Novel nomogram-based integrated gonadotropin therapy individualization in in vitro fertilization/intracytoplasmic sperm injection: A modeling approach / 대한생식의학회지

Objective@#This study aimed to characterize a validated model for predicting oocyte retrieval in controlled ovarian stimulation (COS) and to construct model-based nomograms for assistance in clinical decision-making regarding the gonadotropin protocol and dose. @*Methods@#This observational, retrospective, cohort study included 636 women with primary unexplained infertility and a normal menstrual cycle who were attempting assisted reproductive therapy for the first time. The enrolled women were split into an index group (n=497) for model building and a validation group (n=139). The primary outcome was absolute oocyte count. The dose-response relationship was tested using modified Poisson, negative binomial, hybrid Poisson-Emax, and linear models. The validation group was similarly analyzed, and its results were compared to that of the index group. @*Results@#The Poisson model with the log-link function demonstrated superior predictive performance and precision (Akaike information criterion, 2,704; λ=8.27; relative standard error (λ)=2.02%). The covariate analysis included women’s age (p<0.001), antral follicle count (p<0.001), basal follicle-stimulating hormone level (p<0.001), gonadotropin dose (p=0.042), and protocol type (p=0.002 and p<0.001 for short and antagonist protocols, respectively). The estimates from 500 bootstrap samples were close to those of the original model. The validation group (n=139) showed model assessment metrics comparable to the index model. Based on the fitted model, a static nomogram was built to improve visualization. In addition, a dynamic electronic tool was created for convenience of use. @*Conclusion@#Based on our validated model, nomograms were constructed to help clinicians individualize the stimulation protocol and gonadotropin doses in COS cycles.

Novel nomogram-based integrated gonadotropin therapy individualization in in vitro fertilization/intracytoplasmic sperm injection: A modeling approach / 대한생식의학회지

Objective@#This study aimed to characterize a validated model for predicting oocyte retrieval in controlled ovarian stimulation (COS) and to construct model-based nomograms for assistance in clinical decision-making regarding the gonadotropin protocol and dose. @*Methods@#This observational, retrospective, cohort study included 636 women with primary unexplained infertility and a normal menstrual cycle who were attempting assisted reproductive therapy for the first time. The enrolled women were split into an index group (n=497) for model building and a validation group (n=139). The primary outcome was absolute oocyte count. The dose-response relationship was tested using modified Poisson, negative binomial, hybrid Poisson-Emax, and linear models. The validation group was similarly analyzed, and its results were compared to that of the index group. @*Results@#The Poisson model with the log-link function demonstrated superior predictive performance and precision (Akaike information criterion, 2,704; λ=8.27; relative standard error (λ)=2.02%). The covariate analysis included women’s age (p<0.001), antral follicle count (p<0.001), basal follicle-stimulating hormone level (p<0.001), gonadotropin dose (p=0.042), and protocol type (p=0.002 and p<0.001 for short and antagonist protocols, respectively). The estimates from 500 bootstrap samples were close to those of the original model. The validation group (n=139) showed model assessment metrics comparable to the index model. Based on the fitted model, a static nomogram was built to improve visualization. In addition, a dynamic electronic tool was created for convenience of use. @*Conclusion@#Based on our validated model, nomograms were constructed to help clinicians individualize the stimulation protocol and gonadotropin doses in COS cycles.

Quantiferon vs. tuberculin testing in detection of latent tuberculous infection among chronic renal failure patients

Latent tuberculous infection [LTBI] lacks a solid gold standard in its diagnosis and many clinicians rely upon tuberculin testing, however there has been an increasing interest in depending on Interferon Gamma Release Assays especially Quantiferon-Gold [QFT-G]. Since chronic renal failure [CRF] poses an important health problem in Egypt and taking into consideration the immuno compromisation caused by this condition, LTBI detection emerged as an important health concern in those patients. In this study, the aim was to find which tool was better in the detection of LTBI in CRF patients. Forty patients with chronic renal failure and on hemodialysis, with exclusion of active tuberculosis and other immuno compromisation conditions were tested for LTBI by tuberculin skin test [TST] and QFT-G. 25% of the tested showed LTBI. It was found that although both tests gave comparable results, yet there was a discrepancy between both. TST + /QFT + group was 10%, TST + /QFT- group was 5%, TST-/QFT+ was 10% and TST-/QFT- group was 75%.In Chronic renal failure and probably any immuno compromisation setting, it would be better to perform both tuberculin and Quantiferon tests to detect latent tuberculous infection

Frequency of Fc gamma receptor IIIa-158V polymorphisms in Egyptian children with immune thrombocytopenic purpura

