Morphological scoring of human pronuclear zygotes for prediction of pregnancy outcome.

BACKGROUND: As embryo selection is not allowed by law in Switzerland, we need a single early scoring system to identify zygotes with high implantation potential and to select zygotes for fresh transfer or cryopreservation. The underlying aim is to maximize the cumulated pregnancy rate while limiting the number of multiple pregnancies. METHODS: In all, 613 fresh and 617 frozen-thawed zygotes were scored for proximity, orientation and centring of the pronuclei, cytoplasmic halo, and number and polarization of the nucleolar precursor bodies. From these individual scores, a cumulated pronuclear score (CPNS) was calculated. Correlation between CPNS and implantation was examined and compared between fresh and frozen-thawed zygotes. The effect of freezing on CPNS was also investigated. RESULTS: CPNS was positively associated with embryo implantation in both fresh and frozen zygotes. With similar CPNS, frozen zygotes presented implantation rates as high as those of fresh zygotes. Nucleolar precursor bodies pattern and cytoplasmic halo appeared as the most important factors predictive of implantation for both types of zygotes, while pronuclei position was specifically relevant for frozen-thawed zygotes. Freezing induced an alteration of most zygote parameters, resulting in a significantly lower CPNS and a lower pregnancy rate. CONCLUSIONS: CPNS may be used as a single prognostic tool for implantation of both fresh and frozen-thawed zygotes. Lower CPNS values of frozen-thawed zygotes may also be indicative of freezing damage to zygotes. Successful implantation of frozen zygotes despite lower CPNS suggests that they may recover after thawing and in vitro culture.

Addictions [Addiction].

The news in addiction medicine in 2013 are presented according to the new version of the DSM (DSM-5); new data on cannabinoid, highlight hypotheses on self-medication; a current status about treatment of the addiction via the internet is shown; and new therapeutic perspectives emerge from the knowledge on traumatic antecedents in addictive populations.

Prevention of overweight and obesity: a Spanish approach

Background. Obesity is considered a major public health issue in most developed countries nowadays. This paper provides an overview of current population data available in Spain and the approach to develop preventive strategies in the country. Methods. Review of population data available is based on individually measured weight and height as well as determinants. On this basis, the approach used in the country to develop preventive strategies is discussed. Results. According to the DORICA study, the prevalence of obesity (BMI ≥30 kg m−2) is 15.5% in Spanish adults aged 25–60 years (13.2% in men and 17.5% in women). Obesity rates are higher among women aged 45 years and older, low social class, living in semi-urban places. Population estimates for the prevalence of obesity in Spanish children and young people based on the enKid study are 13.9% for the whole group. In this study, overweight and obesity is related to absence of breastfeeding, low consumption of fruit and vegetables, high consumption of cakes, buns, softdrinks and butchery products, low physical activity levels and a positive association with time spent watching TV. In 2005, the Spanish Ministry of Health jointly with the Spanish Agency for Food Safety and Nutrition launched the multifaceted NAOS strategy for nutrition, physical activity and the prevention of obesity. The important role of the family and the school setting as well as the responsibility of the Health Administration and Pediatric Care in the prevention of obesity is highlighted in the document. The need for environmental actions is recognised. The PERSEO programme, a multicomponent school-based intervention project is part of the strategy currently in place. Conclusion. Obesity is a public health issue in Spain. A national multifaceted strategy was launched to counteract the problem. Environmental and policy actions are a priority. Young children and their families are among the main target groups.

