bluuebunny/crossref_metadata_2025 huggingface dataset:
Measurement of Tc‐99m DTPA Serum Clearance for Estimating Glomerular Filtration Rate in Children With Cancer
Authors: Rodman John H. , Maneval Daniel C. , Magill H. Lynn , Sunderland Marc
Published: October 2023

Clearance of the radiopharmaceutical Tc‐99m DTPA estimated from blood samples with no urine collection can provide a reliable estimate of glomerular filtration rate (GFR) in adults, but has not been well studied in children. The disposition of Tc‐99m DTPA was determined in 17 children with cancer, and the influence of binding and study design on the estimates for serum clearance were evaluated. Nine blood samples were obtained over 6 hours in each patient, and serum was assayed for total and free Tc‐99m. Free Tc‐99m DTPA was determined by ultrafiltration. Estimates of clearance derived from a two‐compartment model for ultrafiltrable Tc‐99m DTPA were determined from all nine measured concentrations, and these results served as a reference value for GFR in each subject. Total Tc‐99m DTPA concentrations also were best described by a two‐compartment model, but the median total clearance (35 ml/min) was significantly (p<0.01) lower than the ultrafiltrate clearance (58 ml/min). The effect of a simplified sampling schedule was assessed from clearance estimates based on a 3‐point subset of the ultrafiltrable data. The median clearance of 69 ml/minute was significantly higher (p<0.01) than the reference GFR. However with a correction factor included to account for the positive bias arising from the limited sampling schedule, the reference estimates for GFR were well predicted (r2=0.99) with no significant bias. Ultrafiltrable Tc‐99m DTPA serum clearance using a limited sampling schedule can provide a consistent and clinically feasible estimate of glomerular filtration rate in children, but binding in serum and study design are potentially important confounding factors.
Pharmacotherapy of Preterm Labor
Authors: Travis Britt E. , McCullough Jill M.
Published: October 2023

Preterm labor is defined as the onset of uterine contractions in a woman who has completed less than 37 weeks of pregnancy. It may be due to maternal, placental, fetal, or idiopathic causes, and it is associated with a number of risk factors. Nondrug measures such as bedrest and hydration have been used alone or in combination with drug therapy to treat the disorder. Pharmacologic (tocolytic) agents include ethanol, progesterone, indomethacin, nifedipine, β‐adrenergic agonists, and magnesium salts. The three most commonly used drugs are ritodrine, terbutaline, and magnesium.
Seizure After Lidocaine for Bronchoscopy: Case Report and Review of the Use of Lidocaine in Airway Anesthesia
Authors: Wu Fen‐Lin , Razzaghi Azita , Souney Paul F.
Published: October 2023

Lidocaine‐induced seizures have been reported after topical administration. A 30‐year‐old, 48‐kg women with acquired immunodeficiency syndrome, chronic end‐stage renal failure, anemia, congestive heart failure (CHF), cardiomyopathy, and increased liver function tests was admitted to the hospital with fever, chills, and dry cough. Bronchoscopy was performed to rule out Pneumocystis carinii pneumonitis; the patient experienced seizure activity after administration of a total dose of topical lidocaine 300 mg. Plasma drug concentration measured shortly after seizure, and at 4 and 22 hours after seizure were 12.0, 7.6, and 1.4 mg/L, respectively. A direct correlation exists between clinical symptoms and blood level of lidocaine; as the level increases to 8–12 mg/L the probability of seizure increases. The extent of absorption and bioavailability after airway administration depends on tissue vascularity, sites and techniques of application, patient's disease state, and, most important, the dose/unit body weight. The lidocaine dose should be titrated slowly and patients monitored for altered mental status. The dose often has to be decreased empirically in patients with liver disease or CHF. Efforts should be made to deliver minimum amounts of the drug to the lower respiratory tract, since its pharmacokinetics at that site are similar to those with intravenous administration.
Drug‐Drug Interactions With Fluoroquinolones
Authors: Marchbanks C. Randall
Published: October 2023

Antimicrobials of the fluoroquinolone class are involved in a number of clinically important drug‐drug interactions. Many of these interactions occur with all the available agents and exhibit little interpatient variability. In contrast, others occur only with specific fluoroquinolones and their extent varies markedly among subjects. The oral absorption of all fluoroquinolones is significantly impaired when coadministered with aluminum‐ and magnesium‐containing antacids and sucralfate, as well as with other metal cations such as calcium and iron. Concomitant use of these agents, even when dosed several hours apart, should be avoided. Enoxacin and ciprofloxacin impair the hepatic metabolism of theophylline and caffeine, leading to significantly increased serum concentrations. Ofloxacin and lomefloxacin have only minimal effects on xanthine metabolism. Case reports suggest that concomitant administration of several fluoroquinolones and warfarin, a drug that is also highly metabolized by the liver, leads to increased hypoprothrombinemic effects; prospective studies, however, failed to confirm this interaction. Clinicians must be aware of these and other potential drug‐drug interactions with fluoroquinolones for optimal use of the agents.
The Role of Fluoroquinolones in Sexually Transmitted Diseases
Authors: Tartaglione Teresa A. , Hooton Thomas M.
Published: October 2023

