The effect of day 5 blastocyst assessment timing on live birth prediction and development of a prediction algorithm.

RESEARCH QUESTION: Does variation in day 5 assessment timing confound live birth prediction using snapshot blastocyst morphology and is it possible to develop a numerical prediction algorithm? DESIGN: Retrospective multicentre cohort study including 4851 autologous oocyte single day 5 fresh embryo transfers performed at 11 Monash IVF clinics between 2016 and 2020. Repeat cycles of the same patients were excluded to avoid clustering effects in regression analysis. RESULTS: Hours post insemination (HPI) at day 5 assessment (115.9 ± 2.6 h) significantly correlated with blastocyst developmental stage (r = 0.118, P < 0.001). Independent association (expressed as adjusted odds ratio [aOR] and 95% confidence interval [CI]) was identified between live birth and HPI (aOR 0.950, 95% CI 0.925-0.976, P < 0.001) after accounting for blastocyst morphology and a range of patient/cycle characteristics. Algorithms were constructed using four significant live birth predictors: HPI at day 5 assessment, blastocyst developmental stage (aOR 1.347, 95% CI 1.217-1.491, P < 0.001), morphological grade (aOR 1.314, 95% 1.197-1.443, P < 0.001) and maternal age (aOR 0.922, 95% CI 0.907-0.936, P < 0.001). Receiver operating characteristic (ROC) analysis showed consistent predicting performance of algorithms via five-fold cross-validation, with similar area under the ROC curve (AUC 0.718, 0.715, 0.720, 0.712, 0.726, P < 0.001, respectively, in development subsets; and AUC 0.718, 0.731, 0.709, 0.741, 0.684, P < 0.001, respectively, in validation subsets). A score (ranging from 0.1 to 4.7) calculator based on the final algorithm was subsequently created. CONCLUSIONS: Day 5 assessment timing is a confounding factor for live birth prediction using snapshot blastocyst morphology. A numerical algorithm incorporating day 5 assessment HPI, blastocyst morphology and maternal age can be developed for live birth prediction.

Morphometric and morphokinetic differences in the sperm- and oocyte-originated pronuclei of male and female human zygotes: a time-lapse study.

PURPOSE: To study the morphometric and morphokinetic profiles of pronuclei (PN) between male and female human zygotes. METHOD(S): This retrospective cohort study included 94 consecutive autologous single day 5 transfer cycles leading to a singleton live birth. All oocytes were placed in the EmbryoScope + incubator post-sperm injection with all annotations performed retrospectively by one embryologist (L-SO). Timing parameters included 2nd polar body extrusion (tPB2), sperm-originated PN (tSPNa) or oocyte-originated PN (tOPNa) appearance, and PN fading (tPNF). Morphometrics were evaluated at 8 (stage 1), 4 (stage 2), and 0 h before PNF (stage 3), measuring PN area (um2), PN juxtaposition, and nucleolar precursor bodies (NPB) arrangement. RESULTS: Male zygotes had longer time intervals of tPB2_tSPNa than female zygotes (4.8 ± 0.2 vs 4.2 ± 0.1 h, OR = 1.442, 95% CI 1.009-2.061, p = 0.044). SPN increased in size from stage 1 through 2 to 3 (435.3 ± 7.2, 506.7 ± 8.0, and 556.3 ± 8.9 um2, p = 0.000) and OPN did similarly (399.0 ± 6.1, 464.3 ± 6.7, and 513.8 ± 6.5 um2, p = 0.000), with SPN being significantly larger than OPN at each stage (p < 0.05 respectively). More male than female zygotes reached central PN juxtaposition at stage 1 (76.7% vs 51.0%, p = 0.010), stage 2 (97.7% vs 86.3%, p = 0.048), and stage 3 (97.7% vs 86.3%, p = 0.048). More OPN showed aligned NPBs than in SPN at stage 1 only (44.7% vs 28.7%, p = 0.023). CONCLUSION(S): Embryos with different sexes display different morphokinetic and morphometric features at the zygotic stage. Embryo selection using such parameters may lead to unbalanced sex ratio in resulting offspring.

