Tag: pubmed

Reprod Sci. 2021 Nov 1. doi: 10.1007/s43032-021-00767-0. Online ahead of print.

ABSTRACT

Unexplained infertile couples can have further expectant management before starting assisted reproductive treatments. However, ovarian reserve and in vitro fertilization (IVF) outcomes rapidly decline after 39 years or more. It is thus important to clarify whether a waiting policy is also appropriate for women of advanced age. Couples who had access to a waiting list for approximately 1 year before receiving reimbursed public IVF were compared with those paying for access to immediate treatment. To allow for comparisons between these two strategies, we followed up couples who opted to pay for 1 year after the last embryo transfer from their first cycle. We calculated the proportion of live births in both groups and compared these using logistic regression models and a two-sample Z test for equality of proportions. Six hundred thirty-five couples were evaluated. Out of 359 couples in the immediate group, 70 (19.5%) had a live birth of which 11 after natural conception and 59 after IVF. Out of 276 couples in the waiting group, 57 (20.7%) had a live birth of which 37 after natural conception and 20 after IVF. There was no statistically significant difference between the two strategies in terms of the crude cumulative live birth rate (cLBR). The adjusted odds ratio of 0.69 (95%CI:0.39-1.22) did not change this conclusion as our sensitivity analyses. The cLBR for the ‘waiting before IVF’ and the ‘immediate’ strategies were similar. Further studies are needed to better characterize couples affected by unexplained infertility in order to individualize treatment strategies.

PMID:34724170 | DOI:10.1007/s43032-021-00767-0

Graefes Arch Clin Exp Ophthalmol. 2021 Nov 1. doi: 10.1007/s00417-021-05466-9. Online ahead of print.

ABSTRACT

PURPOSE: This study aims to determine the 5-year visual field progression and identify the prognostic factors for progression in Malay patients with primary glaucoma.

METHODS: A retrospective cohort record review study was conducted among 222 patients (222 eyes) with primary glaucoma who were selected from a glaucoma research database of a tertiary center in Malaysia. The patients were Malays and diagnosed with primary open-angle glaucoma (POAG) or primary angle-closure glaucoma (PACG). Patients who were followed up regularly for at least 6 months between 1 January 2009 and 31 December 2014 and completed another 1-year follow-up after recruitment (between 1 January 2015 and 31 December 2015) were selected. Multiple prognostic factors that influence visual field progression were identified. Progression of visual field loss was based on the Advanced Glaucoma Intervention Study and Hodapp-Parrish-Anderson scores. Kaplan-Meier survival and Cox proportional hazard regression analyses were performed.

RESULTS: Sixty-three patients (28.4%) developed visual field progression after a mean (SD) follow-up of 6.9 (3.3) years. Those with POAG progressed faster (mean time, 10.6 years; 95% confidence interval [CI], 9.3, 11.9) than those with PACG (17.3 years; 95% CI, 14.8, 19.9) but not statistically significant. Disc hemorrhage and history of eye pain increased the risk of progression by 2.8-folds (95% CI, 1.6, 4.8) and 2.5-folds (1.4, 4.4), respectively.

CONCLUSION: The 5-year survival of the Malay primary glaucoma patients with visual field progression was similar with that of other Asian populations. However, aggressive management is required for those with disc hemorrhages and eye pain related to increased intraocular pressure.

PMID:34724110 | DOI:10.1007/s00417-021-05466-9

Obstet Gynecol Surv. 2021 Oct;76(10):634-643. doi: 10.1097/OGX.0000000000000943.

ABSTRACT

IMPORTANCE: Substance use during pregnancy is a major health issue for both the mother and the fetus, but it also represents an important public health concern.

OBJECTIVE: The aim of this review was to summarize and compare recommendations from recently published guidelines on substance use during pregnancy and especially regarding alcohol, smoking, and drug use.

EVIDENCE ACQUISITION: A descriptive review of guidelines from the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, the World Health Organization (WHO), the Society of Obstetricians and Gynaecologists of Canada, and the American College of Obstetricians and Gynecologists on substance use was conducted. Regarding the term “substance use,” the most recently published Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition substances were used.

