Depression in Adults with Congenital Heart Disease: Prevalence, Prognosis, and Intervention

Data on the prevalence of depression in adult congenital heart disease (ACHD) patients differ widely. We aim to summarize the best available information on the prevalence of depression, its prognostic impact, and psychiatric interventions for depressed ACHD patients. We reviewed references in relevant publications up to October 17, 2017. For homogeneity of data, studies in which depression was independently assessed in patients aged 18 years or older or with a mean/median age older than 18 years were included. Retrospective and postoperative evaluation studies were excluded. Twenty publications met these criteria. Study samples included ACHD patients followed up at ACHD-specialized hospitals in 13 countries. The prevalence of depression differed widely, ranging from 6 to 69%. Depression has been shown to be an independent predictor of adverse clinical outcomes. It is also frequently associated with other prognostic variables (i.e., poor functional class, unfavorable perceived health status, and low quality of life). Currently, no randomized clinical trials on psychiatric interventions in ACHD are available. In summary, depression is highly prevalent in ACHD patients, yet it is often unrecognized and untreated. The adverse prognostic impact of depression calls for specialized psychiatric interventions, for which more research is needed in the ACHD patient population

Does advancing male age influence the expression levels and localisation patterns of phospholipase C zeta (PLCζ) in human sperm?

Socio-economic factors have led to an increasing trend for couples to delay parenthood. However, advancing age exerts detrimental effects upon gametes which can have serious consequences upon embryo viability. While such effects are well documented for the oocyte, relatively little is known with regard to the sperm. One fundamental role of sperm is to activate the oocyte at fertilisation, a process initiated by phospholipase C zeta (PLCζ), a sperm-specific protein. While PLCζ deficiency can lead to oocyte activation deficiency and infertility, it is currently unknown whether the expression or function of PLCζ is compromised by advancing male age. Here, we evaluate sperm motility and the proportion of sperm expressing PLCζ in 71 males (22–54 years; 44 fertile controls and 27 infertile patients), along with total levels and localisation patterns of PLCζ within the sperm head. Three different statistical approaches were deployed with male age considered both as a categorical and a continuous factor. While progressive motility was negatively correlated with male age, all three statistical models concurred that no PLCζ–related parameter was associated with male age, suggesting that advancing male age is unlikely to cause problems in terms of the sperm’s fundamental ability to activate an oocyt

Depression in Adults with Congenital Heart Disease: Prevalence, Prognosis, and Intervention

Data on the prevalence of depression in adult congenital heart disease (ACHD) patients differ widely. We aim to summarize the best available information on the prevalence of depression, its prognostic impact, and psychiatric interventions for depressed ACHD patients. We reviewed references in relevant publications up to October 17, 2017. For homogeneity of data, studies in which depression was independently assessed in patients aged 18 years or older or with a mean/median age older than 18 years were included. Retrospective and postoperative evaluation studies were excluded. Twenty publications met these criteria. Study samples included ACHD patients followed up at ACHD-specialized hospitals in 13 countries. The prevalence of depression differed widely, ranging from 6 to 69%. Depression has been shown to be an independent predictor of adverse clinical outcomes. It is also frequently associated with other prognostic variables (i.e., poor functional class, unfavorable perceived health status, and low quality of life). Currently, no randomized clinical trials on psychiatric interventions in ACHD are available. In summary, depression is highly prevalent in ACHD patients, yet it is often unrecognized and untreated. The adverse prognostic impact of depression calls for specialized psychiatric interventions, for which more research is needed in the ACHD patient population

Genetic markers of ovarian follicle number and menopause in women of multiple ethnicities

Oocyte loss has a significant impact on fertility and somatic health. Yet, we know little about factors that impact this process. We sought to identify genetic variants associated with ovarian reserve (oocyte number as measured by antral follicle count, A

Study protocol for a Developmental Epidemiological Study of Children born through Reproductive Technologies (DESCRT).

