The effect of endometriosis on live birth rate and other reproductive outcomes in ART cycles: a cohort study

Study question: What is the effect of endometriosis compared to unexplained subfertility on live birth rate in women undergoing IVF and embryo transfer (ET)? Summary answer: Endometriosis decreases live birth rate in women undergoing IVF-ET treatment, particularly with increasing severity of the disease. What is known already: Endometriosis affects up to 50% of women seeking fertility treatment and is known to reduce fecundity. There remains a debate as to effects of endometriosis on the outcomes of IVF treatment, with live birth being a secondary outcome or not reported in most studies. Study design, size, duration: A retrospective cohort study analyzing data of IVF treatment cycles from January 2000 to December 2014 was carried out. Participants/materials, setting, methods: Women with endometriosis (n = 531) and women with unexplained subfertility (n = 737) undergoing a first cycle of IVF-ET in a tertiary fertility treatment center were included in the study. The primary outcome was live birth. Other outcome measures were response to ovarian stimulation, embryo development and implantation rate. Bivariate and multivariate logistic regression analysis was performed and differences compared using Chi squared test of Student’s t-test as appropriate. Main results and the role of chance: Women with endometriosis had 24% less likelihood of a live birth when compared to those with unexplained subfertility [odds ratio (OR) 0.76 (95% CI, 0.59–0.98) P = 0.035]. This effect became more apparent with increasing severity of endometriosis. Using multivariable logistic regression analysis, the trend for lower live birth rate remained but did not reach statistical significance [adjusted OR 0.76 (95% CI 0.56–1.03), P = 0.078]. Women with endometriosis were as likely as those with unexplained subfertility to have a singleton live birth when two embryos were transferred as opposed to a single ET [OR 1.38 (95% CI 0.73–2.62), P = 0.32 and OR 3.22 (95% CI 1.7–6.05), P = 0.0003, respectively]. Compared to women with unexplained subfertility, those with endometriosis had fewer oocytes retrieved [(10.54 (95% CI 10.13–0.95) and 9.15 (95% CI 8.69–9.6), respectively], lower blastocyst transfer [OR 0.24 (95% CI 0.12–0.5), P = 0.0001] and a significantly reduced implantation rate [OR 0.73 (0.58–0.92), P = 0.007]. Limitations reasons for caution: The study is limited by a retrospective design. By limiting the study to a single ET cycle, it was not possible to assess the cumulative outcome including use of all frozen embryos. Wider implications of the findings: Endometriosis has similar phenotypes among women in different populations and would be expected to have a similar effect on fertility. These results are therefore generalizable to other populations of women. Study funding/competing interest(s): None. Trial registration number: Not applicable

Elevated calcitonin precursor levels are related to mortality in an animal model of sepsis

BACKGROUND: Increased serum levels of procalcitonin (ProCT) and its component peptides have been reported in humans with sepsis. Using a hamster model of bacterial peritonitis, we investigated whether serum ProCT levels are elevated and correlate with mortality and hypocalcemia. RESULTS: Incremental increases in doses of bacteria resulted in proportional increases in 72h mortality rates (0, 20, 70, and 100%) as well as increases in serum total immunoreactive calcitonin (iCT) levels at 12 h (250, 380, 1960, and 4020 pg/ml, respectively, vs control levels of 21 pg/ml). Gel filtration studies revealed that ProCT was the predominant (> 90%) molecular form of serum iCT secreted. In the metabolic experiments, total iCT peaked at 12 h concurrent with the maximal decrease in serum calcium. CONCLUSIONS: In this animal model, hyper-procalcitoninemia was an early systemic marker of sepsis which correlated closely with mortality and had an inverse correlation with serum calcium levels

A Look at the Generalized Heron Problem through the Lens of Majorization-Minimization

In a recent issue of this journal, Mordukhovich et al.\ pose and solve an interesting non-differentiable generalization of the Heron problem in the framework of modern convex analysis. In the generalized Heron problem one is given $k+1$ closed convex sets in \Real^d equipped with its Euclidean norm and asked to find the point in the last set such that the sum of the distances to the first $k$ sets is minimal. In later work the authors generalize the Heron problem even further, relax its convexity assumptions, study its theoretical properties, and pursue subgradient algorithms for solving the convex case. Here, we revisit the original problem solely from the numerical perspective. By exploiting the majorization-minimization (MM) principle of computational statistics and rudimentary techniques from differential calculus, we are able to construct a very fast algorithm for solving the Euclidean version of the generalized Heron problem.Comment: 21 pages, 3 figure

Quasi-experimental study designs series-paper 6: risk of bias assessment.

