Oocyte cryopreservation beyond cancer: tools for ethical reflection

Purpose

This article offers physicians a tool for structured ethical reflection on challenging situations surrounding oocyte cryopreservation in young healthy women.

Methods

A systematic literature review offers a comprehensive overview of the ethical debate surrounding the practice. Ethical Counseling Methodology (ECM) offers a practical approach for addressing ethical uncertainties. ECM consists of seven steps: (i) case presentation; (ii) analysis of possible implications; (iii) presentation of ethical question(s); (iv) explanation of ethical terms; (v) presentation of the ethical arguments in favor of and against the procedure; (vi) examination of the individual patient’s beliefs and wishes; and (vii) conclusive summary.

Results

The most problematic aspects in the ethical debate include the distinction between medical and non-medical use of oocyte cryopreservation, safety and efficiency of the procedure, and marketing practices aimed at healthy women. Female empowerment and enhanced reproductive choices (granted oocyte cryopreservation is a safe and efficient technique) are presented as ethical arguments supporting the practice, while ethical reservations towards oocyte cryopreservation are based on concerns about maternal and fetal safety and wider societal implications.

Conclusions

Oocyte cryopreservation is gaining popularity among healthy reproductive age women. However, despite promised benefits it also involves risks that are not always properly communicated in commercialized settings. ECM offers clinicians a tool for structured ethical analysis taking into consideration a wide range of implications, various ethical standpoints, and patients’ perceptions and beliefs.     

血管紧张素Ⅱ对小鼠足细胞小窝蛋白1表达的影响

目的 观察血管紧张素Ⅱ（AngⅡ）刺激及氯沙坦干预对足细胞小窝蛋白1（caveolin-1）表达的影响,探讨caveolin-1在足细胞损伤中的作用.方法 体外培养永生化小鼠足细胞（MPC）,AngⅡ（10-6mol/L）刺激不同时间（3 h、6h、12 h和24 h）;Losartan（10-6 mol/L）提前预处理3h后与AngⅡ（10-6 mol/L）共孵育6h,Hoechst-33342检测足细胞凋亡率,Western-blot法检测各组细胞caveolin-1蛋白表达,免疫荧光检测caveolin-1及其磷酸化水平.结果 ①AngⅡ刺激3h,足细胞即开始发生凋亡,随着刺激时间的延长,足细胞凋亡明显增多（P＜0.05）.②AngⅡ刺激不同时间caveolin-1表达总量无明显改变（P＞0.05）,从3h开始,caveolin-1磷酸化水平明显增高（P＜0.05）.③Losartan干预后caveolin-1磷酸化水平明显降低（P＜0.05）.结论 caveolin-1可能在AngⅡ诱导的足细胞损伤中发挥着重要的作用.     

蛋黄油的古今应用及研究进展

蛋黄油的应用伴随着中医药的发展而发展。中医在应用蛋黄油治疗一些疾病,尤其是皮肤病、烧烫伤、及其创面难愈方面的疾病,药效更显著,作用更为突出。现代药理学研究表明,蛋黄油具有抗炎、镇痛、促进创面愈合等作用。由于蛋黄油在临床使用过程中对多种疾病的显著疗效,进一步推动了蛋黄油在临床更大范围的使用。     

Symposium

This study aims to provide an estimate of women's risk of ovarian hyperstimulation syndrome (OHSS) when undergoing superovulation to donate eggs for research. This is an essential prerequisite for appropriate informed consent. In the absence of sufficiently large numbers of egg donors to assess the risk, comparative data was obtained from women undergoing the same superovulation protocol for in vitro fertilization (IVF) treatment. In this prospective study 339 women, who developed ≥20 follicles after superovulation in their first treatment cycle (total number of treatment cycles during the same period – 2417), were intensively monitored on five occasions, between human chorionic gonadotrophin and pregnancy test, according to our routine clinical protocol. Hospital admission was needed for 49 (14.5%) women, 13 (3.8%) needed intravenous fluids and 9 (2.7%) needed paracentesis. The admission rates were similar in pregnant and non-pregnant women (13.5% vs. 15%); the need for intravenous fluids and paracentesis were 3.2% vs. 2.3% and 6.3% vs. 2.3%, respectively. The peak increase in haematocrit occurred on Day 4 after hCG, and the mean day of hospital admission was Day 5. If an egg donor develops <20 follicles, she can be reassured that the risk of OHSS is very small (<0.1%). If ≥20 follicles develop, her risk of hospital admission due to OHSS is <15%. The absence of pregnancy in egg donors does not eliminate the risk of OHSS. Given the timescale of development of the haematological and biochemical abnormalities, egg donors who develop ≥20 follicles should be actively monitored for the first week after egg collection.     

