P-135 Clinical outcomes depending on post-warming culture duration of vitrified-warmed single blastocyst transfer cycles

Study question

What is the impact of post-warming blastocysts after very short-term culture (<2 hours) or short-term culture (2–4 hours) on the clinical outcomes?

Summary answer

The clinical outcomes of very short-term culture and short-term culture were not significantly different in vitrified-warmed blastocyst transfer.

What is known already

In vitrified-warmed blastocyst transfer (VBT), complete blastomere survival and mitotic resumption during warming are generally considered to be the most important factors affecting pregnancy outcomes. It has been assumed that a sufficient warming time may be required for resumption of cell proliferation and development. Currently there is evidence that suggests a minimum mean time of 2.70 ± 1.20 necessary to complete the re-expansion of the embryo that allows evaluating its adequate development. However, the effect of culture duration on pregnancy outcomes in VBT remains controversial.

Study design, size, duration

A retrospective observational study was carried out, with all the patients who had frozen-thawed embryos transferred between January and December 202, in Clínica Alemana, Santiago, Chile. The average standard time for embryo thawing in our center is 2 hours. However, on certain occasions, due to its insufficient development and the pressing schedule of surgery rooms, a second embryo must be thawed, usually in less than 2 hours.

Participants/materials, setting, methods

Embryos were divided into two study groups depending on whether their post-warming culture period was very short-term (<2 hours) or short-term culture (2–4 hours). Only transfers of 1 embryo on day 5-6 were included. Embryo morphology was analyzed with a Garner microscope score to estimate the quality of the embryos in both groups.

Main results and the role of chance

During the study period, a total of 127 single VBT cycles were included: 48 in the very short-term group and 79 in the short-term group. Patients’ demographic characteristics did not significantly differ between the groups. (Age 34.9±3.6 vs 35±3.4, p=0.89; Infertility duration (yr) 2.75±1.1 vs 2.5 ±1.1, p=0.24; AMH 2.1 [0.2-5.4] vs 2.1 [0.2-5], p=0.84) An analysis of previous fresh in vitro fertilization cycles and subsequent VBT cycle parameters revealed no differences in the number of retrieved oocytes (11.7 vs 12, p=0.74), the number of fertilized oocytes (8.6 vs 8.5, p=0.86), the number of vitrified blastocysts (3.4 vs 3.6, p=0.87) and in both groups. The clinical pregnancy rate per embryo transferred were similar in the very short-term culture group and the short-term culture group (66.7% vs. 68.4%, p=0.44). There was no significant difference in the ongoing pregnancy rate per embryo transferred between the two groups (18,8% vs. 16.5.%, p=0.74). The miscarriage rate in both groups was comparable (p=0.77).

Limitations, reasons for caution

The small number of women recruited ant the retrospective design of the study, should be recognized as possible sources of bias.

Wider implications of the findings

This study showed that the culture time after warming was irrelevant for blastocyst implantation potential, and that the speed of re-expansion was not correlated with clinical outcomes.

Embryo transfer timing after warming may be determined by optimizing each laboratory’s work flow.

Trial registration number

0

Electroconvulsive therapy for catatonia in juvenile neuropsychiatric lupus

Neuropsychiatric manifestations are serious and frequent complications of systemic lupus erythematous (SLE). Catatonia is a neuropsychiatric disorder characterized by motor disturbance (including waxy flexibility and catalepsy), stupor, excitement, negativism, mutism, echopraxia and echolalia. Catatonia associated with SLE has been only rarely reported, especially in children. Here we present a case of a 14-year-old patient encountered in consultation-liaison psychiatry who presented catatonia associated with SLE. Her catatonia was refractory to treatment with pulse methylprednisolone, intravenous cyclophosphamide and rituximab. The patient responded to a combined therapy of electroconvulsive therapy and benzodiazepines. The present case suggests that although rarely reported, catatonia seen in the background of SLE should be promptly identified and treated to reduce the morbidity.

Photocatalytic degradation of pentachlorophenol on TiO2 sol-gel catalysts

The photocatalytic degradation of pentachlorophenol (PCP) in aqueous solution was investigated using TiO2 catalysts. The samples were prepared by the sol-gel method using different gelation pH and different calcination temperatures. The solids were characterized by specific surface area, X-ray diffraction, UV-Vis absorbance, FTIR and pentachlorophenol adsorption. The catalytic activity of the solids was evaluated in a conventional photoreactor at 298 K using 30 ppm of pentachlorophenol. It was found that the reaction follows a first-order reaction and the kinetic constant values change slightly with the pH of gelation and more significantly with the calcination temperature.

[Daily mortality in Santiago and its relationship with air pollution]

BACKGROUND

Santiago de Chile, due to meteorological and topographic factors, is one of the most polluted cities in the world. The adverse effects of contamination on health are relatively well known, but they may be overvalued.

AIM

To evaluate the short term effects of exposure to air pollution on mortality of people over 65 years old.

MATERIAL AND METHODS

Daily mortality data in Santiago, from 1988 to 1993, was obtained from the National Statistics Institute. Daily concentrations of contaminants in Santiago and meteorological variables, were obtained from SESMA the Metropolitan Environmental Health Services. An association between contamination and mortality due to respiratory or cardiovascular diseases in subjects over 65 years old was searched, using temporal series analysis.

