The association between anti-Müllerian hormone and IVF-ICSI outcome in poor responder patients performing long protocol.

PURPOSE OF INVESTIGATION: Ovarian reserve reflects the capacity of the ovaries for a successful pregnancy. Anti-Müllerian hormone (AMH) could be a useful marker to predict ovarian reserve and to adjust controlled ovarian stimulation. The aim of this study was to assess the relationship between AMH and intracytoplasmic sperm injection-in vitro fertilization (IVF-ICSI) outcome in poor responder women. MATERIALS AND METHODS: This study was conducted prospectively for a period of 12 months. Inclusion criteria were FSH value > 15 iu/l or antral follicle number < 4, on the 2nd day of cycle. All patients underwent GnRH agonist stimulation with long protocol. Serum AMH levels were measured in the treatment cycle just before the stimulation. After the treatment, patients who were pregnant formed the study group and patients who were not pregnant formed the control group. Serum AMH level was the main outcome measure. RESULTS: The study and control group consisted of 34 and 70 patients, respectively. No significant difference was found in duration of infertility, antral follicular count, basal E2 and FSH levels. The mean serum AMH level was significantly higher in study group (p = 0.005). The retrieved oocyte number, metaphase 2 oocyte number, and fertilization rate were also significantly higher in the study group. DISCUSSION: Evaluation of serum AMH seems to be a useful marker to predict IVF-ICSI outcome in poor responder patients.

Comparing mouse and human cingulate cortex organization using functional connectivity.

The subdivisions of the extended cingulate cortex of the human brain are implicated in a number of high-level behaviors and affected by a range of neuropsychiatric disorders. Its anatomy, function, and response to therapeutics are often studied using non-human animals, including the mouse. However, the similarity of human and mouse frontal cortex, including cingulate areas, is still not fully understood. Some accounts emphasize resemblances between mouse cingulate cortex and human cingulate cortex while others emphasize similarities with human granular prefrontal cortex. We use comparative neuroimaging to study the connectivity of the cingulate cortex in the mouse and human, allowing comparisons between mouse 'gold standard' tracer and imaging data, and, in addition, comparison between the mouse and the human using comparable imaging data. We find overall similarities in organization of the cingulate between species, including anterior and midcingulate areas and a retrosplenial area. However, human cingulate contains subareas with a more fine-grained organization than is apparent in the mouse and it has connections to prefrontal areas not present in the mouse. Results such as these help formally address between-species brain organization and aim to improve the translation from preclinical to human results.

Protocol and preregistration for the CODEC project: measuring, modelling and mechanistically understanding the nature of cognitive variability in early childhood.

BACKGROUND: Children's cognitive performance fluctuates across multiple timescales. However, fluctuations have often been neglected in favour of research into average cognitive performance, limiting the unique insights into cognitive abilities and development that cognitive variability may afford. Preliminary evidence suggests that greater variability is associated with increased symptoms of neurodevelopmental disorders, and differences in behavioural and neural functioning. The relative dearth of empirical work on variability, historically limited due to a lack of suitable data and quantitative methodology, has left crucial questions unanswered, which the CODEC (COgnitive Dynamics in Early Childhood) study aims to address. METHOD: The CODEC cohort is an accelerated 3-year longitudinal study which encompasses 600 7-to-10-year-old children. Each year includes a 'burst' week (3 times per day, 5 days per week) of cognitive measurements on five cognitive domains (reasoning, working memory, processing speed, vocabulary, exploration), conducted both in classrooms and at home through experience sampling assessments. We also measure academic outcomes and external factors hypothesised to predict cognitive variability, including sleep, mood, motivation and background noise. A subset of 200 children (CODEC-MRI) are invited for two deep phenotyping sessions (in year 1 and year 3 of the study), including structural and functional magnetic resonance imaging, eye-tracking, parental measurements and questionnaire-based demographic and psychosocial measures. We will quantify developmental differences and changes in variability using Dynamic Structural Equation Modelling, allowing us to simultaneously capture variability and the multilevel structure of trials nested in sessions, days, children and classrooms. DISCUSSION: CODEC's unique design allows us to measure variability across a range of different cognitive domains, ages, and temporal resolutions. The deep-phenotyping arm allows us to test hypotheses concerning variability, including the role of mind wandering, strategy exploration, mood, sleep, and brain structure. Due to CODEC's longitudinal nature, we are able to quantify which measures of variability at baseline predict long-term outcomes. In summary, the CODEC study is a unique longitudinal study combining experience sampling, an accelerated longitudinal 'burst' design, deep phenotyping, and cutting-edge statistical methodologies to better understand the nature, causes, and consequences of cognitive variability in children. TRIAL REGISTRATION: ClinicalTrials.gov - NCT06330090.

