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Background: Early bonding by skin-to-skin contact (SSC) is considered to be beneficial following vaginal delivery. Aim: We aimed to examine the impact of intraoperative bonding during caesarean section on maternal oxytocin levels, newborn feeding outcomes and maternal emotional wellbeing.Methods: We performed a prospective, randomized-controlled pilot study, which took place at a single academic tertiary hospital between September 2013 and January 2014. Pregnant women were recruited and randomly assigned to intraoperative (“early”) SCC (n=17) versus postoperative (“late”) SCC (n=18). We investigated maternal oxytocin levels, breastfeeding and newborn feeding outcomes as well as maternal emotional wellbeing.Findings: We found, that maternal oxytocin levels were comparable between the ‘Early SSC Group’ and the ‘Late SSC Group’ at each time point. Newborn drinking volume did not differ significantly on the second (p=0.213) and fourth (p=0.986) day after birth and the necessity of formula supplementation was similar in both groups (p=0.1). There were no significant differences in depressive symptoms and bonding behavior between the ‘Early SSC Group’ and the ‘Late SSC Group’. Discussion: Our study did not reveal significant differences regarding the investigated parameters. However, this needs to be further evaluated in a larger prospective randomized trial.Conclusion: Maternal oxytocin levels, breastfeeding and newborn feeding outcomes, and maternal emotional wellbeing seem to be unvaried by early SSC after caesarean section. TRIAL REGISTRATIONClinicalTrials.gov (10/07/2013; NCT01894880)review board approved the protocol (25-425 ex 12/13)

Background Embryo transfer (ET) is a crucial step of in vitro fertilisation (IVF) treatment, and involves placing the embryo(s) in the woman's uterus. There is a negative association between endometrial wave-like activity (contractile activities) at the time of ET and clinical pregnancy, but no specific treatment is currently used in clinical practice to counteract their effects. Oxytocin is a hormone produced by the hypothalamus and released by the posterior pituitary. Its main role involves generating uterine contractions during and after childbirth. Atosiban is the best known oxytocin antagonist (and is also a vasopressin antagonist), and it is commonly used to delay premature labour by halting uterine contractions. Other oxytocin antagonists include barusiban, nolasiban, epelsiban, and retosiban. Administration of oxytocin antagonists around the time of ET has been proposed as a means to reduce uterine contractions that may interfere with embryo implantation. The intervention involves administering the medication before, during, or after the ET (or a combination). Objectives To evaluate the effectiveness and safety of oxytocin antagonists around the time of ET in women undergoing assisted reproduction. Search methods We searched the Cochrane Gynaecology and Fertility (CGF) Group trials register, CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, and two trials registers in March 2021; and checked references and contacted study authors and experts in the field to identify additional studies. Selection criteria We included randomised controlled trials (RCTs) of the use of oxytocin antagonists for women undergoing ET, compared with the non-use of this intervention, the use of placebo, or the use of another similar drug. Data collection and analysis We used standard methodological procedures recommended by Cochrane. Primary review outcomes were live birth and miscarriage; secondary outcomes were clinical pregnancy and other adverse events. Main results We included nine studies (including one comprising three separate trials, 3733 women analysed in total) investigating the role of three different oxytocin antagonists administered intravenously (atosiban), subcutaneously (barusiban), or orally (nolasiban). We found very low- to high-certainty evidence: the main limitations were serious risk of bias due to poor reporting of study methods, and serious or very serious imprecision. Intravenous atosiban versus normal saline or no intervention We are uncertain of the effect of intravenous atosiban on live birth rate (risk ratio (RR) 1.05, 95% confidence interval (CI) 0.88 to 1.24; 1 RCT, N = 800; low-certainty evidence). In a clinic with a live birth rate of 38% per cycle, the use of intravenous atosiban would be associated with a live birth rate ranging from 33.4% to 47.1%. We are uncertain whether intravenous atosiban influences miscarriage rate (RR 1.08, 95% CI 0.75 to 1.56; 5 RCTs, N = 1424; I² = 0%; very low-certainty evidence). In a clinic with a miscarriage rate of 7.2% per cycle, the use of intravenous atosiban would be associated with a miscarriage rate ranging from 5.4% to 11.2%. Intravenous atosiban may increase clinical pregnancy rate (RR 1.50, 95% CI 1.18 to 1.89; 7 RCTs, N = 1646; I² = 69%; low-certainty evidence), and we are uncertain whether multiple or ectopic pregnancy and other complication rates were influenced by the use of intravenous atosiban (very low-certainty evidence). Subcutaneous barusiban versus placebo One study investigated barusiban, but did not report on live birth or miscarriage. We are uncertain whether subcutaneous barusiban influences clinical pregnancy rate (RR 0.96, 95% CI 0.69 to 1.35; 1 RCT, N = 255; very low-certainty evidence). Trialists reported more mild to moderate injection site reactions with barusiban than with placebo, but there was no difference in severe reactions. They reported no serious drug reactions; and comparable neonatal outcome between groups. Oral nolasiban versus placebo Nolasiban does not increase live birth rate (RR 1.13, 95% CI 0.99 to 1.28; 3 RCTs, N = 1832; I² = 0%; high-certainty evidence). In a clinic with a live birth rate of 33% per cycle, the use of oral nolasiban would be associated with a live birth rate ranging from 32.7% to 42.2%. We are uncertain of the effect of oral nolasiban on miscarriage rate (RR 1.45, 95% CI 0.73 to 2.88; 3 RCTs, N = 1832; I² = 0%; low-certainty evidence). In a clinic with a miscarriage rate of 1.5% per cycle, the use of oral nolasiban would be associated with a miscarriage rate ranging from 1.1% to 4.3%. Oral nolasiban improves clinical pregnancy rate (RR 1.15, 95% CI 1.02 to 1.30; 3 RCTs, N = 1832; I² = 0%; high-certainty evidence), and probably does not increase multiple or ectopic pregnancy, or other complication rates (moderate-certainty evidence). Authors' conclusions We are uncertain whether intravenous atosiban improves pregnancy outcomes for women undergoing assisted reproductive technology. This conclusion is based on currently available data from seven RCTs, which provided very low- to low-certainty evidence across studies. We could draw no clear conclusions about subcutaneous barusiban, based on limited data from one RCT. Further large well-designed RCTs reporting on live births and adverse clinical outcomes are still required to clarify the exact role of atosiban and barusiban before ET. Oral nolasiban appears to improve clinical pregnancy rate but not live birth rate, with an uncertain effect on miscarriage and adverse events. This conclusion is based on a phased study comprising three trials that provided low- to high-certainty evidence. Further large, well-designed RCTs, reporting on live births and adverse clinical outcomes, should focus on identifying the subgroups of women who are likely to benefit from this intervention.

