Effects of air pollution on clinical pregnancy rates after in vitro fertilisation (IVF): a retrospective cohort study.

OBJECTIVE: To evaluate the effect of air pollution, from oocyte retrieval to embryo transfer, on the results of in vitro fertilisation (IVF) in terms of clinical pregnancy rates, at two fertility centres, from 2013 to 2019. DESIGN: Exploratory retrospective cohort study. SETTING: This retrospective cohort study was performed in the Reproductive Biology Department of Bordeaux University Hospital localised in Bordeaux, France and the Jean Villar Fertility Center localised in Bruges, France. PARTICIPANTS: This study included 10 763 IVF attempts occurring between January 2013 and December 2019, 2194 of which resulted in a clinical pregnancy. PRIMARY AND SECONDARY OUTCOME MEASURES: The outcome of the IVF attempt was recorded as the presence or absence of a clinical pregnancy; exposure to air pollution was assessed by calculating the cumulative exposure of suspended particulate matter, fine particulate matter, black carbon, nitrogen dioxide and ozone (O3), over the period from oocyte retrieval to embryo transfer, together with secondary exposure due to the presence of the biomass boiler room, which was installed in 2016, close to the Bordeaux University Hospital laboratory. The association between air pollution and IVF outcome was evaluated by a random-effects logistic regression analysis. RESULTS: We found negative associations between cumulative O3 exposure and clinical pregnancy rate (OR=0.92, 95% CI = (0.86 to 0.98)), and between biomass boiler room exposure and clinical pregnancy rate (OR=0.75, 95% CI = (0.61 to 0.91)), after adjustment for potential confounders. CONCLUSION: Air pollution could have a negative effect on assisted reproductive technology results and therefore precautions should be taken to minimise the impact of outdoor air on embryo culture.

In utero exposure to Azathioprine in autoimmune disease. Where do we stand?

Azathioprine (AZA), an oral immunosuppressant, is safe during pregnancy. Some reports suggested different impairments in the offspring of mothers with autoimmune diseases (AI) exposed in utero to AZA. These observations are available from retrospective studies or case reports. However, data with respect to the long-term safety in the antenatally exposed child are still lacking. The aim of this study is to summarize the current knowledge in this field and to focus on the need for a prospective study on this population. We performed a PubMed search using several search terms. The actual data show that although the risk of congenital anomalies in offspring, as well as the infertility risk, are similar to those found in general population, there is a higher incidence of prematurity, of lower weight at birth and an intra-uterine delay of development. There is also an increased risk of materno- fetal infections, especially cytomegalovirus infection. Some authors raise the interrogations about neurocognitive impairment. Even though the adverse outcomes might well be a consequence of maternal illness and disease activity, interest has been raised about a contribution of this drug. However, the interferences between the external agent (in utero exposure to AZA), with the host (child genetic susceptibility, immune system anomalies, emotional status), environment (public health, social context, availability of health care), economic, social, and behavioral conditions, cultural patterns, are complex and represent confounding factors. In conclusion, it is necessary to perform studies on the medium and long-term outcome of children born by mothers with autoimmune diseases, treated with AZA, in order to show the safety of AZA exposure. Only large-scale population studies with long-term follow-up will allow to formally conclude in this field. TAKE HOME MESSAGES.

CTG Expansion in the DMPK Gene: Semen Quality Assessment and Outcome of Preimplantation Genetic Diagnosis.

