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On the prediction of optical aberrations by personalized eye models.

PURPOSE: The purpose of this study is to develop and analyze a method to obtain optical schematic models of individual eyes. Each model should be able to reproduce the measured monochromatic wave aberration with high fidelity. METHODS: First, we choose a generic eye model as the input guess and then apply a two-stage customization procedure. Stage 1 consists of replacing, in the initial generic model, those anatomic and optical parameters with experimental data measured on the eye under analysis. The set of experimental data was that provided by a standard clinical preoperative examination, namely lens topography, ultrasound biometry, and total wave aberration. Then, the second stage is to find the unknown lens structure that would reproduce the measured wave aberration through optical optimization. Two totally different initial eye models have been compared; one considers a simpler constant refractive index for the lens, whereas the second model has a gradient-index (GRIN) lens. RESULTS: This automatic customization method has been applied to 19 eyes with different degrees of spherical ametropia (from +0.4 D to -8 D). Two models have been obtained for each eye (constant and gradient index lens). The results were highly satisfactory, with 100% convergence, and with average RMS prediction errors approximately lambda/100. This is one order of magnitude lower than typical measurement errors. The models with a constant refractive index lens tended to overestimate surface curvatures, whereas for the GRIN model, lens surfaces were too flat. CONCLUSIONS: The proposed method is highly efficient and robust giving a high-fidelity reproduction of the wavefront in all cases attempted so far. Limitations found in reproducing the geometry of the lens seem to be associated with the use of inaccurate models of its refractive index.

Accommodation, Ocular↗

[Effect of varicocelectomy with hyperbaric oxygenation in treating infertile patients with varicocele].

OBJECTIVE: To explore the therapeutic effects of combination of varicocelectomy with hyperbaric oxygenation (HBO) in treating infertile patients with varicocele. METHODS: Ninety-six patients were randomly divided into two groups: 40 patients in group A treated by varicocelectomy with HBO, and 56 in group B treated by solitary varicocelectomy. RESULTS: The sperm density, sperm motility, sperm vigor, normality, serum testosterone, the pregnant rate of patients spouses were improved respectively in both two groups (P <0.01 or P < 0.05), and group A had better results than group B (P < 0.05). LH, FSH in group A decreased significantly after the therapy. Group A had higher sperm penetration asay (SPA) percentages than group B(P < 0.05), and the pregnant time of patient's spouses in group A was earlier than that in group B (P < 0.05). CONCLUSION: Varicocelectomy with HBO can more effectively regulate reproductive hormone, improve semen quality, SPA index and pregnant rate than solitary varicocelectomy in treating infertile patients with varicocele and can markedly shorten the pregnant time.

Adult↗

The sperm chromatin structure assay as a diagnostic tool in the human fertility clinic.

BACKGROUND: Sperm DNA integrity has been shown to be necessary for achieving and sustaining embryo development. The objective was to evaluate the sperm chromatin structure assay (SCSA) as a diagnostic tool in clinical practice for intrauterine insemination (IUI), in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) treatments. METHODS: A total of 385 semen samples from 234 couples were frozen for SCSA, and smears were prepared for morphology: 48 IUI, 139 IVF and 47 ICSI. The main SCSA variables were DNA fragmentation index (DFI), standard deviation of DFI (SD-DFI) and high DNA stainability (HDS), and the reproductive outcomes were biochemical pregnancy (BP), clinical pregnancy (CP) and implantation ratio (IR). RESULTS: The results showed no significant difference in the fertility variables BP, CP and IR when <27% DFI was used between the IVF and ICSI groups. A low number of patients received IUI with low success rate, and statistical analysis was therefore not performed. Ongoing pregnancy was achieved for both IVF and ICSI couples with DFI levels >27%, and six couples in ICSI treatment achieved CP full-term. DFI >27% had a high prognostic power for predicting no CP for IVF patients, with a specificity of 97%. Couples diagnosed with male infertility had a significantly higher level of DFI compared to couples with idiopathic fertility. Sperm head morphology showed low but significant correlations with the SCSA variables. CONCLUSION: SCSA is a useful tool in andrological diagnosis and contributes with a prognosis for the fertility outcome of conventional IVF. Although full-term pregnancy can be achieved with assisted reproductive techniques with a DFI >27%, the probability of a successful pregnancy may be reduced.

Chromatin↗

Obesity does not impact implantation rates or pregnancy outcome in women attempting conception through oocyte donation.

