[Research advances of porous organic framework materials on enrichment and detection of mycotoxins]

Mycotoxins are a class of toxic secondary metabolites produced by fungi. These substances are carcinogenic, teratogenic, and mutagenic, and cause serious harm to the human body; thus, they have attracted wide attention worldwide. Establishing accurate, rapid, and sensitive methods for the detection of mycotoxins is of great significance. Chromatography is a commonly used technology for mycotoxin detection. However, it is challenging to use in the direct analysis of these metabolites because of the wide variety and distribution of mycotoxins, their complex sample matrix, and their very low content in actual samples. Therefore, the development of suitable sample pretreatment methods for the efficient separation and enrichment of mycotoxins is necessary. In recent years, porous organic framework materials, which are represented by metal-organic frameworks (MOFs) and covalent-organic frameworks (COFs), have been widely applied in the sample pretreatment of mycotoxins owing to their many advantages, which include a large specific surface area, high porosity, adjustable pore size, diverse frame structures, uniform active site distribution, and modifiable structures. In addition, MOF/COF materials feature excellent fluorescence and electrochemical properties, rendering them highly suitable for mycotoxin analysis and sensing. In this article, the recent applications of MOF/COF materials in conventional sample pretreatment methods (e. g., solid-phase extraction, dispersive solid-phase extraction, magnetic solid-phase extraction, and immunomagnetic bead separation) for mycotoxin separation and enrichment are reviewed. Research on the use of MOF/COF materials for the fluorescence and electrochemical sensing of mycotoxins is also summarized. Finally, the existing challenges and future development trends of these materials are discussed and prospected to provide a reference for future research on the applications of MOF/COF materials in mycotoxin detection and analysis.

Ovarian Stimulation Strategies for Intrauterine Insemination in Couples with Unexplained Infertility - A Systematic Review and Individual Participant Data Meta-analysis

Background: Intrauterine insemination with ovarian stimulation (IUI-OS) is a first-line treatment for couples with unexplained infertility. Individual participant data meta-analysis (IPD-MA) is the gold standard for evidence synthesis.

Aim: To compare the effectiveness and safety of ovarian stimulation with gonadotrophin, Letrozole and clomiphene citrate (CC) and to explore treatment-covariate interactions for important baseline characteristics in women undergoing IUI.

Method: We searched electronic databases including PubMed, MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL). We included randomised controlled trials (RCTs) comparing IUI-OS with gonadotropins, Letrozole or CC among couples with unexplained infertility. We excluded dose comparing studies of the same drug. We contacted the authors of eligible RCTs to share the IPD and established the IUI IPD-MA collaboration. The primary effectiveness outcome was live birth and the primary safety outcome was multiple pregnancy. We used a one-stage approach using a random effects model.

Results: Six RCTs (n= 2299) provided IPD. Gonadotropins increased the chance of a live birth compared to both CC (5 RCTs, 1946 women, RR 1.28, 95%CI 1.10 to 1.49, I2 = 25%, moderate-quality evidence) whereas there was insufficient evidence of a difference between Letrozole and CC (1 RCT, 599 women, RR 0.77 95%CI 0.58 to 1.03). Gonadotropins increased the risk of a multiple pregnancy compared to both CC (4 RCTs, 1696 women, RR 2.17, 95%CI 1.33 to 3.55, I2 = 69%, low-quality evidence) whereas there was insufficient evidence of a difference between Letrozole and CC (1 RCT, 599 women, RR 0.71, 95%CI 0.33 to 1.56). No strong evidence on the treatment-covariate interactions (female age, BMI or primary versus secondary infertility) was found.

Conclusion: Gonadotropins increased the chance of a live birth compared to both CC and Letrozole but also increased the chance of a multiple pregnancy. Further RCTs comparing Letrozole and other interventions in couples with unexplained infertility are needed.

Can We Identify Subgroups in Which ICSI is Cost-Effective Over IVF: A Secondary Analysis of a Randomised Clinical Trial

Background: The use of intracytoplasmic sperm injection (ICSI) has increased substantially worldwide, primarily in couples with non-male factor infertility. We recently published the results of a large randomised controlled trial (RCT) comparing ICSI and IVF showing no significant improvement of ICSI over IVF in couples with normal semen concentration and motility. Here, we assess the cost-effectiveness of ICSI in these couples, with additional attention for subgroups.

Aim: To assess the effectiveness and cost-effectiveness of ICSI versus IVF in relation to sperm morphology.

