Endometriosis in a 22-Year-Old with Premature Ovarian Insufficiency Secondary to Pre-Pubertal Bone Marrow Transplant: a Case Report.

Endometriosis is often diagnosed in reproductive aged women with spontaneous ovarian activity. Here we described a case of endometriosis diagnosed in a patient with premature ovarian insufficiency (POI) due to prepubertal bone marrow transplant (BMT). The patient is a 22-year-old nulligravid female who presented with chronic pelvic pain. She had an inherited bone marrow failure syndrome (Diamond-Blackfan anemia), which required gonadotoxic chemotherapy for BMT at a young age prior to puberty. At age 13, she received hormone therapy with transdermal estrogen with subsequent addition of cyclic progestin and was later transitioned to combined oral contraceptive pills (COC). Endometriosis was suspected due to progressive dysmenorrhea and multiple cyclic systemic symptoms. She underwent a trial of elagolix, but could not tolerate it due to worsened arthralgia. Norethindrone acetate (NET-A) was then started, and she underwent diagnostic laparoscopy. Laparoscopy revealed scattered superficial endometriotic lesions in the pelvis. Histological studies showed florid endometriosis. Patient continues on NET-A 10mg and oral estradiol 0.5mg daily since the surgery and has experienced sustained improvement in her symptoms. Endometriosis should be considered as a possible cause for progressive dysmenorrhea or pelvic pain, even in the setting of POI. The balance between HT for overall health benefits in young women with POI and the risk of endometriosis exacerbation is delicate, but achievable.

Human-specific epigenomic states in spermatogenesis.

Infertility is becoming increasingly common, affecting one in six people globally. Half of these cases can be attributed to male factors, many driven by abnormalities in the process of sperm development. Emerging evidence from genome-wide association studies, genetic screening of patient cohorts, and animal models highlights an important genetic contribution to spermatogenic defects, but comprehensive identification and characterization of the genes critical for male fertility remain lacking. High divergence of gene regulation in spermatogenic cells across species poses challenges for delineating the genetic pathways required for human spermatogenesis using common model organisms. In this study, we leveraged post-translational histone modification and gene transcription data for 15,491 genes in four mammalian species (human, rhesus macaque, mouse, and opossum), to identify human-specific patterns of gene regulation during spermatogenesis. We combined H3K27me3 ChIP-seq, H3K4me3 ChIP-seq, and RNA-seq data to define epigenetic states for each gene at two stages of spermatogenesis, pachytene spermatocytes and round spermatids, in each species. We identified 239 genes that are uniquely active, poised, or dynamically regulated in human spermatogenic cells distinct from the other three species. While some of these genes have been implicated in reproductive functions, many more have not yet been associated with human infertility and may be candidates for further molecular and epidemiologic studies. Our analysis offers an example of the opportunities provided by evolutionary and epigenomic data for broadly screening candidate genes implicated in reproduction, which might lead to discoveries of novel genetic targets for diagnosis and management of male infertility and male contraception.

Construction and validation of risk prediction model for gastrointestinal bleeding in patients after coronary artery bypass grafting.

This study aimed to develop a risk prediction model for gastrointestinal bleeding in patients after coronary artery bypass grafting (CABG) and assessed its accuracy. A retrospective analysis was conducted on 232 patients who underwent CABG under general anesthesia in our hospital between January 2022 and December 2022. The patients were divided into gastrointestinal bleeding (GIB) group (n = 52) and group without gastrointestinal bleeding (non-GIB) (n = 180). The independent risk factors for gastrointestinal bleeding in post-CABG patients were analyzed using χ2 test, t test and logistic multivariate regression analysis. A prediction model was established based on the identified risk factors. To verify the accuracy of the prediction model, a verification group of 161 patients who met the criteria was selected between January to June 2023, and the Bootstrap method was used for internal validation. The discrimination of the prediction model was evaluated using the area under the curve (AUC), where a higher AUC indicates a stronger discrimination effect of the model. The study developed a risk prediction model for gastrointestinal bleeding after CABG surgery. The model identified four independent risk factors: duration of stay in the intensive care unit (ICU) (OR 0.761), cardiopulmonary bypass time (OR 1.019), prolonged aortic occlusion time (OR 0.981) and re-operation for bleeding (OR 0.180). Based on these factors, an individualized risk prediction model was constructed. The C-index values of the modeling group and the verification group were 0.805 [95% CI (0.7303-0.8793)] and 0.785 [95% CI (0.6932-0.8766)], respectively, which indicated a good accuracy and discrimination of this model. The calibration and standard curves showed similar results, which further supported the accuracy of the risk prediction model. In conclusion, ICU time, cardiopulmonary bypass time, aortic occlusion time and re-operation for bleeding are identified as independent risk factors for gastrointestinal bleeding in patients after CABG. The risk prediction model developed in this study demonstrates strong predictive performance and provides valuable insights for clinical medical professionals in evaluating gastrointestinal complications in CABG patients.

