A prospective randomized clinical trial comparing 150 IU and 225 IU of recombinant follicle-stimulating hormone (Gonal-F*) in a fixed-dose regimen for controlled ovarian stimulation in in vitro fertilization treatment

OBJECTIVE: To compare fixed daily doses of the recombinant FSH (rFSH) Gonal-F (150 IU vs. 225 IU) for ovarian stimulation in IVF-ET. DESIGN: Single-center prospective, randomized study. Assisted conception unit of a university hospital.One hundred twenty-four women aged 23-41 years participated in the study. Exclusion criteria were as follows: FSH of >10 IU/L, polycystic ovarian syndrome, one ovary or previous ovarian surgery, previous poor response to ovarian stimulation, or ovarian hyperstimulation syndrome (OHSS). INTERVENTION(S): Randomized to commence 150 IU or 225 IU of Gonal-F per day without dose alterations during treatment. MAIN OUTCOME MEASURE(S): Number of oocytes retrieved and total rFSH dose. RESULT(S): More oocytes were retrieved in women aged or=33 years), the number of oocytes retrieved in the two groups were similar. No significant differences were found for fertilization rate, number of embryos formed and cryopreserved, and pregnancy rates between the two groups. The total rFSH dose used was higher in the 225-IU group (2,595.0 +/- 510.0 vs. 1,897.5 +/- 457.5 IU). The cancellation rate due to insufficient ovarian response was higher in the 150-IU group (15.0% vs. 3.3%). All cases of ovarian hyperstimulation syndrome (n = 4) occurred in the 225-IU group. CONCLUSION(S): Two hundred twenty-five IU is more effective than 150 IU in younger women but requires a higher total dose of Gonal-F. The use of 225 IU in older women did not result in a higher oocyte yield, suggesting that 225 IU of rFSH does not compensate for the age-related decline in the number of follicles available for stimulation.     

Pseudomonas infection, allergy, and cystic fibrosis

The clinical significance of the high prevalence of positive immediate skin tests in cystic fibrosis is unclear. Using analysis of variance, we have tested the hypothesis that patients with allergic cystic fibrosis have worse lung disease than non-allergic patients. Clinical data, skin prick tests, total or specific IgE antibody levels, chest radiographs, and pulmonary function tests were obtained in 104 cystic fibrosis patients. Patients with positive immediate skin reactions to at least one allergen were more likely to be persistently colonised by Pseudomonas aeruginosa than skin test negative patients. The skin test positive patients were also significantly older (mean difference 2.15 years). Analysis of variance showed that pseudomonas infection was the most significant factor contributing to lung damage and the effect of allergy was not significant. Similar longitudinal analysis of pulmonary function over 5 years and study of the hospital admission rate showed that the only statistically significant factor associated with deterioration was colonisation with P. aeruginosa.     

Menstrual and reproductive risk factors for ischemic heart disease

The role of hormones in ischemic heart disease is of considerable interest, but limited data are available pertaining to risk factors associated with endogenous hormones. We examined the association between menstrual and reproductive factors and ischemic heart disease in a cohort of 867 white, college-educated women who prospectively recorded menstrual cycle data for at least 5 years from their early 20s through their menopause. Ischemic heart disease history was obtained from a self-administered (N = 714) or proxy-administered (N = 153) questionnaire completed at a mean age of 73 years. The analysis included 44,899 person-years of follow-up and 45 cases of myocardial infarction, angioplasty, heart bypass surgery, or ischemic heart disease-related mortality. Ischemic heart disease risk decreased with increasing age at menarche (age-adjusted RR 0.76 per year, 95% CI = 0.60-0.95). Considering menstrual cycle characteristics ages 28-32, there was little overall association with length, variability, or bleeding duration. Ischemic heart disease risk increased with later age at first birth (age-adjusted RR 2.90 for ages 33-43 compared with 25-29) and later age at last birth (age-adjusted RR 3.79 for ages > or =40 compared with 35-39), but there was little association with high parity.     

Chlorination of benzidine and other aromatic amines in aqueous environments

The fate of aniline,N,N-dimethylaniline and benzidine in chlorinated waters was investigated. Conditions were controlled to approximate the process chlorination of raw water supplies and wastewater secondary effluents. As the molar ratio, (Cl₂)/(amine), was increased, amine depletions increased and leveled off at about (Cl₂)/(amine)=1. Depletions in distilled water with ‘free’ chlorine were somewhat higher than those in activated sludge/secondary effluent with combined chlorine. For each amine the number and type of products appeared to be independent of the water matrix and the ratio, (Cl₂)/(amine). For the monophenyl amines ring chlorination was a significant depletion pathway. Extended chlorination of aniline yielded a precipitated product, while theN-substituted amine,N,N-dimethylaniline did not yield a solid product. In contrast to the monophenyl amines, when benzidine (p,p′-diaminobiphenyl) was exposed to chlorinated waters, a solid product resulted immediately. Infra-red analysis of this product indicated a polymeric structure with no ring chlorination. GLC analysis of the chlorination supernatant showed no ring substituted isomers of benzidine.     

