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PubMed1999

Lipoprotein-genotype associations in Trinidadian neonates.

OBJECTIVES: We hypothesized that common variation in the angiotensinogen (AGT), beta-3-adrenergic receptor, intestinal fatty acid-binding protein, serum paraoxonase, paraoxonase-2, hepatic lipase, apolipoprotein E (APOE), and Werner helicase (WRN) genes would be associated with variation in biochemical phenotypes in a previously unstudied neonatal sample. DESIGN AND METHODS: We examined associations of both nongenetic and genetic variables with plasma lipoprotein traits in neonates from Trinidad. RESULTS: Among nongenetic variables, we found significant associations between plasma concentrations of: 1) lipoprotein(a) [Lp(a)] and both ethnicity (p = 0.037) and birth weight (p = 0.001); 2) total cholesterol and gender (p = 0.010); 3) triglyceride and birth weight (p = 0.035); and 4) apolipoprotein AI and gender (p = 0.016). Among genetic variables, we found that: 1) common variation on chromosome 1q in AGT codon 235 was significantly associated with variation in plasma apolipoproteins AI (p<0.0001) and B (p = 0.013); 2) common variation in WRN at codon 1367 was significantly associated with variation in plasma Lp(a) (p<0.0001); and 3) common variation in APOE at codons 112 and 158 was significantly associated with variation in plasma triglycerides (p = 0.013). CONCLUSIONS: The associations with AGT and WRN are novel and may have resulted either from a direct influence of the genetic variants or through linkage disequilibrium with other functional loci, such as the familial combined hyperlipidemia locus on chromosome 1q in the case of AGT. Despite the fact that there are some limitations in making determinations from cord blood, the results suggest that there may be genetic determinants of plasma lipoproteins in neonates.

Africa↗
PubMed2000

Hyaluronan in follicular fluids and fertilization of oocytes.

OBJECTIVE: To determine the concentrations of hyaluronan, E(2), and progesterone in follicular fluids (FFs) and the incidence of apoptotic granulosa cells. Also, to examine the relationship between the concentration of hyaluronan and follicular steroids, the incidence of apoptotic cells, and the fertilizability of the oocyte in the same follicle. DESIGN: Samples of 130 follicles were retrospectively analyzed for hyaluronan and steroids and the incidence of apoptotic cells. SETTING: The reproductive center in Yamagata University Hospital. PATIENT(S): Forty women infertile because of tubal damage or unknown causes undergoing IVF treatment were selected. INTERVENTION(S): The samples were collected from follicle aspirations. MAIN OUTCOME MEASUREMENT(S): The concentrations of hyaluronan and steroids in FFs, the incidence of apoptotic granulosa cells, and oocyte fertilizability. RESULT(S): The levels of hyaluronan in FF were found to correlate positively with P (r=0.444, P<0.0001) and the incidence of apoptotic cumulus granulosa cells (r=0.387, P=0.002) and inversely with E(2) (r = -0.601, P<0.0001) and free T (r = -0.344, P=0.001). The concentration of hyaluronan in FFs containing a subsequently fertilized oocyte after insemination was significantly lower than that in FFs containing a subsequently unfertilized oocyte (P=0.0005) (fertilized, 50.0 +/- 2.6 ng/mL; triploidy, 59.1 +/- 6.8; and unfertilized, 66.9 +/- 5.9). CONCLUSION(S): The concentration of hyaluronan in FF is an indicator for estimation of oocyte viability for fertilization.

Apoptosis↗
PubMed2002

Role of acupuncture in the treatment of female infertility.

OBJECTIVE: To review existing scientific rationale and clinical data in the utilization of acupuncture in the treatment of female infertility. DESIGN: A MEDLINE computer search was performed to identify relevant articles. RESULTS: Although the understanding of acupuncture is based on ancient medical theory, studies have suggested that certain effects of acupuncture are mediated through endogenous opioid peptides in the central nervous system, particularly beta-endorphin. Because these neuropeptides influence gonadotropin secretion through their action on GnRH, it is logical to hypothesize that acupuncture may impact on the menstrual cycle through these neuropeptides. Although studies of adequate design, sample size, and appropriate control on the use of acupuncture on ovulation induction are lacking, there is only one prospective randomized controlled study examining the efficacy of acupuncture in patients undergoing IVF. Besides its central effect, the sympathoinhibitory effects of acupuncture may impact on uterine blood flow. CONCLUSION: Although the definitive role of acupuncture in the treatment of female infertility is yet to be established, its potential impact centrally on the hypothalamic-pituitary-ovarian axis and peripherally on the uterus needs to be systemically examined. Prospective randomized controlled studies are needed to evaluate the efficacy of acupuncture in female fertility treatment.

