Implementation of a virtual community of practice to promote the empowerment of middle-aged people with multimorbidity: study protocol of a randomised controlled trial.

INTRODUCTION: Empowering people living with multimorbidity (multiple chronic conditions) to gain greater confidence in managing their health can enhance their quality of life. Education focused on self-management is a key tool for fostering patient empowerment and is mostly provided on an individual basis. Virtual communities of practice (VCoP) present a unique opportunity for online education in chronic condition self-management within a social context. This research aims to evaluate the effectiveness/cost-effectiveness of individualised, online self-management education compared with VCoP among middle-aged individuals living with multiple chronic conditions. METHODS AND ANALYSIS: People aged 30-60, living with ≥2 chronic conditions and receiving care in primary care (PC) centres and outpatient hospital-based clinics in Madrid and Canary Islands will enrol in an 18-month parallel-design, blinded (intervention assessment and data analysts), pragmatic (adhering to the intention-to-treat principle), individually randomised trial. The trial will compare two 12-month web-based educational offers of identical content; one delivered individually (control) and the other with online social interaction (VCoP, intervention). Using repeated measures mixed linear models, with the patient as random effect and allocation groups and time per group as fixed effects, we will estimate between-arm differences in the change in Patient Activation Measure from baseline to 12 months (primary endpoint), including measurements at 6-month and 18-month follow-up. Other outcomes will include measures of depression and anxiety, treatment burden, quality of life. In addition to a process evaluation of the VCoP, we will conduct an economic evaluation estimating the relative cost-effectiveness of the VCoP from the perspectives of both the National Health System and the Community. ETHICS AND DISSEMINATION: The trial was approved by Clinical Research Ethics Committees of Gregorio Marañón University Hospital in Madrid/Nuestra Señora Candelaria University Hospital in Santa Cruz de Tenerife. The results will be disseminated through workshops, policy briefs, peer-reviewed publications and local/international conferences. TRIAL REGISTRATION NUMBER: NCT06046326.

Physicochemical Characterisation of Seeds, Oil and Defatted Cake of Three Hempseed Varieties Cultivated in Spain.

The increasing use of hempseed in food products highlights the need for a comprehensive database for scientific research and industrial applications. In food development, information about the techno-functional properties of raw materials plays a crucial role in determining the suitability of each product for specific applications. Thus, this study aims to characterise three hempseed varieties (Ferimon, Henola and Uso-31), comparing their physicochemical and nutritional compositions. Moreover, the study investigates the impact of hempseed varieties on the techno-functional, physical and thermal properties of the partially defatted hempseed flours (PDHFs) obtained from single screw pressing (SSP) oil extraction. The fatty acid and tocopherol profiles of the dehulled seeds and oil were also analysed. Significant variations in yield and physical properties were observed among hempseed varieties, influenced by genetics, adaptation to agro-climatic conditions and cultivation systems. Despite its lower yield (kg/ha), Uso-31 exhibited superior 1000-seed weight, dehulling yield and larger mean seed size (1.79 ± 0.02 mm). Hempseed oil was rich in unsaturated fatty acids, particularly linoleic (51.2-53.4 g/100 g oil) and α-linolenic (14.88-18.97 g/100 oil) acids, showing variations in γ- and α-tocopherols depending on the variety. The variety also influenced the least gelation concentration (LGC) and techno-functional properties such as water absorption capacity (WAC), emulsifying activity (EA) and emulsion stability (ES). SDS-PAGE and DSC measurements indicated the presence of 11S and 7S globulin proteins with denaturation temperatures above 87.8 °C. These findings confirm that the studied hempseed flours are valuable techno-functional and nutritional ingredients suitable for sustainable food formulations.

Valorisation of Buckwheat By-Product as a Health-Promoting Ingredient Rich in Fibre for the Formulation of Gluten-Free Bread.

