Emotional intelligence and coping strategies as determinants of quality of life in depressed patient-caregiver dyads: An actor-partner interdependence analysis.

OBJECTIVE: Patients with major depressive disorder (MDD) and their natural caregivers experience major lifestyle difficulties. Little is known concerning dyadic (i.e., patient and natural caregiver) characteristics' impact on quality of life. In a sample of depressed patient-caregiver dyads, we examined quality of life (QoL) levels compared with the general population and whether QoL is influenced by emotional intelligence (EI) and coping strategies using the actor-partner interdependence model (APIM). METHODS: This cross-sectional study involved 79 patient-caregiver dyads. The self-reported data, completed by patients and their primary caregivers, included QoL (SF-36), EI (TEIQue-SF) and coping strategies (BriefCope). The QoL of patients and caregivers was compared with 158 French age-sex-matched healthy controls. The dyadic interactions were analyzed using structural equation modeling. RESULTS: Patients and their caregivers experienced lower QoL levels than French age-sex-matched controls. The EI findings showed actor (degree to which the person's EI was associated with his/her own QoL) and partner (degree to which the person's EI was associated with QoL of the other member of the dyad) effects for patients and caregivers. The coping strategies (i.e., problem solving, positive thinking, avoidance and social support) revealed only actor effects. CONCLUSION: QoL is seriously impaired in depressed patients and their primary caregivers and is associated with EI and coping strategies. Targeted interventions focusing on EI and coping strategies could be offered to improve QoL in dyads.

Distribution and characterization of endogenous benzodiazepine receptor ligand (endozepine)-like peptides in the rat gastrointestinal tract.

Endozepine is the generic name for a family of peptides that are capable of displacing benzodiazepines and the 3-carboxylate ester of beta-carboline from their specific binding sites on synaptosomal membranes. The 104-amino acid polypeptide diazepam-binding inhibitor (DBI) and the octadecaneuropeptide (ODN) generated by tryptic digestion of DBI are two members of the endozepine family. In the present study we have used RIA, HPLC, in situ hybridization, and immunohistochemical techniques to identify and localize endozepine-like molecules in the rat gastrointestinal tract. Significant amounts of endozepine-like immunoreactivity (LI) were detected throughout the gut; the highest concentrations were found in the duodenum and antrum. HPLC analysis revealed that the immunoreactive material eluted as a major peak with a higher retention time than that of synthetic ODN. The distribution of the immunoreactive peptide(s) was studied using the peroxidase-antiperoxidase technique at the light microscope level. Endozepine-LI was localized only in the epithelial cell layer of the intestine in both goblet cells and enterocytes. In the stomach, endozepine-LI appeared to be restricted to deep layer of the epithelial cells. The diffuse neuroendocrine cells (amine precursor uptake and decarboxylation system) as well as myenteric and neuronal cells were devoid of immunoreactivity. A good correlation was observed between RIA and immunocytochemical data, in that the esophagus, which contained very low concentrations of endozepine-LI, also exhibited weak immunostaining of secretory cells. In situ hybridization using a 35S-labeled cRNA probe showed that endozepine mRNA was located in the mucosa. Taken together, these results show that in the rat, epithelial cells synthesize endozepine-LI material. Since epithelial cells also contain a high density of peripheral-type benzodiazepine-binding sites, our data indicate that endozepines may play a role in water, electrolyte, and/or mucus regulation in the rat gastrointestinal tract. The occurrence of high levels of endozepine-LI in the rat stomach also suggests that endozepines can be involved in the regulation of gastric acid secretion through modulation of local gamma-aminobutyric acid-ergic neurotransmission.

Seasonal influence of diurnal rhythms in the onset of the plasma luteinizing hormone surge in women.

The time of the LH surge onset in plasma was detected in 75 human cycles. The preovulatory LH surge began between midnight and 0730 h in two thirds of the patients. According to the season of study, the LH surge began between 1030 and 2215 h in 52.4% of the spring cycles compared with 12.9% of the cycles studied during other seasons (P less than 0.001). The highest frequency of the LH surge occurrence over a 3-h time interval was 1500 +/- 1.5 h during the spring cycles (28.6%) and 0300 +/- 1.5 h (42.5%) during the other seasons. It was estimated that ovulation occurred primarily in the morning during the spring and primarily in the evening during autumn and winter.

Interleukin-6 biosynthesis in human preovulatory follicles: some of its potential roles at ovulation.

