Genetic Diversity of Stenocarpella maydis in the Major Corn Production Areas of the United States.

The fungus Stenocarpella maydis (Berk.) B. Sutton, causal agent of Diplodia ear rot, is a prevalent corn (Zea mays L.) pathogen in the United States. Although S. maydis reduces grain quality, causes yield loss, and can produce mycotoxins in some countries, few studies have examined its biology and genetic diversity. We analyzed the genetic diversity of 174 S. maydis isolates sampled across the major corn production areas in the United States using nine different microsatellites. In all, 55 unique multilocus genotypes (MLG) were observed out of the 174 S. maydis isolates tested. After conducting a Bayesian clustering analysis by STRUCTURE, it was observed that the most probable number of genetic groups was two; however, no separation by their geographical location was identified. According to the minimum spanning network, the S. maydis population is linked across geographic regions of the United States but also contains private genotypes. Temporal diversity in the inoculum source was also observed at one location across 4 years. The haploid stage of S. maydis was confirmed and both mating type genes were amplified among selected isolates with unique MLG. We theorize that, although S. maydis is primarily an asexual fungus, sporadic cryptic recombination may occur, which could contribute to the genetic diversity observed in this study.

Results with GnRH antagonist protocols are equivalent to GnRH agonist protocols in comparable patient populations.

OBJECTIVE: To determine whether ovarian stimulation outcome and success rates are equivalent between GnRH agonist and GnRH antagonist regimens when all other variables are held constant. STUDY DESIGN: Retrospective analysis. Infertile patients (n = 1,277) < 35 years of age, with normal ovarian reserve, undergoing their first in vitro fertilization cycle with a GnRH antagonist or agonist were included. Outcome variables were analyzed and compared between both groups. RESULTS: Of the total number of patients included, 21% (n = 268) underwent stimulation with a GnRH antagonist protocol and 79% (n = 1,009) with an agonist protocol. While the mean number of embryos transferred was similar between both groups, as well as the implantation rate for blastocyst embryo transfers, the implantation rate was noted to be slightly higher for the down-regulation group who underwent a Day 3 embryo transfer (p = 0.01). However, the overall clinical pregnancy, loss and high-order multiple pregnancy rates were constant in both groups. CONCLUSION: Although numerous variables were analyzed in our study, the differences noted did not have an impact on our final results as the clinical pregnancy rates were maintained in the antagonist group.

Should ICSI be recommended routinely in patients with four or fewer oocytes retrieved?

PURPOSE: To determine if patients with a low response to controlled ovarian hyperstimulation during IVF benefit from intracytoplasmic sperm injection (ICSI) METHODS: Retrospective analysis of 350 IVF cycles in which four or fewer oocytes were retrieved. Severe male factor cases were excluded from analysis. Conventional insemination (CI) and ICSI were compared, with primary outcome measures of fertilization rate, implantation rate, clinical pregnancy rate per embryo transfer, and pregnancy loss rate. RESULT(S): Fertilization rates per oocyte retrieved for CI and ICSI were comparable (51.5% vs. 51.8%). Parallel implantation rates (22% vs. 25%), clinical pregnancy rates (32.8% vs. 33.3%), and loss rates (26.7% vs. 39.5%) were also noted. No difference in cancelled cycles was reported. CONCLUSION(S): Our results demonstrate that in the presence of normal semen parameters, low egg number is not an indication to perform ICSI.

[Genetic thrombophilia and markers of endothelial activation in patients with preeclampsia]. / Trombofilia genética y marcadores de activación endotelial en pacientes con preeclampsia.

BACKGROUND: The presence of thrombosis in preeclampsia suggests that endothelial function could play an important role in its pathogenesis. OBJECTIVE: Determine the association between markers of genetic thrombophilia, endothelial activation and preeclampsia. MATERIAL AND METHOD: Prospective study of cases and controls to determine the factor V Leiden existence, protrombin G20210A, methylenetetrahydrofolate reductase C677T, activated protein C resistance and levels of von Willebrand factor and the sFlt1 receptor were determined in 28 women with preeclampsia and 41 pregnant controls. RESULTS: Methylenetetrahydrofolate reductase C677T had a high allelic frequency (0.50). Even in the absence of factor V Leiden, there were significant differences in the prevalence of activated protein C resistance and abnormal levels of sFlt1 between patients with preeclampsia homozygous for methylenetetrahydrofolate reductase C677T and controls (72 vs. 10%, p <0.008 and 63.6 vs. 10%, p < 0.05, respectively). Patients with two or more abnormal tests, including homozygousity for the C677T allele had an increased risk of preeclampsia than those with one or no abnormal test (OR: 3.15; CI: 1.1-9.02). CONCLUSION: Methylenetetrahydrofolate reductase C677T has a high allelic prevalence and is associated with markers of thrombosis and endothelial activation in Mexican women with preeclampsia.