Bread is a widely consumed food that has often been used as a vehicle for functional ingredients such as dietary fibre. Fibre-rich breads have beneficial physiological effects on health, helping to combat chronic pathologies such as cardiovascular disease, diabetes, and certain types of colon cancer. The aim of this study is to evaluate the technological and nutritional effects of the inclusion of buckwheat hull particles (BH) at two addition levels (3 and 6%) and two particle sizes (fine, D50: 62.7 µm; coarse, D50: 307 µm) in a gluten-free (GF) bread formulation. A significant (p < 0.05) increase in the dough elastic modulus (G') was observed for all doughs containing BH, from 712 Pa for a rice-based dough to 1027-3738 Pa for those containing BH. Compared to rice-based breads, those containing BH showed a significant (p < 0.05) increase in total dietary fibre content (from three to five times) and in antioxidant capacity (from 78 to 290 mg TE/100 g dw. in the ORAC test). Breads containing fine BH at a level of 3% had similar sensory properties to the rice-based bread, demonstrating that it is possible to improve the TDF content while maintaining the sensory quality of the GF bread.

Microwave Modification of Quinoa Grains at Constant and Varying Water Content Modulates Changes in Structural and Physico-Chemical Properties of the Resulting Flours.

Microwave-assisted heat moisture treatment (MWT) was applied to quinoa grains, a nutritious gluten-free pseudocereal of great interest in food product development, to achieve the physical modification of the quinoa flour. The effect of treating quinoa grains at different initial water contents (WC; 10%, 20%, and 30%) in two operational systems was compared: one open at atmospheric pressure and variable WC (V system), and the other in hermetic containers at constant WC (C system). The morphological structure of the obtained flours and their techno-functional, rheological, and thermal properties were evaluated. MWT proved to be effective in modifying these properties, the main effects probably being caused by protein denaturation and aggregation, and intragranular molecular rearrangements of starch, with disruption of short-range molecular order and even the partial collapse of starch granules in the samples treated at the highest WC. The greatest differences were observed for the 20 and 30% WC treated-samples, particularly when using C system, which increased their water absorption capacity and decreased their foaming, emulsion, and gel-forming capacities. Based on these results, the control of WC and its evolution during MWT of quinoa grains appears to be a viable and effective approach to adapt flour functionality to the needs of food production, allowing a wider range of flour properties depending on the MWT conditions.

The Application of High-Hydrostatic-Pressure Processing to Improve the Quality of Baked Products: A Review.

The current trend in the food industry is towards "clean label" products with high sensory and nutritional quality. However, the inclusion of nutrient-rich ingredients in recipes often leads to sensory deficiencies in baked goods. To meet these requirements, physically modified flours are receiving more and more attention from bakery product developers. There are various findings in the literature on high hydrostatic pressure (HHP) technology, which can be used to modify various matrices so that they can be used as ingredients in the baking industry. HHP treatments can change the functionality of starches and proteins due to cold gelatinization and protein unfolding. As a result, the resulting ingredients are more suitable for nutrient-rich bakery formulations. This review describes the information available in the literature on HHP treatment conditions for ingredients used in the production of bakery products and analyses the changes in the techno-functional properties of these matrices, in particular their ability to act as structuring agents. The impact of HHP-treated ingredients on the quality of dough and bakery products and the effects on some nutritional properties of the treated matrices have been also analysed. The findings presented in this paper could be of particular interest to the bakery industry as they could be very useful in promoting the industrial application of HHP technology.

Relationships between lipids levels in blood plasma, follicular fluid and seminal plasma with ovarian response and sperm concentration regardless of age and body mass index.

PURPOSE: There is a considerable literature supporting the role of lipids in fertility. However, little is known about their impact on male and female gametes. Our study aimed to investigate the relationships between lipids levels in serum, follicular fluid and seminal plasma with ovarian response and sperm concentration regardless of age and body mass index (BMI). METHODS: 51 follicular fluid and serum samples of IVF-ICSI cycles and 52 seminal plasma and serum samples of males in the infertility study were analyzed for cholesterol, triglycerides, and non-esterified fatty acids. The parameters used to assess gonadal response were number of mature oocytes in metaphase II and total motile sperm. Differences between groups were studied by means Principal Component Analysis, Kolmogorov-Smirnov test, Pearson correlation, Student's T, and multivariate linear regression. RESULTS: Using a multivariate linear regression model to exclude the effect of the age and BMI, we found that the lipid profile in follicular fluid and plasma influence inversely and significantly on ovarian response and the number of matured oocytes recovered. Moreover, we found that seminal lipid levels are predictors of seminal quality independent of plasma lipid values. CONCLUSION: Our current analysis demonstrates the association of low ovarian response and low number of motile sperms with abnormal lipids levels.

Arboreal camera trapping sheds light on seed dispersal of the world's only epiphytic gymnosperm: Zamia pseudoparasitica.

