Pregnancy and neonatal outcomes in infertile patients with positive tuberculin skin test results.

RESEARCH QUESTION: Do infertile women with positive tuberculin skin test (TST) results have a higher risk of adverse pregnancy outcomes after IVF or intracytoplasmic sperm injection and embryo transfer (ICSI-ET) and does preventive anti-tuberculosis treatment applied to infertile women with positive TST results before IVF/ICSI-ET affect pregnancy and neonatal outcomes? DESIGN: This was a retrospective cohort analysis of 6283 infertile women who underwent IVF/ICSI-ET treatment for the first time at the Reproductive Hospital affiliated to Shandong University from November 2016 to September 2022. None of the participants had prior tuberculosis or active tuberculosis. According to their TST results, 5947 patients who had never received preventive anti-tuberculosis treatment were divided into a TST-positive group (1704 cases) and a TST-negative group (4243 cases). A total of 504 patients with TST (+++) results (using the 20 mm sclerosis threshold) were divided into a treated TST (+++) group (336 cases) and an untreated TST (+++) group (168 cases) according to whether they received preventive anti-tuberculosis treatment before IVF/ICSI-ET. The outcome measures were pregnancy outcomes and neonatal outcomes. RESULTS: There were no significant differences in pregnancy or neonatal outcomes between the TST-positive group and the TST-negative group (P > 0.05). In the TST (+++) group, there were no significant differences in pregnancy or neonatal outcomes between the treated TST (+++) group and the untreated TST (+++) group (P > 0.05). CONCLUSIONS: For infertile women undergoing IVF/ICSI-ET without prior tuberculosis or active tuberculosis, positive TST results and preventive anti-tuberculosis treatments prior to IVF/ICSI-ET do not affect pregnancy or neonatal outcomes.

Impact of a previous late miscarriage on subsequent pregnancy outcomes: A retrospective cohort study over 10 years.

OBJECTIVE: To explore the prognostic impact of a previous late miscarriage (LM) on the subsequent pregnancy outcomes of women with infertility. METHOD: This retrospective cohort study included couples who had experienced LM following their first embryo transfer during an in vitro fertilization (IVF) cycle from January 2008 to December 2020. Subgroup analysis and binary logistic regression were performed to evaluate the associations between LM due to different causes and subsequent pregnancy outcomes. RESULTS: A total of 1072 women who had experienced LM were included in this study, comprising 458, 146, 412, and 56 women with LM due to unexplained factors (unLM), fetal factors (feLM), cervical factors (ceLM; i.e. cervical incompetence), and trauma factors (trLM), respectively. Compared with the general IVF (gIVF) population, the early miscarriage rate was significantly higher in the unLM group (8.28% vs. 13.47%, adjusted odds ratio [OR] 1.60, 95% confidence interval [95% CI] 1.12-2.28; P = 0.01). Furthermore, women in the unLM and ceLM groups had a dramatically increased risk of recurrent LM (unLM: 4.24% vs. 9.43%, aOR 1.91, 95% CI 1.24-2.94; P = 0.003; ceLM: 4.24% vs.15.53%, aOR 2.68, 95% CI 1.82-3.95; P < 0.001) and consequently a reduced frequency of live birth (unLM: 49.96% vs. 43.01%, aOR 0.75, 95% CI 0.61-0.91; P = 0.004; ceLM: 49.96% vs. 38.59%, aOR 0.61, 95% CI 0.49-0.77; P < 0.001) compared with the gIVF population. CONCLUSION: A previous LM due to an unexplained factor or cervical incompetence was significantly associated with a higher risk of miscarriage and a lower live birth rate after subsequent embryo transfer.

Pregnancy and neonatal outcomes after long-term vitrification of blastocysts among 6,900 patients after their last live birth.