RESULTS

There was a significant association between air pollution, meteorological variables on the same and previous days and mortality. PM10 had the strongest association with mortality. The relative risk of a 100 micrograms/m3 increment in PM10 was 1.052 for the elderly, 1.025 for cardiovascular and 1.061 for respiratory mortality. The relative risk of SO2 was 1.006 for all deaths and 1.017 for respiratory deaths. The figures for O3 were 1.015 for all deaths and 1.008 for cardiovascular deaths.

CONCLUSIONS

This work confirms a consistent association between air pollution and daily mortality, specially for particulate matter, even for levels below Chilean norms.

Enalapril effects on alcohol intake and other consummatory behaviors in alcoholics

Animal studies suggest that angiotensin-converting enzyme inhibitors decrease alcohol intake. In a double-blind crossover study 42 normotensive alcoholics (36 men and six women) aged 24 to 65 years, consuming 8.2 +/- 2.3 (mean +/- SD) standard alcoholic drinks per day, were randomized to enalapril, 10 mg/day (n = 20) or 20 mg/day (n = 22), and placebo for 4 weeks. They monitored their daily alcohol intake and attended biweekly assessments, but no other treatment or advice was given. Compliance and alcohol intake were verified objectively. Mean daily alcoholic drinks were not significantly different during 10 mg/day enalapril (mean +/- SEM, 7.5 +/- 0.5), and its placebo (7.2 +/- 0.5), but both decreased from baseline (8.1 +/- 0.5; both p less than 0.05). Similarly, mean daily drinks during 20 mg/day enalapril (6.8 +/- 0.6) and its placebo (7.2 +/- 0.4) was not significantly different, but both were lower than baseline (8.3 +/- 0.5; both p less than 0.01). Fourteen (64%) of the patients taking 20 mg/day enalapril decreased alcohol intake from placebo by an average of 21% (range, 1.6% to 78.3%). Self-ratings of interest, desire, craving, and liking for alcohol also decreased from baseline during enalapril and placebo treatments, but the effects of both were similar. Plasma renin activity increased, compared with placebo, after 10 mg/day enalapril (from 0.3 +/- 0.2 [mean +/- SD] to 1.9 +/- 1.5 ng/L/sec) and after 20 mg/day enalapril (from 0.4 +/- 0.3 to 2.8 +/- 4.0 ng/L/sec) (both p less than 0.05). Blood pressure decreased within a normotensive range, compared with placebo, with 10 mg/day enalapril (by 6.0 and 8.5 mm Hg systolic and diastolic blood pressures) and 20 mg/day enalapril (by 7.7 and 5.0 mm Hg, respectively). Side effects were few and mild. No patient characteristic or drug effect correlated with changes in alcohol intake. There were no significant variations in nonalcoholic beverages, cigarette smoking, or body weight. These results indicate that enalapril does not alter alcohol intake in normotensive alcoholics with normal plasma renin activity. Studies with higher doses of enalapril in humans may be limited by increased frequency and severity of side effects.

Fluoxetine differentially alters alcohol intake and other consummatory behaviors in problem drinkers

The effects of fluoxetine, a relatively selective long-acting serotonin uptake inhibitor, on the consumption of alcoholic and nonalcoholic drinks, cigarette smoking, and body weight were assessed in 29 men who were early stage problem drinkers. After a 2-week baseline, subjects were randomly assigned to receive 40 mg/day fluoxetine (n = 8), 60 mg/day fluoxetine (n = 11), or placebo (n = 10) for 4 weeks. Fluoxetine 60 mg/day decreased mean daily alcoholic drinks from (X +/- SEM) 8.3 +/- 0.7 during baseline to 6.9 +/- 0.7 and decreased total drinks per 14 days from 115.8 +/- 9.3 to 96.5 +/- 9.5 (p less than 0.01; 17.3% decrease from baseline), with no significant increase in days of abstinence. Neither 40 mg/day fluoxetine nor placebo had effects on intake of alcohol. Fluoxetine 60 mg/day decreased total and mean daily alcoholic drinks compared with 40 mg/day fluoxetine (ANCOVA, both p less than 0.02), but neither dose of fluoxetine was different from placebo. Compared with placebo, both 40 mg/day fluoxetine and 60 mg/day fluoxetine no differences were detected between treatment groups, 60 mg/day fluoxetine increased mean daily nonalcoholic beverages from baseline (5.0 +/- 0.4 to 5.6 +/- 0.3, p less than 0.01) and increased daily cigarettes smoked (from 25.1 +/- 4.6 to 26.9 +/- 4.5, p less than 0.05), whereas no significant changes from baseline were observed with 40 mg/day fluoxetine or placebo.(ABSTRACT TRUNCATED AT 250 WORDS)

The utility of the MCMI as a DSM-III Axis I diagnostic tool

The present study examined the utility of the MCMI as a provider of DSM-III Axis I diagnostic hypotheses with a heterogeneous psychiatric inpatient population. Participants represented 31 consecutive referrals made to the psychology department for a clinical and/or diagnostic assessment from a psychiatric rehabilitation unit. Three independent diagnoses derived from the MCMI, a structured interview (DIS), and an unstructured psychiatric interview were obtained for each participant. The percentage agreement between the two criterion diagnoses was 54.8%. Agreement between the MCMI and criterion diagnoses was, at best, 15% for those cases that had an Axis I diagnosis. These findings are in keeping with past research and support the contention that the MCMI is not a useful tool in generating clinically correct or meaningful DSM-III Axis I diagnostic hypotheses.