The diagnosis of male infertility--prospective time-specific study of conception rates related to seminal analysis and post-coital sperm--mucus penetration and survival in otherwise unexplained infertility

Infertile women without any inherent female infertility factorsand able to secrete normal cervical mucus were studied prospectivelyin relation to post-coital sperm—mucus penetration (PCT)and their partner's seminal analysis, excluding men with azoospermia.Time-specific cumulative conception rates calculated as forlife-table analysis were related to each measured seminal variableon routine analysis of 2–3 samples (volume, density, proportionwith progressive motility, and proportion with normal morphology);to various derivatives from combinations of these variables;to seminal findings after vital staining; and to the PCT results.The best seminal predictor of fertility was the motile normalsperm density (MNSD), the 18 month conception rates being 57.4%+ 4.6 (SE) and 30.2% + 5.9 (ratio 1.9, P < 0.001) above andbelow a derived threshold value of 4 x 10⁶/ml. The PCT led torates of 55.6% ± 4.3 and 14.9% ± 5.1 (ratio 3.73,P < 0.001) for positive and negative results, respectively.The PCT also gave rise to a significantly distinct intermediatepoor-psitive sub-group (conception rate 30.6% ± 9.0).Seminal analysis (the MNSD) did not affect the conception rateassociated with a positive PCT but helped to discriminate furtherwith a negative PCT (conception rates 22.5% ± 8.7 withan MNSD above 4 x 10⁶/ml versus 5.6% ± 4.8 below, P <0.05). The PCT was the single best predictor of fertility butseminal analysis (the MNSD) was of additional value after anegative PCT.     

Regulated activity of the IgH intron enhancer (E{micro}) in the T lymphocyte lineage

The activity of the IgH (E_µ) enhancer in the T lymphocytelineage has been investigated using both transgenic mice andtransfection studies. Thymocyte fractionation experiments indicatethat a transgene consisting of the bacterial chloramphenicolacetyl transferase (CAT) gene, linked to Eµ and the SV40early promoter (E_µ–CAT), is expressed only in thymocyteswith a mature medullary phenotype and not in immature cells.Transfection of this same construct into two thymoma cell linesrepresenting different stages of thymocyte development mimicsthe pattern of activity observed in vivo. Further transfectionexperiments suggest that this pattern of expression might beattributed to the differential activity of the E2E3 and octanucleotidemotifs of E_µ during development. In contrast, an Ig transgene(linked to E_µ and an Ig V promoter) is expressed in themajority of thymocytes. We envisage that the different patternsof expression of the two transgenes reflect interactions betweentheir respective promoters and the factors which are bound toE_µ at different stages of thymocyte development. Althoughdiffering in their pattern of expression within the thymus,the two transgenes share the property of extinction in peripheralT lymphocytes. These results indicate that the expression ofE_µ-linked transgenes in the thymus cannot simply be explainedby activation of the enhancer in a lymphoid progenitor cellprior to B/T lineage divergence. Rather, the enhancer (or componentsof it) must be independently activated (and inactivated) duringT lymphocyte development. Furthermore, this activity is consistentwith the developmental timing of Ig D_H–J_H rearrangementsin these cells.     

Further evidence for the vitality of chondrocytes in the mandibular condyle as revealed by 35S-sulfate autoradiography

Histochemical and autoradiographic studies using ³⁵S-sulfate indicate that the majority of the cartilage cells in the developing mandibular condyle of the young mouse are active, vital cells. Concomitant with the increase of hypoxic conditions within the deeper layers of the cartilage, an increase in sulfated glycosaminoglucuronoglycans synthesis takes place. Hypertrophic chon-drocytes in the premineralized and mineralized zones reveal marked ³⁵S-sulfate uptake in comparison with the less differentiated cells in the chondroblastic and perichondrial zones. These observations of radiosulfate activity support the concept that calcification processes in the condylar cartilage are not necessarily accompanied by degeneration and death of the hypertrophic chondrocytes. The radiosulfate activity of the surviving chondrocytes in the vicinity of the ossification front indicates possible modulation into osteoprogenitor cells.     