Return to sport and patient satisfaction after arthroscopic Bankart repair: a single-institution experience.

Introduction: Arthroscopic Bankart repair is a widely accepted procedure to treat recurrent shoulder dislocation. This study aims to describe our experience with arthroscopic Bankart repair and its functional outcome. Methods: 107 patients who underwent arthroscopic Bankart repair from 2008 to 2013 were followed up for a minimum of three years and reviewed by an independent observer. 80 consented to being interviewed using the Oxford Shoulder Instability Score (OSIS) and Simple Shoulder Test. Results: 82 shoulders (two bilateral) were studied. Mean age at first dislocation was 19.4 ± 3.4 (12.0-31.0) years. Mean follow-up was 4.4 ± 1.3 (3.0-9.0) years and 2.5 ± 3.0 (0.1-15.4) years elapsed from first dislocation to surgery. 41 (50.0%) patients played overhead or contact sports and 44 (53.7%) played competitive sports before injury; 8 (9.8%) patients reported recurrence of dislocation, which was significantly associated with playing competitive sports before injury (p <0.039), 5 (6.1%) underwent revision surgery and 22 (26.8%) reported residual instability after surgery. 49 (59.8%) patients returned to playing sports, 75 (91.5%) were satisfied with their surgery and 79 (96.3%) were willing to undergo the surgery again. 74 (90.2%) patients had two-year good/excellent OSIS, which was significantly associated with playing competitive sports before injury (p = 0.039), self-reported stability after surgery (p = 0.017), satisfaction with surgery (p = 0.018) and willingness to undergo surgery again (p = 0.024). Conclusion: Arthroscopic Bankart repair yields good functional outcomes and is associated with high patient satisfaction, although not all patients return to sports.

Effects of Potential Probiotic Strains on the Fecal Microbiota and Metabolites of D-Galactose-Induced Aging Rats Fed with High-Fat Diet.

Both aging and diet play an important role in influencing the gut ecosystem. Using premature senescent rats induced by D-galactose and fed with high-fat diet, this study aims to investigate the effects of different potential probiotic strains on the dynamic changes of fecal microbiome and metabolites. In this study, male Sprague-Dawley rats were fed with high-fat diet and injected with D-galactose for 12 weeks to induce aging. The effect of Lactobacillus plantarum DR7, L. fermentum DR9, and L. reuteri 8513d administration on the fecal microbiota profile, short-chain fatty acids, and water-soluble compounds were analyzed. It was found that the administration of the selected strains altered the gut microbiota diversity and composition, even at the phylum level. The fecal short-chain fatty acid content was also higher in groups that were administered with the potential probiotic strains. Analysis of the fecal water-soluble metabolites revealed that administration of L. plantarum DR7 and L. reuteri 8513d led to higher fecal content of compounds related to amino acid metabolism such as tryptophan, leucine, tyrosine, cysteine, methionine, valine, and lysine; while administration of L. fermentum DR9 led to higher prevalence of compounds related to carbohydrate metabolism such as erythritol, xylitol, and arabitol. In conclusion, it was observed that different strains of lactobacilli can cause difference alteration in the gut microbiota and the metabolites, suggesting the urgency to explore the specific metabolic impact of specific strains on the host.

Lactobacillus plantarum DR7 improved upper respiratory tract infections via enhancing immune and inflammatory parameters: A randomized, double-blind, placebo-controlled study.