[Causes of under recorded in job accidents]. / Causas de subregistro de accidentes de trabajo.

OBJECTIVE: To determine causes of under-record the job accidents in the IMSS at Veracruz state. METHODS: A prospective cross-sectional study was carried out in patients with a job accident who not concluded the proceedings to established as job accident (JA) in a Primary Care Unit, from September to December, in 2005. The data were obtained from ST-4-30-8 formats at emergency room. The results were analyzed through statistical programme. RESULTS: From 587 patients having job accidents, 242 (41 %) did not complete the administrative proceeding which would mark it as an accident during their work journey, and in this group, 118 (49 %) were agree to answer the survey. Contusions and wounds predominated on diagnostic. The proceeding for job accident was not completed by patients because: 53% said that did not matter, 24 % patients had not validity in the institute, and 10 % patients had not obtained boss permission to complete proceedings. CONCLUSIONS: Patients apathy, invalidity in the institute, and lack boss permission to complete proceedings were the main reasons of under-recorded.

The morphology of extracted testicular sperm correlates with fertilization but not pregnancy rates.

OBJECTIVE: To investigate sperm morphology on the day of fresh testicular sperm extraction (TESE) with intracytoplasmic sperm injection (ICSI), and its effect on fertilization and pregnancy rates, as TESE in conjunction with ICSI results in high fertilization and pregnancy rates in most patients, but to our knowledge only one small study has assessed the morphology of retrieved sperm and found no correlation with the success of fertilization. PATIENTS AND METHODS: In a retrospective database analysis in a large academic centre, 68 men had 75 cycles of TESE combined with ICSI from January 2004 until April 2006. Sperm obtained by TESE was morphologically analysed at high (x 400-600) magnification and used for ICSI on the day of tissue retrieval. Sperm were classified as being either normal, having an amorphous head, having a mid-piece defect or having multiple defects. The calculated percentage of abnormal sperm injected was compared with the normal fertilization rate using Pearson's correlation coefficient, and pregnancy rates between groups were compared using chi-square analysis. RESULTS: Fifteen cycles had all morphologically normal sperm; 21 cycles had 50-99% normal forms and 39 cycles had <50% normal sperm. There was a highly significant correlation between the percentage of normal sperm used for ICSI and fertilization rates (P = 0.007). Overall, 43 clinical pregnancies resulted in this series, i.e. three among the group with all normal sperm injected, 12 in the group with 50-99% normal sperm and 28 in the group with <50% normal forms. There were also 11 pregnancies in cycles that used no normal forms. Pregnancy rates did not differ significantly among the groups (P = 0.08). CONCLUSIONS: TESE with ICSI frequently results in successful pregnancy; normal morphology was highly and significantly associated with successful fertilization, but importantly there were still 10 clinical pregnancies in cycles where only abnormal sperm were used. Sperm morphology after TESE should be assessed at the time of the procedure, and whenever possible, morphologically normal sperm chosen for injection. However, it is reassuring that acceptable fertilization and pregnancy rates are still achievable in cases with no morphologically normal sperm available.

Hepatitis C virus seroprevalence in multi-transfused patients in Colombia.

