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  1. Article ; Online: Two-dimensional ultrasound results in underestimation of the ovarian follicle size compared to automated three-dimensional imaging in women undergoing IVF.

    Kyprianou, Miltiades A / Dakou, Konstantina / Lainas, George T / Xenariou, Marianna / Makris, Andreas / Lainas, Tryfon G

    Journal of ultrasound

    2023  

    Abstract: Background: Traditionally, for the assessment of follicle growth during IVF, two-dimensional (2D) transvaginal ultrasound (US) is used. In the past few years three-dimensional (3D) US has also been introduced.: Objectives: To compare follicular sizes ...

    Abstract Background: Traditionally, for the assessment of follicle growth during IVF, two-dimensional (2D) transvaginal ultrasound (US) is used. In the past few years three-dimensional (3D) US has also been introduced.
    Objectives: To compare follicular sizes between 2 and 3D ultrasound imaging on the final day of controlled ovarian stimulation.
    Methods: A prospective observational cohort study including 121 women undergoing controlled ovarian stimulation (COS) between January 2017 and July 2018. All women were assessed by transvaginal 2D and 3D ultrasonography to measure ovarian follicle dimensions on the final day of COS.
    Results: The mean difference in paired comparisons between the 3D and 2D US measurements in 25 women with monofollicular development was + 1.6 ± 2.5 mm for the x-dimension and + 1.7 ± 2.4 mm for the y-dimension; and in the total number of 1197 paired measurements of follicles the mean difference + 2.1 ± 3.3 mm and + 1.8 ± 3.9 mm for the x- and y-dimension respectively. In all cases the paired t-test showed that differences were statistically significant (p < 0.01). Further it was conjectured that the 2D underestimation results from the inherent difficulty to precisely place the US probe simultaneously on the perpendicular maximal of the x and y follicle diameters, leading to measurement errors that, by theory, are normally distributed. Running Monte-Carlo simulations based on these measurement errors it was found that both the mean difference and standard deviation are of the same magnitude as the ones found in real measurements, thus proving the conjecture.
    Conclusions: The utilisation of 3D US results in different measurements of the follicular dimensions, and volumes, when compared to conventional 2D US. The differences in the x- and y-dimensions may affect the outcome of an IVF cycle as they are used to define the day of triggering final oocyte maturation, which is associated with the yield of mature oocytes and the probability of live birth.
    Language English
    Publishing date 2023-06-23
    Publishing country Italy
    Document type Journal Article
    ZDB-ID 2365426-0
    ISSN 1876-7931 ; 1971-3495
    ISSN (online) 1876-7931
    ISSN 1971-3495
    DOI 10.1007/s40477-023-00797-1
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: qSOFA combined with suPAR for early risk detection and guidance of antibiotic treatment in the emergency department: a randomized controlled trial.

    Adami, Maria Evangelia / Kotsaki, Antigone / Antonakos, Nikolaos / Giannitsioti, Efthymia / Chalvatzis, Stamatios / Saridaki, Maria / Avgoustou, Christina / Akinosoglou, Karolina / Dakou, Konstantina / Damoraki, Georgia / Katrini, Konstantina / Koufargyris, Panagiotis / Lekakis, Vasileios / Panagaki, Antonia / Safarika, Asimina / Eugen-Olsen, Jesper / Giamarellos-Bourboulis, Evangelos J

    Critical care (London, England)

    2024  Volume 28, Issue 1, Page(s) 42

    Abstract: Background: Sepsis guidelines suggest immediate start of resuscitation for patients with quick Sequential Organ Failure Assessment (qSOFA) 2 or 3. However, the interpretation of qSOFA 1 remains controversial. We investigated whether measurements of ... ...

