Fertility preservation for non-medical reasons: controversial, but increasingly common.

BACKGROUND Fertility-preserving measures for women are increasingly being performed for non-medical reasons in Germany. This is now a controversial matter. METHODS The authors searched the PubMed database for pertinent publications on the basis of their clinical and scientific experience and evaluated relevant data from the registry of the German FertiPROTEKT network (www.fertiprotekt. com). The various fertility-preserving measures that are available are described and critically discussed. RESULTS In most cases, the creation of a fertility reserve currently involves the cryopreservation of unfertilized oocytes, rather than of ovarian tissue. Most of the women who decide to undergo this procedure are over 35 years old. According to data from the FertiPROTEKT registry, most such procedures carried out in the years 2012 and 2013 involved a single stimulation cycle. The theoretical probability of childbirth per stimulation is 40% in women under age 35 and 30% in women aged 35 to 39. If the oocytes are kept for use at a later date, rather than at once, the maternal risk is higher, because the mother is older during pregnancy. The risk to the child may be higher as well because of the need for in vitro fertilization (IVF). Pregnancy over age 40 often leads to complications such as gestational diabetes and pre-eclampsia. IVF may be associated with a higher risk of epigenetic abnormalities. Ethicists have upheld women's reproductive freedom while pointing out that so-called social freezing merely postpones social problems, rather than solving them. CONCLUSION Fertility preservation for non-medical reasons should be critically discussed, and decisions should be made on a case-by-case basis.

Selenium isotope analysis by N-TIMS: Potential and challenges

The isotope composition of selenium (Se) can provide important constraints on biological, geochemical, and cosmochemical processes taking place in different reservoirs on Earth and during planet formation. To provide precise qualitative and quantitative information on these processes, accurate and highly precise isotope data need to be obtained. The currently applied ICP-MS methods for Se isotope measurements are compromised by the necessity to perform a large number of interference corrections. Differences in these correction methods can lead to discrepancies in published Se isotope values of rock standards which are significantly higher than the acclaimed precision. An independent analytical approach applying a double spike (DS) and state-of-the-art TIMS may yield better precision due to its smaller number of interferences and could test the accuracy of data obtained by ICP-MS approaches. This study shows that the precision of Se isotope measurements performed with two different Thermo Scientific™ Triton™ Plus TIMS is distinctly deteriorated by about ±1‰ (2 s.d.) due to δ80/78Se by a memory Se signal of up to several millivolts and additional minor residual mass bias which could not be corrected for with the common isotope fractionation laws. This memory Se has a variable isotope composition with a DS fraction of up to 20% and accumulates with increasing number of measurements. Thus it represents an accumulation of Se from previous Se measurements with a potential addition from a sample or machine blank. Several cleaning techniques of the MS parts were tried to decrease the memory signal, but were not sufficient to perform precise Se isotope analysis. If these serious memory problems can be overcome in the future, the precision and accuracy of Se isotope analysis with TIMS should be significantly better than those of the current ICP-MS approaches.

Caplacizumab for Acquired Thrombotic Thrombocytopenic Purpura.