OBJECTIVES: Rigorous and transparent bias assessment is a core component of high-quality systematic reviews. We assess modifications to existing risk of bias approaches to incorporate rigorous quasi-experimental approaches with selection on unobservables. These are nonrandomized studies using design-based approaches to control for unobservable sources of confounding such as difference studies, instrumental variables, interrupted time series, natural experiments, and regression-discontinuity designs. STUDY DESIGN AND SETTING: We review existing risk of bias tools. Drawing on these tools, we present domains of bias and suggest directions for evaluation questions. RESULTS: The review suggests that existing risk of bias tools provide, to different degrees, incomplete transparent criteria to assess the validity of these designs. The paper then presents an approach to evaluating the internal validity of quasi-experiments with selection on unobservables. CONCLUSION: We conclude that tools for nonrandomized studies of interventions need to be further developed to incorporate evaluation questions for quasi-experiments with selection on unobservables

Optical Photometry of the Type Ia SN 1999ee and the Type Ib/c SN 1999ex in IC 5179

We present UBVRIz lightcurves of the Type Ia SN 1999ee and the Type Ib/c SN 1999ex, both located in the galaxy IC 5179. SN 1999ee has an extremely well sampled lightcurve spanning from 10 days before Bmax through 53 days after peak. Near maximum we find systematic differences ~0.05 mag in photometry measured with two different telescopes, even though the photometry is reduced to the same local standards around the supernova using the specific color terms for each instrumental system. We use models for our bandpasses and spectrophotometry of SN 1999ee to derive magnitude corrections (S-corrections) and remedy this problem. This exercise demonstrates the need of accurately characterizing the instrumental system before great photometric accuracies of Type Ia supernovae can be claimed. It also shows that this effect can have important astrophysical consequences since a small systematic shift of 0.02 mag in the B-V color can introduce a 0.08 mag error in the extinction corrected peak B magnitudes of a supernova and thus lead to biased cosmological parameters. The data for the Type Ib/c SN 1999ex present us with the first ever observed shock breakout of a supernova of this class. These observations show that shock breakout occurred 18 days before Bmax and support the idea that Type Ib/c supernovae are due to core collapse of massive stars rather than thermonuclear disruption of white dwarfs.Comment: 55 pages, 15 figures, accepted by the Astronomical Journa

Small Prototype Gamma Spectrometer Using CsI(Tl) Scintillator Coupled to a Solid-State Photomultiplier

Small solid-state photomultipliers (SSPMs) are an alternative scintillator light-detection technology to traditional photomultiplier tubes that offer advantages such as lower bias voltages and insensitivity to magnetic fields. A digital spectrometer using a commercially available SSPM was constructed and characterized at Oregon State University as a prototype for small, highly-mobile, low-power, robust spectroscopy devices. The SSPM has over 19,000 microcells in a photo-sensitive area of 6.32 x 6.32 mm and was coupled to 6 x 6 x 10 mm reflectively-coated CsI(Tl) crystals. The rest of the spectrometer consists of a fast preamplifier and 200 MHz, 12-bit digital pulse processor based around a field-programmable gate array (FPGA). The efficiency, resolution, linearity, and peak-to-Compton ratio of the system were characterized.This is an author's peer-reviewed final manuscript, as accepted by the publisher. The published article is copyrighted by IEEE-Institute of Electrical and Electronics Engineers and can be found at: http://ieeexplore.ieee.org/xpl/RecentIssue.jsp?punumber=23. (c) 2013 IEEE. Personal use of this material is permitted. Permission from IEEE must be obtained for all other users, including reprinting/republishing this material for advertising or promotional purposes, creating new collective works for resale or redistribution to servers or lists, or reuse of any copyrighted components of this work in other works.Keywords: scintillation, gamma radiation detection, digital pulse processing, solid-state photomultiplierKeywords: scintillation, gamma radiation detection, digital pulse processing, solid-state photomultiplie

Pennsylvania Folklife Vol. 36, No. 4

• The Art of Glass Blowing • Portrait Painting • The Ox Roast • Herbal Soap-Making • Fly-Fishing and Fly-Tying • Chalkware • Silversmithing • Festival Focus • Festival Programs • Coopering • Knife Making • Corn Husk Dolls • Salt Glaze Pottery • Blacksmithing and Iron Working • Bird Carving • Soft Pretzelshttps://digitalcommons.ursinus.edu/pafolklifemag/1116/thumbnail.jp

I smoke to cope with pain: patients\u27 perspectives on the link between cigarette smoking and pain

BACKGROUND: For people with chronic pain, cigarette smoking is associated with greater pain intensity and impairment. Researchers have hypothesized a reciprocal relationship in which pain and smoking exacerbate each other, resulting in greater pain and increased smoking. This study aimed to qualitatively examine patient perspectives on this association. METHODS: A retrospective thematic analysis of smoking cessation counseling notes for 136 veterans in the Pain and Smoking Study, a tailored smoking cessation trial, was conducted. A validated codebook was applied to each counseling note by four independent coders using Atlas.ti (Atlas.ti, Berlin, Germany). Coders participated in a consensus-forming exercise with salient themes validated among the wider research team. KEY RESULTS: Participants averaged 60 years of age (range 28-77 years) and were 9% female. The median number of cigarettes smoked per day was 15, with a mean pain intensity score in the last week (from 0-10) of 5.1. While not all patients acknowledged a connection between pain and smoking, we found that (1) pain motivates smoking and helps manage pain-related distress, as a coping strategy and through cognitive distraction, and (2) pain motivates smoking but smoking does not offer pain relief. Concerns about managing pain without smoking was identified as a notable barrier to cessation. CONCLUSION: Many patients with chronic pain who smoke readily identified pain as a motivator of their smoking behavior and are reluctant to quit for this reason. Integrated interventions for smokers with pain should address these perceptions and expectancies and promote uptake of more adaptive self-management strategies for pain