Predictors of Catastrophic Outcome after Endovascular Thrombectomy in Elderly Patients with Acute Anterior Circulation Stroke

Número óptimo de ovocitos: modelo de predicción para fertilización in vitro / Optimal number of oocytes: In vitro fertilization predictive model

Resumen OBJETIVO: desarrollar un modelo de predicción para conseguir un recién nacido vivo con el menor número de ovocitos capturados. MATERIALES Y MÉTODOS: estudio observacional, longitudinal y retrolectivo, efectuado en el Instituto Nacional de Perinatología entre 2011 y 2016 en ciclos de FIV en fresco. Criterios de inclusión: pacientes mayores de 18 años de edad, con diagnóstico de infertilidad, a quienes se realizó fertilización in vitro con transferencia de embriones en fresco (FIV-TE). Las variables de estudio fueron: edad, IMC, concentración basal de FSH, tipo de infertilidad, tiempo de infertilidad y número de ovocitos capturados. Se elaboró un árbol de decisión tipo CHAID y un modelo binario de regresión logística. Para el análisis estadístico se utilizó el programa Statistic Package for Social Sciences (SPSS). Se consideró significativa la probabilidad de error alfa < 5%. RESULTADOS: se registraron 673 ciclos, de los que se obtuvieron 5,910 óvulos. El número óptimo de ovocitos recuperados fue mayor de 12 (independientemente de la edad), con RM = 4.666, IC95%: 2.676-8.137, p = <0.01. Las mujeres menores de 37 años de edad, con concentración basal de FSH <4.2 mUI/mL y recuperación de hasta 5 ovocitos tuvieron mayor posibilidad (28%) de obtener un recién nacido vivo (χ2 = 7.797; gl = 1, p = <0.047); por su parte, las pacientes entre 38 y 40 años de edad (RM = 0.338, IC95%: 0.147-0.776, p = <0.011) y tiempo de infertilidad de 10 a 12 años de evolución (RM = 0.394, IC95%: 0.181-0.858, p = 0.019) tuvieron menor posibilidad de obtener un recién nacido vivo. CONCLUSION: el número óptimo de ovocitos a recuperar es mayor de 12 (independientemente de la edad). Las mujeres menores de 37 años de edad, con concentración basal de FSH <4.2 mUI/mL y captura de hasta 5 ovocitos tienen mayor posibilidad de tener un recién nacido vivo.

Abstract OBJECTIVE: Develop a model to optimize the reproductive outcome (live birth rate). Identify the minimal number of oocytes to capture. MAERIALS AND METHODS: Observational, longitudinal, and retrolective study was made. In fresh IVF cycles, performed at INPer between 2011-2016. A logistic regression model was fitted with a CHAID, and performed a decision tree to predict live birth (LBR). Inclusion criteria: patients over 18 years of age, diagnosed with infertility, who underwent in vitro fertilization with fresh embryo transfer (FIV-TE). The study variables were: age, BMI, basal FSH concentration, type of infertility, time of infertility and number of oocytes captured. A decision tree type CHAID and a binary logistic regression model were performed. Statistical Package for Social Sciences (SPSS) was used for the statistical analysis. The probability of error alpha <5% was considered significant. RESULTS: A total of 673 cycles were studied. The optimal number was >12 oocytes (OR = 4.666, 95% CI: 2.676-8.137, p=<0.01). The highest chance to have LB (28%), was in women <37 years old, with FSH <4.2 mIU / mL and <5 oocytes; χ2 = 7.797 (df = 1, p = <0.047). The lowest chance was in 38-40 years (OR = 0.338, 95% CI: 0.147-0.776, p = <0.011) with a longer lapse of infertility; 10-12 years (OR = 0.394, 95% CI: 0.181-0.858, p = 0.019). CONCLUSION: Our data suggest that in the >12 oocytes may be the optimal number to obtain, independent of the age. On the other hand the best chance to have a live birth is with an age <37, FSH <4.2 mIU/mL and <5 oocytes. Fewer oocytes than previously deemed optimal, because the probability of having a euploid embryo in this group of people is much bigger.

Outcome Predictors of Uvulopalatopharyngoplasty / 대한이비인후과학회지

The prognostic factor for surgical success in obstructive sleep apnea (OSA) patient is very important for determining treatment modality. If the chance of surgical success is expected to be high, surgery could be the first option. However, the chance is low, continuous positive airway pressure or oral appliance should be given priority. This article is a systematic review with regard to outcome predictor of uvulopalatopharyngoplasty in OSA. Various predictors are briefly reviewed and problems are discussed to help readers' decision.

