Subfertility versus ART: unraveling the origins of fetal cardiac programming.

STUDY QUESTION: Do spontaneously conceived (SC) fetuses from subfertile couples show the same signs of cardiac remodeling as those observed after IVF treatments? SUMMARY ANSWER: As opposed to fetuses from IVF, SC fetuses from subfertile couples do not show cardiac remodeling and present a similar cardiac structure and function to those of SC fetuses from fertile couples. WHAT IS KNOWN ALREADY: Subjects conceived by IVF present signs of cardiac remodeling and suboptimal function in utero and during childhood, including larger atria, more globular and thicker ventricles, reduced longitudinal motion, and impaired relaxation as compared to SC individuals from fertile couples. There are no previous publications investigating the independent cardiac programming effects of infertility in SC fetuses from subfertile couples (with time-to-pregnancy (TTP) over 12 months). STUDY DESIGN, SIZE, DURATION: A prospective cohort study of 289 singleton pregnancies exposed and not exposed to subfertility recruited from 2019 to 2021, including 96 SC pregnancies from fertile couples (TTP under 12 months), 97 SC from subfertile couples (TTP over 12 months), and 96 from IVF after fresh embryo transfer. Fetal echocardiography was performed in all pregnancies. Epidemiological data and perinatal outcomes were collected in all pregnancies. The overall attrition rate was 15.7%. PARTICIPANTS/MATERIALS, SETTING, METHODS: SC from subfertile couples and IVF pregnancies were identified as eligible at pregnancy diagnosis, and eligible SC pregnancies from fertile couples who attended our maternal-fetal unit were invited to participate at third trimester, being matched to the other groups by maternal age. Fetal echocardiography was performed at 29-34 weeks of pregnancy to assess cardiac structure and function, and results were adjusted by parental age, maternal smoking status, child's birth order, birthweight centile, gestational age, and estimated fetal weight at scan. MAIN RESULTS AND THE ROLE OF CHANCE: Parental age, ethnicity, BMI, and smoking exposure, median gestational age and estimated fetal weight were similar in all study groups. There were no significant differences in infertility duration or etiology between the subfertile and the IVF populations (TTP: subfertile median 35 months (interquartile range 20-48) versus IVF: 47 (25-61); P-value = 0.051). While both fertile and subfertile SC groups presented similar fetal cardiac results, IVF fetuses showed larger atria (right atria-to-heart ratio: IVF mean 18.9% (SD 3.4) versus subfertile 17.8% (3.5) versus fertile 17.6% (3.3); adjusted P-value < 0.001), more globular ventricles (right ventricular sphericity index: IVF 1.56 (0.25) versus subfertile 1.72 (0.26) versus fertile 1.72 (0.26); <0.001), and thicker myocardial walls (relative wall thickness: IVF 0.86 (0.22) versus subfertile 0.64 (0.13) versus fertile 0.64 (0.18); <0.001). Whereas SC fetuses from fertile and subfertile couples had preserved cardiac function, IVF fetuses showed signs of suboptimal systolic and diastolic function, with reduced tricuspid ring displacement (IVF 7.26 mm (1.07) versus subfertile 8.04 mm (1.18) versus fertile 7.89 mm (1.51); <0.001) and increased left myocardial performance index (IVF 0.49 (0.08) versus subfertile 0.45 (0.09) versus fertile 0.45 (0.10); <0.001). A sub-analysis including only unexplained infertility cases in subfertile SC and IVF groups showed similar results. LIMITATIONS, REASONS FOR CAUTION: The fetal cardiac changes reported here are subclinical, and most of the cardiovascular parameters were within normal ranges. Although echocardiographic changes are recognized as potential cardiovascular risk factors, their association with long-term cardiovascular disease remains to be demonstrated. WIDER IMPLICATIONS OF THE FINDINGS: Subfertility per se does not seem to be associated to fetal cardiac remodeling, which has been previously described in IVF fetuses. Future studies are warranted to further investigate other factors related to the observed fetal cardiac changes associated with ART. STUDY FUNDING/COMPETING INTEREST(S): This project has been partially funded with support from the Erasmus + Programme of the European Union (Framework Agreement number: 2013-0040). This publication reflects the views only of the author, and the Commission cannot be held responsible for any use, which may be made of the information contained therein. Additionally, the research leading to these results has received funding from 'la Caixa' Foundation under grant agreement LCF/PR/GN18/10310003, the Instituto de Salud Carlos III (PI15/00130, PI16/00861, PI17/00675, PI18/00073, INT21/00027)-co-funded by the European Union, Cerebra Foundation for the Brain Injured Child (Carmarthen, Wales, UK) and AGAUR 2017 SGR grant no 1531. The authors have no conflicts of interest to declare. TRIAL REGISTRATION NUMBER: N/A.

Fetal neurosonography and infant neurobehavior following conception by assisted reproductive technology with fresh or frozen embryo transfer.

