Association between different dual trigger dosages and in vitro fertilization results in patients with patient-oriented strategies encompassing individualized oocyte number group IV

Objective@#Dual trigger is used to induce final oocyte maturation during the process of controlled ovarian hyperstimulation, yet yielding controversial results. Also, there are yet no data regarding the effect of the dosage of the dual trigger on clinical outcomes. Based on the Patient-Oriented Strategies Encompassing IndividualizeD Oocyte Number (POSEIDON) criteria, this study aimed to determine the clinical difference of a single bolus versus two boluses of gonadotropin-releasing hormone agonist (GnRHa) in POSEIDON group IV patients using dual trigger. @*Methods@#We screened a total of 1,256 patients who underwent in vitro fertilization (IVF) cycles who met the POSEIDON group IV criteria. Six hundred and twenty-nine patients received one bolus of GnRHa, and 627 patients were given two boluses. All patients received the same dose of recombinant human chorionic gonadotropin during the dual trigger cycle. @*Results@#Metaphase II oocyte retrieval rate, fertilization rate and clinical pregnancy rate did not differ between the two groups. However, a lower percentage of at least one top-quality embryo transfer (34.3% vs. 26.0%, P=0.001) in the two bolus-GnRHa group was noted. @*Conclusion@#A double bolus of GnRHa did not show superior clinical results compared to a single bolus of GnRHa in the dual trigger IVF cycle. Therefore, GnRHa doses for use should be decided based on individual clinical situations considering cost-effectiveness and patient compliance, but further investigation will be needed.

Does Post-Warming Extended Culture Duration Affect the Clinical and Obstetric Outcomes of Patients of Advanced Maternal Age? A SingleCenter Study

Background@#The single vitrified-warmed blastocyst transfer (SVBT) cycle has been increasingly utilized for assisted reproductive technology. Women of advanced maternal age (AMA) comprise a significant portion of patients who have undergone ‘freeze-all’ cycles. This study investigated the association between the post-warming extended culture duration and pregnancy outcomes in patients of AMA. @*Methods@#This retrospective cohort study analyzed the outcomes of 697 SVBT cycles between January 2016 and December 2017. The cycles were divided into 3 groups based on the age of the female partners: group I: < 35 years (n = 407), group II: 35–37 years (n = 176); and group III, 38–40 years (n = 114). Data are shown as the mean ± standard error of the mean. Data were analyzed using one-way ANOVA followed by Duncan’s multiple range test. Statistical significance was set at P < 0.001. @*Results@#The blastocyst rate, clinical pregnancy rate, and live birth rate (LBR) was significantly lower in the AMA groups. However, there were no significant differences in LBR in the transfer between the AMA and younger groups according to blastocyst morphology and post-warming extended culture duration. @*Conclusion@#Post-warming extended culture of blastocysts is not harmful to patients of AMA. It could be a useful parameter in clinical counseling and decision making for fertility treatments.

Factors Affecting the Quality of Sleep in Young Adults

Purpose@#The study aimed to identify the effects of sleep hygiene (use of caffeine, alcohol, night eating syndrome, stress, and coping styles), social network, and smartphone-related factors on quality of sleep in young adults. @*Methods@#This was a descriptive research design. Participants completed a questionnaire on evidence-based variables including caffeine intake, alcohol consumption, social network, night eating syndrome, stress, coping styles, and smartphone-related factors. Stepwise multiple regression was used for data analysis to identify factors that influenced the participants’ quality of sleep. This study included 288 young adults in South Korea. @*Results@#This study identified the factors affecting quality of sleep in young adults. Their average weekly sleep duration was 6.86 hours with low sleep quality, indicated by a score of 59.34 points (range 17-100). The predictors of sleep quality were sleep mood, sub-items of night eating syndrome, effects of pain over the last four weeks, and social networks, which explained 33% of the variance. @*Conclusion@#Sleep-induced diseases in young adults could be prevented by identifying sleep mood, pain, and social networks, which is important for health and using them as a basis for intervention.

