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A total of 88 Fallopian tubes from 44 patients was examined with hysterosalpingo contrast sonography (HyCoSy), hysterosalpingogram (HSG), and laparoscopic chromopertubation (LC) in order to assess their relative accuracy for measuring tubal patency. HyCoSy was done by transvaginal ultrasound and the contrast was SH U 454 (Echovist®). The flow of multiple fractions of the contrast medium through each Fallopian tube was observed in real time in appropriate imaging planes by means of a transvaginal probe. Compared with laparoscopic results, we found a sensitivity of 85.2%, a specificity of 85.2%, a positive predictive value (PPV) of 71.9%, a negative predictive value (NPV) of 92.9% and concordance (HyCoSy/LC) of 85.2%, while the corresponding values for HSG were sensitivity = 85.2%, specificity = 83.6%, PPV = 69.7%, NPV = 92.7% and concordance (HSG/LC) of 84.1%. Compared with HSG results, HyCoSy obtained a co-positivity of 66.7%, a co-negativity of 81.8% and a concordance of 76.1%. In conclusion, HyCoSy with SH U 454 proved to be a reliable and safe modality for evaluating tubal patency; it is suitable as an outpatient diagnostic procedure to be used before more invasive procedures. [ABSTRACT FROM PUBLISHER]

Accurately predicting phosphorous (P) and calcium (Ca) dietary requirements is critical for optimizing dairy cattle performance, and minimizing mineral excretions and ecosystems eutrophication. This study provides a new factorial system to determine net and dietary P and Ca requirements for maintenance and lactation, derived from a meta-regression of mineral trials involving lactating dairy cows. A comprehensive global database was constructed from 57 peer-reviewed articles of mineral balance trials, with a wide range of dietary and animal performance data. We estimated the net requirements for maintenance from the intercept of a nonlinear equation between mineral intake and the sum of total fecal and urinary excretions, which is an estimate of endogenous mineral loss. Mineral secreted in milk was used to obtain net requirements for lactation. The mineral metabolizable coefficient was quantified through observed (treatment means) mineral intake and total fecal and urinary excretions, discounting the estimated endogenous excretions from our proposed models. The nonlinear models of total fecal and urinary mineral excretion were evaluated (observed versus predicted values) using a 5-fold cross validation approach. The models to estimate the sum of endogenous fecal and urinary excretions of P (0.135±0.043 g P/kg BW0.75) and Ca (0.360±0.144 g Ca/kg BW0.75) exhibited suitable precision and accuracy; r = 0.89 and 0.79, concordance correlation coefficient = 0.85 and 0.77, and root mean square prediction error = 24.1 and 20.5% observed means, respectively. Dietary variables (forage level, fiber, starch, crude protein, and ether extract) did not affect the metabolizable coefficient (MC) of P and Ca; therefore, an overall dietary MC of P (0.69±0.01) and Ca (0.65±0.02) were proposed. Our new system estimates lower net and dietary P requirements for lactating dairy cows compared to the NASEM-2021 and NRC-2001 models, but slightly higher Ca requirements than NASEM-2021.This proposed system holds potential to reduce the use of phosphorus in diets for dairy cows, and thus to enhance economic efficiency and environmental sustainability of the dairy industry., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Oliveira, Soares. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Research Question: Should ovulation be triggered in a modified natural cycle (mNC) with recombinant human chorionic gonadotrophin (rHCG) as soon as a mean follicle diameter of 17 mm is visible, or is more flexible planning possible?, Design: This multicentre, retrospective, observational study of 3087 single frozen blastocyst transfers in mNC was carried out between January 2020 and September 2022. The inclusion criteria included endometrial thickness ≥7 mm and serum progesterone <1.5 ng/ml. The main outcome was ongoing pregnancy rate. Secondary end-points were pregnancy rate, implantation rate, clinical pregnancy rate and miscarriage rate. The mean follicle size at triggering was stratified into three groups (13.0-15.9, 16.0-18.9 and 19.0-22 mm)., Results: The baseline characteristics between the groups did not vary significantly for age, body mass index and the donor's age for egg donation. No differences were found in pregnancy rate (64.5%, 60.2% and 57.4%; P = 0.19), clinical pregnancy rate (60.5%, 52.8% and 50.6%; P = 0.10), implantation rate (62.10%, 52.9% and 51.0%; P = 0.05) or miscarriage rate (15.0%, 22.2%; and 25.0%; P = 0.11). Although ongoing pregnancy rate (54.9%, 46.8% and 43.1%; P = 0.02) varied significantly in the univariable analysis, it was no longer significant after adjustment for the use of preimplantation genetic testing for aneuploidies and egg donation., Conclusions: The findings showed rHCG could be flexibly administered with a mean follicle size between 13 and 22 mm as long as adequate endometrial characteristics are met, and serum progesterone is <1.5 ng/ml. Considering the follicular growth rate of 1-1.5 mm/day, this approach could allow a flexibility for FET scheduling of 6-7 days, simplifying mNC FET planning in clinical practice., (Copyright © 2023 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.)

Study Question: How does a natural proliferative phase (NPP) strategy for frozen embryo transfer (FET) compare with the conventional artificial (AC) and natural (NC) endometrial preparation protocols in terms of live birth rates (LBR)?, Summary Answer: This study supports the hypothesis that, just as for NC, NPP-FET may be a superior alternative to AC in terms of LBR., What Is Known Already: Although FETs are increasing worldwide, the optimal FET protocol is still largely controversial. Despite recent evidence supporting a possibly higher efficacy and safety of NC FETs, their widespread use is limited by the difficulties encountered during cycle monitoring and scheduling., Study Design, Size, Duration: In this single center retrospective cohort study, we describe the NPP-FET protocol, in which vaginal progesterone is initiated during the proliferative phase as soon as an endometrium with a thickness of at least 7 mm is identified and ovulation is ruled out, regardless of mean diameter of the dominant follicle., Participants/materials, Setting, Methods: For comparison, we considered all blastocyst stage FET cycles preformed at a private infertility center between January 2010 and June 2022, subdivided according to the following subgroups of endometrial preparation: AC, NPP, and NC. We performed multivariable generalized estimating equations regression analysis to account for the following potential confounding variables: oocyte age at retrieval, oocyte source (autologous without preimplantation genetic testing for aneuploidies (PGT-A) versus autologous with PGT-A versus donated), number of oocytes retrieved/donated, embryo developmental stage (Day 5 versus Day 6), number of embryos transferred, quality of the best embryo transferred, and year of treatment. The main outcome measure was LBR. The secondary outcomes included hCG positive, clinical pregnancy and miscarriage rates, and the following perinatal outcomes: first trimester bleeding, second/third trimester bleeding, preterm rupture of membranes, gestational diabetes, gestational hypertensive disorders (GHD), and gestational age at delivery., Main Results and the Role of Chance: A total of 5791 FET cycles were included in this analysis (2226 AC, 349 NPP, and 3216 NC). The LBR for FET was lower in the AC subgroup when compared to the NPP and NC (38.4%, 49.1%, and 45.2%, respectively; P < 0.01 AC versus NPP and AC versus NC). The rates of miscarriage were also lower in the NPP and NC subgroups when compared to AC (19.7%, 25.0%, and 34.9%, respectively; P < 0.01 NPP versus AC and NC versus AC). Considering perinatal outcomes, NPP-FET and NC were associated with a significantly lower first trimester bleeding compared to AC (17.3%, 14.7%, and 37.6%, respectively; P < 0.01 NPP versus AC and NC versus AC). Additionally, NC was associated with a lower rate of GHD when compared with AC (8.6% versus 14.5%, P < 0.01), while the rate following NPP-FET was 9.4%., Limitations, Reasons for Caution: This study is limited by its retrospective design. Moreover, there was also a low number of patients in the NPP subgroup, which may have led the study to be underpowered to detect clinically relevant differences between the subgroups., Wider Implications of the Findings: Our study posits that the NPP-FET protocol may be an effective and safe alternative to both NC and AC, while still allowing for enhanced practicality in patient follow-up and FET scheduling. Further investigation on NPP-FET is warranted, with prospective studies including a larger and more homogeneous subsets of patients., Study Funding/competing Interest(s): This research was supported by the IVI-RMA-Lisbon (2008-LIS-053-CG). The authors did not receive any funding for this study. The authors have no competing interests., Trial Registration Number: Not applicable., (© The Author(s) 2024. Published by Oxford University Press on behalf of European Society of Human Reproduction and Embryology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Crambe meal (CM) is a potential dietary protein source for ruminant, but its effects in diets for lactating dairy cows remains unknown. We evaluated the effects of inclusion of the low-glucosinolates (GIs) CM (450 mg GIs/kg DM) in partial total mixed ration (pTMR) on performance, efficiency of nutrient utilization, and hepatic function of crossbred Holstein × Zebu and Jersey cows. Eight crossbred Holstein × Zebu cows and four Jersey cows were blocked by breed and days in milk, and randomly assigned in a replicated 4 × 4 Latin square design, and distributed in one of four isonitrogenous TMRs (130 g CP/kg DM): 0, 45, 90, and 135 g CM/kg DM pTMR. Crambe meal was included in pTMR replacing soybean meal (SBM) and ground corn grain (GCG). The pTMRs were offered ad libitum between 7:00 a.m. and 5:00 p.m. Cows were kept on pasture of Panicum maximum cv. Mombaça (90.4 g CP/kg DM) between 6:00 p.m. and 6:30 a.m. Pasture intake was measured from external and internal fecal excretion marker. Inclusion of CM did not affect (P ≤ 0.05) the DM intakes of pTMR and pasture, apparent total-tract digestibilities of organic matter, CP and NDF, ruminal outflow microbial protein, milk yield, milk composition, urinary N excretion, milk N efficiency, and level of plasm hepatic enzymes. The effects of CM inclusion in pTMR were independent of breed. Low-glucosinolates CM can be incorporated up to 135 g/kg DM in pTMR in replacement of SBM and GCG without affecting performance, efficiency of nutrient utilization, and hepatic function of crossbred Holstein × Zebu and Jersey cows., (© 2023. The Author(s), under exclusive licence to Springer Nature B.V.)

