303 research outputs found
Reply: Rapid changes in practice make analysis of historical databases irrelevant for contemporary counselling
No full textLive birth and perinatal outcomes following stimulated and unstimulated IVF: Analysis of over two decades of a nationwide data
No full textSTUDY QUESTION Does ovarian stimulation affect perinatal outcomes of preterm birth (PTB) and low birth weight (LBW) following IVF treatment. SUMMARY ANSWER Despite no significant differences in the risks of PTB and LBW between stimulated and unstimulated IVF in the present study, the study cannot exclude the effect of ovarian stimulation on the perinatal outcomes following IVF. WHAT IS ALREADY KNOWN Pregnancies resulting from assisted reproductive treatments (ART) are associated with a higher risk of pregnancy complications compared to spontaneously conceived pregnancies attributed to the underlying infertility and the in vitro fertilization techniques. It is of interest to determine the effect size of ovarian stimulation use in achieving a live birth and whether ovarian stimulation that is routinely used in IVF, affects perinatal outcomes of birth weight and gestational age at delivery compared to unstimulated IVF. STUDY DESIGN, SIZE, DURATION Anonymous data were obtained from the Human Fertilisation and Embryology Authority (HFEA), the statutory regulator of ART in the UK. The HFEA has collected data prospectively on all ART performed in the UK since 1991. Data from 1991 to 2011 comprising a total of 591 003 fresh IVF ± ICSI cycles involving 584 835 stimulated IVF cycles and 6168 unstimulated IVF cycles were analyzed. PARTICIPANTS/MATERIALS, SETTING, METHODS Data on all women undergoing either stimulated or unstimulated fresh IVF ± ICSI cycles during the period from 1991 to 2011 were analyzed to compare live birth rates, singleton live birth rates, perinatal outcomes of PTB, early PTB (<32 weeks), LBW and very LBW (<1500 grams) among singleton live births. Adjusted logistic regression was performed for each perinatal outcome for confounding factors: female age, period of treatment, cause of infertility, number of previous IVF cycles and previous live birth. MAIN RESULTS AND THE ROLE OF CHANCE Analysis of the large nationwide data demonstrated 3.5 times (95% confidence interval (CI): 3.1-3.9) as many unstimulated IVF cycles being required to achieve one live birth compared to stimulated IVF and 2.9 times (95% CI: 2.6-3.2) as many unstimulated IVF cycles being required to achieve one singleton live birth compared to stimulated IVF. There was no significant difference in the unadjusted odds for PTB (odds ratio (OR) 1.27, 95% CI: 0.80-2.00) and LBW (OR 1.48, 95% CI: 0.90-2.42) between stimulated and unstimulated IVF cycles. There was no significant difference in the risk of the adverse perinatal outcomes after adjusting for potential confounders; PTB (adjusted odds ratio (aOR) 1.43, 95% CI: 0.91-2.26) and LBW (aOR 1.58, 95% CI: 0.96-2.58). LIMITATIONS, REASONS FOR CAUTION Although the analysis was adjusted for a number of important confounders, the dataset had no information on smoking, body mass index (BMI) and the medical history of women during pregnancy to allow adjustment. Anonymized nature of the dataset did not make it permissible to analyse one cycle per woman. Given the smaller number of perinatal events with unstimulated IVF, a larger study is needed to investigate further. WIDER IMPLICATIONS OF THE FINDINGS Analysis of this large dataset demonstrates that ovarian stimulation has a vital role in maximizing efficacy of IVF. Although there were no significant differences for PTB and LBW following stimulated compared to unstimulated IVF, the CIs were wide enough to include possible clinically important effects. STUDY FUNDING/COMPETING INTEREST(S) No funding was obtained. There are no competing interests to declare
Trimebutine maleate as a multidimensional-antibacterial agent against functional dyspepsia: A prospective multicenter randomized, double-blind controlled trial
No full text[No Abstract Available]Galenica A.E. Pharmaceutical Company, GreeceJ. Kountouras: B. Research Grant (principal investigator, collaborator or consultant and pending grants as well as grants already received); Modest; This work has been financially supported by Galenica A.E. Pharmaceutical Company, Greece. E. Gavalas: None. A. Papaefthymiou: None. I. Tsechelidis: None. S. Polyzos: None. S. Bor: None. M. Diculescu: None. A. Bochenek: None. K. Jadallah: None. J. Rozciecha: None. T. Karakan: None. P. Dabrowski: None. M. Tadeusz: None. Z. Spirchez: None. O. Sezgin: None. M. Gulten: None. N. Farsakh: None. M. Doulberis: None
The performance of the Elecsys® anti-Müllerian hormone assay in predicting extremes of ovarian response to corifollitropin alfa