Acupuncture↗
PubMed1992

Specific binding sites for insulin in the human myometrium and leiomyomas of the uterus.

OBJECTIVE: To investigate whether there are increased binding sites for insulin in the leiomyomas of the uterus. STUDY DESIGN: Samples of myomas and myometrium were obtained from seven patients with myomas at the time of hysterectomy. Binding studies were performed with [125I] insulin. RESULTS: The percent total binding of [125I] insulin in the myomal tissues (mean +/- SE 20.7% +/- 2.3%/100 micrograms protein) was significantly higher (P less than 0.01) than that in the myometrium (14.7% +/- 1.3%/100 micrograms protein). Scatchard analysis revealed that the increase in binding is because of increase in receptor affinity. CONCLUSIONS: There is increased binding of insulin in the myomas because of increase in receptor affinity. This could increase the sensitivity of the biological response of the myomal cells to insulin.

Adult↗
PubMed1994

The hemizona assay is of good prognostic value for the ability of sperm to fertilize oocytes in vitro.

OBJECTIVES: To assess the prognostic value of hemizona assay (HZA) in predicting the success of IVF. DESIGN: Samples from 133 patients, who were referred for semen evaluation, were tested by HZA. Thirty samples were tested twice to assess interassay variation. Seventy couples were also referred for IVF. Results of HZA were compared with standard parameters of sperm quality, fertilization rates, and pregnancies. RESULTS: The intra-assay and interassay coefficient of variation were 8% and 14%, respectively. Hemizona assay results had the highest correlation with sperm morphology (r = 0.60). Of all parameters evaluated, fertilization rates were best predicted by hemizona index (HZI) (r = 0.75). The assay was found to have high sensitivity and specificity rates, at a threshold HZI of 23%. CONCLUSIONS: The HZA is a valuable prognostic test for IVF. With a threshold HZI of 23%, it has a good predictive value for fertilization rates in IVF, and may thus be used for patient preselection before IVF.

Female↗
PubMed1995

Danazol concentrations in ovary, uterus, and serum and their effect on the hypothalamic-pituitary-ovarian axis during vaginal administration of a danazol suppository.

OBJECTIVE: To determine danazol concentrations in the ovary, uterus, and serum during daily vaginal administration of a danazol suppository and to examine its effect on the hypothalamic-pituitary-ovarian axis. DESIGN: Sampling of tissues after vaginal or oral administration of danazol and sampling of blood during control and danazol-administration menstrual cycles. SETTING: Outpatient volunteers and inpatients at a public hospital. PARTICIPANTS: Thirty patients who were to undergo hysterectomy and oophorectomy because of uterine leiomyoma and eight regularly menstruating volunteers. INTERVENTIONS: Danazol was administered as a vaginal suppository (100 mg) or orally (400 mg). MAIN OUTCOME MEASURE: Danazol concentrations in the ovary, uterus, and serum, and serum E2 and P levels. RESULTS: Danazol concentrations in the ovary and uterus after daily vaginal administration of a suppository containing 100 mg danazol were comparable to those after daily oral administration of 400 mg danazol, but the serum danazol concentration was much lower. Menstrual cycle patterns of serum E2 and P levels were normal during daily vaginal administration of a danazol suppository. CONCLUSION: Daily administration of a suppository containing 100 mg danazol produces high ovarian and uterine concentrations but low serum concentrations, and no effect was detected on the hypothalamic-pituitary-ovarian axis.

Adult↗
PubMed1997

Immunodetection of cotinine protein in granulosa-lutein cells of women exposed to cigarette smoke.

