Anti-Müllerian hormone: a marker for oocyte quantity, oocyte quality and embryo quality?

Serum anti-Müllerian hormone (AMH) concentrations decline with increasing age and constitute a sensitive marker for ovarian ageing. In addition, basal serum AMH concentrations predict ovarian response during IVF cycles. Concomitantly, oocyte quantity and embryo quality decrease with advancing age. Hence, it was postulated that AMH in serum constitutes a marker for embryo quality. Women aged 37 years and younger with regular menstrual cycles, normal body mass index and partners with normal semen parameters were randomly assigned to either a standard or mild stimulation protocol for IVF treatment. Blood samples were drawn at cycle day 3 and at the day of human chorionic gonadotrophin administration. Embryo quality was assessed using embryo morphology score and preimplantation genetic screening. Serum AMH concentrations on cycle day 3 were correlated with the number of oocytes retrieved in both groups. AMH and embryo morphology were correlated after mild stimulation, but not after conventional ovarian stimulation. AMH and the chromosomal competence of embryos were not correlated. Serum AMH is predictive for ovarian response to stimulation. However, the lack of a consistent correlation with embryo morphology and embryo aneuploidy rate is not in favour of a direct relationship between oocyte quantity and embryo quality.     

Practical wisdom in complex medical practices: a critical proposal

In recent times, daily, ordinary medical practices have incontrovertibly been developing under the condition of complexity. Complexity jeopardizes the moral core of practicing medicine: helping people, with their illnesses and suffering, in a medically competent way. Practical wisdom (a modification of the Aristotelian phronèsis) has been proposed as part of the solution to navigate complexity, aiming at the provision of morally good care. Practical wisdom should help practitioners to maneuver in complexity, where the presupposed linear ways of operating prove to be insufficient. However, this solution is unsatisfactory, because the proposed versions of practical wisdom are too individualistic of nature, while physicians are continuously operating in varying teams, and dealing with complicated technologies and pressing structures. A second point of critique is, that these versions are theory based, and thus insufficiently attuned to the actual context of everyday medical practices. Now, our proposal is to use an approach of practical wisdom that enables medical practices to counter the complexity issue and to re-invent the moral core of medical practicing as well. This implies a practice oriented approach, as thematized by practice theory, qualitative empirical research from the inside, and abduction from actual performed practical wisdom towards an apt understanding of phronèsis.

     

Dietary Intake in the Lifelines Cohort Study: Baseline Results from the Flower Food Frequency Questionnaire among 59,982 Participants

The role of nutrition in health and disease is well established. However, more research on this topic is needed to fill gaps in our current knowledge. The Lifelines cohort study, a large Dutch prospective cohort study, was established as a resource for international researchers, aiming to obtain insight into the aetiology of healthy ageing. The study started with 167,729 participants, covering three generations, aiming to follow them for thirty years. This article describes the habitual dietary intake, assessed using the Flower Food Frequency Questionnaire (FFQ), among Lifelines cohort study participants at baseline, stratified by sex and different categories of age, socioeconomic status (SES) and body mass index (BMI). A total of 59,982 adults (23,703 men and 36,279 women), who completed the Flower FFQ and reported plausible habitual dietary intake, were included in the analyses. Median daily energy intake was higher in men (2368 kcal) than in women (1848 kcal), as well as macronutrient intake. Energy and macronutrient intake decreased with increasing age and BMI categories; no differences were observed between SES categories. Intake of most micronutrients was higher in men than in women. Differences were observed between age categories, but not between SES and BMI categories. Food groups were consumed in different amounts by men and women; differences between age, SES and BMI categories were observed as well. The Lifelines cohort study provides extensive dietary intake data, which are generalisable to the general Dutch population. As such, highly valuable dietary intake data are available to study associations between dietary intake and the development of chronic diseases and healthy aging.     

