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The pathophysiology of isolated pleural effusion in ovarian hyperstimulation syndrome (OHSS) is not well defined. The objective of the current review is to delineate the pathophysiology, risk factors, preventive measures, and therapeutic options of isolated pleural effusion in severe OHSS. Major databases were searched until June 2016. Studies evaluating women who presented with pleural effusion as the sole extra-ovarian manifestation of severe OHSS were included. Data were extracted from 24 articles encompassing 30 reported cases. Values were expressed as mean ± SEM. Patients were young (31.5 ± 0.8 years old) and 29.1% of them were diagnosed with polycystic ovary syndrome. All the patients received human chorionic gonadotropin to trigger oocyte maturation. Estradiol level was 3110 ± 330 pg/mL on the day of the ovulatory trigger. Dyspnea was the presenting symptom in 86.6% of the patients. Pleural effusion was predominantly on the right side (80%). Ninety percent of the patients underwent thoracentesis (4332 ± 769 mL): 66.7% exudate and 33.3% transudate. Fluid initially accumulates in the peritoneal cavity then enters the pleural space due to the pressure gradient through the thoracic duct and diaphragmatic defects, which are more common on the right side. The risk factors, prevention, and management, which are also discussed in this review, are similar to those of severe OHSS. [ABSTRACT FROM AUTHOR]

Background: There is no consensus on the exact parameters that define the LH surge for natural cycle frozenthawed embryo transfers (NC-FET). Accurately determining the LH surge would affect the timing, and subsequently the success rates, of embryo transfer. Therefore, the aim of this study was to delineate the optimal levels and relationship for luteinizing hormone (LH) and estradiol in an effort to optimally identify the LH surge in NC-FET. Methods: It is a retrospective study that was performed in an academic medical center. Patients who underwent blastocyst NC-FET who either had preimplantation genetic screening (PGS) or were <35 years old but did not undergo PGS (non-PGS) were included in separate analyses. They were divided into two groups: Group A included patients whose LH surge was defined as the first attainment of LH ⩾ 17 IU/L during the follicular phase with a ⩾30% drop in estradiol levels the following day; group B encompassed patients whose LH level continued to rise and the surge was defined as the highest serum LH level occurring a day after LH ⩾ 17 IU/L despite a ⩾ 30% drop in estradiol levels. The main outcomes measures were implantation and live birth rates. Results: Four hundred-seven non-PGS and 284 PGS NC-FET were included. Among non-PGS cycles, group A was associated with significantly higher implantation rates (48.7% vs. 38.1%) and live birth rates (52.9% vs. 40.1%) compared to group B. In contrast, group A and B had comparable live birth rates among PGS cycles. Conclusions: Among non-PGS cycles, measuring LH and estradiol levels the day after an LH ⩾ 17 IU/L and defining the surge as the first day of LH ⩾ 17 IU/L in the context of a ⩾ 30% drop in estradiol the following day was associated with better NC-FET outcomes than defining the surge as the day representing the highest serum LH level despite a ⩾30% drop in estradiol levels. [ABSTRACT FROM AUTHOR]

The identification of a new generation of potent broadly neutralizing HIV-1 antibodies (bnAbs) has generated substantial interest in their potential use for the prevention and/or treatment of HIV-1 infection. While combinations of bnAbs targeting distinct epitopes on the viral envelope (Env) will likely be required to overcome the extraordinary diversity of HIV-1, a key outstanding question is which bnAbs, and how many, will be needed to achieve optimal clinical benefit. We assessed the neutralizing activity of 15 bnAbs targeting four distinct epitopes of Env, including the CD4-binding site (CD4bs), the V1/V2-glycan region, the V3-glycan region, and the gp41 membrane proximal external region (MPER), against a panel of 200 acute/early clade C HIV-1 Env pseudoviruses. A mathematical model was developed that predicted neutralization by a subset of experimentally evaluated bnAb combinations with high accuracy. Using this model, we performed a comprehensive and systematic comparison of the predicted neutralizing activity of over 1,600 possible double, triple, and quadruple bnAb combinations. The most promising bnAb combinations were identified based not only on breadth and potency of neutralization, but also other relevant measures, such as the extent of complete neutralization and instantaneous inhibitory potential (IIP). By this set of criteria, triple and quadruple combinations of bnAbs were identified that were significantly more effective than the best double combinations, and further improved the probability of having multiple bnAbs simultaneously active against a given virus, a requirement that may be critical for countering escape in vivo. These results provide a rationale for advancing bnAb combinations with the best in vitro predictors of success into clinical trials for both the prevention and treatment of HIV-1 infection. [ABSTRACT FROM AUTHOR]

