Revitalization of thiazolidinedione the optimum agents to be combined with SGLT 2 inhibitors to optimize glycemic control and reduce cardiovascular mortality: randomized control trial

Background: Type 2 diabetes mellitus (T2DM) significantly increases morbidity and mortality from cardiovascular disease. The present study was conducted to know the effect of thiazolidinedione and SGLT2 inhibitor on glycemic control, blood pressure and lipid profile and effect on cardiovascular mortality in T2DM. Methods: A total 80 patients of aged ≥40 years with T2DM were included and divided into 4 groups based on ongoing treatment i.e., (lifestyle modification + Tab metformin 500mg BD) + 1) Tab metformin 500mg; 2) Tab dapagliflozin 10mg OD; 3) Tab pioglitazone 15mg OD; 4) Tab pioglitazone 15mg OD + Tab Dapagliflozin 10mg OD. Results: The change in FBS, PLBS and HbA1C from pre-intervention to post-intervention was highest in the patients with DAPA + pioglitazone group followed by patients with pioglitazone group then the patients with DAPA group and lowest in patients with metformin group. There was a statistically significant difference between them, (p<0.001). The weight reduction was highest in the patients with DAPA 10mg group followed by patients with metformin group, (p<0.001). The change in SBP, DBP and change in lipid profile (triglyceride and cholesterol, LDL and HDL) from pre-intervention to post-intervention was highest in the patients with DAPA+ pioglitazone group. This change was statistically significant (p<0.001). Conclusions: The combination of pioglitazone and dapagliflozin not only helped in glycemic control but also had reduction in blood pressures, improvement in the lipid profile and caused slight weight reduction. There were no major adverse drug reactions, and no MACE was observed during the study. Hence this combination of pioglitazone and dapagliflozin may reduce the cardiovascular mortality (which needs longer duration study)

Room temperature ferromagnetism in sol-gel prepared Co-doped ZnO

We report on the high temperature ferromagnetism in Co-doped ZnO samples with 2%, 4% and 6% nominal Co concentrations prepared by the sol-gel method. X-ray diffraction and X-ray photoelectron spectroscopy analyses confirm the absence of metallic Co clusters or any other impurity phases different from wurtzite-type ZnO. It is also observed that Co has occupied Zn sites. UV-visible absorption studies show an increase in band gap with Co concentration. The field dependence of magnetization exhibited clear ferromagnetism at room temperature with saturation magnetization and coercive field of the order of 0.0066-0.0239 emu/g and 149.09-40.31 Oe, respectively. Increase of saturation magnetization value with Co doping indicated that the ferromagnetism in the samples may be due to percolation of bound magnetic polarons. (C) 2012 Elsevier Ltd. All rights reserved.15331431

An expert commentary on essential equipment, supplies and culture media in the assisted reproductive technology laboratory

International audienceThe assisted reproductive technology (ART) laboratory is a complex system designed to sustain the fertilization, survival, and culture of the preimplantation embryo to the blastocyst stage. ART outcomes depend on numerous factors, among which are the equipment, supplies and culture media used. The number and type of incubators also may affect ART results. While large incubators may be more suitable for media equilibration, bench-top incubators may provide better embryo culture conditions in separate or smaller chambers and may be coupled with time-lapse systems that allow continuous embryo monitoring. Microscopes are essential for observation, assessment, and micromanipulation. Workstations provide a controlled environment for gamete and embryo handling and their quantity should be adjusted according to the number of ART cycles treated in order to provide a steady and efficient workflow. Continuous maintenance, quality control and monitoring of equipment are essential and quality control devices such as the thermometer, and pH-meter are necessary to maintain optimal culture conditions. Tracking, appropriate delivery and storage conditions, and quality control of all consumables are recommended so that adequate quantity and quality are available for use. Embryo culture media have evolved: preimplantation embryos are cultured either by sequential media or single-step media that can be used for interrupted or uninterrupted culture. There is currently no sufficient evidence that any individual commercially-available culture system is better than others in terms of embryo viability. In this review, we aim to analyze the various parameters that should be taken into account when choosing the essential equipment, consumables and culture media systems that will create optimal culture conditions and provide the most effective patient treatment

Oocyte quality and embryo selection strategies: a review for the embryologists, by the embryologists

