Early cryoprecipitate transfusion versus standard care in severe postpartum haemorrhage: a pilot cluster-randomised trial.

There is a lack of evidence evaluating cryoprecipitate transfusion in severe postpartum haemorrhage. We performed a pilot cluster-randomised controlled trial to evaluate the feasibility of a trial on early cryoprecipitate delivery in severe postpartum haemorrhage. Pregnant women (>24 weeks gestation), actively bleeding within 24 h of delivery and who required at least one unit of red blood cells were eligible. Women declining transfusion in advance or with inherited clotting deficiencies were not eligible. Four UK hospitals were randomly allocated to deliver either the intervention (administration of two pools of cryoprecipitate within 90 min of first red blood cell unit requested plus standard care), or the control group treatment (standard care, where cryoprecipitate is administered later or not at all). The primary outcome was the proportion of women who received early cryoprecipitate (intervention) vs. standard care (control). Secondary outcomes included consent rates, acceptability of the intervention, safety outcomes and preliminary clinical outcome data to inform a definitive trial. Between March 2019 and January 2020, 199 participants were recruited; 19 refused consent, leaving 180 for analysis (110 in the intervention and 70 in the control group). Adherence to assigned treatment was 32% (95%CI 23-41%) in the intervention group vs. 81% (95%CI 70-90%) in the control group. The proportion of women receiving cryoprecipitate at any time-point was higher in the intervention (60%) vs. control (31%) groups; the former had fewer red blood cell transfusions at 24 h (mean difference -0.6 units, 95%CI -1.2 to 0); overall surgical procedures (odds ratio 0.6, 95%CI 0.3-1.1); and intensive care admissions (odds ratio 0.4, 95%CI 0.1-1.1). There was no increase in serious adverse or thrombotic events in the intervention group. Staff interviews showed that lack of awareness and uncertainty about study responsibilities contributed to lower adherence in the intervention group. We conclude that a full-scale trial may be feasible, provided that protocol revisions are put in place to establish clear lines of communication for ordering early cryoprecipitate in order to improve adherence. Preliminary clinical outcomes associated with cryoprecipitate administration are encouraging and merit further investigation.

Competition between Coulomb and van der Waals Interactions in Xe-Cs

Microscopic insight into interactions is a key for understanding the properties of heterogenous interfaces. We analyze local attraction in noncovalently bonded Xe-Cs^{+} aggregates and monolayers on Cu(111) as well as repulsion upon electron transfer. Using two-photon photoemission spectroscopy, scanning tunneling microscopy, and coupled cluster calculations combined with an image-charge model, we explain the intricate impact Xe has on Cs^{+}/Cu(111). We find that attraction between Cs^{+} and Xe counterbalances the screened Coulomb repulsion between Cs^{+} ions on Cu(111). Furthermore, we observe that the Cs 6s electron is repelled from Cu(111) due to xenon's electron density. Together, this yields a dual, i.e., attractive or repulsive, response of Xe depending on the positive or negative charge of the respective counterparticle, which emphasizes the importance of the Coulomb interaction in these systems.

Serum ferritin thresholds for the diagnosis of iron deficiency in pregnancy: a systematic review.

The aim of this review was to understand the landscape of serum ferritin in diagnosing iron deficiency in the aetiology of anaemia in pregnancy. Iron deficiency in pregnancy is a major public health problem leading to the development of anaemia. Reducing the global prevalence of anaemia in women of reproductive age is a 2025 global nutrition target. Bone marrow aspiration is the gold standard test for iron deficiency but requires an invasive procedure; therefore, serum ferritin is the most clinically useful test. We undertook a systematic search of electronic databases and trial registers from inception to January 2016. Studies of iron or micronutrient supplementation in pregnancy with pre-defined serum ferritin thresholds were included. Two independent reviewers selected studies, extracted data and assessed quality. There were 76 relevant studies mainly of observational study design (57%). The most commonly used thresholds of serum ferritin for the diagnosis of iron deficiency were <12 and <15 ng mL-1 (68%). Most primary studies provided no justification for the choice of serum ferritin threshold used, but 25 studies (33%) used thresholds defined by expert consensus in a guideline development process. There were five studies (7%) using a serum ferritin threshold defining iron deficiency derived from primary studies of bone marrow aspiration. Unified international thresholds of iron deficiency for women throughout pregnancy are required for accurate assessments of the global disease burden and for evaluating effectiveness of interventions addressing this problem.

