Family Building in Transgender Patients: Modern Strategies with Assisted Reproductive Technology Treatment

Purpose

Transgender and gender diverse (TGD) individuals continue to face adversity, stigma, and inequality, especially in health care. This study aimed to characterize the experience of TGD people and partners of TGD people with regard to fertility treatment.

Methods

All TGD patients presenting to a single academic center between 2013 and 2021 were included. Baseline demographics collected included patient age, body mass index, anti-Mullerian hormone, basal antral follicle count, history of gender-affirming surgery, and/or gender-affirming hormone therapy. Outcomes included total patients who progressed to treatment, cycle type(s), and clinical outcomes.

Results

In total, 82 patients who identified as TGD or had a partner who identified as TGD presented to care seeking fertility treatment. Of the 141 planned cycles, 106 (75.2%) progressed to treatment. Of the 15 in vitro fertilization (IVF) and co-IVF cycles, 12 achieved live birth. Of the 76 intrauterine inseminations 7 patients were discharged with ongoing pregnancies and one achieved live birth.

Conclusion

These findings reaffirm that TGD individuals utilize the entire array of fertility services. With recent advances in access to care and modern medicine, assisted reproductive technology treatment has the power to support TGD patients in building contemporary family structures.

Exploring the role of milk yield in the first week of lactation on the association between hyperketonemia and reproductive performance in dairy cattle

•

No clear evidence was found to support an association between hyperketonemia and reproductive performance.

•

Hyperketonemia was associated with lower risk of pregnancy among low-yielding cows.

•

Early lactation plays a role in the association of hyperketonemia with reproduction.

The objective of this retrospective cohort study was to investigate whether the association of hyperketonemia (HYK) with reproductive performance differs based on milk production during the first week of lactation (wk 1). Data between calving and 150 d in milk (DIM) from 2,091 Holstein dairy cows from 5 commercial dairy herds in Minnesota were collected. The concentration of β-hydroxybutyrate (BHB) was measured twice between 3 and 10 DIM in whole blood to diagnose HYK (defined as BHB ≥1.2 mmol/L). The average wk 1 milk yield was classified into 3 levels (low = lower 25th percentile; mid = 25th to 75th percentile; high = upper 75th percentile) according to parity and herd. Log-binomial regression, Cox-proportional hazard regression, and linear regression models were used to investigate the association of HYK with pregnancy to first insemination, pregnancy by 150 DIM, and calving-to-conception interval (CCI) between groups, respectively. To describe the differences in these estimates between each wk 1 milk yield level, an interaction term of HYK and stratified levels of wk 1 milk yield was added. The incidence of HYK between 3 to 10 DIM was 14.2% (4.6% in primiparous cows and 19.4% in multiparous cows). In the study population, the effect of HYK on reproduction was greater in cows with low milk yield. Among cows with low milk yield levels, HYK was associated with lower risk of pregnancy to first insemination [risk ratio = 0.62; 95% confidence interval (CI): 0.39–0.98], lower risk of pregnancy up to 150 DIM (hazard ratio = 0.70; 95% CI: 0.51–0.96), and extended days of CCI (mean difference = 13.0; 95% CI: 5.1–20.9). In contrast, among cows with mid and high wk 1 milk yield levels, hyperketonemic (HYK+) cows had a similar reproductive performance to non-HYK (HYK−) cows. Our results suggest that early-lactation milk yield plays a role in the association of hyperketonemia with reproductive performance. These results merit further investigation to determine the role that early milk yield has in the association of hyperketonemia with health and productivity outcomes.

Characterization of Agfa Structurix series D4 and D3sc x-ray films in the 0.7-4.6 keV energy range

X-ray films remain a key asset for high-resolution x-ray spectral imaging in high-energy-density experiments conducted at the National Ignition Facility (NIF). The soft x-ray Opacity Spectrometer (OpSpec) fielded at the NIF has an elliptically shaped crystal design that measures x rays in the 900-2100 eV range and currently uses an image plate as the detecting medium. However, Agfa D4 and D3sc x-ray films' higher spatial resolution provides increased spectral resolution to the data over the IP-TR image plates, driving the desire for regular use of x-ray film as a detecting medium. The calibration of Agfa D4 x-ray film for use in the OpSpec is communicated here. These calibration efforts are vital to the accuracy of the NIF opacity measurements and are conducted in a previously un-studied x-ray energy range under a new film development protocol required by NIF. The absolute response of Agfa D4 x-ray film from 705 to 4620 eV has been measured using the Nevada National Security Site Manson x-ray source. A broader range of energies was selected to compare results with previously published data. The measurements were taken using selected anodes, filters, and applied voltages to produce well-defined energy lines.