No full textResearch question: What is the performance of anti-Müllerian hormone (AMH) as measured by the Elecsys® AMH assay in predicting ovarian response in women treated with 150 μg corifollitropin alfa (CFA)? Design: Multicentre, prospective study conducted between December 2015 and April 2018. Women were aged 18–43 years, had regular menstrual bleeding, a body mass index of 17–35 kg/m2 and weighed 60 kg or over. Exclusion criteria: previous oophorectomy, history of ovarian hyperstimulation syndrome, a previous IVF and intracytoplasmic sperm injection cycle producing over 30 follicles measuring 11 mm or wider, basal antral follicle count (AFC) over 20 or polycystic ovarian syndrome. All women were treated with 150 μg CFA followed by recombinant FSH (150–300 IU/day) in a fixed gonadotrophin releasing hormone antagonist protocol. Results: Of the 219 patients enrolled, 22.8% had low ovarian response (three or fewer oocytes), 66.2% had normal response and 11% had high ovarian response (15 or more oocytes). The AMH and AFC presented an area under the curve of 0.883 (95% CI 0.830 to 0.936) and 0.879 (95% CI 0.826 to 0.930), respectively, for low ovarian response; and an AUC of 0.865 (95% CI 0.793 to 0.935) and 0.822 (95% CI 0.734 to 0.909) for high ovarian response. An AMH cut-off of 1.0 ng/ml provided a sensitivity of 92.0% and a specificity of 66.9% in the prediction of low ovarian response; a cut-off of 2.25 ng/ml predicted high ovarian response with a sensitivity of 54.2% and a specificity of 91.8%. Conclusions: The automated Elecsys® AMH assay predicts ovarian response in a CFA antagonist protocol. The best predictors of ovarian response in CFA-treated patients were AMH and AFC
Algorithmic options for joint time-frequency analysis in structural dynamics applications
No full textThe purpose of this paper is to present recent research efforts by the authors supporting the superiority of joint time-frequency analysis over the traditional Fourier transform in the study of non-stationary signals commonly encountered in the fields of earthquake engineering, and structural dynamics. In this respect, three distinct signal processing techniques appropriate for the representation of signals in the time-frequency plane are considered. Namely, the harmonic wavelet transform, the adaptive chirplet decomposition, and the empirical mode decomposition, are utilized to analyze certain seismic accelerograms, and structural response records. Numerical examples associated with the inelastic dynamic response of a seismically-excited 3-story benchmark steel-frame building are included to show how the mean-instantaneous-frequency, as derived by the aforementioned techniques, can be used as an indicator of global structural damage
Effect of Genetic Variants of Gonadotropins and Their Receptors on Ovarian Stimulation Outcomes: A Delphi Consensus
No full textBackground: A Delphi consensus was conducted to evaluate the influence of single nucleotide polymorphisms (SNPs) in genes encoding gonadotropin and gonadotropin receptors on clinical ovarian stimulation outcomes following assisted reproductive technology (ART) treatment. Methods: Nine experts plus two Scientific Coordinators discussed and amended statements plus supporting references proposed by the Scientific Coordinators. The statements were distributed via an online survey to 36 experts, who voted on their level of agreement or disagreement with each statement. Consensus was reached if the proportion of participants agreeing or disagreeing with a statement was >66%. Results: Eleven statements were developed, of which two statements were merged. Overall, eight statements achieved consensus and two statements did not achieve consensus. The statements reaching consensus are summarized here. (1) SNP in the follicle stimulating hormone receptor (FSHR), rs6166 (c.2039A>G, p.Asn680Ser) (N=5 statements): Ser/Ser carriers have higher basal FSH levels than Asn/Asn carriers. Ser/Ser carriers require higher amounts of gonadotropin during ovarian stimulation than Asn/Asn carriers. Ser/Ser carriers produce fewer oocytes during ovarian stimulation than Asn/Asn or Asn/Ser carriers. There is mixed evidence supporting an association between this variant and ovarian hyperstimulation syndrome. (2) SNP of FSHR, rs6165 (c.919G>A, p.Thr307Ala) (N=1 statement): Few studies suggest Thr/Thr carriers require a shorter duration of gonadotropin stimulation than Thr/Ala or Ala/Ala carriers. (3) SNP of FSHR, rs1394205 (−29G>A) (N=1 statement): Limited data in specific ethnic groups suggest that A/A allele carriers may require higher amounts of gonadotropin during ovarian stimulation and produce fewer oocytes than G/G carriers. (4) SNP of FSH β-chain (FSHB), rs10835638 (−211G>T) (N=1 statement): There is contradictory evidence supporting an association between this variant and basal FSH levels or oocyte number. (5) SNPs of luteinizing hormone β-chain (LHB) and LH/choriogonadotropin receptor (LHCGR) genes (N=1 statement): these may influence ovarian stimulation outcomes and could represent potential future targets for pharmacogenomic research in ART, although data are still very limited. Conclusions: This Delphi consensus provides clinical perspectives from a diverse international group of experts. The consensus supports a link between some variants in gonadotropin/gonadotropin receptor genes and ovarian stimulation outcomes; however, further research is needed to clarify these findings
