Myo-inositol supplementation reduces the amount of gonadotropins and length of ovarian stimulation in women undergoing IVF: a systematic review and meta-analysis of randomized controlled trials

Purpose

To evaluate whether oral myo-inositol supplementation (MI) is able to reduce the amount of gonadotropins (GA) and the length of controlled ovarian hyperstimulation (SL) in both Polycystic Ovarian Syndrome (PCOS) and non-PCOS women undergoing in vitro fertilization (IVF).

Methods

We performed a systematic review (PROSPERO ID: CRD42017069439) of randomized controlled trials (RCTs). We searched articles published in English between January 1985 to August 2017, using the combination of the Medical Subject Headings “Inositol” with “Ovulation Induction”, “follicle-stimulating hormone, human, with HCG C-terminal peptide”, “Reproductive Techniques, Assisted”, and “Fertilization in Vitro”. We collected data about GA and SL comparing MI to no treatment or d-Chiro-Inositol (DCI) supplementation (controls). A subgroup analysis was performed to evaluate selected outcomes in PCOS and non-PCOS women.

Results

We included 8 studies embedding 812 participants. We found a reduction in GA (p?<?0.00001) and SL (p?=?0.0007) in patients receiving MI with respect to controls. MI was effective in both PCOS (p?<?0.00001) and non-PCOS women (p?=?0.02) in reducing GA; conversely, MI supplementation decreased the SL only in PCOS women (p?<?0.00001).

Conclusion

During IVF, MI is effective in both PCOS and non-PCOS women in saving gonadotropins, but reduces efficiently SL only in PCOS women.

     

Post space debridement in oval-shaped canals: the use of a new ultrasonic tip with oval section

This study evaluates the effect on post space debridement in oval-shaped canals of an experimental ultrasonic tip with oval section (Satelec) compared with a circular ultrasonic tip (KaVo). Thirty teeth with an oval-shaped canal were endodontically treated and obturated and then randomly divided into 3 groups (n = 10) according to the procedure used for post space debridement: Satelec tip, Largo #2 drill + KaVo file, and Largo #2 drill + water. Debris and dentin tubules were evaluated by assigning scores to scanning electron microscope post spaces images; lower scores corresponded to fewer debris and higher number of open tubules. The Satelec group showed significantly lower debris and open tubules scores than KaVo group (p < .05) and control group (p < .05), which differed significantly between each other (p < .05). Also the debris and open tubules scores in different post space regions differed significantly among the experimental groups (p < .001). The oval ultrasonic tip resulted in a better post space debridement than a circular ultrasonic tip in oval-shaped canals.     

Validity and reliability of body composition analysers in children and adults

We tested the validity and reliability of the BioSpace InBody 320, Omron and Bod-eComm body composition devices in men and women (n 254; 21-80 years) and boys and girls (n 117; 10-17 years). We analysed percentage body fat (%BF) and compared the results with dual-energy X-ray absorptiometry (DEXA) in adults and compared the results of the InBody with underwater weighing (UW) in children. All body composition devices were correlated (r 0.54-0.97; P< or =0.010) to DEXA except the Bod-eComm in women aged 71-80 years (r 0.54; P=0.106). In girls, the InBody %BF was correlated with UW (r 0.79; P< or =0.010); however, a more moderate correlation (r 0.69; P< or =0.010) existed in boys. Bland-Altman plots indicated that all body composition devices underestimated %BF in adults (1.0-4.8 %) and overestimated %BF in children (0.3-2.3 %). Lastly, independent t tests revealed that the mean %BF assessed by the Bod-eComm in women (aged 51-60 and 71-80 years) and in the Omron (age 18-35 years) were significantly different compared with DEXA (P< or =0.010). In men, the Omron (aged 18-35 years), and the InBody (aged 36-50 years) were significantly different compared with DEXA (P=0.025; P=0.040 respectively). In addition, independent t tests indicated that the InBody mean %BF in girls aged 10-17 years was significantly different from UW (P=0.001). Pearson's correlation analyses demonstrated that the Bod-eComm (men and women) and Omron (women) had significant mean differences compared with the reference criterion; therefore, the %BF output from these two devices should be interpreted with caution. The repeatability of each body composition device was supported by small CV (<3.0 %).     