The aims of this study were to investigate the effects of Lactobacillus plantarum DR7 isolated from bovine milk against upper respiratory tract infections (URTI) and elucidate the possible mechanisms underlying immunomodulatory properties. The DR7 strain (9 log cfu/d) was administered for 12 wk in a randomized, double-blind, and placebo-controlled human study involving 109 adults (DR7, n = 56; placebo, n = 53). Subjects were assessed for health conditions monthly via questionnaires, and blood samples were evaluated for cytokine concentrations, peroxidation and oxidative stress, and gene expression in T cells and natural killer (NK) cells. The administration of DR7 reduced the duration of nasal symptoms (mean difference 5.09 d; 95% CI: 0.42-9.75) and the frequency of URTI (mean difference 0.32; 95% CI: 0.01-0.63) after 12 and 4 wk, respectively, compared with the placebo. The DR7 treatment suppressed plasma proinflammatory cytokines (IFN-γ, TNF-α) in middle-aged adults (30 to 60 yr old), while enhancing anti-inflammatory cytokines (IL-4, IL-10) in young adults (<30 yr old), accompanied by reduced plasma peroxidation and oxidative stress levels compared with the placebo. Young adults who received DR7 showed higher expression of plasma CD44 and CD117 by 4.50- and 2.22-fold, respectively, compared with the placebo. Meanwhile, middle-aged adults showed lower expression of plasma CD4 and CD8 by 11.26- and 1.80-fold, respectively, compared with the placebo, indicating less T-cell activation. In contrast, both young and middle-aged adults who received DR7 showed enhanced presence of nonresting and mature NK cells compared with those who received the placebo. We postulate that DR7 alleviated the symptoms of URTI by improving inflammatory parameters and enhancing immunomodulatory properties.

Lactobacillus Strains Alleviated Aging Symptoms and Aging-Induced Metabolic Disorders in Aged Rats.

Aging is an inevitable and ubiquitous progress that affects all living organisms. A total of 18 strains of lactic acid bacteria (LAB) were evaluated on the activation of adenosine monophosphate-activated protein kinase (AMPK), an intracellular energy sensor mediating lifespan extension. The cell-free supernatant (CFS) of Lactobacillus fermentum DR9 (LF-DR9), Lactobacillus paracasei OFS 0291 (LP-0291), and Lactobacillus helveticus OFS 1515 (LH-1515) showed the highest activation of AMPK and was further evaluated. The phosphorylation of AMPK by these three LAB strains was more evident in U2OS and C2C12 cells, compared to the other cell lines and control (P < .05). Using premature senescent Sprague-Dawley rats induced by D-galactose (D-gal), the administration of LAB (10 log CFU/rat/day) for 12 weeks prevented the shortening of telomere length in D-gal-treated rats compared to the untreated control (P < .05). LF-DR9 lowered gene expression of p53, a known senescent biomarker, in gastrocnemius muscle and tibia compared to the control. The selected LAB strains also enhanced lipid, renal, and liver profile of rats, suggesting added potential of the strains in preventing aging-induced metabolic diseases. Strain LP-0291 and LH-1515 showed ability to adhere to mucin, no antibiotic resistance, tolerated and proliferated under gastric and intestinal simulated conditions, and inhibited the growth of pathogens Escherichia coli, Staphylococcus aureus, and Staphylococcus epidermidis, comparable to commercial probiotic LF-DR9 and Lactobacillus sakei Probio 65. This study provided an insight into the potential of LAB for exhibiting antisenescence effects, with potentials as new medicinal foods for targeted antiaging therapies.

Lactobacillus plantarum DR7 Reduces Cholesterol via Phosphorylation of AMPK That Down-regulated the mRNA Expression of HMG-CoA Reductase.

Hypercholesterolemia is one of the primary risk factors for cardiovascular diseases. The use of lactobacilli probiotics to reduce blood cholesterol levels have been extensively reported. However, more information is needed to evaluate the possible mechanisms involved and to identify possible targets for further therapeutic development. In this study, strains of lactobacilli were screened based on the ability to assimilate cholesterol, and prevention of cholesterol accumulation in hepatic (HepG2) and intestinal (HT-29) cells. Cell free supernatant (CFS) from Lactobacillus plantarum DR7 showed a higher ability to assimilate cholesterol, reduction in cholesterol accumulation in both HepG2 and HT-29 cells, accompanied by reduced mRNA expression of HMG-CoA reductase (HMGCR) in HepG2 (p<0.05), compared to other lactobacilli. The reduction of HMGCR expression was also diminished in the presence of an AMPK inhibitor (Compound C), suggesting that L. plantarum DR7 exerted its effect via the AMPK pathway, typically via the phosphorylation of AMPK instead of the AMPK mRNA expression in HepG2 (p<0.05). Altogether, our present study illustrated that lactobacilli could exert cholesterol lowering properties along the AMPK pathway, specifically via phosphorylation of AMPK that led to reduced expression of HMGCR.