OBJECTIVE: To independently evaluate the effect of body mass index (BMI) on implantation, pregnancy, and incidence of spontaneous miscarriage using the donor oocyte recipient model. DESIGN: Institutional Review Board-approved retrospective data analyses of donor oocyte cycles from 1999 to 2004. SETTING: Private assisted reproductive technology (ART) center. PATIENT(S): Five hundred thirty-six first cycle recipients of donor oocytes. INTERVENTION(S): Data were collected from the first cycle of each donor oocyte recipient included in the study. The body mass index (BMI) of each recipient was calculated using the formula weight (in kilograms)/height (in meters squared). Patients were divided into four groups based on BMI: underweight, normal, overweight, and obese. Pregnancy outcomes in each group were compared. MAIN OUTCOME MEASURE(S): Body mass index, implantation rate, pregnancy rate (PR), miscarriage rate. RESULT(S): There were no statistically significant differences in the implantation rates, ongoing PRs, or spontaneous abortion rates among patients in the four BMI groups. When further divided into those patients receiving blastocyst vs. day 3 transfers, there was still no effect of BMI on implantation rate, PR, or loss rate among the blastocyst or day 3 donor oocyte recipients. CONCLUSION(S): Body mass index has no adverse impact on implantation or reproductive outcome in donor oocyte recipients. Therefore, obesity does not appear to exert a negative effect on endometrial receptivity.

Adult↗

Association of lipoprotein(a), insulin resistance, and reproductive hormones in a multiethnic cohort of pre- and perimenopausal women (The SWAN Study).

Because evidence suggests lipoprotein (Lp(a)) may be an important cardiovascular risk factor in women, we evaluated whether reproductive hormones may influence Lp(a) concentrations and insulin resistance in a large multicenter study of women transitioning to postmenopause. Data were taken from the Study of Women's Health Across the Nation (SWAN), a prospective multiethnic study of menopausal transition (1,368 Caucasians, 808 African-Americans, 220 Chinese, 216 Hispanic, and 251 Japanese). Blood was assayed for Lp(a), follicle stimulating hormone, estradiol (E2), testosterone, and sex hormone binding globulin (free estradiol index and free androgen index), thyroid stimulating hormone, and glucose and insulin (to calculate insulin resistance). African-American women had twofold higher mean Lp(a) values than women of the other 4 race/ethnic groups, adjusted for body mass index (BMI). Lp(a) was modestly correlated with E2 (r = 0.10) in women without self-reported diagnosed heart disease but not in women with self-reported heart disease. Lp(a) was positively associated with log insulin resistance in women without self-reported heart disease but not in women with self-reported heart disease, an association that was not significant after adjusting for ethnicity, BMI, smoking, age, and site. Race/ethnicity, particularly being African-American, accounted for most of the explained Lp(a) variations. Lp(a) was very modestly associated (r = -0.04) with insulin resistance after adjusting for ethnicity and BMI, and this association was not modified by reproductive hormones, including androgens.

Adult↗

Amyloidosis of the endometrium: an asymptomatic presentation.

BACKGROUND: Amyloidosis of the endometrium is a rare occurrence according to current literature. Previously reported cases have presented with menorrhagia or postmenopausal bleeding. CASE: A postmenopausal woman with multiple medical problems presented with fatigue and weight loss. During the evaluation for her 18-kg weight loss, a computed tomography scan revealed an enlarged uterus and liver lesions. Endometrial and liver biopsies were performed secondary to concern over metastatic cancer, given an enlarged uterus in a postmenopausal woman with liver masses. She was found to have systemic primary amyloidosis in multiple organs, including her endometrium. CONCLUSION: This patient represents an interesting case of systemic amyloidosis involving the endometrium that is not associated with vaginal bleeding. The presence of amyloid in the endometrium may be more common than currently recognized, because patients without vaginal bleeding are not routinely evaluated for amyloid deposition in their reproductive organs.

Aged↗

African-American women have higher initial HbA1c levels in diabetic pregnancy.

OBJECTIVE: African-American women with diabetes are at greater risk for poor glycemic control outside of pregnancy. We evaluated the effect of race on glycemic control in a racially mixed population of women with diabetes entering prenatal care. RESEARCH DESIGN AND METHODS: HbA1c levels along with demographic data were collected at the first prenatal visit from a group of 234 women with preexisting diabetes. We applied logistic multivariate analysis to identify factors associated with HbA1c levels above the median for the group. RESULTS: The median HbA1c level for the group was 8%. HbA1c levels were 8.7 +/- 2.0% in African-Americans and 7.7 +/- 1.5% in Caucasians (P < 0.001). African-American racial designation was significantly and independently associated with high HbA1c when controlled for maternal age, parity, White classification, diabetes type, education, marital status, obesity, insurance type, and first trimester entry into care. The effect of race was confined to the nonobese patients, for whom the adjusted odds ratio for African-American race as a predictor of high HbA1c was 8.15 with a 95% CI of 2.41-27.58 (P = 0.001). CONCLUSIONS: We found a clear racial disparity in glycemic control among women entering prenatal care with preexisting diabetes. This study demonstrates that there generally is need for better glycemic control among reproductive-age women with diabetes, but especially among those who are African-American.

