inhibition of transcriptional activation of ori lambda is responsible for inhibition of lambda plasmid DNA replication in amino acid-starved wild type strains.(ABSTRACT TRUNCATED AT 250 WORDS)
Bacteriophage lambda↗
Monoclonal antibodies defining functional sites on the toxin superantigen staphylococcal enterotoxin B.
Four monoclonal antibodies (mAbs) were produced binding to four nonoverlapping epitopes on the superantigen staphylococcal enterotoxin B (SEB). The mAbs were tested for their ability to detect SEB bound to major histocompatibility complex (MHC) class II, to inhibit SEB binding to MHC class II, to inhibit SEB stimulation of T cell hybridomas, to bind to various nonfunctional mutants of SEB, and to capture and present SEB and its mutants to T cells in the absence of MHC class II. We concluded that two mAbs, B344 and B327, bound to epitopes not required for superantigen function, one mAb, 2B33, blocked an MHC interaction site on SEB, and the fourth mAb, B87, blocked the T cell recognition site on SEB. Moreover, two mAbs (B344 and 2B33) were capable of presenting SEB, although much less efficiently than APC, to CD4- but not CD4+ T cell hybridomas. The results confirm the functional domains on SEB originally defined by mutation and show that MHC class II is not always an essential component of the superantigen ligand.
Animals↗
Differential replication of plasmids during stringent and relaxed response of Escherichia coli.
Stringent control of DNA replication has been demonstrated for a few replicons like oriC, pBR322, and plasmids derived from coliphage lambda. In this study we investigated the replication of other plasmids harboring a well defined origin (orip15A, oripSC101, and oriRK2 = oriV) in amino-acid-starved stringent and relaxed strains of Escherichia coli. We found differential replication of plasmids during stringent and relaxed response. Inhibition of DNA synthesis or amplification of plasmid DNA in amino acid-starved relA+ and relA- cells depends on the kind of replicon and, surprisingly, on the nature of deprived amino acid. We conclude that there are no general rules for stringent control of DNA replication and each replicon must be considered separately. There are, however, possible explanations for the differences shown between replicons in their response to stringent and relaxed conditions.
Amino Acids↗
Development of children born after ovarian superovulation induced by long-acting gonadotropin-releasing hormone agonist and menotropins, and by in vitro fertilization.
The use of a gonodotropin-releasing hormone (Gn-RH) agonist in an in vitro fertilization (IVF) program raises the question of any influence on the physical, neurologic, and mental development of the children. We compared the development of children born after long-acting Gn-RH agonist treatment with that of children born after spontaneous pregnancies. Children from singleton pregnancies and > or = 28 months of age were examined by a pediatric neurologist and a psychologist who did not know to which group the children belonged. The General Cognitive Index test was used. Each group included 30 children. Five children cooperated only partly. Physical and neurologic findings were normal in all children, except that one in the group born after in vitro fertilization had diffuse hypotonia, attention-deficit hyperactivity disorder, and hyperactivity. The General Cognitive Index for the 26 children in the study group and the 29 children in the control group who fully cooperated were 102 +/- 13.3 and 106 +/- 13.5, respectively (p = 0.37). The verbal perception, motor, and memory indexes were not significantly different. We conclude that the long-acting Gn-RH agonist had no clinically identifiable influence on the development of these children.
Adult↗
Ultrasonic control without hormone determination for ovulation induction in in-vitro fertilization/embryo transfer with gonadotrophin-releasing hormone analogue and human menopausal gonadotrophin.
A total of 114 patients admitted to an in-vitro fertilization-embryo transfer programme for the first time, were randomly assigned to the study group or controls. Gonadotrophin-releasing hormone analogue (GnRHa) and human menopausal gonadotrophin (HMG) were used for ovulation induction. The study patients were followed up merely by ultrasonography and the controls by ultrasonography and serum determinations of oestradiol, progesterone and luteinizing hormone (LH). There was no significant difference in the duration and total amount of HMG used for ovulation induction (10.9 versus 11.5 days and 34.8 versus 37.9 ampoules, respectively). The number of oocytes retrieved (11.7 versus 13.4) and the numbers of embryos replaced (2.6 versus 2.8) and cryopreserved (1.9 versus 3.3) were also similar. Pregnancy rates were similar. Pregnancy rate per ovum retrieval was 22.2 versus 25% and per embryo transfer 27.2 versus 26.5%. Oestradiol patterns were also similar. The rate and severity of ovarian hyperstimulation syndrome were virtually identical. We conclude that 'ultrasound-only' monitoring of ovulation induction in IVF cycles treated by GnRHa-HMG in the long protocol is as effective and safe as the conventional ultrasound and hormone determination, but far simpler, swifter and more cost-effective.
