Hyperreactio luteinalis despite the absence of a corpus luteum and suppressed serum follicle stimulating concentrations in a triplet pregnancy

Hyperreactio luteinalis is characterized by moderate to marked cystic enlargement of the ovaries related to multiple theca lutein cysts and is associated with very high sex steroid concentrations. It is a rare condition especially in the first trimester. The case described below is believed to be the only case of hyperreactio luteinalis reported following frozen embryo transfer. This case provides an opportunity to gain further insight into the mechanism responsible for this unusual condition. The 30 year old woman demonstrated a slightly elevated LH/FSH ratio (5 and 3 mIU/ml respectively) and normal baseline androgen concentrations. Two years following oocyte retrieval she had a second frozen embryo transfer. The ovaries were normal size when the embryos were transferred and androgens were still normal. The ovaries did not begin to enlarge until 51 days from transfer. A dichorionic intrauterine pregnancy with monozygotic twins in the left gestational sac was seen. Eventually, 86 days from transfer, the ovaries enlarged to 145x103x116 mm right; and 83x95x117 mm left. Serum oestradiol was 30 078 pg/ml, beta-human chorionic gonadotrophin (HCG) 239 920 mIU/ml, serum progesterone >160 ng/ml, total testosterone 2254 ng/dl, free testosterone 42.3 pg/ml and androstenedione 7328 ng/dl. Throughout the first trimester, serum FSH was <1 mIU/ml. Thus, neither FSH nor a corpus luteum is necessary to initiate this syndrome.     

Testicular sperm retrieval: What should we expect from the fresh and subsequent cryopreserved sperm injection?

We sought to compare ICSI outcomes of cycle using fresh versus thawed TESE spermatozoa obtained during the previous fresh TESE. All consecutive couples undergoing ICSI cycles using fresh TESE spermatozoa, followed by ICSI cycle using cryopreserved sperm remaining from the previous fresh TESE procedure were included. Ovarian stimulation (OS)/laboratory variables and cycle outcome were assessed and compared between those utilising fresh versus thawed TESE spermatozoa. Seventy-five couples were evaluated, with no in-between groups differences in OS nor embryological variables. While implantation and LBR per embryo transfer were nonsignificantly higher in the frozen as compared to the fresh TESE, there was a trend towards higher LBRs per patient in the frozen TESE group. The cumulative miscarriage rate (4% versus 14.7%, p < .022 respectively) was significantly lower and the cumulative LBR (34.7% versus 16%, p < .007 respectively) was significantly higher using frozen TESE spermatozoa. Moreover, significantly higher proportion of frozen TESE sperm samples used pentoxifylline to enhance sperm motility. In conclusion, the results of ICSI cycles using frozen TESE spermatozoa are as good, or even better than using fresh TESE spermatozoa. Further studies are required to explore the factors responsible for the improved ICSI outcome, while using frozen versus fresh TESE sperm samples.     

A modified frozen elephant trunk hybrid device to facilitate supra‐aortic trunk anastomosis

Reimplantation of the supra‐aortic vessels can be challenging with Thoraflex Hybrid. A device modification made the vessel lengths more appropriate and the position of the neo‐vessels in the chest avoided malpositioning and kinking and facilitated sternum closure; this may improve operating times as well as allowing complete and continuous cerebral trivascular perfusion and corrects positioning of the intrathoracic vessels.     

Electrical Analysis of Fresh,Excised Human Skin: A Comparison with Frozen Skin

Samples of human allograft skin prepared without freezing ("fresh skin) were found to have electrical and sodium ion transport properties which differed only slightly from those of skin which had been similarly treated but stored frozen (frozen skin). The fresh skin samples were less permeable to sodium ions during passive diffusion and less conductive than frozen skin at low current levels. They were more permselective for sodium versus chloride during constant-current iontophoresis and showed slightly more asymmetry in their current–voltage properties. Overall, the electrical behavior of the two tissues was similar enough to support the use of frozen tissue in iontophoresis studies. However, caution should be exercised when considering the use of frozen skin for applications, such as those based on electroosmosis, where the observed differences could have a major impact on the results.     