The management of sexually transmitted diseases (STDs) has reached a new level in the era of antibiotic resistance and human immunodeficiency virus infection. To date, no single antimicrobial is capable of eradicating the commonly encountered STD pathogens including Neisseria gonorrhoeae, Chlamydia trachomatis, and Treponema pallidum. Among the marketed fluoroquinolones, ciprofloxacin, ofloxacin, lomefloxacin, and enoxacin all provide excellent in vitro activity (MIC90 < 0.06 μg/ml) and excellent in vivo efficacy against N. gonorrhoeae, including multiply resistant isolates (penicillinase‐producing N. gonorrhoeae and chromosomally mediated resistant N. gonorrhoeae). Ofloxacin is the only fluoroquinolone approved by the Food and Drug Administration for chlamydial infection. All of the quinolones lack reliable in vitro activity against Ureaplasma urealyticum, a cause of nongonococcal urethritis. Although limited data suggest the usefulness of ciprofloxacin and ofloxacin in the treatment of pelvic inflammatory disease, these drugs cannot currently be recommended for single‐agent therapy. Haemophilus ducreyi infections, however, can be managed effectively with the fluoroquinolones. Although their role continues to evolve, this class of drugs cannot be used equally to treat all STDs, and notably, no quinolone to date inhibits T. pallidum.
In Vitro Evaluation of the Effect of Metered‐Dose Inhaler Administration Technique on Aerosolized Drug Delivery
Authors: Shalansky Karen F. , Htan Eileen Y.H. , Lyster Don M. , Mouat Brenda , Tweeddale Martin G.
Published: October 2023

The administration of aerosolized metered‐dose inhalers (MDIs) to mechanically ventilated patients is labor intensive due to the large number of activations required and the currently recommended 30‐ to 60‐second “wait and shake” between each puff. No studies have been published that assess the relationship between this delay between puffs and drug delivery. To address this issue, we conducted an in vitro, randomized, single‐blind study using fenoterol MDI containing technetium‐99m pertechnetate. Four modes of MDI administration were tested in triplicate by random sequence. Eight activations of the MDI were performed for each mode according to the following procedures: rapid succession (5 sec apart); 30‐second intervals and shaking MDI between two rapid activations; 30‐second intervals and shaking between each activation; and 60‐second intervals and shaking between each activation. Two closed in vitro systems were designed to collect and measure the radiolabeled aerosol. In the first system, the MDI was activated into a plastic collection container; with the second system, the MDI was administered through an aerosol holding chamber with attached circuit filter positioned on the inspiratory line of the ventilator circuit. Sixty‐second intervals between each activation were not tested with the second system. Radioactivity was measured before and after each mode of testing. No difference was found between the various modes of administration other than a 14% decrease in the amount of radioactivity released with the 60‐second waiting period between puffs, compared with their rapid succession when using the plastic collection container system. Our results support the hypothesis that the delay after each activation of a MDI may not be necessary.
Zidovudine Pharmacokinetics in HIV‐Positive Women During Different Phases of the Menstrual Cycle
Authors: Cordaro Joseph A. , Morse Gene D. , Bartos Linda , Gugino Lawrence J. , Maliszewski Maureen , Colomaio Rosemarie , Shelton Mark , O'Donnell Alice , Hewitt Ross
Published: October 2023

Study Objective. To examine the pharmacokinetics of zidovudine during the menstrual cycle in human immunodeficiency virus‐ (HIV‐) positive women.

Design. Open, unblinded study.

Setting. A women's clinic for acquired immunodeficiency syndrome (AIDS) at a large medical center.

Patients. HIV‐positive women with a CD4+ cell count above 200/mm3, receiving long‐term zidovudine therapy, with a history of regular menstrual cycles.

Interventions. All patients received a 100‐mg dose of zidovudine in the fasted state on three occasions.

Measurements and Main Results. Zidovudine and zidovudine‐glucuronide plasma concentrations were measured with radioimmunoassay to determine the pharmacokinetic characteristics during each menstrual phase. The drug's mean peak plasma concentrations (range 233–808 ng/ml) were 556 ± 145, 385 ± 132, and 495 ± 143 ng/ml during the menstrual, late follicular‐ovulatory, and luteal phases, respectively. Initially, plasma concentrations declined in a linear fashion from 0 to 4 hours, with a prolonged elimination phase in many patients after 4 hours. The mean zidovudine area under the curve was 886 ± 156, 845 ± 268, and 775 ± 167 ng·hour/ml. The mean percentage of dose recovered was 44.2 ± 26.0, 56.9 ± 19.1, and 42.2 ± 16.6, respectively.

Conclusions. The pharmacokinetics of zidovudine were not different during the three phases of the menstrual cycle; however, considerable intrapatient and interpatient variability was noted for many of the values.
Evaluation of Transdermal Theophylline Pharmacokinetics in Neonates
Authors: Micali Giuseppe , Bhatt Renuka H. , Distefano G. , Caltabiano L. , Cook Brian , Fischer James H. , Solomon Lawrence M. , West Dennis P.
Published: October 2023

Theophylline may be administered by several routes, but problems are associated with neonatal dosing. The transdermal route may provide a safer and noninvasive method of administration, yet produce therapeutic concentrations in a consistent and reliable manner. To study the feasibility of this in the apnea of prematurity, stable neonates were administered a subtherapeutic transdermal dose for 24 hours in order to assess pharmacokinetics and bioavailability. This was followed with routine intravenous theophylline therapy according to institutional policy. Six of nine neonates had detectable serum theophylline concentrations that increased slowly after patch application. Mean (± SD) maximum serum concentration was 2.4 ± 1.3 μg/ml, mean time to maximum serum concentration was 22 ± 8.2 hours, and mean latency period was 8.0 ± 4.9 hours. Mean total amount of theophylline delivered to the skin was 18.6 ± 4.1 mg. Mean fractional absorption at 30 hours was 0.25 ± 0.12. These data demonstrate that it is possible to produce systemic theophylline concentrations with a transdermal patch in preterm infants sufficient to study pharmacokinetics and bioavailability, and that transdermal delivery of therapeutic doses is technologically feasible.
Pathophysiology of Heart Failure
Authors: Patterson J. Herbert , Adams Kirkwood F.
Published: October 2023