The effect of chronic pelvic pain scoring on pre-term delivery rate.

A total of 57 pregnant women, who were admitted to the outpatient clinic having high visual analogue scale (VAS) and a history of chronic pelvic pain before pregnancy, were evaluated with the international pelvic pain assessment form (IPPAF). Gynaecological disorders, pain at ovulation, dysmenorrhoea, level of cramps with period and suspicion of endometriosis were determined to be higher in the pre-term group (p < 0.05). Regarding urological disorders, pain when the bladder was full, pain with urination, a positive answer to the question, 'Does your urgency bother you?' and suspicion of interstitial cystitis were also determined to be higher in the pre-term group (p < 0.05). Thus, the total IPPAF scores were significantly higher in the pre-term group (p < 0.05). The pregnant women with a higher total IPPAF score before pregnancy may thus have a higher probability of pre-term labour.

The effects of hormone therapy on ischemia modified albumin and soluble CD40 ligand levels in obese surgical menopausal women.

PURPOSE: To determine the effects of hormone therapy (HT) on ischemia modified albumin (IMA) and soluble (s)CD40 ligand in obese surgical menopausal women. MATERIALS AND METHODS: A total of 52 obese surgical menopausal women with a body mass index (BMI) > 30 kg/m2 were admitted to the study. Twenty-seven women received estradiol hemihydrate two mg and 25 did not receive any menopausal therapy. At baseline and after three and six months of treatment, IMA and sCD40 ligand levels were measured. RESULTS: There were no significant differences among the groups for any variables at baseline. No difference in change in the serum sCD40L levels was found in obese surgical menopausal women after three and six months of HT. Serum IMA levels were statistically lowered in obese women with HT after six months of treatment. CONCLUSION: HT may have a beneficial reduction in IMA levels in obese surgical menopausal women.

Large retroperitoneal schwannoma mimicking ovarian carcinoma: case report and literature review.

UNLABELLED: In this article we present a case of retroperitoneal schwannoma localized in the pelvic cavity with complete cystic degeneration, mimicking ovarian carcinoma. CASE: A 25-year-old nulligravid woman was admitted to our gynecology out-patient clinic with the complaint of abdominal distension, right flank pain and pollakiuria. Sonographic study showed a cytic mass containing necrotic areas and filling the whole pelvic cavity. Computed tomography and colonography suggested the possible diagnosis of a right ovarian malign tumor. Laparotomy revealed a retroperitoneal cystic lesion. Microscopic examination of the pelvic mass confirmed the diagnosis of cystic degenerative schwannoma. After six months of initial surgery she is still alive without any evidence of disease. CONCLUSION: In the present case, it is emphasized that it is easy to make an error and misdiagnose a pelvic mass as an ovarian tumor when it is in fact a tumor from another origin. Additonally, clinicians should keep in mind that retroperitoneal schwannoma may mimic cystic ovarian carcinoma even in young women.

Combined administration of misoprostol in the first and second trimester missed abortion cases.

OBJECTIVE: We aimed to investigate the effectiveness and adverse effects of combined (vaginal + oral) administration of misoprostol in missed abortion cases. MATERIAL AND METHODS: 48 missed abortion cases between 8 and 20 weeks of gestation were enrolled in this study. Misoprostol-induced medical abortion was planned; the first dose (200 microg) was administered intravaginally and subsequent doses (200 microg each) orally every following hour. A maximum of six doses (1200 microg) were used. Revision curettage was performed on all subjects who aborted. RESULTS: The mean time interval from the first dose of misoprostol until the abortion was 6.27 +/- 3.02 hours. The success rate was 95% for the whole group. We observed misoprostol-related trembling in one patient and fever in two patients. CONCLUSION: We believe that our low-dose combined misoprostol protocol is a safe, effective and well-tolerated method with minimal adverse effects for the termination of both first and second trimester pregnancy losses.

Does dehydroepiandrosterone supplementation really affect IVF-ICSI outcome in women with poor ovarian reserve?