Clinical application of anti-Mullerian hormone as a predictor of controlled ovarian hyperstimulation outcome / 대한생식의학회지

OBJECTIVE: In 2009 anti-Mullerian hormone (AMH) assay was approved for clinical use in Korea. This study was performed to determine the reference values of AMH for predicting ovarian response to controlled ovarian hyperstimulation (COH) using the clinical assay data. METHODS: One hundred sixty-two women who underwent COH cycles were included in this study. We collected data on age, basal AMH and FSH levels, total dose of gonadotropins, stimulation duration, and numbers of oocytes retrieved and fertilized. Blood samples were obtained on cycle day 3 before gonadotropin administration started. Serum AMH levels were measured at a centralized clinical laboratory center. The correlation between the AMH level and COH outcomes and cut-off values for poor and high response after COH was analyzed. RESULTS: Concentration of AMH was significantly correlated with the number of oocytes retrieved (OPU; r=0.700, p or =20) response were 0.94+/-0.15 ng/mL, 2.79+/-0.21 ng/mL, and 6.94+/-0.90 ng/mL, respectively. The cut-off level, sensitivity and specificity for poor and high response were 1.08 ng/mL, 85.8%, and 78.6%; and 3.57 ng/mL, 94.4%, and 83.3%, respectively. CONCLUSION: Our data present clinical reference values of the serum AMH level for ovarian response in Korean women. The serum AMH level could be a clinically useful predictor of ovarian response to COH.

Anti-Mullerian hormone and female reproduction / 대한산부인과학회지

Anti-Mullerian hormone (AMH), also called Mullerian-inhibiting substance, is a member of the transforming growth factor (TGF)-beta superfamily. It is well known that AMH is expressed by Sertoli cells in fetal testis, and that it induces Mullerian duct degeneration during male fetal development. However, in females AMH is produced by granulosa cells of the ovarian follicles. Recently, numerous studies have demonstrated that AMH could be a useful marker of ovarian function. Serum AMH levels decrease progressively with age, become undetectable after menopause, and show high cycle-to-cycle reproducibility. It has been shown that AMH level is correlated with various outcomes of controlled ovarian hyperstimulation (COH). Many studies showed that AMH can discriminate very effectively poor responders, cycle cancellation, and ovarian hyperstimulation syndrome after COH. AMH also has a functional role in folliculogenesis and could be a qualitative marker of ovarian follicular states. In addition, AMH has been associated with various clinical statuses such as polycystic ovarian syndrome, endometriosis, obesity, granulosa cell tumor, and premature ovarian failure. AMH is an effective and promising biomarker of various conditions in female reproduction. In this article, current research results on role of AMH as a marker of ovarian function and dysfunction are discussed.

Prognostic Effects of 4th Ventricular Hemorrhage in Intraventricular Hemorhage

Intraventricular hemorrhage(IVH) from any source is generally considered to be of grave prognostic significance. However, little is known about the prognostic effect of fourth IVH. The analysis of 65 patients with computerized tomography(CT)-documented fourth IVH treated between 1990 and 1994 is here in presented. The etiologies of the studied fourth IVH include hypertensive intracranial hemorrhage(39 cases), spontaneous subarachnoid hemorrhage(12 cases), primary IVH(9 cases), trauma(4 cases), Moyamoya disease(1 case). A 66.7% mortality rate was found in patients with a Glasgow coma scale(GCS) score of 3 to 5, 53.8% for those with a GCS score of 6 to 8, 28.6% for those patients with a GCS score of 9 to 12, and 9.5% for patients with a GCS score of 13 to 15. Admission status was significant outcome predictor(p<0.001). The mortality rate for patients with dilatation and fixed pupil was 64.7%. Pupillary reflex was also used as an outcome predictor(p<0.05). The mortality rate of patients with hemorrhagic dilatati on of the fourth ventricle was 70% while those with no hemorrhagic dilatation of the fourth ventricle was 28.9%. Hemorrhagic dilatation of the fourth ventricle was a potent predictor of outcome in fourth IVH(p<0.005). The mortality rate of patients with a ventriculocranial ratio(VCR) of 0.23 or more than 0.23, as calculated from initial CT scan, was 76.5% and those with a VCR of less than 0.16 was 26.7%. We have found that VCR is a potent prodictor of outcome in fourth IVH(p<0.005). The prognostic values of age, etiology of fourth IVH, lood pressure, the number of ventricle of hemorrhage presenting was found to be statistically insignificant. Patients with all ventricular hemorrhage and urokinase irrigation have a 64.5% mortality rate. Patients with fourth IVH and hemorrhagic dilatation of fourth ventricle, increased VCR, poor admission status, dilatation and fixed pupil are considered poor prognosis. Urokinase irrigation was the recommended management for these patients.