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Yorke A, Hunthausen N, Paly J, Carter R, Yang F, Jhingran A, Della Biancia C, Dempsey C, Shulman A, Ford E, Li B. Needs and Strengths Assessment for Radiotherapy Centers in Africa Transitioning to IMRT. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wang W, Shilo K, Amann J, Shulman A, Hojjat-Farsangi M, Mellstedt H, Schultz J, Croce C, Carbone D. P47.10 Predicting ROR1/BCL2 Combination Targeted Therapy of Small Cell Carcinoma of the Lung. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Masgutov R, Masgutova G, Mullakhmetova A, Zhuravleva M, Shulman A, Rogozhin A, Syromiatnikova V, Andreeva D, Zeinalova A, Idrisova K, Allegrucci C, Kiyasov A, Rizvanov A. Adipose-Derived Mesenchymal Stem Cells Applied in Fibrin Glue Stimulate Peripheral Nerve Regeneration. Front Med (Lausanne) 2019; 6:68. [PMID: 31024916 PMCID: PMC6465797 DOI: 10.3389/fmed.2019.00068] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 03/19/2019] [Indexed: 01/01/2023] Open
Abstract
Mesenchymal stem cells (MSCs) hold a great promise for cell therapy. To date, they represent one of the best choices for the treatment of post-traumatic injuries of the peripheral nervous system. Although autologous can be easily transplanted in the injured area, clinical advances in this filed have been impaired by lack of preservation of graft cells into the injury area after transplantation. Indeed, cell viability is not retained after injection into the blood stream, and cells injected directly into the area of injury either are washed off or inhibit regeneration through scar formation and neuroma development. This study proposes a new way of MSCs delivery to the area of traumatic injury by using fibrin glue, which not only fixes cells at the site of application but also provides extracellular matrix support. Using a sciatic nerve injury model, MSC derived from adipose tissue embedded in fibrin glue were able to enter the nerve and migrate mainly retrogradely after transplantation. They also demonstrated a neuroprotective effect on DRG L5 sensory neurons and stimulated axon growth and myelination. Post-traumatic changes of the sensory neuron phenotype were also improved. Importantly, MSCs stimulated nerve angiogenesis and motor function recovery. Therefore, our data suggest that MSC therapy using fibrin glue is a safe and efficient method of cell transplantation in cases of sciatic nerve injury, and that this method of delivery of regeneration stimulants could be beneficial for the successful treatment of other central and peripheral nervous system conditions.
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Affiliation(s)
- Ruslan Masgutov
- OpenLab Gene and Cell Technologies, Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
- Department of Orthopaedics, Republic Clinical Hospital, Kazan, Russia
| | - Galina Masgutova
- OpenLab Gene and Cell Technologies, Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
| | - Adelya Mullakhmetova
- OpenLab Gene and Cell Technologies, Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
| | - Margarita Zhuravleva
- OpenLab Gene and Cell Technologies, Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
| | - Anna Shulman
- Scientific Department, Republic Clinical Hospital, Kazan, Russia
| | - Alexander Rogozhin
- OpenLab Gene and Cell Technologies, Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
- Department of Neurology, Kazan State Medical Academy, Branch of Russian Medical Academy of Postgraduate Education, Kazan, Russia
| | - Valeriya Syromiatnikova
- OpenLab Gene and Cell Technologies, Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
| | - Dina Andreeva
- OpenLab Gene and Cell Technologies, Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
| | - Alina Zeinalova
- OpenLab Gene and Cell Technologies, Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
| | - Kamilla Idrisova
- OpenLab Gene and Cell Technologies, Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
| | - Cinzia Allegrucci
- School of Veterinary Medicine and Science, University of Nottingham, Nottingham, United Kingdom
| | - Andrey Kiyasov
- OpenLab Gene and Cell Technologies, Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
| | - Albert Rizvanov
- OpenLab Gene and Cell Technologies, Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
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Shulman A, Peltonen M, Sjöström CD, Andersson-Assarsson JC, Taube M, Sjöholm K, le Roux CW, Carlsson LMS, Svensson PA. Incidence of end-stage renal disease following bariatric surgery in the Swedish Obese Subjects Study. Int J Obes (Lond) 2018; 42:964-973. [PMID: 29568103 PMCID: PMC6019553 DOI: 10.1038/s41366-018-0045-x] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 11/24/2017] [Accepted: 12/07/2017] [Indexed: 01/08/2023]
Abstract
Background Obesity is a major public health problem leading to co-morbidities such as diabetes, hypertension and kidney failure. Bariatric surgery results in pronounced and maintained weight loss and prevention of obesity-related diseases and their complications. Most studies of bariatric surgery on kidney disease show improvements after surgery. However, long-term studies analyzing hard end-points are lacking. Here we report on the long-term effects of bariatric surgery compared to usual obesity care on incidence of end-stage renal disease (ESRD) alone and in combination with chronic kidney disease stage 4 (CKD4/ESRD). Methods 4047 patients were included in the Swedish Obese Subjects (SOS) study. Inclusion criteria were age 37–60 years and BMI≥34 in men and BMI≥38 in women. Patients in the bariatric surgery group (N=2010) underwent banding (18%), vertical banded gastroplasty (69%) or gastric bypass (13%); controls (N=2037) received usual obesity care. In this analysis, patients were followed up for a median time of 18 years. The incidence of ESRD and CKD4 was obtained by crosschecking the SOS database with the Swedish National Patient Register. Results During follow-up, ESRD occurred in 13 patients in the surgery group and in 26 patients in the control group (adjusted hazard ratio (HR) = 0.27; 95% CI 0.12 – 0.60; p=0.001). The number of CKD4/ESRD events was 23 in the surgery group and 39 in the control group (adjusted HR = 0.33; 95% CI 0.18 – 0.62; p<0.001). In both analyses, bariatric surgery had a more favorable effect in patients with baseline serum insulin levels above median compared to those with lower insulin levels (interaction p=0.010). Treatment benefit of bariatric surgery was also greater in patients with macroalbuminuria at baseline compared to those without macroalbuminuria (interaction p<0.001). Conclusions Our study showed for the first time that bariatric surgery is associated with a long-term protection against ESRD and CKD4/ESRD.