International audienceWith the advance of assisted reproduction techniques, and the trend towards blastocyst culture and single embryo transfer, gamete and embryo assessment have gained greater importance in ART treatment. Embryo quality depends mainly on gamete quality and culture conditions. Oocyte maturity identification is necessary in order to plan fertilization timing. Mature oocytes at the metaphase II stage show a higher fertilization rate compared to immature oocytes. Morphology assessment is a critical yet challenging task that may serve as a good prognostic tool for future development and implantation potential if done effectively. Various grading systems have been suggested to assess embryos at pronuclear, cleavage, and blastocyst stages. By identifying the embryo with the highest implantation potential, it is possible to reduce the number of embryos transferred without compromising the chances of a successful pregnancy. Apart from the conventional morphology assessment, there are several invasive or non-invasive methods for embryo selection such as preimplantation genetic testing, morphokinetics, proteomics, metabolomics, oxygen consumption, and measurement of oxidative stress in culture medium. Morphokinetics is a method based on time-lapse technology and continuous monitoring of embryos. In this review, we aimed to describe and compare the most effective and widely used methods for gamete and embryo assessment as well as embryo selection

Optimizing embryological aspects of oocyte retrieval, oocyte denudation, and embryo loading for transfer

International audienceOocyte retrieval, oocyte denudation, and embryo transfer are crucial processes during assisted reproduction technology (ART). Air quality in the ART laboratory, temperature, pH of the media used and the time interval between oocyte retrieval and insemination are all critical factors. Anesthesia is required for oocyte retrieval, however, evidence regarding the potential impact of different methods (general anesthesia, conscious sedation, and local anesthesia) on the clinical outcomes is unclear. The optimal timing of oocyte denudation following retrieval has not been established. Regarding the mechanical denudation process, there is a lack of evidence to demonstrate the safest minimum inner diameter of denuding pipettes used to complete the removal of granulosa cells surrounding the oocytes. During embryo transfer, many clinics worldwide flush the catheter before embryo loading, in an attempt to potentially rinse off any toxic agents; however, there is insufficient evidence to show that flushing the embryo transfer catheter before loading increases the success of ART outcome. Considering the serious gaps in knowledge in ART practice, the aim of this review is to provide an updated overview of the current knowledge regarding the various steps and techniques involved in oocyte retrieval, oocyte denudation, and embryo loading for transfer

Sperm morphology assessment in the era of intracytoplasmic sperm injection: Reliable results require focus on standardization, quality control, and training

Semen analysis is the first, and frequently, the only step in the evaluation of male fertility. Although the laboratory procedures are conducted according to the World Health Organization (WHO) guidelines, semen analysis and especially sperm morphology assessment is very difficult to standardize and obtain reproducible results. This is mainly due to the highly subjective nature of their evaluation. ICSI is the choice of treatment when sperm morphology is severely abnormal (teratozoospermic). Hence, the standardization of laboratory protocols for sperm morphology evaluation represents a fundamental step to ensure reliable, accurate and consistent laboratory results that avoid misdiagnoses and inadequate treatment of the infertile patient. This article aims to promote standardized laboratory procedures for an accurate evaluation of sperm morphology, including the establishment of quality control and quality assurance policies. Additionally, the clinical importance of sperm morphology results in assisted reproductive outcomes is discussed, along with the clinical management of teratozoospermic patients

A comprehensive guide to sperm recovery in infertile men with retrograde ejaculation

International audienceRetrograde ejaculation (RE) is a condition defined as the backward flow of the semen during ejaculation, and when present can result in male infertility. RE may be partial or complete, resulting in either low seminal volume or complete absence of the ejaculate (dry ejaculate). RE can result from anatomic, neurological or pharmacological conditions. The treatment approaches outlined are determined by the cause. Alkalinizing urinary pH with oral medications or by adding sperm wash media into the bladder prior to ejaculation may preserve the viability of the sperm. This article provides a step-by-step guide to diagnose RE and the optimal techniques to retrieve sperm. Copyrigh

Sperm Morphology Assessment in the Era of Intracytoplasmic Sperm Injection: Reliable Results Require Focus on Standardization, Quality Control, and Training

Semen analysis is the first, and frequently, the only step in the evaluation of male fertility. Although the laboratory procedures are conducted according to the World Health Organization (WHO) guidelines, semen analysis and especially sperm morphology assessment is very difficult to standardize and obtain reproducible results. This is mainly due to the highly subjective nature of their evaluation. ICSI is the choice of treatment when sperm morphology is severely abnormal (teratozoospermic). Hence, the standardization of laboratory protocols for sperm morphology evaluation represents a fundamental step to ensure reliable, accurate and consistent laboratory results that avoid misdiagnoses and inadequate treatment of the infertile patient. This article aims to promote standardized laboratory procedures for an accurate evaluation of sperm morphology, including the establishment of quality control and quality assurance policies. Additionally, the clinical importance of sperm morphology results in assisted reproductive outcomes is discussed, along with the clinical management of teratozoospermic patients