Epiphytic lifestyles have evolved independently in ecologically, morphologically, and taxonomically diverse plant species. Although this adaptation is widespread among angiosperms, it is only known to have arisen in a single gymnosperm species, Zamia pseudoparasitica (Cycadophyta). Zamia pseudoparasitica is endemic to the mountains of Western Panama, and little is known about the ecology of this unusual cycad. Here, we provide the first report of a potential seed disperser of Z. pseudoparasitica. Between late October 2019 and March 2020, we conducted arboreal camera trapping at three sites along the Talamanca Cordillera in Western Panama, yielding an accumulated survey effort of 271 camera days. Weekly direct observations were also performed using handheld binoculars at one site. Arboreal camera trapping revealed at least seven mammal species that visit this epiphytic cycad. At all three sites, the Northern olingo (Bassaricyon gabbii) was seen visiting individuals of Z. pseudoparasitica repeatedly, both while cones were closed and after they had opened. We estimated the time-varying intensity of the visits throughout our sampling and used mixed models to compare the length of visits when cones were closed versus when they were open. Both duration and time-varying intensity of visits increased after cones had opened and we documented Northern olingo removing and carrying away seeds. We also observed predation by the yellow-eared toucanet (Selenidera spectabilis) which picked and destroyed mature Z. pseudoparasitica seeds. These results suggest that the Northern olingo could be an important seed dispersal agent for this rare epiphytic gymnosperm.

Assessment of Maternal Effects and Genetic Variability in Resistance to Verticillium dahliae in Olive Progenies.

The use of genetic resistance is likely the most efficient, economically convenient and environmentally friendly control method for plant diseases, as well as a fundamental piece in an integrated management strategy. This is particularly important for woody crops affected by diseases in which mainly horizontal resistance mechanisms are operative, such as Verticillium wilt, caused by Verticillium dahliae. In this study, we analyzed the variability in resistance to Verticillium wilt of olive trees in progenies from five crosses: 'Picual' × 'Frantoio', 'Arbosana' × 'Koroneiki', 'Sikitita' × 'Arbosana', 'Arbosana' × 'Frantoio' and 'Arbosana' × 'Arbequina' and their respective reciprocal crosses. Additionally, seedlings of 'Picual' and 'Frantoio' in open pollination were used as controls. In October 2016 and 2018, the fruits were harvested, and seeds germinated. Six-week-old seedlings were inoculated by dipping their bare roots in a conidial suspension of V. dahliae, and disease progress in terms of symptom severity and mortality was evaluated weekly. Additionally, seedling growth was evaluated every two weeks. At the end of the experiment, no significant differences were found for any of the assessed parameters when reciprocal crosses were compared. These results suggest that there is no maternal or paternal effect in regard to the heritability of resistance. In addition, this study identifies the best crosses for obtaining the highest number of resistant genotypes, highlighting the importance of the selection of specific cultivars to optimize the breeding process.

Application of Autoclave Treatment for Development of a Natural Wheat Bran Antioxidant Ingredient.

The study evaluated the effect of autoclaving as a hydrothermal treatment on the quality and bioactivity of wheat bran (WB) with the objective of producing a natural ingredient with enhanced healthy properties. Nutritional, antioxidant, techno-functional and sensorial parameters were studied, and temperatures of 100, 115 and 130 °C were explored. Of these, 130 °C was found to be the best treatment, resulting in an ingredient with high storage stability, antioxidant properties, a four-fold increase in the concentration of free ferulic acid (compared with non-treated WB), and increased content of apigenin-6-C-arabinoside-8-C-hexoside, a flavonoid with reported antioxidant and antifungal properties. On the other hand, the autoclave treatment enhanced water absorption capacity and reduced WB pasting viscosity, mainly at higher temperature (130 °C), which would allow incorporation of the treated WB in liquid matrices such as juices, soups or milkshakes, among others. Although the glycemic index (GI) of the autoclaved samples increased, the use of intermediate particle size of 106 to 300 µm could contribute to the reduction of the glycemic load.

Functional Status and Disability in Patients After Acute Stroke: A Longitudinal Study.