OBJECTIVE: We aimed to explore fetal cortical brain development by neurosonography in fetuses conceived by assisted reproductive technology (ART), including frozen and fresh embryo transfer (ET), compared with those conceived spontaneously (SC), and to investigate its association with infant neurobehavior at 12 months of age. METHODS: This was a prospective cohort study of 210 singleton pregnancies, including 70 SC pregnancies, 70 conceived by in-vitro fertilization (IVF) following frozen ET and 70 conceived by IVF after fresh ET. Fetal neurosonography was performed at 32 ± 2 gestational weeks to assess cortical development. Sulci depths were measured offline and normalized by biparietal diameter (BPD). Ages and Stages Questionnaires (ASQ) were completed postnatally, at 12 ± 1 months of corrected age. Neurosonographic findings were adjusted by regression analysis for maternal age, ethnicity, parity, fetal sex and fetal-weight centile and gestational age at scan, and ASQ scores were adjusted for maternal age, ethnicity, parity, educational level and employment status, gestational age at birth, breastfeeding, infant sex and infant age at the ASQ evaluation. RESULTS: Overall, in comparison to the SC fetuses, fetuses conceived by ART showed statistically significant differences in cortical development, with reduced parieto-occipital sulci depth adjusted for BPD (mean ± SD: fresh ET, 12.5 ± 2.5 vs frozen ET, 13.4 ± 2.6 vs SC, 13.4 ± 2.6, P < 0.001), cingulate sulci depth adjusted for BPD (median (interquartile range (IQR)): fresh ET, 5.8 (4.2-7.4) vs frozen ET, 5.8 (4.1-7.5) vs SC, 6.5 (4.8-7.8), P = 0.001) and calcarine sulci depth adjusted for BPD (median (IQR): fresh ET, 13.5 (10.1-16.1) vs frozen ET, 14.5 (12.1-15.8) vs SC, 16.4 (14.3-17.9), P < 0.001), together with lower Sylvian fissure grading score. Changes in cortical development were more pronounced in the fresh ET than in the frozen ET group. ART infants showed lower ASQ scores as compared to SC infants, particularly in the fresh ET group (mean ± SD global ASQ Z-score: fresh ET, -0.3 ± 0.4 vs frozen ET, -0.2 ± 0.4 vs SC, 0 ± 0.4, P < 0.001). CONCLUSIONS: Fetuses conceived by ART show a distinctive pattern of cortical development and suboptimal infant neurodevelopment, with more pronounced changes in those conceived following fresh ET. These findings support the existence of in-utero brain reorganization associated with ART and warrant follow-up studies to assess its long-term persistence. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Comparison of dimension reduction techniques applied to the analysis of airborne radionuclide activity concentration.

Temporal variation of airborne radionuclide activity concentration is highly influenced by several meteorological parameters. A traditional key tool to perform a combined analysis on these data is Principal Component Analysis (PCA), a linear dimensionality reduction technique that prioritizes the conservation of the data set global structure. While it reveals important information regarding the correlation among the considered variables, the obtained visual representations do not usually allow to clearly discern different clusters of states with common properties. The main goal of this study is applying two recently introduced non linear dimensionality reduction techniques, t-distributed Stochastic Neighbor Embedding (t-SNE) and Uniform Manifold Approximation and Projection (UMAP) to a data set composed by 7Be and gross beta (Aß) activity concentration and other meteorological data gathered in Mallorca (Spain) between 2004 and 2014. Compared to PCA, both algorithms reveal more details on the local structure of the data set. UMAP allows to clearly identify data clusters with different characteristics that are not clearly identified with the alternative techniques.

Istmocele y fertilidad: revisión de la literatura a propósito de un caso / Isthmocele and fertility: A case report and review of the literature

Una de las complicaciones que puede derivarse de una cesárea es el istmocele. En muchos casos este será asintomático y puede pasar desapercibido, pero en ocasiones da lugar a sintomatología, como por ejemplo sangrado uterino anómalo, infertilidad secundaria, o bien problemas en un futuro embarazo, como acretismo placentario o rotura uterina. Existe a día de hoy mucha controversia sobre el diagnóstico de esta entidad y su posible tratamiento. La motivación de este estudio es presentar una breve revisión de la literatura a raíz de un caso clínico sobre una paciente con istmocele e infertilidad secundaria.(AU)

One of the complications that can result from a caesarean section is isthmocele. In many cases, it will be asymptomatic and can go unnoticed, but sometimes it leads to symptoms such as abnormal uterine bleeding, secondary infertility, or problems in a future pregnancy such as placental accreta or uterine rupture. There is currently much controversy about the diagnosis of this entity and its possible treatment. The aim of the present study is to present a brief review of the literature based on a case report of a patient with isthmocele and secondary infertility.(AU)

Cardiac remodeling in fetuses conceived by ARTs: fresh versus frozen embryo transfer.

