Norethisterone treatment to control timing of the IVF cycle

The use of norethisterone to control the timing of the precedingmenstrual cycle and in consequence the timing of the in-vitrofertilization (IVF) cycle has been evaluated in a therapeuticIVF programme in which oocyte recovery was limited to 2 dayseach week. A consecutive series of 181 cycles after norethisteroneand 29 untreated controls were compared. Menstruation occurred2– 3 days after norethisterone as planned in 82% of patientsoverall and in 87% of patients whose menstrual cycle lengthvaried by no more than 2 days about the median. Norethisteronetreatment did not significantly affect the outcome of IVF treatmentcompared with the controls in respect to cycles abandoned (12versus 0%, respectively), peak follicular diameter (mean 18.1mm versus 18.3 mm 48 h before laparoscopy), oocyte recoveryrate (4.6 versus 4.5 per patient), oocyte morphology (63% versus52% mature), or fertilization rate (72 versus 65% of matureoocytes). Clinical pregnancies were too few for comparison (rates27 versus 9% per laparoscopy) but the overall rate (23%) indicatedeffectiveness of the methods. Prior norethisterone treatmentappears to be an effective and useful means of controlling thetiming of the oocyte recovery in IVF treatment.     

Exclusion of the familial Mediterranean fever locus as a susceptibility region for autosomal dominant familial Hibernian fever.

Autosomal dominant periodic fevers constitute a range of syndromes characterised by recurrent attacks of fever and abdominal pain. Familial Hibernian fever (FHF) has been described in only one United Kingdom based family, but two other Irish families have been found with similar clinical features. FHF resembles familial Mediterranean fever (FMF) in several clinical features, but the mode of inheritance of FHF is dominant whereas FMF is recessive. We have investigated whether autosomal dominant periodic fevers, in particular FHF, map to the FMF susceptibility locus (MEFV) on chromosome 16p13.3. We have used informative microsatellite markers flanking this locus to genotype members of the three families mentioned above. Two point and multipoint lod scores definitively excluded linkage to MEFV in the two larger families. A haplotype study confirmed these findings, indicating that FHF is genotypically as well as phenotypically distinct from FMF.     

Medicare managed care and the need for quality measurement

With the increasing penetration of managed care as health insurance coverage for Medicare beneficiaries, accountability for quality of care is being demanded. While HEDIS 2.5 has become the standard for assessing the performance of health plans in caring for their commercial members, no such standard exists for Medicare enrollees. U.S. Quality Algorithms, the performance measurement subsidiary of U.S. Healthcare, has developed the Medicare Quality Report Card as a tool for performance assessment and quality improvement. This article describes how the measures of quality important to the Medicare population were chosen, how the measures were calculated, and how they have been used in programs designed to improve the quality of care for U.S. Healthcare Medicare members.     

The effectiveness of a treatment protocol for male lower urinary tract symptoms in general practice: a practical randomised controlled trial

BACKGROUND: Randomised controlled trials have shown the efficacy of several treatment modalities for lower urinary tract symptoms (LUTS) in selected populations. The effectiveness in daily practice has hardly been investigated, especially in primary care and is dependent on choices between all possible treatment options and best investigated in a comprehensive study, including all treatment modalities (watchful waiting, alpha-blockers, 5-alpha-reductase inhibitors, and surgery). AIM: Assessment of the effectiveness of a comprehensive treatment protocol for LUTS in primary care. DESIGN OF STUDY: Randomised controlled trial. SETTING: Fourteen general practices in the Netherlands. METHOD: Intervention: treatment protocol based on a formalised expert opinion. Control condition: usual care. Study population: 208 subjects with moderate to severe LUTS (IPSS > or =8, median = 13). OUTCOME MEASURES: symptom severity (IPSS [International Prostate Symptom Score]), bother score (Dan-PSS [Danish Prostate Symptom Score]), and maximum urinary flow (Q(max)); incidence of acute urinary retention and urinary tract infections. RESULTS: In the intervention group markedly more subjects used an alpha-blocker at end of follow-up than in the usual care group (24% versus 6%). No significant differences were found between intervention and control group in IPSS, Q(max) or Dan-PSS. CONCLUSION: alpha-blockers and watchful waiting are the most frequent treatment modalities for LUTS in primary care. Our study showed no evidence that a protocol using well-defined indications for all possible treatment modalities based on a formalised expert opinion procedure has added value. Based on our results, we cannot recommend a broadening of the indication for alpha-blockers, which, however, seems to be the current trend.     

Age-related changes in nigrostriatal dopaminergic function in heterozygous mutant dopamine transporter knock-out mice

In this report we compared three different parameters of nigrostriatal dopaminergic (NSDA) function – locomotor activity, striatal dopamine (DA) levels and 3,4-dihydroxyphenylacetic acid (DOPAC)/DA ratios between heterozygous mutant dopamine transporter mice (+/− DAT) and their wild type controls (+/+ DAT) at three different age range periods: 4–10, 11–17 and 18–24 months of age. Locomotor activity of the +/− DAT mice failed to differ over the three age periods sampled. In +/+ DAT mice a significant decrease in locomotor activity was obtained at the 18–24-month old period compared with scores at the two earlier age periods. In addition, locomotor scores of +/+ DAT mice at 18–24 months of age were significantly decreased as compared with scores of the +/− DAT mice at this age. Striatal DA concentrations of +/− DAT mice also failed to differ over the three age periods sampled, while that of +/+ DAT mice showed significant decreases in striatal DA at 11–17 and 18–24 months of age as compared to their 4–10-month old cohorts. Striatal DOPAC/DA ratios were significantly increased in both +/+ and +/− DAT mice at the 11–17 and 18–24 month age periods as compared with their respective 4–10-month old groups. Striatal DOPAC/DA ratios of +/− DAT mice were significantly greater than that of the +/+ DAT mice at 18–24 months of age. These findings reveal the significance of interactions between a mutation of the dopamine transporter and aging upon NSDA function and the importance of isolating such variables when using knock-out models.     

The endogenous soluble VEGF receptor-2 isoform suppresses lymph node metastasis in a mouse immunocompetent mammary cancer model

Background  

Cancer metastasis contributes significantly to cancer mortality and is facilitated by lymphangiogenesis and angiogenesis. A new splicing variant, endogenous soluble vascular endothelial growth factor receptor-2 (esVEGFR-2) that we recently identified is an endogenous selective inhibitor of lymphangiogenesis. To evaluate the antimetastatic potential of esVEGFR-2, gene therapy with vector expressing esVEGFR-2 (pesVEGFR-2) or endostatin (pEndo) as a positive control was conducted on murine metastatic mammary cancer.