Immune thrombocytopenic purpura [ITP] is a bleeding disorder of infants, children and adults. The majority of affected children have the acute form of ITP, defined by duration of thrombocytopenia [<150 x 10[9]/L] of <6 months. Previous studies have shown that Fc gamma receptor [FcyRs] play crucial roles in platelet phagocytosis; antibodies bound to platelets have their Fc portion exposed which allows binding to monocytes/macrophages that express Fc receptors for lgG [FcgammaRs]. The Fc gammaRIIla Valine [V] has increased affinity for three separate lgG subclasses when compared with the FcgammaRIlIa Phenylalanine [F]. The aim of the present study was to assess the frequency of occurrence of the high affinity allelic variant FcgammaRllIa-158V in Egyptian children with ITP in comparison to normal individuals. Determination of FcgammaRlIIa genotype was performed for 30 ITP patients and 10 healthy control subjects by nested PCR followed by RFLP analysis. In our study, the allelic frequency of FcgammaRIlIa-158V was [76.6%] among ITP patient group in contrast to [20%] among the control group. These results suggest that FcgammaRllIa-158 V/F polymorphism contributes to the pathogenesis of childhood ITP by increased clearance of antibodysensitized platelets by the high affinity FcgammaRlIIa-158V allelic variant. Besides the epidemiologic and pathophysiologic interest, this knowl edge may be of use in the future designing of novel therapeutic interventions

Recent isolation and identification of equine herpes viral abortion [EHV-1] in Egypt-2007

The present study was planned to isolate and identify the local Equine herpes viral abortion [EHV-1]. So, samples [liver, lung, spleen, placenta and serum] of 5 aborted mares and their foeti were collected from a private stud in Egypt, with a history of recurrent abortion during [2005, 2006]. Attempts for isolation of the causative agent were performed on chorioallantoic membrane of SPF enibryonated chicken eggs and tissue culture [VERO cells]. The highest titre was obtained from the liver of foeti which ranged from 8-9 log10 EID50 at 3[rd] egg passage and 7-8 logio TCID50 at 5[th] tissue culture passage. These results were confirmed by different serological tests [AGPT, VN test, ELISA and IF] by using reference rabbit anti-EHV-1 sera. In addition, antibodies against EHV-1 were detected in mares sera by AGPT and ELISA

Studies on the volatile compounds developed from earth-oven cooked lamb

Effect of earth-oven cooking method on the volatiles developed from lamb meat was studied. The volatiles of earth-oven cooked lamb meat were extracted by steam distillation for 2.5 hr under reduced pressure. Extraction of neutral and phospholipid compounds of lamb fat was done and subjected to flavour extraction. Several aldehydes, ketones, alcohols, esters and acids were identified tentatively. Kovat index and comparison of retention times authentic samples in the neutral acidic-fractions of the flavour. Basic fraction of the flavour contains heterocyclic compounds such as pyrazines, thiazolines and oxazolines

Heterocyclic synthesis with biologically active S-[6-aryl pyridazin 3-yl] thioglycollic acid hydrazides

A number of S-[6-ary1pyridazin-3-yl] thioglycollic acid hydrazides [Ia-c] and thiosemicarbazide derivatives IIa-c have been prepared. 6-Arylpyridazin-3-mercaptomethenyl[4-phenyl--l,2,4-triazolo-5-thiones] [IIIa-c]; 6-arylpyridazin-3-mercaptometheny]-[4-phenyl-l,2,4-triazolo-5-mercaptomethyl ether [IVa]; 6-aryl pyridazin-3-mercaptomethyl-[4-phenyl-I,2,4-triazolo-5-mercaptocyanoethyl] [IVb] and the Mannich bases Va-c have been synthesized from III. The 6-arylpyridazin-3-mercaptomethenyl [5-aminophenyl-l,3-4-thiadiazolines] [VIa-c] and the corresponding 1,3-4-oxadiazoline derivative VII have been synthesized from the phenyl-thiosemicarbazide derivatives IIa-c. The antibacterial activity of the prepared compounds has been screened

Pathological and molecular studies on avian leukosis virus subgroup [J] in chicken parents flocks