Aim: Assess the budget impact of nationwide screening for diminished ovarian reserve (OR), via anti-Müllerian hormone (AMH) levels, to the Portugal National Health System (NHS). Patients & methods: The clinical journey was determined using literature and the family planning decision-making process/response using survey results. A panel of four local clinicians validated all assumptions/inputs. Results: Screening for OR led to an expected savings of € 9.4 million for the NHS, driven by a 24% reduction in medically assisted reproduction (MAR) use. When needed, referral for MAR was earlier and more women used first-line versus second-line techniques. The model estimated a 12% decrease in failure. Conclusion: This model shows AMH screening may allow more informed decisions, leading to a shorter fertility journey, more efficient use of treatments, and substantial cost-savings for the NHS.

Enteric methane emission is the main source of greenhouse gas contribution from dairy cattle. Therefore, it is essential to evaluate drivers and develop more accurate predictive models for such emissions. In this study, we built a large and intercontinental experimental dataset to: (1) explain the effect of enteric methane emission yield (g methane/kg diet intake) and feed conversion (kg diet intake/kg milk yield) on enteric methane emission intensity (g methane/kg milk yield); (2) develop six models for predicting enteric methane emissions (g/cow/day) using animal, diet, and dry matter intake as inputs; and to (3) compare these 6 models with 43 models from the literature. Feed conversion contributed more to enteric methane emission (EME) intensity than EME yield. Increasing the milk yield reduced EME intensity, due more to feed conversion enhancement rather than EME yield. Our models predicted methane emissions better than most external models, with the exception of only two other models which had similar adequacy. Improved productivity of dairy cows reduces emission intensity by enhancing feed conversion. Improvement in feed conversion should be prioritized for reducing methane emissions in dairy cattle systems.

Study Question: For a woman with infertility and overweight/obesity, can infertility treatment be postponed to first promote weight loss?, Summary Answer: Advice regarding a delay in IVF treatment to optimize female weight should consider female age, particularly in women over 38 years for whom only substantial weight loss in a short period of time (3 months) seems to provide any benefit., What Is Known Already: Body weight excess and advanced age are both common findings in infertile patients, creating the dilemma of whether to promote weight loss first or proceed to fertility treatment immediately. Despite their known impact on fertility, studies assessing the combined effect of female age and BMI on cumulative live birth rates (CLBRs) are still scarce and conflicting., Study Design, Size, Duration: We performed a multicentre retrospective cohort study including 14 213 patients undergoing their first IVF/ICSI cycle with autologous oocytes and subsequent embryo transfers, between January 2013 and February 2018 in 18 centres of a multinational private fertility clinic. BMI was subdivided into the following subgroups: underweight (<18.5 kg/m2), normal weight (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2), and obesity (≥30.0 kg/m2)., Participants/materials, Setting, Methods: The primary outcome was CLBR. The secondary outcome was time to pregnancy. To assess the influence of female age and BMI on CLBR, two multivariable regression models were developed with BMI being added in the models as either an ordinal categorical variable (Model 1) or a continuous variable (Model 2) using the best-fitting fractional polynomials. CLBR was estimated over 1-year periods (Model 1) and shorter timeframes of 3 months (Model 2). We then compared the predicted CLBRs according to BMI and age., Main Results and the Role of Chance: When compared to normal weight, CLBRs were lower in women who were overweight (adjusted odds ratio (aOR) 0.86, 95% CI 0.77-0.96) and obese (aOR 0.74, 95% CI 0.62-0.87). A reduction of BMI within 1 year, from obesity to overweight or overweight to normal weight would be potentially beneficial up to 35 years old, while only a substantial reduction (i.e. from obesity to normal BMI) would be potentially beneficial in women aged 36-38 years. Above 38 years of age, even considerable weight loss did not compensate for the effect of age over a 1-year span but may be beneficial in shorter time frames. In a timeframe of 3 months, there is a potential benefit in CLBR if there is a loss of 1 kg/m2 in BMI for women up to 33.25 years and 2 kg/m2 in women aged 33.50-35.50 years. Older women would require more challenging weight loss to achieve clinical benefit, specifically 3 kg/m2 in women aged 35.75-37.25 years old, 4 kg/m2 in women aged 37.50-39.00 years old, and 5 kg/m2 or more in women over 39.25 years old., Limitations, Reasons for Caution: This study is limited by its retrospective design and lower number of women in the extreme BMI categories. The actual effect of individual weight loss on patient outcomes was also not evaluated, as this was a retrospective interpatient comparison to estimate the combined effect of weight loss and ageing in a fixed period on CLBR., Wider Implications of the Findings: Our findings suggest that there is potential benefit in weight loss strategies within 1 year prior to ART, particularly in women under 35 years with BMI ≥25 kg/m2. For those over 35 years of age, weight loss should be considerable or occur in a shorter timeframe to avoid the negative effect of advancing female age on CLBR. A tailored approach for weight loss, according to age, might be the best course of action., Study Funding/competing Interest(s): No specific funding was obtained for this study. All authors have no conflicts to declare., Trial Registration Number: N/A., (© The Author(s) 2023. Published by Oxford University Press on behalf of European Society of Human Reproduction and Embryology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

The first case of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), in Brazil was diagnosed on February 26, 2020. Due to the important epidemiological impact of COVID-19, the present study aimed to analyze the specificity of IgG antibody responses to the S1, S2 and N proteins of SARS-CoV-2 in different COVID-19 clinical profiles. This study enrolled 136 individuals who were diagnosed with or without COVID-19 based on clinical findings and laboratory results and classified as asymptomatic or as having mild, moderate or severe disease. Data collection was performed through a semistructured questionnaire to obtain demographic information and main clinical manifestations. IgG antibody responses to the S1 and S2 subunits of the spike (S) protein and the nucleocapsid (N) protein were evaluated using an enzyme-linked immunosorbent assay (ELISA) according to the manufacturer's instructions. The results showed that among the participants, 87.5% (119/136) exhibited IgG responses to the S1 subunit and 88.25% (120/136) to N. Conversely, only 14.44% of the subjects (21/136) displayed S2 subunit responses. When analyzing the IgG antibody response while considering the different proteins of the virus, patients with severe disease had significantly higher antibody responses to N and S1 than asymptomatic individuals ( p ≤ 0.0001), whereas most of the participants had low antibody titers against the S2 subunit. In addition, individuals with long COVID-19 showed a greater IgG response profile than those with symptomatology of a short duration. Based on the results of this study, it is concluded that levels of IgG antibodies may be related to the clinical evolution of COVID-19, with high levels of IgG antibodies against S1 and N in severe cases and in individuals with long COVID-19.