BACKGROUND: Hepatitis C Virus (HCV) infection is a public health problem worldwide, with particular relevance in multi-transfused patients given that HCV is principally transmitted by exposure to infected blood. STUDY DESIGN: Between February and September 2003 a cross-sectional study was carried out in four hospital centres in Bogotá and Medellin, Colombia, to determine the risk factors for HCV infection in 500 multi-transfused patients. RESULTS: The study population was distributed in five groups: haemophilia, haemodyalsis, acute bleeding, ontological illnesses and sickle cell disease or thalassemia. Serum samples from patients were tested for HCV antibodies (Asxym, Abbott). An overall prevalence (9.0%; 95% confidence interval (CI): 6.4-11.6) (45/500) of HCV infection was found. Anti-HCV antibodies were detected in 32.2% of patients with haemophilia, 6.1% of patients undergoing haemodialysis, 7.1% of patients with sickle cell disease or thalassemia, 2.6% of patients with acute bleeding and 3.4% of patients with ontological or hematological diseases. The main risk factors associated with infection by HCV were: to be hemophilic (odds ratio, OR = 18.03; 95% Cl: 3.96-114.17), having received transfusions before 1995 (OR = 12.27; 95% Cl: 5.57-27.69), and having received more than 48 units of blood components (OR = 6.08; 95% CI: 3.06-12.1). In the multivariate analysis, only the year of transfusions (before 1995) remained significantly associated with risk of infection by HCV. CONCLUSIONS: The data show a 3-fold reduction in the infection risk between 1993 and 1995, when the serological screening for HCV in blood donors was being introduced. A reduction greater than 90% was achieved by 1995 when the screening coverage reached 99%.

Monozygotic pregnancies conceived by in vitro fertilization: understanding their prognosis.

OBJECTIVE: To analyze the outcomes and particular characteristics of monozygotic (MZ) pregnancies conceived by in vitro fertilization (IVF). DESIGN: Retrospective data analysis. SETTING: Large private-academic fertility center. PATIENT(S): IVF-conceived MZ pregnancies. INTERVENTION(S): Statistical analysis of MZ pregnancy outcomes depending on fetal order and pregnancy reductions status. MAIN OUTCOME MEASURE(S): Spontaneous pregnancy reduction, pregnancy loss, take-home baby rate, perinatal mortality, gestational age at delivery, and birth weight. RESULT(S): A total of 72 of 3,426 pregnancies (2.1%) were MZ, and 70 were included in the study. Of these, 34 cases (48.5%) were high-order multiple pregnancies (HOMP), and 36 (51.5%) were non-HOMP. In the HOMP group, only 2.9% (1 of 34) had a complete pregnancy loss while 38.8% (14 of 36) of the non-HOMP were lost by 20 weeks' gestation. Of the HOMP patients, 73.1% therapeutically reduced the MZ component, and a statistically significant difference in gestational age of delivery (37.8 ± 3.2 vs. 28.1 ± 7.7) and birth weight (2796 ± 865.8 vs. 1110.0 ± 731.6) was seen when compared with nonreduced HOMP. CONCLUSION(S): Twinning with MZ is encountered in a small but important number of pregnancies derived from assisted reproduction. The prognosis for these patients is unfavorable, particularly for single-implantation MZ pregnancies and for nonreduced HOMP. Patients who do not spontaneously reduce a MZ-HOMP by 12 weeks may benefit from therapeutically reducing the MZ component of the pregnancy.

Resistencia a la fractura in vitro de incrustaciones cerámicas usando dos materiales como bases cavitarias / in vitro fractures strength of ceramic inlays, using two types of cavity bases

Las bases cavitarias son usadas en odontología restauradora,varios materiales se recomiendan como base cavitaria en incrustaciones cerámicas. Objetivo: Comparar la resistencia a la fractura in vitro de una cerámica (disilicato de litio) como material restaurativo usando diferentes bases cavitarias en inlays en premolares. Material y métodos: Se elaboraron cavidades estandarizadas para inlays cerámicas MOD en 30 premolares. Se asignaron aleatoriamente tres grupos (n = 10): grupo 1: sin base cavitaria; grupo 2: base ionómero de vidrio reforzado con resina (VitrebondTM, 3M); grupo 3: base resina compuesta (FiltekTM Z350 XT, 3M). Las incrustaciones fueron fabricadas con disilicato de litio (IPS e.max®, Ivoclar) cementadas con (RelyXTM, 3M) y almacenadas en agua bidestilada (37 oC por 24 horas). Semidió la resistencia a la fractura en una máquina universal de pruebas mecánicas (MTS® Alliance RT/30) a una velocidad de 0.5 mm/minuto,fracturadas las muestras se registró bajo microscopia estereoscópica elmodo de fallo. Los datos se analizaron usando ANOVA de una vía y comparaciones post hoc con la prueba Scheffé. (Programa IBM SPSS STATISTICS 21.0). Resultados: El grupo control (sin base) obtuvo la media más alta (105.16 Kgf ± 11.41) siendo estadísticamente significativa con relación al grupo 2 (77.04 ± 19.69). El grupo 3 obtuvo una media (94.81 ± 10.65) siendo estadísticamente diferente del grupo 2 (p = .001). El modo de fallo más común fue el patrón IV (60 por ciento). Conclusiones: La resistencia a la fractura de inlays cerámicas de disilicato de litio es mayor en cavidades sin base cavitaria...