BACKGROUND Acquired thrombotic thrombocytopenic purpura (TTP) is caused by aggregation of platelets on ultralarge von Willebrand factor multimers. This microvascular thrombosis causes multiorgan ischemia with potentially life-threatening complications. Daily plasma exchange and immunosuppressive therapies induce remission, but mortality and morbidity due to microthrombosis remain high. METHODS Caplacizumab, an anti-von Willebrand factor humanized single-variable-domain immunoglobulin (Nanobody), inhibits the interaction between ultralarge von Willebrand factor multimers and platelets. In this phase 2, controlled study, we randomly assigned patients with acquired TTP to subcutaneous caplacizumab (10 mg daily) or placebo during plasma exchange and for 30 days afterward. The primary end point was the time to a response, defined as confirmed normalization of the platelet count. Major secondary end points included exacerbations and relapses. RESULTS Seventy-five patients underwent randomization (36 were assigned to receive caplacizumab, and 39 to receive placebo). The time to a response was significantly reduced with caplacizumab as compared with placebo (39% reduction in median time, P=0.005). Three patients in the caplacizumab group had an exacerbation, as compared with 11 patients in the placebo group. Eight patients in the caplacizumab group had a relapse in the first month after stopping the study drug, of whom 7 had ADAMTS13 activity that remained below 10%, suggesting unresolved autoimmune activity. Bleeding-related adverse events, most of which were mild to moderate in severity, were more common with caplacizumab than with placebo (54% of patients vs. 38%). The frequencies of other adverse events were similar in the two groups. Two patients in the placebo group died, as compared with none in the caplacizumab group. CONCLUSIONS Caplacizumab induced a faster resolution of the acute TTP episode than did placebo. The platelet-protective effect of caplacizumab was maintained during the treatment period. Caplacizumab was associated with an increased tendency toward bleeding, as compared with placebo. (Funded by Ablynx; ClinicalTrials.gov number, NCT01151423.).

Is human herpesvirus 8 infection more common in men than in women? Systematic review and meta-analysis.

All forms of Kaposi sarcoma (KS) are more common in men than in women. It is unknown if this is due to a higher prevalence of human herpesvirus 8 (HHV-8), the underlying cause of KS, in men compared to women. We did a systematic review and meta-analysis to examine the association between HHV-8 seropositivity and gender in the general population. Studies in selected populations like for example, blood donors, hospital patients, and men who have sex with men were excluded. We searched Medline and Embase from January 1994 to February 2015. We included observational studies that recruited participants from the general population and reported HHV-8 seroprevalence for men and women or boys and girls. We used random-effects meta-analysis to pool odds ratios (OR) of the association between HHV-8 and gender. We used meta-regression to identify effect modifiers, including age, geographical region and type of HHV-8 antibody test. We included 22 studies, with 36,175 participants. Men from sub-Saharan Africa (SSA) (OR 1.21, 95% confidence interval [CI] 1.09-1.34), but not men from elsewhere (OR 0.94, 95% CI 0.83-1.06), were more likely to be HHV-8 seropositive than women (p value for interaction=0.010). There was no difference in HHV-8 seroprevalence between boys and girls from SSA (OR 0.90, 95% CI 0.72-1.13). The type of HHV-8 assay did not affect the overall results. A higher HHV-8 seroprevalence in men than women in SSA may partially explain why men have higher KS risk in this region. This article is protected by copyright. All rights reserved.

An Oka principle for equivariant isomorphisms

Let G be a reductive complex Lie group acting holomorphically on normal Stein spaces X and Y, which are locally G-biholomorphic over a common categorical quotient Q. When is there a global G-biholomorphism X → Y? If the actions of G on X and Y are what we, with justification, call generic, we prove that the obstruction to solving this local-to-global problem is topological and provide sufficient conditions for it to vanish. Our main tool is the equivariant version of Grauert's Oka principle due to Heinzner and Kutzschebauch. We prove that X and Y are G-biholomorphic if X is K-contractible, where K is a maximal compact subgroup of G, or if X and Y are smooth and there is a G-diffeomorphism ψ : X → Y over Q, which is holomorphic when restricted to each fibre of the quotient map X → Q. We prove a similar theorem when ψ is only a G-homeomorphism, but with an assumption about its action on G-finite functions. When G is abelian, we obtain stronger theorems. Our results can be interpreted as instances of the Oka principle for sections of the sheaf of G-biholomorphisms from X to Y over Q. This sheaf can be badly singular, even for a low-dimensional representation of SL2(ℂ). Our work is in part motivated by the linearisation problem for actions on ℂn. It follows from one of our main results that a holomorphic G-action on ℂn, which is locally G-biholomorphic over a common quotient to a generic linear action, is linearisable.