Adult↗

The impact of musk ketone on reproduction in zebrafish (Danio rerio).

Nitro musks are a group of nitrated benzenes mainly used by the fragrance industry as a substitute for natural musk. Two of the most common nitro musks, musk xylene and musk ketone, have been detected in water, fish, human adipose tissue, as well as in human breast milk. In this study, female zebrafish were dietary-exposed to musk ketone, prior to spawning with unexposed males. The fish were exposed for 8 weeks at two different dose levels. Accumulation of the compound in the fish as well as reproductive success were studied. Exposed females had reduced body weight and length, as well as reduced liver- and gonad somatic index. The results from the reproduction study showed a dose-dependent reduction in fecundity. Early life-stage mortality was increased and the median survival time was reduced. In addition, an embryo/larvae toxicity test was performed, using newly fertilized zebrafish eggs from unexposed parental fish. Eggs were exposed to a series of different concentrations of musk ketone via the surrounding water. A NOEC value of 10 micrograms/l and a LOEC value of 33 micrograms/l was determined. Conclusively, the present study clearly shows that musk ketone negatively affects reproduction and early life-stage survival in zebrafish.

Animals↗

Increased muscular efficiency during lactation in Colombian women.

OBJECTIVE: To determine the muscular efficiency of lactating women and compare it to that of nonpregnant, nonlactating (NPNL) women. DESIGN: The study was retrospective. The subjects were selected randomly in the two groups and studied on three occasions (rounds) separated by approximately three months. SUBJECTS: There were 109, 101, and 80 NPNL women and 45, 31 and 16 lactating women in rounds 1, 2 and 3 respectively, 19-43 y of age, living under economically deprived conditions in Cali, Colombia, who participated in the study. METHODS: Muscular efficiency was measured as delta efficiency on a cycle ergometer. RESULTS: Muscular efficiency was significantly higher in lactating women in all three rounds compared to NPNL women. In six women it was possible to measure efficiency at variable times prior to their pregnancies, and again during lactation about three months post partum. There was a statistically significant (P = 0.03) increase in muscular efficiency during lactation. CONCLUSION: Lactation results in about a 5% increase in muscular efficiency which may contribute to the adaptation of the mother to the increased energy demands associated with lactation.

Adult↗

[Cortical bone mass and risk factors for osteoporosis among postmenopausal women in our environment].

OBJECTIVE: To evaluate the relevance of the so called risk factors for osteoporosis among women. MATERIALS AND METHODS: A total of 150 consecutive postmenopausal women who had been enrolled in the gynecology outpatient clinics of the Health Areas affiliated to the Alcalá de Henares University Hospital. Bone mass of these women was calculated as index of metacarpal cortical area/total area (CA/TA) (mm2), measured by radiogrammetry. RESULTS: With the ANOVA test, a late menarchial age and a shorter reproductive life induced a lower bone mass (p < 0.0005 and < 0.05, respectively); also, a history of bone fractures without previous relevant trauma (p < 0.05) was obtained. By correlational studies, there was a negative significance between CA/TA index and chronological age, menarchial age, menopausal age and number of fractures (r = -0.20 to -0.30; p < 0.05 to < 0.0001) and a positive significance with years of reproductive life (r = 0.17; p < 0.05). These values virtually remain unchanged when with partial correlation are weight adjusted, but with the multiple regression model, the CA/TA index is negatively significant only with menopause years (p < 0.005). Taking the average of the metacarpal CA/TA index as value, a sensitivity of 50% and an specificity of 78% were obtained to indicate fractures and a negative predictive value of 92%. CONCLUSION: These results indicate the greater importance of menarchial age, of reproductive life years and therefore of menopausal years, as determinants of postmenopausal bone mass and show a very acceptable specificity of the CA/TA index as predictive for bone fracture.

Analysis of Variance↗

Determinants of birth intervals in Vietnam: a hazard model analysis.

