27 research outputs found
Luteal Phase Support Using Subcutaneous Progesterone: A Systematic Review
No full textLuteal phase support (LPS) is crucial in assisted reproductive technology (ART) cycles when the luteal phase has been found to be defective. Such deficiency is most likely related to the supraphysiological steroid levels that usually occurr in stimulated cycles which, in turn, could severely affect luteinizing hormone (LH) secretion and function, thereby negatively influencing the luteal phase. A number of different medications and routes have been successfully used for LPS in ART. Although an optimal protocol has not yet been identified, the existing plethora of medications offer the opportunity to personalize LPS according to individual needs. Subcutaneous administration progesterone has been proposed for LPS and could represent an alternative to a vaginal and intramuscular route. The aim of the present systematic review is to summarize the evidence found in the literature concerning the application of subcutaneous progesterone in ARTs, highlighting the benefits and limits of this novel strategy. With this aim in mind, we carried out systematic research in the Medline, ISI Web of Knowledge, and Embase databases from their inception through to November 2020. Randomized controlled trials (RCTs) were preferred by the authors in the elaboration of this article, although case-control and cohort studies have also been considered. According to our findings, evidence exists which supports that, in women with a good prognosis undergoing a fresh in vitro fertilization (IVF) cycle, subcutaneous Pg is not inferior to vaginal products. In the Frozen-thawed embryo transfer (FET) cycle, data concerning efficacy is mixed with an increased miscarriage rate in women undergoing a subcutaneous route in oocyte donor recipients. Data concerning the acceptance of the subcutaneous route versus the vaginal route are encouraging despite the different scales and questionnaires which were used. In addition, a cost-effective analysis has not yet been conducted
Advanced Sperm Selection Techniques for Assisted Reproduction
No full textMale infertility accounts for approximately 40% of infertility cases. There are many causes of male infertility, including environmental factors, age, lifestyle, infections, varicocele, and cancerous pathologies. Severe oligozoospermia, cryptozoospermia, and azoospermia (obstructive and non-obstructive) are identified as severe male factor infertility, once considered conditions of sterility. Today, in vitro fertilization (IVF) techniques are the only treatment strategy in cases of male factor infertility for which new methodologies have been developed in the manipulation of spermatozoa to achieve fertilization and increase success rates. This review is an update of in vitro manipulation techniques, in particular sperm selection, emphasizing clinical case-specific methodology. The success of an IVF process is related to infertility diagnosis, appropriate choice of treatment, and effective sperm preparation and selection. In fact, selecting the best spermatozoa to guarantee an optimal paternal heritage means increasing the blastulation, implantation, ongoing pregnancy and live birth rates, resulting in the greater success of IVF techniques
Endometrial microbiota profile in in-vitro fertilization (IVF) patients by culturomics-based analysis
No full textIntroductionIt is well recognized that the human uterus and adjoining tissues of the female reproductive tract exist in a non-sterile state where dysbiosis can impact reproductive outcomes. The endometrial microbiota is a part of this greater milieu. To date, it has largely been studied using 16S rRNA or metagenomics-based methodologies. Despite the known advantages of sequencing analysis, several difficulties have been noted including sample contamination and standardization of DNA extraction or sequencing. The aim of this study was to use a culturomics-based method to analyze the endometrial microbiota and correlate the results with ongoing pregnancy rates.MethodsA prospective cohort study was performed at the University of Naples from October 2022 and February 2023. Ninety-three patients undergoing an IVF cycle with single embryo transfer (ET) (fresh or frozen) were enrolled in the study. Following ET, the catheter tip was inserted into brain heart infusion (BHI) medium under sterile conditions for culture. After 24h and 48h of incubation the microorganisms in the colonies were identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS).ResultsOverall, 68 (73,92%) patients resulted positive for one or more microbes and 25 patients (26,08%) had no microbial growth. Across all participants, the four most important phyla were Firmicutes (87,76%), Proteobacteria (27,94%), Actinobacteria (10,29%) and Ascomycota (8,82%). Lactobacillus species, in particular, was significantly correlated with ongoing pregnancy rate (p=0,05). On the other hand, Staphylococcus subspecies (spp.) (p<0,05) and Enterobacteriaceae (p<0,001) were found to have a negative impact on the implantation rate.DiscussionDetection of bacteria by culturomics from catheter tips used for embryo transfer has been shown to be a reliable method to detect pathogen growth. Endometrial microbiota testing in clinical practice could certainly offer a means to further improve diagnosis and treatment strategies in IVF patients