[Distribution Characteristics and Risk Assessment of Microplastics in Farmland Soil in Guyuan].

The farmland ecosystem faces the emerging risk of microplastic pollution. To investigate the distribution characteristics of microplastics in agricultural soils in Guyuan City, the abundance, type, color, size, and shape of microplastics in Guyuan City agricultural soils were analyzed using field survey, microscopic observation, and Fourier transform infrared spectroscopy. In addition, the risk of microplastic pollution was assessed using the pollution load index method (PLI). The results showed that the microplastic abundance of agricultural soils (0-20 cm) in Guyuan City ranged from 186.32 to 1286.24 n·kg-1, and the microplastic abundance of soils in facility agriculture increased significantly by 35.56% and 228.91% compared with those in non-facility agriculture with and without film, respectively, and the microplastic abundance in the arable layer was 0.31 times higher than that in the plough pan layer. PE (26.42% to 62.83%) and PP (27.64% to 42.62%) were the main microplastic polymer types, and the number of soil polymer species was significantly greater in facility agriculture than that in non-facility agriculture. Microplastics <100 µm accounted for 32.21%-42.52%, whereas >1000 µm accounted for only 0.28%-12.31%. The particle size of microplastics in the arable layer was 47.39% higher than that in the plough pan layer, and the particle size of microplastics was the largest in facility agriculture and the smallest in non-facility film-free planting. Microplastics were mostly in the form of films, fibers, fragments, and microbeads, with the greatest abundance in the form of fibers and the second largest in the form of films. A total of seven colors of microplastics were monitored, mainly white and black. The overall risk of contamination in the study area was low, and the highest risk of microplastic contamination was found in the soil of facility agriculture. The results of the study will provide data reference for the assessment of microplastic contamination in agricultural soils and microplastic soil environmental behavior in China.

[Effects of Combined Pollution of Microplastics and Lead on Maize Seed Germination and Growth].

Microplastics are a new contaminant that are causing worldwide concern. However, an understanding of their impact on agricultural seed germination remains inadequate. To investigate the effects of combined microplastic and heavy metal contamination on crop seed germination and growth, the effects of exposure to different single and combined concentrations of lead (Pb) and three microplastics[polyethylene (PE), polypropylene (PP), and polyvinyl chloride (PVC)] on maize seed germination and growth were investigated using maize seeds. The results showed that:the inhibition of maize seed germination by Pb single exposure generally increased with Pb concentration. Compared with that in CK, 500, 1000, and 1500 mg·L-1 PE exposure significantly inhibited maize seed germination, but 100 and 300 mg·L-1 exposure had no significant effect (except at d 5). All PP concentration exposures significantly inhibited maize seed germination, with higher concentrations resulting in stronger inhibition. Compared to that under PP and PE exposure, PVC single exposure inhibited maize germination less, and 500, 1000, and 1500 mg·L-1 exposures produced a facilitative effect at the later stages of germination. The germination index, germination potential, and vigor index of maize seeds decreased with the increase in the single exposure concentration of lead and three types of microplastics, significantly decreased compared with that of CK under the combined exposure of Pb and PE, and did not change significantly under the combined exposure of PP and Pb or PVC and Pb. Among the three types of microplastics, PVC had the least effect on corn seed vigor. Both single exposures of 10 mg·L-1Pb and 100 mg·L-1 of the three microplastics promoted maize stalk and root growth, whereas other concentrations showed mostly inhibitory effects. When the PE concentration was 500 mg·L-1, the 10 and 20 mg·L-1Pb exposures both promoted maize seed stalk and root growth; however, the combined PP and Pb exposures did not produce significant inhibition, whereas 500 mg·L-1PVC and 10 mg·L-1Pb showed the strongest inhibition of maize stalk and root growth under combined PVC and Pb exposures. The effects of combined exposure to microplastics and Pb on the germination and growth of maize seeds were essentially antagonistic, thus slowing down the toxic effects of their respective single exposures on maize seeds.