There was absence of any regional differences in parity progressions and length of birth intervals, although urban-rural differences persisted at most birth orders, suggesting that, as in other studies, the urban-rural differentials are the primary source of variations in fertility between different areas of a country. The significantly higher probability of a subsequent birth after birth order 2 in areas with high infant mortality compared to those with low infant mortality suggests that women in the high-risk provinces may be more likely to advance beyond parity 2 and continue on into the advanced parities. The provinces identified as having high infant mortality had also been identified in other studies as the provinces with the highest crude birth rates and population growth rates, the least available family planning services, and highest crude death rates. Mothers' education was consistently related to the likelihood of another birth at each birth order, with the most-educated women experiencing a significantly lower probability of having a subsequent birth at every birth order. This concurs with results in other studies, suggesting that the woman's education is a prime determinant of fertility and that increasing the educational attainment of women is one of the most beneficial measures to reduce fertility. The significant relationship between the previous birth interval of the index child and the probability that the index child would be followed by a subsequent birth conforms with other studies of birth interval dynamics that suggest that pregnancy-spacing for a given woman remains constant throughout her reproductive career.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

Tritiated-thymidine-induced increased DNA content and irreversible differentiation in a human melanoma cell line.

When cultured in the presence of 2.0 microCi/ml (methyl-3H)thymidine (3H-TdR) the growth rate of 6 human melanoma lines and 1 subline progressively slowed then stopped, a change that was accompanied by loss of reproductive viability as assessed by colony formation in agar, but unaccompanied by a comparable inhibition of thymidine incorporation. In all cases increases in cell size, nuclear size and DNA content were observed. In 1 cell line only, MM96, these changes were accompanied by a profound increase in morphological differentiation. Despite this MM96 did not show increased differentiation in response to 2 x 10(-7) M alpha melanocyte stimulating-hormone (alpha MSH), which in fact stimulated growth, or in response to 10(-3) M N6,O2'-dibutyryl adenosine 3':5'-monophosphate (db-cAMP), 10(-3) M theophylline or 5 x 10(-4)M guanosine-5'-triphosphate (GTP), all of which retarded growth. With none of the cell lines was differentiation increased in response to 10(-3)M db-cAMP although in each case growth was retarded. These results reinforce the importance of colony assays vs DNA synthesis studies in assessing reproductive viability and show that supra-reproductively lethal levels of 3H-TdR can by-pass defects in the differentiation pathway of at least one, but not all, human melanoma cell lines.

Cell Count↗

Correlates of oral contraceptive use in Italian women, 1991-93.

In order to understand the determinants of oral contraceptive (OC) use in Italy, we analyzed data on 1577 women aged under age 60 (median age 50 years) admitted as controls in a case-control study of breast cancer. Included in this group were women with acute, non-neoplastic, non-gynecologic, non-hormone-related diseases, admitted between 1991 and 1994 to a network of hospitals in six Italian centres. A total of 275 (17.4%) women reported ever OC use. Oral contraceptive use was strongly related to the level of education: in comparison with women reporting < 7 years of schooling, the multivariate odds ratios (OR) of ever OC use were 2.2 and 3.5, respectively, in women reporting 7-11 and > or = 12 years of schooling (chi 1(2) trend 40.87 p < 0.001). OC use was inversely related to body mass index (BMI): in comparison with leaner women (BMI, Kg/m2, < 25), the OR of being an ever OC user was 0.8 and 0.7, respectively, in women with BMI 25-< 30 and > or = 30 (chi 1(2) trend 3.36, p = 0.07). Parous women more frequently tended to be OC users than nulliparous ones, the estimated OR being 2.4 and 2.3, respectively, in women reporting 1 or 2 and 3 or more births in comparison with nulliparae. Likewise, women with history of induced abortions were more frequently ever OC users (OR for > or = 1 induced abortions vs no induced abortion, 1.8, 95% Cl 1.2-2.6). However, no relationship emerged between OC use and history of spontaneous abortions. Finally, there was no relation between pill use and history of hypertension, cholelithiasis, thyroid diseases, hyperlipidemia, family history of breast cancer, uterine fibroids and benign breast disease. Women with a history of diabetes were less likely to be OC users (OR 0.6), but the finding was not significant. The results of this analysis are comparable with those of a study conducted in the same population in the early 1980's, and suggest that sociodemographic and reproductive factors, rather than medical history, are major determinants of OC use in this population.

Adult↗

Longitudinal changes in bone density in relation to oral contraceptive use.

The primary aim of this 36-month prospective cohort study was to evaluate the association between use of oral contraceptives (OCs) and bone mineral density in reproductive-age women. The 36-month bone density (g/cm2) at the spine, hip and whole body and percent change from baseline (measured at 6-month intervals) were evaluated among 245 women 18-39 years of age; 89 were using OCs (median duration: 3.7 years at study entry) and 156 were not using any hormonal contraception. Before and after adjustment for covariates (baseline bone density, age, race, ever pregnant, exercise, body mass and calcium intake), women using OCs did not differ significantly from comparison women in percent change in bone density over 36 months or in absolute bone density at 36 months. All p-values for between-group differences were >0.55. In conclusion, within the limitations of this study, OCs did not appear to impact bone density over time in this cohort of reproductive-age women.