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Affiliation(s)
- A Shulman
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - M Peltonen
- Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - C D Sjöström
- Global Medicines Development, Cardiovascular and Metabolic Disease, AstraZeneca, Gothenburg, Sweden
| | - J C Andersson-Assarsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - M Taube
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - K Sjöholm
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - C W le Roux
- Diabetes Complications Research Centre, Conway Institute, University College Dublin, Dublin, Ireland.,Investigative Science, Imperial College London, London, UK
| | - L M S Carlsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - P-A Svensson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. .,Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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Aviram R, Aviram A, Gvili S, Zimmer Y, Shulman A, Tepper R. Software toolbox for analysis of the endometrial myometrial junction - a pilot study. CLIN EXP OBSTET GYN 2017. [DOI: 10.12891/ceog3905.2017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Aviram R, Aviram A, Gvili SO, Zimmer Y, Shulman A, Tepper R. Software toolbox for analysis of the endometrial myometrial junction - a pilot study. CLIN EXP OBSTET GYN 2017; 44:440-443. [PMID: 29949289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE To develop and evaluate an algorithm for computerized evaluation and measurement of the endometrial-myometrial junction (EMJ). MATERIALS AND METHODS The advanced image processing toolbox of the Matlab software package was used for identificiation and quantitative analysis of the EMJ area on three-dimensional (3D) rendered coronal plane uterine images, with clear-cut borders of the EMJ. The algorithm was used to process the images and calculate the geometric parameters characterizing the identified EM The manual measurements of the maximum thickness of the EMJ were compared to automated measurements performed by the algorithm on the same images. RESULTS For all three interfaces, the mean maximum manual measurement was less than the mean maximui computed measurement. The differences between the two measurements were not statistically significant (p = 0.275, 0.608 and 0.41 for the right wall, left wall, and fundus, respectively). The mean systematic and random errors ranged from 5.4% tol9.3% and 20.4 to 48.6%, respectively. Pearson correlations for the right wall, left wall and fundus (r = 0.642, p = 0.001; r = 0.730, p < 0.001, and r 0.694, p < 0.001, respectively) were good. CONCLUSIONS Maximum EMJ thickness measurements performed by the innovative Matla software algorithm are as accurate as manual measurements, and have the potential to reduce inter-observer variability.
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Haikin Herzberger E, Miller N, Ghetler Y, Tamir Yaniv R, Amichay Keren K, Shulman A, Wiser A. High C-reactive protein levels in women undergoing IVF are associated with low quality embryos. Fertil Steril 2016. [DOI: 10.1016/j.fertnstert.2016.07.756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Haikin Herzberger E, Hershko Klement A, Mazaki-Tovi S, Kanety H, Hemi R, Zada N, Shulman A, Wiser A. Changes in serum inhibin B levels throughout controlled ovarian hyperstimulation, rather than initial concentrations, are better predictors of ovarian response. Fertil Steril 2016. [DOI: 10.1016/j.fertnstert.2016.07.894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Ganor-Paz Y, Friedler-Mashiach Y, Ghetler Y, Hershko-Klement A, Berkovitz A, Gonen O, Shulman A, Wiser A. What is the best treatment for women with polycystic ovarian syndrome and high LH/FSH ratio? A comparison among in vitro fertilization with GnRH agonist, GnRH antagonist and in vitro maturation. J Endocrinol Invest 2016; 39:799-803. [PMID: 26797707 DOI: 10.1007/s40618-015-0429-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 12/28/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate whether high LH/FSH ratio has a clinical impact on patients with polycystic ovary syndrome (PCOS) undergoing in vitro fertilization (IVF) with GnRH-agonist/antagonist protocols or in vitro maturation (IVM) treatments. METHODS We retrospectively reviewed all PCOS patients with day 3 LH/FSH ratio ≥1.5 who underwent IVF or IVM. The main outcomes measures were embryo quality and pregnancy rate. RESULTS A total of 75 cycles were included. Among these, 44 patients underwent long agonist protocol, 16 antagonist protocol and 15 IVM. Age, basal LH and FSH levels, as well as duration of infertility were comparable for all groups. The LH level on the day of hCG administration was significantly lower in the antagonist group (0.9 IU/ml) compared to the long agonist group (1.4 IU/ml, p = 0.01). There was no difference in pregnancy rates among the groups: 27.2 % in the long agonist group, 37.5 % in the antagonist group and 26.6 % among the IVM patients. CONCLUSIONS High LH/FSH ratio had no adverse effect on pregnancy rates in all three treatment modes.
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Affiliation(s)
- Y Ganor-Paz
- Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tshernichovsky Street, Kfar Saba, Israel.
- Tel Aviv University, Tel Aviv, Israel.
| | - Y Friedler-Mashiach
- Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tshernichovsky Street, Kfar Saba, Israel
| | - Y Ghetler
- Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tshernichovsky Street, Kfar Saba, Israel
- Tel Aviv University, Tel Aviv, Israel
| | - A Hershko-Klement
- Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tshernichovsky Street, Kfar Saba, Israel
- Tel Aviv University, Tel Aviv, Israel
| | - A Berkovitz
- Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tshernichovsky Street, Kfar Saba, Israel
- Tel Aviv University, Tel Aviv, Israel
| | - O Gonen
- Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tshernichovsky Street, Kfar Saba, Israel
- Tel Aviv University, Tel Aviv, Israel
| | - A Shulman
- Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tshernichovsky Street, Kfar Saba, Israel
- Tel Aviv University, Tel Aviv, Israel
| | - A Wiser
- Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tshernichovsky Street, Kfar Saba, Israel
- Tel Aviv University, Tel Aviv, Israel
