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.     

Isolation of mutants of CHO cells resistant to 6(p-hydroxyphenylazo)-uracil I. A novel BrdU cross-resistant phenotype

Three classes of mutants resistant to the drug 6(p-hydroxyphenylazo)-uracil have been isolated from mutagenized cultures of CHO cells. One class of these mutants designated HPU ^R A exhibits a unique form of cross-resistance to bromodeoxyuridine in that it is resistant to this drug only in the presence of thymidine. The molecular basis of the BrdU resistance is unknown but does not appear to involve the known targets of the drug. An interesting feature of these mutants is that they give rise, at a high frequency, to a subpopulation of cells which are much more resistant to BrdU.     

Isolation of mutants of CHO cells resistant to 6 (p-hydroxyphenylazo)-uracil II. Mutants auxotrophic for deoxypyrimidines

Two classes of CHO mutants resistant to the drug 6(p-hydroxyphenylazo)-uracil have been characterized. Both classes exhibited a nutritional requirement that could be satisfied by deoxypyrimidines and uridine but not other ribopyrimidines. A biochemical investigation of these mutants revealed a structural defect in ribonucleotide reductase resulting in a two- to fourfold increase in the K_m for UDP and CDP. As a consequence of this lesion, the cells had imbalanced deoxypyrimidine pools and showed an increase in the rate of spontaneous mutation to 6-thioguanine resistance but not emetine resistance.     

The effect of prostaglandin E2 and ADH on diffusional water permeability in the collecting duct of an isolated rat papilla

The effect of prostaglandin on diffusional water permeability has been studied in collecting ducts in an isolated rat papilla. PGE₂ increased water permeability. The effect was significant at a concentration of 10^–8 mol l^–1 and was maximal with a concentration of 10^–6 mol l^–1. The maximal increment of 0.94±0.10 (SEM) m s^–1 was approximately half that produced by maximal stimulation with antidiuretic hormone (2.18±0.12 m s^–1).A concentration of 10^–8 mol l^–1 produced an increase in basal water permeability and 25 unit ml^–1 ADH, which without PGE₂ present gave a similar increase, had no incremental effect. ADH 100 unit ml^–1 increased permeability to a value similar to that observed in the absence of PGE₂. Thus PGE₂ and ADH both increase water permeability but the increments are not additive.Indomethacin in a concentration that inhibited prostaglandin production altered the response of the collecting duct to ADH. The dose response curve was shifted to the left and the maximal increase in water permeability and the lowest dose at which a response occurred took place at concentrations less than 1/2 those required in its absence.Prostaglandins influence the action of ADH and it is likely that in life they regulate and modulate the change in water permeability induced by anti-diuretic hormone.     

Cytolysis of neuraminidase-treated autochthonous lymphoid cells by autologous serum.

Rabbit lymph node cells treated with bacterial neuraminidase become susceptible to cytolysis by autologous antibody and complement. Cytolysis of cells can be prevented by absorbing out the antibodies, probably IgM antibodies, from the autologous serum using neuraminidase-treated autochthonous lymph node cells. The significance of this mechanism is discussed.     

Continuous Glucose Monitoring Use in Clinical Trials for On-Market Diabetes Drugs

To the best of our knowledge, there are no published data on the historical and recent use of CGM in clinical trials of pharmacological agents used in the treatment of diabetes. We analyzed 2,032 clinical trials of 40 antihyperglycemic therapies currently on the market with a study start date between 1 January 2000 and 31 December 2019. According to ClinicalTrials.gov, 119 (5.9%) of these trials used CGM. CGM usage in clinical trials has increased over time, rising from <5% before 2005 to 12.5% in 2019. However, it is still low given its inclusion in the American Diabetes Association’s latest guidelines and known limitations of A1C for assessing ongoing diabetes care.

The availability of reliable continuous glucose monitoring (CGM) systems has proven to be a major innovation in diabetes management and research. Most current CGM systems are approved for 7- to 14-day use and use a wire-tipped glucose oxidase sensor inserted in subcutaneous tissue to monitor glucose concentrations in interstitial fluid. One implanted CGM system is approved for longer-term use (90–180 days); it operates with fluorescence-based technology. CGM sensors record a glucose data point every 1–15 minutes (depending on the system), collecting far more granular data and information on glycemic patterns than self-monitoring of blood glucose (SMBG) alone. Real-time CGM or intermittently scanned CGM systems send data continuously or intermittently to dedicated receivers or smartphones, whereas professional CGM systems provide retrospective data, either blinded or unblinded, for analysis and can be used to identify patterns of hypo- and hyperglycemia. Professional CGM can be helpful to evaluate patients when other CGM systems are not available to the patient or the patient prefers a blinded analysis or a shorter experience with unblinded data.In the 20 years since CGM systems first became available to people with diabetes, technological improvements, particularly pertaining to accuracy and form factor, have made CGM increasingly viable for both patient use and clinical investigation (1,2). Average sensor MARD (mean absolute relative difference; a summary accuracy statistic) has decreased from >20 to <10% (3–10), including two systems that do not require fingerstick calibrations and three that are approved to be used for insulin dosing (11). Concurrently, size, weight, and cost of CGM systems have all decreased, while user-friendliness and convenience have increased (12).To encourage use of CGM-derived data, researchers and clinicians have worked to develop a standard set of glycemic metrics beyond A1C. In 2017, two international groups of leading diabetes clinical and research organizations published consensus definitions for key metrics, including clinically relevant glycemic cut points for hypoglycemia (<70 and <54 mg/dL), hyperglycemia (>180 and >250 mg/dL), and time in range (TIR; 70–180 mg/dL) (13,14).CGM-derived metrics provide far greater precision and granularity than is possible with SMBG or A1C data alone (Table 1), enabling clinicians and investigators to better represent inter- and intraday glycemic differences with metrics such as TIR, glycemic variability, and time in hypoglycemia and hyperglycemia (15). Crucially, CGM also allows for the accurate measurement and detection of nocturnal glycemia (16). The use of these metrics enables a more comprehensive understanding of glycemic management that can facilitate individualized treatment for people with diabetes or prediabetes. Although A1C is a useful estimate of mean glucose over the previous 2–3 months, especially when evaluating population health, it is important to include other glycemic outcomes in clinical trials. Furthermore, there is emerging evidence suggesting that TIR predicts the development of microvascular complications at least as well as A1C (17,18).TABLE 1Benefits of CGM Compared With A1C Alone in Assessing Glycemia