Resuspension of house dust and allergens during walking and vacuum cleaning.

Conventional wisdom has been that hard, resilient surfaces resuspend fewer particles than carpeted surfaces, however, exceptions to this have been demonstrated and uncertainty remains about the factors that lead to this resuspension, notably, the effect of vacuum cleaning on either increasing or reducing resuspension from flooring. The purpose of this study was to determine how resuspension of house dust by aerodynamic size or particle type, including cat allergen and bacterial endotoxin, is affected by flooring, dust loading, embedding dust, and walking/cleaning activities. House dust was blown in and allowed to settle in a walk-in chamber after overnight deposition followed by walking or a vacuum cleaning procedure. Using an aerosol particle sizer and large-volume air samplers at different heights in the chamber, concentrations of airborne particles, resuspension rates, and fractions were computed for four types of flooring conditions during six walking activities. Carpeting resulted in significantly more airborne cat allergen and airborne endotoxin than a laminate floor. Height does have an effect on measured allergen over carpet and this is apparent with concentrations at the infant and adult air samplers. Walking on laminate flooring resuspends less house dust than walking on an equally dusty carpeted floor, where dust is entirely on the surface of the carpet. However, vacuum cleaning a laminate floor resuspended more dust than vacuum cleaning carpets, at large particle sizes of 5 µm and 10 µm. Activities following a deep cleaning of hard resilient or a carpeted surface is likely to leave no differences in resuspended particles between them.

Physical Properties of Blood Are Altered in Young and Lean Women with Polycystic Ovary Syndrome.

Classic features of polycystic ovary syndrome (PCOS) include derangement of metabolic and cardiovascular health, and vascular dysfunction is commonly reported. These comorbidities indicate impaired blood flow; however, other than limited reports of increased plasma viscosity, surprisingly little is known regarding the physical properties of blood in PCOS. We aimed to investigate whether haemorheology was impaired in women with PCOS. We thus measured a comprehensive haemorheological profile, in a case-control design, of lean women with PCOS and age-matched healthy controls. A clinical examination determined similar cardiovascular risk for the two groups. Whole blood and plasma viscosity was measured using a cone-plate viscometer. The magnitude and rate of red blood cell (RBC) aggregation was determined using a light-transmission aggregometer, and the degree of RBC deformability was measured via laser-diffraction ektacytometry. Plasma viscosity was significantly increased in women with PCOS. Blood viscosity was also increased for PCOS at lower-to-moderate shear rates in both native and standardised haematocrit samples. The magnitude of RBC aggregation-a primary determinant of low-shear blood viscosity-was significantly increased in PCOS at native and 0.4 L·L-1 haematocrit. No difference was detected between PCOS and CON groups for RBC deformability measurements. A novel measure indicating the effectiveness of oxygen transport by RBC (i.e., the haematocrit-to-viscosity ratio; HVR) was decreased at all shear rates in women with PCOS. In a group of young and lean women with PCOS with an unremarkable cardiovascular risk profile based on clinical data, significant haemorheological impairment was observed. The degree of haemorheological derangement observed in the present study reflects that of overt chronic disease, and provides an avenue for future therapeutic intervention in PCOS.

Inactivation of Mold Spores from Moist Carpet Using Steam Vapor: Contact Time and Temperature.