Association between primary hypothyroidism and metabolic dysfunction-associated steatotic liver disease: an updated meta-analysis
No full textObjective: epidemiological studies have reported an association between primary hypothyroidism and metabolic dysfunction-associated steatotic liver disease (MASLD). However, the magnitude of the risk and whether this risk changes with the severity of MASLD remains uncertain. We performed a meta-analysis of observational studies to quantify the magnitude of the association between primary hypothyroidism and the risk of MASLD. Design: we systematically searched PubMed, Scopus and Web of Science from database inception to 31 January 2024, using predefined keywords to identify observational studies in which MASLD was diagnosed by liver biopsy, imaging or International Classification of Diseases codes. A meta-analysis was performed using random-effects modelling. Results: we identified 24 cross-sectional and 4 longitudinal studies with aggregate data on ∼76.5 million individuals. Primary hypothyroidism (defined as levothyroxine replacement treatment, subclinical hypothyroidism or overt hypothyroidism) was associated with an increased risk of prevalent MASLD (n=24 studies; random-effects OR 1.43, 95% CI 1.23 to 1.66; I 2=89%). Hypothyroidism was also associated with a substantially higher risk of metabolic dysfunction-associated steatohepatitis or advanced fibrosis (n=5 studies; random-effects OR 2.84, 95% CI 2.07 to 3.90; I 2=0%). Meta-analysis of data from four longitudinal studies showed that there was a marginally non-significant association between hypothyroidism and risk of developing MASLD over a median 4.5-year follow-up (random-effects HR 1.39, 95% CI 0.98 to 1.97; I 2=85%). Sensitivity analyses did not modify these findings. The funnel plot did not reveal any significant publication bias. Conclusion: this large and updated meta-analysis provides evidence that primary hypothyroidism is significantly associated with both an increased presence of and histological severity of MASLD.</p
Situation Awareness for Mobile Information Access in Heterogeneous Wireless Networks
No full textThe physical properties of the wireless communication channel imply a sharing
of the limited frequency spectrum among its users. Hence, the available
transportation capacity of wireless links is typically several orders of
magnitude below the capacity of comparable fixed wire connections. In
consequence, mobile users, accessing information by means of a hypertext
system, such as the world wide web, experience undesirable long waiting times
for requested documents.
This thesis' primary objective is the improvement of information access for
mobile users. The approach proposed and discussed in this thesis is partly
based on the assumption that mobile devices are increasingly equipped with
multiple wireless access technologies which facilitate the use of heterogeneous
wireless access networks, differing in parameters such as range, data-rate and
costs. Since some of these networks are deployed with partial coverage, a
user's mobility causes changes of the actual network conditions. Furthermore,
it is assumed that a particular user's scope of interest in information is
time-variant and depending on this user's actual situation. Advances in the
fields of ubiquitous and pervasive computing, particularly the work on context
sensors and observation of user interaction, render it feasible to derive
information on the user's context. In this thesis it is therefore proposed to
employ knowledge about the user's context and behavior, to pro-actively
transmit documents' data, especially during favorable network conditions, over
the wireless communication link, before the user requests the documents.
Human behavior, as observed from outside, is inherently probabilistic, despite
advances in sensor technology. Therefore a probabilistic model for the user
context is formulated. In order to distinguish this model from
non-probabilistic context models and context awareness, the terms ``situation
model'' and ``situation awareness'' are introduced. Since the concept of
situation awareness may as well be utilized for other applications, such as
handover decisions, pro-active computing or future user interfaces to search
engines, the situation model and its discussion is intentionally kept as
general as possible, in order to enable its application to various domains. The
properties of a situation model are analyzed from an information theoretic
viewpoint. This perspective is used later on to illustrate the selection of
suitable sensor data, based on metrics such as conditional entropy and mutual
information.
