Throughout pregnancy, the decidua is predominantly populated by NK lymphocytes expressing Killer immunoglobulin-like receptors (KIR) that recognize human leukocyte antigen-C (HLA-C) ligands from ...trophoblast cells. This study aims to investigate the association of KIR-HLA-C phenotypes in couples facing infertility, particularly recurrent pregnancy loss (RPL) and recurrent implantation failure (RIF), in comparison to a reference population and fertile controls. This observational, non-interventional retrospective case-control study included patients consecutively referred to our Reproductive Immunology Unit from 2015 to 2019. We analyzed the frequencies of KIR and HLA-C genes. As control groups, we analyzed a reference Spanish population for KIR analysis and 29 fertile controls and their male partners for KIR and HLA-C combinations. We studied 397 consecutively referred women with infertility and their male partners. Among women with unexplained RPL (133 women) and RIF (176 women), the centromeric (cen)AA KIR genotype was significantly more prevalent compared to the reference Spanish population (p = 0.001 and 0.02, respectively). Furthermore, cenAA was associated with a 1.51-fold risk of RPL and a 1.2-fold risk of RIF. Conversely, the presence of BB KIR showed a lower risk of reproductive failure compared to non-BB KIR (OR: 0.12, p < 0.001). Women and their partners with HLA-C1C1/C1C1 were significantly less common in the RPL-Group (p < 0.001) and RIF-Group (p = 0.002) compared to the control group. Moreover, the combination of cenAA/C1C1 in women with C1C1 partners was significantly higher in the control group than in the RPL (p = 0.009) and RIF (p = 0.04) groups, associated with a 5-fold increase in successful pregnancy outcomes. In our cohort, the cenAA KIR haplotype proved to be a more accurate biomarker than the classic AA KIR haplotype for assessing the risk of RPL and RIF, and might be particularly useful to identify women at increased risk among the heterogeneous KIR AB or Bx population. The classification of centromeric KIR haplotypes outperforms classical KIR haplotypes, making it a better indicator of potential maternal-fetal KIR-HLA-C mismatch in patients.
Objective
To study the location and expression of receptors (SR-BI/CLA-1, SR-BII, and LDLr) and transporter (ABCA1) involved in uptake and efflux of cholesterol in human spermatozoa and assess ...whether obesity alters its location/expression and whether this could be related to infertility.
Design
Observational study.
Setting
None
Patient(s)
Ten controls and 20 obese patients.
Intervention(s)
Anthropometric parameters. Serum and semen samples were collected.
Main outcome measure(s)
Spermatozoon concentration, immunolocalization, and protein expression in semen.
Results
Spermatozoon concentration and motility was decreased in morbidly obese patients. SR-BI/CLA-1, SR-BII, LDLr, and ABCA1 are located in the spermatozoon cell membrane and the localization does not change between obese patients and controls. Control spermatozoa showed high SR-BI expression, and less expression for the rest of the receptors analyzed, indicating that SR-BI/CLA-1 is relevant in human spermatozoon cholesterol uptake/efflux. On the contrary, spermatozoa of obese patients showed less SR-BI/CLA-1 expression than controls, and more intense positive staining for SR-BII, LDLr, and ABCA1. Finally, human sperm expresses the 130- and 82-kDa hormone-sensitive lipase (HSL) isoforms. The 130-kDa isoform is expressed in the control sperm, and the expression disappears in the obese patients.
Conclusion(s)
The presence of lipid receptors/transporters and HSL in human spermatozoa suggests their role in the process of maturation/capacitation. The changes in the expression of lipid receptors/transporters and the lack of the 130-kDa HSL isoform in obese patients prevent the hydrolysis of cholesterol esters internalized by these receptors, and favor their accumulation in the cytoplasm of the spermatozoa that could contribute to lipotoxicity and infertility.
Background
Even though obesity surgery normalizes circulating testosterone concentrations in males with obesity-associated secondary hypogonadism, its impact on spermatogenesis remains controversial. ...We aimed to evaluate sperm characteristics in obese men after bariatric surgery as well as changes in reproductive hormones.
