ABSTRACT
PURPOSE: To investigate whether the ability of human spermatozoa to decondense in vitro in the presence of heparin (Hep) and glutathione (GSH) is related to assisted reproduction (ART) success. METHODS: Cross-sectional pilot study involving male partners of 129 infertile couples undergoing ICSI with (45) or without (84) donor oocytes at two infertility clinics in CABA, Argentina, between October 2012 and December 2013. In vitro decondensation kinetics with Hep and GSH and DNA fragmentation (TUNEL) were determined on the same sample used for ICSI. The possible relationship of decondensation parameters (maximum decondensation and decondensation velocity) and TUNEL values with ART success was evaluated. RESULTS: Embryo quality correlated positively with decondensation velocity (D60/D30) (Spearman's correlation, p < 0.05). According to D60/D30 values, patients were classified as slow decondensers (SlowD) (n = 68) or fast decondensers (FastD) (n = 61). Embryo quality was better in FastD (unpaired t test, p < 0.05). FastD and SlowD were subdivided according to use of donor oocytes. Among SlowD, biochemical and clinical pregnancy rates per transfer were significantly higher in donor (n = 19) vs. in non-donor (n = 31) cycles (Fisher's exact test, p < 0.05). TUNEL values were not related to embryo quality, but no clinical pregnancies or live births were achieved in TUNEL+ SlowD (n = 7). CONCLUSION: Decondensation kinetics of human spermatozoa in vitro with Hep and GSH could be related to embryo quality and ART success.
Subject(s)
Embryo, Mammalian/physiology , Spermatozoa/physiology , Argentina , Cross-Sectional Studies , DNA Fragmentation , Female , Fertilization in Vitro/methods , Humans , In Situ Nick-End Labeling/methods , Infertility/therapy , Live Birth , Male , Oocytes/physiology , Pilot Projects , Pregnancy , Pregnancy Rate , Sperm Injections, Intracytoplasmic/methodsABSTRACT
BACKGROUND: Several experiences of Bed Management have been published, most of them focusing on Emergency Department organization. Aosta Hospital is 70 km away from the nearest Hospital, so that ambulance diversion is not feasible and patients' admissions from ED need to be managed at the local level solely. Aim of this study was to test efficacy of an innovative Bed Management model. SETTING AND METHODS: Bed Management procedure consisted of an algorithm of both rational outward allocation of patients and support to "difficult" discharges. Hospital indicators of the pre-intervention period (years 2008-2011) were compared with those of the post-intervention period (years 2012-2015), splitting data into ten medical wards mostly admitting patients form ED and seven surgery wards mostly admitting "planned" patients. RESULTS: In the before-after analysis, mean length of stay decreases from 7.84 to 7.41 days (p= 0.000), and bed occupancy from 81% to 77%. Outlier days fell from 6.3% to 5.4% (p= 0.000), and the same did long stay patients (from 5.8% to 5%, p = 0.000). By contrast, ED admissions increased from 16.5% to 17.8%, as very short stays (23.9 to 25.3%, p= 0.000) and the 30 days unplanned readmissions (9.9% to 11.9%, p =0.000). The observed variations were more significant in the medical wards. Finally, waiting times in ED significantly decreased during the study period in the medical wards. CONCLUSIONS: We propose a comprehensive BM model, including governance of difficult discharges within a general hospital perspective. Further organization research on Bed Management is needed, also to propose BM standards, to be adopted in any Hospital.
Subject(s)
Bed Occupancy , Emergency Service, Hospital/organization & administration , Hospital Administration , Hospitalization , Models, Organizational , Algorithms , Follow-Up Studies , Humans , Italy , Middle Aged , Time FactorsABSTRACT
A fifty-three years old surgeon had acute renal failure consisting with acute tubulo-interstizial nephropaty twelve days after influenza vaccination; he was on statin therapy since one month. He was given steroidal therapy and fully recovered two weeks apart. This is the fourth case report of acute renal failure after influenza vaccination in patients on statins therapy. The case we describe could account for a underestimated, even if very rare, phenomenon.
Subject(s)
Acute Kidney Injury/chemically induced , Hydroxymethylglutaryl-CoA Reductase Inhibitors/adverse effects , Influenza Vaccines/adverse effects , Nephritis, Interstitial/chemically induced , Drug Interactions , Humans , Male , Middle AgedABSTRACT
The aim of this study was to determine whether socio-economical status (SES) is associated with overweight and obesity in prepuberal children. In an area of North-Western Italy a sample of 1420 children, aged 10-11 years, had his/her height and weight recorded, (overweight and obesity were defined, respectively, as relative body weight > or = 120% and > or = 140%), and parents were requested to compile a questionnaire exploring some demographic and social conditions. 23% of the sample resulted overweight or obese. Prevalence rate ratios (PRR) of overweight and obesity (together) were calculated, adjusting for parents' age, parents' area of birth, and school district. PRR for mother's lowest educational level compared to the highest was 1.59 (95% CI: 1.19-2.13), while for father's education was 1.21 (0.90-1.63). PRRs for 'unemployed' or 'manual' mother compared to 'upper non manual' were respectively 1.83 (1.20-2.79) and 2.20 (1.31-3.68), while for 'unemployed' or 'manual' father were 2.63 (1.97-2.63), and 1.63 (1.27-2.09). The cultural resources of the mother, and the economical resources of the family seem to influence the prevalence of weight gain in prepuberal children. This should be taken into account when planning programs for the prevention or reduction of obesity in children.