In the present work we explored cellular sites of interleukin-6 (IL-6) biosynthesis in human follicular aspirates from patients undergoing in vitro fertilization therapy and the effects of this cytokine on oocyte fertilization and granulosa cell (GC) steroidogenesis. Biological IL-6 activity from 20-40 IU/mL was present in follicular fluids from 22 patients; it was also detected in 10 of 22 supernatants of cultured oocyte-cumulus complexes and in cumulus cell and GC cultures. Biological IL-6 activity in oocyte-cumulus complex cultures was not related to fertilization rates. Total ribonucleic acid was isolated from follicular aspirates and GC-enriched preparations. After reverse transcriptase and polymerase chain reaction cycles using oligonucleotide primers corresponding to known cDNA sequences for IL-6, a 126-basepair band characterized the amplification product of IL-6 transcripts on gel electrophoresis. To localize IL-6 messenger ribonucleic acid, in situ hybridization analysis was performed using a [35S]IL-6 riboprobe. The distribution of transcripts was more dense (15% vs. 3% stained cells) in GC-enriched preparations, which contained more than 95% GCs, than in original follicular preparations, which contained 20-40% viable GCs; it was not significantly modified by the presence of macrophage contaminants. The expression of IL-6 protein was assessed by positive immunohistological stainings. Biological IL-6 activity was higher, and in situ hybridization signals were more dense and more intense in 24-h GC cultures than in 72-h GC cultures, suggesting that IL-6 biosynthesis was transiently induced. Under experimental conditions of low IL-6 endogenous levels in cultures, adding recombinant human IL-6 from 10-200 IU/mL had no effect on progesterone production or aromatase activity in GC cultures free of macrophages, whereas in GC cultures including macrophage contaminants, stimulatory effects on basal and hCG-stimulated progesterone production and on basal and FSH-stimulated aromatase activities were observed. The present study provides strong support for the view that IL-6 is produced by GCs in the preovulatory follicle at the time of ovulation. In addition, we showed that IL-6 might be an intraovarian regulatory factor concerned with steroidogenesis.

Treatment of flail chest with Judet's struts.

This report describes our experience with the operative stabilization of flail chest with the use of Judet's struts. In a series of 18 patients with flail chest, the method allowed shorter duration of artificial ventilation and decreased functional sequelae. We find this technique to be better than previously published methods, since it provides better stabilization and immobilization of the ribs and thus obviates the need for artificial ventilation.

Improvements in ovarian stimulation for in vitro fertilization.

What are the major improvements in stimulation over recent years? The stimulated cycle has completely superseded the natural cycle since this is the only method of obtaining several embryos. In conventional stimulation, despite an enormous body of literature, no single treatment modality has emerged as superior to other forms of therapy. Undoubtedly it is the experience and habits of individual IVF teams that determine the success of one or another method. Therefore programmed stimulation is an improvement in that it introduces the factors of convenience and simplicity while retaining the clinical efficacy of stimulation by conventional treatment. The analogues of LHRH are still in an early phase of development, but they appear to be associated with a low cancellation rate even in previous poor-responders. Furthermore, preliminary results seem to indicate that this is the first development since the widespread adoption of follicular stimulation, which is associated with an increased pregnancy rate. We are currently involved in trying to associate programmed stimulation and analogue treatment in a bid to combine the advantages of both therapies. Finally, embryo cryopreservation must be mentioned. There is no point in refining our stimulation protocols to obtain many embryos if those surplus to immediate requirement are disposed of. Cryopreservation offers the means of maximizing the pregnancy potential of a single IVF cycle while reducing the possibility of multiple pregnancy.

Should the vagus nerves be isolated from the fundoplication wrap? A prospective study.

OBJECTIVE: To assess whether careful dissection and isolation of vagus nerves from the three-quarter Nissen fundoplication wrap (a periesophageal posterior gastric wrap 270 degrees in circumference) could modify the postoperative outcome and reduce postoperative gastric emptying disturbances. DESIGN: Open randomized control trial. SETTING: University hospital. PATIENTS: Forty-two patients with proved esophageal reflux and indication for surgery, after informed consent. INTERVENTIONS: A three-quarter Nissen fundoplication with (21 cases) or without (21 cases) dissection and exclusion of vagus nerves from the wrap. MAIN OUTCOME MEASURES: Standard questionnaire, acid reflux test, and gastric emptying study before and 3 months after surgery. RESULTS: No difference was found between the groups. There was a correlation between preoperative and post-operative gastric emptying. CONCLUSION: Exclusion of the vagus nerves from the three-quarter Nissen fundoplication wrap provides no advantage on postoperative gastric emptying and does not affect outcome of reflux surgery.