新鲜羊膜移植治疗眼表疾病的临床评价

目的 评价新鲜人羊膜在眼表重建术手术中的临床价值。方法 用新鲜羊膜移植,治疗陈旧性睑球粘连、结膜囊缺失,复发性翼状胬肉、蚕蚀性角膜溃疡、热烧伤后角膜和结膜溶解等眼表疾病的连续病例１９例（２１只眼）。结果 １９例患者的羊膜移植手术均为一次成功。平均随访１２．５个月,羊膜移植片未见免疫排斥反应或溶解吸收。手术后,患者的睑球粘连松解,结膜囊形成,蚕蚀性角膜溃疡和复发性翼状胬肉在随访期间未见复发,角膜和结     

The influence of ovarian follicular activity on late proliferative phase serum IGFBP-1 in down-regulated assisted conception cycles

Serum insulin-like growth factor binding protein-1 (IGFBP-1)concentrations were measured at the end of the proliferativephase in infertility patients undergoing normal menstrual cyclefrozen embryo transfer, exogenous hormone-supported frozen embryotransfer and in-vitro fertilization (IVF) treatment cycles.These patients were divided into five groups according to theirovarian follicular activity. The exogenous hormone-supportedfrozen embryo transfer group, who had no ovarian follicles,and the IVF groups (number of follicles ranging from 4–38)showed statistically higher serum IGFBP-1 concentrations whencompared to the normal menstrual cycle group (P0.01). Therewas no significant difference in the serum IGFBP-1 concentrationsbetween the exogenous hormone support frozen embryo transfergroup and the poor or normal response IVF groups (number offollicles ranging from 4 to 16). An IVF group that displayedan excessive response to our standard human menopausal gonadotrophinstimulation (>>20 mature follicles or oestradiol >>10000 pmol/1) showed a significantly higher serum IGFBP-1 concentrationwhen compared with the other groups (P = 0.001). This subgroupwas subsequently given a modified (follicle-stimulating hormone)stimulation regime which resulted in a significant reductionin serum IGFBP-1 concentrations (P << 0.05). There wasno correlation between serum oestradiol and IGFBP-1 overallor within the patient groups. We conclude that serum IGFBP-1concentrations in our down-regulated assisted conception cyclesdid not increase in line with ovarian follicular activity, unlessan excessive response was displayed.     

Long-term treatment with β-blockers after myocardial infarction

Summary 162 patients discharged from hospital after myocardial infarction were randomly allocated to two groups, one received alprenolol 400 mg daily and the other served as the control. The period of follow-up was two years and all other treatment given was standardized. The two groups did not differ with respect to risk factors for myocardial infarction, the course of the acute infarct or treatment during follow-up. After two years one patient in the group treated with alprenolol had died suddenly as compared to nine in the control group. During the same period four fresh infarcts had occurred in the alprenolol group compared to 15 in the control group. Both these differences were statistically significant. Only four patients were obliged to discontinue -blocker treatment because of suspected side-effects. Long-term post-infarction treatment with -blockers appears to be an effective form of secondary therapy without serious side-effects.     

阿苯达唑聚氰基丙烯酸正丁酯纳米粒的制备、性质及其组织靶向性研究阿苯达唑聚氰基丙烯酸正丁酯纳米粒的制备、性质及其组织靶向性研究

目的制备阿苯达唑聚氰基丙烯酸正丁酯纳米粒（albendazole polybutycyanocrylate nanoparticles，ABZ-PBCA-NP）TDDS给药系统，并考察相关特性及组织分布靶向性。方法种子乳化聚合法制备阿苯达唑纳米粒；等温吸附法考察纳米粒载药特性；动态透析法研究4种制剂的体外释药动力学；同位素标记阿苯达唑纳米粒在小鼠脏器组织分布和生物利用度。结果ABZ-PBCA-NP体外释药遵循Higuchi方程，加入PVP制成的载药纳米粒符合双指数函数。纳米粒的载药方式遵循Langmuir吸附方程。小鼠ig ³H-ABZ-PBCA-NP后, 药物的肝、脾中的靶向指数分别为11.4和3.9，阿苯达唑纳米粒和混悬剂相对生物利用度分别为76.0%和36.9%。结论制备纳米粒加入PVP可使药物具吸附性和分散性，纳米粒载体可降低药物与血浆蛋白结合率，增强药物的肝、脾脏器靶向性和延缓释药。     

新鲜羊膜移植与自体球结膜移植治疗翼状胬肉的临床观察

目的:观察新鲜羊膜移植与自体球结膜移植治疗翼状胬肉的临床疗效。方法:随机将翼状胬肉患者分为A、B2组。A组30例(32眼)采用翼状胬肉切除联合新鲜羊膜移植。B组37例(40眼)采用翼状胬肉切除及自体球结膜移植。观察术后角膜愈合情况、角膜缘新生血管及角结膜是否有翼状胬肉样组织。结果:术后随访6～18mo,A组复发2眼(6%);B组复发3眼(8%)。结论:自体球结膜移植,取材方便,没有严重的并发症及排斥反应;新鲜羊膜移植损伤小,取材及处理相对复杂,但二者均能有效的减少翼状胬肉的术后复发,复发率相近。