To examine the association between third trimester cervical length (CL) measurement and duration of the first stage of labor. This prospective cohort study included women with a singleton pregnancy who had routine CL measurements taken by transvaginal ultrasonography between 37 and 39 weeks gestation. Subjective duration of the first stage of labor was defined as the duration of contractions that the women subjectively had from the onset of regular contractions to full effacement of the cervix. Objective duration of first stage of labor was defined as 3 cm cervical dilation independent of cervical effacement until full effacement of the cervix. Associations between variables were analyzed using nonparametric correlations coefficients. A model relating the duration of labor to predictors was built using linear regression. In this analysis a total of 129 women were included. There was no significant correlation between CL and subjective duration of labor (ρ = −0.037, p = 0.695); however, a reduction in CL increased the objective duration of the first stage of labor (ρ = −0.269, p = 0.013). In univariate analysis parity (p = 0.018), hypertensive disorders (p = 0.013) and induction of labor (p = 0.022) were significantly associated with subjective duration of the first stage of labor. A long cervix in the third trimester is not associated with a prolonged first stage of labor. Induction of labor and multiparity were associated with a shorter first stage of labor while hypertension was associated with a longer duration of labor.

The removal of cumulus cells in a process called oocyte denudation is required in order to visualise, grade and manipulate the oocytes before injection. The objective of this study was to appraise critically the published randomised controlled trials (RCTs) comparing recombinant hyaluronidase with bovine hyaluronidase for oocyte denudation before intracytoplasmic sperm injection (ICSI). We performed a comprehensive literature search of the standard medical databases in order to identify the RCTs comparing oocyte denudation with recombinant hyaluronidase or bovine hyaluronidase before ICSI. Three RCTs involving 2445 oocytes collected from 200 women were analysed. There was substantial heterogeneity among the included RCTs. A meta-analysis from the available moderate to high quality trials found no statistical difference in terms of fertilisation rate, embryo quality and live birth rate between the use of recombinant or bovine hyaluronidase for oocyte denudation before ICSI.IMPACT STATEMENTWhat is already known on this subject? The removal of cumulus cells in a process called oocyte denudation is required in order to visualise, grade and manipulate the oocytes before injection. The long-established source of hyaluronidase has been represented by bovine testes, but concern has been raised regarding the possible negative effects over the fragile oocytes by mechanisms involving low enzyme purity, variable concentrations, trauma, prolonged exposure and integration of external DNA in the oocyte. Recombinant human hyaluronidase has been proposed as an alternative in order to counteract the possible negative effects of using animal derived products.What do the results of this study add? A meta-analysis from the available moderate to high quality trials found no statistical difference in fertilisation rate, embryo quality and live birth rate between the use of recombinant or bovine hyaluronidase for oocyte denudation before ICSI.What are the implications of these findings or clinical practice and/or further research? Future trials should be powered adequately in order to be able to identify the possible small differences between the study groups and they should be conducted according to the CONSORT guidelines as the absence of blinding for outcome assessors can induce detection bias.

To describe the prevalence and spectrum of cardio-pathogenic variants in singleton fetuses after unexplained intrauterine fetal death (IUFD). DNA from post-mortem fibroblastic tissue samples of 16 fetuses after unexplained IUFD was retrieved at two tertiary university hospitals for clinical exome sequencing with subsequent filtering of 122 cardio-specific genes to elucidate underlying cardio-pathogenic variants. In total, we included 12 (75%) male and four (25%) female fetuses who were stillborn at a median gestational age of 34+6 (23+2–40+5) weeks. In two (12.5%) fetuses no cardio-pathogenic variants were found. In 14 (87.5%) fetuses, overall 33 variants were detected in 22 cardio-specific genes, involving 14 (63.63%) genes associated with cardiomyopathy, six (27.27%) arrhythmogenic susceptibility genes and two (9.09%) arrhythmia and cardiomyopathy associated genes. Among the 33 variants, five (15.2%) were classified as likely benign according to the American College of Medical Genetics and Genomics; 28 (84.8%) variants were considered as variants of uncertain significance. Compared to a cohort of explained IUFDs, the cases with and without fetal variants in cardiac genes differed not significantly regarding maternal age, previous history of stillbirth, time of stillbirth or fetal sex. Unexplained stillbirth may be caused by cardio-genetic pathologies, yet a high number of variants of uncertain significance merit a more detailed post-mortem examination including family segregation analysis.

Background & aims: Vitamin D supplementation may affect glycemic as well as hormonal regulation. Thus, the aim of the current study was to investigate whether vitamin D supplementation has any significant effects on metabolic and endocrine parameters in healthy premenopausal women. Primary outcome measure was the plasma glucose area under the curve (AUCgluc). Methods: The current study was a single-center, double-blind, randomized placebo-controlled trial that was conducted at the Medical University of Graz, Austria, between March 2013 and October 2017. One-hundred and fifty healthy premenopausal women with 25-hydroxyvitamin D [25(OH)D] concentrations 2; baseline 25(OH)D 55.8 ± 19.7 nmol/L] completed the study. Vitamin D supplementation had no significant effect on AUCgluc (mean treatment effect 11.70; p = 0.069), while it had a significant treatment effect on homeostatic model assessment-insulin resistance (HOMA-IR; mean treatment effect 0.31; p = 0.019) and quantitative insulin-sensitivity check index (QUICKI; mean treatment effect −0.019; p = 0.013). There was no significant effect on the remaining secondary outcome parameters. Conclusions: In this randomized-controlled trial in healthy premenopausal women, there was a significant treatment effect of vitamin D supplementation on HOMA-IR and QUICKI, while there was no significant treatment effect on AUCgluc.