Severe Ovarian Hyperstimulation Syndrome in a Woman With Breast Cancer Under Letrozole Triggered With GnRH Agonist: A Case Report and Review of the Literature
No full textWe report a rare case of ovarian hyperstimulation syndrome (OHSS) in a 28-year-old woman with breast cancer and with a history of polycystic ovary syndrome (PCOS) despite treatment with letrozole and gonadotropin-releasing hormone agonist (GnRH-a) triggering in a GnRH antagonist (GnRH-ant) protocol without the administration of any human chorionic gonadotropin (hCG) for luteal-phase support. The patient, who underwent controlled ovarian syndrome (COS)-oocyte cryopreservation before chemotherapy, required hospitalization. Complete recovery was achieved after treatment with volume expanders, human albumin, and cabergoline. Based on our case and literature review, it is possible to establish that estradiol (E2) modulation with letrozole and GnRH-a triggering does not eliminate the risk of OHSS. Furthermore, it is advisable to postpone GnRH-a depot to minimize the risk of OHSS after the suspension of letrozole, following menstruation or at least 7–8 days after triggering. It would be desirable to identify high-risk patients, also on a genetic basis, in order to avoid delays in oncologic treatments that could strongly impact life expectancy
Cryopreservation of ovarian tissue: the biggest challenge of oncofertility
No full text: Survival rates after cancer diagnosis and treatment have been raising through the last decades. Nowadays, oncofertility represents a useful strategy for young women affected by cancer to preserve their ovarian function and their family planning opportunity. Apart from more diffused techniques as cryopreservation of mature oocytes after controlled ovarian stimulation and gonadal downregulation with gonadotropin-releasing hormone agonist depots, the cryopreservation of the cortical region of the ovarian tissue, which contains 90% of the follicular reserve, and later autologous transplant represent a possible and intriguing strategy. Nonetheless, the safety of the procedure is still a matter of debate and is a topic of great interest in both oncologic and reproductive fields. Especially, in order to improve the efficacy of the strategy the open questions are: 1) how to search for malignant cells; 2) slow freezing vs. vitrification; 3) state of the art on the "artificial ovary." The aim of this review was to summarize the recent advances in ovarian tissue cryopreservation and present future perspectives
Violencia y desamparo en los orígenes
No full textThis piece of work approaches violence and helplessness at the origins from Winnicott’s perspective. The author tries to reflect from a metapsychological point of view questioning the unconscious register statute of the early failures produced by intrusions coming from the environment. Following Rousillon, the author states that these traumas were “lost” because they did notreceive a psychic representation. Analysis’ work must allow these traumas to be registered and to enter into the psychic dynamic. The author proposes as a hypothesis that something of a primal repression nature must arise as an inscription.A clinical situation is presented in order to exemplify some of the aspects shown in this piece of work.El trabajo aborda el tema de la violencia y el desamparo en los orígenes desde la perspectiva de Winnicott. Intenta hacer una reflexión desde el punto de vista metapsicológico, interrogándose sobre el estatuto del registro inconsciente de las fallas tempranas producidas por las intrusiones del medio ambiente. Siguiendo a Rousillon, plantea que estos traumas quedaron "perdidos" al no recibir una representación psíquica. El trabajo de análisis debe posibilitar el registro y el ingreso de estos traumas en la dinámica psíquica. Se plantea como hipótesis que algo del orden de la represión primaria debe de acontecer, en el sentido de inscripción. El trabajo muestra una situación clínica intentando aproximarse a algunos aspectos de los expuestos
Agresividad y transferencia negativa
No full textIn this piece of work the author approaches aggressiveness and negative transference taking as starting points Melanie Klein’s and Bion’s lines of thought. In the development of her work, the author includes a dialogue with contemporary authors such as R. Caper, L. Grinberg and others. This piece of writing shows the difficulties to communicate in transference in a patient whoshows difficulties in her ability to think and the holding role of the analyst which enables the progress of the analytic treatment.En este trabajo la autora plantea el tema de la agresividad y transferencia negativa tomando como punto de partida formulaciones del pensamiento de M. Klein y de W. Bion. Incluye en el desarrollo de su trabajo el diálogo con pensadores contemporáneos como R. Caper, L. Grinberg entre otros. El trabajo muestra problemas de comunicación en la transferencia de una paciente con dificultades en la capacidad para pensar y el papel de la función continente del analista que posibilita la evolución del análisis
Calibration and analysis of the telluric O2-bands: A spectropolarimetric approach for aerosol and cloud analysis