Reactive rise in blood pressure upon cuff inflation : cuff inflation at the arm causes a greater rise in pressure than at the wrist in hypertensive patients

Résumé en français: Il est admis que l'inflation d'une manchette à pression au niveau du bras engendre une augmentation réactionnelle de la tension artérielle qui peut être le résultat d'une gêne lors de l'inflation et peut diminuer la précision de la mesure. Dans cette étude, nous comparons séquentiellement l'augmentation de la tension artérielle lorsque la manchette à pression est positionnée au niveau du bras et au niveau du poignet. Nous avons étudié un collectif de 34 participants normotendus et 34 patients hypertendus. Chacun d'eux était équipé de deux manchettes à pression, l'une au niveau du bras et l'autre au niveau du poignet. Nous avons randomisé l'ordre d'inflation des manchettes ainsi que la pression d'inflation maximale (180mmHg versus 240mmHg). Trois mesures étaient effectuées pour chaque pression d'inflation maximale, ceci au bras comme poignet, et leur séquence était également randomisée. En parallèle, un enregistrement continu de la tension artérielle avait lieu au niveau du majeur de la main opposée à l'aide d'un photoplethysmographe. Cette valeur était considérée comme la valeur de tension artérielle au repos. Pour les participants normotendus, aucune différence statistiquement significative n'a pu être mise en évidence en lien avec la position de la manchette à pression, ceci indépendamment de la pression d'inflation maximale. Variation de la pression systolique à 180 mmHg: 4.3+/-3.0 mmHg au bras et 3.7+/-2.9 mmHg au poignet (p=ns), à 240 mmHg: 5.5+/-3.9 au bras et 4.2+/-2.7 mmHg au poignet (p=0.052). En revanche, concernant les patients hypertendus, une augmentation significative de la tension artérielle a été mise en évidence entre le bras et le poignet. Ceci pour les valeurs de tension artérielle systolique et diastolique et quelle que soit la pression d'inflation maximale utilisée. Augmentation de la pression artérielle systolique 6.513.5 mmHg au bras et 3.812.1mmHg au poignet pour une pression d'inflation maximale de 180 mmHg (p<0.01) et respectivement 6.413.5 mmHg et 4.713.0 mmHg pour 240 mmHg (p=0.01). L'augmentation des valeurs de tension artérielle était indépendante de la valeur tensionnelle de base. Ces résultats montrent que les patients hypertendus réagissent significativement moins à l'inflation d'une manchette ä pression lorsque celle-ci est positionnée au niveau du poignet par rapport au bras, ceci indépendamment des valeurs de tension artérielle de base des patients. Nous pouvons donc suggérer que l'inflation d'une manchette à pression cause moins de désagrément lorsqu'elle est placée au niveau du poignet, notamment chez les patients hypertendus et qu'elle peut être une alternative à la mesure standard au niveau du bras.

Evolución de parámetros bioquímicos nutricionales en pacientes de hemodiálisis durante un año de seguimiento

Current high survival in hemodialysis patients (52% at 5 years) have made the chronic manifestations to emerge such as the high hyponutrition prevalence of these patients, as well as the importance of the nutritional status in their morbimortality. The reason for protein-caloric hyponutrition is multifactorial, although chronic inflammatory conditions associated to the dialysis technique are becoming more and more relevant. The variations in several nutritional biochemical parameters (total proteins, plasma albumin, transferrin, and total cholesterol) have been assessed in 73 hemodialysis patients for one year. The mean age of the patients was 53.3 +/- 18.69 years (43 males and 30 females). The average on hemodialysis program was 43 +/- 33 months, with a mean session duration of 246 +/- 24 minutes, and mean hemodialysis dose administered of 1.37 +/- 0.27 (KT/V) (second generation Daurgidas). A decrease in all the biochemical parameters assessed has been observed, with statistically significant differences: total proteins (p < 0.001), albumin (p < 0.00001), total cholesterol (p < 0.05), and transferrin (p < 0.01). The evolution of the nutritional biochemical parameters assessed showed an important nutritional deterioration of the patients remaining stable with the therapy.

Gériatrie [Review in geriatric medicine 2013].

Physical activity appears once again as the single most effective preventative intervention in older persons to delaying functional decline, avoiding falls, and mitigating the odds of developing dementia. Integrated care that promotes interdisciplinary collaboration among healthcare professionals is a major avenue to improve care coordination in polymorbid older patients. A study depicts the large gap between physicians and nurses' views about their respective skills and role in such a collaboration. On the cognitive side, while several studies show that new cohorts of older persons appear to age in better cognitive shape, results of trials of semagestat, a gamma-secretase inhibitor, and post-menopausal estrogenic therapy were disappointing. Finally, a study challenges the benefits of hydration in terminally ill patients.