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Makufa R, Bvochora-Nsingo M, Karumekayi T, Schneider RJ, Efstathiou JA, Dryden-Peterson S, Odom A, Shulman A, Pipman Y, Gierga DP. SU-F-P-09: A Global Medical Physics Collaboration for Implementation of Modern Radiotherapy in Botswana. Med Phys 2016. [DOI: 10.1118/1.4955716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Agbeve R, Doudoo C, Acquah G, Oppong P, Shulman A. Evolution of the ideal workflow: A case study of prostate cancer radiotherapy at SGMC. Phys Med 2015. [DOI: 10.1016/j.ejmp.2015.07.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Shulman A. WE-AB-213-01: AAPM Projects and Collaborations in Africa. Med Phys 2015. [DOI: 10.1118/1.4925832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Haas J, Yinon Y, Shulman A. Perinatal outcome of twin pregnancies following multifetal pregnancy reduction: when is the optimal time to perform it? Fertil Steril 2014. [DOI: 10.1016/j.fertnstert.2014.07.278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Adler A, Assous MV, Paikin S, Shulman A, Miller-Roll T, Hillel S, Aronov R, Carmeli Y, Schwaber MJ. Emergence of VIM-producing Aeromonas caviae in Israeli hospitals. J Antimicrob Chemother 2014; 69:1211-4. [DOI: 10.1093/jac/dkt505] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
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Cohen S, Jakobson-Setton A, Shulman A. Hysteroscopically Guided Transvaginal Ultrasound Tubal Catheterization – A Novel Office Procedure. J Minim Invasive Gynecol 2013. [DOI: 10.1016/j.jmig.2013.08.468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Haas J, Dor J, Hourvitz A, Shulman A. A comparative study of early multifetal pregnancy reduction from triplets to twins versus triplets to singeltons performed at 7-8 weeks of gestation. Fertil Steril 2013. [DOI: 10.1016/j.fertnstert.2013.07.335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Hershko Klement A, Berkovitz A, Wiser A, Gonen O, Amichay K, Shulman A. Follicular estrogen for GnRH-antagonist protocol programming: a prospective randomized clinical trial. Fertil Steril 2013. [DOI: 10.1016/j.fertnstert.2013.07.263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
STUDY QUESTION Does the position of the germinal vesicle (GV) in human oocytes correlate with molecular and morphological parameters as well as with maturation-competence? SUMMARY ANSWER The position of GV in human oocytes correlates with density of microtubule (MT) filaments, concentration of Fyn, nucleolus localization and the ability of the oocytes to complete maturation following GV breakdown (GVBD). WHAT IS KNOWN ALREADY Our knowledge is confined to oocytes of young mice where maturation-competence is correlated with a central GV and regulated by MTs and the presence of a chromatin ring. Fyn kinase is localized at the spindle and cortex of mouse oocytes and plays a role in both maturation and MT stabilization. STUDY DESIGN, SIZE, DURATION Spatial localization of the GV and nucleolus (central or peripheral), the presence of a chromatin ring, the localization of Fyn, MT density and oocyte maturation were assessed in 153 human oocytes, 335 oocytes from young mice (2-month-old) and 146 oocytes from old mice (12-month-old). PARTICIPANTS/MATERIALS, SETTING, METHODS GV human oocytes were donated by consenting female patients (n = 57), 21-45-year-old undergoing IVF/ICSI. As a control, GV mouse oocytes were collected from female mice after injection of pregnant mares' serum gonadotrophin. Human and mouse GV oocytes allocated for immunocytochemistry were fixed on day of retrieval, stained with specific antibodies and imaged using a confocal laser-scanning microscope. Human and mouse oocytes allocated for maturation were incubated for 48 and 24 h, respectively. GVBD and extrusion of the first polar body (PBI) were assessed using differential interference contrast optics. MAIN RESULTS AND THE ROLE OF CHANCE GV location was peripheral and independent of age in 69.9% of the human oocytes, but GV location did vary with age in mice oocytes; it was central in 89.9% of the oocytes retrieved from young-mice and peripheral in 52.1% of the oocytes retrieved from old mice (P < 0.05). A central GV, whether in human or mouse oocytes, was highly correlated with a central nucleolus, absence of Fyn at the GV and a dense MT network (P < 0.05), whereas a peripheral GV correlated with peripheral nucleolus, presence of Fyn at the GV and a flimsy MT network. After 48 h in culture, no degeneration was observed in human central-GV oocytes, however, 12/95 (12.6%) of the peripheral-GV oocytes degenerated (P < 0.05). No correlation was observed between GV position and presence of a chromatin ring. The percentage of human oocytes that extruded the PBI after completing GVBD was significantly higher (73.7%) in central than in peripheral-GV oocytes (45.8%; P < 0.05). In mice oocytes, central location of the GV correlated with maturation competence in young (P < 0.05) but not old mice. LIMITATIONS, REASONS FOR CAUTION The fact that the human GV oocytes used in this study were exposed to gonadotrophic stimulation but failed to mature in vivo might be a sign of their low quality and this should be considered when drawing conclusions from the data. Furthermore, our observation that only peripheral-GV human oocytes were degraded may indicate that they are of a lower quality than central-GV human oocytes. WIDER IMPLICATIONS OF THE FINDINGS We suggest that the central location of GV within the oocytes, which is associated with an absence of Fyn at the GV and the presence of thick filamentous MTs in the ooplasm, may serve as a predictor of successful maturation and provide new insights for the use of IVM.
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Affiliation(s)
- M Levi
- Department of Cell and Developmental Biology, Tel Aviv University, Tel-Aviv, Israel.
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Wiser A, Sachar S, Ghetler Y, Shulman A, Breitbart H. Assessment of sperm hyperactivated motility and acrosome reaction can discriminate the use of spermatozoa for conventional in vitro fertilisation or intracytoplasmic sperm injection: preliminary results. Andrologia 2013; 46:313-5. [PMID: 23356546 DOI: 10.1111/and.12068] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2012] [Indexed: 12/25/2022] Open
Abstract
Basic semen analysis is insufficient for determining the fertility potential. The aim of this study was to determine if hyperactivated motility (HAM) and acrosome reaction (AR) can be useful tests for evaluating semen quality during male infertility evaluations and to help the clinician decide whether regular insemination or intracytoplasmic sperm injection (ICSI) is preferable during in vitro fertilisation. A prospective study was conducted. Patients with normal sperm according to World Health Organization guidelines who underwent IVF treatment and planned regular insemination were asked to participate. A portion of sperm sample was evaluated for HAM and AR on day of ovum pick up. In HAM assessment, 93.3% of patients with increased HAM had a high fertilisation rate compared with 64% in the group without increased HAM (P = 0.059). For the AR evaluation, 91.7% of samples with a low rate of spontaneous AR had a high fertilisation rate compared with 39.3% in the group with a high rate of spontaneous AR (P = 0.004).
