P–127 Does sperm quality really matter for conceiving through an intrauterine insemination program? A retrospective analysis of 5920 attempts taking into account repetition of cycles

Study question Are parameters of sperm quality part of the prognosis factors for an infertile couple to obtain a live birth when entering an intrauterine insemination program considering repetition of attempts? Summary answer Paradoxically, a lower sperm morphology independently predict quick live birth through IUI, as well as younger female age, lower D3 FSH, and higher triggering estradiol. What is known already Many studies have highlighted different prognosis factors for obtaining a live birth after IUI involving: male parameters (semen),female parameters (age, parity, ovulation, tubal, and endometriosis status, history of pelvic surgery),couple parameters (duration of infertility, number of previous attempt),IUI parameters (follicle number, endometrial thickness, estradiol at triggering, day of IUI, number of spermatozoa inseminated). However, most of these studies have included small number of attempts, semen parameters were either not collected or assessed with heterogeneity, and repetition of attempts (although iconic for IUI) was not considered, allocating inappropriate weight to cycles which failed in conceiving. Study design, size, duration We retrospectively studied the entire cohort of IUI attempts carried out with partner’s sperm at our center between 09/09/2003 and 01/17/2017. We included all male, female, couple and IUI parameters available. Each basic semen analyzes included have been carried out by a restricted number of skilled andrologists from our center. The closest semen assessment performed before IUI was considered as male parameter. IUI attempts were considered repeated unless a live birth or IUI abandonment occurred. Participants/materials, setting, methods Our primary outcome was live birth occurrence. We included 2228 couples having performed 5920 IUI attempts, with 636 live births obtained. A mixed logistic regression model was used to take into account IUI repetition before obtaining a live birth. A survival analysis using Cox model, with IUI rank as time variable, live birth as endpoint, and taking into account recurrences was carried out to determine which parameter best predict a quick live birth through IUI. Main results and the role of chance Included women were 33.7 ± 4.6 years old in mean. Baseline semen assessment was available for 64% of couples. Muti-variate analysis showed that live birth was more frequent when: Femal factors: age was young (33 to 38yo, OR 0.76 [0.60;0.96], >38 yo OR 0.49 [0.35;0.67], p = 0.0001), FSH ≤ 8.0 (OR 0.59 [0.45;0.79], p = 0.0002), AMH > 8.9ng/mL (OR 0.59 [0.45;0.79], p = 0.0001), endometriosis was absent (OR 0.56 [0.36;0.88], p = 0.0109), the patient already delivered (OR 1.36 [1.06;1.74], p = 0.0034) Male factors: sperm motility ≤26.0% (OR 0.71 [0.53;0.96], p = 0.0062), sperm vitality ≤72.0% (OR 0.65 [0.47;0.90], p = 0.0032), sperm typical form ≤ 25.0% (OR 0.51 [0.34 ; 0.78], p = 0.0016), IUI attempt factors: total dose of gonadotropin > 495.0 (OR 1.54 [1.26;1.88], p = 0.0001) follicle number > 2 (OR 1.23 [1.69;2.21], p = 0.0296), Estradiol at trigerring > 215.0pg/ml (OR 1.90 [1.53;2.36], p = 0.0001), Endometrial thickness >9.6mm (OR 1.43, p = 0.0024), day of IUI >13 (1.53 [1.24;1.89], p = 0.0001). Using Cox model, couples obtained quickly a livebirth if: woman age was below 33yo: For 33 to 38 yo, OR 0.37 [0.25;0.54], p = 0.0001, >38yo OR 0.19 [0.11;0.32], p = 0.0001 D3 FSH<8 (if above, OR 0.55 [0.34;0.90], p = 0.0160) - Sperm typical form ≤25.0 (if above, OR 0.34 [0.20;0.58], p = 0.0001) Triggering estradiol >215.0pg/ml, OR 1.99 [1.51;2.63], p = 0.0001) Limitations, reasons for caution Baseline semen assessment was missing a bit more when cycles were successful, so that a bias connot be excluded. This weird result concerning semen parameters which appear to lower the live birth rate when they are good should thus be considered with caution. Wider implications of the findings: Good baseline semen parameters do not appear as primordial for obtaining an IUI live birth, and were even found deleterious. However, thresholds highlighted in the present study were high, i.e. of limited clinical mean, and semen below them to remain normal. After confirming, explanations should be investigated: excessive acrosome reaction. Trial registration number Not applicable

