Vaginal misoprostol before copper IUD insertion after previous insertion failure: a double-blind,placebo-controlled,parallel-group,randomised clinical trial

Objective: The aim of the study was to assess whether vaginal administration of misoprostol before copper intrauterine device (IUD) insertion increased the success of the procedure among parous women with previous insertion failure.

Methods: A single-centre, parallel-group, double-blind, placebo-controlled, randomised clinical trial was conducted at Ain Shams University Maternity Hospital, Cairo, Egypt, between October 2015 and August 2016. The study comprised 90 parous women undergoing TCu380A IUD insertion after a failed attempt. A computer-generated list of random numbers was used to assign participants to receive either misoprostol 200?μg or a placebo tablet, applied vaginally 10?h and 4?h prior to the second attempted IUD insertion, without ultrasound guidance. The primary outcome was the success of IUD insertion. Secondary outcomes were to establish the effect on insertion success of cervical dilation, cervical softening and previous mode of delivery.

Results: Forty-two women (93.3%) in the misoprostol group and 24 women (53.3%) in the placebo group had a successful IUD insertion (p?<?.001). Cervical dilation was required in 24 women in the misoprostol group and 44 women in the placebo group. Misoprostol application significantly increased insertion success in women with previous caesarean delivery (p?<?.001) but did not affect insertion success in women with previous vaginal delivery (p?=?.481).

Conclusion: Vaginal misoprostol before IUD insertion in parous women with previous insertion failure increased the rate of successful insertion, particularly in women with previous caesarean delivery.     

急性肝损伤大鼠肝组织中铁钙锌铜锰含量的变化

应用Ｄ－半乳糖胺加内毒素脂多糖制成大鼠急性肝损伤模型，并分别于给药后６、１２、２４、４８小时采集肝组织标本，用原子吸收分光光度计（火焰法）定量分析铁钙铜锌锰５种元素含量。结果肝组织中铁、钙随肝损伤的加重逐渐增高，锌则降低；伴随着肝组织中丙二醛含量增高，超氧化物岐化酶活性降低，而铜、锰变化不明显。结果提示：急性肝损伤时，肝组织中有铁超载、钙超载及锌含量的降低。     

Heart involvement in hepatolenticular degeneration

The case of a 10-year-old boy with a mild abdominal form of hepatolenticular degeneration, showing clinical, laboratory and histological manifestations of heart involvement is reported. The microscopical examination of myocardial fragments collected by intracavitary puncture biopsy, using hematoxylin-eosine and the histochemical method with rubeanic acid, showed a medium degree of myocardial damage and the presence of copper deposition in the tissue. Copper concentration on a myocardial biopsy fragment was almost 10 times the normal heart content. Comments are made on the relationship of the clinical, laboratory and pathological findings with the degree of copper storage on the myocardium.     

Biliary excretion of 64Cu, 65Zn and 203Hg in the rat with liver injury induced by CCl4

In rats the effect of a chronic administration of CCl₄ on the excretion and disstribution of ⁶⁴Cu, ⁶⁵Zn, and ²⁰³Hg was investigated. The biliary excretion of these metals was studied with particular attention. It was found that total excretion of ⁶⁴Cu, ⁶⁵Zn, or ²⁰³Hg from the organism did not change significantly in comparison with the control group, but the ratio of individual excretion pathways did change. The course of excretion curves regarding the bile in exposed animals is prolonged. The histologic examination of the livers revealed a large interindividual variability in the response of the liver tissue to the same CCl₄ exposure. Differences in distribution in the kidneys and livers in exposed and control animals was also found.     

Oxidative stress, mitochondrial permeability transition, and cell death in Cu-exposed trout hepatocytes

We have previously shown that, in trout hepatocytes, exposure to a high dose of copper (Cu) leads to disruption of Ca(2+) homeostasis and elevated formation of reactive oxygen species (ROS), with the latter ultimately causing cell death. In the present study, we aimed at identifying, using a lower Cu concentration, the role of mitochondria in this scenario, the potential involvement of the mitochondrial permeability transition (MPT), and the mode of cell death induced by the metal. Incubation with 10 muM Cu resulted in a strong stimulation of ROS formation, and after 2 h of exposure a significant increase of both apoptotic and necrotic cells was seen. Co-incubation of Cu-treated hepatocytes with the iron-chelator deferoxamine significantly inhibited ROS production and completely prevented cell death. The origin of the radicals generated was at least partly mitochondrial, as visualized by confocal laser scanning microscopy. Furthermore, ROS production was diminished by inhibition of mitochondrial respiration, but since this also aggravated the elevation of intracellular Ca(2+) induced by Cu, it did not preserve cell viability. In a sub-population of cells, Cu induced a decrease of mitochondrial membrane potential and occurrence of the MPT. Cyclosporin A, which did not inhibit ROS formation, prevented the onset of the MPT and inhibited apoptotic, but not necrotic, cell death. Cu-induced apoptosis therefore appears to be dependent on induction of the MPT, but the prominent contribution of mitochondria to ROS generation also suggests an important role of mitochondria in necrotic cell death.     