OBJECTIVES: It is difficult to choose the correct fertility treatment in women with poor ovarian reserve. Although various methods have been used, the management of controlled ovarian hyperstimulation is not easy in poor responders. The aim of this study was to evaluate the efficacy of dehydroepiandrosterone (DHEA) on in vitro fertilization-intracytoplasmic sperm injection (IVF-ICSI) outcome of poor responders. STUDY DESIGN: This was a randomized, prospective controlled trial. Women with serum antimullerian hormone<1 ng/ml or serum follicle-stimulating hormone>15 IU/l and antral follicle count <4 on day 2 of the menstrual cycle were considered to have poor ovarian reserve. All women were treated with a microdose induction protocol. Women in the study group received IVF-ICSI and DHEA 75 mg daily for 12 weeks. Women in the control group received IVF-ICSI without DHEA supplementation. RESULTS: In total, 208 women with diminished ovarian reserve was enrolled in the study, 104 in the study group and 104 in the control group. The number of oocytes retrieved and the fertilization rate were slightly higher in the study group, but the pregnancy rate was higher in the control group. The differences were not significant. CONCLUSIONS: The results failed to show that DHEA supplementation enhances IVF-ICSI outcome in women with poor ovarian reserve.

[Pediatric fiberoptic bronchoscopy. Analysis of a decade]. / Fibrobroncoscopia pediátrica. Análisis de una década.

OBJECTIVE: To review the contribution of new advances in flexible bronchoscopy to the management of respiratory problems in children. METHODS: Over a 10-year-period, 536 flexible bronchoscopies were performed under sedation and local anesthesia in 433 children aged from 5 days to 14 years. Data on symptomatology, underlying diseases, indications, sedation, instrumentation, findings and complications were prospectively collected and stored in a database for later analysis. RESULTS: Underlying disease was found in 300 children (69.3 %). The most common indications for flexible bronchoscopy were persistent atelectasis (n 166), stridor (n 134), tuberculosis (n 66), suspected foreign body (n 61), persistent wheezing (n 55), middle lobe syndrome (n 47) and opportunistic pneumonias (n 41). In 178 patients the procedures were performed on an outpatient basis. One hundred forty-seven bronchoalveolar lavages, 10 bronchial biopsies, and 8 selective bronchographies were performed. Airway anomalies were found in 447 procedures (83.4 %) and 32 pathogenic organisms were identified. In 13 patients cytological study of the samples obtained guided the diagnosis of noninfectious lung disease. Therapeutic interventions were performed in 54 (10.1 %) flexible bronchoscopies. The most important of these were aspiration of bronchial secretions (n 31), removal of foreign bodies (n 6), selective intubation (n 5), and balloon dilatation of bronchial stenosis (n 2). The procedure was diagnostically or therapeutically useful in 391 procedures (79.2 %). CONCLUSION: Although rigid bronchoscopy is currently the procedure of choice in most therapeutic interventions, flexible bronchoscopy is very useful in improving airway exploration and understanding of respiratory disorders in children.

Fibrobroncoscopia pediátrica. Análisis de una década / Pediatric fiberoptic bronchoscopy. Analysis of a decade

Objetivo: Estudiar la contribución de los progresivos avances en fibrobroncoscopia al tratamiento de los trastornos respiratorios del niño. Métodos: A lo largo de 10 años se han realizado 536 fibrobroncoscopias en 433 niños de edades comprendidas entre 5 días y 14 años, bajo sedación y anestesia local. Prospectivamente se recogieron datos sobre la sintomatología del paciente, enfermedades subyacentes, indicaciones, sedación, instrumentación, hallazgos y complicaciones, y almacenados posteriormente en una base de datos para su análisis. Resultados: Tenían enfermedad subyacente 300 niños (69,3%). Las indicaciones más frecuentes de fibrobroncoscopia fueron las siguientes: atelectasia persistente (n = 166), estridor (n = 134), tuberculosis (n = 66), sospecha de cuerpo extraño (n = 61), sibilancias persistentes (n = 55), síndrome de lóbulo medio (n = 47), neumonías oportunistas (n = 41). Los procedimientos fueron realizados en hospital de día en 178 casos. Se realizaron 147 lavados broncoalveolares, 10 biopsias bronquiales y 8 broncografías selectivas. Se detectaron alteraciones de las vías respiratorias en 447 exploraciones (83,4%) y se identificaron 32 microorganismos con responsabilidad etiológica. En 13 casos, los estudios citológicos de las muestras obtenidas orientaron el diagnóstico de la enfermedad pulmonar no infecciosa responsable. Se hicieron 54 indicaciones terapéuticas (10,1%), siendo las más destacadas: aspiración de secreciones bronquiales (n = 31), extracción de cuerpos extraños (n = 6), intubación selectiva (n = 5), dilatación con balón de estenosis bronquial (n = 2). Se obtuvo un rendimiento diagnóstico-terapéutico en 391 procedimientos (72,9 %). Conclusión: La fibrobroncoscopia es una técnica de gran utilidad en el diagnóstico y orientación de la enfermedad respiratoria pediátrica, aunque hoy día la broncoscopia rígida la aventaja como instrumento terapéutico (AU)