BACKGROUND: Stroke is a major public health problem. OBJECTIVE: To use the Barthel Index to evaluate basic activities of daily living in stroke survivors and detect any predictors of functional outcome at 6 months after stroke. METHODS: In an observational longitudinal study, data were gathered on consecutive patients admitted to the comprehensive stroke unit at Hospital San Pedro de Alcantara, Cáceres, Spain. Sociodemographic and clinical data were obtained prospectively at hospital admission and during follow-up 6 months later. Information on type of stroke, score on the Barthel Index, findings from the neurological evaluation, and other relevant data were collected. RESULTS: Of 236 patients admitted, 175 participated in the study. Mean age was 69.60 (SD, 12.52) years, 64.6% were men, and mortality was 12.8%. Six months after experiencing a stroke, 84.8% of patients had returned to their own homes, 8.0% were institutionalized, and the others were residing at a family member's home. Scores on the Barthel Index 6 months after stroke correlated with baseline scores on the National Institute of Health Stroke Scale (r = -0.424; P < .001) and with depressive mood 6 months after stroke (r = -0.318; P < .001). Age was negatively associated with Barthel Index scores at the time of hospital discharge and 6 months after stroke. CONCLUSIONS: Functional status 6 months after stroke was influenced by age, sex, stroke severity, type of stroke, baseline status, mood, and social risk. Comorbid conditions, socioeconomic level, and area of residence did not affect patients' functional status.

Oxidative stress in follicular fluid of young women with low response compared with fertile oocyte donors.

The aim of this study was to determine the concentrations of oxidative stress markers, antioxidant enzymes and cytokines in the follicular fluid of young women with low response in ovarian stimulation cycles compared with high responders and fertile oocyte donors of the same age, to assess the impact of oxidative stress on ovarian reserve. The activity of follicular fluid antioxidant enzymes glutathione transferase, glutathione reductase and glutathione peroxidase was significantly lower in young women with reduced ovarian reserve compared with that in high responders and oocyte donors. Follicular fluid concentrations of oxidative stress marker malondialdehyde combined with 4-hydroxyalkenals and nitric oxide were higher in low responders than in high responders and oocyte donors. Significant differences between low responders and donors in concentrations of IL-2, IL-6, IL-8 and vascular endothelial growth factor were observed, with higher concentrations in low responders. However, IL-10 concentration was lower in low responders than in high responders and donors. No significant differences were found in follicular fluid concentrations of tumour necrosis factor alpha between the three groups. These results demonstrate that different concentrations of oxidative stress markers, oxidant enzymes and cytokines in low responders compared with high responders and oocyte donors may negatively impact ovarian response.

Anemia and Outcome in Outpatients With Peripheral Artery Disease.

The influence of anemia on outcome in stable outpatients with peripheral artery disease (PAD) has not been consistently investigated. We used data from the Factores de Riesgo y ENfermedad Arterial (FRENA) Registry to compare ischemic events and mortality rates in stable outpatients with symptomatic PAD and anemia. Of 1663 patients with PAD, 208 (12.5%) had anemia. Over 18 months, patients with anemia had a higher rate of myocardial infarction (MI; rate ratio [RR]: 2.10; 95% confidence interval [CI]: 1.04-3.99), limb amputation (RR: 2.98; 95%CI: 1.70-5.05), and higher mortality (RR: 3.58; 95%CI: 2.39-5.28) than those without anemia. The rates of ischemic stroke (RR: 0.75; 95%CI: 0.23-1.93) and major bleeding (RR: 0.93; 95%CI: 0.15-3.51) were similar. On multivariable analysis, anemia was associated with an increased risk to die (hazard ratio [HR]: 2.32; 95%CI: 1.53-3.50) but not to develop MI (HR: 1.49; 95%CI: 0.73-3.05) or to have limb amputation (HR: 1.49; 95%CI: 0.86-2.59). In stable outpatients with PAD, anemia was associated with increased mortality but not with an increased rate of subsequent ischemic events or major bleeding.

Diagnostic accuracy of sperm DNA degradation index (DDSi) as a potential noninvasive biomarker to identify men with varicocele-associated infertility.