Heart failure, a major contributor to cardiovascular disease morbidity and mortality, is newly diagnosed in approximately 400,000 patients each year, and is particularly prevalent in individuals over age 65 years. Average mortality rates 5 years after diagnosis are 45–60%, and may be as high as 50% after 1 year for those with New York Heart Association class IV heart disease. Heart failure occurs when myocardial muscle dysfunction prevents the heart from pumping enough blood at normal cardiac pressures to meet the metabolic needs of the body, especially during exercise, and compensatory hemodynamic and neurohormonal mechanisms are overwhelmed or maladaptive. Pathologic classifications are broadly based on the presence of systolic (dilated cardiomyopathy) or diastolic (hypertrophic or restrictive cardiomyopathies) dysfunction. The etiologies of heart failure may include inadequate coronary blood flow, pressure or volume overload, cardiomyopathy, or pericardial disease. Coronary artery disease, idiopathic dilated cardiomyopathy, and hypertension are the most frequent causes, and certain drugs may also worsen myocardial function. When contractility is reduced, stroke volume and cardiac output are decreased, and alterations in the kidneys may induce fluid retention to compensate for the perceived low output and reduced circulating blood volume. Fluid retention in turn causes preload or filling pressure to increase and symptoms of pulmonary congestion to emerge. Depressed contractility also results in a reduction in blood pressure, leading to compensatory neurohormonal activation and vasoconstriction, which significantly elevate afterload and further reduce stroke volume. The overall approach to heart failure includes defining the etiology, identifying precipitant factors, and assessing the severity of myocardial dysfunction and clinical symptoms. By carefully characterizing the patient with congestive heart failure, the most effective plan of nonpharmacologic and pharmacologic interventions can be initiated.
Immunosuppressive Properties of Calcium Channel Blockers
Authors: Chitwood Kerri K. , Heim‐Duthoy Karen L.
Published: October 2023

Calcium channel blockers are extensively used for their beneficial effects on the cardiovascular system. Solid organ transplant recipients commonly have cardiovascular disease and are often treated with these agents. Research demonstrates that calcium antagonists may have beneficial effects in this population that are independent of their effects on the cardiovascular system. Indeed, both in vitro and in vivo studies suggested that they may possess immunosuppressive properties. Their actions at the cellular level in both the afferent and efferent arms of the immune system indicate that alone, as well as in combination with cyclosporine, these agents possess immunosuppressive properties that may potentially benefit the transplant population.
Administration of Insulin by Continuous Ambulatory Peritoneal Dialysis
Authors: Chan Edwina , Montgomery Patricia A.
Published: October 2023

Many patients with diabetic nephropathy undergoing continuous ambulatory peritoneal dialysis (CAPD) use their peritoneal access to administer insulin. Compared with the subcutaneous route, intraperitoneal (IP) insulin may display more consistent absorption, produce more physiologic insulin concentrations, and be more convenient to administer. However, there are no well‐controlled trials that have demonstrated a clinically significant difference in glycemic control between IP and subcutaneous administration. For patients who choose to begin IP insulin at the time CAPD is initiated, the starting dose is 2–3 times the previous subcutaneous dose. For patients previously stabilized on CAPD, the conversion factor may be less. Doses are divided equally between bags. Some authors recommend adding more insulin to bags with a higher concentration of dextrose. In addition, the dose should be decreased when added to a bag used for an overnight dwell. Exchanges performed during the day may be timed to start 30 minutes before a meal. Unless clinical trials demonstrate a difference in efficacy between subcutaneous and peritoneal insulin administration, the route will remain a matter of patient preference.
The Disposition and Cerebrospinal Fluid Penetration of Morphine and Its Two Major Glucuronidated Metabolites in Adults Undergoing Lumbar Myelogram
Authors: Laizure S. Casey , Miller Joseph H. , Stevens Robert C. , Donahue David J. , Laster Robert E. , Brown Donna
Published: October 2023

Study Objective. To determine the pharmacokinetic disposition of morphine and its two major glucuronidated metabolites, morphine‐6‐glucuronide (M6G) and morphine‐3‐glucuronide (M3G), in serum and their penetration into cerebrospinal fluid (CSF).

Design. A single‐dose, open‐label pharmacokinetic study.

Setting. The Memphis Neurosciences Center at Methodist Hospital.

Patients. Twenty patients undergoing a diagnostic lumbar myelogram.

Interventions. All patients received morphine sulfate 10 mg intramuscularly approximately 1.5 hours before the procedure.

Measurements and Main Results. Three blood samples were drawn after the dose and a CSF sample was drawn immediately after lumbar puncture. The mean ± standard deviation for the half‐life of morphine was 2.8 ± 1.4 hours. The apparent half‐lives of M6G and M3G were 5.7 ± 3.1 and 6.3 ± 2.2 hours, respectively, and were inversely related to the estimated creatinine clearance (r=‐0.61, p<0.007 and r=‐0.69, p<0.002, respectively). The mean concentrations of morphine, M6G, and M3G in the CSF (collection time 1.5 ± 0.32 hrs, n=19) were 3.1 ± 3.7, 12.5 ±17.6, and 19.6 ±16.1 nmol/L, respectively.