RESULTS: All the reviewed guidelines recommend appropriate counseling and screening women regarding alcohol, smoking, and drug use during the antenatal period, while the management options vary. More specifically, the prompt management of alcohol dependence is emphasized by all the guidelines except from the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, which makes no recommendation upon. The use of alcohol during breastfeeding should be avoided. Regarding smoking cessation, all guidelines recommend the use of certain psychosocial, behavioral interventions, and pharmacotherapy. All the guidelines, except the one from the WHO, suggest screening drug users for coexistent sexually transmitted infections. Brief interventions are considered beneficial, while a gradual decrease in benzodiazepines is suggested, as well as the discontinuation of marijuana and methamphetamine use. However, there is controversy regarding breastfeeding in those women as the WHO recommends in favor, whereas the Society of Obstetricians and Gynaecologists of Canada and the American College of Obstetricians and Gynecologists recommend against this practice. Finally, all the guidelines state that, following delivery, close monitoring of the neonate is needed.

CONCLUSIONS: The diversity of guidelines’ recommendations concerning substance use reflects the different ways of the management of pregnant women during routine antenatal care due to absence of strong evidence. More research in the areas of dispute may allow the adoption of an international consensus, in order to early detect and appropriately manage pregnant women with harmful addictions.

PMID:34724075 | DOI:10.1097/OGX.0000000000000943

Strahlenther Onkol. 2021 Nov 1. doi: 10.1007/s00066-021-01866-2. Online ahead of print.

ABSTRACT

PURPOSE: Randomized comparison of the effect of radiotherapy on painful osteoarthritis (OA) applying a standard-dose vs. a very-low-dose regime PATIENTS AND METHODS: Patients with OA of the hand and knee joints were included. Further inclusion criteria: symptoms for more than 3 months, favorable general health status, age above 40 years. Patients with prior local radiotherapy, trauma, rheumatoid arthritis, or vascular diseases were excluded. After randomization (every joint was randomized separately), the following protocols were applied: standard arm: total dose 3.0 Gy, single fractions of 0.5 Gy twice weekly; experimental arm: total dose 0.3 Gy, single fractions of 0.05 Gy twice weekly. The dosage was not known to the patients. The patients were examined 3 and 12 months after radiotherapy. Scores like VAS (visual analogue scale), KOOS-SF (the knee injugy and osteoarthritis outcome score), SF-SACRAH (short form score for the assessment and quantification of chronic rheumatic affections of the hands), and SF-12 (short form 12) were used.

RESULTS: A total of 64 knees and 172 hands were randomized. 3.0 Gy was applied to 87 hands and 34 knees, 0.3 Gy was given to 85 hands and 30 knees. After 3 months, we observed good pain relief after 3 Gy and after 0.3 Gy, there was no statistically significant difference. Side effects were not recorded. The trial was closed prematurely due to slow recruitment.

CONCLUSION: We found favorable pain relief and a limited response in the functional and quality of life scores in both arms. The effect of low doses such as 0.3 Gy on pain is widely unknown. Further trials are necessary to compare a conventional dose to placebo and to further explore the effect of low doses on inflammatory disorders.

PMID:34724085 | DOI:10.1007/s00066-021-01866-2

Andrology. 2021 Nov 1. doi: 10.1111/andr.13123. Online ahead of print.

ABSTRACT

BACKGROUND: An explosive increase in couples attending assisted reproductive technologies (ART) has been recently observed, despite an overall success rate about 20-30%. Considering the ART-related economic and psycho-social costs, the improvement of these percentages is extremely relevant. However, in the identification of predictive markers of ART success, male parameters are largely underestimated so far.

STUDY DESIGN: Retrospective, observational study.

