13 research outputs found
Dehydroepiandrosterone (DHEA) supplementation improves in vitro fertilization outcomes of poor ovarian responders, especially in women with low serum concentration of DHEA-S: a retrospective cohort study
Background: Dehydroepiandrosterone (DHEA) is now widely used as an adjuvant for in vitro fertilization (IVF)
cycles in poor ovarian responders (PORs). Several studies showed that DHEA supplementation could improve IVF
outcomes of PORs. However, most of the PORs do not respond to DHEA clinically. Therefore, the aim of this study
is to confirm the beneficial effects of DHEA on IVF outcomes of PORs and to investigate which subgroups of PORs
can best benefit from DHEA supplementation.
Methods: This retrospective cohort study was performed between January 2015 and December 2017. A total of
151 PORs who fulfilled the Bologna criteria and underwent IVF cycles with the gonadotropin-releasing hormone
antagonist protocol were identified. The study group (n = 67) received 90 mg of DHEA daily for an average of
3 months before the IVF cycles. The control group (n = 84) underwent the IVF cycles without DHEA pretreatment.
The basic and cycle characteristics and IVF outcomes between the two groups were compared using independent
t-tests, Chi-Square tests and binary logistic regression.
Results: The study and control groups did not show significant differences in terms of basic characteristics. The study
group demonstrated a significantly greater number of retrieved oocytes, metaphase II oocytes, fertilized oocytes, day 3
embryos and top-quality embryos at day 3 and a higher clinical pregnancy rate, ongoing pregnancy rate and live birth
rate than those measures in the control group. The multivariate analysis revealed that DHEA supplementation was
positively associated with clinical pregnancy rate (OR = 4.93, 95% CI 1.68–14.43, p = 0.004). Additionally, in the study
group, the multivariate analysis showed that serum dehydroepiandrosterone-sulfate (DHEA-S) levels < 180 μg/dl were
significantly associated with a rate of retrieved oocytes > 3 (OR = 5.92, 95% CI 1.48–23.26, p = 0.012).
Conclusions: DHEA supplementation improves IVF outcomes of PORs. In PORs with DHEA pretreatment, women with
lower DHEA-S level may have greater possibility of attaining more than 3 oocytes
Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study
Despite current guidelines, intraperitoneal drain placement after elective colorectal surgery remains widespread. Drains were not associated with earlier detection of intraperitoneal collections, but were associated with prolonged hospital stay and increased risk of surgical-site infections.Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien-Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P < 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P < 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk
Pregnancy-induced hypertension is an independent risk factor for meconium aspiration syndrome: A retrospective population based cohort study
Objective: Meconium aspiration syndrome (MAS), possibly resulting from fetal hypoxia, is a respiratory
distress disorder in the infant. Pregnancy-induced hypertension (PIH) can cause placental dysfunction
and lead to fetal hypoxia, which may induce the development of MAS. Therefore, the aim of this study
was to determine the association between PIH and MAS and to identify the predictive risk factors.
Materials and methods: This was a retrospective cohort study. We selected patients with newly diagnosed
PIH and a matched cohort group from the Taiwan National Health Insurance Research Database
(NHIRD), from January 1, 2000 till December 31, 2013. For each patient in the PIH cohort, 4 subjects
without PIH, matched for age and year of delivery, were randomly selected as the comparison cohort. The
incidence of meconium aspiration syndrome was assessed in both groups.
Results: Among the 23.3 million individuals registered in the NHIRD, 29,013 patients with PIH and
116,052 matched controls were identified. Patients who experienced PIH had a higher incidence of MAS
than did those without PIH. According to a multivariate analysis, PIH (odds ratio [OR] ¼ 1.70, 95% confidence
interval [CI] ¼ 1.49e1.93, p < 0.0001) was independently associated with increased risk of MAS.
Additionally, age 30 years (OR ¼ 1.26, 95% CI ¼ 1.12e1.42, p ¼ 0.0001), nulliparity (OR ¼ 1.13, 95%
CI ¼ 1.01e1.27, p ¼ 0.0367) and patients with diabetes mellitus (OR ¼ 3.09, 95% CI ¼ 1.35e7.09,
p ¼ 0.0078) were also independent risk factors of MAS.
