Miracle-dz/UniFAR-FTUs huggingface dataset:
Is AMH useful to reduce low ovarian response to GnRH antagonist protocol in oocyte donors?

Abstract We aimed to establish the reference values of Anti-Müllerian hormone (AMH) in our oocyte donor population and correlate them with the ovarian response to an antagonist stimulation protocol and to study the predictive capacity of AMH for poor response (PR). Normal AMH curves were obtained for 172 candidates. AMH levels decreased with age although they showed great heterogeneity and spread in absolute values at any age range. AMH levels showed a positive correlation, statistically significant, with the Antral Follicle Count (r = 0,705), and number of oocytes retrieved (r = 0,356). In receiver operating characteristic curve analysis a threshold value of AMH = 2.31 ng/ml predictive for retrieval <6 MII (area under the curve (AUC) 0.675) was identified. This cut-off predicted PR with a sensitivity of 70.4% and a specificity of 61.8%, (PPV = 39.6%; NPV = 85.5%, p = 0.004). When performing a multiple logistic regression analysis including age, AFC and FSH, an AUC = 0.668 for PR was obtained whereas if AMH was added to the model it resulted in an AUC = 0.713. In oocyte donors aged 18 to 35 with an AFC ≥ 10 and basal FSH <10 mIU/ml, measuring AMH levels improved just slightly the prediction for PR.
Estrogen replacement therapy and ovarian cancer mortality in a large prospective study of US women.

CONTEXT Postmenopausal estrogen use is associated with increased risk of endometrial and breast cancer, 2 hormone-related cancers. The effect of postmenopausal estrogen use on ovarian cancer is not established. OBJECTIVES To examine the association between postmenopausal estrogen use and ovarian cancer mortality and to determine whether the association differs according to duration and recency of use. DESIGN AND SETTING The American Cancer Society's Cancer Prevention Study II, a prospective US cohort study with mortality follow-up from 1982 to 1996. PARTICIPANTS A total of 211 581 postmenopausal women who completed a baseline questionnaire in 1982 and had no history of cancer, hysterectomy, or ovarian surgery at enrollment. MAIN OUTCOME MEASURE Ovarian cancer mortality, compared among never users, users at baseline, and former users as well as by total years of use of estrogen replacement therapy (ERT). RESULTS A total of 944 ovarian cancer deaths were recorded in 14 years of follow-up. Women who were using ERT at baseline had higher death rates from ovarian cancer than never users (rate ratio [RR], 1.51; 95% confidence interval [CI], 1.16-1.96). Risk was slightly but not significantly increased among former estrogen users (RR, 1.16; 95% CI, 0.99-1.37). Duration of use was associated with increased risk in both baseline and former users. Baseline users with 10 or more years of use had an RR of 2.20 (95% CI, 1.53-3.17), while former users with 10 or more years of use had an RR of 1.59 (95% CI, 1.13-2.25). Annual age-adjusted ovarian cancer death rates per 100 000 women were 64.4 for baseline users with 10 or more years of use, 38.3 for former users with 10 or more years of use, and 26.4 for never users. Among former users with 10 or more years of use, risk decreased with time since last use reported at study entry (RR for last use <15 years ago, 2.05; 95% CI, 1.29-3.25; RR for last use >/=15 years ago, 1.31; 95% CI, 0.79-2.17). CONCLUSIONS In this population, postmenopausal estrogen use for 10 or more years was associated with increased risk of ovarian cancer mortality that persisted up to 29 years after cessation of use.
Actions Speak Louder than Words: Econometric Evidence to Target Tacit Collusion in Oligopolistic Markets

Tacit collusion reduces welfare comparably to explicit collusion but remains mostly unaddressed by antitrust enforcement which greatly depends on evidence of explicit communication. We propose to target specific elements of firms’ behavior that facilitate tacit collusion by providing quantitative evidence that links these actions to an anticompetitive market outcome. We apply our approach to incidents on the Italian gasoline market where the market leader unilaterally announced its commitment to a policy of sticky pricing and large price changes which facilitated price alignment and coordination of price changes. Antitrust policy has to distinguish such active promotion of a collusive strategy from passive (best response) alignment. Our results imply the necessity of stronger legal instruments which target unilateral conduct that aims at bringing about collusion.
Disease management evaluation A comprehensive review of current state of the art