Conclusions. Elderly patients and patients with renal dysfunction receiving morphine may experience prolonged analgesic and adverse effects secondary to a decrease in the clearance of M6G.
Oral Torsemide in Patients With Chronic Congestive Heart Failure: Effects on Body Weight, Edema, and Electrolyte Excretion
Authors: Patterson J. Herbert , Adams Kirkwood F. , Applefeld Mark M. , Corder Clinton N. , Masse Benoit R. ,   The Torsemide Investigators Group
Published: October 2023

Study Objective. To assess the effects of torsemide on the primary end point of change in body weight from baseline, and the following secondary end points: urinary sodium, potassium, and chloride excretion, and urine volume after the first dose of drug.

Design. Randomized, parallel, double‐blind, multicenter study in patients treated with torsemide 5 mg (n=19), 10 mg (n=18), or 20 mg (n=14), or placebo (n=15) for 7 days.

Patients. Sixty‐six patients with New York Heart Association class II or III congestive heart failure and edema.

Results. At the end of the study, patients treated with torsemide 10 and 20 mg demonstrated a significant reduction in body weight compared with those receiving placebo (−1.62 and −1.30 kg, respectively), and those treated with torsemide 5 mg did not (−0.60 kg). The severity of edema decreased with increasing torsemide dose. Torsemide caused no greater frequency of adverse effects with increasing dose.

Conclusion. Orally administered torsemide 5, 10, and 20 mg once/day for 7 days were well tolerated. Doses of 10 and 20 mg were effective in producing weight loss.
Drug‐Induced Lichen Planus
Authors: Thompson Dennis F. , Skaehill Penny A.
Published: October 2023

Lichen planus is a relatively common skin disorder of unknown etiology. A wide variety of drugs have been implicated in its cause. Using five or more cases of drug‐induced lichen planus reported in at least three separate reports with at least one case of probable cause by the scale of Naranjo et al as criteria, sufficient evidence exists that β‐blockers, methyldopa, penicillamine, quinidine, and quinine play a role in this disorder. Evidence is insufficient for angiotensin‐converting enzyme inhibitors, sulfonylurea agents, carbamazepine, gold, lithium, and a host of miscellaneous drugs. Given available epidemiologic evidence, nonsteroidal antiinflammatory agents probably should also be considered causative. Differentiating drug‐induced lichen planus from the idiopathic disorder is difficult; most evidence is based on the dechallenge and rechallenge with the drug when these data are available.
Retrospective Analysis of Postoperative Nausea and Vomiting to Determine Antiemetic Activity of Droperidol Added to Propofol: A Possible Drug Interaction
Authors: Wagner Bertil K.J. , Berman Stefanie L. , Devitt Patricia A. , O'Hara Dorene A.
Published: October 2023

Propofol decreases the frequency of postoperative nausea and vomiting. We investigated whether its antiemetic activity could be improved further by coadministration of droperidol. We retrospectively reviewed the records of 266 women who underwent laparoscopic operations with nitrous oxide anesthesia and thiopental or propofol induction. The records were screened for frequency and time of occurrence of nausea and vomiting, concurrent drug use, duration of surgery, and times of recovery room admission and discharge. The combination of droperidol and thiopental decreased the frequency of nausea and vomiting over droperidol plus propofol, propofol alone, and thiopental alone. The addition of droperidol to propofol anesthesia doubled the frequency of multiple nausea and vomiting episodes, suggesting a possible interaction between the drugs. We cannot recommend that droperidol be added to propofol anesthesia for prophylaxis of postoperative nausea and vomiting.
Intranasal Butorphanol‐Induced Apraxia Reversed by Naloxone
Authors: Gora‐Harper Mary Lea , Sunahara Janice E , Gray Mary S.
Published: October 2023

Intranasal butorphanol is an opioid agonist‐antagonist that is effective for the treatment of acute pain. Common adverse effects associated with the agent are somnolence, dizziness, nausea, and vomiting; they are readily reversed with naloxone. A patient developed signs and symptoms consistent with apraxia after a single dose of intranasal butorphanol. She was mentally alert, but she was unable to move or speak despite normal muscle tone and reflex movements. When she attempted to speak she had no voluntary control. At the emergency room she was administered naloxone 2 mg intramuscularly which resulted in complete reversal of the symptoms in a short time. No other published cases describe these findings with butorphanol. Health care professionals should be aware that patients who are prescribed intranasal butorphanol, even in typical doses, may be at risk for such a reaction. This is important because, unlike the injectable formulation, the intranasal product is primarily used in the outpatient setting.
How To Counsel Patients About Depression and Its Treatment
Authors: Stimmel Glen L.
Published: October 2023

To provide effective counseling for patients receiving drug therapy for depression, one must understand the natural course of mood disorders, the appropriate dose and duration of antidepressant therapy, and how to individualize the discussion of potential adverse effects and use of alcohol. Patients must understand that effective antidepressant treatment requires several weeks before onset of clinical effect, and 6–12 months of therapy is necessary to prevent relapse. Discussion of adverse effects must address what the patient should do if an adverse effect occurs, with the focus on common, expectable effects of the particular drug. Rather than merely telling patients not to drink alcohol, appropriate counseling should focus on the possible consequences of drinking while taking antidepressant drugs.
Considerations for Therapy of Mixed Infections: Focus on Intraabdominal Infection
Authors: DiPiro Joseph T.
Published: October 2023