    Abstract Background: Sepsis guidelines suggest immediate start of resuscitation for patients with quick Sequential Organ Failure Assessment (qSOFA) 2 or 3. However, the interpretation of qSOFA 1 remains controversial. We investigated whether measurements of soluble urokinase plasminogen activator receptor (suPAR) may improve risk detection when qSOFA is 1.
    Methods: The study had two parts. At the first part, the combination of suPAR with qSOFA was analyzed in a prospective cohort for early risk detection. At the second part, the double-blind, randomized controlled trial (RCT) SUPERIOR evaluated the efficacy of the suPAR-guided medical intervention. SUPERIOR took place between November 2018 and December 2020. Multivariate stepwise Cox regression was used for the prospective cohort, while univariate and multivariate logistic regression was used for the RCT. Consecutive admissions at the emergency department (ED) with suspected infection, qSOFA 1 and suPAR ≥ 12 ng/mL were allocated to single infusion of placebo or meropenem. The primary endpoint was early deterioration, defined as at least one-point increase of admission Sequential Organ Failure Assessment (SOFA) score the first 24 h.
    Results: Most of the mortality risk was for patients with qSOFA 2 and 3. Taking the hazard ratio (HR) for death of patients with qSOFA = 1 and suPAR < 12 ng/mL as reference, the HR of qSOFA = 1 and suPAR ≥ 12 ng/mL for 28-day mortality was 2.98 (95% CI 2.11-3.96). The prospective RCT was prematurely ended due to pandemia-related ED re-allocations, with 91 patients enrolled: 47 in the placebo and 44 in the meropenem arm. The primary endpoint was met in 40.4% (n = 19) and 15.9% (n = 7), respectively (difference 24.5% [5.9-40.8]; odds ratio 0.14 [0.04-0.50]). One post hoc analysis showed significant median changes of SOFA score after 72 and 96 h equal to 0 and - 1, respectively.
    Conclusions: Combining qSOFA 1 with the biomarker suPAR improves its prognostic performance for unfavorable outcome and can help decision for earlier treatment. Trial registration EU Clinical Trials Register (EudraCT, 2018-001008-13) and Clinical-Trials.gov (NCT03717350). Registered 24 October 2018.
    MeSH term(s) Humans ; Organ Dysfunction Scores ; Receptors, Urokinase Plasminogen Activator ; Meropenem ; Sepsis ; Prognosis ; Anti-Bacterial Agents ; Emergency Service, Hospital ; Hospital Mortality ; ROC Curve ; Retrospective Studies
    Chemical Substances Receptors, Urokinase Plasminogen Activator ; Meropenem (FV9J3JU8B1) ; Anti-Bacterial Agents
    Language English
    Publishing date 2024-02-06
    Publishing country England
    Document type Randomized Controlled Trial ; Journal Article
    ZDB-ID 2041406-7
    ISSN 1466-609X ; 1364-8535
    ISSN (online) 1466-609X
    ISSN 1364-8535
    DOI 10.1186/s13054-024-04825-2
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 5517: Show issues Location:
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  3. Article ; Online: Macrolides for better resolution of community-acquired pneumonia: A global meta-analysis of clinical outcomes with focus on microbial aetiology.

    Kyprianou, Miltiades / Dakou, Konstantina / Aktar, Aftab / Aouina, Hichem / Behbehani, Naser / Dheda, Keertan / Juvelekian, Georges / Khattab, Adel / Mahboub, Bassam / Nyale, George / Oraby, Sayed / Sayiner, Abdullah / Shibl, Atef / El Deen, Mohamed Awad Tag / Unal, Serhat / Zubairi, Ali Bin Sarwar / Davidson, Ross / Giamarellos-Bourboulis, Evangelos J

    International journal of antimicrobial agents

    2023  Volume 62, Issue 4, Page(s) 106942

    Abstract: Objectives: This meta-analysis examined the effect of macrolides on resolution of community-acquired pneumonia (CAP) and interpretation of clinical benefit according to microbiology; emphasis is given to data under-reported countries (URCs).: Methods!# ...

    Abstract Objectives: This meta-analysis examined the effect of macrolides on resolution of community-acquired pneumonia (CAP) and interpretation of clinical benefit according to microbiology; emphasis is given to data under-reported countries (URCs).
    Methods: This meta-analysis included 47 publications published between 1994 and 2022. Publications were analysed for 30-d mortality (58 759 patients) and resolution of CAP (6465 patients). A separate meta-analysis was done for the prevalence of respiratory pathogens in URCs.
    Results: Mortality after 30 d was reduced by the addition of macrolides (odds ratio [OR] 0.65, 95% confidence interval [CI] 0.51-0.82). The OR for CAP resolution when macrolides were added to the treatment regimen was 1.23 (95% CI 1.00-1.52). In the CAP resolution analysis, the most prevalent pathogen was Streptococcus pneumoniae (12.68%; 95% CI 9.36-16.95%). Analysis of the pathogen epidemiology from the URCs included 12 publications. The most prevalent pathogens were S. pneumoniae (24.91%) and Klebsiella pneumoniae (12.90%).
    Conclusion: The addition of macrolides to the treatment regimen led to 35% relative decrease of 30-d mortality and to 23% relative increase in resolution of CAP.
    MeSH term(s) Humans ; Macrolides/therapeutic use ; Macrolides/pharmacology ; Anti-Bacterial Agents/therapeutic use ; Anti-Bacterial Agents/pharmacology ; Pneumonia/drug therapy ; Streptococcus pneumoniae ; Klebsiella pneumoniae ; Community-Acquired Infections/microbiology
    Chemical Substances Macrolides ; Anti-Bacterial Agents
    Language English
    Publishing date 2023-08-03
    Publishing country Netherlands
    Document type Meta-Analysis ; Journal Article
    ZDB-ID 1093977-5
    ISSN 1872-7913 ; 0924-8579
    ISSN (online) 1872-7913
    ISSN 0924-8579
    DOI 10.1016/j.ijantimicag.2023.106942
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    Zs.A 3368: Show issues Location:
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  4. Article ; Online: Macrolides for better resolution of community-acquired pneumonia: A global meta-analysis of clinical outcomes with focus on microbial etiology