Primordial follicle activation as new treatment for primary ovarian insufficiency / 대한생식의학회지

Primordial follicle activation is a process in which individual primordial follicles leave their dormant state and enter a growth phase. While existing hormone stimulation strategies targeted the growing follicles, the remaining dormant primordial follicles were ruled out from clinical use. Recently, in vitro activation (IVA), which is a method for controlling primordial follicle activation, has provided an innovative technology for primary ovarian insufficiency (POI) patients. IVA was developed based on Hippo signaling and phosphatase and tensin homolog (PTEN)/phosphatidylinositol-3-kinase (PI3K)/protein kinase B (AKT)/forkhead box O3 (FOXO3) signaling modulation. With this method, dormant primordial follicles are activated to enter growth phase and developed into competent oocytes. IVA has been successfully applied in POI patients who only have a few remaining remnant primordial follicles in the ovary, and healthy pregnancies and deliveries have been reported. IVA may also provide a promising option for fertility preservation in cancer patients and prepubertal girls whose fertility preservation choices are limited to tissue cryopreservation. Here, we review the basic mechanisms, translational studies, and current clinical results for IVA. Limitations and further study requirements that could potentially optimize IVA for future use will also be discussed.

Effects of paternal age on human embryo development in in vitro fertilization with preimplantation genetic screening / 대한생식의학회지

OBJECTIVE: As paternal age increases, the quality of sperm decreases due to increased DNA fragmentation and aneuploidy. Higher levels of structural chromosomal aberrations in the gametes ultimately decrease both the morphologic quality of embryos and the pregnancy rate. In this study, we investigated whether paternal age affected the euploidy rate. METHODS: This study was performed using the medical records of patients who underwent in vitro fertilization (IVF) procedures with preimplantation genetic screening (PGS) from January 2016 to August 2017 at a single center. Based on their morphological grade, embryos were categorized as good- or poor-quality blastocysts. The effects of paternal age were elucidated by adjusting for maternal age. RESULTS: Among the 571 total blastocysts, 219 euploid blastocysts were analyzed by PGS (38.4%). When the study population was divided into four groups according to both maternal and paternal age, significant differences were only noted between groups that differed by maternal age (group 1 vs. 3, p=0.031; group 2 vs. 4, p=0.027). Further analysis revealed no significant differences in the euploidy rate among the groups according to the morphological grade of the embryos. CONCLUSION: Paternal age did not have a significant impact on euploidy rates when PGS was performed. An additional study with a larger sample size is needed to clarify the effects of advanced paternal age on IVF outcomes.

Correlation between Morphologic Grading and Euploidy Rates of Blastocysts, and Clinical Outcomes in In Vitro Fertilization Preimplantation Genetic Screening

BACKGROUND: The standard morphological evaluation has been widely used for embryo selection, but it has limitations. This study aimed to investigate the correlation between morphologic grading and euploidy rate of in vitro fertilization (IVF) preimplantation genetic screening (PGS) and compare the pregnancy rates in young and old ages. METHODS: This is a retrospective study using the medical records of patients who underwent IVF procedures with PGS between January 2016 and February 2017 in a single center. The embryo grades were categorized into 4 groups: excellent, good, fair, and poor. Basic characteristics, euploidy rates, clinical pregnancy (CP) rates and ongoing pregnancy rates were analyzed. RESULTS: The excellent group had significantly higher rate of euploid embryos than fair group (47.82% vs. 29.33%; P = 0.023) and poor group (47.82% vs. 29.60%; P = 0.005). When the four groups were recategorized into two groups (excellent and good vs. fair and poor), they also showed significant difference in euploidy rates (44.52% vs. 29.53%; P = 0.002). When the patients were divided into two groups by age 35, the CP rates for those under and over 35 years old were 44.74% and 47.83%, respectively, which showed no significant difference. CONCLUSION: The significant differences among the euploidy rates of different morphologic embryo grades demonstrated the positive correlations between the morphologic grading of the embryo and the euploidy rate of PGS. Additionally, there was no significant difference between the younger and older patients' CP rates. These findings emphasize the fact that old age patients might benefit from PGS whatever the indication of PGS is.