The task of obtaining and continuously adjusting suitable probabilities for the
model is formally treated as an estimation problem. Several estimators, such as
maximum likelihood (ML), minimum mean square error (MMSE), and maximum
a~posteriori (MAP) are discussed and related to Bayesian estimation.
Particularly, the temporal development of the estimation is investigated and
illustrated.
The concept of situation awareness is then applied to the prefetching of
documents in hypertext systems. A thorough analysis yields qualitative and
quantitative insights into the effects of situation aware prefetching on the
average waiting time and transported data volume. The necessity for the
assumption of a user policy is discussed and an optimum probability threshold
is derived.
The investigation of situation-aware prefetching is further extended by means
of simulations towards various mobile networking scenarios. For this purpose a
novel mobility model is developed and used in conjunction with models for
network topology and traffic to obtain insight into the influence of situation
aware prefetching in both heterogeneous and hybrid wireless networking
scenarios. Results of several simulations are discussed, showing the influence
of parameters such as document probabilities, probability thresholds or level
of network deployment. Simulation results show that significant reductions in
average waiting time are obtainable with the proposed concept.
Finally, implementation aspects of the proposed concept are addressed. A system
architecture for realizing situation-aware mobile information access in a
heterogeneous wireless access infrastructure is proposed. Integration aspects
as well as operational experiences obtained in an experimental testbed are
discussed.
The thesis concludes with a short summary of the achieved results and a brief
outlook to further research inspired by this work
Survival with aromatase inhibitors and inactivators versus standard hormonal therapy in advanced breast cancer: meta-analysis
No full textBACKGROUND: Aromatase inhibitors and inactivators have been extensively tested in patients with advanced breast cancer, but it is unclear whether they offer any survival benefits compared with standard hormonal treatment with tamoxifen or progestagens. We performed a meta-analysis of randomized controlled trials that compared several generations of aromatase inhibitors and inactivators with standard hormonal treatment in patients with advanced breast cancer. METHODS: The endpoint that we assessed was survival. Trials were located through searches of PubMed and Cochrane Library (last update March 2006). Relative hazards (RHs) were summarized across trials through fixed- and random-effects analyses, and heterogeneity was assessed with the Q and I2 statistics. All statistical tests were two-sided. RESULTS: Twenty-five different comparisons, with a total of 8504 patients, were included in the meta-analysis. We found statistically significant survival benefits with third-generation aromatase inhibitors and inactivators (vorozole, letrozole, examestane, and anastrazole) (RH = 0.87, 95% confidence interval [CI] = 0.82 to 0.93; P<.001) but not with first-generation (aminoglutethimide) or second-generation (formestane and fadrozole) agents. The difference in the summary effects between these two groups of trials was statistically significant (P = .04). The survival benefit with third-generation agents in first-line trials, in which these agents were compared with tamoxifen (11% RH reduction, 95% CI = 1% to 19%; P = .03), was identical to their benefit in second- and subsequent-line trials in which these agents were compared with other treatments (14% RH reduction, 95% CI = 6% to 21%; P<.001). CONCLUSIONS: Inhibition of the aromatase system, in particular with third-generation aromatase inhibitors and inactivators, appears to be associated with statistically significant improved survival of patients with advanced breast cancer compared with standard hormonal treatments.J Natl Cancer Ins
Effect of periodontal disease treatment during pregnancy on preterm birth incidence : a metaanalysis of randomized trials
No full textWe conducted a metaanalysis of randomized controlled trials to determine whether periodontal disease treatment with scaling and/or root planing during pregnancy may reduce preterm birth (PTB) or low birthweight (LBW) infant incidence. Treatment resulted in significantly lower PTB (odds ratio [OR], 0.55; 95% confidence interval [CI], 0.35-0.86; P = .008) and borderline significantly lower LBW (OR, 0.48; 95% CI, 0.23-1.00; P = .049), whereas no difference was found for spontaneous abortion/stillbirth (OR, 0.73; 95% CI, 0.41-1.31; P = .292). Subgroup analysis suggested significant effect of treatment in the absence of history of PTB or LBW (OR, 0.48; 95% CI, 0.29-0.77; P = .003) and less severe periodontal disease as defined by probing depth (OR, 0.49; 95% CI, 0.28-0.87; P = .014) or bleeding on probing site (OR, 0.37; 95% CI, 0.14-0.95; P = .04). If ongoing large and well-designed randomized trials support our results, we might need to reassess current practice or at least be cautious prior to rejecting treatment of periodontal disease with scaling and/or root planing during pregnancy
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