Purpose: It has been hypothesized that vitamin D is associated with androgen levels in men. We, therefore, aimed to evaluate whether vitamin D supplementation increases serum total testosterone (TT) levels in men with low TT levels at baseline. Methods: The Graz Vitamin D&TT-RCT is a single-center, double-blind, randomized placebo-controlled trial conducted between March 2013 and November 2017 at the endocrine outpatient clinic at the Medical University of Graz, Austria. One-hundred healthy men with serum TT levels < 10.4 nmol/l and 25-hydroxyvitamin D [25(OH)D] levels < 75 nmol/l participated in the trial. Subjects were randomized to receive 20,000 IU of vitamin D3/week (n = 50) or placebo (n = 50) for 12 weeks. Primary outcome was TT measured using mass spectrometry. Secondary outcomes were free testosterone, free androgen index, sex hormone-binding globulin, estradiol, follicle-stimulating hormone, luteinizing hormone, metabolic characteristics, and body composition. Results: Ninety-four men [mean age and 25(OH)D: 47 (± 12) years and 56.3 (± 18.3) nmol/l, respectively] completed the study. We found no significant treatment effect on serum TT or on the remaining secondary outcome variables. Conclusion: Vitamin D treatment had no effect on serum TT levels in middle-aged healthy men with low TT levels.

Protocols to induce a monofollicular or multifollicular response in women undergoing controlled ovarian stimulation (COS) commonly rely on follicular stimulating hormone (FSH) injections. Some decades ago, the purification of gonadotrophin from human menopausal urine, which contained FSH and luteinizing hormone (LH), has been described [1]. The use of specific monoclonal antibodies, which bind FSH or LH molecules in human menopausal gonadotrophin (hMG), leads to the availability of urinary (u) FSH. Further purification of hMG minimized the activity of LH by immunoaffinity chromatography and resulted in a higher purified FSH.

Purpose Vitamin D status may be associated with insulin resistance and other key features of polycystic ovary syndrome (PCOS), but data from preliminary randomized controlled trials (RCTs) are conflicting. Therefore, we aimed to investigate the effects of vitamin D supplementation on plasma glucose area under the curve (AUCgluc, primary outcome measure) and on other metabolic and endocrine parameters (secondary outcome measures). Methods This study was a single-center, double-blind, randomized placebo-controlled trial conducted between December 2011 and July 2017 at the Medical University of Graz, Austria. One-hundred and eighty women with PCOS and 25-hydroxyvitamin D [25(OH)D] concentrations

Vitamin D is well known for its effects on calcium and mineral metabolism. However, vitamin D effects on bone turnover markers (BTMs), which are used together with bone mineral density (BMD) to evaluate bone health, are less clear. We therefore examined vitamin D effects on BTMs (beta-cross laps (CTX) and osteocalcin (OC)) and BMD in a post-hoc analysis of a randomized controlled trial (RCT). This is a post-hoc analysis of the Graz Vitamin D&amp, TT-RCT, a single-center, double-blind, randomized placebo-controlled trial conducted between December 2012 and November 2017 at the endocrine outpatient clinic at the Medical University of Graz, Austria. A total of 200 healthy men with serum 25-hydroxyvitamin D (25(OH)D) levels &lt, 75 nmol/L participated in the trial. Subjects were randomized to receive 20,000 IU of vitamin D3/week (n = 100) or placebo (n = 100) for 12 weeks. Outcome measures were BTMs, BMD, and trabecular bone score (TBS). A total of 192 men (mean age and 25(OH)D: 43 (&plusmn, 13) years and 54.9 (&plusmn, 18.3) nmol/L, respectively) completed the study. We found no significant treatment effect on BTMs, BMD, or TBS (p &gt, 0.05 for all). In middle-aged healthy men, vitamin D treatment for 12 weeks had no significant effect on BTMs or BMD.

