Search Immortality Topics:

Page 10,720«..1020..10,71910,72010,72110,722..10,73010,740..»


Prediction of sperm retrieval in men with non-obstructive azoospermia using artificial neural networks: leptin is a good assistant diagnostic marker

Posted: January 22, 2011 at 6:12 pm

BACKGROUND

At present, non-invasive methods are not comprehensive enough to enable urologists to predict sperm retrieval results accurately in patients with non-obstructive azoospermia (NOA). Our aim was to improve the prediction accuracy of sperm retrieval by using leptin and artificial neural networks (ANNs).

METHODS

Data from May 2004 to July 2010 for 280 patients with NOA were reviewed and assigned into the training and testing set for ANNs. All patients underwent standard diagnostic infertility evaluation and testicular sperm extraction (TESE). Twelve factors were recorded as the input variables for ANNs:
testicular volume,
semen volume, seminal pH, seminal alpha-glucosidase and fructose,
serum hormones including FSH, LH, total testosterone (TT), prolactin, estradiol,
serum and seminal leptin. Three ANN models were constructed with the following input variables: ANN1-
, ANN2-
and ANN3-
. The prediction accuracy for FSH, leptin and ANN models was compared by receiver operating characteristic (ROC) curve analysis.

RESULTS

All ANN models were better than FSH. ANN1 had the largest area under the curve (AUC =0.83) and demonstrated significant improvement compared with FSH (AUC =0.63, P< 0.01) and leptin (AUC =0.59, P< 0.01).

CONCLUSIONS

ANNs improve the prediction accuracy of sperm retrieval. Although the leptin AUC is low, combined use of leptin and FSH can significantly improve the prediction accuracy for sperm recovery in NOA patients. Leptin may be a good assistant marker for diagnosing NOA. However, studies with larger numbers of patients are required to confirm the improved predictive performance of ANNs.

Recommendation and review posted by G. Smith

Ephrin A1 induces intercellular dissociation in Ishikawa cells: possible implication of the Eph-ephrin A system in human embryo implantation

Posted: January 22, 2011 at 6:12 pm

BACKGROUND

During implantation, the human embryo invades endometrial stromal tissues, reducing the intercellular connections among epithelial cell layers. Since Eph–ephrin interaction can induce repulsive forces to control cell position and movement, we examined the possible involvement of this system in intercellular dissociation among endometrial epithelial cells.

METHODS

The expression of Eph A receptor on human endometrial epithelial cells and endometrial carcinoma-derived Ishikawa cells was examined by RT–PCR, immunohistochemistry and western blotting. The effects of recombinant ephrin A1 on Eph A2 phosphorylation in Ishikawa cells were also examined by western blotting. A permeability assay was performed to determine the effects of ephrin A1 on cell-to-cell adhesion.

RESULTS

Eph A1, A2 and A4 mRNAs were detected in human endometrial epithelial cells and Ishikawa cells, and ephrin A1 was present in human blastocysts. Immunohistochemical staining showed that Eph A1, A2 and A4 receptors were expressed on the cell surface region of luminal and glandular epithelial cells in human endometrium in both the proliferative and secretory phase. The presence of Eph A2 protein in the human endometrium was confirmed by western blot analysis. Recombinant ephrin A1 was bound to Ishikawa cells and induced phosphorylation of Eph A2 expressed in Ishikawa cells. In addition, stimulation by ephrin A1 for 20 min increased the permeability of monolayer Ishikawa cells versus control cultures (P < 0.01), without affecting cell viability.

CONCLUSIONS

This study demonstrated that the Eph–ephrin A system can promote intercellular dissociation in Ishikawa cells suggesting an important role in the initial step of embryo implantation by opening the endometrial epithelial cell barrier.

Recommendation and review posted by G. Smith

Guideline adherence in ectopic pregnancy management

Posted: January 22, 2011 at 6:12 pm

BACKGROUND

Evidence-based guidelines have been issued for ectopic pregnancy (EP), covering both diagnostic and therapeutic management. In general, guidelines aim to reduce practice variation and to improve quality of care. To assess the guideline adherence in the management of EP, we developed guideline-based quality indicators and measured patient care in various hospitals.

METHODS

A panel of experts and clinicians developed quality indicators based on recommendations from the Dutch guideline on EP management, using the systematic RAND-modified Delphi method. With these indicators, patient care was assessed in six Dutch hospitals between January 2003 and December 2005. For each quality indicator, a ratio for guideline adherence was calculated. Overall adherence was reported, as well as adherence per hospital type, i.e. academic, teaching and non-teaching hospitals.

RESULTS

Out of 30 guideline-based recommendations, 12 quality indicators were selected covering procedural, structural and outcome aspects of care. For 317 women surgically treated for EP, these aspects were assessed. Overall adherence to the guideline was 75%. The highest adherence (98%) was observed for performing transvaginal sonography during the diagnostic workup. The lowest adherence (21%) was observed for performing salpingotomy in case of contra-lateral tubal pathology. Wide variance in adherence (0–100%) existed between academic, teaching and non-teaching hospitals.

CONCLUSIONS

The overall guideline adherence was reasonable, with ample room for improvement in various aspects of care. Further research should focus on the barriers for guideline dissemination and adherence, to further improve the management of EP.

