Extended culture of poor-quality supernumerary embryos improves ART outcomes

Purpose

The aims of this study were to investigate the possible benefits of extending the culture of poor-quality day-2 embryos (PQE) versus good-quality embryos (GQE) and to identify factors associated with pregnancy and live birth when transferring frozen-thawed blastocysts originating from GQE and PQE.

Methods

This is a retrospective cohort follow-up study performed between November 2012 and February 2015 at the IVF Laboratory Unit of Cochin University Hospital (Paris, France) including 3108 day-2 supernumerary embryos resulting from 1237 IVF/ICSI cycles.

Results

Total blastulation rate was 67.2% from GQE and 48.7% from PQE. Percentage of good-quality blastocysts was 60.7 and 47.9% respectively including 14.7 and 7.3% top-quality blastocysts. A total of 150 blastocysts originating from GQE and 729 from PQE were frozen, and then, 37 and 164 were thawed and transferred respectively resulting in 19 (51.4%) and 61 (37.9%) clinical pregnancies with 13 (35.1%) deliveries from GQE and 32 (19.9%) from PQE (p = 0.046) without any difference in neonatal outcomes. Quality of blastocysts that resulted in live birth was similar in the two groups. Women < 35 years old and day-5 blastocyst expansion were predictive of pregnancy and live birth.

Conclusions

(i) PQE are able to reach the blastocyst stage, to implant, and to give healthy babies and (ii) women age and day of blastocyst expansion are predictive of pregnancy and live birth.

     

Toll‐like receptors as novel therapeutic targets for herpes simplex virus infection

Seropositivity for HSV reaches more than 70% within the world population, and yet no approved vaccine exists. While HSV1 is responsible for keratitis, encephalitis, and labialis, HSV2 carriers have a high susceptibility to other STD infections, such as HIV. Induction of antiviral innate immune responses upon infection depends on a family of pattern recognition receptors called Toll‐like receptors (TLR). TLRs bridge innate and adaptive immunity by sensing virus infection and activating antiviral immune responses. HSV adopts smart tricks to evade innate immunity and can also manipulate TLR signaling to evade the immune system or even confer destructive effects in favor of virus replication. Here, we review mechanisms by which HSV can trick TLR signaling to impair innate immunity. Then, we analyze the role of HSV‐mediated molecular cues, in particular, NF‐κB signaling, in promoting protective versus destructive effects of TLRs. Finally, TLR‐based therapeutic opportunities with the goal of preventing or treating HSV infection will be discussed.     

Development of innate immunity in chicken embryos and newly hatched chicks: a disease control perspective

Newly hatched chickens are confronted by a wide array of pathogenic microbes because their adaptive immune defences have limited capabilities to control these pathogens. In such circumstances, and within this age group, innate responses provide a degree of protection. Moreover, as the adaptive immune system is relatively naïve to foreign antigens, synergy with innate defences is critical. This review presents knowledge on the ontogeny of innate immunity in chickens pre-hatch and early post-hatch and provides insights into possible interventions to modulate innate responses early in the life of the bird. As in other vertebrate species, the chicken innate immune system which include cellular mediators, cytokine and chemokine repertoires and molecules involved in antigen detection, develop early in life. Comparison of innate immune systems in newly hatched chickens and mature birds has revealed differences in magnitude and quality, but responses in younger chickens can be boosted using innate immune system modulators. Functional expression of pattern recognition receptors and several defence molecules by innate immune system cells of embryos and newly hatched chicks suggests that innate responses can be modulated at this stage of development to combat pathogens. Improved understanding of innate immune system ontogeny and functionality in chickens is critical for the implementation of sound and safe interventions to provide long-term protection against pathogens. Next-generation tools for studying genetic and epigenetic regulation of genes, functional metagenomics and gene knockouts can be used in the future to explore and dissect the contributions of signalling pathways of innate immunity and to devise more efficacious disease control strategies.     

Evaluation of stool antigen test for Helicobacter pylori infection in asymptomatic children from a developing country using 13C-urea breath test as a standard

OBJECTIVE: Prevalence of asymptomatic Helicobacter pylori infection is very high in infants and children in developing countries. C urea breath test (UBT) is a reliable non-invasive diagnostic test for H. pylori infection in children that avoids invasive endoscopy. We compared a newly introduced H. pylori stool antigen test (with a high sensitivity and specificity in symptomatic children) with UBT in asymptomatic children mostly 1-5 years old, from a population with a high prevalence of infection. METHOD: Eighty six asymptomatic children (42 boys and 44 girls) were tested for H. pylori infection using the UBT and a stool antigen test (HpSA) based on a sandwich enzyme immunoassay for antigen detection. RESULTS: Forty five of the eighty-six (52.3%) children tested positive for H. pylori using the breath test. In 34 of these forty-five children, H. pylori antigen was detected in stool (sensitivity = 75.6%, 95% CI = 63 to 88%). Of the 50 of 86 (58%) children positive by HpSA test, 34 were positive for breath test. Of the 41 children with negative UBT test 25 were negative for stool antigen test (specificity = 61%, 95% CI = 46 to 76%). CONCLUSION: The sensitivity and specificity of the new stool antigen test are lower in asymptomatic children with high H. pylori prevalence rate compared to those reported for children with gastrointestinal symptoms. Its usefulness is limited for diagnosis in an asymptomatic child with H. pylori infection.     

