Analysis of endometrial blood flow with color Doppler energy in predicting outcome in GnRH antagonist down regulated ICSI/IVF cycles: a prospective cohort study setting

Background: The study was conducted to assess the association between endometrial blood flow pattern assessed with colour Doppler around the day of HCG administration and IVF outcome following GnRH antagonist down regulated cycles.Methods: It was a prospective, cohort study. Total of sixty-eight patients undergoing IVF-ET/ICSI were recruited in the study. All the patients underwent controlled ovarian stimulation with a step-up protocol, and GnRH antagonists were used for down-regulation. Transvaginal ultrasound measurements of all patients were performed on the day of HCG injection. A 6.5 MHz pulsed Doppler system was used for blood flow analysis. Bilateral uterine arteries, pulsatility index and resistance index were calculated along with uterine artery peak systolic velocity on both sides. Endometrial blood flow was analysed by detecting flow in the intra-endometrial or the adjacent sub-endometrial regions.Results: Baseline FSH in pregnant group was lower (6.29) than non-pregnant group (7.36). The overall pregnancy rate was 45.6% (n=31) and the ongoing pregnancy rate was 41.1% (n=28). Total of 57 patients out of 68 patients had both good endometrial and sub-endometrial blood flow. The overall pregnancy rate in this group was 47.3%. Similarly, in patients who had minimal endometrial and sub-endometrial blood flow the pregnancy rate was 37.5%. There was no significant correlation between pregnancy outcomes and the color flow Doppler parameters such as average uterine PI, average uterine RI and right/left uterine peak systolic velocity.Conclusion: Uterine artery PI, RI and PSV has no role in predicting endometrial receptivity and thus pregnancy outcome in IVF-ET cycle, however those patient with good endometrial and sub-endometrial flow have higher pregnancy rate than those with minimal flow rate

Application of sub-micrometer vibrations to mitigate bacterial adhesion

As a prominent concern regarding implantable devices, eliminating the threat of opportunistic bacterial infection represents a significant benefit to both patient health and device function. Current treatment options focus on chemical approaches to negate bacterial adhesion, however, these methods are in some ways limited. The scope of this study was to assess the efficacy of a novel means of modulating bacterial adhesion through the application of vibrations using magnetoelastic materials. Magnetoelastic materials possess unique magnetostrictive property that can convert a magnetic field stimulus into a mechanical deformation. In vitro experiments demonstrated that vibrational loads generated by the magnetoelastic materials significantly reduced the number of adherent bacteria on samples exposed to Escherichia coli, Staphylococcus epidermidis and Staphylococcus aureus suspensions. These experiments demonstrate that vibrational loads from magnetoelastic materials can be used as a post-deployment activated means to deter bacterial adhesion and device infection

An evaluation of clouds and precipitation in convection-permitting forecasts for South Africa

Since 2016, the South African Weather Service (SAWS) has been running convective-scale simulations to assist with forecast operations across southern Africa. These simulations are run with a tropical configuration of the Met Office Unified Model (UM), nested in the Met Office global model, but without data assimilation. For November 2016, convection-permitting simulations at 4.4-km and 1.5-km grid length are compared against a simulation at 10-km grid length with convection parametrization (the current UM global atmosphere configuration) to identify the benefits of increasing model resolution for forecasting convection across southern Africa. The simulations are evaluated against satellite rainfall estimates, CloudSat vertical cloud profiles, and SAWS radar data. In line with previous studies using the UM, on a monthly time scale, the diurnal cycle of convection and the distribution of rainfall rates compare better against observations when convection-permitting model configurations are used. The SAWS radar network provides a three-dimensional composite of radar reflectivity for northeast South Africa at 6-minute intervals, allowing the evaluation of the vertical development of precipitating clouds and of the timing of the onset of deep convection. Analysis of four case study days indicates that the 4.4-km simulations have a later onset of convection than the 1.5-km simulations, but there is no consistent bias of the simulations against the radar observations across the case studies

General dynamical equations of motion for elastic body systems

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/76290/1/AIAA-11407-643.pd

Alzheimer’s disease-associated complement gene variants influence plasma complement protein levels

Background: Alzheimer’s disease (AD) has been associated with immune dysregulation in biomarker and genome-wide association studies (GWAS). GWAS hits include the genes encoding complement regulators clusterin (CLU) and complement receptor 1 (CR1), recognised as key players in AD pathology, and complement proteins have been proposed as biomarkers. Main body: To address whether changes in plasma complement protein levels in AD relate to AD-associated complement gene variants we first measured relevant plasma complement proteins (clusterin, C1q, C1s, CR1, factor H) in a large cohort comprising early onset AD (EOAD; n = 912), late onset AD (LOAD; n = 492) and control (n = 504) donors. Clusterin and C1q were significantly increased (p < 0.001) and sCR1 and factor H reduced (p < 0.01) in AD plasma versus controls. ROC analyses were performed to assess utility of the measured complement biomarkers, alone or in combination with amyloid beta, in predicting AD. C1q was the most predictive single complement biomarker (AUC 0.655 LOAD, 0.601 EOAD); combining C1q with other complement or neurodegeneration makers through stepAIC-informed models improved predictive values slightly. Effects of GWS SNPs (rs6656401, rs6691117 in CR1; rs11136000, rs9331888 in CLU; rs3919533 in C1S) on protein concentrations were assessed by comparing protein levels in carriers of the minor vs major allele. To identify new associations between SNPs and changes in plasma protein levels, we performed a GWAS combining genotyping data in the cohort with complement protein levels as endophenotype. SNPs in CR1 (rs6656401), C1S (rs3919533) and CFH (rs6664877) reached significance and influenced plasma levels of the corresponding protein, whereas SNPs in CLU did not influence clusterin levels. Conclusion: Complement dysregulation is evident in AD and may contribute to pathology. AD-associated SNPs in CR1, C1S and CFH impact plasma levels of the encoded proteins, suggesting a mechanism for impact on disease risk