    Kyprianou, Miltiades / Dakou, Konstantina / Aktar, Aftab / Aouina, Hichem / Behbehani, Naser / Dheda, Keertan / Juvelekian, Georges / Khattab, Adel / Mahboub, Bassam / Nyale, George / Oraby, Sayed / Sayiner, Abdullah / Shibl, Atef / Deen, Mohamed Awad Tag El / Unal, Serhat / Zubairi, Ali Bin Sarwar / Davidson, Ross / Giamarellos-Bourboulis, Evangelos J.

    International Journal of Antimicrobial Agents. 2023 Aug. 03, p.106942-

    2023  , Page(s) 106942–

    Abstract: This meta-analysis examined the impact of macrolides on resolution of CAP and interpretation of clinical benefit according to microbiology; emphasis is given to data under-reported countries (URCs). This meta-analysis included 63 publications published ... ...

    Abstract This meta-analysis examined the impact of macrolides on resolution of CAP and interpretation of clinical benefit according to microbiology; emphasis is given to data under-reported countries (URCs). This meta-analysis included 63 publications published between 1994 and 2022. Publications were analyzed for resolution of CAP (6,465 patients) and 30-day mortality (58,759 patients). A separate meta-analysis was done for the prevalence of respiratory pathogens in URCs. Mortality after 30 days was reduced by the addition of macrolides (OR 0.65, 95% CI 0.51–0.82). The odds ratio (OR) of CAP resolution when macrolides were added to the treatment regimen was 1.23 (95% confidence interval [CI] 1.00-1.52). The most prevalent pathogen was Streptococcus pneumoniae (12.68%; 95% CI 9.36-16.95%). Analysis of the epidemiology from the URCs included 12 publications. The most prevalent pathogens were S. pneumoniae (24.91%) and Klebsiella pneumoniae (12.90%). The addition of macrolides to the treatment regimen led to relative 35% decrease of 30-day mortality and to 23% relative increase resolution of CAP. PROSPERO; number CRD42022325280.
    Keywords Klebsiella pneumoniae ; Streptococcus pneumoniae ; confidence interval ; epidemiology ; macrolides ; meta-analysis ; microbiology ; mortality ; odds ratio ; pathogens ; pneumonia ; Community-acquired pneumonia ; under-reported countries
    Language English
    Dates of publication 2023-0803
    Publishing place Elsevier Ltd
    Document type Article ; Online
    Note Pre-press version
    ZDB-ID 1093977-5
    ISSN 1872-7913 ; 0924-8579
    ISSN (online) 1872-7913
    ISSN 0924-8579
    DOI 10.1016/j.ijantimicag.2023.106942
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  5. Article ; Online: Clarithromycin for early anti-inflammatory responses in community-acquired pneumonia in Greece (ACCESS): a randomised, double-blind, placebo-controlled trial.

    Giamarellos-Bourboulis, Evangelos J / Siampanos, Athanasios / Bolanou, Amalia / Doulou, Sarantia / Kakavoulis, Nikolaos / Tsiakos, Konstantinos / Katopodis, Sokratis / Schinas, Georgios / Skorda, Lamprini / Alexiou, Zoi / Armenis, Konstantinos / Katsaounou, Paraskevi / Chrysos, George / Masgala, Aikaterini / Poulakou, Garyphalia / Antonakos, Nikolaos / Safarika, Asimina / Kyprianou, Miltiades / Dakou, Konstantina /
    Gerakari, Styliani / Papanikolaou, Ilias C / Milionis, Haralampos / Marangos, Markos / Dalekos, George N / Tzavara, Vasiliki / Akinosoglou, Karolina / Hatziaggelaki, Eryfilli / Sympardi, Styliani / Kontopoulou, Theano / Mouktaroudi, Maria / Papadopoulos, Antonios / Niederman, Michael S

    The Lancet. Respiratory medicine

    2024  Volume 12, Issue 4, Page(s) 294–304

    Abstract: Background: Addition of macrolide antibiotics to β-lactam antibiotics for the treatment of patients in hospital with community-acquired pneumonia is based on results from observational studies and meta-analyses rather than randomised clinical trials. We ...