STUDY QUESTION: Do fetuses from frozen embryo transfer (FET) present signs of cardiac remodeling and suboptimal function similar to those observed in fetuses from fresh embryo transfer (ET)? SUMMARY ANSWER: Fetuses from both fresh ET and FET present signs of fetal cardiac remodeling and suboptimal function, with more pronounced changes after fresh ET as compared to FET. WHAT IS KNOWN ALREADY: Our group and others have previously demonstrated that fetuses and children conceived by ARTs present cardiac remodeling and suboptimal function. These fetuses show dilated atria, more globular and thicker ventricles, reduced longitudinal motion, and impaired relaxation. Cardiac changes were already present in utero and persisted after birth. Most of the ART fetuses included in previous publications were from fresh ET. However, singletons from FET have different perinatal outcomes compared to those from fresh ET. There are no previous studies comparing cardiac morphology and function between fetuses following fresh and FET. STUDY DESIGN, SIZE, DURATION: This is a prospective cohort study of 300 singleton pregnancies recruited from 2017 to 2020, including 100 spontaneously conceived (SC) pregnancies, 100 fetuses conceived by IVF with FET, and 100 fetuses conceived by IVF with fresh ET. Fetal structural and functional echocardiography was performed in all pregnancies. PARTICIPANTS/MATERIALS, SETTING, METHODS: Pregnancies conceived by IVF were recruited from a single assisted reproduction center, ensuring homogeneity in IVF stimulation protocols, endometrial preparation for FET, laboratory procedures, and embryo culture conditions. SC pregnancies from fertile couples were selected from the general population and matched to IVF pregnancies by maternal age. Epidemiological and perinatal outcomes were collected in all cases. Fetal echocardiography was performed at 28-33 weeks of pregnancy to assess cardiac structure and function in all pregnancies. All echocardiographic comparisons were adjusted by maternal age, nulliparity, birthweight centile, preeclampsia, and prematurity. MAIN RESULTS AND THE ROLE OF CHANCE: Parental age, ethnicity, body mass index and smoking were similar among the study groups. Median gestational age at echocardiography and estimated fetal weight were similar in all study groups. Both fresh ET and FET groups showed similar fetal echocardiographic changes, with more pronounced features in the fresh ET as compared to FET pregnancies. Fetuses conceived by IVF showed larger atria (right atria-to-heart ratio: fresh ET mean 18.1% (SD 3.2) vs FET 18.0% (3.9) vs SC 17.3% (3.2); linear tendency P-value <0.001), more globular ventricles (right ventricular sphericity index: fresh ET 1.62 (0.29) vs FET 1.61 (0.25) vs SC 1.68 (0.26); <0.001) and thicker myocardial walls (relative wall thickness: fresh ET 0.79 (0.21) vs FET 0.74 (0.22) vs SC 0.65 (0.25); <0.001) as compared to SC pregnancies. Both fresh ET and FET groups also had signs of suboptimal systolic and diastolic function, with reduced tricuspid annular systolic peak velocity (fresh ET 7.17 cm/s (1.22) vs FET 7.41 cm/s (1.19) vs SC 7.58 cm/s (1.32); <0.001) and increased left myocardial performance index (fresh ET 0.53 (0.08) vs FET 0.53 (0.08) vs SC 0.50 (0.09); <0.001) as compared to SC pregnancies. LIMITATIONS, REASONS FOR CAUTION: The cardiac changes reported here are subclinical, with most cardiovascular indexes lying within normal ranges. Although echocardiographic changes are recognized as potential cardiovascular risk factors, their association with the long-term cardiovascular disease remains to be proven. The observed milder fetal cardiac features in FET fetuses cannot condition the choice of this technique and must be considered together with the global perinatal results related to these gestations. WIDER IMPLICATIONS OF THE FINDINGS: The identification of cardiac remodeling in fetuses conceived by IVF with fresh ET and FET represents an opportunity for early detection. Future studies are warranted to study the potential long-term consequences of these findings. STUDY FUNDING/COMPETING INTEREST(S): This project has been partially funded with support from the Erasmus + Programme of the European Union (Framework Agreement number: 2013-0040). This publication reflects the views only of the author, and the Commission cannot be held responsible for any use, which may be made of the information contained therein. Additionally, the research leading to these results has received funding from 'la Caixa' Foundation under grant agreement LCF/PR/GN18/10310003, the Instituto de Salud Carlos III (PI15/00130, PI17/00675, PI18/00073) integrated into the Plan Nacional de I + D+I and cofinanced by ISCIII-Subdirección General de Evaluación and Fondo Europeo de Desarrollo Regional (FEDER) 'Una manera de hacer Europa', Cerebra Foundation for the Brain Injured Child (Carmarthen, Wales, UK) and AGAUR 2017 SGR grant n° 1531. The authors declare no conflicts of interest. TRIAL REGISTRATION NUMBER: N/A.

Electrochemical corrosion behavior and mechanical properties of Ti-Ag biomedical alloys obtained by two powder metallurgy processing routes.