Results of in vitro fertilization with embryo cryopreservation and a recommendation for uniform reporting.

The analyzed data from 295 cycles in which certain embryos were frozen demonstrate a comparable aptitude for development of embryos either fresh or frozen-thawed in cycles yielding four or more embryos. This supports the clinical advantage of freezing certain embryos in this situation. However, there was no advantage in freezing embryos if only one to three were available in the IVF cycle. A formula is proposed to give the current outcome and to compare the success rate of IVF-ET according to various parameters, including the policy for embryo cryopreservation. This formula enables all teams to present their data in an identical manner.

Evidence of uterine inadequacy to egg implantation in stimulated in vitro fertilization cycles.

From 104 IVF cycles 166 embryos were immediately transferred (63 embryo transfers, ET), whereas 151 embryos were frozen until later transfer (77 embryo transfers). There were 8 (12.7%) or 19 (24.7%) pregnancies after fresh or frozen-thawed ET, respectively. Sixteen pregnancies (29.1%) originated from 55 ETs of frozen-thawed embryos coming from IVF cycles in which pregnancy was not induced by fresh ET. The pregnancy rate after fresh ET (10.5%) was lower than that obtained when the same patients received frozen-thawed embryos (27.1%, P less than 0.02). It is concluded that a normal pregnancy rate may result if the embryos originating from an unsuccessful IVF-ET cycle are transferred in a favorable uterus.

Relationships between in vitro progesterone production by granulosa-luteal cells and certain characteristics of human stimulated cycles.

OBJECTIVE: To explore the conditions of a suitable luteal phase in human stimulated cycles, progesterone (P) production by cultured granulosa cells from preovulatory follicles was related to preovulatory serum estradiol (E2) and number of oocytes. DESIGN: Progesterone production was measured in the presence or absence of human chorionic gonadotropin (hCG) using radioimmunoassay; data were compared using Student's t-test; correlations used linear regression. SETTING: In vitro fertilization and embryo transfer (IVF-ET) for infertility treatment at hospital Antoine Beclère, Clamart, France; scientific studies at Institut National de la Santé et de la Recherche Médicale, Unit 187, Clamart, France. PATIENTS, PARTICIPANTS: Nineteen women, 33 +/- 4 years old, undergoing IVF-ET for nonovarian causes. MAIN OUTCOME MEASURES: High preovulatory E2 usually correlates with high luteal P level. Atretic follicle has reduced follicular E2 production combined with a loss of responsiveness to gonadotropins. RESULTS: Granulosa-luteal cell P production correlated with E2 level (P less than 0.0002). Six cycles, with 14 oocytes recovered per cycle on average, showed reduced plasma E2 per oocyte (P less than 0.001) combined with reduced responsiveness to hCG by granulosa-luteal cells (P less than 0.02). CONCLUSION: Recovery of numerous oocytes might be associated with follicular atresia and deficient luteal phase.

Minimum time lapse between luteinizing hormone surge or human chorionic gonadotropin administration and follicular rupture.

Occurrence of ovulation was detected by laparoscopy between 22 and 47 hours following the onset of the luteinizing hormone (LH) surge in plasma (61 patients) or human chorionic gonadotropin (hCG) administration (76 patients). None of 22 patients had ovulated before the 34th hour following LH surge or hCG, as compared with 3.4% (3 of 89) and 50.0% (11 of 22) laparoscoped after 34 to 37 hours or 37 to 39 hours, respectively. Whether measured with respect to the initial rise of LH or the injection of hCG, the time lapse before ovulation was comparable. Ovulation was more frequently established at 37 to 39 hours in spontaneous cycles (10/13) than in clomiphene-treated cycles (1/9, P less than 0.01). The onset of the LH rise was found to be a more accurate criterion than the LH peak in determining the time of ovulation.

Influence of human menopausal gonadotropin on the recruitment of human ovarian follicles.

Human menopausal gonadotropin (hMG) was administered once (225 IU) to 16 women during different phases of the menstrual cycle: either late-luteal, early-follicular, midfollicular, or late-follicular phases before surgical ovarian resection or ablation. The mitotic index (MI) of follicular granulosa cells and the proportion of recruitable healthy follicles were analyzed 4 to 5 days after hMG injection, the findings being compared with those in unstimulated ovaries from 22 normally cycling patients. The percentages of healthy recruitable follicles greater than or equal to 2 mm in diameter was not altered by hMG as compared with controls. The granulosa cell MI was highly stimulated by hMG when administered in late-luteal or early-follicular phases; however, no granulosa cell MI stimulation was noted when hMG was administered in the midfollicular or late-follicular phases. The progressive abolition of the ability of hMG to stimulate follicular growth as ovulation approaches supports the existence of an inhibitory activity (possibly ovarian) designed to suppress the selection and the maturation of the less developed antral follicles from the midfollicular phase of the spontaneous human menstrual cycle.

