Intraovarian platelet-rich plasma injection and IVF outcomes in patients with poor ovarian response: a double-blind randomized controlled trial.

STUDY QUESTION: Does platelet-rich plasma (PRP) intraovarian injection increase the number of retrieved oocytes in successive ovarian punctions among patients with poor ovarian reserve (POR)? SUMMARY ANSWER: The injection of PRP increases the number of retrieved oocytes without increasing the quality of developed blastocysts. WHAT IS KNOWN ALREADY: Management of women with reduced ovarian response to stimulation is one of the significant challenges in reproductive medicine. Recently, PRP treatment has been proposed as an adjunct in assisted reproduction technology, with controversial results. STUDY DESIGN, SIZE, DURATION: This placebo-controlled, double-blind, randomized trial included 60 patients with POR stratified according to the POSEIDON classification groups 3 and 4. It was conducted to explore the efficacy and safety of intraovarian PRP injection. Patients were proposed to undergo three consecutive ovarian stimulations to accumulate oocytes and were randomized to receive either PRP or placebo during their first oocyte retrieval. Randomization was performed using computer-generated randomization codes. Double blinding was ensured so that neither the participant nor the investigators knew of the treatment allotted. All patients underwent three ovarian stimulations and egg retrieval procedures. ICSI was performed after a third ovarian puncture. The primary endpoint was the number of mature oocytes retrieved after PRP or placebo injection in successive ovarian punctures. PARTICIPANTS/MATERIALS, SETTING, METHODS: Sixty women (30-42 years) fulfilling inclusion criteria were randomized in equal proportions to the treatment or control groups. MAIN RESULTS AND THE ROLE OF CHANCE: The baseline demographic and clinical characteristics [age, BMI, anti-Müllerian hormone (AMH) levels] were comparable between the groups. Regarding the primary endpoint, the cumulative number (mean ± SEM) of retrieved mature oocytes was slightly higher in the treatment group: 10.45 ± 0.41 versus 8.91 ± 0.39 in the control group, respectively (95% CI of the difference 0.42-2.66; P = 0,008). The number of mature oocytes obtained among all patients increased in successive egg retrievals: 2.61 ± 0.33 (mean ± SEM) in punction 1 (P1), 3.85 ± 0.42 in P2, and 4.73 ± 0.44 in P3. However, the increase was higher among patients receiving the assessed PRP treatment. In P2, the number of retrieved mature oocytes was 4.18 ± 0.58 versus 3.27 ± 0.61 in controls (95% CI of the difference: -0.30 to 2.12; P = 0.138) and in P3, 5.27 ± 0.73 versus 4.15 ± 0.45 (95% CI of the difference: 0.12-2.12; P = 0.029). The mean ± SEM number of developed and biopsied blastocysts was 2.43 ± 0.60 in the control group and 1.90 ± 0.32 in the treatment group, respectively (P = 0.449). The mean number of euploid blastocysts was 0.81 ± 0.24 and 0.81 ± 0.25 in the control and treatment groups, respectively (P = 1.000). The percentages of patients with euploid blastocysts were 53.33% (16 out of 30) and 43.33% (13 out of 30) for patients in the control and treatment groups, respectively (Fisher's exact test P = 0.606). The overall pregnancy rate per ITT was 43% (26 out of 60 patients). However, the percentage of clinical pregnancies was higher in the control group (18 out of 30, 60%) than in the treatment group (8 out of 30, 27%) (P = 0.018). There was also a trend toward poorer outcomes in the treatment group when considering full-term pregnancies (P = 0.170). There were no differences between control and treatment groups regarding type of delivery, and sex of newborns. LIMITATIONS, REASONS FOR CAUTION: The mechanism of the potential beneficial effect of PRP injection on the number of retrieved oocytes is unknown. Either delivered platelet factors or a mechanical effect could be implicated. Further studies will be needed to confirm or refute the data presented in this trial and to specify the exact mechanism of action, if any, of PRP preparations. WIDER IMPLICATIONS OF THE FINDINGS: The increasing number of women with a poor response to ovarian stimulation supports the exploration of new areas of research to know the potential benefits of therapies capable of increasing the number of oocytes available for fertilization and improving the quality of developed blastocysts. An increase in the retrieved oocytes in both arms of the trial suggests that, beyond the release of growth factor from platelets, a mechanical effect can play a role. However, neither improvement in euploid blastocyst development nor pregnancy rates have been demonstrated. STUDY FUNDING/COMPETING INTEREST(S): This trial was supported by Basque Government and included in HAZITEK program, framed in the new Euskadi 2030 Science and Technology Plan (PCTI 2030). These aids are co-financed by the European Regional Development Fund (FEDER). The study funders had no role in the study design, implementation, analysis, manuscript preparation, or decision to submit this article for publication. No competing interests are declared by all the authors. TRIAL REGISTRATION NUMBER: Clinical Trial Number EudraCT 2020-000247-32. TRIAL REGISTRATION DATE: 3 November 2020. DATE OF FIRST PATIENT'S ENROLLMENT: 16 January 2021.