Non-anaemic iron deficiency in pregnancy: the views of health service users and health care professionals.

BACKGROUND: The prevalence of anaemia in pregnancy in Europe is 25% and that resulting from iron deficiency is estimated at 40%. The maternal and fetal morbidity of non-anaemic iron deficiency (NAID) in pregnancy is likely to be significant. OBJECTIVES: To determine the views and opinions of health service users and clinicians concerning NAID in pregnancy in order to inform future research. METHODS: Two semi-structured focus groups were carried out to determine health service users' views on anaemia and NAID in pregnancy. A questionnaire was administered to obstetricians, haematologists, midwives and anaesthetists to elucidate their views on NAID in pregnancy. RESULTS: The study indicated that health service users and clinicians were interested in implementing testing for NAID in pregnancy with serum ferritin, if proven to be effective at reducing the effects of anaemia and improving maternal and neonatal outcomes. Clinicians had reservations in the use of intravenous iron supplementation for NAID in pregnancy. CONCLUSION: NAID is now accepted as a target condition for research by health service users and clinicians. The focus of future research should be on screening for NAID and its treatment.

Effects of aromatase inhibitor on menopausal hyperplasia in a case of obesity.

The aromatase inhibitor anastrazole proved effective in the treatment of endometrial hyperplasia and postmenopausal bleeding in an obese 65-year-old woman with high operative risk. During anastrazole administration for 12 months, the endometrial thickness decreased from 9.8 mm to 2.4 mm and the control endometrial histology showed an atrophic endometrium. Uterine bleeding did not occur in the post-treatment, 3-year follow-up period. The endometrial thicknesses measured yearly by ultrasonography were 2.9, 3.5 and 3.3 mm. The plasma estradiol levels increased from < 73 pmol/l post-treatment to 112, 98 and 103 pmol/l. This case demonstrates that long-term aromatase inhibitor treatment can result in a refractory status of the endometrium and the estradiol produced in the adipose tissue does not exert a proliferative effect.

Effect of body weight on testosterone/estradiol ratio in oligozoospermic patients.

To evaluate the effect of body mass on the hormonal and semen profiles of subfertile men with oligozoospemia, sperm concentration and reproductive hormone levels were compared in two body mass index (BMI) groups: underweight or normal weight patients (BMI = 25 kg/m2) vs. overweight or obese patients (BMI > 25 kg/m2). The mean BMI was 27 +/- 4.6 kg/m2. The testosterone/estradiol ratio was significantly reduced in the high BMI group as compared to the low BMI group (17 +/- 4 vs. 12 +/- 3; p < 0.05). A similar difference was found in the sperm concentration (11.2 +/- 3.16 x 10(6)/ml vs. 8.1 +/- 2.6 x 10(6)/ml). A nonsignificant difference was found in the LH/FSH ratio (1.41 +/- 0.64 vs. 1.63 +/- 0.72). We concluded that obesity and the consequent estrogen excess decrease the sperm concentration by influencing the hypothalamo-pituitary system.

Is there a relationship between cell phone use and semen quality?

This study was conducted to determine a possible relationship between regular cell phone use and different human semen attributes. The history-taking of men in our university clinic was supplemented with questions concerning cell phone use habits, including possession, daily standby position and daily transmission times. Semen analyses were performed by conventional methods. Statistics were calculated with SPSS statistical software. A total of 371 were included in the study. The duration of possession and the daily transmission time correlated negatively with the proportion of rapid progressive motile sperm (r = -0.12 and r = -0.19, respectively), and positively with the proportion of slow progressive motile sperm (r = 0.12 and r = 0.28, respectively). The low and high transmitter groups also differed in the proportion of rapid progressive motile sperm (48.7% vs. 40.6%). The prolonged use of cell phones may have negative effects on the sperm motility characteristics.

Effect of body weight on sperm concentration in normozoospermic males.