Glibenclamide treatment in a Cantú syndrome patient with a pathogenic ABCC9 gain‐of‐function variant: Initial experience

Cantú syndrome (CS), characterized by hypertrichosis, distinctive facial features, and complex cardiovascular abnormalities, is caused by pathogenic variants in ABCC9 and KCNJ8 genes. These genes encode gain‐of‐function mutations in the regulatory (SUR2) and pore‐forming (Kir6.1) subunits of K_ATP channels, respectively, suggesting that channel‐blocking sulfonylureas could be a viable therapy. Here we report a neonate with CS, carrying a heterozygous ABCC9 variant (c.3347G>A, p.Arg1116His), born prematurely at 32 weeks gestation. Initial echocardiogram revealed a large patent ductus arteriosus (PDA), and high pulmonary pressures with enlarged right ventricle. He initially received surfactant and continuous positive airway pressure ventilation and was invasively ventilated for 4 weeks, until PDA ligation. After surgery, he still had ongoing bilevel positive airway pressure (BiPAP) requirement, but was subsequently weaned to nocturnal BiPAP. He was treated for pulmonary hypertension with Sildenafil, but failed to make further clinical improvement. A therapeutic glibenclamide trial was commenced in week 11 (initial dose of 0.05 mg^–1 kg^–1 day^–1 in two divided doses). After 1 week of treatment, he began to tolerate time off BiPAP when awake, and edema improved. Glibenclamide was well tolerated, and the dose was slowly increased to 0.15 mg^?1 kg^?1day^?1 over the next 12 weeks. Mild transient hypoglycemia was observed, but there was no cardiovascular dysfunction. Confirmation of therapeutic benefit will require studies of more CS patients but, based on this limited experience, consideration should be given to glibenclamide as CS therapy, although problems associated with prematurity, and complications of hypoglycemia, might limit outcome in critically ill neonates with CS.     

The Turner syndrome research registry: Creating equipoise between investigators and participants

To address knowledge gaps about Turner syndrome (TS) associated disease mechanisms, the Turner Syndrome Society of the United States created the Turner Syndrome Research Registry (TSRR), a patient‐powered registry for girls and women with TS. More than 600 participants, parents or guardians completed a 33‐item foundational survey that included questions about demographics, medical conditions, psychological conditions, sexuality, hormonal therapy, patient and provider knowledge about TS, and patient satisfaction. The TSRR platform is engineered to allow individuals living with rare conditions and investigators to work side‐by‐side. The purpose of this article is to introduce the concept, architecture, and currently available content of the TSRR, in anticipation of inviting proposals to utilize registry resources.     

Structural diversity among anti-p-azophenylarsonate monoclonal antibodies from A/J mice: Comparison of Id and Id sequences

Amino acid sequence analyses were carried out on monoclonal anti-p-azophenylarsonate antibodies isolated from the ascites of mice carrying cell lines obtained from the fusion of A/J splenic lymphocytes with the myeloma cell line Sp2/0–Ag14. The partial primary structures of both heavy and light chains from seven idiotype negative hybridoma proteins are compared to those of six idiotype positive molecules. Amino-terminal amino acid sequences (40–47 residues) of heavy chains from molecules bearing the major cross-reacting idiotype, Id^CR, demonstrated 95% homology to each other. Similarly, aminoterminal sequences of Id^CR+light chains were homologous to each other. However, sequence variations were evident in individual antibodies in both framework and complementarity-determining regions, suggesting that a large family of molecules accounts for the major cross-reacting idiotype, as previously reported (Marshak-Rothstein et al., 1980b).

Heavy and light chains from seven Id^CR-negative monoclonal antibodies were subjected to amino-terminal (37–48 residues) amino acid sequence analysis. Four heavy chains were blocked to Edman degradation, but could be sequenced after enzymatic removal of the amino-terminal pyrrolidone carboxylic acid residue. In comparison with Id^CR-positive heavy chains, the Id^CR-negative heavy chains demonstrate greater diversity in both framework and complementarity-determining regions, with several different subgroups represented in contrast to the results from pooled serum Id^CR-positive antibodies (Capra et al., 1975). One of the seven Id^CR-negative light chains was blocked. The sequences of the remaining Id^CR-negative light chains exhibited marked variations in both framework and complementarity-determining regions, with different chain lengths in the first complementarity-determining region in several light chains.