Extracellular vesicles (EVs) are membrane-delimited vesicular bodies carrying different molecules, classified according to their size, density, cargo, and origin. Research on this topic has been actively growing through the years, as EVs are associated with critical pathological processes such as neurodegenerative diseases and cancer. Despite that, studies exploring the physiological functions of EVs are sparse, with particular emphasis on their role in organismal development, initial cell differentiation, and morphogenesis. In this review, we explore the topic of EVs from a developmental perspective, discussing their role in the earliest cell-fate decisions and neural tissue morphogenesis. We focus on the function of EVs through development to highlight possible conserved or novel processes that can impact disease progression. Specifically, we take advantage of what was learned about their role in development so far to discuss EVs impact on glioblastoma, a particular brain tumor of stem-cell origin and poor prognosis, and how their function can be hijacked to improve current therapies., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Study Question: Do children born after vitrified-thawed embryo transfers (ETs) using donated oocytes have worse perinatal outcomes when compared with fresh ET?, Summary Answer: No significant difference in birthweight and prematurity rates between fresh or frozen embryo transfers (FETs) in newborns after oocyte donation was found., What Is Known Already: Autologous singletons born after fresh ET have been previously associated with higher rates of preterm birth and low birthweight, while FETs seem to confer a higher risk of hypertensive disorders during pregnancy and macrosomia. However, studies comparing these outcomes using autologous oocytes are unable to adequately disentangle the putative detrimental consequences of embryo vitrification from the possible effects that ovarian stimulation and endometrial preparation may have on endometrial receptivity prior to ET. The oocyte donation model is, for this reason, a more appropriate setting to study these hypotheses; however so far, the information available regarding neonatal outcomes in this patient population is limited to either small and/or heterogeneous studies., Study Design, Size, Duration: We performed a multicentre retrospective cohort study including 5848 singletons born between 2009 and February 2020 following oocyte donation and single blastocyst transfer, subdivided according to whether a fresh ET or FET was performed. We also performed two additional sensitivity analyses, subgrouping the sample according to the type of endometrial preparation (natural versus artificial) and whether the donated oocytes had previously been vitrified or not., Participants/materials, Setting, Methods: Patients with a first singleton livebirth after single blastocyst transfer were compared using multivariable regression analysis to account for potential confounding factors. The primary outcome was birthweight. Secondary outcomes were birthweight z-scores and percentiles, small/large for gestational age, gestational age at delivery, gender, prematurity (<37 weeks and <32 weeks), neonatal morbidity (Apgar scores and need for neonatal intensive care) and maternal morbidity (gestational hypertensive disorders, gestational diabetes and caesarean delivery)., Main Results and the Role of Chance: There was no significant difference between the fresh ET and FET groups in terms of mean birthweight (3215 g versus 3200 g) and birthweight z-scores (0.03 versus 0.1), in both the unadjusted and confounder-adjusted models. However, artificial endometrial preparation was associated with a higher birthweight (3220 g versus 3105 g) and birthweight z-scores (0.06 versus -0.13) when compared with a transfer in a natural cycle. Although a 1-day statistically significant difference in gestational age at birth (275 versus 274 days) was detected, premature birth rates (<37 weeks) did not vary significantly between groups (9.9% and 11.2% for fresh ET and FET, respectively). No other statistically significant differences were found in the remaining neonatal and maternal outcomes studies between the fresh ET and FET groups., Limitations, Reasons for Caution: This study is limited by its retrospective design and lack of information regarding congenital malformations. Moreover, the sample selection criteria that were used may limit the generalizability of our results., Wider Implications of the Findings: Perinatal outcomes did not seem to be affected significantly by the embryo vitrification process in an oocyte donation model. Hence, other factors may contribute to the hindered perinatal outcomes described in ART, particularly the potential effect that ovarian stimulation and endometrial preparation may have on endometrial receptivity., Study Funding/competing Interest(s): No specific funding was obtained for this study. All authors have no conflicts to declare., Trial Registration Number: N/A., (© The Author(s) 2022. Published by Oxford University Press on behalf of European Society of Human Reproduction and Embryology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Non-canonical secretion pathways, collectively known as unconventional protein secretion (UPS), are alternative secretory mechanisms usually associated with stress-inducing conditions. UPS allows proteins that lack a signal peptide to be secreted, avoiding the conventional endoplasmic reticulum-Golgi complex secretory pathway. Molecules that generally rely on the canonical pathway to be secreted may also use the Golgi bypass, one of the unconventional routes, to reach the extracellular space. UPS studies have been increasingly growing in the literature, including its implication in the biology of several diseases. Intercellular communication between brain tumor cells and the tumor microenvironment is orchestrated by various molecules, including canonical and non-canonical secreted proteins that modulate tumor growth, proliferation, and invasion. Adult brain tumors such as gliomas, which are aggressive and fatal cancers with a dismal prognosis, could exploit UPS mechanisms to communicate with their microenvironment. Herein, we provide functional insights into the UPS machinery in the context of tumor biology, with a particular focus on the secreted proteins by alternative routes as key regulators in the maintenance of brain tumors., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer (LA) declared a shared affiliation, with no collaboration, with the authors (RI, MP, RA, ME, JB, GC, CF, AF, JA, SS, MS, and ML) to the handling editor at the time of the review., (Copyright © 2022 Iglesia, Prado, Alves, Escobar, Fernandes, Fortes, Souza, Boccacino, Cangiano, Soares, Araújo, Tiek, Goenka, Song, Keady, Hu, Cheng and Lopes.)

Research Question: Does late-follicular phase progesterone elevation have a deleterious effect on embryo euploidy, blastocyst formation rate and cumulative live birth rates (CLBR)?, Design: A multicentre retrospective cross-sectional study including infertile patients aged 18-40 years who underwent ovarian stimulation in a gonadotrophin-releasing hormone antagonist protocol and preimplantation genetic testing for aneuploidies (PGT-A) followed by a freeze-all strategy and euploid embryo transfer between August 2017 and December 2019. The sample was stratified according to the progesterone concentrations on the day of trigger: normal (≤1.50 ng/ml) and high (>1.50 ng/ml). Moreover, sensitivity analyses were performed to determine whether different conclusions would have been drawn if different cut-offs had been adopted. The primary outcome was the embryo euploidy rate. Secondary outcomes were the blastocyst formation rate, the number of euploid blastocysts and CLBR., Results: Overall 1495 intracytoplasmic sperm injection PGT-A cycles were analysed. Late-follicular phase progesterone elevation was associated with significantly higher late-follicular oestradiol concentrations (2847.56 ± 1091.10 versus 2240.94 ± 996.37 pg/ml, P < 0.001) and significantly more oocytes retrieved (17.67 ± 8.86 versus 12.70 ± 7.00, P < 0.001). The number of euploid embryos was significantly higher in the progesterone elevation group (2.32 ± 1.74 versus 1.86 ± 1.42, P = 0.001), whereas the blastocyst formation rate (47.1% [43.7-50.5%] versus 51.0% [49.7-52.4%]), the embryo euploidy rate (48.3% [44.9-51.7%] versus 49.1% [47.7-50.6%], the live birth rate in the first frozen embryo transfer (34.1% versus 31.1%, P = 0.427) and CLBR (38.9% versus 37.0%, P = 0.637) were not significantly different between the two groups., Conclusions: Euploidy rate and CLBR do not significantly differ among PGT-A cycles with and without late-follicular progesterone elevation in a freeze-all approach., (Copyright © 2021. Published by Elsevier Ltd.)

