Embryo Culture Media Influence on Live Birth Rate and Birthweight after IVF/ICSI: A Systematic Review Comparing Vitrolife G5 Media to Other Common Culture Media

Previous studies have indicated that culture media vary in efficiency and outcomes, such as live birth rate, birthweight and embryo quality. Does Vitrolife G5 series culture media result in higher live birth rates and birthweight compared to other common culture media? This study is a systematic review based on the PRISMA criteria. Relevant search terms, mesh terms (PubMed and Cochrane) and Emtree terms (Embase) were identified. We searched the literature using PubMed, Embase and Cochrane, on November 10, 2019. The inclusion criteria involved published articles in English comparing Vitrolife G5 to other common culture media. We included randomized controlled trials (RCTs) and cohort studies. The quality of the studies was assessed using the Cochrane Risk of Bias tool 2.0 and the Newcastle-Ottawa Scale. Primary outcomes were live birth rate and birthweight. Secondary outcomes were fertilization rate, implantation rate, biochemical pregnancy rate, clinical pregnancy rate, miscarriage rate, multiple pregnancies and congenital malformations. Of 187 articles screened, 11 studies fulfilled the inclusion criteria: Five RCTs and six retrospective cohort studies. Only one study reported live birth rate, showing a non-significantly higher live birth rate for Vitrolife G5 media. Birthweight had equivocal results with three of six studies, showing significantly lower (2)/higher (1) birthweights, whereas the others were non-significant. Overall, there were no significant differences concerning secondary outcomes. The results are equivocal, and we need more studies to evaluate culture media and their effect on short- and long-term health.

Is head injury a risk factor for schizophrenia?

BACKGROUND

The few studies that have examined whether head injury is a risk factor for later schizophrenia have had important methodological problems.

METHOD

We examined the rates of head injury among 8288 persons in the 15 years up to their first admission with schizophrenia and compared them with 82880 age- and gender-matched controls. We used hospitalization for concussion or severe head injury as a definition of head injury. We controlled for any generally altered accident proneness prior to schizophrenia by also comparing the groups with respect to exposition to fractures not involving the skull or spine.

RESULTS

Males with schizophrenia had significantly reduced exposure to concussion (OR = 0.864, p = 0.024), whereas females had significantly increased exposure (OR = 1.322, p = 0.025). No differences were found as regards severe head injury. Males had significantly reduced risk of other fractures (OR = 0.616, p < 0.0001), whereas the risk in females did not differ from controls (OR = 1.154, p = 0.189). After adjusting head injury with the risk for other fractures, both concussion and severe head injury were significantly increased in males (OR = 1.501, p < 0.001 and OR = 1.516. p < 0.001, respectively) but not in females (OR = 1.15, p = 0.413 and OR = 0.819, p = 0.442, respectively).

CONCLUSION

Our results do not exclude that for males, head injury may contribute to the risk for schizophrenia in a limited number of cases. This relation may also exist for females, but it is paralleled by an increased liability to traumas in general. Premorbid general accident proneness requires consideration when studying this association.

[Treatment needs of alcoholics with parental alcoholism]

The present study covers 375 consecutive patients referred to the three outpatient clinics at the Psychiatric department of Odense University Hospital from November 1995 to February 1997. The aim of the study was to describe differences in problem profiles for alcoholics with or without parental alcoholism. All patients were assessed by means of the Addiction Severity Index at admission. There was a tendency towards alcoholics with parental alcoholism having more severe alcohol problems than alcoholics without such a family history. Furthermore, alcoholics with parental alcoholism had a more complex problem profile, i.e. more legal problems, psychological problems and work-related problems, especially among the males. In sum, male alcoholics with a family history of alcoholism showed a problem profile almost as complex as that of female alcoholics in general.

Factors associated with compliance of alcoholics in outpatient treatment

Predictors of compliance with psychosocial treatment were examined in a clinical sample of 150 patients seeking outpatient treatment for alcohol problems. Predictor variables were as follows: a) patient characteristics at the beginning of treatment and b) treatment characteristics of a matching model developed from the Conceptual System Theory. This model was based on the conceptual level of patients and therapists, and on the structure of the treatment. Using logistic regression analysis, we identified predictors of compliance in the motivation phase (first four consultations) and the active treatment phase (the remainder of the agreed treatment period of 12 months). Predictors of compliance in the motivation phase were a) therapists with a high conceptual level, characterized by an attitude toward the patients of empathetic and reflective listening; b) disulfiram; and c) psychopharmacological treatment. The only patient-related predictors of compliance in the active treatment phase were a) age below 40 and b) the presence of family and social problems, both factors predicting noncompliance. The only treatment-related predictor variables were a) the matching of patients with the structure of treatment and b) disulfiram during the first month of treatment, both factors predicting compliance. Two years after the beginning of treatment, those patients who completed the motivation phase as well as the active treatment phase had a significantly better psychosocial function than the noncompliant patients.