International Legal Approaches to Neurosurgery for Psychiatric Disorders

Neurosurgery for psychiatric disorders (NPD), also sometimes referred to as psychosurgery, is rapidly evolving, with new techniques and indications being investigated actively. Many within the field have suggested that some form of guidelines or regulations are needed to help ensure that a promising field develops safely. Multiple countries have enacted specific laws regulating NPD. This article reviews NPD-specific laws drawn from North and South America, Asia and Europe, in order to identify the typical form and contents of these laws and to set the groundwork for the design of an optimal regulation for the field. Key challenges for this design that are revealed by the review are how to define the scope of the law (what should be regulated), what types of regulations are required (eligibility criteria, approval procedures, data collection, and oversight mechanisms), and how to approach international harmonization given the potential migration of researchers and patients.

Tid for anerkjennelse: Andre verdenskrig 75 år etter frigjøringen1

In this article, the author argues that the need for recognition is a defining feature of the ways WW2 is commemorated and represented today, both in terms of professional history and popular narratives. WW2 as a source of recognition for groups and individuals is described as a process with three constitutive elements: diversity of narratives, a “moral turn”, and the personal acquisition of history. While representations of Norway and WW2 previously fit into an ideal-typical form based on how different stories related to the established – or later expanded and nuanced – basic narrative, the memory culture has turned and gained a more horizontally arranged structure from the 2000s. The characteristic of the 2020 anniversary seems to be a battle for attention and recognition. This is described as an agonistic memory culture. Also, WW2 as a source of recognition means that sensitive dimensions are activated. This has led to a change regarding the role of historians in society. Historians and other professional history-workers must not only master “real history”, but they must also be able to handle and contribute to meaningful processing of conflicts related to how the past is being understood, articulated, and negotiated.

Shanghai lilong

The lilong (里弄) is the typical form of residential alley in Shanghai, with two essential spatial features: multifunctionality and a semi-public character. However, this spatial characterization has undergone significant changes in the modernization and urbanization process of Shanghai. The cognitive value of the lilong has transitioned from residential to commodity, and finally to cultural. This study addresses this transformation, adopting Lefebvre’s triad spatial framework to interpret the sociospatial dynamics of the lilong. Tianzifang (田子坊) is used as a case study area, as it is the subject of a community-initiated regeneration that has changed the deteriorating alley residence into a mixed-use commercial and residential creative cluster.

14. Enforcement

This chapter analyses the enforcement of international law by States acting individually, that is, decentralized enforcement, including by their courts, as well as through retortion or countermeasures (once called reprisals). This is the typical form of enforcement under traditional international law. At the same time, enforcement might take place through measures taken by States acting collectively, that is, through mechanisms that include resort to collective measures, such as those adopted at the UN level (or within other international organizations), which can lead to collective sanctions. The first form of enforcement looks at the traditional law governing retortion and reprisals or countermeasures (as they are now called), as well as at the post-1945 law, taking into account that the ban on the use of armed force in international relations imposes that all enforcement measures taken by States individually must be peaceful. The second form examines the issue of collective sanctions, such as those taken at UN level.