Titanium is frequently used as a biomaterial and the importance of Ti-Ag alloys has increased thanks to the antibacterial behavior of silver. In this study, Ti-Ag alloys (5, 10 and 15 wt% Ag) were obtained by two different powder metallurgy routes: blended elemental (BE) and mechanical alloying (MA). The influence of the powder mixture methodology on both microstructure and electrochemical behavior was analyzed. Powders were compacted at 600 and 900 MPa, respectively, and sintered at high vacuum for 3 h at 950 °C. The obtained Ti-Ag alloys were microstructurally characterized by Scanning Electron Microscopy (SEM), Energy Dispersive X-Ray Spectroscopy (EDS) and X-Ray Diffraction (XRD), and mechanically tested by hardness and bending tests. Electrochemical tests were run using a three-electrode cell in an artificial Fusayama saliva solution. Open-Circuit Potential (OCP), polarization curves, potentiostatic tests and Electrochemical Impedance Spectroscopy (EIS) techniques were employed to evaluate the corrosion resistance of the studied Ti-Ag alloys. The initial characteristics of powders before sintering and after blend/alloying modified the electrochemical behavior of the Ti-Ag-sintered alloys and were determined. The samples obtained with the BE powders better resisted corrosion than the MA samples, and this behavior was directly related to the quantity and distribution of intermetallic Ti2Ag. A large quantity of intermetallics present on both the edge and inside grains reduced the corrosion resistance of TiAg alloys.

Pandemia del SARS-CoV-2 y reproducción asistida / SARS-CoV-2 pandemic and assisted reproduction

La pandemia por el nuevo virus SARS-CoV-2 ha provocado un proceso de adaptación a la nueva situación por parte de toda de la sociedad y, con ello, los centros de reproducción asistida. Tras la fase aguda de la crisis sanitaria, en la que se redujo de forma drástica la actividad, se han reanudado los ciclos, guiados por las recomendaciones de las sociedades científicas. En este artículo revisamos toda la información publicada respecto al virus y el sistema reproductivo, señalando la presencia de enzima convertidora de angiotensina tipo ii(angiotensin-converting enzyme 2, ACE2) en el sistema reproductivo femenino y masculino, a nivel testicular, ovárico, endometrial y a nivel embrionario. Además, realizamos un análisis comparativo entre las recomendaciones de las sociedades científicas en cuanto al cribado de la infección, las normas de funcionamiento y las medidas generales de laboratorio

The pandemic caused by the new SARS-CoV-2 virus has led to a process of adaptation to the new situation by society as a whole and, therefore, by assisted reproduction centres. After the acute phase of the health crisis, when activity was drastically reduced, cycles have resumed, guided by the recommendations of scientific societies. In this article, a review is presented of all the published information regarding the virus and the reproductive system, pointing out the presence of angiotensin-converting enzyme 2 (ACE2) in the female and male reproductive system, at the testicular, ovarian, endometrial and embryonic levels. In addition, a comparative analysis is carried out between the recommendations of the scientific societies regarding the screening of infection, performance standards, and general laboratory measurements

[SARS-CoV-2 pandemic and assisted reproduction]. / Pandemia del SARS-CoV-2 y reproducción asistida.

The pandemic caused by the new SARS-CoV-2 virus has led to a process of adaptation to the new situation by society as a whole and, therefore, by assisted reproduction centres. After the acute phase of the health crisis, when activity was drastically reduced, cycles have resumed, guided by the recommendations of scientific societies.In this article, a review is presented of all the published information regarding the virus and the reproductive system, pointing out the presence of angiotensin-converting enzyme 2 (ACE2) in the female and male reproductive system, at the testicular, ovarian, endometrial and embryonic levels. In addition, a comparative analysis is carried out between the recommendations of the scientific societies regarding the screening of infection, performance standards, and general laboratory measurements.

Salbutamol tolerability and efficacy in patients with spinal muscular atrophy type II.

Spinal muscular atrophy (SMA) is an autosomal recessive disease caused by homozygous deletions or loss-of-function mutations in SMN1, which result in a degeneration of motor neurons in the spinal cord and brain stem. Even without a randomized placebo-controlled trial, salbutamol has been offered to patients with SMA in the neuromuscular clinics of most of hospitals for many years. We describe the response to salbutamol in 48 patients with SMA type II who were not taking any other medication. We investigate the changes over an eighteen-month period in motor functional scales and we analyze side effects and subjective response to treatment. Our results suggest that oral administration of salbutamol might be helpful in the maintenance of motor function in patients with SMA type II. An apparent beneficial effect was observed in functional scales of children under the age of 6, especially during the first 6 months of therapy. The majority of patients of all ages referred some kind of subjective positive effect associated with therapy intake. Salbutamol seemed safe and was well tolerated without serious side effects.

Influence of fiber connectivity in simulations of cardiac biomechanics.

PURPOSE: Personalized computational simulations of the heart could open up new improved approaches to diagnosis and surgery assistance systems. While it is fully recognized that myocardial fiber orientation is central for the construction of realistic computational models of cardiac electromechanics, the role of its overall architecture and connectivity remains unclear. Morphological studies show that the distribution of cardiac muscular fibers at the basal ring connects epicardium and endocardium. However, computational models simplify their distribution and disregard the basal loop. This work explores the influence in computational simulations of fiber distribution at different short-axis cuts. METHODS: We have used a highly parallelized computational solver to test different fiber models of ventricular muscular connectivity. We have considered two rule-based mathematical models and an own-designed method preserving basal connectivity as observed in experimental data. Simulated cardiac functional scores (rotation, torsion and longitudinal shortening) were compared to experimental healthy ranges using generalized models (rotation) and Mahalanobis distances (shortening, torsion). RESULTS: The probability of rotation was significantly lower for ruled-based models [95% CI (0.13, 0.20)] in comparison with experimental data [95% CI (0.23, 0.31)]. The Mahalanobis distance for experimental data was in the edge of the region enclosing 99% of the healthy population. CONCLUSIONS: Cardiac electromechanical simulations of the heart with fibers extracted from experimental data produce functional scores closer to healthy ranges than rule-based models disregarding architecture connectivity.