Recommendation and review posted by G. Smith

Closed blastocyst vitrification of biopsied embryos: evaluation of 100 consecutive warming cycles

Posted: January 22, 2011 at 6:12 pm

BACKGROUND

The aim of this study was to analyse the outcome of closed blastocyst vitrification of embryos biopsied at the cleavage stage.

METHODS

Vitrification of supernumerary blastocysts was performed using the closed CBS-VIT High Security straws. Warming cycles (n= 100) for patients with preimplantation genetic diagnosis (PGD) and/or aneuploidy screening in the fresh cycle were analysed. The outcome parameters were morphological survival and transfer rates after warming, clinical pregnancy rate and implantation rate (with fetal heart beat). Clinical outcome was compared with two control groups of (i) vitrified/warming transfer cycles without embryo biopsy and (ii) fresh Day 5 transfer of biopsied embryos.

RESULTS

In total, 131 blastocysts were warmed with a morphological survival of 83.2% (109/131) and a transfer rate of 79.4% (104/131). Day 5 blastocysts survived significantly better (90.4%) than Day 6 blastocysts (70.8%, P< 0.01). No difference in survival rate was observed between early cavitating (89.2%) and full/expanded blastocysts (93.3%). In nine cycles, no blastocyst was available for transfer. The clinical pregnancy rate was 19.2% (15/78) after single-embryo transfer (SET) and 38.5% (5/13) after double-embryo transfer (DET). In SET, the implantation rate for blastocysts frozen on Day 5 was 13.7% (7/51), which was not different from the implantation rate of Day 6 blastocysts (18.5%, 5/27). The overall implantation rate of vitrified PGD biopsied blastocysts (14.4%) was comparable with that of vitrified blastocysts without biopsy (20.4%), but lower than the implantation rate obtained in the fresh PGD cycles (24.4%).

CONCLUSION

Blastocysts on Day 5 and Day 6 of development derived from biopsied embryos can be successfully vitrified using a closed system.

Recommendation and review posted by G. Smith

Vaginal misoprostol prior to insertion of an intrauterine device: an RCT

Posted: January 22, 2011 at 6:12 pm

BACKGROUND

Misoprostol is an agent that may ripen the cervix in nonpregnant women. Here, we investigate whether vaginal misoprostol administered prior to intrauterine device (IUD) insertion reduces the number of failed insertions, insertion-related complications and pain during insertion.

METHODS

We conducted a double-blinded, multicenter randomized controlled trial among patients requesting an IUD. Nulli- and multi-parous women were included, and both copper-containing and levonorgestrel-releasing IUDs were used. Participants were allocated to either 400 µg misoprostol or placebo (administered 3h prior to IUD insertion). The primary outcome measure was failed insertion. Secondary outcome measures were insertion-related complications, pain, difficulty of insertion and side-effects.

RESULTS

Two hundred and seventy participants were randomized. After drop out for various reasons (mainly no show), 199 participants had an IUD inserted; 102 received misoprostol and 97 received placebo. Only three insertions failed; two in the misoprostol group and one in the placebo group [P = 0.59, relative risk (RR) 1.9, 95% confidence interval (CI) 0.2–20.6]. The overall incidence of insertion-related complications was 21.8% in the misoprostol versus 19.1% in the placebo group (mainly vasovagal-like reactions) and did not differ between groups (P = 0.65, RR 1.1, 95% CI 0.7–2.0). No difference in pain scores between groups was found. Side-effects were more common in the misoprostol group (P = 0.05, RR 1.3, 95% CI 1.0–1.7).

CONCLUSION

The study showed no benefit for use of misoprostol prior to IUD insertion. However, there is a tendency of possible harm regarding side-effects. Therefore, we would not recommend standard pretreatment with misoprostol.

The trial was registered in the European Clinical Trials Database EudraCT 2006-006897-60.

Recommendation and review posted by G. Smith

Combined oral contraceptives and body weight: do oral contraceptives cause weight gain? A primate model

Posted: January 22, 2011 at 6:12 pm

BACKGROUND

The aim of this study was to determine if oral contraceptive (OC) use affects body weight, body composition and metabolism in primates.

METHODS

Reproductive-age female rhesus monkeys of normal and obese BMI were studied to document baseline weight stability, then treated continuously with an OC (dosed to achieve equivalent human serum levels for a 30 µg ethinyl estradiol/150 µg levonorgestrel preparation) for 237 days. Monkeys were monitored for changes in body weight, levels of physical activity (measured by a triaxial Actical accelerometer), food/caloric intake, percent body fat (dual energy X-ray absorptiometry, DEXA) and metabolism (24 h metabolic rate and serum metabolic substrate and hormone concentrations).

RESULTS

All 10 monkeys completed the study protocol with no adverse events. While body weight (–0.73% change) and percent body fat (–1.78% change) of the normal BMI group did not significantly decrease from baseline, obese monkeys showed a significant decrease in body weight (–8.58% change, P < 0.01) and percent body fat (–12.13% change P = 0.02) with OC treatment. In both the obese (P = 0.03) and the normal BMI (P = 0.01) groups, there was a significant increase in basal metabolic rate with OC use. No changes were seen in food intake, activity level or % lean muscle mass with OC use for either BMI-based group.

CONCLUSIONS

Overall, OC use appears to cause a slight increase in basal metabolic rate in female monkeys, leading to a decrease in body weight and percent body fat in obese individuals.

Recommendation and review posted by G. Smith


Page 10,720«..1020..10,71910,72010,72110,722..10,73010,740..»