OBJECTIVE: To evaluate whether prolonged storage of vitrified blastocysts negatively impacts pregnancy and neonatal outcomes. DESIGN: A retrospective cohort study. SETTING: University hospital. PATIENT(S): A total of 6,900 patients who desired to transfer vitrified blastocysts from the same oocyte retrieval cycle as their last live birth met the inclusion criteria and were grouped according to the storage duration (1,890 patients in group 1 with storage duration < 3 years, 2,693 patients in group 2 with storage duration between 3 and 4 years, 1,344 patients in group 3 with storage duration between 4 and 5 years, 578 patients in group 4 with storage duration between 5 and 6 years and 395 patients in group 5 with storage duration ≥ 6 years but ≤ 10.5 years). INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Rates of blastocyst survival, biochemical pregnancy, clinical pregnancy, miscarriage, ectopic pregnancy, and live birth and neonatal outcomes. RESULT(S): The survival rates of the vitrified blastocysts significantly decreased with prolonged storage from group 1 to the subsequent groups 2, 3, 4, and 5. After adjusting for potential confounding factors, the rates of biochemical pregnancy, clinical pregnancy, and live birth were significantly decreased when the vitrified blastocysts were stored for more than 6 years (group 5) compared with these for less than 3 years (group 1) but no distinct differences were found in these above-mentioned indicators among group 1, 2, 3, and group 4 (group 1 as reference). However, no significant differences were noted in the rates of miscarriage and ectopic pregnancy and neonatal outcomes on prolonged storage of vitrified blastocysts. CONCLUSION(S): Long-term blastocyst vitrification for more than 6 years can negatively affect the rates of biochemical pregnancy, clinical pregnancy, and live birth but does not impact neonatal outcomes.

Value of Rehabilitation Training for Children with Cerebral Palsy Diagnosed and Analyzed by Computed Tomography Imaging Information Features under Deep Learning.

To analyze the brain CT imaging data of children with cerebral palsy (CP), deep learning-based electronic computed tomography (CT) imaging information characteristics were used, thereby providing help for the rehabilitation analysis of children with CP and comorbid epilepsy. The brain CT imaging data of 73 children with CP were collected, who were outpatients or inpatients in our hospital. The images were randomly divided into two groups. One group was the artificial intelligence image group, and hybrid segmentation network (HSN) model was employed to analyze brain images to help the treatment. The other group was the control group, and original images were used to help diagnosis and treatment. The deep learning-based HSN was used to segment the CT image of the head of patients and was compared with other CNN methods. It was found that HSN had the highest Dice score (DSC) among all models. After treatment, six cases in the artificial intelligence image group returned to normal (20.7%), and the artificial intelligence image group was significantly higher than the control group (X 2 = 335191, P < 0.001). The cerebral hemodynamic changes were obviously different in the two groups of children before and after treatment. The VP of the cerebral artery in the child was (139.68 ± 15.66) cm/s after treatment, which was significantly faster than (131.84 ± 15.93) cm/s before treatment, P < 0.05. To sum up, the deep learning model can effectively segment the CP area, which can measure and assist the diagnosis of future clinical cases of children with CP. It can also improve medical efficiency and accurately identify the patient's focus area, which had great application potential in helping to identify the rehabilitation training results of children with CP.

Heat shock protein 70 expression protects against sepsis-associated cardiomyopathy by inhibiting autophagy.

OBJECTIVES: Increasing evidence suggests that heat shock protein 70 (Hsp70) has a protective effect in sepsis-induced cardiomyopathy; however, the protective mechanism remains unclear. METHODS: Previous studies have also implicated autophagy in sepsis-induced cardiomyopathy. The aim of the current study was to reveal the protective mechanisms of Hsp70 in sepsis-induced cardiomyopathy using a cecal ligation and puncture (CLP) rat sepsis model. The roles of Hsp70 and autophagy in sepsis-induced cardiomyopathy were investigated by pretreating rats with the Hsp70 inhibitor quercetin or the autophagy inhibitor 3-methyladenine (3-Ma) before CLP. We also investigated the protective mechanisms of Hsp70 and the relationship between Hsp70 and autophagy in vitro by stimulating H9c2 cells with lipopolysaccharide (LPS) to simulate sepsis. RESULTS: The result show that inhibition of Hsp70 promoted sepsis-induced death in rats, while inhibition of autophagy inhibited sepsis-induced death. These results suggested that both Hsp70 and autophagy were involved in sepsis-induced cardiomyopathy. Overexpression of Hsp70 in H9c2 myocardial cells in vitro suppressed LPS-induced apoptosis, while inhibition of autophagy with 3-Ma also decreased LPS-induced H9c2 cell apoptosis, suggesting that the protective effect of Hsp70 in sepsis-induced cardiomyopathy was related to autophagy regulation. CONCLUSION: Overall, these results suggested that Hsp70 protected against sepsis-induced cardiac impairment by attenuating sepsis-induced autophagy.