Medición ecográfica de parámetros anatómicos de la vía aérea superior en adultos / Ultrasound measurement of anatomical parameters of the upper airway in adults

Antecedentes: La mayoría de los trabajos sobre anatomía ecográfica de la vía aérea (VA) se limitan a la descripción morfológica. Presentamos un estudio cuyo objetivo es ofrecer datos objetivos de medidas de normalidad. Materiales y métodos: Estudio observacional para describir con ecografía las características de la VA superior en adultos sin criterios clínicos de VA difícil (VAD) y comparación con modelos anatómicos de disección en cadáver. Resultados: Se incluyó a 45 voluntarios (27 varones y 18 mujeres) y 3 modelos de cadáver. La calidad de la exploración fue muy buena/buena en el 93% de los casos. Mediciones: diámetro traqueal (1,3±0,3cm), cuerda vocal (1,6±0,5cm), membrana tirocricoidea (0,94±0,32cm), membrana cricotraqueal (0,3±0,09cm), grosor de los músculos del suelo de la boca (MSB) (1,5±0,26cm), tejido subcutáneo de la grasa submandibular y MSB (2,11±0,34cm), distancia hioides-mandíbula (5,35±0,69cm), distancia paladar-suelo de la boca (4,92±0,5cm), distancia paladar-borde anterior de la mandíbula (5,51±0,7cm), ángulo de los ejes bucal y faríngeo (114±14). Diferencias observadas: el diámetro traqueal fue mayor en hombres (H: 1,4±0,3 vs. M: 1,2±0,2cm; p=0,014). La altura mostró una correlación significativa con el diámetro traqueal (R: 0,501; p <0,001), la longitud de la cuerda vocal (R: 0,363; p=0,016) y el grosor MSB (R=0,299; p=0,046), así como con las distancias hioides-mandíbula (R: 0,556; p<0,001) y mandíbula-paladar (R: 0,362; p=0,015). Conclusiones: La ecografía permite evaluar la anatomía de la VA superior y calcular distancias entre estructuras anatómicas. En nuestro estudio se definen estas distancias en voluntarios adultos sin criterios clínicos de VAD