Effect of state insurance mandates on racial/ethnic disparities in the utilization and outcomes of donor oocyte-assisted reproductive technologies.

OBJECTIVE: To characterize racial/ethnic disparities in donor oocyte-assisted reproductive technology (ART) nationwide and examine the impact of state insurance mandates on disparities in utilization and outcomes. DESIGN: Retrospective cohort study. SETTING: Donor oocyte ART cycles in the United States (US). PATIENT(S): Women who underwent donor oocyte ART in 2014-2016, as reported to the Society for Assisted Reproductive Technology Clinic Outcome Reporting System. INTERVENTION(S): Race/ethnicity of oocyte recipients. MAIN OUTCOME MEASURE(S): Live birth through 1 or more donor oocyte ART cycles in 2014-2016 per recipient. RESULT(S): We analyzed 44,033 donor ART cycles performed for 28,157 oocyte recipients, 99.2% (27,919/28,157) of whom were aged 25-54 years. Race/ethnicity data were reported for 61.4% (17,281/28,157) of the recipients. Among recipients aged 25-54 years with race data, 65.8% (11,264/17,128) identified as non-Hispanic White, whereas 58.9% were White among women aged 25-54 in the 2016 US census. In contrast, Black recipients comprised 8.3% of those aged 25-54 years with race data, compared with 13.7% nationwide. Among White recipients, 7.0% (791/11,356) lived in states with donor ART mandates (Massachusetts/New Jersey), compared with 6.5% (93/1,439) of Black recipients, 8.1% (108/1,335) of Hispanic recipients, and 5.8% (184/3,151) of Asian recipients. Black recipients had a higher median age and body mass index and were more likely to have uterine factor infertility. White recipients had the highest cumulative probability of live birth in the nonmandate (64.6%, 6,820/10,565) and mandate (69.5%, 550/791) states, followed by Asian recipients (nonmandate, 63.4% [1,881/2,967]; mandate, 65.2% [120/184]), Hispanic recipients (nonmandate, 60.5% [742/1,227]; mandate, 68.5% [74/108]), and Black recipients (nonmandate, 48.7% [655/1,346]; mandate, 48.4% [45/93]). The multivariable Poisson regression adjusting for donor's age and recipient's age, body mass index, nulliparity, history of recurrent pregnancy loss, diminished ovarian reserve, tubal factor and uterine factor infertility, prior ART treatment, use of preimplantation genetic testing, cumulative number of embryos transferred, use of blastocysts, and frozen-thawed transfers, demonstrated that Black recipients had a lower cumulative probability of a live birth than White recipients (relative risk [RR], 0.82; 95% confidence interval [CI], 0.77-0.87), as were Hispanic recipients (RR, 0.93; 95% CI, 0.89-0.99) and Asian recipients (RR, 0.96; 95% CI, 0.93-0.99). These disparities were not modified by state mandate for donor ART. CONCLUSION(S): State mandates for donor oocyte ART in their current forms are insufficient in decreasing racial/ethnic disparities.

Insights into enhanced removal of Cd2+ from aqueous solutions by attapulgite supported sulfide-modified nanoscale zero-valent iron.