Treatment of recurrent glioblastoma: can local delivery of mitoxantrone improve survival?

In this study, the records of 276 adult patients with recurrent glioblastoma (GBM) treated at recurrence at our institution between 2004 and 2006 were reviewed for progression-free survival (PFS), overall survival (OS), and toxicity. At recurrence, all patients underwent systemic treatment with temozolomide (200 mg/sqm on days 1–5 every 28 days) until tumor progression. Patients, whose tumor was judged resectable without risk of adjunctive neurological deficit, underwent a second surgery with or without positioning of a Rickam/Ommaya reservoir. The reservoir was used for locoregional chemotherapy with mitoxantrone. Two hundred seventy-six rGBL patients (pts) were divided into three subgroups: A 161 pts treated only with temozolomide, B 50 pts re-operated-on +temozolomide, and C 65 pts re-operated on + temozolomide + locoregional CHT. For group A, the 6 month PFS and 6 month survival (ST) were 39.3 and 43%, respectively, with a median survival time (mST) of 5 months (range 4–6) and 25% of pts alive at 9 months. For group B, the 6 month PFS and 6 month survivors were 64 and 74.1%, respectively, with a mST of 8 months (range 6–10) and 25% of pts alive at 12 months. For group C, the 6 month PFS and 6 month survivors were 70.7 and 87.7%, respectively, with a mST of 11 months (range 9–13) and 25% of pts alive at 18 months (A vs. B vs. C, log-rank P < 0.001) (B vs. C, P = 0.041) (A vs. B P = 0.009). Cox proportional hazard model was used to obtain Hazard Ratio (HR) for type of treatment corrected by age and time (in months) between diagnosis and first recurrence: second tumor debulking was statistically effective for survival, reducing by 36% the risk of death (HR = 0.64; 0.46–0.89), but the most significant favorable prognostic factor for survival was the local delivery of mitoxantrone which reduced the risk of death to 50% (HR = 0.50; 0.38–0.68).     

Interstitial Chemotherapy Plus Systemic Chemotherapy for Glioblastoma Patients: Improved Survival in Sequential Studies

We investigated the efficacy of 3 different systemic chemotherapy regimes in 122 patients with histologically confirmed glioblastoma, KPS>60, age<65. Locoregional chemotherapy was delivered to 22 patients from all three systemic chemotherapy groups. Chemotherapy was given before and during radiotherapy, which was the same for all patients consisting of unconventional fractionation with a break between courses.Survival (Kaplan–Meier) was significantly longer in the subgroup receiving cisplatinum plus BCNU compared to those receiving cisplatinum plus etoposide or carboplatinum plus BCNU with median survival time 21.5 months, 15 months and 15 months respectively (log rank test p=0.01). Survival was also significantly longer in patients who received locoregional therapy compared to those who received only systemic chemotherapy (21 vs 15 months, p=0.01). Univariate analysis showed that age, postoperative Karnofsky status and extent of resection were not predictive of survival in the series, although there were trends to better outcome in younger patients and those undergoing total/subtotal resection.Age, systemic chemotherapy type and interstitial treatment were included in a multivariate analysis, and both locoregional treatment and chemotherapy with cisplatinum plus BCNU were significantly predictive of survival [P=0.01]. These encouraging preliminary results suggest that further trials with locoregional and systemic therapy prior to radiotherapy are worth pursuing.     

Primary mantle-cell non-Hodgkin’s lymphoma of the tongue

The evaluation of tongue swellings often represents a diagnostic challenge, because of the wide spectrum of benign and malignant possible lesions. We report a case of a patient presenting a tongue mass. An incisional biopsy was performed. Diagnosis of primary Mantle Cell non-Hodgkin's Lymphoma of the tongue was made by histological, immunohistochemical and cytogenetic studies. Our patient was treated with Rituximab-Cyclophosphamide, Epirubicine, Vincristine, Prednisone polychemotherapy plus Rituximab as single agent maintenance. Complete remission was achieved and no relapse has occurred during a follow-up of 53 months. We emphasize the importance of including also NHL in differential diagnosis of a tongue mass.     