Background: Most of the works on ultrasound airway anatomy are limited to a morphological description. A study was conducted in order to provide an objective normal range of measurements. Materials and methods: Observational study to describe the ultrasound characteristics of the upper airway in adults without clinical difficult airway criteria, compared to cadaver dissection anatomical models. Results: The study included 45 volunteers (27 men and 18 women), and 3fresh cadavers. The quality of the examination was very good/good in 93% of the cases. Measurements: tracheal diameter (1.3±0.3cm), vocal cord (1.6±0.5cm), cricothyroid membrane (0.94±0.32cm), cricotracheal membrane (0.3±0.09cm), thickness of the muscles in the floor of the mouth (MFM) (1.5±0.26cm), sub-mandibular subcutaneous fat plus MFM (2.11±0.34cm), hyoid-mandible distance (5.35±0.69cm), palate-floor of the mouth distance (4.92±0.5cm), palate-anterior border of the mandible (5.51±0.7cm), and palate-pharynx angle (114±14). Observed differences: Males had a larger tracheal diameter than females (M: 1.4±0.3 vs. F: 1.2±0.2cm, p=0.014). Subject height showed a significant correlation with the tracheal diameter (R: 0.501, p<0.001), as well as the length of the vocal cord (R: 0.363, p=0.016), the thickness of MFM (R=0.299, p=0.046) as well as the hyoid-mandible (R: 0.556; p<0.001) and palate-mandible distances (R: 0.362; p=0.015). Conclusions: Ultrasound allows the anatomy of upper airway to be evaluated, as well as to calculate distances between the anatomical structures. The study defines these distances in adult volunteers without clinical difficult airway criteria

Ultrasound measurement of anatomical parameters of the upper airway in adults. / Medición ecográfica de parámetros anatómicos de la vía aérea superior en adultos.

BACKGROUND: Most of the works on ultrasound airway anatomy are limited to a morphological description. A study was conducted in order to provide an objective normal range of measurements. MATERIALS AND METHODS: Observational study to describe the ultrasound characteristics of the upper airway in adults without clinical difficult airway criteria, compared to cadaver dissection anatomical models. RESULTS: The study included 45 volunteers (27 men and 18 women), and 3fresh cadavers. The quality of the examination was very good/good in 93% of the cases. MEASUREMENTS: tracheal diameter (1.3±0.3cm), vocal cord (1.6±0.5cm), cricothyroid membrane (0.94±0.32cm), cricotracheal membrane (0.3±0.09cm), thickness of the muscles in the floor of the mouth (MFM) (1.5±0.26cm), sub-mandibular subcutaneous fat plus MFM (2.11±0.34cm), hyoid-mandible distance (5.35±0.69cm), palate-floor of the mouth distance (4.92±0.5cm), palate-anterior border of the mandible (5.51±0.7cm), and palate-pharynx angle (114±14). Observed differences: Males had a larger tracheal diameter than females (M: 1.4±0.3 vs. F: 1.2±0.2cm, p=0.014). Subject height showed a significant correlation with the tracheal diameter (R: 0.501, p<0.001), as well as the length of the vocal cord (R: 0.363, p=0.016), the thickness of MFM (R=0.299, p=0.046) as well as the hyoid-mandible (R: 0.556; p<0.001) and palate-mandible distances (R: 0.362; p=0.015). CONCLUSIONS: Ultrasound allows the anatomy of upper airway to be evaluated, as well as to calculate distances between the anatomical structures. The study defines these distances in adult volunteers without clinical difficult airway criteria.

Efecto de dietas con restricción moderada de energía sobre el estado nutricional de algunos minerales en mujeres obesas / Effect of moderate energy-restricted diets on the nutritional status of selected minerals in obese women