CONTEXT: Myotonic dystrophy (DM) is an autosomal dominant disorder characterized mainly by myotonia but also by primary hypogonadism. No study has reported on fertility management of patients affected by DM type 1 (DM1). OBJECTIVE: This study investigates the impact of CTG repeats in the DMPK gene on semen quality and preimplantation genetic diagnosis (PGD) outcome. DESIGN: This is a monocentric retrospective observational study conducted from January 2003 to January 2019. SETTING: Antoine Béclère University Hospital, Clamart, France. PATIENTS: Three groups were compared in this study: male DM1 patients (Group A, n = 18), unaffected partners of DM1 female patients (Group B, n = 30), and proven fertile men (Group C, n = 33). Reproductive outcomes after PGD were compared between groups A and B. RESULTS: Sperm volume was reduced in group A (2.0 mL) when compared with groups B (3.0 mL; P < 0.01) and C (3.5 mL; P < 0.01). Progressive motility in raw sperm was also decreased in group A (30%) as compared to group C (40%; P < 0.01). The median number of progressive spermatozoa retrieved after sperm preparation was 2.7 million (M) in group A, which was significantly less than those of groups B (10.0 M; P < 0.01) and C (62.2 M; P < 0.01). Sperm motility was inversely correlated to the number of CTG repeats (Spearman r2 = 0.48, Pearson r2 = 0.35). Cumulative live birth rate per transfer was similar between groups, with 32.2% in group A versus 26.8% in group B. CONCLUSIONS: As a precautionary measure, we advise physicians to perform regular monitoring of semen quality in affected males, which would allow sperm cryopreservation should semen parameters fall. PGD allows good reproductive outcomes without disease transmission.

Tumor markers in pancreatic cystic fluids for diagnosis of malignant cysts.

BACKGROUND AND AIM: Early diagnosis of premalignant or malignant pancreatic cysts is essential to improve prognosis. Sampling of pancreatic cyst fluid by fine-needle aspiration during endoscopic ultrasonography (EUS) enables cytopathological examination combined with biochemical analysis. This study aimed to provide an aid based on biological markers for the preoperative management of patients with pancreatic cysts. METHODS: Pancreatic fluids obtained by EUS-guided fine-needle aspiration from 115 patients with cystic lesions were assayed for amylase, lipase, carcinoembryonic antigen (CEA), CA 19-9 and CA 72-4. In addition, chromogranin A (CgA) and neuron-specific enolase (NSE) were measured in 28 fluid samples. RESULTS: ROC curve analysis of the different markers for diagnosis of mucinous cysts showed that CEA had the highest area under the curve (0.93, 95% CI 0.87-0.97), with a sensitivity and specificity of 89% and 93%, respectively, at the cutoff value of 317 µg/L. The CgA and NSE concentrations in 5 NET cysts (median values of 210 [63-492] and 68.5 [9-496] µg/L, respectively) were higher than in 23 other cysts (median values of 8 [7-828] and 2.7 [0.5-35.8] µg/L, respectively) (p = 0.0015 and p = 0.0045, respectively). CONCLUSIONS: CEA is the best marker for identifying a cyst as mucinous. In case of low levels of CEA, our results suggest that CgA and NSE measurements may be helpful in the diagnosis of a neuroendocrine tumor and therefore deserve further investigation.

Práticas sociais das perversões: modernidade do laço, organização social e dilemas morais / Social practices of perversions: modernity of bonds, social organization and moral dilemmas / Usages sociaux des perversions: modernité du lien, organisation sociale et dilemmes moraux / Usos sociales de las perversiones: modernidad del enlace, organisación social y dilemas morales

Propomos estudar primeiramente certos aspectos do discurso capitalista, aproximando-os dos processos perversos da clínica do sujeito para, em seguida, questionar a dimensão da moral e da construção social. Apoiaremo-nos em algumas pesquisas experimentais sobre a submissão à autoridade, bem como sobre algumas questões postas pela filosofia moral em termos de "dilemas", a fim de avaliar os efeitos de divisão subjetiva. A orientação perversa parece ser aqui um motor essencial, fazendo passar, em nome do Outro, um gozo que não diz seu nome, um gozo desmentido.