Methods
Twenty severely obese men (body mass index (BMI) ≥ 35 kg/m
2
) were evaluated before and 2 years after bariatric surgery. The serum was assayed for insulin, leptin, kisspeptin, and inhibin B, among other hormones. Homeostasis model assessment of insulin resistance (HOMA-IR) was estimated. We used World Health Organization reference values for sperm analysis.
Results
After surgery, serum total testosterone, calculated free testosterone, inhibin B, and kisspeptin increased, whereas fasting insulin, HOMA-IR, and leptin concentrations decreased. Despite these improvements, sperm volume showed a small decrease after surgery, while the rest of sperm characteristics remained mostly unchanged. Abnormal sperm concentration persisted in 60% of the patients.
Conclusions
Sperm characteristics may not improve after bariatric surgery despite the beneficial changes of reproductive hormones.
The pain assessment in advanced dementia (PAINAD) appears to be a clinically useful tool. However, the salivary determination of tumor necrosis factor receptor type II (sTNF-RII) and secretory IgA ...(sIgA) as pain biomarkers is still incipient. The aim was to correlate the PAINAD score with sTNF-RII and sIgA biomarker levels in the saliva of patients with advanced dementia. In this regard, a cross-sectional study was conducted. The sample consisted of 75 elderly patients with a clinical diagnosis of dementia and a global deterioration scale (GDS) score of 5 to 7. The PAINAD scale was determined by a previously trained professional and the collection of salivary samples was performed using the passive secretion method. Human sTNF-RII and sIgA using ELISA kits. The results showed a correlation between the PAINAD scale (numeric, binary, and recoded) and sTNF-RII and sIgA (
< 0.001). No association between the sociodemographic and clinical variables and the PAINAD scale was found (
> 0.05). Between 97.3% and 96.2% of patients with pain on the PAINAD scale also showed pain based on the sTNF-RII levels; in all of them, sIgA levels did not fit the logistic models. Therefore, the correlation highlights the usefulness of this scale and confirms the usefulness of sTNF-RII and sIgA as biomarkers of pain.
IntroductionPain is an under-diagnosed problem in elderly people, especially in those with cognitive impairment who are unable to verbalise their pain. Although the Pain assessment in advanced ...dementia scale (PAINAD) scale is a tool recognised for its clinical interest in this type of patients, its correlation with the saliva biomarkers reinforced its utility. The aim of this research will be to correlate the scores of this scale with the levels of biomarkers of pain found in saliva samples of patients with cognitive impairment and inability to communicate.Methods and analysisThis is an observational study. The level of pain will be evaluated using the PAINAD scale. Moreover, pain biomarkers, in particular secretory IgA and soluble tumour necrosis factor receptor type II, will be determined in saliva. Both assessments will be conducted in 75 patients aged over 65 years with advanced cognitive impairment and inability to communicate. The PAINAD scores will be correlated with the levels of these biomarkers of pain. A control group consisting of 75 healthy subjects aged over 65 years will be included in the study. Moreover, sociodemographic variables and variables related to pain, dementia and other clinical conditions will be recorded. The analysis will be performed with the statistical package SPSS V.22 and the software R.Ethics and disseminationThe study has been reviewed and approved by the Andalusian Human Research Ethics Committee. In addition, this study has been financed by the Junta de Andalucía through a regional health research fund (Research code: PI-0357–2017). The results will be actively disseminated trough a high-impact journal in our study area, conference presentations and social media.
Cystic Fibrosis (CF) is a genetic disease with equal prevalence across sexes. However, women present worse lung function with faster function decline, earlier onset of bacterial colonization, more ...frequent pulmonary exacerbations (PE), greater bronchial hyper-responsiveness, and higher mortality rates after puberty than men. The etiology of this gender disparity remains elusive but female hormones have been implicated in several studies.
A 20-year-old female with CF with severe recurrent PE, always related to the menstrual cycle since menarche, combined with lung function decline requiring multiple courses of intravenous antibiotics. We report the cessation of PE and recovery of pulmonary function following the insertion of a subcutaneous implant with 68 mg of etonogestrel (Implanon®, Organon Española S.A. Laboratories, Madrid, Spain).