Diagnostic accuracy of a bovine specific electronic beta-hydroxybutyrate handheld meter in fresh blood and stored serum samples

•

The nova vet handheld beta-hydroxybutyrate meter showed high accuracy and precision.

•

Anticoagulants caused minimal interference in measurements.

•

The best calibration factor on cattle was obtained with the default slope setting.

This study aims to evaluate the diagnostic accuracy of the bovine specific beta-hydroxybutyrate (BHB) meter Nova Vet (NVET). We evaluated the accuracy and agreement of the NVET in fresh blood and thawed serum with the reference laboratory assay; and the repeatability, the interference by anticoagulants, and the optimum slope calibration factor. Individual blood samples were collected from 200 Holstein and crossbred cows between 3 and 14 days post-calving from 13 dairy herds in Minnesota. Using a laboratory assay with a cut point of 1.2 BHB mmol/L hyperketonemia prevalence was 10.6% (95% CI: 6.7, 15.8). The sensitivity of NVET in blood and serum was 100.0% while the specificity was 98.3 and 97.7% respectively. The agreement between NVET and the laboratory assay was the highest using blood samples (concordance correlation coefficient –CCC = 96.2, 95% CI: 95.0, 97.1. The coefficient of variation including within day (intra-meter), between- days, and -batches was 13.4% when testing blood samples. Minimal interference was observed with the use of anticoagulants (K-EDTA and Li-Heparin, CCC 0.90 and 0.93 respectively) in reference to whole blood without anticoagulant. The best calibration slope factor in serum was 1.0 (Youden's index: 0.98). Results suggest that the NVET device maintained a high accuracy and precision to quantified BHB concentration when applied in fresh blood and thawed serum under field conditions using the default calibration slope (1.0), and with minimal anticoagulant interference when used in whole blood samples.

Association between hoof lesions and fertility in lactating Jersey cows

The objectives of this study were to evaluate the association between hoof lesions and fertility in dairy cows. Lactating Jersey cows (n = 1,639) were enrolled at 20 ± 3 d in milk (D20), examined and treated for presence of hoof lesions (HL), and evaluated for body condition score (BCS). Afterward, they were managed according to standard farm procedures, including estrus detection and presynchronization and a 5 d Cosynch-72 protocol for cows that failed to show estrus. Ovaries were scanned at 27 and 41 ± 3 d in milk, and cows with a corpus luteum greater than 20 mm on at least 1 exam were considered cyclic. At 120 ± 3 d in milk (D120), cows were re-examined for HL and BCS. Cows were classified at D20 according to HL status as healthy (n = 1,197) or having HL (n = 429), and according to HL category as healthy (n = 1,197) or having a sole hemorrhage (n = 280), noninfectious HL (sole ulcer, toe ulcer, or white line disease; n = 113), or infectious HL (digital dermatitis and foot rot; n = 36). Cows with HL at D20 had reduced odds of being cyclic (38.3 vs. 51.9%) and a longer interval from calving to first service (58 vs. 51 d) compared with healthy cows. Cows with infectious HL at D20 had reduced odds of pregnancy to first service (16.7 vs. 38.3%) compared with healthy cows. Cows with sole hemorrhage at D20 were more likely to lose pregnancies between d 32 and 64 after the first service postpartum compared with healthy cows (10.5 vs. 5.2%). Cows with sole hemorrhage at D20 had a smaller hazard of pregnancy (67.9 vs. 75.5%) at 150 d in milk and more days open (88 vs. 77d) compared with healthy cows. To assess the relationship between the development of HL and fertility, cows were classified as healthy (no HL at D20 and D120; n = 308), cured (any HL at D20 and no HL at D120; n = 72), new HL (no HL at D20 and any HL at D120; n = 597), and chronic (any HL at D20 and D120; n = 226). Sole hemorrhage accounted for 93% of new HL. The proportions of cows with HL at D20 and D120 were 26.9 and 68.4%, respectively. We found no evidence for a difference in pregnancy hazard at 150 d in milk between cows that remained healthy (n = 308) and cows that developed new HL (n = 597). Hoof lesions at D20, but not new HL, were associated with decreased odds of cyclicity, longer interval from calving to first service postpartum, and reduced pregnancy hazard in Jersey cows. The effect of an HL diagnosis in early lactation and management to reduce chronic HL in dairy cows warrants further investigation.

