Hyperemesis gravidarum (HEG), associated with pregnancy, is a severe form of nausea and vomiting causing decrease in nutrient antioxidants. Hence, we hypothesize that oxidation injury may be involved in the pathogenesis of HEG. Plasma levels of the ubiquitous antioxidant, reduced glutathione (GSH) may serve as a sensitive measure for systemic oxidative stress. Women with pregnancies complicated by HEG (study group) were compared with pregnant women without HEG (pregnant control group) and with healthy nonpregnant women (nonpregnant control group). Plasma GSH levels were determined in the study group at the time of admission to hospital, and when the vomiting had ceased, it was compared with those of the two control groups. Plasma GSH levels were significantly higher in the pregnant control group than in nonpregnant controls (6.13 +/- 2.9 microM vs. 1.01 +/- 0.3 microM p <0.01). In contrast, values in the HEG women at the time of admission were significantly lower than the pregnant controls (3.12 +/- 1.6 microM, p <0.01). At the second sampling, when the women had ceased vomiting, plasma GSH values were higher than at the acute stage of the illness and were no longer significantly different from the pregnant control group (4.43 +/- 1.6 microM). Low values of plasma GSH in HEG patients suggest that oxidative stress is associated with this condition.
Purpose
To evaluate the association between a rise in serum luteinized hormone (LH) levels during artificial FET cycles and clinical pregnancy rate.
Methods-Retrospective cohort study of women undergoing artificial FET cycles. We compared cycles in which LH double itself from early follicular phase and further(group-A), to cycles without rise in LH(group-B). Endometrium preparation was achieved by administration of 2mg*3\day estradiol-valerate tablets. Embryo transfer(ET) was conducted after achieving endometrial thickness>7mm and vaginal progesterone was added according to embryo's-age. A beta-hCG was measured 13-14 days after ET. Clinical pregnancy was diagnosed on trans-vaginal-ultrasound.
Results:
Data from 984-FET cycles were retrieved. LH, E2, progesterone-values, endometrial thickness and pregnancy outcomes were available in all patients. From 984-FET cycles 629(63.9%) had a doubling and 355(36.07%) had no rise in LH. Mean patient age was 30 years, similar in both groups. Overall pregnancy rate was 24.8%. Overall pregnancy rate per FET cycles in group-A was higher, however, it was not statistically significant(25.8% vs. 23.1%, P=0.3.9). A multivariable logistic regression analysis was calculated to assess the effect of LH rise and pregnancy outcomes, after adjusting for confounders including rise in E2 level and endometrial thickness. In this model, there was no association between doubling LH values and pregnancy rates(aOR 1.06 95%CI:0.75-1.5, P=0.74).
Conclusion:
LH rise during artificial FET cycles does not alter pregnancy rates. Apparently, hormonal monitoring of LH levels may not yield useful information in artificial FET cycle, and may be omitted.
Mechanical assist devices have emerged as an established therapeutic option for patients with end-stage heart failure. Recognizing patients who will do poorly postimplant is essential to optimize patient management and outcomes. Hypothesis: Since albumin level may reflect nutritional status, improvement in albumin from pre to postimplant may be an important prognostic indicator in patients treated with continuous flow left ventricular assist devices (cfLVAD). Methods: In this retrospective single center study we included all patients who underwent cfLVAD implantation (HeartMate II and HeartWare HVAD) at an academic center from 2008 to 2014. We excluded patients who died, were transplanted, or hospitalized during the first 3 months post-implant. Pre-implant albumin was defined as the albumin closest to but prior to the day of implant and not more than 30 days before surgery. Hypoalbuminemia was defined as <3.5 g/dL and normal albumin as ≥3.5 g/dL. We tested for association with clinical outcomes post cfLVAD including 1 and 2-year survival and time to first post-implant hospitalization. Results: From 202 total patients (80% male, mean age 56 ± 16 years), 145 were included for survival analysis and 93 were included for hospitalization analysis. The mean albumin at pre-implant, 3-months post-implant and 6-months post-implant was 3.5 ± 0.6 g/ dL, 3.6 ± 0.7 g/dL, and 3.9 ± 0.5 g/dL, respectively (P < .01). Hypoalbuminemia at 3-months post-implant correlated with increased mortality (HR 2.19 CI 1.20-4.01, P = .01) and reduced time to first post-implant hospital admission (HR 2.36 CI 1.37-4.06, P < .01). Decrease in albumin from pre-implant to 3-months post-implant was also associated with increased mortality (HR 2.93 CI 1.57-5.44, P < .01) and shorter time to first postimplant hospital admission (HR 1.70 CI 1.03-2.81, P = .04). Subgroup analysis revealed that those who started with hypoalbuminemia but had normal albumin values at 3-months post-implant had improved survival and longer time to first post-implant hospitalization than those who had persistent hypoalbuminemia, decrease in albumin over time and even those who maintained normal albumin throughout. Conclusions: Our study is the first to demonstrate the importance of post-implant albumin as well as the changes in albumin from pre-to post-implant on the prognosis of cfLVAD patients. This suggests that regardless of pre-implant albumin, therapeutic intervention to improve albumin or nutritional status post-implant may prevent hospitalizations and improve outcomes.Background: Either as bridge to transplant or destination therapy, left ventricular assist devices (LVADs) serve many patients with advanced heart failure (AHF). Systemic dysfunction, including extended periods of cerebral hypoperfusion, places patients with AHF at increased risk for cognitive decline. Despite reports of improvement in multiple body systems following LVAD placement, including increased cerebral perfusion, research examining longitudinal outcomes of cognition is sparse. In prior research (...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.