Objectives To identify, appraise and summarize the current evidence regarding the efficacy of strategies aimed at improving assisted reproductive techniques in women with polycystic ovary syndrome (PCOS). Methods A comprehensive literature search of the standard medical databases was performed. The last electronic search was run in July 2015. The primary outcome measures were live birth/ongoing pregnancy and ovarian hyperstimulation syndrome (OHSS). The secondary outcome measures were clinical pregnancy and miscarriage. Results We screened 1021 records and completely assessed 173, finally including 66 studies in the quantitative analysis. Many different interventions were assessed, however the overall quality of the studies was low. We observed moderate-quality evidence that there is no clinically relevant difference in live birth/ongoing pregnancy rates (relative risk (RR), 0.95 (95% CI, 0.84–1.08)), or clinical pregnancy (RR, 1.02 (95% CI, 0.91–1.15)) when comparing antagonist and agonist protocols for ovarian stimulation. Additionally, we found low-quality evidence that metformin improves live birth/ongoing pregnancy (RR, 1.28 (95% CI, 1.01–1.63)) and clinical pregnancy rates (RR, 1.26 (95% CI, 1.04–1.53)) when compared with placebo or no intervention. We further found low-quality evidence that there is no clinically relevant difference in live birth/ongoing pregnancy rates (RR, 1.03 (95% CI, 0.80–1.34)) and clinical pregnancy rates (RR, 0.99 (95% CI, 0.81–1.22)) when comparing human menopausal gonadotropin for inducing ovulation and artificial preparation with estradiol valerate for endometrial preparation for frozen embryo transfer (FET). Low-quality evidence suggests that mannitol compared with no intervention (RR, 0.54 (95% CI, 0.39–0.77)) and antagonist protocols compared with agonist protocols (RR, 0.63 (95% CI, 0.49–0.80)) reduce rates of OHSS. Conclusion There is low- to moderate-quality evidence suggesting that antagonist protocols are preferable to agonist ones, because they reduce the incidence of OHSS without interfering with clinical pregnancy and live birth for women with PCOS. Additionally there is low-quality evidence pointing to a benefit of metformin supplementation on clinical pregnancy and live birth; and that ovulation induction and administration of estradiol seem to be equally effective for endometrial preparation before FET for women with PCOS. For all other interventions, the evidence is of very low quality, not allowing any meaningful conclusions to be drawn. Estrategias para mejorar el resultado de la reproduccion asistida en mujeres con sindrome de ovario poliquistico: revision sistematica y metaanalisis RESUMEN Objetivos Identificar, evaluar y resumir la evidencia actual sobre la eficacia de las estrategias para mejorar las tecnicas de reproduccion asistida en mujeres con sindrome de ovario poliquistico (SOP). Metodos Se realizo una busqueda exhaustiva de literatura en las bases de datos medicas estandar. La ultima busqueda electronica se realizo en julio de 2015. Las medidas de resultado primarias fueron los nacimientos vivos/embarazos en curso y el sindrome de hiperestimulacion ovarica (SHO). Las medidas de resultado secundarias fueron el embarazo confirmado ecograficamente y el aborto. Resultados Se cribaron 1021 registros, de los que se evaluaron por completo 173, para finalmente incluir 66 estudios en el analisis cuantitativo. Aunque se evaluaron muchas intervenciones diferentes, en general la calidad de los estudios fue baja. Se observo evidencia de calidad moderada de que no hay diferencias relevantes clinicamente en las tasas de nacimientos vivos/embarazos en curso (riesgo relativo (RR): 0,95 (IC 95%, 0,84–1,08)), o de embarazos confirmados ecograficamente (RR: 1,02 (IC 95%, 0,91–1,15)), cuando se comparan los protocolos de antagonistas y agonistas para la estimulacion ovarica. Ademas, se encontro evidencia de baja calidad en que la metformina mejora las tasas de nacimientos vivos/embarazos en curso (RR: 1,28 (IC 95%, 1,01–1,63)) y de embarazos confirmados ecograficamente (RR: 1,26 (IC 95%, 1,04–1,53)) en comparacion con un placebo o la no intervencion. Se encontro tambien evidencia de baja calidad en que no hay diferencias relevantes clinicamente en las tasas de nacimientos vivos/embarazos en curso (RR: 1,03 (IC 95%, 0,80–1,34)) y las tasas de embarazos confirmados ecograficamente (RR: 0,99 (IC 95%, 0.81–1,22)) al comparar la gonadotropina menopausica humana para la induccion de la ovulacion y la preparacion artificial con el valerato de estradiol para preparar el endometrio para la transferencia de embriones congelados (TEC). La baja calidad de la evidencia sugiere que el manitol, en comparacion con la no intervencion (RR: 0,54 (IC 95%, 0,39–0,77)), y los protocolos de antagonistas, en comparacion con los protocolos de agonistas (RR: 0,63 (IC 95%, 0,49–0,80)), reducen las tasas de SHO. Conclusion Hay evidencia de calidad baja a moderada que sugiere que los protocolos de antagonistas son preferibles a los de agonistas, ya que reducen la tasa de SHO sin interferir con el embarazo confirmado ecograficamente y los nacimientos vivos en las mujeres con SOP. Ademas, existe evidencia de baja calidad que indica un beneficio del uso de metformina como aporte suplementario en embarazos confirmados ecograficamente y en nacimientos vivos; y que la induccion de la ovulacion y la administracion de estradiol parecen ser igualmente eficaces para la preparacion del endometrio antes de la TEC en mujeres con SOP. Para el resto de procedimientos, la evidencia es de muy baja calidad, y por ello no permite extraer conclusiones importantes.

Studies suggest that non-pregnant women with polycystic ovary syndrome (PCOS) may be at elevated risk of 25 hydroxyvitamin D (25(OH)D) deficiency. Furthermore, there is evidence suggesting that 25(OH)D may also play an important role during pregnancy. Data regarding 25(OH)D deficiency during pregnancy in PCOS patients and its association with perinatal outcome is scarce. The aim of the study was to investigate whether mothers with and without PCOS have different 25(OH)D levels at term, how maternal 25(OH)D levels are reflected in their offspring, and if 25(OH)D levels are associated with an adverse perinatal outcome. Therefore, we performed a cross-sectional observational study and included 79 women with PCOS according to the ESHRE/ASRM 2003 definition and 354 women without PCOS and an ongoing pregnancy ≥ 37 + 0 weeks of gestation who gave birth in our institution between March 2013 and December 2015. Maternal serum and cord blood 25(OH)D levels were analyzed at the day of delivery. Maternal 25(OH)D levels did not differ significantly in women with PCOS and without PCOS (p = 0.998), nor did the 25(OH)D levels of their respective offspring (p = 0.692). 25(OH)D deficiency (&lt, 20 ng/mL) was found in 26.9% and 22.5% of women with and without PCOS (p = 0.430). There was a strong positive correlation between maternal and neonatal 25(OH)D levels in both investigated groups (r ≥ 0.79, p &lt, 0.001). Linear regression estimates of cord blood 25(OH)D levels are about 77% of serum 25(OH)D concentrations of the mother. Compared to healthy controls, the risk for maternal complications was increased in PCOS women (48% vs. 65%, p = 0.009), while there was no significant difference in neonatal complications (22% and 22%, p = 1.0). However, 25(OH)D levels were similar between mothers and infants with and without perinatal complications. Although the share of women and infants with 25(OH)D deficiency was high in women with PCOS and without PCOS, it seems that the incidence of adverse perinatal outcome was not affected. The long-term consequences for mothers and infants with a 25(OH)D deficiency have to be investigated in future studies.

Objectives: The aetiology of polycystic ovary syndrome (PCOS) is not particularly mapped, however, a complex interaction of various factors, such as genetic, environmental and intrauterine factors, can be assumed. Experimental animal studies and clinical observations support the hypothesis that developmental programming by excess intrauterine steroid is relevant. The aim of the study was to investigate whether mothers with and without PCOS exhibit different androgen and anti-Mullerian hormone (AMH) levels at the end of pregnancy and how maternal hormone levels are reflected in their offspring. Methods: Between March 2013 and December 2015, we performed a prospective cross-sectional study at the Medical University of Graz. We included 79 women with PCOS according to the ESHRE/ASRM 2003 definition and 354 women without PCOS, both with an ongoing pregnancy &ge, 37 + 0 weeks of gestation, who gave birth in our institution. Primary outcome parameters were the levels of maternal and neonatal androgens (testosterone, free testosterone, androstenedione) and AMH at delivery. Results: Androgen levels in female offspring of PCOS and non-PCOS women at birth did not differ, while maternal hormone levels differed significantly. Androgen levels in PCOS boys were significantly higher when compared to levels in PCOS girls. Discussion: Our findings do not support the hypothesis that maternal androgen excess contributes to elevated androgen concentrations in the female offspring. Nevertheless, the effects of the increased androgen concentrations in mothers on their offspring have to be investigated in future studies.

