39 research outputs found
How much variation in oocyte yield after controlled ovarian stimulation can be explained? A multilevel modelling study
No full textStudy question: How much variation in COS response can be accounted for by known patient and treatment characteristics, and what are the implications for individualised stimulation protocols?Summary answer: There is substantial variation in the COS responses of similar women and in repeated COS episodes undertaken by the same woman, which cannot be accounted for at present. This suggests that there is likely to be limited scope for personalised treatment unless additional predictors of ovarian response can be identified.What is known already: The goal of individualized COS is to safely collect enough oocytes to maximise the chance of success in an ART cycle. Personalisation of treatment rests on the ability to reduce variation in response through modifiable factors. Study design, size, duration: Multilevel modelling of a routine ART database covering the period 1st October 2008 to 8th August 2012 was employed to estimate the amount of variation in COS response and the extent to which this could be explained by immutable patient characteristics and by manipulable treatment variables. 1851 treatment cycles undertaken by 1430 patients were included. The study was not subject to attrition, as cancelled cycles were included in the analysis.Participants/materials, setting, methods: Women of 21-43 years of age undergoing ovarian stimulation for IVF (possibly with ICSI) using their own eggs at the Reproductive Medicine Department of St Mary’s Hospital, Manchester, England.Main results and the role of chance: Substantial unexplained variation in COS response was observed (3.4-fold (95% CI: 3.12 to 3.61)). Only a relatively small amount of this variation (around 19%) can be explained by modifiable factors. A significant, previously undescribed predictor of response was the practitioner performing oocyte pickup, with 1.5 fold variation between surgeons with the highest and lowest yields. Limitations, reasons for caution: Although a large number of covariables were adjusted for in the analysis, including those that were used for dosing and determination of the stimulation regimen, this study is subject to confounding due to unmeasured variables and measurement error. Wider implications of the findings: The present study suggests that there are limits to the extent that COS response can be predicted on the basis of known factors, or controlled by manipulation of treatment factors. Moreover, modifiable variation in response appears to be partially attributable to differences between surgeons performing oocyte pick up. Consequently, consistent prevention of ineffective or unsafe responses is not likely to be possible at present. Our results highlight the importance of blinding surgeons in RCTs. Study funding/ competing interests: JW is funded by a Doctoral Research Fellowship from the National Institute for Health Research (DRF-2014-07-050) supervised by SAR. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health. JW is a statistical editor of the Cochrane Gynaecology and Fertility Group. SR is a statistical editor for Human Reproduction. JW also declares that publishing peer-reviewed articles benefits his career. ALM has received consultation fees fromfrom MSD, Merck Serono, Ferring, TEVA, Roche, Beckman Coulter.<br/
Antibacterial Therapy in the Treatment of Acute and Chronic Bronchitis
No full textAcute infections account for more than 90% of all respiratory tract diseases in childhood [1]. Despite the availability of practical recommendations on the use of antibacterial drugs in children in outpatient practice [2], drugs of this type are often prescribed unreasonably, and therefore the issues of their rational use in the treatment of respiratory tract infections remain relevant. Since up to 70% of acute respiratory infections are viral in nature, they do not require antibacterial therapy. This provision applies to both most diseases of the upper respiratory tract and acute bronchitis. Prescribing antibiotics for respiratory viral infection does not reduce the duration of treatment and the number of complications, and unjustified prescribing increases the risk of side effects, disrupts the biocenosis and contributes to the spreadof drug resistance.
Objective: to analyze the prescriptions of antibacterial drugs in the treatment of acute and chronic bronchitis
Antibacterial Therapy in the Treatment of Acute and Chronic Bronchitis
No full textAcute infections account for more than 90% of all respiratory tract diseases in childhood [1]. Despite the availability of practical recommendations on the use of antibacterial drugs in children in outpatient practice [2], drugs of this type are often prescribed unreasonably, and therefore the issues of their rational use in the treatment of respiratory tract infections remain relevant. Since up to 70% of acute respiratory infections are viral in nature, they do not require antibacterial therapy. This provision applies to both most diseases of the upper respiratory tract and acute bronchitis. Prescribing antibiotics for respiratory viral infection does not reduce the duration of treatment and the number of complications, and unjustified prescribing increases the risk of side effects, disrupts the biocenosis and contributes to the spreadof drug resistance.
Objective: to analyze the prescriptions of antibacterial drugs in the treatment of acute and chronic bronchitis
Scenario of Linguo – Cultural Essence of Verbs Expressing Behavior Peculiar to the Uzbeks
No full textThe author analyses lingua-cognitive and linguo-cultural essence of the verbs compiling the scenario of spiritual processes peculiar to the conduct of the Uzbeks. Here, the verbs compiling this scenario, based on systematic peculiarities in paradigmatic relations, go into syntagmatic relations, in expressing the very reality. The author also says that this condition creates instantaneous condition and this condition put them in order of a new system. In this order, the basis of verbs is stable lingua-cultural value. The author tries to prove that some verbs serve as direct unifiers of the events of a literary work
Effect of salpingectomy, ovarian cystectomy and unilateral salpingo-oopherectomy on ovarian reserve
No full textPelvic surgery can affect ovarian reserve, but estimates of the potential effect of different surgical procedures are lacking. This study examines the markers of ovarian reserve after different procedures in order to help the provision of informed consent before surgery. Anti-Müllerian hormone (AMH), antral follicle count (AFC) and follicle-stimulating hormone (FSH) of women with a history of salpingectomy, ovarian cystectomy or unilateral salpingo-oophorectomy were compared to those without history of surgery using cross-sectional data adjusting for patient and clinical factors in multivariable regression model. There were 138 women who had had salpingectomy, 36 unilateral salpingo-oopherectomy, 41 cystectomy for ovarian cysts that are other than endometrioma and 40 women had had excision of endometrioma. There was no significant difference in AMH (9 %; p = 0.33), AFC (-2 %; p = 0.59) or FSH (-14 %; p = 0.21) in women with a history of salpingectomy compared to women without surgery. Women with a history of unilateral salpingo-oophorectomy were found to have significantly lower AMH (-54 %; p = 0.001). These women also had lower AFC (-28 %; p = 0.34) and higher FSH (14 %; p = 0.06), the effect of which did not reach statistical significance. The study did not find any significant associations between a history of cystectomy, for disease other than endometrioma and AMH (7 %; p = 0.62), AFC (13 %; p = 0.18) or FSH. (11 %; p = 0.16). Women with a history of cystectomy for ovarian endometrioma had 66 % lower AMH (p = 0.002). Surgery for endometrioma did not significantly affect AFC (14 %; p = 0.22) or FSH (10 %; p = 0.28). Salpingo-oopherectomy and cystectomy for endometrioma cause a significant reduction in AMH levels. Neither salpingectomy nor cystectomy for cysts other than endometrioma has appreciable effects on ovarian reserve.</p
Emergence and Development of Traditional Singing Art
No full textIn this article, the emergence of traditional singing art, status art, folklore, works dedicated to the science of music during the Khanate period and their analysis, artists who created in the direction of traditional singing and their activities are detailed
Emergence and Development of Traditional Singing Art
No full textIn this article, the emergence of traditional singing art, status art, folklore, works dedicated to the science of music during the Khanate period and their analysis, artists who created in the direction of traditional singing and their activities are detailed
