No abstract available.
Acrosome* ; Fertilization* ; Humans* ; Male ; Spermatozoa*

No abstract available.
Animals ; Coculture Techniques ; Fertilization in Vitro ; Mice*

A career in surgery in the United Kingdom demands a commitment to a long journey of assessment. The assessment methods used must ensure that the appropriate candidates are selected into a programme of study or a job and must guarantee public safety by regulating the progression of surgical trainees and the certification of trained surgeons. This review attempts to analyse the psychometric properties of various assessment methods used in the selection of candidates to medical school, job selection, progression in training, and certification. Validity is an indicator of how well an assessment measures what it is designed to measure. Reliability informs us whether a test is consistent in its outcome by measuring the reproducibility and discriminating ability of the test. In the long journey of assessment in surgical training, the same assessment formats are frequently being used for selection into a programme of study, job selection, progression, and certification. Although similar assessment methods are being used for different purposes in surgical training, the psychometric properties of these assessment methods have not been examined separately for each purpose. Because of the significance of these assessments for trainees and patients, their reliability and validity should be examined thoroughly in every context where the assessment method is being used.
Certification ; Great Britain* ; Humans ; Methods* ; Psychometrics ; Reproducibility of Results ; Schools, Medical

Guinea pigs were fed a hypercholesterolemic diet (0.25 g/100 g cholesterol) and randomly allocated either to a Control group (n = 9) or to a Lutein (0.1 g/100 g) group (n = 10) for 12 weeks to evaluate oxidative stress and inflammation in both liver and eyes. Malondialdehyde (MDA) concentrations and inflammatory cytokines were measured as well as hepatic nuclear factor-kappaB (NF-kappaB) binding. Lutein concentrations were greater in eyes (P < 0.01) and liver (P < 0.001) in the Lutein group. All guinea pigs had high concentrations of hepatic cholesterol as well as high plasma ALT and AST levels indicative of liver injury. However, the Lutein group had 43% lower hepatic free cholesterol than the Controls (P < 0.05). Hepatic MDA and MDA in the eye were lower in the Lutein compared to the Control group (P < 0.05). Hepatic tumor necrosis factor-alpha was 32% lower in the Lutein group (P < 0.05). Lastly, the Lutein group presented lower NF-kappaB DNA binding activity than the Control group (P < 0.001). These results suggest that in the presence of high cholesterol, lutein exerts both antioxidant and anti-inflammatory effects, which can be explained by attenuated NF-kappaB DNA binding activity. Furthermore, results also suggest that lutein accumulates in the eyes of guinea pigs to protect against oxidative stress.
Animals ; Cholesterol ; Cytokines ; Diet ; DNA ; Eye ; Guinea ; Guinea Pigs ; Inflammation ; Lipid Peroxidation ; Liver ; Lutein ; Malondialdehyde ; NF-kappa B ; Oxidative Stress ; Plasma ; Tumor Necrosis Factor-alpha

OBJECTIVE: This study was performed to examine the maturation and the development to the blastocyst stage of immature oocytes collected from patients with high risk of ovarian hyperstimulation syndrome (OHSS). MATERIALS AND METHODS: Cumulus-oocyte complexes (COCs) were collected following only HCGpriming for non stimulated IVF-ET cycles of the patients. At the time of oocyte collection, COCs were classified into three groups in accordance with their appearance (Group I: oocytes with dispersed cumulus cells; Group II: oocytes with compacted cumulus cells; Group III: oocytes with sparse cumulus cells). The in vitro maturation and blastocyst development rates of the COCs were compared among these groups. From August 2001 to June 2002, 48 IVM/IVF-ET cycles from 42 patients (mean age: 32.4+/-3.8 years) were performed. To prevent the occurrence of OHSS, the patients were primed with 10,000 IU HCG alone 36 h before oocyte collection without gonadotropin stimulation. Oocytes were aspirated on cycle days from 7 to 13. The normal COCs were classified into three groups according to their appearance. The aspirated immature oocytes were cultured in YS maturation medium containing 30% (v/v) human follicular fluid (HFF), 1 IU/ml FSH, 10 IU/ml HCG and 10 ng/ml rhEGF. Fertilization was induced by intracytoplasmic sperm injection (ICSI). All zygotes were co-cultured with cumulus cells in 10 mul YS medium containing 10% HFF until day 7 after oocyte collection. Blastocyst transfer was performed on day 5 after ICSI. RESULTS: The mean number of oocytes cultured in the IVM/IVF cycles was 24.7+/-10.6. Of 1185 COCs, those assigned to Group I, II and III were 470 (39.7%), 414 (35.0%) and 301 (25.4%), respectively. The maturation rate (94.5%, 444/470, p<0.05) in Group I was significantly higher than those of Group II (62.8%, 260/414) and Group III (73.1%, 220/301). Especially, 30.9% of COCs in Group I (145/470) was matured on the day of oocyte aspiration. There were no differences in the rates of fertilization and cleavage among the three groups. The development rate to the blastocyst stage in Group I (54.6%, 206/377, p<0.05) was also significantly higher than those in Group II (33.0%, 68/206) and Group III (30.1%, 52/173). Twenty-four clinical pregnancies (50.0%) was obtained and 22 pregnancies (45.8%) are ongoing. Implantation rate in the present study was 24.6%. CONCLUSION: These results suggest that there is a positive correlation between the appearance of COCs and the developmental competence of the immature oocytes in non stimulated IVM/IVF cycles.
Blastocyst ; Cumulus Cells ; Embryo Transfer ; Female ; Fertilization ; Follicular Fluid ; Gonadotropins ; Humans ; Mental Competency ; Oocyte Retrieval ; Oocytes* ; Ovarian Hyperstimulation Syndrome ; Ovary* ; Pregnancy ; Sperm Injections, Intracytoplasmic ; Zygote