Favorable effects of egg white protein on lipid metabolism in rats and mice

Egg is a cholesterol-rich food and has a strong hyper-cholesterolemic action. However, all the cholesterol is in egg yolk and egg white is cholesterol-free. The effect of egg white protein and its hydrolysates on the serum lipids were compared with casein and soybean protein in rats and mice. The animals were given 30% casein diet (Ca group) or diets of 15% casein plus 15% soybean protein isolate (SPI group), egg white protein (EW group) or egg white protein hydrolysates (EW-P group) for 3 (rats) or 2 (mice) weeks. Food intake and growth were very similar among the different dietary groups. Hypocholesterolemic effect was observed in SP, EW and EW-P groups in rats and EW group in mice. Prevention of the reduction of HDL-cholesterol was found in EW and EW-P groups in rats and EW-P group in mice. The result suggests the possibility of the use of egg white for the prevention and treatment of hyper-cholesteremia.     

Effects of Intravenous Phospholipid on Low Density Lipoprotein Turnover in Man*

The mechanism of the rise in plasma low density lipoprotein (LDL) levels following intravenous administration of a triglyceride-phospholipid emulsion (Intralipid) has been investigated by measuring LDL turnover in eight healthy subjects. The plasma half-life, and the absolute and fractional catabolic rates of LDL protein (apo-LDL) were unaffected by intragastric Intralipid, whereas apo-LDL half-life was prolonged and its fractional catabolic rate was decreased by intravenous Intralipid. Similar changes were observed after intravenous administration of the egg phospholipid constituent of Intralipid. Accompanying increases in the oleate: linoleate ratio of both high and low density lipoprotein cholesterol esters were secondary to phospholipid exchange between infused and endogenous lecithin. These results suggest that the increased concentration of LDL in plasma following intravenous administration of egg phospholipid-containing emulsions was due, at least in part, to a decrease in the fractional catabolic rate of apo-LDL. The data further suggest a possible relationship between apo-LDL catabolism and the fatty acid composition of LDL.     

Efficacy and side effects of praziquantel in the treatment of Schistosomiasis mansoni in schoolchildren in Shesha Kekele Elementary School,Wondo Genet,Southern Ethiopia

Objective

To evaluate the efficacy and side effects of praziquantel (PZQ) in the treatment of schistosomiasis in Ethiopia.

Methods

In a cross-sectional study, stool specimens were collected from randomly selected 299 school children in Shesha Kekele Elementary School, Wondo Genet, Southern Ethiopia, in April 2010. Stool specimens were examined using a single Kato-Katz thick smear for Schistosoma mansoni (S. mansoni) ova. Children who were found positive for S. mansoni were treated with a single oral dose of PZQ at 40 mg/kg bw and interviewed for treatment-related symptoms 24 hours after drug administration. Four weeks post-treatment, stool specimens were collected from the same children and examined following the same procedure as in the pre-treatment. Drug efficacy was determined based on cure and egg reduction rates.

Results

Pre-treatment prevalence of S. mansoni infection was 74.9% with geometric mean egg count of 268. The evaluated generic PZQ produced an overall cure rate of 73.6% (P<0.000 1, OR: 8.33, CI: 5.3–13.1) and egg reduction rate of 68.2% (P=0.03, F=0.64). The cure rate showed significant association with age (χ²=11, P=0.004), the highest rate being observed in the 15–22 age group. 83% of S. mansoni infected children showed various treatment-related symptoms, the most frequent being headache, nausea, and abdominal pain. These symptoms were associated with age (P<0.001) and pre-treatment intensity of infection (P<0.05).

Conclusions

The present observations revealed relatively lower cure and egg reduction rates of the PZQ evaluated as compared to previous reports for other PZQ brands in Ethiopia. Hence, in depth studies are recommended to clarify whether the present relatively lower cure rate is the actual cure rate of the praziquantel evaluated, treatment failure, or reduced susceptibility of the parasite. Treatment-related side effects observed were transient and tolerable.     

