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Background: Partial pituitary desensitization using gonadotrophin-releasing hormone (GnRH) agonists may be sufficient in women undergoing controlled ovarian hyperstimulation for assisted reproduction. However, the minimal effective agonist dose remains to be determined. The aim of the study was to investigate the effect of a reduced daily dose of triptorelin, administered at the start of ovarian stimulation, on the results of IVF and intracytoplasmic sperm injection.Methods: A total of 132 patients was randomized in two groups. Pituitary desensitization was obtained in group 1 (66 patients) with a single 3.75 mg injection (i.m.) of triptorelin. In group 2, 66 patients received 100 microg triptorelin daily, which was then reduced to 50 microg at the start of follicle-stimulating hormone (FSH) stimulation.Results: No significant differences were found in terms of pregnancy rate per transfer (38% in group 1 versus 34.9% in group 2), implantation rate (20.2 versus 18%) and abortion rate (8.3 versus 9.1%). The number of FSH ampoules used, as well as the number of days stimulation required, was significantly reduced in group 2 (41 +/- 26 versus 46.6 +/- 25.3, P < 0.03 and 11 +/- 1.3 versus 11.8 +/- 1.5, P < 0.002 respectively). No significant differences were seen in oestradiol concentrations and in follicle number, in the quantity of oocytes collected and fertilized, or in the number of embryos obtained or transferred.Conclusion: A reduced dose of triptorelin is enough for pituitary suppression during ovarian stimulation but provides no significant improvement in IVF cycle outcome when compared with depot formulation. The possibility of a shorter treatment protocol requiring lower amounts of gonadotrophins should be considered in view of its economic advantage. [ABSTRACT FROM AUTHOR]

Results obtained in two groups of patients treated with gamete intra-Fallopian transfer (GIFT) are reported. Hysteroscopic GIFT was carried out in some cases where general anaesthesia was not advisable or possible, i.e. difficulties in tubal catheterization due to pelvic adhesions, extended distal tubal damage, patients' intolerance, lack of available operating theatre. Ovarian stimulation was started on 131 patients for a total of 147 cycles. Twenty-five cycles were cancelled because of failure of the ovarian response. Either laparoscopic (group 1; 73 patients) or hysteroscopic GIFT (group 2; 50 patients) was performed. In group 1 a mean of 6.8 +/- 3.4 oocytes per cycle were retrieved and a mean of 4.7 +/- 1.3 mature oocytes were transferred. The pregnancy rate was 30.1% per retrieval (22 clinical pregnancies). In group 2, a mean of 5.0 +/- 3.1 oocytes was harvested and 3.9 +/- 2.0 mature oocytes per cycle were transferred. Thirteen clinical pregnancies were achieved (26.5% per cycle) in group 2. Comparing the two groups, the number of recovered and transferred oocytes was significantly lower in hysteroscopic GIFT (P less than 0.05 and P less than 0.001 respectively). [ABSTRACT FROM AUTHOR]

