Cryopreservation time does not decrease follicular viability in ovarian tissue frozen for fertility preservation

OBJECTIVE: To determine the effect of storage duration on cryopreserved ovarian tissue using fresh and frozenthawed samples. METHODS: Seventeen fertile patients underwent an ovarian biopsy during elective laparoscopic tubal ligation. The tissue sample was divided into three parts: one part was processed fresh (FG), and two were slowly frozen, cryopreserved for 30 (G30) or 180 days (G180), thawed and analyzed. Follicular density, follicular viability, and steroidogenic capacity were assessed. RESULTS: We observed no differences between the groups in follicular density, which was assessed in hematoxylin and eosin-stained tissue sections. A heterogeneous follicular distribution was observed in the parenchyma, with a mean density of 361.3±255.4, 454.9±676.3, and 296.8±269.0 follicles/mm3 for FG, G30 and G180, respectively (p = 0.46). Follicular viability was greater in FG (93.4%) when compared with the cryopreserved tissues (70.8% for G30 (p<0.001) and 78.4% for G180 (p<0.001)), with no difference in viability between the frozen samples (p>0.05). The steroidogenic capacity of the tissue was not significantly reduced following cryopreservation. CONCLUSION: The slow freezing procedures used for ovarian cryopreservation are capable of preserving follicular viability and maintaining the steroidogenic capacity of the tissue despite a roughly 30% decrease in follicular viability. Furthermore, short-term storage of ovarian tissue does not appear to compromise follicle integrity

Concentration of steroid hormones in the follicular fluid of mature and immature ovarian follicles of patients with polycystic ovary syndrome submitted to in vitro fertilization

OBJETIVO: avaliar a concentração dos hormônios esteroides no fluido folicular (FF) de folículos pequenos (10-14 mm) e grandes (&gt; 18 mm) de mulheres com síndrome dos ovários policísticos (SOP) submetidas à hiperestimulação ovariana controlada (HOC) e ciclos de fertilização in vitro (FIV). MÉTODOS: estudo caso-controle foi conduzido em 13 mulheres inférteis com SOP (17 ciclos) e 31 mulheres inférteis por fator masculino - Grupo Controle (31 ciclos). Os FF foram aspirados individualmente e dividos em 4 grupos: G1 (FF pequeno do Grupo Controle), G2 (FF pequeno do grupo SOP), G3 (FF grande do Grupo Controle) e G4 (FF grande do grupo SOP). A metodologia utilizada para as dosagens de estradiol, progesterona e &#946;-hCG foi a quimioluminescência, e de testosterona e androstenediona o radioimunoensaio. Para a análise das dosagens hormonais no FF entre os grupos SOP e Controle utilizou-se o teste t não-pareado, e para a comparação entre os quatro grupos, o ANOVA. Para a taxa de gravidez, foi utilizado o teste exato de Fisher. RESULTADOS: os folículos pequenos dos dois grupos tiveram valores menores de progesterona (8.435±3.305 ng/mL) comparados aos grandes (10.280±3.475 ng/mL), com valor de p<0,01. Os níveis de progesterona de todos os folículos do grupo SOP (8.095±4.151 ng/mL) foram inferiores ao Controle (9.824±3.128 ng/mL), com valor de p=0,03. Os níveis de testosterona diferiram entre G1 (326,6±124,4 ng/dL) e G3 (205,8±98,91 ng/dL), com valor de p<0,001, e entre G3 (205,8±98,91 ng/dL) e G4 (351,10±122,1 ng/dL), com valor de p<0,001. Os folículos pequenos (508,9±266 ng/dL) apresentaram valores superiores de testosterona comparados aos grandes (245,10±123 ng/dL), com valor de p<0,0001. As taxas de gravidez não diferiram entre os grupos SOP (5/13, 38,5%) e Controle (9/31, 40,9%), com valor de p=072. CONCLUSÕES: mulheres com SOP apresentam altas concentrações de testosterona no FF, independentemente do estágio de desenvolvimento folicular, e níveis de progesterona diminuídos, sugerindo que fatores parácrinos podem inibir sua secreção pelas células foliculares. As taxas de gravidez mostraram que o tratamento de HOC e FIV é uma boa opção para mulheres com infertilidade secundária à SOP.PURPOSE: to evaluate the concentration of steroid hormones in follicular fluid (FF) of small (10-14 mm) and large (&gt; 18 mm) follicles of women with polycystic ovary syndrome (PCOS) submitted to controlled ovarian hyperstimulation (COH) and in vitro fertilization (IVF) cycles. METHODS: a case-control study was conducted on 13 infertile women with PCOS (17 cycles) and 31 infertile women due to male factor - Control Group (31 cycles). FF was aspirated individually and divided into four groups: G1 (FF of small follicles of the Control Group), G2 (FF of small follicles of the PCOS group), G3 (FF of large follicles of the Control Group) and G4 (FF of large follicles of the PCOS group). Estrogen, progesterone and &#946;-hCG were determined by chemiluminescence, and testosterone and androstenedione by radioimmunoassay. The unpaired t-test was used to compare the hormone determinations in the FF of the PCOS and Control Groups, and the four groups were compared by ANOVA. Fisher's exact test was used to compare the pregnancy rates. RESULTS: the small follicles of the two groups had lower progesterone levels (8,435±3,305 ng/mL) than large follicles (10,280±3,475 ng/mL), p-value <0.01. The progesterone levels of all follicles of group PCOS (8,095±4,151 ng/mL) were lower than Control (9,824±3,128 ng/mL), p-value =0.03. Testosterone differed between G1 (326.6±124.4 ng/dL) and G3 (205.8±98.91 ng/dL), p-value <0.001, and between G3 (205.8±98.91 ng/dL) and G4 (351.10±122.1ng/dL), p-value <0.001. Small follicles had higher testosterone levels (508.9±266 ng/dL) than large follicles (245.10±123 ng/dL), p-value <0.0001. The pregnancy rates did not differ between the PCOS (5/13, 38.5%) and the Control groups (9/31, 40.9%), p-value =072. CONCLUSIONS: women with PCOS had high testosterone concentrations in the FF, regardless of the stage of follicle development, and reduced progesterone levels, suggesting that paracrine factors may inhibit the secretion of the latter by follicular cells. The pregnancy rates showed that treatment with COH and IVF is a good option for women with infertility secondary to PCOS.Conselho Nacional de Desenvolvimento à Pesquisa e Tecnologia (CNPq