Background and aimsApparent aspiration is a notable adverse event during gastrointestinal endoscopy under sedation (GIES), but data about inapparent aspiration are scarce. Generally, particularly older patients are at higher risk of suffering from adverse events.ObjectiveThe objective of this article is to determine the risk of pneumonia, lower respiratory tract infection (LRI) and systemic inflammatory activation after GIES, especially in patients of at least 65 years.MethodsThe retrospective case-control study included 250 patients undergoing GIES and assigned age-, gender- and time of performance-matched controls without invasive procedure or sedation (ratio 1:1).ResultsOn day 3 patients of advanced age presented with both pneumonia and LRI more often (2.6 vs. 0.0%, p = 0.041 and 7.8 vs. 2.5%, p = 0.034, respectively). In general, several inflammatory parameters increased significantly after GIES (i.e. white blood cell count (increase of ≥ 25%) 18.6 vs. 6.9%, p ConclusionsPatients of advanced age carry an increased risk of pneumonia and LRI after GIES. Patients are generally more likely to feature inflammation and to receive antibiotic treatment.

Vitamin D might play a role in metabolic processes and obesity. We therefore examined vitamin D effects on metabolic markers and obesity in a randomized controlled trial (RCT). This is a post-hoc analysis of the Graz Vitamin D&amp, TT-RCT, a single-center, double-blind, randomized placebo-controlled trial. We included 200 healthy men with serum 25-hydroxyvitamin D (25(OH) D) levels &lt, 75 nmol/L. Subjects received 20,000 IU of vitamin D3/week (n = 100) or placebo (n = 100) for 12 weeks. Outcome measures were metabolic markers, anthropometric measures, and body composition assessed by Dual-energy X-ray absorptiometry. One-hundred and ninety-two men completed the study. We found a significant treatment effect on fasting glucose/fasting insulin ratio (−5.3 (−10.4 to −0.2), p = 0.040), whereas we observed no significant effect on the remaining outcome parameters. In subgroup analyses of men with baseline 25(OH)D levels &lt, 50 nmol/L (n = 80), we found a significant effect on waist circumference (1.6 (0.3 to 2.9) cm, p = 0.012), waist-to-hip ratio (0.019 (0.002 to 0.036), p = 0.031), total body fat (0.029 (0.004 to 0.055) %, p = 0.026), and android fat (1.18 (0.11 to 2.26) %, p = 0.010). In middle-aged healthy men, vitamin D treatment had a negative effect on insulin sensitivity. In vitamin D deficient men, vitamin D has an unfavorable effect on central obesity and body composition.

In der Schwangerschaftsberatung wird ein Interventionsmodell erprobt, das Screenings zum Alkohol- und/oder Tabakkonsum sowie psychoedukative Materialien, motivierende Kurzinterventionen und Elemente des SKOLL-Trainings umfasst. Die Zahl erfasster rauchender Schwangerer entspricht annahernd den bundesdeutschen Haufigkeiten, wahrend sich im Alkoholscreening in einer ersten Projektphase deutliche Unterschatzungen zeigen. Es steht aber weniger die reale Zahl konsumierender Schwangerer im Vordergrund des Interventionsmodells, sondern vielmehr die Ermoglichung der Thematisierung und Sensibilisierung des Konsums in einem nicht suchtspezifischen Setting. Screening und nachfolgende Interventionsschritte stosen mehrheitlich auf positive Reaktionen und Interesse der Schwangeren an weitergehender Information zum Suchtmittelkonsum, eroffnen also in der Schwangerschaftsberatung Wege der Pravention fetaler Schadigungen.

In sportmedizinischen Untersuchungen erzielten jugendliche Athleten haufig nicht die erwarteten Ausdauerleistungen. In dieser prospektiven, longitudinalen Studie wurden 180 Schuler aus 2 Sportgymnasien (A und B) von der 9. bis zur 12. bzw. 13. Schulstufe untersucht. Die erste maximale Ergometrie wurde zu Beginn der 9. Jahrgangsstufe entweder auf dem Fahrrad oder Laufband absolviert und danach bei allen Schulern jahrlich bis zum Schulende kontrolliert Die Sportarten umfassten alpines Schifahren (42 Madchen, 86 Jungen) und nordische Disziplinen (23 Madchen, 29 Jungen). Alpines Schifahren: Die Absolutleistung der Madchen der Schule A verbesserte sich bis zur 11. Klasse signifikant (p

Recently, a new rebound tonometer has been introduced into the market, which might be useful for glaucoma screenings in developing countries. Disposable probes, that are potentially reusable, are recommended by the manufacturer. Our study aimed to address the question of microbial transmission risks if the probes are reused.IOP measurements were obtained from 100 healthy eyes. The used probes were inoculated on broth and culture media. In addition, 10 probes were analyzed using environmental scanning electron microscopy in saturated hydrogen-steam atmosphere after usage and wipe disinfection technique with Sekusept 4% solution or Isopropanol 70%.No bacterial or fungal growth could be detected in any of the inoculated agar plates or broth tubes. No microorganisms, clumps of cells, or single intact epithelium cells were detected in any of the probes using environmental scanning electron microscopy. Cell debris was detected on seven probes; three probes were completely free of any residual cell elements.Transmission of possibly infective material through reused probes is significantly less than for reusable Goldmann probes if the same sterilization protocols are applied. Re-usage of the probes appears safe and is helpful in avoiding unnecessary costs.

