Effect of Auricular Acupressure on Peri- and Early Postmenopausal Women with Anxiety: A Double-Blinded, Randomized, and Controlled Pilot Study

We tested effects of auricular acupressure on peri- and early postmenopausal women with anxiety (PPWA). Fifty PPWA were randomly assigned to the auricular acupressure group (AG) or the sham group (SG). After 3 meals and before sleep every day for 4 weeks, the AG received auricular acupressure on the bilateral ear shenmen and subcortex points for 3 min per point on alternating ears. The SG received sham auricular acupressure. The Alprazolam was reduced from 0.5 mg/day at baseline to 0.3 mg/day 4 weeks after auricular acupressure (4 W) in the AG (P < .05) whereas maintained at 0.5 mg/day in the SG (P > .05). The Zolpidem was reduced from 3.0 mg/day at baseline to 1.5 mg/day at 4 W (P < .05) whereas was reduced from 2.4 mg/day to 1.9 mg/day at 4 W in the SG (P > .05), thus, significant tapering medication, suggesting auricular acupressure is helpful to PPWA

Association between estradiol levels in early pregnancy and risk of preeclampsia after frozen embryo transfer

IntroductionThe failure of remodeling the spiral arteries is associated with the pathogenesis of preeclampsia. Estradiol (E2) plays a crucial role in placentation and may be involved in the development of preeclampsia. However, there is a lack of data in this area. This study aims to assess the association between serum estradiol levels in early pregnancy and the risk of preeclampsia.MethodsWe conducted a retrospective cohort study on patients who conceived after frozen embryo transfer (FET) using data from a database at a university-affiliated in vitro fertilization center. The study period spanned from January 1, 2010, to December 31, 2020. Multivariable logistic regression analyses were performed to determine the adjusted effect of E2 levels on the risk of preeclampsia. We compared the odds ratios of preeclampsia across quartiles of E2 levels and assessed their significance.ResultsSerum E2 levels at the fifth gestational week were significantly different between women with and without preeclampsia after FET programmed cycles (607.5 ± 245.4 vs. 545.6 ± 294.4 pg/ml, p=0.009). A multivariable logistic regression model demonstrated that E2 levels in early pregnancy were independent risk factors for preeclampsia. We observed an increased odds ratio of preeclampsia with increasing quartiles of estradiol levels after adjusting for potential confounders in FET programmed cycles. When comparing quartiles 3 and 4 (E2 &gt; 493 pg/ml at the fifth gestational week) to quartiles 1 and 2, the odds ratios of preeclampsia were significantly higher.ConclusionWe found that serum E2 levels in early pregnancy may impact the risk of preeclampsia, particularly following FET programmed cycles. The association between E2 levels in early pregnancy and preeclampsia deserves further investigation

Breastmilk as a Multisensory Intervention for Relieving Pain during Newborn Screening Procedures: A Randomized Control Trial

The study aim was to explore the effects of multisensory breastmilk interventions on short-term pain of infants during newborn screening. This is a randomized controlled trial. A total of 120 newborns were recruited and assigned by randomization to one of three treatment conditions: Condition 1 = routine care (gentle touch + verbal comfort); Condition 2 = breastmilk odor + routine care; or Condition 3 = breastmilk odor + taste + routine care. Pain was scored with the Neonatal Infant Pain Scale (NIPS). Data were collected from video recordings at 1 min intervals over the 11 phases of heel sticks: phase 1, 5 min before heel stick without stimuli (baseline); phase 2 to phase 6 (during heel stick); and phase 7 to phase 11 (recovery). Generalized estimating equations compared differences in pain scores for newborns over phases among the three conditions. Compared with the routine care, provision of the odor and taste of breastmilk reduce NIPS scores during heel sticks (B = &minus;4.36, SE = 0.45, p &lt; 0.001 [phase6]), and during recovery (B = &minus;3.29, SE = 0.42, p &lt; 0.001 [phase7]). Our findings provide new data, which supports the use of multisensory interventions that include breastmilk odor and taste in combination with gentle touch and verbal comfort to relieve pain in infants undergoing newborn screening

Progestin-primed ovarian stimulation versus GnRH antagonist protocol in poor responders: Risk of premature LH surge and outcome of oocyte retrieval