Intraabdominal infections are a wide range of diseases that include penetrating abdominal trauma, appendicitis, peritonitis, and abscess. Most are polymicrobic, involving aerobic and anaerobic bacteria. The primary treatment is surgery, but important issues regarding administration of antimicrobials may affect patient outcome. Evaluation of an antimicrobial regimen must include consideration of outcomes—survival, organ failure, adverse drug effects, and superinfection. Single‐agent regimens have demonstrated benefit in patients with acute intraabdominal contamination and established infections. Guidelines for selecting antimicrobial agents are available from the Surgical Infection Society. Regimens are effective when active against most bacteria isolated from the focus of abdominal infection. The patient's clinical response, not culture results independent of clinical findings, is the primary guide for directing changes in therapy.
Computer‐Assisted Semen Analysis (CASA) of Epididymal Sperm from the Domestic Cat
Authors: STACHECKI JAMES J. , GINSBURG KENNETH A. , LEACH RICHARD E. , ARMANT D. RANDALL
Published: October 2023

ABSTRACT: Motion characteristics of epididymal sperm from domestic cats exhibiting a high (>60%; normozoospermic; n = 21) or low (<40%; teratozoospermic; n = 6) occurrence of structurally normal spermatozoa were correlated with morphology (MOR) using computer‐assisted semen analysis (CASA). Mean values and standard errors for percent motility (MOT), curvilinear velocity (VCL), linearity (LIN), straight line velocity (VSL), and amplitude of lateral head displacement (ALH) were recorded for 3 hours. Average values for percent normal spermatozoa, MOT, VCL, VSL, and ALH were higher (P < 0.01) in samples from normozoospermic cats than from teratozoospermic cats at 0 hours, and there was no difference in motion parameters over the 3‐hour incubation period in either group. Strong correlations (P < 0.01) existed between MOR and VCL, VSL, ALH, or MOT, but not LIN, upon regression analysis. We conclude that (1) motion parameters of domestic cat sperm are significantly correlated with morphology and (2) abnormal motion parameters associated with low fertility potential in other species are prevalent in samples from teratozoospermic cats. The correlation between morphology and altered sperm movement found in this study suggests that motion analysis of spermatozoa by CASA may be useful in evaluating fertilization potential in felids.
Performance and Comparison of CASA Systems Equipped with Different Phase‐Contrast Optics
Authors: YEUNG CHING‐HEI , NIESCHLAG EBERHARD
Published: October 2023

ABSTRACT: Most computer‐aided sperm analysis (CASA) systems for human spermatozoa use positive phase‐contrast optics. In this study the performance of one of these (HTM) and two other systems using negative phase optics (IVOS and SM) were assessed by scrutinizing the video‐playback of the analyzed images for errors in the recognition of motile and immotile spermatozoa and in the tracking of motile cells. Whereas both the HTM and IVOS provided accurate measurements of motile sperm concentrations, errors in total sperm concentrations and motility percentages were greater in the IVOS than the HTM. However, IVOS appeared to be more accurate in tracking motile spermatozoa. Individual sperm track data suggested that velocity measurements may be biased by the elimination of incomplete tracks from the analysis. With the SM system, discrimination of immotile spermatozoa from non‐sperm particles in semen was poor despite an additional algorithm for tail detection. The use of negative phase optics in CASA may be superior to that of positive phase in the analysis of motile spermatozoa but inferior in the recognition of immotile spermatozoa.
Immunoreactive Ubiquitin in Human Seminal Plasma
Authors: LIPPERT THEODOR H. , SEEGER HARALD , SCHIEFERSTEIN GEORG , VOELTER WOLFGANG
Published: October 2023

ABSTRACT: The polypeptide ubiquitin, up to now almost exclusively discovered in intracellular spaces, was measured immunologically in a total of 187 samples of human seminal plasma. The values were between 1.83 and 19.11 μg/ml. In spermatozoa ubiquitin was detected too; the values, however, were significantly lower than in the seminal plasma. The origin and function of ubiquitin in human seminal plasma is still unclear. The possible role of ubiquitin in reproduction is discussed.
Column Separation of Motile Sperm from Stallion Semen
Authors: CASEY PATRICK J. , ROBERTSON KATHRYN R. , LIU IRWIN K. M. , ESPINOZA SERGIO BOTTA , DROBNIS ERMA Z.
Published: October 2023

ABSTRACT: Subfertility in stallions is common, and methodologies are needed to increase the fertility in these animals. In other species, removal of the dead sperm from semen increases the quality and fertility of semen. With horse semen we evaluated 48 combinations of column separation techniques using micro‐spin chromatography columns. The greatest improvement in motility was observed with glass wool, whereas glass beads exhibited the greatest recovery of motile sperm. Although centrifugation time did not influence recovery rate or percent motility, a column length of 2 cm was superior for recovery of motile sperm. In scale‐up experiments using 2‐cm columns of glass beads in 50‐ml syringe barrels, centrifugation proved to be superior to gravity flow, suction, and syringe plunger as extraction methods for drawing semen through the column; however, gravity flow produced acceptable results and may be more suitable for use in a field setting. When the volume of semen for separation was increased from 10 ml to 20 ml, the recovery rate of motile sperm was also increased. Further increasing the volume of semen for separation did not improve the recovery rate, and for volumes greater than 50 ml the column had a tendency to “clog.” Thus, a suitable method for column separation of equine sperm utilizes a 2‐cm column of glass beads in a 50‐ml syringe casing. Centrifugation is the ideal extraction method; however, gravity flow is an acceptable extraction method suited to the field setting, using a maximum semen volume of 50 ml.
The Postcoital Test: A Quantitative Method
Authors: DOODY MICHAEL C. , GOOD MICHAEL C.
Published: October 2023