Point-of-care microcirculation evaluated with sidestream dark field technology: agreement and comparison between sublingual and sublabial mucosa.

To investigate whether sublabial mucosa is more suitable for evaluation of microcirculation than commonly used sublingual mucosa in ICU patients, we enrolled 57 adults (47 critically ill patients and 10 volunteers) at convenience from Oct 2018 to Jan 2019. Videomicroscopy images at both sublingual mucosa and sublabial mucosa were acquired at the same time in each enrollee. Qualified images were recorded for later analysis. Four video clips of the same site were comprehensively evaluated to yield one Point Of carE Microcirculation (POEM) score by blinded investigator; POEM scores at both sites were statistically analyzed for correlation and agreement. Procedure time needed to acquire qualified images was also compared. POEM scores between the two sites showed no significant difference and a statistically significant correlation (Spearman correlation coefficient 0.716, P < 0.001). The intra-class correlation coefficient was 0.866 (95% C.I. 0.774, 0.921), suggesting good to excellent consistency and agreement between the POEM scores at the two sites. The procedure time needed to acquire 4 clips of qualified images at sublingual and sublabial sites were 10.5±3.9 minutes and 7.1±3.3 minutes respectively, P < 0.001. This study indicates that point of care evaluation of microcirculation by POEM score shows good to excellent agreement between sublingual mucosa and sublabial mucosa. It is easier to acquire qualified videomicroscopy images at sublabial mucosa than at sublingual mucosa. Therefore, sublabial mucosa might be more suitable for bedside evaluation of microcirculation with handheld SDF device in ICU.

Path-following and semismooth Newton methods for the variational inequality arising from two membranes problem.

A semismooth Newton method, based on variational inequalities and generalized derivative, is designed and analysed for unilateral contact problem between two membranes. The problem is first formulated as a corresponding regularized problem with a nonlinear function, which can be solved by the semismooth Newton method. We prove the convergence of the method in the function space. To improve the performance of the semismooth Newton method, we use the path-following method to adjust the parameter automatically. Finally, some numerical results are presented to illustrate the performance of the proposed method.

Predictors and patterns of chronic pain three months after cardiac surgery in Taiwan.

OBJECTIVES: Clinicians and researchers have a very limited understanding of how acute pain after cardiac surgery may develop into chronic pain. The aims of this study were to describe the pattern of pain during the first 3 months after cardiac surgery and to examine the predictors of surgery-related chronic pain. DESIGN: A prospective panel study was conducted to monitor changes in worst and average pain intensity before and during the first 3 months following cardiac surgery in a sample of Taiwanese patients. Fifty-three patients who underwent a midsternotomy rated pain intensity before surgery and at postoperative days 7, 10, 30, and 90. The participants also rated beliefs about opioid use, and their medical records were reviewed to document opioid use during the first week after surgery. RESULTS: The patients who reported chronic pain 90 days following surgery showed an unusual pattern of an increase in pain from 10 to 30 days after surgery. Higher worst pain intensity ratings at 30 days following surgery and more negative beliefs in opioid use were both associated with a greater likelihood of reporting chronic pain at 3 months. CONCLUSION: Patients reporting a pattern of increasing pain starting about 10 days after surgery and holding negative beliefs about opioid use are at risk of developing chronic pain and may require more careful monitoring and pain treatment. The possible benefits of interventions that minimize pain during the weeks after surgery and that alter negative beliefs about opioid use should be examined in future research.