The intensification of milk production in Brazil in the past decade has imposed great stress on the environment. Therefore, it is very important to find a balance between economic, social, and environmental objectives. The paper assesses the economic costs by production systems: confined feedlot, semi-confined feedlot, and pasture in the south of the country. The economic assessment was realized on some investment analysis tools and the GHG emissions costs for the different production systems indicated. Our results show that hectare and the total area of rural properties were lower in the confined feedlot system, followed by the semi-confined feedlot system and pasture-based grazing system. However, the reduction of the need for feed inputs in the pasture system resulted in lower feeding costs when compared to the other systems. The hectare analysis suggested that the superior productivity of the semi-confined system conditioned higher emission costs in relation to the other systems. However, considered the total emissions of the systems, the pasture system obtained higher values, justified by the greater need for an area for production. The results showed that the higher the food efficiency of a system, the greater the profitability., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Objective: Present a treatment protocol to avoid biofilm reformation in hard-to-heal wounds, using a hydrofiber dressing with 1.2% ionic silver, ethylenediaminetetraacetic acid and benzethonium chloride., Method: A retrospective, descriptive and analytic study on the use of a treatment protocol, including three case studies. Patient records for hard-to-heal wounds were analysed according to an algorithm for biofilm detection and best-practice recommendations for wound hygiene., Results: The adopted protocol was based on three pillars: identifying clinical signs suggesting biofilm, performing wound hygiene, and applying an antibiofilm dressing., Conclusion: Wound healing rates can improve after protocol implementation. Adequate control of local signs of infection and exudate, as well as visual and indirect signs of biofilm, were achieved. All patients progressed well towards wound-size reduction and closure using the hydrofiber dressing.

The search for sustainability has pointed to the need to transition from a linear to a circular model. However, such a transition is not trivial. Modifying production chains with the focus on reducing virgin raw materials consumption, cut emissions, and prevent waste generation implies implementing new processes and services, which can add considerable environmental impacts to the supply chain. This paper analyzes a real case from a production system aligned with circular economy principles. The production system consists of the manufacturing of baseboards made of recycled Expanded Polystyrene (EPS), obtained from an extensive reverse logistics system composed of different recycling processes. The system's potential environmental impacts were assessed by two widely used methodologies, Life Cycle Assessment (LCA) and Emergy Analysis (EMA). For comparison purposes, the analysis was carried out for a fictional linear production system, in which the baseboard would be made of virgin EPS. EMA attributed a lower emergy load to the circular scenario compared to the linear scenario (8.62E+15 seJ to recycled EPS versus 1.26E+16 seJ to virgin EPS). LCA results indicate both scenarios as environmental preferable depending on the impact category under analysis (e.g. circular system has better performance regarding global warming, while the linear scenario demonstrated better results under water consumption). For the circular scenario, EMA identified the main impact drivers, such as transportation and electricity consumption. From LCA perspective impacts are also driven by electricity consumption. However, differently from EMA, logistics were only significant for Land Use impact category whereas Liquefied Petroleum Gas consumption and, landfill air emissions were identified as impact hotspots. These convergences and differences between the findings of LCA and EMA have demonstrated potentially complementation to broaden available information related to systems, enabling decision makers to act effectively in improving the environmental performance of their production processes, especially when implementing circular practices., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Study Question: Are there differences in the clinical outcomes of IUI among different populational groups (heterosexual couples, single women and lesbian couples)?, Summary Answer: The outcome of donor IUI (D-IUI) is similar in all populational groups and better than that seen with autologous insemination., What Is Known Already: A vast body of literature on clinical outcome is available for counselling heterosexual couples regarding decisions related to ART. The reproductive potential of single women, lesbian couples and heterosexual couples who need donor semen is assumed to be better, but there is a scarcity of data on their ART performance to actually confirm it., Study Design, Size, Duration: In this retrospective multicentric cohort study, a total of 7228 IUI treatment cycles performed in 3807 patients between January 2013 and December 2016 in 13 private clinics belonging to the same reproductive medicine group in Spain were included. Patients with previous IUI attempts were excluded from the study. Only 1.9% of cycles were lost to follow-up., Participants/materials, Setting, Methods: A total of 5318 D-IUI cycles were performed in three different populational groups: heterosexual couples (D-HC, 1167 cycles), single women (SW, 2839 cycles) and lesbian couples (LC, 1312), while a total of 1910 autologous IUI cycles were performed in heterosexual couples (A-HC). This last one was considered the control group and was composed of cycles performed in couples with a male partner with sperm parameters equivalent to those requested from donors. In order to identify factors with an impact on clinical outcome, a multivariate logistic regression analysis was performed. Regarding live birth rate (LBR), mixed effect models were employed to control for the fact that different patients were submitted to different numbers of treatments., Main Results and the Role of Chance: Parameters that were significant to the primary outcome (LBR) according to the multivariate analysis were the populational group (D-HC, SW, LC and A-HC) to which the patient belonged, female age and a diagnosis of low ovarian reserve. At the age range of good prognosis (≤37 years), LBR was similar in all groups that underwent D-IUI (18.8% for D-HC, 16.5% for SW and 17.6% for LC) but was significantly lower in the autologous IUI (A-HC) group (11%). For all these significant findings, the strength of the association was confirmed by P values <0.001. From 38 years of age on, no significant differences were observed among the populational groups studied, and for all of them, LBR was below 7% from 40 years of age on., Limitations, Reasons for Caution: To the best of our knowledge, a smoking habit was the only known factor with a potential effect on ART outcome that could not be controlled for, due to the unavailability of this information in a significant percentage of the clinical files studied. Our study was not capable of precisely quantifying the impact of a diagnosis of low ovarian reserve on the LBR of both IUI and D-IUI, due to the number of cycles performed in patients with such diagnosis (n = 231, 3.2% of the total)., Wider Implications of the Findings: For the first time, a comparison among D-HC, SW, LC and A-HC was performed in a study with a robust sample size and controlling for potential sources of bias. There is now sound evidence that equivalent clinical outcome is seen in the three groups treated with donor semen (D-HC, SW and LC). Specifically, regarding the comparison between SW and LC, our findings rule out differences in LBR proposed by previous publications, with very similar clinical outcomes within the same age ranges. At age ranges of good prognosis (≤37 years), reproductive performance of D-IUI is significantly better than that seen in heterosexual couples undergoing autologous IUI, even when only cases of optimal sperm quality are considered in this last group. This finding is in agreement with the concept that, as a group, A-HC are more prone to have female factor infertility, even when their infertility assessment finds no contraindication to IUI. Age affects all these groups equally, with none of them reaching a 7% LBR after the age of 40 years. Our findings will be useful for the counselling of patients from the different populations studied here about ART strategies., Study Funding/competing Interest(s): None., (© The Author(s) 2019. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For permissions, please e-mail: journals.permission@oup.com.)

Background: Time-lapse monitoring (TLM) technology has been implemented in the clinical setting for the culture and selection of human embryos. Many studies have assessed the association between sperm DNA fragmentation (sDNAf) and clinical outcomes after ART, but little is known about the influence of sDNA on embryo morphokinetics., Objectives: The objective of this retrospective study, which includes 971 embryos from 135 consecutive ICSI cycles (56 cases with own oocytes, 79 with oocytes from young and healthy donors), was to assess if sDNAf has an impact on embryo morphokinetics., Materials and Methods: Samples used to perform ICSI were analyzed by the flow cytometry TUNEL assay, and embryo development was assessed through an EmbyoScope ® system. The association between sDNAf and the timings of cell cleavage was analyzed by categorizing the first variable into quartiles: ≤6.50%; 6.51-10.70%; 10.71-20.15%; >20.15%., Results: In cases where sDNAf was above 20.15% (the upper quartile), embryos derived from donated oocytes (n = 644) showed significantly slower divisions. Such association was not observed in embryos obtained from the patients' own oocytes (n = 327). The embryo cleavage pattern (either normal, direct from 1 to 3 blastomeres, direct from 1 to 4 blastomeres, incomplete, reversed or asynchronous) was independent of the sDNAf level. Blastocyst arrival rate was 63.0% and the rate of good quality embryos (transferred and frozen embryos divided by the number of zygotes) was 45.49%. Neither parameter was related to the levels of sDNAf., Discussion: According to our results, the association between high sDNAf and donated oocytes led to delayed cell division. To our knowledge, this is the first study suggesting that sDNAf can delay human embryo cleavage timings when oocytes from donors are inseminated., Conclusions: This finding may indicate that, in the presence of increased DNA damage, time is needed before the first embryonic cell division for the activation of the optimal DNA repairing machinery in higher quality oocytes., (© 2018 American Society of Andrology and European Academy of Andrology.)