Changes of APRI score in HBeAg-negative treatment-naive chronic hepatitis B patients receiving 3 year entecavir therapy / 中华实验和临床病毒学杂志

Objective@#We aimed to evaluate changes towards liver fibrosis during entecavir(ETV)treatment by non-invasive fibrosis markers in chronic hepatitis B (CHB) patients who need antiviral therapy.@*Methods@#Totally 303 HBeAg negative treatment-naive CHB patients were enrolled and liver biopsy was performed before starting antiviral therapy in this study. Totally 196 patients who need antiviral therapy were treated with ETV for at least 3 years. A clinical and virological evaluation was performed at baseline and again after 1, 2 and 3 years during ETV treatment. AST-to-platelet ratio index (APRI) was used to assess dynamic changes of liver fibrosis in HBeAg negative CHB patients after 1, 2, 3 years of ETV treatment.@*Results@#All enrolled patients experienced liver biopsy at baseline. According to Metavir fibrosis stages, F1, F2, F3 and F4 patients were 107, 125, 54 and 17, respectively. The APRI score enabled the correct identification of patients with severe fibrosis (METAVIR F3-F4). The APRI values significantly decreased in F2 and F3 patients after 1 year ETV therapy (P<0.01). But for F4 patients, APRI values decreased significantly at year 3 (P<0.05).@*Conclusions@#APRI values decreased significantly during ETV treatment in HBeAg-negative CHB patients indicating that these noninvasive fibrosis tests might be useful for monitoring improvement of liver fibrosis and assessing treatment efficacy during long-term ETV treatment.

Clinical outcomes of single versus double blastocyst transfer in fresh and vitrified-warmed cycles / 대한생식의학회지

OBJECTIVE: Assisted reproductive technology has been associated with an increase in multiple pregnancies. The most effective strategy for reducing multiple pregnancies is single embryo transfer. Beginning in October 2015, the National Supporting Program for Infertility in South Korea has limited the number of embryos that can be transferred per in vitro fertilization (IVF) cycle depending on the patient's age. However, little is known regarding the effect of age and number of transferred embryos on the clinical outcomes of Korean patients. Thus, this study was performed to evaluate the effect of the number of transferred blastocysts on clinical outcomes. METHODS: This study was carried out in the Fertility Center of CHA Gangnam Medical Center from January 2013 to December 2014. The clinical outcomes of 514 women who underwent the transfer of one or two blastocysts on day 5 after IVF and of 721 women who underwent the transfer of one or two vitrified-warmed blastocysts were analyzed retrospectively. RESULTS: For both fresh and vitrified-warmed cycles, the clinical pregnancy rate and live birth or ongoing pregnancy rate were not significantly different between patients who underwent elective single blastocyst transfer (eSBT) and patients who underwent double blastocyst transfer (DBT), regardless of age. However, the multiple pregnancy rate was significantly lower in the eSBT group than in the DBT group. CONCLUSION: The clinical outcomes of eSBT and DBT were equivalent, but eSBT had a lower risk of multiple pregnancy and is, therefore, the best option.

The Prevalence of Asthma, Allergic Rhinitis, and Atopic Dermatitis in Elementary School Students according to the Body Mass Index

PURPOSE: This study aimed to assess the prevalence of asthma, allergic rhinitis, and atopic dermatitis in elementary school students according to thebody mass index. METHODS: This study was conducted as cross-sectional descriptive research using a structured questionnaire. Data were collected from 6,398 students at 15 elementary schools located in Y City in Korea. The cross-sectional survey used the Korean version of International Study of Asthma and Allergies in Childhood questionnaire. Logistic regression analysis was performed to estimate the odds ratios of body mass index. RESULTS: The symptom prevalence of asthma, allergic rhinitis, and atopic dermatitis in the last 12 months was 12.4%, 49.5%, and 24.5%, respectively. The symptom prevalence of asthma was significantly higher in the obesity group. The number of those without any asthma symptom in lifetime was significantly smaller in the overweight (OR=0.70, p=.004) and obesity (OR=0.57, p=.005) groups than in the healthy weight group. CONCLUSION: These results suggest that asthma, allergic rhinitis, and atopic dermatitis prevention programs for elementary school students should include weight control intervention.