OBJECTIVES: To evaluate whether conventional semen parameters could predict the ART success MATERIALS AND METHODS: All couples attending a single third-level Fertility Centre from 1992 to 2020 were retrospectively enrolled, collecting all semen and ART parameters of fresh cycles. Fertilization rate (FR) was the primary end-point, representing a parameter immediately dependent from male contribution. Pregnancy and live birth rates were considered in relation to semen variables. Statistical analyses were performed using the parameters obtained according to WHO manual edition used for semen analysis.

RESULTS: 22013 in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) cycles were considered. Overall, FR was significantly lower in patients with abnormal semen parameters compared to normozoospermic men, irrespective to the WHO manual edition. In the IVF setting, both progressive motility (p = 0.012) and motility after capacitation (p = 0.002) significantly predicted fertilization rate (statistical accuracy = 71.1%). Sperm motilities predicted also pregnancy (p<0.001) and live birth (p = 0.001) rates. In ICSI cycles, sperm morphology predicted FR (p = 0.001, statistical accuracy = 90.3%). Sperm morphology significantly predicted both pregnancy (p<0.001) and live birth (p<0.001) rates, and a cut off of 5.5% was identified as a threshold to predict clinical pregnancy (AUC = 0.811, p<0.001).

DISCUSSION: Interestingly, sperm motility plays a role in predicting IVF success, while sperm morphology is the relevant parameter in ICSI cycles. These parameters may be considered reliable tools to measure the male role on ART outcomes, potentially impacting the clinical management of infertile couples. This article is protected by copyright. All rights reserved.

PMID:34723422 | DOI:10.1111/andr.13123

J Magn Reson Imaging. 2021 Nov 1. doi: 10.1002/jmri.27979. Online ahead of print.

ABSTRACT

BACKGROUND: Despite concerns about safety, gadolinium-based contrast agents (GBCAs) are still used for abdominal and pelvic imaging during pregnancy. Researchers have mainly focused on teratogenicity, while very little is known about their possible direct effects on uterine contractility, yet free gadolinium potentially impacts contractility through interaction with calcium channels.

PURPOSE: To investigate possible effects of selected GBCAs (namely gadoteridol, gadoversetamide, gadobutrol, gadoterate meglumine, and gadoxetic acid) on the contractility of rat myometrium.

STUDY TYPE: In vitro organ bath study.

ANIMAL MODEL: Myometria were isolated from adult (10-12 weeks old) Sprague Dawley rats, both pregnant (N = 8) and nonpregnant (N = 36).

FIELD STRENGTH/SEQUENCE: NA.

ASSESSMENT: Myometrial strips were suspended in tissue bath containing physiological saline and isometric contractions were recorded. GBCAs were added to the tissue bath cumulatively, and their effects on contractility parameters (quantified by amplitude, frequency, and area under contractility curve [AUC]) were evaluated by 10-minute intervals.

STATISTICAL TESTS: Normality data, checked by Shapiro-Wilk test, were transformed by arcsine when needed. One- or two-way analysis of variance was performed, where appropriate, followed by Student-Newman-Keuls test. A P value of <0.05 was considered statistically significant.

RESULTS: All of the assayed GBCAs elicited some alterations in the myometrial contractility in a concentration-dependent manner. Gadoterate meglumine, gadoxetic acid, and gadoversetamide caused a concentration-dependent significant attenuation in AUC (oxytocin-induced, from 100% during control period to 45.1 ± 9.0% (nonpregnant) and 59.9 ± 8.5% (pregnant), for 90 μM gadoterate meglumine; respectively), and frequency of the spontaneous and oxytocin-induced contractions. Gadobutrol and gadoteridol at highest dose significantly attenuated mean AUC and frequency of oxytocin-induced contractions of nonpregnant myometrium.

DATA CONCLUSION: Results from this in vitro study indicate that GBCAs elicit modulation of myometrial contractions at clinically relevant concentrations. These effects may account, at least partially, for the known potential side effects (rare cases of miscarriages and elective abortion) of these agents.

LEVEL OF EVIDENCE: 1 TECHNICAL EFFICACY: Stage 5.

