Epstein-Barr virus induced acute hepatitis with hyperferritinemia: A rare presentation.

Elevated aminotransaminases and hyperbilirubinemia are common in primary Epstein-Barr Virus (EBV) infection in the adult and pediatric population and the disease course is usually subclinical and self-limited. However, EBV-induced hepatitis is an uncommon diagnosis, accounting for less than 1% of acute hepatitis causes. Acute EBV-hepatitis usually affects immunocompromised and older populations, with nearly half of patients being aged greater than 60 years. Significantly elevated ferritin levels correlate with severe infection and have been associated with EBV complications such as infectious mononucleosis, autoimmune hemolytic anemia, and hemophagocytic lymphohistiocytosis. We present a case of isolated acute cholestatic EBV-hepatitis and hyperferritinemia in an adult immunocompetent patient.

Recommendations from Diabetes UK's 2022 diabetes and physical activity workshop.

AIMS: To describe the process and outputs of a workshop convened to identify key priorities for future research in the area of diabetes and physical activity and provide recommendations to researchers and research funders on how best to address them. METHODS: A 1-day research workshop was conducted, bringing together researchers, people living with diabetes, healthcare professionals, and members of staff from Diabetes UK to identify and prioritise recommendations for future research into physical activity and diabetes. RESULTS: Workshop attendees prioritised four key themes for further research: (i) better understanding of the physiology of exercise in all groups of people: in particular, what patient metabolic characteristics influence or predict the physiological response to physical activity, and the potential role of physical activity in beta cell preservation; (ii) designing physical activity interventions for maximum impact; (iii) promoting sustained physical activity across the life course; (iv) designing physical activity studies for groups with multiple long-term conditions. CONCLUSIONS: This paper outlines recommendations to address the current gaps in knowledge related to diabetes and physical activity and calls on the research community to develop applications in these areas and funders to consider how to stimulate research in these areas.

Impact of sperm morphology on the likelihood of pregnancy after intrauterine insemination.

OBJECTIVE: To determine whether there is a difference in ongoing pregnancy rates (PRs) between patients undergoing IUI with strict sperm morphology ≤4% compared with >4% on initial semen analysis. DESIGN: Retrospective chart review with multivariate analysis. SETTING: Academic outpatient reproductive center. PATIENT(S): A total of 408 couples with male and/or female factor infertility and known strict sperm morphology (SSM). INTERVENTION(S): A total of 856 IUIs with partner's sperm (IUI-P). MAIN OUTCOME MEASURE(S): Ongoing PRs based on ultrasound documentation of intrauterine pregnancy with fetal heart tones. RESULT(S): There is no statistically significant difference in per cycle PRs when comparing patients with a strict sperm morphology of ≤4% versus >4% who undergo IUI-P (17.3% vs. 16.7%; odds ratio 0.954, 95% confidence interval 0.66-1.37). Multiple potential confounding factors were assessed using multivariate analysis. CONCLUSION(S): Strict sperm morphology ≤4% is not associated with lower PRs in couples undergoing IUI-P, and thus should not be the sole reason for advancing to IVF.

Radial artery pseudoaneurysm: a simplified treatment method.

A radial artery pseudoaneurysm represents a rare, potentially catastrophic complication of arterial cannulation that has been reported after cardiac catheterization. Treatment options are limited to chemical, mechanical, and combined approaches to obliterate the radial artery pseudoaneurysm and tract. Manual compression protocols using the TR Band (Terumo Medical Corporation, Somerset, NJ) have been variable and anecdotal, without objective measurements of adequate compression, making this technique prone to failure. In this report, we present an efficient, safe, and noninvasive management protocol using a pulse oximeter and the TR Band for treatment of radial artery pseudoaneurysms that is cost-effective and efficient and ensures correction without occlusion of the radial artery.

Endoscopic Ultrasound Guided Embolization of a Pancreatic Pseudoaneurysm.

Pseudoaneurysms are rare complications of chronic pancreatitis and are associated with a high mortality. In this article we demonstrate a novel utilization of endoscopic ultrasound (EUS) technology to embolize a large pancreatic pseudoaneurysm when gold standard therapies had proven futile.

Modelling of AlAs/GaAs interfacial structures using high-angle annular dark field (HAADF) image simulations.

High angle annular dark field (HAADF) image simulations were performed on a series of AlAs/GaAs interfacial models using the frozen-phonon multislice method. Three general types of models were considered-perfect, vicinal/sawtooth and diffusion. These were chosen to demonstrate how HAADF image measurements are influenced by different interfacial structures in the technologically important III-V semiconductor system. For each model, interfacial sharpness was calculated as a function of depth and compared to aberration-corrected HAADF experiments of two types of AlAs/GaAs interfaces. The results show that the sharpness measured from HAADF imaging changes in a complicated manner with thickness for complex interfacial structures. For vicinal structures, it was revealed that the type of material that the probe projects through first of all has a significant effect on the measured sharpness. An increase in the vicinal angle was also shown to generate a wider interface in the random step model. The Moison diffusion model produced an increase in the interface width with depth which closely matched the experimental results of the AlAs-on-GaAs interface. In contrast, the interface width decreased as a function of depth in the linear diffusion model. Only in the case of the perfect model was it possible to ascertain the underlying structure directly from HAADF image analysis.