Our case report supports the key role of female hormones in the development of PE and in the decline of lung function in a woman with CF. When appropriate, hormonal manipulation through contraceptive methods should be considered as potential treatment.
Abstract
Aim
To evaluate the effectiveness and safety of tofacitinib in ulcerative colitis UC in real life.
Methods
Patients from the prospectively maintained ENEIDA registry and treated with ...tofacitinib due to active UC were included. Clinical activity and effectiveness were defined based on Partial Mayo Score PMS. Short-term response/remission was assessed at Weeks 4, 8, and 16.
Results
A total of 113 patients were included. They were exposed to tofacitinib for a median time of 44 weeks. Response and remission at Week 8 were 60% and 31%, respectively. In multivariate analysis, higher PMS at Week 4 (odds ratio OR = 0.2; 95% confidence interval CI = 0.1–0.4) was the only variable associated with lower likelihood of achieving remission at Week 8. Higher PMS at Week 4 OR = 0.5; 95% CI = 0.3–0.7 and higher PMS at Week 8 OR = 0.2; 95% CI = 0.1–0.5 were associated with lower probability of achieving remission at Week 16. A total of 45 patients 40% discontinued tofacitinib over time. Higher PMS at Week 8 was the only factor associated with higher tofacitinib discontinuation hazard ratio = 1.5; 95% CI = 1.3–1.6. A total of 34 patients had remission at Week 8; of these, 65% had relapsed 52 weeks after achieving remission; the dose was increased to 10 mg/12 h in nine patients, and five of them reached remission again. Seventeen patients had adverse events.
Conclusions
Tofacitinib is effective and safe in UC patients in real practice, even in a highly refractory cohort. A relevant proportion of patients discontinue the drug over time, mainly due to primary failure.
Summary
Background and Aims
Data on the outcomes after switching from adalimumab (ADA) originator to ADA biosimilar are limited. The aim was to compare the treatment persistence, clinical efficacy, ...and safety outcomes in inflammatory bowel disease patients who maintained ADA originator vs. those who switched to ADA biosimilar.
Methods
Patients receiving ADA originator who were in clinical remission at standard dose of ADA originator were included. Patients who maintained ADA originator formed the non‐switch cohort (NSC), and those who switched to different ADA biosimilars constituted the switch cohort (SC). Clinical remission was defined as a Harvey–Bradshaw index ≤4 in Crohn's disease and a partial Mayo score ≤2 in ulcerative colitis. To control possible confounding effects on treatment discontinuation, an inverse probability treatment weighted proportional hazard Cox regression was performed.
Results
Five hundred and twenty‐four patients were included: 211 in the SC and 313 in the NSC. The median follow‐up was 13 months in the SC and 24 months in the NSC (p < 0.001). The incidence rate of ADA discontinuation was 8% and 7% per patient‐year in the SC and in the NSC, respectively (p > 0.05). In the multivariate analysis, switching from ADA originator to ADA biosimilar was not associated with therapy discontinuation. The incidence rate of relapse was 8% per patient‐year in the SC and 6% per patient‐year in the NSC (p > 0.05). Six percent of the patients had adverse events in the SC vs. 5% in the NSC (p > 0.05).
Conclusion
Switching to ADA biosimilar did not impair patients' outcomes in comparison with maintaining on the originator.
Internet resources on ageing and health Estrada-Lorenzo, José-Manuel; Barderas-Manchado, Ana; Fuentelsaz-Gallego, Carmen ...
Enfermería clínica,
2009 Jul-Aug, Letnik:
19, Številka:
4
Journal Article
Recenzirano
The general ageing of the world population at the beginning of the XXI century is an established fact, and in the next few years it will be a topic for debate and of interest to the public and, in ...particular, among health professionals. The Internet, as an inexhaustible information source of a different kind, could be a useful resource for consulting and updating for these professionals. The main health sciences sources that are available on the Internet are presented and commented upon. These may be useful for those professionals who wish to identify the most relevant information on ageing.
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