Pregnancy after drug-free in vitro activation of follicles and fresh tissue autotransplantation in primary ovarian insufficiency patient: a case report and literature review.

BACKGROUND: The aim of this report was to describe a case of pregnancy after drug-free in vitro activation (IVA) of follicles and fresh tissue autotransplantation in primary ovarian insufficiency (POI) patient and to review the pertinent literature. METHODS: We present a case in wich a 32 - years old patient with POI became pregnant after IVA without tissue culture and with ovarian tissue transplantation. We also reviewed the literature using Pubmed database. CASE PRESENTATION: Pretreatment with estradiol/progesterone stopped the day before surgery. The removal of the ovarian cortex and autotransplantation were performed by laparoscopy in the same surgical act. Ovarian fragments were transplanted in contralateral ovary and peritoneal pocket near to the ovary. Immediately after surgery GnRH agonist together HMG injections started, leading the growth of 3 preovulatory follicles and the retrieval of two mature eggs. After IVF two embryos were transferred and singleton pregnancy was established and currently she is 25 weeks pregnant. RESULTS: A total of 51 patients with POI in whom an in vitro activation of ovarian tissue was performed, were collected from the revieew of the literature. In 29.4% of them, follicular development was obtained and in 4 of them a pregnancy. In all of them, a combined technique (fragmentation and activation) was performed in two laparoscopies. No case has been reported successfully after drug-free in vitro activation. CONCLUSIONS: This is the first report about a case with pregnancy after drug-free in vitro activation of follicles and fresh tissue autotransplantation in POI patient.

Manual motor speed dysfunction as a neurocognitive endophenotype in euthymic bipolar disorder patients and their healthy relatives. Evidence from a 5-year follow-up study.

BACKGROUND: Few studies have examined Manual Motor Speed (MMS) in bipolar disorder (BD). The aim of this longitudinal, family study was to explore whether dysfunctional MMS represents a neurocognitive endophenotype of BD. METHODS: A sample of 291 subjects, including 131 BD patients, 77 healthy first-degree relatives (BD-Rel), and 83 genetically-unrelated healthy controls (HC), was assessed with the Finger-Tapping Test (FTT) on three occasions over a 5-year period. Dependence of FTT on participants´ age was removed by means of a lineal model of HC samples, while correcting simultaneously the time and learning effect. Differences between groups were evaluated with an ANOVA test. RESULTS: The patients' performance was significantly worse than that of HC over time (p≤0.006), and these deficits remained when non-euthymic BD patients (n=9) were excluded from analysis. Some significant differences between BD patients and BD-Rel (p≤0.037) and between BD-Rel and HC (p≤0.033) were found, but they tended to disappear as time progressed (p≥0.057). Performance of the BD-Rel group was intermediate to that of BD and HC. Most sociodemographic and clinical variables did not affect these results in patients. (p≥0.1). However, treatment with carbamazepine and benzodiazepines may exert a iatrogenic effect on MMS performance (p≤0.006). LIMITATIONS: Only right-handed subjects were included in this study. Substantial attrition over time was detected. CONCLUSIONS: There were significant differences between the patients´ MMS performance and that of healthy relatives and controls, regardless of most clinical and sociodemographic variables. Dysfunctional MMS could be considered an endophenotype of BD. Further studies are needed to rule out possible iatrogenic effects of some psychopharmacological treatments.

The interaction between hybrid organic-inorganic halide perovskite and selective contacts in perovskite solar cells: an infrared spectroscopy study.

The interaction of hybrid organic-inorganic halide perovskite and selective contacts is crucial to get efficient, stable and hysteresis-free perovskite-based solar cells. In this report, we analyze the vibrational properties of methylammonium lead halide perovskites deposited on different substrates by infrared absorption (IR) measurements (4000-500 cm(-1)). The materials employed as substrates are not only characterized by different chemical natures (TiO2, ZnO and Al2O3), but also by different morphologies. For all of them, we have investigated the influence of these substrate properties on perovskite formation and its degradation by humidity. The effect of selective-hole contact (Spiro-OmeTad and P3HT) layers on the degradation rate by moisture has also been studied. Our IR results reveal the existence of a strong interaction between perovskite and all ZnO materials considered, evidenced by a shift of the peaks related to the N-H vibrational modes. The interaction even induces a morphological change in ZnO nanoparticles after perovskite deposition, pointing to an acid-base reaction that takes place through the NH3(+) groups of the methylammonium cation. Our IR and X-ray diffraction results also indicate that this specific interaction favors perovskite decomposition and PbI2 formation for ZnO/perovskite films subjected to humid conditions. Although no interaction is observed for TiO2, Al2O3, and the hole selective contact, the morphology and chemical nature of both contacts appear to play an important role in the rate of degradation upon exposure to moisture.