OBJECTIVE: To detect immunoreactivity to cotinine protein, a major metabolite of nicotine, in granulosa-lutein cells from patients exposed to cigarette smoke, as measured by levels of cotinine in follicular fluid (FF) samples. DESIGN: Controlled immunocytochemical study. SETTING: Hospital IVF-ET program treating infertile patients. PATIENT(S): Twenty-eight women classified by self-reported smoking habits: active smokers (n = 17), passive smokers (n = 4), and nonsmokers (n = 7). INTERVENTION(S): Ovarian hyperstimulation. MAIN OUTCOME MEASURE(S): Grades of immunostaining intensity were assessed in granulosa-lutein cells. Patient scores of cell immunostaining were calculated and regressed on levels of FF cotinine. RESULT(S): Cotinine levels in FF were higher in active smokers than in passive smokers or nonsmokers. Cotinine immunostaining was visualized in the nucleus and cytoplasm of granulosa-lutein cells. Mean grades and mean scores of immunostaining intensity were higher in active smokers than in passive smokers or nonsmokers. There was a strong positive correlation between scores of cell immunostaining and FF cotinine levels. CONCLUSION(S): The association between cotinine expression in granulosa-lutein cells and FF cotinine provides reliable evidence for a dose-related effect. This constituent of cigarette smoke appears to interact directly with and incorporate into these ovarian cells. Our approach seems useful for monitoring ovarian exposure to environmental toxins.

Animals↗
PubMed1999

Medication compliance and older people: a review of the literature.

The purpose of this paper is to critically review a select body of literature pertaining to medication compliance among older people. As there is a vast amount of literature on the topic, this review is selective to include (1) a critique of the more commonly cited compliance theories, (2) an analysis of the key variables influencing medication compliance among older people and (3) a critical evaluation of the literature which examines these phenomena. In addition, studies, which explore the benefits of Self-Administration of Medication Schemes, are the subject of particular scrutiny, by virtue of the fact that they address not only the education component but also the behavioural component of a well-organised patient education programme. The review is limited to material published in English since 1980 with the exception of the literature on compliance theories, which originated in previous decades. Key search terms including medication, compliance, older people, self-medication and education were used to derive the relevant material from the Medline and CINAHL databases. The literature was then critically reviewed using the criteria identified by Roe (1993) [Roe, B., 1993. Undertaking a critical review of the literature. Nurse Researcher 1(1), 35-46.] which emphasises the need for clarity in key areas such as research design, sample selection, research methods, results, discussion and conclusions. Empirical research which met this criteria was included in the review and in the main, this was found in academic rather than professional journals. The review concludes with a summary of the main points and a discussion of the implications for nursing practice, education and research.

Aged↗
PubMed1999

Sexuality during pregnancy and after childbirth: a metacontent analysis of 59 studies.

The aim of this study is to gain a systematic overview of all existing studies on parental sexuality during pregnancy and the postpartum period (months 1-6). Investigations of psychological and medical data banks and cross-references revealed 59 relevant studies published in English or German between 1950 and 1996. These primary studies were metacontent analyzed, according to the following categories: methodology (samples, designs): type of descriptive data researched (sexual activity, interest, enjoyment, orgasm, problems); and type of correlational data researched (sexual variables and pregnancy outcome, maternal physical and psychological health, sociodemographic data, biographical data, partnership data). On average, female sexual interest and coital activity declines slightly in the first trimester of pregnancy, shows variable patterns in the second trimester, and decreases sharply in the third trimester. Most couples do not practice intercourse for about 2 months around the delivery. Afterwards, sexual interest and activity tends to be reduced for several months as compared with the prepregnancy level, and sexual problems occur relatively often. But most remarkable is the interindividual variability concerning sexual responsiveness, orgasm, activity, and enjoyment. Descriptive research is focused on coital activity of (expectant) mothers. Data about fathers, noncoital activities, and sexual feelings are scarce. Data analysis is focused on three questions: (1) Does sexual activity in pregnancy harm the fetus? (if there are no risk factors: no); (2) Are physical and mental symptoms or data about the delivery and sexual variables correlated? (in some cases: yes); (3) Are sociodemographic data and sexual variables correlated? (mostly not). Research deficits (e.g., conceptual reductionism "sexuality=intercourse," neglect of the male partners, validity, reliability, neglect of the nonsexual partnership and of biographical influences) are critically discussed. Medical, counseling, and psychotherapeutic implications are derived.

Female↗
PubMed1994

Results of an epidemiological survey using a modified American Urological Association symptom index for benign prostatic hyperplasia in France.