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Affiliation(s)
- A Wiser
- IVF Unit, Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Sava, Israel
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Shulman A. WE-A-211-02: Establishing a Modern Radiation Oncology Infrastructure in West Africa Through the Systematic Resolution of the Fundamental Problems Associated with Medicine in the Region. Med Phys 2012. [DOI: 10.1118/1.4736038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Shahar S, Wiser A, Ickowicz D, Lubart R, Shulman A, Breitbart H. Light-mediated activation reveals a key role for protein kinase A and sarcoma protein kinase in the development of sperm hyper-activated motility. Hum Reprod 2011; 26:2274-82. [PMID: 21771771 DOI: 10.1093/humrep/der232] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Hyper-activated motility (HAM) is part of the sperm capacitation process, which is necessary for fertilization. In this study, we investigated the effect of visible light on sperm motility and hyperactivation and evaluated pathways mediating these effects. METHODS Human sperm (1 × 10⁷ cells/ml) in capacitation media were irradiated for 3 min with 40 mW/cm² visible light (400-800 nm with maximum energy at 600 nm). Sperm motility was assessed and analyzed by computer-assisted sperm analysis. The involvement of sperm capacitation factors was investigated as follows. The generation of reactive oxygen species (ROS) was measured using 20,70-dichlorofluorescein diacetate. Protein kinase A (PKA) and sarcoma protein kinase (Src) activity were measured using western blot analysis and inhibited using 50 µM H89 and 10 µM PP2, respectively. Soluble adenlyl cyclase was inhibited using 20 µM 2-OH-Estradiol. The intracellular concentration of free Ca(2+) was assessed using the fluorescent calcium indicator, Fluo-4/AM. Sperm DNA fragmentation was determined using the sperm chromatin dispersion test. RESULTS Light irradiation of human sperm caused a significant increase in hyper-HAM but not total motility. The production of ROS and activation of soluble adenylyl cyclase and PKA mediated the effect of light on HAM. Light irradiation also activated Src, and inhibition of Src significantly reduced the effect of light on HAM. Light irradiation caused a rapid increase in intracellular Ca²⁺ concentration and the increase in HAM was significantly reduced when voltage-dependent-Ca²⁺-channel activity was blocked or when Ca²⁺-deficient medium was used. CONCLUSIONS Light irradiation of human sperm for a short time causes a significant increase in HAM in a mechanism mediated by ROS production, activation of PKA, Src and Ca²⁺ influx.
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Affiliation(s)
- S Shahar
- The Mina & Everard Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan 52900, Israel
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Wiser A, Ghetler Y, Gonen O, Piura E, Berkovits A, Itskovich A, Rom T, Shulman A. Re-evaluation of post-wash sperm is a helpful tool in the decision to perform in vitro fertilisation or intracytoplasmic sperm injection. Andrologia 2011; 44:73-7. [PMID: 21714800 DOI: 10.1111/j.1439-0272.2010.01107.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The aim of this study was to find discriminatory parameters, based on sperm characteristics on the day of ovum pickup, that can help guide the decision to perform either intracytoplasmic sperm injection (ICSI) or in vitro fertilisation (IVF). We evaluated 112 cycles fertilised with both regular and ICSI insemination during the same cycle. A total of 112 cycles were analysed. In 62 cycles, fertilisation was obtained with both ICSI and IVF, and in 50 cycles, fertilisation was obtained by ICSI alone. The sperm samples were re-evaluated after the preparation process. The mean initial total motile sperm count (TMSC) was 66.3 × 10(6) ± 47.5 in the group that underwent both methods and 23.1 × 10(6) ± 20.4 in the ICSI only group (P < 0.05). After sperm preparation, the mean post-wash TMSC was 4.4 × 10(6) ± 3.4 and 1.06 × 10(6) ± 0.9 respectively (P < 0.05). A cutoff of 1.5 × 10(6) or fewer sperm after preparation as an indicator for ICSI has a sensitivity of 80% and a specificity of 77%. Re-evaluation of TMSC can prevent unexpected fertilisation failure. Fewer than 1.5 million TMSC after wash should be considered an indication for ICSI fertilisation.
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Affiliation(s)
- A Wiser
- IVF Unit, Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Sava, Israel.
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Wiser A, Shulman A. Reply: DHEA administration in poor responders. Hum Reprod 2011. [DOI: 10.1093/humrep/deq398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
OBJECTIVE This study aims to evaluate the impact of a national mental health arts festival for the general public, encompassing a wide variety of art forms and themes. METHOD An evaluation was undertaken with 415 attendees from 20 different events, combining qualitative and quantitative approaches. RESULTS The findings demonstrate positive impact on the relationship between arts and mental health. Events increased positive attitudes, including positive representations of people's contributions, capabilities and potential to recover. They did not decrease negative attitudes. Intended behaviour change was modest and one film event increased audience perceptions of dangerousness. CONCLUSION The paper argues that the arts can change stigma by constructing shared meanings and engaging audiences on an emotional level. Carefully programmed, collaborative, community-based arts festivals should form an integral part of national programmes to address stigma and to promote mental health and wellbeing, alongside traditional social marketing and public education approaches.
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Affiliation(s)
- N Quinn
- Universities of Strathclyde and Glasgow, UK
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Wiser A, Gonen O, Ghetler Y, Shavit T, Berkovitz A, Shulman A. Addition of dehydroepiandrosterone (DHEA) for poor-responder patients before and during IVF treatment improves the pregnancy rate: a randomized prospective study. Hum Reprod 2010; 25:2496-500. [PMID: 20729538 DOI: 10.1093/humrep/deq220] [Citation(s) in RCA: 152] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate the effect of dehydroepiandrosterone (DHEA) supplementation on in vitro fertilization (IVF) data and outcomes among poor-responder patients. METHODS A randomized, prospective, controlled study was conducted. All patients received the long-protocol IVF. Those in the study group received 75 mg of DHEA once a day before starting the next IVF cycle and during treatment. RESULTS Thirty-three women with significantly diminished ovarian reserves were enrolled, 17 in the DHEA group and 16 in the control group. The 33 patients underwent 51 IVF cycles. The DHEA group demonstrated a non-significant improvement in estradiol levels on day of hCG (P = 0.09) and improved embryo quality during treatment (P = 0.04) between first and second cycles. Patients in the DHEA group also had a significantly higher live birth rate compared with controls (23.1% versus 4.0%; P = 0.05), respectively. Six of seven deliveries were among patients with secondary infertility (P = 0.006). CONCLUSION Dehydroepiandrosterone supplementation can have a beneficial effect on ovarian reserves for poor-responder patients on IVF treatment. Clinicaltrials.gov: NCT01145144.
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Affiliation(s)
- A Wiser
- IVF Unit, Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel.