A novel 3D absorption correction method for quantitative EDX-STEM tomography.

This paper presents a novel 3D method to correct for absorption in energy dispersive X-ray (EDX) microanalysis of heterogeneous samples of unknown structure and composition. By using STEM-based tomography coupled with EDX, an initial 3D reconstruction is used to extract the location of generated X-rays as well as the X-ray path through the sample to the surface. The absorption correction needed to retrieve the generated X-ray intensity is then calculated voxel-by-voxel estimating the different compositions encountered by the X-ray. The method is applied to a core/shell nanowire containing carbon and oxygen, two elements generating highly absorbed low energy X-rays. Absorption is shown to cause major reconstruction artefacts, in the form of an incomplete recovery of the oxide and an erroneous presence of carbon in the shell. By applying the correction method, these artefacts are greatly reduced. The accuracy of the method is assessed using reference X-ray lines with low absorption.

Enhanced reactivity and related optical changes of Ag nanoparticles on amorphous Al2O3 supports.

Pairs of samples containing Ag nanoparticles (NPs) of different dimensions have been produced under the same conditions but on different substrates, namely standard glass slides and a thin layer of amorphous aluminum oxide (a-Al2O3) on-glass. Upon storage in ambient conditions (air and room temperature) the color of samples changed and a blue-shift and damping of the surface plasmon resonance was observed. The changes are weaker for the samples on-glass and tend to saturate after 12 months. In contrast, the changes for the samples on a-Al2O3 appear to be still progressing after 25 months. While x-ray photoelectron spectroscopy shows a slight sulfurization and negligible oxidation of the Ag for the on-glass samples upon 25 months aging, it shows that Ag is strongly oxidized for the on a-Al2O3 samples and sulfurization is negligible. Both optical and chemical results are consistent with the production of a shell at the expense of a reduction of the metal core dimensions, the latter being responsible for the blue-shift and related to the small (<10 nm initial diameter) of the NPs. The enhanced reactivity of the Ag NPs on the a-Al2O3 supports goes along with specific morphological changes of the Ag NPs and the observation of nitrogen.

Feticide followed by mifepristone-misoprostol regimen for midtrimester termination of pregnancy in two cases of complete placenta previa.

Placenta previa (PP), with a frequency of 5-7% in the second trimester, is considered one of the most important causes of obstetric hemorrhage. Surgical curettage is the classically recommended method to perform a midtrimester termination of pregnancy (TOP) in the presence of PP. Recent clinical reports suggest that induction of delivery is possible in these cases, but no information on mifepristone-misoprostol regimen is available. We present 2 cases of mifepristone-misoprostol midtrimester TOP with a diagnosis of complete PP. In both cases, a preinduction feticide was performed. Neither of the 2 cases presented a significant maternal bleeding. This report is relevant considering that this regimen is the most widely used and generally reported as the safest and most effective medical midtrimester TOP method.

[Nutritional status in chronic renal failure patients assisted at the hemodialysis program of the "Hermanos Ameijeiras" Hospital]. / Estado nutricional de los pacientes con insuficiencia renal crónica atendidos en el programa de Hemodialisis del Hospital Clínico-Quirúrgico "Hermanos Ameijeiras".

INTRODUCTION: Heterogeneity of malnutrition rates associated with End-Stage Renal Disease (ESRD) under Haemodialysis (HD) points towards differing performances of the used indicators. OBJECTIVES: To identify those indicators that better describe the nutritional state of the patient with ESRD under HD. SETTING: Program of Haemodialysis, Service of Nephrology, "Hermanos Ameijeiras" Hospital (Havana City, Cuba). METHODS: Twenty-eight patients were recruited. Hospital admissions between december 2001-december 2002 were recorded. The condition of the patient (alive/deceased) after one year of observation was registered. The Subjective Global Assessment (SGA) form was administered to each patient. The nutritional profile included: height, weight, mid-arm circumference (MAC), triceps skinfold (TSF), albumin and total lymphocyte count (TLC). Nutritional status as described by means of albumin and MAC was correlated with SGA score, the ocurrence of hospital admissions and the final condition of the patient. RESULTS: Malnutrition rates were as follows (albumin < 35 g/L): 42.9%; (MAC < cut-off value): 60.7%; [(MAC < cut-off value) and/or (albumin < 35)]: 71.4%; (SGA score = At Risk/Malnourished): 42.9%. SGA score was an independent predictor of the ocurrence of admissions [OR = 14.14; CI 95%: 1.5-137.3] and mortality [OR = 21.0; CI 95%: 2.9-151.4]. Serum albumin was an independent predictor of the patient's mortality [OR = 21.0; CI 95%: 2.9-151.4]. The [(MAC < Cut-off value) and/or (albumin < 35)] rule failed to predict patient's morbimortality. Seventy-seven point eight percent of patients with +60 years-old died during the year of observation [OR = 13.2; IC 95%: 1.9-89.5]. CONCLUSIONS: Increased mortality associated with diminished values of albumin and MAC justifies the fostering of nutritional intervention aimed to preserve lean tissues.

