Live Birth Rate after Surgical and Expectant Management of Endometriomas after In Vitro Fertilization: A Systematic Review,Meta-Analysis,and Critical Appraisal of Current Guidelines and Previous Meta-Analyses

Controversy exists regarding surgical management of endometriomas in infertile women before in vitro fertilization (IVF) because growing evidence indicates that surgery may impair the ovarian response. The objective of the present systematic review and meta-analysis was to compare surgical and expectant management of endometriomas regarding IVF outcomes. Prospective and retrospective controlled studies were found via the Cochrane Library, Embase, and MEDLINE databases. Thirteen studies (1 randomized controlled trial and 12 observational studies, N?=?2878) were pooled, and similar live birth rates were observed in the surgically and expectantly managed groups (odds ratio?=?0.83; 95% confidence interval [CI], 0.56–1.22; p?=?.98). The clinical pregnancy rates (odds ratio?=?0.83; 95% CI, 0.66–1.05; p?=?.86), the number of mature oocytes retrieved, and the miscarriage rates were not statistically different between study groups. However, the total number of oocytes retrieved was lower in the surgery group (mean difference?=??1.51; 95% CI, ?2.60 to ?0.43; p?=?.02). Findings suggest that surgical management of endometriomas before IVF therapy yields similar live birth rates as expectant management. However, future properly designed randomized controlled trials are warranted.     

Hysterosalpingosonography Is Not as Effective as Hysterosalpingography to Increase Chances of Pregnancy

Objective

This study sought to examine whether hysterosalpingosonography (sono-HSG) is as effective as hysterosalpingography (HSG) in facilitating conception by comparing pregnancy rates in the 6 months following the procedures.

Testing and improving experimental parameters for the use of low molecular weight targets in array-CGH experiments

Array-comparative genomic hybridization (CGH) has evolved as a useful technique for the detection and characterization of deletions, and, to a lesser extent, of duplications. The resolution of the technique is dictated by the genomic distance between targets spotted on the microarray, and by the targets' sizes. The use of region-specific, high-resolution microarrays is a specific goal when studying regions that are prone to rearrangements, such as those involved in deletion syndromes. The aim of the present study was to evaluate the best experimental conditions to be used for array-CGH analysis using low molecular weight (LMW) targets. The parameters tested were: the target concentration, the way LMW targets are prepared (either as linearized plasmids or as purified PCR products), and the way the targets are attached to the array-CGH slide (in a random fashion on amino-silane coated slides, or by one amino-modified end on epoxysilane-coated slides). As a test case, we constructed a microarray harboring LMW targets located in the CREBBP gene, mutations of which cause the Rubinstein-Taybi syndrome (RTS). From 10 to 15% of RTS patients have a CREBBP deletion. We showed that aminosilane- and epoxysilane-coated slides were equally efficient with targets above 1,000 bp in size. On the other hand, with the smallest targets, especially those below 500 bp, epoxysilane-coated slides were superior to aminosilane-coated slides, which did not allow deletion detection. Use of the high resolution array allowed us to map intragenic breakpoints with precision and to identify a very small deletion and a duplication that were not detected by the currently available techniques for finding CREBBP deletions.     

Identification and in silico analyses of novel TGFBR1 and TGFBR2 mutations in Marfan syndrome-related disorders

Very recently, heterozygous mutations in the genes encoding transforming growth factor beta receptors I (TGFBR1) and II (TGFBR2) have been reported in Loeys-Dietz aortic aneurysm syndrome (LDS). In addition, dominant TGFBR2 mutations have been identified in Marfan syndrome type 2 (MFS2) and familial thoracic aortic aneurysms and dissections (TAAD). In the past, mutations of these genes were associated with atherosclerosis and several human cancers. Here, we report a total of nine novel and one known heterozygous sequence variants in the TGFBR1 and TGFBR2 genes in nine of 70 unrelated individuals with MFS-like phenotypes who previously tested negative for mutations in the gene encoding the extracellular matrix protein fibrillin-1 (FBN1). To assess the pathogenic impact of these sequence variants, in silico analyses were performed by the PolyPhen, SIFT, and Fold-X algorithms and by means of a 3D homology model of the TGFBR2 kinase domain. Our results showed that in all but one of the patients the pathogenic effect of at least one sequence variant is highly probable (c.722C > T, c.799A > C, and c.1460G > A in TGFBR1 and c.773T > G, c.1106G > T, c.1159G > A, c.1181G > A, and c.1561T > C in TGFBR2). These deleterious alleles occurred de novo or segregated with the disease in the families, indicating a causative association between the sequence variants and clinical phenotypes. Since TGFBR2 mutations found in patients with MFS-related disorders cannot be distinguished from heterozygous TGFBR2 mutations reported in tumor samples, we emphasize the importance of segregation analysis in affected families. In order to be able to find the mutation that is indeed responsible for a MFS-related phenotype, we also propose that genetic testing for sequence alterations in TGFBR1 and TGFBR2 should be complemented by mutation screening of the FBN1 gene.     