A total of 274 men (aged: 26 +/- 4.9 years) with normozoospermia were enrolled into this study. Their body mass index (BMI: kg/m2) varied between 17 and 39. According to BMI, the patients were divided into four groups: Group 1: 17-20, Group 2: 20.1-25, Group 3: 25.1-30 and Group 4: 30.1-39. Twenty-nine subjects were found in the first, 96 in the second, 91 in the third and 58 men in the fourth group. Sperm concentration was significantly lower in the obese group (29 x 10(6)/ml, p < 0.05) than in the group of BMI 17-20, 20-25 and 25-30. In advance, in the obese group, sperm count continuously decreased with aging. We conclude that obesity is associated with a lower sperm count in case of normozoospermia.

Effect of female body weight on efficiency of donor AI.

A total of 1,144 infertile women were treated by artificial donor insemination. Unsuccessful ovulation induction was found in 96 of these cases. The obese women (BMI: 28-36) had a relative risk of unsuccessful ovulation induction of 2.7 (95% confidence interval (CI) = 2.1-3.4) compared with women lower or normal body weight (BMI: 20-24). The effect was smaller in women with a BMI 25-27 or < 19 (relative risk (RR) = 1.4, 95% CI = 0.9-2.1 and 1.5, 95% CI = 0.8-2.5), respectively. During the AID treatment 412 pregnancies occurred. Pregnancy rate achieved by insemination was 28% (50 pregnancies per 178 cases, BMI 16-19), 42% (251/599, BMI 20-24), 33% (92/286, BMI 25-27), and 21% (19/81, BMI 28-36), respectively, in the different BMI groups.

Results of insemination (AIH) following GnRH treatment of endometriosis.

Endometriosis is one of the most frequent benign diseases in gynecology. It is the cause of the pelvic pain and infertility in more than 35% of women of reproductive age. The most appropriate treatment for endometriosis is the combination of surgery and adjuvant medical therapy with GnRH agonists. The authors demonstrate the results of 33 artificial intrauterine homolog inseminations after a 6-month GnRH analog therapy.

[Treatment of infertility, caused by retrograde ejaculation, using intrauterine insemination with sperm enhanced by the "swim up" method]. / Retrograd ejaculatio okozta infertilitás kezelése "swim-up" technikával dúsított ondó intrauterin inseminatiójával.

The causes and the pathomechanism of retrograde ejaculation are reported by the authors. In their case following the failure of the conservative treatment a successful intrauterine insemination was carried out in the superovulatory monitored cycle by semen are covered from the postcoital urine and washed in Ham-F-10. After an undisturbed twin pregnancy a mature male and a female infant was born using Caesarean section. There is a greater chance for pregnancy if the sperms recovered from the postcoital urine are numerous and if their motility is good.

A comparison of sperm antibody assays.

Cytotoxicity and Immunobead-binding immunoglobulin G assays agreed in 81% of sera from infertile men (n = 173), 74% of sera from their wives, 75% of seminal plasma, and 82% of cervical mucous samples (p less than 0.001; chi 2 analysis of positive and negative results) when tested against sperm from the same donors. Cytotoxic and immunofluorescent IgG antibody results agreed in 79% of sera from men and women, 76% of seminal plasma, and 76% of cervical mucus (p less than 0.001; chi 2 analysis of positive and negative results). Titers or percent binding of sperm by cytotoxicity, hemagglutination, and IgG Immunobead-binding or immunofluorescence assays in serum and secretions of husbands and wives correlated (p less than 0.001). A significantly increased number of positive results was observed in cytotoxic and Immunobead-binding IgG assays when the husbands' and donors' sperm were used rather than donors' sperm alone. On the basis of this study we conclude: (1) that cytotoxicity, Immunobead-binding IgG, and immunofluorescent IgG sperm antibody assays correlate when sperm from the same source are used, (2) that women's isoimmunity to husbands' sperm is associated with their husbands' autoimmunity to sperm irrespective of the assay, and (3) that it is desirable to use sperm from the husbands and nonautoimmune fertile men in these assays.

Intrauterine insemination with washed sperm.