The sulfidation of nanoscale zerovalent iron (nZVI) has received increasing attention for reducing the oxidizability of nZVI and improving its reactivity toward heavy metal ions. Here, a sulfide (S)-modified attapulgite (ATP)-supported nanoscale nZVI composite (S-nZVI@ATP) was rapidly synthesized under acidic conditions and used to alleviate Cd2+ toxicity from an aqueous solution. The degree of oxidation of S-nZVI@ATP was less than that of nZVI@ATP, indicating that the sulfide modification significantly reduced the oxidation of nZVI. The optimal loading ratio was at an S-to-Fe molar ratio of 0.75, and the adsorption performance of S-nZVI@ATP for Cd2+ was significantly improved compared with that of nZVI@ATP. The removal of Cd2+ by S-nZVI@ATP was 100% when the adsorbent addition was 1 g/L, the solution was 30 mL, and the adsorption was performed at 25 °C for 24 h with an initial Cd2+ concentration of 100 mg/L. Kinetics studies showed that the adsorption process of Cd followed the pseudo-second-order model, indicating that chemisorption was the dominant adsorption mechanism. The adsorption of Cd2+ by S-nZVI @ATP is dominated by the complexation between the iron oxide or iron hydroxide shell of S-nZVI and Cd2+ and the formation of Cd(OH)2 and CdS precipitates.

Early detection of velamentous cord insertion at the eighth week of gestation.

Velamentous cord insertion can be diagnosed at 8 weeks of gestation, earlier than previously reported. Fetal surveillance may be informed and prognosis may be impacted by early diagnosis once viability is reached.

When "facts" are not facts: what does p value really mean, and how does it deceive us?

The recent paper in JAMA alleging that frozen embryo transfer causes twice the risk of childhood cancer in the offspring is an excellent example of the erroneous use of statistical tests (and the misinterpretation of p value) that is common in much of the medical literature, even in very high impact journals. These myths backed by misleading statements of "statistical significance" can cause far-reaching harm to patients and doctors who might not understand the pitfalls of specious statistical testing.

Supramolecular organogels fabricated with dicarboxylic acids and primary alkyl amines: controllable self-assembled structures.

Supramolecular organogels are soft materials comprised of low-molecular-mass organic gelators (LMOGs) and organic liquids. Owning to their unique supramolecular structures and potential applications, LMOGs have attracted wide attention from chemists and biochemists. A new "superorganogel" system based on dicarboxylic acids and primary alkyl amines (R-NH2) from the formation of organogels is achieved in various organic media including strong and weak polar solvents. The gelation properties of these gelators strongly rely on the molecular structure. Their aggregation morphology in the as-obtained organogels can be controlled by the solvent polarity and the tail chain length of R-NH2. Interestingly, flower-like self-assemblies can be obtained in organic solvents with medium polarity, such as tetrahydrofuran, pyridine and dichloromethane, when the gelators possess a suitable length of carbon chain. Moreover, further analyses of Fourier transformation infrared spectroscopy and 1H nuclear magnetic resonance spectroscopy reveal that the intermolecular acid-base interaction and van der Waals interaction are critical driving forces in the process of organogelation. In addition, this kind of organogel system displays excellent mechanical properties and thermo-reversibility, and its forming mechanism is also proposed.

Syndemic of Lifetime Mental Illness, Substance Use Disorders, and Trauma and Their Association With Adverse Perinatal Outcomes.

Adverse perinatal outcomes are a significant contributor to neonatal and infant deaths. Mental illness, substance use disorders, and interpersonal trauma are often prevalent within obstetrical populations. Previous literature has documented the individual associations between these psychosocial factors and adverse perinatal outcomes. The co-occurrence of these three psychosocial factors might represent a syndemic among pregnant women, although they have not been described as such in the literature. Analysis of the interrelatedness and aggregate effect of these factors may allow for a more effective screening process that may reduce adverse perinatal outcomes. The objective of this article is to examine whether psychosocial factors (mental illness, substance use disorders, and interpersonal trauma) were independently and synergistically associated with adverse perinatal outcomes. This is a retrospective cohort study of 1,656 pregnant women at a single institution. Perinatal outcome and psychosocial data were abstracted from each participant's electronic medical record. Univariate and bivariate analyses, and multiple logistic regression were performed. Mean age was 27.5 (SD = 6.2) years. The majority was Black (60.6%) and single (58%). Psychosocial factors were reported in 35% of women. The incidence of adverse perinatal outcomes increased with greater number of psychosocial factors: 21.2% if no psychosocial factor, 27.0% if one psychosocial factor, 27.4% if two, and 35.3% if all three (for trend, p = .01). Women who reported all three psychosocial factors had twice the odds of adverse perinatal outcomes (adjusted odds ratio = 2.04, 95% confidence interval = [1.09, 3.81], p = .03) compared with those who reported none. Our data suggest there is a synergistic relationship between the psychosocial factors that is associated with increased adverse perinatal outcomes. A validated screening tool is needed to stratify patient's risk of adverse perinatal outcomes based on psychosocial factors. Such screening could lead to tailored interventions that could decrease adverse perinatal outcomes.