In the last few years, there has been a significant improvement in oocyte cryopreservation techniques. To investigate the clinical significance of oocyte freezing, an assessment of the cumulative pregnancy rate per started cycle derived from the use of fresh and frozen-thawed oocytes was performed. Between 2004 and 2006, 749 cycles were carried out, in which no more than three fresh oocytes were inseminated either by standard IVF or microinjection. Supernumerary mature oocytes were cryopreserved by slow cooling. Cryopreservation of fresh embryos was performed in rare cases to prevent the risk of ovarian hyperstimulation syndrome using a standard embryo freezing protocol. Fresh embryo transfer cycles totalled 680, 257 of which resulted in pregnancy. The pregnancy rates per patient and per transfer were 34.3% and 37.8% respectively. When frozen-thawed oocytes were used, following 660 thawing cycles, 590 embryo transfers were performed in 510 patients. Eighty-eight pregnancies were achieved with embryos from frozen oocytes, with a success rate of 17.2% per cycle. When fresh and frozen-thawed cycles were combined, the number of pregnancies was 355, giving a cumulative pregnancy rate of 47.4%. Oocyte cryopreservation can contribute considerably to the overall clinical success, ensuring a cumulative rate approaching that achievable with embryo storage. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the effectiveness and safety profiles of Direct Selective Laser Trabeculoplasty (DSLT)., Materials and Methods: Retrospective study of 15 eyes of 10 patients diagnosed with open angle glaucoma (OAG) or ocular hypertension (OHT) who underwent DSLT in June 2023 at University Hospitals of Leicester, UK. We defined success as IOP reduced ≥20% from baseline with no additional medications needed or as a decrease in the number of anti-glaucoma medications while maintaining target IOP. We also considered secondary outcomes such as final BCVA and final number of anti-glaucoma medications., Results: At the fourth month visit, success was reached in 11 eyes (73.3%). We registered 4 failures (26.7%). Mean IOP at baseline was 22.7 ± 4.4 mmHg and was reduced to 18.7 ± 4.2 mmHg ( p  = 0.008). The absolute mean reduction of IOP in the group of eyes that maintained unchanged the number of medications was 5.4 ± 2.7 mmHg, as baseline IOP was 21.4 ± 4.3 mmHg, and final IOP was 15.9 ± 2.3 mmHg, with a 25.7% reduction ( p  = 0.003). Mean BCVA remained unchanged (0.1 ± 0.1 logMAR, p  = 1.00). No significant adverse events requiring surgical or clinical intervention were observed., Conclusion: DSLT showed profiles of effectiveness and safety comparable with those of SLT in the literature and consistent with the results obtained in previous studies on DSLT itself. DSLT may represent a valid alternative to traditional SLT., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose: To investigate the relationship between imaging biomarkers and mesopic and dark-adapted (ie, scotopic) functions in patients with treatment-naïve mild diabetic retinopathy (DR) and normal visual acuity., Design: Prospective cross-sectional study., Methods: In this study, 60 patients with treatment-naïve mild DR (Early Treatment of Diabetic Retinopathy Study levels 20-35) and 30 healthy control subjects underwent microperimetry, structural optical coherence tomography (OCT), and OCT angiography (OCTA)., Results: The foveal mesopic (22.4 ± 4.5 dB and 25.8 ± 2.0 dB, P = .005), parafoveal mesopic (23.2 ± 3.8 and 25.8 ± 1.9, P < .0001), and parafoveal dark-adapted (21.1 ± 2.8 dB and 23.2 ± 1.9 dB, P = .003) sensitivities were reduced in DR eyes. For foveal mesopic sensitivity, the regression analysis showed a significant topographic association with choriocapillaris flow deficits percentage (CC FD%; β = -0.234, P = .046) and ellipsoid zone (EZ) normalized reflectivity (β = 0.282, P = .048). Parafoveal mesopic sensitivity was significantly topographically associated with inner retinal thickness (β = 0.253, P = .035), deep capillary plexus (DCP) vessel length density (VLD; β = 0.542, P = .016), CC FD% (β = -0.312, P = .032), and EZ normalized reflectivity (β = 0.328, P = .031). Similarly, parafoveal dark-adapted sensitivity was topographically associated with inner retinal thickness (β = 0.453, P = .021), DCP VLD (β = 0.370, P = .030), CC FD% (β = -0.282, P = .048), and EZ normalized reflectivity (β = 0.295, P = .042)., Conclusions: In treatment-naïve mild DR eyes, both rod and cone functions are affected and they are associated with both DCP and CC flow impairment, which suggests that a macular hypoperfusion at these levels might implicate a reduction in photoreceptor function. Normalized EZ reflectivity may be a valuable structural biomarker for assessing photoreceptor function in DR. NOTE: Publication of this article is sponsored by the American Ophthalmological Society., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Aims: The current study aimed to validate the Italian version of the Staff Attitude to Coercion Scale (SACS), which assesses mental health care staff's attitudes to the use of coercion in treatment., Methods: The original English version of the SACS was translated into Italian, according to the back-translation procedure. Subsequently, it was empirically validated by performing an exploratory factor analysis on a sample of 217 mental health professionals (Mean = 43.40 years, SD = 11.06) recruited form Italian general hospital (acute) psychiatric wards (GHPWs), with at least 1 year of work experience (i.e., inclusion criteria)., Results: Results confirmed the three-factor solution of the original version for the Italian version of the SACS, though three items loaded on different factors, compared to the original. The three extracted factors, explained 41% of total variance, and were labeled similarly to the original scale and according to their respective item content, i.e., Factor 1 "Coercion as offending" (items: 3, 13, 14, and 15), Factor 2 "Coercion as care and security" (items: 1, 2, 4, 5, 7, 8, and 9), and Factor 3 "Coercion as treatment" (items: 6, 10, 11, and 12). The internal consistency of the three-factor model of the Italian version of the SACS was assessed through Cronbach's α and yielded acceptable indexes, ranging from 0.64 to 0.77., Conclusion: The present findings suggest that the Italian version of the SACS is a valid and reliable tool that can be used to assess healthcare professionals' attitudes toward coercion., 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., (Copyright © 2023 Venturini, Bassi, Salcuni, Kotzalidis, Telesforo, Salustri, Trevisi, Roselli, Tarsitani, Infante, Niolu, Polselli and Boldrini.)