Method: We performed a cost-effectiveness alongside a randomised clinical trial comparing ICSI and IVF. Between 16th March 2018 and 12th August 2019, we had randomized 1,064 couples (532 to ICSI vs 532 to IVF) in two centres in VietNam. After comparing the difference in life birth rate, we calculated the incremental cost-effectiveness ratio as the additional cost to establish one live birth. We also looked at (cost-)effectiveness in subgroups by the baseline characteristics treatment-indication, ovarian response, total-motile-count and sperm-morphology.

Results: In the base case, there were per 100 women 3.4 more babies born for an extra cost of €65,600. This translates to €19,294 per extra life birth, which is comparable to the benchmark of €15,000 per live birth.

We did not find significant interaction with any of the baseline characteristics (all P-values for interaction [Formula: see text] 0.05). However, for sperm morphology, in the 458 couples with [Formula: see text]=4% normoform cells, live birth rates were 32.1% versus 32.9% (RR 0.97 (0.75 to 1.27)), while in 201 women with [Formula: see text]4% normoform cells this was 36.2% versus 29.7% (RR 1.22 (0.97, 1.54)). While this would implicate no effectiveness of ICSI in couples with completely normal sperm, in couples with normal total sperm count and motility, those with sperm morphology [Formula: see text]4% would have 6.5 additional babies per 100 women, resulting in a cost-effectiveness of €10,076 per extra life birth.

Conclusion: In couples with completely normal sperm (normal total sperm count, motility and morphology) ICSI does not add anything to the chances obtained with IVF. In couples with a normal total sperm count and motility with abnormal morphology, ICSI could be considered as it seems cost-effective.

How Low Can You Go? Transfer of Low-Grade Blastocysts

Background: Low grade blastocyst (LGB) transfer results in varied live birth rates (5-39%). Only limited studies with small sample sizes (n=10-440) exist, due to LGB transfer being less desirable. Definitions of LGB and study designs are heterogenous, further confounding outcome interpretation.

Aim: This study aimed to obtain sufficient LGB transfers to determine live birth rates, as well as allow subgroup analysis by blastocyst quality and maternal age.

Method: This study was a multicentre, multinational retrospective cohort study across nine IVF clinics in China and New Zealand between 2012 to 2019. 6966 single blastocyst transfer cycles on days 5-7 (fresh and frozen) were collected; of these, 875 transfers were from LGBs (<3BB). Blastocysts with expansion stage 1 or 2 (early blastocysts) were excluded.

The main outcome was live birth rate.

Blastocysts were grouped according to quality grade: good-grade blastocysts (GGBs; n=3849, AA, AB and BA), moderate-grade blastocysts (MGBs; n=2242, BB) and LGBs (n=875, AC, CA, BC, CB and CC). Live birth rates were compared using the Pearson Chi-squared test. A logistic regression analysis examined the relationship between blastocyst grade and live birth after adjustment for confounders: clinic, female age, expansion stage, and blastocyst age.

Results: Live birth rates for GGBs, MGBs and LGBs were 45%, 36% and 28% respectively (p<0.0001). Within the LGB group, the highest live birth rates were for grade C TE (30%) and the lowest were for grade C ICM (19%). The lowest combined grade (CC) had a 15% live birth rate (n=7/48).

The odds of live birth were 2.33 (95% CI = 1.88-2.89) for GGBs compared to LGBs and 1.56 (95% CI = 1.28-1.92) for MGBs compared to LGBs following fresh and frozen blastocyst transfers (p<0.0001). The odds of live birth according to ICM grade were 1.31 (A versus B; 95% CI = 1.15-1.48), 2.82 (A versus C; 95% CI = 1.91-4.18) and 2.16 (B versus C; 95% CI = 1.48-3.16; all p<0.0001). The odds of live birth according to TE grade were 1.33 (A versus B; 95% CI = 1.17-1.50, p<0.0001), 1.85 (A versus C; 95% CI = 1.45-2.34, p<0.0001) and 1.39 (B versus C; 95% CI = 1.12-1.73, p=0.0024).

Conclusion: The live birth rate for LGBs is 28%, with rates ranging between 15-31% for the different inner cell mass (ICM) and trophectoderm (TE) subgroups of LGBs. Even those in the lowest grading tier maintain modest live birth rates (15%; CC). Thus, these can be considered for transfer in women with few other options.

Underdetection of pre-existing HIV/AIDS during psychiatric hospitalizations

OBJECTIVES

People with severe mental illness are 10 times more likely to have HIV/ AIDS than the general population, yet little is known about the characteristics and frequency of recognition of pre-existing HIV/AIDS diagnoses among inpatients with severe mental illness. This study examines documentation rates of pre-existing HIV/ AIDS among inpatients within psychiatric hospitals in New York State.