Comparisons between the amino-terminal sequences of Id^CR-positive and Id^CR-negative monoclonal antibodies suggest that specific sequences in the first complementarity-determining regions of both heavy and light chains are not sufficient to account for the major cross-reacting idiotype. The structural basis for Id^CR in A/J mice is likely to be in other segments of the variable regions.     

Effect of exercise,hypoxia, and epinephrine on lysosomes and plasma enzymes

In order to study the possible relation of hepatic lysosomal stability and enzyme release from the liver during stress, rats were sacrificed after swimming exercise, hypoxia, and epinephrine injections. Each of the stresses caused a decrease in hepatic lysosomal stability, an increase in plasma ornithine carbamoyltransferase (OCT), a liver specific enzyme, and increases in plasma creatine phosphokinase (CPK) and aspartate aminotransferase (AAT). With exercise, the decrease in lysosomal stability and the increase in OCT were first seen at one hour. The OCT increase preceded the lysosomal changes after hypoxia and followed the lysosomal changes after epinephrine injection. Prednisolone reduced the lysosomal and CPK (but not the OCT and AAT) changes with exercise, but had no effect with hypoxia or epinephrine injections. Adrenalectomy delayed the lysosomal changes and eliminated the increase in OCT after hypoxia and epinephrine. The varying time sequence of hepatic lysosomal changes and enzyme release with these stresses suggests that these two phenomena are not causally related.     

The intercellular adhesion molecule (ICAM) family of proteins

Macromolecular adhesive associations between cells are important for transmitting spatial and temporal information that is critical for immune system function. One such group of proteins, the intercellular adhesion molecules (ICAMs), has grown as newly identified members are revealed. In addition, the functions of the ICAMs, in general, have begun to be better understood, including intracellular signaling events. This information has led to the design of novel therapeutic agents that may prove effective in a variety of disease states.     

Prolonged Replication of a Type 1 Vaccine-Derived Poliovirus in an Immunodeficient Patient

VP1 sequences were determined for poliovirus type 1 isolates obtained over a 189-day period from a poliomyelitis patient with common variable immunodeficiency syndrome (a defect in antibody formation). The isolate from the first sample, taken 11 days after onset of paralysis, contained two poliovirus populations, differing from the Sabin 1 vaccine strain by ~10%, differing from diverse type 1 wild polioviruses by 19 to 24%, and differing from each other by 5.5% of nucleotides. Specimens taken after day 11 appeared to contain only one major poliovirus population. Evolution of VP1 sequences at synonymous third-codon positions occurred at an overall rate of ~3.4% per year over the 189-day period. Assuming this rate to be constant throughout the period of infection, the infection was calculated to have started ~9.3 years earlier. This estimate is about the time (6.9 years earlier) the patient received his last oral poliovirus vaccine dose, approximately 2 years before the diagnosis of immunodeficiency. These findings may have important implications for the strategy to eliminate poliovirus immunization after global polio eradication.     

Mechanical measures during maximal velocity knee extension exercise and their relation to fibre composition of the human vastus lateralis muscle

Summary A method for measuring the maximal velocity of knee extension exercise is described using a very light lever arm. Instrumentation of the lever arm with a potentiometer and accelerometer also allows for the measurement of peak acceleration, time to peak acceleration, the average rate of development of acceleration (jerk) and peak torque. With this apparatus and surface electromyography, electromechanical delay (EMD) was also determined. This apparatus was tested using 17 female and 10 male subjects, and the measures obtained were related to the percentage of fast twitch fibres (% FT) and the relative area of fast twitch fibres (% FTA) in the vastus lateralis determined from duplicate muscle biopsy samples. Peak velocity of unloaded knee extension averaged 12.1±1.2 and 12.2±1.7 rad · s^–1 for females and males, respectively, and were not significantly different. As well, peak acceleration, time to peak acceleration jerk and EMD values were not significantly different between the female and male subjects, but the mean peak torque for the female subjects (73.5±14.7 N · m) was significantly lower than that for the males (98.4±31.5 N · m). Peak acceleration was significantly correlated with %FT (r=0.40,P=0.04) for the total subject population. None of the other measures was significantly related to either %FT or %FTA for the male and female subjects or the combined population of subjects.