Background: Insight affects adherence and treatment outcome and relates to cognitive impairment and psychopathology. We investigated the relationship of insight with cognition in patients with major depression, schizophrenia and bipolar disorder in acute psychiatric care, long-term inpatient, and outpatient settings., Methods: Eighty-one patients (women, 59.5%; age, 45.9 ± 13.5 years; 27 in each setting group; 33.3% with DSM-IV bipolar disorder, 39.5% with unipolar major depression, and 27.2% with schizophrenia) underwent the Wisconsin Card Sorting Test (WCST) to test flexibility, clinician-rated Scale to Assess Unawareness of Mental Disorder (SUMD), and self-rated Insight Scale (IS) to assess insight/awareness., Results: Poor performance on the WCST correlated with higher SUMD scores such as current psychiatric illness unawareness, impaired symptom attribution, unawareness of medication effect, or of social consequences, but not with IS scores. The latter correlated with days on continuous treatment. Patients receiving psycho-education showed greater symptom awareness compared to patients treated with drugs alone. Cognitive flexibility and diagnostic category did not correlate. Poor insight corresponded with severe mental illness, particularly acute psychosis., Conclusions: Treatment setting specificity reflects psychopathology and severity. Insight is inversely proportional to illness severity and cognitive flexibility, which is also affected by psychopathology. Limitations comprise group heterogeneity, cross-sectional design, and limited sample size., (Copyright © 2012 S. Karger AG, Basel.)

Cotard’s syndrome is a delusional syndrome, first described in the 1880ies by Cotard, characterized by a nihilistic delusions about the self and/or the world. In same other cases there is an intense nihilistic belief that the patient’s entire body or parts of it are disintegrated or dead. The syndrome is often associated with severe depression, but are also described neurological cases. Koro was described a little later from Asia and consisted in the belief that one’s own genitalia are shrinking or disappearing and death will ensue thereafter, but there are many cultural variants and the syndrome may present in an incomplete form. We report on a KLS sharing more features with annihilation delusions, such as Cotard’s syndrome. In KLS, the délire de négation may be limited to localized systems or organs. We believe that some complete and incomplete forms of Koro, when embedded in a depressive core, may represent a variant of Cotard’s delusion. In fact, our patient did not reach a complete denial of his entire body, but rather focused on sexual identity. We analysed the psychosexual issues of our case according to Kretschmer’s 1918 view of a “bipolar setting” between sthenic and asthenic characters of a patient suffering from sensitive delusions of (self-) reference. This view may allow us to relate the personological character to the genetic comprehensibility of the delusion.

The aim of this study was to compare results obtained using two different GnRH analogue regimens in women > or = 40 undergoing IVF cycles. Patients using GnRH-a from mid-luteal phase of the previous cycle (group A) needed more days of ovarian stimulation than patients GnRH-a in the follicular phase of the same cycle "flare-up" (group B) (11.7 +/- 1.3 vs 10.8 +/- 2 respectively). Group A patients developed more follicles and obtained more oocytes than group B (9.2 +/- 4.9 vs 6.1 +/- 4.4; And 7.6 +/- 4.7 vs 4.2 +/- 3.2, respectively). The cancellation rate was significantly higher in B than A (20 vs 8.6%, respectively). Pregnancy rates however were significantly lower in "flare-up" than in mid-luteal group (3 vs 14% per cycle, 4.7 vs 17% per patient, 3.8 vs 15.2% per oocyte retrieval and 5.4 vs 18.8% per transfer, respectively). Different results obtained in the two groups suggest that Gn-RH-a long protocol allows better ovarian stimulation and consequently improved pregnancy rate than "flare-up" in women > or = 40 years old.

A great deal of information is available on the morphology of the claustrum in various animal species, as well as on its neuronal distribution and relationships with the cerebral cortex and other nuclei. However, no research has been performed on synaptic organization. Here we report an ultrastructural study performed on 7 male albino rats of the Wistar strain weighing 270-310 g. Five rats were sacrificed by prolonging general anesthesia with diethyl ether until death. Three of these rats were secured to the stereotaxic atlas coordinates of Paxinos and Watson (1982); the claustrum area was marked by injecting 1 microliter of a 10% Evans Blue solution into the nucleus. The brain was then removed from the skull, cut into 2-3 mm thick coronal sections, and tissue samples taken from the area immediately adjacent to the marked area were immersed in 2% OsO4 buffered with 2% potassium dichromate containing 0.2% CaCl2 at pH 7.7 (Gobel, 1968). After dehydration they were embedded in Durcupan and the ultrafine sections were stained with uranyl acetate and lead citrate and observed with either a Zeiss 9S2 or a Hitachi H 800 electron microscope. The samples from two other rats, taken with the stereotaxic techniques described, were fixed for 12 h in 0.6 potassium permanganate solution buffered with veronal-acetate at pH 7.4 (Luft, 1956). After processing for electron microscopy, a portion of the sections were used without any contrast medium and the remainder were stained with uranyl acetate and lead citrate.(ABSTRACT TRUNCATED AT 250 WORDS)