Limited Electronic Distribution Rights This document and trademark(s) contained herein are protected by law as indicated in a notice appearing later in this work. This electronic representation of RAND intellectual property is provided for non-commercial use only. Unauthorized posting of RAND electronic documents to a non-RAND Web site is prohibited. RAND electronic documents are protected under copyright law. Permission is required from RAND to reproduce, or reuse in another form, any of our research documents for commercial use. For information on reprint and linking permissions, please see RAND Permissions. Skip all front matter: Jump to Page 16 The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. This electronic document was made available from www.rand. org as a public service of the RAND Corporation. CHILDREN AND FAMILIES
Gr upSM Genetics and Epigenetics Pathogenesis of Behçet ’ s Syndrome

Vasculitides are a group of diseases characterized by inflammation and destruction of blood vessel wall during the disease course. The disease itself exhibit non-specific signs and symptoms as well as differences in patho physiology, vessel involvement, and demographics [1]. Complexity of the disease related to the structural and function of the vessel, the tissue, and the associated microenvironment involved in the disease [2]. Behçet’s syndrome (BS) is a vasculitides, which is also characterized numerous systemic manifestations, including oral aphthous ulcers, skin lesions, ocular diseases, neurologic diseases, rheumatologic diseases, gastrointestinal disease and genital ulcers. These clinical manifestations of BS are present mainly due to the inflammation of the blood vessels and it is known for its ability to affect both, arteries and the veins. However, the etiology of BS is only partially understood, and previous studies have demonstrated a role of genetic and epigenetic factors contributes to disease pathophysiology. Jibran Sualeh Muhammad1* and Muhammad Ishaq2 1Department of Biological and Biomedical Sciences, The Aga Khan University, Pakistan 2Department of Internal Medicine, Jinnah Medical College Hospital, Pakistan *Corresponding author: Jibran Sualeh Muhammad, Department of Biological and Biomedical Sciences, The Aga Khan University, Karachi 74800, Pakistan. Tel: +922134864435, +923342811050; Email: jibran.sualeh@aku.edu
Recent Secular Trends in Pubertal Timing: Implications for Evaluation and Diagnosis of Precocious Puberty

The decline in age at puberty in the general population has been paralleled by an increase in the number of girls referred for evaluation of precocious puberty (PP). In 1999, The Lawson Wilkins Pediatric Endocrine Society recommended a lowering of the age limit for evaluation of PP in girls. However, the limited evidence on which these recommendations were based led many experts to question these new suggestions. The emergence of new European pubertal timing data evaluated by robust clinical as well as biochemical markers has broadened our insight on how to interpret the recent pubertal changes. The recent pubertal trends have resulted in a concomitant lowering of the lower limit of normality of the pubertal onset. However, evidence suggests that age at the gonadotropin and sex steroid surges have not changed. Thus, it looks as if an increasing proportion of contemporary early pubertal girls may experience isolated gonadotropin-independent thelarche rather than central PP, which may not be discernible on pubertal examination alone. Thus, the population-based limits of normality should not be directly translated into revision of age limits for evaluation of PP due to the risk of misdiagnosing rapid progressive PP as well as intracranial and other underlying pathology.
Extending McNemar's Test: Estimation and Inference When Paired Binary Outcome Data Are Misclassified

Summary McNemar's test is popular for assessing the difference between proportions when two observations are taken on each experimental unit. It is useful under a variety of epidemiological study designs that produce correlated binary outcomes. In studies involving outcome ascertainment, cost or feasibility concerns often lead researchers to employ error‐prone surrogate diagnostic tests. Assuming an available gold standard diagnostic method, we address point and confidence interval estimation of the true difference in proportions and the paired‐data odds ratio by incorporating external or internal validation data. We distinguish two special cases, depending on whether it is reasonable to assume that the diagnostic test properties remain the same for both assessments (e.g., at baseline and at follow‐up). Likelihood‐based analysis yields closed‐form estimates when validation data are external and requires numeric optimization when they are internal. The latter approach offers important advantages in terms of robustness and efficient odds ratio estimation. We consider internal validation study designs geared toward optimizing efficiency given a fixed cost allocated for measurements. Two motivating examples are presented, using gold standard and surrogate bivariate binary diagnoses of bacterial vaginosis (BV) on women participating in the HIV Epidemiology Research Study (HERS).
Transcutaneous electrical nerve stimulation (TENS) for the treatment of rheumatoid arthritis in the hand (Review)