Sex chromosome micromosaicism in infertile men with normal karyotypes.

OBJECTIVE: To define the prevalence of low-level sex chromosome mosaicism in a cohort of infertile men. DESIGN: Prospective cohort study of infertile men. SETTING: Tertiary university infertility center. PATIENT(S): One hundred one consecutive men who presented with primary infertility for evaluation. INTERVENTION(S): Fluorescent in situ hybridization for X and Y was performed on 200 cells, and if an aberrant sex chromosome complement was noted, 400 cells were counted. For this study, any abnormality in sex chromosome complement was defined as micromosaicism. MAIN OUTCOME MEASURE(S): Low-level sex chromosome mosaicism. RESULT(S): Sixty-seven of these men (67%) had no mosaicism, and 34 men (34%) had micromosaicism. The median percentage of abnormal chromosomes in these men was 2%. The mean age of the men without micromosaicism was lower than for men with micromosaicism (31.1 years vs. 35.2 years). A trend toward higher FSH levels in men with low-level mosaicism was seen. Median sperm density and percent motility were higher in normal men. Percent normal morphology was identical between groups. CONCLUSION(S): We found low-level sex chromosome mosaicism in 34% of infertile men who presented for evaluation. Men with low-level mosaicism were significantly older. Low-level mosaicism may emerge with advancing age and may therefore help to explain the decline in fertility potential seen in older men.

Advances and controversies in assisted reproductive technology.

As the incidence and awareness of infertility have increased in the last decades, reproductive endocrinologists and scientists have striven to improve the therapeutic options being offered to patients. One of the most advanced and efficient technologies currently being offered is assisted reproductive technology. Among the various techniques that are comprised by assisted reproductive technology, in vitro fertilization is the most widely studied and used, being responsible for approximately 1% of all live births in the United States. As this technology has evolved, many controversies have arisen, and it is the purpose of this article to review what in the authors' opinion are the most current and controversial aspects of the whole process of in vitro fertilization and its related techniques.

Paternal age and assisted reproductive technology outcome in ovum recipients.

This study suggests that paternal age may be inversely associated with reproductive outcome, as demonstrated by a decline in fertilization, blastocyst formation, implantation and cryopreservation rates with advancing age.

Elevated body mass index (BMI) does not adversely affect in vitro fertilization outcome in young women.

OBJECTIVE: To determine if elevated body mass index in young women with normal ovarian reserve was associated with poorer ovarian response, difficulty at embryo transfer, and lower clinical pregnancy rates. MATERIALS AND METHODS: Retrospective study of 417 first, fresh in vitro fertilization cycles performed between October 2004 and December 2006. All women were under the age of 35 and had normal cycle day 3 follicle stimulating hormone and estradiol levels. Subjects were divided into groups by BMI: <18.5, 18.5-24.9, 25-29.9, > or = 30. RESULTS: Cancellation rates, peak estradiol levels, and mean number of oocytes retrieved were similar in all groups. There was a trend toward increasing difficulty in visualizing the air bubble at time of embryo transfer and lower implantation rates at higher body mass indices. Clinical and ongoing pregnancy rates were similar among groups. CONCLUSION: Obesity in young women does not adversely affect clinical pregnancy rates in patients treated with in vitro fertilization.

Human blastocyst morphological quality is significantly improved in embryos classified as fast on day 3 (>or=10 cells), bringing into question current embryological dogma.