ABSTRACT: A minor modification of the postcoital test (PCT) is made, which allows for a volumetric inspection of the cervical mucus with a standard clinical microscope. Homogeneously sized (40.3‐μm) plastic microspheres are sprayed on to the cervical mucus prior to placement of the coverslip, and these act as spacers to keep the slide‐to‐coverslip distance constant. As a result a known volume of cervical mucus is inspected with each microscope field of view and actual sperm concentrations can be calculated. Results from 20 patients are presented. Postcoital mucus samples were analyzed with and without spacer particles. Much of the variability in the microscopic portion (sperm concentration and motility) of the PCT test seems to be attributable to a factor controlled by the microparticles, presumably slide‐to‐coverslip distance. Variability in both sperm density and motility is decreased by the application of the microspheres.
Evaluation of Corpora Alterations and Erectile Dysfunction Following Radical Surgery for Peyronie's Disease and Long‐term Follow‐up on 152 Operated Patients
Authors: AUSTONI EDOARDO , COLOMBO FULVIO , MANTOVANI FRANCO
Published: October 2023

ABSTRACT: The radical surgical option we propose for Peyronie's disease consists in removing the sclerohyalinotic focus of disease and replacing it by an autologous dermal graft taken from the upper outer thigh area. Between 1981 and 1991, we operated on 335 patients with Peyronie's disease, 152 of whom underwent plaque excision and dermal graft. All could be assessed with a 2‐year follow‐up. Two main complications were observed: mild penile flexure due to scar retraction of the graft (35% of cases), and partial erectile deficit with decreased corporal rigidity (17% of cases). The degree of graft retraction is linked to the individual's histologic response. A mild deviation of the penis can occur some months after surgery and is not a relapse flexure due to disease progression, but is mere scar retraction and will spontaneously regress. Because the patient will date the onset of a postoperative erectile deficit from the time of the operation, it is advisable to assess preoperatively the erectile ability of all patients. Furthermore, an impaired erectile response could result from hypoaesthesia of the glans, postsurgical stress, and fibrosis of the erectile tissue. A retrospective assessment of radical surgery cases involving plaque excision and dermal graft led us to propose this option where precise indications apply, providing that other alterations of the erectile function are preoperatively assessed.
Our Experience With Penile Deformations: Incidence, Operative Techniques, and Results
Authors: YACHIA DANIEL
Published: October 2023

ABSTRACT: Between the initiation of the “Penile Deformity Clinic” in 1988 in our Department of Urology, and the end of 1992, 1,862 males aged 0 (less than 24 hours old) to 78 years old were examined. Five hundred of them were newborns, aged 0 to 5 days; they were examined to determine the incidence of congenital penile curvature. Two hundred and seventeen congenital curvatures were seen, and 102 of them were corrected surgically using four different corporoplasty techniques. From the 116 Peyronie's Disease patients, 37 were treated surgically, either by corporoplasty or prosthesis implantation. From the 29 iatrogenic penile deformities, all the result of previous hypospadias repairs or urethroplasties for stricture repairs, 18 needed surgical intervention, mostly for cosmetic reasons. Three congenital curvatures, corrected by plication, and one by Nesbit corporoplasty, recurred. Three other cases corrected by Nesbit corporoplasty reported temporary loss of glans sensation, and in a fourth one the sensory loss was permanent. It is our opinion that concentrating the care of these deformities in the hands of a small group of surgeons specialized in penile reconstructive surgery yields the best functional and esthetic results.
Androgen Regulation of Molecular Forms of β‐D‐Glucuronidase in the Mouse Epididymis: Comparison With Liver and Kidney
Authors: ABOU‐HAILA A. , TULSIANI D. R. P. , SKUDLAREK M. D. , ORGEBIN‐CRIST M.‐C.
Published: October 2023

ABSTRACT: The expression and androgen regulation of β‐glucuronidase molecular forms were examined in mouse epididymis, liver, and kidney. Two‐dimensional polyacrylamide gel electrophoresis performed under nondenaturing conditions showed that, compared to liver and kidney, which contain four microsomal (M1‐M4) and a major lysosomal (L) form of β‐glucuronidase, the epididymis revealed regional differences and tissue specificity in the expression of the various molecular forms of the enzyme. Only the lysosomal form (pl 5.4–6.1) is present in the caput epididymidis while the corpus/cauda contains the lysosomal form, the free X form (pl 5.9‐6.3) and the four microsomal forms (X form complexed with egasyn). Mutant mice that lack egasyn have no microsomal forms in the distal epididymis. In epididymal fluid, the lysosomal form is found throughout the epididymis, whereas the X form appears only in the corpus/cauda epididymidis. Sodium dodecyl Sulfate (SDS)‐gel electrophoresis and western blot analysis of immunoprecipitated β‐glucuronidase revealed only one band corresponding to the L form (apparent molecular weight 74 kDa) in the caput epididymidis and two bands in the corpus/cauda (apparent molecular weights 73 and 75 kDa), corresponding to L and X forms, respectively. Castration of mice led to the suppression of the regional differences in the appearance of X and M forms in the epididymis. Testosterone supplementation to castrated mice restored the characteristic electrophoretic pattern of β‐glucuronidase in the caput epididymidis. In the liver and kidney, castration has no effect on the expression of the molecular forms, whereas androgen treatment induced the X form in the kidney. Histochemical localization of β‐glucuronidase confirmed the region specificity seen in the epididymis and in addition revealed cell specificity in the expression of β‐glucuronidase. These results indicate that β‐glucuronidase shows tissue specificity and, in the case of the epididymis, region and cell specificity. In addition, the enzyme in the different tissues responds differentially to androgens.
Role of CD44 expressed in renal tubules during maladaptive repair in renal fibrogenesis in an allopurinol‐induced rat model of chronic kidney disease
Authors: Matsushita Kohei , Toyoda Takeshi , Akane Hirotoshi , Morikawa Tomomi , Ogawa Kumiko
Published: October 2023