PURPOSE: Varicocele is a frequent cause of impaired testicular function that has been associated with increased levels of sperm DNA fragmentation (SDF). Sperm with degraded DNA (DDS), as observed using the sperm chromatin dispersion (SCD) test, represent a subpopulation of spermatozoa with extensive DNA and nuclear protein damage. The aim of this work was to determine the usefulness of sperm DNA degradation index (DDSi) as a novel noninvasive biomarker to identify infertile men with varicocele. METHODS: A total of 593 semen samples obtained from men attending infertility clinics were analyzed for SDF and DDS with the SCD test. These samples were classified as: (1) fertile donors; (2) infertile patients with least two failed assisted reproduction cycles; (3) leukocytospermia; (4) Chlamydia trachomatis infection; (5) testicular cancer, and (6) infertile men with varicocele. The DDSi was obtained by determining the proportion of DDS in the whole sperm population presenting with fragmented DNA. The diagnostic accuracy of DDSi was evaluated by correlation coefficient and receiver operating characteristics analyses. RESULTS: A positive correlation (r ≥ 0.52) was observed between the SDF and the frequency of degraded sperm in all patient groups. The sperm DNA degradation index (DDSi) was at least twice as higher in infertile men with varicocele (mean: 0.54) compared with other clinical conditions and fertile donors (means ranging from 0.02 to 0.21; P < 0.0001). A DDSi ≥ 0.33 identified patients with varicocele with 94 % accuracy. CONCLUSION: Although DDS is not pathognomonic of varicocele, the DDSi is a useful noninvasive biomaker to identify infertile individuals with varicocele when examining sperm DNA damage during a routine semen analysis. This finding may alert practitioners and laboratories performing semen analysis that in the presence of an abnormal DDSi it is likely that a given patient has varicocele. It is therefore strongly recommended that such patients be referred to urologists in order to undergo a full andrological examination and be properly counseled.

Determinants of Quality of Life in Stroke Survivors After 6 Months, from a Comprehensive Stroke Unit: A Longitudinal Study.

BACKGROUND: In the social model of stroke, health-related quality of life (HRQoL) is the result of interplay among stroke severity, social support, and health-promoting behaviors. Our objective was to identify determinants of HRQoL in stroke survivors. METHODS: Ischemic stroke patients were evaluated at 6 months with the Short Form 12 Health Survey, including physical component survey (PCS) and mental health component survey (MCS) summary scores. Multivariate stepwise regression analyses determined independent predictors of scores. Models included age, gender, socioeconomic class, education, residential environment, social support, previous comorbidity (Charlson Index), previous stroke, side of stroke, National Institutes of Health Stroke Scale (NIHSS) score at admission, Barthel Index (BI) and modified Rankin Scale (mRS) scores at discharge, and length of stay. RESULTS: A total of 131 patients participated (mean age 70.1, SD = 12.5; 62.6% males). In all, 33.6% had a BI score <90 and an mRS score >2 (poor outcome). The mean (SD) PCS score was 39.46 (9.3) and mean (SD) MCS score was 34.86 (10.1). Lower PCS score was associated with female sex (ß = 0.204, p = .009), poor social support (ß = -0.225, p = .003), and poor Charlson Index (ß = -0.162, p = .032) and BI scores (ß = 0.384, p < .0001). Lower MCS score was associated with female sex (ß = 0.162, p = .062) and poor NIHSS (ß = -0.265, p = .019) and BI scores (ß = 0.203, p < .071). CONCLUSION: Stroke severity, disability, gender, social support, and previous stroke have significant impacts on the physical and mental domains of generic HRQoL.

[LIMB SHAKING: DESCRIPTION OF A CASE FROM A NURSING PERSPECTIVE]. / Limb shaking: DESCRIPCIÓN DE UN CASO DESDE LA PERSPECTIVA ENFERMERA.

INTRODUCTION: Limb shaking, which was described by MillerFisher in 1962, is characterized by involuntary, irregular, stereotyped a hemibody triggered by the contralateral hemisphere hypoperfusion. It is associated with an occlusion or stenosis preoclusive of the extracranial internal carotid artery (ICA) contralateral to the movements, and poor circulation contralateral. This causes ischemia resulting in typical clinical manifestations of stroke and these abnormal movements. OBJECTIVE: To describe a case of limb shaking. MATERIALS AND METHODS: 59 years old man, with cardiovascular risk factors, who go to the Emergency room with symptoms and motor dysphasia and sudden loss of strength in right limbs, with distal brachial predominance. Admitted to Stroke Unit for neurological and hemodynamic monitoring, which coincides with the beginning of the sitting have an episode of these involuntary movements. RESULTS: Diagnostic tests confirm a left frontal cortical ischemic stroke. The EEG shows a normal background bioelectric activity. The angio-MRI and angiography showed a left ICA pseudoocclusion. DISCUSSON: A diagnosis of limb shaking based in the clinical examination and additional tests, which confirm the finding of a left ICA pseudo-occlusion and refractory to antiepileptic treatment. CONCLUSION: The limb shaking is a rare syndrome, which must be recognized and differentiated early from other processes to treat it properly. Treatment is aimed at restoring cerebral blood flow through the ischemic hemisphere revascularization.