Adult↗
Critically ill obstetrical patients: outcome and predictability.
OBJECTIVE: To determine the applicability of the Acute Physiology and Chronic Health Evaluation (APACHE) II scoring system in predicting outcome in a subgroup of critically ill obstetrical patients. DESIGN: Retrospective data collection. SETTING: A multidisciplinary intensive care unit (ICU) in a university hospital. PATIENTS: All patients (n = 1,670) admitted for > 24 hrs to the ICU during an 8-yr period, of whom 58 were obstetrical patients and 120 were nonobstetrical young women. MEASUREMENTS AND MAIN RESULTS: The mean APACHE II score in the obstetrical group was 11, with a mortality risk of 16.6%. In this group, the mortality ratio, which is the ratio between actual and predicted mortality rate, was low (0.416) and significantly (p = .021) different from the expected mortality ratio of 1. The mean APACHE II score in the group of nonobstetrical young women was 10, with a mortality risk of 10.17%. In all nonobstetrical ICU patients including all the admitted patients excluding the obstetrical patients, the mean APACHE II score was 15, with a mortality risk of 24.18%. The mortality ratio in the nonobstetrical young women group and in the nonobstetrical ICU patient group was 0.986 and 1.006, respectively, which was nonsignificantly different from the expected mortality ratio. CONCLUSIONS: Obstetrical patients requiring intensive care in our ICU had a better outcome than predicted, as expressed by a low mortality ratio. Various explanations that may be applicable to any subgroup of critically ill patients with a different mortality ratio are presented. The subgroup itself may be uniquely different, similar to our obstetrical patients with their physiologic changes of pregnancy. Another explanation may relate to an improvement in care of the subgroup and therefore a better outcome.
Critical Illness↗
Human decidua-associated protein 200 levels in uterine fluid at hysteroscopy.
Hysterosocpic intrauterine findings and levels of human decidua-associated protein 200 (hDP 200) in the uterine fluid were recorded in 116 women investigated for infertility or recurrent abortions. The levels of hDP 200 were significantly higher in the presence of submucous myomas or endometrial polyps, and lower in the presence of intrauterine adhesions in comparison to those in normal uterine cavities. hDP 200, an immunoglobin secreted by the endometrium, may be involved in implantation and placentation and its level in the uterine cavity is influenced by the presence of intrauterine pathology.
Abortion, Habitual↗
Memory impairment in patients with stereotaxic lesions to the hippocampus and amygdala.
The study aimed at testing: (1) whether stereotaxic damage to the hippocampus and amygdala results in a memory deficit, (2) whether the memory functions subserved by the hippocampus are lateralized and (3) whether time limited storage of sensory information is impaired after focal hippocampal and amygdalar lesions. Seven patients with unilateral stereotaxic damage to the anterior part of hippocampus and unilateral or bilateral damage to the medial part of amygdala and 11 control subjects with no brain damage participated in the research. They were presented with memory tests that required either remembering a spatial arrangement of simultaneously presented verbal vs nonverbal stimuli or a temporal order of sequentially presented items. Moreover, a sensory information storage test was used. The results indicate that even small damage limited to the anterior part of the hippocampus and medial part of the amygdala results in a mild memory deficit. Memory impairment was not related to the side of hippocampal lesion. This suggests that memory function subserved by the hippocampus is not lateralized. Differential effects of left and right lobectomies found in previous studies were, thus, probably due to the damage to temporal cortex. The results showed, however, that sensory information storage limited to 3 s is not impaired after focal damage to the hippocampus and amygdala. A clear lateralization effect showing right hemisphere advantage in that function was found.
Amygdala↗