Steam vapor has been shown to reduce viable mold spores in carpet, but the minimal effective temperature and contact time has not been established. This study evaluated the effectiveness of steam vapor in reducing the number of viable mold spores in carpet as a function of temperature and contact time. Seventy carpet samples were inoculated with a liquid suspension of Cladosporium sphaerospermum and incubated over a water-saturated foam carpet pad for 24 hr. Steam was applied to the samples as the temperature was measured from the carpet backing. Contact time was closely monitored over seven time intervals: 0, 2, 4, 8, 12, 16, and 20 sec. Following steam vapor treatment, mold spores were extracted from the carpet samples and the extract was plated on DG-18 plates at 1:1, 1:10, 1:100 dilutions followed by one week of incubation. Raw colony forming units were determined using an automated colony counter and adjusted based on dilution factor, extraction volume, and plated volume. Analysis of variance and linear regression were used to test for statistically significant relationships. Steam contact time exhibited a linear relationship to observed temperature of carpet backing (F = 90.176, R(2) = 0.609). Observed temperature of carpet backing had a positive relationship to percent reduction of mold (F = 76.605, R(2) = 0.569). Twelve seconds of steam vapor contact time was needed to achieve over 90% mold reduction on moist carpet.

Mold management of wetted carpet.

This study evaluated the growth and removal of fungi on wetted carpet using newly designed technologies that rely on physical principles of steam, heat, and fluid flow. Sixty samples of carpet were embedded with heat-treated house dust, followed by embedding, wearing with a hexapod, and wetting. Samples were inoculated using a liquid suspension of Cladosporium sphaerospermum prior to placement over a water-saturated foam pad. Incubation times were 24 hr, 7 days, and 30 days. Cleaning was performed using three methods; high-flow hot water extraction, hot water and detergent, and steam. Fungal loading increased from approximately 1500 colony forming units per area (CFU/cm(2)) in 24 hr to a maximum of approximately 10,200 CFU/cm(2) after 7 days with a slight decline to 9700 CFU/cm(2) after 30 days incubation. Statistically significant differences were found among all three methods for removal of fungi for all three time periods (p < 0.05). Steam-vapor was significantly better than the alternative methods (p <0.001) with over 99% efficiency in mold spore decline from wetted carpet after 24 hr and 30 days, and over 92% efficiency after 7 days. The alternative methods exhibited lower efficiencies with a decline over time, from a maximum of 82% and 81% at 24 hr down to 60% and 43% at 30 days for detergent-hot water and high-flow, hot water extraction, respectively. The net effect of the mold management study demonstrates that while steam has a consistent fungal removal rate, the detergent and high-flow, hot water methods decline in efficiency with increasing incubation time.

Inactivation of dust mites, dust mite allergen, and mold from carpet.

Carpet is known to be a reservoir for biological contaminants, such as dust mites, dust mite allergen, and mold, if it is not kept clean. The accumulation of these contaminants in carpet might trigger allergies or asthma symptoms in both children and adults. The purpose of this study is to compare methods for removal of dust mites, dust mite allergens, and mold from carpet. Carpets were artificially worn to simulate 1 to 2 years of wear in a four-person household. The worn carpets were inoculated together with a common indoor mold (Cladosporium species) and house dust mites and incubated for 6 weeks to allow time for dust mite growth on the carpet. The carpets were randomly assigned to one of the four treatment groups. Available treatment regimens for controlling carpet contaminants were evaluated through a literature review and experimentation. Four moderately low-hazard, nondestructive methods were selected as treatments: vacuuming, steam-vapor, Neem oil (a natural tree extract), and benzalkonium chloride (a quaternary ammonium compound). Steam vapor treatment demonstrated the greatest dust mite population reduction (p < 0.05) when compared to other methods. The two physical methods, steam vapor and vacuuming, have no statistically significant efficacy in inactivating dust mite allergens (p = 0.084), but have higher efficacy when compared to the chemical method on dust mite allergens (p = 0.002). There is no statistically significant difference in the efficacy for reducing mold in carpet (p > 0.05) for both physical and chemical methods. The steam-vapor treatment effectively killed dust mites and denatured dust mite allergen in the laboratory environment.

Tunnel enlargement 5 years after anterior cruciate ligament reconstruction: a radiographic and functional evaluation.