Sonographic Findings and Clinical Outcomes in Women With Massive Subchorionic Hematoma Detected in the Second Trimester

BackgroundSmall hematomas on the placental surface, termed subamniotic hemorrhage, are a common finding either at the routine 18- to 20-week anatomy ultrasound or at subsequent assessments of fetal growth and well-being. Hemorrhage beneath or at the edge of the placenta, or behind an isolated area of the fetal membranes, is of greater concern.The CasesWe describe the ultrasound findings and clinical outcomes in two women with a diagnosis of massive intrauterine hematoma arising from the fetal membranes. Both required blood transfusion because of the extent of concealed and revealed bleeding. In each case the initial placental appearances and uterine artery Doppler studies were normal. Both hematomas resolved with growth of the fetus and amniotic sac. Each neonate survived the perinatal period favourably. One was born vaginally at 32 weeks’ gestation following premature preterm rupture of the membranes, and the second was born by emergency Caesarean section at 37 weeks because of a recurrence of antepartum hemorrhage.ConclusionsLarge intrauterine hematomas may be acutely detrimental to maternal health in the second trimester. Ultrasound assessment of the placenta is useful to define the perinatal prognosis and may demonstrate gradual resolution. Despite a dramatic initial presentation, this finding may be compatible with a favourable outcome.     

THE EFFECT OF CULTURAL FACTORS ON DAILY COPING AND INVOLUNTARY RESPONSES TO STRESS AMONG LOW‐INCOME LATINO ADOLESCENTS

This study used daily diary methodology to examine associations between cultural factors and daily coping and responses to stress among predominantly low‐income Latino adolescents. A total of 58 middle school students (53% male, mean age = 13.31, 95% Latino) completed baseline measures assessing demographic characteristics, familism, ethnic identity, and family ethnic socialization. They subsequently completed 7 consecutive daily diaries assessing daily stress, coping, and involuntary stress responses. Results yielded main effects of stress, gender, familism, and ethnic identity on adolescents’ coping and involuntary stress responses. In addition, interactions between stress and familism, ethnic identity, and family ethnic socialization emerged. Results suggest that familism may promote adaptive responses to stress, while adolescents who report more family ethnic socialization may rely more on maladaptive responses at high levels of stress. Findings related to ethnic identity were mixed and varied depending on levels of ethnic identity exploration versus commitment.     

High frequency of precancerous lesions of gastric cancer associated with Helicobacter pylori and response to treatment,in Chiapas,Mexico

Stomach cancer is the second cause of death in Mexico in patients with malignant tumors. This disease represents a public health problem. A strong association has been described between chronic infection with Helicobacter pylori and gastric cancer. This malignancy is preceded by a series of preneoplastic conditions, including chronic atrophic gastritis (CAG), intestinal metaplasia (IM), and dysplasia. The objective of this study was to establish the prevalence of preneoplastic conditions associated with infection of Helicobacter pylori in the state of Chiapas and its eradication with antibiotics. Persons infected with Helicobacter pylori and with CAG were identified by serology against CagA protein and serologic levels of gastrin. An endoscopy with biopsy was performed at the beginning of the study, and at 6 weeks and 1 year thereafter. A total of 281 people were enrolled and randomly assigned to treatment or placebo group. CAG was found in 59%, IM in 51%, and dysplasia in 13%. In intent-to-treat and per-protocol analysis, Helicobacter pylori was eliminated in 70 and 76%, respectively. These results indicate high frequency of preneoplastic conditions associated with Helicobacter pylori and an excellent eradication rate. They also offer a possible alternative for preventing gastric cancer.