Characterisation of InAs/GaAs short period superlattices using column ratio mapping in aberration-corrected scanning transmission electron microscopy.

The image processing technique of column ratio mapping was applied to aberration-corrected high angle annular dark field (HAADF) images of short period MBE (molecular beam epitaxy) grown InAs/GaAs superlattices. This method allowed the Indium distribution to be mapped and a more detailed assessment of interfacial quality to be made. Frozen-phonon multislice simulations were also employed to provide a better understanding of the experimental column ratio values. It was established that ultra-thin InAs/GaAs layers can be grown sufficiently well by MBE. This is despite the fact that the Indium segregated over 3-4 monolayers. Furthermore, the effect of the growth temperature on the quality of the layers was also investigated. It was demonstrated that the higher growth temperature resulted in a better quality superlattice structure.

What is the optimal follicular size before triggering ovulation in intrauterine insemination cycles with clomiphene citrate or letrozole? An analysis of 988 cycles.

OBJECTIVE: To determine the optimal size of the leading follicle before human chorionic gonadotropin (hCG) administration in cycles with clomiphene citrate (CC) and letrozole, and to examine any differences in the optimal leading follicle size between cycles with CC and letrozole. DESIGN: A retrospective study. SETTING: University hospital-based reproductive center. PATIENT(S): 1,075 women undergoing intrauterine insemination cycles with CC or letrozole. INTERVENTION(S): Leading follicle diameters and endometrial thickness were recorded 24 hours before hCG administration, together with other cycles parameters, and were compared between pregnant and nonpregnant patients. MAIN OUTCOME MEASURE(S): Leading follicle diameter and intrauterine insemination outcome. RESULT(S): Eight percent of patients (n = 87) were excluded because their leading follicle was less than 18 mm by days 11 to 13. Pregnancy was recorded as clinical pregnancy with fetal heart activity seen at 6- to 7-week transvaginal ultrasound. For both CC and letrozole, higher pregnancy rates were achieved when the leading follicles were in the 23 to 28 mm range. The optimal size of the leading follicle was not statistically significantly different between cycles using CC or letrozole. However, for each endometrial thickness, the optimal follicular size of the leading follicle was different. Each additional millimeter of endometrial thickness increased the optimal follicular size by 0.5 mm. Thicker endometrial lining led to a higher probability of pregnancy. CONCLUSION(S): The optimal size of the leading follicle in ovulation induction with CC and letrozole is similar for both drugs and is closely related to the endometrial thickness.

Experimental evaluation of interfaces using atomic-resolution high angle annular dark field (HAADF) imaging.

Aberration-corrected high angle annular dark field (HAADF) imaging in scanning transmission electron microscopy (STEM) can now be performed at atomic-resolution. This is an important tool for the characterisation of the latest semiconductor devices that require individual layers to be grown to an accuracy of a few atomic layers. However, the actual quantification of interfacial sharpness at the atomic-scale can be a complicated matter. For instance, it is not clear how the use of the total, atomic column or background HAADF signals can affect the measured sharpness or individual layer widths. Moreover, a reliable and consistent method of measurement is necessary. To highlight these issues, two types of AlAs/GaAs interfaces were studied in-depth by atomic-resolution HAADF imaging. A method of analysis was developed in order to map the various HAADF signals across an image and to reliably determine interfacial sharpness. The results demonstrated that the level of perceived interfacial sharpness can vary significantly with specimen thickness and the choice of HAADF signal. Individual layer widths were also shown to have some dependence on the choice of HAADF signal. Hence, it is crucial to have an awareness of which part of the HAADF signal is chosen for analysis along with possible specimen thickness effects for future HAADF studies performed at the scale of a few atomic layers.

Cost-effectiveness of vasectomy reversal.

In this era of cost-consciousness and containment, it is imperative to examine not only treatment outcomes but also cost of these treatments. With improvements of in vitro fertilization outcome and continued development of less-invasive sperm retrieval methods, physicians and couples must examine all options available after surgical sterilization. Vasectomy reversal remains the gold standard of treatment; however, certain situations may be present in which sperm acquisition/in vitro fertilization may be a better option. A physician's responsibility is to present all options with the pros and cons of each, including cost, to help arrive at an informed decision.

Outcomes after testicular aspiration and testicular tissue cryopreservation for obstructive azoospermia and ejaculatory dysfunction.

PURPOSE: We examined the rate of successful sperm retrieval, fertilization, pregnancy and live births in patients with obstructive azoospermia and ejaculatory dysfunction who underwent testicular sperm aspiration in conjunction with in vitro fertilization/intracytoplasmic sperm injection using cryopreserved testicular tissue. MATERIALS AND METHODS: We retrospectively reviewed the records of 40 couples who underwent testicular sperm aspiration from August 2003 to November 2007. All procedures were performed before intracytoplasmic sperm injection with the goal of tissue cryopreservation. RESULTS: Mature sperm was successfully retrieved and cryopreserved in 39 of 40 patients (97%) with an average of 5 vials cryopreserved per couple. Of the women 34 underwent in vitro fertilization/intracytoplasmic sperm injection and in 5 treatment was planned. The fertilization rate was 58% with a pregnancy rate of 61.4% (27 of 44 cycles). There were 17 live births, 5 ongoing pregnancies and 5 miscarriages. No complications were noted and all patients returned to full activity within 2 to 3 days. CONCLUSIONS: Testicular sperm aspiration with cryopreservation is a safe and effective sperm retrieval method in patients with obstructive azoospermia and ejaculatory dysfunction when in vitro fertilization/intracytoplasmic sperm injection will be performed.