Biometriemessungen haben das Potenzial, die refraktiven Ergebnisse der Kataraktchirurgie in Entwicklungslandern zu verbessern. Ihre Durchfuhrung ist jedoch in entlegenen Gegenden logistisch schwierig. Bei Kataraktpatienten in einem Camp in Nordkenia wurde eine Biometrie mit tragbaren Geraten versucht, und es wurden Grunde fur ein Biometrieversagen notiert. PMMA-Linsen der Starke 17–27 dpt wurden implantiert und ein Modell zur Berechnung des postoperativen Refraktionsfehlers bei Verwendung von Standardlinsen (22 dpt) generiert. In 104 von 131 Augen (80%) war die Biometrie moglich. Hornhautschaden waren der Hauptgrund fur ein Scheitern. Die durchschnittliche berechnete Linsenstarke fur Emmetropie betrug 21,56 dpt, SD:1,96 (min: 14,78 dpt, max: 27,24 dpt). Bei Verwendung von 22 dpt Standardlinsen hatten 20% aller Patienten einen Refraktionsfehler von mehr als 2 dpt und 7% einen Fehler von mehr als 3 dpt gehabt. Okulare Komorbiditat erschwert Biometrie in entlegenen Gegenden. Dennoch erscheint ihr Einsatz sinnvoll und ist notwendig, um postoperative Refraktionsfehler zu begrenzen. Ohne Biometrie kann ein schlechtes refraktives Ergebnis bei mindestens 20% aller Operierten erwartet werden.

BACKGROUND: After the U. S. Embassy bombing in 1998 in Nairobi, Kenya, a relief operation was immediately initiated by the Department of Ophthalmology of the Ludwig Maximilians University (LMU) Munich, Germany. Surgical devices and material (such as a vitrectomy unit, silicon oil, perfluordecalin, intraocular lenses, sutures) were supplied to operate on 42 ocular-injured victims of this bombing attack. Apart from these specific operations in Kenya, there is a big need for vitreoretinal surgery in East Africa, as in all other developing countries. Therefore, a vitreoretinal training program was started in 2000 in Nairobi, Kenya. We report about the first 7 years of collaboration between the Ludwig Maximilians University of Munich, Germany and the University of Nairobi in cooperation with the Kenyatta National Hospital, Kenya. MATERIAL AND METHODS: The training program was based on an annual project week in which the author (CLS) carried out vitreoretinal surgery himself and assisted and supervised surgery done by the local Kenyan colleagues at the Kenyatta National Hospital. Within the observation period of the present work (2000 - 2006) the following data were collected: number and kind of surgery, indications, surgeons, grading of eye pathology and the surgical procedure, time to prepare for surgery and duration of surgery. RESULTS: In total, 293 vitreoretinal surgeries were performed during the observation period. Surgeries carried out by the local Kenyan colleagues independently, without intervention of the author, increased from 29.4 % (2000) to 78.6 % (2006). Due to a constant development in the learning process during the project week more severe cases were treated and preparation time for surgery from the nursing side has shortened. CONCLUSIONS: By initiating a project week with high frequency surgery, supported by a highly experienced visiting surgeon, vitreoretinal surgery can be successfully set up in an ophthalmic clinic of a developing country. This approach has some advantages when compared to long-period projects, especially for the purposes of sustainability. However, to be successful it requires systematic planning which is described in this article.

Background/aims: Contaminated ophthalmic solutions represent a potential cause of avoidable ocular infection. This study aimed to determine the magnitude and pattern of microbial contamination of multi-dose ocular solutions at the Department of Ophthalmology, University of Nairobi, at the Kenyatta National Hospital, Kenya. Methods: 101 vials were obtained for microbial examination after an average use of 2 weeks. The dropper tip and the residual eye drop were examined for contamination. The specimens were cultured, the number of colonies counted, the organisms identified and susceptibility testing to selected antimicrobial agents was done. Results: Six (6%) of the 101 analysed vials were contaminated: 4/77 vials (5%) from a multi-user setting and 2/24 vials (8%) from a single user setting. Three contaminations (3/38, 8%) occurred in vials from the eye ward, another three (3/59, 5%) in vials from the outpatient clinic. Most bacteria identified belonged to the normal commensal flora of the eye. Isolated contaminants were micrococci (n = 2), Staphylococcus epidermidis , Haemophilus sp, Bacillus sp and a Gram negative rod. The dropper tip was more often contaminated (n = 6) than the residual solution (n = 1), and only one vial showed a contamination of both the drop and the tip. Conclusion: Our data show a contamination rate of 6%, which is in the lower range of data published on the contamination of eye drops elsewhere (0.07% to 35.8%).