The prevalence of urinary symptoms associated with benign prostatic hyperplasia was studied in a community-based, nationwide, representative sample of 2,011 French men 50 to 80 years old. Symptoms were assessed by the American Urological Association symptom index. After exclusion of patients with prostate cancer, 6.9% of the subjects reported having undergone prostate surgery. Among the surgery-free subjects, nocturia and repeat voiding within 2 hours were the most prevalent symptoms. Based on the American Urological Association symptom index, 18.8% of the men were considered free of urinary symptoms, and 67%, 13% and 1.2%, respectively, ranked between 1 and 7, 8 and 19, and 20 or more. The proportion of men scoring greater than 7 approximately doubled with each decade of age. Our estimation indicated that in 1992 approximately 1.14 million French men had moderate to severe urinary symptoms that were likely to be associated with benign prostatic hyperplasia. Previous studies had yielded higher prevalence estimates, probably due to differences in sampling design and diagnostic criteria.

Aged↗
PubMed1993

The impact of diet on coronary heart disease.

The epidemiologic relationship between dietary intake and coronary heart disease (CHD) is reviewed by presenting the findings of the major large national and international cohort studies. There is considerable heterogeneity in the results from these studies because of the many differences in design, sample population, and analysis. Dietary intervention studies, which have numerous limitations, likewise have reported discrepant results, although short-term dietary changes do appear to reduce the likelihood of CHD progression. Although proof is lacking that the currently recommended prudent dietary patterns reduce the incidence or severity of CHD, healthy dietary choices are both inexpensive and safe and are supported by a foundation of sound biological principles.

Clinical Trials as Topic↗
PubMed2000

Soil-to-plant and plant-to-cow's milk transfer of radiocaesium in alpine pastures: significance of seasonal variability.

Because our present knowledge on the environmental behaviour of fallout radiocaesium in semi-natural environments is rather limited, the transfer of this radionuclide and of natural 40K, from soil-to-plant as well as from plant-to-cow's milk was investigated for a typical alpine pasture (site P). For comparison, a nearby alpine pasture (site K) not used for cattle grazing was also studied. Small seasonal effects were found for 137Cs in the plants, but they were different for the two pastures. Due to the presence of a large variety of different plant species on the pastures and soil adhesion on the vegetation from trampling cattle, the scattering of the data was very large, and the seasonal effects were observable only because of the large number of samples (N approximately 100) collected. The aggregated soil-to-plant transfer factor of 137Cs was for site P, on average, 0.002 +/- 0.001 m2 kg(-1). The plant-to-milk transfer coefficient was, on average, 0.02 day l(-1). The 137Cs concentration in the milk of the cows varied within the grazing period only between 1.4 and 2.9 Bq l(-1), with a significant maximum in the beginning of August. As a result of soil adhesion due to cattle trampling, significantly higher ash- and 137Cs contents of the plants were observed at site P as compared to site K. Possible consequences of the above observations with respect to a representative sampling design of vegetation and milk are discussed.

Animal Feed↗
PubMed2006

Microarray analysis of RNA processing and modification.

Most RNAs are processed from precursors by mechanisms that include covalent modifications, as well as the removal of flanking and intervening sequences. Traditional methods to detect RNA processing, such as Northern blotting, reverse-transcribed polymerase chain reaction and primer extension assays, are difficult to apply on a large scale. This chapter outlines several methods for analysis of the processing and modification of RNA using microarrays. These encompass protocols for the application of homemade microarrays and custom-designed commercial inkjet microarrays and are tailored for the large-scale analysis of processing of mRNA, including alternative splicing, as well as for the analysis of processing and modification of noncoding RNA. This chapter also describes practical aspects of microarray design, sample preparation, hybridization, and data analysis.

Animals↗
PubMed2001

Effects of holding time during cooling and of type of package on plasma membrane integrity, motility and in vitro oocyte penetration ability of frozen-thawed boar spermatozoa.