Clinical translation of a click-labeled 18F-octreotate radioligand for imaging neuroendocrine tumors

© 2016 by the Society of Nuclear Medicine and Molecular Imaging, Inc. We conducted the first-in-human study of 18F-fluoroethyl triazole [Tyr3] octreotate (18F-FET-βAG-TOCA) in patients with neuroendocrine tumors (NETs) to evaluate biodistribution, dosimetry, and safety. Despite advances in clinical imaging, detection and quantification of NET activity remains a challenge, with no universally accepted imaging standard. Methods: Nine patients were enrolled. Eight patients had sporadic NETs, and 1 had multiple endocrine neoplasia type 1 syndrome. Patients received 137-163 MBq (mean ± SD, 155.7 ± 8 MBq) of 18F-FET-βAG-TOCA. Safety data were obtained during and 24 h after radioligand administration. Patients underwent detailed wholebody PET/CT multibed scanning over 4 h with sampling of venous bloods for radioactivity and radioactive metabolite quantification. Regions of interest were defined to derive individual and mean organ residence times; effective dose was calculated with OLINDA 1.1. Results: All patients tolerated 18F-FET-βAG-TOCA with no adverse events. Over 60% parent radioligand was present in plasma at 60 min. High tumor (primary and metastases)-to-background contrast images were observed. Physiologic distribution was seen in the pituitary, salivary glands, thyroid, and spleen, with low background distribution in the liver, an organ in which metastases commonly occur. The organs receiving highest absorbed dose were the gallbladder, spleen, stomach, liver, kidneys, and bladder. The calculated effective dose over all subjects (mean ± SD) was 0.029 ± 0.004 mSv/MBq. Conclusion: The favorable safety, imaging, and dosimetric profile makes 18F-FET-βAGTOCA a promising candidate radioligand for staging and management of NETs. Clinical studies in an expanded cohort are ongoing to clinically qualify this agent

Addressing the human resources crisis: A case study of Cambodia's efforts to reduce maternal mortality (1980-2012)

Objective: To identify factors that have contributed to the systematic development of the Cambodian human resources for health (HRH) system with a focus on midwifery services in response to high maternal mortality in fragile resource-constrained countries. Design: Qualitative case study. Review of the published and grey literature and in-depth interviews with key informants and stakeholders using an HRH system conceptual framework developed by the authors ('House Model'; Fujita et al, 2011). Interviews focused on the perceptions of respondents regarding their contributions to strengthening midwifery services and the other external influences which may have influenced the HRH system and reduction in the maternal mortality ratio (MMR). Setting: Three rounds of interviews were conducted with senior and mid-level managers of the Ministries of Health (MoH) and Education, educational institutes and development partners. Participants: A total of 49 interviewees, who were identified through a snowball sampling technique. Main outcome measures: Scaling up the availability of 24 h maternal health services at all health centres contributing to MMR reduction. Results: The incremental development of the Cambodian HRH system since 2005 focused on the production, deployment and retention of midwives in rural areas as part of a systematic strategy to reduce maternal mortality. The improved availability and access to midwifery services contributed to significant MMR reduction. Other contributing factors included improved mechanisms for decision-making and implementation; political commitment backed up with necessary resources; leadership from the top along with a growing capacity of mid-level managers; increased MoH capacity to plan and coordinate; and supportive development partners in the context of a conducive external environment. Conclusions: Lessons from this case study point to the importance of a systemic and comprehensive approach to health and HRH system strengthening and of ongoing capacity enhancement and leadership development to ensure effective planning, implementation and monitoring of HRH policies and strategies.sch_iih3pub3197pub

Mechanisms involved in acquisition of blaNDM genes by IncA/C2 and IncFIIY plasmids

blaNDM genes confer carbapenem resistance and have been identified on transferable plasmids belonging to different incompatibility (Inc) groups. Here we present the complete sequences of four plasmids carrying a blaNDM gene, pKP1-NDM-1, pEC2-NDM-3, pECL3-NDM-1, and pEC4-NDM-6, from four clinical samples originating from four different patients. Different plasmids carry segments that align to different parts of the blaNDM region found on Acinetobacter plasmids. pKP1-NDM-1 and pEC2-NDM-3, from Klebsiella pneumoniae and Escherichia coli, respectively, were identified as type 1 IncA/C2 plasmids with almost identical backbones. Different regions carrying blaNDM are inserted in different locations in the antibiotic resistance island known as ARI-A, and ISCR1 may have been involved in the acquisition of blaNDM-3 by pEC2-NDM-3. pECL3-NDM-1 and pEC4-NDM-6, from Enterobacter cloacae and E. coli, respectively, have similar IncFIIY backbones, but different regions carrying blaNDM are found in different locations. Tn3-derived inverted-repeat transposable elements (TIME) appear to have been involved in the acquisition of blaNDM-6 by pEC4-NDM-6 and the rmtC 16S rRNA methylase gene by IncFIIY plasmids. Characterization of these plasmids further demonstrates that even very closely related plasmids may have acquired blaNDM genes by different mechanisms. These findings also illustrate the complex relationships between antimicrobial resistance genes, transposable elements, and plasmids and provide insights into the possible routes for transmission of blaNDM genes among species of the Enterobacteriaceae family