Conclusion: Patients with PIH obtained higher subsequent risk for the development of MAS than those
without PIH. Besides, age 30 years, nulliparity and patients with diabetes mellitus are the independent risk factors of developing MAS
The Identification and Reporting of Severe Violence Against Children: International Standards and Practices
Predictive role of renal resistive index for clinical outcome after revascularization in hypertensive patients with atherosclerotic renal artery stenosis: a monocentric observational study
BACKGROUND: The present study evaluated the predictive value of renal resistive index (RI) for renal function and blood pressure (BP) outcome in hypertensive patients with unilateral atherosclerotic renal artery stenosis submitted to successful revascularization. METHODS: In 158 hypertensive patients with atherosclerotic renal artery stenosis RI was acquired. Twelve months after revascularization, they were classified on the basis of renal function and BP outcome as benefit (BP 15 mmHg with the same of reduced drugs; decrease in glomerular filtration rate > 20%), or failure. RESULTS: Regarding renal function outcome, RI in the stenotic and in the contralateral kidney were significantly higher in patients with failure (n = 20) than in those with benefit (0.72 +/- 0.11 vs 0.61 +/- 0.11 and 0.76 +/- 0.08 vs 0.66 +/- 0.09, p 0.73 provided the largest area under the curve (0.77), and the highest sensitivity (80%) and specificity (72%). In the multivariate logistic regression analysis, RI in the contralateral kidney >0.73 was an independent predictor of a failure in renal function outcome.Regarding BP outcome, patients with no benefit from revascularization (n = 60) had similar RI in the stenotic and contralateral kidney (p = ns), but presented higher pulse pressure, albuminuria and hypertension duration in comparison to patients with improved BP control. CONCLUSIONS: RI in the contralateral kidney is an independent predictor of renal function outcome after successful revascularization in hypertensive patients with unilateral atherosclerotic renal artery stenosis, whereas it is not able to predict blood pressure outcome
The influence of meteorological variables on the oviposition dynamics of Aedes aegypti (Diptera: Culicidae) in four environmentally distinct areas in northeast Brazil
N-acetylcysteine infusion reduces the resistance index of renal artery in the early stage of systemic sclerosis
AIM: To evaluate resistance index (RI) changes in renal artery after N-acetylcysteine infusion in patients with systemic sclerosis. METHODS: In an open-label study 40 patients with systemic sclerosis (SSc) were treated with N-acetylcysteine (NAC) iv infusion over 5 consecutive hours, at a dose of 0.015 g x kg(-1) x h(-1). Renal haemodynamic effects were evaluated by color Doppler examination before and after NAC infusion. RESULTS: NAC infusion significantly reduced RI in a group of sclerodermic patients with early/active capillaroscopic pattern, modified Rodnan Total Skin Score (mRTSS) 14 and severe-end stage score to the vascular domain of DSS. In patients with reduction of RI after NAC infusion, diffusion capacity for carbon monoxide mean value was significantly higher than in those patients with an increase of RI. No significant differences in renal blood flow were found between patients with different subsets of SSc. CONCLUSION: In patients with low disease severity NAC ameliorates vascular renal function
N-acetylcysteine infusion reduces the resistance index of renal artery in the early stage of systemic sclerosis
Evaluating the effect of mutations and ligand binding on transthyretin homotetramer dynamics
<div><p>Native transthyretin (TTR) homotetramer dissociation is the first step of the fibrils formation process in amyloid disease. A large number of specific point mutations that destabilize TTR quaternary structure have shown pro-amyloidogenic effects. Besides, several compounds have been proposed as drugs in the therapy of TTR amyloidosis due to their TTR tetramer binding affinities, and therefore, contribution to its integrity. In the present paper we have explored key positions sustaining TTR tetramer dynamical stability. We have identified positions whose mutations alter the most the TTR tetramer equilibrium dynamics based on normal mode analysis and their response to local perturbations. We have found that these positions are mostly localized at β-strands E and F and EF-loop. The monomer-monomer interface is pointed out as one of the most vulnerable regions to mutations that lead to significant changes in the TTR-tetramer equilibrium dynamics and, therefore, induces TTR amyloidosis. Besides, we have found that mutations on residues localized at the dimer-dimer interface and/or at the T4 hormone binding site destabilize the tetramer more than the average. Finally, we were able to compare several compounds according to their effect on vibrations associated to the ligand binding. Our ligand comparison is discussed and analyzed in terms of parameters and measurements associated to TTR-ligand binding affinities and the stabilization of its native state.</p></div