Intrauterine insemination with washed semen has been carried out in our department since the beginning of 1986. Couples are examined carefully according to the principles of WHO before entering the program. The cycles of those couples treated by intrauterine insemination were monitored. Oestradiol values showed the highest levels on days 13 and 14, such as the size of folliculi, and serum progesterone level increased on days 14 and 15 ovulatory cycle. Insemination was performed with washed sperm after cleansing from it different albumin components and bacteria; the insemination was carried out in two groups. Good results were achieved in cases where the poor quality or hostility of the cervical mucus was the cause of infertility. The treatment can be successful if the spermiogram does not show severe deviation. No success can be expected in severe deviation of the spermiogram.

Variations in prolactin secretion in hyper- and normoprolactinaemia with or without galactorrhoea.

The circadian variations and secretory rhythms in prolactin secretion were examined in 10 hyperprolactinaemic and 10 normoprolactinaemic women with or without galactorrhoea in order to establish a clearer picture of this secretion and to find, if exists, correlation between the prolactin level and galactorrhoea. In the normoprolactinaemic women a rhythmical rise and fall were observed within 20 min, with higher values during nocturnal sleeping; these changes were more marked in the galactorrhoeic group. In the hyperprolactinaemic group the diurnal and pulsation changes were less pronounced, galatorrhoea usually being accompanied by a higher degree of hyperprolactinaemia. In galactorrhoeic patients with a normal basal prolactin level, a relative prolactin excess may be reckoned with at certain times. A proportion of these women can in fact then be regarded as hyperprolactinaemic. In the hyperprolactinaemic cases without galactorrhoea, a decreased prolactin sensitivity and milk-forming ability of the breasts may be assumed.

Special antigens on sperm from autoimmune infertile men.

Sera from three fertile men and four infertile men without sperm antibodies, 17 infertile men with sperm antibodies in serum and seminal plasma (S.P.), and 25 infertile men with sperm antibodies in S.P. were tested by Western Blot analysis against sperm membrane extracts and S.P. from fertile nonautoimmune men and infertile autoimmune men. Sera from fertile men reacted against common antigens with molecular weights (MW) of 28, 38, 48, 60, and 68 kD present on sperm from autoimmune and nonautoimmune men and special antigen of MW 76 kD on the sperm of fertile men. Sera from 15 of 17 (88%) autoimmune infertile men with sperm antibodies in serum and S.P. detected special antigens with MW of 58 kD (sera reactivity in 47% of these men), 43kD (in 29%), 30 kD (in 24%), 35 kD (in 18%), 52 kD (in 12%), 41 kD (in 6%), and 71 kD (in 6%) on the sperm of autoimmune men in addition to the common antigens. Sera from 15 of 25 (60%) men with sperm antibodies in their S.P. showed reactivity to special antigens with MW 52 kD (in 20%), 35 kD (in 16%), 41 kD (in 16%), 58 kD (in 8%), 70/71 kD (in 8%), 30 kD (in 8%), and 56 kD (in 4%). Sera from 18 of 42 (43%) infertile men with sperm antibodies also detected special antigens of MW 26, 46, and 76 kD present only in fertile men's sperm. Sera from only 15 of 42 (36%) autoimmune infertile men reacted against special antigens with MW 17, 20, 23, 30, 43, and 58 kD in the seminal plasma of autoimmune infertile men.(ABSTRACT TRUNCATED AT 250 WORDS)

Prolactin release during nursing in early puerperium.

The changes induced in prolactin levels during the first 6 days following delivery were studied. Blood samples for prolactin assay were taken from 9 women at 5-min intervals during breast feeding. The levels of lactation were followed via the amounts of milk produced during suckling. The highest prolactin levels were observed on days 2-4 following delivery. There appeared to be some correlation between the basal and breast-feeding-induced prolactin levels and the level of lactation. A relatively low basal level and a moderate feeding-induced response are early indicators of delayed and less productive lactation. In unfavourable cases the feeding-induced prolactin increases gradually disappeared and lactation stopped. The correlation between the prolactin level and the quantity of milk formed is not a close one, but the observed tendencies agree with the role of prolactin. From day 5 on, the prolactin demands of the breasts are lower.