Background Rheumatoid arthritis (RA) is a chronic, inflammatory, system disease. It commonly aHects the small peripheral joints (such as fingers and wrist). The main goals of intervention for RA are preventing joint deformity, preserving joint function, and reducing inflammation and pain. Transelectrical nerve stimulation (TENS) is a form of electrotherapy and is thought to produce analgesia according to the gate control theory. Objectives To determine the eHicacy and safety of TENS in the treatment of RA of the hand. The primary outcomes of interest were relief of grip pain and resting pain intensity, relief of joint tenderness, number of tender joints and patient assessment of disease. The secondary objective was to determine the most eHective mode of TENS application in pain control. Search methods We searched for relevant studies, in English, in the Cochrane field of physical and related therapies, the Cochrane Controlled Trials Register, MEDLINE, EMBASE, HEALTHSTAR, Sports Discus, CINAHL, Current
A survey of blood pressure parameters after aneurysmal subarachnoid hemorrhage

Purpose/aim: Blood pressure (BP) regulation is recommended following aneurysmal subarachnoid hemorrhage (aSAH) to prevent re-bleeding and to treat delayed cerebral ischemia. However, optimal BP thresholds are not well established. There is also variation with regard to the BP component (e.g. systolic vs. mean) that is targeted or manipulated. Materials and methods: An 18-question survey was distributed to physicians and advanced practitioner members of the Neurocritical Care Society. Respondents were asked which BP parameter they manipulated and what their thresholds were in different clinical scenarios. They were also asked whether they were influenced by the presence of incidental aneurysms. Answers were analyzed for differences in training background and treatment setting. Results: There were 128 responses. The majority were neurointensivists (47 neurology and 37 non-neurology) and treated patients in dedicated neurointensive care units (n = 98). Systolic BP (SBP) was preferred over mean arterial pressure (MAP). Prior to aneurysm treatment, SBP limits ranged from 140 to 180 mm Hg. After aneurysm treatment, SBP limits ranged from 160 to 240 mm Hg. The maximum and minimum MAPs varied by as much as 50%. Nearly two-thirds of the respondents were influenced by the presence of incidental aneurysms. Training background influenced tolerance to BP limits with neurology-trained neurointensivists accepting higher BP limits when treating delayed ischemia ( p = .018). They were also more likely to follow SBP ( p = .018) and have a limit of 140 mm Hg prior to aneurysm treatment ( p = .001). Conclusions: There is large practice variability in BP management following aSAH. There is also uncertainty over the importance of incidental aneurysms. Further research could evaluate whether this variability has clinical significance.
Neurologic Manifestations of Schönlein‐Henoch Purpura

ABSTRACT. The presence of a possible cerebral involvement in Schönlein‐Henoch Purpura was investigated in a prospective study comprising 26 children. A hampering headache accompanied by behavioural changes was present in 8 patients (31%). No cases of seizures, aphasia, ataxia, pareses or cerebral haemorrhage were found. EEG‐ahnormalities like slow wave foci, sharp waves, and paroxysms were demonstrated in 12 patients (46%) during the acute phase of the disease. The EEG‐changes were transient but persisted in 4 patients during a follow‐up period lasting one year. A significant association was found between the presence of headache and an abnormal EEG‐tracing.
Immaturity or Starvation? Longitudinal Study of Leptin Levels in Premature Infants