A promoção da saúde pelas ondas do rádio: um foco na propaganda de medicamentos

This article refers to the reporting experience developed in partnership among the Na-tional Agency for Sanitary Surveillance, Sanitary Surveillance of Juiz de Fora city − MG and Faculty of Pharmacy of the Federal University of Juiz de Fora involving radio commu-nicators, health professionals and academics to reflect and discuss on the Rational Use of Drugs. Fields of Health, Communication and Education have joined together to work towards a common interest. The high frequency of misleading advertisements of drugs has contributed to self-medication. Through the creation of the project “Health promo-tion through radio waves” we aimed, through a symposium, mobilize local radio stations, in order to reduce the rate of irregular drug advertisements broadcast by this medium. The symposium was attended by 159 participants, divided into the following categories: 102 students, 26 health professionals, media professionals and 5 participants classified in other categories. We found that the primary target audience, broadcasters, had poor adhesion pointing to the need for new strategies to mobilize this category. This initiative will favorably influence the Sanitary Surveillance’s reality transformation by means of health promotion and decreasing the sanitary risk generated by drug advertising in radio.Este trabalho refere-se à experiência desenvolvida em parceria com a Agência Nacional de Vigilância Sanitária, Vigilância Sanitária Municipal de Juiz de Fora − MG e Faculdade de Farmácia da Universidade Federal de Juiz de Fora, envolvendo radiocomunicadores, profissionais e acadêmicos da saúde para reflexão e discussão sobre o Uso Racional de Medicamentos. Os campos da Saúde, da Comunicação e da Educação se integraram para reunir esforços em prol de um interesse comum. A alta frequência de propagan-das enganosas de medicamentos tem contribuído para a automedicação. Através da criação do projeto “A promoção da saúde pelas ondas do rádio” buscamos, mediante a realização de seminário, a mobilização das emissoras de rádio locais, objetivando reduzir o índice de propagandas irregulares de medicamentos veiculados por esse meio de comunicação. O seminário contou com 159 participantes, distribuídos nas seguintes categorias: 102 estudantes, 26 profissionais de saúde, 5 profissionais de comunicação e 5 participantes enquadrados em outras categorias. Verificamos que o público alvo princi-pal − os radialistas − demonstrou pouca adesão, apontando para a necessidade de novas estratégias de mobilização da categoria que, a partir da consciência sanitária adquirida, atuará como promotora da saúde e contribuirá para reduzir o risco sanitário gerado pela propaganda de medicamentos no rádio

A IMPORTÂNCIA DA IMPLEMENTAÇÃO DOS CUIDADOS PALIATIVOS NA UNIDADE DE TERAPIA INTENSIVA

To discuss the importance of implementing palliative care in the intensive care unit through the existing literature. Methods: This is a qualitative integrative literature review. The search for the works involved in the research was carried out in the following databases: SCIELO, LILACS, BDENF and MEDLINE, using the health sciences descriptors: "Hospice care", "Palliative care" and "Intensive care unit". The inclusion criteria were: published between 2013 and 2023, with free access to full texts, articles in Portuguese, English and Spanish and related to the theme. Exclusion criteria were: duplicate articles, incomplete articles, abstracts, reviews, debates, articles published in event proceedings and unavailable in full. Results: This care has some principles that guarantee its effectiveness when implemented in the ICU, such as promoting individual and continuous care for patients, involving family members in this process, respecting the autonomy of the patient, establishing an environment conducive to the necessary care, among others. Conclusion: The study in question concludes that the implementation of palliative care in the ICU, despite having numerous barriers, promotes a less painful dying process when applied correctly by health professionals, among these aspects, the participation of the family in this process is emphasized.Discutir por meio da literatura existente acerca da importância da implementação dos cuidados paliativos na unidade de terapia intensiva. Métodos: Trata-se de uma revisão integrativa da literatura de caráter qualitativo. A busca dos trabalhos envolvidos na pesquisa foi realizada nas seguintes bases de dados: SCIELO, LILACS, BDENF e MEDLINE, a partir dos descritores em ciências da saúde: “Assistência hospitalar”, “Cuidados paliativos” e “Unidade de terapia intensiva”. Os critérios de inclusão foram: publicados no período entre 2013 e 2023, cujo acesso ao periódico era livre aos textos completos, artigos em idioma português, inglês e espanhol e relacionados a temática. Critérios de exclusão foram: artigos duplicados, incompletos, resumos, resenhas, debates, artigos publicados em anais de eventos e indisponíveis na íntegra. Resultados: Esses cuidados possuem alguns princípios que garantem a sua efetividade na implementação na UTI como promover o cuidado individual e continuo aos pacientes, envolver os familiares nesse processo, respeitar a autonomia do enfermo, estabelecer um ambiente propício aos cuidados necessários dentre outros. Conclusão: O estudo em questão conclui que a implementação dos cuidados paliativos na UTI apesar de possui inúmeras barreiras ele promover um processo de morrer menos doloroso quando aplicado corretamente por meio dos profissionais de saúde, dentre esses aspectos enfatiza-se a participação da família nesse processo

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation