How to use Chlamydia antibody testing in subfertility patients

Screening for tubal factor subfertility by means of Chlamydia antibody testing (CAT) was introduced into the initial work-up of subfertile couples several years ago. The results reported, however, are heterogeneous, and no uniformity exists in cut-off levels of titres, or in definitions of tubal factor subfertility. We performed a prospective cohort study to evaluate the implications of varying the definitions of tubal pathology and of modifying the cut-off levels on the clinical impact of CAT in predicting tubal factor subfertility. In 227 consecutive patients who attended our fertility clinic, the Chlamydia IgG antibody titre was determined and related to tuboperitoneal abnormalities at laparoscopy as a reference standard. According to received operating characteristic (ROC) curve analysis, a titre of 16 is the optimum cut-off level. Increasing the cut-off level improves specificity and positive likelihood ratio (LR+), at the expense of sensitivity and negative LR (LR-). Changing the definition of tubal factor subfertility from unspecified tuboperitoneal abnormalities into extensive adhesions and/or bilateral distal tubal occlusion improves LR+, LR- and kappa significantly. We conclude that CAT is more accurate in predicting severe distal tubal pathology than unspecified tuboperitoneal abnormalities. Although from a statistical point of view a titre of 16 is the optimum cut-off level, from a clinical point of view 32 or 64 may be preferable, depending on the aim of screening and the inception cohort.      

Anxiety during pregnancy and fetal attachment after in-vitro fertilization conception

The aim of this study was to compare 70 couples who had conceived by in- vitro fertilization (IVF) with 63 matched controls for the prevalence of anxiety and quality of attachment to the baby during pregnancy. Results for mothers showed no group differences using a global measure of anxiety, the Spielberger State-Trait Anxiety Inventory. However, pregnancy-specific measures revealed significantly higher levels of anxiety in IVF mothers about the survival and normality of their unborn babies, about damage to their babies during childbirth and about separating from their babies after birth. When IVF mothers were differentiated according to the number of treatment cycles, more differences in anxiety level were revealed, with most increases occurring in mothers who had experienced two or more treatment cycles. IVF fathers did not differ from controls on the global anxiety measure. No data on pregnancy-specific anxiety were available for fathers. Neither IVF mothers nor IVF fathers differed from controls on measures of attachment to the baby during pregnancy. Results are discussed in the context of the need for researchers to employ differentiated and issue-specific measures to identify concerns that may be unique to IVF couples. Clinical implications regarding the need for psychological support during pregnancy are also discussed.      

Metallo-beta-lactamase VIM-2 in clinical isolates of Pseudomonas aeruginosa from Portugal

Resistance to carbapenems is emerging, and it is a great problem to therapeutics. Three isolates of Pseudomonas aeruginosa from a Portuguese hospital identified in urine and sputum, in 1995, presented a high-level resistance to imipenem (> 32 mg/L). Afterward, one isolate of P. aeruginosa recovered from urine of an ambulatory patient in 1998 showed high resistance to imipenem and meropenem. The resistance to carbapenems in these strains was associated with the production of a class B beta-lactamase, as was demonstrated by imipenem hydrolysis and inhibition by EDTA. Using primers described for bla(IMP) and bla(VIM), the amplification of the latter was observed in all isolates and a VIM-2 metallo-enzyme was identified. The pulsed-field gel electrophoresis (PFGE) patterns of these isolates were indistinguishable, suggesting dissemination to the community of this VIM-2 producer.     

Association analysis of COMT polymorphisms and schizophrenia in a Chinese Han population: a case-control study.

Schizophrenia is a common disease with complex mode of inheritance; great efforts have been made to identify the susceptible genes. Catechol-O-methyltransferase (COMT) gene has long been considered as a candidate gene mainly because of two reasons: First, it encodes a key dopamine catabolic enzyme. Second, it maps to the velocardiofacial syndrome (VCFS) region of chromosome 22q11, which is associated with schizophrenia predisposition. Numerous case-control and family-based studies have been conducted, majority of them focused on a functional Val/Met polymorphism (rs4680). Unfortunately, these studies have produced conflicting results. In a previous report, Shifman et al. found a three-marker haplotype (rs737865-rs4680-rs165599) that showed significant association with schizophrenia. In this study, we try to replicate their findings in Chinese Han population and failed to find any associations.     

大鼠睾丸血管构筑的观察

本文通过血管灌注透明标本和微血管腐蚀铸型扫描电镜,观察大鼠睾丸的大血管和微细血管的构筑。大鼠生精小管的周围,有两种小血管配布。1.管间血管:该血管或为1条毛细血管前微动脉,或为2条并行的较大的毛细血管连结成网状,位于生精小管间三角形的间质柱内,并与小管平行走行。2.管周毛细血管:连于管间血管之间,呈绳梯状围绕生精小管,并在生精小管上皮下固有膜内,形成管周毛细血管网。本文还观察了大鼠睾丸较大血管及睾丸固有鞘膜脏层的血管配布特点,讨论了这些血管配布的意义。     

181例柯兴氏综合征的临床病理

本文收集自1957至1984年181例柯兴氏综合征的肾上腺标本,对30例作了电镜观察。对88例用电子计算机作逐步回归分析,结果表明治疗方式、病理类型、紫纹和性征异常对预后影响较大。并对肾上腺皮腺癌诊断标准的掌握、皮质增生中腺瘤样结节和皮质腺瘤间可能存在的转化关系、肾上腺皮质增生的诊断标准以及柯兴氏综合征病例肾上腺病损的超微结构进行了讨论。