Human growth hormone for poor responders: a randomized placebo-controlled trial provides no evidence for improved live birth rate.

RESEARCH QUESTION: Does the addition of human growth hormone (HGH) to an IVF cycle improve the live birth rate in previously documented poor responders to FSH? DESIGN: Double-blind, placebo-controlled, randomized clinical trial comparing HGH to placebo in maximal stimulation in an IVF cycle. The study was stopped after 4 years. Women receiving ovarian stimulation in one IVF cycle, having failed to produce more than 5 eggs in a previous cycle with more than 250 IU/day of FSH were included. Basal FSH was ≤15 IU/l, body mass index <33 kg/m2, age <41 years. HGH or placebo were added from the start of the cycle in a double-blinded manner. The primary outcome was live birth rate. MAIN RESULTS: The live birth rates following an IVF cycle were 9/62 (14.5%) for growth hormone and 7/51 (13.7%) for the placebo group (risk difference 0.8%, 95% confidence interval [CI] -12.1 to 13.7%; odds ratio [OR] 1.07, 95% CI 0.37-3.10). There was a greater odds of oocyte retrieval with growth hormone (OR 5.67, 95% CI 1.54-20.80) but no better chance of embryo transfer (OR 1.42, 95% CI 0.50-4.00). Birth weights were comparable. CONCLUSIONS: Planned participant numbers were not reached. It was not possible to demonstrate an increase in live birth rate from the addition of growth hormone in women with a previous poor ovarian response to IVF.

MicroRNA-regulated pathways associated with endometriosis.

Endometriosis is a prevalent gynecological disease characterized by growth of endometriotic tissue outside the uterine cavity. MicroRNAs (miRNAs) are naturally occurring posttranscriptional regulatory molecules that potentially play a role in endometriotic lesion development. We assessed miRNA expression by microarray analysis in paired ectopic and eutopic endometrial tissues and identified 14 up-regulated (miR-145, miR-143, miR-99a, miR-99b, miR-126, miR-100, miR-125b, miR-150, miR-125a, miR-223, miR-194, miR-365, miR-29c and miR-1) and eight down-regulated (miR-200a, miR-141, miR-200b, miR-142-3p, miR-424, miR-34c, miR-20a and miR-196b) miRNAs. The differential expression of six miRNAs was confirmed by quantitative RT-PCR. An in silico analysis identified 3851 mRNA transcripts as putative targets of the 22 miRNAs. Of these predicted targets, 673 were also differentially expressed in ectopic vs. eutopic endometrial tissue, as determined by microarray. Functional analysis suggested that the 673 miRNA targets constitute molecular pathways previously associated with endometriosis, including c-Jun, CREB-binding protein, protein kinase B (Akt), and cyclin D1 (CCND1) signaling. These pathways appeared to be regulated both transcriptionally as well as by miRNAs at posttranscriptional level. These data are a rich and novel resource for endometriosis and miRNA research and suggest that the 22 miRNAs and their cognate mRNA target sequences constitute pathways that promote endometriosis. Accordingly, miRNAs are potential therapeutic targets for treating this disease.

Actor training for surgical team simulations.

BACKGROUND: Immersive simulations can enable surgeons to learn complex sets of skills required for safe surgical practice without risk to patients. However, recruiting healthcare professionals to support surgeons training as members of an operating theatre (OT) team is challenging and resource intensive. AIM: We developed a training programme for actors to take on the role of an OT team to support validation studies in a simulated environment. This article describes the evaluation of the programme. METHODS: The programme comprised of written materials, video discussion and experiential activities. Evaluation methods consisted of post-simulation interviews and questionnaires with actors and surgeons. Participants were recruited by convenience sampling. Quantitative data were analysed using descriptive statistics and interviews were analysed using thematic extraction. RESULTS: Three actors participated in the programme. Twelve surgeons completed simulations. All data suggest that the training was successful. Actors were perceived as realistic. Suggestions were made to improve training. CONCLUSION: After a brief training, actors can realistically portray members of an OT team in simulations designed to support surgeon training. This article highlights factors that contributed to success and suggests improvements. Although there are limitations with the study, its findings have relevance to training and assessment that focuses on individual clinician's functioning as a member of an OT team.