Objective: Leptin, the protein product of the ob gene, is a potential placental growth factor and is integral to the body’s system of energy regulation as shown in animal models. Premature infants are especially vulnerable to changes in energy regulation, and several studies have demonstrated a rapid fall in leptin values at birth. The purpose of the present investigation was to measure leptin levels in premature infants throughout hospitalization. Methods: Eligible infants were less than 32 weeks’ gestation, appropriate for gestational age, and hospitalized at Christiana Hospital Special Care Nursery. Serum samples for leptin analysis were drawn within 24 h of birth and twice a week thereafter until discharge. Concurrent growth measurements were obtained with each leptin sample. Body mass index, ponderal index, and midarm circumference/head circumference ratios were calculated to assess growth. Results: Leptin levels were low and remained low for the duration of the premature infants’ hospitalization (mean ± SD = 1.35 ± 0.63 ng/ml/ml, range 0–3.06). After controlling for weight, there was a small (r2 = 0.1, p < 0.00001) but significant correlation between leptin and postnatal age after 4 days of age. Despite an increase in caloric intake during the study period, there was no relationship between leptin and caloric intake. There were significant negative correlations between measurements of growth and both leptin and the leptin/weight ratio. Maternal diabetes and the use of steroids had small but significant effects on the leptin/weight ratio. Conclusion: In this population of predominantly female premature infants, leptin levels were very low as compared to term infants, children and adults, and did not change appreciably over the study period. The low leptin levels seen in these premature infants are similar to those levels seen in malnourished adults, anorexics, and in animal models of starvation. We speculate that a critical adipose store needs to be reached before increased amounts of leptin can be adequately produced. Persistently low leptin levels may also reflect an immaturity in the hypothalamic-pituitary-adrenal axis.
Developmental increase in placental low density lipoprotein uptake during baboon pregnancy.

The present study determined whether a developmental increase in placental low density lipoprotein (LDL) uptake occurred in baboon pregnancy, which was related to the increasing concentrations of estrogen typical of advancing gestation. LDL uptake was determined on collagenase-dispersed placental trophoblast cells purified via 50% Percoll gradient centrifugation and obtained from baboons between days 55-178 of gestation (i.e. the last two-thirds of gestation; term = 184 days). The majority of cells in the 50% Percoll-isolated fraction used to determine LDL uptake were syncytiotrophoblasts at all stages of gestation examined, as determined by immunohistochemical staining for syncytiotrophoblast-specific placental lactogen and pregnancy-specific-beta 1-glycoprotein. Placental LDL uptake, as determined by Scatchard analysis, increased progressively during the last two-thirds of gestation and was correlated (r = 0.87, P less than 0.001; curvilinear regression) with gestational age. Mean +/- SE LDL uptake early in pregnancy on days 55-58 was 1.9 +/- 0.2 ng/micrograms cell protein (n = 3). Placental LDL uptake (ng/microgram cell protein) at midgestation on days 94-104 (2.8 +/- 0.2; n = 5) increased to a value late in gestation on days 159-178 (14.6 +/- 1.0; n = 13), which was approximately 5-fold greater (P less than 0.001) than at midgestation, whereas uptake on days 128-138 was intermediate in value (8.3; n = 2) between the latter two periods. The apparent dissociation constant for placental LDL uptake was lower (P less than 0.01) at midgestation (0.33 micrograms/ml) than late in gestation (0.81 micrograms/ml). Placental LDL degradation, which depends on uptake, also increased with advancing stages of pregnancy, and was correlated (r = 0.74, P less than 0.01; curvilinear regression) with gestational age. Overall mean peripheral serum LDL cholesterol concentration was 46.5 +/- 1.7 mg/dl between days 50-170 of gestation. However, there was no significant change in serum LDL levels during this period. Maternal peripheral serum estradiol concentrations increased from 0.3 ng/ml on day 55 to an initial peak of approximately 3.5 ng/ml on days 70-80, then declined to approximately 1.0 ng/ml at midgestation. Estradiol then increased progressively throughout the remainder of pregnancy to maximal values of over 6 ng/ml late in gestation. In summary, there was a progressive increase in placental LDL uptake with advancing stages in the last two-thirds of baboon pregnancy, which was associated with a concomitant rise in maternal serum estradiol concentrations. (ABSTRACT TRUNCATED AT 400 WORDS)
Neural cells from primary human striatal xenografts migrate extensively in the adult rat CNS