To identify, appraise and summarize the current evidence regarding the efficacy of strategies aimed at improving assisted reproductive techniques in women with polycystic ovary syndrome (PCOS).A comprehensive literature search of the standard medical databases was performed. The last electronic search was run in July 2015. The primary outcome measures were live birth/ongoing pregnancy and ovarian hyperstimulation syndrome (OHSS). The secondary outcome measures were clinical pregnancy and miscarriage.We screened 1021 records and completely assessed 173, finally including 66 studies in the quantitative analysis. Many different interventions were assessed, however the overall quality of the studies was low. We observed moderate-quality evidence that there is no clinically relevant difference in live birth/ongoing pregnancy rates (relative risk (RR), 0.95 (95% CI, 0.84-1.08)), or clinical pregnancy (RR, 1.02 (95% CI, 0.91-1.15)) when comparing antagonist and agonist protocols for ovarian stimulation. Additionally, we found low-quality evidence that metformin improves live birth/ongoing pregnancy (RR, 1.28 (95% CI, 1.01-1.63)) and clinical pregnancy rates (RR, 1.26 (95% CI, 1.04-1.53)) when compared with placebo or no intervention. We further found low-quality evidence that there is no clinically relevant difference in live birth/ongoing pregnancy rates (RR, 1.03 (95% CI, 0.80-1.34)) and clinical pregnancy rates (RR, 0.99 (95% CI, 0.81-1.22)) when comparing human menopausal gonadotropin for inducing ovulation and artificial preparation with estradiol valerate for endometrial preparation for frozen embryo transfer (FET). Low-quality evidence suggests that mannitol compared with no intervention (RR, 0.54 (95% CI, 0.39-0.77)) and antagonist protocols compared with agonist protocols (RR, 0.63 (95% CI, 0.49-0.80)) reduce rates of OHSS.There is low- to moderate-quality evidence suggesting that antagonist protocols are preferable to agonist ones, because they reduce the incidence of OHSS without interfering with clinical pregnancy and live birth for women with PCOS. Additionally there is low-quality evidence pointing to a benefit of metformin supplementation on clinical pregnancy and live birth; and that ovulation induction and administration of estradiol seem to be equally effective for endometrial preparation before FET for women with PCOS. For all other interventions, the evidence is of very low quality, not allowing any meaningful conclusions to be drawn. Estrategias para mejorar el resultado de la reproducción asistida en mujeres con síndrome de ovario poliquístico: revisión sistemática y metaanálisis RESUMEN OBJETIVOS: Identificar, evaluar y resumir la evidencia actual sobre la eficacia de las estrategias para mejorar las técnicas de reproducción asistida en mujeres con síndrome de ovario poliquístico (SOP). MÉTODOS: Se realizó una búsqueda exhaustiva de literatura en las bases de datos médicas estándar. La última búsqueda electrónica se realizó en julio de 2015. Las medidas de resultado primarias fueron los nacimientos vivos/embarazos en curso y el síndrome de hiperestimulación ovárica (SHO). Las medidas de resultado secundarias fueron el embarazo confirmado ecográficamente y el aborto.Se cribaron 1021 registros, de los que se evaluaron por completo 173, para finalmente incluir 66 estudios en el análisis cuantitativo. Aunque se evaluaron muchas intervenciones diferentes, en general la calidad de los estudios fue baja. Se observó evidencia de calidad moderada de que no hay diferencias relevantes clínicamente en las tasas de nacimientos vivos/embarazos en curso (riesgo relativo (RR): 0,95 (IC 95%, 0,84-1,08)), o de embarazos confirmados ecográficamente (RR: 1,02 (IC 95%, 0,91-1,15)), cuando se comparan los protocolos de antagonistas y agonistas para la estimulación ovárica. Además, se encontró evidencia de baja calidad en que la metformina mejora las tasas de nacimientos vivos/embarazos en curso (RR: 1,28 (IC 95%, 1,01-1,63)) y de embarazos confirmados ecográficamente (RR: 1,26 (IC 95%, 1,04-1,53)) en comparación con un placebo o la no intervención. Se encontró también evidencia de baja calidad en que no hay diferencias relevantes clínicamente en las tasas de nacimientos vivos/embarazos en curso (RR: 1,03 (IC 95%, 0,80-1,34)) y las tasas de embarazos confirmados ecográficamente (RR: 0,99 (IC 95%, 0.81-1,22)) al comparar la gonadotropina menopáusica humana para la inducción de la ovulación y la preparación artificial con el valerato de estradiol para preparar el endometrio para la transferencia de embriones congelados (TEC). La baja calidad de la evidencia sugiere que el manitol, en comparación con la no intervención (RR: 0,54 (IC 95%, 0,39-0,77)), y los protocolos de antagonistas, en comparación con los protocolos de agonistas (RR: 0,63 (IC 95%, 0,49-0,80)), reducen las tasas de SHO. CONCLUSIÓN: Hay evidencia de calidad baja a moderada que sugiere que los protocolos de antagonistas son preferibles a los de agonistas, ya que reducen la tasa de SHO sin interferir con el embarazo confirmado ecográficamente y los nacimientos vivos en las mujeres con SOP. Además, existe evidencia de baja calidad que indica un beneficio del uso de metformina como aporte suplementario en embarazos confirmados ecográficamente y en nacimientos vivos; y que la inducción de la ovulación y la administración de estradiol parecen ser igualmente eficaces para la preparación del endometrio antes de la TEC en mujeres con SOP. Para el resto de procedimientos, la evidencia es de muy baja calidad, y por ello no permite extraer conclusiones importantes.

Einleitung: Substanzabhangigkeit und Kindesmissbrauch treten haufig gemeinsam auf. Suchtprobleme gehoren einerseits zu den wichtigsten Ursachen, andererseits zu den haufigsten Folgen fruher Gewalt und Vernachlassigung. So entwickelt eine von funf Personen mit Vernachlassigungs- und/oder Missbrauchserfahrungen in Kindheit und Jugend eine Suchterkrankung. Zudem weist jeder zweite Substanzabhangige traumatische Erfahrungen im familiaren Kontext auf. Die Suchterkrankung bei Eltern stellt dabei auserdem den bedeutsamsten Risikofaktor fur die Ausubung von Missbrauch und/oder Vernachlassigung gegenuber Kindern dar. Methoden: Die Stichprobe der Studie bestand aus einer Experimentalgruppe von 200 traumatisierten Patienten mit einer Abhangigkeitsproblematik sowie einer Kontrollgruppe mit 80 gesunden traumatisierten Personen. Eingeschlossen wurden Probanden im Alter von 18 – 65 Jahren mit Missbrauchs- (sexuell, physisch und emotional) und Vernachlassigungserfahrungen (emotional und physisch) gemas dem Childhood Trauma Questionnaire (CTQ). Personen der Experimentalgruppe wiesen zudem eine Substanzabhangigkeit auf (Alkohol, Drogen und/oder Medikamente). Die Daten wurden mittels Selbstratingfragebogen zu Trauma- und Gewalterfahrungen (ACE, CTQ), zu Konfliktlosungsstrategien in Zusammenhang mit Gewalt- und Missbrauchserfahrungen in der Kindheit (CTS-R V+VI) sowie durch die Erhebung von Informationen zum Substanzmissbrauch (ASI Lite, CAST 6) gewonnen. Zu psychischen Storungen erfolgte das strukturierte klinische Interview fur DSM-IV (SKID-I). Ergebnisse: Anhand der erhobenen Daten wurde versucht ein Bild von den Eltern und den damit verbundenen Belastungen in Kindheit und Jugend fur die untersuchten Suchtkranken zu zeichnen. Dabei spielten die wahrgenommene Eltern-Kind-Beziehung, familiare psychische Erkrankungen, Traumatisierungen der Eltern und das elterliche Konfliktverhalten eine bedeutsame Rolle. Es wurde ein Belastungsprofil der traumatisierten Substanzabhangigen erstellt, um Einflusse der genannten Variablen in suchtbelasteten Familien zu untersuchen. Diskussion: Aus den Befunden werden Implikationen fur die Suchtpravention bei Kindern aus suchtbelasteten Familien und die Suchtforschung abgeleitet.