The effect of a prolonged holding time (HT) during cooling on plasma membrane integrity (PMI), motility and in vitro oocyte penetration ability of boar spermatozoa frozen-thawed in different types of package was investigated. Boar semen was frozen in a split-sample design using 3 different HTs (3, 10 and 20 h) during cooling and three different types of freezing package: Maxi-straws, Medium-straws and FlatPacks. Assessment of PMI (SYBR-14 and propidium iodide, fluorescence microscopy) and sperm motility (visually and with CASA) was done during cooling (at 32 degrees C, 15 degrees C, 5 degrees C) and post-thaw (PT). The in vitro oocyte penetration ability of the spermatozoa was tested only PT, using a homologous in vitro penetration assay (hIVP). During cooling the HTs used had no significant (p<0.05) effect on either PMI or percentage of motile spermatozoa Post-thaw PMI was significantly higher (p<0.05) for 10 h and 20 h HT compared with 3 h, and the percentage of motile spermatozoa decreased significantly with 20 h HT as opposed to 3 h and 10 h. Regarding the freezing packages, the FlatPacks and Maxi-straws yielded significantly more PMI than did the Medium-straws (p<0.05). Post-thaw motility was significantly higher for FlatPacks than for straws, in terms of both percentage motile spermatozoa, and sperm velocity and lateral head displacement (LHD). The hIVP did not show any significant differences among the HTs, although FlatPacks yielded a significantly higher penetration rate and more spermatozoa per penetrated oocyte (p<0.05) than did the straws. Changes in motility patterns, toward a more circular motility during cooling and PT, could be noticed where individual spermatozoa showed a capacitation-like motility pattern. The changes were more obvious with 10-h and 20-h HTs than with 3-h HT.

Animals↗
PubMed2003

Influence of extender, temperature, and addition of glycerol on post-thaw sperm parameters in ram semen.

Using a two-step extension methodology, two experiments were conducted using a split-sample design to compare the effect on post-thaw ram sperm parameters of a milk-based extender (Experiment 1) containing four different egg yolk concentrations (5% [M5], 10% [M10], 15% [M15], and 20% [M20]), and a commercially available extender (Bioexcell); IMV, L'Aigle, France) free from additives of animal origin, containing two different final glycerol concentrations (3.2% [B] and 6.4% [BB]) (Experiment 2). In both experiments, glycerol was added either at 5 degrees C or at 15 degrees C together with the second fraction of each extender. The sperm characteristics assessed were motility (measured subjectively [SM] and by means of cell motion analysis (CASA), membrane integrity (SYBR-14/PI), and capacitation status (chlortetracycline (CTC)/EthD-1). Results of Experiment 1 showed no significant positive effect of increasing the concentration of egg yolk above 10% on post-thaw motility, membrane integrity, or induction of sperm capacitation-like changes. In Experiment 2, Bioexcell (BB) yielded similar post-thaw results as did the milk extender (control). In both experiments, post-thaw sperm parameters were better preserved when glycerol was added at 5 degrees C, although the results were not always statistically significant for all variables studied. In conclusion, when using milk-based extenders for freezing ram semen, low (5-10%) concentrations of egg yolk and the addition of glycerol at 5 degrees C are recommended. Furthermore, the results indicate that when freezing ram semen, Bioexcell containing 6.4% glycerol may be used as an alternative extender to the conventional milk extender containing 5% egg yolk.

Acrosome Reaction↗
PubMed2003

Fertility of ram semen frozen in Bioexcell and used for cervical artificial insemination.

The current use of ingredients of animal origin, such as egg yolk, in semen extenders presents a risk of microbial contamination, and has led to the search for alternatives. Such an extender is commercially available for bull semen (Bioexcell), IMV, L'Aigle, France), and it has previously been tested in vitro for freezing ram semen, with satisfactory results. The aim of the present study was to compare the fertility results of ewes in Uruguay, after cervical insemination with ram semen that was frozen in Bioexcell versus semen frozen in a conventional milk-egg yolk extender (control). Semen from five Corriedale rams was frozen, using a split sample design, in either milk-egg yolk or Bioexcell extender, using a two-step extension method. The sperm parameters assessed after thawing were subjective motility, membrane integrity (SYBR-14/PI), and capacitation status (CTC). Thawed semen was inseminated intracervically once during spontaneous estrus in 970 Corriedale ewes that grazed in natural pastures, under extensive management conditions. Fertility was recorded as nonreturn rates at 21 days (NRR-21) and 36 days (NRR-36) after artificial insemination (AI), as well as pregnancy rate (PR-US, diagnosed ultrasonographically 50 days after AI of the last ewe). Subjective motility was slightly higher in Bioexcell than in the milk extender (47 vs. 46.5%; NS), as was membrane integrity (38 vs. 37.7%; NS) and the percentage of uncapacitated spermatozoa (28.5 vs. 26.3%; NS). There were no statistically significant differences in fertility rates found between Bioexcell and the control extender: NRR-21 (35.9 vs. 33.2%), NRR-36 (34.8 vs. 32.6%), and PR-US (28.4 vs. 27.2%). In conclusion, Bioexcell appears to be an alternative to the conventional milk-egg yolk extender for freezing ram semen, and provides similar fertility results after cervical AI under extensive management conditions. Thus, Bioexcell, containing no additives of animal origin, can offer a safer alternative when frozen semen is used for introducing new genetic material into a flock or a country.