[Differences between male and female alcoholics and differences in their need of treatment]

The present study covers 375 consecutive patients referred to the three outpatient clinics at the Psychiatric Department of Odense University Hospital from November 1995 to February 1997. The aim of the study was to describe differences in problem profiles for men and women. All patients were assessed by means of the Addiction Severity Index at admission. All patients needed treatment for alcohol problems. Significantly more female alcoholics, however, had problems with mental health, physical health, drug use and family/social life. More men than women had legal problems. Almost half of the women had previously attempted to commit suicide, and almost one third of the women suffered from anxiety disorder at the time of admission. Significantly more women than men had partner who also had an alcohol problem.

[Atypical acute dystonia]

Acute dystonia is a common adverse effect following anti-psychotic medication, which mainly appears shortly after beginning treatment or increasing the dosage. Laryngeal dysfunction may carely occur as part of the picture of acute dystonia and, if so, usually with dyspnoea. We describe a case of acute dystonia with atypical onset without relation to changes in dosage and with laryngeal involvement with aphonia, but without dyspnoea.

Patient-treatment matching improves compliance of alcoholics in outpatient treatment

In chronic medical disorders, patient compliance is very poor and often less than 50%. The purpose of this investigation was to determine whether the proper matching of patient, treatment, and therapist would improve patient compliance in the outpatient treatment of alcoholics. We randomly placed 119 alcoholics who had commenced protracted outpatient treatment for alcoholism in either low or high structured treatments. These 119 patients were offered 12 months of individual treatment. Interruption of this treatment was recorded as noncompliance. The treatment courses were expressed in survival curves. The consequence of compliance for long-term prognosis was described by means of the Addiction Severity Index. The form of treatment in itself had no importance for compliance. However, correct matching of a patient and a treatment structure resulted in a compliance rate of 63% as opposed to 38% compliance among mismatched patients. Twenty-four months after the initiation of treatment, patients in the compliance group had a significantly higher level of function than those in the noncompliance group. Our investigation of alcoholics involved in outpatient treatment shows that the correct matching of patients and treatment structure improves compliance and long-term prognosis. It is hoped that the present investigation will generate interest in future research on correct matching to gain improved compliance in patients with a chronic medical disorder.

[Factors related to suicidal behavior among alcoholics]

Of 181 alcoholics who consecutively sought treatment as out- or inpatients, 68 (37.6%) had attempted suicide at least once. Compared with non-attempters, the suicide attempters were significantly more likely to be female, have had a chaotic upbringing and to have known suicide attempts in the family and social circle. Significantly more attempters suffered from depressive disorder, feelings of hopelessness, anxiety attacks, agoraphobia, substance abuse or cluster B personality disorders (dissocial, impulsive, borderline, and histrionic). Also significantly more suicide attempters had committed crimes and received early pension. Assessment of coping showed that suicide attempters had a significantly lower tendency to make plans or to make the best of a stressful situation by growing from it. They were significantly more likely to show mental disengagement, to resort to denial and drink alcohol or take drugs when faced with stressful events or difficulties. When evaluated on the Addiction Severity Index Scale, the suicide attempters were found to have a significantly greater need of treatment.

[Ambulatory treatment of alcoholics. A prospective study]

The present study covers 130 consecutive patients referred to the two outpatient clinics for alcoholism in Odense over a ten-month period from January to October 1993. The aim of the study was to describe the process of treatment over 12 months and assess the condition of the patients 12 months after the admission for treatment. All patients were assessed by means of the Addiction Severity Index at admission and after 12 months. While female alcoholics typically had psychiatric complaints, the drinking pattern was, however, alike for both sexes. Patients who themselves terminated their treatment had a significantly worse drinking pattern than those who completed treatment. Twelve months after the admission there was a significant decrease in the alcohol abuse and an improvement in psycho-social function for both sexes.

Alcohol problems among suicide attempters in the Nordic countries

The purpose of this study was to see whether and how the number of suicide attempters with alcohol problems and their drinking habits differ between the Nordic areas under study. Problem-drinkers were defined as persons who themselves felt that they had an alcohol problem. The analyses were based on data collected at five Nordic research centers participating in the WHO/Euro Multicentre Study on Parasuicide, namely: Helsinki (Finland); Umeå and Stockholm (Sweden); Słr-Trłndelag (Norway); and Odense (Denmark). The results showed that the frequency of problem-drinking among suicide attempters differed markedly between the areas under study; the Finnish male and the Danish female suicide attempters included the highest proportions of self-identified problem-drinkers. The pattern of drinking among the suicide attempters also differed between the areas. The analyses indicate that the point when alcohol becomes a problem to somebody, especially to a degree that it increases the risk of suicidal behavior, not only depends on how much and how often the person drinks alcohol; the prevailing drinking pattern, the attitudes towards drinking alcohol, and the level of social control are also important factors to take into consideration when relations between alcohol and suicidal behavior are under study.