Bacteriological and pathological studies of egg peritonitis in commerciallayer chicken in Namakkal area

Objective

To detect the various bacteriological agents and pathological changes in commercial layer chicken affected with egg yolk peritonitis in Namakkal region of India.

Methods

A total of 6 572 layer chicken from 85 commercial farms were subjected for the study, out of which 1 715 showed various types of oviduct abnormalities. Among the 1 715, 264 birds from six farms were identified as egg peritonitis on the basis of postmortem examination. Trachea, lung, heart blood, liver, peritoneal exudate, oviduct (infundibulum, magnum, uterus) and cloacal swabs were collected from the 264 birds with egg peritonitis lesion for screening of bacterial agents. Signalment, clinical signs and pathological changes were recorded in the affected flocks.

Result

The results of the present investigation indicated that the E. coli associated egg peritonitis was responsible for 15.39% of the reproductive tract abnormalities in commercial layers between 21 and 80 week of age. In the affected flocks egg production drop and mortality varied from 3% to 20% and 0.5% to 7.0% respectively. It was noticed during peak egg production (21 to 60 week) and southwest monsoon season (58%). Statistical analysis of age, season and egg production by Chi square test of independence revealed highly significant difference. E. coli was isolated as a pure culture and concurrent with other bacterial agents in 226 and 38 birds respectively. Among the fifteen E. coli serotypes identified serotype O₁₆₆, O₆₄ and O₁₁₁ were predominant. Necropsy examination of affected birds revealed the presence of amorphous or insipissiated yolk material in the abdominal cavity with inflammatory changes in the ovary, oviduct and intestine. Microscopically the oviduct surface epithelium showed degeneration and desquamation, moderate to marked infiltration of inflammatory cells especially heterophils and lymphocytes in various regions and lumen contained serofibrinous exudate, inflammatory and desquamated epithelial cells with bacterial microcolonies. Ovarian follicles revealed hyperemia, degeneration of granulosa cells and infiltration of inflammatory cells. Intestine showed degenerative, necrotic and inflammatory lesion.

Conclusion

The findings of this study showed that the egg peritonitis might be caused by either the translocation of intestinal E. coli into the peritoneal cavity or by the movement of cloacal E. coli into the oviduct followed by ascension of these bacteria up the oviduct, through the infundibulum, and into the peritoneal cavity. To control the egg peritonitis faecal contamination with E. coli should be minimized.     

云南省保山8月龄～15岁麻疹疫苗接种人群鸡蛋过敏现况调查

目的通过了解云南省保山市5县(区)8月龄~15岁麻疹疫苗接种人群鸡蛋过敏的患病率,估计因鸡蛋过敏而不能接种麻疹减毒活疫苗的免疫空白人群规模,从而为保山市消除麻疹以及接种过程中可能出现的过敏反应制订相应的策略提供基线资料。方法采取现况调查,具体为对8月龄~15岁即将接种麻疹减毒活疫苗的儿童进行问卷调查,同时对有过敏史的再进行个案调查。结果调查8月龄~15岁麻疹疫苗接种人群502 561人,患病率为3.94/万,鸡蛋过敏儿童198人,平均年龄为(8.30±4.27)岁,患病率在年龄上差异无统计学意义(P>0.05),性别上差异有统计学意义,男/女(122/76,P<0.001);5县(区)鸡蛋过敏患病率不全相同(P<0.001);鸡蛋过敏儿童可出现皮疹、腹痛、腹泻、唇肿、呕吐、发热等临床症状。个体与个体之间临床表现不完全一致,但有共同点就是出现临床症状前有食用鸡蛋病史。其中,鸡蛋过敏者有1个临床症状者79例(占48.99%),有2个临床症状者66例(占33.33%),有3个临床症状者33例(占16.67%),有4个临床症状者2例(占1.01%)。结论本次调查反映了鸡蛋过敏人群在麻疹减毒活疫苗接种对象中占有一定的比例,这类人不能接种含微量鸡蛋蛋白组份的麻疹减毒活疫苗。因此,为实现我国政府作出的到2012年消除麻疹承诺,制订相应的策略消除免疫空白人群显得尤为重要。在接种疫苗前,对这类鸡蛋过敏人群进行规模估计对保山消除麻疹有相当重要的意义。