PURPOSE: The aetiology and clinical significance of enlargement of bone tunnels following anterior cruciate ligament (ACL) reconstruction remains controversial. This phenomenon has been attributed to biological factors and mechanical factors. We wanted to study the amount of femoral and tibial tunnel enlargement 5 years post-ACL reconstruction. By standardizing the type of femoral fixation, we also wanted to determine whether the type of tibial fixation had any bearing to the amount of tibial tunnel enlargement. METHODS: All patients who underwent arthroscopic hamstring autograft ACL reconstruction between January 2000 and December 2000 were identified. All grafts were fixed with close-looped endobutton proximally. The grafts were fixed on the tibial side with staples or bioabsorbable interference screws. At a minimum of 5 years after surgery, these patients were recalled. They were assessed with Lysholm knee, Tegner activity and the IKDC Subjective and Objective forms and a KT-1000 arthrometer. The diameter of the bone tunnels and tunnel positions in the anterior-posterior and lateral radiographs were measured using digital callipers by a two blinded researchers. RESULTS: We found that the femoral tunnel enlarged more than the tibial tunnel. At 5 years, the mean tibial tunnel enlargement was 2.46 mm and the mean femoral tunnel enlargement was 3.23 mm. All 54 patients had endobutton femoral fixation. Of them, 34 patients had tibial graft fixation with staples (extracortical fixation) and 20 patients had tibial graft fixation with bioabsorbable interference screws (aperture fixation). The mean enlargement as measured by the two independent observers in the extracortical group was 1.98 mm (24.7 %)* and 1.51 mm (18.2 %)**compared to 3.27 mm (40.4 %)* and 2.92 mm (30.0 %)** in the aperture fixation group. This difference in tibial tunnel enlargement between the groups was significant (p < 0.001, mean difference 1.29 mm). However, this was not correlated with any significant difference in clinical outcome at 5 years. CONCLUSION: We, like some authors, have shown that the use of interference screws in tibial fixation despite being aperture fixation actually has a greater amount of tibial enlargement. This lends weight to the biological theory to tunnel enlargement.

A Multiple Indicators Multiple Cause (MIMIC) model of respiratory health and household factors in Chinese children: the seven Northeastern cities (SNEC) study.

In China, with the rapid economic development and improvement of living standards over the past few decades, the household living environment has shifted dramatically. The aim of the present study is to assess the impact of home environment factors on respiratory symptoms and asthma in Chinese children. Investigators analyzed data collected in the 25 districts from the seven Northeastern cities to examine health effects on respiratory symptoms and asthma in 31,049 children aged 2-14 years. Factor analysis was used to reduce 33 children's lifestyle and household variables to six new 'factor' variables. The multiple indicators multiple causes approach was used to examine the relationship between indoor air pollution and respiratory health status, controlling for covariates. Factor analyses generated six factor variables of potential household risk factors from an original list of 33 variables. The respiratory symptoms and asthma were significantly associated with the recent home renovation factor (estimate = 0.076, p < 0.001), pet ownership factor (estimate = 0.095, p < 0.001), environmental tobacco smoke (ETS) exposure factor (estimate = 0.181, p < 0.001) and PVC-flooring factor (estimate = 0.031, p = 0.007). Home ventilation factor was not related to any respiratory condition (estimate = 0.028, p = 0.074). Independent respiratory health effects existed for multiple household environmental factors recent home renovation, pet ownership, ETS, and PVC-flooring.

Do new wipe materials outperform traditional lead dust cleaning methods?