El objetivo del estudio fue comparar los cambios en la ingesta y estado nutricional de algunos minerales, durante tres meses de tratamiento para reducción de peso, utilizando dietas con distinto aporte energético. 62 mujeres obesas (edad 33,2 ± 8,3 años; IMC 34,6 ± 3,4 kg/m2) fueron asignadas a dos tratamientos dietéticos: uno con 1000 kcal/día (Dieta 1) y otro con 1300 kcal/día (Dieta 2). Al inicio y después de tres meses se evaluó ingesta de hierro (Fe), cinc (Zn), cobre (Cu) y calcio (Ca) con encuestas alimentarias de registro de tres días. Se analizaron parámetros de laboratorio respecto al estado nutricional de Fe, Zn y Cu: hemoglobina, ferritina sérica, cinc-protoporfirina, saturación de transferrina, cinc plasmático, cinc en pelo y cobre plasmático. La reducción de peso fue 10,8% en la Dieta 1 y 8,5% en la Dieta 2 (p= 0,29). La ingesta de Fe, Zn, Cu y Ca se redujo en promedio en 50, 30, 40 y 9%, respectivamente. El cambio de ferritina sérica fue significativo en el grupo con la dieta 1 (p= 0,040), en pacientes con pérdida de peso ≥10% (p=0,006), y aquellas con menor ingesta proteica (p=0,033). En los otros parámetros de laboratorio, aunque se observaron tendencias a mayores alteraciones en el grupo con 1000 kcal/día, estas no alcanzaron significación estadística. La indicación de dietas con 1000 y 1300 kcal/día, no produjo alteraciones significativas en el estado nutricional de minerales durante los tres primeros meses de tratamiento, a excepción de un mayor deterioro de los depósitos de hierro.

The aim of this study was to compare changes of nutrient intakes and nutritional status of selected minerals, during a three-month weightloss program using diets with distinct energy contents. 62 obese women (age 33.2 ± 8.3 years; BMI 34.6 ± 3.4 kg/m2) were allocated to two diets, one supplying 1000 kcal/d (Diet 1), and the other 1300 kcal/d (Diet 2). Before and after 3 months, intakes of iron (Fe), zinc (Zn), copper (Cu), and calcium (Ca) were evaluated through selfreported three-day dietary records. Selected laboratory parameters related to the nutritional status of iron, zinc and copper were analyzed: hemoglobin, serum ferritin, zinc-protoporfirin, transferrin saturation, plasma zinc, hair zinc, and plasma copper. Mean weight loss was 10.8% on Diet 1 and 8.5% on Diet 2 (p= 0.29). Intakes of Fe, Zn, Cu and Ca decresed by 50%, 30%, 40%, and 9%, respectively. The change of serum ferritin was significantly greater in the group on Diet 1 (p= 0.04), in ≥10% of weight loss subjects (p= 0.006) and in patients with lower protein intake (p= 0.033). Others parameters studied, although tended consistently to present greater disturbances in subjects receiving the 1000 kcal/d diet, they did not reach statistical significance. The prescription of weight-reducing diets with 1000 y 1300 kcal/d did not produce major effects on the nutritional status of minerals during the first three months of treatment, except by the significant detriment of body iron stores in subjects receiving the 1000 kcal diet, as indicated by the changes of serum ferritin.

Morphometric study of the human fetal heart. I. Arterial segment.

This study measured the dimensions of the great arteries of normal human fetal hearts at an early fetal stage (between 13-20 weeks post-fertilization) in 103 fetuses obtained by necropsy. Different segments of the aorta and the pulmonary artery were dissected and their external diameters measured under stereoscopic magnification. All segments showed linear growth during this period of fetal development. Ranges in median values of external diameters associated with the pulmonary artery were: 2.1-4.2 mm for the valve ring; 2.2-4.2 mm for the main pulmonary trunk; 1.2-2.5 mm for the right pulmonary artery; 0.9-2.18 mm for the left pulmonary artery; and 4.0-8.0 mm for the length of the main pulmonary trunk. Similarly, in the aorta, median diameters were: 2.1-4.2 mm for the ascending aorta; 1.92-3.8 mm for the aortic arch; 1.45-3.0 mm for the aortic isthmus; and 1.75 -3.35 mm for the descending aorta. The diameter of the ductus arteriosus ranged between 1.2-2.45 mm. The growth rates of the pulmonary artery and the aorta were similar. The diameter of the ascending aorta was found to be greater than that of the descending aorta and the right pulmonary artery was wider than the left pulmonary artery. In addition, the magnitude of growth in the various aortic segments was different and the ratios obtained between the aortic isthmus and the ascending and descending aortae, ranged between 0.66-0.93. This study provides important morphometric reference information concerning the dimensions and growth of the great arteries of the fetal heart and has clinical application in pediatric cardiac surgery and echocardiography.

