Modified natural cycle IVF versus conventional stimulation in advanced-age Bologna poor responders

Research questionDo ongoing pregnancy rates (OPR) differ between modified natural cycle IVF (MNC-IVF) and conventional high-dose ovarian stimulation (HDOS) in advanced-age Bologna poor responders?DesignThis was a retrospective cohort study including patients with poor ovarian response (POR) attending a tertiary referral university hospital from 1 January 2011 to 1 March 2017. All women who fulfilled the Bologna criteria for POR and aged ≥40 years who underwent their first intracytoplasmic sperm injection (ICSI) cycle in the study centre were included.ResultsIn total, 476 advanced-age Bologna poor responder patients were included in the study: 189 in the MNC-IVF group and 287 in the HDOS group. OPR per patient were significantly lower in the MNC-IVF group (5/189, 2.6%) compared with the HDOS group (29/287, 10.1%) (P = 0.002). However, after adjustment for relevant confounders (number of oocytes and presence of at least one top-quality embryo), the multivariate logistic regression analysis showed that the type of treatment strategy (HDOS versus MNC-IVF) was not significantly associated with OPR (odds ratio 2.56, 95% confidence interval 0.9–7.6).ConclusionsIn advanced-age Bologna poor responders, MNC-IVF, which is a more patient-friendly approach, could be a reasonable alternative in this difficult-to-treat group of women.     

Changing approaches in women's health: new insights and new pitfalls in prenatal preventive care

In this article, we contend that the standard definition of risk factors in pregnancy is not the neutral or technical process that women may assume it to be, but is colored by the prejudice of its context: a capitalist and patriarchal society. In such a society, only paid work is valued, and thus there is little study of the ill effects of housework on pregnant women; such a study would mean considering and possibly changing our sex-biased division of labor. Physicians and the mass media stress risk factors such as smoking, while omitting to mention that drugs prescribed by doctors are not always safe, and some are prescribed for years before-and even after-their harmful effects are known. Further examples are given from the field of childbirth, and we advance the hypothesis that, especially in fee-for-service medical systems, the physician can represent a risk factor. "Information" is often offered as the solution for pregnancy risks, the responsibility for this being the woman's. The mystification and narrowness of such a victim-blaming approach are evident. The key factor in prenatal preventive care is the mother's level of education: to admit this would be to acknowledge the need for change of a social system that keeps women in ignorance. We point out the limitations of the proposed individualistic solutions and conclude that, in redefining risk factors for women and their babies, we must analyze our society in feminist terms and in terms of social class.     

Biometric study of furcation area of first maxillary molars

The present investigation was designed to study the distance from the 3 bifurcation entrances to their opposite roots, and also the virtual center of the trifurcation (TC), which is equidistant from each bifurcation entrance, of maxillary molars. Thirty-five teeth devoid of any surface damage or fused roots were selected. Roots were included in acrylic resin and cross-sectioned at the cementoenamel junction to the apex using a rotary diamond blade and 0.45-mm slices were obtained. A profile projector apparatus was used to obtain the coordinated points on a Cartesian plane, which allowed the calculation of all distances present using analytic geometric formulas. Based on statistical analysis (comparison by Kruskal-Wallis ANOVA test, p<0.05), the following results were obtained: 1) mean distance from the buccal furcation reaching the palatal root was 6.72 +/- 0.99 mm (range 4.73-8.67 mm); 2) mean distance from the mesial and distal furcations to the distal and mesial roots were 5.42 +/- 0.83 mm (range 3.78-7.07 mm) and 5.90 +/- 0.87 mm (range 4.18-7.59 mm), respectively. All means were determined up to the point of 1.40 mm from each bifurcation opening; 3) mean distance of TC was 4.26 +/- 0.42 mm (range 3.44-5.08 mm) for all levels.     