Einleitung/Zielsetzung: In den letzten Jahrzehnten kam es in Osterreich sowie weltweit zu einem deutlichen Anstieg der Kaiserschnittrate. Unter bonding bzw. early skin-to-skin contact (SSC) versteht man die Phase der Bindungsentwicklung zwischen Mutter und Kind, welche idealerweise gleich nach der Geburt beginnt. Mogliche Bedenken, das bonding auch nach dem Kaiserschnitt im Operationssaal einzufuhren, sind neben Organisatorischen (Anderung des etablierten Ablaufes) auch das veranderte Ambiente im Operationssaal (Temperatur, Helligkeit, Larm). Im Rahmen dieser Studie sollten Effekte des fruhen SSC nach einer Schnittentbindung auf die Mutter und das Neugeborene evaluiert werden. Material & Methoden: Im Rahmen einer prospektiven randomisierten Pilotstudie wurden 35 Frauen eingeschlossen. Randomisiert wurde in eine ‚early bonding‘ Gruppe (n = 17) und eine ‚late bonding‘ Gruppe (n = 18). Evaluiert wurden die kindliche Adaptation, die Ausschuttung von Oxytocin, Cortisol und Chromogranin A bei der Mutter und die Ausschuttung von Cortisol beim Kind, sowie die mutterliche Schmerzverarbeitung und psychische Situation (Edinburgh Postnatal Depression Scale und Postpartum Bonding Questionnaire). Ergebnisse: Die kindliche Adaptation und Temperaturregulation bewegten sich in beiden Gruppen im Normbereich. Die Ausschuttung von Oxytocin, Cortisol und Chromogranin A bei den Muttern war vergleichbar und es gab keinen Unterschied hinsichtlich der mutterlichen Schmerzverarbeitung in den jeweiligen Gruppen. Im Beziehungsverhalten und der Befindlichkeit zwischen den beiden Gruppen konnte kein signifikanter Unterschied festgestellt werden. Zusammenfassung: Sectiobonding kann – falls von den Eltern gewunscht – angeboten werden.

To evaluate antenatal surveillance strategies and the optimal timing of delivery for monoamniotic twin pregnancies.Obstetric and perinatal outcomes were retrospectively retrieved for 193 monoamniotic twin pregnancies. Fetal and neonatal outcomes were compared between fetuses followed in an inpatient setting and those undergoing intensive outpatient follow-up from 26 to 28 weeks of gestation until planned cesarean delivery between 32 and 35 weeks of gestation. The risk of fetal death was compared with the risk of neonatal complications.Fetal deaths occurred in 18.1% of fetuses (70/386). Two hundred ninety-five neonates from 153 pregnancies were born alive after 23 weeks of gestation. There were 17 neonatal deaths (5.8%), five of whom had major congenital anomalies. The prospective risk of a nonrespiratory neonatal complication was lower than the prospective risk of fetal death after 32 4/7 weeks of gestation (95% confidence interval 32 0/7-33 4/7). The incidence of death or a nonrespiratory neonatal complication was not significantly different between fetuses managed as outpatients (14/106 [13.2%]) or inpatients (15/142 [10.5%]; P=.55). Our statistical power to detect a difference in outcomes between these groups was low.The in utero risk of a monoamniotic twin fetus exceeds the risk of a postnatal nonrespiratory complication at 32 4/7 weeks of gestation. If close fetal surveillance is instituted after 26-28 weeks of gestation and delivery takes place at approximately 33 weeks of gestation, the risk of fetal or neonatal death is low, no matter the surveillance setting.II.

The dynamics of coherent states is investigated for generic integrable and nearly integrable quantum mappings on the plane. An entropy in terms of Husimi distribution functions is employed to describe the decoherence process and to detect two characteristic time scales of dynamical quantum chaos. Expressions for the coherence time and for the relaxation time are given in terms of classical quantities, ℏ and a quantum asymmetry parameter, both time scales satisfying power laws in ℏ. Specifically, it turns out that the coherence time can delay to infinity, thus revealing the possibility of long lasting coherent quantum states. An exact lower bound and a dynamical upper bound for the entropy are presented, as well as the time evolution of the entropy up to the relaxation time. We argue that the results should hold for generic integrable and nearly integrable quantum systems of one degree of freedom. Also, the Husimi time evolution operator is derived for confining potentials.

An isolated case with the hyperkeratotic variant of porokeratosis Mibelli (PM) is reported. The 62-year-old woman developed multiple brown macules with well demarcated large keratotic nodules on both legs. Histopathological studies revealed the presence of a cornoid lamella characteristic of porokeratosis. Ultrastructural investigations revealed dyskeratotic as well as edematous, swollen keratinocytes; autophagocytotic vacuoles were visible. The clinical and ultrastructural peculiarities of the hyperkeratotic variant of PM suggest the possibility of a separate entity.

Objective Early bonding by skin-to-skin contact (SSC) has been demonstrated to be beneficial for mothers and newborns following vaginal delivery. The aim of this study was to investigate the impact of intraoperative bonding (early SSC) after cesarean section on neonatal adaptation, maternal pain and stress response. Study design This prospective, randomized-controlled pilot study was performed at a single academic tertiary hospital (Department of Obstetrics and Gynecology, Medical University of Graz, Austria) between September 2013 and January 2014. Women were randomly assigned to intraoperative ("early") SCC (n = 17) versus postoperative ("late") SCC (n = 18). Main variables investigated were neonatal transition (Apgar score, arterial oxygen saturation, heart rate and temperature), maternal pain perception and both maternal and neonatal stress response by measuring the stress biomarkers salivary free cortisol and salivary alpha amylase. Results There was no evidence for differences in parameters reflecting neonatal transition or stress response between the 'Early SSC Group' and the 'Late SSC Group'. Maternal salivary cortisol and alpha-amylase levels as well as maternal wellbeing and pain did not differ between the groups. However, the rise of maternal salivary alpha-amylase directly after delivery was higher in the 'Early SSC Group' compared to the 'Late SSC Group' (p = 0.004). Conclusions This study did not reveal significant risks for the newborn in terms of neonatal transition when early SSC is applied in the operating room. Maternal condition and stress marker levels did not differ either, although the rise of maternal salivary alpha-amylase directly after delivery was higher in the 'Early SSC Group' compared to the 'Late SSC Group', which may indicate a stressor sign due to intensive activation of the sympathetic-adreno-medullary-system. This needs to be further evaluated in a larger prospective randomized trial. Trial registration ClinicalTrials.gov NCT01894880.