OBJECTIVE: To evaluate developmental potential of fast cleaving day 3 embryos. DESIGN: Retrospective analysis. SETTING: Academic reproductive center. PATIENT(S): Three thousand five hundred twenty-nine embryos. INTERVENTION(S): Day 3 embryos were classified according to cell number: slow cleaving: or=10 cells, and further evaluated on day 5. The preimplantation genetic diagnosis (PGD) results of 43 fast cleaving embryos were correlated to blastocyst formation. Clinical outcomes of transfers involving only fast cleaving embryos (n = 4) were evaluated. MAIN OUTCOME MEASURE(S): Blastocyst morphology correlated to day 3 blastomere number. Relationship between euploidy and blastocyst formation of fast cleaving embryos. Implantation, pregnancy (PR), and birth rates resulting from fast embryo transfers. RESULT(S): Blastocyst formation rate was significantly greater in the intermediate cleaving (72.7%) and fast cleaving (54.2%) groups when compared to the slow cleaving group (38%). Highest quality blastocysts were formed significantly more often in the fast cleaving group. Twenty fast cleaving embryos that underwent PGD, formed blastocysts, of which 45% (9/20) were diagnosed as euploid. Aneuploidy was diagnosed in 82.6% (19/23) of arrested embryos. A 50% implantation and 100% PR and birth rate were achieved with embryo transfers involving fast cleaving embryos. CONCLUSION(S): Fast cleaving embryos not only reach the blastocyst stage at a similar rate to intermediate cleaving embryos, but also exceed morphological quality criteria on day 5. Fast cleaving embryo transfers demonstrated a high clinical potential.

Redefining in vitro fertilization success: should triplets be considered failures?

OBJECTIVE: To evaluate how the ranking of IVF programs changes if high-order multiple pregnancies (HOMPs) are considered negative outcomes. DESIGN: Retrospective analysis. SETTING: The 2004 Society for Assisted Reproductive Technology Clinic Outcome Reporting System. PATIENT(S): Two hundred seven programs that performed >50 IVF cycles were analyzed, and only patients 2.4 embryos decreased, as opposed to the programs that transferred fewer embryos (1.8-2.4). CONCLUSION(S): Reclassifying HOMPs as failed cycles will result in a reduced rank in programs that maintain high embryo replacements. Redefining success as a singleton or twin birth significantly changes the ranking order of programs and, potentially, how programs are perceived.

Report of four donor-recipient oocyte cryopreservation cycles resulting in high pregnancy and implantation rates.

OBJECTIVE: To determine the clinical potential of donor-oocyte cryopreservation and thaw techniques for recipient patients. DESIGN: Institutional review board-approved prospective study of donor oocyte cryopreservation. SETTING: A large, private infertility center. PATIENT(S): Four anonymous oocyte donors underwent ovarian hyperstimulation for the purpose of oocyte retrieval and cryopreservation. The oocytes were subsequently thawed, fertilized, and transferred to 4 recipient patients. INTERVENTION(S): Oocytes were obtained from young donor patients and were cryopreserved with a slow freeze/rapid thaw protocol in which 1,2-propanediol (PrOH) and sucrose were used as cryoprotectants. Oocytes that survived were inseminated using intracytoplasmic sperm injection (ICSI). Resulting embryos were replaced into the recipient patients on the third day post-insemination. MAIN OUTCOME MEASURE(S): Post-thaw survival rate, fertilization rate, cleavage rate, implantation and clinical pregnancy rates. RESULT(S): A total of 79 metaphase II oocytes were frozen, stored frozen overnight in liquid nitrogen, and then thawed. The post-thaw survival rate was 86.1%. Normal fertilization following ICSI occurred in 89.7% of the surviving oocytes. Cleavage was observed in 91.8% of normally fertilized oocytes. A total of 23 embryos were transferred to 4 recipient patients. A clinical pregnancy rate of 75% and an implantation rate of 26.1% were achieved. CONCLUSION(S): Human oocyte cryopreservation is an effective technique that can be applied in clinical situations with high oocyte survival and clinical pregnancy rates expected.

Moderately elevated levels of basal follicle-stimulating hormone in young patients predict low ovarian response, but should not be used to disqualify patients from attempting in vitro fertilization.