Government guidelines have traditionally recommended the use of wet mopping, sponging, or vacuuming for removal of lead-contaminated dust from hard surfaces in homes. The emergence of new technologies, such as the electrostatic dry cloth and wet disposable clothes used on mopheads, for removal of dust provides an opportunity to evaluate their ability to remove lead compared with more established methods. The purpose of this study was to determine if relative differences exist between two new and two older methods for removal of lead-contaminated dust (LCD) from three wood surfaces that were characterized by different roughness or texture. Standard leaded dust, <75 µm, was deposited by gravity onto the wood specimens. Specimens were cleaned using an automated device. Electrostatic dry cloths (dry Swiffer), wet Swiffer cloths, paper shop towels with non-ionic detergent, and vacuuming were used for cleaning LCD from the specimens. Lead analysis was by anodic stripping voltammetry. After the cleaning study was conducted, a study of the coefficient of friction was performed for each wipe material. Analysis of variance was used to evaluate the surface and cleaning methods. There were significant interactions between cleaning method and surface types, p = 0.007. Cleaning method was found be a significant factor in removal of lead, p <0.001, indicating that effectiveness of each cleaning methods is different. However, cleaning was not affected by types of surfaces. The coefficient of friction, significantly different among the three wipes, is likely to influence the cleaning action. Cleaning method appears to be more important than texture in LCD removal from hard surfaces. There are some small but important factors in cleaning LCD from hard surfaces, including the limits of a Swiffer mop to conform to curved surfaces and the efficiency of the wetted shop towel and vacuuming for cleaning all surface textures. The mean percentage reduction in lead dust achieved by the traditional methods (vacuuming and wet wiping) was greater and more consistent compared to the new methods (electrostatic dry cloth and wet Swiffer mop). Vacuuming and wet wiping achieved lead reductions of 92% ± 4% and 91%, ± 4%, respectively, while the electrostatic dry cloth and wet Swiffer mops achieved lead reductions of only 89 ± 8% and  81 ± 17%, respectively.

Cannulated cancellous screw fixation for capitellum fractures in adolescents.

PURPOSE: To review the outcome of 9 adolescents treated with 2 to 3 cannulated cancellous screws for type-1 capitellum fractures. METHODS: Records of 8 boys and one girl aged 12 to 14 (mean, 14) years with type-1 capitellum fractures were reviewed. The mechanism of injury was a fall on the flexed elbow. No patient had associated injuries or neurovascular compromise. In 2 patients, the fracture was minimally displaced and treated with a cast. The remaining 7 patients with displaced fractures underwent open reduction and internal fixation using 4.0-mm cannulated partially threaded cancellous screws inserted in a posterior-to-anterior direction. In one patient, a Kirschner wire was added to fix a small comminuted fragment. Elbow pain, range of motion, stability, and function were evaluated using the Mayo Elbow Performance Index. RESULTS: The mean follow-up period was 7 (range, 2-18) months. The mean Mayo Elbow Performance Index score was 100, indicating excellent outcome. No patient developed avascular necrosis or heterotrophic ossification. All patients achieved anatomic bone union. All implants were removed after a mean of 4.7 (range, 2-7) months. CONCLUSION: The fixation of type-1 capitellum fractures with 2 to 3 cannulated cancellous screws inserted posteroanteriorly achieved excellent functional outcome.

Does high body mass index increase the risk of miscarriage after spontaneous and assisted conception? A meta-analysis of the evidence.

OBJECTIVE: To investigate the association between obesity and miscarriage. DESIGN: Meta-analysis. SETTING: The Academic Unit of Reproductive and Developmental Medicine, The University of Sheffield, United Kingdom. PATIENT(S): Obese and overweight patients who had miscarriage after spontaneous or assisted conception, compared with patients with a normal body mass index. INTERVENTION(S): A systematic review was conducted for all relevant articles in MEDLINE from 1964 to September 2006 and in EMBASE from 1974 to September 2006, using a combination of the following search terms: obesity/obes*/obes$/BMI, miscarriage/abortion/pregnancy, IVF, clomifene/clomiphene, gonadotrophins/gonadotrop*/gonadotrop$. MAIN OUTCOME MEASURE(S): Pregnancy loss at <20 weeks of gestation. RESULT(S): Sixteen studies were included in the meta-analysis. Patients with a body mass index of > or =25 kg/m(2) had significantly higher odds of miscarriage, regardless of the method of conception (odds ratio, 1.67; 95% confidence interval, 1.25-2.25). Subgroup analysis from a limited number of studies suggested that this group of women may also have significantly higher odds of miscarriage after oocyte donation (odds ratio, 1.52; 95% confidence interval, 1.10-2.09) and ovulation induction (odds ratio, 5.11; 95% confidence interval, 1.76-14.83). There was no evidence for increased odds of miscarriage after IVF-intracytoplasmic sperm injection. CONCLUSION(S): There is evidence that obesity may increase the general risk of miscarriage. However, there is insufficient evidence to describe the effect of obesity on miscarriage in specific groups such as those conceiving after assisted conception.