Column ratio mapping: a processing technique for atomic resolution high-angle annular dark-field (HAADF) images.

An image processing technique is presented for atomic resolution high-angle annular dark-field (HAADF) images that have been acquired using scanning transmission electron microscopy (STEM). This technique is termed column ratio mapping and involves the automated process of measuring atomic column intensity ratios in high-resolution HAADF images. This technique was developed to provide a fuller analysis of HAADF images than the usual method of drawing single intensity line profiles across a few areas of interest. For instance, column ratio mapping reveals the compositional distribution across the whole HAADF image and allows a statistical analysis and an estimation of errors. This has proven to be a very valuable technique as it can provide a more detailed assessment of the sharpness of interfacial structures from HAADF images. The technique of column ratio mapping is described in terms of a [110]-oriented zinc-blende structured AlAs/GaAs superlattice using the 1 angstroms-scale resolution capability of the aberration-corrected SuperSTEM 1 instrument.

Non-targeted detection of chemical contamination in carbonated soft drinks using NMR spectroscopy, variable selection and chemometrics.

An efficient method for detecting malicious and accidental contamination of foods has been developed using a combined 1H nuclear magnetic resonance (NMR) and chemometrics approach. The method has been demonstrated using a commercially available carbonated soft drink, as being capable of identifying atypical products and to identify contaminant resonances. Soft-independent modelling of class analogy (SIMCA) was used to compare 1H NMR profiles of genuine products (obtained from the manufacturer) against retail products spiked in the laboratory with impurities. The benefits of using feature selection for extracting contaminant NMR frequencies were also assessed. Using example impurities (paraquat, p-cresol and glyphosate) NMR spectra were analysed using multivariate methods resulting in detection limits of approximately 0.075, 0.2, and 0.06 mM for p-cresol, paraquat and glyphosate, respectively. These detection limits are shown to be approximately 100-fold lower than the minimum lethal dose for paraquat. The methodology presented here is used to assess the composition of complex matrices for the presence of contaminating molecules without a priori knowledge of the nature of potential contaminants. The ability to detect if a sample does not fit into the expected profile without recourse to multiple targeted analyses is a valuable tool for incident detection and forensic applications.

Trizygotic quintuplet pregnancy following simultaneous embryo splitting in an oocyte donatin cycle.

PURPOSE: To report a trizygotic quintuplet pregnancy following simultaneous embryo splitting in an oocyte donation cycle after transfer of 3 embryos. METHODS: A 40-year-old Caucasian female G3P1 with two previous spontaneous abortions and diminished ovarian reserve presented for IVF. The patient underwent an oocyte donation cycle secondary to diminished ovarian reserve. Three embryos were transferred per patient request. RESULTS: The three embryo transfer resulted in a trizygotic quintuplet pregnancy. Selective embryo reduction was performed at 11 weeks leaving a dizygotic twin gestation. The patient underwent SVD, or spontaneous vaginal delivery at 36 weeks gestation with respective weights and apgars of 2673 g (apgars 7(1), 9(5)) and 2722 g (apgars 7(1), 9(5)). The twins are presently doing well without complications. CONCLUSIONS: Although rare, the possibility of simultaneous embryo splitting must be factored into determining number of embryos for fresh transfer.

Timing of hCG administration does not affect pregnancy rates in couples undergoing intrauterine insemination using clomiphene citrate.

BACKGROUND: Therapeutic intrauterine insemination (IUI) combined with clomiphene citrate ovarian stimulation is widely used to improve pregnancy rates for a variety of disorders. The goal of this study was to elucidate whether hCG administration at 24 or 36 hours after clomiphene citrate stimulation impacts pregnancy rates. METHODS: The study was conducted as a retrospective chart review of 182 clomiphene citrate/IUI cycles in 90 women at the Center for Reproductive Health at the University of Cincinnati Medical Center. Comparisons were made between IUls performed at 24 hours versus 36 hours after hCG. Clinical variables included age of the female partner, semen concentration and motility, and infertility diagnosis. Outcomes were pregnancy rates and live birth rates. Data analysis was performed using Chi square for proportions and Student's t-test for continuous variables. RESULTS: The pregnancy rate was 7% in the 24-hour group and 15.9% in the 36-hour group (P=0.057). However, the live birth rate was 4.0% in the 24-hour group and 8.5% in the 36-hour group (P=0.2). CONCLUSIONS: There is no significant difference in pregnancy rates in couples utilizing clomiphene citrate and undergoing IUI, whether hCG is administered at 24 hours or 36 hours prior to the procedure.