Retrieving oocytes from small non-stimulated follicles in polycystic ovary syndrome (PCOS): in vitro maturation (IVM) is not indicated in the new GnRH antagonist era

It has been two decades since pregnancies have been obtained through in?vitro maturation (IVM) of germinal vesicle-stage oocytes retrieved from non-stimulated ovaries. This technique first offered in PCOS cannot be recommended today in this indication because the results do not match those of regular ART, and new GnRH antagonist and agonist-trigger protocols reliably prevent OHSS.     

Sorting nexin-14, a gene expressed in motoneurons trapped by an in vitro preselection method.

A gene-trap strategy was set up in embryonic stem (ES) cells with the aim of trapping genes expressed in restricted neuronal lineages. The vector used trap genes irrespective of their activity in undifferentiated totipotent ES cells. Clones were subjected individually to differentiation in a system in which ES cells differentiated into neurons. Two ES clones in which the trapped gene was expressed in ES-derived neurons were studied in detail. The corresponding cDNAs were cloned, sequenced, and analysed by in situ hybridisation on wild-type embryo sections. Both genes are expressed in the nervous system. One gene, YR-23, encodes a large intracellular protein of unknown function. The second clone, YR-14, represents a sorting nexin (SNX14) gene whose expression in vivo coincides with that of LIM-homeodomain Islet-1 in several tissues. Sorting nexins are proteins associated with the endoplasmic reticulum (ER) and may play a role in receptor trafficking. Gene trapping followed by screening based on in vitro preselection of differentiated ES recombinant clones, therefore, has the potential to identify integration events in subsets of genes before generation of mouse mutants.     

Isolated Acute Traumatic Subtalar Dislocations: Review of 13 Cases at a Mean Follow-Up of 6 Years and Literature Review

Isolated acute traumatic subtalar dislocations are quite rare. They correspond to talotarsal dislocation, including the talonavicular and talocalcaneal joints. The purpose of the present study was to evaluate the functional and radiologic outcomes of the treatment of acute traumatic isolated subtalar dislocations. The present retrospective study included 13 patients who had sustained isolated subtalar dislocations during a 10-year period. Of the 13 cases, 10 (76.9%) were medial dislocations and 3 (23.1%) were lateral dislocations. All the patients underwent immediate closed reduction under anesthesia followed by immobilization. No open reduction was required. The mean follow-up period was 72.6 (range 24.4 to 124.8) months. The mean American Orthopaedic Foot and Ankle Society ankle-hindfoot score was 80.1 of 100 (range 66 to 90). The score result was good in 69% of cases and poor in 31% of cases. The subtalar mobility was reduced for 8 (61.5%) patients and significantly affected the American Orthopaedic Foot and Ankle Society score (p = .002). Subtalar osteoarthritis was present in 6 (46.1%) cases with talonavicular osteoarthritis in 3 (23.1%) cases. No cases of avascular necrosis of the talus were noted. In accordance with the published data, the prognosis of isolated acute traumatic subtalar dislocations is favorable. Medial dislocations are more frequent than lateral dislocations. Emergent closed reduction makes it possible to remove soft tissue injuries. The risk of post-traumatic subtalar osteoarthritis is significant, even without an initial subtalar lesion. A postreduction computed tomography scan will enable the diagnosis of osteochondral lesions.     

Enhanced expression of P-selectin (CD62P) by endothelial cells seeded onto synthetic arterial prostheses (PET, Dacron) is correlated with leukocyte interactions.

This study evaluated the expression by seeded endothelial cells (S-EC) of P-selectin (CD62P/GMP-140/PADGEM), an adhesion molecule implicated in endothelial-leukocyte interactions. Endothelial cells were seeded onto knitted polyethylene terephthalate (PET, Dacron(R)) prostheses and compared with control endothelial cells (C-EC) cultured in flasks to the same stage. Using flow cytometry techniques, we observed that CD62P expression by PET S-EC was significantly increased (p<0.05) compared to C-EC. Moreover, RT PCR techniques showed that the CD62P RNA level was higher on S-ECs compared to C-ECs. Following adhesion assays, increased polymorphonuclear neutrophil (PMN) attachment to the PET-seeded prostheses as compared to control cultures (p<0.001) was observed. PMN adherence was enhanced by TNFalpha activation. PMN adhesion was decreased significantly (p<0.001) after the incubation of resting EC or TNFalpha-activated EC-seeded prostheses with a blocking monoclonal antibody (LYP20) directed against the P-selectin. Such results suggest that: (1) PET prosthetic material may induce the expression of P-selectin by S-EC; (2) seeding conditions provoke an increase in PMN adhesion; (3) increased PMN interactions with seeded PET material is partially dependent upon P-selectin expression by the S-EC.     

Achalasia mimicking psychiatric eating disorders

Anorexia nervosa and psychogen vomiting are psychiatric eating disorders characterized by unexplained weight loss and induced vomiting. These diagnoses require absence of somatic disease. Achalasia is a primary disorder of the esophagus that can be responsible for the same symptoms. This may occult the real diagnosis, especially as dysphagia is not constant and variable in time. We report four cases of achalasia mistakenly diagnosed and treated as anorexia nervosa or psychogen vomiting. Achalasia was unrecognized because specific symptoms, such as dysphagia, were overlooked or misinterpreted by the patients' physicians and psychiatrists, or by the patients themselves. In patients with such eating disorders considered to be psychiatric, physicians should inquire about signs suggestive of achalasia. The diagnosis of achalasia is suspected by imaging and endoscopy, and confirmed or ruled out by manometry.