OBJECTIVE: To evaluate and compare IVF outcomes of patients within different age categories who had a normal basal FSH level with outcomes of patients with an elevated day 3 FSH level. DESIGN: Retrospective analysis. SETTING: Large, private IVF center. PATIENT(S): We analyzed 2,708 patients. Of these, 2,477 had normal basal FSH levels, and 231 had elevated basal FSH levels (> or =13.03 IU/L). Patients were segregated into various age groups. INTERVENTION: Follow-up. MAIN OUTCOME MEASURE(S): Outcomes of IVF overall, including cancellation rates, oocyte yield, and fertilization, implantation, and clinical pregnancy rates (PRs). RESULT(S): Cancellation rates were significantly higher in patients with elevated day 3 FSH levels compared with patients with normal FSH levels in all age groups. A significantly lower oocyte yield was observed in patients with elevated basal FSH. Fertilization rates were not affected by FSH levels. A significant decrease in the number of embryos available for transfer in patients > or =38 with an elevated day 3 FSH level was found. Implantation and clinical PRs were lower in patients >40 years of age who had an elevated day 3 FSH level when compared to same age patients with a normal day 3 FSH level. Loss rates were not significantly different. CONCLUSION(S): Young women with an elevated basal FSH level should be counseled differently than older women, and should be given adequate counseling and granted the opportunity to undergo an IVF cycle.

Blastocyst embryo transfer is associated with a sex-ratio imbalance in favor of male offspring.

OBJECTIVE: To evaluate the sex ratio of offspring born after blastocyst transfers. DESIGN: Retrospective data analysis. SETTING: A large assisted reproductive technology center. PATIENT(S): We included 1,284 offspring from 937 deliveries during the period August 2003-August 2005. INTERVENTION(S): Tabulation and statistical analysis of all births resulting from fresh IVF cycles. The sex of resulting offspring was compared in both day 3 and blastocyst transfers for all births and for singleton deliveries. In addition, the sex of children conceived with the use of autologous oocytes and donor oocytes was evaluated. MAIN OUTCOME MEASURE: Sex ratio of offspring born following embryo transfers (ETs) after day 3 of culture and sequential blastocycst culture. RESULT(S): The overall sex ratio was significantly shifted toward males when blastocyst transfers were performed. Blastocyst transfers with only the use of autologous oocytes resulted again in a significantly higher proportion of male offspring. An even greater proportional difference was encountered in singleton offspring from donor oocytes. However, significance was not reached because of the limited number of offspring in the subgroup. CONCLUSION(S): This is the first individual-center report of a significant sex-ratio imbalance after the sequential media culture of blastocysts. The large imbalance in singleton births associated with the use of donor oocytes, although not significant, is cautionary in regard to the use of elective single ETs. Observation and publication of phenomena such as the effects of extended culture on the sex ratio of live-borns will allow us a better understanding of early differences in sexual dimorphism of the embryo, and will allow us to counsel our patients more appropriately.

Presence of hydrosalpinx correlated to endometrial inflammatory response in vivo.

OBJECTIVE: To evaluate and compare the inflammatory response and mediators in the endometrium of patients with hydrosalpinges compared with normal controls. DESIGN: Retrospective case-control study. SETTING: Urban medical center. PATIENT(S) AND INTERVENTION(S): Hysterectomy samples were identified as being affected by hydrosalpinx or salpingitis (n = 30) and were age-matched with control samples (n = 30). INTERVENTIONS: Fallopian tube and endometrial slides were analyzed for leukocytes and immunohistochemical techniques performed for cytokines (interleukin-2 [IL-2]). MAIN OUTCOME MEASURE(S): Evaluate and compare the endometrial inflammatory response (leukocytes and cytokines) from samples affected and non-affected by hydrosalpinx and salpingitis. RESULT(S): Examination of tubal and endometrial slides with hydrosalpinx demonstrated a statistically significant increase in the number of overall inflammatory cells. High-intensity immunohistochemical staining for IL-2 was demonstrated in 7.4% of controls versus 65% of cases. CONCLUSION(S): A defined, identifiable, local response to hydrosalpingeal fluid has been demonstrated in the endometrium. This response consists of statistically significant elevations of leukocytes and IL-2. An inflammatory endometrial response may be an independent contributor to the decreased reproductive outcome observed in patients with hydrosalpinges.