The kidney is a major target organ for the adverse effects of pharmaceuticals; renal tubular epithelial cells (TECs) are particularly vulnerable to drug‐induced toxicity. TECs have regenerative capacity; however, maladaptive repair of TECs after injury leads to renal fibrosis, resulting in chronic kidney disease (CKD). We previously reported the specific expression of CD44 in failed‐repair TECs of rat CKD model induced by ischemia reperfusion injury. Here, we investigated the pathophysiological role of CD44 in renal fibrogenesis in allopurinol‐treated rat CKD model. Dilated or atrophic TECs expressing CD44 in fibrotic areas were collected by laser microdissection and subjected to microarray analysis. Gene ontology showed that extracellular matrix (ECM)‐related genes were upregulated and differentiation‐related genes were downregulated in dilated/atrophic TECs. Ingenuity Pathway Analysis identified CD44 as an upstream regulator of fibrosis‐related genes, including Fn1, which encodes fibronectin. Immunohistochemistry demonstrated that dilated/atrophic TECs expressing CD44 showed decreases in differentiation markers of TECs and clear expression of mesenchymal markers during basement membrane attachment. In situ hybridization revealed an increase in Fn1 mRNA in the cytoplasm of dilated/atrophic TECs, whereas fibronectin was localized in the stroma around these TECs, supporting the production/secretion of ECM by dilated/atrophic TECs. Overall, these data indicated that dilated/atrophic TECs underwent a partial epithelial–mesenchymal transition (pEMT) and that CD44 promoted renal fibrogenesis via induction of ECM production in failed‐repair TECs exhibiting pEMT. CD44 was detected in the urine and serum of APL‐treated rats, which may reflect the expression of CD44 in the kidney.
Porous scaffold hydroxyapatite from sand lobster shells (Panulirus homarus) using polyethylene oxide/chitosan as polymeric porogen for bone tissue engineering
Authors: Kadek Hariscandra Dinatha I. , Jamilludin Muhammad A. , Supii Apri I. , Wihadmadyatami Hevi , Partini Juliasih , Yusuf Yusril
Published: October 2023

The hydroxyapatite (HAp; Ca10(PO4)6(OH)2)) has good biocompatibility, bioactivity, and osteoconductivity as a bone implant because the main inorganic mineral of human bone is HAp. The use of scaffold HAp from biogenic resources that contain high calcium and polymer as a pore forming agent to support bone growth is a longstanding area of interest. In this study, porous scaffolds based on HAp were synthesized from sand lobster (SL; Panulirus homarus) shells as a source of calcium using the porogen leaching method with polyethylene oxide (PEO) and chitosan (Chs) as polymeric porogen. The present study aims to synthesize HAp derived from SL shells and evaluate the effect variations of PEO on the physicochemical properties of the scaffold and cytotoxicity in cell viability assay. Briefly, the SL shell powder was calcinated with temperature variations of 600°C, 800°C, and 1000°C for 6 h. Based on the characterization, it was shown that 1000°C was the optimum calcination temperature for SL shells to synthesize HAp using the precipitation method. The characterization results of HAp using energy dispersive x‐ray (EDX) revealed that the molar ratio of Ca/P was 1.67. The Fourier transform infrared (FTIR) and x‐ray diffractometer (XRD) spectral patterns indicated that HAp had been successfully synthesized with minor β‐tricalcium phosphate (β‐TCP), a calcium phosphate with high biocompatibility. Porous scaffolds were synthesized by varying the concentration of PEO at 0, 5, 10, and 15 wt %. Physicochemical analysis revealed that a higher concentration of PEO affected decreased crystallinity and compressive strength, but on the other hand, the porosity and pore sizes increased. Based on the physicochemical analysis, the synthesized porous scaffold showed that HAp/PEO/Chs 15 wt % had the most potential as a scaffold for biomedical applications. MTT Assay, after 24 h incubation, revealed that the scaffold was safe for use at low concentrations on the MC3T3E1 osteoblast cells, with a percentage of cell viability of 83.23 ± 3.18% at 23.4375 μg/mL. Although the cell viability decreased at higher concentrations, the HAp/PEO/Chs 15 wt % scaffold was cytocompatible with the cells. Thus, in the present study, HAp/PEO/Chs 15 wt % was the best scaffold based on pore structure, chemical composition, mechanical and crystalographic properties and cell viability.
Sense of community affects community satisfaction: Mediating role of community participation
Authors: Gamo Bereket Roba , Park Duk‐Byeong
Published: October 2023