Maladies infectieuses [Infectious diseases].

The recommendations for the treatment of gonorrhea have been changed: ceftriaxone 500 mg IM plus azithromycin 1 g PO is recommended. Prophylaxis of recurrent cellulitis with penicillin 250 mg 2 x/d PO may be considered. E. coli ESBL does not require contact isolation anymore. Fecal transplantation seems so far to be the most effective treatment of recurrent C. dificile. Two new respiratory viruses, Middle East Coronavirus (MERS-CoV) and avian-origin Influenza A (H7N9) have been reported. Oral valganciclovir treatment reduces the risk of hearing loss in congenital CMV infection. An outbreak of mould infections of the central nervous system has been described in the United States following injection of contaminated steroids.

Islet-brain1/C-Jun N-terminal kinase interacting protein-1 (IB1/JIP-1) promoter variant is associated with Alzheimer's disease.

Islet-brain1 (IB1) or c-Jun NH2 terminal kinase interacting protein-1 (JIP-1), the product of the MAPK8IP1 gene, functions as a neuronal scaffold protein to allow signalling specificity. IB1/JIP-1 interacts with many cellular components including the reelin receptor ApoER2, the low-density lipoprotein receptor-related protein (LRP), kinesin and the Alzheimer's amyloid precursor protein. Coexpression of IB1/JIP-1 with other components of the c-Jun NH2 terminal-kinase (JNK) pathway activates the JNK activity; conversely, selective disruption of IB1/JIP-1 in mice reduces the stress-induced apoptosis of neuronal cells. We therefore hypothesized that IB1/JIP-1 is a risk factor for Alzheimer's disease (AD). By immunocytochemistry, we first colocalized the presence of IB1/JIP-1 with JNK and phosphorylated tau in neurofibrillary tangles. We next identified a -499A>G polymorphism in the 5' regulatory region of the MAPK8IP1 gene. In two separate French populations the -499A>G polymorphism of MAPK8IP1 was not associated with an increased risk to AD. However, when stratified on the +766C>T polymorphism of exon 3 of the LRP gene, the IB1/JIP-1 polymorphism was strongly associated with AD in subjects bearing the CC genotype in the LRP gene. The functional consequences of the -499A>G polymorphism of MAPK8IP1 was investigated in vitro. In neuronal cells, the G allele increased transcriptional activity and was associated with an enhanced binding activity. Taken together, these data indicate that the increased transcriptional activity in the presence of the G allele of MAPK8IP1 is a risk factor to the onset of in patients bearing the CC genotype of the LRP gene.

Valoració de l'UCI oberta vs tancada dels professionals que han desenvolupat la seva tasca assistencial en els dos règims de visites: factors contribuients

Es pretén conèixer la valoració que fan els professionals de la Salut que treballen en un sistema de visites obert, dins una Unitat de Cures Intensives Polivalent d’Adults, en comparació a l’experiència d’haver treballat en un sistema de visites tancat. Malgrat ser ben valorat per pacients, familiars i professionals; el sistema obert provoca inconvenients que afecten directament a la tasca assistencial dels professionals. Cal trobar estratègies que permetin millorar les relacions interprofessionals amb les famílies i disminuir les interferències a l’hora de fer les cures, a la vegada, que es puguin mantenir els beneficis d’un sistema de visites obert.

Initial complications and factors related to prehospital mortality in acute myocardial infarction with ST segment elevation.