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Simchen MJ, Shulman A, Wiser A, Zilberberg E, Schiff E. The aged uterus: multifetal pregnancy outcome after ovum donation in older women. Hum Reprod 2009; 24:2500-3. [DOI: 10.1093/humrep/dep238] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Machtinger R, Stockheim D, Seidman D, Dor J, Schiff E, Shulman A. O-41. Fertil Steril 2006. [DOI: 10.1016/j.fertnstert.2006.07.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Wiser A, Baum M, Elitzur S, Dor J, Shulman A. The “Aging” of Endometrium, and its Impact on ART Treatments Results. Fertil Steril 2005. [DOI: 10.1016/j.fertnstert.2005.07.665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Wiser A, Levron J, Kreizer D, Achiron R, Shrim A, Schiff E, Dor J, Shulman A. Outcome of pregnancies complicated by severe ovarian hyperstimulation syndrome (OHSS): a follow-up beyond the second trimester. Hum Reprod 2005; 20:910-4. [PMID: 15618246 DOI: 10.1093/humrep/deh713] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
UNLABELLED The main aim of this study was to assess the obstetric complications for those pregnancies that are complicated by ovarian hyperstimulation syndrome (OHSS) and continue beyond the first trimester. We checked also for other related serious events that occurred during the first trimester. METHODS We included only patients whose pregnancies continued beyond the first trimester and compared them with IVF-treated patients displaying moderate ovarian response. RESULTS We studied 165 patients with OHSS (101 singletons and 64 twins) and 156 IVF control patients (85 singletons and 71 twins). Two serious complications, gestational diabetes mellitus (GDM) and pregnancy-induced hypertension (PIH), were noted in both groups. However, the incidence of these two complications did not differ significantly between the groups. In the OHSS group, GDM presented with an incidence of 9.9% for singletons and 9.4% for twins, and 12.9% and 7.0%, respectively, for the control group. PIH presented as 6.9% for singletons and 10.9% for twins in the OHSS group, and 8.2% and 7.0%, respectively, for the control groups. During the first trimester laparoscopies for suspected ovarian torsion were performed in 13 patients, and in 10 patients the diagnosis were confirmed. CONCLUSIONS Although patients with OHSS-complicated pregnancies previously reported a relatively high risk of GDM and PIH, the occurrence rates do not differ from a matched control group of normally responding patients who conceived after IVF.
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Affiliation(s)
- A Wiser
- IVF Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer (affiliated with Sackler Faculty of Medicine, Tel Aviv University), Israel
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Machtinger R, Stockheim D, Seidman D, Schiff E, Shulman A. Clinical assessment is suboptimal (not enough) to establish complete uterine evacuation after medical abortion: A prospective study of 430 cases. Fertil Steril 2004. [DOI: 10.1016/j.fertnstert.2004.07.363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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31
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Machtinger R, Stockheim D, Shulman A, Dulitzki M, Schiff E, Seidman D. A randomized prospective study comparing the effectiveness of four protocols for treatment of first trimester spontaneous abortion. Fertil Steril 2004. [DOI: 10.1016/j.fertnstert.2004.07.204] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Shulman A, Strashun A. Descending auditory system/cerebellum/tinnitus. Int Tinnitus J 2003; 5:92-106. [PMID: 10753427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
The cerebellum and the descending auditory system (DAS) are considered clinically significant for influencing the development of the clinical course of tinnitus of the severe disabling type. It is hypothesized that the SPECT of Brain perfusion asymmetries in cerebellum, demonstrated since 1993, reflect clinically the influence of an aberrant auditory stimulus i.e. tinnitus, on the activity and function of the descending auditory system highlighted by the cerebellum and the acousticomotor systems. SPECT of Brain perfusion asymmetries in the cerebellum have been demonstrated in 60-70% of tinnitus patients of the central type. Electrophysiologic support for this finding includes interference in ocular fixation suppression of the vestibulocular (VOR) with rotation and position testing. Abnormalities in cerebellar function are considered to reflect the psychomotor component of tinnitus. Support for the hypothesis is demonstrated with one patient with a predominantly central type tinnitus of the severe disabling type with cerebellar perfusion asymmetries and associated electrophysiologic evidence of interference in the VOR with rotation testing.
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Affiliation(s)
- A Shulman
- Martha Entenmann Tinnitus Research Center, Inc, Health Sciences Center at Brooklyn, State University of New York, Brooklyn, New York 11203, USA
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Ferber-Meiri B, Lamer-Geva L, Levron J, Shulman A, Bider D, Levin T. The effect of seasonal changes on IVF outcome. Fertil Steril 2003. [DOI: 10.1016/s0015-0282(03)01239-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Zalel Y, Gamzu R, Shulman A, Achiron R, Schiff G, Lidor A. The progestative effect of the levonorgestrel-releasing intrauterine system--when does it manifest? Contraception 2003; 67:473-6. [PMID: 12814817 DOI: 10.1016/s0010-7824(03)00044-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The objective of the study was to evaluate, clinically and sonographically, the time required for the progestative effect of the levonorgestrel-releasing intrauterine system (IUS, Mirena) to be manifested. Doppler flow of the cervical branch and spiral artery of the uterine artery, as well as the endometrial width (up to day 10 of the cycle), were evaluated in 36 women carrying levonorgestrel-releasing IUS 1-2 months after insertion of the device compared to 4-6 months after insertion. The rate of intermenstrual bleeding was reduced from 44% during the first 2 months, to only 8% of women after 4-6 months of use. Complete cessation of menstrual bleeding occurred in 5% after 2 months and in 66% after 4-6 months following insertion. While there was no change in the Doppler flow in the cervical branch of the uterine artery between both groups, there was a significant reduction in the subendometrial flow in the spiral artery. This observation was reinforced by the demonstration of significant reduction in endometrial thickness in the following 4 months of use. The present study has demonstrated that the local progestative effect of the levonorgestrel-releasing IUS on the endometrium is already manifested within a period of 3 months and over after insertion.
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Affiliation(s)
- Y Zalel
- The Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, and Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Gan, 52621, Tel-Hashomer, Israel.
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35
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Zalel Y, Shulman A, Lidor A, Achiron R, Mashiach S, Gamzu R. The local progestational effect of the levonorgestrel-releasing intrauterine system: a sonographic and Doppler flow study. Hum Reprod 2002; 17:2878-80. [PMID: 12407042 DOI: 10.1093/humrep/17.11.2878] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND We aimed to evaluate the effect of the levonorgestrel-releasing intrauterine system (LNG-IUS) on the uterine vasculature and the endometrium. METHODS The study was a prospective controlled study evaluating the local effects of LNG-IUS compared with the copper intrauterine device (IUD). Forty-seven women carrying LNG-IUS (group A) were compared with 35 women carrying copper IUD in a control group (group B). Clinical measures of menstrual bleeding, endometrial thickness and Doppler flow of the cervical branch of the uterine artery and spiral artery were evaluated and compared between the two groups. RESULTS Doppler flow in the cervical branch of the uterine artery did not reveal any changes between the groups (resistance index = 0.6 +/- 0.01 in both groups). Endometrial width was significantly thinner in group A (4.1 +/- 0.2 mm) compared with group B (7.3 +/- 0.2 mm) (P < 0.0001). Subendometrial flow in the spiral artery was significantly reduced in 35 women of group A (75%) and in none of group B (P < 0.0001). CONCLUSIONS The present study offers an explanation for the oligomenorrhoea in LNG-IUS users, i.e. a local progestational effect on the endometrium with no change in the blood flow in the uterine artery. This should be presented to the women in the pre-contraceptive counselling in order to lessen the discontinuation rate.