Uterine artery embolization and future fertility potential.

The growing body of evidence concerning the safety and efficacy of uterine artery embolization (UAE) has led to increasing confidence amongst gynecologists and interventional radiologists that UAE can be used safely to treat women with symptomatic fibroids. UAE is clearly preferable for certain subgroups of patients, for example those with increased risks of complications of general anesthesia, those with religious objection to blood transfusion and those wishing to avoid surgical risk. This review of the available literature demonstrates the paucity of information concerning safety and efficacy of UAE for those wishing to conceive. Case reports and series are largely positive. However, there are continuing concerns over the effects of UAE on ovarian and uterine function, and on subsequent pregnancy outcome. More long-term data and randomized controlled trials are required to address these issues. Women who undergo embolization should be told that the effects on pregnancy and the resulting child are uncertain and that there may be long-term implications for the health and development of the offspring. Hence, it is inadvisable to try to conceive following the procedure. Given the available evidence, concern must remain that UAE may lead to significant damage to fertility, with higher risk of miscarriage and adverse pregnancy outcome when compared with open or laparoscopic myomectomy.

Removal of lead contaminated dusts from hard surfaces.

Government guidelines have widely recommended trisodium phosphate (TSP) or "lead-specific" cleaning detergents for removal of lead-contaminated dust (LCD) from hard surfaces, such as floors and window areas. The purpose of this study was to determine if low-phosphate, non-lead-specific cleaners could be used to efficiently remove LCD from 3 types of surfaces (vinyl flooring, wood, and wallpaper). Laboratory methods were developed and validated for simulating the doping, embedding, and sponge cleaning of the 3 surface types with 4 categories of cleaners: lead-specific detergents, nonionic cleaners, anionic cleaners, and trisodium phosphate (TSP). Vinyl flooring and wood were worn using artificial means. Materials were ashed, followed by ultrasound extraction, and anodic stripping voltammetry (ASV). One-way analysis of variance approach was used to evaluate the surface and detergent effects. Surface type was found to be a significant factor in removal of lead (p < 0.001). Vinyl flooring cleaned better than wallpaper by over 14% and wood cleaned better than wallpaper by 13%. There was no difference between the cleaning action of vinyl flooring and wood. No evidence was found to support the use of TSP or lead-specific detergents over all-purpose cleaning detergents for removal of lead-contaminated dusts. No-phosphate, non-lead-specific detergents are effective in sponge cleaning of lead-contaminated hard surfaces and childhood lead prevention programs should consider recommending all-purpose household detergents for removal of lead-contaminated dust after appropriate vacuuming.

Gonadotropin-releasing hormone antagonist in in vitro fertilization superovulation.

The use of gonadotropin-releasing hormone (GnRH) antagonists in in vitro fertilization superovulation remains controversial. The GnRH agonist 'long protocol' has been seen as the gold standard for many years. Comparisons and meta-analyses of the efficacy of GnRH antagonists and agonists have been largely inconclusive, with the dataset being contaminated with outdated reports of poorer efficacy with GnRH antagonists, which have stemmed from studies of their use as a second-line drug in older women and women who were poor responders. This work cannot reflect the actual clinical effectiveness of GnRH antagonist and must be interpreted with care. The major advantages of GnRH antagonists use in superovulation include a gentler and more patient-friendly stimulation cycle with less hypoestrogenic side effects, with the potential to lower the risk of ovarian hyperstimulation and enhanced embryo growth. Our current clinical experience with GnRH antagonists in in vitro fertilization is limited, although there are a growing number of in vitro fertilization centers embracing this new technology. There is a clear need for a modern, suitably powered clinical trial to demonstrate the place of GnRH antagonist-based superovulation protocols and in subgroups of patients, such as polycystic ovary syndrome or poor responders.