A fall onto the mouth

A 34-year-old woman appeared at the office of a general dental practitioner after a bicycle accident. At first, the only injury seemed to be some small tooth enamel fractures. Several weeks later, she developed a swelling in the lower lip and was referred to an oral and maxillofacial surgeon. A radiograph of the lower lip revealed some of the tooth enamel fragments. This case-report illustrates the importance of a meticulous examination in case of a patient with a dental trauma.     

Scale-up for bulk production of vaccine against meningococcal disease

At the Netherlands Vaccine Institute (NVI) a vaccine against Neisseria meningitidis serogroup B organisms based on different porA subtypes contained in outer membrane vesicles (OMVs) is in advanced stage of development and will be evaluated in clinical trial studies in the near future. In order to meet the expected demand for product, the current biopharmaceutical production process is being scaled-up. This study describes the scale-up approach for the upstream process and the resulting bioreactor design and operation strategy leading towards a feasible solution for bulk production of a vaccine against meningococcal disease. The technically realized 1.2 m(3) bioreactor, equipped with a turbine impeller for gas dispersion, was complemented with an upward pumping impeller and a rotary plate foam breaker to contain foam inside the bioreactor. Aeration and ventilation in the culture broth were controlled by increasing the stirrer speed and gas flow rate simultaneously at increasing oxygen demand. The scale-up was successful and comparable growth curves and nutrient consumption profiles were reached on 0.06 and 1.2 m(3).     

A gingival hyperplasia in a patient suffering from neurofibromatosis

A 30-year-old woman suffering from neurofibromatosis type 1 was referred by her dentist to the department of oral and maxillofacial surgery of a university medical centre for excision of a gingival hyperplasia in the mandibular frontal region. The hyperplasia was a neurofibroma, which was surgically removed, as were 2 neurofibromas of the tongue, a postauricular neurofibroma and 2 neurofibromas of the feet.     

Diseases of the maxillary sinus: an overview

Because of the intimate relationship between the maxillary teeth and the maxillary sinus, it is no surprise that odontogenic infections, odontogenic cysts and tumours which have their origin in the mucosa and the bone of the maxilla may extend into the maxillary sinus and, occasionally, into the nasal cavity. Diseases of the maxillary sinus can also extend into the oral cavity and can cause symptoms that mimic those of odontogenic diseases. Important diseases of the maxillary sinus are maxillary sinusitis, oroantral communications, antroliths, cysts and neoplasms.     

Indicating analgesics in oral health care

A representative survey amongst Dutch dentists and oral and maxillofacial surgeons showed that almost all of them indicated analgesics regularly. Thirty-five% of the dentists advised their patients in case of one or several tooth extractions to use analgesics. Forty-seven % of these dentists advised using the analgesics before the pain starts. After similar treatments, 89% of the oral and maxillofacial surgeons indicated analgesics and 73% advised taking the analgesic preventatively. Also in the case of other treatments oral and maxillofacial surgeons advised more often than dentists using analgesics preventatively. Dentists usually advised paracetamol and oral and maxillofacial surgeons a non-steroidal anti-inflammatory drug. Most dentists and all oral and maxillofacial surgeons thought that they had enough knowledge about the side-effects and interactions of analgesics. The majority of the dentists and oral and maxillofacial surgeons indicated that they would like to be updated on analgesia by post-graduate education occasionally     

Oncologic aspects of vermilionectomy in microinvasive squamous cell carcinoma of the lower lip

Twelve patients with microinvasive squamous cell carcinoma of the lower lip were studied in order to determine whether vermilionectomy was justifiable. The maximum tumor thickness (MTT) varied between 1.1 and 3.1 mm. In none of the patients was there local recurrence during a mean follow-up period of 4.4 years (range 4–8). In view of these results and of what has been reported in the literature, it seems warranted to conclude that vermilionectomy is an appropriate procedure in microinvasive carcinoma of the lower lip with a MTT of up to 3 mm.