Utilización del casco en bicicleta y motocicleta / Use od helmets with bicycles abd motorbikes

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La red de vigilancia epidemiológica en Bolivia

El Gobierno de Bolivia y las prefecturas departamentales juegan un papel de coordinadores del sistema de vigilancia mientras que la responsabilidad de recolección de datos en el campo asienta en una combinación del sector público y privado. Por lo tanto podemos decir que el cuerpo del sistema de vigilancia está compuesto de una armazón, el sector público, mientras que la musculatura la forma del sector público y privado combinados. El desarrollo de este sistema reconoce la realidad política y económica de Bolívia, donde existe un sistema gubernamental descentralizado y donde los fondos disponibles para un servicio veterinario estatal son limitados. Este sistema, aun pareciendo complicado, funciona bien y está mejorando la calidad y frecuencia de la información epidemiológica. Además, este sistema refleja los principios de sostenibilidad a largo plazo. La UNIVEP es consciente de la necessidad que existe de mejorar los datos, fortalecer los avances y mantener los vínculos existentes. En el futuro será importante ampliar el enfoque sobre la fiebre aftosa a otras enfermedades que son prioritarias para el ganadero. Esta tarea debería estar dirigida por los ganaderos mismos y las unidades informativas. De esta manera, el papel de las UNIVEPs tanto departamentales como central será más de asesoramiento y análisis.

Resolution of unilateral fetal hydrothorax with associated non-immune hydrops after intrauterine thoracentesis.

Congenital hydrothorax has been successfully managed in utero by two different treatment modalities: thoracentesis and pleuroamniotic shunting. Unfortunately, there is a paucity of data as to which method is better for the management of this problem. This case report supports the use of thoracentesis as the initial procedure for primary fetal hydrothorax. We report a pregnancy complicated by primary fetal hydrothorax with non-immune hydrops that completely resolved after two thoracenteses in the early third trimester. Complete resolution was maintained throughout pregnancy without the need for further antenatal or neonatal intervention, i.e. further thoracentesis, pleuroamniotic shunt placement, intubation, or chest and/or abdominal tube placement. The child was delivered at 42 weeks and is doing well without problems at 1 year of age. We believe that intrauterine thoracentesis should be the initial procedure of choice for the treatment of primary fetal hydrothorax with mediastinal shift, and pleuroamniotic shunting should be reserved for cases that require repetitive thoracenteses.

Salud mental y SIDA

Aunque el SIDA se presente como una enfermedad misteriosa, los científicos han avanzado mucho en su estudio. Lo que se conoce hoy día permite afirmar que se trata de una enfermedad de transmisión conductual que directa o indirectamente afectará a todos los pobladores de este planeta. La epidemiología del SIDA permite afirmar, que por su formación básica de expertos en conducta y en los factores psicosociales que inciden sobre ésta, así como de responsables por el manejo de las perturbaciones mentales debidas a las infecciones del cerebro, los profesionales de la Salud Mental están en disposición de participar en la atención integral de esta enfermedad. El presente trabajo pretende ser una guía de los modos posibles de intervención de los trabajadores de la Salud Mental para lograr, ante la temible perspectiva de 54,000 muertos por SIDA en 1991, una reducción importante de esta cifra

Overnight access to sugar and response to DDT in Anopheles albimanus Wied.

A study was made of the response of A. albimanus females to DDT after overnight access to sugar solutions. Tarsal contact with the solutions had a statistically significant protective effect proportional to the strength of the solution. Prior access to sugar can produce considerable experimental error and thus invalidate DDT susceptibility tests. Reports of DDT resistance among anophelines should be treated with caution when the tests were conducted on insects that had access to sugar.