Abstract: Currently, an intramedullary (IM) guide is often used for performing the distal femoral resection in total knee arthroplasty (TKA). However, this method assumes that in most patients, the distal femoral mechanical–anatomical angle (FMAA) is 5°. Preoperative, standing, AP hip-to-ankle radiographs were reviewed in 493 patients undergoing primary TKA, and the FMAA was digitally measured. Correlation coefficients relative to several radiographic measurements, along with demographic variables, were performed. A significant number of patients (28.6%) had an FMAA outside the range of 5°±2° (range 2.0°–9.6°). The only measurement demonstrating a fair/moderate correlation with the FMAA was the neck–shaft angle (r=−0.55). Using an IM resection guide, without obtaining AP hip-to-ankle radiographs to determine each patient''s true FMAA, may lead to malalignment of the femoral component. [Copyright &y& Elsevier]

Objective: To determine whether blastocyst grading can predict pregnancy outcomes in the frozen-thawed embryo transfer (FET) of euploid blastocysts.Design: Retrospective cohort study.Setting: Academic medical center.Patient(s): Women who underwent FET of euploid embryo(s) between January 2013 and December 2015, with blastocysts were divided into four groups based on their morphologic grading before cryopreservation: excellent (≥3AA), good (3-6AB, 3-6BA, 1-2AA), average (3-6BB, 3-6AC, 3-6CA, 1-2AB, 1-2BA), and poor (1-6BC, 1-6CB, 1-6CC, 1-2BB).Intervention(s): FET.Main Outcomes Measure(s): Ongoing pregnancy rate (OPR).Result(s): A total of 417 FET cycles (477 embryos) were included. Excellent-quality embryos (n = 38) yielded a statistically significantly higher OPR than poor-quality embryos (n = 106) (84.2% vs. 35.8%; adjusted odds ratio 11.0; 95% confidence interval, 3.8-32.1) and average-quality embryos (n = 197) (84.2% vs. 55.8%; adjusted odds ratio 4.8; 95% confidence interval, 1.7-13.3). Good-quality embryos (n = 76) were associated with a statistically significantly higher OPR than poor-quality embryos (61.8% vs. 35.8%). These odds ratios were adjusted for patient's age, body mass index, number of transferred embryos, type of frozen cycle, peak endometrial thickness, day of trophectoderm biopsy (5 or 6), and total number of euploid embryos for each patient. An inner cell mass grade of A yielded a statistically significantly higher OPR than ICM grade C (76.2% vs. 13.5%) or grade B (76.2% vs. 53.6%) after controlling for all confounders.Conclusion(s): Contrary to prior published studies, the current data suggest that blastocyst morphologic grading and particularly inner cell mass grade is a useful predictor of OPR per euploid embryo. Morphologic grading should be used to help in the selection among euploid blastocysts. [ABSTRACT FROM AUTHOR]

Human cleavage-stage embryos frequently acquire chromosomal aneuploidies during mitosis due to unknown mechanisms. Here, we show that S phase at the 1-cell stage shows replication fork stalling, low fork speed, and DNA synthesis extending into G2 phase. DNA damage foci consistent with collapsed replication forks, DSBs, and incomplete replication form in G2 in an ATR- and MRE11-dependent manner, followed by spontaneous chromosome breakage and segmental aneuploidies. Entry into mitosis with incomplete replication results in chromosome breakage, whole and segmental chromosome errors, micronucleation, chromosome fragmentation, and poor embryo quality. Sites of spontaneous chromosome breakage are concordant with sites of DNA synthesis in G2 phase, locating to gene-poor regions with long neural genes, which are transcriptionally silent at this stage of development. Thus, DNA replication stress in mammalian preimplantation embryos predisposes gene-poor regions to fragility, and in particular in the human embryo, to the formation of aneuploidies, impairing developmental potential., Competing Interests: Declaration of interests D.E. is a member of the Cell editorial board., (Copyright © 2022 Elsevier Inc. All rights reserved.)

This Letter describes how gold pyramidal nanoshells (nanopyramids) can be assembled into low- and high-order structures by varying the rate of solvent evaporation and surface wettability. Single-particle and individual-cluster dark field scattering spectra on isolated, dimers and trimers of nanopyramids were compared. We found that the short wavelength resonances blue-shifted as the particles assembled; the magnitude of this shift was greater for high-order structures. To test which assembled architecture supported a larger Raman-active volume, we compared their surface enhanced Raman scattering (SERS) response of the resonant Raman molecule methylene blue (λ(ex) = 633 nm). We discovered that high-order structures exhibited more Raman scattering compared to low-order assemblies. Finite-difference time-domain modeling of nanopyramid assemblies revealed that the highest electromagnetic field intensities were localized between adjacent particle faces, a result that was consistent with the SERS observations. Thus, the local spatial arrangement of the same number of nanoparticles in assembled clusters is an important design parameter for optimizing nanoparticle-based SERS sensors.