DESIGN

Retrospective cohort study to examine recognition of pre-existing HIV/AIDS among psychiatric inpatients.

METHODS

Patient-level Medicaid claims records were linked with hospital and regional data for people admitted to psychiatric inpatient units in New York State. Presence of HIV/AIDS diagnoses prior to psychiatric hospitalization was coded for each inpatient (n = 14 602). Adjusted odds ratios of undocumented HIV/AIDS diagnoses at the time of discharge were calculated using logistic regression analyses.

RESULTS

About 5.1% (741/14 602) of unique psychiatric inpatients had pre-existing HIV/AIDS diagnoses. Of these inpatients, 58.3% (432/741) were not coded as having HIV/AIDS upon discharge. Higher rates of missed detection were associated with younger age, non-Hispanic white race/ethnicity, shorter length of stay, more distal coding of an HIV/AIDS diagnosis, and fewer HIV/AIDS-related Medicaid claims in the past year. Hospitals with higher readmission rates also had higher rates of undetected HIV/AIDS diagnoses.

CONCLUSION

Over half of inpatients previously diagnosed with HIV/AIDS did not have their HIV-positive status noted upon discharge from psychiatric hospitalization. This finding underscores how frequently clinically significant medical comorbidities fail to be incorporated into psychiatric treatment and treatment planning. Inpatient clinicians are missing important opportunities to optimize HIV/AIDS treatment and reduce morbidity and mortality.

Perfusion of Isolated Carotid Sinus With Hydrogen Sulfide Attenuated the Renal Sympathetic Nerve Activity in Anesthetized Male Rats

The purpose of the present study was to define the indirect central effect of hydrogen sulfide (H2S) on baroreflex control of sympathetic outflow. Perfusing the isolated carotid sinus with sodium hydrosulfide (NaHS), a H2S donor, the effect of H2S was measured by recording changes of renal sympathetic nerve activity (RSNA) in anesthetized male rats. Perfusion of isolated carotid sinus with NaHS (25, 50, 100 μmol/l) dose and time-dependently inhibited sympathetic outflow. Preconditioning of glibenclamide (20 µmol/l), a ATP-sensitive K+ channels (KATP) blocker, the above effect of NaHS was removed. With 1, 4-dihydro-2, 6-dimethyl-5-nitro-4-(2-[trifluoromethyl] phenyl) pyridine-3-carboxylic acid methyl ester (Bay K8644, 500 nmol/l) pretreatment, which is an agonist of L-calcium channels, the effect of NaHS was eliminated. Perfusion of cystathionine γ-lyase (CSE) inhibitor, DL-propargylglycine (PPG, 200 μmol/l), increased sympathetic outflow. The results show that exogenous H2S in the carotid sinus inhibits sympathetic outflow. The effect of H2S is attributed to opening KATP channels and closing the L-calcium channels.

[Surgical treatment of obstructive hypertrophic cardiomyopathy with ventricular septal myectomy concomitant mitral valve replacement]

OBJECTIVE

To summarize the experiences and results of ventricular septal myectomy concomitant mitral valve replacement (MVR) for obstructive hypertrophic cardiomyopathy (OHCM).

METHODS

From January 2000 to June 2007, 22 patients of OHCM with moderate or severe mitral regurgitation underwent concomitant ventricular septal myectomy concomitant MVR. There were 20 male and 2 female patients. The age ranged from 28 to 51 years old with a mean of (36 + or - 5) years old. The left ventricular out tract gradient pressure (LVOTGP) was 55 to 120 mm Hg (1 mm Hg = 0.133 kPa), with a mean of (88.0 + or - 15.8) mm Hg. The manifestation of pre-operative UCG, intra-operative transesophageal echocardiography (TEE) and post-operative UCG in 10 d, 6 months and 1 year were compared and analyzed.

RESULTS

One patient died in hospital due to serious ventricular arrhythmias. The intra-operative TEE showed that the phenomenon of systolic anterior motion (SAM) of mitral valve disappeared in all patients. Twenty-one cases were followed-up. The intra-operative TEE and post-operative UCG in every period of all 21 cases survived indicated that the mean LVOTGP and interventricular septal thickness (IVST) decreased obviously (P < 0.01).

CONCLUSION

Concomitant ventricular septal myectomy concomitant MVR is an effective and safe treatment for OHCM with moderate or severe mitral regurgitation, the short and mid-term outcome is excellent.