OBJECTIVE Hospital mortality in myocardial infarction ST-elevation myocardial infarction has decreased in recent years, in contrast to prehospital mortality. Our objective was to determine initial complications and factors related to prehospital mortality in patients with acute myocardial infarction with ST segment elevation (STEMI). METHODS Observational study based on a prospective continuous register of patients of any age attended by out-of-hospital emergency teams in Andalusia between January 2006 and June 2009. This includes patients with acute coronary syndrome-like symptoms whose initial ECG showed ST elevation or presumably new left bundle branch block (LBBB). Epidemiological, prehospital data and final diagnostic were recorded. The study included all patients with STEMI on the register, without age restrictions. Forward stepwise logistic regression analysis was performed to control for confounders. RESULTS A total of 2528 patients were included, 24% were women. Mean age 63.4±13.4 years; 16.7% presented atypical clinical symptoms. Initial complications: ventricular fibrillation (VF) 8.4%, severe bradycardia 5.8%, third-degree atrial-ventricular (AV) block 2.4% and hypotension 13.5%. Fifty-two (2.1%) patients died before reaching hospital. Factors associated with prehospital mortality were female sex (OR 2.36, CI 1.28 to 4.33), atypical clinical picture (OR 2.31, CI 1.21 to 4.41), hypotension (OR 4.95, CI 2.60 to 9.20), LBBB (OR 4.29, CI 1.71 to 10.74), extensive infarction (ST elevation in ≥5 leads) (OR 2.53, CI 1.28 to 5.01) and VF (OR 2.82, CI 1.38 to 5.78). CONCLUSIONS A significant proportion of patients with STEMI present early complications in the prehospital setting, and some die before reaching hospital. Prehospital mortality was associated with female sex and atypical presentation, as pre-existing conditions, and hypotension, extensive infarction, LBBB and VF on emergency team attendance.

Improving integrated care in chronic kidney failure patients with a standard-based interoperability framework.

This paper introduces the evaluation report after fostering a Standard-based Interoperability Framework (SIF) between the Virgen del Rocío University Hospital (VRUH) Haemodialysis (HD) Unit and 5 outsourced HD centres in order to improve integrated care by automatically sharing patients' Electronic Health Record (EHR) and lab test reports. A pre-post study was conducted during fourteen months. The number of lab test reports of both emergency and routine nature regarding to 379 outpatients was computed before and after the integration of the SIF. Before fostering SIF, 19.38 lab tests per patient were shared between VRUH and HD centres, 5.52 of them were of emergency nature while 13.85 were routine. After integrating SIF, 17.98 lab tests per patient were shared, 3.82 of them were of emergency nature while 14.16 were routine. The inclusion of a SIF in the HD Integrated Care Process has led to an average reduction of 1.39 (p=0.775) lab test requests per patient, including a reduction of 1.70 (p=0.084) in those of emergency nature, whereas an increase of 0.31 (p=0.062) was observed in routine lab tests. Fostering this strategy has led to the reduction in emergency lab test requests, which implies a potential improvement of the integrated care.

Urologie [Urology].

This article intended to general practitioners brings an overview on current diseases in urology such as stone disease, benign prostatic hyperplasia, sexual dysfunction and localized cancers of prostate, bladder and kidney.

Prise en charge d'adolescents souffrant d'anorexie mentale: le rôle des parents, une approche basée sur l'évidence [Adolescents with an eating disorder: an evidence-based approach on the role of parents].

L'adolescence est une période de grands changements et de ce fait potentiellement de grande vulnérabilité. Ainsi, les bouleversements physiques et psychiques induits par les processus pubertaires sont un terrain propice à l'émergence d'un trouble des conduites alimentaires (TCA). La thérapie familiale selon Maudsley, ou family based treatment (FBT), a émergé en parallèle aux avancées neurobiologiques, qui confirment une origine multifactorielle des troubles du comportement alimentaire. Cette thérapie replace les parents au centre de la prise en charge des adolescents souffrant d'un TCA avec comme grand atout, une approche basée sur l'évidence scientifique. Adolescence is a time of great change and therefore, potentially of great vulnerability. Thus, physical and psychological changes induced by pubertal processes are fertile ground for the emergence of an eating disorder (ED). Family therapy according to Maudsley or "family based treatment" (FBT) has emerged in parallel with neurobiological advances confirming a multifactorial origin of eating disorders. This therapy places parents at the centre of care for adolescents with EDs. Its great asset is the evidence-based approach underpinning the therapy.