PMID:34723414 | DOI:10.1002/jmri.27979

J Women’s Health Care Manag. 2021;2(2). doi: 10.47275/2692-0948-121. Epub 2021 Mar 27.

ABSTRACT

BACKGROUND: The extent to which smoking and drinking in a local community is associated with nutrition and Z-scores of infants from spontaneous preterm deliveries, is uncertain.

AIM: To investigate associations of different levels of maternal smoking and drinking in spontaneous preterm birth with infant birthweight Z-scores.

METHODS: Information, including gestational age (determined by earliest ultrasound), maternal arm circumference (measured at enrolment), smoking-drinking data (obtained up to 4 occasions), birthweight data (obtained from medical records) and birthweight Z-scores (calculated from INTERGROWTH- 21st study), collected over a period of nine years was used to compare 407 spontaneous preterm births with 3 493 spontaneous term births Analyses of variance, correlations and multiple regression were performed in STATISTICA.

RESULTS: Women with spontaneous preterm birth, had significantly lower gravidity and smaller arm circumference when compared to women with spontaneous birth at term. Women with spontaneous preterm birth drank more and heavier during pregnancy, and more smoked. Gestational age at birth was significantly longer in heavy-smokers-heavy-drinkers compared to heavy-smokers-no-drinkers (7.1 days) and in no-smokers-heavy-drinkers when compared to no-smokers-no-drinkers (11.2 days). Birthweight was significantly lower in low-smokers-heavy-drinkers when compared to low-smokers-no-drinkers (240g) and in heavy-smokers-low-drinkers when compared to no-smokers-low-drinkers (273g). Birthweight Z-scores were significantly lower in low-smokers-heavy-drinkers when compared to low-smokers-low-drinkers and low-smokers-no-drinkers; and, also significantly lower in heavy-smokers-low-drinkers when compared to low-smokers-low-drinkers and no-smokers-low-drinkers.

CONCLUSION: Alcohol aggravates the detrimental effect of smoking on birthweight and birthweight Z-scores but seems to counteract the negative association of smoking with gestational age.

PMID:34723283 | PMC:PMC8553154 | DOI:10.47275/2692-0948-121

J Magn Reson Imaging. 2021 Nov 1. doi: 10.1002/jmri.27977. Online ahead of print.

ABSTRACT

BACKGROUND: Amide proton transfer weighted imaging (APTw), intravoxel incoherent motion (IVIM), and positron emission tomography (PET) imaging all have the potential to characterize solitary pulmonary lesions (SPLs).

PURPOSE: To compare APTw and IVIM with PET imaging for distinguishing between benign and malignant SPLs and their subtypes.

STUDY TYPE: Prospective.

POPULATION: Ninety-five patients, 78 with malignant SPLs (including 48 with adenocarcinoma [AC] and 17 with squamous cell carcinoma [SCC]), and 17 with benign SPLs.

FIELD STRENGTH/SEQUENCE: Fast spin-echo (FSE) T2WI, FSE APTw and echo-planar imaging IVIM, MR-base attenuation correction (MRAC), and PET imaging on a 3-T whole-body PET/MR system.

ASSESSMENT: The magnetization transfer ratio asymmetry (MTRasym) at 3.5 ppm, diffusion coefficient (D), pseudo diffusion coefficient (D*), perfusion fraction (f), and the maximum standardized uptake value (SUVmax) were analyzed.

STATISTICAL TESTS: Individual sample t-test, Delong test, Pearson’s correlation analysis, and area under the receiver operating characteristic curve (AUC). P < 0.05 indicated statistical significance.