Antiparasitic photodynamic therapy (ApPDT) is an emerging approach to manage cutaneous leishmaniasis (CL) since no side effects, contraindications and parasite resistance have been reported. In addition, methylene blue (MB) is a suitable photosensitizer to mediate ApPDT on CL. In this study we aimed to look for the best parameters to eradicate Leishmania amazonensis and investigated the cell death pathways involved in MB-mediated ApPDT. MB uptake by parasites was determined using different MB concentrations (50, 100, 250 and 500 μM) and incubation times (10, 30 and 60 min). L. amazonensis promastigotes were cultured and submitted to ApPDT using different concentrations of MB (50, 100 and 250 μM) combined to a red LED emitting at 645 ± 10 nm. The pre-irradiation time was 10 min. Two optical powers (100 mW and 250 mW) were tested and cells were exposed to 60 and 300 s of MB-mediated ApPDT delivering energies of 6, 15, 30 and 75 J and fluences of 21.2, 53.1, 106.2 and 265.4 J/cm 2 , respectively. Following ApPDT, cells were prepared for flow cytometry and transmission electron microscopy to unravel the mechanisms of cell death. Our results showed the lowest MB concentration (50 μM) and the lowest optical power (100 mW) promoted the highest percentage of cell decrease. ApPDT caused alterations on cell membrane permeability as well depolarization of mitochondrial membrane potential. We also observed ultrastructural changes of the parasites such as cell shrinkage, intense vacuolization of the cytoplasm, enlargement of mitochondrion-kinetoplast complex, and small blebs on parasite flagella and cell membrane after MB-mediated ApPDT. Taken together, our findings ratify that ApPDT parameters play a pivotal role in cell susceptibility and suggest that apoptosis is involved in parasite death regardless MB-mediated ApPDT protocol., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Isotretinoin (13-cis-retinoic acid) is a pharmaceutical vitamin A analog that is frequently used in the treatment of severe cystic acne, many women at reproductive age being exposed to this substance. This drug has a clearly documented teratogenicity and data from rodents and humans indicate that a direct aggression to ovarian follicles also occurs. Here we report the case of a 29-year-old woman with breast cancer referred for emergency preservation of reproductive potential that used isotretinoin up to the day before the initiation of ovarian stimulation. Ultrasound scan showed an antral follicle count of 17 and 13 follicles on the right and the left ovary, respectively, and her antimüllerian hormone levels were 4.03 ng/ml. Standard ovarian stimulation for oocyte vitrification in oncological patients was initiated during the luteal phase and final estradiol levels were 49 pg/ml. Three mature oocytes were obtained. Other four oocytes were retrieved in the germinal vesicle and metaphase I developmental stage, all of which matured in vitro in the following 30 h and were also vitrified. Response to ovarian stimulation, both in terms of the number of mature oocytes obtained and serum sex steroids production were in the lower range of what is observed in patients with a similar clinical profile. These findings suggest that isotretinoin impairs follicular-oocyte maturation.

Colloidal super-paramagnetic microbeads conjugated with annexin V are effective for separating apoptotic spermatozoa by MACS as a result of the high affinity of annexin V for externalized PS molecules. The effectiveness of the procedure in reducing the percentage of sperm with fragmented DNA and abnormal morphology has also been reported. However, it is still unknown if it could decrease the percentage of aneuploid spermatozoa. The objective of our prospective study, performed on 16 males with abnormal FISH on spermatozoa, was to assess if MACS columns were useful tools to retain spermatozoa carrying chromosomal abnormalities in semen samples processed after density gradient centrifugation (DGC). The pellet obtained after DGC was subjected to MACS, and sperm FISH analyses were performed both in the eluded fraction and in the fraction retained in the column. The observed frequencies of disomy and nullisomy 13, 18, and 21, X and Y, as well as the diploidy rates in the MACS eluded fraction and the fraction retained in the MACS column were recorded. We observed that the frequencies of aneuploidies in the eluded fraction were lower than in the fraction retained in the MACS column (0.59% vs. 0.75%; p = 0.010). DGC determined a significant reduction in sperm concentration (z-ratio = 2.83; p = 0.005) and a significant increase in sperm progressive motility (z-ratio = -3.5; p < 0.001). MACS also led to a significant reduction in sperm concentration (z-ratio = 3.14; p = 0.002) and a significant increase in progressive motility (z-ratio = -2.59; p = 0.01) when compared with the post-DGC sample. Sperm concentration was similar in the two fractions generated by MACS (z-ratio = 0.63; p = 0.52), while progressive motility was significantly higher in the MACS eluded fraction (z-ratio = 2.42; p = 0.02). According to our results, MACS columns are able to selectively retain spermatozoa carrying chromosomal abnormalities. Furthermore, the performance of DGC and MACS on semen samples leads to an enrichment of progressive motility., (© 2017 American Society of Andrology and European Academy of Andrology.)

Because the consumption of materials is generally higher than their recovery rate, improving municipal solid waste (MSW) management is fundamental for increasing the efficiency of natural resource use and consumption in urban areas. More broadly, the characteristics of a MSW management system influence the end-of-life (EOL) impacts of goods consumed by households. We aim to indicate the extent to which greenhouse gas emissions from a MSW management system can be reduced by increasing waste paper recycling. We also address the stakeholders' contribution for driving transition towards an improved scenario. Life cycle assessment (LCA) addresses the EOL impacts of the paper industry, driven by the characteristics of MSW management in Florianópolis, Brazil, by varying the level of stakeholders' commitment through different recycling scenarios. The results show that 41% of the climate change impacts from waste paper management could be reduced when increasing the waste paper recycling rates and reducing waste paper landfilling. To achieve such emissions reduction, the industry contribution to the MSW management system would have to increase from 17% in the business-as-usual scenario to 74% in the target scenario. We were able to measure the differences in stakeholders' contribution by modelling the MSW management system processes that are under the industry's responsibility separately from the processes that are under the government's responsibility, based on the Brazilian legal framework. The conclusions indicate that LCA can be used to support policy directions on reducing the impacts of MSW management by increasing resource recovery towards a circular economy.

Ferreira, DV, Ferreira-Júnior, JB, Soares, SRS, Cadore, EL, Izquierdo, M, Brown, LE, and Bottaro, M. Chest press exercises with different stability requirements result in similar muscle damage recovery in resistance trained men. J Strength Cond Res 31(1): 71-79, 2017-This study investigated the time course of 96 hours of muscle recovery after 3 different chest press exercises with different stability requirements in resistance-trained men. Twenty-seven men (23.5 ± 3.8 years) were randomly assigned to one of the 3 groups: (a) Smith machine bench press; (b) barbell bench press; or (c) dumbbell bench press. Participants performed 8 sets of 10 repetition maximum with 2 minutes rest between sets. Muscle thickness, peak torque (PT), and soreness were measured pre, post, 24, 48, 72, and 96 hours after exercise. There were no differences in the time course of PT or muscle thickness values of the pectoralis major (p = 0.98 and p = 0.91, respectively) or elbow extensors (p = 0.07 and p = 0.86, respectively) between groups. Muscle soreness of the pectoralis major was also not different between groups (p > 0.05). However, the Smith machine and barbell groups recovered from triceps brachii muscle soreness by 72 hours after exercise (p > 0.05), whereas the dumbbell group did not present any triceps brachii muscle soreness after exercise (p > 0.05). In conclusion, resistance-trained men experience similar muscle damage recovery after Smith machine, barbell, and dumbbell chest press exercise. However, muscle soreness of the elbow extensors takes a longer time to recover after using a barbell chest press exercise.

Leishmaniasis is an overlooked tropical disease affecting approximately 1 million people in several countries. Clinical manifestation depends on the interaction between Leishmania and the host's immune response. Currently available treatment options for leishmaniasis are limited and induce severe side effects. In this research, we tested nitro-heterocyclic compounds (BSF series) as a new alternative against Leishmania. Its activity was measured in Leishmania (Leishmania) infantum promastigotes and intracellular amastigotes using MTT colorimetric assay. Additionally, we assessed the phosphatidylserine exposure by promastigotes, measured by flow cytometry, as well as nitric oxide production, measured by Griess' method. The nitro-heterocyclic compounds (BSF series) showed activity against L. (L.) infantum promastigotes, inducting the phosphatidylserine exposition by promastigotes, decreasing intracellular amastigotes and increasing oxide nitric production. The selectivity index was more prominent to Leishmania than to macrophages. Compared to amphotericin b, our compounds presented higher IC50, however the selectivity index was more specific to parasite than to amphotericin b. In conclusion, these nitro-heterocyclic compounds showed to be promising as an anti-Leishmania drug, in in vitro studies., (Copyright © 2016 Elsevier Inc. All rights reserved.)