Dissecting amazonian biodiversity

Biogeographical and biodiversity studies in Iowland Amazonian rain forests typically refer to observed or postulated distribution barriers such as past unfavorable climates, mountains, rivers, and river floodplains that divide the uniform tierra firme (noninundated) forest. Present-day ecological heterogeneity within tierra firme has hardly been discussed in this context, although edaphic differences are known to affect species distribution patterns in both inundated areas and tierra firme. Quantification of landscape heterogeneity in Peruvian Iowland Amazonia (500,000 kilometers squared), based on field studies and satellite image analysis, shows that Peruvian Amazonia is considerably more heterogeneous than previously reported. These observations have implications for the research, management, and conservation of Amazonian biodiversity.

Safety and efficacy of a pentavalent human-bovine (WC3) reassortant rotavirus vaccine

BACKGROUND

Rotavirus is a leading cause of childhood gastroenteritis and death worldwide.

METHODS

We studied healthy infants approximately 6 to 12 weeks old who were randomly assigned to receive three oral doses of live pentavalent human-bovine (WC3 strain) reassortant rotavirus vaccine containing human serotypes G1, G2, G3, G4, and P[8] or placebo at 4-to-10-week intervals in a blinded fashion. Active surveillance was used to identify subjects with serious adverse and other events.

RESULTS

The 34,035 infants in the vaccine group and 34,003 in the placebo group were monitored for serious adverse events. Intussusception occurred in 12 vaccine recipients and 15 placebo recipients within one year after the first dose including six vaccine recipients and five placebo recipients within 42 days after any dose (relative risk, 1.6; 95 percent confidence interval, 0.4 to 6.4). The vaccine reduced hospitalizations and emergency department visits related to G1-G4 rotavirus gastroenteritis occurring 14 or more days after the third dose by 94.5 percent (95 percent confidence interval, 91.2 to 96.6 percent). In a nested substudy, efficacy against any G1-G4 rotavirus gastroenteritis through the first full rotavirus season after vaccination was 74.0 percent (95 percent confidence interval, 66.8 to 79.9 percent); efficacy against severe gastroenteritis was 98.0 percent (95 percent confidence interval, 88.3 to 100 percent). The vaccine reduced clinic visits for G1-G4 rotavirus gastroenteritis by 86.0 percent (95 percent confidence interval, 73.9 to 92.5 percent).

CONCLUSIONS

This vaccine was efficacious in preventing rotavirus gastroenteritis, decreasing severe disease and health care contacts. The risk of intussusception was similar in vaccine and placebo recipients. (ClinicalTrials.gov number, NCT00090233.)

Efficacy and safety of freeze-dried cat's claw in osteoarthritis of the knee: mechanisms of action of the species Uncaria guianensis

AIM

The purpose of this investigation was to evaluate the ability of cat's claw, an Amazonian medicinal plant, to treat osteoarthritis of the knee, collect safety and tolerance information and compare the antioxidant, and anti-inflammatory actions of Uncaria guianensis and Uncaria tomentosa in vitro.