A highly sensitive luminescent probe based on Ru(II)-bipyridine complex for Cu2+, l-Histidine detection and cellular imaging.

A ruthenium(II) bipyridyl complex conjugated with functionalized Schiff base (RuA) has been synthesized and functioned as a luminescent probe. The luminescence of RuA was greatly quenched by Cu2+ due to its molecular coordination with paramagnetic Cu2+. Subsequently, the addition of l-Histidine can turn on the luminescence of the RuA-Cu(II) ensemble, which can be attributed to the replacement of RuA in RuA-Cu(II) ensemble by l-Histidine. On the basis of the quenching and recovery of the luminescence of RuA, we proposed a rapid and highly sensitive on-off-on luminescent assay for sensing Cu2+ and l-Histidine in aqueous solution. Under the optimal conditions, Cu2+ and l-Histidine can be detected in the concentration range of 5 nM-9.0 µM and 50 nM-30 µM, respectively, and the corresponding detection limits were calculated to be 0.35 and 0.44 nM (S/N=3), separately. The proposed luminescent probe has been successfully utilized for the analysis of Cu2+ and l-Histidine in real samples (drinking water and biological fluids). Furthermore, the probe revealed good photostability, low cytotoxicity and excellent permeability, making it a suitable candidate for cell imaging and labeling in vitro.

A selective and sensitive fluorescent probe for the determination of HSA and trypsin.

A simple fluorescent probe HBI-GR based on the combination of the fluorophore (p-HBI) in green fluorescent protein (GFP) and Guanine riboside (GR) for HSA was successfully synthesized. HBI-GR showed an obvious fluorescence enhancement toward HSA without interference from other proteins, amino acids, anions and commonly existing metal ions. HBI-GR exhibited high sensitivity towards HSA with a good linear relationship between the fluorescence intensity of HBI-GR and HSA concentration from 0 to 0.06mgmL-1. The limit of detection, based on a signal-to-noise ratio of 3, was 15.09ngmL-1, which was much lower than that of most other reported probes. HBI-GR was almost non-fluorescent because of the bond twisting in the exited state of chromophore HBI. After binding to the hydrophobic pocket of HSA, it showed an obvious fluorescence enhancement due to the rigidifying of the flexible chromophore HBI by the hydrophobic environment. The resulting HBI-GR/HSA system also showed a satisfactory sensing ability toward trypsin through decreased fluorescence intensity with the detection limit of 0.0282ngmL-1. The fluorescence decreasing process was occurred as the lysine and arginine amino acids residues of HSA were cleaved by trypsin, which led to further exposure of HBI-GR to the PBS buffer phase and a concomitant decrease of the HBI-GR fluorescence intensity. Moreover, the probe HBI-GR was successfully used to detect HSA in healthy human urine and human blood serum samples. The practical application of the HBI-GR/HSA system for trypsin detection in healthy human urine also achieved satisfactory result.

Missed Opportunities for Repeat HIV Testing in Pregnancy: Implications for Elimination of Mother-to-Child Transmission in the United States.