Serum is not necessary in human in vitro fertilization, early embryo culture, and transfer.

Human in vitro fertilization (IVF), embryo culture (EC), and embryo transfer (ET) are commonly performed in various media supplemented with blood serum. To determine whether serum is really necessary, the results of IVF, EC, and ET were compared by using two types of media: B2 medium supplemented with human cord serum and B3 medium without any serum. B3 medium is similar to B2, except that it contains 1% pure controlled human serum albumin in place of 1% bovine serum albumin. We did not observe any difference between the results obtained by using B2 or B3 at any phase of IVF, EC, and ET processes. Both media give an overall evolutive pregnancy rate of about 16%. B3 medium with serum seems to increase slightly the cleavage speed. Our results indicate that there are no positive effects when serum is used for human IVF-ET. To avoid serum supplementation is of evident interest for the homogeneity of the results. This will also lead to a better understanding of human early development and control of the egg quality by metabolic analysis of the media following in vitro EC.

Apparatus for the in vitro fertilization and culture of human oocytes.

PIP: An apparatus for in vitro fertilization and culture of mammalian eggs that permits close control over variations in temperature, lighting, and pH has been developed to imitate natural conditions as far as possible. All handling of the oocyte and zygote are performed inside a baby incubator which has a system of air saturation using water vapor. A binocular dissecting microscope and an inverted compound microscope are built into the enclosure to permit simultaneous observation of the egg at widely different magnifications. Lighting is restricted to the longer wavelengths, which do not harm mammalian eggs. The microscope is equipped with a camera system. A gas mixture of 5% CO2, 5% O2, and 90% N2 is delivered at a pressure of 1 bar by a double reduction valve arrangement. The gas passes into the incubator through a filter and is humidified and warmed inside the incubator by bubbling through a bottle of sterile distilled water. The gas is finally distributed by a series of culture tubes. The culture tubes are usually kept in darkness; their position is changed as the development of the egg progresses to take advantage of the slight temperature differentials within the apparatus. Less than 1 minute after puncture of the follicle, the fluid is transferred to the incubator and is examined in a petri dish using the stereomicroscope. The oocyte is immediately transferred to a culture tube containing medium and placed at 36.8 degrees Celsius. 16-20 hours after insemination the egg is transferred under the stereomicroscope by pipetting directly into a new tube, where the medium is supplemented by a small quantity of maternal serum. It is kept at 37.2 degrees Celsius. After 2-4 days of culture in vitro, if normal development is observed, the egg is transferred to the patient's uterus. The variation in temperature at any given point in the apparatus is less than .2 degrees Celsius. 114 human oocytes have been collected, of which 58% were fertilized. 82% of the fertilized eggs underwent normal cleavage, and 38 embryos were replaced in the uteri of 34 patients. 8 early pregnancies resulted, of which 2 lasted more than 3 months. The fertilization rate was closely related to the quality of male and female gametes; it was 94% when both were favorable.^ieng

Platelet-activating factor-acether is a component of human follicular fluid.

OBJECTIVE: Platelet-activating factor-acether (PAF-acether) presence was investigated in 27 human follicular fluids (FFs). DESIGN: Aggregation of washed rabbit platelets was used to measure PAF-acether. Data were compared using Student's t-test. SETTING: Follicular fluids came from the in vitro fertilization program at Antoine Béclère Hospital, and PAF-acether was assayed at Institut National de la Santé et de la Recherche Médicale, Unités 187 and 200, Clamart, France. PATIENTS, PARTICIPANTS: The study concerned five infertile women 29 to 39 years of age. INTERVENTIONS: Ovaries were stimulated with human menopausal gonadotropin under gonadotropin-releasing hormone agonist (GnRH-a) action. MAIN OUTCOME MEASURES: The height of platelet aggregation was compared between FFs and synthetic PAF-acether. RESULTS: Mean FF concentration of PAF-acether was 1,367 to 3,467 pg/mL among women. Values were higher for patients in a long than in a short GnRH-a protocol (P less than 0.05). However, PAF-acether concentration was not related to fertilization rate. CONCLUSIONS: Platelet-activating factor-acether is possibly involved in oocyte release from the follicle, a process occulted by follicular puncture.