The present study was carried out on 10 parent chickens flocks collected from different provinces. The examined cases were classified into 47 commercial layers and 198 broiler parents to study the gross and microscopical lesions of different tumors induced by avian leukosis subgroup-J [ALV-J] in broiler breeders and layers flocks. Serological tests were conducted on 245 serum samples to detect the antibodies of ALV-J. Polymerase chain reaction PCR was carried out on tissue samples to confirm the presence of DNA of ALV subgroup J. Myeloid leukosis was recorded in four broiler flocks induced by the novel sub group-J of ALV. Pathological findings of infected parent chickens flocks revealed multiple neoplastic nodules in different organs including liver, kidney, gonads, intestine, skeletal muscle and bone. Histologically, the main constituent of tumor lesions was mature and immature myelocytes. Nephroblastoma was considered as the first recorded cases in Egyptian broiler parent flocks affected with ALV subgroup J. The results of this work concluded that the histopathological examination plays a crucial and decisive role in diagnosing different types of neoplasm caused by avian leukosis virus subgroup-J. The application of PCR test verified the presence of DNA of ALV-J that induced the tumors of myeloid leukosis

Synthesis and behaviour of a static benzoxazinone derivative towards nitrogen and sulphur nucleophieles

4 [H]-3,l-BENZOXAZIN-4-one derivatives bear saturated aliphatic substituents at position-2, [so called dynamic benzoxazinones], e.g., CH[3][1] C[3]H[7] [iso] [2], CH[2]COCH[3][3], CH2CN[4], C[3]H[7][n] and CH[2]CH[2]COOH[5] are among the more recent heterocyclic compounds. The electronically unsaturated character of these rings made difficult the synthesis of satisfactorily stable rings. New organic substituents with special properties in steric and in an electronic manner-helped to solve this problem. In the last two decades, our contribution to the solution of this problem includes the use of bulk substituents involving strong conjugation power [which so called static benzoxazinones[6-12]. In continuation of our recent article [1,3], on the behaviour of a static benzoxazinone derivative towards nitrogen and carbon nucleophiles, another derivative namely 2-[2-[4-bromohydroxyimmobenzyl] phenyl]-4[H]-3,l-benzoxazin-4-one [3] was obtained via the interaction of 1 - [4-bromophenyl] -4[H] -3,2 -benzoxazin-4-one [2] with anthranilic acid in boiling n-butanol in which hetero-ring opening takes place followed by cyclisation

Synthesis and reactions of 2- [2, [2, 4, 6-trimethyl benzoyl] Vinyl] -4H-3, 1-benzoxazin-4-one of expected biological activity

Beta-[2,4,6-trimethyibenzoyl]- acryloyl chloride reacts with anthranilic acid to give [1] which is easily cyclized by the action of acetic anhydride to give the Benzoxazone[2]. Condensation of [2] with hydrazine hydrate give [3]. The behaviour of [3] towards the action of aromatic aldehydes, ketones, phthalic anhydride and phthalyl amino acid chlorides has been investigated. Reactions of [2] with o-phenylene diamine, ammonia, grignard reagents, friedl-crafts reaction and bomine has been described

Preliminary trials for the improvement of the locally produced inactivated RVF vaccine

After the last outbreak of RVF in Egypt during 1993, research works were directed towards the development of a much higher immunogenic and more potent inactivated RVF vaccine. The present work reports on the production of a much safer, more economic and potent inactivated vaccine as well as increasing its shelf live validity. The vaccine was safe when tested in suckling mice and potent when tested in adult mice and sheep. It had an ED[50] of 0.0005/ml. Yet, this vaccine has to be tried on a large scale to judge upon its validity for field use and/or replacing the present classical inactivated one

Laparoscopic staging of intra-abdominal malignancy

Forty-six patients with intra-abdominal malignancy underwent diagnostic laparoscopy just prior to their operation. All patients were candidates for curative resection of their tumors as proved by routine clinical, laparotomy, endoscopic and radiological examination [including CT]. Diagnostic laparoscopy was free of specific complications or mortalities. It contraindicated curative resection in 37% of cases, eliminated unnecessary exploration in 21.7% of patients and changed the operative plan to palliative operation in 12.5%. The main advantage of diagnostic laparoscopy appeared in detecting hepatic and peritoneal deposits, especially in pancreatic and hepatic tumors. Laparoscopy did not replace laparotomy in gastric, colonic and esophageal tumors as palliative resection or bypass operation was mandatory in these cases. However, diagnostic laparoscopy did not replace CT which may superior in assessing local infiltration

effect of injection sclerotherapy on the progress of the underlying liver pathology and portal hypertension