Vascular Impairment of Erection in Patients with Diabetes and Peyronie's Disease: Is that Accumulative?

IntroductionThe vascular impairment of erection has been shown in diabetic patients as well as in patients with Peyronie's disease (PD). However, the impact of both conditions together on vascular impairment has not been well addressed.AimThe aim of this study was to assess the impact of type 2 diabetes mellitus (DM) and PD solely, and together, on impairment of vascular status of erection in patients with erectile dysfunction (ED).MethodsThree hundred four male patients with a clinical diagnosis of ED who visited our Andrology clinic and who had DM and/or PD were enrolled in this study. Of the patients, 214, 28, and 62 had DM, PD, and both DM and PD, respectively. Patients were interviewed for ED using the International Index of Erectile Function. All patients were also interviewed for sociodemographic data and medical comorbidities including DM. The diagnosis of PD was based on a palpable penile plaque or acquired penile curvature. Color Doppler ultrasonography was used to evaluate the hemodynamics of erection in all patients.Main Outcome MeasuresWe assessed the impact of type 2 DM and PD on erectile function (EF) domain and on deterioration of Doppler parameters of erection.ResultsAge, obesity, smoking, and medical comorbidities were significantly higher in patients with both DM and PD than in patients with any of the conditions alone. The means of EF domain, Q3, and Q4 were significantly lower in patients with both DM and PD than in patients with any of the conditions alone. Patients with DM only had significantly lower means of EF domain, Q3, and Q4 than patients with PD only. The means of peak systolic velocity and resistive index were significantly lower, and the means of end-diastolic velocity were significantly higher in patients with both DM and PD than in patients with any of the conditions alone.ConclusionsType 2 DM and PD solely, and together, negatively affect the vascular status of erection. Type 2 DM demonstrated the principal effect; however, presence of PD has an additive impairment effect on erection and Doppler parameters. El-Sakka AI, and Tayeb KA. Vascular impairment of erection in patients with diabetes and Peyronie's Disease: Is that accumulative? J Sex Med 2009;6:1736–1742.     

Preemptive analgesia in rhegmatogenous retinal detachment surgery: is it effective?

PURPOSE: To evaluate the efficacy of preemptive analgesia in surgical repair of retinal detachment (RD) using scleral buckle and cryopexy under general anesthesia. METHODS: Thirty patients who were scheduled for rhegmatogenous RD surgical repair using scleral buckle and cryopexy and who were American Society of Anesthesiologists physical status I, II, or III were included in this study. The patients were randomly divided into two equal groups. The surgery was done under general anesthesia in both groups, but in Group 2, sub-Tenon anesthesia was given as preemptive analgesia after induction anesthesia and before start of surgery. Both groups were statistically comparable as regards patient age and weight and duration of anesthesia and surgery. RESULTS: The incidences of intraoperative oculocardiac reflex and postoperative vomiting were significantly lower in Group 2 compared with Group 1 (P < 0.001 and 0.0113, respectively). The time of first postoperative analgesic dose was significantly shorter in Group 1 (46.67 +/- 18.84 minutes) compared with Group 2 (162.67 +/- 29.391 minutes) (P < 0.001). The total analgesic consumption per 24 hours was significantly higher in Group 1 compared with Group 2 (P < 0.001). The time of discharge from the hospital was significantly shorter in Group 2 (8.8 +/- 2.704 hours) compared with Group 1 (12.4 +/- 3.481 hours) (P = 0.0018). CONCLUSION: The use of sub-Tenon block as preemptive analgesia after induction of general anesthesia and before the start of rhegmatogenous RD surgical repair was effective in reducing postoperative pain and analgesic requirements compared with an unblocked group. The use of sub-Tenon block was also effective in reducing intraoperative incidence of oculocardiac reflex and postoperative incidence of vomiting.     

Outcome of major cardiac injuries at a Canadian trauma center

Background  

Canadian trauma units have relatively little experience with major cardiac trauma (disruption of a cardiac chamber) so injury outcome may not be comparable to that reported from other countries. We compared our outcomes to those of other centers.     

Overactive bladder in the male patient: bladder,outlet, or both?

Generations of urologists have presumed that the cause of lower urinary tract symptoms (LUTS) in men is infravesical (prostatic) obstruction. When symptoms such as urinary urgency and frequency can’t easily be explained directly by obstruction, secondary effects of obstruction on the bladder are identified as causative factors. Although to some extent this explanation may still be accurate, emerging concepts in the pathophysiology of LUTS in men may be at odds with these traditional explanations. The idea that primary bladder pathology may explain the symptom complex in at least one subset of men with LUTS has both experimental and clinical support. This review discusses the physiologic and clinical observations used to explain the mechanisms underlying LUTS. Specifically, this review focuses on two data sets: one supporting infravesical obstruction as the causative factor for LUTS, and another positing that a primary bladder abnormality is responsible.