Chronic inflammatory demyelinating polyneuropathy associated with diabetes: a European multicentre comparative reappraisal

IntroductionThe association between chronic inflammatory demyelinating polyneuropathy (CIDP) and diabetes is uncertain despite important diagnostic and management implications.MethodsWe retrospectively analysed two European cohorts, totaling 257 patients with ‘definite’ or ‘probable’ CIDP, from Serbia and Birmingham, UK.ResultsDiabetes was present at CIDP diagnosis in 25/139 (18%) subjects in the Serbian cohort and in 23/118 (19.5%) in the UK cohort. In both cohorts, diabetes prevalence was higher than local general population prevalence rates (RR: 2.09; 95% CI 1.39 to 2.95 and RR: 2.22; 95% CI 1.46 to 3.17, respectively). Considering typical CIDP only, diabetes prevalence was greater than expected in both cohorts (RR: 2.58; 95% CI 1.60 to 3.82 and RR: 2.68; 95% CI 1.71 to 3.87, respectively). CIDP with diabetes occurred later in life than CIDP without diabetes (58.96 years, SD: 11.09 vs 51.71 years, SD: 16.02; p=0.003) and presented more frequently in the typical form than in patients without diabetes (79.2% vs 61.2%; p=0.02). Baseline Inflammatory Neuropathy Cause and Treatment disability scores were similar in patients with and without diabetes (p=0.90). Proportions of treatment responders were similar in both groups (70% vs 74.9%; p=0.65), as were response amplitudes (p=0.87).DiscussionOur results, both for all CIDP and typical CIDP presentations, support a twofold increased relative risk of diabetes compared with the general population. CIDP with diabetes appears to present older and more frequently in the typical form, as compared with CIDP without diabetes. CIDP with diabetes appears similar to CIDP without diabetes in disability levels at diagnosis and probability, as well as amplitude of treatment response.

Redesigning the Borobudur chair to sustain local creative industries: introducing to wangun concept

Redesigning the already existed thing is a common practice in the world of design. This study objectively conducted to produce a fresh new look and commercially bargaining product of furniture in addition to pursue current aesthetic needs. This study focuses on reconstructing the Borobudur chair, a typical form of chair inspired from the 8th century Borobudur temple reliefs, which theoretically does not follow modern art. This proposes a traditional conceptual approach called wangun (beauty) inspired by the wisdom of local Javanese culture, which is termed as Ngowahi Rupa (the change of form). Ngowahi Rupa does not change the 'inner structure' of an object, the changes occur only at the 'outer structure' level. There were two distinctive chairs being redesigned in this study, the first type of chair can accommodate one person only, and the other accommodates three people. Both types of chairs constitute of a complete structure of chair such as the legs, seat stands, and backrests, which in the sense of wangun conceptually termed telu-teluning atunggal. The Ngowahi Rupa furniture making process not only demands visual aspects, but also the concept of the creative industry. The concept was applied in redesigning the Borobudur chair that synergically in accordance with the rapidly developed creative industries in Indonesia. The results of redesigning the old-type of chair objectively contribute to the advance of current furniture industry and trend, both in Indonesia and abroad, in addition to maintaining the excellence of the creative industry with regard to the economic concern.

APPLICATION OF COMPLEX BIOREGULATORY DRUGS IN MODERN DENTAL PRACTICE (REVIEW OF LITERATURE)