HIV testing is an effective intervention that is used for reducing perinatal HIV transmission. Centers for Disease Control and Prevention recommends a second HIV test during the third trimester of pregnancy for women in settings with an elevated HIV incidence (≥17 cases per 100,000 person-years). We conducted a retrospective cohort study at a single hospital in Baltimore, Maryland, to determine whether a second HIV test was done and to compare HIV retesting with mandated syphilis retesting. Of women who delivered at this hospital, 98.8% received prenatal care. Descriptive, bivariate, and multivariable analyses were performed. Among 1632 women, mean age was 27.6 years (standard deviation: 6.3), 59.6% were black, and 55.5% were single. HIV retesting was done in 28.4% of women, which was significantly less often compared with the state-mandated syphilis retesting (78.7%, p < 0.001). The odds of having an HIV retest were 15 times higher among women who received prenatal care at a teaching clinic [adjusted odds ratio (aOR): 15.58; 95% confidence interval (CI): 11.12-21.81], and they were lower among women with private insurance (aOR: 0.54, 95% CI: 0.34-0.86). The odds of having a syphilis retest were twice as high among women who received prenatal care at a faculty practice (aOR: 2.17; 95% CI: 1.53-3.09), and they were lower among women with private insurance (aOR: 0.61, 95% CI: 0.43-0.88). Emphasizing an "opt-out" HIV retesting approach through state laws may minimize risk perception, and this is one strategy that can be considered in areas of high HIV incidence to reach the goal of eliminating perinatal HIV transmission in the United States.

A specific and biocompatible fluorescent sensor based on the hybrid of GFP chromophore and peptide for HSA detection.

It is still a challenge for clinical diagnostics to design non-toxic and selective sensors for a specific analyte in blood serum, which contains a large number of proteins, small molecules, and ions. Herein, H1, a synthetic hybrid of green fluorescent protein (GFP) chromophore and peptide for human serum albumin (HSA) detection via obvious fluorescence enhancement was reported. The fluorescence response was caused by the non-covalent binding between H1 and the subdomain IIA cavity of HSA, and this specific binding behavior can be confirmed by the decrease of fluorescence intensity of the sole tryptophan residue (Trp-214) located in the same subdomain. H1 showed remarkable sensitivity and selectivity toward HSA without interference from other proteins. A good linear relationship between the fluorescence intensity of H1 and HSA concentration from 0 to 67.0µgmL(-1) was obtained with the detection limit reaching as low as 198.6ngL(-1). Moreover, H1 was successfully utilized to detect trace HSA in healthy human urine (HU) and human blood serum (HBS), respectively. The resulting H1/HSA system also showed a satisfactory sensing ability toward anionic surfactant sodium dodecyl sulfate (SDS) through decreased fluorescence intensity with the detection limit of 3.48ngL(-1).

Obstetric Surgical Site Infections: 2 Grams Compared With 3 Grams of Cefazolin in Morbidly Obese Women.

OBJECTIVE: To estimate whether morbidly obese gravid patients were less likely to develop a surgical site infection after receiving a higher dose of preoperative prophylactic antibiotics. METHODS: A retrospective cohort study of morbidly obese pregnant women undergoing cesarean delivery was conducted at two tertiary care centers from 2008 to 2013. Exposure was defined as receiving 2 g compared with 3 g cefazolin preoperatively. Disease was defined by diagnosis of a surgical site infection using Centers for Disease Control and Prevention criteria. We estimated a sample size of 141 patients in each group for a 67% reduction (15% to 5%) in risk for a surgical site infection. RESULTS: There were 335 women included in the cohort with a median absolute weight of 310 (interquartile range 299-333) pounds. Forty-four (13.1%) women were diagnosed with a surgical site infection. There was no difference in surgical site infection among those women who received 2 g compared with 3 g cefazolin (13.1% [23/175] compared with 13.1% [21/160]; P=.996). Labor (crude odds ratio [OR] 2.31, 95% confidence interval [CI] 1.21-4.40), internal labor monitoring (OR 2.78, 1.45-5.31), blood loss greater than 1,500 mL (OR 2.15, 1.09-5.78), and staple closure (OR 2.2, 1.15-4.21) were associated with a surgical site infection among the entire cohort. After multivariable analysis, blood loss greater than 1,500 mL (adjusted OR 3.32, 1.32-8.37) and staple closure (adjusted OR 2.45, 1.19-5.02) remained associated with an increased risk for a surgical site infection, whereas 3 g cefazolin still was not associated with reduced risk for a surgical site infection (adjusted OR 1.33, 0.64-2.74). CONCLUSION: In our multicenter retrospective cohort study, preoperative 3 g cefazolin prophylaxis administered to morbidly obese gravid patients did not reduce surgical site infections. LEVEL OF EVIDENCE: III.