Study questionsThe primary objective of this study is to determine what parental factors or specific ART may influence the risk for adverse cardiometabolic outcomes among children so conceived and their parents. The secondary objective of this study is to prospectively examine the effects of infertility or ART on the intrauterine environment, obstetric and neonatal outcomes.What is known alreadyPregnancies conceived with ART are at an increased risk of being affected by adverse obstetric and neonatal outcomes when compared to spontaneously conceived (SC) pregnancies among fertile women. Small cohort studies have suggested ART-conceived children may have a higher risk of long-term cardiometabolic disturbances as well. Currently, few studies have compared long-term cardiometabolic outcomes among ART-conceived children and non-IVF treated (NIFT) children, to children conceived spontaneously to parents with infertility (subfertile parents).Study design size durationThe Developmental Epidemiological Study of Children born through Reproductive Technologies (DESCRT) is a prospective cohort study that aims to: establish a biobank and epidemiological cohort of children born to subfertile or infertile parents who either conceived spontaneously (without assistance) or used reproductive technologies to conceive (all offspring were from couples assessed and/or treated in the same institute); prospectively examine the effects of infertility or ART on the intrauterine environment, obstetric and neonatal outcomes; and determine what parental factors or ART may influence the cardiometabolic risk of children so conceived. Pregnancies and resultant children will be compared by mode of conception, namely offspring that were conceived without medical assistance or SC or following NIFT, IVF with fresh embryo transfer or frozen embryo transfer (FET), and by fertilization method (conventional versus ICSI). DESCRT has a Child group evaluating long-term outcomes of children as well as a Pregnancy group that will compare obstetric and neonatal outcomes of children conceived since the commencement of the study. Recruitment started in May of 2017 and is ongoing. When the study began, we estimated that ∼4000 children would be eligible for enrollment.Participants/materials setting methodsEligible participants are first-trimester pregnancies (Pregnancy group) or children (Child group) born to parents who were evaluated at an infertility center in the University of California, San Francisco, CA, USA who were SC or conceived after reproductive treatments (NIFT, IVF ± ICSI, FET). Children in the Child group were conceived at UCSF and born from 2001 onwards. In the Pregnancy group, enrollment began in November of 2017.The primary outcome is the cardiometabolic health of offspring in the Child group, as measured by blood pressure and laboratory data (homeostatic model assessment for insulin resistance (HOMA-IR), oral glucose disposition). There are several secondary outcome measures, including: outcomes from parental survey response (assessing parent/child medical history since delivery-incidence of cardiometabolic adverse events), anthropomorphic measurements (BMI, waist circumference, skinfold thickness), and laboratory data (liver enzymes, lipid panel, metabolomic profiles). In the Pregnancy group, outcomes include laboratory assessments (bhCG, maternal serum analytes, soluble fms-like tyrosine kinase-1 (sFLT-1), and placental growth factor (PlGF)) and placental assessments (placental volume in the second and third trimester and placental weight at delivery). Importantly, aliquots of blood and urine are stored from parents and offspring as part of a biobank. The DESCRT cohort is unique in two ways. First, there is an extensive amount of clinical and laboratory treatment data: parental medical history and physical examination at the time of treatment, along with ovarian reserve and infertility diagnosis; and treatment specifics: for example, fertilization method, culture O2 status, embryo quality linked to each participant. These reproductive data will aid in identifying explanatory variables that may influence the primary cardiometabolic outcomes of the offspring-and their parents. Second, the DESCRT control group includes pregnancies and children SC from parents with subfertility, which may help to assess when infertility, as opposed to reproductive treatments, may be affecting offspring cardiometabolic health.Study funding/competing interestsThis study is funded by the National Institutes of Health NICHD (1R01HD084380-01A1). A.J.A. is a shareholder in Carrot and consultant for Flo Health. The other authors have no conflicts of interest.Trial registration numberNCT03799107.Trial registration date10 January 2019.Date of first patient’s enrollment10 May 2017

The sensitivity and specificity of hyperglycosylated hCG (hhCG) levels to reliably diagnose clinical IVF pregnancies at 6 days following embryo transfer