Estado nutricional de los pacientes con insuficiencia renal crónica atendidos en el programa de Hemodiálisis del Hospital Clínico-Quirúrgico “Hermanos Ameijeiras” / Nutricional status in chronic renal failure patients assisted at the Hemodialysis program of the “Hermanos Ameijeiras” hospital

Introducción: La heterogenidad de las tasas de desnutrición asociada a la Insuficiencia Renal Crónica (IRC) en Hemodiálisis (HD) implica rendimiento(s) dispar(es) del (los) indicador(es) empleado(s).Objetivos: Identificar aquellos indicadores que mejor describan el estado nutricional y la evolución natural del paciente con IRC en HD. Escenario: Programa de Hemodiálisis, Servicio de Nefrología, Hospital Clínico-Quirúrgico “Hermanos Ameijeiras” (Ciudad La Habana, Cuba).Métodos: Se reclutaron 28 pacientes. Se registraron los ingresos entre diciembre 2001-diciembre 2002. Se registró la condición (Vivo/Fallecido) al año de observación. A cada paciente se le rellenó la Encuesta Subjetiva Global (ESG). El perfil nutricional incluyó: talla, peso, circunferencia del brazo (CB), pliegue cutáneo tricipital (PCT), albúmina y conteo total de linfocitos (CTL). El estado nutricional descrito mediante la albúmina y la CB se correlacionó con la ESG, la ocurrencia de ingresos y la condición final. Resultados: Las tasas de desnutrición fueron: (albúmina< 35 g/L): 42,9%; (CB < punto de corte): 60,7%; [(CB< Punto de corte) y/o (albúmina < 35)]: 71,4%; (ESG =En riesgo/Desnutrido): 42,9%. La ESG fue un predictor independiente de la ocurrencia de ingresos [OR = 14,14;IC 95%: 1,5-137,3] y la mortalidad [OR = 21,0; IC 95%:2,9-151,4]. La albúmina fue un predictor independiente de la mortalidad [OR = 21,0; IC 95%: 2,9-151,4]. La regla[(CB < punto de corte) y/o (albúmina < 35)] falló en predecir la morbi-mortalidad del paciente. El 77,8% de los pacientes con + 60 años falleció durante el año de observación [OR = 13,2; IC 95%: 1,9-89,5]. Conclusiones: Una mortalidad incrementada con valores disminuidos de la albúmina y la CB justifica las políticas de intervención nutricional orientadas a preservar los tejidos magros

Introduction: Heterogeneity of malnutrition rates associated with End-Stage Renal Disease (ESRD) under Haemodialysis (HD) points towards differing performances of the used indicators. Objectives: To identify those indicators that better describe the nutritional state of the patient with ESRD under HD.Setting: Program of Haemodialysis, Service of Nephrology,“Hermanos Ameijeiras” Hospital (Havana City,Cuba).Methods: Twenty-eight patients were recruited. Hospitalad missions between december 2001-december 2002were recorded. The condition of the patient (alive/deceased) after one year of observation was registered. The Subjective Global Assessment (SGA) form was administered to each patient. The nutritional profile included: height, weight, mid-arm circumference (MAC), triceps skinfold (TSF), albumin and total lymphocyte count (TLC). Nutritional status as described by means of albumin and MAC was correlated with SGA score, the occurrence of hospital admissions and the final condition of the patient. Results: Malnutrition rates were as follows (albumin< 35 g/L): 42.9%; (MAC < cut-off value): 60.7%; [(MAC< cut-off value) and/or (albumin < 35)]: 71.4%; (SGA score = At Risk/Malnourished): 42.9%. SGA score was an independent predictor of the occurrence of admissions [OR = 14.14; CI 95%: 1.5-137.3] and mortality[OR = 21.0; CI 95%: 2.9-151.4]. Serum albumin was an independent predictor of the patient’s mortality [OR =21.0; CI 95%: 2.9-151.4]. The [(MAC < Cut-off value) and/or (albumin < 35)] rule failed to predict patient’s morbimortality. Seventy-seven point eight percent of patients with +60 years-old died during the year of observation [OR = 13.2; IC 95%: 1.9-89.5] Conclusions: Increased mortality associated with diminished values of albumin and MAC justifies the fostering of nutritional intervention aimed to preserve lean tissues

La densitometría de calcáneo permite discriminar fracturas de muñeca en mujeres ancianas / Calcaneal densitometry as a tool for identifying wrist fractures in older women