Malformación de Dandy-Walker de diagnóstico tardío revelada por hipertensión intracraneal / Late diagnosis of Dandy-Walker’s malformation revealed by intracranial hypertension

La malformación de Dandy-Walker se ha descrito clásicamente por la triada de dilatación quística del cuarto ventrículo, hipoplasia del vermis cerebeloso e hidrocefalia. Los síntomas suelen aparecer en la infancia precoz. La presentación en la edad adulta es extremadamente rara, aunque puede ocurrir de forma espontánea o tras un traumatismo craneal. Caso clínico. Varón de 24 años que acude a urgencias por un cuadro compatible con hipertensión intracraneal. El TAC craneal reveló una malformación de Dandy-Walker. Comentario y Conclusiones. Aproximadamente el 80% de los pacientes con esta malformación se presentan durante le primer año de vida, principalmente con marcrocrania secundaria a la hidrocefalia. Por el contrario, en la edad adulta suelen presentarse con síntomas de disfunción de estructuras posteriores dando lugar a nistagmus, alteración de la marcha y ataxia, aunque también podrían presentar síntomas de hipertensión intracraneal...

Cilostazol and outcome in outpatients with peripheral artery disease.

BACKGROUND: Cilostazol increases the walking distance in patients with intermittent claudication, but there is scarce evidence of any effect on the risk for subsequent ischemic events, bleeding or death. PATIENTS AND METHODS: We used data from the FRENA Registry to compare the clinical outcome in stable outpatients with intermittent claudication, according to the use of cilostazol. RESULTS: As of January 2013, 1,317 patients with intermittent claudication were recruited in FRENA, of whom 191 (14.5%) received cilostazol. Over a mean follow-up of 18months, 39 patients developed myocardial infarction, 23 ischemic stroke, 20 underwent limb amputation, 15 had major bleeding and 70 died. There were no significant differences in the rate of subsequent ischemic events, major bleeding or death between patients receiving or not receiving cilostazol. On multivariate analysis, the use of cilostazol had no influence on the risk for subsequent myocardial infarction (hazard ratio [HR]: 0.97; 95% CI: 0.33-20.8), ischemic stroke (HR: 1.46; 95% CI: 0.48-4.43), limb amputation (HR: 0.34; 95% CI: 0.04-20.6), major bleeding (HR: 1.52; 95% CI: 0.33-7.09) or death (HR: 0.90; 95% CI: 0.40-20.0). CONCLUSIONS: In stable outpatients with intermittent claudication, the use of cilostazol was not associated with increased rates of subsequent ischemic events, major bleeding or death.

Experience in IVIg therapy for selected women with recurrent reproductive failure and NK cell expansion.

PROBLEM: Recurrent reproductive failure (RRF) has been associated with expansion of circulating NK cells, key cells for maternal tolerance, decidual vasculogenesis and embryo growth. This study reports our experience in intravenous immunoglobulin (IVIg) therapy of a large cohort of women with RRF with expanded circulating NK and/or NKT-like cells (blood NKT cells are a heterogeneous subset of T cells that share properties of both T cells and NK cells). METHOD OF STUDY: Observational study of RRF women with NK or NKT-like expansion (>12% or 10% cutoff levels of total lymphocytes, respectively), treated with IVIg for the next gestation. RESULTS: By multivariant logistic regression analysis after adjusting for age, NK cells subsets and other therapies, IVIg significantly improved the live birth rate to 96.3% in women with recurrent miscarriage (RM) compared with 30.6% in case not receiving IVIg (P < 0.0001). In women with recurrent implantation failure (RIF), in comparison with women not receiving IVIg, treatment increased the pregnancy rate from 26.2 to 93.8% (P ≤ 0.0001) and the live birth rate from 17.9 to 80.0% in RIF (P ≤ 0.0001). CONCLUSIONS: Immunomodulation with IVIg in our selected group of RRF patients with immunologic alterations enhanced clinical pregnancy and live birth rates. Our results may facilitate the design of future clinical trials of IVIg in this pathology.