Objective To determine the sensitivity and specificity of hyperglycosylated hCG (hhCG) measurements for the diagnosis of clinical pregnancies in the IVF setting and how soon post embryo transfer (ET) a pregnancy can be detected using an ultrasensitive (hh

Psychological stress and reproductive aging among pre-menopausal women

BackgroundLife history models suggest that biological preparation for current versus longer term reproduction is favored in environments of adversity. In this context, we present a model of reproductive aging in which environmental adversity is proposed to increase the number of growing follicles at the cost of hastening the depletion of the ovarian reserve over time. We evaluated this model by examining psychological stress in relation to reproductive aging indexed by antral follicle count (AFC), a marker of total ovarian reserve. We hypothesized that stress would be related to (i) higher AFC in younger women, reflecting greater reproductive readiness as well as (ii) greater AFC loss across women, reflecting more accelerated reproductive aging.MethodsIn a multi-ethnic, community sample of 979 participants [ages 25-45 (mean (standard deviation) = 35.2 (5.5)); 27.5% Caucasian] in the Ovarian Aging study, an investigation of the correlates of reproductive aging, the interaction of age-x-stress was assessed in relation to AFC to determine whether AFC and AFC loss varied across women experiencing differing levels of stress. Stress was assessed by the perceived stress scale and AFC was assessed by summing the total number of antral follicles visible by transvaginal ultrasound.ResultsIn linear regression examining AFC as the dependent variable, covariates (race/ethnicity, socio-economic status, menarcheal age, hormone-containing medication for birth control, parity, cigarette smoking, bodymass index, waist-to-hip ratio) and age were entered on step 1, stress on step 2 and the interaction term (age-x-stress) on step 3. On step 3, significant main effects showed that older age was related to lower AFC (b = -0.882, P = 0.000) and greater stress was related to higher AFC (b = 0.545, P = 0.005). Follow-up analyses showed that the main effect of stress on AFC was present in the younger women only. A significant interaction term (b = -0.036, P = 0.031) showed the relationship between age and AFC varied as function of stress. When the sample was divided into tertiles of stress, the average follicle loss was -0.781, -0.842 and -0.994 follicles/year in the low-, mid- and high-stress groups, respectively.ConclusionsPsychological stress was related to higher AFC among younger women and greater AFC decline across women, suggesting that greater stress may enhance reproductive readiness in the short term at the cost of accelerating reproductive aging in the long term. Findings are preliminary, however, due to the cross-sectional nature of the current study

Somatic cells regulate maternal mRNA translation and developmental competence of mouse oocytes

Germ cells divide and differentiate in a unique local microenvironment under the control of somatic cells. Signals released in this niche instruct oocyte reentry into the meiotic cell cycle. Once initiated, the progression through meiosis and the associat

The effect of shared intentionality on technology dynamics.

<p>Blue-colored vertices represent individuals playing ‘new’, white vertices represent individuals playing ‘old’. Individuals not shown are assumed to be playing ‘old’. <b>a:</b> In the absence of SI, the only better response for any individual is to retain his current strategy. <b>b:</b> For low <i>α</i>, coalitions of SI type individuals can coordinate payoff improving switches back to ‘old’. <b>c:</b> For high <i>α</i>, coalitions of SI type individuals can coordinate payoff improving switches to ‘new’ [<a href="http://www.ploscompbiol.org/article/info:doi/10.1371/journal.pcbi.1004587#pcbi.1004587.ref014" target="_blank">14</a>]. Note that threshold values of <i>α</i> depend on graph structure and that different interaction structures can yield different thresholds [<a href="http://www.ploscompbiol.org/article/info:doi/10.1371/journal.pcbi.1004587#pcbi.1004587.ref014" target="_blank">14</a>, <a href="http://www.ploscompbiol.org/article/info:doi/10.1371/journal.pcbi.1004587#pcbi.1004587.ref046" target="_blank">46</a>]. For an example with explicitly calculated thresholds, see Section S2.2.</p