It has been reported that periodic resistance training (retraining after short-term detraining) could maintain muscle performance. However, the training volume used in previous studies differed between continuous and periodic training groups. This study compared strength gains following 20 sessions of continuous and periodic resistance training programs. 60 healthy, detrained women were randomly assigned into one of two groups: (1) continuous resistance training group or (2) retraining resistance group. The continuous resistance training group performed a non-interrupted resistance training program for 10 wk., while the retraining resistance group trained for 5 wk., detrained 2 wk., and resumed training for 5 wk. All participants performed three sets of 8-12 maximum repetitions of lower- and upper-body exercises two days per week, with at least 48 hr. between sessions. There was no significant difference on knee extensors and elbow flexors peak torque gain between the continuous resistance training group and the retraining resistance group. The results suggest that 2 wk. of detraining does not affect strength gains after a total of 10 wk. in detrained women.

Background: HIV infected women have higher rates of infertility. Objective. The purpose of this literature review is to evaluate the effectiveness of fresh IVF/ICSI cycles in HIV infected women., Materials and Methods: A search of the PubMed database was performed to identify studies assessing fresh nondonor oocyte IVF/ICSI cycle outcomes of serodiscordant couples with an HIV infected female partner., Results and Discussion: Ten studies met the inclusion criteria. Whenever a comparison with a control group was available, with the exception of one case, ovarian stimulation cancelation rate was higher and pregnancy rate (PR) was lower in HIV infected women. However, statistically significant differences in both rates were only seen in one and two studies, respectively. A number of noncontrolled sources of bias for IVF outcome were identified. This fact, added to the small size of samples studied and heterogeneity in study design and methodology, still hampers the performance of a meta-analysis on the issue. Conclusion. Prospective matched case-control studies are necessary for the understanding of the specific effects of HIV infection on ovarian response and ART outcome.

It has been demonstrated that body cooling may decrease neuromuscular performance. However, the effect of a single session of whole body cryotherapy (-110°C) on neuromuscular performance has not been well documented. Thus, the aim of this study was to evaluate the effects of a single exposure of WBC on elbow flexor neuromuscular performance. Thirteen physically active, healthy young men (age=27.9±4.2 years, mass=79.4±9.7 kg, height=176.7±5.2 cm) were randomly exposed to 2 different experimental conditions separated by a minimum of 72 h: 1) whole body cryotherapy- 3 min at -110°C; 2) control- 3 min at 21°C. All subjects were tested for maximal isokinetic elbow flexion at 60°.s(-1) 30 min before and 10 min after each condition. There were no significant differences in peak torque, average power, total work or muscle activity between conditions. Peak torque was lower at post-test compared to pre-test in both conditions (F=6.58, p=0.025). However, there were no differences between pre-test and post-test for any other variables. These results indicate that strength specialists, athletic trainers and physical therapists might utilize whole body cryotherapy before training or rehabilitation without compromising neuromuscular performance of the elbow flexors., (© Georg Thieme Verlag KG Stuttgart · New York.)

The aim of this study was to evaluate the effects of a single partial-body cryotherapy bout between training sessions on strength recovery. 12 young men (23.9±5.9 years) were randomly exposed to 2 different conditions separated by 7 days: 1) Partial-body cryotherapy (subjects were exposed to 3 min of partial-body cryotherapy at - 110 °C between 2 high-intensity training sessions); 2) Control (subjects were not exposed to partial-body cryotherapy between 2 high-intensity training sessions). Subjects were exposed to partial-body cryotherapy after the first training session. The 2 knee extension high-intensity training sessions were separated by a 40-min rest interval. Knee extension training consisted of 6 sets of 10 repetitions at 60°.s(-1) for concentric actions and 6 sets of 10 at 180.s(-1) for eccentric actions. The decrease in eccentric peak torque and total work was significantly (p<0.05) less after partial-body cryotherapy (5.6 and 2%, respectively) when compared to control (16 and 11.6%, respectively). However, the decrease in concentric peak torque and total work was not different (p>0.05) between partial-body cryotherapy (9.4 and 6.5%, respectively) and control (7.5 and 5.2%, respectively). These results indicate that the use of partial-body cryotherapy between-training sessions can enhance eccentric muscle performance recovery., (© Georg Thieme Verlag KG Stuttgart · New York.)

This study compared the environmental burdens of two broiler chicken production systems in Brazil and two in France. One Brazilian system represents large-scale production in the Center-West region of the country; the other is a small-scale production in the South. One of the French systems represents an extensive broiler chicken production system, known as "Label Rouge"; the other is a standard system. Life-cycle impact assessments were performed using the CML-IA characterization method. The main functional unit adopted was 1 tonne of cooled and packaged chicken, ready for distribution. For the systems and impacts studied, production scale did not affect the environmental impact, but production intensity did. The extensive Label Rouge system had the largest impact among the impact categories studied. This resulted principally from the high feed-conversion ratio of this production system (3.1 kg of feed per kg of live weight) in conjunction with the fact that the feed-production stage contributed most to the overall impact. The contribution of deforestation to the crop-production stage was significant, particularly for climate change, equaling 19% of total emissions of CO2eq per tonne of cooled and packaged chicken, in the system of the Center-West of Brazil. The French systems were also affected, since they import crops from Brazil. The system of southern Brazil had less climate change impact because there is no longer deforestation in southern Brazil for crop production., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

The aim of this study was to examine the effect of adding single-joint (SJ) exercises to a multi-joint (MJ) exercise resistance-training program on upper body muscle size and strength. Twenty-nine untrained young men participated in a 10-week training session. They were randomly divided in 2 groups: the MJ group performed only MJ exercises (lat pulldown and bench press); the MJ+SJ group performed the same MJ exercises plus SJ exercises (lat pulldown, bench press, elbow flexion, and elbow extension). Before and after the training period, the muscle thickness (MT) of the elbow flexors was measured with ultrasound, and peak torque (PT) was measured with an isokinetic dynamometer. There was a significant (p < 0.05) increase in MT (6.5% for MJ and 7.04% for MJ+SJ) and PT (10.40% for MJ and 12.85% for MJ+SJ) in both groups, but there were no between-group differences. Therefore, this study showed that the inclusion of SJ exercises in a MJ exercise training program resulted in no additional benefits in terms of muscle size or strength gains in untrained young men.