No full textEarthshine observations are a classical benchmark for the studies of the atmospheres of exo-earth type planets. For this kind of observations, background subtraction is a critical and challenging task to disentangle the effects of atmospheric scattering from atmospheric transmission of molecular lines. In fact, although usually neglected, the background itself carries information on the composition of our atmosphere, and further crucial information may be extracted from the analysis of spectropolarimetric observations of the O2 lines at sunset. In this talk we will first discuss the surprisingly high variability of telluric lines in Earthshine spectra. With full vector radiative transfer calculations of the Earth\u2019s atmosphere we show the impact of aerosol and cloud properties on the spectropolarimetric appearance of the O2 band. They demonstrate that high spectral resolution observations allow to constrain high clouds and aerosols with high sensitivity. We suggest to use HARPS in polarimetric mode to observe the sky at zenith during sunset various times in order to obtain a larger sample of different sky polarisation spectra at high resolution in the O2B spectral band for further modelling
Detailed optical and near-infrared polarimetry, spectroscopy and broad-band photometry of the afterglow of GRB 091018 : polarization evolution
No full textFollow-up observations of large numbers of gamma-ray burst (GRB) afterglows, facilitated by the Swift satellite, have produced a large sample of spectral energy distributions and light curves, from which their basic micro- and macro-physical parameters can in principle be derived. However, a number of phenomena have been observed that defy explanation by simple versions of the standard fireball model, leading to a variety of new models. Polarimetry can be a major independent diagnostic of afterglow physics, probing the magnetic field properties and internal structure of the GRB jets. In this paper we present the first high-quality multi-night polarimetric light curve of a Swift GRB afterglow, aimed at providing a well-calibrated data set of a typical afterglow to serve as a benchmark system for modelling afterglow polarization behaviour. In particular, our data set of the afterglow of GRB 091018 (at redshift z = 0.971) comprises optical linear polarimetry (R band, 0.13-2.3d after burst); circular polarimetry (R band) and near-infrared linear polarimetry (Ks band). We add to that high-quality optical and near-infrared broad-band light curves and spectral energy distributions as well as afterglow spectroscopy. The linear polarization varies between 0 and 3per cent, with both long and short time-scale variability visible. We find an achromatic break in the afterglow light curve, which corresponds to features in the polarimetric curve. We find that the data can be reproduced by jet break models only if an additional polarized component of unknown nature is present in the polarimetric curve. We probe the ordered magnetic field component in the afterglow through our deep circular polarimetry, finding P circ < 0.15per cent (2σ), the deepest limit yet for a GRB afterglow, suggesting ordered fields are weak, if at all present. Our simultaneous R- and Ks-band polarimetry shows that dust-induced polarization in the host galaxy is likely negligible
Loss of STK11 expression is an early event in prostate carcinogenesis and predicts therapeutic response to targeted therapy against MAPK/p38
No full textProstate cancer (PCa) is the second leading cause of cancer-related death in men; however, the molecular mechanisms leading to its development and progression are not yet fully elucidated. Of note, it has been recently shown that conditional stk11 knockout mice develop atypical hyperplasia and prostate intraepithelial neoplasia (PIN). We recently reported an inverse correlation between the activity of the STK11/AMPK pathway and the MAPK/p38 cascade in HIF1A-dependent malignancies. Furthermore, MAPK/p38 overactivation was detected in benign prostate hyperplasia, PIN and PCa in mice and humans. Here we report that STK11 expression is significantly decreased in PCa compared to normal tissues. Moreover, STK11 protein levels decreased throughout prostate carcinogenesis. To gain insight into the role of STK11-MAPK/p38 activity balance in PCa, we treated PCa cell lines and primary biopsies with a well-established MAPK14-MAPK11 inhibitor (SB202190), which has been extensively used in vitro and in vivo. Our results indicate that inhibition of MAPK/p38 significantly affects PCa cell survival in an STK11-dependent manner. Indeed, we found that pharmacologic inactivation of MAPK/p38 does not affect viability of STK11-proficient PCa cells due to the triggering of the AMPK-dependent autophagic pathway, while it induces apoptosis in STK11-deficient cells irrespective of androgen receptor (AR) status. Of note, AMPK inactivation or autophagy inhibition in STK11-proficient cells sensitize SB202190-treated PCa cells to apoptosis. On the other end, reconstitution of functional STK11 in STK11-deficient PCa cells abrogates apoptosis. Collectively, our data show that STK11 is a key factor involved in the early phases of prostate carcinogenesis, and suggest that it might be used as a predictive marker of therapeutic response to MAPK/p38 inhibitors in PCa patients
