Does previous response to clomifene citrate influence the selection of gonadotropin dosage given in subsequent superovulation treatment cycles?

PURPOSE: To determine whether ovarian response to previous clomifene treatment could influence the selection of the starting dose of gonadotropins in subsequent in vitro fertilization (IVF) or intra uterine insemination (IUI). METHODS: Forty three anovular women who had received clomifene for ovulation induction followed by gonadotropins for IUI or IVF superovulation were reviewed retrospectively. Data on gonadotropin dose were compared between clomifene-resistant patients and clomifene responders. RESULTS: IVF patients who had had prior superovulation/IUI treatment received similar doses of gonadotropins regardless of response to clomifene (1610 IU versus 1560 IU, p = 0.74). In IVF patients not receiving prior IUI treatment, the clomifene-resistant women were given higher doses of gonadotropins than those responding to clomifene (2500 IU versus 1440 IU, p = 0.042). CONCLUSIONS: We found that, in our Unit, clinicians appeared to use prior non-response to clomifene as a reason for prescribing a higher starting dose of gonadotropins in IVF treatment, a practice that is not evidence-based.     

Longitudinal diffusion tensor imaging changes in early Parkinson’s disease: ICICLE-PD study

Objective

To investigate whether white matter microstructural changes can be used as a predictor of worsening of motor features or cognitive decline in patients with Parkinson’s disease and verify whether white matter microstructural longitudinal changes differ between patients with Parkinson’s disease with normal cognition and those with mild cognitive impairment.

Methods

We enrolled 120 newly diagnosed patients with early stage Parkinson’s disease (27 with mild cognitive impairment and 93 with normal cognition) along with 48 controls. Participants were part of the incidence of cognitive impairment in cohorts with longitudinal evaluation in Parkinson’s disease study and were assessed at baseline and 18 months later with cognitive, motor tests and diffusion tensor imaging. The relationships between fractional anisotropy and mean diffusivity with disease status, cognitive and motor function were investigated.

Results

At baseline, patients with early stage Parkinson’s disease had significantly higher widespread mean diffusivity relative to controls, regardless of cognitive status. In patients with Parkinson’s disease/mild cognitive impairment, higher mean diffusivity was significantly correlated with lower attention and executive function scores. At follow-up frontal mean diffusivity increased significantly when comparing patients with Parkinson’s disease/mild cognitive impairment with those with normal cognition. Baseline mean diffusivity was a significant predictor of worsening of motor features in Parkinson’s disease.

Conclusions

Mean diffusivity represents an important correlate of cognitive function and predictor of motor impairment in Parkinson’s disease: DTI is potentially a useful tool in stratification of patients into clinical trials and to monitor the impact of treatment on motor function.

     

Genetic variants of interferon regulatory factor 5 associated with chronic hepatitis B infection

AIM To investigate possible effects of IRF5 polymorphisms in the 3' UTR region of the IFR5 locus on susceptibilityto hepatitis B virus(HBV) infection and progression of liver diseases among clinically classified Vietnamese patients.METHODS Four IFR5 SNPs(rs13242262 A/T, rs77416878 C/T, rs10488630 A/G, and rs2280714 T/C) were genotyped in clinically classified HBV patients [chronic hepatitis B(CHB). n = 99; liver cirrhosis(LC), n = 131; hepatocellular carcinoma(HCC), n = 149] and in 242 healthy controls by direct sequencing and Taq Man realtime PCR assays. RESULTS Comparing patients and controls, no significant association was observed for the four IFR5 variants. However, the alleles rs13242262 T and rs10488630 G contributed to an increased risk of liver cirrhosis(LC vs CHB: OR = 1.5, 95%CI: 1.1-2.3, adjusted P = 0.04; LC vs CHB: OR = 1.7, 95%CI: 1.1-2.6, adjusted P = 0.019). Haplotype IRF5*TCGT constructed from 4 SNPs was observed frequently in LC compared to CHB patients(OR = 2.1, 95%CI: 1.2-3.3, adjusted P = 0.008). Haplotype IRF5*TCAT occurred rather among CHB patients than in the other HBV patient groups(LC vs CHB: OR = 0.4, 95%CI: 0.2-0.8, adjusted P = 0.03; HCC vs CHB: OR = 0.3, 95%CI: 0.15-0.7, adjusted P = 0.003). The IRF5*TCAT haplotype was also associated with increased levels of ALT, AST and bilirubin. CONCLUSION Our study shows that IFR5 variants may contribute as a host factor in determining the pathogenesis in chronic HBV infections.     