Animals↗
PubMed2002

Mechanical properties and radiopacity of experimental glass-silica-metal hybrid composites.

OBJECTIVES: Experimental glass-silica-metal hybrid composites (polycomposites) were developed and tested mechanically and radiographically in this fundamental pilot study. To determine whether mechanical properties of a glass-silica filled two-paste dental composite based on a Bis-GMA/polyglycol dimethacrylate blend could be improved through the incorporation of titanium (Ti) particles (particle size ranging from 1 to 3 microm) or silver-tin-copper (Ag-Sn-Cu) particles (particle size ranging from 1 to 50 microm) we measured the diametral tensile strength, fracture toughness and radiopacity of five composites. METHODS: The five materials were: I, the original unmodified composite (control group); II, as group I but containing 5% (wt/wt) of Ti particles; III, as group II but with Ti particles treated with 4-methacryloyloxyethyl trimellitate anhydride (4-META) to promote Ti-resin bonding; IV, as group I but containing 5% (wt/wt) of Ag-Sn-Cu particles; and V, as group IV but with the metal particles treated with 4-META. Ten specimens of each group were tested in a standard diametral tensile strength test and a fracture toughness test using a single-edge notched sample design and five specimens of each group were tested using a radiopacity test. RESULTS: The diametral tensile strength increased statistically significantly after incorporation of Ti treated with 4-META, as tested by ANOVA (P=0.004) and Fisher's LSD test. A statistically significant increase of fracture toughness was observed between the control group and groups II, III and V as tested by ANOVA (P=0.003) and Fisher's LSD test. All other groups showed no statistically significant increase in diametral tensile strength and fracture toughness respectively when compared to their control groups. No statistically significant increase in radiopacity was found between the control group and the Ti filled composite, whereas a statistically significant increase in radiopacity was found between the control group and the Ag-Sn-Cu filled composite as tested by ANOVA (P=0.000) and Fisher's LSD procedure. SIGNIFICANCE: The introduction of titanium and silver-tin-copper fillers has potential as added components in composites to provide increased mechanical strength and radiopacity, for example for use in core materials.

Algorithms↗
PubMed1998

Socioeconomic status, standard of living, and neurotic disorder.

BACKGROUND: Evidence on the association between socioeconomic status and the prevalence of neurotic disorder is contradictory. We studied the association between three elements of socioeconomic status and the prevalence of neurotic psychiatric disorder in a representative sample of adults aged 16-64 living in private households in the UK. METHODS: A cross-sectional survey of 10,108 adults aged 16-65 resident in private households in the UK was selected by a multi-stage, clustered, random-sampling design. Neurotic disorders were defined using a standardised interview, the revised clinical interview schedule (CIS-R). Data for 9570 people were available for this study. FINDINGS: We used housing tenure and access to cars as measures of standard of living; both were associated with the prevalence of neurotic disorder even after adjustment for other socioeconomic and demographic variables, including Registrar General's Social Class and educational attainment. Those people with no access to a car had an odds ratio for neurotic disorder of 1.4 (95% CI 1.1-1.7), compared with those who had access to two or more cars. People who rented their homes were also at increased risk (1.3 [1.1-1.5]). We estimated that about 10% of the neurotic disorder in the UK could be attributed to the increased prevalence of those without cars who rented their homes. There was a complex interaction between Registrar General's Social Class and sex, and there was no independent association with educational attainment. INTERPRETATION: There is an independent association between low standard of living and the prevalence of neurotic psychiatric disorder. The UK has experienced one of the largest increases in income inequality within western market economies over the past 20 years, and this inequality may have had adverse consequences for the mental health of the population.

Adolescent↗