Objetivo. Determinar si la densidad mineral ósea (DMO) obtenida mediante densitometría de calcáneo permite discriminar mujeres mayores de 60 años con y sin fractura de muñeca. Material y método. Estudio retrospectivo de casos-control, estableciendo como hipótesis de trabajo el mayor riesgo de fracturas distales de antebrazo, en mujeres mayores de 60 años cuya densitometría de calcáneo refleja una T-score < ­0,6. Desde el uno de octubre de 2003 hasta el 31 de marzo de 2004 se atendió a 66 mujeres mayores de 60 años con fractura distal de antebrazo, constituyendo los casos-muestra del estudio. De forma aleatoria se escogieron 60 mujeres con características similares a los casos y que no habían padecido fractura alguna, constituyéndose de esta manera el grupo control. La DMO se midió mediante absorciometría dual de rayos X (DEXA) en calcáneo (PIXI). Se utilizó para ello el equipo LUNAR (modelo 30200). Resultados. La media de la DMO medida obtenida mediante densitometría de calcáneo fue de 0,368 (0,273-0,542) para los pacientes con fractura distal de antebrazo, frente a 0,472 (0,289-0,668) para los pacientes sin fractura, estableciéndose diferencias significativas (p < 0,01). El cálculo de la odds ratio reflejó un riesgo de padecer fractura distal de antebrazo en mujeres mayores de 60 años con una T-score < ­0,6 obtenida mediante PIXI en calcáneo de 10,67 veces superior respecto a mujeres del mismo grupo de edad con una T-score > ­0,6. Conclusiones. La DMO de calcáneo mediante DEXA permite discriminar mujeres con y sin fractura de muñeca

Purpose. To determine whether bone mineral density (BMD) measured by means of calcaneal densitometry is a reliable means of discriminating between women over 60 with and without a wrist fracture. Materials and methods. This is a case-control retrospective study that established as its working hypothesis that women over 60 with a calcaneal densitometry T-score < ­0.6 are at a higher risk of sustaining distal forearm fractures. Between 1 October 2003 and 31 March 2004, 66 women older than 60 presented with a distal forearm fracture; these women constituted the sample cases of our study. Sixty women with similar characteristics to the ones mentioned but who had not sustained a fracture were randomly selected to make up the control group. BMD was measured through dual-energy x-ray absortiometry (DEXA) of the calcaneus (PIXI). A Lunar device (model 30200) was used. Results. The average BMD as measured through calcaneal densitometry was 0.368 (0.273-0.542) for patients with a distal forearm fracture, as compared with 0.472 (0.289-0.668) for patients without a fracture, which constitutes a significant difference (p < 0.01). The odds ratio revealed that the risk of sustaining a distal forearm fracture in women over 60 with a PIXI calcaneal T-score < ­0.6 is 10.67 times higher than in women in the same group but with a T-score > ­0.6. Conclusions. Calcaneal BMD measured by a DEXA scan is a reliable way to discriminate between women with and without a wrist fracture (AU)

Grupos de Apoyo Nutricional en un entorno hospitalario. La experiencia cubana / Nutritional support groups at a hospital setting. The cuban experience

En este trabajo se presentan los resultados de 8 años de trabajo ininterrumpido de un Grupo de Apoyo Nutricional (GAN) dentro de un hospital de tercer nivel de la ciudad de La Habana (CUBA). Los resultados se refieren al desempeño del Grupo en los 3 dominios de la actuación médica, por un lado, y el despliegue de un Programa de Intervención Alimentaria, Nutrimental y Metabólica (PRINUMA) de alcance institucional, por el otro. La labor asistencial ha servido para demostrar la factibilidad de los esquemas de intervención conducidos bajo la premisa del uso primordial de la vía enteral, y los beneficios que resultan de su observación en casos seleccionados. La labor docente ha sido siempre una prioridad del trabajo del Grupo, y ha permitido exponer a los grupos básicos de trabajo de la institución a ideas novedosas y nuevos modos de hacer, a fin de desterrar las prácticas indeseables que puedan atentar contra el estado nutricional del paciente, y que muchas veces están sustentadas en mitos, dogmas y sofismas. La labor investigativa ha sido un perfecto complemento del desempeño del Grupo en los 2 dominios anteriores, y ha hecho posible la incorporación de temas de apoyo nutricional y Nutrición Artificial en la carpeta de investigaciones de la institución. La labor médica del GAN se ha acompañado de una intensa actividad de despliegue del PRINUMA para dar respuesta a los retos que traen consigo el reconocimiento de la desnutrición asociada a las enfermedades como un problema institucional de salud. Las pautas adoptadas en este artículo para el reporte de las actividades del Grupo pueden convertirse en una plataforma metodológica que facilite la evaluación por terceras partes

The results achieved by a Nutritional Support Group (NSG) operating within a tertiary-level hospital in the city of Havana (CUBA) for the last 8 years are presented in this work. Results relate to the performance of the Group in the three domains of medical care, on one hand, and the inception of a Metabolic, Nutritional and Feeding Intervention Program (PRINUMA) of institutional reach, on the other. Nutritional assistance has served the purpose of demonstrating the feasibility of intervention schemes conducted under the premise of the use of the enteral route as first choice, and the benefits observed in selected cases. Teaching has always been a priority of the Group, as a tool to expose the institution’s medical care teams to new ideas and novel ways of acting, in order to eliminate those undesirable practices attempting against the patient’s nutriture that have arisen most of the times from myths, fallacies and dogmas. Research has been a perfect complemment of the Group’s performance in the two previous domains, making possible the incorporation of nutritional support and Artificial nutrition issues into the institution’s R&D portfolio. GAN’s medical workup has been accompannied by the deployment of the PRINUMA, in order to respond to the challenges brought about by the recognition of disease- associated-malnutrition as an institutional health problem. The guidelines followed in this article for reporting the Group’s activities can become a methodological platform for the purpose of assessment by third parties