Primary neural cells do not appear to migrate significantly following transplantation into the adult rodent CNS, which is in contrast to expanded neural precursor cells where migration is well‐documented. However, most transplant studies of primary neural tissue have been performed in an allograft situation in which it is difficult to identify graft‐derived cells. We have, therefore, used a xenograft paradigm to investigate the potential for cells derived from grafts of primary human fetal striatal tissue (gestational age of 66–72 days) to migrate following intrastriatal transplantation in an athymic adult rat model of Huntington's disease. The use of an antibody specific to human nuclear antigen enabled clear identification of graft‐derived cells within the host brain, and specific neural phenotypes were determined using human‐specific tau for neurons, glial fibrillary acidic protein for mature astrocytes and Ki67 for proliferative cells. At 6 weeks, the graft mass was very dense with a high proliferative index, few cells had migrated away from the graft, and the cells that had differentiated both within and away from the graft were mainly neurons. In contrast, at 6 months, the graft core was dispersed significantly more and a large number of graft‐derived cells had migrated throughout the brain as far rostral as the olfactory bulb and as caudal as the substantia nigra. Cells had differentiated into both neurons and astrocytes and the level of proliferation was significantly lower within the graft. These results demonstrate that primary neural xenografts contain proliferative cells that possess the ability to migrate and differentiate into both neurons and astrocytes, and suggest that these cells could contribute to normal graft function. This property may be a consequence of the xenograft situation and could potentially be exploited to provide the opportunity to target regions of distant pathology in neurodegenerative diseases using xenotransplantation of embryonic neural tissue.
Acute Toxicity From Breast Cancer Radiation Using Helical Tomotherapy With a Simultaneous Integrated Boost

Purpose: To evaluate 2 simultaneous integrated boost treatment planning techniques using helical tomotherapy for breast conserving therapy with regard to acute skin toxicity and dosimetry. Methods: Thirty-two patients were studied. The original approach was for 16 patients and incorporated a directional block of the ipsilateral lung and breast. An additional 16 patients were planned for using a modified approach that incorporates a full block of the ipsilateral lung exclusive of 4 cm around the breast. Dose–volume histograms of targets and critical structures were evaluated. Skin toxicity monitoring was performed throughout treatment and follow-up using the Common Terminology Criteria for Adverse Events. Results: Treatment was well tolerated with patients receiving a median dose of 59.36 Gy. Of the 16 patients in both groups, 8 had grade 2 erythema immediately after radiation. On 3-week follow-up, 10 and 7 patients in the original and modified groups showed grade 1 erythema. On 3- and 6-month follow-up, both groups had minimal erythema, with all patients having either grade 0 or 1 symptoms. No grade 2 or 3 toxicities were reported. Mean treatment time was 7.5 and 10.4 minutes using the original and modified methods. Adequate dose coverage was achieved using both methods (V95 = 99.5% and 98%). Mean dose to the heart was 10.5 and 1.8 Gy, respectively (P < .01). For right-sided tumors, the original and modified plans yielded a mean of 8.8 and 1.1 Gy (P < .01) versus 11.7 and 2.4 Gy for left-sided tumors (P < .01). The mean dose to the ipsilateral lung was also significantly lower in the modified plans (11.8 vs 5.0 Gy, P < .01). Conclusions: Tomotherapy is capable of delivering homogeneous treatment plans to the whole breast and lumpectomy cavity using simultaneous integrated boost treatment. Using the treatment methods described herein, extremely low doses to critical structures can be achieved without compromising acute skin toxicity.
Antioxidant Properties of Medicinal Plants from Peru

There is a wide diversity of plants and seasonal crops in Peru, due to the presence of many climatic zones. Numerous plants are used to cure or prevent diseases. These plants are promising candidates for functional foods products. The most frequent form in which they are used is an aqueous infusion or decoction. In this study, we compared the antioxidant properties of ten Peruvian plants infusions and investigated their relation to the phenolic content. The studied plants were: Uncaria tomentosa (cat’s claw), Lepidium meyenii (maca), Berberis vulgaris L. (barberry, agracejo), Phyllantus niruri (chanca piedra), Annona muricata L. (graviola, soursop), Gentianella alborosea (hercampure), Geranium dielsianum (pasuchaca), Tabebuia ochracea (tahuari), Notholaena nivea (“cuti cuti”) and Tiquilia paronychioides (“flor de arena”). Infusions of all studied plants have shown antioxidant activity, though there was a large diversity between the results. The antioxidant properties, determined with DPPH and ABTS scavenging assays as well as FRAP test, were strongly correlated with total phenolic content, while there was no correlation with the carotenoid content.