PGT-HLA programmes for the cure of a sick sibling: clinical strategies for this challenging search.

The ultimate goal of a preimplantation genetic testing and human leukocyte antigen (PGT-HLA) matching programme is the birth of a healthy, HLA-compatible child for the treatment or cure of a sick sibling. Several authors have published successful cases of the births of children HLA-matched to siblings affected by different conditions and diseases. However, there are many reports of failed attempts. Couples seeking an HLA-matched sibling for their affected child look for positive outcomes in the shortest possible time. Nevertheless, there is no published consensus or guidelines with recommendations for these cases. Here, the authors aimed to analyse different approaches for these programmes, highlighting the most promising strategies for the families and fertility units. Furthermore, the authors mention a successful case of a PGT-HLA matching programme after a previous failed attempt following the strategies proposed. Which is the most cost-effective and time-efficient approach in a PGT-HLA matching programme?

Elective single versus double embryo transfer: live birth outcome and patient acceptance in a prospective randomised trial.

The purpose of this study was to determine which strategy of embryo transfer has a better trade-off in live birth delivery rate versus multiple pregnancy considering patient acceptance: elective single embryo transfer (eSET) or elective double embryo transfer (eDET). In all, 199 women <38 years of age undergoing their first IVF treatment in a private centre were included in a prospective open-label randomised controlled trial. Patients were randomised into four groups: (1) eSET on Day 3; (2) eSET on Day 5; (3) eDET on Day 3; and (4) eDET on Day 5. Per patient, main analysis included acceptance of assigned group, as well as multiple and live birth delivery rates of the fresh cycle. Secondary analysis included the rates of subsequent cryotransfers and the theoretical cumulative success rate. Of 98 patients selected for eSET, 40% refused and preferred eDET. The live birth delivery rate after eDET was significantly higher after eDET versus eSET (65% vs 42%, respectively; odds ratio=1.6, 95% confidence interval 1.1-2.1). No multiple births were observed after eSET, compared with 35% after eDET. Although live birth delivery is higher with eDET, the increased risk of multiple births is avoided with eSET. Nearly half the patients refused eSET even after having been well informed about its benefits.

Community-based health care for indigenous women in Mexico: a qualitative evaluation.

INTRODUCTION: Indigenous women in Mexico represent a vulnerable population in which three kinds of discrimination converge (ethnicity, gender and class), having direct repercussions on health status. The discrimination and inequity in health care settings brought this population to the fore as a priority group for institutional action. The objective of this study was to evaluate the processes and performance of the "Casa de la Mujer Indígena", a community based project for culturally and linguistically appropriate service delivery for indigenous women. The evaluation summarizes perspectives from diverse stakeholders involved in the implementation of the model, including users, local authorities, and institutional representatives. METHODS: The study covered five Casas implementation sites located in four Mexican states. A qualitative process evaluation focused on systematically analyzing the Casas project processes and performance was conducted using archival information and semi-structured interviews. Sixty-two interviews were conducted, and grounded theory approach was applied for data analysis. RESULTS: Few similarities were observed between the proposed model of service delivery and its implementation in diverse locations, signaling discordant operating processes. Evidence gathered from Casas personnel highlighted their ability to detect obstetric emergencies and domestic violence cases, as well as contribute to the empowerment of women in the indigenous communities served by the project. These themes directly translated to increases in the reporting of abuse and referrals for obstetric emergencies. CONCLUSIONS: The model's cultural and linguistic competency, and contributions to increased referrals for obstetric emergencies and abuse are notable successes. The flexibility and community-based nature of the model has allowed it to be adapted to the particularities of diverse indigenous contexts. Local, culturally appropriate implementation has been facilitated by the fact that the Casas have been implemented with local leadership and local women have taken ownership. Users express overall satisfaction with service delivery, while providing constructive feedback for the improvement of existing Casas, as well as more cost-effective implementation of the model in new sites. Integration of user's input obtained from this process evaluation into future planning will undoubtedly increase buy-in. The Casas model is pertinent and viable to other contexts where indigenous women experience disparities in care.

Effect of Group Embryo Culture under Low-Oxygen Tension in Benchtop Incubators on Human Embryo Culture: Prospective, Randomized, Controlled Trial.