Effects of COVID-19 on Parkinson's Disease Clinical Features: A Community-Based Case-Control Study

The impact of coronavirus disease 2019 (COVID-19) on clinical features of Parkinson's disease (PD) has been poorly characterized so far. Of 141 PD patients resident in Lombardy, we found 12 COVID-19 cases (8.5%), whose mean age and disease duration (65.5 and 6.3 years, respectively) were similar to controls. Changes in clinical features in the period January 2020 to April 2020 were compared with those of 36 PD controls matched for sex, age, and disease duration using the clinical impression of severity index for PD, the Movement Disorders Society Unified PD Rating Scale Parts II and IV, and the nonmotor symptoms scale. Motor and nonmotor symptoms significantly worsened in the COVID-19 group, requiring therapy adjustment in one third of cases. Clinical deterioration was explained by both infection-related mechanisms and impaired pharmacokinetics of dopaminergic therapy. Urinary issues and fatigue were the most prominent nonmotor issues. Cognitive functions were marginally involved, whereas none experienced autonomic failure. © 2020 International Parkinson and Movement Disorder Society     

Adjuvant chemotherapy with epirubicin, leucovorin, 5-fluorouracil and etoposide regimen in resected gastric cancer patients: a randomized phase III trial by the Gruppo Oncologico Italia Meridionale (GOIM 9602 Study).

BACKGROUND: This randomized, multicenter, phase III trial evaluated the efficacy and safety of the combination of epirubicin, leucovorin, 5-fluorouracil and etoposide (ELFE regimen) as adjuvant therapy for radically resected gastric cancer patients. PATIENTS AND METHODS: From June 1996 to June 2001, 228 stage IB-IIIB gastric cancer patients were enrolled. All patients received a total or subtotal gastrectomy with at least a D1 lymphoadenectomy and were randomly assigned to receive surgery alone or surgery followed by chemotherapy. RESULTS: A total number of 630 cycles was delivered with a median number of 5. With a median follow-up of 60 months, the 5-year overall survival (OS) was 48% in the treatment arm and 43.5% in the control arm [hazard ratio (HR) 0.91; 95% confidence interval (CI) 0.69-1.21; P = 0.610); the 5-year disease-free survival (DFS) was 44% in the treatment arm and 39% in the control arm (HR 0.88; 95% CI 0.78-0.91; P = 0.305). In node-positive patients, the 5-year OS was 41% in the treatment arm and 34% in the control arm (HR 0.84; 95% CI 0.69-1.01; P = 0.068), while the 5-year DFS was 39% in the treatment arm and 31% in the control arm (HR 0.88; 95% CI 0.78-0.91; P = 0.051). The most common grade 3-4 toxic effects according to World Health Organization criteria were hematological and gastrointestinal. CONCLUSIONS: In radically resected gastric cancer patients, adjuvant chemotherapy with ELFE regimen does not improve OS over surgery alone.     

Blood brain barrier impairment is associated with cerebrospinal fluid markers of neuronal damage in HIV-positive patients

Blood brain barrier impairment occurs early in the course of infection by HIV and it may persist in a subset of patients despite effective antiretroviral treatment. We tested the hypothesis that HIV-positive patients with dysfunctional blood brain barrier may have altered biomarkers of neuronal damage. In adult HIV-positive highly active antiretroviral treatment (HAART)-treated patients (without central nervous system infections and undergoing lumbar punctures for clinical reasons) cerebrospinal fluid albumin to serum ratios (CSAR), total tau, phosphorylated tau, 1–42 beta amyloid, and neopterin were measured. In 101 adult patients, cerebrospinal fluid-to-serum albumin ratios were 4.8 (3.7–6.1) with 12 patients (11.9 %) presenting age-defined impaired blood brain barrier. A significant correlation was observed between CSAR and total tau (p?=?0.005), phosphorylated tau (p?=?0.008), and 1–42 beta amyloid (p?=?0.040). Patients with impaired blood brain barrier showed significantly higher total tau (201.6 vs. 87.3 pg/mL, p?=?0.010), phosphorylated tau (35.3 vs. 32.1 ng/mL, p?=?0.035), and 1–42 beta amyloid (1134 vs. 830 pg/mL, p?=?0.045). Despite effective antiretroviral treatment, blood brain barrier impairment persists in some HIV-positive patients: it is associated with markers of neuronal damage and it was not associated with CSF neopterin concentrations.