Linkage replication of the MYP12 locus in common myopia

PURPOSE: Myopia is a common disorder with a large public health impact. Although 12 myopia loci have been reported and heterogeneity for high myopia loci have been demonstrated, replication of high-myopia loci with a common myopia phenotype has not been successful. This study reports the successful replication of MYP12 in three large, multigenerational families with autosomal dominant (AD) common myopia (spherical equivalent [SphE] 相似文献   

Emergency drugs in general practice

General practitioners need the knowledge, skills, drugs and equipment for managing medical emergencies. Clinics need treatment rooms and doctor's bags that enable emergencies to be managed onsite and offsite respectively. Rural medical generalists may provide more advanced emergency management in their local hospitals. In managing emergencies, GPs may be working with paramedics, therefore it helps to be familiar with their skills and with the drugs they carry.     

Loss of language in early development of autism and specific language impairment

Background: Several authors have highlighted areas of overlap in symptoms and impairment among children with autism spectrum disorder (ASD) and children with specific language impairment (SLI). By contrast, loss of language and broadly defined regression have been reported as relatively specific to autism. We compare the incidence of language loss and language progression of children with autism and SLI. Methods: We used two complementary studies: the Special Needs and Autism Project (SNAP) and the Manchester Language Study (MLS) involving children with SLI. This yielded a combined sample of 368 children (305 males and 63 females) assessed in late childhood for autism, history of language loss, epilepsy, language abilities and nonverbal IQ. Results: language loss occurred in just 1% of children with SLI but in 15% of children classified as having autism or autism spectrum disorder. Loss was more common among children with autism rather than milder ASD and is much less frequently reported when language development is delayed. For children who lost language skills before their first phrases, the phrased speech milestone was postponed but long‐term language skills were not significantly lower than children with autism but without loss. For the few who experienced language loss after acquiring phrased speech, subsequent cognitive performance is more uncertain. Conclusions: Language loss is highly specific to ASD. The underlying developmental abnormality may be more prevalent than raw data might suggest, its possible presence being hidden for children whose language development is delayed.     

Intravenous digital subtraction angiography of orbital and ocular circulation

In serial experiments on cats, intravenous digital subtraction angiography (DSA) was utilized to observe orbital and ocular circulation. Images of the orbital arterial system as well as normal ocular vasculature were obtained, utilizing dosage of contrast material acceptable for human study. Images obtained after intraarterial DSA had no advantage over those obtained with intravenous DSA. After retrobulbar injection of 3 ml of saline, intravenous DSA demonstrated straightening of the external ophthalmic arteries showing the potential of this method for identifying orbital vascular pathology.     

Preservation of reproductive potential in diethylstilbestrol-related vaginal adenocarcinoma

One consequence of vaginal adenocarcinoma in adolescents is the loss of reproductive potential. This report describes total removal of the vagina and of the vaginal portion of the cervix with an attached strip of bladder wall, together with bilateral extraperitoneal pelvic lymph adenectomy which allows preservation of reproductive potential. The woman, age 23, had had intrauterine exposure to stilbestrol and ethisterone. 2 factors affect the management of such cases: 1) removal of the primary tumor must be geographically clear in 3 dimensions, and 2) the incidence of pelvic lymph node metastasis is greater than that of comparable squamous cell lesions, indicating a need for lymphadenectomy. In this case menstruation was suppressed by medroxyprogesterone injection. Follow-up for a number of years is needed.     

Tear Histamine Levels in Vernal Conjunctivitis and Other Ocular Inflammations

Histamine levels were measured in tears from normal volunteers (geometric mean, 5 ng/ml), patients with vernal conjunctivitis (16 ng/ml), and patients with a wide variety of external ocular inflammatory disease (3 ng/ml). Histamine levels were significantly higher in patients with vernal conjunctivitis than in normal subjects (P < 0.01) or patients with other types of ocular inflammation (P < 0.001). We postulate that histamine is an important mediator in the expression of the inflammatory response in vernal conjunctivitis, and that its elevation may be caused by abnormalities in the number of mast cells, the stability of the mast cells or in the system that regulates histamine.