Community satisfaction is a central component of community development because it indicates the overall contentment of residents with their community. As such, it can indicate the directions for community development. This study is aimed at examining a sense of community and community participation as factors influencing community satisfaction in the Yirgachefe district of Ethiopia. We collected data from 360 randomly selected household heads (male = 80.2%, female = 19.2%) residing in 12 rural communities. We used structural equation modeling to analyze the data. Results revealed that residents with a higher sense of community were more likely to have participated in their community and to be satisfied with their community. However, sense of community only indirectly influenced community satisfaction and had an insignificant direct effect on community satisfaction. There is a fully mediating effect of community participation between sense of community and community satisfaction. We propose policy implications based on the study.
Assessment of fetal myocardial performance index in pregnant women with SARS‐CoV‐2 infection: A prospective cohort study
Authors: Kahramanoğlu Özge , Akalin Munip , Bilir Esra , Ocal Aydin , Dizdaroğulları Gizem Elif , Eyisoy Gokhan , Demirci Oya
Published: October 2023

Objectives

Our aim was to investigate the effects of the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection on fetal myocardial performance in women who had it during their pregnancy.

Materials and Methods

In our prospective cohort study including healthy pregnant women and pregnant with SARS‐CoV‐2 infection, we collected patients' data between June 2021 and April 2022. Maternal characteristics, gestational age at SARS‐CoV‐2 infection and ultrasound examination, and body mass index were noted. Fetal biometry, fetal anatomy scanning, placenta, amniotic fluid index (AFI), and Doppler parameters were routinely examined in all patients. Left ventricular myocardial performance index (MPI) was measured during fetal echocardiography examination. Doppler parameters, AFI, and MPI values were compared between two groups.

Results

Compared with the control group (n = 80), MPI values were found within normal limits in fetuses of pregnant women with SARS‐CoV‐2 infection (n = 80) (MPI: 0.38 ± 0.06 in the control groups vs. 0.39 ± 0.05 in the SARS‐COV‐2 positive group, p = 0.79). There was no relationship between SARS‐CoV‐2 infection and changes in AFI and umbilical artery pulsatility index (PI) values. Uterine artery PI values were significantly higher in pregnant women with (SARS‐CoV‐2) infection (0.81 in the control group vs. 0.97 in the SARS‐CoV‐2 group, p < 0.05).

Conclusions

Fetal cardiac functions were not affected in pregnant women with previous (SARS‐CoV‐2) infection. Further metaanalyses are warranted to confirm the results.
Clinical study of left ventricular structure and function in patients with Anderson–Fabry disease before and after enzyme replacement therapy
Authors: Huang Shuyue , Wang Jian , Zhang Wei , Gao Feng , Chen Yaodong , Shui Wen , Xing Xueqing , Chen Shuqiong , Mu Yixuan
Published: October 2023

Aims

Cardiac left ventricular hypertrophy (LVH) is the most common manifestation of heart involvement in Anderson–Fabry disease (AFD). Conventional cardiac imaging is not sensitive enough to detect early signs of LVH in AFD. It remains uncertain whether enzyme replacement therapy (ERT) can prevent LVH progression and improve myocardial function. This study aimed to assess the effectiveness of two‐dimensional speckle tracking echocardiography (2D‐STE) in early detection of cardiac involvement in AFD and monitoring the efficacy of agalsidase alfa and agalsidase beta therapy.

Methods and Results

Thirteen consecutive AFD patients and 12 healthy controls underwent standard transthoracic 2D, color Doppler, tissue Doppler echocardiography, and 2D strain analysis. Global longitudinal strain (GLS) and global circumferential strain (GCS) were measured. Diastolic strain rate (SR) was extracted. Compared to healthy subjects, AFD patients without LVH showed lower levels of GLS (p < 0.001) and SR (p = 0.01), while there was no difference in GCS (p = 0.82). Following treatment, apical circumferential strain (ACS) showed improvement (p = 0.01).

Conclusion

In AFD patients without LVH, there was a decrease in global and segmental LS. Higher plasma Lyso‐GL‐3 concentrations were associated with elevated ACS values after ERT, indicating that ACS in AFD patients without LVH, albeit normal, is involved in early LV dysfunction.
Late‐onset cytomegalovirus cholangiopathy in a renal transplant patient: Case report and review of the literature
Authors: Loh Nicole Min Hui , Doshi Bhavesh , Pang Ning Qi
Published: October 2023

This case report highlights the investigation and treatment of a 70‐year‐old male with cytomegalovirus (CMV) cholangiopathy. The patient underwent a kidney transplant in 2016 and presented 3 years later with the atypical presentation of left shoulder pain associated with dilated biliary tree and mild transaminitis. Initial endoscopic retrograde cholangiopancreatography (ERCP) showed diffuse stricture of the common bile duct, requiring stenting, and over the course of a year multiple stent changes were required to prevent cholestasis. CMV polymerase chain reaction (PCR) tests were conducted on bile duct brushings and found to be positive. Oral valganciclovir was given for 6 weeks but the strictures did not resolve. He underwent a laparoscopic total choledochectomy and hepaticojejunostomy as definitive treatment. CMV involvement of the biliary tract has rarely been reported in kidney transplant patients. Antiviral therapy in the form of ganciclovir or valganciclovir is often sufficient to eradicate CMV infection and improve clinical disease. Surgical management should be considered only if the patient has failed medical therapy, or if there is suspicion of malignancy. This case shows that in renal transplant patients presenting with cholangiopathy, CMV disease should be considered as a possible differential even in patients without early CMV infection or with prior CMV prophylaxis.