Purpose: For poor ovarian responders (PORs), gonadotropin-releasing hormone (GnRH) antagonist was commonly used for prevention of premature LH surge during controlled ovarian stimulation (COS) over the past two decades. The application of progestin-primed ovarian stimulation (PPOS) recently increased, but the role of PPOS for PORs was uncertain. We aimed to analyze the incidence of premature luteinizing hormone (LH) surge and the outcome of oocyte retrieval among PPOS and GnRH antagonist protocol for PORs. Methods: This was a single-center retrospective study, which enrolled the PORs (defined by the Bologna criteria) undergoing COS with PPOS or flexible GnRH antagonist protocol during January 2018 to December 2021. We compared the incidence of premature LH surge (LH > 10 mIU/mL) and the outcome of oocyte retrieval between the PPOS group and the GnRH antagonist group. Results: A total of 314 women were recruited, with 54 in the PPOS group and 260 in the GnRH antagonist group. The PPOS group had lower incidence of premature LH surges compared with the GnRH antagonist protocol group (5.6% vs 16.9%, P value 0.035). There was no significant difference between the two groups regarding the number of oocytes retrieved (3.4 vs 3.8, P value 0.066) and oocyte retrieval rates (88.9% vs 88.0%, P value 0.711). Conclusion: Compared with PPOS, GnRH antagonist protocol had higher risk of premature LH surges for PORs but may not affect pregnancy rates. PPOS is suitable for oocyte or embryo cryopreservation, but should not totally replace GnRH antagonist protocol for patients undergoing in vitro fertilization (IVF)

Interleukin-23 Mediates Osteoclastogenesis in Collagen-Induced Arthritis by Modulating MicroRNA-223

Interleukin-23 (IL-23) plays a pivotal role in rheumatoid arthritis (RA). IL-23 and microRNA-223 (miR-223) are both up-regulated and mediate osteoclastogenesis in mice with collagen-induced arthritis (CIA). The aim of this study was to examine the association between IL-23 and miR-223 in contributing to osteoclastogenesis and arthritis. Levels of IL-23p19 in joints of mice with CIA were determined. Lentiviral vectors expressing short hairpin RNA (shRNA) targeting IL-23p19 and lisofylline (LSF) were injected intraperitoneally into arthritic mice. Bone marrow-derived macrophages (BMMs) were treated with signal transducers and activators of transcription 4 (STAT4) specific shRNA and miR-223 sponge carried by lentiviral vectors in response to IL-23 stimulation. Treatment responses were determined by evaluating arthritis scores and histopathology in vivo, and detecting osteoclast differentiation and miR-223 levels in vitro. The binding of STAT4 to the promoter region of primary miR-223 (pri-miR-223) was determined in the Raw264.7 cell line. IL-23p19 expression was increased in the synovium of mice with CIA. Silencing IL-23p19 and inhibiting STAT4 activity ameliorates arthritis by reducing miR-223 expression. BMMs from mice in which STAT4 and miR-223 were silenced showed decreased osteoclast differentiation in response to IL-23 stimulation. IL-23 treatment increased the expression of miR-223 and enhanced the binding of STAT4 to the promoter of pri-miR-223. This study is the first to demonstrate that IL-23 promotes osteoclastogenesis by transcriptional regulation of miR-223 in murine macrophages and mice with CIA. Furthermore, our data indicate that LSF, a selective inhibitor of STAT4, should be an ideal therapeutic agent for treating RA through down-regulating miR-223-associated osteoclastogenesis

Simulation education utilizing phantom and angle reference guide in pulmonary nodule CT localization

Objective: The incidence of sub-centimeter pulmonary nodules has been increasing along with the use of low-dose computed tomography (LDCT) as a screening tool for early lung cancer detection. In our institution, pulmonary nodule computed tomography-guided localization (PNCL) is performed preoperatively with the laser angle guided assembly (LAGA), an angle reference device. This study aims to investigate the efficacy of postgraduate education in a phantom simulation of PNCL, with or without LAGA. Setting design: This prospective study was conducted in an academic hospital in Taiwan. Seven thoracic surgery residents and three experienced senior physicians were recruited to perform PNCL using a phantom simulation, with or without LAGA, for five nodules each and complete a questionnaire. Performance data were collected. χ2 tests, Mann-Whitney U test, univariate and multivariate linear regression were used for statistical analyses. Results: The confidence level increased from median 7[range 1, 9] to 8, range [6,9] (p = 0.001) before and after the simulation education course. The scores of enhanced PNCL ability and course satisfaction were as high as 8 [5,9], and 9 [7,9]. LAGA enabled broader puncture angles (with 27.5° [0°,80°]; without 14° [0°, 80°], p = 0.003), a lower puncture frequency (with 1 [1,4]; without 2 [1,5], p < 0.001), and a smaller angle deviation (with 3°[ 0°,8°]; without 5°[ 0°,19°], p = 0.002). Pleural depth in millimeters was associated with increased puncture frequency (0.019[0,010,0.028]) and procedure time (0.071'[ 0.018,0.123']. The PNCL-experienced physicians performed the procedure in less time (−2.854'[-4.646′,1.061']. The traverse direction toward the mediastinum diminished the frequency (toward 1[ 1,3]; away 1 [1,5], p = 0.003) and time (toward 7.5'[2′,18]'; away 9'[ 3’,31'], p = 0.027). The learning curve did not improve procedure performance after ten PNCL simulation rounds. Conclusions: The phantom PNCL simulation education course increased the confidence level, enhanced residents’ skill acquisition, and promoted learning satisfaction. The angle reference device helped improve the outcomes of the puncture frequency and reduced angle deviation