Prognostic factors associated with clinical pregnancy in in vitro fertilization using pituitary down-regulation with depot and daily low-dose luteal phase gonadotropin releasing hormone agonists: A single center's experience.

AIM: To review the experience on depot-dose, and daily low-dose gonadotropin releasing hormone agonist (GnRHa) long protocols and identify prognostic factors. SETTING AND DESIGN: A chart review was conducted on 2106 depot and 1299 daily low-dose cycles at a university hospital. METHODS: Clinical parameters were summarized, and prognostic factors of clinical pregnancy for each protocol were identified by logistic regressions. Missing data were imputed using multiple imputations (MI) and the regression models were rerun after MI. RESULTS: Clinical pregnancy rate was 57.5% and 46.9% in the depot and daily low-dose groups, respectively. Logistic regressions with MI identified age (odds ratio [OR]: 0.95, 95% confidence interval [CI]: 0.92-0.98), serum progesterone (OR: 0.62, 95% CI: 0.45-0.84) and endometrial thickness (OR: 1.06, 95% CI: 1.02-1.12) on human chorionic gonadotropin (hCG) day, number of oocytes retrieved (OR: 1.04, 95% CI: 1.01-1.06), fertilization rate (OR: 2.66, 95% CI: 1.46-4.87) and ratio of good-quality D3 embryos (OR: 4.31, 95% CI: 2.79-6.67) as prognostic factors in the depot group. Age (OR: 0.95, 95% CI: 0.92-0.98), endometrial thickness on hCG day (OR: 1.09, 95% CI: 1.03-1.15), ratio of good quality D3 embryos (OR: 2.56, 95% CI: 1.59-4.13) and the number of cryopreserved embryos (OR: 1.07, 95% CI: 1.003-1.15) are prognostic for the daily low-dose protocol. Some regression coefficients that are significant under model-wise deletion become nonsignificant after MI. CONCLUSIONS: Age, embryo quality and endometrial thickness on hCG day are important prognostic factors for both 1.0/1.3 mg depot and 0.05/0.1 mg daily low-dose luteal phase GnRHa long protocols. MI is a valuable tool to gauge and address bias caused by missing data in reproductive medicine.

Reclaiming fertility awareness methods to inform timed intercourse for HIV serodiscordant couples attempting to conceive.

INTRODUCTION: Increased life expectancy of HIV-positive individuals during recent years has drawn attention to their quality of life, which includes fulfillment of fertility desires. In particular, heterosexual HIV serodiscordant couples constitute a special group for whom the balance between desired pregnancy and the risk of viral transmission should be carefully considered and optimized. Although advanced assisted reproductive technologies are available, such treatments are expensive and are often unavailable. Moreover, standard viral load testing and antiretroviral therapy may not be accessible due to structural or individual barriers. To reduce the risk of HIV transmission, a lower cost alternative is timed condomless sex combined with other risk-reduction strategies. However, timed condomless sex requires specific knowledge of how to accurately predict the fertile window in a menstrual cycle. The aim of this study was to summarize inexpensive fertility awareness methods (FAMs) that predict the fertile window and may be useful for counselling HIV-positive couples on lower cost options to conceive. METHODS: Original English-language research articles were identified by a detailed Medline and Embase search in July 2014. Relevant citations in the included articles were also retrieved. RESULTS AND DISCUSSION: Calendar method, basal body temperature and cervicovaginal mucus secretions are the most accessible and sensitive FAMs, although poor specificity precludes their independent use in ovulation detection. In contrast, urinary luteinizing hormone testing is highly specific but less sensitive, and more expensive. To maximize the chance of conception per cycle, the likelihood of natural conception needs to be assessed with a basic fertility evaluation of both partners and a combination of FAMs should be offered. Adherence to other risk-reduction strategies should also be advised, and timely referral to reproductive medicine specialists is necessary when sub/infertility is suspected. CONCLUSIONS: FAMs provide effective, economical and accessible options for HIV serodiscordant couples to conceive while minimizing unnecessary viral exposure. It is important for health care providers to initiate conversations about fertility desires in HIV-positive couples and to educate identified couples on safer conception strategies.