PURPOSE: To assess real-world treatment patterns, health care utilization, costs, and survival among Medicare enrollees with locally advanced/unresectable or metastatic gastric cancer receiving standard first-line chemotherapy. MATERIALS AND METHODS: This was a retrospective analysis of the Surveillance, Epidemiology, and End Results-Medicare linked database (2000~2009). The inclusion criteria were as follows: (1) first diagnosed with locally advanced/unresectable or metastatic gastric cancer between July 1, 2000 and December 31, 2007 (first diagnosis defined the index date); (2) > or =65 years of age at index; (3) continuously enrolled in Medicare Part A and B from 6 months before index through the end of follow-up, defined by death or the database end date (December 31, 2009), whichever occurred first; and (4) received first-line treatment with fluoropyrimidine and/or a platinum chemo-therapy agent. RESULTS: In total, 2,583 patients met the inclusion criteria. The mean age at index was 74.8+/-6.0 years. Over 90% of patients died during follow-up, with a median survival of 361 days for the overall post-index period and 167 days for the period after the completion of first-line chemotherapy. The mean total gastric cancer-related cost per patient over the entire post-index follow-up period was United States dollar (USD) 70,808+/-56,620. Following the completion of first-line chemotherapy, patients receiving further cancer-directed treatment had USD 25,216 additional disease-related costs versus patients receiving supportive care only (P<0.001). CONCLUSIONS: The economic burden of advanced gastric cancer is substantial. Extrapolating based on published incidence estimates and staging distributions, the estimated total disease-related lifetime cost to Medicare for the roughly 22,200 patients expected to be diagnosed with this disease in 2014 approaches USD 300 millions.
Aged* ; Delivery of Health Care ; Diagnosis ; Drug Therapy ; Epidemiology ; Follow-Up Studies ; Humans ; Incidence ; Medicare ; Medicare Part A ; Platinum ; Retrospective Studies ; Stomach Neoplasms* ; United States

This article was initially published on Nutrition Research and Practice with mistyped concentration of lutein used in the study.

OBJECTIVE: The purpose of this study was to investigate pregnancy outcomes in women with epilepsy using lamotrigine (LTG). METHODS: We retrospectively reviewed the medical records of all patients who had been diagnosed as epilepsy and gave live singleton births in Yonsei University Health System, Seoul, Korea, between February 1996 and December 2007. Nine patients who were not taking antiepileptic drugs (AEDs) were excluded from this study. We subdivided the enrolled patients into 2 groups; patients exposed to LTG and others exposed to other AEDs. Congenital malformation, spontaneous abortion, small for gestational age, termination of pregnancy, intrauterine fetal death, preterm delivery, and adverse maternal outcomes were documented to evaluate the pregnancy outcomes. The statistical significance was defined as P<0.05. RESULTS: 129 cases were found in all medical records. The overall risk of congenital malformations in the AED group was 6.2% (n=8), which included 4 cases to carbamazepine (CBZ) monotherapy, 1 to valproate (VPA) monotherapy, and 3 to VPA+CBZ polytherapy. Congenital malformations were significantly increased in the non- LTG groups than in the LTG group (8.7% vs. 0%, P=0.047), especially in non-LTG polytherapy group (20.0% vs. 0%, P=0.049). The rates of spontaneous abortion, small for gestational age, termination of pregnancy, intrauterine fetal death, preterm delivery, and adverse maternal outcomes were no significant differences between the two groups. CONCLUSION: This study demonstrates that administration of LTG in pregnant women with epilepsy could be more effective in decreasing teratogenicity than administration of other AEDs in polytherapy.
Abortion, Spontaneous ; Anticonvulsants ; Carbamazepine ; Epilepsy ; Female ; Fetal Death ; Gestational Age ; Humans ; Korea ; Medical Records ; Parturition ; Pregnancy ; Pregnancy Outcome ; Pregnant Women ; Retrospective Studies ; Triazines ; Valproic Acid

Fixed-dose combinations development requires pharmacokinetic drugdrug interaction (DDI) studies between active ingredients. For some drugs, pharmacokinetic properties such as long half-life or delayed distribution, make it difficult to conduct such clinical trials and to estimate the exact magnitude of DDI. In this study, the conventional (non-compartmental analysis and bioequivalence [BE]) and modelbased analyses were compared for their performance to evaluate DDI using amlodipine as an example. Raw data without DDI or simulated data using pharmacokinetic models were compared to the data obtained after concomitant administration.Regardless of the methodology, all the results fell within the classical BE limit. It was shown that the model-based approach may be valid as the conventional approach and reduce the possibility of DDI overestimation. Several advantages (i.e., quantitative changes in parameters and precision of confidence interval) of the model-based approach were demonstrated, and possible application methods were proposed. Therefore, it is expected that the model-based analysis is appropriately utilized according to the situation and purpose.