Effects of removing symbiotic green algae on the response of Hydra viridissima (Pallas 1776) to metals

Hydra viridissima is distinctively green due to symbiotic algae within the endodermal cells. The current investigation was designed to see if these algae influenced the response of Hydra to pollutants, by comparing the toxicity of copper, cadmium, and zinc to both symbiotic and aposymbiotic (free of their endosymbiotic algae) H. viridissima. The results demonstrated that the toxicity of the metals was generally similar for both groups of Hydra. However, at the lowest copper concentrations there was a difference between the two group of polyps, with aposymbiotic animals dying at concentrations where symbiotic Hydra survived. The lowest observed effect concentrations were 0.0068 and 0.016 mg/L for aposymbiotic and symbiotic Hydra, respectively. It is suggested that the symbiotic Hydra derive benefits from the association that enable them to better tolerate the toxicant. This work demonstrated that experimental manipulation of symbionts can help to explain their complex interactions and the ways in which they respond to pollutants.     

The effects of cadmium, copper, lead, and zinc on the growth and reproduction of Proisotoma minuta Tullberg (Collembola)

Laboratory studies were conducted to evaluate Proisotoma minuta sensitivity toward selected heavy metals (Cd, Cu, Pb, and Zn). The experimental results showed a reduction in adult survival and no reproduction at the highest concentrations of Cd and Zn. Application of Pb at all levels resulted in large numbers of progeny and no significant mortality compared to controls. EC50 reproduction values for Cd, Cu, and Zn were 125, 696, and 283 microg g(-1), respectively. No significant difference in time from the introduction of adults into the test soils to the appearance of the first-instar animals was observed between different metal treatments. The growth rate of adults decreased for all metal treatments compared to the controls. It is suggested that the accumulation of metals in P. minuta affects metabolism and results in a slower growth rate. The absence of any statistically significant effect on mortality at all concentrations of Pb may be due to greater tolerance of P. minuta to Pb than to other metals.     

A comparison of PET imaging characteristics of various copper radioisotopes

Purpose PET radiotracers which incorporate longer-lived radionuclides enable biological processes to be studied over many hours, at centres remote from a cyclotron. This paper examines the radioisotope characteristics, imaging performance, radiation dosimetry and production modes of the four copper radioisotopes, ⁶⁰Cu, ⁶¹Cu, ⁶²Cu and ⁶⁴Cu, to assess their merits for different PET imaging applications. Methods Spatial resolution, sensitivity, scatter fraction and noise-equivalent count rate (NEC) are predicted for ⁶⁰Cu, ⁶¹Cu, ⁶²Cu and ⁶⁴Cu using a model incorporating radionuclide decay properties and scanner parameters for the GE Advance scanner. Dosimetry for ⁶⁰Cu, ⁶¹Cu and ⁶⁴Cu is performed using the MIRD model and published biodistribution data for copper(II) pyruvaldehyde bis(N⁴-methyl)thiosemicarbazone (Cu-PTSM). Results ⁶⁰Cu and ⁶²Cu are characterised by shorter half-lives and higher sensitivity and NEC, making them more suitable for studying the faster kinetics of small molecules, such as Cu-PTSM. ⁶¹Cu and ⁶⁴Cu have longer half-lives, enabling studies of the slower kinetics of cells and peptides and prolonged imaging to compensate for lower sensitivity, together with better spatial resolution, which partially compensates for loss of image contrast. ⁶¹Cu-PTSM and ⁶⁴Cu-PTSM are associated with radiation doses similar to [¹⁸F]-fluorodeoxyglucose, whilst the doses for ⁶⁰Cu-PTSM and ⁶²Cu-PTSM are lower and more comparable with H₂¹⁵O. Conclusion The physical and radiochemical characteristics of the four copper isotopes make each more suited to some imaging tasks than others. The results presented here assist in selecting the preferred radioisotope for a given imaging application, and illustrate a strategy which can be extended to the majority of novel PET tracers.     

TCu 380A IUD: a reversible permanent contraceptive method in women over 35 years of age

OBJECTIVE: The objective of the study was to evaluate the performance of the TCu 380A IUD in women who had been using the device for more than 10 years and who were 35 years of age or more on completion of the 10th year of IUD use. METHODS: A total of 228 women who had an IUD inserted between 1987 and 1992 were included in the study. The cutoff date for analysis was January 31, 2004. Clinical performance was evaluated by life-table analysis. The mean age of women at 10 years of use was 38.8+/-0.4 years and mean parity was 2.2+/-0.08 (mean+/-SD). The duration of follow-up beyond 10 years ranged from 1 to 72 months. No pregnancy was observed in 366 woman-years of observation beyond 10 years of use. The main reason for discontinuation was removal of the device because the clients had previously been informed that the IUD was not approved for use beyond 10 years. This reason accounted for a gross cumulative 6 years discontinuation rate of 42.5 per 100 women beyond 10 years. The other main reasons for discontinuation beyond 10 years of use were surgical sterilization, menopause and expulsion with gross cumulative 6-year termination rates of 19.2, 11.0 and 21.2 per 100 women, respectively. The cumulative continuation rate beyond 10 years was 67.0 at the end of the first year of follow-up and 21.2 at the end of the sixth year. CONCLUSION: We found no evidence that the TCu 380A IUD loses its effectiveness after 10 years of use. RESULTS: The concept that women who have insertion of a TCu 380A IUD at the age of 25 years or older could use this IUD as a reversible but permanent method of contraception up to the menopause continues to be supported by the accumulation of evidence, although definitive evidence remains to be obtained.