Neuroendocrine carcinoma of the colon with metastasis to the brain: a case report and review of the literature

The Authors report a case of a 71-year-old male with synchronous neuroendocrine colon carcinoma and a solitary brain metastasis. The patient was treated surgically with resection of both the cerebral and intestinal lesions followed by cerebral radiotherapy. A pulmonary metastasis was discovered after 3 months and treated with interferon and octreotide. No further cerebral or intestinal relapses were observed. The patient died of cardiac disease 11 months after the first operation. Central nervous system metastases from carcinoid tumours are rare. The reported survival in untreated cases or in cases treated by radiotherapy alone is 4 months. In the case reported, surgical resection of the cerebral and intestinal lesions followed by intracranial radiotherapy yielded complete local control of the disease and a slight improvement in survival.     

Incidence of atrial fibrillation in an Italian population followed by their GPs through a telecardiology service

BACKGROUND: Atrial fibrillation (AF) is the most common sustained cardiac tachyarrhythmia and is often an occasional diagnosis in the absence of known cardiac disease. The aim of this study is to describe an Italian patient population with AF followed by their General Practitioners (GPs) using a telecardiology service. METHODS: A total of 655 Italian GPs were equipped with a portable electrocardiographer. The ECG tracing of all consecutive patients (7516) received between January and September 2001 was included into the study. RESULTS: AF was detected in 719 patients (9.%) (77+/-12 years). In 448 patients, it was a known chronic condition, while in 271 patients, it was a new diagnosis. In the chronic AF, the principal reason for the teleconsultation was a routine control by the GPs, but an uncontrolled cardiac rate was present in 29% of the cases, while an antiplatelet or anticoagulation therapy was administered in only 46.2% cases. The teleconsultation alone provided a solution to the GPs' requests in 348 patients (77.6%) (154 cases (34.5%) required no further action while 194 patients (43.5%) needed therapy adjustments only), while 47 patients (10.5%) required hospitalization and 51 patients needed further diagnostic tests. In 271 cases, a first evidence of atrial fibrillation was recorded: in 259 patients, GPs requested a teleconsultation in the presence of symptoms (mainly palpitation, dyspnoea and fatigue) and in 12 for routine control; in this case, 121 patients (46.9%) needed Emergency Department (ED) admission, 113 patients (39.1%) needed therapy adjustments and, for 19 patients (7.5%), further diagnostic tests were prescribed. CONCLUSION: In Italy, many patients, in particular the elderly, with AF are followed by their GPs on a routine basis; a telecardiology service may provide a useful tool in the home management of chronic AF and in the first detection of new cases of AF.     

Application and advantages of monoenergetic reconstruction images for the reduction of metallic artifacts using dual-energy CT in knee and hip prostheses

Objective

The study aimed to assess image quality when using dual-energy CT (DECT) to reduce metal artifacts in subjects with knee and hip prostheses.

Methods

Twenty-two knee and 10 hip prostheses were examined in 31 patients using a DECT protocol (tube voltages 100 and 140 kVp). Monoenergetic reconstructions were extrapolated at 64, 69, 88, 105, 110, 120, 140, 170, and 190 kilo-electron volts (keV) and the optimal energy was manually selected. The B60–140 and Fast DE reconstructions were made by CT. The image quality and diagnostic value were subjectively and objectively determined. Double-blind qualitative assessment was performed by two radiologists using a Likert scale. For quantitative analysis, a circular region of interest (ROI) was placed by a third radiologist within the most evident streak artifacts on every image. Another ROI was placed in surrounding tissues without artifacts as a reference.

Results

The inter-reader agreement for the qualitative assessment was nearly 100%. The best overall image quality (37.8% rated “excellent”) was the Fast DE Siemens reconstruction, followed by B60–140 and Opt KeV (20.5 and 10.2% rated excellent). On the other hand, DECT images at 64, 69 and 88 keV had the worse scores. The number of artifacts was significantly different between monoenergetic images. Nevertheless, because of the high number of pairwise comparisons, no differences were found in the post hoc analysis except for a trend toward statistical significance when comparing the 170 and 64 keV doses.

Conclusions

DECT with specific post-processing may reduce metal artifacts and significantly enhance the image quality and diagnostic value when evaluating metallic implants.