Effect of a gonadotropin-releasing hormone agonist and gonadotropins on ovarian follicles in cynomolgus monkey: a model for human ovarian hyperstimulation.

STUDY OBJECTIVE: To examine the effect on large follicles (greater than or equal to 2 mm) of human menopausal gonadotropin (hMG) and buserelin acetate, a gonadotropin-releasing hormone agonist in monkeys. DESIGN: Experimental. SETTING: Reproductive research laboratory. ANIMALS: Fourteen cyclic cynomolgus monkeys receiving hMG alone for 8 days or buserelin acetate plus 8 (group 1), 12 (group 2), or 16 (group 3) days of hMG administration always starting from day 1 of the cycle. RESULTS: The different treatments were effective in over-riding the specific ovulatory quota of 1, and more large follicles developed in treatments involving long duration and higher doses of hMG. In buserelin acetate plus hMG treatments, the frequency of dissociated follicles and follicles in late atresia were, respectively, lower and higher than in hMG alone treatment. The numbers of recoverable mature oocytes (germinal vesicle breakdown) were similar to the numbers of such oocytes recovered after hyperstimulation performed for human in vitro fertilization and embryo transfer (IVF-ET). However, the number of mature oocytes enclosed in typically preovulatory follicles was very low because there were numerous dysmature follicles. CONCLUSION: These data suggest a deleterious effect of buserelin acetate plus hMG treatments on the recruitable follicles at the time when treatments start. The implications of these observations in the field of human IVF-ET are discussed.

Relationships between embryo transfer results and ovarian response and in vitro fertilization rate: analysis of 186 human pregnancies.

We studied the relationships between "pretransfer" parameters (number of follicles, oocytes, and embryos) and the result (occurrence and quality of pregnancy) obtained by transferring one, two, or three embryos. The analysis concerns 186 pregnancies compared with 186 implantation failures. The chances for an oocyte to cleave or for a pregnancy to continue decreased when the number of preovulatory follicles increased. The number of transferred embryos increased with oocyte cleavage rate in nonpregnant patients and in patients with an ongoing pregnancy, but such a relation was not found in the case of failed pregnancy (biochemical pregnancies and abortions). Failed pregnancies occurred in patients who demonstrated the highest oocyte cleavage rate (94.1%), compared with 81.2% for implantation failure and 84.8% for ongoing pregnancy (P less than 0.01). The cleavage rate was also higher in cases of multiple, compared with single, ongoing pregnancies after the transfer of three embryos (79.7% versus 64.5%, P less than 0.001). An important finding was the higher survival rate after triple-embryo transfer in patients, yielding numerous oocytes. The survival rate (fetuses per transferred embryos) after the transfer of three embryos was 14.9% in patients yielding five oocytes, versus 7.7% in patients yielding 3.4 oocytes (P less than 0.05). These results are related to oocyte and embryo viability and uterine ability for pregnancy.

Human embryo features that influence the success of cryopreservation with the use of 1,2 propanediol.

Eighty-five human embryos fertilized in vitro were frozen and thawed with 1,2 propanediol as a cryoprotective agent. The effects of viability of in vitro culture duration, stage, and morphologic appearance of embryos were examined after thawing. Survival was higher for 2-day-old embryos than for 3-day-old embryos (56% versus 18%) and for 2-, 4-, and 8-cell embryos than for intermediate-cleavage-stage embryos (67% versus 22%). Among 19 regular-cell-size embryos at the 2-, 4-, and 8-cell stage, 15 (79%) kept 50% or more of their initial number of blastomeres after thawing and 9 were intact. The average viability of all 2-day-old frozen-thawed embryos can be estimated at 19%.

Selective oocyte retrieval: a new approach to ovarian hyperstimulation.

Selective oocyte retrieval is a new approach to ovarian hyperstimulation (OHS) that prevents side effects of OHS and multiple pregnancies by puncturing most of the ovarian follicles 35 hours after hCG administration as in an IVF program. The remaining intact follicles can still result in a singleton or twin pregnancy. In three patients who presented a multiple follicular development, this technique resulted in two pregnancies; moreover, the retrieved oocytes were fertilized and the embryos frozen.

Importance of semen preparation in avoidance of reduced in vitro fertilization results attributable to bacteria.

Although the physical treatment of semen for IVF and related procedures is sufficient to remove most organisms present in semen, the pathogenic varieties tend to be more resistant. The supplementation of oocyte culture medium with both penicillin and streptomycin was associated with the eradication of 100% of organisms in the current study. In these circumstances, the presence of pathogenic organisms in the untreated semen is not associated with reduced oocyte fertilization in vitro.