Selective reduction in multiple gestations: pregnancy outcome after transvaginal and transabdominal needle-guided procedures

Selective fetal reduction was performed in the first trimester of pregnancy in 20 women with multifetal gestations after ovulation induction with human menopausal gonadotropin (hMG). In 10 women (group A) reduction was performed transabdominally, and in 10 women (group B) the transvaginal approach was used. The transvaginal technique achieved penetration of several gestational sacs without withdrawing the needle from the uterus. Fetal termination using either procedure occurred with intrafetal injection of potassium chloride. Six (60%, group A) and eight (80%, group B) patients delivered healthy newborns. One patient (group B) is at 30 weeks' gestation. Four (40%, group A) and one (10%, group B) aborted 1 day to 8 weeks after the procedure (1 septic abortion, each group). Our results suggest that transvaginal fetal reduction offers a better outcome, with minimal complications, to patients referred for selective continuation of pregnancy.     

Midtrimester diagnosis of endocardial fibroelastosis and atrial septal defect: a case report

We present a case report of endocardial fibroelastosis combined with atrial septal defect in which the diagnosis was strongly suspected at 25 weeks of gestation. To our knowledge the only previous report of prenatal diagnosis of endocardial fibroelastosis was of one made at 36 weeks of gestation.     

Syndrome dimensions of the child behavior checklist and the teacher report form: a critical empirical evaluation

The construct representation of the cross-informant model of the Child Behavior Checklist (CBCL) and the Teacher Report Form (TRF) was evaluated using confirmatory factor analysis. Samples were collected in seven different countries. The results are based on 13,226 parent ratings and 8893 teacher ratings. The adequacy of fit for the cross-informant model was established on the basis of three approaches: conventional rules of fit, simulation, and comparison with other models. The results indicated that the cross-informant model fits these data poorly. These results were consistent across countries, informants, and both clinical and population samples. Since inadequate empirical support for the cross-informant syndromes and their differentiation was found, the construct validity of these syndrome dimensions is questioned.     

Gonadotrophin-releasing hormone agonist compared with human chorionic gonadotrophin for ovulation induction after clomiphene citrate treatment

The objective of this study was to compare hormonal response,luteal phase adequacy and pregnancy and abortion rates in patientsrandomized to receive human chorionic gonadotrophin (HCG) orgonadotrophinreleasing hormone agonist (GnRHa) during ovulationcycles stimulated by clomiphene citrate. Anovulatory patientsreceived either one s.c. dose of tryptorelin (0.1 mg; n = 104)or one i.m. dose of HCG (10 000 IU; n = 106) after clomiphenecitrate stimulation had induced enlarged ovarian follicles (>17mm in diameter). A short-lived, transitory increase in serumluteinizing hormone (98 ± 9 IU/1) and follicle-stimulatinghormone (30 ± 5 IU/1) concentrations was measured at12 h following the injection of GnRHa, and these concentrationsreturned to baseline levels by 36 h post-injection. Midlutealprogesterone concentrations were similar in both groups (>10ng/ml), and the mean luteal phase duration was also not significantlydifferent (13 days). There were no significant differences inthe mean number of pregnancies (12.0 versus 12.6% per cycle)and the abortion rate (18.2 versus 12.5%) between the GnRHa-and HCG-treated groups respectively. There were no complicationsrelated to treatment in either group. The results show thata relatively low dose of GnRHa can be used in place of HCG toinduce ovulation in clomiphene citrate-treated patients.     

Interleukin-6 produced by enteric neurons regulates the number and phenotype of microbe-responsive regulatory T cells in the gut

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FDG PET/CT Response Assessment Criteria for Patients with Hodgkin’s and Non-Hodgkin’s Lymphoma at End of Therapy: A Multiparametric Approach

Purpose

Based on the International Harmonization Project (IHP) criteria, positron emission tomography (PET) response assessment of residual nodal masses in patients with lymphoma after completion of therapy is performed visually using mediastinal blood pool as the reference. The primary objective of this study was to define the optimal reference for PET response assessment. Secondary aim was to assess if morphological criteria on computed tomography (CT) may improve performance of PET.

Methods

This institutional review board approved retrospective study included 137 patients, with Hodgkin’s (n = 43) or non-Hodgkin’s lymphoma (n = 94) assessed for residual masses (n = 180) after completion of therapy with pathology and clinical and imaging surveillance data (mean, 19 months) as the standard of reference. Two readers independently assessed response by IHP and Deauville criteria. The addition of morphological parameters on CT was assessed in relation to therapy response.

Results

Based on the standard of reference, 36 patients (26.3 %) had residual lymphoma. For IHP and Deauville criteria, sensitivity, specificity and accuracy were 97.2 %, 97.2 % (p = 1); 79.2 %, 92.1 % (p < 0.001); and 83.9 %, 93.4 % (p = 0.001), respectively. Of the morphological parameters assessed, only change in size over course of therapy was significant (p < 0.003) and improved specificity for IHP-based interpretation to 90.4 % (p = 0.008).

Conclusions

Using liver as the visual reference to determine PET positivity for lymphoma patients being assessed for residual masses at the end of therapy improves specificity, yet maintains the high sensitivity of PET in identifying residual disease. The addition of change in size after therapy improves specificity of PET when using IHP-based but not Deauville-based interpretation.     

Ethics and regulation of inter-country medically assisted reproduction: a call for action

The proliferation of medically assisted reproduction (MAR) for the treatment of infertility has brought benefit to many individuals around the world. But infertility and its treatment continue to be a cause of suffering, and over the past decade, there has been a steady growth in a new global market of inter-country medically assisted reproduction (IMAR) involving ‘third-party’ individuals acting as surrogate mothers and gamete donors in reproductive collaborations for the benefit of other individuals and couples who wish to have children. At the same time there is evidence of a double standard of care for third-party women involved in IMAR, violations of human rights of children and women, and extreme abuses that are tantamount to reproductive trafficking. This paper is the report of an inter-disciplinary working group of experts who convened in Israel to discuss the complex issues of IMAR. In Israel too IMAR practices have grown rapidly in recent years, mainly because of restrictions on access to domestic surrogacy for same sex couples and a chronically insufficient supply of egg cells for the treatment of couples and singles in need. Drawing upon local expertise, the paper describes documented practices that are harmful, suggests principles of good practice based on an ethic of care, and calls for action at the international, national and professional levels to establish a human rights based system of international governance for IMAR based on three regulatory models: public health monitoring, inter-country adoption, and trafficking in human beings, organs and tissues.     

Improved prognosis during long-term treatment with beta-blockers after myocardial infarction: analysis of randomized trials and pooling of results

We reviewed 14 randomized controlled trials that involved long-term treatment of patients after myocardial infarction with beta-blockers. Studies in which randomization was carried out at the time of hospital admission were excluded because of a very high rate of early withdrawal before hospital discharge. Seven studies were found methodologically acceptable, and their results were analyzed according to the "intention-to-treat" principle to avoid bias caused by late withdrawals. Although only two of the trials found a significant reduction in total deaths in the beta-blocker groups, pooling the data from all seven studies showed a highly significant treatment benefit (p less than 0.001). The best estimate of the magnitude of the reduction in mortality rates is 26%. Pooling of the data revealed similarly significant reductions in the rates of reinfarction (p less than 0.001) and sudden death (p less than 0.001).