Adolescent↗

Diurnal and ultradian rhythmicity of plasma leptin: effects of gender and adiposity.

Plasma leptin shows a nocturnal rise and a pulsatile pattern. This work was undertaken to determine the effects of gender and obesity on this pattern. Twenty-four-hour leptin profiles were evaluated in 31 subjects [17 male, 14 female; age: 36 +/- 2 yr (mean +/- SEM); body mass index: 27.5 +/- 1.0 kg/m2]. Plasma leptin profiles were higher in obese (body mass index > 27 kg/m2) than in lean subjects and higher in women than in men, regardless of fat mass. Leptin showed diurnal rhythmicity with peaks between 2200-0300 (median: 0120) and nadirs between 0800 and 1740 (median: 1033). Spectral analysis revealed 2 components (periodicities: 24 and 12 h) with higher relative amplitudes in lean than in obese subjects. The relative diurnal amplitude also was higher in men than in women, controlling for adiposity. Insulinemia, female sex, and age were negative determinants of diurnal rhythm relative amplitude. Pulse analysis revealed 3.6 +/- 0.3 pulses/24 h, occurring mostly 2-3 h after meals. Pulse frequency correlated negatively with fat mass and insulinemia (Spearman's r = -0.54 and -0.37, respectively; P < 0.05 for each). Thus, obesity is associated not only with higher leptin levels but also with blunted diurnal excursions and dampened pulsatility. This abnormal rhythmicity may contribute to leptin resistance in obesity. The significance of the sexual dimorphism in the diurnal amplitude is unclear, but it may be related to leptin's putative role as a metabolic signal to the reproductive axis.

Adipose Tissue↗

Increased prevalence of obstructive sleep apnea syndrome in obese women with polycystic ovary syndrome.

Obstructive Sleep Apnea (OSA) is considerably more common in men than women. Preliminary data suggest that androgens may play a role in the male predominance of apnea. Polycystic Ovary Syndrome (PCOS) is characterized by menstrual disturbances, androgen excess, and frequently obesity. These features suggest that women with PCOS may be at increased risk for OSA. To determine whether obese women with PCOS have an increased prevalence of sleep apnea compared with age and weight-matched reproductively normal women, we performed overnight polysomnography for determination of the apnea-hypopnea index (AHI) in 18 obese women with PCOS and age and weight-matched control women. Additional measurements included waist, hip, and neck circumferences, serum total testosterone, unbound testosterone, and DHEAS. Women with PCOS had a higher AHI than controls (22.5 +/- 6.0, vs. 6.7 +/- 1.0, P = 0.008). Women with PCOS were also more likely to suffer from symptomatic OSA syndrome (44.4% vs. 5.5%, P = 0.008). AHI correlated with waist-hip ratio (r = 0.51, P < 0.03), serum testosterone (r = 0.52, P < 0.03) and unbound testosterone (r = 0.50, P < 0.05) in women with PCOS. We conclude that obese women with PCOS are at increased risk of OSA when compared with matched reproductively normal women. Women with PCOS should be carefully questioned regarding symptoms of sleep apnea.

Adult↗

Outcome of maternal nutritional supplementation: a comprehensive review of the Bacon Chow study.

In a double blind controlled intervention, two groups of nutritionally at-risk rural Taiwanese women were given a nutrient-rich dietary supplement (group A, n = 114) or a placebo (group B, n = 111) beginning after the birth of one child and continuing through the lactation period for a subsequent child. Outcome variables assessed include infant birth measurements postnatal physical growth, motor, mental, and dental development, morbidity, and maternal weight and skinfold changes during pregnancy and lactation. While few A-B differences in mean values of outcome variables were found, there were significant responses in subgroups of the sample. Comparisons of infants born after a nutrient-supplemented pregnancy (A2) versus an unsupplemented pregnancy (A1) showed that A2 male infants weighed more than A1 males at birth, and A1-A2 sibling correlations in birth measurements, especially Rohrer's index (wt/l3) were significantly reduced. Important mediators of supplement effects included sex of the offspring, season of birth, maternal body size, and birth of a previous infant characterized by dysmorphic prenatal growth. The limited effects of supplementation on the population as a whole may reflect the operation of long term adaptations which allow women to maintain reproductive success despite their apparent marginal nutritional status.

Adult↗