The establishment of rules to manage Health Care Waste (HCW) is a challenge for the public sector. Regulatory agencies must ensure the safety of waste management alternatives for two very different profiles of generators: (1) hospitals, which concentrate the production of HCW and (2) small establishments, such as clinics, pharmacies and other sources, that generate dispersed quantities of HCW and are scattered throughout the city. To assist in developing sector regulations for the small generators, we evaluated three management scenarios using decision-making tools. They consisted of a disinfection technique (microwave, autoclave and lime) followed by landfilling, where transportation was also included. The microwave, autoclave and lime techniques were tested at the laboratory to establish the operating parameters to ensure their efficiency in disinfection. Using a life cycle assessment (LCA) and cost analysis, the decision-making tools aimed to determine the technique with the best environmental performance. This consisted of evaluating the eco-efficiency of each scenario. Based on the life cycle assessment, microwaving had the lowest environmental impact (12.64 Pt) followed by autoclaving (48.46 Pt). The cost analyses indicated values of US$0.12 kg(-1) for the waste treated with microwaves, US$1.10 kg(-1) for the waste treated by the autoclave and US$1.53 kg(-1) for the waste treated with lime. The microwave disinfection presented the best eco-efficiency performance among those studied and provided a feasible alternative to subsidize the formulation of the policy for small generators of HCW., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Oysters represent a substantial fraction of the world's overall intensive aquaculture production. In Brazil, oyster aquaculture is still in the deployment phase but has the potential for growth and, likewise other aquaculture products, generate environmental impacts over their life cycle. Special attention should be devoted to the disposal or processing of the oyster shells, whose high calcium carbonate content (80-95%) gives them the potential for use as raw material for several other products. The objective of this study was to conduct a cradle-to-grave Life Cycle Assessment (LCA) of 1 kg of oysters produced in southern Brazil, incorporating the recycling of the oyster shells on the LCA. Two scenarios were considered. The first scenario (termed scenario A) assumed that the oyster shells were deposited in a landfill, whereas the second scenario (scenario B) assumed that the shells were processed to make them available as raw material as a source of CaCO(3). We used Eco-indicator 99 H/A to perform the impact assessment. Scenario A had an overall impact of 93.71 mPt, whereas scenario B had an overall impact of 58.97 mPt. The latter scenario had lower environmental impacts, however they were depended strongly on the distance between the source of the shells (restaurant) and the shell-processing facility. This distance must not be greater than 323 km to yield overall environmental benefits. Moreover, it is hypothesized that the environmental benefits would be even higher than predicted because there is no evidence that all post-consumer shell residues would receive proper waste management, as assumed for scenario A (landfill)., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Vascular endothelial growth factor is the factor that causes increased capillary permeability and therefore the most serious manifestations of ovarian hyperstimulation syndrome. Dopamine agonists can both prevent and treat ovarian hyperstimulation syndrome by blocking expression of the vascular endothelial growth factor receptor., (Copyright © 2012 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Ovarian hyperstimulation syndrome (OHSS) occurs when ovaries primed with follicle-stimulating hormone/leuteinizing hormone (LH) are subsequently exposed to human chorionic gonadotropin (hCG). The ultimate pathophysiological step underlying this clinical picture is increased vascular permeability (VP). With the administration of hCG, the expression vascular endothelial growth factor (VEGF) and VEGF receptor 2 (VEGFR-2) mRNA increases significantly rising to a maximum coinciding with peaked VP. Immunohistochemistry shows the presence of VEGF and VEGFR-2 proteins in the granulosa-lutein and endothelial cells of the entire corpus luteum. These findings suggest that the syndrome can be prevented by inducing ovulation with LH or gonadotropin-releasing hormone analogs, which prevent VEGF overexpression. Also, coadministration of a dopamine agonist inhibits phosphorylation of the receptor VEGFR-2. In a trial of 69 oocyte donors, the incidence of moderate OHSS was 20% with the dopamine agonist cabergoline and 44% with a placebo ( P = 0.04). Another dopamine agonist, quinagolide, was also effective in nonpregnant patients, but those pregnant did not benefit from dopamine agonist administration. In conclusion, the pathophysiological mechanisms involved in OHSS show that targeting VEGF/VEGFR2 is an effective preventive approach to treat the syndrome. Pharmaco-prevention through dopamine agonists is effective only in nonpregnant high-risk OHSS women. Embryo cryopreservation plus dopamine agonist administration might be the most appropriate way to prevent OHSS in high-risk patients., (© Thieme Medical Publishers.)

Soybean production and its supply chain are highly dependent on inputs such as land, fertilizer, fuel, machines, pesticides and electricity. The expansion of this crop in Brazil in recent decades has generated concerns about its environmental impacts. To assess these impacts, two representative chains supplying soybeans to Europe were identified: Center West (CW) and Southern (SO) Brazil. Each supply chain was analyzed using Life Cycle Assessment methodology. We considered different levels of use of chemical and organic fertilizers, pesticides and machinery, different distances for transportation of inputs and different yield levels. Because transportation contributed strongly to environmental impacts, a detailed study was performed to identify the routes used to transport soybeans to seaports. Additionally, we considered different levels of land occupation and land transformation to represent the impact of deforestation in the CW region. Environmental impacts were calculated for 1000 kg of soybean up to and including the delivery to Europe at the seaport in Rotterdam, at 13% humidity. Overall results showed that the impacts are greater for CW than for SO for all impact categories studied, including acidification (7.7 and 5.3 kg SO(2) eq., respectively), climate change (959 and 510 kg CO(2) eq.), cumulative energy demand (12,634 and 6,999 MJ) and terrestrial ecotoxicity (4.9 and 3.1 kg 1,4-DCB eq.), except eutrophication and land occupation. The same trend was observed for the crop-production stage. Efforts to reduce chemical fertilizers and diesel consumption can reduce CO(2) emissions. Although deforestation for crop production has decreased in recent years, the contribution of deforestation to climate change and cumulative energy demand remains significant. In the CW scenario deforestation contributed 29% to climate change and 20% to cumulative energy demand. Results also showed that although there are different transportation options in Brazil, the current predominance of road transport causes severe environmental impacts. In CW, road transport contributed 19% to climate change and 24% to cumulative energy demand, while in SO it contributed 12% and 15% to these impacts, respectively. Improvements in the logistics of transportation, giving priority to rail and river transports over road transport, can contribute significantly to reducing greenhouse gas emissions and decreasing energy use. Future studies involving Brazilian soybeans should take into account the region of origin as different levels of environmental impact are predicted., (2010 Elsevier Ltd. All rights reserved.)

We analyzed the impact of chronic exposure to urban air pollution on the development of atherosclerosis. Hyperlipemic mice (LDLR(-/-)) were submitted to a high fat diet and air pollution for four months. We measured the susceptibility of LDL to oxidative modifications (TBARS), the presence of anti-oxLDL and an apoB-derived peptide (apoB-D) in blood and the degree of atherosclerosis in the aortic arch. Air pollution increased the susceptibility of LDL to oxidation as well as anti-oxLDL and anti-apo-B levels. These levels were even higher than in mice submitted to a high fat diet and non-polluted air. The lipid content of the atherosclerotic plaques in the aorta was increased in groups with a high cholesterol diet independently of the air quality. However, the thickness of the arterial wall was greater in mice fed a high lipid diet with polluted air. Thus, we conclude that urban air pollution exacerbates the susceptibility of LDL to oxidation, atherogenesis and vascular remodeling in hyperlipemic mice and that an immune response accompanies this process.

Objective: To demonstrate that the location of the air bubble after embryo transfer (ET) does not necessarily indicate the final embryo location., Design: Case report., Setting: Private clinic., Patient(s): A couple with primary infertility for whom a diagnosis of bicornuate uterus with a very open angle between horns was confirmed., Intervention(s): Laparoscopy and hysteroscopy were performed before an IVF cycle in which a single embryo was replaced., Main Outcome Measure(s): Air bubble image immediately after ET and gestational sac location 3 weeks later., Result(s): Immediately after a single ET, the air bubble was seen in the left uterine horn. Three weeks later, a gestational sac was seen in the right uterine horn., Conclusion(s): The location of the air bubble immediately after ET does not necessarily indicate the final embryo location.

The aim of the present cross-sectional investigation was to evaluate percentage of bone loss in patients who had been one year under periodontal maintenance at the Department of Periodontology, Faculty of Dentistry, University of São Paulo by radiographic analysis. Complete sets of periapical radiographs provided data regarding percentage of alveolar bone loss, which was correlated with arches, tooth group and proximal sites. The sample consisted of 27 men and 53 women ranging in age from 16 to 85 years (mean: 48.3 years). A total of 1,120 periapical radiographs (1,970 teeth) were digitized and analyzed with the Image Tool software (University of Texas Health Science Center). Bone loss was defined as when the distance between the cemento-enamel junction and the alveolar bone crest was greater than 2 mm. Two examiners (p<0.0001) performed radiographic measurements of bone loss. The Greenhouse-Geisser normality test and a univariate analysis of variance were used for statistical analysis. Mean bone loss was 20.60% (+/-12.12). The highest level of bone loss was observed on the distal surface and in the upper arch, as well as in the upper incisors and molars.