    Abstract Background: Addition of macrolide antibiotics to β-lactam antibiotics for the treatment of patients in hospital with community-acquired pneumonia is based on results from observational studies and meta-analyses rather than randomised clinical trials. We investigated if addition of the macrolide clarithromycin to treatment with a β-lactam antibiotic in this population could improve early clinical response-the new regulatory endpoint for community-acquired pneumonia-and explored the possible contribution of modulation of the inflammatory host response to that outcome.
    Methods: The ACCESS trial was a phase 3 prospective, double-blind, randomised controlled trial, in which adults in hospital with community-acquired pneumonia who had systemic inflammatory response syndrome, Sequential Organ Failure Assessment (SOFA) score of 2 or more, and procalcitonin 0·25 ng/mL or more were enrolled in 18 internal medicine departments of public Greek hospitals. Patients were randomly assigned (1:1) by computer-generated block randomisation to standard of care medication (including intravenous administration of a third-generation cephalosporin or intravenous administration of β-lactam plus β-lactamase inhibitor combination) plus either oral placebo or oral clarithromycin 500 mg twice daily for 7 days. Investigators, staff, and patients were masked to group allocation. The primary composite endpoint required that patients fulfilled both of the following conditions after 72 hours (ie, day 4 of treatment): (1) decrease in respiratory symptom severity score of 50% or more as an indicator of early clinical response and (2) decrease in SOFA score of at least 30% or favourable procalcitonin kinetics (defined as ≥80% decrease from baseline or procalcitonin <0·25 ng/mL), or both, as an indicator of early inflammatory response. Participants who were randomly assigned and received allocated treatment were included in the primary analysis population. This trial is complete and is registered with the EU Clinical Trials Register (2020-004452-15) and ClinicalTrials.gov (NCT04724044).
    Findings: Patients were enrolled between Jan 25, 2021, and April 11, 2023, and 278 individuals were randomly allocated to receive standard of care in combination with either clarithromycin (n=139) or placebo (n=139). 134 patients in the clarithromycin group (five withdrew consent) and 133 patients in the placebo group (six withdrew consent) were included in the analysis of the primary endpoint. The primary endpoint was met in 91 (68%) patients in the clarithromycin group and 51 (38%) patients in the placebo group (difference 29·6% [95% CI 17·7-40·3]; odds ratio [OR] 3·40 [95% CI 2·06-5·63]; p<0·0001). Serious treatment-emergent adverse events (TEAEs) occurred in 58 (43%) patients in the clarithromycin group and 70 (53%) patients in the placebo group (difference 9·4% [95% CI -2·6 to 20·9]; OR 0·67 [95% CI 0·42 to 1·11]; p=0·14). None of the serious TEAEs was judged to be related to treatment assignment.
    Interpretation: Addition of clarithromycin to standard of care enhances early clinical response and attenuates the inflammatory burden of community-acquired pneumonia. The mechanism of benefit is associated with changes in the immune response. These findings suggest the importance of adding clarithromycin to β-lactams for treatment of patients in hospital with community-acquired pneumonia to achieve early clinical response and early decrease of the inflammatory burden.
    Funding: Hellenic Institute for the Study of Sepsis and Abbott Products Operations.
    MeSH term(s) Adult ; Humans ; Clarithromycin/therapeutic use ; Greece ; Prospective Studies ; Procalcitonin ; Pneumonia/drug therapy ; Anti-Bacterial Agents ; Anti-Inflammatory Agents ; Double-Blind Method ; Treatment Outcome
    Chemical Substances Clarithromycin (H1250JIK0A) ; Procalcitonin ; Anti-Bacterial Agents ; Anti-Inflammatory Agents
    Language English
    Publishing date 2024-01-03
    Publishing country England
    Document type Randomized Controlled Trial ; Clinical Trial, Phase III ; Journal Article
    ZDB-ID 2686754-0
    ISSN 2213-2619 ; 2213-2600
    ISSN (online) 2213-2619
    ISSN 2213-2600
    DOI 10.1016/S2213-2600(23)00412-5
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 7041: Show issues Location:
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