RESULTS: The MTRasym and SUVmax were significantly higher, and D was significantly lower in the malignant group (3.3 ± 2.6 [%], 7.8 ± 5, and 1.2 ± 0.3 [×10^-3 mm² /second]) compared to the benign group (-0.3 ± 1.6 [%], 3.1 ± 3.8, and 1.6 ± 0.3 [×10^-3 mm² /second]). The MTRasym and D were significantly lower, and SUVmax was significantly higher in the SCC group (0.8 ± 1.0 [%], 1.0 ± 0.2 [×10^-3 mm² /second] than in the AC group (4.1 ± 2.6 [%], 1.3 ± 0.3 [×10^-3 mm² /second], 6.7 ± 4.6). Besides, the combination (AUC = 0.964) of these three methods showed higher diagnostic efficacy than any individual method (AUC = 0.917, 0.851, 0.82, respectively) in identifying malignant and benign SPLs. However, APTw showed better diagnostic efficacy than the combination of three methods or PET imaging alone in distinguishing SCC and AC groups (AUC = 0.934, 0.781, 0.725, respectively).

DATA CONCLUSION: APTw, IVIM, and PET imaging are all effective methods to distinguish benign and malignant SPLs and their subtypes. APTw is potentially more capable than PET imaging of distinguishing lung SCC from AC.

LEVEL OF EVIDENCE: 2 TECHNICAL EFFICACY: Stage 2.

PMID:34723413 | DOI:10.1002/jmri.27977

JACS Au. 2021 Aug 26;1(10):1556-1571. doi: 10.1021/jacsau.1c00297. eCollection 2021 Oct 25.

ABSTRACT

Polymers with precisely defined monomeric sequences present an exquisite tool for controlling material properties by harnessing both the robustness of synthetic polymers and the ability to tailor the inter- and intramolecular interactions so crucial to many biological materials. While polymer scientists traditionally synthesized and studied the physics of long molecules best described by their statistical nature, many biological polymers derive their highly tailored functions from precisely controlled sequences. Therefore, significant effort has been applied toward developing new methods of synthesizing, characterizing, and understanding the physics of non-natural sequence-defined polymers. This perspective considers the synergistic advantages that can be achieved via tailoring both precise sequence control and attributes of traditional polymers in a single system. Here, we focus on the potential of sequence-defined polymers in highly associating systems, with a focus on the unique properties, such as enhanced proton conductivity, that can be attained by incorporating sequence. In particular, we examine these materials as key model systems for studying previously unresolvable questions in polymer physics including the role of chain shape near interfaces and how to tailor compatibilization between dissimilar polymer blocks. Finally, we discuss the critical challenges-in particular, truly scalable synthetic approaches, characterization and modeling tools, and robust control and understanding of assembly pathways-that must be overcome for sequence-defined polymers to attain their potential and achieve ubiquity.

PMID:34723259 | PMC:PMC8549048 | DOI:10.1021/jacsau.1c00297

JACS Au. 2021 Jul 22;1(10):1708-1718. doi: 10.1021/jacsau.1c00300. eCollection 2021 Oct 25.

ABSTRACT

This work considers the evaluation of density functional theory (DFT) when comparing against experimental observations of CO binding trends on the strong binding Pt(111) and intermediate binding Cu(111) and for weak binding Ag(111) and Au(111) surfaces important in electrocatalysis. By introducing thermal fluctuations using appropriate statistical mechanical NVT and NPT ensembles, we find that the RPBE and B97M-rV DFT functionals yield qualitatively better metal surface strain trends and CO enthalpies of binding for Cu(111) and Pt(111) than found at 0 K, thereby correcting the overbinding by 0.2 to 0.3 eV to yield better agreement with the enthalpies determined from experiment. The importance of dispersion effects are manifest for the weak CO binding Ag(111) and Au(111) surfaces at finite temperatures in which the RPBE functional does not bind CO at all, while the B97M-rV functional shows that the CO-metal interactions are a mixture of chemisorbed and physisorbed species with binding enthalpies that are within ∼0.05 eV of experiment. Across all M(111) surfaces, we show that the B97M-rV functional consistently predicts the correct atop site preference for all metals due to thermally induced surface distortions that preferentially favor the undercoordinated site. This study demonstrates the need to fully account for finite temperature fluctuations to make contact with the binding enthalpies from surface science experiments and electrocatalysis applications.

PMID:34723274 | PMC:PMC8549055 | DOI:10.1021/jacsau.1c00300