Background: Ovarian hyperstimulation syndrome (OHSS) typically occurs when ovaries are primed with FSH/LH and subsequently exposed to hCG. The ultimate pathophysiological step underlying this clinical picture is increased vascular permeability (VP)., Methods: A search of the literature was carried out using PubMed and the authors' files., Results: In rodents and humans, the expression of vascular endothelial growth factor (VEGF) and VEGF receptor 2 (VEGFR-2) mRNA increases during ovarian stimulation. With the administration of hCG, the expression of each rises to a maximum. Expression of VEGF/VEGFR-2 mRNAs correlates with enhanced VP, with both peaking 48 h following an injection of hCG. Immunohistochemistry shows the presence of VEGF and VEGFR-2 proteins in the granulosa-lutein and endothelial cells of the entire corpus luteum. Increased VP may be mediated through adhesion molecules such as VE-cadherin, which is involved in the loosening of endothelial intercellular junctions. These findings regarding the pathophysiology of OHSS suggest that the syndrome can be prevented by inducing ovulation with LH or GnRH analogues, which prevent VEGF overexpression. Also, co-administration of a dopamine agonist inhibits phosphorylation of the receptor VEGFR-2. In a trial of 69 oocyte donors, the incidence of moderate OHSS was 20% with the dopamine agonist cabergoline and 44% with a placebo (P = 0.04)., Conclusions: The pathophysiological mechanisms involved in OHSS suggest potential preventive approaches, but larger trials are necessary for evaluating the efficacy and safety of the pharmaco-prevention of OHSS.

Objective: To provide a summary of the actual knowledge about the clinical factors affecting the oocyte recipient (other than those associated with uterine cavity abnormalities) on the outcome of oocyte donation cycles., Design: Review of the literature., Setting: Information regarding the association between age, body mass index (BMI), endometrial priming, tobacco consumption, hydrosalpinx, and endometriosis/adenomyosis in oocyte recipients and the results of oocyte donation cycles., Result(s): Recipient age and the presence of hydrosalpinx are clearly associated with a poorer outcome in oocyte donation cycles. The negative impact of tobacco consumption has recently been confirmed. The exact relevance of an elevated BMI is under debate but it is likely that it determines a lower ongoing pregnancy rate (PR). Endometriosis may be significant for endometrial receptiveness in the context of a natural cycle, but no negative impact is detected when standard endometrial priming protocols are used in oocyte donation. The same may be true for adenomyosis, although its relevance to endometrial receptiveness is less clear., Conclusion(s): Accumulated knowledge in the field of oocyte donation has led to the recognition of clinical variables that affect cycle outcome by impairing endometrial receptiveness. Many studies are being carried out on endometrial molecular and gene expression changes taking place in these circumstances. In the near future a comprehensive understanding of these processes should be achieved, from a genetic, molecular, and clinical perspective. These advances in the collective knowledge will lead to an improvement in the diagnosis and treatment of infertile patients.

Background: The role of thrombophilia and thyroid autoimmunity in unexplained infertility (UI), implantation failure (IF) and recurrent spontaneous abortion (RSA) is controversial and poorly understood., Methods: From March, 2004 to January, 2007, 119 women were prospectively included: 32 oocyte donors, 31 patients with UI, 26 with IF and 30 with RSA. The IF and RSA groups presented normal preimplantation genetic screening. Protein C, protein S, antithrombin III, lupus anticoagulant, activated protein C resistance (APCR), immunoglobulin M and G anticardiolipin antibodies, homocystine, Factor V Leiden, prothrombin G20210A mutation, methylentetrahydrofolate reductase C677T mutation, thyroid-stimulating hormone (TSH), free thyroxine, anti-thyroid peroxidase (TPO) and anti-thyroglobulin (TG) antibodies were assessed., Results: The prevalence of thrombophilia was high and similar among groups. In the IF group, the prevalence of APCR (15.4%), lupus anticoagulant (11.5%) and combined thrombophilia (19.2%) was higher, but not significantly different, than the other three groups. The prevalence of thyroid autoimmunity in women with IF (anti-TPO antibodies, P = 0.009; anti-TPO plus anti-TG antibodies,P = 0.04) and UI (anti-TPO, P = 0.002; anti-TG, P = 0.019; anti-TPO plus anti-TG antibodies, P = 0.005) was significantly increased in comparison to those with RSA. There was also a trend towards a higher prevalence of thyroid autoimmunity in the UI and IF groups than in the control group. TSH and free thyroxine levels all remained within a normal range., Conclusions: When embryo aneuploidy is ruled out, thrombophilia could constitute an etiologic factor in IF. Furthermore, thyroid autoimmunity is strongly related to UI and IF.

Objective: To compare outcome parameters and cumulative pregnancy rates (PRs) in oocyte donation cycles over a period of 10 years., Design: Retrospective study., Setting: University-affiliated assisted reproductive technology program., Patient(s): Women undergoing oocyte donation (10,537 cycles) between 1995 and 2005., Intervention(s): Ovarian stimulation and oocyte retrieval in donors. Embryo transfer performed in recipients after endometrial preparation., Main Outcome Measure(s): Outcome parameters and cumulative PRs were calculated and compared in relation to indication, age, and origin of sperm used., Result(s): Overall PR, implantation rate, clinical PR, and miscarriage rate per embryo transfer performed were 54.9%, 27%, 50.3%, and 19%, respectively. Ongoing PR per transfer was 40.2%, and twin and high-order multiple PRs were 39% and 6%, respectively. Mean number of embryos transferred was reduced from 3.6 +/- 0.8 to 1.9 +/- 0.3, implantation rate improved from 16.7% to 38.3%, and ongoing PR improved from 31% to 44.3%. Cumulative PRs did not differ significantly among different indications for oocyte donation, age groups, or origin of sperm used for oocyte insemination. Overall cumulative PRs after three and five cycles were calculated as 87% and 96.8%, respectively., Conclusion(s): Significant improvements in outcome parameters were achieved within 10 years. Similar cumulative PRs were observed regardless of recipient age, indication for oocyte donation, or sperm origin.

Background: Ovarian orthotopic transplantation in patients with premature ovarian failure is reported to result in full-term pregnancies. Ischaemia and freezing/thawing are potentially injurious for tissues. This study was designed to analyse the effect of ischaemia on long-term ovarian function in humans., Methods: Prospective case-control study. Subjects were 12 premenopausal women undergoing hysterectomy and fresh orthotopic transplantation of the entire ovarian cortex plus a control group of five patients undergoing hysterectomy only. Follow-up lasted 2 years. Serum FSH and anti-Müllerian hormone (AMH) were recorded, and ovulatory cycles were determined by vaginal ultrasound and serum progesterone levels., Results: Follow-up showed that ovulation was restored in 11 of the 12 patients who received grafts over the duration of the study (9.3 +/- 1.73 ovulations versus 12.0 +/- 0.86 in controls, NS), and 9 of 12 patients remained ovulatory after 2 years. We identified four patterns of FSH secretion during the study, 5 of 12 (41.7%) women having the same pattern as controls. There was a trend for serum AMH levels 7 days after surgery (0.16 +/- 0.02 microg/l) to be lower than pre-surgery levels (0.38 +/- 0.09 microg/l, P = 0.07) and higher in women whose FSH patterns suggested normal ovarian function, but the results did not reach significance. After transplantation, FSH correlated more closely (r = -0.639, P = 0.02) with normal ovarian function than AMH (r = 0.465, P = 0.12)., Conclusions: Fresh orthotopic ovarian cortex transplantation is a viable procedure. It maintains normal ovarian function after 2 years in 75% of cases and preserves ovarian function against ischaemia in 41.7% of patients.

Background: Cigarette smoking has long been known to have an effect on female fertility. The existence of an ovarian factor is clear when one considers that the mean age of the menopause is lower and IVF cycle outcome is worse in heavy smokers. The hypothesis of a concomitant uterine effect is raised by indirect evidence from in vitro and in vivo studies, but as yet, no direct evidence has been gained to confirm its existence. In this work, we analyse the association between smoking habit in oocyte recipients and cycle outcome., Methods: We have retrospectively analysed the outcome of all oocyte donation cycles performed in our clinic from January 2002 to June 2005 from which there was available information regarding patient current smoking status. Husband and donor smoking status were controlled variables, as well as donor and recipient age, patient body mass index, embryo number and quality and duration of endometrial priming., Results: Pregnancy rate (PR) in non-heavy smokers (0-10 cigarettes/day) was significantly higher than in heavy smokers (>10 cigarettes/day) (52.2 versus 34.1%, respectively). Interestingly, multiple PR was significantly higher in heavy smokers (60 versus 31%)., Conclusion: Tobacco consumption determines reduced uterine receptiveness and an increased risk of multiple pregnancies. This last issue remains to be clarified.