Lens opacity and refractive influences on the measurement of retinal vascular fractal dimension

Acta Ophthalmol. 2010: 88: e234–e240

Abstract.

Purpose: To examine the influence of lens opacity and refraction on the measurement of retinal vascular fractal dimension (Df). Methods: Optic disc photographs (right eyes) of 3654 baseline Blue Mountains Eye Study participants (aged 49–97 ) were digitized. Retinal vascular Df was quantified using a computer‐based program. Summated severity scores for nuclear, cortical and posterior subcapsular (PSC) cataract were assessed from lens photographs. Refraction data were converted to spherical equivalent refraction (SER), as sum spherical plus 0.5 cylinder power. Axial length was measured at 10‐year follow‐up examinations using an IOL master. Results: Mean Df of the retinal vasculature was 1.444 ± 0.023 for 2859 eligible participants. Increasing lens opacity scores were associated with significant reduction in Df (β = ?0.0030, p < 0.0001). Both cortical and PSC cataract involving central lens area were associated with reduced Df, after controlling for confounding factors (p_trend ≤ 0.0105). Increasing myopia severity was associated with reduced Df after adjusting for lens opacity scores and other confounders (p_trend < 0.0001). The slope of Df decrease per SER reduction was 0.0040 in eyes with SER ≤ ?4D, compared to ?0.0016 in eyes with SER > ?4D. For axial length quintiles, there were no significant differences in mean Df in all groups except a reduction in the fifth quintile (axial length ≥24.15 mm) (all p < 0.05). Conclusion: Ocular media opacity independently influenced retinal vascular Df measurement, but we found no evidence supporting any refractive axial magnification effect on this measure. Myopic refraction ≤?4D was associated with a reduction in Df, suggesting rarefaction of retinal vasculature associated with high myopia.     

In vivo evidence of duality effects for lovastatin in a nude mouse cancer model

Statins, hydroxy‐methyl‐glutaryl coenzyme A reductase inhibitors, are the most effective medication for lowering cholesterol, cardiovascular morbidity and mortality. On the basis of our previous in vitro experimental results on an anaplastic thyroid cancer cell line, we designed a nude mouse model in which cancer cells were seeded subcutaneously to examine the potential anticancer effects of lovastatin in vivo. As expected, tumor growth was significantly reduced in the mice treated with 5 or 10 mg/kg/day of lovastatin compared with the positive control group. However, the tumor grew much faster in the mice treated with 1 mg/kg/day of lovastatin than in the positive control group. We suspect this result might be related to vascular endothelial growth factor. In this model, we found that lovastatin inhibits tumor growth at a high dosage (5 or 10 mg/kg/day), suggesting it could be used as an effectively adjuvant chemotherapy for cancer. However, it also promotes tumor growth at a low dosage (1 mg/kg/day). This duality effect should be further studied for patients treated with various dosages of statins.     

Tailored education enhances healthy behaviour self‐efficacy in childhood cancer survivors: A randomised controlled study with a 4‐month follow‐up

This study was to evaluate the acceptability and effectiveness of a tailored education on healthy behaviour self‐efficacy (HBSE) and health promotion lifestyle (HPL) for childhood cancer survivors. A two‐group, randomised study with repeated measures was conducted in Taiwan. Participants were randomly assigned to receive six 45–60 min individual education and follow‐up telephone counselling sessions (n = 34) or standard of care only (n = 35). Each participant was assessed with HBSE and HPL questionnaires and was evaluated at three time points (at baseline, and then 1 and 4 months after intervention). The attrition rate was 7.2%. HBSE and HPL scores increased across the three time points in the experimental group (all p < 0.05), except for the HBSE exercise subscale (p = 0.85). HBSE scores were significantly higher for the experimental group than for the control group after 4 months of intervention (F = 5.32, p = 0.02, η² = 0.25). No significant improvements in HBSE were observed over time in the control group. The intervention was acceptable and effective in promoting HBSE in childhood cancer survivors. Further empirical work is needed to reveal the effects of the intervention over a longer period of time and to improve patient engagement in exercise.