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Affiliation(s)
- Y Zalel
- Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, (affiliated to the Sackler Faculty of Medicine, Tel-Aviv University), Tel-Hashomer, Israel.
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Abstract
BACKGROUND It has been reported that second-trimester serum markers may be affected by assisted reproduction, leading to a higher false-positive rate. METHODS A total of 285 naturally and 71 IVF-conceived singletons which underwent a serial disclosure Down's syndrome screening programme were compared. The study protocol included first-trimester combined [nuchal translucency (NT), free beta-HCG and pregnancy-associated plasma protein-A (PAPP-A)] testing. The second-trimester triple serum screening included alpha-fetoprotein (AFP), intact HCG and unconjugated estriol (uE3). After excluding aneuploidies, miscarriages, anatomical anomalies and cases with incomplete follow-up, the serum samples of normal cases were assessed and correlated. RESULTS NT measurement was not significantly changed in either group. However, the IVF group had lower PAPP-A [0.96 versus 1.05 multiples of normal median (MoM)] and higher AFP (1.13 versus 1.07 median MoM). Both groups had similar rates of first-trimester false-positive results (FPR; 7 and 9% respectively), but the IVF group had a significantly higher mid-gestation FPR rate (10 versus 5%; Pearson chi2, P = 0.029). This has contributed to amniocentesis uptake rates of 15 and 13% for the IVF and natural conception pregnancies respectively. CONCLUSIONS The IVF group tended to have a significantly higher second-trimester FPR rate. To counterbalance this phenomenon, integrated first- and second-trimester screening tests or the use of NT alone might be a reasonable option that deserves further investigation.
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Affiliation(s)
- R Maymon
- Department of Obstetrics and Gynecology, Assaf Harofe Medical Center, Zerifin, Israel.
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Feldman B, Seidman DS, Levron J, Bider D, Shulman A, Shine S, Dor J. In vitro fertilization following natural cycles in poor responders. Gynecol Endocrinol 2001; 15:328-34. [PMID: 11727354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
This prospective study was designed to examine the feasibility of natural cycle in vitro fertilization (IVF) in poor responders, and the clinical factors that may predict successful outcome. Twenty-two poor responders underwent IVF treatment with 44 unstimulated cycles. The results of the natural cycles were compared with those of the 55 low-response stimulated cycles of these patients during the 12 months prior to the study. Eighteen (82%) patients had at least one oocyte retrieved, while nine (41%) had at least one cycle with embryo transfer. Two (9%) patients each gave birth to a healthy term baby. These results are comparable with those of the stimulated cycles. Serum early follicular follicle stimulating hormone (FSH) level was found to be the only reliable predictor of oocyte recovery and overall outcome in each specific natural cycle. However, because of great variability in basal FSH levels among different cycles of the same patient, this is not a reliable predictor of outcome in future cycles. We conclude that poor responders are a unique group of patients who may benefit from natural-cycle IVF treatment.
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Affiliation(s)
- B Feldman
- In Vitro Fertilization Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Lipitz S, Shulman A, Achiron R, Zalel Y, Seidman DS. A comparative study of multifetal pregnancy reduction from triplets to twins in the first versus early second trimesters after detailed fetal screening. Ultrasound Obstet Gynecol 2001; 18:35-38. [PMID: 11489223 DOI: 10.1046/j.1469-0705.2001.00431.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVES To compare the outcome of multifetal pregnancy reduction from triplets to twins performed either early (at 11-12 weeks' gestation) or late (at 13-14 weeks). METHODS Ninety-five high-order pregnancies following assisted conception were studied. Transabdominal sonographically guided multifetal pregnancy reduction was performed early in 46 women, while 49 women first underwent a sonographic fetal anomaly scan before undergoing selective reduction. RESULTS Sonographic screening led to selective termination of a specific fetus in nine cases due to increased nuchal translucency and relative intrauterine growth restriction in three cases each, and meningomyelocele, abdominal cyst and cystic hygroma in one case each. In the early reduction group a diagnosis of hypoplastic left heart in the two remaining twins was subsequently made, and one pair of twins suffers from cerebral palsy. The rate of pregnancy loss was not statistically different between the early (4.3%; 2/46) and late (4.0%; 2/49) termination groups. The birth weight and gestational age at birth were not statistically different between the early ( n = 85) and late ( n = 94) groups (2110 +/- 580 vs. 2140 +/- 490 g, and 35.8 +/- 3.0 vs. 35.7 +/- 3.5 weeks). Similarly there was no statistically significant difference between early and late groups in the incidence of very premature (24-32 weeks; 9.3 vs. 8.3%) and premature (33-36 weeks; 46.5 vs. 47.9%) births. CONCLUSIONS Early second-trimester multifetal pregnancy reduction from triplets to twins may allow more selective termination of abnormal fetuses without an adverse effect on the outcome of pregnancy. However, further studies are needed in order to confirm our observations in a larger series.
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Affiliation(s)
- S Lipitz
- Ultrasound Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Israel.
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Out HJ, David I, Ron-El R, Friedler S, Shalev E, Geslevich J, Dor J, Shulman A, Ben-Rafael Z, Fisch B, Dirnfeld M. A randomized, double-blind clinical trial using fixed daily doses of 100 or 200 IU of recombinant FSH in ICSI cycles. Hum Reprod 2001; 16:1104-9. [PMID: 11387277 DOI: 10.1093/humrep/16.6.1104] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The effect of 100 and 200 IU per day recombinant FSH (rFSH) on numbers of oocytes retrieved and the total dose used in ovarian stimulation before intracytoplasmic sperm injection was investigated in a double-blind, randomized multicentre trial. A total of 91 women was treated with a low-dose protocol and 88 with a high-dose regimen at five centres. For each started cycle, significantly more oocytes were retrieved in the 200 IU group than in 100 IU group (12.0 versus 5.7, P < 0.001); total rFSH consumption was 1121 and 1875 IU in the low- and high-dose groups respectively. Significant variations were noted between centres with regard to numbers of oocytes collected per started cycle, ranging from 2.8 to 7.2 in the 100 IU group and from 9.0 to 19.1 in the high-dose group. Exploratory analyses of secondary outcomes suggested there were no differences in vital pregnancy rates per started cycle (19.2 versus 16.9%) and per embryo transfer (26.2 versus 19.3%) in the low- and high dose groups respectively. There were four hospitalizations due to ovarian hyperstimulation syndrome, all in the 200 IU group.
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Affiliation(s)
- H J Out
- Organon Laboratories, Cambridge Science Park, Cambridge, UK.