MATERIALS AND METHODS

Forty-five patients with osteoarthritis of the knee were recruited, 30 were treated with freeze-dried U guianensis, and 15 with placebo. Hematological parameters were assessed on entry and exit of the four-week trial. Pain, medical and subject assessment scores and adverse effects were collected at weeks 1, 2 and 4. The antioxidant and anti-inflammatory activity of the cat's claw species was determined by the alpha,alpha-diphenyl-beta-picrylhydrazyl (DPPH) free radical scavenging method. Inhibition of TNFalpha and prostaglandin E2 (PGE2) production was determined in RAW 264.7 cells by ELISA.

RESULTS

Cat's claw had no deleterious effects on blood or liver function or other significant side-effects compared to placebo. Pain associated with activity, medical and patient assessment scores were all significantly reduced, with benefits occurring within the first week of therapy. Knee pain at rest or at night, and knee circumference were not significantly reduced by cat's claw during this brief trial. In vitro tests indicated that U guianensis and U. tomentosa were equivalent at quenching DPPH radicals (EC50, 13.6-21.7 microg/ml) as well as inhibiting TNFalpha production. However, the latter action was registered at much lower concentrations (EC50, 10.2-10.9 ng/ml). Cat's claw (10 microg/ml) had no effect on basal PGE2 production, but reduced LPS-induced PGE2 release (P < 0.05), but at higher concentrations than that required for TNFalpha inhibition.

CONCLUSION

Cat's claw is an effective treatment for osteoarthritis. The species, U guianensis and U tomentosa are equiactive. They are effective antioxidants, but their anti-inflammatory properties may result from their ability to inhibit TNFalpha and to a lesser extent PGE2 production.

Lyme neuroborreliosis masquerading as a brainstem tumor in a 15-year-old

A 15-year-old boy had onset of unilateral facial weakness. A few days later, he experienced mild vertigo, double vision, and headache. Examination confirmed a peripheral right seventh nerve weakness in addition to an internuclear ophthalmoplegia. The neurologic features suggested a pontine glioma. A T2-weighted MRI scan revealed demyelinating lesions in the pons and in several areas of the cerebrum, including the periventricular region. Subsequent history revealed that he had been diagnosed with Lyme arthritis 7 years earlier while living in Connecticut. The radiographic studies favored a diagnosis of multiple sclerosis. However, studies of blood and cerebrospinal fluid established a diagnosis of Lyme neuroborreliosis.

Prevention of indwelling central venous catheter sepsis

In an attempt to decrease the incidence of central venous catheter sepsis in children with cancer, we conducted a study to evaluate the benefit of adding broad-spectrum antibiotics to the catheter "flush solution." In a prospective, placebo-controlled, double-blinded, randomized trial, 69 children with different types of malignancies were studied. The central venous catheters in these children were flushed with either the standard solution (normal saline + 100 U/ml of heparin) or the study solution (25 microgram/ml of both amikacin and vancomycin added to the standard solution). At the conclusion of the study, 64 children with a total of 67 indwelling central venous lines were assessable. The total catheter days on study were 20,700 days, with a median of 323 catheter days per patient. We documented 10 events of catheter-related infections (0.49 events/1,000 catheter days at risk). Five of these events were catheter-related sepsis (0.24 sepses/1,000 catheter days): two were fungal and three were bacterial. Due to the low incidence of catheter-related sepsis in this study, no statement regarding the prophylactic use of antibiotics could be made. The extremely low rate of catheter-related sepsis reported herein may be retrospectively attributed to continuous staff education regarding aseptic techniques in handling these catheters. Staff education is essential, and probably the most effective factor in preventing catheter-related sepsis.

The use of transvaginal ultrasound to aspirate bilateral hydrosalpinges prior to in vitro fertilization: a case report

Transvaginal ultrasound has recently been introduced diagnostically for follicular monitoring, early pregnancy localization (1), pelvic structure identification, early fetal development (2), detection of ovarian enlargement in postmenopausal women (3), and detection of endometrial carcinoma (4). Transvaginal ultrasound has had a major impact on patient monitoring and treatment for in vitro fertilization and embryo transfer (IVF/ET). Therapeutically transvaginal ultrasound has been introduced for oocyte retrieval and selective pregnancy reduction. The purpose of this paper is to present the therapeutic use of transvaginal ultrasound to aspirate large bilateral hydrosalpinges which complicated embryo transfer during an in vitro fertilization cycle.