In vitro maturation of human oocytes: Its role in infertility treatment and new possibilities / 대한생식의학회지

IVM refers to the maturation of immature oocytes in culture after their recovery from small antral follicles at the stage prior to selection and dominance. IVM requires little or no FSH in vivo and has been proposed as an alternative to conventional IVF, since it reduces the primary adverse effects caused by controlled ovarian stimulation, including the ovarian hyperstimulation syndrome. Moreover, IVM is a promising option for cases for which no standard protocol is suitable, such as FSH resistance, contraindications for ovarian stimulatory drugs, and the need for urgent fertility preservation. Recently, IVM has been used in women with regular cycles and normal ovaries. However, the pregnancy rate following IVM is suboptimal compared with that of conventional IVF, indicating that further studies to optimize the protocol and the culture conditions are warranted.

Preoperative Localization and Intraoperative Parathyroid Hormone Assay in Korean Patients with Primary Hyperparathyroidism

BACKGROUND: The intraoperative parathyroid hormone (IOPTH) assay is widely used in patients with primary hyperparathyroidism (PHPT). We investigated the usefulness of the IOPTH assay in Korean patients with PHPT. METHODS: We retrospectively reviewed the data of 33 patients with PHPT who underwent parathyroidectomy. Neck ultrasonography (US) and 99mTc-sestamibi scintigraphy (MIBI scan) were performed preoperatively and IOPTH assays were conducted. RESULTS: The sensitivity of neck US and MIBI scans were 91% and 94%, respectively. A 50% decrease in parathyroid hormone (PTH) levels 10 minutes after excision of the parathyroid gland was obtained in 91% (30/33) of patients and operative success was achieved in 97% (32/33) of patients. The IOPTH assay was 91% true-positive, 3% true-negative, 0% false-positive, and 6% false-negative. The overall accuracy of the IOPTH assay was 94%. In five cases with discordant neck US and MIBI scan results, a sufficient decrease in IOPTH levels helped the surgeon confirm the complete excision of the parathyroid gland with no additional neck exploration. CONCLUSION: The IOPTH assay is an accurate tool for localizing hyperfunctioning parathyroid glands and is helpful for evaluating cases with discordant neck US and MIBI scan results.

Hepatitis C virus: virology and life cycle

Hepatitis C virus (HCV) is a positive sense, single-stranded RNA virus in the Flaviviridae family. It causes acute hepatitis with a high propensity for chronic infection. Chronic HCV infection can progress to severe liver disease including cirrhosis and hepatocellular carcinoma. In the last decade, our basic understanding of HCV virology and life cycle has advanced greatly with the development of HCV cell culture and replication systems. Our ability to treat HCV infection has also been improved with the combined use of interferon, ribavirin and small molecule inhibitors of the virally encoded NS3/4A protease, although better therapeutic options are needed with greater antiviral efficacy and less toxicity. In this article, we review various aspects of HCV life cycle including viral attachment, entry, fusion, viral RNA translation, posttranslational processing, HCV replication, viral assembly and release. Each of these steps provides potential targets for novel antiviral therapeutics to cure HCV infection and prevent the adverse consequences of progressive liver disease.

Relationship between Obesity and Depression in the Korean Working Population

This study was conducted to investigate potential relationship between obesity and depression in Korean working population. A total of 8,121 workers, aged 21-75 yr, participated in this nationwide cross-section research. The participants asked to complete a questionnaire regarding the socio-demographic factors and health-related behaviors, height, and weight. To measure degree of depression, the Korean version of the Center for Epidemiologic Studies-Depression scale (CES-D) was used. Chi-square test and multivariate logistic regression analyses were performed to examine the degree of association between obesity and depression. Compared to normal-weight women, overweight women had a lower adjusted odds ratio (OR) for depression (OR=0.65, 95% confidence interval 0.46 to 0.97). Underweight (1.42, 0.83 to 2.44) and obese women (BMI > or =30) had higher ORs for depression (1.47, 0.64 to 3.36), but these were insignificant. Compared to normal-weight men, obese men had higher crude ORs (1.94, 1.03 to 3.62) and adjusted ORs (1.77, 0.89 to 3.53) for depression, while underweight and overweight men showed no significant differences. These findings suggest that being overweight may protect Korean female worker against depression.