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Rosen ED, Raymond S, Zollman A, Noria F, Sandoval-Cooper M, Shulman A, Merz JL, Castellino FJ. Laser-induced noninvasive vascular injury models in mice generate platelet- and coagulation-dependent thrombi. Am J Pathol 2001; 158:1613-22. [PMID: 11337359 PMCID: PMC1891954 DOI: 10.1016/s0002-9440(10)64117-x] [Citation(s) in RCA: 108] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
A minimally invasive laser-induced injury model is described to study thrombus development in mice in vivo. The protocol involves focusing the beam of an argon-ion laser through a compound microscope on the vasculature of a mouse ear that is sufficiently thin such that blood flow can be visualized by intravital microscopy. Two distinct injury models have been established. The first involves direct laser illumination with a short, high-intensity pulse. In this case, thrombus formation is inhibited by the GPIIb/IIIa antagonist, G4120. However, the anticoagulants, hirulog, PPACK, and NapC2 have minimal effect. This indicates that thrombus development induced by this model mainly involves platelet interactions. The second model involves low-intensity laser illumination of mice injected with Rose Bengal dye to induce photochemical injury in the region of laser illumination. Thrombi generated by this latter procedure have a slower development and are inhibited by both anticoagulant and anti-platelet compounds.
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Affiliation(s)
- E D Rosen
- Department of Chemistry and Biochemistry, W. M. Keck Center for Transgene Research, University of Notre Dame, Notre Dame, Indiana, USA.
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Abstract
The current study compared triple serum screening results and outcomes in 37 oocyte donation (OD) and 46 self oocyte IVF-conceived singletons of similarly aged women (28.8 +/- 4.4 years and 30.7 +/- 4.5 years respectively). Both groups were followed from their embryo transfer and throughout pregnancy. Although the daily pattern of first-trimester serum beta-human chorionic gonadotrophin (HCG) was similar in both groups, higher mid-gestation HCG serum concentrations were found, i.e. 1.38 and 1.32 multiples of the median (median MoM) for IVF and OD respectively, in comparison with 0.99 median MoM from the same reference laboratory. Only the OD group had significantly increased alpha fetoprotein (AFP) concentrations (1.45 median MoM) (P = 0.002) compared with the reference laboratory. A total of 11% of the IVF and 13% of the OD women were found to be screen positive. In neither group were chromosomal abnormalities detected and no fetal or neonatal deaths were recorded. Seven (15%) of the OD and seven (19%) of the IVF women had an adverse obstetric outcome. Of those cases, six IVF and four OD women had serum HCG > or = 1.2 MoM and five OD women had AFP >1.2 MoM. Therefore, in those pregnancies the high serum HCG concentrations may alert for adverse obstetric outcome rather than indicating a high risk for Down's syndrome fetuses.
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Affiliation(s)
- R Maymon
- Department of Obstetrics and Gynecology, Assaf Harofe Medical Center, Zerifin, Israel.
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Goldstein BA, Shulman A, Lenhardt ML, Richards DG, Madsen AG, Guinta R. Long-term inhibition of tinnitus by UltraQuiet therapy: preliminary report. Int Tinnitus J 2001; 7:122-7. [PMID: 14689651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
Masking of tinnitus by noise can produce residual inhibition, a persistence in the reduction in tinnitus after the noise is removed. Typically, this relief is very short-lived, on the order of minutes. This report highlights long-term inhibition of tinnitus by UltraQuiet therapy, a new technique that employs patterned sound in the 10- to 20-kHz range, presented through bone conduction. Nine subjects participated in a study of the efficacy of this tinnitus suppression technique. Eight reported improvement in tinnitus symptoms; one did not complete the study. The duration of the improvement ranged from days to weeks. This long-term inhibition may involve a truly plastic change in the brain at the central level.
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Affiliation(s)
- B A Goldstein
- Martha Entenmann Tinnitus Research Center, Health Science Center at Brooklyn, State University of New York, Box 1239, 450 Clarkson Avenue, Brooklyn, NY 11203, USA
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Tang W, Seidman MD, Henig JP, Shulman A, Stracher A. The effects of leupeptin on cochlear blood flow, auditory sensitivity, and histology. Int Tinnitus J 2001; 7:4-12. [PMID: 14964948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
The purpose of this study was to evaluate the long-term safety of administering leupeptin (1 mg/ml in Hank's Balanced Salt Solution) to the round window membrane by investigating its effects on cochlear blood flow, auditory sensitivity (i.e., auditory brainstem response), and cochlear histology. A comparison of baseline and posttreatment measurements of cochlear blood flow and mean arterial blood pressure in guinea pigs revealed no significant changes. Auditory brainstem response measurements revealed no significant changes in auditory threshold shifts when compared to controls at the 2-, 4-, 6-, and 8-week time points. Furthermore, poststudy surface preparations of the organs of Corti and cytocochleograms from leupeptin-treated ears and controls revealed no significant hair cell losses. These data suggest that the prolonged administration of leupeptin (1 mg/ml at a rate of 0.5 microliter/hr for 8 weeks) to the round window membrane is not ototoxic. This study may serve as a basis for future clinical trials of leupeptin administration for the prevention or treatment of noise-induced hearing loss and the management of tinnitus.
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Affiliation(s)
- W Tang
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health System, Detroit, Michigan, USA
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Shulman A. Keeping the record straight. Int Tinnitus J 2001; 7:1-3. [PMID: 14964947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
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45
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Goldstein B, Shulman A. Central auditory speech test findings in individuals with subjective idiopathic tinnitus. Int Tinnitus J 2000; 5:16-9. [PMID: 10753411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
This study reports central auditory speech test performance of 25 consecutive patients with subjective idiopathic tinnitus of the severe disabling type. A preliminary study of 14 individuals who had subjective idiopathic tinnitus and complained of difficulty in hearing and understanding revealed a high incidence of abnormal central auditory speech test performance (71%), despite satisfactory peripheral hearing. The results (1) identify objectively for the first time that tinnitus affects specific components of the auditory pathway; (2) provide a basis for monitoring methods of tinnitus control; and (3) provide a basis for understanding "the interference effect" and problem of communication difficulties in patients with tinnitus of the severe disabling type.