In the research for the highly efficient, wide spectrum, safe drugs, dental practitioners in recent years have been increasingly paying attention to complex bioregulatory drugs (CBDs). They affect the body in small doses, initiate, activate and regulate defense mechanisms, restore the processes of self-regulation and detoxification, all without suppressing immunity. Aim of the research was to analyze the scientific literature on the effectiveness of the bioregulatory drugs in the treatment of dental diseases. Materials and methods. The bibliosemantic and analytical methods were used in our research. Results. The use of CBDs in the treatment of periodontal diseases was the most researched. In the treatment of chronic generalized periodontitis of mild and moderate severity, along with the conventional methods (removal of dental deposits, curettage of periodontal pockets with subsequent polishing of the root’s surface), the Traumeel S ointment was applied to the vestibular and oral surfaces of the marginal gums of patients with mild degree of disease. Traumeel S in pills had been prescribed for patients with chronic generalized periodontitis of moderate severity, along with ointment applications. The course of treatment was 14 days. Clinical examination of patients during the course of treatment revealed that the drug Traumeel S contributed to the reduction of edema and bleeding in the gums. This was confirmed by a significant decrease in all periodontal and hygienic indices. Laboratory study of mixed saliva of patients found a significant reduction in the content of superoxide dismutase twice over. All this led to the conclusion that the Traumeel S exhibited pronounced anti-inflammatory and antioxidant effects. Thus, its use is justified in the supplementary treatment of chronic generalized periodontitis. Practical interest, in our view, lies in a comprehensive approach to the treatment of generalized periodontitis, depending on the age of patients and the severity of the disease. For all participants in the study group, the following CBDs were added to traditional periodontitis treatment: Traumeel S, Lymphomyosot and Echinacea compositum. Traumeel S ointment was issued in the form of applications; Lymphomyosot was administered by 10 drops three times a day for 3 weeks, and Echinacea compositum − intramuscularly. Patients with severe periodontitis were injected with Traumeel S under the mucous membrane of the gum. Effectiveness of the treatment was monitored by clinical and radiological examination. The authors of the method concluded that the use of CBDs relieved inflammatory processes in the short term, suspended dystrophic and destructive processes, and promoted long-term stabilization of the disease (up to 2 years). It should also be noted that the use of CBDs did not cause any side effects. In the treatment of the treatment of various forms of lichen planus (except atypical), drug Mucosa compositum was used via an injection under the lesions. In patients with an atypical form, it was administered as infiltration anesthesia to the transitional folds on the upper or lower jaw, depending on the localization and prevalence of the process. Regardless of lichen planus form, the subjective sensations in patients disappeared after 4-5 injections. In patients with atypical form either the complete disappearance of signs of the disease or its transformation into a typical form with the appearance of papules on an unchanged background were observed. The exudative hyperemic form after 8 injections had transformed into a typical form. In the erosive-ulcerative form, a decrease in the size of erosion was observed after 6-8 injections, and epithelialization, disappearance of hyperemia, transformation into a typical form − after 10-12 injections. During the observation period of 5-8 months, there were no symptoms of exacerbation in the patients. In addition, no adverse effects were reported in any of the patients examined using Mucosa compositum. A noteworthy study was carried out by the dental surgeons to substantiate the use of CBDs in maxillofacial surgery, especially in such difficult conditions as phlegmon of different etiology and localization. Comprehensive treatment of all patients included conventional surgery and traditional drug therapy. Therapy of patients in the main group was supplemented with the introduction of the drug Lymphomyosot intravenously; antibiotic therapy was not used. Therapy of patients in the comparison group was supplemented by intravenous administration of the drug Traumeel S. Antibiotic therapy was not used. Analysis of clinical and laboratory parameters, and of patients’ immunograms reliably showed that the use of these drugs provides a more positive course of the wound process and a more pronounced reduction in total intoxication, which leads to a shorter treatment time compared with the traditional therapy. Based on the analysis of available literature, we concluded that it is advisable to improve approaches to the treatment of major dental diseases by introducing complex bioregulatory drugs. The question of modern application of the CBDs in dentistry remains relevant and requires further study.

Pomniki uczestników walk narodowowyzwoleńczych na południowo-wschodnim obszarze dawnego województwa tarnopolskiego

Artykuł obejmuje analizę nagrobków w województwie tarnopolskim (Ukraina), które oznaczają miejsca pochówku uczestników polskich bitew niepodległościowych i wojen w XX wieku. Ich identyfikacja była możliwa dzięki pracom inwentaryzatorskim prowadzonym przez Instytut Historii Sztuki Uniwersytetu Kardynała Stefana Wyszyńskiego w Warszawie. Pomimo swojej typowej formy, znaczenie omawianych zabytków leży w ich związku z historią Polski. The article covers the analysis of tombstones in the Ternopil voivodeship (Ukraine) which mark the burial places of participants in Polish independence battles and wars in the 20th century. Their identification was possible thanks to inventory work carried out by the Institute of Art History of Cardinal Stefan Wyszynski University in Warsaw. Despite their typical form, the significance of the monuments discussed lies in their connections with the history of Poland.