The Levels of Impacts of Events, Depression and Anxiety among Injured Workers

PURPOSE: The aim of this study was to investigate the impact of accidental events, depression, and anxiety among workers with industrial accidents in South Korea. METHODS: The participants were 510 workers with industrial accidents. Data were collected by personal interviews with structured questionnaires for three months from August to October in 2005. For analyses, frequencies and means were utilized. RESULTS: The participants' average age was 44.9 years, and about 91% of them were male. Also, they had a greater risk of poverty after being injured. The most frequent cause of accidents was fall (32.2%), and the most frequent injured body area was extremities (73.9%). For around a half of the participants, the treatment period was 12 months or shorter. The participants were at great risk of experiencing a negative impact due to events, depression, and anxiety. CONCLUSION: It is necessary to develop: (a) strategies for injured workers to be financially stable during recuperation; and (b) supporting systems for them not to suffer and exacerbate mental health problems after being injured.

A Case of Successful Selective Abortion Using Radio-frequency Ablation in Twin Pregnancy Suffering from Severe Twin to Twin Transfusion Syndrome

Twin to twin transfusion syndrome (TTTS) is one of the major complication of monochorionic twin pregnancy which is mainly understood by placental vascular anastomosis. Perinatal mortality and morbidity is high as 80-100% if untreated and even higher if the disease is developed at early stage. Variety of methods of isolating or intercepting placental vascular anastomosis are introduced, but they are only available in centers where all the required equipments are prepared. We report here a case of TTTS complicated with severe polyhydroamnios during the second trimester. The blood supply to donor twin was interrupted successfully at 19+2 weeks of gestation by minimally invasive radio-frequency cord ablation, under ultrasound guidance. The normal recipient twin was delivered successfully at 35 weeks of gestation and had no eventful neonatal course.

A Case of Successful Selective Abortion Using Radio-frequency Ablation in Twin Pregnancy Suffering from Severe Twin to Twin Transfusion Syndrome

Twin to twin transfusion syndrome (TTTS) is one of the major complication of monochorionic twin pregnancy which is mainly understood by placental vascular anastomosis. Perinatal mortality and morbidity is high as 80-100% if untreated and even higher if the disease is developed at early stage. Variety of methods of isolating or intercepting placental vascular anastomosis are introduced, but they are only available in centers where all the required equipments are prepared. We report here a case of TTTS complicated with severe polyhydroamnios during the second trimester. The blood supply to donor twin was interrupted successfully at 19+2 weeks of gestation by minimally invasive radio-frequency cord ablation, under ultrasound guidance. The normal recipient twin was delivered successfully at 35 weeks of gestation and had no eventful neonatal course.

Relationship between Brand Nicotine Yield of Cigarettes and Urine Cotinine Level in Male Smokers / 가정의학회지

BACKGROUND: As one of harm reduction strategies, tobacco manufacturers have begun to introduce lower-yield cigarettes. Lower-yield cigarettes, so called light cigarettes, have been perceived as less hazardous by some smokers. However, there have been very few studies concerning smoking lower yield products the lead to lower nicotine absorption. We evaluated the association between brand nicotine yield of cigarettes and actual nicotine intake by measuring urinary cotinine. METHODS: Four hundred sixty four male smokers aged 18 or over who participated in health check-ups in a hospital from May to October 2007 filled out a self-administered smoking questionnaire. Urinary cotinine concentration was measured at the time of participation. The subjects were divided into three groups (ultralight [nicotine: 0.05 mg], light [0.1 mg], and regular [> 0.1 mg] group) according to the level of brand nicotine yield of cigarettes which they smoked. RESULTS: The median urinary cotinine concentrations of ultralight (N = 62), light (N = 216), and regular (N = 186) groups were 735.5 ng/mL (interquartile range, 320 to 1,300 ng/mL), 956.0 ng/mL (429 to 1,491 ng/mL), and 1,067.5 ng/mL (615 to 1,613 ng/mL), respectively. There was a signifi cant difference in urinary cotinine between the regular and the other groups (P = 0.015). However, multiple logistic regression analysis to evaluate the risk of being in the highest quartile of urinary cotinine concentration (> or = 1,532 ng/mL) after adjusting for possible confounding variables showed that the odds ratios were 0.84 (95% CI, 0.52 to 1.37) in the light nicotine group and 0.82 (95% CI, 0.38 to1.72) in the ultralight nicotine group compared to the regular nicotine group. CONCLUSION: There was no significant difference in the risk of elevated urinary cotinine concentrations in male adult smokers according to brand nicotine yield of cigarettes groups.