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Affiliation(s)
- B Goldstein
- Martha Entenmann Tinnitus Research Center, Inc., State University of New York Health Sciences Center at Brooklyn, NY 11203, USA
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Dor J, Bider D, Shulman A, Levron JL, Shine S, Mashiach S, Rabinovici J. Effects of gonadotrophin-releasing hormone agonists on human ovarian steroid secretion in vivo and in vitro-results of a prospective, randomized in-vitro fertilization study. Hum Reprod 2000; 15:1225-30. [PMID: 10831545 DOI: 10.1093/humrep/15.6.1225] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The aim of this prospective randomized study was to compare the effects of two gonadotrophin-releasing hormone (GnRH) agonists, buserelin and triptorelin, on human ovarian follicular steroidogenesis, oocyte fertilization and IVF treatment outcome. Ovulatory, healthy women undergoing IVF were treated either with human menopausal gonadotrophin (HMG) alone or with HMG and one of the two GnRH agonists. Serum and follicular fluid hormonal concentrations and cultures of luteinizing granulosa cells obtained during follicular aspiration were analysed. GnRH agonist treatment significantly affected steroidogenesis both in serum and follicular fluid. In follicular fluid, progesterone and oestradiol concentrations were significantly elevated while testosterone concentrations were significantly lower in the triptorelin group. The ratios of testosterone/progesterone, oestradiol/progesterone but not oestradiol/testosterone concentrations were significantly affected by GnRH agonist administration. Similarly, the steroidogenic activity of luteinizing granulosa cells in vitro was significantly decreased in women treated with GnRH agonists. Women treated with GnRH agonists had significantly more fertilized oocytes and cleaving embryos. The results indicate a marked effect of GnRH agonists on the pattern of ovarian follicular steroidogenesis that cannot be explained solely by changes in gonadotrophin concentrations.
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Affiliation(s)
- J Dor
- IVF Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Israel.
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Cohen AD, Porath A, Bessorai R, Shulman A, Snir Y. [Use of civilian emergency departments by the Israel Defense Force for emergency care for soldiers]. Harefuah 2000; 138:815-7, 912. [PMID: 10883242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Many physicians, civilian as well as in military, feel that some referrals of soldiers to civilian emergency departments are inappropriate and that soldiers should receive medical attention within their military units. We therefore evaluated referrals of soldiers to our emergency department. 707 referral letters from military physicians and the corresponding emergency room discharge letters were evaluated. Most soldiers were referred for mild trauma (45.0%) or miscellaneous diseases (52.9%); 22 (3.1%) were hospitalized. It appears that some military physicians use the civilian hospital emergency department as a surrogate for an outpatient specialty clinic and for x-ray and laboratory services. This is in contrast to the designated functions of the emergency department which are to provide emergency and trauma services and to evaluate the need for hospitalization of referred patients.
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Affiliation(s)
- A D Cohen
- Medical Corps, Israel Defense Forces
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48
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Schneider D, Schneider L, Shulman A, Claussen CF, Just E, Koltchev C, Kersebaum M, Dehler R, Goldstein B, Claussen E. Gingko biloba (Rökan) therapy in tinnitus patients and measurable interactions between tinnitus and vestibular disturbances. Int Tinnitus J 2000; 6:56-62. [PMID: 14689620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
Tinnitus is one of the most important symptoms in neurootology after vertigo, nausea, and hearing loss. In most cases, the origin of the tinnitus remains inexplicable. Well-known, however, is that tinnitus may arise in any part of the hearing pathway (i.e., both within the cochlea receptor and in the temporal lobe and projections). Tinnitus also is associated frequently with vertigo, nausea and hearing loss. An age predominance exists, with tinnitus more common among those older than 40 years. From this starting point, a great demand exists today for new ideas and developments in the diagnosis and treatment of tinnitus.
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Affiliation(s)
- D Schneider
- University Head Center, Ear, Nose, and Throat Department, Neurotology Unit, 11 Josef-Schneider-St., D-97080, Würzburg, Germany.
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Shulman A, Goldstein B. Intratympanic drug therapy with steroids for tinnitus control: a preliminary report. Int Tinnitus J 2000; 6:10-20. [PMID: 14689612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
Intratympanic drug therapy (ITDT) is a surgical technique of instilling medication into the middle ear to perfuse the inner ear in treating hearing loss, tinnitus, vertigo, and ear blockage, alone or in combination, in patients with a predominantly inner-ear site of lesion. This preliminary report of ITDT focuses on attempts at tinnitus control (TC). Between November 1997 and February 1999, 10 patients with severe tinnitus were treated with steroid medication and were last seen in February 2000. TC was established in 7 of these 10 patients (70%). The clinical diagnosis of a predominantly cochlear-type tinnitus was established in each patient by a correlation of the clinical history with a medical-audiological tinnitus patient protocol that included cochleovestibular testing. An additional single patient with sudden hearing loss experienced no hearing improvement on ITDT steroid therapy. Vertigo as an associated complaint was reported by 6 of 10 patients with subjective idiopathic tinnitus. Significant control of the associated vertigo complaint was reported by 5 of 10 patients. Duration of tinnitus relief in 7 of 10 patients was hours in 1 of the 7; days in another of the 7; and 1 year or more in 5 of the 7. One of the seven patients reported TC 3 months after the procedure. Complications included tympanic membrane perforation that persisted for more than 6 months in two patients and an increase in the complaint of ear blockage and tinnitus intensity in one patient. In our preliminary study, ITDT with steroid has resulted in both short- and long-term tinnitus relief in 7 of 10 patients (70%) identified to have a predominantly cochlear-type tinnitus.
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Affiliation(s)
- A Shulman
- Martha Entenmann Tinnitus Research Center, Health Science Center at Brooklyn, State University of New York, Box 1239, 450 Clarkson Avenue, Brooklyn, New York 11203, USA.
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Shulman A, Strashun AM, Seibyl JP, Daftary A, Goldstein B. Benzodiazepine receptor deficiency and tinnitus. Int Tinnitus J 2000; 6:98-111. [PMID: 14689626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
As regards the symptom of a predominantly central tinnitus of the severe, disabling type, it has been hypothesized that a deficiency in the benzodiazepine receptor exists in the medial temporal lobe system of brain and is directly related to affect impairments including anxiety, stress, depression, and fear. This hypothesis has been investigated with single-photon emission computed tomography using the benzodiazepine radioligand 123I Iomazenil. Visual analysis revealed preliminary results of diminished benzodiazepine-binding sites in the medial temporal cortex of all patients with severe tinnitus (N = 6), a finding that is consistent with the hypothesis implicating GABAergic mechanisms in the pathophysiology of the disorder. An abnormal gamma-aminobutyric acid--A benzodiazepine receptor density may be an objective neurochemical measure of the severity of a central-type tinnitus and a rationale for treatment. Clinical correlation with the history, clinical course of the patient, and stress questionnaire are presented.
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Affiliation(s)
- A Shulman
- Martha Entenmann Tinnitus Research Center, Inc., Health Sciences Center at Brooklyn, State University of New York, Box 1239, 450 Clarkson Avenue, Brooklyn, New York 11203, USA.
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