To evaluate the efficacy of group embryo culture under low-oxygen tension in benchtop incubators on human embryo development in vitro. The study was designed as a prospective, patient blind, randomized, controlled trial of a complex intervention. One hundred forty-eight women undergoing IVF were recruited in our fertility practice and randomized into two groups: intervention group (study culture strategy) or control group (control culture strategy). Intervention group embryos were cultured grouped under low-oxygen tension in benchtop incubators while control group embryos were cultured individually under atmospheric oxygen tension in large-box incubators. Using the study culture strategy, there were a significantly higher implantation rate (65.1% vs 49.2%; RR, 1.42; 95% CI, 1.17-1.73) and live birth delivery rate per embryo transfer (52.7% vs 39.5%; RR, 1.33; 95% CI, 1.02-1.75) with the first fresh embryo transfer. Cumulative implantation rate (56.7% vs 43.6%; RR, 1.30; 95% CI, 1.05-1.62) and cumulative live birth rate per embryo transfer (47.4% vs 36.2%; RR, 1.31; 95% CI, 1.01-1.69) were also statistically significantly increased in the study culture strategy. Human embryos exposed to our study culture condition strategy had statistically significant increased cumulative implantation rate and cumulative live birth rate per embryo transferred. Our findings suggest that this strategy specially favours poor quality embryos. Clinical Trial Registration Number: NCT01904006.

Consideraciones ante la asistencia en salud mental a menores en casos de desacuerdo parental / Considerations on mental health care for minors in cases of parental disagreement

Menores procedentes de familias en conflicto, bien por ruptura, separación o divorcio de sus progenitores, bien por otras razones, con frecuencia acuden a los Centros de Salud Mental de Niños y Adolescentes. Los profesionales se ven entonces envueltos en situaciones muy cargadas emocionalmente y a veces fuertemente judicializadas, en las que pueden surgir dudas sobre cuál sería la actitud a seguir desde el punto de vista clínico, ético y legal. Este artículo de revisión pretende dar respuesta a algunas de estas dudas frecuentes en nuestra práctica clínica habitual, proporcionando una guía de asistencia al menor cuando dicha asistencia está mediatizada por un desacuerdo entre progenitores. Todo ello dentro del actual marco legal del Estado español

Minors that come from broken homes due to a break-up, legal separation, divorce, or for other reasons, frequently go to Child and Adolescent Mental Health Centres. Professionals can find themselves involved in very emotionally charged, and sometimes strongly legally contested situations, where doubts may arise about what procedure they should follow from an ethical, clinical and legal point of view. This review article, based on Spanish law, tries to answer some of the doubts frequently encountered in common clinical practice, and may provide a guide to assisting the child when there is a disagreement between the parents

Metabotropic Ca(2+) channel-induced Ca(2+) release and ATP-dependent facilitation of arterial myocyte contraction.

Voltage-gated Ca(2+) channels in arterial myocytes can mediate Ca(2+) release from the sarcoplasmic reticulum and, thus, induce contraction without the need of extracellular Ca(2+) influx. This metabotropic action of Ca(2+) channels (denoted as calcium-channel-induced calcium release or CCICR) involves activation of G proteins and the phospholipase C-inositol 1,4,5-trisphosphate pathway. Here, we show a form of vascular tone regulation by extracellular ATP that depends on the modulation of CCICR. In isolated arterial myocytes, ATP produced facilitation of Ca(2+)-channel activation and, subsequently, a strong potentiation of CCICR. The facilitation of L-type channel still occurred after full blockade of purinergic receptors and inhibition of G proteins with GDPbetaS, thus suggesting that ATP directly interacts with Ca(2+) channels. The effects of ATP appear to be highly selective, because they were not mimicked by other nucleotides (ADP or UTP) or vasoactive agents, such as norepinephrine, acetylcholine, or endothelin-1. We have also shown that CCICR can trigger arterial cerebral vasoconstriction in the absence of extracellular calcium and that this phenomenon is greatly facilitated by extracellular ATP. Although, at low concentrations, ATP does not induce arterial contraction per se, this agent markedly potentiates contractility of partially depolarized or primed arteries. Hence, the metabotropic action of L-type Ca(2+) channels could have a high impact on vascular pathophysiology, because, even in the absence of Ca(2+) channel opening, it might mediate elevations of cytosolic Ca(2+) and contraction in partially depolarized vascular smooth muscle cells exposed to small concentrations of agonists.

Educación nutricional y su importancia en la salud del niño / Nutritional education and its importance in child health

Se hacen consideraciones acerca de la importancia de la educación nutricional de la promoción y presentación de la salud del niño y las causas de su poca efectividad en muchos medios. Se plantea que la educación nutricional debe estar orientada más hacia la acción que hacia el conocimiento en sí mismo, por lo cual el educador en Nutrición no debe desviarse del contexto en que trabaja. Se subraya la necesidad de conocer las características y costumbres de la población; por su carácter preventivo debe estar dirigida hacia lo que debe y puede hacer la familia y requiere como elemento decisivo la necesidad de participación de la comunidad en las acciones que se emprendan