Vascular endothelial cell growth factor (VEGF) polymorphisms and haplotypes in Korean women with advanced endometriosis / 대한산부인과학회지

OBJECTIVE: Endometriosis is the presence of normal endometrial mucosa (glands and stroma) abnormally implanted on the outside of uterus. The pathophysiology of endometriosis is not clear yet, but Sampson's theory of the transplantation of endometrial tissue onto the pelvic peritoneum via retrograde menstruation is most widely accepted. Vascular endothelial cell growth factor (VEGF) is involved in the pathophysiology of endometriosis via its angiogenetic property. This study was designed to investigate whether single nucleotide polymorphism and its haplotype and diplotype of VEGF genes are associated with the risk of advanced endometriosis or not. METHODS: This study investigated 260 patients of endometriosis; they underwent operation, and were diagnosed with endometriosis stage III, IV histopathologically. And control group of 199 women underwent surgery with benign ovarian cyst. The single nucleotide polymorphisms of VEGF gene were -2578C>A, 405G>C, 936C>T. They were analyzed by polymerase chain reaction and restriction fragment length polymorphism, and haplotype and diplotype analysis were done. RESULTS: The result of this study showed no association among -2578C/A, 405G>C, 936C>T single nucleotide polymorphisms and severe endometriosis. Haplotype and diplotype of -2578C>A, 405G>C, 936C>T in the VEGF gene were shown to have no association with endometriosis. We found no association between VEGF genetic polymorphism and risk of endometriosis. And haplotype and diplotype analysis also revealed no statistically significant value between VEGF polymorphism and endometriosis. CONCLUSIONS: So, the results of this study suggest polymorphism of VEGF gene may not be associated with risk of endometriosis in Korean women.

Two cases of paratubal cysts manifesting as huge pelvic masses in young women / 대한산부인과학회지

Paratubal cysts come from paraovarium of the broad ligament between the fallopian tube and ovary. Overall, these cysts constitute 10% of all adnexal masses and are commonly incidental findings upon surgical exploration for other reasons. They more commonly occur in women between 30 and 40 years of age. We report two cases of rapidly growing, huge paratubal cysts in young women, which are presented with brief review of literature.

Association between Depression and Cardiovascular Risk Factors in Workers Undergoing Comprehensive Medical Examination in a University-based Hospital

BACKGROUND: Depression increases the risk of cardiovascular risk factors in adults. However, the association between depression and cardiovascular risk factors was not well evaluated in South Korea. Our study was done to evaluate the association between depression and cardiovascular risk factors in workers. METHODS: The study population was selected among adults working in several industries that had more than 50 employees. They had received their medical examinations at the Health Promotion Center of Hallym University Sacred Heart Hospital between March and November 2005. We estimated the odds ratio to determine whether depression (Korean Center for Epidemiologic Studies Depression Scale score > or =21) was associated with each cardiovascular risk factors (hypertension, diabetes mellitus, hypercholesterolemia, and obesity). RESULTS: The prevalence of depression was 15.5%. Depression was significantly associated with hypertension (P<0.001), obesity (P=0.03) and hypercholesterolemia (P=0.004). The adjusted odds ratio for hypertension and hypercholesterolemia were 1.41 (95% CI 1.04~1.91) and 1.59 (95% CI 1.05~2.40), respectively. The association between depression and obesity was eliminated after adjustment (1.25, 95% CI: 0.97~1.61). CONCLUSION: Depression was significantly associated with hypertension and hypercholesterolemia in workers. Further long-term study on the association of depression with cardiovascular risk factors is necessary.