Is diabetes mellitus associated with increased incidence and disease-specific mortality in endometrial cancer? A systematic review and meta-analysis of cohort studies.

OBJECTIVE: To assess the association between diabetes mellitus (DM) and the incidence and disease-specific mortality of endometrial cancer (EC). METHODS: MEDLINE, EMBASE and conference abstracts of the 2011-2013 Annual Meetings of Society of Gynecological Oncology were searched for reports of original cohort studies that enrolled diabetic and non-diabetic women who were free of EC at baseline to compare the incidence and disease-specific mortality of EC by DM status. The included reports were examined for demographic characteristics of study populations, study design, effect measures and risk of bias. Statistical heterogeneity was evaluated with Chi-square test of the Cochrane Q statistics at the 0.05 significance level and I(2) statistic. Publication bias was assessed by visual examination of a funnel plot and the Egger's test for small-study effects. RESULTS: Twenty-nine cohort studies (17 prospective, 12 retrospective) were eligible for this review, 23 of which reported EC incidence, five reported disease-specific mortality and one reported both. For incidence of EC among women with versus without DM, the summary relative risk (RR) was 1.89 (95%CI, 1.46-2.45; p<0.001) and the summary incidence rate ratio was 1.61 (95%CI, 1.51-1.71; p<0.001). The pooled RR of disease-specific mortality was 1.32 (95%CI, 1.10-1.60; p=0.003), while results in the studies reporting standardized mortality ratios were inconsistent. There remains considerable amount of clinical and methodological heterogeneity among the included studies; moreover, the hazard ratios for incident EC showed significant statistical heterogeneity and therefore were not quantitatively synthesized. CONCLUSIONS: There is consistent evidence for an independent association between DM and an increased risk of incident EC, while the association between DM and EC-specific mortality remains uncertain. Further studies with better considerations for selection bias, information bias and confounding will further facilitate causal inference involving DM and EC.

A single institutional comparison of endoscopic and open abdominal component separation.

BACKGROUND: The authors analyzed surgical factors and outcomes data in the largest single institutional study comparing endoscopic (ECS) and open component separation (OCS) in ventral hernia repairs (VHR). METHODS: A prospectively maintained database was reviewed, identifying 76 patients who underwent component separation for VHR with mesh from 2010 to 2013: 34 OCS and 42 ECS. Comparisons were made for demographics, surgical risk factors, and peri-operative outcomes. Wound complications and hernia occurrence post-operatively were reviewed. Risk analyses were performed to determine the association of pre-operative risk factors with surgical site occurrences. RESULTS: Twenty-five ECS patients underwent subsequent laparoscopic hernia repair, and 17 underwent open repair. Operative time for ECS was longer than OCS (334 vs. 239 min; P < 0.001); however, there was no difference in length of stay (4 days in both groups, P = 0.64) and estimated blood loss (ECS: 97 vs. OCS: 93 cc, P = 0.847). In a sub-analysis of ECS patients, those who underwent laparoscopic hernia repair had a 96 min shorter operative time (P < 0.001) and lower EBL (63 vs. 147 cc, P < 0.001) than open repair. Wound complications were 24% in the ECS (n = 10) and 32% in OCS group (n = 11). There was one midline hernia recurrence in the ECS group (mean follow-up of 8 months, range 0.5-34.5 months) and no hernia recurrences in the OCS group (mean follow-up 10 months, range 0.5-30 months). Three of the patients in the ECS group developed new lateral abdominal wall hernias post-operatively. CONCLUSIONS: The ECS group had a significantly longer operative time than the OCS group. Post-operative wound complications were similar between ECS and OCS groups. Patients in the ECS group who underwent subsequent laparoscopic VHR had a shorter operative time and blood loss than open repair.