Fifty patients presenting with acute variceal bleeding received sclerotherapy with the aim of obliterating their varices and were followed up for one year. The effect of sclerotherapy on the portal pressure and the liver pathology was recorded. The portal vein diameter was measured by real time ultrasonography as an indirect index of the portal pressure. The underlying liver pathology was determined by percutaneous liver biopsy. Bleeding was controlled in 90% of the patients at the end of one month. Twelve patients had recurrence of bleeding and the final control of bleeding was 84.1%. The one-year survival rate was 80%, which was not significantly influenced by the size of the liver nor the spleen. The type of liver pathology had no significant effect on the survival. The portal vein diameter taken as an index of the portal pressure [mean 1.57 +/- 0.22 cm] showed no significant change after the completion of sclerotherapy [mean 1.56 +/- 0.198 cm]. The different parameters of liver functions were compared before and after sclerotherapy and no detectable difference was observed that could be ascribed to the injection procedure. In fact, the mean Child's score improved significantly from 6.73 +/- 0.94 to 5.92 +/- 0.90 points after sclerotherapy. The type and extent of liver pathology present [1/5 cirrhosis, 2/5 bilharzial and 2/5 mixed] showed no change after sclerotherapy indicating the absence of any toxic effect of the sclerosant on the liver. It was concluded that injection sclerotherapy shown to be an effective method of controlling variceal bleeding which did not interfere with the portal bleed flow to the liver and has no deleterious after-effects on the liver parenchyma

value of pre-operative endoscopic biliary stunting

Thirty-eight patients [twenty males and eighteen females their mean age was 53.7 years] with surgical obstructive jaundice were assessed clinically, biochemically and ultrasonographically. The causes of obstruction were calcular [12 patients], postoperative benign stricture [5 patients] and malignant obstruction [21 patients]. Their mean bilirubin value was 10.6 +/- 0.78 mg%. Thirteen patients had cholangitis. ERCP and endoscopic stenting were in all of them. Stenting succeeded in 81.6%. Nine patients with malignant obstructive jaundice were left with their stent for permanent palliative drainage. In 22 patients, the stent was used for preoperative preparation without added morbidity or mortality. The stent was dislodged or obstructed in nine patients. The stenting procedure was repeated in two of them. The other seven patients were subjected to biliary drainage operation. Endoscopic biliary stenting has an undoubted value in preoperative preparation of jaundiced patients as well as in long-term drainage in patients with inoperable carcinoma

Soluble interleukin-2 receptor, interleukin-4 and interferon-gamma in bronchoalveolar lavage fluid of asthmatic patients

To clarify the role of immunoregulatory cytokinesis in pathogenesis of bronchial asthma, soluble interleukin-2 receptor [sIL-2R], interleukin-4 [IL-4] and interferon-gamma [IFN-gamma] as products of T-cell activation were estimated in bronco-alveolar lavage [BAL] fluid of asthmatic patients. Their levels were correlated with the degree of bronchial hyperreactivity [BHR] [PD20], sIL-2R and IL-4 levels were significantly higher in asthmatics than normal controls. In extrinsic asthma, their levels were significantly higher than that in intrinsic asthma. IL-4 levels showed significant inverse correlation with PD20 in extrinsic asthma. SIL-2R level showed insignificant inverse correlation with PD20 in both extrinsic and intrinsic asthmatic, IL-4 was poorly correlated with PD20 in intrinsic asthma. There was no significant difference in concentration of IFN-gamma between asthmatics and normal controls, however, it was slightly higher in normal controls. The results of this study suggested that the elevated T-cell markers [sIL-2R, IL4] in BAL fluid from asthmatic patients is an indication that T-cell activation is present in asthma. The higher level of these cytokinesis in atopic asthma and their correlation with BHR suggested the preferential activation of the TH2. The lower level of IFN-gamma may suggest its role in the treatment of bronchial asthma and this may open the way for further studies

Intrapleurally administered streptokinase in management of loculated empyema

Intrapleural streptokinase was used in 22 patients with loculated empyema in whom intercostal tube thoracostomy was ineffective for drainage of the pleural space and they were potential c and idates for rib resection tube drainage to cut the septa. Effectiveness of intrapleural streptokinase was assessed radiographically and by monitoring the volume of fluid drained through chest tube in the first 48 hours. 14 patients [63.64%] showed radiological and clinical improvement. The time elapse between intercostal tube thoracostomy and instillation of streptokinase was important prognostic factor that determined the outcome of this procedure. In conclusion, intrapleural instillation of streptokinase is safe and effective in promoting drainage of loculated purulent effusion. Early administration may lead to fewer intrapleural installations and better response. Intrapleural administered streptokinase may decrease the number of patients for whom inadequate drainage might lead to rib resection tube drainage or decortication later

Human splenic vasculature in vivo and post-resection comparative study

Twenty two cadaveric or surgically removed spleens and 16 in vivo splenic angiograms were studied for their splenic vasculature. The results of both cadaveric spleens and angiographic studies of splenic vasculature were very similar. Thus, preoperative selective splenic angiography is very helpful to study the anatomy of the splenic vasculature which may allow safe partial splenectomy