Our main purpose here is to study certain aspects of the capitalist discourse and compare them with the processes of perversion observed during clinical investigations of subjects. We then take on the dimension of morality and social construction. Experimental research on submission to authority is used as well as issues raised by moral philosophy concerning "dilemmas," in order to evaluate their effects in terms of division of the subject. The inclination to perversion seems to be an essential driving force that, in the name of the Other, brings about a jouissance that will not say its name, a denied jouissance.

Nous nous proposons d'étudier tout d'abord certains aspects issus du discours capitaliste en les rapprochant des processus pervers issu de la clinique du sujet, pour ensuite questionner la dimension de la morale et de la construction sociale. Nous nous appuierons sur certaines recherches expérimentales portant sur la soumission à l'autorité, ainsi que sur certaines questions posées par la philosophie morale en termes de "dilemmes", afin d'en mesurer les effets de division subjective. L'orientation perverse semble être ici un moteur essentiel faisant passer, au nom de l'Autre, une jouissance qui ne dit pas son nom, une jouissance démentie.

Proponemos examinar primero ciertos aspectos del discurso capitalista, acercándolos a procesos perversos procedentes de la clínica del sujeto, para, luego, estudiar la dimensión de la moral y de la construcción social. Para ello, utilizaremos algunas investigaciones experimentales sobre sumisión a la autoridad y algunos aspectos de la filosofía moral relacionados con los "dilemas" para tratar de apreciar sus efectos en la división subjetiva. La orientación perversa parece ser un motor esencial para permitir, en nombre del Otro, un goce que no dice su nombre, un goce desmentido.

Práticas sociais das perversões: modernidade do laço, organização social e dilemas morais / Social practices of perversions: modernity of bonds, social organization and moral dilemmas / Usages sociaux des perversions: modernité du lien, organisation sociale et dilemmes moraux / Usos sociales de las perversiones: modernidad del enlace, organisación social y dilemas morales

Propomos estudar primeiramente certos aspectos do discurso capitalista, aproximando-os dos processos perversos da clínica do sujeito para, em seguida, questionar a dimensão da moral e da construção social. Apoiaremo-nos em algumas pesquisas experimentais sobre a submissão à autoridade, bem como sobre algumas questões postas pela filosofia moral em termos de "dilemas", a fim de avaliar os efeitos de divisão subjetiva. A orientação perversa parece ser aqui um motor essencial, fazendo passar, em nome do Outro, um gozo que não diz seu nome, um gozo desmentido.(AU)

Our main purpose here is to study certain aspects of the capitalist discourse and compare them with the processes of perversion observed during clinical investigations of subjects. We then take on the dimension of morality and social construction. Experimental research on submission to authority is used as well as issues raised by moral philosophy concerning "dilemmas," in order to evaluate their effects in terms of division of the subject. The inclination to perversion seems to be an essential driving force that, in the name of the Other, brings about a jouissance that will not say its name, a denied jouissance.(AU)

Nous nous proposons d'étudier tout d'abord certains aspects issus du discours capitaliste en les rapprochant des processus pervers issu de la clinique du sujet, pour ensuite questionner la dimension de la morale et de la construction sociale. Nous nous appuierons sur certaines recherches expérimentales portant sur la soumission à l'autorité, ainsi que sur certaines questions posées par la philosophie morale en termes de "dilemmes", afin d'en mesurer les effets de division subjective. L'orientation perverse semble être ici un moteur essentiel faisant passer, au nom de l'Autre, une jouissance qui ne dit pas son nom, une jouissance démentie.(AU)

Proponemos examinar primero ciertos aspectos del discurso capitalista, acercándolos a procesos perversos procedentes de la clínica del sujeto, para, luego, estudiar la dimensión de la moral y de la construcción social. Para ello, utilizaremos algunas investigaciones experimentales sobre sumisión a la autoridad y algunos aspectos de la filosofía moral relacionados con los "dilemas" para tratar de apreciar sus efectos en la división subjetiva. La orientación perversa parece ser un motor esencial para permitir, en nombre del Otro, un goce que no dice su nombre, un goce desmentido.(AU)