[Productivity and patient satisfaction. An evaluation of a urological short-term unit]

A study of a short term unit was performed in the Urological Department of the University Hospital of Copenhagen at Hvidovre. The study reflects the productivity of the unit by measuring patient flow, average admission time, utilization of the bed capacity and examination and treatment activities. Patient satisfaction was also evaluated. The results showed a total rise in productivity of 6%, a fall of one day in the average length of hospital stay and a high degree of patient satisfaction. Surgical short term units can be recommended, provided that admission criteria are precise, the nursing staff and medical staff of the unit are highly qualified and a continuity of the patients' stay at the hospital is secured.

The effect of indomethacin infusion on renal hemodynamics and on the renin-angiotensin system during unilateral ureteral obstruction of the pig

Obstruction of the urinary tract is associated with an increase in pelvic pressure (PP) and a decline in ipsilateral renal blood flow (RBF). To investigate the influence of the renal prostaglandins on these parameters, pigs with complete unilateral ureteral obstruction (UUO) were studied under general anesthesia after administration of indomethacin 30 minutes before obstruction. Pelvic pressure increased to a maximum of 41.1 +/- 2.4 cm. H2O after 6 hours, but maximum pressure, as well as the rate of pressure increase, was significantly reduced after indomethacin. A transient but significant increase in mean aortic blood pressure was seen, together with a bilateral decrease in RBF immediately after indomethacin administration. Ipsilaterally RBF decreased by 25% from 319 +/- 21 ml. per minute to 237 +/- 16 ml. per minute and contralaterally by 23% from 300 +/- 20 ml. per minute to 231 +/- 25 ml. per minute. After 15 hours a further decline was measured in ipsilateral RBF to 136 +/- 20 ml. per minute but, on the contralateral side, RBF was only slightly reduced to 281 +/- 36 ml. per minute after 15 hours. Following indomethacin a sustained increase in ipsilateral renal vascular resistance (RVR) was observed from 37.6 +/- 3.6 mm. Hg x ml.-1 x min. x gm. to 130.5 +/- 42.3 mm. Hg x ml.-1 x min. x gm. compared with a much smaller increase from 37.4 +/- 3.2 mm. Hg x ml.-1 x min. x gm. to 55.1 +/- 9.2 mm. Hg x ml.-1 x min. x gm. in the control group. Renal secretion rate of angiotensin II was significantly reduced 2 and 6 hours after indomethacin administration on the obstructed side, and was not significantly changed on the contralateral side. It can be concluded that inhibition of prostaglandin synthesis during unilateral ureteral obstruction in pigs results in reduced pelvic pressure, renal blood flow and angiotensin II secretion rate from the affected kidney, and that renal prostaglandin synthesis plays an important role for the perfusion of the kidney during ureteral obstruction.

Enhanced intrarenal angiotensin II generation in response to obstruction of the pig ureter

The effect of acute unilateral complete ureteral obstruction (UUO) on renal hemodynamics has been examined in a pig model. Pigs were operated on under general anesthesia, electromagnetic flow probes were inserted around renal arteries, and catheters were implanted in renal veins and aorta for blood sampling. The influence of 15 h of obstruction on the physiological variation in immunoreactive angiotensin II (ANG II) was measured together with detailed analysis of the renal handling of ANG II in anesthetized animals. Pelvic pressure rose significantly within 2 h to a maximum of 59.9 +/- 2.9 cmH2O (n = 10). The ipsilateral renal blood flow (RBF) was reduced by 30% from 319 +/- 35 to 241 +/- 42 ml/min (P = 0.001), whereas contralateral RBF did not change. A temporary significant increase in mean aortic blood pressure was seen during the first 2 h after UUO. Renal vascular resistance increased by 44% in the obstructed kidney from 37 +/- 3 to 55 +/- 9 mmHg.ml-1.min.g during the course of obstruction. Concomitantly, the plasma concentration of immunoreactive ANG II increased from all three sample sites by 8-15 times. This increase was highly significant compared with the sham-operated group. The results show that the pig kidney responds to UUO by a net secretion of ANG II from the ipsilateral kidney. Our observations on the ANG II renal secretion rate suggest that part of the immunoreactive ANG II in the renal venous effluent originated de novo from intrarenal generation.

[Pattern of choice in preparation of attempted suicide by poisoning--with particular reference to changes in the pattern of prescriptions]

This investigation was initiated in 1990 to investigate the choice of preparation in cases of attempted suicide treated in the Emergency Unit in Odense University Hospital during the past decade. The results show that 1) an increase has occurred particularly among young women in the use of analgesics obtainable without prescription (e.g. 13% of young women employed paracetamol as the toxic agent), 2) the number of persons employed dextropropoxyphene did not decrease and 3) a great increase was observed in the number of cases of poisoning with ketobemodoni chloridum. In 1985, several barbiturates were withdrawn from the Danish Medical Codex and this was followed by a decrease in the number of cases of poisoning among women but not among men. At present, approximately 10% of men who poison themselves still employ barbiturates. The number of cases of poisoning with barbiturates in men is thus not reduced but phenobarbital is the preparation of choice. The authors conclude that more attention and care should be paid when prescribing dextropropoxyphene, ketobemodoni chloridum and phenobarbital and the availability of paracetamol without prescription must be debated critically.